Sunteți pe pagina 1din 87

ANEXA 2a

SUBLISTA A - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 90% DIN PRETUL DE REFERINTA CONFORM

DENUMIRILOR COMUNE INTERNATIONALE (DCI) CORESPUNZATOARE MEDICAMENTELOR DE CARE BENEFICIAZA ASIGURATII, IN TRATAMENTUL AMBULATORIU CU CONTRIBUTIE
PERSONALA DIN HG NR. 720/2008 CU COMPLETARILE SI MODIFICARILE ULTERIOARE
VALABILA INCEPAND CU 01 IANUARIE 2016

Co-plata maxima a Val. maxima suportata de Co-plata maxima a


asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)

1 A02BC OMEPRAZOLUM ULTOP CAPS. G 20mg KRKA D.D. SLOVENI CUTIE X 1 FLAC. PE X 14 CAPS. GAST P-6 14 0.547200 0.128514 0.492480 0.183234
2 A02BC OMEPRAZOLUM OMEPRAZOL 20 mg CAPS. G 20mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. PVC-AL-PA/AL P-6 14 0.547200 0.138514 0.492480 0.193234
3 A02BC OMEPRAZOLUM OMEPRAZOL LPH 20 mg CAPS. G 20mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAP P-6 20 0.547200 0.116800 0.492480 0.171520
4 A02BC OMEPRAZOLUM OMERAN 20 CAPS. G 20mg EUROPHARM SA ROMANIA CUTIE X 4 BLIST. AL/AL X 7 CAPS. G P-6 28 0.547200 0.246371 0.492480 0.301091
5 A02BC OMEPRAZOLUM OMEPRAZOL 20 mg CAPS. G 20mg SLAVIA PHARM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAP P-6 30 0.547200 0.235466 0.492480 0.290186
6 A02BC OMEPRAZOLUM OMEPRAZOL TERAPIA 20 mg CAPS. G 20mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAP P-6 30 0.547200 0.231800 0.492480 0.286520
7 A02BC OMEPRAZOLUM OMEPRAZOL ARENA 20 mg CAPS. G 20mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAP P-6 30 0.547200 0.214466 0.492480 0.269186
8 A02BC OMEPRAZOLUM OMEPRAZOL FARMEX 20 mg CAPS. G 20mg FARMEX COMPANY ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAP P-6 30 0.547200 0.147800 0.492480 0.202520
9 A02BC OMEPRAZOLUM NOVOGAST 20 mg CAPS. G 20mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 FOLII AL/PE X 10 CAPS. GAS P-6 20 0.547200 0.300300 0.492480 0.355020
10 A02BC OMEPRAZOLUM OMEPRAZOL ROMPHARM 2 CAPS. G 20mg ROMPHARM COMP ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAP P-6 30 0.547200 0.191466 0.492480 0.246186
11 A02BC OMEPRAZOLUM ORTANOL 20 mg CAPS. G 20mg LEK PHARMACEU SLOVENI CUTIE CU 2 BLIST. AL/AL X 7 CAPS. P-6 14 0.437857 0.000000 0.394071 0.043786
12 A02BC OMEPRAZOLUM HELICID 20 CAPS. G 20mg ZENTIVA K.S. CEHIA CUTIE X 1 FLAC. DIN STICLA X 2 P-6 28 0.547200 0.108871 0.492480 0.163591
13 A02BC OMEPRAZOLUM OMEZ 20mg CAPS. G 20mg DR. REDDY'S L ROMANIA CUTIE X 3 FOLII AL/PE-PE/AL X P-6 30 0.547200 0.193466 0.492480 0.248186
14 A02BC OMEPRAZOLUM OMEPRAZOL AUROBINDO 2 CAPS. G 20mg AU MALTA CUTIE CU BLIST P6L 28 0.331428 0.000000 0.298285 0.033143
15 A02BC OMEPRAZOLUM OMZATOL 20 mg CAPS. G 20mg ROMASTRU TRADI ROMANIA CUTIE X 4 BLIST. PA-AL-PVC/AL P-6 28 0.547200 0.246371 0.492480 0.301091
16 A02BC OMEPRAZOLUM OMZATOL 20 mg CAPS. G 20mg NEOLA PHARMA S.R. ROMANIA CUTIE X 4 BLIST. PA-AL-PVC/AL P-6 28 0.547200 0.246371 0.492480 0.301091
17 A02BC OMEPRAZOLUM OMZATOL 20 mg CAPS. G 20mg NEOLA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL P-6 14 0.547200 0.246371 0.492480 0.301091
18 A02BC OMEPRAZOLUM OMEPRAZOL ATB 20 mg CAPS. G 20mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 FOLII AL/PE X 10 CAPS. GAS P-6 20 0.547200 0.300300 0.492480 0.355020
19 A02BC OMEPRAZOLUM OMEPRAZOL ZENTIVA 20 mg CAPS. G 20mg ZENTIVA K.S. CEHIA CUTIE X 1 FLAC. DIN STICLA X 2 P-6 28 0.376785 0.000000 0.339106 0.037679
20 A02BC OMEPRAZOLUM OMEPRAZOL ZENTIVA 20 mg CAPS. G 20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 2 BLISTERE DIN OPA-AL-PED-PE-DESICANT-PED/AL A CATE 14 CAPSULE GASTROREZISTENTE P6L 28 0.376785 0.000000 0.339106 0.037679
21 A02BC OMEPRAZOLUM OMEPRAZOL ZENTIVA 20 mg CAPS. G 20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 4 BLISTERE DIN OPA-AL-PED-PE-DESICANT-PED/AL A CATE 7 CAPSULE GASTROREZISTENTE P6L 28 0.376785 0.000000 0.339106 0.037679
22 A02BC OMEPRAZOLUM OMEPRAZOL LPH 20 mg CAPS. G 20mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAP P-6 30 0.547200 0.117466 0.492480 0.172186
23 A02BC OMEPRAZOLUM OMERAN 20 mg CAPS. G 20mg GLAXOSMITHKL ROMANIA CUTIE CU 4 BLIST. AL/AL X 7 CAPS. P6L 28 0.547200 0.246371 0.492480 0.301091
24 A02BC OMEPRAZOLUM ORTANOL 40 mg CAPS. G 40mg LEK PHARMACEU SLOVENI CUTIE X 1 BLIST. AL/AL X 7 CAPS. G P-6 7 1.094400 0.097028 0.984960 0.206468
25 A02BC OMEPRAZOLUM OMEPRAZOL AUROBINDO 4 CAPS. G 40mg AU MALTA CUTIE CU BLIST P6L 14 0.645714 0.000000 0.581142 0.064572
26 A02BC OMEPRAZOLUM OMEDAR 20 mg COMP 20mg DAR AL DAWA PH ROMANIA CUTIE X 1 FLAC P-6 28 0.535357 0.000000 0.481821 0.053536
27 A02BC OMEPRAZOLUM OMEZ 40 mg PULB. P 40mg DR. REDDY'S L ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU CAPACITATE DE 15 ML CU PULB.PT. SOL. PERF. S/P-RF 1 15.153749 1.676251 13.638374 3.191626
28 A02BC OMEPRAZOLUM OMEPRAZOL ZENTIVA 40 m PULB. P 40mg ZENTIVA K.S. CEHIA CUTIE X 1 FLAC. DIN STICLA CU LIO S/P-RF 1 15.153749 1.686251 13.638374 3.201626
29 A02BC OMEPRAZOLUM HELICID 40 INF PULB. P FA ZENTIVA K.S. CEHIA CUTIE X 1 FLAC. DIN STICLA CU P S/P-RF 1 15.153749 1.676251 13.638374 3.191626
30 A02BC LANSOPRAZOLUM LEVANT 15 mg CAPS. G 15mg RANBAXY UK LTD. M CUTIE X 2 BLIST. PVC-AL-P P-6 14 0.273600 0.212828 0.246240 0.240188
31 A02BC LANSOPRAZOLUM LANZUL CAPS. G 30mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. PVC-PE P-6 14 0.547200 0.425657 0.492480 0.480377
32 A02BC LANSOPRAZOLUM LEVANT 30 mg CAPS. G 30mg RANBAXY UK LTD. M CUTIE X 2 BLIST. PVC-AL-P P-6 14 0.547200 0.294942 0.492480 0.349662
33 A02BC LANSOPRAZOLUM LANZAP 30mg CAPS. G 30mg DR. REDDY'S L ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL P-6 20 0.547200 0.316300 0.492480 0.371020
34 A03AD PAPAVERINI HYDROCHLORI PAPAVERINA ARENA 100 mg COMPR. 100mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.217500 0.012000 0.195750 0.033750
35 A03AD PAPAVERINI HYDROCHLORI PAPAVERINA FARMACOM 20 COMPR. 200 mg FARMACOM S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.427000 0.000000 0.384300 0.042700
36 A03FA METOCLOPRAMIDUM METOCLOPRAMID COMPR. 10mg SLAVIA PHARM SRL ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 COMPR. P-6 40 0.103500 0.000000 0.093150 0.010350
37 A03FA METOCLOPRAMIDUM METOCLOPRAMID 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 COMPR. P-6 40 0.104000 0.043250 0.093600 0.053650
38 A03FA METOCLOPRAMIDUM METOCLOPRAMID ARENA 1 COMPR. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 4 BLIST. PVC/AL A CATE 10 P6L 40 0.104000 0.000000 0.093600 0.010400
39 A03FA METOCLOPRAMIDUM METOCLOPRAMID BIOFAR SIROP 1mg/5ml BIOFARM S.A. ROMANIA CUTIE X 1 FLA P-R 1 9.010000 0.000000 8.109000 0.901000
40 A03FA METOCLOPRAMIDUM METOCLOPRAMID 5mg/ml SOL. INJ. 5mg/ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 2 ML P-R 5 2.742000 0.000000 2.467800 0.274200
41 A05AA ACIDUM URSODEOXYCHOL URSOFALK (R) CAPS. 250mg DR. FALK PHARMA GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CAPS. P6L 100 1.152400 0.000000 1.037160 0.115240
42 A05AA ACIDUM URSODEOXYCHOL URSOFALK (R) CAPS. 250mg DR. FALK PHARMA GERMANI CUTIE X 2 BLIST. AL/PVC X 25 CAPS. P-6 50 1.152400 0.061000 1.037160 0.176240
43 A05AA ACIDUM URSODEOXYCHOL URSOROM 250 mg CAPS. 250mg ROMPHARM COMP ROMANIA CUTIE CU 4 BLIST. PVC/AL X 15 CAPS. P6L 60 0.788500 0.000000 0.709650 0.078850
44 A05AA ACIDUM URSODEOXYCHOL URSOFALK 500 mg COMPR. FILM 500mg DR. FALK PHARMA GERMANI CUTIE CU 4 BLIST. PVC-PVDC/AL X P6L 100 2.304800 0.376900 2.074320 0.607380
45 A05AA ACIDUM URSODEOXYCHOL URSOFALK 250 mg/5 ml SUSP. ORALA 250mg/5ml DR. FALK PHARMA GERMANI CUTIE CU 1 FLAC. DIN STICLA BRUNA X 250 ML SUSP. ORALA+1LINGURITA DOZATOARE DIN PP P6L 1 57.620055 39.869945 51.858049 45.631951
46 A06AD LACTULOSUM DUPHALAC (R) LICHID ORAL 66,7% AB OLANDA FLACON DIN PEID P P6L 1 6.899858 3.850142 6.209872 4.540128

Pagina 1 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
47 A06AD LACTULOSUM LACTULOSE SIROP 65% E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLACON X 300 ML P-6 1 10.085999 0.714001 9.077399 1.722601
48 A06AD LACTULOSUM LACTULOSE SIROP 65% E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLACON X 100 ML P-6 1 3.361999 0.228001 3.025799 0.564201
49 A06AD LACTULOSUM LACTULOSE-MIP 650 mg/ml SIROP 650mg/ml MIP PHARMA GMBH GERMANI CUTIE X 1 FLAC. PET DE CULOARE BRUNA X 500 ML SIROP + 1 MASURA DOZATOARE DIN PP P-6 1 16.809999 0.420001 15.128999 2.101001
50 A06AD LACTULOSUM LACTULOSE-MIP 650 mg/ml SIROP 650mg/ml MIP PHARMA GMBH GERMANI CUTIE X 1 FLAC. PET DE CULOARE BRUNA X 1000 ML SIROP + 1 MASURA DOZATOARE DIN PP P-6 1 33.340000 0.000000 30.006000 3.334000
51 A06AD LACTULOSUM LACTULAK 660 mg/ml SOL. ORALA 660 mg/ml ROMPHARM COMP ROMANIA CUTIE X P-6 1 6.730000 0.000000 6.057000 0.673000
52 A07AA NYSTATINUM NISTATINA COMPR. FILM 500.000ui ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.480000 0.000000 0.432000 0.048000
53 A07EC SULFASALAZINUM SULFASALAZIN EN COMPR. FILM. GASTROREZ. 500mg KRKA D.D. NOVO M SLOVENI CUTIE X 5 BLIST. AL/PVC X 1 P-6 50 0.584200 0.000000 0.525780 0.058420
54 A07EC SULFASALAZINUM SALAZIDIN GR 500 mg COMP 500mg AC HELCOR PHARM ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 P6L 50 0.585200 0.000000 0.526680 0.058520
55 A07EC MESALAZINUM** PENTASA 1 g CO 1g FERRING GMBH GERMANI CUTIE CU 6 BLIST. AL/AL X 10 CO P6L 60 1.650889 1.542444 1.485800 1.707533
56 A07EC MESALAZINUM** PENTASA 500mg COMPR. 500mg FERRING GMBH GERMANI CUTIE X 10 BLIST. AL/PVC X 10 COM P-6 100 0.825444 0.557556 0.742899 0.640101
57 A07EC MESALAZINUM** S COMP 250mg DR. FALK PHARMA GERMANI CUTIE X 10 BLIST. PVC-PV P-6 100 0.412721 0.176979 0.371448 0.218252
58 A07EC MESALAZINUM** S COMP 500mg DR. FALK PHARMA GERMANI CUTIE X 10 BLIST. PVC-PV P-6 100 0.825444 0.294956 0.742899 0.377501
59 A07EC MESALAZINUM** S COMP 500mg DR. FALK PHARMA GERMANI CUTIE X 5 BLIST. PVC-P P-6 50 0.825444 0.395756 0.742899 0.478301
60 A07EC MESALAZINUM** MESALAZINA SOFARFARM COMPR. GASTROREZISTENTE 400mg SOFARFARM S.R.L. ROMANIA CUTIE CU 4 BLIST. PVC P6L 60 0.660354 0.150312 0.594318 0.216348
61 A07EC MESALAZINUM** MESALAZINA SOFARFARM COMPR. GASTROREZISTENTE 800mg SOFARFARM S.R.L. ROMANIA CUTIE CU 4 BLIST. PVC P6L 60 1.320712 0.185788 1.188640 0.317860
62 A07EC MESALAZINUM** MESALAZINA SOFARFARM COMPR. GASTROREZISTENTE 800mg SOFARFARM S.R.L. ROMANIA CUTIE CU 6 BLIST. PVC P6L 90 1.320712 0.133732 1.188640 0.265804
63 A07EC MESALAZINUM** PENTASA 1000mg SUPOZ. 1000mg FERRING GMBH GERMANI CUTIE X 4 BLIST. AL X 7 SUPOZ. + CUTIE PLASTIC X 28 CAUCIURI DE PROTECTIE A DEGETULUI P-6 28 5.886666 0.320476 5.297999 0.909143
64 A07EC MESALAZINUM** SALOFALK 1 g SUPOZ. 1g DR. FALK PHARMA GERMANI CUTIE CU FOLII TERMOSUDATE P6L 30 5.886666 0.000000 5.297999 0.588667
65 A07EC MESALAZINUM** SALOFALK (R) 250 mg SUPOZ. 250mg DR. FALK PHARMA GERMANI CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6 10 1.471662 0.702338 1.324495 0.849505
66 A07EC MESALAZINUM** SALOFALK (R) 500 mg SUPOZ. 500mg DR. FALK PHARMA GERMANI CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6 10 2.943333 0.656667 2.648999 0.951001
67 A07EC MESALAZINUM** SALOFALK 4 g/ 60 ml SUSP. RECT 4g/60ml DR. FALK PHARMA GERMANI CUTIE X 7 BLIST. AL/PE CONTINAND FIECARE CATE 1 FLACON UNIDOZA X 60 ML SUSPENSIE RECTALA + APLICA P-6 7 20.875714 0.000000 18.788142 2.087572
68 B01AA ACENOCUMAROLUM TROMBOSTOP 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.187749 0.038251 0.168974 0.057026
69 B01AA ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg NOVARTIS PHARM GERMANI CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.350000 0.000000 0.315000 0.035000
70 B01AC TICLOPIDINUM1) TICLODIN COMPR. FILM 250mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. FILM. P-R 20 0.267267 1.509233 0.240540 1.535960
71 B01AC TICLOPIDINUM1) IPATON COMPR. FILM 250mg EGIS PHARMA UNGARIA CUTIE X 2 BLIST. AL/ PVC X 10 COMPR. P-R 20 0.267267 0.420733 0.240540 0.447460
72 B02BA PHYTOMENADIONUM FITOMENADION 10 mg/ml SOL. INJ. 10mg/ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE PREVAZU S/P-RF 5 3.340000 0.000000 3.006000 0.334000
73 B03AA FERROSI SULFAS FERROGRADUMET (R) COMPR. 105mg TEOFARMA SRL ITALIA CUTIE X 3 BLIST. AL/PVC X 10 COMP P-6 30 0.282000 0.000000 0.253800 0.028200
74 B03AA FERROSI SULFAS TARDYFERON 80 mg DRAJ. ELIB 80mg LAB. PIERRE FABRE FRANTA CUTIE X 3 BLIST. AL/PVDC-PE- P-6 30 0.228972 0.186694 0.206074 0.209592
75 B03AB COMPL MALTOFER COMPR. MAS 100mg VIFOR FRANCE S.A. FRANTA CUTIE X 3 BLIST. AL/PA-AL-PVC X P-6 30 0.636035 0.107298 0.572431 0.170902
76 B03AB COMPL FER ROMPHARM 50 mg/ml PIC. ORALE 50mg/ml ROMPHARM COMP ROMANIA CUTIE CU 1 FLAC. PEID + APLICATOR PT. PICURARE DIN PEJD X 30 ML PIC. ORALE, SOL. P6L 1 8.780000 0.000000 7.902000 0.878000
77 B03AB COMPL FERGLUROM FORTE 50 mg/ PICA 50mg/ml
BIOFARM S.A. ROMANIA CUTI P-6 1 9.120000 0.000000 8.208000 0.912000
78 B03AB COMPL FERRUM HAUSMANN (R) PICAT 50mg/ml
VIFOR FRANCE S.A. FRANTA CUTIE X 1 FLACON CU PICURATOR X 3 P-6 1 9.120000 4.920000 8.208000 5.832000
79 B03AB COMPL FERRUM HAUSMANN (R) SIROP 10mg/ml
VIFOR FRANCE S.A. FRANTA CUTIE X 1 FLACON X 150 ML + P-6 1 9.120000 6.860000 8.208000 7.772000
80 B03AB COMPL FERGLUROM 50mg/5ml SIROP 50mg/5ml
BIOFARM S.A. ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 100 ML SIROP + MASURA DOZATOARE GRADATA DE LA 2,5 - 20 ML P-6 1 6.080000 4.310000 5.472000 4.918000
81 B03A C SORBIFER DURULES COMPR. FILM 100mg+60mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 50 COMPR. FILM. P-6 50 0.307800 0.000000 0.277020 0.030780
82 B03BB ACIDUM FOLICUM ACIFOL 5 mg COMPR. FILM 5mg ZENTIVA S.A. ROMANIA CUTIE X 1 FLAC. DIN PEID X 30 COMPR P-6 30 0.255666 0.000000 0.230099 0.025567
83 C01AA DIGOXINUM DIGOXIN SOPHARMA 0,25 m COMPR. 0,25 mg CN UNIFARM S.A. ROMANIA CUTIE X 20 COMPRIMATE PRF 20 0.138802 0.061698 0.124921 0.075579
84 C01AA DIGOXINUM DIGOXIN ZENTIVA 0,25 mg COMPR. 0,25mg ZENTIVA S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-R 25 0.138800 0.000000 0.124920 0.013880
85 C01AA DIGOXINUM DIGOXIN 0,5 mg/2 ml SOL. INJ. 0,5mg/2ml ZENTIVA S.A. ROMANIA C S/P-RF 5 1.652000 0.000000 1.486800 0.165200
86 C01AA DIGOXINUM DIGOXIN ZENTIVA 0,5 mg/2m SOL. INJ. 0,5mg/2ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA CU INEL DE RUPERE SAU CU PUNCT DE RUPERE SAU CU INEL DE RUPERE SI DOUA INELE (ROSU SI PORTOCALIU)X 2 ML SOL. INJ. S/P-RF 5 1.652000 0.000000 1.486800 0.165200
87 C01BA CHINIDINI SULFAS CHINIDINA ARENA 200 mg COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 1 FLAC. PEID X 20 COMPR. P-R 20 0.641350 0.000650 0.577215 0.064785
88 C01BA CHINIDINI SULFAS CHINIDINA ARENA 200 mg COMPR. 200mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.641350 0.045650 0.577215 0.109785
89 C01BA CHINIDINI SULFAS CHINIDINA ARENA 200 mg COMPR. 200mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.641350 0.024650 0.577215 0.088785
90 C01BA CHINIDINI SULFAS CHINIDINA ARENA 200 mg COMPR. 200mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. PRF 50 0.639400 0.000000 0.575460 0.063940
91 C01BC PROPAFENONUM PROPAFENONA ARENA 150 COMPR. 150mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.329400 0.011100 0.296460 0.044040
92 C01BC PROPAFENONUM PROPAFENONA ARENA 150 COMPR. 150mg ARENA GROUP SA ROMANIA CUTIE X 10 BLIST. AL/PVC X 10 COMPR. P-R 100 0.329400 0.000000 0.296460 0.032940
93 C01BC PROPAFENONUM RYTMONORM (R) COMPR. FILM 150mg ABBOTT GMBH&CO. GERMANI CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-R 50 0.329400 0.194200 0.296460 0.227140
94 C01BC PROPAFENONUM PROPAFENON AL 150 COMPR. FILM 150mg ALIUD PHA GERMANI CUTIE X 4 BLIST. X 25 COMPR. FILM. P-R 100 0.329400 0.000000 0.296460 0.032940
95 C01BC PROPAFENONUM RYTMONORM SOL. INJ. 70mg/20ml ABBOTT GMBH&CO. GERMANI CUTIE X 5 FIOLE DIN STICLA I P-R 5 7.358000 0.000000 6.622200 0.735800
96 C01BD AMIODARONUM CORDARONE 200 mg COMPR. 200mg SANOFI-AVENTIS FRANTA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.291916 0.177084 0.262724 0.206276
97 C01BD AMIODARONUM AMIODARONA LPH 200 mg COMPR. 200mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.291916 0.012750 0.262724 0.041942
98 C01BD AMIODARONUM AMIODARONA ARENA 200 COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.253666 0.000000 0.228299 0.025367
99 C01BD AMIODARONUM CORDARONE 200 mg COMPR. 200mg SANOFI-AVENTIS FRANTA CUTIE CU 2 BLIST. PVC/AL X 15 COMPR. P-R 30 0.291916 0.177084 0.262724 0.206276
100 C01DA NITROGLYCERINUM NITROMINT 2,6 mg COMPR. 2,6mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 60 COMPR. ELIB. PR P-6 60 0.150882 0.044284 0.135793 0.059373
101 C01DA NITROGLYCERINUM NITROGLICERINA 0,5 mg COMPR. S 0,5mg ZENTIVA SA ROMANIA CUTIE X 2 BLIST. PVC-PVD P-6 20 0.088402 0.112098 0.079561 0.120939

Pagina 2 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
102 C01DA NITROGLYCERINUM NITRODERM (R) TTS 5 SIST. TERAP. TRANSDERM. 25mg NOVARTIS PHARM GERMANI CUTIE X 10 PLICURI X 1 SIS P-6 10 1.557999 0.000001 1.402199 0.155801
103 C01DA NITROGLYCERINUM NITROMINT SPRAY 0,4mg/doza EGIS PHARMA UNGARIA CUTIE X 1 FLACON X 10G (18 P-6 1 12.730000 0.000000 11.457000 1.273000
104 C01DA NITROGLYCERINUM NITROMINT SPRAY 0,4mg/doza EGIS PHARMA UNGARIA CUTI P-6 1 12.730000 0.000000 11.457000 1.273000
105 C01DA ISOSORBIDI DINITRAS ISOSORBID DINITRAT 10 mg COMPR. 10mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 3, BLIST. AL/PVC X 20 COMPR. P-6 60 0.031000 0.000000 0.027900 0.003100
106 C01DA ISOSORBIDI DINITRAS ISODINIT(R) RETARD COMPR. 20mg PHARMAKI GEN M CUTIE X 6 BLIST. X 10 COMPR. ELIB. PR P-6 60 0.068333 0.000000 0.061499 0.006834
107 C01DA ISOSORBIDI MONONITRAS MONO ROM SR 40 mg CAPS. ELIB 40mg ROMPHARM COMP ROMANIA CUTIE CU 2 BLIST. PVC/PVDC/AL P6L 20 0.290159 0.302841 0.261143 0.331857
108 C01DA ISOSORBIDI MONONITRAS OLICARD 40 mg RETARD CAPS. ELIB 40mg ABBOTT LABO GERMANI CUTIE X 2 BLIST. PVC/AL X 10 CAPS. P-6 20 0.290159 0.151841 0.261143 0.180857
109 C01DA ISOSORBIDI MONONITRAS MONO ROM SR 60 mg CAPS. ELIB 60mg ROMPHARM COMP ROMANIA CUTIE CU 2 BLIST. PVC/PVDC/AL P6L 20 0.435238 0.489262 0.391714 0.532786
110 C01DA ISOSORBIDI MONONITRAS MONONITRON (R) EP 60 mg COMPR. 60mg ZENTIVA S.A ROMANIA CUTIE CU 4 BLIST. PVC/AL X 10 CO P-6 40 0.435016 0.509484 0.391514 0.552986
111 C01EA ALPROSTADILUM*** PRIDAX 20mcg CONC. 20mcg GEBRO PHARMA G AUSTRIA CUTIE X 5 FLAC. X 1 ML CONC. PT. SO S/P-RF 5 42.012500 10.297500 37.811250 14.498750
112 C01EA ALPROSTADILUM*** VASAPROSTAN 20 LIOF. PT 20g UCB PHARMA GMBH GERMANI CUTIE X 10 FIOLE X 5 ML LIOF. PT. SOL PRF 10 38.580000 0.000000 34.722000 3.858000
113 C02AB METHYLDOPUM DOPEGYT COMPR. 250mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 50 COMPR. P-6 50 0.554400 0.000000 0.498960 0.055440
114 C02AC CLONIDINUM CLONIDINA SINTOFARM 0,1 COMPR. 0,15mg SINTOFARM SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.209031 0.030969 0.188127 0.051873
115 C02AC CLONIDINUM CLONIDINA ARENA 0,15 mg COMPR. 0,15mg ARENA GROUP SA ROMANIA CUTIE X 1 FLAC. X 50 COMPR. P-6 50 0.209031 0.046969 0.188127 0.067873
116 C02AC CLONIDINUM CLONIDINA ARENA 0,15 mg COMPR. 0,15mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. P6L 50 0.209031 0.046769 0.188127 0.067673
117 C03AA HYDROCHLOROTHIAZIDUM NEFRIX 25 mg COMPR. 25mg ZENTIVA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-6 25 0.173200 0.000000 0.155880 0.017320
118 C03BA INDAPAMIDUM SERDIMID 1,5 mg CO 1,5mg SLAVIA PHARM S.R.L ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 P6L 30 0.279809 0.069857 0.251828 0.097838
119 C03BA INDAPAMIDUM INDAPAMIDA SOPHARMA 1, CO 1,5mg SOPHARMA PLC BULGARI CUTIE CU 3 BLIST. PVC/AL X 10 CO P6L 30 0.279809 0.042191 0.251828 0.070172
120 C03BA INDAPAMIDUM SERDIMID 2,5 mg CO 2,5mg SLAVIA PHARM S.R.L ROMANIA CUTIE CU 2 BLIST. PVC/AL X 15 P6L 30 0.466349 0.054984 0.419714 0.101619
121 C03BA INDAPAMIDUM INDAPAMIDA TERAPIA 1,5 m COMPR. CU ELIB. PRELUNGITA 1,5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CO P-6 30 0.279809 0.069857 0.251828 0.097838
122 C03BA INDAPAMIDUM INDAPAMIDA TERAPIA 2,5m COMPR. CU ELIB. PRELUNGITA 2,5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10COM P-6 30 0.466349 0.048651 0.419714 0.095286
123 C03BA INDAPAMIDUM INDAPAMID SR ZENTIVA 1,5 COMPR. E 1,5 mg ZENTIVA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 1 P6L 30 0.279809 0.069857 0.251828 0.097838
124 C03BA INDAPAMIDUM INDAPAMIDA MYLAN 1,5 mg COMPR. 1,5 mg MYLAN S.A.S. FRANTA CUTIE CU BLIST DIN PVC/AL X P-6 30 0.268000 0.000000 0.241200 0.026800
125 C03BA INDAPAMIDUM TERTENSIF SR 1,5 mg COMPR. 1,5mg LES LAB. SERVIER FRANTA CUTIE X 2 BLIST. AL/PVC X 15 COMP P-6 30 0.279809 0.258524 0.251828 0.286505
126 C03BA INDAPAMIDUM INDAPAMID LPH 1,5 mg COMPR. 1,5mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CO P-6 30 0.279809 0.069857 0.251828 0.097838
127 C03BA INDAPAMIDUM INDAPAMID MCC 1,5 mg COMPR. 1,5mg MAGISTRA C&C SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMP P-6 30 0.279809 0.069857 0.251828 0.097838
128 C03BA INDAPAMIDUM IDUREN SR 1,5 mg COMPR. 1,5mg VIM SPECTRUM SRL ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC P-6 30 0.279809 0.069857 0.251828 0.097838
129 C03BA INDAPAMIDUM DIUREMID SR 1,5 mg COMPR. 1,5mg GLEN ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CO P-6 30 0.279809 0.069857 0.251828 0.097838
130 C03BA INDAPAMIDUM INDAPAMIDA TEVA 1,5 mg COMPR. 1,5mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/AL P-6 30 0.264666 0.000000 0.238199 0.026467
131 C03BA INDAPAMIDUM INDAPAMIDA SR TORRENT 1 COMPR. 1,5mg TORRENT PHARMA S ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CO P6L 30 0.279809 0.069857 0.251828 0.097838
132 C03BA INDAPAMIDUM INDAPAMID LPH (R) 2,5 mg COMPR. FILM 2,5mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.466349 0.054984 0.419714 0.101619
133 C03BA INDAPAMIDUM INDAPAMID SR 1,5 mg L COMPR. FILM. ELIB. PREL. 1,5 mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 C P-6 20 0.279809 0.070191 0.251828 0.098172
134 C03BA INDAPAMIDUM RAWEL SR 1,5 mg COMPR. FILM. ELIB. PREL. 1,5mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PV P-6 30 0.264666 0.000000 0.238199 0.026467
135 C03BA INDAPAMIDUM IMPAMID SR 1,5 mg COMPR. FILM. ELIB. PREL. 1,5mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. PVC-PV P-6 30 0.279809 0.069857 0.251828 0.097838
136 C03BA INDAPAMIDUM INDAPAMIDA ACTAVIS 1,5 mg COMPR. FILM. ELIB. PREL. 1,5mg ACTAVIS GROUP P ISLANDA CUTIE CU BL P-6 30 0.268666 0.000000 0.241799 0.026867
137 C03CA FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R.L ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.156500 0.000000 0.140850 0.015650
138 C03CA FUROSEMIDUM FUROSEMID SLAVIA COMPR. 40mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.156500 0.000000 0.140850 0.015650
139 C03CA FUROSEMIDUM FUROSEMID ZENTIVA COMPR. 40mg ZENTIVA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 20 COMPR. P-6 20 0.156750 0.156250 0.141075 0.171925
140 C03CA FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.156750 0.000250 0.141075 0.015925
141 C03CA FUROSEMIDUM FUROSEMID ARENA 40 mg COMPR. 40mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.156750 0.156250 0.141075 0.171925
142 C03CA FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.156750 0.114250 0.141075 0.129925
143 C03CA FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. DIN PVC/AL X 10 C P-6 30 0.156750 0.000916 0.141075 0.016591
144 C03CA FUROSEMIDUM FUROSEMID 20 mg/2 ml SOL. INJ. 10mg/ml ZENTIVA SA ROMANIA CUTIE P-R 5 1.260000 0.000000 1.134000 0.126000
145 C03DA SPIRONOLACTONUM VEROSPIRON CAPS. 100mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6 30 0.753000 0.000000 0.677700 0.075300
146 C03DA SPIRONOLACTONUM SPIRONOLACTONA ARENA CAPS. 25mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 CAPS. P-6 50 0.220833 0.112567 0.198749 0.134651
147 C03DA SPIRONOLACTONUM SPIRONOLACTONA LPH 25 CAPS. 25mg LABORMED PHARMA ROMANIA CUTIE CU 6 BLIST. PVC/AL X 10 CAPS. P6L 60 0.220833 0.115500 0.198749 0.137584
148 C03DA SPIRONOLACTONUM VEROSPIRON CAPS. 50mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6 30 0.441666 0.000000 0.397499 0.044167
149 C03DA SPIRONOLACTONUM SPIRONOLACTONA ARENA CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P-6 30 0.441666 0.120334 0.397499 0.164501
150 C03DA SPIRONOLACTONUM SPIRONOLACTONA BIOEEL COMPR. 25mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.220833 0.001667 0.198749 0.023751
151 C03DA SPIRONOLACTONUM SPIRONOLACTONA TERAPI COMPR. FILM 25mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.220833 0.148967 0.198749 0.171051
152 C03DA SPIRONOLACTONUM ALSPIRON 25 mg COMPR. FILM 25mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.215000 0.000000 0.193500 0.021500
153 C03DA SPIRONOLACTONUM ALSPIRON 50 mg COMPR. FILM 50mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.441666 0.245334 0.397499 0.289501
154 C03EB COM DIUROCARD 50 mg/20 mg CAPS. 50mg/20 mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 1.079083 0.009917 0.971174 0.117826
155 C03EB COM DIUREX 50 CAPS. 50mg/20mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-6 20 1.079083 0.130417 0.971174 0.238326
156 C03EB COM DIOCOR 50 mg/20 mg CAPS. 50mg/20mg SANIENCE S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 1.049333 0.000000 0.944399 0.104934

Pagina 3 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
157 C03EB COM DIOCOR 50 mg/20 mg CAPS. 50mg/20mg SANIENCE S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. P6L 20 1.079083 0.086417 0.971174 0.194326
158 C04AD PENTOXIFYLLINUM PENTOXI RETARD 400 mg COMPR. 400mg TERAPIA SA ROMANIA CUTIE X 4 BLIST. X 10 COMPR. CU ELI P-6 40 0.432283 0.149467 0.389054 0.192696
159 C04AD PENTOXIFYLLINUM PENTOXI RETARD 400 mg COMPR. 400mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. FILM. P-6 20 0.432283 0.460717 0.389054 0.503946
160 C04AD PENTOXIFYLLINUM PENTOXIFILINA SR ZENTI COMPR. 400mg ZENTIVA AS SLOVACI CUTIE X 2 BLIST. PVC-PV P-6 20 0.432283 0.098717 0.389054 0.141946
161 C04AD PENTOXIFYLLINUM PENTOXIFILINA SR ZENTI COMPR. 400mg ZENTIVA AS SLOVACI CUTIE X 5 BLIST. PVC-PV P-6 50 0.426200 0.000000 0.383580 0.042620
162 C04AD PENTOXIFYLLINUM PENTOXIFILINA SR ZENTI COMPR. 600mg ZENTIVA AS SLOVACI CUTIE X 5 BLIST. PVC-PV P-6 50 0.648425 0.053575 0.583582 0.118418
163 C04AD PENTOXIFYLLINUM PENTOXIFILINA SR ZENTI COMPR. 600mg ZENTIVA AS SLOVACI CUTIE X 10 BLIST. PVC P-6 100 0.648425 0.029875 0.583582 0.094718
164 C04AD PENTOXIFYLLINUM VASONIT RETARD 600 mg COMPR. 600mg LANN AUSTRIA CUTIE X 5 BLIST. PVC/AL X 10 COMP P-6 50 0.648425 0.027375 0.583582 0.092218
165 C04AD PENTOXIFYLLINUM ANGIOPENT 400 mg COMPR. FILM. ELIB. PREL. 400mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 C P-6 20 0.318000 0.000000 0.286200 0.031800
166 C04AD PENTOXIFYLLINUM OXIFLUX 400 mg COMPR. FILM. ELIB. PREL. 400mg LABORMED PHARMA ROMANIA CUTIE X 6 BLIST. AL/PVC X 10 C P-6 60 0.318166 0.000000 0.286349 0.031817
167 C04AD PENTOXIFYLLINUM ANGIOPENT 600 mg COMPR. FILM. ELIB. PREL. 600mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST., AL/PVC X 10 P-6 20 0.648425 0.174575 0.583582 0.239418
168 C07AA PROPRANOLOLUM PROPRANOLOL EEL 10 mg COMPR. 10 mg BIO EEL S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 25 COMPR. P6L 50 0.025800 0.041600 0.023220 0.044180
169 C07AA PROPRANOLOLUM PROPRANOLOL 10 mg COMPR. 10mg SINTOFARM SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.025800 0.056200 0.023220 0.058780
170 C07AA PROPRANOLOLUM PROPRANOLOL EEL 40 mg COMPR. 40mg BIO EEL SRL ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.099600 0.000000 0.089640 0.009960
171 C07AA PROPRANOLOLUM PROPRANOLOL 40 mg COMPR. 40mg SINTOFARM SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.099600 0.000000 0.089640 0.009960
172 C07AA PROPRANOLOLUM PROPRANOLOL ARENA 40 COMPR. 40mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.103200 0.000000 0.092880 0.010320
173 C07AA SOTALOLUM SOTALOL AL 160 COMPR. 160mg ALIUD PHARMA GMB GERMANI CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.412800 0.146000 0.371520 0.187280
174 C07AA SOTALOLUM DAROB (R) 80 mg COMPR. 80mg ABBOTT GMBH&CO. GERMANI CUTIE X 2 BLIST. AL/PVP X 10 COMPR. P-6 20 0.206400 0.311100 0.185760 0.331740
175 C07AA SOTALOLUM SOTAGAMMA 80 COMPR. 80mg WORWAG GERMANI CUTIE X 10 BLIST. AL/PVC-PVDC X 10 P-6 100 0.206400 0.130100 0.185760 0.150740
176 C07AA SOTALOLUM SOTALOL AL 80 COMPR. 80mg ALIUD PHARMA GMB GERMANI CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.206400 0.120600 0.185760 0.141240
177 C07AB METOPROLOLUM BLOXAN COMPR. 100mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC/PVD P-6 30 0.077000 0.000000 0.069300 0.007700
178 C07AB METOPROLOLUM BETAPROL 100 mg COMPR. 100mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.221400 0.074933 0.199260 0.097073
179 C07AB METOPROLOLUM EGILOK 100 mg COMPR. 100mg EGIS PHARMA UNGARIA CUTIE X, 1 FLAC. DIN STICLA BRUN P-6 20 0.221400 0.075100 0.199260 0.097240
180 C07AB METOPROLOLUM METOPROLOL LPH 100 mg COMPR. 100mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.221400 0.024600 0.199260 0.046740
181 C07AB METOPROLOLUM METOPROLOL LAROPHARM COMPR. 100mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.221400 0.075100 0.199260 0.097240
182 C07AB METOPROLOLUM METOPROLOL 100 mg COMPR. 100mg MAGISTRA C & C SR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.221400 0.074933 0.199260 0.097073
183 C07AB METOPROLOLUM METOPROLOL TERAPIA 100 COMPR. 100mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.221400 0.074933 0.199260 0.097073
184 C07AB METOPROLOLUM METOPROLOL VIM SPE COMPR. 100mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.221400 0.075100 0.199260 0.097240
185 C07AB METOPROLOLUM METOPROLOL ARENA 100 COMPR. 100mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.221400 0.020933 0.199260 0.043073
186 C07AB METOPROLOLUM METOPROLOL 100 mg COMPR. 100mg SLAVIA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.221400 0.069100 0.199260 0.091240
187 C07AB METOPROLOLUM METOPROLOL AL 100 COMPR. 100mg ALIUD PHARMA GMB GERMANI CUTIE X 3 BLIST. DIN PVC-PVDC/AL P-6 30 0.221400 0.074933 0.199260 0.097073
188 C07AB METOPROLOLUM METOPROLOL ZENTIVA 100 COMPR. 100mg ZENTIVA S.A. ROMANIA CUTIE CU 3 BLIST. DIN PVC/AL X 1 P6L 30 0.221400 0.074933 0.199260 0.097073
189 C07AB METOPROLOLUM EGILOK 25 mg COMPR. 25mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA P-6 20 0.055349 0.043151 0.049814 0.048686
190 C07AB METOPROLOLUM METOPROLOL LPH 25 mg COMPR. 25mg LABORMED PHARMA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-6 20 0.055349 0.043151 0.049814 0.048686
191 C07AB METOPROLOLUM METOPROLOL 25 mg COMPR. 25mg MAGISTRA C & C SR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.055349 0.043317 0.049814 0.048852
192 C07AB METOPROLOLUM METOPROLOL ARENA 25 MG COMPR. 25mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.055349 0.043317 0.049814 0.048852
193 C07AB METOPROLOLUM METOPROLOL LPH 25 mg COMPR. 25mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 20 COMPR. P-6 60 0.055349 0.042984 0.049814 0.048519
194 C07AB METOPROLOLUM METOPROLOL LAROPHAR COMPR. 50mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.110700 0.071800 0.099630 0.082870
195 C07AB METOPROLOLUM BETAPROL 50 mg COMPR. 50mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.110700 0.071633 0.099630 0.082703
196 C07AB METOPROLOLUM EGILOK 50 mg COMPR. 50mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA P-6 20 0.110700 0.071800 0.099630 0.082870
197 C07AB METOPROLOLUM METOPROLOL LPH 50 mg COMPR. 50mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.110700 0.053633 0.099630 0.064703
198 C07AB METOPROLOLUM METOPROLOL 50 mg COMPR. 50mg MAGISTRA C & C SR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.110700 0.071633 0.099630 0.082703
199 C07AB METOPROLOLUM METOPROLOL TERAPIA 50 COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.110700 0.133300 0.099630 0.144370
200 C07AB METOPROLOLUM METOPROLOL VIM SPEC COMPR. 50mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.110700 0.061800 0.099630 0.072870
201 C07AB METOPROLOLUM METOPROLOL ARENA 50 MG COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.110700 0.071633 0.099630 0.082703
202 C07AB METOPROLOLUM METOPROLOL 50 mg COMPR. 50mg SLAVIA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.110700 0.071800 0.099630 0.082870
203 C07AB METOPROLOLUM METOPROLOL AL 50 COMPR. 50mg ALIUD PHARMA GMB GERMANI CUTIE X 3 BLIST. DIN PVC-PVDC/AL P-6 30 0.110700 0.040966 0.099630 0.052036
204 C07AB METOPROLOLUM METOPROLOL ZENTIVA 50 m COMPR. 50mg ZENTIVA S.A. ROMANIA CUTIE CU 3 BLIST. DIN PVC/AL X 1 P6L 30 0.110700 0.071633 0.099630 0.082703
205 C07AB METOPROLOLUM METOSUCCINAT SANDOZ 1 COMPR. 190mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PP/AL X 10 COMP P-6 30 0.420660 0.083340 0.378594 0.125406
206 C07AB METOPROLOLUM METOSUCCINAT SANDOZ 4 COMPR. 47,5mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PP/AL X 10 COMP P-6 30 0.105164 0.110502 0.094647 0.121019
207 C07AB METOPROLOLUM METOSUCCINAT SANDOZ 9 COMPR. 95mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PP/AL X 10 COMP P-6 30 0.210330 0.148003 0.189297 0.169036
208 C07AB METOPROLOLUM METOPROLOL RETARD 100 COMPR. 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. PVC- P-6 20 0.221400 0.075100 0.199260 0.097240
209 C07AB METOPROLOLUM METOPROLOL TA COMPR. FILM 100mg AU MALTA CUTIE CU BLIST. PVC-PVDC/AL X 30 P6L 30 0.221400 0.074933 0.199260 0.097073
210 C07AB METOPROLOLUM METOPROLOL TART COMPR. FILM 50mg AU MALTA CUTIE CU BLIST. PVC-PVDC/AL X 30 P6L 30 0.110700 0.070633 0.099630 0.081703
211 C07AB METOPROLOLUM BETALOC (R) ZOK 100 mg COMPR. FILM. ELIB. PREL. 100mg ASTRAZENECA AB SUEDIA CUTIE X 1 FLAC. X 30 COMPR. FILM. E P-6 30 0.221400 0.234600 0.199260 0.256740

Pagina 4 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
212 C07AB METOPROLOLUM BETALOC (R) ZOK 50 mg COMPR. FILM. ELIB. PREL. 50mg ASTRAZENECA AB SUEDIA CUTIE X 1 FLAC. X 30 COMPR. FILM. E P-6 30 0.110700 0.269300 0.099630 0.280370
213 C07AB METOPROLOLUM METOSUCCINAT SANDOZ 1 CO 190mg HEXAL AG GERMANI CUTIE X 3 BLIST. ACL P-6 30 0.420660 0.083340 0.378594 0.125406
214 C07AB METOPROLOLUM METOSUCCINAT SANDOZ 4 CO 47,5mg HEXAL AG GERMANI CUTIE X 3 BLIST. ACL P-6 30 0.105164 0.110502 0.094647 0.121019
215 C07AB METOPROLOLUM METOSUCCINAT SANDOZ 9 CO 95mg HEXAL AG GERMANI CUTIE X 3 BLIST. ACL P-6 30 0.210330 0.148003 0.189297 0.169036
216 C07AB ATENOLOLUM ATENOLOL LPH 100 mg COMPR. 100mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.365666 0.000000 0.329099 0.036567
217 C07AB ATENOLOLUM ATENOLOL LPH 100 mg COMPR. 100mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.365000 0.000000 0.328500 0.036500
218 C07AB ATENOLOLUM ATENOLOL ARENA 100 MG COMPR. 100mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.324500 0.000000 0.292050 0.032450
219 C07AB ATENOLOLUM ATENOLOL LPH 50 mg COMPR. 50mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.204000 0.000000 0.183600 0.020400
220 C07AB ATENOLOLUM ATENOLOL LPH 50 mg COMPR. 50mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.204000 0.000000 0.183600 0.020400
221 C07AB ATENOLOLUM ATENOLOL ARENA 50 MG COMPR. 50mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.185000 0.000000 0.166500 0.018500
222 C07AB BETAXOLOLUM LOKREN 20 mg COMPR. FILM 20mg SANOFI-AVENTIS FRANTA CUTIE X 2 BLIST. AL/PVC X 14 COMPR.F P-6 28 0.332100 0.023971 0.298890 0.057181
223 C07AB BISOPROLOLUM BISOPROLOL LPH 10mg COMPR. 10mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 C P-6 30 0.332100 0.241566 0.298890 0.274776
224 C07AB BISOPROLOLUM BISOBLOCK 10 mg COMPR. 10mg ACTAVIS GROUP P ISLANDA CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.231000 0.000000 0.207900 0.023100
225 C07AB BISOPROLOLUM BISOPROLOL LPH 5mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 C P-6 30 0.166050 0.086616 0.149445 0.103221
226 C07AB BISOPROLOLUM BISOBLOCK 5 mg COMPR. 5mg ACTAVIS GROUP P ISLANDA CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.122333 0.000000 0.110099 0.012234
227 C07AB BISOPROLOLUM BOREZ 10 mg COMPR. FILM 10 mg ALKALOID-INT D.O.O SLOVENI CUTIE CU 3 BLI P6L 30 0.332100 0.030900 0.298890 0.064110
228 C07AB BISOPROLOLUM CONCOR 10 mg COMPR. FILM 10mg MERCK KGAA GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR.F P-6 30 0.332100 0.550900 0.298890 0.584110
229 C07AB BISOPROLOLUM BISOGAMMA (R) 10 COMPR. FILM 10mg WORWAG GERMANI CUTIE X 10 BLIST. X 10 COMPR. FILM. P 100 0.332100 0.169100 0.298890 0.202310
230 C07AB BISOPROLOLUM BISOGAMMA (R) 10 COMPR. FILM 10mg WORWAG GERMANI CUTIE X 3 BLIST. X 10 COMPR. FILM. P-6 30 0.332100 0.028566 0.298890 0.061776
231 C07AB BISOPROLOLUM CONCOR COR 10 mg COMPR. FILM 10mg MERCK KGAA GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.332100 0.753233 0.298890 0.786443
232 C07AB BISOPROLOLUM BISOTENS 10 mg COMPR. FILM 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.332100 0.014566 0.298890 0.047776
233 C07AB BISOPROLOLUM BISOPROLOL FU COMPR. FILM 10mg AU MALTA CUTIE CU BLIST. PA-PVC- P6L 30 0.332100 0.140566 0.298890 0.173776
234 C07AB BISOPROLOLUM CONCOR COR 10 mg COMPR. FILM 10mg MERCK KGAA GERMANI CUTIE CU 3 BLIST. PVC/AL X 10 COMPR P6L 30 0.332100 0.753233 0.298890 0.786443
235 C07AB BISOPROLOLUM SOBYC 10 mg COMPR. FILM 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. AL/AL X 30 COMPR. FI P6L 30 0.332100 0.015233 0.298890 0.048443
236 C07AB BISOPROLOLUM BOREZ 2,5 mg COMPR. FILM 2,5 mg ALKALOID-INT D.O.O SLOVENI CUTIE CU 3 BLI P6L 30 0.083025 0.160308 0.074722 0.168611
237 C07AB BISOPROLOLUM CONCOR COR 2,5 mg COMPR. FILM 2,5mg MERCK KGAA GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.083025 0.291308 0.074722 0.299611
238 C07AB BISOPROLOLUM CONCOR COR 2,5 mg COMPR. FILM 2,5mg MERCK KGAA GERMANI CUTIE CU 3 BLIST. PVC/AL X 10 COMPR P6L 30 0.083025 0.291308 0.074722 0.299611
239 C07AB BISOPROLOLUM SOBYC 2,5 mg COMPR. FILM 2,5mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. AL/AL X 30 COMPR. FI P6L 30 0.083025 0.125975 0.074722 0.134278
240 C07AB BISOPROLOLUM CONCOR 5 mg COMPR. FILM 5mg MERCK KGAA GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR.F P-6 30 0.166050 0.348950 0.149445 0.365555
241 C07AB BISOPROLOLUM BISOGAMMA (R) 5 COMPR. FILM 5mg WORWAG GERMANI CUTIE X 3 BLIST. X 10 COMPR. FILM. P-6 30 0.160333 0.000000 0.144299 0.016034
242 C07AB BISOPROLOLUM BISOGAMMA (R) 5 COMPR. FILM 5mg WORWAG GERMANI CUTIE X 4 BLIST. X 25 COMPR. FILM. P-6 100 0.166050 0.002850 0.149445 0.019455
243 C07AB BISOPROLOLUM CONCOR COR 5 mg COMPR. FILM 5mg MERCK KGAA GERMANI CUTIE X 3 BLIST. AL/PVC, X 10 COMPR. P-6 30 0.166050 0.223283 0.149445 0.239888
244 C07AB BISOPROLOLUM BISOTENS 5 mg COMPR. FILM 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.166050 0.040283 0.149445 0.056888
245 C07AB BISOPROLOLUM BISOPROLOL FUMAR COMPR. FILM 5mg AU MALTA CUTIE CU BLIST. PA-PVC- P6L 30 0.166050 0.106283 0.149445 0.122888
246 C07AB BISOPROLOLUM CONCOR COR 5 mg COMPR. FILM 5mg MERCK KGAA GERMANI CUTIE CU 3 BLIST. PVC/AL X 10 COMPR P6L 30 0.166050 0.223283 0.149445 0.239888
247 C07AB BISOPROLOLUM SOBYC 5 mg COMPR. FILM 5mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. AL/AL X 30 COMPR. FI P6L 30 0.166050 0.040283 0.149445 0.056888
248 C07A CARVEDILOLUM CARVEDILOL SANDOZ 12,5 COMPR. 12,5 mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 P6L 30 0.246149 0.031184 0.221534 0.055799
249 C07A CARVEDILOLUM DILATREND (R) 12,5 mg COMPR. 12,5mg ROCHE ROMANIA S.R ROMANIA CUTIE X 2 BLIST. OPA-AL-PVDC/AL X P-6 28 0.246149 0.588136 0.221534 0.612751
250 C07A CARVEDILOLUM CORYOL 12,5 mg COMPR. 12,5mg KRKA D.D. NOVO M SLOVENI CUTIE X 4 BLIST. OPA-AL-PVC/AL X 7 P-6 28 0.246149 0.013136 0.221534 0.037751
251 C07A CARVEDILOLUM TALLITON (R) 12,5 mg COMPR. 12,5mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA P-6 30 0.246149 0.034851 0.221534 0.059466
252 C07A CARVEDILOLUM CARVEDILOL LPH 12,5 mg COMPR. 12,5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.246149 0.216184 0.221534 0.240799
253 C07A CARVEDILOLUM CARVEDILOL VIM SPECT COMPR. 12,5mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.246149 0.089851 0.221534 0.114466
254 C07A CARVEDILOLUM GLADYCOR 12,5 mg COMPR. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6 30 0.246149 0.139184 0.221534 0.163799
255 C07A CARVEDILOLUM MIOCARVIL 12,5 mg COMPR. 12,5mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6 30 0.246149 0.216184 0.221534 0.240799
256 C07A CARVEDILOLUM CARVEDILOL HELCOR 12,2 COMPR. 12,5mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.246149 0.205851 0.221534 0.230466
257 C07A CARVEDILOLUM DILATREND (R) 25 mg COMPR. 25mg ROCHE ROMANIA S.R ROMANIA CUTIE X 2 BLIST. OPA-AL-PVDC/AL X P-6 28 0.492299 0.434486 0.443069 0.483716
258 C07A CARVEDILOLUM CORYOL 25 mg COMPR. 25mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. OPA-AL-PVC/AL X 14 P-6 28 0.355000 0.000000 0.319500 0.035500
259 C07A CARVEDILOLUM TALLITON (R) 25 mg COMPR. 25mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA P-6 30 0.492299 0.031034 0.443069 0.080264
260 C07A CARVEDILOLUM CARVEDILOL LPH 25 mg COMPR. 25mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.492299 0.109701 0.443069 0.158931
261 C07A CARVEDILOLUM GLADYCOR 25 mg COMPR. 25mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6 30 0.492299 0.031701 0.443069 0.080931
262 C07A CARVEDILOLUM MIOCARVIL 25 mg COMPR. 25mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6 30 0.492299 0.108701 0.443069 0.157931
263 C07A CARVEDILOLUM CARVEDILOL HELCOR 25 mg COMPR. 25mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.492299 0.110201 0.443069 0.159431
264 C07A CARVEDILOLUM CARVEDILOL SANDOZ 25 mg COMPR. 25mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 P6L 30 0.317333 0.000000 0.285599 0.031734
265 C07A CARVEDILOLUM DILATREND (R) 6,25 mg COMPR. 6,25mg ROCHE ROMANIA S.R ROMANIA CUTIE X 2 BLIST. OPA-AL-PVDC/AL X P-6 28 0.123074 0.266568 0.110766 0.278876
266 C07A CARVEDILOLUM CORYOL (R) COMPR. 6,25mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. OPA-AL-PVC/AL X 7 P-6 28 0.123074 0.075140 0.110766 0.087448

Pagina 5 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
267 C07A CARVEDILOLUM TALLITON 6,25 mg COMPR. 6,25mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA P-6 30 0.123074 0.061926 0.110766 0.074234
268 C07A CARVEDILOLUM CARVEDILOL LPH 6,25 mg COMPR. 6,25mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.123074 0.115259 0.110766 0.127567
269 C07A CARVEDILOLUM CARVEDILOL VIM SPECT COMPR. 6,25mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.123074 0.104926 0.110766 0.117234
270 C07A CARVEDILOLUM GLADYCOR 6,25 mg COMPR. 6,25mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6 30 0.123074 0.061926 0.110766 0.074234
271 C07A CARVEDILOLUM MIOCARVIL 6,25 mg COMPR. 6,25mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. P-6 30 0.123074 0.115259 0.110766 0.127567
272 C07A CARVEDILOLUM CARVEDILOL SANDOZ 6,25 COMPR. 6,25mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 P6L 30 0.123074 0.057259 0.110766 0.069567
273 C07A CARVEDILOLUM CARVEDILOL AUROBINDO 1 COMPR. FILM 12,5mg AU MALTA CUTIE CU BLIST. PVC-PE-PVDC/AL P6L 28 0.246149 0.010993 0.221534 0.035608
274 C07A CARVEDILOLUM CARVEDILOL AUROBINDO 2 COMPR. FILM 25mg AU MALTA CUTIE CU BLIST. PVC-PE-PVDC/AL P6L 28 0.285714 0.000000 0.257142 0.028572
275 C07A CARVEDILOLUM CARVEDILOL AUROBINDO 6 COMPR. FILM 6,25mg AU MALTA CUTIE CU BLIST. PVC-PE-PVDC/AL P6L 28 0.123074 0.056926 0.110766 0.069234
276 C08CA AMLODIPINUM AMLODIPINA TEVA 10 mg COMPR. 10 mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 C P6L 30 0.123333 0.000000 0.110999 0.012334
277 C08CA AMLODIPINUM AMLOHEXAL 10 mg COMPR. 10mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC-COC-PVDC P-6 30 0.264299 0.029367 0.237869 0.055797
278 C08CA AMLODIPINUM TENOX (R) 10 COMPR. 10mg KRKA D.D. SLOVENI CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 P-6 30 0.264299 0.029367 0.237869 0.055797
279 C08CA AMLODIPINUM AMLODIPINE MEDOCHEMIE COMPR. 10mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. PVC-PE-PVDC/AL X P-6 30 0.264299 0.029367 0.237869 0.055797
280 C08CA AMLODIPINUM ALMACOR 10 mg COMPR. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6 30 0.264299 0.029367 0.237869 0.055797
281 C08CA AMLODIPINUM AMLODIPINA LPH 10 mg COMPR. 10mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.264299 0.029367 0.237869 0.055797
282 C08CA AMLODIPINUM AMLODIPINA TERAPIA 10 m COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 P-6 30 0.264299 0.029367 0.237869 0.055797
283 C08CA AMLODIPINUM AMLODIPINA TERAPIA 10 m COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. ACLAR-PVC/AL X 10 P-6 30 0.264299 0.029367 0.237869 0.055797
284 C08CA AMLODIPINUM AMLODIPINA AUROBINDO 1 COMPR. 10mg AU MALTA CUTIE CU BLIST. PVC/PVDC-AL X 30 C P6L 30 0.255333 0.000000 0.229799 0.025534
285 C08CA AMLODIPINUM RECOTENS 10 mg COMPR. 10mg ICN POLFA RZESZO POLONIA CUTIE CU BLIST. PVC-PE-PVDC/AL X P6L 30 0.264299 0.029367 0.237869 0.055797
286 C08CA AMLODIPINUM AMLODIPIN VIM SPECTRUM COMPR. 10mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC/AL P-6 20 0.264299 0.029201 0.237869 0.055631
287 C08CA AMLODIPINUM AMLODIPINA ACTAVIS 10 mg COMPR. 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC/AL X 20 C P6L 20 0.192500 0.000000 0.173250 0.019250
288 C08CA AMLODIPINUM AMLODIPINA ZENTIVA 10 mg COMPR. 10mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 C P6L 30 0.264299 0.009034 0.237869 0.035464
289 C08CA AMLODIPINUM NORVASC 10 mg COMPR. 10mg PFIZER EUROPE M M CUTIE CU BLIST. PVC-PVDC/AL X 30 C P6L 30 0.264299 0.187701 0.237869 0.214131
290 C08CA AMLODIPINUM AMLODIPINA HELCOR 10 mg COMPR. 10mg A.C. HELCOR PH ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.264299 0.029201 0.237869 0.055631
291 C08CA AMLODIPINUM AMLODIPINA ARENA 10 mg COMPR. 10mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 C P-6 30 0.264299 0.029367 0.237869 0.055797
292 C08CA AMLODIPINUM AMLODIPINA VIM SPECTR COMPR. 10mg VIM SPECTRUM S.R. ROMANIA CUTIE CU 2 BLIST. OPA-AL-PVC/AL X P6L 20 0.264299 0.029201 0.237869 0.055631
293 C08CA AMLODIPINUM AMLODIPINA VIM SPECTR COMPR. 10mg VIM SPECTRUM S.R. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X P6L 30 0.264299 0.029367 0.237869 0.055797
294 C08CA AMLODIPINUM AMLODIPINA TEVA 5 mg COMPR. 5 mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 C P6L 30 0.125333 0.000000 0.112799 0.012534
295 C08CA AMLODIPINUM AMLOHEXAL 5 mg COMPR. 5mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC-COC-PVDC P-6 30 0.132149 0.238184 0.118934 0.251399
296 C08CA AMLODIPINUM TENOX (R) 5 COMPR. 5mg KRKA D.D. SLOVENI CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 P-6 30 0.132149 0.097517 0.118934 0.110732
297 C08CA AMLODIPINUM AMLODIPINE MEDOCHEMIE COMPR. 5mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. PVC-PE-PVDC/AL X P-6 30 0.132149 0.096851 0.118934 0.110066
298 C08CA AMLODIPINUM ALMACOR 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6 30 0.132149 0.098851 0.118934 0.112066
299 C08CA AMLODIPINUM AMLODIPINA LPH 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.132149 0.238184 0.118934 0.251399
300 C08CA AMLODIPINUM AMLODIPINA TERAPIA 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 P-6 30 0.132149 0.238184 0.118934 0.251399
301 C08CA AMLODIPINUM AMLODIPINA TERAPIA 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. ACLAR-PVC/AL X 10 P-6 30 0.132149 0.238184 0.118934 0.251399
302 C08CA AMLODIPINUM AMLODIPINA AUROBINDO 5 COMPR. 5mg AU MALTA CUTIE CU BLIST. PVC/PVDC-AL X 30 C P6L 30 0.132149 0.049184 0.118934 0.062399
303 C08CA AMLODIPINUM RECOTENS 5 mg COMPR. 5mg ICN POLFA RZESZO POLONIA CUTIE CU BLIST. PVC-PE-PVDC/AL X P6L 30 0.132149 0.131184 0.118934 0.144399
304 C08CA AMLODIPINUM AMLODIPIN VIM SPECTRU COMPR. 5mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC/AL P-6 20 0.132149 0.237851 0.118934 0.251066
305 C08CA AMLODIPINUM AMLODIPINA ACTAVIS 5 mg COMPR. 5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC/AL X 20 C P6L 20 0.121500 0.000000 0.109350 0.012150
306 C08CA AMLODIPINUM AMLODIPINA ZENTIVA 5 mg COMPR. 5mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 C P6L 30 0.132149 0.003851 0.118934 0.017066
307 C08CA AMLODIPINUM NORVASC 5 mg COMPR. 5mg PFIZER EUROPE M M CUTIE CU BLIST. PVC-PVDC/AL X 30 C P6L 30 0.132149 0.437517 0.118934 0.450732
308 C08CA AMLODIPINUM AMLODIPINA HELCOR 5 mg COMPR. 5mg A.C. HELCOR PH ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.132149 0.237851 0.118934 0.251066
309 C08CA AMLODIPINUM AMLODIPINA ARENA 5 mg COMPR. 5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 C P-6 30 0.132149 0.140517 0.118934 0.153732
310 C08CA AMLODIPINUM AMLODIPINA VIM SPECTRU COMPR. 5mg VIM SPECTRUM S.R. ROMANIA CUTIE CU 2 BLIST. OPA-AL-PVC/AL X P6L 20 0.132149 0.237851 0.118934 0.251066
311 C08CA AMLODIPINUM AMLODIPINA VIM SPECTRU COMPR. 5mg VIM SPECTRUM S.R. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X P6L 30 0.132149 0.238184 0.118934 0.251399
312 C08CA FELODIPINUM PLENDIL COMPR. 10mg ASTRAZENECA AB SUEDIA CUTIE X 1 FLAC. DIN PE X 30 COMPR. P-6 30 0.264299 1.030367 0.237869 1.056797
313 C08CA FELODIPINUM PLENDIL COMPR. 2,5mg ASTRAZENECA AB SUEDIA CUTIE 1 FLAC. DIN PE X 30 COMPR. E P-6 30 0.066074 0.703926 0.059466 0.710534
314 C08CA FELODIPINUM PLENDIL COMPR. 5mg ASTRAZENECA AB SUEDIA CUTIE X 1 FLAC. DIN PE X, 30 COMP P-6 30 0.132149 0.712184 0.118934 0.725399
315 C08CA FELODIPINUM SISTAR 10 mg COMPR. FILM. ELIB. MODIF. 10mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. P-6 30 0.264299 0.605367 0.237869 0.631797
316 C08CA FELODIPINUM SISTAR 2,5 mg COMPR. FILM. ELIB. MODIF. 2,5mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. P-6 30 0.066074 0.434259 0.059466 0.440867
317 C08CA FELODIPINUM SISTAR 5 mg COMPR. FILM. ELIB. MODIF. 5mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. P-6 30 0.132149 0.416851 0.118934 0.430066
318 C08CA FELODIPINUM AURONAL 10 mg COMPR. FILM. ELIB. PREL. 10mg EGIS PHARMA UNGARIA CUTIE X 3 BLIST. AL/PVC-P P-6 30 0.264299 0.605367 0.237869 0.631797
319 C08CA FELODIPINUM FELODIPIN SANDOZ 10 mg COMPR. FILM. ELIB. PREL. 10mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 C P-6 30 0.264299 0.546034 0.237869 0.572464
320 C08CA FELODIPINUM AURONAL 2,5 mg COMPR. FILM. ELIB. PREL. 2,5mg EGIS PHARMA UNGARIA CUTIE X 3 BLIST. AL/PVC-P P-6 30 0.066074 0.434592 0.059466 0.441200
321 C08CA FELODIPINUM AURONAL 5 mg COMPR. FILM. ELIB. PREL. 5mg EGIS PHARMA UNGARIA CUTIE X 3 BLIST. AL/PVC-P P-6 30 0.132149 0.416851 0.118934 0.430066

Pagina 6 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
322 C08CA FELODIPINUM FELODIPIN SANDOZ 5 mg 5mg
COMPR. FILM. ELIB. PREL. HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 C P-6 30 0.132149 0.251517 0.118934 0.264732
323 C08CA NIFEDIPINUM ADALAT CR 30 COMPR. 30mg BAYER PHARMA AG GERMANI CUTIE X 2 BLIST. AL/PP X 14 COMPR. P-6 28 0.132149 0.409993 0.118934 0.423208
324 C08CA NIFEDIPINUM NIFEDIPIN RETARD TERAPI COMPR. 20mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 C P-6 50 0.088099 0.135901 0.079289 0.144711
325 C08DA VERAPAMILUM VERAPAMIL ARENA 40 mg CAPS. 40mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 0.099832 0.015168 0.089848 0.025152
326 C08DA VERAPAMILUM VERAPAMIL ARENA 80 mg CAPS. 80mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 0.199666 0.000667 0.179699 0.020634
327 C08DA VERAPAMILUM ISOPTIN RR COMPR. 240mg ABBOTT GMBH&CO. GERMANI CUTIE X 2 BLIST. PVC-PVDC/AL X 10 P-6 20 0.598999 0.229001 0.539099 0.288901
328 C08DA VERAPAMILUM CORDAMIL 40 mg COMPR. FILM 40mg AC HELCOR SRL ROMANIA CUTIE X 3 BLIST. X 10 COMPR.FILM. P-6 30 0.099832 0.011168 0.089848 0.021152
329 C08DA VERAPAMILUM CORDAMIL 80 mg COMPR. FILM 80mg AC HELCOR SRL ROMANIA CUTIE X 3 BLIST. X 10 COMPR.FILM. P-6 30 0.197666 0.000000 0.177899 0.019767
330 C08DA VERAPAMILUM ISOPTIN (R) 80 mg COMPR. FILM 80mg ABBOTT GMBH&CO. GERMANI CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.199666 0.104134 0.179699 0.124101
331 C08DA VERAPAMILUM VERAPAMIL 40 mg DRAJ. 40mg SANOFI-AVE ROMANIA CUTIE X 2 BLIST. AL/PVC X 25 DRAJ. P-6 50 0.099832 0.145368 0.089848 0.155352
332 C08DA VERAPAMILUM VERAPAMIL 80 mg DRAJ. 80mg SANOFI-AVE ROMANIA CUTIE X 2 BLIST. AL/PVC X 25 DRAJ. P-6 50 0.197600 0.000000 0.177840 0.019760
333 C08DB DILTIAZEMUM DILTIAZEM SR ROMPHARM CAPS. ELIB 180mg ROMPHARM COMP ROMANIA CUTIE CU 3 B P6L 30 0.781541 0.411459 0.703386 0.489614
334 C08DB DILTIAZEMUM DILTIAZEM SR ROMPHARM CAPS. ELIB 90mg ROMPHARM COMP ROMANIA CUTIE CU 3 BLI P6L 21 0.227619 0.000000 0.204857 0.022762
335 C08DB DILTIAZEMUM DILTIAZEM EIPICO 60 mg COMPR. 60mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 2, BLIST. AL/PVC X 10 COMPR. P-6 20 0.260513 0.008987 0.234461 0.035039
336 C08DB DILTIAZEMUM DILTIAZEM LPH 60 mg COMPR. 60mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.260513 0.018987 0.234461 0.045039
337 C08DB DILTIAZEMUM DILTIAZEM ARENA 60 mg COMPR. 60mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. DIN AL/ PVC X 10COM P-6 50 0.260513 0.017087 0.234461 0.043139
338 C08DB DILTIAZEMUM DILTIAZEM BIOEEL 60 mg COMPR. 60mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. DIN AL/ PVC X 10 CO P-6 20 0.260513 0.008987 0.234461 0.035039
339 C08DB DILTIAZEMUM DILTIAZEM LPH 60 mg COMPR. 60mg LABORMED PHARMA ROMANIA CUTIE X 6 BLIST. DIN PVC/AL X 10 C P-6 60 0.260513 0.019153 0.234461 0.045205
340 C08DB DILTIAZEMUM DILZEM 90 mg RETARD COMPR. 90mg PFIZER EUROPE M M CUTIE X 3 BLIST. AL/PVC X 10 COMP P-6 30 0.350333 0.000000 0.315299 0.035034
341 C09AA CAPTOPRILUM CAPTOPRIL MCC 12,5 mg COMPR. 12,5mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC, X 10 COMPR. P-6 30 0.037324 0.080342 0.033591 0.084075
342 C09AA CAPTOPRILUM CAPTOPRIL 25 mg COMPR. 25mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.074648 0.067018 0.067183 0.074483
343 C09AA CAPTOPRILUM CAPTOPRIL 25 EEL COMPR. 25mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.074648 0.076352 0.067183 0.083817
344 C09AA CAPTOPRILUM CAPTOPRIL - AC 25 mg COMPR. 25mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.074648 0.043852 0.067183 0.051317
345 C09AA CAPTOPRILUM CAPTOPRIL MCC 25 mg COMPR. 25mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.074648 0.043352 0.067183 0.050817
346 C09AA CAPTOPRILUM CAPTOPRIL LPH 25 mg COMPR. 25mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.074648 0.043352 0.067183 0.050817
347 C09AA CAPTOPRILUM CAPTOPRIL SINTOFARM 25 COMPR. 25mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.074648 0.080018 0.067183 0.087483
348 C09AA CAPTOPRILUM CAPTOPRIL ARENA 25 mg COMPR. 25mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.074648 0.043852 0.067183 0.051317
349 C09AA CAPTOPRILUM CAPTOPRIL ARENA 50 mg COMPR. 50 mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.138000 0.000000 0.124200 0.013800
350 C09AA CAPTOPRILUM CAPTOPRIL 50 mg COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.149297 0.081369 0.134367 0.096299
351 C09AA CAPTOPRILUM CAPTOPRIL 50 EEL COMPR. 50mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.149297 0.044203 0.134367 0.059133
352 C09AA CAPTOPRILUM CAPTOPRIL - AC 50 mg COMPR. 50mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.138000 0.000000 0.124200 0.013800
353 C09AA CAPTOPRILUM CAPTOPRIL MCC 50 mg COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.149297 0.006369 0.134367 0.021299
354 C09AA CAPTOPRILUM CAPTOPRIL LPH 50 mg COMPR. 50mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.136000 0.000000 0.122400 0.013600
355 C09AA ENALAPRILUM ENALAPRIL 10 mg COMPR. 10mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.149297 0.050203 0.134367 0.065133
356 C09AA ENALAPRILUM ENALAPRIL LPH 10 mg COMPR. 10mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR. P-6 30 0.149297 0.050036 0.134367 0.064966
357 C09AA ENALAPRILUM ENALAPRIL LPH 10 mg COMPR. 10mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/AL X 10 COMPR. P-6 20 0.149297 0.049703 0.134367 0.064633
358 C09AA ENALAPRILUM ENAP 10 mg COMPR. 10mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 P-6 20 0.149297 0.050203 0.134367 0.065133
359 C09AA ENALAPRILUM ENALAPRIL SLAVIA 10 mg COMPR. 10mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/ AL X 10 COMPR. P-6 20 0.149297 0.041203 0.134367 0.056133
360 C09AA ENALAPRILUM RENITEC 10 mg COMPR. 10mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. P-6 28 0.149297 0.157131 0.134367 0.172061
361 C09AA ENALAPRILUM ENALAPRIL TERAPIA 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC-PE-PVDC X P-6 20 0.149297 0.050203 0.134367 0.065133
362 C09AA ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC, X 10 COMPR. P-6 30 0.149297 0.050036 0.134367 0.064966
363 C09AA ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. AL/PVC, X 10 COMPR. P-6 50 0.149297 0.050103 0.134367 0.065033
364 C09AA ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 10 BLIST. AL/PVC, X 10 COMPR. P-6 100 0.149297 0.049903 0.134367 0.064833
365 C09AA ENALAPRILUM ENALAPRIL VIM SPECTRUM COMPR. 10mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 10 P-6 20 0.149297 0.050203 0.134367 0.065133
366 C09AA ENALAPRILUM ENALAPRIL LAROPHARM 10 COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.149297 0.049703 0.134367 0.064633
367 C09AA ENALAPRILUM ENALAPRIL TERAPIA 10mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL/PVC X 1 P6L 20 0.149297 0.050203 0.134367 0.065133
368 C09AA ENALAPRILUM ENALAPRIL 20 mg COMPR. 20mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.298595 0.031905 0.268735 0.061765
369 C09AA ENALAPRILUM ENALAPRIL LPH 20 mg COMPR. 20mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/AL X 10 COMPR. P-6 20 0.298595 0.031905 0.268735 0.061765
370 C09AA ENALAPRILUM ENALAPRIL LPH 20 mg COMPR. 20mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR. P-6 30 0.298595 0.032071 0.268735 0.061931
371 C09AA ENALAPRILUM ENAP 20 mg COMPR. 20mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 P-6 20 0.298595 0.031905 0.268735 0.061765
372 C09AA ENALAPRILUM RENITEC 20 mg COMPR. 20mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. P-6 28 0.298595 0.210333 0.268735 0.240193
373 C09AA ENALAPRILUM ENALAPRIL TERAPIA 20 mg COMPR. 20mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC-PE-PVDC X P-6 20 0.298595 0.031905 0.268735 0.061765
374 C09AA ENALAPRILUM ENALAPRIL ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6 30 0.298595 0.032071 0.268735 0.061931
375 C09AA ENALAPRILUM ENALAPRIL ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. P-6 50 0.298595 0.032005 0.268735 0.061865
376 C09AA ENALAPRILUM ENALAPRIL SLAVIA 20 mg COMPR. 20mg SLAVIA PHARM S.R.L ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.298595 0.031905 0.268735 0.061765

Pagina 7 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
377 C09AA ENALAPRILUM ENALAPRIL LAROPHARM 20 COMPR. 20mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.298595 0.031905 0.268735 0.061765
378 C09AA ENALAPRILUM ENALAPRIL TERAPIA 20mg COMPR. 20mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL/PVC X 1 P6L 20 0.298595 0.031905 0.268735 0.061765
379 C09AA ENALAPRILUM ENALAPRIL 5 mg COMPR. 5mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.074648 0.018352 0.067183 0.025817
380 C09AA ENALAPRILUM ENAP 5 mg COMPR. 5mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 P-6 20 0.074648 0.019352 0.067183 0.026817
381 C09AA ENALAPRILUM RENITEC 5 mg COMPR. 5mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. P-6 28 0.074648 0.069637 0.067183 0.077102
382 C09AA ENALAPRILUM ENALAPRIL LPH (R) 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR. P-6 30 0.074648 0.018685 0.067183 0.026150
383 C09AA ENALAPRILUM ENALAPRIL LPH (R) 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/AL X 10 COMPR. P-6 20 0.074648 0.018352 0.067183 0.025817
384 C09AA ENALAPRILUM ENALAPRIL TERAPIA 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC-PE-PVDC X P-6 20 0.074648 0.018352 0.067183 0.025817
385 C09AA ENALAPRILUM ENALAPRIL ARENA 5 mg COMPR. 5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.074648 0.018685 0.067183 0.026150
386 C09AA ENALAPRILUM ENALAPRIL SLAVIA 5 mg COMPR. 5mg SLAVIA PHARM S.R.L ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.074648 0.015352 0.067183 0.022817
387 C09AA ENALAPRILUM ENALAPRIL LAROPHARM 5 COMPR. 5mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. P6L 20 0.074648 0.015352 0.067183 0.022817
388 C09AA ENALAPRILUM ENALAPRIL TERAPIA 5mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL/PVC- X P6L 20 0.074648 0.018352 0.067183 0.025817
389 C09AA ENALAPRILUM ENAP 1,25 mg/ml SOL. INJ./PE 1,25mg/ml KRKA, D.D., NOVO SLOVENI CUTIE CU 5 FIOLE DIN STICLA PR/PRF 5 3.204000 0.000000 2.883600 0.320400
390 C09AA LISINOPRILUM RANOLIP COMPR. 10mg RANBAXY U.K. LIMI M CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.149297 0.369036 0.134367 0.383966
391 C09AA LISINOPRILUM LISIREN 10 mg COMPR. 10mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.149297 0.387703 0.134367 0.402633
392 C09AA LISINOPRILUM LISINOPRIL SANDOZ 10 mg COMPR. 10mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.149297 0.120703 0.134367 0.135633
393 C09AA LISINOPRILUM LISINOPRIL 10 MEDO COMPR. 10mg MEDOCHEMIE RO ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.149297 0.105036 0.134367 0.119966
394 C09AA LISINOPRILUM LISINOPRIL ACTAVIS 10 mg COMPR. 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 COMPR. P-6 30 0.149297 0.120703 0.134367 0.135633
395 C09AA LISINOPRILUM LISINOPRIL ATB 10 MG COMPR. 10mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.149297 0.264036 0.134367 0.278966
396 C09AA LISINOPRILUM TONOLYSIN 10 mg COMPR. 10mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.149297 0.237131 0.134367 0.252061
397 C09AA LISINOPRILUM TONOLYSIN 2,5 mg COMPR. 2,5mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.037324 0.273747 0.033591 0.277480
398 C09AA LISINOPRILUM RANOLIP COMPR. 20mg RANBAXY U.K. LIMI M CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.298595 0.500738 0.268735 0.530598
399 C09AA LISINOPRILUM LISIREN 20 mg COMPR. 20mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6 20 0.298595 0.483905 0.268735 0.513765
400 C09AA LISINOPRILUM LISINOPRIL SANDOZ 20 mg COMPR. 20mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.298595 0.080405 0.268735 0.110265
401 C09AA LISINOPRILUM LISINOPRIL ACTAVIS 20 mg COMPR. 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 COMPR. P-6 30 0.298595 0.080405 0.268735 0.110265
402 C09AA LISINOPRILUM LISINOPRIL ATB 20 MG COMPR. 20mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.298595 0.513405 0.268735 0.543265
403 C09AA LISINOPRILUM TONOLYSIN 20 mg COMPR. 20mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.298595 0.350333 0.268735 0.380193
404 C09AA LISINOPRILUM LISINOPRIL 20 MEDO COMPR. 20mg MEDOCHEMIE RO ROMANIA CUTIE X 2 BLIST. PVDC/AL X 10 COMPR. P-6 20 0.298595 0.129905 0.268735 0.159765
405 C09AA LISINOPRILUM LISINOPRIL ATB 40 MG COMPR. 40mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.597191 0.762142 0.537471 0.821862
406 C09AA LISINOPRILUM RANOLIP COMPR. 5mg RANBAXY U.K. LIMI M CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.074648 0.190018 0.067183 0.197483
407 C09AA LISINOPRILUM LISINOPRIL 5 MEDO COMPR. 5mg MEDOCHEMIE RO ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.074648 0.118018 0.067183 0.125483
408 C09AA LISINOPRILUM LISINOPRIL ACTAVIS 5 mg COMPR. 5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 COMPR. P-6 30 0.074648 0.118352 0.067183 0.125817
409 C09AA LISINOPRILUM TONOLYSIN 5 mg COMPR. 5mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.074648 0.188566 0.067183 0.196031
410 C09AA RAMIPRILUM VIVACE 10 mg COMPR. 10 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7 COMPR. P-6 28 0.238214 0.000000 0.214392 0.023822
411 C09AA RAMIPRILUM PIRAMIL 10 mg COMPR. 10mg SANDOZ SRL ROMANIA CUTIE X 4 FOLII AL-LDPE/LDPE-AL X P-6 28 0.302142 0.000000 0.271927 0.030215
412 C09AA RAMIPRILUM RAMIPRIL-AC 10 mg COMPR. 10mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.302000 0.000000 0.271800 0.030200
413 C09AA RAMIPRILUM AMPRIL 10 mg COMPR. 10mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 P-6 30 0.302000 0.000000 0.271800 0.030200
414 C09AA RAMIPRILUM ZENRA 10 COMPR. 10mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.302142 0.000000 0.271927 0.030215
415 C09AA RAMIPRILUM TRITACE 10 COMPR. 10mg SANOFI - ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.464285 0.000000 0.417856 0.046429
416 C09AA RAMIPRILUM RAMIPRIL AUROBINDO 10 m COMPR. 10mg AU MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 P-6 28 0.302142 0.000000 0.271927 0.030215
417 C09AA RAMIPRILUM AMPRIGEN 10 mg COMPR. 10mg ALVOGEN IPCO S.A. LUXEM CUTIE CU 3 BLIST. PVC-PE-PVDC/AL P6L 30 0.302000 0.000000 0.271800 0.030200
418 C09AA RAMIPRILUM RAMIRAN 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 P6L 30 0.302000 0.000000 0.271800 0.030200
419 C09AA RAMIPRILUM RAMIRAN 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL- P6L 30 0.302000 0.000000 0.271800 0.030200
420 C09AA RAMIPRILUM VIVACE 2,5 mg COMPR. 2,5 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7COMPR. P-6 28 0.149297 0.000345 0.134367 0.015275
421 C09AA RAMIPRILUM PIRAMIL 2,5 mg COMPR. 2,5mg SANDOZ SRL ROMANIA CUTIE X 4 FOLII AL-LDPE/LDPE-AL X P-6 28 0.149297 0.022845 0.134367 0.037775
422 C09AA RAMIPRILUM RAMIPRIL-AC 2,5 mg COMPR. 2,5mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.149297 0.019036 0.134367 0.033966
423 C09AA RAMIPRILUM AMPRIL 2,5 mg COMPR. 2,5mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 P-6 30 0.149297 0.022703 0.134367 0.037633
424 C09AA RAMIPRILUM ZENRA 2,5 COMPR. 2,5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.149297 0.016774 0.134367 0.031704
425 C09AA RAMIPRILUM TRITACE(R) 2,5 COMPR. 2,5mg SANOFI - ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.149297 0.115345 0.134367 0.130275
426 C09AA RAMIPRILUM AMPRIGEN 2,5 mg COMPR. 2,5mg ALVOGEN IPCO S.A. LUXEM CUTIE CU 3 BLIST. PVC-PE-PVDC/AL P6L 30 0.149297 0.022703 0.134367 0.037633
427 C09AA RAMIPRILUM RAMIRAN 2,5 mg COMPR. 2,5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 P6L 30 0.149297 0.022703 0.134367 0.037633
428 C09AA RAMIPRILUM RAMIRAN 2,5 mg COMPR. 2,5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL- P6L 30 0.149297 0.022703 0.134367 0.037633
429 C09AA RAMIPRILUM VIVACE 5 mg COMPR. 5 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7 COMPR. P-6 28 0.172142 0.000000 0.154927 0.017215
430 C09AA RAMIPRILUM PIRAMIL 5 mg COMPR. 5mg SANDOZ SRL ROMANIA CUTIE X 4 FOLII AL-LDPE/LDPE-AL X P-6 28 0.248214 0.000000 0.223392 0.024822
431 C09AA RAMIPRILUM RAMIPRIL-AC 5 mg COMPR. 5mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.248000 0.000000 0.223200 0.024800

Pagina 8 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
432 C09AA RAMIPRILUM AMPRIL 5 mg COMPR. 5mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 P-6 30 0.248000 0.000000 0.223200 0.024800
433 C09AA RAMIPRILUM ZENRA 5 COMPR. 5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.239285 0.000000 0.215356 0.023929
434 C09AA RAMIPRILUM TRITACE 5 COMPR. 5mg SANOFI - ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.298595 0.083190 0.268735 0.113050
435 C09AA RAMIPRILUM RAMIPRIL AUROBINDO 5 mg COMPR. 5mg AU MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 P-6 28 0.248214 0.000000 0.223392 0.024822
436 C09AA RAMIPRILUM AMPRIGEN 5 mg COMPR. 5mg ALVOGEN IPCO S.A. LUXEM CUTIE CU 3 BLIST. PVC-PE-PVDC/AL P6L 30 0.248000 0.000000 0.223200 0.024800
437 C09AA RAMIPRILUM RAMIRAN 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 P6L 30 0.248000 0.000000 0.223200 0.024800
438 C09AA RAMIPRILUM RAMIRAN 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL- P6L 30 0.248000 0.000000 0.223200 0.024800
439 C09AA QUINAPRILUM ACCUPRO 10 mg COMPR. FILM 10mg PFIZER EUROPE M M CUTIE X 3 BLIST. PVC/AL/PA X 10 COM P-6 30 0.099531 0.302135 0.089577 0.312089
440 C09AA QUINAPRILUM ACCUPRO (R) 20 COMPR. FILM 20mg PFIZER EUROPE M M CUTIE X 3 BLIST. AL/PA-AL-PVC X 1 P-6 30 0.199063 0.377603 0.179156 0.397510
441 C09AA QUINAPRILUM ACCUPRO (R) 5 COMPR. FILM 5mg PFIZER EUROPE M M CUTIE X 3 BLIST. AL/PA-AL-PVC X 1 P-6 30 0.049765 0.142235 0.044788 0.147212
442 C09AA FOSINOPRILUM MONOPRIL 10 mg COMPR. 10mg BRISTOL MYERS UNGARIA CUTIE X 2 BLIST. AL/PVC-PVDC X 14 C P-6 28 0.099531 0.485826 0.089577 0.495780
443 C09AA FOSINOPRILUM FOSYPRIL 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL-PVC-PA/AL X 10 C P-6 30 0.099531 0.281135 0.089577 0.291089
444 C09AA FOSINOPRILUM FOSINOPRIL AUROBINDO 1 COMPR. 10mg AU MALTA CUTIE CU BLIST. PVC-PE-PVDC/AL X P6L 30 0.099531 0.281135 0.089577 0.291089
445 C09AA FOSINOPRILUM MONOPRIL 10 mg COMPR. 10mg PHARMASWISS CESK REPUBLIKA S.R.O. CUTIE X 2 BLIST. AL/PVC-PVDC X 14 C
REPUBLICA CEHA P-6 28 0.099531 0.485826 0.089577 0.495780
446 C09AA FOSINOPRILUM MONOPRIL 20 mg COMPR. 20mg BRISTOL-MYERS S UNGARIA CUTIE X 2 BLIST. AL/PVC-PVDC X 14 C P-6 28 0.199063 0.649865 0.179156 0.669772
447 C09AA FOSINOPRILUM FOSYPRIL 20 mg COMPR. 20mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL-PVC-PA/AL, X 10 P-6 30 0.199063 0.352937 0.179156 0.372844
448 C09AA FOSINOPRILUM FOSINOPRIL AUROBINDO 2 COMPR. 20mg AU MALTA CUTIE CU BLIST. PVC-PE-PVDC/AL X P6L 30 0.199063 0.352937 0.179156 0.372844
449 C09AA FOSINOPRILUM MONOPRIL 20 mg COMPR. 20mg PHARMASWISS CESK REPUBLIKA S.R.O. REPUBLICA CEHA CUTIE X 2 BLIST. AL/PVC-PVDC X 14 C P-6 28 0.199063 0.649865 0.179156 0.669772
450 C09BA COMBINATII (ENALAPRILUM+HYDROCHLOROTHIAZIDUM) ENAP HL COMPR. 10mg+12,5m KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 P-6 20 0.380925 0.046075 0.342832 0.084168
451 C09BA COMBINATII (ENALAPRILUM+HYDROCHLOROTHIAZIDUM) ENAP H COMPR. 10mg+25mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 P-6 20 0.380925 0.086075 0.342832 0.124168
452 C09BA COMBINATII (ENALAPRILUM+HYDROCHLOROTHIAZIDUM) VIMAPRIL H COMPR. 10mg/25mg VIM SPECTRUM SRL ROMANIA CUTIE X 3 BLIST.OPA-AL-PVC/AL A C P-6 30 0.380925 0.013075 0.342832 0.051168
453 C09BA COMBINATII (ENALAPRILUM+HYDROCHLOROTHIAZIDUM) ENAP (R) HL 20 mg/12,5 mg COMPR. 20 mg/12,5m KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. OPA-AL-PVC/AL X 10 P-6 20 0.380925 0.031075 0.342832 0.069168
454 C09BA C TRITACE 2,5 PLUS COMPR. 2,5mg/12,5m SANOFI - ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.314285 0.000000 0.282856 0.031429
455 C09BA C HARTIL HCT 5 mg/25mg COMPR. 5mg/25mg EGIS PHARMA UNGARIA CUTIE X 2 BLIST. PVC-PCTFE/AL X 14 P-6 28 0.374285 0.000000 0.336856 0.037429
456 C09BA C TRITACE 5 PLUS COMPR. 5mg/25mg SANOFI - ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.380925 0.194789 0.342832 0.232882
457 C09CA LOSARTANUM LODIAL 100mg COMPR. FILM 100 mg ALKALOID-INT D.O.O SLOVENI CUTIE CU 2 BLIST. DIN PVC/AL X 15 P6L 30 0.694927 0.529739 0.625434 0.599232
458 C09CA LOSARTANUM TALOSAN 100 mg COMPR. FILM 100mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PA-AL- PVC/AL X P-6 30 0.694927 0.423073 0.625434 0.492566
459 C09CA LOSARTANUM TALOSAN 100 mg COMPR. FILM 100mg TERAPIA SA ROMANIA CUTIE X 3 FOLII AL/PE X 10 COMPR. FIL P-6 30 0.694927 0.423073 0.625434 0.492566
460 C09CA LOSARTANUM LOZAP 100 COMPR. FILM 100mg ZENTIVA A.S. SLOVACI CUTIE CU 3 BLIST. PVC-PVDC/AL X P-6 30 0.445333 0.000000 0.400799 0.044534
461 C09CA LOSARTANUM LORISTA 100 mg COMPR. FILM 100mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC-PVDC/AL X 28 P6L 28 0.517857 0.000000 0.466071 0.051786
462 C09CA LOSARTANUM LOSARTAN ZENTIVA 100 mg COMPR. FILM 100mg ZENTIVA A.S. SLOVACI CUTIE CU 3 BLIST. PVC-PVDC/AL X P-6 30 0.445333 0.000000 0.400799 0.044534
463 C09CA LOSARTANUM LODIAL 50mg COMPR. FILM 50 mg ALKALOID-INT D.O.O SLOVENI CUTIE CU 3 BLIST. DIN PVC/AL X 10 P6L 30 0.334333 0.000000 0.300899 0.033434
464 C09CA LOSARTANUM TALOSAN 50 mg COMPR. FILM 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PA-AL- PVC/AL X P-6 30 0.334333 0.000000 0.300899 0.033434
465 C09CA LOSARTANUM TALOSAN 50 mg COMPR. FILM 50mg TERAPIA SA ROMANIA CUTIE X 3 FOLII AL/PE X 10 COMPR. FIL P-6 30 0.334333 0.000000 0.300899 0.033434
466 C09CA LOSARTANUM LOZAP 50 COMPR. FILM 50mg ZENTIVA A.S. SLOVACI CUTIE CU 3 BLIST. PVC-PVDC/AL X P-6 30 0.268000 0.000000 0.241200 0.026800
467 C09CA LOSARTANUM COZAAR 50 mg COMPR. FILM 50mg MERCK SHARP & ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL P-6 28 0.347463 0.167179 0.312716 0.201926
468 C09CA LOSARTANUM LORISTA 50 mg COMPR. FILM 50mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. DIN PVC-PVDC/ P6L 28 0.334642 0.000000 0.301177 0.033465
469 C09CA LOSARTANUM LOSARTAN ZENTIVA 50 mg COMPR. FILM 50mg ZENTIVA A.S. SLOVACI CUTIE CU 3 BLIST. PVC-PVDC/AL X P-6 30 0.268000 0.000000 0.241200 0.026800
470 C10AA SIMVASTATINUM SIMVASTATINA ARENA 10 mg COMPR. FILM 10 mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. DIN PVC - PVD P-6 28 0.125296 0.198989 0.112766 0.211519
471 C10AA SIMVASTATINUM SIMVAHEXAL (R) 10 mg COMPR. FILM 10mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.125296 0.022037 0.112766 0.034567
472 C10AA SIMVASTATINUM ZEPLAN (R) 10 mg COMPR. FILM 10mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.125296 0.078275 0.112766 0.090805
473 C10AA SIMVASTATINUM SINTENAL 10 mg COMPR. FILM 10mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.125296 0.186370 0.112766 0.198900
474 C10AA SIMVASTATINUM VASILIP 10 mg COMPR. FILM 10mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. DIN PVC/PE/ P-6 28 0.125296 0.198275 0.112766 0.210805
475 C10AA SIMVASTATINUM SIMVASTATIN LPH 10 mg COMPR. FILM 10mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.125296 0.198704 0.112766 0.211234
476 C10AA SIMVASTATINUM SIMVASTATINA SUN 10 mg COMPR. FILM 10mg CIPLA (UK) LIMITED M CUTIE X 1 BLIST. PVC-PVDC/AL X 28 P-6 28 0.125296 0.016846 0.112766 0.029376
477 C10AA SIMVASTATINUM SIMVACARD 10 mg COMPR. FILM 10mg ZENTIVA K.S. CEHIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL P-6 28 0.125296 0.023275 0.112766 0.035805
478 C10AA SIMVASTATINUM SIMVASTATIN AUROBINDO COMPR. FILM 10mg AUROBINDO PH M CUTIE CU BLIST. PVC/PE/PVDC/AL P6L 30 0.125296 0.022704 0.112766 0.035234
479 C10AA SIMVASTATINUM SIMVASTATIN ACTAVIS 10 m COMPR. FILM 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC/AL X 30 P6L 30 0.125296 0.022037 0.112766 0.034567
480 C10AA SIMVASTATINUM SIMVASTATIN TERAPIA 10 m COMPR. FILM 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 P6L 30 0.125296 0.179370 0.112766 0.191900
481 C10AA SIMVASTATINUM SIMVASTATINA ARENA 20 mg COMPR. FILM 20 mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. DIN PVC - PVD P-6 28 0.250593 0.182621 0.225533 0.207681
482 C10AA SIMVASTATINUM SIMVAHEXAL (R) 20 mg COMPR. FILM 20mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.250593 0.090073 0.225533 0.115133
483 C10AA SIMVASTATINUM ZEPLAN (R) 20 mg COMPR. FILM 20mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.250593 0.182621 0.225533 0.207681
484 C10AA SIMVASTATINUM ZOCOR 20 mg COMPR. FILM 20mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/A P-6 28 0.250593 0.415835 0.225533 0.440895
485 C10AA SIMVASTATINUM SINTENAL 20 mg COMPR. FILM 20mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.250593 0.182407 0.225533 0.207467
486 C10AA SIMVASTATINUM VASILIP 20 mg COMPR. FILM 20mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. DIN PVC/PE/ P-6 28 0.250593 0.182621 0.225533 0.207681

Pagina 9 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
487 C10AA SIMVASTATINUM SIMCOR 20 mg COMPR. FILM 20mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.250593 0.182407 0.225533 0.207467
488 C10AA SIMVASTATINUM SIMVASTATIN LPH 20 mg COMPR. FILM 20mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.250593 0.182407 0.225533 0.207467
489 C10AA SIMVASTATINUM SIMVASTATINA SUN 20 mg COMPR. FILM 20mg CIPLA (UK) LIMITED M CUTIE X 1 BLIST. PVC-PVDC/AL X 28 P-6 28 0.235000 0.000000 0.211500 0.023500
490 C10AA SIMVASTATINUM SIMVACARD 20 mg COMPR. FILM 20mg ZENTIVA K.S. CEHIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL P-6 28 0.245357 0.000000 0.220821 0.024536
491 C10AA SIMVASTATINUM SIMVASTATIN AUROBINDO COMPR. FILM 20mg AUROBINDO PH M CUTIE CU BLIST. PVC/PE/PVDC/AL P6L 30 0.246000 0.000000 0.221400 0.024600
492 C10AA SIMVASTATINUM SIMVASTATIN ACTAVIS 20 m COMPR. FILM 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC/AL X 30 P6L 30 0.118666 0.000000 0.106799 0.011867
493 C10AA SIMVASTATINUM SIMVASTATIN TERAPIA 20 m COMPR. FILM 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 P6L 30 0.250593 0.182407 0.225533 0.207467
494 C10AA SIMVASTATINUM SIMVAHEXAL (R) 30 mg COMPR. FILM 30mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.375890 0.107443 0.338301 0.145032
495 C10AA SIMVASTATINUM SIMVASTATINA ARENA 40 mg COMPR. FILM 40 mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. DIN PVC - PVD P-6 28 0.501187 0.605955 0.451068 0.656074
496 C10AA SIMVASTATINUM VASILIP (R) 40 mg COMPR. FILM 40mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. PVC/PE/PVDC/AL P-6 28 0.501187 0.450241 0.451068 0.500360
497 C10AA SIMVASTATINUM ZEPLAN (R) 40 mg COMPR. FILM 40mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.501187 0.049170 0.451068 0.099289
498 C10AA SIMVASTATINUM SINTENAL 40 mg COMPR. FILM 40mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.501187 0.565146 0.451068 0.615265
499 C10AA SIMVASTATINUM SIMVAHEXAL (R) 40 mg COMPR. FILM 40mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.501187 0.125479 0.451068 0.175598
500 C10AA SIMVASTATINUM SIMCOR 40 mg COMPR. FILM 40mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.501187 0.605146 0.451068 0.655265
501 C10AA SIMVASTATINUM SIMVASTATIN LPH 40 mg COMPR. FILM 40mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.501187 0.605146 0.451068 0.655265
502 C10AA SIMVASTATINUM SIMVASTATINA SUN 40 mg COMPR. FILM 40mg CIPLA (UK) LIMITED M CUTIE X 1 BLIST. PVC-PVDC/AL X 28 P-6 28 0.323571 0.000000 0.291213 0.032358
503 C10AA SIMVASTATINUM SIMVACARD 40 mg COMPR. FILM 40mg ZENTIVA K.S. CEHIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL P-6 28 0.337857 0.000000 0.304071 0.033786
504 C10AA SIMVASTATINUM SIMVASTATIN AUROBINDO COMPR. FILM 40mg AUROBINDO PH M CUTIE CU BLIST. PVC/PE/PVDC/AL P6L 30 0.338000 0.000000 0.304200 0.033800
505 C10AA SIMVASTATINUM SIMVASTATIN ACTAVIS 40 m COMPR. FILM 40mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC/AL X 30 P6L 30 0.237333 0.000000 0.213599 0.023734
506 C10AA SIMVASTATINUM SIMVASTATIN TERAPIA 40 m COMPR. FILM 40mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 P6L 30 0.501187 0.390813 0.451068 0.440932
507 C10AA LOVASTATINUM MEDOSTATIN COMPR. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 1 BLIST. X 10 COMPR. P-6 10 0.167062 0.357938 0.150355 0.374645
508 C10AA LOVASTATINUM LOVASTATINA ARENA 20 mg COMPR. 20mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 C P-6 30 0.167062 0.727604 0.150355 0.744311
509 C10AA PRAVASTATINUM PRAVATOR 20 mg COMPR. 20mg RANBAXY U.K. LIMI M CUTIE X 4 BLIST. PA-AL-PVC/AL X 7 C P-6 28 0.250593 0.581549 0.225533 0.606609
510 C10AA PRAVASTATINUM PRAVATOR 40 mg COMPR. 40mg RANBAXY U.K. LIMI M CUTIE X 4 BLIST. PE-AL-PVC/AL X 7 C P-6 28 0.501187 0.814884 0.451068 0.865003
511 C10AB FENOFIBRATUM LIPOFIB 160 mg CAPS. 160mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6 30 0.754650 0.034350 0.679185 0.109815
512 C10AB FENOFIBRATUM LIPIVIM CAPS. PULB. MICRONIZATA 200mg VIM SPECTRUM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6 30 0.881000 0.000000 0.792900 0.088100
513 C10AB FENOFIBRATUM LIPANTHYL SUPRA 160 mg COMPR. 160mg LAB. FOURNIER SA FRANTA CUTIE X 3 BLIST. PVC- P-6 30 0.754650 0.420016 0.679185 0.495481
514 C10AB FENOFIBRATUM LIPANTIL NANO 145 mg COMPR. FILM 145mg LABORATOI FRANTA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.683901 0.486765 0.615510 0.555156
515 D01AC MICONAZOLUM MICONAZOL NITRAT 2% CREMA 2% SLAVIA PHARM SRL ROMANIA CUTIE X 1 TUB X 20 G P-R 1 4.636666 2.373334 4.172999 2.837001
516 D07AA HYDROCORTISONUM HIDROCORTIZON 1% UNGUENT 1% ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB X 20 G P-R 1 7.670000 0.000000 6.903000 0.767000
517 D07AC BETAMETHASONUM EKARZIN 0,5MG/G CREMA 0,5mg/g ANTIBIOTICE S.A. ROMANIA CUTIE X 1 TUB DIN AL X 15 G CREMA P-R 1 7.670000 0.000000 6.903000 0.767000
518 D07AC BETAMETHASONUM BETADERM 1 mg/g CREMA 1mg/g E.I.P.I.CO. MED S.R. ROMANIA CUTIE X 1 TUB X 20 G P-R 1 3.512400 2.247600 3.161160 2.598840
519 D07AC BETAMETHASONUM BETADERM 1mg/g UNGUENT 1mg/g E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 TUB X 20 G P-R 1 3.512400 2.247600 3.161160 2.598840
520 G01AF MICONAZOLUM GYNOZOL 200 CAPS. VAG. 200mg PHARCO IMPEX 93 S ROMANIA CUTIE X 2 BLIST. X 3 CAPS. VAG. MOI P-R 6 1.031666 0.000000 0.928499 0.103167
521 G01AF MICONAZOLUM GYNOZOL 400 CAPS. VAG. 400mg PHARCO IMPEX 93 S ROMANIA CUTIE X 1 BLIST. X 3 CAPS. VAG. MOI P-R 3 1.976666 0.000000 1.778999 0.197667
522 G02AB ERGOMETRINUM MALEAT DE ERG SOL. INJ. 0,2mg/ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ., CU INEL DE RUPERE P-R 5 1.480000 0.000000 1.332000 0.148000
523 G03BA TESTOSTERONUM* UNDESTOR TESTOCAPS 40 CAPS. MOI 40mg N.V. ORGANON OLANDA CUTIE X 6 PLICU P-R 60 0.818333 0.000000 0.736499 0.081834
524 G03BA TESTOSTERONUM* ANDROGEL 50 mg GEL 50mg LAB. BESINS I FRANTA CUTIE X 30 PLICURI DIN FOLIE PET P-R 30 4.574333 0.000000 4.116899 0.457434
525 G03BA TESTOSTERONUM* TESTIM 50 mg GEL TRA 50mg FERRING GMBH GERMANI CUTIE CU 30 TUBURI DIN AL X 5 PR/PRF 30 4.832083 0.773250 4.348874 1.256459
526 G03BA TESTOSTERONUM* NEBIDO 1000 mg/4 ml SOL. INJ. 1000mg/4ml BAYER PHARMA AG GERMANI CUTIE CU 1 FIOLA DIN STICLA BRUNA, CU CAPACITATEA DE 5 ML A 4 ML SOL. INJ. S/P-RF 1 434.605000 0.765000 391.144500 44.225500
527 G03BA TESTOSTERONUM* NEBIDO 1000 mg/4 ml SOL. INJ. 1000mg/4ml BAYER PHARMA AG GERMANI CUTIE CU 1 FLAC. DIN STICLA BRUNA, CU CAPACITATEA DE 6 ML A 4 ML SOL. INJ. PR/PRF 1 434.350000 0.000000 390.915000 43.435000
528 G03C ESTRADIOLUM* OESTROGEL 0,6 mg/g GEL 0,6mg/g LABORATOIRES BESINS INTERNATIONAL FRANTA CUTI P-6 1 6.415578 7.404422 5.774020 8.045980
529 G03C ESTRADIOLUM* CLIMARA PLASTURE TRANSDERM. 50g/24ore BAYER PHARMA AG GERMANI CUTIE X 4 PLICURI X 1 PLASTURE T P-6 4 7.755000 0.000000 6.979500 0.775500
530 G04C DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 1mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PVDC/AL X 10 C P-6 30 0.148687 0.203646 0.133818 0.218515
531 G04C DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 1mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PVDC/AL X 10 C P-6 30 0.148687 0.203646 0.133818 0.218515
532 G04C DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 2mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PVDC/AL X 10 C P-6 30 0.297374 0.293292 0.267636 0.323030
533 G04C DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 2mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PVDC/AL X 10 C P-6 30 0.297374 0.293292 0.267636 0.323030
534 G04C DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 4mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PVDE/AL X 10 C P-6 30 0.594749 0.044251 0.535274 0.103726
535 G04C DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 4mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PVDE/AL X 10 C P-6 30 0.594749 0.044251 0.535274 0.103726
536 G04C DOXAZOSINUM CARDURA XL 4 mg (vezi G0 COMPR. 4mg PFIZER EUROPE M M CUTIE X 4 BLIST. AL-P P-6 28 0.594749 0.388465 0.535274 0.447940
537 G04C DOXAZOSINUM CARDURA XL 4 mg (vezi G0 COMPR. 4mg PFIZER EUROPE M M CUTIE X 4 BLIST. AL-P P-6 28 0.594749 0.388465 0.535274 0.447940
538 H02AB METHYLPREDNISOLONUM* SOLU - MEDROL ACT-O-VIAL L 250mg/4ml PFIZER EUROPE M M CUTIE X 1 FLAC. BICOMPARTIMENTAT (COMPARTIMENT INFERIOR) LIOF. PT. SOL. INJ. + (COMPARTIMENT SUPERIOR) 4ML SOLV P-R 1 16.565000 3.915000 14.908500 5.571500
539 H02AB METHYLPREDNISOLONUM* LEMOD SOLU 125 mg 125mg
PULB+SOLV. PT. SOL. INJ./PERF. STADA HEMOFARM S ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. S/P-RF 1 8.282500 0.527500 7.454250 1.355750
540 H02AB METHYLPREDNISOLONUM* LEMOD SOLU 500 mg 500mg
PULB+SOLV. PT. SOL. INJ./PERF. STADA HEMOFARM S ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. S/P-RF 1 31.020000 0.000000 27.918000 3.102000
541 H02AB PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R.L ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.090333 0.046667 0.081299 0.055701

Pagina 10 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
542 H02AB PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.090333 0.000000 0.081299 0.009034
543 H02AB PREDNISONUM PREDNISON 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.090333 0.033333 0.081299 0.042367
544 H02AB PREDNISONUM PREDNISON - RICHTER 5 mg COMPR. 5mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COMPR. P-R 20 0.090333 0.043167 0.081299 0.052201
545 H02AB HYDROCORTISONUM* HYDROCORTISONE ROUSS COMPR. 10mg CN UNIFARM ROMANIA CUTIE X 1 FLAC. 25 COMPR. PRF 25 0.506800 0.000000 0.456120 0.050680
546 H02AB HYDROCORTISONUM* HYDROCORTISONE SUCC LIOF. + SOLV. PT. SOL. INJ. 100mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU LIOF. PT. SOL. INJ. + 1 FIOLA SOLV. X 2 ML S/P-RF 1 3.527999 0.382001 3.175199 0.734801
547 H02AB HYDROCORTISONUM* HIDROCORTIZON HF 500 mg PULB. + SOLV. PT. SOL. INJ./PERF. 500mg STADA HEMOFARM S ROMANIA CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 20 ML, INCHIS CU DOP DIN CAUCIUC GRI, ETANSAT CU CAPSA DIN ALUMINIU, CONTINAND PULB. PT. SOL. INJ./PERF. SI 1 FIOLA CU 4 ML SOLV. PR/PRF 1 11.910000 0.000000 10.719000 1.191000
548 H02AB HYDROCORTISONUM* HIDROCORTIZON HF 100 mg PULB. SI SOLV. PT. SOL. INJ./PERF.100mg STADA HEMOFARM S ROMANIA CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 5 ML, INCHIS CU DOP DIN CAUCIUC GRI, ETANSAT CU CAPSA DE ALUMINIU, CONTINAND PULB. PT. SOL.INJ./PERF. SI O FIOLA CU 2 ML SOLV. PR/PRF 1 3.527999 3.562001 3.175199 3.914801
549 H02AB HYDROCORTISONUM* HIDROCORTIZON HEMISUC SOL. INJ. I.V. 25mg/5ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE X 1 ML SOL. A + S/P-RF 5 0.881999 3.544001 0.793799 3.632201
550 J01AA DOXYCYCLINUM DOXICICLINA ATB 100 mg CAPS. 100 mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 0.376250 0.039750 0.338625 0.077375
551 J01AA DOXYCYCLINUM DOXICICLINA ARENA CAPS. 100mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.363000 0.000000 0.326700 0.036300
552 J01AA DOXYCYCLINUM DOXICICLINA SANDOZ 100 CAPS. 100mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-R 10 0.361000 0.000000 0.324900 0.036100
553 J01CA AMOXICILLINUM AMOXICILINA ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.308000 0.000000 0.277200 0.030800
554 J01CA AMOXICILLINUM AMOXICILINA ANTIBIOTICE CAPS. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.314775 0.045225 0.283297 0.076703
555 J01CA AMOXICILLINUM OSPAMOX 250 mg CAPS. 250mg SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. AL-PVC/PVDC X 6 CAP P-RF/S 12 0.314775 0.055225 0.283297 0.086703
556 J01CA AMOXICILLINUM AMOXICILINA SANDOZ 250 CAPS. 250mg SANDOZ SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.314775 0.004225 0.283297 0.035703
557 J01CA AMOXICILLINUM AMOXICILINA ANTIBIOTICE CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-R 10 0.483636 0.123364 0.435272 0.171728
558 J01CA AMOXICILLINUM AMOXICILINA FORTE 500 mg CAPS. 500mg FARMEX COMPANY ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-R 10 0.483636 0.108364 0.435272 0.156728
559 J01CA AMOXICILLINUM AMOXICILINA FORTE 500 mg CAPS. 500mg FARMEX COMPANY ROMANIA CUTIE X 2 BLIST. X 10 CAPS. P-R 20 0.440500 0.000000 0.396450 0.044050
560 J01CA AMOXICILLINUM AMOXICILINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 5 CAPS. P-R 10 0.483636 0.106364 0.435272 0.154728
561 J01CA AMOXICILLINUM AMOXICILINA SANDOZ 500 CAPS. 500mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-R 10 0.483636 0.009364 0.435272 0.057728
562 J01CA AMOXICILLINUM OSPAMOX 1000 mg COMPR. FILM 1000mg SANDOZ GMBH AUSTRIA CUTIE 2 BLIST. PVC-PVDC/AL X 6 CO P-R 12 0.910000 0.000000 0.819000 0.091000
563 J01CA AMOXICILLINUM OSPAMOX 500 mg COMPR. FILM 500mg SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. PVC-PVDC/AL X 6 P-R 12 0.483636 0.008030 0.435272 0.056394
564 J01CA AMOXICILLINUM AMOXICILINA TERAPIA 1 g C 1g TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC P-R 21 0.959047 0.000000 0.863142 0.095905
565 J01CA AMOXICILLINUM DUOMOX 1000 mg 1000mg
COMPR. PT. DISPERSIE ORALA ASTELLAS P OLANDA CUTIE X 4 BLIST. AL/PVC X 5 COMPR. P-R 20 0.967273 0.008227 0.870545 0.104955
566 J01CA AMOXICILLINUM DUOMOX 250 mg 250mg
COMPR. PT. DISPERSIE ORALA ASTELLAS P OLANDA CUTIE X 4 BLIST. AL/PVC X 5 COMPR. P-R 20 0.314775 0.115225 0.283297 0.146703
567 J01CA AMOXICILLINUM DUOMOX 500 mg 500mg
COMPR. PT. DISPERSIE ORALA ASTELLAS P OLANDA CUTIE X 4 BLIST. AL/PVC X 5 COMPR. P-R 20 0.483636 0.115864 0.435272 0.164228
568 J01CA AMOXICILLINUM DUOMOX 750 mg 750mg
COMPR. PT. DISPERSIE ORALA ASTELLAS P OLANDA CUTIE X 4 BLIST. AL/PVC X 5 COMPR. P-R 20 0.725455 0.035545 0.652909 0.108091
569 J01CA AMOXICILLINUM AMOXICILINA SANDOZ 125 PUL 125mg/5ml SANDOZ S.R.L. ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA CONTINAND 20 G PULB PT. 60 ML SUSP. ORALA + 1 LINGURITA DOZATOARE P-R 1 1.888650 4.061350 1.699785 4.250215
570 J01CA AMOXICILLINUM AMOXICILINA SANDOZ 250 PUL 250mg/5ml SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 20 G PULB. PT. 60 ML SUSP. ORALA + 1 LINGURITA DOZATOARE PE CU GRADATII PT. 1,25 ML, 2,5 ML, 5 ML P-R 1 3.777300 1.232700 3.399570 1.610430
571 J01CA AMOXICILLINUM OSPAMOX 250 mg/5 ml PUL 250mg/5ml SANDOZ GMBH AUSTRIA CUTIE X 1 FLAC. X 6,6 G PULB. PT. 60 ML SUSP. ORALA + O LINGURITA DOZATOARE P-R 1 3.777300 1.212700 3.399570 1.590430
572 J01CE PHENOXYMETHYLPENICILL OSPEN (R) 1000 COMPR. FILM 1000000ui SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. AL/PVC-PVDC X 12 P-R 12 0.299166 0.000000 0.269249 0.029917
573 J01CE PHENOXYMETHYLPENICILL OSPEN 1500 COMPR. FILM 1500000ui SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. AL/PVC-PVDC X 6 P-R 12 0.457031 0.070469 0.411327 0.116173
574 J01CE PHENOXYMETHYLPENICILL OSPEN (R) 500 COMPR. FILM 500000ui SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. AL/PVC-PVDC X 12 P-R 12 0.152343 0.073490 0.137108 0.088725
575 J01CE PHENOXYMETHYLPENICILL OSPEN 400.000 U.I./5 ml SUSP. ORALA 400.000U.I./ SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 60 ML SUSP. ORALA CU CAPAC SI LINGURITA DOZATOARE P-R 1 0.203124 8.716876 0.182811 8.737189
576 J01CE BENZATHINI BENZYLPENIC MOLDAMIN 1200000 UI PULB. PT 1200000UI ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FL P-R 1 4.970048 0.619952 4.473043 1.116957
577 J01CE BENZATHINI BENZYLPENIC MOLDAMIN 1200000 UI PULB. PT 1200000UI ANTIBIOTICE S.A. ROMANIA CUTI S/P-RF 100 4.662700 0.000000 4.196430 0.466270
578 J01CF OXACILLINUM OXACILINA ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.307220 0.061280 0.276498 0.092002
579 J01CF OXACILLINUM OXACILINA 250 mg CAPS. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.307220 0.084280 0.276498 0.115002
580 J01CF OXACILLINUM OXACILINA SANDOZ 250 mg CAPS. 250mg SANDOZ SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.307220 0.092780 0.276498 0.123502
581 J01CF OXACILLINUM OXACILINA 500 mg CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-R 10 0.614440 0.163560 0.552996 0.225004
582 J01CF OXACILLINUM OXACILINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-R 10 0.614440 0.028560 0.552996 0.090004
583 J01CF OXACILLINUM OXACILINA FORTE 500 mg CAPS. 500mg FARMEX COMPANY ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.558500 0.000000 0.502650 0.055850
584 J01CF OXACILLINUM OXACILINA SANDOZ 500 mg CAPS. 500mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-R 10 0.614440 0.115560 0.552996 0.177004
585 J01CF OXACILLINUM OXACILINA ATB 1000 mg PULB. PT. SOL. INJ./PERF. 1000mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 F PRF 1 5.303075 0.226925 4.772767 0.757233
586 J01CF OXACILLINUM OXACILINA ATB 1000 mg PULB. PT. SOL. INJ./PERF. 1000mg ANTIBIOTICE SA ROMANIA CUTIE CU PRF 100 4.622300 0.000000 4.160070 0.462230
587 J01CF OXACILLINUM OXACILINA ATB 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 F PRF 1 2.651537 2.448463 2.386383 2.713617
588 J01CF OXACILLINUM OXACILINA ATB 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU PRF 100 2.651537 1.668063 2.386383 1.933217
589 J01CF OXACILLINUM OXACILINA ANTIBIOTICE 50 PULB. PT. SOL. INJ./PERF. I.M./I.V. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. I.M./I.V. P-RF/S 100 2.651537 1.668063 2.386383 1.933217
590 J01CF OXACILLINUM OXACILINA ANTIBIOTICE 50 PULB. PT. SOL. INJ./PERF. I.M./I.V. 500mg ANTIBIOTICE SA ROMANIA C P-R 1 2.651537 2.448463 2.386383 2.713617
591 J01CF OXACILLINUM OXACILINA ANTIBIOTICE 1 g PULB. PT. SOL. INJ./PERF.I.M./I.V. 1g ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. I.M./I.V. P-RF/S 100 4.622300 0.000000 4.160070 0.462230
592 J01CF OXACILLINUM OXACILINA ANTIBIOTICE 1 g PULB. PT. SOL. INJ./PERF.I.M./I.V. 1g ANTIBIOTICE SA ROMANIA C P-R 1 5.303075 0.226925 4.772767 0.757233
593 J01CR AMOXICILLINUM + AUGMENTIN SR 1000 mg/62 COMPR. 1000mg/62, BEECHAM GROUP P M CUTIE CU 7 BLIST. AL/PVC-AL X 4 P-R 28 1.181428 0.461429 1.063285 0.579572
594 J01CR AMOXICILLINUM + AMOKSIKLAV 2 x 1000 mg COMPR. FILM 1000mg LEK PHARMACEU SLOVENI CUTIE X 2 BLIST. AL/AL X 7 COMPR.FILM P-R 14 0.962142 0.000000 0.865927 0.096215
595 J01CR AMOXICILLINUM + ENHANCIN 500 mg/125mg COMPR. FILM 500 mg/125 RANBAXY UK LIMITE M CUTIE X 4 FOLII AL-PEJD X 7 COMPR. F P-R 28 0.590714 0.000357 0.531642 0.059429
596 J01CR AMOXICILLINUM + AMOXIPLUS 500/125 mg COMPR. FILM 500/125mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL X 7 P-R 14 0.590714 0.000000 0.531642 0.059072

