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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 MAI 2020

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

1.143 W66454003 C07AB02 METOPROLOLUM METOPROLOL TARTRAT AUROBINDO 100 mgCOMPR. FILM. 100mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0,232274 0,079392 0,209046 0,102620
1.144 W66453003 C07AB02 METOPROLOLUM METOPROLOL TARTRAT AUROBINDO 50 mg COMPR. FILM. 50mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0,116137 0,074863 0,104523 0,086477
1.145 W66459003 C07AB07 BISOPROLOLUM BISOPROLOL FUMARAT AUROBINDO 10 mg COMPR. FILM. 10mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0,348412 0,030254 0,313570 0,065096
1.146 W66458003 C07AB07 BISOPROLOLUM BISOPROLOL FUMARAT AUROBINDO 5 mg COMPR. FILM. 5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0,174206 0,042127 0,156785 0,059548
1.147 W66438003 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA AUROBINDO 250 mg COMPR. FILM. 250mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 10 0,518000 0,000000 0,466200 0,051800
1.148 W66439003 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA AUROBINDO 500 mg COMPR. FILM. 500mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 10 0,758000 0,000000 0,682200 0,075800
1.149 W66461007 J02AC01 FLUCONAZOLUM FLUCONAZOL AUROBINDO 100 mg CAPS. 100mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC TRANSPARENT/PVDC-AL X 7 CAPS. PRF 7 3,106285 0,243715 2,795656 0,554344
1.150 W66462001 J02AC01 FLUCONAZOLUM FLUCONAZOL AUROBINDO 150 mg CAPS. 150mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC TRANSPARENT/PVDC-AL X 1 CAPS. PRF 1 4,659427 1,640573 4,193484 2,106516
1.151 W66460007 J02AC01 FLUCONAZOLUM FLUCONAZOL AUROBINDO 50 mg CAPS. 50mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC TRANSPARENT/PVDC-AL X 7 CAPS. PRF 7 1,553142 0,172572 1,397827 0,327887

SE MODIFICA

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 0,689400 0,487933 0,620460 0,556873
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 0,689400 0,487933 0,620460 0,556873
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 0,344700 0,006966 0,310230 0,041436
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 0,344700 0,006966 0,310230 0,041436
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 0,344700 0,007442 0,310230 0,041912
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 1,116000 0,124000 1,004400 0,235600
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 1,116000 0,124000 1,004400 0,235600
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 1,116000 0,124000 1,004400 0,235600
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 1,116000 1,070000 1,004400 1,181600
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 0,223200 3,853800 0,200880 3,876120
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 0,223200 3,361800 0,200880 3,384120
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 0,558000 0,186000 0,502200 0,241800
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 0,558000 0,162000 0,502200 0,217800
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 0,558000 0,188000 0,502200 0,243800
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 0,558000 0,160000 0,502200 0,215800
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 0,558000 0,114000 0,502200 0,169800
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 0,558000 0,199000 0,502200 0,254800
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 0,558000 0,162000 0,502200 0,217800
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 0,558000 0,199000 0,502200 0,254800
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 1,116000 0,131000 1,004400 0,242600
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 1,116000 0,277000 1,004400 0,388600
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 1,116000 0,328000 1,004400 0,439600
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 1,116000 0,328000 1,004400 0,439600
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 1,674000 2,403000 1,506600 2,570400
633 W57948001 J01MA02 CIPROFLOXACINUM CIPROBAY XR 1000 mg 1000 mg
COMPR. FILM. ELIB. PREL. BAYER PHARMA AG GERMANIA CUTIE X 1 BLIST. DIN PP/AL X 7 COMPR. FILM. ELIB. PREL. P-RF 7 2,232000 10,856571 2,008800 11,079771
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 2,232000 10,856571 2,008800 11,079771
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 1,116000 1,929000 1,004400 2,040600
657 W08372001 J02AC01 FLUCONAZOLUM FLUCOVIM 100 CAPS. 100mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 BLIST. X 4 CAPS. P-RF 4 3,106285 3,633715 2,795656 3,944344
658 W43597002 J02AC01 FLUCONAZOLUM FLUCONAZOLE TEVA 100 mg CAPS. 100mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 7 CAPS. P-RF 7 3,106285 1,655143 2,795656 1,965772
659 W58225007 J02AC01 FLUCONAZOLUM FLUCONAZOL AUROBINDO 100 mg CAPS. 100mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC TRANSPARENT/PVDC-AL X 7 CAPS. PRF 7 3,106285 0,243715 2,795656 0,554344
660 W08373001 J02AC01 FLUCONAZOLUM FLUCOVIM 150 CAPS. 150mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 FLAC. X 1 CAPS. P-RF 1 4,659427 2,890573 4,193484 3,356516

Pagina 1 din 2
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)
661 W03156001 J02AC01 FLUCONAZOLUM DIFLUCAN 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-RF 1 4,659427 6,960573 4,193484 7,426516
662 W44089001 J02AC01 FLUCONAZOLUM FLUCORIC 150 mg CAPS. 150mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. FOLIE PVC-PVDC/AL X 1 CAPS.P-RF 1 4,659427 2,890573 4,193484 3,356516
663 W43598001 J02AC01 FLUCONAZOLUM FLUCONAZOLE TEVA 150 mg CAPS. 150mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 1 CAPS. P-RF 1 4,659427 2,000573 4,193484 2,466516
664 W42693001 J02AC01 FLUCONAZOLUM FLUCONAZOL 150 mg CAPS. 150mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-RF 1 4,659427 2,890573 4,193484 3,356516
665 W51994001 J02AC01 FLUCONAZOLUM FLUCONAZOL MEDOCHEMIE 150 mg CAPS. 150mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-RF 1 4,659427 2,870573 4,193484 3,336516
666 W52334001 J02AC01 FLUCONAZOLUM FLUCONAZOL LAROPHARM 150 mg CAPS. 150mg LAROPHARM S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 CAPSULA P-RF 1 4,659427 2,870573 4,193484 3,336516
667 W53943002 J02AC01 FLUCONAZOLUM FLUCONAZOL ARENA 150 MG CAPS. 150mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-RF 1 4,659427 2,890573 4,193484 3,356516
1.059 W65085001 J02AC01 FLUCONAZOLUM DIFLUCAN 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 BLIST. PVC/AL X 1 CAPS. PRF 1 4,659427 6,960573 4,193484 7,426516
668 W57239001 J02AC01 FLUCONAZOLUM FLUCONAZOL LPH 150 mg CAPS. 150mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 1 CAPS. PRF 1 4,659427 2,870573 4,193484 3,336516
669 W57430001 J02AC01 FLUCONAZOLUM FLUCONAZOL ROMPHARM 150 mg CAPS. 150mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 1 CAPS. PRF 1 4,659427 2,870573 4,193484 3,336516
670 W58226001 J02AC01 FLUCONAZOLUM FLUCONAZOL AUROBINDO 150 mg CAPS. 150mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU 1 BLIST. PVC TRANSPARENT/PVDC-AL X 1 CAPS. PRF 1 4,659427 1,640573 4,193484 2,106516
671 W60221003 J02AC01 FLUCONAZOLUM FLUCONAZOL ZENTIVA 150 mg CAPS. 150mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 BLIST. PVC-PE-PVDC/AL X 1 CAPS. P-RF 1 4,659427 2,890573 4,193484 3,356516
672 W60221001 J02AC01 FLUCONAZOLUM FLUCONAZOL ZENTIVA 150 mg CAPS. 150mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-RF 1 4,659427 2,890573 4,193484 3,356516
674 W08374001 J02AC01 FLUCONAZOLUM FLUCOVIM 50 CAPS. 50mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 BLIST. X 7 CAPS. P-RF 7 1,553142 1,374000 1,397827 1,529315
675 W03157001 J02AC01 FLUCONAZOLUM DIFLUCAN 50 mg CAPS. 50mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-RF 7 1,553142 2,951143 1,397827 3,106458
676 W44098001 J02AC01 FLUCONAZOLUM FLUCORIC 50 mg CAPS. 50mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. FOLIE PVC-PVDC/AL X 7 CAPS.P-RF 7 1,553142 1,374000 1,397827 1,529315
677 W43596001 J02AC01 FLUCONAZOLUM FLUCONAZOLE TEVA 50 mg CAPS. 50mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 7 CAPS. P-RF 7 1,553142 0,518286 1,397827 0,673601
678 W42321001 J02AC01 FLUCONAZOLUM FLUCONAZOL 50 mg CAPS. 50mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-RF 7 1,553142 1,372572 1,397827 1,527887
679 W51993001 J02AC01 FLUCONAZOLUM FLUCONAZOL MEDOCHEMIE 50 mg CAPS. 50mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-RF 7 1,553142 0,966858 1,397827 1,122173
680 W53942002 J02AC01 FLUCONAZOLUM FLUCONAZOL ARENA 50 MG CAPS. 50mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-RF 7 1,553142 1,374000 1,397827 1,529315
1.060 W65084001 J02AC01 FLUCONAZOLUM DIFLUCAN 50 mg CAPS. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 BLIST. PVC/AL X 7 CAPS. PRF 7 1,553142 2,951143 1,397827 3,106458
681 W58224007 J02AC01 FLUCONAZOLUM FLUCONAZOL AUROBINDO 50 mg CAPS. 50mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC TRANSPARENT/PVDC-AL X 7 CAPS. PRF 7 1,553142 0,172572 1,397827 0,327887
682 W58322002 J02AC01 FLUCONAZOLUM DIFLUCAN 10 mg/ml PULB. PT. SUSP. ORALA 10mg/ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU 1 FLAC. DIN PEÎD, DE CAPACITATE 60 ML, PREVAZUT CU SISTEM DE ÎNCHIDERE SECURIZAT PENTRU COPII, CE CONTINE PULB. PENTRU 35 ML SUSP. ORALA SI O SERINGA DIN PP DE 5 ML CU MARCAJ LA FIECARE 0,2 ML PRF 1 10,871998 19,958002 9,784798 21,045202
1.061 W65087001 J02AC01 FLUCONAZOLUM DIFLUCAN 10 mg/ml PULB. PT. SUSP. ORALA 10mg/ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. DIN PEÎD, DE CAPACITATE 60 ML, PREVAZUT CU SISTEM DE ÎNCHIDERE SECURIZAT PENTRU COPII, CE CONTINE PULB. PENTRU 35 ML SUSP. ORALA SI O SERINGA DIN PP DE 5 ML CU MARCAJ LA FIECARE 0,2 ML PRF 1 0,310628 30,519372 0,279565 30,550435

