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ANEXA 6

(ANEXA 2a la Ordinul CNAS nr. 1611/2018)

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 SI FARA CONTRIBUTIE PERSONALA DIN
HG NR. 720/2008, CU MODIFICARILE SI COMPLETARILE ULTERIOARE,
VALABILA INCEPAND CU 19 MARTIE 2019

Contributie maxima Val. maxima suportata de Contributie maxima


a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

Prescriptie
Cod_CIM

cant. beneficiaza de (pt. asiguratii care beneficiaza de


UT/ Pret de compensare 100% beneficiaza de compensare 90%
Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)

SE ADAUGA

1,023 W65062001 A02BC03 LANSOPRAZOLUM LEVANT 15 mg CAPS. GASTROREZ. 15mg TERAPIA S.A. ROMANIA CUTIE CU 2 BLIST. AL-PVC-PA/AL X 7 CAPS. GASTROREZ. P6L 14 0.266175 0.245253 0.239557 0.271871
1,024 W65063001 A02BC03 LANSOPRAZOLUM LEVANT 30 mg CAPS. GASTROREZ. 30mg TERAPIA S.A. ROMANIA CUTIE CU 2 BLIST. AL-PVC-PA/AL X 7 CAPS. GASTROREZ. P6L 14 0.532350 0.354792 0.479115 0.408027
1,025 W62461001 B01AA07 ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg MERUS LABS LUXCO II S.A.R.L. LUXEMBURG CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.355000 0.000000 0.319500 0.035500
1,026 W63966005 C08CA01 AMLODIPINUM ALMIDEN 10 mg COMPR. 10mg ACCORD HEALTHCARE LIMITED CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR.
MAREA BRITANIE P6L 30 0.278399 0.017934 0.250559 0.045774
1,027 W64900006 C08CA01 AMLODIPINUM NORVASC 10 mg COMPR. 10mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.278399 0.197601 0.250559 0.225441
1,028 W63965005 C08CA01 AMLODIPINUM ALMIDEN 5 mg COMPR. 5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.139199 0.024134 0.125279 0.038054
1,029 W64899006 C08CA01 AMLODIPINUM NORVASC 5 mg COMPR. 5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.139199 0.315467 0.125279 0.329387
1,030 W65067001 C09AA03 LISINOPRILUM RANOLIP 10 mg COMPR. 10mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.156600 0.389400 0.140940 0.405060
1,031 W65068001 C09AA03 LISINOPRILUM RANOLIP 20 mg COMPR. 20mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.313200 0.528466 0.281880 0.559786
1,032 W65066001 C09AA03 LISINOPRILUM RANOLIP 5 mg COMPR. 5mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.078300 0.200033 0.070470 0.207863
1,033 W62447012 C09AA05 RAMIPRILUM TRITACE 10 mg COMPR. 10mg SANOFI ROMANIA S.R.L.ROMANIA CUTIE CU BLIST. PVC/AL/ X 90 COMPR. P6L 90 0.588777 0.000000 0.529899 0.058878
1,034 W62451011 C09AA05 RAMIPRILUM TRITACE 2,5 mg COMPR. 2,5mg SANOFI ROMANIA S.R.L.ROMANIA CUTIE CU BLIST. PVC/AL/ X 60 COMPR. P6L 60 0.156600 0.168066 0.140940 0.183726
1,035 W62382008 C09AA05 RAMIPRILUM TRITACE 5 mg COMPR. 5mg SANOFI ROMANIA S.R.L.ROMANIA CUTIE CU BLIST. PVC/AL/ X 30 COMPR. P6L 30 0.313200 0.210800 0.281880 0.242120
1,036 W65064001 C10AA03 PRAVASTATINUM PRAVATOR 20 mg COMPR. 20mg TERAPIA S.A. ROMANIA CUTIE X 4 BLIST. PA-AL-PVC/AL X 7 COMPR.P-6L 28 0.193349 0.676293 0.174014 0.695628
1,037 W65065001 C10AA03 PRAVASTATINUM PRAVATOR 40 mg COMPR. 40mg TERAPIA S.A. ROMANIA CUTIE X 4 BLIST. PA-AL-PVC/AL X 7 COMPR.P-6L 28 0.386699 0.999015 0.348029 1.037685
1,038 W65088002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 500 mg/125 mg COMPR. FILM. 500mg/125mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA PRF
CUTIE CU 2 BLIST. PVC-PVDC/AL X 7 COMPR. FILM., FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTOARE DIN AL LAMINAT 14 0.578775 0.377653 0.520897 0.435531
1,039 W65089001 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 875 mg/125 mg COMPR. FILM. 875mg/125mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA PRF
CUTIE CU 2 BLIST. PVC-PVDC/AL X 7 COMPR. FILM., FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTOARE DIN AL LAMINAT 14 1.012857 0.544285 0.911571 0.645571
1,040 W64190005 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN FP 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml GLAXOSMITHKLINE (GSK) SRL ROMANIA PRF
CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA CARE CONTINE PULB. PT 70 ML SUSP. ORALA SI O LINGURITA 1 18.384500 2.695500 16.546050 4.533950
1,041 W65099003 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN ES 600mg/42,9 mg/5 ml PULB. PT. SUSP. ORALA 600 mg/42,9mg/5ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA PRF
CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA CONTINÂND PULB. PENTRU 100 ML SUSPENSIE SI O LINGURITA DOZATOARE DIN POLISTIREN, MARCAT CU GRADATII PT. MASURAREA VOLUMELOR 2,5 ML SI 5,0 ML 1 37.470000 0.000000 33.723000 3.747000
1,042 W65111001 J01DC02 CEFUROXIMUM ZINNAT 125 mg COMPR. FILM. 125mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. PRF 10 1.190000 0.000000 1.071000 0.119000
1,043 W65112001 J01DC02 CEFUROXIMUM ZINNAT 250 mg COMPR. FILM. 250mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. PRF 10 1.034100 0.714900 0.930690 0.818310
1,044 W65113001 J01DC02 CEFUROXIMUM ZINNAT 500 mg COMPR. FILM. 500mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-RF 10 2.068200 0.936800 1.861380 1.143620
1,045 W65114001 J01DC02 CEFUROXIMUM ZINNAT 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA PRF
CUTIE CU 1 FLAC. DIN STICLA BRUNA CONTINAND GRANULE PT. 50 ML SUSP. ORALA + 1 MASURA DOZATOARE A 5 ML 1 12.663333 8.536667 11.396999 9.803001
1,046 W63367003 J01DD08 CEFIXIMUM CEFIXIMA AUROBINDO 200 mg COMPR. FILM. 200mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 10 COMPR. FILM. PRF 10 3.731000 0.000000 3.357900 0.373100
1,047 W65069001 J01MA01 OFLOXACINUM ZANOCIN 200 mg COMPR. FILM. 200mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. FILM. PRF 10 1.122300 0.117700 1.010070 0.229930
1,048 W65056001 J01MA02 CIPROFLOXACINUM CIFRAN COMPR. FILM. 250mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. PRF 10 0.561150 0.195850 0.505035 0.251965
1,049 W65057001 J01MA02 CIPROFLOXACINUM CIFRAN COMPR. FILM. 500mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. PRF 10 0.958000 0.000000 0.862200 0.095800
1,050 W60377004 J01MA06 NORFLOXACINUM NORFLOXACINA ARENA 400 mg CAPS. 400mg ARENA GROUP SA ROMANIA CUTIE CU 5 BLIST DIN PVC/AL X 10 CAPS. PRF 50 0.852250 0.097350 0.767025 0.182575
1,051 W60377003 J01MA06 NORFLOXACINUM NORFLOXACINA ARENA 400 mg CAPS. 400mg ARENA GROUP SA ROMANIA CUTIE CU 2 BLIST. DIN PVC/AL X 10 CAPS. PRF 20 0.852250 0.128750 0.767025 0.213975
1,052 W65059001 N03AX12 GABAPENTINUM GABARAN 300 mg CAPS. 300mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 50 0.389516 1.028884 0.350564 1.067836
1,053 W65060001 N03AX12 GABAPENTINUM GABARAN 400 mg CAPS. 400mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 50 0.519356 1.070044 0.467420 1.121980
1,054 W65061001 N03AX12 GABAPENTINUM GABARAN 600 mg COMPR. FILM. 600mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. AL-PVC-PA/AL X 10 COMPR. FILM. P6L 30 0.779034 1.516632 0.701130 1.594536
1,055 W65049001 N05BA12 ALPRAZOLAMUM * XANAX 0,25 mg COMPR. 0,25mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.069500 0.128833 0.062550 0.135783
1,056 W65050001 N05BA12 ALPRAZOLAMUM * XANAX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.139000 0.162333 0.125100 0.176233
1,057 W65051001 N05BA12 ALPRAZOLAMUM * XANAX 1 mg COMPR. 1mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.278000 0.138000 0.250200 0.165800
1,058 W64944001 R03AC02 SALBUTAMOLUM VENTOLIN 5 mg/ml SOL. DE INHALAT PRIN NEBULIZATOR 5mg/ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 10 ML SOL. DE INHAL. PRIN NEBULIZATOR P6L 1 1.804950 6.395050 1.624455 6.575545

SE MODIFICA

1 W64020007 A02BC01 OMEPRAZOLUM OMEZ 10 mg CAPS. GASTROREZ. 10mg ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ.
DR. REDDY'S LABORATORIES P6L 30 0.266175 0.368158 0.239557 0.394776
2 W42129001 A02BC01 OMEPRAZOLUM OMEPRAZOL-RICHTER 20 mg CAPS. GASTROREZ. 20mg ROMANIA CUTIE X 2 BLIST. PVC-AL-PA/AL X 7 CAPS. GASTROREZ.
GEDEON RICHTER ROMANIA SA P-6L 14 0.532350 0.189792 0.479115 0.243027
3 W51990001 A02BC01 OMEPRAZOLUM OMEPRAZOL 20 mg CAPS. GASTROREZ. 20mg SLAVIA PHARM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. GASTROREZ. P-6L 30 0.532350 0.291983 0.479115 0.345218
4 W52044001 A02BC01 OMEPRAZOLUM OMEPRAZOL TERAPIA 20 mg CAPS. GASTROREZ. 20mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. GASTROREZ. P-6L 30 0.532350 0.288316 0.479115 0.341551
5 W52887001 A02BC01 OMEPRAZOLUM OMEPRAZOL ARENA 20 mg CAPS. GASTROREZ. 20mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. GASTROREZ. P-6L 30 0.532350 0.269983 0.479115 0.323218

Pagina 1 din 5
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

Prescriptie
Cod_CIM

cant. beneficiaza de (pt. asiguratii care beneficiaza de


UT/ Pret de compensare 100% beneficiaza de compensare 90%
Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
6 W53138001 A02BC01 OMEPRAZOLUM OMEPRAZOL FARMEX 20 mg CAPS. GASTROREZ. 20mg FARMEX COMPANY SRLROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAPS. GASTROREZ. P-6L 30 0.532350 0.199650 0.479115 0.252885
7 W55651001 A02BC01 OMEPRAZOLUM OMEPRAZOL ROMPHARM 20 mgCAPS. GASTROREZ. 20mg ROMPHARM COMPANY SRL ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAPS. GASTROREZ. P-6L 30 0.532350 0.245650 0.479115 0.298885
9 W58105001 A02BC01 OMEPRAZOLUM OMEZ 20mg CAPS. GASTROREZ. 20mg DR. REDDY'S LABORATORIES ROMANIA CUTIE X 3 FOLII AL/PE-PE/AL X 10 CAPS. GASTROREZ. P-6L 30 0.532350 0.247316 0.479115 0.300551
11 W60470001 A02BC01 OMEPRAZOLUM OMEPRAZOL ATB 20 mg CAPS. GASTROREZ. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 FOLII AL/PE X 10 CAPS. GASTR. P-6L 20 0.532350 0.359650 0.479115 0.412885
15 W61506002 A02BC01 OMEPRAZOLUM OMERAN 20 mg CAPS. GASTROREZ. 20mg GLAXOSMITHKLINE (GSK) SRL ROMANIA CUTIE CU 4 BLIST. AL/AL X 7 CAPS. GASTROREZ. P6L 28 0.532350 0.303721 0.479115 0.356956
16 W53138002 A02BC01 OMEPRAZOLUM OMEPRAZOL FARMEX 20 mg CAPS. GASTROREZ. 20mg FARMEX COMPANY SRLROMANIA CUTIE X 3 BLIST. AL/AL X 10 CAPS. GASTROREZ. P6L 30 0.532350 0.199650 0.479115 0.252885
17 W64021007 A02BC01 OMEPRAZOLUM OMEZ 20 mg CAPS. GASTROREZ. 20mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. P6L 30 0.532350 0.226650 0.479115 0.279885
18 W64023001 A02BC01 OMEPRAZOLUM OMEPRAZOL DR. REDDY'S 20 mgCAPS. GASTROREZ. 20mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 3 FOLII AL/PE-PE/AL X 10 CAPS. GASTROREZ. P6L 30 0.532350 0.247983 0.479115 0.301218
22 W57994002 A02BC01 OMEPRAZOLUM OMEDAR 20 mg COMPR. GASTROREZ. 20mg DAR AL DAWA PHARMA S.R.L. ROMANIA CUTIE X 1 FLAC. DE STICLA BRUNA X 28 COMPR. FILM. GASTROREZ. P-6L 28 0.532350 0.031578 0.479115 0.084813
25 W42951001 A02BC03 LANSOPRAZOLUM LEVANT 15 mg CAPS. GASTROREZ. 15mg RANBAXY UK LTD. MAREA BRITANIE CUTIE X 2 BLIST. PVC-AL-PO/AL-PE X 7 CAPS. GASTROREZ. P-6L 14 0.266175 0.245253 0.239557 0.271871
26 W03936001 A02BC03 LANSOPRAZOLUM LANZUL CAPS. GASTROREZ. 30mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 7 CAPS. GASTROREZ. P-6L 14 0.532350 0.157650 0.479115 0.210885
27 W42952001 A02BC03 LANSOPRAZOLUM LEVANT 30 mg CAPS. GASTROREZ. 30mg RANBAXY UK LTD. MAREA BRITANIE CUTIE X 2 BLIST. PVC-AL-PO/AL-PE X 7 CAPS. GASTROREZ. P-6L 14 0.532350 0.354792 0.479115 0.408027
30 W04254002 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 COMPR. P-6L 40 0.112875 0.041625 0.101587 0.052913
31 W52253001 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID LAROPHARM COMPR. 10mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 20 COMPR. P-6L 40 0.112875 0.003375 0.101587 0.014663
34 W57360001 A03FA01 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-RF 5 2.887999 0.000001 2.599199 0.288801
36 W00187001 A05AA02 ACIDUM URSODEOXYCHOLICUM * URSOFALK (R) CAPS. 250mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 2 BLIST. AL/PVC X 25 CAPS. P-6L 50 1.210399 0.015401 1.089359 0.136441
37 W58710002 A05AA02 ACIDUM URSODEOXYCHOLICUM * URSOFALK 500 mg COMPR. FILM. 500mg DR. FALK PHARMA GMBH GERMANIA CUTIE CU 4 BLIST. PVC-PVDC/AL X 25 COMPR.FILM. P6L 100 2.420799 0.288301 2.178719 0.530381
60 W00009002 B01AA07 ACENOCUMAROLUM TROMBOSTOP 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.192541 0.045125 0.173286 0.064380
69 W51228001 B03AB05 COMPLEX DE HIDROXID DE FER (III) POLIMALTOZAT FERRUM HAUSMANN (R) PICATURI ORALE-SOL. 50mg/ml VIFOR FRANCE S.A. FRANTA CUTIE X 1 FLACON CU PICURATOR X 30 MLP-6L 1 13.337499 1.242501 12.003749 2.576251
70 W51231001 B03AB05 COMPLEX DE HIDROXID DE FER (III) POLIMALTOZAT FERRUM HAUSMANN (R) SIROP 10mg/ml VIFOR FRANCE S.A. FRANTA CUTIE X 1 FLACON X 150 ML + O MASURA DOZATOARE P-6L 1 13.337499 3.492501 12.003749 4.826251
75 W59968001 C01BA01 CHINIDINI SULFAS CHINIDINA ARENA 200 mg COMPR. 200mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.687532 0.035968 0.618778 0.104722
76 W59968002 C01BA01 CHINIDINI SULFAS CHINIDINA ARENA 200 mg COMPR. 200mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.687532 0.014134 0.618778 0.082888
82 W62339001 C01BC03 PROPAFENONUM RYTMONORM 70 mg/20 ml SOL. INJ. 70mg/20ml MYLAN HEALTHCARE GMBH GERMANIACUTIE X 5 FIOLE DIN STICLA INCOLORA X 20 ML SOL. INJ. PRF 5 6.165999 0.000001 5.549399 0.616601
286 W59964001 C08DB01 DILTIAZEMUM DILTIAZEM SR ROMPHARM 180 mg CAPS. ELIB. PREL. 180mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 3 BLIST. DIN FOLIE DE PVC/PVDC/AL X 10 CAPS. ELIB. PREL. P6L 30 0.793916 0.462084 0.714524 0.541476
415 W60908002 C10AA01 SIMVASTATINUM SIMVASTATINA ARENA 10 mg COMPR. FILM. 10 mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. DIN PVC - PVD /AL X 14 COMPR. FILM. P-6L 28 0.096674 0.244397 0.087006 0.254065
416 W12477002 C10AA01 SIMVASTATINUM ZEPLAN (R) 10 mg COMPR. FILM. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILMP-6L 28 0.096674 0.117968 0.087006 0.127636
417 W42158001 C10AA01 SIMVASTATINUM SINTENAL 10 mg COMPR. FILM. 10mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.096674 0.231659 0.087006 0.241327
418 W08725001 C10AA01 SIMVASTATINUM VASILIP 10 mg COMPR. FILM. 10mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. DIN PVC/PE/PVDC/AL X 7 COMPR. FILM. P-6L 28 0.096674 0.203683 0.087006 0.213351
419 W42328001 C10AA01 SIMVASTATINUM SIMVASTATIN LPH 10 mg COMPR. FILM. 10mg LABORMED PHARMA SAROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 0.096674 0.244326 0.087006 0.253994
420 W56959001 C10AA01 SIMVASTATINUM SIMVACARD 10 mg COMPR. FILM. 10mg ZENTIVA K.S. CEHIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.096674 0.059040 0.087006 0.068708
422 W59878005 C10AA01 SIMVASTATINUM SIMVASTATIN TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.096674 0.059326 0.087006 0.068994
423 W60907002 C10AA01 SIMVASTATINUM SIMVASTATINA ARENA 20 mg COMPR. FILM. 20 mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. DIN PVC - PVD /AL X 14 COMPR. FILM. P-6L 28 0.193349 0.262722 0.174014 0.282057
424 W12478002 C10AA01 SIMVASTATINUM ZEPLAN (R) 20 mg COMPR. FILM. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILMP-6L 28 0.193349 0.262722 0.174014 0.282057
425 W51357002 C10AA01 SIMVASTATINUM ZOCOR 20 mg COMPR. FILM. 20mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR.FILM. P-6L 28 0.193349 0.508436 0.174014 0.527771
426 W42159001 C10AA01 SIMVASTATINUM SINTENAL 20 mg COMPR. FILM. 20mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.193349 0.262651 0.174014 0.281986
427 W08479001 C10AA01 SIMVASTATINUM VASILIP 20 mg COMPR. FILM. 20mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. DIN PVC/PE/PVDC/AL X 7 COMPR. FILM. P-6L 28 0.193349 0.262365 0.174014 0.281700
428 W42327001 C10AA01 SIMVASTATINUM SIMVASTATIN LPH 20 mg COMPR. FILM. 20mg LABORMED PHARMA SAROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.193349 0.262651 0.174014 0.281986
429 W56960001 C10AA01 SIMVASTATINUM SIMVACARD 20 mg COMPR. FILM. 20mg ZENTIVA K.S. CEHIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.193349 0.065222 0.174014 0.084557
430 W58958005 C10AA01 SIMVASTATINUM SIMVASTATIN AUROBINDO 20 mgCOMPR. FILM. 20mg AUROBINDO PHARMA LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC/PE/PVDC/AL X 30 COMPR. FILM. P6L 30 0.193349 0.054651 0.174014 0.073986
431 W59879005 C10AA01 SIMVASTATINUM SIMVASTATIN TERAPIA 20 mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.193349 0.262651 0.174014 0.281986
432 W41703002 C10AA01 SIMVASTATINUM SIMVAHEXAL (R) 30 mg COMPR. FILM. 30mg HEXAL AG GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.290024 0.218309 0.261021 0.247312
433 W60906002 C10AA01 SIMVASTATINUM SIMVASTATINA ARENA 40 mg COMPR. FILM. 40 mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. DIN PVC - PVD /AL X 14 COMPR. FILM. P-6L 28 0.386699 0.778658 0.348029 0.817328
434 W13137001 C10AA01 SIMVASTATINUM VASILIP (R) 40 mg COMPR. FILM. 40mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. PVC/PE/PVDC/AL X 7 COMPR. FILM P-6L 28 0.386699 0.392586 0.348029 0.431256
435 W41446002 C10AA01 SIMVASTATINUM ZEPLAN (R) 40 mg COMPR. FILM. 40mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-6L 28 0.386699 0.192586 0.348029 0.231256
436 W41547001 C10AA01 SIMVASTATINUM SINTENAL 40 mg COMPR. FILM. 40mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.386699 0.736634 0.348029 0.775304
437 W52431001 C10AA01 SIMVASTATINUM SIMVASTATIN LPH 40 mg COMPR. FILM. 40mg LABORMED PHARMA S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.386699 0.740967 0.348029 0.779637
440 W59880005 C10AA01 SIMVASTATINUM SIMVASTATIN TERAPIA 40 mg COMPR. FILM. 40mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.386699 0.552634 0.348029 0.591304
441 W06752001 C10AA02 LOVASTATINUM MEDOSTATIN COMPR. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 1 BLIST. X 10 COMPR. P-6L 10 0.128899 0.424101 0.116009 0.436991
442 W57367004 C10AA02 LOVASTATINUM LOVASTATINA ARENA 20 mg COMPR. 20mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.128899 0.813101 0.116009 0.825991
443 W43037001 C10AA03 PRAVASTATINUM PRAVATOR 20 mg COMPR. 20mg RANBAXY U.K. LIMITED MAREA BRITANIE CUTIE X 4 BLIST. PA-AL-PVC/AL X 7 COMPR.P-6L 28 0.193349 0.676293 0.174014 0.695628
444 W43843001 C10AA03 PRAVASTATINUM PRAVATOR 40 mg COMPR. 40mg RANBAXY U.K. LIMITED MAREA BRITANIE CUTIE X 4 BLISTERE DIN PA-AL-PVC/AL X 7 COMPRIMATE P-6L 28 0.386699 0.999015 0.348029 1.037685
463 W51724001 G04CAN1 DOXAZOSINUM DOXAZOSIN ARENA 1 mg (vezi C02CA04) COMPR. 1mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. DIN AL/PVC X 10 COMPR. P-6L 30 0.139950 0.716383 0.125955 0.730378
464 W51724001 G04CAN1 DOXAZOSINUM DOXAZOSIN ARENA 1 mg (vezi C02CA04) COMPR. 1mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. DIN AL/PVC X 10 COMPR. P-6L 30 0.139950 0.716383 0.125955 0.730378
465 W08648002 G04CAN1 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 2mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.279900 0.341433 0.251910 0.369423
466 W08648002 G04CAN1 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 2mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.279900 0.341433 0.251910 0.369423
467 W08649002 G04CAN1 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 4mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDE/AL X 10 COMPR. P-6L 30 0.559800 0.112533 0.503820 0.168513

