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ANTIRETROVIRAL (ARV) CEILING PRICE LIST

The Clinton Health Access Initiative (CHAI) supports national governments to expand high-quality care and treatment to people living with HIV/AIDS.
CHAI offers reduced prices for antiretrovirals (ARVs) to members of its Procurement Consortium.

SUPPLIERS & PRODUCTS
CHAI has agreements with eight manufacturers of ARV formulations, active pharmaceutical ingredients and/or pharmaceutical intermediates: Aurobindo
Pharma, Cipla Ltd., Emcure Pharmaceuticals, Hetero Drugs, Matrix Laboratories, Micro Labs Ltd., Ranbaxy Laboratories and Strides Arcolabs. The ARVs
included in CHAI’s pricing agreements are: abacavir (ABC), atazanavir (ATV), efavirenz (EFV), emtricitabine (FTC), lamivudine (3TC), lopinavir/ritonavir
(LPV/r), nevirapine (NVP), ritonavir (RTV), stavudine (d4T), tenofovir (TDF) and zidovudine (AZT).

TERMS & CONDITIONS
Prices listed below are available to countries participating in the CHAI Procurement Consortium, which currently includes over 70 nations. These prices apply
to procurements by national governments that are members of the CHAI Procurement Consortium, or organizations procuring on behalf of member
governments, to support public care and treatment programs. Products should be purchased directly from partner suppliers or through procurement agents
representing the aforementioned programs. For TDF products offered by suppliers under a voluntary license from Gilead, indicated pricing is available only to
countries covered under the voluntary license. Please contact Neeraj Mohan at mneeraj@clintonhealthaccess.org with any questions related to this issue.
Access to CHAI prices assumes prompt payment following the shipment of orders. Purchasers issuing requests for price quotes and/or tenders to which
CHAI partner suppliers are invited to respond should reference membership in the CHAI Procurement Consortium, but requests and tenders need not be
restricted to CHAI partner suppliers.

PRICES
CHAI ceiling prices represent the maximum levels at which indicated suppliers may price their products when selling or communicating price quotes to
members of the CHAI Procurement Consortium. CHAI notes that there may be, in several cases, opportunities to obtain lower prices as a result of higher
volumes, greater competition, and other market factors. We encourage Consortium members to seek and take advantage of such opportunities and to base
treatment decisions on observed market prices, with ceiling prices indicating the upper bounds of treatment costs. Prices listed below are FCA Airport from
the point of export. Annual treatment costs for pediatric formulations are determined based on the recommended daily dosing for a 10 kg child (unless a
formulation is not recommended for a 10kg child, in which case the annual price is calculated based on dosing for an applicable weight band).

QUALITY
CHAI is committed to the sustainable supply of high-quality ARVs, consistent with the specifications of dossiers approved by the World Health Organization
(WHO), U.S. Food and Drug Administration (U.S. FDA), or a stringent regulatory authority (SRA) as defined by the International Conference on
Harmonization (ICH). In the list below, footnotes specify the applicable quality assurance status for each formulation: (1) Approved by the WHO
Prequalification Programme; (2) Approved by the U.S. FDA or other SRA; (3) Submitted to the WHO, U.S. FDA or other SRA for review and recommended
for procurement by Expert Review Panel (ERP) of The Global Fund; (4) Submitted to the WHO, U.S. FDA or other SRA for review but not yet
recommended by ERP.
Clinton Health Access Initiative—Antiretroviral (ARV) Ceiling Price List
                             ZIDOVUDINE / AZT                                                       AZT+3TC / Zidovudine+Lamivudine
                                                      3TC / Lamivudine

