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ANEXA 2a

SUBLISTA A - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 90% DIN PRETUL DE REFERINTA CONFORM
DENUMIRILOR COMUNE INTERNATIONALE (DCI) CORESPUNZATOARE MEDICAMENTELOR DE CARE BENEFICIAZA ASIGURATII IN TRATAMENTUL AMBULATORIU CU SI FARA CONTRIBUTIE
PERSONALA DIN HG NR. 720/2008, REPUBLICATA, CU MODIFICARILE SI COMPLETARILE ULTERIOARE,
VALABILA INCEPAND CU 01 AUGUST 2023

Contributie maxima Val. maxima suportata de Contributie maxima


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

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

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


Nr crt.

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

1 W64020007 A02BC01 OMEPRAZOLUM OMEZ 10 mg CAPS. GASTROREZ. 10mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. P6L 30 0.252401 0.535599 0.227160 0.560840
2 W42129001 A02BC01 OMEPRAZOLUM OMEPRAZOL-RICHTER 20 mg CAPS. GASTROREZ. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. PVC-AL-PA/AL X 7 CAPS. GASTROREZ. P-6L 14 0.504803 0.577339 0.454322 0.627820
3 W51990001 A02BC01 OMEPRAZOLUM OMEPRAZOL SLAVIA 20 mg CAPS. GASTROREZ. 20mg SLAVIA PHARM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. GASTROREZ. P-6L 30 0.504803 0.576863 0.454322 0.627344
4 W52044001 A02BC01 OMEPRAZOLUM OMEPRAZOL TERAPIA 20 mg CAPS. GASTROREZ. 20mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. GASTROREZ. P-6L 30 0.504803 0.576863 0.454322 0.627344
5 W52887001 A02BC01 OMEPRAZOLUM OMEPRAZOL ARENA 20 mg CAPS. GASTROREZ. 20mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. GASTROREZ. P-6L 30 0.504803 0.576863 0.454322 0.627344
6 W53138001 A02BC01 OMEPRAZOLUM OMEPRAZOL FARMEX 20 mg CAPS. GASTROREZ. 20mg FARMEX COMPANY SRL ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAPS. GASTROREZ. P-6L 30 0.504803 0.575863 0.454322 0.626344
7 W55651001 A02BC01 OMEPRAZOLUM OMEPRAZOL ROMPHARM 20 mg CAPS. GASTROREZ. 20mg ROMPHARM COMPANY SRL ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAPS. GASTROREZ. P-6L 30 0.504803 0.437530 0.454322 0.488011
8 W60470001 A02BC01 OMEPRAZOLUM OMEPRAZOL ATB 20 mg CAPS. GASTROREZ. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 FOLII AL/PE X 10 CAPS. GASTR. P-6L 20 0.504803 0.576197 0.454322 0.626678
9 W60303002 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 20 mg CAPS. GASTROREZ. 20mg ZENTIVA K.S. CEHIA CUTIE X 1 FLAC. DIN STICLA X 28 CAPS. GASTROREZ. P-6L 28 0.481071 0.000000 0.432963 0.048108
10 W59906022 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 20 mg CAPS. GASTROREZ. 20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 2 BLISTERE DIN OPA-AL-PEÎD-PE-DESICANT-PEÎD/AL A CATE 14 CAPSULE GASTROREZISTENTE P6L 28 0.481071 0.000000 0.432963 0.048108
11 W59906021 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 20 mg CAPS. GASTROREZ. 20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 4 BLISTERE DIN OPA-AL-PEÎD-PE-DESICANT-PEÎD/AL A CATE 7 CAPSULE GASTROREZISTENTE P6L 28 0.481071 0.000000 0.432963 0.048108
12 W42284004 A02BC01 OMEPRAZOLUM OMEPRAZOL LPH 20 mg CAPS. GASTROREZ. 20mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. PVC-AL-OPA/AL X 10 CAPS. GASTROREZ P-6L 30 0.504803 0.576863 0.454322 0.627344
13 W64021007 A02BC01 OMEPRAZOLUM OMEZ 20 mg CAPS. GASTROREZ. 20mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. P6L 30 0.504803 0.439197 0.454322 0.489678
14 W64023001 A02BC01 OMEPRAZOLUM OMEPRAZOL DR. REDDY'S 20 mg CAPS. GASTROREZ. 20mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 3 FOLII AL/PE-PE/AL X 10 CAPS. GASTROREZ. P6L 30 0.504803 0.439197 0.454322 0.489678
15 W59906030 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 20 mg CAPS. GASTROREZ. 20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 4 BLIST. OPA-AL-PVC/AL X 7 CAPS. GASTROREZ. P6L 28 0.481071 0.000000 0.432963 0.048108
16 W59906031 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 20 mg CAPS. GASTROREZ. 20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 2 BLIST. OPA-AL-PVC/AL X 14 CAPS. GASTROREZ. P6L 28 0.481071 0.000000 0.432963 0.048108
17 W61506003 A02BC01 OMEPRAZOLUM OMERAN 20 mg CAPS. GASTROREZ. 20mg GLAXOSMITHKLINE (GSK) SRL ROMANIA CUTIE CU 5 BLIST. AL/AL X 6 CAPS. GASTROREZ. P6L 30 0.504803 0.502863 0.454322 0.553344
18 W67667003 A02BC01 OMEPRAZOLUM OMERAN 20 mg CAPS. GASTROREZ. 20mg GLAXOSMITHKLINE TRADING SERVICES LIMITED IRLANDA CUTIE CU 5 BLIST. AL/AL X 6 CAPS. GASTROREZ. P6L 30 0.504803 0.502863 0.454322 0.553344
19 W68415015 A02BC01 OMEPRAZOLUM OMECOD 20 mg CAPS. GASTROREZ. 20mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. P6L 30 0.504803 0.576863 0.454322 0.627344
20 W68838005 A02BC01 OMEPRAZOLUM OMEPRAZOL MEDREG 20 mg CAPS. GASTROREZ. 20mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. TERMOFORMATE PVC-PE-PVDC/AL X 30 CAPS. GASTROREZ. P6L 30 0.504803 0.576863 0.454322 0.627344
21 W67841001 A02BC01 OMEPRAZOLUM OMEPRAZOL ANTIBIOTICE 20 mg CAPS. GASTROREZ. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. OPA-AL-PVC/AL X 10 CAPS. GASTROREZ. P6L 20 0.504803 0.443197 0.454322 0.493678
22 W14125001 A02BC01 OMEPRAZOLUM ORTANOL 40 mg CAPS. GASTROREZ. 40mg LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 1 BLIST. AL/AL X 7 CAPS. GASTROREZ. P-6L 7 0.831428 0.000000 0.748285 0.083143
23 W64022007 A02BC01 OMEPRAZOLUM OMEZ 40 mg CAPS. GASTROREZ. 40mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. P6L 30 1.009607 0.367059 0.908646 0.468020
24 W68414013 A02BC01 OMEPRAZOLUM OMECOD 40 mg CAPS. GASTROREZ. 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 7 CAPS. GASTROREZ. P6L 7 1.009607 0.507535 0.908646 0.608496
25 W56141001 A02BC01 OMEPRAZOLUM OMEZ 40 mg PULB. PT. SOL. PERF. 40mg DR. REDDY'S LABORATORIES ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU CAPACITATE DE 15 ML CU PULB.PT. SOL. PERF. S/P-RF 1 17.796600 3.663400 16.016940 5.443060
26 W60679001 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 40 mg PULB. PT. SOL. PERF. 40mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 10 ML CU PULB. PT. SOL. PERF. PR/PRF 1 17.796600 3.653400 16.016940 5.433060
27 W60679002 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 40 mg PULB. PT. SOL. PERF. 40mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 6 ML CU PULB. PT. SOL. PERF. PR/PRF 1 17.796600 3.653400 16.016940 5.433060
28 W69103001 A02BC01 OMEPRAZOLUM OMEPRAZOL ROMPHARM 40 mg PULB. PT. SOL. PERF. 40mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CARE CONTINE PULB. PT. SOL. PERF. PR/PRF 1 17.796600 3.663400 16.016940 5.443060
29 W69372001 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 40 mg PULB. PT. SOL. PERF. 40mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU UN FLAC. DIN STICLA TRANSPARENTA BOROSILICATA CU PULB. PT. SOL. PERF. PR/PRF 1 17.796600 3.653400 16.016940 5.433060
30 W69372002 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 40 mg PULB. PT. SOL. PERF. 40mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 5 FLAC. DIN STICLA TRANSPARENTA BOROSILICATA CU PULB. PT. SOL. PERF. PR/PRF 5 17.290000 0.000000 15.561000 1.729000
31 W69372003 A02BC01 OMEPRAZOLUM OMEPRAZOL ZENTIVA 40 mg PULB. PT. SOL. PERF. 40mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 10 FLAC. DIN STICLA TRANSPARENTA BOROSILICATA CU PULB. PT. SOL. PERF. PR/PRF 10 16.399000 0.000000 14.759100 1.639900
32 W65062001 A02BC03 LANSOPRAZOLUM LEVANT 15 mg CAPS. GASTROREZ. 15mg TERAPIA S.A. ROMANIA CUTIE CU 2 BLIST. AL-PVC-PA/AL X 7 CAPS. GASTROREZ. P6L 14 0.252401 0.561884 0.227160 0.587125
33 W03936001 A02BC03 LANSOPRAZOLUM LANZUL CAPS. GASTROREZ. 30mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 7 CAPS. GASTROREZ. P-6L 14 0.504803 0.735911 0.454322 0.786392
34 W65063001 A02BC03 LANSOPRAZOLUM LEVANT 30 mg CAPS. GASTROREZ. 30mg TERAPIA S.A. ROMANIA CUTIE CU 2 BLIST. AL-PVC-PA/AL X 7 CAPS. GASTROREZ. P6L 14 0.504803 0.735911 0.454322 0.786392
35 W08691002 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID SLAVIA 10 mg COMPR. 10mg SLAVIA PHARM SRL ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 COMPR. P-6L 40 0.187250 0.000000 0.168525 0.018725
36 W04254002 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID TERAPIA 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 COMPR. P-6L 40 0.187250 0.000000 0.168525 0.018725
37 W52253001 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID LAROPHARM 10 mg COMPR. 10mg LAROPHARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 20 COMPR. P-6L 40 0.187250 0.000000 0.168525 0.018725
38 W54362003 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID ARENA 10 mg COMPR. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 4 BLIST. PVC/AL A CATE 10 COMPR. P6L 40 0.187250 0.000000 0.168525 0.018725
39 W52254001 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID BIOFARM 1mg/5ml SIROP 1mg/5ml BIOFARM S.A. ROMANIA CUTIE X 1 FLAC. DIN STICLA X 100 ML SIROP + MASURA DOZATOARE P-RF 1 15.190000 0.000000 13.671000 1.519000
40 W68548001 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID HAMELN 5 mg/ml SOL INJ. 5 mg/ml HAMELN PHARMA GMBH GERMANIA CUTIE CU 10 FIOLE DIN STICLA INCOLORA CARE CONTIN 2 ML SOL. INJ PRF 10 3.068000 0.000000 2.761200 0.306800
41 W57360001 A03FA01 METOCLOPRAMIDUM METOCLOPRAMID TERAPIA 5mg/ml SOL. INJ. 5mg/ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 2 ML P-RF 5 3.895200 4.212800 3.505680 4.602320
42 W00187002 A05AA02 ACIDUM URSODEOXYCHOLICUM * URSOFALK 250 mg CAPS. 250mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 4 BLIST. AL/PVC X 25 CAPS. P6L 100 0.891149 0.261451 0.802034 0.350566
43 W00187001 A05AA02 ACIDUM URSODEOXYCHOLICUM * URSOFALK 250 mg CAPS. 250mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 2 BLIST. AL/PVC X 25 CAPS. P-6L 50 0.891149 0.400851 0.802034 0.489966
44 W66895001 A05AA02 ACIDUM URSODEOXYCHOLICUM * ACID URSODEOXICOLIC POLISANO 250 mg CAPS. 250mg POLISANO PHARMACEUTICALS S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVC/AL X 10 CAPS. P6L 50 0.891149 0.053251 0.802034 0.142366
45 W66895002 A05AA02 ACIDUM URSODEOXYCHOLICUM * ACID URSODEOXICOLIC POLISANO 250 mg CAPS. 250mg POLISANO PHARMACEUTICALS S.A. ROMANIA CUTIE CU 10 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 100 0.837900 0.000000 0.754110 0.083790
46 W66895003 A05AA02 ACIDUM URSODEOXYCHOLICUM * ACID URSODEOXICOLIC POLISANO 250 mg CAPS. 250mg POLISANO PHARMACEUTICALS S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 20 CAPS. P6L 100 0.837900 0.000000 0.754110 0.083790
47 W58710002 A05AA02 ACIDUM URSODEOXYCHOLICUM * URSOFALK 500 mg COMPR. FILM. 500mg DR. FALK PHARMA GMBH GERMANIA CUTIE CU 4 BLIST. PVC-PVDC/AL X 25 COMPR.FILM. P6L 100 1.782299 0.808101 1.604069 0.986331
48 W58363001 A05AA02 ACIDUM URSODEOXYCHOLICUM * URSOFALK 250 mg/5 ml SUSP. ORALA 250mg/5ml DR. FALK PHARMA GMBH GERMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 250 ML SUSP. ORALA+1LINGURITA DOZATOARE DIN PP P6L 1 44.557542 67.132458 40.101787 71.588213
49 W64011001 A06AD11 LACTULOSUM LACTECON 667 g/l LICHID ORAL 66,7% BGP PRODUCTS B.V. OLANDA FLACON DIN PEID PREVAZUT CU MASURA DOZATOARE X 200 ML P6L 1 9.433774 8.996226 8.490396 9.939604
50 W64559001 A06AD11 LACTULOSUM LACTECON 667 g/l LICHID ORAL 66,7% MYLAN HEALTHCARE B.V. OLANDA FLACON DIN PEID PREVAZUT CU MASURA DOZATOARE X 200 ML P6L 1 9.433774 8.996226 8.490396 9.939604
51 W44054002 A06AD11 LACTULOSUM LACTULOSE EIPICO 650 mg/ml SIROP 650mg/ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLACON X 300 ML P-6L 1 13.790000 0.000000 12.411000 1.379000

Pagina 1 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
52 W44054001 A06AD11 LACTULOSUM LACTULOSE EIPICO 650 mg/ml SIROP 650mg/ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLACON X 100 ML P-6L 1 4.590000 0.000000 4.131000 0.459000
53 W68854001 A06AD11 LACTULOSUM LACTECON 667 g/l SOL. ORALA 66,7% VIATRIS HEALTHCARE LIMITED IRLANDA FLACON DIN PEID PREVAZUT CU MASURA DOZATOARE DIN PP CU GRADATII X 200 ML SOL. ORALA P6L 1 9.433774 8.996226 8.490396 9.939604
54 W05695001 A07AA02 NYSTATINUM NISTATINA ATB 500000 UI COMPR. FILM. 500.000ui ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 20 1.370000 0.000000 1.233000 0.137000
55 W07440001 A07EC01 SULFASALAZINUM SULFASALAZINA EN 500 mg COMPR. GASTROREZ. 500mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P-6L 50 0.722000 0.000000 0.649800 0.072200
56 W59162002 A07EC01 SULFASALAZINUM SALAZIDIN GR 500 mg COMPR. GASTROREZ. 500mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P6L 50 0.722000 0.000000 0.649800 0.072200
57 W58461001 A07EC02 MESALAZINUM ** PENTASA 1 g COMPR. CU ELIB. PREL. 1g FERRING GMBH GERMANIA CUTIE CU 6 BLIST. OPA-AL-PVC/AL X 10 COMPR. CU ELIB. PREL. P6L 60 2.067561 1.066772 1.860804 1.273529
58 W58055001 A07EC02 MESALAZINUM ** PENTASA 500mg COMPR. ELIB. PREL. 500mg FERRING GMBH GERMANIA CUTIE X 10 BLIST. AL/PVC X 10 COMPR. ELIB. PREL. P-6L 100 1.033780 0.589120 0.930402 0.692498
59 W04124001 A07EC02 MESALAZINUM ** SALOFALK 250 mg COMPRIMATE GASTROREZISTENTE COMPR. GASTROREZ. 250mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 10 BLIST. PVC-PE-PVDC/AL X 10 COMPR. GASTROREZ. P-6L 100 0.516888 0.240012 0.465199 0.291701
60 W04126001 A07EC02 MESALAZINUM ** SALOFALK 500 mg COMPRIMATE GASTROREZISTENTE COMPR. GASTROREZ. 500mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 10 BLIST. PVC-PVDC/AL X 10 COMPR. GASTROREZ. P-6L 100 1.033780 0.062120 0.930402 0.165498
61 W04126002 A07EC02 MESALAZINUM ** SALOFALK 500 mg COMPRIMATE GASTROREZISTENTE COMPR. GASTROREZ. 500mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 COMPR. GASTROREZ. P-6L 50 1.033780 0.120420 0.930402 0.223798
62 W68601001 A07EC02 MESALAZINUM ** MESALAZINA SOFAR 400 mg 400mg
COMPR. GASTROREZISTENTE SOFAR S.P.A. ITALIA CUTIE CU 4 BLIST. PVC/AL X 15 COMPR. GASTROREZ. P6L 60 0.827023 0.251643 0.744320 0.334346
63 W68601002 A07EC02 MESALAZINUM ** MESALAZINA SOFAR 400 mg 400mg
COMPR. GASTROREZISTENTE SOFAR S.P.A. ITALIA CUTIE CU 8 BLIST. PVC/AL X 15 COMPR. GASTROREZ. P6L 120 0.827023 0.163310 0.744320 0.246013
64 W60409003 A07EC02 MESALAZINUM ** MESALAZINA SOFARFARM 800 mg 800mg
COMPR. GASTROREZISTENTE SOFARFARM S.R.L. ROMANIA CUTIE CU 8 BLIST. PVC/AL X 15 COMPR. GASTROREZISTENTE P6L 120 1.654049 0.183784 1.488644 0.349189
65 W68603001 A07EC02 MESALAZINUM ** MESALAZINA SOFAR 800 mg 800mg
COMPR. GASTROREZISTENTE SOFAR S.P.A. ITALIA CUTIE CU 4 BLIST. PVC/AL X 15 COMPR. GASTROREZISTENTE P6L 60 1.654049 0.283951 1.488644 0.449356
66 W68603002 A07EC02 MESALAZINUM ** MESALAZINA SOFAR 800 mg 800mg
COMPR. GASTROREZISTENTE SOFAR S.P.A. ITALIA CUTIE CU 6 BLIST. PVC/AL X 15 COMPR. GASTROREZISTENTE P6L 90 1.654049 0.183951 1.488644 0.349356
67 W68603003 A07EC02 MESALAZINUM ** MESALAZINA SOFAR 800 mg 800mg
COMPR. GASTROREZISTENTE SOFAR S.P.A. ITALIA CUTIE CU 8 BLIST. PVC/AL X 15 COMPR. GASTROREZISTENTE P6L 120 1.654049 0.183784 1.488644 0.349189
68 W61355001 A07EC02 MESALAZINUM ** PENTASA 2 g GRAN. ELIB. PREL. 2g FERRING GMBH GERMANIA CUTIE CU 60 PLICURI PET/AL/PEJD X 2 G GRANULE CU ELIB. PREL. P6L 60 4.135125 2.226208 3.721612 2.639721
69 W58054001 A07EC02 MESALAZINUM ** PENTASA 1000mg SUPOZ. 1000mg FERRING GMBH GERMANIA CUTIE CU 4 BLIST. AL/AL X 7 SUPOZ. + CUTIE PLASTIC CU 28 DISPOZITIVE DE PROTECTIE A DEGETULUI P-6L 28 5.904333 0.496381 5.313899 1.086815
70 W56484005 A07EC02 MESALAZINUM ** SALOFALK 1 g SUPOZ. 1g DR. FALK PHARMA GMBH GERMANIA CUTIE CU FOLII TERMOSUDATE PVC/PE X 30 SUPOZ. P6L 30 5.904333 0.000000 5.313899 0.590434
71 W04125003 A07EC02 MESALAZINUM ** SALOFALK 250 mg SUPOZ. 250mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6L 10 1.476078 2.409922 1.328470 2.557530
72 W04127003 A07EC02 MESALAZINUM ** SALOFALK 500 mg SUPOZ. 500mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6L 10 2.952166 0.845834 2.656949 1.141051
73 W04128001 A07EC02 MESALAZINUM ** SALOFALK 4 g/ 60 ml SUSP. RECTALA 4g/60ml DR. FALK PHARMA GMBH GERMANIA CUTIE X 7 BLIST. AL/PE CONTINAND FIECARE CATE 1 FLACON UNIDOZA X 60 ML SUSPENSIE RECTALA + APLICA P-6L 7 22.227142 0.000000 20.004427 2.222715
74 W66550001 A09AA02 PANCREATINUM ** PANKREAL 35000 CAPS. GASTROREZ. 420mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 1 FLAC. DIN PEID INCHIS CU CAPAC DIN PP X 50 CAPS. GASTROREZ. P6L 50 2.426400 0.000000 2.183760 0.242640
75 W68661001 A09AA02 PANCREATINUM ** PANKREAL 35000 CAPS. GASTROREZ. 420mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 FLAC. DIN PEID INCHIS CU CAPAC DIN PP X 50 CAPS. GASTROREZ. P6L 50 2.426400 0.000000 2.183760 0.242640
76 W00009002 B01AA07 ACENOCUMAROLUM TROMBOSTOP 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.334020 0.356313 0.300618 0.389715
77 W62461001 B01AA07 ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg MERUS LABS LUXCO II S.A.R.L. LUXEMBURG CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.430500 0.000000 0.387450 0.043050
78 W07616001 B01AC05 TICLOPIDINUM (1) TICLODIN 250 mg COMPR. FILM. 250mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. FILM. P6L 20 0.419027 1.707473 0.377124 1.749376
79 W07968001 B01AC05 TICLOPIDINUM (1) IPATON 250 mg COMPR. FILM. 250mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. AL/ PVC X 10 COMPR.FILM. P6L 20 0.419027 1.707473 0.377124 1.749376
80 W05001002 B02BA01 PHYTOMENADIONUM FITOMENADION TERAPIA 10 mg/ml SOL. INJ. 10mg/ml TERAPIA SA ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 1 ML SOL. INJ. PRF 5 9.880000 0.000000 8.892000 0.988000
81 W10038010 B03AA07 COMBINATII (FERROSI SULFAS+ACIDUM ASCORBICUM) SORBIFER DURULES 100 mg+60 mg COMPR. FILM. 100mg+60mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, AVAND CAPAC DIN PE CU COMPENSATOR X 120 COMPR. FILM. P6L 120 0.457666 0.000000 0.411899 0.045767
82 W43097001 B03AA07 FERROSI SULFAS FERROGRADUMET 105 mg COMPR. ELIB. PREL. 105mg TEOFARMA SRL ITALIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-6L 30 0.359666 0.000000 0.323699 0.035967
83 W08016001 B03AA07 FERROSI SULFAS TARDYFERON 80 mg COMPR. ELIB. PREL. 80mg PIERRE FABRE MEDICAMENT FRANTA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P-6L 30 0.300110 0.163223 0.270099 0.193234
84 W44026001 B03AB05 COMPLEX DE HIDROXID DE FER (III) POLIMALTOZAT MALTOFER 100 mg COMPR. MAST. 100mg VIFOR FRANCE S.A. FRANTA CUTIE X 3 BLIST. AL/PA-AL-PVC X 10 COMPR. MASTIC. P-6L 30 0.833638 0.257695 0.750274 0.341059
85 W54079001 B03AB05 COMPLEX DE HIDROXID DE FER (III) POLIMALTOZAT FERGLUROM 50 mg/ml PICATURI ORALE, SOL. 50mg/ml BIOFARM S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, DE CLASA HIDROLITICA III, PREVAZUT CU PICURATOR DIN PE X 30 ML PICATURI ORALE, SOL. P-6L 1 14.670000 0.000000 13.203000 1.467000
86 W51228001 B03AB05 COMPLEX DE HIDROXID DE FER (III) POLIMALTOZAT FERRUM HAUSMANN 50 mg/ml PICATURI ORALE-SOL. 50mg/ml VIFOR FRANCE S.A. FRANTA CUTIE CU 1 FLAC. DE STICLA BRUNA, CU DOP PICURATOR DIN PEJD X 30 ML PIC. ORALE, SOL. P-6L 1 18.967500 1.432500 17.070750 3.329250
87 W51231001 B03AB05 COMPLEX DE HIDROXID DE FER (III) POLIMALTOZAT FERRUM HAUSMANN 10 mg/ml SIROP 10mg/ml VIFOR FRANCE S.A. FRANTA CUTIE CU 1 FLAC. DIN STICLA BRUNA, CU DOP PICURATOR DIN PE + O MASURA DOZATOARE X 150 ML SIROP P-6L 1 18.967500 10.292500 17.070750 12.189250
88 W52797001 B03AB05 COMPLEX DE HIDROXID DE FER (III) POLIMALTOZAT FERGLUROM 50mg/5ml SIROP 50mg/5ml BIOFARM S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, DE CLASA HIDROLITICA III, CU CAPACITATEA DE 100 ML + MASURA DOZATOARE GRADATA DE LA 2,5 - 20 ML X 100 ML SIROP P-6L 1 12.645000 2.025000 11.380500 3.289500
89 W42875001 B03BB01 ACIDUM FOLICUM ACIFOL 5 mg COMPR. FILM. 5mg ZENTIVA S.A. ROMANIA CUTIE X 1 FLAC. DIN PEID X 30 COMPR. FILM. P-6L 30 2.254333 0.000000 2.028899 0.225434
90 W58535002 C01AA05 DIGOXINUM DIGOXINA ZENTIVA 0,25 mg COMPR. 0,25mg ZENTIVA S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-RF 25 0.512350 0.676050 0.461115 0.727285
91 W66390001 C01AA05 DIGOXINUM DIGOXIN LECIVA 0,25 mg COMPR. 0,25mg S.C. ZENTIVA S.A. ROMANIA CUTIE CU 1 BLISTER X 30 COMPR. PRF 30 0.287000 0.000000 0.258300 0.028700
92 W60427001 C01AA05 DIGOXINUM DIGOXIN ZENTIVA 0,5 mg/2ml SOL. INJ. 0,5mg/2ml ZENTIVA S.A. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA, CU INEL DE RUPERE X 2 ML SOL. INJ. P-RF 5 10.990000 0.000000 9.891000 1.099000
93 W59968002 C01BA01 CHINIDINI SULFAS CHINIDINA ARENA 200 mg COMPR. 200mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.759550 0.018450 0.683595 0.094405
94 W59968003 C01BA01 CHINIDINI SULFAS CHINIDINA ARENA 200 mg COMPR. 200mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. PRF 50 0.753400 0.000000 0.678060 0.075340
95 W56891002 C01BC03 PROPAFENONUM PROPAFENONA ARENA 150 mg COMPR. 150mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.423300 0.010200 0.380970 0.052530
96 W56891003 C01BC03 PROPAFENONUM PROPAFENONA ARENA 150 mg COMPR. 150mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-RF 50 0.423300 0.010500 0.380970 0.052830
97 W56891004 C01BC03 PROPAFENONUM PROPAFENONA ARENA 150 mg COMPR. 150mg ARENA GROUP SA ROMANIA CUTIE X 10 BLIST. AL/PVC X 10 COMPR. P-RF 100 0.419900 0.000000 0.377910 0.041990
98 W12499003 C01BC03 PROPAFENONUM PROPAFENONA AL 150 mg COMPR. FILM. 150mg ALIUD PHARMA GMBH & CO. KG GERMANIA CUTIE X 4 BLIST. X 25 COMPR. FILM. P-RF 100 0.419900 0.000000 0.377910 0.041990
99 W62345001 C01BC03 PROPAFENONUM RYTMONORM 150 mg COMPR. FILM. 150mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. FILM. PRF 50 0.423300 0.243900 0.380970 0.286230
100 W68791001 C01BC03 PROPAFENONUM RYTMONORM 150 mg COMPR. FILM. 150mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. FILM. PRF 50 0.423300 0.243900 0.380970 0.286230
101 W06951001 C01BD01 AMIODARONUM CORDARONE 200 mg COMPR. 200mg SANOFI-AVENTIS FRANCE FRANTA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. DIVIZ. P-RF 30 0.388333 0.199667 0.349499 0.238501
102 W00311002 C01BD01 AMIODARONUM AMIODARONA LPH 200 mg COMPR. 200mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.388333 0.000000 0.349499 0.038834
103 W53954002 C01BD01 AMIODARONUM AMIODARONA ARENA 200 MG COMPR. 200mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.388333 0.000000 0.349499 0.038834
104 W64483001 C01BD01 AMIODARONUM CORDARONE 200 mg COMPR. 200mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.388333 0.199667 0.349499 0.238501
105 W64483002 C01BD01 AMIODARONUM CORDARONE 200 mg COMPR. 200mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 15 COMPR. PRF 30 0.388333 0.199667 0.349499 0.238501
106 W04591002 C01DA02 NITROGLYCERINUM NITROMINT 2,6 mg COMPR. ELIB. PREL. 2,6mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 60 COMPR. ELIB. PREL. P-6L 60 0.249101 0.000065 0.224190 0.024976
107 W42792002 C01DA02 NITROGLYCERINUM NITROGLICERINA 0,5 mg COMPR. SUBLING. 0,5mg ZENTIVA SA ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. SUBLINGUALE P-6L 20 0.128402 1.529598 0.115561 1.542439
108 W07257001 C01DA02 NITROGLYCERINUM NITROMINT 0,4 mg/doza SPRAY SUBLINGUAL 0,4mg/doza EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLACON X 10G (180 DOZE) SPRAY SUBLINGUAL P-6L 1 18.490000 0.000000 16.641000 1.849000
109 W07257002 C01DA02 NITROGLYCERINUM NITROMINT 0,4 mg/doza SPRAY SUBLINGUAL 0,4mg/doza EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLACON DIN PLASTIC X 10G (180 DOZE) SPRAY SUBLINGUAL P-6L 1 18.490000 0.000000 16.641000 1.849000
110 W44053001 C01DA08 ISOSORBIDI DINITRAS ISOSORBID DINITRAT EIPICO 10 mg COMPR. 10mg E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 20 COMPR. P-6L 60 0.079833 0.000000 0.071849 0.007984

Pagina 2 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
111 W53684002 C01DA08 ISOSORBIDI DINITRAS ISOSORBID DINITRAT ARENA 10 mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.070333 0.000000 0.063299 0.007034
112 W69000001 C01DA14 ISOSORBIDI MONONITRAS OLICARD RETARD 40 mg CAPS. CU ELIB. PREL. 40mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. ELIB. PREL. P6L 20 0.479041 0.084959 0.431136 0.132864
113 W62347001 C01DA14 ISOSORBIDI MONONITRAS OLICARD RETARD 40 mg CAPS. ELIB. PREL. 40mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE X 2 BLIST. PVC/AL X 10 CAPS. ELIB. PREL. P-6L 20 0.479041 0.084959 0.431136 0.132864
114 W13871002 C01DA14 ISOSORBIDI MONONITRAS MONONITRON EP 60 mg COMPR. ELIB. PREL. 60mg ZENTIVA S.A ROMANIA CUTIE CU 4 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-6L 40 0.718561 0.905189 0.646704 0.977046
115 W53697001 C01EA01 ALPROSTADILUM ** PRIDAX 20mcg CONC. PT. SOL. PERF. 20mcg GEBRO PHARMA GMBH AUSTRIA CUTIE CU 5 FIOLE PREVAZUTE CU PUNCT DE RUPERE X 1 ML CONC. PT. SOL. PERF. PR/PRF 5 52.470333 0.731667 47.223299 5.978701
116 W67213002 C01EA01 ALPROSTADILUM ** VASAPROSTAN 20 µg/ml PULB. PT. SOL. PERF. 20µg/ml AMDIPHARM LIMITED IRLANDA CUTIE CU 15 FIOLE DIN STICLA INCOLORA,DE TIP I, CU PUNCT DE RUPERE, CU CAPACITATE DE 5 ML, CONTINÂND 48,2 MG PULB. PT. SOL. PERF. PRF 15 52.470333 10.383667 47.223299 15.630701
117 W66688003 C01EA01 ALPROSTADILUM ** ALPROSTADIL ROMPHARM 20 micrograme PULB. PT. SOL. PERF. 20micrograme ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 15 FLAC. DE STICLA DE TIP I PR/PRF 15 51.738666 0.000000 46.564799 5.173867
118 W04208001 C02AB01 METHYLDOPUM DOPEGYT 250 mg COMPR. 250mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 50 COMPR. P-6L 50 0.728000 0.000000 0.655200 0.072800
119 W01369003 C02AC01 CLONIDINUM CLONIDINA SINTOFARM 0,15 mg COMPR. 0,15mg SINTOFARM SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 0.293760 0.032640 0.264384 0.062016
120 W60265001 C02AC01 CLONIDINUM CLONIDINA ARENA 0,15 mg COMPR. 0,15mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. P6L 50 0.293760 0.032640 0.264384 0.062016
121 W51724001 C02CA04 DOXAZOSINUM COMPR.
DOXAZOSIN ARENA 1 mg (vezi C02CA04) 1mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. DIN AL/PVC X 10 COMPR. P-6L 30 0.194681 0.988652 0.175212 1.008121
122 W51724001 C02CA04 DOXAZOSINUM COMPR.
DOXAZOSIN ARENA 1 mg (vezi C02CA04) 1mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. DIN AL/PVC X 10 COMPR. P-6L 30 0.194681 0.988652 0.175212 1.008121
123 W08648002 C02CA04 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 2mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. PVC-PVDE/AL X 10 COMPR. P-6L 30 0.389362 0.362971 0.350425 0.401908
124 W08648002 C02CA04 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 2mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. PVC-PVDE/AL X 10 COMPR. P-6L 30 0.389362 0.362971 0.350425 0.401908
125 W08649002 C02CA04 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 4mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDE/AL X 10 COMPR. P-6L 30 0.778724 0.035942 0.700851 0.113815
126 W08649002 C02CA04 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 4mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDE/AL X 10 COMPR. P-6L 30 0.778724 0.035942 0.700851 0.113815
127 W67252002 C02CA04 DOXAZOSINUM CARDURA XL 4 mg (vezi G04CAN1) COMPR. ELIB. MODIF. 4mg UPJOHN EESV OLANDA CUTIE X 4 BLIST. AL-PA-PVDC/AL-PVDC X 7 COMPR. ELIB. MODIF. P6L 28 0.778724 0.342347 0.700851 0.420220
128 W67252002 C02CA04 DOXAZOSINUM CARDURA XL 4 mg (vezi G04CAN1) COMPR. ELIB. MODIF. 4mg UPJOHN EESV OLANDA CUTIE X 4 BLIST. AL-PA-PVDC/AL-PVDC X 7 COMPR. ELIB. MODIF. P6L 28 0.778724 0.342347 0.700851 0.420220
129 W43198002 C03AA03 HYDROCHLOROTHIAZIDUM NEFRIX 25 mg COMPR. 25mg ZENTIVA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-6L 25 1.431600 0.000000 1.288440 0.143160
130 W69003001 C03BA11 INDAPAMIDUM INDAPAMID SR LAROPHARM 1,5 mg COMPR. CU ELIB. PREL. 1,5 mg LAROPHARM S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. ELIB. PREL. P6L 30 0.400199 0.044467 0.360179 0.084487
131 W43065002 C03BA11 INDAPAMIDUM RAWEL SR 1,5 mg COMPR. CU ELIB. PREL. 1,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. CU ELIB. PREL. P-6L 30 0.281000 0.000000 0.252900 0.028100
132 W52836001 C03BA11 INDAPAMIDUM IMPAMID SR 1,5 mg COMPR. CU ELIB. PREL. 1,5mg ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 15 COMPR. ELIB. PREL. P-6L
GEDEON RICHTER ROMANIA SA 30 0.400199 0.044467 0.360179 0.084487
133 W62788001 C03BA11 INDAPAMIDUM INDAPAMIDA SLAVIA 1,5 mg COMPR. CU ELIB. PREL. 1,5mg SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. CU ELIB. PREL. P6L 30 0.400199 0.044467 0.360179 0.084487
134 W56973001 C03BA11 INDAPAMIDUM INDAPAMIDA TERAPIA 1,5 mg COMPR. CU ELIB. PRELUNGITA 1,5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. CU ELIB. PREL. P-6L 30 0.400199 0.044467 0.360179 0.084487
135 W61972001 C03BA11 INDAPAMIDUM INDAPAMID SR ZENTIVA 1,5 mg COMPR. ELIB. PREL 1,5 mg ZENTIVA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. ELIB. PREL. P6L 30 0.400199 0.044467 0.360179 0.084487
136 W03592001 C03BA11 INDAPAMIDUM TERTENSIF SR 1,5 mg COMPR. ELIB. PREL. 1,5mg LES LAB. SERVIER FRANTA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. ELIB. PREL. P-6L 30 0.400199 0.180801 0.360179 0.220821
137 W13662001 C03BA11 INDAPAMIDUM INDAPAMID LPH 1,5 mg COMPR. ELIB. PREL. 1,5mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-6L 30 0.400199 0.044467 0.360179 0.084487
138 W52005001 C03BA11 INDAPAMIDUM INDAPAMID MCC 1,5 mg COMPR. ELIB. PREL. 1,5mg MAGISTRA C&C SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-6L 30 0.400199 0.044467 0.360179 0.084487
139 W53212001 C03BA11 INDAPAMIDUM IDUREN SR 1,5 mg COMPR. ELIB. PREL. 1,5mg VIM SPECTRUM SRL ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. ELIB. PREL. P-6L 30 0.400199 0.044467 0.360179 0.084487
140 W62164001 C03BA11 INDAPAMIDUM INDAPAMIDA ATB 1,5 mg COMPR. ELIB. PREL. 1,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P6L 30 0.400199 0.044467 0.360179 0.084487
141 W67387001 C03BA11 INDAPAMIDUM INDAPAMIDA SR MEDREG 1,5 mg COMPR. ELIB. PREL. 1,5mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P6L 30 0.400199 0.044467 0.360179 0.084487
142 W13675001 C03BA11 INDAPAMIDUM INDAPAMID LPH 2,5 mg COMPR. FILM. 2,5mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 0.664666 0.000000 0.598199 0.066467
143 W03265002 C03CA01 FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.389000 0.000000 0.350100 0.038900
144 W42036002 C03CA01 FUROSEMIDUM FUROSEMID SLAVIA 40 mg COMPR. 40mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.397500 0.000000 0.357750 0.039750
145 W43155001 C03CA01 FUROSEMIDUM FUROSEMID ZENTIVA 40 mg COMPR. 40mg ZENTIVA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 20 COMPR. P-6L 20 0.397500 0.000000 0.357750 0.039750
146 W52043001 C03CA01 FUROSEMIDUM FUROSEMID ARENA 40 mg COMPR. 40mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.397500 0.000000 0.357750 0.039750
147 W60369001 C03CA01 FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.397500 0.000000 0.357750 0.039750
148 W03264003 C03CA01 FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. DIN PVC/AL X 10 COMPRIMATE P-6L 30 0.397500 0.000500 0.357750 0.040250
149 W03265003 C03CA01 FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P6L 30 0.397500 0.000500 0.357750 0.040250
150 W67808003 C03CA01 FUROSEMIDUM FUROSEMID MEDREG 40 mg COMPR. 40mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.376333 0.000000 0.338699 0.037634
151 W68090001 C03CA01 FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.397500 0.000000 0.357750 0.039750
152 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 1.538000 0.000000 1.384200 0.153800
153 W68522002 C03CA01 FUROSEMIDUM FUROSEMID HAMELN 10 mg/ml SOL INJ. 10mg/ml HAMELN PHARMA 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 1.538000 0.000000 1.384200 0.153800
154 W58282001 C03CA01 FUROSEMIDUM FUROSEMID ZENTIVA 20 mg/2 ml SOL. INJ. 20mg/2ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 2 ML SOL. INJ. P-RF 5 1.538000 0.068000 1.384200 0.221800
155 W55360002 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA ARENA 25 mg CAPS. 25mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 CAPS. P-6L 50 0.438000 0.033800 0.394200 0.077600
156 W57830002 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA LPH 25 mg CAPS. 25mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 6 BLIST. PVC/AL X 10 CAPS. P6L 60 0.438000 0.034000 0.394200 0.077800
157 W54823001 C03DA01 SPIRONOLACTONUM VEROSPIRON CAPS. 50mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6L 30 0.510666 0.000000 0.459599 0.051067
158 W55359001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA ARENA 50 mg CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P-6L 30 0.875666 0.000000 0.788099 0.087567
159 W60370001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA BIOEEL 25 mg COMPR. 25mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.438000 0.033500 0.394200 0.077300
160 W68089001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA BIOEEL 25 mg COMPR. 25mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.438000 0.033500 0.394200 0.077300
161 W08893001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA TERAPIA 25 mg COMPR. FILM. 25mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 50 0.438000 0.033800 0.394200 0.077600
162 W52138001 C03DA01 SPIRONOLACTONUM ALSPIRON 25 mg COMPR. FILM. 25mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 0.438000 0.033500 0.394200 0.077300
163 W41550001 C03DA01 SPIRONOLACTONUM ALSPIRON 50 mg COMPR. FILM. 50mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 0.876000 0.000000 0.788400 0.087600
164 W58726003 C03EB01 COMBINATII (SPIRONOLACTONUM+FUROSEMIDUM) DIUROCARD 50 mg/20 mg CAPS. 50mg/20 mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 1.400666 0.000000 1.260599 0.140067
165 W07005001 C03EB01 COMBINATII (SPIRONOLACTONUM+FUROSEMIDUM) DIUREX 50 mg/20 mg CAPS. 50mg/20mg TERAPIA SA ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. P-6L 20 1.436124 0.106376 1.292511 0.249989
166 W53123003 C04AD03 PENTOXIFYLLINUM OXIFLUX 400 mg COMPR. CU ELIB. PREL. 400mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 6 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-6L 60 0.545400 0.128266 0.490860 0.182806
167 W69429003 C04AD03 PENTOXIFYLLINUM PENTOXIFILINA RETARD LPH 400 mg COMPR. CU ELIB. PREL. 400mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 6 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P6L 60 0.545400 0.084266 0.490860 0.138806
168 W13574002 C04AD03 PENTOXIFYLLINUM PENTOXI RETARD 400 mg COMPR. ELIB. PREL. 400mg TERAPIA SA ROMANIA CUTIE X 4 BLIST. X 10 COMPR. CU ELIB. PREL. P-6L 40 0.545400 0.196100 0.490860 0.250640
169 W53002004 C04AD03 PENTOXIFYLLINUM PENTOXIFILINA SR ZENTIVA 400 mg COMPR. ELIB. PREL. 400mg ZENTIVA AS REPUBLICA SLOVACA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. ELIB. PREL. P-6L 20 0.545400 0.018600 0.490860 0.073140

Pagina 3 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
170 W53002005 C04AD03 PENTOXIFYLLINUM PENTOXIFILINA SR ZENTIVA 400 mg COMPR. ELIB. PREL. 400mg ZENTIVA AS REPUBLICA SLOVACA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. ELIB. PREL. P-6L 50 0.447400 0.000000 0.402660 0.044740
171 W66977001 C04AD03 PENTOXIFYLLINUM ANGIOPENT RETARD 400 mg COMPR. ELIB. PREL. 400mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P6L 20 0.545400 0.592600 0.490860 0.647140
172 W66977002 C04AD03 PENTOXIFYLLINUM ANGIOPENT RETARD 400 mg COMPR. ELIB. PREL. 400mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 4 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P6L 40 0.545400 0.488350 0.490860 0.542890
173 W53506006 C04AD03 PENTOXIFYLLINUM PENTOXIFILINA SR ZENTIVA 600 mg COMPR. ELIB. PREL. 600mg ZENTIVA AS REPUBLICA SLOVACA CUTIE X 10 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. ELIB. PREL. P-6L 100 0.544600 0.000000 0.490140 0.054460
174 W54452002 C04AD03 PENTOXIFYLLINUM VASONIT RETARD 600 mg COMPR. ELIB. PREL. 600mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-6L 50 0.808800 0.000000 0.727920 0.080880
175 W66978001 C04AD03 PENTOXIFYLLINUM ANGIOPENT RETARD 600 mg COMPR. ELIB. PREL. 600mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P6L 20 0.818099 0.230401 0.736289 0.312211
176 W56674001 C07AA05 PROPRANOLOLUM PROPRANOLOL BIOEEL 10 mg COMPR. 10 mg BIO EEL S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 25 COMPR. P6L 50 0.032800 0.071600 0.029520 0.074880
177 W08683002 C07AA05 PROPRANOLOLUM PROPRANOLOL SINTOFARM 10 mg COMPR. 10mg SINTOFARM SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 0.032800 0.071600 0.029520 0.074880
178 W68094001 C07AA05 PROPRANOLOLUM PROPRANOLOL BIOEEL 10 mg COMPR. 10mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 25 COMPR. P6L 50 0.032800 0.071600 0.029520 0.074880
179 W12724002 C07AA05 PROPRANOLOLUM PROPRANOLOL BIOEEL 40 mg COMPR. 40mg BIO EEL SRL ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 0.131200 0.000000 0.118080 0.013120
180 W08684002 C07AA05 PROPRANOLOLUM PROPRANOLOL SINTOFARM 40 mg COMPR. 40mg SINTOFARM SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 0.131200 0.000000 0.118080 0.013120
181 W53681002 C07AA05 PROPRANOLOLUM PROPRANOLOL ARENA 40 mg COMPR. 40mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 0.131200 0.000000 0.118080 0.013120
182 W68095001 C07AA05 PROPRANOLOLUM PROPRANOLOL BIOEEL 40 mg COMPR. 40mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. P6L 50 0.131200 0.000000 0.118080 0.013120
183 W41673003 C07AA07 SOTALOLUM SOTAGAMMA 80 mg COMPR. 80mg WORWAG PHARMA GMBH & CO. KGGERMANIA CUTIE X 10 BLIST. AL/PVC-PVDC X 10 COMPR. P-6L 100 0.262400 0.071500 0.236160 0.097740
184 W08420005 C07AA07 SOTALOLUM SOTALOL AL 80 COMPR. 80mg ALIUD PHARMA GMBH GERMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 0.262400 0.245400 0.236160 0.271640
185 W62335001 C07AA07 SOTALOLUM DAROB 80 mg COMPR. 80mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.262400 0.401600 0.236160 0.427840
186 W68979001 C07AA07 SOTALOLUM DAROB 80 mg COMPR. 80mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.262400 0.401600 0.236160 0.427840
187 W04263002 C07AB02 METOPROLOLUM BETAPROL 100 mg COMPR. 100mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.333000 0.044666 0.299700 0.077966
188 W04266001 C07AB02 METOPROLOLUM EGILOK 100 mg COMPR. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X, 1 FLAC. DIN STICLA BRUNA X 20 COMPR. P-6L 20 0.333000 0.044500 0.299700 0.077800
189 W07222003 C07AB02 METOPROLOLUM METOPROLOL LPH 100 mg COMPR. 100mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.333000 0.044666 0.299700 0.077966
190 W42176001 C07AB02 METOPROLOLUM METOPROLOL MCC 100 mg COMPR. 100mg MAGISTRA C & C SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.333000 0.039333 0.299700 0.072633
191 W52230001 C07AB02 METOPROLOLUM METOPROLOL TERAPIA 100 mg COMPR. 100mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.333000 0.044666 0.299700 0.077966
192 W53669001 C07AB02 METOPROLOLUM METOPROLOL VIM SPECTRUM 100 mg COMPR. 100mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.333000 0.044500 0.299700 0.077800
193 W53941002 C07AB02 METOPROLOLUM METOPROLOL ARENA 100 MG COMPR. 100mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.333000 0.044666 0.299700 0.077966
194 W57206001 C07AB02 METOPROLOLUM METOPROLOL SLAVIA 100 mg COMPR. 100mg SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0.333000 0.037000 0.299700 0.070300
195 W42025001 C07AB02 METOPROLOLUM METOPROLOL MCC 25 mg COMPR. 25mg MAGISTRA C & C SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.083249 0.106417 0.074924 0.114742
196 W53922001 C07AB02 METOPROLOLUM METOPROLOL ARENA 25 MG COMPR. 25mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.083249 0.106417 0.074924 0.114742
197 W42973003 C07AB02 METOPROLOLUM METOPROLOL LPH 25 mg COMPR. 25mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 20 COMPR. P-6L 60 0.083249 0.106751 0.074924 0.115076
198 W04264002 C07AB02 METOPROLOLUM BETAPROL 50 mg COMPR. 50mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.166500 0.143833 0.149850 0.160483
199 W04268001 C07AB02 METOPROLOLUM EGILOK 50 mg COMPR. 50mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 20 COMPR. P-6L 20 0.166500 0.052500 0.149850 0.069150
200 W07223003 C07AB02 METOPROLOLUM METOPROLOL LPH 50 mg COMPR. 50mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.166500 0.143833 0.149850 0.160483
201 W42197001 C07AB02 METOPROLOLUM METOPROLOL MCC 50 mg COMPR. 50mg MAGISTRA C & C SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.166500 0.143833 0.149850 0.160483
202 W52231001 C07AB02 METOPROLOLUM METOPROLOL TERAPIA 50 mg COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.166500 0.148500 0.149850 0.165150
203 W53670001 C07AB02 METOPROLOLUM METOPROLOL VIM SPECTRUM 50 mg COMPR. 50mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.166500 0.148500 0.149850 0.165150
204 W53940001 C07AB02 METOPROLOLUM METOPROLOL ARENA 50 MG COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.166500 0.143833 0.149850 0.160483
205 W57205001 C07AB02 METOPROLOLUM METOPROLOL SLAVIA 50 mg COMPR. 50mg SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0.166500 0.144500 0.149850 0.161150
206 W43226004 C07AB02 METOPROLOLUM METOSUCCINAT SANDOZ 47,5 mg COMPR. CU ELIB. MODIF. 47,5mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. ACLAR-PVC/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.166500 0.108833 0.149850 0.125483
207 W43227004 C07AB02 METOPROLOLUM METOSUCCINAT SANDOZ 95 mg COMPR. CU ELIB. MODIF. 95mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. ACLAR-PVC/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.333000 0.124666 0.299700 0.157966
208 W43226010 C07AB02 METOPROLOLUM METOSUCCINAT SANDOZ 47,5 mg COMPR. ELIB. MODIF. 47,5mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PP/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.166500 0.108833 0.149850 0.125483
209 W43227010 C07AB02 METOPROLOLUM METOSUCCINAT SANDOZ 95 mg COMPR. ELIB. MODIF. 95mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PP/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.333000 0.124666 0.299700 0.157966
210 W66032001 C07AB02 METOPROLOLUM BETALOC ZOK 100 mg COMPR. ELIB. PREL. 100mg RECORDATI INDUSTRIA CHIMICA E FARMACEUTICA S.P.A. ITALIA CUTIE CU 1 FLAC. PEID X 30 COMPR. ELIB. PREL. P6L 30 0.333000 0.694666 0.299700 0.727966
211 W66033001 C07AB02 METOPROLOLUM BETALOC ZOK 50 mg COMPR. ELIB. PREL. 50mg RECORDATI INDUSTRIA CHIMICA E FARMACEUTICA S.P.A. ITALIA CUTIE CU 1 FLAC. PEID X 30 COMPR. ELIB. PREL. P6L 30 0.166500 0.502166 0.149850 0.518816
212 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 0.306000 0.000000 0.275400 0.030600
213 W67867004 C07AB02 METOPROLOLUM METOPROLOL MEDREG 100 mg COMPR. FILM. 100mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.333000 0.044666 0.299700 0.077966
214 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 0.166500 0.105833 0.149850 0.122483
215 W67866004 C07AB02 METOPROLOLUM METOPROLOL MEDREG 50 mg COMPR. FILM. 50mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.166500 0.026166 0.149850 0.042816
216 W00491003 C07AB03 ATENOLOLUM ATENOLOL LPH 100 mg COMPR. 100mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.467000 0.000000 0.420300 0.046700
217 W53950002 C07AB03 ATENOLOLUM ATENOLOL ARENA 100 MG COMPR. 100mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.464500 0.000000 0.418050 0.046450
218 W61517001 C07AB03 ATENOLOLUM ATENOLOL 100 mg COMPR. 100mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.464500 0.000000 0.418050 0.046450
219 W00492003 C07AB03 ATENOLOLUM ATENOLOL LPH 50 mg COMPR. 50mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.260000 0.000000 0.234000 0.026000
220 W53949002 C07AB03 ATENOLOLUM ATENOLOL ARENA 50 MG COMPR. 50mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.259500 0.000000 0.233550 0.025950
221 W61516001 C07AB03 ATENOLOLUM ATENOLOL 50 mg COMPR. 50mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.259500 0.000000 0.233550 0.025950
222 W12507001 C07AB05 BETAXOLOLUM LOKREN 20 mg COMPR. FILM. 20mg SANOFI-AVENTIS FRANCE FRANTA CUTIE X 2 BLIST. AL/PVC X 14 COMPR.FILM. P-6L 28 0.499500 0.235857 0.449550 0.285807
223 W12507003 C07AB05 BETAXOLOLUM LOKREN 20 mg COMPR. FILM. 20mg SANOFI-AVENTIS FRANCE FRANTA CUTIE CU 6 BLIST. PVC/AL X 14 COMPR. FILM. P6L 84 0.499500 0.402285 0.449550 0.452235
224 W64210003 C07AB05 BETAXOLOLUM LOKREN 20 mg COMPR. FILM. 20mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 6 BLIST. PVC/AL X 14 COMPR. FILM. P6L 84 0.499500 0.402285 0.449550 0.452235
225 W67248003 C07AB05 BETAXOLOLUM LOKREN 20 mg COMPR. FILM. 20mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU 6 BLIST. PVC/AL X 14 COMPR. FILM. P6L 84 0.499500 0.402285 0.449550 0.452235
226 W67248001 C07AB05 BETAXOLOLUM LOKREN 20 mg COMPR. FILM. 20mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU 2 BLIST. PVC/AL X 14 COMPR. FILM. P6L 28 0.499500 0.235857 0.449550 0.285807
227 W69093003 C07AB07 BISOPROLOLUM CORSIB 10 mg COMPR. 10mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.499500 0.210166 0.449550 0.260116
228 W69091003 C07AB07 BISOPROLOLUM CORSIB 2,5 mg COMPR. 2,5mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.124875 0.184791 0.112387 0.197279

Pagina 4 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
229 W69092003 C07AB07 BISOPROLOLUM CORSIB 5 mg COMPR. 5mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.249750 0.072916 0.224775 0.097891
230 W13630003 C07AB07 BISOPROLOLUM BISOGAMMA 10 mg COMPR. FILM. 10mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU 10 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-6L 100 0.290300 0.000000 0.261270 0.029030
231 W43154001 C07AB07 BISOPROLOLUM BISOTENS 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.499500 0.051166 0.449550 0.101116
232 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 0.499500 0.407833 0.449550 0.457783
233 W60569004 C07AB07 BISOPROLOLUM SOBYC 10 mg COMPR. FILM. 10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 0.443333 0.000000 0.398999 0.044334
234 W66286002 C07AB07 BISOPROLOLUM CONCOR 10 mg COMPR. FILM. 10mg MERCK ROMANIA SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 30 COMPR. FILM. P6L 60 0.499500 0.407833 0.449550 0.457783
235 W66286001 C07AB07 BISOPROLOLUM CONCOR 10 mg COMPR. FILM. 10mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.499500 0.499500 0.449550 0.549450
236 W60567004 C07AB07 BISOPROLOLUM SOBYC 2,5 mg COMPR. FILM. 2,5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 0.124875 0.184791 0.112387 0.197279
237 W66288002 C07AB07 BISOPROLOLUM CONCOR COR 2,5 mg COMPR. FILM. 2,5mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.124875 0.254791 0.112387 0.267279
238 W00626001 C07AB07 BISOPROLOLUM CONCOR 5 mg COMPR. FILM. 5mg MERCK KGAA GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR.FILM. P-6L 30 0.249750 0.407250 0.224775 0.432225
239 W43153001 C07AB07 BISOPROLOLUM BISOTENS 5 mg COMPR. FILM. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.249750 0.089583 0.224775 0.114558
240 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 0.249750 0.417750 0.224775 0.442725
241 W60358002 C07AB07 BISOPROLOLUM CONCOR COR 5 mg COMPR. FILM. 5mg MERCK KGAA GERMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.249750 0.246916 0.224775 0.271891
242 W60568004 C07AB07 BISOPROLOLUM SOBYC 5 mg COMPR. FILM. 5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 0.249750 0.016916 0.224775 0.041891
243 W13629005 C07AB07 BISOPROLOLUM BISOGAMMA 5 mg COMPR. FILM. 5mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU 10 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P6L 100 0.167600 0.000000 0.150840 0.016760
244 W66285002 C07AB07 BISOPROLOLUM CONCOR 5 mg COMPR. FILM. 5mg MERCK ROMANIA SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 30 COMPR. FILM. P6L 60 0.249750 0.417750 0.224775 0.442725
245 W66285001 C07AB07 BISOPROLOLUM CONCOR 5 mg COMPR. FILM. 5mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.249750 0.407250 0.224775 0.432225
246 W66287002 C07AB07 BISOPROLOLUM CONCOR COR 5 mg COMPR. FILM. 5mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.249750 0.246916 0.224775 0.271891
247 W59931001 C07AG02 CARVEDILOLUM CARVEDILOL SANDOZ 12,5 mg COMPR. 12,5 mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.309600 0.292733 0.278640 0.323693
248 W12649001 C07AG02 CARVEDILOLUM CORYOL 12,5 mg COMPR. 12,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 4 BLIST. OPA-AL-PVC/AL X 7 COMPR. P-6L 28 0.309600 0.021828 0.278640 0.052788
249 W42058001 C07AG02 CARVEDILOLUM TALLITON 12,5 mg COMPR. 12,5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P-6L 30 0.309600 0.034400 0.278640 0.065360
250 W42659001 C07AG02 CARVEDILOLUM CARVEDILOL LPH 12,5 mg COMPR. 12,5mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC ALB OPAC/AL X 10 COMPR. P-6L 30 0.309600 1.010400 0.278640 1.041360
251 W53658001 C07AG02 CARVEDILOLUM CARVEDILOL VIM SPECTRUM 12,5mg COMPR. 12,5mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.309600 0.381400 0.278640 0.412360
252 W53751001 C07AG02 CARVEDILOLUM GLADYCOR 12,5 mg COMPR. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.309600 0.181400 0.278640 0.212360
253 W58304001 C07AG02 CARVEDILOLUM CARVEDILOL HELCOR 12,5 mg COMPR. 12,5mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.309600 0.382400 0.278640 0.413360
254 W63454001 C07AG02 CARVEDILOLUM CARVEDILOL SLAVIA 12,5 mg COMPR. 12,5mg SLAVIA PHARM S.R.L. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.309600 0.993733 0.278640 1.024693
255 W42058002 C07AG02 CARVEDILOLUM TALLITON 12,5 mg COMPR. 12,5mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU 2 BLIST. DIN OPA-AL-PVC/AL X 15 COMPR. P6L 30 0.309600 0.034400 0.278640 0.065360
256 W12648002 C07AG02 CARVEDILOLUM CORYOL 25 mg COMPR. 25mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 14 COMPR. P-6L 28 0.453571 0.000000 0.408213 0.045358
257 W42059001 C07AG02 CARVEDILOLUM TALLITON 25 mg COMPR. 25mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P-6L 30 0.619200 0.029466 0.557280 0.091386
258 W42658001 C07AG02 CARVEDILOLUM CARVEDILOL LPH 25 mg COMPR. 25mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC ALB OPAC/AL X 10 COMPR. P-6L 30 0.619200 0.757133 0.557280 0.819053
259 W53752001 C07AG02 CARVEDILOLUM GLADYCOR 25 mg COMPR. 25mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.619200 0.048466 0.557280 0.110386
260 W58305001 C07AG02 CARVEDILOLUM CARVEDILOL HELCOR 25 mg COMPR. 25mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.619200 0.149800 0.557280 0.211720
261 W59932001 C07AG02 CARVEDILOLUM CARVEDILOL SANDOZ 25 mg COMPR. 25mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.619200 0.226133 0.557280 0.288053
262 W63455001 C07AG02 CARVEDILOLUM CARVEDILOL SLAVIA 25 mg COMPR. 25mg SLAVIA PHARM S.R.L. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.619200 0.763466 0.557280 0.825386
263 W42059002 C07AG02 CARVEDILOLUM TALLITON 25 mg COMPR. 25mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU 2 BLIST. DIN OPA-AL-PVC/AL X 15 COMPR. P6L 30 0.619200 0.029466 0.557280 0.091386
264 W41867002 C07AG02 CARVEDILOLUM CORYOL 6,25mg COMPR. 6,25mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. OPA-AL-PVC/AL X 7 COMPR. P-6L 28 0.154799 0.095558 0.139319 0.111038
265 W41912001 C07AG02 CARVEDILOLUM TALLITON 6,25 mg COMPR. 6,25mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P-6L 30 0.154799 0.056867 0.139319 0.072347
266 W42660001 C07AG02 CARVEDILOLUM CARVEDILOL LPH 6,25 mg COMPR. 6,25mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6L 30 0.154799 0.481201 0.139319 0.496681
267 W53663001 C07AG02 CARVEDILOLUM CARVEDILOL VIM SPECTRUM 6,25 mg COMPR. 6,25mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.154799 0.167201 0.139319 0.182681
268 W53750001 C07AG02 CARVEDILOLUM GLADYCOR 6,25 mg COMPR. 6,25mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.154799 0.080534 0.139319 0.096014
269 W59930001 C07AG02 CARVEDILOLUM CARVEDILOL SANDOZ 6,25 mg COMPR. 6,25mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.154799 0.188201 0.139319 0.203681
270 W63453001 C07AG02 CARVEDILOLUM CARVEDILOL SLAVIA 6,25 mg COMPR. 6,25mg SLAVIA PHARM S.R.L. ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. P-6L 30 0.154799 0.781867 0.139319 0.797347
271 W41912002 C07AG02 CARVEDILOLUM TALLITON 6,25 mg COMPR. 6,25mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU 2 BLIST. DIN OPA-AL-PVC/AL X 15 COMPR. P6L 30 0.154799 0.056867 0.139319 0.072347
272 W66017007 C07AG02 CARVEDILOLUM CARVEDILOL AUROBINDO 12,5mg COMPR. FILM. 12,5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.309600 0.091471 0.278640 0.122431
273 W66018007 C07AG02 CARVEDILOLUM CARVEDILOL AUROBINDO 25mg COMPR. FILM. 25mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.589285 0.000000 0.530356 0.058929
274 W66016007 C07AG02 CARVEDILOLUM CARVEDILOL AUROBINDO 6,25mg COMPR. FILM. 6,25mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.154799 0.128058 0.139319 0.143538
275 W42020001 C08CA01 AMLODIPINUM TENOX 10 mg COMPR. 10mg KRKA D.D. SLOVENIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.373000 0.000000 0.335700 0.037300
276 W53430001 C08CA01 AMLODIPINUM ALMACOR 10 mg COMPR. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.374000 0.000000 0.336600 0.037400
277 W55742001 C08CA01 AMLODIPINUM AMLODIPINA LPH 10 mg COMPR. 10mg LABORMED PHARMA S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.374000 0.000000 0.336600 0.037400
278 W57500001 C08CA01 AMLODIPINUM AMLODIPINA TERAPIA 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.374000 0.000000 0.336600 0.037400
279 W57500002 C08CA01 AMLODIPINUM AMLODIPINA TERAPIA 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. ACLAR-PVC/AL X 10 COMPR. P-6L 30 0.374000 0.000000 0.336600 0.037400
280 W60290001 C08CA01 AMLODIPINUM AMLODIPINA HELCOR 10 mg COMPR. 10mg A.C. HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.374500 0.000000 0.337050 0.037450
281 W60373002 C08CA01 AMLODIPINUM AMLODIPINA ARENA 10 mg COMPR. 10mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.374000 0.000000 0.336600 0.037400
282 W61982002 C08CA01 AMLODIPINUM AMLODIPINA VIM SPECTRUM 10 mg COMPR. 10mg VIM SPECTRUM S.R.L. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.374000 0.000000 0.336600 0.037400
283 W67203006 C08CA01 AMLODIPINUM NORVASC 10 mg COMPR. 10mg UPJOHN EESV OLANDA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.432524 0.200809 0.389271 0.244062
284 W68483004 C08CA01 AMLODIPINUM AMLODIPINA MEDREG 10 mg COMPR. 10mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.374000 0.000000 0.336600 0.037400
285 W42019001 C08CA01 AMLODIPINUM TENOX 5 mg COMPR. 5mg KRKA D.D. SLOVENIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.216262 0.077071 0.194635 0.098698
286 W53429001 C08CA01 AMLODIPINUM ALMACOR 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.216262 0.104738 0.194635 0.126365
287 W55743001 C08CA01 AMLODIPINUM AMLODIPINA LPH 5 mg COMPR. 5mg LABORMED PHARMA S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.216262 0.255738 0.194635 0.277365

Pagina 5 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
288 W57499001 C08CA01 AMLODIPINUM AMLODIPINA TERAPIA 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.216262 0.255738 0.194635 0.277365
289 W57499002 C08CA01 AMLODIPINUM AMLODIPINA TERAPIA 5 mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. ACLAR-PVC/AL X 10 COMPR. P-6L 30 0.216262 0.255738 0.194635 0.277365
290 W60289001 C08CA01 AMLODIPINUM AMLODIPINA HELCOR 5 mg COMPR. 5mg A.C. HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.216262 0.255238 0.194635 0.276865
291 W60372002 C08CA01 AMLODIPINUM AMLODIPINA ARENA 5 mg COMPR. 5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.216262 0.255738 0.194635 0.277365
292 W61981002 C08CA01 AMLODIPINUM AMLODIPINA VIM SPECTRUM 5 mg COMPR. 5mg VIM SPECTRUM S.R.L. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.216262 0.255738 0.194635 0.277365
293 W67202006 C08CA01 AMLODIPINUM NORVASC 5 mg COMPR. 5mg UPJOHN EESV OLANDA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.216262 0.462738 0.194635 0.484365
294 W68482004 C08CA01 AMLODIPINUM AMLODIPINA MEDREG 5 mg COMPR. 5mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.216262 0.255738 0.194635 0.277365
295 W42170001 C08CA02 FELODIPINUM SISTAR 10 mg COMPR. CU ELIB. MODIF. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.432524 0.662476 0.389271 0.705729
296 W42168001 C08CA02 FELODIPINUM SISTAR 5 mg COMPR. CU ELIB. MODIF. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.216262 0.474404 0.194635 0.496031
297 W03102002 C08CA02 FELODIPINUM PLENDIL 10 mg COMPR. ELIB. PREL. 10mg ASTRAZENECA AB SUEDIA CUTIE CU 1 FLAC. DE CULOARE ALBA DIN PEID X 30 COMPR. ELIB. PREL. P-6L 30 0.432524 0.424809 0.389271 0.468062
298 W03104001 C08CA02 FELODIPINUM PLENDIL 5 mg COMPR. ELIB. PREL. 5mg ASTRAZENECA AB SUEDIA CUTIE CU 1 FLAC. DE CULOARE ALBA DIN PEID X 30 COMPR. ELIB. PREL. P-6L 30 0.216262 0.419738 0.194635 0.441365
299 W06813001 C08CA02 FELODIPINUM AURONAL 10 mg COMPR. FILM. ELIB. PREL.10mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 3 BLIST. AL/PVC-PE-PVDC X 10 COMPR. ELIB. PREL. P-6L 30 0.432524 0.676476 0.389271 0.719729
300 W06814001 C08CA02 FELODIPINUM AURONAL 2,5 mg COMPR. FILM. ELIB. PREL.2,5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 3 BLIST. AL/PVC-PE-PVDC X 10 COMPR. ELIB. PREL. P-6L 30 0.108131 0.531202 0.097317 0.542016
301 W06815001 C08CA02 FELODIPINUM AURONAL 5 mg COMPR. FILM. ELIB. PREL.5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 3 BLIST. AL/PVC-PE-PVDC X 10 COMPR. ELIB. PREL. P-6L 30 0.216262 0.483738 0.194635 0.505365
302 W04542001 C08CA05 NIFEDIPINUM NIFEDIPIN RETARD TERAPIA 20 mg COMPR. ELIB. PREL. 20mg TERAPIA SA ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-6L 50 0.144174 0.517226 0.129756 0.531644
303 W63872001 C08CA05 NIFEDIPINUM ADALAT 30 mg COMPR. ELIB. PREL. 30mg BAYER AG GERMANIA CUTIE CU 2 BLIST. AL/PP X 14 COMPR. ELIB. PREL. P6L 28 0.216262 0.524809 0.194635 0.546436
304 W63872002 C08CA05 NIFEDIPINUM ADALAT 30 mg COMPR. ELIB. PREL. 30mg BAYER AG GERMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 14 COMPR. ELIB. PREL. P6L 28 0.216262 0.524809 0.194635 0.546436
305 W60127001 C08DA01 VERAPAMILUM VERAPAMIL ARENA 40 mg CAPS. 40mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 0.172832 0.444501 0.155548 0.461785
306 W57108002 C08DA01 VERAPAMILUM VERAPAMIL ARENA 80 mg CAPS. 80mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 0.345666 0.157667 0.311099 0.192234
307 W68848001 C08DA01 VERAPAMILUM ISOPTIN RR 240 mg COMPR. CU ELIB. PREL. 240mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P6L 20 1.037000 0.000000 0.933300 0.103700
308 W62364001 C08DA01 VERAPAMILUM ISOPTIN RR 240 mg COMPR. ELIB. PREL. 240mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P-6L 20 1.037000 0.000000 0.933300 0.103700
309 W06068001 C08DA01 VERAPAMILUM CORDAMIL 40 mg COMPR. FILM. 40mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE X 3 BLIST. X 10 COMPR.FILM. P-6L 30 0.172832 0.321168 0.155548 0.338452
310 W06069001 C08DA01 VERAPAMILUM CORDAMIL 80 mg COMPR. FILM. 80mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE X 3 BLIST. X 10 COMPR.FILM. P-6L 30 0.255333 0.000000 0.229799 0.025534
311 W59964001 C08DB01 DILTIAZEMUM DILTIAZEM SR ROMPHARM 180 mg CAPS. ELIB. PREL. 180mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 3 BLIST. DIN FOLIE DE PVC/PVDC/AL X 10 CAPS. ELIB. PREL. P6L 30 1.029000 0.398666 0.926100 0.501566
312 W44079001 C08DB01 DILTIAZEMUM DILTIAZEM EIPICO 60 mg COMPR. 60mg E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 2, BLIST. AL/PVC X 10 COMPR. P-6L 20 0.343000 0.000000 0.308700 0.034300
313 W12201003 C08DB01 DILTIAZEMUM DILTIAZEM ARENA 60 mg COMPR. 60mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. DIN AL/ PVC X 10COMPR. P-6L 50 0.343000 0.011000 0.308700 0.045300
314 W53585001 C08DB01 DILTIAZEMUM DILTIAZEM BIOEEL 60 mg COMPR. 60mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. DIN AL/ PVC X 10 COMPR. P-6L 20 0.343000 0.000000 0.308700 0.034300
315 W41897003 C08DB01 DILTIAZEMUM DILTIAZEM LPH 60 mg COMPR. 60mg LABORMED PHARMA SA ROMANIA CUTIE X 6 BLIST. DIN PVC/AL X 10 COMPRIMATE P-6L 60 0.343000 0.013666 0.308700 0.047966
316 W68551001 C08DB01 DILTIAZEMUM DILTIAZEM BIOEEL 60 mg COMPR. 60mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.343000 0.000000 0.308700 0.034300
317 W00775001 C09AA01 CAPTOPRILUM CAPTOPRIL TERAPIA 25 mg COMPR. 25mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.098849 0.098484 0.088964 0.108369
318 W00774002 C09AA01 CAPTOPRILUM CAPTOPRIL LAROPHARM 25 mg COMPR. 25mg LAROPHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-6L 20 0.098849 0.101651 0.088964 0.111536
319 W43029001 C09AA01 CAPTOPRILUM CAPTOPRIL - AC 25 mg COMPR. 25mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.098849 0.093651 0.088964 0.103536
320 W06857001 C09AA01 CAPTOPRILUM CAPTOPRIL MCC 25 mg COMPR. 25mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.098849 0.101484 0.088964 0.111369
321 W08550001 C09AA01 CAPTOPRILUM CAPTOPRIL LPH 25 mg COMPR. 25mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.098849 0.098484 0.088964 0.108369
322 W41981002 C09AA01 CAPTOPRILUM CAPTOPRIL SINTOFARM 25 mg COMPR. 25mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.098849 0.098484 0.088964 0.108369
323 W53677002 C09AA01 CAPTOPRILUM CAPTOPRIL ARENA 25 mg COMPR. 25mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.098849 0.101651 0.088964 0.111536
324 W68552001 C09AA01 CAPTOPRILUM CAPTOPRIL BIOEEL 25 mg COMPR. 25mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.098849 0.093651 0.088964 0.103536
325 W53678001 C09AA01 CAPTOPRILUM CAPTOPRIL ARENA 50 mg COMPR. 50 mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.197699 0.096801 0.177929 0.116571
326 W00777001 C09AA01 CAPTOPRILUM CAPTOPRIL TERAPIA 50 mg COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197699 0.095967 0.177929 0.115737
327 W43028001 C09AA01 CAPTOPRILUM CAPTOPRIL - AC 50 mg COMPR. 50mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.197699 0.096801 0.177929 0.116571
328 W42060001 C09AA01 CAPTOPRILUM CAPTOPRIL MCC 50 mg COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197699 0.095967 0.177929 0.115737
329 W00776003 C09AA01 CAPTOPRILUM CAPTOPRIL LPH 50 mg COMPR. 50mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197699 0.095967 0.177929 0.115737
330 W68553001 C09AA01 CAPTOPRILUM CAPTOPRIL BIOEEL 50 mg COMPR. 50mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.197699 0.096801 0.177929 0.116571
331 W12405001 C09AA02 ENALAPRILUM ENALAPRIL MCC 10 mg COMPR. 10mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.197699 0.055801 0.177929 0.075571
332 W02920004 C09AA02 ENALAPRILUM ENALAPRIL LPH 10 mg COMPR. 10mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.197699 0.056634 0.177929 0.076404
333 W02922001 C09AA02 ENALAPRILUM ENAP 10 mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-6L 20 0.197699 0.055801 0.177929 0.075571
334 W41447001 C09AA02 ENALAPRILUM ENALAPRIL SLAVIA 10 mg COMPR. 10mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/ AL X 10 COMPR. P-6L 20 0.197699 0.055801 0.177929 0.075571
335 W51276001 C09AA02 ENALAPRILUM RENITEC 10 mg COMPR. 10mg CUTIE X 2 BLIST. AL/AL X 14 COMPR.
MERCK SHARP & DOHME ROMANIA P-6L 28 0.197699 0.230872 0.177929 0.250642
336 W53672002 C09AA02 ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC, X 10 COMPR. P-6L 30 0.197699 0.056634 0.177929 0.076404
337 W53672003 C09AA02 ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. AL/PVC, X 10 COMPR. P-6L 50 0.197699 0.056301 0.177929 0.076071
338 W53672004 C09AA02 ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 10 BLIST. AL/PVC, X 10 COMPR. P-6L 100 0.197699 0.056201 0.177929 0.075971
339 W53666002 C09AA02 ENALAPRILUM ENALAPRIL VIM SPECTRUM 10 mg COMPR. 10mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 20 0.197699 0.055801 0.177929 0.075571
340 W58491002 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 10 mg COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.197699 0.055801 0.177929 0.075571
341 W62035001 C09AA02 ENALAPRILUM ENALAPRIL TERAPIA 10mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL/PVC X 10 COMPRIMATE (2 ANI) P6L 20 0.197699 0.055801 0.177929 0.075571
342 W02922002 C09AA02 ENALAPRILUM ENAP 10 mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 30 0.197699 0.056634 0.177929 0.076404
343 W02922003 C09AA02 ENALAPRILUM ENAP 10 mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 6 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 60 0.197699 0.056467 0.177929 0.076237
344 W58491003 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 10 mg COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 20 0.197699 0.055801 0.177929 0.075571
345 W68245001 C09AA02 ENALAPRILUM RENITEC 10 mg COMPR. 10mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. P6L 28 0.197699 0.230872 0.177929 0.250642
346 W12199001 C09AA02 ENALAPRILUM ENALAPRIL MCC 20 mg COMPR. 20mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.395398 0.026102 0.355858 0.065642

Pagina 6 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
347 W02921003 C09AA02 ENALAPRILUM ENALAPRIL LPH 20 mg COMPR. 20mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.395398 0.026268 0.355858 0.065808
348 W02923001 C09AA02 ENALAPRILUM ENAP 20 mg COMPR. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-6L 20 0.395398 0.026102 0.355858 0.065642
349 W51277001 C09AA02 ENALAPRILUM RENITEC 20 mg COMPR. 20mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. P-6L 28 0.395398 0.354244 0.355858 0.393784
350 W53674001 C09AA02 ENALAPRILUM ENALAPRIL ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.395398 0.026268 0.355858 0.065808
351 W53674004 C09AA02 ENALAPRILUM ENALAPRIL ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. P-6L 50 0.395398 0.026202 0.355858 0.065742
352 W56712001 C09AA02 ENALAPRILUM ENALAPRIL SLAVIA 20 mg COMPR. 20mg SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.395398 0.026102 0.355858 0.065642
353 W58492001 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 20 mg COMPR. 20mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.395398 0.026102 0.355858 0.065642
354 W62036001 C09AA02 ENALAPRILUM ENALAPRIL TERAPIA 20mg COMPR. 20mg TERAPIA SA ROMANIA P6L
CUTIE X 2 BLISTERE AL/PVC X 10 COMPRIMATE (2 ANI) 20 0.395398 0.026102 0.355858 0.065642
355 W02923002 C09AA02 ENALAPRILUM ENAP 20 mg COMPR. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 30 0.395398 0.026268 0.355858 0.065808
356 W02923003 C09AA02 ENALAPRILUM ENAP 20 mg COMPR. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 6 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 60 0.395398 0.026268 0.355858 0.065808
357 W58492002 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 20 mg COMPR. 20mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 20 0.395398 0.026102 0.355858 0.065642
358 W68246001 C09AA02 ENALAPRILUM RENITEC 20 mg COMPR. 20mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. P6L 28 0.395398 0.354244 0.355858 0.393784
359 W12198001 C09AA02 ENALAPRILUM ENALAPRIL MCC 5 mg COMPR. 5mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.098849 0.019651 0.088964 0.029536
360 W02925001 C09AA02 ENALAPRILUM ENAP 5 mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-6L 20 0.098849 0.019651 0.088964 0.029536
361 W51275001 C09AA02 ENALAPRILUM RENITEC 5 mg COMPR. 5mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. P-6L 28 0.098849 0.261151 0.088964 0.271036
362 W12811003 C09AA02 ENALAPRILUM ENALAPRIL LPH 5 mg COMPR. 5mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.098849 0.019151 0.088964 0.029036
363 W53673001 C09AA02 ENALAPRILUM ENALAPRIL ARENA 5 mg COMPR. 5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.098849 0.019151 0.088964 0.029036
364 W58490002 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 5 mg COMPR. 5mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. P6L 20 0.098849 0.019651 0.088964 0.029536
365 W62034001 C09AA02 ENALAPRILUM ENALAPRIL TERAPIA 5mg COMPR. 5mg TERAPIA SA ROMANIA P6L
CUTIE X 2 BLISTERE AL/PVC- X 10 COMPRIMATE (2 ANI) 20 0.098849 0.019651 0.088964 0.029536
366 W02925002 C09AA02 ENALAPRILUM ENAP 5 mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 30 0.098849 0.019151 0.088964 0.029036
367 W02925003 C09AA02 ENALAPRILUM ENAP 5 mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 6 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 60 0.098849 0.019817 0.088964 0.029702
368 W58490003 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 5 mg COMPR. 5mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 20 COMPR. P6L 20 0.098849 0.019651 0.088964 0.029536
369 W68244001 C09AA02 ENALAPRILUM RENITEC 5 mg COMPR. 5mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. P6L 28 0.098849 0.261151 0.088964 0.271036
370 W58233001 C09AA02 ENALAPRILUM ENAP 1,25 mg/ml SOL. INJ./PERF. 1,25mg/ml KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ. PR/PRF 5 4.086000 0.000000 3.677400 0.408600
371 W42156001 C09AA03 LISINOPRILUM LISIREN 10 mg COMPR. 10mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.197699 0.487801 0.177929 0.507571
372 W42593001 C09AA03 LISINOPRILUM LISINOPRIL SANDOZ 10 mg COMPR. 10mg HEXAL AG GERMANIACUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.197699 0.109967 0.177929 0.129737
373 W43054001 C09AA03 LISINOPRILUM LISINOPRIL MEDO 10 mg COMPR. 10mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197699 0.288634 0.177929 0.308404
374 W53916002 C09AA03 LISINOPRILUM LISINOPRIL ATB 10 MG COMPR. 10mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197699 0.329634 0.177929 0.349404
375 W54841001 C09AA03 LISINOPRILUM TONOLYSIN 10 mg COMPR. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 0.197699 0.295515 0.177929 0.315285
376 W65067001 C09AA03 LISINOPRILUM RANOLIP 10 mg COMPR. 10mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.197699 0.488634 0.177929 0.508404
377 W42088001 C09AA03 LISINOPRILUM LISIREN 20 mg COMPR. 20mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0.395398 0.640102 0.355858 0.679642
378 W42594001 C09AA03 LISINOPRILUM LISINOPRIL SANDOZ 20 mg COMPR. 20mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.395398 0.036935 0.355858 0.076475
379 W53917002 C09AA03 LISINOPRILUM LISINOPRIL ATB 20 MG COMPR. 20mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.395398 0.640602 0.355858 0.680142
380 W54840001 C09AA03 LISINOPRILUM TONOLYSIN 20 mg COMPR. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 0.395398 0.423530 0.355858 0.463070
381 W43055002 C09AA03 LISINOPRILUM LISINOPRIL MEDO 20 mg COMPR. 20mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 2 BLIST. PVDC/AL X 10 COMPR. P-6L 20 0.395398 0.458102 0.355858 0.497642
382 W65068001 C09AA03 LISINOPRILUM RANOLIP 20 mg COMPR. 20mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.395398 0.640602 0.355858 0.680142
383 W53918002 C09AA03 LISINOPRILUM LISINOPRIL ATB 40 MG COMPR. 40mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.790797 0.836536 0.711717 0.915616
384 W43053001 C09AA03 LISINOPRILUM LISINOPRIL MEDO 5 mg COMPR. 5mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.098849 0.147817 0.088964 0.157702
385 W54842001 C09AA03 LISINOPRILUM TONOLYSIN 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 0.098849 0.232579 0.088964 0.242464
386 W65066001 C09AA03 LISINOPRILUM RANOLIP 5 mg COMPR. 5mg TERAPIA S.A. ROMANIA
CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.098849 0.238484 0.088964 0.248369
387 W51933002 C09AA05 RAMIPRILUM VIVACE 10 mg COMPR. 10 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7 COMPR. P-6L 28 0.385357 0.000000 0.346821 0.038536
388 W64367002 C09AA05 RAMIPRILUM VIVACE 10 mg COMPR. 10 mg TEVA B.V. OLANDA CUTIE CU 4 BLIST. AL/AL X 7 COMPR. P6L 28 0.385357 0.000000 0.346821 0.038536
389 W42940001 C09AA05 RAMIPRILUM RAMIPRIL-AC 10 mg COMPR. 10mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.385333 0.000000 0.346799 0.038534
390 W42972001 C09AA05 RAMIPRILUM AMPRIL 10 mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.384666 0.000000 0.346199 0.038467
391 W43524001 C09AA05 RAMIPRILUM ZENRA 10 mg COMPR. 10mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6L 28 0.385357 0.000000 0.346821 0.038536
392 W62447001 C09AA05 RAMIPRILUM TRITACE 10 mg COMPR. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 28 COMPR. P6L 28 0.669285 0.000000 0.602356 0.066929
393 W62662001 C09AA05 RAMIPRILUM RAMIPRIL ATB 10 mg COMPR. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.304000 0.000000 0.273600 0.030400
394 W62447012 C09AA05 RAMIPRILUM TRITACE 10 mg COMPR. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 90 COMPR. P6L 90 0.689777 0.000000 0.620799 0.068978
395 W64288002 C09AA05 RAMIPRILUM RAMIPRIL AUROBINDO 10 mg COMPR. 10mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC TRANSPARENT/AL X 28 COMPR. P6L 28 0.337857 0.000000 0.304071 0.033786
396 W51934002 C09AA05 RAMIPRILUM VIVACE 2,5 mg COMPR. 2,5 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7COMPR. P-6L 28 0.197699 0.021943 0.177929 0.041713
397 W64365002 C09AA05 RAMIPRILUM VIVACE 2,5 mg COMPR. 2,5 mg TEVA B.V. OLANDA CUTIE CU 4 BLIST. AL/AL X 7 COMPR. P6L 28 0.197699 0.021943 0.177929 0.041713
398 W42939001 C09AA05 RAMIPRILUM RAMIPRIL-AC 2,5 mg COMPR. 2,5mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197699 0.021967 0.177929 0.041737
399 W42970001 C09AA05 RAMIPRILUM AMPRIL 2,5 mg COMPR. 2,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.197699 0.021967 0.177929 0.041737
400 W43522001 C09AA05 RAMIPRILUM ZENRA 2,5 mg COMPR. 2,5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6L 28 0.197699 0.021943 0.177929 0.041713
401 W62451001 C09AA05 RAMIPRILUM TRITACE 2,5 mg COMPR. 2,5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 28 COMPR. P6L 28 0.197699 0.257301 0.177929 0.277071
402 W62660001 C09AA05 RAMIPRILUM RAMIPRIL ATB 2,5 mg COMPR. 2,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.189666 0.000000 0.170699 0.018967
403 W62451011 C09AA05 RAMIPRILUM TRITACE 2,5 mg COMPR. 2,5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 60 COMPR. P6L 60 0.197699 0.257634 0.177929 0.277404
404 W51932002 C09AA05 RAMIPRILUM VIVACE 5 mg COMPR. 5 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7 COMPR. P-6L 28 0.291071 0.000000 0.261963 0.029108
405 W64366002 C09AA05 RAMIPRILUM VIVACE 5 mg COMPR. 5 mg TEVA B.V. OLANDA CUTIE CU 4 BLIST. AL/AL X 7 COMPR. P6L 28 0.291071 0.000000 0.261963 0.029108

