Objective: This study conducted a survey of the status of medicine adoption and appropriate use in hospitals. We compared the findings with 2015 survey results to evaluate the changes over time. We also evaluated the impact of changes in the current health care environment, including local community collaboration and the COVID-19 pandemic.Methods: The survey included 500 randomly selected hospitals with more than 200 beds, over 50% of which are general ward beds, as well as 175 hospitals that were randomly selected from the respondents of the 2015 survey. The survey questionnaire included the number of medicines, availability of medication lists, adoption decisions, and impacts of local collaboration efforts and the COVID-19 pandemic on drug adoption and appropriate use.Results: A total of 260 responses were collected from 675 hospitals (39% response rate). Of the 260 respondents, 90 were regional medical care support hospitals, 23 were special functioning hospitals, 143 were general hospitals other than those specified, and 4 were other hospital types. The average number of adopted medicines was 644 for oral medicines, 234 for topical medicines, and 228 for injectable medicines. Ninety-five percent of the hospitals used package inserts or interview forms when adopting medicines, but 15% used original articles. About 36% of the hospitals used standardized methods (hospital formulary management or protocol-based pharmacotherapy management), indicating a lack of pharmacists with pharmaceutical evaluation skills. As for local community collaboration regarding adopted medicines, the most common example was providing information to community pharmacists’ associations, and the most common method was sending information by e-mail, regardless of the hospital type. Regional collaboration meetings were few. The COVID-19 pandemic changed the method of obtaining drug information from pharmaceutical companies.Conclusion: For hospital pharmacists, the selection of adopted medicines is one of the tasks of pharmaceutical management. There are urgent needs for the use of standardized methods and the training of pharmacists involved in the selection of adopted medicines. The establishment of a system to provide appropriate use of medicine to patients by standardizing the method of medicine adoption and information sharing is desirable.