ADULT PRODUCTS                                                              CEILING PRICE (USD)                                   SUPPLIER
Name and strength                              Packaging                    Per Year   Per pack   Per unit   Aurobindo   Cipla Emcure Hetero   Matrix Ranbaxy Micro
                                                                                                                 2         1             1,2     1,2             4
3TC (150m g)                                   HDPE bottle 60 tablets         $32        $2.6     $0.044
                                                                                                                 2         1,2                   1,2
ABC (300m g)                                   HDPE bottle 60 tablets        $210       $17.5     $0.292
                                                                                                                 2         1,2           1,2     1,2             1
AZT (300m g)                                   HDPE bottle 60 tablets         $89        $7.4     $0.123
                                                                                                                 2         1,2           1,2     1,2     1       1
AZT (300m g) + 3TC (150m g)                    HDPE bottle 60 tablets        $105        $8.8     $0.146
                                                                                                                 2         1,2           1,2     1,2     1
AZT (300m g) + 3TC (150m g) + NVP (200m g)     HDPE bottle 60 tablets        $134       $11.2     $0.186
                                                                                                                                  2              1,2
ATV (300m g) *                                 HDPE bottle 30 capsules       $265       $22.1     $0.736
                                                                                                                 2
d4T (30m g)                                    HDPE bottle 60 capsules        $24        $2.0     $0.033
                                                                                                                           1,2           2               1
d4T (30m g) + 3TC (150m g)                     HDPE bottle 60 tablets         $45        $3.8     $0.063
                                                                                                                           1,2           1,2             1
d4T (30m g) + 3TC (150m g) + NVP (200m g)      HDPE bottle 60 tablets         $79        $6.6     $0.110
                                                                                                                 2                               1,2
EFV (600m g)                                   HDPE bottle 30 tablets         $60        $5.0     $0.167
                                                                             $399       $33.3     $0.277         2         2                     1,2
LPV/r (200/50m g)                              HDPE bottle 120 tablets
                                                                                                                 2         1,2           1,2     1,2
NVP (200m g)                                   HDPE bottle 60 tablets         $36        $3.0     $0.050
                                                                                                                                                  1
RTV (100m g) heat stable *                     HDPE bottle 30 tablets         $90        $7.5     $0.250
                                                                                                                 2         1,2           2       1,2     1
TDF (300m g)                                   HDPE bottle 30 tablets         $78        $6.5     $0.217
                                                                                                                 2         2             2       1,2
TDF + 3TC (300/300m g) *                       HDPE bottle 30 tablets         $99        $8.3     $0.275
                                                                                                                 2         3                     1,2
TDF + FTC (300/200m g)                         HDPE bottle 30 tablets        $126       $10.5     $0.350
                                                                                                                                                 1,2
TDF + 3TC + EFV (300/300/600 m g)              HDPE bottle 30 tablets        $169       $14.1     $0.469
                                                                                                                                                 1,2
TDF + FTC + EFV (300/200/600 m g)              HDPE bottle 30 tablets        $194       $16.2     $0.539
                                               Blister Pack of 30 tablets
ATV (300m g) + RTV 100m g +                    each of ATV + RTV +                                                                                4
                                                                             $395       $32.9
TDF /3TC (300/300m g)                          TDF/3TC

                                   Nevirapine / NVP
*Abbott, the originator for the heat-stable formulation of RTV, has an access pricing policy of its own and has not joined CHAI’s ceiling price agreement. The
company supplies the drug at a reduced price of $42 per person per year to its Category 1 countries, which includes countries in sub-Saharan Africa and all
other Least Developed Countries. Thus, when the individual components are purchased separately from different suppliers, the TDF+3TC+ATV+RTV
regimen is available at less than $410 per person per year.




Version: May 2011
KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA
               NOMOR 092/MENKES/SK/II/2012

                            TENTANG

      HARGA ECERAN TERTINGGI OBAT GENERIK TAHUN 2012

             DENGAN RAHMAT TUHAN YANG MAHA ESA

            MENTERI KESEHATAN REPUBLIK INDONESIA,

Menimbang    : a. bahwa dalam rangka menjamin ketersediaan dan
                  pemerataan obat untuk memenuhi kebutuhan
                  pelayanan kesehatan, perlu dilakukan rasionalisasi
                  terhadap harga obat generik yang telah ditetapkan
                  dalam Keputusan Menteri Kesehatan Nomor
                  632/Menkes/SK/III/2011;
               b. bahwa berdasarkan pertimbangan sebagaimana
                  dimaksud dalam huruf a, perlu menetapkan
                  Keputusan Menteri Kesehatan tentang Harga Eceran
                  Tertinggi Obat Generik Tahun 2012;

