Currently, analyzing pharmaceuticals and biomarkers is crucial for ensuring medication safety and protecting life and health, and there is an urgent need to develop new and efficient analytical techniques in view of the limitations of traditional analytical methods. Molecularly imprinted ratiometric fluorescent (MI-RFL) sensors have received increasing attention in the field of analytical detection due to their high selectivity, sensitivity and anti-interference ability, short response time, and visualization. This review summarizes the recent advances of MI-RFL sensors in the field of pharmaceuticals and biomarkers detection. Firstly, the fluorescence sources and working mechanisms of MI-RFL sensors are briefly introduced. On this basis, new techniques and strategies for preparing molecularly imprinted polymers, such as dummy template imprinting, nanoimprinting, multi-template imprinting, and stimulus-responsive imprinting strategies, are presented. Then, dual- and triple-emission types of fluorescent sensors are introduced. Subsequently, specific applications of MI-RFL sensors in pharmaceutical analysis and biomarkers detection are highlighted. In addition, innovative applications of MI-RFL sensors in point-of-care testing are discussed in-depth. Finally, the challenges of MI-RFL sensors for analysis of pharmaceuticals and biomarkers are proposed, and the research outlook and development trends of MI-RFL sensors are prospected.