Pagina 7 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
406 W42237001 C09AA05 RAMIPRILUM RAMIPRIL-AC 5 mg COMPR. 5mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.316333 0.000000 0.284699 0.031634
407 W42971001 C09AA05 RAMIPRILUM AMPRIL 5 mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.315333 0.000000 0.283799 0.031534
408 W43523001 C09AA05 RAMIPRILUM ZENRA 5 mg COMPR. 5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6L 28 0.316428 0.000000 0.284785 0.031643
409 W62382001 C09AA05 RAMIPRILUM TRITACE 5 mg COMPR. 5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 28 COMPR. P6L 28 0.395398 0.091744 0.355858 0.131284
410 W62661001 C09AA05 RAMIPRILUM RAMIPRIL ATB 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.219666 0.000000 0.197699 0.021967
411 W62382008 C09AA05 RAMIPRILUM TRITACE 5 mg COMPR. 5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 30 COMPR. P6L 30 0.395398 0.211602 0.355858 0.251142
412 W64287005 C09AA05 RAMIPRILUM RAMIPRIL AUROBINDO 5 mg COMPR. 5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC TRANSPARENT/AL X 28 COMPR. P6L 28 0.277500 0.000000 0.249750 0.027750
413 W05345001 C09AA06 QUINAPRILUM ACCUPRO 10 mg COMPR. FILM. 10mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. PVC/AL/PA X 10 COMPR. FILM. P-6L 30 0.131799 0.380867 0.118619 0.394047
414 W64842001 C09AA06 QUINAPRILUM ACCUPRO 10 mg COMPR. FILM. 10mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. AL/PA/AL/PVC X 10 COMPR. FILM. P6L 30 0.131799 0.380867 0.118619 0.394047
415 W41466001 C09AA06 QUINAPRILUM ACCUPRO 20 mg COMPR. FILM. 20mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. AL/PA-AL-PVC X 10 COMPR. FILM. P-6L 30 0.263599 0.553401 0.237239 0.579761
416 W64840001 C09AA06 QUINAPRILUM ACCUPRO 20 mg COMPR. FILM. 20mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. AL/PA/AL/PVC X 10 COMPR. FILM. P6L 30 0.263599 0.553401 0.237239 0.579761
417 W41465001 C09AA06 QUINAPRILUM ACCUPRO 5 mg COMPR. FILM. 5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. AL/PA-AL-PVC X 10 COMPR. FILM. P-6L 30 0.065899 0.254434 0.059309 0.261024
418 W64841001 C09AA06 QUINAPRILUM ACCUPRO 5 mg COMPR. FILM. 5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. AL/PA/AL/PVC X 10 COMPR. FILM. P6L 30 0.065899 0.254434 0.059309 0.261024
419 W64284006 C09AA09 FOSINOPRILUM FOSINOPRIL AUROBINDO 10 mg COMPR. 10mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. P6L 30 0.131799 0.287867 0.118619 0.301047
420 W66866001 C09AA09 FOSINOPRILUM MONOPRIL 10 mg COMPR. 10mg BAUSCH HEALTH IRELAND LIMITED IRLANDA CUTIE CU 2 BLIST. AL/PVC/PVDC X 14 COMPR. P6L 28 0.131799 0.653558 0.118619 0.666738
421 W64285006 C09AA09 FOSINOPRILUM FOSINOPRIL AUROBINDO 20 mg COMPR. 20mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. P6L 30 0.263599 0.310734 0.237239 0.337094
422 W66867001 C09AA09 FOSINOPRILUM MONOPRIL 20 mg COMPR. 20mg IRLANDA CUTIE CU 2 BLIST. AL/PVC/PVDC X 14 COMPR.
BAUSCH HEALTH IRELAND LIMITED P6L 28 0.263599 0.819972 0.237239 0.846332
423 W01855001 C09BA02 COMBINATII (ENALAPRILUM+HYDROCHLOROTHIAZIDUM) ENAP-HL 10 mg/12,5 mg COMPR. 10mg+12,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-6L 20 0.443000 0.000000 0.398700 0.044300
424 W01854001 C09BA02 COMBINATII (ENALAPRILUM+HYDROCHLOROTHIAZIDUM) ENAP H 10 mg/25 mg COMPR. 10mg+25mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-6L 20 0.595500 0.000000 0.535950 0.059550
425 W42590001 C09BA02 COMBINATII (ENALAPRILUM+HYDROCHLOROTHIAZIDUM) ENAP-HL 20 mg/12,5 mg COMPR. 20 mg/12,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 20 0.598387 0.085613 0.538548 0.145452
426 W52320001 C09BA05 COMBINATII (RAMIPRILUM+HYDROCHLOROTHIAZIDUM) HARTIL HCT 5 mg/25mg COMPR. 5mg/25mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. PVC-PCTFE/AL X 14 COMPR. P-6L 28 0.476071 0.000000 0.428463 0.047608
427 W62429001 C09BA05 COMBINATII (RAMIPRILUM+HYDROCHLOROTHIAZIDUM) TRITACE PLUS 5 mg/25 mg COMPR. 5mg/25mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/ AL X 28 COMPR. P6L 28 0.598387 0.009113 0.538548 0.068952
428 W58235006 C09CA01 LOSARTANUM LORISTA 100 mg COMPR. FILM. 100mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0.567857 0.000000 0.511071 0.056786
429 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 0.413142 0.013524 0.371827 0.054839
430 W53260003 C09CA01 LOSARTANUM TALOSAN 50 mg COMPR. FILM. 50mg TERAPIA SA ROMANIA CUTIE CU 3 BLIST. AL/PEJD X 10 COMPR. FILM. P-6L 30 0.413142 0.013524 0.371827 0.054839
431 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 0.382500 0.000000 0.344250 0.038250
432 W60908002 C10AA01 SIMVASTATINUM SIMVASTATINA ARENA 10 mg COMPR. FILM. 10 mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.138439 0.274775 0.124595 0.288619
433 W12477002 C10AA01 SIMVASTATINUM ZEPLAN 10 mg COMPR. FILM. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM P-6L 28 0.138439 0.118703 0.124595 0.132547
434 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 0.138439 0.274561 0.124595 0.288405
435 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 0.138439 0.050846 0.124595 0.064690
436 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 0.138439 0.274561 0.124595 0.288405
437 W60907002 C10AA01 SIMVASTATINUM SIMVASTATINA ARENA 20 mg COMPR. FILM. 20 mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.276878 0.274907 0.249190 0.302595
438 W12478002 C10AA01 SIMVASTATINUM ZEPLAN 20 mg COMPR. FILM. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM P-6L 28 0.276878 0.268479 0.249190 0.296167
439 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 0.276878 0.275122 0.249190 0.302810
440 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 0.276878 0.036693 0.249190 0.064381
441 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 0.276878 0.275122 0.249190 0.302810
442 W60906002 C10AA01 SIMVASTATINUM SIMVASTATINA ARENA 40 mg COMPR. FILM. 40 mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLIST. DIN PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.553756 0.811601 0.498380 0.866977
443 W41446002 C10AA01 SIMVASTATINUM ZEPLAN 40 mg COMPR. FILM. 40mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-6L 28 0.553756 0.127672 0.498380 0.183048
444 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 0.553756 0.812577 0.498380 0.867953
445 W56961001 C10AA01 SIMVASTATINUM SIMVACARD 40 mg COMPR. FILM. 40mg ZENTIVA K.S. CEHIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.430714 0.000000 0.387642 0.043072
446 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 0.553756 0.207577 0.498380 0.262953
447 W06752001 C10AA02 LOVASTATINUM MEDOSTATIN 20 mg COMPR. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 1 BLIST. X 10 COMPR. P-6L 10 0.184585 0.955415 0.166126 0.973874
448 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 0.184585 0.918748 0.166126 0.937207
449 W43325002 C10AB05 FENOFIBRATUM LIPOFIB 160 mg CAPS. 160mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6L 30 0.859932 0.146068 0.773938 0.232062
450 W13251001 C10AB05 FENOFIBRATUM LIPIVIM 200 mg CAPS. 200mg VIM SPECTRUM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6L 30 1.074916 0.048750 0.967424 0.156242
451 W62362001 C10AB05 FENOFIBRATUM LIPANTIL NANO 145 mg COMPR. FILM. 145mg MYLAN MEDICAL SAS FRANTA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL A CATE 10 COMPR. FILM. P-6L 30 1.074916 0.286417 0.967424 0.393909
452 W68980001 C10AB05 FENOFIBRATUM LIPANTIL NANO 145 mg COMPR. FILM. 145mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL A CATE 10 COMPR. FILM. P6L 30 1.074916 0.286417 0.967424 0.393909
453 W62360002 C10AB05 FENOFIBRATUM LIPANTHYL SUPRA 160 mg COMPR. FILM. 160mg MYLAN MEDICAL SAS FRANTA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-6L 30 1.058666 0.000000 0.952799 0.105867
454 W68978002 C10AB05 FENOFIBRATUM LIPANTHYL SUPRA 160 mg COMPR. FILM. 160mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-6L 30 1.058666 0.000000 0.952799 0.105867
455 W13742001 D01AC02 MICONAZOLUM MICONAZOL SLAVIA 20 mg/g CREMA 20mg/g SLAVIA PHARM SRL ROMANIA CUTIE X 1 TUB X 20 G P-RF 1 7.228333 18.961667 6.505499 19.684501
456 W12026001 D07AA02 HYDROCORTISONUM HIDROCORTIZON ATB 10mg/g UNGUENT 10mg/g ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB DIN AL X 20 G UNGUENT P-RF 1 6.578571 3.201429 5.920713 3.859287
457 W53471001 D07AA02 HYDROCORTISONUM HIDROCORTIZON FITERMAN 10 mg/g UNGUENT 10mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB DIN AL X 20 G UNGUENT P-RF 1 6.578571 0.001429 5.920713 0.659287
458 W53471002 D07AA02 HYDROCORTISONUM HIDROCORTIZON FITERMAN 10 mg/g UNGUENT 10mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB DIN AL X 35 G UNGUENT P-RF 1 11.510000 0.000000 10.359000 1.151000
459 W53770001 D07AC01 BETAMETHASONUM BETAMETAZONA FITERMAN 0,5 mg/g CREMA 0,5mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB AL X 20 G CREMA P-RF 1 7.025000 4.405000 6.322500 5.107500
460 W53912001 D07AC01 BETAMETHASONUM EKARZIN 0,5MG/G CREMA 0,5mg/g ANTIBIOTICE S.A. ROMANIA CUTIE X 1 TUB DIN AL X 15 G CREMA P-RF 1 5.268750 4.511250 4.741875 5.038125
461 W44047001 D07AC01 BETAMETHASONUM BETADERM 1 mg/g CREMA 1mg/g E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 TUB X 20 G P-RF 1 14.050000 0.000000 12.645000 1.405000
462 W44048001 D07AC01 BETAMETHASONUM BETADERM 1mg/g UNGUENT 1mg/g E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 TUB X 20 G P-RF 1 14.050000 0.000000 12.645000 1.405000
463 W51339001 G01AF04 MICONAZOLUM GYNOZOL 200 CAPS. VAG. 200mg PHARCO IMPEX 93 S.R.L. ROMANIA CUTIE X 2 BLIST. X 3 CAPS. VAG. MOI P-RF 6 2.491666 0.000000 2.242499 0.249167
464 W51340001 G01AF04 MICONAZOLUM GYNOZOL 400 CAPS. VAG. 400mg PHARCO IMPEX 93 S.R.L. ROMANIA CUTIE X 1 BLIST. X 3 CAPS. VAG. MOI P-RF 3 4.793333 0.000000 4.313999 0.479334

Pagina 8 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
465 W60232003 G02AB03 ERGOMETRINUM MALEAT DE ERGOMETRINA ZENTIVA 0,2 mg/ml SOL. INJ. 0,2mg/ml ZENTIVA S.A. ROMANIA 5
CUTIE X 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ., CU INEL DE RUPERE P-RF 9.198000 0.000000 8.278200 0.919800
466 W62752001 G03BA03 TESTOSTERONUM * ANDROGEL 16,2 mg/g GEL 16,2mg/g BESINS HEALTHCARE BELGIA 1
CUTIE CU 1 RECIPIENT MULTIDOZA DIN PP, CARE CONTINE UN REZERVOR DIN PEJD, PREVAZUT CU UN ADAPTOR LA CARE SE CONECTEAZA O POMPA DOZATOARE CU 88 G GEL PRF 266.400000 0.000000 239.760000 26.640000
467 W63885002 G03BA03 TESTOSTERONUM * NEBIDO 1000 mg/4 ml SOL. INJ. 1000mg/4ml BAYER AG GERMANIA
CUTIE CU 1 FLAC. DIN STICLA BRUNA, CU CAPACITATEA DE 6 ML A 4 ML SOL. INJ. 1 PR/PRF 452.730000 0.000000 407.457000 45.273000
468 W66776001 G03CA03 ESTRADIOLUM * ESTRADIOL BESINS 0,75 mg/doza GEL TRANSDERMIC 0,75mg/doza BESINS HEALTHCARE SA BELGIA PRF 1
CUTIE CU 1 RECIPIENT MULTIDOZA, FORMAT DINTR-UN FLAC. DIN PP SI O POMPA DOZATOARE DIN PP CU 80 G GEL 39.170000 0.000000 35.253000 3.917000
469 W62058002 G03CA03 ESTRADIOLUM * LENZETTO 1,53 mg/doza SPRAY TRANSDERMIC, SOL. 1,53mg/doza GEDEON RICHTER ROMANIA S.A. ROMANIA P6L 1
CUTIE CU UN FLAC. DIN STICLA CARE CONTINE 6,5 ML SOL., PREVAZUT CU O POMPA DOZATOARE 49.993666 3.746334 44.994299 8.745701
470 W05539002 H01AC01 SOMATROPINUM ** GENOTROPIN 16 UI/ml (5,3 mg/ml) PULB. + SOLV. PT. SOL. INJ. 16UI/ml (5,3mg/ml) PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 CARTUS BICAMERAL MULTIDOZA CU PULB. SI SOLV. PT. SOL. INJ. P-RF 1 402.840000 43.960000 362.556000 84.244000
471 W64823002 H01AC01 SOMATROPINUM ** GENOTROPIN 16 UI/ml (5,3 mg/ml) PULB. + SOLV. PT. SOL. INJ. 16UI/ml(5,3mg/ml) PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 CARTUS BICAMERAL MULTIDOZA CARE CONTINE PULB. SI SOLV. PT. SOL. INJ. PRF 1 402.840000 43.960000 362.556000 84.244000
472 W07530001 H01AC01 SOMATROPINUM ** ZOMACTON 4 mg (12 UI) PULB. + SOLV. PT. SOL. INJ. 4mg (12ui) FERRING GMBH GERMANIA CUTIE X 1 FLAC. LIOF. PT. SOL. INJ. + 1 FIOLA X 3,5 ML SOLV. 1 PR/PRF 302.130000 164.400000 271.917000 194.613000
473 W63194001 H01AC01 SOMATROPINUM ** OMNITROPE 10 mg/1,5 ml SOL INJ. IN CARTUS 10mg/1,5ml SANDOZ GMBH AUSTRIA CUTIE X 1 CARTUS X 1,5 ML SOL.INJ. (PENTRU SUREPAL 10) 1 PR/PRF 720.130000 0.000000 648.117000 72.013000
474 W63193001 H01AC01 SOMATROPINUM ** OMNITROPE 5 mg/1,5 ml SOL INJ. IN CARTUS 5mg/1,5ml SANDOZ GMBH AUSTRIA CUTIE X 1 CARTUS X 1,5 ML SOL.INJ. (PENTRU SUREPAL 5) 1 PR/PRF 377.662499 17.597501 339.896249 55.363751
475 W55322001 H01AC01 SOMATROPINUM ** NUTROPINAq 10 mg/2 ml SOL. INJ. 10mg/2ml IPSEN PHARMA FRANTA CUTIE X 1 CARTUS X 2 ML. SOL. INJ. P-RF/R 1 755.324999 175.765001 679.792499 251.297501
476 W52345001 H01AC01 SOMATROPINUM ** OMNITROPE 3,3mg/ml SOL. INJ. 3,3mg/ml SANDOZ GMBH AUSTRIA CUTIE X 1CARTUS X 1,5 ML SOL.INJ. P-RF/R 1 377.662499 17.597501 339.896249 55.363751
477 W52346001 H01AC01 SOMATROPINUM ** OMNITROPE 6,7mg/ml SOL. INJ. 6,7mg/ml SANDOZ GMBH AUSTRIA CUTIE X 1CARTUS X 1,5 ML SOL.INJ. P-RF/R 1 720.130000 0.000000 648.117000 72.013000
478 W66036001 H01AC01 SOMATROPINUM ** SAIZEN 5,83 mg/ml SOL. INJ. IN CARTUS 5,83mg/ml MERCK ROMANIA SRL ROMANIA 1
CUTIE CU 1 CARTUS DIN STICLA CU DOP CU PISTON DIN CAUCIUC SI CAPSA DIN AL CU INSERTIE DE CAUCIUC X 1,03 ML SOL. INJ. (6 MG SOMATROPINA) PR/PRF 453.305780 177.514220 407.975202 222.844798
479 W66037003 H01AC01 SOMATROPINUM ** SAIZEN 8 mg/ml SOL. INJ. IN CARTUS 8mg/ml MERCK ROMANIA SRL ROMANIA 1
CUTIE CU 1 CARTUS DIN STICLA CU DOP CU PISTON DIN CAUCIUC SI CAPSA DIN AL CU INSERTIE DE CAUCIUC X 2,50 ML SOL. INJ. (20 MG SOMATROPINA) PR/PRF 1,161.290000 0.000000 1,045.161000 116.129000
480 W66430001 H01AC01 SOMATROPINUM ** NORDITROPIN NORDIFLEX 10 mg/1,5 ml 6,7mg/ml
SOL. INJ. IN STILOU INJ. PREUMPLUT NOVO NORDISK A/S DANEMARCA CUTIE CU 1 STILOU INJ. PREUMPLUT MULTIDOZA X 1,5 ML SOL. INJ. PRF 1 755.324999 198.835001 679.792499 274.367501
481 W08307001 H02AB04 METHYLPREDNISOLONUM * LEMOD SOLU 125 mg 125mg
PULB+SOLV. PT. SOL. INJ./PERF. STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. X 2 ML PRF 1 27.447500 8.842500 24.702750 11.587250
482 W08310001 H02AB04 METHYLPREDNISOLONUM * LEMOD SOLU 500 mg 500mg
PULB+SOLV. PT. SOL. INJ./PERF. STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. X 7,8 ML PRF 1 98.000000 0.000000 88.200000 9.800000
483 W05242001 H02AB07 PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.175000 0.000000 0.157500 0.017500
484 W12565002 H02AB07 PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.000000 0.157500 0.017500
485 W13686002 H02AB07 PREDNISONUM PREDNISON SINTOFARM 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.000000 0.157500 0.017500
486 W53341001 H02AB07 PREDNISONUM PREDNISONA-RICHTER 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COMPR. P-RF 20 0.175000 0.000000 0.157500 0.017500
487 W68137001 H02AB09 HYDROCORTISONUM * HYDROCORTISONE ROUSSEL 10 mg COMPR. 10mg BIO EEL S.R.L. ROMANIA CUTIE CU 1 BLIST. X 25 COMPR. PRF 25 1.035600 0.000000 0.932040 0.103560
488 W68176001 H02AB09 HYDROCORTISONUM * ALKINDI 0,5 mg 0,5mg DIURNAL EUROPE B.V OLANDA CUTIE CU UN FLACON X 50 CAPSULE
GRANULE AMBALATE ÎN CAPSULE CARE TREBUIE DESCHISE PRF 50 2.601428 0.784972 2.341285 1.045115
489 W68177001 H02AB09 HYDROCORTISONUM * ALKINDI 1 mg 1mg DIURNAL EUROPE B.V OLANDA CUTIE CU UN FLACON X 50 CAPSULE
GRANULE AMBALATE ÎN CAPSULE CARE TREBUIE DESCHISE PRF 50 5.203012 1.570188 4.682710 2.090490
490 W68178001 H02AB09 HYDROCORTISONUM * ALKINDI 2 mg 2mg DIURNAL EUROPE B.V OLANDA CUTIE CU UN FLACON X 50 CAPSULE
GRANULE AMBALATE ÎN CAPSULE CARE TREBUIE DESCHISE PRF 50 10.406025 2.006375 9.365422 3.046978
491 W68179001 H02AB09 HYDROCORTISONUM * ALKINDI 5 mg 5mg DIURNAL EUROPE B.V OLANDA CUTIE CU UN FLACON X 50 CAPSULE
GRANULE AMBALATE ÎN CAPSULE CARE TREBUIE DESCHISE PRF 50 26.015220 2.890580 23.413698 5.492102
492 W58639001 H02AB09 HYDROCORTISONUM * HIDROCORTIZON HF 500 mg 500mg
PULB. + SOLV. PT. SOL. INJ./PERF. STADA HEMOFARM S.R.L. ROMANIA 1
CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 20 ML, INCHIS CU DOP DIN CAUCIUC GRI, ETANSAT CU CAPSA DIN ALUMINIU, CONTINAND PULB. PT. SOL. INJ./PERF. SI 1 FIOLA CU 4 ML SOLV. PR/PRF 40.630000 0.000000 36.567000 4.063000
493 W66429001 H02AB09 HYDROCORTISONUM * HIDROCORTIZON ROMPHARM 100 mg PULB. PT. SOL. INJ./PERF. 100mg S.C. ROMPHARM COMPANY S.R.L ROMANIA PRF 1
CUTIE CU 1 FLAC. DIN STICLA INCHIS CU DOP DIN CAUCIUC BROMOBUTILIC SI SIGILAT CU CAPAC DIN PLASTIC SI CAPSA DETASABILA DIN AL X PULB. PT. SOL. INJ./PERF. 9.030000 0.000000 8.127000 0.903000
494 W58638001 H02AB09 HYDROCORTISONUM * HIDROCORTIZON HF 100 mg 100mg
PULB. SI SOLV. PT. SOL. INJ./PERF. STADA HEMOFARM S.R.L. ROMANIA 1
CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 5 ML, INCHIS CU DOP DIN CAUCIUC GRI, ETANSAT CU CAPSA DE ALUMINIU, CONTINAND PULB. PT. SOL.INJ./PERF. SI O FIOLA CU 2 ML SOLV. PR/PRF 9.030000 0.000000 8.127000 0.903000
495 W44080001 H02AB09 HYDROCORTISONUM * HYDROCORTISONE SUCCINAT SODIC EIPICO 100 mg 100mg
PULB+SOLV. PT. SOL. INJ./PERF. E.I.P.I.CO. MED S.R.L. ROMANIA PRF 1
CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU DOP DIN CAUCIUC BUTILIC, SIGILAT CU O CAPSA DIN AL ACOPERITA CU UN DISC DE PP DE CULOARE PORTOCALIU DESCHIS CONTINAND PULB. PENTRU SOL. INJ. + FIOLA DIN STICLA INCOLORA A 2 ML SOLV. PREVAZUTA CU INEL DE RUPERE 9.030000 0.000000 8.127000 0.903000
496 W51922003 H02AB09 HYDROCORTISONUM * HIDROCORTIZON ZENTIVA 19.6mg/5ml SOL. INJ. 19,6mg/5ml ZENTIVA S.A. ROMANIA PRF 5
CUTIE CU 5 FIOLE DIN STICLA INCOLORA, CU CAPACITATEA DE 5 ML (CU INEL DE RUPERE SAU PUNCT DE RUPERE) X 1 ML SOL. A + 5 FIOLE DIN STICLA BRUNA CU CAPACITATEA DE 5ML (CU INEL DE RUPERE SAU PUNCT DE RUPERE) X 4 ML SOL. B 2.364957 4.635043 2.128461 4.871539
497 W56642001 J01AA02 DOXYCYCLINUM DOXICICLINA ATB 100 mg CAPS. 100 mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 0.530000 0.000000 0.477000 0.053000
498 W02885004 J01AA02 DOXYCYCLINUM DOXICICLINA ARENA 100 mg CAPS. 100mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.531000 0.000000 0.477900 0.053100
499 W00347001 J01CA04 AMOXICILLINUM AMOXICILINA ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.469000 0.000000 0.422100 0.046900
500 W00346001 J01CA04 AMOXICILLINUM AMOXICILINA ATB 250 mg CAPS. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.508500 0.370000 0.457650 0.420850
501 W00351001 J01CA04 AMOXICILLINUM AMOXICILINA ATB 500 mg CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 0.602383 0.172617 0.542144 0.232856
502 W08428003 J01CA04 AMOXICILLINUM AMOXICILINA FORTE FARMEX 500 mg CAPS. 500mg FARMEX COMPANY SRL ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-RF 10 0.602383 0.172617 0.542144 0.232856
503 W08428001 J01CA04 AMOXICILLINUM AMOXICILINA FORTE FARMEX 500 mg CAPS. 500mg FARMEX COMPANY SRL ROMANIA CUTIE X 2 BLIST. X 10 CAPS. P-RF 20 0.602383 0.172117 0.542144 0.232356
504 W13739001 J01CA04 AMOXICILLINUM AMOXICILINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 5 CAPS. P-RF 10 0.602383 0.170617 0.542144 0.230856
505 W13739003 J01CA04 AMOXICILLINUM AMOXICILINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. PRF 100 0.602383 0.033217 0.542144 0.093456
506 W41600001 J01CA04 AMOXICILLINUM OSPAMOX 1000 mg COMPR. FILM. 1000mg SANDOZ GMBH AUSTRIA CUTIE 2 BLIST. PVC-PVDC/AL X 6 COMPR. FILM. P-RF 12 1.051666 0.000000 0.946499 0.105167
507 W41578001 J01CA04 AMOXICILLINUM OSPAMOX 500 mg COMPR. FILM. 500mg SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. PVC-PVDC/AL X 6 COMPR.FILM. P-RF 12 0.569166 0.000000 0.512249 0.056917
508 W41580002 J01CA04 AMOXICILLINUM OSPAMOX 125 mg/5 ml PULB. PT. SUSP. ORALA 125mg/5ml SANDOZ GMBH AUSTRIA CUTIE X 1 FLAC. X 5,1 G PULB. PT. 60 ML SUSP. ORALA + O LINGURITA DOZATOARE P-RF 1 3.050999 4.519001 2.745899 4.824101
509 W00388002 J01CA04 AMOXICILLINUM OSPAMOX 250 mg/5 ml PULB. PT. SUSP. ORALA 250mg/5ml SANDOZ GMBH AUSTRIA CUTIE X 1 FLAC. X 6,6 G PULB. PT. 60 ML SUSP. ORALA + O LINGURITA DOZATOARE P-RF 1 6.101999 0.158001 5.491799 0.768201
510 W41595001 J01CE02 PHENOXYMETHYLPENICILLINUM OSPEN 1000 COMPR. FILM. 1000000ui SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. AL/PVC-PVDC X 12 COMPR. FILM. P-RF 12 0.643333 0.016667 0.578999 0.081001
511 W41594003 J01CE02 PHENOXYMETHYLPENICILLINUM OSPEN 1500 COMPR. FILM. 1500000ui SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. AL/PVC-PVDC X 6 COMPR. FILM. P-RF 12 0.890000 0.000000 0.801000 0.089000
512 W41596001 J01CE02 PHENOXYMETHYLPENICILLINUM OSPEN 500 COMPR. FILM. 500000ui SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. AL/PVC-PVDC X 12 COMPR. FILM. P-RF 12 0.321666 0.034167 0.289499 0.066334
513 W55413001 J01CE02 PHENOXYMETHYLPENICILLINUM OSPEN 400.000 U.I./5 ml SUSP. ORALA 400.000U.I./5ml SANDOZ GMBH AUSTRIA P-RF 1
CUTIE CU 1 FLAC. DIN STICLA BRUNA X 60 ML SUSP. ORALA CU CAPAC SI LINGURITA DOZATOARE 0.428888 10.941112 0.385999 10.984001
514 W55416003 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA P-RF 1
CUTIE CU 1 FLAC. DIN STICLA INCOLORA, CAPACITATE 10 ML CONTINAND PULB. PT. SUSP. INJ. I.M. 18.833325 28.186675 16.949992 30.070008
515 W55416001 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA PRF 50
CUTIE CU 50 FLAC. DIN STICLA INCOLORA, CAPACITATE 10 ML CONTINAND PULB. PT. SUSP. INJ. I.M. 18.833325 14.701475 16.949992 16.584808
516 W55416002 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA P-RF 100
CUTIE CU 100 FLAC. DIN STICLA INCOLORA, CAPACITATE 10 ML CONTINAND PULB. PT. SUSP. INJ. I.M. 18.833325 13.992775 16.949992 15.876108
517 W55416004 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA PRF 10
CUTIE CU 10 FLAC. DIN STICLA INCOLORA, CAPACITATE 10 ML CONTINAND PULB. PT. SUSP. INJ. I.M. 18.833325 20.311675 16.949992 22.195008
518 W04675002 J01CF04 OXACILLINUM OXACILINA ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.468465 0.040535 0.421618 0.087382
519 W11729001 J01CF04 OXACILLINUM OXACILINA ATB 250 mg CAPS. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.468465 0.410035 0.421618 0.456882
520 W07274001 J01CF04 OXACILLINUM OXACILINA ATB 500 mg CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-RF 10 0.936930 0.055070 0.843237 0.148763
521 W13743001 J01CF04 OXACILLINUM OXACILINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 0.936930 0.055070 0.843237 0.148763
522 W12910001 J01CF04 OXACILLINUM OXACILINA FORTE 500 mg CAPS. 500mg FARMEX COMPANY SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. P-RF 20 0.936930 0.055570 0.843237 0.149263
523 W12910003 J01CF04 OXACILLINUM OXACILINA FORTE 500 mg CAPS. 500mg FARMEX COMPANY S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 0.936930 0.055070 0.843237 0.148763

Pagina 9 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
524 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 9.954000 0.000000 8.958600 0.995400
525 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 10.808250 2.971750 9.727425 4.052575
526 W60469003 J01CF04 OXACILLINUM OXACILINA ATB 1000 mg PULB. PT. SOL. INJ./PERF. 1000mg ANTIBIOTICE SA ROMANIA CUTIE CU 100 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 100 9.245700 0.000000 8.321130 0.924570
527 W60469004 J01CF04 OXACILLINUM OXACILINA ATB 1000 mg PULB. PT. SOL. INJ./PERF. 1000mg ANTIBIOTICE SA ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. PRF 10 10.808250 0.284750 9.727425 1.365575
528 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 5.404125 1.916475 4.863712 2.456888
529 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 5.404125 4.165875 4.863712 4.706288
530 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 5.404125 1.246275 4.863712 1.786688
531 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 5.404125 2.316875 4.863712 2.857288
532 W00400003 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 2 x 1000 mg COMPR. FILM. 1000mg LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 2 BLIST. AL/AL X 7 COMPR.FILM. P-RF 14 1.225714 0.000000 1.103142 0.122572
533 W68990002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 875 mg/125 mg COMPR. FILM. 1000mg LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE CU 2 BLIST. AL/AL X 7 COMPR.FILM. PRF 14 1.225714 0.000000 1.103142 0.122572
534 W65088002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 500 mg/125 mg COMPR. FILM. 500mg/125mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 2 BLIST. PVC-PVDC/AL X 7 COMPR. FILM., FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTOARE DIN AL LAMINAT PRF 14 0.700408 0.848163 0.630367 0.918204
535 W69672008 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 500 mg/125 mg COMPR. FILM. 500mg/125mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 0.700408 0.052449 0.630367 0.122490
536 W59497004 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM ENHANCIN 875 mg/125 mg COMPR. FILM. 875mg/125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL INTRODUSE IN PUNGI DE POLIESTER/AL/POLIESTER/PE X 14 COMPR. FILM. PRF 14 1.225714 0.000000 1.103142 0.122572
537 W59497007 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM ENHANCIN 875 mg/125 mg COMPR. FILM. 875mg/125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL INTRODUSE IN PUNGI DE POLIESTER/AL/POLIESTER/PE X 21 COMPR. FILM. PRF 21 1.225714 0.000476 1.103142 0.123048
538 W64212008 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXICILINA/ACID CLAVULANIC AUROBINDO 875 mg/125 mg COMPR. FILM. 875mg/125mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1.075000 0.000000 0.967500 0.107500
539 W65089001 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 875 mg/125 mg COMPR. FILM. 875mg/125mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 2 BLIST. PVC-PVDC/AL X 7 COMPR. FILM., FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTOARE DIN AL LAMINAT PRF 14 1.225714 0.667143 1.103142 0.789715
540 W69673008 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 875 mg/125 mg COMPR. FILM. 875mg/125mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 1.225714 0.000000 1.103142 0.122572
541 W62046002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV QUICKTAB 625 mg COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE 625mg SANDOZ S.R.L. ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-RF 14 0.700408 0.815306 0.630367 0.885347
542 W00399001 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 156,25mg/5ml PULB. PT. SUSP. ORALA 156,25mg/5ml LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 1 FLAC. DIN STICLA BRUNA CU 25 MG PULB. PT. 100 ML SUSP. ORALA P-RF 1 9.316071 4.493929 8.384463 5.425537
543 W08783002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, TIP III, CU PULB. PT. 70 ML SUSP. ORALA + SERINGA DOZATOARE CU MARCAJE PT. MASURAREA VOLUMELOR (1,25; 2,5 SI 5 ML) P-RF 1 17.070000 0.000000 15.363000 1.707000
544 W64190005 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN FP 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml GLAXOSMITHKLINE (GSK) SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA CARE CONTINE PULB. PT 70 ML SUSP. ORALA SI O LINGURITA PRF 1 20.868000 2.842000 18.781200 4.928800
545 W67768003 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN FP 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml GLAXOSMITHKLINE TRADING SERVICES LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA (DE CAPACITATE 147ML)CARE CONTINE PULB. PT 70 ML SUSP. ORALA SI O SERINGA PT. ADMINISTRARE ORALA PRF 1 20.868000 2.842000 18.781200 4.928800
546 W67768004 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN FP 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml GLAXOSMITHKLINE TRADING SERVICES LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA (DE CAPACITATE 147ML) CARE CONTINE PULB. PT 70 ML SUSP. ORALA SI O LINGURITA PRF 1 20.868000 2.842000 18.781200 4.928800
547 W65099003 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN ES 600mg/42,9 mg/5 ml PULB. PT. SUSP. ORALA 600 mg/42,9mg/5ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA CONTINÂND PULB. PENTRU 100 ML SUSPENSIE SI O LINGURITA DOZATOARE DIN POLISTIREN, MARCAT CU GRADATII PT. MASURAREA VOLUMELOR 2,5 ML SI 5,0 ML PRF 1 44.717142 2.712858 40.245427 7.184573
548 W67567002 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 600 mg/42,9 mg/5 ml PULB. PT. SUSP. ORALA 600mg/42,9mg/5ml SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA CU CAPACITATEA DE 180 ML SI PREVAZUTA CU PIPETA DOZATOARE CU PISTON DIN POLISTIREN SI CORP DIN PEJD MARCATA DE LA 0,4 ML PANA LA 5 ML CU 33,10 G PULB. PT. SUSP. ORALA PRF 1 35.160000 0.000000 31.644000 3.516000
549 W00402001 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 312,5mg/5ml PULB. PT.SUSP. ORALA 312,5mg/5ml LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE CU 1 FLAC. DIN STICLA BRUNA SI SERINGA DOZATOARE CU MARCAJE DE LA 0,4 LA 5 ML CONTINAND 25 MG PULB. PT. 100 ML SUSP. RECONSTITUITA P-RF 1 18.632142 5.587858 16.768927 7.451073
550 W12083001 J01DB01 CEFALEXINUM CEFALEXINA ATB 250 mg CAPS. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 CAPS. P-RF 20 0.695500 0.099500 0.625950 0.169050
551 W12084001 J01DB01 CEFALEXINUM CEFALEXINA ATB 500 mg CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-RF 10 1.391000 0.000000 1.251900 0.139100
552 W06883003 J01DB01 CEFALEXINUM CEFALEXINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. PVC/AL X 10 CAPS. P-RF 10 1.391000 0.000000 1.251900 0.139100
553 W44127002 J01DB01 CEFALEXINUM KEFLEX (R) 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml ACTAVIS GROUP HF ISLANDA CUTIE X 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + LINGURITA DOZATOARE P-RF 1 13.880000 0.000000 12.492000 1.388000
554 W64364001 J01DB01 CEFALEXINUM KEFLEX 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml TEVA B.V. OLANDA CUTIE CU 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + LINGURITA DOZATOARE PRF 1 13.880000 0.000000 12.492000 1.388000
555 W55436001 J01DB05 CEFADROXILUM CEFORAN 500 mg CAPS. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. P-RF 10 1.391000 1.244000 1.251900 1.383100
556 W65111001 J01DC02 CEFUROXIMUM ZINNAT 125 mg COMPR. FILM. 125mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. PRF 10 1.633000 0.000000 1.469700 0.163300
557 W12657001 J01DC02 CEFUROXIMUM ZINNAT (R) 250 mg COMPR. FILM. 250mg GLAXOWELLCOME UK LTD. MAREA BRITANIE CUTIE X 1 BLIST. X, 10 COMPR.FILM P-RF 10 1.489500 0.447500 1.340550 0.596450
558 W62257003 J01DC02 CEFUROXIMUM CEFUROXIMA AUROBINDO 250 mg COMPR. FILM. 250mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 10 COMPR. FILM. PRF 10 1.222000 0.000000 1.099800 0.122200
559 W65112001 J01DC02 CEFUROXIMUM ZINNAT 250 mg COMPR. FILM. 250mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. PRF 10 1.489500 0.447500 1.340550 0.596450
560 W69576003 J01DC02 CEFUROXIMUM CEFUROXIMA AUROBINDO 250 mg COMPR. FILM. 250mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 10 COMPR. FILM. PR/PRF 10 0.744750 0.648250 0.670275 0.722725
561 W12659001 J01DC02 CEFUROXIMUM ZINNAT (R) 500 mg COMPR. FILM. 500mg GLAXOWELLCOME UK LTD. MAREA BRITANIE CUTIE X 1 BLIST. X 10 COMPR.FILM P-RF 10 2.979000 0.331000 2.681100 0.628900
562 W62258003 J01DC02 CEFUROXIMUM CEFUROXIMA AUROBINDO 500 mg COMPR. FILM. 500mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 10 COMPR. FILM. PRF 10 2.083000 0.000000 1.874700 0.208300
563 W65113001 J01DC02 CEFUROXIMUM ZINNAT 500 mg COMPR. FILM. 500mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-RF 10 2.979000 0.331000 2.681100 0.628900
564 W69577003 J01DC02 CEFUROXIMUM CEFUROXIMA AUROBINDO 500 mg COMPR. FILM. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 10 COMPR. FILM. PR/PRF 10 1.489500 0.884500 1.340550 1.033450
565 W65114001 J01DC02 CEFUROXIMUM ZINNAT 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA BRUNA CONTINAND GRANULE PT. 50 ML SUSP. ORALA + 1 MASURA DOZATOARE A 5 ML PRF 1 16.472500 0.047500 14.825250 1.694750
566 W00985003 J01DC04 CEFACLORUM CEFACLOR ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 0.744750 1.260250 0.670275 1.334725
567 W56967001 J01DC04 CEFACLORUM CEFACLOR TERAPIA 250 mg CAPS. 250mg TERAPIA SA ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 15 CAPS. P-RF 15 0.744750 1.260583 0.670275 1.335058
568 W55271001 J01DC04 CEFACLORUM CEFACLOR ARENA 500 mg CAPS. 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 1.489500 2.081500 1.340550 2.230450
569 W56966001 J01DC04 CEFACLORUM CEFACLOR TERAPIA 500 mg CAPS. 500mg TERAPIA SA ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 15 CAPS. P-RF 15 1.489500 1.863833 1.340550 2.012783
570 W56969001 J01DC04 CEFACLORUM CEFACLOR TERAPIA 125mg/5ml GRAN. PT. SUSP. ORALA 125mg/5ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID CU GRAN.PT. 75 ML SUSP.ORALA P-RF 1 12.354375 21.645625 11.118937 22.881063
571 W56968001 J01DC04 CEFACLORUM CEFACLOR TERAPIA 250mg/5ml GRAN. PT. SUSP. ORALA 250 mg/5 ml TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID CU GRAN. PT. 75 ML SUSP. ORALA P-RF 1 22.880000 0.000000 20.592000 2.288000
572 W44129002 J01DC04 CEFACLORUM CECLOR (R) 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml ACTAVIS GROUP HF ISLANDA CUTIE X 1 FLAC. PEID DE CULOARE ALBA, CU GRANULE PT. 75 ML SUSP. ORALA + 1 LINGURITA DOZATOARE P-RF 1 24.708750 5.471250 22.237875 7.942125
573 W64369001 J01DC04 CEFACLORUM CECLOR 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml TEVA B.V. OLANDA CUTIE CU 1 FLAC. PEID CONTINAND GRANULE PT. 75 ML SUSP. ORALA + 1 LINGURITA DOZATOARE DIN POLISTIREN PRF 1 24.708750 5.471250 22.237875 7.942125
574 W12210001 J01DC04 CEFACLORUM CEFAKLOR 125 mg/5 ml PULB. PT. SUSP. ORALA 125mg/5ml STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. PULB. PT. 60 ML SUSP. ORALA + O MASURA DOZATOARE P-RF 1 9.883500 7.216500 8.895150 8.204850
575 W51321001 J01DC04 CEFACLORUM CEFAKLOR 250 mg/5 ml PULB. PT. SUSP. ORALA 250mg/5ml STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. PULB. PT. 60 ML SUSP. ORALA + O MASURA DOZATOARE P-RF 1 19.767000 13.003000 17.790300 14.979700
576 W57455001 J01DD08 CEFIXIMUM EFICEF 100 mg CAPS. 100mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 2.574750 0.276250 2.317275 0.533725
577 W13701001 J01DD08 CEFIXIMUM EFICEF 200 mg CAPS. 200mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 5.149500 0.069500 4.634550 0.584450
578 W68974005 J01DD08 CEFIXIMUM CEFIXIMA STADA 200 mg COMPR. FILM. 200mg STADA M&D SRL ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 10 COMPR. FILM. PRF 10 5.080000 0.000000 4.572000 0.508000
579 W60256001 J01DD08 CEFIXIMUM XIFIA 400mg COMPR. FILM. 400mg INN-FARM D.O.O. SLOVENIA CUTIE CU UN BLISTER PVC-PVDC/AL X 5 COMPRIMATE FILMATE PRF 5 10.299000 1.695000 9.269100 2.724900
580 W60256003 J01DD08 CEFIXIMUM XIFIA 400mg COMPR. FILM. 400mg INN-FARM D.O.O. SLOVENIA CUTIE CU 2 BLISTERE PVC-PVDC/AL A CATE 5 COMPRIMATE FILMATE PRF 10 10.299000 0.346000 9.269100 1.375900
581 W68975007 J01DD08 CEFIXIMUM CEFIXIMA STADA 400 mg COMPR. FILM. 400mg STADA M&D SRL ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 10 COMPR. FILM. PRF 10 8.662000 0.000000 7.795800 0.866200
582 W61965002 J01DD08 CEFIXIMUM XIFIA 100 mg/5 ml GRANULE PT. SUSP. ORALA 100mg/5ml INN-FARM D.O.O. SLOVENIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, CU CAPCITATEA DE 150 ML CARE CONTINE 53 G GRAN. PT. SUSP. ORALA+1 MASURA DOZATOARE DIN PP PT. MASURAREA VOLUMULUI DE SOLVENT GRADATA LA 66 ML+1 SERINGA DOZATOARE DIN PLASTIC A 5 ML, GRADATA DE LA 0,5 ML PANA LA 5 ML PRF 1 51.495000 45.215000 46.345500 50.364500

Pagina 10 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
583 W05741001 J01EE01 SULFAMETHOXAZOLUM + TRIMETHOPRIMUM TAGREMIN COMPR. 400mg/80mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.510000 0.000000 0.459000 0.051000
584 W05738001 J01EE01 SULFAMETHOXAZOLUM + TRIMETHOPRIMUM SUMETROLIM 400 mg/80 mg COMPR. 400mg/80mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.510000 0.000000 0.459000 0.051000
585 W44046001 J01EE01 SULFAMETHOXAZOLUM + TRIMETHOPRIMUM EPITRIM 200 mg/40 mg/5 ml SUSP. ORALA 200mg/40mg /5ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLACON DIN STICLA BRUNA CU MASURA DOZATOARE X 100 ML P-RF 1 17.570000 0.000000 15.813000 1.757000
586 W05739001 J01EE01 SULFAMETHOXAZOLUM + TRIMETHOPRIMUM SUMETROLIM 25mg/ml+5mg/ml SUSP. ORALA 25mg/ml+5mg/ml EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLACON DIN STICLA BRUNA X 100 ML SUSP. ORALA + MASURA DOZATOARE P-RF 1 11.760937 2.339063 10.584843 3.515157
587 W61210001 J01FA01 ERYTHROMYCINUM ERITROMICINA ATB 200 mg COMPR. 200mg ANTIBIOTICE SA ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0.563142 0.361358 0.506827 0.417673
588 W41838002 J01FA09 CLARITHROMYCINUM FROMILID UNO 500 mg COMPR. CU ELIB. PREL. 500mg KRKA D.D. SLOVENIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 7 COMPR. ELIB. PREL. P-RF 7 2.815713 0.290001 2.534141 0.571573
589 W68970001 J01FA09 CLARITHROMYCINUM KLACID SR 500 mg COMPR. CU ELIB. PREL. 500mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 BLIST. PVC/PVDC/AL X 5 COMPR. ELIB. PREL. PRF 5 2.815713 0.562287 2.534141 0.843859
590 W63492001 J01FA09 CLARITHROMYCINUM KLACID SR 500 mg COMPR. ELIB. PREL. 500mg MYLAN PRODUCTS LIMITED MAREA BRITANIE CUTIE CU 1 BLIST. PVC/PVDC/AL X 5 COMPR. ELIB. PREL. PRF 5 2.815713 0.562287 2.534141 0.843859
591 W65279001 J01FA09 CLARITHROMYCINUM KLACID SR 500 mg COMPR. ELIB. PREL. 500mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 1 BLIST. PVC/PVDC/AL X 5 COMPR. ELIB. PREL. PRF 5 2.815713 0.562287 2.534141 0.843859
592 W14043001 J01FA09 CLARITHROMYCINUM KLERIMED 250 mg COMPR. FILM. 250mg MEDOCHEMIE LTD. CIPRU CUTIE X 2 BLIST. AL/PVC-PVDC X 7 COMPR. FILM. P-RF 14 1.407856 0.062858 1.267070 0.203644
593 W44093001 J01FA09 CLARITHROMYCINUM KLABAX 250 mg COMPR. FILM. 250mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC X 14 COMPR. FILM. P-RF 14 1.407856 0.204286 1.267070 0.345072
594 W08490001 J01FA09 CLARITHROMYCINUM FROMILID 250 mg COMPR. FILM. 250mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. PVC-PVDC/AL X 7 COMPR. FILM. P-RF 14 1.407856 0.167858 1.267070 0.308644
595 W62390002 J01FA09 CLARITHROMYCINUM KLACID 250 mg COMPR. FILM. 250mg BGP PRODUCTS S.R.L. ITALIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. PRF 14 1.407856 0.647144 1.267070 0.787930
596 W65820002 J01FA09 CLARITHROMYCINUM KLACID 250 mg COMPR. FILM. 250mg MYLAN ITALIA S.R.L. ITALIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. PRF 14 1.407856 0.647144 1.267070 0.787930
597 W68967002 J01FA09 CLARITHROMYCINUM KLACID 250 mg COMPR. FILM. 250mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. PRF 14 1.407856 0.647144 1.267070 0.787930
598 W14044001 J01FA09 CLARITHROMYCINUM KLERIMED 500 mg COMPR. FILM. 500mg MEDOCHEMIE LTD. CIPRU CUTIE X 2 BLIST. AL/PVC-PVDC X 7 COMPR. FILM. P-RF 14 2.359285 0.000000 2.123356 0.235929
599 W44087001 J01FA09 CLARITHROMYCINUM KLABAX 500 mg COMPR. FILM. 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC X 14 COMPR. FILM. P-RF 14 2.315714 0.000000 2.084142 0.231572
600 W08491001 J01FA09 CLARITHROMYCINUM FROMILID 500 mg COMPR. FILM. 500mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. PVC-PVDC/AL X 7 COMPR. FILM. P-RF 14 2.402857 0.000000 2.162571 0.240286
601 W54044001 J01FA09 CLARITHROMYCINUM ROCLARIN 500 mg COMPR. FILM. 500mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 20 2.213000 0.000000 1.991700 0.221300
602 W60254003 J01FA09 CLARITHROMYCINUM LEKOKLAR 500 mg COMPR. FILM. 500mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 14 COMPR. FILM. PRF 14 1.935000 0.000000 1.741500 0.193500
603 W62389001 J01FA09 CLARITHROMYCINUM KLACID 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml BGP PRODUCTS S.R.L. ITALIA CUTIE CU 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + 1 LINGURITA DOZATOARE X 2,5 ML/5 ML PRF 1 18.154799 4.545201 16.339319 6.360681
604 W65821001 J01FA09 CLARITHROMYCINUM KLACID 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml MYLAN ITALIA S.R.L. ITALIA CUTIE CU 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + 1 LINGURITA DOZATOARE X 2,5 ML/5 ML PRF 1 18.154799 4.545201 16.339319 6.360681
605 W66370001 J01FA09 CLARITHROMYCINUM KLABAX 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml TERAPIA SA ROMANIA CUTIE CU 1 FLACON CU 41,66 - 46,04 G GRANULE PENTRU PREPARAREA A 60 ML DE SUSPENSIE ORALA PRF 1 16.350000 0.000000 14.715000 1.635000
606 W68969001 J01FA09 CLARITHROMYCINUM KLACID 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 FLAC. PEID CU GRANULE PT. 60 ML SUSP. ORALA + 1 LINGURITA DOZATOARE X 2,5 ML/5 ML PRF 1 18.154799 4.545201 16.339319 6.360681
607 W62389002 J01FA09 CLARITHROMYCINUM KLACID 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml BGP PRODUCTS S.R.L. ITALIA CUTIE CU 1 FLAC. PEID CU GRANULE PT. 100 ML SUSP. ORALA + 1 LINGURITA DOZATOARE X 2,5 ML/5 ML PRF 1 30.258000 3.362000 27.232200 6.387800
608 W65821002 J01FA09 CLARITHROMYCINUM KLACID 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml MYLAN ITALIA S.R.L. ITALIA CUTIE CU 1 FLAC. PEID CU GRANULE PT. 100 ML SUSP. ORALA + 1 LINGURITA DOZATOARE X 2,5 ML/5 ML PRF 1 30.258000 3.362000 27.232200 6.387800
609 W66370002 J01FA09 CLARITHROMYCINUM KLABAX 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml TERAPIA SA ROMANIA CUTIE CU 1 FLACON CU 69,44 - 76,75 G GRANULE PENTRU PREPARAREA A 100 ML DE SUSPENSIE ORALA PRF 1 24.840000 0.000000 22.356000 2.484000
610 W68969002 J01FA09 CLARITHROMYCINUM KLACID 125 mg/5 ml GRAN. PT. SUSP. ORALA 125mg/5ml VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 FLAC. PEID CU GRANULE PT. 100 ML SUSP. ORALA + 1 LINGURITA DOZATOARE X 2,5 ML/5 ML PRF 1 30.258000 3.362000 27.232200 6.387800
611 W66369002 J01FA09 CLARITHROMYCINUM KLABAX 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml TERAPIA SA ROMANIA CUTIE CU 1 FLACON CU 69,44 - 76,75 G GRANULE PENTRU PREPARAREA A 100 ML DE SUSPENSIE ORALA PRF 1 60.516000 2.934000 54.464400 8.985600
612 W66369001 J01FA09 CLARITHROMYCINUM KLABAX 250 mg/5 ml GRAN. PT. SUSP. ORALA 250mg/5ml TERAPIA SA ROMANIA CUTIE CU 1 FLACON CU 41,66 - 46,04 G GRANULE PENTRU PREPARAREA A 60 ML DE SUSPENSIE ORALA PRF 1 36.309599 4.250401 32.678639 7.881361
613 W62343001 J01FA09 CLARITHROMYCINUM KLACID I.V. 500 mg PULB. PT. CONC. PT. SOL. PERF. 500mg MYLAN MEDICAL SAS FRANTA CUTIE CU 1 FLAC. DIN STICLA INCOLORA I, DE CAPACITATE 15 ML CONTINAND PULB. PT. CONC. PT. SOL. PERF. PRF 1 20.758000 26.582000 18.682200 28.657800
614 W68968001 J01FA09 CLARITHROMYCINUM KLACID I.V. 500 mg PULB. PT. CONC. PT. SOL. PERF. 500mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA INCOLORA I, DE CAPACITATE 15 ML CONTINAND PULB. PT. CONC. PT. SOL. PERF. PRF 1 20.758000 26.582000 18.682200 28.657800
615 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 1.597050 1.049950 1.437345 1.209655
616 W56957001 J01MA01 OFLOXACINUM OFLOXIN 200 mg COMPR. FILM. 200mg ZENTIVA K.S. CEHIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.597050 1.049950 1.437345 1.209655
617 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 1.597050 1.049950 1.437345 1.209655
618 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 0.319410 4.313590 0.287469 4.345531
619 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 0.798525 0.004475 0.718672 0.084328
620 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 0.798525 0.102475 0.718672 0.182328
621 W01288001 J01MA02 CIPROFLOXACINUM CIPROLEN 250 mg COMPR. FILM. 250mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.798525 0.116475 0.718672 0.196328
622 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 0.798525 0.116475 0.718672 0.196328
623 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 0.798525 0.116475 0.718672 0.196328
624 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 0.798525 0.116975 0.718672 0.196828
625 W65056001 J01MA02 CIPROFLOXACINUM CIFRAN 250 mg COMPR. FILM. 250mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. PRF 10 0.798525 0.116475 0.718672 0.196328
626 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 0.798525 0.004475 0.718672 0.084328
627 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 1.354000 0.000000 1.218600 0.135400
628 W44076001 J01MA02 CIPROFLOXACINUM CIPROCIN 500 mg COMPR. FILM. 500mg E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 10 1.533000 0.000000 1.379700 0.153300
629 W01289001 J01MA02 CIPROFLOXACINUM CIPROLEN 500 mg COMPR. FILM. 500mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.597050 0.149950 1.437345 0.309655
630 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 1.597050 0.149950 1.437345 0.309655
631 W12545001 J01MA02 CIPROFLOXACINUM CIPRO QUIN 500 mg COMPR. FILM. 500mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 10 1.597050 0.149950 1.437345 0.309655
632 W54039001 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 1.597050 0.149950 1.437345 0.309655
633 W54039002 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 20 1.597050 0.094450 1.437345 0.254155
634 W65057001 J01MA02 CIPROFLOXACINUM CIFRAN 500 mg COMPR. FILM. 500mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. PRF 10 1.597050 0.149950 1.437345 0.309655
635 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 0.806000 0.000000 0.725400 0.080600
636 W42772001 J01MA02 CIPROFLOXACINUM CIPRINOL 750 mg COMPR. FILM. 750mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 1 BLIST. AL/PVC-PVDC X 10 COMPR. FILM. P-RF 10 2.395575 2.237425 2.156017 2.476983
637 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 2.395575 2.237425 2.156017 2.476983
638 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 1.597050 1.970950 1.437345 2.130655
639 W60377003 J01MA06 NORFLOXACINUM NORFLOXACINA ARENA 400 mg CAPS. 400mg ARENA GROUP SA ROMANIA CUTIE CU 2 BLIST. DIN PVC/AL X 10 CAPS. PRF 20 1.126000 0.237000 1.013400 0.349600
640 W60377004 J01MA06 NORFLOXACINUM NORFLOXACINA ARENA 400 mg CAPS. 400mg ARENA GROUP SA ROMANIA CUTIE CU 5 BLIST DIN PVC/AL X 10 CAPS. PRF 50 1.126000 0.112200 1.013400 0.224800
641 W14009001 J01MA06 NORFLOXACINUM NORFLOXACIN LAROPHARM 400 mg COMPR. FILM. 400mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 10 1.126000 0.238000 1.013400 0.350600

Pagina 11 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
642 W07984001 J01MA06 NORFLOXACINUM NOLICIN 400 mg COMPR. FILM. 400mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 20 1.126000 0.003500 1.013400 0.116100
643 W58303001 J01MA06 NORFLOXACINUM NORFLOXACIN HELCOR 400 mg COMPR. FILM. 400mg A.C. HELCOR PHARMA S.R.L. ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 20 1.126000 0.237000 1.013400 0.349600
644 W62811001 J01MA06 NORFLOXACINUM NORFLOXACINA ATB 400 mg COMPR. FILM. 400mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 20 1.122500 0.000000 1.010250 0.112250
645 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 0.467000 0.000000 0.420300 0.046700
646 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 0.467000 0.000000 0.420300 0.046700
647 W64585001 J01XD01 METRONIDAZOLUM METRONIDAZOL VIOSER 500 mg/100 ml SOL. PERF. 500mg/100ml VIOSER S.A. PARENTERAL SOLUTIONS INDUSTRY GRECIA CUTIE CU 1 FLAC. PEJD X 100 ML SOL. PERF. PRF 1 4.950583 1.399417 4.455524 1.894476
648 W64585002 J01XD01 METRONIDAZOLUM METRONIDAZOL VIOSER 500 mg/100 ml SOL. PERF. 500mg/100ml VIOSER S.A. PARENTERAL SOLUTION INDUSTRY GRECIA CUTIE CU 10 FLAC. PEJD X 100 ML SOL. PERF. PRF 10 4.950583 0.809417 4.455524 1.304476
649 W42139002 J01XD01 METRONIDAZOLUM METRONIDAZOL A 5 g/l SOL. PERF. 5g/l INFOMED FLUIDS SRL ROMANIA CUTIE X 12 FLACOANE X 200 ML S/P-RF 12 9.508333 0.000000 8.557499 0.950834
650 W42138002 J01XD01 METRONIDAZOLUM METRONIDAZOL B 5 g/l SOL. PERF. 5g/l INFOMED FLUIDS SRL ROMANIA CUTIE X 12 FLACOANE X 200 ML S/P-RF 12 9.508333 0.000000 8.557499 0.950834
651 W08927001 J01XD01 METRONIDAZOLUM METRONIDAZOL BRAUN 5mg/ml SOL. PERF. 5mg/ml B. BRAUN MELSUNGEN AG GERMANIA CUTIE X 10 FLAC. DIN STICLA INCOLORA X 100 ML SOL. PERF. S/P-RF 10 4.950583 0.846417 4.455524 1.341476
652 W08927002 J01XD01 METRONIDAZOLUM METRONIDAZOL BRAUN 5mg/ml SOL. PERF. 5mg/ml B. BRAUN MELSUNGEN AG GERMANIA CUTIE X 10 FLAC. DIN PEJD X 100 ML SOL. PERF. S/P-RF 10 4.950583 0.846417 4.455524 1.341476
653 W08927003 J01XD01 METRONIDAZOLUM METRONIDAZOL BRAUN 5mg/ml SOL. PERF. 5mg/ml B. BRAUN MELSUNGEN AG GERMANIA CUTIE X 20 FLAC. DIN PEJD X 100 ML SOL. PERF. S/P-RF 20 4.950583 0.196417 4.455524 0.691476
654 W08372001 J02AC01 FLUCONAZOLUM FLUCOVIM 100 CAPS. 100mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 BLIST. X 4 CAPS. P-RF 4 5.471999 2.690501 4.924799 3.237701
655 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 5.471999 1.943715 4.924799 2.490915
656 W08373001 J02AC01 FLUCONAZOLUM FLUCOVIM 150 CAPS. 150mg VIM SPECTRUM SRL ROMANIA CUTIE CU 1 BLIST. AL/PVC X 1 CAPS. P-RF 1 8.207999 0.912001 7.387199 1.732801
657 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 8.207999 4.302001 7.387199 5.122801
658 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 8.207999 0.912001 7.387199 1.732801
659 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 8.207999 0.912001 7.387199 1.732801
660 W42693001 J02AC01 FLUCONAZOLUM FLUCONAZOL SLAVIA 150 mg CAPS. 150mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 1 CAPS. P-RF 1 8.207999 0.912001 7.387199 1.732801
661 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 8.207999 0.912001 7.387199 1.732801
662 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 8.207999 0.912001 7.387199 1.732801
663 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 8.207999 0.912001 7.387199 1.732801
664 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 8.207999 0.912001 7.387199 1.732801
665 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 8.207999 0.912001 7.387199 1.732801
666 W65085001 J02AC01 FLUCONAZOLUM DIFLUCAN 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 BLIST. PVC/AL X 1 CAPS. PRF 1 8.207999 4.302001 7.387199 5.122801
667 W68087001 J02AC01 FLUCONAZOLUM FLUCONAZOL BIOEEL 150 mg CAPS. 150mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 1 CAPS. PRF 1 8.207999 0.912001 7.387199 1.732801
668 W43599002 J02AC01 FLUCONAZOLUM FLUCONAZOLE TEVA 200 mg CAPS. 200mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 7 CAPS. P-RF 7 6.982857 0.000000 6.284571 0.698286
669 W08374001 J02AC01 FLUCONAZOLUM FLUCOVIM 50 CAPS. 50mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 BLIST. X 7 CAPS. P-RF 7 2.735999 0.808286 2.462399 1.081886
670 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 2.735999 2.031143 2.462399 2.304743
671 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 2.735999 0.808286 2.462399 1.081886
672 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 2.735999 0.808286 2.462399 1.081886
673 W42321001 J02AC01 FLUCONAZOLUM FLUCONAZOL SLAVIA 50 mg CAPS. 50mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 7 CAPS. P-RF 7 2.735999 0.808286 2.462399 1.081886
674 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 2.735999 0.808286 2.462399 1.081886
675 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 2.735999 0.808286 2.462399 1.081886
676 W65084001 J02AC01 FLUCONAZOLUM DIFLUCAN 50 mg CAPS. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 BLIST. PVC/AL X 7 CAPS. PRF 7 2.735999 2.031143 2.462399 2.304743
677 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 19.151999 21.268001 17.236799 23.183201
678 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 19.151999 21.268001 17.236799 23.183201
679 W42857001 J05AB01 ACICLOVIRUM ACICLOVIR SLAVIA 200 mg CAPS. 200mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 1.239482 0.177518 1.115533 0.301467
680 W53675001 J05AB01 ACICLOVIRUM ACICLOVIR ARENA 200 mg CAPS. 200mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 1.239482 0.177518 1.115533 0.301467
681 W56038001 J05AB01 ACICLOVIRUM ACICLOVIR FARMEX 200 mg CAPS. 200mg FARMEX COMPANY S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. P-RF 20 1.239482 0.177518 1.115533 0.301467
682 W53676001 J05AB01 ACICLOVIRUM ACICLOVIR ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 2.478964 0.924036 2.231067 1.171933
683 W00044001 J05AB01 ACICLOVIRUM ACICLOVIR TERAPIA 200 mg COMPR. 200mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 1.239482 0.177518 1.115533 0.301467
684 W06667003 J05AB01 ACICLOVIRUM ACICLOVIR 200 mg COMPR. 200mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 4 BLIST. PVC-PVDC/AL X 5 COMPR. P-RF 20 1.239482 0.177518 1.115533 0.301467
685 W53225001 J05AB01 ACICLOVIRUM ACICLOVIR LAROPHARM 200 mg COMPR. 200mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 1.239482 0.177518 1.115533 0.301467
686 W06668003 J05AB01 ACICLOVIRUM ACICLOVIR 400 mg COMPR. 400mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 5 COMPR. P-RF 10 2.478964 0.667036 2.231067 0.914933
687 W00058001 J05AB01 ACICLOVIRUM VIROLEX PULB. PT. SOL. INJ./PERF. 250mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 5 FLAC. X 250 MG PULB. PT. SOL. INJ./PERF. S/P-RF 5 51.391000 0.923000 46.251900 6.062100
688 W67998002 J05AB01 ACICLOVIRUM VIRICIN 250 mg PULB. PT. SOL. PERF. 250mg MEDOCHEMIE LTD. CIPRU CUTIE CU 5 FLACOANE DIN STICLA INCOLORA CU PULB. PT. SOL. PERF. PR/PRF 5 50.468000 0.000000 45.421200 5.046800
689 W69293002 J05AB01 ACICLOVIRUM ACICLOVIR ROMPHARM 250 mg PULB. PT. SOL. PERF. 250mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 5 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. PERF. PR/PRF 5 51.391000 1.327000 46.251900 6.466100
690 W42120001 M01AB01 INDOMETACINUM INDOMETACIN LAROPHARM 25 mg CAPS. 25mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST., PVC/AL, X 10 CAPS. P-6L 20 0.108000 0.000000 0.097200 0.010800
691 W53948002 M01AB01 INDOMETACINUM INDOMETACIN ARENA 50 MG CAPS. 50mg ARENA GROUP SA ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. P-6L 20 0.349274 0.274226 0.314346 0.309154
692 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 0.822916 0.083750 0.740624 0.166042
693 W03609001 M01AB01 INDOMETACINUM INDOMETACIN SINTOFARM 50 mg SUPOZ. 50mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6L 10 0.822916 0.085084 0.740624 0.167376
694 W12694002 M01AB01 INDOMETACINUM INDOMETACIN MCC 50 mg SUPOZ. 50mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII TERMOSUDATE PVC/PE X 5 SUPOZ. P-6L 10 0.822916 0.085084 0.740624 0.167376
695 W03600003 M01AB01 INDOMETACINUM INDOMETACIN ATB 50 mg SUPOZ. 50mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ. P6L 6 0.822916 0.083750 0.740624 0.166042
696 W63730001 M01AB05 DICLOFENACUM DICLOREUM 150 mg CAPS. ELIB. PREL. 150mg ALFASIGMA S.P.A. ITALIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. ELIB. PREL. P6L 20 1.047824 1.914176 0.943041 2.018959
697 W53220001 M01AB05 DICLOFENACUM DICLOFENAC DUO PHARMASWISS 75 mg CAPS. ELIB. PREL. 75mg PHARMASWISS CESKA REPUBLIKA S.R.O. CEHIA CUTIE X 3 BLIST. PVC/PVDC/AL X 10 CAPS. ELIB. PREL. P-6L 30 0.523912 0.107754 0.471520 0.160146
698 W67013001 M01AB05 DICLOFENACUM DICLOFENAC DUO PHARMASWISS 75 mg CAPS. ELIB. PREL. 75mg BAUSCH HEALTH IRELAND LIMITED IRLANDA CUTIE CU 3 BLIST. PVC/PVDC/AL X 10 CAPS. ELIB. PREL. P6L 30 0.523912 0.107754 0.471520 0.160146
699 W51307002 M01AB05 DICLOFENACUM REFEN RETARD 100 mg COMPR. CU ELIB. PREL. 100mg STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. CU ELIB. PREL. P-6L 20 0.578000 0.000000 0.520200 0.057800
700 W02472002 M01AB05 DICLOFENACUM DICLOTARD 100 mg COMPR. CU ELIB. PREL. 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P-6L 20 0.698549 0.225951 0.628694 0.295806

Pagina 12 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
701 W51307003 M01AB05 DICLOFENACUM REFEN RETARD 100 mg COMPR. ELIB. PREL. 100mg STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P6L 20 0.578000 0.000000 0.520200 0.057800
702 W54364001 M01AB05 DICLOFENACUM DICLOFENAC ARENA 25 mg COMPR. GASTROREZ. 25mg ARENA GROUP SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P-6L 30 0.174637 0.261029 0.157173 0.278493
703 W02459003 M01AB05 DICLOFENACUM DICLOFENAC 50 mg COMPR. GASTROREZ. 50mg TERAPIA SA ROMANIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. GASTROREZ. P-6L 20 0.349274 0.267226 0.314346 0.302154
704 W54363004 M01AB05 DICLOFENACUM DICLOFENAC ARENA 50 mg COMPR. GASTROREZ. 50mg ARENA GROUP SA ROMANIA CUTIE CU 1 BLIST. PVC/AL X 30 COMPR. GASTROREZ. P-6L 30 0.201333 0.000000 0.181199 0.020134
705 W60292001 M01AB05 DICLOFENACUM DICLOFENAC HELCOR 50 mg COMPR. GASTROREZ. 50mg A.C. HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. GASTROREZ. P-6L 20 0.349274 0.265726 0.314346 0.300654
706 W55024001 M01AB05 DICLOFENACUM REFEN 75 mg SOL. INJ./PERF. 25mg/ml STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 3 ML SOL. INJ./PERF. P-RF 5 2.455500 1.002500 2.209950 1.248050
707 W14114001 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDANTE X 3 SUPOZ. P-6L 6 1.143333 0.000000 1.028999 0.114334
708 W12288001 M01AB05 DICLOFENACUM DICLOFENAC SINTOFARM 100 mg SUPOZ. 100mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6L 10 1.645832 2.343168 1.481248 2.507752
709 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 0.724000 0.000000 0.651600 0.072400
710 W14114003 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ. P6L 6 1.143333 0.000000 1.028999 0.114334
711 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 0.205729 2.362604 0.185156 2.383177
712 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 0.205729 2.876271 0.185156 2.896844
713 W56142001 M01AB15 KETOROLACUM TROMETHAMIN KETOROL 10 mg COMPR. FILM. 10mg DR. REDDY'S LABORATORIES ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-6L 20 0.232849 0.436651 0.209564 0.459936
714 W44108003 M01AB15 KETOROLACUM TROMETHAMIN KETANOV 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU 2 BLIST. OPA-AL-PVC/AL A CATE 10 COMPR. FILM. P-6L 20 0.232849 0.436651 0.209564 0.459936
715 W44107001 M01AB15 KETOROLACUM TROMETHAMIN KETANOV 30 mg/ml SOL. INJ. 30mg/ml TERAPIA SA ROMANIA CUTIE CU 10 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ. P-RF 10 3.274000 0.000000 2.946600 0.327400
716 W56143003 M01AB15 KETOROLACUM TROMETHAMIN KETOROL 30 mg/ml SOL. INJ. 30mg/ml DR. REDDY'S LABORATORIES ROMANIA CUTIE X 1 BLIST. X 10 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PR/PRF 10 3.274000 0.000000 2.946600 0.327400
717 W61916001 M01AB15 KETOROLACUM TROMETHAMIN KETOROLAC TROMETAMOL ROMPHARM 30 mg/ml SOL. INJ. 30mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA, PREVAZUTE CU INEL DE RUPERE X 1 ML SOL. INJ. PRF 5 3.272000 0.000000 2.944800 0.327200
718 W61916002 M01AB15 KETOROLACUM TROMETHAMIN KETOROLAC TROMETAMOL ROMPHARM 30 mg/ml SOL. INJ. 30mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA, PREVAZUTE CU INEL DE RUPERE X 1 ML SOL. INJ. PRF 10 3.274000 0.000000 2.946600 0.327400
719 W57635001 M01AB16 ACECLOFENACUM AFLAMIL 100mg COMPR. FILM. 100mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 2 BLIST. PA-AL-PVC/AL X 10 COMPR. FILM. P-6L 20 0.349274 0.574226 0.314346 0.609154
720 W61427001 M01AB16 ACECLOFENACUM AFLAMIL 100 mg PULB. PT.SUSP. ORALA 100mg GEDEON RICHTER ROMANIA S.A. ROMANIA CUTIE CU 20 PLICURI UNIDOZA DIN MATERIAL COMPLEX DIN HARTIE DE TIP OPALINA LAMINATA PE UN STRAT DE ALUMINIU (20 ΜM) SI FILM DIN PEJD P6L 20 0.349274 1.373726 0.314346 1.408654
721 W56784001 M01AC02 TENOXICAMUM TENOXICAM ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.665549 1.115451 0.598994 1.182006
722 W12900001 M01AC02 TENOXICAMUM NEO-ENDUSIX 20 mg COMPR. FILM. 20mg ANFARM HELLAS S.A. GRECIA CUTIE X 1 BLIST. X 10 COMPR. FILM. P-6L 10 0.665549 0.430451 0.598994 0.497006
723 W12899001 M01AC02 TENOXICAMUM NEO-ENDUSIX 20 mg/ml PULB+SOLV. PT. SOL. INJ. 20mg/ml ANFARM HELLAS S.A. PHARMACEUTICALS GRECIA CUTIE X 1 FLAC. PULB. + 1 FIOLA SOLV. P-RF 1 3.310499 8.719501 2.979449 9.050551
724 W04103001 M01AC06 MELOXICAMUM MOVALIS 15 mg COMPR. 15mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 20 0.665549 0.041451 0.598994 0.108006
725 W43917001 M01AC06 MELOXICAMUM MELOXICAM MCC 15 mg COMPR. 15mg MAGISTRA C & C SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.457500 0.000000 0.411750 0.045750
726 W53657001 M01AC06 MELOXICAMUM MELOXICAM VIM SPECTRUM 15 mg COMPR. 15mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.457500 0.000000 0.411750 0.045750
727 W42654003 M01AC06 MELOXICAMUM MELOXICAM LPH 15 mg COMPR. 15mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P6L 30 0.457666 0.000000 0.411899 0.045767
728 W04104001 M01AC06 MELOXICAMUM MOVALIS 7,5 mg COMPR. 7,5mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 20 0.332774 0.362226 0.299496 0.395504
729 W43916001 M01AC06 MELOXICAMUM MELOXICAM MCC 7,5 mg COMPR. 7,5mg MAGISTRA C & C SRL ROMANIA CUTIE X 2 BLIAT. AL/PVC X 10 COMPR. P-6L 20 0.332774 0.037226 0.299496 0.070504
730 W53656001 M01AC06 MELOXICAMUM MELOXICAM VIM SPECTRUM 7,5 mg COMPR. 7,5mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.332774 0.037226 0.299496 0.070504
731 W53827001 M01AC06 MELOXICAMUM MELOXICAM LAROPHARM 7,5 mg COMPR. 7,5mg LAROPHARM SRL ROMANIA CUTIE X 1 BLIST. PVC/AL X 20 COMPR. P-6L 20 0.332774 0.037226 0.299496 0.070504
732 W42653003 M01AC06 MELOXICAMUM MELOXICAM LPH 7,5 mg COMPR. 7,5mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P6L 30 0.332774 0.036892 0.299496 0.070170
733 W61229001 M01AC06 MELOXICAMUM MELOXICAM ROMPHARM 15 mg/1,5 ml SOL INJ. 15mg/1,5ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 3 FIOLE DIN STICLA INCOLORA, PREVAZUTE CU INEL DE RUPERE, CU CAPACITATEA DE 2 ML CARE CONTIN 1,5 ML SOL. INJ. PRF 3 2.856666 0.000000 2.570999 0.285667
734 W61229002 M01AC06 MELOXICAMUM MELOXICAM ROMPHARM 15 mg/1,5 ml SOL INJ. 15mg/1,5ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA, PREVAZUTE CU INEL DE RUPERE, CU CAPACITATEA DE 2 ML CARE CONTIN 1,5 ML SOL. INJ. PRF 5 2.856000 0.000000 2.570400 0.285600
735 W60600001 M01AC06 MELOXICAMUM MELOX 15 mg/1,5 ml SOL. INJ. 15mg/1,5ml MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST. DIN PVC A 5 FIOLE TRANSPARENTE DIN STICLA CU CAPACITATEA DE 2 ML, CONTINAND 1,5 ML PRF 5 3.310499 1.361501 2.979449 1.692551
736 W41449001 M01AC06 MELOXICAMUM MELOXICAM MCC 15 mg SUPOZ. 15mg MAGISTRA C & C ROMANIA CUTII X 2 FOLII TERMOSUDATE PVC/PE X 3 SUPOZ. P-6L 6 2.550000 0.000000 2.295000 0.255000
737 W42896001 M01AE03 KETOPROFENUM KETONAL DUO 150 mg CAPS. ELIB. PREL. 150mg SANDOZ S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC-TE-PVDC X 10 CAPS. ELIB. PREL. P-6L 20 0.907200 0.044300 0.816480 0.135020
738 W43110001 M01AE03 KETOPROFENUM KETOPROXIN 100 mg COMPR. FILM. 100mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. PVC/ALX 10 COMPR. FILM. P-6L 20 0.357500 0.000000 0.321750 0.035750
739 W63532001 M01AE03 KETOPROFENUM PROFENID 100 mg COMPR. FILM. 100mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 15 COMPR. FILM. P6L 30 0.498333 0.000000 0.448499 0.049834
740 W43111001 M01AE03 KETOPROFENUM KETOPROXIN 50 mg COMPR. FILM. 50mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. PVC/ALX 10 COMPR. FILM. P-6L 20 0.302399 0.153101 0.272159 0.183341
741 W60385001 M01AE03 KETOPROFENUM KETOPROFEN ROMPHARM 100 mg/2ml SOL. INJ. 100 mg/2ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU INEL DE RUPERE A CATE 2ML SOL. INJ PRF 5 1.454000 0.000000 1.308600 0.145400
742 W60385002 M01AE03 KETOPROFENUM KETOPROFEN ROMPHARM 100 mg/2ml SOL. INJ. 100 mg/2ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA PREVAZUTE CU INEL DE RUPERE A CATE 2ML SOL. INJ PRF 10 1.447000 0.000000 1.302300 0.144700
743 W54214001 M01AE03 KETOPROFENUM KETOPROFEN TERAPIA 100mg/2ml SOL. INJ. 100mg/2ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE X 2 ML P-RF 5 2.001000 0.547000 1.800900 0.747100
744 W14020001 M01AE03 KETOPROFENUM KETOMAG 100 mg SUPOZ. 100mg MAGISTRA C & C ROMANIA CUTIE X 2 FOLII LAMINATE PVC/PE X 5 SUPOZ. P-6L 10 1.317000 0.000000 1.185300 0.131700
745 W00242003 M04AA01 ALLOPURINOLUM MILURIT 100 mg COMPR. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 60 COMPR. P6L 60 0.207194 0.010306 0.186474 0.031026
746 W65236001 M04AA01 ALLOPURINOLUM MILURIT 200 mg COMPR. 200mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P6L 30 0.414388 0.173612 0.372949 0.215051
747 W00243001 M04AA01 ALLOPURINOLUM MILURIT 300 mg COMPR. 300mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-6L 30 0.590666 0.000000 0.531599 0.059067
748 W01429002 M04AC01 COLCHICINUM COLCHICINA 1 mg COMPR. 1mg BIOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 20 COMPR. P-RF 40 1.077000 0.000000 0.969300 0.107700
749 W12691002 N02AX02 TRAMADOLUM TRAMADOL 50 mg CAPS. 50mg KRKA D.D. SLOVENIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.341915 0.107085 0.307723 0.141277
750 W52049001 N02AX02 TRAMADOLUM TRAMADOL ARENA 50 mg CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.341915 0.253585 0.307723 0.287777
751 W60291001 N02AX02 TRAMADOLUM TRAMACALM 50 mg CAPS. 50mg A.C. HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. P-RF 10 0.341915 0.253085 0.307723 0.287277
752 W42440001 N02AX02 TRAMADOLUM TRAMAG 50 mg COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.341915 0.253585 0.307723 0.287777
753 W42957001 N02AX02 TRAMADOLUM CLORHIDRAT DE TRAMADOL BIOEEL 50 mg COMPR. 50mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.341915 0.253585 0.307723 0.287777
754 W68093001 N02AX02 TRAMADOLUM CLORHIDRAT DE TRAMADOL BIOEEL 50 mg COMPR. 50mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.341915 0.253585 0.307723 0.287777
755 W43360001 N02AX02 TRAMADOLUM TRAMADOL RETARD 150 mg COMPR. CU ELIB. PREL. 150mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. CU ELIB. PREL. P-RF 30 1.025750 0.276583 0.923175 0.379158
756 W43361001 N02AX02 TRAMADOLUM TRAMADOL RETARD 200 mg COMPR. CU ELIB. PREL. 200mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. CU ELIB. PREL. P-RF 30 1.367665 0.261001 1.230898 0.397768
757 W58072001 N02AX02 TRAMADOLUM TRAMADOL RETARD 100 mg COMPR. ELIB. PREL. 100mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. AL/PVC X 10 COMPR. ELIB. PREL. PRF 30 0.683832 0.149834 0.615448 0.218218
758 W61448003 N02AX02 TRAMADOLUM MABRON RETARD 100 mg COMPR. ELIB. PREL. 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 30 0.683832 0.000834 0.615448 0.069218
759 W61449001 N02AX02 TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. PREL. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST. DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 10 1.022000 0.000000 0.919800 0.102200