Mengingat    : 1. Undang-Undang Nomor 5 Tahun 1997 tentang
                  Psikotropika (Lembaran Negara Republik Indonesia
                  Tahun 1997 Nomor 10, Tambahan Lembaran Negara
                  Republik Indonesia Nomor 3671);
               2. Undang-Undang Nomor 8 Tahun 1999 tentang
                  Perlindungan    Konsumen     (Lembaran    Negara
                  Republik Indonesia Tahun 1999 Nomor 42,
                  Tambahan Lembaran Negara Republik Indonesia
                  Nomor 3821);
               3. Undang-Undang Nomor 32 Tahun 2004 tentang
                  Pemerintahan Daerah (Lembaran Negara Republik
                  Indonesia Tahun 2004 Nomor 125, Tambahan
                  Lembaran Republik Indonesia Negara Nomor 4437)
                  sebagaimana telah diubah beberapa kali terakhir
                  dengan Undang-Undang Nomor 12 Tahun 2008
                  (Lembaran Negara Republik Indonesia Tahun 2008
                  Nomor 59, Tambahan Lembaran Negara Republik
                  Indonesia Nomor 4844);
- 17 -


NO                  NAMA OBAT                        KEMASAN          HET + PPN

      Klorpromazin tablet salut 100 mg (HCl)       btl 1000 tablet
250                                                                     164.700
                                                        salut
251 Kodein tablet 10 mg                             btl 250 tablet      144.208

252 Kodein tablet 10 mg                            btl 1000 tablet      456.030

253 Kodein tablet 15 mg                             btl 250 tablet      245.693

254 Kodein tablet 20 mg                             btl 250 tablet      320.909

255 Kodein tablet 30 mg                             btl 20 tablet          8.910

256 Kolkisin tablet 500 mcg                      ktk 10 x 10 tablet      36.690
    Kotrimoksazol DOEN I (dewasa)
    kombinasi:
257                                              ktk 10 x 10 tablet      22.275
    Sulfametoksazol     400 mg
    Trimetoprim           80 mg
    Kotrimoksazol DOEN II (pediatrik)
    kombinasi :
258                                              ktk 10 x 10 tablet      10.247
    Sulfametoksazol     100 mg
    Trimetoprim           20 mg
    Kotrimoksazol Suspensi kombinasi:
259 Sulfametoksazol 200 mg + Trimetoprim             btl 60 ml             5.346
    40 mg / 5 ml
260 Kuinidin tablet 100 mg                         btl 1000 tablet      211.923

261 Kuinidin tablet 200 mg                       ktk 10 x 10 tablet      56.430

262 Kuinidin tablet 200 mg                         btl 1000 tablet      610.295

263 Kuinin (Kina) tablet 200 mg                     ktk 60 tablet        47.250

264 Kuinin Dihidroklorida injeksi 25% - 2 ml        ktk 30 ampul        171.180
                                                   ktk 100 ampul
265 Kuinin injeksi i.v. 25% (sebagai 2 HCl)                             485.352
                                                       @ 2 ml
266 Kuinin tablet 222 mg (H2SO4.7H2O)              btl 1000 tablet      540.000

267 Lamivudine tablet 150 mg                        btl 60 tablet       102.600



                                               Lamivudine / 3TC
- 21 -   Nevirapine / NVP

NO                   NAMA OBAT                            KEMASAN          HET + PPN

      Nevirapin tablet 200 mg
328                                                      btl 60 tablet       211.613

329 Nifedipin tablet 10 mg                            ktk 10 x 10 tablet      17.415
                                                      ktk 10 x 10 tablet
330 Nistatin tablet salut 500.000 IU/gram                                     81.000
                                                            salut
                                                      ktk 10 x 10 tablet
331 Nistatin vaginal tablet 100.000 IU/gram                                   49.950
                                                           vaginal
332 Nitrofurantoin tablet 100 mg                        btl 100 tablet          8.343

