KEPUTUSAN KEPALA BADAN PENGAWAS OBAT DAN MAKANAN
REPUBLIK INDONESIA
NOMOR: 05017/SK/KBPOM
TENTANG
HARGA JUAL OBAT GENERIK TAHUN 2001
KEPALA BADAN PENGAWAS OBAT DAN MAKANAN
Menimbang : a. Bahwa kesinambungan dalam penyediaan dan ketersediaan obat Generik dengan harga terjangkau yang selama ini dapat memenuhi kebutuhan masyarakat perlu terus dipertahankan;
b. Bahwa kemampuan keuangan negara sangat terbatas sehingga tidak dapat menyediakan subsidi untuk pengadaan bahan baku obat;
c. Bahwa berdasarkan butir a dan b diatas, maka harga obat generik perlu ditinjau dan ditetapkan kembali.
Mengingat : 1. Undang-undang Nomor 23 Tahun 1992 tentang Kesehatan; 2. PP Nomor 25 Tahun 2000 tentang Kewenangan Pemerintah
dan Kewenangan Provinsi Sebagai Daerah Otonom;
3. Peraturan Menteri Kesehatan Nomor 085/Menkes/Per/I/ 1989 tentang Kewajiban Menulis Resep dan/atau Menggunakan Obat Generik di Fasilitas Pelayanan Kesehatan Pemerintah.
MEMUTUSKAN
Menetapkan : KEPUTUSAN KEPALA BADAN PENGAWAS OBAT DAN MAKANAN TENTANG HARGA JUAL OBAT GENERIK TAHUN 2001.
Pertama : Harga Jual Obat Generik Tahun 2001 sebagaimana tercantum dalam lampiran I dan II Keputusan ini;
Kedua : Harga Jual Obat Generik Tahun 2001 sebagaimana dimaksud pada butir pertama adalah:
1. Harga Netto Apotik (HNA) Obat Generik adalah harga jual per satuan kemasan franko unit pelayanan Kesehatan Kabupaten/Kota dan Apotik, termasuk Pajak Pertambahan Nilai (PPN) sebasar 10%;
2. Harga Jual Apotik (HJA) Obat Generik adalah harga jual per satuan kemasan termasuk Pajak Pertambahan Nilai (PPN) sebesar 10%;
Ketiga : Dengan diberlakukannya keputusan ini maka Keputusan Direktur Jenderal Pengawasan Obat dan Makanan No. HK.00.06.2.3981 tanggal 29 September 1999 tentang Harga Netto Apotik (HNA) Obat Generik dan No. HK.00.06.2.3982 tanggal 29 September 1999 tentang Harga Jual Apotik (HJA) Obat Generik dinyatakan tidak berlaku;
Keempat : Keputusan ini mulai berlaku sejak tanggal ditetapkan dan apabila terdapat kekurangan atau kekeliruan dalam Keputusan ini akan diadakan perubahan atau perbaikan seperlunya.
Ditetapkan di : Jakarta Pada tanggal : 15 Mei 2001
Tembusan disampaikan kepada Yth.
1. Menteri Kesehatan dan Kesejahteraan Sosial RI 2. Sekretaris Jenderal Depkes & Kesos
3. Para Direktur Jenderal dilingkungan Depkes & Kesos 4. lnspektorat Badan Pengawas Obat dan Makanan 5. Kepala Dinas Kesehatan Propinsi seluruh Indonesia 6. Kepala Dinas Kesehatan Kab/Kota seluruh Indonesia
7. Kepala Balai Pemeriksaan Obat dan Makanan seluruh Indonesia 8. Gabungan Perusahaan Farmasi Indonesia Pusat
HARGA NETTO APOTIK (HNA) OBAT GENERIK
Lampiran I : Keputusan Kepala Badan Pengawas Obat dan Makanan RI Nomor : 05017/SK/KBPOM.
Tanggal : 15 Mei 2001
HNA + PPN
NO. NAMA OBAT KEMASAN
(Rupiah)
1 Albendazol tablet 400 mg ktk 5 x 6 tablet 12.221
2 Alopurinol tablet 100 mg strip 10 x 10 tablet 12.833
3 Ambroxol sirup 15mg/ml btl 60 ml 3.600
4 Ambroxol tablet 30 mg strip 10x10 tablet 13.200
5 Amilorid tablet 5 mg strip 10 x 10 tablet 10.320
6 Aminofilin injesi 24 mg/ml - 10 ml ktk 30 amp @ 10ml 23.750
7 Aminofilina tablet 200 mg btl 100 tablet 6.500
btl 1000 tablet 43.440 8 Amitriptilin HCI tablet salut 25 mg strip 10 x 10 tablet 10.920 9 Amoksisilin 250 mg + Asam Klavulanat 125 mg ktk 30 kaplet 70.320 10 Amoksisilin 500 mg + Asam Klavulanat 125 mg ktk 30 kaplet 100.000 11 Amoksisilin kapsul 250 mg strip 10 x 10 kapsul 27.300 ktk 120 kapsul 32.670 12 Amoksisilin kaplet 500 mg strip 10 x 10 kaplet 48.420 13 Amoksisilin sirup kering 12-5 mg/5ml btl 60 ml 3.315 14 Ampisilin kaplet 250 mg strip 10 x 10 kaplet 23.400 15 Ampisilin kaplet 500 mg strip 10 x 10 kaplet 44.750 16 Ampisilin serbuk injeksi (im/iv) 500 mg dus 1 vial 3.800 17 Ampisilin serbuk injeksi (im/iv) 1000 mg dus 1 vial 4.750 18 Ampisilin sirup kering 125 mg/5ml btl 60 ml 3.120 19 Antalgin (Metampiron) injeksi 250 mg/ml - 2 ml ktk 30 amp/2ml 10.000 20 Antalgin (Metampiron) tablet 500 mg strip 10 x 10 tablet 9.000 btl 1000 tablet 62.790 21 Antasida DOEN suspensi, kombinasi :