Pagina 2 din 5
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

Prescriptie
Cod_CIM

cant. beneficiaza de (pt. asiguratii care beneficiaza de


UT/ Pret de compensare 100% beneficiaza de compensare 90%
Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
468 W08649002 G04CAN1 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 4mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDE/AL X 10 COMPR. P-6L 30 0.559800 0.112533 0.503820 0.168513
469 W13893002 G04CAN1 DOXAZOSINUM CARDURA XL 4 mg (vezi G04CAN1) COMPR. ELIB. MODIF. 4mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 4 BLIST. AL-PA-PVDC/AL-PVDC X 7 COMPR. ELIB. PREL. P-6L 28 0.559800 0.446271 0.503820 0.502251
470 W13893002 G04CAN1 DOXAZOSINUM CARDURA XL 4 mg (vezi G04CAN1) COMPR. ELIB. MODIF. 4mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 4 BLIST. AL-PA-PVDC/AL-PVDC X 7 COMPR. ELIB. PREL. P-6L 28 0.559800 0.446271 0.503820 0.502251
487 W00351001 J01CA04 AMOXICILLINUM AMOXICILINA ATB 500 mg CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 0.488250 0.144750 0.439425 0.193575
488 W08428003 J01CA04 AMOXICILLINUM AMOXICILINA FORTE FARMEX 500 mg CAPS. 500mg FARMEX COMPANY SRLROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-RF 10 0.488250 0.127750 0.439425 0.176575
490 W13739001 J01CA04 AMOXICILLINUM AMOXICILINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 5 CAPS. P-RF 10 0.488250 0.132750 0.439425 0.181575
491 W42902001 J01CA04 AMOXICILLINUM AMOXICILINA SANDOZ 500 mg CAPS. 500mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 0.488250 0.030750 0.439425 0.079575
493 W41578001 J01CA04 AMOXICILLINUM OSPAMOX 500 mg COMPR. FILM. 500mg SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. PVC-PVDC/AL X 6 COMPR.FILM. P-RF 12 0.488250 0.029250 0.439425 0.078075
511 W60469001 J01CF04 OXACILLINUM OXACILINA ATB 1000 mg PULB. PT. SOL. INJ./PERF. 1000mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 1 5.565100 0.244900 5.008590 0.801410
513 W60468001 J01CF04 OXACILLINUM OXACILINA ATB 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 1 2.782550 2.577450 2.504295 2.855705
514 W60468003 J01CF04 OXACILLINUM OXACILINA ATB 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 100 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 100 2.782550 1.729150 2.504295 2.007405
515 W55354004 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN SR 1000 mg/62,5 mgCOMPR. ELIB. PREL. 1000mg/62,5mg BEECHAM GROUP PLC MAREA BRITANIE CUTIE CU BLIST. AL/PVC-AL-PP X 28 COMPR. ELIB. PREL. P-RF 28 1.157550 0.572807 1.041795 0.688562
516 W00400003 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 2 x 1000 mg COMPR. FILM. 1000mg LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 2 BLIST. AL/AL X 7 COMPR.FILM. P-RF 14 1.012857 0.000000 0.911571 0.101286
517 W57628002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM ENHANCIN 500 mg/125mg COMPR. FILM. 500 mg/125 mg RANBAXY UK LIMITED CUTIE X 4 FOLII AL-PEJD X 7 COMPR. FILM. P-RF
MAREA BRITANIE 28 0.578775 0.043725 0.520897 0.101603
518 W54453002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 500mg/125mg COMPR. FILM. 500mg/125mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM.
P-RF 14 0.578775 0.043367 0.520897 0.101245
519 W55163002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 500 mg/125 mg COMPR. FILM. 500mg/125mg BEECHAM GROUP PLC MAREA BRITANIE 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-RF 14 0.578775 0.377653 0.520897 0.435531
521 W55401002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 875 mg/125 mg COMPR. FILM. 875mg/125mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 14 1.012857 0.000000 0.911571 0.101286
522 W55164001 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 875 mg/125 mg COMPR. FILM. 875mg/125mg BEECHAM GROUP PLC MAREA BRITANIE 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-RF 14 1.012857 0.544285 0.911571 0.645571
523 W59497004 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM ENHANCIN 875 mg/125 mg COMPR. FILM. 875mg/125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL INTRODUSE IN PUNGI DE POLIESTER/AL/POLIESTER/PE X 14 COMPR. FILM. PRF 14 1.012857 0.000000 0.911571 0.101286
526 W62046002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV QUICKTAB 625 mg 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-RF 14 0.578775 0.711225 0.520897 0.769103
527 W00399001 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 156,25mg/5ml PULB. PT. SUSP. ORALA 156,25mg/5ml LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 1 FLAC. DIN STICLA BRUNA CU 25 MG PULB. PT. 100 ML SUSP. ORALA P-RF 1 8.207366 2.702634 7.386629 3.523371
529 W55355001 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN BIS 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml SMITHKLINE BEECHAM LTD. MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 35 ML SUSP. ORALA + 1 SERINGA PT. ADM. ORALA P-RF 1 9.192250 1.377750 8.273025 2.296975
530 W55355004 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN BIS 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml SMITHKLINE BEECHAM LTD. MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 35 ML SUSP. ORALA + MASURA DOZATOARE P-RF 1 9.192250 1.377750 8.273025 2.296975
531 W55355005 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN BIS 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml SMITHKLINE BEECHAM LTD. MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 35 ML SUSP. ORALA +LINGURITA DOZATOARE PRF 1 9.192250 1.607750 8.273025 2.526975
532 W55355006 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN BIS 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml SMITHKLINE BEECHAM LTD. MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 70 ML SUSP. ORALA +LINGURITA DOZATOARE PRF 1 18.384500 2.775500 16.546050 4.613950
534 W00402001 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 312,5mg/5ml 312,5mg/5ml
PULB. PT.SUSP. ORALA LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 1 FLAC. DIN STICLA BRUNA CU 25 G PULB. PT. 100 ML SUSP. ORALA + LINGURITA DOZATOARE P-RF 1 16.414732 3.585268 14.773258 5.226742
542 W44127002 J01DB01 CEFALEXINUM KEFLEX (R) 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml ACTAVIS GROUP HF ISLANDA CUTIE X 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + LINGURITA DOZATOARE P-RF 1 10.617499 0.832501 9.555749 1.894251
545 W64364001 J01DB01 CEFALEXINUM KEFLEX® 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml TEVA B.V. OLANDA CUTIE CU 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + LINGURITA DOZATOARE PRF 1 10.617499 0.832501 9.555749 1.894251
550 W41659001 J01DB05 CEFADROXILUM CEXYL 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml SANDOZ S.R.L. ROMANIA CUTIE X 1 FLAC. CU GRAN PENTRU 60 ML SUSP. ORALA + O LINGURITA DOZATOARE P-RF 1 5.308749 7.851251 4.777874 8.382126
551 W41660001 J01DB05 CEFADROXILUM CEXYL 250 mg/5 ml GRAN. SUSP. ORALA 250mg/5ml SANDOZ S.R.L. ROMANIA CUTIE X 1 FLAC. CU GRAN. PT. 60 ML SUSP. ORALA + O LINGURITA DOZATOARE P-RF 1 10.617499 1.402501 9.555749 2.464251
561 W12552001 J01DC02 CEFUROXIMUM ZINNAT GRAN. PT. SUSP. ORALA 125mg/5ml GLAXO WELLCOME UK LTD. MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA BRUNA CONTINAND GRANULE PT. 50 ML SUSP. ORALA + 1 MASURA DOZATOARE P-RF 1 12.663333 8.536667 11.396999 9.803001
569 W44130002 J01DC04 CEFACLORUM CECLOR (R) 125 mg/5 ml GRAN. PT. SUSP. ORALA 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-RF 1 9.497500 4.432500 8.547750 5.382250
570 W56969001 J01DC04 CEFACLORUM CEFACLOR TERAPIA 125mg/5ml GRAN. PT. SUSP. ORALA 125mg/5ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID CU GRAN.PT. 75 ML SUSP.ORALA P-RF 1 9.497500 0.042500 8.547750 0.992250
572 W44129002 J01DC04 CEFACLORUM CECLOR (R) 250 mg/5 ml GRAN. PT. SUSP. ORALA 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-RF 1 18.995000 10.085000 17.095500 11.984500
573 W64369001 J01DC04 CEFACLORUM CECLOR 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml TEVA B.V. OLANDA CUTIE CU 1 FLAC. PEID CONTINAND GRANULE PT. 75 ML SUSP. ORALA + 1 LINGURITA DOZATOARE DIN POLISTIREN PRF 1 18.995000 10.085000 17.095500 11.984500
574 W12210001 J01DC04 CEFACLORUM CEFAKLOR 125 mg/5 ml PULB. PT. SUSP. ORALA 125mg/5ml STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. PULB. PT. 60 ML SUSP. ORALA + O MASURA DOZATOARE P-RF 1 7.598000 1.942000 6.838200 2.701800
575 W51321001 J01DC04 CEFACLORUM CEFAKLOR 250 mg/5 ml PULB. PT. SUSP. ORALA 250mg/5ml STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. PULB. PT. 60 ML SUSP. ORALA + O MASURA DOZATOARE P-RF 1 15.196000 2.214000 13.676400 3.733600
576 W57455001 J01DD08 CEFIXIMUM EFICEF 100 mg CAPS. 100mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 1.992249 0.361751 1.793024 0.560976
578 W60256001 J01DD08 CEFIXIMUM XIFIA 400mg COMPR. FILM. 400mg INN-FARM D.O.O. SLOVENIA CUTIE CU UN BLISTER PVC-PVDC/AL X 5 COMPRIMATE FILMATE PRF 5 7.968999 2.583001 7.172099 3.379901
579 W60256003 J01DD08 CEFIXIMUM XIFIA 400mg COMPR. FILM. 400mg INN-FARM D.O.O. SLOVENIA CUTIE CU 2 BLISTERE PVC-PVDC/AL A CATE 5 COMPRIMATE FILMATE PRF 10 7.968999 2.053001 7.172099 2.849901
580 W63368003 J01DD08 CEFIXIMUM CEFIXIMA AUROBINDO 400 mg COMPR. FILM. 400mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 7.968999 0.371001 7.172099 1.167901
581 W61965002 J01DD08 CEFIXIMUM XIFIA 100 mg/5 ml GRANULE PT. SUSP. ORALA 100mg/5ml INN-FARM D.O.O. SLOVENIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, CU CAPCITATEA DE 150 ML CARE CONTINE 53 G GRAN. PT. SUSP. ORALA+1 MASURA DOZATOARE DIN PP PT. MASURAREA VOLUMULUI DE SOLVENT GRADATA LA 66 ML+1 SERINGA DOZATOARE DIN PLASTIC A 5 ML, GRADATA DE LA 0,5 ML PANA LA 5 ML PRF 1 39.845000 37.475000 35.860500 41.459500
609 W07914001 J01MA01 OFLOXACINUM ZANOCIN COMPR. FILM. 200mg RANBAXY UK LIMITED MAREA BRITANIE CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.122300 0.117700 1.010070 0.229930
610 W53584001 J01MA01 OFLOXACINUM OFLOXACINA LAROPHARM 200 mg COMPR. FILM. 200mg LAROPHARM S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10COMPR. FILM.P-RF 10 1.122300 0.117700 1.010070 0.229930
611 W56957001 J01MA01 OFLOXACINUM OFLOXIN 200 COMPR. FILM. 200mg ZENTIVA K.S. CEHIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.122300 1.063700 1.010070 1.175930
612 W54037001 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 100 mg COMPR. FILM. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.224460 3.852540 0.202014 3.874986
613 W54037002 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 100 mg COMPR. FILM. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 20 0.224460 3.360540 0.202014 3.382986
614 W44077004 J01MA02 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 COMPR. FILM. P-RF 10 0.561150 0.158850 0.505035 0.214965
615 W01273001 J01MA02 CIPROFLOXACINUM CIPRINOL 250 mg COMPR. FILM. 250mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 1 BLIST. AL/PVC-PVDC X 10 COMPR. FILM. P-RF 10 0.561150 0.182850 0.505035 0.238965
616 W01288001 J01MA02 CIPROFLOXACINUM CIPROLEN (R) 250 mg COMPR. FILM. 250mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.561150 0.158850 0.505035 0.214965
617 W01271002 J01MA02 CIPROFLOXACINUM CUMINOL 250 mg COMPR. FILM. 250mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.561150 0.184850 0.505035 0.240965
618 W07862001 J01MA02 CIPROFLOXACINUM CIFRAN COMPR. FILM. 250mg RANBAXY UK LIMITED MAREA BRITANIE CUTIE X 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. P-RF 10 0.561150 0.195850 0.505035 0.251965
619 W54038001 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 250 mg COMPR. FILM. 250mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.561150 0.156850 0.505035 0.212965
620 W54038002 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 250 mg COMPR. FILM. 250mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 20 0.561150 0.110850 0.505035 0.166965
622 W01274001 J01MA02 CIPROFLOXACINUM CIPRINOL 500 mg COMPR. FILM. 500mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 1 BLIST. AL/PVC-PVDC X 10 COMPR. FILM. P-RF 10 1.122300 0.124700 1.010070 0.236930
624 W01289001 J01MA02 CIPROFLOXACINUM CIPROLEN (R) 500 mg COMPR. FILM. 500mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.122300 0.270700 1.010070 0.382930

