The Directorate General of Pharmaceuticals and Medical Devices of the Indonesian Ministry of Health through the Directorate of Pharmaceutical Management and Services held a Harmonization and Synchronization Meeting in the Framework of Preparation and Implementation of the National Formulary (Fornas) in Jakarta on June 10-11, 2024 which aims to discuss strategic plans related to the use of Short Acting Insulin in FKTP, the determination of drugs for chronic diseases and the selection of National Essential Medicines (OEN) based on consideration of the WHO Essential Medicine List (EML).

The meeting was attended by Deputy Minister of Health Prof. dr. Dante Saksono Harbuwono, Sp. PD-KEMD, Fornas Team, representatives from POM, PERKENI professional organizations and related units within the Ministry of Health.

In order to improve the quality of health services, the Ministry of Health strives to ensure the accessibility of safe, efficacious, quality, and affordable drugs in sufficient types and quantities. In the implementation of national health insurance, a list of drugs is compiled in the form of a National Formulary (Fornas).

Fornas contains a list of national essential medicines, which is a list of selected essential medicines that are most needed and must be available at first-level health care facilities and advanced health care facilities in accordance with health service needs.

The latest edition of Fornas has been stipulated through the Minister of Health Decree No. HK.01.07/Menkes/2197/2023 on the National Formulary on December 28, 2023 and came into effect on March 1, 2024.

In an effort to develop the Fornas, the implementation of the Fornas review is not only carried out by carrying out a comprehensive revision process every two years, if necessary, a review can be carried out as needed and is currently in the process of preparing an addendum to the Fornas.

Director of Pharmaceutical Management and Services, Agusdini Banun said in his report that in line with the process of preparing addendums and implementing Fornas, there are several things that need to be followed up regarding the development of Fornas in order to support optimal health services.

"In Fornas 2023, it has been determined that short acting insulin or regular insulin injection of 100 IU/mL can be provided and given by the First Level Health Service Facility (FPKTP) for the referral program, but not yet as initial treatment," said Agusdini.

Agusdini added that as an initial treatment in FPKTP is given basal insulin injection of 100 IU/mL human or analog, because its use is easier, the risk of hypoglycemia is relatively lower and basal insulin rarely causes an increase in blood sugar levels in the morning.

Meanwhile, Parenteral Antidiabetes (insulin) can be provided in health facilities by considering, among others, initial treatment, drug dosage, doctor competence and supporting facilities.

Furthermore, she conveyed that for the treatment of Diabetes Mellitus (DM) patients, it is necessary to provide insulin in FPKTP, especially in areas far from hospitals. Therefore, adjustments will be made to the restrictions on the use of insulin in Fornas, so that it can be provided at FPKTP and not only as a drug for the referral program (PRB).

"In the preparation of Fornas, drugs listed in the WHO Essential Medicine List (EML) can be used as a reference in determining national essential drugs that will be included in Fornas, by considering the types of drugs according to health service needs, disease patterns and cost control in Indonesia," Agusdini added.

Deputy Minister of Health Prof. Dante Harbuwono in his direction said that insulin drugs for the treatment of Diabetes Mellitus (DM) patients should be available in a standard model, the insulin drug should not be included in the context of initial initiation at FPKTP and may be referred back if the patient has stabilized the use of insulin in the hospital.

"In formulating the use of insulin, it is better to strengthen the knowledge of our general practitioners, especially in health centers, to be able to use insulin properly," said Dante.

He added that if possible, the Teaching Hospital will strengthen education on the use of insulin for general practitioners. Because the use of insulin is very important for their provision to be able to use multiple dose insulin in very remote areas.

"I hope the fornas team can formulate exceptions for very remote areas or areas with limited access and anticipate that the use of insulin in the puskemas can run well," said Dante.

Dante further emphasized that the community really needs our hard work, we should all respond to this wisely, hopefully these very remote areas can continue to use the initiation of the use of multiple dose insulin from the beginning of short acting insulin.

"We have the capacity to distribute to puskesmas, the rules must be formulated between the Ministry of Health, POM, BPJS and Fornas, so that it can take place wisely and concretely in the field so that it is useful for the community," concluded Dante.