Magnesium Hidroksida 200 mg/ 5 ml + Alumunium Hidroksida 200 mg/ 5 ml
btl 60 ml 3.250
22 Antasida DOEN tablet, komb : Magnesium Hidroksida 200 mg+ Al Hidroksida 200 mg
strip 10 x 10 tablet btl 1000 tablet
7.865 42.952
23 Antihemoroid DOEN kombinasi dus 10 supp 10.500
24 Antimigren DOEN kombinasi :
Ergotamin Tartrat 1 mg + Kofein 50 mg 100 tablet 12.840 25 Anti Parkinson DOEN kombinasi :
Karbidopa 25 mg + Levodopa 250 mg
ktk 100 tablet 85.200 26 Asam Askorbat ( Vit. C ) tablet 50 mg btl 1000 tablet 16.804
27 Asam Folat tablet 1 mg btl 100 tablet 3.500
28 Asam Mefenamat kapsul 250 mg strip 10 x 10 kapsul 13.728 strip 12 x 10 kapsul 16.434 29 Asam Mefenamat tablet salut selaput 500 mg strip 10 x 10 kaplet 26.350
30 Asetosal tablet 100 mg ktk 100 tablet 6.306
31 Asetosal tablet 500 mg ktk 100 tablet 10.560
(Rupiah)
32 Asiklovir cream 5 % tube 5 gr 3.525
33 Asiklovir tablet 200 mg ktk 50 tablet 49.000
ktk 30 tablet 29.700 ktk 100 tablet 89.400
34 Asiklovir tablet 400 mg ktk 50 tablet 78.000
ktk 30 tablet 48.000 ktk 100 tablet 136.080 35 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ktk 100 amp @ 1 ml 32.000 36 Atropin Suffat tablet 0,5 mg btl 500 tablet 13.890 37 Atropin Sulfat tetes mata 0,5% 24 btl @ 5 ml 72.593
38 Betametason krim 0,1 % 25 tube @ 5 g 62.500
39 Bezafibrate tablet 200 mg strip 5 x 10 tablet 23.700 40 Deksametason Injeksi 5 mg/ml - 1 ml ktk 100 amp @ 1 ml 117.650 41 Deksametason tablet 0,5 mg strip 10 x 10 tablet 8.125 btl 1000 tablet 30.875
42 Dekstrometorfan sirup 10 mg/5 ml btl 60 ml 3.120
43 Dekstrometorfan tablet 15 mg strip 10 x 10 tablet 9.375 btl 1000 tablet 66.250 44 Diazepam injeksi 5 mg/ml - 2 ml ktk 100 amp @ 2 ml 75.600
45 Diazepam tablet 2 mg btl 1000 tablet 12.720
46 Diazepam tablet 5 mg btl 100 tablet 3.480
btl 500 tablet 11.200 47 Difenhidramin HCI lnjeksi 10 mg/ml - 1 ml ktk 30 amp @ 1 ml 14.300 48 Digoksin tablet 0,25 mg strip 10 x 10 tablet 9.750 49 Dikloksasilin kapsul 125 mg strip 10 x 10 kapsul 40.680 50 Diltiazem tablet salut 30 mg strip 10 x 10 tablet 26.000 51 Dimenhidrinat tablet 50 mg btl 100 tablet 9.700 52 Doksisiklin kapsul 100 mg strip 10 x 10 kapsul 31.500
53 Efedrin HCI tablet 25 mg btl 1000 tablet 39.719
54 Epinefrin HCI/Bitartrat inj 0,1 %-1 ml ktk 30 amp @ 1 ml 9.877 55 Eritromisin kapsul 250 mg strip 10 x 10 kapsul 50.400 ktk 120 kapsul 59.000 56 Eritromisin kapsul 500 mg strip 10 x 10 kapsul 97.000
57 Eritromisin sirup 200 mg/5 ml btl 60 ml 7.550
58 Etambutol tablet 250 mg strip 20 x 10 tablet 38.500 59 Etambutol tablet 500 mg strip 10 x 10 tablet 36.500
60 Eter Anestetik btl 140 ml 9.360
61 Famotidine tablet 20 mg strip 5x10 tablet 9.500
62 Famotidine tablet 40 mg strip 5x10 tablet 14.500
63 Fenilbutazon tablet salut 200 mg btl 1000 tablet 80.400 64 Fenobarbital injeksi 50 mg/ml - 2 ml Ktk 30 amp @ 2 ml 11.880
65 Fenobarbital tablet 30 mg btl 1000 tablet 14.665
66 Fenobarbital tablet 100 mg btl 250 tablet 11.220
67 Fenoksimetil Penisilin tablet 250 mg strip 10 x 10 tablet 24.375 68 Fenoksimetil Penisilin tablet 500 mg strip 10 x 10 tablet 42.400 69 Fero Sulfat tablet salut 300 mg btl 1000 tablet 18.600 70 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ktk 30 amp @ 1 ml 31.000 71 Fitomenadion (Vit.K1) tablet salut gula 10 mg btl 100 tablet 68.063
HNA + PPN
NO. NAMA OBAT KEMASAN
(Rupiah)
72 Furosemid tablet 40 mg strip 10 x 10 tablet 8.820 strip 20 x 10 tablet 16.920 btl 250 tablet 16.380 73 Furosemid injeksi 10 mg/ml ktk 25 ampul/2 ml 38.000 74 Garam Oralit untuk 200 ml air, kombinasi dos 25 sachet 8.600 75 Gemfibrozil kapsul 300 mg strip 10x10 kapsul 50.580
76 Gemfibrozil tablet 600 mg strip 10x10 tablet 90.000