Pagina 3 din 5
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

Prescriptie
Cod_CIM

cant. beneficiaza de (pt. asiguratii care beneficiaza de


UT/ Pret de compensare 100% beneficiaza de compensare 90%
Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
625 W01272001 J01MA02 CIPROFLOXACINUM CUMINOL 500 mg COMPR. FILM. 500mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.122300 0.321700 1.010070 0.433930
627 W12545001 J01MA02 CIPROFLOXACINUM CIPRO QUIN (R) COMPR. FILM. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.122300 0.321700 1.010070 0.433930
632 W54040001 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 750 mg COMPR. FILM. 750mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.683450 2.393550 1.515105 2.561895
633 W57948001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 1000 mg COMPR. FILM. ELIB. PREL. 1000 mg BAYER PHARMA AG GERMANIACUTIE X 1 BLIST. DIN PP/AL X 7 COMPR. FILM. ELIB. PREL. P-RF 7 2.244600 10.843971 2.020140 11.068431
634 W63880001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 1000 mg COMPR. FILM. ELIB. PREL. 1000 mg BAYER AG GERMANIACUTIE X 1 BLIST. DIN PP/AL X 7 COMPR. FILM. ELIB. PREL. P-RF 7 2.244600 10.843971 2.020140 11.068431
635 W57949001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 500 mg COMPR. FILM. ELIB. PREL. 500 mg BAYER PHARMA AG GERMANIACUTIE X 1 BLIST. DIN PP/AL X 3 COMPR. FILM. ELIB. PREL. P-RF 3 1.122300 8.837700 1.010070 8.949930
636 W63879001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 500 mg COMPR. FILM. ELIB. PREL. 500 mg BAYER AG GERMANIACUTIE X 1 BLIST. DIN PP/AL X 3 COMPR. FILM. ELIB. PREL. P-RF 3 1.122300 8.837700 1.010070 8.949930
637 W52445001 J01MA03 PEFLOXACINUM PEFLOXACIN LAROPHARM COMPR. FILM. 400mg LAROPHARM S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.122300 1.922700 1.010070 2.034930
638 W14009001 J01MA06 NORFLOXACINUM NORFLOXACIN LAROPHARM 400 mg COMPR. FILM. 400mg LAROPHARM SRL ROMANIA CUTIE X 1 BLIST. X 10 COMPR. FILM. P-RF 10 0.852250 0.110750 0.767025 0.195975
639 W41800001 J01MA06 NORFLOXACINUM NORFLOXACINA LPH 400 mg COMPR. FILM. 400mg LABORMED PHARMA SAROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 20 0.852250 0.006750 0.767025 0.091975
641 W58303001 J01MA06 NORFLOXACINUM NORFLOXACIN HELCOR 400 mg COMPR. FILM. 400mg A.C. HELCOR PHARMA S.R.L. ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 20 0.852250 0.074750 0.767025 0.159975
642 W62811001 J01MA06 NORFLOXACINUM NORFLOXACINA ATB 400 mg COMPR. FILM. 400mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 20 0.852250 0.074750 0.767025 0.159975
683 W42857001 J05AB01 ACICLOVIRUM ACICLOVIR 200 mg CAPS. 200mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.847350 0.256650 0.762615 0.341385
684 W53675001 J05AB01 ACICLOVIRUM ACICLOVIR ARENA 200 mg CAPS. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.847350 0.322150 0.762615 0.406885
685 W56038001 J05AB01 ACICLOVIRUM ACICLOVIR FARMEX 200 mg CAPS. 200mg FARMEX COMPANY S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. P-RF 20 0.847350 0.280650 0.762615 0.365385
686 W53676001 J05AB01 ACICLOVIRUM ACICLOVIR ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 1.694700 0.433300 1.525230 0.602770
687 W00044001 J05AB01 ACICLOVIRUM ACICLOVIR TERAPIA 200 mg COMPR. 200mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.847350 0.089650 0.762615 0.174385
689 W53225001 J05AB01 ACICLOVIRUM ACICLOVIR LAROPHARM 200 mg COMPR. 200mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 0.847350 0.094150 0.762615 0.178885
690 W60558001 J05AB01 ACICLOVIRUM ACICLOVIR-RICHTER 200 mg COMPR. 200mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0.847350 0.094150 0.762615 0.178885
691 W06668003 J05AB01 ACICLOVIRUM ACICLOVIR 400 mg COMPR. 400mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 5 COMPR.P-RF 10 1.694700 1.209300 1.525230 1.378770
754 W54214001 M01AE03 KETOPROFENUM KETOPROFEN TERAPIA 100MG/2ML SOL. INJ./CONC. SOL. PERF. 100mg/2ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE X 2 ML P-RF 5 1.424000 0.678000 1.281600 0.820400
755 W14020001 M01AE03 KETOPROFENUM KETOMAG SUPOZ. 100mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII LAMINATE PVC/PE X 5 SUPOZ. P-6L 10 0.713000 0.000000 0.641700 0.071300
788 W05969001 N02AX02 TRAMADOLUM TRAMADOL SUPOZ. 100mg KRKA D.D. SLOVENIA CUTIE X 1 BLIST. X, 5 SUPOZ. P-RF 5 1.217999 0.000001 1.096199 0.121801
814 W56688004 N03AX12 GABAPENTINUM GABAPENTIN AUROBINDO 100 mg CAPS. 100 mg AUROBINDO PHARMA LIMITED MAREA BRITANIE CUTIE CU BLIST. DIIN POLIAMIDA/AL/PVC-AL X 50 CAPS. P6L 50 0.129837 0.027363 0.116853 0.040347
815 W64281004 N03AX12 GABAPENTINUM GABAPENTIN AUROBINDO 100 mg CAPS. 100 mg ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 50 CAPS. P6L
AUROBINDO PHARMA ROMANIA S.R.L. 50 0.129837 0.027363 0.116853 0.040347
816 W54332002 N03AX12 GABAPENTINUM GRIMODIN 100 mg CAPS. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS. P-6L 60 0.129837 0.477329 0.116853 0.490313
817 W60025001 N03AX12 GABAPENTINUM GABAPENTIN ARENA 100 mg CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.129837 0.298996 0.116853 0.311980
818 W56689004 N03AX12 GABAPENTINUM GABAPENTIN AUROBINDO 300 mg CAPS. 300 mg AUROBINDO PHARMA LIMITED MAREA BRITANIE CUTIE CU BLIST. POLIAMIDA/AL/PVC-AL X 50 CAPS. P6L 50 0.389516 0.081884 0.350564 0.120836
819 W64282004 N03AX12 GABAPENTINUM GABAPENTIN AUROBINDO 300 mg CAPS. 300 mg ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 50 CAPS. P6L
AUROBINDO PHARMA ROMANIA S.R.L. 50 0.389516 0.081884 0.350564 0.120836
820 W41589005 N03AX12 GABAPENTINUM GABAGAMMA 300 mg CAPS. 300mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.389516 0.406784 0.350564 0.445736
821 W42824001 N03AX12 GABAPENTINUM GABARAN 300 mg CAPS. 300mg RANBAXY UK LTD. MAREA BRITANIE CUTIE X 5 BLIST. PVC-PVDC/AL X 10 CAPS. P-6L 50 0.389516 1.028884 0.350564 1.067836
822 W43540001 N03AX12 GABAPENTINUM GABALEPT 300 mg CAPS. 300mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.389516 0.066484 0.350564 0.105436
823 W54333001 N03AX12 GABAPENTINUM GRIMODIN 300 mg CAPS. 300mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS. P-6L 60 0.389516 0.216650 0.350564 0.255602
824 W60026001 N03AX12 GABAPENTINUM GABAPENTIN ARENA 300 mg CAPS. 300mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.389516 0.555650 0.350564 0.594602
825 W64360001 N03AX12 GABAPENTINUM GABALEPT 300 mg CAPS. 300mg TEVA B.V. OLANDA CUTIE CU 10 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 CAPS. P6L 100 0.389516 0.066484 0.350564 0.105436
826 W56690004 N03AX12 GABAPENTINUM GABAPENTIN AUROBINDO 400 mg CAPS. 400 mg AUROBINDO PHARMA LIMITED MAREA BRITANIE CUTIE CU BLIST. POLIAMIDA/AL/PVC-AL X 50 CAPS. P6L 50 0.519356 0.109844 0.467420 0.161780
827 W64283004 N03AX12 GABAPENTINUM GABAPENTIN AUROBINDO 400 mg CAPS. 400 mg ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 50 CAPS. P6L
AUROBINDO PHARMA ROMANIA S.R.L. 50 0.519356 0.109844 0.467420 0.161780
828 W41590005 N03AX12 GABAPENTINUM GABAGAMMA 400 mg CAPS. 400mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.519356 0.737144 0.467420 0.789080
829 W42825001 N03AX12 GABAPENTINUM GABARAN 400 mg CAPS. 400mg RANBAXY UK LTD. MAREA BRITANIE CUTIE X 5 BLIST. PVC-PVDC/AL X 10 CAPS. P-6L 50 0.519356 1.070044 0.467420 1.121980
830 W43541001 N03AX12 GABAPENTINUM GABALEPT 400 mg CAPS. 400mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.519356 0.088244 0.467420 0.140180
831 W54334001 N03AX12 GABAPENTINUM GRIMODIN 400 mg CAPS. 400mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS. P-6L 60 0.519356 0.563477 0.467420 0.615413
832 W60027001 N03AX12 GABAPENTINUM GABAPENTIN ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.519356 0.662144 0.467420 0.714080
833 W64361001 N03AX12 GABAPENTINUM GABALEPT 400 mg CAPS. 400mg TEVA B.V. OLANDA CUTIE CU 10 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 CAPS. P6L 100 0.519356 0.088244 0.467420 0.140180
834 W42826001 N03AX12 GABAPENTINUM GABARAN 600 mg COMPR. FILM. 600mg RANBAXY UK LTD. MAREA BRITANIE CUTIE X 3 BLIST. AL-PVC-PA/AL X 10 COMPR. FILM. P-6L 30 0.779034 1.516632 0.701130 1.594536
851 W12943002 N05BA03 MEDAZEPAMUM * MEDAZEPAM LAROPHARM 10 mgCOMPR. 10mg LAROPHARM SRL ROMANIA CUTIE X 1 BLIST. X 20 COMPR. P-RF 20 0.139000 0.027500 0.125100 0.041400
854 W41692001 N05BA06 LORAZEPAMUM * ANXIAR (R) 1 mg COMPR. 1 mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 25 COMPR. P-RF 50 0.111200 0.034800 0.100080 0.045920
855 W06824001 N05BA08 BROMAZEPAMUM * BROMAZEPAM LPH 1,5 mg COMPR. 1,5mg LABORMED PHARMA SAROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.041700 0.074800 0.037530 0.078970
856 W06824003 N05BA08 BROMAZEPAMUM * BROMAZEPAM LPH 1,5 mg COMPR. 1,5mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. PRF 30 0.041700 0.074966 0.037530 0.079136
857 W06826001 N05BA08 BROMAZEPAMUM * BROMAZEPAM LPH 3 mg COMPR. 3mg LABORMED PHARMA SAROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.083400 0.030100 0.075060 0.038440
858 W55412001 N05BA08 BROMAZEPAMUM * BROMAZEPAM ARENA 3 mg COMPR. 3mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. P-RF 10 0.083400 0.030600 0.075060 0.038940
859 W06826003 N05BA08 BROMAZEPAMUM * BROMAZEPAM LPH 3 mg COMPR. 3mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. PRF 30 0.083400 0.030266 0.075060 0.038606
860 W00252001 N05BA12 ALPRAZOLAMUM * XANAX 0,25 mg COMPR. 0,25mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.069500 0.128833 0.062550 0.135783
861 W08624001 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM LPH (R) 0,25 mg COMPR. 0,25mg LABORMED PHARMA SAROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 0.069500 0.062000 0.062550 0.068950
862 W08624003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM LPH (R) 0,25 mg COMPR. 0,25mg LABORMED PHARMA SAROMANIA CUTIE X 3 BLIST. X 10 COMPR. P-RF 30 0.069500 0.061833 0.062550 0.068783
863 W41469001 N05BA12 ALPRAZOLAMUM * PRAZOLEX (R) 0,25 mg COMPR. 0,25mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-RF 30 0.069500 0.062500 0.062550 0.069450
864 W07122001 N05BA12 ALPRAZOLAMUM * FRONTIN 0,25 mg COMPR. 0,25mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-RF 30 0.069500 0.061833 0.062550 0.068783

Pagina 4 din 5
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

Prescriptie
Cod_CIM

cant. beneficiaza de (pt. asiguratii care beneficiaza de


UT/ Pret de compensare 100% beneficiaza de compensare 90%
Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)
865 W59969001 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. PRF 10 0.069500 0.061500 0.062550 0.068450
866 W59969002 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.069500 0.062000 0.062550 0.068950
867 W59969003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.069500 0.061833 0.062550 0.068783
868 W00253001 N05BA12 ALPRAZOLAMUM * XANAX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.139000 0.162333 0.125100 0.176233
869 W08625003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM LPH (R) 0,5 mg COMPR. 0,5mg LABORMED PHARMA SAROMANIA CUTIE X 3 BLIST. X 10 COMPR. P-RF 30 0.139000 0.070666 0.125100 0.084566
870 W08625001 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM LPH (R) 0,5 mg COMPR. 0,5mg LABORMED PHARMA SAROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 0.139000 0.070500 0.125100 0.084400
871 W07123001 N05BA12 ALPRAZOLAMUM * FRONTIN 0,5 mg COMPR. 0,5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-RF 30 0.139000 0.070666 0.125100 0.084566
872 W42783001 N05BA12 ALPRAZOLAMUM * PRAZOLEX (R) 0,5 mg COMPR. 0,5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-RF 30 0.139000 0.071000 0.125100 0.084900
873 W59972001 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. PRF 10 0.139000 0.071000 0.125100 0.084900
874 W59972002 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.139000 0.070500 0.125100 0.084400
875 W59972003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.139000 0.070666 0.125100 0.084566
876 W00254001 N05BA12 ALPRAZOLAMUM * XANAX 1 mg COMPR. 1mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.278000 0.138000 0.250200 0.165800
879 W41470001 N05BA12 ALPRAZOLAMUM * PRAZOLEX (R) 1 mg COMPR. 1mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-RF 30 0.278000 0.000000 0.250200 0.027800
880 W07126001 N05BA12 ALPRAZOLAMUM * FRONTIN 1mg COMPR. 1mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-RF 30 0.278000 0.000000 0.250200 0.027800
882 W59973002 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 1 mg COMPR. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.278000 0.000000 0.250200 0.027800
883 W59973003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 1 mg COMPR. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.278000 0.000000 0.250200 0.027800
989 W12650001 R03AC02 SALBUTAMOLUM VENTOLIN (R) SOL. INHAL. 5mg/ml GLAXOWELLCOME UK LTD. MAREA BRITANIE CUTIE X 1 FALC. DIN STICLA BRUNA X 10 ML SOL. DE INHAL. P-6L 1 1.804950 6.395050 1.624455 6.575545
990 W10597001 R03AC02 SALBUTAMOLUM VENTOLIN 100 INHALER CFC-FREE SUSP. INHAL. PRESURIZATA 100mcg/doza GLAXOWELLCOME UK LTD. MAREA BRITANIE CUTIE X 1 FLACON PRESURIZAT DIN AL PREVAZUT CU VALVA DOZATOARE X 200 DOZE + DISPOZITIV DE ADMINISTRA P-RF 1 9.024750 1.865250 8.122275 2.767725
992 W41683001 R03BA01 BECLOMETASONUM * CLENIL (R) JET 250 mcg SOL. INHALAT PRESURIZATA 250mcg/doza CHIESI FARMACEUTICI SPA ITALIA CUTIE X 1 FLACON PRESURIZAT DIN AL X 200 DOZE, PREVAZUT CU VALVA DOZATOARE + DISPOZITIV DE ADM., "SPASER JET" CU CAPAC P-RF 1 107.369999 0.000001 96.632999 10.737001
1,000 W42239001 R03CC02 SALBUTAMOLUM VENTOLIN (R) SOL. INJ. 0,5mg/ml GLAXO WELLCOME UK LTD. MAREA BRITANIE CUTIE X 5 FIOLE DIN STICLA X 1 ML P-6L 5 0.775999 0.000001 0.698399 0.077601
1,020 W60088001 S01CA05 COMBINATII (CLORAMPHENICOLUM+BETHAMETASONUM) BETABIOPTAL 1,3 mg/g+2,5 mg/g GEL OFT. 1,3mg/g+2,5mg/g THEA FARMA S.P.A. ITALIA CUTIE CU 1 FLAC. DIN PEJD +PICURATOR DIN PE X 5 G GEL OFT. PRF 1 15.774999 38.445001 14.197499 40.022501
1,022 W59771001 S01CA05 COMBINATII (CLORAMPHENICOLUM+BETHAMETASONUM) BETABIOPTAL UNG. OFT. 0,2g+0,5g/100g THEA FARMA S.P.A. ITALIA CUTIE X 1 TUB AL X 5 G P-RF 1 15.774999 1.095001 14.197499 2.672501

Pagina 5 din 5
ANEXA 7
(ANEXA 2b la Ordinul CNAS nr. 1611/2018)
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 SI FARA CONTRIBUTIE PERSONALA
DIN HG NR. 720/2008, CU MODIFICARILE SI COMPLETARILE ULTERIOARE, VALABILA INCEPAND CU 19 MARTIE 2019

Contributie maxima a Val. maxima suportata de Contributie maxima a Val. maxima suportata de Contributie maxima a
asiguratului / UT (pt. sistemul de asigurari social asiguratului / UT (pt. sistemul de asigurari social asiguratului / UT (pt.