SE ELIMINA

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 1,209600 8,750400 1,088640 8,871360
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 1,209600 8,750400 1,088640 8,871360

Pagina 2 din 2
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 MAI 2020

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

1.401 W63737002 B01AB11 SULODEXIDUM ** VESSEL DUE F 250 ULS CAPS. MOI 250ULS ALFASIGMA S.P.A. ITALIA CUTIE CU 3 BLIST. PVDC-PVC/AL-PVDC A CATE 20 CAPS. MOI P6L 60 1,905199 0,172801 0,952599 1,125401 1,714679 0,363321
1.402 W66451005 C09CA04 IRBESARTANUM IRBESARTAN AUROBINDO 150 mg COMPR. 150mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. P6L 28 0,388571 0,000000 0,194285 0,194286 0,349713 0,038858
1.403 W66452005 C09CA04 IRBESARTANUM IRBESARTAN AUROBINDO 300 mg COMPR. 300mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. P6L 28 0,543571 0,000000 0,271785 0,271786 0,489213 0,054358
1.404 W66434003 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN AUROBINDO 16 mg COMPR. 16mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0,706666 0,000000 0,353333 0,353333 0,635999 0,070667
1.405 W66433003 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN AUROBINDO 8 mg COMPR. 8mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0,516333 0,000000 0,258166 0,258167 0,464699 0,051634
1.406 W63093002 M01AH05 ETORICOXIBUM ETORICOXIB STADA 120 mg COMPR. FILM. 120mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 2,450000 0,000000 1,225000 1,225000 2,205000 0,245000
1.407 W63090001 M01AH05 ETORICOXIBUM ETORICOXIB STADA 30 mg COMPR. FILM. 30mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 0,631375 0,931482 0,315687 1,247170 0,568237 0,994620
1.408 W63090002 M01AH05 ETORICOXIBUM ETORICOXIB STADA 30 mg COMPR. FILM. 30mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 0,631375 0,882196 0,315687 1,197884 0,568237 0,945334
1.409 W63091003 M01AH05 ETORICOXIBUM ETORICOXIB STADA 60 mg COMPR. FILM. 60mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,262750 0,620107 0,631375 1,251482 1,136475 0,746382
1.410 W63092003 M01AH05 ETORICOXIBUM ETORICOXIB STADA 90 mg COMPR. FILM. 90mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,717857 0,000000 0,858928 0,858929 1,546071 0,171786
1.411 W66497003 M05BA07 ACIDUM RISEDRONICUM * ACTONEL SAPTAMANAL 35 mg COMPR. FILM. 35mg THERAMEX IRELAND LIMITED IRLANDA CUTIE CU 1 BLIST. PVC/AL X 4 COMPR. FILM. P-6L 4 5,946412 5,378588 2,973206 8,351794 5,351770 5,973230
1.412 W65841001 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * ACID ALENDRONIC/COLECALCIFEROL ACCORD 70 mg/5600 UI COMPR. 70mg/5600UIACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PA-AL-PVC/AL X 4 COMPR. P6L 4 5,946412 4,916088 2,973206 7,889294 5,351770 5,510730
1.413 W66466004 N06AX21 DULOXETINUM ** DULOXETINA AUROBINDO 30 mg CAPS. GASTROREZ. 30mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 0,624059 0,575941 0,312029 0,887971 0,561653 0,638347
1.414 W66467004 N06AX21 DULOXETINUM ** DULOXETINA AUROBINDO 60 mg CAPS. GASTROREZ. 60mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 1,248118 0,004548 0,624059 0,628607 1,123306 0,129360
1.415 W66442004 N07CA01 BETAHISTINUM BETAHISTINA DICLORHIDRAT AUROBINDO 16 mg COMPR. 16mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 60 COMPR. P6L 60 0,290666 0,000000 0,145333 0,145333 0,261599 0,029067
1.416 W66443003 N07CA01 BETAHISTINUM BETAHISTINA DICLORHIDRAT AUROBINDO 24 mg COMPR. 24mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 60 COMPR. P6L 60 0,372833 0,000000 0,186416 0,186417 0,335549 0,037284
1.417 W66441006 N07CA01 BETAHISTINUM BETAHISTINA DICLORHIDRAT AUROBINDO 8 mg COMPR. 8mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 100 COMPR. P6L 100 0,152610 0,035190 0,076305 0,111495 0,137349 0,050451
1.418 W60547004 R03AK08 COMBINATII (BECLOMETASONUM+FORMOTEROLUM) FOSTER NEXTHALER 100/6 micrograme pe doza PULB. DE INHAL. 100/6micrograme pe doza CHIESI PHARMACEUTICALS GMBH AUSTRIA CUTIE CU 1 INHALATOR MULTIDOZA INTRODUS INTR-O PUNGA SIGILATA DIN PET/AL/PE X 180 DOZE PULBERE DE INHALAT PRF 1 195,299999 20,000001 97,649999 117,650001 175,769999 39,530001