77 Gentamisin injeksi 80 mg/2 ml dus 1 vial / ampul 4.800 78 Gentamisin Sulfat salep 1 % ktk 10 tube @ 5 g 18.750 79 Gentamisin Sulfat tetes mata 0,3 % btl 5 ml 3.380 80 Glibenklamid tablet 5 mg strip 10 x 10 tablet 15.900 81 Gliseril Guayakolat tablet 100 mg btl 1000 tablet 28.795 82 Glukosa larutan infus 5 % steril btl 500 ml 4.560 83 Glukosa larutan infus 10 % steril btl 500 ml 4.800 84 Griseofulvin tablet 125 mg, Micronized strip 10 x 10 tablet 17.500 85 Haloperidol tablet 0,5 mg strip 10 x 10 tablet 7.201 86 Haloperidol tablet 1,5 mg strip 10 x 10 tablet 10.625 87 Haloperidol tablet 5 mg strip 10 x 10 tablet 16.350 88 Hidroklorotiazid (HCT) tablet 25 mg btl 1000 tablet 16.500
89 Hidrokortison krim 2,5 % 1 tube @ 5 g 2.640
90 Ibuprofen tablet 200 mg btl 100 tablet 9.000
91 lbuprofen tablet 400 mg strip 10 x 10 tablet 19.500 92 Indometasin kapsul 25 mg strip 10 x 10 kapsul 11.040
93 Isoniazid tablet 100 mg btl 1000 tablet 28.320
94 Isoniazid tablet 300 mg btl 1000 tablet 72.000
95 Isosorbiddinitrat tablet sublingual 5 mg strip 10 x 10 tablet 10.500 96 Kalsium Laktat (Kalk) tablet 500 mg btl 1000 tablet 35.899
97 Kaptopril tablet 12,5 mg strip 6 x 10 tablet 12.000
strip 10 x 10 tablet 19.200 98 Kaptopril tablet 25 mg strip 6 x 10 tablet 19.500 strip 10 x 10 tablet 31.500 99 Kaptopril tablet 50 mg Strip 10 x 10 tablet 52.500 100 Karbamazepin tablet 200 mg strip 10 x 10 tablet 39.585
101 Ketotifen syrup 1 mg / ml btl 60 ml 5.450
102 Ketotifen tablet 1 mg strip 10 x 10 tablet 21.500 103 Klonidin tablet 0,15 mg strip 10 x 10 tablet 20.500 104 Kloramfenikol kapsul 250 mg ktk 120 kapsul 25.700
btl 1000 kapsul
botol 250 kapsul 189.80053.550
105 Kloramfenikol salep mata 1 % tube 5 g 1.563
106 Kloramfenikol suspensi 125 mg/ 5 ml btl 60 ml 5.300
107 Kloramfenikol tetes mata 0,5 % btl 5 ml 4.125
108 Kloramfenikol tetes telinga 3 % 24 botol @ 5 ml 56.200 109 Klorfeniramina Maleat (CTM) tablet 4 mg btl 1000 tablet 15.276
110 Klorokuin tab 150 mg btl 1000 tablet 84.000
111 Klorpromazin HCI injeksi 5 mg/ml - 2 ml Ktk 30 amp @ 2 ml 9.450 112 Klorpromazin HCI injeksi 25 mg/ml - 1 ml Ktk 30 amp @ 1 ml 9.450 113 Klorpromazin HCI tablet salut 25 mg btl 1000 tablet 25.920
(Rupiah)
114 Klorpromazin HCI tablet salut 100 mg btl 1000 tablet 90.720 botol 250 tablet 22.680
115 Klorpropamid tablet 100 mg btl 500 tablet 27.600
116 Kodein Fosfat tablet 10 mg btl 250 tablet 41.250 117 Kombinasi Natrium Klorida dan Glukosa larutan
infus steril 0,45% / 2,5% Btl 500 ml 4.980
118 Kombinasi Natrium Klorida dan Glukosa larutan
infus steril 0,9% / 5% Btl 500 ml 4.980
119 Kombinasi Natrium Klorida dan Glukosa larutan
infus steril 0,9% / 10% Btl 500 ml 4.980
120 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg tablet
Btl 100 tablet 39.125 Strip 10 x 10 tablet 42.000 121 Kotrimoksazol Suspensi, kombinasi Suffa -
metosakzol 100 mg + Trimetroprim 20mg/ 5 ml
2.500 122 Kotrimoksazol Suspensi, kombinasi : Sulfa -
metosakzol 200 mg + Trimetroprim 40 mg/ 5 ml Btl 60 ml 3.465 123 Kotrimaksazol tablet kombinasi :
Sulfametosakzol 400 mg + Trimetroprin 80 mg Btl 100 tablet 17.375 Strip 10 x 10 tablet 17.900 124 Kotrimoksazol tablet pediatrik, kombinasi :
Sulfametosakzol 100 mg + Trimetroprim 20 mg
Strip 10 x 10 tablet 7.000 125 Kuinin Dihidroklorida injeksi 25 % - 2 ml Ktk 100 amp @ 2 ml 120.000
126 Kuinin (Kina) tablet 200 mg Btl 1000 tablet 200.000
127 Lidokain injeksi 1% Ktk 100 amp @ 2 ml 26.880
128 Lidokain comp.injeksi, kombinasi : Lidokain HCI
2 % + Epinefrin 1;80.000 – 2 ml Ktk 100 amp @ 2 ml 43.438
129 Lidokain injeksi 2% Ktk 100 amp @ 2 ml 33.600
130 Mebendazol tablet 100 mg Strip 10 x 10 tablet 1.800 131 Metilergometrin Maleat tablet 0,125 mg Strip 10 x 10 tablet 13.200 132 Metronidazol tablet 250 mg Strip 10 x 10 tablet 11.000 133 Metronidazof tablet 500 mg Strip 10 x 10 tablet 16.400
