Before July 2018, the drug billing system of Social Security Administering Body for the Health Sector (BPJS Kesehatan) of Indonesia was an offline system, which made it possible for members to be prescribed with the same drugs at different health facilities. This fraudulent behaviour cost BPJS Kesehatan around 382 million Indonesian rupiahs (IDR) from August 2017 to July 2018. The system made it possible for the health facilities to reimburse non-covered drugs of around IDR 10.8 billion. On the other hand, the system made it difficult for partner pharmacies to reimburse their bill on time before the expiration dates, which negatively impacted their cash flows.
To overcome these challenges, BPJS Kesehatan developed a web-based Online Pharmacy System, which provides a mechanism for billing the cost of drugs outside the package and provides a history of off-package drug service for each National Health Security member online and in real-time.
The system is having significant impacts on reducing fraud, improving efficiency and increasing the number of on time claims submission.