This study employs the entropy method，coupling coordination degree model，and grey relation analysis to conduct an empirical analysis of the comprehensive development level，coupling coordination status， and driving factors of the“medical-insurance-medicine linkage”system in the Yangtze River Delta region from 2016 to 2022. The results indicate that from 2016 to 2022，the overall development of this system in the Yangtze River Delta region improved，but remained unbalanced characteristics. The coupling coordination degree showed an overall upward trend，increasing from 0.580 to 0.680，progressing from“barely coordinated” to“primarily coordinated”. However，substantial inter - provincial disparities were observed，presenting a stepwise distribution pattern of Zhejiang ＞ Jiangsu ＞ Yangtze River Delta region mean ＞ Anhui ＞ Shanghai Municipality. The efficiency of medical services and the scale of the pharmaceutical industry were identified as key factors to promote the coordinated development of the“medical-insurance-medicine linkage”system，with grey relational degrees of 0.873 and 0.807，respectively. Based on these findings，it is vital to promote balanced and synchronous development of the“medical -insurance -medicine linkage”system，eliminate policy barriers， adopt tailored development paths according to local conditions， and establish a dual driving mechanism focusing on efficiency and scale to foster the coordinated development of the“medical -insurance - medicine linkage”system in the Yangtze River Delta region.