134 Mikonazol krim 2 % Tube 10 g 3.400
135 Natrium Bikarbonat tablet 500 mg Btl 1000 tablet 9.576 136 Natrium Diklofenak tablet 25 mg Ktk 50 tablet 12.000 137 Natrium Diklofenak tablet 50 mg Ktk 50 tablet 17.000 138 Natrium Klorida lart lnfus 0.9 % steril Btl 500 ml 4.620 139 Natrium Tlosulfat injeksi 25 % - 10 ml Ktk 10 ampul @ 10 ml 11.040 140 Nifedipin tablet 10 mg Strip 10 x 10 tablet 30.000 141 Nistatin tablet salut gula 500.000 IU/g Strip 10 x 10 tablet 48.875 142 Nistatin tablet vaginal 100.000 IU/g Strip 10 x 10 dragee 30.624
143 Ofloxacin tablet 200 mg Strip 5x10 tablet 70.400
144 Ofloxacin tablet 400 mg Strip 5x10 tablet 137.500
145 Oksitetrasiklin HCI salep mata 1 % Ktk 25 tube 30.840 146 Oksitetrasiklin HCI salep 3 % Ktk 25 tube @ 5g 24.281 147 Oksitetrasiklin HCI injeksi i.m.50 mg/ml 10 vial 41.580
148 Omeprazol 20 mg Btl 7 kapsul 16.800
HNA + PPN
NO. NAMA OBAT KEMASAN
(Rupiah)
150 Papaverin tablet 40 mg Btl 1000 tablet 51.625
151 Parasetamol sirup 120 mg/5 ml Btl 60 ml 2.375
152 Parasemol tablet 500 mg Strip 10 x 10 tablet 7.579 Btl 1000 tablet 41.844
153 Perphenazin tablet 4 mg Btl 100 tablet 3.840
154 Petidin HCI injeksi 50 mg/ml - 2 ml Ktk 10 amp @ 2 ml 19.063 155 Pilokarpin HCI/Nitrat tetes mata 2% 24 btl @ 5 ml 125.123 156 Pirantel tablet 125 mg Strip 25 x 4 tablet 19.680 Kotak 60 tablet 14.575 157 Pirazinamid tablet 500 mg Strip 10 x 10 tablet 42.600 158 Piridoksin (Vitamin B6) tablet 10 mg Btl 1000 tablet 17.028 159 Piroksikam tablet 10 mg Strip 10 x 10 tablet 12.200 Strip 12 x 10 kapsul 13.000 Strip 12 x 10 kapsul 13.000 160 Piroksikam kapsul 20 mg Strip 10 x 10 tablet 17.300 Strip 12 x 10 kapsul 19.750
161 Povidin Iodida 10 % Btl 30 ml 1.875
Btl 60 ml 3.000 Btl 300 ml 9.720 Btl 1000 ml 33.600 162 Prazikuantel tablet 600 mg Strip 10 x 10 tablet 156.776
163 Prazosin tablet 1 mg Strip 10 x 10 tablet 24.720
164 Prednison tablet 5 mg Btl 1000 tablet 94.510
165 Primakuin tablet 15 mg Btl 1000 tablet 69.960
166 Prometazin tablet 12,5 mg Btl 30 tablet 966
167 Prometazin tablet 25 mg Btl 30 tablet 1.380
168 Propiltiourasil tablet 100 mg Btl 100 tablet 32.544 169 Propranolol tablet 10 mg Strip 10 x 10 tablet 6.600 170 Propranolot tablet 40 mg Strip 10 x 10 tablet 14.400
171 Ranitidin tablet 150 mg Ktk 3 x 10 tablet 18.360
Ktk 10 x 10 tablet 58.752
172 Reserpin tablet 0,10 mg Btl 500 tablet 7.920
173 Reserpin tablet 0,25 mg Btl 500 tablet 10.440
174 Retinol (Vitamin A) kapsul 50.000 IU Btl 1000 tablet 138.000 175 Rifampisin kapsul 300 mg Strip 10 x 10 kapsul 71.200 Ktk 120 kapsul 72.000 176 Rifampisin kaplet 450 mg Strip 10 x 10 kaplet 97.890 177 Rifampisin tablet 600 mg Strip 10 x 10 tablet 122.400 178 Ringer laktat larutan infus steril Btl 500 ml 5.520 179 Salbutamol tablet 2 mg Strip 10 x 10 tablet 10.600 180 Salbutamol tablet 4 mg Strip 10 x 10 tablet 12.000
181 Sefadroksil kapsul 250 mg Ktk 50 kapsul 71.500
182 Sefadroksil kapsul 500 mg Ktk 50 kapsul 114.000
183 Sefadroksil sirup kering 125 mg/5ml Btl 60 ml 9.720 184 Sefadroksil sirup kering 250 mg/5ml Btl 60 ml 17.880
185 Sefaleksin kapsul 250 mg Ktk 50 kapsul 41.500
186 Sefaleksin kapsul 500 mg Ktk 50 kapsul 78.500
(Rupiah)
Btl 100 ml 9.840 188 Sefaleksin sirup kering 250 mg/5ml Btl 60 ml 11.400 189 Sefotaksim serbuk injeksi 500 mg/vial Dus 1 vial 14.960 190 Sefotaksim serbuk injeksi 1000 mg/vial Dus 1 vial 23.100 191 Sefotaksim serbuk injeksi 2000 mg/vial Dus 1 vial 37.950 192 Seftazidim serbuk injeksi 1000 mg/vial Dus 1 vial 38.880 193 Seftriakson serbuk injeksi 250 mg/vial Dus 1 vial @ 10 ml 7.470 194 Seftriakson serbuk injeksi 500 mg/vial Dus 1 vial @ 10 ml 14.500 195 Seftriakson serbuk injeksi 1000 mg/vial Dus 1 vial @ 10 ml 26.600 196 Sefuroksim serbuk injeksi 250 mg/vial Dus 1 vial @ 10 ml 3.720 197 Sefuroksim serbuk injeksi 750 mg/vial Dus 1 vial @ 10 ml 9.000 198 Sefuroksim serbuk injeksi 1000 mg/vial Dus 1 vial @ 10 ml 12.000 199 Sefuroksim tablet salut selaput 250 mg Strip 10 x 1 tablet 31.080 200 Sianokobalamin (Vit.B12) injeksi 500 mg/ml Ktk 100 amp @ 1 ml 46.485 201 Simetidin tablet 200 mg Strip 10 x 10 tablet 18.900 202 Siprofloksasin tablet 250 mg Strip 5 x 10 tablet 52.600 203 Siprofloksasin tablet 500 mg Strip 5 x 10 tablet 90.950