Pagina 11 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
597 J01CR AMOXICILLINUM + AUGMENTIN 500 mg/125 mg COMPR. FILM 500mg/125m BEECHAM GROUP P M CUTIE X 2 BLISTERE PVC-PVDC/AL X 7 COMPRIMATE FILMATE, FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTOARE DIN AL LAMINAT, CONTINAND UN DESICANT P-R 14 0.590714 0.318571 0.531642 0.377643
598 J01CR AMOXICILLINUM + AMOXICILINA/ACID CLAVULANIC AUROBINDO 500 mg/125 mg COMPR. FILM 500mg/125m AUROBINDO PH M CUTIE CU BLIST. OPA-AL-PVC/AL X P-R 14 0.590714 0.000000 0.531642 0.059072
599 J01CR AMOXICILLINUM + AMOKSIKLAV 2 x 625 mg COMPR. FILM 625mg LEK PHARMACEU SLOVENI CUTIE X 1 BLIST. AL/AL X 14 COMPR. FI P-R 14 0.590714 0.000000 0.531642 0.059072
600 J01CR AMOXICILLINUM + AMOXIPLUS 875 mg/125 mg COMPR. FILM 875mg/125m ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PA-AL-PVC/AL X P-R 14 0.962142 0.000000 0.865927 0.096215
601 J01CR AMOXICILLINUM + AUGMENTIN 875 mg/125 mg COMPR. FILM 875mg/125m BEECHAM GROUP P M CUTIE X 2 BLISTERE PVC-PVDC/AL X 7 COMPRIMATE FILMATE, FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTOARE DIN AL LAMINAT, CONTINAND UN DESICANT P-R 14 1.033749 0.445536 0.930374 0.548911
602 J01CR AMOXICILLINUM + AMOXICILINA/ACID CLAVULANIC AUROBINDO 875 mg/125 mg COMPR. FILM 875mg/125m AUROBINDO PH M CUTIE CU BLIST. OPA-AL-PVC/AL X P-R 14 0.962142 0.000000 0.865927 0.096215
603 J01CR AMOXICILLINUM + AMOKSIKLAV QUICKTAB 10 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE
1000mg BIOMEDIAL PHARMA ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-R 14 1.033749 0.824108 0.930374 0.927483
604 J01CR AMOXICILLINUM + AMOKSIKLAV QUICKTAB 10 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE
1000mg SANDOZ S.R.L. ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-R 14 1.033749 0.824108 0.930374 0.927483
605 J01CR AMOXICILLINUM + AMOKSIKLAV QUICKTAB 625 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE
625mg BIOMEDIAL PHARMA ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-R 14 0.590714 0.634286 0.531642 0.693358
606 J01CR AMOXICILLINUM + AMOKSIKLAV QUICKTAB 625 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE
625mg SANDOZ S.R.L. ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-R 14 0.590714 0.634286 0.531642 0.693358
607 J01CR AMOXICILLINUM + AMOKSIKLAV 156,25mg/5ml PUL 156,25mg/5m LEK PHARMACEU SLOVENI CUTIE X 1 FLAC. DIN STICLA BRUNA CU 25 MG PULB. PT. 100 ML SUSP. ORALA P-R 1 5.986607 4.833393 5.387946 5.432054
608 J01CR AMOXICILLINUM + AMOKSIKLAV 2x PUL 400mg+57m LEK PHARMACEU SLOVENI CUTIE X 1 FLAC. DIN STICLA BRUNA CU PULB. PT. 35 ML SUSP.ORALA + SERINGA DOZATOARE P-R 1 6.700000 0.000000 6.030000 0.670000
609 J01CR AMOXICILLINUM + AMOKSIKLAV 2x PUL 400mg+57m LEK PHARMACEU SLOVENI CUTIE X 1 FLAC. DIN STICLA BRUNA CU PULB. PT. 70 ML SUSP.ORALA + SERINGA DOZATOARE P-R 1 13.410000 0.000000 12.069000 1.341000
610 J01CR AMOXICILLINUM + AMOXICILINA/ACID CLAVULANIC AUROBINDO 400 mg/57 mg/5 ml PUL 400mg/57mg AU MALTA CUTIE CU 1 FLAC. PEID CARE CONTINE PULB. PT. SUSP. ORALA PT. OBTINEREA A 35 ML SUSP. RECONSTITUITA + 1 SERINGA DE POLISTIREN CU GRADATII LA INTERVALE DE 0,5 ML
PRF 1 6.700000 0.000000 6.030000 0.670000
611 J01CR AMOXICILLINUM + AUGMENTIN BIS 400 mg/57 PUL 400mg/57mg SMITHKLINE BEE M CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 35 ML SUSP. ORALA + 1 SERINGA PT. ADM. ORALA P-R 1 6.705000 3.615000 6.034500 4.285500
612 J01CR AMOXICILLINUM + AUGMENTIN BIS 400 mg/57 PUL 400mg/57mg SMITHKLINE BEE M CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 35 ML SUSP. ORALA + MASURA DOZATOARE P-R 1 6.705000 3.615000 6.034500 4.285500
613 J01CR AMOXICILLINUM + AUGMENTIN BIS 400 mg/57 PUL 400mg/57mg SMITHKLINE BEE M CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 70 ML SUSP. ORALA + MASURA DOZATOARE P-R 1 13.410000 7.220000 12.069000 8.561000
614 J01CR AMOXICILLINUM + AUGMENTIN (R) ES PUL 600 mg/4 SMITHKLINE BEE M CUTIE X 1 FLACON DIN STICLA CU PULB. PT. 100 ML SUSP. ORALA + 1 MASURA DOZATOARE P-R 1 28.735714 6.844286 25.862142 9.717858
615 J01CR AMOXICILLINUM + AMOKSIKLAV 312,5mg/5ml PU 312,5mg/5ml LEK PHARMACEU SLOVENI CUTIE X 1 FLAC. DIN STICLA BRUNA CU 25 G PULB. PT. 100 ML SUSP. ORALA + LINGURITA DOZATOARE P-R 1 11.973214 7.026786 10.775892 8.224108
616 J01DB CEFALEXINUM CEFALEXINA ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.467549 0.150451 0.420794 0.197206
617 J01DB CEFALEXINUM CEFALEXINA ATB 250 mg CAPS. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 CAPS. P-R 20 0.467549 0.155951 0.420794 0.202706
618 J01DB CEFALEXINUM OSPEXIN (R) 250 mg CAPS. 250mg SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. PVC-PVDC/AL X 12 CA P-R 12 0.467549 0.149951 0.420794 0.196706
619 J01DB CEFALEXINUM CEFALEXIN SANDOZ 25 CAPS. 250mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 CA P-R 10 0.467549 0.153451 0.420794 0.200206
620 J01DB CEFALEXINUM CEFALEXINA ATB 500 mg CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-R 10 0.935099 0.155901 0.841589 0.249411
621 J01DB CEFALEXINUM CEFALEXINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. PVC/AL X 10 CAPS. P-R 10 0.934000 0.000000 0.840600 0.093400
622 J01DB CEFALEXINUM CEFALEXIN SANDOZ CAPS. 500mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 CA P-R 10 0.935099 0.103901 0.841589 0.197411
623 J01DB CEFALEXINUM OSPEXIN 1000 mg COMPR. FILM 1000mg SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. PVC-PVDC/AL X 6 P-R 12 1.365000 0.000000 1.228500 0.136500
624 J01DB CEFALEXINUM OSPEXIN 500 mg COMPR. FILM 500mg SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. PVC-PVDC/AL X 1 P-R 12 0.935099 0.092401 0.841589 0.185911
625 J01DB CEFALEXINUM KEFLEX (R) 125 mg/5 ml GR 125mg/5ml ACTAVIS GROUP HF ISLANDA CUTIE X 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + LINGURITA DOZATOARE P-R 1 5.307500 1.122500 4.776750 1.653250
626 J01DB CEFALEXINUM OSPEXIN (R) 125 mg/5 ml GR 125mg/5ml SANDOZ GMBH AUSTRIA CUT P-R 1 5.307500 1.842500 4.776750 2.373250
627 J01DB CEFALEXINUM CEFALEXIN SANDOZ 125 mg/5 ml GRANULE PENTRU SUSPENSIE ORALA GR 125mg/5ml SANDOZ SRL ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 33 G PT. 60 ML SUSP. ORALA + 1 LINGURITA DOZATOARE P-R 1 5.307500 1.842500 4.776750 2.373250
628 J01DB CEFALEXINUM KEFLEX (R) 250 mg/5 ml GR 250mg/5ml ACTAVIS GROUP HF ISLANDA CUTIE X 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + LINGURITA DOZATOARE P-R 1 10.615000 0.265000 9.553500 1.326500
629 J01DB CEFALEXINUM CEFALEXIN SANDOZ 250 mg/5 ml GRANULE PENTRU SUSPENSIE ORALA GR 250mg/5ml SANDOZ SRL ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 33 G PT. 60 ML SUSP. ORALA + 1 LINGURITA DOZATOARE P-R 1 9.820000 0.000000 8.838000 0.982000
630 J01DB CEFALEXINUM OSPEXIN (R) 250 mg/5 ml GR 250mg/5ml SANDOZ GMBH AUSTRIA CUTIE X 1 FLAC. X 33G GRANULE PT. 60ML SUSP.+ LINGURITA DOZATOARE X 5ML P-R 1 9.820000 0.000000 8.838000 0.982000
631 J01DB CEFADROXILUM CEXYL 250 mg CAPS. 250mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 CA P-R 10 0.467549 1.456451 0.420794 1.503206
632 J01DB CEFADROXILUM CEXYL 500 mg CAPS. 500mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 CA P-R 10 0.935099 0.460901 0.841589 0.554411
633 J01DB CEFADROXILUM CEFORAN 500 mg CAPS. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. P-R 10 0.935099 0.415901 0.841589 0.509411
634 J01DB CEFADROXILUM CEXYL 1000 mg COMPR. FILM 1000mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. PVC/PVDC X 10. CO P-R 10 1.870199 0.842801 1.683179 1.029821
635 J01DB CEFADROXILUM CEXYL 125 mg/5 ml GR 125mg/5ml SANDOZ S.R.L. ROMANIA CUTIE X 1 FLAC. CU GRAN PENTRU 60 ML SUSP. ORALA + O LINGURITA DOZATOARE P-R 1 5.307500 7.192500 4.776750 7.723250
636 J01DB CEFADROXILUM CEXYL 250 mg/5 ml GRAN. S 250mg/5ml SANDOZ S.R.L. ROMANIA CUTIE X 1 FLAC. CU GRAN. PT. 60 ML SUSP. ORALA + O LINGURITA DOZATOARE P-R 1 10.615000 0.955000 9.553500 2.016500
637 J01DC CEFUROXIMUM CEFUROXIMA ATB 250 mg COMPR. 250mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1 BLIST. PVC-AL-PA/AL X 10 P-R 10 0.982800 0.109200 0.884520 0.207480
638 J01DC CEFUROXIMUM CEFUROXIMA ATB 250 mg COMPR. 250mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1 BLIST. PVC-ACLAR/AL X 10 P-R 10 0.982800 0.109200 0.884520 0.207480
639 J01DC CEFUROXIMUM CEFUROXIMA AUROBINDO COMPR. 250mg AUR ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 10 C PRF 10 0.982800 0.109200 0.884520 0.207480
640 J01DC CEFUROXIMUM CEFUROXIMA ATB 500 mg COMPR. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1 BLIST. PVC-AL-PA/AL X 10 P-R 10 1.863000 0.000000 1.676700 0.186300
641 J01DC CEFUROXIMUM CEFUROXIMA ATB 500 mg COMPR. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1 BLIST. PVC-ACLAR/AL X 10 P-R 10 1.863000 0.000000 1.676700 0.186300
642 J01DC CEFUROXIMUM CEFUROXIMA AUROBINDO COMPR. 500mg AUR ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 10 C PRF 10 1.863000 0.000000 1.676700 0.186300
643 J01DC CEFUROXIMUM ZINNAT (R) 125 mg COMPR. FILM 125mg GLAXOWELLCOME M CUTIE X 1 BLIST. X 10 COMPR. FILM. P-R 10 1.076700 0.054300 0.969030 0.161970
644 J01DC CEFUROXIMUM ZINNAT (R) 250 mg COMPR. FILM 250mg GLAXOWELLCOME M CUTIE X 1 BLIST. X, 10 COMPR.FILM P-R 10 0.982800 0.698200 0.884520 0.796480
645 J01DC CEFUROXIMUM ZINNAT (R) 500 mg COMPR. FILM 500mg GLAXOWELLCOME M CUTIE X 1 BLIST. X 10 COMPR.FILM P-R 10 1.965600 0.900400 1.769040 1.096960
646 J01DC CEFUROXIMUM ZINNAT GR 125mg/5ml GLAXO WELLCOME M CUTIE CU 1 FLAC. DIN STICLA BRUNA CONTINAND GRANULE PT. 50 ML SUSP. ORALA + 1 MASURA DOZATOARE P-R 1 10.767000 9.373000 9.690300 10.449700
647 J01DC CEFACLORUM CEFACLOR ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-R 10 0.491400 1.081600 0.442260 1.130740
648 J01DC CEFACLORUM CLORACEF (R) 250 CAPS. 250mg DAR AL DAWA PH ROMANIA CUTIE X 2 BLIST. X 8 CAPS. P-R 16 0.491400 0.896100 0.442260 0.945240
649 J01DC CEFACLORUM CEFACLOR TERAPIA 250 mg CAPS. 250mg TERAPIA SA ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 15 P-R 15 0.491400 0.463933 0.442260 0.513073
650 J01DC CEFACLORUM CLORACEF (R) FORTE 500 CAPS. 500mg DAR AL DAWA PH ROMANIA CUTIE X 2 BLIST. X 8 CAPS. P-R 16 0.982800 0.782200 0.884520 0.880480
651 J01DC CEFACLORUM CEFACLOR ARENA 500 mg CAPS. 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 10 CAPS. P-R 10 0.982800 1.911200 0.884520 2.009480

Pagina 12 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
652 J01DC CEFACLORUM CEFACLOR TERAPIA 500 mg CAPS. 500mg TERAPIA SA ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 15 P-R 15 0.982800 0.783200 0.884520 0.881480
653 J01DC CEFACLORUM CECLOR MR 500 mg CO 500mg ACTAVIS GROUP HF ISLANDA CUTIE CU 1 BLIST. PVC PRF 10 0.982800 1.733200 0.884520 1.831480
654 J01DC CEFACLORUM CECLOR MR 750 mg CO 750mg ACTAVIS GROUP HF ISLANDA CUTIE CU 1 BLIST. PVC PRF 10 1.474200 2.238800 1.326780 2.386220
655 J01DC CEFACLORUM CEFACLOR TERAPIA MR 37 COMPR. 375mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC/PVDC/AL P-R 10 0.737100 2.557900 0.663390 2.631610
656 J01DC CEFACLORUM CEFACLOR TERAPIA MR 75 COMPR. 750mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. X 10 COMPR. ELIB. PR P-R 10 1.474200 1.020800 1.326780 1.168220
657 J01DC CEFACLORUM 375mg
CECLODYNE (R) MR 375 mg COMPR. FILM. ELIB. MODIF. SANDOZ SRL ROMANIA CUTIE X 1 BLIST P-R 10 0.737100 2.811900 0.663390 2.885610
658 J01DC CEFACLORUM 500mg
CECLODYNE (R) MR 500 mg COMPR. FILM. ELIB. MODIF. SANDOZ SRL ROMANIA CUTIE X 1 BLIST P-R 10 0.982800 0.783200 0.884520 0.881480
659 J01DC CEFACLORUM 750mg
CECLODYNE (R) MR 750 mg COMPR. FILM. ELIB. MODIF. SANDOZ SRL ROMANIA CUTIE X 1 BLIST. PVC- P-R 10 1.474200 1.020800 1.326780 1.168220
660 J01DC CEFACLORUM CECLOR (R) 125 mg/5 ml GR 125mg/5ml ACTAVIS GROUP HF ISLANDA CUTIE X 1 FLAC. PEID DE CULOARE ALBA, CU GRANULE PT. 75 ML SUSP. ORALA + 1 LINGURITA DOZATOARE P-R 1 8.075250 5.854750 7.267725 6.662275
661 J01DC CEFACLORUM CEFACLOR TERAPIA 125mg GR 125mg/5ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID P-R 1 8.075250 0.984750 7.267725 1.792275
662 J01DC CEFACLORUM CEFACLOR TERAPIA 250mg GR 250 mg/5 ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID P-R 1 16.150500 1.799500 14.535450 3.414550
663 J01DC CEFACLORUM CEFACLOR TERAPIA 250mg GR 250 mg/5 ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN P-R 1 17.950000 0.000000 16.155000 1.795000
664 J01DC CEFACLORUM CECLOR (R) 250 mg/5 ml GR 250mg/5ml ACTAVIS GROUP HF ISLANDA CUTIE X 1 FLAC. PEID DE CULOARE ALBA, CU GRANULE PT. 75 ML SUSP. ORALA + 1 LINGURITA DOZATOARE P-R 1 16.150500 11.459500 14.535450 13.074550
665 J01DC CEFACLORUM CLORACEF (R) 125 PUL 125mg/5ml DAR AL DAWA PH ROMANIA CUTIE X 1 FLAC. P-R 1 8.075250 0.984750 7.267725 1.792275
666 J01DC CEFACLORUM CEFAKLOR 125 mg/5 ml PUL 125mg/5ml STADA HEMOFARM S ROMANIA CUTIE X P-R 1 6.460200 2.599800 5.814180 3.245820
667 J01DC CEFACLORUM CLORACEF (R) 250 PUL 250mg/5ml DAR AL DAWA PH ROMANIA CUTIE X 1 FLAC P-R 1 16.150500 1.789500 14.535450 3.404550
668 J01DC CEFACLORUM CEFAKLOR 250 mg/5 ml PUL 250mg/5ml STADA HEMOFARM S ROMANIA CUTIE X P-R 1 12.920400 3.609600 11.628360 4.901640
669 J01DD CEFIXIMUM EFICEF 100 mg CAPS. 100mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 1.915987 0.321013 1.724388 0.512612
670 J01DD CEFIXIMUM EFICEF (R) 200 mg CAPS. 200mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-R 10 3.609000 0.000000 3.248100 0.360900
671 J01DD CEFIXIMUM XIFIA 400mg COMPR. FILM 400mg INN-FARM D.O.O. SLOVENI CUTIE CU UN BLISTER PRF 5 7.663950 2.356050 6.897555 3.122445
672 J01DD CEFIXIMUM XIFIA 400mg COMPR. FILM 400mg INN-FARM D.O.O. SLOVENI CUTIE CU 2 BL PRF 10 7.663950 1.852050 6.897555 2.618445
673 J01EE SULFAMETHOXAZ TAGREMIN COMPR. 400mg/80mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.360750 0.039750 0.324675 0.075825
674 J01EE SULFAMETHOXAZ SUMETROLIM COMPR. 400mg/80mg EGIS PHARMA UNGARIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.348000 0.000000 0.313200 0.034800
675 J01EE SULFAMETHOXAZ CO - TRIM ELL COMPR. 400mg/80mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.360750 0.004250 0.324675 0.040325
676 J01EE SULFAMETHOXAZ BITRIM 400mg/80mg COMPR. 400mg/80mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.360750 0.039750 0.324675 0.075825
677 J01EE SULFAMETHOXAZ EPITRIM SUSP. ORALA 200mg/40mg E.I.P.I.CO. MED S.R. ROMANIA CUTIE P-R 1 4.710000 0.000000 4.239000 0.471000
678 J01EE SULFAMETHOXAZ SUMETROLIM SUSP. ORALA 25mg/5mg/ml EGIS PHARMA UNGARIA CUTIE X 1 FLACON DIN STICLA BRUNA X 100 ML SUSP. ORALA + MASURA DOZATOARE P-R 1 4.205531 5.654469 3.784977 6.075023
679 J01FA ERYTHROMYCINUM ERITROMAGIS 200 mg COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.367500 0.000000 0.330750 0.036750
680 J01FA ERYTHROMYCINUM ERITROMICINA 200 mg COMPR. 200mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.388478 0.109022 0.349630 0.147870
681 J01FA ERYTHROMYCINUM ERITROMICINA COMPR. 200mg SANDOZ S.R.L. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.388478 0.033522 0.349630 0.072370
682 J01FA ERYTHROMYCINUM ERITROMICINA ATB 200 mg COMPR. 200mg ANTIBIOTICE SA ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0.388478 0.109022 0.349630 0.147870
683 J01FA CLARITHROMYCINUM CLAXIRIT 500 mg CO 500mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/PVDC/ PRF 7 1.942391 0.491894 1.748151 0.686134
684 J01FA CLARITHROMYCINUM KLACID SR COMPR. 500mg ABBOTT LABORA M CUTIE X 1 BLIST. PVC-PVDC/AL P-R 5 1.942391 1.805609 1.748151 1.999849
685 J01FA CLARITHROMYCINUM KLACID (R) COMPR. FILM 250mg ABBOTT S.R.L. ITALIA CUTIE X 1 BLIST. X 14 COMPR. FILM. P-R 14 0.971195 0.975947 0.874075 1.073067
686 J01FA CLARITHROMYCINUM KLERIMED (R) 250 COMPR. FILM 250mg MEDOCHEMIE LTD. CIPRU CUTIE X 2 BLIST. AL/PVC-PVDC X 7 P-R 14 0.971195 0.200947 0.874075 0.298067
687 J01FA CLARITHROMYCINUM KLABAX 250 mg COMPR. FILM 250mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC X 14 P-R 14 0.971195 0.115947 0.874075 0.213067
688 J01FA CLARITHROMYCINUM FROMILID 250 COMPR. FILM 250mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. PVC-PVDC/AL X 7 P-R 14 0.971195 0.264519 0.874075 0.361639
689 J01FA CLARITHROMYCINUM LEKOKLAR 250 mg COMPR. FILM 250mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 14 PRF 14 0.842142 0.000000 0.757927 0.084215
690 J01FA CLARITHROMYCINUM CLARITROMICINA AUROB COMPR. FILM 250mg AU MALTA CUTIE CU BLSIT. PVC-PVDC/AL X 14 PRF 14 0.756428 0.000000 0.680785 0.075643
691 J01FA CLARITHROMYCINUM KLERIMED (R) 500 COMPR. FILM 500mg MEDOCHEMIE LTD. CIPRU CUTIE X 2 BLIST. AL/PVC-PVDC X 7 P-R 14 1.911428 0.000000 1.720285 0.191143
692 J01FA CLARITHROMYCINUM KLABAX 500 mg COMPR. FILM 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC X 14 P-R 14 1.942391 0.096894 1.748151 0.291134
693 J01FA CLARITHROMYCINUM FROMILID 500 COMPR. FILM 500mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. PVC-PVDC/AL X 7 P-R 14 1.921428 0.000000 1.729285 0.192143
694 J01FA CLARITHROMYCINUM ROCLARIN 500 mg COMPR. FILM 500mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 1.849000 0.000000 1.664100 0.184900
695 J01FA CLARITHROMYCINUM CLAR 500 COMPR. FILM 500mg G REPUBLICA CEHA CUTIE X 5 BLIST. AL/PVC X 4 COMPR. F P-R 20 1.942391 0.413609 1.748151 0.607849
696 J01FA CLARITHROMYCINUM LEKOKLAR 500 mg COMPR. FILM 500mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 14 PRF 14 1.911428 0.000000 1.720285 0.191143
697 J01FA CLARITHROMYCINUM CLARITROMICINA AUROB COMPR. FILM 500mg AU MALTA CUTIE CU BLSIT. PVC-PVDC/AL X 14 PRF 14 1.642142 0.000000 1.477927 0.164215
698 J01FA CLARITHROMYCINUM FROMILID (R) UNO COMPR. FILM. ELIB. PREL. 500mg KRKA D.D. SLOVENI CUTIE X 1 BLIST. PVC P-R 7 1.942391 0.491894 1.748151 0.686134
699 J01FA CLARITHROMYCINUM KLACID (R) GR 125mg/5ml ABBOTT S.R.L. ITALIA CUTIE X 1 FLACON PEID CU GRANULE PT. 100 ML SUSP. ORALA + 1 LINGURITA DOZATOARE X 2,5 ML/5 ML P-R 1 23.854500 6.125500 21.469050 8.510950
700 J01FA CLARITHROMYCINUM KLACID (R) GR 125mg/5ml ABBOTT S.R.L. ITALIA CUTIE X 1 FLACON PEID CU GRANULE PT. 60 ML SUSP. ORALA + 1 LINGURITA DOZATOARE X 2,5 ML/5 ML P-R 1 14.312700 5.407300 12.881430 6.838570
701 J01FA CLARITHROMYCINUM LEKOKLAR 125 mg/5 ml GR 125mg/5ml SANDOZ SRL ROMANIA CUTIE X 1 FLAC. PEID CU 41 G GRANULE PT. 60 ML SUSP. ORALA + LINGURITA DOZATOARE PP P-R 1 12.820000 0.000000 11.538000 1.282000
702 J01FA CLARITHROMYCINUM KLABAX 125 mg/5 ml GR 125mg/5ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN P-R 1 12.820000 0.000000 11.538000 1.282000
703 J01FA CLARITHROMYCINUM KLABAX 250 mg/5 ml GR 250mg/5ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. PEID X P-R 1 47.709000 5.301000 42.938100 10.071900
704 J01FA CLARITHROMYCINUM KLABAX 250 mg/5 ml GR 250mg/5ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. PEID X 42 P-R 1 28.625400 4.244600 25.762860 7.107140
705 J01FA CLARITHROMYCINUM LEKOKLAR 250 mg/5 ml GR 250mg/5ml SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. PEID + SERINGA DE MASURAT DIN PE/PP CU MARCAJE LA 2,5, 3,75 ML SI 5,0 ML SI 1 LINGURITA DOZATOARE DIN PE/PP CU MARCAJE LA 1,25 ML, 2,5 ML SI 5,0 ML CU 41,0 GRANULE PT 60 ML SUSP. ORALA
PRF 1 28.625400 1.234600 25.762860 4.097140
706 J01FA CLARITHROMYCINUM KLACID I.V. PULB. P 500mg ABBOTT LABORA FRANTA CUTIE X 1 FLAC. PULB. PT. SOL. PERF. S/P-RF 1 39.540000 0.000000 35.586000 3.954000

Pagina 13 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
707 J01MA OFLOXACINUM ZANOCIN COMPR. FILM 200mg RANBAXY UK LIMITE M CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 1.179000 0.000000 1.061100 0.117900
708 J01MA OFLOXACINUM OFLOXIN 200 COMPR. FILM 200mg ZENTIVA K.S. CEHIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 1.226700 0.850300 1.104030 0.972970
709 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 1 COMPR. FILM 100mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.245340 3.625660 0.220806 3.650194
710 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 1 COMPR. FILM 100mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.245340 3.158660 0.220806 3.183194
711 J01MA CIPROFLOXACINUM CIPROCIN 250 mg COMPR. FILM 250mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC X 10 P-R 10 0.613350 0.069650 0.552015 0.130985
712 J01MA CIPROFLOXACINUM CIPRINOL 250 mg COMPR. FILM 250mg KRKA D.D. NOVO M SLOVENI CUTIE X 1 BLIST. AL/PVC-PVDC X 10 P-R 10 0.613350 0.093650 0.552015 0.154985
713 J01MA CIPROFLOXACINUM CIPROLEN (R) 250 mg COMPR. FILM 250mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.613350 0.069650 0.552015 0.130985
714 J01MA CIPROFLOXACINUM CUMINOL 250 mg COMPR. FILM 250mg GEDEON RIC ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.613350 0.095650 0.552015 0.156985
715 J01MA CIPROFLOXACINUM CIFRAN COMPR. FILM 250mg RANBAXY UK LIMITE M CUTIE X 1 BLIST. PVC/PVDC-AL X 10 P-R 10 0.613350 0.106650 0.552015 0.167985
716 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 2 COMPR. FILM 250mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.613350 0.067650 0.552015 0.128985
717 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 2 COMPR. FILM 250mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.613350 0.024650 0.552015 0.085985
718 J01MA CIPROFLOXACINUM CIPRINOL 500 mg COMPR. FILM 500mg KRKA D.D. NOVO M SLOVENI CUTIE X 1 BLIST. AL/PVC-PVDC X 10 P-R 10 1.183000 0.000000 1.064700 0.118300
719 J01MA CIPROFLOXACINUM CIPROCIN 500 mg COMPR. FILM 500mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 BLIST. X 10 COMPR. FILM. P-R 10 0.920000 0.000000 0.828000 0.092000
720 J01MA CIPROFLOXACINUM CIPROLEN (R) 500 mg COMPR. FILM 500mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 1.226700 0.095300 1.104030 0.217970
721 J01MA CIPROFLOXACINUM CUMINOL 500 mg COMPR. FILM 500mg GEDEON RIC ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 1.226700 0.144300 1.104030 0.266970
722 J01MA CIPROFLOXACINUM CIFRAN COMPR. FILM 500mg RANBAXY UK LIMITE M CUTIE X 1 BLIST. PVC/PVDC-AL X 10 P-R 10 0.911000 0.000000 0.819900 0.091100
723 J01MA CIPROFLOXACINUM CIPRO QUIN (R) COMPR. FILM 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 1.226700 0.144300 1.104030 0.266970
724 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA COMPR. FILM 500mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.957000 0.000000 0.861300 0.095700
725 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA COMPR. FILM 500mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.852000 0.000000 0.766800 0.085200
726 J01MA CIPROFLOXACINUM CIPRINOL 750 mg COMPR. FILM 750mg KRKA D.D. NOVO M SLOVENI CUTIE X 1 BLIST. AL/PVC-PVDC X 10 P-R 10 1.031000 0.000000 0.927900 0.103100
727 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 7 COMPR. FILM 750mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 1.840050 2.030950 1.656045 2.214955
728 J01MA CIPROFLOXACINUM CIPROBAY XR 1000 mg COMPR. FILM. ELIB. PREL. 1000 mg BAYER PHARMA AG GERMANI CUTIE X 1 BLIST. DIN PP/AL X P-R 7 2.453400 10.100885 2.208060 10.346225
729 J01MA CIPROFLOXACINUM CIPROBAY XR 500 mg COMPR. FILM. ELIB. PREL. 500 mg BAYER PHARMA AG GERMANI CUTIE X 1 BLIST. DIN PP/AL X P-R 3 1.226700 8.326633 1.104030 8.449303
730 J01MA PEFLOXACINUM PEFLOXACIN LAROPHARM COMPR. FILM 400mg LAROPHARM S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 1.226700 1.664300 1.104030 1.786970
731 J01MA NORFLOXACINUM NORFLOXACINA LPH 400 mg COMPR. FILM 400mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.804000 0.012000 0.723600 0.092400
732 J01MA NORFLOXACINUM NOLICIN 400 mg COMPR. FILM 400mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. PVC-PVDC/AL X 10 P-R 20 0.792000 0.000000 0.712800 0.079200
733 J01MA NORFLOXACINUM NORFLOXACIN HELCOR 400 COMPR. FILM 400mg A.C. HELCOR PH ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 P-R 20 0.804000 0.076000 0.723600 0.156400
734 J01MB ACIDUM NALIDIXICUM NALIXID 500 mg CAPS. 500mg ZENTIVA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-R 30 1.013000 0.000000 0.911700 0.101300
735 J01XD METRONIDAZOLUM METRONIDAZOL ARE COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.238666 0.000000 0.214799 0.023867
736 J01XD METRONIDAZOLUM METRONIDAZOL ARE COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.238666 0.000000 0.214799 0.023867
737 J01XD METRONIDAZOLUM FLAGYL ( vezi J01XD01) COMPR. FILM 250mg LABORATOIRE AVE FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 P-R 20 0.301762 0.065738 0.271585 0.095915
738 J01XD METRONIDAZOLUM FLAGYL ( vezi J01XD01) COMPR. FILM 250mg LABORATOIRE AVE FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 P-R 20 0.301762 0.065738 0.271585 0.095915
739 J01XD METRONIDAZOLUM METRONIDAZOL A 5 g/l SOL. PERF. 5g/l INFOMED FLUIDS SR ROMANIA CUTIE X 12 FLACOANE X 200 ML S/P-RF 12 8.667500 0.000000 7.800750 0.866750
740 J01XD METRONIDAZOLUM METRONIDAZOL A 5 g/l SOL. PERF. 5g/l INFOMED FLUIDS SR ROMANIA CUTIE X 1 FLACON X 200 ML S/P-RF 1 8.953750 0.496250 8.058375 1.391625
741 J01XD METRONIDAZOLUM METRONIDAZOL B 5 g/l SOL. PERF. 5g/l INFOMED FLUIDS SR ROMANIA CUTIE X 12 FLACOANE X 200 ML S/P-RF 12 8.499166 0.000000 7.649249 0.849917
742 J01XD METRONIDAZOLUM METRONIDAZOL B 5 g/l SOL. PERF. 5g/l INFOMED FLUIDS SR ROMANIA CUTIE X 1 FLACON X 200 ML S/P-RF 1 8.953750 0.286250 8.058375 1.181625
743 J01XD METRONIDAZOLUM METRONIDAZOL BRAUN 5mg SOL. PERF. 5mg/ml B. BRAUN MELSU GERMANI CUTIE X 10 FLAC. DIN ST S/P-RF 10 4.476875 0.530125 4.029187 0.977813
744 J01XD METRONIDAZOLUM METRONIDAZOL BRAUN 5mg SOL. PERF. 5mg/ml B. BRAUN MELSU GERMANI CUTIE X 10 FLAC. DIN PEJD X 100 ML S/P-RF 10 4.476875 0.530125 4.029187 0.977813
745 J01XD METRONIDAZOLUM METRONIDAZOL BRAUN 5mg SOL. PERF. 5mg/ml B. BRAUN MELSU GERMANI CUTIE X 20 FLAC. DIN PEJD X 100 ML S/P-RF 20 4.476875 0.278625 4.029187 0.726313
746 J02AC FLUCONAZOLUM FLUCOVIM 100 CAPS. 100mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 BLIST. X 4 CAPS. P-R 4 3.078000 3.324500 2.770200 3.632300
747 J02AC FLUCONAZOLUM FUNGOLON 100 mg CAPS. 100mg BALKANPHARM BULGARI CUTIE X 2 BLIST. PVC/AL X 8 CAPS. P-R 16 2.178750 0.000000 1.960875 0.217875
748 J02AC FLUCONAZOLUM FLUCONAZOLE TEVA 100 m CAPS. 100mg TEVA PHARM ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 7 CAP P-R 7 3.078000 1.593428 2.770200 1.901228
749 J02AC FLUCONAZOLUM FLUCONAZOL AUROBINDO CAPS. 100mg AU MALTA CUTIE CU BLIST. PVC TRANSPA PRF 7 3.078000 0.342000 2.770200 0.649800
750 J02AC FLUCONAZOLUM FLUCOVIM 150 CAPS. 150mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 FLAC. X 1 CAPS. P-R 1 4.617000 2.543000 4.155300 3.004700
751 J02AC FLUCONAZOLUM DIFLUCAN 150 mg CAPS. 150mg PFIZER EUROPE M M CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-R 1 4.617000 6.413000 4.155300 6.874700
752 J02AC FLUCONAZOLUM FLUCORIC 150 mg CAPS. 150mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. FOLIE PVC-PVDC/AL P-R 1 4.617000 2.543000 4.155300 3.004700
753 J02AC FLUCONAZOLUM FLUCONAZOL SANDOZ (R) 1 CAPS. 150mg SANDOZ SRL GERMANI CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-R 1 4.617000 2.543000 4.155300 3.004700
754 J02AC FLUCONAZOLUM FLUCONAZOLE TEVA 150 m CAPS. 150mg TEVA PHARM ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 1 CAP P-R 1 4.617000 1.703000 4.155300 2.164700
755 J02AC FLUCONAZOLUM FLUCONAZOL 150 mg CAPS. 150mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-R 1 4.617000 2.543000 4.155300 3.004700
756 J02AC FLUCONAZOLUM FLUCONAZOL MEDOCHEM CAPS. 150mg MEDOCHEMIE RO ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-R 1 4.617000 2.543000 4.155300 3.004700
757 J02AC FLUCONAZOLUM FLUCONAZOL BIOGALENIC CAPS. 150mg LABORATOARELE PROF.DR.MORAIT S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 1 CAP P-R 1 4.617000 1.963000 4.155300 2.424700
758 J02AC FLUCONAZOLUM FLUCONAZOL ARENA 150 CAPS. 150mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-R 1 4.617000 2.543000 4.155300 3.004700
759 J02AC FLUCONAZOLUM FLUCONAZOL ACTAVIS 150 CAPS. 150mg ACTAVIS GROUP P ISLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 1 C PRF 1 4.617000 2.543000 4.155300 3.004700
760 J02AC FLUCONAZOLUM FLUCONAZOL LPH 150 mg CAPS. 150mg LABORMED PHARMA ROMANIA CUTIE CU 1 BLIST. PVC/AL X 1 CAPS. PRF 1 4.617000 2.543000 4.155300 3.004700
761 J02AC FLUCONAZOLUM FLUCONAZOL ROMPHARM CAPS. 150mg ROMPHARM COMP ROMANIA CUTIE CU 1 BLIST. PVC/AL X 1 CAPS. PRF 1 4.617000 2.543000 4.155300 3.004700

Pagina 14 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
762 J02AC FLUCONAZOLUM FLUCONAZOL AUROBINDO CAPS. 150mg AU MALTA CUTIE CU 1 BLIST. PVC PRF 1 4.617000 1.623000 4.155300 2.084700
763 J02AC FLUCONAZOLUM FLUCONAZOL ZENTIVA 150 CAPS. 150mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 BLIST. PVC-PE-PVDC/AL X 1 P-R 1 4.617000 2.543000 4.155300 3.004700
764 J02AC FLUCONAZOLUM FLUCONAZOL ZENTIVA 150 CAPS. 150mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-R 1 4.617000 2.543000 4.155300 3.004700
765 J02AC FLUCONAZOLUM FLUCONAZOLE TEVA 200 m CAPS. 200mg TEVA PHARM ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 7 CAP P-R 7 5.834285 0.000000 5.250856 0.583429
766 J02AC FLUCONAZOLUM FLUCOVIM 50 CAPS. 50mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 BLIST. X 7 CAPS. P-R 7 1.539000 1.241000 1.385100 1.394900
767 J02AC FLUCONAZOLUM DIFLUCAN 50 mg CAPS. 50mg PFIZER EUROPE M M CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-R 7 1.539000 2.738142 1.385100 2.892042
768 J02AC FLUCONAZOLUM FLUCORIC 50 mg CAPS. 50mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. FOLIE PVC-PVDC/AL P-R 7 1.539000 1.241000 1.385100 1.394900
769 J02AC FLUCONAZOLUM FLUCONAZOL SANDOZ (R) 5 CAPS. 50mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-R 7 1.527142 0.000000 1.374427 0.152715
770 J02AC FLUCONAZOLUM FLUCONAZOLE TEVA 50 mg CAPS. 50mg TEVA PHARM ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 7 CAP P-R 7 1.539000 0.426714 1.385100 0.580614
771 J02AC FLUCONAZOLUM FLUCONAZOL 50 mg CAPS. 50mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-R 7 1.539000 1.239571 1.385100 1.393471
772 J02AC FLUCONAZOLUM FLUCONAZOL MEDOCHEMI CAPS. 50mg MEDOCHEMIE RO ROMANIA CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-R 7 1.539000 0.853857 1.385100 1.007757
773 J02AC FLUCONAZOLUM FLUCONAZOL ARENA 50 MG CAPS. 50mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-R 7 1.539000 1.241000 1.385100 1.394900
774 J02AC FLUCONAZOLUM FLUCONAZOL LPH 50 mg CAPS. 50mg LABORMED PHARMA ROMANIA CUTIE CU 1 BLIST. PVC/AL X 7 CAPS. PRF 7 1.539000 1.241000 1.385100 1.394900
775 J02AC FLUCONAZOLUM FLUCONAZOL AUROBINDO CAPS. 50mg AU MALTA CUTIE CU BLIST. PVC TRANSPA PRF 7 1.539000 0.171000 1.385100 0.324900
776 J02AC FLUCONAZOLUM DIFLUCAN 10 mg/ml PUL 10mg/ml PFIZER EUROPE M M CUTIE X 1 FLACON PEID DE CAPACITATE 60 ML, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII + 1 LINGURITA DOZATOARE A 5ML, CU PULB. PENTRU 35 ML SUSP. ORALA
PRF 1 10.773000 18.797000 9.695700 19.874300
777 J02AC FLUCONAZOLUM DIFLAZON 2mg/ml SOL. PERF. 2mg/ml KRKA D.D. NOVO M SLOVENI CUTIE X 1 FLACON DIN STICLA INC S/PR-F 1 22.050000 25.400000 19.845000 27.605000
778 J05AB ACICLOVIRUM ACICLOVIR 200 mg CAPS. 200mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.804149 0.244351 0.723734 0.324766
779 J05AB ACICLOVIRUM ACICLOVIR ARENA 200 mg CAPS. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.804149 0.306851 0.723734 0.387266
780 J05AB ACICLOVIRUM ACICLOVIR FARMEX 200 mg CAPS. 200mg FARMEX COMPANY S ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. P-R 20 0.804149 0.266851 0.723734 0.347266
781 J05AB ACICLOVIRUM ACICLOVIR ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-R 10 1.608299 0.411701 1.447469 0.572531
782 J05AB ACICLOVIRUM ACICLOVIR TERAPIA 200 mg COMPR. 200mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.804149 0.085851 0.723734 0.166266
783 J05AB ACICLOVIRUM ACICLOVIR 200 mg COMPR. 200mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COMPR. P-R 20 0.804149 0.089351 0.723734 0.169766
784 J05AB ACICLOVIRUM ACICLOVIR 200 mg COMPR. 200mg EGIS PHARMA UNGARIA CUTIE X 4 BLIST. PVC-PVDC/AL X 5 CO P-R 20 0.716500 0.000000 0.644850 0.071650
785 J05AB ACICLOVIRUM ACICLOVIR LAROPHARM 20 COMPR. 200mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.804149 0.089351 0.723734 0.169766
786 J05AB ACICLOVIRUM ACICLOVIR-RICHTER 200 mg COMPR. 200mg GEDEON RIC ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0.804149 0.089351 0.723734 0.169766
787 J05AB ACICLOVIRUM ACICLOVIR 400 mg COMPR. 400mg EGIS PHARMA UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 5 CO P-R 10 1.608299 1.149701 1.447469 1.310531
788 J05AB ACICLOVIRUM VIROLEX PULB. PT. SOL. INJ./PERF. 250mg KRKA D.D. NOVO M SLOVENI CUTIE X 5 FLAC. X 250 MG PULB. PT S/P-RF 5 47.124000 0.000000 42.411600 4.712400
789 M01A INDOMETACINUM INDOMETACIN LAROPHAR CAPS. 25mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST., PVC/AL, X 10 CAPS. P-6 20 0.063112 0.020888 0.056800 0.027200
790 M01A INDOMETACINUM INDOMETACIN ARENA 25 M CAPS. 25mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6 30 0.063112 0.010888 0.056800 0.017200
791 M01A INDOMETACINUM INDOMETACIN ARENA 50 MG CAPS. 50mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-6 20 0.126225 0.057275 0.113602 0.069898
792 M01A INDOMETACINUM INDOMETACIN 50 mg SUPOZ. 50mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDATE AL- P-6 6 0.326250 0.387083 0.293625 0.419708
793 M01A INDOMETACINUM INDOMETACIN 50 mg SUPOZ. 50mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6 10 0.326250 0.360750 0.293625 0.393375
794 M01A INDOMETACINUM INDOMETACIN 50 mg SUPOZ. 50mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII TERMOSUDATE PV P-6 10 0.326250 0.357750 0.293625 0.390375
795 M01A DICLOFENACUM DICLOREUM 150 mg CAPS. ELIB 150mg ALFA WASSERMANN ITALIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-6 20 0.378675 2.095825 0.340807 2.133693
796 M01A DICLOFENACUM DICLOFENAC DUO PH CAPS. ELIB 75mg PHARMASWISS CESKA REPUBLIKA S.R.O. CEHIA CUTIE X 3 BLIST. PVC/PVDC/AL X P-6 30 0.189337 0.391663 0.170403 0.410597
797 M01A DICLOFENACUM DICLOTARD 100 mg CO 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. PVC-PV P-6 20 0.252450 0.102050 0.227205 0.127295
798 M01A DICLOFENACUM DICLAC (R) 75 ID COMPR. 75mg HEXAL AG GERMANI CUTIE X 1 BLIST. AL/PP X 10 COMPR. P-6 10 0.163000 0.000000 0.146700 0.016300
799 M01A DICLOFENACUM VOLTAREN (R) RETARD COMPR. FILM. ELIB. PREL. 100mg NOVARTIS PHARM GERMANI CUTIE X 1 BL P-6 10 0.252450 0.292550 0.227205 0.317795
800 M01A DICLOFENACUM REFEN (R) RETARD COMPR. FILM. ELIB. PREL. 100mg STADA HEMOFARM S ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 C P-6 20 0.252450 0.102050 0.227205 0.127295
801 M01A DICLOFENACUM VOLTAREN (R) 50 COMPR. FILM. GASTROREZ. 50mg NOVARTIS PHARM GERMANI CUTIE X 2 P-6 20 0.126225 0.054275 0.113602 0.066898
802 M01A DICLOFENACUM DICLOFENAC 50 mg COMPR. FILM. GASTROREZ. 50mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 1 P-6 20 0.117000 0.000000 0.105300 0.011700
803 M01A DICLOFENACUM DICLOFENAC HELCOR 50 m COMPR. FILM. GASTROREZ. 50mg A.C. HELCOR PH ROMANIA CUTIE X 2 BLIST. AL/PVC X 1 P-6 20 0.117000 0.000000 0.105300 0.011700
804 M01A DICLOFENACUM VOLTAREN RAPID (R) DRAJ. 50mg NOVARTIS PHARM GERMANI CUTIE X 1 BLIST. PVC-PE-PVDC/AL X P-6 10 0.126225 0.116775 0.113602 0.129398
805 M01A DICLOFENACUM DICLOFENAC ARENA 25 mg DRAJ. 25mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRA P-6 30 0.063112 0.134554 0.056800 0.140866
806 M01A DICLOFENACUM DICLOFENAC ARENA 50 mg DRAJ. 50mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 DRAJ P-6 20 0.117000 0.000000 0.105300 0.011700
807 M01A DICLOFENACUM DICLOFENAC ARENA 50 mg DRAJ. 50mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 30 DRAJ P-6 30 0.117000 0.000000 0.105300 0.011700
808 M01A DICLOFENACUM VOLTAREN (R) SOL. INJ. 25mg/ml NOVARTIS PHARM GERMANI CUTIE X 5 FIOLE CU PUNCT DE RUPE P-R 5 0.984600 0.697400 0.886140 0.795860
809 M01A DICLOFENACUM TRATUL (R) SOL. INJ. 30mg/ml GERO AUSTRIA CUTIE X 1 BLIST P P-R 5 1.094000 0.000000 0.984600 0.109400
810 M01A DICLOFENACUM DICLOFENAC 75 mg SOL. INJ. 75mg/3ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 3 ML P-R 5 0.984600 0.109400 0.886140 0.207860
811 M01A DICLOFENACUM REFEN 75 mg SOL. INJ./PE 25mg/ml STADA HEMOFARM S ROMANIA CUTIE CU 5 FIOLE DIN P-R 5 0.842000 0.000000 0.757800 0.084200
812 M01A DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDANTE X 3 P-6 6 0.570000 0.000000 0.513000 0.057000
813 M01A DICLOFENACUM VOLTAREN (R) SUPOZ. 100mg NOVARTIS PHARM GERMANI CUTIE X 1 FOLIE PVC/PE-JD X 5 SUPOZ. P-6 5 0.652500 0.225500 0.587250 0.290750
814 M01A DICLOFENACUM DICLOFENAC 100 mg SUPOZ. 100mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6 10 0.570000 0.000000 0.513000 0.057000
815 M01A DICLOFENACUM DICLOFENAC SODIC 100 mg SUPOZ. 100mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII TERMOSUDATE PV P-6 10 0.572000 0.000000 0.514800 0.057200
816 M01A DICLOFENACUM DICLOFENAC SINTOFARM 1 SUPOZ. 12,5 mg SINTOFARM S.A. ROMANIA CUTIE X 2 FOLII TERM P6L 6 0.081562 0.525104 0.073405 0.533261

Pagina 15 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
817 M01A DICLOFENACUM DICLOFENAC SINTOFARM 1 SUPOZ. 12,5 mg SINTOFARM S.A. ROMANIA CUTIE X 2 FOLII TERM P6L 10 0.081562 0.519438 0.073405 0.527595
818 M01A DICLOFENACUM VOLTAREN (R) SUPOZ. 50mg NOVARTIS PHARM GERMANI CUTIE X 2 FOLII PVC/PEJD X 5 SUPOZ. P-6 10 0.326250 0.633750 0.293625 0.666375
819 M01A KETOROLACUM TROMETHA KETOROL COMPR. FILM 10mg DR. REDDY'S L ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 P-6 20 0.084149 0.265851 0.075734 0.274266
820 M01A KETOROLACUM TROMETHA KETANOV 10 mg COMPR. FILM 10mg TERAPIA SA ROMANIA CUTIE CU 2 BLIST. OPA-AL- P-6 20 0.084149 0.441851 0.075734 0.450266
821 M01A KETOROLACUM TROMETHA KETANOV SOL. INJ. 30mg/ml TERAPIA SA ROMANIA CUTIE X 10 FIOLE X 1 ML P-R 10 1.312800 1.254200 1.181520 1.385480
822 M01A KETOROLACUM TROMETHA KETOROL SOL. INJ. 30mg/ml DR. REDDY'S L ROMANIA CUTIE X 1 BLIST. X 10 P-R 10 1.312800 0.721200 1.181520 0.852480
823 M01A KETOROLACUM TROMETHA KETOROL SOL. INJ. 30mg/ml ROMPHARM COMP ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA, PREVAZUTE CU INEL DE RUPERE X 1 ML SOL. INJ. PRF 5 1.312800 0.721200 1.181520 0.852480
824 M01A KETOROLACUM TROMETHA KETOROL SOL. INJ. 30mg/ml ROMPHARM COMP ROMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA, PREVAZUTE CU INEL DE RUPERE X 1 ML SOL. INJ. PRF 10 1.312800 0.721200 1.181520 0.852480
825 M01A ACECLOFENACUM AFLAMIL 100mg COMPR. FILM 100mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL X 10 P-6 20 0.126225 0.609275 0.113602 0.621898
826 M01A ACECLOFENACUM ACE-TAB 100 mg COMPR. FILM 100mg LABORMED PHARMA ROMANIA CUTIE CU 1 BLIST. PVC-PE-PVDC P6L 20 0.126225 0.352275 0.113602 0.364898
827 M01A TENOXICAMUM TENOXICAM LPH 20 mg CAPS. 20mg LABORMED PHARMA ROMANIACUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-6 20 0.324000 0.248500 0.291600 0.280900
828 M01A TENOXICAMUM TENOXICAM ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIACUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.324000 0.408000 0.291600 0.440400
829 M01A TENOXICAMUM NEO - ENDUSIX (R) COMPR. FILM 20mg ANFARM HELLAS S.A. PHARMACEUTICALS GRECIA CUTIE X 1 BLIST. X 10 COMPR. FILM. P-6 10 0.324000 0.334000 0.291600 0.366400
830 M01A TENOXICAMUM NEO - ENDUSIX (R) LIOF. + SOLV. PT. SOL. INJ. 20mg ANFARM HELLAS S.A. PHARMACEUTICALS GRECIA CUTIE X 1 FLAC. PULB. + 1 FIOLA SOLV. P-R 1 1.965500 3.674500 1.768950 3.871050
831 M01A MELOXICAMUM MOVALIS (R) 15 mg COMPR. 15mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 2 BLIST. PVC-PVDC/AL X 10 C P-6 20 0.324000 0.230000 0.291600 0.262400
832 M01A MELOXICAMUM MOVALIS (R) 15 mg COMPR. 15mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 1 BLIST. PVC-PVDC/AL X 10 C P-6 10 0.324000 0.231000 0.291600 0.263400
833 M01A MELOXICAMUM MELOXICAM LPH 15 mg COMPR. 15mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.324000 0.036000 0.291600 0.068400
834 M01A MELOXICAMUM MELOXICAM SANDOZ 15 mg COMPR. 15mg HEXAL AG GERMANI CUTIE X 2 BLIST. PVC-PVDC/AL X 10 C P-6 20 0.324000 0.036000 0.291600 0.068400
835 M01A MELOXICAMUM MELOXICAM MCC 15 mg COMPR. 15mg MAGISTRA C & C SR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.324000 0.036000 0.291600 0.068400
836 M01A MELOXICAMUM MELOXICAM VIM SPECTRU COMPR. 15mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.324000 0.036000 0.291600 0.068400
837 M01A MELOXICAMUM Meloxicam Zentiva 15 mg c COMPR. 15mg ZENTIVA AS CEHIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 C P-6 20 0.324000 0.026500 0.291600 0.058900
838 M01A MELOXICAMUM MELOXICAM LPH 15 mg COMPR. 15mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P6L 30 0.324000 0.036000 0.291600 0.068400
839 M01A MELOXICAMUM MOVALIS (R) 7,5 mg COMPR. 7,5mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 1 BLIST. PVC-PVDC/AL X 10 C P-6 10 0.162000 0.285000 0.145800 0.301200
840 M01A MELOXICAMUM MOVALIS (R) 7,5 mg COMPR. 7,5mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 2 BLIST. PVC-PVDC/AL X 10 C P-6 20 0.162000 0.285000 0.145800 0.301200
841 M01A MELOXICAMUM MELOXICAM LPH 7,5 mg COMPR. 7,5mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.162000 0.128500 0.145800 0.144700
842 M01A MELOXICAMUM MELOXICAM SANDOZ 7,5 mg COMPR. 7,5mg HEXAL AG GERMANI CUTIE X 2 BLIST. PVC-PVDC/AL X 10 C P-6 20 0.162000 0.128500 0.145800 0.144700
843 M01A MELOXICAMUM MELOXICAM MCC 7,5 mg COMPR. 7,5mg MAGISTRA C & C SR ROMANIA CUTIE X 2 BLIAT. AL/PVC X 10 COMPR. P-6 20 0.162000 0.128500 0.145800 0.144700
844 M01A MELOXICAMUM MELOXICAM VIM SPECTR COMPR. 7,5mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.162000 0.128500 0.145800 0.144700
845 M01A MELOXICAMUM MELOXICAM LPH 7,5 mg COMPR. 7,5mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P6L 30 0.162000 0.128333 0.145800 0.144533
846 M01A MELOXICAMUM MELOXICAM ROMPHARM 1 SOL INJ. 15mg/1,5ml ROMPHARM COMP ROMANIA PRF
CUTIE CU 3 FIOLE DIN STICLA INCOLORA, PREVAZUTE CU INEL DE RUPERE, CU CAPACITATEA DE 2 ML CARE CONTIN 1,5 ML SOL. INJ.
3 1.963333 0.000000 1.766999 0.196334
847 M01A MELOXICAMUM MELOXICAM ROMPHARM 1 SOL INJ. 15mg/1,5ml ROMPHARM COMP ROMANIA PRF
CUTIE CU 5 FIOLE DIN STICLA INCOLORA, PREVAZUTE CU INEL DE RUPERE, CU CAPACITATEA DE 2 ML CARE CONTIN 1,5 ML SOL. INJ.
5 1.964000 0.000000 1.767600 0.196400
848 M01A MELOXICAMUM MELOX 15 mg/1,5 ml SOL. INJ. 10mg/ml MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST. DIN PVC A 5 FIOLE TRANSPARENTE DIN STICLA CU CAPACITATEA DE 2 ML, CONTINAND 1,5 ML PRF 5 1.965500 0.000500 1.768950 0.197050
849 M01A MELOXICAMUM MOVALIS 15mg/1,5ml SOL. INJ. 15mg/1,5ml BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 5 FIOLE DIN STICLA IN P-R 5 1.965500 1.058500 1.768950 1.255050
850 M01A MELOXICAMUM MELOXICAM 15 mg SUPOZ. 15mg MAGISTRA C & C ROMANIA CUTII X 2 FOLII TERMOSUDATE PVC P-6 6 0.759249 0.877417 0.683324 0.953342
851 M01A KETOPROFENUM KETOPROFEN SR TERAPI CAPS. ELIB 100mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. CU ELIB. P-6 10 0.297000 0.000000 0.267300 0.029700
852 M01A KETOPROFENUM KETONAL (R) DUO 150 mg CAPS. ELIB 150mg SANDOZ S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC-TE-P P-6 20 0.712800 0.133700 0.641520 0.204980
853 M01A KETOPROFENUM KETOPROFEN SR TERAPI CAPS. ELIB 200mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. CU ELIB. P-6 10 0.644000 0.000000 0.579600 0.064400
854 M01A KETOPROFENUM KETONAL RETARD COMPR. 150mg LEK PHARMACEU SLOVENI CUTIE X 1 FLAC. X 20 COMPR. CU ELIB P-6 20 0.712800 0.066700 0.641520 0.137980
855 M01A KETOPROFENUM PROFENID (R) 100 mg COMPR. FILM 100mg LAB. AVENTIS FRANTA CUTIE X 2 BLIST X 15 COMPR. FILM. P-6 30 0.431333 0.000000 0.388199 0.043134
856 M01A KETOPROFENUM KETOPROXIN 100 mg COMPR. FILM 100mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. PVC/ALX 10 COMPR. P-6 20 0.280500 0.000000 0.252450 0.028050
857 M01A KETOPROFENUM KETOPROXIN 50 mg COMPR. FILM 50mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. PVC/ALX 10 COMPR. P-6 20 0.237599 0.119901 0.213839 0.143661
858 M01A KETOPROFENUM KETOPROFEN ROMPHAR SOL. INJ. 100 mg/2ml ROMPHARM COMP ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU INEL DE RUPERE A CATE 2ML SOL. INJ PRF 5 1.138000 0.002000 1.024200 0.115800
859 M01A KETOPROFENUM KETOPROFEN ROMPHAR SOL. INJ. 100 mg/2ml ROMPHARM COMP ROMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA PREVAZUTE CU INEL DE RUPERE A CATE 2ML SOL. INJ PRF 10 1.136000 0.000000 1.022400 0.113600
860 M01A KETOPROFENUM KETONAL 100 mg/ 2 ml SOL. INJ. 100mg/2ml LEK PHARMACEU SLOVENI CUTIE X 10 FIOLE X 2 ML SOL. I P-R 10 0.971000 0.000000 0.873900 0.097100
861 M01A KETOPROFENUM KETOPROFEN TERAPIA SOL. INJ./CONC. SOL. PERF. 100mg/2ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE X 2 ML P-R 5 1.138000 0.858000 1.024200 0.971800
862 M01A KETOPROFENUM KETOMAG SUPOZ. 100mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII LAMINATE PVC/PE X P-6 10 0.678000 0.000000 0.610200 0.067800
863 M04A ALLOPURINOLUM* MILURIT 100 mg COMPR. 100mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 50 COMPR. P-6 50 0.151450 0.019350 0.136305 0.034495
864 M04A ALLOPURINOLUM* MILURIT 300 mg COMPR. 300mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-6 30 0.435000 0.000000 0.391500 0.043500
865 M04A COLCHICINUM COLCHICINA COMPR. 1mg BIOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 20 COMPR. P-R 40 0.149500 0.000000 0.134550 0.014950
866 N02AX TRAMADOLUM TRAMADOL CAPS. 50mg KRKA D.D. SLOVENI CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.263832 0.035668 0.237448 0.062052
867 N02AX TRAMADOLUM K-ALMA (R) CAPS. 50mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.263832 0.134668 0.237448 0.161052
868 N02AX TRAMADOLUM TRAMADOL ARENA CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.263832 0.203168 0.237448 0.229552
869 N02AX TRAMADOLUM TRAMACALM CAPS. 50mg A.C. HELCOR PH ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. P-R 10 0.263832 0.121168 0.237448 0.147552
870 N02AX TRAMADOLUM TRAMADOL ZENTIVA 50 mg CAPS. 50mg ZENTIVA A.S. SLOVACI CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.263832 0.020668 0.237448 0.047052
871 N02AX TRAMADOLUM TRAMAG 50 COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.263832 0.134668 0.237448 0.161052

Pagina 16 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
872 N02AX TRAMADOLUM TRAMADOL EEL COMPR. 50mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.263832 0.119668 0.237448 0.146052
873 N02AX TRAMADOLUM TRAMADOL RETARD 100 mg COMPR. 100mg KRKA, D.D., NOVO SLOVENI CUTIE CU 3 BLIST. AL/PVC X 10 CO PRF 30 0.527666 0.126000 0.474899 0.178767
874 N02AX TRAMADOLUM TRAMADOL SR ZENTIVA 100 COMPR. 100mg ZENTIVA AS SLOVACI CUTIE X 3 BLIST. PVC/AL X 10 COMP P-R 30 0.527666 0.102667 0.474899 0.155434
875 N02AX TRAMADOLUM MABRON RETARD 100 mg COMPR. 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST. DIN PVC/ PRF 10 0.527000 0.000000 0.474300 0.052700
876 N02AX TRAMADOLUM MABRON RETARD 100 mg COMPR. 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE D PRF 30 0.527666 0.000334 0.474899 0.053101
877 N02AX TRAMADOLUM MABRON RETARD 100 mg COMPR. 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLISTER DIN PRF 10 0.527000 0.000000 0.474300 0.052700
878 N02AX TRAMADOLUM MABRON RETARD 100 mg COMPR. 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE D PRF 30 0.527666 0.000334 0.474899 0.053101
879 N02AX TRAMADOLUM TRADOLAN RETARD 150 mg COMPR. 150mg LANN AUSTRIA CUTIE CU 3 BLIST. PVC/AL X 10 PRF 30 0.791500 0.326500 0.712350 0.405650
880 N02AX TRAMADOLUM TRAMADOL SR ZENTIVA 150 COMPR. 150mg ZENTIVA AS SLOVACI CUTIE X 3 BLIST. PVC/AL X 10 COMP P-R 30 0.791500 0.112833 0.712350 0.191983
881 N02AX TRAMADOLUM MABRON RETARD 150 mg COMPR. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST. DIN PVC/ PRF 10 0.791500 0.000500 0.712350 0.079650
882 N02AX TRAMADOLUM MABRON RETARD 150 mg COMPR. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE D PRF 30 0.791333 0.000000 0.712199 0.079134
883 N02AX TRAMADOLUM MABRON RETARD 150 mg COMPR. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLISTER DIN PRF 10 0.791500 0.000500 0.712350 0.079650
884 N02AX TRAMADOLUM MABRON RETARD 150 mg COMPR. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE D PRF 30 0.791333 0.000000 0.712199 0.079134
885 N02AX TRAMADOLUM TRADOLAN RETARD 200 mg COMPR. 200mg LANN AUSTRIA CUTIE CU 3 BLIST. PVC/AL X 10 PRF 30 1.055333 0.115333 0.949799 0.220867
886 N02AX TRAMADOLUM MABRON RETARD 200 mg COMPR. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST. DIN PVC/ PRF 10 1.055000 0.000000 0.949500 0.105500
887 N02AX TRAMADOLUM MABRON RETARD 200 mg COMPR. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE D PRF 30 1.055333 0.000000 0.949799 0.105534
888 N02AX TRAMADOLUM MABRON RETARD 200 mg COMPR. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLISTER DIN PRF 10 1.055000 0.000000 0.949500 0.105500
889 N02AX TRAMADOLUM MABRON RETARD 200 mg COMPR. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE D PRF 30 1.055333 0.000000 0.949799 0.105534
890 N02AX TRAMADOLUM TRADOLAN 50 mg COMPR. FILM 50mg LANN AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR.F P-R 30 0.263832 0.066501 0.237448 0.092885
891 N02AX TRAMADOLUM TRAMADOL RETARD 150 mg COMPR. FILM. ELIB. PREL. 150mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. AL/PVC X 10 C P-R 30 0.791500 0.493833 0.712350 0.572983
892 N02AX TRAMADOLUM TRAMADOL RETARD 200 mg COMPR. FILM. ELIB. PREL. 200mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. AL/PVC X 10 P-R 30 1.055333 0.640667 0.949799 0.746201
893 N02AX TRAMADOLUM TRAMADOL ZENTIVA 50 mg COMPR. ORODISPERSABILE 50mg ZENTIVA, A.S. REPUBLICA SLOVACA CUTIE CU 1 PRF 10 0.263832 0.134168 0.237448 0.160552
894 N02AX TRAMADOLUM TRAMADOL ZENTIVA 50 mg COMPR. ORODISPERSABILE 50mg ZENTIVA, A.S. REPUBLICA SLOVACA CUTIE CU 1 PRF 10 0.263832 0.134168 0.237448 0.160552
895 N02AX TRAMADOLUM MABRON SOL. INJ. 100mg MEDOCHEMIE LTD. CIPRU CUTIE X 5 FIOLE DIN STICLA BRUNA S/P-RF 5 1.580422 0.295578 1.422379 0.453621
896 N02AX TRAMADOLUM MABRON SOL. INJ. 100mg MEDOCHEMIE LTD. CIPRU CUTIE X 100 FIOLE DIN STICLA B S/P-RF 100 1.396100 0.000000 1.256490 0.139610
897 N02AX TRAMADOLUM TRAMADOL SOL. INJ. 50mg/ml KRKA D.D. SLOVENI CUTIE X 5 FIOLE X 1 ML S/P-RF 5 0.790208 0.233792 0.711187 0.312813
898 N02AX TRAMADOLUM TRAMADOL SOL. INJ. 50mg/ml KRKA D.D. SLOVENI CUTIE X 5 FIOLE X 2 ML S/P-RF 5 1.580422 1.137578 1.422379 1.295621
899 N02AX TRAMADOLUM TRAMADOL SUPOZ. 100mg KRKA D.D. SLOVENI CUTIE X 1 BLIST. X, 5 SUPOZ. P-R 5 1.158000 0.000000 1.042200 0.115800
900 N02C SUMATRIPTANUM* IMIGRAN DR 100 mg COMPR. DISP 100mg GLAXO WELL M CUTIE CU 1 BLIST. (OPA)-AL-PVC/ P-R 2 8.246250 8.653750 7.421625 9.478375
901 N02C SUMATRIPTANUM* IMIGRAN DR 50 mg COMPR. DISP 50mg GLAXO WELL M CUTIE CU 1 BLIST. (OPA)-AL-PVC/ P-R 2 4.123125 4.391875 3.710812 4.804188
902 N02C SUMATRIPTANUM* XIBIMER 100 mg COMPR. FILM 100mg DR. REDDY'S L ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 6 P-R 6 8.246250 1.803750 7.421625 2.628375
903 N02C SUMATRIPTANUM* SUMACTA 100 mg COMPR. FILM 100mg ACTAVIS GROUP P ISLANDA CUTIE CU 2 BLIST. PVC/AL X 3 COMPR. PRF 6 7.645000 0.000000 6.880500 0.764500
904 N02C SUMATRIPTANUM* XIBIMER 50 mg COMPR. FILM 50mg DR. REDDY'S L ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 6 P-R 6 4.123125 1.408541 3.710812 1.820854
905 N02C SUMATRIPTANUM* SUMACTA 50 mg COMPR. FILM 50mg ACTAVIS GROUP P ISLANDA CUTIE CU 2 BLIST. PVC/AL X 3 COMPR. PRF 6 1.315000 0.000000 1.183500 0.131500
906 N03AF CARBAMAZEPINUM TEGRETOL (R) 200 COMPR. 200mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. PVC-PE-PVDC/AL X P-6 50 0.141800 0.076400 0.127620 0.090580
907 N03AF CARBAMAZEPINUM CARBAMAZEPINA LPH (R) COMPR. 200mg LABORMED PHARMA ROMANIA CUTIE X 6 BLISTERE PVC-PVDC/ P 60 0.141800 0.000033 0.127620 0.014213
908 N03AF CARBAMAZEPINUM CARBAMAZEPINA LPH 200 COMPR. 200mg LABORMED PHARMA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.141800 0.000000 0.127620 0.014180
909 N03AF CARBAMAZEPINUM CARBAVIM COMPR. 200mg VIM SPECTRUM SRL ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.141800 0.000000 0.127620 0.014180
910 N03AF CARBAMAZEPINUM CARBEPSIL 200mg COMPR. 200mg AC HELCOR PHARM ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6 50 0.141800 0.000000 0.127620 0.014180
911 N03AF CARBAMAZEPINUM CARBAMAZEPIN COMPR. 200mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.140000 0.000000 0.126000 0.014000
912 N03AF CARBAMAZEPINUM CARBAMAZEPIN EEL COMPR. 200mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.141800 0.000200 0.127620 0.014380
913 N03AF CARBAMAZEPINUM CARBAMAZEPINA ARENA 20 COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.141800 0.000200 0.127620 0.014380
914 N03AF CARBAMAZEPINUM CARBAMAZEPINA SLAVIA 2 COMPR. 200mg SLAVIA PHARM SRL ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6 50 0.141800 0.000000 0.127620 0.014180
915 N03AF CARBAMAZEPINUM CARBAMAZEPINA TERAPIA COMPR. 200mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. PRF 50 0.141800 0.000000 0.127620 0.014180
916 N03AF CARBAMAZEPINUM CARBEPSIL 400mg COMPR. 400mg AC HELCOR PHARM ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6 50 0.283600 0.108600 0.255240 0.136960
917 N03AF CARBAMAZEPINUM CARBAMAZEPINA ARENA 4 COMPR. 400mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6 20 0.283600 0.108400 0.255240 0.136760
918 N03AF CARBAMAZEPINUM TIMONIL RETARD 150 mg COMPR. CU ELIB. PRELUNGITA 150mg DESITIN ARZN GERMANI CUTIE X 5 BLIST. PVC/AL P6L 50 0.106349 0.197451 0.095714 0.208086
919 N03AF CARBAMAZEPINUM TIMONIL RETARD 300 mg COMPR. CU ELIBERARE PRELUNGITA 300mg DESITIN ARZN GERMANI CUTIE X 5 BLIST. P6L 50 0.212699 0.199901 0.191429 0.221171
920 N03AF CARBAMAZEPINUM TIMONIL RETARD 600 mg COMPR. CU ELIBERARE PRELUNGITA 600mg DESITIN ARZN GERMANI CUTIE X 5 BLIST. P6L 50 0.425399 0.306201 0.382859 0.348741
921 N03AF CARBAMAZEPINUM NEUROTOP (R) RETARD 300 COMPR. 300mg GEROT PHAR AUSTRIA CUTIE X 5 BLIST. AL/PVDC-PVC P-6 50 0.212699 0.143301 0.191429 0.164571
922 N03AF CARBAMAZEPINUM NEUROTOP (R) RETARD 600 COMPR. 600mg GEROT PHAR AUSTRIA CUTIE X 5 BLIST. AL/PVDC-PVC P-6 50 0.425399 0.260601 0.382859 0.303141
923 N03AF CARBAMAZEPINUM TEGRETOL CR 200 COMPR. FILM. ELIB. PREL. 200mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. AL P-6 50 0.141800 0.205600 0.127620 0.219780
924 N03AF CARBAMAZEPINUM TEGRETOL CR 400 COMPR. FILM. ELIB. PREL. 400mg NOVARTIS PHARM GERMANI CUTIE X 3 BLIST. AL P-6 30 0.283600 0.320400 0.255240 0.348760
925 N03AF CARBAMAZEPINUM TIMONIL SIROP SUSP. ORALA 100mg/5ml DESITIN ARZN GERMANI CUTIE X 1 FLACON P-6 1 23.360000 0.000000 21.024000 2.336000
926 N03AX GABAPENTINUM GABAPENTIN AUROBINDO CAPS. 100 mg AUROBINDO PH M CUTIE CU BLIST. DIIN POLIAMID P6L 50 0.149200 0.000000 0.134280 0.014920

Pagina 17 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
927 N03AX GABAPENTINUM GABAGAMMA 100 mg CAPS. 100mg WORWAG GERMANI CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6 100 0.164279 0.029821 0.147851 0.046249
928 N03AX GABAPENTINUM GRIMODIN 100 mg CAPS. 100mg EGIS PHARMA UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CA P-6 60 0.164279 0.412221 0.147851 0.428649
929 N03AX GABAPENTINUM GABAPENTINA PFIZER 100 CAPS. 100mg PFIZER EUROPE M M CUTIE CU BLIST. PVC/PVDC/AL X 50 CA P6L 50 0.164279 0.303521 0.147851 0.319949
930 N03AX GABAPENTINUM GABAPENTINA PFIZER 100 CAPS. 100mg PFIZER EUROPE M M CUTIE CU BLIST. PVC/PVDC/AL X 100 P6L 100 0.164279 0.288421 0.147851 0.304849
931 N03AX GABAPENTINUM GABAPENTIN ARENA 100 mg CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANS P6L 60 0.164279 0.243054 0.147851 0.259482
932 N03AX GABAPENTINUM GABAPENTIN AUROBINDO CAPS. 300 mg AUROBINDO PH M CUTIE CU BLIST. POLIAMIDA/AL/PVC P6L 50 0.447800 0.000000 0.403020 0.044780
933 N03AX GABAPENTINUM GABAGAMMA 300 mg CAPS. 300mg WORWAG GERMANI CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6 100 0.492840 0.263260 0.443556 0.312544
934 N03AX GABAPENTINUM GABARAN 300 mg CAPS. 300mg RANBAXY UK LTD. M CUTIE X 5 BLIST. PVC-PVDC/AL X 10 CA P-6 50 0.492840 0.853760 0.443556 0.903044
935 N03AX GABAPENTINUM GABALEPT 300 mg CAPS. 300mg PLIVA LJUBLJANA D. SLOVENI CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6 100 0.492840 0.026860 0.443556 0.076144
936 N03AX GABAPENTINUM GRIMODIN 300 mg CAPS. 300mg EGIS PHARMA UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CA P-6 60 0.492840 0.082660 0.443556 0.131944
937 N03AX GABAPENTINUM GABAPENTINA PFIZER 300 CAPS. 300mg PFIZER EUROPE M M CUTIE CU BLIST. PVC/PVDC/AL X 50 CA P6L 50 0.447400 0.000000 0.402660 0.044740
938 N03AX GABAPENTINUM GABAPENTINA PFIZER 300 CAPS. 300mg PFIZER EUROPE M M CUTIE CU BLIST. PVC/PVDC/AL X 100 P6L 100 0.433000 0.000000 0.389700 0.043300
939 N03AX GABAPENTINUM GABAPENTIN ARENA 300 mg CAPS. 300mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANS P6L 60 0.492840 0.404493 0.443556 0.453777
940 N03AX GABAPENTINUM GABAPENTIN AUROBINDO CAPS. 400 mg AUROBINDO PH M CUTIE CU BLIST. POLIAMIDA/AL/PVC P6L 50 0.597600 0.000000 0.537840 0.059760
941 N03AX GABAPENTINUM GABAGAMMA 400 mg CAPS. 400mg WORWAG GERMANI CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6 100 0.657121 0.535979 0.591408 0.601692
942 N03AX GABAPENTINUM GABARAN 400 mg CAPS. 400mg RANBAXY UK LTD. M CUTIE X 5 BLIST. PVC-PVDC/AL X 10 CA P-6 50 0.657121 0.851879 0.591408 0.917592
943 N03AX GABAPENTINUM GABALEPT 400 mg CAPS. 400mg PLIVA LJUBLJANA D. SLOVENI CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6 100 0.657121 0.035379 0.591408 0.101092
944 N03AX GABAPENTINUM GRIMODIN 400 mg CAPS. 400mg EGIS PHARMA UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CA P-6 60 0.657121 0.372212 0.591408 0.437925
945 N03AX GABAPENTINUM GABAPENTINA PFIZER 400 CAPS. 400mg PFIZER EUROPE M M CUTIE CU BLIST. PVC/PVDC/AL X 50 CA P6L 50 0.596200 0.000000 0.536580 0.059620
946 N03AX GABAPENTINUM GABAPENTINA PFIZER 400 CAPS. 400mg PFIZER EUROPE M M CUTIE CU BLIST. PVC/PVDC/AL X 100 P6L 100 0.577100 0.000000 0.519390 0.057710
947 N03AX GABAPENTINUM GABAPENTIN ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANS P6L 60 0.657121 0.464545 0.591408 0.530258
948 N03AX GABAPENTINUM GABARAN 600 mg COMPR. FILM 600mg RANBAXY UK LTD. M CUTIE X 3 BLIST. AL-PVC-PA/AL X 1 P-6 30 0.985682 1.194318 0.887113 1.292887
949 N03AX GABAPENTINUM GRIMODIN 600 mg COMPR. FILM 600mg EGIS PHARMA UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 P-6 60 0.985682 0.882151 0.887113 0.980720
950 N03AX GABAPENTINUM GABARAN 800 mg COMPR. FILM 800mg RANBAXY UK LTD. M CUTIE X 3 BLIST. AL-PVC-PA/AL X 1 P-6 30 1.314243 2.290757 1.182818 2.422182
951 N05AD HALOPERIDOLUM HALOPERIDOL LAROPHARM COMPR. 0,5mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.093037 0.074963 0.083733 0.084267
952 N05AD HALOPERIDOLUM HALOPERIDOL ARENA 1 mg COMPR. 1mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.186074 0.080926 0.167466 0.099534
953 N05AD HALOPERIDOLUM HALOPERIDOL ARENA 2 mg COMPR. 2mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLISTERE PVC/AL X 10 C PRF 30 0.372149 0.001184 0.334934 0.038399
954 N05AD HALOPERIDOLUM HALDOL COMPR. 5mg JANSSEN PH BELGIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-R 25 0.299600 0.000000 0.269640 0.029960
955 N05AD HALOPERIDOLUM HALOPERIDOL ROMPHARM PIC. ORALE 2 mg/ml ROMPHARM COMP ROMANIA CUTIE CU PRF 1 3.721497 1.668503 3.349347 2.040653
956 N05AD HALOPERIDOLUM HALOPERIDOL 2 mg/ml PIC. ORALE 2mg/ml GEDEON RIC ROMANIA CUTIE X 1 FLACON P-R 1 3.721497 3.178503 3.349347 3.550653
957 N05AD HALOPERIDOLUM HALOPERIDOL DECANOAT SOL. INJ. 50mg/ml GEDEON RIC ROMANIA CUTIE X 5 FIOLE X 1 ML P-R 5 8.452000 0.000000 7.606800 0.845200
958 N05AD HALOPERIDOLUM HALOPERIDOL RICHTER 5 SOL. INJ. 5mg/ml GEDEON RIC ROMANIA CUTIE X 5 FIOLE DIN STICLA IN P-R 5 1.066859 1.139141 0.960173 1.245827
959 N05BA DIAZEPAMUM DIAZEPAM RICHTER 10 mg COMPR. 10mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.103000 0.000000 0.092700 0.010300
960 N05BA DIAZEPAMUM DIAZEPAM COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.138666 0.000000 0.124799 0.013867
961 N05BA DIAZEPAMUM DIAZEPAM LAROPHARM 10 COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.108000 0.000000 0.097200 0.010800
962 N05BA DIAZEPAMUM DIAZEPAM 10 mg SOL. INJ. 10mg/2ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE X 2 ML S/P-RF 5 2.392000 0.000000 2.152800 0.239200
963 N05BA DIAZEPAMUM DIAZEPAM 5 mg/ml SOL. INJ. 10mg/2ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE X 2 ML S/P-RF 5 2.392000 0.000000 2.152800 0.239200
964 N05BA DIAZEPAMUM DIAZEPA SOL. RECTAL 10mg/2,5ml DESITIN ARZN GERMANI CUTIE X 5 PUNGI X 1 TUB X 2,5 ML + S/P-RF 5 5.178000 0.000000 4.660200 0.517800
965 N05BA DIAZEPAMUM DIAZEPAM DES SOL. RECTAL 5mg/2,5ml DESITIN ARZN GERMANI CUTIE X 5 PUNGI X 1 TUB X 2,5 ML + S/P-RF 5 4.530000 0.000000 4.077000 0.453000
966 N05BA MEDAZEPAMUM* MEDAZEPAM ARENA 10mg COMPR. 10 mg ARENA GROUP SA ROMANIA CUTIE X 2 BLISTERE PVC/AL X 10 C P-R 20 0.127000 0.000000 0.114300 0.012700
967 N05BA MEDAZEPAMUM* MEDAZEPAM ARENA 10mg COMPR. 10 mg ARENA GROUP SA ROMANIA CUTIE X 5 BLISTERE PVC/AL X 10 C P-R 50 0.116400 0.000000 0.104760 0.011640
968 N05BA MEDAZEPAMUM* MEDAZEPAM 10 mg COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE X 1 BLIST. X 20 COMPR. P-R 20 0.131875 0.026125 0.118687 0.039313
969 N05BA MEDAZEPAMUM* MEDAZEPAM LPH 10 mg COMPR. 10mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.128000 0.000000 0.115200 0.012800
970 N05BA MEDAZEPAMUM* MEDAZEPAM LPH 10 mg COMPR. 10mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P-RF/S 30 0.128000 0.000000 0.115200 0.012800
971 N05BA LORAZEPAMUM* ANXIAR (R) 1 mg COMPR. 1 mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 25 COMPR. P-R 50 0.105500 0.033500 0.094950 0.044050
972 N05BA BROMAZEPAMUM* BROMAZEPAM LPH 1,5 mg COMPR. 1,5mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.039562 0.071438 0.035605 0.075395
973 N05BA BROMAZEPAMUM* BROMAZEPAM LPH 1,5 mg COMPR. 1,5mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. PRF 30 0.039562 0.071438 0.035605 0.075395
974 N05BA BROMAZEPAMUM* BROMAZEPAM LPH 3 mg COMPR. 3mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.079125 0.028875 0.071212 0.036788
975 N05BA BROMAZEPAMUM* BROMAZEPAM SLAVIA 3 mg COMPR. 3mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.079125 0.020875 0.071212 0.028788
976 N05BA BROMAZEPAMUM* BROMAZEPAM ARENA 3 mg COMPR. 3mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. P-R 10 0.079125 0.028875 0.071212 0.036788
977 N05BA BROMAZEPAMUM* BROMAZEPAM LPH 3 mg COMPR. 3mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. PRF 30 0.079125 0.028875 0.071212 0.036788
978 N05BA ALPRAZOLAMUM* XANAX 0,25 mg COMPR. 0,25mg PFIZER EUROPE M M CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.065937 0.126729 0.059343 0.133323
979 N05BA ALPRAZOLAMUM* ALPRAZOLAM LPH (R) 0,25 COMPR. 0,25mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.065937 0.059063 0.059343 0.065657
980 N05BA ALPRAZOLAMUM* ALPRAZOLAM LPH (R) 0,25 COMPR. 0,25mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. X 10 COMPR. P-R 30 0.065937 0.058729 0.059343 0.065323
981 N05BA ALPRAZOLAMUM* PRAZOLEX (R) 0,25 mg COMPR. 0,25mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-R 30 0.065937 0.059396 0.059343 0.065990

Pagina 18 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
982 N05BA ALPRAZOLAMUM* FRONTIN 0,25 mg COMPR. 0,25mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-R 30 0.065937 0.059396 0.059343 0.065990
983 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. PRF 10 0.065937 0.059063 0.059343 0.065657
984 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.065937 0.059563 0.059343 0.066157
985 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.065937 0.059396 0.059343 0.065990
986 N05BA ALPRAZOLAMUM* XANAX 0,5 mg COMPR. 0,5mg PFIZER EUROPE M M CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.131875 0.174791 0.118687 0.187979
987 N05BA ALPRAZOLAMUM* ALPRAZOLAM LPH (R) 0,5 m COMPR. 0,5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. X 10 COMPR. P-R 30 0.131875 0.066791 0.118687 0.079979
988 N05BA ALPRAZOLAMUM* ALPRAZOLAM LPH (R) 0,5 m COMPR. 0,5mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.131875 0.067125 0.118687 0.080313
989 N05BA ALPRAZOLAMUM* FRONTIN 0,5 mg COMPR. 0,5mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-R 30 0.131875 0.067458 0.118687 0.080646
990 N05BA ALPRAZOLAMUM* PRAZOLEX (R) 0,5 mg COMPR. 0,5mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-R 30 0.131875 0.067458 0.118687 0.080646
991 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. PRF 10 0.131875 0.068125 0.118687 0.081313
992 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.131875 0.068625 0.118687 0.081813
993 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.131875 0.067458 0.118687 0.080646
994 N05BA ALPRAZOLAMUM* XANAX 1 mg COMPR. 1mg PFIZER EUROPE M M CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.263750 0.141916 0.237375 0.168291
995 N05BA ALPRAZOLAMUM* ALPRAZOLAM LPH (R) 1 mg COMPR. 1mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. X 10 COMPR. P-R 30 0.263333 0.000000 0.236999 0.026334
996 N05BA ALPRAZOLAMUM* ALPRAZOLAM LPH (R) 1 mg COMPR. 1mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.263500 0.000000 0.237150 0.026350
997 N05BA ALPRAZOLAMUM* PRAZOLEX (R) 1 mg COMPR. 1mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-R 30 0.263750 0.000250 0.237375 0.026625
998 N05BA ALPRAZOLAMUM* FRONTIN 1mg COMPR. 1mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-R 30 0.263750 0.000250 0.237375 0.026625
999 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 1 mg COMPR. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. PRF 10 0.263000 0.000000 0.236700 0.026300
1,000 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 1 mg COMPR. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.263750 0.000750 0.237375 0.027125
1,001 N05BA ALPRAZOLAMUM* ALPRAZOLAM ATB 1 mg COMPR. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.263750 0.000250 0.237375 0.026625
1,002 N05C NITRAZEPAMUM NITRAZEPAM LPH (R) 2,5 mg COMPR. 2,5mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.051374 0.019626 0.046236 0.024764
1,003 N05C NITRAZEPAMUM NITRAZEPAM LPH 2,5 mg COMPR. 2.5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.051374 0.019959 0.046236 0.025097
1,004 N05C NITRAZEPAMUM NITRAZEPAM LPH (R) 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.081500 0.000000 0.073350 0.008150
1,005 N05C NITRAZEPAMUM NITRAZEPAM 5 mg COMPR. 5mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.102749 0.022251 0.092474 0.032526
1,006 N05C NITRAZEPAMUM NITRAZEPAM - RICHTER 5 m COMPR. 5mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.102749 0.022251 0.092474 0.032526
1,007 N05C NITRAZEPAMUM NITRAZEPAM LPH 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.081666 0.000000 0.073499 0.008167
1,008 N05CF ZOPICLONUM* IMOVANE 7,5 mg COMPR. FILM 7,5mg SANOFI AVENTIS FRANTA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-R 20 0.363000 0.000000 0.326700 0.036300
1,009 N05CF ZOLPIDEMUM* SANVAL (R) 10 mg COMPR. FILM 10mg LEK PHARMACEU SLOVENI CUTIE X 1 BLIST. X 10 COMPR. FILM. P-R 10 0.225000 0.000000 0.202500 0.022500
1,010 N05CF ZOLPIDEMUM* SANVAL (R) 10 mg COMPR. FILM 10mg LEK PHARMACEU SLOVENI CUTIE X 2 BLIST. X 10 COMPR. FILM. P-R 20 0.224000 0.000000 0.201600 0.022400
1 N05CF ZOLPIDEMUM* ZOLPIDEM ATB 10 MG COMPR. FILM 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.225000 0.000000 0.202500 0.022500
1,012 N05CF ZOLPIDEMUM* STILNOX 10 mg COMPR. FILM 10mg SANOFI - ROMANIA CUTIE X 1 BLIST. PVC/AL X 10 COMPR. P-R 10 0.225000 0.120000 0.202500 0.142500
1,013 N05CF ZOLPIDEMUM* STILNOX 10 mg COMPR. FILM 10mg SANOFI - ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-R 20 0.225000 0.120000 0.202500 0.142500
1,014 N05CF ZOLPIDEMUM* ZOLPIDEM AUROBINDO 10 COMPR. FILM 10mg AU MALTA CUTIE CU BLIST. PVC-PVDC/AL X 10 PRF 10 0.225000 0.000000 0.202500 0.022500
1,015 N05CF ZOLPIDEMUM* STILNOX 10 mg COMPR. FILM 10mg SANOFI - ROMANIA CUTIE X 1 BLIST. PVC/AL X 20 COMPR. P-R 20 0.225000 0.120000 0.202500 0.142500
1,016 N06AA CLOMIPRAMINUM* ANAFRANIL (R) 10 mg DRAJ. 10mg NOVARTIS PHARM GERMANI CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-R 30 0.145412 0.099588 0.130870 0.114130
1,017 N06AA CLOMIPRAMINUM* ANAFRANIL (R) 25 mg DRAJ. 25mg NOVARTIS PHARM GERMANI CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-R 30 0.363532 0.097134 0.327178 0.133488
1,018 N06AA AMITRIPTYLINUM* AMITRIPTILINA ARENA 25 mg COMPR. FILM 25mg ARENA GROUP S.A. ROMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. P-R 50 0.311600 0.000000 0.280440 0.031160
1,019 N06AA DOXEPINUM* DOXEPIN 25 mg DRAJ. 25mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-R 30 0.363532 0.396134 0.327178 0.432488
1,020 N06AB FLUOXETINUM* FLUOXIN 20 mg CAPS. 20mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 7 CAPS. P-R 14 0.585803 0.219911 0.527222 0.278492
1,021 N06AB FLUOXETINUM* FLUOXIN 20 mg CAPS. 20mg VIM SPECTRUM SRL ROMANIA CUTIE X 4 BLIST. PVC/AL X 7 CAPS. P-R 28 0.585803 0.202054 0.527222 0.260635
1,022 N06AB FLUOXETINUM* MAGRILAN 20 mg CAPS. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-R 30 0.422333 0.000000 0.380099 0.042234
1,023 N06AB FLUOXETINUM* ROFLUXIN 20 mg CAPS. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-R 20 0.585803 0.198697 0.527222 0.257278
1,024 N06AB FLUOXETINUM* PROZAC 20 mg COMPR. DISP 20mg ELI LILLY SA SPANIA CUTIE X 2 BLIST. PVC-PE-ACLAR/ P-R 28 0.585803 0.729197 0.527222 0.787778
1,025 N06AB CITALOPRAMUM** LINISAN 10 mg COMPR. FILM 10mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.246000 0.000000 0.221400 0.024600
1,026 N06AB CITALOPRAMUM** LINISAN 20 mg COMPR. FILM 20mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.585803 0.782197 0.527222 0.840778
1,027 N06AB PAROXETINUM* ARKETIS COMPR. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC, X 10 COMPR. P-R 30 0.519666 0.000000 0.467699 0.051967
1,028 N06AB PAROXETINUM* PAROXETINA ATB 20 mg COMPR. FILM 20 mg ANTIBIOTICE SA ROMANIA CUTIE CU 3 BLIST. DIN PVC PRF 30 0.585803 0.031197 0.527222 0.089778
1,029 N06AB PAROXETINUM* SEROXAT 20 mg COMPR. FILM 20mg SMITHKLINE BEECH M CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.585803 0.362863 0.527222 0.421444
1,030 N06AB PAROXETINUM* PAXETIN 20 mg COMPR. FILM 20mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIST. AL/AL X 10 COMPR. FI P-R 30 0.519666 0.000000 0.467699 0.051967
1,031 N06AB PAROXETINUM* PALUXETIL 40 mg COMPR. FILM 40mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. DIN AL/PVC X 30 CO P-R 30 1.171606 0.054060 1.054445 0.171221
1,032 N06AB SERTRALINUM* SERLIFT 100 mg COMPR. FILM 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 14 COMPR. FILM. P-R 28 1.171606 0.110894 1.054445 0.228055
1,033 N06AB SERTRALINUM* ASENTRA (R) COMPR. FILM 100mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. X 7 COMPR. FILM. P-R 28 1.076428 0.000000 0.968785 0.107643
1,034 N06AB SERTRALINUM* SETALOFT 100 mg COMPR. FILM 100mg ACTAVIS GROUP P ISLANDA CUTIE, CU BLISTERE DIN PV P-R 28 0.719642 0.000000 0.647677 0.071965
1,035 N06AB SERTRALINUM* ZOLOFT 100 mg COMPR. FILM 100mg PFIZER EUROPE M M CUTIE X BLISTERE DIN AL/ P-R 28 1.171606 0.801608 1.054445 0.918769
1,036 N06AB SERTRALINUM* ADJUVIN 100 mg COMPR. FILM 100mg LANN AUSTRIA CUTIE CU 3 BLIST. PVC-PVDC/AL X PRF 30 1.171606 0.091394 1.054445 0.208555

Pagina 19 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
1,037 N06AB SERTRALINUM* STIMULOTON 100 mg COMPR. FILM 100mg EGIS PHARMA UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 P-R 28 1.171606 0.110894 1.054445 0.228055
1,038 N06AB SERTRALINUM* SERTRALINA ARENA 100 mg COMPR. FILM 100mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 P-R 30 1.171606 0.110727 1.054445 0.227888
1,039 N06AB SERTRALINUM* SERLIFT 50 mg COMPR. FILM 50mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 14 COMPR. FILM. P-R 28 0.585803 0.138482 0.527222 0.197063
1,040 N06AB SERTRALINUM* ASENTRA (R) COMPR. FILM 50mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. X 7 COMPR. FILM. P-R 28 0.438571 0.000000 0.394713 0.043858
1,041 N06AB SERTRALINUM* SETALOFT 50 mg COMPR. FILM 50mg ACTAVIS GROUP P ISLANDA CUTIE, CU BLISTERE DIN PV P-R 28 0.355000 0.000000 0.319500 0.035500
1,042 N06AB SERTRALINUM* ZOLOFT 50 mg COMPR. FILM 50mg PFIZER EUROPE M M CUTIE X BLIST. DIN AL/PVC X 28 COMP P-R 28 0.585803 0.607054 0.527222 0.665635
1,043 N06AB SERTRALINUM* ADJUVIN 50 mg COMPR. FILM 50mg LANN AUSTRIA CUTIE CU 3 BLIST. PVC-PVDC/AL X PRF 30 0.585803 0.108197 0.527222 0.166778
1,044 N06AB SERTRALINUM* STIMULOTON 50 mg COMPR. FILM 50mg EGIS PHARMA UNGARIA CUTIE X 3 BLIST. X 10 COMPR. FILM. P-R 30 0.533666 0.000000 0.480299 0.053367
1,045 N06AB SERTRALINUM* SERTRALINA ARENA 50 mg COMPR. FILM 50mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 P-R 30 0.585803 0.115197 0.527222 0.173778
1,046 N06AB SERTRALINUM* ZOLOFT 20 mg/ml CO 20mg/ml PFIZER EUROPE M M CUTIE CU 1 FLAC. DIN STICLA BRUNA X 60 ML CONC. PT. SOL. ORALA + 1 PIPETA GRADATA P-R 1 14.059283 37.530717 12.653354 38.936646
1,047 N06AB FLUVOXAMINUM* FEVARIN (R) 100 COMPR. FILM 100mg AB OLANDA CUTIE X 2 BLIST. PVC/PVDC X 15 CO P-R 30 0.585803 0.530863 0.527222 0.589444
1,048 N06AB FLUVOXAMINUM* FEVARIN (R) 50 COMPR. FILM 50mg AB OLANDA CUTIE X 2 BLIST. PVC/PVDC X 15 CO P-R 30 0.292901 0.265432 0.263610 0.294723
1,049 N06AX MIRTAZAPINUM* REMERON SOLTAB 30 mg COMPR. DISP 30mg NV ORGANON OLANDA CUTIE X 5 BLIST. AL/PVC-PA-POLIESTER PERFORAT PT. ELIB. UNEI UNIT. DOZATE X 6 COMPR. DISP. P-R 30 0.490166 1.695167 0.441149 1.744184
1,050 N06AX MIRTAZAPINUM* MIRTAZAPIN ARENA 15 mg COMPR. FILM 15mg ARENA GROUP S.A. ROMANIA CUT PRF 30 0.245083 0.606583 0.220574 0.631092
1,051 N06AX MIRTAZAPINUM* MIRZATEN (R) 30 mg COMPR. FILM 30mg KRKA D.D. SLOVENI CUTIE X 3 BLIST. PVC-PVDC/AL X 10 P-R 30 0.481666 0.000000 0.433499 0.048167
1,052 N06AX MIRTAZAPINUM* PHARMATAZ 30 mg COMPR. FILM 30mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIST. PVC-PVDC/AL, X 1 P-R 30 0.490166 0.327500 0.441149 0.376517
1,053 N06AX MIRTAZAPINUM* ESPRITAL (R) 30 COMPR. FILM 30mg ZENTIVA KS CEHIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 P-R 30 0.481333 0.000000 0.433199 0.048134
1,054 N06AX MIRTAZAPINUM* MIRTAZAPIN ARENA 45 mg COMPR. FILM 45mg ARENA GROUP S.A. ROMANIA CUT PRF 30 0.735249 1.388417 0.661724 1.461942
1,055 N06AX MIRTAZAPINUM* MIRTAZAPINA AUROBINDO COMPR. ORODISPERSABILE 15mg AUROBINDO PH M CUTIE CU BLIST. PA-AL-PVC/AL-POLIESTER-HARTIE X 30 COMPR. ORODISPERSABILE P-R 30 0.245083 0.605583 0.220574 0.630092
1,056 N06AX MIRTAZAPINUM* MIRZATEN Q-TAB 30 mg COMPR. ORODISPERSABILE 30mg KRKA D.D. NOVO M SLOVENI CUTIE CU BL P-R 30 0.490166 0.004834 0.441149 0.053851
1,057 N06AX MIRTAZAPINUM* MIRTAZAPINA AUROBINDO COMPR. ORODISPERSABILE 30mg AUROBINDO PH M CUTIE CU BLIST. PA-AL-PVC/AL-POLIESTER-HARTIE X 30 COMPR. ORODISPERSABILE P-R 30 0.490166 0.385500 0.441149 0.434517
1,058 N06AX MIRTAZAPINUM* ZULIN 30 mg COMPR. ORODISPERSABILE 30mg ANTIBIOTICE S.A. ROMANIA CUTIE X 5 BLIST. AL/AL X 6 CO P-R 30 0.485333 0.000000 0.436799 0.048534
1,059 N06AX MIRTAZAPINUM* MIRTAZAPINA AUROBINDO COMPR. ORODISPERSABILE 45mg AUROBINDO PH M CUTIE CU BLIST. PA-AL-PVC/AL-POLIESTER-HARTIE X 30 COMPR. ORODISPERSABILE P-R 30 0.735249 0.522751 0.661724 0.596276
1,060 N06AX VENLAFAXINUM** EFECTIN EP 150 mg CAPS. ELIB 150 mg PFIZER EUROPE M M CUTIE CU BLIST. DIN PVC/AL X 28 PRF 28 1.153452 0.859405 1.038106 0.974751
1,061 N06AX VENLAFAXINUM** ELIFY EP 150 mg CAPS. ELIB 150 mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST PVC/AL X 30 CAPS. PRF 30 0.998333 0.000000 0.898499 0.099834
1,062 N06AX VENLAFAXINUM** IVRYX 150mg CAPS. ELIB 150 mg NEOLA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. PCV-ACLAR P-R 28 0.860714 0.000000 0.774642 0.086072
1,063 N06AX VENLAFAXINUM** VELAXIN 150 mg CAPS. ELIB 150mg EGIS PHARMA UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL P-R 28 1.153452 0.155119 1.038106 0.270465
1,064 N06AX VENLAFAXINUM** ALVENTA 150mg CAPS. ELIB 150mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/AL X P-R 30 0.554666 0.000000 0.499199 0.055467
1,065 N06AX VENLAFAXINUM** VENLAFAXINA ACTAVIS 150 CAPS. ELIB 150mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 28 CAPS. P-R 28 0.856428 0.000000 0.770785 0.085643
1,066 N06AX VENLAFAXINUM** VENLAFAXINA ARENA EP 15 CAPS. ELIB 150mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC P-R 30 1.153452 0.155214 1.038106 0.270560
1,067 N06AX VENLAFAXINUM** VENLAFAXINA TERAPIA 150 CAPS. ELIB 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL PRF 30 1.153452 0.155214 1.038106 0.270560
1,068 N06AX VENLAFAXINUM** VENLAFAXINA TERAPIA 150 CAPS. ELIB 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X PRF 30 1.153452 0.155214 1.038106 0.270560
1,069 N06AX VENLAFAXINUM** FOBILESS 37,5 mg CAPS. ELIB 37,5mg LANN AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. C P-R 30 0.288363 0.307970 0.259526 0.336807
1,070 N06AX VENLAFAXINUM** VENLAFAXINA ARENA EP 37 CAPS. ELIB 37,5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC P-R 30 0.288363 0.543303 0.259526 0.572140
1,071 N06AX VENLAFAXINUM** EFECTIN EP 75 mg CAPS. ELIB 75 mg PFIZER EUROPE M M CUTIE CU BLIST. DIN PVC/AL X 28 PRF 28 0.576726 0.741488 0.519053 0.799161
1,072 N06AX VENLAFAXINUM** ELIFY EP 75 mg CAPS. ELIB 75 mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 30 CAPS. PRF 30 0.576726 0.172607 0.519053 0.230280
1,073 N06AX VENLAFAXINUM** IVRYX 75mg CAPS. ELIB 75 mg NEOLA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. PCV-ACLAR P-R 28 0.576726 0.086488 0.519053 0.144161
1,074 N06AX VENLAFAXINUM** IVRYX 75mg CAPS. ELIB 75 mg NEOLA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL P-R 28 0.576726 0.086488 0.519053 0.144161
1,075 N06AX VENLAFAXINUM** VELAXIN 75 mg CAPS. ELIB 75mg EGIS PHARMA UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL P-R 28 0.576726 0.308274 0.519053 0.365947
1,076 N06AX VENLAFAXINUM** ALVENTA 75 mg CAPS. ELIB 75mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/AL X P-R 30 0.326000 0.000000 0.293400 0.032600
1,077 N06AX VENLAFAXINUM** FOBILESS 75 mg CAPS. ELIB 75mg LANN AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. C P-R 30 0.576726 0.085940 0.519053 0.143613
1,078 N06AX VENLAFAXINUM** VENLAFAXINA ACTAVIS 75 m CAPS. ELIB 75mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 28 CAPS. P-R 28 0.576726 0.079702 0.519053 0.137375
1,079 N06AX VENLAFAXINUM** VENLAFAXINA ARENA EP 75 CAPS. ELIB 75mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC P-R 30 0.576726 0.302607 0.519053 0.360280
1,080 N06AX VENLAFAXINUM** VENLAFAXINA TERAPIA 75 m CAPS. ELIB 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL PRF 30 0.576726 0.308607 0.519053 0.366280
1,081 N06AX VENLAFAXINUM** VENLAFAXINA TERAPIA 75 m CAPS. ELIB 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X PRF 30 0.576726 0.308607 0.519053 0.366280
1,082 N06AX VENLAFAXINUM** VENLAFAXINA ARENA 37,5 mCOMPR. 37,5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PVDC/AL P-R 30 0.288363 0.543303 0.259526 0.572140
1,083 N06AX VENLAFAXINUM** VENLAFAXINA ARENA 50 mg COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PVDC/AL P-R 30 0.384484 0.462849 0.346035 0.501298
1,084 N06AX VENLAFAXINUM** VENLAFAXINA ARENA 75 mg COMPR. 75mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PVDC/AL P-R 30 0.576726 0.302607 0.519053 0.360280
1,085 N06AX VENLAFAXINUM** ARGOFAN 150 SR COMPR. 150mg ZENTIVA A.S. SLOVACI CUTIE CU BLIST. PVC-PVDC/AL P-R 30 0.665000 0.000000 0.598500 0.066500
1,086 N06AX VENLAFAXINUM** ARGOFAN 75 SR COMPR. 75mg ZENTIVA A.S. SLOVACI CUTIE CU BLIST. PVC-PVDC/AL P-R 30 0.391000 0.000000 0.351900 0.039100
1,087 N07AA NEOSTIGMINI BROMIDUM NEOSTIGMINA LPH 15 mg COMPR. 15mg LABORMED PHARMA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-6 20 0.694624 0.017376 0.625161 0.086839
1,088 N07AA NEOSTIGMINI BROMIDUM NEOSTIGMINA LPH 15 mg COMPR. 15mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PVC/AL X 60 COMPR. P-6 60 0.688833 0.000000 0.619949 0.068884
1,089 P01AB TINIDAZOLUM TINIZOL (R) 500 mg (J01XD02 COMPR. FILM 500mg ZENTIVA S.A. ROMANIA CUTIE X 1 BLIST. X 4 COMPR. FILM. P-R 4 0.603524 0.356476 0.543171 0.416829
1,090 P01AB TINIDAZOLUM TIPROGYN 500 (vezi J01XD0 COMPR. FILM 500mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. X 4 COMPR.FILM. P6L 4 0.603524 0.316476 0.543171 0.376829
1,091 P01AB TINIDAZOLUM TINIZOL (R) 500 mg (J01XD02 COMPR. FILM 500mg ZENTIVA S.A. ROMANIA CUTIE X 1 BLIST. X 4 COMPR. FILM. P-R 4 0.603524 0.356476 0.543171 0.416829

Pagina 20 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
1,092 P01AB TINIDAZOLUM TIPROGYN 500 (vezi J01XD0 COMPR. FILM 500mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. X 4 COMPR.FILM. P6L 4 0.603524 0.316476 0.543171 0.376829
1,093 P02CA ALBENDAZOLUM ALBENDAZOL VIM SPECT COMPR. 200mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 2 COMPR. P-R 2 3.107291 0.002709 2.796561 0.313439
1,094 P02CA ALBENDAZOLUM ESKAZOLE COMPR. 400mg GLAXO SMI M CUTIE X 12 BLIST. PVC-PVDC/AL X 1 C P-R 12 6.198333 0.000000 5.578499 0.619834
1,095 P02CA ALBENDAZOLUM DUADOR 200 mg COMPR. FILM 200mg GEDEON RIC ROMANIA CUTIE X 1 BLIST. X 2 COMPR. FILM. P-R 2 3.107291 0.207709 2.796561 0.518439
1,096 P02CA ALBENDAZOLUM ALBENDAZOL LPH 200 mg COMPR.FILM 200 mg LABORMED PHARMA ROMANIA CUTIE X 1 BLIST. AL/PVC X 2 COMPR. F P-R 2 3.107291 0.212709 2.796561 0.523439
1,097 P02CA ALBENDAZOLUM ZENTEL 0,4 g/10 ml SUSP. ORALA 0,4g/10ml GLAXOSMIT M CUTIE X 1 FLACON UNIDOZA P-R 1 3.951000 1.999000 3.555900 2.394100
1,098 P02CA ALBENDAZOLUM VERMIGAL NOVO 400 mg/10 SUSP. ORALA 400mg/10ml BIOFARM S.A. ROMANIA CUTIE CU 1 FLAC. DIN STIC PRF 1 3.870000 0.000000 3.483000 0.387000
1,099 P02CE LEVAMISOLUM DECARIS 150 mg COMPR. 150mg GEDEON RIC ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 COMPR. P-R 1 3.540000 0.000000 3.186000 0.354000
1,100 P02CE LEVAMISOLUM LEVAMISOL ARENA 150 mg COMPR. 150mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 1 COMPR. P-R 1 3.540000 0.000000 3.186000 0.354000
1,101 P02CE LEVAMISOLUM DECARIS 50 mg COMPR. 50mg GEDEON RIC ROMANIA CUTIE X 1 BLIST. AL/PVC X 2 COMPR. P-R 2 1.179988 0.385012 1.061989 0.503011
1,102 P02CE LEVAMISOLUM LEVAMISOL ARENA 50 mg COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 2 COMPR. P-R 2 1.179988 0.385012 1.061989 0.503011
1,103 R01AD BECLOMETASONUM RINOCLENIL 100 SPRAY NA 100mcg/doza CHIESI FARMACE ITALIA CUTIE X 1 FLACON DIN PET X 30 ML SPRAY NAZ.,SUSP., PREVAZUT CU POMPA DOZATOARE P-R 1 42.718000 5.802000 38.446200 10.073800
1,104 R03AC SALBUTAMOLUM VENTOLIN (R) SOL. INHAL. 5mg/ml GLAXOWELLCOME M CUTIE X 1 FALC. DIN STICL P-6 1 1.616400 6.183600 1.454760 6.345240
1,105 R03AC SALBUTAMOLUM VENTOLIN 100 INHALER C 100mcg/doza
SUSP. INHAL. PRESURIZATA GLAXOWELLCOME M CUTIE X 1 FLACON PRESURIZAT DIN AL PREVAZUT CU VALVA DOZATOARE X 200 DOZE + DISPOZITIV DE ADMINISTRA P-R 1 8.082000 2.808000 7.273800 3.616200
1,106 R03AC SALBUTAMOLUM ASTHALIN INHALER 100mcg/doza
SUSP. INHAL. PRESURIZATA CIPLA (UK) LIMITED M CUTIE X 1 FLAC. AL + VALVA DOZATOARE + DISP. ADM. X 200 DOZE SUSP. INHAL. PRESURIZATA P-6 1 7.070000 0.000000 6.363000 0.707000
1,107 R03BA BECLOMETASONUM* CLENIL (R) JET 250 mcg SOL. INHALAT PRESURIZATA 250mcg/doza CHIESI FARMACE ITALIA CUTIE X 1 FLACON PRESURIZAT DIN AL X 200 DOZE, PREVAZUT CU VALVA DOZATOARE + DISPOZITIV DE ADM., "SPASER JET" CU CAPAC P-R 1 101.960000 0.000000 91.764000 10.196000
1,108 R03BA BUDESONIDUM* FRENOLYN 200 PULB. INHAL. 200 mcg/doz MEDOCHEMIE RO ROMANIA CUTIE X 1 PUNGA, X 1 INHALATOR X P-R 1 26.670000 0.000000 24.003000 2.667000
1,109 R03BA BUDESONIDUM* FRENOLYN 200 PULB. INHAL. 200 mcg/doz MEDOCHEMIE RO ROMANIA CUTIE CU 1 PUNGA DIN POLISTIREN/AL/PE CONTINAND 1 INHALATOR TIP MIAT-HALER X 200 DOZE P-R 1 66.167500 11.652500 59.550750 18.269250
0 R03BA BUDESONIDUM* PULMICORT TURBUHAL PULB. INHAL. 200mcg/doza ASTRAZENECA AB SUEDIA CUTIE X 1 F P-R 1 33.083750 6.626250 29.775375 9.934625
1 R03BA BUDESONIDUM* FRENOLYN 400 PULB. INHAL. 400 mcg/doz MEDOCHEMIE RO ROMANIA CUTIE CU 1 PUNGA DIN POLISTIREN/AL/PE CONTINAND 1 INHALATOR TIP MIAT-HALER X 100 DOZE P-R 1 66.167500 21.192500 59.550750 27.809250
2 R03BA BUDESONIDUM* BUDIAIR 200 mcg 200 mcg/doz
SOL. DE INHALAT PRESURIZATA CHIESI FARMACE ITALIA CUTIE X 1 FLACON X 200 DOZE SOL. DE INHALAT PRESURIZATA + VALVA DOZATOARE + DISPOZITIV DE ADMINISTRA P-R 1 63.460000 0.000000 57.114000 6.346000
3 R03BA BUDESONIDUM* BUDIAIR 200 mcg JET 200mcg/doza
SOL. DE INHALAT PRESURIZATA CHIESI FARMACE ITALIA CUTIE X 1 FLACON X 200 DOZE SOL. DE INHALAT PRESURIZATA = VALVA DOZATOARE + DISPOZITIV JET DE ACTION P-R 1 66.167500 8.122500 59.550750 14.739250
4 R03BB IPRATROPII BROMIDUM* IPRAVENT INHALER 20mcg/d 20mcg/doza
SUSP. INHAL. PRESURIZATA CIPLA (UK) LIMITED M CUTIE X 1 FLACON AL PRESURIZAT X 200 DOZE SUSP.DE INHALAT PRESURIZATA P-6 1 13.080000 0.000000 11.772000 1.308000
5 R03C SALBUTAMOLUM SALBUTAMOL EIPICO 2mg/5 SIROP 2mg/5ml E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUN P-6 1 3.050000 0.000000 2.745000 0.305000
6 R03C SALBUTAMOLUM VENTOLIN (R) SOL. INJ. 0,5mg/ml GLAXO WELLCOME M CUTIE X 5 FIOLE DIN STICLA X 1 ML P-6 5 0.740000 0.000000 0.666000 0.074000
7 R03DA THEOPHYLLINUM TEOTARD (R) 200 mg CAPS. ELIB 200mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. AL/PVC X 10 CAPS. P-R 40 0.243500 0.000000 0.219150 0.024350
8 R03DA THEOPHYLLINUM TEOTARD (R) 350 mg CAPS. ELIB 350mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. AL/PVC X 10 CAPS. P-R 40 0.362500 0.000000 0.326250 0.036250
9 R03DX OMALIZUMABUM** XOLAIR 150 mg SOL INJ. 150mg NOVARTIS EURO M CUTIE CU 1 SERINGA PR/PRF 1 ,536.080000 0.000000 1,382.472000 153.608000
1,120 R03DX OMALIZUMABUM** XOLAIR 75 mg SOL INJ. 75mg NOVARTIS EURO M CUTIE CU 1 PR/PRF 1 789.875000 65.505000 710.887500 144.492500
1,121 R05DA CODEINUM FOSFAT DE CODEINA 15 mg COMPR. 15mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-R 30 0.167500 0.032833 0.150750 0.049583
1,122 R05DA CODEINUM CODEINA FOSFORICA COMPR. 15mg BIO EEL SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-R 25 0.167500 0.037700 0.150750 0.054450
1,123 R05DA CODEINUM FARMACOD COMPR. 15mg FARMACOM SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.151000 0.000000 0.135900 0.015100
1,124 R05DA CODEINUM CODEINA FOSFAT COMPR. 15mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.167500 0.006000 0.150750 0.022750
1,125 R05DA CODEINUM CODEINA FOSFAT LPH 15 m COMPR. 15mg LABORMED PHARMA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-R 20 0.165500 0.000000 0.148950 0.016550
1,126 R05DA CODEINUM CODEINA FOSFAT MCC 15 m COMPR. 15mg MAGISTRA C & C SR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.167500 0.022000 0.150750 0.038750
1,127 R06AB CHLORPHENAMINUM CLORFENIRAMIN COMPR. 4mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.120000 0.000000 0.108000 0.012000
1,128 R06AE CETIRIZINUM CELERG COMPR. FILM 10 mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6 20 0.504900 0.593100 0.454410 0.643590
1,129 R06AE CETIRIZINUM LETIZEN (R) 10 mg COMPR. FILM 10mg KRKA D.D. SLOVENI CUTIE X 2 BLIST. X 10 COMPR. FILM. P-6 20 0.504900 0.045100 0.454410 0.095590
1,130 R06AE CETIRIZINUM ZYRTEC 10 mg/ml PICA 10mg/ml UCB PHARMA GMBH GERMANI CUTIE CU 1 FLAC. DIN STICLA BRUNA + PICURATOR DIN PEJD X 20 ML PIC. ORALE, SOL. P6L 1 10.098000 3.062000 9.088200 4.071800
1,131 R06AX KETOTIFENUM H - KETOTIFEN COMPR. 1mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.175250 0.007250 0.157725 0.024775
1,132 R06AX KETOTIFENUM KETOTIFEN COMPR. 1mg MAGISTRA C&C S.R.L ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.175250 0.003250 0.157725 0.020775
1,133 R06AX KETOTIFENUM KETOTIFEN LAROPHARM 1 COMPR. 1mg LAROPHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-6 20 0.175250 0.003250 0.157725 0.020775
1,134 R06AX KETOTIFENUM KETOTIFEN LPH 1 mg COMPR. 1mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. PVC X 10 COMPR P6L 20 0.172000 0.000000 0.154800 0.017200
1,135 R06AX KETOTIFENUM KETOTIFEN LPH 1 mg COMPR. 1mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR P6L 30 0.172000 0.000000 0.154800 0.017200
1,136 R06AX KETOTIFENUM KETOF 1 mg/5 ml SIROP 1mg/5ml HEXAL AG GERMANI CUTIE X 1 FLACON X 100 P-6 1 11.860000 0.000000 10.674000 1.186000
1,137 S01BC DICLOFENACUM DICLOFENAC ROMPHARM PIC. OFT.-SO 1mg/ml ROMPHARM COMP ROMANIA FLACON PICURATOR DIN PEJD X 5 P-6 1 8.678750 0.951250 7.810875 1.819125
1,138 S01BC DICLOFENACUM UNICLOPHEN (R) 0,1% PICATURI 0,1% UNIMED PHARMA LT SLOVACI CUTIE X 1 FLACON DIN PE X 10 ML PIC. OFTALMICE, SOL., PREVAZUT CU PICURATOR P-6 1 11.650000 0.000000 10.485000 1.165000
1,139 S01BC DICLOFENACUM VOLTAREN OPHTHA CD PICATURI 0,1% LABORATOIRES THE FRANTA CUTIE X 1 FLAC. PEJD X 5 ML PICATURI OFT.-SOL. + PICURATOR PEJD + CAPAC CU INEL DE SIGURANTA P-6 1 8.678750 6.141250 7.810875 7.009125
1,140 S01CA COMBINATII (CLORAMPHENICOLUM+BETHAMETASONUM) BETABIOPTAL PICATUR 0,2g+0,5g/1 THEA FARMA S.P.A. ITALIA CUTIE X 1 FLACON DIN PEJD X 5 ML PIC. OFT.,SUSP. + APLICATOR PT. PICURARE P-R 1 13.940000 0.000000 12.546000 1.394000
1,141 S01CA COMBINATII (CLORAMPHENICOLUM+BETHAMETASONUM) BETABIOPTAL UNG. OFT. 0,2g+0,5g/1 THEA FARMA S.P.A. ITALIA CUTIE X 1 TUB AL X 5 G P-R 1 14.459999 1.560001 13.013999 3.006001

NOT:

Pagina 21 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 90%
tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)

- Tratamentul cu medicamentele corespunztoare DCI-urilor notate cu (*) se iniiaza de medicul de specialitate in limita competen ei i poate fi prescris n continuare de medicul de familie pe baza scrisorii
medicale emise de medicul de specialitate;
- Tratamentul cu medicamentele corespunztoare DCI-urilor notate cu (**) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Snt ii;
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (***) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Snt ii i cu aprobarea
comisiilor de la nivelul Caselor Jude ene de Asigurri de Sntate;
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (1) se efectueaza pentru pacienii cu intoleran la acidum acetylsalicylicum.

