OBJECTIVE： To find out the view of “Two-invoice System” policy in pharmaceutical distribution enterprises （called “enterprises” for short） and provide reference for strengthening their adaptability. METHODS： Totally 15 pharmaceutical enterprises in Jiangsu province were entrusted to issue questionnaires to their nationwide subsidiaries. The questionnaire survey about the effects of “two-invoice system” on pharmaceutical distribution enterprises was conducted among domestic large-scale enterprises， medium and small-scale enterprises. The questionnaire covered the views on the policy of “two-invoice system”， the effects of “two-invoice system” on different scales of enterprises （including finance， marketing， operation and other aspects）， the views on “policy will lead transformation of medium and small-scale distribution enterprises due to difficult survival”， the views on the decrease of drug price after the implementation of “two-invoice system”. The results of surveyed enterprises were analyzed to put forward suggestions for different scales of enterprises. RESULTS： A total of 141 questionnaires were sent out， and 141 questionnaires were collected with recovery rate of 100％. Among them， there were 124 valid questionnaires （83 questionnaires from large-scale enterprises， 41 from medium and small-scale enterprises） with effective rate of 87.94％. 114 people expressed “support” and “very support”to the “two-invoice system” （91.94％）. Among large-scale enterprise managers， 49 people expressed “very support”（59.04％）； 28 expressed “support”（33.73％）； 6 people expressed “general”（7.23％）. Among medium and small-scale enterprise managers， 12， 25 and 4 people expressed above 3 kinds of attitude respectively （29.27％， 60.89％， 9.76％， χ2＝181.036， P＝0.007）. 45 large-scale enterprise managers believed that the implementation of policy would influence “finance” （54.22％）； 31 medium and small-scale enterprise managers also hold same opinion （75.61％） （P＜0.05）； there was no statistical significance in marketing， operation and other aspects between two scales enterprises （P＞0.05）. Among views on “policy will lead transformation of medium and small-scale distribution enterprises due to difficult survival”， 11， 61 and 11 people hold the opinion of “fully agreement”， “agreement”， “neutrality” in large-scale enterprises （13.25％， 73.49％， 13.25％）； 12， 20， 9 people hold the opinion of “fully agreement”， “agreement”， “disagreement” in medium and small-scale enterprises （29.27％， 48.78％， 21.95％） respectively （χ2＝101.451，P＝0.004）. ?Among views on the decrease of drug price after the implementation of “two-invoice system”， 12， 27， 30 and 12 people hold the opinion of “fully agreement”， “agreement”， “disagreement” in large-scale enterprises （14.46％， 32.53％， 36.14％， 14.46％）； 1， 26， 10， 2 people hold the opinion of “fully agreement”， “agreement”， “neutrality”， “disagreement”in medium and small-scale enterprises （2.44％， 63.41％， 24.39％， 4.88％） respectively （χ2＝106.352，P＝0.008）. CONCLUSIONS： Enterprises generally support the “two-invoice system”； the larger the scale of enterprises， the higher the degree of support. The policy mainly influences financial settlement of the enterprise； the smaller the scale of enterprises， the higher the degree of impact. “Two-invoice” will lead transformation of medium and small-scale distribution enterprises due to difficult survival； the policy will lead the price decrease of some drugs. For large-scale enterprises， it is suggested to increase purchasing power， establish logistics management and control platform， reform financial system and simplify the procedure of checking tickets. For medium and small-scale enterprises， it is suggested to establish three party logistics alliance， enhance comprehensive strength， actively promote transformation， and provide medical supporting services.