204 Siprofloksasin tetes mata 0,3 % Btl 10 ml 4.400
205 Spiramisin tablet 250 mg Ktk 50 tablet 52.800
206 Spiramisin tablet 500 mg Ktk 50 tablet 103.000
207 Streptomisin Suffat Injeksi 1500 mg/ml Ktk 30 vial @ 15 ml 54.840 208 Sulfadimidin tablet 500 mg Botol 1000 tablet 97.520 209 Tetrasiklin HCI kapsul 250 mg Btl 1000 kapsul 110.240 210 Tetrasiklin HCI kapsul 500 mg Strip 10 x 10 kapsul 21.875
211 Tiamfenikol kapsul 250 mg Ktk 100 kapsul 42.000
212 Tiamfenikol kapsul 500 mg Ktk 100 kapsul 72.000
213 Tiamin HCI (Vit.B1) injeksi 100 mg/mi - 1 ml Ktk 30 amp @ 1 ml 12.250 214 Tiamin HCI/Mononitrat (Vit.B1) tablet 50 mg 1000 tablet 27.720
215 Tramadol tablet 50 mg Ktk 50 tablet 38.000
216 Tramadol kapsul 50 mg Ktk 50 kapsul 40.000
217 Triheksifenidil tablet 2 mg Strip 10 x 10 tablet 5.700
218 Trisulfa tablet 500 mg Btl 1000 tablet 99.264
219 Verapamil tablet 80 mg Strip 10 x 10 tablet 41.950 220 Vitamin B Kompleks tablet Btl 1000 tablet 18.000
HARGA JUAL APOTIK (HJA) OBAT GENERIK
Lampiran II : Keputusan Kepala Badan Pengawas Obat dan Makanan RI Nomor : 05017/SK/KBPOM
Tanggal : 15 Mei 2001
HNA + PPN
NO. NAMA OBAT KEMASAN
(Rupiah)
1 Albendazol tablet 400 mg ktk 5 X 6 tablet 15.888
2 Alopurinol tablet 100 mg strip 10 x 10 tablet 16.682
3 Ambroxol sirup 15mg/ml btl 60 ml 4.680
4 Ambroxol tablet 30 mg strip 10x10 tablet 17.160
5 Amilorid tablet 5 mg strip 10 x 10 tablet 13.416
6 Aminofilin injeksi 24 mg/ml - 10 ml ktk 30 amp @ 10ml 26.125
7 Aminofilina tablet 200 mg btl 100 tablet 8.450
btl 1000 tablet 56.472 8 Amitriptilin HCI tablet salut 25 mg strip 10 x 10 tablet 14.196 9 Amoksisilin 250 mg + Asam Klavulanat 125 mg ktk 30 kaplet 91.416 10 Amoksisilin 500 mg + Asam Klavulanat 125 mg ktk 30 kaplet 130.000 11 Amokslsilin kapsul 250 mg strip 10 x 10 kapsul 35.490 ktk 120 kapsul 42.471 12 Amoksisilin kaplet 500 mg strip 10 x 10 kaplet 62.946 13 Amoksisilin sirup kering 12-5 mg/5ml btl 60 ml 4.310 14 Ampisilin kaplet 250 mg strip 10 x 10 kaplet 30.420 15 Ampisilin kaplet 500 mg strip 10 x 10 kaplet 58.175 16 Ampisifin serbuk lnjeksi (im/iv) 500 mg dus 1 vial 4.180 17 Ampisilin serbuk lnjeksi (im/iv) 1000 mg dus 1 vial 5.225 18 Ampisilin sirup kering 125 mg/5ml btl 60 ml 4.056 19 Antalgin (Metampiron) lnjeksi 250 mg/ml - 2 ml ktk 30 amp/2ml 11.000 20 Antalgin (Metampiron) tablet 500 mg strip 10 x 10 tablet 11.700 btl 1000 tablet 81.627 21 Antasida DOEN suspensi, kombinasi :
Magnesium Hidroksida 200 mg/5 ml Alumunium Hidroksida 200 mg/5 ml
btl 60 ml 4.225
22 Antasida DOEN tablet komb : Magnesium
Hidroksida 200 mg+Al Hidroksida 200 mg strip 10 x 10 tablet 10.225 btl 1000 tablet 55.838
23 Antihemoroid DOEN kombinasi dus 10 supp 13.650
24 Andmigren DOEN kombinasi : Ergotamin Tartrat
1 mg + Kofein 50 mg 100 tablet 16.692
25 Anti Parkinson DOEN kombinasi : Karbidopa 25 mg + Levodopa 250 mg
ktk 100 tablet 110.760 26 Asam Askorbat ( Vit. C ) tablet 50 mg btl 1000 tablet 21.845
27 Asam Folat tablet 1 mg btl 100 tablet 4.550
28 Asam Mefenamat kapsul 250 mg strip 10 x 10 kapsul 17.846 strip 12 x 10 kapsul 21.354 29 Asam Mefenamat tablet salut selaput 500 mg strip 10 x 10 kaplet 34.255
(Rupiah)
31 Asetosal tablet 500 mg ktk 100 tablet 13.728
32 Asiklovir cream 5 % tube 5 g 4.583
33 Asiklovir tablet 200 mg ktk 50 tablet 63.700
ktk 30 tablet 38.610 ktk 100 tablet 116.220
34 Asiklovir tablet 400 mg ktk 50 tablet 101.400
ktk 30 tablet 62.400 ktk 100 tablet 176.904 35 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ktk 100 amp @ 1 ml 35.200
