Background Few studies have evaluated the medication burden borne by survivors of pediatric cancer. This study aimed to describe the drug utilization pattern of chronic medications in a cohort of young pediatric cancer survivors. Methods This was a population-based study of patients diagnosed with cancer at aged ≤18 years between 2000 and 2013 in Hong Kong, and had survived ≥5 years post-diagnosis. The primary outcome is the use of any chronic medication (medications that were prescribed for ≥30 consecutive days within a 6-month period). Multivariable log-binomial models were used to identify factors associated with chronic medication use. Kaplan-Meier analysis was used to present the cumulative proportion of survivors initiated on a chronic medication across time from cancer diagnosis. Results Of the 2,444 survivors (median age = 22 years, IQR = 16–27 years), 669 (27.4%) required ≥1 chronic medication at ≥ 5 years post-diagnosis. Survivors who developed a chronic health condition (CHC) had a 5.48 (95% CI 4.49–6.71) times higher risk of taking a chronic medication than those without CHC. At 10 years post-diagnosis, the cumulative proportion of survivors being initiated a chronic medication was 33.4% (95% CI 31.1–35.6%) for the overall cohort. Higher cumulative proportions were observed in survivors with endocrine (74.6%, 95% CI 68.4–79.6%), renal (68.8%, 95% CI 54.2–78.7%), neurological (58.6%, 95% CI 46.1–68.1%) and cardiovascular (54.7%, 95% CI 44.0–63.4%) disorders. Conclusion Survivors with certain CHCs had a higher risk of starting a prescription medication early phase of survivorship. Future studies include examining the impact of medication burden on survivors’ functional status.