Prescriptie
Cod_CIM

cant. asiguratii care de sanatate / UT (pt. asiguratii care de sanatate / UT (pt. asiguratii care
UT/ beneficiaza de asiguratii care beneficiaza beneficiaza de asiguratii care beneficiaza beneficiaza de
Nr crt.

Tara det. ambal Pret de referinta compensare 100% din de compensare 50% din compensare 50% din de compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj aj / UT (RON) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)

SE ADAUGA

1,097 W64970003 C09AA04 PERINDOPRILUM PRENESSA 4 mg COMPR. 4mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU 1 BLIST. PVC-PE-PVDC/AL X 30 COMPR. P6L 30 0.313200 0.091466 0.156600 0.248066 0.281880 0.122786
1,098 W61396001 C09AA10 TRANDOLAPRILUM TRANDOLAPRIL ARENA 0,5 mg CAPS. 0,5mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/PE/PVDC ALB OPAC SI FOLIE DE ALUMINIU X 10 CAPS. P6L 30 0.078300 0.158033 0.039150 0.197183 0.070470 0.165863
1,099 W61398001 C09AA10 TRANDOLAPRILUM TRANDOLAPRIL ARENA 2 mg CAPS. 2mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/PE/PVDC ALB OPAC SI FOLIE DE ALUMINIU X 10 CAPS. P6L 30 0.313200 0.102800 0.156600 0.259400 0.281880 0.134120
1,100 W61399001 C09AA10 TRANDOLAPRILUM TRANDOLAPRIL ARENA 4 mg CAPS. 4mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/PE/PVDC ALB OPAC SI FOLIE DE ALUMINIU X 10 CAPS. P6L 30 0.626400 0.155933 0.313200 0.469133 0.563760 0.218573
1,101 W63181001 C10AA04 FLUVASTATINUM FLUVASTATIN ARENA 80 mg COMPR. ELIB. PREL. 80mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. AL/AL X 10 COMPR. ELIB. PREL. P6L 30 0.660333 0.000000 0.330166 0.330167 0.594299 0.066034
1,102 W64879006 C10AA05 ATORVASTATINUM SORTIS 40 mg COMPR. FILM. 40mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. P6L 14 1.160099 0.168472 0.580049 0.748522 1.044089 0.284482
1,103 W64880006 C10AA05 ATORVASTATINUM SORTIS 80 mg COMPR. FILM. 80mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. P6L 14 1.101428 0.000000 0.550714 0.550714 0.991285 0.110143
1,104 W64962001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) CADUET 10mg/10mg COMPR. FILM. 10mg/10mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PA-AL-PVC/PVC-AL X 10 COMPR. FILM. P-6L 30 0.778666 0.030667 0.389333 0.420000 0.700799 0.108534
1,105 W64961001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) CADUET 10mg/5mg COMPR. FILM. 10mg/5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PA-AL-PVC/PVC-AL X 10 COMPR. FILM. P-6L 30 0.778666 0.023000 0.389333 0.412333 0.700799 0.100867
1,106 W64939001 D07AD01 CLOBETASOLUM * DERMOVATE 0,5 mg/g CREMA 0,5mg/g GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 TUB AL X 25 G CREMA PRF 1 6.162500 6.967500 3.081250 10.048750 5.546250 7.583750
1,107 W64943001 D07AD01 CLOBETASOLUM * DERMOVATE 0,5 mg/ml SOL. CUT. 0,05% GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. CU PICURATOR DIN PP X 25 ML SOL. CUTANATA PRF 1 5.690000 0.000000 2.845000 2.845000 5.121000 0.569000
1,108 W64941001 D07AD01 CLOBETASOLUM * DERMOVATE 0,5 mg/g UNGUENT 0,5mg/g GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 TUB AL X 25 G UNGUENT PRF 1 6.162500 3.557500 3.081250 6.638750 5.546250 4.173750
1,109 W65037001 G02CB03 CABERGOLINUM * DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 2 COMPR. P6L 2 10.440000 0.745000 5.220000 5.965000 9.396000 1.789000
1,110 W65037002 G02CB03 CABERGOLINUM * DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 8 COMPR. P6L 8 10.440000 0.000000 5.220000 5.220000 9.396000 1.044000
1,111 W63834001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 150 UI/0,25 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 150UI/0,25ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 210.310000 6.360000 105.155000 111.515000 189.279000 27.391000
1,112 W63837001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 225 UI/0,375 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 225UI/0,375ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 315.465000 9.105000 157.732500 166.837500 283.918500 40.651500
1,113 W63835001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 300 UI/0,50 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 300UI/0,50ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 420.620000 0.000000 210.310000 210.310000 378.558000 42.062000
1,114 W63836001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 450 UI/0,75 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 450UI/0,75ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 598.520000 0.000000 299.260000 299.260000 538.668000 59.852000
1,115 W63833001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 75 UI/0,125 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 75UI/0,125ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 105.155000 6.785000 52.577500 59.362500 94.639500 17.300500
1,116 W62041003 G03XC01 RALOXIFENUM RALOXIFEN ARENA 60 mg COMPR. FILM. 60mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P6L 84 1.522738 0.000000 0.761369 0.761369 1.370464 0.152274
1,117 W62041002 G03XC01 RALOXIFENUM RALOXIFEN ARENA 60 mg COMPR. FILM. 60mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P6L 28 1.561398 0.099673 0.780699 0.880372 1.405258 0.255813
1,118 W62041001 G03XC01 RALOXIFENUM RALOXIFEN ARENA 60 mg COMPR. FILM. 60mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P6L 14 1.561398 0.012887 0.780699 0.793586 1.405258 0.169027
1,119 W65058001 G04CA02 TAMSULOSINUM CONTIFLO MR 0,4 mg CAPS. ELIB. PREL. 0,4mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 CAPS. ELIB. PREL. P6L 30 0.523000 0.000000 0.261500 0.261500 0.470700 0.052300
1,120 W65045001 J01CR04 SULTAMICILLINUM UNASYN 375 mg COMPR. FILM. 375mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL/PVC/PVDC X 6 COMPR. FILM. P6L 12 2.851666 0.000000 1.425833 1.425833 2.566499 0.285167
1,121 W65046001 J01CR04 SULTAMICILLINUM UNASYN 250 mg/ml PULB. PT. SUSP. ORALA 250mg/5ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. DIN PEID CU PULBERE PT. 60 ML SUSP. ORALA RECONSTITUITA SI 1 LINGURITA DOZATOARE CU 2 CUPE PRF 1 22.813328 3.846672 11.406664 15.253336 20.531995 6.128005
1,122 W65032001 J01FF01 CLINDAMYCINUM DALACIN C 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. PVC/AL X 8 CAPS. PRF 16 0.496979 0.261771 0.248489 0.510261 0.447281 0.311469
1,123 W65033001 J01FF01 CLINDAMYCINUM DALACIN C 300 mg CAPS. 300mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. PVC/AL X 8 CAPS. PRF 16 0.930000 0.000000 0.465000 0.465000 0.837000 0.093000
1,124 W65100001 J05AB11 VALACYCLOVIRUM *# VALTREX 500 mg COMPR. FILM. 500 mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. DIN CLORURA DE POLIVINIL/AL X 10 COMPR.FILM. PRF 10 4.886000 0.000000 2.443000 2.443000 4.397400 0.488600
1,125 W64497002 M01AE17 DEXKETOPROFENUM XEDOFEN 50 mg/2 ml SOL INJ./PERF. 50mg/2ml AS KALCEKS LETONIA CUTIE CU 5 FIOLE DIN STICLA BRUNA A CATE 2 ML SOL. INJ./PERF. PRF 5 2.682000 0.000000 1.341000 1.341000 2.413800 0.268200
1,126 W64907002 N03AX16 PREGABALINUM ** # LYRICA 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 56 CAPS. (BLIST. PVC/AL) PRF 56 1.291428 0.000000 0.645714 0.645714 1.162285 0.129143
1,127 W64908001 N03AX16 PREGABALINUM ** # LYRICA 300 mg CAPS. 300mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 14 CAPS. (BLIST. PVC/AL) PRF 14 2.619285 0.000000 1.309642 1.309643 2.357356 0.261929
1,128 W65108002 R03AK06 SALMETEROLUM+FLUTICASONUM * SERETIDE DISKUS 50 micrograme/100 micrograme PULB. INHAL. 50micrograme/100micrograme GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 DISPOZITIV DE INHALAT DIN PLASTIC PREVAZUT CU UN BLISTER IN FORMA DE BANDA X 60 DOZE PULB. DE INHAL. P6L 1 32.532000 68.938000 16.266000 85.204000 29.278800 72.191200
1,129 W65109002 R03AK06 SALMETEROLUM+FLUTICASONUM * SERETIDE DISKUS 50 micrograme/250 micrograme PULB. INHAL. 50micrograme/250micrograme GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 DISPOZITIV DE INHALAT DIN PLASTIC PREVAZUT CU UN BLISTER IN FORMA DE BANDA X 60 DOZE PULB. DE INHAL. P6L 1 81.330000 53.400000 40.665000 94.065000 73.197000 61.533000
1,130 W65110002 R03AK06 SALMETEROLUM+FLUTICASONUM * SERETIDE DISKUS 50 micrograme/500 micrograme PULB. INHAL. 50micrograme/500micrograme GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 DISPOZITIV DE INHALAT DIN PLASTIC PREVAZUT CU UN BLISTER IN FORMA DE BANDA X 60 DOZE PULB. DE INHAL. P6L 1 162.660000 0.000000 81.330000 81.330000 146.394000 16.266000

SE MODIFICA

25 W06755002 A02BC05 ESOMEPRAZOLUM NEXIUM 20 mg COMPR. GASTROREZ. 20mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/PVC-AL-POLIAMIDA X 7 COMPR. GASTROREZISTENTE P-6L 14 0.709799 0.602343 0.354899 0.957243 0.638819 0.673323
26 W56303013 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 20mg COMPR. GASTROREZ. 20mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. GASTROREZ. P6L 14 0.709799 0.267343 0.354899 0.622243 0.638819 0.338323
27 W06756002 A02BC05 ESOMEPRAZOLUM NEXIUM 40 mg COMPR. GASTROREZ. 40mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/PVC-AL-POLIAMIDA X 7 COMPR. GASTROREZISTENTE P-6L 14 1.419599 0.299686 0.709799 1.009486 1.277639 0.441646
28 W56304013 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 40mg COMPR. GASTROREZ. 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. GASTROREZ. P6L 14 1.419599 0.024686 0.709799 0.734486 1.277639 0.166646
29 W56303002 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 20mg 20mg
COMPR. GASTROREZISTENTE TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 14 COMPR. GASTROREZISTENTE P-6L 14 0.709799 0.267343 0.354899 0.622243 0.638819 0.338323
30 W56304002 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 40mg 40mg
COMPR. GASTROREZISTENTE TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 14 COMPR. GASTROREZISTENTE P-6L 14 1.419599 0.024686 0.709799 0.734486 1.277639 0.166646
43 W54445001 A07EA06 BUDESONIDUM ** # BUDENOFALK 2 mg/doza SPUMA RECTALA 2mg/doza DR. FALK PHARMA GMBH GERMANIA CUTIE X 1 FLAC. DIN AL X 14 DOZE X 1,2G SPUMA RECTALA, 14 APLICATOARE LUBREFIANTE PVC SI 14 PUNGI PL P-RF 1 319.939999 0.000001 159.969999 159.970001 287.945999 31.994001
57 W64296002 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) ** # ACID TIOCTIC ROMPHARM 600 mg/24 ml SOL INJ. 600mg/24ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 5 FLAC. DIN STICLA BRUNA CU CAPACITATEA DE 25 ML X 24 ML SOL. INJ. PR/PRF 5 16.461999 0.000001 8.230999 8.231001 14.815799 1.646201
58 W53289002 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) ** # THIOCTACID 600T (vezi N07XN03) SOL. INJ. 25mg/ml MEDA PHARMA GMBH & CO KG GERMANIA CUTIE X 5 FIOLE X 24 ML SOL.INJ. S/P-RF 5 16.461999 8.462001 8.230999 16.693001 14.815799 10.108201
82 W63737001 B01AB11 SULODEXIDUM ** VESSEL DUE F 250 ULS CAPS. MOI 250ULS ALFASIGMA S.P.A. ITALIA CUTIE CU 2 BLIST. PVDC-PVC/AL-PVDC A CATE 25 CAPS. MOI P6L 50 1.905200 0.247000 0.952600 1.199600 1.714680 0.437520
83 W63737002 B01AB11 SULODEXIDUM ** VESSEL DUE F 250 ULS CAPS. MOI 250ULS ALFASIGMA S.P.A. ITALIA CUTIE CU 3 BLIST. PVDC-PVC/AL-PVDC A CATE 20 CAPS. MOI P6L 60 1.905200 0.172800 0.952600 1.125400 1.714680 0.363320
112 W63258002 C01EB17 IVABRADINUM ** IVABRADINE ZENTIVA 5 mg COMPR. FILM. 5 mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.114821 0.270893 0.557410 0.828304 1.003338 0.382376
113 W42777003 C01EB17 IVABRADINUM ** CORLENTOR 5mg COMPR. FILM. 5mg LES LAB. SERVIER FRANTA CUTIE X 56 COMPR. FILM. (BLIST. AL/PVC TIP CALENDAR) P-6L 56 1.114821 0.772500 0.557410 1.329911 1.003338 0.883983
114 W62962004 C01EB17 IVABRADINUM ** BIXEBRA 5 mg COMPR. FILM. 5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.114821 0.271964 0.557410 0.829375 1.003338 0.383447

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Contributie maxima a Val. maxima suportata de Contributie maxima a Val. maxima suportata de Contributie maxima a
asiguratului / UT (pt. sistemul de asigurari social asiguratului / UT (pt. sistemul de asigurari social asiguratului / UT (pt.

Prescriptie
Cod_CIM

cant. asiguratii care de sanatate / UT (pt. asiguratii care de sanatate / UT (pt. asiguratii care
UT/ beneficiaza de asiguratii care beneficiaza beneficiaza de asiguratii care beneficiaza beneficiaza de
Nr crt.