36 Atropin Suffat tablet 0,5 mg btl 500 tablet 18.057
37 Atropin Sulfat tetes mata 0,5% 24 btl @ 5 ml 94.371
38 Betametason krim 0,1 % 25 tube @ 5 g 81.250
39 Bezafibrate tablet 200 mg strip 5 x 10 tablet 30.810
40 Deksametason Injeksi 5 mg/ml - 1 ml ktk 100 amp @ 1 ml 129.415 41 Deksametason tablet 0,5 mg strip 10 x 10 tablet 10.563 btl 1000 tablet 40.138
42 Dekstrometorfan sirup 10 mg/5 ml btl 60 ml 4.056
43 Dekstrometorfan tablet 15 mg strip 10 x 10 tablet 12.188 btl 1000 tablet 86.125 44 Diazepam injeksi 5 mg/ml - 2 ml ktk 100 amp @ 2 ml 83.160
45 Diazepam tablet 2 mg btl 1000 tablet 16.536
46 Diazepam tablet 5 mg btl 100 tablet 4.525
btl 500 tablet 14.560 47 Difenhidramin HCI lnjeksi 10 mg/mi - 1 ml ktk 30 amp @ 1 ml 15.730 48 Digoksin tablet 0,25 mg strip 10 x 10 tablet 12.675 49 Dikloksasilin kapsul 125 mg strip 10 x 10 kapsul 52.884 50 Diltiazem tablet salut 30 mg strip 10 x 10 tablet 33.800
51 Dimenhidrinat tablet 50 mg btl 100 tablet 12.610
52 Doksisiklin kapsul 100 mg strip 10 x 10 kapsul 40.950
53 Efedrin HCI tablet 25 mg btl 1000 tablet 51.634
54 Epinefrin HCI/Bitartrat inj 0,1 %-1 ml ktk 30 amp @ 1 ml 10.865
55 Eritromisin kapsul 250 mg strip 10 x 10 kapsul 65.520
ktk 120 kapsul 76.700 56 Eritromisin kapsul 500 mg strip 10 x 10 kapsul -
57 Eritromisin sirup 200 mg/5 ml btl 60 ml 9.815
58 Etambutol tablet 250 mg strip 20 x 10 tablet 50.050
59 Etambutol tablet 500 mg strip 10 x 10 tablet 47.450
60 Eter Anestetik btl 140 ml 12.168
61 Famotidine tablet 20 mg strip 5x 10 tablet 12.350
62 Famotidine tablet 40 mg strip 5x10 tablet 18.850
63 Fenilbutazon tablet salut 200 mg btl 1000 tablet 104.520 64 Fenobarbital injeksi 50 mg/ml - 2 ml ktk 30 amp @ 2 ml 13.068
65 Fenobarbital tablet 30 mg btl 1000 tablet 19.065
66 Fenobarbital tablet 100 mg btl 250 tablet 14.586
67 Fenoksimetil Penisilin tablet 250 mg strip 10 x 10 tablet 31.688 68 Fenoksimetil Penisilin tablet 500 mg strip 10 x 10 tablet 55.120 69 Fero Sulfat tablet salut 300 mg btl 1000 tablet 24.180 70 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml ktk 30 amp @ 1 ml 34.100
HNA + PPN
NO. NAMA OBAT KEMASAN
(Rupiah)
71 Fitomenadion (Vit.K1) tablet salut gula 10mg btl 100 tablet 88.481
72 Furosemid tablet 40 mg strip 10 x 10 tablet 11.466
strip 20 x 10 tablet 21.996 btl 250 tablet 21.294
73 Furosemid injeksi 10 mg/ml ktk 25 ampul/2 ml 41.800
74 Garam Oralit untuk 200 ml air, kombinasi dos 25 sachet 11.180 75 Gemfibrozil kapsul 300 mg strip 10x10 kapsul 65.754
76 Gemfibrozil tablet 600 mg strip 10x10 tablet 117.000
77 Gentamisin injeksi 80 mg/2 ml dus 1 vial / ampul 5.280 78 Gentamisin Sulfat salep 1 % ktk 10 tube @ 5 g 24.375
79 Gentamisin Sulfat tetes mata 0,3 % btl 5 ml 4.394
80 Glibenklamid tablet 5 mg strip 10 x 10 tablet 20.670 81 Gilseril Guayakolat tablet 100 mg btl 1000 tablet 37.464 82 Glukosa larutan infus 5 % steril btl 500 ml 5.928 83 Glukosa larutan lnfus 10 % steril btl 500 ml 6.240 84 Griseofulvin tablet 125 mg, Micronized strip 10 x 10 tablet 22.750 85 Haloperidol tablet 0,5 mg strip 10 x 10 tablet 9.362 86 Haloperidol tablet 1,5 mg strip 10 x 10 tablet 13.813 87 Haloperidol tablet 5 mg strip 10 x 10 tablet 21.255 88 Hidroklorodazid (HCT) tablet 25 mg btl 1000 tablet 21.450
89 Hidrokortison krim 2,5 % 1 tube @ 5 g 3.432
90 Ibuprofen tablet 200 mg btl 100 tablet 11.700
91 lbuprofen tablet 400 mg strip 10 x 10 tablet 25.350 92 Indometasin kapsul 25 mg strip 10 x 10 kapsul 14.352
93 Isoniazid tablet 100 mg btl 1000 tablet 36.816
94 Isoniazid tablet 300 mg btl 1000 tablet 93.600
95 Isosorbiddinitrat tablet sublingual 5 mg strip 10 x 10 tablet 13.650 96 Kalsium Laktat (Kalk) tablet 500 mg btl 1000 tablet 46.680 97 Kaptopril tablet 12,5 mg strip 6 x 10 tablet - strip 10 x 10 tablet 24.960
98 Kaptopril tablet 25 mg strip 6 x 10 tablet 25.350