SE MODIFICA

82 W63737001 B01AB11 SULODEXIDUM ** VESSEL DUE F 250 ULS CAPS. MOI 250ULS ALFASIGMA S.P.A. ITALIA CUTIE CU 2 BLIST. PVDC-PVC/AL-PVDC A CATE 25 CAPS. MOI P6L 50 1,905199 0,247001 0,952599 1,199601 1,714679 0,437521
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 0,344700 1,138871 0,172350 1,311221 0,310230 1,173341
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 0,344700 1,318871 0,172350 1,491221 0,310230 1,353341
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 0,344700 0,086014 0,172350 0,258364 0,310230 0,120484
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 0,344700 0,086014 0,172350 0,258364 0,310230 0,120484
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 0,689400 0,317742 0,344700 0,662442 0,620460 0,386682
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 4,136400 20,743600 2,068200 22,811800 3,722760 21,157240
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 0,689400 0,479171 0,344700 0,823871 0,620460 0,548111
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 0,689400 0,539933 0,344700 0,884633 0,620460 0,608873
1.365 W66400006 C09CA04 IRBESARTANUM APROVEL 150mg COMPR. FILM. 150mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM.P6L 30 0,689400 0,539933 0,344700 0,884633 0,620460 0,608873
1.366 W66400002 C09CA04 IRBESARTANUM APROVEL 150mg COMPR. FILM. 150mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST. PVC/PVDC/AL X 28 COMPR. FILM.P6L 28 0,689400 0,479171 0,344700 0,823871 0,620460 0,548111
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 1,378800 0,175128 0,689400 0,864528 1,240920 0,313008
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 1,378800 0,256866 0,689400 0,946266 1,240920 0,394746
1.367 W66401007 C09CA04 IRBESARTANUM APROVEL 300mg COMPR. FILM. 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM.P6L 30 1,378800 0,256866 0,689400 0,946266 1,240920 0,394746
1.368 W66401002 C09CA04 IRBESARTANUM APROVEL 300mg COMPR. FILM. 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST PVC/PVDC/AL X 28 COMPR. FILM.P6L 28 1,378800 0,175128 0,689400 0,864528 1,240920 0,313008
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 1,378800 0,051557 0,689400 0,740957 1,240920 0,189437
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 0,689400 0,171314 0,344700 0,516014 0,620460 0,240254
278 W05785002 C09CA07 TELMISARTANUM MICARDIS 80 mg COMPR. 80mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 28COMPR. ( BLIST. PA/AL/PVC) P-6L 28 1,378800 0,069057 0,689400 0,758457 1,240920 0,206937
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 2,162761 0,005453 1,081380 1,086834 1,946484 0,221730
1.272 W62738003 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN ZENTIVA 10 mg/160 mg COMPR. FILM. 10mg/160mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 28 COMPR. FILM. P6L 28 2,228300 0,119200 1,114150 1,233350 2,005470 0,342030
1.274 W62737005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN ZENTIVA 5 mg/160 mg COMPR. FILM. 5mg/160mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 56 COMPR. FILM. P6L 56 2,162761 0,005453 1,081380 1,086834 1,946484 0,221730
1.275 W62737003 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN ZENTIVA 5 mg/160 mg COMPR. FILM. 5mg/160mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 28 COMPR. FILM. P6L 28 2,162761 0,120096 1,081380 1,201477 1,946484 0,336373
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 1,114150 1,076028 0,557075 1,633103 1,002735 1,187443
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 1,114150 1,076028 0,557075 1,633103 1,002735 1,187443
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 1,114150 1,111921 0,557075 1,668996 1,002735 1,223336
1.276 W62736005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN ZENTIVA 5 mg/80 mg COMPR. FILM. 5mg/80mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 56 COMPR. FILM. P6L 56 1,114150 1,111921 0,557075 1,668996 1,002735 1,223336
1.277 W62736003 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN ZENTIVA 5 mg/80 mg COMPR. FILM. 5mg/80mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 28 COMPR. FILM. P6L 28 1,114150 1,232635 0,557075 1,789710 1,002735 1,344050
326 W53445002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM INOVUM 20 mg/5 mg COMPR. FILM. 20mg/5mg MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. LUXEMBOURG CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 1,114150 0,663350 0,557075 1,220425 1,002735 0,774765
1.351 W66041002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SALVO 20 mg/5 mg COMPR. FILM. 20mg/5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,114150 0,492635 0,557075 1,049710 1,002735 0,604050
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 1,114150 0,545850 0,557075 1,102925 1,002735 0,657265
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 1,114150 1,221564 0,557075 1,778639 1,002735 1,332979

Pagina 1 din 4
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)
329 W64151010 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 20 mg/5 mg COMPR. FILM. 20mg/5mg HCS BVBA BELGIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 28X1 COMPR. FILM. P6L 28 1,114150 1,131207 0,557075 1,688282 1,002735 1,242622
330 W64151011 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 20 mg/5 mg COMPR. FILM. 20mg/5mg HCS BVBA BELGIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 30X1 COMPR. FILM. P6L 30 1,114150 1,056183 0,557075 1,613258 1,002735 1,167598
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 1,114150 1,131207 0,557075 1,688282 1,002735 1,242622
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 1,114150 1,221564 0,557075 1,778639 1,002735 1,332979
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 1,114150 1,056183 0,557075 1,613258 1,002735 1,167598
334 W64245006 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 20 mg/5 mg COMPR. FILM. 20mg/5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,114150 1,221564 0,557075 1,778639 1,002735 1,332979
1.196 W65814006 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 20 mg/5 mg COMPR. FILM. 20mg/5mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. 28 1,114150 1,221564 0,557075 1,778639 1,002735 1,332979
1.197 W65814001 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 20 mg/5 mg COMPR. FILM. 20mg/5mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1,114150 1,221564 0,557075 1,778639 1,002735 1,332979
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 1,114150 0,545850 0,557075 1,102925 1,002735 0,657265
336 W53447002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM INOVUM 40 mg/10 mg COMPR. FILM. 40mg/10mg MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. LUXEMBOURG CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 1,908571 0,000000 0,954285 0,954286 1,717713 0,190858
338 W64086002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ZENTIVA 40 mg/10 mg COMPR. FILM. 40mg/10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,228300 0,331700 1,114150 1,445850 2,005470 0,554530
339 W64153010 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/10 mg COMPR. FILM. 40mg/10mg HCS BVBA BELGIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 28X1 COMPR. FILM. P6L 28 2,228300 0,326700 1,114150 1,440850 2,005470 0,549530
340 W64153011 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/10 mg COMPR. FILM. 40mg/10mg HCS BVBA BELGIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 30X1 COMPR. FILM. P6L 30 2,228300 0,327033 1,114150 1,441183 2,005470 0,549863
341 W64153002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/10 mg COMPR. FILM. 40mg/10mg HCS BVBA BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,228300 0,326700 1,114150 1,440850 2,005470 0,549530
342 W64247001 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/10 mg COMPR. FILM. 40mg/10mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,228300 0,331700 1,114150 1,445850 2,005470 0,554530
343 W64153003 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/10 mg COMPR. FILM. 40mg/10mg HCS BVBA BELGIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 2,228300 0,327033 1,114150 1,441183 2,005470 0,549863