Pagina 13 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
760 W61449003 N02AX02 TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. PREL. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 30 1.013333 0.000000 0.911999 0.101334
761 W61449011 N02AX02 TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. PREL. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLISTER DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 10 1.022000 0.000000 0.919800 0.102200
762 W63389001 N02AX02 TRAMADOLUM TRAMAL RETARD 150 mg COMPR. ELIB. PREL. 150mg STADA ARZNEIMITTEL AG GERMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 COMPR.FILM. CU ELIB. PREL. P-RF 10 1.025750 0.359250 0.923175 0.461825
763 W63389002 N02AX02 TRAMADOLUM TRAMAL RETARD 150 mg COMPR. ELIB. PREL. 150mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 1 BLIST. PP/AL X 10 COMPR. ELIB. PREL. P-RF 10 1.025750 0.359250 0.923175 0.461825
764 W61450003 N02AX02 TRAMADOLUM MABRON RETARD 200 mg COMPR. ELIB. PREL. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 30 1.261000 0.000000 1.134900 0.126100
765 W64091003 N02AX02 TRAMADOLUM TRAMADOL KALCEKS 50 mg/ml SOL INJ./PERF. 50mg/ml AS KALCEKS LETONIA CUTIE CU 2 TAVITE DIN PVC CU 10 FIOLE DIN STICLA TRANSPARENTA, CU PUNCT DE RUPERE, A CATE 2 ML SOL. INJ./PERF. PRF 10 2.345000 0.000000 2.110500 0.234500
766 W05967001 N02AX02 TRAMADOLUM TRAMADOL 100 mg/2 ml SOL. INJ. 100mg/2ml KRKA D.D. SLOVENIA CUTIE X 5 FIOLE X 2 ML PRF 5 2.371250 1.258750 2.134125 1.495875
767 W05961001 N02AX02 TRAMADOLUM MABRON 100 mg/2 ml SOL. INJ. 100mg/2ml MEDOCHEMIE LTD. CIPRU CUTIE X 5 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. S/P-RF 5 2.371250 0.008750 2.134125 0.245875
768 W05966001 N02AX02 TRAMADOLUM TRAMADOL 50 mg/1 ml SOL. INJ. 50mg/ml KRKA D.D. SLOVENIA CUTIE X 5 FIOLE X 1 ML PRF 5 1.185621 0.118379 1.067058 0.236942
769 W64948001 N02CC01 SUMATRIPTANUM * IMIGRAN DR 100 mg COMPR. DISP. 100mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 BLIST. (OPA)-AL-PVC/AL X 2 COMPR. DISP. PRF 2 10.055833 6.444167 9.050249 7.449751
770 W59299001 N02CC01 SUMATRIPTANUM * IMIGRAN DR 50 mg COMPR. DISP. 50mg GLAXO WELLCOME UK LIMITED MAREA BRITANIE CUTIE CU 1 BLIST. (OPA)-AL-PVC/AL X 2 COMPR. DISP. P-RF 2 5.027916 4.747084 4.525124 5.249876
771 W64946001 N02CC01 SUMATRIPTANUM * IMIGRAN DR 50 mg COMPR. DISP. 50mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 BLIST. (OPA)-AL-PVC/AL X 2 COMPR. DISP. PRF 2 5.027916 4.747084 4.525124 5.249876
772 W56161005 N02CC01 SUMATRIPTANUM * XIBIMER 100 mg COMPR. FILM. 100mg DR. REDDY'S LABORATORIES ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 6 COMPR. FILM. P-RF 6 10.055833 0.607500 9.050249 1.613084
773 W59112004 N02CC01 SUMATRIPTANUM * SUMACTA 100 mg COMPR. FILM. 100mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 2 BLIST. PVC/AL X 3 COMPR. FILM. PRF 6 9.448333 0.000000 8.503499 0.944834
774 W68041004 N02CC01 SUMATRIPTANUM * SUMACTA 100 mg COMPR. FILM. 100mg TEVA B.V. OLANDA CUTIE CU 2 BLIST. PVC/AL X 3 COMPR. FILM. PRF 6 9.448333 0.000000 8.503499 0.944834
775 W56160005 N02CC01 SUMATRIPTANUM * XIBIMER 50 mg COMPR. FILM. 50mg DR. REDDY'S LABORATORIES ROMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 6 COMPR. FILM. P-RF 6 5.027916 4.860417 4.525124 5.363209
776 W66779002 N02CC01 SUMATRIPTANUM * SUMATRIPTAN SUN 3 mg/0,5 ml SOL INJ. IN STILOU INJECTOR PREUMPLUT 3mg/0,5ml SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA CUTIE CU 2 STILOURI INJECTOARE PREUMPLUTE, FORMATE DINTR-UN CILINDRU DIN STICLA DE 1 ML, CU UN AC DE CALIBRU DE 27 G SI LUNGIME DE 1,27 CM PRF 2 126.165000 0.000000 113.548500 12.616500
777 W67371002 N02CD02 GALCANEZUMABUM ** Ω EMGALITY 120 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 120mg/ml ELI LILLY NEDERLAND BV OLANDA CUTIE CU 3 SERINGI PREUMPLUTE (STICLA) X 1ML SOLUTIE, IN 3 STILOURI INJECTOARE (PENURI) PREUMPLUTE PR/PRF 3 2,062.033333 0.000000 1,855.829999 206.203334
778 W00806001 N03AF01 CARBAMAZEPINUM CARBEPSIL 200mg COMPR. 200mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6L 50 0.263075 0.321125 0.236767 0.347433
779 W69234001 N03AF01 CARBAMAZEPINUM KARAZEPIN COMPR. 200mg CN UNIFARM S.A. ROMANIA CUTIE CU BLIST. X 25 COMPRIMATE PRF 25 0.263075 0.108525 0.236767 0.134833
780 W00807001 N03AF01 CARBAMAZEPINUM CARBEPSIL 400mg COMPR. 400mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6L 50 0.500200 0.000000 0.450180 0.050020
781 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 0.500000 0.000000 0.450000 0.050000
782 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 0.197306 0.190094 0.177575 0.209825
783 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 0.394612 0.131388 0.355150 0.170850
784 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 0.394612 0.046988 0.355150 0.086450
785 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 0.789225 0.012975 0.710302 0.091898
786 W00825001 N03AF01 CARBAMAZEPINUM TIMONIL 100 mg/5 ml SUSP. ORALA 100mg/5ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE X 1 FLACON X 250 ML SUSP.ORALA + MASURA DOZATOARE P-6L 1 52.230000 0.000000 47.007000 5.223000
787 W54332002 N03AX12 GABAPENTINUM GRIMODIN 100 mg CAPS. 100mg UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS. P-6L
EGIS PHARMACEUTICALS P.L.C. 60 0.116690 0.803643 0.105021 0.815312
788 W60025001 N03AX12 GABAPENTINUM GABAPENTIN ARENA 100 mg CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.116690 0.573476 0.105021 0.585145
789 W41589005 N03AX12 GABAPENTINUM GABAGAMMA 300 mg CAPS. 300mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.350074 0.495826 0.315066 0.530834
790 W43540001 N03AX12 GABAPENTINUM GABALEPT 300 mg CAPS. 300mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.350074 0.167926 0.315066 0.202934
791 W54333001 N03AX12 GABAPENTINUM GRIMODIN 300 mg CAPS. 300mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS. P-6L 60 0.350074 0.338759 0.315066 0.373767
792 W60026001 N03AX12 GABAPENTINUM GABAPENTIN ARENA 300 mg CAPS. 300mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.350074 1.249926 0.315066 1.284934
793 W64360001 N03AX12 GABAPENTINUM GABALEPT 300 mg CAPS. 300mg TEVA B.V. OLANDA CUTIE CU 10 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 CAPS. P6L 100 0.350074 0.167926 0.315066 0.202934
794 W65059001 N03AX12 GABAPENTINUM GABARAN 300 mg CAPS. 300mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 50 0.350074 1.129726 0.315066 1.164734
795 W41590005 N03AX12 GABAPENTINUM GABAGAMMA 400 mg CAPS. 400mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.466767 0.716733 0.420090 0.763410
796 W43541001 N03AX12 GABAPENTINUM GABALEPT 400 mg CAPS. 400mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.466767 0.201033 0.420090 0.247710
797 W54334001 N03AX12 GABAPENTINUM GRIMODIN 400 mg CAPS. 400mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS. P-6L 60 0.466767 0.722899 0.420090 0.769576
798 W60027001 N03AX12 GABAPENTINUM GABAPENTIN ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.466767 1.603899 0.420090 1.650576
799 W64361001 N03AX12 GABAPENTINUM GABALEPT 400 mg CAPS. 400mg TEVA B.V. OLANDA P6L
CUTIE CU 10 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 CAPS. 100 0.466767 0.201033 0.420090 0.247710
800 W65060001 N03AX12 GABAPENTINUM GABARAN 400 mg CAPS. 400mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 50 0.466767 1.221633 0.420090 1.268310
801 W65061001 N03AX12 GABAPENTINUM GABARAN 600 mg COMPR. FILM. 600mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. AL-PVC-PA/AL X 10 COMPR. FILM. P6L 30 0.700150 1.695516 0.630135 1.765531
802 W52419001 N05AD01 HALOPERIDOLUM HALOPERIDOL LAROPHARM 0,5 mg COMPR. 0,5mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.213500 0.000000 0.192150 0.021350
803 W56620001 N05AD01 HALOPERIDOLUM HALOPERIDOL ROMPHARM 2 mg/ml PIC. ORALE, SOL. 2 mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLACON PEJD CU PICURATOR PEJD X 10 ML PIC. OFT., SOL. PRF 1 8.719999 0.060001 7.847999 0.932001
804 W61980001 N05AD01 HALOPERIDOLUM HALOPERIDOL ARENA 2 mg/ml PIC. ORALE, SOL. 2mg/ml ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA CARE CONTINE 10 ML PICATURI ORALE, SOL., PREVAZUT CU PICURATOR DIN PEJD PRF 1 8.719999 0.060001 7.847999 0.932001
805 W03427002 N05AD01 HALOPERIDOLUM HALOPERIDOL - RICHTER 2mg/ml PIC. ORALE-SOL. 2mg/ml GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 1 FLAC. PICURATOR DIN STICLA BRUNA X 10 ML PICATURI ORALE, SOLUTIE P-RF 1 8.719999 0.060001 7.847999 0.932001
806 W54845001 N05AD01 HALOPERIDOLUM HALOPERIDOL RICHTER 5 mg/ml SOL. INJ. 5mg/ml GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ. P-RF 5 3.037999 0.000001 2.734199 0.303801
807 W02443001 N05BA01 DIAZEPAMUM DIAZEPAM RICHTER 10 mg COMPR. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 0.176500 0.000000 0.158850 0.017650
808 W12717001 N05BA01 DIAZEPAMUM DIAZEPAM TERAPIA 10 mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P-RF 30 0.176666 0.000000 0.158999 0.017667
809 W52908001 N05BA01 DIAZEPAMUM DIAZEPAM LAROPHARM 10 mg COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.175500 0.000000 0.157950 0.017550
810 W60414001 N05BA01 DIAZEPAMUM DIAZEPAM TERAPIA 5 mg/ml SOL. INJ. 5mg/ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE X 2 ML P-RF 5 7.056000 0.000000 6.350400 0.705600
811 W10514001 N05BA01 DIAZEPAMUM DIAZEPAM DESITIN 10 mg/2,5 ml SOL. RECTALA 10mg/2,5ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 5 PUNGI TUBULARE CONTINAND FIECARE CATE 1 TUB DIN PEJD X 2,5 ML SOL. RECTALA PRF 5 6.692000 0.000000 6.022800 0.669200
812 W10515001 N05BA01 DIAZEPAMUM DIAZEPAM DESITIN 5 mg/2,5 ml SOL. RECTALA 5mg/2,5ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 5 PUNGI TUBULARE CONTINAND FIECARE CATE 1 TUB DIN PEJD X 2,5 ML SOL. RECTALA PRF 5 5.904000 0.000000 5.313600 0.590400
813 W60895002 N05BA03 MEDAZEPAMUM * MEDAZEPAM ARENA 10mg COMPR. 10 mg ARENA GROUP SA ROMANIA CUTIE X 2 BLISTERE PVC/AL X 10 COMPRIMATE P-RF 20 0.168500 0.033500 0.151650 0.050350
814 W60895003 N05BA03 MEDAZEPAMUM * MEDAZEPAM ARENA 10mg COMPR. 10 mg ARENA GROUP SA ROMANIA CUTIE X 5 BLISTERE PVC/AL X 10 COMPRIMATE P-RF 50 0.168500 0.008700 0.151650 0.025550
815 W12943002 N05BA03 MEDAZEPAMUM * MEDAZEPAM LAROPHARM 10 mg COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. AL/PVC X 20 COMPR. P-RF 20 0.168500 0.033500 0.151650 0.050350
816 W53797002 N05BA03 MEDAZEPAMUM * MEDAZEPAM LPH 10 mg COMPR. 10mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.168500 0.033500 0.151650 0.050350
817 W41692001 N05BA06 LORAZEPAMUM * ANXIAR 1 mg COMPR. 1 mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 25 COMPR. P-RF 50 0.134800 0.111200 0.121320 0.124680
818 W66829001 N05BA06 LORAZEPAMUM * TEMELOR 4 mg SOL. INJ. 4mg/ml MEDOCHEMIE LTD. CIPRU CUTIE CU 5 FIOLE ASEZATE IN TAVI DIN PVC ACOPERITE CU FOLIE PROTECTOARE DIN PE X 1 ML SOL. INJ. PRF 5 6.564000 0.000000 5.907600 0.656400

Pagina 14 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
819 W06824003 N05BA08 BROMAZEPAMUM * BROMAZEPAM LPH 1,5 mg COMPR. 1,5mg LABORMED PHARMA S.A. CUTIE CU BLIST. PVC/AL X 30 COMPR.
ROMANIA PRF 30 0.050550 1.082783 0.045495 1.087838
820 W55412001 N05BA08 BROMAZEPAMUM * BROMAZEPAM ARENA 3 mg COMPR. 3mg ARENA GROUP S.A. CUTIE CU 1 BLIST. PVC/AL X 10 COMPR.
ROMANIA P-RF 10 0.101100 0.900900 0.090990 0.911010
821 W06826003 N05BA08 BROMAZEPAMUM * BROMAZEPAM LPH 3 mg COMPR. 3mg LABORMED PHARMA S.A. CUTIE CU BLIST. PVC/AL X 30 COMPR.
ROMANIA PRF 30 0.101100 0.170566 0.090990 0.180676
822 W55412004 N05BA08 BROMAZEPAMUM * BROMAZEPAM ARENA 3 mg COMPR. 3mg ARENA GROUP S.A. CUTIE CU 4 BLIST. PVC/AL X 10 COMPR.
ROMANIA P-RF 40 0.101100 0.812150 0.090990 0.822260
823 W08624003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM LPH 0,25 mg COMPR. 0,25mg LABORMED PHARMA SA CUTIE X 3 BLIST. X 10 COMPR.
ROMANIA P-RF 30 0.084250 0.075083 0.075825 0.083508
824 W41469001 N05BA12 ALPRAZOLAMUM * PRAZOLEX 0,25 mg COMPR. 0,25mg GEDEON RICHTER ROMANIA SA CUTIE X 2 BLIST. AL/PVC X 15 COMPR.
ROMANIA P-RF 30 0.084250 0.075083 0.075825 0.083508
825 W07122001 N05BA12 ALPRAZOLAMUM * FRONTIN 0,25 mg COMPR. 0,25mg EGIS PHARMACEUTICALS P.L.C. CUTIE X 1 FLAC. X 30 COMPR.
UNGARIA P-RF 30 0.084250 0.075083 0.075825 0.083508
826 W59969001 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. CUTIE CU 1 BLIST. PVC/AL X 10 COMPR.
ROMANIA PRF 10 0.084250 0.075750 0.075825 0.084175
827 W59969002 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. CUTIE CU 2 BLIST. PVC/AL X 10 COMPR.
ROMANIA PRF 20 0.084250 0.074250 0.075825 0.082675
828 W59969003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,25 mg COMPR. 0,25mg ANTIBIOTICE S.A. CUTIE CU 3 BLIST. PVC/AL X 10 COMPR.
ROMANIA PRF 30 0.084250 0.075083 0.075825 0.083508
829 W67287001 N05BA12 ALPRAZOLAMUM * XANAX 0,25 mg COMPR. 0,25mg UPJOHN EESV OLANDA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.084250 0.153083 0.075825 0.161508
830 W08625003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM LPH 0,5 mg COMPR. 0,5mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. X 10 COMPR. P-RF 30 0.168500 0.085833 0.151650 0.102683
831 W07123001 N05BA12 ALPRAZOLAMUM * FRONTIN 0,5 mg COMPR. 0,5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-RF 30 0.168500 0.085833 0.151650 0.102683
832 W42783001 N05BA12 ALPRAZOLAMUM * PRAZOLEX 0,5 mg COMPR. 0,5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 2 BLIST. DIN PVC/PVDC/AL X 15 COMPR. P-RF 30 0.168500 0.085833 0.151650 0.102683
833 W59972001 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIACUTIE CU 1 BLIST. PVC/AL X 10 COMPR. PRF 10 0.168500 0.085500 0.151650 0.102350
834 W59972002 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIACUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.168500 0.085000 0.151650 0.101850
835 W59972003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 0,5 mg COMPR. 0,5mg ANTIBIOTICE S.A. ROMANIACUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.168500 0.085833 0.151650 0.102683
836 W67288001 N05BA12 ALPRAZOLAMUM * XANAX 0,5 mg COMPR. 0,5mg UPJOHN EESV OLANDA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.168500 0.184500 0.151650 0.201350
837 W08626003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM LPH 1 mg COMPR. 1mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-RF 30 0.337000 0.000000 0.303300 0.033700
838 W41470001 N05BA12 ALPRAZOLAMUM * PRAZOLEX 1 mg COMPR. 1mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-RF 30 0.337000 0.000000 0.303300 0.033700
839 W07126001 N05BA12 ALPRAZOLAMUM * FRONTIN 1mg COMPR. 1mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 30 COMPR. P-RF 30 0.337000 0.000000 0.303300 0.033700
840 W59973001 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 1 mg COMPR. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. PRF 10 0.330000 0.000000 0.297000 0.033000
841 W59973002 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 1 mg COMPR. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.330500 0.000000 0.297450 0.033050
842 W59973003 N05BA12 ALPRAZOLAMUM * ALPRAZOLAM ATB 1 mg COMPR. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.337000 0.000000 0.303300 0.033700
843 W67289001 N05BA12 ALPRAZOLAMUM * XANAX 1 mg COMPR. 1mg UPJOHN EESV OLANDA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 0.337000 0.126666 0.303300 0.160366
844 W12245003 N05CD02 NITRAZEPAMUM NITRAZEPAM LPH 2,5 mg COMPR. 2.5mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.079124 0.444209 0.071211 0.452122
845 W59781001 N05CD02 NITRAZEPAMUM NITRAZEPAM - RICHTER 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.158000 0.000000 0.142200 0.015800
846 W12246003 N05CD02 NITRAZEPAMUM NITRAZEPAM LPH 5 mg COMPR. 5mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.158249 0.000084 0.142424 0.015909
847 W64484001 N05CF01 ZOPICLONUM * IMOVANE 7,5 mg COMPR. FILM. 7,5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. FILM. PRF 20 0.464000 0.000000 0.417600 0.046400
848 W64484002 N05CF01 ZOPICLONUM * IMOVANE 7,5 mg COMPR. FILM. 7,5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 14 COMPR. FILM. PRF 14 0.744396 1.172032 0.669956 1.246472
849 W53913001 N05CF02 ZOLPIDEMUM * ZOLPIDEM ATB 10 MG COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.287000 0.000000 0.258300 0.028700
850 W62440001 N05CF02 ZOLPIDEMUM * STILNOX 10 mg COMPR. FILM. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 1 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 10 0.344000 0.171000 0.309600 0.205400
851 W62440002 N05CF02 ZOLPIDEMUM * STILNOX 10 mg COMPR. FILM. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 20 0.344000 0.171500 0.309600 0.205900
852 W62440003 N05CF02 ZOLPIDEMUM * STILNOX 10 mg COMPR. FILM. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 1 BLIST. PVC/AL X 20 COMPR. FILM. P-RF 20 0.344000 0.171500 0.309600 0.205900
853 W62440004 N05CF02 ZOLPIDEMUM * STILNOX 10 mg COMPR. FILM. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 1 BLIST. PVC/AL X 14 COMPR. FILM. PRF 14 0.344000 0.172428 0.309600 0.206828
854 W53913002 N05CF02 ZOLPIDEMUM * ZOLPIDEM ATB 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. FILM. PRF 20 0.283500 0.000000 0.255150 0.028350
855 W01358001 N06AA04 CLOMIPRAMINUM * ANAFRANIL 10 mg DRAJ. 10mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-RF 30 0.214266 0.098400 0.192839 0.119827
856 W67624001 N06AA04 CLOMIPRAMINUM * ANAFRANIL 10 mg DRAJ. 10mg ZR PHARMA& GMBH AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. PRF 30 0.214266 0.098400 0.192839 0.119827
857 W01359001 N06AA04 CLOMIPRAMINUM * ANAFRANIL 25 mg DRAJ. 25mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-RF 30 0.535666 0.000000 0.482099 0.053567
858 W67625001 N06AA04 CLOMIPRAMINUM * ANAFRANIL 25 mg DRAJ. 25mg ZR PHARMA& GMBH AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. PRF 30 0.535666 0.000000 0.482099 0.053567
859 W02865001 N06AA12 DOXEPINUM * DOXEPIN 25 mg DRAJ. 25mg TERAPIA SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 DRAJ. P-RF 30 0.535666 1.636000 0.482099 1.689567
860 W60729001 N06AB03 FLUOXETINUM ** FLUOXETIN ARENA 10 mg CAPS. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 0.267741 1.481259 0.240966 1.508034
861 W60729002 N06AB03 FLUOXETINUM ** FLUOXETIN ARENA 10 mg CAPS. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 10 BLIST. PVC/AL X 10 CAPS. PRF 100 0.267741 1.096259 0.240966 1.123034
862 W13241002 N06AB03 FLUOXETINUM ** FLUOXIN 20 mg CAPS. 20mg VIM SPECTRUM SRL ROMANIA CUTIE X 4 BLIST. PVC/AL X 7 CAPS. P-RF 28 0.535483 0.490945 0.481934 0.544494
863 W08497001 N06AB03 FLUOXETINUM ** MAGRILAN 20 mg CAPS. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-RF 30 0.521333 0.000000 0.469199 0.052134
864 W60730001 N06AB03 FLUOXETINUM ** FLUOXETIN ARENA 20 mg CAPS. 20mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 0.535483 0.490517 0.481934 0.544066
865 W60730002 N06AB03 FLUOXETINUM ** FLUOXETIN ARENA 20 mg CAPS. 20mg ARENA GROUP S.A. ROMANIA CUTIE CU 10 BLIST. PVC/AL X 10 CAPS. PRF 100 0.535483 0.291917 0.481934 0.345466
866 W10228001 N06AB03 FLUOXETINUM ** PROZAC 20 mg COMPR. DISP. 20mg ELI LILLY SA SPANIA CUTIE X 2 BLIST. PVC-PE-PCTFE/AL X 14 COMPR. DISP. P-RF 28 0.535483 2.692374 0.481934 2.745923
867 W43706001 N06AB04 CITALOPRAMUM ** LINISAN 20 mg COMPR. FILM. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 0.535483 1.081517 0.481934 1.135066
868 W41796001 N06AB05 PAROXETINUM * ARKETIS 20 mg COMPR. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC, X 10 COMPR. P-RF 30 0.535483 0.127183 0.481934 0.180732
869 W43958002 N06AB05 PAROXETINUM * PAXETIN 20 mg COMPR. FILM. 20mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIST. AL/AL X 10 COMPR. FILM. P-RF 30 0.535483 0.058183 0.481934 0.111732
870 W64362002 N06AB05 PAROXETINUM * PAXETIN 20 mg COMPR. FILM. 20mg TEVA B.V. OLANDA CUTIE CU 3 BLIST. OPA-AL-PVC/PVC-AL-OPA X 10 COMPR. FILM. PRF 30 0.535483 0.058183 0.481934 0.111732
871 W65203003 N06AB05 PAROXETINUM * SEROXAT 20 mg COMPR. FILM. 20mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 3 BLIST. PVC/AL-HARTIE X 10 COMPR. FILM. PRF 30 0.535483 0.345850 0.481934 0.399399
872 W44097001 N06AB06 SERTRALINUM ** SERLIFT 100 mg COMPR. FILM. 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 14 COMPR. FILM. P-RF 28 1.070966 0.462605 0.963869 0.569702
873 W12874001 N06AB06 SERTRALINUM ** ASENTRA 100 mg COMPR. FILM. 100mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. X 7 COMPR. FILM. P-RF 28 1.070966 0.126891 0.963869 0.233988
874 W59303002 N06AB06 SERTRALINUM ** STIMULOTON 100 mg COMPR. FILM. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-RF 28 1.070966 0.462605 0.963869 0.569702
875 W60444001 N06AB06 SERTRALINUM ** SERTRALINA ARENA 100 mg COMPR. FILM. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 1.070966 0.463034 0.963869 0.570131
876 W61376006 N06AB06 SERTRALINUM ** SERTRALINA AUROBINDO 100 mg COMPR. FILM. 100mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. PRF 30 1.070966 0.128367 0.963869 0.235464
877 W67279001 N06AB06 SERTRALINUM ** ZOLOFT 100 mg COMPR. FILM. 100mg UPJOHN EESV OLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PR/PRF 28 1.070966 0.374748 0.963869 0.481845

Pagina 15 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
878 W44096001 N06AB06 SERTRALINUM ** SERLIFT 50 mg COMPR. FILM. 50mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 14 COMPR. FILM. P-RF 28 0.535483 0.388445 0.481934 0.441994
879 W12873001 N06AB06 SERTRALINUM ** ASENTRA 50 mg COMPR. FILM. 50mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. X 7 COMPR. FILM. P-RF 28 0.535483 0.023088 0.481934 0.076637
880 W59302001 N06AB06 SERTRALINUM ** STIMULOTON 50 mg COMPR. FILM. 50mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 3 BLIST. X 10 COMPR. FILM. P-RF 30 0.535483 0.266850 0.481934 0.320399
881 W60443001 N06AB06 SERTRALINUM ** SERTRALINA ARENA 50 mg COMPR. FILM. 50mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 0.535483 0.485517 0.481934 0.539066
882 W61375006 N06AB06 SERTRALINUM ** SERTRALINA AUROBINDO 50 mg COMPR. FILM. 50mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIACUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. PRF 30 0.505333 0.000000 0.454799 0.050534
883 W67278001 N06AB06 SERTRALINUM ** ZOLOFT 50 mg COMPR. FILM. 50mg UPJOHN EESV OLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PR/PRF 28 0.535483 0.278802 0.481934 0.332351
884 W67280001 N06AB06 SERTRALINUM ** ZOLOFT 20 mg/ml CONC. PT. SOL. ORALA 20mg/ml UPJOHN EESV OLANDA CUTIE CU 1 FLAC. DIN STICLA BRUNA, AVAND CAPACITATEA DE 60 ML + 1 PIPETA GRADATA CARE CONTINE CONC. PT. SOL. ORALA PR/PRF 1 12.851603 71.318397 11.566442 72.603558
885 W62371001 N06AB08 FLUVOXAMINUM * FEVARIN 100mg COMPR. FILM. 100mg BGP PRODUCTS B.V. OLANDA CUTIE X 2 BLIST. PVC/PVDC X 15 COMPR. FILM. P-RF 30 0.535483 0.804183 0.481934 0.857732
886 W64560001 N06AB08 FLUVOXAMINUM * FEVARIN 100 COMPR. FILM. 100mg MYLAN HEALTHCARE B.V. OLANDA CUTIE CU 2 BLIST. PVC/PVDC X 15 COMPR. FILM. PRF 30 0.535483 0.804183 0.481934 0.857732
887 W68887001 N06AB08 FLUVOXAMINUM * FEVARIN 100 COMPR. FILM. 100mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVC/PVDC X 15 COMPR. FILM. PRF 30 0.535483 0.804183 0.481934 0.857732
888 W62372001 N06AB08 FLUVOXAMINUM * FEVARIN 50mg COMPR. FILM. 50mg BGP PRODUCTS B.V. OLANDA CUTIE X 2 BLIST. PVC/PVDC X 15 COMPR. FILM. P-RF 30 0.267741 0.444259 0.240966 0.471034
889 W64561001 N06AB08 FLUVOXAMINUM * FEVARIN 50 COMPR. FILM. 50mg MYLAN HEALTHCARE B.V. OLANDA CUTIE CU 2 BLIST. PVC/PVDC X 15 COMPR. FILM. PRF 30 0.267741 0.444259 0.240966 0.471034
890 W68888001 N06AB08 FLUVOXAMINUM * FEVARIN 50 COMPR. FILM. 50mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVC/PVDC X 15 COMPR. FILM. PRF 30 0.267741 0.444259 0.240966 0.471034
891 W60361001 N06AX11 MIRTAZAPINUM * MIRTAZAPIN ARENA 15 mg COMPR. FILM. 15mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. ALBE OPACE DIN PVC-PVDC/AL-PVDC X 10 COMPR. FILM. PRF 30 0.521333 0.564333 0.469199 0.616467
892 W42062001 N06AX11 MIRTAZAPINUM * MIRZATEN (R) 30 mg COMPR. FILM. 30mg KRKA D.D. SLOVENIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 0.614333 0.000000 0.552899 0.061434
893 W44013002 N06AX11 MIRTAZAPINUM * PHARMATAZ 30 mg COMPR. FILM. 30mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIST. PVC-PVDC/AL, X 10 COMPR. FILM. P-RF 30 1.042666 0.000000 0.938399 0.104267
894 W60362001 N06AX11 MIRTAZAPINUM * MIRTAZAPIN ARENA 30 mg COMPR. FILM. 30mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. ALBE OPACE DIN PVC-PVDC/AL-PVDC X 10 COMPR. FILM. PRF 30 1.042666 0.000000 0.938399 0.104267
895 W64363002 N06AX11 MIRTAZAPINUM * PHARMATAZ 30 mg COMPR. FILM. 30mg TEVA B.V. OLANDA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. PRF 30 1.042666 0.000000 0.938399 0.104267
896 W60363001 N06AX11 MIRTAZAPINUM * MIRTAZAPIN ARENA 45 mg COMPR. FILM. 45mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. ALBE OPACE DIN PVC-PVDC/AL-PVDC X 10 COMPR. FILM. PRF 30 1.563999 0.933667 1.407599 1.090067
897 W63233003 N06AX11 MIRTAZAPINUM * REMERON SOLTAB 30 mg COMPR. ORODISPERSABILE 30mg MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE CU 5 BLIST. AL/PVC-PA-POLIESTER PERFORATE PT. ELIB. UNEI UNITATI DOZATE X 6 COMPR. ORODISPERSABILE PRF 30 1.042666 0.716000 0.938399 0.820267
898 W68318003 N06AX11 MIRTAZAPINUM * REMERON SOLTAB 30 mg COMPR. ORODISPERSABILE 30mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 5 BLIST. AL/PVC-PA-POLIESTER PERFORATE PT. ELIB. UNEI UNITATI DOZATE X 6 COMPR. ORODISPERSABILE PRF 30 1.042666 0.716000 0.938399 0.820267
899 W58756003 N06AX16 VENLAFAXINUM ** ELIFY EP 150 mg CAPS. ELIB. PREL. 150 mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST PVC/AL X 30 CAPS.CU ELIB. PREL. PRF 30 1.381666 0.000000 1.243499 0.138167
900 W67116002 N06AX16 VENLAFAXINUM ** EFECTIN EP 150 mg CAPS. ELIB. PREL. 150 mg UPJOHN EESV OLANDA CUTIE CU BLIST. DIN PVC/AL X 28 CAPS. ELIB. PREL. PRF 28 1.566267 0.343375 1.409640 0.500002
901 W52122001 N06AX16 VENLAFAXINUM ** VELAXIN 150 mg CAPS. ELIB. PREL. 150mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC/PVDC-AL X 28 CAPS. ELIB. PREL. P-RF 28 1.566071 0.000000 1.409463 0.156608
902 W52962005 N06AX16 VENLAFAXINUM ** ALVENTA 150mg CAPS. ELIB. PREL. 150mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. ELIB. PREL. P-RF 30 0.707333 0.000000 0.636599 0.070734
903 W55396001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA EP 150 mg CAPS. ELIB. PREL. 150mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 30 1.566267 0.000066 1.409640 0.156693
904 W53268003 N06AX16 VENLAFAXINUM ** FOBILESS 37,5 mg CAPS. ELIB. PREL. 37,5mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF 30 0.391566 0.369767 0.352409 0.408924
905 W55395001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA EP 37,5 mg CAPS. ELIB. PREL. 37,5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 30 0.391566 0.668100 0.352409 0.707257
906 W58755003 N06AX16 VENLAFAXINUM ** ELIFY EP 75 mg CAPS. ELIB. PREL. 75 mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. PRF 30 0.783133 0.004200 0.704819 0.082514
907 W67115002 N06AX16 VENLAFAXINUM ** EFECTIN EP 75 mg CAPS. ELIB. PREL. 75 mg UPJOHN EESV OLANDA CUTIE CU BLIST. DIN PVC/AL X 28 CAPS. ELIB. PREL. PRF 28 0.783133 0.291152 0.704819 0.369466
908 W52123001 N06AX16 VENLAFAXINUM ** VELAXIN 75 mg CAPS. ELIB. PREL. 75mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC/PVDC-AL X 28 CAPS. ELIB. PREL. P-RF 28 0.783133 0.345438 0.704819 0.423752
909 W52961005 N06AX16 VENLAFAXINUM ** ALVENTA 75 mg CAPS. ELIB. PREL. 75mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. ELIB. PREL. P-RF 30 0.415666 0.000000 0.374099 0.041567
910 W53269003 N06AX16 VENLAFAXINUM ** FOBILESS 75 mg CAPS. ELIB. PREL. 75mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF 30 0.783133 0.061867 0.704819 0.140181
911 W55397001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA EP 75 mg CAPS. ELIB. PREL. 75mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 30 0.783133 0.308867 0.704819 0.387181
912 W55398001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA 37,5 mg COMPR. 37,5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PVDC/AL X 10 COMPR. P-RF 30 0.391566 1.508100 0.352409 1.547257
913 W55399001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA 50 mg COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PVDC/AL X 10 COMPR. P-RF 30 0.522089 1.394577 0.469880 1.446786
914 W55400001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA 75 mg COMPR. 75mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE- PVDC/AL X 10 COMPR. P-RF 30 0.783133 1.225867 0.704819 1.304181
915 W52868002 N07AA01 NEOSTIGMINI BROMIDUM NEOSTIGMINA LPH 15 mg COMPR. 15mg LABORMED PHARMA SA ROMANIA CUTIE CU BLIST. PVC/AL X 60 COMPR. P-6L 60 1.858666 0.000000 1.672799 0.185867
916 W65149004 N07XX07 FAMPRIDINE ** Ω FAMPYRA COMPR. ELIB. PREL. 10mg BIOGEN NETHERLANDS B.V. OLANDA CUTIE X 56 COMPRIMATE CU ELIBERARE PRELUNGITA (4 BLISTERE X 14) PR/PRF 56 13.447142 0.000000 12.102427 1.344715
917 W67601001 P01AB01 METRONIDAZOLUM METRONIDAZOL ARENA 125 mg CAPS. 125mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLISTERE DIN AL/PVC TRANSPARENT A CÂTE 10 CAPSULE PRF 30 1.862333 0.000000 1.676099 0.186234
918 W67602001 P01AB01 METRONIDAZOLUM METRONIDAZOL ARENA 500 mg CAPS. 500 mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLISTERE DIN AL/PVC TRANSPARENT A CÂTE 10 CAPSULE PRF 20 1.148500 3.958000 1.033650 4.072850
919 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 1.148500 0.071500 1.033650 0.186350
920 W68353001 P01AB02 TINIDAZOLUM TIPROGYN 500 mg (vezi J01XD02) COMPR. FILM. 500mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 4 COMPR.FILM. P6L 4 1.148500 0.071500 1.033650 0.186350
921 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 1.148500 0.071500 1.033650 0.186350
922 W68353001 P01AB02 TINIDAZOLUM TIPROGYN 500 mg (vezi J01XD02) COMPR. FILM. 500mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 4 COMPR.FILM. P6L 4 1.148500 0.071500 1.033650 0.186350
923 W53579001 P02CA03 ALBENDAZOLUM ALBENDAZOL VIM SPECTRUM 200 mg COMPR. 200mg VIM SPECTRUM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 2 COMPR. P-RF 2 3.466666 0.778334 3.119999 1.125001
924 W00225003 P02CA03 ALBENDAZOLUM ESKAZOLE COMPR. 400mg GLAXO SMITHKLINE EXPORT LTD. MAREA BRITANIE CUTIE X 12 BLIST. PVC-PVDC/AL X 1 COMPR. P-RF 12 6.933333 0.000000 6.239999 0.693334
925 W65213003 P02CA03 ALBENDAZOLUM ESKAZOLE 400 mg COMPR. 400mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 12 BLIST. PVC-PVDC/AL X 1 COMPR. PRF 12 6.933333 0.000000 6.239999 0.693334
926 W13994001 P02CA03 ALBENDAZOLUM DUADOR 200 mg COMPR. FILM. 200mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 1 BLIST. X 2 COMPR. FILM. P-RF 2 3.466666 0.778334 3.119999 1.125001
927 W62163001 P02CA03 ALBENDAZOLUM VERMIGAL NOVO 200 mg COMPR. FILM. 200mg BIOFARM S.A. ROMANIA CUTIE CU 1 BLIST. AL/PVC-PVDC TRANSPARENT X 2 COMPR. FILM. PRF 2 3.466666 1.548334 3.119999 1.895001
928 W60595001 P02CA03 ALBENDAZOLUM VERMIGAL NOVO 400 mg/10 ml SUSP. ORALA 400mg/10ml BIOFARM S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 10 ML SUSP. ORALA PRF 1 4.930000 0.000000 4.437000 0.493000
929 W55331001 P02CE01 LEVAMISOLUM LEVAMISOL ARENA 150 mg COMPR. 150mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 1 COMPR. P-RF 1 12.000000 0.000000 10.800000 1.200000
930 W55330001 P02CE01 LEVAMISOLUM LEVAMISOL ARENA 50 mg COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 2 COMPR. P-RF 2 4.334996 1.005004 3.901496 1.438504
931 W64944001 R03AC02 SALBUTAMOLUM VENTOLIN 5 mg/ml SOL. DE INHALAT PRIN NEBULIZATOR 5mg/ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 10 ML SOL. DE INHAL. PRIN NEBULIZATOR P6L 1 6.180000 3.730000 5.562000 4.348000
932 W12650001 R03AC02 SALBUTAMOLUM VENTOLIN (R) SOL. INHAL. 5mg/ml GLAXOWELLCOME UK LTD. MAREA BRITANIE CUTIE X 1 FALC. DIN STICLA BRUNA X 10 ML SOL. DE INHAL. P-6L 1 6.180000 3.730000 5.562000 4.348000
933 W65178001 R03AC02 SALBUTAMOLUM VENTOLIN 100 INHALER CFC-FREE SUSP. INHAL. PRESURIZATA 100µg/doza GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE X 1 FLACON PRESURIZAT DIN AL PREVAZUT CU VALVA DOZATOARE X 200 DOZE + DISPOZITIV DE ADMINISTRARE P-RF 1 12.250000 0.000000 11.025000 1.225000
934 W41683001 R03BA01 BECLOMETASONUM CLENIL JET 250 mcg/doza 250mcg/doza
SOL. DE INHALAT PRESURIZATA CHIESI FARMACEUTICI SPA ITALIA CUTIE X 1 FLACON PRESURIZAT DIN AL X 200 DOZE, PREVAZUT CU VALVA DOZATOARE + DISPOZITIV DE ADM., "SPASER JET" CU CAPAC P-RF 1 87.320000 26.730000 78.588000 35.462000
935 W67210001 R03BA01 BECLOMETASONUM SOPROBEC 250 micrograme pe doza 250mcg/doza
SOL. DE INHALAT PRESURIZATA GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU FLAC. PRESURIZAT DIN AL PREVAZUT CU UN CONTOR AL DOZELOR, SISTEM DE ACTIONARE DE CULOARE MARONIE SI CAPAC DE PROTECTIE DE CULOARE GRI CARE ELIBEREAZA 200 DOZE (PUFURI) PRF 1 78.410000 0.000000 70.569000 7.841000
936 W43881003 R03BA02 BUDESONIDUM FRENOLYN 200 µg PULB. INHAL. 200 mcg/doza MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE CU 1 PUNGA DIN POLISTIREN/AL/PE CONTINAND 1 INHALATOR TIP MIAT-HALER X 200 DOZE P-RF 1 61.750000 0.000000 55.575000 6.175000

Pagina 16 din 17
Contributie maxima Val. maxima suportata de Contributie maxima
a asiguratului / UT sistemul de asigurari a asiguratului / UT
(pt. asiguratii care sociale de sanatate / UT (pt. asiguratii care

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 90% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
937 W43881001 R03BA02 BUDESONIDUM FRENOLYN 200 µg PULB. INHAL. 200 mcg/doza MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE CU 1 PUNGA DIN POLISTIREN/AL/PE CONTINAND 1 INHALATOR TIP MIAT-HALER X 100 DOZE P-RF 1 32.386250 0.503750 29.147625 3.742375
938 W43882002 R03BA02 BUDESONIDUM FRENOLYN 400 µg PULB. INHAL. 400 mcg/doza MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE CU 1 PUNGA DIN POLISTIREN/AL/PE CONTINAND 1 INHALATOR TIP MIAT-HALER X 100 DOZE P-RF 1 64.772500 32.957500 58.295250 39.434750
939 W69483001 R03BA02 BUDESONIDUM CORTAIR 0,5 mg/ml Suspensie pentru nebulizator SUSP. DE INHALAT PRIN NEBULIZATOR 0,5mg/ml CN UNIFARM S.A. ROMANIA CUTIE CU 20 FIOLE A CATE 2 ML SUSP. PT. NEBULIZATOR PRF 20 0.863632 1.954368 0.777268 2.040732
940 W65226001 R03BB01 IPRATROPII BROMIDUM IPRAVENT INHALER 20 micrograme/doza SOL. DE INHAL. PRESURIZATA 20micrograme/doza AMRING FARMA S.R.L. ROMANIA CUTIE CU 1 FLAC. PRESURIZAT DIN AL X 200 DOZE SOL. DE INHALAT PRESURIZATA P6L 1 22.155006 2.684994 19.939505 4.900495
941 W69439001 R03BB01 IPRATROPII BROMIDUM IPRATOM 500 mcg/2ml 500mcg/2ml
SOL. DE INHALAT PRIN NEBULIZATOR CN UNIFARM S.A. ROMANIA CUTIE CU 20 FIOLE MONODOZA A CATE 2 ML SOL. DE INHALAT PRIN NEBULIZATOR P6L 20 1.063000 0.000000 0.956700 0.106300
942 W05494001 R03CC02 SALBUTAMOLUM SALBUTAMOL MCC 4 mg COMPR. 4mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.661000 0.000000 0.594900 0.066100
943 W44064001 R03CC02 SALBUTAMOLUM SALBUTAMOL EIPICO 2mg/5ml SIROP 2mg/5ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 125 ML SIROP P-6L 1 17.570000 0.000000 15.813000 1.757000
944 W65179001 R03CC02 SALBUTAMOLUM VENTOLIN 0,5 mg/ml SOL. INJ. 0,5mg/ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ. P6L 5 2.034000 0.000000 1.830600 0.203400
945 W07705001 R03DA04 THEOPHYLLINUM TEOTARD 200 mg CAPS. ELIB. PREL. 200mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. AL/PVC X 10 CAPS. ELIB. PREL. P-RF 40 0.635736 0.204764 0.572162 0.268338
946 W05848001 R03DA04 THEOPHYLLINUM TEOTARD 350 mg CAPS. ELIB. PREL. 350mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. AL/PVC X 10 CAPS. ELIB. PREL. P-RF 40 1.112538 0.070962 1.001284 0.182216
947 W65487001 R03DX05 OMALIZUMABUM **1 Ω XOLAIR 150 mg SOL INJ. 150mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR/PRF 1 1,168.600000 0.000000 1,051.740000 116.860000
948 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 0.255333 0.000000 0.229799 0.025534
949 W01409002 R05DA04 CODEINUM FOSFAT DE CODEINA BIOEEL 15 mg COMPR. 15mg BIO EEL SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-RF 25 0.261200 0.000000 0.235080 0.026120
950 W01407004 R05DA04 CODEINUM CODEINA FOSFAT LPH 15 mg COMPR. 15mg LABORMED PHARMA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-RF 20 0.261200 0.000800 0.235080 0.026920
951 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 0.261200 0.000800 0.235080 0.026920
952 W62739001 R05DA04 CODEINUM CODEINA SLAVIA 15mg COMPR. 15mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0.261200 0.000800 0.235080 0.026920
953 W68091001 R05DA04 CODEINUM FOSFAT DE CODEINA BIOEEL 15 mg COMPR. 15mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 25 COMPR. PRF 25 0.261200 0.000000 0.235080 0.026120
954 W01189001 R06AB04 CHLORPHENAMINUM CLORFENIRAMIN 4 mg COMPR. 4mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 1.699999 0.000001 1.529999 0.170001
955 W42728001 R06AE07 CETIRIZINUM CELERG 10 mg COMPR. FILM. 10 mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. FILM. P-6L 20 0.633299 0.765701 0.569969 0.829031
956 W43156001 R06AE07 CETIRIZINUM CETIRIZINA LAROPHARM 10 mg COMPR. FILM. 10mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 0.633299 0.765201 0.569969 0.828531
957 W59369003 R06AE07 CETIRIZINUM ZYRTEC 10 mg/ml PICATURI ORALE, SOL. 10mg/ml UCB PHARMA GMBH GERMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA + PICURATOR DIN PEJD X 20 ML PIC. ORALE, SOL. P6L 1 12.665997 4.704003 11.399397 5.970603
958 W52907001 R06AX17 KETOTIFENUM KETOTIFEN LAROPHARM 1 mg COMPR. 1mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. P-6L 20 0.232500 0.000000 0.209250 0.023250
959 W58781002 R06AX17 KETOTIFENUM KETOTIFEN LPH 1 mg COMPR. 1mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR P6L 30 0.232708 0.000625 0.209437 0.023896
960 W03905001 R06AX17 KETOTIFENUM KETOF 1 mg/5 ml SIROP 1mg/5ml HEXAL AG GERMANIA CUTIE X 1 FLACON X 100 ML SIROP + MASURA DOZATOARE P-6L 1 55.920000 0.000000 50.328000 5.592000
961 W55653001 S01BC03 DICLOFENACUM DICLOFENAC ROMPHARM 1 mg/ml PICATURI OFT., SOL. 1mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE CU 1 FLAC. ALB DIN PEJD, PREVAZUT CU PICURATOR ALB DIN PEJD X 5 ML PIC. OFT., SOL. P-6L 1 14.530000 0.000000 13.077000 1.453000
962 W60088001 S01CA05 COMBINATII (BETHAMETASONUM+CLORAMPHENICOLUM) BETABIOPTAL 1,3 mg/g+2,5 mg/g GEL OFT. 1,3mg/g+2,5mg/g THEA FARMA S.P.A. ITALIA CUTIE CU 1 FLAC. DIN PEJD +PICURATOR DIN PE X 5 G GEL OFT. PRF 1 49.795000 21.365000 44.815500 26.344500
963 W59770001 S01CA05 COMBINATII (BETHAMETASONUM+CLORAMPHENICOLUM) BETABIOPTAL 2 mg/5 mg/ml PICATURI OFT.SUSP. 2mg/5mg/ml THEA FARMA S.P.A. ITALIA CUTIE X 1 FLACON DIN PEJD X 5 ML PIC. OFT.,SUSP. + APLICATOR PT. PICURARE P-RF 1 45.420000 0.000000 40.878000 4.542000
964 W59771001 S01CA05 COMBINATII (BETHAMETASONUM+CLORAMPHENICOLUM) BETABIOPTAL 2 mg/g+5 mg/g UNG. OFT. 2mg/g+5mg/g THEA FARMA S.P.A. ITALIA CUTIE X 1 TUB AL X 5 G P-RF 1 49.795000 4.375000 44.815500 9.354500

NOTĂ:
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu * se iniţiază de către medicul de specialitate în limita competenţei şi poate fi prescris în continuare de medicul de familie pe baza scrisorii medicale emise
de medicul de specialitate;
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu ** se efectuează pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sănătăţii;
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu (1) se efectuează pentru pacienţii cu intoleranţă la acidum acetylsalicylicum.

Pagina 17 din 17
ANEXA 2b

SUBLISTA B - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 50% DIN PRETUL DE REFERINTA CONFORM
DENUMIRILOR COMUNE INTERNATIONALE (DCI) ALE MEDICAMENTELOR DE CARE BENEFICIAZA ASIGURATII IN TRATAMENTUL AMBULATORIU CU SI FARA CONTRIBUTIE PERSONALA
DIN HG NR. 720/2008, REPUBLICATA, CU MODIFICARILE SI COMPLETARILE ULTERIOARE, VALABILA INCEPAND CU 01 AUGUST 2023

Contributie maxima a Val. maxima suportata Val. maxima suportata


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

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

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


Nr crt.

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

1 W56920002 A02BC02 PANTOPRAZOLUM ZENCOPAN 20 mg COMPR. GASTROREZ. 20 mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. NYLON/AL/PVC/AL A CATE 28 COMPR. GASTROREZ. P6L 28 0.266785 0.000000 0.133392 0.133393 0.240106 0.026679
2 W56920009 A02BC02 PANTOPRAZOLUM ZENCOPAN 20 mg COMPR. GASTROREZ. 20 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA/AL/PVC/AL X 28 COMPR. GASTROREZ. P6L 28 0.266785 0.000000 0.133392 0.133393 0.240106 0.026679
3 W54684002 A02BC02 PANTOPRAZOLUM NOLPAZA 20 mg COMPR. GASTROREZ. 20mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 15 COMPR. GASTR. P-6L 30 0.373333 0.000000 0.186666 0.186667 0.335999 0.037334
4 W60432003 A02BC02 PANTOPRAZOLUM PANTOPRAZOL TERAPIA 20 mg COMPR. GASTROREZ. 20mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PA-AL-PVC/AL X 10 COMPR. GASTROREZ. P6L 30 0.422333 0.000000 0.211166 0.211167 0.380099 0.042234
5 W61932062 A02BC02 PANTOPRAZOLUM CONTROLOC 20 mg COMPR. GASTROREZ. 20mg TAKEDA GMBH GERMANIA CUTIE DE CARTON CU BLIST. DIN AL/AL CU RANFORSARE DIN CARTON X 30 COMPR. GASTROREZ. P6L 30 0.434666 0.000000 0.217333 0.217333 0.391199 0.043467
6 W61932035 A02BC02 PANTOPRAZOLUM CONTROLOC 20 mg COMPR. GASTROREZ. 20mg TAKEDA GMBH GERMANIA CUTIE DE CARTON CU BLIST. DIN AL/AL FARA RANFORSARE DIN CARTON X 30 COMPR. GASTROREZ. P6L 30 0.434666 0.000000 0.217333 0.217333 0.391199 0.043467
7 W67388001 A02BC02 PANTOPRAZOLUM PANTOPRAZOL MEDREG 20 mg COMPR. GASTROREZ. 20mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. GASTROREZ. P6L 30 0.422333 0.000000 0.211166 0.211167 0.380099 0.042234
8 W56919002 A02BC02 PANTOPRAZOLUM ZENCOPAN 40 mg COMPR. GASTROREZ. 40 mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. NYLON/AL/PVC/AL A CATE 28 COMPR. GASTROREZ. P6L 28 0.533928 0.000000 0.266964 0.266964 0.480535 0.053393
9 W56919009 A02BC02 PANTOPRAZOLUM ZENCOPAN 40 mg COMPR. GASTROREZ. 40 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA/AL/PVC/AL X 28 COMPR. GASTROREZ. P6L 28 0.533928 0.000000 0.266964 0.266964 0.480535 0.053393
10 W54685002 A02BC02 PANTOPRAZOLUM NOLPAZA 40mg COMPR. GASTROREZ. 40mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 15 COMPR. GASTR. P-6L 30 0.735333 0.000000 0.367666 0.367667 0.661799 0.073534
11 W56172001 A02BC02 PANTOPRAZOLUM SELTRAZ 40 mg COMPR. GASTROREZ. 40mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 2 BLIST. DIN OPA-AL-PVC/AL X 14 COMPR. GASTROREZ. P-6L 28 0.775357 0.000000 0.387678 0.387679 0.697821 0.077536
12 W57634001 A02BC02 PANTOPRAZOLUM PANTOPRAZOL TERAPIA 40 mg COMPR. GASTROREZ. 40mg TERAPIA S.A. ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 10 COMPR. GASTROREZ. P-6L 10 0.775000 0.000000 0.387500 0.387500 0.697500 0.077500
13 W57634003 A02BC02 PANTOPRAZOLUM PANTOPRAZOL TERAPIA 40 mg COMPR. GASTROREZ. 40mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. PA-AL-PVC/AL X 10 COMPR. GASTROREZ. P-6L 30 0.775000 0.000000 0.387500 0.387500 0.697500 0.077500
14 W61933031 A02BC02 PANTOPRAZOLUM CONTROLOC 40mg COMPR. GASTROREZ. 40mg TAKEDA GMBH GERMANIA CUTIE DE CARTON CU BLIST. DIN AL/AL FARA RANFORSARE DIN CARTON X 30 COMPR. GASTROREZ. P6L 30 0.799333 0.000000 0.399666 0.399667 0.719399 0.079934
15 W61933054 A02BC02 PANTOPRAZOLUM CONTROLOC 40mg COMPR. GASTROREZ. 40mg TAKEDA GMBH GERMANIA CUTIE DE CARTON CU BLIST. DIN AL/AL CU RANFORSARE DIN CARTON X 30 COMPR. GASTROREZ. P6L 30 0.799333 0.000000 0.399666 0.399667 0.719399 0.079934
16 W67390001 A02BC02 PANTOPRAZOLUM PANTOPRAZOL MEDREG 40 mg COMPR. GASTROREZ. 40mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. GASTROREZ. P6L 30 0.775000 0.000000 0.387500 0.387500 0.697500 0.077500
17 W61651001 A02BC02 PANTOPRAZOLUM PANTOPRAZOL SUN 40 mg PULB. PT. SOL. INJ. 40mg SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA CU DOP DIN CAUCIUC SI CAPSA DIN AL, CU PULB. PT. SOL. INJ. PRF 1 11.220000 0.000000 5.610000 5.610000 10.098000 1.122000
18 W61931001 A02BC02 PANTOPRAZOLUM CONTROLOC 40mg PULB. PT. SOL. INJ. 40mg TAKEDA GMBH GERMANIA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA, CU CAPSA DIN AL SI DOP DIN CAUCIUC A 40 MG CU PULB. PT. SOL. INJ. PRF 1 14.420000 0.000000 7.210000 7.210000 12.978000 1.442000
19 W66427001 A02BC02 PANTOPRAZOLUM PANTOPRAZOL ROMPHARM 40 mg PULB. PT. SOL. INJ. 40mg S.C. ROMPHARM COMPANY S.R.L ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCHIS CU DOP DIN CAUCIUC BROMOBUTILIC SI SIGILAT CU CAPSA DIN AL X PULB. PT. SOL. INJ. PRF 1 11.220000 0.000000 5.610000 5.610000 10.098000 1.122000
20 W61651003 A02BC02 PANTOPRAZOLUM PANTOPRAZOL SUN 40 mg PULB. PT. SOL. INJ. 40mg SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA CUTIE CU 10 FLAC. DIN STICLA INCOLORA DE TIP I CARE CONTIN PULB. PT. SOL. INJ. PRF 10 9.049000 0.000000 4.524500 4.524500 8.144100 0.904900
21 W68976002 A02BC02 PANTOPRAZOLUM ZENCOPAN 40 mg PULB. PT. SOL. INJ. 40mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 10 FLAC. DIN STICLA TRANSPARENTA TIP I CARE CONTIN PULB. PT. SOL. INJ. PRF 10 9.049000 0.000000 4.524500 4.524500 8.144100 0.904900
22 W56890010 A02BC05 ESOMEPRAZOLUM HELIDES 20 mg CAPS. GASTROREZ. 20mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PA-AL-PVC/AL X 28 CAPS. GASTROREZ. P-6L 28 0.397142 0.000000 0.198571 0.198571 0.357427 0.039715
23 W55421016 A02BC05 ESOMEPRAZOLUM EMANERA 20 mg CAPS. GASTROREZ. 20mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 CAPS. GASTROREZ. P-6L 28 0.377500 0.000000 0.188750 0.188750 0.339750 0.037750
24 W55422004 A02BC05 ESOMEPRAZOLUM EMANERA 40 mg CAPS. GASTROREZ. 40mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PE+DESICANT/AL+ PE X 28 CAPS. GASTROREZ. P-6L 28 0.756071 0.000000 0.378035 0.378036 0.680463 0.075608
25 W56889010 A02BC05 ESOMEPRAZOLUM HELIDES 40 mg CAPS. GASTROREZ. 40mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PA-AL-PVC/AL X 28 CAPS. GASTROREZ. P-6L 28 0.793928 0.000000 0.396964 0.396964 0.714535 0.079393
26 W06755002 A02BC05 ESOMEPRAZOLUM NEXIUM 20 mg COMPR. GASTROREZ. 20mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/PVC-AL-POLIAMIDA X 7 COMPR. GASTROREZISTENTE P-6L 14 0.673071 0.529786 0.336535 0.866322 0.605763 0.597094
27 W56303013 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 20mg COMPR. GASTROREZ. 20mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. GASTROREZ. P6L 14 0.370000 0.000000 0.185000 0.185000 0.333000 0.037000
28 W68972002 A02BC05 ESOMEPRAZOLUM NEXIUM 20 mg COMPR. GASTROREZ. 20mg GRÜNENTHAL GMBH GERMANIA CUTIE CU 2 BLIST. AL/PVC-AL-POLIAMIDA X 7 COMPR. GASTROREZISTENTE P6L 14 0.673071 0.529786 0.336535 0.866322 0.605763 0.597094
29 W06756002 A02BC05 ESOMEPRAZOLUM NEXIUM 40 mg COMPR. GASTROREZ. 40mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/PVC-AL-POLIAMIDA X 7 COMPR. GASTROREZISTENTE P-6L 14 1.346143 0.381714 0.673071 1.054786 1.211528 0.516329
30 W56304013 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 40mg COMPR. GASTROREZ. 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. GASTROREZ. P6L 14 0.740714 0.000000 0.370357 0.370357 0.666642 0.074072
31 W68973002 A02BC05 ESOMEPRAZOLUM NEXIUM 40 mg COMPR. GASTROREZ. 40mg GRÜNENTHAL GMBH GERMANIA CUTIE CU 2 BLIST. AL/PVC-AL-POLIAMIDA X 7 COMPR. GASTROREZISTENTE P6L 14 1.346143 0.381714 0.673071 1.054786 1.211528 0.516329
32 W56303002 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 20mg COMPR. GASTROREZISTENTE 20mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 14 COMPR. GASTROREZISTENTE P-6L 14 0.370000 0.000000 0.185000 0.185000 0.333000 0.037000
33 W56304002 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL TERAPIA 40mg COMPR. GASTROREZISTENTE 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PE-DESICANT-PEID/AL X 14 COMPR. GASTROREZISTENTE P-6L 14 0.740714 0.000000 0.370357 0.370357 0.666642 0.074072
34 W53101001 A02BC05 ESOMEPRAZOLUM NEXIUM 10 mg GRAN. GASTROREZ. PT. SUSP.ORALA 10mg ASTRAZENECA AB SUEDIA CUTIE X 28 PLICURI DIN PET/AL/PEJD CONTINAND GRANULE GASTROREZ. PT. SUSP. ORALA P-6L 28 6.261071 0.000000 3.130535 3.130536 5.634963 0.626108
35 W67732001 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL ROMPHARM 40 mg PULB. PT. SOL. INJ./PERF. 40mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA DE TIP I CARE CONTINE PULB. PT. SOL. INJ./PERF. PR/PRF 1 23.728794 5.621206 11.864397 17.485603 21.355914 7.994086
36 W68187001 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL SUN 40 mg PULB. PT. SOL. INJ./PERF. 40mg SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 5 ML CU PULB. PT. SOL. INJ./PERF. PR/PRF 1 23.728794 9.061206 11.864397 20.925603 21.355914 11.434086
37 W68187002 A02BC05 ESOMEPRAZOLUM ESOMEPRAZOL SUN 40 mg PULB. PT. SOL. INJ./PERF. 40mg SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 5 ML CU PULB. PT. SOL. INJ./PERF. PR/PRF 10 23.728794 2.168206 11.864397 14.032603 21.355914 4.541086
38 W62392006 A02BX05 BISMUTHI OXIDE ULCAMED 120 mg COMPR. FILM. 120mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.059517 0.016554 0.529758 0.546313 0.953565 0.122506
39 W04674001 A03AB06 OTILONIUM BROMIDUM SPASMOMEN 40 mg COMPR. FILM. 40mg A. MENARINI IND. FARM. RIUNITE SRL ITALIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-6L 30 1.022000 0.000000 0.511000 0.511000 0.919800 0.102200
40 W63734002 A07AA11 RIFAXIMINUM NORMIX 200 mg COMPR. FILM. 200mg ALFASIGMA S.P.A. ITALIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL A CATE 12 COMPR. FILM. PRF 36 2.725277 0.000000 1.362638 1.362639 2.452749 0.272528
41 W69191001 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 1 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 18 6.033221 0.655112 3.016610 3.671723 5.429898 1.258435
42 W69191002 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 36 6.033221 0.308445 3.016610 3.325056 5.429898 0.911768
43 W69191003 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 54 6.033221 0.308630 3.016610 3.325241 5.429898 0.911953
44 W69191004 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 4 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 72 6.033221 0.098445 3.016610 3.115056 5.429898 0.701768
45 W69191005 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 5 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 90 5.934777 0.000000 2.967388 2.967389 5.341299 0.593478
46 W63735001 A07AA11 RIFAXIMINUM NORMIX 200mg/10ml GRAN. PT. SUSP. ORALA 200mg/10ml ALFASIGMA S.P.A. ITALIA CUTIE CU UN FLACON DIN STICLA BRUNA CONTINÂND GRANULE PENTRU 60 ML SUSPENSIE ORALA, ÎNSOTIT DE O MASURA DOZATOARE MARCATA LA 5, 10 SI 15 ML. PRF 1 18.099682 7.170318 9.049841 16.220159 16.289713 8.980287
47 W08631001 A07EA06 BUDESONIDUM ** # BUDENOFALK 3 mg CAPS. CU PELETE GASTROREZ. 3mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 10 BLIST. PVC-PVDC/AL X 10 CAPS. CU PELETE GASTROREZ. P-RF 100 3.363200 0.000000 1.681600 1.681600 3.026880 0.336320
48 W61505003 A07EA06 BUDESONIDUM ** # CORTIMENT 9mg COMPR. ELIB. PREL. 9mg FERRING GMBH GERMANIA CUTIE CU BLIST. DIN PA-AL/PVC-AL X 30 COMPRIMATE ELIBERARE PRELUNGITA PRF 30 11.483471 3.920529 5.741735 9.662265 10.335123 5.068877
49 W58169003 A07EA06 BUDESONIDUM ** # BUDENOFALK UNO 9 mg GRANULE GASTROREZ. 9mg DR. FALK PHARMA GMBH GERMANIA CUTIE CU 30 PLICURI DIN POLIESTER/AL/PE CU GRANULE GASTROREZ. PRF 30 11.483471 1.393862 5.741735 7.135598 10.335123 2.542210
50 W54445001 A07EA06 BUDESONIDUM ** # BUDENOFALK 2 mg/doza SPUMA RECTALA 2mg/doza DR. FALK PHARMA GMBH GERMANIA CUTIE X 1 FLAC. DIN AL X 14 DOZE X 1,2G SPUMA RECTALA, 14 APLICATOARE LUBREFIANTE PVC SI 14 PUNGI PL P-RF 1 339.860000 0.000000 169.930000 169.930000 305.874000 33.986000
51 W63750001 A07XA04 RACECADOTRILUM HIDRASEC 100 mg CAPS. 100mg BIOPROJET PHARMA FRANTA CUTIE CU 2 BLIST. X 10 CAPS. PRF 20 3.193937 0.009563 1.596968 1.606532 2.874543 0.328957
52 W63748002 A07XA04 RACECADOTRILUM HIDRASEC 10 mg PULB. ORALA 10mg BIOPROJET PHARMA FRANTA CUTIE CU 16 PLICURI DIN HÂRTIE/AL/PEJD X 1 G PULB. ORALA PRF 16 3.184375 0.000000 1.592187 1.592188 2.865937 0.318438
53 W63749002 A07XA04 RACECADOTRILUM HIDRASEC 30 mg PULB. ORALA 30mg BIOPROJET PHARMA FRANTA CUTIE CU 16 PLICURI DIN HARTIE/AL/PEJD X 3 G PULB. ORALA PRF 16 3.193937 0.119188 1.596968 1.716157 2.874543 0.438582
54 W63610002 A08AB01 ORLISTATUM **1 XENICAL 120mg CAPS. 120mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE X 84 CAPS. TARI (BLISTER PVC/PE/PVDC) PRF 84 1.923333 0.000000 0.961666 0.961667 1.730999 0.192334
55 W00231001 A11CC03 ALFACALCIDOLUM ALPHA D3 0,25 mcg CAPS. MOI 0,25mcg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 1 FLAC. DIN PPID X 50 CAPS. MOI P-RF 50 0.678500 0.207900 0.339250 0.547150 0.610650 0.275750
56 W67321001 A11CC03 ALFACALCIDOLUM ALPHA D3 0,25 micrograme CAPS. MOI 0,25micrograme THERAMEX IRELAND LIMITED IRLANDA CUTIE CU 1 FLAC. DIN PPID X 50 CAPS. MOI PRF 50 0.678500 0.207900 0.339250 0.547150 0.610650 0.275750
57 W44042001 A11CC03 ALFACALCIDOLUM ALPHA D3 0,50 mcg CAPS. MOI 0,50mcg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 1 FLAC. X 30 CAPS. MOI P-RF 30 1.357000 0.000000 0.678500 0.678500 1.221300 0.135700
58 W65339001 A11CC03 ALFACALCIDOLUM ALFACALCIDOL HEATON 0,50 micrograme CAPS. MOI 0,50micrograme HEATON K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. DIN PEID X 30 CAPS. MOI PRF 30 1.357000 0.000000 0.678500 0.678500 1.221300 0.135700
59 W67323001 A11CC03 ALFACALCIDOLUM ALPHA D3 0,50 micrograme CAPS. MOI IRLANDA
0,50micrograme THERAMEX IRELAND LIMITED CUTIE CU 1 FLAC. DIN PPID X 30 CAPS. MOI PRF 30 1.357000 0.000000 0.678500 0.678500 1.221300 0.135700
60 W67770001 A11CC03 ALFACALCIDOLUM MEDIRAZIN 0,5 micrograme CAPS. MOI ZENIVA K.S.
0,50micrograme REPUBLICA CEHA CUTIE CU UN FLACON ALB OPAC DIN PEÎD X 30 CAPSULE MOI PRF 30 1.357000 0.000000 0.678500 0.678500 1.221300 0.135700
61 W60364001 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) ** # THIOSSEN 600 mg COMPR. FILM. 600mg AAA - PHARMA GMBH GERMANIA CUTIE CU 3 BLIST. PVC/PVDC X 10 COMPR. FILM. P-6L 30 1.767000 0.000000 0.883500 0.883500 1.590300 0.176700
62 W67404001 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) ** # ACID TIOCTIC ZENTIVA 600 mg COMPR. FILM. 600mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE OPACE DIN PVC-PVDC/AL X 30 COMPRIMATE FILMATE P-6L 30 1.801666 0.104000 0.900833 1.004833 1.621499 0.284167
63 W64296002 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) ** # ACID TIOCTIC ROMPHARM 600 mg/24 ml SOL INJ. 600mg/24ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 5 FLAC. DIN STICLA BRUNA CU CAPACITATEA DE 25 ML X 24 ML SOL. INJ. PR/PRF 5 17.419500 0.700500 8.709750 9.410250 15.677550 2.442450
64 W60368001 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) ** # THIOSSEN TURBO 600 mg/50ml SOL. INJ. 600mg/50ml AAA - PHARMA GMBH GERMANIA CUTIE CU 10 FLAC. DIN STICLA BRUNA X 50 ML SOL. PERF. SI 10 PUNGI PROTECTOARE DE LUMINA PR/PRF 10 17.186000 0.000000 8.593000 8.593000 15.467400 1.718600