333 Obat Antituberkulosis Kategori 1                        paket            389.070

334 Obat Antituberkulosis Kategori anak                     paket            232.200

335 Obat Batuk Hitam ( O.B.H. ) cairan                    btl 100 ml            1.931

336 Obat Batuk Hitam ( O.B.H. ) cairan                    btl 200 ml            3.846

337 Obat Antituberkulosis FDC Anak                          paket            290.250

338 Obat Antituberkulosis FDC Kategori 1                    paket            486.000

339 Obat Antituberkulosis FDC Kategori 2                    paket           1.620.000

340 Obat Antituberkulosis FDC Sisipan                       paket            216.000

341 Ofloxacin tablet 200 mg                            ktk 5 x 10 tablet      39.832

342 Ofloxacin tablet 400 mg                            ktk 5 x 10 tablet      58.928

343 Oksitetrasiklin HCl salep mata 1%                   tube 3,5 gram           2.835
                                                         ktk 25 tube
344 Oksitetrasiklin HCl salep mata 1%                                         64.800
                                                         @ 3,5 gram
      Oksitetrasiklin HCl injeksi i.m.
345                                                       ktk 10 vial         41.850
      50 mg/ml-10 ml
346 Oksitetrasiklin salep kulit 3%                       tube 5 gram            2.261
                                                         ktk 25 tube
347 Oksitetrasiklin salep kulit 3%                                            55.721
                                                          @ 5 gram
- 29 -


NO                  NAMA OBAT                       KEMASAN          HET + PPN

      Trifluoperazin tablet 1 mg
488                                             ktk 10 x 10 tablet      31.691

489 Trifluoperazin tablet 5 mg                  ktk 10 x 10 tablet      51.300

490 Triheksifenidil tablet 2 mg                 ktk 10 x 10 tablet        5.569

491 Trimetoprim tablet 200 mg                      btl 100 tablet       12.697

492 Valproat tablet 150 mg                         btl 50 tablet        15.922

493 Valproat tablet 250 mg                          btl 50 tablet       23.467
                           Zidovudine+Lamivudine / AZT
494 Verapamil tablet 80 mg +3TC
                           (HCl)                ktk 10 x 10 tablet      47.540

495 Vitamin B Kompleks tablet                     btl 1000 tablet       29.970

496 Zidovudin 300 mg + Lamivudine 150 mg           btl 60 tablet       252.450

497 Zidovudin tablet 100 mg                        btl 60 tablet        76.849

498 Zinc tablet 20 mg                           ktk 10 x 10 tablet      64.125


                                                Zidovudine / AZT

                                       MENTERI KESEHATAN,




                                       ENDANG RAHAYU SEDYANINGSIH

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Perbandingan harga obat arv generik import dan lokal