Tara det. ambal Pret de referinta compensare 100% din de compensare 50% din compensare 50% din de compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj aj / UT (RON) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
115 W62962014 C01EB17 IVABRADINUM ** BIXEBRA 5 mg COMPR. FILM. 5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PERFORAT PT ELIBERAREA UNEI DOZATE DIN OPA-AL-PVC/AL X 56X1 COMPR. FILM. P6L 56 1.114821 0.271964 0.557410 0.829375 1.003338 0.383447
116 W63479001 C01EB17 IVABRADINUM ** RAENOM 5 mg COMPR. FILM. 5mg GEDEON RICHTER ROMANIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.114821 0.271964 0.557410 0.829375 1.003338 0.383447
117 W63443003 C01EB17 IVABRADINUM ** FELOCORD 5 mg COMPR. FILM. 5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.114821 1.590536 0.557410 2.147947 1.003338 1.702019
118 W63904002 C01EB17 IVABRADINUM ** IVABRADINA AUROBINDO 5 mg COMPR. FILM. 5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.114821 0.402500 0.557410 0.959911 1.003338 0.513983
119 W63775001 C01EB17 IVABRADINUM ** IVABRADINA ACCORD 5 mg COMPR. FILM. 5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITAZI DOZATE AL/AL X 56X1 COMPR. FILM. PRF 56 1.114821 1.590536 0.557410 2.147947 1.003338 1.702019
120 W42779003 C01EB17 IVABRADINUM ** CORLENTOR 7,5mg COMPR. FILM. 7,5mg LES LAB. SERVIER FRANTA CUTIE X 56 COMPR. FILM. (BLIST. AL/PVC TIP CALENDAR) P-6L 56 1.672231 0.215090 0.836115 1.051206 1.505007 0.382314
121 W62963004 C01EB17 IVABRADINUM ** BIXEBRA 7,5 mg COMPR. FILM. 7,5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.672231 0.075626 0.836115 0.911742 1.505007 0.242850
122 W62963014 C01EB17 IVABRADINUM ** BIXEBRA 7,5 mg COMPR. FILM. 7,5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PERFORAT PT ELIBERAREA UNEI DOZATE DIN OPA-AL-PVC/AL X 56X1 COMPR. FILM. P6L 56 1.672231 0.075626 0.836115 0.911742 1.505007 0.242850
124 W63480001 C01EB17 IVABRADINUM ** RAENOM 7,5 mg COMPR. FILM. 7,5mg GEDEON RICHTER ROMANIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.672231 0.258304 0.836115 1.094420 1.505007 0.425528
125 W63444003 C01EB17 IVABRADINUM ** FELOCORD 7,5 mg COMPR. FILM. 7,5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.672231 0.940804 0.836115 1.776920 1.505007 1.108028
126 W63905001 C01EB17 IVABRADINUM ** IVABRADINA AUROBINDO 7,5 mg COMPR. FILM. 7,5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.672231 0.097947 0.836115 0.934063 1.505007 0.265171
127 W63776001 C01EB17 IVABRADINUM ** IVABRADINA ACCORD 7,5 mg COMPR. FILM. 7,5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITAZI DOZATE AL/AL X 56X1 COMPR. FILM. P6L 56 1.672231 0.940804 0.836115 1.776920 1.505007 1.108028
364 W51412001 C10AA04 FLUVASTATINUM LESCOL XL 80 mg COMPR. ELIB. PREL. 80mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. AL/AL X 28 (4X7) COMPR. ELIB. PREL. P-6L 28 0.773399 0.243029 0.386699 0.629729 0.696059 0.320369
365 W12893001 C10AA05 ATORVASTATINUM SORTIS 10 mg COMPR. FILM. 10mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-6L 30 0.290024 0.607309 0.145012 0.752321 0.261021 0.636312
366 W54696007 C10AA05 ATORVASTATINUM ATORIS 10 mg COMPR. FILM. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR.FILM. P-6L 30 0.290024 0.075642 0.145012 0.220654 0.261021 0.104645
367 W55516003 C10AA05 ATORVASTATINUM ASCORD 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-6L 30 0.290024 0.454309 0.145012 0.599321 0.261021 0.483312
369 W59408001 C10AA05 ATORVASTATINUM STAVRA 10 mg COMPR. FILM. 10mg ALKALOID-INT D.O.O. SLOVENIA CUTIE CU BLIST. PVC-TE-PVDC/AL X 30 COMPR. FILM. P6L 30 0.290024 0.104309 0.145012 0.249321 0.261021 0.133312
370 W57297016 C10AA05 ATORVASTATINUM ATORVASTATINA MYLAN 10 mg COMPR. FILM. 10mg GENERICS (UK) LTD MAREA BRITANIE CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.290024 0.061642 0.145012 0.206654 0.261021 0.090645
372 W62152005 C10AA05 ATORVASTATINUM TORVACARD 10 mg COMPR. FILM. 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.290024 0.001642 0.145012 0.146654 0.261021 0.030645
374 W64877001 C10AA05 ATORVASTATINUM SORTIS 10 mg COMPR. FILM. 10mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.290024 0.607309 0.145012 0.752321 0.261021 0.636312
375 W12894001 C10AA05 ATORVASTATINUM SORTIS 20 mg COMPR. FILM. 20mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-6L 30 0.580049 0.592617 0.290024 0.882642 0.522044 0.650622
377 W55517003 C10AA05 ATORVASTATINUM ASCORD 20 mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-6L 30 0.580049 0.386617 0.290024 0.676642 0.522044 0.444622
384 W64878001 C10AA05 ATORVASTATINUM SORTIS 20 mg COMPR. FILM. 20mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.580049 0.592617 0.290024 0.882642 0.522044 0.650622
386 W12895001 C10AA05 ATORVASTATINUM SORTIS 40 mg COMPR. FILM. 40mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU BLIST. AL/AL X 14 COMPR. FILM. P-6L 14 1.160099 0.168472 0.580049 0.748522 1.044089 0.284482
408 W13864001 C10AA07 ROSUVASTATINUM CRESTOR 10 mg COMPR. FILM. 10mg ASTRAZENECA UK LTD. MAREA BRITANIE CUTIE X 2 BLIST. X 14 COMPR. FILM. P-6L 28 0.580049 2.746379 0.290024 3.036404 0.522044 2.804384
409 W55327002 C10AA07 ROSUVASTATINUM ROSUCARD 10 mg COMPR. FILM. 10mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 0.580049 0.077284 0.290024 0.367309 0.522044 0.135289
410 W57059005 C10AA07 ROSUVASTATINUM ROSWERA 10 mg COMPR. FILM. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.580049 0.065617 0.290024 0.355642 0.522044 0.123622
411 W55990002 C10AA07 ROSUVASTATINUM ROSTAT 10 mg COMPR. FILM. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 0.580049 0.211284 0.290024 0.501309 0.522044 0.269289
412 W59899004 C10AA07 ROSUVASTATINUM ROSUVASTATINA TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0.580049 0.727808 0.290024 1.017833 0.522044 0.785813
413 W59899017 C10AA07 ROSUVASTATINUM ROSUVASTATINA TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 28 COMPR. FILM. P6L 28 0.580049 0.727808 0.290024 1.017833 0.522044 0.785813
416 W61054001 C10AA07 ROSUVASTATINUM ROSUVASTATINA ATB 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P6L 30 0.580049 0.312617 0.290024 0.602642 0.522044 0.370622
417 W62399023 C10AA07 ROSUVASTATINUM ROSUVASTATINA TEVA 10 mg COMPR. FILM. 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.580049 0.016284 0.290024 0.306309 0.522044 0.074289
420 W64682002 C10AA07 ROSUVASTATINUM ROSI 10 mg COMPR. FILM. 10mg SWYSSI AG GERMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.580049 1.617617 0.290024 1.907642 0.522044 1.675622
422 W13865001 C10AA07 ROSUVASTATINUM CRESTOR 20 mg COMPR. FILM. 20mg ASTRAZENECA UK LTD. MAREA BRITANIE CUTIE X 2 BLIST. X 14 COMPR. FILM. P-6L 28 1.160099 3.704901 0.580049 4.284951 1.044089 3.820911
425 W59900004 C10AA07 ROSUVASTATINUM ROSUVASTATINA TERAPIA 20 mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.160099 0.719186 0.580049 1.299236 1.044089 0.835196
426 W59900017 C10AA07 ROSUVASTATINUM ROSUVASTATINA TERAPIA 20 mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 28 COMPR. FILM. P6L 28 1.160099 0.719186 0.580049 1.299236 1.044089 0.835196
430 W62400023 C10AA07 ROSUVASTATINUM ROSUVASTATINA TEVA 20 mg COMPR. FILM. 20mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 1.160099 0.052567 0.580049 0.632617 1.044089 0.168577
433 W64684002 C10AA07 ROSUVASTATINUM ROSI 20 mg COMPR. FILM. 20mg SWYSSI AG GERMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 1.160099 2.170567 0.580049 2.750617 1.044089 2.286577
437 W59901017 C10AA07 ROSUVASTATINUM ROSUVASTATINA TERAPIA 40 mg COMPR. FILM. 40mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 28 COMPR. FILM. P6L 28 2.320198 0.612302 1.160099 1.772401 2.088178 0.844322
438 W59901004 C10AA07 ROSUVASTATINUM ROSUVASTATINA TERAPIA 40 mg COMPR. FILM. 40mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2.320198 0.612302 1.160099 1.772401 2.088178 0.844322
441 W61056001 C10AA07 ROSUVASTATINUM ROSUVASTATINA ATB 40 mg COMPR. FILM. 40mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P6L 30 2.320198 0.310802 1.160099 1.470901 2.088178 0.542822
442 W64686002 C10AA07 ROSUVASTATINUM ROSI 40 mg COMPR. FILM. 40mg SWYSSI AG GERMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 2.320198 0.460468 1.160099 1.620567 2.088178 0.692488
443 W43678001 C10AA07 ROSUVASTATINUM CRESTOR 5 mg COMPR. FILM. 5mg ASTRAZENECA UK LTD. MAREA BRITANIE CUTIE X 2 BLIST. AL/AL X 14 COMPR. FILM. P-6L 28 0.290024 2.346047 0.145012 2.491059 0.261021 2.375050
444 W57058005 C10AA07 ROSUVASTATINUM ROSWERA 5 mg COMPR. FILM. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.290024 0.039309 0.145012 0.184321 0.261021 0.068312
445 W55989002 C10AA07 ROSUVASTATINUM ROSTAT 5 mg COMPR. FILM. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 0.290024 0.494309 0.145012 0.639321 0.261021 0.523312
446 W59898004 C10AA07 ROSUVASTATINUM ROSUVASTATINA TERAPIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0.290024 1.609976 0.145012 1.754988 0.261021 1.638979
447 W59898017 C10AA07 ROSUVASTATINUM ROSUVASTATINA TERAPIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 28 COMPR. FILM. P6L 28 0.290024 1.609976 0.145012 1.754988 0.261021 1.638979
449 W60391003 C10AA07 ROSUVASTATINUM ROVASTAMED 5mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0.290024 0.790690 0.145012 0.935702 0.261021 0.819693
450 W61053001 C10AA07 ROSUVASTATINUM ROSUVASTATINA ATB 5 mg COMPR. FILM. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P6L 30 0.290024 0.521642 0.145012 0.666654 0.261021 0.550645
460 W43316001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) CADUET 10mg/10mg COMPR. FILM. 10mg/10mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. PA-AL-PVC/PVC-AL X 10 COMPR. FILM. P-6L 30 0.778666 0.030667 0.389333 0.420000 0.700799 0.108534
462 W43315001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) CADUET 10mg/5mg COMPR. FILM. 10mg/5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. PA-AL-PVC/PVC-AL X 10 COMPR. FILM. P-6L 30 0.778666 0.023000 0.389333 0.412333 0.700799 0.100867
464 W56682001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) DUPLECOR 20 mg/10 mg COMPR. FILM. 20mg/10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. ALBE, OPACE DIN PA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 0.778666 0.441667 0.389333 0.831000 0.700799 0.519534
465 W56681001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) DUPLECOR 20 mg/5 mg COMPR. FILM. 20mg/5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. ALBE, OPACE DIN PA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 0.778666 0.167334 0.389333 0.556667 0.700799 0.245201
470 W58498001 D05AX52 COMBINATII (CALCIPOTRIOLUM+BETAMETHASONUM) * DAIVOBET 50 micrograme/0,5 mg/g GEL 50micrograme/0,5mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 FLAC. PEID CU DUZA DIN PEJD SI CAPAC DIN PEID X 15 G GEL PRF 1 55.159999 0.000001 27.579999 27.580001 49.643999 5.516001
471 W56194001 D05AX52 COMBINATII (CALCIPOTRIOLUM+BETAMETHASONUM) * DAIVOBET 50 micrograme/0,5mg/g UNGUENT 50micrograme/0,5mg/g LEO PHARMACEUTICAL PRODUCTS DANEMARCA CUTIE CU 1 TUB DIN AL/EPOXIFENOL X 15 G UNGUENT P-RF 1 55.159999 0.000001 27.579999 27.580001 49.643999 5.516001
480 W63158001 D07AB02 HYDROCORTISONUM BUTYRATUM LOCOID 1 mg/g CREMA 1mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 FLACON DIN AL CU 30 G CREMA PRF 1 12.302499 0.227501 6.151249 6.378751 11.072249 1.457751
481 W63159001 D07AB02 HYDROCORTISONUM BUTYRATUM LOCOID LIPOCREAM 1mg/g CREMA 1mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 FLACON DIN AL X 30 G CREMA PRF 1 12.302499 0.197501 6.151249 6.348751 11.072249 1.427751
482 W63157001 D07AB02 HYDROCORTISONUM BUTYRATUM LOCOID CRELO 1 mg/g EMULSIE CUT. 1mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 FLACON DIN PEJD DE CULOARE ALBA OPAC, PREVAZUT CU APLICATOR PT. PICURARE DIN PEJD INCOLORA X 30 G EMULSIE CUTANATA PRF 1 12.302499 0.457501 6.151249 6.608751 11.072249 1.687751
484 W57223001 D07AC13 MOMETASONUM ELOCOM CREMA 1mg/g MERCK SHARP & DOHME ROMANIA CUTIE X 1 TUB DIN AL X 15 G P-RF 1 3.709999 2.020001 1.854999 3.875001 3.338999 2.391001
485 W59624001 D07AC13 MOMETASONUM MOMETAZONA ATB 1 mg/g CREMA 1mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 15 G UNG. P6L 1 3.709999 0.000001 1.854999 1.855001 3.338999 0.371001
486 W57222001 D07AC13 MOMETASONUM ELOCOM UNGUENT 1mg/g MERCK SHARP & DOHME ROMANIA CUTIE X 1 TUB DIN AL X 15 G P-RF 1 3.709999 2.020001 1.854999 3.875001 3.338999 2.391001
487 W59623001 D07AC13 MOMETASONUM MOMETAZONA ATB 1 mg/g UNGUENT 1mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 15 G UNG. P6L 1 3.709999 0.000001 1.854999 1.855001 3.338999 0.371001
500 W55012001 D07AD01 CLOBETASOLUM * DERMOVATE 0,5 mg/g CREMA 0,5mg/g GLAXO WELLCOME UK LTD. MAREA BRITANIE CUTIE CU 1 TUB AL X 25 G CREMA P-RF 1 6.162500 6.967500 3.081250 10.048750 5.546250 7.583750

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Contributie maxima a Val. maxima suportata de Contributie maxima a Val. maxima suportata de Contributie maxima a
asiguratului / UT (pt. sistemul de asigurari social asiguratului / UT (pt. sistemul de asigurari social asiguratului / UT (pt.

Prescriptie
Cod_CIM

cant. asiguratii care de sanatate / UT (pt. asiguratii care de sanatate / UT (pt. asiguratii care
UT/ beneficiaza de asiguratii care beneficiaza beneficiaza de asiguratii care beneficiaza beneficiaza de
Nr crt.

