Implementation of the BPJS Health Referral Program in Indonesia: Literature Review
Abstract
BPJS Health's Reverse Referral Program (PRB) is an initiative designed to ensure continuity of care for patients with chronic diseases by coordinating between primary healthcare facilities (FKTP) and partner pharmacies. This article aims to review the available literature on the effectiveness of PRB drugs, the flow of referral services, drug availability, and the role of partner pharmacies in supporting program implementation. The method used was a Systematic Literature Review using the Preferred Reporting Items for Systematic Reviews (PRISMA) flow by collecting articles from the Science Direct, Pubmed and Google Scholar databases published between 2019 and 2024 with the keywords "BPJS Referral Program", "Referral Drug Effectiveness", "PRB Drug Availability", and "BPJS Partner Pharmacies". From the initial search results, 39 articles were found (3 articles from ScienceDirect, 11 articles from PubMed, and 25 articles from Google Scholar). Based on the analysis conducted, 6 articles were double-published, 5 articles were incomplete, and 8 articles were not relevant to the topic. Then, after selection, 20 articles were identified as meeting the inclusion criteria. The results of the analysis showed that PRB helps improve patient compliance in chronic disease management and reduces the burden on referral hospitals. However, challenges faced include limited drug distribution, logistical constraints, and suboptimal coordination. This review concludes that technology-based solutions and increased regulatory capacity are needed to ensure the overall effectiveness of this program.
References
Anggara, D., Syaodih, E., & Mulyani, K. (2025). Inventory Control Strategy for the BPJS Patient Referral Program at Zhafir Clinic, Palembang. Journal of Innovation Research and Knowledge, 5.
Anisya Febriyanti, Muhammad Fawwaz, Tania Rahmayanti, & Novita Dwi Istanti. (2023). Process Evaluation of the National Health Insurance Referral System at the First Level Health Facility (FKTP): Literature Review. Journal of Health Sciences and Nursing, 1(2), 131–139. https://doi.org/10.59581/diagnosa-widyakarya.v1i2.391
Ariani, N., & Ayuchecaria, N. (2019). Analysis of Factors Affecting Adherence to Taking Medication for Referral Program Participants in Bandar Lampung. Ibnu Sina Scientific Journal (JIIS):Pharmaceutical and Health Sciences, 4(2), 410–419. https://doi.org/10.36387/jiis.v4i2.359
Budiyanti, N. A., Wiedyaningsih, C., & Andayani, T. M. (2022). Effect of Pharmacist Counseling on Adherence and Quality of Life of Hypertensive Patients in the Reverse Referral Program at the Pharmacy. Pharmaceutics Magazine, 18(3), 324–330. https://doi.org/10.22146/farmaseutik.v18i3.66591
Delima S, F. (2022). Efforts to Improve Compliance Outcomes of the Referral Program in Hospital X by Using the Problem-Solving Cycle. Silampari Nursing Journal, 5(2022).
Efayanti, D. (2019). Analysis of Factors Affecting Adherence to Taking Medication for Referral Program Participants in Bandar Lampung. JFIOnline | Print ISSN 1412-1107 | e-ISSN 2355-696X, 9(1), 19–25. https://doi.org/10.35617/jfi.v9i1.564
Islami, V. H., Ansyori, A. K., & Helmidanora, R. (2023). verview of E-Purchasing Drug Procurement for Patients of the Reverse Referral Program at Kimia Farma Samarinda Pharmacy. Indonesian Journal of Pharmaceutical Research, 5(3), 473–486. https://doi.org/10.33759/0whwam97
Mardiati, N., & Wiedyaningsih, C. (2019). Outpatient Perceptions of Generic Drug Quality. Journal of Management and Pharmacy Practice, 5(3), 195–202.
Martawinata, S., & Soewondo, P. (2023). Analysis of Drug Availability of the Reverse Referral Program (PRB) for Hypertension Cases in Palembang City in 2023. Journal of Cahaya Mandalika (JCM), 557.
Natassa, J., & Munawaroh, U. (2020). Evaluation of the Implementation of the Non-Specialistic Outpatient Referral System for BPJS Participants at the Rambah Hilir I Health Center, Rokan Hulu Regency. Bina Generasi: Journal of Health, 2(11), 64–74. https://doi.org/10.35907/jksbg.v11i01.143
Nurfauzi, Y., Dwi, I., & Nugroho, W. (2021). Pharmacist Monitoring of Changes in Type 2 DM Medications for Prolanis Patients with Educational Participation and Situation Mapping. Pharmaceutical Journal of Indonesia, 18(02), 300–315.
