Modified starch is widely used in pharmaceutical and biomedical sciences. Various modifications such as functionalization, reorganization of the structure, or depolymerization may be used to tune ionicity, hydrophilicity, mucoadhesion, susceptibility to amylolysis by α‐amylase, or porosity. These chemical, physical, or enzymatic modifications modulate and adapt the properties of starches to different usages as tablet excipients, drug carriers, transdermal patches, injectables, wound dressing materials, transient embolizants, scaffolds, and stents. Through an understanding of the starch structure, this Review aims to aid the design of new starch materials for biomedical and pharmaceutical applications. The correlation between structure and properties is analyzed and various phenomena are discussed from this perspective, with particular eye toward the envisaged functionality of new starch‐based materials.