Tara det. ambal Pret de referinta compensare 100% din de compensare 50% din compensare 50% din de compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj aj / UT (RON) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
501 W63648001 D07AD01 CLOBETASOLUM * CLOBETAZOL ATB 0,5 mg/g CREMA 0,5mg/g ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 TUB DIN AL X 25 G CREMA PRF 1 6.162500 2.267500 3.081250 5.348750 5.546250 2.883750
503 W55013001 D07AD01 CLOBETASOLUM * DERMOVATE 0,5 mg/g UNGUENT 0,5mg/g GLAXO WELLCOME UK LTD. MAREA BRITANIE CUTIE CU 1 TUB AL X 25 G UNGUENT P-RF 1 6.162500 3.557500 3.081250 6.638750 5.546250 4.173750
504 W61823001 D07AD01 CLOBETASOLUM * CLOBETAZOL ATB 0,5 mg/g UNGUENT 0,5mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 25 G UNGUENT PRF 1 6.162500 0.157500 3.081250 3.238750 5.546250 0.773750
505 W60525001 D07CA01 COMBINATII (ACIDUM FUSIDICUM+HYDROCORTISONUM) FUCIDIN H CREMA 20mg/g+10mg/g LEO PHARMA A/S DANEMARCA CUTIE X 1 TUB DIN AL X 15 G CREMA P-RF 1 22.159999 0.000001 11.079999 11.080001 19.943999 2.216001
534 W00716002 G02CB03 CABERGOLINUM * DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. X 2 COMPR. P-RF 2 10.440000 0.745000 5.220000 5.965000 9.396000 1.789000
535 W00716001 G02CB03 CABERGOLINUM * DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. X 8 COMPR. P-RF 8 10.440000 0.000000 5.220000 5.220000 9.396000 1.044000
558 W60481002 G03GA05 FOLLITROPINUM ALFA **1 # GONAL - f 75 UI (5,5 µg) PULB. + SOLV. PT. SOL. INJ. 75UI MERCK SERONO EUROPE LIMITED MAREA BRITANIE CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. + 1 SERINGA PREUMPLUTA X 1 ML SOLV. P-RF/R 1 105.155000 23.165000 52.577500 75.742500 94.639500 33.680500
559 W63029001 G03GA05 FOLLITROPINUM ALFA **1 # OVALEAP 300 UI/0,5 ml SOL INJ. 300UI/0,5ml TEVA B.V. OLANDA CUTIE X 1 CARTUS (STICLA TIP I) X 0.5 ML SOLUTIE INJECTABILA + 10 ACE PENTRU INJECTIE PR/PRF 1 420.620000 0.240000 210.310000 210.550000 378.558000 42.302000
562 W60480002 G03GA05 FOLLITROPINUM ALFA **1 # GONAL-f 300 UI/0,5 ml ( 22 µg/0,5 ml) SOL. INJ. IN STILOU INJECTOR PREUMPLUT 300UI/0,5ml MERCK SERONO EUROPE LIMITED MAREA BRITANIE CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 0,5 ML SOL. INJ. + 8 ACE PT. ADM. P-RF/R 1 420.620000 16.590000 210.310000 226.900000 378.558000 58.652000
563 W60485002 G03GA05 FOLLITROPINUM ALFA **1 # GONAL-f 450 UI/0,75 ml (33 µg/0,75 ml) SOL. INJ. IN STILOU INJECTOR PREUMPLUT 450UI/0,75ml MERCK SERONO EUROPE LIMITED MAREA BRITANIE CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 0,75 ML SOL. INJ. + 12 ACE PT. ADM. SUBCUTANATA P-RF/R 1 630.930000 0.180000 315.465000 315.645000 567.837000 63.273000
565 W61937001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 300UI/0,36 ml SOL. INJ. 300UI/0,36ml MERCK SHARP & DOHME CUTIE X 1 CARTUS + 6 ACE
MAREA BRITANIE PR/PRF 1 420.451752 1.178248 210.225876 211.404124 378.406576 43.223424
566 W64697001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 300UI/0,36 ml SOL. INJ. 300UI/0,36ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 CARTUS + 6 ACE PR/PRF 1 420.451752 1.178248 210.225876 211.404124 378.406576 43.223424
567 W43251001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 900UI/1,08 ml SOL. INJ. 900UI/1,08ml N. V. ORGANON OLANDA CUTIE X 1 CARTUS SOL. INJ. + 9 ACE PR/PRF 1 1,261.355256 77.854744 630.677628 708.532372 1,135.219730 203.990270
568 W61938001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 900UI/1,08 ml SOL. INJ. 900UI/1,08ml MERCK SHARP & DOHME MAREA BRITANIE CUTIE X 1 CARTUS SOL. INJ. + 9 ACE PR/PRF 1 1,261.355256 77.854744 630.677628 708.532372 1,135.219730 203.990270
569 W64696001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 900UI/1,08 ml SOL. INJ. 900UI/1,08ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 CARTUS SOL. INJ. + 9 ACE PR/PRF 1 1,261.355256 77.854744 630.677628 708.532372 1,135.219730 203.990270
571 W53455002 G03XC01 RALOXIFENUM EVISTA 60mg COMPR. FILM. 60mg DAIICHI SANKYO EUROPE GMBH GERMANIA CUTIE X 28 COMPR. FILM. (BLIST. ACLAR) P-RF 28 1.561398 0.908959 0.780699 1.689658 1.405258 1.065099
607 W43106001 G04CA02 TAMSULOSINUM OMNIC TOCAS (R) 0,4 COMPR. FILM. ELIB. PREL. 0,4mg ASTELLAS PHARMA EUROPE BV OLANDA CUTIE X 3 FOLII AL/AL X 10 COMPR. FILM. ELIB. PREL. P-6L 30 1.119600 0.160400 0.559800 0.720200 1.007640 0.272360
610 W13534002 G04CB02 DUTASTERIDUM * AVODART 0,5 mg CAPS. MOI 0,5mg GLAXOSMITHKLINE (GSK) SRL ROMANIA CUTIE X 3 BLIST.PVC-PVDC/AL X 10 CAPS. MOI P-6L 30 1.069333 0.582667 0.534666 1.117334 0.962399 0.689601
611 W62669002 G04CB02 DUTASTERIDUM * MAXTRID 0,5 mg CAPS. MOI 0,5mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. P6L 30 1.069333 1.110667 0.534666 1.645334 0.962399 1.217601
612 W62973002 G04CB02 DUTASTERIDUM * DUTASTERIDA ZENTIVA 0,5 mg CAPS. MOI 0,5mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 CAPS. MOI P6L 30 1.069333 0.001000 0.534666 0.535667 0.962399 0.107934
614 W63663002 G04CB02 DUTASTERIDUM * DERIDUST 0,5 mg CAPS. MOI 0,5mg HEATON K.S. REPUBLICA CEHA CUTIE CU BLIST. TRANSPARENTE TIP TRIPLEX (PVC-PE-PVDC)/AL X 30 CAPS. MOI P6L 30 1.069333 1.132667 0.534666 1.667334 0.962399 1.239601
615 W63801002 G04CB02 DUTASTERIDUM * DUTASTERIDA AUROBINDO 0,5 mg CAPS. MOI 0,5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. MOI P6L 30 1.069333 0.557000 0.534666 1.091667 0.962399 0.663934
630 W57960002 H02AB01 BETAMETHASONUM DIPROPHOS SUSP. INJ. 7mg/ml MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE CU 1 FIOLE DIN STICLA TIP I X 1 ML SUSP. INJ. PRF 1 17.159999 0.000001 8.579999 8.580001 15.443999 1.716001
636 W05765001 J01CR04 SULTAMICILLINUM UNASYN PULB. PT. SUSP. ORALA 250mg/5ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. DIN PEID CU PULBERE PT. 60 ML SUSP. ORALA P-RF 1 22.813328 3.846672 11.406664 15.253336 20.531995 6.128005
666 W08637001 J01FF01 CLINDAMYCINUM DALACIN C 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 8 CAPS. P-RF 16 0.496979 0.261771 0.248489 0.510261 0.447281 0.311469
668 W53634002 J01FF01 CLINDAMYCINUM CLINDAMYCIN - MIP 600 mg COMPR. FILM. 600mg MIP PHARMA GMBH GERMANIA CUTIE X 2 BLIST. PVC/AL X 8 COMPR. FILM. P-RF 16 1.987916 0.801459 0.993958 1.795417 1.789124 1.000251
669 W53634003 J01FF01 CLINDAMYCINUM CLINDAMYCIN - MIP 600 mg COMPR. FILM. 600mg MIP PHARMA GMBH GERMANIA CUTIE X 5 BLIST. PVC/AL X 6 COMPR. FILM. P-RF 30 1.987916 0.383750 0.993958 1.377708 1.789124 0.582542
671 W55699003 J01MA12 LEVOFLOXACINUM TAVANIC 250 mg COMPR. FILM. 250mg TERAPIA S.A. ROMANIA CUTIE X1 BLIST. PVC/AL. X 7 COMPR. FILM. P-RF 7 2.244600 0.369685 1.122300 1.491985 2.020140 0.594145
674 W61631003 J01MA12 LEVOFLOXACINUM LEVALOX 250 mg COMPR. FILM. 250mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 7 COMPR. FILM. PRF 7 2.244600 0.393971 1.122300 1.516271 2.020140 0.618431
675 W56939002 J01MA12 LEVOFLOXACINUM FLERADAY 500 mg COMPR. FILM. 500 mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC/PVDC - AL X 7 COMPR. FILM. PRF 7 4.489200 0.172228 2.244600 2.416828 4.040280 0.621148
677 W55700002 J01MA12 LEVOFLOXACINUM TAVANIC 500 mg COMPR. FILM. 500mg TERAPIA S.A. ROMANIA CUTIE X 1 BLIST. PVC/AL X 7COMPR. FILM. P-RF 7 4.489200 0.932228 2.244600 3.176828 4.040280 1.381148
679 W60575001 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PE/PVDC/AL X 5 COMPR. FILM. PRF 5 4.489200 0.166800 2.244600 2.411400 4.040280 0.615720
682 W57939001 J01MA14 MOXIFLOXACINUM AVELOX® 400 mg COMPR. FILM. 400mg BAYER PHARMA AG GERMANIA CUTIE X 1 BLIST. TRANSPARENT PP/AL X 5 COMPR. FILM. P-RF 5 4.489200 5.252800 2.244600 7.497400 4.040280 5.701720
683 W59332001 J01MA14 MOXIFLOXACINUM MOXIFLOXACINA AUROBINDO 400 mg COMPR. FILM. 400mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PVDC/AL X 5 COMPR. FILM. PRF 5 4.489200 0.440800 2.244600 2.685400 4.040280 0.889720
684 W60545001 J01MA14 MOXIFLOXACINUM MOFIL 400 mg COMPR. FILM. 400mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PA/AL/PVC-AL X 5 COMPR. FILM. PRF 5 4.489200 2.832800 2.244600 5.077400 4.040280 3.281720
685 W60943001 J01MA14 MOXIFLOXACINUM MOFLAXA 400 mg COMPR. FILM. 400mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONAINÂND 5 COMPRIMATE FILMATE PRF 5 4.489200 2.874800 2.244600 5.119400 4.040280 3.323720
686 W63876001 J01MA14 MOXIFLOXACINUM AVELOX® 400 mg COMPR. FILM. 400mg BAYER AG GERMANIA CUTIE X 1 BLIST. TRANSPARENT PP/AL X 5 COMPR. FILM. PRF 5 4.489200 5.252800 2.244600 7.497400 4.040280 5.701720
696 W12490001 L01AA01 CYCLOPHOSPHAMIDUM * ENDOXAN (R) 50 mg DRAJ. 50mg BAXTER ONCOLOGY GMBH GERMANIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 DRAJ. P-RF 50 0.571399 0.000001 0.285699 0.285701 0.514259 0.057141
709 W64522002 M01AE17 DEXKETOPROFENUM DEKENOR 50 mg/2 ml SOL INJ./PERF. 50mg/2ml KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU 5 FIOLE DIN STICLA BRUNA, CU PUNCT DE CULOARE ALBA SI INEL DE CULOARE ALBASTRA X 2 ML SOL. INJ./PERF. PRF 5 2.684000 0.000000 1.342000 1.342000 2.415600 0.268400
710 W64522003 M01AE17 DEXKETOPROFENUM DEKENOR 50 mg/2 ml SOL INJ./PERF. 50mg/2ml KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU 10 FIOLE DIN STICLA BRUNA, CU PUNCT DE CULOARE ALBA SI INEL DE CULOARE ALBASTRA X 2 ML SOL. INJ./PERF. PRF 10 2.684000 0.000000 1.342000 1.342000 2.415600 0.268400
711 W43063001 M01AE17 DEXKETOPROFENUM TADOR INJECT SOL. INJ./CONC. PT. SOL. PERF. 50mg/2ml MENARINI INTERNATIONAL OPERATIONS S.A. LUXEMBOURG CUTIE X 5 FIOLE X 2 ML SOL. INJ./CONC. PT.SOL.PERF. P-RF 5 2.848000 1.060000 1.424000 2.484000 2.563200 1.344800
712 W61199001 M01AE17 DEXKETOPROFENUM DEXKETOPROFEN ROMPHARM 50 mg/2 ml SOL. INJ./CONC. PT. SOL. PERF. 50mg/2ml ROMPHARM COMPANY S.R.L. 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 2.782000 0.000000 1.391000 1.391000 2.503800 0.278200
713 W61199002 M01AE17 DEXKETOPROFENUM DEXKETOPROFEN ROMPHARM 50 mg/2 ml SOL. INJ./CONC. PT. SOL. PERF. 50mg/2ml ROMPHARM COMPANY S.R.L. 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 2.781000 0.000000 1.390500 1.390500 2.502900 0.278100
890 W57667003 N06AX14 TIANEPTINUM ** LYXIT 12,5 mg COMPR. FILM. 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN PVC-PVDC/AL X 30 COMPR. FILM. PRF 30 0.484999 0.000001 0.242499 0.242501 0.436499 0.048501
892 W60648003 N06AX14 TIANEPTINUM ** NOBIXAL 12,5 mg COMPR. FILM. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. FILM. PRF 30 0.484999 0.000001 0.242499 0.242501 0.436499 0.048501
893 W60648008 N06AX14 TIANEPTINUM ** NOBIXAL 12,5 mg COMPR. FILM. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 30 COMPR. FILM. PRF 30 0.484999 0.000001 0.242499 0.242501 0.436499 0.048501
894 W41558001 N06AX14 TIANEPTINUM ** COAXIL (R) DRAJ. 12,5mg LES LAB. SERVIER IND. FRANTA CUTIE X 1 BLIST. AL/PVC X 30 DRAJ. P-RF 30 0.484999 0.260334 0.242499 0.502834 0.436499 0.308834
983 W57995002 R03AK08 COMBINATII (BECLOMETASONUM+FORMOTEROLUM) FOSTER 100/6 micrograme pe doza SOL. DE INHALAT PRESURIZATA 100/6micrograme pe doza CHIESI PHARMACEUTICALS GMBH 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 1 201.860000 16.370000 100.930000 117.300000 181.674000 36.556000
1,006 W58575001 R03BB04 TIOTROPIUM * SPIRIVA RESPIMAT 2,5 micrograme SOL. DE INHALAT 2,5micrograme BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 1 AMBALAJ UNIC CU UN INHALATOR RESPIMAT SI UN CARTUS CARE FURNIZEAZA 60 PUFURI (30 DOZE MEDICINALE) SOL. PT. INHALAT PRF 1 138.069999 0.000001 69.034999 69.035001 124.262999 13.807001
1,039 W56019002 R05DA09 DEXTROMETHORPHANUM ROBITUSSIN JUNIOR SOL. ORALA 3,75mg/5ml PFIZER CORPORATION AUSTRIA GMBH AUSTRIA CUTIE X 1 FL. DIN STICLA BRUNA CU CAPAC SECURIZAT X 100 ML SOL. ORALA + MASURA DOZATOARE PT.2,5ML;5M P-RF 1 9.399999 0.000001 4.699999 4.700001 8.459999 0.940001
1,059 W58720004 R06AX27 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 11.199999 0.000001 5.599999 5.600001 10.079999 1.120001
1,060 W60474006 R06AX27 DESLORATADINUM AERIUS 0,5mg/ml SOL. ORALA 0,5mg/ml MERCK SHARP&DOHME LTD. MAREA BRITANIE CUTIE X 1 FLACON X 120 ML SOL. ORALA + LIGURITA DOZATOARE DE 2,5 ML SI 5 ML P-RF 1 11.199999 1.990001 5.599999 7.590001 10.079999 3.110001
1,061 W60622002 R06AX27 DESLORATADINUM LORDESTIN 0,5 mg/ml SOL. ORALA 0,5mg/ml GEDEON RICHTER ROMANIA SA 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 11.199999 0.000001 5.599999 5.600001 10.079999 1.120001
1,062 W64712005 R06AX27 DESLORATADINUM AERIUS 0,5mg/ml SOL. ORALA 0,5mg/ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 FLAC. DIN STICLA X 120 ML SOL. ORALA + LINGURITA DOZATOARE DE 2,5 ML SI 5 ML PRF 1 11.199999 1.990001 5.599999 7.590001 10.079999 3.110001
1,065 W10602001 S01AA12 TOBRAMYCINUM TOBREX PIC. OFT.,SOL. 3mg/ml ALCON COUVREUR NV BELGIA CUTIE X 1 FLACON DIN PEJD CU PICURATOR X 5 ML PIC. OFTALMICE, SOL. P-RF 1 6.700000 0.800000 3.350000 4.150000 6.030000 1.470000
1,066 W63542001 S01AA12 TOBRAMYCINUM TOBREX 3 mg/ml PIC. OFT.,SOL. 3mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE CU 1 FLACON DIN PEJD, PREVAZUT CU PICURATOR DIN PEJD CARE CONTINE 5 ML PIC. OFTALMICE, SOL. PRF 1 6.700000 0.800000 3.350000 4.150000 6.030000 1.470000
1,067 W42218001 S01AA12 TOBRAMYCINUM TOBREX 2 X PICATURI OFT.-SOL. 0,3% ALCON COUVREUR NV BELGIA CUTIE CU 1 FLAC. DIN PEJD, PREVAZUT CU PICURATOR DIN PEJD CARE CONTINE 5 ML PIC. OFT., SOL. P-RF 1 6.700000 2.560000 3.350000 5.910000 6.030000 3.230000
1,068 W63544001 S01AA12 TOBRAMYCINUM TOBREX 2 X 3 mg/ml PICATURI OFT.-SOL. 3mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE CU 1 FLAC. DIN PEJD, PREVAZUT CU PICURATOR DIN PEJD CARE CONTINE 5 ML PIC. OFT., SOL. PRF 1 6.700000 2.560000 3.350000 5.910000 6.030000 3.230000
1,076 W55648001 S01BA01 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 1mg/ml PIC. OFT. SUSP. 1mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE X 1 FLAC. DIN PEID X 5 ML PIC. OFT., SUSPENSIE P-RF 1 5.729999 0.030001 2.864999 2.895001 5.156999 0.603001
1,078 W02427001 S01BA01 DEXAMETHASONUM MAXIDEX (R) PICATURI OFT.-SUSP. 0,1% ALCON COUVREUR NV BELGIA CUTIE X 1 FLACON PICURATOR DIN PE X 5 ML P-RF 1 5.729999 0.000001 2.864999 2.865001 5.156999 0.573001
1,079 W63597001 S01BA01 DEXAMETHASONUM MAXIDEX 1 mg/ml PICATURI OFT.-SUSP. 1 mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE X 1 FLACON PICURATOR DIN PE X 5 ML P-RF 1 5.729999 0.000001 2.864999 2.865001 5.156999 0.573001
1,082 W43768002 S01CA01 COMBINATII ( NETILMICINUM + DEXAMETHASONUM) NETILDEX PIC. OFT.SOL. UNIDOZA 4,55 mg/1,32 mg/ml S.I.F.I. SPA ITALIA CUTIE X 20 FLAC. UNIDOZA DIN PEJD X 0,3 ML PIC.OFT. SOL. P-RF 20 0.436860 2.366640 0.218430 2.585070 0.393174 2.410326

Pagina 3 din 6
ANEXA 8
(ANEXA 2c la Ordinul CNAS nr. 1611/2018
SECŢIUNEA C1 - LISTA MEDICAMENTELOR CU PROCENT DE COMPENSARE 100% DIN PREŢUL DE REFERINŢĂ CONFORM

DCI-urilor UTILIZATE ÎN TRATAMENTUL AMBULATORIU AL UNOR GRUPE DE BOLI


DIN H.G. NR. 720/2008, CU MODIFICARILE SI COMPLETARILE ULTERIOARE;
MEDICAMENTELE DIN ACEASTĂ SUBLISTĂ SE ELIBEREAZĂ PRIN FARMACII CU CIRCUIT DESCHIS PE BAZĂ DE PRESCRIPŢIE MEDICALĂ CU REŢINERE ÎN FARMACIE
VALABILĂ ÎNCEPÂND CU 19 MARTIE 2019

Val. maxima suportata de Contributi


sistemul de asigurari asiguratul
sociale de sanatate / UT asigur

Prescriptie
cant. (pt. asiguratii care benefic
Cod_CIM

UT/ Pret de beneficiaza de compensare compens


Nr crt.