Pagina 22 din 87
ANEXA 2b
SUBLISTA B - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 50% DIN PRETUL DE REFERINTA CONFORM
DENUMIRILOR COMUNE INTERNATIONALE (DCI) ALE MEDICAMENTELOR DE CARE BENEFICIAZA ASIGURATII, IN TRATAMENTUL AMBULATORIU CU CONTRIBUTIE PERSONALA DIN HG NR. 720/2008 CU
MODIFICARILE SI COMPLETARILE ULTERIOARE VALABILA INCEPAND CU 01 IANUARIE 2016

Co-plata maxima a Val. maxima suportata Val. maxima suportata


asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)

1 A02BC PANTOPRAZOLUM CONTROLOC 20 mg COMPR. FILM. GASTROREZ. 20mg NYCOMED GMBH GERMANI CUTIE X 6 BLIST. AL/AL IN SUPORT DE CARTON X 5 COMPR. FILM. GASTROREZ. P-6 30 0.508333 0.000000 0.254166 0.254167 0.457499 0.050834
2 A02BC PANTOPRAZOLUM CONTROLOC 40mg COMPR. FILM. GASTROREZ. 40mg NYCOMED GMBH GERMANI CUTIE X 6 BLIST. AL/AL IN SUPORT DE CARTON X 5 COMPR. FILM. GASTROREZ. P-6 30 0.935666 0.000000 0.467833 0.467833 0.842099 0.093567
3 A02BC PANTOPRAZOLUM SELTRAZ 40 mg COMPR. FILM. GASTROREZ. 40mg DR. REDDY'S L ROMANIA CUTIE X 2 BLIST. DIN OPA-AL-PVC/AL X 14 COMPR. FILM. GASTROREZISTENTE P-6 28 0.608214 0.000000 0.304107 0.304107 0.547392 0.060822
4 A02BC PANTOPRAZOLUM ZENCOPAN 20 mg COMP 20 mg ZENTIVA K.S. R CUTIE CU BLIST. NYLON/AL/PVC/AL A CATE 28 COMPR. GASTROREZ. P6L 28 0.236785 0.000000 0.118392 0.118393 0.213106 0.023679
5 A02BC PANTOPRAZOLUM PANTEXEL 20 mg COMP 20mg GEDEON RIC ROMANIA CUTIE X 2 BLIST P-6 28 0.330714 0.000000 0.165357 0.165357 0.297642 0.033072
6 A02BC PANTOPRAZOLUM NOLPAZA 20 mg COMP 20mg KRKA D.D., NOVO SLOVENI CUTIE X 2 BLIST. OPA- P-6 30 0.273666 0.000000 0.136833 0.136833 0.246299 0.027367
7 A02BC PANTOPRAZOLUM AZATOL 20 mg COMP 20mg NEOLA PHARMA SRL ROMANIA CUTIE P6L 28 0.330714 0.000000 0.165357 0.165357 0.297642 0.033072
8 A02BC PANTOPRAZOLUM PANTOPRAZOL TERAPIA 20 mg COMP 20mg TERAPIA S.A. ROMANIA CUTIE CU 3 BL P6L 30 0.330666 0.000000 0.165333 0.165333 0.297599 0.033067
9 A02BC PANTOPRAZOLUM PANTOPRAZOL TORRENT 20 mg COMP 20mg TORRENT PHARMA S ROMANIA CUTIE CU 3 P6L 30 0.330666 0.000000 0.165333 0.165333 0.297599 0.033067
10 A02BC PANTOPRAZOLUM PANTOPRAZOL AUROBINDO 20 mg COMP 20mg AU MALTA CUTIE CU BLI P6L 30 0.212666 0.000000 0.106333 0.106333 0.191399 0.021267
11 A02BC PANTOPRAZOLUM CONTROLOC 20 mg COMP 20mg TAKEDA GMBH GERMANI CUTIE DE CARTON CU BLIST. DIN AL/AL CU RANFORSARE DIN CARTON X 30 COMPR. GASTROREZ. P6L 30 0.508333 0.000000 0.254166 0.254167 0.457499 0.050834
12 A02BC PANTOPRAZOLUM ZENCOPAN 40 mg COMP 40 mg ZENTIVA K.S. R CUTIE CU BLIST. NYLON/AL/PVC/AL A CATE 28 COMPR. GASTROREZ. P6L 28 0.430714 0.000000 0.215357 0.215357 0.387642 0.043072
13 A02BC PANTOPRAZOLUM PANTEXEL 40 mg COMP 40mg GEDEON RIC ROMANIA CUTIE X 2 BLIST P-6 28 0.608214 0.000000 0.304107 0.304107 0.547392 0.060822
14 A02BC PANTOPRAZOLUM NOLPAZA 40mg COMP 40mg KRKA D.D., NOVO SLOVENI CUTIE X 2 BLIST. OPA- P-6 30 0.576666 0.000000 0.288333 0.288333 0.518999 0.057667
15 A02BC PANTOPRAZOLUM PANTOPRAZOL TERAPIA 40 mg COMP 40mg TERAPIA S.A. ROMANIA CUTIE X 1 BL P-6 10 0.609000 0.000000 0.304500 0.304500 0.548100 0.060900
16 A02BC PANTOPRAZOLUM PANTOPRAZOL TERAPIA 40 mg COMP 40mg TERAPIA S.A. ROMANIA CUTIE X 3 BL P-6 30 0.608000 0.000000 0.304000 0.304000 0.547200 0.060800
17 A02BC PANTOPRAZOLUM PANTOPRAZOL ATB 40 mg COMP 40mg ANTIBIOTICE SA ROMANIA CUTIE CU 3 BLIST. AL/AL P6L 30 0.608000 0.000000 0.304000 0.304000 0.547200 0.060800
18 A02BC PANTOPRAZOLUM AZATOL 40 mg COMP 40mg NEOLA PHARMA SRL ROMANIA CUTIE P6L 28 0.608214 0.000000 0.304107 0.304107 0.547392 0.060822
19 A02BC PANTOPRAZOLUM PANTOPRAZOL TORRENT 40 mg COMP 40mg TORRENT PHARMA S ROMANIA CUTIE CU 3 P6L 30 0.608000 0.000000 0.304000 0.304000 0.547200 0.060800
20 A02BC PANTOPRAZOLUM PANTOPRAZOL AUROBINDO 40 mg COMP 40mg AU MALTA CUTIE CU BLI P6L 30 0.387666 0.000000 0.193833 0.193833 0.348899 0.038767
21 A02BC PANTOPRAZOLUM CONTROLOC 40mg COMP 40mg TAKEDA GMBH GERMANI CUTIE DE CARTON CU BLIST. DIN AL/AL CU RANFORSARE DIN CARTON X 30 COMPR. GASTROREZ. P6L 30 0.935666 0.000000 0.467833 0.467833 0.842099 0.093567
22 A02BC PANTOPRAZOLUM GESOFLUX 20 mg COMPR. GASTROREZISTENTE 20mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLI P6L 30 0.177333 0.000000 0.088666 0.088667 0.159599 0.017734
23 A02BC PANTOPRAZOLUM GESOFLUX 40 mg COMPR. GASTROREZISTENTE 40mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLI P6L 30 0.246000 0.000000 0.123000 0.123000 0.221400 0.024600
24 A02BC PANTOPRAZOLUM NOLPAZA 40 mg PULB. PT. 40mg KRKA D.D., NOVO SLOVENI CUTIE C P-R 1 8.810000 0.000000 4.405000 4.405000 7.929000 0.881000
25 A02BC PANTOPRAZOLUM CONTROLOC 40mg PULB. PT. 40mg NYCOMED GMBH GERMANI CUTIE X 1 FLAC. LIOF. PT. SOL. INJ. S/P-RF 1 13.560000 0.000000 6.780000 6.780000 12.204000 1.356000
26 A02BC PANTOPRAZOLUM CONTROLOC 40mg PULB. PT. 40mg TAKEDA GMBH GERMANI CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA, CU CAPSA DIN AL SI DOP DIN CAUCIUC A 40 MG CU PULB. PT. SOL. INJ. PRF 1 13.560000 0.000000 6.780000 6.780000 12.204000 1.356000
27 A02BC ESOMEPRAZOLUM EMANERA 20 mg CAPS. G 20mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PE+DESICANT/AL+ PE X 28 CAPS. GASTROREZ. P-6 28 0.644285 0.000000 0.322142 0.322143 0.579856 0.064429
28 A02BC ESOMEPRAZOLUM HELIDES 20 mg CAPS. G 20mg ZENTIVA K.S. R CUTIE CU BLIST. PA- P-6 28 0.480000 0.000000 0.240000 0.240000 0.432000 0.048000
29 A02BC ESOMEPRAZOLUM EMANERA 40 mg CAPS. G 40mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PE+DESICANT/AL+ PE X 28 CAPS. GASTROREZ. P-6 28 1.038571 0.000000 0.519285 0.519286 0.934713 0.103858
30 A02BC ESOMEPRAZOLUM HELIDES 40 mg CAPS. G 40mg ZENTIVA K.S. R CUTIE CU BLIST. PA- P-6 28 0.878928 0.000000 0.439464 0.439464 0.791035 0.087893
31 A02BC ESOMEPRAZOLUM NEXIUM 20 mg COMP 20mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. X 7 COMPR P-6 14 0.729599 0.788258 0.364799 1.153058 0.656639 0.861218
32 A02BC ESOMEPRAZOLUM ESOMEPRAZOL SANDOZ 20 mg COMP 20mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X14 P-6 14 0.555000 0.000000 0.277500 0.277500 0.499500 0.055500
33 A02BC ESOMEPRAZOLUM ESOMEPRAZOL TORRENT 20 mg COMP 20mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/AL X 5 P6L 56 0.554642 0.000000 0.277321 0.277321 0.499177 0.055465
34 A02BC ESOMEPRAZOLUM ESOMEPRAZOL TORRENT 20 mg COMP 20mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/AL X 9 P6L 90 0.536777 0.000000 0.268388 0.268389 0.483099 0.053678
35 A02BC ESOMEPRAZOLUM ESOMEPRAZOL TEVA 20 mg COMP 20mg TEVA PHARM ROMANIA CUTIE CU BLIST. AL/AL X 1 P6L 14 0.472142 0.000000 0.236071 0.236071 0.424927 0.047215
36 A02BC ESOMEPRAZOLUM PRAGASTROL 20 mg COMP 20mg ALVOGEN IPCO S.A. LUXE CUTIE CU BL P6L 30 0.720000 0.000000 0.360000 0.360000 0.648000 0.072000
37 A02BC ESOMEPRAZOLUM NEXIUM 40 mg COMP 40mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. AL P-6 14 1.459199 0.671515 0.729599 1.401115 1.313279 0.817435
38 A02BC ESOMEPRAZOLUM ESOMEPRAZOL SANDOZ 40 mg COMP 40mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X14 P-6 14 1.057857 0.000000 0.528928 0.528929 0.952071 0.105786
39 A02BC ESOMEPRAZOLUM ESOMEPRAZOL TORRENT 40 mg COMP 40mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/AL X 5 P6L 56 0.835000 0.000000 0.417500 0.417500 0.751500 0.083500
40 A02BC ESOMEPRAZOLUM ESOMEPRAZOL TORRENT 40 mg COMP 40mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/AL X 9 P6L 90 0.793000 0.000000 0.396500 0.396500 0.713700 0.079300
41 A02BC ESOMEPRAZOLUM PRAGASTROL 40 mg COMP 40mg ALVOGEN IPCO S.A. LUXE CUTIE CU BL P6L 30 1.156000 0.000000 0.578000 0.578000 1.040400 0.115600
42 A02BC ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 20mg COMPR. GASTROREZISTENTE 20mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 14 COMPR. GASTROREZISTENTE P-6 14 0.729599 0.208258 0.364799 0.573058 0.656639 0.281218
43 A02BC ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 40mg COMPR. GASTROREZISTENTE 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 14 COMPR. GASTROREZISTENTE P-6 14 1.384285 0.000000 0.692142 0.692143 1.245856 0.138429
44 A02BC ESOMEPRAZOLUM NEXIUM 10 mg GRAN. GASTROREZ. PT. SUSP.ORALA
10mg ASTRAZENECA AB SUEDIA CUTIE X 28 PLICURI DIN PET/AL/PEJD CONTINAND GRANULE GASTROREZ. PT. SUSP. ORALA P-6 28 2.539642 0.000000 1.269821 1.269821 2.285677 0.253965
45 A02BC ESOMEPRAZOLUM ESOMEPRAZOL SANDOZ 40 mg PULB. PT. SOL. INJ./PERF. 40mg SANDOZ S.R.L. ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 5 ML CU PULB. PT. SOL. INJ./PERF. PRF 10 20.061000 0.000000 10.030500 10.030500 18.054900 2.006100
46 A02BC ESOMEPRAZOLUM ESOMEPRAZOL POLPHARMA 40 mg PULB. PT. SOL. PERF./INJ. 40mg PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 15 ML CONTINAND PULB. PT. SOL. INJ./PERF. P6L 10 20.060000 0.000000 10.030000 10.030000 18.054000 2.006000
47 A03AB OTILONIUM BROMIDUM SPASMOMEN (R) COMPR. FILM 40mg A. M ITALIA CUTIE X 3 BLIST. PVC-PVDC/ P-6 30 1.103333 0.000000 0.551666 0.551667 0.992999 0.110334
48 A06AD MACROGOLUM*2) OLOPEG CONC F CNP PHARMA GMBH GERMANI CUTIE CU 1 FLAC. DIN PET X 500 ML CONC. PT. SOL. ORALA, INSOTIT DE UN RECIPIENT DOZATOR GRADAT PRF 1 33.340000 0.000000 16.670000 16.670000 30.006000 3.334000
49 A06AD MACROGOLUM*2) OLOPEG CONC F CNP PHARMA GMBH GERMANI CUTIE CU 1 FLAC. DIN PET X 200 ML CONC. PT. SOL. ORALA, INSOTIT DE UN RECIPIENT DOZATOR GRADAT PRF 1 13.949499 1.840501 6.974749 8.815251 12.554549 3.235451
50 A07AA RIFAXIMINUM NORMIX 200 mg COMPR. FILM 200mg ALFA WASSERMANN ITALIA CUTIE X 1 BLIST. AL/PVC X 12 C P-R 12 2.519583 0.106250 1.259791 1.366042 2.267624 0.358209
51 A07AA RIFAXIMINUM NORMIX 200 mg COMPR. FILM 200mg ALFA WASSERMANN ITALIA CUTIE X 3 BLIST. AL/PVC A P-R 36 2.413333 0.000000 1.206666 1.206667 2.171999 0.241334
52 A07AA RIFAXIMINUM NORMIX 200mg/10ml GR 200mg/10ml ALFA WASSERMANN ITALIA CUTIE X 1 FLAC. GRAN. PT. 60 ML SUSP. ORALA + 1 MASURA DOZATOARE MARCATA LA 5, 10 SI 15 ML P-R 1 15.117513 4.692487 7.558756 12.251244 13.605761 6.204239
53 A07EA BUDESONIDUM**# BUDENOFALK CAPS. G 3mg DR. FALK PHARMA GERMANI CUTIE X 10 BLIST. PVC-PVDC/AL X 10 CAPS. CU PELETE GASTROREZ. P-R 100 3.516900 0.000000 1.758450 1.758450 3.165210 0.351690
54 A07EA BUDESONIDUM**# BUDENOFALK 2 mg/doza SPUMA RE 2mg/doza DR. FALK PHARMA GERMANI CUTIE X 1 FLAC. DIN AL X 14 DOZE X 1,2G SPUMA RECTALA, 14 APLICATOARE LUBREFIANTE PVC SI 14 PUNGI PL P-R 1 303.800000 0.000000 151.900000 151.900000 273.420000 30.380000
55 A07XA RACECADOTRILUM HIDRASEC 100 mg CAPS. 100mg LABORAT FRANTA CUTIE X 2 BLIST. AL/PVC-PVDC X P-R 20 2.076500 0.000000 1.038250 1.038250 1.868850 0.207650
56 A07XA RACECADOTRILUM HIDRASEC 10 mg PULB. 10mg LABORAT FRANTA CUTIE X 16 PLICURI X 1 G P-R 16 2.307000 0.353000 1.153500 1.506500 2.076300 0.583700
57 A07XA RACECADOTRILUM HIDRASEC 30 mg PULB. 30mg LAB. FOURNIER SA FRANTA CUTIE X 16 PLICURI X 3 G P-R 16 2.307000 0.230500 1.153500 1.384000 2.076300 0.461200
58 A08AB ORLISTATUM**** XENICAL 120mg CAPS. 120mg ROCHE REGISTRA MA CUTIE X 21 CAPS. TARI (BLIS P-R 21 2.029672 1.056518 1.014836 2.071354 1.826704 1.259486
59 A08AB ORLISTATUM**** XENICAL 120mg CAPS. 120mg ROCHE REGISTRA MA CUTIE X 84 CAPS. TARI (BLIS P-R 84 1.677500 0.000000 0.838750 0.838750 1.509750 0.167750

Pagina 23 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
60 A11CC ALFACALCIDOLUM ALPHA D3 0,25 mcg CAPS. MOI 0,25mcg TEVA PHARM ROMANIA CUTIE X 1 FLAC. DIN PPID X 50 C P-R 50 0.543166 0.045834 0.271583 0.317417 0.488849 0.100151
61 A11CC ALFACALCIDOLUM ALFACALCIDOL SANDOZ 0,25 mcg CAPS. MOI 0,25g SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL PRF 30 0.543166 0.222500 0.271583 0.494083 0.488849 0.276817
62 A11CC ALFACALCIDOLUM ALPHA D3 0,50 mcg CAPS. MOI 0,50mcg TEVA PHARM ROMANIA CUTIE X 1 FLAC. X 30 CAPS. MOI P-R 30 1.086333 0.000000 0.543166 0.543167 0.977699 0.108634
63 A11CC ALFACALCIDOLUM ALFACALCIDOL SANDOZ 0,5 mcg CAPS. MOI 0,5g SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL PRF 30 1.086333 0.047333 0.543166 0.590500 0.977699 0.155967
64 A16AX ACIDUM TIOCTICUM (ALFA-LIPOI THIOSSEN 600 (vezi N07XN03) COMPR. FILM 600mg AAA - PHARMA GMB GERMANI CUTIE X 3 BLIST. PVC-PVDC P-6 30 1.592000 0.000000 0.796000 0.796000 1.432800 0.159200
65 A16AX ACIDUM TIOCTICUM (ALFA-LIPOI THIOCTACID 600T (vezi N07XN03) SOL. INJ. 25mg/ml MEDA PHAR GERMANI CUTIE X 5 FIOLE X 24 ML SOL.INJ. S/P-RF 5 24.924000 0.000000 12.462000 12.462000 22.431600 2.492400
66 B01AB DALTEPARINUM**# FRAGMIN 10000 UI/0,4 ml SOL. INJ. 10000UI/0,4m PFIZER EUROPE MA MA CUTIE CU 5 BLISTERE INDIVIDUALE CONTINND FIECARE O SERINGA PREUMPLUTA, FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP A 0,4 ML SOLUTIE INJECTABILA S/P-RF 5 18.430000 0.000000 9.215000 9.215000 16.587000 1.843000
67 B01AB DALTEPARINUM**# FRAGMIN 12500 UI/0,5 ml SOL. INJ. 12500 UI/0,5 PFIZER EUROPE MA MA CUTIE CU 5 BLISTERE INDIVIDUALE CONTINND FIECARE O SERINGA PREUMPLUTA, FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP A 0,5 ML SOLUTIE INJECTABILA S/P-RF 5 23.398000 0.000000 11.699000 11.699000 21.058200 2.339800
68 B01AB DALTEPARINUM**# FRAGMIN15000 UI/0,6 ml SOL. INJ. 15000ui/0,6m PFIZER EUROPE MA MA CUTIE CU 5 BLISTERE INDIVIDUALE CONTINND FIECARE O SERINGA PREUMPLUTA, FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP A 0,6 ML SOLUTIE INJECTABILA S/P-RF 5 27.346000 0.000000 13.673000 13.673000 24.611400 2.734600
69 B01AB DALTEPARINUM**# FRAGMIN 18000 UI/0,72 ml SOL. INJ. 18000 UI/0, PFIZER EUROPE MA MA CUTIE CU 5 BLISTERE INDIVIDUALE CONTINND FIECARE O SERINGA PREUMPLUTA, FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP A 0,72 ML SOLUTIE INJECTABILA S/P-RF 5 33.530000 0.000000 16.765000 16.765000 30.177000 3.353000
70 B01AB DALTEPARINUM**# FRAGMIN 2500 UI/0,2 ml SOL. INJ. 2500ui/0,2ml PFIZER EUROPE MA MA CUTIE CU 10 BLIST. INDIVIDUALE CONTINAND FIECARE 1 SERINGA PREUMPLUTA FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP X 0,2 ML SOLUTIE INJECTABILA S/P-RF 10 5.280730 0.918270 2.640365 3.558635 4.752657 1.446343
71 B01AB DALTEPARINUM**# FRAGMIN 5000 UI/0,2 ml SOL. INJ. 5000ui/0,2ml PFIZER EUROPE MA MA CUTIE CU 10 BLISTERE INDIVIDUALE CONTINND FIECARE O SERINGA PREUMPLUTA, FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP A 0,2 ML SOLUTIE INJECTABILA S/P-RF 10 10.561460 0.889540 5.280730 6.170270 9.505314 1.945686
72 B01AB DALTEPARINUM**# FRAGMIN 7500 UI/0,3 ml SOL. INJ. 7500ui/0,3ml PFIZER EUROPE MA MA CUTIE CU 10 BLISTERE INDIVIDUALE CONTINND FIECARE O SERINGA PREUMPLUTA, FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP A 0,3 ML SOLUTIE INJECTABILA S/P-RF 10 13.673000 0.000000 6.836500 6.836500 12.305700 1.367300
73 B01AB ENOXAPARINUM**# CLEXANE 2000ui anti-Xa/0,2ml SOL. INJ. 2000ui a LAB. AVENTIS FRANTA CUTIE X 10 SERINGI PREU PR/PRF 10 5.280730 1.146270 2.640365 3.786635 4.752657 1.674343
74 B01AB ENOXAPARINUM**# CLEXANE 4000ui anti-Xa/0,4ml SOL. INJ. 4000ui a LAB. AVENTIS FRANTA CUTIE X 10 SERINGI PREU PR/PRF 10 10.561460 1.098540 5.280730 6.379270 9.505314 2.154686
75 B01AB ENOXAPARINUM**# CLEXANE 6000ui anti-Xa/0,6ml SOL. INJ. 6000ui a LAB. AVENTIS FRANTA CUTIE X 10 SERINGI PREU PR/PRF 10 14.988000 0.000000 7.494000 7.494000 13.489200 1.498800
76 B01AB ENOXAPARINUM**# CLEXANE 8000ui anti-Xa/0,8ml SOL. INJ. 8000UI LABORATOIRE AVEN FRANTA CUTIE CU 6 SERINGI PREUMPLUTE (DIN STICLA INCOLORA DE TIP I, CU O CAPACITATE DE 1 ML, PREVAZUTA CU AC CU UN CAP RIGID DIN PLASTIC FARA FILET SI PISTON X 0,8 ML SOL INJ. PR/PRF 6 19.778333 0.000000 9.889166 9.889167 17.800499 1.977834
77 B01AB NADROPARINUM**# FRAXIPARINE 2850 UI anti-factor Xa/0,3 SOL. INJ. 2850 ui A GLAXO GROUP LIMITED/GLAXO WELLCOME HOUSE MA CUTIE CU 10 SERINGI PREUMPLUTE DIN STICLA X 0,3 ML SOL. INJ. S/P-RF 10 5.280730 1.164270 2.640365 3.804635 4.752657 1.692343
78 B01AB NADROPARINUM**# FRAXIPARINE 2850 UI anti-factor Xa/0,3 SOL. INJ. 2850 ui A ASPEN P IRLANDA CUTIE CU 10 SERINGI PREUMPLUTE DIN STICLA X 0,3 ML SOL. INJ. S/P-RF 10 5.280730 1.164270 2.640365 3.804635 4.752657 1.692343
79 B01AB NADROPARINUM**# FRAXIPARINE 3800 UI anti-factor Xa/0,4 SOL. INJ. 3800 ui A GLAXO GROUP LIMITED/GLAXO WELLCOME HOUSE MA CUTIE CU 10 SERINGI PREUMPLUTE DIN STICLA X 0,4 ML SOL. INJ. S/P-RF 10 7.040971 1.456029 3.520485 4.976515 6.336873 2.160127
80 B01AB NADROPARINUM**# FRAXIPARINE 3800 UI anti-factor Xa/0,4 SOL. INJ. 3800 ui A ASPEN P IRLANDA CUTIE CU 10 SERINGI PREUMPLUTE DIN STICLA X 0,4 ML SOL. INJ. S/P-RF 10 7.040971 1.456029 3.520485 4.976515 6.336873 2.160127
81 B01AB NADROPARINUM**# FRAXIPARINE 5700 UI anti-factor Xa/0,6 SOL. INJ. 5700 ui A GLAXO GROUP LIMITED/GLAXO WELLCOME HOUSE MA CUTIE CU 10 SERINGI PREUMPLUTE DIN STICLA X 0,6 ML SOL. INJ. S/P-RF 10 10.561460 2.623540 5.280730 7.904270 9.505314 3.679686
82 B01AB NADROPARINUM**# FRAXIPARINE 5700 UI anti-factor Xa/0,6 SOL. INJ. 5700 ui A ASPEN P IRLANDA CUTIE CU 10 SERINGI PREUMPLUTE DIN STICLA X 0,6 ML SOL. INJ. S/P-RF 10 10.561460 2.623540 5.280730 7.904270 9.505314 3.679686
83 B01AB NADROPARINUM**# FRAXIPARINE 7600 UI anti-factor Xa/0,8 SOL. INJ. 7600 ui A GLAXO GROUP LIMITED/GLAXO WELLCOME HOUSE MA CUTIE CU 10 SERINGI PREUMPLUTE DIN STICLA X 0,8 ML SOL. INJ. S/P-RF 10 14.081943 1.936057 7.040971 8.977029 12.673748 3.344252
84 B01AB NADROPARINUM**# FRAXIPARINE 7600 UI anti-factor Xa/0,8 SOL. INJ. 7600 ui A ASPEN P IRLANDA CUTIE CU 10 SERINGI PREUMPLUTE DIN STICLA X 0,8 ML SOL. INJ. S/P-RF 10 14.081943 1.936057 7.040971 8.977029 12.673748 3.344252
85 B01AB TINZAPARINUM**# INNOHEP 10000 UI ANTI-XA/ml S 10000UI LEO PHARMA A/S DANEM CUTIE CU 10 FLAC. DIN STICLA INCOLORA X 2 ML (20000 UI ANTI-XA) SOL. INJ., CU DOP DE CAUCIUC DE CULOARE CENUSIE DESCHIS, ARMATURA DE ETANSARE DIN AL LACUIT IN AURIU SI CAPSA DE SIGURANTA DIN PP DE CULOARE PORTOCALIE PR/PRF 10 30.175597 22.635403 15.087798 37.723202 27.158037 25.652963
86 B01AB TINZAPARINUM**# INNOHEP 20000 UI ANTI-Xa/ml S 20000 UI LEO PHARMA A/S DANEM CUT IE CU 10 FLAC. DIN ST ICLA INCOLORA X 2 ML (40000 UI ANT I-XA) SOL. INJ., CU DOP DE CAUCIUC DE CULOARE CENUSIE DESCHIS, ARMAT URA DE ET ANSARE DIN AL LACUIT CU LAC DE CULOARE VERDE SI CAPSA DE SIGURANT A DIN PP DE CULOARE VERDE INCHIS PR/PRF 10 60.351199 52.533801 30.175599 82.709401 54.316079 58.568921
87 B01AB TINZAPARINUM**# INNOHEP 10000 UI ANTI-XA/ml SOL. INJ. IN SERINGI PREUMPLUTE 10000UI LEO PHARMA A/S DANEM CUTIE CU 10 SERINGI PREUMPLUTE X 0.35 ML (3500 UI ANTI-XA) SOL. INJ., CU DISPOZITIV DE SIGURANTA PT. AC, INTRODUSE INTR-UN SUPORT DIN PLASTIC CU CAPAC VERDE PR/PRF 10 5.280730 7.047270 2.640365 9.687635 4.752657 7.575343
88 B01AB TINZAPARINUM**# INNOHEP 10000 UI ANTI-XA/ml SOL. INJ. IN SERINGI PREUMPLUTE 10000UI LEO PHARMA A/S DANEM CUTIE CU 10 SERINGI PREUMPLUTE X 0.45 ML (4500 UI ANTI-XA) SOL. INJ., CU DISPOZITIV DE SIGURANTA PT. AC, INTRODUSE INTR-UN SUPORT DIN PLASTIC CU CAPAC ALBASTRU PR/PRF 10 6.789508 9.064492 3.394754 12.459246 6.110557 9.743443
89 B01AB TINZAPARINUM**# INNOHEP 20000 UI ANTI-Xa/ml SOL. INJ. IN SERINGI PREUMPLUTE 20000UI an LEO PHARMA A/S DANEM CUTIE CU 2 SERINGI PREUMPLUTE X 0,50 ML (10000 UI ANTI-XA) SOL. INJ., CU DISPOZITIV DE SIGURANTA PT. AC, INTRODUSE INTR-UN SUPORT DIN PLASTIC CU CAPAC ROSU PR/PRF 2 7.543897 29.446103 3.771948 33.218052 6.789507 30.200493
90 B01AB TINZAPARINUM**# INNOHEP 20000 UI ANTI-Xa/ml SOL. INJ. IN SERINGI PREUMPLUTE 20000UI an LEO PHARMA A/S DANEM CUTIE CU 2 SERINGI PREUMPLUTE X 0,70 ML (14000 UI ANTI-XA) SOL. INJ., CU DISPOZITIV DE SIGURANTA PT. AC, INTRODUSE INTR-UN SUPORT DIN PLASTIC CU CAPAC GALBEN PR/PRF 2 21.122920 29.297080 10.561460 39.858540 19.010628 31.409372
91 B01AB TINZAPARINUM**# INNOHEP 20000 UI ANTI-Xa/ml SOL. INJ. IN SERINGI PREUMPLUTE 20000UI an LEO PHARMA A/S DANEM CUTIE CU 2 SERINGI PREUMPLUTE X 0,90 ML (18000 UI ANTI-XA) SOL. INJ., CU DISPOZITIV DE SIGURANTA PT. AC, INTRODUSE INTR-UN SUPORT DIN PLASTIC CU CAPAC ALBASTRU PR/PRF 2 27.158040 32.616960 13.579020 46.195980 24.442236 35.332764
92 B01AB SULODEXIDUM** VESSEL DUE F CAPS. MOI 250ULS ALFA WASSERMANN ITALIA CUTIE X 2 BLIST. P P-R 50 1.540449 0.523951 0.770224 1.294176 1.386404 0.677996
93 B01AB SULODEXIDUM** COREFLUX 250 ULS CAPS. MOI 250ULS SANIENCE S.R.L. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 C PRF 50 1.365800 0.000000 0.682900 0.682900 1.229220 0.136580
94 B01AB SULODEXIDUM** COREFLUX 600 ULS/2 ml SOL INJ. 600ULS/2ml SANIENCE S.R.L. ROMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 2 ML SOL. INJ. PRF 10 5.413000 0.000000 2.706500 2.706500 4.871700 0.541300
95 B01AB SULODEXIDUM** VESSEL DUE F SOL. INJ. 600ULS/2ml ALFA WASSERMANN ITALIA CUTIE X 10 FIOLE DIN STICLA P-R 10 6.037000 1.872000 3.018500 4.890500 5.433300 2.475700
96 B01AC CLOPIDOGRELUM** PLAVIX 300mg COMPR. FILM 300mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE P-R 30 4.276281 5.066052 2.138140 7.204193 3.848652 5.493681
97 B01AC CLOPIDOGRELUM** PLAVIX 300mg COMPR. FILM 300mg SANOFI CLIR SNC FRANTA CUTIE P-R 30 4.276281 5.066052 2.138140 7.204193 3.848652 5.493681
98 B01AC CLOPIDOGRELUM** ZYLLT COMPR. FILM 75 mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. OPA/AL/P P-R 28 0.460714 0.000000 0.230357 0.230357 0.414642 0.046072
99 B01AC CLOPIDOGRELUM** PLAVIX 75mg COMPR. FILM 75mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 28 COMPR. FILM. (BL P-R 28 1.069070 0.578787 0.534535 1.113322 0.962163 0.685694
100 B01AC CLOPIDOGRELUM** CLOPIDOGREL MYLAN 75mg COMPR. FILM 75mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. DIN P-R 28 0.545714 0.000000 0.272857 0.272857 0.491142 0.054572
101 B01AC CLOPIDOGRELUM** TROGRAN 75 mg COMPR. FILM 75mg G R CUTIE CU BLIST. PV P-R 28 1.069070 0.037715 0.534535 0.572250 0.962163 0.144622
102 B01AC CLOPIDOGRELUM** PLAVOCORIN 75 mg COMPR. FILM 75mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-R 28 0.618928 0.000000 0.309464 0.309464 0.557035 0.061893
103 B01AC CLOPIDOGRELUM** CLOPIDOGREL ACTAVIS 75 mg COMPR. FILM 75mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 28 COMP P-R 28 0.422142 0.000000 0.211071 0.211071 0.379927 0.042215
104 B01AC CLOPIDOGRELUM** DEFROZYP 75 mg COMPR. FILM 75mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. OP P-R 28 1.069070 0.037715 0.534535 0.572250 0.962163 0.144622
105 B01AC CLOPIDOGRELUM** TESSYRON 75 mg COMPR. FILM 75mg GEDEON RIC ROMANIA CUTIE CU BLIST. PVC P-R 30 0.688666 0.000000 0.344333 0.344333 0.619799 0.068867
106 B01AC CLOPIDOGRELUM** CLOPIDOGREL DR. REDDY'S 75 mg COMPR. FILM 75mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. OPA-AL-P P-R 30 1.069070 0.037263 0.534535 0.571798 0.962163 0.144170
107 B01AC CLOPIDOGRELUM** CLOPIDOGREL TERAPIA 75 mg COMPR. FILM 75mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PA-AL- PRF 30 1.069070 0.037263 0.534535 0.571798 0.962163 0.144170
108 B01AC CLOPIDOGRELUM** DEPLATT 75 mg COMPR. FILM 75mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P PRF 30 0.919333 0.000000 0.459666 0.459667 0.827399 0.091934
109 B01AC CLOPIDOGRELUM** TROMBEX 75 mg COMPR. FILM 75mg ZENTIVA K.S. CEHIA CUTIE CU BLISTERE DIN PVC-PVDC/AL CONTINND 30 COMPRIMATE FILMATE P-R 30 0.581000 0.000000 0.290500 0.290500 0.522900 0.058100
110 B01AC CLOPIDOGRELUM** TROMBEX 75 mg COMPR. FILM 75mg ZENTIVA K.S. CEHIA CUTIE CU BLISTERE DIN PVC-PVDC/AL CONTINND 90 COMPRIMATE FILMATE P-R 90 0.562000 0.000000 0.281000 0.281000 0.505800 0.056200
111 B01AC CLOPIDOGRELUM** CLOPIDOGREL AUROBINDO 75 mg COMPR. FILM 75mg AU MALTA CUTIE CU BLIST. PVC-ACLA PRF 28 0.593928 0.000000 0.296964 0.296964 0.534535 0.059393
112 B01AC CLOPIDOGRELUM** PLAVIX 75mg COMPR. FILM 75mg SANOFI CLIR SNC FRANTA CUTIE X 28 COMPR. FILM. ( B P-R 28 1.069070 0.578787 0.534535 1.113322 0.962163 0.685694
113 B01AC TRIFLUSALUM PLATROX 300 mg CAPS. 300 mg G R CUTIE CU 5 BLIST. AL-PVC/PVDC PRF 50 0.534535 0.163065 0.267267 0.430333 0.481081 0.216519
114 B01AC TRIFLUSALUM AFLEN (R) CAPS. 300mg GALENICA S.A. GRECIA CUTIE X 5 BLIST. X 10 CAPS. P-R 50 0.534535 0.538465 0.267267 0.805733 0.481081 0.591919
115 B01AC COMBINATI AGGRENOX 200mg/25mg CAPS. ELI 25mg/200mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 1 FLAC. DIN PP X 60 CAPS. CU ELIB.MODIF. CU SISTEM DE INCHIDERE SECURIZAT PT. COPII +DESICAN P-6 60 0.880833 0.000000 0.440416 0.440417 0.792749 0.088084
116 B01AE DABIGATRANUM ETEXILATUM** PRADAXA 110mg CAPS. 110mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 3 BLIST. (AL/AL) X 10 CAPS. (30X1 BLISTER PERFORAT UNIDOZA ) P-R 30 5.664666 0.000000 2.832333 2.832333 5.098199 0.566467
117 B01AE DABIGATRANUM ETEXILATUM** PRADAXA 110mg CAPS. 110mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 6 BLIST. (AL/AL) X 10 CAPS. (60X1 BLISTER PERFORAT UNIDOZA ) P-R 60 5.664666 0.000000 2.832333 2.832333 5.098199 0.566467
118 B01AF RIVAROXABANUM** XARELTO 10mg COMPR. FILM 10mg BAYER PHARMA AG GERMANI CUTIE X BLIST PP/AL X 10 COMPR. P-R 10 11.170250 0.450750 5.585125 6.035875 10.053225 1.567775
119 B01AF RIVAROXABANUM** XARELTO 10mg COMPR. FILM 10mg BAYER PHARMA AG GERMANI CUTIE X BLIST PP/AL X 30 COMPR. P-R 30 11.020000 0.000000 5.510000 5.510000 9.918000 1.102000
120 B01AF APIXABANUM** ELIQUIS COMPR. FILM 2,5mg BRISTOL-MYERS S MA CUTIE CU BLIST. PERFORATE DINPVC/PVDC/AL A 60 X 1 COMPR. FILM. PRF 60 5.510000 0.000000 2.755000 2.755000 4.959000 0.551000
121 B01AX FONDAPARINUX SODIUM**# ARIXTRA 2,5mg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 2,5mg/0,5ml GLAXO GROUP LTD. MA CUTIE X 10 SERINGI PREUMPLUTE DIN STICLA X 0,5ML SOLUTIE INJECTABILA PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA DE CULOARE ALBASTRA
P-R 10 19.409000 0.000000 9.704500 9.704500 17.468100 1.940900
122 B01AX FONDAPARINUX SODIUM**# ARIXTRA 2,5mg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 2,5mg/0,5ml ASPEN P IRLANDA CUTIE X 10 SERINGI PREUMPLUTE X 0,5 ML SOL. INJ., PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA, DE CULOARE ALBASTRA P-R 10 19.409000 0.000000 9.704500 9.704500 17.468100 1.940900
123 B01AX FONDAPARINUX SODIUM**# ARIXTRA 7,5mg/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 7,5mg/0,6ml GLAXO GROUP LTD. MA CUTIE X 10 SERINGI PREUMPLUTE DIN STICLA X 0,6ML SOLUTIE INJECTABILA PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA DE CULOARE PURPURIE
P-R 10 58.227000 0.293000 29.113500 29.406500 52.404300 6.115700
124 B01AX FONDAPARINUX SODIUM**# ARIXTRA 7,5mg/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 7,5mg/0,6ml ASPEN P IRLANDA CUTIE X 10 SERINGI PREUMPLUTE X 0,6 ML SOL. INJ., PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA, DE CULOARE PURPURIE P-R 10 48.522499 9.997501 24.261249 34.258751 43.670249 14.849751
125 B03AC COMPLEX DE HIDROXID DE FE VENOFER (R) SOL. INJ./PE 20mg/ml VIFOR FRANCE S.A. FRANTA CUTIE X 5 FIOLE X 5 ML S/P-RF 5 31.080000 0.000000 15.540000 15.540000 27.972000 3.108000

Pagina 24 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
126 C01EB IVABRADINUM** CORLENTOR 5mg COMPR. FILM 5mg LES LAB. SERVIER FRANTA CUTIE X 56 COMPR. P-6 56 2.633544 1.358956 1.316772 2.675728 2.370189 1.622311
127 C01EB IVABRADINUM** CORLENTOR 7,5mg COMPR. FILM 7,5mg LES LAB. SERVIER FRANTA CUTIE X 56 COMPR. P-6 56 3.856071 0.000000 1.928035 1.928036 3.470463 0.385608
128 C02AC MOXONIDINUM MOXOGAMMA 0,2 mg COMPR. FILM 0,2mg WORWAG PHARMA GERMANI CUTIE X 3 BLIST. PVC-PVDC/ P-6 30 0.483666 0.000000 0.241833 0.241833 0.435299 0.048367
129 C02AC MOXONIDINUM PHYSIOTENS 0,2 COMPR. FILM 0,2mg ABBOTT PRODUC GERMANI CUTIE X 1 BLIST. PVC-PVDC/ P-6 28 0.836125 0.243517 0.418062 0.661580 0.752512 0.327130
130 C02AC MOXONIDINUM MOXONIDINA MYLAN 0,2 mg COMPR. FILM 0,2mg GENERICS (UK) LTD MA CUTIE CU BLIST. PVC-PVDC/ P6L 28 0.383571 0.000000 0.191785 0.191786 0.345213 0.038358
131 C02AC MOXONIDINUM PHYSIOTENS 0,2 mg COMPR. FILM 0,2mg ABBOTT LABO GERMANI CUTIE CU 1 BLIST. PVC-PV P6L 28 0.836125 0.243517 0.418062 0.661580 0.752512 0.327130
132 C02AC MOXONIDINUM MOXOGAMMA 0,3 mg COMPR. FILM 0,3mg WORWAG PHARMA GERMANI CUTIE X 3 BLIST. PVC-PVDC/ P-6 30 0.697000 0.000000 0.348500 0.348500 0.627300 0.069700
133 C02AC MOXONIDINUM MOXONIDINA MYLAN 0,3 mg COMPR. FILM 0,3mg GENERICS (UK) LTD MA CUTIE CU BLIST. PVC-PVDC/ P6L 28 0.575000 0.000000 0.287500 0.287500 0.517500 0.057500
134 C02AC MOXONIDINUM MOXOGAMMA 0,4 mg COMPR. FILM 0,4mg WORWAG PHARMA GERMANI CUTIE X 3 BLIST. PVC-PVDC/ P-6 30 0.772000 0.000000 0.386000 0.386000 0.694800 0.077200
135 C02AC MOXONIDINUM PHYSIOTENS 0,4 COMPR. FILM 0,4mg ABBOTT PRODUC GERMANI CUTIE X 1 BLIST. PVC-PVDC/ P-6 28 1.602857 0.000000 0.801428 0.801429 1.442571 0.160286
136 C02AC MOXONIDINUM MOXONIDINA MYLAN 0,4 mg COMPR. FILM 0,4mg GENERICS (UK) LTD MA CUTIE CU BLIST. PVC-PVDC/ P6L 28 0.928928 0.000000 0.464464 0.464464 0.836035 0.092893
137 C02AC MOXONIDINUM PHYSIOTENS 0,4 mg COMPR. FILM 0,4mg ABBOTT LABO GERMANI CUTIE CU 1 BLIST. PVC-PV P6L 28 1.602857 0.000000 0.801428 0.801429 1.442571 0.160286
138 C02AC RILMENIDINUM TENAXUM COMPR. 1mg LES LABORATOI FRANTA CUTIE X 2 BLIST. AL/PVC X 15 COM P-6 30 1.003000 0.000000 0.501500 0.501500 0.902700 0.100300
139 C03DA EPLERENONUM*# INSPRA 25 mg COMPR. FILM 25mg PFIZER EUROPE MA MA CUT P-R 30 3.016791 1.716875 1.508395 3.225271 2.715111 2.018555
140 C03DA EPLERENONUM*# INSPRA 50 mg COMPR. FILM 50mg PFIZER EUROPE MA MA CUT P-R 30 4.889000 0.000000 2.444500 2.444500 4.400100 0.488900
141 C07AB NEBIVOLOLUM NEBILET (R) COMPR. 5mg BER GERMANI CUTIE X 2 BLIST. AL/PVC X 14 COM P-6 28 0.647142 0.000000 0.323571 0.323571 0.582427 0.064715
142 C07AB NEBIVOLOLUM NEBIVOLOL ACTAVIS 5 mg COMPR. 5mg ACTAVIS S.R.L. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.363000 0.000000 0.181500 0.181500 0.326700 0.036300
143 C07AB NEBIVOLOLUM X-PRESSOL 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. PVC-PE-PVD P6L 30 0.420666 0.000000 0.210333 0.210333 0.378599 0.042067
144 C07AB NEBIVOLOLUM NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC- PE- P P-6 30 0.420666 0.000000 0.210333 0.210333 0.378599 0.042067
145 C07AB NEBIVOLOLUM NEBIVOLOL TEVA 5 mg COMPR. 5mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/AL P-6 28 0.420357 0.000000 0.210178 0.210179 0.378321 0.042036
146 C07AB NEBIVOLOLUM NEBIVOLOL TEVA 5 mg COMPR. 5mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/AL P-6 30 0.229000 0.000000 0.114500 0.114500 0.206100 0.022900
147 C07AB NEBIVOLOLUM NEBINORM 5 mg COMPR. 5mg G R CUTIE CU BLIST. PVC-PVDC/AL P-6 30 0.229000 0.000000 0.114500 0.114500 0.206100 0.022900
148 C07AB NEBIVOLOLUM NEBIVOLOL SANDOZ 5 mg COMPR. 5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 28 COM P6L 28 0.420357 0.000000 0.210178 0.210179 0.378321 0.042036
149 C07AB NEBIVOLOLUM NEBIVOLOL TERAPIA 5mg COMPR. 5mg TERAPIA S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 14 COM P-6 28 0.420357 0.000000 0.210178 0.210179 0.378321 0.042036
150 C07AB NEBIVOLOLUM NEBIVOLOL TORRENT 5 mg COMPR. 5mg TORRENT PHARMA ROMANIA CUTIE CU 3 BLIST. AL/PVC X 10 C P6L 30 0.420666 0.000000 0.210333 0.210333 0.378599 0.042067
151 C07BB COMBINATII LODOZ 2,5mg/6,25mg COMPR. FILM 2,5mg/6,25mMERCK KGAA GERMANI CUTIE X 3 BLIST. PP/AL X 10 COM P-6 30 0.722000 0.000000 0.361000 0.361000 0.649800 0.072200
152 C07BB COMBINATII LODOZ 2,5mg/6,25mg COMPR. FILM 2,5mg/6,25mMERCK KGAA GERMANI CUTIE X 3 BLIST. PVC/AL X 10 C P-6 30 0.722000 0.000000 0.361000 0.361000 0.649800 0.072200
153 C07BB COMBINATII LODOZ 5mg/6,25mg COMPR. FILM 5mg/6,25mg MERCK KGAA GERMANI CUTIE X 3 BLIST. PP/AL X 10 COM P-6 30 0.722000 0.000000 0.361000 0.361000 0.649800 0.072200
154 C07BB COMBINATII LODOZ 5mg/6,25mg COMPR. FILM 5mg/6,25mg MERCK KGAA GERMANI CUTIE X 3 BLIST. PVC/AL X 10 C P-6 30 0.722000 0.000000 0.361000 0.361000 0.649800 0.072200
155 C08CA LACIDIPINUM LACIPIL 4 mg COMPR. FILM 4mg GLAXO OPERATI MA CUTIE X 2 BLIST. PA-AL-PVC/ P-6 14 0.264299 0.397129 0.132149 0.529279 0.237869 0.423559
156 C08CA LERCANIDIPINUM LERCANIDIPIN ACTAVIS 10 mg COMPR. FILM 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/PVC X 30 C P-6 30 0.264299 0.165034 0.132149 0.297184 0.237869 0.191464
157 C08CA LERCANIDIPINUM LERIDIP COMPR. FILM 10mg BER GERMANI CUTIE X 4 BLIST. AL/PVC X 15 P-6 60 0.264299 0.374867 0.132149 0.507017 0.237869 0.401297
158 C08CA LERCANIDIPINUM LERPIN 10 mg COMPR. FILM 10mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC-PVDC/ P-6 50 0.264299 0.167101 0.132149 0.299251 0.237869 0.193531
159 C08CA LERCANIDIPINUM LERPIN 10 mg COMPR. FILM 10mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC-PVDC/ P-6 98 0.264299 0.153252 0.132149 0.285402 0.237869 0.179682
160 C08CA LERCANIDIPINUM KAPIDIN10 mg COMPR. FILM 10mg ZENTIVA K.S. R CUTIE CU BLIST. AL/PVC X 30 C P-6 30 0.264299 0.165034 0.132149 0.297184 0.237869 0.191464
161 C08CA LERCANIDIPINUM PEGFEL 10 mg COMPR. FILM 10mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. PVC-PVCD P- 28 0.264299 0.164986 0.132149 0.297136 0.237869 0.191416
162 C08CA LERCANIDIPINUM LERCANIDIPIN ACTAVIS 10 mg COMPR. FILM 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/PVDC X 30 P-6 30 0.264299 0.165034 0.132149 0.297184 0.237869 0.191464
163 C08CA LERCANIDIPINUM LERCANIDIPINA ZENTIVA 10 mg COMPR. FILM 10mg ZENTIVA K.S. R CUTIE CU BLIST. AL/PVDC X 30 P-6 30 0.264299 0.165034 0.132149 0.297184 0.237869 0.191464
164 C08CA LERCANIDIPINUM LERCANIDIPIN ACTAVIS 20 mg COMPR. FILM 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/PVC X 30 C P-6 30 0.528598 0.113402 0.264299 0.377701 0.475738 0.166262
165 C08CA LERCANIDIPINUM LERIDIP 20 COMPR. FILM 20mg BER GERMANI CUTIE X 6 BLIST. AL/PVC X 10 C P-6 60 0.528598 0.515402 0.264299 0.779701 0.475738 0.568262
166 C08CA LERCANIDIPINUM LERPIN 20 mg COMPR. FILM 20mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC-PVDC/ P-6 50 0.528598 0.157402 0.264299 0.421701 0.475738 0.210262
167 C08CA LERCANIDIPINUM PEGFEL 20 mg COMPR. FILM 20mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. PVC-PVCD P- 28 0.528598 0.172473 0.264299 0.436772 0.475738 0.225333
168 C08CA LERCANIDIPINUM LERCANIDIPIN ACTAVIS 20 mg COMPR. FILM 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/PVDC X 30 P-6 30 0.528598 0.113402 0.264299 0.377701 0.475738 0.166262
169 C09AA PERINDOPRILUM PRENESSA 2 mg COMPR. 2mg KRKA POLSKA SP. Z POLONIA CUTIE CU 1 BLIST. P-6 30 0.149297 0.223703 0.074648 0.298352 0.134367 0.238633
170 C09AA PERINDOPRILUM PERINDOPRIL TEVA 4 mg COMPR. 4mg TEVA PHARM ROMANIA CUTIE X 1 P-6 30 0.298595 0.341405 0.149297 0.490703 0.268735 0.371265
171 C09AA PERINDOPRILUM VIDOTIN 4 mg COMPR. 4mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR P-6 30 0.298595 0.079071 0.149297 0.228369 0.268735 0.108931
172 C09AA PERINDOPRILUM STOPRESS 4 mg COMPR. 4mg PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE CU BLIST. ACLAR-PV P-6 30 0.298595 0.216071 0.149297 0.365369 0.268735 0.245931
173 C09AA PERINDOPRILUM TREZEN 4 mg COMPR. 4mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/ P-6 30 0.298595 0.596071 0.149297 0.745369 0.268735 0.625931
174 C09AA PERINDOPRILUM TREZEN 4 mg COMPR. 4mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COM P-6 30 0.298595 0.596071 0.149297 0.745369 0.268735 0.625931
175 C09AA PERINDOPRILUM PRENESSA 4 mg COMPR. 4mg KRKA POLSKA SP. Z POLONIA CUTIE CU 1 BLIST. PVC-PE- P-6 30 0.298595 0.189405 0.149297 0.338703 0.268735 0.219265
176 C09AA PERINDOPRILUM PRINDEX 4 mg COMPR. 4mg G R CUTIE CU BLIST. AL/AL X 30 COMPR P-6 30 0.298595 0.096405 0.149297 0.245703 0.268735 0.126265
177 C09AA PERINDOPRILUM ERNYOM 4 mg COMPR. 4mg VIM SPECTRUM S.R. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PV P6L 30 0.298595 0.215071 0.149297 0.364369 0.268735 0.244931
178 C09AA PERINDOPRILUM PERINDOPRIL TEVA 8 mg COMPR. 8mg TEVA PHARM ROMANIA CUTIE X 1 P-6 30 0.597191 0.219809 0.298595 0.518405 0.537471 0.279529
179 C09AA PERINDOPRILUM VIDOTIN 8 mg COMPR. 8mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR P-6 30 0.597191 0.093142 0.298595 0.391738 0.537471 0.152862
180 C09AA PERINDOPRILUM STOPRESS 8 mg COMPR. 8mg PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE CU BLIST. ACLAR-PV P-6 30 0.597191 0.313475 0.298595 0.612071 0.537471 0.373195
181 C09AA PERINDOPRILUM TREZEN 8 mg COMPR. 8mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/ P-6 30 0.597191 1.101809 0.298595 1.400405 0.537471 1.161529
182 C09AA PERINDOPRILUM TREZEN 8 mg COMPR. 8mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COM P-6 30 0.597191 1.101809 0.298595 1.400405 0.537471 1.161529
183 C09AA PERINDOPRILUM PRINDEX 8 mg COMPR. 8mg G R CUTIE CU BLIST. AL/AL X 30 COMPR P-6 30 0.597191 0.027475 0.298595 0.326071 0.537471 0.087195
184 C09AA PERINDOPRILUM PRENESSA 8 mg COMPR. 8mg KRKA POLSKA SP Z POLONIA CUTIE CU BLIST. PVC-PE-PVD P6L 30 0.597191 0.212809 0.298595 0.511405 0.537471 0.272529
185 C09AA PERINDOPRILUM ERNYOM 8 mg COMPR. 8mg VIM SPECTRUM S.R. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PV P6L 30 0.597191 0.162809 0.298595 0.461405 0.537471 0.222529
186 C09AA PERINDOPRILUM PRESTARIUM 10 mg COMPR. FILM 10 mg LES LABORATOI FRANTA CUTIE X 1 FLAC. DIN PP X 30 C P-6 30 0.746489 0.948511 0.373244 1.321756 0.671840 1.023160
187 C09AA PERINDOPRILUM PERINDOPRIL TOSILAT TEVA 10 mg COMPR. FILM 10mg TEVA PHARM ROMANIA CUTIE CU 1 FLAC. PP X 30 COMPR. P6L 30 0.746489 0.118511 0.373244 0.491756 0.671840 0.193160
188 C09AA PERINDOPRILUM PRESTARIUM 5 mg COMPR. FILM 5mg LES LABORATOI FRANTA CUTIE X 1 FLAC. DIN PP X 30 C P-6 30 0.373244 0.616422 0.186622 0.803044 0.335919 0.653747
189 C09AA PERINDOPRILUM PERINDOPRIL TOSILAT TEVA 5 mg COMPR. FILM 5mg TEVA PHARM ROMANIA CUTIE CU 1 FLAC. PP X 30 COMPR. P6L 30 0.373244 0.270422 0.186622 0.457044 0.335919 0.307747
190 C09AA BENAZEPRILUM CIBACEN (R) 20 mg COMPR. FILM 20mg NOVARTIS PHARM GERMANI CUTIE X 2 BLIST. X 14 COMPR. FILM P-6 28 0.796255 1.322316 0.398127 1.720444 0.716629 1.401942
191 C09AA BENAZEPRILUM CIBACEN (R) 5 mg COMPR. FILM 5mg NOVARTIS PHARM GERMANI CUTIE X 2 BLIST. X 14 COMPR. FILM P-6 28 0.199063 0.584151 0.099531 0.683683 0.179156 0.604058

Pagina 25 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
192 C09AA TRANDOLAPRILUM GOPTEN (R) 0,5 mg CAPS. 0,5mg ABBOTT GMBH&CO. GERMANI CUTIE X 2 BLIST. X 10 CAPS. P-6 20 0.074648 0.309852 0.037324 0.347176 0.067183 0.317317
193 C09AA TRANDOLAPRILUM GOPTEN (R) 2 mg CAPS. 2mg ABBOTT GMBH&CO. GERMANI CUTIE X 2 BLIST. X 14 CAPS. P-6 28 0.298595 0.314262 0.149297 0.463560 0.268735 0.344122
194 C09AA TRANDOLAPRILUM GOPTEN (R) 4 mg CAPS. 4mg ABBOTT GMBH&CO. GERMANI CUTIE X 2 BLIST. X 14 CAPS. P-6 28 0.597191 0.579951 0.298595 0.878547 0.537471 0.639671
195 C09AA ZOFENOPRILUM ZOMEN (R) 30 mg COMPR. FILM 30mg MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. LUXEM CUTIE X 2 BLIST. PVC-PVDC/ P-6 28 0.298595 1.249976 0.149297 1.399274 0.268735 1.279836
196 C09AA ZOFENOPRILUM ZOMEN (R) 7,5 mg COMPR. FILM 7,5mg MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. LUXEM CUTIE X 2 BLIST. PVC-PVDC/ P-6 28 0.074648 0.654994 0.037324 0.692318 0.067183 0.662459
197 C09BA COMBINATII (PERINDOPRIL COTREZEN 2 mg/0,625 mg COMPR. 2 mg/0,625 TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL A CATE 3 P6L 30 0.543333 0.000000 0.271666 0.271667 0.488999 0.054334
198 C09BA COMBINATII (PERINDOPRIL PRINDEX PLUS 2 mg/0,625 mg COMPR. 2 mg/0,625m G R CUTIE CU 1 BLIST. PVC/PVDC-AL IN AMBALAJ DE AL X 30 (30X1) COMPR. P6L 30 0.559333 0.000000 0.279666 0.279667 0.503399 0.055934
199 C09BA COMBINATII (PERINDOPRIL CO-PRENESSA 2mg/0,625 mg COMPR. 2mg/0,625mg KRKA POLSKA SP ZO POLONIA CUTIE CU BLIST. PVC-PE-PVD P-6 30 0.372333 0.000000 0.186166 0.186167 0.335099 0.037234
200 C09BA COMBINATII (PERINDOPRIL DANURIT 2 mg/0,625 mg COMPR. 2mg/0,625mg GEDEON RIC ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL P6L 30 0.559333 0.000000 0.279666 0.279667 0.503399 0.055934
201 C09BA COMBINATII (PERINDOPRIL COTREZEN 4 mg/1,25 mg COMPR. 4 mg/1,25 mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL A CATE 3 P6L 30 0.761850 0.075483 0.380925 0.456408 0.685665 0.151668
202 C09BA COMBINATII (PERINDOPRIL PRINDEX PLUS 4 mg/1,25mg COMPR. 4 mg/1,25mg G R CUTIE CU 1 BLIST. PVC/PVDC-AL IN AMBALAJ DE AL X 30 (30X1) COMPR. P6L 30 0.758000 0.000000 0.379000 0.379000 0.682200 0.075800
203 C09BA COMBINATII (PERINDOPRIL PANINDORIL 4 mg/1,25 mg COMPR. 4mg/1, 25mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. AL/AL X 30 COMPR P-6 30 0.703000 0.000000 0.351500 0.351500 0.632700 0.070300
204 C09BA COMBINATII (PERINDOPRIL CO-PRENESSA 4mg/1,25 mg COMPR. 4mg/1,25mg KRKA POLSKA SP ZO POLONIA CUTIE CU BLIST. PVC-PE-PVD P-6 30 0.694000 0.000000 0.347000 0.347000 0.624600 0.069400
205 C09BA COMBINATII (PERINDOPRIL DANURIT 4 mg/1,25mg COMPR. 4mg/1,25mg GEDEON RIC ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL P6L 30 0.761850 0.033150 0.380925 0.414075 0.685665 0.109335
206 C09BA COMBINATII (PERINDOPRIL CO-PRENESSA 8 mg/2,5mg COMPR. 8mg/2,5mg KRKA-POLSKA SP. POLONIA CUTIE CU BLIST. OPA-AL-PVC P-6 30 0.761850 0.236483 0.380925 0.617408 0.685665 0.312668
207 C09BA COMBINATII (PERINDOPRIL NOLITERAX 10 mg/2,5mg COMPR. FILM 10mg/2,5mg LES LAB. SERVIER FRANTA CUTIE X 1 FLAC. DIN PP CU CAPAC PEJD CU SILICAGEL X 30 COMPR. FILM. P-6 30 0.761850 1.013483 0.380925 1.394408 0.685665 1.089668
208 C09BA COMBINATII (PERINDOPRIL NOLIPREL ARG 2,5mg/0,625mg COMPR. FILM 2,5mg/0,625 LES LABORATOI FRANTA CUTIE X 1 FLAC. DIN P P-6 30 0.761850 0.567150 0.380925 0.948075 0.685665 0.643335
209 C09BA COMBINATII (PERINDOPRIL PERINDOPRIL TOSILAT/INDAPA COMPR. FILM 2,5mg/0,625 TEVA PHARM ROMANIA CUTIE CU 1 FLAC. DIN PP X 30 P6L 30 0.339333 0.000000 0.169666 0.169667 0.305399 0.033934
210 C09BA COMBINATII (PERINDOPRIL NOLIPREL ARG FORTE 5mg/1,25mg COMPR. FILM 5mg/1,25mg LES LABORATOI FRANTA CUTIE X 1 FLAC. DIN P P-6 30 0.761850 0.406150 0.380925 0.787075 0.685665 0.482335
211 C09BA COMBINATII (PERINDOPRIL PERINDOPRIL TOSILAT/INDAPAMI COMPR. FILM 5mg/1,25mg TEVA PHARM ROMANIA CUTIE CU 1 FLAC. DIN PP X 30 P6L 30 0.679666 0.000000 0.339833 0.339833 0.611699 0.067967
212 C09BA COMBINATII ACCUZIDE COMPR. FILM 10mg/12,5mg PFIZER EUROPE MA MA CUTIE X 3 BLIST. AL/PVC-A P-6 30 0.536666 0.000000 0.268333 0.268333 0.482999 0.053667
213 C09BA COMBINATII ACCUZIDE FORTE COMPR. FILM 20mg/12,5mg PFIZER EUROPE MA MA CUTIE X 3 BLIST. AL/PVC-A P-6 30 0.761850 0.221150 0.380925 0.602075 0.685665 0.297335
214 C09BB COMBINATII (NITRENDIPIN ENEAS COMPR. 20mg+10mg GALENICA S.A. GRECIA CUTIE X 3 BLIST. PA-PVC-AL/AL P-6 30 2.927000 0.000000 1.463500 1.463500 2.634300 0.292700
215 C09BB COMBINATII (PERINDOPRIL BEATIL 4 mg/ 10 mg COMPR. 4mg/10 mg GEDEON RIC ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL P6L 30 0.731000 0.000000 0.365500 0.365500 0.657900 0.073100
216 C09BB COMBINATII (PERINDOPRIL AMLESSA 4 mg/10 mg COMPR. 4mg/10mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.732000 0.000000 0.366000 0.366000 0.658800 0.073200
217 C09BB COMBINATII (PERINDOPRIL AMLESSA 4 mg/5 mg COMPR. 4mg/5mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.475103 0.189897 0.237551 0.427449 0.427592 0.237408
218 C09BB COMBINATII (PERINDOPRIL BEATIL 4 mg/ 5 mg COMPR. 4mg/5mg GEDEON RIC ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL P6L 30 0.475103 0.135563 0.237551 0.373115 0.427592 0.183074
219 C09BB COMBINATII (PERINDOPRIL AMLESSA 8 mg/10 mg COMPR. 8mg/10mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.950207 0.233126 0.475103 0.708230 0.855186 0.328147
220 C09BB COMBINATII (PERINDOPRIL BEATIL 8 mg/ 10 mg COMPR. 8mg/10mg GEDEON RIC ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL P6L 30 0.950207 0.143793 0.475103 0.618897 0.855186 0.238814
221 C09BB COMBINATII (PERINDOPRIL AMLESSA 8 mg/5 mg COMPR. 8mg/5mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.686260 0.432740 0.343130 0.775870 0.617634 0.501366
222 C09BB COMBINATII (PERINDOPRIL BEATIL 8 mg/ 5 mg COMPR. 8mg/5mg GEDEON RIC ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL P6L 30 0.686260 0.239740 0.343130 0.582870 0.617634 0.308366
223 C09BB COMBINATII (VERAPAM TARKA 240 mg/2 mg COMPR. CU ELIB. MODIF. 240mg/2mg ABBOTT GMBH & CO GERMANI CUTIE CU 2 P6L 28 1.941963 0.112679 0.970981 1.083661 1.747766 0.306876
224 C09BB COMBINATII (VERAPAM TARKA 240 mg/4 mg COMPR. CU ELIB. MODIF. 240mg/4mg ABBOTT GMBH & CO GERMANI CUTIE CU 2 P6L 28 1.941963 0.751608 0.970981 1.722590 1.747766 0.945805
225 C09BB COMBINATII (VERAPAM TARKA COMPR.FILM.ELIB.MODIF. 180mg/2mg ABBOTT GMBH&CO. GERMANI CUTIE P-6 28 1.829285 0.000000 0.914642 0.914643 1.646356 0.182929
226 C09BX COMBIN CO-AMLESSA 4mg/10mg/1,25mg COMPR. 4mg/10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.967000 0.000000 0.483500 0.483500 0.870300 0.096700
227 C09BX COMBIN CO-AMLESSA 4 mg/5mg/1,25 mg COMPR. 4mg/5mg/1 KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.738326 0.151674 0.369163 0.520837 0.664493 0.225507
228 C09BX COMBIN CO-AMLESSA 8 mg/10 mg/2,5 mg COMPR. 8mg/10mg/ KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 1.252666 0.000000 0.626333 0.626333 1.127399 0.125267
229 C09BX COMBIN CO-AMLESSA 8 mg/5 mg/2,5 mg COMPR. 8mg/5mg/2, KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 1.091706 0.050627 0.545853 0.596480 0.982535 0.159798
230 C09BX COMBIN TRIPLIXAM COMPR. FILM 10mg/2,5 LES LABORATOI FRANTA CUTIE C P6L 30 1.485121 0.659212 0.742560 1.401773 1.336608 0.807725
231 C09BX COMBIN TRIPLIXAM COMPR. FILM 10mg/2,5m LES LABORATOI FRANTA CUTIE C P6L 30 1.100174 0.938159 0.550087 1.488246 0.990156 1.048177
232 C09BX COMBIN TRIPLIXAM COMPR. FILM 5mg/1,25 LES LABORATOI FRANTA CUTIE C P6L 30 1.127506 0.301827 0.563753 0.865580 1.014755 0.414578
233 C09BX COMBIN TRIPLIXAM COMPR. FILM 5mg/1,25m LES LABORATOI FRANTA CUTIE C P6L 30 0.742560 0.570773 0.371280 0.942053 0.668304 0.645029
234 C09CA VALSARTANUM WENZELL 160 mg COMPR. FILM 160mg ROMASTRU TRADI ROMANIA CUTIE CU BLIS P-6 28 1.070357 0.000000 0.535178 0.535179 0.963321 0.107036
235 C09CA VALSARTANUM WENZELL 160 mg COMPR. FILM 160mg ROMASTRU TRADI ROMANIA CUTIE CU BLIS P-6 30 1.070333 0.000000 0.535166 0.535167 0.963299 0.107034
236 C09CA VALSARTANUM DIOVAN 160 mg COMPR. FILM 160mg NOVARTIS PHARM GERMANI CUTIE CU BLIST. PV P-6 28 1.389855 0.204073 0.694927 0.899001 1.250869 0.343059
237 C09CA VALSARTANUM VALSACOR 160 mg COMPR. FILM 160mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PV P6L 28 0.534285 0.000000 0.267142 0.267143 0.480856 0.053429
238 C09CA VALSARTANUM AVASSAN 160 mg COMPR. FILM 160mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 1.070357 0.000000 0.535178 0.535179 0.963321 0.107036
239 C09CA VALSARTANUM VALSARTAN TORRENT 160 mg COMPR. FILM 160mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 98 0.462244 0.000000 0.231122 0.231122 0.416019 0.046225
240 C09CA VALSARTANUM VALSARTAN ZENTIVA 160 mg COMPR. FILM 160mg ZENTIVA, K.S. R CUTIE C P-6 28 0.561785 0.000000 0.280892 0.280893 0.505606 0.056179
241 C09CA VALSARTANUM VAPRESS 160 mg COMPR. FILM 160mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PV P6L 28 0.772142 0.000000 0.386071 0.386071 0.694927 0.077215
242 C09CA VALSARTANUM VAPRESS 160 mg COMPR. FILM 160mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTF P6L 28 0.772142 0.000000 0.386071 0.386071 0.694927 0.077215
243 C09CA VALSARTANUM VALSACOR 320 mg COMPR. FILM 320mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PV P-6 30 1.129333 0.000000 0.564666 0.564667 1.016399 0.112934
244 C09CA VALSARTANUM DIOVAN 40 mg COMPR. FILM 40mg NOVARTIS PHARM GERMANI CUTIE CU BLIST. PVC-PE P6L 28 0.347463 2.220751 0.173731 2.394483 0.312716 2.255498
245 C09CA VALSARTANUM AVASSAN 40 mg COMPR. FILM 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.347463 1.232179 0.173731 1.405911 0.312716 1.266926
246 C09CA VALSARTANUM VAPRESS 40 mg COMPR. FILM 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PV P6L 28 0.347463 0.065751 0.173731 0.239483 0.312716 0.100498
247 C09CA VALSARTANUM VAPRESS 40 mg COMPR. FILM 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTF P6L 28 0.347463 0.065751 0.173731 0.239483 0.312716 0.100498
248 C09CA VALSARTANUM WENZELL 80 mg COMPR. FILM 80mg ROMASTRU TRADI ROMANIA CUTIE CU BLIS P-6 28 0.694927 0.107930 0.347463 0.455394 0.625434 0.177423
249 C09CA VALSARTANUM WENZELL 80 mg COMPR. FILM 80mg ROMASTRU TRADI ROMANIA CUTIE CU BLIS P-6 30 0.694927 0.107739 0.347463 0.455203 0.625434 0.177232
250 C09CA VALSARTANUM DIOVAN 80 mg COMPR. FILM 80mg NOVARTIS PHARM GERMANI CUTIE CU BLIST. PVC-PE P6L 28 0.694927 0.500073 0.347463 0.847537 0.625434 0.569566
251 C09CA VALSARTANUM VALSACOR 80 mg COMPR. FILM 80mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PV P6L 28 0.437857 0.000000 0.218928 0.218929 0.394071 0.043786
252 C09CA VALSARTANUM AVASSAN 80 mg COMPR. FILM 80mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.694927 0.107930 0.347463 0.455394 0.625434 0.177423
253 C09CA VALSARTANUM VALSARTAN TORRENT 80 mg COMPR. FILM 80mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 98 0.292755 0.000000 0.146377 0.146378 0.263479 0.029276
254 C09CA VALSARTANUM VALSARTAN ZENTIVA 80 mg COMPR. FILM 80mg ZENTIVA, K.S. R CUTIE C P-6 28 0.522857 0.000000 0.261428 0.261429 0.470571 0.052286
255 C09CA VALSARTANUM VAPRESS 80 mg COMPR. FILM 80mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PV P6L 28 0.385714 0.000000 0.192857 0.192857 0.347142 0.038572
256 C09CA VALSARTANUM VAPRESS 80 mg COMPR. FILM 80mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTF P6L 28 0.385714 0.000000 0.192857 0.192857 0.347142 0.038572
257 C09CA VALSARTANUM DIOVAN 3 mg/ml SOL. ORALA 3mg/ml NOVARTIS PHARM GERMANI CUTIE X 1 FLACON DIN STICLA BRUNA X 160ML SOLUTIE ORALA + 1 TRUSA DE ADMINISTRARE (ADAPTOR PENTRU FLACON + 1 SERINGA DOZATOARE A 5ML + 1 MASURA DOZATOARE A 30ML )
P-6 1 4.169566 37.250434 2.084783 39.335217 3.752609 37.667391

Pagina 26 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
258 C09CA IRBESARTANUM IRBESARTAN AUROBINDO 150 mg COMPR. 150mg AU MALTA CUTIE CU BLIST. PVC-PVDC/AL P6L 28 0.368571 0.000000 0.184285 0.184286 0.331713 0.036858
259 C09CA IRBESARTANUM IRBESARTAN AUROBINDO 300 mg COMPR. 300mg AU MALTA CUTIE CU BLIST. PVC-PVDC/AL P6L 28 0.516071 0.000000 0.258035 0.258036 0.464463 0.051608
260 C09CA IRBESARTANUM IRBESARTAN GALENICA 150 mg COMPR. FILM 150 mg GALENICA S.A. GRECIA CUTIE CU BLIST. PVC P6L 28 0.368571 0.000000 0.184285 0.184286 0.331713 0.036858
261 C09CA IRBESARTANUM APROVEL 150mg COMPR. FILM 150mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X BLIST PVC/PVDC/AL X P-6 28 0.694927 0.510787 0.347463 0.858251 0.625434 0.580280
262 C09CA IRBESARTANUM IRBESARTAN TERAPIA 150 mg COMPR. FILM 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-P P-6 28 0.694927 0.088644 0.347463 0.436108 0.625434 0.158137
263 C09CA IRBESARTANUM IRBESARTAN SANDOZ 150 mg COMPR. FILM 150mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 28 0.616785 0.000000 0.308392 0.308393 0.555106 0.061679
264 C09CA IRBESARTANUM IRPRESTAN 150 mg COMPR. FILM 150mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC/ P-6 30 0.299333 0.000000 0.149666 0.149667 0.269399 0.029934
265 C09CA IRBESARTANUM IFIRMASTA 150 mg COMPR. FILM 150mg KRKA ,D.D., NOVO SLOVENI CUTIE X BLIST. PVC/PE/PV P-6 28 0.537500 0.000000 0.268750 0.268750 0.483750 0.053750
266 C09CA IRBESARTANUM IRBESARTAN TEVA 150 mg COMPR. FILM 150mg TEVA PHARMA B.V. OLANDA CUTIE X BLIST. PVC/PVDC/AL P-6 28 0.597500 0.000000 0.298750 0.298750 0.537750 0.059750
267 C09CA IRBESARTANUM ATOKKEN 150 mg COMPR. FILM 150mg ROMASTRU TRADI ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 0.694927 0.088644 0.347463 0.436108 0.625434 0.158137
268 C09CA IRBESARTANUM IRBESARTAN ZENTIVA 150mg COMPR. FILM 150mg SANOFI-AVENTIS FRANTA CUTIE X 28 COMPR. FILM. (BL P-6 28 0.567500 0.000000 0.283750 0.283750 0.510750 0.056750
269 C09CA IRBESARTANUM IRBESARTAN HF 150 mg COMPR. FILM 150mg STADA HEMOFARM S ROMANIA CUTIE CU BLIST. PVC-PVDC/ P6L 30 0.694927 0.065073 0.347463 0.412537 0.625434 0.134566
270 C09CA IRBESARTANUM APROVEL 150mg COMPR. FILM 150mg SANOFI CLIR SNC FRANTA CUTIE X BLIST PVC/PVDC/AL X P-6 28 0.694927 0.510787 0.347463 0.858251 0.625434 0.580280
271 C09CA IRBESARTANUM ATOKKEN 150 mg COMPR. FILM 150mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 0.694927 0.088644 0.347463 0.436108 0.625434 0.158137
272 C09CA IRBESARTANUM IRBESARTAN TEVA 300 mg COMPR. FILM 300 mg TEVA PHARMA B.V. OLANDA CUTIE X BLIST. PVC/PVDC/AL P-6 28 0.812142 0.000000 0.406071 0.406071 0.730927 0.081215
273 C09CA IRBESARTANUM IRBESARTAN GALENICA 300 mg COMPR. FILM 300 mg GALENICA S.A. GRECIA CUTIE CU BLIST. PVC P6L 28 0.576785 0.000000 0.288392 0.288393 0.519106 0.057679
274 C09CA IRBESARTANUM APROVEL 300mg COMPR. FILM 300mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X BLIST PVC/PVDC/AL X P-6 28 1.389855 0.210859 0.694927 0.905787 1.250869 0.349845
275 C09CA IRBESARTANUM IRBESARTAN TERAPIA 300 mg COMPR. FILM 300mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-P P-6 28 1.075357 0.000000 0.537678 0.537679 0.967821 0.107536
276 C09CA IRBESARTANUM IRBESARTAN SANDOZ 300 mg COMPR. FILM 300mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 28 0.802500 0.000000 0.401250 0.401250 0.722250 0.080250
277 C09CA IRBESARTANUM IFIRMASTA 300mg COMPR. FILM 300mg KRKA ,D.D., NOVO SLOVENI CUTIE X BLIST. PVC/PE/PV P-6 28 0.863571 0.000000 0.431785 0.431786 0.777213 0.086358
278 C09CA IRBESARTANUM ATOKKEN 300 mg COMPR. FILM 300mg ROMASTRU TRADI ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 1.075357 0.000000 0.537678 0.537679 0.967821 0.107536
279 C09CA IRBESARTANUM IRBESARTAN ZENTIVA 300mg COMPR. FILM 300mg SANOFI-AVENTIS FRANTA CUTIE X 28 COMPR. FILM. (BL P-6 28 0.887142 0.000000 0.443571 0.443571 0.798427 0.088715
280 C09CA IRBESARTANUM IRBESARTAN HF 300 mg COMPR. FILM 300mg STADA HEMOFARM S ROMANIA CUTIE CU BLIST. PVC-PVDC/ P6L 30 1.036000 0.000000 0.518000 0.518000 0.932400 0.103600
281 C09CA IRBESARTANUM APROVEL 300mg COMPR. FILM 300mg SANOFI CLIR SNC FRANTA CUTIE X BLIST PVC/PVDC/AL X P-6 28 1.389855 0.210859 0.694927 0.905787 1.250869 0.349845
282 C09CA IRBESARTANUM ATOKKEN 300 mg COMPR. FILM 300mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 1.075357 0.000000 0.537678 0.537679 0.967821 0.107536
283 C09CA IRBESARTANUM ATOKKEN 75 mg COMPR. FILM 75mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 0.347463 0.508965 0.173731 0.682697 0.312716 0.543712
284 C09CA CANDESARTANUM CILEXETIL ATACAND COMPR. 16mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. PVC-PVDC/AL P-6 28 1.389855 0.191930 0.694927 0.886858 1.250869 0.330916
285 C09CA CANDESARTANUM CILEXETIL TANDESAR 16 mg COMPR. 16mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVD P-6 28 1.062500 0.000000 0.531250 0.531250 0.956250 0.106250
286 C09CA CANDESARTANUM CILEXETIL CANDESARTAN SANDOZ 16 mg COMPR. 16mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR P-6 28 0.998928 0.000000 0.499464 0.499464 0.899035 0.099893
287 C09CA CANDESARTANUM CILEXETIL KARBIS 16 mg COMPR. 16mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/AL P-6 30 1.062000 0.000000 0.531000 0.531000 0.955800 0.106200
288 C09CA CANDESARTANUM CILEXETIL CANDESARTAN TORRENT 16 mg COMPR. 16mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.700000 0.000000 0.350000 0.350000 0.630000 0.070000
289 C09CA CANDESARTANUM CILEXETIL ATACAND 16mg COMPR. 16mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC P-6 28 1.389855 0.191930 0.694927 0.886858 1.250869 0.330916
290 C09CA CANDESARTANUM CILEXETIL CANZENO 16mg COMPR. 16mg ZENTIVA K.S. R CUTIE CU BLIST. PVC-PVDC/AL P6L 30 0.866000 0.000000 0.433000 0.433000 0.779400 0.086600
291 C09CA CANDESARTANUM CILEXETIL CANDESARTAN LABORMED 16 mg COMPR. 16mg LABORMED PHARMA ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/A P6L 28 1.062142 0.000000 0.531071 0.531071 0.955927 0.106215
292 C09CA CANDESARTANUM CILEXETIL CANDESARTAN AUROBINDO 16 mg COMPR. 16mg AU MALTA CUTIE CU BLIST. PVC-PVDC/AL P6L 30 1.012333 0.000000 0.506166 0.506167 0.911099 0.101234
293 C09CA CANDESARTANUM CILEXETIL CADEXYL 16 mg COMPR. 16mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PVC-PVDC/AL P6L 28 1.062500 0.000000 0.531250 0.531250 0.956250 0.106250
294 C09CA CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL MCC 16 mg COMPR. 16mg MAGISTRA C&C S.R.L ROMANIA CUTIE CU BLIST. PVC/PVDC-AL P6L 30 1.062000 0.000000 0.531000 0.531000 0.955800 0.106200
295 C09CA CANDESARTANUM CILEXETIL ATACAND 32 mg COMPR. 32mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. AL-PVC/PVDC P-6 28 2.229285 0.000000 1.114642 1.114643 2.006356 0.222929
296 C09CA CANDESARTANUM CILEXETIL KARBIS 32 mg COMPR. 32mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/AL P-6 30 1.449000 0.000000 0.724500 0.724500 1.304100 0.144900
297 C09CA CANDESARTANUM CILEXETIL CANDESARTAN TORRENT 32 mg COMPR. 32mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.603000 0.000000 0.301500 0.301500 0.542700 0.060300
298 C09CA CANDESARTANUM CILEXETIL ATACAND 32 mg COMPR. 32mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC P-6 28 2.229285 0.000000 1.114642 1.114643 2.006356 0.222929
299 C09CA CANDESARTANUM CILEXETIL CANZENO 32mg COMPR. 32mg ZENTIVA K.S. R CUTIE CU BLIST. PVC-PVDC/AL P6L 30 0.963000 0.000000 0.481500 0.481500 0.866700 0.096300
300 C09CA CANDESARTANUM CILEXETIL CADEXYL 32 mg COMPR. 32mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PVC-PVDC/AL P6L 28 1.357857 0.000000 0.678928 0.678929 1.222071 0.135786
301 C09CA CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL MCC 32 mg COMPR. 32mg MAGISTRA C&C S.R.L ROMANIA CUTIE CU BLIST. PVC/PVDC-AL P6L 30 1.449000 0.000000 0.724500 0.724500 1.304100 0.144900
302 C09CA CANDESARTANUM CILEXETIL ATACAND COMPR. 8mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. PVC-PVDC/AL P-6 28 0.694927 0.122215 0.347463 0.469679 0.625434 0.191708
303 C09CA CANDESARTANUM CILEXETIL TANDESAR 8 mg COMPR. 8mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVD P-6 28 0.531071 0.000000 0.265535 0.265536 0.477963 0.053108
304 C09CA CANDESARTANUM CILEXETIL CANDESARTAN SANDOZ 8 mg COMPR. 8mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR P-6 28 0.531071 0.000000 0.265535 0.265536 0.477963 0.053108
305 C09CA CANDESARTANUM CILEXETIL KARBIS 8 mg COMPR. 8mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/AL P-6 30 0.531000 0.000000 0.265500 0.265500 0.477900 0.053100
306 C09CA CANDESARTANUM CILEXETIL CANDESARTAN TORRENT 8 mg COMPR. 8mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.531000 0.000000 0.265500 0.265500 0.477900 0.053100
307 C09CA CANDESARTANUM CILEXETIL ATACAND 8mg COMPR. 8mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC P-6 28 0.694927 0.122215 0.347463 0.469679 0.625434 0.191708
308 C09CA CANDESARTANUM CILEXETIL CANZENO 8mg COMPR. 8mg ZENTIVA K.S. R CUTIE CU BLIST. PVC-PVDC/AL P6L 30 0.531000 0.000000 0.265500 0.265500 0.477900 0.053100
309 C09CA CANDESARTANUM CILEXETIL CANDESARTAN LABORMED 8 mg COMPR. 8mg LABORMED PHARMA ROMANIA CUTIE CU 2 BLIST. PVC-PVDC P6L 28 0.531071 0.000000 0.265535 0.265536 0.477963 0.053108
310 C09CA CANDESARTANUM CILEXETIL CANDESARTAN AUROBINDO 8 mg COMPR. 8mg AU MALTA CUTIE CU BLIST. PVC-PVDC/AL P6L 30 0.531000 0.000000 0.265500 0.265500 0.477900 0.053100
311 C09CA CANDESARTANUM CILEXETIL CADEXYL 8 mg COMPR. 8mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PVC-PVDC/AL P6L 28 0.531071 0.000000 0.265535 0.265536 0.477963 0.053108
312 C09CA CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL MCC 8 mg COMPR. 8mg MAGISTRA C&C S.R.L ROMANIA CUTIE CU BLIST. PVC/PVDC-AL P6L 30 0.531000 0.000000 0.265500 0.265500 0.477900 0.053100
313 C09CA TELMISARTANUM TELMISARTAN ACTAVIS 40mg COMPR. 40 mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 28 COMPR P6L 28 0.546428 0.000000 0.273214 0.273214 0.491785 0.054643
314 C09CA TELMISARTANUM TOLURA 40 mg COMPR. 40mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST.OPA-AL-PVC/AL P-6 28 0.593214 0.000000 0.296607 0.296607 0.533892 0.059322
315 C09CA TELMISARTANUM TEZEO 40 mg COMPR. 40mg ZENTIVA, K.S. R CUTIE CU BLIST. OPA-AL-PVC P-6 30 0.594666 0.000000 0.297333 0.297333 0.535199 0.059467
316 C09CA TELMISARTANUM TELMISARTAN TEVA 40 mg COMPR. 40mg TEVA PHARMA B.V. OLANDA CUTIE CU BLIST. AL/AL PERFORATE PENTRU ELIBERAREA UNEI UNITATI DOZATE 30X1 P6L 30 0.694927 0.107739 0.347463 0.455203 0.625434 0.177232
317 C09CA TELMISARTANUM TELMISARTAN RANBAXY 40 mg COMPR. 40mg RANBAXY (U.K.) LIM MA CUTIE CU BLIST. PA-AL-PVC/AL P6L 28 0.694927 0.766858 0.347463 1.114322 0.625434 0.836351
318 C09CA TELMISARTANUM TELMISARTAN TORRENT 40 mg COMPR. 40mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/ P6L 56 0.694927 0.115251 0.347463 0.462715 0.625434 0.184744
319 C09CA TELMISARTANUM TELMISARTAN ACTAVIS 80mg COMPR. 80 mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 28 COMPR P6L 28 0.914642 0.000000 0.457321 0.457321 0.823177 0.091465
320 C09CA TELMISARTANUM MICARDIS 80 mg COMPR. 80mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 28COMPR. ( BLIST. PA/AL/ P-6 28 1.389855 0.064073 0.694927 0.759001 1.250869 0.203059
321 C09CA TELMISARTANUM TOLURA 80 mg COMPR. 80mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST.OPA-AL-PVC/AL P-6 28 0.861785 0.000000 0.430892 0.430893 0.775606 0.086179
322 C09CA TELMISARTANUM TEZEO 80 mg COMPR. 80mg ZENTIVA, K.S. R CUTIE CU BLIST. OPA-AL-PVC P-6 30 0.788000 0.000000 0.394000 0.394000 0.709200 0.078800
323 C09CA TELMISARTANUM TELMISARTAN TEVA 80 mg COMPR. 80mg TEVA PHARMA B.V. OLANDA CUTIE CU BLIST. AL/AL PERFORATE PENTRU ELIBERAREA UNEI UNITATI DOZATE 30X1 P6L 30 0.976333 0.000000 0.488166 0.488167 0.878699 0.097634

Pagina 27 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
324 C09CA TELMISARTANUM TELMISARTAN RANBAXY 80 mg COMPR. 80mg RANBAXY (U.K.) LIM MA CUTIE CU BLIST. PA-AL-PVC/AL P6L 28 0.976785 0.000000 0.488392 0.488393 0.879106 0.097679
325 C09CA TELMISARTANUM TELMISARTAN TORRENT 80 mg COMPR. 80mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/ P6L 56 0.939464 0.000000 0.469732 0.469732 0.845517 0.093947
326 C09CA TELMISARTANUM TELMARK 40 mg COMPR. FILM 40mg G R CUTIE CU BLIST. AL/AL X 28 COMP P6L 28 0.593214 0.000000 0.296607 0.296607 0.533892 0.059322
327 C09CA TELMISARTANUM TANYDON 40 mg COMPR. FILM 40mg GEDEON RIC ROMANIA CUTIE CU BLIST. AL/AL X 30 COMP P6L 30 0.694927 0.397406 0.347463 0.744870 0.625434 0.466899
328 C09CA TELMISARTANUM TELMISARTAN EGIS 40 mg COMPR. FILM 40mg EGIS PHARMA UNGARIA CUTIE CU BLIST. AL/AL X 28 COMP P6L 28 0.547500 0.000000 0.273750 0.273750 0.492750 0.054750
329 C09CA TELMISARTANUM TELMOTENS 40mg COMPR. FILM 40mg ALVOGEN IPCO S.AR LUXEM CUTIE CU 3 BLIST. N P6L 30 0.694927 0.714073 0.347463 1.061537 0.625434 0.783566
330 C09CA TELMISARTANUM TELMARK 80 mg COMPR. FILM 80mg G R CUTIE CU BLIST. AL/AL X 28 COMP P6L 28 0.914642 0.000000 0.457321 0.457321 0.823177 0.091465
331 C09CA TELMISARTANUM TANYDON 80 mg COMPR. FILM 80mg GEDEON RIC ROMANIA CUTIE CU BLIST. AL/AL X 30 COMP P6L 30 0.976333 0.000000 0.488166 0.488167 0.878699 0.097634
332 C09CA TELMISARTANUM TELMISARTAN EGIS 80 mg COMPR. FILM 80mg EGIS PHARMA UNGARIA CUTIE CU BLIST. AL/AL X 28 COMP P6L 28 0.892500 0.000000 0.446250 0.446250 0.803250 0.089250
333 C09CA TELMISARTANUM TELMOTENS 80mg COMPR. FILM 80mg ALVOGEN IPCO S.AR LUXEM CUTIE CU 3 BLIST. N P6L 30 0.976333 0.000000 0.488166 0.488167 0.878699 0.097634
334 C09DA COMBINATII LORISTA HL 100 mg/12,5 mg COMPR.FILM 100mg/12,5 KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/ P-6 28 0.618571 0.000000 0.309285 0.309286 0.556713 0.061858
335 C09DA COMBINATII LORISTA H COMPR.FILM 50mg+ 12,5 KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. DIN P-6 28 0.455000 0.000000 0.227500 0.227500 0.409500 0.045500
336 C09DA COMBINATII CO - VALSACOR 160 mg/12,5 mg COMPR. FILM 160 mg/12,5 KRKA ,D.D., NOVO SLOVENI CUTIE CU BLIST. PVC P6L 30 0.693963 0.168037 0.346981 0.515019 0.624566 0.237434
337 C09DA COMBINATII CO - VALSACOR 160 mg/25 mg COMPR. FILM 160 mg/25 m KRKA ,D.D., NOVO SLOVENI CUTIE CU BLIST. PV P6L 30 0.693963 0.028703 0.346981 0.375685 0.624566 0.098100
338 C09DA COMBINATII VALSARTAN HIDROCLO COMPR. FILM 160mg/12,5 TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.693963 2.366037 0.346981 2.713019 0.624566 2.435434
339 C09DA COMBINATII CO - VALSACOR 320 mg/12,5 mg COMPR. FILM 320 mg/12,5 KRKA ,D.D., NOVO SLOVENI CUTIE CU BLIST. PV P6L 30 0.693963 0.408370 0.346981 0.755352 0.624566 0.477767
340 C09DA COMBINATII CO - VALSACOR 320 mg/25 mg COMPR. FILM 320 mg/25 m KRKA ,D.D., NOVO SLOVENI CUTIE CU BLIST. PV P6L 30 0.693963 0.413037 0.346981 0.760019 0.624566 0.482434
341 C09DA COMBINATII CO - VALSACOR 80 mg/12,5 mg COMPR. FILM 80 mg/12,5 KRKA ,D.D., NOVO SLOVENI CUTIE CU BLIST. PVC P6L 30 0.489000 0.000000 0.244500 0.244500 0.440100 0.048900
342 C09DA COMBINATII VALSARTAN HIDROCLOROTIA COMPR. FILM 80mg/12,5mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.693963 1.943537 0.346981 2.290519 0.624566 2.012934
343 C09DA COMBINATI COAPROVEL 150mg/12,5mg COMPR. 150mg/12,5 SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL P-6 28 0.693963 0.492465 0.346981 0.839447 0.624566 0.561862
344 C09DA COMBINATI COAPROVEL 300mg/12,5mg COMPR. 300mg/12,5 SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL P-6 28 0.693963 0.756037 0.346981 1.103019 0.624566 0.825434
345 C09DA COMBINATI IRBESARTAN HYDROCH COMPR. FILM 150mg/12,5 SANOFI-AVENTIS FRANTA CUTIE CU BLIST. PVC/PVDC/ P-6 28 0.610714 0.000000 0.305357 0.305357 0.549642 0.061072
346 C09DA COMBINATI IRBESARTAN HYDROCH COMPR. FILM 300mg/12,5 SANOFI-AVENTIS FRANTA CUTIE X 2 BLIST. PVC/PVDC/ P-6 28 0.693963 0.279965 0.346981 0.626947 0.624566 0.349362
347 C09DA COMBINATI IRBESARTAN/ HYDROCHLOR COMPR. FILM 150mg/12,5 TEVA PHARMA B.V. OLANDA CUTIE X BLIST. AL/AL X 28 COMPR. P-6 28 0.659642 0.000000 0.329821 0.329821 0.593677 0.065965
348 C09DA COMBINATI IRBESARTAN HIDROCLORO COMPR. FILM 150mg/12,5 RANBAXY (U.K.) LIM MA CUTIE CU BLIST. OPA-AL-P P6L 28 0.693963 0.077108 0.346981 0.424090 0.624566 0.146505
349 C09DA COMBINATI IRBESARTAN HIDROCLORO COMPR. FILM 150mg/12,5 RANBAXY (U.K.) LIM MA CUTIE CU BLIST. PVC-ACLA P6L 28 0.693963 0.077108 0.346981 0.424090 0.624566 0.146505
350 C09DA COMBINATI COAPROVEL 150mg/12,5mg COMPR. FILM 150mg/12,5 SANOFI CLIR SNC FRANTA CUTIE X 2 BLIST. PVC-PVDC/ P-6 28 0.693963 0.492465 0.346981 0.839447 0.624566 0.561862
351 C09DA COMBINATI CONVERIDE 150 mg/12,5 mg COMPR. FILM 150mg/12,5 MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. O P6L 28 0.693963 0.077108 0.346981 0.424090 0.624566 0.146505
352 C09DA COMBINATI CONVERIDE 150 mg/12,5 mg COMPR. FILM 150mg/12,5 MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.693963 0.077108 0.346981 0.424090 0.624566 0.146505
353 C09DA COMBINATI IRBESARTAN/ HYDROCHLOR COMPR. FILM 300 mg/12,5 TEVA PHARMA B.V. OLANDA CUTIE X BLIST. AL/AL X 28 COMPR. P-6 28 0.693963 0.279965 0.346981 0.626947 0.624566 0.349362
354 C09DA COMBINATI IRBESARTAN HIDROCLORO COMPR. FILM 300mg/12,5 RANBAXY (U.K.) LIM MA CUTIE CU BLIST. OPA-AL-P P6L 28 0.693963 0.279965 0.346981 0.626947 0.624566 0.349362
355 C09DA COMBINATI IRBESARTAN HIDROCLORO COMPR. FILM 300mg/12,5 RANBAXY (U.K.) LIM MA CUTIE CU BLIST. PVC-ACLA P6L 28 0.693963 0.279965 0.346981 0.626947 0.624566 0.349362
356 C09DA COMBINATI COAPROVEL 300mg/12,5mg COMPR. FILM 300mg/12,5 SANOFI CLIR SNC FRANTA CUTIE X 2 BLIST. PVC-PVDC/ P-6 28 0.693963 0.756037 0.346981 1.103019 0.624566 0.825434
357 C09DA COMBINATI CONVERIDE 300 mg/12,5 mg COMPR. FILM 300mg/12,5 MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. O P6L 28 0.693963 0.279965 0.346981 0.626947 0.624566 0.349362
358 C09DA COMBINATI CONVERIDE 300 mg/12,5 mg COMPR. FILM 300mg/12,5 MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.693963 0.279965 0.346981 0.626947 0.624566 0.349362
359 C09DA COMBINATI COAPROVEL 300mg/25mg COMPR. FILM 300mg/25mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 2 BLIST. PVC-PVDC/ P-6 28 0.693963 0.758179 0.346981 1.105161 0.624566 0.827576
360 C09DA COMBINATI IRBESARTAN HIDROCLOR COMPR. FILM 300mg/25mg RANBAXY (U.K.) LIM MA CUTIE CU BLIST. OPA-AL-P P6L 28 0.693963 0.281751 0.346981 0.628733 0.624566 0.351148
361 C09DA COMBINATI IRBESARTAN HIDROCLOR COMPR. FILM 300mg/25mg RANBAXY (U.K.) LIM MA CUTIE CU BLIST. PVC-ACLA P6L 28 0.693963 0.281751 0.346981 0.628733 0.624566 0.351148
362 C09DA COMBINATI COAPROVEL 300mg/25mg COMPR. FILM 300mg/25mg SANOFI CLIR SNC FRANTA CUTIE X 2 BLIST. PVC-PVDC/ P-6 28 0.693963 0.758179 0.346981 1.105161 0.624566 0.827576
363 C09DA COMBINATI CONVERIDE 300 mg/25 mg COMPR. FILM 300mg/25mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. O P6L 28 0.693963 0.281037 0.346981 0.628019 0.624566 0.350434
364 C09DA COMBINATI CONVERIDE 300 mg/25 mg COMPR. FILM 300mg/25mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.693963 0.281037 0.346981 0.628019 0.624566 0.350434
365 C09DA COMBINATII (CANDESARTA CANDESARTAN HIDROCL COMPR. 16mg/12,5mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/AL X 56 COMPR P6L 56 0.641250 0.000000 0.320625 0.320625 0.577125 0.064125
366 C09DA COMBINATII (CANDESARTA CANZENO HCT 16mg/12,5mg COMPR. 16mg/12,5mg ZENTIVA K.S. R CUTIE CU BLIST. PVC/PVDC-AL P6L 30 0.693963 0.041037 0.346981 0.388019 0.624566 0.110434
367 C09DA COMBINATII (CANDESARTA KARBICOMBI 8 mg/12,5 mg COMPR. 8mg/12,5mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIT. PVC-PVDC/AL X P6L 30 0.441333 0.000000 0.220666 0.220667 0.397199 0.044134
368 C09DA COMBINATII (CANDESARTA KARBICOMBI 8 mg/12,5 mg COMPR. 8mg/12,5mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.441333 0.000000 0.220666 0.220667 0.397199 0.044134
369 C09DA COMBINATII (CANDESARTA CANZENO HCT 8mg/12,5mg COMPR. 8mg/12,5mg ZENTIVA K.S. R CUTIE CU BLIST. PVC/PVDC-AL P6L 30 0.441333 0.000000 0.220666 0.220667 0.397199 0.044134
370 C09DA COMBINATI ACTELSAR HCT 80 mg/12,5 mg COMPR. 80 mg/12,5 ACTAVIS GROUP P ISLANDA CUTIE CU BLISTERE DIN AL PRF 28 0.693963 0.400679 0.346981 0.747661 0.624566 0.470076
371 C09DA COMBINATI TOLUCOMBI 80 mg/12,5mg COMPR. 80 mg/12,5m KRKA D.D. SLOVENI CUTIE CU BLIST. DIN PRF 30 0.693963 0.314370 0.346981 0.661352 0.624566 0.383767
372 C09DA COMBINATI TOLUCOMBI 80 mg/25mg COMPR. 80 mg/25mg KRKA D.D. SLOVENI CUTIE CU BLIST. DIN PRF 30 0.693963 0.314370 0.346981 0.661352 0.624566 0.383767
373 C09DA COMBINATI ACTELSAR HCT 80 mg/25mg COMPR. 80 mg/25mg ACTAVIS GROUP P ISLANDA CUTIE CU BLISTERE DIN AL PRF 28 0.693963 0.403894 0.346981 0.750876 0.624566 0.473291
374 C09DA COMBINATI MICARDISPLUS 80/12,5mg COMPR. 80/12,5mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 28COMPR. ( BLIST. PA/AL/ P-6 28 0.693963 0.941037 0.346981 1.288019 0.624566 1.010434
375 C09DA COMBINATI MICARDISPLUS 80/25mg COMPR. 80/25mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X P-6 28 0.693963 0.941037 0.346981 1.288019 0.624566 1.010434
376 C09DA COMBINATI TANYDON HCT 80 mg/12,5 mg COMPR. 80mg/12,5mg GEDEON RIC ROMANIA CUTIE CU BLIST. AL/AL X 30 COMPR P6L 30 0.693963 0.314370 0.346981 0.661352 0.624566 0.383767
377 C09DA COMBINATI TELMISARTAN/HIDROCLOROT COMPR. 80mg/12,5mg EGIS PHARMA UNGARIA CUTIE CU BLIST. AL/AL X 28 COMPR P6L 28 0.693963 0.395679 0.346981 0.742661 0.624566 0.465076
378 C09DA COMBINATI TEZEO HCT 80 mg/12,5 mg COMPR. 80mg/12,5mg ZENTIVA, K.S. R CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.690333 0.000000 0.345166 0.345167 0.621299 0.069034
379 C09DA COMBINATI TELMARK PLUS 80mg/12,5mg COMPR. 80mg/12,5mg G R CUTIE CU BLIST. PVC-AL- P-6 30 0.693963 0.402703 0.346981 0.749685 0.624566 0.472100
380 C09DA COMBINATI TELMISARTAN/HIDROCL COMPR. 80mg/12,5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR P6L 28 0.693963 0.404251 0.346981 0.751233 0.624566 0.473648
381 C09DA COMBINATI TELMISARTAN/HIDROCL COMPR. 80mg/12,5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28X1 CO P6L 28 0.693963 0.404251 0.346981 0.751233 0.624566 0.473648
382 C09DA COMBINATI TANYDON HCT 80 mg/25 mg COMPR. 80mg/25mg GEDEON RIC ROMANIA CUTIE CU BLIST. AL/AL X 30 COMPR P6L 30 0.693963 0.314370 0.346981 0.661352 0.624566 0.383767
383 C09DA COMBINATI TEZEO HCT 80 mg/25 mg COMPR. 80mg/25mg ZENTIVA, K.S. R CUTIE CU BLIST. OPA-AL-PVC P6L 30 0.693963 0.403037 0.346981 0.750019 0.624566 0.472434
384 C09DA COMBINATI TELMARK PLUS 80mg/25mg COMPR. 80mg/25mg G R CUTIE CU BLIST. PVC-AL- P-6 30 0.693963 0.404703 0.346981 0.751685 0.624566 0.474100
385 C09DA COMBINATI TELMISARTAN/HIDROCLORO COMPR. 80mg/25mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR P6L 28 0.693963 0.404251 0.346981 0.751233 0.624566 0.473648
386 C09DA COMBINATI TELMISARTAN/HIDROCLORO COMPR. 80mg/25mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28X1 CO P6L 28 0.693963 0.404251 0.346981 0.751233 0.624566 0.473648
387 C09DB COMBINATII ( VALSARTANUM+ EXFORGE 10mg/160mg COMPR. FILM 10mg/160mg NOVARTIS EURO MA CUTIE X 56 COMPR. FILM. (BLIS P-6 56 3.194642 0.000000 1.597321 1.597321 2.875177 0.319465
388 C09DB COMBINATII ( VALSARTANUM+ EXFORGE 5mg/160mg COMPR. FILM 5mg/160mg NOVARTIS EURO MA CUTIE X 56 COMPR. FILM. (BLIS P-6 56 3.003750 0.000000 1.501875 1.501875 2.703375 0.300375
389 C09DB COMBINATII ( VALSARTANUM+ EXFORGE 5mg/80mg COMPR. FILM 5mg/80mg NOVARTIS EURO MA CUTIE X 56 COMPR. FILM.(BLIST P-6 56 1.669285 1.524643 0.834642 2.359286 1.502356 1.691572

Pagina 28 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
390 C09DB COMBINATII(OLMES SEVIKAR 20 mg/5 mg COMPR. FILM 20mg/5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 1.669285 1.770357 0.834642 2.605000 1.502356 1.937286
391 C09DB COMBINATII(OLMES SEVIKAR 40 mg/10 mg COMPR. FILM 40mg/10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 3.338570 0.431787 1.669285 2.101072 3.004713 0.765644
392 C09DB COMBINATII(OLMES SEVIKAR 40 mg/5 mg COMPR. FILM 40mg/5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 3.004713 0.434929 1.502356 1.937286 2.704241 0.735401
393 C09DX COMBINATII (AMLODIPINA+VA EXFORGE HCT COMPR. FILM 10mg/ NOVARTIS EURO MA CUTIE CU BLIST. DIN PV PRF 28 3.125344 0.243584 1.562672 1.806256 2.812809 0.556119
394 C09DX COMBINATII (AMLODIPINA+VA EXFORGE HCT COMPR. FILM 10mg/1 NOVARTIS EURO MA CUTIE CU BLIST. DIN PV PRF 28 3.339410 0.029518 1.669705 1.699223 3.005469 0.363459
395 C09DX COMBINATII (AMLODIPINA+VA EXFORGE HCT COMPR. FILM 5mg/160 NOVARTIS EURO MA CUTIE CU BLIST. DIN PV PRF 28 3.039719 0.127781 1.519859 1.647641 2.735747 0.431753
396 C09DX COMBINATII (AMLODIPINA+VA EXFORGE HCT COMPR. FILM 5mg/160m NOVARTIS EURO MA CUTIE CU BLIST. DIN PV PRF 28 3.167500 0.000000 1.583750 1.583750 2.850750 0.316750
397 C10AA FLUVASTATINUM LESCOL 20 mg CAPS. 20mg NOVARTIS PHARM GERMANI CUTIE X 4 BLIST. AL/AL X 7 CAPS. P-6 28 0.250593 0.341549 0.125296 0.466846 0.225533 0.366609
398 C10AA FLUVASTATINUM LESCOL 40 mg CAPS. 40mg NOVARTIS PHARM GERMANI CUTIE X 4 BLIST. AL/AL X 7 CAPS. P-6 28 0.501186 0.469528 0.250593 0.720121 0.451067 0.519647
399 C10AA FLUVASTATINUM LESCOL XL 80 mg COMPR. 80mg NOVARTIS PHARM GERMANI CUTIE CU BLIST. AL/ P-6 28 0.967500 0.000000 0.483750 0.483750 0.870750 0.096750
400 C10AA ATORVASTATINUM TORVALIPIN 10 mg COMPR. FILM 10 mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. DIN AL/AL X P-6 30 0.129333 0.000000 0.064666 0.064667 0.116399 0.012934
401 C10AA ATORVASTATINUM SORTIS 10 mg COMPR. FILM 10mg PFIZER EUROPE MA MA CUTIE X 3 BLIST. X 10 COMPR. FILM P-6 30 0.375890 0.711443 0.187945 0.899388 0.338301 0.749032
402 C10AA ATORVASTATINUM ATORIS 10 mg COMPR. FILM 10mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. DIN P-6 30 0.365666 0.000000 0.182833 0.182833 0.329099 0.036567
403 C10AA ATORVASTATINUM GLETOR 10 mg COMPR. FILM 10mg G R CUTIE CU BLIST. OPA-AL-P P-6 30 0.375890 0.130443 0.187945 0.318388 0.338301 0.168032
404 C10AA ATORVASTATINUM ASCORD 10 mg COMPR. FILM 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-A P-6 30 0.375890 0.330776 0.187945 0.518721 0.338301 0.368365
405 C10AA ATORVASTATINUM TORVAZIN 10 mg COMPR. FILM 10mg EGIS PHARMA UNGARIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.375890 0.273443 0.187945 0.461388 0.338301 0.311032
406 C10AA ATORVASTATINUM XAMARA 10 mg COMPR. FILM 10mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.375890 0.330776 0.187945 0.518721 0.338301 0.368365
407 C10AA ATORVASTATINUM ATORVASTATIN RANBAXY 10 mg COMPR. FILM 10mg RANBAXY (U.K.) LIM MA CUTIE CU BLIST. OPA-AL-P P6L 30 0.222333 0.000000 0.111166 0.111167 0.200099 0.022234
408 C10AA ATORVASTATINUM STAVRA 10 mg COMPR. FILM 10mg ALKALOID-INT D.O.O. SLOVENI CUTIE CU BLIST. PV P6L 30 0.375890 0.330776 0.187945 0.518721 0.338301 0.368365
409 C10AA ATORVASTATINUM ATORVASTATINA TORRENT 10 mg COMPR. FILM 10mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 30 0.375890 0.330776 0.187945 0.518721 0.338301 0.368365
410 C10AA ATORVASTATINUM ATORVASTATINA AUROBINDO 10 mg COMPR. FILM 10mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ P6L 30 0.236333 0.000000 0.118166 0.118167 0.212699 0.023634
411 C10AA ATORVASTATINUM TORVALIPIN 20 mg COMPR. FILM 20 mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. DIN AL/AL X P-6 30 0.227000 0.000000 0.113500 0.113500 0.204300 0.022700
412 C10AA ATORVASTATINUM SORTIS 20 mg COMPR. FILM 20mg PFIZER EUROPE MA MA CUTIE X 3 BLIST. X 10 COMPR. FILM P-6 30 0.751780 0.614553 0.375890 0.990443 0.676602 0.689731
413 C10AA ATORVASTATINUM ATORIS 20 mg COMPR. FILM 20mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. DIN P-6 30 0.501333 0.000000 0.250666 0.250667 0.451199 0.050134
414 C10AA ATORVASTATINUM GLETOR 20 mg COMPR. FILM 20mg G R CUTIE CU BLIST. OPA-AL-P P-6 30 0.404333 0.000000 0.202166 0.202167 0.363899 0.040434
415 C10AA ATORVASTATINUM ASCORD 20 mg COMPR. FILM 20mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-A P-6 30 0.751780 0.165886 0.375890 0.541776 0.676602 0.241064
416 C10AA ATORVASTATINUM TORVAZIN 20 mg COMPR. FILM 20mg EGIS PHARMA UNGARIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.334000 0.000000 0.167000 0.167000 0.300600 0.033400
417 C10AA ATORVASTATINUM XAMARA 20 mg COMPR. FILM 20mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.751780 0.165886 0.375890 0.541776 0.676602 0.241064
418 C10AA ATORVASTATINUM ATORVASTATIN RANBAXY 20 mg COMPR. FILM 20mg RANBAXY (U.K.) LIM MA CUTIE CU BLIST. OPA-AL-P P6L 30 0.267000 0.000000 0.133500 0.133500 0.240300 0.026700
419 C10AA ATORVASTATINUM STAVRA 20 mg COMPR. FILM 20mg ALKALOID-INT D.O.O. SLOVENI CUTIE CU BLIST. PV P6L 30 0.751780 0.165886 0.375890 0.541776 0.676602 0.241064
420 C10AA ATORVASTATINUM ATORVASTATINA TORRENT 20 mg COMPR. FILM 20mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 30 0.751780 0.165886 0.375890 0.541776 0.676602 0.241064
421 C10AA ATORVASTATINUM ATORVASTATINA AUROBINDO 20 mg COMPR. FILM 20mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ P6L 30 0.278333 0.000000 0.139166 0.139167 0.250499 0.027834
422 C10AA ATORVASTATINUM ATORIS 30 mg COMPR. FILM 30mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 30 0.608000 0.000000 0.304000 0.304000 0.547200 0.060800
423 C10AA ATORVASTATINUM TORVALIPIN 40 mg COMPR. FILM 40 mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. DIN AL/AL X P-6 30 0.531000 0.000000 0.265500 0.265500 0.477900 0.053100
424 C10AA ATORVASTATINUM SORTIS 40 mg COMPR. FILM 40mg PFIZER EUROPE MA MA CUTIE X 2 BLIST. X 7 COMPR. FILM. P-6 14 1.503561 0.192153 0.751780 0.943934 1.353204 0.342510
425 C10AA ATORVASTATINUM ATORIS 40 mg COMPR. FILM 40mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. DIN P-6 14 1.102857 0.000000 0.551428 0.551429 0.992571 0.110286
426 C10AA ATORVASTATINUM ATORIS 40 mg COMPR. FILM 40mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. DIN P-6 30 0.647000 0.000000 0.323500 0.323500 0.582300 0.064700
427 C10AA ATORVASTATINUM GLETOR 40 mg COMPR. FILM 40mg G R CUTIE CU BLIST. OPA-AL-P P-6 30 0.514666 0.000000 0.257333 0.257333 0.463199 0.051467
428 C10AA ATORVASTATINUM ASCORD 40 mg COMPR. FILM 40mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-A P-6 30 1.102666 0.000000 0.551333 0.551333 0.992399 0.110267
429 C10AA ATORVASTATINUM TORVAZIN 40 mg COMPR. FILM 40mg EGIS PHARMA UNGARIA CUTIE CU BLIST. OPA-AL-P P-6 30 1.102666 0.000000 0.551333 0.551333 0.992399 0.110267
430 C10AA ATORVASTATINUM ATORVASTATIN RANBAXY 40 mg COMPR. FILM 40mg RANBAXY (U.K.) LIM MA CUTIE CU BLIST. OPA-AL-P P6L 30 1.053000 0.000000 0.526500 0.526500 0.947700 0.105300
431 C10AA ATORVASTATINUM STAVRA 40 mg COMPR. FILM 40mg ALKALOID-INT D.O.O. SLOVENI CUTIE CU BLIST. PV P6L 30 1.102666 0.000000 0.551333 0.551333 0.992399 0.110267
432 C10AA ATORVASTATINUM ATORVASTATINA TORRENT 40 mg COMPR. FILM 40mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 30 1.102666 0.000000 0.551333 0.551333 0.992399 0.110267
433 C10AA ATORVASTATINUM ATORVASTATINA AUROBINDO 40 mg COMPR. FILM 40mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ P6L 30 0.478666 0.000000 0.239333 0.239333 0.430799 0.047867
434 C10AA ATORVASTATINUM ATORIS 60 mg COMPR. FILM 60mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 30 1.001666 0.000000 0.500833 0.500833 0.901499 0.100167
435 C10AA ATORVASTATINUM SORTIS 80 mg COMPR. FILM 80mg PFIZER EUROPE MA MA CUTIE X 2 BLIST. X 7 COMPR. FILM. P-6 14 1.677142 0.000000 0.838571 0.838571 1.509427 0.167715
436 C10AA ATORVASTATINUM ASCORD 80 mg COMPR. FILM 80mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-A P-6 30 1.090333 0.000000 0.545166 0.545167 0.981299 0.109034
437 C10AA ATORVASTATINUM ATORIS 80 mg COMPR. FILM 80mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 30 1.017333 0.000000 0.508666 0.508667 0.915599 0.101734
438 C10AA ATORVASTATINUM ATORVASTATIN RANBAXY 80 mg COMPR. FILM 80mg RANBAXY (U.K.) LIM MA CUTIE CU BLIST. OPA-AL-P P6L 30 1.090333 0.000000 0.545166 0.545167 0.981299 0.109034
439 C10AA ATORVASTATINUM STAVRA 80 mg COMPR. FILM 80mg ALKALOID-INT D.O.O. SLOVENI CUTIE CU BLIST. PV P6L 30 1.090333 0.000000 0.545166 0.545167 0.981299 0.109034
440 C10AA ATORVASTATINUM ATORVASTATINA TORRENT 80 mg COMPR. FILM 80mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 30 1.090333 0.000000 0.545166 0.545167 0.981299 0.109034
441 C10AA ATORVASTATINUM ATORVASTATINA AUROBINDO 80 mg COMPR. FILM 80mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ P6L 30 0.768000 0.000000 0.384000 0.384000 0.691200 0.076800
442 C10AA ROSUVASTATINUM ROSUVASTATINA RATIOPHARM 10 mg COMPR. FILM 10 mg RATIOPHARM GMBH GERMANI CUTIE CU BLIST. DIN P-6 30 0.711000 0.000000 0.355500 0.355500 0.639900 0.071100
443 C10AA ROSUVASTATINUM CRESTOR 10 mg COMPR. FILM 10mg ASTRAZENECA UK MA CUTIE X 2 BLIST. X 14 COMPR. FILM P-6 28 0.751780 2.574648 0.375890 2.950538 0.676602 2.649826
444 C10AA ROSUVASTATINUM ROSUCARD 10 mg COMPR. FILM 10mg ZENTIVA K.S. R CUTIE CU BLIST. OPA-AL-P P-6 30 0.751780 0.081220 0.375890 0.457110 0.676602 0.156398
445 C10AA ROSUVASTATINUM ROSUVASTATINA TEVA 10 mg COMPR. FILM 10mg TEVA PHARM ROMANIA CUTIE CU B P-6 30 0.577666 0.000000 0.288833 0.288833 0.519899 0.057767
446 C10AA ROSUVASTATINUM ROXARDIO 10 mg COMPR. FILM 10mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 28 0.311071 0.000000 0.155535 0.155536 0.279963 0.031108
447 C10AA ROSUVASTATINUM ROSWERA 10 mg COMPR. FILM 10mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 30 0.629333 0.000000 0.314666 0.314667 0.566399 0.062934
448 C10AA ROSUVASTATINUM ROSTAT 10 mg COMPR. FILM 10mg GEDEON RIC ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.751780 0.002220 0.375890 0.378110 0.676602 0.077398
449 C10AA ROSUVASTATINUM TINTAROS 10 mg COMPR. FILM 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PA/AL/PVC- P6L 28 0.680714 0.000000 0.340357 0.340357 0.612642 0.068072
450 C10AA ROSUVASTATINUM ROSUVASTATINA TERAPIA 10 mg COMPR. FILM 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.751780 0.490005 0.375890 0.865895 0.676602 0.565183
451 C10AA ROSUVASTATINUM ROSUVASTATINA TERAPIA 10 mg COMPR. FILM 10mg TERAPIA SA ROMANIA CUT P6L 28 0.751780 0.490005 0.375890 0.865895 0.676602 0.565183
452 C10AA ROSUVASTATINUM ROSUVASTATINA AUROBINDO 10 mg COMPR. FILM 10mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ PRF 30 0.751780 0.453886 0.375890 0.829776 0.676602 0.529064
453 C10AA ROSUVASTATINUM ROVASTAMED 10mg COMPR. FILM 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. DIN P6L 28 0.711071 0.000000 0.355535 0.355536 0.639963 0.071108
454 C10AA ROSUVASTATINUM STARCREST 10 mg COMPR. FILM 10mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PA-AL-PVC/ P-6 28 0.688928 0.000000 0.344464 0.344464 0.620035 0.068893
455 C10AA ROSUVASTATINUM ROZUCOR 10 mg COMPR. FILM 10mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 30 0.751780 0.813886 0.375890 1.189776 0.676602 0.889064