Pagina 1 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
65 W52808004 B01AB04 DALTEPARINUM ** # FRAGMIN 5000 UI/0,2 ml SOL. INJ. 5000ui/0,2ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU 10 BLISTERE INDIVIDUALE CONTINÂND FIECARE O SERINGA PREUMPLUTA, FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP A 0,2 ML SOLUTIE INJECTABILA S/P-RF 10 16.530000 1.397000 8.265000 9.662000 14.877000 3.050000
66 W64849001 B01AB04 DALTEPARINUM ** # FRAGMIN 5000 UI/0,2 ml SOL. INJ. 5000UI/0,2ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 10 BLISTERE INDIVIDUALE CONTINÂND FIECARE O SERINGA PREUMPLUTA, FARA SISTEM DE BLOCARE A ACULUI NEEDLE-TRAP A 0,2 ML SOLUTIE INJECTABILA PR/PRF 10 16.530000 1.397000 8.265000 9.662000 14.877000 3.050000
67 W63590012 B01AB05 ENOXAPARINUM ** # CLEXANE 2000 UI (20 mg)/0,2 ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI(20mg)/0,2ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 10 SERINGI PREUMPLUTE (STICLA TIP I) ASAMBLATE CU DOP DIN CAUCIUC (CLOROBUTILIC SAU BROMOBUTILIC) SI AC DE INJECTIE PR/PRF 10 8.265000 0.000000 4.132500 4.132500 7.438500 0.826500
68 W63591023 B01AB05 ENOXAPARINUM ** # CLEXANE 4000 UI (40 mg)/0,4 ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI(40mg)/0,4ml SANOFI ROMANIA S.R.L. ROMANIA CUT IE CU 50 SERINGI PREUMPLUT E (ST ICLA T IP I) ASAMBLAT E CU DOP DIN CAUCIUC (CLOROBUT ILIC SAU BROMOBUT ILIC) SI AC DE INJECT IE CU SIST EM AUT OMAT DE SIGURANT A PREVENT IS® PR/PRF 50 16.530000 2.389600 8.265000 10.654600 14.877000 4.042600
69 W63591012 B01AB05 ENOXAPARINUM ** # CLEXANE 4000 UI (40 mg)/0,4 ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI(40mg)/0,4ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 10 SERINGI PREUMPLUTE (STICLA TIP I) ASAMBLATE CU DOP DIN CAUCIUC (CLOROBUTILIC SAU BROMOBUTILIC) SI AC DE INJECTIE PR/PRF 10 14.608000 0.000000 7.304000 7.304000 13.147200 1.460800
70 W63591021 B01AB05 ENOXAPARINUM ** # CLEXANE 4000 UI (40 mg)/0,4 ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI(40mg)/0,4ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 50 SERINGI PREUMPLUTE (STICLA TIP I) ASAMBLATE CU DOP DIN CAUCIUC (CLOROBUTILIC SAU BROMOBUTILIC) SI AC DE INJECTIE PR/PRF 50 16.530000 2.389600 8.265000 10.654600 14.877000 4.042600
71 W63591022 B01AB05 ENOXAPARINUM ** # CLEXANE 4000 UI (40 mg)/0,4 ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI(40mg)/0,4ml SANOFI ROMANIA S.R.L. ROMANIA CUT IE CU 50 SERINGI PREUMPLUT E (ST ICLA T IP I) ASAMBLAT E CU DOP DIN CAUCIUC (CLOROBUT ILIC SAU BROMOBUT ILIC) SI AC DE INJECT IE CU SIST EM AUT OMAT DE SIGURANT A ERIS® PR/PRF 50 16.530000 2.389600 8.265000 10.654600 14.877000 4.042600
72 W63592029 B01AB05 ENOXAPARINUM ** # CLEXANE 6000 UI (60 mg)/0,6 ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI(60mg)/0,6ml SANOFI ROMANIA S.R.L. ROMANIA CUT IECU 50 SERINGI PREUMPLUT E (ST ICLA T IP I) ASAMBLAT E CU DOP DIN CAUCIUC (CLOROBUT ILIC SAU BROMOBUT ILIC) SI AC DE INJECT IE CU SIST EM AUT OMAT DE SIGURANT A PREVENT IS® PR/PRF 50 24.795000 5.353000 12.397500 17.750500 22.315500 7.832500
73 W63592012 B01AB05 ENOXAPARINUM ** # CLEXANE 6000 UI (60 mg)/0,6 ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI(60mg)/0,6ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 10 SERINGI PREUMPLUTE (STICLA TIP I) ASAMBLATE CU DOP DIN CAUCIUC (CLOROBUTILIC SAU BROMOBUTILIC) SI AC DE INJECTIE PR/PRF 10 17.837000 0.000000 8.918500 8.918500 16.053300 1.783700
74 W63592027 B01AB05 ENOXAPARINUM ** # CLEXANE 6000 UI (60 mg)/0,6 ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI(60mg)/0,6ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 50 SERINGI PREUMPLUTE (STICLA TIP I) ASAMBLATE CU DOP DIN CAUCIUC (CLOROBUTILIC SAU BROMOBUTILIC) SI AC DE INJECTIE PR/PRF 50 24.795000 5.353000 12.397500 17.750500 22.315500 7.832500
75 W63592028 B01AB05 ENOXAPARINUM ** # CLEXANE 6000 UI (60 mg)/0,6 ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI(60mg)/0,6ml SANOFI ROMANIA S.R.L. ROMANIA CUT IE CU 50 SERINGI PREUMPLUT E (ST ICLA T IP I) ASAMBLAT E CU DOP DIN CAUCIUC (CLOROBUT ILIC SAU BROMOBUT ILIC) SI AC DE INJECT IE CU SIST EM AUT OMAT DE SIGURANT A ERIS® PR/PRF 50 24.795000 5.353000 12.397500 17.750500 22.315500 7.832500
76 W63593009 B01AB05 ENOXAPARINUM ** # CLEXANE 8000 UI (80 mg)/0,8 ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI(80mg)/0,8ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 6 SERINGI PREUMPLUTE (STICLA TIP I) ASAMBLATE CU DOP DIN CAUCIUC (CLOROBUTILIC SAU BROMOBUTILIC) SI AC DE INJECTIE PR/PRF 6 22.990000 0.000000 11.495000 11.495000 20.691000 2.299000
77 W59473001 B01AB10 TINZAPARINUM ** # INNOHEP 10000 UI ANTI-XA/ml SOL. INJ. IN FLACON LEO PHARMA A/S
10000UI anti-XA/ml DANEMARCA CUTIE CU 10 FLAC. DIN STICLA INCOLORA X 2 ML (20000 UI ANTI-XA) SOL. INJ., CU DOP DE CAUCIUC DE CULOARE CENUSIE DESCHIS, ARMATURA DE ETANSARE DIN AL LACUIT IN AURIU SI CAPSA DE SIGURANTA DIN PP DE CULOARE PORTOCALIE PR/PRF 10 47.228565 10.496435 23.614282 34.110718 42.505708 15.219292
78 W60955001 B01AB11 SULODEXIDUM ** COREFLUX 250 ULS CAPS. MOI 250ULS SANIENCE S.R.L. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 CAPS. MOI PRF 50 1.847400 0.000000 0.923700 0.923700 1.662660 0.184740
79 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 2.058449 0.311351 1.029224 1.340576 1.852604 0.517196
80 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 2.058449 0.211051 1.029224 1.240276 1.852604 0.416896
81 W60954001 B01AB11 SULODEXIDUM ** COREFLUX 600 ULS/2 ml SOL INJ. 600ULS/2ml SANIENCE S.R.L. ROMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 2 ML SOL. INJ. PRF 10 7.573000 0.000000 3.786500 3.786500 6.815700 0.757300
82 W63736001 B01AB11 SULODEXIDUM ** VESSEL DUE F 600ULS/2ml SOL. INJ. 600ULS/2ml ALFASIGMA S.P.A. ITALIA CUTIE X 10 FIOLE DIN STICLA GALBENA X 2 ML PRF 10 7.955500 1.147500 3.977750 5.125250 7.159950 1.943050
83 W54317002 B01AC04 CLOPIDOGRELUM ** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 FLAC. DIN STICLA INCOLORA X 30 COMPR. FILM. P-RF 30 0.741666 0.000000 0.370833 0.370833 0.667499 0.074167
84 W54317003 B01AC04 CLOPIDOGRELUM ** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 FLAC. DIN STICLA INCOLORA X 90 COMPR. FILM. P-RF 90 0.673666 0.000000 0.336833 0.336833 0.606299 0.067367
85 W57177005 B01AC04 CLOPIDOGRELUM ** PLATEL 75 mg COMPR. FILM. 75mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 28 COMPR. FILM. P-RF 28 0.786785 0.000000 0.393392 0.393393 0.708106 0.078679
86 W54317007 B01AC04 CLOPIDOGRELUM ** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN PVC-PVDC/AL CONTINÂND 30 COMPRIMATE FILMATE P-RF 30 0.741666 0.000000 0.370833 0.370833 0.667499 0.074167
87 W54317009 B01AC04 CLOPIDOGRELUM ** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN PVC-PVDC/AL CONTINÂND 90 COMPRIMATE FILMATE P-RF 90 0.673666 0.000000 0.336833 0.336833 0.606299 0.067367
88 W61520001 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI CLIR SNC FRANTA CUTIE X 28 COMPR. FILM. ( BLIST. PVC-PVDC/AL) P-RF 28 1.676109 0.581748 0.838054 1.419803 1.508498 0.749359
89 W61520013 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI CLIR SNC FRANTA CUTIE X 30 COMPR. FILM. ( BLIST. PVC-PVDC/AL) P-RF 30 1.676109 0.581224 0.838054 1.419279 1.508498 0.748835
90 W65505007 B01AC04 CLOPIDOGRELUM ** CLOPIDOGREL TERAPIA 75 mg COMPR. FILM. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL-PA-PVC/AL X 30 COMPR. FILM. PRF 30 1.365000 0.000000 0.682500 0.682500 1.228500 0.136500
91 W66403001 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 28 COMPR. FILM. ( BLIST. PVC-PVDC/AL) PRF 28 1.676109 0.581748 0.838054 1.419803 1.508498 0.749359
92 W66403013 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 30 COMPR. FILM. ( BLIST. PVC-PVDC/AL) PRF 30 1.676109 0.581224 0.838054 1.419279 1.508498 0.748835
93 W66626001 B01AC04 CLOPIDOGRELUM ** CLOPIDOGREL EIPICO 75 mg COMPR. FILM. 75mg E.I.P.I.CO MED S.R.L. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P6L 30 1.364333 0.000000 0.682166 0.682167 1.227899 0.136434
94 W69341001 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 28 COMPR. FILM. ( BLIST. PVC-PVDC/AL) PRF 28 1.676109 0.581748 0.838054 1.419803 1.508498 0.749359
95 W69341007 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 28 COMPR. FILM.( BLIST. AL/AL) PRF 28 1.676109 0.581748 0.838054 1.419803 1.508498 0.749359
96 W69341013 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 30 COMPR. FILM. ( BLIST. PVC-PVDC/AL) PRF 30 1.676109 0.581224 0.838054 1.419279 1.508498 0.748835
97 W69341014 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 30 COMPR. FILM.( BLIST. AL/AL) PRF 30 1.676109 0.581224 0.838054 1.419279 1.508498 0.748835
98 W53412001 B01AC18 TRIFLUSALUM AFLEN 300 mg CAPS. 300mg GALENICA S.A. GRECIA CUTIE X 5 BLIST. X 10 CAPS. P-RF 50 0.780200 0.000000 0.390100 0.390100 0.702180 0.078020
99 W52943002 B01AE07 DABIGATRANUM ETEXILATUM ** PRADAXA 110mg CAPS. 110mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 3 BLIST. (AL/AL) X 10 CAPS. (30X1 BLISTER PERFORAT UNIDOZA ) P-RF 30 3.969417 0.992583 1.984708 2.977292 3.572475 1.389525
100 W52943002 B01AE07 DABIGATRANUM ETEXILATUM ** Ω # PRADAXA 110mg CAPS. 110mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 3 BLIST. (AL/AL) X 10 CAPS. (30X1 BLISTER PERFORAT UNIDOZA ) P-RF 30 4.962000 0.000000 2.481000 2.481000 4.465800 0.496200
101 W57151003 B01AE07 DABIGATRANUM ETEXILATUM ** Ω # PRADAXA 150mg CAPS. 150mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 6 BLIST. (AL/AL) X 10 CAPS. (60 X1 BLISTER PERFORAT UNIDOZA ) P-RF 60 4.961666 0.000000 2.480833 2.480833 4.465499 0.496167
102 W63896002 B01AF01 RIVAROXABANUM ** XARELTO 10mg COMPR. FILM. 10mg BAYER AG GERMANIA CUTIE X BLIST PP/AL X 10 COMPR. FILM. PRF 10 6.116461 5.106539 3.058230 8.164770 5.504814 5.718186
103 W63896003 B01AF01 RIVAROXABANUM ** XARELTO 10mg COMPR. FILM. 10mg BAYER AG GERMANIA CUTIE X BLIST PP/AL X 30 COMPR. FILM. PRF 30 6.116461 4.525539 3.058230 7.583770 5.504814 5.137186
104 W64154001 B01AF01 RIVAROXABANUM ** XARELTO 2,5 mg COMPR. FILM. 2,5mg BAYER AG GERMANIA CUTIE CU BLIST PP/AL X 98 COMPR. FILM. PRF 98 1.529115 3.775272 0.764557 4.539830 1.376203 3.928184
105 W63897001 B01AF01 RIVAROXABANUM ** Ω # XARELTO 15mg COMPR. FILM. 15mg BAYER AG GERMANIA CUTIE X BLIST PP/AL X 98 COMPR. FILM. PRF 98 9.174693 0.000000 4.587346 4.587347 8.257223 0.917470
106 W63898001 B01AF01 RIVAROXABANUM ** Ω # XARELTO 20mg COMPR. FILM. 20mg BAYER AG GERMANIA CUTIE X BLIST PP/AL X 98 COMPR. FILM. PRF 98 9.174693 0.000000 4.587346 4.587347 8.257223 0.917470
107 W57283003 B01AF02 APIXABANUM ** ELIQUIS COMPR. FILM. 2,5mg BRISTOL-MYERS SQUIBB / PFIZER EEIG MAREA BRITANIE CUTIE CU BLIST. DIN PVC/PVDC/AL X 60 COMPR. FILM. PRF 60 2.773750 1.670083 1.386875 3.056958 2.496375 1.947458
108 W65619003 B01AF02 APIXABANUM ** ELIQUIS 2,5 mg COMPR. FILM. 2,5mg BRISTOL-MYERS SQUIBB / PFIZER EEIG IRLANDA CUTIE CU BLIST. DIN PVC/PVDC/AL X 60 COMPR. FILM. PRF 60 2.773750 1.670083 1.386875 3.056958 2.496375 1.947458
109 W57283003 B01AF02 APIXABANUM ** Ω # ELIQUIS COMPR. FILM. 2,5mg BRISTOL-MYERS SQUIBB / PFIZER EEIG MAREA BRITANIE CUTIE CU BLIST. DIN PVC/PVDC/AL X 60 COMPR. FILM. PRF 60 4.443833 0.000000 2.221916 2.221917 3.999449 0.444384
110 W65619003 B01AF02 APIXABANUM ** Ω # ELIQUIS 2,5 mg COMPR. FILM. 2,5mg BRISTOL-MYERS SQUIBB / PFIZER EEIG IRLANDA CUTIE CU BLIST. DIN PVC/PVDC/AL X 60 COMPR. FILM. PRF 60 4.443833 0.000000 2.221916 2.221917 3.999449 0.444384
111 W59339004 B01AF02 APIXABANUM ** Ω # ELIQUIS 5mg COMPR. FILM. 5 mg BRISTOL-MYERS SQUIBB / PFIZER EEIG MAREA BRITANIE CUTIE CU BLIST. PVC/PVDC/AL X 60 COMPRIMATE FILMATE PRF 60 5.547500 0.000000 2.773750 2.773750 4.992750 0.554750
112 W65620009 B01AF02 APIXABANUM ** Ω # ELIQUIS 5 mg COMPR. FILM. 5 mg BRISTOL-MYERS SQUIBB / PFIZER EEIG IRLANDA CUTIE CU BLIST. PVC/PVDC/AL X 60 COMPRIMATE FILMATE PRF 60 5.547500 0.000000 2.773750 2.773750 4.992750 0.554750
113 W66574001 B01AF03 EDOXABANUM ** Ω # ROTEAS 30 mg COMPR. FILM. 30mg BERLIN-CHEMIE AG GERMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. PRF 30 11.039666 0.000000 5.519833 5.519833 9.935699 1.103967
114 W66575001 B01AF03 EDOXABANUM ** Ω # ROTEAS 60 mg COMPR. FILM. 60mg BERLIN-CHEMIE AG GERMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. PRF 30 11.039666 0.000000 5.519833 5.519833 9.935699 1.103967
115 W67494003 B01AX05 FONDAPARINUX SODIUM ** # ARIXTRA 2,5mg/0,5ml 2,5mg/0,5ml MYLAN IRE HEALTHCARE LIMITED
SOL. INJ. IN SERINGA PREUMPLUTA IRLANDA CUTIE X 10 SERINGI PREUMPLUTE X 0,5 ML SOL. INJ., PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA, DE CULOARE ALBASTRA PRF 10 20.905749 0.025251 10.452874 10.478126 18.815174 2.115826
116 W67496003 B01AX05 FONDAPARINUX SODIUM ** # ARIXTRA 7,5mg/0,6ml 7,5mg/0,6ml MYLAN IRE HEALTHCARE LIMITED
SOL. INJ. IN SERINGA PREUMPLUTA IRLANDA CUTIE X 10 SERINGI PREUMPLUTE X 0,6 ML SOL. INJ., PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA, DE CULOARE PURPURIE PRF 10 62.692000 0.000000 31.346000 31.346000 56.422800 6.269200
117 W51230001 B03AC02 COMPLEX DE HIDROXID DE FER (III) SUCROZA VENOFER 100 mg fer/5 ml SOL. INJ./PERF. 100mg/5ml VIFOR FRANCE S.A. FRANTA CUTIE X 5 FIOLE X 5 ML S/P-RF 5 59.218000 0.000000 29.609000 29.609000 53.296200 5.921800
118 W63258002 C01EB17 IVABRADINUM ** IVABRADINE ZENTIVA 5 mg COMPR. FILM. 5 mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 0.944196 0.366161 0.472098 0.838259 0.849776 0.460581
119 W42777003 C01EB17 IVABRADINUM ** CORLENTOR 5mg COMPR. FILM. 5mg LES LAB. SERVIER FRANTA CUTIE X 56 COMPR. FILM. (BLIST. AL/PVC TIP CALENDAR) P-6L 56 0.944196 0.621696 0.472098 1.093794 0.849776 0.716116
120 W62962004 C01EB17 IVABRADINUM ** BIXEBRA 5 mg COMPR. FILM. 5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 0.944196 0.364732 0.472098 0.836830 0.849776 0.459152
121 W63479001 C01EB17 IVABRADINUM ** RAENOM 5 mg COMPR. FILM. 5mg GEDEON RICHTER ROMANIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 0.944196 0.366161 0.472098 0.838259 0.849776 0.460581
122 W63443003 C01EB17 IVABRADINUM ** FELOCORD 5 mg COMPR. FILM. 5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 0.944196 0.529018 0.472098 1.001116 0.849776 0.623438
123 W65845003 C01EB17 IVABRADINUM ** APREDONAV 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 0.944196 0.321161 0.472098 0.793259 0.849776 0.415581
124 W42779003 C01EB17 IVABRADINUM ** CORLENTOR 7,5mg COMPR. FILM. 7,5mg LES LAB. SERVIER FRANTA CUTIE X 56 COMPR. FILM. (BLIST. AL/PVC TIP CALENDAR) P-6L 56 1.416294 0.230491 0.708147 0.938638 1.274664 0.372121
125 W62963004 C01EB17 IVABRADINUM ** BIXEBRA 7,5 mg COMPR. FILM. 7,5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.416294 0.001920 0.708147 0.710067 1.274664 0.143550
126 W63259002 C01EB17 IVABRADINUM ** IVABRADINE ZENTIVA 7,5 mg COMPR. FILM. 7,5mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.416294 0.084241 0.708147 0.792388 1.274664 0.225871
127 W63444003 C01EB17 IVABRADINUM ** FELOCORD 7,5 mg COMPR. FILM. 7,5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.416294 0.440134 0.708147 1.148281 1.274664 0.581764
128 W65846003 C01EB17 IVABRADINUM ** APREDONAV 7,5 mg COMPR. FILM. 7,5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P6L 56 1.346607 0.000000 0.673303 0.673304 1.211946 0.134661
129 W62327003 C02AC05 MOXONIDINUM PHYSIOTENS 0,2 mg COMPR. FILM. 0,2mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 1.175040 0.157460 0.587520 0.744980 1.057536 0.274964
130 W68789003 C02AC05 MOXONIDINUM PHYSIOTENS 0,2 mg COMPR. FILM. 0,2mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 1.175040 0.157460 0.587520 0.744980 1.057536 0.274964
131 W62333003 C02AC05 MOXONIDINUM PHYSIOTENS 0,4 mg COMPR. FILM. 0,4mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 1.441071 0.000000 0.720535 0.720536 1.296963 0.144108
132 W68790003 C02AC05 MOXONIDINUM PHYSIOTENS 0,4 mg COMPR. FILM. 0,4mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 1.441071 0.000000 0.720535 0.720536 1.296963 0.144108
133 W05447001 C02AC06 RILMENIDINUM TENAXUM 1 mg COMPR. 1mg LES LABORATOIRES SERVIER FRANTA CUTIE CU 2 BLIST. AL/PA-AL-PVC X 15 COMPR. P-6L 30 1.147666 0.000000 0.573833 0.573833 1.032899 0.114767
134 W68950002 C02AC06 RILMENIDINUM TARUZA 1 mg COMPR. 1mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.771000 0.000000 0.385500 0.385500 0.693900 0.077100
135 W62960002 C03DA04 EPLERENONUM # EPLERENONA ARENA 25 mg COMPR. FILM. 25mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 90 COMPR. FILM. PRF 90 1.764541 1.677681 0.882270 2.559952 1.588086 1.854136
136 W67260004 C03DA04 EPLERENONUM # INSPRA 25 mg COMPR. FILM. 25mg UPJOHN EESV OLANDA CUTIE X 3 BLIST. PERFORATE UNIDOZA DIN PVC/AL X 10 COMPR. FILM. PRF 30 1.764541 1.023792 0.882270 1.906063 1.588086 1.200247

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

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
137 W62961002 C03DA04 EPLERENONUM # EPLERENONA ARENA 50 mg COMPR. FILM. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 90 COMPR. FILM. PRF 90 3.529082 0.025473 1.764541 1.790014 3.176173 0.378382
138 W67261004 C03DA04 EPLERENONUM # INSPRA 50 mg COMPR. FILM. 50mg UPJOHN EESV OLANDA CUTIE X 3 BLIST. PERFORATE UNIDOZA DIN PVC/AL X 10 COMPR. FILM. PRF 30 3.452666 0.000000 1.726333 1.726333 3.107399 0.345267
139 W04501004 C07AB12 NEBIVOLOLUM NEBILET 5 mg COMPR. 5mg BERLIN CHEMIE AG MENARINI GROUP GERMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 0.768928 0.000000 0.384464 0.384464 0.692035 0.076893
140 W53839001 C07AB12 NEBIVOLOLUM NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC- PE- PVDC/AL X 10 COMPR. P-6L 30 0.532666 0.000000 0.266333 0.266333 0.479399 0.053267
141 W64198003 C07AB12 NEBIVOLOLUM NEBIVOLOL AUROBINDO 5 mg COMPR. 5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. P6L 30 0.445666 0.000000 0.222833 0.222833 0.401099 0.044567
142 W64800005 C07AB12 NEBIVOLOLUM NEBIVOLOL TEVA 5 mg COMPR. 5mg TEVA B.V. OLANDA CUTIE CU 3 BLIST. PVDC/AL X 10 COMPR. P6L 30 0.536333 0.000000 0.268166 0.268167 0.482699 0.053634
143 W65312001 C07AB12 NEBIVOLOLUM NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.532666 0.000000 0.266333 0.266333 0.479399 0.053267
144 W57345003 C07BB07 COMBINATII (BISOPROLOLUM+HYDROCHLOROTHIAZIDUM) LODOZ 2,5mg/6,25mg COMPR. FILM. 2,5mg/6,25mg MERCK KGAA GERMANIA CUTIE CU 1 BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.613333 0.000000 0.306666 0.306667 0.551999 0.061334
145 W66297001 C07BB07 COMBINATII (BISOPROLOLUM+HYDROCHLOROTHIAZIDUM) LODOZ 2,5mg/6,25mg COMPR. FILM. 2,5mg/6,25mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PP/AL X 10 COMPR. FILM. P6L 30 0.613333 0.000000 0.306666 0.306667 0.551999 0.061334
146 W66297002 C07BB07 COMBINATII (BISOPROLOLUM+HYDROCHLOROTHIAZIDUM) LODOZ 2,5mg/6,25mg COMPR. FILM. 2,5mg/6,25mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.613333 0.000000 0.306666 0.306667 0.551999 0.061334
147 W66297003 C07BB07 COMBINATII (BISOPROLOLUM+HYDROCHLOROTHIAZIDUM) LODOZ 2,5mg/6,25mg COMPR. FILM. 2,5mg/6,25mg MERCK ROMANIA SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.613333 0.000000 0.306666 0.306667 0.551999 0.061334
148 W57344002 C07BB07 COMBINATII (BISOPROLOLUM+HYDROCHLOROTHIAZIDUM) LODOZ 5mg/6,25mg COMPR. FILM. 5mg/6,25mg MERCK KGAA GERMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. FILM. P-6L 30 0.613333 0.000000 0.306666 0.306667 0.551999 0.061334
149 W57344003 C07BB07 COMBINATII (BISOPROLOLUM+HYDROCHLOROTHIAZIDUM) LODOZ 5mg/6,25mg COMPR. FILM. 5mg/6,25mg MERCK KGAA GERMANIA CUTIE CU 1 BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.613333 0.000000 0.306666 0.306667 0.551999 0.061334
150 W66296002 C07BB07 COMBINATII (BISOPROLOLUM+HYDROCHLOROTHIAZIDUM) LODOZ 5mg/6,25mg COMPR. FILM. 5mg/6,25mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.613333 0.000000 0.306666 0.306667 0.551999 0.061334
151 W66296003 C07BB07 COMBINATII (BISOPROLOLUM+HYDROCHLOROTHIAZIDUM) LODOZ 5mg/6,25mg COMPR. FILM. 5mg/6,25mg MERCK ROMANIA SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.613333 0.000000 0.306666 0.306667 0.551999 0.061334
152 W62093003 C07FX05 COMBINATII (METOPROLOLUM+IVABRADINUM) ** IMPLICOR 25 mg/5 mg COMPR. FILM. 25mg/5mg LES LABORATOIRES SERVIER FRANTA CUTIE CU BLIST. PVC-PVDC/AL X 56 COMPR. FILM. P6L 56 1.844464 0.000000 0.922232 0.922232 1.660017 0.184447
153 W62095003 C07FX05 COMBINATII (METOPROLOLUM+IVABRADINUM) ** IMPLICOR 25 mg/7,5 mg COMPR. FILM. 25mg/7,5mg LES LABORATOIRES SERVIER FRANTA CUTIE CU BLIST. PVC-PVDC/AL X 56 COMPR. FILM. P6L 56 1.935401 0.566741 0.967700 1.534442 1.741860 0.760282
154 W62094003 C07FX05 COMBINATII (METOPROLOLUM+IVABRADINUM) ** IMPLICOR 50 mg/5 mg COMPR. FILM. 50mg/5mg LES LABORATOIRES SERVIER FRANTA CUTIE CU BLIST. PVC-PVDC/AL X 56 COMPR. FILM. P6L 56 1.935401 0.030313 0.967700 0.998014 1.741860 0.223854
155 W62096003 C07FX05 COMBINATII (METOPROLOLUM+IVABRADINUM) ** IMPLICOR 50 mg/7,5 mg COMPR. FILM. 50mg/7,5mg LES LABORATOIRES SERVIER FRANTA CUTIE CU BLIST. PVC-PVDC/AL X 56 COMPR. FILM. P6L 56 1.935401 0.675849 0.967700 1.643550 1.741860 0.869390
156 W65175002 C08CA09 LACIDIPINUM LACIPIL 4 mg COMPR. FILM. 4mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 4 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P6L 28 0.432524 0.383190 0.216262 0.599452 0.389271 0.426443
157 W12827004 C08CA13 LERCANIDIPINUM LERIDIP 10 mg COMPR. FILM. 10mg BERLIN CHEMIE AG MENARINI GROUP GERMANIA CUTIE X 4 BLIST. AL/PVC X 15 COMPR.FILM. P-6L 60 0.432524 0.332476 0.216262 0.548738 0.389271 0.375729
158 W67383012 C08CA13 LERCANIDIPINUM LERCANIDIPINA MEDREG 10 mg COMPR. FILM. 10mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. FILM. P6L 60 0.432524 0.114976 0.216262 0.331238 0.389271 0.158229
159 W43062014 C08CA13 LERCANIDIPINUM LERIDIP 20 mg COMPR. FILM. 20mg BERLIN CHEMIE AG MENARINI GROUP GERMANIA CUTIE X 6 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 60 0.865049 0.321451 0.432524 0.753976 0.778544 0.407956
160 W67385012 C08CA13 LERCANIDIPINUM LERCANIDIPINA MEDREG 20 mg COMPR. FILM. 20mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. FILM. P6L 60 0.811833 0.000000 0.405916 0.405917 0.730649 0.081184
161 W68512002 C09AA04 PERINDOPRILUM PRENESSANEO 10 mg COMPR. 10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.988497 0.017503 0.494248 0.511752 0.889647 0.116353
162 W54042001 C09AA04 PERINDOPRILUM TREZEN 4 mg COMPR. 4mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.395398 0.094602 0.197699 0.292301 0.355858 0.134142
163 W54042002 C09AA04 PERINDOPRILUM TREZEN 4 mg COMPR. 4mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.395398 0.094602 0.197699 0.292301 0.355858 0.134142
164 W61726001 C09AA04 PERINDOPRILUM ERNYOM 4 mg COMPR. 4mg VIM SPECTRUM S.R.L. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.395398 0.707935 0.197699 0.905634 0.355858 0.747475
165 W64970003 C09AA04 PERINDOPRILUM PRENESSA 4 mg COMPR. 4mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU 1 BLIST. PVC-PE-PVDC/AL X 30 COMPR. P6L 30 0.395398 0.080268 0.197699 0.277967 0.355858 0.119808
166 W68510002 C09AA04 PERINDOPRILUM PRENESSANEO 5 mg COMPR. 5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.494248 0.326418 0.247124 0.573542 0.444823 0.375843
167 W54043001 C09AA04 PERINDOPRILUM TREZEN 8 mg COMPR. 8mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.790797 0.063869 0.395398 0.459268 0.711717 0.142949
168 W54043002 C09AA04 PERINDOPRILUM TREZEN 8 mg COMPR. 8mg TERAPIA S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.790797 0.063869 0.395398 0.459268 0.711717 0.142949
169 W61727001 C09AA04 PERINDOPRILUM ERNYOM 8 mg COMPR. 8mg VIM SPECTRUM S.R.L. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.790797 1.243536 0.395398 1.638935 0.711717 1.322616
170 W65270004 C09AA04 PERINDOPRILUM PRENESSA 8 mg COMPR. 8mg KRKA D.D, NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. P6L 30 0.700000 0.000000 0.350000 0.350000 0.630000 0.070000
171 W42663001 C09AA04 PERINDOPRILUM PRESTARIUM 10 mg COMPR. FILM. 10 mg LES LABORATOIRES SERVIER FRANTA CUTIE X 1 FLAC. DIN PP X 30 COMPR. FILM. P-6L 30 0.988497 0.106836 0.494248 0.601085 0.889647 0.205686
172 W59480001 C09AA04 PERINDOPRILUM PERINDOPRIL TOSILAT TEVA 10 mg COMPR. FILM. 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. PP X 30 COMPR. FILM. P6L 30 0.971666 0.000000 0.485833 0.485833 0.874499 0.097167
173 W69013003 C09AA04 PERINDOPRILUM PERINDOPRIL ARGININA TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.866333 0.000000 0.433166 0.433167 0.779699 0.086634
174 W69148001 C09AA04 PERINDOPRILUM PRICORON 10 mg COMPR. FILM. 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.988497 0.103169 0.494248 0.597418 0.889647 0.202019
175 W69148003 C09AA04 PERINDOPRILUM PRICORON 10 mg COMPR. FILM. 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. DE CULOARE ALBA PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.988497 0.103169 0.494248 0.597418 0.889647 0.202019
176 W42664001 C09AA04 PERINDOPRILUM PRESTARIUM 5 mg COMPR. FILM. 5mg LES LABORATOIRES SERVIER FRANTA CUTIE X 1 FLAC. DIN PP X 30 COMPR. FILM. P-6L 30 0.494248 0.547752 0.247124 0.794876 0.444823 0.597177
177 W59479001 C09AA04 PERINDOPRILUM PERINDOPRIL TOSILAT TEVA 5 mg COMPR. FILM. 5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. PP X 30 COMPR. FILM. P6L 30 0.494248 0.326418 0.247124 0.573542 0.444823 0.375843
178 W69012005 C09AA04 PERINDOPRILUM PERINDOPRIL ARGININA TERAPIA 5 mg COMPR. FILM. 5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.494248 0.225752 0.247124 0.472876 0.444823 0.275177
179 W69147002 C09AA04 PERINDOPRILUM PRICORON 5 mg COMPR. FILM. 5mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.494248 0.326418 0.247124 0.573542 0.444823 0.375843
180 W69147005 C09AA04 PERINDOPRILUM PRICORON 5 mg COMPR. FILM. 5mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. DE CULOARE ALBA PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.494248 0.326418 0.247124 0.573542 0.444823 0.375843
181 W61396001 C09AA10 TRANDOLAPRILUM TRANDOLAPRIL ARENA 0,5 mg CAPS. 0,5mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/PE/PVDC ALB OPAC SI FOLIE DE ALUMINIU X 10 CAPS. P6L 30 0.098849 0.465484 0.049424 0.514909 0.088964 0.475369
182 W61398001 C09AA10 TRANDOLAPRILUM TRANDOLAPRIL ARENA 2 mg CAPS. 2mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/PE/PVDC ALB OPAC SI FOLIE DE ALUMINIU X 10 CAPS. P6L 30 0.395398 0.108935 0.197699 0.306634 0.355858 0.148475
183 W61399001 C09AA10 TRANDOLAPRILUM TRANDOLAPRIL ARENA 4 mg CAPS. 4mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/PE/PVDC ALB OPAC SI FOLIE DE ALUMINIU X 10 CAPS. P6L 30 0.790797 0.156869 0.395398 0.552268 0.711717 0.235949
184 W13178003 C09AA15 ZOFENOPRILUM ZOMEN 30 mg COMPR. FILM. 30mg MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. LUXEMBURG CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.395398 1.281744 0.197699 1.479443 0.355858 1.321284
185 W13177003 C09AA15 ZOFENOPRILUM ZOMEN 7,5 mg COMPR. FILM. 7,5mg MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. LUXEMBURG CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.098849 0.832222 0.049424 0.881647 0.088964 0.842107
186 W68760002 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) CO-PRENESSANEO 10 mg/2,5 mg COMPR. 10mg/2,5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 1.196775 0.061225 0.598387 0.659613 1.077097 0.180903
187 W65268004 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) CO-PRENESSA 2mg/0,625 mg COMPR. 2mg/0,625mg KRKA D.D, NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. P6L 30 0.713333 0.000000 0.356666 0.356667 0.641999 0.071334
188 W65269004 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) CO-PRENESSA 4mg/1,25 mg COMPR. 4mg/1,25mg KRKA D.D, NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. P6L 30 0.765666 0.000000 0.382833 0.382833 0.689099 0.076567
189 W68759002 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) CO-PRENESSANEO 5 mg/1,25 mg COMPR. 5mg/1,25mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 1.000666 0.000000 0.500333 0.500333 0.900599 0.100067
190 W65267004 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) CO-PRENESSA 8 mg/2,5mg COMPR. 8mg/2,5mg KRKA D.D, NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 1.196775 0.036891 0.598387 0.635279 1.077097 0.156569
191 W54255004 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) NOLITERAX 10 mg/2,5mg COMPR. FILM. 10mg/2,5mg LES LAB. SERVIER FRANTA CUTIE X 1 FLAC. DIN PP CU CAPAC PEJD CU SILICAGEL X 30 COMPR. FILM. P-6L 30 1.196775 0.200558 0.598387 0.798946 1.077097 0.320236
192 W63520001 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) PERINDOPRIL TOSILAT/INDAPAMIDA TEVA 10 mg/2,5 mg COMPR. FILM. 10mg/2,5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. X 30 COMPR. FILM. P6L 30 1.196775 0.198891 0.598387 0.797279 1.077097 0.318569
193 W52783004 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) NOLIPREL ARG 2,5mg/0,625mg COMPR. FILM. 2,5mg/0,625mg LES LABORATOIRES SERVIER FRANTA CUTIE X 1 FLAC. DIN PROPILENA X 30 COMPR. FILM. P-6L 30 1.196775 0.158225 0.598387 0.756613 1.077097 0.277903
194 W60020001 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) PERINDOPRIL TOSILAT/INDAPAMIDA TEVA 2,5 mg/0,625 mg COMPR. FILM. 2,5mg/0,625mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN PP X 30 COMPR. FILM. P6L 30 0.515000 0.000000 0.257500 0.257500 0.463500 0.051500
195 W52784004 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) NOLIPREL ARG FORTE 5mg/1,25mg COMPR. FILM. 5mg/1,25mg LES LABORATOIRES SERVIER FRANTA CUTIE X 1 FLAC. DIN PROPILENA X 30 COMPR. FILM. P-6L 30 1.048333 0.000000 0.524166 0.524167 0.943499 0.104834
196 W60021001 C09BA04 COMBINATII (PERINDOPRILUM+INDAPAMIDUM) PERINDOPRIL TOSILAT/INDAPAMIDA TEVA 5 mg/1,25 mg COMPR. FILM. 5mg/1,25mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN PP X 30 COMPR. FILM. P6L 30 0.868666 0.000000 0.434333 0.434333 0.781799 0.086867
197 W43136001 C09BA06 COMBINATII (QUINAPRILUM+HYDROCHLOROTHIAZIDUM) ACCUZIDE COMPR. FILM. 10mg/12,5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. AL/PVC-AL-OPA X 10 COMPR. FILM. P-6L 30 0.825000 0.000000 0.412500 0.412500 0.742500 0.082500
198 W64843001 C09BA06 COMBINATII (QUINAPRILUM+HYDROCHLOROTHIAZIDUM) ACCUZIDE 10 mg/12,5 mg COMPR. FILM. 10mg/12,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 3 BLIST. AL/PVC-AL-OPA X 10 COMPR. FILM. P-6L 30 0.825000 0.000000 0.412500 0.412500 0.742500 0.082500
199 W43137001 C09BA06 COMBINATII (QUINAPRILUM+HYDROCHLOROTHIAZIDUM) ACCUZIDE FORTE COMPR. FILM. 20mg/12,5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 3 BLIST. AL/PVC-AL-OPA X 10 COMPR. FILM. P-6L 30 1.189000 0.000000 0.594500 0.594500 1.070100 0.118900
200 W64844001 C09BA06 COMBINATII (QUINAPRILUM+HYDROCHLOROTHIAZIDUM) ACCUZIDE FORTE 20 mg/12,5 mg COMPR. FILM. 20mg/12,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 3 BLIST. AL/PVC-AL-OPA X 10 COMPR. FILM. P-6L 30 1.189000 0.000000 0.594500 0.594500 1.070100 0.118900
201 W53229003 C09BB02 COMBINATII (ENALAPRILUM+LERCANIDIPINUM) ** LERCARIL 10 mg /10 mg COMPR. FILM. 10mg/10mg RECORDATI IRELAND LIMITED IRLANDA CUTIE CU BLIST. PA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 0.593154 0.140774 0.296577 0.437351 0.533838 0.200090
202 W53228003 C09BB02 COMBINATII (ENALAPRILUM+LERCANIDIPINUM) ** LERCARIL 20 mg /10 mg COMPR. FILM. 20mg/10mg RECORDATI IRELAND LIMITED IRLANDA CUTIE CU BLIST. PA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 0.889731 0.013840 0.444865 0.458706 0.800757 0.102814
203 W61013003 C09BB02 COMBINATII (ENALAPRILUM+LERCANIDIPINUM) ** LERCARIL 20 mg/20 mg COMPR. FILM. 20mg/20mg RECORDATI IRELAND LIMITED IRLANDA CUTIE CU BLIST. PA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.167857 0.000000 0.583928 0.583929 1.051071 0.116786
204 W57913007 C09BB04 COMBINATII (PERINDOPRILUM+AMLODIPINUM) AMLESSA 4 mg/10 mg COMPR. 4mg/10mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.701000 0.000000 0.350500 0.350500 0.630900 0.070100
205 W57912007 C09BB04 COMBINATII (PERINDOPRILUM+AMLODIPINUM) AMLESSA 4 mg/5 mg COMPR. 4mg/5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.542731 0.158269 0.271365 0.429635 0.488457 0.212543
206 W57915007 C09BB04 COMBINATII (PERINDOPRILUM+AMLODIPINUM) AMLESSA 8 mg/10 mg COMPR. 8mg/10mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 1.085463 0.222203 0.542731 0.764935 0.976916 0.330750
207 W57914007 C09BB04 COMBINATII (PERINDOPRILUM+AMLODIPINUM) AMLESSA 8 mg/5 mg COMPR. 8mg/5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.783945 0.303721 0.391972 0.695694 0.705550 0.382116
208 W53990002 C09BB06 COMBINATII (NITRENDIPINUM+ENALAPRILUM) ENEAS 10 mg/20 mg COMPR. 20mg+10mg GALENICA S.A. GRECIA CUTIE X 3 BLIST. PA-PVC-AL/AL X 10 COMPR. P-6L 30 3.275000 0.000000 1.637500 1.637500 2.947500 0.327500

Pagina 3 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
209 W62349001 C09BB10 COMBINATII (VERAPAMILUM+TRANDOLAPRILUM) TARKA 180 mg/2 mg COMPR. CU ELIB. PREL. 180mg/2mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 2 BLIST. PVDC-PVC/AL X 14 COMPR. CU ELIB. PREL. P-6L 28 1.972142 0.000000 0.986071 0.986071 1.774927 0.197215
210 W68849001 C09BB10 COMBINATII (VERAPAMILUM+TRANDOLAPRILUM) TARKA 180 mg/2 mg COMPR. CU ELIB. PREL. 180mg/2mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVDC-PVC/AL X 14 COMPR. CU ELIB. PREL. P6L 28 1.972142 0.000000 0.986071 0.986071 1.774927 0.197215
211 W62329002 C09BB10 COMBINATII (VERAPAMILUM+TRANDOLAPRILUM) TARKA 240 mg/2 mg COMPR. CU ELIB. PREL. 240mg/2mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 14 COMPR. CU ELIB. PREL. P6L 28 2.073392 0.303750 1.036696 1.340446 1.866052 0.511090
212 W68850002 C09BB10 COMBINATII (VERAPAMILUM+TRANDOLAPRILUM) TARKA 240 mg/2 mg COMPR. CU ELIB. PREL. 240mg/2mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVC-PVDC/AL X 14 COMPR. CU ELIB. PREL. P6L 28 2.073392 0.303750 1.036696 1.340446 1.866052 0.511090
213 W62331002 C09BB10 COMBINATII (VERAPAMILUM+TRANDOLAPRILUM) TARKA 240 mg/4 mg COMPR. CU ELIB. PREL. 240mg/4mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 14 COMPR. CU ELIB. PREL. P6L 28 2.073392 0.674465 1.036696 1.711161 1.866052 0.881805
214 W68851002 C09BB10 COMBINATII (VERAPAMILUM+TRANDOLAPRILUM) TARKA 240 mg/4 mg COMPR. CU ELIB. PREL. 240mg/4mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVC-PVDC/AL X 14 COMPR. CU ELIB. PREL. P6L 28 2.073392 0.674465 1.036696 1.711161 1.866052 0.881805
215 W60513005 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) CO-AMLESSA 4mg/10mg/1,25mg COMPR. 4 mg/1,25 mg/10 mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 1.103333 0.000000 0.551666 0.551667 0.992999 0.110334
216 W68173001 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) PRINDAL 4 mg/1,25 mg/10 mg COMPR. 4 mg/1,25 mg/10 mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONTINÂND 30 COMPRIMATE P6L 30 1.103333 0.000000 0.551666 0.551667 0.992999 0.110334
217 W60512005 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) CO-AMLESSA 4 mg/5mg/1,25 mg COMPR. 4 mg/1,25 mg/5 mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.725220 0.366113 0.362610 0.728723 0.652698 0.438635
218 W68172001 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) PRINDAL 4 mg/1,25 mg/5 mg COMPR. 4 mg/1,25 mg/5 mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONTINÂND 30 COMPRIMATE P6L 30 0.725220 0.365780 0.362610 0.728390 0.652698 0.438302
219 W60515005 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) CO-AMLESSA 8 mg/10 mg/2,5 mg COMPR. 8 mg/2,5 mg/10 mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 1.237666 0.000000 0.618833 0.618833 1.113899 0.123767
220 W68175001 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) PRINDAL 8 mg/2,5 mg/10 mg COMPR. 8 mg/2,5 mg/10 mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONTINÂND 30 COMPRIMATE P6L 30 1.272000 0.000000 0.636000 0.636000 1.144800 0.127200
221 W60514005 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) CO-AMLESSA 8 mg/5 mg/2,5 mg COMPR. 8 mg/2,5 mg/5 mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 1.072327 0.045006 0.536163 0.581170 0.965094 0.152239
222 W68174001 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) PRINDAL 8 mg/2,5 mg/5 mg COMPR. 8 mg/2,5 mg/5 mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONTINÂND 30 COMPRIMATE P6L 30 1.072327 0.045006 0.536163 0.581170 0.965094 0.152239
223 W61004001 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) TRIPLIXAM 10 mg/2,5 mg/10 mg COMPR. FILM. 10mg/2,5mg/10mg LES LABORATOIRES SERVIER FRANTA CUTIE CU 1 FLAC. PP CU CAPAC DIN PEJD X 30 COMPR. FILM. P6L 30 1.458759 0.531907 0.729379 1.261287 1.312883 0.677783
224 W61003001 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) TRIPLIXAM 10 mg/2,5 mg/5 mg COMPR. FILM. 10mg/2,5mg/5mg LES LABORATOIRES SERVIER FRANTA CUTIE CU 1 FLAC. PP CU CAPAC DIN PEJD X 30 COMPR. FILM. P6L 30 1.080646 0.794687 0.540323 1.335010 0.972581 0.902752
225 W61002001 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) TRIPLIXAM 5 mg/1,25 mg/10 mg COMPR. FILM. 5mg/1,25mg/10mg LES LABORATOIRES SERVIER FRANTA CUTIE CU 1 FLAC. PP CU CAPAC DIN PEJD X 30 COMPR. FILM. P6L 30 1.107492 0.646508 0.553746 1.200254 0.996742 0.757258
226 W61001001 C09BX01 COMBINATII (PERINDOPRILUM+INDAPAMIDUM+AMLODIPINUM) TRIPLIXAM 5 mg/1,25 mg/5 mg COMPR. FILM. 5mg/1,25mg/5mg LES LABORATOIRES SERVIER FRANTA CUTIE CU 1 FLAC. PP CU CAPAC DIN PEJD X 30 COMPR. FILM. P6L 30 0.729379 0.827287 0.364689 1.191977 0.656441 0.900225
227 W56930003 C09CA03 VALSARTANUM DIOVAN 160 mg COMPR. FILM. 160mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. TIP CALENDAR PVC-PVDC/AL X 28 COMPR. FILM. P-6L 28 1.426071 0.000000 0.713035 0.713036 1.283463 0.142608
228 W58950003 C09CA03 VALSARTANUM VAPRESS 160 mg COMPR. FILM. 160mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.908928 0.000000 0.454464 0.454464 0.818035 0.090893
229 W58950013 C09CA03 VALSARTANUM VAPRESS 160 mg COMPR. FILM. 160mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTFE/AL X 28 COMPR. FILM. P6L 28 0.908928 0.000000 0.454464 0.454464 0.818035 0.090893
230 W56929003 C09CA03 VALSARTANUM DIOVAN 40 mg COMPR. FILM. 40mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. TIP CALENDAR PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0.413142 1.029358 0.206571 1.235929 0.371827 1.070673
231 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 0.413142 0.724715 0.206571 0.931286 0.371827 0.766030
232 W58948013 C09CA03 VALSARTANUM VAPRESS 40 mg COMPR. FILM. 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTFE/AL X 28 COMPR. FILM. P6L 28 0.413142 0.724715 0.206571 0.931286 0.371827 0.766030
233 W56931003 C09CA03 VALSARTANUM DIOVAN 80 mg COMPR. FILM. 80mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. TIP CALENDAR PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0.826285 0.557643 0.413142 0.970786 0.743656 0.640272
234 W58949003 C09CA03 VALSARTANUM VAPRESS 80 mg COMPR. FILM. 80mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.502500 0.000000 0.251250 0.251250 0.452250 0.050250
235 W58949013 C09CA03 VALSARTANUM VAPRESS 80 mg COMPR. FILM. 80mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTFE/AL X 28 COMPR. FILM. P6L 28 0.502500 0.000000 0.251250 0.251250 0.452250 0.050250
236 W55631001 C09CA03 VALSARTANUM DIOVAN 3 mg/ml SOL. ORALA 3mg/ml NOVARTIS PHARMA GMBH GERMANIA CUT IE X 1 FLACON DIN ST ICLA BRUNA X 160ML SOLUT IE ORALA + 1 T RUSA DE ADMINIST RARE (ADAPT OR PENT RU FLACON + 1 SERINGA DOZAT OARE A 5ML + 1 MASURA DOZAT OARE A 30ML ) P-6L 1 4.957711 25.182289 2.478855 27.661145 4.461939 25.678061
237 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 0.492500 0.000000 0.246250 0.246250 0.443250 0.049250
238 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 0.985714 0.000000 0.492857 0.492857 0.887142 0.098572
239 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 0.825000 0.000000 0.412500 0.412500 0.742500 0.082500
240 W59580002 C09CA04 IRBESARTANUM IRBESARTAN ZENTIVA 150mg COMPR. FILM. 150mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 0.710000 0.000000 0.355000 0.355000 0.639000 0.071000
241 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 0.826285 0.571048 0.413142 0.984191 0.743656 0.653677
242 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 0.826285 0.662643 0.413142 1.075786 0.743656 0.745272
243 W63000003 C09CA04 IRBESARTANUM IRBESARTAN TEVA 150 mg COMPR. FILM. 150mg TEVA B.V. OLANDA CUTIE X BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P-6L 28 0.567857 0.000000 0.283928 0.283929 0.511071 0.056786
244 W65123002 C09CA04 IRBESARTANUM IRBESARTAN ZENTIVA 150mg COMPR. FILM. 150mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 0.710000 0.000000 0.355000 0.355000 0.639000 0.071000
245 W66400006 C09CA04 IRBESARTANUM APROVEL 150mg COMPR. FILM. 150mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM. P6L 30 0.826285 0.571048 0.413142 0.984191 0.743656 0.653677
246 W69393006 C09CA04 IRBESARTANUM APROVEL 150mg COMPR. FILM. 150mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM. P6L 30 0.826285 0.571048 0.413142 0.984191 0.743656 0.653677
247 W63001003 C09CA04 IRBESARTANUM IRBESARTAN TEVA 300 mg COMPR. FILM. 300 mg TEVA B.V. OLANDA CUTIE X BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P-6L 28 0.954642 0.000000 0.477321 0.477321 0.859177 0.095465
248 W54082003 C09CA04 IRBESARTANUM IRBESARTAN TERAPIA 300 mg COMPR. FILM. 300mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL, X 28 COMPR. FILM. P-6L 28 1.326428 0.000000 0.663214 0.663214 1.193785 0.132643
249 W59581002 C09CA04 IRBESARTANUM IRBESARTAN ZENTIVA 300mg COMPR. FILM. 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 1.005000 0.000000 0.502500 0.502500 0.904500 0.100500
250 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 1.652570 0.190430 0.826285 1.016715 1.487313 0.355687
251 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 1.652570 0.189930 0.826285 1.016215 1.487313 0.355187
252 W65124002 C09CA04 IRBESARTANUM IRBESARTAN ZENTIVA 300mg COMPR. FILM. 300mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 1.005000 0.000000 0.502500 0.502500 0.904500 0.100500
253 W66401007 C09CA04 IRBESARTANUM APROVEL 300mg COMPR. FILM. 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM. P6L 30 1.652570 0.190430 0.826285 1.016715 1.487313 0.355687
254 W69394007 C09CA04 IRBESARTANUM APROVEL 300mg COMPR. FILM. 300mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM. P6L 30 1.652570 0.190430 0.826285 1.016715 1.487313 0.355687
255 W55622005 C09CA06 CANDESARTANUM CILEXETIL TANDESAR 16 mg COMPR. 16mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P-6L 28 1.310714 0.000000 0.655357 0.655357 1.179642 0.131072
256 W54889004 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN SANDOZ 16 mg COMPR. 16mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR. P-6L 28 0.713214 0.000000 0.356607 0.356607 0.641892 0.071322
257 W55592003 C09CA06 CANDESARTANUM CILEXETIL KARBIS 16 mg COMPR. 16mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P-6L 30 1.067333 0.000000 0.533666 0.533667 0.960599 0.106734
258 W58808002 C09CA06 CANDESARTANUM CILEXETIL ATACAND 16mg COMPR. 16mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC/PVDC/AL CE CONTINE 28 COMPR. P-6L 28 1.375000 0.000000 0.687500 0.687500 1.237500 0.137500
259 W58874004 C09CA06 CANDESARTANUM CILEXETIL CANZENO 16mg COMPR. 16mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.616333 0.000000 0.308166 0.308167 0.554699 0.061634
260 W61496002 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL MCC 16 mg COMPR. 16mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 1.102000 0.000000 0.551000 0.551000 0.991800 0.110200
261 W62724001 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN ATB 16 mg COMPR. 16mg ANTIBIOTICE SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P6L 30 0.916666 0.000000 0.458333 0.458333 0.824999 0.091667
262 W67397002 C09CA06 CANDESARTANUM CILEXETIL ATACAND 16 mg COMPR. 16mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU BLIST. PVC-PVDC/AL CE CONTINE 28 COMPR. P6L 28 1.375000 0.000000 0.687500 0.687500 1.237500 0.137500
263 W55593003 C09CA06 CANDESARTANUM CILEXETIL KARBIS 32 mg COMPR. 32mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P-6L 30 1.347333 0.000000 0.673666 0.673667 1.212599 0.134734
264 W58806001 C09CA06 CANDESARTANUM CILEXETIL ATACAND 32 mg COMPR. 32mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC/PVDC/AL CE CONTINE 28 COMPR. P-6L 28 2.101785 0.000000 1.050892 1.050893 1.891606 0.210179
265 W58875004 C09CA06 CANDESARTANUM CILEXETIL CANZENO 32mg COMPR. 32mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.956333 0.000000 0.478166 0.478167 0.860699 0.095634
266 W61497002 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL MCC 32 mg COMPR. 32mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 1.380333 0.000000 0.690166 0.690167 1.242299 0.138034
267 W64539008 C09CA06 CANDESARTANUM CILEXETIL TANDESAR 32 mg COMPR. 32mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P6L 28 1.733928 0.000000 0.866964 0.866964 1.560535 0.173393
268 W67398001 C09CA06 CANDESARTANUM CILEXETIL ATACAND 32 mg COMPR. 32mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU BLIST. PVC-PVDC/AL CE CONTINE 28 COMPR. P6L 28 2.101785 0.000000 1.050892 1.050893 1.891606 0.210179
269 W55621005 C09CA06 CANDESARTANUM CILEXETIL TANDESAR 8 mg COMPR. 8mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P-6L 28 0.676428 0.000000 0.338214 0.338214 0.608785 0.067643
270 W55591003 C09CA06 CANDESARTANUM CILEXETIL KARBIS 8 mg COMPR. 8mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P-6L 30 0.667666 0.000000 0.333833 0.333833 0.600899 0.066767
271 W58807002 C09CA06 CANDESARTANUM CILEXETIL ATACAND 8mg COMPR. 8mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC/PVDC/AL CE CONTINE 28 COMPR. P-6L 28 0.826285 0.098357 0.413142 0.511500 0.743656 0.180986
272 W58873004 C09CA06 CANDESARTANUM CILEXETIL CANZENO 8mg COMPR. 8mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.601000 0.000000 0.300500 0.300500 0.540900 0.060100
273 W61495004 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL MCC 8 mg COMPR. 8mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 0.676333 0.000000 0.338166 0.338167 0.608699 0.067634
274 W62723001 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN ATB 8 mg COMPR. 8mg ANTIBIOTICE SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P6L 30 0.676333 0.000000 0.338166 0.338167 0.608699 0.067634
275 W67396002 C09CA06 CANDESARTANUM CILEXETIL ATACAND 8 mg COMPR. 8mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU BLIST. PVC-PVDC/AL CE CONTINE 28 COMPR. P6L 28 0.826285 0.098357 0.413142 0.511500 0.743656 0.180986
276 W56746002 C09CA07 TELMISARTANUM TELMISARTAN ACTAVIS 40mg COMPR. 40 mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. P6L 28 0.670357 0.000000 0.335178 0.335179 0.603321 0.067036
277 W55585002 C09CA07 TELMISARTANUM TOLURA 40 mg COMPR. 40mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST.OPA-AL-PVC/AL X 28 COMPR. P-6L 28 0.667500 0.000000 0.333750 0.333750 0.600750 0.066750
278 W55534001 C09CA07 TELMISARTANUM TEZEO 40 mg COMPR. 40mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P-6L 30 0.601000 0.000000 0.300500 0.300500 0.540900 0.060100
279 W56747002 C09CA07 TELMISARTANUM TELMISARTAN ACTAVIS 80mg COMPR. 80 mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. P6L 28 0.868928 0.000000 0.434464 0.434464 0.782035 0.086893
280 W05785002 C09CA07 TELMISARTANUM MICARDIS 80 mg COMPR. 80mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 28COMPR. ( BLIST. PA/AL/PVC) P-6L 28 1.492857 0.000000 0.746428 0.746429 1.343571 0.149286

Pagina 4 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
281 W55586002 C09CA07 TELMISARTANUM TOLURA 80 mg COMPR. 80mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST.OPA-AL-PVC/AL X 28 COMPR. P-6L 28 0.918571 0.000000 0.459285 0.459286 0.826713 0.091858
282 W55535001 C09CA07 TELMISARTANUM TEZEO 80 mg COMPR. 80mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P-6L 30 0.524000 0.000000 0.262000 0.262000 0.471600 0.052400
283 W56252005 C09DA01 COMBINATII (LOSARTANUM+HYDROCHLOROTHIAZIDUM) LORISTA HL 100 mg/12,5 mg COMPR.FILM 100mg/12,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P-6L 28 0.782100 0.087542 0.391050 0.478592 0.703890 0.165752
284 W43460003 C09DA01 COMBINATII (LOSARTANUM+HYDROCHLOROTHIAZIDUM) LORISTA H 50 mg/12,5 mg COMPR.FILM 50mg+ 12,50mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. DIN PVC-PVDC/AL X 14 COMPR. FILM. P-6L 28 0.580714 0.000000 0.290357 0.290357 0.522642 0.058072
285 W59584002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HYDROCHLOROTHIAZIDE ZENTIVA 150mg/12,5mg COMPR. FILM 150mg/12,5mg SANOFI-AVENTIS GROUPE FRANTA CUTIE CU BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P-6L 28 0.782100 0.092185 0.391050 0.483235 0.703890 0.170395
286 W65144002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HYDROCHLOROTHIAZIDE ZENTIVA 150mg/12,5 mg COMPR. FILM 150mg/12,5mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P6L 28 0.782100 0.092185 0.391050 0.483235 0.703890 0.170395
287 W59585002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HYDROCHLOROTHIAZIDE ZENTIVA 300mg/12,5mg COMPR. FILM 300mg/12,5mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 2 BLIST. PVC/PVDC/AL X 14 COMPR. FILM. P-6L 28 0.782100 0.419685 0.391050 0.810735 0.703890 0.497895
288 W65145002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HYDROCHLOROTHIAZIDE ZENTIVA 300mg/12,5 mg COMPR. FILM 300mg/12,5mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P6L 28 0.782100 0.419685 0.391050 0.810735 0.703890 0.497895
289 W60639002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 150mg/12,5mg COMPR. FILM. 150mg/12,5mg SANOFI CLIR SNC FRANTA CUTIE X BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P-6L 28 0.782100 0.682900 0.391050 1.073950 0.703890 0.761110
290 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 0.782100 0.200042 0.391050 0.591092 0.703890 0.278252
291 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 0.782100 0.200042 0.391050 0.591092 0.703890 0.278252
292 W66394002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 150mg/12,5mg COMPR. FILM. 150mg/12,5mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P6L 28 0.782100 0.682900 0.391050 1.073950 0.703890 0.761110
293 W69398002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 150mg/12,5mg COMPR. FILM. 150mg/12,5mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P6L 28 0.782100 0.682900 0.391050 1.073950 0.703890 0.761110
294 W60640002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/12,5mg COMPR. FILM. 300mg/12,5mg SANOFI CLIR SNC FRANTA CUTIE X BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P-6L 28 0.782100 0.896471 0.391050 1.287521 0.703890 0.974681
295 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 0.782100 0.150757 0.391050 0.541807 0.703890 0.228967
296 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 0.782100 0.150757 0.391050 0.541807 0.703890 0.228967
297 W66395002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/12,5mg COMPR. FILM. 300mg/12,5mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P6L 28 0.782100 0.896471 0.391050 1.287521 0.703890 0.974681
298 W69399002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/12,5mg COMPR. FILM. 300mg/12,5mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P6L 28 0.782100 0.896471 0.391050 1.287521 0.703890 0.974681
299 W60641002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/25mg COMPR. FILM. 300mg/25mg SANOFI CLIR SNC FRANTA CUTIE X BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P-6L 28 0.782100 0.956828 0.391050 1.347878 0.703890 1.035038
300 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 0.782100 0.283257 0.391050 0.674307 0.703890 0.361467
301 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 0.782100 0.283257 0.391050 0.674307 0.703890 0.361467
302 W66396002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/25mg COMPR. FILM. 300mg/25mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P6L 28 0.782100 0.956828 0.391050 1.347878 0.703890 1.035038
303 W69400002 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) COAPROVEL 300mg/25mg COMPR. FILM. 300mg/25mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P6L 28 0.782100 0.956828 0.391050 1.347878 0.703890 1.035038
304 W57536004 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) KARBICOMBI 16 mg/12,5 mg COMPR. 16mg/12,5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIT. PVC-PVDC/AL X 30 COMPR. P6L 30 0.782100 0.086900 0.391050 0.477950 0.703890 0.165110
305 W57536013 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) KARBICOMBI 16 mg/12,5 mg COMPR. 16mg/12,5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.782100 0.086900 0.391050 0.477950 0.703890 0.165110
306 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 0.782100 0.259566 0.391050 0.650616 0.703890 0.337776
307 W64690001 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) CANDESARTAN HCT SWYSSI 16 mg/12,5 mg COMPR. 16mg/12,5mg SWYSSI AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.782100 0.023233 0.391050 0.414283 0.703890 0.101443
308 W57535004 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) KARBICOMBI 8 mg/12,5 mg COMPR. 8mg/12,5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIT. PVC-PVDC/AL X 30 COMPR. P6L 30 0.591000 0.000000 0.295500 0.295500 0.531900 0.059100
309 W57535013 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) KARBICOMBI 8 mg/12,5 mg COMPR. 8mg/12,5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.591000 0.000000 0.295500 0.295500 0.531900 0.059100
310 W58870004 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) CANZENO HCT 8mg/12,5mg COMPR. 8mg/12,5mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 0.630333 0.000000 0.315166 0.315167 0.567299 0.063034
311 W64688001 C09DA06 COMBINATII (CANDESARTANUM CILEXETIL+HCT) CANDESARTAN HCT SWYSSI 8 mg/12,5 mg COMPR. 8mg/12,5mg SWYSSI AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.567666 0.000000 0.283833 0.283833 0.510899 0.056767
312 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 0.782100 0.052185 0.391050 0.443235 0.703890 0.130395
313 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 0.782100 0.086900 0.391050 0.477950 0.703890 0.165110
314 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 0.782100 0.086900 0.391050 0.477950 0.703890 0.165110
315 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 0.782100 0.223257 0.391050 0.614307 0.703890 0.301467
316 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 0.782100 0.676471 0.391050 1.067521 0.703890 0.754681
317 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 0.782100 0.676471 0.391050 1.067521 0.703890 0.754681
318 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 0.782100 0.086900 0.391050 0.477950 0.703890 0.165110
319 W65924001 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELHYCAR 80 mg/12,5 mg COMPR. 80mg/12,5mg SWYSSI AG. GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. P6L 28 0.782100 0.238257 0.391050 0.629307 0.703890 0.316467
320 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 0.782100 0.553900 0.391050 0.944950 0.703890 0.632110
321 W65925001 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELHYCAR 80 mg/25 mg COMPR. 80mg/25mg SWYSSI AG. GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. P6L 28 0.782100 0.238257 0.391050 0.629307 0.703890 0.316467
322 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 1.062142 0.000000 0.531071 0.531071 0.955927 0.106215
323 W64128005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) DIPPERAM 10 mg/160 mg COMPR. FILM. 10mg/160mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC X 56 COMPR. FILM. P6L 56 0.981785 0.000000 0.490892 0.490893 0.883606 0.098179
324 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 1.972515 0.118377 0.986257 1.104635 1.775263 0.315629
325 W67665003 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN AUROBINDO 10 mg/160 mg COMPR. FILM. 10mg/160mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.972515 0.434818 0.986257 1.421076 1.775263 0.632070
326 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 1.062142 0.000000 0.531071 0.531071 0.955927 0.106215
327 W64127005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) DIPPERAM 5 mg/160 mg COMPR. FILM. 5mg/160mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC X 56 COMPR. FILM. P6L 56 0.981785 0.000000 0.490892 0.490893 0.883606 0.098179
328 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 1.914500 0.001392 0.957250 0.958642 1.723050 0.192842
329 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 0.986257 0.075885 0.493128 0.569014 0.887631 0.174511
330 W64126005 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) DIPPERAM 5 mg/80 mg COMPR. FILM. 5mg/80mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC X 56 COMPR. FILM. P6L 56 0.540714 0.000000 0.270357 0.270357 0.486642 0.054072
331 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 0.986257 0.572493 0.493128 1.065622 0.887631 0.671119
332 W67663003 C09DB01 COMBINATII (AMLODIPINUM+VALSARTANUM) AMLODIPINA/VALSARTAN AUROBINDO 5 mg/80 mg COMPR. FILM. 5mg/80mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.986257 1.462743 0.493128 1.955872 0.887631 1.561369
333 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 0.986257 0.949457 0.493128 1.442586 0.887631 1.048083
334 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 0.986257 0.949100 0.493128 1.442229 0.887631 1.047726
335 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 0.986257 0.149100 0.493128 0.642229 0.887631 0.247726
336 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 CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0.986257 0.149100 0.493128 0.642229 0.887631 0.247726
337 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 0.986257 0.839814 0.493128 1.332943 0.887631 0.938440
338 W66702002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 20 mg/5 mg COMPR. FILM. 20mg/5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-PVC/AL X 28 COMPR. FILM. P6L 28 0.986257 0.949457 0.493128 1.442586 0.887631 1.048083
339 W66702011 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 20 mg/5 mg COMPR. FILM. 20mg/5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU UN PACHET CALENDAR DIN OPA-PVC/AL X 28 COMPR. FILM. P6L 28 0.986257 0.949457 0.493128 1.442586 0.887631 1.048083
340 W67835002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM REVERANTZA 20 mg/5 mg COMPR. FILM. 20mg/5mg SWYSSI AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0.986257 0.803028 0.493128 1.296157 0.887631 0.901654
341 W68064002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 20 mg/5 mg COMPR. FILM. 20mg/5mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0.986257 0.949100 0.493128 1.442229 0.887631 1.047726
342 W53447002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM INOVUM 40 mg/10 mg COMPR. FILM. 40mg/10mg LUXEMBOURG CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM.
MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. P-6L 28 1.972515 0.162842 0.986257 1.149100 1.775263 0.360094
343 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 1.972515 0.162842 0.986257 1.149100 1.775263 0.360094
344 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 1.445357 0.000000 0.722678 0.722679 1.300821 0.144536
345 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 CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.445357 0.000000 0.722678 0.722679 1.300821 0.144536
346 W66043002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SALVO 40 mg/10 mg COMPR. FILM. 40mg/10mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.968214 0.000000 0.984107 0.984107 1.771392 0.196822
347 W67078002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/10 mg COMPR. FILM. 40mg/10mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-PVC/AL X 28 COMPR. FILM. P6L 28 1.972515 0.329627 0.986257 1.315885 1.775263 0.526879
348 W67078011 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/10 mg COMPR. FILM. 40mg/10mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU UN PACHET CALENDAR DIN OPA-PVC/AL X 28 COMPR. FILM. P6L 28 1.972515 0.329627 0.986257 1.315885 1.775263 0.526879
349 W68066002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 40 mg/10 mg COMPR. FILM. 40mg/10mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.972515 0.162842 0.986257 1.149100 1.775263 0.360094
350 W53446002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM INOVUM 40 mg/5 mg COMPR. FILM. 40mg/5mg LUXEMBOURG CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM.
MENARINI INTERNATIONAL OPERATIONS LUXEMBURG S.A. P-6L 28 1.775264 0.211164 0.887632 1.098796 1.597737 0.388691
351 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 1.775264 0.211164 0.887632 1.098796 1.597737 0.388691
352 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 1.558214 0.000000 0.779107 0.779107 1.402392 0.155822

Pagina 5 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
353 W66042002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SALVO 40 mg/5 mg COMPR. FILM. 40mg/5mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.775264 0.050807 0.887632 0.938439 1.597737 0.228334
354 W67077002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/5 mg COMPR. FILM. 40mg/5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-PVC/AL X 28 COMPR. FILM. P6L 28 1.775264 0.351878 0.887632 1.239510 1.597737 0.529405
355 W67077011 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM OLSSA 40 mg/5 mg COMPR. FILM. 40mg/5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU UN PACHET CALENDAR DIN OPA-PVC/AL X 28 COMPR. FILM. P6L 28 1.775264 0.351878 0.887632 1.239510 1.597737 0.529405
356 W67836002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM REVERANTZA 40 mg/5 mg COMPR. FILM. 40mg/5mg SWYSSI AG GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.775264 0.276164 0.887632 1.163796 1.597737 0.453691
357 W68065002 C09DB02 OLMESARTANUM MEDOXOMILUM+AMLODIPINUM SEVIKAR 40 mg/5 mg COMPR. FILM. 40mg/5mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.775264 0.211164 0.887632 1.098796 1.597737 0.388691
358 W64768002 C09DX01 COMBINATII (AMLODIPINA+VALSARTAN+HCT) EXFORGE HCT COMPR. FILM. 10mg/160mg/12,5 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU BLIST. DIN PVC/PVDC X 28 COMPR.FILM. PRF 28 1.468928 0.000000 0.734464 0.734464 1.322035 0.146893
359 W64769002 C09DX01 COMBINATII (AMLODIPINA+VALSARTAN+HCT) EXFORGE HCT COMPR. FILM. 10mg/160mg/25 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU BLIST. DIN PVC/PVDC X 28 COMPR.FILM. PRF 28 2.119096 0.188046 1.059548 1.247594 1.907186 0.399956
360 W64770002 C09DX01 COMBINATII (AMLODIPINA+VALSARTAN+HCT) EXFORGE HCT COMPR. FILM. 5mg/160mg/12,5 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU BLIST. DIN PVC/PVDC X 28 COMPR.FILM. PRF 28 1.934354 0.309931 0.967177 1.277108 1.740918 0.503367
361 W64771002 C09DX01 COMBINATII (AMLODIPINA+VALSARTAN+HCT) EXFORGE HCT COMPR. FILM. 5mg/160mg/25 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU BLIST. DIN PVC/PVDC X 28 COMPR.FILM. PRF 28 2.064760 0.179882 1.032380 1.212262 1.858284 0.386358
362 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 0.800714 0.000000 0.400357 0.400357 0.720642 0.080072
363 W63181001 C10AA04 FLUVASTATINUM FLUVASTATIN ARENA 80 mg COMPR. ELIB. PREL. 80mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. AL/AL X 10 COMPR. ELIB. PREL. P6L 30 0.800333 0.000000 0.400166 0.400167 0.720299 0.080034
364 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 0.415317 0.323349 0.207658 0.531008 0.373785 0.364881
365 W54696006 C10AA05 ATORVASTATINUM ATORIS 10 mg COMPR. FILM. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR.FILM. P-6L 28 0.415317 0.018254 0.207658 0.225913 0.373785 0.059786
366 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 0.415317 0.027349 0.207658 0.235008 0.373785 0.068881
367 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 0.196666 0.000000 0.098333 0.098333 0.176999 0.019667
368 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 0.415317 0.323349 0.207658 0.531008 0.373785 0.364881
369 W65497005 C10AA05 ATORVASTATINUM ATORVASTATIN TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.415317 0.027349 0.207658 0.235008 0.373785 0.068881
370 W65547003 C10AA05 ATORVASTATINUM ATORVASTATINA ARENA 10 mg COMPR. FILM. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PA-AL-PVC/AL A CATE 10 COMPRIMATE FILMATE P6L 30 0.415317 0.486683 0.207658 0.694342 0.373785 0.528215
371 W67270001 C10AA05 ATORVASTATINUM SORTIS 10 mg COMPR. FILM. 10mg UPJOHN EESV OLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.415317 0.323349 0.207658 0.531008 0.373785 0.364881
372 W68824002 C10AA05 ATORVASTATINUM ATORVASTATINA MEDREG 10 mg COMPR. FILM. 10mg MEDREG S.R.O REPUBLICA CEHA CUTIE CU BLIST. OPA-PVC/AL X 30 COMPR. FILM. P6L 30 0.343000 0.000000 0.171500 0.171500 0.308700 0.034300
373 W54697006 C10AA05 ATORVASTATINUM ATORIS 20 mg COMPR. FILM. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR.FILM. P-6L 28 0.442857 0.000000 0.221428 0.221429 0.398571 0.044286
374 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 0.702000 0.000000 0.351000 0.351000 0.631800 0.070200
375 W62153005 C10AA05 ATORVASTATINUM TORVACARD 20 mg COMPR. FILM. 20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.388333 0.000000 0.194166 0.194167 0.349499 0.038834
376 W65499005 C10AA05 ATORVASTATINUM ATORVASTATIN TERAPIA 20 mg COMPR. FILM. 20mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.702000 0.000000 0.351000 0.351000 0.631800 0.070200
377 W65548003 C10AA05 ATORVASTATINUM ATORVASTATINA ARENA 20 mg COMPR. FILM. 20mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PA-AL-PVC/AL A CATE 10 COMPRIMATE FILMATE P6L 30 0.830635 0.302031 0.415317 0.717349 0.747571 0.385095
378 W67271001 C10AA05 ATORVASTATINUM SORTIS 20 mg COMPR. FILM. 20mg UPJOHN EESV OLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.830635 0.447365 0.415317 0.862683 0.747571 0.530429
379 W68825002 C10AA05 ATORVASTATINUM ATORVASTATINA MEDREG 20 mg COMPR. FILM. 20mg MEDREG S.R.O REPUBLICA CEHA CUTIE CU BLIST. OPA-PVC/AL X 30 COMPR. FILM. P6L 30 0.506000 0.000000 0.253000 0.253000 0.455400 0.050600
380 W54698004 C10AA05 ATORVASTATINUM ATORIS 40 mg COMPR. FILM. 40mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 14 COMPR.FILM. P-6L 14 0.824285 0.000000 0.412142 0.412143 0.741856 0.082429
381 W54698007 C10AA05 ATORVASTATINUM ATORIS 40 mg COMPR. FILM. 40mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR.FILM. P-6L 30 0.824333 0.000000 0.412166 0.412167 0.741899 0.082434
382 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 1.360000 0.000000 0.680000 0.680000 1.224000 0.136000
383 W62154005 C10AA05 ATORVASTATINUM TORVACARD 40 mg COMPR. FILM. 40mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.766666 0.000000 0.383333 0.383333 0.689999 0.076667
384 W65501005 C10AA05 ATORVASTATINUM ATORVASTATIN TERAPIA 40 mg COMPR. FILM. 40mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.360000 0.000000 0.680000 0.680000 1.224000 0.136000
385 W65549003 C10AA05 ATORVASTATINUM ATORVASTATINA ARENA 40 mg COMPR. FILM. 40mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 30(3X10) COMPR. FILM. P6L 30 1.360000 0.000000 0.680000 0.680000 1.224000 0.136000
386 W67272006 C10AA05 ATORVASTATINUM SORTIS 40 mg COMPR. FILM. 40mg UPJOHN EESV OLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. P6L 14 1.505714 0.000000 0.752857 0.752857 1.355142 0.150572
387 W68826002 C10AA05 ATORVASTATINUM ATORVASTATINA MEDREG 40 mg COMPR. FILM. 40mg MEDREG S.R.O REPUBLICA CEHA CUTIE CU BLIST. OPA-PVC/AL X 30 COMPR. FILM. P6L 30 0.783666 0.000000 0.391833 0.391833 0.705299 0.078367
388 W55519003 C10AA05 ATORVASTATINUM ASCORD 80 mg COMPR. FILM. 80mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-6L 30 1.346333 0.000000 0.673166 0.673167 1.211699 0.134634
389 W57508007 C10AA05 ATORVASTATINUM ATORIS 80 mg COMPR. FILM. 80mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.115000 0.000000 0.557500 0.557500 1.003500 0.111500
390 W62155005 C10AA05 ATORVASTATINUM TORVACARD 80 mg COMPR. FILM. 80mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.990333 0.000000 0.495166 0.495167 0.891299 0.099034
391 W65503005 C10AA05 ATORVASTATINUM ATORVASTATIN TERAPIA 80 mg COMPR. FILM. 80mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.346333 0.000000 0.673166 0.673167 1.211699 0.134634
392 W65550003 C10AA05 ATORVASTATINUM ATORVASTATINA ARENA 80 mg COMPR. FILM. 80mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 30(3X10) COMPR. FILM. P6L 30 1.346333 0.000000 0.673166 0.673167 1.211699 0.134634
393 W67273006 C10AA05 ATORVASTATINUM SORTIS 80 mg COMPR. FILM. 80mg UPJOHN EESV OLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. P6L 14 1.631428 0.000000 0.815714 0.815714 1.468285 0.163143
394 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 0.796000 0.000000 0.398000 0.398000 0.716400 0.079600
395 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 0.781666 0.000000 0.390833 0.390833 0.703499 0.078167
396 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 0.782500 0.000000 0.391250 0.391250 0.704250 0.078250
397 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 0.782500 0.000000 0.391250 0.391250 0.704250 0.078250
398 W60392003 C10AA07 ROSUVASTATINUM ROVASTAMED 10mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0.322857 0.000000 0.161428 0.161429 0.290571 0.032286
399 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 0.579333 0.000000 0.289666 0.289667 0.521399 0.057934
400 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 0.505333 0.000000 0.252666 0.252667 0.454799 0.050534
401 W64682002 C10AA07 ROSUVASTATINUM ROSI 10 mg COMPR. FILM. 10mg SWYSSI AG GERMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.830635 0.352698 0.415317 0.768016 0.747571 0.435762
402 W65079001 C10AA07 ROSUVASTATINUM CRESTOR 10 mg COMPR. FILM. 10mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. FILM. P6L 28 0.830635 0.442579 0.415317 0.857897 0.747571 0.525643
403 W66514007 C10AA07 ROSUVASTATINUM ROSUVASTATINA MSN LABORATORIES 10 mg COMPR. FILM. 10mg VIVANTA GENERICS S.R.O., REPUBLICA CEHA CUTIE CU BLIST. AL/AL CU 30 COMPRIMATE FILMATE P6L 30 0.830635 1.587031 0.415317 2.002349 0.747571 1.670095
404 W55328002 C10AA07 ROSUVASTATINUM ROSUCARD 20 mg COMPR. FILM. 20mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 1.088333 0.000000 0.544166 0.544167 0.979499 0.108834
405 W57061005 C10AA07 ROSUVASTATINUM ROSWERA 20 mg COMPR. FILM. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.120333 0.000000 0.560166 0.560167 1.008299 0.112034
406 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 1.358571 0.000000 0.679285 0.679286 1.222713 0.135858
407 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 1.358571 0.000000 0.679285 0.679286 1.222713 0.135858
408 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 0.607500 0.000000 0.303750 0.303750 0.546750 0.060750
409 W61055001 C10AA07 ROSUVASTATINUM ROSUVASTATINA ATB 20 mg COMPR. FILM. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P6L 30 0.935333 0.000000 0.467666 0.467667 0.841799 0.093534
410 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 1.117333 0.000000 0.558666 0.558667 1.005599 0.111734
411 W64684002 C10AA07 ROSUVASTATINUM ROSI 20 mg COMPR. FILM. 20mg SWYSSI AG GERMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 1.661270 0.066063 0.830635 0.896698 1.495143 0.232190
412 W65078001 C10AA07 ROSUVASTATINUM CRESTOR 20 mg COMPR. FILM. 20mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. FILM. P6L 28 1.315000 0.000000 0.657500 0.657500 1.183500 0.131500
413 W66515007 C10AA07 ROSUVASTATINUM ROSUVASTATINA MSN LABORATORIES 20 mg COMPR. FILM. 20mg VIVANTA GENERICS S.R.O., REPUBLICA CEHA CUTIE CU BLIST. AL/AL CU 30 COMPRIMATE FILMATE P6L 30 1.661270 2.068730 0.830635 2.899365 1.495143 2.234857
414 W55329002 C10AA07 ROSUVASTATINUM ROSUCARD 40 mg COMPR. FILM. 40mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 1.747000 0.000000 0.873500 0.873500 1.572300 0.174700
415 W57063005 C10AA07 ROSUVASTATINUM ROSWERA 40 mg COMPR. FILM. 40mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.316666 0.000000 0.658333 0.658333 1.184999 0.131667
416 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 1.746785 0.000000 0.873392 0.873393 1.572106 0.174679
417 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 1.746785 0.000000 0.873392 0.873393 1.572106 0.174679
418 W60394003 C10AA07 ROSUVASTATINUM ROVASTAMED 40mg COMPR. FILM. 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 1.388928 0.000000 0.694464 0.694464 1.250035 0.138893
419 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 2.795000 0.000000 1.397500 1.397500 2.515500 0.279500
420 W64686002 C10AA07 ROSUVASTATINUM ROSI 40 mg COMPR. FILM. 40mg SWYSSI AG GERMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 2.133333 0.000000 1.066666 1.066667 1.919999 0.213334
421 W66516007 C10AA07 ROSUVASTATINUM ROSUVASTATINA MSN LABORATORIES 40 mg COMPR. FILM. 40mg VIVANTA GENERICS S.R.O., REPUBLICA CEHA CUTIE CU BLIST. AL/AL CU 30 COMPRIMATE FILMATE P6L 30 3.114000 0.000000 1.557000 1.557000 2.802600 0.311400
422 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 0.415317 0.002349 0.207658 0.210008 0.373785 0.043881
423 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 0.398571 0.000000 0.199285 0.199286 0.358713 0.039858
424 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 0.398571 0.000000 0.199285 0.199286 0.358713 0.039858

