Background <p>Designated medical insurance pharmacies serve as a supplement to primary healthcare resources and are vital for promoting drug accessibility in China. This study investigates their spatial accessibility and equity under walking mode, with a focus on exploring the feasibility of resource allocation policies.</p> Methods <p>Seven administrative provinces (Shanghai, Shandong, Chongqing, Liaoning, Shaanxi, Heilongjiang, and Tibet) were selected as research subjects based on population density. Ga2SFCA was employed to measure the spatial accessibility of designated medical insurance pharmacies. The Lorenz curve and Gini coefficient were applied to assess the distribution equity of these pharmacies.</p> Results <p>Designated medical insurance pharmacies are usually distributed in densely populated areas. Shandong has the highest coverage rate of such pharmacies at 78%, while Chongqing has the largest share of areas with high accessibility at 16%. Chongqing achieved the highest accessibility score of 0.117597. The Gini coefficients for these pharmacies were consistently high across provinces, with Shanghai showing a relatively lower value 0.58.</p> Conclusions <p>The accessibility and equity of designated medical insurance pharmacies is associated with demographic, transportation, and socioeconomic factors. A rigid, one-size-fits-all implementation of the 15-minute standard may risk leading to resource redundancy. Differentiated resource allocation policies should be adopted based on regional characteristics. Areas with excessive pharmacy clustering and insufficient pharmacy coverage should be identified and publicly disclosed.</p>