344 W64247006 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/10 mg COMPR. FILM. 40mg/10mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,228300 0,331700 1,114150 1,445850 2,005470 0,554530
1.198 W65816006 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/10 mg COMPR. FILM. 40mg/10mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. 28 2,228300 0,331700 1,114150 1,445850 2,005470 0,554530
1.199 W65816001 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/10 mg COMPR. FILM. 40mg/10mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,228300 0,331700 1,114150 1,445850 2,005470 0,554530
346 W53446002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM INOVUM 40 mg/5 mg COMPR. FILM. 40mg/5mg MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. LUXEMBOURG CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 1,777500 0,000000 0,888750 0,888750 1,599750 0,177750
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 2,005470 0,330244 1,002735 1,332979 1,804923 0,530791
349 W64152010 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/5 mg COMPR. FILM. 40mg/5mg HCS BVBA BELGIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 28X1 COMPR. FILM. P6L 28 2,005470 0,367030 1,002735 1,369765 1,804923 0,567577
350 W64152011 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/5 mg COMPR. FILM. 40mg/5mg HCS BVBA BELGIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI OPA-AL-PVC/AL X 30X1 COMPR. FILM. P6L 30 2,005470 0,367196 1,002735 1,369931 1,804923 0,567743
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 2,005470 0,367030 1,002735 1,369765 1,804923 0,567577
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 2,005470 0,330244 1,002735 1,332979 1,804923 0,530791
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 2,005470 0,367196 1,002735 1,369931 1,804923 0,567743
354 W64246006 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/5 mg COMPR. FILM. 40mg/5mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,005470 0,330244 1,002735 1,332979 1,804923 0,530791
1.200 W65815001 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/5 mg COMPR. FILM. 40mg/5mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 2,005470 0,330244 1,002735 1,332979 1,804923 0,530791
1.201 W65815006 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLMESARTAN MEDOXOMIL/AMLODIPINA ACCORD 40 mg/5 mg COMPR. FILM. 40mg/5mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA P6L
CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. 28 2,005470 0,330244 1,002735 1,332979 1,804923 0,530791
1.348 W66212001 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA ATB 250 mg COMPR. FILM. 250mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM PRF 10 2,232000 0,387000 1,116000 1,503000 2,008800 0,610200
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 2,232000 0,382285 1,116000 1,498285 2,008800 0,605485
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 2,232000 0,406571 1,116000 1,522571 2,008800 0,629771
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 4,464000 0,197428 2,232000 2,429428 4,017600 0,643828
1.349 W66213001 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA ATB 500 mg COMPR. FILM. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM PRF 10 4,464000 0,009000 2,232000 2,241000 4,017600 0,455400
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 4,464000 0,957428 2,232000 3,189428 4,017600 1,403828
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 4,464000 0,192000 2,232000 2,424000 4,017600 0,638400
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 4,464000 2,858000 2,232000 5,090000 4,017600 3,304400
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 4,464000 5,278000 2,232000 7,510000 4,017600 5,724400
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 4,464000 5,278000 2,232000 7,510000 4,017600 5,724400
1.303 W65543001 J01MA14 MOXIFLOXACINUM ERELAN 400 mg COMPR. FILM. 400mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 5 COMPR. FILM. PRF 5 4,464000 2,478000 2,232000 4,710000 4,017600 2,924400
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 4,464000 5,278000 2,232000 7,510000 4,017600 5,724400
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 4,464000 0,466000 2,232000 2,698000 4,017600 0,912400
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 4,464000 2,900000 2,232000 5,132000 4,017600 3,346400
1.294 W66222001 J01MA14 MOXIFLOXACINUM MOXIFLOXACINA AUROBINDO 400 mg COMPR. FILM. 400mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 5 COMPR. FILM. PRF 5 4,464000 0,466000 2,232000 2,698000 4,017600 0,912400
1.150 W65173006 M01AH01 CELECOXIBUM CELEBREX 100 mg CAPS. 100mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. PRF 30 0,631375 0,314625 0,315687 0,630313 0,568237 0,377763
716 W08360009 M01AH01 CELECOXIBUM CELEBREX 100 mg CAPS. 100mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. PVC/ACLAR/AL X 10 CAPS. P-RF 30 0,631375 0,314625 0,315687 0,630313 0,568237 0,377763
717 W08360006 M01AH01 CELECOXIBUM CELEBREX 100 mg CAPS. 100mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. PVC/AL X 10 CAPS. P-RF 30 0,631375 0,314625 0,315687 0,630313 0,568237 0,377763
1.151 W65174004 M01AH01 CELECOXIBUM CELEBREX 200 mg CAPS. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 1,262750 0,315250 0,631375 0,946625 1,136475 0,441525
1.152 W65174006 M01AH01 CELECOXIBUM CELEBREX 200 mg CAPS. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. PRF 30 1,262750 0,264250 0,631375 0,895625 1,136475 0,390525
722 W08361006 M01AH01 CELECOXIBUM CELEBREX 200 mg CAPS. 200mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. PVC/AL X 10 CAPS. P-RF 30 1,262750 0,264250 0,631375 0,895625 1,136475 0,390525
723 W08361007 M01AH01 CELECOXIBUM CELEBREX 200 mg CAPS. 200mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 BLIST. PVC/ACLAR/AL X 10 CAPS. P-RF 10 1,262750 0,315250 0,631375 0,946625 1,136475 0,441525
724 W08361004 M01AH01 CELECOXIBUM CELEBREX 200 mg CAPS. 200mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 BLIST. PVC/AL X 10 CAPS. P-RF 10 1,262750 0,315250 0,631375 0,946625 1,136475 0,441525
725 W08361009 M01AH01 CELECOXIBUM CELEBREX 200 mg CAPS. 200mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. PVC/ACLAR/AL X 10 CAPS. P-RF 30 1,262750 0,264250 0,631375 0,895625 1,136475 0,390525
731 W51225001 M01AH05 ETORICOXIBUM ARCOXIA 120 mg COMPR. FILM. 120mg MERCK SHARP & DOHME ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 7 2,525500 0,593071 1,262750 1,855821 2,272950 0,845621
732 W51225003 M01AH05 ETORICOXIBUM ARCOXIA 120 mg COMPR. FILM. 120mg MERCK SHARP & DOHME ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL, X 14 COMPR. FILM. P-RF 14 2,525500 0,493785 1,262750 1,756535 2,272950 0,746335
733 W62615001 M01AH05 ETORICOXIBUM IMESOL 120 mg COMPR. FILM. 120mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 7 COMPR. FILM. PRF 7 2,525500 0,563071 1,262750 1,825821 2,272950 0,815621
734 W62615002 M01AH05 ETORICOXIBUM IMESOL 120 mg COMPR. FILM. 120mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PERFORAT UNIDOZA AL/AL X 7X1 COMPR. FILM. PRF 7 2,525500 0,563071 1,262750 1,825821 2,272950 0,815621
736 W62798002 M01AH05 ETORICOXIBUM DOLOXIB 120 mg COMPR. FILM. 120mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 2,525500 0,014500 1,262750 1,277250 2,272950 0,267050
737 W62798003 M01AH05 ETORICOXIBUM DOLOXIB 120 mg COMPR. FILM. 120mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 2,525500 0,209500 1,262750 1,472250 2,272950 0,462050
739 W63220003 M01AH05 ETORICOXIBUM ROTICOX 120 mg COMPR. FILM. 120mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 2,525500 0,464500 1,262750 1,727250 2,272950 0,717050
740 W63049001 M01AH05 ETORICOXIBUM COXIENT 120 mg COMPR. FILM. 120mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 2,525500 0,563071 1,262750 1,825821 2,272950 0,815621
741 W63220002 M01AH05 ETORICOXIBUM ROTICOX 120 mg COMPR. FILM. 120mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 2,525500 0,563071 1,262750 1,825821 2,272950 0,815621
745 W53204001 M01AH05 ETORICOXIBUM ARCOXIA 30 mg COMPR. FILM. 30mg MERCK SHARP & DOHME ROMANIA CUTIE X 4 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 28 0,631375 0,977553 0,315687 1,293241 0,568237 1,040691