strip 10 x 10 tablet 40.950 99 Kaptopril tablet 50 mg strip 10 x 10 tablet 68.250 100 Karbamazepin tablet 200 mg strip 10 x 10 tablet 51.461
101 Ketotifen syrup 1 mg 1 ml btl 60 ml 7.085
102 Ketotifen tablet 1 mg strip 10 x 10 tablet 27.950 103 Klonidin tablet 0,15 mg strip 10 x 10 tablet 26.650
104 Kloramfenikol kapsul 250 mg ktk 120 kapsul 33.410
btl 1000 kapsul
botol 250 kapsul 246.740 69.615
105 Kloramfenikol salep mata 1 % tube 5 g 2.031
106 Kloramfenikol suspensi 125 mg/5 ml btl 60 ml 6.890
107 Kloramfenikol tetes mata 0,5 % btl 5 ml 5.363
108 Kloramfenikol tetes telinga 3 % 24 botol @ 5 ml 73.060 109 Klorfeniramina Maleat (CTM) tablet 4 mg btl 1000 tablet 19.859
110 Klorokuin tab 150 mg btl 1000 tablet 109.200
(Rupiah)
112 Klorpromazin HCI injeksi 25 mg/ml - 1 ml ktk 30 amp @ 1 ml 10.395 113 Klorpromazin HCI tablet salut 25 mg btl 1000 tablet 33.696 114 Klorpromazin HCI tablet salut 100 mg btl 1000 tablet 117.936 botol 250 tablet 29.484
115 Klorpropamid tablet 100 mg btl 500 tablet 35.880
116 Kodein Fosfat tablet 10 mg btl 250 tablet 53.625
117 Kombinasi Natrium Klorida dan Glukosa larutan infus steril 0,45% / 2,5%
btl 500 ml 6.474 118 Kombinasi Natrium Klorida dan Glukosa larutan
infus steril 0,9% / 5%
btl 500 ml 6.474 119 Kombinasi Natrium Klorida dan Glukosa larutan
infus steril 0,9% / 10% btl 500 ml 6.474
120 Kombinasi Pirimetamin 25 mg +
Sulfadoksin 500 mg tablet btl 100 tablet 50.863
strip 10 x 10 tablet 54.600 121 Kotrimoksazol Suspensi, kombinasi : Suffa -
metosakzol 100 mg + Trimetroprim 20mg/ 5 ml
btl 60 ml 3.250 122 Kotrimoksazol Suspensi, kombinasi : Suffa -
metosakzol 200 mg + Trimetroprim 40 mg/ 5 ml 4.505 123 Kotrimaksazol tablet kombinasi :Sulfametosakzol
400 mg + Trimetroprin 80 mg
btl 100 tablet 22.588 strip 10 x 10 tablet 23.270 124 Kotrimoksazol tablet pediatrik, kombinasi :
Sulfametosakzol 100 mg + Trimetroprim 20 mg strip 10 x 10 tablet 9.100 125 Kuinin Dihidroklorida injeksi 25 % - 2 ml ktk 100 amp @ 2 ml 132.000
126 Kuinin (Kina) tablet 200 mg btl 1000 tablet 260.000
127 Lidokain injeksi 1% ktk 100 amp @ 2 ml 29.568
128 Lidokain comp.injeksi, kombinasi : Lidokain HCI
2 % + Epinefrin 1;80.000 – 2 ml ktk 100 amp @ 2 ml 47.781
129 Lidokain injeksi 2% ktk 100 amp @ 2 ml 36.960
130 Mebendazol tablet 100 mg strip 10 x 10 tablet 23.400 131 Metilergometrin Maleat tablet 0,125 mg strip 10 x 10 tablet 17.160 132 Metronidazol tablet 250 mg strip 10 x 10 tablet 14.300 133 Metronidazol tablet 500 mg strip 10 x 10 tablet 21.320
134 Mikonazol krim 2 % tube 10 g 4.420
135 Natrium Bikarbonat tablet 500 mg btl 1000 tablet 12.449 136 Natrium Diklofenak tablet 25 mg ktk 50 tablet 15.600 137 Natrium Diklofenak tablet 50 mg ktk 50 tablet 22.100 138 Natrium Klorida lart lnfus 0.9 % steril btl 500 ml 6.006 139 Natrium Tiosulfat injeksi 25 % - 10 ml ktk 10 ampul @ 10 ml 12.144
140 Nifedipin tablet 10 mg strip 10 x 10 tablet 39.000
141 Nistatin tablet salut gula 500.000 IU/g strip 10 x 10 tablet 63.538 142 Nistatin tablet vaginal 100.000 IU/g strip 10 x 10 dragee 39.811
143 Ofloxacin tablet 200 mg strip 5x10 tablet 91.520
144 Ofloxacin tablet 400 mg strip 5x10 tablet 178.750
145 Oksitetrasiklin HCI salep mata 1 % ktk 25 tube 40.092 146 Oksitetrasikfin HCI salep 3 % ktk 25 tube @ 5 g 31.565 147 Oksitetrasiklin HCI injeksi i.m.50 mg/ml 10 vial 45.738
HNA + PPN
NO. NAMA OBAT KEMASAN
(Rupiah)
148 Omeprazol 20 mg btl 7 kapsul 21.840
149 Papaverin lnjeksi 40 mg/ml ktk 100 amp @ 1 ml 39.600
150 Papaverin tablet 40 mg btl 1000 tablet 67.113
151 Parasetamol sirup 120 mg/5 ml btl 60 ml 3.088
152 Parasemol tablet 500 mg strip 10 x 10 tablet 9.853 btl 1000 tablet 54.397
153 Perphenazin tablet 4 mg btl 100 tablet 4.992
154 Petidin HCI injeksi 50 mg/ml - 2 ml ktk 10 amp @ 2 ml 20.969 155 Pilokarpin HCI/Nitrat tetes mata 2% 24 btl @ 5 ml 162.660
156 Pirantel tablet 125 mg strip 25 x 4 tablet 25.584