Pagina 6 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
425 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 0.415317 0.564683 0.207658 0.772342 0.373785 0.606215
426 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 0.297333 0.000000 0.148666 0.148667 0.267599 0.029734
427 W65077001 C10AA07 ROSUVASTATINUM CRESTOR 5 mg COMPR. FILM. 5mg ASTRAZENECA AB SUEDIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. FILM. P6L 28 0.415317 0.920397 0.207658 1.128056 0.373785 0.961929
428 W66513007 C10AA07 ROSUVASTATINUM ROSUVASTATINA MSN LABORATORIES 5 mg COMPR. FILM. 5mg VIVANTA GENERICS S.R.O., REPUBLICA CEHA CUTIE CU BLIST. AL/AL CU 30 COMPRIMATE FILMATE P6L 30 0.415317 1.603016 0.207658 1.810675 0.373785 1.644548
429 W51918006 C10AX09 EZETIMIBUM EZETROL 10 mg COMPR. 10mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. PCTFE/PVC/AL X 14 COMPR. P-RF 28 1.300582 1.026203 0.650291 1.676494 1.170523 1.156262
430 W60949001 C10AX09 EZETIMIBUM COLTOWAN 10 mg COMPR. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC-PE-PVC/AL X 30 COMPR. PRF 30 1.300582 0.002751 0.650291 0.653042 1.170523 0.132810
431 W65800016 C10AX09 EZETIMIBUM EZETIMIB ACCORD 10 mg COMPR. 10mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. AL-PVC/ACLAR X 30 COMPR. PRF 30 1.300582 0.358418 0.650291 1.008709 1.170523 0.488477
432 W66959003 C10AX09 EZETIMIBUM CEXADO 10 mg COMPR. 10mg ZENTIVA K.S. REP. CEHA CUTIE CU BLISTERE DIN PVC/ACLAR/PVC/AL X 30 COMPRIMATE PRF 30 1.299666 0.000000 0.649833 0.649833 1.169699 0.129967
433 W68118006 C10AX09 EZETIMIBUM EZETROL 10 mg COMPR. 10mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. DIN POLICLOROTRIFLUOROETILENA/PVC/AL X 14 COMPR. PRF 28 1.300582 1.026203 0.650291 1.676494 1.170523 1.156262
434 W66959021 C10AX09 EZETIMIBUM CEXADO 10 mg COMPR. 10mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PE/PVDC/AL X 30 COMPR. PRF 30 1.299666 0.000000 0.649833 0.649833 1.169699 0.129967
435 W66280001 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** TORVAZIN PLUS 10 mg/10 mg CAPS. 10mg/10mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU BLIST. OPA-PVC/AL X 30 CAPS. P6L 30 0.621208 2.575458 0.310604 2.886062 0.559087 2.637579
436 W66281001 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** TORVAZIN PLUS 20 mg/10 mg CAPS. 10mg/20mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU BLIST. OPA-PVC/AL X 30 CAPS. P6L 30 1.242416 1.749250 0.621208 2.370458 1.118174 1.873492
437 W66282001 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** TORVAZIN PLUS 40 mg/10 mg CAPS. 10mg/40mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU BLIST. OPA-PVC/AL X 30 CAPS. P6L 30 2.484833 0.941833 1.242416 2.184250 2.236349 1.190317
438 W66253002 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** ZETOVAR 10 mg/10 mg COMPR. 10mg/10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE DE CARTON CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 0.621208 0.888458 0.310604 1.199062 0.559087 0.950579
439 W66254002 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** ZETOVAR 10 mg/20 mg COMPR. 10mg/20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE DE CARTON CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.242416 0.385250 0.621208 1.006458 1.118174 0.509492
440 W66255002 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** ZETOVAR 10 mg/40 mg COMPR. 10mg/40mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE DE CARTON CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.957000 0.000000 0.978500 0.978500 1.761300 0.195700
441 W66256002 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** ZETOVAR 10 mg/80 mg COMPR. 10mg/80mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE DE CARTON CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 2.117333 0.000000 1.058666 1.058667 1.905599 0.211734
442 W68676002 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** COLEATEZ 10 mg/10 mg COMPR. FILM. 10mg/10mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PRF 30 0.621208 1.696458 0.310604 2.007062 0.559087 1.758579
443 W68677002 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** COLEATEZ 10 mg/20 mg COMPR. FILM. 10mg/20mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PRF 30 1.242416 1.323917 0.621208 1.945125 1.118174 1.448159
444 W68678002 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** COLEATEZ 10 mg/40 mg COMPR. FILM. 10mg/40mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PRF 30 2.484833 0.527833 1.242416 1.770250 2.236349 0.776317
445 W68679002 C10BA05 COMBINATII (EZETIMIBUM+ATORVASTATINUM) ** COLEATEZ 10 mg/80 mg COMPR. FILM. 10mg/80mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PRF 30 3.651666 0.000000 1.825833 1.825833 3.286499 0.365167
446 W61288003 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** LIPOCOMB 10 mg/10 mg CAPS. 10mg/10mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 (3X10) CAPS. P6L 30 2.471833 1.396167 1.235916 2.632084 2.224649 1.643351
447 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 2.471833 1.638833 1.235916 2.874750 2.224649 1.886017
448 W61296003 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** LIPOCOMB 40 mg/10 mg CAPS. 40mg/10mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 (3X10) CAPS. P6L 30 2.471833 0.877833 1.235916 2.113750 2.224649 1.125017
449 W67505003 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** ROZETIN 10 mg/10 mg COMPR. FILM. 10 mg/10 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL X 30 COMPRIMATE FILMATE P6L 30 1.767000 0.000000 0.883500 0.883500 1.590300 0.176700
450 W65411002 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** TWICOR 10 mg/10 mg COMPR. FILM. 10mg/10mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 CONPR. FILM. P6L 30 2.471833 0.404167 1.235916 1.640084 2.224649 0.651351
451 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 2.234333 0.000000 1.117166 1.117167 2.010899 0.223434
452 W65827001 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** SUVEZEN 10 mg/10 mg COMPR. FILM. 10mg/10mg SANOFI ROMANIA SRL ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 2.471833 0.852167 1.235916 2.088084 2.224649 1.099351
453 W68673002 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** TWICOR 10 mg/10 mg COMPR. FILM. 10mg/10mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 2.471833 0.404167 1.235916 1.640084 2.224649 0.651351
454 W67506001 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** ROZETIN 20 mg/10 mg COMPR. FILM. 20 mg/10 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL X 30 COMPRIMATE FILMATE P6L 30 1.767000 0.000000 0.883500 0.883500 1.590300 0.176700
455 W65412002 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** TWICOR 20 mg/10 mg COMPR. FILM. 20mg/10mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 CONPR. FILM. P6L 30 2.471833 0.618500 1.235916 1.854417 2.224649 0.865684
456 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 2.462333 0.000000 1.231166 1.231167 2.216099 0.246234
457 W65828001 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** SUVEZEN 20 mg/10 mg COMPR. FILM. 20mg/10mg SANOFI ROMANIA SRL ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 2.471833 1.216167 1.235916 2.452084 2.224649 1.463351
458 W68672002 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** TWICOR 20 mg/10 mg COMPR. FILM. 20mg/10mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 2.471833 0.618500 1.235916 1.854417 2.224649 0.865684
459 W67507001 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** ROZETIN 40 mg/10 mg COMPR. FILM. 40 mg/10 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL X 30 COMPRIMATE FILMATE P6L 30 2.471833 0.003167 1.235916 1.239084 2.224649 0.250351
460 W65538004 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** CO-ROSWERA 40 mg/10 mg COMPR. FILM. 40mg/10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 2.471833 0.676833 1.235916 1.912750 2.224649 0.924017
461 W65829001 C10BA06 COMBINATII (ROSUVASTATINUM+EZETIMIBUM) ** SUVEZEN 40 mg/10 mg COMPR. FILM. 40mg/10mg SANOFI ROMANIA SRL ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 2.471833 1.409833 1.235916 2.645750 2.224649 1.657017
462 W56680001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) DUPLECOR 10 mg/10 mg COMPR. FILM. 10mg/10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. ALBE, OPACE DIN PA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 0.858666 0.000000 0.429333 0.429333 0.772799 0.085867
463 W67263001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) CADUET 10mg/10mg COMPR. FILM. 10mg/10mg UPJOHN EESV OLANDA CUTIE CU 3 BLIST. PA-AL-PVC/PVC-AL X 10 COMPR. FILM. P6L 30 0.921249 0.325417 0.460624 0.786042 0.829124 0.417542
464 W56679001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) DUPLECOR 10 mg/5 mg COMPR. FILM. 10mg/5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. ALBE, OPACE DIN PA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 0.699000 0.000000 0.349500 0.349500 0.629100 0.069900
465 W67262001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) CADUET 10mg/5mg COMPR. FILM. 10mg/5mg UPJOHN EESV OLANDA CUTIE CU 3 BLIST. PA-AL-PVC/PVC-AL X 10 COMPR. FILM. P6L 30 0.921249 0.325417 0.460624 0.786042 0.829124 0.417542
466 W56682001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) DUPLECOR 20 mg/10 mg COMPR. FILM. 20mg/10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. ALBE, OPACE DIN PA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 0.921249 0.402751 0.460624 0.863376 0.829124 0.494876
467 W56681001 C10BX03 COMBINATII (ATORVASTATINUM+AMLODIPINUM) DUPLECOR 20 mg/5 mg COMPR. FILM. 20mg/5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. ALBE, OPACE DIN PA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 0.921249 0.187751 0.460624 0.648376 0.829124 0.279876
468 W65527003 C10BX13 ROSUVASTATINUM+PERINDOPRILUM+INDAPAMIDUM ** ROXIPER 10 mg/4 mg/1,25 mg COMPR. FILM. 10mg/4mg/1,25mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.938029 0.333971 0.469014 0.802986 0.844226 0.427774
469 W65529003 C10BX13 ROSUVASTATINUM+PERINDOPRILUM+INDAPAMIDUM ** ROXIPER 10 mg/8 mg/2,5 mg COMPR. FILM. 10mg/8mg/2,5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.260958 0.372375 0.630479 1.002854 1.134862 0.498471
470 W65528003 C10BX13 ROSUVASTATINUM+PERINDOPRILUM+INDAPAMIDUM ** ROXIPER 20 mg/4 mg/1,25 mg COMPR. FILM. 20mg/4mg/1,25mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.444000 0.000000 0.722000 0.722000 1.299600 0.144400
471 W65530003 C10BX13 ROSUVASTATINUM+PERINDOPRILUM+INDAPAMIDUM ** ROXIPER 20 mg/8 mg/2,5 mg COMPR. FILM. 20mg/8mg/2,5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 1.876059 0.043941 0.938029 0.981971 1.688453 0.231547
472 W05806001 D01BA02 TERBINAFINUM LAMISIL 250 mg COMPR. 250mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 1 BLIST. X 14 COMPR. P-RF 14 1.992142 0.095715 0.996071 1.091786 1.792927 0.294930
473 W53418001 D01BA02 TERBINAFINUM TERBINAFINA SLAVIA 250mg COMPR. 250mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 7 COMPR. P-RF 14 1.992142 0.095715 0.996071 1.091786 1.792927 0.294930
474 W61192002 D01BA02 TERBINAFINUM TERBINAFINA ARENA 250 mg COMPR. 250mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-RF 28 1.896428 0.000000 0.948214 0.948214 1.706785 0.189643
475 W58498001 D05AX52 COMBINATII (CALCIPOTRIOLUM+BETAMETHASONUM) * DAIVOBET 50 micrograme/0,5 mg/g GEL 50micrograme/0,5mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 FLAC. PEID CU DUZA DIN PEJD SI CAPAC DIN PEID X 15 G GEL PRF 1 41.620000 1.030000 20.810000 21.840000 37.458000 5.192000
476 W62934001 D05AX52 COMBINATII (CALCIPOTRIOLUM+BETAMETHASONUM) * ENSTILUM 50 micrograme/0,5 mg/g SPUMA CUT. 50micrograme/0,5mg/g LEO PHARMA A/S DANEMARCA CUT IE CU 1 RECIPIENT PRESURIZAT DIN AL, CU UN ST RAT INT ERIOR DIN LAC POLIAMID-IMIDIC PREVAZUT CU VALVA DOZAT OARE SI SIST EM DE ACT IONARE CARE CONT INE 60 G SPUMA CUT ANAT A PRF 1 166.480000 15.000000 83.240000 98.240000 149.832000 31.648000
477 W56194001 D05AX52 COMBINATII (CALCIPOTRIOLUM+BETAMETHASONUM) * DAIVOBET 50 micrograme/0,5mg/g UNGUENT 50micrograme/0,5mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 TUB DIN AL/EPOXID-FENOL X 15 G UNGUENT P-RF 1 40.590000 0.000000 20.295000 20.295000 36.531000 4.059000
478 W66142001 D06BB04 PODOPHYLLOTOXINUM * CONDYLINE SOL. CUT. 5mg/ml KARO PHARMA AB SUEDIA CUTIE X 1 FLACON DIN STICLA BRUNA X 3,5 ML SOL. CUTANATA + 15 DISPOZITIVE DE APLICARE P-RF 1 45.970000 0.000000 22.985000 22.985000 41.373000 4.597000
479 W07761001 D06BB10 IMIQUIMODUM * ALDARA 5% CREMA 5% MEDA AB SUEDIA CUTIE X 12 PLICURI DIN POLIESTER/AL X 250 MG CREMA P-RF 12 23.308333 0.000000 11.654166 11.654167 20.977499 2.330834
480 W69278001 D06BB10 IMIQUIMODUM * ALDARA 5% CREMA 5% VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE X 12 PLICURI DIN POLIESTER/AL X 250 MG CREMA PRF 12 23.308333 0.000000 11.654166 11.654167 20.977499 2.330834
481 W63158001 D07AB02 HYDROCORTISONUM BUTYRATUM LOCOID 1 mg/g CREMA 1mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 FLACON DIN AL CU 30 G CREMA PRF 1 12.850000 3.220000 6.425000 9.645000 11.565000 4.505000
482 W63159001 D07AB02 HYDROCORTISONUM BUTYRATUM LOCOID LIPOCREAM 1mg/g CREMA 1mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 FLACON DIN AL X 30 G CREMA PRF 1 12.850000 0.000000 6.425000 6.425000 11.565000 1.285000
483 W67758001 D07AB02 HYDROCORTISONUM BUTYRATUM LOCOID 1 mg/g CREMA 1mg/g CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU 1 FLAC. DIN AL X 30 G CREMA PRF 1 12.850000 3.220000 6.425000 9.645000 11.565000 4.505000
484 W67759001 D07AB02 HYDROCORTISONUM BUTYRATUM LOCOID LIPOCREAM 1mg/g CREMA 1mg/g CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU 1 FLAC. DIN AL X 30 G CREMA PRF 1 12.850000 0.000000 6.425000 6.425000 11.565000 1.285000
485 W57223001 D07AC13 MOMETASONUM ELOCOM 1 mg/g CREMA 1mg/g MERCK SHARP & DOHME ROMANIA CUTIE X 1 TUB DIN AL X 15 G P6L 1 5.097500 1.852500 2.548750 4.401250 4.587750 2.362250
486 W59624001 D07AC13 MOMETASONUM MOMETAZONA ATB 1 mg/g CREMA 1mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 15 G CREMA P6L 1 4.480000 0.000000 2.240000 2.240000 4.032000 0.448000
487 W68211001 D07AC13 MOMETASONUM ELOCOM 1 mg/g CREMA 1mg/g ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 TUB DIN AL X 15 G CREMA P6L 1 5.097500 1.852500 2.548750 4.401250 4.587750 2.362250
488 W57222001 D07AC13 MOMETASONUM ELOCOM UNGUENT 1mg/g MERCK SHARP & DOHME ROMANIA CUTIE X 1 TUB DIN AL X 15 G P-RF 1 5.097500 1.852500 2.548750 4.401250 4.587750 2.362250
489 W59623001 D07AC13 MOMETASONUM MOMETAZONA ATB 1 mg/g UNGUENT 1mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 15 G UNG. P6L 1 4.480000 0.000000 2.240000 2.240000 4.032000 0.448000
490 W68212001 D07AC13 MOMETASONUM ELOCOM 1 mg/g UNGUENT 1mg/g ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 TUB DIN AL X 15 G UNG. P6L 1 5.097500 1.852500 2.548750 4.401250 4.587750 2.362250
491 W66063005 D07AC14 METHYLPREDNISOLONUM ACEPONAT ADVANTAN 1mg/g crema CREMA 1mg/g INTENDIS GMBH GERMANIA CUTIE CU 1 TUB DIN AL SIGILAT CU MEMBRANA DIN AL SI INCHIS CU CAPAC CU FILET DIN PEID X 50 G CREMA PRF 1 36.430000 0.000000 18.215000 18.215000 32.787000 3.643000
492 W66594005 D07AC14 METHYLPREDNISOLONUM ACEPONAT ADVANTAN 1mg/g crema CREMA 1mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 TUB DIN AL SIGILAT CU MEMBRANA DIN AL SI INCHIS CU CAPAC CU FILET DIN PEID X 50 G CREMA PRF 1 36.430000 0.000000 18.215000 18.215000 32.787000 3.643000
493 W66062002 D07AC14 METHYLPREDNISOLONUM ACEPONAT ADVANTAN MILK 1mg/g EMULSIE CUT. 1mg/g INTENDIS GMBH GERMANIA CUTIE CU 1 TUB DE AL VERNISAT CU UN STRAT INTERIOR DIN PE X 50 G EMULSIE CUTANATA PRF 1 37.905000 4.425000 18.952500 23.377500 34.114500 8.215500
494 W66593002 D07AC14 METHYLPREDNISOLONUM ACEPONAT ADVANTAN MILK 1mg/g EMULSIE CUT. 1mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 TUB DE AL VERNISAT CU UN STRAT INTERIOR DIN PE X 50 G EMULSIE CUTANATA PRF 1 37.905000 4.425000 18.952500 23.377500 34.114500 8.215500
495 W66064005 D07AC14 METHYLPREDNISOLONUM ACEPONAT ADVANTAN 1 mg/g unguent UNGUENT 1mg/g INTENDIS GMBH GERMANIA CUTIE CU 1 TUB DIN AL CU MEMBRANA DIN AL SI INCHIS CU CAPAC CU FILET DIN PEID X 50 G UNGUENT PRF 1 37.905000 4.665000 18.952500 23.617500 34.114500 8.455500
496 W66595005 D07AC14 METHYLPREDNISOLONUM ACEPONAT ADVANTAN 1 mg/g unguent UNGUENT 1mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 TUB DIN AL CU MEMBRANA DIN AL SI INCHIS CU CAPAC CU FILET DIN PEID X 50 G UNGUENT PRF 1 37.905000 4.665000 18.952500 23.617500 34.114500 8.455500

Pagina 7 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
497 W65212001 D07AC17 FLUTICASONUM PROPIONAT CUTIVATE 0,5mg/g CREMA 0,5mg/g GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 TUB DIN AL X 15 G CREMA PRF 1 13.020000 0.000000 6.510000 6.510000 11.718000 1.302000
498 W65211001 D07AC17 FLUTICASONUM PROPIONAT CUTIVATE 0,05 mg/g UNGUENT 0,05mg/g GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 TUB DIN AL X 15 G UNGUENT PRF 1 16.779999 11.280001 8.389999 19.670001 15.101999 12.958001
499 W63648001 D07AD01 CLOBETASOLUM CLOBETAZOL ATB 0,5 mg/g CREMA 0,5mg/g ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 TUB DIN AL X 25 G CREMA PRF 1 7.315000 2.995000 3.657500 6.652500 6.583500 3.726500
500 W64939001 D07AD01 CLOBETASOLUM DERMOVATE 0,5 mg/g CREMA 0,5mg/g GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 TUB AL X 25 G CREMA PRF 1 7.315000 8.665000 3.657500 12.322500 6.583500 9.396500
501 W64943001 D07AD01 CLOBETASOLUM DERMOVATE 0,5 mg/ml SOL. CUT. 0,5mg/ml GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN PEID, CU PICURATOR DIN PEJD, INCHIS CU CAPAC CU FILET, SECURIZAT, DIN PEID X 25 ML SOL. CUT. PRF 1 7.200000 0.000000 3.600000 3.600000 6.480000 0.720000
502 W52924001 D07AD01 CLOBETASOLUM CLOBETASOL MK 0,5 mg/g UNGUENT 0,5mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB DIN AL X 20 G P-RF 1 5.380000 0.000000 2.690000 2.690000 4.842000 0.538000
503 W61823001 D07AD01 CLOBETASOLUM CLOBETAZOL ATB 0,5 mg/g UNGUENT 0,5mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 25 G UNGUENT PRF 1 7.315000 0.345000 3.657500 4.002500 6.583500 1.076500
504 W64941001 D07AD01 CLOBETASOLUM DERMOVATE 0,5 mg/g UNGUENT 0,5mg/g GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 TUB AL X 25 G UNGUENT PRF 1 7.315000 4.505000 3.657500 8.162500 6.583500 5.236500
505 W60525001 D07CA01 COMBINATII (ACIDUM FUSIDICUM+HYDROCORTISONUM) FUCIDIN H CREMA 20mg/g+10mg/g LEO PHARMA A/S DANEMARCA CUTIE X 1 TUB DIN AL X 15 G CREMA P-RF 1 26.810000 0.000000 13.405000 13.405000 24.129000 2.681000
506 W59984002 D07CC01 COMBINATII (ACIDUM FUSIDICUM+ BETAMETHASONUM) FUCICORT 20 mg/1mg pe gram CREMA 20mg/1mg pe gram LEO PHARMA A/S DANEMARCA CUTIE CU 1 TUB DIN AL X 20 G CREMA PRF 1 34.030000 0.000000 17.015000 17.015000 30.627000 3.403000
507 W66057001 D10AX03 ACIDUM AZELAICUM SKINOREN 200 mg/g CREMA 200mg/g INTENDIS GMBH GERMANIA CUTIE CU 1 TUB DIN AL X 30 G CREMA PRF 1 37.500000 0.000000 18.750000 18.750000 33.750000 3.750000
508 W66597001 D10AX03 ACIDUM AZELAICUM SKINOREN 200 mg/g CREMA 200mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 TUB DIN AL X 30 G CREMA PRF 1 37.500000 0.000000 18.750000 18.750000 33.750000 3.750000
509 W66056003 D10AX03 ACIDUM AZELAICUM SKINOREN 150 mg/g GEL 150mg/g INTENDIS GMBH GERMANIA CUTIE CU 1 TUB AL X 50 G GEL PRF 1 46.875000 11.115000 23.437500 34.552500 42.187500 15.802500
510 W66596003 D10AX03 ACIDUM AZELAICUM SKINOREN 150 mg/g GEL 150mg/g LEO PHARMA A/S DANEMARCA CUTIE CU 1 TUB AL X 50 G GEL PRF 1 46.875000 11.115000 23.437500 34.552500 42.187500 15.802500
511 W03829001 D10BA01 ISOTRETINOINUM ** ROACCUTANE 10 mg CAPS. MOI 10mg ROCHE ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 CAPS. MOI P-RF 30 1.248249 0.781751 0.624124 1.405876 1.123424 0.906576
512 W65390002 D10BA01 ISOTRETINOINUM ** SOTRET 10 mg CAPS. MOI 10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL-PE-HARTIE X 30 CAPS. MOI PRF 30 1.248249 0.067417 0.624124 0.691542 1.123424 0.192242
513 W65391002 D10BA01 ISOTRETINOINUM ** SOTRET 20 mg CAPS. MOI 20mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL-PE-HARTIE X 30 CAPS. MOI PRF 30 2.361666 0.000000 1.180833 1.180833 2.125499 0.236167
514 W01949002 G01AA51 COMBINATII (NEOMICINUM+NEOMIXINUM+NYSTATINUM) POLYGYNAX CAPS. MOI VAG. FARA CONCENTRATIE LAB. INNOTECH INT. FRANTA CUTIE CU 2 BLIST. PVC-PVDC/AL X 6 CAPS. MOI. VAG. P-RF 12 2.596832 0.569001 1.298416 1.867417 2.337148 0.828685
515 W64599001 G01AA51 COMBINATII (NEOMICINUM+POLIMIXINUM+NYSTATINUM) POLYGYNAX VIRGO CAPS. MOI VAG. FARA LABORATOIRE INNOTECH INTERNATIONAL FRANTA CUTIE CU 1 BLIST. PVC/PVDC TRANSPARENT/AL X 6 CAPS. VAG. MOI PRF 6 2.596832 0.404834 1.298416 1.703250 2.337148 0.664518
516 W51716002 G01AA51 COMBINATII (NIFURATELUM+NYSTATINUM) MACMIROR COMPLEX 500 mg/200000 UI CAPS. MOI VAG. 500mg/200000UI POLICHEM SA LUXEMBURG CUTIE X 1 BLIST. AL/PVDC-PVC X 12 CAPS. MOI. VAG. P-RF 12 2.596832 1.257334 1.298416 2.555750 2.337148 1.517018
517 W51914001 G01AA51 COMBINATII (NIFURATELUM+NYSTATINUM) MACMIROR COMPLEX 100 mg+40000 UI/g CREMA VAG. 10g+4000000UI/100g POLICHEM SA LUXEMBURG CUTIE CU 1 TUB DIN AL X 30 G CREMA VAG. SI UN APLICATOR VAGINAL P-RF 1 41.470000 0.000000 20.735000 20.735000 37.323000 4.147000
518 W03126002 G01AF12 FENTICONAZOLUM LOMEXIN 1000 mg CAPS. MOI VAG. 1000mg RECORDATI SPA ITALIA CUTIE X 1 BLIST. PVC/PVDC-AL X 2 CAPS. VAG. MOI P-RF 2 28.510091 7.479909 14.255045 21.734955 25.659081 10.330919
519 W03125002 G01AF12 FENTICONAZOLUM LOMEXIN 600 mg CAPS. MOI VAG. 600mg RECORDATI SPA ITALIA CUTIE X 1 BLIST. PVC/PVDC-AL X 1 CAPS. VAG. MOALE P-RF 1 17.106054 2.173946 8.553027 10.726973 15.395448 3.884552
520 W03123004 G01AF12 FENTICONAZOLUM LOMEXIN 20 mg/g CREMA VAG. 20mg/g RECORDATI SPA ITALIA CUTIE CU 1 TUB AL X 78 G CREMA SI UN APLICATOR DIN PEID P-RF 1 40.530000 0.000000 20.265000 20.265000 36.477000 4.053000
521 W54844001 G01AF15 BUTOCONAZOLUM GYNOFORT 20 mg/g CREMA VAG. 20mg/g ROMANIA GEDEON RICHTER ROMANIA SA CUTIE X 1 APLICATOR PREUMPLUT UNIDOZA DIN PP CU 5 G CREMA VAG. P-RF 1 2.851009 45.748991 1.425504 47.174496 2.565908 46.034092
522 W52516001 G01AF20 COMBINATII (METRONIDAZOLUM+CLOTRIMAZOLUM) MECLODIN COMPR. VAG. 500mg/200mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. TRANSPARENT DIN AL/PVC X 5 COMPR. VAG. P-RF 10 3.195000 0.595000 1.597500 2.192500 2.875500 0.914500
523 W63731001 G01AF20 COMBINATII (METRONIDAZOLUM+CLOTRIMAZOLUM) MECLON 40 mg/g + 200 mg/g CREMA VAG. 200mg/g+40mg/g ALFASIGMA S.P.A. ITALIA CUTIE CU 1 TUB DIN AL X 30 G CREMA VAG. + 6 APLICATOARE DIN PP PRF 1 17.010000 0.000000 8.505000 8.505000 15.309000 1.701000
524 W63733001 G01AF20 COMBINATII (METRONIDAZOLUM+CLOTRIMAZOLUM) MECLON 500 mg/100 mg OVULE 500mg/100mg ALFASIGMA S.P.A. ITALIA CUTIE X 2 FOLII PVC-PE X 5 OVULE PRF 10 3.195000 1.395000 1.597500 2.992500 2.875500 1.714500
525 W61909001 G01AF20 COMBINATII (METRONIDAZOLUM+CLOTRIMAZOLUM) ZIFEX DUO 500 mg/200 mg OVULE 500mg/200mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA DIN PVC-PE X 7 OVULE PRF 7 3.195000 0.106428 1.597500 1.703928 2.875500 0.425928
526 W61909002 G01AF20 COMBINATII (METRONIDAZOLUM+CLOTRIMAZOLUM) ZIFEX DUO 500 mg/200 mg OVULE 500mg/200mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA DIN PVC X 7 OVULE PRF 7 3.195000 0.106428 1.597500 1.703928 2.875500 0.425928
527 W61909003 G01AF20 COMBINATII (METRONIDAZOLUM+CLOTRIMAZOLUM) ZIFEX DUO 500 mg/200 mg OVULE 500mg/200mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 FOLII TERMOSUDATE DIN PVC-PE X 7 OVULE PRF 14 3.195000 0.000000 1.597500 1.597500 2.875500 0.319500
528 W61909004 G01AF20 COMBINATII (METRONIDAZOLUM+CLOTRIMAZOLUM) ZIFEX DUO 500 mg/200 mg OVULE 500mg/200mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 FOLII TERMOSUDATE DIN PVC X 7 OVULE PRF 14 3.195000 0.000000 1.597500 1.597500 2.875500 0.319500
529 W63732001 G01AF20 COMBINATII (METRONIDAZOLUM+CLOTRIMAZOLUM) MECLON SOL. VAGINALA FARA CONCENTRATIE ALFASIGMA S.P.A. ITALIA CUTIE X 5 FLACOANE PVC-PE X 10 ML + 5 FLACOANE PEJD X 130 ML + 5 CANULE P-RF 5 3.194041 2.627959 1.597020 4.224980 2.874636 2.947364
530 W64655001 G02BA03 LEVONORGESTRELUM ** # MIRENA 20 micrograme/24 ore SISTEM CU CEDARE INTRAUTERINA 20micrograme/24ore BAYER AG GERMANIA CUTIE CU UN BLISTER CE CONTINE UN SISTEM PENTRU ADMINISTRARE INTRAUTERINA SI UN INSERTOR PRF 1 512.710000 0.000000 256.355000 256.355000 461.439000 51.271000
531 W00716002 G02CB03 CABERGOLINUM * DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG CUTIE X 1 FLAC. X 2 COMPR.
MAREA BRITANIE P-RF 2 9.260000 2.240000 4.630000 6.870000 8.334000 3.166000
532 W00716001 G02CB03 CABERGOLINUM * DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG CUTIE X 1 FLAC. X 8 COMPR.
MAREA BRITANIE P-RF 8 9.260000 0.000000 4.630000 4.630000 8.334000 0.926000
533 W65037001 G02CB03 CABERGOLINUM * DOSTINEX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 2 COMPR. P6L 2 9.260000 2.240000 4.630000 6.870000 8.334000 3.166000
534 W65037002 G02CB03 CABERGOLINUM * DOSTINEX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 8 COMPR. P6L 8 9.260000 0.000000 4.630000 4.630000 8.334000 0.926000
535 W65037003 G02CB03 CABERGOLINUM * DOSTINEX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. DIN PEID, INCHIS CU CAPAC DIN PP CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 2 COMPR. P6L 2 9.260000 2.240000 4.630000 6.870000 8.334000 3.166000
536 W65037004 G02CB03 CABERGOLINUM * DOSTINEX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. DIN PEID, INCHIS CU CAPAC DIN PP CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 8 COMPR. P6L 8 9.260000 0.000000 4.630000 4.630000 8.334000 0.926000
537 W63310001 G03CA04 ESTRIOLUM * OVESTIN 0,5 mg OVULE 0,5 mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE CU 3 BLIST. PVC/PE X 5 OVULE PRF 15 1.818000 0.000000 0.909000 0.909000 1.636200 0.181800
538 W63437001 G03CX01 TIBOLONUM ** LIVIAL 2,5 mg COMPR. 2,5mg MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 28 COMPR. PRF 28 1.898571 0.000000 0.949285 0.949286 1.708713 0.189858
539 W68214001 G03CX01 TIBOLONUM ** LIVIAL 2,5 mg COMPR. 2,5mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 28 COMPR. PRF 28 1.898571 0.000000 0.949285 0.949286 1.708713 0.189858
540 W12320001 G03DA04 PROGESTERONUM * UTROGESTAN 100 mg CAPS. MOI 100mg LAB. BESINS INTERNATIONAL FRANTA CUTIE X 2 BLIST. X 15 CAPS. MOI P-6L 30 0.734833 0.637833 0.367416 1.005250 0.661349 0.711317
541 W42276001 G03DA04 PROGESTERONUM * UTROGESTAN 200 mg CAPS. MOI 200mg LAB. BESINS INTERNATIONAL FRANTA CUTIE X 2 BLIST. AL/PVC X 7 CAPS. MOI P-6L 14 1.469666 1.898905 0.734833 2.633738 1.322699 2.045872
542 W61648001 G03DA04 PROGESTERONUM * AREFAM 200 mg CAPS. MOI 200mg PHARMASWISS CESKÁ REPUBLIKA S.R.O. REPUBLICA CEHA CUTIE X 2 BLIST. PVC-PVDC/AL X 15 CAPS. MOI PRF 30 1.469666 0.000000 0.734833 0.734833 1.322699 0.146967
543 W67480001 G03DA04 PROGESTERONUM * AREFAM 200 mg CAPS. MOI 200mg EFFIK FRANTA CUTIE CU 2 BLIST. PVC-PVDC/AL X 15 CAPS. MOI PRF 30 1.469666 0.000000 0.734833 0.734833 1.322699 0.146967
544 W60214001 G03DA04 PROGESTERONUM * MASTOPROFEN 10 mg/g GEL 10mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 40 G GEL P6L 1 47.870000 0.000000 23.935000 23.935000 43.083000 4.787000
545 W61888001 G03DA04 PROGESTERONUM * CRINONE 80 mg/g GEL VAGINAL 80mg/g MERCK ROMANIA SRL ROMANIA P6L
CUTIE CU 6 APLICATOARE DOZA UNICA DIN PE, CONTINÂND GEL VAGINAL, PREVAZUTE CU VÂRF CARE SE DESFACE PRIN RASUCIRE, AMBALATE SEPARAT ÎNTR-O FOLIE DIN HÂRTIE/AL/RASINA IONOMERICA 6 13.021666 0.000000 6.510833 6.510833 11.719499 1.302167
546 W67640002 G03DA04 PROGESTERONUM * PROLUTEX 25 mg SOL INJ. 25mg IBSA FARMACEUTICI ITALIA S.R.L. ITALIA CUTIE CU 7 FLAC. DIN STICLA INCOLORA CARE CONTINE SOL. INJ. PRF 7 23.715714 0.000000 11.857857 11.857857 21.344142 2.371572
547 W62383002 G03DB01 DYDROGESTERONUM * DUPHASTON 10 mg COMPR. FILM. 10mg BGP PRODUCTS B.V. OLANDA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. FILM. PRF 20 1.503000 0.000000 0.751500 0.751500 1.352700 0.150300
548 W64558002 G03DB01 DYDROGESTERONUM * DUPHASTON 10 mg COMPR. FILM. 10mg MYLAN HEALTHCARE B.V. OLANDA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. FILM. PRF 20 1.503000 0.000000 0.751500 0.751500 1.352700 0.150300
549 W69083002 G03DB01 DYDROGESTERONUM * DUPHASTON 10 mg COMPR. FILM. 10mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. FILM. PRF 20 1.503000 0.000000 0.751500 0.751500 1.352700 0.150300
550 W63440001 G03DC03 LYNESTRENOLUM * ORGAMETRIL 5 mg COMPR. 5mg MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC X 30 COMPR. P6L 30 0.555333 0.000000 0.277666 0.277667 0.499799 0.055534
551 W68114001 G03DC03 LYNESTRENOLUM * ORGAMETRIL 5 mg COMPR. 5mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC X 30 COMPR. P6L 30 0.555333 0.000000 0.277666 0.277667 0.499799 0.055534
552 W64044001 G03FB01 COMBINATII ** CYCLO-PROGYNOVA DRAJ. FARA CONCENTRATIE BAYER AG GERMANIA CUTIE CU 1 BLIST. PVC/AL TIP CALENDAR X 21 DRAJ. P6L 21 0.427619 0.000000 0.213809 0.213810 0.384857 0.042762
553 W61928001 G03FB08 COMBINATII (ESTRADIOLUM + DIDROGESTERONUM) ** FEMOSTON 2/10, comprimate filmate COMPR. FILM. 2 mg/10 mg BGP PRODUCTS B.V. OLANDA CUTIE X 1 BLIST. TIP CALENDAR X 28 COMPR. FILM. (14 COMPR.FILM. ROSII-CARAMIZII + 14 COMPR.FILM. GALBENE) P6L 28 1.056993 0.209792 0.528496 0.738289 0.951293 0.315492
554 W64557001 G03FB08 COMBINATII (ESTRADIOLUM + DIDROGESTERONUM) ** FEMOSTON 2/10 COMPR. FILM. FARA MYLAN HEALTHCARE B.V. OLANDA CUTIE X 1 BLIST. TIP CALENDAR X 28 COMPR. FILM. (14 COMPR.FILM. ROSII-CARAMIZII + 14 COMPR.FILM. GALBENE) P6L 28 1.056993 0.209792 0.528496 0.738289 0.951293 0.315492
555 W69163001 G03FB08 COMBINATII (ESTRADIOLUM + DIDROGESTERONUM) ** FEMOSTON 2/10 COMPR. FILM. FARA VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE X 1 BLIST. TIP CALENDAR X 28 COMPR. FILM. (14 COMPR.FILM. ROSII-CARAMIZII + 14 COMPR.FILM. GALBENE) P6L 28 1.056993 0.209792 0.528496 0.738289 0.951293 0.315492
556 W65133002 G03GA05 FOLLITROPINUM ALFA **1 # GONAL - f 75 UI (5,5 µg) PULB. + SOLV. PT. SOL. INJ. 75UI MERCK EUROPE B.V. OLANDA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. + 1 SERINGA PREUMPLUTA X 1 ML SOLV. PR/PRF 1 91.456582 20.773418 45.728291 66.501709 82.310923 29.919077
557 W65720001 G03GA05 FOLLITROPINUM ALFA **1 # OVALEAP 300 UI/0,5 ml SOL INJ. 300UI/0,5ml THERAMEX IRELAND LIMITED IRLANDA CUTIE X 1 CARTUS (STICLA TIP I) X 0.5 ML SOLUTIE INJECTABILA + 10 ACE PENTRU INJECTIE PR/PRF 1 365.826330 11.573670 182.913165 194.486835 329.243697 48.156303
558 W65721001 G03GA05 FOLLITROPINUM ALFA **1 # OVALEAP 450 UI/0,75 ml SOL INJ. 450UI/0,75ml THERAMEX IRELAND LIMITED IRLANDA CUTIE X 1 CARTUS (STICLA TIP I) X 0.75 ML SOLUTIE INJECTABILA + 10 ACE PENTRU INJECTIE PR/PRF 1 548.739495 13.510505 274.369747 287.880253 493.865545 68.384455
559 W65722001 G03GA05 FOLLITROPINUM ALFA **1 # OVALEAP 900 UI/ 1,5ml SOL INJ. 900UI/1,5ml THERAMEX IRELAND LIMITED IRLANDA CUTIE X 1 CARTUS (STICLA TIP I) X 1.5ML SOLUTIE INJECTABILA + 20 ACE PENTRU INJECTIE PR/PRF 1 1,003.030000 0.000000 501.515000 501.515000 902.727000 100.303000
560 W63834001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 150 UI/0,25 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 150UI/0,25ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 182.913165 16.816835 91.456582 108.273418 164.621848 35.108152
561 W63837001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 225 UI/0,375 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 225UI/0,375ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 274.369747 23.860253 137.184873 161.045127 246.932772 51.297228
562 W63835001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 300 UI/0,50 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 300UI/0,50ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 365.826330 25.753670 182.913165 208.666835 329.243697 62.336303
563 W63833001 G03GA05 FOLLITROPINUM ALFA **1 # BEMFOLA 75 UI/0,125 ml SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 75UI/0,125ml GEDEON RICHTER PLC UNGARIA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1 AC PT. INJECTARE PR/PRF 1 91.456582 11.343418 45.728291 57.071709 82.310923 20.489077
564 W65135002 G03GA05 FOLLITROPINUM ALFA **1 # GONAL-f 300 UI/0,5 ml ( 22 µg/0,5 ml) SOL. INJ. IN STILOU INJECTOR PREUMPLUT 300UI/0,5ml MERCK EUROPE B.V. OLANDA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 0,5 ML SOL. INJ. + 8 ACE PT. ADM. PR/PRF 1 365.826330 50.533670 182.913165 233.446835 329.243697 87.116303
565 W65134002 G03GA05 FOLLITROPINUM ALFA **1 # GONAL-f 450 UI/0,75 ml (33 µg/0,75 ml) SOL. INJ. IN STILOU INJECTOR PREUMPLUT 450UI/0,75ml MERCK EUROPE B.V. OLANDA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 0,75 ML SOL. INJ. + 12 ACE PT. ADM. SUBCUTANATA PR/PRF 1 548.739495 117.220505 274.369747 391.590253 493.865545 172.094455
566 W65136002 G03GA05 FOLLITROPINUM ALFA **1 # GONAL-f 900 UI/1,5ml (66 µg/1,5 ml) SOL. INJ. IN STILOU INJECTOR PREUMPLUT 900UI/1,5ml MERCK EUROPE B.V. OLANDA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 1,5 ML SOL. INJ. + 20 ACE PT. ADM. SUBCUTANATA PR/PRF 1 1,097.478991 9.911009 548.739495 558.650505 987.731091 119.658909
567 W64697001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 300UI/0,36 ml SOL. INJ. 300UI/0,36ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 CARTUS + 6 ACE PR/PRF 1 365.680000 0.000000 182.840000 182.840000 329.112000 36.568000
568 W67765001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 300UI/0,36 ml SOL. INJ. 300UI/0,36ml N.V . ORGANON OLANDA CUTIE CU 1 CARTUS + 6 ACE PR/PRF 1 365.680000 0.000000 182.840000 182.840000 329.112000 36.568000

Pagina 8 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
569 W64696001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 900UI/1,08 ml SOL. INJ. 900UI/1,08ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 CARTUS SOL. INJ. + 9 ACE PR/PRF 1 961.290000 0.000000 480.645000 480.645000 865.161000 96.129000
570 W67766001 G03GA06 FOLLITROPINUM BETA **1 # PUREGON 900UI/1,08 ml SOL. INJ. 900UI/1,08ml N.V . ORGANON OLANDA CUTIE CU 1 CARTUS SOL. INJ. + 9 ACE PR/PRF 1 961.290000 0.000000 480.645000 480.645000 865.161000 96.129000
571 W65137004 G03GA07 LUTROPINUM ALFA **1 # LUVERIS 75UI PULB+SOLV.PT.SOL.INJ 75UI MERCK EUROPE B.V. OLANDA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ.+ 1 FLAC. A 2 ML SAU 3 ML X 1 ML SOLV. PR/PRF 1 142.160000 0.000000 71.080000 71.080000 127.944000 14.216000
572 W01354001 G03GB02 CLOMIFENUM CLOSTILBEGYT COMPR. 50mg EGIS PHARMACEUTICALS P.L.C. UNGARIA P-RF
CUTIE CU 1 FLAC. DIN STICLA BRUNA INCHIS CU CAPAC DIN PE PREVAZUT CU INEL DE SIGURANTA X 10 COMPR. 10 9.209000 0.000000 4.604500 4.604500 8.288100 0.920900
573 W62041001 G03XC01 RALOXIFENUM RALOXIFEN ARENA 60 mg COMPR. FILM. 60mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P6L 14 1.752738 0.325119 0.876369 1.201488 1.577464 0.500393
574 W62041002 G03XC01 RALOXIFENUM RALOXIFEN ARENA 60 mg COMPR. FILM. 60mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P6L 28 1.752738 0.135119 0.876369 1.011488 1.577464 0.310393
575 W62041003 G03XC01 RALOXIFENUM RALOXIFEN ARENA 60 mg COMPR. FILM. 60mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. P6L 84 1.617619 0.000000 0.808809 0.808810 1.455857 0.161762
576 W62337001 G04BD04 OXYBUTYNINUM DRIPTANE 5 mg COMPR. 5mg MYLAN MEDICAL SAS FRANTA CUTIE X 2 BLIST. AL/PVC X 30 COMPR. PRF 60 0.247221 0.208612 0.123610 0.332223 0.222498 0.233335
577 W68788001 G04BD04 OXYBUTYNINUM DRIPTANE 5 mg COMPR. 5mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. PVC/AL X 30 COMPR. PRF 60 0.247221 0.208612 0.123610 0.332223 0.222498 0.233335
578 W57773001 G04BD07 TOLTERODINUM ** # UROFLOW 1 COMPR. FILM. 1mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0.185416 1.845655 0.092708 1.938363 0.166874 1.864197
579 W57774001 G04BD07 TOLTERODINUM ** # UROFLOW 2 COMPR. FILM. 2mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0.370833 0.346309 0.185416 0.531726 0.333749 0.383393
580 W56677002 G04BD08 SOLIFENACINUM SUCCINATE ** # ZEVESIN 10 mg COMPR. FILM. 10 mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 1.483332 0.100334 0.741666 0.842000 1.334998 0.248668
581 W43104001 G04BD08 SOLIFENACINUM SUCCINATE ** # VESICARE 10 mg COMPR. FILM. 10mg ASTELLAS PHARMA EUROPE BV OLANDA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 1.483332 0.765668 0.741666 1.507334 1.334998 0.914002
582 W63709008 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 10 COMPR. FILM. PRF 10 1.483332 0.041668 0.741666 0.783334 1.334998 0.190002
583 W63709010 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. PRF 30 1.384333 0.000000 0.692166 0.692167 1.245899 0.138434
584 W63709013 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 90 COMPR. FILM. PRF 90 1.228888 0.000000 0.614444 0.614444 1.105999 0.122889
585 W63709001 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 10 1.483332 0.041668 0.741666 0.783334 1.334998 0.190002
586 W63709003 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PRF 30 1.384333 0.000000 0.692166 0.692167 1.245899 0.138434
587 W63709006 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 90 COMPR. FILM. PRF 90 1.228888 0.000000 0.614444 0.614444 1.105999 0.122889
588 W65416003 G04BD08 SOLIFENACINUM SUCCINATE ** # VESISTAD 10 mg COMPR. FILM. 10mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. PRF 30 1.249666 0.000000 0.624833 0.624833 1.124699 0.124967
589 W65416017 G04BD08 SOLIFENACINUM SUCCINATE ** # VESISTAD 10 mg COMPR. FILM. 10mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PRF 30 1.249666 0.000000 0.624833 0.624833 1.124699 0.124967
590 W65416031 G04BD08 SOLIFENACINUM SUCCINATE ** # VESISTAD 10 mg COMPR. FILM. 10mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PRF 30 1.249666 0.000000 0.624833 0.624833 1.124699 0.124967
591 W65952003 G04BD08 SOLIFENACINUM SUCCINATE ** # SOLIFENACIN MSN LABORATORIES 10 mg COMPR. FILM. 10mg VIVANTA GENERICS S.R.O., REPUBLICA CEHA CUTIE CU BLIST. TRANSPARENTE DIN PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 1.483332 2.113001 0.741666 2.854667 1.334998 2.261335
592 W65899002 G04BD08 SOLIFENACINUM SUCCINATE ** # SOLIFENACIN AUROBINDO 10 mg COMPR. FILM. 10mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 1.464666 0.000000 0.732333 0.732333 1.318199 0.146467
593 W56676002 G04BD08 SOLIFENACINUM SUCCINATE ** # ZEVESIN 5 mg COMPR. FILM. 5 mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 0.741666 0.130000 0.370833 0.500833 0.667499 0.204167
594 W43105001 G04BD08 SOLIFENACINUM SUCCINATE ** # VESICARE 5 mg COMPR. FILM. 5mg ASTELLAS PHARMA EUROPE BV OLANDA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.741666 1.507334 0.370833 1.878167 0.667499 1.581501
595 W63708008 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 10 COMPR. FILM. PRF 10 0.741666 1.204334 0.370833 1.575167 0.667499 1.278501
596 W63708010 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. PRF 30 0.741666 1.026334 0.370833 1.397167 0.667499 1.100501
597 W63708013 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 90 COMPR. FILM. PRF 90 0.741666 0.773445 0.370833 1.144278 0.667499 0.847612
598 W63708001 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 10 0.741666 1.204334 0.370833 1.575167 0.667499 1.278501
599 W63708003 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PRF 30 0.741666 1.026334 0.370833 1.397167 0.667499 1.100501
600 W63708006 G04BD08 SOLIFENACINUM SUCCINATE ** # VEZIMED 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 90 COMPR. FILM. PRF 90 0.741666 0.773445 0.370833 1.144278 0.667499 0.847612
601 W65415003 G04BD08 SOLIFENACINUM SUCCINATE ** # VESISTAD 5 mg COMPR. FILM. 5mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. PRF 30 0.741666 0.103667 0.370833 0.474500 0.667499 0.177834
602 W65415017 G04BD08 SOLIFENACINUM SUCCINATE ** # VESISTAD 5 mg COMPR. FILM. 5mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PRF 30 0.741666 0.103667 0.370833 0.474500 0.667499 0.177834
603 W65415031 G04BD08 SOLIFENACINUM SUCCINATE ** # VESISTAD 5 mg COMPR. FILM. 5mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PRF 30 0.741666 0.103667 0.370833 0.474500 0.667499 0.177834
604 W65951003 G04BD08 SOLIFENACINUM SUCCINATE ** # SOLIFENACIN MSN LABORATORIES 5 mg COMPR. FILM. 5mg VIVANTA GENERICS S.R.O., REPUBLICA CEHA CUTIE CU BLIST. TRANSPARENTE DIN PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.741666 2.767000 0.370833 3.137833 0.667499 2.841167
605 W65898002 G04BD08 SOLIFENACINUM SUCCINATE ** # SOLIFENACIN AUROBINDO 5 mg COMPR. FILM. 5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.741666 0.000000 0.370833 0.370833 0.667499 0.074167
606 W62488001 G04BD08 SOLIFENACINUM SUCCINATE ** # VESICARE 1 mg/ml SUSP. ORALA 1mg/ml ASTELLAS PHARMA EUROPE B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA BRUNA DIN PET CARE CONTINE 150 ML SUSP. ORALA P6L 1 22.249980 69.270020 11.124990 80.395010 20.024982 71.495018
607 W43786001 G04BD09 TROSPIUM INKONTAN 15 mg COMPR. FILM. 15mg PHARMAZEUTISCHE FABRIK MONTAVIT GES.M.B.H. AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.278124 0.590542 0.139062 0.729604 0.250311 0.618355
608 W43789001 G04BD09 TROSPIUM INKONTAN 30 mg COMPR. FILM. 30mg PHARMAZEUTISCHE FABRIK MONTAVIT GES.M.B.H. AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.556249 1.021751 0.278124 1.299876 0.500624 1.077376
609 W43038001 G04CA01 ALFUZOSINUM ALFURAN MR 10 mg COMPR. ELIB. PREL. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-ACLAR/AL X 10 COMPR. ELIB. PREL. P-6L 30 0.902000 0.000000 0.451000 0.451000 0.811800 0.090200
610 W62086002 G04CA01 ALFUZOSINUM XATRAL SR 10 mg COMPR. ELIB. PREL. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 3 BLIST. AL/PVCX 10 COMPR. ELIB. PREL. P-6L 30 1.356000 0.000000 0.678000 0.678000 1.220400 0.135600
611 W62086003 G04CA01 ALFUZOSINUM XATRAL SR 10 mg COMPR. ELIB. PREL. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL CU 30 COMPR. ELIB. PREL. P-6L 30 1.356000 0.000000 0.678000 0.678000 1.220400 0.135600
612 W69057005 G04CA02 TAMSULOSINUM TAMSULOSIN MEDREG 0,4 mg CAPS. CU ELIB. PREL. 0,4mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 CAPS. CU ELIB. PREL. P6L 30 1.254666 0.000000 0.627333 0.627333 1.129199 0.125467
613 W56791001 G04CA02 TAMSULOSINUM FOKUSIN 0,4 mg CAPS. ELIB. MODIF. 0,4mg ZENTIVA KS CEHIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 CAPS. ELIB. MODIF. P-6L 30 0.747333 0.000000 0.373666 0.373667 0.672599 0.074734
614 W56791004 G04CA02 TAMSULOSINUM FOKUSIN 0,4 mg CAPS. ELIB. MODIF. 0,4mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 2 BLIST. PVC-PVDC/AL X 15 CAPS. ELIB. MODIF. P6L 30 0.747333 0.000000 0.373666 0.373667 0.672599 0.074734
615 W63984001 G04CA02 TAMSULOSINUM SELDONO 0,4 mg CAPS. ELIB. MODIF. 0,4mg ALKALOID - INT D.O.O. SLOVENIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 10 CAPS. ELIB. MODIF. P6L 30 1.237666 0.000000 0.618833 0.618833 1.113899 0.123767
616 W42715001 G04CA02 TAMSULOSINUM TAMSOL 0,4 mg CAPS. ELIB. PREL. 0,4mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-6L 30 1.027666 0.000000 0.513833 0.513833 0.924899 0.102767
617 W65058001 G04CA02 TAMSULOSINUM CONTIFLO MR 0,4 mg CAPS. ELIB. PREL. 0,4mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 CAPS. ELIB. PREL. P6L 30 1.254666 0.000000 0.627333 0.627333 1.129199 0.125467
618 W43106001 G04CA02 TAMSULOSINUM OMNIC TOCAS 0,4 mg COMPR. CU ELIB. PREL. 0,4mg ASTELLAS PHARMA EUROPE BV OLANDA CUTIE X 3 FOLII AL/AL X 10 COMPR. FILM. ELIB. PREL. P-6L 30 1.102666 0.000000 0.551333 0.551333 0.992399 0.110267
619 W51273002 G04CB01 FINASTERIDUM * PROSCAR 5 mg COMPR. FILM. 5mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. PVC/PE/PVD-AL X 14 COMPR.FILM. P-6L 28 1.322666 0.000191 0.661333 0.661524 1.190399 0.132458
620 W60376002 G04CB01 FINASTERIDUM * FINASTERIDA ARENA 5 mg COMPR. FILM. 5mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-6L 28 1.117142 0.000000 0.558571 0.558571 1.005427 0.111715
621 W51273003 G04CB01 FINASTERIDUM * PROSCAR 5 mg COMPR. FILM. 5mg MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/PE/PVD-AL X 15 COMPR. FILM. P6L 30 1.322666 0.000000 0.661333 0.661333 1.190399 0.132267
622 W68216002 G04CB01 FINASTERIDUM * PROSCAR 5 mg COMPR. FILM. 5mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/PE/PVD-AL X 14 COMPR. FILM. P6L 28 1.322666 0.000191 0.661333 0.661524 1.190399 0.132458
623 W68216003 G04CB01 FINASTERIDUM * PROSCAR 5 mg COMPR. FILM. 5mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/PE/PVD-AL X 15 COMPR. FILM. P6L 30 1.322666 0.000000 0.661333 0.661333 1.190399 0.132267
624 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 1.336000 0.371000 0.668000 1.039000 1.202400 0.504600
625 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 1.336000 1.123333 0.668000 1.791333 1.202400 1.256933
626 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 1.336000 0.000000 0.668000 0.668000 1.202400 0.133600
627 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 1.335666 0.000000 0.667833 0.667833 1.202099 0.133567
628 W67626002 G04CB02 DUTASTERIDUM * AVODART 0,5 mg CAPS. MOI 0,5mg GLAXOSMITHKLINE TRADING SERVICES LIMITED IRLANDA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 CAPS. MOI P6L 30 1.336000 0.371000 0.668000 1.039000 1.202400 0.504600
629 W69036001 H01CC01 GANIRELIXUM ** # GANIRELIX GEDEON RICHTER 0,25 mg/0,5 ml SOL INJ. IN SERINGA PREUMPLUTA 0,25 mg/0,5 ml GEDEON RICHTER PLC. UNGARIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5ML PR/PRF 1 75.380000 0.000000 37.690000 37.690000 67.842000 7.538000
630 W64695001 H01CC01 GANIRELIXUM ** # ORGALUTRAN 0.25mg/0,5ml SOL. INJ. 0,25mg/0,5ml MERCK SHARP & DOHME OLANDA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. + AC ATASAT PR/PRF 1 105.807500 10.142500 52.903750 63.046250 95.226750 20.723250
631 W67695001 H01CC01 GANIRELIXUM ** # ORGALUTRAN 0.25mg/0,5ml SOL. INJ. 0,25mg/0,5ml N.V. ORGANON OLANDA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. + AC ATASAT PR/PRF 1 105.807500 10.142500 52.903750 63.046250 95.226750 20.723250
632 W65132002 H01CC02 CETRORELIXUM ** # CETROTIDE 0,25 mg PULB+SOLV. PT. SOL. INJ. 0,25mg MERCK EUROPE B.V. OLANDA CUT IE CU UN SUPORT CONT INAND: 7 FLAC.PULB. + 7 SERINGI PRE-UMPLUT E X 1 ML SOLV. + 7 ACE PT . INJECT II + 7 ACE PT . INJECT II SUBCUT ANAT E + 14 T AMPOANE IMBIBAT E IN ALCOOL PRF 7 105.807500 15.125357 52.903750 68.029107 95.226750 25.706107
633 W66284001 H02AA02 FLUDROCORTISONUM ASTONIN H 0,1 mg COMPR. 0,1mg MERCK ROMANIA SRL ROMANIA CUTIE CU 1 FLAC. DIN PP DE CULOARE ALBA X 50 COMPR. PRF 50 1.969200 0.000000 0.984600 0.984600 1.772280 0.196920
634 W57960002 H02AB01 BETAMETHASONUM DIPROPHOS SUSP. INJ. 7mg/ml MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE CU 1 FIOLE DIN STICLA TIP I X 1 ML SUSP. INJ. PRF 1 22.680000 0.000000 11.340000 11.340000 20.412000 2.268000
635 W68208002 H02AB01 BETAMETHASONUM DIPROPHOS SUSP. INJ. 7mg/ml ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 FIOLE DIN STICLA TIP I X 1 ML SUSP. INJ. PRF 1 22.680000 0.000000 11.340000 11.340000 20.412000 2.268000
636 W54546003 H03BB02 THIAMAZOLUM THYROZOL 10 mg COMPR. FILM. 10mg MERCK KGAA GERMANIA CUTIE CU BLIST. PVC/AL X 50 COMPR. FILM. P-6L 50 0.333900 0.169100 0.166950 0.336050 0.300510 0.202490
637 W66144003 H03BB02 THIAMAZOLUM THYROZOL 10 mg COMPR. FILM. 10mg MERCK ROMANIA SRL ROMANIA CUTIE CU BLIST. PVC/AL X 50 COMPR. FILM. (2 BLIST. X 25 COMPR. FILM.) P6L 50 0.333900 0.169100 0.166950 0.336050 0.300510 0.202490
638 W54545003 H03BB02 THIAMAZOLUM THYROZOL 20mg COMPR. FILM. 20mg MERCK KGAA GERMANIA CUTIE CU BLIST. PVC/AL X 50 COMPR. FILM. P-6L 50 0.654000 0.000000 0.327000 0.327000 0.588600 0.065400
639 W66145003 H03BB02 THIAMAZOLUM THYROZOL 20mg COMPR. FILM. 20mg MERCK ROMANIA SRL ROMANIA CUTIE CU BLIST. PVC/AL X 50 COMPR. FILM. (2 BLIST. X 25 COMPR. FILM.) P6L 50 0.654000 0.000000 0.327000 0.327000 0.588600 0.065400
640 W54547004 H03BB02 THIAMAZOLUM THYROZOL 5 mg COMPR. FILM. 5mg MERCK KGAA GERMANIA CUTIE CU BLIST. PVC/AL X 100 COMPR. FILM. P6L 100 0.166950 0.234950 0.083475 0.318425 0.150255 0.251645

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

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
641 W66143004 H03BB02 THIAMAZOLUM THYROZOL 5 mg COMPR. FILM. 5mg MERCK ROMANIA SRL ROMANIA CUTIE CU BLIST. PVC/AL X 100 COMPR. FILM. (4 BLIST. X 25 COMPR. FILM.) P6L 100 0.166950 0.234950 0.083475 0.318425 0.150255 0.251645
642 W58901002 J01CR01 AMPICILLINUM + SULBACTAM AMPIPLUS 1000 mg/500 mg PULB. PT. SOL. INJ./PERF. 1000mg/500mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. PRF 50 18.491400 0.000000 9.245700 9.245700 16.642260 1.849140
643 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. PRF 25 18.845550 1.062450 9.422775 10.485225 16.960995 2.947005
644 W05764001 J01CR04 SULTAMICILLINUM UNASYN COMPR. FILM. 375mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC/PVDC X 6 COMPR. P-RF 12 3.451666 0.000000 1.725833 1.725833 3.106499 0.345167
645 W65045001 J01CR04 SULTAMICILLINUM UNASYN 375 mg COMPR. FILM. 375mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL/PVC/PVDC X 6 COMPR. FILM. P6L 12 3.451666 0.000000 1.725833 1.725833 3.106499 0.345167
646 W05765001 J01CR04 SULTAMICILLINUM UNASYN PULB. PT. SUSP. ORALA 250mg/5ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. DIN PEID CU PULBERE PT. 60 ML SUSP. ORALA P-RF 1 27.613328 9.126672 13.806664 22.933336 24.851995 11.888005
647 W65046001 J01CR04 SULTAMICILLINUM UNASYN 250 mg/5 ml PULB. PT. SUSP. ORALA 250mg/5ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. DIN PEID CU PULBERE PT. 60 ML SUSP. ORALA RECONSTITUITA SI 1 LINGURITA DOZATOARE CU 2 CUPE PRF 1 27.613328 9.126672 13.806664 22.933336 24.851995 11.888005
648 W63533001 J01FA02 SPIRAMYCINUM ROVAMYCINE® 1,5 Mil. UI COMPR. FILM. 1,5 Mil.U.I. SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 8 COMPR. FILM. P-RF 16 0.815000 0.000000 0.407500 0.407500 0.733500 0.081500
649 W63534001 J01FA02 SPIRAMYCINUM ROVAMYCINE 3 Mil. UI COMPR. FILM. 3MilU.I. SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 5 COMPR. FILM. PRF 10 1.877140 1.275860 0.938570 2.214430 1.689426 1.463574
650 W63534002 J01FA02 SPIRAMYCINUM ROVAMYCINE 3 Mil. UI COMPR. FILM. 3MilU.I. SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 10 COMPR. FILM. PRF 10 1.877140 1.275860 0.938570 2.214430 1.689426 1.463574
651 W00517001 J01FA10 AZITHROMYCINUM SUMAMED 250 mg CAPS. 250mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 1 BLIST. PVC-PVDC/AL X 6 CAPS. P-RF 6 4.692854 0.913812 2.346427 3.260239 4.223568 1.383098
652 W64359001 J01FA10 AZITHROMYCINUM SUMAMED 250 mg CAPS. 250mg TEVA B.V. OLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 6 CAPS. P-RF 6 4.692854 0.913812 2.346427 3.260239 4.223568 1.383098
653 W00518001 J01FA10 AZITHROMYCINUM SUMAMED 125 mg COMPR. FILM. 125mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 1 BLIST. AL/PVC X 6 COMPR. FILM. P-RF 6 2.346424 2.923576 1.173212 4.096788 2.111781 3.158219
654 W64356001 J01FA10 AZITHROMYCINUM SUMAMED 125 mg COMPR. FILM. 125mg TEVA B.V. OLANDA CUTIE CU 1 BLIST. PVC/AL X 6 COMPR. FILM. PRF 6 2.346424 2.923576 1.173212 4.096788 2.111781 3.158219
655 W42879004 J01FA10 AZITHROMYCINUM AZITROMICINA SANDOZ 250 mg COMPRIMATE FILMATE COMPR. FILM. 250mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. X 6 COMPR. FILM. P-RF 6 3.038333 0.000000 1.519166 1.519167 2.734499 0.303834
656 W42878001 J01FA10 AZITHROMYCINUM AZITROMICINA SANDOZ 500 mg COMPRIMATE FILMATE COMPR. FILM. 500mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. X 3 COMPR. FILM. P-RF 3 3.990000 0.000000 1.995000 1.995000 3.591000 0.399000
657 W43486001 J01FA10 AZITHROMYCINUM AZIBIOT 500 mg COMPR. FILM. 500mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 1 BLIST. AL/PVC X 3 COMPR. FILM. P-RF 3 7.113333 0.000000 3.556666 3.556667 6.401999 0.711334
658 W52840001 J01FA10 AZITHROMYCINUM AZITROMICINA TERAPIA 500 mg COMPR. FILM. 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC-ACLAR/AL X 3 COMPR. FILM. P-RF 3 7.113333 0.000000 3.556666 3.556667 6.401999 0.711334
659 W52840002 J01FA10 AZITHROMYCINUM AZITROMICINA TERAPIA 500 mg COMPR. FILM. 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 3 COMPR. FILM. P-RF 3 7.113333 0.000000 3.556666 3.556667 6.401999 0.711334
660 W57032001 J01FA10 AZITHROMYCINUM AZITROX 500 mg COMPR. FILM. 500mg ZENTIVA K.S. CEHIA CUTIE X 1 BLIST. AL/PVC X 3 COMPR. FILM. P-RF 3 5.910000 0.000000 2.955000 2.955000 5.319000 0.591000
661 W60406001 J01FA10 AZITHROMYCINUM AZITROMICINA ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 3 COMPR. FILM. PRF 3 7.113333 0.000000 3.556666 3.556667 6.401999 0.711334
662 W64357001 J01FA10 AZITHROMYCINUM SUMAMED 500 mg COMPR. FILM. 500mg TEVA B.V. OLANDA CUTIE CU 1 BLIST. PVC/AL X 3 COMPR. FILM. PRF 3 9.385709 1.560957 4.692854 6.253812 8.447138 2.499528
663 W42901001 J01FA10 AZITHROMYCINUM AZITROMICINA SANDOZ 100 mg/5 ml PULB. PT. SUSP. ORALA 100mg/5ml SANDOZ SRL ROMANIA CUTIE CU 1 FLAC. PEID + 1 SERINGA DOZATOARE DIN PE/PP (10 ML) GRADATA IN DIVIZIUNI DE 0,25 ML CONTINAND PULB. PT 20 ML (400 MG) SUSP. ORALA P-RF 1 16.137595 6.232405 8.068797 14.301203 14.523835 7.846165
664 W42877002 J01FA10 AZITHROMYCINUM AZITROMICINA SANDOZ 200 mg/5 ml PULB. PT. SUSP. ORALA 200 mg/5 ml SANDOZ SRL ROMANIA CUTIE CU 1 FLAC. PEID + 1 SERINGA DOZATOARE DIN PE/PP (10 ML) GRADATA IN DIVIZIUNI DE 0,25 ML CONTINAND PULB. PT 20 ML (800 MG) SUSP. ORALA P-RF 1 18.090000 0.000000 9.045000 9.045000 16.281000 1.809000
665 W00520001 J01FA10 AZITHROMYCINUM SUMAMED FORTE PULB. PT. SUSP. ORALA 200mg/5ml PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 1 FLAC. DIN PEID CU PULB. PT. 30 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-RF 1 40.250000 0.000000 20.125000 20.125000 36.225000 4.025000
666 W64358002 J01FA10 AZITHROMYCINUM SUMAMED FORTE 200 mg/5 ml PULB. PT. SUSP. ORALA 200mg/5ml TEVA B.V. OLANDA CUTIE CU 1 FLAC. DIN PEID CONTINAND PULB. PT. 30 ML SUSP. ORALA, O SERINGA PT. ADMINISTRARE ORALA DIN PE/PS SAU PP/PP SI O LINGURITA DOZATOARE PRF 1 40.250000 0.000000 20.125000 20.125000 36.225000 4.025000
667 W00520003 J01FA10 AZITHROMYCINUM SUMAMED FORTE PULB. PT. SUSP. ORALA 200mg/5ml PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 1 FLAC. DIN PEID CU PULB. PT. 37,5 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-RF 1 49.980000 0.000000 24.990000 24.990000 44.982000 4.998000
668 W64358003 J01FA10 AZITHROMYCINUM SUMAMED FORTE 200 mg/5 ml PULB. PT. SUSP. ORALA 200mg/5ml TEVA B.V. OLANDA CUTIE CU 1 FLAC. DIN PEID CONTINAND PULB. PT. 37,5 ML SUSP. ORALA, O SERINGA PT. ADMINISTRARE ORALA DIN PE/PS SAU PP/PP SI O LINGURITA DOZATOARE PRF 1 49.980000 0.000000 24.990000 24.990000 44.982000 4.998000
669 W53281001 J01FA10 AZITHROMYCINUM AZITROX 200 mg/5 ml PULB. PT. SUSP. ORALA 200mg/5ml ZENTIVA S.A. ROMANIA CUTIE CU 1 FLAC. DIN PEÎD PREVAZUT CU SISTEM DE ÎNCHIDERE SECURIZAT PT COPII DIN PP,CONTINÂND PULBERE PENTRU 15 ML SUSPENSIE ORALA RECONSTITUITA,1 LINGURITA DOZATOARE, 1 SERINGA PENTRU ADMINISTRARE ORALA CU CAPACITATEA DE 10 ML, 1 MASURA DOZATOARE P-RF 1 18.430000 0.000000 9.215000 9.215000 16.587000 1.843000
670 W08637001 J01FF01 CLINDAMYCINUM DALACIN C 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 8 CAPS. P-RF 16 0.721757 0.040743 0.360878 0.401622 0.649581 0.112919
671 W65032001 J01FF01 CLINDAMYCINUM DALACIN C 150 mg CAPS. 150mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. PVC/AL X 8 CAPS. PRF 16 0.721757 0.040743 0.360878 0.401622 0.649581 0.112919
672 W08638001 J01FF01 CLINDAMYCINUM DALACIN C 300 mg CAPS. 300mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 8 CAPS. P-RF 16 1.443515 0.078985 0.721757 0.800743 1.299163 0.223337
673 W65033001 J01FF01 CLINDAMYCINUM DALACIN C 300 mg CAPS. 300mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. PVC/AL X 8 CAPS. PRF 16 1.443515 0.078985 0.721757 0.800743 1.299163 0.223337
674 W53634002 J01FF01 CLINDAMYCINUM CLINDAMYCIN - MIP 600 mg COMPR. FILM. 600mg MIP PHARMA GMBH GERMANIA CUTIE X 2 BLIST. PVC/AL X 8 COMPR. FILM. P-RF 16 2.834375 0.000000 1.417187 1.417188 2.550937 0.283438
675 W53634003 J01FF01 CLINDAMYCINUM CLINDAMYCIN - MIP 600 mg COMPR. FILM. 600mg MIP PHARMA GMBH GERMANIA CUTIE X 5 BLIST. PVC/AL X 6 COMPR. FILM. P-RF 30 2.475000 0.000000 1.237500 1.237500 2.227500 0.247500
676 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 3.167142 0.000000 1.583571 1.583571 2.850427 0.316715
677 W60574001 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA ARENA 250 mg COMPR. FILM. 250mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PE/PVDC/AL X 5 COMPR. FILM. PRF 5 3.164000 0.000000 1.582000 1.582000 2.847600 0.316400
678 W60574002 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA ARENA 250 mg COMPR. FILM. 250mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PE/PVDC/AL X 10 COMPR. FILM. PRF 10 3.166000 0.000000 1.583000 1.583000 2.849400 0.316600
679 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 3.194100 0.000185 1.597050 1.597235 2.874690 0.319595
680 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 3.194100 0.001900 1.597050 1.598950 2.874690 0.321310
681 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 5.460000 0.000000 2.730000 2.730000 4.914000 0.546000
682 W52787004 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA ACTAVIS 500 mg COMPR. FILM. 500mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X 1 BLIST. AL/PVC X 7 COMPR. FILM. P-RF 7 4.745714 0.000000 2.372857 2.372857 4.271142 0.474572
683 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 6.160000 0.000000 3.080000 3.080000 5.544000 0.616000
684 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 5.642000 0.000000 2.821000 2.821000 5.077800 0.564200
685 W60575002 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PE/PVDC/AL X 10 COMPR. FILM. PRF 10 5.123000 0.000000 2.561500 2.561500 4.610700 0.512300
686 W61706003 J01MA12 LEVOFLOXACINUM LEVALOX 500 mg COMPR. FILM. 500mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 7 COMPR. FILM. PRF 7 5.460000 0.000000 2.730000 2.730000 4.914000 0.546000
687 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 5.106000 0.000000 2.553000 2.553000 4.595400 0.510600
688 W68675004 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA TEVA 500 mg COMPR. FILM. 500mg TEVA B.V. OLANDA CUTIE CU BLIST. PVC/AL X 7 COMPR. FILM. PRF 7 4.745714 0.000000 2.372857 2.372857 4.271142 0.474572
689 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 6.388200 1.597800 3.194100 4.791900 5.749380 2.236620
690 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 6.388200 2.415800 3.194100 5.609900 5.749380 3.054620
691 W65324001 J01MA14 MOXIFLOXACINUM KIMOKS 400 mg COMPR. FILM. 400mg ALKALOID-INT D.O.O. SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 5 COMPR. FILM. PRF 5 6.388200 1.863800 3.194100 5.057900 5.749380 2.502620
692 W65543001 J01MA14 MOXIFLOXACINUM ERELAN 400 mg COMPR. FILM. 400mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 5 COMPR. FILM. PRF 5 6.388200 2.017800 3.194100 5.211900 5.749380 2.656620
693 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 6.388200 2.415800 3.194100 5.609900 5.749380 3.054620
694 W66200001 J01MA14 MOXIFLOXACINUM MOXIFLOXACINA VIVANTA 400 mg COMPR. FILM. 400mg VIVANTA GENERICS S.R.O., REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 5 COMPR. FILM. PRF 5 6.388200 1.669800 3.194100 4.863900 5.749380 2.308620
695 W03837002 J02AC02 ITRACONAZOLUM ORUNGAL 100 mg CAPS. 100mg BELGIA CUTIE X 3 BLIST. AL/PVC-PE-PVDC X 5 CAPS.
JANSSEN PHARMACEUTICA N.V. P-RF 15 2.744666 0.000000 1.372333 1.372333 2.470199 0.274467
696 W43051001 J02AC02 ITRACONAZOLUM ITRACONAZOL SLAVIA 100 mg CAPS. 100mg SLAVIA PHARM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 5 CAPS. P-RF 15 2.648000 0.000000 1.324000 1.324000 2.383200 0.264800
697 W53958001 J02AC02 ITRACONAZOLUM MICOGAL 100 mg CAPS. 100mg ROMANIA CUTIE CU BLISTERE PVC/AL X 15 CAPSULE
ROMPHARM COMPANY SRL P-RF 15 2.648000 0.000000 1.324000 1.324000 2.383200 0.264800
698 W59235001 J02AC02 ITRACONAZOLUM ITRACONAZOL ARENA 100 mg CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 5 CAPS. P-RF 15 2.648000 0.000000 1.324000 1.324000 2.383200 0.264800
699 W67015006 J02AC02 ITRACONAZOLUM OMICRAL 100 mg CAPS. 100mg BAUSCH HEALTH IRELAND LIMITED IRLANDA CUTIE X 3 BLIST. AL/AL X 5 CAPS. P-RF 15 2.648000 0.000000 1.324000 1.324000 2.383200 0.264800
700 W65100001 J05AB11 VALACYCLOVIRUM # VALTREX 500 mg COMPR. FILM. 500 mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. DIN CLORURA DE POLIVINIL/AL X 10 COMPR.FILM. PRF 10 4.458000 0.000000 2.229000 2.229000 4.012200 0.445800
701 W60087001 J05AB11 VALACYCLOVIRUM # VALACICLOVIR ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PE/PVDC ALB OPAC/AL X 10 COMPR. FILM. PRF 10 3.820000 0.000000 1.910000 1.910000 3.438000 0.382000
702 W12651002 J05AB15 BRIVUDINUM * # BRIVAL 125mg COMPR. 125mg BERLIN CHEMIE AG MENARINI GROUP GERMANIA CUTIE X 1 BLIST. PVC/AL X 7 COMPR. P-RF 7 34.567142 0.000000 17.283571 17.283571 31.110427 3.456715
703 W12490001 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 50 mg DRAJ. 50mg BAXTER ONCOLOGY GMBH GERMANIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 DRAJ. P-RF 50 1.240400 0.000000 0.620200 0.620200 1.116360 0.124040
704 W65081001 L02AE03 GOSERELINUM ** # ZOLADEX 3,6 mg IMPLANT 3,6mg ASTRAZENECA AB SUEDIA CUTIE CU 1 PUNGA X 1 SERINGA PREUMPLUTA MONODOZA A 3,6 MG GASORELINA PR/PRF 1 193.732496 15.577504 96.866248 112.443752 174.359246 34.950754
705 W62378001 L02AE03 GOSERELINUM ** # RESELIGO 3,6 mg IMPLANT IN SERINGA PREUMPLUTA 3,6mg ALVOGEN IPCO S.AR.L. LUXEMBURG CUTIE CU 1 PUNGA CU UN IMPLANT IN SERINGA PREUMPLUTA PR/PRF 1 193.732496 4.247504 96.866248 101.113752 174.359246 23.620754
706 W68571001 L02AE03 GOSERELINUM ** # RESELIGO 3,6 mg IMPLANT IN SERINGA PREUMPLUTA 3,6mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 1 PUNGA CU UN IMPLANT IN SERINGA PREUMPLUTA PR/PRF 1 193.732496 4.247504 96.866248 101.113752 174.359246 23.620754
707 W55726002 L02AE04 TRIPTORELINUM ** # DIPHERELINE PR 11,25 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 11,25mg IPSEN PHARMA FRANTA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. SUSP. INJ. + 1 FIOLA DIN STICLA INCOLORA CU 2 ML SOLV. + 1 BLIST. CU 1 SERINGA DIN PP A 3 ML + 1 BLIST. CU 3 ACE STERILE S/P-RF 1 671.440000 0.000000 335.720000 335.720000 604.296000 67.144000
708 W55727001 L02AE04 TRIPTORELINUM ** # DIPHERELINE 3,75 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 3,75mg IPSEN PHARMA FRANTA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. SUSP. INJ. + 1 FIOLA DIN STICLA INCOLORA X 2 ML SOLV. + 1 BLIST. CU O SERINGA X 3 ML + 1 BLIST. CU 2 ACE STERILE S/P-RF 1 355.680000 0.000000 177.840000 177.840000 320.112000 35.568000
709 W55725001 L02AE04 TRIPTORELINUM ** # DIPHERELINE 0,1 mg PULB+SOLV. PT. SOL. INJ. 0,1mg IPSEN PHARMA FRANTA CUTIE CU 7 FLAC. DIN STICLA TRANSPARENTA, CU CAPACITATEA DE 3 ML CARE CONTIN PULB. PT. SOL. INJ. + 7 FIOLE DIN STICLA TRANSPARENTA, CU CAPACITATEA DE 2 ML CU SOLV. PT. SOL. INJ. S/P-RF 7 7.471779 7.831078 3.735889 11.566968 6.724601 8.578256
710 W58059001 L02AE04 TRIPTORELINUM ** # GONAPEPTYL ZILNIC 0,1 mg/ml SOL. INJ. 0,1mg/ml FERRING GMBH GERMANIA CUTIE X 7 SERINGI PREUMPLUTE DIN STICLA INCOLORA X 1 ML SOL. INJ S/P-RF 7 1.001219 26.678781 0.500609 27.179391 0.901097 26.778903
711 W60846001 L04AX01 AZATHIOPRINUM IMURAN 50 mg COMPR. FILM. 50mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. P-RF 100 0.654500 0.000000 0.327250 0.327250 0.589050 0.065450
712 W62178002 M01AC05 LORNOXICAMUM XEFO RAPID 8 mg COMPR. FILM. 8mg TAKEDA AUSTRIA GMBH AUSTRIA CUTIE CU BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P6L 10 0.887397 0.351603 0.443698 0.795302 0.798657 0.440343

Pagina 10 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
713 W66689001 M01AC05 LORNOXICAMUM LORNOXICAM ROMPHARM 8 mg 8mg ROMPHARM COMPANY S.R.L.
PULB+SOLV. PT. SOL. INJ ROMANIA CUTIE CU 1 SET CARE CONTINE 1 FLAC. DIN STICLA BRUNA CU 8 MG PULB. PT. SOL. INJ. SI O FIOLA CU CAPACITATEA DE 2 ML CU SOLV. PT. SOL. INJ. PRF 1 4.413994 8.236006 2.206997 10.443003 3.972594 8.677406
714 W66689004 M01AC05 LORNOXICAMUM LORNOXICAM ROMPHARM 8 mg PULB+SOLV. PT. SOL. INJ 8mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 10 SETURI CARE CONTIN CÂTE 1 FLAC. DIN STICLA BRUNA CU 8 MG PULB. PT. SOL. INJ. SI O FIOLA CU CAPACITATEA DE 2 ML CU SOLV. PT. SOL. INJ. PRF 10 4.413994 5.767006 2.206997 7.974003 3.972594 6.208406
715 W67023001 M01AE17 DEXKETOPROFENUM TADOR 25 mg COMPR. FILM. 25mg MENARINI INTERNATIONAL OPERATIONS LUXEMBOURG S.A. LUXEMBURG CUTIE X 1 BLIST. PVC/AL X 10 COMPR. FILM. P-6L 10 0.604799 0.477201 0.302399 0.779601 0.544319 0.537681
716 W64497002 M01AE17 DEXKETOPROFENUM XEDOFEN 50 mg/2 ml SOL INJ./PERF. 50mg/2ml AS KALCEKS LETONIA CUTIE CU 5 FIOLE DIN STICLA BRUNA A CATE 2 ML SOL. INJ./PERF. PRF 5 3.196000 0.000000 1.598000 1.598000 2.876400 0.319600
717 W61199001 M01AE17 DEXKETOPROFENUM DEXKETOPROFEN ROMPHARM 50 mg/2 ml 50mg/2ml ROMPHARM COMPANY S.R.L.
SOL. INJ./CONC. PT. SOL. PERF. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA (UN SUPORT A 5 FIOLE), PREVAZUTE CU INEL DE RUPERE, CONTINAND 2 ML DE SOL. INJ./CONC. PT. SOL. PERF. PRF 5 3.366000 0.000000 1.683000 1.683000 3.029400 0.336600
718 W61199002 M01AE17 DEXKETOPROFENUM DEXKETOPROFEN ROMPHARM 50 mg/2 ml 50mg/2ml ROMPHARM COMPANY S.R.L.
SOL. INJ./CONC. PT. SOL. PERF. ROMANIA CUTIE CU 10 FIOLE DIN STICLA BRUNA (DOUA SUPORTURI A CATE 5 FIOLE), PREVAZUTE CU INEL DE RUPERE, CONTINAND 2 ML DE SOL. INJ./CONC. PT. SOL. PERF. PRF 10 3.364000 0.000000 1.682000 1.682000 3.027600 0.336400
719 W43063001 M01AE17 DEXKETOPROFENUM TADOR INJECT 50 mg/2ml SOL. INJ./PERF. 50mg/2ml MENARINI INTERNATIONAL OPERATIONS LUXEMBOURG S.A. LUXEMBOURG CUTIE CU 5 FIOLE DIN STICLA BRUNA, TIP I X 2 ML SOL. INJ./SOL. PERF. P-RF 5 4.002000 0.732000 2.001000 2.733000 3.601800 1.132200
720 W68965003 M01AE52 COMBINATII (NAPROXEN + ESOMEPRAZOL) ** VIMOVO 500 mg/20 mg COMPR. CU ELIB. MODIF. 500mg/20mg GRÜNENTHAL GMBH GERMANIA CUTIE CU 1 FLAC. PEID CU CAPAC PP PREVAZUT CU SIST. SECURIZAT PT. COPII SI DESICANT SILICAGEL X 30 COMPR. ELIB. MODIF. PRF 30 1.850000 0.308666 0.925000 1.233666 1.665000 0.493666
721 W68965004 M01AE52 COMBINATII (NAPROXEN + ESOMEPRAZOL) ** VIMOVO 500 mg/20 mg COMPR. CU ELIB. MODIF. 500mg/20mg GRÜNENTHAL GMBH GERMANIA CUTIE CU 1 FLAC. PEID CU CAPAC PP PREVAZUT CU SIST. SECURIZAT PT. COPII SI DESICANT SILICAGEL X 60 COMPR. ELIB. MODIF. PRF 60 1.850000 0.000000 0.925000 0.925000 1.665000 0.185000
722 W57029003 M01AE52 COMBINATII (NAPROXEN + ESOMEPRAZOL) ** VIMOVO 500 mg/20 mg COMPR. ELIB. MODIF. 500 mg/20 mg ASTRA ZENECA AB SUEDIA CUTIE CU 1 FLAC. PEID CU CAPAC PP PREVAZUT CU SIST. SECURIZAT PT. COPII SI DESICANT SILICAGEL X 30 COMPR. ELIB. MODIF. PRF 30 1.850000 0.308666 0.925000 1.233666 1.665000 0.493666
723 W57029004 M01AE52 COMBINATII (NAPROXEN + ESOMEPRAZOL) ** VIMOVO 500 mg/20 mg COMPR. ELIB. MODIF. 500 mg/20 mg ASTRA ZENECA AB SUEDIA CUTIE CU 1 FLAC. PEID CU CAPAC PP PREVAZUT CU SIST. SECURIZAT PT. COPII SI DESICANT SILICAGEL X 60 COMPR. ELIB. MODIF. PRF 60 1.850000 0.000000 0.925000 0.925000 1.665000 0.185000
724 W60458003 M01AH01 CELECOXIBUM ALGOXIB 100 mg CAPS. 100mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. PRF 30 0.724702 0.019964 0.362351 0.382315 0.652231 0.092435
725 W60519003 M01AH01 CELECOXIBUM ACLEXA 100 mg CAPS. 100mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC/AL X 30 CAPS. PRF 30 0.724702 0.019964 0.362351 0.382315 0.652231 0.092435
726 W60596003 M01AH01 CELECOXIBUM CELECOXIB ACTAVIS 100 mg CAPS. 100mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC/AL X 30 CAPS. PRF 30 0.724702 0.019964 0.362351 0.382315 0.652231 0.092435
727 W61088003 M01AH01 CELECOXIBUM CELECOXIB TERAPIA 100 mg CAPS. 100mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 30 CAPS. PRF 30 0.724702 0.019964 0.362351 0.382315 0.652231 0.092435
728 W67264006 M01AH01 CELECOXIBUM CELEBREX 100 mg CAPS. 100mg UPJOHN EESV OLANDA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. PRF 30 0.724702 0.484631 0.362351 0.846982 0.652231 0.557102
729 W68397003 M01AH01 CELECOXIBUM CELECOXIB TEVA 100 mg CAPS. 100mg TEVA B.V. OLANDA CUTIE CU BLIST. PVC/AL X 30 CAPS. PRF 30 0.724702 0.019964 0.362351 0.382315 0.652231 0.092435
730 W60459003 M01AH01 CELECOXIBUM ALGOXIB 200 mg CAPS. 200mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. PRF 30 1.411000 0.000000 0.705500 0.705500 1.269900 0.141100
731 W60520003 M01AH01 CELECOXIBUM ACLEXA 200 mg CAPS. 200mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC/AL X 30 CAPS. PRF 30 1.341666 0.000000 0.670833 0.670833 1.207499 0.134167
732 W60597003 M01AH01 CELECOXIBUM CELECOXIB ACTAVIS 200 mg CAPS. 200mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC/AL X 30 CAPS. PRF 30 1.412000 0.000000 0.706000 0.706000 1.270800 0.141200
733 W61089003 M01AH01 CELECOXIBUM CELECOXIB TERAPIA 200 mg CAPS. 200mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 30 CAPS. PRF 30 1.411000 0.000000 0.705500 0.705500 1.269900 0.141100
734 W67265004 M01AH01 CELECOXIBUM CELEBREX 200 mg CAPS. 200mg UPJOHN EESV OLANDA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 1.449404 0.068596 0.724702 0.793298 1.304463 0.213537
735 W67265006 M01AH01 CELECOXIBUM CELEBREX 200 mg CAPS. 200mg UPJOHN EESV OLANDA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. PRF 30 1.377666 0.000000 0.688833 0.688833 1.239899 0.137767
736 W68399003 M01AH01 CELECOXIBUM CELECOXIB TEVA 200 mg CAPS. 200mg TEVA B.V. OLANDA CUTIE CU BLIST. PVC/AL X 30 CAPS. PRF 30 1.412000 0.000000 0.706000 0.706000 1.270800 0.141200
737 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 2.898809 0.878333 1.449404 2.327738 2.608928 1.168214
738 W62615001 M01AH05 ETORICOXIBUM IMESOL 120 mg COMPR. FILM. 120mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 7 COMPR. FILM. PRF 7 2.898809 0.878333 1.449404 2.327738 2.608928 1.168214
739 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 2.898809 0.878333 1.449404 2.327738 2.608928 1.168214
740 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 2.352857 0.000000 1.176428 1.176429 2.117571 0.235286
741 W62798005 M01AH05 ETORICOXIBUM DOLOXIB 120 mg COMPR. FILM. 120mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 2.093571 0.000000 1.046785 1.046786 1.884213 0.209358
742 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 2.790714 0.000000 1.395357 1.395357 2.511642 0.279072
743 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 2.882857 0.000000 1.441428 1.441429 2.594571 0.288286
744 W63679002 M01AH05 ETORICOXIBUM ETORICOXIB AUROBINDO 120 mg COMPR. FILM. 120mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 2.132857 0.000000 1.066428 1.066429 1.919571 0.213286
745 W63797003 M01AH05 ETORICOXIBUM GEROCOXAN 120 mg COMPR. FILM. 120mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. OPA-AL-PVC/AL X 7 COMPR. FILM. PRF 7 2.771428 0.000000 1.385714 1.385714 2.494285 0.277143
746 W68250001 M01AH05 ETORICOXIBUM ARCOXIA 120 mg COMPR. FILM. 120mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 7 2.898809 0.878333 1.449404 2.327738 2.608928 1.168214
747 W68250003 M01AH05 ETORICOXIBUM ARCOXIA 120 mg COMPR. FILM. 120mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 14 COMPR. FILM. P-RF 14 2.898809 0.978333 1.449404 2.427738 2.608928 1.268214
748 W62612001 M01AH05 ETORICOXIBUM IMESOL 30 mg COMPR. FILM. 30mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR. FILM. PRF 28 0.724702 0.342440 0.362351 0.704791 0.652231 0.414911
749 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 0.724702 0.342440 0.362351 0.704791 0.652231 0.414911
750 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 0.724702 0.342440 0.362351 0.704791 0.652231 0.414911
751 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 0.724702 0.342440 0.362351 0.704791 0.652231 0.414911
752 W68247003 M01AH05 ETORICOXIBUM ARCOXIA 30 mg COMPR. FILM. 30mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. DIN PA-AL-PVC/AL X 14 COMPRIMATE FILMATE PRF 28 0.724702 0.342440 0.362351 0.704791 0.652231 0.414911
753 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 1.449404 0.684881 0.724702 1.409583 1.304463 0.829822
754 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 1.449404 0.684881 0.724702 1.409583 1.304463 0.829822
755 W62613001 M01AH05 ETORICOXIBUM IMESOL 60 mg COMPR. FILM. 60mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 14 COMPR. FILM. PRF 14 1.449404 1.198453 0.724702 1.923155 1.304463 1.343394
756 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 1.449404 1.198453 0.724702 1.923155 1.304463 1.343394
757 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 1.449404 0.662024 0.724702 1.386726 1.304463 0.806965
758 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 1.449404 0.376667 0.724702 1.101369 1.304463 0.521608
759 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 1.449404 0.684881 0.724702 1.409583 1.304463 0.829822
760 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 1.449404 0.489167 0.724702 1.213869 1.304463 0.634108
761 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 1.449404 0.561310 0.724702 1.286012 1.304463 0.706251
762 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 1.449404 0.314881 0.724702 1.039583 1.304463 0.459822
763 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 1.449404 0.557738 0.724702 1.282440 1.304463 0.702679
764 W68248002 M01AH05 ETORICOXIBUM ARCOXIA 60 mg COMPR. FILM. 60mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 14 1.449404 0.684881 0.724702 1.409583 1.304463 0.829822
765 W68248003 M01AH05 ETORICOXIBUM ARCOXIA 60 mg COMPR. FILM. 60mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 14 COMPR. FILM. P-RF 14 1.449404 0.684881 0.724702 1.409583 1.304463 0.829822
766 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 2.174107 0.738750 1.087053 1.825804 1.956696 0.956161
767 W62614001 M01AH05 ETORICOXIBUM IMESOL 90 mg COMPR. FILM. 90mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 14 COMPR. FILM. PRF 14 2.174107 0.738750 1.087053 1.825804 1.956696 0.956161
768 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 2.174107 0.738750 1.087053 1.825804 1.956696 0.956161
769 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 2.174107 0.283035 1.087053 1.370089 1.956696 0.500446
770 W62797004 M01AH05 ETORICOXIBUM DOLOXIB 90 mg COMPR. FILM. 90mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. PRF 28 2.174107 0.057321 1.087053 1.144375 1.956696 0.274732
771 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 2.174107 0.268035 1.087053 1.355089 1.956696 0.485446
772 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 2.174107 0.118035 1.087053 1.205089 1.956696 0.335446
773 W63427004 M01AH05 ETORICOXIBUM KOSTAROX 90 mg COMPR. FILM. 90mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. P6L 14 2.080000 0.000000 1.040000 1.040000 1.872000 0.208000
774 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 1.634285 0.000000 0.817142 0.817143 1.470856 0.163429
775 W63796005 M01AH05 ETORICOXIBUM GEROCOXAN 90 mg COMPR. FILM. 90mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. PRF 14 2.174107 0.035893 1.087053 1.122947 1.956696 0.253304
776 W68249002 M01AH05 ETORICOXIBUM ARCOXIA 90 mg COMPR. FILM. 90mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 14 2.174107 0.738750 1.087053 1.825804 1.956696 0.956161
777 W68249003 M01AH05 ETORICOXIBUM ARCOXIA 90 mg COMPR. FILM. 90mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 14 COMPR. FILM. P-RF 14 2.174107 0.738750 1.087053 1.825804 1.956696 0.956161
778 W10193001 M03BX01 BACLOFENUM LIORESAL 10 mg COMPR. 10mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 0.296370 0.134430 0.148185 0.282615 0.266733 0.164067
779 W10194001 M03BX01 BACLOFENUM LIORESAL 25 mg COMPR. 25mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 0.740925 0.064075 0.370462 0.434538 0.666832 0.138168
780 W69459001 M03BX01 BACLOFENUM BACLOFEN SINTETICA 0,05 mg/ml SOL INJ. 0,05mg/ml DIRECT PHARMA LOGISTICS S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA A CATE 1 ML SOL. INJ. P6L 5 2.556047 48.473953 1.278023 49.751977 2.300442 48.729558
781 W69460001 M03BX01 BACLOFENUM BACLOFEN SINTETICA 0,5 mg/ml SOL INJ. 0,5mg/ml DIRECT PHARMA LOGISTICS S.R.L. ROMANIA CUTIE CU 1 FIOLA DIN STICLA X 20 ML SOL. INJ. P6L 1 511.210000 50.140000 255.605000 305.745000 460.089000 101.261000
782 W69461001 M03BX01 BACLOFENUM BACLOFEN SINTETICA 2 mg/ml SOL INJ. 2mg/ml DIRECT PHARMA LOGISTICS S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA A CATE 5 ML SOL. INJ. P6L 5 461.070000 0.000000 230.535000 230.535000 414.963000 46.107000
783 W54297001 M05BA04 ACIDUM ALENDRONICUM TEVANAT 70 mg COMPR. 70 mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 1 BLIST. PVC-AL-OPA/AL X 4 COMPR. P-6L 4 3.752500 0.000000 1.876250 1.876250 3.377250 0.375250
784 W60296004 M05BA04 ACIDUM ALENDRONICUM FOSAMAX 70 mg COMPR. 70mg MERCK SHARP & DOHME ROMANIA CUTIE CU 1 BLIST. AL/AL X 2 COMPR. P6L 2 7.339500 3.100500 3.669750 6.770250 6.605550 3.834450

