REPUBLIK INDONESIA
KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA
NOMOR 1239/MENKES/SK/XI/2004
TENTANG
HARGA JUAL OBAT GENERIK
MENTERI KESEHATAN
REPUBLIK INDONESIA
MEMUTUSKAN:
Menetapkan :
Kesatu
: KEPUTUSAN MENTERI KESEHATAN TENTANG HARGA JUAL
OBAT GENERIK
Kedua
Ketiga
Keempat
Ditetapkan di Jakarta
Pada tanggal 10 November 2004
MENTERI KESEHATAN
MENTERI KESEHATAN
REPUBLIK INDONESIA
Lampiran I
Keputusan Menteri Kesehatan
Nomor : 1239/MENKES/SK/XI/2004
Tanggal : 10 November 2004
NAMA OBAT
KEMASAN
Hal 1
HNA + PPN
(Rupiah)
ktk 5 x 6 tablet
12.221
ktk 10 x 10 tablet
16.554
ktk 10 x 10 tablet
10.320
ktk 30 ampul @ 10 ml
38.488
8.030
11.550
32.272
ktk 12 x 10 kapsul
26.136
ktk 10 x 10 kapsul
21.840
btl 60 ml
3.315
ktk 10 vial
57.000
ktk 10 vial
38.000
49.820
9.122
btl 60 ml
3.500
ktk 10 supp
15.876
10
11
12
13
14
Aluminium Hidroksida
200 mg
Magnesium Hidroksida
200 mg
200 mg/5 ml
Magnesium Hidroksida
200 mg/5 ml
150 mg
Heksaklorofen
2,5 mg
ktk 10 x 10 tablet
47.300
ktk 10 x 10 tablet
103.530
ktk 10 x 10 tablet
10.560
18
6.306
19
19.753
20
3.500
ktk 10 x 10 tablet
102.060
15
16
17
21
22
25 mg
Sulfadoksin
500 mg
25 mg
Levodova
250 mg
ktk 50 tablet
64.350
ktk 3 x 10 tablet
38.610
ktk 50 tablet
36.750
ktk 10 x 10 tablet
67.050
ktk 3 x 10 tablet
22.275
MENTERI KESEHATAN
REPUBLIK INDONESIA
NO
NAMA OBAT
23
Asiklovir krim 5%
24
25
26
27
KEMASAN
Hal 2
HNA + PPN
(Rupiah)
tube 2 gram
3.525
ktk 30 amp @ 1 ml
32.000
btl 5 ml
3,025
ktk 10 vial @ 20 ml
54.000
ktk 10 vial @ 20 ml
38.025
28
24.200
29
tube 5 gram
30
31
32
33
34
35
Diazepam tablet 5 mg
36
Diazepam tablet 2 mg
37
2.626
117.650
33.880
ktk 10 x 10 tablet
9.343
btl 60 ml
3.120
66.250
ktk 10 x 10 tablet
9.900
ktk 30 amp @ 2 ml
28.272
34.768
8.692
13.992
ktk 30 amp @ 1 ml
17.733
38
ktk 10 x 10 tablet
39
ktk 25 x 4 kapsul
40.680
40
ktk 10 x 10 tablet
19.500
41
Dimenhidrinat tablet 50 mg
10.185
42
ktk 10 x 10 tablet
31.500
43
42.930
44
20.862
45
ktk 30 amp @ 1 ml
11.200
46
ktk 10 x 10 kapsul
99.000
47
ktk 12 x 10 kapsul
53.100
ktk 10 x 10 kapsul
50.400
10.238
btl 60 ml
8.400
40.920
ktk 20 x 10 tablet
42.800
80.400
Fenobarbital tablet 30 mg
21.230
21.708
48
49
50
51
52
53
ktk 30 amp @ 1 ml
54
ktk 10 x 10 tablet
42.400
55
ktk 10 x 10 tablet
24.375
31.000
56
ktk 30 amp @ 1 ml
57
71.805
58
3.500
ktk 25 amp @ 2 ml
38.000
ktk 20 x 10 tablet
18.315
ktk 10 x 10 tablet
7.938
59
60
Furosemid tablet 40 mg
MENTERI KESEHATAN
REPUBLIK INDONESIA
KEMASAN
Hal 3
HNA + PPN
(Rupiah)
34.430
Natrium
0,70 g
