Objective To explore the application effect of risk grading management of near expiry drugs in Western medicine warehouses based on ABC-VED classification method. Method A historical controlled study was conducted, using 400 nearly effective drugs from the Western Medicine Library of Anhui Children""s Hospital from January 2023 to December 2023 as the control group, and implementing routine management. From January 2024 to December 2024, 400 nearly effective drugs from the same warehouse were used as the observation group to implement risk classification management based on the ABC-VED classification method. The quality of management, satisfaction with cross departmental communication and collaboration, cost-effectiveness, and special management of children""s drugs in the near term were compared between two groups. Results The accuracy of system control, the effectiveness of sales reminders, the standardization of storage and maintenance, and the compliance of outbound adjustment were all higher in the observation group than in the control group (all P＜0.05). The observation group scored higher than the control group in terms of information transmission fluency, response timeliness, and problem-solving efficiency (all P＜0.05). The overall near expiry drug loss rate, monthly average labor control cost, and monthly average control hours in the observation group were lower than those in the control group (all P＜ 0.05). The timely registration rate and priority disposal rate of of children""s near-expiry drugs in the observation group were higher than those in the control group (all P＜0.05). Conclusion The risk classification management of near expiry drugs in the Western medicine library based on the ABC-VED classification method can effectively improve the quality of near expiry drug management, cross departmental collaboration efficiency, reduce drug losses and control costs, and improve the timely registration and priority disposal rate of near expiry drugs for children.