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

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
785 W60296002 M05BA04 ACIDUM ALENDRONICUM FOSAMAX 70 mg COMPR. 70mg MERCK SHARP & DOHME ROMANIA CUTIE CU 1 BLIST. AL/AL X 4 COMPR. P6L 4 7.339500 2.765500 3.669750 6.435250 6.605550 3.499450
786 W68213004 M05BA04 ACIDUM ALENDRONICUM FOSAMAX 70 mg COMPR. 70mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 BLIST. AL/AL X 2 COMPR. P6L 2 7.339500 3.100500 3.669750 6.770250 6.605550 3.834450
787 W68213002 M05BA04 ACIDUM ALENDRONICUM FOSAMAX 70 mg COMPR. 70mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 BLIST. AL/AL X 4 COMPR. P6L 4 7.339500 2.765500 3.669750 6.435250 6.605550 3.499450
788 W63265001 M05BA04 ACIDUM ALENDRONICUM BINOSTO 70 mg COMPR. EFF. 70 mg GALENICA SA GRECIA CUTIE CU 2 BENZI DIN HARTIE/PE/AL/ZN-IONOMER X 2 COMPR. EFF. P6L 4 7.339500 9.483000 3.669750 13.152750 6.605550 10.216950
789 W52948001 M05BA04 ACIDUM ALENDRONICUM ALENDRONAT SANDOZ 70 mg COMPR. FILM. 70mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. OPA-AL-PVC/AL X 2 COMPR. FILM P-6L 2 3.615000 0.000000 1.807500 1.807500 3.253500 0.361500
790 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 7.339500 1.752166 3.669750 5.421916 6.605550 2.486116
791 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 7.339500 3.940500 3.669750 7.610250 6.605550 4.674450
792 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 7.339500 2.905500 3.669750 6.575250 6.605550 3.639450
793 W60074002 M05BA07 ACIDUM RISEDRONICUM RISEDRONAT SODIC ZENTIVA 35mg COMPR. FILM. 35mg ZENTIVA KS REPUBLICA CEHA CUTIE X 1 BLISTER OPA-AL-PVC/AL X 4 COMPRIMATE FILMATE P-6L 4 4.637500 0.000000 2.318750 2.318750 4.173750 0.463750
794 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 7.339500 5.540500 3.669750 9.210250 6.605550 6.274450
795 W66431003 M05BA07 ACIDUM RISEDRONICUM RISEDRONAT AUROBINDO 35 mg COMPR. FILM. 35mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/PE/PVDC-AL X 4 COMPR. FILM. P6L 4 7.339500 0.743000 3.669750 4.412750 6.605550 1.476950
796 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 7.339500 5.540500 3.669750 9.210250 6.605550 6.274450
797 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 15.727500 10.987500 7.863750 18.851250 14.154750 12.560250
798 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 15.727500 10.987500 7.863750 18.851250 14.154750 12.560250
799 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 15.727500 9.242500 7.863750 17.106250 14.154750 10.815250
800 W66935003 M05BA07 ACIDUM RISEDRONICUM ACTONEL 35 mg COMPR. GASTROREZ. 35mg THERAMEX IRELAND LIMITED IRLANDA CUTIE CU BLIST. PVC/AL X 4 COMPR. GASTROREZ. P6L 4 7.339500 13.740500 3.669750 17.410250 6.605550 14.474450
801 W63922002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) ACID ALENDRONIC/COLECALCIFEROL ZENTIVA 70 mg/2800 UI COMPR. 70mg/2800UI ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PA-AL-PVC/AL X 4 COMPR. P6L 4 7.339500 6.093000 3.669750 9.762750 6.605550 6.826950
802 W64728002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) FOSAVANCE 70mg/2800UI COMPR. 70mg/2800UI MERCK SHARP & DOHME OLANDA CUTIE X 4 COMPR. (1 BLISTER DIN AL/AL X 4 COMPR.) P6L 4 7.339500 3.128000 3.669750 6.797750 6.605550 3.861950
803 W67694002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) FOSAVANCE 70mg/2800UI COMPR. 70mg/2800UI N.V. ORGANON OLANDA CUTIE X 4 COMPR. (1 BLISTER DIN AL/AL X 4 COMPR.) P6L 4 7.339500 3.128000 3.669750 6.797750 6.605550 3.861950
804 W62143003 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) DA-BONE 70 mg/5600 UI COMPR. 70mg/5600UI TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4 COMPR., AMBALAJ TIP CALENDAR P6L 4 7.339500 0.888000 3.669750 4.557750 6.605550 1.621950
805 W62143001 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) DA-BONE 70 mg/5600 UI COMPR. 70mg/5600UI TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4 COMPR. P6L 4 7.339500 0.888000 3.669750 4.557750 6.605550 1.621950
806 W62143002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) DA-BONE 70 mg/5600 UI COMPR. 70mg/5600UI TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4X1 COMPR. P6L 4 7.339500 0.888000 3.669750 4.557750 6.605550 1.621950
807 W63923002 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) ACID ALENDRONIC/COLECALCIFEROL ZENTIVA 70 mg/5600 UI COMPR. 70mg/5600UI ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PA-AL-PVC/AL X 4 COMPR. P6L 4 7.339500 6.405500 3.669750 10.075250 6.605550 7.139450
808 W64729001 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) FOSAVANCE 70mg/5600UI COMPR. 70mg/5600UI MERCK SHARP & DOHME OLANDA CUTIE X 2 COMPR. (1 BLISTER DIN AL/AL X 2 COMPR.) P6L 2 7.339500 3.585500 3.669750 7.255250 6.605550 4.319450
809 W67697001 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) FOSAVANCE 70mg/5600UI COMPR. 70mg/5600UI N.V. ORGANON OLANDA CUTIE X 2 COMPR. (1 BLISTER DIN AL/AL X 2 COMPR.) P6L 2 7.339500 3.585500 3.669750 7.255250 6.605550 4.319450
810 W55687009 N02AA05 OXYCODONUM * # OXIDOLOR 20 mg COMPR. ELIB. PREL. 20mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. P-TS 60 1.051435 0.290565 0.525717 0.816283 0.946291 0.395709
811 W55688009 N02AA05 OXYCODONUM * # OXIDOLOR 40 mg COMPR. ELIB. PREL. 40mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. P-TS 60 2.099333 0.000000 1.049666 1.049667 1.889399 0.209934
812 W59147002 N02AA05 OXYCODONUM * # OXICODONA SANDOZ 40 mg COMPR. ELIB. PREL. 40mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 20 COMPR. ELIB. PREL. PS 20 2.102874 0.010626 1.051437 1.062063 1.892586 0.220914
813 W59148002 N02AA05 OXYCODONUM * # OXICODONA SANDOZ 60 mg COMPR. ELIB. PREL. 60mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 20 COMPR. ELIB. PREL. PS 20 3.154314 2.993186 1.577157 4.570343 2.838882 3.308618
814 W55689009 N02AA05 OXYCODONUM * # OXIDOLOR 80 mg COMPR. ELIB. PREL. 80mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. P-TS 60 3.633333 0.000000 1.816666 1.816667 3.269999 0.363334
815 W59149002 N02AA05 OXYCODONUM * # OXICODONA SANDOZ 80 mg COMPR. ELIB. PREL. 80mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 20 COMPR. ELIB. PREL. PS 20 4.205749 0.081751 2.102874 2.184626 3.785174 0.502326
816 W44121001 N02AA08 DIHYDROCODEINUM * DHC CONTINUS 120 mg COMPR. ELIB. PREL. 120mg MUNDIPHARMA GES.M.B.H AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 COMPR. ELIB. PREL. PS 56 1.736368 0.463096 0.868184 1.331280 1.562731 0.636733
817 W44119001 N02AA08 DIHYDROCODEINUM * DHC CONTINUS 60 mg COMPR. ELIB. PREL. 60mg MUNDIPHARMA GESELLSCHAFT M.B.H. AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 COMPR. ELIB. PREL. PS 56 0.868184 0.014494 0.434092 0.448586 0.781365 0.101313
818 W44120001 N02AA08 DIHYDROCODEINUM * DHC CONTINUS 90 mg COMPR. ELIB. PREL. 90mg MUNDIPHARMA GESELLSCHAFT M.B.H. AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 COMPR. ELIB. PREL. PS 56 1.280535 0.000000 0.640267 0.640268 1.152481 0.128054
819 W62536002 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) DORETA EP 75 mg/650 mg COMPR. ELIB. PREL. 75mg/650mg KRKA, D.D., NOVO MESTO
SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 20 COMPR. ELIB. PREL. PRF 20 0.622249 0.683751 0.311124 0.994876 0.560024 0.745976
820 W62536009 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) DORETA EP 75 mg/650 mg COMPR. ELIB. PREL. 75mg/650mg KRKA, D.D., NOVO MESTO
SLOVENIA CUTIE CU BLIST. ALBE PVC-PVDC-HARTIE/AL X 20 COMPR. ELIB. PREL. PRF 20 0.622249 0.558751 0.311124 0.869876 0.560024 0.620976
821 W62536010 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) DORETA EP 75 mg/650 mg COMPR. ELIB. PREL. 75mg/650mg KRKA, D.D., NOVO MESTO
SLOVENIA CUTIE CU BLIST. ALBE PVC-PVDC-HARTIE/AL X 30 COMPR. ELIB. PREL. PRF 30 0.622249 0.641084 0.311124 0.952209 0.560024 0.703309
822 W54375003 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) DORETA 37,5mg/325mg COMPR. FILM. 37,5mg/325mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 20 COMPR. FILM. P-RF 20 0.311000 0.000000 0.155500 0.155500 0.279900 0.031100
823 W54375004 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) DORETA 37,5mg/325mg COMPR. FILM. 37,5mg/325mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P-RF 30 0.310666 0.000000 0.155333 0.155333 0.279599 0.031067
824 W67798003 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) TRAMADOL/PARACETAMOL MEDREG 37,5 mg/325 mg COMPR. FILM. 37,5mg/325mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-AL X 30 COMPR. FILM. PRF 30 0.311124 0.126542 0.155562 0.282104 0.280011 0.157655
825 W61518001 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR 37,5 mg/325 mg COMPR. FILM. 37,5mg+325mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 1 BLIST.DIN HÂRTIE-PET-AL/PVC OPAC X 10 COMPR. FILM. P-RF 10 0.311124 0.608876 0.155562 0.764438 0.280011 0.639989
826 W61518002 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR 37,5 mg/325 mg COMPR. FILM. 37,5mg+325mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 2 BLIST.DIN HÂRTIE-PET-AL/PVC OPAC X 10 COMPR. FILM. P-RF 20 0.311124 0.609376 0.155562 0.764938 0.280011 0.640489
827 W61518003 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR 37,5 mg/325 mg COMPR. FILM. 37,5mg+325mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 3 BLIST.DIN HÂRTIE-PET-AL/PVC OPAC X 10 COMPR. FILM. P-RF 30 0.311124 0.679542 0.155562 0.835104 0.280011 0.710655
828 W61518004 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR 37,5 mg/325 mg COMPR. FILM. 37,5mg+325mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 5 BLIST.DIN HÂRTIE-PET-AL/PVC OPAC X 10 COMPR. FILM. P-RF 50 0.311124 0.531076 0.155562 0.686638 0.280011 0.562189
829 W58620002 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) DORETA 75 mg/650 mg COMPR. FILM. 75 mg/650 mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMP.FILM. PRF 20 0.621500 0.000000 0.310750 0.310750 0.559350 0.062150
830 W58620003 N02AJ13 COMBINATII (TRAMADOLUM+PARACETAMOLUM) DORETA 75 mg/650 mg COMPR. FILM. 75 mg/650 mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMP. FILM. PRF 30 0.622249 0.000084 0.311124 0.311209 0.560024 0.062309
831 W63613001 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 125 mg CAPS. 125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 CAPS. PRF 14 1.750375 1.404625 0.875187 2.279813 1.575337 1.579663
832 W63613003 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 125 mg CAPS. 125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 CAPS. PRF 56 1.689821 0.000000 0.844910 0.844911 1.520838 0.168983
833 W63613008 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 125 mg CAPS. 125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 1.750375 1.404625 0.875187 2.279813 1.575337 1.579663
834 W63613010 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 125 mg CAPS. 125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 1.689821 0.000000 0.844910 0.844911 1.520838 0.168983
835 W61765001 N03AX16 PREGABALINUM ** # PRAGIOLA 150 mg CAPS. 150mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 0.769285 0.000000 0.384642 0.384643 0.692356 0.076929
836 W61765004 N03AX16 PREGABALINUM ** # PRAGIOLA 150 mg CAPS. 150mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 0.741607 0.000000 0.370803 0.370804 0.667446 0.074161
837 W62053001 N03AX16 PREGABALINUM ** # PREGABALIN ZENTIVA 150 mg CAPS. 150mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.754821 0.000000 0.377410 0.377411 0.679338 0.075483
838 W62572001 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 150 mg CAPS. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 CAPS. PRF 14 2.100454 0.560260 1.050227 1.610487 1.890408 0.770306
839 W62572003 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 150 mg CAPS. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 CAPS. PRF 56 1.242500 0.000000 0.621250 0.621250 1.118250 0.124250
840 W62572008 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 150 mg CAPS. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 2.100454 0.560260 1.050227 1.610487 1.890408 0.770306
841 W62572011 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 150 mg CAPS. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 1.242500 0.000000 0.621250 0.621250 1.118250 0.124250
842 W63186001 N03AX16 PREGABALINUM ** # SIRANALEN 150 mg CAPS. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 0.780000 0.000000 0.390000 0.390000 0.702000 0.078000
843 W63186004 N03AX16 PREGABALINUM ** # SIRANALEN 150 mg CAPS. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.754821 0.000000 0.377410 0.377411 0.679338 0.075483
844 W63186008 N03AX16 PREGABALINUM ** # SIRANALEN 150 mg CAPS. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 0.780000 0.000000 0.390000 0.390000 0.702000 0.078000
845 W63186011 N03AX16 PREGABALINUM ** # SIRANALEN 150 mg CAPS. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 0.754821 0.000000 0.377410 0.377411 0.679338 0.075483
846 W65243001 N03AX16 PREGABALINUM ** # PREGABALIN SANDOZ 150 mg CAPS. 150mg SANDOZ GMBH AUSTRIA CUTIE CU BLIST. PVC/PVDC/AL X 56 CAPS. PRF 56 0.714642 0.000000 0.357321 0.357321 0.643177 0.071465
847 W65823003 N03AX16 PREGABALINUM ** # PREGABALINA VIVANTA 150 mg CAPS. 150mg VIVANTA GENERICS S.R.O., CEHIA CUTIE CU BLIST. PVC-ACLAR/AL X 56 CAPS. PRF 56 1.172142 0.000000 0.586071 0.586071 1.054927 0.117215
848 W66797001 N03AX16 PREGABALINUM ** # LYRICA 150 mg CAPS. 150mg UPJOHN EESV OLANDA CUTIE X 14 CAPS. (BLIST. PVC/AL) PRF 14 2.100454 0.194546 1.050227 1.244773 1.890408 0.404592
849 W66797002 N03AX16 PREGABALINUM ** # LYRICA 150 mg CAPS. 150mg UPJOHN EESV OLANDA CUTIE X 56 CAPS. (BLIST. PVC/AL) PRF 56 1.338035 0.000000 0.669017 0.669018 1.204231 0.133804
850 W63615001 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 250 mg CAPS. 250mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 CAPS. PRF 14 3.500755 1.891387 1.750377 3.641765 3.150679 2.241463
851 W63615003 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 250 mg CAPS. 250mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 CAPS. PRF 56 2.898750 0.000000 1.449375 1.449375 2.608875 0.289875
852 W63615008 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 250 mg CAPS. 250mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 3.500755 1.891387 1.750377 3.641765 3.150679 2.241463
853 W63615010 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 250 mg CAPS. 250mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 2.898750 0.000000 1.449375 1.449375 2.608875 0.289875
854 W61768001 N03AX16 PREGABALINUM ** # PRAGIOLA 300 mg CAPS. 300mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 1.792857 0.000000 0.896428 0.896429 1.613571 0.179286
855 W61768004 N03AX16 PREGABALINUM ** # PRAGIOLA 300 mg CAPS. 300mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 1.442857 0.000000 0.721428 0.721429 1.298571 0.144286
856 W63187001 N03AX16 PREGABALINUM ** # SIRANALEN 300 mg CAPS. 300mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 1.772857 0.000000 0.886428 0.886429 1.595571 0.177286

Pagina 12 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
857 W63187004 N03AX16 PREGABALINUM ** # SIRANALEN 300 mg CAPS. 300mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 1.429285 0.000000 0.714642 0.714643 1.286356 0.142929
858 W63187008 N03AX16 PREGABALINUM ** # SIRANALEN 300 mg CAPS. 300mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 1.772857 0.000000 0.886428 0.886429 1.595571 0.177286
859 W63187011 N03AX16 PREGABALINUM ** # SIRANALEN 300 mg CAPS. 300mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 1.429285 0.000000 0.714642 0.714643 1.286356 0.142929
860 W65824003 N03AX16 PREGABALINUM ** # PREGABALINA VIVANTA 300 mg CAPS. 300mg VIVANTA GENERICS S.R.O., CEHIA CUTIE CU BLIST. PVC-ACLAR/AL X 56 CAPS. PRF 56 2.302500 0.000000 1.151250 1.151250 2.072250 0.230250
861 W66798001 N03AX16 PREGABALINUM ** # LYRICA 300 mg CAPS. 300mg UPJOHN EESV OLANDA CUTIE X 14 CAPS. (BLIST. PVC/AL) PRF 14 3.025714 0.000000 1.512857 1.512857 2.723142 0.302572
862 W61763001 N03AX16 PREGABALINUM ** # PRAGIOLA 75 mg CAPS. 75mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 0.626428 0.000000 0.313214 0.313214 0.563785 0.062643
863 W61763004 N03AX16 PREGABALINUM ** # PRAGIOLA 75 mg CAPS. 75mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 0.606607 0.000000 0.303303 0.303304 0.545946 0.060661
864 W62052001 N03AX16 PREGABALINUM ** # PREGABALIN ZENTIVA 75 mg CAPS. 75mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.613750 0.000000 0.306875 0.306875 0.552375 0.061375
865 W62571001 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 75 mg CAPS. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 CAPS. PRF 14 1.050227 0.786915 0.525113 1.312029 0.945204 0.891938
866 W62571003 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 75 mg CAPS. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 CAPS. PRF 56 0.793571 0.000000 0.396785 0.396786 0.714213 0.079358
867 W62571008 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 75 mg CAPS. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 1.050227 0.786915 0.525113 1.312029 0.945204 0.891938
868 W62571011 N03AX16 PREGABALINUM ** # PREGABALINA TERAPIA 75 mg CAPS. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.793571 0.000000 0.396785 0.396786 0.714213 0.079358
869 W63185008 N03AX16 PREGABALINUM ** # SIRANALEN 75 mg CAPS. 75mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 0.635000 0.000000 0.317500 0.317500 0.571500 0.063500
870 W63185011 N03AX16 PREGABALINUM ** # SIRANALEN 75 mg CAPS. 75mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 0.613750 0.000000 0.306875 0.306875 0.552375 0.061375
871 W65242001 N03AX16 PREGABALINUM ** # PREGABALIN SANDOZ 75 mg CAPS. 75mg SANDOZ GMBH AUSTRIA CUTIE CU BLIST. PVC/PVDC/AL X 56 CAPS. PRF 56 0.589821 0.000000 0.294910 0.294911 0.530838 0.058983
872 W65822003 N03AX16 PREGABALINUM ** # PREGABALINA VIVANTA 75 mg CAPS. 75mg VIVANTA GENERICS S.R.O., CEHIA CUTIE CU BLIST. PVC-ACLAR/AL X 56 CAPS. PRF 56 0.600357 0.000000 0.300178 0.300179 0.540321 0.060036
873 W66796001 N03AX16 PREGABALINUM ** # LYRICA 75 mg CAPS. 75mg UPJOHN EESV OLANDA CUTIE X 14 CAPS. (BLIST. PVC/AL) PRF 14 1.050227 0.097630 0.525113 0.622744 0.945204 0.202653
874 W66796002 N03AX16 PREGABALINUM ** # LYRICA 75 mg CAPS. 75mg UPJOHN EESV OLANDA CUTIE X 56 CAPS. (BLIST. PVC/AL) PRF 56 1.042500 0.000000 0.521250 0.521250 0.938250 0.104250
875 W64181001 N03AX16 PREGABALINUM ** # SIRANALEN 20 mg/ml SOL. ORALA 20mg/ml MEDOCHEMIE LTD. CIPRU CUTIE CU 1 FLAC. PEID CONTINAND 473 ML SOL. ORALA, O SERINGA PT. ADMINISTRARE ORALA, UN ADAPTOR DIN PLASTIC ALB CARE SE ATASEAZA LA FLAC. PRIN IMPINGERE PRF 1 132.468643 20.261357 66.234321 86.495679 119.221778 33.508222
876 W60055001 N04BC05 PRAMIPEXOLUM * PRAMIPEXOL ZENTIVA 0,18 mg COMPR. 0,18 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. PRF 30 0.252488 0.624845 0.126244 0.751089 0.227239 0.650094
877 W53525002 N04BC05 PRAMIPEXOLUM * OPRYMEA 0,18mg COMPR. 0,18mg KRKA D.D. SLOVENIA CUTIE X 30 COMPR. (BLIST. AL/AL) P-RF 30 0.252488 0.291845 0.126244 0.418089 0.227239 0.317094
878 W54712001 N04BC05 PRAMIPEXOLUM * MEDOPEXOL 0,18 mg COMPR. 0,18mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 0.252488 0.298512 0.126244 0.424756 0.227239 0.323761
879 W60054001 N04BC05 PRAMIPEXOLUM * PRAMIPEXOL ZENTIVA 0,7 mg COMPR. 0,7 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. PRF 30 0.981900 1.564766 0.490950 2.055716 0.883710 1.662956
880 W53527002 N04BC05 PRAMIPEXOLUM * OPRYMEA 0,7mg COMPR. 0,7mg KRKA D.D. SLOVENIA CUTIE X 30 COMPR. (BLIST. AL/AL) P-RF 30 0.981900 1.308433 0.490950 1.799383 0.883710 1.406623
881 W60244001 N04BC05 PRAMIPEXOLUM * OPRYMEA 0,26mg COMPR. ELIB. PREL. 0,26mg KRKA D.D. SLOVENIA CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-RF 30 0.364705 0.460295 0.182352 0.642648 0.328234 0.496766
882 W54799002 N04BC05 PRAMIPEXOLUM * MIRAPEXIN 0,52 mg COMPR. ELIB. PREL. 0,52mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P-RF 30 0.729411 1.446589 0.364705 1.811295 0.656469 1.519531
883 W60240001 N04BC05 PRAMIPEXOLUM * OPRYMEA 0,52mg COMPR. ELIB. PREL. 0,52mg KRKA D.D. SLOVENIA CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-RF 30 0.729411 0.945255 0.364705 1.309961 0.656469 1.018197
884 W54800002 N04BC05 PRAMIPEXOLUM * MIRAPEXIN 1,05 mg COMPR. ELIB. PREL. 1,05mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P-RF 30 1.472850 2.121816 0.736425 2.858241 1.325565 2.269101
885 W60241001 N04BC05 PRAMIPEXOLUM * OPRYMEA 1,05mg COMPR. ELIB. PREL. 1,05mg KRKA D.D. SLOVENIA CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-RF 30 1.472850 0.535150 0.736425 1.271575 1.325565 0.682435
886 W60243001 N04BC05 PRAMIPEXOLUM * OPRYMEA 2,10mg COMPR. ELIB. PREL. 2,10mg KRKA D.D. SLOVENIA CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-RF 30 2.945701 0.619299 1.472850 2.092150 2.651130 0.913870
887 W54801002 N04BC05 PRAMIPEXOLUM * MIRAPEXIN 2,1 mg COMPR. ELIB. PREL. 2,1mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P-RF 30 2.945701 3.227632 1.472850 4.700483 2.651130 3.522203
888 W62151001 N04BC05 PRAMIPEXOLUM * OPRYMEA 3,15 mg COMPR. ELIB. PREL. 3,15mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE X BLIST. OPA-AL/DESICANT/PE/AL X 30 COMPR. ELIB. PREL. PRF 30 4.418552 4.242448 2.209276 6.451724 3.976696 4.684304
889 W10479001 N04BC08 PIRIBEDILUM ** PRONORAN 50 mg DRAJ. ELIB. PREL. 50mg LES LABORATOIRES SERVIER FRANTA CUTIE X 2 BLIST. AL/PVC X 15 DRAJ. CU ELIB. PREL. P-RF 30 0.876696 0.238637 0.438348 0.676985 0.789026 0.326307
890 W63530001 N05AL03 TIAPRIDUM TIAPRIDAL 100 mg COMPR. 100mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.506000 0.000000 0.253000 0.253000 0.455400 0.050600
891 W08133001 N05BE01 BUSPIRONUM SPITOMIN 10 mg COMPR. 10mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 6 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-RF 60 0.602166 0.000000 0.301083 0.301083 0.541949 0.060217
892 W08134001 N05BE01 BUSPIRONUM SPITOMIN 5 mg COMPR. 5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 6 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-RF 60 0.326686 0.076814 0.163343 0.240157 0.294017 0.109483
893 W13298008 N06AB10 ESCITALOPRAMUM ** CIPRALEX 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA CUTIE X 2 BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 14 COMPR. FILM. P-RF 28 1.070966 0.312962 0.535483 0.848445 0.963869 0.420059
894 W55522003 N06AB10 ESCITALOPRAMUM ** LENUXIN 10 mg COMPR. FILM. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-RF 28 1.070966 0.011534 0.535483 0.547017 0.963869 0.118631
895 W55813002 N06AB10 ESCITALOPRAMUM ** SERODEPS 10mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. POLIAMIDA/AL/PVC-AL X 28 COMPR. FILM. P-RF 28 0.599285 0.000000 0.299642 0.299643 0.539356 0.059929
896 W59746003 N06AB10 ESCITALOPRAMUM ** ESTAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. PRF 14 0.567142 0.000000 0.283571 0.283571 0.510427 0.056715
897 W59746005 N06AB10 ESCITALOPRAMUM ** ESTAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. PRF 28 0.567500 0.000000 0.283750 0.283750 0.510750 0.056750
898 W60685003 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM ACTAVIS 10 mg COMPR. FILM. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVDC/PVDC/AL X 28 COMPR. FILM. PRF 28 0.499285 0.000000 0.249642 0.249643 0.449356 0.049929
899 W60692004 N06AB10 ESCITALOPRAMUM ** ELICEA 10 mg COMPR. FILM. 10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PRF 30 0.599333 0.000000 0.299666 0.299667 0.539399 0.059934
900 W61414004 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM ATB 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. FILM. PRF 28 0.975714 0.000000 0.487857 0.487857 0.878142 0.097572
901 W68274003 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM TEVA 10 mg COMPR. FILM. 10mg TEVA B.V. OLANDA CUTIE CU BLIST. PVDC/PVDC/AL X 28 COMPR. FILM. PRF 28 0.499285 0.000000 0.249642 0.249643 0.449356 0.049929
902 W60686003 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM ACTAVIS 20 mg COMPR. FILM. 20mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVDC/PVDC/AL X 28 COMPR. FILM. PRF 28 1.054285 0.000000 0.527142 0.527143 0.948856 0.105429
903 W68276003 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM TEVA 20 mg COMPR. FILM. 20mg TEVA B.V. OLANDA CUTIE CU BLIST. PVDC/PVDC/AL X 28 COMPR. FILM. PRF 28 1.054285 0.000000 0.527142 0.527143 0.948856 0.105429
904 W13019001 N06AX05 TRAZODONUM ** TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. ELIB. PREL. P-RF 20 1.256666 0.193334 0.628333 0.821667 1.130999 0.319001
905 W13019004 N06AX05 TRAZODONUM ** TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 6 BLIST. AL/PVC X 10 COMPR. ELIB. PREL. P-RF 60 1.250833 0.000000 0.625416 0.625417 1.125749 0.125084
906 W13019002 N06AX05 TRAZODONUM ** TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 3 BLIST. AL/PVC X 20 COMPR. ELIB. PREL. P-RF 60 1.250833 0.000000 0.625416 0.625417 1.125749 0.125084
907 W13019003 N06AX05 TRAZODONUM ** TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 2 BLIST. AL/PVCX 10 COMPR. ELIB. PREL. P-RF 20 1.256666 0.193334 0.628333 0.821667 1.130999 0.319001
908 W66418003 N06AX05 TRAZODONUM ** TRITTICO EP 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE CU 3 BLIST. PVC-PVDC/AL OPAC ALB X 10 COMPR. ELIB. PREL. PRF 30 1.256666 0.147334 0.628333 0.775667 1.130999 0.273001
909 W66419003 N06AX05 TRAZODONUM ** TRITTICO EP 300 mg COMPR. ELIB. PREL. 300mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE CU 3 BLIST. PVC-PVDC/AL OPAC ALB X 10 COMPR. ELIB. PREL. PRF 30 2.513333 0.011667 1.256666 1.268334 2.261999 0.263001
910 W08616002 N06AX05 TRAZODONUM ** TRITTICO AC 75 mg COMPR. ELIB. PREL. 75mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. ELIB. PREL. P-RF 30 0.628333 0.137000 0.314166 0.451167 0.565499 0.199834
911 W55427002 N06AX12 BUPROPIONUM ** # ELONTRIL 150 mg COMPR. ELIB. MODIF. 150mg GLAXOSMITHKLINE (GSK) SRL ROMANIA CUTIE CU 1 FLAC. PEID CU DESICANT X 30 COMPR. ELIB. MODIF. P-RF 30 1.859333 0.000000 0.929666 0.929667 1.673399 0.185934
912 W67767002 N06AX12 BUPROPIONUM ** # ELONTRIL 150 mg COMPR. ELIB. MODIF. 150mg GLAXOSMITHKLINE TRADING SERVICES LIMITED IRLANDA CUTIE CU 1 FLAC. PEID X 30 COMPR. ELIB. MODIF. PRF 30 1.859333 0.000000 0.929666 0.929667 1.673399 0.185934
913 W57667003 N06AX14 TIANEPTINUM ** LYXIT 12,5 mg COMPR. FILM. 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN PVC-PVDC/AL X 30 COMPR. FILM. PRF 30 0.587000 0.000000 0.293500 0.293500 0.528300 0.058700
914 W57667005 N06AX14 TIANEPTINUM ** LYXIT 12,5 mg COMPR. FILM. 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN PVC-PVDC/AL X 90 COMPR. FILM. PRF 90 0.533444 0.000000 0.266722 0.266722 0.480099 0.053345
915 W60648003 N06AX14 TIANEPTINUM ** NOBIXAL 12,5 mg COMPR. FILM. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. FILM. PRF 30 0.587000 0.000000 0.293500 0.293500 0.528300 0.058700
916 W60648008 N06AX14 TIANEPTINUM ** NOBIXAL 12,5 mg COMPR. FILM. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 30 COMPR. FILM. PRF 30 0.587000 0.000000 0.293500 0.293500 0.528300 0.058700
917 W41558001 N06AX14 TIANEPTINUM ** COAXIL 12,5 mg DRAJ. 12,5mg LES LABORATOIRES SERVIER FRANTA CUTIE X 1 BLIST. AL/PVC X 30 DRAJ. P-RF 30 0.587000 0.355000 0.293500 0.648500 0.528300 0.413700
918 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 0.645446 1.095982 0.322723 1.418705 0.580901 1.160527
919 W61820005 N06AX21 DULOXETINUM ** DULSEVIA 30 mg CAPS. GASTROREZ. 30mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. PRF 30 0.645446 0.013554 0.322723 0.336277 0.580901 0.078099
920 W62006001 N06AX21 DULOXETINUM ** DULOXETINA DR. REDDY'S 30 mg CAPS. GASTROREZ. 30mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PE-ACLAR/AL X 28 CAPS. GASTROREZ. PRF 28 0.645446 1.682054 0.322723 2.004777 0.580901 1.746599
921 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 0.645446 0.012054 0.322723 0.334777 0.580901 0.076599
922 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 0.645446 0.142411 0.322723 0.465134 0.580901 0.206956
923 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 0.645446 0.525625 0.322723 0.848348 0.580901 0.590170
924 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 0.549000 0.000000 0.274500 0.274500 0.494100 0.054900
925 W62054002 N06AX21 DULOXETINUM ** DULOXETINE ZENTIVA 30 mg CAPS. GASTROREZ. 30mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PVDC/AL X 28 CAPS. GASTROREZ. PRF 28 0.645446 0.012054 0.322723 0.334777 0.580901 0.076599
926 W68407006 N06AX21 DULOXETINUM ** DULOXETINA TERAPIA 30 mg CAPS. GASTROREZ. 30mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 0.645446 0.013554 0.322723 0.336277 0.580901 0.078099
927 W68407018 N06AX21 DULOXETINUM ** DULOXETINA TERAPIA 30 mg CAPS. GASTROREZ. 30mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. PRF 30 0.645446 0.013554 0.322723 0.336277 0.580901 0.078099
928 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 1.290892 1.228393 0.645446 1.873839 1.161802 1.357483

Pagina 13 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
929 W61821005 N06AX21 DULOXETINUM ** DULSEVIA 60 mg CAPS. GASTROREZ. 60mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. PRF 30 1.290892 0.026774 0.645446 0.672220 1.161802 0.155864
930 W62055001 N06AX21 DULOXETINUM ** DULOXETINE ZENTIVA 60 mg CAPS. GASTROREZ. 60mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PCTFE/AL X 28 CAPS. GASTROREZ. PRF 28 1.107142 0.000000 0.553571 0.553571 0.996427 0.110715
931 W62302003 N06AX21 DULOXETINUM ** DULOXETINA STADA 60 mg CAPS. GASTROREZ. 60mg STADA M&D SRL ROMANIA CUTIE CU BLIST. PVC-PCTFE-PVC/AL X 28 CAPS. GASTROREZ. PRF 28 1.266785 0.000000 0.633392 0.633393 1.140106 0.126679
932 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 1.290892 0.468774 0.645446 1.114220 1.161802 0.597864
933 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 1.098000 0.000000 0.549000 0.549000 0.988200 0.109800
934 W62055002 N06AX21 DULOXETINUM ** DULOXETINE ZENTIVA 60 mg CAPS. GASTROREZ. 60mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PVDC/AL X 28 CAPS. GASTROREZ. PRF 28 1.107142 0.000000 0.553571 0.553571 0.996427 0.110715
935 W68409006 N06AX21 DULOXETINUM ** DULOXETINA TERAPIA 60 mg CAPS. GASTROREZ. 60mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 1.290892 0.026774 0.645446 0.672220 1.161802 0.155864
936 W68409018 N06AX21 DULOXETINUM ** DULOXETINA TERAPIA 60 mg CAPS. GASTROREZ. 60mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. PRF 30 1.290892 0.026774 0.645446 0.672220 1.161802 0.155864
937 W08060002 N06BX16 PRAMIRACETAMUM ** # PRAMISTAR 600 mg COMPR. FILM. 600mg F.I.R.M.A. S.P.A. (MENARINI GROUP) ITALIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P6L 20 4.097000 0.000000 2.048500 2.048500 3.687300 0.409700
938 W58635002 N06BX18 VINPOCETINUM VINPOCETINA VIM SPECTRUM 5 mg CAPS. 5mg VIM SPECTRUM SRL ROMANIA CUTIE X 5 BLIST. X PVC/AL X10 CAPS. P6L 50 0.208400 0.000000 0.104200 0.104200 0.187560 0.020840
939 W54827001 N06BX18 VINPOCETINUM CAVINTON FORTE 10 mg COMPR. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. X 15 COMPR. P-6L 30 0.615733 0.198933 0.307866 0.506800 0.554159 0.260507
940 W67865003 N06BX18 VINPOCETINUM VINPOCETINA COVEX 10 mg COMPR. 10mg COVEX S.A. SPANIA CUTIE CU BLIST. PVC/AL X 60 COMPR. P6L 60 0.615733 0.305267 0.307866 0.613134 0.554159 0.366841
941 W57876003 N07CA01 BETAHISTINUM VERTIMED 16 mg COMPR. 16mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVDC-AL X 30 COMPR. P6L 30 0.404666 0.084334 0.202333 0.286667 0.364199 0.124801
942 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 0.404666 0.338000 0.202333 0.540333 0.364199 0.378467
943 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 0.587500 0.000000 0.293750 0.293750 0.528750 0.058750
944 W65860004 N07CA01 BETAHISTINUM DICLORHIDRAT DE BETAHISTINA ACCORD 24 mg COMPR. 24 mg POLONIA
ACCORD HEALTHCARE POLSKA SP. Z O.O. CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. P6L 60 0.587500 0.000000 0.293750 0.293750 0.528750 0.058750
945 W55890001 N07CA01 BETAHISTINUM BETAHISTINA MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE CU 2 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P-6L 20 0.607000 0.000000 0.303500 0.303500 0.546300 0.060700
946 W55890002 N07CA01 BETAHISTINUM BETAHISTINA MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE CU 5 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P-6L 50 0.607000 0.000000 0.303500 0.303500 0.546300 0.060700
947 W57877003 N07CA01 BETAHISTINUM VERTIMED 24 mg COMPR. 24mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVDC-AL X 30 COMPR. P6L 30 0.607000 0.000000 0.303500 0.303500 0.546300 0.060700
948 W57877006 N07CA01 BETAHISTINUM VERTIMED 24 mg COMPR. 24mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVDC-AL X 60 COMPR. P6L 60 0.587500 0.000000 0.293750 0.293750 0.528750 0.058750
949 W55890003 N07CA01 BETAHISTINUM BETAHISTINA MCC 24 mg COMPR. 24mg MAGISTRA C&C SRL ROMANIA CUTIE CU 6 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P-6L 60 0.587500 0.000000 0.293750 0.293750 0.528750 0.058750
950 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 0.607000 0.367000 0.303500 0.670500 0.546300 0.427700
951 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 0.607000 0.465500 0.303500 0.769000 0.546300 0.526200
952 W63739001 N07CA01 BETAHISTINUM BETAHISTINA ATB 24 mg COMPR. 24mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/PVDC/AL X 10 COMPR. P6L 20 0.607000 0.000000 0.303500 0.303500 0.546300 0.060700
953 W63739004 N07CA01 BETAHISTINUM BETAHISTINA ATB 24 mg COMPR. 24mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 6 BLIST. PVC/PVDC/AL X 10 COMPR. P6L 60 0.587500 0.000000 0.293750 0.293750 0.528750 0.058750
954 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 0.607000 0.465500 0.303500 0.769000 0.546300 0.526200
955 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 0.607000 0.367000 0.303500 0.670500 0.546300 0.427700
956 W68853001 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. 24mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 20 COMPR. P6L 20 0.607000 0.465500 0.303500 0.769000 0.546300 0.526200
957 W68853003 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. 24mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 3 BLIST. PVC-PVDC/AL X 20 COMPR. P6L 60 0.607000 0.367000 0.303500 0.670500 0.546300 0.427700
958 W55889001 N07CA01 BETAHISTINUM BETAHISTINA MCC 8 mg COMPR. 8mg MAGISTRA C&C SRL ROMANIA CUTIE CU 3 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P-6L 30 0.202333 0.024667 0.101166 0.125834 0.182099 0.044901
959 W55889002 N07CA01 BETAHISTINUM BETAHISTINA MCC 8 mg COMPR. 8mg MAGISTRA C&C SRL ROMANIA CUTIE CU 10 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P-6L 100 0.202333 0.024967 0.101166 0.126134 0.182099 0.045201
960 W57875009 N07CA01 BETAHISTINUM VERTIMED 8 mg COMPR. 8mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/PE/PVDC-AL X 100 COMPR. P6L 100 0.202333 0.024967 0.101166 0.126134 0.182099 0.045201
961 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 0.202333 0.025000 0.101166 0.126167 0.182099 0.045234
962 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 0.202333 0.082567 0.101166 0.183734 0.182099 0.102801
963 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 0.202333 0.082567 0.101166 0.183734 0.182099 0.102801
964 W68852002 N07CA01 BETAHISTINUM BETASERC 8 mg COMPR. 8mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 4 BLIST. PVC-PVDC/AL X 25 COMPR. P6L 100 0.202333 0.082567 0.101166 0.183734 0.182099 0.102801
965 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 0.607000 0.426666 0.303500 0.730166 0.546300 0.487366
966 W66245004 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. ORODISPERSABILE 24mg IRLANDA
MYLAN IRE HEALTHCARE LIMITED CUTIE CU BLIST. OPA-AL-PVC/AL X 60 COMPR. ORODISPERSABILE P6L 60 0.607000 0.426666 0.303500 0.730166 0.546300 0.487366
967 W68647004 N07CA01 BETAHISTINUM BETASERC 24 mg COMPR. ORODISPERSABILE 24mg IRLANDA
VIATRIS HEALTHCARE LIMITED CUTIE CU BLIST. OPA-AL-PVC/AL X 60 COMPR. ORODISPERSABILE P6L 60 0.607000 0.426666 0.303500 0.730166 0.546300 0.487366
968 W64195001 N07CA52 COMBINATII (CINARIZINUM +DIMENHIDRINATUM) VERTIGIX 20 mg/40 mg COMPR. 20mg/40mg GALENICA S.A. GRECIA CUTIE CU BLIST. PVC-PVDC/AL-PVDC X 50 COMPR. PRF 50 1.123400 0.000000 0.561700 0.561700 1.011060 0.112340
969 W66044003 N07CA52 COMBINATII (CINARIZINUM +DIMENHIDRINATUM) AZALONUM 20 mg/40 mg COMPR. 20mg/40mg MEDOCHEMIE LIMITED CIPRU CUTIE CU BLIST. OPA-AL-PVC/AL X 50 COMPR. PRF 50 1.168991 0.130609 0.584495 0.715105 1.052091 0.247509
970 W02144006 N07CA52 COMBINATII (CINARIZINUM +DIMENHIDRINATUM) ARLEVERT 20mg + 40mg COMPR. 20mg+40mg HENNIG ARZNEIMITTEL GMBH & CO.KG GERMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 24 COMPR. P-RF 48 1.168991 0.045592 0.584495 0.630088 1.052091 0.162492
971 W55730003 N07XXN3 HIDROLIZAT DE PROTEINA DIN CREIER DE PORCINA ** CEREBROLYSIN 215,2 mg/ml 215,2mg/ml
SOL. INJ./CONC. PT. SOL. PERF. EVER NEURO PHARMA GMBH AUSTRIA CUTIE CU 5 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE X 10 ML SOL. INJ./CONC. PT. SOL. PERF. PR/PRF 5 27.441500 0.922500 13.720750 14.643250 24.697350 3.666650
972 W55730004 N07XXN3 HIDROLIZAT DE PROTEINA DIN CREIER DE PORCINA ** CEREBROLYSIN 215,2 mg/ml 215,2mg/ml
SOL. INJ./CONC. PT. SOL. PERF. EVER NEURO PHARMA GMBH AUSTRIA CUTIE CU 5 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE X 20 ML SOL. INJ./CONC. PT. SOL. PERF. PR/PRF 5 53.038000 0.000000 26.519000 26.519000 47.734200 5.303800
973 W55730002 N07XXN3 HIDROLIZAT DE PROTEINA DIN CREIER DE PORCINA ** CEREBROLYSIN 215,2 mg/ml 215,2mg/ml
SOL. INJ./CONC. PT. SOL. PERF. EVER NEURO PHARMA GMBH AUSTRIA CUTIE CU 5 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE X 5 ML SOL. INJ./CONC. PT. SOL. PERF. PR/PRF 5 13.720750 6.101250 6.860375 12.961625 12.348675 7.473325
974 W54357001 P01BA02 HYDROXYCHLOROQUINUM PLAQUENIL® COMPR. FILM. 200mg ROMANIA CUTIE X 6 BLIST. X 10 COMPR. FILM.
SANOFI - AVENTIS ROMANIA S.R.L. P-6L 60 0.648166 0.000000 0.324083 0.324083 0.583349 0.064817
975 W62084002 P01BA02 HYDROXYCHLOROQUINUM PLAQUENIL 200 mg COMPR. FILM. 200mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 4 BLISTERE DIN PVC/AL X 15 COMPR. FILM. P-6L 60 0.648166 0.000000 0.324083 0.324083 0.583349 0.064817
976 W66244001 R01AD09 MOMETASONUM * FUROAT DE MOMETAZONA AMRING 50 micrograme/doza SPRAY NAZ., SUSP. 50micrograme/doza AMRING FARMA S.R.L. ROMANIA CUTIE CU UN FLAC. DIN PEÎD, PREVAZUT CU POMPA DOZATOARE MANUALA DIN PP CARE CONTINE 18 G SUSPENSIE, ECHIVALENT CU 140 DOZE PRF 1 25.744999 3.225001 12.872499 16.097501 23.170499 5.799501
977 W59422002 R01AD09 MOMETASONUM * FUROAT DE MOMETAZONA SANDOZ 50 micrograme/doza SPRAY NAZ.,SUSP. 50micrograme/doza SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. PEID PREVAZUT CU O POMPA PULVERIZATOARE NAZALA DIN PE/PP CARE CONTINE 18 G SUSP. NAZALA CORESPUNZATOR LA 140 DOZE MASURATE PRF 1 16.070000 0.000000 8.035000 8.035000 14.463000 1.607000
978 W57437001 R01AD09 MOMETASONUM * NASONEX 50mcg/doza SPRAY NAZAL SUSP. 50mcg/doza MERCK SHARP & DOHME ROMANIA CUT IE X 1 FLACON DIN PE PREVAZUT CU POMPA DOZAT OARE, DISPOZIT IV DE ACT IONARE DIN PP SI CAPAC, CU UN VOLUM DE 23,5 ML SUSPENSIE PT . 140 PULVERIZARI SPRAY NAZAL, SUSPENSIE P-RF 1 25.744999 4.485001 12.872499 17.357501 23.170499 7.059501
979 W68334001 R01AD09 MOMETASONUM * NASONEX 50 micrograme/doza SPRAY NAZAL SUSP. 50micrograme/doza ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN PEID DE CULOARE ALBA CARE CONTINE 18 G SUSPENSIE PENTRU 140 DE PULVERIZARI PREVAZUT CU POMPA DOZATOARE PRF 1 25.744999 4.485001 12.872499 17.357501 23.170499 7.059501
980 W59866003 R01AD58 COMBINATII (AZELASTINUM+FLUTICASONUM) ** DYMISTA 137 micrograme/50 micrograme/doza SPRAY NAZ.,SUSP. 137micrograme/50micrograme/doz MEDA PHARMA GMBH & CO KG GERMANIA CUT IE CU 1 FLAC. DIN ST ICLA BRUNA, DE CAPACIT AT E 25 ML, A 23 G SPRAY NAZAL, SUSP. (CEL PUT IN 120 DOZE ELIBERAT E), PREVAZUT CU POMPA DE PULVERIZARE + APLICAT OR NAZAL DIN PP PRF 1 83.250000 0.000000 41.625000 41.625000 74.925000 8.325000
981 W68695003 R01AD58 COMBINATII (AZELASTINUM+FLUTICASONUM) ** DYMISTA 137 micrograme/50 micrograme/doza SPRAY NAZ.,SUSP. 137micrograme/50micrograme/doz VIATRIS HEALTHCARE LIMITED IRLANDA CUT IE CU 1 FLAC. DIN ST ICLA BRUNA, DE CAPACIT AT E 25 ML, A 23 G SPRAY NAZAL, SUSP. (CEL PUT IN 120 DOZE ELIBERAT E), PREVAZUT CU POMPA DE PULVERIZARE + APLICAT OR NAZAL DIN PP PRF 1 83.250000 0.000000 41.625000 41.625000 74.925000 8.325000
982 W63349002 R03AC13 FORMOTEROLUM ** ATIMOS 0,012mg/doza SOL. DE INHALAT PRESURIZATA 0,012mg/doza CHIESI PHARMACEUTICALS GMBH AUSTRIA CUTIE X 1 FLACON X 100 DOZE + VALVA DOZATOARE P-6L 1 112.810000 0.000000 56.405000 56.405000 101.529000 11.281000
983 W64463002 R03AC18 INDACATEROLUM ** ONBREZ BREEZHALER 150 µg CAPS. CU PULB.INHAL. 150µg NOVARTIS EUROPHARM LTD. IRLANDA CUTIECU BLIST. DIN PA/AL/PVC X 30 CAPSULE (3 BIST X10)+ UN INHALATOR PRF 30 2.794166 1.393500 1.397083 2.790583 2.514749 1.672917
984 W64464002 R03AC18 INDACATEROLUM ** ONBREZ BREEZHALER 300 µg CAPS. CU PULB.INHAL. 300µg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU BLIST. DIN PA/AL/PVC X 30 CAPSULE (1 BLIST. X10)+ UN INHALATOR PRF 30 4.659333 0.000000 2.329666 2.329667 4.193399 0.465934
985 W66773001 R03AK06 SALMETEROLUM+FLUTICASONUM * EVERIO AIRMASTER 50 micrograme/100 micrograme PULB. DE INHAL. UNIDOZA 50micrograme/100micrograme ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 INHALATOR A 60 DOZE PULBERE DE INHALAT PRF 1 23.794000 32.926000 11.897000 44.823000 21.414600 35.305400
986 W66774001 R03AK06 SALMETEROLUM+FLUTICASONUM * EVERIO AIRMASTER 50 micrograme/250 micrograme PULB. DE INHAL. UNIDOZA 50micrograme/250micrograme ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 INHALATOR A 60 DOZE PULBERE DE INHALAT PRF 1 59.485000 19.295000 29.742500 49.037500 53.536500 25.243500
987 W66775001 R03AK06 SALMETEROLUM+FLUTICASONUM * EVERIO AIRMASTER 50 micrograme/500 micrograme PULB. DE INHAL. UNIDOZA 50micrograme/500micrograme ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 INHALATOR A 60 DOZE PULBERE DE INHALAT PRF 1 102.100000 0.000000 51.050000 51.050000 91.890000 10.210000
988 W65108002 R03AK06 SALMETEROLUM+FLUTICASONUM * SERETIDE DISKUS 50 micrograme/100 micrograme PULB. INHAL. 50micrograme/100micrograme GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 DISPOZITIV DE INHALAT DIN PLASTIC PREVAZUT CU UN BLISTER IN FORMA DE BANDA X 60 DOZE PULB. DE INHAL. P6L 1 23.794000 50.116000 11.897000 62.013000 21.414600 52.495400
989 W60522001 R03AK06 SALMETEROLUM+FLUTICASONUM * AIRFLUSAL FORSPIRO 50 micrograme/500 micrograme/doza PULB. UNIDOZA DE INHAL. 50micrograme/500micrograme/doz SANDOZ S.R.L. ROMANIA CUTIE CU BLISTER OPA-AL-PVC/AL CONTINAND 1 DISPOZITIV X 60 DOZE CU PULB. DE INHALAT P6L 1 102.100000 0.000000 51.050000 51.050000 91.890000 10.210000
990 W61757001 R03AK06 SALMETEROLUM+FLUTICASONUM * AIRFLUSAL FORSPIRO 50 micrograme/250 micrograme/doza PULB. UNIDOZA DE INHALAT 50micrograme/250micrograme/doz SANDOZ S.R.L. ROMANIA CUTIE CU 1 DISPOZITIV INHALATOR DIN PLASTIC CONTINAND BLISTERE DIN OPA-AL-PVC/AL X 60 UNIDOZE PULBERE DE INHALAT P6L 1 59.485000 19.295000 29.742500 49.037500 53.536500 25.243500
991 W68287001 R03AK06 SALMETEROLUM+FLUTICASONUM * EVERIO 25 micrograme/125 micrograme/doza SUSP. DE INHALAT PRESURIZATA 25micrograme/125micrograme/doz ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 1 INHALATOR SUB PRESIUNE CU 120 DE DOZE MASURATE PRF 1 59.485000 28.955000 29.742500 58.697500 53.536500 34.903500
992 W68288001 R03AK06 SALMETEROLUM+FLUTICASONUM * EVERIO 25 micrograme/250 micrograme/doza SUSP. DE INHALAT PRESURIZATA 25micrograme/250micrograme/doz ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 1 INHALATOR SUB PRESIUNE CU 120 DE DOZE MASURATE PRF 1 111.900000 0.000000 55.950000 55.950000 100.710000 11.190000
993 W65218001 R03AK06 SALMETEROLUM+FLUTICASONUM * SERETIDE INHALER CFC FREE 25 µg/50 µg SUSP. INHAL. PRESURIZATA 25µg/50µg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE X 1 FLACON PRESURIZAT AL X 120 DOZE SUSP. DE INHALAT PRESURIZATA P-6L 1 23.794000 72.776000 11.897000 84.673000 21.414600 75.155400
994 W65229001 R03AK06 SALMETEROLUM+FLUTICASONUM * SERROFLO 25 micrograme/125 micrograme/doza SUSP. INHAL. PRESURIZATA 25micrograme/125micrograme/doz AMRING FARMA S.R.L. ROMANIA CUTIE CU UN FLACON DIN AL PREVAZUT CU O VALVA DE MASURA SI DOZATOR DIN PLASTIC, CU INDICATOR PENTRU DOZA, INTRODUS ÎNTR-O PUNGA CU SAC DE SILICAGEL A 120 DE DOZE SUSPENSIE DE INHALAT PRESURIZATA PRF 1 59.485000 40.155000 29.742500 69.897500 53.536500 46.103500
995 W65230001 R03AK06 SALMETEROLUM+FLUTICASONUM * SERROFLO 25 micrograme/250 micrograme/doza SUSP. INHAL. PRESURIZATA 25micrograme/250micrograme/doz AMRING FARMA S.R.L. ROMANIA CUTIE CU UN FLACON DIN AL PREVAZUT CU O VALVA DE MASURA SI DOZATOR DIN PLASTIC, CU INDICATOR PENTRU DOZA, INTRODUS ÎNTR-O PUNGA CU SAC DE SILICAGEL A 120 DE DOZE SUSPENSIE DE INHALAT PRESURIZATA PRF 1 118.970000 7.070000 59.485000 66.555000 107.073000 18.967000
996 W63867001 R03AK07 COMBINATII (BUDESONIDUM + FORMOTEROLUM) * DUORESP SPIROMAX 160 micrograme/4,5 micrograme PULB. DE INHAL. 160micrograme/4,5micrograme TEVA PHARMA B.V. OLANDA 1 INHALATOR CE CONTINE 120 DOZE PRF 1 126.820000 0.000000 63.410000 63.410000 114.138000 12.682000
997 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 70.898750 3.931250 35.449375 39.380625 63.808875 11.021125
998 W63868001 R03AK07 COMBINATII (BUDESONIDUM + FORMOTEROLUM) * DUORESP SPIROMAX 320 micrograme/9 micrograme PULB. DE INHAL. 320micrograme/9micrograme TEVA PHARMA B.V. OLANDA 1 INHALATOR CE CONTINE 60 DOZE PRF 1 125.610000 0.000000 62.805000 62.805000 113.049000 12.561000
999 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 1 141.797500 2.842500 70.898750 73.741250 127.617750 17.022250
1,000 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 70.898750 13.371250 35.449375 48.820625 63.808875 20.461125

Pagina 14 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
1,001 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 70.898750 0.641250 35.449375 36.090625 63.808875 7.731125
1,002 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 1 141.797500 1.072500 70.898750 71.971250 127.617750 15.252250
1,003 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 1 212.696250 16.603750 106.348125 122.951875 191.426625 37.873375
1,004 W57995002 R03AK08 COMBINATII (BECLOMETASONUM+FORMOTEROLUM) FOSTER 100/6 micrograme pe doza SOL. DE INHALAT PRESURIZATA 100/6micrograme pe doza CHIESI PHARMACEUTICALS GMBH AUSTRIA CUT IE CU 1 FLAC. PRESURIZAT DIN AL PREVAZUT CU VALVA DOZAT OARE, INT RODUS IN DISPOZIT IVUL DE ADMINIST RARE DIN PE CU CAPAC PROT ECT OR DIN PLAST IC A 180 DOZE SOL. DE INHALAT PRF 1 212.160000 0.000000 106.080000 106.080000 190.944000 21.216000
1,005 W62575003 R03AK08 COMBINATII (BECLOMETASONUM+FORMOTEROLUM) FOSTER 200 micrograme/6 micrograme SOL. DE INHALAT PRESURIZATA 200micrograme/6micrograme CHIESI PHARMACEUTICALS GMBH AUSTRIA CUTIE CU 1 FLAC. PRESURIZAT DIN AL PREVAZUT CU VALVA DOZATOARE, INTRODUS INTR-UN DISPOZITIV DE ADMINISTRARE DIN PP CU CAPAC PROTECTOR CE ASIGURA 180 DE DOZE SOL. DE INHALAT PRESURIZATA PRF 1 212.696250 2.193750 106.348125 108.541875 191.426625 23.463375
1,006 W64767001 R03AL04 COMBINATII (INDACATEROLUM+GLICOPIRONIUM) ** ULTIBRO BREEZHALER 85 micrograme/43 micrograme CAPS. CU PULB. DE INHAL. 85micrograme/43micrograme NOVARTIS EUROPHARM LTD. IRLANDA CUTIE X 30 BLISTERE PERFORATE PA-AL-PVC/AL PENTRU ELIBERAREA UNEI UNITATI DOZATE X 1 CAPSULA CU PULBERE DE INHALAT + 1 INHALATOR PR/PRF 30 6.237666 0.000000 3.118833 3.118833 5.613899 0.623767
1,007 W61579001 R03AL05 ACLIDINIUM BROMIDUM+FORMOTEROLUM FUMARAT ** DUAKLIR GENUAIR 340 micrograme/12 micrograme PULB. DE INHAL. 340 micrograme/12 micrograme ASTRAZENECA AB SUEDIA CUTIE CU 1 INHALATOR A 60 DE DOZE PRF 1 215.325000 23.925000 107.662500 131.587500 193.792500 45.457500
1,008 W62377001 R03AL05 ACLIDINIUM BROMIDUM+FORMOTEROLUM FUMARAT ** BRIMICA GENUAIR 340 micrograme/12 micrograme PULB. DE INHAL. 340 micrograme/12 micrograme ASTRAZENECA AB SUEDIA CUTIE CU 1 INHALATOR A 60 DE DOZE PRF 1 215.325000 25.065000 107.662500 132.727500 193.792500 46.597500
1,009 W69355001 R03AL05 ACLIDINIUM BROMIDUM+FORMOTEROLUM FUMARAT ** DUAKLIR GENUAIR 340 micrograme/12 micrograme PULB. DE INHAL. 340 micrograme/12 micrograme COVIS PHARMA EUROPE B.V. OLANDA CUTIE CU 1 INHALATOR A 60 DE DOZE PRF 1 215.325000 23.925000 107.662500 131.587500 193.792500 45.457500
1,010 W61818005 R03AL06 COMBINATII (TIOTROPIUM+OLODATEROLUM) ** SPIOLTO RESPIMAT 2,5 micrograme/2,5 micrograme SOL. DE INHALAT 2,5 micrograme/2,5 micrograme BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU AMBALAJ UNIC FORMAT DIN 1 INHALATOR RESPIMAT REUTILIZABIL SI 1 CARTUS X 60 PUFURI (30 DOZE) SOL. DE INHALAT PRF 1 196.960000 5.520000 98.480000 104.000000 177.264000 25.216000
1,011 W61818007 R03AL06 COMBINATII (TIOTROPIUM+OLODATEROLUM) ** SPIOLTO RESPIMAT 2,5 micrograme/2,5 micrograme SOL. DE INHALAT 2,5 micrograme/2,5 micrograme BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU AMBALAJ UNIC PENTRU REINCARCARE FORMAT DIN 1 CARTUS X 60 PUFURI (30 DOZE) SOL. DE INHALAT PRF 1 195.120000 0.000000 97.560000 97.560000 175.608000 19.512000
1,012 W63847002 R03AL09 BECLOMETASONUM+FORMOTEROLUM+GLICOPIRONIU BROMIDUM ** TRIMBOW 87micrograme/5 micrograme/9 micrograme SOL. DE INHALAT PRESURIZATA 87mcg/5mcg/9mcg ITALIA 1 FLAC. PRESURIZAT CU 180 DOZE
CHIESI FARMACEUTICI S.P.A. PRF 1 329.810000 0.000000 164.905000 164.905000 296.829000 32.981000
1,013 W67403001 R03AL11 COMBINATII(FORMOTEROLUM+GLICOPIRONIUM+BUDESONIDUM) ** TRIXEO AEROSPHERE 5 micrograme/7,2 micrograme/160 micrograme 5µg/7,2µg/160µg ASTRAZENECA AB SUEDIA CUTIE CU UN FLACON X 120 DOZE
SUSP. DE INHALAT PRESURIZATA PRF 1 308.800000 0.000000 154.400000 154.400000 277.920000 30.880000
1,014 W66830002 R03AL12 INDACATEROLUM +GLICOPIRONIUM BROMIDUM+MOMETASONUM ENERZAIR BREEZHALER 114 micrograme/46 micrograme/136 micrograme PULB. DE INHAL. CAPSULE 114µg+46µg+136µg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 30 X 1 CAPSULA (UNITATE DOZATA) + 1 INHALATOR PRF 30 7.394000 0.000000 3.697000 3.697000 6.654600 0.739400
1,015 W65206002 R03BA05 FLUTICASONUM PROPIONAT FLIXOTIDE DISKUS 100 micrograme PULB. INHAL. 100micrograme GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 DISPOZITIV INHALATOR DIN PLASTIC SUB FORMA DE DISC X 1 BLIST. PVC/AL X 60 DOZE INDIVIDUALE P-RF 1 18.856800 19.983200 9.428400 29.411600 16.971120 21.868880
1,016 W65207002 R03BA05 FLUTICASONUM PROPIONAT FLIXOTIDE DISKUS 250 micrograme PULB. INHAL. 250micrograme GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 DISPOZITIV INHALATOR DIN PLASTIC SUB FORMA DE DISC X 1 BLIST. PVC/AL X 60 DOZE INDIVIDUALE P-RF 1 47.142000 16.148000 23.571000 39.719000 42.427800 20.862200
1,017 W65208002 R03BA05 FLUTICASONUM PROPIONAT FLIXOTIDE DISKUS 500 micrograme PULB. INHAL. 500micrograme GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 DISPOZITIV INHALATOR DIN PLASTIC SUB FORMA DE DISC X 1 BLIST. PVC/AL X 60 DOZE INDIVIDUALE P-RF 1 94.284000 4.586000 47.142000 51.728000 84.855600 14.014400
1,018 W69484001 R03BA05 FLUTICASONUM PROPIONAT FLIXON 50 micrograme/doza 50micrograme/doza CN UNIFARM S.A.
SUSP. DE INHALAT PRESURIZATA ROMANIA CUTIE CU 1 INHALATOR X 120 DOZE PRF 1 18.856800 30.053200 9.428400 39.481600 16.971120 31.938880
1,019 W69485001 R03BA05 FLUTICASONUM PROPIONAT FLIXAIR 0,5 mg/2 ml Suspensie pentru nebulizator 0,5mg/2ml CN UNIFARM S.A.
SUSP. DE INHALAT PRIN NEBULIZATOR ROMANIA CUTIE CU 10 FIOLE UNIDOZA A CATE 2 ML SUSP. PT. NEBULIZATOR PRF 10 0.628559 2.144441 0.314279 2.458721 0.565703 2.207297
1,020 W65201001 R03BA05 FLUTICASONUM PROPIONAT FLIXOTIDE 125 INHALER CFC - Free SUSP. INHAL. PRESURIZATA 125µg/doza GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE X 1 FLACON PRESURIZAT DIN AL X 60 DOZE SUSP. DE INHALAT PRESURIZATA P-RF 1 23.571000 17.149000 11.785500 28.934500 21.213900 19.506100
1,021 W63693001 R03BA05 FLUTICASONUM PROPIONAT ARQUIST 125 micrograme SUSP. INHAL. PRESURIZATA 125micrograme AMRING FARMA SRL ROMANIA CUTIE CU 1 RECIPIENT DIN AL SUB PRESIUNE PREVAZUT CU O VALVA DE MASURARE, UN DOZATOR DIN PP CU CAPAC, INTRODUS ÎNTR-O PUNGA DE AL CU SACULET DE SILICAGEL CARE CONTINE 120 DOZE SUSP. DE INHALAT PRESURIZATA PRF 1 47.142000 5.238000 23.571000 28.809000 42.427800 9.952200
1,022 W63695001 R03BA05 FLUTICASONUM PROPIONAT ARQUIST 250 micrograme SUSP. INHAL. PRESURIZATA 250micrograme AMRING FARMA SRL ROMANIA CUTIE CU 1 RECIPIENT DIN AL SUB PRESIUNE PREVAZUT CU O VALVA DE MASURARE, UN DOZATOR DIN PP CU CAPAC, INTRODUS ÎNTR-O PUNGA DE AL CU SACULET DE SILICAGEL CARE CONTINE 120 DOZE SUSP. DE INHALAT PRESURIZATA PRF 1 84.100000 0.000000 42.050000 42.050000 75.690000 8.410000
1,023 W65209001 R03BA05 FLUTICASONUM PROPIONAT FLIXOTIDE 50 µg/doza INHALER CFC-Free SUSP. INHAL. PRESURIZATA 50µg/doza GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN AL PRESURIZAT X 120 DOZE, PREVAZUT CU VALVA DOZATOARE SI DISPOZITIV DE ADMINISTRARE P-RF 1 18.856800 19.983200 9.428400 29.411600 16.971120 21.868880
1,024 W64226001 R03BA08 CICLESONIDUM ALVESCO 160 INHALER SOL. DE INHALAT PRESURIZATA 160micrograme/doza ASTRAZENECA AB SUEDIA CUTIE CU 1 FLAC. DIN AL CU VALVA DOZATOARE X 60 DOZE SOL. DE INHALAT PRESURIZATA PRF 1 85.860000 0.000000 42.930000 42.930000 77.274000 8.586000
1,025 W67523001 R03BA08 CICLESONIDUM ALVESCO 160 INHALER SOL. DE INHALAT PRESURIZATA 160micrograme/doza COVIS PHARMA EUROPE B.V. OLANDA CUTIE CU 1 FLAC. DIN AL CU VALVA DOZATOARE X 60 DOZE SOL. DE INHALAT PRESURIZATA PRF 1 85.860000 0.000000 42.930000 42.930000 77.274000 8.586000
1,026 W67508001 R03BB04 TIOTROPIUM DILOCHOB 18 micrograme CAPS. CU PULB. DE INHAL. 18 micrograme ZENTIVA, K.S. REPUBLICA CEHA CUTIE CARE CONTINE 30 DE CAPSULE (3 BLISTERE OPA-PVC-PET/AL ) SI UN INHALATOR MRX003-T10 DPI PRF 30 3.351000 0.000000 1.675500 1.675500 3.015900 0.335100
1,027 W57488004 R03BB04 TIOTROPIUM SPIRIVA 18 micrograme CAPS. CU PULB. INHAL. 18micrograme BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 3 BLIST. AL/PVC/AL X 10 CAPS. CU PULB. DE INHALAT + 1 DISPOZITIV HANDIHALER PRF 30 4.105333 0.485000 2.052666 2.537667 3.694799 0.895534
1,028 W63214002 R03BB04 TIOTROPIUM GREGAL 10 micrograme PULB. DE INHAL. CAPSULA 10micrograme TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN PEÎD CU CAPAC CU FILET DIN PP, FOLIE PROTECTOARE DIN PE, INEL DE SIGILARE SI CU REZERVOR DIN PEÎD CARE CONTINE SILICAGEL CU 30 CAPSULE SI UN INHALATOR ZONDA PRF 30 3.966000 0.000000 1.983000 1.983000 3.569400 0.396600
1,029 W58575005 R03BB04 TIOTROPIUM SPIRIVA RESPIMAT 2,5 micrograme SOL. DE INHALAT 2,5micrograme BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 1 INHALATOR RESPIMAT RE-UTILIZABIL SI 1 CARTUS CARE FURNIZEAZA 60 PUFURI (30 DOZE MEDICINALE) SOL. DE INHALAT PRF 1 123.160000 12.540000 61.580000 74.120000 110.844000 24.856000
1,030 W58575007 R03BB04 TIOTROPIUM SPIRIVA RESPIMAT 2,5 micrograme SOL. DE INHALAT 2,5micrograme BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 1 CARTUS CARE FURNIZEAZA 60 PUFURI (30 DOZE MEDICINALE) SOL. DE INHALAT PRF 1 123.160000 16.220000 61.580000 77.800000 110.844000 28.536000
1,031 W64726003 R03BB06 GLICOPIRONIUM BROMIDUM ** SEEBRI BREEZHALER CAPS. CU PULB. INHAL. 44 micrograme NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU BLIST. PERFORATE PA-AL-PVC/AL CE CONTINE 30 X 1 CAPSULA CU PULBERE PENTRU INHALAT INSOTITE DE UN INHALATOR PRF 30 4.105333 0.447333 2.052666 2.500000 3.694799 0.857867
1,032 W42796002 R03DA05 AMINOPHYLLINUM MIOFILIN 100 mg CAPS. 100mg ZENTIVA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.423822 0.978178 0.211911 1.190089 0.381439 1.020561
1,033 W68096001 R03DA05 AMINOPHYLLINUM AMINOFILINA BIOEEL 100 mg COMPR. 100mg ROMANIA CUTIE CU 2 BLIST. PVC/AL X 25 COMPR. PRF
BIOEEL MANUFACTURING S.R.L. 50 0.238800 0.000000 0.119400 0.119400 0.214920 0.023880
1,034 W57342001 R03DA05 AMINOPHYLLINUM MIOFILIN 24mg/ml SOL. INJ. 24mg/ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE PREVAZUTE CU INEL DE RUPERE X 10 ML SOL.INJ. S/P-RF 5 19.304000 0.000000 9.652000 9.652000 17.373600 1.930400
1,035 W51362004 R03DC03 MONTELUKASTUM SINGULAIR 10 mg COMPR. FILM. 10mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC X 14 COMPR. FILM. P6L 28 0.995333 1.059309 0.497666 1.556976 0.895799 1.158843
1,036 W56500003 R03DC03 MONTELUKASTUM MONTELUKAST ACTAVIS 10 mg COMPR. FILM. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.995333 0.000000 0.497666 0.497667 0.895799 0.099534
1,037 W56686005 R03DC03 MONTELUKASTUM MONKASTA 10 mg COMPR. FILM. 10mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC//AL X 28 COMPR. FILM. P6L 28 0.995333 0.187167 0.497666 0.684834 0.895799 0.286701
1,038 W67985003 R03DC03 MONTELUKASTUM MONTELUKAST TEVA 10 mg COMPR. FILM. 10mg TEVA B.V. OLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P6L 30 0.995333 0.000000 0.497666 0.497667 0.895799 0.099534
1,039 W68218002 R03DC03 MONTELUKASTUM SINGULAIR 10 mg COMPR. FILM. 10mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. OPA-AL-PVC/AL X 14 COMPR. FILM. P6L 28 0.995333 1.059309 0.497666 1.556976 0.895799 1.158843
1,040 W68468005 R03DC03 MONTELUKASTUM MONTELUKAST MEDREG 10 mg COMPR. FILM. 10mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 0.936428 0.000000 0.468214 0.468214 0.842785 0.093643
1,041 W56567005 R03DC03 MONTELUKASTUM MONTELUKAST ACTAVIS 4 mg COMPR. MAST. 4mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. MAST. P6L 30 0.548000 0.000000 0.274000 0.274000 0.493200 0.054800
1,042 W56684005 R03DC03 MONTELUKASTUM MONKASTA 4 mg COMPR. MAST. 4mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC//AL X 28 COMPR. MAST. P6L 28 0.634642 0.000000 0.317321 0.317321 0.571177 0.063465
1,043 W58747005 R03DC03 MONTELUKASTUM SINGULAIR 4 mg COMPR. MAST. 4mg MERCK SHARP & DOHME ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. MAST. P6L 28 0.637409 1.263662 0.318704 1.582367 0.573668 1.327403
1,044 W67728005 R03DC03 MONTELUKASTUM MONTELUKAST TEVA 4 mg COMPR. MAST. 4mg TEVA B.V. OLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. MAST. P6L 30 0.548000 0.000000 0.274000 0.274000 0.493200 0.054800
1,045 W68298005 R03DC03 MONTELUKASTUM SINGULAIR 4 mg COMPR. MAST. 4mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. MAST. P6L 28 0.637409 1.263662 0.318704 1.582367 0.573668 1.327403
1,046 W51361004 R03DC03 MONTELUKASTUM SINGULAIR 5 mg COMPR. MAST. 5mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 14 COMPR. MAST. P6L 28 0.796762 1.257880 0.398381 1.656261 0.717085 1.337557
1,047 W56685005 R03DC03 MONTELUKASTUM MONKASTA 5 mg COMPR. MAST. 5mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC//AL X 28 COMPR. MAST. P6L 28 0.796762 0.010380 0.398381 0.408761 0.717085 0.090057
1,048 W68217002 R03DC03 MONTELUKASTUM SINGULAIR 5 mg COMPR. MAST. 5mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. OPA-AL-PVC/AL X 14 COMPR. MAST. P6L 28 0.796762 1.257880 0.398381 1.656261 0.717085 1.337557
1,049 W58090003 R03DC03 MONTELUKASTUM SINGULAIR 4 mg GRANULE 4mg MERCK SHARP & DOHME ROMANIA CUTIE CU 28 PLICURI DIN PE/AL/POLIESTER CU GRANULE P6L 28 0.637409 1.263662 0.318704 1.582367 0.573668 1.327403
1,050 W68297003 R03DC03 MONTELUKASTUM SINGULAIR 4 mg GRANULE 4mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 28 PLICURI DIN PE/AL/POLIESTER CU GRANULE P6L 28 0.637409 1.263662 0.318704 1.582367 0.573668 1.327403
1,051 W59312001 R05DA09 DEXTROMETHORPHANUM TUSSIN FORTE 20 mg COMPR. 20mg GLAXOSMITHKLINE (GSK) SRL ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.449000 0.000000 0.224500 0.224500 0.404100 0.044900
1,052 W67666001 R05DA09 DEXTROMETHORPHANUM TUSSIN FORTE 20 mg COMPR. 20mg GLAXOSMITHKLINE TRADING SERVICES LIMITED IRLANDA CUTIE CU 2 BLIST. PVC/AL/HÂRTIE X 10 COMPR. P6L 20 0.449000 0.000000 0.224500 0.224500 0.404100 0.044900
1,053 W06856002 R05DA09 DEXTROMETHORPHANUM ROFEDEX 15mg/5ml SIROP 15mg/5ml BIOFARM SA ROMANIA CUTIE X 1 FLACON DIN STILCA BRUNA X 100 ML + MASURA DOZATOARE P-RF 1 6.735006 6.304994 3.367503 9.672497 6.061505 6.978495
1,054 W60140007 R06AE09 LEVOCETIRIZINUM ZENARO 5 mg COMPR. FILM. 5mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-ACLAR-PVC/AL X 20 COMPR. FILM. P6L 20 0.691000 0.000000 0.345500 0.345500 0.621900 0.069100
1,055 W60140017 R06AE09 LEVOCETIRIZINUM ZENARO 5 mg COMPR. FILM. 5mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PE-PVDC/AL X 20 COMPR. FILM. P6L 20 0.691000 0.000000 0.345500 0.345500 0.621900 0.069100
1,056 W65372011 R06AE09 LEVOCETIRIZINUM XYZAL 5 mg COMPR. FILM. 5mg UCB PHARMA GMBH GERMANIA CUTIE CU 3 BLIST. PVC-AL-OPA/AL X 10 COMPR. FILM. P6L 30 0.716333 0.000000 0.358166 0.358167 0.644699 0.071634
1,057 W58148003 R06AE09 LEVOCETIRIZINUM XYZAL 5 mg/ml PIC. ORALE, SOL. 5mg/ml UCB PHARMA GMBH GERMANIA CUTIE X 1 FLACON DIN STICLA BRUNA X 20 ML PIC. ORALE, SOL., PREVAZUT CU PICURATOR P-6L 1 25.331994 7.508006 12.665997 20.174003 22.798794 10.041206
1,058 W58162004 R06AX27 DESLORATADINUM DASSELTA COMPR. FILM. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPRIMATE FILMATE PRF 30 0.463333 0.000000 0.231666 0.231667 0.416999 0.046334
1,059 W58483007 R06AX27 DESLORATADINUM DESLORATADINA TERAPIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE CU BLIST. PCTFE-PVC/AL X 30 COMPR. FILM. P6L 30 0.555082 0.150251 0.277541 0.427792 0.499573 0.205760
1,060 W58380003 R06AX27 DESLORATADINUM LORDESTIN 5 mg COMPR. FILM. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. FILM. P6L 30 0.555082 0.030584 0.277541 0.308125 0.499573 0.086093
1,061 W64162003 R06AX27 DESLORATADINUM DESLORATADINA AUROBINDO 5 mg COMPR. FILM. 5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. FILM. P6L 30 0.382666 0.000000 0.191333 0.191333 0.344399 0.038267
1,062 W64699011 R06AX27 DESLORATADINUM AERIUS 5 mg COMPR. FILM. 5mg MERCK SHARP & DOHME OLANDA CUTIE CU 30 COMPR. FILM. ( PCTFE/ PVC/AL) PRF 30 0.555082 0.313584 0.277541 0.591125 0.499573 0.369093
1,063 W64699006 R06AX27 DESLORATADINUM AERIUS 5 mg COMPR. FILM. 5mg MERCK SHARP & DOHME OLANDA CUTIE CU 10 COMPR. FILM. ( PCTFE/ PVC/AL) PRF 10 0.555082 0.515918 0.277541 0.793459 0.499573 0.571427
1,064 W67690011 R06AX27 DESLORATADINUM AERIUS 5 mg COMPR. FILM. 5mg N.V. ORGANON OLANDA CUTIE CU 30 COMPR. FILM. ( PCTFE/ PVC/AL) PRF 30 0.555082 0.313584 0.277541 0.591125 0.499573 0.369093
1,065 W67690006 R06AX27 DESLORATADINUM AERIUS 5 mg COMPR. FILM. 5mg N.V. ORGANON OLANDA CUTIE CU 10 COMPR. FILM. ( PCTFE/ PVC/AL) PRF 10 0.555082 0.515918 0.277541 0.793459 0.499573 0.571427
1,066 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 11.900000 1.640000 5.950000 7.590000 10.710000 2.830000
1,067 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 11.900000 1.640000 5.950000 7.590000 10.710000 2.830000
1,068 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 11.900000 1.920000 5.950000 7.870000 10.710000 3.110000
1,069 W67693005 R06AX27 DESLORATADINUM AERIUS 0,5mg/ml SOL. ORALA 0,5mg/ml N.V. ORGANON OLANDA CUTIE CU 1 FLAC. DIN STICLA X 120 ML SOL. ORALA + LINGURITA DOZATOARE DE 2,5 ML SI 5 ML PRF 1 11.900000 1.920000 5.950000 7.870000 10.710000 3.110000
1,070 W66903002 R06AX27 DESLORATADINUM DESLORATADINA FITERMAN 0,5 mg/ml SOL. ORALA 0,5mg/ml FITERMAN PHARMA S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA DE CULOARE BRUNA SI O LINGURITA DOZATOARE DIN POLISTIREN SI CONTINE 100 ML SOL. ORALA P6L 1 9.890000 0.000000 4.945000 4.945000 8.901000 0.989000
1,071 W66903003 R06AX27 DESLORATADINUM DESLORATADINA FITERMAN 0,5 mg/ml SOL. ORALA 0,5mg/ml FITERMAN PHARMA S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA DE CULOARE BRUNA SI O LINGURITA DOZATOARE DIN POLISTIREN SI CONTINE 150 ML SOL. ORALA P6L 1 14.850000 0.000000 7.425000 7.425000 13.365000 1.485000
1,072 W66903001 R06AX27 DESLORATADINUM DESLORATADINA FITERMAN 0,5 mg/ml SOL. ORALA 0,5mg/ml FITERMAN PHARMA S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA DE CULOARE BRUNA SI O LINGURITA DOZATOARE DIN POLISTIREN SI CONTINE 60 ML SOL. ORALA P6L 1 5.950000 0.000000 2.975000 2.975000 5.355000 0.595000

Pagina 15 din 16
Contributie maxima a Val. maxima suportata Val. maxima suportata
asiguratului / UT (pt. de sistemul de asigurari Contributie maxima a de sistemul de asigurari Contributie maxima a
asiguratii care sociale de sanatate / UT asiguratului / UT (pt. sociale de sanatate / UT asiguratului / UT (pt.

