ObjectiveTo systematically review and compare global pharmaceutical regional pooled procurement mechanisms, with the aim of generating evidence to inform decision-making in optimization of medicines regional pooled procurement. MethodsComprehensively search published literature about pharmaceutical regional pooled procurement mechanisms from the inception of each database to the end of 2025 from CNKI, Web of Science, PubMed, Embase and Scopus. Characteristics of the targeted mechanisms were extracted from the included literature. Supplementary information was obtained from official websites of the referenced pharmaceutical regional pooled procurement mechanisms, related international organizations and major media platforms. The compiled information was then categorized for comparative analysis. ResultsA total of 74 literature were included in the analysis, which identified 15 pharmaceutical regional pooled procurement mechanisms. Geographically, the literature predominantly focused on Europe (n=39) and the Americas (n=31). Among these, the Joint Procurement Agreement of the European Union (n=30) and the Revolving Fund of the Pan American Health Organization (n=26) were studied the most. All continents established pharmaceutical regional pooled procurement mechanisms. The majority of these mechanisms (n=10, 66.7%) remain operational. The scope of procured medical products ranged from essential medicines and vaccines to expensive novel medicines, which closely aligns with the regional economic development. To secure operation and management, most of these mechanisms levy an administrative fee on the member states. ConclusionTo ensure the sustainability of the pharmaceutical regional pooled procurement, it is essential to foster stronger regional identity and solidarity, leverage economies of scale, ensure greater transparency, establish stable funding mechanisms, and strengthen technological capacity for accurate forecasting, monitoring and evaluation of the supply and demand.