Pagina 29 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
456 C10AA ROSUVASTATINUM ROSUVASTATINA ATB 10 mg COMPR. FILM 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. P6L 30 0.751780 0.095553 0.375890 0.471443 0.676602 0.170731
457 C10AA ROSUVASTATINUM ROSUVASTATINA RATIOPHARM 20 mg COMPR. FILM 20 mg RATIOPHARM GMBH GERMANI CUTIE CU BLIST. DIN P-6 30 1.094000 0.000000 0.547000 0.547000 0.984600 0.109400
458 C10AA ROSUVASTATINUM CRESTOR 20 mg COMPR. FILM 20mg ASTRAZENECA UK MA CUTIE X 2 BLIST. X 14 COMPR. FILM P-6 28 1.503561 3.361439 0.751780 4.113220 1.353204 3.511796
459 C10AA ROSUVASTATINUM ROSUCARD 20 mg COMPR. FILM 20mg ZENTIVA K.S. R CUTIE CU BLIST. OPA-AL-P P-6 30 0.907666 0.000000 0.453833 0.453833 0.816899 0.090767
460 C10AA ROSUVASTATINUM ROSUVASTATINA TEVA 20 mg COMPR. FILM 20mg TEVA PHARM ROMANIA CUTIE CU B P-6 30 0.907666 0.000000 0.453833 0.453833 0.816899 0.090767
461 C10AA ROSUVASTATINUM ROXARDIO 20 mg COMPR. FILM 20mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 28 0.621428 0.000000 0.310714 0.310714 0.559285 0.062143
462 C10AA ROSUVASTATINUM ROSWERA 20 mg COMPR. FILM 20mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 30 0.930666 0.000000 0.465333 0.465333 0.837599 0.093067
463 C10AA ROSUVASTATINUM ROSTAT 20 mg COMPR. FILM 20mg GEDEON RIC ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 1.109333 0.000000 0.554666 0.554667 0.998399 0.110934
464 C10AA ROSUVASTATINUM TINTAROS 20 mg COMPR. FILM 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PA/AL/PVC- P6L 28 0.907500 0.000000 0.453750 0.453750 0.816750 0.090750
465 C10AA ROSUVASTATINUM ROSUVASTATINA LABORMED 20 mg COMPR. FILM 20mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PA-AL-PVC/ P-6 28 0.664642 0.000000 0.332321 0.332321 0.598177 0.066465
466 C10AA ROSUVASTATINUM ROSUVASTATINA TERAPIA 20 mg COMPR. FILM 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 1.503561 0.281081 0.751780 1.032862 1.353204 0.431438
467 C10AA ROSUVASTATINUM ROSUVASTATINA TERAPIA 20 mg COMPR. FILM 20mg TERAPIA SA ROMANIA CUT P6L 28 1.503561 0.281081 0.751780 1.032862 1.353204 0.431438
468 C10AA ROSUVASTATINUM ROSUVASTATINA AUROBINDO 20 mg COMPR. FILM 20mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ PRF 30 1.503561 0.281439 0.751780 1.033220 1.353204 0.431796
469 C10AA ROSUVASTATINUM ROVASTAMED 20mg COMPR. FILM 20mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. DIN P6L 28 1.093928 0.000000 0.546964 0.546964 0.984535 0.109393
470 C10AA ROSUVASTATINUM STARCREST 20 mg COMPR. FILM 20mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PA-AL-PVC/ P-6 28 0.689642 0.000000 0.344821 0.344821 0.620677 0.068965
471 C10AA ROSUVASTATINUM ROZUCOR 20 mg COMPR. FILM 20mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 30 1.503561 0.509439 0.751780 1.261220 1.353204 0.659796
472 C10AA ROSUVASTATINUM ROSUVASTATINA ATB 20 mg COMPR. FILM 20mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. P6L 30 1.001666 0.000000 0.500833 0.500833 0.901499 0.100167
473 C10AA ROSUVASTATINUM ROSUCARD 40 mg COMPR. FILM 40mg ZENTIVA K.S. R CUTIE CU BLIST. OPA-AL-P P-6 30 1.748666 0.000000 0.874333 0.874333 1.573799 0.174867
474 C10AA ROSUVASTATINUM ROSWERA 40 mg COMPR. FILM 40mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 30 1.522333 0.000000 0.761166 0.761167 1.370099 0.152234
475 C10AA ROSUVASTATINUM ROSTAT 40 mg COMPR. FILM 40mg GEDEON RIC ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 1.096000 0.000000 0.548000 0.548000 0.986400 0.109600
476 C10AA ROSUVASTATINUM TINTAROS 40 mg COMPR. FILM 40mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PA/AL/PVC- P6L 28 1.746785 0.000000 0.873392 0.873393 1.572106 0.174679
477 C10AA ROSUVASTATINUM ROSUVASTATINA TERAPIA 40 mg COMPR. FILM 40mg TERAPIA SA ROMANIA CUT P6L 28 2.784285 0.000000 1.392142 1.392143 2.505856 0.278429
478 C10AA ROSUVASTATINUM ROSUVASTATINA TERAPIA 40 mg COMPR. FILM 40mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 2.784285 0.000000 1.392142 1.392143 2.505856 0.278429
479 C10AA ROSUVASTATINUM ROSUVASTATINA AUROBINDO 40 mg COMPR. FILM 40mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ PRF 30 2.499000 0.000000 1.249500 1.249500 2.249100 0.249900
480 C10AA ROSUVASTATINUM ROVASTAMED 40mg COMPR. FILM 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. DIN P6L 28 1.640357 0.000000 0.820178 0.820179 1.476321 0.164036
481 C10AA ROSUVASTATINUM STARCREST 40 mg COMPR. FILM 40mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PA-AL-PVC/ P-6 28 1.335000 0.000000 0.667500 0.667500 1.201500 0.133500
482 C10AA ROSUVASTATINUM ROZUCOR 40 mg COMPR. FILM 40mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 30 2.620000 0.000000 1.310000 1.310000 2.358000 0.262000
483 C10AA ROSUVASTATINUM ROSUVASTATINA ATB 40 mg COMPR. FILM 40mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. P6L 30 2.498000 0.000000 1.249000 1.249000 2.248200 0.249800
484 C10AA ROSUVASTATINUM CRESTOR 5 mg COMPR. FILM 5mg ASTRAZENECA UK MA CUTIE X 2 BLIST. AL/AL X 14 COMP P-6 28 0.375890 2.260181 0.187945 2.448126 0.338301 2.297770
485 C10AA ROSUVASTATINUM ROXARDIO 5 mg COMPR. FILM 5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 28 0.375890 0.827681 0.187945 1.015626 0.338301 0.865270
486 C10AA ROSUVASTATINUM ROSWERA 5 mg COMPR. FILM 5mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 30 0.327333 0.000000 0.163666 0.163667 0.294599 0.032734
487 C10AA ROSUVASTATINUM ROSTAT 5 mg COMPR. FILM 5mg GEDEON RIC ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.375890 0.396443 0.187945 0.584388 0.338301 0.434032
488 C10AA ROSUVASTATINUM TINTAROS 5 mg COMPR. FILM 5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PA/AL/PVC- P6L 28 0.375890 0.007681 0.187945 0.195626 0.338301 0.045270
489 C10AA ROSUVASTATINUM ROSUVASTATINA TERAPIA 5 mg COMPR. FILM 5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.375890 1.428395 0.187945 1.616340 0.338301 1.465984
490 C10AA ROSUVASTATINUM ROSUVASTATINA TERAPIA 5 mg COMPR. FILM 5mg TERAPIA SA ROMANIA CUT P6L 28 0.375890 1.428395 0.187945 1.616340 0.338301 1.465984
491 C10AA ROSUVASTATINUM ROSUVASTATINA AUROBINDO 5 mg COMPR. FILM 5mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ PRF 30 0.375890 0.651776 0.187945 0.839721 0.338301 0.689365
492 C10AA ROSUVASTATINUM ROVASTAMED 5mg COMPR. FILM 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. DIN P6L 28 0.375890 0.650538 0.187945 0.838483 0.338301 0.688127
493 C10AA ROSUVASTATINUM STARCREST 5 mg COMPR. FILM 5mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PA-AL-PVC/ P-6 28 0.375890 0.312681 0.187945 0.500626 0.338301 0.350270
494 C10AA ROSUVASTATINUM ROZUCOR 5 mg COMPR. FILM 5mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 30 0.375890 1.040776 0.187945 1.228721 0.338301 1.078365
495 C10AA ROSUVASTATINUM ROSUVASTATINA ATB 5 mg COMPR. FILM 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. P6L 30 0.375890 0.394443 0.187945 0.582388 0.338301 0.432032
496 C10AB BEZAFIBRATUM BEZAFIBRAT SLAVIA 200 mg COMPR. 200mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COM P-6 20 0.381500 0.000000 0.190750 0.190750 0.343350 0.038150
497 C10AB BEZAFIBRATUM BEZAFIBRAT ARENA 200 mg COMPR. 200mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. DIN PVC/AL X 1 P-6 20 0.383500 0.000000 0.191750 0.191750 0.345150 0.038350
498 C10AB BEZAFIBRATUM BEZAFIBRAT FARMEX 200 mg COMPR. 200mg FARMEX COMPANY S ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 P-6 20 0.370000 0.000000 0.185000 0.185000 0.333000 0.037000
499 C10AX EZETIMIBUM EZETROL (R) COMPR. 10mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. PCTFE/PVC/AL P-R 28 4.156410 1.283232 2.078205 3.361437 3.740769 1.698873
500 C10AX EZETIMIBUM COLTOWAN 10 mg COMPR. 10mg GEDEON RIC ROMANIA CUTIE CU BLIST. PVC PRF 30 3.728666 0.000000 1.864333 1.864333 3.355799 0.372867
501 C10BX COMBINATII (ATORVASTATI CADUET 10mg/10mg COMPR. FILM 10mg/10mg PFIZER EUROPE MA MA CUTIE X 3 BLIST. PA- P-6 30 0.571332 0.465001 0.285666 0.750667 0.514198 0.522135
502 C10BX COMBINATII (ATORVASTATI DUPLECOR 10 mg/10 mg COMPR. FILM 10mg/10mg GEDEON RIC ROMANIA C P6L 30 0.571332 0.102668 0.285666 0.388334 0.514198 0.159802
503 C10BX COMBINATII (ATORVASTATI ATORDAPIN 10 mg/10 mg COMPR. FILM 10mg/10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 30 0.571332 0.102668 0.285666 0.388334 0.514198 0.159802
504 C10BX COMBINATII (ATORVASTATI TORVALIPIN PLUS 10 mg/10 mg COMPR. FILM 10mg/10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. OPA-AL-P P6L 30 0.571332 0.068001 0.285666 0.353667 0.514198 0.125135
505 C10BX COMBINATII (ATORVASTATI CADUET 10mg/5mg COMPR. FILM 10mg/5mg PFIZER EUROPE MA MA CUTIE X 3 BLIST. PA- P-6 30 0.571332 0.272668 0.285666 0.558334 0.514198 0.329802
506 C10BX COMBINATII (ATORVASTATI DUPLECOR 10 mg/5 mg COMPR. FILM 10mg/5mg GEDEON RIC ROMANIA C P6L 30 0.548666 0.000000 0.274333 0.274333 0.493799 0.054867
507 C10BX COMBINATII (ATORVASTATI TORVALIPIN PLUS 5mg/10mg COMPR. FILM 10mg/5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. OPA-AL-P P6L 30 0.548666 0.000000 0.274333 0.274333 0.493799 0.054867
508 C10BX COMBINATII (ATORVASTATI ATORDAPIN 10mg/5mg COMPR. FILM 10mg/5mg KRKA, D.D., NOVO SLOVENI CUTIE X BL P6L 30 0.548666 0.000000 0.274333 0.274333 0.493799 0.054867
509 C10BX COMBINATII (ATORVASTATI DUPLECOR 20 mg/10 mg COMPR. FILM 20mg/10mg GEDEON RIC ROMANIA C P6L 30 0.571332 0.587668 0.285666 0.873334 0.514198 0.644802
510 C10BX COMBINATII (ATORVASTATI DUPLECOR 20 mg/5 mg COMPR. FILM 20mg/5mg GEDEON RIC ROMANIA C P6L 30 0.571332 0.327334 0.285666 0.613000 0.514198 0.384468
511 D01BA TERBINAFINUM LAMISIL (R) COMPR. 250mg NOVARTIS PHARM GERMANI CUTIE X 1 BLIST. X 14 COMPR. P-R 14 1.267321 1.170536 0.633660 1.804197 1.140588 1.297269
512 D01BA TERBINAFINUM TERBINARAN COMPR. 250mg RANBAXY UK LIMITE MA CUTIE X 3 BLIST. AL/PVDC-PVC P-R 30 1.267321 0.317345 0.633660 0.951006 1.140588 0.444078
513 D01BA TERBINAFINUM TERBINARAN COMPR. 250mg RANBAXY UK LIMITE MA CUTIE X 4 BLIST. AL/PVDC-PVC P-R 28 1.267321 0.317679 0.633660 0.951340 1.140588 0.444412
514 D01BA TERBINAFINUM TERBINAFINE 250 mg COMPR. 250mg ACTAVIS GROUP HF ISLANDA CUTIE X 2 BLIST. PVC-PVDC/AL P-R 28 0.712142 0.000000 0.356071 0.356071 0.640927 0.071215
515 D01BA TERBINAFINUM TERBINAFINA SLAVIA 250mg COMPR. 250mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 7 COMP P-R 14 1.267321 0.081964 0.633660 0.715625 1.140588 0.208697
516 D01BA TERBINAFINUM TERBISIL 250 mg COMPR. 250mg GEDEON RIC ROMANIA CUTIE CU 2 BLIST. PVC/AL X 14 P-R 28 1.267321 0.317679 0.633660 0.951340 1.140588 0.444412
517 D01BA TERBINAFINUM TERBINAFINA ARENA 250 mg COMPR. 250mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COM P-R 28 1.185357 0.000000 0.592678 0.592679 1.066821 0.118536
518 D05AX COMBINATII (CALC DAIVOBET 50 micrograme/0,5 mg/g GEL 50mi LEO PHARMA A/S DANEM CUTIE CU 1 FLAC. PEID CU DUZA DIN PEJD SI CAPAC DIN PEID X 15 G GEL PRF 1 53.860000 0.000000 26.930000 26.930000 48.474000 5.386000
519 D05AX COMBINATII (CALC DAIVOBET 50 micrograme/0,5mg/g UNGUENT 50mi LEO PH DANEM CUTIE CU 1 TUB DIN A P-R 1 53.945000 0.255000 26.972500 27.227500 48.550500 5.649500
520 D05BB ACITRETINUM** NEOTIGASON 10 mg CAPS. 10mg ACTAVIS GROUP P ISLANDA CUTIE X 3 BLIST. AL/PVC-PVDC X P-R 30 1.581666 0.000000 0.790833 0.790833 1.423499 0.158167
521 D06AX ACIDUM FUSIDICUM FUCIDIN 20 mg/g CREMA 20mg/g LEO PHARMA A/S DANEM CUTIE X 1 TUB DIN AL X 15 G CREM P-R 1 11.170000 0.000000 5.585000 5.585000 10.053000 1.117000

Pagina 30 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
522 D06AX ACIDUM FUSIDICUM FUCIDIN 20 mg/g UNGUENT 20mg/g LEO PHARMA A/S DANEM CUTIE X 1 TUB DIN AL X 15 G UNG P-R 1 11.170000 0.000000 5.585000 5.585000 10.053000 1.117000
523 D06BA SULFADIAZINUM FLAMMAZINE CREMA 1% CN UNIFARM ROMANIA BORCAN X 500 G CREMA PRF 1 100.400000 0.000000 50.200000 50.200000 90.360000 10.040000
524 D06BB PODOPHYLLOTOXINUM* WARTEC 1,5 mg/g CREMA 1,5 mg/g GLAXOSMITHKL ROMANIA CUTIE X 1 TUB X 5 G CREMA P-R 1 44.916785 33.423215 22.458392 55.881608 40.425106 37.914894
525 D06BB PODOPHYLLOTOXINUM* CONDYLINE SOL. CUT. 5mg/ml ASTELLAS P OLANDA CUTIE X 1 FLACON DIN STICLA BRUNA X 3,5 ML SOL. CUTANATA + 15 DISPOZITIVE DE APLICARE P-R 1 78.810000 0.000000 39.405000 39.405000 70.929000 7.881000
526 D06BB IMIQUIMODUM* ALDARA 5% CREMA 5% MEDA AB SUEDIA CUTIE X 12 PLICURI P-R 12 21.387500 0.000000 10.693750 10.693750 19.248750 2.138750
527 D07AB HYDROCORTISONUM BUTYRATUM LOCOID (R) crema 0,1% CREMA 0,1% ASTELLAS P OLANDA CUTIE X 1 TUB DIN AL X 30 G P-R 1 11.799999 0.220001 5.899999 6.120001 10.619999 1.400001
528 D07AB HYDROCORTISONUM BUTYRATUM LOCOID (R) LIPOCREAM 0,1% CREMA 0,1% ASTELLAS P OLANDA CUTIE X 1 TUB DIN AL X 30 G P-R 1 11.799999 0.190001 5.899999 6.090001 10.619999 1.370001
529 D07AB HYDROCORTISONUM BUTYRATUM LOCOID CRELO (R) 0,1% EMULSIE CUT 0.1% ASTELLAS P OLANDA CUTIE X 1 FLACON X 30 G P-R 1 11.799999 1.000001 5.899999 6.900001 10.619999 2.180001
530 D07AB HYDROCORTISONUM BUTYRATUM LOCOID (R) SOL. CUT. 0,1% ASTELLAS P OLANDA CUTIE X 1 FLACON PICURATOR P-R 1 11.230000 0.000000 5.615000 5.615000 10.107000 1.123000
531 D07AC MOMETASONUM ELOCOM CREMA 1mg/g MERCK SHARP & ROMANIA CUTIE X 1 TUB DIN AL X 15 G P-R 1 3.530000 1.910000 1.765000 3.675000 3.177000 2.263000
532 D07AC MOMETASONUM MOMETAZONA ATB 1 mg/g CREMA 1mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 15 G UNG P6L 1 3.530000 0.000000 1.765000 1.765000 3.177000 0.353000
533 D07AC MOMETASONUM ELOCOM UNGUENT 1mg/g MERCK SHARP & ROMANIA CUTIE X 1 TUB DIN AL X 15 G P-R 1 3.530000 1.910000 1.765000 3.675000 3.177000 2.263000
534 D07AC MOMETASONUM MOMETAZONA ATB 1 mg/g UNGUENT 1mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 15 G UNG P6L 1 3.530000 0.000000 1.765000 1.765000 3.177000 0.353000
535 D07AC METHYLPREDNISOLONUM ACEP ADVANTAN 1mg/g crema CREMA 1mg/g INTENDIS GMBH GERMANI CUTIE X 1 TUB DIN AL X 30 G CREM P-R 1 21.195000 3.875000 10.597500 14.472500 19.075500 5.994500
536 D07AC METHYLPREDNISOLONUM ACEP ADVANTAN 1mg/g crema CREMA 1mg/g BAYER PHARMA AG GERMANI CUTIE X 1 TUB DIN AL X 30 G CREM P-R 1 21.195000 3.875000 10.597500 14.472500 19.075500 5.994500
537 D07AC METHYLPREDNISOLONUM ACEP ADVANTAN 1mg/g crema CREMA 1mg/g BAYER PHARMA AG GERMANI CUTIE CU 1 TUB DIN AL X 50 G CR P-R 1 35.325000 0.595000 17.662500 18.257500 31.792500 4.127500
538 D07AC METHYLPREDNISOLONUM ACEP ADVANTAN MILK 1mg/g EMULSIE CUT 1mg/g INTENDIS GMBH GERMANI CUTIE X 1 TUB X 50 G P-R 1 33.540000 0.000000 16.770000 16.770000 30.186000 3.354000
539 D07AC METHYLPREDNISOLONUM ACEP ADVANTAN MILK 1mg/g EMULSIE CUT 1mg/g BAYER PHARMA AG GERMANI CUTIE CU 1 TUB DE AL VERNISAT CU UN STRAT INTERIOR DIN PE X 50 G EMULSIE CUTANATA PRF 1 33.540000 0.000000 16.770000 16.770000 30.186000 3.354000
540 D07AC METHYLPREDNISOLONUM ACEP ADVANTAN 1mg/g unguent UNGUENT 1mg/g INTENDIS GMBH GERMANI CUTIE X 1 TUB DIN AL X 30 G UNG P-R 1 21.195000 3.875000 10.597500 14.472500 19.075500 5.994500
541 D07AC METHYLPREDNISOLONUM ACEP ADVANTAN 1 mg/g unguent UNGUENT 1mg/g BAYER PHARMA AG GERMANI CUTIE X 1 TUB DIN AL X 30 G UNG P-R 1 21.195000 3.875000 10.597500 14.472500 19.075500 5.994500
542 D07AC METHYLPREDNISOLONUM ACEP ADVANTAN 1 mg/g unguent UNGUENT 1mg/g BAYER PHARMA AG GERMANI CUTIE CU 1 TUB DIN AL X 50 G U P-R 1 35.325000 0.595000 17.662500 18.257500 31.792500 4.127500
543 D07AC FLUTICASONUM PROPIONAT CUTIVATE CREMA 0,05% GLAXO WELLC MA CUTIE X 1 TUB DIN AL X 15 G CREM P-R 1 10.080000 0.000000 5.040000 5.040000 9.072000 1.008000
544 D07AC FLUTICASONUM PROPIONAT CUTIVATE UNGUENT 0,005% GLAXO WELLC MA CUTIE X 1 TUB DIN AL X 15 G UNG P-R 1 10.080000 0.000000 5.040000 5.040000 9.072000 1.008000
545 D07AD CLOBETASOLUM* DERMOVATE 0,5 mg/g CREMA 0,5mg/g GLAXO WELLCOME MA CUTIE CU 1 TUB AL X 25 G CREMA P-R 1 5.860000 6.610000 2.930000 9.540000 5.274000 7.196000
546 D07AD CLOBETASOLUM* DERMOVATE (R) SOL. CUT. 0,05% GLAXO WELLCOME MA CUTIE X 1 FLACON CU PICU P-R 1 5.410000 0.000000 2.705000 2.705000 4.869000 0.541000
547 D07AD CLOBETASOLUM* DERMOVATE 0,5 mg/g UNGUENT 0,5mg/g GLAXO WELLCOME MA CUTIE CU 1 TUB AL X 25 G UNGUE P-R 1 5.860000 3.380000 2.930000 6.310000 5.274000 3.966000
548 D07AD CLOBETASOLUM* CLOBETAZOL ATB 0,5 mg/g UNGUENT 0,5mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 25 G U PRF 1 5.860000 0.150000 2.930000 3.080000 5.274000 0.736000
549 D07CA COMBINATII FUCIDIN H CREMA 20mg/g+10m LEO PHARMA A/S DANEM CUTIE X 1 TUB DIN AL X 15 G CREM P-R 1 21.030000 0.000000 10.515000 10.515000 18.927000 2.103000
550 D07CC COMBINATII (A FUCICORT 20 mg/1mg pe gram CREMA 20mg/1mg LEO PHARMA A/S DANEM CUTIE X 1 TUB DIN AL X 15 G CREM P-R 1 15.445000 6.815000 7.722500 14.537500 13.900500 8.359500
551 D07XC COMBINATII (MOMETASONU ELOSALIC 1mg+5mg/gram UNGUENT 1mg+50mg/ MERCK SHARP & ROMANIA CUTIE X 1 TUB DIN AL X 15 G P-R 1 16.387500 0.402500 8.193750 8.596250 14.748750 2.041250
552 D07XC COMBINATII (MOMETASONU ELOSALIC 1mg+5mg/gram UNGUENT 1mg+50mg/ MERCK SHARP & ROMANIA CUTIE X 1 TUB DIN AL X 45 G P-R 1 48.760000 0.000000 24.380000 24.380000 43.884000 4.876000
553 D10AD COMBINATII (ISOTRET ISOTREXIN GEL GEL 0,05%/0,2% STIEFEL LABOR MA CUTIE X 1 TUB DIN AL X 30 G GEL P-R 1 37.580000 0.000000 18.790000 18.790000 33.822000 3.758000
554 D10AD COMBINATII (ISOTRET ISOTREXIN GEL GEL 0.5mg/g+20 GLAXOSMITHKL ROMANIA CUTIE X 1 TUB DIN AL X 30 G GEL P-R 1 37.580000 0.000000 18.790000 18.790000 33.822000 3.758000
555 D10AX ACIDUM AZELAICUM SKINOREN CREMA 200mg/g INTENDIS GMBH GERMANI CUTIE X 1 TUB DIN AL X 30 G CREM P-R 1 30.710000 0.000000 15.355000 15.355000 27.639000 3.071000
556 D10AX ACIDUM AZELAICUM SKINOREN CREMA 200mg/g BAYER PHARMA AG GERMANI CUTIE X 1 TUB DIN AL X 30 G CREM P-R 1 30.710000 0.000000 15.355000 15.355000 27.639000 3.071000
557 D10AX ACIDUM AZELAICUM SKINOREN 150mg/g GEL 150mg/g INTENDIS GMBH GERMANI CUTIE X 1 TUB AL X 50 G GEL P-R 1 38.387500 10.062500 19.193750 29.256250 34.548750 13.901250
558 D10AX ACIDUM AZELAICUM SKINOREN 150mg/g GEL 150mg/g BAYER PHARMA AG GERMANI CUTIE X 1 TUB AL X 50 G GEL P-R 1 38.387500 10.062500 19.193750 29.256250 34.548750 13.901250
559 D10BA ISOTRETINOINUM** ROACCUTANE 10 mg CAPS. MOI 10mg ROCHE ROMANIA SR ROMANIA CUTIE X 3 BLIST. PVC-PE-PV P-R 30 1.070583 0.518083 0.535291 1.053375 0.963524 0.625142
560 D10BA ISOTRETINOINUM** SOTRET 10 mg CAPS. MOI 10mg TERAPIA S.A. ROMANIA CUTIE X 3 BL P-R 30 1.066666 0.000000 0.533333 0.533333 0.959999 0.106667
561 D10BA ISOTRETINOINUM** SOTRET 20 mg CAPS. MOI 20mg TERAPIA S.A. ROMANIA CUTIE X 3 BL P-R 30 2.141166 0.007834 1.070583 1.078417 1.927049 0.221951
562 G01AA COMBINATII MACMIROR COMPLEX CAPS. MOI V 500mg/2000 POLICHEM SA LUXEM CUTIE X 1 BLIST. AL/PVDC P-R 12 1.860416 1.360417 0.930208 2.290625 1.674374 1.546459
563 G01AA COMBINATII POLYGYNAX CAPS. MOI V F LAB. INNOTECH INT. FRANTA CUTIE X 2 BLIST. AL/PVC X 6 CA P-R 12 1.860416 0.705417 0.930208 1.635625 1.674374 0.891459
564 G01AA COMBINATII MACMIROR COMPLEX CREMA VAG. 10g/400000U POLICHEM SA LUXEM CUTIE X 1 TUB DIN AL P-R 1 34.650000 0.000000 17.325000 17.325000 31.185000 3.465000
565 G01AF FENTICONAZOLUM LOMEXIN 1000 mg CAPS. MOI V 1000mg RECORDATI SPA ITALIA CUTIE X 1 BLIST. PVC/PVDC P-R 2 17.380091 9.184909 8.690045 17.874955 15.642081 10.922919
566 G01AF FENTICONAZOLUM LOMEXIN 600 mg CAPS. MOI V 600mg RECORDATI SPA ITALIA CUTIE X 1 BLIST. PVC/ P-R 1 10.428054 4.621946 5.214027 9.835973 9.385248 5.664752
567 G01AF FENTICONAZOLUM LOMEXIN CREMA VAGINALA CREMA VAG. 2% RECORDATI SPA ITALIA CUTIE X 1 TUB AL + APLICAT P-R 1 27.112942 8.997058 13.556471 22.553529 24.401647 11.708353
568 G01AF BUTOCONAZOLUM GYNOFORT 2% CREMA VAG. 20mg/g GEDEON RIC ROMANIA CUTIE X 1 APLICATOR PREUMPLUT UNIDOZA DIN PP CU 5 G CREMA VAG. P-R 1 1.738009 32.241991 0.869004 33.110996 1.564208 32.415792
569 G01AF COMBINATII (METRON MECLODIN COMPR. VAG. 500mg/200m ARENA GROUP S.A. ROMANIA CUTIE X 2 B P-R 10 1.386642 0.171358 0.693321 0.864679 1.247977 0.310023
570 G01AF COMBINATII (METRON MECLON CREMA F ALFA WASSERMANN ITALIA CUTIE X 1 TUB DIN AL X 30 G P-R 1 9.980000 0.000000 4.990000 4.990000 8.982000 0.998000
571 G01AF COMBINATII (METRON MECLON CREMA VAG. F ALFA WASSERMAN ITALIA CUTIE X 1 TUB DIN AL X 30 G CREMA VAG. + 6 APLICATOARE DIN POLIPROPILENA P-R 1 13.340000 0.000000 6.670000 6.670000 12.006000 1.334000
572 G01AF COMBINATII (METRON MECLON OVULE 500mg/100m ALFA WASSERMAN ITALIA CUTIE X 2 FOLII PVC-PE X 5 OVULE P-R 10 1.386642 2.448358 0.693321 3.141679 1.247977 2.587023
573 G01AF COMBINATII (METRON ZIFEX DUO 500 mg/200 mg OVULE 500mg/200m ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FOLIE PRF 7 1.386642 0.154786 0.693321 0.848107 1.247977 0.293451
574 G01AF COMBINATII (METRON ZIFEX DUO 500 mg/200 mg OVULE 500mg/200m ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FOLIE TER PRF 7 1.386642 0.154786 0.693321 0.848107 1.247977 0.293451
575 G01AF COMBINATII (METRON ZIFEX DUO 500 mg/200 mg OVULE 500mg/200m ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 FOLII PRF 14 1.386642 0.154072 0.693321 0.847393 1.247977 0.292737
576 G01AF COMBINATII (METRON ZIFEX DUO 500 mg/200 mg OVULE 500mg/200m ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 FOLII PRF 14 1.386642 0.154072 0.693321 0.847393 1.247977 0.292737
577 G01AF COMBINATII (METRON MECLON SOL. VAGINA F ALFA WASSERMAN ITALIA CUTIE X 5 FLACOANE PVC-PE X 10 ML + 5 FLACOANE PEJD X 130 ML + 5 CANULE P-R 5 1.386642 3.177358 0.693321 3.870679 1.247977 3.316023
578 G02BA LEVONORGESTRELUM***# DONASERT 20 micrograme/24 ore SISTEM CU CEDARE INTRAUTERINA 20micro GEDEON RIC ROMANIA CUTIE CU 1 PUNGA TERMOSUDATA CARE CONTINE UN SISTEM CU ELIBERARE INTRAUTERINA SI UN DISPOZITIV DE INSERTIE PRF 1 306.750000 0.000000 153.375000 153.375000 276.075000 30.675000
579 G02BA LEVONORGESTRELUM***# MIRENA 20 micrograme/24 ore SISTEM CU CEDARE INTRAUTERINA 20micro BAYER OY FINLAND CUTIE CU UN BLISTER CE CONTINE UN SISTEM PENTRU ADMINISTRARE INTRAUTERINA SI UN INSERTOR P-R 1 343.540000 110.370000 171.770000 282.140000 309.186000 144.724000
580 G02CB CABERGOLINUM* DOSTINEX COMPR. 0,5mg PFIZER EUROPE M MA CUTIE X 1 FLAC. X 2 COMPR. P-R 2 5.505249 5.289751 2.752624 8.042376 4.954724 5.840276
581 G02CB CABERGOLINUM* DOSTINEX COMPR. 0,5mg PFIZER EUROPE M MA CUTIE X 1 FLAC. X 8 COMPR. P-R 8 5.505249 4.407251 2.752624 7.159876 4.954724 4.957776
582 G03CA PROMESTRIENUM* COLPOTROPHINE 10 mg CAPS. VAG. 10mg LABORATOIRE TH MONACO CUTIE CU 1 BLIST. AL/PVC X 10 PRF 10 0.967250 0.023750 0.483625 0.507375 0.870525 0.120475
583 G03CA PROMESTRIENUM* COLPOTROPHINE 10mg/g CREMA VAG. 10mg/g LABORATOIRE TH MONACO CUTIE CU 1 TUB DIN AL X 15 PRF 1 14.390000 0.000000 7.195000 7.195000 12.951000 1.439000
584 G03CX TIBOLONUM** LIVIAL (R) 2,5 mg COMPR. 2,5mg ORGANON NV OLANDA CUTIE X 1 BLIST. X 28 COMPR. P-R 28 1.586071 0.000000 0.793035 0.793036 1.427463 0.158608
585 G03DA PROGESTERONUM* UTROGESTAN (R) 100 mg CAPS. MOI 100mg LAB. BESINS I FRANTA CUTIE X 2 BLIST. X 15 CAPS. MOI P-6 30 0.565333 0.279667 0.282666 0.562334 0.508799 0.336201
586 G03DA PROGESTERONUM* AREFAM 100 mg CAPS. MOI 100mg MEDICO UNO PHA UNGARIA CUTIE X 2 BLIST. PVC-PVDC/ P-6 30 0.549000 0.000000 0.274500 0.274500 0.494100 0.054900
587 G03DA PROGESTERONUM* AREFAM 100 mg CAPS. MOI 100mg PHARMASWISS CESK REPUBLIKA S.R.O. R CUTIE X 2 BLIST. PVC-PVDC/ P-6 30 0.549000 0.000000 0.274500 0.274500 0.494100 0.054900

Pagina 31 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
588 G03DA PROGESTERONUM* UTROGESTAN (R) 200 mg CAPS. MOI 200mg LAB. BESINS I FRANTA CUTIE X 2 BLIST. AL/PVC X 7 CAPS. P-6 14 1.130666 0.822905 0.565333 1.388238 1.017599 0.935972
589 G03DA PROGESTERONUM* AREFAM 200 mg CAPS. MOI 200mg MEDICO UNO PHA UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL P-6 30 1.130666 0.098000 0.565333 0.663333 1.017599 0.211067
590 G03DA PROGESTERONUM* AREFAM 200 mg CAPS. MOI 200mg PHARMASWISS CESK REPUBLIKA S.R.O. R CUTIE X 2 BLIST. PVC-PVDC/AL P-6 30 1.130666 0.098000 0.565333 0.663333 1.017599 0.211067
591 G03DA PROGESTERONUM* PROGESTOGEL 10 mg/g GEL 10mg/g LABORATOIRES BESINS INTERNATIONAL FRANTA CUTIE CU 1 TU PRF 1 16.162500 5.767500 8.081250 13.848750 14.546250 7.383750
592 G03DA PROGESTERONUM* MASTOPROFEN 10 mg/g GEL 10mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 40 G GEL P6L 1 7.120000 0.000000 3.560000 3.560000 6.408000 0.712000
593 G03DA PROGESTERONUM* CRINONE 80 mg/g GEL VAGINAL 80mg/g MERCK ROMANIA SR ROMANIA CUTIE CU 6 APLICATOARE DOZA UNICA DIN PE, CONTINND GEL VAGINAL, PREVAZUTE CU VRF CARE SE DESFACE PRIN RASUCIRE, AMBALATE SEPARAT NTR-O FOLIE DIN HRTIE/AL/RASINA IONOMERICA
P6L 6 12.005000 0.000000 6.002500 6.002500 10.804500 1.200500
594 G03DB DYDROGESTERONUM* DUPHASTON 10 mg COMPR. FILM 10mg AB OLANDA CUTIE CU 1 BLIST. PVC/AL X 20 P-R 20 1.113000 0.000000 0.556500 0.556500 1.001700 0.111300
595 G03D LYNESTRENOLUM* ORGAMETRIL 5 mg COMPR. 5mg ORGANON NV OLANDA CUTIE X 1 BLIST. X 30 COMPR. P-6 30 0.258333 0.000000 0.129166 0.129167 0.232499 0.025834
596 G03FA COMBINATII** ANGELIQ COMPR. FILM 1mg+2mg BAYER PHARMA AG GERMANI CUTIE X 1 BLI P6L 28 2.062500 0.000000 1.031250 1.031250 1.856250 0.206250
597 G03FB COMBINATII** CYCLO-PROGYNOVA DRAJ. F BAYER PHARMA AG GERMANI CUTIE CU 1 BLIST. PVC/A P-6 21 0.383809 0.000000 0.191904 0.191905 0.345428 0.038381
598 G03FB ESTRADIOL + DIDROGESTERON** FEMOSTON 2/10, comprimate filmate COMPR. FILM 2 mg/10 mg AB OLANDA CUTIE X 1 BLISTER TIP CALENDAR X 28 COMPRIMATE FILMATE (14 COMPR. FILM. ROSII-CARAMIZII + 14 COMPR. FILM. GALBENE) P-R 28 0.690118 0.306310 0.345059 0.651369 0.621106 0.375322
599 G03FB ESTRADIOL + DIDROGESTERON** FEMOSTON 2/10, comprimate filmate COMPR. FILM 2 mg/10 mg BGP PRODUCTS B.V. OLANDA CUTIE X 1 BLIST. TIP CALENDAR X 28 COMPR. FILM. (14 COMPR.FILM. ROSII-CARAMIZII + 14 COMPR.FILM. GALBENE) P-R 28 0.690118 0.306310 0.345059 0.651369 0.621106 0.375322
600 G03G FOLLITROPINUM ALFA****# GONAL - f 75 UI (5,5 g) PULB. + SOLV. PT. SOL. INJ. 75UI MERCK S MA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. + 1 SERINGA PREUMPLUTA X 1 ML SOLV. P-RF/R 1 103.550000 28.980000 51.775000 80.755000 93.195000 39.335000
601 G03G FOLLITROPINUM ALFA****# BEMFOLA 150 UI/0,25 ml 150UI/0,25ml
SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT
FINOX BIOTECH AG LI CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 207.100000 4.400000 103.550000 107.950000 186.390000 25.110000
602 G03G FOLLITROPINUM ALFA****# BEMFOLA 225 UI/0,375 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT
225UI/0,375m FINOX BIOTECH AG LI CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 310.650000 6.610000 155.325000 161.935000 279.585000 37.675000
603 G03G FOLLITROPINUM ALFA****# BEMFOLA 300 UI/0,50 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT
300UI/0,50ml FINOX BIOTECH AG LI CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 414.200000 0.000000 207.100000 207.100000 372.780000 41.420000
604 G03G FOLLITROPINUM ALFA****# BEMFOLA 450 UI/0,75 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT
450UI/0,75ml FINOX BIOTECH AG LI CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 584.410000 0.000000 292.205000 292.205000 525.969000 58.441000
605 G03G FOLLITROPINUM ALFA****# BEMFOLA 75 UI/0,125 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT
75UI/0,125ml FINOX BIOTECH AG LI CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 103.550000 8.790000 51.775000 60.565000 93.195000 19.145000
606 G03G FOLLITROPINUM ALFA****# GONAL-f 300 UI/0,5 ml ( 22 g/0,5 ml) SOL. INJ. IN STILOU INJECTOR PREUMPLUT
300UI/0,5ml MERCK S MA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 0,5 ML SOL. INJ. + 8 ACE PT. ADM. P-RF/R 1 414.200000 91.450000 207.100000 298.550000 372.780000 132.870000
607 G03G FOLLITROPINUM ALFA****# GONAL-f 450 UI/0,75 ml (33 g/0,75 ml) SOL. INJ. IN STILOU INJECTOR PREUMPLUT
450UI/0,75ml MERCK S MA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 0,75 ML SOL. INJ. + 12 ACE PT. ADM. SUBCUTANATA P-RF/R 1 621.300000 114.480000 310.650000 425.130000 559.170000 176.610000
608 G03G FOLLITROPINUM ALFA****# GONAL-f 900 UI/1,5ml (66 g/1,5 ml) SOL. INJ. IN STILOU INJECTOR PREUMPLUT
900UI/1,5ml MERCK S MA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1,5 ML SOL. INJ. + 20 ACE PT. ADM. SUBCUTANATA P-RF/R 1 ,242.600000 141.820000 621.300000 763.120000 1,118.340000 266.080000
609 G03G FOLLITROPINUM BETA****# PUREGON 300UI/0,36 ml SOL. INJ. 300UI/0,36ml N. V. ORGANON OLANDA CUTIE X 1 CARTUS + 6 ACE PR/PRF 1 403.900000 0.000000 201.950000 201.950000 363.510000 40.390000
610 G03G FOLLITROPINUM BETA****# PUREGON 300UI/0,36 ml SOL. INJ. 300UI/0,36ml MERCK SHARP & MA CUTIE X 1 CARTUS + 6 ACE PR/PRF 1 403.900000 0.000000 201.950000 201.950000 363.510000 40.390000
611 G03G FOLLITROPINUM BETA****# PUREGON 900UI/1,08 ml SOL. INJ. 900UI/1,08ml N. V. ORGANON OLANDA CUTIE X 1 CARTUS SOL. INJ. + 9 A PR/PRF 1 ,242.102960 38.157040 621.051480 659.208520 1,117.892664 162.367336
612 G03G FOLLITROPINUM BETA****# PUREGON 900UI/1,08 ml SOL. INJ. 900UI/1,08ml MERCK SHARP & MA CUTIE X 1 CARTUS SOL. INJ. + 9 A PR/PRF 1 ,242.102960 38.157040 621.051480 659.208520 1,117.892664 162.367336
613 G03G LUTROPINUM ALFA****# LUVERIS 75UI P 75UI SERONO EUROPE LT MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ.+ 1 FLAC. A 2 ML SAU 3 ML X 1 ML SOLV. P-RF/R 1 131.710000 0.000000 65.855000 65.855000 118.539000 13.171000
614 G03G CLOMIFENUM CLOSTILBEGYT COMPR. 50mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. DIN STI P-R 10 1.770000 0.000000 0.885000 0.885000 1.593000 0.177000
615 G03XC RALOXIFENUM EVISTA 60mg COMPR. FILM 60mg DAIICHI SA GERMANI CUTIE X 28 COMPR. FILM. (BLIST. P-R 28 2.345357 0.000000 1.172678 1.172679 2.110821 0.234536
616 G04BD OXYBUTYNINUM DRIPTANE ( R ) 5 mg COMPR. 5mg LAB. FOURNIER SA FRANTA CUTIE X 2 BLIST. AL/PVC X 30 COM P-6 60 0.357500 0.000000 0.178750 0.178750 0.321750 0.035750
617 G04BD TOLTERODINUM**# UROFLOW 1 COMPR. FILM 1mg ZENTIVA K.S. R CUTIE CU BLIST. PVC-PVDC/ P6L 28 0.380189 0.435882 0.190094 0.625977 0.342170 0.473901
618 G04BD TOLTERODINUM**# UROFLOW 2 COMPR. FILM 2mg ZENTIVA K.S. R CUTIE CU BLIST. PVC-PVDC/ P6L 28 0.760379 0.098192 0.380189 0.478382 0.684341 0.174230
619 G04BD SOLIFENACINUM SUCCINATE**# ZEVESIN 10 mg COMPR. FILM 10 mg ZENTIVA K.S. R CUTIE CU BLIST. OPA/AL/P P6L 30 3.041516 0.173484 1.520758 1.694242 2.737364 0.477636
620 G04BD SOLIFENACINUM SUCCINATE**# VESICARE 10 mg COMPR. FILM 10mg ASTELLAS P OLANDA CUTIE X 3 BLIST. AL/PVC X 10 C P-6 30 3.041516 1.648817 1.520758 3.169575 2.737364 1.952969
621 G04BD SOLIFENACINUM SUCCINATE**# SOLIFENACIN ACTAVIS 10 mg COMPR. FILM 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 C P6L 30 3.041516 0.173484 1.520758 1.694242 2.737364 0.477636
622 G04BD SOLIFENACINUM SUCCINATE**# ZEVESIN 5 mg COMPR. FILM 5 mg ZENTIVA K.S. R CUTIE CU BLIST. OPA/AL/P P6L 30 1.520758 1.370908 0.760379 2.131287 1.368682 1.522984
623 G04BD SOLIFENACINUM SUCCINATE**# VESICARE 5 mg COMPR. FILM 5mg ASTELLAS P OLANDA CUTIE X 3 BLIST. AL/PVC X 10 C P-6 30 1.520758 3.054575 0.760379 3.814954 1.368682 3.206651
624 G04BD SOLIFENACINUM SUCCINATE**# ASOLFENA 5 mg COMPR. FILM 5mg KRKA, TOVARNA ZDRAVIL, D.D. NOVO MESTO SLOVENI CUTIE CU BLIST. PVC-PVDC/ P6L 30 1.520758 1.370908 0.760379 2.131287 1.368682 1.522984
625 G04BD SOLIFENACINUM SUCCINATE**# SOLIFENACIN ACTAVIS 5 mg COMPR. FILM 5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 C P6L 30 1.520758 1.369242 0.760379 2.129621 1.368682 1.521318
626 G04BD TROSPIUM INKONTAN 15 mg COMPR. FILM 15mg PHARMAZEUTISCHE FABRIK MONTAVIT GES.M.B.H. AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 C P-6 30 0.570284 0.747716 0.285142 1.032858 0.513255 0.804745
627 G04BD TROSPIUM INKONTAN 30 mg COMPR. FILM 30mg PHARMAZEUTISCHE FABRIK MONTAVIT GES.M.B.H. AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 C P-6 30 1.140568 0.983098 0.570284 1.553382 1.026511 1.097155
628 G04CA ALFUZOSINUM ALFURAN MR 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. P P-6 30 0.706666 0.000000 0.353333 0.353333 0.635999 0.070667
629 G04CA ALFUZOSINUM XATRAL SR 10 mg COMPR. 10mg SANOFI-AVE ROMANIA CUTIE X 3 BLIST. AL/PVCX 1 P-6 30 1.087333 0.000000 0.543666 0.543667 0.978599 0.108734
630 G04CA ALFUZOSINUM XATRAL SR 10 mg COMPR. 10mg SANOFI-AVE ROMANIA CUTIE CU 1 BLIST. P P-6 30 1.087333 0.000000 0.543666 0.543667 0.978599 0.108734
631 G04CA ALFUZOSINUM XATRAL LP 5 mg COMPR. FILM. ELIB. PREL. 5mg SANOFI-AVE ROMANIA CUTIE X 2 BLIST. PVC P-6 28 0.582142 0.000000 0.291071 0.291071 0.523927 0.058215
632 G04CA TAMSULOSINUM TAMSOL 0,4 mg CAPS. ELI 0,4mg GEDEON RIC ROMANIA CUTIE X 3 BL P-6 30 0.916666 0.000000 0.458333 0.458333 0.824999 0.091667
633 G04CA TAMSULOSINUM FOKUSIN CAPS. ELI 0,4mg ZENTIVA KS CEHIA CUTIE X 3 BLIST. PVC P-6 30 0.726333 0.000000 0.363166 0.363167 0.653699 0.072634
634 G04CA TAMSULOSINUM CONTIFLO MR CAPS. ELI 0,4mg RANBAXY UK LTD. MA CUTIE X 3 BLIST. PVC-P P-6 30 0.496666 0.000000 0.248333 0.248333 0.446999 0.049667
635 G04CA TAMSULOSINUM TAMSULOSIN AUROBINDO 400 microgra CAPS. ELI 400microgra AU MALTA CUTIE CU BLIST. PV P6L 30 0.909666 0.000000 0.454833 0.454833 0.818699 0.090967
636 G04CA TAMSULOSINUM TAMSULOSIN TEVA 400 g COMPR. CU ELIB. PRELUNGITA 400 g TEVA PHARM ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. CU ELIB. PRELUNG. P6L 30 0.565333 0.000000 0.282666 0.282667 0.508799 0.056534
637 G04CA TAMSULOSINUM OMNIC TOCAS (R) 0,4 COMPR. FILM. ELIB. PREL. 0,4mg ASTELLAS P OLANDA CUTIE X 3 FOLII AL/A P-6 30 1.189499 0.323501 0.594749 0.918251 1.070549 0.442451
638 G04CB FINASTERIDUM* PROSCAR 5 mg COMPR. FILM 5mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. PVC/PE/ P-6 28 0.983124 0.321161 0.491562 0.812723 0.884811 0.419474
639 G04CB FINASTERIDUM* FINASTERIDA ARENA 5 mg COMPR. FILM 5mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 C P-6 28 0.876071 0.000000 0.438035 0.438036 0.788463 0.087608
640 G04CB DUTASTERIDUM* AVODART 0,5 mg CAPS. MOI 0,5mg GLAXOSMITH ROMANIA CUTIE X 3 BLIST.PVC-PVDC/AL P-6 30 3.160666 0.000000 1.580333 1.580333 2.844599 0.316067
641 H01AC SOMATROPINUM***# GENOTROPIN 16 UI/ml (5,3 mg/ml) PULB. + SOLV. PT. SOL. INJ. 16UI/ml PFIZER EUROPE MA MA CUTIE X 1 CARTUS BICAMERAL MULTIDOZA CU PULB. SI SOLV. PT. SOL. INJ. P-R 1 423.587000 40.873000 211.793500 252.666500 381.228300 83.231700
642 H01AC SOMATROPINUM***# ZOMACTON PULB. + SOLV. PT. SOL. INJ. 4mg (12ui) FERRING GMBH GERMANI CUTIE X 1 FLAC. PR/PRF 1 317.690250 130.819750 158.845125 289.664875 285.921225 162.588775
643 H01AC SOMATROPINUM***# NUTROPINAq 10 mg/2 ml SOL. INJ. 10mg/2ml IPSEN PHARMA FRANTA CUTIE X 1 CARTUS X 2 ML. SOL. INJ P-RF/R 1 794.225625 157.414375 397.112812 554.527188 714.803062 236.836938
644 H01AC SOMATROPINUM***# OMNITROPE 3,3mg/ml SOL. INJ. 3,3mg/ml SANDOZ GMBH AUSTRIA CUTIE X 1CARTUS X 1,5 ML SOL.INJ P-RF/R 1 384.340000 0.000000 192.170000 192.170000 345.906000 38.434000
645 H01AC SOMATROPINUM***# OMNITROPE 6,7mg/ml SOL. INJ. 6,7mg/ml SANDOZ GMBH AUSTRIA CUTIE X 1CARTUS X 1,5 ML SOL.INJ P-RF/R 1 712.690000 0.000000 356.345000 356.345000 641.421000 71.269000
646 H01AC SOMATROPINUM***# NORDITROPIN SIMPLEXx 10 mg/1,5ml SOL. IN 10mg/1,5ml NOVO NORDISK A/S DANEM CUTIE X 1 CART P-R 1 794.225625 365.654375 397.112812 762.767188 714.803062 445.076938
647 H01CC GANIRELIXUM***# ORGALUTRAN 0.25mg/0,5ml SOL. INJ. 0,25mg/0,5ml N. V. ORGANON OLANDA CUTIE P-RF/R 1 127.422857 16.207143 63.711428 79.918572 114.680571 28.949429
648 H01CC GANIRELIXUM***# ORGALUTRAN 0.25mg/0,5ml SOL. INJ. 0,25mg/0,5ml MERCK SHARP & MA CUTIE P-RF/R 1 127.422857 16.207143 63.711428 79.918572 114.680571 28.949429
649 H01CC CETRORELIXUM***# CETROTIDE 0,25 mg 0,25mg
PULB+SOLV. PT. SOL. INJ. SERONO EUROPE LT MA CUTIE CU UN SUPORT CONTINAND: 7 FLAC.PULB. + 7 SERINGI PRE-UMPLUTE X 1 ML SOLV. + 7 ACE PT. INJECTII + 7 ACE PT. INJECTII SUBCUTANATE + 14 TAMPOANE IMBIBATE IN ALCOOL
P-R 7 111.215714 0.000000 55.607857 55.607857 100.094142 11.121572
650 H02AA FLUDROCORTISONUM ASTONIN H COMPR. 0,1mg MERCK KGAA GERMANI CUTIE X 1 FLAC. DIN PP X 50 COM P-R 50 0.403000 0.000000 0.201500 0.201500 0.362700 0.040300
651 H02AB BETAMETHASONUM DIPROPHOS SUSP. INJ. I.M 7mg/ml MERCK SHARP & ROMANIA CUTIE X 5 FIOLE X 1 ML P-R 5 5.366000 0.000000 2.683000 2.683000 4.829400 0.536600
652 H03BB THIAMAZOLUM THYROZOL 10 mg COMPR. FILM 10mg MERCK KGAA GERMANI CUTIE CU BLIST. PVC/AL X 50 C P-6 50 0.312165 0.116835 0.156082 0.272918 0.280948 0.148052
653 H03BB THIAMAZOLUM THYROZOL 20mg COMPR. FILM 20mg MERCK KGAA GERMANI CUTIE CU BLIST. PVC/AL X 50 C P-6 50 0.529400 0.000000 0.264700 0.264700 0.476460 0.052940

Pagina 32 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
654 H03BB THIAMAZOLUM THYROZOL 5 mg COMPR. FILM 5mg MERCK KGAA GERMANI CUTIE CU BLIST. PVC/AL X 100 P6L 100 0.156082 0.164118 0.078041 0.242159 0.140473 0.179727
655 J01CR AMPICILLINUM + SULBACTAM AMPIPLUS 1000 mg/500 mg PULB. PT. SOL. INJ./PERF. 1000mg/500 ANTIBIOTICE S.A. ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. PR, PRF 50 15.073600 0.000000 7.536800 7.536800 13.566240 1.507360
656 J01CR SULTAMICILLINUM UNASYN COMPR. FILM 375mg PFIZER EUROPE MA MA CUTIE X 2 BLIST. AL/PVC/PVDC P-R 12 2.861666 0.000000 1.430833 1.430833 2.575499 0.286167
657 J01CR SULTAMICILLINUM UNASYN PUL 250mg/5ml PFIZER EUROPE MA MA CUT P-R 1 23.499996 1.820004 11.749998 13.570002 21.149996 4.170004
658 J01FA SPIRAMYCINUM ROVAMYCINE (R) 1,5 Mil. UI COMPR. FILM 1,5 M ui LAB. AVENTIS FRANTA CUTIE X 2 BLIST. AL/PVC X 8 COM P-R 16 0.638750 0.000000 0.319375 0.319375 0.574875 0.063875
659 J01FA SPIRAMYCINUM ROVAMYCINE (R) 3 Mil. UI COMPR. FILM 3M ui LAB. AVENTIS FRANTA CUTIE X 2 BLIST. AL/PVC X 5 COM P-R 10 1.294926 1.318074 0.647463 1.965537 1.165433 1.447567
660 J01FA SPIRAMYCINUM ROVAMYCINE 3 Mil. UI COMPR. FILM 3MilU.I. LABORATOIRES AV FRANTA CUTIE CU 1 BLIST. AL/PVC X 10 PRF 10 1.294926 1.318074 0.647463 1.965537 1.165433 1.447567
661 J01FA AZITHROMYCINUM AZATRIL 250 mg CAPS. 250mg BALKANPHA BULGARI CUTIE X 1 BLIST. AL/PVC X 6 CAPS. P-R 6 3.237318 0.054348 1.618659 1.673007 2.913586 0.378080
662 J01FA AZITHROMYCINUM SUMAMED 250 mg CAPS. 250mg PLIVA LJUBLIJANA D SLOVENI CUTIE X 1 BLIST. PVC-PVDC/AL X P-R 6 3.237318 1.829348 1.618659 3.448007 2.913586 2.153080
663 J01FA AZITHROMYCINUM SUMAMED 125 mg COMPR. FILM 125mg PLIVA LJUBLJANA D SLOVENI CUTIE X 1 BLIST. AL/PVC X 6 COM P-R 6 1.618657 2.528009 0.809328 3.337338 1.456791 2.689875
664 J01FA AZITHROMYCINUM AZITROMICINA SANDOZ 250 mg COMPR. FILM 250mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. X 6 COMPR. FILM. P-R 6 3.237318 0.054348 1.618659 1.673007 2.913586 0.378080
665 J01FA AZITHROMYCINUM AZITROMICINA TERAPIA 250 mg COMPR. FILM 250mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC-ACLAR P-R 6 3.237318 0.054348 1.618659 1.673007 2.913586 0.378080
666 J01FA AZITHROMYCINUM AZITROMICINA TERAPIA 250 mg COMPR. FILM 250mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/ P-R 6 3.237318 0.054348 1.618659 1.673007 2.913586 0.378080
667 J01FA AZITHROMYCINUM AZIBIOT 250 mg COMPR. FILM 250mg KRKA ,D.D., NOVO SLOVENI CUTIE CU BLIST. PVC-PVDC/A PRF 6 3.237318 0.054348 1.618659 1.673007 2.913586 0.378080
668 J01FA AZITHROMYCINUM SUMAMED 500 mg COMPR. FILM 500mg PLIVA LJUBLJANA D SLOVENI CUTIE X 1 BLIST. AL/PVC X 3 COM P-R 3 6.474636 2.108697 3.237318 5.346015 5.827172 2.756161
669 J01FA AZITHROMYCINUM AZITROMICINA SANDOZ 500 m COMPR. FILM 500mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. X 3 COMPR. FILM. P-R 3 4.063333 0.000000 2.031666 2.031667 3.656999 0.406334
670 J01FA AZITHROMYCINUM AZIBIOT 500 mg COMPR. FILM 500mg KRKA D.D. NOVO M SLOVENI CUTIE X 1 BLIST. AL/PVC X 3 COM P-R 3 5.316666 0.000000 2.658333 2.658333 4.784999 0.531667
671 J01FA AZITHROMYCINUM AZITROMICINA TERAPIA 500 mg COMPR. FILM 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC-ACLAR P-R 3 5.576666 0.000000 2.788333 2.788333 5.018999 0.557667
672 J01FA AZITHROMYCINUM AZITROMICINA TERAPIA 500 mg COMPR. FILM 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/ P-R 3 5.576666 0.000000 2.788333 2.788333 5.018999 0.557667
673 J01FA AZITHROMYCINUM AZITROX (R) 500 COMPR. FILM 500mg ZENTIVA K.S. CEHIA CUTIE X 1 BLIST. AL/PVC X 3 COM P-R 3 5.576666 0.000000 2.788333 2.788333 5.018999 0.557667
674 J01FA AZITHROMYCINUM AZATRIL 500 mg COMPR. FILM 500mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. OPA-PV PRF 3 5.130000 0.000000 2.565000 2.565000 4.617000 0.513000
675 J01FA AZITHROMYCINUM AZITROMICINA ARENA 500 mg COMPR. FILM 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 3 C PRF 3 5.576666 0.000000 2.788333 2.788333 5.018999 0.557667
676 J01FA AZITHROMYCINUM AZITROMICINA TERAPIA 600 mg COMPR. FILM 600mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC-ACLAR P-R 3 7.769566 7.657100 3.884783 11.541883 6.992609 8.434057
677 J01FA AZITHROMYCINUM AZITROMICINA TERAPIA 600 mg COMPR. FILM 600mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/ P-R 3 7.769566 7.657100 3.884783 11.541883 6.992609 8.434057
678 J01FA AZITHROMYCINUM AZITROX 200 mg/5 ml PULB. + SOLV. SUSP. ORALA 200mg/5ml ZENTIVA S.A. ROMANIA CUTIE X 1 FLACON DIN PE CU PULBERE PENTRU 15ML SUSPENSIE ORALA RECONSTITUITA + FLACON CU SOLVENT X 7.5ML SOLVENT + 1 SERINGA PENTRU ADMINISTRAREA ORALA + O LINGURITA DOZATOARE
P-R 1 14.470000 0.000000 7.235000 7.235000 13.023000 1.447000
679 J01FA AZITHROMYCINUM AZITROMICINA SANDOZ 100 mg/5 ml PUL 100mg/5ml SANDOZ SRL ROMANIA CUTIE CU 1 FLAC. PEID + 1 SERINGA DOZATOARE DIN PE/PP (10 ML) GRADATA IN DIVIZIUNI DE 0,25 ML CONTINAND PULB. PT 20 ML (400 MG) SUSP. ORALA
P-R 1 12.722396 6.617604 6.361198 12.978802 11.450156 7.889844
680 J01FA AZITHROMYCINUM AZITROMICINA SANDOZ 200 mg/5 ml PUL 200 mg/5 ml SANDOZ SRL ROMANIA CUTIE CU 1 FLAC. PEID + 1 SERINGA DOZATOARE DIN PE/PP (10 ML) GRADATA IN DIVIZIUNI DE 0,25 ML CONTINAND PULB. PT 20 ML (800 MG) SUSP. ORALA
P-R 1 19.290000 0.000000 9.645000 9.645000 17.361000 1.929000
681 J01FA AZITHROMYCINUM SUMAMED FORTE PUL 200mg/5ml PLIVA LJUBLIJANA D SLOVENI CUTIE X 1 FLAC. DIN PEID CU PULB. PT.15 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-R 1 19.083600 3.176400 9.541800 12.718200 17.175240 5.084760
682 J01FA AZITHROMYCINUM SUMAMED FORTE PUL 200mg/5ml PLIVA LJUBLIJANA D SLOVENI CUTIE X 1 FLAC. DIN PEID CU PULB. PT. 30 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-R 1 38.167200 1.512800 19.083600 20.596400 34.350480 5.329520
683 J01FA AZITHROMYCINUM SUMAMED FORTE PUL 200mg/5ml PLIVA LJUBLIJANA D SLOVENI CUTIE X 1 FLAC. DIN PEID CU PULB. PT. 37,5 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-R 1 47.709000 12.651000 23.854500 36.505500 42.938100 17.421900
684 J01FF CLINDAMYCINUM DALACIN C 150 mg CAPS. 150mg PFIZER EUROPE MA MA CUTIE X 2 BLIST. AL/PVC X 8 CAPS. P-R 16 0.497046 0.290454 0.248523 0.538977 0.447341 0.340159
685 J01FF CLINDAMYCINUM DALACIN C 300 mg CAPS. 300mg PFIZER EUROPE MA MA CUTIE X 2 BLIST. AL/PVC X 8 CAPS. P-R 16 0.994093 0.365907 0.497046 0.862954 0.894683 0.465317
686 J01FF CLINDAMYCINUM CLINDAMYCIN - MIP 300 mg COMPR. FILM 300mg MIP PHARMA GMBH GERMANI CUTIE X 2 BLIST. PVC/AL X 8 COM P-R 16 0.883750 0.000000 0.441875 0.441875 0.795375 0.088375
687 J01FF CLINDAMYCINUM CLINDAMYCIN - MIP 300 mg COMPR. FILM 300mg MIP PHARMA GMBH GERMANI CUTIE X 5 BLIST. PVC/AL X 6 COM P-R 30 0.884000 0.000000 0.442000 0.442000 0.795600 0.088400
688 J01FF CLINDAMYCINUM CLINDAMYCIN - MIP 600 mg COMPR. FILM 600mg MIP PHARMA GMBH GERMANI CUTIE X 2 BLIST. PVC/AL X 8 COM P-R 16 1.988187 0.660563 0.994093 1.654657 1.789368 0.859382
689 J01FF CLINDAMYCINUM CLINDAMYCIN - MIP 600 mg COMPR. FILM 600mg MIP PHARMA GMBH GERMANI CUTIE X 5 BLIST. PVC/AL X 6 COM P-R 30 1.988187 0.747146 0.994093 1.741240 1.789368 0.945965
690 J01MA LEVOFLOXACINUM LEVOFLOXACINA ACTAVIS 250 mg COMPR. FILM 250mg ACTAVIS GROUP P ISLANDA CUTIE X 1 BLIST. AL/PVC X 7 COM P-R 7 1.555714 0.000000 0.777857 0.777857 1.400142 0.155572
691 J01MA LEVOFLOXACINUM TAVANIC 250 mg COMPR. FILM 250mg TERAPIA S.A. ROMANIA CUTIE X1 BLIST. PVC/AL. X 7 CO P-R 7 2.453400 1.398028 1.226700 2.624728 2.208060 1.643368
692 J01MA LEVOFLOXACINUM LEVOTOR 250 mg COMPR. FILM 250mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC/AL X 7 COM P-R 7 1.555714 0.000000 0.777857 0.777857 1.400142 0.155572
693 J01MA LEVOFLOXACINUM LEVALOX 250 mg COMPR. FILM 250mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC-PVDC/A PRF 7 2.453400 0.050885 1.226700 1.277585 2.208060 0.296225
694 J01MA LEVOFLOXACINUM FLERADAY 500 mg COMPR. FILM 500 mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. PVC/PVDC - PRF 7 4.427142 0.000000 2.213571 2.213571 3.984427 0.442715
695 J01MA LEVOFLOXACINUM LEVOFLOXACINA ACTAVIS 500 mg COMPR. FILM 500mg ACTAVIS GROUP P ISLANDA CUTIE X 1 BLIST. AL/PVC X 7 COM P-R 7 3.280000 0.000000 1.640000 1.640000 2.952000 0.328000
696 J01MA LEVOFLOXACINUM TAVANIC 500 mg COMPR. FILM 500mg TERAPIA S.A. ROMANIA CUTIE X 1 BLIST. PVC/AL X 7COMP P-R 7 4.906800 1.684628 2.453400 4.138028 4.416120 2.175308
697 J01MA LEVOFLOXACINUM LEVOTOR 500 mg COMPR. FILM 500mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC/AL X 7 COM P-R 7 3.228571 0.000000 1.614285 1.614286 2.905713 0.322858
698 J01MA LEVOFLOXACINUM LEVALOX 500 mg COMPR. FILM 500mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC-PVDC/A PRF 7 4.274285 0.000000 2.137142 2.137143 3.846856 0.427429
699 J01MA MOXIFLOXACINUM AVELOX 400 mg COMPR. FILM 400mg BAYER PHARMA AG GERMANI CUTIE X 1 BLIST. T P-R 5 4.906800 6.177200 2.453400 8.630600 4.416120 6.667880
700 J01MA MOXIFLOXACINUM MOXIFLOXACINA AUROBINDO 400 mg COMPR. FILM 400mg AU MALTA CUTIE CU BLIST. PVC-PVDC/A PRF 5 4.906800 2.299200 2.453400 4.752600 4.416120 2.789880
701 J01MA MOXIFLOXACINUM MOFINACIN 400 mg COMPR. FILM 400mg ALVOGEN IPCO S.A. LUXEM CUTIE CU BLIST. OPA-AL-PV PRF 5 4.906800 2.299200 2.453400 4.752600 4.416120 2.789880
702 J01MA MOXIFLOXACINUM MOFIL 400 mg COMPR. FILM 400mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PA/AL/PVC-A PRF 5 4.906800 2.299200 2.453400 4.752600 4.416120 2.789880
703 J01MA MOXIFLOXACINUM MOFLAXA 400 mg COMPR. FILM 400mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONAINND 5 COMPRIMATE FILMATE PRF 5 4.906800 2.299200 2.453400 4.752600 4.416120 2.789880
704 J02AC ITRACONAZOLUM* ORUNGAL CAPS. 100mg JANSSEN PH BELGIA CUTIE X 3 BLIST. AL/PVC-PE-PV P-R 15 3.194000 0.000000 1.597000 1.597000 2.874600 0.319400
705 J02AC ITRACONAZOLUM* ITRACONAZOL 100 mg CAPS. 100mg SLAVIA PHARM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 5 CAPS. P-R 15 2.144666 0.000000 1.072333 1.072333 1.930199 0.214467
706 J02AC ITRACONAZOLUM* OMICRAL 100 mg CAPS. 100mg MEDI ROMANIA CUTIE X 3 BLIST. AL/AL X 5 CAPS. P-R 15 2.144666 0.000000 1.072333 1.072333 1.930199 0.214467
707 J02AC ITRACONAZOLUM* MICOGAL 100 mg CAPS. 100mg ROMPHARM COMP ROMANIA CUTIE CU BLISTERE PVC/AL X P-R 15 2.144666 0.000000 1.072333 1.072333 1.930199 0.214467
708 J02AC ITRACONAZOLUM* ITRACONAZOL ARENA 100 mg CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 5 CAPS. P-R 15 2.144666 0.000000 1.072333 1.072333 1.930199 0.214467
709 J02AC ITRACONAZOLUM* OMICRAL 100 mg CAPS. 100mg PHARMASWISS CESKA REPUBLIKA S.R.O. R CUTIE X 3 BLIST. AL/AL X 5 CAPS. P-R 15 2.144666 0.000000 1.072333 1.072333 1.930199 0.214467
710 J05AB VALACYCLOVIRUM* VALTREX 500 mg COMPR. FILM 500 mg THE WEL MA CUT PRF 10 4.661000 0.000000 2.330500 2.330500 4.194900 0.466100
711 J05AB VALACYCLOVIRUM* VALACICLOVIR ARENA 500 mg COMPR. FILM 500mg ARENA GROUP S.A. ROMANIA CUTIE PRF 10 3.131000 0.000000 1.565500 1.565500 2.817900 0.313100
712 J05AB BRIVUDINUM*# BRIVAL 125mg COMPR. 125mg BER GERMANI CUTIE X 1 BLIST. PVC/AL X 7 COMP P-R 7 48.002857 0.000000 24.001428 24.001429 43.202571 4.800286
713 L01AA CYCLOPHOSPHAMIDUM* ENDOXAN (R) 50 mg DRAJ. 50mg BAXTER ONCOL GERMANI CUTIE X 5 BLIST. PVC-PVDC/AL X P-R 50 0.542400 0.000000 0.271200 0.271200 0.488160 0.054240
714 L02AE GOSERELINUM***# ZOLADEX (R) IMPLANT 3,6mg ASTRAZENECA UK MA CUTIE X 1 PLIC X 1 SERI S/P-RF 1 298.459994 4.700006 149.229997 153.930003 268.613994 34.546006
715 L02AE TRIPTORELINUM***# DIPHERELINE 0,1 mg LIOF. + SOLV. PT. SOL. INJ. 0,1mg IPSEN PHARMA FRANTA CUTIE X 7 FL S/P-RF 7 13.681428 0.000000 6.840714 6.840714 12.313285 1.368143
716 L02AE TRIPTORELINUM***# DIPHERELINE PR 11,25 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL.
11,25mg IPSEN PHARMA FRANTA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. SUSP. INJ. + 1 FIOLA DIN STICLA INCOLORA X 2 ML SOLV. + 1 BLIST. CU 1 SERINGA X 3 ML + 1 BLIST. CU 2 ACE STERILE S/P-RF 1 886.880000 0.000000 443.440000 443.440000 798.192000 88.688000
717 L02AE TRIPTORELINUM***# DIPHERELINE 3,75 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL.
3,75mg IPSEN PHARMA FRANTA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. SUSP. INJ. + 1 FIOLA DIN STICLA INCOLORA X 2 ML SOLV. + 1 BLIST. CU O SERINGA X 3 ML + 1 BLIST. CU 2 ACE STERILE S/P-RF 1 371.770000 0.000000 185.885000 185.885000 334.593000 37.177000
718 L02AE TRIPTORELINUM***# GONAPEPTYL ZILNIC 0,1 mg/ml SOL. INJ. 0,1mg/ml FERRING GMBH GERMANI CUTIE X 28 SERINGI PREUMPLUTE DIN STICLA INCOLORA X 1 ML SOL. INJ S/P-RF 28 2.097156 20.075701 1.048578 21.124279 1.887440 20.285417
719 L04AX AZATHIOPRINUM* IMURAN COMPR. FILM 50mg ASPEN EUROPE GM GERMANI CUTIE X 4 BLIST. AL/PVC X 25 C S/P-RF 100 0.614116 0.088184 0.307058 0.395242 0.552704 0.149596

Pagina 33 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
720 L04AX AZATHIOPRINUM* IMURAN COMPR. FILM 50mg ASPEN P IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 C S/P-RF 100 0.614116 0.088184 0.307058 0.395242 0.552704 0.149596
721 M01A LORNOXICAMUM XEFO RAPID 8 mg COMPR. FILM 8mg NYCOMED AUSTR AUSTRIA CUTIE CU BLIST. OPA-AL-P P6L 10 0.431999 0.540001 0.215999 0.756001 0.388799 0.583201
722 M01A LORNOXICAMUM XEFO RAPID 8 mg COMPR. FILM 8mg TAKEDA AUSTRIA G AUSTRIA CUTIE CU BLIST. OPA-AL-P P6L 10 0.431999 0.540001 0.215999 0.756001 0.388799 0.583201
723 M01A LORNOXICAMUM XEFO 8 mg/ 2 ml PULB. + SOLV. PT. SOL. INJ. 8mg/2ml NYCOMED AUSTR AUSTRIA CUTIE CU 10 FLAC. DIN STICLA BRUNA CU PULB. PT. SOL. INJ. + 10 FIOLE DIN STICLA INCOLORA X 2 ML SOLV PRF 10 1.310332 7.789668 0.655166 8.444834 1.179298 7.920702
724 M01A LORNOXICAMUM XEFO 8 mg/ 2 ml PULB. + SOLV. PT. SOL. INJ. 8mg/2ml TAKEDA AUSTRIA G AUSTRIA CUTIE CU 10 FLAC. DIN STICLA BRUNA CU PULB. PT. SOL. INJ. + 10 FIOLE DIN STICLA INCOLORA X 2 ML SOLV. PT. SOL. INJ. PRF 10 1.310332 7.789668 0.655166 8.444834 1.179298 7.920702
725 M01AE DEXKETOPROFENUM TADOR 25 mg COMPR. FILM 25mg B GERMANI CUTIE X 1 BLIST. PVC/AL X 10 C P-6 10 0.475199 0.396801 0.237599 0.634401 0.427679 0.444321
726 M01AE DEXKETOPROFENUM DEXKETOPROFEN TROMETAMOL SA COMPR. FILM 25mg SANDOZ S.R.L. ROMANIA CUTIE BLIST. DI P6L 20 0.475199 0.091801 0.237599 0.329401 0.427679 0.139321
727 M01AE DEXKETOPROFENUM TADOR INJECT SOL. INJ./CONC. PT. SOL. PERF. 50mg/2ml MENARINI INTERNATIONAL OPERATIONS S.A. LUXE CUTIE X 5 FIOLE X 2 ML P-R 5 2.276000 1.788000 1.138000 2.926000 2.048400 2.015600
728 M01AE DEXKETOPROFENUM DEXKETOPROFEN ROMPHARM 50 mg/2 SOL. INJ./CONC. PT. SOL. PERF. 50mg/2ml ROMPHARM CO ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA (UN SUPORT A 5 FIOLE), PREVAZUTE CU INEL DE RUPERE, CONTINAND 2 ML DE SOL. INJ./CONC. PT. SOL. PERF.
PRF 5 2.276000 0.364000 1.138000 1.502000 2.048400 0.591600
729 M01AE DEXKETOPROFENUM DEXKETOPROFEN ROMPHARM 50 mg/2 SOL. INJ./CONC. PT. SOL. PERF. 50mg/2ml ROMPHARM CO ROMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA (DOUA SUPORTURI A CATE 5 FIOLE), PREVAZUTE CU INEL DE RUPERE, CONTINAND 2 ML DE SOL. INJ./CONC. PT. SOL. PERF.
PRF 10 2.276000 0.365000 1.138000 1.503000 2.048400 0.592600
730 M01AE COMBINATII (NAPROXEN + E VIMOVO 500 mg/20 mg COMPR. 500 mg/20 m ASTRA ZENECA AB SUEDIA CUTIE CU 1 FLAC. PEID CU CAPAC PP PREVAZUT CU SIST. SECURIZAT PT. COPII SI DESICANT SILICAGEL X 30 COMPR. ELIB. MODIF. PRF 30 1.611749 0.081251 0.805874 0.887126 1.450574 0.242426
731 M01AE COMBINATII (NAPROXEN + E VIMOVO 500 mg/20 mg COMPR. 500 mg/20 m ASTRA ZENECA AB SUEDIA CUTIE CU 1 FLAC. PEID CU CAPAC PP PREVAZUT CU SIST. SECURIZAT PT. COPII SI DESICANT SILICAGEL X 60 COMPR. ELIB. MODIF. PRF 60 1.584666 0.000000 0.792333 0.792333 1.426199 0.158467
732 M01A CELECOXIBUM CELEBREX 100 mg CAPS. 100mg PFIZER EUROPE MA MA CUTIE X 3 BLIST. AL/PVC X 10 CAPS P-R 30 0.586583 0.311750 0.293291 0.605042 0.527924 0.370409
733 M01A CELECOXIBUM ALGOXIB 100 mg CAPS. 100mg ZENTIVA K.S. R CUTIE CU BLIST. PVC-PVDC/AL X PRF 30 0.584000 0.000000 0.292000 0.292000 0.525600 0.058400
734 M01A CELECOXIBUM ACLEXA 100 mg CAPS. 100mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 30 CAPS PRF 30 0.584000 0.000000 0.292000 0.292000 0.525600 0.058400
735 M01A CELECOXIBUM CELECOXIB ACTAVIS 100 mg CAPS. 100mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 CAPS PRF 30 0.584000 0.000000 0.292000 0.292000 0.525600 0.058400
736 M01A CELECOXIBUM CELETOR 100 mg CAPS. 100mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X PRF 30 0.584000 0.000000 0.292000 0.292000 0.525600 0.058400
737 M01A CELECOXIBUM CALIDEM 100 mg CAPS. 100mg EGIS PHARMA UNGARIA CUTIE CU BLIST. PVC/AL X 30 CAPS PRF 30 0.584000 0.000000 0.292000 0.292000 0.525600 0.058400
738 M01A CELECOXIBUM CELECOXIB TERAPIA 100 mg CAPS. 100mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL PRF 30 0.584000 0.000000 0.292000 0.292000 0.525600 0.058400
739 M01A CELECOXIBUM CELEBREX 200 mg CAPS. 200mg PFIZER EUROPE MA MA CUTIE X 1 BLIST. AL/PVC X 10 CAPS P-R 10 1.173166 0.972834 0.586583 1.559417 1.055849 1.090151
740 M01A CELECOXIBUM CELEBREX 200 mg CAPS. 200mg PFIZER EUROPE MA MA CUTIE X 3 BLIST. AL/PVC X 10 CAPS P-R 30 1.173166 0.640167 0.586583 1.226750 1.055849 0.757484
741 M01A CELECOXIBUM ALGOXIB 200 mg CAPS. 200mg ZENTIVA K.S. R CUTIE CU BLIST. PVC-PVDC/AL X PRF 30 1.173166 0.005167 0.586583 0.591750 1.055849 0.122484
742 M01A CELECOXIBUM ACLEXA 200 mg CAPS. 200mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 30 CAPS PRF 30 1.173166 0.005167 0.586583 0.591750 1.055849 0.122484
743 M01A CELECOXIBUM CELECOXIB ACTAVIS 200 mg CAPS. 200mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 CAPS PRF 30 1.173166 0.005167 0.586583 0.591750 1.055849 0.122484
744 M01A CELECOXIBUM CELETOR 200 mg CAPS. 200mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X PRF 30 1.173166 0.005167 0.586583 0.591750 1.055849 0.122484
745 M01A CELECOXIBUM CALIDEM 200 mg CAPS. 200mg EGIS PHARMA UNGARIA CUTIE CU BLIST. PVC/AL X 10 CAPS PRF 10 1.173166 0.220834 0.586583 0.807417 1.055849 0.338151
746 M01A CELECOXIBUM CALIDEM 200 mg CAPS. 200mg EGIS PHARMA UNGARIA CUTIE CU BLIST. PVC/AL X 30 CAPS PRF 30 1.173166 0.005167 0.586583 0.591750 1.055849 0.122484
747 M01A CELECOXIBUM CELECOXIB TERAPIA 200 mg CAPS. 200mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL PRF 30 1.173166 0.005167 0.586583 0.591750 1.055849 0.122484
748 M01A ETORICOXIBUM ARCOXIA 120 mg COMPR. FILM 120mg MERCK SHARP & ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/ P-R 7 2.346333 2.212238 1.173166 3.385405 2.111699 2.446872
749 M01A ETORICOXIBUM ARCOXIA 120 mg COMPR. FILM 120mg MERCK SHARP & ROMANIA CUTIE X 1 BLIST. PA-AL-PV P-R 14 2.346333 2.065095 1.173166 3.238262 2.111699 2.299729
750 M01A ETORICOXIBUM ARCOXIA 30 mg COMPR. FILM 30mg MERCK SHARP & ROMANIA CUTIE X 4 BLIST. PA-AL-PVC/ P-R 28 0.586583 2.234488 0.293291 2.527780 0.527924 2.293147
751 M01A ETORICOXIBUM ARCOXIA 60 mg COMPR. FILM 60mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/ P-R 14 1.173166 2.023262 0.586583 2.609845 1.055849 2.140579
752 M01A ETORICOXIBUM ARCOXIA 60 mg COMPR. FILM 60mg MERCK SHARP & ROMANIA CUTIE X 1 BLIST. PA-AL-PVC P-R 14 1.173166 2.023262 0.586583 2.609845 1.055849 2.140579
753 M01A ETORICOXIBUM ARCOXIA 90 mg COMPR. FILM 90mg MERCK SHARP & ROMANIA CUTIE X 1 BLIST. PA-AL-PVC P-R 14 1.759749 1.757393 0.879874 2.637268 1.583774 1.933368
754 M01A ETORICOXIBUM ARCOXIA 90 mg COMPR. FILM 90mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/ P-R 14 1.759749 1.757393 0.879874 2.637268 1.583774 1.933368
755 M03BX BACLOFENUM LIORESAL (R) COMPR. 10mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. AL/PVC X 10 COM P-6 50 0.333959 0.079241 0.166979 0.246221 0.300563 0.112637
756 M03BX BACLOFENUM LIORESAL (R) COMPR. 25mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. AL/PVC X 10 COM P-6 50 0.666000 0.000000 0.333000 0.333000 0.599400 0.066600
757 M05BA ACIDUM ALENDRONICUM* TEVANAT 70 mg COMPR. 70 mg TEVA PHARM ROMANIA CUTIE X 1 BLIST. PVC-AL-OPA/A P-6 4 2.705000 0.000000 1.352500 1.352500 2.434500 0.270500
758 M05BA ACIDUM ALENDRONICUM* ACID ALENDRONIC AUROBINDO 70 mg COMPR. 70mg AU MALTA CUTIE CU BLI P6L 4 2.487500 0.000000 1.243750 1.243750 2.238750 0.248750
759 M05BA ACIDUM ALENDRONICUM* FOSAMAX 70 mg COMPR. 70mg MERCK SHARP & ROMANIA CUTIE CU 1 BLIST. AL/AL X 2 COMP P6L 2 6.572249 7.047751 3.286124 10.333876 5.915024 7.704976
760 M05BA ACIDUM ALENDRONICUM* ALENDRONAT SANDOZ 70 mg COMPR. FILM 70mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. OPA-AL-PV P-6 2 4.890000 0.000000 2.445000 2.445000 4.401000 0.489000
761 M05BA ACIDUM ALENDRONICUM* ADRONIK 70 mg COMPR. FILM 70mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/ P-6 12 6.572249 1.563584 3.286124 4.849709 5.915024 2.220809
762 M05BA ACIDUM ALENDRONICUM* ADRONIK 70 mg COMPR. FILM 70mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/ P-6 2 6.572249 2.277751 3.286124 5.563876 5.915024 2.934976
763 M05BA ACIDUM ALENDRONICUM* ADRONIK 70 mg COMPR. FILM 70mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/ P-6 4 6.572249 1.995251 3.286124 5.281376 5.915024 2.652476
764 M05BA ACIDUM RISEDRONICUM* LORINE 35mg COMPR. FILM 35mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1BLIST. PVC- PVDC/ P-6 4 6.572249 0.650251 3.286124 3.936376 5.915024 1.307476
765 M05BA ACIDUM RISEDRONICUM* OSODENS 35 mg COMPR. FILM 35mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL P-6 4 6.572249 0.650251 3.286124 3.936376 5.915024 1.307476
766 M05BA ACIDUM RISEDRONICUM* RISEDRONAT SODIC ZENTIVA 35mg COMPR. FILM 35mg ZENTIVA KS R CUTIE X 1 B P-6 4 3.712500 0.000000 1.856250 1.856250 3.341250 0.371250
767 M05BA ACIDUM RISEDRONICUM* RISEDRONAT AUROBINDO 35 mg COMPR. FILM 35mg AU MALTA CUTIE CU BLIST. PVC/P P6L 4 3.712500 0.000000 1.856250 1.856250 3.341250 0.371250
768 M05BA ACIDUM RISEDRONICUM* ACTONEL SAPTAMANAL 35 mg COMPR. FILM 35mg ACTAVIS GROUP P ISLANDA CUTIE CU 1 BLIST. PVC/AL X 4 C P-6 4 6.572249 4.177751 3.286124 7.463876 5.915024 4.834976
769 M05BA ACIDUM RISEDRONICUM* ACTONEL 75 mg COMPR. FILM 75mg ACTAVIS GROUP P ISLANDA CUTIE CU 1 BLIST. PVC/AL X 2 C P6L 2 14.083392 19.111608 7.041696 26.153304 12.675052 20.519948
770 M05BB COMBIN FOSAVANCE 70mg/2800UI COMPR. 70mg/2800UI MERCK SHARP & MA CUTIE X 4 CO P-6 4 6.572249 11.917751 3.286124 15.203876 5.915024 12.574976
771 M05BB COMBIN FOSAVANCE 70mg/5600UI COMPR. 70mg/5600UI MERCK SHARP & MA CUTIE X 2 CO P-6 2 6.572249 11.102751 3.286124 14.388876 5.915024 11.759976
772 M05BB COMBIN FOSAVANCE 70mg/5600UI COMPR. 70mg/5600UI MERCK SHARP & MA CUTIE X 4 CO P-6 4 6.572249 10.515251 3.286124 13.801376 5.915024 11.172476
773 M05BB COMBIN DA-BONE 70 mg/5600 UI COMPR. 70mg/5600UI TEVA PHARM ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4 COMPR., AMBALAJ TIP CALENDAR P6L 4 6.572249 0.730251 3.286124 4.016376 5.915024 1.387476
774 N02AA OXYCODONUM*# OXYCONTIN 10 mg COMPR. CU ELIB. MODIF. 10 mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. PVC/A PS 60 0.437249 0.608584 0.218624 0.827209 0.393524 0.652309
775 N02AA OXYCODONUM*# OXYCONTIN 20 mg COMPR. CU ELIB. MODIF. 20 mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. PVC/A PS 60 0.874498 0.971835 0.437249 1.409084 0.787048 1.059285
776 N02AA OXYCODONUM*# OXYCONTIN 40 mg COMPR. CU ELIB. MODIF. 40 mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. PVC/A PS 60 1.748999 1.086334 0.874499 1.960834 1.574099 1.261234
777 N02AA OXYCODONUM*# OXYCONTIN 80 mg COMPR. CU ELIB. MODIF. 80mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. PVC/A PS 60 3.497999 1.584834 1.748999 3.333834 3.148199 1.934634
778 N02AA OXYCODONUM*# RELTEBON 10 mg COM 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. CU INCHIDERE SECURIZATA PT. COPII DIN PVC/PVDC/AL/PET/HARTIE X 60 COMPR. ELIB. PREL. PR, PS 60 0.437249 0.242417 0.218624 0.461042 0.393524 0.286142
779 N02AA OXYCODONUM*# RELTEBON 20 mg COM 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. CU INCHIDERE SECURIZATA PT. COPII DIN PVC/PVDC/AL/PET/HARTIE X 60 COMPR. ELIB. PREL. PR, PS 60 0.874498 0.325668 0.437249 0.762917 0.787048 0.413118
780 N02AA OXYCODONUM*# CLORHIDRAT DE OXICODONA TORREN COM 20mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC/PVDC/AL/PET/HARTIE X 60 COMPR. CU ELIB. PREL. PR, PS 60 0.874498 0.325668 0.437249 0.762917 0.787048 0.413118
781 N02AA OXYCODONUM*# RELTEBON 40 mg COM 40mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. CU INCHIDERE SECURIZATA PT. COPII DIN PVC/PVDC/AL/PET/HARTIE X 60 COMPR. ELIB. PREL. PR, PS 60 1.748999 0.194334 0.874499 1.068834 1.574099 0.369234
782 N02AA OXYCODONUM*# CLORHIDRAT DE OXICODONA TORREN COM 40mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC/PVDC/AL/PET/HARTIE X 60 COMPR. CU ELIB. PREL. PR, PS 60 1.748999 0.194334 0.874499 1.068834 1.574099 0.369234
783 N02AA OXYCODONUM*# RELTEBON 80 mg COM 80mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. CU INCHIDERE SECURIZATA PT. COPII DIN PVC/PVDC/AL/PET/HARTIE X 60 COMPR. ELIB. PREL. PR, PS 60 3.303666 0.000000 1.651833 1.651833 2.973299 0.330367
784 N02AA OXYCODONUM*# CLORHIDRAT DE OXICODONA TORREN COM 80mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC/PVDC/AL/PET/HARTIE X 60 COMPR. CU ELIB. PREL. PR, PS 60 3.304000 0.000000 1.652000 1.652000 2.973600 0.330400
785 N02AA OXYCODONUM*# OXIDOLOR 10 mg COMPR. 10mg LA AUSTRIA CUTIE CU BLIST. PVC P-T 60 0.437249 0.242417 0.218624 0.461042 0.393524 0.286142

Pagina 34 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
786 N02AA OXYCODONUM*# OXIDOLOR 20 mg COMPR. 20mg LA AUSTRIA CUTIE CU BLIST. PVC 60 P-T 0.874498 0.325668 0.437249 0.762917 0.787048 0.413118
787 N02AA OXYCODONUM*# OXIDOLOR 40 mg COMPR. 40mg LA AUSTRIA CUTIE CU BLIST. PVC 60 P-T 1.748999 0.194334 0.874499 1.068834 1.574099 0.369234
788 N02AA OXYCODONUM*# OXICODONA SANDOZ 40 mg COMPR. 40mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST PS 20 1.748999 0.297001 0.874499 1.171501 1.574099 0.471901
789 N02AA OXYCODONUM*# OXICODONA SANDOZ 60 mg COMPR. 60mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST PS 20 2.623501 4.606499 1.311750 5.918250 2.361150 4.868850
790 N02AA OXYCODONUM*# OXIDOLOR 80 mg COMPR. 80mg LA AUSTRIA CUTIE CU BLIST. PVC P-T 60 3.303666 0.000000 1.651833 1.651833 2.973299 0.330367
791 N02AA OXYCODONUM*# OXICODONA SANDOZ 80 mg COMPR. 80mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST PS 20 3.497999 0.048501 1.748999 1.797501 3.148199 0.398301
792 N02AA DIHYDROCODEINUM* DHC CONTINUS 120 mg COMPR. 120mg MUNDIPHARMA GE AUSTRIA CUTIE X 1 FLAC. DIN PP X 5 PS 56 1.366660 0.792447 0.683330 1.475777 1.229994 0.929113
793 N02AA DIHYDROCODEINUM* DHC CONTINUS 60 mg COMPR. 60mg MUNDIPHARMA GE AUSTRIA CUTIE X 1 FLAC. DIN PP X 5 PS 56 0.543750 0.000000 0.271875 0.271875 0.489375 0.054375
794 N02AA DIHYDROCODEINUM* DHC CONTINUS 90 mg COMPR. 90mg MUNDIPHARMA GE AUSTRIA CUTIE X 1 FLAC. DIN PP X 5 PS 56 1.024995 0.437147 0.512497 0.949645 0.922495 0.539647
795 N02AX COMBINATII (TRAMADOLU ZALDIAR (R) COMPR. FILM 37,5mg+325 GRUNENTHAL GMBH GERMANI CUTIE X 1 BLIST. PVC OPAC/ P-R 10 0.272875 0.534125 0.136437 0.670563 0.245587 0.561413
796 N02AX COMBINATII (TRAMADOLU TRAUMOBOL 37,5mg/325mg CAPS. 37,5mg/325 ROMPHARM COMP ROMANIA CUTIE X 2 BLISTERE PRF 30 0.272875 0.240791 0.136437 0.377229 0.245587 0.268079
797 N02AX COMBINATII (TRAMADOLU TRAUMOBOL 37,5mg/325mg CAPS. 37,5mg/325 ROMPHARM COMP ROMANIA CUTIE CU 1 BLIST. DIN PVC PRF 15 0.272875 0.253125 0.136437 0.389563 0.245587 0.280413
798 N02AX COMBINATII (TRAMADOLU ZALDIAR COMPR. FILM 37,5mg+325 STADA ARZNEIMIT GERMANI C P-R 10 0.272875 0.534125 0.136437 0.670563 0.245587 0.561413
799 N02AX COMBINATII (TRAMADOLU ZALDIAR COMPR. FILM 37,5mg+325 STADA ARZNEIMIT GERMANI C P-R 20 0.272875 0.533625 0.136437 0.670063 0.245587 0.560913
800 N02AX COMBINATII (TRAMADOLU ZALDIAR COMPR. FILM 37,5mg+325 STADA ARZNEIMIT GERMANI C P-R 30 0.272875 0.517125 0.136437 0.653563 0.245587 0.544413
801 N02AX COMBINATII (TRAMADOLU ZALDIAR COMPR. FILM 37,5mg+325 STADA ARZNEIMIT GERMANI C P-R 50 0.272875 0.387325 0.136437 0.523763 0.245587 0.414613
802 N02AX COMBINATII (TRAMADOLU DORETA 37,5mg/325mg COMPR. FILM 37,5mg/325 KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/ P-R 10 0.272875 0.000125 0.136437 0.136563 0.245587 0.027413
803 N02AX COMBINATII (TRAMADOLU DORETA 37,5mg/325mg COMPR. FILM 37,5mg/325 KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/ P-R 20 0.272500 0.000000 0.136250 0.136250 0.245250 0.027250
804 N02AX COMBINATII (TRAMADOLU PADOLTEN 37,5 mg/325 mg COMPR. FILM 37,5mg/325 S.C.TE ROMANIA CUTIE CU BLIST. PVC/AL X 10 C P-R 10 0.272875 0.252125 0.136437 0.388563 0.245587 0.279413
805 N02AX COMBINATII (TRAMADOLU PADOLTEN 37,5 mg/325 mg COMPR. FILM 37,5mg/325 S.C.TE ROMANIA CUTIE CU BLIST. PVC/AL X 20 C P-R 20 0.272875 0.251625 0.136437 0.388063 0.245587 0.278913
806 N02AX COMBINATII (TRAMADOLU LINEROL 37,5 mg/325 mg COMPR. FILM 37,5mg/325 PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE CU BLIST. PVC/AL X 20 C P-R 20 0.272875 0.251625 0.136437 0.388063 0.245587 0.278913
807 N02AX COMBINATII (TRAMADOLU DORETA 75 mg/650 mg COMPR. FILM 75 mg/650 m KRKA, D.D., NOVO SLOVENI CUTIE CU 1 BLIST. PVC-PVDC PRF 10 0.545000 0.000000 0.272500 0.272500 0.490500 0.054500
808 N02AX COMBINATII (TRAMADOLU DORETA 75 mg/650 mg COMPR. FILM 75 mg/650 m KRKA, D.D., NOVO SLOVENI CUTIE CU 2 BLIST. PVC-PVDC PRF 20 0.545500 0.000000 0.272750 0.272750 0.490950 0.054550
809 N02AX COMBINATII (TRAMADOLU PALGOTAL 75 mg/650 mg COMPR. FILM 75mg/650mg ZENTIVA, K.S. R CUTIE CU BLIST. PVC-PVCD PRF 30 0.537333 0.000000 0.268666 0.268667 0.483599 0.053734
810 N03AX PREGABALINUM**# LYRICA 150 mg CAPS. 150mg PFIZER LIMITED MA CUTIE X 14 CAPS., (BLIST. PVC/AL) P-R 14 2.957051 1.423663 1.478525 2.902189 2.661345 1.719369
811 N03AX PREGABALINUM**# LYRICA 150 mg CAPS. 150mg PFIZER LIMITED MA CUTIE X 56 CAPS., (BLIST. PVC/AL) P-R 56 2.957051 0.939199 1.478525 2.417725 2.661345 1.234905
812 N03AX PREGABALINUM**# LYRICA 300 mg CAPS. 300mg PFIZER LIMITED MA CUTIE X 56 CAPS. (BLIST. PVC/AL) P-R 56 5.731785 0.000000 2.865892 2.865893 5.158606 0.573179
813 N03AX PREGABALINUM**# LYRICA 300 mg CAPS. 300mg PFIZER LIMITED MA CUTIE X 14 CAPS. (BLIST. PVC/AL) P-R 14 5.914103 0.130897 2.957051 3.087949 5.322692 0.722308
814 N03AX PREGABALINUM**# LYRICA 75 mg CAPS. 75mg PFIZER LIMITED MA CUTIE X 14 CAPS., (BLIST. PVC/AL) P-R 14 1.478525 1.154332 0.739262 1.893595 1.330672 1.302185
815 N03AX PREGABALINUM**# LYRICA 75 mg CAPS. 75mg PFIZER LIMITED MA CUTIE X 56 CAPS., (BLIST. PVC/AL) P-R 56 1.478525 0.935403 0.739262 1.674666 1.330672 1.083256
816 N04BC PRAMIPEXOLUM* PRAMIPEXOLE ACCORD 0,088 mg COMPR. 0,088 mg ACCORD HEA MA CUTIE CU 3 BLIST. AL-PVC/A PRF 30 0.087075 0.436258 0.043537 0.479796 0.078367 0.444966
817 N04BC PRAMIPEXOLUM* OPRYMEA 0,088mg COMPR. 0,088mg KRKA D.D. SLOVENI CUTIE X 30 COMPR. (BLIST. AL/AL) P-R 30 0.087075 0.442925 0.043537 0.486463 0.078367 0.451633
818 N04BC PRAMIPEXOLUM* PRAMIPEXOLE ACCORD 0,18 mg COMPR. 0,18 mg ACCORD HEA MA CUTIE CU 3 BLIST. AL-PVC/A PRF 30 0.178109 0.144557 0.089054 0.233612 0.160298 0.162368
819 N04BC PRAMIPEXOLUM* PRAMIPEXOLE ACCORD 0,18 mg COMPR. 0,18 mg ACCORD HEA MA CUTIE CU 10 BLIST. AL-PVC/ PRF 100 0.178109 0.144391 0.089054 0.233446 0.160298 0.162202
820 N04BC PRAMIPEXOLUM* PRAMIPEXOL ZENTIVA 0,18 mg COMPR. 0,18 mg ZENTIVA, K.S. R CUTIE CU 3 BLIST. OPA-AL-PV PRF 30 0.178109 0.208557 0.089054 0.297612 0.160298 0.226368
821 N04BC PRAMIPEXOLUM* OPRYMEA 0,18mg COMPR. 0,18mg KRKA D.D. SLOVENI CUTIE X 30 COMPR. (BLIST. AL/AL) P-R 30 0.178109 0.248557 0.089054 0.337612 0.160298 0.266368
822 N04BC PRAMIPEXOLUM* MEDOPEXOL 0,18 mg COMPR. 0,18mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC PRF 30 0.178109 0.473224 0.089054 0.562279 0.160298 0.491035
823 N04BC PRAMIPEXOLUM* GLEPARK 0,18 mg COMPR. 0,18mg G R CUTIE CU BLIST. AL/AL X 30 COMPR P-R 30 0.178109 0.144557 0.089054 0.233612 0.160298 0.162368
824 N04BC PRAMIPEXOLUM* PRAMIPEXOL TORRENT 0,18 mg COMPR. 0,18mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC P-R 30 0.178109 0.412557 0.089054 0.501612 0.160298 0.430368
825 N04BC PRAMIPEXOLUM* PRAMIPEXOL AUROBINDO 0,18 mg COMPR. 0,18mg AU MALTA CUTIE CU BLIST. PA/AL/PVC-AL PRF 30 0.178109 0.345224 0.089054 0.434279 0.160298 0.363035
826 N04BC PRAMIPEXOLUM* MIGLASEN 0,18 mg COMPR. 0,18mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PV P6L 30 0.178109 0.335891 0.089054 0.424946 0.160298 0.353702
827 N04BC PRAMIPEXOLUM* PRAMIPEXOL AUROBINDO 0,7 mg COMPR. 0,7 mg AU MALTA CUTIE CU BLIST. PA/AL/PVC-AL PRF 30 0.692649 1.196684 0.346324 1.543009 0.623384 1.265949
828 N04BC PRAMIPEXOLUM* PRAMIPEXOL ZENTIVA 0,7 mg COMPR. 0,7 mg ZENTIVA, K.S. R CUTIE CU 3 BLIST. OPA-AL-PV PRF 30 0.692649 1.416351 0.346324 1.762676 0.623384 1.485616
829 N04BC PRAMIPEXOLUM* OPRYMEA 0,7mg COMPR. 0,7mg KRKA D.D. SLOVENI CUTIE X 30 COMPR. (BLIST. AL/AL) P-R 30 0.692649 1.335351 0.346324 1.681676 0.623384 1.404616
830 N04BC PRAMIPEXOLUM* MEDOPEXOL 0,7 mg COMPR. 0,7mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC PRF 30 0.692649 1.341684 0.346324 1.688009 0.623384 1.410949
831 N04BC PRAMIPEXOLUM* GLEPARK 0,7 mg COMPR. 0,7mg G R CUTIE CU BLIST. AL/AL X 30 COMPR P-R 30 0.692649 1.564017 0.346324 1.910342 0.623384 1.633282
832 N04BC PRAMIPEXOLUM* PRAMIPEXOLE ACCORD 0,7mg COMPR. 0,7mg ACCORD HEA MA CUTIE CU 3 BLIST. AL-PVC/A PRF 30 0.692649 1.196684 0.346324 1.543009 0.623384 1.265949
833 N04BC PRAMIPEXOLUM* PRAMIPEXOL TORRENT 0,7 mg COMPR. 0,7mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC P-R 30 0.692649 1.745351 0.346324 2.091676 0.623384 1.814616
834 N04BC PRAMIPEXOLUM* PRAMIPEXOL STADA 0,7 mg COMPR. 0,7mg STADA ARZNEIMIT GERMANI CUTIE X 3 BLIST. OPA-AL -PVC P-R 30 0.692649 1.334684 0.346324 1.681009 0.623384 1.403949
835 N04BC PRAMIPEXOLUM* PRAMIPEXOLE ACCORD 0,7mg COMPR. 0,7mg ACCORD HEA MA CUTIE CU 10 BLIST. AL-PVC/ PRF 100 0.692649 1.008751 0.346324 1.355076 0.623384 1.078016
836 N04BC PRAMIPEXOLUM* MIGLASEN 0,7 mg COMPR. 0,7mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PV P6L 30 0.692649 1.755017 0.346324 2.101342 0.623384 1.824282
837 N04BC PRAMIPEXOLUM* MIRAPEXIN 0,26 mg COMPR. 0,26mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 1 BLIST.OPA-AL-P P-R 10 0.257269 1.261731 0.128634 1.390366 0.231542 1.287458
838 N04BC PRAMIPEXOLUM* OPRYMEA 0,26mg COMPR. 0,26mg KRKA D.D. SLOVENI P-R 30
CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA 0.257269 0.378731 0.128634 0.507366 0.231542 0.404458
839 N04BC PRAMIPEXOLUM* CALMOLAN 0,26 mg COMPR. 0,26mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLI PRF 10 0.257269 0.378731 0.128634 0.507366 0.231542 0.404458
840 N04BC PRAMIPEXOLUM* MIRAPEXIN 0,52 mg COMPR. 0,52mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST.OPA-AL-P P-R 30 0.514539 1.638794 0.257269 1.896064 0.463085 1.690248
841 N04BC PRAMIPEXOLUM* OPRYMEA 0,52mg COMPR. 0,52mg KRKA D.D. SLOVENI P-R 30
CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA 0.514539 0.885127 0.257269 1.142397 0.463085 0.936581
842 N04BC PRAMIPEXOLUM* CALMOLAN 0,52 mg COMPR. 0,52mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLI PRF 30 0.514539 0.885127 0.257269 1.142397 0.463085 0.936581
843 N04BC PRAMIPEXOLUM* MIRAPEXIN 1,05 mg COMPR. 1,05mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST.OPA-AL-P P-R 30 1.038974 3.063026 0.519487 3.582513 0.935076 3.166924
844 N04BC PRAMIPEXOLUM* OPRYMEA 1,05mg COMPR. 1,05mg KRKA D.D. SLOVENI P-R 30
CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA 1.038974 1.086026 0.519487 1.605513 0.935076 1.189924
845 N04BC PRAMIPEXOLUM* OPRYMEA 1,57mg COMPR. 1,57mg KRKA D.D. SLOVENI P-R 30
CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA 1.553513 3.495820 0.776756 4.272577 1.398161 3.651172
846 N04BC PRAMIPEXOLUM* OPRYMEA 2,10mg COMPR. 2,10mg KRKA D.D. SLOVENI P-R 30
CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA 2.077948 2.644385 1.038974 3.683359 1.870153 2.852180
847 N04BC PRAMIPEXOLUM* MIRAPEXIN 2,1 mg COMPR. 2,1mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST.OPA-AL-P P-R 30 2.077948 5.187052 1.038974 6.226026 1.870153 5.394847
848 N04BC PRAMIPEXOLUM* CALMOLAN 2,1 mg COMPR. 2,1mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLI PRF 30 2.077948 2.644385 1.038974 3.683359 1.870153 2.852180
849 N04BC PRAMIPEXOLUM* OPRYMEA 2,62 mg COMPR. 2,62mg KRKA, D.D., NOVO SLOVENI CUTIE PRF 30 2.592487 5.834179 1.296243 7.130423 2.333238 6.093428
850 N04BC PRAMIPEXOLUM* MIRAPEXIN 3,15 mg COMPR. 3,15mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST.OPA-AL-P P-R 30 3.116922 8.833078 1.558461 10.391539 2.805229 9.144771
851 N04BC PRAMIPEXOLUM* OPRYMEA 3,15 mg COMPR. 3,15mg KRKA, D.D., NOVO SLOVENI CUTIE PRF 30 3.116922 4.650411 1.558461 6.208872 2.805229 4.962104

Pagina 35 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
852 N04BC PIRIBEDILUM** PRONORAN 50 mg DRAJ. ELIB 50mg LES LABORATOI FRANTA CUTIE X 2 BLIST. AL/PVC X P-R 30 0.618436 0.316897 0.309218 0.626115 0.556592 0.378741
853 N05AL TIAPRIDUM TIAPRIDAL (R) 100 mg COMPR. 100mg SANOFI-SYNT FRANTA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.402000 0.000000 0.201000 0.201000 0.361800 0.040200
854 N05BE BUSPIRONUM SPITOMIN 10 mg COMPR. 10mg EGIS PHARMA UNGARIA CUTIE X 6 BLIST. AL/OPA-AL- P-R 60 0.246333 0.000000 0.123166 0.123167 0.221699 0.024634
855 N05BE BUSPIRONUM SPITOMIN 5 mg COMPR. 5mg EGIS PHARMA UNGARIA CUTIE X 6 BLIST. AL/OPA-AL- P-R 60 0.129916 0.020250 0.064958 0.085208 0.116924 0.033242
856 N06AB ESCITALOPRAMUM** DEPRESINAL 10 mg COMPR. FILM 10 mg LA AUSTRIA CUTIE CU BLIST. OPA-AL-P P-R 30 0.778666 0.000000 0.389333 0.389333 0.700799 0.077867
857 N06AB ESCITALOPRAMUM** CIPRALEX 10 mg COMPR. FILM 10mg H. LUNDBECK A/S DANEM CUTIE X 2 BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 14 COMPR. FILM. P-R 28 1.171606 0.092679 0.585803 0.678482 1.054445 0.209840
858 N06AB ESCITALOPRAMUM** ESCITIL 10 mg COMPR. FILM 10mg EGIS PHARMA UNGARIA CUTIE CU BLIST. OPA-AL-P P-R 28 0.848928 0.000000 0.424464 0.424464 0.764035 0.084893
859 N06AB ESCITALOPRAMUM** ESCITALOPRAM-TEVA 10 mg COMPR. FILM 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/ P-R 30 0.776000 0.000000 0.388000 0.388000 0.698400 0.077600
860 N06AB ESCITALOPRAMUM** LENUXIN 10 mg COMPR. FILM 10mg GEDEON RIC ROMANIA CUTIE CU BLIST. OPA-AL-P P-R 28 0.848928 0.000000 0.424464 0.424464 0.764035 0.084893
861 N06AB ESCITALOPRAMUM** ESLOREX 10 mg COMPR. FILM 10mg ZENTIVA K.S. CEHIA CUTIE CU BLIST. OPA-AL-P PRF 30 0.780666 0.000000 0.390333 0.390333 0.702599 0.078067
862 N06AB ESCITALOPRAMUM** SERODEPS 10mg COMPR. FILM 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. AL/P P-R 28 0.780357 0.000000 0.390178 0.390179 0.702321 0.078036
863 N06AB ESCITALOPRAMUM** ESTAN 10 mg COMPR. FILM 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PV PRF 14 0.848571 0.000000 0.424285 0.424286 0.763713 0.084858
864 N06AB ESCITALOPRAMUM** ESTAN 10 mg COMPR. FILM 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PV PRF 28 0.848928 0.000000 0.424464 0.424464 0.764035 0.084893
865 N06AB ESCITALOPRAMUM** ESCITALOPRAM ACTAVIS 10 mg COMPR. FILM 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVDC/PVD PRF 28 0.778214 0.000000 0.389107 0.389107 0.700392 0.077822
866 N06AB ESCITALOPRAMUM** ELICEA 10 mg COMPR. FILM 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P PRF 30 0.780666 0.000000 0.390333 0.390333 0.702599 0.078067
867 N06AB ESCITALOPRAMUM** ESCITALOPRAM AUROBINDO 10 mg COMPR. FILM 10mg AUROBINDO PH MA CUTIE CU BLIST. PVC-ACLA PRF 28 0.778214 0.000000 0.389107 0.389107 0.700392 0.077822
868 N06AB ESCITALOPRAMUM** ESCITALOPRAM ATB 10 mg COMPR. FILM 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/ PRF 28 0.765000 0.000000 0.382500 0.382500 0.688500 0.076500
869 N06AB ESCITALOPRAMUM** ESCITALOPRAM TORRENT 10 mg COMPR. FILM 10mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC PRF 28 0.848928 0.000000 0.424464 0.424464 0.764035 0.084893
870 N06AB ESCITALOPRAMUM** ESCITALOPRAM-TEVA 15 mg COMPR. FILM 15mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/ P-R 30 1.130333 0.000000 0.565166 0.565167 1.017299 0.113034
871 N06AB ESCITALOPRAMUM** ELICEA 15 mg COMPR. FILM 15mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P PRF 30 1.369000 0.000000 0.684500 0.684500 1.232100 0.136900
872 N06AB ESCITALOPRAMUM** ESCITALOPRAM-TEVA 20 mg COMPR. FILM 20mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/ P-R 30 1.370000 0.000000 0.685000 0.685000 1.233000 0.137000
873 N06AB ESCITALOPRAMUM** SERODEPS 20mg COMPR. FILM 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. AL/P P-R 28 1.359642 0.000000 0.679821 0.679821 1.223677 0.135965
874 N06AB ESCITALOPRAMUM** ESCITALOPRAM TORRENT 20 mg COMPR. FILM 20mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC PRF 28 2.268571 0.000000 1.134285 1.134286 2.041713 0.226858
875 N06AB ESCITALOPRAMUM** ESCITALOPRAM ACTAVIS 20 mg COMPR. FILM 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVDC/PVD PRF 28 1.399642 0.000000 0.699821 0.699821 1.259677 0.139965
876 N06AB ESCITALOPRAMUM** ELICEA 20 mg COMPR. FILM 20mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P PRF 30 1.406000 0.000000 0.703000 0.703000 1.265400 0.140600
877 N06AB ESCITALOPRAMUM** ELICEA Q-TAB 10 mg COMPR. ORODISPERSABILE 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET X 28 COMPR. ORODIPSERSABILE PRF 28 0.780357 0.000000 0.390178 0.390179 0.702321 0.078036
878 N06AB ESCITALOPRAMUM** ELICEA Q-TAB 10 mg COMPR. ORODISPERSABILE 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET-HARTIE X 28 COMPR. ORODIPSERSABILE PRF 28 0.780357 0.000000 0.390178 0.390179 0.702321 0.078036
879 N06AB ESCITALOPRAMUM** ESCITALOPRAM TEVA 10 mg COMPR. ORODISPERSABILE 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. HARTIE-PET-AL/PVC-AL-OPA X 30 COMPR. ORODISPERSABILE PRF 30 0.933666 0.000000 0.466833 0.466833 0.840299 0.093367
880 N06AB ESCITALOPRAMUM** ELICEA Q-TAB 15 mg COMPR. ORODISPERSABILE 15mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET-HARTIE X 28 COMPR. ORODIPSERSABILE PRF 28 1.369285 0.000000 0.684642 0.684643 1.232356 0.136929
881 N06AB ESCITALOPRAMUM** ELICEA Q-TAB 15 mg COMPR. ORODISPERSABILE 15mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET X 28 COMPR. ORODIPSERSABILE PRF 28 1.351071 0.000000 0.675535 0.675536 1.215963 0.135108
882 N06AB ESCITALOPRAMUM** ELICEA Q-TAB 20 mg COMPR. ORODISPERSABILE 20mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET-HARTIE X 28 COMPR. ORODIPSERSABILE PRF 28 1.576785 0.000000 0.788392 0.788393 1.419106 0.157679
883 N06AB ESCITALOPRAMUM** ELICEA Q-TAB 20 mg COMPR. ORODISPERSABILE 20mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET X 28 COMPR. ORODIPSERSABILE PRF 28 1.576785 0.000000 0.788392 0.788393 1.419106 0.157679
884 N06AB ESCITALOPRAMUM** ESCITALOPRAM TEVA 20 mg COMPR. ORODISPERSABILE 20mg TEVA PHARM ROMANIA CUTIE CU BLIST. HARTIE-PET-AL/PVC-AL-OPA X 30 COMPR. ORODISPERSABILE PRF 30 1.369000 0.000000 0.684500 0.684500 1.232100 0.136900
885 N06AX TRAZODONUM** TRITTICO AC 150 mg COMPR. 150mg ANGELINI FRANC ITALIA CUTIE X 1 BLIST. AL/PVC X P-R 20 1.137124 0.126876 0.568562 0.695438 1.023411 0.240589
886 N06AX TRAZODONUM** TRITTICO AC 150 mg COMPR. 150mg ANGELINI FRANC ITALIA CUTIE X 6 BLIST. AL/PVC X P-R 60 1.094833 0.000000 0.547416 0.547417 0.985349 0.109484
887 N06AX TRAZODONUM** TRITTICO AC 150 mg COMPR. 150mg ANGELINI FRANC ITALIA CUTIE X 3 BLIST. AL/PVC X P-R 60 1.094833 0.000000 0.547416 0.547417 0.985349 0.109484
888 N06AX TRAZODONUM** TRITTICO AC 150 mg COMPR. 150mg ANGELINI FRANC ITALIA CUTIE X 2 BLIST. AL/PVCX 1 P-R 20 1.137124 0.126876 0.568562 0.695438 1.023411 0.240589
889 N06AX TRAZODONUM** TRITTICO AC 75 mg COMPR. 75mg ANGELINI FRANC ITALIA CUTIE X 2 BLIST. AL/PVC X P-R 30 0.568562 0.076104 0.284281 0.360385 0.511705 0.132961
890 N06AX TRAZODONUM** TRITTICO AC 75 mg COMPR. 75mg ANGELINI FRANC ITALIA CUTIE X 1 BLIST. AL/PVC X P-R 30 0.568562 0.076104 0.284281 0.360385 0.511705 0.132961
891 N06AX BUPROPIONUM**# ELONTRIL 150 mg COMPR. 150mg GLAXOSMITHKL ROMANIA CUTIE C P-R 30 1.950333 0.000000 0.975166 0.975167 1.755299 0.195034
892 N06AX TIANEPTINUM** LYXIT 12,5 mg COMPR. FILM 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN P PRF 30 0.460333 0.000000 0.230166 0.230167 0.414299 0.046034
893 N06AX TIANEPTINUM** LYXIT 12,5 mg COMPR. FILM 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN P PRF 90 0.445222 0.000000 0.222611 0.222611 0.400699 0.044523
894 N06AX TIANEPTINUM** NOBIXAL 12,5 mg COMPR. FILM 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/PVDC- PRF 30 0.460333 0.000000 0.230166 0.230167 0.414299 0.046034
895 N06AX TIANEPTINUM** NOBIXAL 12,5 mg COMPR. FILM 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/ACLA PRF 30 0.460333 0.000000 0.230166 0.230167 0.414299 0.046034
896 N06AX TIANEPTINUM** COAXIL (R) DRAJ. 12,5mg LES LAB. SERVIER I FRANTA CUTIE X 1 BLIST. AL/PVC X 30 DRAJ P-R 30 0.460333 0.247333 0.230166 0.477500 0.414299 0.293367
897 N06AX DULOXETINUM** CYMBALTA 30mg CAPS. G 30mg ELI LILLY NEDER OLANDA CUTIE X 28 C P-R 28 1.529196 1.410804 0.764598 2.175402 1.376276 1.563724
898 N06AX DULOXETINUM** DULSEVIA 30 mg CAPS. G 30mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. PRF 30 1.529196 0.482804 0.764598 1.247402 1.376276 0.635724
899 N06AX DULOXETINUM** ZATINEX 30 mg CAPS. G 30mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLI PRF 28 1.529196 0.409375 0.764598 1.173973 1.376276 0.562295
900 N06AX DULOXETINUM** ZATINEX 30 mg CAPS. G 30mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PV PRF 28 1.529196 0.409375 0.764598 1.173973 1.376276 0.562295
901 N06AX DULOXETINUM** DULOXETINA DR. REDDY'S 30 mg CAPS. G 30mg DR. REDDY'S L ROMANIA CUTIE CU BLI PRF 28 1.529196 0.482589 0.764598 1.247187 1.376276 0.635509
902 N06AX DULOXETINUM** CYMBALTA 60mg CAPS. G 60mg ELI LILLY NEDER OLANDA CUTIE, X 28 CAPS P-R 28 3.058392 1.504465 1.529196 3.033661 2.752552 1.810305
903 N06AX DULOXETINUM** DULSEVIA 60 mg CAPS. G 60mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. PRF 30 2.929333 0.000000 1.464666 1.464667 2.636399 0.292934
904 N06AX DULOXETINUM** ZATINEX 60 mg CAPS. G 60mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLI PRF 28 3.044642 0.000000 1.522321 1.522321 2.740177 0.304465
905 N06AX DULOXETINUM** ZATINEX 60 mg CAPS. G 60mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PV PRF 28 3.044642 0.000000 1.522321 1.522321 2.740177 0.304465
906 N06AX DULOXETINUM** DULOXETINA DR. REDDY'S 60 mg CAPS. G 60mg DR. REDDY'S L ROMANIA CUTIE CU BLI PRF 28 3.058392 0.013750 1.529196 1.542946 2.752552 0.319590
907 N06AX DULOXETINUM** DULOXETINE ZENTIVA 60 mg CAPS. G 60mg ZENTIVA, K.S. R CUTIE CU BLIST. P PRF 28 3.058392 0.013750 1.529196 1.542946 2.752552 0.319590
908 N06BX PRAMIRACETAMUM**# PRAMISTAR COMPR. FILM 600mg F.I.R.M. ITALIA CUTIE X 2 BLIST. PA-AL-PVC P-6 20 3.661500 0.000000 1.830750 1.830750 3.295350 0.366150
909 N06BX VINPOCETINUM VINPOCETINA VIM SPECTRUM 5 mg CAPS. 5mg VIM SPECTRUM SRL ROMANIA CUTIE X 5 BLIST. X PVC/AL X10 CA P6L 50 0.163400 0.000000 0.081700 0.081700 0.147060 0.016340
910 N06BX VINPOCETINUM CAVINTON(R) FORTE COMPR. 10mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. X 15 COMPR. P-6 30 0.362232 0.035434 0.181116 0.216550 0.326008 0.071658
911 N06BX VINPOCETINUM CAVINTON(R) COMPR. 5mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 25 COM P-6 50 0.181116 0.070084 0.090558 0.160642 0.163004 0.088196
912 N07CA BETAHISTINUM VERTIMED 16 mg COMPR. 16mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVD P6L 30 0.317360 0.041640 0.158680 0.200320 0.285624 0.073376
913 N07CA BETAHISTINUM BETAHISTINA LPH 16 mg COMPR. 16mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC P-6 30 0.317360 0.264973 0.158680 0.423653 0.285624 0.296709
914 N07CA BETAHISTINUM BETAHISTINA DICLORHIDRAT AURO COMPR. 16mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/AL P6L 60 0.276000 0.000000 0.138000 0.138000 0.248400 0.027600
915 N07CA BETAHISTINUM EMPERIN 24 mg COMPR. 24 mg EGIS PHARMA UNGARIA CUTIE CU BLIST. DIN PVC-PV P6L 60 0.432500 0.000000 0.216250 0.216250 0.389250 0.043250
916 N07CA BETAHISTINUM BETAHISTINA LPH 24 mg COMPR. 24 mg LABORMED PHARMA ROMANIA CUTIE CU 6 BLIST. DIN PVC P-6 60 0.476041 0.000125 0.238020 0.238146 0.428436 0.047730
917 N07CA BETAHISTINUM BETAHISTIN MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE P-6 20 0.476000 0.000000 0.238000 0.238000 0.428400 0.047600