  • 1. ANTIRETROVIRAL (ARV) CEILING PRICE LIST The Clinton Health Access Initiative (CHAI) supports national governments to expand high-quality care and treatment to people living with HIV/AIDS. CHAI offers reduced prices for antiretrovirals (ARVs) to members of its Procurement Consortium. SUPPLIERS & PRODUCTS CHAI has agreements with eight manufacturers of ARV formulations, active pharmaceutical ingredients and/or pharmaceutical intermediates: Aurobindo Pharma, Cipla Ltd., Emcure Pharmaceuticals, Hetero Drugs, Matrix Laboratories, Micro Labs Ltd., Ranbaxy Laboratories and Strides Arcolabs. The ARVs included in CHAI’s pricing agreements are: abacavir (ABC), atazanavir (ATV), efavirenz (EFV), emtricitabine (FTC), lamivudine (3TC), lopinavir/ritonavir (LPV/r), nevirapine (NVP), ritonavir (RTV), stavudine (d4T), tenofovir (TDF) and zidovudine (AZT). TERMS & CONDITIONS Prices listed below are available to countries participating in the CHAI Procurement Consortium, which currently includes over 70 nations. These prices apply to procurements by national governments that are members of the CHAI Procurement Consortium, or organizations procuring on behalf of member governments, to support public care and treatment programs. Products should be purchased directly from partner suppliers or through procurement agents representing the aforementioned programs. For TDF products offered by suppliers under a voluntary license from Gilead, indicated pricing is available only to countries covered under the voluntary license. Please contact Neeraj Mohan at mneeraj@clintonhealthaccess.org with any questions related to this issue. Access to CHAI prices assumes prompt payment following the shipment of orders. Purchasers issuing requests for price quotes and/or tenders to which CHAI partner suppliers are invited to respond should reference membership in the CHAI Procurement Consortium, but requests and tenders need not be restricted to CHAI partner suppliers. PRICES CHAI ceiling prices represent the maximum levels at which indicated suppliers may price their products when selling or communicating price quotes to members of the CHAI Procurement Consortium. CHAI notes that there may be, in several cases, opportunities to obtain lower prices as a result of higher volumes, greater competition, and other market factors. We encourage Consortium members to seek and take advantage of such opportunities and to base treatment decisions on observed market prices, with ceiling prices indicating the upper bounds of treatment costs. Prices listed below are FCA Airport from the point of export. Annual treatment costs for pediatric formulations are determined based on the recommended daily dosing for a 10 kg child (unless a formulation is not recommended for a 10kg child, in which case the annual price is calculated based on dosing for an applicable weight band). QUALITY CHAI is committed to the sustainable supply of high-quality ARVs, consistent with the specifications of dossiers approved by the World Health Organization (WHO), U.S. Food and Drug Administration (U.S. FDA), or a stringent regulatory authority (SRA) as defined by the International Conference on Harmonization (ICH). In the list below, footnotes specify the applicable quality assurance status for each formulation: (1) Approved by the WHO Prequalification Programme; (2) Approved by the U.S. FDA or other SRA; (3) Submitted to the WHO, U.S. FDA or other SRA for review and recommended for procurement by Expert Review Panel (ERP) of The Global Fund; (4) Submitted to the WHO, U.S. FDA or other SRA for review but not yet recommended by ERP.
