Purpose/Significance To investigate and analyze typical cases of open access transformation, and to explore effective paths for open access transformation in medical libraries in China based on international cases. Method/Process The contents of international open access transformation case agreements are analyzed, their transformation processes and effects are dissected, and the characteristics and effective experiences of open access transformation are summarized. Result/Conclusion To effectively engage in open access transformation collaborations, medical libraries in China should prepare comprehensively and strategically prior to agreement negotiations, which includes conducting in-depth analysis and research on the needs of institutional users, selecting suitable transformation models, establishing evidence-based knowledge-sharing frameworks and open resource construction plans, and refining strategic approaches to accelerate the advancement of open access in China.