Pagina 36 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
918 N07CA BETAHISTINUM BETAHISTIN MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE P-6 50 0.476041 0.000159 0.238020 0.238180 0.428436 0.047764
919 N07CA BETAHISTINUM BETASERC 24 mg COMPR. 24mg AB OLANDA CUTIE CU 1 BLIST. PVC-PVDC P-6 20 0.476041 0.256459 0.238020 0.494480 0.428436 0.304064
920 N07CA BETAHISTINUM VERTIMED 24 mg COMPR. 24mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVD P6L 30 0.437000 0.000000 0.218500 0.218500 0.393300 0.043700
921 N07CA BETAHISTINUM VERTIMED 24 mg COMPR. 24mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVD P6L 60 0.437333 0.000000 0.218666 0.218667 0.393599 0.043734
922 N07CA BETAHISTINUM VESTIBO 24 mg COMPR. 24mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC/AL P6L 30 0.424333 0.000000 0.212166 0.212167 0.381899 0.042434
923 N07CA BETAHISTINUM MARBETA 24 mg COMPR. 24mg MEDREG S.R.O. R CUTIE CU 6 BLIST. PVC-PVDC P6L 60 0.476041 0.000125 0.238020 0.238146 0.428436 0.047730
924 N07CA BETAHISTINUM BETAHISTIN MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE P-6 60 0.476041 0.000125 0.238020 0.238146 0.428436 0.047730
925 N07CA BETAHISTINUM BETAHISTINA DICLORHIDRAT AURO COMPR. 24mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/AL P6L 60 0.354166 0.000000 0.177083 0.177083 0.318749 0.035417
926 N07CA BETAHISTINUM MARBETA 24 mg COMPR. 24mg G R CUTIE CU 6 BLIST. PVC-PVDC P6L 60 0.476041 0.000125 0.238020 0.238146 0.428436 0.047730
927 N07CA BETAHISTINUM BETASERC 24 mg COMPR. 24mg AB OLANDA CUTIE CU 3 BLIST. PVC-PVDC P6L 60 0.476041 0.232959 0.238020 0.470980 0.428436 0.280564
928 N07CA BETAHISTINUM BETAHISTIN MCC 8 mg COMPR. 8mg MAGISTRA C&C SRL ROMANIA CUTIE P-6 30 0.158680 0.031320 0.079340 0.110660 0.142812 0.047188
929 N07CA BETAHISTINUM BETASERC 8 mg COMPR. 8mg AB OLANDA CUTIE CU 4 BLIST. PVC-PVDC P-6 100 0.158680 0.133420 0.079340 0.212760 0.142812 0.149288
930 N07CA BETAHISTINUM BETAHISTINA LPH 8 mg COMPR. 8mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC P-6 30 0.158680 0.030986 0.079340 0.110326 0.142812 0.046854
931 N07CA BETAHISTINUM BETAHISTIN MCC 8 mg COMPR. 8mg MAGISTRA C&C SRL ROMANIA CUTIE CU 10 BLIST. PVC-PVDC-TE TRANSPARENT/AL X 10 COMPR. P-6 100 0.158680 0.031120 0.079340 0.110460 0.142812 0.046988
932 N07CA BETAHISTINUM MARBETA 8 mg COMPR. 8mg MEDREG S.R.O. R CUTIE CU 10 BLIST. PVC-PV P6L 100 0.158680 0.031120 0.079340 0.110460 0.142812 0.046988
933 N07CA BETAHISTINUM BETAHISTINA LPH 8 mg COMPR. 8mg LABORMED PHARMA ROMANIA CUTIE CU 9 BLIST. PVC-PVDC P-6 90 0.158680 0.031208 0.079340 0.110548 0.142812 0.047076
934 N07CA BETAHISTINUM BETAHISTINA DICLORHIDRAT AUROBI COMPR. 8mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/AL P6L 100 0.158680 0.021020 0.079340 0.100360 0.142812 0.036888
935 N07CA BETAHISTINUM MARBETA 8 mg COMPR. 8mg G R CUTIE CU 10 BLIST. PVC-PV P6L 100 0.158680 0.031120 0.079340 0.110460 0.142812 0.046988
936 N07CA BETAHISTINUM ACUVER 8 mg/doza SOL. ORALA 8mg/doza CYATHUS EXQUIRERE PHARMAFORSCHUNGS GMBH AUSTRIA CUTIE X 1 FLAC. STICLA P-6 1 11.901037 17.048963 5.950518 22.999482 10.710933 18.239067
937 N07CA BETAHISTINUM ACUVER 8 mg/doza SOL. ORALA 8mg/doza CYATHUS EXQUIRERE PHARMAFORSCHUNGS GMBH AUSTRIA CUTIE X 1 FLAC. ST P-6 1 23.802075 16.477925 11.901037 28.378963 21.421867 18.858133
938 N07CA COMBINATII (CINARIZINUM ARLEVERT COMPR. F HE GERMANI CUTIE X 2 BLIST. PVC-PVDC/AL P-R 48 1.586666 0.000000 0.793333 0.793333 1.427999 0.158667
939 N07XN ACIDUM TIOCTICUM (ALFA-LIPOI THIOCTACID (R) 600 HR (vezi A16AX01) COMPR. FILM 600mg MEDA PHAR GERMANI CUTIE X 1 FLAC. X 30 COMPR. FILM P-6 30 1.899050 0.468616 0.949525 1.418141 1.709145 0.658521
940 N07XN ACIDUM TIOCTICUM (ALFA-LIPOI THIOCTACID (R) 600 HR (vezi A16AX01) COMPR. FILM 600mg MEDA PHAR GERMANI CUTIE X 1 FLAC. X 100 COMPR. FIL P-6 100 1.899050 0.307050 0.949525 1.256575 1.709145 0.496955
941 N07X HIDROLIZAT DE PROT CEREBROLYSIN 215,2 mg/ml SOL. INJ./CONC. PT. SOL. PERF. 215,2mg/ml EVER NEURO P AUSTRIA CUTIE CU 5 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE X 10 ML SOL. INJ./CONC. PT. SOL. PERF. PR/PRF 5 25.828000 0.000000 12.914000 12.914000 23.245200 2.582800
942 N07X HIDROLIZAT DE PROT CEREBROLYSIN 215,2 mg/ml SOL. INJ./CONC. PT. SOL. PERF. 215,2mg/ml EVER NEURO P AUSTRIA CUTIE CU 5 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE X 5 ML SOL. INJ./CONC. PT. SOL. PERF. PR/PRF 5 15.321000 2.407000 7.660500 10.067500 13.788900 3.939100
943 N07X HIDROLIZAT DE PROT CEREBROLYSIN 215,2 mg/ml SOL. INJ./CONC. PT. SOL. PERF. 215,2mg/ml EVER NEURO P AUSTRIA CUTIE CU 10 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE X 1 ML SOL. INJ./CONC. PT. SOL. PERF. PR/PRF 10 3.064200 1.004800 1.532100 2.536900 2.757780 1.311220
944 P01BA HYDROXYCHLOROQUINUM PLAQUENIL COMPR. FILM 200mg SANOFI - ROMANIA CUTIE X 6 BLIST. X 10 COMPR. FILM P-6 60 0.542833 0.000000 0.271416 0.271417 0.488549 0.054284
945 P01BA HYDROXYCHLOROQUINUM PLAQUENIL 200 mg COMPR. FILM 200mg SANOFI ROMANIA S. ROMANIA CUTIE CU 4 BLISTER P-6 60 0.542833 0.000000 0.271416 0.271417 0.488549 0.054284
946 R01AD BUDESONIDUM* RHINOCORT AQUA 32 micrograme/doza SPRAY N 32microg ASTRAZENECA AB SUEDIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 10 ML SPRAY NAZAL, SUSP. ECHIVALENT CU 120 DOZE, PREVAZUT CU POMPA DOZATOARE, APLICATOR SI CAPAC DE PROTECTIE
PRF 1 26.220000 0.000000 13.110000 13.110000 23.598000 2.622000
947 R01AD FLUTICASONUM* FLIXONASE 0,05g/100g SPRAY N 0,05g/100g GLAXOWELLCOME MA CUT P-R 1 28.340000 0.000000 14.170000 14.170000 25.506000 2.834000
948 R01AD MOMETASONUM* MOMETAZONA FUROAT CIPLA 50 micr SPRAY NAZ 50microg CIPLA (EU) LIMITED MA CUTIE CU UN FLAC. DIN PEID, PREVAZUT CU POMPA DOZATOARE MANUALA DIN PP CARE CONTINE 18 G SUSPENSIE, ECHIVALENT CU 140 DOZE
PRF 1 22.707500 0.002500 11.353750 11.356250 20.436750 2.273250
949 R01AD MOMETASONUM* KALMENTE 50 micrograme/doza SPRAY NAZ 50microg ALVOGEN IPCO S.AR LUXEM CUTIE CU 1 FLAC. PEID PREVAZUT CU POMPA DOZATOARE SI APLICATOR NAZAL CARE CONTINE SPRAY NAZAL, SUSP. PT. 140 PULVERIZARI PRF 1 22.700000 0.000000 11.350000 11.350000 20.430000 2.270000
950 R01AD MOMETASONUM* MOMETAZONA FUROAT SANDOZ 50 SPRAY NA 50microg SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. PEID PREVAZUT CU O POMPA PULVERIZATOARE NAZALA DIN PE/PP CARE CONTINE 18 G SUSP. NAZALA CORESPUNZATOR LA 140 DOZE MASURATE
PRF 1 22.707500 0.002500 11.353750 11.356250 20.436750 2.273250
951 R01AD MOMETASONUM* NASONEX 50mcg/doza SPRAY N 50mcg/doza MERCK SHARP & ROMANIA CUTIE X 1 FLACON DIN PE PREVAZUT CU POMPA DOZATOARE, DISPOZITIV DE ACTIONARE DIN PP SI CAPAC, CU UN VOLUM DE 23,5 ML SUSPENSIE PT. 140 PULVERIZARI SPRAY NAZAL, SUSPENSIE
P-R 1 22.707500 11.092500 11.353750 22.446250 20.436750 13.363250
952 R03AC FENOTEROLUM BEROTEC N - 100 mcg SOL. DE INHALAT PRESURIZATA 100mcg/doza BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 1 FLACON PRESURIZAT X 200 DOZE SOL. DE INHALAT PRESURIZATA P-6 1 16.660000 0.000000 8.330000 8.330000 14.994000 1.666000
953 R03AC INDACATEROLUM** ONBREZ BREEZHALER 150 g CAPS 150 g NOVARTIS EURO MA CUTIECU BLIST. DIN PA/AL/PVC X 30 CAPSULE (3 BIST X10)+ UN INHALATOR PRF 30 2.685625 1.611375 1.342812 2.954188 2.417062 1.879938
954 R03AC INDACATEROLUM** ONBREZ BREEZHALER 300 g CAPS 300 g NOVARTIS EURO MA CUTIE CU BLIST. DIN PA/AL/PVC X 30 CAPSULE (1 BLIST. X10)+ UN INHALATOR PRF 30 4.297000 0.000000 2.148500 2.148500 3.867300 0.429700
955 R03AK COMBINATII (FENOTEROLUM BERODUAL (R) N AEROS 0,020mg+ BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE X 1 FLACON PRESURIZAT DIN OTEL X 200 DOZE SOLUTIE DE INHALAT PRESURIZATA P-6 1 33.540000 0.000000 16.770000 16.770000 30.186000 3.354000
956 R03AK SALMETEROLUM+FLUTICASONUM SERETIDE DISKUS 50/100 PULB. INHAL. 50mg/100mg GLAXO WELLC MA CUTIE X 1DI P-6 1 36.422000 70.538000 18.211000 88.749000 32.779800 74.180200
957 R03AK SALMETEROLUM+FLUTICASONUM SERETIDE DISKUS 50/250 PULB. INHAL. 50mg/250mg GLAXOWELLCOME MA CUT P-6 1 91.055000 44.995000 45.527500 90.522500 81.949500 54.100500
958 R03AK SALMETEROLUM+FLUTICASONUM SERETIDE DISKUS 50/500 PULB. INHAL. 50mg/500mg GLAXOWELLCOME MA CUTIE X 1 D P-6 1 182.110000 0.000000 91.055000 91.055000 163.899000 18.211000
959 R03AK SALMETEROLUM+FLUTICASONUM SERETIDE DISKUS 50 micrograme/100 PULB. INHAL. 50micrograme/100micrograme GLAXO WELLC MA CUTIE CU 1 DISPOZITIV DE INHALAT DIN PLASTIC PREVAZUT CU INDICATOR CE ARATA NR. DOZELOR RAMASE X 60 DOZE PULB. DE INHAL.
P6L 1 36.422000 70.538000 18.211000 88.749000 32.779800 74.180200
960 R03AK SALMETEROLUM+FLUTICASONUM SERETIDE DISKUS 50 micrograme/250 PULB. INHAL. 50micrograme/250micrograme GLAXOWELLCOME MA CUTIE CU 1 DISPOZITIV DE INHALAT DIN PLASTIC PREVAZUT CU INDICATOR CE ARATA NR. DOZELOR RAMASE X 60 DOZE PULB. DE INHAL.
P6L 1 91.055000 44.995000 45.527500 90.522500 81.949500 54.100500
961 R03AK SALMETEROLUM+FLUTICASONUM SERETIDE DISKUS 50 micrograme/500 PULB. INHAL. 50micrograme/500micrograme GLAXOWELLCOME MA CUTIE CU 1 DISPOZITIV DE INHALAT DIN PLASTIC PREVAZUT CU INDICATOR CE ARATA NR. DOZELOR RAMASE X 60 DOZE PULB. DE INHAL.
P6L 1 182.110000 0.000000 91.055000 91.055000 163.899000 18.211000
962 R03AK SALMETEROLUM+FLUTICASONUM SERETIDE 25 mcg/125 mcg INHALER SUSP. INHAL. PRESURIZATA 25mcg/125m GLAXOWELLCOME MA CUTIE X 1 FLACON PRESURIZAT AL X 120 DOZE SUSP. DE INHALAT PRESURIZATA P-6 1 91.055000 44.075000 45.527500 89.602500 81.949500 53.180500
963 R03AK SALMETEROLUM+FLUTICASONUM SERETIDE 25 mcg/50 mcg INHALER C SUSP. INHAL. PRESURIZATA 25mcg/50mc GLAXOWELLCOME MA CUTIE X 1 FLACON PRESURIZAT AL X 120 DOZE SUSP. DE INHALAT PRESURIZATA P-6 1 36.422000 70.958000 18.211000 89.169000 32.779800 74.600200
964 R03AK SALMETEROLUM+FLUTICASONUM SERROFLO 25 micrograme/125 microgr SUSP. INHAL. PRESURIZATA 25micrograme/125micrograme/doz CIPLA EUROPE NV BELGIA CUT IE CU UN FLACON DIN AL PREVAZUT CU O VALVA DE MASURA SI DOZAT OR DIN PLAST IC, CU INDICAT OR PENT RU DOZA, INT RODUS NT R-O PUNGA CU SAC DE SILICAGEL A 120 DE DOZE SUSPENSIE DE INHALAT PRESURIZAT A
PRF 1 90.970000 0.000000 45.485000 45.485000 81.873000 9.097000
965 R03AK SALMETEROLUM+FLUTICASONUM SERROFLO 25 micrograme/250 microgr SUSP. INHAL. PRESURIZATA 25micrograme/250micrograme/doz CIPLA EUROPE NV BELGIA CUT IE CU UN FLACON DIN AL PREVAZUT CU O VALVA DE MASURA SI DOZAT OR DIN PLAST IC, CU INDICAT OR PENT RU DOZA, INT RODUS NT R-O PUNGA CU SAC DE SILICAGEL A 120 DE DOZE SUSPENSIE DE INHALAT PRESURIZAT A
PRF 1 116.890000 0.000000 58.445000 58.445000 105.201000 11.689000
966 R03AK COMBINATII (BUDESONID SYMBICORT TURBUHA PULB. DE I 160micrograme/4,5micrograme/in ASTRAZENECA AB SUEDIA CUTIE CU 1 INHALATOR DIN MATERIAL PLASTIC CU 60 DOZE PULB. DE INHAL. P6L 1 74.496666 16.763334 37.248333 54.011667 67.046999 24.213001
967 R03AK COMBINATII (BUDESONID SYMBICORT TURBUHALE PULB. DE I 320micrograme/9micrograme/inha ASTRAZENECA AB SUEDIA CUTIE CU 1 INHALATOR DIN MATERIAL PLASTIC CU 60 DOZE PULB. DE INHAL. P6L 1 148.993333 14.796667 74.496666 89.293334 134.093999 29.696001
968 R03AK COMBINATII (BUDESONID SYMBICORT TURBUHALE PULB. DE I 80micrograme/4,5micrograme/inh ASTRAZENECA AB SUEDIA CUTIE CU 1 INHALATOR DIN MATERIAL PLASTIC CU 60 DOZE PULB. DE INHAL. P6L 1 74.496666 0.823334 37.248333 38.071667 67.046999 8.273001
969 R03AK COMBINATII (BECLO FOSTER 100/6 micrograme pe doza SOL. DE INHALAT PRESURIZATA 100/6micrograme pe doza CHIESI AUSTRIA CUTIE CU 1 FLAC. PRESURIZAT DIN AL PREVAZUT CU VALVA DOZATOARE, INTRODUS IN DISPOZITIVUL DE ADMINISTRARE DIN PE CU CAPAC PROTECTOR DIN PLASTIC A 180 DOZE SOL. DE INHALAT
PRF 1 216.080000 0.000000 108.040000 108.040000 194.472000 21.608000
970 R03AL COMBINATII (INDACATER ULTIBRO BREEZHALER 85 microgra CAPS. CU PULB. DE INHAL. 85micrograme/43micrograme NOVARTIS EURO MA CUTIE X 30 BLISTERE PERFORATE PA-AL-PVC/AL PENTRU ELIBERAREA UNEI UNITATI DOZATE X 1 CAPSULA CU PULBERE DE INHALAT + 1 INHALATOR PR/PRF 30 8.954333 0.000000 4.477166 4.477167 8.058899 0.895434
971 R03BA FLUTICASONUM PROPIONAT* FLIXOTIDE DISKUS 100 mcg PULB. INHAL. 100mcg/doza GLAXO WELLCOME MA CUTIE X 1 DISPOZITIV INHALATOR DIN PLASTIC SUB FORMA DE DISC X 1 BLIST. PVC/AL X 60 DOZE P-R 1 24.317999 10.812001 12.158999 22.971001 21.886199 13.243801
972 R03BA FLUTICASONUM PROPIONAT* FLIXOTIDE DISKUS 250 mcg PULB. INHAL. 250mcg/doza GLAXO WELLCOME MA CUTIE X 1 DISPOZITIV INHALATOR DIN PLASTIC SUB FORMA DE DISC X 1 BLIST. PVC/AL X 60 DOZE P-R 1 60.795000 6.285000 30.397500 36.682500 54.715500 12.364500
973 R03BA FLUTICASONUM PROPIONAT* FLIXOTIDE DISKUS 500 mcg PULB. INHAL. 500mcg/doza GLAXO WELLCOME MA CUTIE X 1 DISPOZITIV INHALATOR DIN PLASTIC SUB FORMA DE DISC X 1 BLIST. PVC/AL X 60 DOZE P-R 1 118.180000 0.000000 59.090000 59.090000 106.362000 11.818000
974 R03BA FLUTICASONUM PROPIONAT* FLIXOTIDE 125 INHALER CFC - Free SUSP. INHAL. PRESURIZATA 125mcg/doza GLAXO WELLCOME MA CUTIE X 1 FLACON PRESURIZAT DIN AL X 60 DOZE SUSP. DE INHALAT PRESURIZATA P-R 1 30.397500 3.612500 15.198750 18.811250 27.357750 6.652250
975 R03BA FLUTICASONUM PROPIONAT* FLIXOTIDE (R) 50 INHALER CFC - Free 50mcg/doza GLAXO WELLCOME
SUSP. INHAL. PRESURIZATA MA CUTIE X 1 FLACON PRESURIZAT X 120 DOZE X 50 MCG, PREVAZUT CU VALVA DOZATOARE P-R 1 24.317999 10.902001 12.158999 23.061001 21.886199 13.333801
976 R03BA FLUTICASONUM PROPIONAT* FLIXOTIDE NEBULES 0,5 mg/2 ml 0,5mg/2ml GLAXO WELLC
SUSP. INHAL. PRIN NEBULIZATOR MA CUTIE CU 2 FOLII SIGILATE POLIESTER/AL/ PEJD A CATE 5 FIOLE DIN PEJD X 2,5ML CONTINAND CATE 2ML SUSP PRF 10 0.810599 1.995401 0.405299 2.400701 0.729539 2.076461
977 R03BA FLUTICASONUM PROPIONAT* FLIXOTIDE NEBULES 2 mg/2 ml 2mg/2ml GLAXO WELLC
SUSP. INHAL. PRIN NEBULIZATOR MA CUTIE CU 2 FOLII SIGILATE POLIESTER/AL/ PEJD A CATE 5 FIOLE DIN PEJD X 2,5ML CONTINAND CATE 2ML SUSP PRF 10 3.242399 4.963601 1.621199 6.584801 2.918159 5.287841
978 R03BA MOMETASONUM* ASMANEX TWISTHALER 200 g PULB. INHAL. 200g/doza MERCK SHARP & ROMANIA CUTIE X 1 DISPOZITIV DE ADM. X P-6 1 33.613750 7.016250 16.806875 23.823125 30.252375 10.377625
979 R03BA MOMETASONUM* ASMANEX TWISTHALER 400 g PULB. INHAL. 400g/doza MERCK SHARP & ROMANIA CUTIE X 1 DISPOZITIV DE ADM. X P-6 1 62.550000 0.000000 31.275000 31.275000 56.295000 6.255000
980 R03BA CICLESONIDUM* ALVESCO 160 INHALER 160g/doza NYCOMED GMBH
SOL. DE INHALAT PRESURIZATA GERMANI CUTIE X 1 FLAC. DIN AL CU VALVA DOZATOARE X 60 DOZE SOL. DE INHALAT PRESURIZATA P-R 1 89.330000 0.000000 44.665000 44.665000 80.397000 8.933000
981 R03BA CICLESONIDUM* ALVESCO 80 INHALER 80g/doza NYCOMED GMBH
SOL. DE INHALAT PRESURIZATA GERMANI CUTIE X 1 FLAC. DIN AL CU VALVA DOZATOARE X 60 DOZE SOL. DE INHALAT PRESURIZATA P-R 1 51.371249 20.118751 25.685624 45.804376 46.234124 25.255876
982 R03BB TIOTROPIUM* SPIRIVA 18 micrograme CAP 18microgram BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST. AL/PVC/AL X 10 CAPS. CU PULB. DE INHALAT + 1 DISPOZITIV HANDIHALER PRF 30 5.127666 0.236334 2.563833 2.800167 4.614899 0.749101
983 R03BB TIOTROPIUM* SPIRIVA RESPIMAT 2,5 micrograme SOL. DE IN 2,5microgra BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 1 AMBALAJ UNIC CU UN INHALATOR RESPIMAT SI UN CARTUS CARE FURNIZEAZA 60 PUFURI (30 DOZE MEDICINALE) SOL. PT. INHALAT
PRF 1 153.829999 4.250001 76.914999 81.165001 138.446999 19.633001

Pagina 37 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
984 R03BB GLICOPIRONIUM BROMIDUM** SEEBRI BREEZHALER CAP 44 microgra NOVARTIS EURO MA CUTIE CU BLIST. PERFORATE PA-AL-PVC/AL CE CONTINE 30 X 1 CAPSULA CU PULBERE PENTRU INHALAT INSOTITE DE UN INHALATOR PRF 30 4.986000 0.000000 2.493000 2.493000 4.487400 0.498600
985 R03DA AMINOPHYLLINUM MIOFILIN 100 mg CAPS. 100mg ZENTIVA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS P-R 20 0.172934 0.015066 0.086467 0.101533 0.155640 0.032360
986 R03DA AMINOPHYLLINUM AMINOFILINA EEL COMPR. 100mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 25 COM P-R 50 0.140800 0.000000 0.070400 0.070400 0.126720 0.014080
987 R03DA AMINOPHYLLINUM AMINOFILINA ARENA 100 MG COMPR. 100mg ARENA GROUP SA ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 COM P-R 40 0.172934 0.007316 0.086467 0.093783 0.155640 0.024610
988 R03DA AMINOPHYLLINUM AMINOFILINA ARENA 200 MG COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.345870 0.054630 0.172935 0.227565 0.311283 0.089217
989 R03DA AMINOPHYLLINUM MIOFILIN 24mg/ml SOL. INJ. 24mg/ml ZENTIVA S.A. ROMANIA CU S/P-RF 5 2.452000 0.000000 1.226000 1.226000 2.206800 0.245200
990 R03DC MONTELUKASTUM* ASTHATOR 10 mg COMPR. 10 mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR P6L 28 0.913189 0.803239 0.456594 1.259834 0.821870 0.894558
991 R03DC MONTELUKASTUM* SINGULAIR (R) COMPR. FILM 10mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC P6L 28 0.913189 1.639668 0.456594 2.096263 0.821870 1.730987
992 R03DC MONTELUKASTUM* MONTELUKAST TEVA 10 mg COMPR. FILM 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. DIN AL/AL X P6L 28 0.720714 0.000000 0.360357 0.360357 0.648642 0.072072
993 R03DC MONTELUKASTUM* MONTELUKAST TEVA 10 mg COMPR. FILM 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. DIN AL/AL X P6L 30 0.721000 0.000000 0.360500 0.360500 0.648900 0.072100
994 R03DC MONTELUKASTUM* MONTELUKAST ACTAVIS 10 mg COMPR. FILM 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. OPA-AL-P P6L 30 0.826333 0.000000 0.413166 0.413167 0.743699 0.082634
995 R03DC MONTELUKASTUM* MONKASTA 10 mg COMPR. FILM 10mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL- P6L 28 0.913189 0.086096 0.456594 0.542691 0.821870 0.177415
996 R03DC MONTELUKASTUM* ASTMASAN 10 mg COMPR. FILM 10mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.913189 0.275382 0.456594 0.731977 0.821870 0.366701
997 R03DC MONTELUKASTUM* STANGEN 10 mg COMPR. FILM 10mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. AL/PE-PEID/PE SI DESICANT/AL/OPA X 28 COMPR. FILM. P6L 28 0.913189 0.803239 0.456594 1.259834 0.821870 0.894558
998 R03DC MONTELUKASTUM* SOLOK 10 mg COMPR. FILM 10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL- P6L 28 0.913189 0.803239 0.456594 1.259834 0.821870 0.894558
999 R03DC MONTELUKASTUM* MONART 10 mg COMPR. FILM 10mg G R CUTIE CU 1 FLAC. PEID X 28 COM P6L 28 0.913189 0.803239 0.456594 1.259834 0.821870 0.894558
0 R03DC MONTELUKASTUM* MONTELUKAST AUROBINDO 10 mg COMPR. FILM 10mg AU MALTA CUTIE CU BLIST. PA-AL-PVC/ P6L 28 0.913189 0.028953 0.456594 0.485548 0.821870 0.120272
1 R03DC MONTELUKASTUM* MONTELUKAST ABBOTT 10 mg COMPR. FILM 10mg ABBOTT LABORA MA CUTIE CU BLIST. OPA-AL-P P6L 28 0.913189 0.803239 0.456594 1.259834 0.821870 0.894558
2 R03DC MONTELUKASTUM* ASTHATOR 4 mg COMPR. MAS 4 mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/AL X 28 COM P6L 28 0.528214 1.060000 0.264107 1.324107 0.475392 1.112822
3 R03DC MONTELUKASTUM* SINGULAIR COMPR. MAS 4mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. OPA-AL P-R 28 0.528214 1.833571 0.264107 2.097678 0.475392 1.886393
4 R03DC MONTELUKASTUM* MONTELUKAST TEVA 4 mg COMPR. MAS 4mg TEVA PHARM ROMANIA CUTIE CU BLIST. DIN AL/AL X P6L 28 0.527857 0.000000 0.263928 0.263929 0.475071 0.052786
5 R03DC MONTELUKASTUM* MONTELUKAST TEVA 4 mg COMPR. MAS 4mg TEVA PHARM ROMANIA CUTIE CU BLIST. DIN AL/AL X P6L 30 0.527333 0.000000 0.263666 0.263667 0.474599 0.052734
6 R03DC MONTELUKASTUM* MONTELUKAST ACTAVIS 4 mg COMPR. MAS 4mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. OPA-AL- P6L 30 0.434000 0.000000 0.217000 0.217000 0.390600 0.043400
7 R03DC MONTELUKASTUM* MONKASTA 4 mg COMPR. MAS 4mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OP P6L 28 0.528214 0.220357 0.264107 0.484464 0.475392 0.273179
8 R03DC MONTELUKASTUM* MONTELUKAST ALVOGEN 4 mg COMPR. MAS 4mg ALVOGEN IPCO S.A. LUXEM CUTIE CU BLIST P6L 28 0.528214 1.059286 0.264107 1.323393 0.475392 1.112108
9 R03DC MONTELUKASTUM* STANGEN 4 mg COMPR. MAS 4mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. AL/PE-PEID/PE SI DESICANT/AL/OPA X 28 COMPR. MAST. P6L 28 0.528214 1.058928 0.264107 1.323035 0.475392 1.111750
0 R03DC MONTELUKASTUM* SOLOK 4 mg COMPR. MAS 4mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PAPVC/AL P6L 28 0.528214 1.040000 0.264107 1.304107 0.475392 1.092822
1 R03DC MONTELUKASTUM* MONART 4 mg COMPR. MAS 4mg G R CUTIE CU 1 FLAC. PEID X 28 C P6L 28 0.528214 1.040000 0.264107 1.304107 0.475392 1.092822
2 R03DC MONTELUKASTUM* MONTELUKAST AUROBINDO 4 mg COMPR. MAS 4mg AU MALTA CUTIE CU BLIST. PVC P6L 28 0.528214 1.060000 0.264107 1.324107 0.475392 1.112822
3 R03DC MONTELUKASTUM* SINGULAIR 4 mg COMPR. MAS 4mg MERCK SHARP & ROMANIA CUTIE CU BLIST. OPA-AL- P6L 28 0.528214 1.833571 0.264107 2.097678 0.475392 1.886393
4 R03DC MONTELUKASTUM* MONTELUKAST ABBOTT 4 mg COMPR. MAS 4mg ABBOTT LABORA MA CUTIE CU BLIST. OPA-AL- P6L 28 0.528214 1.059286 0.264107 1.323393 0.475392 1.112108
5 R03DC MONTELUKASTUM* ASTMASAN 4 mg COMPR. MAS 4mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X 28 COM P6L 28 0.528214 0.000000 0.264107 0.264107 0.475392 0.052822
6 R03DC MONTELUKASTUM* ASTHATOR 5 mg COMPR. MAS 5 mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. AL/AL X 28 COM P6L 28 0.660267 1.056161 0.330133 1.386295 0.594240 1.122188
7 R03DC MONTELUKASTUM* SINGULAIR (R) COMPR. MAS 5mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. OPA-AL P6L 28 0.660267 1.892590 0.330133 2.222724 0.594240 1.958617
8 R03DC MONTELUKASTUM* MONTELUKAST TEVA 5 mg COMPR. MAS 5mg TEVA PHARM ROMANIA CUTIE CU BLIST. DIN AL/AL X P6L 28 0.542500 0.000000 0.271250 0.271250 0.488250 0.054250
9 R03DC MONTELUKASTUM* MONTELUKAST TEVA 5 mg COMPR. MAS 5mg TEVA PHARM ROMANIA CUTIE CU BLIST. DIN AL/AL X P6L 30 0.542333 0.000000 0.271166 0.271167 0.488099 0.054234
0 R03DC MONTELUKASTUM* MONTELUKAST ACTAVIS 5 mg COMPR. MAS 5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. OPA-AL- P6L 30 0.483666 0.000000 0.241833 0.241833 0.435299 0.048367
1 R03DC MONTELUKASTUM* MONKASTA 5 mg COMPR. MAS 5mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. OP P6L 28 0.660267 0.120090 0.330133 0.450224 0.594240 0.186117
2 R03DC MONTELUKASTUM* MONTELUKAST ALVOGEN 5 mg COMPR. MAS 5mg ALVOGEN IPCO S.A. LUXEM CUTIE CU BLIST P6L 28 0.660267 1.056161 0.330133 1.386295 0.594240 1.122188
3 R03DC MONTELUKASTUM* STANGEN 5 mg COMPR. MAS 5mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. AL/PE-PEID/PE SI DESICANT/AL/OPA X 28 COMPR. MAST. P6L 28 0.660267 1.056161 0.330133 1.386295 0.594240 1.122188
4 R03DC MONTELUKASTUM* SOLOK 5 mg COMPR. MAS 5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PA/PVC/AL X P6L 28 0.660267 1.056161 0.330133 1.386295 0.594240 1.122188
5 R03DC MONTELUKASTUM* MONART 5 mg COMPR. MAS 5mg G R CUTIE CU 1 FLAC. PEID X 28 C P6L 28 0.660267 1.056161 0.330133 1.386295 0.594240 1.122188
6 R03DC MONTELUKASTUM* MONTELUKAST AUROBINDO 5 mg COMPR. MAS 5mg AU MALTA CUTIE CU BLIST. PVC P6L 28 0.660267 1.056161 0.330133 1.386295 0.594240 1.122188
7 R03DC MONTELUKASTUM* MONTELUKAST ABBOTT 5 mg COMPR. MAS 5mg ABBOTT LABORA MA CUTIE CU BLIST. OPA-AL- P6L 28 0.660267 1.056161 0.330133 1.386295 0.594240 1.122188
8 R03DC MONTELUKASTUM* ASTMASAN 5 mg COMPR. MAS 5mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X 28 COM P6L 28 0.560357 0.000000 0.280178 0.280179 0.504321 0.056036
9 R03DC MONTELUKASTUM* ASTMASAN 4 mg GRANULE 4mg SANDOZ S.R.L. ROMANIA CUTIE CU 28 PLICUR P6L 28 0.528214 1.060000 0.264107 1.324107 0.475392 1.112822
0 R03DC MONTELUKASTUM* SINGULAIR 4 mg GRANULE 4mg MERCK SHARP & ROMANIA CUTIE CU 28 P6L 28 0.528214 1.833571 0.264107 2.097678 0.475392 1.886393
1 R03DX FENSPIRIDUM EURESPAL 80 mg 80mg
COMPR. CU ELIBERARE PRELUNGITA LES LABORATOI FRANTA CUTIE P-6 30 0.952666 0.000000 0.476333 0.476333 0.857399 0.095267
2 R03DX FENSPIRIDUM EURESPAL 2 mg/ml SIROP 2mg/ml LES LAB. SERVIER I FRANTA CUTIE X 1 FLACON PVC P-6 1 20.370000 0.000000 10.185000 10.185000 18.333000 2.037000
3 R05DA DEXTROMETHORPHANUM TUSSIN FORTE 20 mg COMPR. 20mg GLAXOSMITHKL ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 C P6L 20 0.352000 0.000000 0.176000 0.176000 0.316800 0.035200
4 R05DA DEXTROMETHORPHANUM ROFEDEX SIROP 15mg/5ml BIOFARM SA ROMANIA CUTIE X 1 FLACON DIN STILCA BRUNA X 100 ML + MASURA DOZATOARE P-R 1 5.470000 0.000000 2.735000 2.735000 4.923000 0.547000
5 R05DA DEXTROMETHORPHANUM HUMISEC pentru adulti 20mg/15 ml SIROP 20mg/15 ml LAB. URGO SA FRANTA CUTIE X 1 FLACON X 200 ML + O MASURA DOZATOARE DIN POLIPROPILENA P-R 1 4.850066 5.969934 2.425033 8.394967 4.365059 6.454941
6 R05DA DEXTROMETHORPHANUM HUMISEC pentru copii 5mg/5ml SIROP 5mg/5ml LAB. URGO SA FRANTA CUTIE X 1 FLACON X 125 ML SIROP + O MASURA DOZATOARE PENTRU MASURAREA VOLUMELOR 2,5ML; 5ML; 7,5ML; 15ML P-R 1 8.460000 0.000000 4.230000 4.230000 7.614000 0.846000
7 R05DA DEXTROMETHORPHANUM TUSSIN 6,5mg/5ml SIROP 6,5mg/5ml ROPHARMA S.A. ROMANIA CUTIE X 1 FLAC. X 115ML SIROP + O LINGURITA DOZATOARE GRADATA LA 1,25ML; 2,5ML SI 5 ML P-R 1 2.725883 5.444117 1.362941 6.807059 2.453294 5.716706
8 R05DA DEXTROMETHORPHANUM ROBITUSSIN JUNIOR SOL. ORALA 3,75mg/5ml PF AUSTRIA CUTIE X 1 FL. DIN STICLA BRUNA CU CAPAC SECURIZAT X 100 ML SOL. ORALA + MASURA DOZATOARE PT.2,5ML;5M P-R 1 6.042000 2.898000 3.021000 5.919000 5.437800 3.502200
9 R05DA DEXTROMETHORPHANUM ROBITUSSIN ANTITUSSICUM SOL. ORALA 7,5mg/5ml PF AUSTRIA CUTIE X 1 FL. DIN STICLA BRUNA CU CAPAC SECURIZAT X 100 ML SOL. ORALA + MASURA DOZATOARE PT.2,5ML;5M P-R 1 2.734999 6.205001 1.367499 7.572501 2.461499 6.478501
0 R06AE LEVOCETIRIZINUM XYZAL (R) COMPR. FILM 5mg U.C.B. GMBH GERMANI CUTIE X 3 BLIST. X 10 COMPR. FILM P-6 30 0.863333 0.000000 0.431666 0.431667 0.776999 0.086334
1 R06AE LEVOCETIRIZINUM LEVOCETIRIZINA SANDOZ 5 mg COMPR. FILM 5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/ P-6 10 0.561000 0.000000 0.280500 0.280500 0.504900 0.056100
2 R06AE LEVOCETIRIZINUM CETIZAL 5 mg COMPR. FILM 5mg G R CUTIE CU BLIST. PVC-PVDC/ P-6 10 0.561000 0.000000 0.280500 0.280500 0.504900 0.056100
3 R06AE LEVOCETIRIZINUM LEVOCETIRIZINA ACTAVIS 5 mg COMPR. FILM 5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC/ P6L 10 0.362000 0.000000 0.181000 0.181000 0.325800 0.036200
4 R06AE LEVOCETIRIZINUM ZENARO 5 mg COMPR. FILM 5mg ZENTIVA, K.S. R CUTIE CU BLIST. PVC P6L 20 0.561000 0.000000 0.280500 0.280500 0.504900 0.056100
5 R06AE LEVOCETIRIZINUM XYZAL PIC. ORALE 5mg/ml UCB PHARMA GMBH GERMANI CUTIE X 1 FLACON DIN STICLA BRUNA X 20 ML PIC. ORALE, SOL., PREVAZUT CU PICURATOR P-6 1 20.196000 5.534000 10.098000 15.632000 18.176400 7.553600
6 R06AE LEVOCETIRIZINUM ZENARO 0,5 mg/ml SIROP 0,5mg/ml ZENTIVA, K.S. R CUTIE X 1 FLACON DIN STICLA BRUNA CU CAPAC DIN PP PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 200ML SIROP + 1 LINGURITA DOZATOARE DE 5ML
P6L 1 20.196000 3.644000 10.098000 13.742000 18.176400 5.663600
7 R06AX DESLORATADINUM DYNID 5 mg COMPR. 5mg G R CUTIE CU BLIST. AL/AL X 30 COMPR P6L 30 0.356666 0.165667 0.178333 0.344000 0.320999 0.201334
8 R06AX DESLORATADINUM DESLORATADINA ACTAVIS COMPR. FILM 5 mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. DIN OPA/AL/PVC- PRF 10 0.322000 0.000000 0.161000 0.161000 0.289800 0.032200
9 R06AX DESLORATADINUM DESLORATADINA ACTAVIS COMPR. FILM 5 mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. DIN OPA/AL/PVC- PRF 30 0.322666 0.000000 0.161333 0.161333 0.290399 0.032267

Pagina 38 din 87
Co-plata maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Co-plata maxima a de sistemul de asigurari Co-plata maxima a

Prescriptie
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.
cant. beneficiaza de (pt. asiguratii care asiguratii care (pt. asiguratii care asiguratii care
UT/ Pret de compensare 100% beneficiaza de beneficiaza de beneficiaza de beneficiaza de
Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
0 R06AX DESLORATADINUM DESLORATADINA SANDOZ 5 mg COMPR. FILM 5 mg SANDOZ S.R.L. ROMANIA CUTIE P6L 30 0.350333 0.000000 0.175166 0.175167 0.315299 0.035034
1 R06AX DESLORATADINUM DASSELTA COMPR. FILM 5mg KRKA D.D. NOVO M SLOVENI CUTIE PRF 30 0.356666 0.006334 0.178333 0.184667 0.320999 0.042001
2 R06AX DESLORATADINUM DESLORATADINA TERAPIA 5 mg COMPR. FILM 5mg TERAPIA SA ROMANIA CUTIE CU BLIST. PCTFE-PV P6L 30 0.356666 0.196334 0.178333 0.374667 0.320999 0.232001
3 R06AX DESLORATADINUM LORDESTIN 5 mg COMPR. FILM 5mg GEDEON RIC ROMANIA CUTIE CU BLIST. PV P6L 30 0.356666 0.182667 0.178333 0.361000 0.320999 0.218334
4 R06AX DESLORATADINUM AERIUS 5mg COMPR. FILM 5mg MERCK SHARP& MA CUTIE X 10 COMPR. FILM. ( PCTF P-R 10 0.356666 0.490334 0.178333 0.668667 0.320999 0.526001
5 R06AX DESLORATADINUM AERIUS 5mg COMPR. FILM 5mg MERCK SHARP& MA CUTIE X 30COMPR. FILM. ( PCTF P-R 30 0.356666 0.494334 0.178333 0.672667 0.320999 0.530001
6 R06AX DESLORATADINUM AERIUS 2,5mg COMPR. ORODISPERSABILE 2,5mg MERCK SHARP& MA CUTIE X 30 COMPR. OR P-R 30 0.178333 0.809333 0.089166 0.898500 0.160499 0.827167
7 R06AX DESLORATADINUM AERIUS 5mg COMPR. ORODISPERSABILE 5mg MERCK SHARP& MA CUTIE X 30 COMPR. OR P-R 30 0.356666 0.631000 0.178333 0.809333 0.320999 0.666667
8 R06AX DESLORATADINUM DESLORATADINA SANDOZ 0.5 mg/ml SOL. ORALA 0,5 mg/ml SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA CU CAPACITATEA DE 125 ML X 120 ML, SOL. ORALA + LINGURITA DOZATOARE DE 2,5 ML SI 5 ML SAU CU SERINGA DOZATOARE DE 5 ML, MARCATA LA FIECARE 0,5ML
P6L 1 10.627500 0.002500 5.313750 5.316250 9.564750 1.065250
9 R06AX DESLORATADINUM DESLORATADINA ALVOGEN 0,5 mg/ml SOL. ORALA 0,5mg/ml ALVOGEN IPCO S.A. LUXEM CUTIE CU 1 FLAC. DIN STICLA BRUNA A 120 ML SOL. ORALA + 1 LINGURITA DOZATOARE SAU O SERINGA DOZATOAR P6L 1 10.620000 0.000000 5.310000 5.310000 9.558000 1.062000
0 R06AX DESLORATADINUM DYNID 0,5 mg/ml SOL. ORALA 0,5mg/ml G R CUTIE CU 1 FLAC. DIN STICLA BRUNA X 120 ML SOL. ORALA + 1 LINGURITA DOZATOARE SAU O SERINGA DOZATOARE ( SERINGA DOZATOARE ARE GRADATII DE 2,5 ML SI 5 ML; LINGURITA DOZATOARE ARE CAPACITATEA DE 2,5 ML SI 5 ML
P6L 1 10.627500 0.002500 5.313750 5.316250 9.564750 1.065250
1 R06AX DESLORATADINUM AERIUS 0,5mg/ml SOL. ORALA 0,5mg/ml MERCK SHARP& MA CUTIE X 1 FLACON X 120 ML SOL. ORALA + LIGURITA DOZATOARE DE 2,5 ML SI 5 ML P-R 1 10.627500 5.722500 5.313750 11.036250 9.564750 6.785250
2 R06AX DESLORATADINUM LORDESTIN 0,5 mg/ml SOL. ORALA 0,5mg/ml GEDEON RIC ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, CU O LINGURITA DOZATOARE GRADATA LA 2,5 ML SI 5 ML X 120 ML SOL. P6L 1 10.627500 0.002500 5.313750 5.316250 9.564750 1.065250
3 S01AA GENTAMICINUM GENTAMICIN SULPHATE PIC. OFT., S 0,3% E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLACON X 10ML P-R 1 4.710000 0.000000 2.355000 2.355000 4.239000 0.471000
4 S01AA TOBRAMYCINUM TOBROM 3 mg/ml PIC. OFT., S 3mg/ml ROMPHARM COMP ROMANIA CUTIE C 1 FLAC. PEJD X 5 ML P P-R 1 4.080000 0.000000 2.040000 2.040000 3.672000 0.408000
5 S01AA TOBRAMYCINUM TOBREX PIC. OFT.,SO 3mg/ml ALCON COUVREUR BELGIA CUTIE X 1 FLACON DIN PEJD CU PICURATOR X 5 ML PIC. OFTALMICE, SOL. P-R 1 4.080000 3.810000 2.040000 5.850000 3.672000 4.218000
6 S01AA TOBRAMYCINUM TOBREX 2 X PICATURI 0,3% ALCON COUVREUR BELGIA CUTIE X 1 FLAC. PEID P-R 1 4.080000 15.810000 2.040000 17.850000 3.672000 16.218000
7 S01AA TOBRAMYCINUM TOBREX (R) UNG. OFT. 0,3% ALCON COUVREUR BELGIA CUTIE X 1 TUB DIN AL X 3, P-R 1 3.060000 5.580000 1.530000 7.110000 2.754000 5.886000
8 S01AA NETILMICINUM NETTACIN (R) PIC. OFT., S 0,3% S.I.F.I. SPA ITALIA CUTIE X 1 FLACON X 5ML P-R 1 14.710000 0.000000 7.355000 7.355000 13.239000 1.471000
9 S01AA NETILMICINUM NETTACIN (R) PICATURI 0,3% S.I.F.I. SPA ITALIA CUTIE X 3 FOLII TERMOSUDATE X 5 FLACOANE UNIDOZA DIN POLIETILENA X 0,3 ML P-R 15 1.297769 0.703564 0.648884 1.352449 1.167992 0.833341
0 S01AA NETILMICINUM NETTAVISC 3mg/g UNG. OFT. 3mg/g S.I.F.I. SPA ITALIA CUTIE X 1 TUB DIN AL X 5 G UNGUENT OFTALMIC, PREV. CU APLICATOR P-R 1 21.629497 12.080503 10.814748 22.895252 19.466547 14.243453
1 S01AX OFLOXACINUM FLOXAL (R) PICATURI 0,3% DR. GERHARD MANN CHEM.PHARM.FABRIK GMBH GERMANI CUTIE X 1 FLACON D P-R 1 10.895000 3.325000 5.447500 8.772500 9.805500 4.414500
2 S01AX OFLOXACINUM FLOXAL (R) UNG. OFT. 0,3% DR. GERHARD MANN CHEM.PHARM.FABRIK GMBH GERMANI CUTIE X 1 TUB DIN AL P-R 1 14.680000 0.000000 7.340000 7.340000 13.212000 1.468000
3 S01BA DEXAMETHASONUM DEXAMETAZONA ROMPHARM 1mg/ml PIC. OFT. SU 1mg/ml ROMPHARM COMP ROMANIA CUTIE X 1 FLAC. DIN P-R 1 10.120000 0.000000 5.060000 5.060000 9.108000 1.012000
4 S01BA DEXAMETHASONUM DEXAMETAZONA ROMPHARM 1mg/ml PIC. OFT. SU 1mg/ml ROMPHARM COMP ROMANIA CUTIE X 1 FLAC. DIN P-R 1 5.382500 0.107500 2.691250 2.798750 4.844250 0.645750
5 S01BA DEXAMETHASONUM MAXIDEX (R) PICAT 0,1% ALCON COUVREUR BELGIA CUTIE X 1 FLACON PICURATOR P-R 1 5.382500 3.057500 2.691250 5.748750 4.844250 3.595750
6 S01BA BETAMETHASONUM OPHTAMESONE 1 mg/ml PIC. OFT./AURIC./NAZALE SOL. 1 mg/ml DAR AL DAWA P ROMANIA CUTIE CU 1 FLAC. PEJD, PREVAZUT CU APLICATOR PT. PICURARE DIN PEJD A 10 ML PIC. OFT., AURICULARE, NAZALE SOL. P6L 1 4.670000 0.000000 2.335000 2.335000 4.203000 0.467000
7 S01CA COMBINATII ( NET NETILDEX PIC. OFT.,SO 4,55 mg/ S.I.F.I. SPA ITALIA CUTIE X 1 FLACON DIN PEJD P-R 1 8.160750 24.409250 4.080375 28.489625 7.344675 25.225325
8 S01CA COMBINATII ( NET NETILDEX PIC 4,55 mg/ S.I.F.I. SPA ITALIA CUTIE X 20 FLA P-R 20 0.489645 2.171855 0.244822 2.416678 0.440680 2.220820
9 S01CA COMBINATII SPERSADEX COMP PICATURI 5mg/ml+1mg LABORATOIRES THE FRANTA CUTIE X 1 FLACON X 5 ML S P-R 1 8.160750 4.799250 4.080375 8.879625 7.344675 5.615325
0 S01CA COMBINATII (TOBRAMY DEXATOBROM 3 mg+1 mg/ml PIC. OFT. SU 3mg+1mg/ml ROMPHARM CO ROMANIA CUTIE CU 1 FLAC. PEJD A 5 ML P-R 1 5.050000 0.000000 2.525000 2.525000 4.545000 0.505000
1 S01CA COMBINATII (TOBRAMY TOBRADEX ( R ) PICAT 3mg+1mg/ml ALCON COUVREUR BELGIA CUTIE X 1 FLACON PICURATOR P P-R 1 7.770000 0.000000 3.885000 3.885000 6.993000 0.777000
2 S01CA COMBINATII (TOBRAMY TOBRADEX (R) UNG. OFT. 3 mg/1 mg/g ALCON COUVREUR BELGIA CUTIE X 1 TUB AL, P-R 1 5.712525 7.357475 2.856262 10.213738 5.141272 7.928728
3 S01GX OLOPATADINUM OPATANOL 1mg/ml PIC. OFT., SO 1mg/ml ALCON LABORATO MA CUTIE X 1 FLACON X 5 ML P-R 1 28.000000 0.000000 14.000000 14.000000 25.200000 2.800000

NOT:
- Tratamentul cu medicamentele corespunztoare DCI-urilor notate cu (*) se iniiaza de medicul de specialitate in limita competenei i poate fi prescris n continuare de medicul de familie pe baza scrisorii
medicale emise de medicul de specialitate;
- Tratamentul cu medicamentele corespunztoare DCI-urilor notate cu (**) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sntii;
- Tratamentul cu medicamentele corespunztoare DCI-urilor notate cu (***) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Snt ii i cu aprobarea
comisiilor de la nivelul Caselor Judeene de Asigurri de Sntate;
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (****) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale MS si cu aprobarea comisiilor de la nivelul
Casei Nationale de Asigurari de Sanatate;
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (2) se prescrie numai in etapa pregtitoare pentru colonoscopie;
- Pentru medicamentele corespunztoare DCI-urilor notate cu (#) regulile de prescriere sunt stabilite prin Contractul Cadru.

Pagina 39 din 87
ANEXA 2c

SECIUNEA C1 - LISTA MEDICAMENTELOR CU PROCENT DE COMPENSARE 100% DIN PREUL DE REFERIN CONFORM
DCI-urilor UTILIZATE N TRATAMENTUL AMBULATORIU AL UNOR GRUPE DE BOLI
DIN H.G. NR. 720/2008, CU MODIFICARILE SI COMPLETARILE ULTERIOARE;
MEDICAMENTELE DIN ACEAST SUBLIST SE ELIBEREAZ PRIN FARMACII CU CIRCUIT DESCHIS PE BAZ DE PRESCRIPIE MEDICAL CU REINERE N FARMACIE
VALABIL NCEPND CU 01 IANUARIE 2016

Val. maxima suportata de Co-plata maxima a


sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)

1.INSUFICIENTA CARDIACA CRONICA(CLASA III SAU IV NYHA) - G 1

1 B01AA ACENOCUMAROLUM TROMBOSTOP 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.226000 0.226000 0.000000
2 B01AA ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg NOVARTIS PHARM GERMANI CUTIE CU 2 BLIST. AL/PVC X 10 C P-R 20 0.350000 0.350000 0.000000
3 C01A DIGOXINUM DIGOXIN SOPHARMA 0,25 m COMPR. 0,25 mg CN UNIFARM S.A. ROMANIA CUTIE X 20 COMPRIMATE PRF 20 0.166560 0.166560 0.033940
4 C01A DIGOXINUM DIGOXIN ZENTIVA 0,25 mg COMPR. 0,25mg ZENTIVA S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COM P-R 25 0.138800 0.138800 0.000000
5 C01A DIGOXINUM DIGOXIN 0,5 mg/2 ml SOL. INJ. 0,5mg/2ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA CU INEL DE RUPERE X 2 ML SOL. INJ. S/P-RF 5 1.652000 1.652000 0.000000
6 C01A DIGOXINUM DIGOXIN ZENTIVA 0,5 mg/2ml SOL. INJ. 0,5mg/2ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA CU INEL DE RUPERE SAU CU PUNCT DE RUPERE SAU CU INEL DE RUPERE SI DOUA INELE (ROSU SI PORTOCALIU)X 2 ML SOL. INJ. S/P-RF 5 1.652000 1.652000 0.000000
7 C03A HYDROCHLOROTHIAZIDUM NEFRIX 25 mg COMPR. 25mg ZENTIVA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COM P-6 25 0.173200 0.173200 0.000000
8 C03CA FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.156500 0.156500 0.000000
9 C03CA FUROSEMIDUM FUROSEMID SLAVIA COMPR. 40mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.156500 0.156500 0.000000
10 C03CA FUROSEMIDUM FUROSEMID ZENTIVA COMPR. 40mg ZENTIVA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 20 C P-6 20 0.187800 0.187800 0.125200
11 C03CA FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.157000 0.157000 0.000000
12 C03CA FUROSEMIDUM FUROSEMID ARENA 40 mg COMPR. 40mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.187800 0.187800 0.125200
13 C03CA FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.187800 0.187800 0.083200
14 C03CA FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. DIN PVC/AL P-6 30 0.157666 0.157666 0.000000
15 C03CA FUROSEMIDUM FUROSEMID 20 mg/2 ml SOL. INJ. 10mg/ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 2 ML SOL. INJ. P-R 5 1.260000 1.260000 0.000000
16 C03DA SPIRONOLACTONUM VEROSPIRON CAPS. 100mg GEDEON R ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS P-6 30 0.753000 0.753000 0.000000
17 C03DA SPIRONOLACTONUM SPIRONOLACTONA ARENA CAPS. 25mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 CAP P-6 50 0.258000 0.258000 0.075400
18 C03DA SPIRONOLACTONUM SPIRONOLACTONA LPH 25 CAPS. 25mg LABORMED PHARMA ROMANIA CUTIE CU 6 BLIST. PVC/AL X 10 CAP P6L 60 0.258000 0.258000 0.078333
19 C03DA SPIRONOLACTONUM VEROSPIRON CAPS. 50mg GEDEON R ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS P-6 30 0.441666 0.441666 0.000000
20 C03DA SPIRONOLACTONUM SPIRONOLACTONA ARENA CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAP P-6 30 0.529999 0.529999 0.032001
21 C03DA SPIRONOLACTONUM SPIRONOLACTONA BIOEEL COMPR. 25mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.222500 0.222500 0.000000
22 C03DA SPIRONOLACTONUM SPIRONOLACTONA TERAPI COMPR. FILM. 25mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 CO P-6 50 0.258000 0.258000 0.111800
23 C03DA SPIRONOLACTONUM ALSPIRON 25 mg COMPR. FILM. 25mg AC HELCOR PHAR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CO P-6 20 0.215000 0.215000 0.000000
24 C03DA SPIRONOLACTONUM ALSPIRON 50 mg COMPR. FILM. 50mg AC HELCOR PHAR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CO P-6 20 0.529999 0.529999 0.157001
25 C07A METOPROLOLUM BLOXAN COMPR. 100mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIS P-6 30 0.077000 0.077000 0.000000
26 C07A METOPROLOLUM BETAPROL 100 mg COMPR. 100mg AC HELCOR PHAR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.092400 0.092400 0.203933
27 C07A METOPROLOLUM EGILOK 100 mg COMPR. 100mg EGIS PHAR UNGARIA CUTIE X, 1 FLAC. DIN STICL P-6 20 0.092400 0.092400 0.204100
28 C07A METOPROLOLUM METOPROLOL LPH 100 mg COMPR. 100mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.092400 0.092400 0.153600
29 C07A METOPROLOLUM METOPROLOL LAROPHARM COMPR. 100mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.092400 0.092400 0.204100
30 C07A METOPROLOLUM METOPROLOL 100 mg COMPR. 100mg MAGISTRA C & C SR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.092400 0.092400 0.203933
31 C07A METOPROLOLUM METOPROLOL TERAPIA 100 COMPR. 100mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.092400 0.092400 0.203933
32 C07A METOPROLOLUM METOPROLOL VIM SPE COMPR. 100mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.092400 0.092400 0.204100
33 C07A METOPROLOLUM METOPROLOL ARENA 100 COMPR. 100mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.092400 0.092400 0.149933
34 C07A METOPROLOLUM METOPROLOL 100 mg COMPR. 100mg SLAVIA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.092400 0.092400 0.198100
35 C07A METOPROLOLUM METOPROLOL AL 100 COMPR. 100mg ALIUD PHARMA GMB GERMANI CUTIE X 3 BLIST. DIN PVC-PV P-6 30 0.092400 0.092400 0.203933
36 C07A METOPROLOLUM METOPROLOL ZENTIVA 100 COMPR. 100mg ZENTIVA S.A. ROMANIA CUTIE CU 3 BLIST. DIN PVC/ P6L 30 0.092400 0.092400 0.203933
37 C07A METOPROLOLUM EGILOK 25 mg COMPR. 25mg EGIS PHAR UNGARIA CUTIE X 1 FLAC. DIN STICLA P-6 20 0.098500 0.098500 0.000000
38 C07A METOPROLOLUM METOPROLOL LPH 25 mg COMPR. 25mg LABORMED PHARMA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COM P-6 20 0.098500 0.098500 0.000000
39 C07A METOPROLOLUM METOPROLOL 25 mg COMPR. 25mg MAGISTRA C & C SR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.098666 0.098666 0.000000

Pagina 40 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APPDET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
40 C07A METOPROLOLUM METOPROLOL ARENA 25 MG COMPR. 25mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.098666 0.098666 0.000000
41 C07A METOPROLOLUM METOPROLOL LPH 25 mg COMPR. 25mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 20 COM P-6 60 0.098333 0.098333 0.000000
42 C07A METOPROLOLUM METOPROLOL LAROPHARM COMPR. 50mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.181999 0.181999 0.000501
43 C07A METOPROLOLUM BETAPROL 50 mg COMPR. 50mg AC HELCOR PHAR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.181999 0.181999 0.000334
44 C07A METOPROLOLUM EGILOK 50 mg COMPR. 50mg EGIS PHAR UNGARIA CUTIE X 1 FLAC. DIN STICLA P-6 20 0.181999 0.181999 0.000501
45 C07A METOPROLOLUM METOPROLOL LPH 50 mg COMPR. 50mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.164333 0.164333 0.000000
46 C07A METOPROLOLUM METOPROLOL 50 mg COMPR. 50mg MAGISTRA C & C SR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.181999 0.181999 0.000334
47 C07A METOPROLOLUM METOPROLOL TERAPIA 50 m COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.181999 0.181999 0.062001
48 C07A METOPROLOLUM METOPROLOL VIM SPEC COMPR. 50mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.172500 0.172500 0.000000
49 C07A METOPROLOLUM METOPROLOL ARENA 50 MG COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.181999 0.181999 0.000334
50 C07A METOPROLOLUM METOPROLOL 50 mg COMPR. 50mg SLAVIA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.181999 0.181999 0.000501
51 C07A METOPROLOLUM METOPROLOL AL 50 COMPR. 50mg ALIUD PHARMA GMB GERMANI CUTIE X 3 BLIST. DIN PVC-PV P-6 30 0.151666 0.151666 0.000000
52 C07A METOPROLOLUM METOPROLOL ZENTIVA 50 m COMPR. 50mg ZENTIVA S.A. ROMANIA CUTIE CU 3 BLIST. DIN PVC/ P6L 30 0.181999 0.181999 0.000334
53 C07A METOPROLOLUM METOSUCCINAT SANDOZ 1 COMPR. ELIB. 190mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PP/AL X P-6 30 0.504000 0.504000 0.000000
54 C07A METOPROLOLUM METOSUCCINAT SANDOZ 47 COMPR. ELIB. 47,5mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PP/AL X P-6 30 0.215666 0.215666 0.000000
55 C07A METOPROLOLUM METOSUCCINAT SANDOZ 95 COMPR. ELIB. 95mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PP/AL X P-6 30 0.358333 0.358333 0.000000
56 C07A METOPROLOLUM METOPROLOL RETARD 100 COMPR. ELIB. P 100mg TERAPIA SA ROMANIA CUTIE X 2 P-6 20 0.092400 0.092400 0.204100
57 C07A METOPROLOLUM METOPROLOL COMPR. FILM. 100mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PVDC P6L 30 0.092400 0.092400 0.203933
58 C07A METOPROLOLUM METOPROLOL TART COMPR. FILM. 50mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PVDC P6L 30 0.181333 0.181333 0.000000
59 C07A METOPROLOLUM BETALOC (R) ZOK 100 mg COMPR. FI 100mg ASTRAZENECA AB SUEDIA CUTIE X 1 FLAC. X 30 COMPR. P-6 30 0.092400 0.092400 0.363600
60 C07A METOPROLOLUM BETALOC (R) ZOK 50 mg COMPR. FI 50mg ASTRAZENECA AB SUEDIA CUTIE X 1 FLAC. X 30 COMPR. P-6 30 0.181999 0.181999 0.198001
61 C07A METOPROLOLUM METOSUCCINAT SANDOZ 1 COMPR.FILM. 190mg HEXAL AG GERMANI CUTIE X P-6 30 0.504000 0.504000 0.000000
62 C07A METOPROLOLUM METOSUCCINAT SANDOZ 47 COMPR.FILM. 47,5mg HEXAL AG GERMANI CUTIE X P-6 30 0.215666 0.215666 0.000000
63 C07A METOPROLOLUM METOSUCCINAT SANDOZ 95 COMPR.FILM. 95mg HEXAL AG GERMANI CUTIE X P-6 30 0.358333 0.358333 0.000000
64 C07A METOPROLOLUM BETALOC SOL. INJ./PERF. 5mg/5ml ASTRAZENECA AB SUEDIA CUTIE X 5 FIOLE X 5 ML SOL.INJ. I S 5 4.086000 4.086000 0.000000
65 C07A BISOPROLOLUM BOREZ 10 mg COMPR. FILM. 10 mg ALKALOID-INT D.O.O SLOVENI C P6L 30 0.277200 0.277200 0.085800
66 C07A BISOPROLOLUM CONCOR COR 10 mg COMPR. FILM. 10mg MERCK KGAA GERMANI CUTIE X 3 BLIST. AL/PVC X 10 CO P-6 30 0.277200 0.277200 0.808133
67 C07A BISOPROLOLUM CONCOR COR 10 mg COMPR. FILM. 10mg MERCK KGAA GERMANI CUTIE CU 3 BLIST. PVC/AL X 1 P6L 30 0.277200 0.277200 0.808133
68 C07A BISOPROLOLUM SOBYC 10 mg COMPR. FILM. 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. AL/AL X 30 COMP P6L 30 0.277200 0.277200 0.070133
69 C07A BISOPROLOLUM BOREZ 2,5 mg COMPR. FILM. 2,5 mg ALKALOID-INT D.O.O SLOVENI C P6L 30 0.243333 0.243333 0.000000
70 C07A BISOPROLOLUM CONCOR COR 2,5 mg COMPR. FILM. 2,5mg MERCK KGAA GERMANI CUTIE X 3 BLIST. AL/PVC X 10 CO P-6 30 0.250800 0.250800 0.123533
71 C07A BISOPROLOLUM CONCOR COR 2,5 mg COMPR. FILM. 2,5mg MERCK KGAA GERMANI CUTIE CU 3 BLIST. PVC/AL X 1 P6L 30 0.250800 0.250800 0.123533
72 C07A BISOPROLOLUM SOBYC 2,5 mg COMPR. FILM. 2,5mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. AL/AL X 30 COMP P6L 30 0.209000 0.209000 0.000000
73 C07A BISOPROLOLUM CONCOR COR 5 mg COMPR. FILM. 5mg MERCK KGAA GERMANI CUTIE X 3 BLIST. AL/PVC, X 10 C P-6 30 0.146799 0.146799 0.242534
74 C07A BISOPROLOLUM CONCOR COR 5 mg COMPR. FILM. 5mg MERCK KGAA GERMANI CUTIE CU 3 BLIST. PVC/AL X 1 P6L 30 0.146799 0.146799 0.242534
75 C07A BISOPROLOLUM SOBYC 5 mg COMPR. FILM. 5mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. AL/AL X 30 COMP P6L 30 0.146799 0.146799 0.059534
76 C07A NEBIVOLOLUM** NEBILET (R) COMPR. 5mg BER GERMANI CUTIE X 2 BLIST. AL/PVC X 14 COM P-6 28 0.274800 0.274800 0.372342
77 C07A NEBIVOLOLUM** NEBIVOLOL ACTAVIS 5 mg COMPR. 5mg ACTAVIS S.R.L. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.274800 0.274800 0.088200
78 C07A NEBIVOLOLUM** X-PRESSOL 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. PVC-PE-PVD P6L 30 0.274800 0.274800 0.145866
79 C07A NEBIVOLOLUM** NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC- PE- P P-6 30 0.274800 0.274800 0.145866
80 C07A NEBIVOLOLUM** NEBIVOLOL TEVA 5 mg COMPR. 5mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X P-6 28 0.274800 0.274800 0.145557
81 C07A NEBIVOLOLUM** NEBIVOLOL TEVA 5 mg COMPR. 5mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X P-6 30 0.229000 0.229000 0.000000
82 C07A NEBIVOLOLUM** NEBINORM 5 mg COMPR. 5mg G REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X P-6 30 0.229000 0.229000 0.000000
83 C07A NEBIVOLOLUM** NEBIVOLOL SANDOZ 5 mg COMPR. 5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 28 COM P6L 28 0.274800 0.274800 0.145557
84 C07A NEBIVOLOLUM** NEBIVOLOL TERAPIA 5mg COMPR. 5mg TERAPIA S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 14 COM P-6 28 0.274800 0.274800 0.145557
85 C07A NEBIVOLOLUM** NEBIVOLOL TORRENT 5 mg COMPR. 5mg TORRENT PHARMA ROMANIA CUTIE CU 3 BLIST. AL/PVC X 10 C P6L 30 0.274800 0.274800 0.145866
86 C07AG CARVEDILOLUM CARVEDILOL SANDOZ 12,5 COMPR. 12,5 mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PVC-PVDC/A P6L 30 0.277333 0.277333 0.000000
87 C07AG CARVEDILOLUM DILATREND (R) 12,5 mg COMPR. 12,5mg ROCHE ROMANIA S.R ROMANIA CUTIE X 2 BLIST. OPA-AL-PV P-6 28 0.308570 0.308570 0.525715
88 C07AG CARVEDILOLUM CORYOL 12,5 mg COMPR. 12,5mg KRKA D.D. NOVO M SLOVENI CUTIE X 4 BLIST. OPA-AL-PVC/ P-6 28 0.259285 0.259285 0.000000
89 C07AG CARVEDILOLUM TALLITON (R) 12,5 mg COMPR. 12,5mg EGIS PHAR UNGARIA CUTIE X 1 FLAC. DIN STICLA P-6 30 0.281000 0.281000 0.000000

Pagina 41 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
90 C07AG CARVEDILOLUM CARVEDILOL LPH 12,5 mg COMPR. 12,5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.308570 0.308570 0.153763
91 C07AG CARVEDILOLUM CARVEDILOL VIM SPECT COMPR. 12,5mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.308570 0.308570 0.027430
92 C07AG CARVEDILOLUM GLADYCOR 12,5 mg COMPR. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COM P-6 30 0.308570 0.308570 0.076763
93 C07AG CARVEDILOLUM MIOCARVIL 12,5 mg COMPR. 12,5mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COM P-6 30 0.308570 0.308570 0.153763
94 C07AG CARVEDILOLUM CARVEDILOL HELCOR 12,2 COMPR. 12,5mg AC HELCOR PHAR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.308570 0.308570 0.143430
95 C07AG CARVEDILOLUM DILATREND (R) 25 mg COMPR. 25mg ROCHE ROMANIA S.R ROMANIA CUTIE X 2 BLIST. OPA-AL-PV P-6 28 0.342856 0.342856 0.583929
96 C07AG CARVEDILOLUM CORYOL 25 mg COMPR. 25mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. OPA-AL-PVC/A P-6 28 0.342856 0.342856 0.012144
97 C07AG CARVEDILOLUM TALLITON (R) 25 mg COMPR. 25mg EGIS PHAR UNGARIA CUTIE X 1 FLAC. DIN STICLA P-6 30 0.342856 0.342856 0.180477
98 C07AG CARVEDILOLUM CARVEDILOL LPH 25 mg COMPR. 25mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.342856 0.342856 0.259144
99 C07AG CARVEDILOLUM GLADYCOR 25 mg COMPR. 25mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COM P-6 30 0.342856 0.342856 0.181144
100 C07AG CARVEDILOLUM MIOCARVIL 25 mg COMPR. 25mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COM P-6 30 0.342856 0.342856 0.258144
101 C07AG CARVEDILOLUM CARVEDILOL HELCOR 25 mg COMPR. 25mg AC HELCOR PHAR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.342856 0.342856 0.259644
102 C07AG CARVEDILOLUM CARVEDILOL SANDOZ 25 mg COMPR. 25mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PVC-PVDC/A P6L 30 0.317333 0.317333 0.000000
103 C07AG CARVEDILOLUM DILATREND (R) 6,25 mg COMPR. 6,25mg ROCHE ROMANIA S.R ROMANIA CUTIE X 2 BLIST. OPA-AL-PV P-6 28 0.216000 0.216000 0.173642
104 C07AG CARVEDILOLUM CORYOL (R) COMPR. 6,25mg KRKA D.D. SLOVENI CUTIE X 4 BLIST. OPA-AL-PVC/ P-6 28 0.198214 0.198214 0.000000
105 C07AG CARVEDILOLUM TALLITON 6,25 mg COMPR. 6,25mg EGIS PHAR UNGARIA CUTIE X 1 FLAC. DIN STICLA P-6 30 0.185000 0.185000 0.000000
106 C07AG CARVEDILOLUM CARVEDILOL LPH 6,25 mg COMPR. 6,25mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COM P-6 30 0.216000 0.216000 0.022333
107 C07AG CARVEDILOLUM CARVEDILOL VIM SPECT COMPR. 6,25mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.216000 0.216000 0.012000
108 C07AG CARVEDILOLUM GLADYCOR 6,25 mg COMPR. 6,25mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COM P-6 30 0.185000 0.185000 0.000000
109 C07AG CARVEDILOLUM MIOCARVIL 6,25 mg COMPR. 6,25mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COM P-6 30 0.216000 0.216000 0.022333
110 C07AG CARVEDILOLUM CARVEDILOL SANDOZ 6,25 COMPR. 6,25mg HEXAL AG GERMANI CUTIE CU 3 BLIST. PVC-PVDC/A P6L 30 0.180333 0.180333 0.000000
111 C07AG CARVEDILOLUM CARVEDILOL AUROBINDO 1 COMPR. FILM. 12,5mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PE P6L 28 0.257142 0.257142 0.000000
112 C07AG CARVEDILOLUM CARVEDILOL AUROBINDO COMPR. FILM. 25mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PE P6L 28 0.285714 0.285714 0.000000
113 C07AG CARVEDILOLUM CARVEDILOL AUROBINDO 6 COMPR. FILM. 6,25mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PE P6L 28 0.180000 0.180000 0.000000
114 C09A CAPTOPRILUM CAPTOPRIL MCC 12,5 mg COMPR. 12,5mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC, X 10 COM P-6 30 0.117666 0.117666 0.000000
115 C09A CAPTOPRILUM CAPTOPRIL 25 mg COMPR. 25mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.141600 0.141600 0.000066
116 C09A CAPTOPRILUM CAPTOPRIL 25 EEL COMPR. 25mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.141600 0.141600 0.009400
117 C09A CAPTOPRILUM CAPTOPRIL - AC 25 mg COMPR. 25mg AC HELCOR PHAR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.118500 0.118500 0.000000
118 C09A CAPTOPRILUM CAPTOPRIL MCC 25 mg COMPR. 25mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.118000 0.118000 0.000000
119 C09A CAPTOPRILUM CAPTOPRIL LPH 25 mg COMPR. 25mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.118000 0.118000 0.000000
120 C09A CAPTOPRILUM CAPTOPRIL SINTOFARM 25 COMPR. 25mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.141600 0.141600 0.013066
121 C09A CAPTOPRILUM CAPTOPRIL ARENA 25 mg COMPR. 25mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.118500 0.118500 0.000000
122 C09A CAPTOPRILUM CAPTOPRIL ARENA 50 mg COMPR. 50 mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.138000 0.138000 0.000000
123 C09A CAPTOPRILUM CAPTOPRIL 50 mg COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.163200 0.163200 0.067466
124 C09A CAPTOPRILUM CAPTOPRIL 50 EEL COMPR. 50mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.163200 0.163200 0.030300
125 C09A CAPTOPRILUM CAPTOPRIL - AC 50 mg COMPR. 50mg AC HELCOR PHAR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.138000 0.138000 0.000000
126 C09A CAPTOPRILUM CAPTOPRIL MCC 50 mg COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.155666 0.155666 0.000000
127 C09A CAPTOPRILUM CAPTOPRIL LPH 50 mg COMPR. 50mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.136000 0.136000 0.000000
128 C09A ENALAPRILUM ENALAPRIL 10 mg COMPR. 10mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.199500 0.199500 0.000000
129 C09A ENALAPRILUM ENALAPRIL LPH 10 mg COMPR. 10mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR P-6 30 0.199333 0.199333 0.000000
130 C09A ENALAPRILUM ENALAPRIL LPH 10 mg COMPR. 10mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/AL X 10 COMPR P-6 20 0.199000 0.199000 0.000000
131 C09A ENALAPRILUM ENAP 10 mg COMPR. 10mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. AL/OPA-AL-PV P-6 20 0.199500 0.199500 0.000000
132 C09A ENALAPRILUM ENALAPRIL SLAVIA 10 mg COMPR. 10mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/ AL X 10 COM P-6 20 0.190500 0.190500 0.000000
133 C09A ENALAPRILUM RENITEC 10 mg COMPR. 10mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR P-6 28 0.228600 0.228600 0.077828
134 C09A ENALAPRILUM ENALAPRIL TERAPIA 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC-PE- P-6 20 0.199500 0.199500 0.000000
135 C09A ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC, X 10 COM P-6 30 0.199333 0.199333 0.000000
136 C09A ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. AL/PVC, X 10 COM P-6 50 0.199400 0.199400 0.000000
137 C09A ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 10 BLIST. AL/PVC, X 10 C P-6 100 0.199200 0.199200 0.000000
138 C09A ENALAPRILUM ENALAPRIL VIM SPECTRUM COMPR. 10mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC/A P-6 20 0.199500 0.199500 0.000000
139 C09A ENALAPRILUM ENALAPRIL LAROPHARM 10 COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 C P6L 20 0.199000 0.199000 0.000000

Pagina 42 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
140 C09A ENALAPRILUM ENALAPRIL TERAPIA 10mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL P6L 20 0.199500 0.199500 0.000000
141 C09A ENALAPRILUM ENALAPRIL 20 mg COMPR. 20mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.330500 0.330500 0.000000
142 C09A ENALAPRILUM ENALAPRIL LPH 20 mg COMPR. 20mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/AL X 10 COMPR P-6 20 0.330500 0.330500 0.000000
143 C09A ENALAPRILUM ENALAPRIL LPH 20 mg COMPR. 20mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR P-6 30 0.330666 0.330666 0.000000
144 C09A ENALAPRILUM ENAP 20 mg COMPR. 20mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. AL/OPA-AL-PV P-6 20 0.330500 0.330500 0.000000
145 C09A ENALAPRILUM RENITEC 20 mg COMPR. 20mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR P-6 28 0.396600 0.396600 0.112328
146 C09A ENALAPRILUM ENALAPRIL TERAPIA 20 mg COMPR. 20mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC-PE- P-6 20 0.330500 0.330500 0.000000
147 C09A ENALAPRILUM ENALAPRIL ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COM P-6 30 0.330666 0.330666 0.000000
148 C09A ENALAPRILUM ENALAPRIL ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. PVC/AL X 10 COM P-6 50 0.330600 0.330600 0.000000
149 C09A ENALAPRILUM ENALAPRIL SLAVIA 20 mg COMPR. 20mg SLAVIA PHARM S.R.L ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 C P6L 20 0.330500 0.330500 0.000000
150 C09A ENALAPRILUM ENALAPRIL LAROPHARM 20 COMPR. 20mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 C P6L 20 0.330500 0.330500 0.000000
151 C09A ENALAPRILUM ENALAPRIL TERAPIA 20mg COMPR. 20mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL P6L 20 0.330500 0.330500 0.000000
152 C09A ENALAPRILUM ENALAPRIL 5 mg COMPR. 5mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.093000 0.093000 0.000000
153 C09A ENALAPRILUM ENAP 5 mg COMPR. 5mg KRKA D.D. NOVO M SLOVENI CUTIE X 2 BLIST. AL/OPA-AL-PV P-6 20 0.094000 0.094000 0.000000
154 C09A ENALAPRILUM RENITEC 5 mg COMPR. 5mg MERCK SHARP & ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR P-6 28 0.108000 0.108000 0.036285
155 C09A ENALAPRILUM ENALAPRIL LPH (R) 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR P-6 30 0.093333 0.093333 0.000000
156 C09A ENALAPRILUM ENALAPRIL LPH (R) 5 mg COMPR. 5mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/AL X 10 COMPR P-6 20 0.093000 0.093000 0.000000
157 C09A ENALAPRILUM ENALAPRIL TERAPIA 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC-PE- P-6 20 0.093000 0.093000 0.000000
158 C09A ENALAPRILUM ENALAPRIL ARENA 5 mg COMPR. 5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.093333 0.093333 0.000000
159 C09A ENALAPRILUM ENALAPRIL SLAVIA 5 mg COMPR. 5mg SLAVIA PHARM S.R.L ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 C P6L 20 0.090000 0.090000 0.000000
160 C09A ENALAPRILUM ENALAPRIL LAROPHARM 5 COMPR. 5mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 20 C P6L 20 0.090000 0.090000 0.000000
161 C09A ENALAPRILUM ENALAPRIL TERAPIA 5mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL P6L 20 0.093000 0.093000 0.000000
162 C09A ENALAPRILUM ENAP 1,25 mg/ml SOL. INJ./PERF. 1,25mg/ml KRKA, D.D., NOVO SLOVENI CUTIE CU 5 FIOLE D PR/PRF 5 3.204000 3.204000 0.000000
163 C09A LISINOPRILUM RANOLIP COMPR. 10mg RANBAXY U.K. LIMI MA CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.305199 0.305199 0.213134
164 C09A LISINOPRILUM LISIREN 10 mg COMPR. 10mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.305199 0.305199 0.231801
165 C09A LISINOPRILUM LISINOPRIL SANDOZ 10 mg COMPR. 10mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.270000 0.270000 0.000000
166 C09A LISINOPRILUM LISINOPRIL 10 MEDO COMPR. 10mg MEDOCHEMIE RO ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.254333 0.254333 0.000000
167 C09A LISINOPRILUM LISINOPRIL ACTAVIS 10 mg COMPR. 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 COM P-6 30 0.270000 0.270000 0.000000
168 C09A LISINOPRILUM LISINOPRIL ATB 10 MG COMPR. 10mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.305199 0.305199 0.108134
169 C09A LISINOPRILUM TONOLYSIN 10 mg COMPR. 10mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COM P-6 28 0.305199 0.305199 0.081229
170 C09A LISINOPRILUM TONOLYSIN 2,5 mg COMPR. 2,5mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COM P-6 28 0.311071 0.311071 0.000000
171 C09A LISINOPRILUM RANOLIP COMPR. 20mg RANBAXY U.K. LIMI MA CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.454800 0.454800 0.344533
172 C09A LISINOPRILUM LISIREN 20 mg COMPR. 20mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COM P-6 20 0.454800 0.454800 0.327700
173 C09A LISINOPRILUM LISINOPRIL SANDOZ 20 mg COMPR. 20mg HEXAL AG GERMANI CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.379000 0.379000 0.000000
174 C09A LISINOPRILUM LISINOPRIL ACTAVIS 20 mg COMPR. 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 COM P-6 30 0.379000 0.379000 0.000000
175 C09A LISINOPRILUM LISINOPRIL ATB 20 MG COMPR. 20mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.454800 0.454800 0.357200
176 C09A LISINOPRILUM TONOLYSIN 20 mg COMPR. 20mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COM P-6 28 0.454800 0.454800 0.194128
177 C09A LISINOPRILUM LISINOPRIL 20 MEDO COMPR. 20mg MEDOCHEMIE RO ROMANIA CUTIE X 2 BLIST. PVDC/AL X 10 C P-6 20 0.428500 0.428500 0.000000
178 C09A LISINOPRILUM LISINOPRIL ATB 40 MG COMPR. 40mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 1.359333 1.359333 0.000000
179 C09A LISINOPRILUM RANOLIP COMPR. 5mg RANBAXY U.K. LIMI MA CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.231199 0.231199 0.033467
180 C09A LISINOPRILUM LISINOPRIL 5 MEDO COMPR. 5mg MEDOCHEMIE RO ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.192666 0.192666 0.000000
181 C09A LISINOPRILUM LISINOPRIL ACTAVIS 5 mg COMPR. 5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 30 COM P-6 30 0.193000 0.193000 0.000000
182 C09A LISINOPRILUM TONOLYSIN 5 mg COMPR. 5mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COM P-6 28 0.231199 0.231199 0.032015
183 C09A RAMIPRILUM VIVACE 10 mg COMPR. 10 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7 COMPR. P-6 28 0.238214 0.238214 0.000000
184 C09A RAMIPRILUM PIRAMIL 10 mg COMPR. 10mg SANDOZ SRL ROMANIA CUTIE X 4 FOLII AL-LDPE/LDPE- P-6 28 0.285856 0.285856 0.016286
185 C09A RAMIPRILUM RAMIPRIL-AC 10 mg COMPR. 10mg AC HELCOR PHAR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.285856 0.285856 0.016144
186 C09A RAMIPRILUM AMPRIL 10 mg COMPR. 10mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. OPA-AL-PVC/A P-6 30 0.285856 0.285856 0.016144
187 C09A RAMIPRILUM ZENRA 10 COMPR. 10mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.285856 0.285856 0.016286
188 C09A RAMIPRILUM TRITACE 10 COMPR. 10mg SANOFI - ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COM P-6 28 0.285856 0.285856 0.178429
189 C09A RAMIPRILUM RAMIPRIL AUROBINDO 10 m COMPR. 10mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. OPA-AL-PVC/A P-6 28 0.285856 0.285856 0.016286

Pagina 43 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
190 C09A RAMIPRILUM AMPRIGEN 10 mg COMPR. 10mg ALVOGEN IPCO S.A. LUXEM CUTIE CU 3 BLIST. PVC-PE-P P6L 30 0.285856 0.285856 0.016144
191 C09A RAMIPRILUM RAMIRAN 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A P6L 30 0.285856 0.285856 0.016144
192 C09A RAMIPRILUM RAMIRAN 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE CU BLI P6L 30 0.285856 0.285856 0.016144
193 C09A RAMIPRILUM VIVACE 2,5 mg COMPR. 2,5 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7COMPR. P-6 28 0.149642 0.149642 0.000000
194 C09A RAMIPRILUM PIRAMIL 2,5 mg COMPR. 2,5mg SANDOZ SRL ROMANIA CUTIE X 4 FOLII AL-LDPE/LDPE- P-6 28 0.172142 0.172142 0.000000
195 C09A RAMIPRILUM RAMIPRIL-AC 2,5 mg COMPR. 2,5mg AC HELCOR PHAR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.168333 0.168333 0.000000
196 C09A RAMIPRILUM AMPRIL 2,5 mg COMPR. 2,5mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. OPA-AL-PVC/A P-6 30 0.172000 0.172000 0.000000
197 C09A RAMIPRILUM ZENRA 2,5 COMPR. 2,5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.166071 0.166071 0.000000
198 C09A RAMIPRILUM TRITACE(R) 2,5 COMPR. 2,5mg SANOFI - ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.179570 0.179570 0.085072
199 C09A RAMIPRILUM AMPRIGEN 2,5 mg COMPR. 2,5mg ALVOGEN IPCO S.A. LUXEM CUTIE CU 3 BLIST. PVC-PE-P P6L 30 0.172000 0.172000 0.000000
200 C09A RAMIPRILUM RAMIRAN 2,5 mg COMPR. 2,5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A P6L 30 0.172000 0.172000 0.000000
201 C09A RAMIPRILUM RAMIRAN 2,5 mg COMPR. 2,5mg TERAPIA SA ROMANIA CUTIE CU BLI P6L 30 0.172000 0.172000 0.000000
202 C09A RAMIPRILUM VIVACE 5 mg COMPR. 5 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7 COMPR. P-6 28 0.172142 0.172142 0.000000
203 C09A RAMIPRILUM PIRAMIL 5 mg COMPR. 5mg SANDOZ SRL ROMANIA CUTIE X 4 FOLII AL-LDPE/LDPE- P-6 28 0.206570 0.206570 0.041644
204 C09A RAMIPRILUM RAMIPRIL-AC 5 mg COMPR. 5mg AC HELCOR PHAR ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.206570 0.206570 0.041430
205 C09A RAMIPRILUM AMPRIL 5 mg COMPR. 5mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. OPA-AL-PVC/A P-6 30 0.206570 0.206570 0.041430
206 C09A RAMIPRILUM ZENRA 5 COMPR. 5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.206570 0.206570 0.032715
207 C09A RAMIPRILUM TRITACE 5 COMPR. 5mg SANOFI - ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6 28 0.206570 0.206570 0.175215
208 C09A RAMIPRILUM RAMIPRIL AUROBINDO 5 mg COMPR. 5mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. OPA-AL-PVC/A P-6 28 0.206570 0.206570 0.041644
209 C09A RAMIPRILUM AMPRIGEN 5 mg COMPR. 5mg ALVOGEN IPCO S.A. LUXEM CUTIE CU 3 BLIST. PVC-PE-P P6L 30 0.206570 0.206570 0.041430
210 C09A RAMIPRILUM RAMIRAN 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A P6L 30 0.206570 0.206570 0.041430
211 C09A RAMIPRILUM RAMIRAN 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE CU BLI P6L 30 0.206570 0.206570 0.041430
212 C09CA VALSARTANUM** WENZELL 160 mg COMPR. FILM. 160mg ROMASTRU TRADI ROMANIA CUTIE CU BLIST P-6 28 0.554692 0.554692 0.515665
213 C09CA VALSARTANUM** WENZELL 160 mg COMPR. FILM. 160mg ROMASTRU TRADI ROMANIA CUTIE CU BLIST P-6 30 0.554692 0.554692 0.515641
214 C09CA VALSARTANUM** DIOVAN 160 mg COMPR. FILM. 160mg NOVARTIS PHARM GERMANI CUTIE CU BLIST. PVC-PE P-6 28 0.554692 0.554692 1.039236
215 C09CA VALSARTANUM** VALSACOR 160 mg COMPR. FILM. 160mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PE P6L 28 0.534285 0.534285 0.000000
216 C09CA VALSARTANUM** AVASSAN 160 mg COMPR. FILM. 160mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.554692 0.554692 0.515665
217 C09CA VALSARTANUM** VALSARTAN TORRENT 160 COMPR. FILM. 160mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 98 0.462244 0.462244 0.000000
218 C09CA VALSARTANUM** VALSARTAN ZENTIVA 160 mg COMPR. FILM. 160mg ZENTIVA, K.S. REPUBLICA CEHA CU P-6 28 0.554692 0.554692 0.007093
219 C09CA VALSARTANUM** VAPRESS 160 mg COMPR. FILM. 160mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE P6L 28 0.554692 0.554692 0.217450
220 C09CA VALSARTANUM** VAPRESS 160 mg COMPR. FILM. 160mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTF P6L 28 0.554692 0.554692 0.217450
221 C09CA VALSARTANUM** VALSACOR 320 mg COMPR. FILM. 320mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC-PE P-6 30 1.129333 1.129333 0.000000
222 C09CA VALSARTANUM** DIOVAN 40 mg COMPR. FILM. 40mg NOVARTIS PHARM GERMANI CUTIE CU BLIST. PVC-PE- P6L 28 0.495856 0.495856 2.072358
223 C09CA VALSARTANUM** AVASSAN 40 mg COMPR. FILM. 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.495856 0.495856 1.083786
224 C09CA VALSARTANUM** VAPRESS 40 mg COMPR. FILM. 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE P6L 28 0.413214 0.413214 0.000000
225 C09CA VALSARTANUM** VAPRESS 40 mg COMPR. FILM. 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTF P6L 28 0.413214 0.413214 0.000000
226 C09CA VALSARTANUM** WENZELL 80 mg COMPR. FILM. 80mg ROMASTRU TRADI ROMANIA CUTIE CU BLIST P-6 28 0.351306 0.351306 0.451551
227 C09CA VALSARTANUM** WENZELL 80 mg COMPR. FILM. 80mg ROMASTRU TRADI ROMANIA CUTIE CU BLIST P-6 30 0.351306 0.351306 0.451360
228 C09CA VALSARTANUM** DIOVAN 80 mg COMPR. FILM. 80mg NOVARTIS PHARM GERMANI CUTIE CU BLIST. PVC- P6L 28 0.351306 0.351306 0.843694
229 C09CA VALSARTANUM** VALSACOR 80 mg COMPR. FILM. 80mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PE P6L 28 0.351306 0.351306 0.086551
230 C09CA VALSARTANUM** AVASSAN 80 mg COMPR. FILM. 80mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 28 0.351306 0.351306 0.451551
231 C09CA VALSARTANUM** VALSARTAN TORRENT 80 m COMPR. FILM. 80mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P6L 98 0.292755 0.292755 0.000000
232 C09CA VALSARTANUM** VALSARTAN ZENTIVA 80 mg COMPR. FILM. 80mg ZENTIVA, K.S. REPUBLICA CEHA CU P-6 28 0.351306 0.351306 0.171551
233 C09CA VALSARTANUM** VAPRESS 80 mg COMPR. FILM. 80mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE P6L 28 0.351306 0.351306 0.034408
234 C09CA VALSARTANUM** VAPRESS 80 mg COMPR. FILM. 80mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTF P6L 28 0.351306 0.351306 0.034408
235 C09CA VALSARTANUM** DIOVAN 3 mg/ml SOL. ORALA 3mg/ml NOVARTIS PHARM GERMANI CUTIE X 1 FLACON DIN STICLA BRUNA X 160ML SOLUTIE ORALA + 1 TRUSA DE ADMINISTRARE (ADAPTOR PENTRU FLACON + 1 SERINGA DOZATOARE A 5ML + 1 MASURA DOZATOARE A 30ML )
P-6 1 41.420000 41.420000 0.000000
236 C09CA CANDESARTANUM CILEXETIL** ATACAND COMPR. 16mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. PVC-PVDC/AL P-6 28 0.840000 0.840000 0.741785
237 C09CA CANDESARTANUM CILEXETIL** TANDESAR 16 mg COMPR. 16mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC P-6 28 0.840000 0.840000 0.222500
238 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN SANDOZ 16 COMPR. 16mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR P-6 28 0.840000 0.840000 0.158928
239 C09CA CANDESARTANUM CILEXETIL** KARBIS 16 mg COMPR. 16mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/AL X P-6 30 0.840000 0.840000 0.222000

Pagina 44 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
240 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN TORRENT 1 COMPR. 16mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A P6L 30 0.700000 0.700000 0.000000
241 C09CA CANDESARTANUM CILEXETIL** ATACAND 16mg COMPR. 16mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. P-6 28 0.840000 0.840000 0.741785
242 C09CA CANDESARTANUM CILEXETIL** CANZENO 16mg COMPR. 16mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X P6L 30 0.840000 0.840000 0.026000
243 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN LABORMED COMPR. 16mg LABORMED PHARMA ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/ P6L 28 0.840000 0.840000 0.222142
244 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN AUROBIND COMPR. 16mg MALTA
AUROBINDO PHARMA (MALTA) LIMITED CUTIE CU BLIST. PVC-PVDC/AL X P6L 30 0.840000 0.840000 0.172333
245 C09CA CANDESARTANUM CILEXETIL** CADEXYL 16 mg COMPR. 16mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X P6L 28 0.840000 0.840000 0.222500
246 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN CILEXETI COMPR. 16mg MAGISTRA C&C S.R. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X P6L 30 0.840000 0.840000 0.222000
247 C09CA CANDESARTANUM CILEXETIL** ATACAND 32 mg COMPR. 32mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. AL-PVC/PVDC P-6 28 0.723600 0.723600 1.505685
248 C09CA CANDESARTANUM CILEXETIL** KARBIS 32 mg COMPR. 32mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/AL X P-6 30 0.723600 0.723600 0.725400
249 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN TORRENT 3 COMPR. 32mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A P6L 30 0.603000 0.603000 0.000000
250 C09CA CANDESARTANUM CILEXETIL** ATACAND 32 mg COMPR. 32mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. P-6 28 0.723600 0.723600 1.505685
251 C09CA CANDESARTANUM CILEXETIL** CANZENO 32mg COMPR. 32mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X P6L 30 0.723600 0.723600 0.239400
252 C09CA CANDESARTANUM CILEXETIL** CADEXYL 32 mg COMPR. 32mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X P6L 28 0.723600 0.723600 0.634257
253 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN CILEXETI COMPR. 32mg MAGISTRA C&C S.R. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X P6L 30 0.723600 0.723600 0.725400
254 C09CA CANDESARTANUM CILEXETIL** ATACAND COMPR. 8mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. PVC-PVDC/AL P-6 28 0.637200 0.637200 0.179942
255 C09CA CANDESARTANUM CILEXETIL** TANDESAR 8 mg COMPR. 8mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC P-6 28 0.531071 0.531071 0.000000
256 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN SANDOZ 8 m COMPR. 8mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR P-6 28 0.531071 0.531071 0.000000
257 C09CA CANDESARTANUM CILEXETIL** KARBIS 8 mg COMPR. 8mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PVDC/AL X P-6 30 0.531000 0.531000 0.000000
258 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN TORRENT 8 COMPR. 8mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A P6L 30 0.531000 0.531000 0.000000
259 C09CA CANDESARTANUM CILEXETIL** ATACAND 8mg COMPR. 8mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. P-6 28 0.637200 0.637200 0.179942
260 C09CA CANDESARTANUM CILEXETIL** CANZENO 8mg COMPR. 8mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X P6L 30 0.531000 0.531000 0.000000
261 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN LABORMED COMPR. 8mg LABORMED PHARMA ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/A P6L 28 0.531071 0.531071 0.000000
262 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN AUROBINDO COMPR. 8mg MALTA CUTIE CU BLIST. PVC-PVDC/AL X
AUROBINDO PHARMA (MALTA) LIMITED P6L 30 0.531000 0.531000 0.000000
263 C09CA CANDESARTANUM CILEXETIL** CADEXYL 8 mg COMPR. 8mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X P6L 28 0.531071 0.531071 0.000000
264 C09CA CANDESARTANUM CILEXETIL** CANDESARTAN CILEXETIL COMPR. 8mg MAGISTRA C&C S.R. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X P6L 30 0.531000 0.531000 0.000000

2. BOLNAVI CU PROTEZE VALVULARE SI VASCULARE - G2

1 B01AA ACENOCUMAROLUM TROMBOSTOP 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.226000 0.226000 0.000000
2 B01AA ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg NOVARTIS PHARM GERMANI CUTIE CU 2 BLIST. AL/PVC X 10 C P-R 20 0.350000 0.350000 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea cardiologie, chirurgie cardiovascular i chirurgie vascular.

3. BOLNAVI CU PROCEDURI INTERVENTIONALE PERCUTANE, NUMAI DUPA IMPLANTAREA UNEI PROTEZE ENDOVASCULARE (STENT)- G3

1 B01A CLOPIDOGRELUM*** PLAVIX 300mg COMPR. FILM. 300mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X P-R 30 9.342333 9.342333 0.000000
2 B01A CLOPIDOGRELUM*** PLAVIX 300mg COMPR. FILM. 300mg SANOFI CLIR SNC FRANTA CUTIE X P-R 30 9.342333 9.342333 0.000000
3 B01A CLOPIDOGRELUM*** ZYLLT COMPR. FILM. 75 mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. OPA/AL/P P-R 28 0.460714 0.460714 0.000000
4 B01A CLOPIDOGRELUM*** PLAVIX 75mg COMPR. FILM. 75mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 28 COMPR. FILM. (BLI P-R 28 0.506570 0.506570 1.141287
5 B01A CLOPIDOGRELUM*** CLOPIDOGREL MYLAN 75m COMPR. FILM. 75mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. D P-R 28 0.506570 0.506570 0.039144
6 B01A CLOPIDOGRELUM*** TROGRAN 75 mg COMPR. FILM. 75mg G REPUBLICA CEHA CUTIE CU BLIST. PVC-PE P-R 28 0.506570 0.506570 0.600215
7 B01A CLOPIDOGRELUM*** PLAVOCORIN 75 mg COMPR. FILM. 75mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-R 28 0.506570 0.506570 0.112358
8 B01A CLOPIDOGRELUM*** CLOPIDOGREL ACTAVIS 75 COMPR. FILM. 75mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 28 COMP P-R 28 0.422142 0.422142 0.000000
9 B01A CLOPIDOGRELUM*** DEFROZYP 75 mg COMPR. FILM. 75mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. OPA-AL- P-R 28 0.506570 0.506570 0.600215
10 B01A CLOPIDOGRELUM*** TESSYRON 75 mg COMPR. FILM. 75mg GEDEON R ROMANIA CUTIE CU BLIST. PVC P-R 30 0.506570 0.506570 0.182096
11 B01A CLOPIDOGRELUM*** CLOPIDOGREL DR. REDDY COMPR. FILM. 75mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. OPA-AL-P P-R 30 0.506570 0.506570 0.599763
12 B01A CLOPIDOGRELUM*** CLOPIDOGREL TERAPIA 75 COMPR. FILM. 75mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PA-AL- PRF 30 0.506570 0.506570 0.599763
13 B01A CLOPIDOGRELUM*** DEPLATT 75 mg COMPR. FILM. 75mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P PRF 30 0.506570 0.506570 0.412763

Pagina 45 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
14 B01A CLOPIDOGRELUM*** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. CEHIA CUTIE CU BLISTERE DIN PVC-PVDC/AL CONTINND 30 COMPRIMATE FILMATE P-R 30 0.506570 0.506570 0.074430
15 B01A CLOPIDOGRELUM*** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. CEHIA CUTIE CU BLISTERE DIN PVC-PVDC/AL CONTINND 90 COMPRIMATE FILMATE P-R 90 0.506570 0.506570 0.055430
16 B01A CLOPIDOGRELUM*** CLOPIDOGREL AUROBINDO COMPR. FILM. 75mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-ACLA PRF 28 0.506570 0.506570 0.087358
17 B01A CLOPIDOGRELUM*** PLAVIX 75mg COMPR. FILM. 75mg SANOFI CLIR SNC FRANTA CUTIE X 28 COMPR. FILM. ( B P-R 28 0.506570 0.506570 1.141287

Tratamentul se iniiaz de ctre medicul n specialitatea cardiologie, chirurgie cardiovascular i chirurgie vascular.

4. HEPATITELE CRONICE DE ETIOLOGIE VIRALA B, C i D - G4

1 FARA DASABUVIRUM**** EXVIERA 250mg COMPR. FILM. 250 mg ABBVIE LTD. MA CUTIE X BLISTERE PVC-PE-PCTFE/FOLIE DIN AL X 56 COMPRIMATE FILMATE (AMBALAJ MULTIPLU CARE CONTINE 4 CUTII INTERIOARE X 14 COMPRIMATE FILMATE)
PR 56 113.407142 113.407142 0.000000
2 FARA OMBITASVIRUM+PARITAPREVI VIEKIRAX COMPR. FILM. 12,5 ABBVIE LTD. MA CUTIE X BLISTERE PVC-PE-PCTFE/FOLIE DIN AL X 56 COMPRIMATE FILMATE(AMBALAJ MULTIPLU CARE CONTINE 4 CUTII INTERIOARE X 14 COMPRIMATE FILMATE)
PR 56 ,190.124285 1,190.124285 0.000000
3 J05AB RIBAVIRINUM**** REBETOL 200 mg CAPS. 200mg MERCK SHARP & MA CUTIE X 140 CAPS. ( BLIST. PVC/ P-RF/R 140 2.333071 2.333071 0.000000
4 J05AB RIBAVIRINUM**** COPEGUS 200mg COMPR. FILM. 200mg ROCHE ROMANIA SR ROMANIA CUTIE X 1 FLAC. PEID X 168 COMP P-RF/R 168 1.949464 1.949464 0.000000
5 J05AB RIBAVIRINUM**** MODERIBA 200 mg COMPR. FILM. 200mg ABBVIE LIMITED MA CUTIE CU 1 FLAC. PEID X 168 COM PRF 168 2.339356 2.339356 2.867489
6 J05AB RIBAVIRINUM**** MODERIBA 400 mg COMPR. FILM. 400mg ABBVIE LIMITED MA CUTIE CU 1 FLAC. PEID X 56 COMP PRF 56 10.544464 10.544464 0.000000
7 J05AB RIBAVIRINUM**** MODERIBA 600 mg COMPR. FILM. 600mg ABBVIE LIMITED MA CUTIE CU 1 FLAC. PEID X 56 COMP PRF 56 13.558214 13.558214 0.000000
8 J05AF LAMIVUDINUM**** LAMIVUDINE TEVA 100 mg COMPR. FILM. 100 mg TEVA PHARMA B.V. OLANDA CUTIE CU BLIST. PVC/PVDC P-RF/R 30 2.836666 2.836666 0.000000
9 J05AF LAMIVUDINUM**** ZEFFIX 100 mg COMPR. FILM. 100mg GLAXO GROUP LTD. MA CUTIE X 28 COMPR. FILM. (B P-RF/R 28 3.403999 3.403999 0.959572
10 J05AF TENOFOVIRUM DISOPROXIL FUMARAT VIREAD 245mg COMPR. FILM. 245mg GILEAD SCIENCE INTERNATIONAL LIMITED MA CUTIE X 1 FLAC. DIN PEID X 3 P-RF/R 30 32.970399 32.970399 8.027267
11 J05AF TENOFOVIRUM DISOPROXIL FUMARAT TENOFOVIR DISOPROXIL COMPR. FILM. 245mg TEVA PHARM ROMANIA CUTIE CU 1 FLAC. DIN PED CU CAPAC CAPAC PREVAZUT CU SISTEM SECURIZAT PENTRU COPII DIN PP SI RECIPIENT CU DESICANT, A 30 COMPR. FILM.
PR 30 27.475333 27.475333 0.000000
12 J05AF TENOFOVIRUM DISOPROXIL FUMARAT TENOFOVIR DISOPROXIL COMPR. FILM. 245mg TEVA PHARM ROMANIA CUTIE CU 1 FLAC. DIN PED CU PERETII NGROSATI CU CAPAC PREVAZUT CU SISTEM SECURIZAT PENTRU COPII DIN PP SI RECIPIENT CU DESICANT, A 30 COMPR. FILM.
PR 30 27.475333 27.475333 0.000000
13 J05AF ADEFOVIRUM DIPIVOXILUM**** HEPSERA COMPR. 10mg GILEAD SCIENCE INTERNATIONAL LIMITED MA CUTIE X 1 FLAC. DIN PEID X 30 C P-RF/R 30 41.273333 41.273333 0.000000
14 J05AF ENTECAVIRUM**** BARACLUDE 0,5mg COMPR. FILM. 0,5mg BRISTOL-MYERS SQUIBB PHARMA EEIG MA CUTIE X 30 X 1 COMPR. FI P-RF/R 30 57.113666 57.113666 0.000000
15 J05AF ENTECAVIRUM**** BARACLUDE 1mg COMPR. FILM. 1mg BRISTOL-MYERS SQUIBB PHARMA EEIG MA CUTIE X 30 X 1 COMPR. FI P-RF/R 30 61.447000 61.447000 0.000000
16 L03AA FILGRASTIMUM (G-CSF)** ZARZIO 30MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 60MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLU P-RF/R 1 110.870000 110.870000 0.000000
17 L03AA FILGRASTIMUM (G-CSF)** ZARZIO 48MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 96MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLU P-RF/R 1 163.380000 163.380000 7.000000
18 L03AA FILGRASTIMUM (G-CSF)** ACCOFIL 30 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 30MU/0,5 ml ACCORD HE MA AMBALAJ CU 1 SER PR 1 101.990000 101.990000 0.000000
19 L03AA FILGRASTIMUM (G-CSF)** ACCOFIL 30 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 30MU/0,5 ml ACCORD HE MA AMBALAJ CU 5 SER PR 5 92.674000 92.674000 0.000000
20 L03AA FILGRASTIMUM (G-CSF)** ACCOFIL 48 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 48MU/0,5 ml ACCORD HE MA AMBALAJ CU 1 SER PR 1 150.280000 150.280000 0.000000
21 L03AA FILGRASTIMUM (G-CSF)** ACCOFIL 48 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 48MU/0,5 ml ACCORD HE MA AMBALAJ CU 5 SER PR 5 136.150000 136.150000 0.000000
22 L03AA FILGRASTIMUM (G-CSF)** NIVESTIM 30 MU/0,5 ml SOL. INJ./PERF. 300g/0,5ml HOSPIRA UK LIMITE MA CUTIE X 5 SERINGI PREUMPLUTE (STICLA) X 0,5 ML SOL. INJ. SAU PERF. P-R 5 106.198000 106.198000 0.000000
23 L03AA FILGRASTIMUM (G-CSF)** TEVAGRASTIM 30MUI/0,5ml SOL. INJ./PERF. 300g/0,5ml TEVA GMBH GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. SAU PERF. CU APARATOARE DE SIG.PT.AC PR 1 111.208800 111.208800 8.351200
24 L03AA FILGRASTIMUM (G-CSF)** NIVESTIM 48 MU/0,5 ml SOL. INJ./PERF. 480g/0,5ml HOSPIRA UK LIMITE MA CUTIE X 5 SERINGI PREUMPLUTE (STICLA) X 0,5 ML SOL. INJ. SAU PERF. P-R 5 162.800000 162.800000 0.000000
25 L03AA FILGRASTIMUM (G-CSF)** TEVAGRASTIM 48MUI/0,8ml SOL. INJ./PERF. 480g/0,8ml TEVA GMBH GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,8 ML SOL. INJ. SAU PERF. CU APARATOARE DE SIG.PT.AC PR 1 163.380000 163.380000 7.460000
26 L03AB INTERFERONUM ALFA 2A**** ROFERON A SOL. INJ. 9Mui/0,5ml ROCHE ROMANIA S.R ROMANIA CUTIE X PR 1 178.400000 178.400000 0.000000
27 L03AB INTERFERONUM ALFA 2B**** INTRON A 18 milioane U.I. SOL. INJ 18 milioane U MERCK SHARP & MA CUTIE X 1 STILOU INJECTOR (PEN) X 1,2 ML SOL. INJ. + 12 ACE + 12 TAMPOANE DEZINFECTANTE P-RF/R 1 390.310000 390.310000 0.000000
28 L03AB INTERFERONUM ALFA 2B**** INTRON A 30 milioane U.I. SOL. INJ 30 milioane U MERCK SHARP & MA CUTIE X 1 STILOU INJECTOR (PEN) X 1,2 ML + 12 ACE + 12 TAMPOANE DEZINFECTANTE P-RF/R 1 604.410000 604.410000 0.000000
29 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 100 g PULB. + S 100g MERCK SHARP & MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 674.210000 674.210000 0.000000
30 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 100 g PULB. + S 100g MERCK SHARP & MA CUTIE X 1 FLAC. CU PR 1 674.210000 674.210000 0.000000
31 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 120 g PULB. + S 120g MERCK SHARP & MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 794.880000 794.880000 0.000000
32 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 120 g PULB. + S 120g MERCK SHARP & MA CUTIE X 1 FLAC. CU PR 1 794.880000 794.880000 0.000000
33 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 150 g PULB. + S 150g MERCK SHARP & MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 975.890000 975.890000 0.000000
34 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 150 g PULB. + S 150g MERCK SHARP & MA CUTIE X 1 FLAC. CU PR 1 975.890000 975.890000 0.000000
35 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 50 g PULB. + S 50g MERCK SHARP & MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 370.000000 370.000000 0.000000
36 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 50 g PULB. + S 50g MERCK SHARP & MA CUTIE X 1 FLAC. CU PR 1 370.000000 370.000000 0.000000
37 L03AB PEGINTERFERON ALFA-2A**** PEGASYS 180 mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 180mcg/0,5ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PRE-U P-RF/R 1 781.040000 781.040000 0.000000
38 N04B AMANTADINUM** VIREGYT (R)- K CAPS. 100mg EGIS PHAR UNGARIA CUTIE X 1 FLAC. X 50 CAPS. P-6 50 0.354400 0.354400 0.000000

Tratamentul se initiaz de ctre medicul n specialitatea gastroenterologie / boli infectioase si nefrologie (doar pentru pacientii cu afectare renala consecutiva infectiei cu virusuri hepatitice)

Pagina 46 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)

5. HEPATITA AUTOIMUNA - G5

1 H02A METHYLPREDNISOLONUM MEDROL A 16 COMPR. 16mg PFIZER EUROPE M MA CUTIE X 5 BLIST. A-PVC/PVC X 1 P-R 50 0.543200 0.543200 0.000000
2 H02A METHYLPREDNISOLONUM MEDROL 32 COMPR. 32mg PFIZER EUROPE M MA CUTIE X 2 BLIST. AL-PVC/PVC X P-R 20 1.234000 1.234000 0.000000
3 H02A METHYLPREDNISOLONUM SOLU - MEDROL ACT-O-VIAL LIOF. SI SOL 250mg/4ml PFIZER EUROPE M MA CUTIE X 1 FLAC. BICOMPARTIMENTAT (COMPARTIMENT INFERIOR) LIOF. PT. SOL. INJ. + (COMPARTIMENT SUPERIOR) 4ML SOLV P-R 1 20.480000 20.480000 0.000000
4 H02A METHYLPREDNISOLONUM LEMOD SOLU 125 mg P 125mg STADA HEMOFARM S ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOL S/P-RF 1 8.810000 8.810000 0.000000
5 H02A METHYLPREDNISOLONUM LEMOD SOLU 500 mg P 500mg STADA HEMOFARM S ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOL S/P-RF 1 31.020000 31.020000 0.000000
6 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN EUROPE GM GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
7 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN P IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
8 L04AX AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEW AUSTRIA CUTIE CU 1 FLAC. PEID X 100 C PR 100 0.788900 0.788900 0.000000

Tratamentul se initiaz de ctre medicul n specialitatea gastroenterologie

6. CIROZA BILIARA PRIMARA, COLANGITA SCLEROZANTA PRIMITIVA, HEPATITA CRONICA SI CIROZE DE ALTE ETIOLOGII CU COLESTAZA - G6

1 A05AA ACIDUM URSODEOXYCHOLICUM URSOFALK (R) CAPS. 250mg DR. FALK PHARMA GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CAPS P6L 100 0.946200 0.946200 0.206200
2 A05AA ACIDUM URSODEOXYCHOLICUM URSOFALK (R) CAPS. 250mg DR. FALK PHARMA GERMANI CUTIE X 2 BLIST. AL/PVC X 25 CAPS P-6 50 0.946200 0.946200 0.267200
3 A05AA ACIDUM URSODEOXYCHOLICUM URSOROM 250 mg CAPS. 250mg ROMPHARM COM ROMANIA CUTIE CU 4 BLIST. PVC/AL X 15 CAP P6L 60 0.788500 0.788500 0.000000
4 A05AA ACIDUM URSODEOXYCHOLICUM URSOFALK 500 mg COMPR. FILM. 500mg DR. FALK PHARMA GERMANI CUTIE CU 4 BLIST. PVC-PV P6L 100 2.681700 2.681700 0.000000
5 A05AA ACIDUM URSODEOXYCHOLICUM URSOFALK 250 mg/5 ml SUSP. ORALA 250mg/5ml DR. FALK PHARMA GERMANI CUTIE CU 1 FLAC. DIN STICLA BRUNA X 250 ML SUSP. ORALA+1LINGURITA DOZATOARE DIN PP P6L 1 97.490000 97.490000 0.000000

Tratamentul se initiaz de ctre medicul n specialitatea gastroenterologie

7. CIROZA HEPATICA - G7

1 A06AD LACTULOSUM DUPHALAC (R) LICHID ORAL 66,7% ABBOTT HEALTHCARE PRODUCTS B.V. OLANDA FLACON P6L 1 10.750000 10.750000 0.000000
2 A06AD LACTULOSUM LACTULOSE SIROP 65% E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLACON X 300 ML P-6 1 10.800000 10.800000 0.000000
3 A06AD LACTULOSUM LACTULOSE SIROP 65% E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLACON X 100 ML P-6 1 3.590000 3.590000 0.000000
4 A06AD LACTULOSUM LACTULOSE-MIP 650 mg/ml SIROP 650mg/ml MIP PHARMA GMBH GERMANI CUTIE X 1 FLAC. PET DE CULOARE BRUNA X 500 ML SIROP + 1 MASURA DOZATOARE DIN PP P-6 1 17.230000 17.230000 0.000000
5 A06AD LACTULOSUM LACTULOSE-MIP 650 mg/ml SIROP 650mg/ml MIP PHARMA GMBH GERMANI CUTIE X 1 FLAC. PET DE CULOARE BRUNA X 1000 ML SIROP + 1 MASURA DOZATOARE DIN PP P-6 1 33.340000 33.340000 0.000000
6 A06AD LACTULOSUM LACTULAK 660 mg/ml SOL. ORALA 660 mg/ml ROMPHARM COM ROMANIA CUTIE X 1 FLAC. PEID X 200 ML SOL. ORALA SI O LINGURITA DOZATOARE P-6 1 6.730000 6.730000 0.000000
7 A07AA RIFAXIMINUM NORMIX 200 mg COMPR. FILM. 200mg ALFA WASSERMANN ITALIA CUTIE X 1 BLIST. AL/PVC X 12 CO P-R 12 2.625833 2.625833 0.000000
8 A07AA RIFAXIMINUM NORMIX 200 mg COMPR. FILM. 200mg ALFA WASSERMANN ITALIA CUTIE X 3 BLIST. AL/PVC A C P-R 36 2.413333 2.413333 0.000000
9 A07AA RIFAXIMINUM NORMIX 200mg/10ml GRAN. PT. S 200mg/10ml ALFA WASSERMANN ITALIA CUTIE X 1 FLAC. GRAN. PT. 60 ML SUSP. ORALA + 1 MASURA DOZATOARE MARCATA LA 5, 10 SI 15 ML P-R 1 19.810000 19.810000 0.000000
10 C03CA FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R.ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.156500 0.156500 0.000000
11 C03CA FUROSEMIDUM FUROSEMID SLAVIA COMPR. 40mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.156500 0.156500 0.000000
12 C03CA FUROSEMIDUM FUROSEMID ZENTIVA COMPR. 40mg ZENTIVA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 20 C P-6 20 0.187800 0.187800 0.125200
13 C03CA FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.157000 0.157000 0.000000
14 C03CA FUROSEMIDUM FUROSEMID ARENA 40 mg COMPR. 40mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.187800 0.187800 0.125200
15 C03CA FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.187800 0.187800 0.083200
16 C03CA FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. DIN PVC/AL P-6 30 0.157666 0.157666 0.000000
17 C03CA FUROSEMIDUM FUROSEMID 20 mg/2 ml SOL. INJ. 10mg/ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 2 ML SOL. INJ. P-R 5 1.260000 1.260000 0.000000
18 C03DA SPIRONOLACTONUM VEROSPIRON CAPS. 100mg GEDEON R ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS P-6 30 0.753000 0.753000 0.000000
19 C03DA SPIRONOLACTONUM SPIRONOLACTONA ARENA CAPS. 25mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 CAP P-6 50 0.258000 0.258000 0.075400
20 C03DA SPIRONOLACTONUM SPIRONOLACTONA LPH 25 CAPS. 25mg LABORMED PHARMA ROMANIA CUTIE CU 6 BLIST. PVC/AL X 10 CAP P6L 60 0.258000 0.258000 0.078333
21 C03DA SPIRONOLACTONUM VEROSPIRON CAPS. 50mg GEDEON R ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS P-6 30 0.441666 0.441666 0.000000

Pagina 47 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APPDET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
22 C03DA SPIRONOLACTONUM SPIRONOLACTONA ARENA CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAP P-6 30 0.529999 0.529999 0.032001
23 C03DA SPIRONOLACTONUM SPIRONOLACTONA BIOEEL COMPR. 25mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.222500 0.222500 0.000000
24 C03DA SPIRONOLACTONUM SPIRONOLACTONA TERAPI COMPR. FILM. 25mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 CO P-6 50 0.258000 0.258000 0.111800
25 C03DA SPIRONOLACTONUM ALSPIRON 25 mg COMPR. FILM. 25mg AC HELCOR PHAR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CO P-6 20 0.215000 0.215000 0.000000
26 C03DA SPIRONOLACTONUM ALSPIRON 50 mg COMPR. FILM. 50mg AC HELCOR PHAR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CO P-6 20 0.529999 0.529999 0.157001
27 FARA DASABUVIRUM**** EXVIERA 250mg COMPR. FILM. 250 mg ABBVIE LTD. MA CUTIE X BLISTERE PVC-PE-PCTFE/FOLIE DIN AL X 56 COMPRIMATE FILMATE (AMBALAJ MULTIPLU CARE CONTINE 4 CUTII INTERIOARE X 14 COMPRIMATE FILMATE)
PR 56 113.407142 113.407142 0.000000
28 FARA OMBITASVIRUM+PARITAPREVI VIEKIRAX COMPR. FILM. 12,5 ABBVIE LTD. MA CUTIE X BLISTERE PVC-PE-PCTFE/FOLIE DIN AL X 56 COMPRIMATE FILMATE(AMBALAJ MULTIPLU CARE CONTINE 4 CUTII INTERIOARE X 14 COMPRIMATE FILMATE)
PR 56 ,190.124285 1,190.124285 0.000000
29 J05AB RIBAVIRINUM**** REBETOL 200 mg CAPS. 200mg MERCK SHARP & MA CUTIE X 140 CAPS. ( BLIST. PVC/ P-RF/R 140 6.248214 6.248214 1.633857
30 J05AB RIBAVIRINUM**** COPEGUS 200mg COMPR. FILM. 200mg ROCHE ROMANIA SR ROMANIA CUTIE X 1 FLAC. PEID X 168 COMP P-RF/R 168 6.248214 6.248214 1.549643
31 J05AB RIBAVIRINUM**** MODERIBA 200 mg COMPR. FILM. 200mg ABBVIE LIMITED MA CUTIE CU 1 FLAC. PEID X 168 COM PRF 168 5.206845 5.206845 0.000000
32 J05AB RIBAVIRINUM**** MODERIBA 400 mg COMPR. FILM. 400mg ABBVIE LIMITED MA CUTIE CU 1 FLAC. PEID X 56 COMP PRF 56 10.544464 10.544464 0.000000
33 J05AB RIBAVIRINUM**** MODERIBA 600 mg COMPR. FILM. 600mg ABBVIE LIMITED MA CUTIE CU 1 FLAC. PEID X 56 COMP PRF 56 13.558214 13.558214 0.000000
34 J05AF LAMIVUDINUM**** LAMIVUDINE TEVA 100 mg COMPR. FILM. 100 mg TEVA PHARMA B.V. OLANDA CUTIE CU BLIST. PVC/PVDC P-RF/R 30 2.836666 2.836666 0.000000
35 J05AF LAMIVUDINUM**** ZEFFIX 100 mg COMPR. FILM. 100mg GLAXO GROUP LTD. MA CUTIE X 28 COMPR. FILM. (B P-RF/R 28 3.403999 3.403999 0.959572
36 J05AF ADEFOVIRUM DIPIVOXILUM**** HEPSERA COMPR. 10mg GILEAD SCIENCE INTERNATIONAL LIMITED MA CUTIE X 1 FLAC. DIN PEID X 30 C P-RF/R 30 41.273333 41.273333 0.000000
37 J05AF ENTECAVIRUM**** BARACLUDE 0,5mg COMPR. FILM. 0,5mg BRISTOL-MYERS SQUIBB PHARMA EEIG MA CUTIE X 30 X 1 COMPR. FI P-RF/R 30 57.113666 57.113666 0.000000
38 J05AF ENTECAVIRUM**** BARACLUDE 1mg COMPR. FILM. 1mg BRISTOL-MYERS SQUIBB PHARMA EEIG MA CUTIE X 30 X 1 COMPR. FI P-RF/R 30 61.447000 61.447000 0.000000
39 L03AA FILGRASTIMUM (G-CSF)** ZARZIO 30MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 60MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLU P-RF/R 1 110.870000 110.870000 0.000000
40 L03AA FILGRASTIMUM (G-CSF)** ZARZIO 48MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 96MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLU P-RF/R 1 163.380000 163.380000 7.000000
41 L03AA FILGRASTIMUM (G-CSF)** ACCOFIL 30 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 30MU/0,5 ml ACCORD HE MA AMBALAJ CU 1 SER PR 1 101.990000 101.990000 0.000000
42 L03AA FILGRASTIMUM (G-CSF)** ACCOFIL 30 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 30MU/0,5 ml ACCORD HE MA AMBALAJ CU 5 SER PR 5 92.674000 92.674000 0.000000
43 L03AA FILGRASTIMUM (G-CSF)** ACCOFIL 48 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 48MU/0,5 ml ACCORD HE MA AMBALAJ CU 1 SER PR 1 150.280000 150.280000 0.000000
44 L03AA FILGRASTIMUM (G-CSF)** ACCOFIL 48 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 48MU/0,5 ml ACCORD HE MA AMBALAJ CU 5 SER PR 5 136.150000 136.150000 0.000000
45 L03AA FILGRASTIMUM (G-CSF)** NIVESTIM 30 MU/0,5 ml SOL. INJ./PERF. 300g/0,5ml HOSPIRA UK LIMITE MA CUTIE X 5 SERINGI PREUMPLUTE (STICLA) X 0,5 ML SOL. INJ. SAU PERF. P-R 5 106.198000 106.198000 0.000000
46 L03AA FILGRASTIMUM (G-CSF)** TEVAGRASTIM 30MUI/0,5ml SOL. INJ./PERF. 300g/0,5ml TEVA GMBH GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. SAU PERF. CU APARATOARE DE SIG.PT.AC PR 1 111.208800 111.208800 8.351200
47 L03AA FILGRASTIMUM (G-CSF)** NIVESTIM 48 MU/0,5 ml SOL. INJ./PERF. 480g/0,5ml HOSPIRA UK LIMITE MA CUTIE X 5 SERINGI PREUMPLUTE (STICLA) X 0,5 ML SOL. INJ. SAU PERF. P-R 5 162.800000 162.800000 0.000000
48 L03AA FILGRASTIMUM (G-CSF)** TEVAGRASTIM 48MUI/0,8ml SOL. INJ./PERF. 480g/0,8ml TEVA GMBH GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,8 ML SOL. INJ. SAU PERF. CU APARATOARE DE SIG.PT.AC PR 1 163.380000 163.380000 7.460000
49 L03AB INTERFERONUM ALFA 2A**** ROFERON A SOL. INJ. 9Mui/0,5ml ROCHE ROMANIA S.R ROMANIA CUTIE X PR 1 178.400000 178.400000 0.000000
50 L03AB INTERFERONUM ALFA 2B**** INTRON A 18 milioane U.I. SOL. INJ 18 milioane U MERCK SHARP & MA CUTIE X 1 STILOU INJECTOR (PEN) X 1,2 ML SOL. INJ. + 12 ACE + 12 TAMPOANE DEZINFECTANTE P-RF/R 1 390.310000 390.310000 0.000000
51 L03AB INTERFERONUM ALFA 2B**** INTRON A 30 milioane U.I. SOL. INJ 30 milioane U MERCK SHARP & MA CUTIE X 1 STILOU INJECTOR (PEN) X 1,2 ML + 12 ACE + 12 TAMPOANE DEZINFECTANTE P-RF/R 1 604.410000 604.410000 0.000000
52 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 100 g PULB. + S 100g MERCK SHARP & MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 674.210000 674.210000 0.000000
53 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 100 g PULB. + S 100g MERCK SHARP & MA CUTIE X 1 FLAC. CU PR 1 674.210000 674.210000 0.000000
54 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 120 g PULB. + S 120g MERCK SHARP & MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 794.880000 794.880000 0.000000
55 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 120 g PULB. + S 120g MERCK SHARP & MA CUTIE X 1 FLAC. CU PR 1 794.880000 794.880000 0.000000
56 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 150 g PULB. + S 150g MERCK SHARP & MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 975.890000 975.890000 0.000000
57 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 150 g PULB. + S 150g MERCK SHARP & MA CUTIE X 1 FLAC. CU PR 1 975.890000 975.890000 0.000000
58 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 50 g PULB. + S 50g MERCK SHARP & MA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 370.000000 370.000000 0.000000
59 L03AB PEGINTERFERON ALFA-2B**** PEGINTRON 50 g PULB. + S 50g MERCK SHARP & MA CUTIE X 1 FLAC. CU PR 1 370.000000 370.000000 0.000000
60 L03AB PEGINTERFERON ALFA-2A**** PEGASYS 180 mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 180mcg/0,5ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PRE-U P-RF/R 1 781.040000 781.040000 0.000000
61 N04B AMANTADINUM** VIREGYT (R)- K CAPS. 100mg EGIS PHAR UNGARIA CUTIE X 1 FLAC. X 50 CAPS. P-6 50 0.354400 0.354400 0.000000