Pagina 2 din 4
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)
746 W62612001 M01AH05 ETORICOXIBUM IMESOL 30 mg COMPR. FILM. 30mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR. FILM. PRF 28 0,631375 0,977553 0,315687 1,293241 0,568237 1,040691
747 W62612002 M01AH05 ETORICOXIBUM IMESOL 30 mg COMPR. FILM. 30mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PERFORAT UNIDOZA AL/AL X 28X1 COMPR. FILM. PRF 28 0,631375 0,977553 0,315687 1,293241 0,568237 1,040691
748 W62713003 M01AH05 ETORICOXIBUM ETORICOXIB TEVA 30 mg COMPR. FILM. 30mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 0,631375 1,381482 0,315687 1,697170 0,568237 1,444620
749 W62795001 M01AH05 ETORICOXIBUM DOLOXIB 30 mg COMPR. FILM. 30mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 0,631375 1,468625 0,315687 1,784313 0,568237 1,531763
750 W62795002 M01AH05 ETORICOXIBUM DOLOXIB 30 mg COMPR. FILM. 30mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 0,631375 1,402553 0,315687 1,718241 0,568237 1,465691
751 W53204005 M01AH05 ETORICOXIBUM ARCOXIA 30 mg COMPR. FILM. 30mg MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. DIN PA-AL-PVC/AL X 14 COMPRIMATE FILMATE PRF 28 0,631375 0,977553 0,315687 1,293241 0,568237 1,040691
752 W63046003 M01AH05 ETORICOXIBUM COXIENT 30 mg COMPR. FILM. 30mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 0,631375 1,375410 0,315687 1,691098 0,568237 1,438548
753 W63217003 M01AH05 ETORICOXIBUM ROTICOX 30 mg COMPR. FILM. 30mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 0,631375 0,977553 0,315687 1,293241 0,568237 1,040691
754 W63425007 M01AH05 ETORICOXIBUM KOSTAROX 30 mg COMPR. FILM. 30mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0,631375 0,976839 0,315687 1,292527 0,568237 1,039977
755 W63676002 M01AH05 ETORICOXIBUM ETORICOXIB AUROBINDO 30 mg COMPR. FILM. 30mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 0,631375 0,579339 0,315687 0,895027 0,568237 0,642477
756 W63794005 M01AH05 ETORICOXIBUM GEROCOXAN 30 mg COMPR. FILM. 30mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 0,631375 0,859696 0,315687 1,175384 0,568237 0,922834
757 W51227002 M01AH05 ETORICOXIBUM ARCOXIA 60 mg COMPR. FILM. 60mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 14 1,262750 0,997964 0,631375 1,629339 1,136475 1,124239
758 W51227003 M01AH05 ETORICOXIBUM ARCOXIA 60 mg COMPR. FILM. 60mg MERCK SHARP & DOHME ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 14 COMPR. FILM. P-RF 14 1,262750 0,997964 0,631375 1,629339 1,136475 1,124239
759 W62613001 M01AH05 ETORICOXIBUM IMESOL 60 mg COMPR. FILM. 60mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 14 COMPR. FILM. PRF 14 1,262750 0,975821 0,631375 1,607196 1,136475 1,102096
760 W62613002 M01AH05 ETORICOXIBUM IMESOL 60 mg COMPR. FILM. 60mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PERFORAT UNIDOZA AL/AL X 14X1 COMPR. FILM. PRF 14 1,262750 0,975821 0,631375 1,607196 1,136475 1,102096
761 W62714002 M01AH05 ETORICOXIBUM ETORICOXIB TEVA 60 mg COMPR. FILM. 60mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,262750 0,695107 0,631375 1,326482 1,136475 0,821382
762 W62796001 M01AH05 ETORICOXIBUM DOLOXIB 60 mg COMPR. FILM. 60mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 1,262750 0,695821 0,631375 1,327196 1,136475 0,822096
763 W62796002 M01AH05 ETORICOXIBUM DOLOXIB 60 mg COMPR. FILM. 60mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,262750 0,695107 0,631375 1,326482 1,136475 0,821382
764 W62796004 M01AH05 ETORICOXIBUM DOLOXIB 60 mg COMPR. FILM. 60mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 1,262750 0,403678 0,631375 1,035053 1,136475 0,529953
765 W63047002 M01AH05 ETORICOXIBUM COXIENT 60 mg COMPR. FILM. 60mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,262750 0,377250 0,631375 1,008625 1,136475 0,503525
766 W63218002 M01AH05 ETORICOXIBUM ROTICOX 60 mg COMPR. FILM. 60mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,262750 0,916535 0,631375 1,547910 1,136475 1,042810
767 W63218004 M01AH05 ETORICOXIBUM ROTICOX 60 mg COMPR. FILM. 60mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 1,262750 0,846178 0,631375 1,477553 1,136475 0,972453
768 W63426004 M01AH05 ETORICOXIBUM KOSTAROX 60 mg COMPR. FILM. 60mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. P6L 14 1,262750 0,460821 0,631375 1,092196 1,136475 0,587096
769 W63677002 M01AH05 ETORICOXIBUM ETORICOXIB AUROBINDO 60 mg COMPR. FILM. 60mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,262750 0,442964 0,631375 1,074339 1,136475 0,569239
770 W63795005 M01AH05 ETORICOXIBUM GEROCOXAN 60 mg COMPR. FILM. 60mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,262750 0,394392 0,631375 1,025767 1,136475 0,520667
771 W51226003 M01AH05 ETORICOXIBUM ARCOXIA 90 mg COMPR. FILM. 90mg MERCK SHARP & DOHME ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 14 COMPR. FILM. P-RF 14 1,894125 0,511589 0,947062 1,458652 1,704712 0,701002
772 W51226002 M01AH05 ETORICOXIBUM ARCOXIA 90 mg COMPR. FILM. 90mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 14 1,894125 0,511589 0,947062 1,458652 1,704712 0,701002
773 W62614001 M01AH05 ETORICOXIBUM IMESOL 90 mg COMPR. FILM. 90mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 14 COMPR. FILM. PRF 14 1,894125 0,488732 0,947062 1,435795 1,704712 0,678145
774 W62614002 M01AH05 ETORICOXIBUM IMESOL 90 mg COMPR. FILM. 90mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PERFORAT UNIDOZA AL/AL X 14X1 COMPR. FILM. PRF 14 1,894125 0,488732 0,947062 1,435795 1,704712 0,678145
776 W62797001 M01AH05 ETORICOXIBUM DOLOXIB 90 mg COMPR. FILM. 90mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 1,894125 0,190160 0,947062 1,137223 1,704712 0,379573
777 W62797002 M01AH05 ETORICOXIBUM DOLOXIB 90 mg COMPR. FILM. 90mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,894125 0,190160 0,947062 1,137223 1,704712 0,379573
779 W63048002 M01AH05 ETORICOXIBUM COXIENT 90 mg COMPR. FILM. 90mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,894125 0,486589 0,947062 1,433652 1,704712 0,676002
780 W63219003 M01AH05 ETORICOXIBUM ROTICOX 90 mg COMPR. FILM. 90mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,894125 0,420160 0,947062 1,367223 1,704712 0,609573
781 W63219005 M01AH05 ETORICOXIBUM ROTICOX 90 mg COMPR. FILM. 90mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 1,894125 0,345875 0,947062 1,292938 1,704712 0,535288
783 W63678002 M01AH05 ETORICOXIBUM ETORICOXIB AUROBINDO 90 mg COMPR. FILM. 90mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1,894125 0,015160 0,947062 0,962223 1,704712 0,204573
