Establishing essential medicine policy (EMP) is one of 5 health system reform pillars in China in 2009. After three-year implementation, the strengthens and weaknesses of EMP need to be monitoring and evaluation. OBJECTIVES:  The paper reviews the process of listing, pricing, purchasing, utilization and reimbursement of essential medicines and discusses the achievements and issues of EMP. METHODS: The EMLs are collected and compared from 31 provinces; the indictors of EDP are evaluated before and after implementation. RESULTS: Although national EDL only contains 307 essential medicines, the number of added EMs in provincial EDL are various from 64 through 455. The zero-markup policy of EDs conducted in public grass-roots health facilities (urban community health centers and rural township hospitals) have reached to 98.8%. More than 95% EDs can be reimbursement by medical insurance schemes. The average percentage of price cutting was 25%-50% after tender bidding and purchasing. Quality assurance and sufficient provision of ED became a problem. The number of essential medicines is still not meet the needs of outpatients so that patients flow back to the secondary and tertiary hospitals, the financial subsidies from government usually are not supported timely. Along with the expansion of EDP in village health posts and hospitals, how to incentive and maintain the income level of health professionals have to be considered. CONCLUSIONS: To promote the EMP, the adjustment of EDL is required in 2012. The criteria of selection on essential medicines in provincial level should be unified. The implementation of EMP will not be successful in village and urban hospital level until solving the problem of remuneration and payment system in health settings.