Tratamentul se iniiaz de ctre medicul in specialitatea gastroenterologie sau boli infectioase

8. Leucemii, limfoame, aplazie medulara, gamapatii monoclonale maligne, mieloproliferari cronice si tumori maligne, sindroame mielodisplazice - G10

1 A04AA ONDANSETRONUM** OSETRON 4 mg COMPR. FILM. 4mg DR. REDDY'S L ROMANIA CUTIE X 1 BLIST. P-R 10 1.975000 1.975000 0.000000
2 A04AA ONDANSETRONUM** OSETRON 8 mg COMPR. FILM. 8mg DR. REDDY'S L ROMANIA CUTIE X 1 BLIST. P-R 10 3.345000 3.345000 0.000000
3 A04AA ONDANSETRONUM** OSETRON 8 mg SOLUTI SOL. INJ. 2mg/ml DR. REDDY'S L ROMANIA CUTIE X 1 BLIST. AL/PVC S/P-RF 5 9.078000 9.078000 0.000000
4 A04AA ONDANSETRONUM** OSETRON 4 mg SOLUTIE SOL. INJ. 2mg/ml DR. REDDY'S L ROMANIA CUTIE 1 BLIST. AL/PVC X 5 FI S/P-RF 5 4.936000 4.936000 0.000000

Pagina 48 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
5 A04AA ONDANSETRONUM** EMESET 8 mg/4 ml SOL. INJ./PERF. 2mg/ml CIPLA (UK) LIMITED MA CUTIE X 5 S/P-RF 5 9.074000 9.074000 0.000000
6 A04AA ONDANSETRONUM** EMESET 4 mg/2 ml SOL. INJ./PERF. 2mg/ml CIPLA (UK) LIMITED MA CUTIE X 5 FI S/P-RF 5 4.936000 4.936000 0.000000
7 A04AA GRANISETRONUM** GRANISETRON ACTAVIS 1 m COMPR. FILM. 1mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 10 CO P-R 10 11.747000 11.747000 0.000000
8 A04AA GRANISETRONUM** GRANEGIS 1 mg COMPR. FILM. 1mg EGIS PHAR UNGARIA CUTIE CU BLIST. PVC/AL X 10 CO P-R 10 12.136000 12.136000 0.000000
9 A04AA GRANISETRONUM** GRANORED 1 mg COMPR. FILM. 1mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. PVC-PVDC PRF 10 14.096400 14.096400 4.408600
10 A04AA GRANISETRONUM** SETROGEN 1 mg COMPR. FILM. 1mg ALVOGEN IPCO S.A. LUXEM CUTIE CU 1 BLIST. PVC/AL X 1 PRF 10 14.096400 14.096400 3.092600
11 A04AA GRANISETRONUM** GRANISETRON ACTAVIS 2 m COMPR. FILM. 2mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X 10 CO P-R 10 24.501000 24.501000 0.000000
12 A04AA GRANISETRONUM** GRANORED 2 mg COMPR. FILM. 2mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. PVC-PVDC PRF 10 28.198000 28.198000 0.000000
13 A04AA GRANISETRONUM** GRANISETRON TEVA 1mg/1m CONC. PT. 1mg/1ml TEVA PHARM ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA X 1 ML CONC. PT. SOL. PERF./INJ. S 5 14.580000 14.580000 0.000000
14 A04AA GRANISETRONUM** GRANISETRON TEVA 3mg/3m CONC. PT. 3mg/3ml TEVA PHARM ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA X 3 ML CONC. PT. SOL. PERF./INJ. S 5 33.974000 33.974000 0.000000
15 A04AA GRANISETRONUM** GRANISETRON KABI 1 mg/ml SOL. INJ. 1mg/ml FRESENIUS K ROMANIA CUTIE CU 5 FIOLE D PR 5 28.870000 28.870000 0.000000
16 A04AA PALONOSETRONUM** ALOXI 500mcg CAPS. MOI 500mcg HELSINN BIREX PHARMACEUTICALS LTD. IRLANDA CUTI PRF 1 288.130000 288.130000 0.000000
17 A04AA PALONOSETRONUM** ALOXI SOL. INJ. 250 mcg/5ml HELSINN BIREX PHARMACEUTICALS LTD. IRLANDA CUTIE X 1 FLAC. DIN STICLA X 5 P-R 1 329.720000 329.720000 0.000000
18 B03XA EPOETINUM ALFA*** BINOCRIT 1000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 1000UI/0,5ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMP S/P-RF/R 6 21.785000 21.785000 0.000000
19 B03XA EPOETINUM ALFA*** BINOCRIT 2000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/1,0ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMPLU S/P-RF/R 6 45.386666 45.386666 0.000000
20 B03XA EPOETINUM ALFA*** BINOCRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,7 SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUM P-RF/R 1 488.460000 488.460000 0.000000
21 B03XA EPOETINUM ALFA*** BINOCRIT 3000UI/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 3000UI/0,3ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMP S/P-RF/R 6 68.290000 68.290000 0.000000
22 B03XA EPOETINUM ALFA*** EPREX 40000 UI/ml SOL. INJ. IN SERINGA PREUMPLUTA 40 000UI/ml JOHNSON & JOH SLOVENI CUTIE CU 1 SERINGA PREU S/P-RF 1 912.804000 912.804000 99.806000
23 B03XA EPOETINUM ALFA*** BINOCRIT 40000 UI/1 ml SOL. INJ. IN SERINGA PREUMPLUTA 40000 UI/1 m SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPL P-RF/R 1 760.670000 760.670000 0.000000
24 B03XA EPOETINUM ALFA*** BINOCRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMP S/P-RF/R 6 87.998333 87.998333 0.000000
25 B03XA EPOETINUM ALFA*** BINOCRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMP S/P-RF/R 6 107.725000 107.725000 0.000000
26 B03XA EPOETINUM BETA*** NEORECORMON 10000UI/0,6 SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/0,6m ROCHE REGISTRA MA CUTIE X 6 SERI S/P-RF/R 6 280.040000 280.040000 0.000000
27 B03XA EPOETINUM BETA*** NEORECORMON 2000UI/0,3 SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,3ml ROCHE REGISTRA MA CUTIE X 6 SERI S/P-RF/R 6 59.898333 59.898333 0.000000
28 B03XA EPOETINUM BETA*** NEORECORMON 30000UI/0,6 SOL. INJ. IN SERINGA PREUMPLUTA 30000 UI/0,6 ROCHE REGISTRA MA CUTIE X 1 SERINGA PRE-U S/P-RF/R 1 999.550000 999.550000 0.000000
29 B03XA EPOETINUM BETA*** NEORECORMON 4000UI/0,3 SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,3ml ROCHE REGISTRA MA CUTIE X 6 SERI S/P-RF/R 6 108.236666 108.236666 0.000000
30 B03XA EPOETINUM BETA*** NEORECORMON 5000UI/0,3 SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,3ml ROCHE REGISTRA MA CUTIE X 6 SERI S/P-RF/R 6 154.340000 154.340000 0.000000
31 B03XA EPOETINUM ZETA*** RETACRIT 10000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/1,0m HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUMPL PR 1 228.050000 228.050000 0.000000
32 B03XA EPOETINUM ZETA*** RETACRIT 2000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,6ml HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUMP PR 1 51.940000 51.940000 0.000000
33 B03XA EPOETINUM ZETA*** RETACRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,7 HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUM PR 1 533.260000 533.260000 0.000000
34 B03XA EPOETINUM ZETA*** RETACRIT 3000UI/0,9ml SOL. INJ. IN SERINGA PREUMPLUTA 3000UI/0,9ml HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUMP PR 1 73.980000 73.980000 0.000000
35 B03XA EPOETINUM ZETA*** RETACRIT 40000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 40000UI/1,0m HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUMPL PR 1 693.880000 693.880000 0.000000
36 B03XA EPOETINUM ZETA*** RETACRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml HOSPIRA UK LIMITE
MA CUTIE X 1 SERINGA PREUMP PR 1 98.650000 98.650000 0.000000
37 B03XA EPOETINUM ZETA*** RETACRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml HOSPIRA UK LIMITE
MA CUTIE X 1 SERINGA PREUMP PR 1 123.300000 123.300000 0.000000
38 B03XA EPOETINUM ZETA*** RETACRIT 6000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI/0,6ml HOSPIRA UK LIMITE
MA CUTIE X 1 SERINGA PREUMP PR 1 140.320000 140.320000 0.000000
39 B03XA EPOETINUM ZETA*** RETACRIT 8000UI/0,8ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI/0,8ml HOSPIRA UK LIMITE
MA CUTIE X 1 SERINGA PREUMP PR 1 196.010000 196.010000 0.000000
40 B03XA DARBEPOETINUM ALFA*** ARANESP 100mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 100mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 647.495000 647.495000 0.000000
41 B03XA DARBEPOETINUM ALFA*** ARANESP 10mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 10mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 78.342500 78.342500 0.000000
42 B03XA DARBEPOETINUM ALFA*** ARANESP 150mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 150mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 962.400000 962.400000 0.000000
43 B03XA DARBEPOETINUM ALFA*** ARANESP 20mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 20mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 143.647500 143.647500 0.000000
44 B03XA DARBEPOETINUM ALFA*** ARANESP 300mcg/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 300mcg/0,6ml AMGEN EUROPE BV OLANDA CUTIE X 1 SERINGA PREUMPL P-RF/R 1 ,960.260000 1,960.260000 0.000000
45 B03XA DARBEPOETINUM ALFA*** ARANESP 30mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 30mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 206.655000 206.655000 0.000000
46 B03XA DARBEPOETINUM ALFA*** ARANESP 40mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 40mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 269.612500 269.612500 0.000000
47 B03XA DARBEPOETINUM ALFA*** ARANESP 500mcg/ml SOL. INJ. IN SERINGA PREUMPLUTA 500mcg/ml AMGEN EUROPE BV OLANDA CUTIE X 1 SERINGA PREUMPLU P-RF/R 1 ,219.860000 3,219.860000 0.000000
48 B03XA DARBEPOETINUM ALFA*** ARANESP 50mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 50mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 321.740000 321.740000 0.000000
49 B03XA DARBEPOETINUM ALFA*** ARANESP 60mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 60mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 395.560000 395.560000 0.000000
50 B03XA DARBEPOETINUM ALFA*** ARANESP 80mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 80mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 521.557500 521.557500 0.000000
51 G03HA CYPROTERONUM** ANDROCUR COMPR. 50mg BAYER PHARMA AG GERMANI CUTIE X 5 BLIST. AL/PVC X 10 COM P-R 50 2.250800 2.250800 0.000000
52 H02A DEXAMETHASONUM DEXAMED COMPR. 0,5mg CN UNIFARM S.A. ROMANIA CUTIE CU 10 BLISTERE X 10 CO PRF 100 0.190800 0.190800 0.000000
53 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU UN SUPORT CU 10 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 10 0.832000 0.832000 0.000000
54 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU UN SUPORT CU 25 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 25 0.816800 0.816800 0.000000

Pagina 49 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
55 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU 100 FIOLE D PRF 100 0.736400 0.736400 0.000000
56 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU UN SUPORT CU 10 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. PRF 10 1.387000 1.387000 0.000000
57 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU 25 FIOLE PRF 25 1.327200 1.327200 0.000000
58 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU 100 FIOLE D PRF 100 1.246200 1.246200 0.000000
59 H02A DEXAMETHASONUM DEXAMETHASONE SO SOL. INJ. 8mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 100 FIOLE DIN P-R 100 1.256100 1.256100 0.000000
60 H02A DEXAMETHASONUM DEXAMETHASONE SO SOL. INJ. 8mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 5 FIOLE DIN STIC P-R 5 1.380000 1.380000 0.000000
61 H02A DEXAMETHASONUM DEXAMED SOL. INJ. 8mg/2ml MEDOCHEMIE LTD. CIPRU CUTIE X 10 FIOLE DIN ST P-R 10 1.425000 1.425000 0.000000
62 J02AC ITRACONAZOLUM ORUNGAL CAPS. 100mg JANSSEN PH BELGIA CUTIE X 3 BLIST. AL/PVC-PE-PVD P-R 15 2.573599 2.573599 0.620401
63 J02AC ITRACONAZOLUM ITRACONAZOL 100 mg CAPS. 100mg SLAVIA PHARM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 5 CAPS. P-R 15 2.144666 2.144666 0.000000
64 J02AC ITRACONAZOLUM OMICRAL 100 mg CAPS. 100mg MEDI ROMANIA CUTIE X 3 BLIST. AL/AL X 5 CAPS. P-R 15 2.144666 2.144666 0.000000
65 J02AC ITRACONAZOLUM MICOGAL 100 mg CAPS. 100mg ROMPHARM COM ROMANIA CUTIE CU BLISTERE PVC/AL X P-R 15 2.144666 2.144666 0.000000
66 J02AC ITRACONAZOLUM ITRACONAZOL ARENA 100 CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 5 CAPS. P-R 15 2.144666 2.144666 0.000000
67 J02AC ITRACONAZOLUM OMICRAL 100 mg CAPS. 100mg PHARMASWISS CESKA REPUBLIKA S.R.O. REPUBLICA CEHA CUTIE X 3 BLIST. AL/AL X 5 CAPS. P-R 15 2.144666 2.144666 0.000000
68 J02AC VORICONAZOLUM** VFEND 200mg COMPR. FILM. 200mg PFIZER LIMITED MA CUTIE X 28 COMPR. FILM. (BLIST. P-R 28 132.002857 132.002857 0.000000
69 J02AC VORICONAZOLUM** VFEND 50mg COMPR. FILM. 50mg PFIZER LIMITED MA CUTIE X 28COMPR. FILM. ( BLIST. P-R 28 36.496071 36.496071 0.000000
70 J02AC VORICONAZOLUM** VFEND 200mg PULB. PT. SOL. 200mg PFIZER LIMITED MA CUTIE X 1 FLAC. UNIDOZA X 30ML P-R 1 512.920000 512.920000 0.000000
71 J02AC VORICONAZOLUM** VFEND 40 mg/ml PULB. PT. SU 40mg/ml PFIZER LIMITED MA CUTIE X 1 FLAC. PEID DE 100ML X 45 G PULB. PT. SUSP. ORALA + 1 MASURA DOZATOARE (23 ML) + 1 SERINGA PT. ADM. ORALA (5 ML) + 1 ADAPTOR P-R 1 ,266.130000 2,266.130000 0.000000
72 J02AC POSACONAZOLUM** NOXAFIL 100mg CAPS. GASTRO 100mg MERCK SHARP MA CUTIE CU BLIST. PVC/PCTF/AL X 24 COMPRIMATE GASTROREZISTENTE PR 24 147.492083 147.492083 0.000000
73 J02AC POSACONAZOLUM** NOXAFIL 40mg/ml SUSP. ORALA 40mg/ml MERCK SHARP & MA CUTIE X 1 FLAC. X 105ML SUSP. O P-RF/R 1 ,660.080000 2,660.080000 0.000000
74 J02AX CASPOFUNGINUM** CANCIDAS 50 mg P 50mg MERCK SHARP & MA CUTIE X 1 FLAC. PULB. PT S 1 ,396.750000 1,396.750000 0.000000
75 J02AX CASPOFUNGINUM** CANCIDAS 70 mg P 70mg MERCK SHARP & MA CUTIE X 1 FLAC. PULB. PT S 1 ,801.340000 1,801.340000 0.000000
76 L01XX ANAGRELIDUM*** THROMBOREDUCTIN 0,5 mg CAPS. 0,5mg AOP AUSTRIA CUTIE CU 1 FLAC. DIN PE X 100 CA PR 100 14.483900 14.483900 0.000000
77 L04AD CICLOSPORINUM EQUORAL 100 mg CAPS. MOI 100mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 6.232400 6.232400 0.000000
78 L04AD CICLOSPORINUM SANDIMMUN NEORAL (R) CAPS. MOI 25mg NOVARTIS PHARM GERMANI CUTIE X 10 BLIST. X 5 CAPS. MOI S/P-RF 50 1.784400 1.784400 0.574000
79 L04AD CICLOSPORINUM EQUORAL 25 mg CAPS. MOI 25mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 1.487000 1.487000 0.000000
80 L04AD CICLOSPORINUM SANDIMMUN NEORAL (R) CAPS. MOI 50mg NOVARTIS PHARM GERMANI CUTIE X 10 BLIST. X 5 CAPS. MOI S/P-RF 50 3.040560 3.040560 0.788040
81 L04AD CICLOSPORINUM EQUORAL 50 mg CAPS. MOI 50mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 2.533800 2.533800 0.000000
82 N02A MORPHYNUM MST CONTINUS 100 mg COMPR. ELIB. 100mg MUNDIPHARMA GE AUSTRIA CUTIE C P-T 60 2.910799 2.910799 0.628367
83 N02A MORPHYNUM MST CONTINUS 10 mg COMPR. ELIB. 10mg MUNDIPHARMA GE AUSTRIA CUTIE C P-T 60 0.626333 0.626333 0.000000
84 N02A MORPHYNUM MST CONTINUS 200 mg COMPR. ELIB. 200mg MUNDIPHARMA GE AUSTRIA CUTIE C P-T 60 6.769666 6.769666 0.000000
85 N02A MORPHYNUM MST CONTINUS 30 mg COMPR. ELIB. 30mg MUNDIPHARMA GE AUSTRIA CUTIE C P-T 60 0.925599 0.925599 0.184234
86 N02A MORPHYNUM MST CONTINUS 60 mg COMPR. ELIB. 60mg MUNDIPHARMA GE AUSTRIA CUTIE C P-T 60 1.944000 1.944000 0.300333
87 N02A MORPHYNUM SEVREDOL 10 mg COMPR. FILM. 10mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. AL/PVC-P P-T 60 0.751599 0.751599 0.114734
88 N02A MORPHYNUM SEVREDOL 20 mg COMPR. FILM. 20mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. AL/PVC-P P-T 60 1.219500 1.219500 0.000000
89 N02A MORPHYNUM VENDAL (R) RETARD 100 mg COMPR. FI 100mg LA AUSTRIA CUTIE X 3 BLIST. P-T 30 2.425666 2.425666 0.000000
90 N02A MORPHYNUM VENDAL (R) RETARD 30 mg COMPR. FI 30mg LA AUSTRIA CUTIE X 3 BLIST. P-T 30 0.771333 0.771333 0.000000
91 N02A MORPHYNUM VENDAL (R) RETARD 60 mg COMPR. FI 60mg LA AUSTRIA CUTIE X 3 BLIST. P-T 30 1.620000 1.620000 0.000000
92 N02A MORPHYNUM MORFINA ZENTIVA 20 mg/ml SOL. INJ. 20mg/ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE X 1 ML P-T 5 1.720000 1.720000 0.000000
93 N02A OXYCODONUM OXYCONTIN 10 mg COMPR. CU 10 mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. PVC/AL PS 60 0.815599 0.815599 0.230234
94 N02A OXYCODONUM OXYCONTIN 20 mg COMPR. CU 20 mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. PVC/AL PS 60 1.440199 1.440199 0.406134
95 N02A OXYCODONUM OXYCONTIN 40 mg COMPR. CU 40 mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. PVC/AL PS 60 2.331999 2.331999 0.503334
96 N02A OXYCODONUM OXYCONTIN 80 mg COMPR. CU 80mg MUNDIPHARMA GE AUSTRIA CUTIE CU BLIST. PVC/AL PS 60 3.964399 3.964399 1.118434
97 N02A OXYCODONUM RELTEBON 10 mg COMPR. CU E 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. CU INCHIDERE SECURIZATA PT. COPII DIN PVC/PVDC/AL/PET/HARTIE X 60 COMPR. ELIB. PREL. PR, PS 60 0.679666 0.679666 0.000000
98 N02A OXYCODONUM RELTEBON 20 mg COMPR. CU E 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. CU INCHIDERE SECURIZATA PT. COPII DIN PVC/PVDC/AL/PET/HARTIE X 60 COMPR. ELIB. PREL. PR, PS 60 1.200166 1.200166 0.000000
99 N02A OXYCODONUM CLORHIDRAT COMPR. CU E 20mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC/PVDC/AL/PET/HARTIE X 60 COMPR. CU ELIB. PREL. PR, PS 60 1.200166 1.200166 0.000000
100 N02A OXYCODONUM RELTEBON 40 mg COMPR. CU E 40mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. CU INCHIDERE SECURIZATA PT. COPII DIN PVC/PVDC/AL/PET/HARTIE X 60 COMPR. ELIB. PREL. PR, PS 60 1.943333 1.943333 0.000000
101 N02A OXYCODONUM CLORHIDRAT COMPR. CU E 40mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC/PVDC/AL/PET/HARTIE X 60 COMPR. CU ELIB. PREL. PR, PS 60 1.943333 1.943333 0.000000
102 N02A OXYCODONUM RELTEBON 80 mg COMPR. CU E 80mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. CU INCHIDERE SECURIZATA PT. COPII DIN PVC/PVDC/AL/PET/HARTIE X 60 COMPR. ELIB. PREL. PR, PS 60 3.303666 3.303666 0.000000
103 N02A OXYCODONUM CLORHIDRAT COMPR. CU E 80mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC/PVDC/AL/PET/HARTIE X 60 COMPR. CU ELIB. PREL. PR, PS 60 3.304000 3.304000 0.000000
104 N02A OXYCODONUM OXIDOLOR 10 mg COMPR. ELIB. P 10mg LA AUSTRIA CUTIE CU BLIST. PVC P-T 60 0.679666 0.679666 0.000000

Pagina 50 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
105 N02A OXYCODONUM OXIDOLOR 20 mg COMPR. ELIB. P 20mg LA AUSTRIA CUTIE CU BLIST. PVC P-T 60 1.200166 1.200166 0.000000
106 N02A OXYCODONUM OXIDOLOR 40 mg COMPR. ELIB. P 40mg LA AUSTRIA CUTIE CU BLIST. PVC P-T 60 1.943333 1.943333 0.000000
107 N02A OXYCODONUM OXICODONA SANDOZ 40 mg COMPR. ELIB. P 40mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST PS 20 2.046000 2.046000 0.000000
108 N02A OXYCODONUM OXICODONA SANDOZ 60 mg COMPR. ELIB. P 60mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST PS 20 7.230000 7.230000 0.000000
109 N02A OXYCODONUM OXIDOLOR 80 mg COMPR. ELIB. P 80mg LA AUSTRIA CUTIE CU BLIST. PVC P-T 60 3.303666 3.303666 0.000000
110 N02A OXYCODONUM OXICODONA SANDOZ 80 mg COMPR. ELIB. P 80mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST PS 20 3.546500 3.546500 0.000000
111 N02A DIHYDROCODEINUM DHC CONTINUS 120 mg COMPR. ELIB. P 120mg MUNDIPHARMA GE AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 PS 56 2.159107 2.159107 0.000000
112 N02A DIHYDROCODEINUM DHC CONTINUS 60 mg COMPR. ELIB. P 60mg MUNDIPHARMA GE AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 PS 56 0.543750 0.543750 0.000000
113 N02A DIHYDROCODEINUM DHC CONTINUS 90 mg COMPR. ELIB. P 90mg MUNDIPHARMA GE AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 PS 56 1.462142 1.462142 0.000000
114 N02A PETHIDINUM MIALGIN (R) 100 mg/2 ml SOL. INJ. 50mg/ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA X 2 ML P-T 5 1.942000 1.942000 0.000000
115 N02A FENTANYLUM** LUNALDIN 100 micrograme COMPR. SUBLIN 100microgra GEDEON RICHTER P UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 29.404000 29.404000 0.000000
116 N02A FENTANYLUM** LUNALDIN 200 micrograme COMPR. SUBLIN 200microgra GEDEON RICHTER P UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 27.380000 27.380000 0.000000
117 N02A FENTANYLUM** LUNALDIN 300 micrograme COMPR. SUBLIN 300microgra GEDEON RICHTER P UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 27.968000 27.968000 0.000000
118 N02A FENTANYLUM** LUNALDIN 400 micrograme COMPR. SUBLIN 400microgra GEDEON RICHTER P UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 27.968000 27.968000 0.000000
119 N02A FENTANYLUM** LUNALDIN 600 micrograme COMPR. SUBLIN 600microgra GEDEON RICHTER P UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 27.968000 27.968000 0.000000
120 N02A FENTANYLUM** LUNALDIN 800 micrograme COMPR. SUBLIN 800microgra GEDEON RICHTER P UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 27.968000 27.968000 0.000000
121 N02A FENTANYLUM** FENTANYL TTS SANDOZ 1 PLASTUR 100mcg/h SANDOZ S.R.L. ROMANIA CUTIE X 5 PLIC DIN HARTIE/PE/AL/PE X 1 PLASTURE TRANSDERMIC P-T 5 31.884000 31.884000 2.056000
122 N02A FENTANYLUM** FENTANYL ACTAVIS 100m PLASTUR 100microgr ACTAVIS GROUP P ISLANDA CUTIE X 5 PLICURI MULTISTRAT DIN HARTIE -PEJD- AL- SURLYN X 1 PLASTURE TRANSDERMIC PS 5 26.570000 26.570000 0.000000
123 N02A FENTANYLUM** ALGOGESIC 100 micrograme/ PLASTUR 100micro ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 5 PLICURI COMPOZITE ALCATUITE DIN PET-ADEZIV-AL-SURLYN X 1 PLASTURE TRANSDERMIC PS 5 31.884000 31.884000 7.800000
124 N02A FENTANYLUM** DOLFORIN 100 g/ORA PLASTUR 100g/ora GEDEON R ROMANIA CUTIE X P-T 5 31.884000 31.884000 7.800000
125 N02A FENTANYLUM** FENTANYL TTS SANDOZ 25 PLASTUR 25mcg/h SANDOZ S.R.L. ROMANIA CUTIE X 5 PLIC DIN HARTIE/PE/AL/PE X 1 PLASTURE TRANSDERMIC P-T 5 10.538400 10.538400 1.231600
126 N02A FENTANYLUM** FENTANYL ACTAVIS 25micr PLASTUR 25microgram ACTAVIS GROUP P ISLANDA CUTIE X 5 PLICURI MULTISTRAT DIN HARTIE -PEJD- AL- SURLYN X 1 PLASTURE TRANSDERMIC PS 5 8.782000 8.782000 0.000000
127 N02A FENTANYLUM** ALGOGESIC 25 micrograme/o PLASTUR 25microgra ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 5 PLICURI COMPOZITE ALCATUITE DIN PET-ADEZIV-AL-SURLYN X 1 PLASTURE TRANSDERMIC PS 5 10.538400 10.538400 1.813600
128 N02A FENTANYLUM** DOLFORIN 25 g/ORA PLASTUR 25g/ora GEDEON R ROMANIA CUTIE X P-T 5 10.538400 10.538400 3.653600
129 N02A FENTANYLUM** FENTANYL TTS SANDOZ 50 PLASTUR 50mcg/h SANDOZ S.R.L. ROMANIA CUTIE X 5 PLIC DIN HARTIE/PE/AL/PE X 1 PLASTURE TRANSDERMIC P-T 5 16.424000 16.424000 0.000000
130 N02A FENTANYLUM** FENTANYL ACTAVIS 50micr PLASTUR 50microgram ACTAVIS GROUP P ISLANDA CUTIE X 5 PLICURI MULTISTRAT DIN HARTIE -PEJD- AL- SURLYN X 1 PLASTURE TRANSDERMIC PS 5 15.444000 15.444000 0.000000
131 N02A FENTANYLUM** ALGOGESIC 50 micrograme/o PLASTUR 50microgra ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 5 PLICURI COMPOZITE ALCATUITE DIN PET-ADEZIV-AL-SURLYN X 1 PLASTURE TRANSDERMIC PS 5 18.532800 18.532800 4.927200
132 N02A FENTANYLUM** DOLFORIN 50 g/ORA PLASTUR 50g/ora GEDEON R ROMANIA CUTIE X P-T 5 18.532800 18.532800 6.529200
133 N02A FENTANYLUM** FENTANYL TTS SANDOZ 75 PLASTUR 75mcg/h SANDOZ S.R.L. ROMANIA CUTIE X 5 PLIC DIN HARTIE/PE/AL/PE X 1 PLASTURE TRANSDERMIC P-T 5 30.532000 30.532000 0.000000
134 N02A FENTANYLUM** ALGOGESIC 75 micrograme/o PLASTUR 75microgra ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 5 PLICURI COMPOZITE ALCATUITE DIN PET-ADEZIV-AL-SURLYN X 1 PLASTURE TRANSDERMIC PS 5 32.076000 32.076000 0.000000
135 N02A FENTANYLUM** DOLFORIN 75 g/ORA PLASTUR 75g/ora GEDEON R ROMANIA CUTIE X P-T 5 32.076000 32.076000 0.000000
136 N02AX TRAMADOLUM TRAMADOL CAPS. 50mg KRKA D.D. SLOVENI CUTIE X 2 BLIST. AL/PVC X 10 CAPS P-R 20 0.299500 0.299500 0.000000
137 N02AX TRAMADOLUM K-ALMA (R) CAPS. 50mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS P-R 20 0.341400 0.341400 0.057100
138 N02AX TRAMADOLUM TRAMADOL ARENA CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS P-R 20 0.341400 0.341400 0.125600
139 N02AX TRAMADOLUM TRAMACALM CAPS. 50mg A.C. HELCOR PH ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAP P-R 10 0.341400 0.341400 0.043600
140 N02AX TRAMADOLUM TRAMADOL ZENTIVA 50 mg CAPS. 50mg ZENTIVA A.S. SLOVACI CUTIE X 2 BLIST. AL/PVC X 10 CAPS P-R 20 0.284500 0.284500 0.000000
141 N02AX TRAMADOLUM TRAMAG 50 COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.341400 0.341400 0.057100
142 N02AX TRAMADOLUM TRAMADOL EEL COMPR. 50mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.341400 0.341400 0.042100
143 N02AX TRAMADOLUM TRAMADOL RETARD 100 mg COMPR. ELIB. P 100mg KRKA, D.D., NOVO SLOVENI CUTIE CU 3 BLIST. AL/PVC PRF 30 0.632400 0.632400 0.021266
144 N02AX TRAMADOLUM TRAMADOL SR ZENTIVA 10 COMPR. ELIB. P 100mg ZENTIVA AS SLOVACI CUTIE X 3 BLIST. PVC/AL X P-R 30 0.630333 0.630333 0.000000
145 N02AX TRAMADOLUM MABRON RETARD 100 mg COMPR. ELIB. P 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST PRF 10 0.527000 0.527000 0.000000
146 N02AX TRAMADOLUM MABRON RETARD 100 mg COMPR. ELIB. P 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 PRF 30 0.528000 0.528000 0.000000
147 N02AX TRAMADOLUM MABRON RETARD 100 mg COMPR. ELIB. P 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 B PRF 10 0.527000 0.527000 0.000000
148 N02AX TRAMADOLUM MABRON RETARD 100 mg COMPR. ELIB. P 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 PRF 30 0.528000 0.528000 0.000000
149 N02AX TRAMADOLUM TRADOLAN RETARD 150 mg COMPR. ELIB. P 150mg LA AUSTRIA CUTIE CU 3 BLIST. PRF 30 0.949599 0.949599 0.168401
150 N02AX TRAMADOLUM TRAMADOL SR ZENTIVA 15 COMPR. ELIB. P 150mg ZENTIVA AS SLOVACI CUTIE X 3 BLIST. PVC/AL X P-R 30 0.904333 0.904333 0.000000
151 N02AX TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. P 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST PRF 10 0.792000 0.792000 0.000000
152 N02AX TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. P 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 PRF 30 0.791333 0.791333 0.000000
153 N02AX TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. P 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 B PRF 10 0.792000 0.792000 0.000000
154 N02AX TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. P 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 PRF 30 0.791333 0.791333 0.000000

Pagina 51 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
155 N02AX TRAMADOLUM TRADOLAN RETARD 200 mg COMPR. ELIB. P 200mg LA AUSTRIA CUTIE CU 3 BLIST. PRF 30 1.170666 1.170666 0.000000
156 N02AX TRAMADOLUM MABRON RETARD 200 mg COMPR. ELIB. P 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST PRF 10 1.055000 1.055000 0.000000
157 N02AX TRAMADOLUM MABRON RETARD 200 mg COMPR. ELIB. P 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 PRF 30 1.055333 1.055333 0.000000
158 N02AX TRAMADOLUM MABRON RETARD 200 mg COMPR. ELIB. P 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 B PRF 10 1.055000 1.055000 0.000000
159 N02AX TRAMADOLUM MABRON RETARD 200 mg COMPR. ELIB. P 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 PRF 30 1.055333 1.055333 0.000000
160 N02AX TRAMADOLUM TRADOLAN 50 mg COMPR. FILM. 50mg LA AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 CO P-R 30 0.330333 0.330333 0.000000
161 N02AX TRAMADOLUM TRAMADOL RETARD 150 mg COMPR. FI 150mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. P-R 30 0.949599 0.949599 0.335734
162 N02AX TRAMADOLUM TRAMADOL RETARD 200 mg COMPR. FI 200mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. AL/ P-R 30 1.266000 1.266000 0.430000
163 N02AX TRAMADOLUM TRAMADOL ZENTIVA 50 mg COMPR 50mg ZENTIVA, A.S. REPUBLICA SLOVACA CUTIE CU 1 BLIST. OPA-AL-PVC/AL X 10 COMPR. ORODISPERSABILE PRF 10 0.341400 0.341400 0.056600
164 N02AX TRAMADOLUM TRAMADOL ZENTIVA 50 mg COMPR 50mg ZENTIVA, A.S. REPUBLICA SLOVACA CUTIE PRF 10 0.341400 0.341400 0.056600
165 N02AX TRAMADOLUM MABRON SOL. INJ. 100mg MEDOCHEMIE LTD. CIPRU CUTIE X 5 FIOLE DIN STIC S/P-RF 5 1.675320 1.675320 0.200680
166 N02AX TRAMADOLUM MABRON SOL. INJ. 100mg MEDOCHEMIE LTD. CIPRU CUTIE X 100 FIOLE DIN S/P-RF 100 1.396100 1.396100 0.000000
167 N02AX TRAMADOLUM TRAMADOL SOL. INJ. 50mg/ml KRKA D.D. SLOVENI CUTIE X 5 FIOLE X 1 ML S/P-RF 5 1.024000 1.024000 0.000000
168 N02AX TRAMADOLUM TRAMADOL SOL. INJ. 50mg/ml KRKA D.D. SLOVENI CUTIE X 5 FIOLE X 2 ML S/P-RF 5 1.675320 1.675320 1.042680
169 N02AX TRAMADOLUM TRAMADOL SUPOZ. 100mg KRKA D.D. SLOVENI CUTIE X 1 BLIST. X, 5 SUPOZ. P-R 5 1.158000 1.158000 0.000000
170 N07BC METHADONUM SINTALGON 2,5 mg COMPR. 2,5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 25 COM P-T 50 0.506400 0.506400 0.000000
171 N07BC METHADONUM METADON BIOEEL 5 mg COMPR. 5mg BIO EEL SRL ROMANIA CUTIE X 5 BLIST. AL/PVC-PVDC P-T 50 0.326000 0.326000 0.000000
172 N07BC METHADONUM MISYO 10 mg/ml CONC. PT. SO 10mg/ml INN-FARM D.O.O. SLOVENI CUTIE CU 1 FLAC. DIN STICLA BRUNA CU CAPAC DIN PP 28 CU SIGILIU DIN PE A 1000 ML CONC. PT. SOL. ORAL PS 1 387.080000 387.080000 0.000000
173 N07BC METHADONUM MISYO 10 mg/ml CONC. PT. SO 10mg/ml INN-FARM D.O.O. SLOVENI CUTIE CU 1 FLAC. DIN STICLA BRUNA CU CAPAC DIN PP 28 PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PT. COPII, A 1000 ML CONC. PT. SOL. ORALA
PS 1 387.080000 387.080000 0.000000
174 R05DA CODEINUM FOSFAT DE CODEINA 15 mg COMPR. 15mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.181200 0.181200 0.019133
175 R05DA CODEINUM CODEINA FOSFORICA COMPR. 15mg BIO EEL SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COM P-R 25 0.181200 0.181200 0.024000
176 R05DA CODEINUM FARMACOD COMPR. 15mg FARMACOM SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.151000 0.151000 0.000000
177 R05DA CODEINUM CODEINA FOSFAT COMPR. 15mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.173500 0.173500 0.000000
178 R05DA CODEINUM CODEINA FOSFAT LPH 15 mg COMPR. 15mg LABORMED PHARMA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COM P-R 20 0.165500 0.165500 0.000000
179 R05DA CODEINUM CODEINA FOSFAT MCC 15 m COMPR. 15mg MAGISTRA C & C SR ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.181200 0.181200 0.008300
180 V03A DEFEROXAMINUM**3) DESFERAL PULB. PT. S 500mg NOVARTIS PHARM GERMANI CU S/P-RF 10 13.266000 13.266000 0.000000
181 V03A DEFERASIROXUM*** EXJADE 125mg COMPR. DISP. 125mg NOVARTIS EURO MA CUTIE X 28 COMPR. DISP.(B PR 28 27.555357 27.555357 0.000000
182 V03A DEFERASIROXUM*** EXJADE 250mg COMPR. DISP. 250mg NOVARTIS EURO MA CUTIE X 28 COMPR. DISP. ( PV PR 28 52.592500 52.592500 0.000000
183 V03A DEFERASIROXUM*** EXJADE 500mg COMPR. DISP. 500mg NOVARTIS EURO MA CUTIE X 28 COMPR. DISP. ( PV PR 28 95.897142 95.897142 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea oncologie sau hematologie.

9. EPILEPSIE - G11

1 N03A PHENOBARBITALUM FENOBARBITAL ZENTIVA 10 COMPR. 100 mg ZENTIVA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COM P-R 25 0.142800 0.142800 0.039600
2 N03A PHENOBARBITALUM FENOBARBITAL ARENA 100m COMPR. 100mg SC ARENA GROUP S ROMANIA CUTIE X 1 FLAC. X 10 COMPR. P-R 10 0.119000 0.119000 0.000000
3 N03A PHENOBARBITALUM FENOBARBITAL ARENA 100m COMPR. 100mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIS P-R 30 0.142800 0.142800 0.044200
4 N03A PHENOBARBITALUM FENOBARBITAL ZENTIVA 1 SOL. INJ. 100 mg/ml ZENTIVA S.A ROMANIA CUTIE X 5 FIOLE D P-R 5 2.274000 2.274000 0.000000
5 N03A PHENYTOINUM FENITOINA RICHTER 100 mg COMPR. 100mg GEDEON R ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6 20 0.144000 0.144000 0.000000
6 N03A PHENYTOINUM PHENHYDAN 250 mg/5 ml SOL. INJ. 250mg/5ml DESITIN ARZNE GERMANI CUTIE CU 5 FIOLE D P-R 5 14.054000 14.054000 0.000000
7 N03AF CARBAMAZEPINUM TEGRETOL (R) 200 COMPR. 200mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. PVC-PE-PVD P-6 50 0.168000 0.168000 0.050200
8 N03AF CARBAMAZEPINUM CARBAMAZEPINA LPH (R) COMPR. 200mg LABORMED PHARMA ROMANIA CUTIE X 6 BLISTERE PV P-6L/S 60 0.141833 0.141833 0.000000
9 N03AF CARBAMAZEPINUM CARBAMAZEPINA LPH 200 COMPR. 200mg LABORMED PHARMA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COM P-6 50 0.141800 0.141800 0.000000
10 N03AF CARBAMAZEPINUM CARBAVIM COMPR. 200mg VIM SPECTRUM SRL ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COM P-6 50 0.141800 0.141800 0.000000
11 N03AF CARBAMAZEPINUM CARBEPSIL 200mg COMPR. 200mg AC HELCOR PHAR ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6 50 0.141800 0.141800 0.000000
12 N03AF CARBAMAZEPINUM CARBAMAZEPIN COMPR. 200mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.140000 0.140000 0.000000
13 N03AF CARBAMAZEPINUM CARBAMAZEPIN EEL COMPR. 200mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.142000 0.142000 0.000000
14 N03AF CARBAMAZEPINUM CARBAMAZEPINA ARENA 20 COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-6 20 0.142000 0.142000 0.000000
15 N03AF CARBAMAZEPINUM CARBAMAZEPINA SLAVIA 2 COMPR. 200mg SLAVIA PHARM SRL ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COM P-6 50 0.141800 0.141800 0.000000
16 N03AF CARBAMAZEPINUM CARBAMAZEPINA TERAPIA COMPR. 200mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 C PRF 50 0.141800 0.141800 0.000000

Pagina 52 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DET. APP
DETINATOR APP AMBALAJ laj (RON) pretul de referinta) referinta)
17 N03AF CARBAMAZEPINUM CARBEPSIL 400mg COMPR. 400mg AC HELCOR PHAR ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6 50 0.392200 0.392200 0.000000
18 N03AF CARBAMAZEPINUM CARBAMAZEPINA ARENA 4 COMPR. 400mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COM P-6 20 0.392000 0.392000 0.000000
19 N03AF CARBAMAZEPINUM TIMONIL RETARD 150 mg CO 150mg DESITIN ARZNE GERMANI CUTIE X 5 BLIS P6L 50 0.303800 0.303800 0.000000
20 N03AF CARBAMAZEPINUM TIMONIL RETARD 300 mg COMPR. CU ELIBERARE PRELUNGITA 300mg DESITIN ARZNE GERMANI CUTIE X 5 BLIST. PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P6L 50 0.412600 0.412600 0.000000
21 N03AF CARBAMAZEPINUM TIMONIL RETARD 600 mg COMPR. CU ELIBERARE PRELUNGITA 600mg DESITIN ARZNE GERMANI CUTIE X 5 BLIST. PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P6L 50 0.731600 0.731600 0.000000
22 N03AF CARBAMAZEPINUM NEUROTOP (R) RETARD 30 COMPR. ELIB. P 300mg GEROT PH AUSTRIA CUTIE X 5 BLIST. P-6 50 0.356000 0.356000 0.000000
23 N03AF CARBAMAZEPINUM NEUROTOP (R) RETARD 60 COMPR. ELIB. P 600mg GEROT PH AUSTRIA CUTIE X 5 BLIST. AL P-6 50 0.686000 0.686000 0.000000
24 N03AF CARBAMAZEPINUM TEGRETOL CR 200 COMPR. FI 200mg NOVARTIS PHARM GERMANI CUTIE P-6 50 0.168000 0.168000 0.179400
25 N03AF CARBAMAZEPINUM TEGRETOL CR 400 COMPR. FI 400mg NOVARTIS PHARM GERMANI CUTIE P-6 30 0.470400 0.470400 0.133600
26 N03AF CARBAMAZEPINUM TIMONIL SIROP SUSP. ORALA 100mg/5ml DESITIN ARZNE GERMANI CUTIE P-6 1 23.360000 23.360000 0.000000
27 N03AF OXCARBAZEPINUM TRILEPTAL (R) 300 mg COMPR. FILM. 300mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. PVC-PE P-6 50 0.887000 0.887000 0.000000
28 N03AF OXCARBAZEPINUM TRILEPTAL (R) 600 mg COMPR. FILM. 600mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. PVC-PE P-6 50 1.372200 1.372200 0.000000
29 N03AG ACIDUM VALPROICUM + SARURI ORFIRIL LONG 150 mg CAPS. ELIB. PRE 150mg DESITIN ARZNE GERMANI CUTIE X 1 FLAC. DIN PP X 50 CAPS. CU MINICOMPR. CU ELIB. PRELUNG. P-6 50 0.227760 0.227760 0.127840
30 N03AG ACIDUM VALPROICUM + SARURI CONVULEX (R) 150 mg CAPS. MOI 150mg GEROT PH AUSTRIA CUTIE X 10 B P-6 100 0.189800 0.189800 0.000000
31 N03AG ACIDUM VALPROICUM + SARURI CONVULEX 150 mg CAPS. MOI 150mg GERO AUSTRIA CUTIE CU 5 P6L 100 0.189800 0.189800 0.000000
32 N03AG ACIDUM VALPROICUM + SARURI CONVULEX (R) 300 mg CAPS. MOI 300mg GEROT PH AUSTRIA CUTIE X 10 B P-6 100 0.234500 0.234500 0.000000
33 N03AG ACIDUM VALPROICUM + SARURI CONVULEX 300 mg CAPS. MOI 300mg GERO AUSTRIA CUTIE CU 5 P6L 100 0.234500 0.234500 0.000000
34 N03AG ACIDUM VALPROICUM + SARURI CONVULEX (R) 500 mg CAPS. MOI 500mg GEROT PH AUSTRIA CUTIE X 10 B P-6 100 0.304800 0.304800 0.000000
35 N03AG ACIDUM VALPROICUM + SARURI CONVULEX 500 mg CAPS. MOI 500mg GERO AUSTRIA CUTIE CU 1 P6L 100 0.304800 0.304800 0.000000
36 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE CHRONO 300 mg COMPR. ELIB. P 300mg SANOFI-AVENTIS FRANTA CUTIE X 2 FLAC. DIN PP X 50 P-6 100 0.281400 0.281400 0.067700
37 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE (R) CHRONO 500 COMPR. ELIB. P 500mg SANOFI-AVENTIS FRANTA CUTIE X 1 FLAC. PP X 30 C P-R 30 0.365760 0.365760 0.103240
38 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE 200 mg COMPR. GAST 200mg SANOFI-AVENTIS FRANTA CUTIE X 1 FLAC. DIN PP P-6 40 0.277250 0.277250 0.000000
39 N03AG ACIDUM VALPROICUM + SARURI ORFIRIL LONG 1000 mg MINICOMPR. 1000mg DESITIN ARZNE GERMANI CUTIE X 50 MINIPLICURI. DIN PET/AL/PE CU MINICOMPR. CU ELIB. PRELUNG. P-6 50 1.924200 1.924200 0.000000
40 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE SIROP 57,64mg/ml SANOFI - AVENTI FRANTA CUTIE X 1 FLAC P-6 1 18.430000 18.430000 0.000000
41 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE SIROP 57,64mg/ml SANOFI - AVENTI FRANTA CUTIE X 1 FLACON X P-6 1 18.430000 18.430000 0.000000
42 N03AX LAMOTRIGINUM** LAMOTRIX 100 mg COMPR. 100mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.903600 0.903600 0.028066
43 N03AX LAMOTRIGINUM** PLEXXO (R) 100 mg COMPR. 100mg DESITIN ARZNE GERMANI CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.849666 0.849666 0.000000
44 N03AX LAMOTRIGINUM** LAMICTAL 100 mg COMPR. 100mg THE WE MA CUTIE CU BLIST. PVC/AL X 28 COM P-6 28 0.903600 0.903600 0.501757
45 N03AX LAMOTRIGINUM** LAMOTRIX 200 mg COMPR. 200mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 1.768000 1.768000 0.000000
46 N03AX LAMOTRIGINUM** LAMICTAL 25 mg COMPR. 25mg THE WE MA CUTIE CU BLIST. PVC/AL X 28 COM P-6 28 0.149285 0.149285 0.000000
47 N03AX LAMOTRIGINUM** LAMOTRIX 50 mg COMPR. 50mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.409999 0.409999 0.086667
48 N03AX LAMOTRIGINUM** LAMOTRIN 100 mg COMPR. DISP. 100mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIS P-6 30 0.753000 0.753000 0.000000
49 N03AX LAMOTRIGINUM** LAMOTRIN 50 mg COMPR. DISP. 50mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIS P-6 30 0.341666 0.341666 0.000000
50 N03AX LAMOTRIGINUM** LAMICTAL 2 mg COMPR. DISP./M 2mg THE WE MA CUTIE X 1 FLAC. DIN PEID P-6 30 0.009333 0.009333 0.000000
51 N03AX LAMOTRIGINUM** LAMICTAL 5 mg COMPR. DISP./M 5mg THE WE MA CUTIE X BLIST. PVC-PV P-6 30 0.026333 0.026333 0.000000
52 N03AX TOPIRAMATUM** TOPRAN 100 mg COMPR. FILM. 100mg TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 60 P-6 60 0.632400 0.632400 0.350266
53 N03AX TOPIRAMATUM** TOPIRAMAT ACTAVIS 100 mg COMPR. FILM. 100mg ACTAVIS S.R.L. ROMANIA CUTIE X 6 BLIST. OPA-AL- P-R 60 0.632400 0.632400 0.347433
54 N03AX TOPIRAMATUM** LUSITRAX 100mg COMPR. FILM. 100mg ROMASTRU TRADI ROMANIA CUTIE P-R 30 0.632400 0.632400 0.382933
55 N03AX TOPIRAMATUM** TORLEPTA 100 mg COMPR. FILM. 100mg G REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMP P-R 30 0.632400 0.632400 0.382933
56 N03AX TOPIRAMATUM** NEXTOP 100 mg COMPR. FILM. 100mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.527000 0.527000 0.000000
57 N03AX TOPIRAMATUM** TOPAMAX 100 mg COMPR. FILM. 100mg JOHNSON & JOH SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 28 0.632400 0.632400 0.879385
58 N03AX TOPIRAMATUM** TOPAMAX 100 mg COMPR. FILM. 100mg JOHNSON & JOH SLOVENI CUTIE CU 1 FLAC. PEID X 60 COM P6L 60 0.632400 0.632400 0.865100
59 N03AX TOPIRAMATUM** TOPILEX 100 mg COMPR. FILM. 100mg LA AUSTRIA CUTIE CU BLIST. PVC/PE/ P6L 30 0.632400 0.632400 0.381933
60 N03AX TOPIRAMATUM** NEXTOP 200 mg COMPR. FILM. 200mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 5.168333 5.168333 0.000000
61 N03AX TOPIRAMATUM** TOPRAN 25 mg COMPR. FILM. 25mg TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 60 P-6 60 0.242799 0.242799 0.147534
62 N03AX TOPIRAMATUM** TOPIRAMAT ACTAVIS 25 mg COMPR. FILM. 25mg ACTAVIS S.R.L. ROMANIA CUTIE X 6 BLIST. OPA-AL- P-R 60 0.242799 0.242799 0.147367
63 N03AX TOPIRAMATUM** LUSITRAX 25 mg COMPR. FILM. 25mg ROMASTRU TRADI ROMANIA CUTIE P-R 30 0.242799 0.242799 0.148201
64 N03AX TOPIRAMATUM** TORLEPTA 25 mg COMPR. FILM. 25mg G REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMP P-R 30 0.242799 0.242799 0.147534
65 N03AX TOPIRAMATUM** NEXTOP 25 mg COMPR. FILM. 25mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.202333 0.202333 0.000000
66 N03AX TOPIRAMATUM** TOPAMAX 25 mg COMPR. FILM. 25mg JOHNSON & JOH SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 28 0.242799 0.242799 0.358272

Pagina 53 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
67 N03AX TOPIRAMATUM** TOPILEX 25 mg COMPR. FILM. 25mg LA AUSTRIA CUTIE CU BLIST. PVC/PE/ P6L 30 0.242799 0.242799 0.146867
68 N03AX TOPIRAMATUM** TOPRAN 50 mg COMPR. FILM. 50mg TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 60 P-6 60 0.413599 0.413599 0.229067
69 N03AX TOPIRAMATUM** TOPIRAMAT ACTAVIS 50 mg COMPR. FILM. 50mg ACTAVIS S.R.L. ROMANIA CUTIE X 6 BLIST. OPA-AL- P-R 60 0.413599 0.413599 0.212401
70 N03AX TOPIRAMATUM** LUSITRAX 50 mg COMPR. FILM. 50mg ROMASTRU TRADI ROMANIA CUTIE P-R 30 0.413599 0.413599 0.250401
71 N03AX TOPIRAMATUM** TORLEPTA 50 mg COMPR. FILM. 50mg G REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMP P-R 30 0.413599 0.413599 0.233067
72 N03AX TOPIRAMATUM** NEXTOP 50 mg COMPR. FILM. 50mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 30 0.344666 0.344666 0.000000
73 N03AX TOPIRAMATUM** TOPAMAX 50 mg COMPR. FILM. 50mg JOHNSON & JOH SLOVENI CUTIE CU BLIST. OPA-AL-P P6L 28 0.413599 0.413599 0.608186
74 N03AX TOPIRAMATUM** TOPAMAX 50 mg COMPR. FILM. 50mg JOHNSON & JOH SLOVENI CUTIE CU 1 FLAC. PEID X 60 COM P6L 60 0.413599 0.413599 0.618067
75 N03AX TOPIRAMATUM** TOPILEX 50 mg COMPR. FILM. 50mg LA AUSTRIA CUTIE CU BLIST. PVC/PE/ P6L 30 0.413599 0.413599 0.233401
76 N03AX GABAPENTINUM*** GABAPENTIN AUROBINDO CAPS. 100 mg AUROBINDO PH MA CUTIE CU BLIST. D P6L 50 0.149200 0.149200 0.000000
77 N03AX GABAPENTINUM*** GABAGAMMA 100 mg CAPS. 100mg WORWAG GERMANI CUTIE X 10 BLIST. AL/PVC X 10 CAP P-6 100 0.179040 0.179040 0.015060
78 N03AX GABAPENTINUM*** GRIMODIN 100 mg CAPS. 100mg EGIS PHAR UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X P-6 60 0.179040 0.179040 0.397460
79 N03AX GABAPENTINUM*** GABAPENTINA PFIZER 100 CAPS. 100mg PFIZER EUROPE M MA CUTIE CU BLIST. PVC/PVDC/AL X P6L 50 0.179040 0.179040 0.288760
80 N03AX GABAPENTINUM*** GABAPENTINA PFIZER 100 CAPS. 100mg PFIZER EUROPE M MA CUTIE CU BLIST. PVC/PVDC/AL X P6L 100 0.179040 0.179040 0.273660
81 N03AX GABAPENTINUM*** GABAPENTIN ARENA 100 mg CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 B P6L 60 0.179040 0.179040 0.228293
82 N03AX GABAPENTINUM*** GABAPENTIN AUROBINDO CAPS. 300 mg AUROBINDO PH MA CUTIE CU BLIST. POLIAM P6L 50 0.447800 0.447800 0.000000
83 N03AX GABAPENTINUM*** GABAGAMMA 300 mg CAPS. 300mg WORWAG GERMANI CUTIE X 10 BLIST. AL/PVC X 10 CAP P-6 100 0.519600 0.519600 0.236500
84 N03AX GABAPENTINUM*** GABARAN 300 mg CAPS. 300mg RANBAXY UK LTD. MA CUTIE X 5 BLIST. PVC-PVDC/AL X P-6 50 0.519600 0.519600 0.827000
85 N03AX GABAPENTINUM*** GABALEPT 300 mg CAPS. 300mg PLIVA LJUBLJANA D SLOVENI CUTIE X 10 BLIST. AL/PVC X 10 CAP P-6 100 0.519600 0.519600 0.000100
86 N03AX GABAPENTINUM*** GRIMODIN 300 mg CAPS. 300mg EGIS PHAR UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X P-6 60 0.519600 0.519600 0.055900
87 N03AX GABAPENTINUM*** GABAPENTINA PFIZER 300 CAPS. 300mg PFIZER EUROPE M MA CUTIE CU BLIST. PVC/PVDC/AL X P6L 50 0.447400 0.447400 0.000000
88 N03AX GABAPENTINUM*** GABAPENTINA PFIZER 300 CAPS. 300mg PFIZER EUROPE M MA CUTIE CU BLIST. PVC/PVDC/AL X P6L 100 0.433000 0.433000 0.000000
89 N03AX GABAPENTINUM*** GABAPENTIN ARENA 300 mg CAPS. 300mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 B P6L 60 0.519600 0.519600 0.377733
90 N03AX GABAPENTINUM*** GABAPENTIN AUROBINDO CAPS. 400 mg AUROBINDO PH MA CUTIE CU BLIST. POLIAM P6L 50 0.597600 0.597600 0.000000
91 N03AX GABAPENTINUM*** GABAGAMMA 400 mg CAPS. 400mg WORWAG GERMANI CUTIE X 10 BLIST. AL/PVC X 10 CAP P-6 100 0.692520 0.692520 0.500580
92 N03AX GABAPENTINUM*** GABARAN 400 mg CAPS. 400mg RANBAXY UK LTD. MA CUTIE X 5 BLIST. PVC-PVDC/AL X P-6 50 0.692520 0.692520 0.816480
93 N03AX GABAPENTINUM*** GABALEPT 400 mg CAPS. 400mg PLIVA LJUBLJANA D SLOVENI CUTIE X 10 BLIST. AL/PVC X 10 CAP P-6 100 0.692500 0.692500 0.000000
94 N03AX GABAPENTINUM*** GRIMODIN 400 mg CAPS. 400mg EGIS PHAR UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X P-6 60 0.692520 0.692520 0.336813
95 N03AX GABAPENTINUM*** GABAPENTINA PFIZER 400 CAPS. 400mg PFIZER EUROPE M MA CUTIE CU BLIST. PVC/PVDC/AL X P6L 50 0.596200 0.596200 0.000000
96 N03AX GABAPENTINUM*** GABAPENTINA PFIZER 400 CAPS. 400mg PFIZER EUROPE M MA CUTIE CU BLIST. PVC/PVDC/AL X P6L 100 0.577100 0.577100 0.000000
97 N03AX GABAPENTINUM*** GABAPENTIN ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 B P6L 60 0.692520 0.692520 0.429146
98 N03AX GABAPENTINUM*** GABARAN 600 mg COMPR. FILM. 600mg RANBAXY UK LTD. MA CUTIE X 3 BLIST. AL-PVC- P-6 30 2.180000 2.180000 0.000000
99 N03AX GABAPENTINUM*** GRIMODIN 600 mg COMPR. FILM. 600mg EGIS PHAR UNGARIA CUTIE CU BLIST. PVC-PVDC P-6 60 1.867833 1.867833 0.000000
100 N03AX GABAPENTINUM*** GABARAN 800 mg COMPR. FILM. 800mg RANBAXY UK LTD. MA CUTIE X 3 BLIST. AL-PVC- P-6 30 3.605000 3.605000 0.000000
101 N03AX LEVETIRACETAMUM** LEVETIRACETAM TORRE COMPR. FILM. 1000 mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. DIN P P-R 30 1.878799 1.878799 1.285867
102 N03AX LEVETIRACETAMUM** LEVETIRACETAM TERAPIA COMPR. FILM. 1000 mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC PRF 30 1.878799 1.878799 1.635201
103 N03AX LEVETIRACETAMUM** KEPPRA 1000 mg COMPR. FILM. 1000mg UCB PHARMA SA BELGIA CUTIE X 30 COMPR. FILM.1 (BLIST P-R 30 1.878799 1.878799 3.247534
104 N03AX LEVETIRACETAMUM** LEVETIRACETAM ACTAVIS COMPR. FILM. 1000mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. DIN AL/PVC X PRF 30 1.864000 1.864000 0.000000
105 N03AX LEVETIRACETAMUM** LEVETIRACETAM TEVA 100 COMPR. FILM. 1000mg TEVA PHARMA OLANDA CUTIE CU BLIST. PVC/PVDC-A PRF 30 1.878799 1.878799 0.050201
106 N03AX LEVETIRACETAMUM** TRUND 1000 mg COMPR. FILM. 1000mg G REPUBLICA CEHA CUTIE CU 6 BLIST. PRF 60 1.784333 1.784333 0.000000
107 N03AX LEVETIRACETAMUM** EPILETAM 1000 mg COMPR. FILM. 1000mg EGIS PHAR UNGARIA CUTIE CU 3 BLIST. PRF 30 1.878799 1.878799 1.635201
108 N03AX LEVETIRACETAMUM** LEVETIRACETAM AUROB COMPR. FILM. 1000mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC/PE/ PRF 30 1.878799 1.878799 1.502534
109 N03AX LEVETIRACETAMUM** MYAKELL 1000 mg COMPR. FILM. 1000mg ROMASTRU TRAD ROMANIA CUTIE CU 3 BLIST. PRF 30 1.878799 1.878799 1.635201
110 N03AX LEVETIRACETAMUM** NORMEG 1000 mg COMPR. FILM. 1000mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 3 BLIST. PVC/AL X 1 PRF 30 1.565666 1.565666 0.000000
111 N03AX LEVETIRACETAMUM** LEVELANZ 1000 mg COMPR. FILM. 1000mg ABBOTT LABORA MA CUTIE CU BLIST. OPA-AL-P PRF 28 1.878799 1.878799 1.634772
112 N03AX LEVETIRACETAMUM** LEVELANZ 1000 mg COMPR. FILM. 1000mg ABBOTT LABORA MA CUTIE CU BLIST. PVC-PVDC PRF 28 1.878799 1.878799 1.634772
113 N03AX LEVETIRACETAMUM** LEVETIRACETAM TEVA 250 COMPR. FILM. 250 mg TEVA PHARMA OLANDA CUTIE CU BLIST. PVC/PVDC-A PRF 30 0.472666 0.472666 0.000000
114 N03AX LEVETIRACETAMUM** LEVETIRACETAM TORRENT COMPR. FILM. 250 mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. DIN P PRF 30 0.525999 0.525999 0.204001
115 N03AX LEVETIRACETAMUM** LEVETIRACETAM TERAPIA COMPR. FILM. 250 mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P PRF 30 0.525999 0.525999 0.430334
116 N03AX LEVETIRACETAMUM** KEPPRA 250 mg COMPR. FILM. 250mg UCB PHARMA SA BELGIA CUTIE X 30 COMPR. FILM. (BLIST. P-R 30 0.525999 0.525999 0.897667

Pagina 54 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
117 N03AX LEVETIRACETAMUM** LEVETIRACETAM ACTAVIS COMPR. FILM. 250mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. DIN AL/PVC X PRF 30 0.477666 0.477666 0.000000
118 N03AX LEVETIRACETAMUM** TRUND 250 mg COMPR. FILM. 250mg G REPUBLICA CEHA CUTIE CU 6 BLIST. PRF 60 0.438333 0.438333 0.000000
119 N03AX LEVETIRACETAMUM** EPILETAM 250 mg COMPR. FILM. 250mg EGIS PHAR UNGARIA CUTIE CU 3 BLIST. PRF 30 0.525999 0.525999 0.430334
120 N03AX LEVETIRACETAMUM** LEVETIRACETAM AUROBI COMPR. FILM. 250mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PE PRF 30 0.525999 0.525999 0.224334
121 N03AX LEVETIRACETAMUM** MYAKELL 250 mg COMPR. FILM. 250mg ROMASTRU TRAD ROMANIA CUTIE CU 3 BLIST. PRF 30 0.525999 0.525999 0.430334
122 N03AX LEVETIRACETAMUM** LEVELANZ 250 mg COMPR. FILM. 250mg ABBOTT LABORA MA CUTIE CU BLIST. OPA-AL-P PRF 28 0.525999 0.525999 0.425429
123 N03AX LEVETIRACETAMUM** LEVELANZ 250 mg COMPR. FILM. 250mg ABBOTT LABORA MA CUTIE CU BLIST. PVC-PVDC PRF 28 0.525999 0.525999 0.425429
124 N03AX LEVETIRACETAMUM** LEVETIRACETAM TORRENT COMPR. FILM. 500 mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. DIN P PRF 30 0.673599 0.673599 0.660067
125 N03AX LEVETIRACETAMUM** LEVETIRACETAM TERAPIA COMPR. FILM. 500 mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-P PRF 30 0.673599 0.673599 1.076067
126 N03AX LEVETIRACETAMUM** KEPPRA 500 mg COMPR. FILM. 500mg UCB PHARMA SA BELGIA CUTIE X 30 COMPR. FILM. (BLIST. P-R 30 0.673599 0.673599 1.882401
127 N03AX LEVETIRACETAMUM** LEVETIRACETAM ACTAVIS COMPR. FILM. 500mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. DIN AL/PVC X PRF 30 0.645000 0.645000 0.000000
128 N03AX LEVETIRACETAMUM** LEVETIRACETAM TEVA 500 COMPR. FILM. 500mg TEVA PHARMA OLANDA CUTIE CU BLIST. PVC/PVDC-A PRF 30 0.561333 0.561333 0.000000
129 N03AX LEVETIRACETAMUM** TRUND 500 mg COMPR. FILM. 500mg G REPUBLICA CEHA CUTIE CU 6 BLIST. PRF 60 0.673599 0.673599 0.228067
130 N03AX LEVETIRACETAMUM** EPILETAM 500 mg COMPR. FILM. 500mg EGIS PHAR UNGARIA CUTIE CU 3 BLIST. PRF 30 0.673599 0.673599 1.076067
131 N03AX LEVETIRACETAMUM** LEVETIRACETAM AUROBI COMPR. FILM. 500mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PE PRF 30 0.673599 0.673599 0.709067
132 N03AX LEVETIRACETAMUM** MYAKELL 500 mg COMPR. FILM. 500mg ROMASTRU TRAD ROMANIA CUTIE CU 3 BLIST. PRF 30 0.673599 0.673599 1.076067
133 N03AX LEVETIRACETAMUM** NORMEG 500 mg COMPR. FILM. 500mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 3 BLIST. PVC/AL X 1 PRF 30 0.673599 0.673599 0.135401
134 N03AX LEVETIRACETAMUM** LEVELANZ 500 mg COMPR. FILM. 500mg ABBOTT LABORA MA CUTIE CU BLIST. OPA-AL-P PRF 28 0.673599 0.673599 1.075686
135 N03AX LEVETIRACETAMUM** LEVELANZ 500 mg COMPR. FILM. 500mg ABBOTT LABORA MA CUTIE CU BLIST. PVC-PVDC PRF 28 0.673599 0.673599 1.075686
136 N03AX LEVETIRACETAMUM** LEVETIRACETAM TORRENT COMPR. FILM. 750 mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. DIN P PRF 30 2.362000 2.362000 0.000000
137 N03AX LEVETIRACETAMUM** MYAKELL 750 mg COMPR. FILM. 750mg ROMASTRU TRAD ROMANIA CUTIE CU 3 BLIST. PRF 30 2.834400 2.834400 0.423600
138 N03AX LEVETIRACETAMUM** LEVETIRACETAM DESITIN GRANULE ACOPERITE, IN PLIC UNIDOZA 1000mg DESITIN ARZNE GERMANI CUTIE CU 30 PLICURI UNIDOZA DIN HARTIE/AL/PE CONTINAND GRANULE ACOPERITE PRF 30 1.878799 1.878799 1.635201
139 N03AX LEVETIRACETAMUM** LEVETIRACETAM DESITIN 2 GRANULE ACOPERITE, IN PLIC UNIDOZA 250mg DESITIN ARZNE GERMANI CUTIE CU 30 PLICURI UNIDOZA DIN HARTIE/AL/PE CONTINAND GRANULE ACOPERITE PRF 30 0.525999 0.525999 0.362667
140 N03AX LEVETIRACETAMUM** LEVETIRACETAM DESITIN 5 GRANULE ACOPERITE, IN PLIC UNIDOZA 500mg DESITIN ARZNE GERMANI CUTIE CU 30 PLICURI UNIDOZA DIN HARTIE/AL/PE CONTINAND GRANULE ACOPERITE PRF 30 0.673599 0.673599 1.076067
141 N03AX LEVETIRACETAMUM** LEVETIRACETAM DESITIN 7 GRANULE ACOPERITE, IN PLIC UNIDOZA 750mg DESITIN ARZNE GERMANI CUTIE CU 60 PLICURI UNIDOZA DIN HARTIE/AL/PE CONTINAND GRANULE ACOPERITE PRF 60 2.834400 2.834400 0.042766
142 N03AX LEVETIRACETAMUM** LEVETIRACETA SOL. ORALA 100 mg/ml ACTAVIS GROUP P ISLANDA CUTIE X 1 FLACON DIN STICLA BRUNA A 300ML PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII + 1 SERINGA PENTRU ADMINISTRARE ORALA A 10ML
PRF 1 61.270000 61.270000 0.000000
143 N03AX LEVETIRACETAMUM** KEPPRA 100 mg/ml SOL. ORALA 100mg/ml UCB PHARMA SA BELGIA CUTIE X 1 FLACON X 300 ML SOL. ORALA + SERINGA PT. ADMIN. ORALA P-R 1 73.524000 73.524000 15.986000
144 N03AX LEVETIRACETAMUM** TRUND 100 mg/ml SOL. ORALA 100mg/ml G REPUBLICA CEHA CUTIE X 1 FLACON DIN STICLA BRUNA X 300ML SOLUTIE ORALA, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII DIN PP + O SERINGA DOZATAOARE (PP, PE) DE 10ML SI UN ADAPTOR PT. SERINGA PE
PRF 1 61.270000 61.270000 0.000000
145 N03AX LEVETIRACETAMUM** LEVETIRACETAM RAT SOL. ORALA 100mg/ml RATIOPHARM GMBH GERMANI CUTIE CU UN FLACON DIN STICLA BRUNA A 300 ML, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII + O SERINGA PENTRU ADMINISTRARE ORALA GRADATA A 10ML
PRF 1 61.270000 61.270000 0.000000
146 N03AX PREGABALINUM*** LYRICA 150 mg CAPS. 150mg PFIZER LIMITED MA CUTIE X 14 CAPS., (BLIST. PVC/AL) P-R 14 3.029570 3.029570 1.351144
147 N03AX PREGABALINUM*** LYRICA 150 mg CAPS. 150mg PFIZER LIMITED MA CUTIE X 56 CAPS., (BLIST. PVC/AL) P-R 56 3.029570 3.029570 0.866680
148 N03AX PREGABALINUM*** PREGABALIN ZENTIVA 150 m CAPS. 150mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CAPS PRF 56 2.524642 2.524642 0.000000
149 N03AX PREGABALINUM*** LYRICA 300 mg CAPS. 300mg PFIZER LIMITED MA CUTIE X 56 CAPS. (BLIST. PVC/AL) P-R 56 5.731785 5.731785 0.000000
150 N03AX PREGABALINUM*** LYRICA 300 mg CAPS. 300mg PFIZER LIMITED MA CUTIE X 14 CAPS. (BLIST. PVC/AL) P-R 14 6.045000 6.045000 0.000000
151 N03AX PREGABALINUM*** LYRICA 75 mg CAPS. 75mg PFIZER LIMITED MA CUTIE X 14 CAPS., (BLIST. PVC/AL) P-R 14 1.597285 1.597285 1.035572
152 N03AX PREGABALINUM*** LYRICA 75 mg CAPS. 75mg PFIZER LIMITED MA CUTIE X 56 CAPS., (BLIST. PVC/AL) P-R 56 1.597285 1.597285 0.816643
153 N03AX PREGABALINUM*** PREGLENIX 75 mg CAPS. 75mg G REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 14 CAPS PRF 14 1.597285 1.597285 0.170572
154 N03AX PREGABALINUM*** PREGLENIX 75 mg CAPS. 75mg G REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CAPS PRF 56 1.597285 1.597285 0.027715
155 N03AX PREGABALINUM*** PREGABALIN ZENTIVA 75 mg CAPS. 75mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CAPS PRF 56 1.331071 1.331071 0.000000
156 N03AX STIRIPENTOLUM** DIACOMIT 250mg CAPS. 250mg BIOCODEX FRANTA CUTIE X 1 FLAC. DIN PP X 60 CAPS. P-RF/R 60 12.749333 12.749333 0.000000
157 N03AX STIRIPENTOLUM** DIACOMIT 500mg CAPS. 500mg BIOCODEX FRANTA CUTIE X 1 FLAC. DIN PP X 60 CAPS. P-RF/R 60 25.643166 25.643166 0.000000
158 N03AX STIRIPENTOLUM** DIACOMIT 250mg PULB. PT. SU 250mg BIOCODEX FRANTA CUTIE X 60 PLICURI HARTIE/AL/PE P-RF/R 60 12.749333 12.749333 0.000000
159 N03AX STIRIPENTOLUM** DIACOMIT 500mg PULB. PT. SU 500mg BIOCODEX FRANTA CUTIE X 60 PLICURI HARTIE/AL/PE P-RF/R 60 25.643166 25.643166 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea neurologie i neurologie pediatric.

10. BOALA PARKINSON - G12

Pagina 55 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
1 N04A TRIHEXYPHENIDYLUM ROMPARKIN (R) 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COM P-6 50 0.562400 0.562400 0.000000
2 N04B COMBINATII (LEVODOPUM+CARBIDOP ISICOM 250 mg/25 mg COMPR. 250mg/25mg DESITIN ARZNE GERMANI CUTIE X 10 BLIST. PP/AL X 10 COMP P-6 100 0.773600 0.773600 0.000000
3 N04B COMBINATII (LEVODOPUM+CARBIDOP DUODOPA GEL INT. FAR ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANI CUTIE X 7 CASETE BRUNE TRANSPARENTE X 100 GEL INT. IN PUNGA PVC S/P-RF 7 452.308571 452.308571 0.000000
4 N04B COMBINATII (LEVOD TADOGLEN 100 mg/25 mg/2 COMPR. FILM. 100mg/ G REPUBLICA CEHA CUTIE CU 1 FLAC. PEID X 100 C PRF 100 1.782700 1.782700 0.000000
5 N04B COMBINATII (LEVOD STALEVO 100 mg/25 mg/200 COMPR. FILM. 100mg/2 ORION CORPORATI FINLAND CUTIE X 1 FLAC. PEID X 100 COMP P-R 100 2.139000 2.139000 0.603400
6 N04B COMBINATII (LEVOD LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 100 mg/25 mg/200 mg COMPR. FILM. 100mg/2 TEVA PHARM ROMANIA CUTIE CU 1 FLAC. ALB DIN PRF 100 1.782500 1.782500 0.000000
7 N04B COMBINATII (LEVOD STALEVO 125 mg/31,25 mg COMPR. FILM. 12 ORION CORPORATI FINLAND CUTIE X 1 FLAC. HDPE X 100 COM PRF 100 2.139000 2.139000 0.603400
8 N04B COMBINATII (LEVOD LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 125 mg/31,25 mg/200 mg COMPR. FILM. 12 TEVA PHARM ROMANIA CUTIE CU 1 FLAC. ALB DIN PRF 100 1.782500 1.782500 0.000000
9 N04B COMBINATII (LEVOD TADOGLEN 150 mg/37,5 m COMPR. FILM. 150mg G REPUBLICA CEHA CUTIE CU 1 FLAC. PEID X 100 C PRF 100 1.851000 1.851000 0.000000
10 N04B COMBINATII (LEVOD STALEVO 150 mg/37,5 mg/2 COMPR. FILM. 150m ORION CORPORATI FINLAND CUTIE X 1 FLAC. PEID X 100 COMP P-R 100 2.221200 2.221200 0.626500
11 N04B COMBINATII (LEVOD LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 150 mg/37,5 mg/200 mg COMPR. FILM. 150m TEVA PHARM ROMANIA CUTIE CU 1 FLAC. ALB DIN PRF 100 1.851000 1.851000 0.000000
12 N04B COMBINATII (LEVOD TADOGLEN 200 mg/50 mg/2 COMPR. FILM. 200mg/ G REPUBLICA CEHA CUTIE CU 1 FLAC. PEID X 100 C PRF 100 1.994800 1.994800 0.000000
13 N04B COMBINATII (LEVOD STALEVO 200 mg/50 mg/200 COMPR. FILM. 200mg/5 ORION CORPORATI FINLAND CUTIE X 1 FLAC. PEID X 100 COMP P-R 100 2.393760 2.393760 0.675440
14 N04B COMBINATII (LEVOD LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 200 mg/50 mg/200 mg COMPR. FILM. 200mg/5 TEVA PHARM ROMANIA CUTIE CU 1 FLAC. ALB DIN PRF 100 1.995000 1.995000 0.000000
15 N04B COMBINATII (LEVOD TADOGLEN 50 mg/12,5 mg/2 COMPR. FILM. 50mg G REPUBLICA CEHA CUTIE CU 1 FLAC. PEID X 100 C PRF 100 1.646200 1.646200 0.000000
16 N04B COMBINATII (LEVOD STALEVO 50 mg/12,5 mg/20 COMPR. FILM. 50mg/1 ORION CORPORATI FINLAND CUTIE X 1 FLAC. PEID X 100 COMP P-R 100 1.975440 1.975440 0.557260
17 N04B COMBINATII (LEVOD LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 50 mg/12,5 mg/200 mg COMPR. FILM. 50mg/1 TEVA PHARM ROMANIA CUTIE CU 1 FLAC. ALB DIN PRF 100 1.646200 1.646200 0.000000
18 N04B COMBINATII (LEVOD STALEVO 75 mg/18,75 mg/2 COMPR. FILM. 75mg ORION CORPORATI FINLAND CUTIE X 1 FLAC. HDPE X 100 COM PRF 100 1.515120 1.515120 1.325480
19 N04B COMBINATII (LEVOD LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 75 mg/18,75 mg/200 mg COMPR. FILM. 75mg TEVA PHARM ROMANIA CUTIE CU 1 FLAC. ALB DIN PRF 100 1.262600 1.262600 0.000000
20 N04B AMANTADINUM** VIREGYT (R)- K CAPS. 100mg EGIS PHAR UNGARIA CUTIE X 1 FLAC. X 50 CAPS. P-6 50 0.354400 0.354400 0.000000
21 N04BC BROMOCRIPTINUM BROCRIPTIN (N04BC01) DRAJ. 2,5mg BIOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 20 DRAJ. P-R 40 0.549000 0.549000 0.000000
22 N04BC ROPINIROLUM** ROPINIROL TEVA 2 mg COMPR. CU E 2mg TEVA PHARM ROMANIA CUTIE PRF 30 0.916333 0.916333 0.000000
23 N04BC ROPINIROLUM** REQUIP-MODUTAB 2 mg COMPR. CU E 2mg SMITHKLINE BEE MA CUTIE P-R 28 1.099285 1.099285 0.265000
24 N04BC ROPINIROLUM** ROPINIROL TEVA 4 mg COMPR. CU E 4mg TEVA PHARM ROMANIA CUTIE PRF 30 1.773000 1.773000 0.000000
25 N04BC ROPINIROLUM** REQUIP-MODUTAB 4 mg COMPR. CU E 4mg SMITHKLINE BEE MA CUTIE P-R 28 2.127428 2.127428 0.462929
26 N04BC ROPINIROLUM** ROPINIROL TEVA 8 mg COMPR. CU E 8mg TEVA PHARM ROMANIA CUTIE PRF 30 3.044666 3.044666 0.000000
27 N04BC ROPINIROLUM** REQUIP-MODUTAB 8 mg COMPR. CU E 8mg SMITHKLINE BEE MA CUTIE P-R 28 3.653570 3.653570 0.869287
28 N04BC ROPINIROLUM** ROLPRYNA EP 2 mg COMPR. CU ELIBERARE PRELUNGITA 2 mg KRKA ,D.D., NOV SLOVENI CUTIE CU BLIST. PRF 28 0.916071 0.916071 0.000000
29 N04BC ROPINIROLUM** ROLPRYNA EP 4 mg COMPR. CU ELIBERARE PRELUNGITA 4 mg KRKA ,D.D., NOV SLOVENI CUTIE CU BLIST. PRF 28 1.772857 1.772857 0.000000
30 N04BC ROPINIROLUM** ROLPRYNA EP 8 mg COMPR. CU ELIBERARE PRELUNGITA 8 mg KRKA ,D.D., NOV SLOVENI CUTIE CU BLIST. PRF 28 3.044642 3.044642 0.000000
31 N04BC ROPINIROLUM** ROPINIROL AUROBINDO 2 m COMPR. ELIB. P 2 mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PV PRF 28 0.916071 0.916071 0.000000
32 N04BC ROPINIROLUM** ROPINIROL ACTAVIS 2 mg COMPR. ELIB. P 2mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 28 C PRF 28 0.916071 0.916071 0.000000
33 N04BC ROPINIROLUM** NERVAMAT 2 mg COMPR. ELIB. P 2mg EGIS PHAR UNGARIA CUTIE CU 4 BLIST. PRF 28 0.916071 0.916071 0.000000
34 N04BC ROPINIROLUM** ROPINIROL AUROBINDO 4 m COMPR. ELIB. P 4 mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PV PRF 28 1.772857 1.772857 0.000000
35 N04BC ROPINIROLUM** NERVAMAT 4 mg COMPR. ELIB. P 4mg EGIS PHAR UNGARIA CUTIE CU 4 BLIST. PRF 28 1.772857 1.772857 0.000000
36 N04BC ROPINIROLUM** ROPINIROL ACTAVIS 4 mg COMPR. ELIB. P 4mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 28 C PRF 28 1.772857 1.772857 0.000000
37 N04BC ROPINIROLUM** ROPINIROL AUROBINDO 8 m COMPR. ELIB. P 8 mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PV PRF 28 3.044642 3.044642 0.000000
38 N04BC ROPINIROLUM** NERVAMAT 8 mg COMPR. ELIB. P 8mg EGIS PHAR UNGARIA CUTIE CU 4 BLIST. PRF 28 3.044642 3.044642 0.000000
39 N04BC ROPINIROLUM** ROPINIROL ACTAVIS 8 mg COMPR. ELIB. P 8mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 28 C PRF 28 3.044642 3.044642 0.000000
40 N04BC PRAMIPEXOLUM** PRAMIPEXOLE ACCORD 0, COMPR. 0,088 mg ACCORD HE MA CUTIE CU 3 BLIST. AL-PVC/AL PRF 30 0.523333 0.523333 0.000000
41 N04BC PRAMIPEXOLUM** OPRYMEA 0,088mg COMPR. 0,088mg KRKA D.D. SLOVENI CUTIE X 30 COMPR. (BLIST. AL/AL) P-R 30 0.530000 0.530000 0.000000
42 N04BC PRAMIPEXOLUM** PRAMIPEXOLE ACCORD 0, COMPR. 0,18 mg ACCORD HE MA CUTIE CU 3 BLIST. AL-PVC/AL PRF 30 0.322666 0.322666 0.000000
43 N04BC PRAMIPEXOLUM** PRAMIPEXOLE ACCORD 0, COMPR. 0,18 mg ACCORD HE MA CUTIE CU 10 BLIST. AL-PVC/ PRF 100 0.322500 0.322500 0.000000
44 N04BC PRAMIPEXOLUM** PRAMIPEXOL ZENTIVA 0,18 COMPR. 0,18 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 3 BLIST. OPA-AL-PV PRF 30 0.386666 0.386666 0.000000
45 N04BC PRAMIPEXOLUM** OPRYMEA 0,18mg COMPR. 0,18mg KRKA D.D. SLOVENI CUTIE X 30 COMPR. (BLIST. AL/AL) P-R 30 0.387000 0.387000 0.039666
46 N04BC PRAMIPEXOLUM** MEDOPEXOL 0,18 mg COMPR. 0,18mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC/A PRF 30 0.387000 0.387000 0.264333
47 N04BC PRAMIPEXOLUM** GLEPARK 0,18 mg COMPR. 0,18mg G REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMPR P-R 30 0.322666 0.322666 0.000000
48 N04BC PRAMIPEXOLUM** PRAMIPEXOL TORRENT 0,1 COMPR. 0,18mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A P-R 30 0.387000 0.387000 0.203666
49 N04BC PRAMIPEXOLUM** PRAMIPEXOL AUROBINDO COMPR. 0,18mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PA/AL/PVC-AL PRF 30 0.387000 0.387000 0.136333
50 N04BC PRAMIPEXOLUM** MIGLASEN 0,18 mg COMPR. 0,18mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PV P6L 30 0.387000 0.387000 0.127000

Pagina 56 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
51 N04BC PRAMIPEXOLUM** PRAMIPEXOL AUROBINDO COMPR. 0,7 mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PA/AL/PVC-AL PRF 30 1.889333 1.889333 0.000000
52 N04BC PRAMIPEXOLUM** PRAMIPEXOL ZENTIVA 0,7 m COMPR. 0,7 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 3 BLIST. OPA-AL-PV PRF 30 2.041680 2.041680 0.067320
53 N04BC PRAMIPEXOLUM** OPRYMEA 0,7mg COMPR. 0,7mg KRKA D.D. SLOVENI CUTIE X 30 COMPR. (BLIST. AL/AL) P-R 30 2.028000 2.028000 0.000000
54 N04BC PRAMIPEXOLUM** MEDOPEXOL 0,7 mg COMPR. 0,7mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC/A PRF 30 2.034333 2.034333 0.000000
55 N04BC PRAMIPEXOLUM** GLEPARK 0,7 mg COMPR. 0,7mg G REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMPR P-R 30 2.041680 2.041680 0.214986
56 N04BC PRAMIPEXOLUM** PRAMIPEXOLE ACCORD 0, COMPR. 0,7mg ACCORD HE MA CUTIE CU 3 BLIST. AL-PVC/AL PRF 30 1.889333 1.889333 0.000000
57 N04BC PRAMIPEXOLUM** PRAMIPEXOL TORRENT 0,7 COMPR. 0,7mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A P-R 30 2.041680 2.041680 0.396320
58 N04BC PRAMIPEXOLUM** PRAMIPEXOL STADA 0,7 mg COMPR. 0,7mg STADA ARZNEIMITT GERMANI CUTIE X 3 BLIST. OPA-AL -PVC/ P-R 30 2.027333 2.027333 0.000000
59 N04BC PRAMIPEXOLUM** PRAMIPEXOLE ACCORD 0, COMPR. 0,7mg ACCORD HE MA CUTIE CU 10 BLIST. AL-PVC/ PRF 100 1.701400 1.701400 0.000000
60 N04BC PRAMIPEXOLUM** MIGLASEN 0,7 mg COMPR. 0,7mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PV P6L 30 2.041680 2.041680 0.405986
61 N04BC PRAMIPEXOLUM** MIRAPEXIN 0,26 mg COMPR. ELIB. P 0,26mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 1 BLIST.OPA-AL-PVC P-R 10 0.763200 0.763200 0.755800
62 N04BC PRAMIPEXOLUM** OPRYMEA 0,26mg COMPR. ELIB. P 0,26mg KRKA D.D. SLOVENI CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-R 30 0.636000 0.636000 0.000000
63 N04BC PRAMIPEXOLUM** CALMOLAN 0,26 mg COMPR. ELIB. P 0,26mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. A PRF 10 0.636000 0.636000 0.000000
64 N04BC PRAMIPEXOLUM** MIRAPEXIN 0,52 mg COMPR. ELIB. P 0,52mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST.OPA-AL-PVC P-R 30 1.679599 1.679599 0.473734
65 N04BC PRAMIPEXOLUM** OPRYMEA 0,52mg COMPR. ELIB. P 0,52mg KRKA D.D. SLOVENI CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-R 30 1.399666 1.399666 0.000000
66 N04BC PRAMIPEXOLUM** CALMOLAN 0,52 mg COMPR. ELIB. P 0,52mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. A PRF 30 1.399666 1.399666 0.000000
67 N04BC PRAMIPEXOLUM** MIRAPEXIN 1,05 mg COMPR. ELIB. P 1,05mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST.OPA-AL-PVC P-R 30 2.550000 2.550000 1.552000
68 N04BC PRAMIPEXOLUM** OPRYMEA 1,05mg COMPR. ELIB. P 1,05mg KRKA D.D. SLOVENI CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-R 30 2.125000 2.125000 0.000000
69 N04BC PRAMIPEXOLUM** OPRYMEA 1,57mg COMPR. ELIB. P 1,57mg KRKA D.D. SLOVENI CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-R 30 5.049333 5.049333 0.000000
70 N04BC PRAMIPEXOLUM** OPRYMEA 2,10mg COMPR. ELIB. P 2,10mg KRKA D.D. SLOVENI CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-R 30 4.722333 4.722333 0.000000
71 N04BC PRAMIPEXOLUM** MIRAPEXIN 2,1 mg COMPR. ELIB. P 2,1mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST.OPA-AL-PVC P-R 30 5.666799 5.666799 1.598201
72 N04BC PRAMIPEXOLUM** CALMOLAN 2,1 mg COMPR. ELIB. P 2,1mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. A PRF 30 4.722333 4.722333 0.000000
73 N04BC PRAMIPEXOLUM** OPRYMEA 2,62 mg COMPR. ELIB. P 2,62mg KRKA, D.D., NOVO SLOVENI CUTIE PRF 30 8.426666 8.426666 0.000000
74 N04BC PRAMIPEXOLUM** MIRAPEXIN 3,15 mg COMPR. ELIB. P 3,15mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANI CUTIE CU 3 BLIST.OPA-AL-PVC P-R 30 9.320799 9.320799 2.629201
75 N04BC PRAMIPEXOLUM** OPRYMEA 3,15 mg COMPR. ELIB. P 3,15mg KRKA, D.D., NOVO SLOVENI CUTIE PRF 30 7.767333 7.767333 0.000000
76 N04BC ROTIGOTINUM*** NEUPRO 2mg/24h PLASTUR 2mg/24h UCB IRLANDA CUTIE X 28 PLASTURI TRANSDERM P-R 28 7.975714 7.975714 0.000000
77 N04BC ROTIGOTINUM*** NEUPRO 4mg/24h PLASTUR 4mg/24h UCB IRLANDA CUTIE X 28 PLASTURI TRANSDERM P-R 28 11.431428 11.431428 0.000000
78 N04BC ROTIGOTINUM*** NEUPRO 6mg/24h PLASTUR 6mg/24h UCB IRLANDA CUTIE X 28 PLASTURI TRANSDERM P-R 28 14.614285 14.614285 0.000000
79 N04BC ROTIGOTINUM*** NEUPRO 8mg/24h PLASTUR 8mg/24h UCB IRLANDA CUTIE X 28 PLASTURI TRANSDERM P-R 28 17.376071 17.376071 0.000000
80 N04BD SELEGILINUM SELEGOS COMPR. 5mg MEDOCHEMIE LTD. CIPRU CUTIE X 5 BLIST. DIN AL/PVC X 1 P-6 50 0.725200 0.725200 0.000000
81 N04BD SELEGILINUM SELEGOS COMPR. 5mg MEDOCHEMIE LTD. CIPRU CUTIE X 10 BLIST. DIN AL/PVC X P-6 100 0.701100 0.701100 0.000000
82 N04BD RASAGILINUM*** AZILECT 1mg COMPR. 1mg TEVA PHARMA GMBH GERMANI CUTIE X 30 COMPR.(BLIST. AL/AL) P-R 30 14.349333 14.349333 0.000000
83 N04BX ENTACAPONUM*** COMTAN 200mg COMPR. FILM. 200mg NOVARTIS EURO MA CUTIE X 1 FLAC. DIN STICLA BRUNA CU SISTEM DE INCHIDERE SECURIZAT X 100 COMPR. FILM. P-R 100 1.922280 1.922280 0.542220
84 N04BX ENTACAPONUM*** ENTACAPONE TEVA COMPR. FILM. 200mg TEVA PHARMA B.V. OLANDA CUTIE X 1 FLAC. DIN PEID X 10 PRF 100 1.601900 1.601900 0.000000
85 N04BX ENTACAPONUM*** ENCAPIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC PRF 30 1.779000 1.779000 0.000000
86 N04BX ENTACAPONUM*** ENCAPIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC PRF 60 1.689166 1.689166 0.000000
87 N04BX ENTACAPONUM*** ENCAPIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC PRF 100 1.601900 1.601900 0.000000
88 N05AH CLOZAPINUM** LEPONEX (R) 100 mg COMPR. 100mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. X 10 COMPR. P-R 50 1.274200 1.274200 0.000000
89 N05AH CLOZAPINUM** LEPONEX (R) 25 mg COMPR. 25mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. X 10 COMPR. P-R 50 0.386200 0.386200 0.000000

Tratamentul se initiaza de catre medicul in specialitatea neurologie

11. MIASTENIA GRAVIS - G13

1 H02A PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.108399 0.108399 0.028601
2 H02A PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.090333 0.090333 0.000000
3 H02A PREDNISONUM PREDNISON 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.108399 0.108399 0.015267
4 H02A PREDNISONUM PREDNISON - RICHTER 5 mg COMPR. 5mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COM P-R 20 0.108399 0.108399 0.025101
5 L01BA METHOTREXATUM METHOTREXAT "EBEWE" 5 CONC. PT. 100mg/ml EBEW AUSTRIA CUTIE X 1 FLACON X 50 ML S 1 374.090000 374.090000 0.000000

Pagina 57 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
6 L01BA METHOTREXATUM METHOTREXAT "EBEWE" 1 CONC. PT. 100mg/ml EBEW AUSTRIA CUTIE X 1 TUB DIN M S 1 82.990000 82.990000 0.000000
7 L01BA METHOTREXATUM BENDATREXAT SOL INJ. 25mg/ml CN UNIFARM S.A. ROMANIA CUTIE CU 1 FLAC. X 2 ML PR 1 64.090000 64.090000 0.000000
8 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 0,75 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJ
PR 1 61.880000 61.880000 0.000000
9 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 2,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE PR 1 118.008000 118.008000 9.082000
10 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE
PR 1 46.730000 46.730000 0.000000
11 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,5 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE
PR 1 79.700000 79.700000 0.000000
12 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,40ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 98.340000 98.340000 0.000000
13 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,20ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 56.076000 56.076000 13.944000
14 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,50ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 110.680000 110.680000 0.000000
15 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0.30ML SOLUTIA INJECTABILA PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 74.880000 74.880000 0.000000
16 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN EUROPE GM GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
17 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN P IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
18 L04AX AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEW AUSTRIA CUTIE CU 1 FLAC. PEID X 100 C PR 100 0.788900 0.788900 0.000000
19 N07A NEOSTIGMINI BROMIDUM NEOSTIGMINA LPH 15 mg COMPR. 15mg LABORMED PHARMA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COM P-6 20 0.712000 0.712000 0.000000
20 N07A NEOSTIGMINI BROMIDUM NEOSTIGMINA LPH 15 mg COMPR. 15mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PVC/AL X 60 COM P-6 60 0.688833 0.688833 0.000000
21 N07A PYRIDOSTIGMINI BROMIDUM MESTINON 60 mg DRAJ. 60mg MEDA AB SUEDIA CUTIE X 1 FLAC. X 20 DRAJ. S/P-RF 20 0.618500 0.618500 0.000000

Tratamentul se initiaza de catre medicul in specialitatea neurologie

12. SCLEROZA MULTIPLA - G14

1 H02A METHYLPREDNISOLONUM MEDROL A 16 COMPR. 16mg PFIZER EUROPE M MA CUTIE X 5 BLIST. A-PVC/PVC X 1 P-R 50 0.543200 0.543200 0.000000
2 H02A METHYLPREDNISOLONUM MEDROL 32 COMPR. 32mg PFIZER EUROPE M MA CUTIE X 2 BLIST. AL-PVC/PVC X P-R 20 1.234000 1.234000 0.000000
3 H02A METHYLPREDNISOLONUM SOLU - MEDROL ACT-O-VIAL LIOF. SI SOL 250mg/4ml PFIZER EUROPE M MA CUTIE X 1 FLAC. BICOMPARTIMENTAT (COMPARTIMENT INFERIOR) LIOF. PT. SOL. INJ. + (COMPARTIMENT SUPERIOR) 4ML SOLV P-R 1 20.480000 20.480000 0.000000
4 H02A METHYLPREDNISOLONUM LEMOD SOLU 125 mg P 125mg STADA HEMOFARM S ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOL S/P-RF 1 8.810000 8.810000 0.000000
5 H02A METHYLPREDNISOLONUM LEMOD SOLU 500 mg P 500mg STADA HEMOFARM S ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOL S/P-RF 1 31.020000 31.020000 0.000000
6 H02A PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.108399 0.108399 0.028601
7 H02A PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.090333 0.090333 0.000000
8 H02A PREDNISONUM PREDNISON 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.108399 0.108399 0.015267
9 H02A PREDNISONUM PREDNISON - RICHTER 5 mg COMPR. 5mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COM P-R 20 0.108399 0.108399 0.025101
10 L01BA METHOTREXATUM METHOTREXAT "EBEWE" 5 CONC. PT. 100mg/ml EBEW AUSTRIA CUTIE X 1 FLACON X 50 ML S 1 374.090000 374.090000 0.000000
11 L01BA METHOTREXATUM METHOTREXAT "EBEWE" 1 CONC. PT. 100mg/ml EBEW AUSTRIA CUTIE X 1 TUB DIN M S 1 82.990000 82.990000 0.000000
12 L01BA METHOTREXATUM BENDATREXAT SOL INJ. 25mg/ml CN UNIFARM S.A. ROMANIA CUTIE CU 1 FLAC. X 2 ML PR 1 64.090000 64.090000 0.000000
13 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 0,75 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJ PR 1 61.880000 61.880000 0.000000
14 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 2,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE
PR 1 118.008000 118.008000 9.082000
15 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE
PR 1 46.730000 46.730000 0.000000
16 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,5 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE PR 1 79.700000 79.700000 0.000000
17 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,40ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 98.340000 98.340000 0.000000
18 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,20ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 56.076000 56.076000 13.944000
19 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,50ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 110.680000 110.680000 0.000000
20 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0.30ML SOLUTIA INJECTABILA PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 74.880000 74.880000 0.000000
21 L01DB MITOXANTRONUM*** ONKOTRONE CONC. PT. SOL. 2mg/ml BAXTER ONCOLO GERMANI CUTIE X 1 FLACON X 10 ML CO S 1 555.760000 555.760000 0.000000
22 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN EUROPE GM GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
23 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN P IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
24 L04AX AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEW AUSTRIA CUTIE CU 1 FLAC. PEID X 100 C PR 100 0.788900 0.788900 0.000000

Tratamentul se iniiaz de ctre medicul din specialitatea neurologie.

Pagina 58 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)

13. BOLI PSIHICE (SCHIZOFRENIE, TULBURRI SCHIZOTIPALE I DELIRANTE, TULBURRI AFECTIVE MAJORE, TULBURRI PSIHOTICE ACUTE I BOLI PSIHICE COPII, AUTISM, TULBURRI CU
DEFICIT DE ATENIE/HIPERREACTIVITATE) - G15

1 N03AG ACIDUM VALPROICUM + SARURI ORFIRIL LONG 150 mg CAPS. ELIB. PRE 150mg DESITIN ARZNE GERMANI CUTIE X 1 FLAC. DIN PP X 50 CAPS. CU MINICOMPR. CU ELIB. PRELUNG. P-6 50 0.227760 0.227760 0.127840
2 N03AG ACIDUM VALPROICUM + SARURI CONVULEX (R) 150 mg CAPS. MOI 150mg GEROT PH AUSTRIA CUTIE X 10 B P-6 100 0.189800 0.189800 0.000000
3 N03AG ACIDUM VALPROICUM + SARURI CONVULEX 150 mg CAPS. MOI 150mg GERO AUSTRIA CUTIE CU 5 P6L 100 0.189800 0.189800 0.000000
4 N03AG ACIDUM VALPROICUM + SARURI CONVULEX (R) 300 mg CAPS. MOI 300mg GEROT PH AUSTRIA CUTIE X 10 B P-6 100 0.234500 0.234500 0.000000
5 N03AG ACIDUM VALPROICUM + SARURI CONVULEX 300 mg CAPS. MOI 300mg GERO AUSTRIA CUTIE CU 5 P6L 100 0.234500 0.234500 0.000000
6 N03AG ACIDUM VALPROICUM + SARURI CONVULEX (R) 500 mg CAPS. MOI 500mg GEROT PH AUSTRIA CUTIE X 10 B P-6 100 0.304800 0.304800 0.000000
7 N03AG ACIDUM VALPROICUM + SARURI CONVULEX 500 mg CAPS. MOI 500mg GERO AUSTRIA CUTIE CU 1 P6L 100 0.304800 0.304800 0.000000
8 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE CHRONO 300 mg COMPR. ELIB. P 300mg SANOFI-AVENTIS FRANTA CUTIE X 2 FLAC. DIN PP X 50 P-6 100 0.281400 0.281400 0.067700
9 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE (R) CHRONO 500 COMPR. ELIB. P 500mg SANOFI-AVENTIS FRANTA CUTIE X 1 FLAC. PP X 30 C P-R 30 0.365760 0.365760 0.103240
10 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE 200 mg COMPR. GAST 200mg SANOFI-AVENTIS FRANTA CUTIE X 1 FLAC. DIN PP P-6 40 0.277250 0.277250 0.000000
11 N03AG ACIDUM VALPROICUM + SARURI ORFIRIL LONG 1000 mg MINICOMPR. 1000mg DESITIN ARZNE GERMANI CUTIE X 50 MINIPLICURI. DIN PET/AL/PE CU MINICOMPR. CU ELIB. PRELUNG. P-6 50 1.924200 1.924200 0.000000
12 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE SIROP 57,64mg/ml SANOFI - AVENTI FRANTA CUTIE X 1 FLAC P-6 1 18.430000 18.430000 0.000000
13 N03AG ACIDUM VALPROICUM + SARURI DEPAKINE SIROP 57,64mg/ml SANOFI - AVENTI FRANTA CUTIE X 1 FLACON X P-6 1 18.430000 18.430000 0.000000
14 N03AX LAMOTRIGINUM** LAMOTRIX 100 mg COMPR. 100mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.903600 0.903600 0.028066
15 N03AX LAMOTRIGINUM** PLEXXO (R) 100 mg COMPR. 100mg DESITIN ARZNE GERMANI CUTIE X 3 BLIST. X 10 COMPR. P-6 30 0.849666 0.849666 0.000000
16 N03AX LAMOTRIGINUM** LAMICTAL 100 mg COMPR. 100mg THE WE MA CUTIE CU BLIST. PVC/AL X 28 COM P-6 28 0.903600 0.903600 0.501757
17 N03AX LAMOTRIGINUM** LAMOTRIX 200 mg COMPR. 200mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 1.768000 1.768000 0.000000
18 N03AX LAMOTRIGINUM** LAMICTAL 25 mg COMPR. 25mg THE WE MA CUTIE CU BLIST. PVC/AL X 28 COM P-6 28 0.149285 0.149285 0.000000
19 N03AX LAMOTRIGINUM** LAMOTRIX 50 mg COMPR. 50mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COM P-6 30 0.409999 0.409999 0.086667
20 N03AX LAMOTRIGINUM** LAMOTRIN 100 mg COMPR. DISP. 100mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIS P-6 30 0.753000 0.753000 0.000000
21 N03AX LAMOTRIGINUM** LAMOTRIN 50 mg COMPR. DISP. 50mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIS P-6 30 0.341666 0.341666 0.000000
22 N03AX LAMOTRIGINUM** LAMICTAL 2 mg COMPR. DISP./M 2mg THE WE MA CUTIE X 1 FLAC. DIN PEID P-6 30 0.009333 0.009333 0.000000
23 N03AX LAMOTRIGINUM** LAMICTAL 5 mg COMPR. DISP./M 5mg THE WE MA CUTIE X BLIST. PVC-PV P-6 30 0.026333 0.026333 0.000000
24 N04A TRIHEXYPHENIDYLUM ROMPARKIN (R) 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COM P-6 50 0.562400 0.562400 0.000000
25 N05AD HALOPERIDOLUM HALOPERIDOL LAROPHARM COMPR. 0,5mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.168000 0.168000 0.000000
26 N05AD HALOPERIDOLUM HALOPERIDOL ARENA 1 mg COMPR. 1mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 C PRF 30 0.267000 0.267000 0.000000
27 N05AD HALOPERIDOLUM HALOPERIDOL ARENA 2 mg COMPR. 2mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLISTERE PVC/AL PRF 30 0.373333 0.373333 0.000000
28 N05AD HALOPERIDOLUM HALDOL COMPR. 5mg JANSSEN PH BELGIA CUTIE X 1 BLIST. AL/PVC X 25 COM P-R 25 0.299600 0.299600 0.000000
29 N05AD HALOPERIDOLUM HALOPERIDOL ROMPHARM PIC. ORALE, SOL 2 mg/ml ROMPHARM COM ROMANIA CUTIE CU 1 FLACON PEJD CU PICURATOR PEJD X 10 ML PIC. OFT., SOL. PRF 1 5.390000 5.390000 0.000000
30 N05AD HALOPERIDOLUM HALOPERIDOL 2 mg/ml PIC. ORALE-SOL. 2mg/ml GEDEON R ROMANIA CUTIE P-R 1 6.468000 6.468000 0.432000
31 N05AD HALOPERIDOLUM HALOPERIDOL DECANOAT SOL. INJ. 50mg/ml GEDEON R ROMANIA CUTIE X 5 FIOLE X 1 ML P-R 5 8.452000 8.452000 0.000000
32 N05AD HALOPERIDOLUM HALOPERIDOL RICHTER 5 m SOL. INJ. 5mg/ml GEDEON R ROMANIA CUTIE X 5 FIOLE D P-R 5 2.206000 2.206000 0.000000
33 N05A SERTINDOL** SERDOLECT 16 mg COMPR. FILM. 16mg H. LUNDBECK A/S DANEM CUTIE X 2 BLIST. PVC-PVD P-R 28 14.899285 14.899285 0.000000
34 N05A SERTINDOL** SERDOLECT 4 mg COMPR. FILM. 4mg H. LUNDBECK A/S DANEM CUTIE X 3 BLIST. PVC-PVD P-R 30 3.767000 3.767000 0.000000
35 N05A ZIPRASIDONUM** ZYPSILA 40 mg CAPS. 40mg KRKA D.D. NOVO M SLOVENI CUTIE X 6 BLIST. PVC-PVDC/AL X P-R 60 2.787333 2.787333 0.000000
36 N05A ZIPRASIDONUM** ZYPSILA 60 mg CAPS. 60mg KRKA D.D. NOVO M SLOVENI CUTIE X 6 BLIST. PVC-PVDC/AL X P-R 60 4.212166 4.212166 0.000000
37 N05A ZIPRASIDONUM** ZYPSILA 80 mg CAPS. 80mg KRKA D.D. NOVO M SLOVENI CUTIE X 6 BLIST. PVC-PVDC/AL X P-R 60 4.330833 4.330833 0.000000
38 N05AF FLUPENTIXOLUM** FLUANXOL DEPOT SOL. INJ. 20mg/ml H. LUNDBECK A/S DANEM CUTIE X 10 FIOLE DI P-R 10 7.118000 7.118000 0.000000
39 N05AF ZUCLOPENTHIXOLUM** CLOPIXOL 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEM CUTIE X 1 FLAC. DIN PEJD X 50 COMPR. FILM., INCHIS CU CAPAC CU FILET, PREVAZUT CU SISTEM DE INCHIDER P-R 50 0.358800 0.358800 0.000000
40 N05AF ZUCLOPENTHIXOLUM** CLOPIXOL 25 mg COMPR. FILM. 25mg H. LUNDBECK A/S DANEM CUTIE X 1 FLAC. DIN PEJD X 50 COMPR. FILM., INCHIS CU CAPAC CU FILET, PREVAZUT CU SISTEM DE INCHIDER P-R 50 0.568000 0.568000 0.000000
41 N05AF ZUCLOPENTHIXOLUM** CLOPIXOL 20 mg/ml PIC. ORALE-SOL. 20mg/ml H. LUNDBECK A/S DANEM CUTIE X 1 FLAC. + P-R 1 29.290000 29.290000 0.000000
42 N05AF ZUCLOPENTHIXOLUM** CLOPIXOL (R) DEPOT SOL. INJ. 200mg/ml H. LUNDBECK A/S DANEM CUTIE X 10 FIOLE X 1 ML P-R 10 12.456000 12.456000 0.000000
43 N05AF ZUCLOPENTHIXOLUM** CLOPIXOL ACUPHASE (R) SOL. INJ. 50mg/ml H. LUNDBECK A/S DANEM CUTIE X 5 FIOLE X 1 ML P-R 5 9.058000 9.058000 0.000000
44 N05AH CLOZAPINUM** LEPONEX (R) 100 mg COMPR. 100mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. X 10 COMPR. P-R 50 1.274200 1.274200 0.000000
45 N05AH CLOZAPINUM** LEPONEX (R) 25 mg COMPR. 25mg NOVARTIS PHARM GERMANI CUTIE X 5 BLIST. X 10 COMPR. P-R 50 0.386200 0.386200 0.000000
46 N05AH OLANZAPINUM** ZALASTA 10mg COMPR. 10mg KRKA D.D. NOVO M SLOVENI CUTIE X 28 COMPR., (BLISTER P-R 28 0.671428 0.671428 0.000000

Pagina 59 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
47 N05AH OLANZAPINUM** OLAZAX 10 mg COMPR. 10mg G REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 28 COMPR P-R 28 0.671570 0.671570 0.070215
48 N05AH OLANZAPINUM** ZALASTA 5mg COMPR. 5mg KRKA D.D. NOVO M SLOVENI CUTIE X 28 COMPR., (BLISTER P-R 28 0.440357 0.440357 0.000000
49 N05AH OLANZAPINUM** OLAZAX 5 mg COMPR. 5mg G CUTIE CU BLIST. AL/AL X 28 COMPR
REPUBLICA CEHA P-R 28 0.446400 0.446400 0.107885
50 N05AH OLANZAPINUM** ZYPREXA 10 mg COMPR. FILM. 10mg ELI LILLY NEDER OLANDA CUTIE X 28 COMPR. P-R 28 0.671570 0.671570 6.514858
51 N05AH OLANZAPINUM** LAPOZAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 28 COMP P-R 28 0.671570 0.671570 2.413430
52 N05AH OLANZAPINUM** LAPOZAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 30 COMP P-R 30 0.671570 0.671570 2.413763
53 N05AH OLANZAPINUM** OLANZAPINA ACTAVIS 10 mg COMPR. FILM. 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 30 COMP P-R 30 0.563000 0.563000 0.000000
54 N05AH OLANZAPINUM** BLOONIS 10 mg COMPR. FILM. 10mg SANOFI - ROMANIA CUTIE CU BLIST. OPA-AL-P P-R 28 0.671428 0.671428 0.000000
55 N05AH OLANZAPINUM** LAPOZAN 15 mg COMPR. FILM. 15mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 28 COMP P-R 28 2.440713 2.440713 4.871787
56 N05AH OLANZAPINUM** EGOLANZA 15 mg COMPR. FILM. 15mg EGIS PHAR UNGARIA CUTIE CU BLIST. OPA-AL-P P-R 28 2.440713 2.440713 5.162501
57 N05AH OLANZAPINUM** EGOLANZA 20 mg COMPR. FILM. 20mg EGIS PHAR UNGARIA CUTIE CU BLIST. OPA-AL-P P-R 28 2.764285 2.764285 6.115000
58 N05AH OLANZAPINUM** ZYPREXA 5 mg COMPR. FILM. 5mg ELI LILLY NEDER OLANDA CUTIE X 28 COMPR. P-R 28 0.446400 0.446400 3.342885
59 N05AH OLANZAPINUM** LAPOZAN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 28 COMP P-R 28 0.446400 0.446400 0.846100
60 N05AH OLANZAPINUM** LAPOZAN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 30 COMP P-R 30 0.446400 0.446400 2.016600
61 N05AH OLANZAPINUM** OLANZAPINA ACTAVIS 5 mg COMPR. FILM. 5mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. AL/AL X 30 COMP P-R 30 0.372000 0.372000 0.000000
62 N05AH OLANZAPINUM** BLOONIS 5 mg COMPR. FILM. 5mg SANOFI - ROMANIA CUTIE CU BLIST. OPA-AL-P P-R 28 0.443928 0.443928 0.000000
63 N05AH OLANZAPINUM** ZALASTA 10mg COMPR 10mg KRKA D.D. NOVO M SLOVENI CUTIE P-R 28 0.586071 0.586071 0.000000
64 N05AH OLANZAPINUM** OLANZAPINE TEVA 10mg COMPR 10mg TEVA PHARMA BV OLANDA CUTIE CU BLIST. OPA P-R 30 0.671570 0.671570 0.062430
65 N05AH OLANZAPINUM** OLANZAPINA TERAPIA 10 mg COMPR 10mg TERAPIA S.A. ROMANIA CUTIE C P-R 28 0.671570 0.671570 4.084501
66 N05AH OLANZAPINUM** OLAZAX DISPERZI 10 mg COMPR 10mg G REPUBLICA CEHA CUTIE CU BLIST. AL/ P-R 28 0.671570 0.671570 0.358430
67 N05AH OLANZAPINUM** LAPOZAN 10 mg COMPR 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/ P-R 30 0.671570 0.671570 2.412430
68 N05AH OLANZAPINUM** LAPOZAN 10 mg COMPR 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/ P-R 50 0.671570 0.671570 2.252630
69 N05AH OLANZAPINUM** BLOONIS 10 mg COMPR 10mg SANOFI - ROMANIA CUTIE P-R 28 0.671428 0.671428 0.000000
70 N05AH OLANZAPINUM** OLANZAPINA DR. REDDY'S COMPR 10mg DR. REDDY'S L ROMANIA CUTIE P-R 35 0.671570 0.671570 3.746144
71 N05AH OLANZAPINUM** OLANZAPINA ACTAVIS 10 mg COMPR 10mg ACTAVIS GROUP P ISLANDA CUTIE P-R 28 0.559642 0.559642 0.000000
72 N05AH OLANZAPINUM** IRROPIA 10 mg COMPR 10mg ROMASTRU TRADI ROMANIA CUTIE CU 4 BLIST. PRF 28 0.671570 0.671570 0.361287
73 N05AH OLANZAPINUM** OLANZAPINA TORRENT 10 m COMPR 10mg TORRENT PHARMA S ROMANIA CUTIE P-R 28 0.671570 0.671570 3.776644
74 N05AH OLANZAPINUM** WRANELON 10 mg COMPR 10mg GALENICA S.A. GRECIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 (4X7) COMPR. ORODISPERSABILE PRF 28 0.671570 0.671570 0.362001
75 N05AH OLANZAPINUM** OLANZAPINA AUROBINDO 1 COMPR 10mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLISTERE DIN PA/AL+EAA-PE+DESICANT-PED//AL-PE X 28 COMPR. ORODISPERSABILE PRF 28 0.671570 0.671570 0.362001
76 N05AH OLANZAPINUM** ZALASTA 15mg COMPR 15mg KRKA D.D. NOVO M SLOVENI CUTIE P-R 28 2.033928 2.033928 0.000000
77 N05AH OLANZAPINUM** OLANZAPINE TEVA 15mg COMPR 15mg TEVA PHARMA BV OLANDA CUTIE CU BLIST. OPA P-R 30 2.440713 2.440713 0.586953
78 N05AH OLANZAPINUM** OLANZAPINA TERAPIA 15 mg COMPR 15mg TERAPIA S.A. ROMANIA CUTIE C P-R 28 2.440713 2.440713 3.426787
79 N05AH OLANZAPINUM** OLAZAX DISPERZI 15 mg COMPR 15mg G REPUBLICA CEHA CUTIE CU BLIST. AL/ P-R 28 2.440713 2.440713 3.426787
80 N05AH OLANZAPINUM** LAPOZAN 15 mg COMPR 15mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/ P-R 30 2.440713 2.440713 3.426287
81 N05AH OLANZAPINUM** BLOONIS 15 mg COMPR 15mg SANOFI - ROMANIA CUTIE P-R 28 2.440713 2.440713 0.000001
82 N05AH OLANZAPINUM** OLANZAPINA DR. REDDY'S COMPR 15mg DR. REDDY'S L ROMANIA CUTIE P-R 35 2.440713 2.440713 3.426429
83 N05AH OLANZAPINUM** OLANZAPINA ACTAVIS 15 mg COMPR 15mg ACTAVIS GROUP P ISLANDA CUTIE P-R 28 2.435000 2.435000 0.000000
84 N05AH OLANZAPINUM** IRROPIA 15 mg COMPR 15mg ROMASTRU TRADI ROMANIA CUTIE CU 4 BLIST. PRF 28 2.440713 2.440713 0.129644
85 N05AH OLANZAPINUM** OLANZAPINA TORRENT 15 m COMPR 15mg TORRENT PHARMA S ROMANIA CUTIE P-R 28 2.440713 2.440713 3.426787
86 N05AH OLANZAPINUM** WRANELON 15 mg COMPR 15mg GALENICA S.A. GRECIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 (4X7) COMPR. ORODISPERSABILE PRF 28 2.440713 2.440713 2.030358
87 N05AH OLANZAPINUM** OLANZAPINA AUROBINDO 1 COMPR 15mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLISTERE DIN PA/AL+EAA-PE+DESICANT-PED//AL-PE X 28 COMPR. ORODISPERSABILE PRF 28 2.440713 2.440713 1.757144
88 N05AH OLANZAPINUM** OLANZAPINA POLPHARMA 2 COMPR 20 mg PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE CU BLIST PRF 28 2.764285 2.764285 6.508215
89 N05AH OLANZAPINUM** ZALASTA 20mg COMPR 20mg KRKA D.D. NOVO M SLOVENI CUTIE P-R 28 2.303571 2.303571 0.000000
90 N05AH OLANZAPINUM** OLANZAPINE TEVA 20mg COMPR 20mg TEVA PHARMA BV OLANDA CUTIE CU BLIST. OPA P-R 30 2.304000 2.304000 0.000000
91 N05AH OLANZAPINUM** OLANZAPINA TERAPIA 20 mg COMPR 20mg TERAPIA S.A. ROMANIA CUTIE C P-R 28 2.764285 2.764285 6.577857
92 N05AH OLANZAPINUM** OLAZAX DISPERZI 20 mg COMPR 20mg G REPUBLICA CEHA CUTIE CU BLIST. AL/ P-R 28 2.764285 2.764285 3.458215
93 N05AH OLANZAPINUM** BLOONIS 20 mg COMPR 20mg SANOFI - ROMANIA CUTIE P-R 28 2.764285 2.764285 0.000357
94 N05AH OLANZAPINUM** OLANZAPINA DR. REDDY'S COMPR 20mg DR. REDDY'S L ROMANIA CUTIE P-R 35 2.764285 2.764285 5.624857
95 N05AH OLANZAPINUM** OLANZAPINA ACTAVIS 20 mg COMPR 20mg ACTAVIS GROUP P ISLANDA CUTIE P-R 28 2.749642 2.749642 0.000000
96 N05AH OLANZAPINUM** IRROPIA 20 mg COMPR 20mg ROMASTRU TRADI ROMANIA CUTIE CU 4 BLIST. PRF 28 2.764285 2.764285 3.457143