789 W60296004 M05BA04 ACIDUM ALENDRONICUM * FOSAMAX 70 mg COMPR. 70mg MERCK SHARP & DOHME ROMANIA CUTIE CU 1 BLIST. AL/AL X 2 COMPR. P6L 2 5,946412 3,373588 2,973206 6,346794 5,351770 3,968230
790 W60296002 M05BA04 ACIDUM ALENDRONICUM * FOSAMAX 70 mg COMPR. 70mg MERCK SHARP & DOHME ROMANIA CUTIE CU 1 BLIST. AL/AL X 4 COMPR. P6L 4 5,946412 3,076088 2,973206 6,049294 5,351770 3,670730
792 W56763001 M05BA04 ACIDUM ALENDRONICUM * ADRONIK 70 mg COMPR. FILM. 70mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 12 COMPR. FILM. P-6L 12 5,946412 2,622754 2,973206 5,595960 5,351770 3,217396
793 W56763002 M05BA04 ACIDUM ALENDRONICUM * ADRONIK 70 mg COMPR. FILM. 70mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 2 COMPR. FILM. P-6L 2 5,946412 3,373588 2,973206 6,346794 5,351770 3,968230
794 W56763003 M05BA04 ACIDUM ALENDRONICUM * ADRONIK 70 mg COMPR. FILM. 70mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 4 COMPR. FILM. P-6L 4 5,946412 3,076088 2,973206 6,049294 5,351770 3,670730
795 W54377002 M05BA07 ACIDUM RISEDRONICUM * LORINE 35mg COMPR. FILM. 35mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1BLIST. PVC- PVDC/AL X 4 COMPR. FILM. P-6L 4 5,946412 1,661088 2,973206 4,634294 5,351770 2,255730
796 W55565003 M05BA07 ACIDUM RISEDRONICUM * OSODENS 35 mg COMPR. FILM. 35mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4 COMPR. FILM. P-6L 4 5,946412 1,658588 2,973206 4,631794 5,351770 2,253230
799 W61163003 M05BA07 ACIDUM RISEDRONICUM * ACTONEL SAPTAMANAL 35 mg COMPR. FILM. 35mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 1 BLIST. PVC/AL X 4 COMPR. FILM. P-6L 4 5,946412 5,378588 2,973206 8,351794 5,351770 5,973230
800 W61164001 M05BA07 ACIDUM RISEDRONICUM * ACTONEL 75 mg COMPR. FILM. 75mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 1 BLIST. PVC/AL X 2 COMPR. FILM. P6L 2 12,742312 10,767688 6,371156 17,138844 11,468080 12,041920
801 W62565001 M05BA07 ACIDUM RISEDRONICUM * RISEDRONAT AUROBINDO 75 mg COMPR. FILM. 75mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU 1 BLIST. PVC/AL X 2 COMPR. FILM. P6L 2 12,742312 9,587688 6,371156 15,958844 11,468080 10,861920
1.354 W66214001 M05BA07 ACIDUM RISEDRONICUM * ACTONEL 75 mg COMPR. FILM. 75mg THERAMEX IRELAND LIMITED IRLANDA CUTIE CU 1 BLIST. PVC/AL X 2 COMPR. FILM. P6L 2 12,742312 10,767688 6,371156 17,138844 11,468080 12,041920
1.394 W66432001 M05BA07 ACIDUM RISEDRONICUM * RISEDRONAT AUROBINDO 75 mg COMPR. FILM. 75mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 2 COMPR. FILM. P6L 2 12,742312 9,587688 6,371156 15,958844 11,468080 10,861920
802 W42702002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * FOSAVANCE 70mg/2800UI COMPR. 70mg/2800UIMERCK SHARP & DOHME MAREA BRITANIE CUTIE X 4 COMPR. (1 BLISTER DIN AL/AL X 4 COMPR.) P-6L 4 5,946412 3,076088 2,973206 6,049294 5,351770 3,670730
803 W63914002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * ACID ALENDRONIC/COLECALCIFEROL AUROBINDO 70 mg/2800 UI COMPR. 70mg/2800UIAUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 4 COMPR. P6L 4 5,946412 0,878588 2,973206 3,851794 5,351770 1,473230
804 W63922002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * ACID ALENDRONIC/COLECALCIFEROL ZENTIVA 70 mg/2800 UI COMPR. 70mg/2800UIZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PA-AL-PVC/AL X 4 COMPR. P6L 4 5,946412 6,913588 2,973206 9,886794 5,351770 7,508230
805 W64728002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * FOSAVANCE 70mg/2800UI COMPR. 70mg/2800UIMERCK SHARP & DOHME OLANDA CUTIE X 4 COMPR. (1 BLISTER DIN AL/AL X 4 COMPR.) P6L 4 5,946412 3,076088 2,973206 6,049294 5,351770 3,670730
806 W52559001 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * FOSAVANCE 70mg/5600UI COMPR. 70mg/5600UIMERCK SHARP & DOHME MAREA BRITANIE CUTIE X 2 COMPR. (1 BLISTER DIN AL/AL X 2 COMPR.) P-6L 2 5,946412 3,373588 2,973206 6,346794 5,351770 3,968230
807 W62143003 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * DA-BONE 70 mg/5600 UI COMPR. 70mg/5600UITEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4 COMPR., AMBALAJ TIP CALENDAR P6L 4 5,946412 0,301088 2,973206 3,274294 5,351770 0,895730
808 W62143001 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * DA-BONE 70 mg/5600 UI COMPR. 70mg/5600UITEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4 COMPR. P6L 4 5,946412 1,668588 2,973206 4,641794 5,351770 2,263230
809 W62143002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * DA-BONE 70 mg/5600 UI COMPR. 70mg/5600UITEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4X1 COMPR. P6L 4 5,946412 1,668588 2,973206 4,641794 5,351770 2,263230
810 W63074002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * ACID ALENDRONIC/COLECALCIFEROL SANDOZ 70 mg/5600 UI COMPR. 70mg/5600UISANDOZ S.R.L. ROMANIA CUTIE CU BLIST. AL/AL X 4 COMPR.P6L 4 5,946412 1,608588 2,973206 4,581794 5,351770 2,203230
811 W63915002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * ACID ALENDRONIC/COLECALCIFEROL AUROBINDO 70 mg/5600 UI COMPR. 70mg/5600UIAUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 4 COMPR. P6L 4 5,946412 0,878588 2,973206 3,851794 5,351770 1,473230
812 W63923002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * ACID ALENDRONIC/COLECALCIFEROL ZENTIVA 70 mg/5600 UI COMPR. 70mg/5600UIZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PA-AL-PVC/AL X 4 COMPR. P6L 4 5,946412 1,416088 2,973206 4,389294 5,351770 2,010730
813 W64729001 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) * FOSAVANCE 70mg/5600UI COMPR. 70mg/5600UIMERCK SHARP & DOHME OLANDA CUTIE X 2 COMPR. (1 BLISTER DIN AL/AL X 2 COMPR.) P6L 2 5,946412 3,373588 2,973206 6,346794 5,351770 3,968230
895 W43297002 N06AX21 DULOXETINUM ** CYMBALTA 30mg CAPS. GASTROREZ. 30mg ELI LILLY NEDERLAND BV OLANDA CUTIE X 28 CAPS. GASTROREZ.( BLIST. PVC/PE/PCTFE/AL) P-RF 28 0,624059 1,155583 0,312029 1,467613 0,561653 1,217989
896 W61820005 N06AX21 DULOXETINUM ** DULSEVIA 30 mg CAPS. GASTROREZ. 30mg KRKA, D.D., NOVO MESTO SLOVENIA PRF
CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. 30 0,624059 0,469941 0,312029 0,781971 0,561653 0,532347
897 W61959001 N06AX21 DULOXETINUM ** ZATINEX 30 mg CAPS. GASTROREZ. 30mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 CAPS. GASTROREZ. PRF 28 0,624059 0,597726 0,312029 0,909756 0,561653 0,660132
898 W61959002 N06AX21 DULOXETINUM ** ZATINEX 30 mg CAPS. GASTROREZ. 30mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 CAPS. GASTROREZ. PRF 28 0,624059 0,597726 0,312029 0,909756 0,561653 0,660132