ktk 25 sachet
8.800
Kalium klorida
0,30 g
0,58 g
200 ml air
Glukosa Anhidrat
4g
NO
61
62
NAMA OBAT
63
64
Glibenklamida tablet 5 mg
65
ktk 1 vial @ 2 ml
3.750
tube 5 gram
1.950
ktk 10 x 10 tablet
16.695
30.210
4.900
66
btl 500 ml
67
btl 500 ml
4.650
68
ktk 10 x 10 tablet
14.960
69
Haloperidol tablet 5 mg
ktk 10 x 10 tablet
16.350
70
ktk 10 x 10 tablet
10.625
71
ktk 10 x 10 tablet
7.201
72
Hidroklorotiazida tablet 25 mg
18.040
73
74
75
tube 5 g
2.825
ktk 10 x 10 tablet
19.500
9.000
76
80.000
77
28.320
78
ktk 10 x 10 tablet
10.500
79
46.858
80
81
Kaptropil tablet 25 mg
Kaptropil tablet 12,5 mg
ktk 10 x 10 tablet
20.475
ktk 6 x 10 tablet
12.675
ktk 10 x 10 tablet
14.300
ktk 6 x 10 tablet
8.580
ktk 10 vial @ 20 ml
210.417
189.800
53.550
ktk 12 x 10 kapsul
25.700
btl 60 ml
5.300
85
btl 5 ml
2.576
86
19.524
87
84.000
13.033
82
Ketamin injeksi 10 mg
83
84
88
ktk 30 amp @ 2 ml
89
ktk 30 amp @ 1 ml
12.527
90
95.256
91
25.920
92
ktk 10 x 10 tablet
16.400
6.400
93
Sulfametoksazol
400 mg
Trimetoprim
20 mg
100 mg
Trimetoprim
20 mg
MENTERI KESEHATAN
REPUBLIK INDONESIA
NO
NAMA OBAT
94
95
KEMASAN
Hal 4
HNA + PPN
(Rupiah)
152.004
243.672
ktk 30 vial @ 2 ml
18.288
33.600
5.322
96
97
98
ktk 5 x 6 tablet
70.570
ktk 10 x 10 tablet
11.120
99
100
101
ktk 30 amp @ 2 ml
13.608
31.500
13.860
102
ktk 10 x 10 tablet
103
ktk 10 x 10 tablet
16.236
104
ktk 10 x 10 tablet
10.605
105
tube 10 g
106
14.083
107
btl 500 ml
4.712
108
109
Nifedipin tablet 10 mg
110
111
112
113
3.740
ktk 10 amp @ 10 ml
21.104
ktk 10 x 10 tablet
30.000
51.500
32.500
ktk 10 vial @ 10 ml
44.906
1.357
btl 60 ml
2.375
52.305
114
115
ktk 10 x 10 tablet
8.500
116
4.008
117
4.241
118
119
120
btl 5 ml
5.214
ktk 10 x 10 tablet
39.270
21.650
17.323
17.028
122
Primakuin tablet 15 mg
99.640
123
btl 1000 ml
42.000
btl 300 ml
15.660
btl 60 ml
3.300
121
btl 30 ml
btl 100 tablet
2.160
124
125
24.720
Prednison tablet 5 mg
94.511
126
160.000
127
ktk 30 vial @ 15 ml
180.600
128
ktk 10 x 10 tablet
14.400
129
ktk 10 x 10 tablet
7.200
130
33.920
131
ktk 10 x 10 tablet
45.000
ktk 3 x 10 tablet
14.025
MENTERI KESEHATAN
REPUBLIK INDONESIA
NO
NAMA OBAT
KEMASAN
Hal 5
HNA + PPN
(Rupiah)
132
100.984
133
16.250
21.801
134
135
16.575
136
208.000
137
ktk 10 x 10 kaplet
159.120
127.257
138
139
140
141
142
ktk 12 x 10 kapsul
93.600
ktk 10 x 10 kapsul
92.560
btl 500 ml
7.319
ktk 10 x 10 tablet
15.600
ktk 10 x 10 tablet
13.780
91.000
143
144
ktk 5 x 10 tablet
56.162
145
ktk 30 vial @ 15 ml
71.292
133,078
146
147
ktk 10 x 10 kapsul
