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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 01 IULIE 2019

Contributie maxima Val. maxima suportata de Contributie maxima


a asiguratului / UT sistemul de asigurari a asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
Cod_CIM

cant. beneficiaza de (pt. asiguratii care beneficiaza de


Nr crt.

UT/ Pret de compensare 100% beneficiaza de compensare 90%


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

1.080 W65259002 C03CA01 FUROSEMIDUM FUROSEMID HAMELN 10 mg/ml SOL INJ. 10mg/ml HAMELN PHARMA PLUS GMBH GERMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA DE TIP I, PREVAZUTE CU PUNCT DE RUPERE A CATE 2 ML SOL. INJ. PRF 10 1,328000 0,000000 1,195200 0,132800
1.081 W00625002 C07AB07 BISOPROLOLUM CONCOR 10 mg COMPR. FILM. 10mg MERCK KGAA GERMANIA CUTIE CU 2 BLIST. PVC/AL X 30 COMPR. FILM. P-6L 60 0,344399 0,383267 0,309959 0,417707
1.082 W00626002 C07AB07 BISOPROLOLUM CONCOR 5 mg COMPR. FILM. 5mg MERCK KGAA GERMANIA CUTIE CU 2 BLIST. PVC/AL X 30 COMPR. FILM. P-6L 60 0,172199 0,340134 0,154979 0,357354
1.083 W60469004 J01CF04 OXACILLINUM OXACILINA ATB 1000 mg 1000mg
PULB. PT. SOL. INJ./PERF. ANTIBIOTICE SA ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 10 5,482150 0,139850 4,933935 0,688065
1.084 W60469002 J01CF04 OXACILLINUM OXACILINA ATB 1000 mg PULB. PT. SOL. INJ./PERF. 1000mg ANTIBIOTICE SA ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 50 5,062600 0,000000 4,556340 0,506260
1.085 W60468002 J01CF04 OXACILLINUM OXACILINA ATB 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 50 2,741075 1,932125 2,466967 2,206233
1.086 W60468004 J01CF04 OXACILLINUM OXACILINA ATB 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 10 2,741075 2,447925 2,466967 2,722033
1.087 W03600003 M01AB01 INDOMETACINUM INDOMETACIN ATB 50 mg SUPOZ. 50mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ. P6L 6 0,300541 0,444459 0,270486 0,474514
1.088 W14114003 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ. P6L 6 0,598333 0,000000 0,538499 0,059834
1.089 W12403003 N03AF01 CARBAMAZEPINUM CARBAMAZEPINA SLAVIA 200 mg COMPR. 200mg SLAVIA PHARM SRL ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. PRF 50 0,149200 0,000000 0,134280 0,014920
1.090 W08798003 N05BA08 BROMAZEPAMUM * BROMAZEPAM SLAVIA 3 mg COMPR. 3mg SLAVIA PHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. P-RF 10 0,083400 0,021600 0,075060 0,029940
1.091 W65214001 P02CA03 ALBENDAZOLUM ZENTEL 0,4 g/10 ml SUSP. ORALA 0,4g/10ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE X 1 FLACON UNIDOZA DIN PVC X 10 ML SUSP. ORALA P-RF 1 4,648500 1,611500 4,183650 2,076350
1.092 W62739001 R05DA04 CODEINUM CODEINA SLAVIA 15mg COMPR. 15mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0,182500 0,000000 0,164250 0,018250

SE MODIFICA

406 W58838001 C09CA01 LOSARTANUM LODIAL 100mg COMPR. FILM. 100 mg ALKALOID-INT D.O.O. SLOVENIA CUTIE CU 2 BLIST. DIN PVC/AL X 15 COMPR. FILM. P6L 30 0,686700 0,314300 0,618030 0,382970
407 W53261001 C09CA01 LOSARTANUM TALOSAN 100 mg COMPR. FILM. 100mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PA-AL- PVC/AL X 10 COMPR. FILM. P-6L 30 0,686700 0,490633 0,618030 0,559303
408 W53261003 C09CA01 LOSARTANUM TALOSAN 100 mg COMPR. FILM. 100mg TERAPIA SA ROMANIA CUTIE X 3 FOLII AL/PE X 10 COMPR. FILM. P-6L 30 0,686700 0,490633 0,618030 0,559303
410 W58837001 C09CA01 LOSARTANUM LODIAL 50mg COMPR. FILM. 50 mg ALKALOID-INT D.O.O. SLOVENIA CUTIE CU 3 BLIST. DIN PVC/AL X 10 COMPR. FILM. P6L 30 0,343350 0,008316 0,309015 0,042651
411 W53260001 C09CA01 LOSARTANUM TALOSAN 50 mg COMPR. FILM. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PA-AL- PVC/AL X 10 COMPR. FILM. P-6L 30 0,343350 0,008316 0,309015 0,042651
412 W53260003 C09CA01 LOSARTANUM TALOSAN 50 mg COMPR. FILM. 50mg TERAPIA SA ROMANIA CUTIE X 3 FOLII AL/PE X 10 COMPR. FILM. P-6L 30 0,343350 0,008316 0,309015 0,042651
414 W58237004 C09CA01 LOSARTANUM LORISTA 50 mg COMPR. FILM. 50mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0,343350 0,008792 0,309015 0,043127
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 0,101324 0,239747 0,091191 0,249880
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 0,101324 0,113318 0,091191 0,123451
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 0,101324 0,227009 0,091191 0,237142
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 0,101324 0,199033 0,091191 0,209166
419 W42328001 C10AA01 SIMVASTATINUM SIMVASTATIN LPH 10 mg COMPR. FILM. 10mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 0,101324 0,239676 0,091191 0,249809
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 0,101324 0,054390 0,091191 0,064523
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 0,101324 0,054676 0,091191 0,064809
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 0,202649 0,253422 0,182384 0,273687
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 0,202649 0,253422 0,182384 0,273687
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 0,202649 0,499136 0,182384 0,519401
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 0,202649 0,253351 0,182384 0,273616
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 0,202649 0,253065 0,182384 0,273330
428 W42327001 C10AA01 SIMVASTATINUM SIMVASTATIN LPH 20 mg COMPR. FILM. 20mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0,202649 0,253351 0,182384 0,273616
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 0,202649 0,055922 0,182384 0,076187
430 W58958005 C10AA01 SIMVASTATINUM SIMVASTATIN AUROBINDO 20 mg COMPR. FILM. 20mg AUROBINDO PHARMA LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC/PE/PVDC/AL X 30 COMPR. FILM. P6L 30 0,202649 0,045351 0,182384 0,065616
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 0,202649 0,253351 0,182384 0,273616
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 0,303975 0,204358 0,273577 0,234756
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 0,405299 0,760058 0,364769 0,800588
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 0,405299 0,373986 0,364769 0,414516
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 0,405299 0,173986 0,364769 0,214516