Pagina 60 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
97 N05AH OLANZAPINUM** OLANZAPINA TORRENT 20 m COMPR 20mg TORRENT PHARMA S ROMANIA CUTIE P-R 28 2.764285 2.764285 3.245000
98 N05AH OLANZAPINUM** WRANELON 20 mg COMPR 20mg GALENICA S.A. GRECIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 (4X7) COMPR. ORODISPERSABILE PRF 28 2.764285 2.764285 2.111786
99 N05AH OLANZAPINUM** OLANZAPINA AUROBINDO 2 COMPR 20mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLISTERE DIN PA/AL+EAA-PE+DESICANT-PED//AL-PE X 28 COMPR. ORODISPERSABILE PRF 28 2.764285 2.764285 2.421072
100 N05AH OLANZAPINUM** ZALASTA 5mg COMPR 5mg KRKA D.D. NOVO M SLOVENI CUTIE P-R 28 0.440357 0.440357 0.000000
101 N05AH OLANZAPINUM** OLANZAPINE TEVA 5mg COMPR 5mg TEVA PHARMA BV OLANDA CUTIE X 30 COMPR. FILM. (BL P-R 30 0.443666 0.443666 0.000000
102 N05AH OLANZAPINUM** OLANZAPINA TERAPIA 5 mg COMPR 5mg TERAPIA S.A. ROMANIA CUTIE C P-R 28 0.446400 0.446400 2.060742
103 N05AH OLANZAPINUM** OLAZAX DISPERZI 5 mg COMPR 5mg G REPUBLICA CEHA CUTIE CU BLIST. AL/ P-R 28 0.446400 0.446400 0.107885
104 N05AH OLANZAPINUM** LAPOZAN 5 mg COMPR 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/ P-R 30 0.446400 0.446400 0.845933
105 N05AH OLANZAPINUM** LAPOZAN 5 mg COMPR 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/ P-R 50 0.446400 0.446400 0.845800
106 N05AH OLANZAPINUM** OLANZAPINA DR. REDDY'S COMPR 5mg DR. REDDY'S L ROMANIA CUTIE P-R 35 0.446400 0.446400 2.016457
107 N05AH OLANZAPINUM** OLANZAPINA ACTAVIS 5 mg COMPR 5mg ACTAVIS GROUP P ISLANDA CUTIE P-R 28 0.446400 0.446400 0.015742
108 N05AH OLANZAPINUM** IRROPIA 5 mg COMPR 5mg ROMASTRU TRADI ROMANIA CUTIE CU 4 BLIST. PRF 28 0.446400 0.446400 0.107885
109 N05AH OLANZAPINUM** OLANZAPINA TORRENT 5 mg COMPR 5mg TORRENT PHARMA S ROMANIA CUTIE P-R 28 0.446400 0.446400 1.598600
110 N05AH OLANZAPINUM** WRANELON 5 mg COMPR 5mg GALENICA S.A. GRECIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 (2X14) COMPR. ORODISPERSABILE PRF 28 0.446400 0.446400 0.107885
111 N05AH OLANZAPINUM** OLANZAPINA AUROBINDO 5 COMPR 5mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLISTERE DIN PA/AL+EAA-PE+DESICANT-PED//AL-PE X 28 COMPR. ORODISPERSABILE PRF 28 0.446400 0.446400 0.107885
112 N05AH OLANZAPINUM** OLANZAPINA TORRENT 7,5 COMPR 7,5mg TORRENT PHARMA S ROMANIA CUTIE P-R 28 3.313571 3.313571 0.000000
113 N05AH OLANZAPINUM** ZYPADHERA 210mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 210mg ELI LILLY NEDER OLANDA CUTIE X 1 FLAC X P-RF/R 1 650.040000 650.040000 0.000000
114 N05AH OLANZAPINUM** ZYPADHERA 300mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 300mg ELI LILLY NEDER OLANDA CUTIE X 1 FLAC X P-RF/R 1 916.710000 916.710000 0.000000
115 N05AH OLANZAPINUM** ZYPADHERA 405mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 405mg ELI LILLY NEDER OLANDA CUTIE X 1 FLAC X P-RF/R 1 ,223.460000 1,223.460000 0.000000
116 N05AH OLANZAPINUM** ZYPREXA 10 mg PULB. PT. SOL. I 10mg ELI LILLY NEDER OLANDA CUTIE X 1 FLAC. X 10 MG PULB.PT P-R 1 20.710000 20.710000 0.000000
117 N05AH QUETIAPINUM** SEROQUEL XR 150 mg COMPR. ELIB. P 150mg ASTRAZENECA UK MA CUTIE CU 6 BLIST P-R 60 1.770199 1.770199 1.316134
118 N05AH QUETIAPINUM** QUETIAPINA TEVA 150 mg COMPR. ELIB. P 150mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC/ACLA PRF 60 1.475166 1.475166 0.000000
119 N05AH QUETIAPINUM** QUETIAPINA TEVA 200 mg COMPR. ELIB. P 200mg TEVA PHARM ROMANIA CUTIE CU BLIS PRF 60 1.953500 1.953500 0.000000
120 N05AH QUETIAPINUM** QUETIAPINA TEVA 300 mg COMPR. ELIB. P 300mg TEVA PHARM ROMANIA CUTIE CU BLIS PRF 60 2.752000 2.752000 0.000000
121 N05AH QUETIAPINUM** QUETIAPINA TEVA 400 mg COMPR. ELIB. P 400mg TEVA PHARM ROMANIA CUTIE CU BLIS PRF 60 3.405166 3.405166 0.000000
122 N05AH QUETIAPINUM** QUETIAPINA TEVA 50 mg COMPR. ELIB. P 50mg TEVA PHARM ROMANIA CUTIE CU BLIS PRF 60 0.742500 0.742500 0.000000
123 N05AH QUETIAPINUM** KETILEPT 100 mg COMPR. FILM. 100mg EGIS PHAR UNGARIA CUTIE X BLIST. PVC-PVDC/AL P-R 60 0.426799 0.426799 0.538701
124 N05AH QUETIAPINUM** QUETIAPINE TEVA 100 mg COMPR. FILM. 100mg TEVA PHARMAC ROMANIA CUTIE CU BLIST. PVC-P P-RF/S 60 0.355666 0.355666 0.000000
125 N05AH QUETIAPINUM** KVENTIAX 100 mg COMPR. FILM. 100mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 60 CO P-R 60 0.355666 0.355666 0.000000
126 N05AH QUETIAPINUM** QUETROP 100 mg COMPR. FILM. 100mg G REPUBLICA CEHA CUTIE CU 6 BLIST. PVC/AL X 1 P-R 60 0.426799 0.426799 1.033701
127 N05AH QUETIAPINUM** Q MIND 100 mg COMPR. FILM. 100mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC/AL X 60 CO P-R 60 0.426799 0.426799 0.418201
128 N05AH QUETIAPINUM** KATHIRA 100 mg COMPR. FILM. 100mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. PRF 60 0.426799 0.426799 0.473367
129 N05AH QUETIAPINUM** KATHIRA 150 mg COMPR. FILM. 150mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. PRF 60 1.492666 1.492666 0.000000
130 N05AH QUETIAPINUM** KETILEPT 200 mg COMPR. FILM. 200mg EGIS PHAR UNGARIA CUTIE X BLIST. PVC-PVDC/AL P-R 60 0.602799 0.602799 0.347367
131 N05AH QUETIAPINUM** QUETIAPINE TEVA 200 mg COMPR. FILM. 200mg TEVA PHARMAC ROMANIA CUTIE CU BLIST. PVC-P P-RF/S 60 0.504833 0.504833 0.000000
132 N05AH QUETIAPINUM** KVENTIAX 200 mg COMPR. FILM. 200mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 60 CO P-R 60 0.502333 0.502333 0.000000
133 N05AH QUETIAPINUM** QUETROP 200 mg COMPR. FILM. 200mg G REPUBLICA CEHA CUTIE CU 6 BLIST. PVC/AL X 1 P-R 60 0.602799 0.602799 1.275034
134 N05AH QUETIAPINUM** Q MIND 200 mg COMPR. FILM. 200mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC/AL X 60 CO P-R 60 0.602799 0.602799 0.813367
135 N05AH QUETIAPINUM** KATHIRA 200 mg COMPR. FILM. 200mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. PRF 60 0.602799 0.602799 0.889867
136 N05AH QUETIAPINUM** KATHIRA 25 mg COMPR. FILM. 25mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. PRF 60 0.588000 0.588000 0.000000
137 N05AH QUETIAPINUM** KETILEPT 300 mg COMPR. FILM. 300mg EGIS PHAR UNGARIA CUTIE X BLIST. PVC-PVDC/AL P-R 60 1.256799 1.256799 0.352867
138 N05AH QUETIAPINUM** QUETIAPINE TEVA 300 mg COMPR. FILM. 300mg TEVA PHARMAC ROMANIA CUTIE CU BLIST. PVC-P P-RF/S 60 1.051166 1.051166 0.000000
139 N05AH QUETIAPINUM** KVENTIAX 300 mg COMPR. FILM. 300mg KRKA D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 60 CO P-R 60 1.047333 1.047333 0.000000
140 N05AH QUETIAPINUM** QUETROP 300 mg COMPR. FILM. 300mg G REPUBLICA CEHA CUTIE CU 6 BLIST. PVC/AL X 1 P-R 60 1.256799 1.256799 1.445534
141 N05AH QUETIAPINUM** Q MIND 300 mg COMPR. FILM. 300mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC/AL X 60 CO P-R 60 1.256799 1.256799 0.489701
142 N05AH QUETIAPINUM** KATHIRA 300 mg COMPR. FILM. 300mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. PRF 60 1.256799 1.256799 0.700034
143 N05AH QUETIAPINUM** SEROQUEL XR 200 mg COMPR. FI 200mg ASTRAZENECA UK MA CUTIE X 6 BLIST. OPACE AL/PVC-PCTFE X 10 COMPR. FILM. ELIB. PREL. P-R 60 2.344200 2.344200 1.771133
144 N05AH QUETIAPINUM** SEROQUEL XR 300 mg COMPR. FI 300mg ASTRAZENECA UK MA CUTIE X 6 BLIST. OPACE AL/PVC-PCTFE X 10 COMPR. FILM. ELIB. PREL. P-R 60 3.302400 3.302400 2.844766
145 N05AH QUETIAPINUM** SEROQUEL XR 400 mg COMPR. FI 400mg ASTRAZENECA U MA CUTIE X 6 BLI P-R 60 4.086199 4.086199 3.775301
146 N05AH QUETIAPINUM** SEROQUEL XR 50 mg COMPR. FI 50mg ASTRAZENECA UK MA CUTIE X 6 BLIST. OPACE DIN AL/PVC-PCTFE X 10 COMPR. FILM. ELIB. PREL. P-R 60 0.891000 0.891000 0.213333

Pagina 61 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
147 N05AL SULPIRIDUM EGLONYL (R) 50 mg CAPS. 50mg SANOFI-SYNT FRANTA CUTIE X 2 BLIST. X 15 CAPS. P-R 30 0.274333 0.274333 0.000000
148 N05AL SULPIRIDUM EGLONYL 50 mg CAPS. 50mg SANOFI-SYNT FRANTA CUTIE CU 1 BLIST. PVC/AL X 30 CAP PRF 30 0.274333 0.274333 0.000000
149 N05AL SULPIRIDUM EGLONYL (R) 200 mg COMPR. 200mg SANOFI-SYNT FRANTA CUTIE X 1 BLIST. X 12 COMPR. P-R 12 0.698333 0.698333 0.000000
150 N05AL AMISULPRIDUM** AMISULPRIDA LPH 200 mg COMPR. 200mg LABORMED PHARMA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/A P-R 30 1.522000 1.522000 0.000000
151 N05AL AMISULPRIDUM** MIDORA 200 mg COMPR. 200mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 C P-R 30 1.522000 1.522000 0.000000
152 N05AL AMISULPRIDUM** SOLIAN 200 mg COMPR. DIVIZ. 200mg SANOFI-AVENTIS FRANTA CUTIE X 3 BLIST. AL/PVC X 10 CO P-R 30 1.826400 1.826400 0.437266
153 N05AL AMISULPRIDUM** SOLIAN 400 mg COMPR. FILM. 400mg SANOFI-AVENTIS FRANTA CUTIE X 3 BLIST. PVC-PVD P-R 30 3.672000 3.672000 0.000000
154 N05AX RISPERIDONUM** RISPERIDONE TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMAC ROMANIA CUTIE X 6 BLIST. PVC-PVD P-R 60 0.303833 0.303833 0.000000
155 N05AX RISPERIDONUM** SPRING 1 mg COMPR. FILM. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE P-R 30 0.364599 0.364599 0.150401
156 N05AX RISPERIDONUM** RONYDAL 1 mg COMPR. FILM. 1mg ROMASTRU TRAD ROMANIA CUTIE CU 6 BLIST. P-R 60 0.364599 0.364599 0.050901
157 N05AX RISPERIDONUM** RISPEN 1 COMPR. FILM. 1mg ZENTIVA KS CEHIA CUTIE X 5 BLIST. PVC-PVD P-R 50 0.359600 0.359600 0.000000
158 N05AX RISPERIDONUM** RISPERIDONA ARENA 1 mg COMPR. FILM. 1mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIS P-R 20 0.364599 0.364599 0.018901
159 N05AX RISPERIDONUM** RONYDAL 1 mg COMPR. FILM. 1mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. P-R 60 0.364599 0.364599 0.050901
160 N05AX RISPERIDONUM** RISPEN 2 COMPR. FILM. 2 mg ZENTIVA KS CEHIA CUTIE X 5 BLIST. PVC-PVD P-R 50 0.309000 0.309000 0.000000
161 N05AX RISPERIDONUM** RISPERIDONE TEVA 2 mg COMPR. FILM. 2mg TEVA PHARM ROMANIA CUTIE X 6 BLIST. PVC-PVD P-R 60 0.309000 0.309000 0.222333
162 N05AX RISPERIDONUM** RISON 2 mg COMPR. FILM. 2mg ACTAVIS GROUP HF. ISLANDA CUTIE X 2 BLIST. PVC-PVD P-R 20 0.257500 0.257500 0.000000
163 N05AX RISPERIDONUM** SPRING 2 mg COMPR. FILM. 2mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE P-R 30 0.309000 0.309000 0.564000
164 N05AX RISPERIDONUM** RONYDAL 2 mg COMPR. FILM. 2mg ROMASTRU TRAD ROMANIA CUTIE CU 6 BLIST. P-R 60 0.309000 0.309000 0.614333
165 N05AX RISPERIDONUM** RISPERIDONA ARENA 2 mg COMPR. FILM. 2mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIS P-R 20 0.309000 0.309000 0.530000
166 N05AX RISPERIDONUM** RONYDAL 2 mg COMPR. FILM. 2mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. P-R 60 0.309000 0.309000 0.614333
167 N05AX RISPERIDONUM** TORENDO 3 mg COMPR. FILM. 3mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PE P-R 30 0.507600 0.507600 0.687733
168 N05AX RISPERIDONUM** RISPERIDONE TEVA 3 mg COMPR. FILM. 3mg TEVA PHARM ROMANIA CUTIE X 6 BLIST. PVC-PVD P-R 60 0.507600 0.507600 0.270066
169 N05AX RISPERIDONUM** RISON 3 mg COMPR. FILM. 3mg ACTAVIS GROUP HF. ISLANDA CUTIE X 2 BLIST. PVC-PVD P-R 20 0.423000 0.423000 0.000000
170 N05AX RISPERIDONUM** SPRING 3 mg COMPR. FILM. 3mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE P-R 30 0.507600 0.507600 0.874066
171 N05AX RISPERIDONUM** RONYDAL 3 mg COMPR. FILM. 3mg ROMASTRU TRAD ROMANIA CUTIE CU 6 BLIST. P-R 60 0.507600 0.507600 0.919566
172 N05AX RISPERIDONUM** RISPEN 3 COMPR. FILM. 3mg ZENTIVA KS CEHIA CUTIE X 5 BLIST. PVC-PVD P-R 50 0.507600 0.507600 0.000000
173 N05AX RISPERIDONUM** RISPERIDONA ARENA 3 mg COMPR. FILM. 3mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIS P-R 20 0.507600 0.507600 0.851400
174 N05AX RISPERIDONUM** RONYDAL 3 mg COMPR. FILM. 3mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. P-R 60 0.507600 0.507600 0.919566
175 N05AX RISPERIDONUM** RISPEN 4 COMPR. FILM. 4 mg ZENTIVA KS CEHIA CUTIE X 5 BLIST. PVC-PVD P-R 50 0.309000 0.309000 0.000000
176 N05AX RISPERIDONUM** TORENDO 4 mg COMPR. FILM. 4mg KRKA D.D. NOVO M SLOVENI CUTIE X 3 BLIST. PVC-PE P-R 30 0.309000 0.309000 1.334333
177 N05AX RISPERIDONUM** RISPERIDONE TEVA 4 mg COMPR. FILM. 4mg TEVA PHARM ROMANIA CUTIE X 6 BLIST. PVC-PVD P-R 60 0.309000 0.309000 0.795833
178 N05AX RISPERIDONUM** RISON 4 mg COMPR. FILM. 4mg ACTAVIS GROUP HF. ISLANDA CUTIE X 2 BLIST. PVC-PVD P-R 20 0.257500 0.257500 0.000000
179 N05AX RISPERIDONUM** SPRING 4 mg COMPR. FILM. 4mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE P-R 30 0.309000 0.309000 1.579666
180 N05AX RISPERIDONUM** RONYDAL 4 mg COMPR. FILM. 4mg ROMASTRU TRAD ROMANIA CUTIE CU 6 BLIST. P-R 60 0.309000 0.309000 1.608833
181 N05AX RISPERIDONUM** RISPERIDONA MEDOCHEMI COMPR. FILM. 4mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE PRF 20 0.309000 0.309000 1.503500
182 N05AX RISPERIDONUM** RISPERIDONA ARENA 4 mg COMPR. FILM. 4mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIS P-R 20 0.309000 0.309000 1.416000
183 N05AX RISPERIDONUM** RONYDAL 4 mg COMPR. FILM. 4mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 6 BLIST. P-R 60 0.309000 0.309000 1.608833
184 N05AX RISPERIDONUM** TORENDO Q-TAB 1 mg COMPR 1mg KRKA D.D. NOVO M SLOVENI CUTIE P-R 30 0.364599 0.364599 0.062067
185 N05AX RISPERIDONUM** ESSENS OD 1 mg COMPR 1mg TERAPIA SA ROMANIA CUTIE P-R 30 0.364599 0.364599 0.070067
186 N05AX RISPERIDONUM** TORENDO Q-TAB 2 mg COMPR 2mg KRKA D.D. NOVO M SLOVENI CUTIE P-R 30 0.309000 0.309000 0.597000
187 N05AX RISPERIDONUM** ESSENS OD 2 mg COMPR 2mg TERAPIA SA ROMANIA CUTIE P-R 30 0.309000 0.309000 0.619666
188 N05AX RISPERIDONUM** ESSENS OD 3 mg COMPR 3mg TERAPIA SA ROMANIA CUTIE P-R 30 0.507600 0.507600 0.929733
189 N05AX RISPERIDONUM** RISPOLEPT CONSTA 25 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 25mg JANSSEN PH BELGIA CUTIE CU 1 FLACON PULBERE PT SUSP. INJ. CU ELIB. PREL., O SERINGA PRE-UMPLUTA CU 2 ML SOLVENT + 2 ACE S/P-RF 1 374.930000 374.930000 0.000000
190 N05AX RISPERIDONUM** RISPOLEPT CONSTA 37,5 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 37,5mg JANSSEN PH BELGIA CUTIE CU 1 FLACON PULBERE PT SUSP. INJ. CU ELIB. PREL., O SERINGA PRE-UMPLUTA CU 2 ML SOLVENT + 2 ACE S/P-RF 1 530.080000 530.080000 0.000000
191 N05AX RISPERIDONUM** RISPOLEPT CONSTA 50 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 50mg JANSSEN PH BELGIA CUTIE CU 1 FLACON PULBERE PT SUSP. INJ. CU ELIB. PREL., O SERINGA PRE-UMPLUTA CU 2 ML SOLVENT + 2 ACE S/P-RF 1 635.690000 635.690000 0.000000
192 N05AX RISPERIDONUM** RISPOLEPT SOL. ORALA 1mg/ml JANSSEN PH BELGIA CUTIE X 1 FLACON DIN STICLA BRUNA X 30 ML SOL. ORALA + 1 PIPETA P-R 1 17.330000 17.330000 0.000000
193 N05AX ARIPIPRAZOLUM** ABILIFY 10mg COMPR. 10mg OTSUKA PHARMACEUTICAL EUROPE LTD. MA CUTIE X 1BLI P-R 28 5.626713 5.626713 5.855787
194 N05AX ARIPIPRAZOLUM** ARYZALERA 10mg COMPR. 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/A PRF 30 5.626713 5.626713 1.665287
195 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL GLENMARK 1 COMPR. 10mg G REPUBLICA CEHA CUTIE CU 1 BLSIT. OPA-AL-PV PRF 28 5.626713 5.626713 1.836858
196 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL TEVA 10 mg COMPR. 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A PRF 30 5.626713 5.626713 1.836953

Pagina 62 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
197 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL AUROBINDO COMPR. 10mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PA-AL-PVC/AL PRF 30 5.511666 5.511666 0.000000
198 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL SANDOZ 10 m COMPR. 10mg SANDOZ GMBH AUSTRIA CUTIE CU BLIST. ALU/ALU X 28 CO PRF 28 5.626713 5.626713 1.836858
199 N05AX ARIPIPRAZOLUM** ARIPIPRAZOLE ZENTIVA 10 COMPR. 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLI PRF 28 5.626713 5.626713 1.665072
200 N05AX ARIPIPRAZOLUM** RESTIGULIN 10 mg COMPR. 10mg GEDEON RI ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL PRF 28 4.688928 4.688928 0.000000
201 N05AX ARIPIPRAZOLUM** ABILIFY 15mg COMPR. 15mg OTSUKA PHARMACEUTICAL EUROPE LTD. MA CUTIE X 1BLI P-R 28 6.889599 6.889599 4.592901
202 N05AX ARIPIPRAZOLUM** ARYZALERA 15mg COMPR. 15mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/A PRF 30 6.889599 6.889599 0.574067
203 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL GLENMARK 1 COMPR. 15mg G REPUBLICA CEHA CUTIE CU 1 BLSIT. OPA-AL-PV PRF 28 6.889599 6.889599 0.573972
204 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL TEVA 15 mg COMPR. 15mg TEVA PHARM ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A PRF 30 6.889599 6.889599 0.574067
205 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL AUROBINDO COMPR. 15mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PA-AL-PVC/AL PRF 30 5.741333 5.741333 0.000000
206 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL SANDOZ 15 m COMPR. 15mg SANDOZ GMBH AUSTRIA CUTIE CU BLIST. ALU/ALU X 28 CO PRF 28 6.889599 6.889599 0.573972
207 N05AX ARIPIPRAZOLUM** ARIPIPRAZOLE ZENTIVA 15 COMPR. 15mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLI PRF 28 6.889599 6.889599 0.573972
208 N05AX ARIPIPRAZOLUM** RESTIGULIN 15 mg COMPR. 15mg GEDEON RI ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL PRF 28 6.889599 6.889599 0.017543
209 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL TEVA 20 mg COMPR. 20mg TEVA PHARM ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A PRF 30 12.270000 12.270000 0.000000
210 N05AX ARIPIPRAZOLUM** ARIPIPRAZOL TEVA 30 mg COMPR. 30mg TEVA PHARM ROMANIA CUTIE CU BLIST. OPA-AL-PVC/A PRF 30 12.270000 12.270000 0.000000
211 N05AX ARIPIPRAZOLUM** ASTORET 10 mg COMPR 10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. DETASABIL (PEEL-OF) DIN PA/AL/PVC-AL X 28 COMPR. ORODISPERSABILE PRF 28 5.626713 5.626713 1.836858
212 N05AX ARIPIPRAZOLUM** ARIPIPRAZOLE ZENTIVA 10 COMPR 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA/AL/PVC/AL (BLISTER AL-AL) X 28 COMPR. ORODISPERSABILE PRF 28 5.626713 5.626713 1.665072
213 N05AX ARIPIPRAZOLUM** ASTORET 15 mg COMPR 15mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. DETASABIL (PEEL-OF) DIN PA/AL/PVC-AL X 28 COMPR. ORODISPERSABILE PRF 28 6.889599 6.889599 0.573972
214 N05AX ARIPIPRAZOLUM** ARIPIPRAZOLE ZENTIVA 15 COMPR 15mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA/AL/PVC/AL (BLISTER AL-AL) X 28 COMPR. ORODISPERSABILE PRF 28 6.889599 6.889599 0.573972
215 N05AX ARIPIPRAZOLUM** ABILIFY MAINTENA 400mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 400mg OTSUKA PHARMACEUTICAL EUROPE LTD. MA CUT IE CU UN FL.X 400 MG PULB., UN FL. DE 2 ML CU SOLV., O SERINGA LUER-LOCK DE 3 ML CU AC HIPODERMIC SECURIZAT , O SERINGA JET ABILA DE 3 ML CU VRF LUER-LOCK, UN ADAPT OR PENT RU FLACON, UN AC HIPODERMIC SECURIZAT SI UN AC HIPODERMIC SECURIZAT PT OBEZI
PRF 1 ,163.560000 1,163.560000 0.000000
216 N05AX ARIPIPRAZOLUM** ABILIFY 7,5mg/ml SOL. INJ. 7,5mg/ml OTSUKA PHARMACEUTICAL EUROPE LTD. MA CUTIE X 1FLAC. X 1,3ML SOL.INJ P-R 1 19.950000 19.950000 0.000000
217 N05AX PALIPERIDONUM** INVEGA 3mg COMPR. ELIB. P 3mg JANSS BELGIA CUTIE X 30 COMPR.E P-R 30 15.777333 15.777333 0.000000
218 N05AX PALIPERIDONUM** INVEGA 6mg COMPR. ELIB. P 6mg JANSS BELGIA CUTIEX 30 COMPR.ELI P-R 30 16.040000 16.040000 0.000000
219 N05AX PALIPERIDONUM** INVEGA 9mg COMPR. ELIB. P 9mg JANSS BELGIA CUTIE X 30 COMPR.E P-R 30 17.477333 17.477333 0.000000
220 N05AX PALIPERIDONUM** XEPLION SUSP. INJ 100mg JAN BELGIA CUTIE CU 1 SERINGA PREUMPLUT PR 1 ,463.340000 1,463.340000 0.000000
221 N05AX PALIPERIDONUM** XEPLION SUSP. INJ 150mg JAN BELGIA CUTIE CU 1 SERINGA PREUMPLUT PR 1 ,055.980000 2,055.980000 0.000000
222 N05AX PALIPERIDONUM** XEPLION SUSP. INJ 50mg JAN BELGIA CUTIE CU 1 SERINGA PREUMPLUT PR 1 944.130000 944.130000 0.000000
223 N05AX PALIPERIDONUM** XEPLION SUSP. INJ 75mg JAN BELGIA CUTIE CU 1 SERINGA PREUMPLUT PR 1 ,202.120000 1,202.120000 0.000000
224 N06A CITALOPRAMUM** LINISAN 10 mg COMPR. FILM. 10mg GEDEON R ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CO P-R 30 0.246000 0.246000 0.000000
225 N06A CITALOPRAMUM** LINISAN 20 mg COMPR. FILM. 20mg GEDEON R ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CO P-R 30 1.368000 1.368000 0.000000
226 N06A ESCITALOPRAMUM** DEPRESINAL 10 mg COMPR. FILM. 10 mg LA AUSTRIA CUTIE CU BLIST. OPA-AL-P P-R 30 0.778666 0.778666 0.000000
227 N06A ESCITALOPRAMUM** CIPRALEX 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEM CUTIE X 2 BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 14 COMPR. FILM. P-R 28 0.918000 0.918000 0.346285
228 N06A ESCITALOPRAMUM** ESCITIL 10 mg COMPR. FILM. 10mg EGIS PHAR UNGARIA CUTIE CU BLIST. OPA-AL-P P-R 28 0.848928 0.848928 0.000000
229 N06A ESCITALOPRAMUM** ESCITALOPRAM-TEVA 10 mg COMPR. FILM. 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC P-R 30 0.776000 0.776000 0.000000
230 N06A ESCITALOPRAMUM** LENUXIN 10 mg COMPR. FILM. 10mg GEDEON R ROMANIA CUTIE CU BLIST. OPA-AL-P P-R 28 0.848928 0.848928 0.000000
231 N06A ESCITALOPRAMUM** ESLOREX 10 mg COMPR. FILM. 10mg ZENTIVA K.S. CEHIA CUTIE CU BLIST. OPA-AL-P PRF 30 0.780666 0.780666 0.000000
232 N06A ESCITALOPRAMUM** SERODEPS 10mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. A P-R 28 0.780357 0.780357 0.000000
233 N06A ESCITALOPRAMUM** ESTAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE PRF 14 0.848571 0.848571 0.000000
234 N06A ESCITALOPRAMUM** ESTAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE PRF 28 0.848928 0.848928 0.000000
235 N06A ESCITALOPRAMUM** ESCITALOPRAM ACTAVIS 10 COMPR. FILM. 10mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVDC/PVD PRF 28 0.778214 0.778214 0.000000
236 N06A ESCITALOPRAMUM** ELICEA 10 mg COMPR. FILM. 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P PRF 30 0.780666 0.780666 0.000000
237 N06A ESCITALOPRAMUM** ESCITALOPRAM AUROBIND COMPR. FILM. 10mg AUROBINDO PH MA CUTIE CU BLIST. PVC-ACLA PRF 28 0.778214 0.778214 0.000000
238 N06A ESCITALOPRAMUM** ESCITALOPRAM ATB 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC PRF 28 0.765000 0.765000 0.000000
239 N06A ESCITALOPRAMUM** ESCITALOPRAM TORRENT COMPR. FILM. 10mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC PRF 28 0.848928 0.848928 0.000000
240 N06A ESCITALOPRAMUM** ESCITALOPRAM-TEVA 15 mg COMPR. FILM. 15mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC P-R 30 1.018713 1.018713 0.111620
241 N06A ESCITALOPRAMUM** ELICEA 15 mg COMPR. FILM. 15mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P PRF 30 1.018713 1.018713 0.350287
242 N06A ESCITALOPRAMUM** ESCITALOPRAM-TEVA 20 mg COMPR. FILM. 20mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-PVDC P-R 30 1.370000 1.370000 0.000000
243 N06A ESCITALOPRAMUM** SERODEPS 20mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. A P-R 28 1.359642 1.359642 0.000000
244 N06A ESCITALOPRAMUM** ESCITALOPRAM TORRENT COMPR. FILM. 20mg TORRENT PHARMA ROMANIA CUTIE CU BLIST. PVC PRF 28 1.631570 1.631570 0.637001
245 N06A ESCITALOPRAMUM** ESCITALOPRAM ACTAVIS 20 COMPR. FILM. 20mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVDC/PVD PRF 28 1.399642 1.399642 0.000000
246 N06A ESCITALOPRAMUM** ELICEA 20 mg COMPR. FILM. 20mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-P PRF 30 1.406000 1.406000 0.000000

Pagina 63 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
247 N06A ESCITALOPRAMUM** ELICEA Q-TAB 10 mg COMPR 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET X 28 COMPR. ORODIPSERSABILE PRF 28 0.780357 0.780357 0.000000
248 N06A ESCITALOPRAMUM** ELICEA Q-TAB 10 mg COMPR 10mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET-HARTIE X 28 COMPR. ORODIPSERSABILE PRF 28 0.780357 0.780357 0.000000
249 N06A ESCITALOPRAMUM** ESCITALOPRAM TEVA 10 mg COMPR 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. HARTIE-PET-AL/PVC-AL-OPA X 30 COMPR. ORODISPERSABILE PRF 30 0.918000 0.918000 0.015666
250 N06A ESCITALOPRAMUM** ELICEA Q-TAB 15 mg COMPR 15mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET-HARTIE X 28 COMPR. ORODIPSERSABILE PRF 28 1.018713 1.018713 0.350572
251 N06A ESCITALOPRAMUM** ELICEA Q-TAB 15 mg COMPR 15mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET X 28 COMPR. ORODIPSERSABILE PRF 28 1.018713 1.018713 0.332358
252 N06A ESCITALOPRAMUM** ELICEA Q-TAB 20 mg COMPR 20mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET-HARTIE X 28 COMPR. ORODIPSERSABILE PRF 28 1.576785 1.576785 0.000000
253 N06A ESCITALOPRAMUM** ELICEA Q-TAB 20 mg COMPR 20mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL-PVC/AL-PET X 28 COMPR. ORODIPSERSABILE PRF 28 1.576785 1.576785 0.000000
254 N06A ESCITALOPRAMUM** ESCITALOPRAM TEVA 20 mg COMPR 20mg TEVA PHARM ROMANIA CUTIE CU BLIST. HARTIE-PET-AL/PVC-AL-OPA X 30 COMPR. ORODISPERSABILE PRF 30 1.369000 1.369000 0.000000
255 N06AX TRAZODONUM** TRITTICO AC 150 mg COMPR. ELIB. P 150mg ANGELINI FRAN ITALIA CUTIE X 1 BLIST. AL/PVC X P-R 20 1.264000 1.264000 0.000000
256 N06AX TRAZODONUM** TRITTICO AC 150 mg COMPR. ELIB. P 150mg ANGELINI FRAN ITALIA CUTIE X 6 BLIST. AL/PVC X P-R 60 1.094833 1.094833 0.000000
257 N06AX TRAZODONUM** TRITTICO AC 150 mg COMPR. ELIB. P 150mg ANGELINI FRAN ITALIA CUTIE X 3 BLIST. AL/PVC X P-R 60 1.094833 1.094833 0.000000
258 N06AX TRAZODONUM** TRITTICO AC 150 mg COMPR. ELIB. P 150mg ANGELINI FRAN ITALIA CUTIE X 2 BLIST. AL/PVCX 10 P-R 20 1.264000 1.264000 0.000000
259 N06AX TRAZODONUM** TRITTICO AC 75 mg COMPR. ELIB. P 75mg ANGELINI FRAN ITALIA CUTIE X 2 BLIST. AL/PVC X P-R 30 0.644666 0.644666 0.000000
260 N06AX TRAZODONUM** TRITTICO AC 75 mg COMPR. ELIB. P 75mg ANGELINI FRAN ITALIA CUTIE X 1 BLIST. AL/PVC X P-R 30 0.644666 0.644666 0.000000
261 N06AX TIANEPTINUM** LYXIT 12,5 mg COMPR. FILM. 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN P PRF 30 0.460333 0.460333 0.000000
262 N06AX TIANEPTINUM** LYXIT 12,5 mg COMPR. FILM. 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN P PRF 90 0.445222 0.445222 0.000000
263 N06AX TIANEPTINUM** NOBIXAL 12,5 mg COMPR. FILM. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/PVDC PRF 30 0.460333 0.460333 0.000000
264 N06AX TIANEPTINUM** NOBIXAL 12,5 mg COMPR. FILM. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/ACLA PRF 30 0.460333 0.460333 0.000000
265 N06AX TIANEPTINUM** COAXIL (R) DRAJ. 12,5mg LES LAB. SERVIER I FRANTA CUTIE X 1 BLIST. AL/PVC X 30 DRAJ. P-R 30 0.534266 0.534266 0.173400
266 N06AX VENLAFAXINUM** EFECTIN EP 150 mg CAPS. ELIB. PRE 150 mg PFIZER EUROPE M MA CUTIE CU BLIST. DIN PVC/A PRF 28 0.665599 0.665599 1.347258
267 N06AX VENLAFAXINUM** ELIFY EP 150 mg CAPS. ELIB. PRE 150 mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST PVC/AL X 3 PRF 30 0.665599 0.665599 0.332734
268 N06AX VENLAFAXINUM** IVRYX 150mg CAPS. ELIB. PRE 150 mg NEOLA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. P-R 28 0.665599 0.665599 0.195115
269 N06AX VENLAFAXINUM** VELAXIN 150 mg CAPS. ELIB. PRE 150mg EGIS PHAR UNGARIA CUTIE X 2 BLIST. P-R 28 0.665599 0.665599 0.642972
270 N06AX VENLAFAXINUM** ALVENTA 150mg CAPS. ELIB. PRE 150mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PV P-R 30 0.554666 0.554666 0.000000
271 N06AX VENLAFAXINUM** VENLAFAXINA ACTAVIS 150 CAPS. ELIB. PRE 150mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X P-R 28 0.665599 0.665599 0.190829
272 N06AX VENLAFAXINUM** VENLAFAXINA ARENA EP 15 CAPS. ELIB. PRE 150mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLI P-R 30 0.665599 0.665599 0.643067
273 N06AX VENLAFAXINUM** VENLAFAXINA TERAPIA 150 CAPS. ELIB. PRE 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. P PRF 30 0.665599 0.665599 0.643067
274 N06AX VENLAFAXINUM** VENLAFAXINA TERAPIA 150 CAPS. ELIB. PRE 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PV PRF 30 0.665599 0.665599 0.643067
275 N06AX VENLAFAXINUM** FOBILESS 37,5 mg CAPS. ELIB. PRE 37,5mg LA AUSTRIA CUTIE X BLIST. PVC/AL X 30 P-R 30 0.596333 0.596333 0.000000
276 N06AX VENLAFAXINUM** VENLAFAXINA ARENA EP 37 CAPS. ELIB. PRE 37,5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLI P-R 30 0.715599 0.715599 0.116067
277 N06AX VENLAFAXINUM** EFECTIN EP 75 mg CAPS. ELIB. PRE 75 mg PFIZER EUROPE M MA CUTIE CU BLIST. DIN PVC/A PRF 28 0.391200 0.391200 0.927014
278 N06AX VENLAFAXINUM** ELIFY EP 75 mg CAPS. ELIB. PRE 75 mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X PRF 30 0.391200 0.391200 0.358133
279 N06AX VENLAFAXINUM** IVRYX 75mg CAPS. ELIB. PRE 75 mg NEOLA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. P-R 28 0.391200 0.391200 0.272014
280 N06AX VENLAFAXINUM** IVRYX 75mg CAPS. ELIB. PRE 75 mg NEOLA PHARMA S.R. ROMANIA CUTIE X 2 BLIST. P-R 28 0.391200 0.391200 0.272014
281 N06AX VENLAFAXINUM** VELAXIN 75 mg CAPS. ELIB. PRE 75mg EGIS PHAR UNGARIA CUTIE X 2 BLIST. P P-R 28 0.391200 0.391200 0.493800
282 N06AX VENLAFAXINUM** ALVENTA 75 mg CAPS. ELIB. PRE 75mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. PVC-PV P-R 30 0.326000 0.326000 0.000000
283 N06AX VENLAFAXINUM** FOBILESS 75 mg CAPS. ELIB. PRE 75mg LA AUSTRIA CUTIE X BLIST. PVC/AL X 30 P-R 30 0.391200 0.391200 0.271466
284 N06AX VENLAFAXINUM** VENLAFAXINA ACTAVIS 75 m CAPS. ELIB. PRE 75mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC/AL X P-R 28 0.391200 0.391200 0.265228
285 N06AX VENLAFAXINUM** VENLAFAXINA ARENA EP 75 CAPS. ELIB. PRE 75mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLI P-R 30 0.391200 0.391200 0.488133
286 N06AX VENLAFAXINUM** VENLAFAXINA TERAPIA 75 CAPS. ELIB. PRE 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. P PRF 30 0.391200 0.391200 0.494133
287 N06AX VENLAFAXINUM** VENLAFAXINA TERAPIA 75 CAPS. ELIB. PRE 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PV PRF 30 0.391200 0.391200 0.494133
288 N06AX VENLAFAXINUM** VENLAFAXINA ARENA 37,5 mCOMPR. 37,5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PV P-R 30 0.715599 0.715599 0.116067
289 N06AX VENLAFAXINUM** VENLAFAXINA ARENA 50 mg COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PV P-R 30 0.847333 0.847333 0.000000
290 N06AX VENLAFAXINUM** VENLAFAXINA ARENA 75 mg COMPR. 75mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PV P-R 30 0.391200 0.391200 0.488133
291 N06AX VENLAFAXINUM** ARGOFAN 150 SR COMPR. ELIB. P 150mg ZENTIVA A.S. SLOVACI CUTIE CU BLIST. PVC P-R 30 0.665000 0.665000 0.000000
292 N06AX VENLAFAXINUM** ARGOFAN 75 SR COMPR. ELIB. P 75mg ZENTIVA A.S. SLOVACI CUTIE CU BLIST. PVC P-R 30 0.391000 0.391000 0.000000
293 N06AX DULOXETINUM** CYMBALTA 30mg CAPS. GASTRO 30mg ELI LILLY NEDER OLANDA CUTIE X 28 CAPS. P-R 28 2.326285 2.326285 0.613715
294 N06AX DULOXETINUM** DULSEVIA 30 mg CAPS. GASTRO 30mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. PRF 30 2.012000 2.012000 0.000000
295 N06AX DULOXETINUM** ZATINEX 30 mg CAPS. GASTRO 30mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PRF 28 1.938571 1.938571 0.000000
296 N06AX DULOXETINUM** ZATINEX 30 mg CAPS. GASTRO 30mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PV PRF 28 1.938571 1.938571 0.000000

Pagina 64 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
297 N06AX DULOXETINUM** DULOXETINA DR. REDDY'S CAPS. GASTRO 30mg DR. REDDY'S L ROMANIA CUTIE CU BLIS PRF 28 2.011785 2.011785 0.000000
298 N06AX DULOXETINUM** CYMBALTA 60mg CAPS. GASTRO 60mg ELI LILLY NEDER OLANDA CUTIE, X 28 CAPS P-R 28 3.515199 3.515199 1.047658
299 N06AX DULOXETINUM** DULSEVIA 60 mg CAPS. GASTRO 60mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. PRF 30 2.929333 2.929333 0.000000
300 N06AX DULOXETINUM** ZATINEX 60 mg CAPS. GASTRO 60mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PRF 28 3.044642 3.044642 0.000000
301 N06AX DULOXETINUM** ZATINEX 60 mg CAPS. GASTRO 60mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PV PRF 28 3.044642 3.044642 0.000000
302 N06AX DULOXETINUM** DULOXETINA DR. REDDY'S CAPS. GASTRO 60mg DR. REDDY'S L ROMANIA CUTIE CU BLIS PRF 28 3.072142 3.072142 0.000000
303 N06AX DULOXETINUM** DULOXETINE ZENTIVA 60 mg CAPS. GASTRO 60mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PV PRF 28 3.072142 3.072142 0.000000
304 N06B ATOMOXETINUM*** STRATTERA 10 mg CAPS. 10mg ELI LILLY AND MA CUTIE X 1 BLIST. PVC-PE-PCTFE P-R 7 13.407142 13.407142 0.000000
305 N06B ATOMOXETINUM*** STRATTERA 18 mg CAPS. 18mg ELI LILLY AND MA CUTIE X 1 BLIST. PVC-PE-PCTFE P-R 7 13.491428 13.491428 0.000000
306 N06B ATOMOXETINUM*** STRATTERA 25 mg CAPS. 25mg ELI LILLY AND MA CUTIE X 4 BLIST. PVC-PE-PCTFE P-R 28 12.654285 12.654285 0.000000
307 N06B ATOMOXETINUM*** STRATTERA 40 mg CAPS. 40mg ELI LILLY AND MA CUTIE X 4 BLIST. PVC-PE-PCTFE P-R 28 12.654285 12.654285 0.000000
308 N06B ATOMOXETINUM*** STRATTERA 60 mg CAPS. 60mg ELI LILLY AND MA CUTIE X 4 BLIST. PVC-PE-PCTFE P-R 28 12.654285 12.654285 0.000000
309 N06B ATOMOXETINUM*** STRATTERA 80 mg CAPS. 80mg ELI LILLY AND MA CUTIE X 4 BLIST. PCTFE-PE-PVC P-RF/R 28 15.916785 15.916785 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea psihiatrie i psihiatrie pediatric/neuropsihiatrie infantil.

14. DEMENTE(DEGENERATIVE, VASCULARE, MIXTE) - G 16

1 N06DA DONEPEZILUM*** YASNAL 10 mg COMPR. FILM. 10mg KRKA D.D. NOVO M SLOVENI CUTIE CU, BLIST., P-R 28 1.251428 1.251428 0.000000
2 N06DA DONEPEZILUM*** DAVIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVD P-R 30 1.256570 1.256570 0.896763
3 N06DA DONEPEZILUM*** DAVIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CO P-R 30 1.256570 1.256570 0.896763
4 N06DA DONEPEZILUM*** TUADIN 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE P-R 30 1.237666 1.237666 0.000000
5 N06DA DONEPEZILUM*** PRIDIA 10 mg COMPR. FILM. 10mg LABORMED PHARMA ROMANIA CUTIE CU BLIST. PVC-PE P-R 28 1.256570 1.256570 1.063787
6 N06DA DONEPEZILUM*** DONECEPT 10 MG COMPR. FILM. 10mg ACTAVIS GROUP P ISLANDA CUTIE X BLIST. PVC/AL X 28 COMP P-R 28 1.047142 1.047142 0.000000
7 N06DA DONEPEZILUM*** COGNEZIL 10 mg COMPR. FILM. 10mg G REPUBLICA CEHA CUTIE X BLISTERE PVC P-R 28 1.256570 1.256570 0.477001
8 N06DA DONEPEZILUM*** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 28 CO P-R 28 1.256570 1.256570 0.862001
9 N06DA DONEPEZILUM*** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 50 CO P-R 50 1.256570 1.256570 0.755230
10 N06DA DONEPEZILUM*** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 CO P-R 56 1.256570 1.256570 0.755037
11 N06DA DONEPEZILUM*** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 60 CO P-R 60 1.256570 1.256570 0.755096
12 N06DA DONEPEZILUM*** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 98 CO P-R 98 1.256570 1.256570 0.650981
13 N06DA DONEPEZILUM*** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 100 P-R 100 1.256570 1.256570 0.651030
14 N06DA DONEPEZILUM*** DONEPEZIL TORRENT 10 mg COMPR. FILM. 10mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC/AL X 30 CO PRF 30 1.256570 1.256570 0.564096
15 N06DA DONEPEZILUM*** XALINAT 10 mg COMPR. FILM. 10mg GALENICA S.A. GRECIA CUTIE X 2 BLIST. PVC-PE P-R 28 1.256570 1.256570 1.059858
16 N06DA DONEPEZILUM*** YASNAL 5 mg COMPR. FILM. 5mg KRKA D.D. NOVO M SLOVENI CUTIE CU BLIST. DI P-R 28 0.985000 0.985000 0.000000
17 N06DA DONEPEZILUM*** ZILDON 5 mg COMPR. FILM. 5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 28 CO P-R 28 1.158856 1.158856 0.552215
18 N06DA DONEPEZILUM*** DAVIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVD P-R 30 1.158856 1.158856 0.383810
19 N06DA DONEPEZILUM*** DAVIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CO P-R 30 1.158856 1.158856 0.383810
20 N06DA DONEPEZILUM*** TUADIN 5 mg COMPR. FILM. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE P-R 30 1.158856 1.158856 0.347144
21 N06DA DONEPEZILUM*** DONECEPT 5 MG COMPR. FILM. 5mg ACTAVIS GROUP P ISLANDA CUTIE X BLIST. PVC/AL X 28 COMP P-R 28 0.965714 0.965714 0.000000
22 N06DA DONEPEZILUM*** COGNEZIL 5 mg COMPR. FILM. 5mg G REPUBLICA CEHA CUTIE X BLISTERE PVC P-R 28 1.158856 1.158856 0.127215
23 N06DA DONEPEZILUM*** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 28 CO P-R 28 1.158856 1.158856 0.371144
24 N06DA DONEPEZILUM*** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 50 CO P-R 50 1.158856 1.158856 0.293744
25 N06DA DONEPEZILUM*** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 CO P-R 56 1.158856 1.158856 0.294179
26 N06DA DONEPEZILUM*** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 60 CO P-R 60 1.158856 1.158856 0.293810
27 N06DA DONEPEZILUM*** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 98 CO P-R 98 1.158856 1.158856 0.218797
28 N06DA DONEPEZILUM*** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 100 P-R 100 1.158856 1.158856 0.218944
29 N06DA DONEPEZILUM*** DONEPEZIL TORRENT 5 mg COMPR. FILM. 5mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC/AL X 30 CO PRF 30 1.158856 1.158856 0.100477
30 N06DA DONEPEZILUM*** XALINAT 5 mg COMPR. FILM. 5mg GALENICA S.A. GRECIA CUTIE X 2 BLIST. PVC-PE P-R 28 1.158856 1.158856 0.553286
31 N06DA DONEPEZILUM*** YASNAL 10 mg COMPR 10 mg KRKA D.D. SLOVENI CUTIE CU BLIST. OPA/AL/PVC SI FOLIE PET-AL TIP "PEEL-OPEN" A CATE 28 COMPR. ORODISP. PRF 28 1.251428 1.251428 0.000000

Pagina 65 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
32 N06DA DONEPEZILUM*** ARICEPT EVESS COMPR 10mg PFIZER EUROPE M MA CUTIE X 2 BLIST. AL/PVC-PVDC-PE-PVDC-PVC X 14 COMPR. ORODISPERSABILE P-R 28 1.256570 1.256570 4.127001
33 N06DA DONEPEZILUM*** DONEPEZIL TEVA 10 mg COMPR 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 28 COMPR. ORODISP. P-R 28 1.187142 1.187142 0.000000
34 N06DA DONEPEZILUM*** DARIZOL 10 mg COMPR 10mg ROMASTRU TRADI ROMANIA CUTIE CU 2 BLIST. PVC-PCTFE(ACLAR)/AL /FOLIE DE AL DETASABILA X 14 COMPR. ORODISPERSABILE PRF 28 1.256570 1.256570 1.063787
35 N06DA DONEPEZILUM*** DONEPEZIL STADA HEMO COMPR 10mg STADA HEMOFARM ROMANIA CUTIE PRF 28 1.256570 1.256570 0.854858
36 N06DA DONEPEZILUM*** DONEPEZIL STADA HEMO COMPR 10mg STADA HEMOFARM ROMANIA CUTIE CU BLIST. AL/ PRF 28 1.256570 1.256570 2.433430
37 N06DA DONEPEZILUM*** DARIZOL 10 mg COMPR 10mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 2 BLIST. PVC-PCTFE(ACLAR)/AL /FOLIE DE AL DETASABILA X 14 COMPR. ORODISPERSABILE PRF 28 1.256570 1.256570 1.063787
38 N06DA DONEPEZILUM*** ARICEPT EVESS COMPR 10mg PFIZER EUROPE M MA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. ORODISPERSABILE PRF 28 1.256570 1.256570 4.127001
39 N06DA DONEPEZILUM*** YASNAL 5 mg COMPR 5 mg KRKA D.D. SLOVENI CUTIE CU BLIST. OPA/AL/PVC SI FOLIE PET-AL "PEEL-OPEN" A CATE 28 COMPR. ORODISP. PRF 28 1.158856 1.158856 0.023286
40 N06DA DONEPEZILUM*** ARICEPT EVESS COMPR 5mg PFIZER EUROPE M MA CUTIE X 2 BLIST. AL/PVC-PVDC-PE-PVDC-PVC X 14 COMPR. ORODISPERSABILE P-R 28 1.158856 1.158856 2.940786
41 N06DA DONEPEZILUM*** DONEPEZIL TEVA 5 mg COMPR 5mg TEVA PHARM ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 28 COMPR. ORODISP. P-R 28 1.158856 1.158856 0.028286
42 N06DA DONEPEZILUM*** DARIZOL 5 mg COMPR 5mg ROMASTRU TRADI ROMANIA CUTIE CU 2 BLIST. PVC-PCTFE(ACLAR)/AL /FOLIE DE AL DETASABILA X 14 COMPR. ORODISPERSABILE PRF 28 1.158856 1.158856 0.498286
43 N06DA DONEPEZILUM*** DONEPEZIL STADA HEMO COMPR 5mg STADA HEMOFARM ROMANIA CUTIE PRF 28 1.055357 1.055357 0.000000
44 N06DA DONEPEZILUM*** DONEPEZIL STADA HEMO COMPR 5mg STADA HEMOFARM ROMANIA CUTIE CU BLIST. AL/ PRF 28 1.158856 1.158856 1.506144
45 N06DA DONEPEZILUM*** DARIZOL 5 mg COMPR 5mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 2 BLIST. PVC-PCTFE(ACLAR)/AL /FOLIE DE AL DETASABILA X 14 COMPR. ORODISPERSABILE PRF 28 1.158856 1.158856 0.498286
46 N06DA DONEPEZILUM*** ARICEPT EVESS COMPR 5mg PFIZER EUROPE M MA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. ORODISPERSABILE PRF 28 1.158856 1.158856 2.940786
47 N06DA RIVASTIGMINUM*** RIDAXIN 1,5 mg CAPS. 1,5mg ROMASTRU TRAD ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAP P-RF/R 56 1.178570 1.178570 0.005715
48 N06DA RIVASTIGMINUM*** RIVASTIGMINA TORRENT 1, CAPS. 1,5mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X P-RF/R 56 1.178570 1.178570 0.114108
49 N06DA RIVASTIGMINUM*** RIDAXIN 1,5 mg CAPS. 1,5mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAP P-RF/R 56 1.178570 1.178570 0.005715
50 N06DA RIVASTIGMINUM*** NIMVASTID 1.5mg CAPS. 1.5mg KRKA ,D.D., NOV SLOVENI CUTIE X BLIST. PVC/PVDC/AL X P-RF/R 28 0.982142 0.982142 0.000000
51 N06DA RIVASTIGMINUM*** NIMVASTID 3mg CAPS. 3mg KRKA ,D.D., NOV SLOVENI CUTIE X BLIST. PVC/PVDC/AL X P-RF/R 28 1.174285 1.174285 0.000000
52 N06DA RIVASTIGMINUM*** RIVASTIGMINE SANDOZ 3mg CAPS. 3mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST.PVC/AL X 56 CAPS. P-RF/R 56 1.409142 1.409142 0.983358
53 N06DA RIVASTIGMINUM*** RIDAXIN 3 mg CAPS. 3mg ROMASTRU TRAD ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAP P-RF/R 56 1.409142 1.409142 1.005143
54 N06DA RIVASTIGMINUM*** RIVASTIGMINA TORRENT 3 CAPS. 3mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X P-RF/R 56 1.409142 1.409142 0.554429
55 N06DA RIVASTIGMINUM*** RIDAXIN 3 mg CAPS. 3mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAP P-RF/R 56 1.409142 1.409142 1.005143
56 N06DA RIVASTIGMINUM*** RIDAXIN 4,5 mg CAPS. 4,5mg ROMASTRU TRAD ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAP P-RF/R 56 2.080285 2.080285 0.156857
57 N06DA RIVASTIGMINUM*** RIDAXIN 4,5 mg CAPS. 4,5mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAP P-RF/R 56 2.080285 2.080285 0.156857
58 N06DA RIVASTIGMINUM*** RIDAXIN 6 mg CAPS. 6mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAP P-RF/R 56 2.724428 2.724428 0.128250
59 N06DA RIVASTIGMINUM*** NIMVASTID 1.5 mg COMPR 1.5mg KRKA ,D.D., NOV SLOVENI CUTIE X BLIST.UNIDOZA OPA/AL/PVC/PET/AL X (28 X 1) COMPR. ORODISPESABILE P-RF/R 28 0.982142 0.982142 0.000000
60 N06DA RIVASTIGMINUM*** NIMVASTID 3mg COMPR 3mg KRKA ,D.D., NOV SLOVENI CUTIE X BLIST.UNIDOZA OPA/AL/PVC/PET/AL X (28 X 1) COMPR. ORODISPESABILE P-RF/R 28 1.174285 1.174285 0.000000
61 N06DA RIVASTIGMINUM*** NIMVASTID 4.5 mg COMPR 4.5mg KRKA ,D.D., NOV SLOVENI CUTIE X BLIST.UNIDOZA OPA/AL/PVC/PET/AL X (28 X 1) COMPR. ORODISPESABILE P-RF/R 28 1.733571 1.733571 0.000000
62 N06DA RIVASTIGMINUM*** NIMVASTID 6mg COMPR 6mg KRKA ,D.D., NOV SLOVENI CUTIE X BLIST.UNIDOZA OPA/AL/PVC/PET/AL X (28 X 1) COMPR. ORODISPESABILE P-RF/R 28 2.270357 2.270357 0.000000
63 N06DA RIVASTIGMINUM*** EXELON 13,3mg/24h PLASTUR 13,3/24h NOVARTIS EURO MA CUTIE X 30 PLICURI X 1 P PR 30 11.130666 11.130666 0.000000
64 N06DA RIVASTIGMINUM*** EXELON 4,6mg/24h PLASTUR 4,6mg/24h NOVARTIS EURO MA CUTIE X 30 PLICURI X 1 P PR 30 3.568800 3.568800 4.503200
65 N06DA RIVASTIGMINUM*** EVERTAS 4,6 mg/24 h PLASTUR 4,6mg/24h ZENTIVA, K.S. REPUBLICA CEHA CUTIE X 30 PLICURI DIN MATERIAL MULTILAMINAT DIN HARTIE/TEREFTALAT DE POLIETILENA/ALUMINIU/PILIACRILONITRIL PREVAZUTE CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 1 PLASTURE TRANSDERMIC
PRF 30 2.974000 2.974000 0.000000
66 N06DA RIVASTIGMINUM*** EXELON 9,5mg/24h PLASTUR 9,5mg/24h NOVARTIS EURO MA CUTIE X 30 PLICURI X 1 P PR 30 6.295999 6.295999 1.776001
67 N06DA RIVASTIGMINUM*** EVERTAS 9,5 mg/24 h PLASTUR 9,5mg/24h ZENTIVA, K.S. REPUBLICA CEHA CUTIE X 30 PLICURI DIN MATERIAL MULTILAMINAT DIN HARTIE/TEREFTALAT DE POLIETILENA/ALUMINIU/PILIACRILONITRIL PREVAZUTE CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 1 PLASTURE TRANSDERMIC
PRF 30 5.246666 5.246666 0.000000
68 N06DA RIVASTIGMINUM*** RIVASTIGMINA DR. RE PLASTURI 4,6mg/24ore DR. REDDY'S L ROMANIA CUT IE CU 30 PLICURI DIN MAT ERIAL MULT ILAMINAT DIN HRT IE/POLIET ILENT EREFT ALAT /AL/POLIACRILONIT RIL CU CU SIST EM DE NCHIDERE SECURIZAT PENT RU COPII, A CT E 1 PLAST URE T RANSDERMIC PROT EJ. DE O FOLIE DIN FILM DIN T EREFT ALAT DE POLIET ILENA SILICONAT A
PRF 30 3.568800 3.568800 1.677866
69 N06DA RIVASTIGMINUM*** RIVASTIGMINA DR. RE PLASTURI 9,5mg/24ore DR. REDDY'S L ROMANIA CUT IE CU 30 PLICURI DIN MAT ERIAL MULT ILAMINAT DIN HRT IE/POLIET ILENT EREFT ALAT /AL/POLIACRILONIT RIL CU CU SIST EM DE NCHIDERE SECURIZAT PENT RU COPII, A CT E 1 PLAST URE T RANSDERMIC PROT EJ. DE O FOLIE DIN FILM DIN T EREFT ALAT DE POLIET ILENA SILICONAT A
PRF 30 5.246666 5.246666 0.000000
70 N06DA RIVASTIGMINUM*** RIVASTIGMINA TEVA 2 mg/ml SOL. ORALA 2mg/ml TEVA PHARM ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 125 ML SOL. ORALA + 1 SERINGA DOZATOARE P-RF/R 1 433.380000 433.380000 0.000000
71 N06DA GALANTAMINUM*** GALSYA 16 mg CAPS. ELIB. PRE 16mg KRKA D.D. NOVO M SLOVENI CUTIE CU BL PRF 30 1.815666 1.815666 0.000000
72 N06DA GALANTAMINUM*** GALANTAMINA ZENTIVA 16 CAPS. ELIB. PRE 16mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 CAPS. ELIB. PREL. PRF 28 1.513571 1.513571 0.000000
73 N06DA GALANTAMINUM*** GALSYA 24 mg CAPS. ELIB. PRE 24mg KRKA D.D. NOVO M SLOVENI CUTIE CU BL PRF 30 1.815666 1.815666 0.000000
74 N06DA GALANTAMINUM*** GALANTAMINA ZENTIVA 24 CAPS. ELIB. PRE 24mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 CAPS. ELIB. PREL. PRF 28 1.513571 1.513571 0.000000
75 N06DA GALANTAMINUM*** GALSYA 8 mg CAPS. ELIB. PRE 8mg KRKA D.D. NOVO M SLOVENI CUTIE CU BL PRF 30 1.815666 1.815666 0.000000
76 N06DA GALANTAMINUM*** GALANTAMINA ZENTIVA 8 m CAPS. ELIB. PRE 8mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 CAPS. ELIB. PREL. PRF 28 1.513571 1.513571 0.000000
77 N06DA GALANTAMINUM*** REMINYL (R) 4 mg/ml SOL. ORALA 4mg/ml JANSSEN-PHA BELGIA CUTIE X 1 FLACON X 100 P-R 1 124.860000 124.860000 0.000000
78 N06DX MEMANTINUM*** MEMANTINA RATIOPHARM 1 COMPR. FILM. 10 mg RATIOPHARM GMBH GERMANI CUTIE CU BLISTERE DIN FOLIE PVC/PVDC-AL X 56 COMPRIMATE FILMATE PR 56 0.650785 0.650785 0.221715
79 N06DX MEMANTINUM*** EBIXA 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEM CUTIE X 56 COMPR. FILM. (BLIST. A P-RF/R 56 0.650785 0.650785 1.572250
80 N06DX MEMANTINUM*** MEMANTINA TORRENT 10 m COMPR. FILM. 10mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC-PVDC PR 56 0.650785 0.650785 0.009572
81 N06DX MEMANTINUM*** NEMDATINE 10mg COMPR. FILM. 10mg ACTAVIS GROUP P ISLANDA CUTI PR 28 0.647857 0.647857 0.000000

Pagina 66 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
82 N06DX MEMANTINUM*** MEMANTINA DR. REDDY'S 1 COMPR. FILM. 10mg DR. REDDY'S L ROMANIA CUTIE CU BLIST. PVC/AL X 56 CO PR 56 0.570892 0.570892 0.000000
83 N06DX MEMANTINUM*** MIRVEDOL 10 mg COMPR. FILM. 10mg GEDEON R ROMANIA CUTIE CU BLIST. PVC-PE PR 56 0.650785 0.650785 0.396179
84 N06DX MEMANTINUM*** MEMANTINA AUROBINDO 1 COMPR. FILM. 10mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PE PR 56 0.542321 0.542321 0.000000
85 N06DX MEMANTINUM*** MEMANTINA TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE PR 56 0.650785 0.650785 0.034393
86 N06DX MEMANTINUM*** MEMANTINA TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. PA-AL-PV PR 56 0.650785 0.650785 0.034393
87 N06DX MEMANTINUM*** MEMANTINA ATB 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CO PR 56 0.650785 0.650785 0.005286
88 N06DX MEMANTINUM*** MARIXINO 10mg COMPR. FILM. 10mg CONSILIENT HEAL IRLANDA CUTIE X BL PR 56 0.619821 0.619821 0.000000
89 N06DX MEMANTINUM*** COGNOMEM 10 mg COMPR. FILM. 10mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CO PR 56 0.650785 0.650785 0.034393
90 N06DX MEMANTINUM*** MEMANTINA LA COMPR. FILM. 10mg LA AUSTRIA CUTIE CU BLIST. PVC-PE PR 70 0.628428 0.628428 0.000000
91 N06DX MEMANTINUM*** MANTOMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. TRANSPARENT PVC-PE-PVDC/AL X 56 COMPR. FILM. PRF 56 0.650785 0.650785 0.032965
92 N06DX MEMANTINUM*** MANTOMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PA-AL-PV PRF 56 0.650785 0.650785 0.032965
93 N06DX MEMANTINUM*** MEMANTINE ACCORD 10 mg COMPR. FILM. 10mg ACCORD HE MA CUTIE CU BLIST. PVC/PE PR 14 0.648571 0.648571 0.000000
94 N06DX MEMANTINUM*** MEMANTINE ACCORD 10 mg COMPR. FILM. 10mg ACCORD HE MA CUTIE CU BLIST. PVC/PE PR 28 0.647857 0.647857 0.000000
95 N06DX MEMANTINUM*** MEMANTINA RATIOPHARM 2 COMPR. FILM. 20 mg RATIOPHARM GMBH GERMANI CUTIE X BLISTERE DIN FOLIE PVC/PVDC-AL X 28 COMPRIMATE FILMATE PR 28 1.644428 1.644428 0.100572
96 N06DX MEMANTINUM*** MEMANTINA TORRENT 20 m COMPR. FILM. 20mg TORRENT PHARMA S ROMANIA CUTIE CU BLIST. PVC-PVDC PR 56 1.644428 1.644428 0.373786
97 N06DX MEMANTINUM*** NEMDATINE 20mg COMPR. FILM. 20mg ACTAVIS GROUP P ISLANDA CUTI PR 28 1.552500 1.552500 0.000000
98 N06DX MEMANTINUM*** MEMANTINA TERAPIA 20 mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE PR 28 1.644428 1.644428 0.449500
99 N06DX MEMANTINUM*** MEMANTINA TERAPIA 20 mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. PA-AL-PV PR 28 1.644428 1.644428 0.449500
100 N06DX MEMANTINUM*** MEMANTINA ATB 20 mg COMPR. FILM. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 28 CO PR 28 1.491071 1.491071 0.000000
101 N06DX MEMANTINUM*** COGNOMEM 20 mg COMPR. FILM. 20mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CO PR 56 1.644285 1.644285 0.000000
102 N06DX MEMANTINUM*** MANTOMED 20 mg COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. TRANSPARENT PVC-PE-PVDC/AL X 56 COMPR. FILM. PRF 56 1.644428 1.644428 0.419857
103 N06DX MEMANTINUM*** MANTOMED 20 mg COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PA-AL-PV PRF 56 1.644428 1.644428 0.419857
104 N06DX MEMANTINUM*** MEMANTINE ACCORD 20 mg COMPR. FILM. 20mg ACCORD HE MA CUTIE CU BLIST. PVC/PE PRF 14 1.540714 1.540714 0.000000
105 N06DX MEMANTINUM*** MEMANTINE ACCORD 20 mg COMPR. FILM. 20mg ACCORD HE MA CUTIE CU BLIST. PVC/PE PRF 28 1.491071 1.491071 0.000000
106 N06DX MEMANTINUM*** MEMANTINA TEVA 10 mg COMPR 10mg TEVA PHARM ROMANIA CUTIE CU BLIST. PT. ELIBERAREA UNEI UNITATI DOZATE DIN OPA-AL-PVC/AL X 56X1 COMPR. ORODISPERSABILE PR 56 0.650785 0.650785 0.034393
107 N06DX MEMANTINUM*** MEMANTINA TEVA 20 mg COMPR 20mg TEVA PHARM ROMANIA CUTIE CU BLIST. PT. ELIBERAREA UNEI UNITATI DOZATE DIN OPA-AL-PVC/AL X 28X1 COMPR. ORODISPERSABILE
PR 28 1.370357 1.370357 0.000000
108 N06DX MEMANTINUM*** EBIXA 5mg/doza PICATURI ORA 5mg/doza H LUNDBECK A/S DANEM CUTIE X 1 FLACON DIN STICLA BRUNA CU POMPA DOZATOARE X 50 ML SOLUTIE P-RF/R 1 115.980000 115.980000 25.020000
109 N06DX MEMANTINUM*** MEMANTINA TEVA 10 mg/ml SOL. ORALA 10 mg/ml TEVA PHARM ROMANIA CUTIE CU 1 FLAC. DIN STICLA + SERINGA DOZATOARE A 50 ML SOL. ORALA PR 1 96.650000 96.650000 0.000000
110 N06DX MEMANTINUM*** MEMANTINA TORRENT 10 m SOL. ORALA 10mg/ml TORRENT PHARMA ROMANIA CUTIE CU 1 FLAC. A 100 ML SOL. SOL. ORALA SI O POMPA DOZATOARE PR 1 183.300000 183.300000 0.000000

Tratamentul se initiaza de catre medicul in specialitatea psihiatrie, neurologie sau geriatrie

15. COLAGENOZE MAJORE (LUPUS ERITEMATOS SISTEMIC, SCLERODERMIE, POLI/DERMATOMIOZITA, VASCULITE SISTEMICE) - G 17

1 H02A METHYLPREDNISOLONUM5) MEDROL A 16 COMPR. 16mg PFIZER EUROPE M MA CUTIE X 5 BLIST. A-PVC/PVC X 1 P-R 50 0.543200 0.543200 0.000000
2 H02A METHYLPREDNISOLONUM5) MEDROL 32 COMPR. 32mg PFIZER EUROPE M MA CUTIE X 2 BLIST. AL-PVC/PVC X P-R 20 1.234000 1.234000 0.000000
3 L01AA CYCLOPHOSPHAMIDUM ENDOXAN (R) 50 mg DRAJ. 50mg BAXTER ONCOLO GERMANI CUTIE X 5 BLIST. PVC-PVDC/AL X P-R 50 0.542400 0.542400 0.000000
4 L01AA CYCLOPHOSPHAMIDUM ENDOXAN 200 mg PULB. P 200mg ACTAVIS S.R.L. ROMANIA CUTIE X 1 FLAC. PULB. PT. SOL. S 1 15.890000 15.890000 0.000000
5 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN EUROPE GM GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
6 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN P IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
7 L04AX AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEW AUSTRIA CUTIE CU 1 FLAC. PEID X 100 C PR 100 0.788900 0.788900 0.000000
8 P01BA HYDROXYCHLOROQUINUM PLAQUENIL COMPR. FILM. 200mg SANOFI - ROMANIA CUTIE X 6 BLIST. X 10 COMPR. FILM P-6 60 0.542833 0.542833 0.000000
9 P01BA HYDROXYCHLOROQUINUM PLAQUENIL 200 mg COMPR. FILM. 200mg SANOFI ROMANIA S. ROMANIA CUTIE CU 4 BLISTERE DI P-6 60 0.542833 0.542833 0.000000

Tratamentul se initiaza si se monitorizeaza de catre medicul in specialitatea reumatologie, nefrologie si boli infectioase.

16. POLIARTRITA REUMATOIDA , ARTROPATIA PSORIAZICA SI ARTRITA JUVENILA - G 18

Pagina 67 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
1 A07E SULFASALAZINUM SULFASALAZIN EN COMPR. 500mg KRKA D.D. NOVO M SLOVENI CUTIE X 5 BLIST. A P-6 50 0.584200 0.584200 0.000000
2 A07E SULFASALAZINUM SALAZIDIN GR 500 mg COMPR. GAST 500mg AC HELCOR PHAR ROMANIA CUTIE CU 5 BLIST. PVC/ P6L 50 0.585200 0.585200 0.000000
3 H02A BETAMETHASONUM DIPROPHOS SUSP. INJ. I.M. 7mg/ml MERCK SHARP & ROMANIA CUTIE X 5 FIOLE X 1 ML P-R 5 5.366000 5.366000 0.000000
4 H02A METHYLPREDNISOLONUM5) MEDROL A 16 COMPR. 16mg PFIZER EUROPE M MA CUTIE X 5 BLIST. A-PVC/PVC X 1 P-R 50 0.543200 0.543200 0.000000
5 H02A METHYLPREDNISOLONUM5) MEDROL 32 COMPR. 32mg PFIZER EUROPE M MA CUTIE X 2 BLIST. AL-PVC/PVC X P-R 20 1.234000 1.234000 0.000000
6 L01BA METHOTREXATUM METHOTREXAT "EBEWE" 5 CONC. PT. 100mg/ml EBEW AUSTRIA CUTIE X 1 FLACON X 50 ML S 1 374.090000 374.090000 0.000000
7 L01BA METHOTREXATUM METHOTREXAT "EBEWE" 1 CONC. PT. 100mg/ml EBEW AUSTRIA CUTIE X 1 TUB DIN M S 1 82.990000 82.990000 0.000000
8 L01BA METHOTREXATUM BENDATREXAT SOL INJ. 25mg/ml CN UNIFARM S.A. ROMANIA CUTIE CU 1 FLAC. X 2 ML PR 1 64.090000 64.090000 0.000000
9 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 0,75 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJ
PR 1 61.880000 61.880000 0.000000
10 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 2,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE PR 1 118.008000 118.008000 9.082000
11 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE
PR 1 46.730000 46.730000 0.000000
12 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,5 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE
PR 1 79.700000 79.700000 0.000000
13 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,40ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 98.340000 98.340000 0.000000
14 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,20ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 56.076000 56.076000 13.944000
15 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,50ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 110.680000 110.680000 0.000000
16 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0.30ML SOLUTIA INJECTABILA PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 74.880000 74.880000 0.000000
17 L04AA LEFLUNOMIDUM** LEFLUNOMIDA SANDOZ 10 COMPR. FILM. 10 mg SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLACON PEID CU CAPAC PP CU DESICANT X 30 COMPR. FILM. PR 30 1.899666 1.899666 0.000000
18 L04AA LEFLUNOMIDUM** LEFLUNOMIDE WINTHROP COMPR. FILM. 10mg SANOFI- AVENTIS DEUTSCHLAND GMBH GERMANI CUTIE X 1 FLAC. PEID X 30 COMPR PR 30 1.899666 1.899666 0.000000
19 L04AA LEFLUNOMIDUM** LEFLON 10 mg COMPR. FILM. 10mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL PR 30 1.899666 1.899666 0.000000
20 L04AA LEFLUNOMIDUM** LEFLUNOMIDA SANDOZ 20 COMPR. FILM. 20 mg SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLACON PEID CU CAPAC PP DESICANT X 30 COMPR. FILM. PR 30 3.149333 3.149333 0.000000
21 L04AA LEFLUNOMIDUM** LEFLUNOMIDE WINTHROP COMPR. FILM. 20mg SANOFI- AVENTIS DEUTSCHLAND GMBH GERMANI CUTIE X 1 FLAC. PEID X 30 COMPR PR 30 3.608333 3.608333 0.000000
22 L04AA LEFLUNOMIDUM** LEFLON 20 mg COMPR. FILM. 20mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL PR 30 3.608333 3.608333 0.000000
23 L04AD CICLOSPORINUM EQUORAL 100 mg CAPS. MOI 100mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 6.232400 6.232400 0.000000
24 L04AD CICLOSPORINUM SANDIMMUN NEORAL (R) CAPS. MOI 25mg NOVARTIS PHARM GERMANI CUTIE X 10 BLIST. X 5 CAPS. MOI S/P-RF 50 1.784400 1.784400 0.574000
25 L04AD CICLOSPORINUM EQUORAL 25 mg CAPS. MOI 25mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 1.487000 1.487000 0.000000
26 L04AD CICLOSPORINUM SANDIMMUN NEORAL (R) CAPS. MOI 50mg NOVARTIS PHARM GERMANI CUTIE X 10 BLIST. X 5 CAPS. MOI S/P-RF 50 3.040560 3.040560 0.788040
27 L04AD CICLOSPORINUM EQUORAL 50 mg CAPS. MOI 50mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 2.533800 2.533800 0.000000
28 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN EUROPE GM GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
29 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN P IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
30 L04AX AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEW AUSTRIA CUTIE CU 1 FLAC. PEID X 100 C PR 100 0.788900 0.788900 0.000000
31 L04AX METHOTREXATUM METHOTREXATE PCH 10mg COMPR. 10mg TEVA PHARM ROMANIA CUTIE X 10COMPR. P6L 10 2.989000 2.989000 0.000000
32 L04AX METHOTREXATUM METHOTREXATE PCH 2,5mg COMPR. 2,5mg TEVA PHARM ROMANIA CUTIE X30 COMPRIMATE P6L 30 0.747666 0.747666 0.000000
33 M01AB DICLOFENACUM DICLOREUM 150 mg CAPS. ELIB. PRE 150mg ALFA WASSERMANN ITALIA CUTIE X 2 BLIST. AL/PVC X 10 P-6 20 2.474500 2.474500 0.000000
34 M01AB DICLOFENACUM DICLOFENAC DUO PH CAPS. ELIB. PRE 75mg PHARMASWISS CESKA REPUBLIKA S.R.O. CEHIA CUTIE X 3 BLIST. PVC/P P-6 30 0.195600 0.195600 0.385400
35 M01AB DICLOFENACUM DICLOTARD 100 mg COMPR. CU E 100mg TERAPIA SA ROMANIA CUTIE X 2 BL P-6 20 0.354500 0.354500 0.000000
36 M01AB DICLOFENACUM DICLAC (R) 75 ID COMPR. ELIB. 75mg HEXAL AG GERMANI CUTIE X 1 BLIST. AL/PP X 10 P-6 10 0.163000 0.163000 0.000000
37 M01AB DICLOFENACUM VOLTAREN (R) RETARD COMPR. FI 100mg NOVARTIS PHARM GERMANI CUTIE P-6 10 0.425400 0.425400 0.119600
38 M01AB DICLOFENACUM REFEN (R) RETARD COMPR. FI 100mg STADA HEMOFARM S ROMANIA CUTIE X 2 BLIST. P-6 20 0.354500 0.354500 0.000000
39 M01AB DICLOFENACUM VOLTAREN (R) 50 COMPR. 50mg NOVARTIS PHARM GERMANI CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. GASTROREZ. P-6 20 0.140400 0.140400 0.040100
40 M01AB DICLOFENACUM DICLOFENAC 50 mg COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. A P-6 20 0.117000 0.117000 0.000000
41 M01AB DICLOFENACUM DICLOFENAC HELCOR 50 m COMPR. 50mg A.C. HELCOR PH ROMANIA CUTIE X 2 BLIST. A P-6 20 0.117000 0.117000 0.000000
42 M01AB DICLOFENACUM VOLTAREN RAPID (R) DRAJ. 50mg NOVARTIS PHARM GERMANI CUTIE X 1 BLIST. PVC-PE-PVDC P-6 10 0.140400 0.140400 0.102600
43 M01AB DICLOFENACUM DICLOFENAC ARENA 25 mg DRAJ. GASTROR 25mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X P-6 30 0.197666 0.197666 0.000000
44 M01AB DICLOFENACUM DICLOFENAC ARENA 50 mg DRAJ. GASTROR 50mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X P-6 20 0.117000 0.117000 0.000000
45 M01AB DICLOFENACUM DICLOFENAC ARENA 50 mg DRAJ. GASTROR 50mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X P-6 30 0.117000 0.117000 0.000000
46 M01AB DICLOFENACUM VOLTAREN (R) SOL. INJ. 25mg/ml NOVARTIS PHARM GERMANI CUTIE X 5 FIOLE CU PUNCT DE P-R 5 1.010400 1.010400 0.671600
47 M01AB DICLOFENACUM TRATUL (R) SOL. INJ. 30mg/ml GERO AUSTRIA CUTI P-R 5 1.010400 1.010400 0.083600
48 M01AB DICLOFENACUM DICLOFENAC 75 mg SOL. INJ. 75mg/3ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 3 ML P-R 5 1.010400 1.010400 0.083600
49 M01AB DICLOFENACUM REFEN 75 mg SOL. INJ./PERF. 25mg/ml STADA HEMOFARM S ROMANIA CU P-R 5 0.842000 0.842000 0.000000
50 M01AB DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDANT P-6 6 0.570000 0.570000 0.000000

Pagina 68 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
51 M01AB DICLOFENACUM VOLTAREN (R) SUPOZ. 100mg NOVARTIS PHARM GERMANI CUTIE X 1 FOLIE PVC/PE-JD X 5 S P-6 5 0.684000 0.684000 0.194000
52 M01AB DICLOFENACUM DICLOFENAC 100 mg SUPOZ. 100mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6 10 0.570000 0.570000 0.000000
53 M01AB DICLOFENACUM DICLOFENAC SODIC 100 mg SUPOZ. 100mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII TERMOSU P-6 10 0.572000 0.572000 0.000000
54 M01AB DICLOFENACUM DICLOFENAC SINTOFARM 1 SUPOZ. 12,5 mg SINTOFARM S.A. ROMANIA CUTIE X 2 P6L 6 0.606666 0.606666 0.000000
55 M01AB DICLOFENACUM DICLOFENAC SINTOFARM 1 SUPOZ. 12,5 mg SINTOFARM S.A. ROMANIA CUTIE X 2 P6L 10 0.601000 0.601000 0.000000
56 M01AB DICLOFENACUM VOLTAREN (R) SUPOZ. 50mg NOVARTIS PHARM GERMANI CUTIE X 2 FOLII PVC/PEJD X 5 SUP P-6 10 0.960000 0.960000 0.000000
57 P01BA HYDROXYCHLOROQUINUM PLAQUENIL COMPR. FILM. 200mg SANOFI - ROMANIA CUTIE X 6 BLIST. X 10 COMPR. FILM P-6 60 0.542833 0.542833 0.000000
58 P01BA HYDROXYCHLOROQUINUM PLAQUENIL 200 mg COMPR. FILM. 200mg SANOFI ROMANIA S. ROMANIA CUTIE CU 4 BLISTERE DI P-6 60 0.542833 0.542833 0.000000

Tratamentul se iniiaz de ctre medicul din specialitatea reumatologie, nefrologie, medicin intern, pediatrie i reabilitare medical.

17. SPONDILITA ANKILOZANTA - G 19

1 A07E SULFASALAZINUM SULFASALAZIN EN COMPR. 500mg KRKA D.D. NOVO M SLOVENI CUTIE X 5 BLIST. A P-6 50 0.584200 0.584200 0.000000
2 A07E SULFASALAZINUM SALAZIDIN GR 500 mg COMPR. GAST 500mg AC HELCOR PHAR ROMANIA CUTIE CU 5 BLIST. PVC/ P6L 50 0.585200 0.585200 0.000000
3 H02A BETAMETHASONUM DIPROPHOS SUSP. INJ. I.M. 7mg/ml MERCK SHARP & ROMANIA CUTIE X 5 FIOLE X 1 ML P-R 5 5.366000 5.366000 0.000000
4 M01AB DICLOFENACUM DICLOREUM 150 mg CAPS. ELIB. PRE 150mg ALFA WASSERMANN ITALIA CUTIE X 2 BLIST. AL/PVC X 10 P-6 20 2.474500 2.474500 0.000000
5 M01AB DICLOFENACUM DICLOFENAC DUO PH CAPS. ELIB. PRE 75mg PHARMASWISS CESKA REPUBLIKA S.R.O. CEHIA CUTIE X 3 BLIST. PVC/P P-6 30 0.195600 0.195600 0.385400
6 M01AB DICLOFENACUM DICLOTARD 100 mg COMPR. CU E 100mg TERAPIA SA ROMANIA CUTIE X 2 BL P-6 20 0.354500 0.354500 0.000000
7 M01AB DICLOFENACUM DICLAC (R) 75 ID COMPR. ELIB. 75mg HEXAL AG GERMANI CUTIE X 1 BLIST. AL/PP X 10 P-6 10 0.163000 0.163000 0.000000
8 M01AB DICLOFENACUM VOLTAREN (R) RETARD COMPR. FI 100mg NOVARTIS PHARM GERMANI CUTIE P-6 10 0.425400 0.425400 0.119600
9 M01AB DICLOFENACUM REFEN (R) RETARD COMPR. FI 100mg STADA HEMOFARM S ROMANIA CUTIE X 2 BLIST. P-6 20 0.354500 0.354500 0.000000
10 M01AB DICLOFENACUM VOLTAREN (R) 50 COMPR. 50mg NOVARTIS PHARM GERMANI CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. GASTROREZ. P-6 20 0.140400 0.140400 0.040100
11 M01AB DICLOFENACUM DICLOFENAC 50 mg COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. A P-6 20 0.117000 0.117000 0.000000
12 M01AB DICLOFENACUM DICLOFENAC HELCOR 50 m COMPR. 50mg A.C. HELCOR PH ROMANIA CUTIE X 2 BLIST. A P-6 20 0.117000 0.117000 0.000000
13 M01AB DICLOFENACUM VOLTAREN RAPID (R) DRAJ. 50mg NOVARTIS PHARM GERMANI CUTIE X 1 BLIST. PVC-PE-PVDC P-6 10 0.140400 0.140400 0.102600
14 M01AB DICLOFENACUM DICLOFENAC ARENA 25 mg DRAJ. GASTROR 25mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X P-6 30 0.197666 0.197666 0.000000
15 M01AB DICLOFENACUM DICLOFENAC ARENA 50 mg DRAJ. GASTROR 50mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X P-6 20 0.117000 0.117000 0.000000
16 M01AB DICLOFENACUM DICLOFENAC ARENA 50 mg DRAJ. GASTROR 50mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X P-6 30 0.117000 0.117000 0.000000
17 M01AB DICLOFENACUM VOLTAREN (R) SOL. INJ. 25mg/ml NOVARTIS PHARM GERMANI CUTIE X 5 FIOLE CU PUNCT DE P-R 5 1.010400 1.010400 0.671600
18 M01AB DICLOFENACUM TRATUL (R) SOL. INJ. 30mg/ml GERO AUSTRIA CUTI P-R 5 1.010400 1.010400 0.083600
19 M01AB DICLOFENACUM DICLOFENAC 75 mg SOL. INJ. 75mg/3ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 3 ML P-R 5 1.010400 1.010400 0.083600
20 M01AB DICLOFENACUM REFEN 75 mg SOL. INJ./PERF. 25mg/ml STADA HEMOFARM S ROMANIA CU P-R 5 0.842000 0.842000 0.000000
21 M01AB DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDANT P-6 6 0.570000 0.570000 0.000000
22 M01AB DICLOFENACUM VOLTAREN (R) SUPOZ. 100mg NOVARTIS PHARM GERMANI CUTIE X 1 FOLIE PVC/PE-JD X 5 S P-6 5 0.684000 0.684000 0.194000
23 M01AB DICLOFENACUM DICLOFENAC 100 mg SUPOZ. 100mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6 10 0.570000 0.570000 0.000000
24 M01AB DICLOFENACUM DICLOFENAC SODIC 100 mg SUPOZ. 100mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII TERMOSU P-6 10 0.572000 0.572000 0.000000
25 M01AB DICLOFENACUM DICLOFENAC SINTOFARM 1 SUPOZ. 12,5 mg SINTOFARM S.A. ROMANIA CUTIE X 2 P6L 6 0.606666 0.606666 0.000000
26 M01AB DICLOFENACUM DICLOFENAC SINTOFARM 1 SUPOZ. 12,5 mg SINTOFARM S.A. ROMANIA CUTIE X 2 P6L 10 0.601000 0.601000 0.000000
27 M01AB DICLOFENACUM VOLTAREN (R) SUPOZ. 50mg NOVARTIS PHARM GERMANI CUTIE X 2 FOLII PVC/PEJD X 5 SUP P-6 10 0.960000 0.960000 0.000000

Tratamentul se iniiaz de ctre medicul din specialitatea reumatologie sau reabilitare medical.

NEUROENDOCRINE) - G 22

Pagina 69 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)

1 G02CB CABERGOLINUM** DOSTINEX COMPR. 0,5mg PFIZER EUROPE M MA CUTIE X 1 FLAC. X 2 COMPR. P-R 2 10.795000 10.795000 0.000000
2 G02CB CABERGOLINUM** DOSTINEX COMPR. 0,5mg PFIZER EUROPE M MA CUTIE X 1 FLAC. X 8 COMPR. P-R 8 9.912500 9.912500 0.000000
3 H01AX PEGVISOMANTUM**** SOMAVERT 10 mg PULB. + S 10mg PFIZER LIMITED MA CUTIE X 30 FLAC. CU PULB., INSOTITE DE 30 FLAC. X 8 ML SOLV. PT. RECONSTITUIRE P-RF/R 30 270.534666 270.534666 0.000000
4 H01AX PEGVISOMANTUM**** SOMAVERT 20 mg PULB. + S 20mg PFIZER LIMITED MA CUTIE X 30 FLAC. CU LIOF., INSOTITE DE 30 FLAC. A 8 ML SOLV. PT. RECONSTITUIRE P-RF/R 30 539.183333 539.183333 0.000000
5 H01B DESMOPRESSINUM DESMOPRESINA TEVA 0,2mg COMPR. 0,2mg TEVA PHARMAC ROMANIA CUTIE CU BLIST. OPA-AL- PVC/ P-R 30 2.499333 2.499333 0.000000
6 H01B DESMOPRESSINUM MINIRIN 0,2 mg COMPR. 0,2mg FERRING GMBH GERMANI CUTIE X 1 FLAC. DIN PEID X 30 C P-R 30 2.999199 2.999199 0.846134
7 H01B DESMOPRESSINUM MINIRIN MELT 120 mcg LIOF. ORAL 120mcg FERRING GMBH GERMANI CUTIE X 3 BLIST. AL/ P-R 30 6.047000 6.047000 0.000000
8 H01B DESMOPRESSINUM MINIRIN MELT 60 mcg LIOF. ORAL 60mcg FERRING GMBH GERMANI CUTIE X 1 BLIST A P-R 10 3.337000 3.337000 0.000000
9 H01B DESMOPRESSINUM MINIRIN MELT 60 mcg LIOF. ORAL 60mcg FERRING GMBH GERMANI CUTIE X 3 BLIST A P-R 30 3.169333 3.169333 0.000000
10 H01CB OCTREOTIDUM**** SANDOSTATIN LAR 20 mg PULB. + SOLV. PT. SUSP. INJ. (I.M.) CU ELIB. PRELU 20mg NOVARTIS PHARM GERMANI CUTIE X 1 FLAC. PULBERE + 1 SERINGA PREUMPLUTA X 2,5 ML SOLVENT + 2 ACE PR 1 ,919.710000 2,919.710000 0.000000
11 H01CB OCTREOTIDUM**** SANDOSTATIN LAR 10 mg PULB.+SO 10mg NOVARTIS PHARM GERMANI CUTIE X 1 FLAC. PULBERE + 1 SERINGA PREUMPLUTA X 2 ML SOLVENT + ADAPTOR PT FLACON+1 AC PR 1 ,495.280000 1,495.280000 0.000000
12 H01CB OCTREOTIDUM**** SANDOSTATIN LAR 20 mg PULB.+SO 20mg NOVARTIS PHARM GERMANI CUTIE X 1 FLAC. PULBERE + 1 SERINGA PREUMPLUTA X 2 ML SOLVENT + ADAPTOR PT FLACON+1 AC PR 1 ,919.710000 2,919.710000 0.000000
13 H01CB OCTREOTIDUM**** SANDOSTATIN LAR 30 mg PULB.+SO 30mg NOVARTIS PHARM GERMANI CUTIE X 1 FLAC. PULBERE + 1 SERINGA PREUMPLUTA X 2 ML SOLVENT + ADAPTOR PT FLACON+1 AC PR 1 ,251.210000 4,251.210000 0.000000
14 H01CB OCTREOTIDUM**** SANDOSTATIN LAR 10 mg PULB.+SOLV.PT.SUSP. INJ. (I.M.) CU ELIB. PRELUNG. 10mg NOVARTIS PHARM GERMANI CUTIE X 1 FLAC. PULBERE + 1 SERINGA PREUMPLUTA X 2,5 ML SOLVENT + 2 ACE PR 1 ,519.360000 1,519.360000 0.000000
15 H01CB OCTREOTIDUM**** SANDOSTATIN LAR 30 mg PULB.+SOLV.PT.SUSP. INJ. (I.M.) CU ELIB. PRELUNG. 30mg NOVARTIS PHARM GERMANI CUTIE X 1 FLAC. PULB. + 1 SERINGA PREUMPLUTA X 2,5 ML SOLVENT + 2 ACE PR 1 ,344.140000 4,344.140000 0.000000
16 H01CB OCTREOTIDUM**** SANDOSTATIN 0,1 mg/ml SOL. INJ. 0,1mg/ml NOVARTIS PHARM GERMANI CUTIE CU 5 FIOLE D PR 5 8.830000 8.830000 0.000000
17 H01CB LANREOTIDUM**** SOMATULINE PR 30 mg LIOF. PT. 30mg IPSEN PHARMA FRANTA CUTIE X 1 FLACON LIOF. + 1 FIOLA X 2 ML SOLV. + 1 SERINGA X 3 ML + 2 ACE S 1 ,611.250000 1,611.250000 0.000000
18 H01CB LANREOTIDUM**** SOMATULINE AUTOGEL 120 SOL. INJ. CU 120mg IPSEN PHARMA FRANTA CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. CU ELIB. PREL., IN PUNGA AL/NYLON/PE + AC S/P-RF 1 ,667.070000 4,667.070000 0.000000
19 H01CB LANREOTIDUM**** SOMATULINE AUTOGEL 120 SOL. INJ. IN SERINGA PREUMPLUTA 120mg IPSEN PHARMA FRANTA CUTIE CU 1 SERINGA PREUMPLUTA PE TEREFTALAT/AL/PE LAMINATA X 0,5 ML PREVAZUTA CU SIST. DE SIGURANTA AUTOMAT SI 1 AC DIN OTEL (1,2MMX20MM), TEACA DIN PLASTIC PT. AC (PEID) SI 1 OPRITOR PT. PISTON (BROMOBUTIL CAUCIUC)
PR 1 ,667.070000 4,667.070000 0.000000
20 H01CB PASIREOTIDUM** SIGNIFOR 0,3 mg SOL INJ. 0,3mg NOVARTIS EURO MA CUTIE CU 30 FIOLE DIN STICLA PR 30 223.166333 223.166333 0.000000
21 H01CB PASIREOTIDUM** SIGNIFOR 0,6 mg SOL INJ. 0,6mg NOVARTIS EURO MA CUTIE CU 30 FIOLE DIN STICLA PR 30 262.131666 262.131666 0.000000
22 H01CB PASIREOTIDUM** SIGNIFOR 0,9 mg SOL INJ. 0,9mg NOVARTIS EURO MA CUTIE CU 30 FIOLE DIN STICLA PR 30 295.473666 295.473666 0.000000
23 H02A FLUDROCORTISONUM ASTONIN H COMPR. 0,1mg MERCK KGAA GERMANI CUTIE X 1 FLAC. DIN PP X 50 COMP P-R 50 0.403000 0.403000 0.000000
24 H02A PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.108399 0.108399 0.028601
25 H02A PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.090333 0.090333 0.000000
26 H02A PREDNISONUM PREDNISON 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.108399 0.108399 0.015267
27 H02A PREDNISONUM PREDNISON - RICHTER 5 mg COMPR. 5mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COM P-R 20 0.108399 0.108399 0.025101
28 H02A HYDROCORTISONUM HYDROCORTISONE ROUSS COMPR. 10mg CN UNIFARM ROMANIA CUTIE X 1 FLAC. 25 COMPR. PRF 25 0.506800 0.506800 0.000000
29 H02A HYDROCORTISONUM HYDROCORTISONE SUCC LIOF. + S 100mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU LIOF. PT. SOL. INJ. + 1 FIOLA SOLV. X 2 ML S/P-RF 1 3.910000 3.910000 0.000000
30 H02A HYDROCORTISONUM HIDROCORTIZON HF 500 mg PULB. + SOLV. PT. SOL. INJ./PERF. 500mg STADA HEMOFARM S ROMANIA CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 20 ML, INCHIS CU DOP DIN CAUCIUC GRI, ETANSAT CU CAPSA DIN ALUMINIU, CONTINAND PULB. PT. SOL. INJ./PERF. SI 1 FIOLA CU 4 ML SOLV. PR/PRF 1 11.910000 11.910000 0.000000
31 H02A HYDROCORTISONUM HIDROCORTIZON HF 100 mg PULB. SI SOLV. PT. SOL. INJ./PERF. 100mg STADA HEMOFARM S ROMANIA CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 5 ML, INCHIS CU DOP DIN CAUCIUC GRI, ETANSAT CU CAPSA DE ALUMINIU, CONTINAND PULB. PT. SOL.INJ./PERF. SI O FIOLA CU 2 ML SOLV. PR/PRF 1 4.692000 4.692000 2.398000
32 H02A HYDROCORTISONUM HIDROCORTIZON HEMISUC SOL. INJ. I.V. 25mg/5ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE X 1 ML S/P-RF 5 4.426000 4.426000 0.000000
33 H03A LEVOTHYROXINUM EUTHYROX 100mcg COMPR. 100mcg MERCK KGAA GERMANI CUTIE X 4 BLIST. PP/AL X 25 COMPR P-6 100 0.121400 0.121400 0.000000
34 H03A LEVOTHYROXINUM EUTHYROX 100g COMPR. 100g MERCK KGAA GERMANI CUTIE X 4 BLIST. PVC/AL X 25 COM P-6 100 0.121400 0.121400 0.000000
35 H03A LEVOTHYROXINUM EUTHYROX 200mcg COMPR. 200mcg MERCK KGAA GERMANI CUTIE X 4 BLIST. AL/PP X 25 COMPR P-6 100 0.250500 0.250500 0.000000
36 H03A LEVOTHYROXINUM EUTHYROX 200g COMPR. 200g MERCK KGAA GERMANI CUTIE X 4 BLIST. AL/PVC X 25 COM P-6 100 0.250500 0.250500 0.000000
37 H03A LEVOTHYROXINUM EUTHYROX 25mcg COMPR. 25mcg MERCK KGAA GERMANI CUTIE X 4 BLIST. PP/AL X 25 COMPR P-6 100 0.085800 0.085800 0.000000
38 H03A LEVOTHYROXINUM EUTHYROX 25g COMPR. 25g MERCK KGAA GERMANI CUTIE X 4 BLIST. PVC/AL X 25 COM P-6 100 0.085800 0.085800 0.000000
39 H03A LEVOTHYROXINUM EUTHYROX 50mcg COMPR. 50mcg MERCK KGAA GERMANI CUTIE X 4 BLIST. PP/AL X 25 COMPR P-6 100 0.085800 0.085800 0.000000
40 H03A LEVOTHYROXINUM EUTHYROX 50g COMPR. 50g MERCK KGAA GERMANI CUTIE X 4 BLIST. PVC/AL X 25 COM P-6 100 0.085800 0.085800 0.000000
41 H03CA KALII IODIDUM JODID 100 COMPR. 100mcg MERCK KGAA GERMANI CUTIE X 4 BLIST. AL/PP X 25 COMPR P-R 100 0.127300 0.127300 0.000000
42 H03CA KALII IODIDUM JODID 100 COMPR. 100mcg MERCK KGAA GERMANI CUTIE X 4 BLIST. AL/PVC X 25 COM P-R 100 0.127300 0.127300 0.000000
43 N04BC BROMOCRIPTINUM BROCRIPTIN (N04BC01) DRAJ. 2,5mg BIOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 20 DRAJ. P-R 40 0.549000 0.549000 0.000000

Tratamentul se initiaza de catre medicul in specialitatea endocrinologie sau oncologie

Pagina 70 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
19. BOALA WILSON - G23

1 M01C PENICILLAMINUM**4) CUPRIPEN 250mg CAPS. 250mg CN UNIFARM S.A. ROMANIA FLACON X 30 CAPSULE PRF 30 1.362000 1.362000 0.000000

Tratamentul se iniiaz de ctre medicul din specialitatea endocrinologie, neurologie sau neurologie pediatric.

20. BOALA CRONICA DE RINICHI - faza predializa - G 25

1 B03A COMPLEX DE HIDROXID DE FER (II VENOFER (R) SOL. INJ./PERF. 20mg/ml VIFOR FRANCE S.A. FRANTA CUTIE X 5 FIOLE X 5 ML S/P-RF 5 31.080000 31.080000 0.000000
2 B03XA EPOETINUM ALFA** BINOCRIT 1000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 1000UI/0,5ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMP S/P-RF/R 6 21.785000 21.785000 0.000000
3 B03XA EPOETINUM ALFA** BINOCRIT 2000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/1,0ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMPLU S/P-RF/R 6 45.386666 45.386666 0.000000
4 B03XA EPOETINUM ALFA** BINOCRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,7 SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUM P-RF/R 1 488.460000 488.460000 0.000000
5 B03XA EPOETINUM ALFA** BINOCRIT 3000UI/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 3000UI/0,3ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMP S/P-RF/R 6 68.290000 68.290000 0.000000
6 B03XA EPOETINUM ALFA** EPREX 40000 UI/ml SOL. INJ. IN SERINGA PREUMPLUTA 40 000UI/ml JOHNSON & JOH SLOVENI CUTIE CU 1 SERINGA PREU S/P-RF 1 912.804000 912.804000 99.806000
7 B03XA EPOETINUM ALFA** BINOCRIT 40000 UI/1 ml SOL. INJ. IN SERINGA PREUMPLUTA 40000 UI/1 m SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPL P-RF/R 1 760.670000 760.670000 0.000000
8 B03XA EPOETINUM ALFA** BINOCRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMP S/P-RF/R 6 87.998333 87.998333 0.000000
9 B03XA EPOETINUM ALFA** BINOCRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMP S/P-RF/R 6 107.725000 107.725000 0.000000
10 B03XA EPOETINUM BETA** NEORECORMON 10000UI/0,6 SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/0,6m ROCHE REGISTRA MA CUTIE X 6 SERI S/P-RF/R 6 280.040000 280.040000 0.000000
11 B03XA EPOETINUM BETA** NEORECORMON 2000UI/0,3 SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,3ml ROCHE REGISTRA MA CUTIE X 6 SERI S/P-RF/R 6 59.898333 59.898333 0.000000
12 B03XA EPOETINUM BETA** NEORECORMON 30000UI/0,6 SOL. INJ. IN SERINGA PREUMPLUTA 30000 UI/0,6 ROCHE REGISTRA MA CUTIE X 1 SERINGA PRE-U S/P-RF/R 1 999.550000 999.550000 0.000000
13 B03XA EPOETINUM BETA** NEORECORMON 4000UI/0,3 SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,3ml ROCHE REGISTRA MA CUTIE X 6 SERI S/P-RF/R 6 108.236666 108.236666 0.000000
14 B03XA EPOETINUM BETA** NEORECORMON 5000UI/0,3 SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,3ml ROCHE REGISTRA MA CUTIE X 6 SERI S/P-RF/R 6 154.340000 154.340000 0.000000
15 B03XA EPOETINUM ZETA** RETACRIT 10000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/1,0m HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUMPL PR 1 228.050000 228.050000 0.000000
16 B03XA EPOETINUM ZETA** RETACRIT 2000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,6ml HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUMP PR 1 51.940000 51.940000 0.000000
17 B03XA EPOETINUM ZETA** RETACRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,7 HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUM PR 1 533.260000 533.260000 0.000000
18 B03XA EPOETINUM ZETA** RETACRIT 3000UI/0,9ml SOL. INJ. IN SERINGA PREUMPLUTA 3000UI/0,9ml HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUMP PR 1 73.980000 73.980000 0.000000
19 B03XA EPOETINUM ZETA** RETACRIT 40000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 40000UI/1,0m HOSPIRA UK LIMITE MA CUTIE X 1 SERINGA PREUMPL PR 1 693.880000 693.880000 0.000000
20 B03XA EPOETINUM ZETA** RETACRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml HOSPIRA UK LIMITE
MA CUTIE X 1 SERINGA PREUMP PR 1 98.650000 98.650000 0.000000
21 B03XA EPOETINUM ZETA** RETACRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml HOSPIRA UK LIMITE
MA CUTIE X 1 SERINGA PREUMP PR 1 123.300000 123.300000 0.000000
22 B03XA EPOETINUM ZETA** RETACRIT 6000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI/0,6ml HOSPIRA UK LIMITE
MA CUTIE X 1 SERINGA PREUMP PR 1 140.320000 140.320000 0.000000
23 B03XA EPOETINUM ZETA** RETACRIT 8000UI/0,8ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI/0,8ml HOSPIRA UK LIMITE
MA CUTIE X 1 SERINGA PREUMP PR 1 196.010000 196.010000 0.000000
24 B03XA DARBEPOETINUM ALFA** ARANESP 100mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 100mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 647.495000 647.495000 0.000000
25 B03XA DARBEPOETINUM ALFA** ARANESP 10mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 10mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 78.342500 78.342500 0.000000
26 B03XA DARBEPOETINUM ALFA** ARANESP 150mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 150mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 962.400000 962.400000 0.000000
27 B03XA DARBEPOETINUM ALFA** ARANESP 20mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 20mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 143.647500 143.647500 0.000000
28 B03XA DARBEPOETINUM ALFA** ARANESP 300mcg/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 300mcg/0,6ml AMGEN EUROPE BV OLANDA CUTIE X 1 SERINGA PREUMPL P-RF/R 1 ,960.260000 1,960.260000 0.000000
29 B03XA DARBEPOETINUM ALFA** ARANESP 30mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 30mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 206.655000 206.655000 0.000000
30 B03XA DARBEPOETINUM ALFA** ARANESP 40mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 40mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 269.612500 269.612500 0.000000
31 B03XA DARBEPOETINUM ALFA** ARANESP 500mcg/ml SOL. INJ. IN SERINGA PREUMPLUTA 500mcg/ml AMGEN EUROPE BV OLANDA CUTIE X 1 SERINGA PREUMPLU P-RF/R 1 ,219.860000 3,219.860000 0.000000
32 B03XA DARBEPOETINUM ALFA** ARANESP 50mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 50mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 321.740000 321.740000 0.000000
33 B03XA DARBEPOETINUM ALFA** ARANESP 60mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 60mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 395.560000 395.560000 0.000000
34 B03XA DARBEPOETINUM ALFA** ARANESP 80mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 80mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLU P-RF/R 4 521.557500 521.557500 0.000000
35 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 100mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 100mcg/0,3ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUM S/P-RF/R 1 778.610000 778.610000 0.000000
36 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 120mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 120mcg/0,3ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUM S/P-RF/R 1 930.390000 930.390000 0.000000
37 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 150mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 150mcg/0,3ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUM S/P-RF/R 1 ,132.460000 1,132.460000 0.000000
38 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 200mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 200mcg/0,3ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUM S/P-RF/R 1 ,486.320000 1,486.320000 0.000000
39 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 250mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 250mcg/0,3ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUM S/P-RF/R 1 ,861.580000 1,861.580000 0.000000
40 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 30mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 30mcg/0,3ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUM S/P-RF/R 1 264.720000 264.720000 0.000000
41 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 360mcg/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 360mcg/0,6ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUMP S/P-RF/R 1 ,768.720000 2,768.720000 0.000000

Pagina 71 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
42 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 50 mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 50 mcg/0,3ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUM S/P-RF/R 1 424.740000 424.740000 0.000000
43 B03XA METOXI-POLIETILENGLICOL EPOETI MIRCERA 75mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 75mcg/0,3ml ROCHE REGISTRA MA CUTIE X 1 SERINGA PREUM S/P-RF/R 1 601.690000 601.690000 0.000000
44 C09CA IRBESARTANUM** IRBESARTAN AUROBINDO 1 COMPR. 150mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PVDC/AL X P6L 28 0.359199 0.359199 0.009372
45 C09CA IRBESARTANUM** IRBESARTAN AUROBINDO 3 COMPR. 300mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PVDC/AL X P6L 28 0.516071 0.516071 0.000000
46 C09CA IRBESARTANUM** IRBESARTAN GALENICA 15 COMPR. FILM. 150 mg GALENICA S.A. GRECIA CUTIE CU BLIST. P6L 28 0.359199 0.359199 0.009372
47 C09CA IRBESARTANUM** APROVEL 150mg COMPR. FILM. 150mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X BLIST PVC/PVDC/AL X P-6 28 0.359199 0.359199 0.846515
48 C09CA IRBESARTANUM** IRBESARTAN TERAPIA 150 COMPR. FILM. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-P P-6 28 0.359199 0.359199 0.424372
49 C09CA IRBESARTANUM** IRBESARTAN SANDOZ 150 m COMPR. FILM. 150mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 28 0.359199 0.359199 0.257586
50 C09CA IRBESARTANUM** IRPRESTAN 150 mg COMPR. FILM. 150mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. PVC-PVDC P-6 30 0.299333 0.299333 0.000000
51 C09CA IRBESARTANUM** IFIRMASTA 150 mg COMPR. FILM. 150mg KRKA ,D.D., NOV SLOVENI CUTIE X BLIST. PVC/PE/PV P-6 28 0.359199 0.359199 0.178301
52 C09CA IRBESARTANUM** IRBESARTAN TEVA 150 mg COMPR. FILM. 150mg TEVA PHARMA B.V. OLANDA CUTIE X BLIST. PVC/PVDC/AL P-6 28 0.359199 0.359199 0.238301
53 C09CA IRBESARTANUM** ATOKKEN 150 mg COMPR. FILM. 150mg ROMASTRU TRAD ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 0.359199 0.359199 0.424372
54 C09CA IRBESARTANUM** IRBESARTAN ZENTIVA 150m COMPR. FILM. 150mg SANOFI-AVENTIS FRANTA CUTIE X 28 COMPR. FILM. (BLI P-6 28 0.359199 0.359199 0.208301
55 C09CA IRBESARTANUM** IRBESARTAN HF 150 mg COMPR. FILM. 150mg STADA HEMOFARM S ROMANIA CUTIE CU BLIST. PVC-PVDC P6L 30 0.359199 0.359199 0.400801
56 C09CA IRBESARTANUM** APROVEL 150mg COMPR. FILM. 150mg SANOFI CLIR SNC FRANTA CUTIE X BLIST PVC/PVDC/AL X P-6 28 0.359199 0.359199 0.846515
57 C09CA IRBESARTANUM** ATOKKEN 150 mg COMPR. FILM. 150mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 0.359199 0.359199 0.424372
58 C09CA IRBESARTANUM** IRBESARTAN TEVA 300 mg COMPR. FILM. 300 mg TEVA PHARMA B.V. OLANDA CUTIE X BLIST. PVC/PVDC/AL P-6 28 0.619285 0.619285 0.192857
59 C09CA IRBESARTANUM** IRBESARTAN GALENICA 30 COMPR. FILM. 300 mg GALENICA S.A. GRECIA CUTIE CU BLIST. P6L 28 0.576785 0.576785 0.000000
60 C09CA IRBESARTANUM** APROVEL 300mg COMPR. FILM. 300mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X BLIST PVC/PVDC/AL X P-6 28 0.619285 0.619285 0.981429
61 C09CA IRBESARTANUM** IRBESARTAN TERAPIA 300 COMPR. FILM. 300mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-P P-6 28 0.619285 0.619285 0.456072
62 C09CA IRBESARTANUM** IRBESARTAN SANDOZ 300 m COMPR. FILM. 300mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-P P-6 28 0.619285 0.619285 0.183215
63 C09CA IRBESARTANUM** IFIRMASTA 300mg COMPR. FILM. 300mg KRKA ,D.D., NOV SLOVENI CUTIE X BLIST. PVC/PE/PV P-6 28 0.619285 0.619285 0.244286
64 C09CA IRBESARTANUM** ATOKKEN 300 mg COMPR. FILM. 300mg ROMASTRU TRAD ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 0.619285 0.619285 0.456072
65 C09CA IRBESARTANUM** IRBESARTAN ZENTIVA 300m COMPR. FILM. 300mg SANOFI-AVENTIS FRANTA CUTIE X 28 COMPR. FILM. (BLI P-6 28 0.619285 0.619285 0.267857
66 C09CA IRBESARTANUM** IRBESARTAN HF 300 mg COMPR. FILM. 300mg STADA HEMOFARM S ROMANIA CUTIE CU BLIST. PVC-PVDC P6L 30 0.619285 0.619285 0.416715
67 C09CA IRBESARTANUM** APROVEL 300mg COMPR. FILM. 300mg SANOFI CLIR SNC FRANTA CUTIE X BLIST PVC/PVDC/AL X P-6 28 0.619285 0.619285 0.981429
68 C09CA IRBESARTANUM** ATOKKEN 300 mg COMPR. FILM. 300mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 0.619285 0.619285 0.456072
69 C09CA IRBESARTANUM** ATOKKEN 75 mg COMPR. FILM. 75mg NEOLA PHARMA S.R. ROMANIA CUTIE CU 2 BLIST. PVC-PV P6L 28 0.856428 0.856428 0.000000
70 H02A PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.108399 0.108399 0.028601
71 H02A PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.090333 0.090333 0.000000
72 H02A PREDNISONUM PREDNISON 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.108399 0.108399 0.015267
73 H02A PREDNISONUM PREDNISON - RICHTER 5 mg COMPR. 5mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COM P-R 20 0.108399 0.108399 0.025101
74 H05BX PARICALCITOLUM** ZEMPLAR 1g CAPS. MOI 1g ABBVIE FARMAC SPANIA CUTIE X 4 BLIST. P P-R 28 10.363571 10.363571 0.000000
75 H05BX PARICALCITOLUM** ZEMPLAR 2g CAPS. MOI 2g ABBVIE FARMAC SPANIA CUTIE X 4 BLIST. PVC/F P-R 28 17.300357 17.300357 0.000000
76 H05BX PARICALCITOLUM** PARICALCITOL FRES SOL INJ. 2micrograme FRESENIUS MEDICAL CARE DEUTSCHLAND GMBH GERMANI CUTIE CU 5 FIOLE DIN STICLA INCOLORA CU CAPACITATEA DE 2 ML X 1 ML SOL. INJ. PR 5 13.302000 13.302000 0.000000
77 H05BX PARICALCITOLUM** PARICALCITOL FRES SOL INJ. 5micrograme FRESENIUS MEDICAL CARE DEUTSCHLAND GMBH GERMANI CUTIE CU 5 FIOLE DIN STICLA INCOLORA CU CAPACITATEA DE 2 ML X 1 ML SOL. INJ. PR 5 26.916000 26.916000 0.000000
78 H05BX PARICALCITOLUM** ZEMPLAR SOL. INJ. 5 g/ml ABBVIE FARMAC SPANIA CUTIE X 5 FIOLE X 1 ML SOL. INJ. S 5 32.299200 32.299200 15.386800
79 L01AA CYCLOPHOSPHAMIDUM ENDOXAN (R) 50 mg DRAJ. 50mg BAXTER ONCOLO GERMANI CUTIE X 5 BLIST. PVC-PVDC/AL X P-R 50 0.542400 0.542400 0.000000
80 L04AD CICLOSPORINUM EQUORAL 100 mg CAPS. MOI 100mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 6.232400 6.232400 0.000000
81 L04AD CICLOSPORINUM SANDIMMUN NEORAL (R) CAPS. MOI 25mg NOVARTIS PHARM GERMANI CUTIE X 10 BLIST. X 5 CAPS. MOI S/P-RF 50 1.784400 1.784400 0.574000
82 L04AD CICLOSPORINUM EQUORAL 25 mg CAPS. MOI 25mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 1.487000 1.487000 0.000000
83 L04AD CICLOSPORINUM SANDIMMUN NEORAL (R) CAPS. MOI 50mg NOVARTIS PHARM GERMANI CUTIE X 10 BLIST. X 5 CAPS. MOI S/P-RF 50 3.040560 3.040560 0.788040
84 L04AD CICLOSPORINUM EQUORAL 50 mg CAPS. MOI 50mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 2.533800 2.533800 0.000000
85 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN EUROPE GM GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
86 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN P IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
87 L04AX AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEW AUSTRIA CUTIE CU 1 FLAC. PEID X 100 C PR 100 0.788900 0.788900 0.000000
88 V06D COMBINATII (AMINOACIZI)** KETOSTERIL COMPR. FILM. FAR FRESENIUS KABI DEUTSCHLAND GMBH GERMANI CUTIE X 5 BLIST. DIN PVC/AL P-R 100 2.272200 2.272200 0.000000

Tratamentul se initiaza de catre medicul in specialitatea nefrologie.

Pagina 72 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)

21. GLAUCOM - G 26

1 S01E DORZOLAMIDUM DORZOPT 20 mg/ml PIC. OFT., SOL 20mg/ml ROMPHARM COM ROMANIA CUTIE X 1 FLAC. PEJD X 5 ML PIC P-R 1 14.530000 14.530000 0.000000
2 S01E DORZOLAMIDUM TRUSOPT SOL. OFT. 20mg/ml MERCK SHARP & ROMANIA CUTIE X 1 FL P-6 1 17.436000 17.436000 4.904000
3 S01E BRINZOLAMIDUM AZOPT 10mg/ml PICATURI OFT.- 10mg/ml ALCON LABORATO MA CUTIE X 1 FLACON, PEJD X 5 ML P-6 1 44.870000 44.870000 0.000000
4 S01E TIMOLOLUM TIMOLOL ROMPHARM 0,25% PIC. OFT., SOL. 2,5mg/ml ROMPHARM COM ROMANIA CUTIE X 1 FLAC. PICURATOR DIN PEID X 5 ML PIC. OFTALMICE, SOL. P-6 1 3.110000 3.110000 0.000000
5 S01E TIMOLOLUM TIMOLOL ROMPHARM 0,5% PIC. OFT.,SOL. 5mg/ml ROMPHARM COM ROMANIA CUTIE X 1 FLAC. PICURATOR DIN PEID X 5 ML PIC. OFTALMICE, SOL. P-6 1 4.980000 4.980000 0.000000
6 S01E TIMOLOLUM TIMOLOL 0,25% PICATURI OFT.- 0,25% E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLACO P-6 1 3.130000 3.130000 0.000000
7 S01E TIMOLOLUM TIMOLOL 0,5% PICATURI OFT.- 0,5% E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 FLACON CU PICURATOR P-6 1 5.300000 5.300000 0.000000
8 S01E BETAXOLOLUM BETAX PIC. OFT.-SOL. 5mg/ml ROMPHARM SRL ROMANIA CUTIE X 1 FLACON P-6 1 5.320000 5.320000 0.000000
9 S01E BETAXOLOLUM BETOPTIC PIC.OFTALMICE 5mg/ml ALCON COUVREUR BELGIA CUTIE X 1 FLACON DIN PEJD PREV. CU PICURATOR X 5 ML PIC.OFTALMICE, SOL. P-6 1 6.384000 6.384000 6.436000
10 S01E BETAXOLOLUM BETOPTIC - S PICATURI OFT.- 0,25% ALCON COUVREUR BELGIA CUTIE X 1 FLACON DIN PEJD P-6 1 15.330000 15.330000 0.000000
11 S01E CARTEOLOLUM FORTINOL EP 2% P 20mg/ml DR. GERHARD MANN CHEM.PHARM.FABRIK GMBH GERMANI CUTIE P-6 1 10.890000 10.890000 0.000000
12 S01E COMBINATII ( BRINZOLAMIDUM + T AZARGA PIC. OFT. SUSP. 10mg/ml+5 ALCON LAB MA CUTIE X 1 FLAC. X 5 ML SUSP. OFT. P-R 1 58.030000 58.030000 0.000000
13 S01E COMBINATII (BIMATOPROSTUM + T GANFORT PIC. OFT.,SOL. 300mcg/ ALLERGAN PHARMACEUTICALS IRELAND IRLANDA CUTIE X 1 FLAC. DIN PEJD X 3 P-R 1 69.360000 69.360000 0.000000
14 S01E COMBINATII (DORZOLAMIDUM+TIMO SIFIOPT 20 mg/5 mg/ml PIC. OFT., SOL. 20mg/5mg/ml OFTAFARMA ROM ROMANIA CUTIE CU 1 FLAC. PE ALB, OPAC +PICURATOR PEID A 5 ML PIC. OFT. SOL. PRF 1 26.430000 26.430000 0.000000
15 S01E COMBINATII (DORZOLAMIDUM+TIMO COSOPT PIC. OFT.-SOL. 20mg/ml+5 MERCK SHARP & ROMANIA CUTIE P-6 1 31.716000 31.716000 7.634000
16 S01E COMBINATII (LATANOPROSTUM+TIM GLAUTAN PLUS 50 mic PIC. OFT., SOL 50 micrograme/ml + 5 mg/ml ROMPHARM COM ROMANIA CUTIE X 1 FLACON DIN PEJD CU PICURATOR DIN PEJD INCHIS CU CAPAC DIN PEID X 2.5ML PICATURI OFTALMICE-
P6L 1 29.000000 29.000000 0.000000
17 S01E COMBINATII (LATANOPROSTUM+TIM PIC. OFT., SOL 50micrograme/ml+5mg/ml STADA HEMOFARM S
LATANOPROST/TIMOLOL STADA HEMOFARM 50 micrograme/ml si 5 mg/ml ROMANIA CUTIE CU 1 FLAC. TRANSPARENT PEJD + PICURATOR TRANSPARENT PEJD X 2,5 ML PIC. OFT., SOL. P6L 1 29.000000 29.000000 0.000000
18 S01E COMBINATII (LATANOPROSTUM+TIM XALCOM (R) SOL. OFT. 50mcg/ml+ PFIZER EUROPE M MA CUTIE X 1 FLACON X 2,5 ML P-6 1 34.800000 34.800000 8.370000
19 S01E COMBINATII (TRAVOPROSTUM+TIMO DUOTRAV 40mcg/ml + 5mg/ml PIC. OFT.-SOL. 40mcg/ml ALCON LAB MA CUTIE X 1 FLAC. D P-R 1 62.810000 62.810000 0.000000
20 S01EE LATANOPROSTUM SIFITAN 50 micrograme/ml PIC. OFT., SOL 50microgra NTC S.R.L. ITALIA CUTIE CU 1 FLAC. PEJD X 2,5 M P6L 1 25.150000 25.150000 0.000000
21 S01EE LATANOPROSTUM LATANOPROST STADA PIC. OFT., SOL. 50 microgr STADA HEMOFARM S ROMANIA CUTIE CU 1 FLAC. DIN PEJD CU CAPAC DIN PEID X 2,5 ML PIC. OFT. PT. APROX. 80 PIC. SOL. P6L 1 25.150000 25.150000 0.000000
22 S01EE LATANOPROSTUM MONOPOST 50 micrograme/m PIC. OFT., SOL., IN RECIPIENT UNIDOZA 50microgra LABORATOIRES THE FRANTA CUTIE CU 30 (6X5) RECIPIENTE UNIDOZA DIN PEID AMBALATE CATE 5 IN 6 PLICURI LAMINATE DIN PE-AL-COPOLIMER A CATE 0,2 MILILITRI PIC. OFT., SOL.
P6L 30 1.874000 1.874000 0.000000
23 S01EE LATANOPROSTUM GLAUTAN 0,05 mg/ml PIC. OFT.,SOL. 0,05mg/ml ROMPHARM COM ROMANIA CUTIE CU 1 FLAC. PEJD CU CAPACITATEA DE 5 ML+PICURATOR DIN PEJD, CU CAPAC DE SIGURANTA DIN PEJD X 2,5 ML PIC. OFT., SOL.
P6L 1 25.150000 25.150000 0.000000
24 S01EE LATANOPROSTUM XALATAN (R) PICATURI OFT.- 50mcg/ml PFIZER EUROPE M MA CUTIE X 1 FLACON PICURATOR PE P-6 1 30.180000 30.180000 7.260000
25 S01EE BIMATOPROSTUM BIMAGAN 0,3 mg/ml PIC. OFT., SOL 0,3 mg/ml ROMPHARM COM ROMANIA CUTIE X 1 FLACON ALB DIN PEJD CU PICURATOR DIN PEJD SI CAPAC CU INEL DE SIGURANTA DIN PEID X 3ML PICATURI OFTALMICE , SOLUTIE PRF 1 42.800000 42.800000 0.000000
26 S01EE BIMATOPROSTUM BIMAGAN 0,1 mg/ml PIC. OFT., SOL. 0,1mg/ml ROMPHARM COM ROMANIA CUTIE CU UN FLACON DIN PEJD CU PICURATOR DIN PEJD SI CAPAC VERDE- ALBASTRUI DIN PED A 3 ML PICATURI OFTALMICE, SOLUTIE PRF 1 50.970000 50.970000 0.000000
27 S01EE BIMATOPROSTUM LUMIGAN 0,1mg/ml PIC. OFT.,SOL. 0,1mg/ml ALLERGAN PHARMACEUTICALS IRELAND IRLANDA CUTIE X 1 FLAC. DIN PEJD X 3 P-R 1 61.164000 61.164000 13.296000
28 S01EE TRAVOPROSTUM IZBA PIC. OFT., SOL 30mcg/ml ALCON LAB MA CUTIE X 1 FLACON PRF 1 87.630000 87.630000 0.000000
29 S01EE TRAVOPROSTUM BONDULC 40 micrograme/ml PIC. OFT., SOL. 40microgra ACTAVIS GROUP P ISLANDA CUTIE CU 1 FLAC. TRANSLUCID DIN PP CU CAPACITATEA DE 5 ML, PREVAZUT CU DOP PICURATOR TRANSPARENT DIN PEJD SI CAPAC DIN PEID A 2,5 ML PIC. OFT., SOL.
P6L 1 33.440000 33.440000 0.000000
30 S01EE TRAVOPROSTUM TRAVOPROST ZENTIVA PIC. OFT., SOL. 40microgra ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. TRANSLUCID DIN PP CU CAPACITATEA DE 5 ML, CU PICURATOR TRANSPARENT DIN PEJD A 2 ,5 ML PIC. OFT. SOL.
P6L 1 36.290000 36.290000 0.000000
31 S01EE TRAVOPROSTUM TRAVATAN 40mcg/ml PICATURI OFT.S 40mcg/ml ALCON LABORATO MA CUTIE X 1 FLACON X 2,5 ML P-6 1 40.128000 40.128000 15.712000

Tratamentul se iniiaz de ctre medicul n specialitatea oftalmologie.