kotak 60 tablet 18.948 157 Pirazinamid tablet 500 mg strip 10 x 10 tablet 55.380 158 Piridoksin (Vitamin B6) tablet 10 mg btl 1000 tablet 22.136 159 Piroksikam tablet 10 mg strip 10 x 10 tablet 15.860 strip 12 x 10 kapsul 16.900 160 Piroksikam kapsul 20 mg strip 10 x 10 tablet 22.490 strip 12 x 10 kapsul 25.675
161 Povidin lodida 10 % btl 30 ml 2.438
btl 60 ml 3.900 btl 300 ml 12.636 btl 1000 ml 43.680 162 Prazikuantel tablet 600 mg strip 10 x 10 tablet 203.809
163 Prazosin tablet 1 mg strip 10 x 10 tablet 32.136
164 Prednison tablet 5 mg strip 10 x 10 tablet 122.863
165 Primakuin tablet 15 mg btl 1000 tablet 90.948
166 Prometazin tablet 12,5 mg btl 30 tablet 1.256
167 Prometazin tablet 25 mg btl 30 tablet 1.794
168 Propiltiourasil tablet 100 mg btl 100 tablet 42.307 169 Propranolol tablet 10 mg strip 10 x 10 tablet 8.580 170 Propranolot tablet 40 mg strip 10 x 10 tablet 18.720
171 Ranitidin tablet 150 mg ktk 3 x 10 tablet 23.868
ktk 10 x 10 tablet 76.378
172 Reserpin tablet 0,10 mg btl 500 tablet 10.296
173 Reserpin tablet 0,25 mg btl 500 tablet 13.572
174 Retinol (Vitamin A) kapsul 50.000 IU btl 1000 tablet 179.400 175 Rifampisin kapsul 300 mg strip 10 x 10 kapsul 92.560 ktk 120 kapsul 93.600
176 Rifampisin kaplet 450 mg strip 10 x 10 kaplet 127.257
177 Rifampisin tablet 600 mg strip 10 x 10 tablet 159.120
178 Ringer laktat larutan infus steril btl 500 ml 7.176
179 Salbutamot tablet 2 mg strip 10 x 10 tablet 13.780
180 Salbutamol tablet 4 mg strip 10 x 10 tablet 15.600
181 Sefadroksil kapsul 250 mg ktk 50 kapsul 92.950
182 Sefadroksil kapsul 500 mg ktk 50 kapsul 148.200
183 Sefadroksil sirup kering 125 mg/5ml btl 60 ml 12.636
184 Sefadroksil sirup kering 250 mg/5ml btl 60 ml 23.244
185 Sefaleksin kapsul 250 mg ktk 50 kapsul 53.950
(Rupiah)
187 Sefaleksin sirup kering 125 mg/5ml btl 60 ml - btl 100 ml 12.792 188 Sefaleksin sirup kering 250 mg/5ml btl 60 ml 14.820 189 Sefotaksim serbuk injeksi 500 mg/vial dus 1 vial 16.456 190 Sefotaksim serbuk injeksi 1000 mg/vial dus 1 vial 25.410 191 Sefotaksim serbuk injeksi 2000 mg/vial dus 1 vial 41.745 192 Seftazidim serbuk injeksi 1000 mg/vial dus 1 vial 42.768 193 Seftriakson serbuk injeksi 250 mg/vial dus 1 vial @ 10 ml 8.217 194 Seftriakson serbuk injeksi 500 mg/vial dus 1 vial @ 10 ml 15.950 195 Seftriakson serbuk injeksi 1000 mg/vial dus 1 vial @ 10 ml 29.260 196 Sefuroksim serbuk injeksi 250 mg/vial dus 1 vial @ 10 ml 4.092 197 Sefuroksim serbuk injeksi 750 mg/vial dus 1 vial @ 10 ml 9.900 198 Sefuroksim serbuk injeksi 1000 mg/vial dus 1 vial @ 10 ml 13.200 199 Sefuroksim tablet salut selaput 250 mg strip 10 x 1 tablet 34.188 200 Sianokobalamin (Vit.B12) injeksi 500 mg/ml ktk 100 amp @ 1 ml 51.123
201 Simetidin tablet 200 mg strip 10 x 10 tablet 24.570
202 Siprofloksasin tablet 250 mg strip 5 x 10 tablet 68.380 203 Siprofloksasin tablet 500 mg strip 5 x 10 tablet 118.235 204 Siprofloksasin tetes mata 0,3 % btl 10 ml 5.720
205 Spiramisin tablet 250 mg ktk 50 tablet 68.640
206 Spiramisin tablet 500 mg ktk 50 tablet 133.900
207 Streptomisin Suffat Injeksi 1500 mg/ml ktk 30 vial @ 15 ml 60.324
208 Sulfadimidin tablet 500 mg botol 1000 tablet 126.776
209 Tetrasiklin HCI kapsul 250 mg btl 1000 kapsul 143.312 210 Tet-asiklin HCI kapsul 500 mg strip 10 x 10 kapsul 28.438
211 Tiamfenikol kapsul 250 mg ktk 100 kapsul 54.600
212 Tiamfenikol kapsul 500 mg ktk 100 kapsul 93.600
213 Tiamin HCI (Vit.B1) injeksi 100 mg/mi - 1 ml ktk 30 amp @ 1 ml 13.475 214 Tiamin HCI/Mononitrat (Vit.B1) tablet 50 mg 1000 tablet 36.036
215 Tramadol tablet 50 mg ktk 50 tablet 49.400
216 Tramadol kapsul 50 mg ktk 50 kapsul 52.000
217 Triheksifenidil tablet 2 mg strip 10 x 10 tablet 7.410
218 Trisulfa tablet 500 mg btl 1000 tablet 129.043
219 Verapamil tablet 80 mg strip 10 x 10 tablet 54.535
220 Vitamin B Kompleks tablet btl 1000 tablet 23.400