Pagina 1 din 3
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT

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

UT/ Pret de compensare 100% beneficiaza de compensare 90%


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)
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 0,405299 0,718034 0,364769 0,758564
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 0,405299 0,722367 0,364769 0,762897
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 0,405299 0,534034 0,364769 0,574564
441 W06752001 C10AA02 LOVASTATINUM MEDOSTATIN COMPR. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 1 BLIST. X 10 COMPR. P-6L 10 0,135099 0,417901 0,121589 0,431411
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 0,135099 0,806901 0,121589 0,820411
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 0,202649 0,666993 0,182384 0,687258
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 0,202649 0,666993 0,182384 0,687258
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 0,405299 0,980415 0,364769 1,020945
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 0,405299 0,980415 0,364769 1,020945
502 W55416003 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SUSP. INJ. I.M. P-RF 1 5,289609 0,600391 4,760648 1,129352
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 5,482150 0,327850 4,933935 0,876065
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 2,741075 2,618925 2,466967 2,893033
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 2,741075 1,770625 2,466967 2,044733
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 1,144125 0,095875 1,029712 0,210288
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 1,144125 0,095875 1,029712 0,210288
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 1,144125 0,095875 1,029712 0,210288
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 1,144125 1,041875 1,029712 1,156288
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 0,228825 3,848175 0,205942 3,871058
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 0,228825 3,356175 0,205942 3,379058
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 0,572062 0,171938 0,514855 0,229145
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 0,572062 0,147938 0,514855 0,205145
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 0,572062 0,173938 0,514855 0,231145
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 0,572062 0,145938 0,514855 0,203145
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 0,572062 0,099938 0,514855 0,157145
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 0,572062 0,184938 0,514855 0,242145
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 0,572062 0,147938 0,514855 0,205145
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 0,572062 0,184938 0,514855 0,242145
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 1,144125 0,102875 1,029712 0,217288
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 1,144125 0,248875 1,029712 0,363288
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 1,144125 0,299875 1,029712 0,414288
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 1,144125 0,299875 1,029712 0,414288
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 1,716187 2,360813 1,544568 2,532432
633 W57948001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 1000 mg COMPR. FILM. ELIB. PREL. 1000 mg BAYER PHARMA AG GERMANIA CUTIE X 1 BLIST. DIN PP/AL X 7 COMPR. FILM. ELIB. PREL. P-RF 7 2,288250 10,800321 2,059425 11,029146
634 W63880001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 1000 mg COMPR. FILM. ELIB. PREL. 1000 mg BAYER AG GERMANIA CUTIE X 1 BLIST. DIN PP/AL X 7 COMPR. FILM. ELIB. PREL. P-RF 7 2,288250 10,800321 2,059425 11,029146
635 W57949001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 500 mg COMPR. FILM. ELIB. PREL. 500 mg BAYER PHARMA AG GERMANIA CUTIE X 1 BLIST. DIN PP/AL X 3 COMPR. FILM. ELIB. PREL. P-RF 3 1,144125 8,815875 1,029712 8,930288
636 W63879001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 500 mg COMPR. FILM. ELIB. PREL. 500 mg BAYER AG GERMANIA CUTIE X 1 BLIST. DIN PP/AL X 3 COMPR. FILM. ELIB. PREL. P-RF 3 1,144125 8,815875 1,029712 8,930288
637 W52445001 J01MA03 PEFLOXACINUM PEFLOXACIN LAROPHARM 400 mg COMPR. FILM. 400mg LAROPHARM S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 10 1,144125 1,900875 1,029712 2,015288
646 W08257001 J01XD01 METRONIDAZOLUM FLAGYL ( vezi J01XD01) COMPR. FILM. 250mg LABORATOIRE AVENTIS FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 20 0,383000 0,000000 0,344700 0,038300
648 W08257001 J01XD01 METRONIDAZOLUM FLAGYL ( vezi J01XD01) COMPR. FILM. 250mg LABORATOIRE AVENTIS FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 20 0,383000 0,000000 0,344700 0,038300
647 W63535001 J01XD01 METRONIDAZOLUM FLAGYL 250 mg (vezi P01AB01) COMPR. FILM. 250mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 20 0,383000 0,000000 0,344700 0,038300
649 W63535001 J01XD01 METRONIDAZOLUM FLAGYL 250 mg (vezi P01AB01) COMPR. FILM. 250mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 20 0,383000 0,000000 0,344700 0,038300
696 W03600001 M01AB01 INDOMETACINUM INDOMETACIN ATB 50 mg SUPOZ. 50mg ANTIBIOTICE SA ROMANIA CUTIE CU 2 FOLII TERMOSUDATE PVC/PE X 3 SUPOZ. P-6L 6 0,300541 0,444459 0,270486 0,474514
697 W03609001 M01AB01 INDOMETACINUM INDOMETACIN 50 mg SUPOZ. 50mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6L 10 0,300541 0,423459 0,270486 0,453514
698 W12694002 M01AB01 INDOMETACINUM INDOMETACIN 50 mg SUPOZ. 50mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII TERMOSUDATE PVC/PE X 5 SUPOZ. P-6L 10 0,300541 0,420459 0,270486 0,450514
711 W14114001 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDANTE X 3 SUPOZ. P-6L 6 0,598333 0,000000 0,538499 0,059834
712 W12288001 M01AB05 DICLOFENACUM DICLOFENAC 100 mg SUPOZ. 100mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6L 10 0,598000 0,000000 0,538200 0,059800
713 W02480002 M01AB05 DICLOFENACUM DICLOFENAC SODIC 100 mg SUPOZ. 100mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII TERMOSUDATE PVC/PE X 5 SUPOZ. P-6L 10 0,601083 0,000917 0,540974 0,061026
714 W60401001 M01AB05 DICLOFENACUM DICLOFENAC SINTOFARM 12,5 mg SUPOZ. 12,5 mg SINTOFARM S.A. ROMANIA CUTIE X 2 FOLII TERMOSUDATE DIN PVC-PE X 3 SUPOZITOARE P6L 6 0,075135 0,561531 0,067621 0,569045
715 W60401002 M01AB05 DICLOFENACUM DICLOFENAC SINTOFARM 12,5 mg SUPOZ. 12,5 mg SINTOFARM S.A. ROMANIA CUTIE X 2 FOLII TERMOSUDATE DIN PVC-PE X 5 SUPOZITOARE P6L 10 0,075135 0,556865 0,067621 0,564379
794 W51397003 N03AF01 CARBAMAZEPINUM TEGRETOL (R) 200 COMPR. 200mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 5 BLIST. PVC-PE-PVDC/AL X 10 COMPR.P-6L 50 0,149350 0,068850 0,134415 0,083785
797 W00797001 N03AF01 CARBAMAZEPINUM CARBAMAZEPIN EEL COMPR. 200mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0,149350 0,000150 0,134415 0,015085
798 W00798002 N03AF01 CARBAMAZEPINUM CARBAMAZEPINA ARENA 200 mg COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0,149350 0,000150 0,134415 0,015085
802 W00807001 N03AF01 CARBAMAZEPINUM CARBEPSIL 400mg COMPR. 400mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6L 50 0,298700 0,114500 0,268830 0,144370
803 W53816001 N03AF01 CARBAMAZEPINUM CARBAMAZEPINA ARENA 400 mg COMPR. 400mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0,298700 0,114300 0,268830 0,144170
804 W58631001 N03AF01 CARBAMAZEPINUM TIMONIL RETARD 150 mg COMPR. CU ELIB. PRELUNGITA 150mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. CU ELIB. PRELUNGITA P6L 50 0,112012 0,207788 0,100810 0,218990
805 W58632001 N03AF01 CARBAMAZEPINUM TIMONIL RETARD 300 mg COMPR. CU ELIBERARE PRELUNGITA 300mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P6L 50 0,224025 0,210575 0,201622 0,232978

Pagina 2 din 3
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT

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

UT/ Pret de compensare 100% beneficiaza de compensare 90%


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)
806 W58633001 N03AF01 CARBAMAZEPINUM TIMONIL RETARD 600 mg 600mg
COMPR. CU ELIBERARE PRELUNGITA DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P6L 50 0,448050 0,322350 0,403245 0,367155
807 W12426001 N03AF01 CARBAMAZEPINUM NEUROTOP (R) RETARD 300 mg COMPR. ELIB. PREL. 300mg GEROT PHARMAZEUTIKA GMBH AUSTRIA CUTIE X 5 BLIST. AL/PVDC-PVC X 10 COMPR. ELIB. PREL P-6L 50 0,224025 0,121175 0,201622 0,143578
808 W63239001 N03AF01 CARBAMAZEPINUM NEUROTOP RETARD 300 mg COMPR. ELIB. PREL. 300mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 5 BLIST. AL/PVDC-PVC X 10 COMPR. ELIB. PREL. P6L 50 0,224025 0,121175 0,201622 0,143578
809 W12428001 N03AF01 CARBAMAZEPINUM NEUROTOP (R) RETARD 600 mg COMPR. ELIB. PREL. 600mg GEROT PHARMAZEUTIKA GMBH AUSTRIA CUTIE X 5 BLIST. AL/PVDC-PVC X 10 COMPR. ELIB. PREL. P-6L 50 0,448050 0,252150 0,403245 0,296955
810 W63238001 N03AF01 CARBAMAZEPINUM NEUROTOP RETARD 600 mg COMPR. ELIB. PREL. 600mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 5 BLIST. AL/PVDC-PVC X 10 COMPR. ELIB. PREL. P6L 50 0,448050 0,252150 0,403245 0,296955
811 W51395001 N03AF01 CARBAMAZEPINUM TEGRETOL CR 200 COMPR. FILM. ELIB. PREL. 200mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 5 BLIST. AL-PVC/PVDC X 10 COMPR. FILM. CU ELIB. PREL.P-6L 50 0,149350 0,216450 0,134415 0,231385
812 W51394001 N03AF01 CARBAMAZEPINUM TEGRETOL CR 400 COMPR. FILM. ELIB. PREL. 400mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 3 BLIST. AL-PVC/PVDC X 10 COMPR. FILM. CU ELIB. PREL.P-6L 30 0,298700 0,337633 0,268830 0,367503
898 W01358001 N06AA04 CLOMIPRAMINUM * ANAFRANIL (R) 10 mg DRAJ. 10mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-RF 30 0,203309 0,054357 0,182978 0,074688
899 W01359001 N06AA04 CLOMIPRAMINUM * ANAFRANIL (R) 25 mg DRAJ. 25mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-RF 30 0,485333 0,000000 0,436799 0,048534
901 W02865001 N06AA12 DOXEPINUM * DOXEPIN 25 mg DRAJ. 25mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-RF 30 0,508274 0,292059 0,457446 0,342887
976 W42888001 P01AB02 TINIDAZOLUM TINIZOL (R) 500 mg (J01XD02) COMPR. FILM. 500mg ZENTIVA S.A. ROMANIA CUTIE X 1 BLIST. X 4 COMPR. FILM. P-RF 4 0,766000 0,244000 0,689400 0,320600
978 W42888001 P01AB02 TINIDAZOLUM TINIZOL (R) 500 mg (J01XD02) COMPR. FILM. 500mg ZENTIVA S.A. ROMANIA CUTIE X 1 BLIST. X 4 COMPR. FILM. P-RF 4 0,766000 0,244000 0,689400 0,320600
977 W10714001 P01AB02 TINIDAZOLUM TIPROGYN 500 (vezi J01XD02) COMPR. FILM. 500mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. X 4 COMPR.FILM. P6L 4 0,766000 0,204000 0,689400 0,280600
979 W10714001 P01AB02 TINIDAZOLUM TIPROGYN 500 (vezi J01XD02) COMPR. FILM. 500mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. X 4 COMPR.FILM. P6L 4 0,766000 0,204000 0,689400 0,280600
985 W00228001 P02CA03 ALBENDAZOLUM ZENTEL 0,4 g/10 ml SUSP. ORALA 0,4g/10ml GLAXOSMITHKLINE EXPORT LTD. MAREA BRITANIE CUTIE X 1 FLACON UNIDOZA DIN PVC X 10 ML SUSP. ORALA P-RF 1 4,648500 1,611500 4,183650 2,076350
1.005 W01411002 R05DA04 CODEINUM FOSFAT DE CODEINA 15 mg COMPR. 15mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0,182500 0,028166 0,164250 0,046416
1.006 W01409002 R05DA04 CODEINUM CODEINA FOSFORICA COMPR. 15mg BIO EEL SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-RF 25 0,182500 0,033100 0,164250 0,051350
1.008 W54406001 R05DA04 CODEINUM CODEINA FOSFAT MCC 15 mg COMPR. 15mg MAGISTRA C & C SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0,182500 0,017000 0,164250 0,035250

