The purpose of this study is to portray the mathematical literacy profile of pharmacy students in vocational high schools based on the solving of drug dosage calculation problem according to the PISA 2022 perspective. The research design used in this study was qualitative case study in which there were two eleventh-grade female students in SMK Kesehatan Mulia Husada with high and equivalent mathematical ability proven by their scores in the Mathematical Ability Test. The data were gathered through a Mathematical Ability Test, Mathematical Literacy Tasks, the work of the students, and clinical interviews through the think-aloud technique. The analysis was conducted based on the three mathematical literacy processes described in the PISA 2022 framework including formulating, employing, and interpreting and evaluating. The results showed that both students have good mathematical literacy competence in drug dosage calculation. First, in the formulating process, both students could find out the relevant clinical information, choose appropriate mathematical models, and explain the usage of Clark’s formula and Body Surface Area. Second, in the employing process, both students could apply proportionally reasoning, do formula substitution, conversion units of measurement, and calculate dosages-volumes as well as self-correct themselves in case of mistakes. Third, in the interpreting and evaluating process, both students explained the interpretation of the numerical answers in terms of dosages’ safety and reasoned the choice of rounding up/rounding down by taking into consideration the percentage deviation and the feasibility of measuring devices. Based on the result, it can be seen that the students with high mathematical ability are able to link mathematical procedures with the context of vocational pharmacy problem. Therefore, the learning of mathematics for pharmacy-oriented vocational program must incorporate dosage calculation problem.