HARGA BPJS PRODUK KIMIA FARMA KATEGORI OBAT GENERIK 2017

HARGA
NO NAMA GENERIK KEMASAN YANG DITAWARKAN HARGA INC HNA IN PPN HNA EXC
PPN / TAB /BOX PPN /BOX
1 Albendazol tablet/kapsul/kaplet 400 mg Dus, 10 strip @10 tablet kunyah 390 39,000 35,455
2 Alprazolam tablet/kapsul/kaplet 1 mg Dus, 10 strip @10 tablet 143 14,300 13,000
3 Amlodipin tablet/kapsul/kaplet 10 mg Dus, 5 strip @10 tablet 104 5,200 4,727
4 Amlodipin tablet/kapsul/kaplet 5 mg Dus, 5 strip @10 tablet 85 4,250 3,864
5 Antimalaria DOEN kombinasi: Pirimetamin 25 mg + Sulfadoksin Dus, 10 strip @10 tablet 593 59,300 53,909
6 Asam askorbat (vitamin C) tab 50 mg Dus 10 strip @ 10 tablet 104 10,400 9,455
7 Asam askorbat (vitamin C) tablet/kapsul/kaplet 250 mg Dus, 10 strip @10 tablet 114 11,400 10,364
8 Azitromisin tablet/kapsul/kaplet 500 mg Dus, 2 strip @10 kaptab salut selaput 1,888 37,760 34,327
9 Betametason krim 0,1% (sebagai Valerat) tube 5 gram 1,349 1,349 1,226
10 Dietilkarbamazin tablet scored 100 mg Dus, 10 strip @10 tablet 156 15,600 14,182
11 Diltiazem HCl tablet/kapsul/kaplet 30 mg Dus, 10 strip @ 10 tablet 135 13,500 12,273
12 Dimenhidrinat tablet/kapsul/kaplet 50 mg botol plastik @ 100 tablet 99 9,900 9,000
13 Etambutol tablet/kapsul/kaplet 250 mg (HCl) Dus, 20 strip @10 tablet salut selaput 359 71,800 65,273
14 Fenobarbital tablet/kapsul/kaplet 30 mg Dus, 10 strip @ 10 tablet 165 16,500 15,000
15 Flukonazol tab/kaps 150 mg (G) Dus, 10 kapsul 18,000 180,000 163,636
16 Furosemid tablet/kapsul/kaplet 40 mg Dus, 20 strip @10 tablet 72 14,400 13,091
17 Glimepiride tablet/kapsul/kaplet 1 mg Dus, 5 strip @10 tablet 194 9,700 8,818
18 Glimepiride tablet/kapsul/kaplet 3 mg Dus, 5 strip @10 tablet 283 14,150 12,864
19 Glimepiride tablet/kapsul/kaplet 4 mg Dus, 5 strip @10 tablet 281 14,050 12,773
20 Griseofulvin (micronized) tablet/kapsul/kaplet 125 mg Dus, 10 strip @10 tablet 245 24,500 22,273
21 Hidroklorotiazid tab 25 mg Dus, 10 strip @ 10 tablet 149 14,900 13,545
22 Hidrokortison krim 2,5% tube @ 5 gram 2,640 2,640 2,400
23 Isoniazid tablet/kapsul/kaplet 300 mg Dus, 10 strip @ 10 tablet 170 17,001 15,455
24 Ketokonazol krim 2% tube 10 gr 2,596 2,596 2,360
25 Klonidin tablet/kapsul/kaplet 0,15 mg Dus, 10 strip @10 tablet 170 17,001 15,455
26 Kloramfenikol salep mata 1 % tube @ 5 gram 1,810 1,810 1,645
27 Kodein tablet/kapsul/kaplet 10 mg Dus, 10 strip @ 10 tablet 550 55,000 50,000

250 125.550 5.000 86.800 10.227 33 Kuinin tab salut selaput 200 mg (222 mg sebagai garam) (G) Dus. 10 strip @ 6 tablet salut selaput 670 40. 10 strip @10 tablet 80 8.700 7. 5 strip @10 tablet 229 11.909 36 Metoklopramide tablet/kapsul/kaplet 5 mg Dus.200 7. 10 strip @10 kapsul 82 8.700 15.545 48 Vitamin B Kompleks tablet Dus. 10 strip @10 tablet 123 12. 10 strip @ 10 tablet 115 11.455 35 Metoklopramide tablet/kapsul/kaplet 10 mg Dus.545 34 Levofloksasin tablet/kapsul/kaplet 500 mg Dus.818 32 kombinasi: Levonogestrel 150 mcg + etinilestradiol 30 mcg Dus. Folat 0.500 10.364 29 Kodein tablet/kapsul/kaplet 20 mg Dus.450 10.300 11. 10 strip @ 10 tablet 1.636 30 kombinasi: ergotamin 1 mg + kafein 50 mg botol plastik @ 100 tablet salut selaput 167 16.727 40 Retinol (vitamin A) 100.28 Kodein tablet/kapsul/kaplet 15 mg Dus.000 UI botol plastik @ 50 kapsul 505 25. 10 strip @ 10 tablet salut gula 350 35.182 38 Obat Anti Tuberculosis FDC Kategori I Paket 374.380 340.909 41 Retinol (vitamin A) kaps lunak 200.182 .955 42 Salbutamol tablet/kapsul/kaplet 2 mg (sebagai Sulfat) Dus.200 12.800 7. 5 strip @10 tablet salut selaput 494 24.251 22.000 113.045 45 Simvastatin tablet/kaplet/salut 20 mg Dus. 10 strip @10 tablet salut selapu 303 30.455 49 Zinc tablet dispersible 20 mg Dus.300 27.345 39 Piridoksin (Vitamin B6) tab/kap/kapl 10 mg (HCl) (G) Dus.000 38. 5 strip @10 tablet 111 5.800 46.350 1.455 47 Verapamil tablet/kapsul/kaplet 80 mg (HCl) Dus.400 42.380 374. 10 strip @10 tablet dispersibel 508 50.091 43 Salbutamol tablet/kapsul/kaplet 4 mg (sebagai Sulfat) Dus.182 31 kombinasi: ferro fumarat 60 mg + as.701 22.273 44 Simvastatin tablet/kaplet/salut 10 mg Dus. 10 strip @ 10 tablet 118 11. 10 strip @10 tablet 87 8.000 31.4 mg tablet salut Dus. 10 strip @ 10 tablet 950 95.000 (G) Botol plastik @ 50 kapsul lunak 284 14. 100 blister@28 tablet 48 1.409 46 Tiamin (Vitamin B1) tablet/kapsul/kaplet 50 mg (HCl/ Nitrat) Dus.000 7. 10 strip @10 tablet 78 7.182 37 Morfin tablet 10 mg (G) Botol @ 30 tablet 1.200 36.