SE ELIMINA

413 W56259005 C09CA01 LOSARTANUM COZAAR 50 mg COMPR. FILM. 50mg MERCK SHARP & DOHME ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P-6L 28 0,345375 0,196767 0,310837 0,231305
644 W53689002 J01XD01 METRONIDAZOLUM METRONIDAZOL ARENA 250 mg (J01XD01) COMPR.
250mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0,251666 0,000000 0,226499 0,025167
645 W53689002 J01XD01 METRONIDAZOLUM METRONIDAZOL ARENA 250 mg (J01XD01) COMPR.
250mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0,251666 0,000000 0,226499 0,025167
900 W52017001 N06AA09 AMITRIPTYLINUM * AMITRIPTILINA ARENA 25 mg COMPR. FILM. 25mg ARENA GROUP S.A. ROMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 50 0,327800 0,000000 0,295020 0,032780

Pagina 3 din 3
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 01 IULIE 2019

Contributie Val. maxima suportata Contributie Val. maxima suportata Contributie


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

Prescriptie
cant. beneficiaza de asiguratii care beneficiaza de asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de compensare 100% beneficiaza de compensare 50% beneficiaza de compensare 90%
Nr crt.

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

SE ADAUGA

1.175 W65282004 C03DA04 EPLERENONUM * # INSPRA 25 mg COMPR. FILM. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 3 BLIST. PERFORATE UNIDOZA DIN PVC/AL X 10 COMPR. FILM. PRF 30 1,720666 1,696334 0,860333 2,556667 1,548599 1,868401
1.176 W65283004 C03DA04 EPLERENONUM * # INSPRA 50 mg COMPR. FILM. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 3 BLIST. PERFORATE UNIDOZA DIN PVC/AL X 10 COMPR. FILM. PRF 30 3,441333 0,000000 1,720666 1,720667 3,097199 0,344134
1.177 W65311001 C07AB12 NEBIVOLOLUM NEBIVOLOL ATB 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. P-6L 30 0,442333 0,000000 0,221166 0,221167 0,398099 0,044234
1.178 W65312001 C07AB12 NEBIVOLOLUM NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0,442333 0,000000 0,221166 0,221167 0,398099 0,044234
1.179 W62875006 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN STADA 10 mg/160 mg COMPR. FILM. 10mg/160mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC-TE-PVDC/AL X 56 COMPR. FILM. P6L 56 2,226428 0,000000 1,113214 1,113214 2,003785 0,222643
1.180 W62874006 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN STADA 5 mg/160 mg COMPR. FILM. 5mg/160mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC-TE-PVDC/AL X 56 COMPR. FILM. P6L 56 2,168214 0,000000 1,084107 1,084107 1,951392 0,216822
1.181 W62873006 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN STADA 5 mg/80 mg COMPR. FILM. 5mg/80mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC-TE-PVDC/AL X 56 COMPR. FILM. P6L 56 1,280000 0,946071 0,640000 1,586071 1,152000 1,074071
1.182 W62399024 C10AA07 ROSUVASTATINUM ROSUVASTATINA TEVA 10 mg COMPR. FILM. 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30X1 COMPR. FILM. P6L 30 0,607950 0,005383 0,303975 0,309358 0,547155 0,066178
1.183 W62400024 C10AA07 ROSUVASTATINUM ROSUVASTATINA TEVA 20 mg COMPR. FILM. 20mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30X1 COMPR. FILM. P6L 30 1,178000 0,000000 0,589000 0,589000 1,060200 0,117800
1.184 W65535004 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** CO-ROSWERA 10 mg/10 mg COMPR. FILM. 10mg/10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 4,102000 0,000000 2,051000 2,051000 3,691800 0,410200
1.185 W65537004 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** CO-ROSWERA 20 mg/10 mg COMPR. FILM. 20mg/10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 4,102000 0,394333 2,051000 2,445333 3,691800 0,804533
1.186 W65417002 G04CB02 DUTASTERIDUM * ASIUM 0,5 mg CAPS. MOI 0,5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. TRANSPARENTE DIN TRIPLEX (PVC-PE-PVDC)AL X 30 CAPS. MOI P6L 30 1,064499 0,014167 0,532249 0,546417 0,958049 0,120617
1.187 W58901001 J01CR01 AMPICILLINUM + SULBACTAM AMPIPLUS 1000 mg/500 mg PULB. PT. SOL. INJ./PERF. 1000mg/500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. PR, PRF 1 16,858550 3,461450 8,429275 11,890725 15,172695 5,147305
1.188 W58901004 J01CR01 AMPICILLINUM + SULBACTAM AMPIPLUS 1000 mg/500 mg PULB. PT. SOL. INJ./PERF. 1000mg/500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 25 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. PR, PRF 25 16,858550 0,352650 8,429275 8,781925 15,172695 2,038505
1.189 W58901003 J01CR01 AMPICILLINUM + SULBACTAM AMPIPLUS 1000 mg/500 mg PULB. PT. SOL. INJ./PERF. 1000mg/500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. PR, PRF 10 16,858550 0,854450 8,429275 9,283725 15,172695 2,540305
1.190 W63876017 J01MA14 MOXIFLOXACINUM AVELOX 400 mg COMPR. FILM. 400mg BAYER AG GERMANIA CUTIE CU 1 BLIST. TRANSPARENT PVC-PVDC/AL X 5 COMPR. FILM. PRF 5 4,576500 5,165500 2,288250 7,453750 4,118850 5,623150
1.191 W65024001 R03AK07 COMBINATII (BUDESONIDUM + FORMOTEROLUM) * AIRBUFO FORSPIRO 160 micrograme/4,5 micrograme PULB. DE INHAL. UNIDOZA SANDOZ S.R.L.
160micrograme/4,5micrograme ROMANIA CUTIE CU 1 DISPOZITIV DE INHALAT DIN PLASTIC DE CULOARE ROSIE/ALBA CE CONTINE 1 BLIST. OPA-AL-PVC/AL X 60 DOZE CU PULB. DE INHALAT UNIDOZA P6L 1 64,282500 0,817500 32,141250 32,958750 57,854250 7,245750
1.192 W65421001 S01AA23 NETILMICINUM NETTACIN 3 mg/g UNG. OFT. 3mg/g SIFI S.P.A. ITALIA CUTIE CU 1 TUB DIN AL PREVAZUT CU APLICATOR DIN PEJD X 5 G UNG. OFT. PRF 1 26,680500 7,679500 13,340250 21,019750 24,012450 10,347550

