DAFTAR OBAT BPJS PRB

No. Nama Obat Satuan Harga

1 fenobarbital 100 mg tab Rp 88.00
2 akarbose 100 mg Rp 1,060.00
3 akarbose 50 mg Rp 778.00
4 allopurinol 100 mg Rp 196.00
5 amlodipin 10 mg Rp 103.00
6 amlodipn 5 mg Rp 78.00
7 analog insulin basal 100 IU /ml Rp 89,799.00
8 analog insulin campuran 100 IU/ ml Rp 113,018.00
9 analog insulin prandial 100 iu / ml Rp 95,326.00
10 as. Valproat 100 ml Rp 15,354.00
11 as. Valproat 250 mg Rp 1,249.00
12 asam asetilsalisilat 100 mg Rp 278.00
13 asam asetilsalisilat 80 mg Rp 269.00
14 bisoprolol 2,5 mg Rp 155.00
15 bisoprolol 5 mg Rp 191.00
16 digoksin 0.25 mg Rp 164.00
17 diltiazem 100 mg Rp 6,324.00
18 diltiazem 200 mg Rp 6,856.00
19 diltiazem 30 mg Rp 171.00
20 fenitoin 100 mg Rp 221.00
21 fenitoin 30 mg Rp 248.00
22 fenobarbital 30 mg Rp 228.00
23 fenoterol inh 200 dosis Rp 81,030.00
24 furosemid 40 mg Rp 169.00
25 gibenklamid 5 mg Rp 161.00
26 glibenklamid 2.5 mg Rp 198.00
27 glikazid 30 mg Rp 681.00
28 glikazid 80 mg Rp 386.00
29 glikquidon 30 mg Rp 1,250.00
30 glimepirid Rp 124.00
31 glimepirid 2 mg Rp 219.00
32 glimepirid 3 mg Rp 356.00
33 glimepridid 4 mg Rp 385.00
34 haloperidol 0.5 mg Rp 118.00
35 haloperidol 1,5 mg Rp 185.00
36 haloperidol 5 mg Rp 238.00
37 HCT 25 mg Rp 185.00
38 irbesartan 300 mg Rp 1,373.00
39 isdn 10 mg Rp 323.00
40 isdn 5 mg Rp 115.00
41 kandesartan 16 mg Rp 425.00
42 kandesartan 8 mg Rp 356.00
43 kaptopril 12,5 mg Rp 101.00
44 kaptopril 25 mg Rp 134.00
45 kaptopril 50 mg Rp 206.00
46 klonidin Rp 183.00
47 klopidogrel 75 mg Rp 919.00
48 lisinopril 5 mg Rp 219.00
49 metformin 500 mg Rp 203.00
50 metformin 850 mg Rp 264.00
51 metildopa 250 mg Rp 1,901.00
52 nifedipin 10 mg Rp 180.00
53 nifedipin 20 mg Rp 4,805.00
54 nifedipin 30 mg Rp 5,306.00
55 ramipril 10 mg Rp 888.00
56 ramipril 5 mg Rp 194.00
57 salbutamol 100 SK inh 100 Rp 35,576.00
58 salbutamol 200 SK Inh 200 Rp 9,341.00
59 simvastatin 20 mg Rp 218.00
60 spironolakton 25 mg Rp 313.00
61 telmisartan 40 mg Rp 2,498.00
62 telmisartan 80 mg Rp 3,746.00
63 teofilin Rp 428.00
64 valproat tab lepas lambat 500 mg Rp 3,500.00
65 valsartan 160 mg Rp 898.00
66 valsartan 80 mg Rp 496.00
67 verapamil 80 mg Rp 506.00
68 vit b12 Rp 58.00
69
70