  • 2. Clinton Health Access Initiative—Antiretroviral (ARV) Ceiling Price List ZIDOVUDINE / AZT AZT+3TC / Zidovudine+Lamivudine 3TC / Lamivudine ADULT PRODUCTS CEILING PRICE (USD) SUPPLIER Name and strength Packaging Per Year Per pack Per unit Aurobindo Cipla Emcure Hetero Matrix Ranbaxy Micro 2 1 1,2 1,2 4 3TC (150m g) HDPE bottle 60 tablets $32 $2.6 $0.044 2 1,2 1,2 ABC (300m g) HDPE bottle 60 tablets $210 $17.5 $0.292 2 1,2 1,2 1,2 1 AZT (300m g) HDPE bottle 60 tablets $89 $7.4 $0.123 2 1,2 1,2 1,2 1 1 AZT (300m g) + 3TC (150m g) HDPE bottle 60 tablets $105 $8.8 $0.146 2 1,2 1,2 1,2 1 AZT (300m g) + 3TC (150m g) + NVP (200m g) HDPE bottle 60 tablets $134 $11.2 $0.186 2 1,2 ATV (300m g) * HDPE bottle 30 capsules $265 $22.1 $0.736 2 d4T (30m g) HDPE bottle 60 capsules $24 $2.0 $0.033 1,2 2 1 d4T (30m g) + 3TC (150m g) HDPE bottle 60 tablets $45 $3.8 $0.063 1,2 1,2 1 d4T (30m g) + 3TC (150m g) + NVP (200m g) HDPE bottle 60 tablets $79 $6.6 $0.110 2 1,2 EFV (600m g) HDPE bottle 30 tablets $60 $5.0 $0.167 $399 $33.3 $0.277 2 2 1,2 LPV/r (200/50m g) HDPE bottle 120 tablets 2 1,2 1,2 1,2 NVP (200m g) HDPE bottle 60 tablets $36 $3.0 $0.050 1 RTV (100m g) heat stable * HDPE bottle 30 tablets $90 $7.5 $0.250 2 1,2 2 1,2 1 TDF (300m g) HDPE bottle 30 tablets $78 $6.5 $0.217 2 2 2 1,2 TDF + 3TC (300/300m g) * HDPE bottle 30 tablets $99 $8.3 $0.275 2 3 1,2 TDF + FTC (300/200m g) HDPE bottle 30 tablets $126 $10.5 $0.350 1,2 TDF + 3TC + EFV (300/300/600 m g) HDPE bottle 30 tablets $169 $14.1 $0.469 1,2 TDF + FTC + EFV (300/200/600 m g) HDPE bottle 30 tablets $194 $16.2 $0.539 Blister Pack of 30 tablets ATV (300m g) + RTV 100m g + each of ATV + RTV + 4 $395 $32.9 TDF /3TC (300/300m g) TDF/3TC Nevirapine / NVP *Abbott, the originator for the heat-stable formulation of RTV, has an access pricing policy of its own and has not joined CHAI’s ceiling price agreement. The company supplies the drug at a reduced price of $42 per person per year to its Category 1 countries, which includes countries in sub-Saharan Africa and all other Least Developed Countries. Thus, when the individual components are purchased separately from different suppliers, the TDF+3TC+ATV+RTV regimen is available at less than $410 per person per year. Version: May 2011
  • 3. KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 092/MENKES/SK/II/2012 TENTANG HARGA ECERAN TERTINGGI OBAT GENERIK TAHUN 2012 DENGAN RAHMAT TUHAN YANG MAHA ESA MENTERI KESEHATAN REPUBLIK INDONESIA, Menimbang : a. bahwa dalam rangka menjamin ketersediaan dan pemerataan obat untuk memenuhi kebutuhan pelayanan kesehatan, perlu dilakukan rasionalisasi terhadap harga obat generik yang telah ditetapkan dalam Keputusan Menteri Kesehatan Nomor 632/Menkes/SK/III/2011; b. bahwa berdasarkan pertimbangan sebagaimana dimaksud dalam huruf a, perlu menetapkan Keputusan Menteri Kesehatan tentang Harga Eceran Tertinggi Obat Generik Tahun 2012; Mengingat : 1. Undang-Undang Nomor 5 Tahun 1997 tentang Psikotropika (Lembaran Negara Republik Indonesia Tahun 1997 Nomor 10, Tambahan Lembaran Negara Republik Indonesia Nomor 3671); 2. Undang-Undang Nomor 8 Tahun 1999 tentang Perlindungan Konsumen (Lembaran Negara Republik Indonesia Tahun 1999 Nomor 42, Tambahan Lembaran Negara Republik Indonesia Nomor 3821); 3. Undang-Undang Nomor 32 Tahun 2004 tentang Pemerintahan Daerah (Lembaran Negara Republik Indonesia Tahun 2004 Nomor 125, Tambahan Lembaran Republik Indonesia Negara Nomor 4437) sebagaimana telah diubah beberapa kali terakhir dengan Undang-Undang Nomor 12 Tahun 2008 (Lembaran Negara Republik Indonesia Tahun 2008 Nomor 59, Tambahan Lembaran Negara Republik Indonesia Nomor 4844);