SE MODIFICA

131 W42324004 C03DA04 EPLERENONUM * # INSPRA 25 mg COMPR. FILM. 25mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. PERFORATE UNIDOZA PVC/AL X 10 COMPR. FILM. P-RF 30 1,720666 1,696334 0,860333 2,556667 1,548599 1,868401
216 W56930003 C09CA03 VALSARTANUM DIOVAN 160 mg COMPR. FILM. 160mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P-6L 28 1,373400 0,220528 0,686700 0,907228 1,236060 0,357868
222 W56929003 C09CA03 VALSARTANUM DIOVAN 40 mg COMPR. FILM. 40mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28COMPR. FILM. P6L 28 0,343350 2,224864 0,171675 2,396539 0,309015 2,259199
223 W57789002 C09CA03 VALSARTANUM AVASSAN 40 mg COMPR. FILM. 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0,343350 1,320221 0,171675 1,491896 0,309015 1,354556
224 W58948003 C09CA03 VALSARTANUM VAPRESS 40 mg COMPR. FILM. 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0,343350 0,087364 0,171675 0,259039 0,309015 0,121699
225 W58948013 C09CA03 VALSARTANUM VAPRESS 40 mg COMPR. FILM. 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTFE/AL X 28 COMPR. FILM. P6L 28 0,343350 0,087364 0,171675 0,259039 0,309015 0,121699
226 W56931003 C09CA03 VALSARTANUM DIOVAN 80 mg COMPR. FILM. 80mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X28COMPR. FILM. P6L 28 0,686700 0,508300 0,343350 0,851650 0,618030 0,576970
231 W55631001 C09CA03 VALSARTANUM DIOVAN 3 mg/ml SOL. ORALA 3mg/ml NOVARTIS PHARMA GMBH GERMANIA P-6L
CUTIE X 1 FLACON DIN STICLA BRUNA X 160ML SOLUTIE ORALA + 1 TRUSA DE ADMINISTRARE (ADAPTOR PENTRU FLACON + 1 SERINGA DOZATOARE A 5ML + 1 MASURA DOZATOARE A 30ML ) 1 4,120200 20,759800 2,060100 22,819900 3,708180 21,171820
234 W54081003 C09CA04 IRBESARTANUM IRBESARTAN TERAPIA 150 mg COMPR. FILM. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL, X 28 COMPR. FILM. P-6L 28 0,686700 0,138657 0,343350 0,482007 0,618030 0,207327
237 W60637002 C09CA04 IRBESARTANUM APROVEL 150mg COMPR. FILM. 150mg SANOFI CLIR SNC FRANTA CUTIE X BLIST PVC/PVDC/AL X 28 COMPR. FILM.P-6L 28 0,686700 0,519014 0,343350 0,862364 0,618030 0,587684
1.132 W60637006 C09CA04 IRBESARTANUM APROVEL 150mg COMPR. FILM. 150mg SANOFI CLIR SNC FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM.P-6L 30 0,686700 0,542633 0,343350 0,885983 0,618030 0,611303
243 W60638002 C09CA04 IRBESARTANUM APROVEL 300mg COMPR. FILM. 300mg SANOFI CLIR SNC FRANTA CUTIE X BLIST PVC/PVDC/AL X 28 COMPR. FILM.P-6L 28 1,373400 0,227314 0,686700 0,914014 1,236060 0,364654
1.134 W60638007 C09CA04 IRBESARTANUM APROVEL 300mg COMPR. FILM. 300mg SANOFI CLIR SNC FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM.P-6L 30 1,373400 0,262266 0,686700 0,948966 1,236060 0,399606
247 W58808002 C09CA06 CANDESARTANUM CILEXETIL ATACAND 16mg COMPR. 16mg ASTRAZENECA AB SUEDIA
CUTIE CU BLIST. PVC/PVDC/AL CE CONTINE 28 COMPR. P-6L 28 1,373400 0,056957 0,686700 0,743657 1,236060 0,194297
264 W58807002 C09CA06 CANDESARTANUM CILEXETIL ATACAND 8mg COMPR. 8mg ASTRAZENECA AB SUEDIA
CUTIE CU BLIST. PVC/PVDC/AL CE CONTINE 28 COMPR. P-6L 28 0,686700 0,174014 0,343350 0,517364 0,618030 0,242684
278 W05785002 C09CA07 TELMISARTANUM MICARDIS 80 mg COMPR. 80mg GERMANIA CUTIE X 28COMPR. ( BLIST. PA/AL/PVC)
BOEHRINGER INGELHEIM INTERNATIONAL GMBH P-6L 28 1,373400 0,074457 0,686700 0,761157 1,236060 0,211797
290 W07646001 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 150mg/12,5mg COMPR. 150mg/12,5mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. P-6L 28 0,686099 0,523186 0,343049 0,866236 0,617489 0,591796
291 W07647001 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/12,5mg COMPR. 300mg/12,5mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. P-6L 28 0,686099 0,841401 0,343049 1,184451 0,617489 0,910011
1.137 W65145002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HYDROCHLOROTHIAZIDE ZENTIVA 300mg/12,5 mg COMPR. FILM300mg/12,5mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P6L 28 0,686099 0,339615 0,343049 0,682665 0,617489 0,408225
293 W59585002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HYDROCHLOROTHIAZIDE ZENTIVA 300mg/12,5mg COMPR. FILM300mg/12,5mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 2 BLIST. PVC/PVDC/AL X 14 COMPR. FILM. P-6L 28 0,686099 0,339615 0,343049 0,682665 0,617489 0,408225
294 W60639002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 150mg/12,5mg COMPR. FILM. 150mg/12,5mg SANOFI CLIR SNC FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0,686099 0,523186 0,343049 0,866236 0,617489 0,591796
295 W61154002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) CONVERIDE 150 mg/12,5 mg COMPR. FILM. 150mg/12,5mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. OPACE PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0,686099 0,125686 0,343049 0,468736 0,617489 0,194296
296 W61154011 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) CONVERIDE 150 mg/12,5 mg COMPR. FILM. 150mg/12,5mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0,686099 0,125686 0,343049 0,468736 0,617489 0,194296
297 W60640002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/12,5mg COMPR. FILM. 300mg/12,5mg SANOFI CLIR SNC FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0,686099 0,841401 0,343049 1,184451 0,617489 0,910011
298 W61158002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) CONVERIDE 300 mg/12,5 mg COMPR. FILM. 300mg/12,5mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. OPACE PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0,686099 0,227472 0,343049 0,570522 0,617489 0,296082
299 W61158011 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) CONVERIDE 300 mg/12,5 mg COMPR. FILM. 300mg/12,5mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0,686099 0,227472 0,343049 0,570522 0,617489 0,296082
300 W60641002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/25mg COMPR. FILM. 300mg/25mg SANOFI CLIR SNC FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0,686099 0,843186 0,343049 1,186236 0,617489 0,911796
301 W61159002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) CONVERIDE 300 mg/25 mg COMPR. FILM. 300mg/25mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. OPACE PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0,686099 0,193901 0,343049 0,536951 0,617489 0,262511
302 W61159011 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) CONVERIDE 300 mg/25 mg COMPR. FILM. 300mg/25mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0,686099 0,193901 0,343049 0,536951 0,617489 0,262511
304 W58871004 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) CANZENO HCT 16mg/12,5mg COMPR. 16mg/12,5mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 0,686099 0,087901 0,343049 0,430951 0,617489 0,156511
308 W59718002 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) ACTELSAR HCT 80 mg/12,5 mg COMPR. 80 mg/12,5 mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLISTERE DIN AL/AL X 28 COMPRIMATE PRF 28 0,686099 0,438543 0,343049 0,781593 0,617489 0,507153

Pagina 1 din 3
Contributie Val. maxima suportata Contributie Val. maxima suportata Contributie
maxima a de sistemul de maxima a de sistemul de maxima a
asiguratului / UT asigurari sociale de asiguratului / UT asigurari sociale de asiguratului / UT
(pt. asiguratii care sanatate / UT (pt. (pt. asiguratii care sanatate / UT (pt. (pt. asiguratii care

Prescriptie
cant. beneficiaza de asiguratii care beneficiaza de asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de compensare 100% beneficiaza de compensare 50% beneficiaza de compensare 90%
Nr crt.