TARA DET. ambal referinta / UT 100% din pretul de din pr


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP APP AMBALAJ aj (RON) referinta) refe

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

SE ADAUGA

231 W62461001 B01AA07 ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg MERUS LABS LUXCO II S.A.R.L. LUXEMBURG CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.355000 0.355000
232 W65067001 C09AA03 LISINOPRILUM RANOLIP 10 mg COMPR. 10mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.304399 0.304399
233 W65068001 C09AA03 LISINOPRILUM RANOLIP 20 mg COMPR. 20mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.428400 0.428400
234 W65066001 C09AA03 LISINOPRILUM RANOLIP 5 mg COMPR. 5mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.243600 0.243600
235 W62447012 C09AA05 RAMIPRILUM TRITACE 10 mg COMPR. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 90 COMPR. P6L 90 0.240856 0.240856
236 W62451011 C09AA05 RAMIPRILUM TRITACE 2,5 mg COMPR. 2,5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 60 COMPR. P6L 60 0.188400 0.188400
237 W62382008 C09AA05 RAMIPRILUM TRITACE 5 mg COMPR. 5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 30 COMPR. P6L 30 0.168428 0.168428

2. BOLNAVI CU PROTEZE VALVULARE SI VASCULARE - G2

SE ADAUGA

2 W62461001 B01AA07 ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg MERUS LABS LUXCO II S.A.R.L. LUXEMBURG CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.355000 0.355000

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

SE ADAUGA

70 W64953003 J05AB04 RIBAVIRINUM **1 REBETOL 200 mg CAPS. 200mg MERCK SHARP & DOHME OLANDA CUTIE X 140 CAPS. ( BLIST. PVC/PE/PVDC ) PR 140 2.485285 2.485285
71 W63864002 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 0,5 mg COMPR. FILM. 0,5mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE DIN (OPA/AL/PVC-AL) X 30X1 COMPR. PR 30 9.668799 9.668799
72 W64968001 L03AB05 INTERFERONUM ALFA 2B **1 INTRON A 10 milioane U.I./ml SOL. INJ./PERF. 10 milioane U.I./ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 FLAC. X 1 ML SOL. INJ/PERF. PR 1 285.320000 285.320000
73 W64967001 L03AB05 INTERFERONUM ALFA 2B **1 INTRON A 18 milioane U.I./3 ml SOL. INJ./PERF. 18 milioane U.I./3ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 FLAC. X 3 ML SOL. INJ/PERF. PR 1 467.900000 467.900000
74 W64950002 L03AB10 PEGINTERFERON ALFA-2B **1 PEGINTRON 50 µg PULB. + SOLV. PT. SOL. INJ. 50µg MERCK SHARP & DOHME OLANDA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 387.660000 387.660000

SE MODIFICA

27 W64007001 J05AF10 ENTECAVIRUM **1 ENTECAVIR AUROBINDO 0,5 mg COMPR. FILM. 0,5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 9.668799 9.668799
39 W64008001 J05AF10 ENTECAVIRUM **1 ENTECAVIR AUROBINDO 1 mg COMPR. FILM. 1mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 31.124400 31.124400

7. CIROZA HEPATICA - G7

SE ADAUGA

88 W64953003 J05AB04 RIBAVIRINUM **1 REBETOL 200 mg CAPS. 200mg MERCK SHARP & DOHME OLANDA CUTIE X 140 CAPS. ( BLIST. PVC/PE/PVDC ) PR 140 2.485285 2.485285
89 W63864002 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 0,5 mg COMPR. FILM. 0,5mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE DIN (OPA/AL/PVC-AL) X 30X1 COMPR. PR 30 9.668799 9.668799
90 W64968001 L03AB05 INTERFERONUM ALFA 2B **1 INTRON A 10 milioane U.I./ml SOL. INJ./PERF. 10 milioane U.I./ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 FLAC. X 1 ML SOL. INJ/PERF. PR 1 285.320000 285.320000
91 W64967001 L03AB05 INTERFERONUM ALFA 2B **1 INTRON A 18 milioane U.I./3 ml SOL. INJ./PERF. 18 milioane U.I./3ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 FLAC. X 3 ML SOL. INJ/PERF. PR 1 467.900000 467.900000
92 W64950002 L03AB10 PEGINTERFERON ALFA-2B **1 PEGINTRON 50 µg PULB. + SOLV. PT. SOL. INJ. 50µg MERCK SHARP & DOHME OLANDA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ. + 1 FIOLA SOLV. + 1 SERINGA + 2 ACE + 1 TAMPON DEZINFECTANT PR 1 387.660000 387.660000

Pagina 1 din 12
Val. maxima suportata de Contributi
sistemul de asigurari asiguratul
sociale de sanatate / UT asigur

Prescriptie
cant. (pt. asiguratii care benefic
Cod_CIM

UT/ Pret de beneficiaza de compensare compens


Nr crt.

TARA DET. ambal referinta / UT 100% din pretul de din pr


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP APP AMBALAJ aj (RON) referinta) refe

SE MODIFICA

45 W64007001 J05AF10 ENTECAVIRUM **1 ENTECAVIR AUROBINDO 0,5 mg COMPR. FILM. 0,5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 9.668799 9.668799
57 W64008001 J05AF10 ENTECAVIRUM **1 ENTECAVIR AUROBINDO 1 mg COMPR. FILM. 1mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 31.124400 31.124400

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

SE ADAUGA

219 W64987001 EPOETINUM ZETA **


B03XA01 RETACRIT 10000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/1,0ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 231.500000 231.500000
220 W64990001 EPOETINUM ZETA **
B03XA01 RETACRIT 2000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,6ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. PR 1 53.530000 53.530000
221 W64991001 EPOETINUM ZETA **
B03XA01 RETACRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,75ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,75 ML SOL. INJ. PR 1 506.530000 506.530000
222 W64993001 EPOETINUM ZETA **
B03XA01 RETACRIT 40000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 40000UI/1,0ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 615.530000 615.530000
223 W64994001 EPOETINUM ZETA **
B03XA01 RETACRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,4 ML SOL. INJ. PR 1 101.650000 101.650000
224 W64995001 EPOETINUM ZETA **
B03XA01 RETACRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. PR 1 122.700000 122.700000
225 W64996001 EPOETINUM ZETA **
B03XA01 RETACRIT 6000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI/0,6ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. PR 1 144.600000 144.600000
226 W64997001 EPOETINUM ZETA **
B03XA01 RETACRIT 8000UI/0,8ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI/0,8ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,8 ML SOL. INJ. PR 1 206.430000 206.430000
227 W64931001 VORICONAZOLUM **
J02AC03 VFEND 200 mg COMPR. FILM. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 14.358856 14.358856 4
228 W64929001 VORICONAZOLUM **
J02AC03 VFEND 200 mg PULB. PT. SOL. PERF. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. UNIDOZA X 30 ML PRF 1 329.844000 329.844000 4
229 W64930001 VORICONAZOLUM **
J02AC03 VFEND 40 mg/ml PULB. PT. SUSP. ORALA 40mg/ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 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 PRF 1 1,546.390000 1,546.390000
230 W64693001 POSACONAZOLUM **
J02AC04 NOXAFIL 100mg COMPR. GASTROREZ. 100mg MERCK SHARP & DOHME OLANDA CUTIE CU BLIST. PVC/PCTFE/AL X 24 COMPR. GASTROREZ. PR 24 144.731666 144.731666
231 W64694001 POSACONAZOLUM **
J02AC04 NOXAFIL 300mg CONC. PT. SOL. PERF. 300mg MERCK SHARP & DOHME OLANDA CUTIE CU 1 FLAC. X 16,7ML CONC. PT SOL. PERF. (18MG POSACONAZOL/ML) PR 1 1,491.710000 1,491.710000
232 W64692001 POSACONAZOLUM **
J02AC04 NOXAFIL 40mg/ml SUSP. ORALA 40mg/ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 FLAC. X 105 ML SUSP. ORALA PR 1 2,795.780000 2,795.780000
233 W64671001 L01XX35 ANAGRELIDUM ** ANAGRELIDA SANDOZ 0,5 mg CAPS. 0,5mg SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. PEID X 100 CAPS. PR 100 9.346800 9.346800
234 W64720001 N02AA01 MORPHYNUM MARACEX 20 mg/ml SOL INJ./PERF. 20mg/ml AS KALCEKS LETONIA CUTIE CU 10 FIOLE DIN STICLA INCOLORA CU CAPACITATEA DE 1 ML SOL. INJ./PERF. PS 10 1.806000 1.806000
235 W63213001 N07BC02 METHADONUM METHASAN 10 mg/ml CONC. PT. SOL. ORALA 10mg/ml LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA PS 1
CUTIE CU 1 FLAC. DIN STICLA BRUNA CARE CONTINE 100 ML CONC. PT. SOL. ORALA, SERINGA GRADATA PT. ADMINISTRARE ORALA SI UN ADAPTOR PT. FLAC. 45.260000 45.260000

9. EPILEPSIE - G11

SE ADAUGA

163 W65105001 N03AX09 LAMOTRIGINUM ** LAMICTAL 100 mg COMPR. 100mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR. P6L 28 1.113199 1.113199
164 W65103003 N03AX09 LAMOTRIGINUM ** LAMICTAL 25 mg COMPR. 25mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR. P6L 28 0.156785 0.156785
165 W65059001 N03AX12 GABAPENTINUM ** GABARAN 300 mg CAPS. 300mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 50 0.547200 0.547200
166 W65060001 N03AX12 GABAPENTINUM ** GABARAN 400 mg CAPS. 400mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 50 0.729120 0.729120
167 W65061001 N03AX12 GABAPENTINUM ** GABARAN 600 mg COMPR. FILM. 600mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. AL-PVC-PA/AL X 10 COMPR. FILM. P6L 30 2.295666 2.295666
168 W64907002 N03AX16 PREGABALINUM ** LYRICA 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 56 CAPS. (BLIST. PVC/AL) PRF 56 0.889500 0.889500
169 W64908001 N03AX16 PREGABALINUM ** LYRICA 300 mg CAPS. 300mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 14 CAPS. (BLIST. PVC/AL) PRF 14 1.922785 1.922785

13. BOLI PSIHICE (SCHIZOFRENIE, TULBURĂRI SCHIZOTIPALE ŞI DELIRANTE, TULBURĂRI AFECTIVE MAJORE, TULBURĂRI PSIHOTICE ACUTE ŞI BOLI PSIHICE COPII, AUTISM, TULBURĂRI CU DEFICIT DE ATENŢIE/HIPERREACTIVITATE) - G15

SE ADAUGA

297 W65105001 N03AX09 LAMOTRIGINUM ** LAMICTAL 100 mg COMPR. 100mg IRLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR.
GLAXOSMITHKLINE (IRELAND) LIMITED P6L 28 1.113199 1.113199
298 W65103003 N03AX09 LAMOTRIGINUM ** LAMICTAL 25 mg COMPR. 25mg IRLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR.
GLAXOSMITHKLINE (IRELAND) LIMITED P6L 28 0.156785 0.156785
299 W08728005 N05AX08 RISPERIDONUM ** RISPOLEPT 1 mg/ml SOL. ORALA 1mg/ml JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 100 ML SOL. ORALA SI O PIPETA DOZATOARE PRF 1 44.990000 44.990000

16. POLIARTRITA REUMATOIDĂ, ARTROPATIA PSORIAZICĂ, PSORIAZIS CRONIC SEVER ŞI ARTRITA JUVENILĂ - G 18

Pagina 2 din 12
Val. maxima suportata de Contributi
sistemul de asigurari asiguratul
sociale de sanatate / UT asigur

Prescriptie
cant. (pt. asiguratii care benefic
Cod_CIM

UT/ Pret de beneficiaza de compensare compens


Nr crt.

TARA DET. ambal referinta / UT 100% din pretul de din pr


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP APP AMBALAJ aj (RON) referinta) refe

SE ADAUGA

50 W62665001 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ARENA 100 mg COMPR. FILM. 100mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PA/AL/PVC-AL X 3 COMPR. FILM. PR 3 13.513333 13.513333
51 W62663001 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ARENA 10 mg COMPR. FILM. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PA/AL/PVC-AL X 10 COMPR. FILM. PR 30 2.000666 2.000666
52 W62664001 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ARENA 20 mg COMPR. FILM. 20mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PA/AL/PVC-AL X 10 COMPR. FILM. PR 30 3.149333 3.149333

SE MODIFICA

6 W62602001 L01BA01 METHOTREXATUM METHOTREXATE 2,5 mg COMPR. FILM. 2,5mg CN UNIFARM S.A. ROMANIA CUTIE CU 10 BLIST. X 10 COMPR. FILM. PR 100 0.372800 0.372800

18. BOLI ENDOCRINE (GUŞĂ ENDEMICĂ, INSUFICIENŢĂ SUPRARENALĂ CRONICĂ, DIABETUL INSIPID, MIXEDEMUL ADULTULUI, TUMORI HIPOFIZARE CU EXPANSIUNE SUPRASELARĂ, TUMORI NEUROENDOCRINE ŞI OSTEOPOROZĂ SEVERĂ) - G 22

SE ADAUGA

47 W65037001 G02CB03 CABERGOLINUM ** DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 2 COMPR. P6L 2 11.185000 11.185000
48 W65037002 G02CB03 CABERGOLINUM ** DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 8 COMPR. P6L 8 10.440000 10.440000

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

SE ADAUGA

70 W64987001 B03XA01 EPOETINUM ZETA ** RETACRIT 10000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/1,0ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 231.500000 231.500000
71 W64990001 B03XA01 EPOETINUM ZETA ** RETACRIT 2000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,6ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. PR 1 53.530000 53.530000
72 W64991001 B03XA01 EPOETINUM ZETA ** RETACRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,75ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,75 ML SOL. INJ. PR 1 506.530000 506.530000
73 W64993001 B03XA01 EPOETINUM ZETA ** RETACRIT 40000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 40000UI/1,0ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 615.530000 615.530000
74 W64994001 B03XA01 EPOETINUM ZETA ** RETACRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,4 ML SOL. INJ. PR 1 101.650000 101.650000
75 W64995001 B03XA01 EPOETINUM ZETA ** RETACRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. PR 1 122.700000 122.700000
76 W64996001 B03XA01 EPOETINUM ZETA ** RETACRIT 6000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI/0,6ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. PR 1 144.600000 144.600000
77 W64997001 B03XA01 EPOETINUM ZETA ** RETACRIT 8000UI/0,8ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI/0,8ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,8 ML SOL. INJ. PR 1 206.430000 206.430000

21. GLAUCOM - G 26

SE ADAUGA

41 W65048001 S01ED51 COMBINATII (LATANOPROSTUM+TIMOLOLUM) XALCOM 50 micrograme/ml+5 mg/ml SOL. OFT. 50 micrograme/ml+5 mg/ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. PEJD CU CAPACITATE 5 ML, PREVAZUT CU PICURATOR DIN PEJD SAU PEMD X 2,5 ML PIC. OFT. SOL. P6L 1 24.270000 24.270000
42 W65047001 S01EE01 LATANOPROSTUM XALATAN 50 µg/ml PICATURI OFT., SOL. 50µg/ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLACON PICURATOR DIN PE CONTINÂND 2,5 ML PICATURI OFTALMICE, SOLUTIE, PREVAZUT CU CAPAC CU FILET SI CAPAC SUPLIMENTAR DE PROTECTIE DIN PE P6L 1 27.470000 27.470000

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

SE ADAUGA

76 W63367003 J01DD08 CEFIXIMUM CEFIXIMA AUROBINDO 200 mg COMPR. FILM. 200mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 10 COMPR. FILM. PRF 10 3.731000 3.731000
77 W65056001 J01MA02 CIPROFLOXACINUM CIFRAN COMPR. FILM. 250mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. PRF 10 0.621600 0.621600
78 W65057001 J01MA02 CIPROFLOXACINUM CIFRAN COMPR. FILM. 500mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. PRF 10 0.909600 0.909600

IMUNOSUPRESOARE SELECTIVE - G31

Pagina 3 din 12
Val. maxima suportata de Contributi
sistemul de asigurari asiguratul
sociale de sanatate / UT asigur

Prescriptie
cant. (pt. asiguratii care benefic
Cod_CIM

UT/ Pret de beneficiaza de compensare compens


Nr crt.