Nurul Wakiyah Saharani, Pratiwi Ramlan, Khaeriyah Adri, & Mardhatillah. (2024). Evaluation of the Implementation of the Referral Program on Compliance of Bpjs Health Patients at the Fella Clinic, Sidenreng Rappang Regency. Moderate: Scientific Journal of Government Science, 10(4), 698–709. https://doi.org/10.25157/moderat.v10i4.3981
Paramita, A., Andarwati, P., & Kristiana, L. (2019). Efforts to Control the Quality and Cost of the Reverse Referral Program Using the Root Cause Analysis Approach. Journal of Health Science and Prevention, 3(2), 68–78. https://doi.org/10.29080/jhsp.v3i2.214
Pitasari, N. W. N., & Risna, R. (2024). Evaluation of Antidiabetic Drug Use in the Referral Program at Pharmacy X, Jayapura Regency. Cendekia Journal of Pharmacy, 8(2), 111–118. https://doi.org/10.31596/cjp.v8i2.238
Pratiwi, Y., Asro, I. K., Wildayanti, W., Pratitis, M. P., Rahmawaty, A., & Tunggadewi, A. P. (2024). Evaluation of the Use and Cost of Oral Antidiabetic Drugs for the Referral Program with the ATC / DDD & DU 90% Method at Sana Farma Pharmacy, Kudus Regency. Cendekia Journal of Pharmacy, 8(2), 145–161. https://doi.org/10.31596/cjp.v8i2.291
Rahasasti & Laeliyah. (2020). The Effect of Pharmaceutical Education on Knowledge and Adherence to Medication in Hypertensive Patients: A Study with Prolanis Participants at Kalidewi Health Center, Cirebon Regency. Syntax Idea, 2(7), 1689–1699.
Rahayu, E., & Kusumawati, F. (2023). Analysis of Drug Procurement Constraints of the Reverse Referral Program (PRB) in First Level Health Facilities (Case Study at BLUD Puskesmas in Indragiri Hilir Regency). Journal of National Health Insurance, 3(1), 56–67. https://doi.org/10.53756/jjkn.v3i1.126
Sari, A., & Yeni, R. (2022). Study of the Implementation of the Referral Program at the BPJS Health South Jakarta Branch in 2021. Indonesian Scholar Journal of Medical and Health Science, 1(07), 236–249.
Setiawati, M. E., & Nurrizka, R. H. (2019). Evaluation of the Implementation of a Tiered Referral System in the National Health Insurance Program. Indonesian Journal of Health Policy, 08(01), 35–40.
Suryani, N., Saibi, Y., & Anwar, V. A. (2020). Profile of Drug Information Provision to Patients with Antidiabetic Prescriptions in South Tangerang Pharmacies. Pharmaceutical and Biomedical Sciences Journal (PBSJ), 2(1), 43–48. https://doi.org/10.15408/pbsj.v2i1.15280
Tampoliu, M. K. K., Aritonang, M., & Anggriani, Y. (2020). Analysis of Pharmacy Service Performance and Financial Performance at BPJS Chronic Reverse Referral Program Pharmacies and Pharmacies Not Cooperating with BPJS in Bogor City, West Java. Jurnal Ilmiah Manuntung, 6(2), 199–208.
Taufiq, R., Nuraini, F., & Yanuardi. (2019). Analysis and Design of an Information System for the Drug Referral Program in BPJS Tangerang City. Engineering Journal, 8(2), 68–73. https://doi.org/10.31000/jt.v8i2.2226
Tumole, O., Mongi, J., Karauwan, F. A., Farmasi, S., Mipa, F., Indonesiatomohon, U. K., Biologi, S., Mipa, F., Kristen, U., & Tomohon, I. (2021). Evaluation of Adherence to Taking Medication for Hypertensive Patients with BPJS Referral Program at Life Farma Pharmacy Dendengan Dalam Manado City. Journal of Biofarmaset Tropis, 4(February 2020), 102–108.
Wijayanti, T., & Murti Andayani, T. (2023). Drug utilization pattern and cost estimates of antihypertensive drugs in pharmacies BPJS Kesehatan back-referral program in Kudus Regency Pola penggunaan obat dan biaya obat antihipertensi pada apotek program rujuk balik BPJS Kesehatan di Kabupaten Kudus. Jurnal Ilmiah Farmasi (Scientific Journal of Pharmacy), 19(1), 31–43.
Wiyatami, M. A., Yasin, N. M., & Sari, I. P. (2023). The Effect of Education by Pharmacists Using the Brief Counseling Method on the Level of Knowledge, Compliance, and Clinical Outcomes of Hypertensive Patients. Pharmaceutics Magazine, 19(3), 336–344.
Copyright (c) 2025 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
