As the upstream core link of pharmaceutical production, the market monopoly issue of active pharmaceutical ingredients (API) has become a governance challenge in the healthcare industry. This paper analyzes the causes of monopoly from macro system, middle market structure, micro enterprise behavior based on the current landscape of China's API market, proposing governance strategies informed by domestic practice. The study revealed that high market entry barriers and deficient competition mechanisms constitute primary drivers of recurring monopolies, necessitating multidimensional solutions including sound construction of regulatory system, optimized centralized procurement policies, enhanced coordination between different departments, and strengthened industry self-discipline to achieve breakthroughs in governance.