The current heavy disease burden in China, coupled with limited medical insurance coverage, has made pharmaceutical charitable assistance a crucial supplement to the multi-level medical security system. This paper systematically reviews the development and typical models of pharmaceutical patient assistance programs (PAPs) globally. Building on analyses of international experiences such as the U.S. multi-product bundled assistance, patient support under the UK's NHS system, Germany’s co-payment assistance, and Australia’s universal pharmaceutical benefits scheme (PBS), it summarizes the implementation characteristics of China’s three prevailing models: co-assistance, financial aid, and free drugs. The paper further examines the blurred boundaries between charitable intent and marketing objectives in domestic drug donations, revealing deep-seated contradictions at both institutional and operational levels. Finally, it proposes collaborative philanthropy as an innovative path for collaborative governance. By promoting multi-source donations, establishing a centralized drug pool, and strengthening enabling policies, the approach aims to enhance drug accessibility and strengthen the public welfare attributes of such programs, thus offering a theoretical reference for optimizing China’s pharmaceutical charity system.