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

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


Nr crt.

Tara det. amba referinta / UT din pretul de compensare 50% din compensare 50% din compensare 90% din compensare 90% din
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) pretul de referinta) pretul de referinta) pretul de referinta) pretul de referinta)
1,073 W44051001 S01AA11 GENTAMICINUM GENTAMICINA SULFAT EIPICO 3 mg/ml PIC. OFT., SOL 3mg/ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN PEJD PREVAZUT CU PICURATOR X 10 ML PIC. OFT. SOL. P-RF 1 10.878000 6.692000 5.439000 12.131000 9.790200 7.779800
1,074 W53829001 S01AA12 TOBRAMYCINUM TOBROM 3 mg/ml PIC. OFT., SOL 3mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE C 1 FLAC. PEJD X 5 ML PIC. OFT. SOL P-RF 1 6.530000 0.000000 3.265000 3.265000 5.877000 0.653000
1,075 W63542001 S01AA12 TOBRAMYCINUM TOBREX 3 mg/ml PIC. OFT.,SOL. 3mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE CU 1 FLACON DIN PEJD, PREVAZUT CU PICURATOR DIN PEJD CARE CONTINE 5 ML PIC. OFTALMICE, SOL. PRF 1 9.065000 0.845000 4.532500 5.377500 8.158500 1.751500
1,076 W63543001 S01AA12 TOBRAMYCINUM TOBREX 3 mg/g UNG. OFT. 3mg/g NOVARTIS PHARMA GMBH GERMANIA CUTIE X 1 TUB DIN AL X 3,5 G UNGUENT OFTALMIC P-RF 1 6.798750 4.121250 3.399375 7.520625 6.118875 4.801125
1,077 W12757001 S01AA23 NETILMICINUM NETTACIN 3 mg/ml PIC. OFT., SOL 3mg/ml S.I.F.I. SPA ITALIA CUTIE X 1 FLACON X 5ML P-RF 1 32.360000 0.000000 16.180000 16.180000 29.124000 3.236000
1,078 W41510001 S01AA23 NETILMICINUM NETTACIN 3 mg/ml PICATURI OFT.-SOL. 3mg/ml S.I.F.I. SPA ITALIA CUTIE X 3 FOLII TERMOSUDATE X 5 FLACOANE UNIDOZA DIN POLIETILENA X 0,3 ML P-RF 15 1.985220 0.484780 0.992610 1.477390 1.786698 0.683302
1,079 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 33.087000 8.483000 16.543500 25.026500 29.778300 11.791700
1,080 W41891001 S01AE01 OFLOXACINUM FLOXAL 3 mg/ml PICATURI OFT.-SOL. 3mg/ml DR. GERHARD MANN CHEM.PHARM.FABRIK GMBH GERMANIA CUTIE CU 1 FLACON PICURATOR DIN PEJD X 5 ML PICATURI OFT., SOL. P6L 1 11.935000 0.125000 5.967500 6.092500 10.741500 1.318500
1,081 W41890001 S01AE01 OFLOXACINUM FLOXAL 3 mg/g UNG. OFT. 3mg/g DR. GERHARD MANN CHEM.PHARM.FABRIK GMBH GERMANIA CUTIE CU 1 TUB DIN AL LAMINAT, CU DOP PREVAZUT CU VARF APLICATOR DIN PEID SI CAPAC DIN PEID X 3 G UNGUENT P6L 1 17.840000 0.000000 8.920000 8.920000 16.056000 1.784000
1,082 W55648001 S01BA01 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 1mg/ml PIC. OFT. SUSP. 1mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE X 1 FLAC. DIN PEID X 5 ML PIC. OFT., SUSPENSIE P-RF 1 6.950000 0.000000 3.475000 3.475000 6.255000 0.695000
1,083 W63597001 S01BA01 DEXAMETHASONUM MAXIDEX 1 mg/ml PICATURI OFT.-SUSP. 1 mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE CU 1 FLAC. DIN PEJD, PREVAZUT CU PICURATOR DIN PEJD X 5 ML PIC. OFT., SOL. P-RF 1 7.234999 0.285001 3.617499 3.902501 6.511499 1.008501
1,084 W60319001 S01BA06 BETAMETHASONUM OPHTAMESONE 1 mg/ml PIC. OFT./AURIC./NAZALE SOL. 1 mg/ml DAR AL DAWA PHARMA S.R.L. ROMANIA CUTIE CU 1 FLAC. PEJD, PREVAZUT CU APLICATOR PT. PICURARE DIN PEJD A 10 ML PIC. OFT., AURICULARE, NAZALE SOL. P6L 1 25.820000 0.000000 12.910000 12.910000 23.238000 2.582000
1,085 W43768002 S01CA01 COMBINATII ( NETILMICINUM + DEXAMETHASONUM) Netildex 3 mg/1 mg/ml PIC. OFT., SOL IN FLAC. UNIDOZA 3mg/1mg/ml S.I.F.I. SPA ITALIA CUTIE X 20 FLAC. UNIDOZA DIN PEJD X 0,3 ML PIC.OFT. SOL. P-RF 20 0.608676 2.937324 0.304338 3.241662 0.547808 2.998192
1,086 W43769001 S01CA01 COMBINATII ( NETILMICINUM + DEXAMETHASONUM) NETILDEX 3 mg/1 mg/ml PIC. OFT.,SOL. 3mg/1mg/ml S.I.F.I. SPA ITALIA CUTIE X 1 FLACON DIN PEJD X 5 ML PIC. OFT.SOL. P-RF 1 10.144607 37.545393 5.072303 42.617697 9.130146 38.559854
1,087 W58786001 S01CA01 COMBINATII (CLORAMPHENICOLUM+DEXAMETHASONUM) SPERSADEX COMP PICATURI OFT.-SOL. 5mg/ml+1mg/ml LABORATOIRES THEA FRANTA CUTIE X 1 FLACON X 5 ML SOL. OFT. + PICURATOR P-RF 1 10.144607 6.385393 5.072303 11.457697 9.130146 7.399854
1,088 W55127001 S01CA01 COMBINATII (TOBRAMYCINUM +DEXAMETAZONUM) DEXATOBROM 3 mg+1 mg/ml PIC. OFT. SUSP. 3mg+1mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLAC. PEJD A 5 ML + PICURATOR P-RF 1 6.440000 0.000000 3.220000 3.220000 5.796000 0.644000
1,089 W63594001 S01CA01 COMBINATII (TOBRAMYCINUM +DEXAMETAZONUM) TOBRADEX PICATURI OFT.-SUSP. 3mg/1mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE CU 1 FLAC. DIN PEJD, PREVAZUT CU PICURATOR DIN PEJD X 5 ML PIC. OFT., SUSP. PRF 1 9.910000 0.000000 4.955000 4.955000 8.919000 0.991000
1,090 W63595001 S01CA01 COMBINATII (TOBRAMYCINUM +DEXAMETAZONUM) TOBRADEX UNG. OFT. 3mg/1mg/g NOVARTIS PHARMA GMBH GERMANIA CUTIE CU 1 TUB AL, PREVAZUT CU APLICATOR DIN PEJD X 3,5 G UNG. OFT. PRF 1 7.101224 3.648776 3.550612 7.199388 6.391101 4.358899
1,091 W63173001 S01GX09 OLOPATADINUM OLOPATADINA ROMPHARM 1 mg/ml PIC. OFT., SOL. 1mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLAC. ALB. DIN PEJD X 5 ML PIC. OFT. SOL., PREVAZUT CU PICURATOR ALB DIN PEJD PRF 1 22.137500 1.062500 11.068750 12.131250 19.923750 3.276250
1,092 W64476001 S01GX09 OLOPATADINUM OPATANOL 1mg/ml PIC. OFT., SOL. 1mg/ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 FLAC. X 5 ML PRF 1 22.137500 1.062500 11.068750 12.131250 19.923750 3.276250
1,093 W67299002 S01GX09 OLOPATADINUM OLOPATADINA UNIMED PHARMA 1 mg/ml PIC. OFT., SOL. 1mg/ml UNIMED PHARMA SPOL. S.R.O. SLOVACIA CUTIE CU 1 FLAC. DIN PE CU PICURATOR NOVELIA X 10 ML PIC. OFT., SOL. PRF 1 42.150000 0.000000 21.075000 21.075000 37.935000 4.215000

NOTĂ:
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu * se iniţiază de medicul de specialitate în limita competenţei şi poate fi prescris în continuare de medicul de familie pe baza scrisorii
medicale emise de medicul de specialitate.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu ** se efectuează pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sănătăţii.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu (2) se prescrie numai în etapa pregătitoare pentru colonoscopie.
- Pentru medicamentele corespunzătoare DCI-urilor notate cu # regulile de prescriere sunt stabilite prin contractul-cadru.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu **1 se efectuează pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sănătăţii şi pot fi administrate şi
în regim de spitalizare de zi.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu Ω se efectuează în baza contractelor cost-volum încheiate.

Pagina 16 din 16
ANEXA 2c

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, REPUBLICATA, 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 AUGUST 2023

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

1 W62286004 A10BK01 DAPAGLIFLOZINUM ** FORXIGA 10 mg COMPR. FILM. 10mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. DIN ALU/ALU X 30X1 COMPR. FILM. (UNITATE DOZATA) PRF 30 6.785000 6.785000 0.000000
2 W62286005 A10BK01 DAPAGLIFLOZINUM ** FORXIGA 10 mg COMPR. FILM. 10mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. DIN ALU/ALU X 90X1 COMPR. FILM. (UNITATE DOZATA PRF 90 6.294555 6.294555 0.000000
3 W60940002 A10BK03 EMPAGLIFLOZINUM ** JARDIANCE 10mg COMPR. FILM. 10mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU BLIST. PERFORATE DIN PVC/AL PENTRU ELIBERAREA UNEI UNITATI DOZATE X 90X1 COMPR. FILM. PRF 90 6.423000 6.423000 0.000000
4 W00009002 B01AA07 ACENOCUMAROLUM TROMBOSTOP 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.690333 0.690333 0.000000
5 W62461001 B01AA07 ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg MERUS LABS LUXCO II S.A.R.L. CUTIE CU 2 BLIST. AL/PVC X 10 COMPR.
LUXEMBURG P-RF 20 0.430500 0.430500 0.000000
6 W58535002 C01AA05 DIGOXINUM DIGOXINA ZENTIVA 0,25 mg COMPR. 0,25mg ZENTIVA S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-RF 25 0.344400 0.344400 0.844000
7 W66390001 C01AA05 DIGOXINUM DIGOXIN LECIVA 0,25 mg COMPR. 0,25mg S.C. ZENTIVA S.A. ROMANIA CUTIE CU 1 BLISTER X 30 COMPR. PRF 30 0.287000 0.287000 0.000000
8 W60427001 C01AA05 DIGOXINUM DIGOXIN ZENTIVA 0,5 mg/2ml SOL. INJ. 0,5mg/2ml ZENTIVA S.A. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA, CU INEL DE RUPERE X 2 ML SOL. INJ. P-RF 5 10.990000 10.990000 0.000000
9 W43198002 C03AA03 HYDROCHLOROTHIAZIDUM NEFRIX 25 mg COMPR. 25mg ZENTIVA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-6L 25 1.431600 1.431600 0.000000
10 W03265002 C03CA01 FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.389000 0.389000 0.000000
11 W42036002 C03CA01 FUROSEMIDUM FUROSEMID SLAVIA 40 mg COMPR. 40mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.397500 0.397500 0.000000
12 W43155001 C03CA01 FUROSEMIDUM FUROSEMID ZENTIVA 40 mg COMPR. 40mg ZENTIVA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 20 COMPR. P-6L 20 0.397500 0.397500 0.000000
13 W52043001 C03CA01 FUROSEMIDUM FUROSEMID ARENA 40 mg COMPR. 40mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.397500 0.397500 0.000000
14 W60369001 C03CA01 FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.397500 0.397500 0.000000
15 W03264003 C03CA01 FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. DIN PVC/AL X 10 COMPRIMATE P-6L 30 0.398000 0.398000 0.000000
16 W03265003 C03CA01 FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P6L 30 0.398000 0.398000 0.000000
17 W67808003 C03CA01 FUROSEMIDUM FUROSEMID MEDREG 40 mg COMPR. 40mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.376333 0.376333 0.000000
18 W68090001 C03CA01 FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.397500 0.397500 0.000000
19 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 1.538000 1.538000 0.000000
20 W68522002 C03CA01 FUROSEMIDUM FUROSEMID HAMELN 10 mg/ml SOL INJ. 10mg/ml HAMELN PHARMA 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 1.538000 1.538000 0.000000
21 W58282001 C03CA01 FUROSEMIDUM FUROSEMID ZENTIVA 20 mg/2 ml SOL. INJ. 20mg/2ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 2 ML SOL. INJ. P-RF 5 1.606000 1.606000 0.000000
22 W55360002 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA ARENA 25 mg CAPS. 25mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 CAPS. P-6L 50 0.471800 0.471800 0.000000
23 W57830002 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA LPH 25 mg CAPS. 25mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 6 BLIST. PVC/AL X 10 CAPS. P6L 60 0.472000 0.472000 0.000000
24 W54823001 C03DA01 SPIRONOLACTONUM VEROSPIRON CAPS. 50mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6L 30 0.510666 0.510666 0.000000
25 W55359001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA ARENA 50 mg CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P-6L 30 0.612799 0.612799 0.262867
26 W60370001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA BIOEEL 25 mg COMPR. 25mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.471500 0.471500 0.000000
27 W68089001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA BIOEEL 25 mg COMPR. 25mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.471500 0.471500 0.000000
28 W08893001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA TERAPIA 25 mg COMPR. FILM. 25mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 50 0.471800 0.471800 0.000000
29 W52138001 C03DA01 SPIRONOLACTONUM ALSPIRON 25 mg COMPR. FILM. 25mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 0.471500 0.471500 0.000000
30 W41550001 C03DA01 SPIRONOLACTONUM ALSPIRON 50 mg COMPR. FILM. 50mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 0.612799 0.612799 0.263201
31 W04263002 C07AB02 METOPROLOLUM BETAPROL 100 mg COMPR. 100mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.367200 0.367200 0.010466
32 W04266001 C07AB02 METOPROLOLUM EGILOK 100 mg COMPR. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X, 1 FLAC. DIN STICLA BRUNA X 20 COMPR. P-6L 20 0.367200 0.367200 0.010300
33 W07222003 C07AB02 METOPROLOLUM METOPROLOL LPH 100 mg COMPR. 100mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.367200 0.367200 0.010466
34 W42176001 C07AB02 METOPROLOLUM METOPROLOL MCC 100 mg COMPR. 100mg MAGISTRA C & C SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.367200 0.367200 0.005133
35 W52230001 C07AB02 METOPROLOLUM METOPROLOL TERAPIA 100 mg COMPR. 100mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.367200 0.367200 0.010466
36 W53669001 C07AB02 METOPROLOLUM METOPROLOL VIM SPECTRUM 100 mg COMPR. 100mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.367200 0.367200 0.010300
37 W53941002 C07AB02 METOPROLOLUM METOPROLOL ARENA 100 MG COMPR. 100mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.367200 0.367200 0.010466
38 W57206001 C07AB02 METOPROLOLUM METOPROLOL SLAVIA 100 mg COMPR. 100mg SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0.367200 0.367200 0.002800
39 W42025001 C07AB02 METOPROLOLUM METOPROLOL MCC 25 mg COMPR. 25mg MAGISTRA C & C SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.189666 0.189666 0.000000
40 W53922001 C07AB02 METOPROLOLUM METOPROLOL ARENA 25 MG COMPR. 25mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.189666 0.189666 0.000000
41 W42973003 C07AB02 METOPROLOLUM METOPROLOL LPH 25 mg COMPR. 25mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 20 COMPR. P-6L 60 0.190000 0.190000 0.000000
42 W04264002 C07AB02 METOPROLOLUM BETAPROL 50 mg COMPR. 50mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.231199 0.231199 0.079134
43 W04268001 C07AB02 METOPROLOLUM EGILOK 50 mg COMPR. 50mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 20 COMPR. P-6L 20 0.219000 0.219000 0.000000
44 W07223003 C07AB02 METOPROLOLUM METOPROLOL LPH 50 mg COMPR. 50mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.231199 0.231199 0.079134
45 W42197001 C07AB02 METOPROLOLUM METOPROLOL MCC 50 mg COMPR. 50mg MAGISTRA C & C SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.231199 0.231199 0.079134
46 W52231001 C07AB02 METOPROLOLUM METOPROLOL TERAPIA 50 mg COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.231199 0.231199 0.083801
47 W53670001 C07AB02 METOPROLOLUM METOPROLOL VIM SPECTRUM 50 mg COMPR. 50mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.231199 0.231199 0.083801
48 W53940001 C07AB02 METOPROLOLUM METOPROLOL ARENA 50 MG COMPR. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.231199 0.231199 0.079134
49 W57205001 C07AB02 METOPROLOLUM METOPROLOL SLAVIA 50 mg COMPR. 50mg SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0.231199 0.231199 0.079801
50 W43226004 C07AB02 METOPROLOLUM METOSUCCINAT SANDOZ 47,5 mg COMPR. CU ELIB. MODIF. 47,5mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. ACLAR-PVC/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.231199 0.231199 0.044134

Pagina 1 din 37
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)
51 W43227004 C07AB02 METOPROLOLUM METOSUCCINAT SANDOZ 95 mg COMPR. CU ELIB. MODIF. 95mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. ACLAR-PVC/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.367200 0.367200 0.090466
52 W43226010 C07AB02 METOPROLOLUM METOSUCCINAT SANDOZ 47,5 mg COMPR. ELIB. MODIF. 47,5mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PP/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.231199 0.231199 0.044134
53 W43227010 C07AB02 METOPROLOLUM METOSUCCINAT SANDOZ 95 mg COMPR. ELIB. MODIF. 95mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PP/AL X 10 COMPR. ELIB. MODIF. P-6L 30 0.367200 0.367200 0.090466
54 W66032001 C07AB02 METOPROLOLUM BETALOC ZOK 100 mg COMPR. ELIB. PREL. 100mg RECORDATI INDUSTRIA CHIMICA E FARMACEUTICA S.P.A. ITALIA CUTIE CU 1 FLAC. PEID X 30 COMPR. ELIB. PREL. P6L 30 0.367200 0.367200 0.660466
55 W66033001 C07AB02 METOPROLOLUM BETALOC ZOK 50 mg COMPR. ELIB. PREL. 50mg RECORDATI INDUSTRIA CHIMICA E FARMACEUTICA S.P.A. ITALIA CUTIE CU 1 FLAC. PEID X 30 COMPR. ELIB. PREL. P6L 30 0.231199 0.231199 0.437467
56 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 0.306000 0.306000 0.000000
57 W67867004 C07AB02 METOPROLOLUM METOPROLOL MEDREG 100 mg COMPR. FILM. 100mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.367200 0.367200 0.010466
58 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 0.231199 0.231199 0.041134
59 W67866004 C07AB02 METOPROLOLUM METOPROLOL MEDREG 50 mg COMPR. FILM. 50mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.192666 0.192666 0.000000
60 W66031001 C07AB02 METOPROLOLUM BETALOC 5 mg/5 ml SOL. INJ. I.V/PERF. 5mg/5ml RECORDATI INDUSTRIA CHIMICA E FARMACEUTICA S.P.A. ITALIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 5 ML SOL. INJ. I.V./PERF. PR 5 4.084000 4.084000 0.000000
61 W69093003 C07AB07 BISOPROLOLUM CORSIB 10 mg COMPR. 10mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.348360 0.348360 0.361306
62 W69091003 C07AB07 BISOPROLOLUM CORSIB 2,5 mg COMPR. 2,5mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.309666 0.309666 0.000000
63 W69092003 C07AB07 BISOPROLOLUM CORSIB 5 mg COMPR. 5mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. P6L 30 0.201120 0.201120 0.121546
64 W60569004 C07AB07 BISOPROLOLUM SOBYC 10 mg COMPR. FILM. 10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 0.348360 0.348360 0.094973
65 W60567004 C07AB07 BISOPROLOLUM SOBYC 2,5 mg COMPR. FILM. 2,5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 0.309666 0.309666 0.000000
66 W66288002 C07AB07 BISOPROLOLUM CONCOR COR 2,5 mg COMPR. FILM. 2,5mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.371599 0.371599 0.008067
67 W60358002 C07AB07 BISOPROLOLUM CONCOR COR 5 mg COMPR. FILM. 5mg MERCK KGAA GERMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.201120 0.201120 0.295546
68 W60568004 C07AB07 BISOPROLOLUM SOBYC 5 mg COMPR. FILM. 5mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 0.201120 0.201120 0.065546
69 W66287002 C07AB07 BISOPROLOLUM CONCOR COR 5 mg COMPR. FILM. 5mg MERCK ROMANIA SRL ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.201120 0.201120 0.295546
70 W04501004 C07AB12 NEBIVOLOLUM ** NEBILET 5 mg COMPR. 5mg BERLIN CHEMIE AG MENARINI GROUP GERMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 0.534799 0.534799 0.234129
71 W53839001 C07AB12 NEBIVOLOLUM ** NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC- PE- PVDC/AL X 10 COMPR. P-6L 30 0.532666 0.532666 0.000000
72 W64198003 C07AB12 NEBIVOLOLUM ** NEBIVOLOL AUROBINDO 5 mg COMPR. 5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 30 COMPR. P6L 30 0.445666 0.445666 0.000000
73 W64800005 C07AB12 NEBIVOLOLUM ** NEBIVOLOL TEVA 5 mg COMPR. 5mg TEVA B.V. OLANDA CUTIE CU 3 BLIST. PVDC/AL X 10 COMPR. P6L 30 0.534799 0.534799 0.001534
74 W65312001 C07AB12 NEBIVOLOLUM ** NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.532666 0.532666 0.000000
75 W59931001 C07AG02 CARVEDILOLUM CARVEDILOL SANDOZ 12,5 mg COMPR. 12,5 mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.397713 0.397713 0.204620
76 W12649001 C07AG02 CARVEDILOLUM CORYOL 12,5 mg COMPR. 12,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 4 BLIST. OPA-AL-PVC/AL X 7 COMPR. P-6L 28 0.331428 0.331428 0.000000
77 W42058001 C07AG02 CARVEDILOLUM TALLITON 12,5 mg COMPR. 12,5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P-6L 30 0.344000 0.344000 0.000000
78 W42659001 C07AG02 CARVEDILOLUM CARVEDILOL LPH 12,5 mg COMPR. 12,5mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC ALB OPAC/AL X 10 COMPR. P-6L 30 0.397713 0.397713 0.922287
79 W53658001 C07AG02 CARVEDILOLUM CARVEDILOL VIM SPECTRUM 12,5mg COMPR. 12,5mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.397713 0.397713 0.293287
80 W53751001 C07AG02 CARVEDILOLUM GLADYCOR 12,5 mg COMPR. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.397713 0.397713 0.093287
81 W58304001 C07AG02 CARVEDILOLUM CARVEDILOL HELCOR 12,5 mg COMPR. 12,5mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.397713 0.397713 0.294287
82 W63454001 C07AG02 CARVEDILOLUM CARVEDILOL SLAVIA 12,5 mg COMPR. 12,5mg SLAVIA PHARM S.R.L. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.397713 0.397713 0.905620
83 W42058002 C07AG02 CARVEDILOLUM TALLITON 12,5 mg COMPR. 12,5mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU 2 BLIST. DIN OPA-AL-PVC/AL X 15 COMPR. P6L 30 0.344000 0.344000 0.000000
84 W12648002 C07AG02 CARVEDILOLUM CORYOL 25 mg COMPR. 25mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 14 COMPR. P-6L 28 0.453571 0.453571 0.000000
85 W42059001 C07AG02 CARVEDILOLUM TALLITON 25 mg COMPR. 25mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P-6L 30 0.544285 0.544285 0.104381
86 W42658001 C07AG02 CARVEDILOLUM CARVEDILOL LPH 25 mg COMPR. 25mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC ALB OPAC/AL X 10 COMPR. P-6L 30 0.544285 0.544285 0.832048
87 W53752001 C07AG02 CARVEDILOLUM GLADYCOR 25 mg COMPR. 25mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.544285 0.544285 0.123381
88 W58305001 C07AG02 CARVEDILOLUM CARVEDILOL HELCOR 25 mg COMPR. 25mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.544285 0.544285 0.224715
89 W59932001 C07AG02 CARVEDILOLUM CARVEDILOL SANDOZ 25 mg COMPR. 25mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.544285 0.544285 0.301048
90 W63455001 C07AG02 CARVEDILOLUM CARVEDILOL SLAVIA 25 mg COMPR. 25mg SLAVIA PHARM S.R.L. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.544285 0.544285 0.838381
91 W42059002 C07AG02 CARVEDILOLUM TALLITON 25 mg COMPR. 25mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU 2 BLIST. DIN OPA-AL-PVC/AL X 15 COMPR. P6L 30 0.544285 0.544285 0.104381
92 W41867002 C07AG02 CARVEDILOLUM CORYOL 6,25mg COMPR. 6,25mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. OPA-AL-PVC/AL X 7 COMPR. P-6L 28 0.250357 0.250357 0.000000
93 W41912001 C07AG02 CARVEDILOLUM TALLITON 6,25 mg COMPR. 6,25mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P-6L 30 0.211666 0.211666 0.000000
94 W42660001 C07AG02 CARVEDILOLUM CARVEDILOL LPH 6,25 mg COMPR. 6,25mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6L 30 0.253999 0.253999 0.382001
95 W53663001 C07AG02 CARVEDILOLUM CARVEDILOL VIM SPECTRUM 6,25 mg COMPR. 6,25mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.253999 0.253999 0.068001
96 W53750001 C07AG02 CARVEDILOLUM GLADYCOR 6,25 mg COMPR. 6,25mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.235333 0.235333 0.000000
97 W59930001 C07AG02 CARVEDILOLUM CARVEDILOL SANDOZ 6,25 mg COMPR. 6,25mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.253999 0.253999 0.089001
98 W63453001 C07AG02 CARVEDILOLUM CARVEDILOL SLAVIA 6,25 mg COMPR. 6,25mg SLAVIA PHARM S.R.L. ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. P-6L 30 0.253999 0.253999 0.682667
99 W41912002 C07AG02 CARVEDILOLUM TALLITON 6,25 mg COMPR. 6,25mg EGIS PHARMACEUTICALS PLC UNGARIA CUTIE CU 2 BLIST. DIN OPA-AL-PVC/AL X 15 COMPR. P6L 30 0.211666 0.211666 0.000000
100 W66017007 C07AG02 CARVEDILOLUM CARVEDILOL AUROBINDO 12,5mg COMPR. FILM. 12,5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.397713 0.397713 0.003358
101 W66018007 C07AG02 CARVEDILOLUM CARVEDILOL AUROBINDO 25mg COMPR. FILM. 25mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.544285 0.544285 0.045000
102 W66016007 C07AG02 CARVEDILOLUM CARVEDILOL AUROBINDO 6,25mg COMPR. FILM. 6,25mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.253999 0.253999 0.028858
103 W00775001 C09AA01 CAPTOPRILUM CAPTOPRIL TERAPIA 25 mg COMPR. 25mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197333 0.197333 0.000000
104 W00774002 C09AA01 CAPTOPRILUM CAPTOPRIL LAROPHARM 25 mg COMPR. 25mg LAROPHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-6L 20 0.200500 0.200500 0.000000
105 W43029001 C09AA01 CAPTOPRILUM CAPTOPRIL - AC 25 mg COMPR. 25mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.192500 0.192500 0.000000
106 W06857001 C09AA01 CAPTOPRILUM CAPTOPRIL MCC 25 mg COMPR. 25mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.200333 0.200333 0.000000
107 W08550001 C09AA01 CAPTOPRILUM CAPTOPRIL LPH 25 mg COMPR. 25mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197333 0.197333 0.000000
108 W41981002 C09AA01 CAPTOPRILUM CAPTOPRIL SINTOFARM 25 mg COMPR. 25mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.197333 0.197333 0.000000
109 W53677002 C09AA01 CAPTOPRILUM CAPTOPRIL ARENA 25 mg COMPR. 25mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.200500 0.200500 0.000000
110 W68552001 C09AA01 CAPTOPRILUM CAPTOPRIL BIOEEL 25 mg COMPR. 25mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.192500 0.192500 0.000000

Pagina 2 din 37
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)
111 W53678001 C09AA01 CAPTOPRILUM CAPTOPRIL ARENA 50 mg COMPR. 50 mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.294500 0.294500 0.000000
112 W00777001 C09AA01 CAPTOPRILUM CAPTOPRIL TERAPIA 50 mg COMPR. 50mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.293666 0.293666 0.000000
113 W43028001 C09AA01 CAPTOPRILUM CAPTOPRIL - AC 50 mg COMPR. 50mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.294500 0.294500 0.000000
114 W42060001 C09AA01 CAPTOPRILUM CAPTOPRIL MCC 50 mg COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.293666 0.293666 0.000000
115 W00776003 C09AA01 CAPTOPRILUM CAPTOPRIL LPH 50 mg COMPR. 50mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.293666 0.293666 0.000000
116 W68553001 C09AA01 CAPTOPRILUM CAPTOPRIL BIOEEL 50 mg COMPR. 50mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.294500 0.294500 0.000000
117 W12405001 C09AA02 ENALAPRILUM ENALAPRIL MCC 10 mg COMPR. 10mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.253500 0.253500 0.000000
118 W02920004 C09AA02 ENALAPRILUM ENALAPRIL LPH 10 mg COMPR. 10mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.254333 0.254333 0.000000
119 W02922001 C09AA02 ENALAPRILUM ENAP 10 mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-6L 20 0.253500 0.253500 0.000000
120 W41447001 C09AA02 ENALAPRILUM ENALAPRIL SLAVIA 10 mg COMPR. 10mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/ AL X 10 COMPR. P-6L 20 0.253500 0.253500 0.000000
121 W51276001 C09AA02 ENALAPRILUM RENITEC 10 mg COMPR. 10mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. P-6L 28 0.304200 0.304200 0.124371
122 W53672002 C09AA02 ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC, X 10 COMPR. P-6L 30 0.254333 0.254333 0.000000
123 W53672003 C09AA02 ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. AL/PVC, X 10 COMPR. P-6L 50 0.254000 0.254000 0.000000
124 W53672004 C09AA02 ENALAPRILUM ENALAPRIL ARENA 10mg COMPR. 10mg ARENA GROUP SA ROMANIA CUTIE X 10 BLIST. AL/PVC, X 10 COMPR. P-6L 100 0.253900 0.253900 0.000000
125 W53666002 C09AA02 ENALAPRILUM ENALAPRIL VIM SPECTRUM 10 mg COMPR. 10mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 20 0.253500 0.253500 0.000000
126 W58491002 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 10 mg COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.253500 0.253500 0.000000
127 W62035001 C09AA02 ENALAPRILUM ENALAPRIL TERAPIA 10mg COMPR. 10mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL/PVC X 10 COMPRIMATE (2 ANI) P6L 20 0.253500 0.253500 0.000000
128 W02922002 C09AA02 ENALAPRILUM ENAP 10 mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 30 0.254333 0.254333 0.000000
129 W02922003 C09AA02 ENALAPRILUM ENAP 10 mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 6 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 60 0.254166 0.254166 0.000000
130 W58491003 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 10 mg COMPR. 10mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 20 0.253500 0.253500 0.000000
131 W68245001 C09AA02 ENALAPRILUM RENITEC 10 mg COMPR. 10mg ROMANIA
ORGANON BIOSCIENCES S.R.L. CUTIE CU 2 BLIST. AL/AL X 14 COMPR. P6L 28 0.304200 0.304200 0.124371
132 W12199001 C09AA02 ENALAPRILUM ENALAPRIL MCC 20 mg COMPR. 20mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.421500 0.421500 0.000000
133 W02921003 C09AA02 ENALAPRILUM ENALAPRIL LPH 20 mg COMPR. 20mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.421666 0.421666 0.000000
134 W02923001 C09AA02 ENALAPRILUM ENAP 20 mg COMPR. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-6L 20 0.421500 0.421500 0.000000
135 W51277001 C09AA02 ENALAPRILUM RENITEC 20 mg COMPR. 20mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. P-6L 28 0.505800 0.505800 0.243842
136 W53674001 C09AA02 ENALAPRILUM ENALAPRIL ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.421666 0.421666 0.000000
137 W53674004 C09AA02 ENALAPRILUM ENALAPRIL ARENA 20 mg COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. P-6L 50 0.421600 0.421600 0.000000
138 W56712001 C09AA02 ENALAPRILUM ENALAPRIL SLAVIA 20 mg COMPR. 20mg SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.421500 0.421500 0.000000
139 W58492001 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 20 mg COMPR. 20mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.421500 0.421500 0.000000
140 W62036001 C09AA02 ENALAPRILUM ENALAPRIL TERAPIA 20mg COMPR. 20mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL/PVC X 10 COMPRIMATE (2 ANI) P6L 20 0.421500 0.421500 0.000000
141 W02923002 C09AA02 ENALAPRILUM ENAP 20 mg COMPR. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 30 0.421666 0.421666 0.000000
142 W02923003 C09AA02 ENALAPRILUM ENAP 20 mg COMPR. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 6 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 60 0.421666 0.421666 0.000000
143 W58492002 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 20 mg COMPR. 20mg LAROPHARM SRL ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 20 0.421500 0.421500 0.000000
144 W68246001 C09AA02 ENALAPRILUM RENITEC 20 mg COMPR. 20mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. P6L 28 0.505800 0.505800 0.243842
145 W12198001 C09AA02 ENALAPRILUM ENALAPRIL MCC 5 mg COMPR. 5mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.118500 0.118500 0.000000
146 W02925001 C09AA02 ENALAPRILUM ENAP 5 mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 2 BLIST. AL/OPA-AL-PVC X 10 COMPR. P-6L 20 0.118500 0.118500 0.000000
147 W51275001 C09AA02 ENALAPRILUM RENITEC 5 mg COMPR. 5mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. P-6L 28 0.141600 0.141600 0.218400
148 W12811003 C09AA02 ENALAPRILUM ENALAPRIL LPH 5 mg COMPR. 5mg LABORMED PHARMA SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 0.118000 0.118000 0.000000
149 W53673001 C09AA02 ENALAPRILUM ENALAPRIL ARENA 5 mg COMPR. 5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.118000 0.118000 0.000000
150 W58490002 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 5 mg COMPR. 5mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. P6L 20 0.118500 0.118500 0.000000
151 W62034001 C09AA02 ENALAPRILUM ENALAPRIL TERAPIA 5mg COMPR. 5mg TERAPIA SA ROMANIA CUTIE X 2 BLISTERE AL/PVC- X 10 COMPRIMATE (2 ANI) P6L 20 0.118500 0.118500 0.000000
152 W02925002 C09AA02 ENALAPRILUM ENAP 5 mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 30 0.118000 0.118000 0.000000
153 W02925003 C09AA02 ENALAPRILUM ENAP 5 mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 6 BLIST. AL/OPA-AL-PVC X 10 COMPR. P6L 60 0.118666 0.118666 0.000000
154 W58490003 C09AA02 ENALAPRILUM ENALAPRIL LAROPHARM 5 mg COMPR. 5mg LAROPHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 20 COMPR. P6L 20 0.118500 0.118500 0.000000
155 W68244001 C09AA02 ENALAPRILUM RENITEC 5 mg COMPR. 5mg ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. P6L 28 0.141600 0.141600 0.218400
156 W58233001 C09AA02 ENALAPRILUM ENAP 1,25 mg/ml SOL. INJ./PERF. 1,25mg/ml KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ. PR/PRF 5 4.086000 4.086000 0.000000
157 W42156001 C09AA03 LISINOPRILUM LISIREN 10 mg COMPR. 10mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.369199 0.369199 0.316301
158 W42593001 C09AA03 LISINOPRILUM LISINOPRIL SANDOZ 10 mg COMPR. 10mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.307666 0.307666 0.000000
159 W43054001 C09AA03 LISINOPRILUM LISINOPRIL MEDO 10 mg COMPR. 10mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.369199 0.369199 0.117134
160 W53916002 C09AA03 LISINOPRILUM LISINOPRIL ATB 10 MG COMPR. 10mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.369199 0.369199 0.158134
161 W54841001 C09AA03 LISINOPRILUM TONOLYSIN 10 mg COMPR. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 0.369199 0.369199 0.124015
162 W65067001 C09AA03 LISINOPRILUM RANOLIP 10 mg COMPR. 10mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.369199 0.369199 0.317134
163 W42088001 C09AA03 LISINOPRILUM LISIREN 20 mg COMPR. 20mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0.518799 0.518799 0.516701
164 W42594001 C09AA03 LISINOPRILUM LISINOPRIL SANDOZ 20 mg COMPR. 20mg HEXAL AG GERMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P-6L 30 0.432333 0.432333 0.000000
165 W53917002 C09AA03 LISINOPRILUM LISINOPRIL ATB 20 MG COMPR. 20mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.518799 0.518799 0.517201
166 W54840001 C09AA03 LISINOPRILUM TONOLYSIN 20 mg COMPR. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 0.518799 0.518799 0.300129
167 W43055002 C09AA03 LISINOPRILUM LISINOPRIL MEDO 20 mg COMPR. 20mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 2 BLIST. PVDC/AL X 10 COMPR. P-6L 20 0.518799 0.518799 0.334701
168 W65068001 C09AA03 LISINOPRILUM RANOLIP 20 mg COMPR. 20mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.518799 0.518799 0.517201
169 W53918002 C09AA03 LISINOPRILUM LISINOPRIL ATB 40 MG COMPR. 40mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 1.627333 1.627333 0.000000
170 W43053001 C09AA03 LISINOPRILUM LISINOPRIL MEDO 5 mg COMPR. 5mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.246666 0.246666 0.000000

Pagina 3 din 37
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)
171 W54842001 C09AA03 LISINOPRILUM TONOLYSIN 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 0.295999 0.295999 0.035429
172 W65066001 C09AA03 LISINOPRILUM RANOLIP 5 mg COMPR. 5mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. P6L 30 0.295999 0.295999 0.041334
173 W51933002 C09AA05 RAMIPRILUM VIVACE 10 mg COMPR. 10 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7 COMPR. P-6L 28 0.364800 0.364800 0.020557
174 W64367002 C09AA05 RAMIPRILUM VIVACE 10 mg COMPR. 10 mg TEVA B.V. OLANDA CUTIE CU 4 BLIST. AL/AL X 7 COMPR. P6L 28 0.364800 0.364800 0.020557
175 W42940001 C09AA05 RAMIPRILUM RAMIPRIL-AC 10 mg COMPR. 10mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.364800 0.364800 0.020533
176 W42972001 C09AA05 RAMIPRILUM AMPRIL 10 mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.364800 0.364800 0.019866
177 W43524001 C09AA05 RAMIPRILUM ZENRA 10 mg COMPR. 10mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6L 28 0.364800 0.364800 0.020557
178 W62447001 C09AA05 RAMIPRILUM TRITACE 10 mg COMPR. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 28 COMPR. P6L 28 0.364800 0.364800 0.304485
179 W62662001 C09AA05 RAMIPRILUM RAMIPRIL ATB 10 mg COMPR. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.304000 0.304000 0.000000
180 W62447012 C09AA05 RAMIPRILUM TRITACE 10 mg COMPR. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 90 COMPR. P6L 90 0.364800 0.364800 0.324977
181 W64288002 C09AA05 RAMIPRILUM RAMIPRIL AUROBINDO 10 mg COMPR. 10mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC TRANSPARENT/AL X 28 COMPR. P6L 28 0.337857 0.337857 0.000000
182 W51934002 C09AA05 RAMIPRILUM VIVACE 2,5 mg COMPR. 2,5 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7COMPR. P-6L 28 0.219642 0.219642 0.000000
183 W64365002 C09AA05 RAMIPRILUM VIVACE 2,5 mg COMPR. 2,5 mg TEVA B.V. OLANDA CUTIE CU 4 BLIST. AL/AL X 7 COMPR. P6L 28 0.219642 0.219642 0.000000
184 W42939001 C09AA05 RAMIPRILUM RAMIPRIL-AC 2,5 mg COMPR. 2,5mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.219666 0.219666 0.000000
185 W42970001 C09AA05 RAMIPRILUM AMPRIL 2,5 mg COMPR. 2,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.219666 0.219666 0.000000
186 W43522001 C09AA05 RAMIPRILUM ZENRA 2,5 mg COMPR. 2,5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6L 28 0.219642 0.219642 0.000000
187 W62451001 C09AA05 RAMIPRILUM TRITACE 2,5 mg COMPR. 2,5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 28 COMPR. P6L 28 0.227599 0.227599 0.227401
188 W62660001 C09AA05 RAMIPRILUM RAMIPRIL ATB 2,5 mg COMPR. 2,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.189666 0.189666 0.000000
189 W62451011 C09AA05 RAMIPRILUM TRITACE 2,5 mg COMPR. 2,5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 60 COMPR. P6L 60 0.227599 0.227599 0.227734
190 W51932002 C09AA05 RAMIPRILUM VIVACE 5 mg COMPR. 5 mg ACTAVIS GROUP HF ISLANDA CUTIE X 4 BLIST. AL/AL X 7 COMPR. P-6L 28 0.263599 0.263599 0.027472
191 W64366002 C09AA05 RAMIPRILUM VIVACE 5 mg COMPR. 5 mg TEVA B.V. OLANDA CUTIE CU 4 BLIST. AL/AL X 7 COMPR. P6L 28 0.263599 0.263599 0.027472
192 W42237001 C09AA05 RAMIPRILUM RAMIPRIL-AC 5 mg COMPR. 5mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.263599 0.263599 0.052734
193 W42971001 C09AA05 RAMIPRILUM AMPRIL 5 mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P-6L 30 0.263599 0.263599 0.051734
194 W43523001 C09AA05 RAMIPRILUM ZENRA 5 mg COMPR. 5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. X 14 COMPR. P-6L 28 0.263599 0.263599 0.052829
195 W62382001 C09AA05 RAMIPRILUM TRITACE 5 mg COMPR. 5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 28 COMPR. P6L 28 0.263599 0.263599 0.223543
196 W62661001 C09AA05 RAMIPRILUM RAMIPRIL ATB 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. P6L 30 0.219666 0.219666 0.000000
197 W62382008 C09AA05 RAMIPRILUM TRITACE 5 mg COMPR. 5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL/ X 30 COMPR. P6L 30 0.263599 0.263599 0.343401
198 W64287005 C09AA05 RAMIPRILUM RAMIPRIL AUROBINDO 5 mg COMPR. 5mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC TRANSPARENT/AL X 28 COMPR. P6L 28 0.263599 0.263599 0.013901
199 W56930003 C09CA03 VALSARTANUM ** DIOVAN 160 mg COMPR. FILM. 160mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. TIP CALENDAR PVC-PVDC/AL X 28 COMPR. FILM. P-6L 28 1.090713 1.090713 0.335358
200 W58950003 C09CA03 VALSARTANUM ** VAPRESS 160 mg COMPR. FILM. 160mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.908928 0.908928 0.000000
201 W58950013 C09CA03 VALSARTANUM ** VAPRESS 160 mg COMPR. FILM. 160mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTFE/AL X 28 COMPR. FILM. P6L 28 0.908928 0.908928 0.000000
202 W56929003 C09CA03 VALSARTANUM ** DIOVAN 40 mg COMPR. FILM. 40mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. TIP CALENDAR PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 1.365428 1.365428 0.077072
203 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 1.137857 1.137857 0.000000
204 W58948013 C09CA03 VALSARTANUM ** VAPRESS 40 mg COMPR. FILM. 40mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTFE/AL X 28 COMPR. FILM. P6L 28 1.137857 1.137857 0.000000
205 W56931003 C09CA03 VALSARTANUM ** DIOVAN 80 mg COMPR. FILM. 80mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. TIP CALENDAR PVC-PVDC/AL X 28 COMPR. FILM. P6L 28 0.603000 0.603000 0.780928
206 W58949003 C09CA03 VALSARTANUM ** VAPRESS 80 mg COMPR. FILM. 80mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P6L 28 0.502500 0.502500 0.000000
207 W58949013 C09CA03 VALSARTANUM ** VAPRESS 80 mg COMPR. FILM. 80mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PCTFE/AL X 28 COMPR. FILM. P6L 28 0.502500 0.502500 0.000000
208 W55631001 C09CA03 VALSARTANUM ** DIOVAN 3 mg/ml SOL. ORALA 3mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE X 1 FLACON DIN STICLA BRUNA X 160ML SOLUTIE ORALA + 1 TRUSA DE ADMINISTRARE (ADAPTOR PENTRU FLACON + 1 SERINGA DOZATOARE A 5ML + 1 MASURA DOZATOARE A 30ML ) P-6L 1 30.140000 30.140000 0.000000
209 W55622005 C09CA06 CANDESARTANUM CILEXETIL ** TANDESAR 16 mg COMPR. 16mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P-6L 28 0.739599 0.739599 0.571115
210 W54889004 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN SANDOZ 16 mg COMPR. 16mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR. P-6L 28 0.713214 0.713214 0.000000
211 W55592003 C09CA06 CANDESARTANUM CILEXETIL ** KARBIS 16 mg COMPR. 16mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P-6L 30 0.739599 0.739599 0.327734
212 W58808002 C09CA06 CANDESARTANUM CILEXETIL ** ATACAND 16mg COMPR. 16mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC/PVDC/AL CE CONTINE 28 COMPR. P-6L 28 0.739599 0.739599 0.635401
213 W58874004 C09CA06 CANDESARTANUM CILEXETIL ** CANZENO 16mg COMPR. 16mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.616333 0.616333 0.000000
214 W61496002 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN CILEXETIL MCC 16 mg COMPR. 16mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 0.739599 0.739599 0.362401
215 W62724001 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN ATB 16 mg COMPR. 16mg ANTIBIOTICE SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P6L 30 0.739599 0.739599 0.177067
216 W67397002 C09CA06 CANDESARTANUM CILEXETIL ** ATACAND 16 mg COMPR. 16mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU BLIST. PVC-PVDC/AL CE CONTINE 28 COMPR. P6L 28 0.739599 0.739599 0.635401
217 W55593003 C09CA06 CANDESARTANUM CILEXETIL ** KARBIS 32 mg COMPR. 32mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P-6L 30 1.147599 1.147599 0.199734
218 W58806001 C09CA06 CANDESARTANUM CILEXETIL ** ATACAND 32 mg COMPR. 32mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC/PVDC/AL CE CONTINE 28 COMPR. P-6L 28 1.147599 1.147599 0.954186
219 W58875004 C09CA06 CANDESARTANUM CILEXETIL ** CANZENO 32mg COMPR. 32mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.956333 0.956333 0.000000
220 W61497002 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN CILEXETIL MCC 32 mg COMPR. 32mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 1.147599 1.147599 0.232734
221 W64539008 C09CA06 CANDESARTANUM CILEXETIL ** TANDESAR 32 mg COMPR. 32mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P6L 28 1.147599 1.147599 0.586329
222 W67398001 C09CA06 CANDESARTANUM CILEXETIL ** ATACAND 32 mg COMPR. 32mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU BLIST. PVC-PVDC/AL CE CONTINE 28 COMPR. P6L 28 1.147599 1.147599 0.954186
223 W55621005 C09CA06 CANDESARTANUM CILEXETIL ** TANDESAR 8 mg COMPR. 8mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P-6L 28 0.676428 0.676428 0.000000
224 W55591003 C09CA06 CANDESARTANUM CILEXETIL ** KARBIS 8 mg COMPR. 8mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P-6L 30 0.667666 0.667666 0.000000
225 W58807002 C09CA06 CANDESARTANUM CILEXETIL ** ATACAND 8mg COMPR. 8mg ASTRAZENECA AB SUEDIA CUTIE CU BLIST. PVC/PVDC/AL CE CONTINE 28 COMPR. P-6L 28 0.721200 0.721200 0.203442
226 W58873004 C09CA06 CANDESARTANUM CILEXETIL ** CANZENO 8mg COMPR. 8mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.601000 0.601000 0.000000
227 W61495004 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN CILEXETIL MCC 8 mg COMPR. 8mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 0.676333 0.676333 0.000000
228 W62723001 C09CA06 CANDESARTANUM CILEXETIL ** CANDESARTAN ATB 8 mg COMPR. 8mg ANTIBIOTICE SA ROMANIA CUTIE CU 3 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 COMPR. P6L 30 0.676333 0.676333 0.000000
229 W67396002 C09CA06 CANDESARTANUM CILEXETIL ** ATACAND 8 mg COMPR. 8mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU BLIST. PVC-PVDC/AL CE CONTINE 28 COMPR. P6L 28 0.721200 0.721200 0.203442
230 W64479001 C09DX04 COMBINATII (SACUBITRILUM+VALSARTANUM) ** Ω ENTRESTO 24 mg/26 mg COMPR. FILM. 24mg/26mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 28 COMPR. FILM. (BLIST. PVC/PVDC/AL X 14 COMPR. FILM.) PRF 28 11.858214 11.858214 0.000000

Pagina 4 din 37
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)
231 W64480001 C09DX04 COMBINATII (SACUBITRILUM+VALSARTANUM) ** Ω ENTRESTO 49 mg/51 mg COMPR. FILM. 49mg/51mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 56 COMPR. FILM. (BLIST. PVC/PVDC/AL X 14 COMPR. FILM.) PRF 56 10.888928 10.888928 0.000000
232 W64481001 C09DX04 COMBINATII (SACUBITRILUM+VALSARTANUM) ** Ω ENTRESTO 97 mg/103 mg COMPR. FILM. 97mg/103mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 56 COMPR. FILM. (BLIST. PVC/PVDC/AL X 14 COMPR. FILM.) PRF 56 10.888928 10.888928 0.000000

2. BOLNAVI CU PROTEZE VALVULARE SI VASCULARE - G2

1 W00009002 B01AA07 ACENOCUMAROLUM TROMBOSTOP 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.690333 0.690333 0.000000
2 W62461001 B01AA07 ACENOCUMAROLUM SINTROM 4 mg COMPR. 4mg MERUS LABS LUXCO II S.A.R.L. LUXEMBURG CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.430500 0.430500 0.000000

Tratamentul se iniţiază de către medicul în specialitatea cardiologie, chirurgie cardiovasculară şi chirurgie vasculară.

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

1 W54317002 B01AC04 CLOPIDOGRELUM ** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 FLAC. DIN STICLA INCOLORA X 30 COMPR. FILM. P-RF 30 0.741666 0.741666 0.000000
2 W54317003 B01AC04 CLOPIDOGRELUM ** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 FLAC. DIN STICLA INCOLORA X 90 COMPR. FILM. P-RF 90 0.673666 0.673666 0.000000
3 W57177005 B01AC04 CLOPIDOGRELUM ** PLATEL 75 mg COMPR. FILM. 75mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 28 COMPR. FILM. P-RF 28 0.786785 0.786785 0.000000
4 W54317007 B01AC04 CLOPIDOGRELUM ** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN PVC-PVDC/AL CONTINÂND 30 COMPRIMATE FILMATE P-RF 30 0.741666 0.741666 0.000000
5 W54317009 B01AC04 CLOPIDOGRELUM ** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN PVC-PVDC/AL CONTINÂND 90 COMPRIMATE FILMATE P-RF 90 0.673666 0.673666 0.000000
6 W61520001 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI CLIR SNC FRANTA CUTIE X 28 COMPR. FILM. ( BLIST. PVC-PVDC/AL) P-RF 28 0.808399 0.808399 1.449458
7 W61520013 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI CLIR SNC FRANTA CUTIE X 30 COMPR. FILM. ( BLIST. PVC-PVDC/AL) P-RF 30 0.808399 0.808399 1.448934
8 W65505007 B01AC04 CLOPIDOGRELUM ** CLOPIDOGREL TERAPIA 75 mg COMPR. FILM. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL-PA-PVC/AL X 30 COMPR. FILM. PRF 30 0.808399 0.808399 0.556601
9 W66403001 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 28 COMPR. FILM. ( BLIST. PVC-PVDC/AL) PRF 28 0.808399 0.808399 1.449458
10 W66403013 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 30 COMPR. FILM. ( BLIST. PVC-PVDC/AL) PRF 30 0.808399 0.808399 1.448934
11 W66626001 B01AC04 CLOPIDOGRELUM ** CLOPIDOGREL EIPICO 75 mg COMPR. FILM. 75mg E.I.P.I.CO MED S.R.L. ROMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P6L 30 0.808399 0.808399 0.555934
12 W69341001 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 28 COMPR. FILM. ( BLIST. PVC-PVDC/AL) PRF 28 0.808399 0.808399 1.449458
13 W69341007 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 28 COMPR. FILM.( BLIST. AL/AL) PRF 28 0.808399 0.808399 1.449458
14 W69341013 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 30 COMPR. FILM. ( BLIST. PVC-PVDC/AL) PRF 30 0.808399 0.808399 1.448934
15 W69341014 B01AC04 CLOPIDOGRELUM ** PLAVIX 75mg COMPR. FILM. 75mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X 30 COMPR. FILM.( BLIST. AL/AL) PRF 30 0.808399 0.808399 1.448934
16 W62794001 B01AC24 TICAGRELOR ** Ω BRILIQUE COMPR. FILM. 60 mg ASTRA ZENECA AB SUEDIA BLISTER CALENDAR TRANSPARENT DIN PVC-PVDC/AL (CU SIMBOLURILE SOARE/LUNA) X 56 COMPR. FILM. PRF 56 4.649642 4.649642 0.000000
17 W56291004 B01AC24 TICAGRELOR ** Ω BRILIQUE COMPR. FILM. 90 mg ASTRA ZENECA AB SUEDIA CUTIE CU 4 BLIST. CALENDAR TRANSPARENT DIN PVC-PVDC/ALUMINIU (CU SIMBOLURILE SOARE/LUNA) X 14 COMPR. FILM. P-RF 56 5.594821 5.594821 0.000000

Tratamentul se iniţiază de către medicul în specialitatea cardiologie, chirurgie cardiovasculară şi chirurgie vasculară.

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

1 W62522002 J05AF05 LAMIVUDINUM **1 LAMIVUDINA TEVA 100 mg COMPR. FILM. 100 mg TEVA B.V. OLANDA CUTIE CU BLIST. PVC/PVDC/AL X 30 COMPR. FILM. P-RF 30 4.689000 4.689000 0.000000
2 W65306001 J05AF05 LAMIVUDINUM **1 ZEFFIX 100 mg COMPR. FILM. 100mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 28 COMPR. FILM. (BLIST. PVC-AL/PVC-AL) PR 28 4.589285 4.589285 0.000000
3 W60828015 J05AF07 TENOFOVIRUM DISOPROXIL **1 TENOFOVIR DISOPROXIL TEVA 245 mg COMPR. FILM. 245mg TEVA PHARMACEUTICALS S.R.L. ROMANIA PR
CUTIE CU 1 FLAC. DIN PEÎD CU CAPAC CAPAC PREVAZUT CU SISTEM SECURIZAT PENTRU COPII DIN PP SI RECIPIENT CU DESICANT, A 30 COMPR. FILM. 30 19.020399 19.020399 1.231934
4 W62771001 J05AF07 TENOFOVIRUM DISOPROXIL **1 VIROFOB 245 mg COMPR. FILM. 245mg ALVOGEN IPCO S.AR.L. LUXEMBURG CUTIE CU 1 FLAC. PEID CU CAPAC DIN PP X 30 COMPR. FILM. PR 30 18.776000 18.776000 0.000000
5 W63256001 J05AF07 TENOFOVIRUM DISOPROXIL **1 TENOFOVIR DISOPROXIL MYLAN COMPR. FILM. 245mg MYLAN S.A.S FRANTA CUTIE X 1 FLAC. DIN PEID X 30 COMPR. FILM PR 30 18.231000 18.231000 0.000000
6 W64012002 J05AF07 TENOFOVIRUM DISOPROXIL **1 TENOFOVIR DISOPROXIL AUROBINDO 245 mg COMPR. FILM. 245mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 15.850333 15.850333 0.000000
7 W65812001 J05AF07 TENOFOVIRUM DISOPROXIL **1 TENOFOVIR DISOPROXIL ACCORD 245 mg COMPR. FILM. 245mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 17.547666 17.547666 0.000000
8 W65970001 J05AF07 TENOFOVIRUM DISOPROXIL **1 TENOFOVIR STADA 245 mg COMPR. FILM. 245mg STADA M&D SRL ROMANIA CUTIE CU 1 FLAC. PEID CU CAPAC DIN PP, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PT. COPII X 30 (1X30) COMPR. FILM. PR 30 19.020399 19.020399 5.253267
9 W65970002 J05AF07 TENOFOVIRUM DISOPROXIL **1 TENOFOVIR STADA 245 mg COMPR. FILM. 245mg STADA M&D SRL ROMANIA PR
AMBALAJ MULTIPLU CU 3 FLAC. PEID CU CAPAC DIN PP, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PT. COPII X 90 (3X30) COMPR. FILM. 90 19.020399 19.020399 3.618934
10 W65737001 J05AF07 TENOFOVIRUM DISOPROXIL **1 TENOFOVIR DISOPROXIL ACCORDPHARMA 245 mg COMPR. FILM. 245mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU 1 BLIST. PERFORAT PT. ELIBERAREA UNEI UNITATI DOZATE DIN OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 17.547666 17.547666 0.000000
11 W68144001 J05AF07 TENOFOVIRUM DISOPROXIL **1 TENOFOVIR DISOPROXIL MYLAN COMPR. FILM. 245mg MYLAN PHARMACEUTICALS LIMITED IRLANDA CUTIE X 1 FLAC. DIN PEID X 30 COMPR. FILM. PR 30 18.231000 18.231000 0.000000
12 W68200001 J05AF07 TENOFOVIRUM DISOPROXIL **1 VIROFOB 245 mg COMPR. FILM. 245mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 1 FLAC. PEID CU CAPAC DIN PP X 30 COMPR. FILM. PR 30 18.776000 18.776000 0.000000
13 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 5.463333 5.463333 0.000000
14 W63932001 J05AF10 ENTECAVIRUM **1 ENTECAVIR SANDOZ 0,5 mg COMPR. FILM. 0,5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PR 30 6.308799 6.308799 19.055201
15 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 5.463333 5.463333 0.000000
16 W63864001 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 0,5 mg COMPR. FILM. 0,5mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. (OPA/ALU/PVC-ALU) X 30 COMPR. FILM. PR 30 6.307000 6.307000 0.000000
17 W63803001 J05AF10 ENTECAVIRUM **1 ENTECAVIR ALVOGEN 0,5 mg COMPR. FILM. 0,5mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 6.308799 6.308799 20.925201
18 W63755002 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 0,5 mg COMPR. FILM. 0,5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 5.463333 5.463333 0.000000
19 W64664003 J05AF10 ENTECAVIRUM **1 ENTECAVIR SANIENCE 0,5 mg COMPR. FILM. 0,5mg SANIENCE S.R.L. ROMANIA CUTIE CU 3 BLIST. AL/PVC-PVDC(120) X 10 COMPR. FILM. PR 30 5.257333 5.257333 0.000000
20 W64664002 J05AF10 ENTECAVIRUM **1 ENTECAVIR SANIENCE 0,5 mg COMPR. FILM. 0,5mg SANIENCE S.R.L. ROMANIA CUTIE CU 3 BLIST. AL/PVC-PVDC(60) X 10 COMPR. FILM. PR 30 5.257333 5.257333 0.000000
21 W65671001 J05AF10 ENTECAVIRUM **1 ENTECAVIR ACCORD 0,5 mg COMPR. FILM. 0,5mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU 30 X 1 COMPR. FILM. PR 30 6.308799 6.308799 12.169534
22 W65511001 J05AF10 ENTECAVIRUM **1 ENTECAVIR TERAPIA 0,5 mg COMPR. FILM. 0,5mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. UNIDOZA PENTRU ELIBERAREA UNEI UNITATI DOZATE DIN OPA-AL-PVC/AL CONTINAND 30X1 COMPR. FILM. PR 30 6.308799 6.308799 0.000201
23 W68145001 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 0,5 mg COMPR. FILM. 0,5mg MYLAN PHARMACEUTICALS LIMITED IRLANDA CUTIE CU BLIST. (OPA/ALU/PVC-ALU) X 30 COMPR. FILM. PR 30 6.307000 6.307000 0.000000

Pagina 5 din 37
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)
24 W68663001 J05AF10 ENTECAVIRUM **1 ENTECAVIR LABORMED 0,5 mg COMPR. FILM. 0,5mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 6.308799 6.308799 20.925201
25 W65511005 J05AF10 ENTECAVIRUM **1 ENTECAVIR TERAPIA 0,5 mg COMPR. FILM. 0,5mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL CONTINAND 30 COMPR. FILM. PR 30 6.308799 6.308799 0.000201
26 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 15.721999 15.721999 12.783334
27 W63933001 J05AF10 ENTECAVIRUM **1 ENTECAVIR SANDOZ 1 mg COMPR. FILM. 1mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PR 30 15.721999 15.721999 14.220001
28 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 15.721999 15.721999 12.783334
29 W63865001 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 1 mg COMPR. FILM. 1mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. (OPA/ALU/PVC-ALU) X 30 COMPR. FILM. PR 30 13.101666 13.101666 0.000000
30 W63814001 J05AF10 ENTECAVIRUM **1 ENTECAVIR ALVOGEN 1 mg COMPR. FILM. 1mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 15.721999 15.721999 41.338334
31 W63756002 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 15.721999 15.721999 12.783334
32 W63756005 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. UNIDOZA PVC-PVDC/AL X 30X1 COMPR. FILM. PR 30 15.721999 15.721999 12.783334
33 W65672001 J05AF10 ENTECAVIRUM **1 ENTECAVIR ACCORD 1 mg COMPR. FILM. 1mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU 30 X 1 COMPR. FILM. PR 30 15.721999 15.721999 10.925334
34 W65512001 J05AF10 ENTECAVIRUM **1 ENTECAVIR TERAPIA 1 mg COMPR. FILM. 1mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. UNIDOZA PENTRU ELIBERAREA UNEI UNITATI DOZATE DIN OPA-AL-PVC/AL CONTINAND 30X1 COMPR. FILM. PR 30 13.273333 13.273333 0.000000
35 W68146001 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 1 mg COMPR. FILM. 1mg MYLAN PHARMACEUTICALS LIMITED IRLANDA CUTIE CU BLIST. (OPA/ALU/PVC-ALU) X 30 COMPR. FILM. PR 30 13.101666 13.101666 0.000000
36 W68664001 J05AF10 ENTECAVIRUM **1 ENTECAVIR LABORMED 1 mg COMPR. FILM. 1mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 15.721999 15.721999 41.338334
37 W65512005 J05AF10 ENTECAVIRUM **1 ENTECAVIR TERAPIA 1 mg COMPR. FILM. 1mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL CONTINAND 30 COMPR. FILM. PR 30 13.273333 13.273333 0.000000
38 W68897001 J05AP01 RIBAVIRINUM **1 VIRON 200 mg CAPS. 200mg CN UNIFARM S.A. ROMANIA CUTIE CU BLIST. DIN PVC/PVDC/AL X 140 CAPSULE PRF 140 4.295357 4.295357 0.000000
39 W64756001 J05AP51 COMBINATII (LEDIPASVIRUM+SOFOSBUVIRUM) **1 β HARVONI 90 mg/400 mg COMPR. FILM. 90mg/400mg GILEAD SCIENCES IRELAND UC IRLANDA CUTIE CU 1 FLAC. PEID PREVAZUT CU UN SISTEM DE INCHIDERE SECURIZAT PT. COPII X 28 COMPR. FILM. PR 28 2,155.721785 2,155.721785 0.000000
40 W64754001 J05AP55 COMBINATII (SOFOSBUVIRUM+VELPATASVIRUM) **1 β EPCLUSA 400mg/100mg COMPR. FILM. 400mg/100mg GILEAD SCIENCES IRELAND UC IRLANDA CUTIE CU 1 FLAC. PEID PREVAZUT CU SISTEM SECURIZAT PENTRU COPII X 28 COMPR. FILM. PR 28 1,460.103214 1,460.103214 0.000000
41 W64760001 J05AP56 SOFOSBUVIRUM +VELPATASVIRUM + VOXILAPREVIRUM **1 β VOSEVI 400 mg/100 mg/100 mg COMPR. FILM. 400mg/100mg/100mg GILEAD SCIENCES IRELAND UC IRLANDA CUTIE CU 1 FLAC. PEID X 28 COMPR. FILM. PR 28 1,987.856428 1,987.856428 0.000000
42 W65905001 J05AP57 COMBINATII (GLECAPREVIRUM + PIBRENTASVIRUM) **1 β MAVIRET 100 mg/40 mg COMPR. FILM. 100mg/40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 4 BLIST. PVC/PE/PCTFE/AL X 21 COMPR. FILM PR 84 624.816666 624.816666 0.000000
43 W53892001 L03AA02 FILGRASTIMUM (G-CSF) ** ZARZIO 30MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 60MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL P-RF/R 1 87.490000 87.490000 0.000000
44 W53893001 L03AA02 FILGRASTIMUM (G-CSF) ** ZARZIO 48MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 96MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL P-RF/R 1 147.312000 147.312000 0.678000
45 W67882001 L03AA02 FILGRASTIMUM (G-CSF) ** ACCOFIL 12 MU/0,2 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 12 MU/0,2 ml ACCORD HEALTHCARE S.L.U. SPANIA AMBALAJ CU 1 SERINGA PREUMPLUTA (STICLA) CU 0,2 ML SOL. INJ. CU DISPOZITIV DE SIGURANTA PENTRU AC PR 1 142.490000 142.490000 0.000000
46 W65658001 L03AA02 FILGRASTIMUM (G-CSF) ** ACCOFIL 30 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 30MU/0,5 ml ACCORD HEALTHCARE S.L.U. SPANIA AMBALAJ CU 1 SERINGA PREUMPLUTA (STICLA) CU 0,5 ML SOL. INJ. PR 1 93.080000 93.080000 0.000000
47 W65659001 L03AA02 FILGRASTIMUM (G-CSF) ** ACCOFIL 48 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 48MU/0,5 ml ACCORD HEALTHCARE S.L.U. SPANIA AMBALAJ CU 1 SERINGA PREUMPLUTA (STICLA) CU 0,5 ML SOL. INJ. PR 1 122.760000 122.760000 0.000000
48 W67883001 L03AA02 FILGRASTIMUM (G-CSF) ** ACCOFIL 70 MU/0,73 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 70 MU/0,73 ml ACCORD HEALTHCARE S.L.U. SPANIA AMBALAJ CU 1 SERINGA PREUMPLUTA (STICLA) CU 0,73 ML SOL. INJ. CU DISPOZITIV DE SIGURANTA PENTRU AC PR 1 960.390000 960.390000 0.000000
49 W64857002 L03AA02 FILGRASTIMUM (G-CSF) ** NIVESTIM 30 MU/0,5 ml SOL. INJ./PERF. 300µg/0,5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 5 SERINGI PREUMPLUTE (STICLA) X 0,5 ML SOL. INJ. SAU PERF. PR 5 89.510000 89.510000 0.000000
50 W64858002 L03AA02 FILGRASTIMUM (G-CSF) ** NIVESTIM 48 MU/0,5 ml SOL. INJ./PERF. 480µg/0,5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 5 SERINGI PREUMPLUTE (STICLA) X 0,5 ML SOL. INJ. SAU PERF. PR 5 145.440000 145.440000 0.000000
51 W68070001 L03AB11 PEGINTERFERON ALFA-2A **1 PEGASYS 180 microrgrame/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 180µg/0,5ml ZR PHARMA& GMBH AUSTRIA CUTIE X 1 SERINGA PRE-UMPLUTA X 0,5 ML + 1 AC PR 1 750.530000 750.530000 0.000000
52 W00264001 N04BB01 AMANTADINUM ** VIREGYT-K 100 mg CAPS. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 50 CAPS. P-6L 50 0.493400 0.493400 0.000000

Tratamentul se iniţiază de către medicul în specialitatea gastroenterologie, boli infecţioase, nefrologie (doar pentru pacienţii cu afectare renală consecutivă infecţiei cu virusuri hepatitice), gastroenterologie pediatrică şi pediatrie cu
supraspecializare/competenţă/atestat în gastroenterologie pediatrică.