Tara det. amb referinta / din pretul de compensare 50% din din pretul de compensare 90% din din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj alaj UT (RON) referinta) pretul de referinta) referinta) pretul de referinta) referinta)
309 W59819005 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TOLUCOMBI 80 mg/12,5mg COMPR. 80 mg/12,5mg KRKA D.D. SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPRIMATE PRF 30 0,686099 0,102234 0,343049 0,445284 0,617489 0,170844
310 W59820005 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TOLUCOMBI 80 mg/25mg COMPR. 80 mg/25mg KRKA D.D. SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPRIMATE PRF 30 0,686099 0,102234 0,343049 0,445284 0,617489 0,170844
311 W59719001 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) ACTELSAR HCT 80 mg/25mg COMPR. 80 mg/25mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLISTERE DIN AL/AL X 28 COMPRIMATE PRF 28 0,686099 0,463901 0,343049 0,806951 0,617489 0,532511
312 W12033002 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) MICARDISPLUS 80/12,5mg COMPR. 80/12,5mg GERMANIA CUTIE X 28COMPR. ( BLIST. PA/AL/PVC)
BOEHRINGER INGELHEIM INTERNATIONAL GMBH P-6L 28 0,686099 0,949972 0,343049 1,293022 0,617489 1,018582
313 W53178002 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) MICARDISPLUS 80/25mg COMPR. 80/25mg GERMANIA CUTIE X 28 COMPR. (BLIST. PA/AL/PVC/AL SAU PA/PA/AL/PVC/AL)
BOEHRINGER INGELHEIM INTERNATIONAL GMBH P-6L 28 0,686099 1,027115 0,343049 1,370165 0,617489 1,095725
314 W59921007 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMISARTAN/HIDROCLOROTIAZIDA EGIS 80 mg/12,5 mg COMPR. 80mg/12,5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. AL/AL X 30 COMPR. P6L 30 0,686099 0,102234 0,343049 0,445284 0,617489 0,170844
316 W60206003 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TEZEO HCT 80 mg/12,5 mg COMPR. 80mg/12,5mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0,686099 0,041234 0,343049 0,384284 0,617489 0,109844
317 W60248003 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMARK PLUS 80mg/12,5mg COMPR. 80mg/12,5mg GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-AL-OPA/AL X 30 COMPRIMATE P-6L 30 0,686099 0,431901 0,343049 0,774951 0,617489 0,500511
318 W60207003 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TEZEO HCT 80 mg/25 mg COMPR. 80mg/25mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0,686099 0,317901 0,343049 0,660951 0,617489 0,386511
319 W60249003 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMARK PLUS 80mg/25mg COMPR. 80mg/25mg GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-AL-OPA/AL X 30 COMPRIMATE P-6L 30 0,686099 0,433567 0,343049 0,776617 0,617489 0,502177
320 W51851005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) EXFORGE 10mg/160mg COMPR. FILM. 10mg/160mg NOVARTIS EUROPHARM LTD. MAREA BRITANIE CUTIE X 56 COMPR. FILM. (BLIST. PVC/PVDC ) P-6L 56 2,560000 0,634642 1,280000 1,914642 2,304000 0,890642
321 W64723005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) EXFORGE 10mg/160mg COMPR. FILM. 10mg/160mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE X 56 COMPR. FILM. (BLIST. PVC/PVDC ) P6L 56 2,560000 0,634642 1,280000 1,914642 2,304000 0,890642
322 W51852005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) EXFORGE 5mg/160mg COMPR. FILM. 5mg/160mg NOVARTIS EUROPHARM LTD. MAREA BRITANIE CUTIE X 56 COMPR. FILM. (BLIST. PVC/PVDC ) P-6L 56 2,484705 0,519045 1,242352 1,761398 2,236234 0,767516
323 W64722005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) EXFORGE 5mg/160mg COMPR. FILM. 5mg/160mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE X 56 COMPR. FILM. (BLIST. PVC/PVDC ) P6L 56 2,484705 0,519045 1,242352 1,761398 2,236234 0,767516
324 W51853005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) EXFORGE 5mg/80mg COMPR. FILM. 5mg/80mg NOVARTIS EUROPHARM LTD. MAREA BRITANIE CUTIE X 56 COMPR. FILM.(BLIST.PVC/PVDC ) P-6L 56 1,280000 1,913928 0,640000 2,553928 1,152000 2,041928
325 W64721005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) EXFORGE 5mg/80mg COMPR. FILM. 5mg/80mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE X 56 COMPR. FILM. (BLIST. PVC/PVDC ) P6L 56 1,280000 1,913928 0,640000 2,553928 1,152000 2,041928
326 W53445002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM INOVUM 20 mg/5 mg COMPR. FILM. 20mg/5mg LUXEMBOURG CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM.
MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. P-6L 28 1,280000 0,522142 0,640000 1,162142 1,152000 0,650142
327 W57427002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 20 mg/5 mg COMPR. FILM. 20mg/5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,280000 2,159642 0,640000 2,799642 1,152000 2,287642
328 W64084002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ZENTIVA 20 mg/5 mg COMPR. FILM. 20mg/5mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,280000 1,055714 0,640000 1,695714 1,152000 1,183714
329 W64151010 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 20 mg/5 mg COMPR. FILM. 20mg/5mg HCS BVBA BELGIA P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 28X1 COMPR. FILM. 28 1,280000 0,965357 0,640000 1,605357 1,152000 1,093357
330 W64151011 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 20 mg/5 mg COMPR. FILM. 20mg/5mg HCS BVBA BELGIA P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 30X1 COMPR. FILM. 30 1,280000 0,890333 0,640000 1,530333 1,152000 1,018333
331 W64151002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 20 mg/5 mg COMPR. FILM. 20mg/5mg HCS BVBA BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,280000 0,965357 0,640000 1,605357 1,152000 1,093357
332 W64245001 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 20 mg/5 mg COMPR. FILM. 20mg/5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,280000 1,055714 0,640000 1,695714 1,152000 1,183714
333 W64151003 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 20 mg/5 mg COMPR. FILM. 20mg/5mg HCS BVBA BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1,280000 0,890333 0,640000 1,530333 1,152000 1,018333
334 W64245006 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 20 mg/5 mg COMPR. FILM. 20mg/5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. 28 1,280000 1,055714 0,640000 1,695714 1,152000 1,183714
335 W64426002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 20 mg/5 mg COMPR. FILM. 20mg/5mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,280000 2,159642 0,640000 2,799642 1,152000 2,287642
337 W57425002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 40 mg/10 mg COMPR. FILM. 40mg/10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,560000 1,210357 1,280000 2,490357 2,304000 1,466357
345 W64428002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 40 mg/10 mg COMPR. FILM. 40mg/10mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,560000 1,210357 1,280000 2,490357 2,304000 1,466357
347 W57426002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 40 mg/5 mg COMPR. FILM. 40mg/5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,304000 1,135642 1,152000 2,287642 2,073600 1,366042
348 W64085002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ZENTIVA 40 mg/5 mg COMPR. FILM. 40mg/5mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,304000 0,031714 1,152000 1,183714 2,073600 0,262114
349 W64152010 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/5 mg COMPR. FILM. 40mg/5mg HCS BVBA BELGIA P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 28X1 COMPR. FILM. 28 2,304000 0,068500 1,152000 1,220500 2,073600 0,298900
350 W64152011 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/5 mg COMPR. FILM. 40mg/5mg HCS BVBA BELGIA P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 30X1 COMPR. FILM. 30 2,304000 0,068666 1,152000 1,220666 2,073600 0,299066
351 W64152002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/5 mg COMPR. FILM. 40mg/5mg HCS BVBA BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,304000 0,068500 1,152000 1,220500 2,073600 0,298900
352 W64246001 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/5 mg COMPR. FILM. 40mg/5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,304000 0,031714 1,152000 1,183714 2,073600 0,262114
353 W64152003 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/5 mg COMPR. FILM. 40mg/5mg HCS BVBA BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 2,304000 0,068666 1,152000 1,220666 2,073600 0,299066
354 W64246006 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/5 mg COMPR. FILM. 40mg/5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. 28 2,304000 0,031714 1,152000 1,183714 2,073600 0,262114
355 W64427002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 40 mg/5 mg COMPR. FILM. 40mg/5mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,304000 1,135642 1,152000 2,287642 2,073600 1,366042
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 0,810599 0,205829 0,405299 0,611129 0,729539 0,286889
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 0,303975 0,593358 0,151987 0,745346 0,273577 0,623756
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 0,303975 0,061691 0,151987 0,213679 0,273577 0,092089
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 0,303975 0,440358 0,151987 0,592346 0,273577 0,470756
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 0,303975 0,090358 0,151987 0,242346 0,273577 0,120756
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 0,303975 0,047691 0,151987 0,199679 0,273577 0,078089
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 0,291666 0,000000 0,145833 0,145833 0,262499 0,029167
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 0,303975 0,593358 0,151987 0,745346 0,273577 0,623756
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 0,607950 0,564716 0,303975 0,868691 0,547155 0,625511
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 0,607950 0,358716 0,303975 0,662691 0,547155 0,419511
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 0,607950 0,564716 0,303975 0,868691 0,547155 0,625511
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 1,215900 0,112671 0,607950 0,720621 1,094310 0,234261
389 W55518003 C10AA05 ATORVASTATINUM ASCORD 40 mg COMPR. FILM. 40mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-6L 30 1,123666 0,000000 0,561833 0,561833 1,011299 0,112367
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 1,215900 0,112671 0,607950 0,720621 1,094310 0,234261
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 0,607950 2,718478 0,303975 3,022453 0,547155 2,779273
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 0,607950 0,037716 0,303975 0,341691 0,547155 0,098511
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 0,607950 0,183383 0,303975 0,487358 0,547155 0,244178
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 0,607950 0,699907 0,303975 1,003882 0,547155 0,760702
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 0,607950 0,699907 0,303975 1,003882 0,547155 0,760702
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 0,607950 0,284716 0,303975 0,588691 0,547155 0,345511
1.138 W65079001 C10AA07 ROSUVASTATINUM CRESTOR 10 mg COMPR. FILM. 10mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. FILM. P6L 28 0,607950 2,718478 0,303975 3,022453 0,547155 2,779273
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 0,607950 0,049383 0,303975 0,353358 0,547155 0,110178
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 0,607950 1,589716 0,303975 1,893691 0,547155 1,650511
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 1,215900 3,649100 0,607950 4,257050 1,094310 3,770690
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 1,215900 0,663385 0,607950 1,271335 1,094310 0,784975
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 1,215900 0,663385 0,607950 1,271335 1,094310 0,784975

Pagina 2 din 3
Contributie Val. maxima suportata Contributie Val. maxima suportata Contributie
maxima a de sistemul de maxima a de sistemul de maxima a
asiguratului / UT asigurari sociale de asiguratului / UT asigurari sociale de asiguratului / UT
(pt. asiguratii care sanatate / UT (pt. (pt. asiguratii care sanatate / UT (pt. (pt. asiguratii care

Prescriptie
cant. beneficiaza de asiguratii care beneficiaza de asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de compensare 100% beneficiaza de compensare 50% beneficiaza de compensare 90%
Nr crt.