22. PEMFIGUS - G 27

1 H02A DEXAMETHASONUM DEXAMED COMPR. 0,5mg CN UNIFARM S.A. ROMANIA CUTIE CU 10 BLISTERE X 10 CO PRF 100 0.190800 0.190800 0.000000
2 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU UN SUPORT CU 10 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 10 0.832000 0.832000 0.000000
3 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU UN SUPORT CU 25 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 25 0.816800 0.816800 0.000000
4 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU 100 FIOLE D PRF 100 0.736400 0.736400 0.000000
5 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU UN SUPORT CU 10 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. PRF 10 1.387000 1.387000 0.000000
6 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU 25 FIOLE PRF 25 1.327200 1.327200 0.000000
7 H02A DEXAMETHASONUM DEXAMETAZONA ROMPHA SOL. INJ. 4mg/ml ROMPHARM COM ROMANIA CUTIE CU 100 FIOLE D PRF 100 1.246200 1.246200 0.000000
8 H02A DEXAMETHASONUM DEXAMETHASONE SO SOL. INJ. 8mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 100 FIOLE DIN P-R 100 1.256100 1.256100 0.000000
9 H02A DEXAMETHASONUM DEXAMETHASONE SO SOL. INJ. 8mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 5 FIOLE DIN STIC P-R 5 1.380000 1.380000 0.000000
10 H02A DEXAMETHASONUM DEXAMED SOL. INJ. 8mg/2ml MEDOCHEMIE LTD. CIPRU CUTIE X 10 FIOLE DIN ST P-R 10 1.425000 1.425000 0.000000

Pagina 73 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
11 H02A METHYLPREDNISOLONUM MEDROL A 16 COMPR. 16mg PFIZER EUROPE M MA CUTIE X 5 BLIST. A-PVC/PVC X 1 P-R 50 0.543200 0.543200 0.000000
12 H02A METHYLPREDNISOLONUM MEDROL 32 COMPR. 32mg PFIZER EUROPE M MA CUTIE X 2 BLIST. AL-PVC/PVC X P-R 20 1.234000 1.234000 0.000000
13 H02A METHYLPREDNISOLONUM SOLU - MEDROL ACT-O-VIAL LIOF. SI SOL 250mg/4ml PFIZER EUROPE M MA CUTIE X 1 FLAC. BICOMPARTIMENTAT (COMPARTIMENT INFERIOR) LIOF. PT. SOL. INJ. + (COMPARTIMENT SUPERIOR) 4ML SOLV P-R 1 20.480000 20.480000 0.000000
14 H02A METHYLPREDNISOLONUM LEMOD SOLU 125 mg P 125mg STADA HEMOFARM S ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOL S/P-RF 1 8.810000 8.810000 0.000000
15 H02A METHYLPREDNISOLONUM LEMOD SOLU 500 mg P 500mg STADA HEMOFARM S ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOL S/P-RF 1 31.020000 31.020000 0.000000
16 H02A PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COM P-R 20 0.108399 0.108399 0.028601
17 H02A PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.090333 0.090333 0.000000
18 H02A PREDNISONUM PREDNISON 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COM P-R 30 0.108399 0.108399 0.015267
19 H02A PREDNISONUM PREDNISON - RICHTER 5 mg COMPR. 5mg GEDEON R ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COM P-R 20 0.108399 0.108399 0.025101
20 J04BA DAPSONUM 4) DISULONE COMPR. 100mg CN UNIFARM ROMANIA CUTIE X 100 COMPR. P-R 100 0.489700 0.489700 0.000000
21 L01AA CYCLOPHOSPHAMIDUM ENDOXAN (R) 50 mg DRAJ. 50mg BAXTER ONCOLO GERMANI CUTIE X 5 BLIST. PVC-PVDC/AL X P-R 50 0.542400 0.542400 0.000000
22 L01AA CYCLOPHOSPHAMIDUM ENDOXAN 200 mg PULB. P 200mg ACTAVIS S.R.L. ROMANIA CUTIE X 1 FLAC. PULB. PT. SOL. S 1 15.890000 15.890000 0.000000
23 L01BA METHOTREXATUM METHOTREXAT "EBEWE" 5 CONC. PT. 100mg/ml EBEW AUSTRIA CUTIE X 1 FLACON X 50 ML S 1 374.090000 374.090000 0.000000
24 L01BA METHOTREXATUM METHOTREXAT "EBEWE" 1 CONC. PT. 100mg/ml EBEW AUSTRIA CUTIE X 1 TUB DIN M S 1 82.990000 82.990000 0.000000
25 L01BA METHOTREXATUM BENDATREXAT SOL INJ. 25mg/ml CN UNIFARM S.A. ROMANIA CUTIE CU 1 FLAC. X 2 ML PR 1 64.090000 64.090000 0.000000
26 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 0,75 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJ PR 1 61.880000 61.880000 0.000000
27 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 2,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE
PR 1 118.008000 118.008000 9.082000
28 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE PR 1 46.730000 46.730000 0.000000
29 L01BA METHOTREXATUM METOTREXAT EBEWE 10 mg SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEW AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,5 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE PR 1 79.700000 79.700000 0.000000
30 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,40ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 98.340000 98.340000 0.000000
31 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,20ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 56.076000 56.076000 13.944000
32 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0,50ML SOL. INJ. PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 110.680000 110.680000 0.000000
33 L01BA METHOTREXATUM METOJECT 50mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 50mg/ml MEDAC GESELLSCAFT FUR KLINISCHE SPEZIALPRPARATE GERMANI CUTIE X 1 SERINGA PREUMPLUTA X 0.30ML SOLUTIA INJECTABILA PREVAZUTA CU AC SI TAMPOANE CU ALCOOL P-R 1 74.880000 74.880000 0.000000
34 L04AD CICLOSPORINUM EQUORAL 100 mg CAPS. MOI 100mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 6.232400 6.232400 0.000000
35 L04AD CICLOSPORINUM SANDIMMUN NEORAL (R) CAPS. MOI 25mg NOVARTIS PHARM GERMANI CUTIE X 10 BLIST. X 5 CAPS. MOI S/P-RF 50 1.784400 1.784400 0.574000
36 L04AD CICLOSPORINUM EQUORAL 25 mg CAPS. MOI 25mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 1.487000 1.487000 0.000000
37 L04AD CICLOSPORINUM SANDIMMUN NEORAL (R) CAPS. MOI 50mg NOVARTIS PHARM GERMANI CUTIE X 10 BLIST. X 5 CAPS. MOI S/P-RF 50 3.040560 3.040560 0.788040
38 L04AD CICLOSPORINUM EQUORAL 50 mg CAPS. MOI 50mg TEVA CZECH CEHIA CUTIE X 5 BLIST. X 10 CAPS. MOI S/P-RF 50 2.533800 2.533800 0.000000
39 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN EUROPE GM GERMANI CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
40 L04AX AZATHIOPRINUM IMURAN COMPR. FILM. 50mg ASPEN P IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 CO S/P-RF 100 0.702300 0.702300 0.000000
41 L04AX AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEW AUSTRIA CUTIE CU 1 FLAC. PEID X 100 C PR 100 0.788900 0.788900 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea dermatologie.

23. BOALA GAUCHER - G 29

1 A16AB IMIGLUCERASUM**** CEREZYME 400U PUL 400U GENZYME EUROPE OLANDA CUTIE X 1 FLAC. PULB. PT. C PR 1 ,149.520000 6,149.520000 0.000000

Dup precizarea diagnosticului de ctre laboratoarele de specialitate, tratamentul se iniiaz de ctre medicul din specialitatea gastroenterologie, hematologie, neurologie, neurologie pediatric i pediatrie.

24. BOLI VENERICE (SIFILIS, GONOREE, INFECTIA CU CHLAMIDIA) - G 30

1 J01AA DOXYCYCLINUM DOXICICLINA ATB 100 mg CAPS. 100 mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAP PRF 10 0.416000 0.416000 0.000000
2 J01AA DOXYCYCLINUM DOXICICLINA ARENA CAPS. 100mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS P-R 20 0.363000 0.363000 0.000000
3 J01AA DOXYCYCLINUM DOXICICLINA SANDOZ 100 m CAPS. 100mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS P-R 10 0.361000 0.361000 0.000000
4 J01AA TETRACYCLINUM TETRACICLINA ARENA 250 CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST., AL/PVC X 10 CAPS P-R 20 0.155000 0.155000 0.000000
5 J01AA TETRACYCLINUM TETRACICLINA ATB 250 mg CAPS. 250mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAP PRF 20 0.186000 0.186000 0.150000

Pagina 74 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
6 J01CE BENZYLPENICILLINUM PENICILINA G SODICA PULB. PT. SOL. I 1 000 000ui ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN S P-RF/S 100 4.141700 4.141700 0.000000
7 J01CE BENZYLPENICILLINUM PENICILINA G SODICA PULB. PT. SOL. I 1 000 000ui ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. DIN STICL P-R 1 4.850000 4.850000 0.000000
8 J01CE BENZYLPENICILLINUM PENICILINA G POTASICA PULB. PT. SOL. I 1000000ui ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. DIN STICL P-R 1 4.840000 4.840000 0.000000
9 J01CE BENZYLPENICILLINUM PENICILINA G POTASICA PULB. PT. SOL. I 1000000ui ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN S P-RF/S 100 4.141700 4.141700 0.000000
10 J01CE BENZYLPENICILLINUM PENICILINA G SODICA PULB. PT. SOL. I 400 000ui ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN S P-RF/S 100 2.848000 2.848000 0.000000
11 J01CE BENZYLPENICILLINUM PENICILINA G SODICA PULB. PT. SOL. I 400 000ui ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. DIN STICL P-R 1 3.270000 3.270000 0.000000
12 J01CE PHENOXYMETHYLPENICILLINUM OSPEN (R) 1000 COMPR. FILM. 1000000ui SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. AL/PVC- P-R 12 0.299166 0.299166 0.000000
13 J01CE PHENOXYMETHYLPENICILLINUM OSPEN 1500 COMPR. FILM. 1500000ui SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. AL/PVC-PVD P-R 12 0.527500 0.527500 0.000000
14 J01CE PHENOXYMETHYLPENICILLINUM OSPEN (R) 500 COMPR. FILM. 500000ui SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. AL/PVC- P-R 12 0.225833 0.225833 0.000000
15 J01CE PHENOXYMETHYLPENICILLINUM OSPEN 400.000 U.I./5 ml SUSP. ORALA 400.000U.I./ SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 60 ML SUSP. ORALA CU CAPAC SI LINGURITA DOZATOARE P-R 1 8.920000 8.920000 0.000000
16 J01CE BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. 1200000UI ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SUSP. INJ. I.M. P-R 1 5.590000 5.590000 0.000000
17 J01CE BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. 1200000UI ANTIBIOTICE S.A. ROMANIA CUTIE CU 100 FLAC. DIN STICLA INCOLORA CU PULB. PT. SUSP. INJ. I.M. S/P-RF 100 4.662700 4.662700 0.000000
18 J01DD CEFIXIMUM EFICEF 100 mg CAPS. 100mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAP PRF 10 2.237000 2.237000 0.000000
19 J01DD CEFIXIMUM EFICEF (R) 200 mg CAPS. 200mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS P-R 10 3.609000 3.609000 0.000000
20 J01DD CEFIXIMUM XIFIA 400mg COMPR. FILM. 400mg INN-FARM D.O.O. SLOVENI CUTIE CU PRF 5 10.020000 10.020000 0.000000
21 J01DD CEFIXIMUM XIFIA 400mg COMPR. FILM. 400mg INN-FARM D.O.O. SLOVENI CUTIE CU 2 BLISTERE PVC-PVDC/AL A CATE 5 COMPRIMATE FILMATE PRF 10 9.516000 9.516000 0.000000
22 J01FA0 ERYTHROMYCINUM ERITROMAGIS 200 mg COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.367500 0.367500 0.000000
23 J01FA0 ERYTHROMYCINUM ERITROMICINA 200 mg COMPR. 200mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.441000 0.441000 0.056500
24 J01FA0 ERYTHROMYCINUM ERITROMICINA COMPR. 200mg SANDOZ S.R.L. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.422000 0.422000 0.000000
25 J01FA0 ERYTHROMYCINUM ERITROMICINA ATB 200 mg COMPR. 200mg ANTIBIOTICE SA ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 C PRF 20 0.441000 0.441000 0.056500
26 J01FA1 AZITHROMYCINUM AZATRIL 250 mg CAPS. 250mg BALKANPHARM BULGARI CUTIE X 1 BLIST. AL/PVC X 6 CAPS. P-R 6 3.291666 3.291666 0.000000
27 J01FA1 AZITHROMYCINUM SUMAMED 250 mg CAPS. 250mg PLIVA LJUBLIJANA D SLOVENI CUTIE X 1 BLIST. PVC-PVDC/AL X P-R 6 3.949999 3.949999 1.116667
28 J01FA1 AZITHROMYCINUM SUMAMED 125 mg COMPR. FILM. 125mg PLIVA LJUBLJANA D SLOVENI CUTIE X 1 BLIST. AL/PVC X 6 COM P-R 6 4.146666 4.146666 0.000000
29 J01FA1 AZITHROMYCINUM AZITROMICINA SANDOZ 250 mg COMPRIMATE FILMATE COMPR. FILM. 250mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. X 6 COMPR. FILM. P-R 6 3.291666 3.291666 0.000000
30 J01FA1 AZITHROMYCINUM AZITROMICINA TERAPIA 25 COMPR. FILM. 250mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC-ACL P-R 6 3.291666 3.291666 0.000000
31 J01FA1 AZITHROMYCINUM AZITROMICINA TERAPIA 25 COMPR. FILM. 250mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/ P-R 6 3.291666 3.291666 0.000000
32 J01FA1 AZITHROMYCINUM AZIBIOT 250 mg COMPR. FILM. 250mg KRKA ,D.D., NOV SLOVENI CUTIE CU BLIST. PVC-PVDC/A PRF 6 3.291666 3.291666 0.000000
33 J01FA1 AZITHROMYCINUM SUMAMED 500 mg COMPR. FILM. 500mg PLIVA LJUBLJANA D SLOVENI CUTIE X 1 BLIST. AL/PVC X 3 COM P-R 3 4.875999 4.875999 3.707334
34 J01FA1 AZITHROMYCINUM AZITROMICINA SANDOZ 500 mg COMPRIMATE FILMATE COMPR. FILM. 500mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. X 3 COMPR. FILM. P-R 3 4.063333 4.063333 0.000000
35 J01FA1 AZITHROMYCINUM AZIBIOT 500 mg COMPR. FILM. 500mg KRKA D.D. NOVO M SLOVENI CUTIE X 1 BLIST. AL/PVC X 3 COM P-R 3 4.875999 4.875999 0.440667
36 J01FA1 AZITHROMYCINUM AZITROMICINA TERAPIA 50 COMPR. FILM. 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC-ACL P-R 3 4.875999 4.875999 0.700667
37 J01FA1 AZITHROMYCINUM AZITROMICINA TERAPIA 50 COMPR. FILM. 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/ P-R 3 4.875999 4.875999 0.700667
38 J01FA1 AZITHROMYCINUM AZITROX (R) 500 COMPR. FILM. 500mg ZENTIVA K.S. CEHIA CUTIE X 1 BLIST. AL/PVC X 3 COM P-R 3 4.875999 4.875999 0.700667
39 J01FA1 AZITHROMYCINUM AZATRIL 500 mg COMPR. FILM. 500mg ACTAVIS GROUP P ISLANDA CUTIE CU BLIST. OPA-PVC-A PRF 3 4.875999 4.875999 0.254001
40 J01FA1 AZITHROMYCINUM AZITROMICINA ARENA 500 m COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 3 C PRF 3 4.875999 4.875999 0.700667
41 J01FA1 AZITHROMYCINUM AZITROMICINA TERAPIA 60 COMPR. FILM. 600mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC-ACL P-R 3 15.426666 15.426666 0.000000
42 J01FA1 AZITHROMYCINUM AZITROMICINA TERAPIA 60 COMPR. FILM. 600mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/ P-R 3 15.426666 15.426666 0.000000
43 J01FA1 AZITHROMYCINUM AZITROX 200 mg/5 ml PULB. + 200mg/5ml ZENTIVA S.A. ROMANIA CUTIE X 1 FLACON DIN PE CU PULBERE PENTRU 15ML SUSPENSIE ORALA RECONSTITUITA + FLACON CU SOLVENT X 7.5ML SOLVENT + 1 SERINGA PENTRU ADMINISTRAREA ORALA + O LINGURITA DOZATOARE
P-R 1 14.470000 14.470000 0.000000
44 J01FA1 AZITHROMYCINUM AZITROMICINA SANDOZ 10 PULB. PT. SU 100mg/5ml SANDOZ SRL ROMANIA CUTIE CU 1 FLAC. PEID + 1 SERINGA DOZATOARE DIN PE/PP (10 ML) GRADATA IN DIVIZIUNI DE 0,25 ML CONTINAND PULB. PT 20 ML (400 MG) SUSP. ORALA P-R 1 19.340000 19.340000 0.000000
45 J01FA1 AZITHROMYCINUM AZITROMICINA SANDOZ 20 PULB. PT. SU 200 mg/5 ml SANDOZ SRL ROMANIA CUTIE CU 1 FLAC. PEID + 1 SERINGA DOZATOARE DIN PE/PP (10 ML) GRADATA IN DIVIZIUNI DE 0,25 ML CONTINAND PULB. PT 20 ML (800 MG) SUSP. ORALA P-R 1 19.290000 19.290000 0.000000
46 J01FA1 AZITHROMYCINUM SUMAMED FORTE PULB. PT. SU 200mg/5ml PLIVA LJUBLIJANA D SLOVENI CUTIE X 1 FLAC. DIN PEID CU PULB. PT.15 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-R 1 17.364000 17.364000 4.896000
47 J01FA1 AZITHROMYCINUM SUMAMED FORTE PULB. PT. SU 200mg/5ml PLIVA LJUBLIJANA D SLOVENI CUTIE X 1 FLAC. DIN PEID CU PULB. PT. 30 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-R 1 39.680000 39.680000 0.000000
48 J01FA1 AZITHROMYCINUM SUMAMED FORTE PULB. PT. SU 200mg/5ml PLIVA LJUBLIJANA D SLOVENI CUTIE X 1 FLAC. DIN PEID CU PULB. PT. 37,5 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-R 1 60.360000 60.360000 0.000000
49 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 1 COMPR. FILM. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 3.871000 3.871000 0.000000
50 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 1 COMPR. FILM. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CO P-R 20 3.404000 3.404000 0.000000
51 J01MA CIPROFLOXACINUM CIPROCIN 250 mg COMPR. FILM. 250mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 BLIST. AL/PVC- P-R 10 0.683000 0.683000 0.000000
52 J01MA CIPROFLOXACINUM CIPRINOL 250 mg COMPR. FILM. 250mg KRKA D.D. NOVO M SLOVENI CUTIE X 1 BLIST. AL/PVC- P-R 10 0.707000 0.707000 0.000000
53 J01MA CIPROFLOXACINUM CIPROLEN (R) 250 mg COMPR. FILM. 250mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 0.683000 0.683000 0.000000
54 J01MA CIPROFLOXACINUM CUMINOL 250 mg COMPR. FILM. 250mg GEDEON R ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 0.709000 0.709000 0.000000
55 J01MA CIPROFLOXACINUM CIFRAN COMPR. FILM. 250mg RANBAXY UK LIMITE MA CUTIE X 1 BLIST. PVC/PVD P-R 10 0.720000 0.720000 0.000000

Pagina 75 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APPDET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
56 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 2 COMPR. FILM. 250mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 0.681000 0.681000 0.000000
57 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 2 COMPR. FILM. 250mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CO P-R 20 0.638000 0.638000 0.000000
58 J01MA CIPROFLOXACINUM CIPRINOL 500 mg COMPR. FILM. 500mg KRKA D.D. NOVO M SLOVENI CUTIE X 1 BLIST. AL/PVC- P-R 10 1.022400 1.022400 0.160600
59 J01MA CIPROFLOXACINUM CIPROCIN 500 mg COMPR. FILM. 500mg E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 1 BLIST. X 10 COMPR. FILM P-R 10 0.920000 0.920000 0.000000
60 J01MA CIPROFLOXACINUM CIPROLEN (R) 500 mg COMPR. FILM. 500mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 1.022400 1.022400 0.299600
61 J01MA CIPROFLOXACINUM CUMINOL 500 mg COMPR. FILM. 500mg GEDEON R ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 1.022400 1.022400 0.348600
62 J01MA CIPROFLOXACINUM CIFRAN COMPR. FILM. 500mg RANBAXY UK LIMITE MA CUTIE X 1 BLIST. PVC/PVD P-R 10 0.911000 0.911000 0.000000
63 J01MA CIPROFLOXACINUM CIPRO QUIN (R) COMPR. FILM. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 1.022400 1.022400 0.348600
64 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 0.957000 0.957000 0.000000
65 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CO P-R 20 0.852000 0.852000 0.000000
66 J01MA CIPROFLOXACINUM CIPRINOL 750 mg COMPR. FILM. 750mg KRKA D.D. NOVO M SLOVENI CUTIE X 1 BLIST. AL/PVC- P-R 10 1.031000 1.031000 0.000000
67 J01MA CIPROFLOXACINUM CIPROFLOXACINA ARENA 7 COMPR. FILM. 750mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CO P-R 10 1.237200 1.237200 2.633800
68 J01MA CIPROFLOXACINUM CIPROBAY XR 1000 mg COMPR. FI 1000 mg BAYER PHARMA AG GERMANI CUTIE X 1 BLIST. DI P-R 7 12.554285 12.554285 0.000000
69 J01MA CIPROFLOXACINUM CIPROBAY XR 500 mg COMPR. FI 500 mg BAYER PHARMA AG GERMANI CUTIE X 1 BLIST. DI P-R 3 1.022400 1.022400 8.530933
70 J01MA CIPROFLOXACINUM CIPRINOL (R) CONC. PT. SOL 100mg/10ml KRKA D.D. SLOVENI CUTIE X 50 FIOLE X 10 ML S 50 2.833800 2.833800 0.000000
71 J01MA CIPROFLOXACINUM CIPRINOL (R) CONC. PT. SOL 100mg/10ml KRKA D.D. SLOVENI CUTIE X 5 FIOLE X 10 ML S/P-RF 5 3.400560 3.400560 0.073440
72 J01MA CIPROFLOXACINUM CIPROFLOXACINA ZENTIV CONC. PT. SOL 100mg/10ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA PREVAZUTE CU INEL DE RUPERE X 10 ML S/P-RF 5 3.400560 3.400560 0.085440
73 J01MA CIPROFLOXACINUM CIPROFLOXACINA INFOM SOL. PERF. 2mg/ml INFOMED FLUIDS SR ROMANIA CUTIE X 10 PUNGI PVC PLASTIFI S 10 8.815000 8.815000 0.000000
74 J01MA CIPROFLOXACINUM CIPROFLOXACINA INFOM SOL. PERF. 2mg/ml INFOMED FLUIDS SR ROMANIA CUTIE X 10 PUNGI PVC PLASTIFI S 10 16.023000 16.023000 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea dermatologie i obstetric-ginecologie (pentru gonoree i infecia cu Chlamidia).

IMUNOSUPRESOARE SELECTIVE - G31


25. BOALA CRONICA INFLAMATORIE INTESTINALA - G31a

1 L04AB INFLIXIMABUM**** REMICADE 100 mg P 100mg JANSSEN BIOLOGIC OLANDA CUTIE X PR 3 ,902.410000 1,902.410000 0.000000
2 L04AB INFLIXIMABUM**** INFLECTRA 100 mg P 100mg HOSPIRA UK LIMITE MA CUTIE X PR 3 ,628.203333 1,628.203333 0.000000
3 L04AB INFLIXIMABUM**** REMSIMA 100mg P 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X PR 1 ,593.040000 1,593.040000 0.000000
4 L04AB ADALIMUMABUM**** HUMIRA 40 mg SOL. INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD. MA CUTIE X 2 BLIST. X 1 SERINGA PREUMPLUTA X 0,8 ML + 1 TAMPON CU ALCOOL P-RF/R 2 ,956.550000 1,956.550000 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea gastro-enterologie i medicin intern.

Pagina 76 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
26. POLIARTITRITA REUMATOIDA - G31b

1 L01XC RITUXIMABUM**** MABTHERA 100 mg CONC. PT. SOL 10mg/ml ROCHE REGISTRA MA CUTIE X 2 FLACOANE X 10 ML S 2 ,032.520000 1,032.520000 0.000000
2 L01XC RITUXIMABUM**** MABTHERA 500 mg CONC. PT. SOL 10mg/ml ROCHE REGISTRA MA CUTIE S 1 ,088.050000 5,088.050000 0.000000
3 L04AA ABATACEPTUM**** ORENCIA PUL 250mg BRISTOL-MYERS S MA CUTIE X 1 FLAC. X 250 MG PULB S 1 ,434.080000 1,434.080000 0.000000
4 L04AA ABATACEPTUM**** ORENCIA SOL INJ. IN SERINGA PRE-UMPLUTA 125mg/ml BRISTOL-MYERS S MA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA CU AC CU GARDA X 125 MG/ML SOL INJ. PR 4 983.055000 983.055000 0.000000
5 L04AB ETANERCEPTUM**** ENBREL 10mg de uz pediatric PULB+SOLV. 10mg PFIZER LIMITED MA CUTIE CU 4 FLACOANE CU PULBERE + 4 SERINGI PRE-UMPLUTE X 1ML APA + 4 ACE CU INJECTOARE DIN OTEL INOXIDABIL + 4 ADAPTOARE PENTRU FLACON + 8 TAMPOANE CU ALCOOL MEDICNAL
PR 4 209.250000 209.250000 0.000000
6 L04AB ETANERCEPTUM**** ENBREL 25mg PULB. + S 25mg PFIZER LIMITED MA CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 496.610000 496.610000 0.000000
7 L04AB ETANERCEPTUM**** ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 496.277500 496.277500 0.000000
8 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 975.780000 975.780000 0.000000
9 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 975.780000 975.780000 0.000000
10 L04AB INFLIXIMABUM**** REMICADE 100 mg P 100mg JANSSEN BIOLOGIC OLANDA CUTIE X PR 3 ,902.410000 1,902.410000 0.000000
11 L04AB INFLIXIMABUM**** INFLECTRA 100 mg P 100mg HOSPIRA UK LIMITE MA CUTIE X PR 3 ,628.203333 1,628.203333 0.000000
12 L04AB INFLIXIMABUM**** REMSIMA 100mg P 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X PR 1 ,593.040000 1,593.040000 0.000000
13 L04AB ADALIMUMABUM**** HUMIRA 40 mg SOL. INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD. MA CUTIE X 2 BLIST. X 1 SERINGA PREUMPLUTA X 0,8 ML + 1 TAMPON CU ALCOOL P-RF/R 2 ,956.550000 1,956.550000 0.000000
14 L04AB CERTOLIZUMAB PEGOL**** CIMZIA SOL. INJ. IN SERINGA PREUMPLUTA 200 mg UCB PHARMA SA BELGIA CUTIE X 2 SERINGI PREUMPLUTE DIN STICLA CU PISTON A 1 ML + 2 TAMPOANE CU ALCOOL P-RF/R 2 ,859.470000 1,859.470000 0.000000
15 L04AB GOLIMUMAB**** SIMPONI 50 mg SOL. 50mg/0,5ml JANSSEN BIOLOGIC OLANDA CUTIE X 1 STILOU I PR 1 ,988.470000 3,988.470000 0.000000
16 L04AB GOLIMUMAB**** SIMPONI 50 mg SOL. INJ. IN SERINGA PREUMPLUTA 50mg/0,5ml JANSSEN BIOLOGIC OLANDA CUTIE X 1 SERINGA PREUMPLUTA PR 1 ,988.470000 3,988.470000 0.000000
17 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 1 FLAC X 4 ML CONC. PT S 1 648.750000 648.750000 0.000000
18 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 4 FLAC X 4 ML CONC. PT S 4 610.770000 610.770000 0.000000
19 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 1 FLAC X 20 ML CONC. S 1 ,908.050000 2,908.050000 0.000000
20 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 4 FLAC X 20 ML CONC. S 4 ,383.597500 3,383.597500 0.000000
21 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 1 FLAC X 10 ML CONC. S 1 ,508.960000 1,508.960000 0.000000
22 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 4 FLAC X 10 ML CONC. S 4 ,700.557500 1,700.557500 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea reumatologie, medicin intern, nefrologie (pentru pacienii cu afectare renal) i reabilitarea medical.

27. ARTROPATIA PSORIAZICA - G31c

1 L04AB ETANERCEPTUM**** ENBREL 10mg de uz pediatric PULB+SOLV. 10mg PFIZER LIMITED MA CUTIE CU 4 FLACOANE CU PULBERE + 4 SERINGI PRE-UMPLUTE X 1ML APA + 4 ACE CU INJECTOARE DIN OTEL INOXIDABIL + 4 ADAPTOARE PENTRU FLACON + 8 TAMPOANE CU ALCOOL MEDICNAL
PR 4 209.250000 209.250000 0.000000
2 L04AB ETANERCEPTUM**** ENBREL 25mg PULB. + S 25mg PFIZER LIMITED MA CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 496.610000 496.610000 0.000000
3 L04AB ETANERCEPTUM**** ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 496.277500 496.277500 0.000000
4 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 975.780000 975.780000 0.000000
5 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 975.780000 975.780000 0.000000
6 L04AB INFLIXIMABUM**** REMICADE 100 mg P 100mg JANSSEN BIOLOGIC OLANDA CUTIE X PR 3 ,902.410000 1,902.410000 0.000000
7 L04AB INFLIXIMABUM**** INFLECTRA 100 mg P 100mg HOSPIRA UK LIMITE MA CUTIE X PR 3 ,628.203333 1,628.203333 0.000000
8 L04AB INFLIXIMABUM**** REMSIMA 100mg P 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X PR 1 ,593.040000 1,593.040000 0.000000
9 L04AB ADALIMUMABUM**** HUMIRA 40 mg SOL. INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD. MA CUTIE X 2 BLIST. X 1 SERINGA PREUMPLUTA X 0,8 ML + 1 TAMPON CU ALCOOL P-RF/R 2 ,956.550000 1,956.550000 0.000000
10 L04AB GOLIMUMAB**** SIMPONI 50 mg SOL. 50mg/0,5ml JANSSEN BIOLOGIC OLANDA CUTIE X 1 STILOU I PR 1 ,988.470000 3,988.470000 0.000000
11 L04AB GOLIMUMAB**** SIMPONI 50 mg SOL. INJ. IN SERINGA PREUMPLUTA 50mg/0,5ml JANSSEN BIOLOGIC OLANDA CUTIE X 1 SERINGA PREUMPLUTA PR 1 ,988.470000 3,988.470000 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea reumatologie i reabilitare medical.

28. SPONDILITA ANKILOZANTA - G 31d

Pagina 77 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
1 L04AB ETANERCEPTUM**** ENBREL 10mg de uz pediatric PULB+SOLV. 10mg PFIZER LIMITED MA CUTIE CU 4 FLACOANE CU PULBERE + 4 SERINGI PRE-UMPLUTE X 1ML APA + 4 ACE CU INJECTOARE DIN OTEL INOXIDABIL + 4 ADAPTOARE PENTRU FLACON + 8 TAMPOANE CU ALCOOL MEDICNAL
PR 4 209.250000 209.250000 0.000000
2 L04AB ETANERCEPTUM**** ENBREL 25mg PULB. + S 25mg PFIZER LIMITED MA CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 496.610000 496.610000 0.000000
3 L04AB ETANERCEPTUM**** ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 496.277500 496.277500 0.000000
4 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 975.780000 975.780000 0.000000
5 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 975.780000 975.780000 0.000000
6 L04AB INFLIXIMABUM**** REMICADE 100 mg P 100mg JANSSEN BIOLOGIC OLANDA CUTIE X PR 3 ,902.410000 1,902.410000 0.000000
7 L04AB INFLIXIMABUM**** INFLECTRA 100 mg P 100mg HOSPIRA UK LIMITE MA CUTIE X PR 3 ,628.203333 1,628.203333 0.000000
8 L04AB INFLIXIMABUM**** REMSIMA 100mg P 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X PR 1 ,593.040000 1,593.040000 0.000000
9 L04AB ADALIMUMABUM**** HUMIRA 40 mg SOL. INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD. MA CUTIE X 2 BLIST. X 1 SERINGA PREUMPLUTA X 0,8 ML + 1 TAMPON CU ALCOOL P-RF/R 2 ,956.550000 1,956.550000 0.000000
10 L04AB GOLIMUMAB**** SIMPONI 50 mg SOL. 50mg/0,5ml JANSSEN BIOLOGIC OLANDA CUTIE X 1 STILOU I PR 1 ,988.470000 3,988.470000 0.000000
11 L04AB GOLIMUMAB**** SIMPONI 50 mg SOL. INJ. IN SERINGA PREUMPLUTA 50mg/0,5ml JANSSEN BIOLOGIC OLANDA CUTIE X 1 SERINGA PREUMPLUTA PR 1 ,988.470000 3,988.470000 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea reumatologie, medicin intern i reabilitare medical.

Pagina 78 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
TARA amba referinta / UT compensare 100% din din pretul de
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)

29. ARTRITA JUVENILA - G 31e

1 L04AA ABATACEPTUM**** ORENCIA PUL 250mg BRISTOL-MYERS S MA CUTIE X 1 FLAC. X 250 MG PULB S 1 ,434.080000 1,434.080000 0.000000
2 L04AB ETANERCEPTUM**** ENBREL 10mg de uz pediatric PULB+SOLV. 10mg PFIZER LIMITED MA CUTIE CU 4 FLACOANE CU PULBERE + 4 SERINGI PRE-UMPLUTE X 1ML APA + 4 ACE CU INJECTOARE DIN OTEL INOXIDABIL + 4 ADAPTOARE PENTRU FLACON + 8 TAMPOANE CU ALCOOL MEDICNAL
PR 4 209.250000 209.250000 0.000000
3 L04AB ETANERCEPTUM**** ENBREL 25mg PULB. + S 25mg PFIZER LIMITED MA CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 496.610000 496.610000 0.000000
4 L04AB ETANERCEPTUM**** ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 496.277500 496.277500 0.000000
5 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 975.780000 975.780000 0.000000
6 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 975.780000 975.780000 0.000000
7 L04AB ADALIMUMABUM**** HUMIRA 40 mg SOL. INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD. MA CUTIE X 2 BLIST. X 1 SERINGA PREUMPLUTA X 0,8 ML + 1 TAMPON CU ALCOOL P-RF/R 2 ,956.550000 1,956.550000 0.000000
8 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 1 FLAC X 4 ML CONC. PT S 1 648.750000 648.750000 0.000000
9 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 4 FLAC X 4 ML CONC. PT S 4 610.770000 610.770000 0.000000
10 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 1 FLAC X 20 ML CONC. S 1 ,908.050000 2,908.050000 0.000000
11 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 4 FLAC X 20 ML CONC. S 4 ,383.597500 3,383.597500 0.000000
12 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 1 FLAC X 10 ML CONC. S 1 ,508.960000 1,508.960000 0.000000
13 L04AC TOCILIZUMABUM**** ROACTEMRA 20mg/ml CONC. PT. SOL 20mg/ml ROCHE REGISTRA MA CUTIE X 4 FLAC X 10 ML CONC. S 4 ,700.557500 1,700.557500 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea reumatologie, pediatrie i reabilitare medical.

30. PSORIAZIS CRONIC SEVER - G 31f

1 L04AB ETANERCEPTUM**** ENBREL 10mg de uz pediatric PULB+SOLV. 10mg PFIZER LIMITED MA CUTIE CU 4 FLACOANE CU PULBERE + 4 SERINGI PRE-UMPLUTE X 1ML APA + 4 ACE CU INJECTOARE DIN OTEL INOXIDABIL + 4 ADAPTOARE PENTRU FLACON + 8 TAMPOANE CU ALCOOL MEDICNAL
PR 4 209.250000 209.250000 0.000000
2 L04AB ETANERCEPTUM**** ENBREL 25mg PULB. + S 25mg PFIZER LIMITED MA CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 496.610000 496.610000 0.000000
3 L04AB ETANERCEPTUM**** ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 496.277500 496.277500 0.000000
4 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MA CUTIE X 4 S P-RF/R 4 975.780000 975.780000 0.000000
5 L04AB ETANERCEPTUM**** ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 975.780000 975.780000 0.000000
6 L04AB INFLIXIMABUM**** REMICADE 100 mg P 100mg JANSSEN BIOLOGIC OLANDA CUTIE X PR 3 ,902.410000 1,902.410000 0.000000
7 L04AB INFLIXIMABUM**** INFLECTRA 100 mg P 100mg HOSPIRA UK LIMITE MA CUTIE X PR 3 ,628.203333 1,628.203333 0.000000
8 L04AB INFLIXIMABUM**** REMSIMA 100mg P 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X PR 1 ,593.040000 1,593.040000 0.000000
9 L04AB ADALIMUMABUM**** HUMIRA 40 mg SOL. INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD. MA CUTIE X 2 BLIST. X 1 SERINGA PREUMPLUTA X 0,8 ML + 1 TAMPON CU ALCOOL P-RF/R 2 ,956.550000 1,956.550000 0.000000

Tratamentul se iniiaz de ctre medicul n specialitatea dermatologie.

NOTA:

- Pentru medicamentele corespunztoare acestei seciuni iniierea tratamentului se face de ctre medicul de specialitate, altul dect medicul de familie, excepie fcnd medicamentele din G1 - Insuficien cardiac
cronic (clasa III sau IV Nyha) poziiile 2, 3, 4, 5, 6, 7 i 9, (conf. HG 720/2008, cu modificarile si completarile ulterioare) pentru care iniierea tratamentului poate fi efectuat i de ctre medicul de familie.
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (**) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale MS;
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (***) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale MS si cu aprobarea comisiilor de la nivelul
Caselor Judetene de Asigurari de Sanatate;
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (****) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale MS si cu aprobarea comisiilor de la nivelul
Casei Nationale de Asigurari de Sanatate;
- Medicamentul corespunzator DCI-ului notat cu (3) se livreaza impreuna cu solventul;
- Medicamentele corespunztoare DCI-urilor notate cu (4) se import cu avizul Ageniei Naionale a Medicamentului i a Dispozitivelor Medicale.
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (5) se utilizeaza numai pentru cazurile fara raspuns terapeutic la prednisonum.
- Tratamentul cu medicamentele corespunztoare DCI-urilor notate cu () se efectueaz n baza contractelor cost-volum-rezultat ncheiate.

Pagina 79 din 87
ANEXA 2d

SECIUNEA C3 - LISTA DE MEDICAMENTE CU PROCENT DE COMPENSARE 100% - CONFORM DCI-URILOR DIN CANAMED, ALTELE DECT CELE DIN SUBLISTELE A, B, C1,
C2, INDICATE PENTRU COPII PN LA 18 ANI, TINERI DE LA 18 LA 26 DE ANI DACA SUNT ELEVI, STUDENI SAU UCENICI DAC NU REALIZEAZ VENITURI, PRECUM I
GRAVIDE I LUZE
DIN HG NR. 720/2008 CU MODIFICARILE SI COMPLETARILE ULTERIOARE
VALABIL NCEPND CU 01 IANUARIE 2016

Val. maxima suportata de Co-plata maxima a


sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
cod Tara det. amba referinta / UT compensare 100% din din pretul de
Nr. crt ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)

1 A03AD DROTAVERINUM NO - SPA 40 mg/2 ml SOL. INJ. 40mg/2ml CHINOIN PRIVATE UNGARIA CUTIE X 25 FIOLE X 2ML SOL. INJ. P- 25 1.016800 1.016800 0.000000
2 A03BA ATROPINUM SULFAT DE ATROPINA T SOL. INJ. 1mg/ml TAKEDA GMBH GERMANI CUTIE S 5 1.606000 1.606000 0.000000
3 A03BB BUTYLSCOPOLAMMONII BRO SCOBUTIL 10 mg/ml SOL. INJ. 10mg/ml NYCOMED GMBH GERMANI CUTIE X 5 F P- 5 0.672000 0.672000 0.000000
4 A03DA COMBINATII PIAFEN COMPR. FAR ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P- 20 0.375000 0.375000 0.000000
5 A03DA COMBINATII ALGIFEN COMPRIMATE COMPR. FAR ZENTIVA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P- 20 0.375000 0.375000 0.000000
6 A03DA COMBINATII ALGIFEN SOLUTIE INJECTA SOL. INJ. FAR ZENTIVA SA ROMANIA CUTIE X 5 F P- 5 2.540000 2.540000 0.000000
7 A05B COMBINATII ASPATOFORT (R) SOL. INJ. FAR TERAPIA SA ROMANIA CUTIE X 10 FIOLE X 10 ML P- 10 3.253000 3.253000 0.000000
8 A06AD COMBINATII ENDOFALK PUL FAR DR. FALK PHARMA GERMANI CUTIE X 6 P P- 6 5.656666 5.656666 0.000000
9 A06AD COMBINATII FORTRANS PUL FAR IPSEN PHARMA FRANTA CUTIE CU 4 PLI P- 4 6.787999 6.787999 3.127001
10 A07AX NIFUROXAZIDUM ERCEFURYL (R) 200 mg CAPS. 200mg SANOFI-SYNTHEL FRANTA CUTIE X 2 BLIST. X 14 CAPS. P- 28 0.422500 0.422500 0.000000
11 A11CA RETINOLUM VITAMINA A FORTE BIOF CAPS. MOI 50000ui BIOFARM SA ROMANIA CUTIE CU 2 BLIST. PVC/AL X 15 CAPS. MO P6L 30 0.190666 0.190666 0.000000
12 A11CA RETINOLUM VITAMINA A BIOFARM 20mg/m PIC. ORALE 20mg/ml BIOFARM SA ROMANIA CUTIE X 1 FLAC. DIN STICLA P-6 1 3.070000 3.070000 0.000000
13 A11CC CALCITRIOLUM ROCALTROL CAPS. MOI 0,25mcg ROCHE ROMANIA S.R ROMANIA CUTIE CU 5 BLIST. AL/PVC X 20 CAPS. MO P6L 100 0.691000 0.691000 0.000000
14 A11CC COLECALCIFEROLUM VIGANTOLETTEN 1000 COMPR. 1000UI MERCK KGAA GERMANI CUTIE X 1 BLIST. AL/PVC X 30 COMPR. P-6 30 0.286000 0.286000 0.000000
15 A11CC COLECALCIFEROLUM VIGANTOLETTEN 500 COMPR. 500UI MERCK KGAA GERMANI CUTIE X 1 BLIST. AL/PVC X 30 COMPR. P-6 30 0.231666 0.231666 0.000000
16 A11CC COLECALCIFEROLUM VITAMINA D3 BIOFARM 1800 PIC. ORALE 0,45mg/ml BIOFARM S.A. ROMANIA CUTIE X 1 FLACON X 10 ML PIC. ORALE, P-6 1 5.240000 5.240000 0.000000
17 A11CC COLECALCIFEROLUM VIGANTOL OIL PIC. ORALE 0,5mg/ml MERCK KGAA GERMANI CUTIE X 1 FLACON DIN STICLA X 10 ML PIC. ORALE SOLUTIE, PREVAZUT CU PICURATOR P-6 1 6.010000 6.010000 0.000000
18 A11CC COMBINATII FLUOR VIGANTOLETTEN 10 COMPR. 1000 UI/0,5 MERCK KGAA GERMANI CUTIE X 1 BLIST. AL/PVC X 30 COMPR. P-6 30 0.277000 0.277000 0.000000
19 A11CC COMBINATII FLUOR VIGANTOLETTEN 50 COMPR. 500 UI/0,55 MERCK KGAA GERMANI CUTIE X 1 BLIST. AL/PVC X 30 COMPR. P-6 30 0.222333 0.222333 0.000000
20 A11DA THIAMINUM VITAMINA B1 ZENTIVA 100 m SOL. INJ. 100mg/2ml ZENTIVA SA ROMANIA CUTIE P- 5 1.448000 1.448000 0.000000
21 A11DA BENFOTIAMINUM BENFOGAMMA DRAJ. 50mg WORWAG GERMANI CUTIE X 5 BLIST. PVC-PVDC/AL X 10 DRAJ P-6 50 0.596000 0.596000 0.000000
22 A11D COMBINATII MILGAMMA (R) N CAPS. MOI FAR WORWAG GERMANI CUTIE X 5 BLIST. PVC/PVDC X 10 CAPS. P-6 50 0.972600 0.972600 0.000000
23 A11D COMBINATII MILGAMMA (R) 100+100mg DRAJ. 100mg+100m WORWAG GERMANI CUTIE X 4 BLIST. PVC-PVDC/AL X 15 DRAJ P-6 60 1.555333 1.555333 0.000000
24 A11D COMBINATII MILGAMMA (R) (vezi B03BA51 DRAJ. FAR WORWAG GERMANI CUTIE X 5 BLIST. PVC/PVDC X 10 DRAJ. P-6 50 0.972600 0.972600 0.000000
25 A11D COMBINATII MILGAMMA (R) (vezi B03BA51 DRAJ. FAR WORWAG GERMANI CUTIE X 5 BLIST. PVC/PVDC X 10 DRAJ. P-6 50 0.972600 0.972600 0.000000
26 A11D COMBINATII MILGAMMA (R) N SOL. INJ. FAR WORWAG GERMANI CU P- 5 3.842000 3.842000 0.000000
27 A11D COMBINATII MILGAMMA (R) NA SOL. INJ. FAR WORWAG GERMANI CU P- 5 3.842000 3.842000 0.000000
28 A11D COMBINATII NEUROMULTIVIT COMPR. FILM FAR LANNA AUSTRIA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. P-6 20 0.553680 0.553680 0.025820
29 A11D COMBINATII NEUROMULTIVIT COMPR. FILM FAR LANNA AUSTRIA CUTIE CU 5 BLIST. PVC/AL X 20 COMPR. P-6 100 0.461400 0.461400 0.000000
30 A11GA ACIDUM ASCORBICUM ACID ASCORBIC ARENA 750 SOL INJ. 750mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRU PRF 5 2.046000 2.046000 0.000000
31 A11GA ACIDUM ASCORBICUM VITAMINA C ARENA 750 mg SOL. INJ. 750mg ARENA GROUP S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA X P- 5 2.455200 2.455200 2.796800
32 A11HA PYRIDOXINUM VITAMINA B6 250 mg COMPR. 250 mg ARENA GROUP SA ROMANIA CUTIE X 1 FLACON DIN PE X 20 COMPR. P-6 20 0.472500 0.472500 0.000000
33 A11HA PYRIDOXINUM VITAMINA B6 ZENTIVA 250 m COMPR. 250mg ZENTIVA SA ROMANIA CUTIE X 1 FLAC. DIN PE X 20 COMPR. P-6 20 0.472500 0.472500 0.000000
34 A11HA PYRIDOXINUM VITAMINA B6 ZENTIVA 250 m SOL. INJ. 250mg/5ml ZENTIVA SA ROMANIA CUTIE P- 5 2.144000 2.144000 0.000000
35 A11HA PYRIDOXINUM VITAMINA B6 ZENTIVA 50 m SOL. INJ. 50mg/2ml ZENTIVA SA ROMANIA CUTIE P- 5 1.448000 1.448000 0.000000
36 A11HA TOCOFEROLUM VITAMINA E 400 mg CAPS. MOI 400mg PHARCO IMPEX 93 S ROMANIA CUTIE X 2 BLIST. AL/PVC X 12 CAPS. MOI P-6 24 0.404583 0.404583 0.000000
37 A12AA CALCII GLUCONAS GLUCONAT DE CALCIU 94mg SOL. INJ. 94mg/ml B. BRAUN MELS GERMANI CUTIE X 20 FIOLE DIN PEJD X 10 ML SOL. P- 20 0.875000 0.875000 0.000000
38 A12AA CALCII GLUCONAS GLUCONAT DE CALC SOL. INJ. 95mg/ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE X 10 ML SOL. INJ. P- 5 1.050000 1.050000 2.254000
39 A16AA LEVOCARNITINUM CARNIL (R) SOL. ORALA 100mg/ml ANFARM HELLAS S.A. PHARMACEUTICALS GRECIA CUTIE X 10 FLACOANE DIN STICLA BRUNA, ACOPERITE CU UN CAPAC DIN AL. X 10 ML P-6 10 1.599000 1.599000 0.000000
40 A16AX DIVERSE ACTOVEGIN (R) DRAJ. 200mg NYCOMED AUSTR AUSTRIA CUTIE X 1 FLAC. DIN STICLA BRUNA X P-6 50 2.901600 2.901600 0.000000

Pagina 80 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
cod Tara det. amba referinta / UT compensare 100% din din pretul de
Nr. crt ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)
41 A16AX DIVERSE ACTOVEGIN 200 mg DRAJ. 200mg TAKEDA AUSTRIA G AUSTRIA CUTIE CU 1 FLAC. DIN STICLA BRUNA P6L 50 2.901600 2.901600 0.000000
42 A16AX DIVERSE ACTOVEGIN (R) SOL. INJ. 200mg/5ml
NYCOMED AUSTR AUSTRIA CUTIE X 5 FIOLE PUNCT DE RUPERE X 5 P- 5 21.744000 21.744000 0.000000
43 A16AX DIVERSE ACTOVEGIN 200 mg/5 ml SOL. INJ. 200mg/5ml
TAKEDA AUSTRIA G AUSTRIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA CU PUNCT DE RUPERE X 5 ML SOL. INJ. PR 5 21.744000 21.744000 0.000000
44 B02BX ETAMSYLATUM ETAMSILAT ZENTIVA 250mg SOL. INJ. 250mg/2ml
ZENTIVA S.A ROMANIA CUTIE X 5 FIOLE X 2 ML SOL. INJ. P- 5 1.396000 1.396000 0.000000
45 B02BX CARBAZOCHROMI SALICYLAS ADRENOSTAZIN SOL. INJ. 0,3mg/ml
TERAPIA SA ROMANIA CUTIE X 5 FIOLE X 5 ML P- 5 2.638000 2.638000 0.000000
46 B03AA FERROSI GLUCONAS ASCOFER COMPR. FAR ARENA GROUP SA ROMANIA CUTIE X 1 FLAC. X 20 COMPR. P-6 20 0.400500 0.400500 0.000000
47 B03AD COMBINATII FERRETAB (R) CAPS. ELIB FAR LANNA AUSTRIA CUTIE X 5 BLIST. AL/PVC X 20 CAPS. EL P-6 100 0.286000 0.286000 0.000000
48 B03AD COMBINATII FERRETAB (R) CAPS. ELIB FAR LANNA AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. EL P-6 30 0.343200 0.343200 0.019800
49 B03AD COMBINATII TARDYFERON FOL (R) DRAJ. ELIB FAR LAB. PIERRE FABRE FRANTA CUTIE X 3 BLIST. AL/PVDC-PE-PVC P-6 30 0.463333 0.463333 0.000000
50 B03AD COMBINATII MALTOFER FOL COMPR. MAS FAR VIFOR FRANCE S.A. FRANTA CUTIE X 3 BLIST. AL/PA-AL-PVC X 10 P-6 30 0.617333 0.617333 0.000000
51 B03AE COMBINATII FERRO - FOLGAMMA (R) CAPS. MOI FAR WORWAG GERMANI CUTIE X 5 BLIST. X 10 CAPS. MOI P- 50 0.497000 0.497000 0.000000
52 B03AE COMBINATII TOT'HEMA SOL. ORALA FAR LABORATOIRE INNOTECH INTERNATIONAL FRANTA CUTIE X 20 FIOLE X 10 ML P-6 20 0.886500 0.886500 0.000000
53 B03BA CYANOCOBALAMINUM VITAMINA B12 ZENTIVA 50g SOL. INJ. 50g/ml ZENTIVA SA ROMANIA CUTIE P- 5 1.448000 1.448000 0.000000
54 C01EA ALPROSTADILUM** ALPROSTADIL "REMEDIA" 5 CONC. 500g FARMACEUTICA ROMANIA CUTIE X 5 FLAC. X 1 ML CONC. PT. SOL. S 5 332.144000 332.144000 0.000000
55 C05AA COMBINATII HEMORZON SUPOZ. FAR ANTIBIOTICE SA ROMANIA CUTIE CU 2 FOLII TERMOFORMATE PV P-6 6 1.210000 1.210000 0.000000
56 C05AA COMBINATII HEMORZON UNGUENT FAR ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB X 18 G P-6 1 12.960000 12.960000 0.000000
57 C05AA COMBINATII ULTRAPROCT SUPOZITOAR SUPOZ. FAR INTENDIS GMBH GERMANI CUTIE X 2 FOLII X 5 SUPOZ. P- 10 1.342000 1.342000 0.000000
58 C05AA COMBINATII ULTRAPROCT UNGUENT RE UNGUENT FAR INTENDIS GMBH GERMANI CUTIE X 1 TUB AL X 30 G + 1 CANULA PE P- 1 32.060000 32.060000 0.000000
59 C05AD COMBINATII DOXIPROCT UNGUENT FAR OM PHARMA S.A. PORTUG CUTI P-6 1 21.660000 21.660000 0.000000
60 C05BX CALCII DOBESILAS DOXILEK CAPS. 500mg LEK PHARMACEU SLOVENI CUTIE X 3 BLIST. AL/PVC. X 10 CAPS. P-6 30 0.742000 0.742000 0.000000
61 C05CA TROXERUTINUM (COMBINATII) GINKOR FORT CAPS. FAR IPSEN PHARMA FRANTA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6 30 0.890000 0.890000 0.000000
62 C07N COMBINATII DISTONOCALM (R) COMPR. FILM FAR ZENTIVA S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FI P-6 30 0.245666 0.245666 0.000000
63 C08CA NIMODIPINUM NIMOTOP 30 mg COMPR. FILM 30mg BAYER PHARMA AG GERMANI CUTIE CU 10 BLIST. AL/PP X 10 COMPR. P- 100 0.713400 0.713400 0.000000
64 C08CA NIMODIPINUM NIMOTOP SOL. PERF. 10mg/50ml BAYER PHARMA AG GERMANI S
CUTIE X 5 CUTII X 1 FLACON DIN STICLA DE CULOARE BRUNA X 50 ML + 1 PERFUZOR DIN POLIETILENA 5 29.144000 29.144000 0.000000
65 D01AC ISOCONAZOLUM TRAVOGEN CREMA 10mg/1g BAYER PHARMA AG GERMANI CUTIE X 1 TUB DIN AL X 30 G CREMA PRF 1 17.470000 17.470000 0.000000
66 D01AC ISOCONAZOLUM TRAVOGEN CREMA 10mg/1g INTENDIS GMBH GERMANI CUTIE X 1 TUB, DIN AL X 20 G CREMA P- 1 11.630000 11.630000 0.000000
67 D01AC ISOCONAZOLUM TRAVOGEN 10mg/g CREMA 10mg/g BAYER PHARMA AG GERMANI CUTIE X 1 TUB DIN AL X 20 G CREMA PRF 1 11.630000 11.630000 0.000000
68 D01AC KETOCONAZOLUM KETOCONAZOL CREMA 2% TIS FARMACEUTIC S ROMANIA CUTIE X 1 TUB PEJD X 15 G P- 1 3.470000 3.470000 0.000000
69 D01AC KETOCONAZOLUM KETOCONAZOL CREMA CREMA 20mg/g SC HYPERION SA ROMANIA CUTIE X 1 TUB DIN AL X 20 G CREMA P- 1 4.640000 4.640000 0.000000
70 D01AC KETOCONAZOLUM KETOCONAZOL CREMA CREMA 20mg/g SC HYPERION SA ROMANIA CUTIE X 1 TUB DIN AL X 15 G CREMA P- 1 3.470000 3.470000 0.000000
71 D01AC KETOCONAZOLUM NIZORAL 20 mg/g CREMA 20mg/g JANSSEN P BELGIA CUTIE CU 1 TUB DIN AL X 15 G CREMA PRF 1 4.164000 4.164000 1.186000
72 D05A COMBINATII ASORIAN SOL. CUT. FAR BIOFARM SA ROMANIA CUTIE X 1 FLACON X 100 ML P- 1 10.550000 10.550000 0.000000
73 D07AC FLUOCINOLONI ACETONIDUM FLUOCINOLON ACETONID UNGUENT 0,025% LAROPHARM SRL ROMANIA CUTIE X 1 TUB AL X 20 G P- 1 7.670000 7.670000 0.000000
74 D07CB COMBINATII NIDOFLOR CREMA FAR ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB X 15 G P- 1 10.370000 10.370000 0.000000
75 D07C COMBINATII FLUOCINOLON N UNGUENT 0,25mg/5mg/ ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB X 18 G P- 1 8.510000 8.510000 0.000000
76 D07C COMBINATII FLUOCINOLON N ATB 0,25 UNGUENT 0,25mg/5mg/ ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 18 G UNG. PRF 1 8.510000 8.510000 0.000000
77 D07XB COMBINATII TRIAMCINOLON S CREMA FAR ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB X 15 G P- 1 9.340000 9.340000 0.000000
78 D07XC COMBINATII DIPROSALIC SOL. CUT. FAR MERCK SHARP & ROMANIA CUTIE X P- 1 6.270000 6.270000 0.000000
79 D07XC COMBINATII DIPROSALIC UNGUENT FAR MERCK SHARP & ROMANIA CUTIE X 1 TUB DIN AL X 15 G UNGUENT P- 1 3.420000 3.420000 0.000000
80 D07XC COMBIN SAL-EKARZIN 0,50 mg/30 UNGUENT 0,50m ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 TUB AL X 15 G UNGUENT P- 1 7.260000 7.260000 0.000000
81 D07XC COMBINATII TRAVOCORT CREMA 10mg/1mg/1g INTENDIS GMBH GERMANI CUTIE X 1 TUB DIN AL X 30 G CREMA P- 1 26.150000 26.150000 0.000000
82 D07XC COMBINATII TRAVOCORT CREMA 10mg/1mg/1g BAYER PHARMA AG GERMANI CUTIE X 1 TUB DIN AL X 30 G CREMA P- 1 26.150000 26.150000 0.000000
83 D10AF ERYTHROMYCINUM ERYFLUID SOL. CUT. 4g/30ml PIERRE FAB FRANTA CUTIE X 1 FLACON X 100 ML SOL. CUT. P- 1 21.790000 21.790000 0.000000
84 D10AF ERYTHROMYCINUM ERYFLUID SOL. CUT. 4g/30ml PIERRE FAB FRANTA CUTIE X 1 FLACON X 30 ML SOL. CUT. P- 1 8.400000 8.400000 0.000000
85 D10AF COMBINATII ZINERYT PU 40mg/12mg/ ASTELLAS OLANDA P-
CUTIE X 1 FLAC. DIN PEID PULB. PT. SOL. CUTANATA + APLICATOR DIN PP CU SOLV. PT 30 ML SOL. CUTANATA 1 27.380000 27.380000 0.000000
86 D11AH PIMECROLIMUS ELIDEL 1% (10mg/g) CREMA 10mg/g MEDA PHARMA GERMANI CUTIE X 1 TUB AL X 30 G CREMA P- 1 124.050000 124.050000 0.000000
87 G01AF METRONIDAZOLUM FLAGYL OVULE 500mg LAB. AVENTIS FRANTA CUTIE X 2 BLIST. X 5 OVULE P- 10 0.884000 0.884000 0.000000
88 G01AX CICLOPIROXUM DAFNEGIN OVULE 100mg POLICHEM SA LUXEM CUTIE X 1 FOLIE. TERMOSUDATA DIN PVC/PE X 6 OVULE + 6 APLICATOARE DIN PE P-6 6 6.000000 6.000000 0.000000
89 G01B COMBINATII TERGYNAN COMPR. VAG. FAR LAB. BOUCHARA FRANTA CUTIE X 1 FOLIE HARTIE/PE/AL/PE P- 10 2.613000 2.613000 0.000000

Pagina 81 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
cod Tara det. amba referinta / UT compensare 100% din din pretul de
Nr. crt ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)
90 G03D NOMEGESTROLUM LUTENYL (R) COMPR. 5mg LAB. THERAMEX MONACO CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P6L 10 1.943000 1.943000 0.000000
91 G03G GONADOTROPHINUM CHORI PREGNYL 5000 LIOF. + SOLV. PT. SOL. INJ. 5000ui/ml NV ORGANON OLANDA CUTIE CU 1 FIOLA CU CAPACITATEA DE 2 ML, DIN STICLA INCOLORA, CU PUNCT DE RUPERE, TIP OPC, CONTINND PULB. PT. SOL. INJ. SI 1 FIOLA CU CAPACITATEA DE 1 ML, DIN STICLA INCOLORA, CU PUNCT DE RUPERE, TIP OPC, CONTINND SOLV. PT. SOL. INJ. S/P-RF 1 15.180000 15.180000 0.000000
92 G03G MENOTROPINUM MENOPUR LIOF. + SOLV. PT. SOL. INJ. FAR FERRING GMBH GERMANI CUTIE X 10 FLAC. DIN STICLA INCOLORA CU LIOF. + 10 FIOLE X 1 ML SOLV. PT. SOL. INJ. S/P-RF 10 78.451000 78.451000 0.000000
93 G04B COMBINATII URALYT-U GRANULE FAR MADAUS GMBH GERMANI CUTIE X 1 FLAC. PP X 280 G GRANULE + 1 LINGURITA DOZATOARE + 1 CALENDAR DE CONTROL + HARTIE INDICATO P-6 1 59.060000 59.060000 0.000000
94 H03AA COMBINATII NOVOTHYRAL (R) 100 COMPR. 100mcg+20m MERCK KGAA GERMANI CUTIE X 4 BLIST. AL/PP X 25 COMPR. P-6 100 0.300300 0.300300 0.000000
95 J01DB CEFAZOLINUM LYZOLIN 1g PULB. PT. 1g SC ANSAMED SRL ROMANIA CUTIE X 1 FLACON PR 1 7.410000 7.410000 0.000000
96 J01DD COMBINATII (CEF SULCEF 1000 mg/1000 mg PULB. PT. SOL. INJ./PERF. 1000mg/100 MEDOCHEMIE S.R.L. ROMANIA C S/P-RF 1 23.076840 23.076840 3.103160
97 J01DD COMBINATII (CEF SULCEF 1000 mg/1000 mg PULB. PT. SOL. INJ./PERF. 1000mg/100 MEDOCHEMIE S.R.L. ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. S/P-RF 10 22.818000 22.818000 0.000000
98 J01DD COMBINATII (CEF SULCEF 1000 mg/1000 mg PULB. PT. SOL. INJ./PERF. 1000mg/100 MEDOCHEMIE S.R.L. ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. S/P-RF 50 19.939200 19.939200 0.000000
99 J01DD COMBINATII (CEF SULCEF 1000 mg/1000 mg PULB. PT. SOL. INJ./PERF. 1000mg/100 MEDOCHEMIE S.R.L. ROMANIA CUTIE CU 100 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. S 100 19.230700 19.230700 0.000000
100 J01EB SULFAFURAZOLUM SULFAFURAZOL ARENA 500 COMPR. 500mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P- 20 0.655500 0.655500 0.000000
101 J01GB GENTAMICINUM GENTAMICINA EIPICO 40 mg SOL INJ. 40mg/ml E.I.P.I.CO MED S.R.L. ROMANIA CUTIE CU 3 FLAC. DIN STICLA TIP I INCOLORA CU CAPACITATEA DE 2,5 ML, CONTINAND 2 ML SOL. INJ. PRF 3 0.686666 0.686666 0.000000
102 J01GB GENTAMICINUM GENTAMICIN KRKA SOL. INJ. 40mg/ml KRKA D.D. NOVO M SLOVENI CUTIE X 10 FIOLE DIN STICLA INC P- 10 0.740000 0.740000 0.000000
103 J01GB GENTAMICINUM GENTAMICIN KRKA SOL. INJ. 80mg/2ml KRKA D.D. NOVO M SLOVENI CUTIE X 50 FIOLE DIN STICLA INC P-RF/S 50 0.823999 0.823999 0.036601
104 J01GB GENTAMICINUM GENTAMICIN KRKA SOL. INJ. 80mg/2ml KRKA D.D. NOVO M SLOVENI CUTIE X 10 FIOLE DIN STICLA INC P- 10 0.823999 0.823999 0.170001
105 J01XB COLISTINUM COLISTINA ATB 1.000.000 UI PULB. PT. SOL. INJ./PERF. 1000000ui ANTIBIOTICE SA ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA, NCHISE CU DOP DIN CAUCIUC HALOBUTILIC, SIGILAT CU CAPSA DIN ALUMINIU PREVAZUTA CU DISC FLIP-OFF DIN POLIPROPILENA, CONTINND PULB. PENTRU SOL. INJ./PERF.
S 10 21.974000 21.974000 0.000000
106 J02AC VORICONAZOLUM** VFEND 200mg COMPR. FILM 200mg PFIZER LIMITED M CUTIE X 28 COMPR. FILM. (BLIST.PVC/AL) P- 28 132.002857 132.002857 0.000000
107 J02AC VORICONAZOLUM** VFEND 50mg COMPR. FILM 50mg PFIZER LIMITED M CUTIE X 28COMPR. FILM. ( BLIST. PVC/AL P- 28 36.496071 36.496071 0.000000
108 J02AC VORICONAZOLUM** VFEND 40 mg/ml PUL 40mg/ml PFIZER LIMITED M CUTIE X 1 FLAC. PEID DE 100ML X 45 G PULB. PT. SUSP. ORALA + 1 MASURA DOZATOARE (23 ML) + 1 SERINGA PT. ADM. ORALA (5 ML) + 1 ADAPTOR P- 1 ,266.130000 2,266.130000 0.000000
109 M01A PHENYLBUTAZONUM FENILBUTAZONA 250 mg SUPOZ. 250mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII TERMOSUDATE PVC/ P-6 10 1.089000 1.089000 0.000000
110 M01A COMBINATII TRATUL PLUS CAPS. FAR LANNA AUSTRIA CUTIE X 3 BLIST. PVC-PVDC/AL X P-6 30 0.546000 0.546000 0.000000
111 M01A COMBINATII TRATUL PLUS CAPS. FAR LANNA AUSTRIA CUTIE X 5 BLIST. PVC-PVDC/AL X P-6 50 0.517800 0.517800 0.000000
112 M01A COMBINATII NEODOLPASSE 0,30 mg+0, SOL. PERF. 0,30mg+0 FRESENIUS AUSTRIA CUTIE CU 10 FLAC. DIN STI PR 10 22.722000 22.722000 0.000000
113 M01A COMBINATII ACECLOFEN SUPOZ. FAR ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDATE AL/PE P-6 6 1.036666 1.036666 0.000000
114 M01A COMBINATII (DICL DICLOPRAM 75 mg/20 mg CAPS. EL 75mg/20mg PHARMASWISS CESKA REPUBLIKA S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PV P6L 30 2.095000 2.095000 0.000000
115 M01A COMBINATII (DICL DICLOPRAM 75 mg/20 mg CAPS. EL 75mg/20mg PHARMASWISS CESKA REPUBLIKA S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PV P6L 60 1.989666 1.989666 0.000000
116 M01A DICLOFENACUM+MISOPROST ARTHROTEC 75 COM 75mg+0,200 PFIZER EUROPE M M CUTIE X 2 BLIST. AL X 10 COMPR. GA P-6 20 1.482500 1.482500 0.000000
117 M01A IBUPROFENUM PADUDEN (R) SR 300 mg CAPS. ELIB 300mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. ELIB. PREL. P-6 10 1.453000 1.453000 0.000000
118 M01A IBUPROFENUM BRUFEN RETARD 800 mg CO 800mg ABBOTT SCANDINA SUEDIA CUTIE CU BLIST. PVC/PVDC-AL P6L 30 0.628000 0.628000 0.000000
119 M01A IBUPROFENUM BRUFEN 400 mg COMPR. FILM 400mg ABBOTT SCANDINA SUEDIA CUTIE CU BLIST. AL/PVC X 30 COMPR. FI P-6 30 0.234000 0.234000 0.065333
120 M01A IBUPROFENUM BRUFEN 400 mg COMPR. FILM 400mg ABBOTT SCANDINA SUEDIA CUTIE CU BLIST. AL/PVC X 60 COMPR. FI P-6 60 0.234000 0.234000 0.065666
121 M01A IBUPROFENUM BRUFEN 400 mg COMPR. FILM 400mg ABBOTT SCANDINA SUEDIA CUTIE CU BLIST. PVC-PVDC/AL X 30 C P-6 30 0.234000 0.234000 0.065333
122 M01A IBUPROFENUM BRUFEN 400 mg COMPR. FILM 400mg ABBOTT SCANDINA SUEDIA CUTIE CU BLIST. PVC-PVDC/AL X 60 C P-6 60 0.234000 0.234000 0.065666
123 M01A IBUPROFENUM IBUPROFEN CIPLA 400 COMPR. FILM 400mg CIPLA (UK) LIMITED M CUTIE CU 2 BLIST. PVCAL X 10 COMPR. F P6L 20 0.195000 0.195000 0.000000
124 M01A IBUPROFENUM IBUPROFEN CIPLA 600 COMPR. FILM 600mg CIPLA (UK) LIMITED M CUTIE CU 2 BLIST. PVCAL X 10 COMPR. F P6L 20 0.380000 0.380000 0.000000
125 M01A IBUPROFENUM FASPIC 600 GRAN 600mg ZAMBON S.P.A. ITALIA CUTIE X 30 PLICURI UNIDOZA X P-6 30 0.456000 0.456000 0.429333
126 M01A IBUPROFENUM BRUFEN 600 mg GRANULE EF 600mg ABBOTT SCANDINA SUEDIA CUTIE CU 20 PLICURI DIN FOLII LAMINATE DIN HARTIE/PE/AL/PE, TERMOSUDATE, CE CONTIN GRANULE EFF. P6L 20 0.456000 0.456000 0.088500
127 M01A IBUPROFENUM IBALGIN BABY SUSP. ORALA 100mg/5ml ZENTIVA K.S. CEHIA CUTIE X 1 FLAC. DIN STICLA X 100 ML SUSP. ORALA + PIPETA DOZATOARE GRADATA P- 1 6.920000 6.920000 0.000000
128 M01A IBUPROFENUM IBALGIN BABY SUSP. ORALA 100mg/5ml ZENTIVA K.S. CEHIA CUTIE CU 1 FLAC. DIN STICLA BRUNA INCHIS CU CAPAC DIN PE X 100 ML SUSP. ORALA + PIPETA DOZATOARE GRA P- 1 6.920000 6.920000 0.000000
129 M01A IBUPROFENUM ALGIN BABY 100 mg/5 ml SUSP. ORALA 100mg/5ml ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 100 ML SUSP. ORALA, CU CAPAC DIN PP SI O SERINGA DOZATOARE (GRADATA) DIN PEJD PRF 1 6.920000 6.920000 0.000000
130 M01A IBUPROFENUM ALGIN BABY 100 mg/5 ml SUSP. ORALA 100mg/5ml ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 100 ML SUSP. ORALA, CU CAPAC DIN PE SI O SERINGA DOZATOARE (GRADATA) DIN PEJD PRF 1 6.920000 6.920000 0.000000
131 M01A IBUPROFENUM BRUFEN 20 mg/ml SUSP. ORALA 20mg/ml ABBOTT SCANDINA SUEDIA CUTIE CU 1 FLAC. DE 100 ML SUSP. ORALA, DIN PET DE CULOARE BRUNA CU CAPAC DIN AL SI SIGILIU DIN PEJD + SERINGA DOZATOARE DIN PP DE 5 ML P6L 1 8.304000 8.304000 2.326000
132 M01A NAPROXENUM REUXEN 250 mg COMPR. 250mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.751000 0.751000 0.000000
133 M01A NAPROXENUM REUXEN 500 mg COMPR. 500mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 1.196500 1.196500 0.000000
134 M01A NAPROXENUM NALDOREX 275 mg COMPR. FILM 275mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 10 COMPR. FI P6L 10 1.055000 1.055000 0.000000
135 M01A NAPROXENUM NALDOREX 275 mg COMPR. FILM 275mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 20 COMPR. FI P6L 20 0.902000 0.902000 0.000000
136 M01A NAPROXENUM NALDOREX 550 mg COMPR. FILM 550mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 10 COMPR. FI P6L 10 1.511400 1.511400 0.075600
137 M01A NAPROXENUM NALDOREX 550 mg COMPR. FILM 550mg KRKA, D.D., NOVO SLOVENI CUTIE CU BLIST. PVC/AL X 20 COMPR. FI P6L 20 1.259500 1.259500 0.000000
138 M01A ACIDUM MEFENAMICUM VIDAN COMPR. FILM 500mg VIANEX SA GRECIA CUTIE X 3 BLIST. AL/PVC X 8 COMPR. FIL P-6 24 0.432083 0.432083 0.000000

Pagina 82 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
cod Tara det. amba referinta / UT compensare 100% din din pretul de
Nr. crt ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)
139 M01A PARECOXIBUM DYNASTAT 40mg 40mg
PULB. + SOLV. PT. SOL. INJ. PFIZER LIMITED M CUTIE X 5 FLAC. PULB. X 40 MG + 5 S/P-RF 5 30.554000 30.554000 0.000000
140 M01A PARECOXIBUM DYNASTAT 40mg PULB. PT. 40mg PFIZER LIMITED M CUTIE X 10 FLAC. X 40 MG PULB. PT. SOL S/P-RF 10 30.123000 30.123000 0.000000
141 M03B CHLORZOXAZONUM CLORZOXAZON 250 mg COMPR. 250mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.229500 0.229500 0.000000
142 M03B CHLORZOXAZONUM CLORZOXAZONA 250 mg COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.213666 0.213666 0.000000
143 M03B CHLORZOXAZONUM CLORZOXAZONA ARENA 25 COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.213666 0.213666 0.000000
144 M03BX TOLPERISONUM MYDOCALM COMPR. FILM 150mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR.FI P-6 30 0.504000 0.504000 0.000000
145 M03BX TOLPERISONUM MYDOCALM COMPR. FILM 150mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR.FI P-6 20 0.509000 0.509000 0.000000
146 M03BX TOLPERISONUM MYDOCALM COMPR. FILM 50mg GEDEON RIC ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FI P-6 30 0.252666 0.252666 0.000000
147 M09AX ACIDUM HIALURONICUM HYALGAN (R) SOL. INJ. 20mg/2ml CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 2 ML P- 1 127.790000 127.790000 0.000000
148 N02AA COMBINATII ( PARAC ULTRACOD 500 mg/30 mg COMPR. 500 mg/30 m ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 CO PRF 30 0.793200 0.793200 0.333466
149 N02AA COMBINATII ( PARA PARADOREN 500mg/30mg COMPR. 500mg+30mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P- 20 0.661000 0.661000 0.000000
150 N02AA COMBINATII ( PARA PARADOREN 500mg/60mg COMPR. 500mg+60mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P- 20 1.028500 1.028500 0.000000
151 N02AA COMBINATII (IBUPROFENU BRUFEN PLUS 400 mg/30 mg COMPR. FILM 400mg/30mg BGP PRODUCTS AB SUEDIA CUTIE CU BLIST. AL/PVDC-PVC/PV PRF 30 1.021000 1.021000 0.000000
152 N02BB METAMIZOLUM NATRIUM ALGOCALMIN (R) 500 mg COMPR. 500mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P- 20 0.384600 0.384600 0.043900
153 N02BB METAMIZOLUM NATRIUM ALINDOR COMPR. 500mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P- 20 0.384600 0.384600 0.043900
154 N02BB METAMIZOLUM NATRIUM SINTOCALMIN COMPR. 500mg SINTOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P- 20 0.342000 0.342000 0.000000
155 N02BB METAMIZOLUM NATRIUM NOVOCALMIN COMPR. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P- 20 0.384600 0.384600 0.038900
156 N02BB METAMIZOLUM NATRIUM METAMIZOL FARMACOM 50 COMPR. 500mg FARMACOM SA ROMANIA CUTIE X 2 BLIST., PVC/AL X 10 COMPR. P- 20 0.326000 0.326000 0.000000
157 N02BB METAMIZOLUM NATRIUM ALGOBLOCK COMPR. 500mg BIOFARM S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P- 20 0.320500 0.320500 0.000000
158 N02BB METAMIZOLUM NATRIUM ALGOZONE 500mg COMPR. 500mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST.PVC-PVDC/AL A CAT P- 20 0.353000 0.353000 0.000000
159 N02BB METAMIZOLUM NATRIUM ALVOTOR 500 mg/ml PIC. ORALE 500mg/ml TORRENT PHARMA S ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, PREVAZUT CU PICURATOR DIN PEJD A 100 ML PIC. ORALE, SOL. P6L 1 28.460000 28.460000 0.000000
160 N02BB METAMIZOLUM NATRIUM ALGOCALMIN (R) 1 g/2 ml SOL. INJ. 1g/2ml ZENTIVA S.A. ROMANIA CUTIE X 5 F P- 5 1.226000 1.226000 0.000000
161 N02BB METAMIZOLUM NATRIUM SINTOCALMIN 300 mg SUPOZ. 300mg SINTOFARM SA ROMANIA CUTIE X 2 BLIST. PVC/PE X 3 SUPOZ. P- 6 1.261666 1.261666 0.000000
162 N02BB METAMIZOLUM NATRIUM NOVOCALMIN 300 mg SUPOZ. 300mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 FOLII TERMOSU PRF 12 1.253333 1.253333 0.000000
163 N05C MIDAZOLAMUM DORMICUM (R) COMPR. FILM 7,5mg ROCHE ROMANIA S.R ROMANIA CUTIE X 1 BLIST. PVC/PVDC/AL X 10 C P- 10 0.578000 0.578000 0.000000
164 N05C MIDAZOLAMUM MIDAZOLAM TORREX 1 mg/m SOL. INJ. 1mg/ml CHIESI P AUSTRIA CUTIE X 10 FIOLE X 5 ML SOL. INJ. S/P-RF 10 1.770000 1.770000 0.000000
165 N05C CINOLAZEPAMUM GERODORM (R) COMPR. 40mg GEROT PHAR AUSTRIA CUTIE X 3 BLIST. AL/PVDC-PVC X 10 CO P- 30 0.797000 0.797000 0.000000
166 N06BA METHYLFENIDATUM*** CONCERTA 18 mg COMPR. FILM. ELIB. PREL. 18mg JANSSEN P BELGIA CUTIE X 1 FLAC. DIN PEID X PR, PS 30 2.966666 2.966666 0.000000
167 N06BA METHYLFENIDATUM*** CONCERTA 36 mg COMPR. FILM. ELIB. PREL. 36mg JANSSEN P BELGIA CUTIE X 1 FLAC. DIN PEID X PR, PS 30 4.681333 4.681333 0.000000
168 N06BA METHYLFENIDATUM*** CONCERTA 54 mg COMPR. FILM. ELIB. PREL. 54mg JANSSEN P BELGIA CUTIE X 1 FLAC. DIN PEID X PR, PS 30 6.082000 6.082000 0.000000
169 N06BX PYRITINOLUM PIRITINOL ARENA 100 mg DRAJ. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. X 10 DRAJ. P-6 30 0.450000 0.450000 0.000000
170 N06BX PYRITINOLUM ENCEPHABOL 100 mg DRAJ. 100mg MERCK KGAA GERMANI CUTIE CU 5 BLIST. PVC/AL X 10 DRAJ. P6L 50 0.540000 0.540000 0.129600
171 N06BX PYRITINOLUM ENCEPHABOL 200 mg DRAJ. 200mg MERCK KGAA GERMANI CUTIE CU 5 BLIST. PVC/AL X 10 DRAJ. P6L 50 1.259200 1.259200 0.000000
172 N06BX PYRITINOLUM ENCEPHABOL 80,5 mg/5 ml SUSP. ORALA 80,5mg/5ml MERCK KGAA GERMANI CUTIE CU 1 FLAC. DIN STICLA BRUNA X 200 ML + 1 LINGURITA DOZATOARE DIN PP ALBA, CU GRADATII LA 1,25 ML, 2,5 ML, 5 ML P6L 1 42.110000 42.110000 0.000000
173 N07CA CINNARIZINUM CINARIZINA ARENA 25 mg CAPS. 25mg ARENA GROUP SA ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 CAPS. P-6 40 0.085500 0.085500 0.000000
174 N07CA CINNARIZINUM STUGERON 25 mg COMPR. 25mg TERAPIA SA ROMANIA CUTIE X 4 BLIST. X 10 COMPR. P-6 40 0.093600 0.093600 0.088900
175 N07CA CINNARIZINUM CINARIZIN 25 mg COMPR. 25mg LAROPHARM SRL ROMANIA CUTIE X 3 BLIST. X 20 COMPR. P-6 60 0.078000 0.078000 0.000000
176 P01AX TENONITROZOLUM ATRICAN 250 mg CAPS. MOI GASTROREZ. 250mg LAB. INNOTECH INT. FRANTA CUTIE X 1 BLIST. AL/PVC X 8 CAP P- 8 1.445000 1.445000 0.000000
177 P02CC PYRANTELUM HELMINTOX (R) SUSP. ORALA 125mg/2,5ml LAB. INNOTECH INT. FRANTA CUTIE X 1 FLACON X 15 ML P- 1 6.560000 6.560000 0.000000
178 R01AD TIXOCORTOLUM PIVALONE 0,9mg/pulverizare SPRAY NAZAL SUSPENSIE 0,9mg/pulve PFIZER EUROPE M M CUTIE X 1 P- 1 10.880000 10.880000 0.000000
179 R01A COMBINATII (B BIORINIL SPRAY NAZ 0,5 mg/1 mg/ THEA FARMA SPA ITALIA CUTI P- 1 26.840000 26.840000 0.000000
180 R01BA COMBINATI AERINAZE (vezi R06AX2 COMPR. FILM. ELIB. MODIF. 2,5mg/120mg MERCK SHARP & M CUTIE X 10 COMPR.FILM.EL P- 10 2.179000 2.179000 0.000000
181 R01BA COMBINATII (LO CLARINASE 5 mg/120 mg COMPR. 5mg/120mg MERCK SHARP & ROMANIA CUTIE CU 1 BLIST. PVC/AL X 7 COMPR. P-6 7 1.372857 1.372857 0.000000
182 R02AB FUSAFUNGINUM BIOPAROX 50mg/10ml
SPRAY BUCOFARINGIAN SI NAZAL-SOL. LES LABORATOI FRANTA CUTIE X 1 FLACON PRESURIZAT DIN AL X 10 ML SOL. + 3 APLIC. DIN PE: 1 APLIC. BUCAL (ALB) + 2 APLIC. P- 1 20.770000 20.770000 0.000000
183 R03CA EPHEDRINI HYDROCHLORIDUM EFEDRINA ARENA COMPR. 50mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P- 30 0.324666 0.324666 0.000000
184 R03CA EPHEDRINI HYDROCHLORIDUM EFEDRINA 50 mg/ ml SOL. INJ. 50mg/ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE CU INEL DE RUPERE S 5 1.538000 1.538000 0.000000
185 R03CA EPHEDRINI HYDROCHLORIDUM EFEDRINA ZENTIVA 50 mg/ m SOL. INJ. 50mg/ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE CU INEL DE RUPERE S 5 1.538000 1.538000 0.000000
186 R05CB ACETYLCYSTEINUM ACC INJECT 300mg/3ml 300mg/3ml
SOL. INJ./ SOL. PT. INHALAT PRIN NEBULIZATOR
HEXAL AG GERMANI CUTIE X 5 FIOLE DIN STICLA BRUNA X S/P-RF 5 1.566000 1.566000 0.000000
187 R05CB ACETYLCYSTEINUM FLUIMUCIL 2% PEDIATRIC SOL. ORALA 2% ZAMBON S.P.A. ITALIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 100 ML SOL. ORALA + MASURA DOZATOARE (5 SI 10 ML) P- 1 13.620000 13.620000 0.000000

Pagina 83 din 87
Val. maxima suportata de Co-plata maxima a
sistemul de asigurari asiguratului / UT

Prescriptie
sociale de sanatate / UT (pt. asiguratii care
cant. (pt. asiguratii care beneficiaza de
UT/ Pret de beneficiaza de compensare 100%
cod Tara det. amba referinta / UT compensare 100% din din pretul de
Nr. crt ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)
188 R05CB ACETYLCYSTEINUM FLUIMUCIL 300mg/3ml
SOL.INJ./INHAL.NEBULIZ./INSTILATIE ENDOTRAHEOBRON.
ZAMBON S.P.A. ITALIA CUTIE X 5 FIOLE DIN STICLA X 3 ML SOL.INJ/SOL.PT.INHALAT PRIN NEBULIZATOR/SOL.PT.INSTILATIE ENDOTRAH S/P-RF 5 1.710000 1.710000 0.000000
189 R05CB CARBOCISTEINUM RHINATHIOL 100mg/5ml pent SIROP 100 mg/5 ml SANOFI-AVENTIS OT FRANTA CUTIE X 1 FLACON DIN STICLA INCOLORA X 125 ML SIROP + LINGURITA DOZATOARE P- 1 7.428000 7.428000 2.092000
190 R05CB CARBOCISTEINUM HUMEX EXPECTORANT SIROP 100mg/5ml LAB. URGO FRANTA CUTIE X 1 FLACON X 12 P- 1 6.190000 6.190000 0.000000
191 R05CB CARBOCISTEINUM RHINATHIOL 2% pentru copii SIROP 2% SANOFI-AVENTIS OT FRANTA CUTIE X 1 FLACON DIN STICLA INCOLORA X 125 ML SIROP + LINGURITA DOZATOARE P- 1 7.428000 7.428000 2.092000
192 R05CB CARBOCISTEINUM FLUIDOL 100mg/5ml SOL. ORALA 100mg/5ml TIS FARMACEUTIC S ROMANIA CUTIE X 1 FLACON DIN PVC X 100 ML SIROP + LINGURITA DUBLA GRADATA LA 2,5 SI 5 ML P- 1 4.160000 4.160000 0.000000
193 R06AD PROMETHAZINUM ROMERGAN SIROP 5mg/5ml BIOFARM S.A. ROMANIA CUTIE X P- 1 2.910000 2.910000 0.000000
194 R06AE MECLOZINUM EMETOSTOP COMPR. 30mg SPECIFAR SA GRECIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P- 10 0.373000 0.373000 0.000000
195 R06AX CYPROHEPTADINUM PERITOL COMPR. 4mg EGIS PHARMA UNGARIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.168500 0.168500 0.000000
196 R06AX CYPROHEPTADINUM CIPROHEPTADINA ARENA 4 COMPR. 4mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.169333 0.169333 0.000000
197 R06AX LORATADINUM CLARITINE SIROP 1mg/ml MERCK SHARP & ROMANIA CUTIE X 1 FLACON X 120 ML + LIN P-6 1 12.756000 12.756000 3.594000
198 R06AX LORATADINUM LORATADINA BIOFARM 5mg/ SIROP 5mg/5ml BIOFARM S.A. ROMANIA CUTIE CU UN FLACON DIN STICLA BRUNA X 100ML SIROP SI O MASURA DOZATOARE DIN PE, PREVAZUTA CU GRADATII DE LA 2,5 LA 20ML P- 1 7.350000 7.350000 0.000000
199 R06AX LORATADINUM LORATADINA LEK 5mg/5ml SUSP. ORALA 5mg/5ml LEK PHARMACEU SLOVENI CUTIE X 1 FLACON DIN STICLA BRUNA X 120 ML SUSP. ORALA + LINGURITA DOZATOARE P-6 1 10.630000 10.630000 0.000000
200 S01AA CHLORAMPHENICOLUM SIFICETINA PULB. + SOLV. PT. SOL. OFT. 4mg/ml S.I.F.I. SPA ITALIA CUTIE X 1 FLAC. STICLA BRUNA X 5 ML SOLV. + O PUNGA X UN REZERVOR CU PULB. + UN PICURATOR P- 1 20.030000 20.030000 0.000000
201 S01AA ACIDUM FUSIDICUM FUCITHALMIC 10mg/g GEL OFT. 10mg/g AMDIPHARM LIMITE IRLANDA CUTIE X 1 TUB AL P-6 1 13.980000 13.980000 0.000000
202 S01AA KANAMYCINUM KANAMICINA SULFAT 1% UNG. OFT. 1% ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB AL X 6 G P- 1 6.640000 6.640000 0.000000
203 S01AA COMBINATII COLBIOCIN PULB. + SOLV. PT. SOL. OFT. FAR S.I.F.I. SPA ITALIA C P- 1 33.280000 33.280000 0.000000
204 S01BA FLUOROMETHOLONUM FLUMETOL S PICATUR 2mg/ml THEA FARMA SPA ITALIA CUTIE X 1 FLACON PEJD X 10ML PIC. O P- 1 33.220000 33.220000 0.000000
205 S01BC INDOMETACINUM INDOCOLLYRE (R) 0,1% PICATURI 0,1% LAB. CHAUVIN FRANTA CUTIE X 1 FLACON PICURATOR DI P-6 1 14.500000 14.500000 0.000000
206 S02CA COMBINATII OTIS-T PICATURI AURICULARE-SOL. FAR TIS FARMACEUTIC S ROMANIA CUTIE X 1 FLACON DIN PE X 10 P- 1 4.212000 4.212000 0.948000
207 S02CA COMBINATII SOLUTIE AURICULARA CU CLORAMFENICOL SI FLUOCINOLON SOL. AUR FAR BIOFARM SA ROMANIA CUTIE X 1 FLAC DIN STICLA BRUNA+APLICATOR TIP PIPETA X 10 ML SOL. AURICULARA P- 1 3.510000 3.510000 0.000000

Nota:
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (**) se efectueaza pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale MS;
- Tratamentul cu medicamentele corespunzatoare DCI-urilor notate cu (***) se face pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale MS si cu aprobarea comisiilor de la nivelul
Caselor Judetene de Asigurari de Sanatate;
Medicamentele din aceast sublist corespund DCI-urilor din nomenclatorul de produse, altele dect cele din sublistele A, B, sublista C seciunea C1 i sublista D. Pentru categoriile de asigurai menionate n
aceast sublist, medicamentele corespunztoare denumirilor comune internaionale din sublista A, sublista B, seciunea C1 a sublistei C i sublista D se vor acorda n regim de compensare de 100% la pre de
referin, indiferent de indicaia pentru care sunt prevzute n aceste subliste.

Pagina 84 din 87
ANEXA 2e

SUBLISTA D - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 20% DIN PRETUL DE REFERINTA CONFORM

DENUMIRILOR COMUNE INTERNATIONALE (DCI) CORESPUNZATOARE MEDICAMENTELOR DE CARE BENEFICIAZA ASIGURATII, IN TRATAMENTUL AMBULATORIU CU CONTRIBUTIE
PERSONALA DIN HG NR. 720/2008 CU COMPLETARILE SI MODIFICARILE ULTERIOARE
VALABILA INCEPAND CU 01 IANUARIE 2016

Co-plata maxima a Val. maxima suportata de Co-plata maxima a


asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 20%
tara det. amba referinta / UT din pretul de compensare 20% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)

1 A02BA RANITIDINUM RANITIDINA ARENA 300 mg CAPS. 300mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 5 CAPS. P-6 10 0.419850 0.250150 0.083970 0.586030
2 A02BA RANITIDINUM RANITIDIN ARENA 150mg COMPR. 150mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6 20 0.209925 0.025575 0.041985 0.193515
3 A02BA RANITIDINUM RANITIDINA 150 mg COMPR. 150mg MAGISTRA C&C S.R.L ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.209925 0.026575 0.041985 0.194515
4 A02BA RANITIDINUM RANITIDIN COMPR. 150mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.209925 0.025575 0.041985 0.193515
5 A02BA RANITIDINUM ZANTAC 150 mg COMPR. FILM 150mg GLAXO WELLCOME M CUTIE X 2 BLIST. AL/AL X 10 COMPR. FI P-6 20 0.209925 0.153575 0.041985 0.321515
6 A02BA RANITIDINUM RANITIDINA LPH 150 mg COMPR. FILM 150mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 P-6 20 0.209925 0.025575 0.041985 0.193515
7 A02BA RANITIDINUM RANITIDINA ATB 150 MG COMPR. FILM 150mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. FILM. P-6 20 0.209925 0.025575 0.041985 0.193515
8 A02BA RANITIDINUM RANITIDINA LAROPHARM 1 COMPR. FILM 150mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6 20 0.209925 0.021075 0.041985 0.189015
9 A02BA RANITIDINUM RANITIDINA LPH 150 mg COMPR. FILM 150mg LABORMED PHARMA ROMANIA CUTIE CU 3 P-6 30 0.209925 0.026408 0.041985 0.194348
10 A02BA RANITIDINUM ARNETIN SOL. INJ. 25mg/ml MEDOCHEMIE LTD. CIPRU CUTIE X 5 FIOLE X 2 ML P-R 5 1.470596 1.157404 0.294119 2.333881
11 A02BA FAMOTIDINUM FAMODIN 20 mg COMPR. FILM 20mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.209925 0.086408 0.041985 0.254348
12 A02BA FAMOTIDINUM FAMOTIDINA ZENTIVA 20mg COMPR. FILM 20mg ZENTIVA S.A ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.202333 0.000000 0.040466 0.161867
13 A02BA FAMOTIDINUM QUAMATEL 20 mg COMPR. FILM 20mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6 28 0.209925 0.140075 0.041985 0.308015
14 A02BA FAMOTIDINUM FAMOTIDINA ZENTIVA 40 mg COMPR. FILM 40mg ZENTIVA S.A ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.267000 0.000000 0.053400 0.213600
15 A02BA FAMOTIDINUM FAMODIN 40 mg COMPR. FILM 40mg AC HELCOR PHARM ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.410333 0.000000 0.082066 0.328267
16 A02BA FAMOTIDINUM QUAMATEL 20 mg PULB+SOLV. PT. SOL. INJ./PERF. 20mg GEDEON RIC ROMANIA CUTIE X 5 FLACOANE DIN STICLA INCOLORA CU PULBERE PENTRU SOLUTIE INJ./PERF. + 5 FIOLE DIN STICLA INCOLORA X 5ML SOLV. PENTRU UZ PARENTERAL S/P-RF 5 3.908000 0.000000 0.781600 3.126400
17 A02BA NIZATIDINUM NIZATIDIN VIM SPECTRUM CAPS. 150mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-6 20 0.209925 0.701575 0.041985 0.869515
18 A02BX SUCRALFATUM GASTROFAIT COMPR. 1g E.I.P.I.CO. MED S.R.L ROMANIA CUTIE X 5 BLIST. AL/PVC X 4 COMPR. P-6 20 0.305000 0.000000 0.061000 0.244000
19 A02BX SUCRALFATUM VENTER COMPR. 1g KRKA D.D. SLOVENI CUTIE X 5 BLIST. X 10 COMPR. P-6 50 0.310100 0.015300 0.062020 0.263380
20 A03AA MEBEVERINUM DUSPATALIN 200 mg CAPS. ELIB 200mg AB OLANDA CUTIE X 3 BLIST. X 10 CAPS. ELIB. PREL P-6 30 0.778666 0.000000 0.155733 0.622933
21 A03AA MEBEVERINUM DUSPATALIN 200 mg CAPS. ELIB 200mg AB OLANDA CUTIE X 2 BLIST. X 15 CAPS. ELIB. PREL P-6 30 0.778666 0.000000 0.155733 0.622933
22 A03AA MEBEVERINUM COLOSPASMIN DRAJ. 100mg E.I.P.I.CO. MED SRL ROMANIA CUTIE X 2 BLIST., AL/PVC X 10 DRAJ. P-6 20 0.389333 0.056667 0.077866 0.368134
23 A03AA TRIMEBUTINUM TRIMEBUTIN 100 COMPR. 100mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6 30 0.384666 0.000000 0.076933 0.307733
24 A03AA TRIMEBUTINUM COLPERIN 100 mg COMPR. 100mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.384666 0.000000 0.076933 0.307733
25 A03AA TRIMEBUTINUM DEBRIDAT 100 mg COMPR. FILM 100mg PFIZER EUROPE M M CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.384666 0.208000 0.076933 0.515733
26 A03AA TRIMEBUTINUM DEBRIDAT 200 mg COMPR. FILM 200mg PFIZER EUROPE M M CUTIE CU 3 BLIST. PVC/AL X 10 COMPR P6L 30 0.769334 0.355332 0.153866 0.970800
27 A03AA TRIMEBUTINUM IBUTIN (R) 300 mg COMPR. FILM. ELIB. PREL. 300mg ZENTIVA SA ROMANIA CUTIE X 2 BLIST. PVC-PV P-6 20 1.154002 0.714498 0.230800 1.637700
28 A03AA TRIMEBUTINUM DEBRIDAT GR 24mg/5ml PFIZER EUROPE M M CUTIE X 1 FLAC. DIN STICLA BRUNA X 76,25 G GRANULE PT. 125ML SUSP. + MASURA DOZATOARE P-6 1 6.563250 3.856750 1.312650 9.107350
29 A03AA TRIMEBUTINUM DEBRIDAT GR 24mg/5ml PFIZER EUROPE M M CUTIE X 1 FLAC. DIN STICLA BRUNA X 152,5 G GRANULE PT. 250ML SUSP. + MASURA DOZATOARE P-6 1 12.500000 0.000000 2.500000 10.000000
30 A03FA DOMPERIDONUM MOTILIUM 10 mg COMPR. FILM 10mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. X 10 COMPR. FILM. P-6 10 0.104000 0.352000 0.020800 0.435200
31 A03FA DOMPERIDONUM OROPERIDYS 10 mg COMPR. ORODISPERSABILE 10mg PIERRE FABRE FRANTA CUTIE CU BLIST. PVC-PE-PVD P6L 30 0.104000 0.597666 0.020800 0.680866
32 C01EB TRIMETAZIDINUM TRIMETAZIDINA LPH 35 mg C 35mg LABORMED PHARMA ROMANIA CUTIE X 6 BLIST. AL/PVC X 10 P-6 60 0.401083 0.000250 0.080216 0.321117
33 C01EB TRIMETAZIDINUM TRIMETAZIDINA ATB 35 mg CO 35mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC-P P6L 30 0.401000 0.000000 0.080200 0.320800
34 C01EB TRIMETAZIDINUM PREDUCTAL MR 35 mg COMPR. 35mg LES LABORATOI FRANTA CUTIE X 2 BLIST. AL/PVC X 30 P-6 60 0.401083 0.196417 0.080216 0.517284
35 C01EB TRIMETAZIDINUM TRIMELUZINE 35 mg COMPR. 35mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-ACLAR/A P6L 60 0.380333 0.000000 0.076066 0.304267
36 C01EB TRIMETAZIDINUM MODUXIN MR 35 mg COMPR. 35mg GEDEON RIC ROMANIA CUTIE CU BLIST. AL/PVC P6L 30 0.401000 0.000000 0.080200 0.320800
37 C01EB TRIMETAZIDINUM MODUXIN (R) 20 mg COMPR. FILM 20mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.229190 0.034143 0.045838 0.217495
38 C01EB TRIMETAZIDINUM TRIMETAZIDINA LPH (R) 20 COMPR. FILM 20mg LABORMED PHARMA ROMANIA CUTIE X 3 BLIST. AL/PVC X 20 COMPR. P-6 60 0.229190 0.034310 0.045838 0.217662
39 C01EB TRIMETAZIDINUM PREDUCTAL 20 mg COMPR. FILM 20mg LES LABORATOI FRANTA CUTIE CU 2 BLIST. PVC/AL X 30 COMPR P-6 60 0.229190 0.175976 0.045838 0.359328
40 C01EB TRIMETAZIDINUM DILATAN 20 mg COMPR. FILM 20mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 P-6 30 0.229190 0.034143 0.045838 0.217495
41 C01EB TRIMETAZIDINUM PREDUTRIM 20 mg/ml PIC. ORALE 20mg/ml ROMPHARM COMP ROMANIA CUTIE CU 1 FLAC. PEID + APLICATOR PT. PICURARE DIN PEJD X 50 ML PIC. ORALE P6L 1 11.459521 0.870479 2.291904 10.038096
42 C04AE NICERGOLINUM NICERIUM (R) 15 CAPS. ELI 15mg HEXAL AG GERMANI CUTIE X 3 BLIST. PP/AL X 10 CAPS. EL P-6 30 0.450166 0.514500 0.090033 0.874633
43 C04AE NICERGOLINUM NICERIUM (R) 30 UNO CAPS. ELI 30mg HEXAL AG GERMANI CUTIE X 3 BLIST. PP/AL X 10 CAPS. EL P-6 30 0.900333 0.000000 0.180066 0.720267
44 C04AE NICERGOLINUM NICERGOLINA LPH 10 mg COMPR. FILM 10mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.300111 0.165222 0.060022 0.405311
45 C04AE NICERGOLINUM GRALIN 10 mg COMPR. FILM 10mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. P-6 30 0.300111 0.162555 0.060022 0.402644
46 C04AE NICERGOLINUM SERMION COMPR. FILM 30mg PFIZER EUROPE M M CUTIE X 2 BLIST. PVC-PVDC/AL- P-6 30 0.900333 0.440333 0.180066 1.160600

Pagina 85 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 20%
tara det. amba referinta / UT din pretul de compensare 20% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
47 C04AE NICERGOLINUM NICERGOLINA LPH 30 mg COMPR. FILM 30mg LABORMED PHARMA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.900333 0.000000 0.180066 0.720267
48 C04AE NICERGOLINUM GRALIN 30 mg COMPR. FILM 30mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. P-6 30 0.900333 0.000000 0.180066 0.720267
49 C04AE NICERGOLINUM GRALIN 5 mg COMPR. FILM 5mg SLAVIA PHARM S.R.L ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. P-6 30 0.150055 0.083611 0.030011 0.203655
50 C04AE NICERGOLINUM NICERIUM (R) 10 DRAJ. 10mg HEXAL AG GERMANI CUTIE X 1 BLIST. AL/PVC X 25 DRAJ. P-6 25 0.300111 0.285489 0.060022 0.525578
51 C04AE NICERGOLINUM SINERGOLIN 30 DRAJ. 30mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-6 30 0.883333 0.000000 0.176666 0.706667
52 C04AE NICERGOLINUM SINERGOLIN 30 DRAJ. 30mg SINTOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 DRAJ. P-6 20 0.882000 0.000000 0.176400 0.705600
53 C04AX VINCAMINUM OXYBRAL SR 30 mg CAPS. ELIB 30mg GLAXOSMITHKL ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC P-6 10 0.961000 0.000000 0.192200 0.768800
54 C04AX VINCAMINUM VINCAMINA DRAJ. 10mg BIOFARM SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 DRAJ. P-6 20 0.327250 0.020750 0.065450 0.282550
55 C05CA DIOSMINUM (COMBINATII)** DETRALEX ( R ) COMPR. FILM 500mg LES LABORATOI FRANTA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6 30 0.912666 0.000000 0.182533 0.730133
56 C10AX ACID OMEGA-3-ESTERI ETILICI TEVOCOR 1000 mg CAPS. MOI 1000 mg TEVA PHARM ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 30 PRF 30 1.372333 0.000000 0.274466 1.097867
57 C10AX ACID OMEGA-3-ESTERI ETILICI OMACOR (R) CAPS. MOI 1000mg PRONOVA NORVEGI FALC. DIN PEID X 28 CAPS. MOI P-R 28 1.557106 0.554322 0.311421 1.800007
58 D06BB ACICLOVIRUM ZOVIRAX CREMA 5% THE WE M CUTIE X 1 TUB X 5G CREMA P-R 1 2.115750 19.734250 0.423150 21.426850
59 D06BB ACICLOVIRUM ACICLOVIR 50mg/g CREMA 5% GEDEON RIC ROMANIA CUTIE X 1 TUB X 5 G CREMA P-R 1 2.115750 3.044250 0.423150 4.736850
60 D06BB ACICLOVIRUM ACICLOVIR 50mg/g CREMA 5% GEDEON RIC ROMANIA CUTIE X 1 TUB X 15 G CREMA P-R 1 6.347250 1.542750 1.269450 6.620550
61 D06BB ACICLOVIRUM ACICLOVIR SLAVIA 50 mg/g CREMA 50mg/g SLAVIA PHARM S.R.L ROMANIA CUTIE CU 1 TUB AL X 5 G CREMA P-R 1 2.115750 3.474250 0.423150 5.166850
62 D06BB ACICLOVIRUM ACICLOVIR-RICHTER 50mg/g CREMA 50mg/g GEDEON RIC ROMANIA CUTIE CU 1 TUB AL X 5 G CREMA PRF 1 2.115750 3.044250 0.423150 4.736850
63 D06BB ACICLOVIRUM ACICLOVIR HYPERION CREMA 50mg/g HYPERION S.A. ROMANIA CUTIE X 1 TUB DIN AL X 15 G CREMA P-R 1 6.347250 0.982750 1.269450 6.060550
64 D06BB ACICLOVIRUM ACICLOVIR TIS 50mg/g CREMA 50mg/g TIS FARMACEUTIC S ROMANIA CUTIE X 1 TUB DIN PEJD X 15 G CREMA P-R 1 4.700000 0.000000 0.940000 3.760000
65 D06BB ACICLOVIRUM ACICLOVIR SLAVIA 50 mg/g CREMA 50mg/g SLAVIA PHARM S.R.L ROMANIA CUTIE CU 1 TUB AL X 15 G CREMA P-R 1 6.347250 0.612750 1.269450 5.690550
66 D06BB ACICLOVIRUM ACICLOVIR TERAPIA 50 mg/g CREMA 50mg/g TERAPIA S.A. ROMANIA CUTIE CU 1 TUB DIN AL X 15 G CREMA PRF 1 6.347250 0.612750 1.269450 5.690550
67 D06BB ACICLOVIRUM ACICLOVIR-RICHTER 50mg/g CREMA 50mg/g GEDEON RIC ROMANIA CUTIE CU 1 TUB AL X 15 G CREMA PRF 1 6.347250 1.542750 1.269450 6.620550
68 H05BA CALCITONINUM (SOMON) NYLEX (R) SOL. INJ. 100UI/ml PROEL E.P. CORON GRECIA CUTIE X 5 FIOLE X 1ML P-R 5 6.714000 0.000000 1.342800 5.371200
69 H05BA CALCITONINUM (SOMON) MIACALCIC (R) SOL. INJ. 50ui/ml NOVARTIS PHARM GERMANI CUTIE X 5 FIOLE X 1 ML P-R 5 3.600675 2.331325 0.720135 5.211865
70 M01A PIROXICAMUM PIROXSAL 20 mg COMPR. 20mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST.PVC/ AL X 10 COMPR. P-6 20 0.136500 0.000000 0.027300 0.109200
71 M01A PIROXICAMUM FLAMEXIN COMPR. 20mg CHIESI FARMACE ITALIA CUTIE X 3 BLIST. PVC-PDVC/AL P-6 30 0.324000 0.643000 0.064800 0.902200
72 M01A PIROXICAMUM PIROXICAM ARENA 20 MG COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.128000 0.000000 0.025600 0.102400
73 M01A PIROXICAMUM PIROXICAM HELCOR 20 mg COMPR. 20mg AC HELCOR PHARM ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.222000 0.000000 0.044400 0.177600
74 M01A PIROXICAMUM FLAMEXIN COMPR. EFF. 20mg CHIESI FARMACE ITALIA CUTIE X 1 BLIST. AL-PE/AL X 10 COMPR P-6 10 0.324000 1.231000 0.064800 1.490200
75 M01A PIROXICAMUM FLAMEXIN COMPR. EFF. 20mg CHIESI FARMACE ITALIA CUTIE X 2 BLIST. AL-PE/AL X 10 COMPR P-6 20 0.324000 1.230500 0.064800 1.489700
76 M01A PIROXICAMUM FLAMEXIN COMPR. EFF. 20mg CHIESI FARMACE ITALIA CUTIE X 3 BLIST. AL-PE/AL X 10 COMPR P-6 30 0.324000 1.181000 0.064800 1.440200
77 M01A PIROXICAMUM FLAMEXIN (R) PULB. 20mg/plic CHIESI FARMACE ITALIA CUT P-6 20 0.324000 1.031000 0.064800 1.290200
78 M01A PIROXICAMUM HOTEMIN SOL. INJ. 20mg/ml EGIS PHARMA UNGARIA CUTIE X 1 BLIST. C-PET/PE X 5 FIO P-R 5 1.965500 0.244500 0.393100 1.816900
79 M01A PIROXICAMUM PIROXICAM ATB 20 mg SUPOZ. 20 mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 FOLII TERMOSUDATE PV P6L 6 0.759249 0.009084 0.151849 0.616484
80 M01A PIROXICAMUM PIROXICAM ATB 20 mg SUPOZ. 20 mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA P P6L 6 0.759249 0.009084 0.151849 0.616484
81 M01A PIROXICAMUM PIROXICAM SINTOFARM 20 SUPOZ. 20mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII TERMOSUDATE X 5 SU P-6 10 0.732000 0.000000 0.146400 0.585600
82 M01AX NIMESULIDUM LEMESIL COMPR. 100mg ANFARM HELLAS S.A. PHARMACEUTICALS GRECIA CUTIE X 2 BLIST. X 10 COMPR. P-R 20 0.356400 0.040600 0.071280 0.325720
83 M01AX NIMESULIDUM NIMESULID 100 mg COMPR. 100mg MAGISTRA C & C ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.356400 0.039600 0.071280 0.324720
84 M01AX NIMESULIDUM NIMESULID SLAVIA COMPR. 100mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.356400 0.039600 0.071280 0.324720
85 M01AX NIMESULIDUM APONIL COMPR. 100mg MEDOCHEMIE LTD CIPRU CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-R 20 0.356400 0.039600 0.071280 0.324720
86 M01AX NIMESULIDUM APONIL COMPR. 100mg MEDOCHEMIE LTD CIPRU CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.356400 0.039600 0.071280 0.324720
87 M01AX NIMESULIDUM NIMESULID ARENA 100 mg COMPR. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-R 10 0.356400 0.039600 0.071280 0.324720
88 M01AX NIMESULIDUM NIMELID 100 mg/plic GRANULE PT. SUSP. ORALA 100mg/plic ROMPHARM COMP ROMANIA CUTIE CU 10 PLICURI DIN FOLIE MULTISTRAT (HARTIE/AL/PE) X 2 G GRANULE PT. SUSP. ORALA PRF 10 0.356400 0.039600 0.071280 0.324720
89 M01AX NIMESULIDUM NIMELID 100 mg/plic GRANULE PT. SUSP. ORALA 100mg/plic ROMPHARM COMP ROMANIA CUTIE CU 30 PLICURI DIN FOLIE MULTISTRAT (HARTIE/AL/PE) X 2 G GRANULE PT. SUSP. ORALA PRF 30 0.356400 0.039600 0.071280 0.324720
90 M05B ACIDUM IBANDRONICUM** ACID IBANDRONIC TEVA 15 COMPR. FILM 150 mg TEVA PHARMA B.V. OLANDA CUTIE CU BLIST. DI P6L 1 28.166785 7.233215 5.633357 29.766643
91 M05B ACIDUM IBANDRONICUM** OSSICA 150 mg COMPR. FILM 150mg GEDEON RICHTER P UNGARIA CUTIE CU 1 BLIST. PVC-PE-PVDC/ P-6 1 28.166785 7.513215 5.633357 30.046643
92 M05B ACIDUM IBANDRONICUM** QUODIXOR 150 mg COMPR. FILM 150mg ALVOGEN IPCO S.AR LUXEM CUTIE CU BLIST. PA-AL-PVC/AL X 1 P-6 1 28.166785 7.503215 5.633357 30.036643
93 M05B ACIDUM IBANDRONICUM** OSAGRAND 150 mg COMPR. FILM 150mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 1 BLIST. PVC-PVDC/AL X P6L 1 28.166785 7.513215 5.633357 30.046643
94 M05B ACIDUM IBANDRONICUM** ACID IBANDRONIC SANDO COMPR. FILM 150mg SANDOZ S.R.L. ROMANIA CUTIE CU 1 BLIST. PA-AL-PVC/AL X P6L 1 28.166785 7.513215 5.633357 30.046643
95 M05B ACIDUM IBANDRONICUM** ACID IBANDRONIC AUR COMPR. FILM 150mg AU MALTA CUTIE CU BLIST. PVC-PE-PVDC/AL P6L 1 28.166785 6.873215 5.633357 29.406643
96 M05B ACIDUM IBANDRONICUM** OSSICA 3 mg SOL INJ. IN SERINGA PREUMPLUTA 3mg GEDEON RIC ROMANIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA A 3 ML SOL. INJ. + 1 AC PT. INJECTIE P6L 1 102.101625 1.928375 20.420325 83.609675
97 M05B ACIDUM IBANDRONICUM** ACID IBANDRONIC ACCORD SOL INJ. IN SERINGA PREUMPLUTA 3mg ACCORD HEA M CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA SI 1 AC PT. INJECTARE PR/PRF 1 100.840000 0.000000 20.168000 80.672000
98 M05B ACIDUM IBANDRONICUM** OSAGRAND 3 mg/3 ml SOL. INJ. 3mg/3ml ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 1 FIOLA DIN STICLA P6L 1 102.101625 2.708375 20.420325 84.389675
99 M05B ACIDUM IBANDRONICUM** BONVIVA 3mg/3ml SOL. INJ. IN SERINGA PREUMPLUTA 3mg/3ml ROCHE REGISTRA M CUTIE X 1 SERI P-6 1 102.101625 50.798375 20.420325 132.479675
100 M05BX STRONTIUM RANELATUM OSSEOR 2 g GR 2g LES LAB. SERVIER FRANTA CUTIE X 28 PLICURI HARTI P-R 28 5.203214 0.000000 1.040642 4.162572
101 N03AE CLONAZEPAMUM RIVOTRIL COMPR. 0,5mg ROCHE ROMANIA S.R ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA P-R 50 0.069873 0.071927 0.013974 0.127826

Pagina 86 din 87
Co-plata maxima a Val. maxima suportata de Co-plata maxima a
asiguratului / UT sistemul de asigurari asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
cant. beneficiaza de (pt. asiguratii care beneficiaza de
UT/ Pret de compensare 100% beneficiaza de compensare 20%
tara det. amba referinta / UT din pretul de compensare 20% din din pretul de
Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
102 N03AE CLONAZEPAMUM RIVOTRIL 2 mg COMPR. 2mg ROCHE ROMANIA S.R ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRU P-R 30 0.225000 0.000000 0.045000 0.180000
103 N06BX PIRACETAMUM PIRACETAM ARENA 400 mg CAPS. 400mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6 30 0.099674 0.265992 0.019934 0.345732
104 N06BX PIRACETAMUM PIRACETAM SLAVIA 400 mg COMPR. 400mg SLAVIA PHARM SRL ROMANIA CUTIE X 4 BLIST. DIN PVC/AL X 10 COM P-6 40 0.099674 0.019326 0.019934 0.099066
105 N06BX PIRACETAMUM PIRACETAM FARMEX 400 mg COMPR. 400mg FARMEX COMPANY ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 COMPR. P-6 40 0.099674 0.011326 0.019934 0.091066
106 N06BX PIRACETAMUM PIRACETAM MCC 400mg COMPR. 400mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6 20 0.099674 0.061326 0.019934 0.141066
107 N06BX PIRACETAMUM PIRACETAM SINTOFARM 40 COMPR. 400mg SINTOFARM SA ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6 20 0.099674 0.072826 0.019934 0.152566
108 N06BX PIRACETAMUM PIRACETAM SINTOFARM 40 COMPR. 400mg SINTOFARM SA ROMANIA CUTIE X 4 BLIST. PVC/AL X 10 COMPR. P-6 40 0.099674 0.061826 0.019934 0.141566
109 N06BX PIRACETAMUM PIRACETAM LAROPHARM 4 COMPR. 400mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.099674 0.212326 0.019934 0.292066
110 N06BX PIRACETAMUM LUCETAM (R) 1200 mg COMPR. FILM 1200mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. X 20 COMPR. FILM. P-6 20 0.272500 0.000000 0.054500 0.218000
111 N06BX PIRACETAMUM NOOTROPIL 1200 mg COMPR. FILM 1200mg U.C.B. PHARMA S.A. BELGIA CUTIE CU 10 BLIST. PVC/AL X 10 COMP P6L 100 0.299025 0.107175 0.059805 0.346395
112 N06BX PIRACETAMUM PIRACETAM 400 mg COMPR. FILM 400mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. X 10 COMPR. FILM. P-6 20 0.099674 0.082326 0.019934 0.162066
113 N06BX PIRACETAMUM LUCETAM COMPR. FILM 400mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. DIN STICLA BR P-6 60 0.099674 0.021992 0.019934 0.101732
114 N06BX PIRACETAMUM PIRACETAM HELCOR 400mg COMPR. FILM 400mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6 20 0.099674 0.022826 0.019934 0.102566
115 N06BX PIRACETAMUM PIRACETAM-RICHTER 400 m COMPR. FILM 400mg GEDEON RIC ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR P6L 20 0.099674 0.082326 0.019934 0.162066
116 N06BX PIRACETAMUM PIRACETAM 800 mg COMPR. FILM 800mg GEDEON RIC ROMANIA CUTIE X 2 BLIST. X 10 COMPR. FILM. P-6 20 0.199349 0.021651 0.039869 0.181131
117 N06BX PIRACETAMUM LUCETAM COMPR. FILM 800mg EGIS PHARMA UNGARIA CUTIE X 1 FLAC. DIN STICLA BR P-6 30 0.199349 0.021984 0.039869 0.181464
118 N06BX PIRACETAMUM NOOTROPIL 800 mg COMPR. FILM 800mg U.C.B. PHARMA S.A. BELGIA CUTIE CU 6 BLIST. PVC/AL X 15 COMPR P6L 90 0.199349 0.141206 0.039869 0.300686
119 N06BX PIRACETAMUM PIRACETAM HELCOR 800mg COMPR. FILM 800mg AC HELCOR PHARM ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR.F P-6 20 0.199349 0.021651 0.039869 0.181131
120 N06BX PIRACETAMUM PIRACETAM-RICHTER 800 m COMPR. FILM 800mg GEDEON RIC ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR P6L 20 0.199349 0.021651 0.039869 0.181131
121 N06BX PIRACETAMUM MEMOTAL1 g/5 ml SOL. INJ. 1g/5ml ZENTIVA SA ROMANIA C P-R 5 1.862000 0.000000 0.372400 1.489600
122 R05CB ERDOSTEINUM** ERDOMED 300 mg CAPS. 300mg CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 CA P-6 10 1.633000 0.000000 0.326600 1.306400
123 R05CB ERDOSTEINUM** ERDOMED 225 mg GR 225mg CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE CU 20 PLICURI UNIDOZA DIN P-6 20 1.293937 0.207563 0.258787 1.242713
124 R05CB ERDOSTEINUM** ERDOMED 175 mg/5 ml PUL 175mg/5ml CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA BRUNA A 50 G PULB. PT. OBTINEREA A 100 ML SUSP. ORALA + 1 MASURA DOZATOA P-6 1 24.439999 0.000001 4.887999 19.552001

NOT:

- Tratamentul cu medicamentele corespunztoare DCI-urilor notate cu (**) se efectueaz pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sntii.

Pagina 87 din 87

S-ar putea să vă placă și