Regulation, Reimbursement Notes From Indonesia

Indonesia sees a spurt in the use of generic drugs as the spread of national health insurance deepens demand. But policy makers remain concerned about the access to affordable medicines.

JAKARTA – Indonesia has made progress on getting patients to accept generic drugs, a key aim for the government as it looks to manage costs for the phased launch of universal health care that started this year.

At the same time, capitation payments to clinics have been set at rates equivalent to first-level health care providers, easing concern that rural services would lose providers such as doctors and nurses who could get more lucrative work elsewhere.

Given the rapidly changing landscape for medical services in Indonesia, PharmAsia News takes a closer look at recent developments using local-language press and government sources. For the previous version, see: (Also see "Regulation, Reimbursement Notes From Indonesia" - HBW Insight, 30 Apr, 2014.).

Use Of Generic Drugs On The Rise

Consumption of generic drugs has skyrocketed in Indonesia since phased universal health care was launched this year, reaching up to 70% of the market use, director general of pharmacy at the Ministry of Health, Maura Linda Sitanggang said (Also see "Indonesia’s Drug Formulary Short On Generic Equivalents" - Scrip, 26 Feb, 2014.). The stepped up use of generic drugs has been triggered by rising awareness and trust among the public and health workers about the improved quality of the medicines, he said. "In Indonesia, the names of generic drugs and their brands are different, but they are still generic drugs," he said. (Click here for more - Indonesian language).

Quality Drugs A Challenge For National Insurance Program

Providing effective and affordable drugs is a key challenge of the National Health Insurance program, an expert said. Before the introduction of the National Health Insurance (JKN), doctors often prescribed medicines that patients could not afford and they need to change that practice, said Hasbullah Thabrany, a professor at the Faculty of Public Health at the University of Indonesia (Also see "Confusion Marks Rollout Of Universal Health Coverage In Indonesia" - Scrip, 14 Jan, 2014.). "With the introduction of JKN, doctors need to prescribe medicines that are not only effective, but also cheap. This is our biggest challenge." She said doctors in hospitals could cooperate to decide which drugs are considered effective. (Click here for more - Indonesian language).

No More Barriers To Clinic Capitation Payments

Health workers can now breathe a sigh of relief after the use of capitation rates at first-level health providers such as community clinics was officially effective as of April 21, removing regulatory barriers present in some regions. The director of the National Social Security Administration Board for Health (BPJS Kesehatan), Fahmi Idris, said the presidential decree on capitation payments would be followed by a Health Ministry regulation and a decree of the Home Affairs Minister. "We hope that the presidential decree can solve problems anticipated in the implementation of capitation," he said. Capitation payments for health care workers such as doctors or nurses provide a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care. (Click here for more - Indonesian language).

Shortage Of Pharmacoeconomists

Indonesia still has a shortage of pharmacoeconomists as it struggles to make health care more efficient and effective, a pharmacoeconomist said. "We still have very few pharmacoeconomists, while our neighbors Malaysia and Singapore have many experts in pharmacoeconomics," said president of the Indonesian chapter of the International Society for Pharmacoeconomics Outcome Research (ISPOR), Ahmad Fuad Afdhal. Pharmacoeconomics is a discipline that compares the value of one pharmaceutical drug or drug therapy to another. He said Indonesia needed many more pharmacologists because their research would contribute to health services that are affordable, efficient and effective. He added however there was growing interest in the field. (Click here for more - Indonesian language)