  • 4. - 17 - NO NAMA OBAT KEMASAN HET + PPN Klorpromazin tablet salut 100 mg (HCl) btl 1000 tablet 250 164.700 salut 251 Kodein tablet 10 mg btl 250 tablet 144.208 252 Kodein tablet 10 mg btl 1000 tablet 456.030 253 Kodein tablet 15 mg btl 250 tablet 245.693 254 Kodein tablet 20 mg btl 250 tablet 320.909 255 Kodein tablet 30 mg btl 20 tablet 8.910 256 Kolkisin tablet 500 mcg ktk 10 x 10 tablet 36.690 Kotrimoksazol DOEN I (dewasa) kombinasi: 257 ktk 10 x 10 tablet 22.275 Sulfametoksazol 400 mg Trimetoprim 80 mg Kotrimoksazol DOEN II (pediatrik) kombinasi : 258 ktk 10 x 10 tablet 10.247 Sulfametoksazol 100 mg Trimetoprim 20 mg Kotrimoksazol Suspensi kombinasi: 259 Sulfametoksazol 200 mg + Trimetoprim btl 60 ml 5.346 40 mg / 5 ml 260 Kuinidin tablet 100 mg btl 1000 tablet 211.923 261 Kuinidin tablet 200 mg ktk 10 x 10 tablet 56.430 262 Kuinidin tablet 200 mg btl 1000 tablet 610.295 263 Kuinin (Kina) tablet 200 mg ktk 60 tablet 47.250 264 Kuinin Dihidroklorida injeksi 25% - 2 ml ktk 30 ampul 171.180 ktk 100 ampul 265 Kuinin injeksi i.v. 25% (sebagai 2 HCl) 485.352 @ 2 ml 266 Kuinin tablet 222 mg (H2SO4.7H2O) btl 1000 tablet 540.000 267 Lamivudine tablet 150 mg btl 60 tablet 102.600 Lamivudine / 3TC
  • 5. - 21 - Nevirapine / NVP NO NAMA OBAT KEMASAN HET + PPN Nevirapin tablet 200 mg 328 btl 60 tablet 211.613 329 Nifedipin tablet 10 mg ktk 10 x 10 tablet 17.415 ktk 10 x 10 tablet 330 Nistatin tablet salut 500.000 IU/gram 81.000 salut ktk 10 x 10 tablet 331 Nistatin vaginal tablet 100.000 IU/gram 49.950 vaginal 332 Nitrofurantoin tablet 100 mg btl 100 tablet 8.343 333 Obat Antituberkulosis Kategori 1 paket 389.070 334 Obat Antituberkulosis Kategori anak paket 232.200 335 Obat Batuk Hitam ( O.B.H. ) cairan btl 100 ml 1.931 336 Obat Batuk Hitam ( O.B.H. ) cairan btl 200 ml 3.846 337 Obat Antituberkulosis FDC Anak paket 290.250 338 Obat Antituberkulosis FDC Kategori 1 paket 486.000 339 Obat Antituberkulosis FDC Kategori 2 paket 1.620.000 340 Obat Antituberkulosis FDC Sisipan paket 216.000 341 Ofloxacin tablet 200 mg ktk 5 x 10 tablet 39.832 342 Ofloxacin tablet 400 mg ktk 5 x 10 tablet 58.928 343 Oksitetrasiklin HCl salep mata 1% tube 3,5 gram 2.835 ktk 25 tube 344 Oksitetrasiklin HCl salep mata 1% 64.800 @ 3,5 gram Oksitetrasiklin HCl injeksi i.m. 345 ktk 10 vial 41.850 50 mg/ml-10 ml 346 Oksitetrasiklin salep kulit 3% tube 5 gram 2.261 ktk 25 tube 347 Oksitetrasiklin salep kulit 3% 55.721 @ 5 gram
  • 6. - 29 - NO NAMA OBAT KEMASAN HET + PPN Trifluoperazin tablet 1 mg 488 ktk 10 x 10 tablet 31.691 489 Trifluoperazin tablet 5 mg ktk 10 x 10 tablet 51.300 490 Triheksifenidil tablet 2 mg ktk 10 x 10 tablet 5.569 491 Trimetoprim tablet 200 mg btl 100 tablet 12.697 492 Valproat tablet 150 mg btl 50 tablet 15.922 493 Valproat tablet 250 mg btl 50 tablet 23.467 Zidovudine+Lamivudine / AZT 494 Verapamil tablet 80 mg +3TC (HCl) ktk 10 x 10 tablet 47.540 495 Vitamin B Kompleks tablet btl 1000 tablet 29.970 496 Zidovudin 300 mg + Lamivudine 150 mg btl 60 tablet 252.450 497 Zidovudin tablet 100 mg btl 60 tablet 76.849 498 Zinc tablet 20 mg ktk 10 x 10 tablet 64.125 Zidovudine / AZT MENTERI KESEHATAN, ENDANG RAHAYU SEDYANINGSIH