Objective: The paper analyzes the problems in the implementation of medical security policies in designated retail pharmacies and proposes improvement measures to provide a reference for standardizing the management of designated retail pharmacies. Method: Based on the special inspection results of 180 designated retail pharmacies in a district of Tongling City, Anhui Province from 2023 to 2024, the paper summarizes and analyzes the problems in the management of designated retail pharmacies. Results: Among the 180 designated retail pharmacies, the medical insurance administrative department punished 63 times (35.0%), held 78 regulatory talks (43.3%) and transferred 29 times (16.1%) to the market supervision department. Common illegal and irregular behaviors included licensed pharmacists or pharmaceutical professionals who were not on duty selling prescription drugs or selling prescription drugs without a physician's prescription (16.1%), inconsistent details of the computer sales system and the medical insurance card system (11.1%) and inconsistent inventory quantities of drugs in computer systems (8.3%). Compared with the years of 2023, the incidence of various illegal and irregular behaviors in 2024 was basically similar. Conclusions: There are still many illegal and irregular issues in the implementation of medical insurance policies by designated retail pharmacies. Laws should be enforced strictly to comprehensively ensure the safety of medical insurance funds, education and awareness of corporate responsibility should be strengthened and collaborative governance should be implemented to continuously improve the quality and efficiency of regulatory work.