32.512
148
153.371
149
ktk 30 amp @ 1 ml
22.198
150
42.208
151
Triheksifenidil tablet 2 mg
ktk 10 x 10 tablet
7.410
152
ktk 10 x 10 tablet
65.280
153
30.592
MENTERI KESEHATAN,
MENTERI KESEHATAN
REPUBLIK INDONESIA
Lampiran II
Keputusan Menteri Kesehatan
Nomor :
1239/MENKES/SK/XI/2004
Tanggal : 10 November 2004
KEMASAN
Hal 1
HJA + PPN
(Rupiah)
ktk 5 x 6 tablet
15.888
ktk 10 x 10 tablet
21.520
ktk 10 x 10 tablet
13.416
ktk 30 ampul @ 10 ml
50.034
10.439
NO
1
NAMA OBAT
15.015
41.954
ktk 12 x 10 kapsul
33.977
ktk 10 x 10 kapsul
28.392
btl 60 ml
4.310
ktk 10 vial
74.100
11
ktk 10 vial
49.400
12
64.766
11.859
btl 60 ml
4.550
ktk 10 supp
20.639
ktk 10 x 10 tablet
61.490
ktk 10 x 10 tablet
134.589
13.728
10
13
14
Aluminium Hidroksida
200 mg
magnesium Hidroksida
200 mg
200 mg/5 ml
Magnesium Hidroksida
200 mg/5 ml
150 mg
Heksaklorofen
15
16
2,5 mg
25 mg
Sulfadoksin
500 mg
25 mg
Levodova
250 mg
17
ktk 10 x 10 tablet
18
8.198
19
25.679
20
ktk 10 x 10 tablet
21
22
4.550
132.678
ktk 50 tablet
83.693
ktk 3 x 10 tablet
50.193
ktk 50 tablet
47.775
ktk 10 x 10 tablet
87.165
ktk 3 x 10 tablet
28.964
MENTERI KESEHATAN
REPUBLIK INDONESIA
NO
23
NAMA OBAT
Asiklovir krim 5%
24
25
26
KEMASAN
Hal 2
HNA + PPN
(Rupiah)
tube 2 gram
4.583
ktk 30 amp @ 1 ml
41.600
btl 5 ml
3.932
ktk 10 vial @ 20 ml
70.200
27
ktk 10 vial @ 20 ml
49.433
28
31.460
29
tube 5 gram
3.414
30
31
32
33
34
35
Diazepam tablet 5 mg
36
Diazepam tablet 2 mg
152.945
44.044
ktk 10 x 10 tablet
12.146
btl 60 ml
4.056
86.125
ktk 10 x 10 tablet
12.870
ktk 30 amp @ 2 ml
36.754
45.198
11.300
18.190
ktk 30 amp @ 1 ml
23.053
37
38
ktk 10 x 10 tablet
13.309
39
ktk 25 x 4 kapsul
52.884
40
ktk 10 x 10 tablet
23.350
41
Dimenhidrinat tablet 50 mg
13.241
42
ktk 10 x 10 tablet
40.950
43
55.809
44
27.121
45
ktk 30 amp @ 1 ml
14.560
46
ktk 10 x 10 kapsul
128.700
47
ktk 12 x 10 kapsul
68.130
ktk 10 x 10 kapsul
65.520
btl 60 ml
10.920
53.196
48
49
50
51
ktk 20 x 10 tablet
55.640
104.520
52
Fenobarbital tablet 30 mg
27.599
53
ktk 30 amp @ 1 ml
28.220
54
ktk 10 x 10 tablet
55.120
55
ktk 10 x 10 tablet
31.688
56
ktk 30 amp @ 1 ml
40.300
57
93.347
58
59
60
Furosemid tablet 40 mg
4.550
ktk 25 amp @ 2 ml
49.400
ktk 20 x 10 tablet
23.810
ktk 10 x 10 tablet
10.319
MENTERI KESEHATAN
REPUBLIK INDONESIA
KEMASAN
Hal 3
HNA + PPN
(Rupiah)
44.759
Natrium
0,70 g
ktk 25 sachet
11.440
Kalium klorida
0,30 g
0,58 g
200 ml air
Glukosa Anhidrat
4g
NO
61
62
NAMA OBAT
63
64
Glibenklamida tablet 5 mg
65
ktk 1 vial @ 2 ml
4.875
tube 5 gram
