Objective: From the perspective of modernized medical insurance governance, this study explores the hierarchical governance pathways and collaborative mechanisms of financial support in national and inter-provincial alliance drug centralized procurement. Methods: Based on the theories of governance system modernization and collaborative governance, combined with transaction cost and institutional economics analytical approaches, the theoretical logic of centralized procurement and financial instrument synergy is elucidated, while differences in financial needs, risk attributes, and governance tools between the national and provincial levels are analyzed. Results: After centralized procurement enters the normalized stage, there is room for refinement in national financial infrastructure, regional risk-sharing mechanisms, and cross-departmental policy coordination. Traditional administrative measures struggle to meet the financing and supply guarantee needs of selected enterprises. Quantitative analysis reveals that the average financing demand of enterprises selected in national centralized procurement is approximately 6 to 7 times that of inter-provincial alliance enterprises, with significant financing cost disparities (200~300 basis points). Provincial risk compensation funds exhibit relatively limited coverage. Conclusion: The study establishes a dual-layer governance system integrating national credit information platforms with policy-based financial support, supplemented by provincial risk compensation funds and local financial collaboration, while designing phased implementation pathways for the near, medium, and long-term to provide theoretical support for the long-term operation of centralized drug procurement and the modernization of medical insurance governance.