Tara det. amb referinta / din pretul de compensare 50% din din pretul de compensare 90% din din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj alaj UT (RON) referinta) pretul de referinta) referinta) pretul de referinta) referinta)
1.139 W65078001 C10AA07 ROSUVASTATINUM CRESTOR 20 mg COMPR. FILM. 20mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. FILM. P6L 28 1,215900 3,649100 0,607950 4,257050 1,094310 3,770690
428 W60393003 C10AA07 ROSUVASTATINUM ROVASTAMED 20mg COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,152142 0,000000 0,576071 0,576071 1,036927 0,115215
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 1,215900 2,114766 0,607950 2,722716 1,094310 2,236356
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 2,431800 0,500700 1,215900 1,716600 2,188620 0,743880
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 2,431800 0,500700 1,215900 1,716600 2,188620 0,743880
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 2,431800 0,199200 1,215900 1,415100 2,188620 0,442380
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 2,431800 0,348866 1,215900 1,564766 2,188620 0,592046
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 0,303975 2,332096 0,151987 2,484084 0,273577 2,362494
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 0,303975 0,025358 0,151987 0,177346 0,273577 0,055756
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 0,303975 0,480358 0,151987 0,632346 0,273577 0,510756
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 0,303975 1,596025 0,151987 1,748013 0,273577 1,626423
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 0,303975 1,596025 0,151987 1,748013 0,273577 1,626423
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 0,303975 0,507691 0,151987 0,659679 0,273577 0,538089
1.140 W65077001 C10AA07 ROSUVASTATINUM CRESTOR 5 mg COMPR. FILM. 5mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. FILM. P6L 28 0,303975 2,332096 0,151987 2,484084 0,273577 2,362494
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 0,303975 0,776739 0,151987 0,928727 0,273577 0,807137
459 W61295003 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** LIPOCOMB 20 mg/10 mg CAPS. 20mg/10mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 (3X10) CAPS. P6L 30 4,102000 0,394333 2,051000 2,445333 3,691800 0,804533
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 1,064499 0,587501 0,532249 1,119751 0,958049 0,693951
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 1,064499 1,115501 0,532249 1,647751 0,958049 1,221951
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 1,064499 0,005834 0,532249 0,538084 0,958049 0,112284
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 1,064499 1,137501 0,532249 1,669751 0,958049 1,243951
616 W63857002 G04CB02 DUTASTERIDUM * AVATERID 0,5 mg CAPS. MOI 0,5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. MOI P6L 30 1,064499 0,003834 0,532249 0,536084 0,958049 0,110284
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 2,288250 0,326035 1,144125 1,470160 2,059425 0,554860
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 2,288250 0,350321 1,144125 1,494446 2,059425 0,579146
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 4,576500 0,084928 2,288250 2,373178 4,118850 0,542578
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 4,576500 0,844928 2,288250 3,133178 4,118850 1,302578
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 4,576500 0,079500 2,288250 2,367750 4,118850 0,537150
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 4,576500 5,165500 2,288250 7,453750 4,118850 5,623150
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 4,576500 0,353500 2,288250 2,641750 4,118850 0,811150
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 4,576500 2,745500 2,288250 5,033750 4,118850 3,203150
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 4,576500 2,787500 2,288250 5,075750 4,118850 3,245150
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 4,576500 5,165500 2,288250 7,453750 4,118850 5,623150
978 W56427001 R03AK07 COMBINATII (BUDESONIDUM + FORMOTEROLUM) * SYMBICORT TURBUHALER 160 micrograme/4,5 micrograme/inhalatie PULB. DE INHAL. 160micrograme/4,5micrograme/in ASTRAZENECA AB SUEDIA CUTIE CU 1 INHALATOR DIN MATERIAL PLASTIC CU 60 DOZE PULB. DE INHAL. P6L 1 64,282500 16,237500 32,141250 48,378750 57,854250 22,665750
980 W56428001 R03AK07 COMBINATII (BUDESONIDUM + FORMOTEROLUM) * SYMBICORT TURBUHALER 320 micrograme/9 micrograme/inhalatie PULB. DE INHAL. 320micrograme/9micrograme/inha ASTRAZENECA AB SUEDIA CUTIE CU 1 INHALATOR DIN MATERIAL PLASTIC CU 60 DOZE PULB. DE INHAL. P6L 1 128,565000 24,335000 64,282500 88,617500 115,708500 37,191500
981 W56426001 R03AK07 COMBINATII (BUDESONIDUM + FORMOTEROLUM) * SYMBICORT TURBUHALER 80 micrograme/4,5 micrograme/inhalatie PULB. DE INHAL. 80micrograme/4,5micrograme/inh ASTRAZENECA AB SUEDIA CUTIE CU 1 INHALATOR DIN MATERIAL PLASTIC CU 60 DOZE PULB. DE INHAL. P6L 1 64,282500 15,047500 32,141250 47,188750 57,854250 21,475750
982 W62789001 R03AK07 COMBINATII (BUDESONIDUM + FORMOTEROLUM) * SYMBICORT 160 micrograme/4,5 micrograme/inhalatie SUSP. DE INHALAT PRESURIZATA 160micrograme/4,5micrograme ASTRAZENECA AB SUEDIA CUTIE CU 1 PUNGA DIN FOLIE LAMINATA+1 DISPOZITIV DE INHALARE ALCATUIT DINTR-UN FLAC. PRESURIZAT,INCHIS CU O VALVA DOZATOARE SI ATASAT UNUI INDICATOR AL DOZELOR,INCLUS INTR-UN DIAPOZITIV INHALATOR DIN PLASTIC DE CULOARE ROSIE CU 120 ACTIONARI P6L 1 128,565000 17,445000 64,282500 81,727500 115,708500 30,301500
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 1 192,847500 25,382500 96,423750 121,806250 173,562750 44,667250
1.072 W41510001 S01AA23 NETILMICINUM NETTACIN (R) PICATURI OFT.-SOL. 0,3% S.I.F.I. SPA ITALIA CUTIE X 3 FOLII TERMOSUDATE X 5 FLACOANE UNIDOZA DIN POLIETILENA X 0,3 ML P-RF 15 1,600830 0,507170 0,800415 1,307585 1,440747 0,667253
1.073 W43512001 S01AA23 NETILMICINUM NETTAVISC 3mg/g UNG. OFT. 3mg/g S.I.F.I. SPA ITALIA CUTIE X 1 TUB DIN AL X 5 G UNGUENT OFTALMIC, PREV. CU APLICATOR P-RF 1 26,680500 7,679500 13,340250 21,019750 24,012450 10,347550