2.535
ktk 10 x 10 tablet
21.704
39.273
6.370
66
btl 500 ml
67
btl 500 ml
6.045
68
ktk 10 x 10 tablet
19.448
69
Haloperidol tablet 5 mg
ktk 10 x 10 tablet
21.255
70
ktk 10 x 10 tablet
13.813
71
ktk 10 x 10 tablet
9.362
72
Hidroklorotiazida tablet 25 mg
23.452
73
74
75
tube 5 g
3.673
ktk 10 x 10 tablet
25.350
11.700
76
104.000
77
36.816
78
ktk 10 x 10 tablet
13.650
60.915
79
80
Kaptropil tablet 25 mg
ktk 10 x 10 tablet
26.618
ktk 6 x 10 tablet
16.478
ktk 10 x 10 tablet
18.590
81
ktk 6 x 10 tablet
11.154
ktk 10 vial @ 20 ml
273.542
246.740
69.615
ktk 12 x 10 kapsul
33.410
btl 60 ml
6.890
85
btl 5 ml
3.349
86
25.381
87
109.200
16.943
82
Ketamin injeksi 10 mg
83
84
88
ktk 30 amp @ 2 ml
89
ktk 30 amp @ 1 ml
16.285
90
123.833
91
33.696
92
ktk 10 x 10 tablet
21.320
8.320
93
Sulfametoksazol
400 mg
Trimetoprim
20 mg
100 mg
Trimetoprim
20 mg
MENTERI KESEHATAN
REPUBLIK INDONESIA
NO
NAMA OBAT
94
95
96
KEMASAN
Hal 4
HNA + PPN
(Rupiah)
197.605
316.774
ktk 30 vial @ 2 ml
23.774
43.680
6.919
97
98
ktk 5 x 6 tablet
91.741
ktk 10 x 10 tablet
14.456
99
ktk 30 amp @ 2 ml
17.690
40.950
ktk 10 x 10 tablet
18.018
103
ktk 10 x 10 tablet
21.107
104
ktk 10 x 10 tablet
13.786
100
101
102
105
tube 10 g
106
18.308
107
btl 500 ml
6.126
ktk 10 amp @ 10 ml
27.435
108
109
Nifedifin tablet 10 mg
110
111
112
113
4.862
ktk 10 x 10 tablet
39.000
66.950
42.250
ktk 10 vial @ 10 ml
58.378
1.764
btl 60 ml
3.088
67.997
114
115
ktk 10 x 10 tablet
11.050
116
5.210
117
5.513
118
btl 5 ml
6.777
119
ktk 10 x 10 tablet
51.901
28.145
22.520
22.136
122
Primakuin tablet 15 mg
129.532
123
btl 1000 ml
54.600
btl 300 ml
20.358
btl 60 ml
4.290
120
121
btl 30 ml
btl 100 tablet
2.808
124
125
32.136
Frednison tablet 5 mg
122.863
126
208.000
127
ktk 30 vial @ 15 ml
234.780
128
ktk 10 x 10 tablet
18.720
129
ktk 10 x 10 tablet
9.360
130
44.096
131
ktk 10 x 10 tablet
58.500
ktk 3 x 10 tablet
18.233
MENTERI KESEHATAN
REPUBLIK INDONESIA
NO
NAMA OBAT
KEMASAN
Hal 5
HNA + PPN
(Rupiah)
132
100.984
133
16.250
21.801
134
135
16.575
136
208.000
137
138
139
140
141
142
ktk 10 x 10 kaplet
159.120
127.257
ktk 12 x 10 kapsul
93.600
ktk 10 x 10 kapsul
92.560
btl 500 ml
7.319
ktk 10 x 10 tablet
15.600
ktk 10 x 10 tablet
13.780
91.000
143
144
ktk 5 x 10 tablet
56.162
145
ktk 30 vial @ 15 ml
71.292
146
133,078
147
ktk 10 x 10 kapsul
32.512
148
153.371
149
ktk 30 amp @ 1 ml
22.198
150
42.208
151
Triheksifenidil tablet 2 mg
ktk 10 x 10 tablet
7.410
152
ktk 10 x 10 tablet
65.280
153
30.592
MENTERI KESEHATAN,