Retriksi BPJS Kronis [PDF]

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RETRIKSI OBAT OBAT BPJS KRONIS NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44



NAMA OBAT ACARBOSE 100 MG ACARBOSE 50 MG ACETYLSISTEIN ACTRAPID ADALAT OROS 20 MG ADALAT OROS 30 MG ALLOPURINOL 100 MG ALLOPURINOL 300 MG ALPENTIN 100 MG ALPRAZOLAM 0,25 ALPRAZOLAM 0,5 ALPRAZOLAM 1 MG AMINOPHYLIN AMITRIOTYLINE AMLODIPINE 10 MG AMLODIPINE 5 MG ARICEPT 10 MG ARTROVENT MDI ASAM FOLAT 1 MG ASAM MEFENAMAT 500 ATORVASTATIN 20 BEROTEC MDI BETAHISTINE BINECAP BISOPROLOL 5 MG BRICASMA TURBU CALAC CANDESARTAN 16 MG CANDESARTAN 8 MG CAPTOPRIL 12,5 CAPTOPRIL 25 MG CAPTOPRIL 50 MG CASODEX 50 MG CLOBAZAM CLONIDINE CLOPIDOGREL 75 CLOZAPINE CONCOR 2,5 DEPAKOTE 250 DIAMICRON DIGOXIN DILTIAZEM DOPAMET 250 DORNER



RETRIKSI PER BULAN 90TAB 90 TAB 10CAP 3PEN 30TAB 30TAB 30TAB 30TAB 60CAP 30TAB 30TAB 30TAB 30TAB 60TAB 30TAB 30TAB 30TAB 1TBG 30TAB 30TAB 1TBG 20TAB 2500MG/HR,UTK 2MGG,TIAP 3 MGG 30TAB 1TBG 30TAB 30TAB 90TAB 90TAB 90TAB 30TAB 60TAB 90TAB 30TAB 30TAB 90TAB 30TAB 30TAB 90TAB 90TAB 90TAB



45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92



EUTHYROX 100 FARNORMIN FENITOIN FUROSEMIDE GABAPENTIN 300 GEMFIBROZIL 300 GLIBENCLAMIDE GLIMEPIRIDE 3MG GLIMEPIRIDE 1 MG GLIMEPIRIDE 2 MG GLIMEPIRIDE 4 MG HALOPERIDOL 0,5 MG HALOPERIDOL 1,5 MG HALOPERIDOL 5 MG HARNAL 0,2 HARNAL OCAS HERBESSER CD 100 HERBESSER CD 200 HYTROZ 1 MG HYTROZ 2 MG IBUPROFEN 400 IRBESARTAN 150 IRBESARTAN 300 ISDN KSR LANSOPRAZOLE LANTUS LEVEMIR LEVOPAR LISINOPRIL 10 MG LISINOPRIL 5 MG MADOPAR METFORMIN 850 MG METHYLPREDNISOLONE 16 MG METHYLPREDNISOLONE 4 MG MICARDIS 40 MICARDIS 80 MINIASPI NEO MERCAZOLE NITRAL NITROKAF RETARD 2,5 MG NITROKAF RETARD 5 MG OMEPRAZOLE ONBREZZ 150 ONBREZZ 300 PIOGLITAZONE 15 MG PIOGLITAZONE 30 MG PREDNISONE



60TAB 30TAB 90CAP 120TAB 30CAP 30CAP 90TAB 60TAB 60TAB 60TAB 30TAB 90TAB 90TAB 90TAB 30TAB 30TAB 30TAB 30TAB 30TAB 30TAB 30TAB 30TAB 30TAB 90TAB 90TAB 30CAP 20IU/HR 20IU/HR 120TAB 30TAB 30TAB 120TAB 60TAB 30TAB 30TAB 30TAB 30TAB 180TAB 90TAB 90CAP 90CAP 30CAP 30CAP 30CAP 30TAB 30TAB



93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129



PROBENID PROPRANOLOL 10 MG PROPRANOLOL 40 MG PULMICORT TURBU RAMIPRIL 10 MG RAMIPRIL 5 MG RETAPHYL RISPERIDONE SALBUTAMOL 2 MG SALBUTAMOL 4 MG SERETIDE DISKUS 100 SERETIDE DISKUS 250 SERETIDE INH 50 SIFROL 0,375 SIFROL 0,750 SIMVASTATIN 10 MG SIMVASTATIN 20 MG SPIRIVA HANDIHALER (30'S) SPIRIVA REFILL STALEVO SYMBICORT 60 160 SYMBICORT 60 80 TANAPRESS 10 MG TANAPRESS 5 MG THP THYROZOL 10 MG THYROZOL 5 MG TRIFLUOFERAZIN 5 MG URSODEOXYCHOLIC ACID VALPROAD ACID VALSARTAN 160 MG VALSARTAN 80 MG VERAPAMIL VIT B1 50 MG VITAMIN B COMP VITAMIN B12 WARFARIN 1 MG



BKT,01 DESEMBER 2018



REFI



30TAB 90TAB 30TAB 1TBG 30TAB 30TAB 30TAB 60TAB 1TBG 1TBG 1TBG 30TAB 30TAB 30TAB 30TAB 1TBG/THN 30CAP 90TAB 1TBG 3TBG 30TAB 30TAB 60TAB 90TAB 120TAB 90TAB 30CAP 5FLS 30TAB 30TAB 90TAB 30TAB 30TAB 30TAB 30TAB