Pagina 3 din 4
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)
900 W62305004 N06AX21 DULOXETINUM ** DULOXETINA AUROBINDO 30 mg CAPS. GASTROREZ. 30mg MALTA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 30 CAPS. GASTROREZ.
AUROBINDO PHARMA (MALTA) LIMITED PRF 30 0,624059 0,575941 0,312029 0,887971 0,561653 0,638347
901 W62054001 N06AX21 DULOXETINUM ** DULOXETINE ZENTIVA 30 mg CAPS. GASTROREZ. 30mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PCTFE/AL X 28 CAPS. GASTROREZ. PRF 28 0,624059 0,618441 0,312029 0,930471 0,561653 0,680847
902 W62274004 N06AX21 DULOXETINUM ** DULASOLAN 30 mg CAPS. GASTROREZ. 30mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. TRANSPARENTE PVC-PCTFE/AL X 30 CAPS. GASTOREZ. PRF 30 0,624059 0,480274 0,312029 0,792304 0,561653 0,542680
903 W62301003 N06AX21 DULOXETINUM ** DULOXETINA STADA 30 mg CAPS. GASTROREZ. 30mg STADA M&D SRL ROMANIA CUTIE CU BLIST. PVC-PCTFE-PVC/AL X 28 CAPS. GASTROREZ. PRF 28 0,624059 1,349155 0,312029 1,661185 0,561653 1,411561
904 W62808002 N06AX21 DULOXETINUM ** DULOXETINA SANDOZ 30 mg CAPS. GASTROREZ. 30mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 28 CAPS. GASTROREZ. PRF 28 0,624059 0,419869 0,312029 0,731899 0,561653 0,482275
905 W62801002 N06AX21 DULOXETINUM ** ONELAR 30 mg CAPS. GASTROREZ. 30mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 CAPS. GASTROREZ. PRF 28 0,624059 0,533083 0,312029 0,845113 0,561653 0,595489
906 W62801012 N06AX21 DULOXETINUM ** ONELAR 30 mg CAPS. GASTROREZ. 30mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PA-AL-PVC/AL X 28 CAPS. GASTROREZ. PRF 28 0,624059 0,533083 0,312029 0,845113 0,561653 0,595489
907 W63955004 N06AX21 DULOXETINUM ** DOZZEX 30 mg CAPS. GASTROREZ. 30mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. TRANSPARENTE PVC-PCTFE/AL X 28 CAPS. GASTROREZ. PRF 28 0,624059 0,628441 0,312029 0,940471 0,561653 0,690847
908 W63230001 N06AX21 DULOXETINUM ** DULOXETINA DR. REDDY'S 45 mg CAPS. GASTROREZ. 45mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PE-ACLAR/AL X 28 CAPS. GASTROREZ. PRF 28 0,936088 1,396054 0,468044 1,864098 0,842479 1,489663
909 W43298001 N06AX21 DULOXETINUM ** CYMBALTA 60mg CAPS. GASTROREZ. 60mg ELI LILLY NEDERLAND BV OLANDA CUTIE, X 28 CAPS. GASTROREZ.( BLIST. PVC/PE/PCTFE/AL) P-RF 28 1,248118 1,461882 0,624059 2,085941 1,123306 1,586694
916 W62306004 N06AX21 DULOXETINUM ** DULOXETINA AUROBINDO 60 mg CAPS. GASTROREZ. 60mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 1,248118 0,004548 0,624059 0,628607 1,123306 0,129360
918 W62803003 N06AX21 DULOXETINUM ** ONELAR 60 mg CAPS. GASTROREZ. 60mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 CAPS. GASTROREZ. PRF 30 1,248118 0,547548 0,624059 1,171607 1,123306 0,672360
919 W62803013 N06AX21 DULOXETINUM ** ONELAR 60 mg CAPS. GASTROREZ. 60mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 1,248118 0,547548 0,624059 1,171607 1,123306 0,672360
921 W63956004 N06AX21 DULOXETINUM ** DOZZEX 60 mg CAPS. GASTROREZ. 60mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. TRANSPARENTE PVC-PCTFE/AL X 28 CAPS. GASTROREZ. PRF 28 1,248118 0,051167 0,624059 0,675226 1,123306 0,175979
925 W57876003 N07CA01 BETAHISTINUM VERTIMED 16 mg COMPR. 16mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVDC-AL X 30 COMPR.P6L 30 0,305221 0,072779 0,152610 0,225390 0,274698 0,103302
926 W56369001 N07CA01 BETAHISTINUM BETAHISTINA LPH 16 mg COMPR. 16mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0,305221 0,308112 0,152610 0,460723 0,274698 0,338635
929 W57312003 N07CA01 BETAHISTINUM BETAHISTINA LPH 24 mg COMPR. 24 mg LABORMED PHARMA SA ROMANIA CUTIE CU 6 BLIST. DIN PVC-PVDC/AL X 10 COMPR. P-6L 60 0,457833 0,043667 0,228916 0,272584 0,412049 0,089451
930 W55890001 N07CA01 BETAHISTINUM BETAHISTIN MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE CU 2 BLIST. PVC-PVDC-TE TRANSPARENT/AL X 10 COMPR. P-6L 20 0,457833 0,043667 0,228916 0,272584 0,412049 0,089451
931 W55890002 N07CA01 BETAHISTINUM BETAHISTIN MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE CU 5 BLIST. PVC-PVDC-TE TRANSPARENT/AL X 10 COMPR. P-6L 50 0,457833 0,043567 0,228916 0,272484 0,412049 0,089351
932 W57877003 N07CA01 BETAHISTINUM VERTIMED 24 mg COMPR. 24mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVDC-AL X 30 COMPR.P6L 30 0,457833 0,002500 0,228916 0,231417 0,412049 0,048284
933 W57877006 N07CA01 BETAHISTINUM VERTIMED 24 mg COMPR. 24mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVDC-AL X 60 COMPR.P6L 60 0,457833 0,002833 0,228916 0,231750 0,412049 0,048617
935 W55890003 N07CA01 BETAHISTINUM BETAHISTIN MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE CU 6 BLIST. PVC-PVDC-TE TRANSPARENT/AL X 10 COMPR. P-6L 60 0,457833 0,043667 0,228916 0,272584 0,412049 0,089451
937 W61738004 N07CA01 BETAHISTINUM MARBETA 24 mg COMPR. 24mg GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU 6 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 60 0,457833 0,043667 0,228916 0,272584 0,412049 0,089451
938 W61967003 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. 24mg BGP PRODUCTS B.V.OLANDA CUTIE CU 3 BLIST. PVC-PVDC/AL X 20 COMPR. P6L 60 0,457833 0,289000 0,228916 0,517917 0,412049 0,334784
939 W61967001 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. 24mg BGP PRODUCTS B.V.OLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 20 COMPR. P6L 20 0,457833 0,314167 0,228916 0,543084 0,412049 0,359951
942 W64556001 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. 24mg MYLAN HEALTHCARE B.V. OLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 20 COMPR. P6L 20 0,457833 0,314167 0,228916 0,543084 0,412049 0,359951
943 W64556003 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. 24mg MYLAN HEALTHCARE B.V. OLANDA CUTIE CU 3 BLIST. PVC-PVDC/AL X 20 COMPR. P6L 60 0,457833 0,289000 0,228916 0,517917 0,412049 0,334784
944 W55889001 N07CA01 BETAHISTINUM BETAHISTIN MCC 8 mg COMPR. 8mg MAGISTRA C&C SRL ROMANIA CUTIE CU 3 BLIST. PVC-PVDC-TE TRANSPARENT/AL X 10 COMPR. P-6L 30 0,152610 0,047723 0,076305 0,124028 0,137349 0,062984
945 W55889002 N07CA01 BETAHISTINUM BETAHISTIN MCC 8 mg COMPR. 8mg MAGISTRA C&C SRL ROMANIA CUTIE CU 10 BLIST. PVC-PVDC-TE TRANSPARENT/AL X 10 COMPR. P-6L 100 0,152610 0,047390 0,076305 0,123695 0,137349 0,062651
946 W57875009 N07CA01 BETAHISTINUM VERTIMED 8 mg COMPR. 8mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVDC-AL X 100 COMPR. P6L 100 0,152610 0,035190 0,076305 0,111495 0,137349 0,050451
947 W56368004 N07CA01 BETAHISTINUM BETAHISTINA LPH 8 mg COMPR. 8mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 9 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 90 0,152610 0,047390 0,076305 0,123695 0,137349 0,062651
948 W61220006 N07CA01 BETAHISTINUM BETAHISTINA DICLORHIDRAT AUROBINDO 8 mg COMPR. 8mg MALTA
AUROBINDO PHARMA (MALTA) LIMITED CUTIE CU BLIST. PA-AL-PVC/AL X 100 COMPR. P6L 100 0,152610 0,035190 0,076305 0,111495 0,137349 0,050451
949 W62009002 N07CA01 BETAHISTINUM BETASERC 8 mg COMPR. 8mg BGP PRODUCTS B.V.OLANDA CUTIE CU 4 BLIST. PVC-PVDC/AL X 25 COMPR. P-6L 100 0,152610 0,136490 0,076305 0,212795 0,137349 0,151751
950 W64555002 N07CA01 BETAHISTINUM BETASERC 8 mg COMPR. 8mg MYLAN HEALTHCARE B.V. OLANDA CUTIE CU 4 BLIST. PVC-PVDC/AL X 25 COMPR. P6L 100 0,152610 0,136490 0,076305 0,212795 0,137349 0,151751
951 W62326004 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. ORODISPERSABILE 24mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 60 COMPR. ORODISPERSABILE P6L 60 0,457833 0,368000 0,228916 0,596917 0,412049 0,413784
1.355 W66245004 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. ORODISPERSABILE 24mg MYLAN IRE HEALTHCARE LIMITED IRLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 60 COMPR. ORODISPERSABILE P6L 60 0,457833 0,368000 0,228916 0,596917 0,412049 0,413784
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 65,100000 15,420000 32,550000 47,970000 58,590000 21,930000
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 1 130,200000 22,700000 65,100000 87,800000 117,180000 35,720000
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 65,100000 14,230000 32,550000 46,780000 58,590000 20,740000
1.191 W65024001 R03AK07 COMBINATII (BUDESONIDUM + FORMOTEROLUM) * AIRBUFO FORSPIRO 160 micrograme/4,5 micrograme PULB. DE INHAL. UNIDOZA 160micrograme/4,5micrograme SANDOZ S.R.L. 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 65,100000 0,000000 32,550000 32,550000 58,590000 6,510000
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 1 130,200000 15,810000 65,100000 80,910000 117,180000 28,830000
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 1 195,299999 22,930001 97,649999 120,580001 175,769999 42,460001
1.059 W58720004 R06AX27 DESLORATADINUM DESLORATADINA SANDOZ 0.5 mg/ml SOL. ORALA 0,5 mg/ml SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA CU CAPACITATEA DE 125 ML X 120 ML, SOL. ORALA + LINGURITA DOZATOARE DE 2,5 ML SI 5 ML SAU CU SERINGA DOZATOARE DE 5 ML, MARCATA LA FIECARE 0,5ML P6L 1 11,200000 0,000000 5,600000 5,600000 10,080000 1,120000
1.060 W60474006 R06AX27 DESLORATADINUM AERIUS 0,5mg/ml SOL. ORALA 0,5mg/ml MERCK SHARP&DOHME LTD. MAREA BRITANIE CUTIE X 1 FLACON X 120 ML SOL. ORALA + LIGURITA DOZATOARE DE 2,5 ML SI 5 ML P-RF 1 11,200000 1,990000 5,600000 7,590000 10,080000 3,110000
1.061 W60622002 R06AX27 DESLORATADINUM LORDESTIN 0,5 mg/ml SOL. ORALA 0,5mg/ml GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, CU O LINGURITA DOZATOARE GRADATA LA 2,5 ML SI 5 ML X 120 ML SOL. P6L 1 11,200000 0,000000 5,600000 5,600000 10,080000 1,120000
1.062 W64712005 R06AX27 DESLORATADINUM AERIUS 0,5mg/ml SOL. ORALA 0,5mg/ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 FLAC. DIN STICLA X 120 ML SOL. ORALA + LINGURITA DOZATOARE DE 2,5 ML SI 5 ML PRF 1 11,200000 1,990000 5,600000 7,590000 10,080000 3,110000