SE ELIMINA

254 W58252021 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN MYLAN 16 mg COMPR. 16mg GENERICS (UK) LTD.MAREA BRITANIE CUTIE CU BLISTERE DIN PVC/AL X 30 COMPRIMATE P6L 30 0,864333 0,000000 0,432166 0,432167 0,777899 0,086434
271 W58251021 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN MYLAN 8 mg COMPR. 8mg GENERICS (UK) LTD.MAREA BRITANIE CUTIE CU BLISTERE DIN PVC/AL X 30 COMPRIMATE P6L 30 0,476666 0,000000 0,238333 0,238333 0,428999 0,047667
303 W57991006 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) CANDESARTAN HIDROCLOROTIAZIDA TORRENT 16 mg/12,5 mg COMPR. 16mg/12,5mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. AL/AL X 56 COMPR.
P6L 56 0,654599 0,020579 0,327299 0,347879 0,589139 0,086039
419 W62948019 C10AA07 ROSUVASTATINUM ROSUVASTATINA MYLAN 10 mg COMPR. FILM. 10mg GENERICS (UK) LTD. T/A MYLAN MAREA BRITANIE CUTIE CU BLIST. AL-OPA/AL/PVC X 30 COMPR. FILM. P6L 30 0,308666 0,000000 0,154333 0,154333 0,277799 0,030867
418 W62948004 C10AA07 ROSUVASTATINUM ROSUVASTATINA MYLAN 10 mg COMPR. FILM. 10mg GENERICS (UK) LTD T/A MYLAN MAREA BRITANIE CUTIE CU BLIST. AL-POLIAMIDA/AL/PEJD DESICANT/PEID X 30 COMPR. FILM. P6L 30 0,308666 0,000000 0,154333 0,154333 0,277799 0,030867
431 W62949004 C10AA07 ROSUVASTATINUM ROSUVASTATINA MYLAN 20 mg COMPR. FILM. 20mg GENERICS (UK) LTD T/A MYLAN MAREA BRITANIE CUTIE CU BLIST. AL-POLIAMIDA/AL/PEJD DESICANT/PEID X 30 COMPR. FILM. P6L 30 0,618000 0,000000 0,309000 0,309000 0,556200 0,061800
432 W62949019 C10AA07 ROSUVASTATINUM ROSUVASTATINA MYLAN 20 mg COMPR. FILM. 20mg GENERICS (UK) LTD. T/A MYLAN MAREA BRITANIE CUTIE CU BLIST. AL-OPA/AL/PVC X 30 COMPR. FILM. P6L 30 0,618000 0,000000 0,309000 0,309000 0,556200 0,061800
451 W62947004 C10AA07 ROSUVASTATINUM ROSUVASTATINA MYLAN 5 mg COMPR. FILM. 5mg GENERICS (UK) LTD T/A MYLAN MAREA BRITANIE CUTIE CU BLIST. AL-POLIAMIDA/AL/PEJD DESICANT/PEID X 30 COMPR. FILM. P6L 30 0,154666 0,000000 0,077333 0,077333 0,139199 0,015467
452 W62947019 C10AA07 ROSUVASTATINUM ROSUVASTATINA MYLAN 5 mg COMPR. FILM. 5mg GENERICS (UK) LTD. T/A MYLAN MAREA BRITANIE CUTIE CU BLIST. AL-OPA/AL/PVC X 30 COMPR. FILM. P6L 30 0,154666 0,000000 0,077333 0,077333 0,139199 0,015467

Pagina 3 din 3
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 01 IULIE 2019

Val. maxima suportata Contributie maxima


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

Prescriptie
cant. (pt. asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de beneficiaza de compensare 100%


Nr crt.

TARA amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)

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

SE ADAUGA

238 W65259002 C03CA01 FUROSEMIDUM FUROSEMID HAMELN 10 mg/ml SOL INJ. 10mg/ml HAMELN PHARMA PLUS GMBH GERMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA DE TIP I, PREVAZUTE CU PUNCT DE RUPERE A CATE 2 ML SOL. INJ. PRF 10 1,328000 1,328000 0,000000
239 W65312001 C07AB12 NEBIVOLOLUM ** NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0,239599 0,239599 0,202734
240 W65311001 C07AB12 NEBIVOLOLUM ** NEBIVOLOL ATB 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. P-6L 30 0,239599 0,239599 0,202734

SE ELIMINA

213 W58252021 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN MYLAN 16 mg COMPR. 16mg GENERICS (UK) LTD. MAREA BRITANIE CUTIE CU BLISTERE DIN PVC/AL X 30 COMPRIMATE P6L 30 0,638570 0,638570 0,225763
230 W58251021 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN MYLAN 8 mg COMPR. 8mg GENERICS (UK) LTD. MAREA BRITANIE CUTIE CU BLISTERE DIN PVC/AL X 30 COMPRIMATE P6L 30 0,457713 0,457713 0,018953

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

SE ADAUGA

82 W65515002 J05AF10 ENTECAVIRUM **1 VIREN 0,5 mg COMPR. FILM. 0,5mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE AL/AL X 30X1 COMPR. FILM. PR 30 9,668666 9,668666 0,000000
83 W65516002 J05AF10 ENTECAVIRUM **1 VIREN 1 mg COMPR. FILM. 1mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE AL/AL X 30X1 COMPR. FILM. PR 30 31,124333 31,124333 0,000000

7. CIROZA HEPATICA - G7

SE ADAUGA

99 W65259002 C03CA01 FUROSEMIDUM FUROSEMID HAMELN 10 mg/ml SOL INJ. 10mg/ml HAMELN PHARMA PLUS GMBH GERMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA DE TIP I, PREVAZUTE CU PUNCT DE RUPERE A CATE 2 ML SOL. INJ. PRF 10 1,328000 1,328000 0,000000
100 W65515002 J05AF10 ENTECAVIRUM **1 VIREN 0,5 mg COMPR. FILM. 0,5mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE AL/AL X 30X1 COMPR. FILM. PR 30 9,668666 9,668666 0,000000
101 W65516002 J05AF10 ENTECAVIRUM **1 VIREN 1 mg COMPR. FILM. 1mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE AL/AL X 30X1 COMPR. FILM. PR 30 31,124333 31,124333 0,000000

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

SE ADAUGA

237 W62739001 R05DA04 CODEINUM CODEINA SLAVIA 15mg COMPR. 15mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0,182500 0,182500 0,000000

9. EPILEPSIE - G11

SE ADAUGA

172 W12403003 N03AF01 CARBAMAZEPINUM CARBAMAZEPINA SLAVIA 200 mg COMPR. 200mg SLAVIA PHARM SRL ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. PRF 50 0,149200 0,149200 0,000000

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

Prescriptie
cant. (pt. asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de beneficiaza de compensare 100%


Nr crt.

TARA amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
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 ELIMINA

122 W56922003 N05AH04 QUETIAPINUM ** Q MIND 100 mg COMPR. FILM. 100mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 60 COMPR. FILM. P-RF 60 0,890000 0,890000 0,000000
123 W56924003 N05AH04 QUETIAPINUM ** Q MIND 200 mg COMPR. FILM. 200mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 60 COMPR. FILM. P-RF 60 1,491500 1,491500 0,000000
124 W56925003 N05AH04 QUETIAPINUM ** Q MIND 300 mg COMPR. FILM. 300mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 60 COMPR. FILM. P-RF 60 1,839500 1,839500 0,000000

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

SE ADAUGA

62 W14114003 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ. P6L 6 0,598333 0,598333 0,000000

17. SPONDILITA ANKILOZANTA - G 19

SE ADAUGA

21 W14114003 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ. P6L 6 0,598333 0,598333 0,000000

21. GLAUCOM - G 26

SE ADAUGA

43 W64002001 S01ED51 COMBINATII (TRAVOPROSTUM+TIMOLOLUM) TRAVOPROST/TIMOLOL ZENTIVA 40 micrograme/ml+5 mg/ml PIC. OFT., SOL. 40micrograme/ml+5mg/ml ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. PP, CU PICURATOR INCOLOR DIN PEJD X 2,5 ML PIC. OFT., SOL. P6L 1 41,470000 41,470000 0,000000

SE MODIFICA

25 W43319001 S01ED51 COMBINATII (TRAVOPROSTUM+TIMOLOLUM) DUOTRAV 40mcg/ml + 5mg/ml PIC. OFT.-SOL. 40mcg/ml + 5mg/ml ALCON LABORATORIES (UK) LTD. CUTIE X 1 FLAC. DIN PP X 2,5 ML PIC. OFTALMICE,SOLUTIE
MAREA BRITANIE P-RF 1 49,764000 49,764000 12,716000
26 W63647001 S01ED51 COMBINATII (TRAVOPROSTUM+TIMOLOLUM) DUOTRAV 40µg/ml + 5mg/ml PIC. OFT.-SOL. 40µg/ml + 5mg/ml NOVARTIS EUROPHARM LTD. CUTIE CU 1 FLAC. DIN PP X 2,5 ML PIC. OFTALMICE,SOLUTIE PRF
MAREA BRITANIE 1 49,764000 49,764000 12,716000
27 W64597001 S01ED51 COMBINATII (TRAVOPROSTUM+TIMOLOLUM) DUOTRAV 40 micrograme/ml + 5mg/ml PIC. OFT.-SOL. 40µg/ml + 5mg/ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 FLAC. DIN PP X 2,5 ML PIC. OFTALMICE,SOLUTIE PRF 1 49,764000 49,764000 12,716000

