Struga were the defending champions, having won their first title in 2022–23.
The second-placed team (Shkendija) and 2023–24 Macedonian Football Cup winners (Tikvesh) qualified for the Conference League first qualifying round.
The tenth-placed team (Vardar) qualified for the Macedonian First Football League play-off.
The league standings after matches 22 are used to determine the games for the last 11 matchdays.
The tenth-placed club (Vardar) faced the third-placed club from the 2023–24 Macedonian Second Football League (Detonit Plachkovica) for the final place in the following season's Macedonian First Football League.