A joint assessment by Indonesia’s Ministry of Health (MoH), the World Health Organization (WHO) and the School of Pharmacy at Institut Teknologi Bandung (ITB) provides new evidence to improve medicine pricing, procurement and availability under the national health insurance scheme (JKN). Conducted across 25 health facilities in four provinces between September 2024 and March 2025, the review provides a valuable starting point for strengthening equitable access to medicines. While not nationally representative, it examines procurement, pricing, and distribution practices for chronic disease, chemotherapy, and Refer-Back Programme medicines – and how related inefficiencies are affecting availability and financial protection.
Managing medicine pricing and procurement remains complex in Indonesia’s decentralized health system. Multiple procurement pathways, price ceilings and financing mechanisms are in place, but gaps persist that affect affordability, disrupt supply chains and strain hospital budgets. This has raised ongoing concerns about the reliability of medicine access under the JKN, with direct implications for progress on the National Pharmaceutical and Medical Device Transformation Strategy, the Health Transformation Agenda and National Medium-Term Development Plan (RPJMN) 2025–2029.
The review found that many facilities are purchasing medicines at prices above national reimbursement ceilings, especially for medicines procured outside pooled purchasing mechanisms. In over half of facilities assessed, procurement prices exceeded claimable rates set in MoH decree HK.01.07/MENKES/503/2024, in some cases by up to 10 times. Despite the consolidated showcase, a list of medicines with maximum prices set by the MoH to help hospitals and health facilities buy medicines more easily and affordably, many facilities still struggle with price alignment.
While 64% of facilities reported stock availability above 80% of the medicines reviewed, shortages were frequently reported for insulin, aspirin, clopidogrel, paracetamol and certain chemotherapy drugs. Facilities in Papua and South Sulawesi provinces reported greater challenges, with shortages linked to forecasting inaccuracies, delayed payments, regulatory backlogs, dependence on imported raw materials and global supply disruptions.
“Ensuring the availability of quality, effective and affordable medicines is a necessity,” said Dita Novianti Sugandi Argadiredja, Director of Pharmaceutical Production and Distribution, MoH. “We remain committed to making sure medicines are distributed equitably and according to actual needs, no matter the location. The consolidated showcase has made access easier, but assessments are still needed to ensure alignment with the established claim values.”
The review also identified key operational constraints affecting procurement, particularly in Papua and South Sulawesi. Many hospitals reported limited access to e-catalogue credentials or trained staff, resulting in reliance on manual procurement and delayed purchasing. E-catalogue, an electronic system managed by the national procurement agency (LKPP) that lists approved suppliers and standard prices for government purchases, is designed to improve transparency and efficiency, but access barriers limit its full utilization. In some cases, wholesalers restricted access to available stock due to outstanding hospital debts, while reimbursement verification delays further contributed to recurring stockouts.
Focus group discussion in Jakarta. Credit: ITB School of Pharmacy
An agenda for action
Based on the findings, immediate priorities include improving forecasting accuracy and timeliness, expanding procurement staff training, strengthening e-catalogue capacity and addressing credentialing delays. Administrative procedures must also be streamlined to shorten payment and verification processes.
In the medium term, priorities include monitoring procurement price alignment and fulfillment rates. It’s also important to improve coordination between BPJS Kesehatan, which manages health insurance funding, and LKPP, the agency responsible for national procurement policies. Another key focus is aligning national formularies – official lists of medicines approved for use in healthcare –with e-catalogue listings and claims systems. Meanwhile, longer-term options include increasing domestic active pharmaceutical ingredient production and integrating procurement and financial data into the SatuSehat platform for real-time monitoring.
“Today, as a result of this review, we have a clear agenda for the next phase of pharmaceutical reform,” said Professor Roderick Salenga, Team Lead for Health Systems at WHO Indonesia. “Stronger procurement and financing systems are essential to secure reliable access to medicines, protect public resources and sustain progress toward universal health coverage.”
In the months ahead, WHO will continue to work with MoH and key national agencies to translate the findings into action, strengthen procurement and secure more reliable access to medicines, in alignment with the WHO Country Cooperation Strategy 2023–2027 and Indonesia’s national health reform priorities.
Written by Liyana Rakinaturia, National Professional Officer (Essential Drugs and Medicines), WHO Indonesia