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

SE ADAUGA

79 W58283006 J01CE01 BENZYLPENICILLINUM PENICILINA G POTASICA ATB 1000000 UI PULB. PT. SOL. INJ. 1000000UI ANTIBIOTICE SA ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CARE CONTIN PULB. PT. SOL. INJ. PRF 10 4,876000 4,876000 0,000000
80 W00574003 J01CE01 BENZYLPENICILLINUM PENICILINA G SODICA ATB 1000000 UI PULB. PT. SOL. INJ. 1000000UI ANTIBIOTICE SA ROMANIA CUTIE X 50 FLAC. DIN STICLA CU PULB. PT. SOL. INJ. P-RF 50 4,458400 4,458400 0,000000
81 W00574006 J01CE01 BENZYLPENICILLINUM PENICILINA G SODICA ATB 1000000 UI PULB. PT. SOL. INJ. 1000000UI ANTIBIOTICE SA ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CARE CONTIN PULB. PT. SOL. INJ. PRF 10 4,951000 4,951000 0,000000
82 W58283001 J01CE01 BENZYLPENICILLINUM PENICILINA G POTASICA ATB 1000000 UI PULB. PT. SOL. INJ. 1000000ui ANTIBIOTICE SA ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA CARE CONTIN PULB. PT. SOL. INJ. P-RF 50 4,391200 4,391200 0,000000
83 W00576003 J01CE01 BENZYLPENICILLINUM PENICILINA G SODICA ATB 400000 UI PULB. PT. SOL. INJ. 400000UI ANTIBIOTICE SA ROMANIA CUTIE X 50 FLAC. DIN STICLA CU PULB. PT. SOL. INJ. P-RF 50 2,967800 2,967800 0,000000
84 W00576006 J01CE01 BENZYLPENICILLINUM PENICILINA G SODICA ATB 400000 UI PULB. PT. SOL. INJ. 400000UI ANTIBIOTICE SA ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. PRF 10 3,295000 3,295000 0,000000

IMUNOSUPRESOARE SELECTIVE - G31


25. BOALA CRONICA INFLAMATORIE INTESTINALA - G31a

SE ADAUGA

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

Prescriptie
cant. (pt. asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de beneficiaza de compensare 100%


Nr crt.

TARA amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
20 W65224001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN PEN PREUMPLUT 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000
21 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000

SE MODIFICA

6 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 1.339,488000 1.339,488000 627,282000
7 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 1.339,488000 1.339,488000 627,282000
11 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 1.339,488000 1.339,488000 515,687000
12 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 1.339,488000 1.339,488000 515,687000
13 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 1.339,488000 1.339,488000 298,232000
14 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 1.339,488000 1.339,488000 712,487000
15 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 1.339,488000 1.339,488000 712,487000
19 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 PEN-URI PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 1.339,488000 1.339,488000 241,012000

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

Prescriptie
cant. (pt. asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de beneficiaza de compensare 100%


Nr crt.

TARA amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)
26. POLIARTITRITA REUMATOIDA - G31b

SE ADAUGA

57 W65224001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN PEN PREUMPLUT 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000
58 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000

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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 298,232000
51 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 PEN-URI PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 1.339,488000 1.339,488000 241,012000

27. ARTROPATIA PSORIAZICA - G31c

SE ADAUGA

37 W65224001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN PEN PREUMPLUT 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000
38 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000

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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 298,232000
34 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 PEN-URI PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 1.339,488000 1.339,488000 241,012000

28. SPONDILITA ANKILOZANTA - G 31d

SE ADAUGA

38 W65224001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN PEN PREUMPLUT 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000
39 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000

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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 298,232000
35 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 PEN-URI PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 1.339,488000 1.339,488000 241,012000

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

Prescriptie
cant. (pt. asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de beneficiaza de compensare 100%


Nr crt.

TARA amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP DET. APP AMBALAJ laj (RON) pretul de referinta) referinta)

29. ARTRITA JUVENILA - G 31e

SE ADAUGA

34 W65224001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN PEN PREUMPLUT 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000
35 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000

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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 298,232000
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 1.339,488000 1.339,488000 712,487000
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 1.339,488000 1.339,488000 712,487000
29 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 PEN-URI PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 1.339,488000 1.339,488000 241,012000

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

SE ADAUGA

42 W65224001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN PEN PREUMPLUT 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000
43 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 1.116,240000 1.116,240000 0,000000

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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 627,282000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 515,687000
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 1.339,488000 1.339,488000 298,232000
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 1.339,488000 1.339,488000 712,487000
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 1.339,488000 1.339,488000 712,487000
39 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 PEN-URI PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 1.339,488000 1.339,488000 241,012000

Pagina 5 din 5
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 01 IULIE 2019

Val. maxima suportata de Contributie maxima


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

Prescriptie
cant. (pt. asiguratii care beneficiaza de
Cod_CIM

UT/ Pret de beneficiaza de compensare 100%


Nr crt.

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


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

SE ADAUGA

242 W56319003 C05AA01 COMBINATII HEMORZON SUPOZ. ANTIBIOTICE SA


FARA CONCENTRATIE ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ.P6L 6 1,271666 1,271666 0,000000
243 W14016003 M01AB55 COMBINATII (PARACETAMOLUM+DICLOFENACUM) ACECLOFEN 500 mg/50 mg SUPOZ. 500mg/50mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA AL/PE X 6 SUPOZ. P6L 6 1,091666 1,091666 0,000000
244 W12591001 N02BB02 METAMIZOLUM NATRIUM METAMIZOL FARMACOM 500 mg COMPR. 500mg FARMACOM SA ROMANIA CUTIE X 2 BLIST., PVC/AL X 10 COMPR. P-RF 20 0,326000 0,326000 0,000000

SE MODIFICA

176 W42786002 N02BB02 METAMIZOLUM NATRIUM ALGOCALMIN (R) 500 mg COMPR. 500mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0,391200 0,391200 0,059300
177 W41738001 N02BB02 METAMIZOLUM NATRIUM ALINDOR 500 mg COMPR. 500mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-RF 20 0,391200 0,391200 0,059300
179 W08609001 N02BB02 METAMIZOLUM NATRIUM NOVOCALMIN COMPR. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 0,391200 0,391200 0,054800
181 W42786004 N02BB02 METAMIZOLUM NATRIUM ALGOCALMIN 500 mg COMPR. 500mg ZENTIVA S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-RF 30 0,391200 0,391200 0,055133
183 W63055002 N02BB02 METAMIZOLUM NATRIUM ALVOTOR 500 mg COMPR. 500mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 20 COMPR. PRF 20 0,391200 0,391200 0,000300

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 01 IULIE 2019

Contributie maxima Val. maxima suportata de Contributie maxima


a asiguratului / UT sistemul de asigurari a asiguratului / UT

Prescriptie
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care
Cod_CIM

cant. beneficiaza de (pt. asiguratii care beneficiaza de


Nr crt.

UT/ Pret de compensare 100% beneficiaza de compensare 20%


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

111 W05051001 N06BX03 PIRACETAMUM PIRACETAM SLAVIA 400 mg COMPR. 400mg SLAVIA PHARM SRL ROMANIA CUTIE X 4 BLIST. DIN PVC/AL X 10 COMPR. P-6L 40 0,121000 0,004250 0,024200 0,101050

SE MODIFICA

90 W52016002 N06BX03 PIRACETAMUM PIRACETAM ARENA 400 mg CAPS. 400mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6L 30 0,121000 0,264333 0,024200 0,361133
91 W08467001 N06BX03 PIRACETAMUM PIRACETAM FARMEX 400 mg COMPR. 400mg FARMEX COMPANY SRL ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 COMPR. P-6L 40 0,116750 0,000000 0,023350 0,093400
92 W05045001 N06BX03 PIRACETAMUM PIRACETAM MCC 400mg COMPR. 400mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0,121000 0,048500 0,024200 0,145300
93 W54455002 N06BX03 PIRACETAMUM PIRACETAM SINTOFARM 400 mg COMPR. 400mg SINTOFARM SA ROMANIA CUTIE X 4 BLIST. PVC/AL X 10 COMPR. P-6L 40 0,121000 0,049000 0,024200 0,145800
94 W60657001 N06BX03 PIRACETAMUM PIRACETAM LAROPHARM 400 mg COMPR. 400mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0,121000 0,208000 0,024200 0,304800
95 W57920002 N06BX03 PIRACETAMUM PIRACETAM HELCOR 400mg COMPR. FILM. 400mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 0,121000 0,007500 0,024200 0,104300
96 W60618001 N06BX03 PIRACETAMUM PIRACETAM-RICHTER 400 mg COMPR. FILM. 400mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. FILM.P6L 20 0,121000 0,071000 0,024200 0,167800
97 W57090002 N06BX03 PIRACETAMUM NOOTROPIL 800 mg COMPR. FILM. 800mg U.C.B. PHARMA S.A. BELGIA CUTIE CU 6 BLIST. PVC/AL X 15 COMPR. FILM.P6L 90 0,242000 0,116666 0,048400 0,310266
98 W57921001 N06BX03 PIRACETAMUM PIRACETAM HELCOR 800mg COMPR. FILM. 800mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR.FILM. P-6L 20 0,232500 0,000000 0,046500 0,186000
99 W60617001 N06BX03 PIRACETAMUM PIRACETAM-RICHTER 800 mg COMPR. FILM. 800mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. FILM.P6L 20 0,232500 0,000000 0,046500 0,186000

Pagina 1 din 1