TARA DET. ambal referinta / UT 100% din pretul de din pr


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP APP AMBALAJ aj (RON) referinta) refe
25. BOALA CRONICA INFLAMATORIE INTESTINALA - G31a

SE ADAUGA

16 W64887001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN PEN PREUMPLUT 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 PEN PREUMPLUT + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000
17 W64886001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN SERINGA PREUMPLUTA 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 SERINGA PREUMPLUTA CU PROTECTIE AUTOMATA A ACULUI + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000

SE MODIFICA

5 W63195001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE LTD MAREA BRITANIE CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
6 W64710001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
10 W62576001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD MAREA BRITANIE CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
11 W64709001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
12 W65083001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,461.192000 1,461.192000 17
13 W64708001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL. INJ. 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA 2 CUTII A CATE 1 FLACON ( 0,8 ML SOLUTIE STERILA)+ O SERINGA STERILA+ UN AC STERIL+UN ADAPTOR STERIL PENTRU FLACON + 2 TAMPOANE CU ALCOOL PR 2 1,461.192000 1,461.192000 59
14 W59945002 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg/0,80 ml SOL. INJ. 40mg/0,8ml ABBVIE LTD. MAREA BRITANIE 2 CUTII A CATE 1 FLACON ( 0,8 ML SOLUTIE STERILA)+ O SERINGA STERILA+ UN AC STERIL+UN ADAPTOR STERIL PENTRU FLACON + 2 TAMPOANE CU ALCOOL PR 2 1,461.192000 1,461.192000 59

Pagina 4 din 12
Val. maxima suportata de Contributi
sistemul de asigurari asiguratul
sociale de sanatate / UT asigur

Prescriptie
cant. (pt. asiguratii care benefic
Cod_CIM

UT/ Pret de beneficiaza de compensare compens


Nr crt.

TARA DET. ambal referinta / UT 100% din pretul de din pr


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP APP AMBALAJ aj (RON) referinta) refe
26. POLIARTITRITA REUMATOIDA - G31b

SE ADAUGA

48 W64887001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN PEN PREUMPLUT 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 PEN PREUMPLUT + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000
49 W64886001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN SERINGA PREUMPLUTA 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 SERINGA PREUMPLUTA CU PROTECTIE AUTOMATA A ACULUI + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000

SE MODIFICA

32 W63195001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE LTD MAREA BRITANIE CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
33 W64710001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
34 W62576001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD MAREA BRITANIE CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
35 W64709001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
36 W65083001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,461.192000 1,461.192000 17

27. ARTROPATIA PSORIAZICA - G31c

SE ADAUGA

31 W64887001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN PEN PREUMPLUT 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 PEN PREUMPLUT + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000
32 W64886001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN SERINGA PREUMPLUTA 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 SERINGA PREUMPLUTA CU PROTECTIE AUTOMATA A ACULUI + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000

SE MODIFICA

16 W63195001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE LTD MAREA BRITANIE CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
17 W64710001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
18 W62576001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD MAREA BRITANIE CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
19 W64709001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
20 W65083001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,461.192000 1,461.192000 17

28. SPONDILITA ANKILOZANTA - G 31d

SE ADAUGA

32 W64887001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN PEN PREUMPLUT 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 PEN PREUMPLUT + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000
33 W64886001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN SERINGA PREUMPLUTA 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 SERINGA PREUMPLUTA CU PROTECTIE AUTOMATA A ACULUI + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000

SE MODIFICA

16 W63195001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE LTD MAREA BRITANIE CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
17 W64710001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
18 W62576001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD MAREA BRITANIE CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
19 W64709001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
20 W65083001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,461.192000 1,461.192000 17

29. ARTRITA JUVENILA - G 31e

Pagina 5 din 12
Val. maxima suportata de Contributi
sistemul de asigurari asiguratul
sociale de sanatate / UT asigur

Prescriptie
cant. (pt. asiguratii care benefic
Cod_CIM

UT/ Pret de beneficiaza de compensare compens


Nr crt.

TARA DET. ambal referinta / UT 100% din pretul de din pr


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP APP AMBALAJ aj (RON) referinta) refe
SE ADAUGA

27 W64887001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN PEN PREUMPLUT 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 PEN PREUMPLUT + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000
28 W64886001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN SERINGA PREUMPLUTA 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 SERINGA PREUMPLUTA CU PROTECTIE AUTOMATA A ACULUI + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000

SE MODIFICA

12 W63195001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE LTD MAREA BRITANIE CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
13 W64710001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
14 W62576001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD MAREA BRITANIE CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
15 W64709001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
16 W65083001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,461.192000 1,461.192000 17
17 W64708001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL. INJ. 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA 2 CUTII A CATE 1 FLACON ( 0,8 ML SOLUTIE STERILA)+ O SERINGA STERILA+ UN AC STERIL+UN ADAPTOR STERIL PENTRU FLACON + 2 TAMPOANE CU ALCOOL PR 2 1,461.192000 1,461.192000 59
18 W59945002 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg/0,80 ml SOL. INJ. 40mg/0,8ml ABBVIE LTD. MAREA BRITANIE 2 CUTII A CATE 1 FLACON ( 0,8 ML SOLUTIE STERILA)+ O SERINGA STERILA+ UN AC STERIL+UN ADAPTOR STERIL PENTRU FLACON + 2 TAMPOANE CU ALCOOL PR 2 1,461.192000 1,461.192000 59

30. PSORIAZIS CRONIC SEVER (PLĂCI) - G 31f

SE ADAUGA

36 W64887001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN PEN PREUMPLUT 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 PEN PREUMPLUT + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000
37 W64886001 L04AB04 ADALIMUMABUM **1 HULIO SOL INJ. IN SERINGA PREUMPLUTA 40mg MYLAN S.A.S. FRANTA CUTIE CU 1 SERINGA PREUMPLUTA CU PROTECTIE AUTOMATA A ACULUI + 2 TAMPOANE ALCOOL PR 1 1,217.660000 1,217.660000

SE MODIFICA

16 W63195001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE LTD MAREA BRITANIE CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
17 W64710001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN PEN PREUMPLUT 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE 2 BLIST. CU CÂTE UN PEN PRE-UMPLUT (0,4 ML SOL. STERILA) SI 1 TAMPON CU ALCOOL PR 2 1,461.192000 1,461.192000 50
21 W62576001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE LTD MAREA BRITANIE CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
22 W64709001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 2 BLIST. CE CONTIN CATE O SERINGA PREUMPLUTA (0,4 ML SOL. STERILA) SI UN TAMPON ALCOOL PR 2 1,461.192000 1,461.192000 39
23 W65083001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL INJ. IN SERINGA PREUMPLUTA 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,461.192000 1,461.192000 17
24 W64708001 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg SOL. INJ. 40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA 2 CUTII A CATE 1 FLACON ( 0,8 ML SOLUTIE STERILA)+ O SERINGA STERILA+ UN AC STERIL+UN ADAPTOR STERIL PENTRU FLACON + 2 TAMPOANE CU ALCOOL PR 2 1,461.192000 1,461.192000 59
25 W59945002 L04AB04 ADALIMUMABUM **1 HUMIRA 40 mg/0,80 ml SOL. INJ. 40mg/0,8ml ABBVIE LTD. MAREA BRITANIE 2 CUTII A CATE 1 FLACON ( 0,8 ML SOLUTIE STERILA)+ O SERINGA STERILA+ UN AC STERIL+UN ADAPTOR STERIL PENTRU FLACON + 2 TAMPOANE CU ALCOOL PR 2 1,461.192000 1,461.192000 59

Pagina 6 din 12
ANEXA 9
(ANEXA 2d la Ordinul CNAS nr. 1611/2018)

SECŢIUNEA C3 - LISTA DE MEDICAMENTE CU PROCENT DE COMPENSARE 100% DIN PRE ȚUL DE REFERINȚĂ - CONFORM DCI-URILOR, ALTELE DECÂT CELE DIN
SUBLISTELE A, B, SUBLISTA C SECŢIUNEA C1 ŞI SUBLISTA D, CORESPUNZĂTOARE MEDICAMENTELOR, DE CARE BENEFICIAZĂ COPIII PÂNĂ LA 18 ANI, TINERII DE LA
18 LA 26 DE ANI DACĂ SUNT ELEVI, UCENICI SAU STUDENŢI, DACĂ NU REALIZEAZĂ VENITURI, PRECUM ŞI GRAVIDE ŞI LEHUZE, ÎN TRATAMENTUL AMBULATORIU,
DIN HG NR. 720/2008, CU MODIFICARILE SI COMPLETARILE ULTERIOARE,
VALABILĂ ÎNCEPÂND CU 19 MARTIE 2019

Contributie
Val. maxima suportata de maxima a
sistemul de asigurari asiguratului / UT
sociale de sanatate / UT (pt. asiguratii care

Prescriptie
Cod_CIM

cant. (pt. asiguratii care beneficiaza de


UT/ Pret de beneficiaza de compensare 100%
Nr crt.

Tara det. amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)

SE ADAUGA

229 W42822003 A11HA02 PYRIDOXINUM VITAMINA B6 ARENA 250 mg COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE CU 5 BLIST. DIN FOLIE PVC ALBA OPACA/AL X 10 COMPR. P6L 50 0.493000 0.493000 0.000000
230 W42822002 A11HA02 PYRIDOXINUM VITAMINA B6 ARENA 250 mg COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE CU 2 BLIST. DIN FOLIE PVC ALBA OPACA/AL X 10 COMPR. P6L 20 0.497000 0.497000 0.000000
231 W64578003 G03GA02 MENOTROPINUM MERIOFERT 150 UI PULB+SOLV. PT. SOL. INJ. 150UI IBSA FARMACEUTICI ITALIA S.R.L. ITALIA PR
CUTIE CU 10 SETURI CARE CONTIN: FLACOANE CU PULB. PT. SOL. INJ. SI FIOLE CU SOLVENT PT. SOL. INJ. 10 159.313000 159.313000 0.000000
232 W64577003 G03GA02 MENOTROPINUM MERIOFERT 75 UI PULB+SOLV. PT. SOL. INJ. 75UI IBSA FARMACEUTICI ITALIA S.R.L. ITALIA PR
CUTIE CU 10 SETURI CARE CONTIN: FLACOANE CU PULB. PT. SOL. INJ. SI FIOLE CU SOLVENT PT. SOL. INJ. 10 82.191000 82.191000 0.000000
233 W64965001 J01DB04 CEFAZOLINUM CEFAZOLIN 1 g 1g
PULB. PT. SOL. INJ. I.V./I.M. CN UNIFARM S.A. ROMANIA CUTIE CU 1 FLAC. PULB. PT. SOL. INJ. PR 1 342.770000 342.770000 0.000000
234 W64931001 J02AC03 VORICONAZOLUM ** VFEND 200 mg COMPR. FILM. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 14.358856 14.358856 43.581144
235 W64930001 J02AC03 VORICONAZOLUM ** VFEND 40 mg/ml PULB. PT. SUSP. ORALA 40mg/ml PFIZER EUROPE MA EEIG BELGIA PRF
CUTIE CU 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 1 1,546.390000 1,546.390000 0.000000
236 W64924001 M01AH04 PARECOXIBUM DYNASTAT 40 mg PULB. PT. SOL. INJ. 40mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 10 FLAC. X 40 MG PULB. PT. SOL. INJ.PRF 10 31.727000 31.727000 0.000000

Pagina 1 din 1
ANEXA 10
(ANEXA 2e la Ordinul CNAS nr. 1611/2018)

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 SI FARA CONTRIBUTIE PERSONALA DIN
HG NR. 720/2008, CU COMPLETARILE SI MODIFICARILE ULTERIOARE,
VALABILA INCEPAND CU 19 MARTIE 2019

Contributie maxima Val. maxima suportata de Contributie maxima


a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

Prescriptie
Cod_CIM

cant. beneficiaza de (pt. asiguratii care beneficiaza de


UT/ Pret de compensare 100% beneficiaza de compensare 20%
Nr crt.

tara det. amba referinta / UT din pretul de compensare 20% din din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) referinta)

SE ADAUGA

103 W65034001 A03AA05 TRIMEBUTINUM DEBRIDAT 100 mg COMPR. FILM. 100mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL/PVC X 15 COMPR. FILM.P6L 30 0.405333 0.000000 0.081066 0.324267
104 W65035001 A03AA05 TRIMEBUTINUM DEBRIDAT 200 mg COMPR. FILM. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM.P6L 30 0.810668 0.373665 0.162133 1.022200
105 W65036002 A03AA05 TRIMEBUTINUM DEBRIDAT GRAN. PT. SUSP. ORALA 24mg/5ml PFIZER EUROPE MA EEIG BELGIA P6L
CUTIE X 1 FLAC. DIN STICLA BRUNA X 76,25 G GRANULE PT. 125ML SUSP. + SERINGA DOZATOARE GRADATA 1 6.580000 4.390000 1.316000 9.654000
106 W65036001 A03AA05 TRIMEBUTINUM DEBRIDAT GRAN. PT. SUSP. ORALA 24mg/5ml PFIZER EUROPE MA EEIG BELGIA P6L
CUTIE X 1 FLAC. DIN STICLA BRUNA X 152,5 G GRANULE PT. 250ML SUSP. + MASURA DOZATOARE GRADATA 1 13.160000 0.000000 2.632000 10.528000
107 W64910001 D06BB03 ACICLOVIRUM ACEVIREX 50 mg/g CREMA 50mg/g GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 TUB DIN AL X 5 G CREMA PRF 1 2.272500 20.727500 0.454500 22.545500

SE MODIFICA

29 W07832002 A03AA05 TRIMEBUTINUM DEBRIDAT GRAN. PT. SUSP. ORALA 24mg/5ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. DIN STICLA BRUNA X 76,25 G GRANULE PT. 125ML SUSP. + MASURA DOZATOARE P-6L 1 6.580000 4.390000 1.316000 9.654000
30 W12227001 A03FA03 DOMPERIDONUM MOTILIUM 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. X 10 COMPR. FILM. P-6L 10 0.112875 0.368125 0.022575 0.458425
31 W58243002 A03FA03 DOMPERIDONUM OROPERIDYS 10 mg COMPR. ORODISPERSABILE 10mg PIERRE FABRE MEDICAMENT FRANTA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. ORODISP. P6L 30 0.112875 0.588791 0.022575 0.679091
32 W61966003 A03FA03 DOMPERIDONUM DOMOTIL 10 mg COMPR. ORODISPERSABILE 10mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. ORODISPERSABILE P6L 30 0.112875 0.367458 0.022575 0.457758
33 W13661001 C01EB15 TRIMETAZIDINUM TRIMETAZIDINA LPH 35 mg COMPR. CU ELIB. MODIF. 35mg LABORMED PHARMA SAROMANIA CUTIE X 6 BLISTERE X 10 COMPRIMATE CU ELIBERARE MODIFICATA P-6L 60 0.422665 0.000001 0.084533 0.338133
34 W57454001 C01EB15 TRIMETAZIDINUM TRIMETAZIDINA ATB 35 mg COMPR. CU ELIB. PREL. 35mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. CU ELIB. PREL. P6L 30 0.422665 0.000001 0.084533 0.338133
35 W07058001 C01EB15 TRIMETAZIDINUM PREDUCTAL MR 35 mg COMPR. ELIB. MODIF. 35mg LES LABORATOIRES SERVIER FRANTA CUTIE X 2 BLIST. AL/PVC X 30 COMPR. FILM. ELIB. MODIF. P-6L 60 0.422665 0.189668 0.084533 0.527800
36 W59722004 C01EB15 TRIMETAZIDINUM MODUXIN MR 35 mg COMPR. ELIB. PREL. 35mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. AL/PVC X 30 COMPR. CU ELIB. PRELUNG. P6L 30 0.422665 0.000001 0.084533 0.338133
50 W00040001 D06BB03 ACICLOVIRUM ZOVIRAX CREMA 5% THE WELLCOME FOUNDATION LTD. MAREA BRITANIE CUTIE X 1 TUB X 5G CREMA P-RF 1 2.272500 13.677500 0.454500 15.495500
52 W55128001 D06BB03 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-RF 1 6.817500 0.512500 1.363500 5.966500
53 W58038001 D06BB03 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 6.817500 0.512500 1.363500 5.966500
54 W60557002 D06BB03 ACICLOVIRUM ACICLOVIR-RICHTER 50mg/g CREMA 50mg/g GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 1 TUB AL X 15 G CREMA PRF 1 6.817500 1.492500 1.363500 6.946500
55 W55128002 D06BB03 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-RF 1 2.272500 3.617500 0.454500 5.435500
56 W60557001 D06BB03 ACICLOVIRUM ACICLOVIR-RICHTER 50mg/g CREMA 50mg/g GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 1 TUB AL X 5 G CREMA PRF 1 2.272500 3.167500 0.454500 4.985500
57 W58038002 D06BB03 ACICLOVIRUM ACICLOVIR TERAPIA 50 mg/g CREMA 50mg/g TERAPIA S.A. ROMANIA CUTIE CU 1 TUB DIN AL A 5 G CREMA PRF 1 2.272500 5.057500 0.454500 6.875500
58 W64229001 D06BB03 ACICLOVIRUM ACEVIREX 50 mg/g CREMA 50mg/g THE WELLCOME FOUNDATION LTD. MAREA BRITANIE CUTIE CU 1 TUB DIN AL X 5 G CREMA PRF 1 2.272500 20.727500 0.454500 22.545500
102 W63144001 R05CB15 ERDOSTEINUM ** ERDOMED 175 mg/5 ml PULB. PT. SUSP. ORALA 175mg/5ml ANGELINI PHARMA ÖSTERREICH GMBH AUSTRIA P-6L
CUTIE CU 1 FLAC. DIN STICLA BRUNA A 50 G PULB. PT. OBTINEREA A 100 ML SUSP. ORALA + 1 MASURA DOZATOARE DIN PP 1 25.149999 0.000001 5.029999 20.120001

Pagina 1 din 1