Pagina 4 din 4
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 MAI 2020

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

252 W66454003 C07AB02 METOPROLOLUM METOPROLOL TARTRAT AUROBINDO 100 mg COMPR. FILM. 100mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0,258399 0,258399 0,053267
253 W66453003 C07AB02 METOPROLOLUM METOPROLOL TARTRAT AUROBINDO 50 mg COMPR. FILM. 50mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0,191000 0,191000 0,000000
254 W66434003 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN AUROBINDO 16 mg COMPR. 16mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0,638570 0,638570 0,068096
255 W66433003 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN AUROBINDO 8 mg COMPR. 8mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0,457713 0,457713 0,058620

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

SE ADAUGA

92 W63755007 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 0,5 mg COMPR. FILM. 0,5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PR 30 8,252400 8,252400 2,327600
93 W63755010 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 0,5 mg COMPR. FILM. 0,5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. UNIDOZA OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 8,252400 8,252400 2,327600
94 W63756010 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. UNIDOZA OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 28,064666 28,064666 0,000000
95 W63756007 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PR 30 28,064666 28,064666 0,000000

7. CIROZA HEPATICA - G7

SE ADAUGA

110 W63755007 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 0,5 mg COMPR. FILM. 0,5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PR 30 8,252400 8,252400 2,327600
111 W63755010 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 0,5 mg COMPR. FILM. 0,5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. UNIDOZA OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 8,252400 8,252400 2,327600
112 W63756010 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. UNIDOZA OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 28,064666 28,064666 0,000000
113 W63756007 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PR 30 28,064666 28,064666 0,000000

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

SE ADAUGA

250 W66225001 J02AC04 POSACONAZOLUM ** POSACONAZOLE ACCORD 100 mg COMPR. GASTROREZ. 100mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU BLIST. PVC/PE/PVDC/AL X 24 COMPR. GASTROREZ PR 24 95,108750 95,108750 0,000000

SE MODIFICA

97 W60913001 J02AC04 POSACONAZOLUM ** NOXAFIL 100mg COMPR. GASTROREZ. 100mg MERCK SHARP & DOHME LTD. MAREA BRITANIE CUTIE CU BLIST. PVC/PCTF/AL X 24 COMPRIMATE GASTROREZISTENTE PR 24 114,130500 114,130500 30,601166
230 W64693001 J02AC04 POSACONAZOLUM ** NOXAFIL 100mg COMPR. GASTROREZ. 100mg MERCK SHARP & DOHME OLANDA CUTIE CU BLIST. PVC/PCTFE/AL X 24 COMPR. GASTROREZ. PR 24 114,130500 114,130500 30,601166

9. EPILEPSIE - G11

Pagina 1 din 3
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)
SE ADAUGA

210 W66571001 N03AX14 LEVETIRACETAMUM ** NETROLEX 100 mg/ml SOL. ORALA 100mg/ml CN UNIFARM S.A. ROMANIA CUTIE CU 1 FLAC. X 150 ML SOL. ORALA PR 1 98,750000 98,750000 0,000000

10. BOALA PARKINSON - G12

SE ADAUGA

104 W66562012 N04BD02 RASAGILINUM ** RASAGILINA AUROBINDO 1 mg COMPR. 1mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. PRF 30 1,851333 1,851333 0,000000

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

SE ADAUGA

367 W66466004 N06AX21 DULOXETINUM ** DULOXETINA AUROBINDO 30 mgCAPS. GASTROREZ. 30mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 1,200000 1,200000 0,000000
368 W66467004 N06AX21 DULOXETINUM ** DULOXETINA AUROBINDO 60 mgCAPS. GASTROREZ. 60mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 1,252666 1,252666 0,000000

SE MODIFICA

329 W61181001 N06BA09 ATOMOXETINUM ** ATOMOXETINA ZENTIVA 10 mg CAPS. 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 7 CAPS. PRF 7 4,931428 4,931428 0,000000
330 W61182001 N06BA09 ATOMOXETINUM ** ATOMOXETINA ZENTIVA 18 mg CAPS. 18mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 7 CAPS. PRF 7 5,020800 5,020800 0,000628
333 W61183003 N06BA09 ATOMOXETINUM ** ATOMOXETINA ZENTIVA 25 mg CAPS. 25mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 28 CAPS. PRF 28 5,086785 5,086785 0,000000
337 W61184003 N06BA09 ATOMOXETINUM ** ATOMOXETINA ZENTIVA 40 mg CAPS. 40mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 28 CAPS. PRF 28 5,334000 5,334000 0,000285

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

SE ADAUGA

89 W64475008 N06DA03 RIVASTIGMINUM ** EXELON 13,3 mg/24h PLASTURE TRANSDERMIC 13,3mg/24h NOVARTIS EUROPHARM LTD. IRLANDA CUTIE X 30 PLICURI DIN HÂRTIE/PET/PE/AL/PA X 1 PLASTURE TRANSDERMIC PR 30 10,123000 10,123000 0,000000
90 W64473005 N06DA03 RIVASTIGMINUM ** EXELON 4,6 mg/24h PLASTURE TRANSDERMIC 4,6mg/24h NOVARTIS EUROPHARM LTD. IRLANDA CUTIE X 30 PLICURI DIN HÂRTIE/PET/PE/AL/PA X 1 PLASTURE TRANSDERMIC PR 30 3,668400 3,668400 0,842266
91 W64474005 N06DA03 RIVASTIGMINUM ** EXELON 9,5 mg/24h PLASTURE TRANSDERMIC 9,5mg/24h NOVARTIS EUROPHARM LTD. IRLANDA CUTIE X 30 PLICURI DIN HÂRTIE/PET/PE/AL/PA X 1 PLASTURE TRANSDERMIC PR 30 5,066799 5,066799 0,913867

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

SE ADAUGA

87 W66451005 C09CA04 IRBESARTANUM ** IRBESARTAN AUROBINDO 150 mg COMPR. 150mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. P6L 28 0,388571 0,388571 0,000000
88 W66452005 C09CA04 IRBESARTANUM ** IRBESARTAN AUROBINDO 300 mg COMPR. 300mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. P6L 28 0,543571 0,543571 0,000000

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

SE ADAUGA

89 W66438003 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA AUROBINDO 250 mg COMPR. FILM. 250mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 10 0,518000 0,518000 0,000000
90 W66439003 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA AUROBINDO 500 mg COMPR. FILM. 500mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 10 0,758000 0,758000 0,000000

SE ELIMINA

Pagina 2 din 3
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)

71 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 0,909600 0,909600 9,050400
72 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 0,909600 0,909600 9,050400

Pagina 3 din 3
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 MAI 2020

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

270 W66551001 N02AA59 COMBINATII (IBUPROFENUM+CODEINUM)BRUFEN


PLUS 400 mg/30 mg COMPR. FILM. 400mg/30mg MYLAN IRE HEALTHCARE LIMITED IRLANDA CUTIE CU BLIST. AL/PVDC-PVC/PVDC X 30 COMPR. FILM. PRF 30 1,075000 1,075000 0,000000
271 W66102001 N05CD08 MIDAZOLAMUM MIDAZOLAM SUN 1 mg/ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 1mg/ml SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA CUTIE CU 1 SERINGA PREUMPLUTA PREVAZUTA CU CAPAC CU FILET SI DOP DIN CAUCIUC X 50 ML SOL. INJ./PERF. + 1 SACULET ABSORBANT DE OXIGEN PRF 1 31,507200 31,507200 56,292800
272 W66103001 N05CD08 MIDAZOLAMUM MIDAZOLAM SUN 2 mg/ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 2mg/ml SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA CUTIE CU 1 SERINGA PREUMPLUTA PREVAZUTA CU CAPAC CU FILET SI DOP DIN CAUCIUC X 50 ML SOL. INJ./PERF. + 1 SACULET ABSORBANT DE OXIGEN PRF 1 118,950000 118,950000 0,000000
273 W62182004 R06AX13 LORATADINUM CLARITINE 1 mg/ml SIROP 1mg/ml BAYER S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN PET X 120 ML SIROP + 1 MASURA DOZATOARE DIN PP P6L 1 13,440000 13,440000 3,770000

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 MAI 2020

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 MODIFICA

78 W55441001 M05BA06 ACIDUM IBANDRONICUM * OSSICA 150 mg COMPR. FILM. 150mg GEDEON RICHTER PLC.UNGARIA CUTIE CU 1 BLIST. PVC-PE-PVDC/AL X 1 COMPR. FILM. P-6L 1 25,484625 7,695375 5,096925 28,083075
81 W58574001 M05BA06 ACIDUM IBANDRONICUM * ACID IBANDRONIC SANDOZ 150 mg COMPR. FILM. 150mg SANDOZ S.R.L. ROMANIA CUTIE CU 1 BLIST. PA-AL-PVC/AL X 1 COMPR. FILM. P6L 1 25,484625 3,345375 5,096925 23,733075
82 W60664001 M05BA06 ACIDUM IBANDRONICUM * ACID IBANDRONIC AUROBINDO 150 mg COMPR. FILM. 150mg AUROBINDO PHARMA (MALTA) LIMITED MALTA CUTIE CU BLIST. PVC-PE-PVDC/AL X 1 COMPR. FILM. P6L 1 25,484625 4,235375 5,096925 24,623075
116 W66455001 M05BA06 ACIDUM IBANDRONICUM * ACID IBANDRONIC AUROBINDO 150 mg COMPR. FILM. 150mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 1 COMPR. FILM. P6L 1 25,484625 4,235375 5,096925 24,623075

Pagina 1 din 1

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