5. HEPATITA AUTOIMUNA - G5

1 W04224001 H02AB04 METHYLPREDNISOLONUM MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG CUTIE X 5 BLIST. A-PVC/PVC X 10 COMPR.
MAREA BRITANIE P-RF 50 0.811200 0.811200 0.000000
2 W65156001 H02AB04 METHYLPREDNISOLONUM MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 5 BLIST. AL-PVC/PVC X 10 COMPR. PRF 50 0.811200 0.811200 0.000000
3 W04222001 H02AB04 METHYLPREDNISOLONUM MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG CUTIE X 2 BLIST. AL-PVC/PVC X 10 COMPR.
MAREA BRITANIE P-RF 20 3.329000 3.329000 0.000000
4 W65157001 H02AB04 METHYLPREDNISOLONUM MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL-PVC/PVC X 10 COMPR. PRF 20 3.329000 3.329000 0.000000
5 W08307001 H02AB04 METHYLPREDNISOLONUM LEMOD SOLU 125 mg PULB+SOLV. PT. SOL. INJ./PERF. 125mg STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. X 2 ML PRF 1 36.290000 36.290000 0.000000
6 W08310001 H02AB04 METHYLPREDNISOLONUM LEMOD SOLU 500 mg PULB+SOLV. PT. SOL. INJ./PERF. 500mg STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. X 7,8 ML PRF 1 98.000000 98.000000 0.000000
7 W60846001 L04AX01 AZATHIOPRINUM IMURAN 50 mg COMPR. FILM. 50mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. P-RF 100 0.654500 0.654500 0.000000

Tratamentul se initiază de către medicul în specialitatea gastroenterologie

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

1 W00187002 A05AA02 ACIDUM URSODEOXYCHOLICUM URSOFALK 250 mg CAPS. 250mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 4 BLIST. AL/PVC X 25 CAPS. P6L 100 1.005480 1.005480 0.147120
2 W00187001 A05AA02 ACIDUM URSODEOXYCHOLICUM URSOFALK 250 mg CAPS. 250mg DR. FALK PHARMA GMBH GERMANIA CUTIE X 2 BLIST. AL/PVC X 25 CAPS. P-6L 50 1.005480 1.005480 0.286520
3 W66895001 A05AA02 ACIDUM URSODEOXYCHOLICUM ACID URSODEOXICOLIC POLISANO 250 mg CAPS. 250mg POLISANO PHARMACEUTICALS S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVC/AL X 10 CAPS. P6L 50 0.944400 0.944400 0.000000
4 W66895002 A05AA02 ACIDUM URSODEOXYCHOLICUM ACID URSODEOXICOLIC POLISANO 250 mg CAPS. 250mg POLISANO PHARMACEUTICALS S.A. ROMANIA CUTIE CU 10 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 100 0.837900 0.837900 0.000000
5 W66895003 A05AA02 ACIDUM URSODEOXYCHOLICUM ACID URSODEOXICOLIC POLISANO 250 mg CAPS. 250mg POLISANO PHARMACEUTICALS S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 20 CAPS. P6L 100 0.837900 0.837900 0.000000
6 W58710002 A05AA02 ACIDUM URSODEOXYCHOLICUM URSOFALK 500 mg COMPR. FILM. 500mg DR. FALK PHARMA GMBH GERMANIA CUTIE CU 4 BLIST. PVC-PVDC/AL X 25 COMPR.FILM. P6L 100 2.590400 2.590400 0.000000
7 W58363001 A05AA02 ACIDUM URSODEOXYCHOLICUM URSOFALK 250 mg/5 ml SUSP. ORALA 250mg/5ml DR. FALK PHARMA GMBH GERMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 250 ML SUSP. ORALA+1LINGURITA DOZATOARE DIN PP P6L 1 111.690000 111.690000 0.000000
8 W64488001 A05AA04 ACIDUM OBETICHOLICUM ** Ω OCALIVA 5 mg COMPR. FILM. 5mg INTERCEPT PHARMA LTD. MAREA BRITANIE CUTIE CU 1 FLAC. DIN HDPE X 30 COMPR. PRF 30 413.813000 413.813000 0.000000

Tratamentul se initiază de către medicul în specialitatea gastroenterologie

Pagina 6 din 37
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)

7. CIROZA HEPATICA - G7

1 W64011001 A06AD11 LACTULOSUM LACTECON 667 g/l LICHID ORAL 66,7% BGP PRODUCTS B.V. OLANDA FLACON DIN PEID PREVAZUT CU MASURA DOZATOARE X 200 ML P6L 1 18.430000 18.430000 0.000000
2 W64559001 A06AD11 LACTULOSUM LACTECON 667 g/l LICHID ORAL 66,7% MYLAN HEALTHCARE B.V. OLANDA FLACON DIN PEID PREVAZUT CU MASURA DOZATOARE X 200 ML P6L 1 18.430000 18.430000 0.000000
3 W44054002 A06AD11 LACTULOSUM LACTULOSE EIPICO 650 mg/ml SIROP 650mg/ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLACON X 300 ML P-6L 1 13.790000 13.790000 0.000000
4 W44054001 A06AD11 LACTULOSUM LACTULOSE EIPICO 650 mg/ml SIROP 650mg/ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLACON X 100 ML P-6L 1 4.590000 4.590000 0.000000
5 W68854001 A06AD11 LACTULOSUM LACTECON 667 g/l SOL. ORALA 66,7% VIATRIS HEALTHCARE LIMITED IRLANDA FLACON DIN PEID PREVAZUT CU MASURA DOZATOARE DIN PP CU GRADATII X 200 ML SOL. ORALA P6L 1 18.430000 18.430000 0.000000
6 W63734002 A07AA11 RIFAXIMINUM NORMIX 200 mg COMPR. FILM. 200mg ALFASIGMA S.P.A. ITALIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL A CATE 12 COMPR. FILM. PRF 36 2.725277 2.725277 0.000000
7 W69191001 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 1 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 18 6.688333 6.688333 0.000000
8 W69191002 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 36 6.341666 6.341666 0.000000
9 W69191003 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 3 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 54 6.341851 6.341851 0.000000
10 W69191004 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 4 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 72 6.131666 6.131666 0.000000
11 W69191005 A07AA11 RIFAXIMINUM NORMIX 400 mg COMPR. FILM. 400mg ALFASIGMA S.P.A. ITALIA CUTIE CU 5 BLIST. PVC-PE-PVDC/AL X 18 COMPR. FILM. PRF 90 5.934777 5.934777 0.000000
12 W63735001 A07AA11 RIFAXIMINUM NORMIX 200mg/10ml GRAN. PT. SUSP. ORALA 200mg/10ml ALFASIGMA S.P.A. ITALIA CUTIE CU UN FLACON DIN STICLA BRUNA CONTINÂND GRANULE PENTRU 60 ML SUSPENSIE ORALA, ÎNSOTIT DE O MASURA DOZATOARE MARCATA LA 5, 10 SI 15 ML. PRF 1 25.270000 25.270000 0.000000
13 W03265002 C03CA01 FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.389000 0.389000 0.000000
14 W42036002 C03CA01 FUROSEMIDUM FUROSEMID SLAVIA 40 mg COMPR. 40mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.397500 0.397500 0.000000
15 W43155001 C03CA01 FUROSEMIDUM FUROSEMID ZENTIVA 40 mg COMPR. 40mg ZENTIVA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 20 COMPR. P-6L 20 0.397500 0.397500 0.000000
16 W52043001 C03CA01 FUROSEMIDUM FUROSEMID ARENA 40 mg COMPR. 40mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.397500 0.397500 0.000000
17 W60369001 C03CA01 FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.397500 0.397500 0.000000
18 W03264003 C03CA01 FUROSEMIDUM FUROSEMID LPH 40 mg COMPR. 40mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. DIN PVC/AL X 10 COMPRIMATE P-6L 30 0.398000 0.398000 0.000000
19 W03265003 C03CA01 FUROSEMIDUM FUROSEMID MCC 40 mg COMPR. 40mg MAGISTRA C&C S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P6L 30 0.398000 0.398000 0.000000
20 W67808003 C03CA01 FUROSEMIDUM FUROSEMID MEDREG 40 mg COMPR. 40mg MEDREG S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 0.376333 0.376333 0.000000
21 W68090001 C03CA01 FUROSEMIDUM FUROSEMID BIOEEL 40 mg COMPR. 40mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.397500 0.397500 0.000000
22 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 1.538000 1.538000 0.000000
23 W68522002 C03CA01 FUROSEMIDUM FUROSEMID HAMELN 10 mg/ml SOL INJ. 10mg/ml HAMELN PHARMA 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 1.538000 1.538000 0.000000
24 W58282001 C03CA01 FUROSEMIDUM FUROSEMID ZENTIVA 20 mg/2 ml SOL. INJ. 20mg/2ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 2 ML SOL. INJ. P-RF 5 1.606000 1.606000 0.000000
25 W55360002 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA ARENA 25 mg CAPS. 25mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 CAPS. P-6L 50 0.471800 0.471800 0.000000
26 W57830002 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA LPH 25 mg CAPS. 25mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 6 BLIST. PVC/AL X 10 CAPS. P6L 60 0.472000 0.472000 0.000000
27 W54823001 C03DA01 SPIRONOLACTONUM VEROSPIRON CAPS. 50mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-6L 30 0.510666 0.510666 0.000000
28 W55359001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA ARENA 50 mg CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P-6L 30 0.612799 0.612799 0.262867
29 W60370001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA BIOEEL 25 mg COMPR. 25mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.471500 0.471500 0.000000
30 W68089001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA BIOEEL 25 mg COMPR. 25mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.471500 0.471500 0.000000
31 W08893001 C03DA01 SPIRONOLACTONUM SPIRONOLACTONA TERAPIA 25 mg COMPR. FILM. 25mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 50 0.471800 0.471800 0.000000
32 W52138001 C03DA01 SPIRONOLACTONUM ALSPIRON 25 mg COMPR. FILM. 25mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 0.471500 0.471500 0.000000
33 W41550001 C03DA01 SPIRONOLACTONUM ALSPIRON 50 mg COMPR. FILM. 50mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 0.612799 0.612799 0.263201
34 W62522002 J05AF05 LAMIVUDINUM **1 LAMIVUDINA TEVA 100 mg COMPR. FILM. 100 mg TEVA B.V. OLANDA CUTIE CU BLIST. PVC/PVDC/AL X 30 COMPR. FILM. P-RF 30 4.689000 4.689000 0.000000
35 W65306001 J05AF05 LAMIVUDINUM **1 ZEFFIX 100 mg COMPR. FILM. 100mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 28 COMPR. FILM. (BLIST. PVC-AL/PVC-AL) PR 28 4.589285 4.589285 0.000000
36 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 5.463333 5.463333 0.000000
37 W63932001 J05AF10 ENTECAVIRUM **1 ENTECAVIR SANDOZ 0,5 mg COMPR. FILM. 0,5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PR 30 6.308799 6.308799 19.055201
38 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 5.463333 5.463333 0.000000
39 W63864001 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 0,5 mg COMPR. FILM. 0,5mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. (OPA/ALU/PVC-ALU) X 30 COMPR. FILM. PR 30 6.307000 6.307000 0.000000
40 W63803001 J05AF10 ENTECAVIRUM **1 ENTECAVIR ALVOGEN 0,5 mg COMPR. FILM. 0,5mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 6.308799 6.308799 20.925201
41 W63755002 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 0,5 mg COMPR. FILM. 0,5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 5.463333 5.463333 0.000000
42 W64664003 J05AF10 ENTECAVIRUM **1 ENTECAVIR SANIENCE 0,5 mg COMPR. FILM. 0,5mg SANIENCE S.R.L. ROMANIA CUTIE CU 3 BLIST. AL/PVC-PVDC(120) X 10 COMPR. FILM. PR 30 5.257333 5.257333 0.000000
43 W64664002 J05AF10 ENTECAVIRUM **1 ENTECAVIR SANIENCE 0,5 mg COMPR. FILM. 0,5mg SANIENCE S.R.L. ROMANIA CUTIE CU 3 BLIST. AL/PVC-PVDC(60) X 10 COMPR. FILM. PR 30 5.257333 5.257333 0.000000
44 W65671001 J05AF10 ENTECAVIRUM **1 ENTECAVIR ACCORD 0,5 mg COMPR. FILM. 0,5mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU 30 X 1 COMPR. FILM. PR 30 6.308799 6.308799 12.169534
45 W65511001 J05AF10 ENTECAVIRUM **1 ENTECAVIR TERAPIA 0,5 mg COMPR. FILM. 0,5mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. UNIDOZA PENTRU ELIBERAREA UNEI UNITATI DOZATE DIN OPA-AL-PVC/AL CONTINAND 30X1 COMPR. FILM. PR 30 6.308799 6.308799 0.000201
46 W68145001 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 0,5 mg COMPR. FILM. 0,5mg MYLAN PHARMACEUTICALS LIMITED IRLANDA CUTIE CU BLIST. (OPA/ALU/PVC-ALU) X 30 COMPR. FILM. PR 30 6.307000 6.307000 0.000000
47 W68663001 J05AF10 ENTECAVIRUM **1 ENTECAVIR LABORMED 0,5 mg COMPR. FILM. 0,5mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 6.308799 6.308799 20.925201
48 W65511005 J05AF10 ENTECAVIRUM **1 ENTECAVIR TERAPIA 0,5 mg COMPR. FILM. 0,5mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL CONTINAND 30 COMPR. FILM. PR 30 6.308799 6.308799 0.000201
49 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 15.721999 15.721999 12.783334
50 W63933001 J05AF10 ENTECAVIRUM **1 ENTECAVIR SANDOZ 1 mg COMPR. FILM. 1mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PR 30 15.721999 15.721999 14.220001
51 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 15.721999 15.721999 12.783334
52 W63865001 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 1 mg COMPR. FILM. 1mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. (OPA/ALU/PVC-ALU) X 30 COMPR. FILM. PR 30 13.101666 13.101666 0.000000
53 W63814001 J05AF10 ENTECAVIRUM **1 ENTECAVIR ALVOGEN 1 mg COMPR. FILM. 1mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 15.721999 15.721999 41.338334
54 W63756002 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PR 30 15.721999 15.721999 12.783334
55 W63756005 J05AF10 ENTECAVIRUM **1 ENTECAVIR TEVA 1 mg COMPR. FILM. 1mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. UNIDOZA PVC-PVDC/AL X 30X1 COMPR. FILM. PR 30 15.721999 15.721999 12.783334
56 W65672001 J05AF10 ENTECAVIRUM **1 ENTECAVIR ACCORD 1 mg COMPR. FILM. 1mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU 30 X 1 COMPR. FILM. PR 30 15.721999 15.721999 10.925334
57 W65512001 J05AF10 ENTECAVIRUM **1 ENTECAVIR TERAPIA 1 mg COMPR. FILM. 1mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. UNIDOZA PENTRU ELIBERAREA UNEI UNITATI DOZATE DIN OPA-AL-PVC/AL CONTINAND 30X1 COMPR. FILM. PR 30 13.273333 13.273333 0.000000

Pagina 7 din 37
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)
58 W68146001 J05AF10 ENTECAVIRUM **1 ENTECAVIR MYLAN 1 mg COMPR. FILM. 1mg MYLAN PHARMACEUTICALS LIMITED IRLANDA CUTIE CU BLIST. (OPA/ALU/PVC-ALU) X 30 COMPR. FILM. PR 30 13.101666 13.101666 0.000000
59 W68664001 J05AF10 ENTECAVIRUM **1 ENTECAVIR LABORMED 1 mg COMPR. FILM. 1mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE OPA-AL-PVC/AL X 30X1 COMPR. FILM. PR 30 15.721999 15.721999 41.338334
60 W65512005 J05AF10 ENTECAVIRUM **1 ENTECAVIR TERAPIA 1 mg COMPR. FILM. 1mg S.C. TERAPIA S.A. ROMANIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL CONTINAND 30 COMPR. FILM. PR 30 13.273333 13.273333 0.000000
61 W68897001 J05AP01 RIBAVIRINUM **1 VIRON 200 mg CAPS. 200mg CN UNIFARM S.A. ROMANIA CUTIE CU BLIST. DIN PVC/PVDC/AL X 140 CAPSULE PRF 140 4.295357 4.295357 0.000000
62 W64756001 J05AP51 COMBINATII (LEDIPASVIRUM+SOFOSBUVIRUM) **1 β HARVONI 90 mg/400 mg COMPR. FILM. 90mg/400mg GILEAD SCIENCES IRELAND UC IRLANDA CUTIE CU 1 FLAC. PEID PREVAZUT CU UN SISTEM DE INCHIDERE SECURIZAT PT. COPII X 28 COMPR. FILM. PR 28 2,155.721785 2,155.721785 0.000000
63 W64754001 J05AP55 COMBINATII (SOFOSBUVIRUM+VELPATASVIRUM) **1 β EPCLUSA 400mg/100mg COMPR. FILM. 400mg/100mg GILEAD SCIENCES IRELAND UC IRLANDA CUTIE CU 1 FLAC. PEID PREVAZUT CU SISTEM SECURIZAT PENTRU COPII X 28 COMPR. FILM. PR 28 1,460.103214 1,460.103214 0.000000
64 W64760001 J05AP56 SOFOSBUVIRUM +VELPATASVIRUM + VOXILAPREVIRUM **1 β VOSEVI 400 mg/100 mg/100 mg COMPR. FILM. 400mg/100mg/100mg GILEAD SCIENCES IRELAND UC IRLANDA CUTIE CU 1 FLAC. PEID X 28 COMPR. FILM. PR 28 1,987.856428 1,987.856428 0.000000
65 W65905001 J05AP57 COMBINATII (GLECAPREVIRUM + PIBRENTASVIRUM) **1 β MAVIRET 100 mg/40 mg COMPR. FILM. 100mg/40mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 4 BLIST. PVC/PE/PCTFE/AL X 21 COMPR. FILM PR 84 624.816666 624.816666 0.000000
66 W53892001 L03AA02 FILGRASTIMUM (G-CSF) ** ZARZIO 30MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 60MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL P-RF/R 1 87.490000 87.490000 0.000000
67 W53893001 L03AA02 FILGRASTIMUM (G-CSF) ** ZARZIO 48MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 96MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL P-RF/R 1 147.312000 147.312000 0.678000
68 W67882001 L03AA02 FILGRASTIMUM (G-CSF) ** ACCOFIL 12 MU/0,2 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 12 MU/0,2 ml ACCORD HEALTHCARE S.L.U. SPANIA AMBALAJ CU 1 SERINGA PREUMPLUTA (STICLA) CU 0,2 ML SOL. INJ. CU DISPOZITIV DE SIGURANTA PENTRU AC PR 1 142.490000 142.490000 0.000000
69 W65658001 L03AA02 FILGRASTIMUM (G-CSF) ** ACCOFIL 30 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 30MU/0,5 ml ACCORD HEALTHCARE S.L.U. SPANIA AMBALAJ CU 1 SERINGA PREUMPLUTA (STICLA) CU 0,5 ML SOL. INJ. PR 1 93.080000 93.080000 0.000000
70 W65659001 L03AA02 FILGRASTIMUM (G-CSF) ** ACCOFIL 48 MU/0,5 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 48MU/0,5 ml ACCORD HEALTHCARE S.L.U. SPANIA AMBALAJ CU 1 SERINGA PREUMPLUTA (STICLA) CU 0,5 ML SOL. INJ. PR 1 122.760000 122.760000 0.000000
71 W67883001 L03AA02 FILGRASTIMUM (G-CSF) ** ACCOFIL 70 MU/0,73 ml SOL. INJ. SAU PERF. IN SERINGA PREUMPLUTA 70 MU/0,73 ml ACCORD HEALTHCARE S.L.U. SPANIA AMBALAJ CU 1 SERINGA PREUMPLUTA (STICLA) CU 0,73 ML SOL. INJ. CU DISPOZITIV DE SIGURANTA PENTRU AC PR 1 960.390000 960.390000 0.000000
72 W64857002 L03AA02 FILGRASTIMUM (G-CSF) ** NIVESTIM 30 MU/0,5 ml SOL. INJ./PERF. 300µg/0,5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 5 SERINGI PREUMPLUTE (STICLA) X 0,5 ML SOL. INJ. SAU PERF. PR 5 89.510000 89.510000 0.000000
73 W64858002 L03AA02 FILGRASTIMUM (G-CSF) ** NIVESTIM 48 MU/0,5 ml SOL. INJ./PERF. 480µg/0,5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 5 SERINGI PREUMPLUTE (STICLA) X 0,5 ML SOL. INJ. SAU PERF. PR 5 145.440000 145.440000 0.000000
74 W68070001 L03AB11 PEGINTERFERON ALFA-2A **1 PEGASYS 180 microrgrame/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 180µg/0,5ml ZR PHARMA& GMBH AUSTRIA CUTIE X 1 SERINGA PRE-UMPLUTA X 0,5 ML + 1 AC PR 1 750.530000 750.530000 0.000000
75 W00264001 N04BB01 AMANTADINUM ** VIREGYT-K 100 mg CAPS. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 50 CAPS. P-6L 50 0.493400 0.493400 0.000000

Tratamentul se iniţiază de către medicul în specialitatea gastroenterologie, boli infecţioase, nefrologie (doar pentru pacienţii cu afectare renală consecutivă infecţiei cu virusuri hepatitice), gastroenterologie pediatrică şi pediatrie cu
supraspecializare/competenţă/atestat în gastroenterologie pediatrică.

8. Medicamente de suport pentru afecţiuni oncologice, hematologice şi pentru terapia durerii - G10

1 W56153001 A04AA01 ONDANSETRONUM ** OSETRON 4 mg COMPR. FILM. 4mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 BLIST. AL-PVDC/PVC X 10 COMPR. FILM. P-RF 10 3.400000 3.400000 0.000000
2 W56154001 A04AA01 ONDANSETRONUM ** OSETRON 8 mg COMPR. FILM. 8mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 BLIST. AL-PVDC/PVC X 10 COMPR. FILM. P-RF 10 5.106000 5.106000 0.000000
3 W68355004 A04AA01 ONDANSETRONUM ** ONDANSETRON KALCEKS 2 mg/ml SOL INJ./PERF. 2 mg/ml AKCIJU SABIEDRIBA KALCEKS LETONIA CUTIE CU 5 FIOLE DIN STICLA TRANSPARENTA PREVAZUTE CU PUNCT DE RUPERE A CATE 4 ML SOLUTIE INJ./PERF. PR 5 15.484800 15.484800 3.483200
4 W68355001 A04AA01 ONDANSETRONUM ** ONDANSETRON KALCEKS 2 mg/ml SOL INJ./PERF. 2 mg/ml AKCIJU SABIEDRIBA KALCEKS LETONIA CUTIE CU 5 FIOLE DIN STICLA TRANSPARENTA PREVAZUTE CU PUNCT DE RUPERE A CATE 2 ML SOLUTIE INJ./PERF. PR 5 7.555200 7.555200 3.126800
5 W57424001 A04AA01 ONDANSETRONUM ** OSETRON 8 mg SOLUTIE INJECTABILA SOL. INJ. 2mg/ml DR. REDDY'S LABORATORIES ROMANIA CUTIE X 1 BLIST. AL/PVC X 5 FIOLE X 4 ML SOL. INJ. S/P-RF 5 12.904000 12.904000 0.000000
6 W57423001 A04AA01 ONDANSETRONUM ** OSETRON 4 mg SOLUTIE INJECTABILA SOL. INJ. 2mg/ml DR. REDDY'S LABORATORIES ROMANIA CUTIE 1 BLIST. AL/PVC X 5 FIOLE X 2 ML SOL. INJ. S/P-RF 5 7.234000 7.234000 0.000000
7 W68620001 A04AA01 ONDANSETRONUM ** ONDASAN 2 mg/ml SOL. INJ. 2mg/ml MESFARMA SRL ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA, TIP I, INTRODUSE IN SUPORT AL-PVC A CATE 2 ML SOL. INJ. PR 5 6.296000 6.296000 0.000000
8 W57716002 A04AA02 GRANISETRONUM ** GRANORED 1 mg COMPR. FILM. 1mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 10 20.702000 20.702000 0.000000
9 W66610002 A04AA02 GRANISETRONUM ** GRANISETRON ALVOGEN 1 mg COMPR. FILM. 1mg ALVOGEN PHARMA TRADING EUROPE EOOD BULGARIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM. PRF 10 20.702000 20.702000 0.000000
10 W68168002 A04AA02 GRANISETRONUM ** GRANISETRON LABORMED 1 mg COMPR. FILM. 1mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM. PRF 10 20.702000 20.702000 0.000000
11 W66612002 A04AA02 GRANISETRONUM ** GRANISETRON ALVOGEN 2 mg COMPR. FILM. 2mg ALVOGEN PHARMA TRADING EUROPE EOOD BULGARIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM. PRF 10 34.234000 34.234000 0.000000
12 W68169002 A04AA02 GRANISETRONUM ** GRANISETRON LABORMED 2 mg COMPR. FILM. 2mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM. PRF 10 34.234000 34.234000 0.000000
13 W69033001 A04AA02 GRANISETRONUM ** SANCUSO 3,1 mg/24 ore PLASTURE TRANSDERMIC 3,1 mg/24 ore KYOWA KIRIN HOLDINGS B.V. OLANDA CUTIE CU 1 PLASTURE TRANSPLASTURE TRANSDERMIC (HÂRTIE ACOPERITA CU POLIESTER/ALUMINIU/LLDPE) PRF 1 352.280000 352.280000 0.000000
14 W53853003 A04AA02 GRANISETRONUM ** GRANISETRON KABI 1 mg/ml SOL. INJ. 1mg/ml FRESENIUS KABI ROMANIA SRL ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 3 ML SOL. INJ. PR 5 30.626000 30.626000 0.000000
15 W56568002 A04AA05 PALONOSETRONUM ** ALOXI 500mcg CAPS. MOI 500mcg HELSINN BIREX PHARMACEUTICALS LTD. IRLANDA CUTIE X BLISTER DIN POLIAMIDA/AL/PVC X 1 CAPSULA MOALE PRF 1 309.780000 309.780000 0.000000
16 W68356001 A04AA05 PALONOSETRONUM ** PALONOSETRON KALCEKS 250 micrograme SOL INJ. 250 micrograme/5 ml AKCIJU SABIEDRIBA KALCEKS LETONIA CUTIE CU UN FLACON DIN STICLA INCOLORA CU 5 ML SOLUTIE INJECTABILA PR 1 138.564000 138.564000 101.196000
17 W62987001 A04AA05 PALONOSETRONUM ** FERANT 250 micrograme SOL INJ. 250micrograme MEDOCHEMIE LTD. CIPRU CUTIE CU 1 FIOLA DIN STICLA INCOLORA CARE CONTINE 5 ML SOL. INJ. PR 1 115.470000 115.470000 0.000000
18 W65704001 A04AA05 PALONOSETRONUM ** PALONOSETRON ACCORD 250 micrograme SOL INJ. 250micrograme ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU 1 FLAC. CARE CONTINE 5 ML SOLUTIE PALONOSETRON PRF 1 115.470000 115.470000 0.000000
19 W43177001 A04AA05 PALONOSETRONUM ** ALOXI SOL. INJ. 250 mcg/5ml HELSINN BIREX PHARMACEUTICALS LTD. IRLANDA CUTIE X 1 FLAC. DIN STICLA X 5 ML SOL. INJ. P-RF 1 138.564000 138.564000 19.146000
20 W63032001 A04AA05 PALONOSETRONUM ** PALONOSETRON FRESENIUS KABI 250 micrograme SOL. INJ. 250micrograme FRESENIUS KABI ROMANIA SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA TIP I CARE CONTINE 5 ML SOL. INJ. PRF 1 138.564000 138.564000 19.146000
21 W63231001 A04AA05 PALONOSETRONUM ** PALONOSETRON DR. REDDY'S 250 micrograme SOL. INJ. 250micrograme DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 FLAC. TUBULAR DIN STICLA CONTINAND 5 ML SOL. INJ. PRF 1 138.564000 138.564000 97.706000
22 W63033002 A04AA05 PALONOSETRONUM ** PALONOSETRON FRESENIUS KABI 250 micrograme SOL. INJ. IN SERINGA PREUMPLUTA 250micrograme FRESENIUS KABI ROMANIA SRL ROMANIA CUTIE CU 10 SERINGI PREUMPLUTE CARE CONTIN 5 ML SOL. INJ. PRF 10 135.096000 135.096000 0.000000
23 W62207001 A04AA55 COMBINATII (NETUPITANTUM+PALONOSETRONUM) ** AKYNZEO 300 mg/0,5 mg CAPS. 300mg/0,5mg IRLANDA BLISTER DIN AL/AL X 1 CAPS.
HELSINN BIREX PHARMACEUTICALS LTD. PRF 1 338.660000 338.660000 0.000000
24 W52283002 B03XA01 EPOETINUM ALFA ** BINOCRIT 2000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/1,0ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMPLUTE X 1ML SOL. INJ. PR 6 57.956666 57.956666 0.000000
25 W55046001 B03XA01 EPOETINUM ALFA ** BINOCRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,75ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,75ML SOL. INJ. PR 1 651.340000 651.340000 0.000000
26 W57497004 B03XA01 EPOETINUM ALFA ** EPREX 40000 UI/ml SOL. INJ. IN SERINGA PREUMPLUTA 40 000UI/ml JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 1,022.664000 1,022.664000 262.556000
27 W55048001 B03XA01 EPOETINUM ALFA ** BINOCRIT 40000 UI/1 ml SOL. INJ. IN SERINGA PREUMPLUTA 40000 UI/1 ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 1ML SOL. INJ. PR 1 852.220000 852.220000 0.000000
28 W52285002 B03XA01 EPOETINUM ALFA ** BINOCRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMPLUTE X 0,4ML SOL. INJ. PR 6 105.705000 105.705000 0.000000
29 W64395002 B03XA01 EPOETINUM BETA ** NEORECORMON 10000 UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/0,6ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 6 SERINGI PREUMPLUTE X 0,6 ML SOL. INJ. + 6 ACE PR 6 326.240000 326.240000 0.000000
30 W64396002 B03XA01 EPOETINUM BETA ** NEORECORMON 2000 UI/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 6 SERINGI PREUMPLUTE X 0,3 ML SOL. INJ. X 6 ACE PR 6 56.261666 56.261666 0.000000
31 W64397001 B03XA01 EPOETINUM BETA ** NEORECORMON 30000 UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 30000 UI/0,6ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 SERINGA PRE-UMPLUTA X 0,6 ML + 1 AC PR 1 1,163.530000 1,163.530000 0.000000
32 W64398002 B03XA01 EPOETINUM BETA ** NEORECORMON 4000 UI/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 6 SERINGI PREUMPLUTE X 0,3 ML SOL. INJ. + 6 ACE PR 6 102.505000 102.505000 0.000000
33 W64399002 B03XA01 EPOETINUM BETA ** NEORECORMON 5000 UI/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 6 SERINGI PREUMPLUTE X 0,3 ML SOL. INJ. + 6 ACE PR 6 144.476666 144.476666 0.000000
34 W60969001 B03XA01 EPOETINUM ZETA ** RETACRIT 10000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/1,0ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 1ML SOL. INJ. PR 1 245.910000 245.910000 0.000000
35 W64987001 B03XA01 EPOETINUM ZETA ** RETACRIT 10000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/1,0ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 245.910000 245.910000 0.000000

Pagina 8 din 37
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)
36 W60964001 B03XA01 EPOETINUM ZETA ** RETACRIT 2000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,6ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,6ML SOL. INJ. PR 1 60.840000 60.840000 0.000000
37 W64990001 B03XA01 EPOETINUM ZETA ** RETACRIT 2000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,6ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. PR 1 60.840000 60.840000 0.000000
38 W60967001 B03XA01 EPOETINUM ZETA ** RETACRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,75ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,75ML SOL. INJ. PR 1 659.210000 659.210000 0.000000
39 W64991001 B03XA01 EPOETINUM ZETA ** RETACRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,75ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,75 ML SOL. INJ. PR 1 659.210000 659.210000 0.000000
40 W60965001 B03XA01 EPOETINUM ZETA ** RETACRIT 3000UI/0,9ml SOL. INJ. IN SERINGA PREUMPLUTA 3000UI/0,9ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,9ML SOL. INJ. PR 1 80.990000 80.990000 0.000000
41 W64992001 B03XA01 EPOETINUM ZETA ** RETACRIT 3000UI/0,9ml SOL. INJ. IN SERINGA PREUMPLUTA 3000UI/0,9ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,9 ML SOL. INJ. PR 1 80.990000 80.990000 0.000000
42 W60966001 B03XA01 EPOETINUM ZETA ** RETACRIT 40000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 40000UI/1,0ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 1ML SOL. INJ. PR 1 876.590000 876.590000 0.000000
43 W64993001 B03XA01 EPOETINUM ZETA ** RETACRIT 40000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 40000UI/1,0ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 876.590000 876.590000 0.000000
44 W60973001 B03XA01 EPOETINUM ZETA ** RETACRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,4ML SOL. INJ. PR 1 107.970000 107.970000 0.000000
45 W64994001 B03XA01 EPOETINUM ZETA ** RETACRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,4 ML SOL. INJ. PR 1 107.970000 107.970000 0.000000
46 W60972001 B03XA01 EPOETINUM ZETA ** RETACRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL. INJ. PR 1 133.170000 133.170000 0.000000
47 W64995001 B03XA01 EPOETINUM ZETA ** RETACRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. PR 1 133.170000 133.170000 0.000000
48 W60971001 B03XA01 EPOETINUM ZETA ** RETACRIT 6000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI/0,6ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,6ML SOL. INJ. PR 1 153.590000 153.590000 0.000000
49 W64996001 B03XA01 EPOETINUM ZETA ** RETACRIT 6000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI/0,6ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. PR 1 153.590000 153.590000 0.000000
50 W60970001 B03XA01 EPOETINUM ZETA ** RETACRIT 8000UI/0,8ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI/0,8ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,8ML SOL. INJ. PR 1 304.810000 304.810000 0.000000
51 W64997001 B03XA01 EPOETINUM ZETA ** RETACRIT 8000UI/0,8ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI/0,8ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,8 ML SOL. INJ. PR 1 304.810000 304.810000 0.000000
52 W41530002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 100mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 100mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,5 ML P-RF/R 4 640.115000 640.115000 0.000000
53 W41522002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 10mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 10mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,4 ML P-RF/R 4 79.912500 79.912500 0.000000
54 W41524002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 20mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 20mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,5 ML P-RF/R 4 138.357500 138.357500 0.000000
55 W41525002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 30mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 30mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,3 ML P-RF/R 4 218.422500 218.422500 0.000000
56 W41526002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 40mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 40mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,4 ML P-RF/R 4 266.452500 266.452500 0.000000
57 W41533001 B03XA02 DARBEPOETINUM ALFA ** ARANESP 500mcg/ml SOL. INJ. IN SERINGA PREUMPLUTA 500mcg/ml AMGEN EUROPE BV OLANDA CUTIE X 1 SERINGA PREUMPLUTA A 1 ML X 1 ML P-RF/R 1 3,028.900000 3,028.900000 0.000000
58 W41527002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 50mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 50mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,5 ML P-RF/R 4 352.230000 352.230000 0.000000
59 W41528002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 60mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 60mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,3 ML P-RF/R 4 379.785000 379.785000 0.000000
60 W41529002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 80mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 80mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,4 ML P-RF/R 4 500.495000 500.495000 0.000000
61 W64041001 G03HA01 CYPROTERONUM ** ANDROCUR 50 mg COMPR. 50mg BAYER AG GERMANIA CUTIE CU 5 BLIST. AL/PVC X 10 COMPR. PRF 50 2.065800 2.065800 0.000000
62 W63171002 H02AB02 DEXAMETHASONUM DEXAMETAZONA KRKA 20 mg COMPR. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 20 COMPR. PRF 20 6.795500 6.795500 0.000000
63 W63169002 H02AB02 DEXAMETHASONUM DEXAMETAZONA KRKA 4 mg COMPR. 4mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 20 COMPR. PRF 20 1.720000 1.720000 0.000000
64 W59780001 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU UN SUPORT CU 10 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 10 0.929000 0.929000 0.000000
65 W59780003 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU UN SUPORT CU 25 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 25 0.914000 0.914000 0.000000
66 W59780004 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 100 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 100 0.823800 0.823800 0.000000
67 W59780005 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU UN SUPORT CU 10 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. PRF 10 1.667520 1.667520 0.150480
68 W59780007 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 25 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. PRF 25 1.667520 1.667520 0.024480
69 W44063002 H02AB02 DEXAMETHASONUM DEXAMETHASONE SODIUM PHOSPHATE 8 mg/2 ml SOL. INJ. 8mg/2ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 100 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. P-RF 100 1.389600 1.389600 0.000000
70 W44063001 H02AB02 DEXAMETHASONUM DEXAMETHASONE SODIUM PHOSPHATE 8 mg/2 ml SOL. INJ. 8mg/2ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. P-RF 5 1.667520 1.667520 0.148480
71 W08299001 H02AB02 DEXAMETHASONUM DEXAMED 8 mg/2 ml SOL. INJ. 8mg/2ml MEDOCHEMIE LTD. CIPRU CUTIE X 10 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. P-RF 10 1.667520 1.667520 0.150480
72 W03837002 J02AC02 ITRACONAZOLUM ORUNGAL 100 mg CAPS. 100mg JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE X 3 BLIST. AL/PVC-PE-PVDC X 5 CAPS. P-RF 15 2.744666 2.744666 0.000000
73 W43051001 J02AC02 ITRACONAZOLUM ITRACONAZOL SLAVIA 100 mg CAPS. 100mg SLAVIA PHARM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 5 CAPS. P-RF 15 2.648000 2.648000 0.000000
74 W53958001 J02AC02 ITRACONAZOLUM MICOGAL 100 mg CAPS. 100mg ROMPHARM COMPANY SRL ROMANIA CUTIE CU BLISTERE PVC/AL X 15 CAPSULE P-RF 15 2.648000 2.648000 0.000000
75 W59235001 J02AC02 ITRACONAZOLUM ITRACONAZOL ARENA 100 mg CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. AL/PVC X 5 CAPS. P-RF 15 2.648000 2.648000 0.000000
76 W67015006 J02AC02 ITRACONAZOLUM OMICRAL 100 mg CAPS. 100mg BAUSCH HEALTH IRELAND LIMITED IRLANDA CUTIE X 3 BLIST. AL/AL X 5 CAPS. P-RF 15 2.648000 2.648000 0.000000
77 W08947008 J02AC03 VORICONAZOLUM ** VFEND 200mg COMPR. FILM. 200mg PFIZER LIMITED MAREA BRITANIE CUTIE X 28 COMPR. FILM. (BLIST.PVC/AL) P-RF 28 23.319199 23.319199 52.899372
78 W61628005 J02AC03 VORICONAZOLUM ** VORICONAZOL ZENTIVA 200 mg COMPR. FILM. 200mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 19.600714 19.600714 0.000000
79 W61628006 J02AC03 VORICONAZOLUM ** VORICONAZOL ZENTIVA 200 mg COMPR. FILM. 200mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. PRF 30 19.432666 19.432666 0.000000
80 W64073003 J02AC03 VORICONAZOLUM ** VERRIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 14 COMPR. FILM. PRF 14 23.319199 23.319199 6.767229
81 W64073005 J02AC03 VORICONAZOLUM ** VERRIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 23.319199 23.319199 4.235443
82 W64073008 J02AC03 VORICONAZOLUM ** VERRIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. PRF 56 23.319199 23.319199 2.974372
83 W64931001 J02AC03 VORICONAZOLUM ** VFEND 200 mg COMPR. FILM. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 23.319199 23.319199 52.899372
84 W65715001 J02AC03 VORICONAZOLUM ** VORICONAZOLE ACCORD 200 mg COMPR. FILM. 200mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU BLIST. PVC/AL X 28 COMPR. PRF 28 23.319199 23.319199 16.420801
85 W64072003 J02AC03 VORICONAZOLUM ** VERRIA 50 mg COMPR. FILM. 50mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 14 COMPR. FILM. PRF 14 28.775000 28.775000 0.000000
86 W64072005 J02AC03 VORICONAZOLUM ** VERRIA 50 mg COMPR. FILM. 50mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 26.225714 26.225714 0.000000
87 W64072008 J02AC03 VORICONAZOLUM ** VERRIA 50 mg COMPR. FILM. 50mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. PRF 56 24.980535 24.980535 0.000000
88 W68026001 J02AC03 VORICONAZOLUM ** VORICONAZOL ROMPHARM 200 mg PULB. PT. CONC. PT. SOL. PERF. FARA CONCENTRATIE ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA, INCOLORA CARE CONTINE PULB. PT. CONC. PT. SOL. PERF. PRF 1 391.760000 391.760000 0.000000
89 W10489001 J02AC03 VORICONAZOLUM ** VFEND 200mg PULB. PT. SOL. PERF. 200mg PFIZER LIMITED MAREA BRITANIE CUTIE X 1 FLAC. UNIDOZA X 30ML P-RF 1 391.760000 391.760000 0.000000
90 W62122001 J02AC03 VORICONAZOLUM ** VORICONAZOL FRESENIUS KABI 200 mg PULB. PT. SOL. PERF. 200mg FRESENIUS KABI ROMANIA SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA TIP I, CU CAPACITATEA DE 25 ML, CU PULBERE PT. SOL. PERF. PRF 1 470.112000 470.112000 38.608000
91 W62815001 J02AC03 VORICONAZOLUM ** VORICONAZOL ZENTIVA 200 mg PULB. PT. SOL. PERF. 200mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. DIN STICLA CU CAPCITATEA DE 25 ML CU PULB. PT. SOL. PERF. PRF 1 470.112000 470.112000 357.478000
92 W64929001 J02AC03 VORICONAZOLUM ** VFEND 200 mg PULB. PT. SOL. PERF. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. UNIDOZA X 30 ML PRF 1 391.760000 391.760000 0.000000
93 W41889001 J02AC03 VORICONAZOLUM ** VFEND 40 mg/ml PULB. PT. SUSP. ORALA 40mg/ml PFIZER LIMITED MAREA BRITANIE CUTIE X 1 FLAC. PEID DE 100ML X 45 G PULB. PT. SUSP. ORALA + 1 MASURA DOZATOARE (23 ML) + 1 SERINGA PT. ADM. ORALA (5 ML) + 1 ADAPTOR P-RF 1 1,934.780000 1,934.780000 0.000000
94 W64930001 J02AC03 VORICONAZOLUM ** VFEND 40 mg/ml PULB. PT. SUSP. ORALA 40mg/ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. PEID DE 100ML X 45 G PULB. PT. SUSP. ORALA + 1 MASURA DOZATOARE (23 ML) + 1 SERINGA PT. ADM. ORALA (5 ML) + 1 ADAPTOR PRF 1 1,934.780000 1,934.780000 0.000000
95 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 34.182500 34.182500 0.000000

Pagina 9 din 37
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)
96 W66225002 J02AC04 POSACONAZOLUM ** POSACONAZOLE ACCORD 100 mg COMPR. GASTROREZ. 100mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU BLIST. PVC/PE/PVDC/AL PERFORAT PENTRU ELIBERAREA UNEI DOZE X 24X1 COMPR. GASTROREZ PR 24 34.182500 34.182500 0.000000
97 W66364009 J02AC04 POSACONAZOLUM ** POSACONAZOL ZENTIVA 100 mg COMPR. GASTROREZ. 100mg ZENTIVA K.S. REP. CEHA CUTIE CU BLIST. OPAC NEPERFORAT DIN PVC-PE-PVDC/AL X 24 COMPR. GASTROREZ. PR 24 41.019000 41.019000 11.502666
98 W66421009 J02AC04 POSACONAZOLUM ** POSACONAZOL MYLAN 100 mg COMPR. GASTROREZ. 100mg MYLAN S.A.S. FRANTA CUTIE CU BLIST. PVC-PE-PVDC/AL X 24 COMPR. GASTROREZ. PR 24 40.512500 40.512500 0.000000
99 W66832009 J02AC04 POSACONAZOLUM ** POSACONAZOL STADA 100 mg COMPR. GASTROREZ. 100mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. DIN PVC-PE-PVDC/AL X 24 COMPR. GASTROREZ. PR 24 34.182500 34.182500 0.000000
100 W68234009 J02AC04 POSACONAZOLUM ** POSACONAZOL MYLAN 100 mg COMPR. GASTROREZ. 100mg MYLAN PHARMACEUTICALS LIMITED IRLANDA CUTIE CU BLIST. PVC-PE-PVDC/AL X 24 COMPR. GASTROREZ. PR 24 40.512500 40.512500 0.000000
101 W65835001 J02AC04 POSACONAZOLUM ** POSACONAZOL MYLAN 40 mg/ml SUSP. ORALA 40mg/ml MYLAN IRELAND LIIMTED IRLANDA PR
CUTIE CU 1 FLAC. DIN STICLA, CU CAPAC DIN PE CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII SI O LINGURITA DE MASURARE A DOZELOR X 105 ML SUSP. ORALA 1 766.510000 766.510000 0.000000
102 W66224001 J02AC04 POSACONAZOLUM ** POSACONAZOLE AHCL 40 mg/ml SUSP. ORALA 40mg/ml ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA INCHIS CU CAPAC DIN PP + 1 LINGURITA DOZATOARE X 105 ML SUSP. ORALA PR 1 766.510000 766.510000 0.000000
103 W69004001 J02AC04 POSACONAZOLUM ** POSACONAZOL VIATRIS 40 mg/ml SUSP. ORALA 40mg/ml VIATRIS LIMITED IRLANDA PR
CUTIE CU 1 FLAC. DIN STICLA, CU CAPAC DIN PE CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII SI O LINGURITA DE MASURARE A DOZELOR X 105 ML SUSP. ORALA 1 766.510000 766.510000 0.000000
104 W63845001 J02AC05 ISAVUCONAZOLUM ** CRESEMBA 100 mg CAPS. 100mg BASILEA MEDICAL LTD MAREA BRITANIE CUTIE CU BLIST. AL/AL X 14 CAPS. PRF 14 199.629285 199.629285 0.000000
105 W65622001 J02AC05 ISAVUCONAZOLUM ** CRESEMBA 100 mg CAPS. 100mg BASILEA PHARMACEUTICA DEUTSCHLAND GMBH GERMANIA CUTIE CU 2 BLIST. AL/AL X 7 CAPS. PRF 14 199.629285 199.629285 0.000000
106 W63457001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA ZENTIVA 50 mg PULB. PT. CONC. PT. SOL. PERF. 50mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA DE TIP I, CU CAPACITATEA DE 10 ML CARE CONTINE PULB. PT. CONC. PT. SOL. PERF. PR 1 1,035.020000 1,035.020000 0.000000
107 W63403001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA MYLAN 50 mg PULB. PT. CONC. PT. SOL. PERF. 50mg MYLAN S.A.S. FRANTA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA CU CAPACITATEA DE 10 ML CARE CONTINE PULB. PT. CONCENTRAT PT. SOL. PERF. PR 1 1,035.020000 1,035.020000 0.000000
108 W64793001 J02AX04 CASPOFUNGINUM ** CANCIDAS 50 mg PULB. PT. CONC. PT. SOL. PERF. 50mg MERCK SHARP & DOHME OLANDA CUTIE X 1 FLAC. X 50 MG PULB. PTR. CONC. PTR. SOL. PERF. PR 1 1,035.020000 1,035.020000 0.000000
109 W68225001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA MYLAN 50 mg PULB. PT. CONC. PT. SOL. PERF. 50mg MYLAN PHARMACEUTICALS LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA CU CAPACITATEA DE 10 ML CARE CONTINE PULB. PT. CONCENTRAT PT. SOL. PERF. PR 1 1,035.020000 1,035.020000 0.000000
110 W68343001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA STADA M&D 50 mg PULB. PT. CONC. PT. SOL. PERF. 50mg STADA M&D SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA CU CAPACITATEA DE 10 ML CU PULB. PT. CONC. PT. SOL. PERF. PR 1 1,035.020000 1,035.020000 0.000000
111 W69111001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA ROMPHARM 50 mg PULB. PT. CONC. PT. SOL. PERF. 50mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA, CU CAPAC. DE 10 ML, CU PULB. PT. CONC. PT. SOL. PERF. PR 1 1,035.020000 1,035.020000 0.000000
112 W63458001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA ZENTIVA 70 mg PULB. PT. CONC. PT. SOL. PERF. 70mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA DE TIP I, CU CAPACITATEA DE 10 ML CARE CONTINE PULB. PT. CONC. PT. SOL. PERF. PR 1 1,329.230000 1,329.230000 0.000000
113 W63404001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA MYLAN 70 mg PULB. PT. CONC. PT. SOL. PERF. 70mg MYLAN S.A.S. FRANTA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA CU CAPACITATEA DE 10 ML CARE CONTINE PULB. PT. CONCENTRAT PT. SOL. PERF. PR 1 1,329.230000 1,329.230000 0.000000
114 W64792001 J02AX04 CASPOFUNGINUM ** CANCIDAS 70 mg PULB. PT. CONC. PT. SOL. PERF. 70mg MERCK SHARP & DOHME OLANDA CUTIE X 1 FLAC. X 70 MG PULB. PTR. CONC. PTR. SOL. PERF. PR 1 1,329.230000 1,329.230000 0.000000
115 W68226001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA MYLAN 70 mg PULB. PT. CONC. PT. SOL. PERF. 70mg MYLAN PHARMACEUTICALS LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA CU CAPACITATEA DE 10 ML CARE CONTINE PULB. PT. CONCENTRAT PT. SOL. PERF. PR 1 1,329.230000 1,329.230000 0.000000
116 W68342001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA STADA M&D 70 mg PULB. PT. CONC. PT. SOL. PERF. 70mg STADA M&D SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA CU CAPACITATEA DE 10 ML CU PULB. PT. CONC. PT. SOL. PERF. PR 1 1,329.230000 1,329.230000 0.000000
117 W62968001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA STADA 50 mg PULB. PT.CONC. PT. SOL. PERF. 50mg STADA M&D SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 10 ML CARE CONTINE PULB. PT. CONC. PT. SOL. PERF. PR 1 1,035.020000 1,035.020000 0.000000
118 W62969001 J02AX04 CASPOFUNGINUM ** CASPOFUNGINA STADA 70 mg PULB. PT.CONC. PT. SOL. PERF. 70mg STADA M&D SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 10 ML CARE CONTINE PULB. PT. CONC. PT. SOL. PERF. PR 1 1,329.230000 1,329.230000 0.000000
119 W61708002 L01XX35 ANAGRELIDUM ** THROMBOREDUCTIN 0,5 mg CAPS. 0,5mg AOP ORPHAN PHARMACEUTICALS AG AUSTRIA CUTIE CU 1 FLAC. DIN PE X 100 CAPS. PRF 100 5.431080 5.431080 0.327820
120 W64564002 L01XX35 ANAGRELIDUM ** GRENALVON 0,5 mg CAPS. 0,5mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU 1 FLAC. PEID X 100 CAPS. PR 100 5.431080 5.431080 5.193120
121 W64540001 L01XX35 ANAGRELIDUM ** ANAGRELIDA TERAPIA 0,5 mg CAPS. 0,5mg TERAPIA S.A. ROMANIA CUTIE CU 1 FLAC. PEID X 100 CAPS. PR 100 4.525900 4.525900 0.000000
122 W68277002 L01XX35 ANAGRELIDUM ** GRENALVON 0,5 mg CAPS. 0,5mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 1 FLAC. PEID X 100 CAPS. PR 100 5.431080 5.431080 5.193120
123 W64565001 L01XX35 ANAGRELIDUM ** GRENALVON 1 mg CAPS. 1mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU 1 FLAC. PEID X 42 CAPS. PR 42 14.763360 14.763360 5.978068
124 W64565002 L01XX35 ANAGRELIDUM ** GRENALVON 1 mg CAPS. 1mg ALVOGEN MALTA OPERATIONS (ROW) LTD. MALTA CUTIE CU 1 FLAC. PEID X 100 CAPS. PR 100 14.763360 14.763360 5.016840
125 W65795001 L01XX35 ANAGRELIDUM ** ANAGRELIDA ACCORD 1 mg CAPS. 1mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU 1 FLAC. PEID X 100 CAPS. PR 100 12.302800 12.302800 0.000000
126 W68278001 L01XX35 ANAGRELIDUM ** GRENALVON 1 mg CAPS. 1mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 1 FLAC. PEID X 42 CAPS. PR 42 14.763360 14.763360 5.978068
127 W68278002 L01XX35 ANAGRELIDUM ** GRENALVON 1 mg CAPS. 1mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 1 FLAC. PEID X 100 CAPS. PR 100 14.763360 14.763360 5.016840
128 W51399001 L04AD01 CICLOSPORINUM SANDIMMUN NEORAL 25 mg CAPS. MOI 25mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 BLIST. X 5 CAPS. MOI PR 50 1.789800 1.789800 0.000000
129 W51398001 L04AD01 CICLOSPORINUM SANDIMMUN NEORAL 50 mg CAPS. MOI 50mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 BLIST. X 5 CAPS. MOI PR 50 3.281200 3.281200 0.000000
130 W12686002 N02AA01 MORPHYNUM VENDAL RETARD 100 mg COMPR. CU ELIB. PREL. 100mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 3 BLIST. AL/PVC X 10 COMPR. ELIB. PREL. P-TS 30 3.092666 3.092666 0.000000
131 W12682002 N02AA01 MORPHYNUM VENDAL RETARD 30 mg COMPR. CU ELIB. PREL. 30mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 3 BLIST. AL/PVC X 10 COMPR. ELIB. PREL. P-TS 30 1.415000 1.415000 0.000000
132 W12684002 N02AA01 MORPHYNUM VENDAL RETARD 60 mg COMPR. CU ELIB. PREL. 60mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 3 BLIST. AL/PVC X 10 COMPR. ELIB. PREL. P-TS 30 1.930000 1.930000 0.000000
133 W59252003 N02AA01 MORPHYNUM SEVREDOL 10 mg COMPR. FILM. 10mg MUNDIPHARMA GES.M.B.H AUSTRIA CUTIE CU BLIST. AL/PVC-PVDC X 60 COMPR. FILM. PS 60 1.133833 1.133833 0.000000
134 W59251003 N02AA01 MORPHYNUM SEVREDOL 20 mg COMPR. FILM. 20mg MUNDIPHARMA GES.M.B.H AUSTRIA CUTIE CU BLIST. AL/PVC-PVDC X 60 COMPR. FILM. PS 60 1.385666 1.385666 0.000000
135 W64720001 N02AA01 MORPHYNUM MARACEX 20 mg/ml SOL INJ./PERF. 20mg/ml AS KALCEKS LETONIA CUTIE CU 10 FIOLE DIN STICLA INCOLORA CU CAPACITATEA DE 1 ML SOL. INJ./PERF. PS 10 5.207000 5.207000 0.000000
136 W59797001 N02AA01 MORPHYNUM MORFINA ZENTIVA 20 mg/ml SOL. INJ. 20mg/ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE X 1 ML P-TS 5 6.248400 6.248400 0.873600
137 W55687009 N02AA05 OXYCODONUM OXIDOLOR 20 mg COMPR. ELIB. PREL. 20mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. P-TS 60 1.342000 1.342000 0.000000
138 W55688009 N02AA05 OXYCODONUM OXIDOLOR 40 mg COMPR. ELIB. PREL. 40mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. P-TS 60 2.099333 2.099333 0.000000
139 W59147002 N02AA05 OXYCODONUM OXICODONA SANDOZ 40 mg COMPR. ELIB. PREL. 40mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 20 COMPR. ELIB. PREL. PS 20 2.113500 2.113500 0.000000
140 W59148002 N02AA05 OXYCODONUM OXICODONA SANDOZ 60 mg COMPR. ELIB. PREL. 60mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 20 COMPR. ELIB. PREL. PS 20 6.147500 6.147500 0.000000
141 W55689009 N02AA05 OXYCODONUM OXIDOLOR 80 mg COMPR. ELIB. PREL. 80mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. P-TS 60 3.633333 3.633333 0.000000
142 W59149002 N02AA05 OXYCODONUM OXICODONA SANDOZ 80 mg COMPR. ELIB. PREL. 80mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 20 COMPR. ELIB. PREL. PS 20 4.287500 4.287500 0.000000
143 W44121001 N02AA08 DIHYDROCODEINUM DHC CONTINUS 120 mg COMPR. ELIB. PREL. 120mg MUNDIPHARMA GES.M.B.H AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 COMPR. ELIB. PREL. PS 56 2.199464 2.199464 0.000000
144 W44119001 N02AA08 DIHYDROCODEINUM DHC CONTINUS 60 mg COMPR. ELIB. PREL. 60mg MUNDIPHARMA GESELLSCHAFT M.B.H. AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 COMPR. ELIB. PREL. PS 56 0.882678 0.882678 0.000000
145 W44120001 N02AA08 DIHYDROCODEINUM DHC CONTINUS 90 mg COMPR. ELIB. PREL. 90mg MUNDIPHARMA GESELLSCHAFT M.B.H. AUSTRIA CUTIE X 1 FLAC. DIN PP X 56 COMPR. ELIB. PREL. PS 56 1.280535 1.280535 0.000000
146 W42905002 N02AB02 PETHIDINUM MIALGIN 100 mg/2 ml SOL. INJ. 50mg/ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA X 2 ML PS 5 12.060000 12.060000 0.000000
147 W58214001 N02AB03 FENTANYLUM ** LUNALDIN 100 micrograme COMPR. SUBLING. 100micrograme GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 32.766000 32.766000 0.000000
148 W58215001 N02AB03 FENTANYLUM ** LUNALDIN 200 micrograme COMPR. SUBLING. 200micrograme GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 32.766000 32.766000 0.000000
149 W58216001 N02AB03 FENTANYLUM ** LUNALDIN 300 micrograme COMPR. SUBLING. 300micrograme GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 35.894000 35.894000 0.000000
150 W58217001 N02AB03 FENTANYLUM ** LUNALDIN 400 micrograme COMPR. SUBLING. 400micrograme GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 32.155000 32.155000 0.000000
151 W58218001 N02AB03 FENTANYLUM ** LUNALDIN 600 micrograme COMPR. SUBLING. 600micrograme GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 35.350000 35.350000 0.000000
152 W58219001 N02AB03 FENTANYLUM ** LUNALDIN 800 micrograme COMPR. SUBLING. 800micrograme GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. SECURIZATE PT. COPII OPA/AL/PVC-HARTIE/POLIESTER/AL X 10 COMPR. SUBLINGUALE PRF 10 33.657000 33.657000 0.000000
153 W53503005 N02AB03 FENTANYLUM ** FENTANYL TTS SANDOZ 100 mcg/h PLASTURE TRANSDERMIC 100mcg/h SANDOZ S.R.L. ROMANIA CUTIE CU 5 PLICURI DIN PET/PE/AL/PE X 1 PLASTURE TRANSDERMIC P-TS 5 35.086000 35.086000 0.000000
154 W53251003 N02AB03 FENTANYLUM ** FENTANYL ACTAVIS 100micrograme/h PLASTURE TRANSDERMIC 100micrograme/h ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X 5 PLICURI MULTISTRAT DIN HARTIE -PEJD- AL- SURLYN X 1 PLASTURE TRANSDERMIC PS 5 31.206000 31.206000 0.000000
155 W53500005 N02AB03 FENTANYLUM ** FENTANYL TTS SANDOZ 25 mcg/h PLASTURE TRANSDERMIC 25mcg/h SANDOZ S.R.L. ROMANIA CUTIE CU 5 PLICURI DIN PET/PE/AL/PE X 1 PLASTURE TRANSDERMIC P-TS 5 12.714000 12.714000 0.000000

Pagina 10 din 37
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)
156 W53248003 N02AB03 FENTANYLUM ** FENTANYL ACTAVIS 25micrograme/h PLASTURE TRANSDERMIC 25micrograme/h ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X 5 PLICURI MULTISTRAT DIN HARTIE -PEJD- AL- SURLYN X 1 PLASTURE TRANSDERMIC PS 5 15.256800 15.256800 3.637200
157 W53501005 N02AB03 FENTANYLUM ** FENTANYL TTS SANDOZ 50 mcg/h PLASTURE TRANSDERMIC 50mcg/h SANDOZ S.R.L. ROMANIA CUTIE CU 5 PLICURI DIN PET/PE/AL/PE X 1 PLASTURE TRANSDERMIC P-TS 5 20.508000 20.508000 0.000000
158 W53249003 N02AB03 FENTANYLUM ** FENTANYL ACTAVIS 50micrograme/h PLASTURE TRANSDERMIC 50micrograme/h ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X 5 PLICURI MULTISTRAT DIN HARTIE -PEJD- AL- SURLYN X 1 PLASTURE TRANSDERMIC PS 5 24.609600 24.609600 3.034400
159 W53502005 N02AB03 FENTANYLUM ** FENTANYL TTS SANDOZ 75 mcg/h PLASTURE TRANSDERMIC 75mcg/h SANDOZ S.R.L. ROMANIA CUTIE CU 5 PLICURI DIN PET/PE/AL/PE X 1 PLASTURE TRANSDERMIC P-TS 5 29.726000 29.726000 0.000000
160 W69031002 N02AB03 FENTANYLUM ** PECFENT 100 micrograme SPRAY NAZAL, SOL. 100 micrograme/pulverizare KYOWA KIRIN HOLDINGS B.V. OLANDA CUTIE CU 4 FLACOANE DIN STICLA CU POMPA DOZATOARE ATASATA X 1,55ML PR/PS 4 204.107500 204.107500 0.000000
161 W69032002 N02AB03 FENTANYLUM ** PECFENT 400 micrograme SPRAY NAZAL, SOL. 400 micrograme/pulverizare KYOWA KIRIN HOLDINGS B.V. OLANDA CUTIE CU 4 FLACOANE DIN STICLA CU POMPA DOZATOARE ATASATAX 1,55ML PR/PS 4 218.100000 218.100000 0.000000
162 W12691002 N02AX02 TRAMADOLUM TRAMADOL 50 mg CAPS. 50mg KRKA D.D. SLOVENIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.449000 0.449000 0.000000
163 W52049001 N02AX02 TRAMADOLUM TRAMADOL ARENA 50 mg CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.538800 0.538800 0.056700
164 W60291001 N02AX02 TRAMADOLUM TRAMACALM 50 mg CAPS. 50mg A.C. HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. P-RF 10 0.538800 0.538800 0.056200
165 W42440001 N02AX02 TRAMADOLUM TRAMAG 50 mg COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.538800 0.538800 0.056700
166 W42957001 N02AX02 TRAMADOLUM CLORHIDRAT DE TRAMADOL BIOEEL 50 mg COMPR. 50mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.538800 0.538800 0.056700
167 W68093001 N02AX02 TRAMADOLUM CLORHIDRAT DE TRAMADOL BIOEEL 50 mg COMPR. 50mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.538800 0.538800 0.056700
168 W43360001 N02AX02 TRAMADOLUM TRAMADOL RETARD 150 mg COMPR. CU ELIB. PREL. 150mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. CU ELIB. PREL. P-RF 30 1.215999 1.215999 0.086334
169 W43361001 N02AX02 TRAMADOLUM TRAMADOL RETARD 200 mg COMPR. CU ELIB. PREL. 200mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. CU ELIB. PREL. P-RF 30 1.513200 1.513200 0.115466
170 W58072001 N02AX02 TRAMADOLUM TRAMADOL RETARD 100 mg COMPR. ELIB. PREL. 100mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU 3 BLIST. AL/PVC X 10 COMPR. ELIB. PREL. PRF 30 0.821599 0.821599 0.012067
171 W61448003 N02AX02 TRAMADOLUM MABRON RETARD 100 mg COMPR. ELIB. PREL. 100mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 30 0.684666 0.684666 0.000000
172 W61449001 N02AX02 TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. PREL. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLIST. DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 10 1.022000 1.022000 0.000000
173 W61449003 N02AX02 TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. PREL. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 30 1.013333 1.013333 0.000000
174 W61449011 N02AX02 TRAMADOLUM MABRON RETARD 150 mg COMPR. ELIB. PREL. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU 1 BLISTER DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 10 1.022000 1.022000 0.000000
175 W63389001 N02AX02 TRAMADOLUM TRAMAL RETARD 150 mg COMPR. ELIB. PREL. 150mg STADA ARZNEIMITTEL AG GERMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 COMPR.FILM. CU ELIB. PREL. P-RF 10 1.215999 1.215999 0.169001
176 W63389002 N02AX02 TRAMADOLUM TRAMAL RETARD 150 mg COMPR. ELIB. PREL. 150mg STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 1 BLIST. PP/AL X 10 COMPR. ELIB. PREL. P-RF 10 1.215999 1.215999 0.169001
177 W61450003 N02AX02 TRAMADOLUM MABRON RETARD 200 mg COMPR. ELIB. PREL. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU 3 BLISTERE DIN PVC/AL X 10 COMPR. CU ELIB. PREL. PRF 30 1.261000 1.261000 0.000000
178 W64091003 N02AX02 TRAMADOLUM TRAMADOL KALCEKS 50 mg/ml SOL INJ./PERF. 50mg/ml AS KALCEKS LETONIA CUTIE CU 2 TAVITE DIN PVC CU 10 FIOLE DIN STICLA TRANSPARENTA, CU PUNCT DE RUPERE, A CATE 2 ML SOL. INJ./PERF. PRF 10 2.345000 2.345000 0.000000
179 W05967001 N02AX02 TRAMADOLUM TRAMADOL 100 mg/2 ml SOL. INJ. 100mg/2ml KRKA D.D. SLOVENIA CUTIE X 5 FIOLE X 2 ML PRF 5 2.814000 2.814000 0.816000
180 W05961001 N02AX02 TRAMADOLUM MABRON 100 mg/2 ml SOL. INJ. 100mg/2ml MEDOCHEMIE LTD. CIPRU CUTIE X 5 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. S/P-RF 5 2.380000 2.380000 0.000000
181 W05966001 N02AX02 TRAMADOLUM TRAMADOL 50 mg/1 ml SOL. INJ. 50mg/ml KRKA D.D. SLOVENIA CUTIE X 5 FIOLE X 1 ML PRF 5 1.304000 1.304000 0.000000
182 W51921003 N07BC02 METHADONUM SINTALGON 2,5 mg COMPR. 2,5mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 25 COMPR. P-TS 50 0.677800 0.677800 0.000000
183 W55532002 N07BC02 METHADONUM METADON BIOEEL 20 mg COMPR. 20mg BIO EEL SRL ROMANIA CUTIE X 5 BLIST. AL/PVC-PVDC X 10 COMPR. P-TS 50 2.149200 2.149200 0.000000
184 W68464002 N07BC02 METHADONUM METADON BIOEEL 20 mg COMPR. 20mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 5 BLIST. AL/PVC-PVDC X 10 COMPR. PS 50 2.149200 2.149200 0.000000
185 W55533002 N07BC02 METHADONUM METADON BIOEEL 5 mg COMPR. 5mg BIO EEL SRL ROMANIA CUTIE X 5 BLIST. AL/PVC-PVDC X 10 COMPR. P-TS 50 1.167000 1.167000 0.000000
186 W68465002 N07BC02 METHADONUM METADON BIOEEL 5 mg COMPR. 5mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 5 BLIST. AL/PVC-PVDC X 10 COMPR. PS 50 1.167000 1.167000 0.000000
187 W60166003 N07BC02 METHADONUM MISYO 10 mg/ml CONC. PT. SOL. ORALA 10mg/ml INN-FARM D.O.O. SLOVENIA CUTIE CU 1 FLAC. DIN STICLA BRUNA CU CAPAC DIN PP 28 CU SIGILIU DIN PE A 1000 ML CONC. PT. SOL. ORAL PS 1 425.720000 425.720000 0.000000
188 W60166004 N07BC02 METHADONUM MISYO 10 mg/ml CONC. PT. SOL. ORALA 10mg/ml INN-FARM D.O.O. SLOVENIA PS
CUTIE CU 1 FLAC. DIN STICLA BRUNA CU CAPAC DIN PP 28 PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PT. COPII, A 1000 ML CONC. PT. SOL. ORALA 1 425.720000 425.720000 0.000000
189 W63213001 N07BC02 METHADONUM METHASAN 10 mg/ml CONC. PT. SOL. ORALA 10mg/ml LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA PS
CUTIE CU 1 FLAC. DIN STICLA BRUNA CARE CONTINE 100 ML CONC. PT. SOL. ORALA, SERINGA GRADATA PT. ADMINISTRARE ORALA SI UN ADAPTOR PT. FLAC. 1 56.480000 56.480000 0.000000
190 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 0.255333 0.255333 0.000000
191 W01409002 R05DA04 CODEINUM FOSFAT DE CODEINA BIOEEL 15 mg COMPR. 15mg BIO EEL SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-RF 25 0.261200 0.261200 0.000000
192 W01407004 R05DA04 CODEINUM CODEINA FOSFAT LPH 15 mg COMPR. 15mg LABORMED PHARMA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. P-RF 20 0.262000 0.262000 0.000000
193 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 0.262000 0.262000 0.000000
194 W62739001 R05DA04 CODEINUM CODEINA SLAVIA 15mg COMPR. 15mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0.262000 0.262000 0.000000
195 W68091001 R05DA04 CODEINUM FOSFAT DE CODEINA BIOEEL 15 mg COMPR. 15mg BIOEEL MANUFACTURING S.R.L. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 25 COMPR. PRF 25 0.261200 0.261200 0.000000
196 W02408001 V03AC01 DEFEROXAMINUM ** (3) DESFERAL 500 mg PULB. PT. SOL. INJ./PERF. 500mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 FLAC. DIN STICLA X 500 MG LIOF. PT. SOL. INJ./PERF. PR 10 14.893000 14.893000 0.000000
197 W64443001 V03AC03 DEFERASIROXUM ** EXJADE 180 mg COMPR. FILM. 180mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU BLIST. PVC/PVDC/ALU X 30 COMPR. FILM. PR 30 5.896800 5.896800 19.054866
198 W66803001 V03AC03 DEFERASIROXUM ** REDITENS 180 mg COMPR. FILM. 180mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. FILM. PRF 30 5.233333 5.233333 0.000000
199 W66841001 V03AC03 DEFERASIROXUM ** DEFERASIROX STADA 180 mg COMPR. FILM. 180mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. FILM. PR 30 4.914000 4.914000 0.000000
200 W68074001 V03AC03 DEFERASIROXUM ** DEFERASIROX ACCORD 180 mg COMPR. FILM. 180mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU BLIST. (PVC/PE/PVDC/ALU) X 30X1 (UNIT DOSE) PR 30 5.896800 5.896800 16.497866
201 W68284001 V03AC03 DEFERASIROXUM ** ZEOKS 180 mg COMPR. FILM. 180mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE X 30X1 COMPR. FILM. PR 30 5.896800 5.896800 29.611533
202 W68284003 V03AC03 DEFERASIROXUM ** ZEOKS 180 mg COMPR. FILM. 180mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL NEPERFORATE X 30 COMPR. FILM. PR 30 5.896800 5.896800 29.611533
203 W68284005 V03AC03 DEFERASIROXUM ** ZEOKS 180 mg COMPR. FILM. 180mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE X 30X1 COMPR. FILM. PR 30 5.896800 5.896800 29.611533
204 W68284007 V03AC03 DEFERASIROXUM ** ZEOKS 180 mg COMPR. FILM. 180mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL NEPERFORATE X 30 COMPR. FILM. PR 30 5.896800 5.896800 29.611533
205 W64444001 V03AC03 DEFERASIROXUM ** EXJADE 360 mg COMPR. FILM. 360mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU BLIST. PVC/PVDC/ALU X 30 COMPR. FILM. PR 30 14.901600 14.901600 29.387400
206 W66804001 V03AC03 DEFERASIROXUM ** REDITENS 360 mg COMPR. FILM. 360mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. FILM. PRF 30 14.901600 14.901600 54.411066
207 W66842001 V03AC03 DEFERASIROXUM ** DEFERASIROX STADA 360 mg COMPR. FILM. 360mg STADA M&D S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. FILM. PR 30 12.418000 12.418000 0.000000
208 W68075001 V03AC03 DEFERASIROXUM ** DEFERASIROX ACCORD 360 mg COMPR. FILM. 360mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU BLIST. (PVC/PE/PVDC/ALU) X 30X1 (UNIT DOSE) PR 30 14.901600 14.901600 30.422733
209 W68283001 V03AC03 DEFERASIROXUM ** ZEOKS 360 mg COMPR. FILM. 360mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE X 30X1 COMPR. FILM. PR 30 14.901600 14.901600 54.411066
210 W68283003 V03AC03 DEFERASIROXUM ** ZEOKS 360 mg COMPR. FILM. 360mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL NEPERFORATE X 30 COMPR. FILM. PR 30 14.901600 14.901600 54.411066
211 W68283005 V03AC03 DEFERASIROXUM ** ZEOKS 360 mg COMPR. FILM. 360mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL PERFORATE PT. ELIBERAREA UNEI UNITATI DOZATE X 30X1 COMPR. FILM. PR 30 14.901600 14.901600 54.411066
212 W68283007 V03AC03 DEFERASIROXUM ** ZEOKS 360 mg COMPR. FILM. 360mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL NEPERFORATE X 30 COMPR. FILM. PR 30 14.901600 14.901600 54.411066
213 W66802001 V03AC03 DEFERASIROXUM ** REDITENS 90 mg COMPR. FILM. 90mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. FILM. PRF 30 3.335000 3.335000 0.000000

Pagina 11 din 37
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)

9. EPILEPSIE - G11

1 W42801002 N03AA02 PHENOBARBITALUM FENOBARBITAL ZENTIVA 100 mg COMPR. 100 mg ZENTIVA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 25 COMPR. P-RF 25 0.977599 0.977599 0.000001
2 W57366002 N03AA02 PHENOBARBITALUM FENOBARBITAL ARENA 100mg COMPR. 100mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLISTERE DIN PVC/AL A CÂTE 10 COMPRIMATE P-RF 30 0.814666 0.814666 0.000000
3 W42870001 N03AA02 PHENOBARBITALUM SOL. INJ.
FENOBARBITAL ZENTIVA 100 mg/ml 100 mg/ml ZENTIVA S.A ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA X 2 ML SOL. INJ. P-RF 5 12.764000 12.764000 0.000000
4 W12143001 N03AB02 PHENYTOINUM FENITOINA RICHTER 100 mg COMPR. 100mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-6L 20 0.566500 0.566500 0.000000
5 W55235001 N03AB02 PHENYTOINUM PHENHYDAN 250 mg/5 ml SOL. INJ. 250mg/5ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 5 ML SOL. INJ. P-RF 5 24.854000 24.854000 0.000000
6 W00806001 N03AF01 CARBAMAZEPINUM CARBEPSIL 200mg COMPR. 200mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6L 50 0.445920 0.445920 0.138280
7 W69234001 N03AF01 CARBAMAZEPINUM KARAZEPIN COMPR. 200mg CN UNIFARM S.A. ROMANIA CUTIE CU BLIST. X 25 COMPRIMATE PRF 25 0.371600 0.371600 0.000000
8 W00807001 N03AF01 CARBAMAZEPINUM CARBEPSIL 400mg COMPR. 400mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 5 BLIST. X 10 COMPR. P-6L 50 0.500200 0.500200 0.000000
9 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 0.500000 0.500000 0.000000
10 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 0.387400 0.387400 0.000000
11 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 0.526000 0.526000 0.000000
12 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 0.441600 0.441600 0.000000
13 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 0.802200 0.802200 0.000000
14 W00825001 N03AF01 CARBAMAZEPINUM TIMONIL 100 mg/5 ml SUSP. ORALA 100mg/5ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE X 1 FLACON X 250 ML SUSP.ORALA + MASURA DOZATOARE P-6L 1 52.230000 52.230000 0.000000
15 W51417002 N03AF02 OXCARBAZEPINUM TRILEPTAL 300 mg COMPR. FILM. 300mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 5 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-6L 50 1.057000 1.057000 0.000000
16 W51416002 N03AF02 OXCARBAZEPINUM TRILEPTAL 600 mg COMPR. FILM. 600mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 5 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-6L 50 1.508200 1.508200 0.000000
17 W08721001 N03AG01 ACIDUM VALPROICUM + SARURI ORFIRIL LONG 150 mg CAPS. ELIB. PREL. 150mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 1 FLAC. DIN PE X 50 CAPS. CU MINI-COMPR. CU ELIB. PRELUNG. P-6L 50 0.444120 0.444120 0.190680
18 W63234001 N03AG01 ACIDUM VALPROICUM + SARURI CONVULEX 150 mg CAPS. MOI GASTROREZ. 150mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 5 BLIST. PVDC-PVC/AL X 20 CAPS. MOI GASTROREZ. P6L 100 0.370100 0.370100 0.000000
19 W63235001 N03AG01 ACIDUM VALPROICUM + SARURI CONVULEX 300 mg CAPS. MOI GASTROREZ. 300mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 5 BLIST. PVDC-PVC/AL X 20 CAPS. MOI GASTROREZ. P6L 100 0.458100 0.458100 0.000000
20 W64667001 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE CHRONO 300 mg COMPR. ELIB. PREL. 300mg SANOFI ROMANIA SRL ROMANIA CUTIE X 2 FLAC. DIN PP X 50 COMPR. ELIB. PREL. P-6L 100 0.413800 0.413800 0.000000
21 W64666001 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE CHRONO 500 mg COMPR. ELIB. PREL. 500mg SANOFI ROMANIA SRL ROMANIA CUTIE X 1 FLAC. PP X 30 COMPR. ELIB. PREL. P-RF 30 0.641333 0.641333 0.000000
22 W64668001 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE 200 mg COMPR. GASTROREZ. 200mg SANOFI ROMANIA SRL ROMANIA CUTIE X 1 FLAC. DIN PP X 40 COMPR. GASTROREZ. P-6L 40 0.445250 0.445250 0.000000
23 W08325005 N03AG01 ACIDUM VALPROICUM + SARURI ORFIRIL LONG 1000 mg MINICOMPR. ELIB. PREL. 1000mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE X 100 MINIPLICURI. DIN HARTIE/AL/PE CU MINICOMPR. CU ELIB. PRELUNG. P-6L 100 2.098300 2.098300 0.000000
24 W08325001 N03AG01 ACIDUM VALPROICUM + SARURI ORFIRIL LONG 1000 mg MINICOMPR. ELIB. PREL. 1000mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 50 MINI-PLICURI DIN HARTIE/AL/PE CU MINI-COMPR. CU ELIB. PRELUNG. P-6L 50 2.212600 2.212600 0.000000
25 W43170001 N03AG01 ACIDUM VALPROICUM + SARURI VALEPIL 200 mg/5 ml SIROP 200mg/5ml ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA CU 100 ML SI O LINGURITA DOZATOARE DUBLA (2,5/5 ML) P-6L 1 44.730000 44.730000 0.000000
26 W64489001 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE 57,64 mg/ml SIROP 57,64mg/ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 1 FLACON X 150 ML + 1 SERINGA PT. ADMIN. ORALA P6L 1 22.790000 22.790000 0.000000
27 W64489002 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE 57,64 mg/ml SIROP 57,64mg/ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 1 FLACON X 150 ML + 1 LINGURITA DOZATOARE P6L 1 22.790000 22.790000 0.000000
28 W42997002 N03AX09 LAMOTRIGINUM ** LAMOTRIX 100 mg COMPR. 100mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 1.062000 1.062000 0.000000
29 W65105001 N03AX09 LAMOTRIGINUM ** LAMICTAL 100 mg COMPR. 100mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. X 28 COMPR. FILM. P6L 28 1.274400 1.274400 0.183100
30 W42996002 N03AX09 LAMOTRIGINUM ** LAMOTRIX 200 mg COMPR. 200mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 2.166333 2.166333 0.000000
31 W65103003 N03AX09 LAMOTRIGINUM ** LAMICTAL 25 mg COMPR. 25mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR. P6L 28 0.355000 0.355000 0.000000
32 W42995002 N03AX09 LAMOTRIGINUM ** LAMOTRIX 50 mg COMPR. 50mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.630333 0.630333 0.000000
33 W65102001 N03AX09 LAMOTRIGINUM ** LAMICTAL 2 mg COMPR. MAST./DISP. 2mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN PEID X 30 COMPR. MAST./DISP. P6L 30 0.300333 0.300333 0.000000
34 W65101004 N03AX09 LAMOTRIGINUM ** LAMICTAL 5 mg COMPR. MAST./DISP. 5mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. MAST./DISP. P6L 30 0.171666 0.171666 0.000000
35 W65101010 N03AX09 LAMOTRIGINUM ** LAMICTAL 5 mg COMPR. MAST./DISP. 5mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU FLAC. DIN PEID X 30 COMPR. MAST./DISP. P6L 30 0.171666 0.171666 0.000000
36 W53160001 N03AX11 TOPIRAMATUM ** TOPIRAMAT ACTAVIS 100 mg COMPR. FILM. 100mg ACTAVIS S.R.L. ROMANIA CUTIE X 6 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-RF 60 1.502400 1.502400 0.073266
37 W59849002 N03AX11 TOPIRAMATUM ** TOPILEX 100 mg COMPR. FILM. 100mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC/PE/PVDC/AL X 30 COMPR. FILM. P6L 30 1.252000 1.252000 0.000000
38 W64806001 N03AX11 TOPIRAMATUM ** TOPIRAMAT TEVA 100 mg COMPR. FILM. 100mg TEVA B.V. OLANDA CUTIE CU 6 BLIST. AL/PVC-AL-OPA X 10 COMPR. FILM. PRF 60 1.502400 1.502400 0.073266
39 W53158001 N03AX11 TOPIRAMATUM ** TOPIRAMAT ACTAVIS 25 mg COMPR. FILM. 25mg ACTAVIS S.R.L. ROMANIA CUTIE X 6 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-RF 60 0.571833 0.571833 0.000000
40 W59847002 N03AX11 TOPIRAMATUM ** TOPILEX 25 mg COMPR. FILM. 25mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC/PE/PVDC/AL X 30 COMPR. FILM. P6L 30 0.497333 0.497333 0.000000
41 W64802001 N03AX11 TOPIRAMATUM ** TOPIRAMAT TEVA 25 mg COMPR. FILM. 25mg TEVA B.V. OLANDA CUTIE CU 6 BLIST. AL/PVC-AL-OPA X 10 COMPR. FILM. PRF 60 0.571833 0.571833 0.000000
42 W53159001 N03AX11 TOPIRAMATUM ** TOPIRAMAT ACTAVIS 50 mg COMPR. FILM. 50mg ACTAVIS S.R.L. ROMANIA CUTIE X 6 BLIST. OPA-AL-PVC/AL X 10 COMPR. FILM. P-RF 60 0.749500 0.749500 0.000000
43 W59848002 N03AX11 TOPIRAMATUM ** TOPILEX 50 mg COMPR. FILM. 50mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC/PE/PVDC/AL X 30 COMPR. FILM. P6L 30 0.790333 0.790333 0.000000
44 W64804001 N03AX11 TOPIRAMATUM ** TOPIRAMAT TEVA 50 mg COMPR. FILM. 50mg TEVA B.V. OLANDA CUTIE CU 6 BLIST. AL/PVC-AL-OPA X 10 COMPR. FILM. PRF 60 0.749500 0.749500 0.000000
45 W54332002 N03AX12 GABAPENTINUM ** GRIMODIN 100 mg CAPS. 100mg UNGARIA
EGIS PHARMACEUTICALS P.L.C. CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS.
P-6L 60 0.828199 0.828199 0.092134
46 W60025001 N03AX12 GABAPENTINUM ** GABAPENTIN ARENA 100 mg CAPS. 100mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.690166 0.690166 0.000000
47 W41589005 N03AX12 GABAPENTINUM ** GABAGAMMA 300 mg CAPS. 300mg WORWAG PHARMA GMBH & CO. KG GERMANIACUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.621600 0.621600 0.224300
48 W43540001 N03AX12 GABAPENTINUM ** GABALEPT 300 mg CAPS. 300mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.518000 0.518000 0.000000
49 W54333001 N03AX12 GABAPENTINUM ** GRIMODIN 300 mg CAPS. 300mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS. P-6L 60 0.621600 0.621600 0.067233
50 W60026001 N03AX12 GABAPENTINUM ** GABAPENTIN ARENA 300 mg CAPS. 300mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.621600 0.621600 0.978400
51 W64360001 N03AX12 GABAPENTINUM ** GABALEPT 300 mg CAPS. 300mg TEVA B.V. OLANDA CUTIE CU 10 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 CAPS. P6L 100 0.518000 0.518000 0.000000
52 W65059001 N03AX12 GABAPENTINUM ** GABARAN 300 mg CAPS. 300mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 50 0.621600 0.621600 0.858200
53 W41590005 N03AX12 GABAPENTINUM ** GABAGAMMA 400 mg CAPS. 400mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.801360 0.801360 0.382140
54 W43541001 N03AX12 GABAPENTINUM ** GABALEPT 400 mg CAPS. 400mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 10 BLIST. AL/PVC X 10 CAPS. P-6L 100 0.667800 0.667800 0.000000
55 W54334001 N03AX12 GABAPENTINUM ** GRIMODIN 400 mg CAPS. 400mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 60 CAPS. P-6L 60 0.801360 0.801360 0.388306
56 W60027001 N03AX12 GABAPENTINUM ** GABAPENTIN ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE CU 6 BLIST. TRANSPARENTE PVC-PVDC/AL X 10 CAPS. P6L 60 0.801360 0.801360 1.269306
57 W64361001 N03AX12 GABAPENTINUM ** GABALEPT 400 mg CAPS. 400mg TEVA B.V. OLANDA CUTIE CU 10 BLIST. PVC-PVDC TRANSPARENTA/AL X 10 CAPS. P6L 100 0.667800 0.667800 0.000000

Pagina 12 din 37
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)
58 W65060001 N03AX12 GABAPENTINUM ** GABARAN 400 mg CAPS. 400mg TERAPIA S.A. ROMANIA CUTIE CU 5 BLIST. PVC-PVDC/AL X 10 CAPS. P6L 50 0.801360 0.801360 0.887040
59 W65061001 N03AX12 GABAPENTINUM ** GABARAN 600 mg COMPR. FILM. 600mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. AL-PVC-PA/AL X 10 COMPR. FILM. P6L 30 2.395666 2.395666 0.000000
60 W58650001 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM TERAPIA 1000 mg COMPR. FILM. 1000 mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMP.FILM. PRF 30 0.714799 0.714799 1.717201
61 W66007002 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM AUROBINDO 1000 mg COMPR. FILM. 1000mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC-AL X 30 COMPR. FILM. PRF 30 0.595666 0.595666 0.000000
62 W58649003 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM TERAPIA 500 mg COMPR. FILM. 500 mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR.FILM. PRF 30 0.357600 0.357600 0.906400
63 W66006002 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM AUROBINDO 500 mg COMPR. FILM. 500mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. FILM. PRF 30 0.298000 0.298000 0.000000
64 W57149002 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM DESITIN 1000 mg GRANULE ACOPERITE, IN PLIC UNIDOZA 1000mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 30 PLICURI UNIDOZA DIN HARTIE/AL/PE CONTINAND GRANULE ACOPERITE PRF 30 0.714799 0.714799 1.758867
65 W57147002 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM DESITIN 500 mg GRANULE ACOPERITE, IN PLIC UNIDOZA 500mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 30 PLICURI UNIDOZA DIN HARTIE/AL/PE CONTINAND GRANULE ACOPERITE PRF 30 0.357600 0.357600 1.057400
66 W57148004 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM DESITIN 750 mg GRANULE ACOPERITE, IN PLIC UNIDOZA 750mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 60 PLICURI UNIDOZA DIN HARTIE/AL/PE CONTINAND GRANULE ACOPERITE PRF 60 1.817833 1.817833 0.000000
67 W57146002 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM DESITIN 250 mg GRANULE DRAJEFIATE IN PLIC 250mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 30 PLICURI DIN HARTIE/AL/PE CONTINAND GRANULE DRAJEFIATE PRF 30 0.697000 0.697000 0.000000
68 W57146003 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM DESITIN 250 mg GRANULE DRAJEFIATE IN PLIC 250mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 50 PLICURI DIN HARTIE/AL/PE CONTINAND GRANULE DRAJEFIATE PRF 50 0.674200 0.674200 0.000000
69 W57146005 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM DESITIN 250 mg GRANULE DRAJEFIATE IN PLIC 250mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 100 PLICURI DIN HARTIE/AL/PE CONTINAND GRANULE DRAJEFIATE PRF 100 0.602000 0.602000 0.000000
70 W57148003 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM DESITIN 750 mg GRANULE DRAJEFIATE IN PLIC 750mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 50 PLICURI DIN HARTIE/AL/PE CONTINAND GRANULE DRAJEFIATE PRF 50 1.817800 1.817800 0.000000
71 W66333001 N03AX14 LEVETIRACETAMUM ** LEVETIRACETAM ACCORD 100 mg/ml SOL. ORALA 100mg/ml ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, O SERINGA DOZATOARE DE 10 ML CU UN ADAPTOR PT. SERINGA X 300 ML SOL. ORALA PR 1 81.340000 81.340000 0.000000
72 W63613001 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 125 mg CAPS. 125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 CAPS. PRF 14 2.027785 2.027785 1.127215
73 W63613003 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 125 mg CAPS. 125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 CAPS. PRF 56 1.689821 1.689821 0.000000
74 W63613008 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 125 mg CAPS. 125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 2.027785 2.027785 1.127215
75 W63613010 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 125 mg CAPS. 125mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 1.689821 1.689821 0.000000
76 W61765001 N03AX16 PREGABALINUM ** PRAGIOLA 150 mg CAPS. 150mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 0.769285 0.769285 0.000000
77 W61765004 N03AX16 PREGABALINUM ** PRAGIOLA 150 mg CAPS. 150mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 0.741607 0.741607 0.000000
78 W62053001 N03AX16 PREGABALINUM ** PREGABALIN ZENTIVA 150 mg CAPS. 150mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.754821 0.754821 0.000000
79 W62572001 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 150 mg CAPS. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 CAPS. PRF 14 0.857570 0.857570 1.803144
80 W62572003 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 150 mg CAPS. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 CAPS. PRF 56 0.857570 0.857570 0.384930
81 W62572008 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 150 mg CAPS. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 0.857570 0.857570 1.803144
82 W62572011 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 150 mg CAPS. 150mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.857570 0.857570 0.384930
83 W63186001 N03AX16 PREGABALINUM ** SIRANALEN 150 mg CAPS. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 0.780000 0.780000 0.000000
84 W63186004 N03AX16 PREGABALINUM ** SIRANALEN 150 mg CAPS. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.754821 0.754821 0.000000
85 W63186008 N03AX16 PREGABALINUM ** SIRANALEN 150 mg CAPS. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 0.780000 0.780000 0.000000
86 W63186011 N03AX16 PREGABALINUM ** SIRANALEN 150 mg CAPS. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 0.754821 0.754821 0.000000
87 W65243001 N03AX16 PREGABALINUM ** PREGABALIN SANDOZ 150 mg CAPS. 150mg SANDOZ GMBH AUSTRIA CUTIE CU BLIST. PVC/PVDC/AL X 56 CAPS. PRF 56 0.714642 0.714642 0.000000
88 W65823003 N03AX16 PREGABALINUM ** PREGABALINA VIVANTA 150 mg CAPS. 150mg VIVANTA GENERICS S.R.O., CEHIA CUTIE CU BLIST. PVC-ACLAR/AL X 56 CAPS. PRF 56 0.857570 0.857570 0.314572
89 W66797001 N03AX16 PREGABALINUM ** LYRICA 150 mg CAPS. 150mg UPJOHN EESV OLANDA CUTIE X 14 CAPS. (BLIST. PVC/AL) PRF 14 0.857570 0.857570 1.437430
90 W66797002 N03AX16 PREGABALINUM ** LYRICA 150 mg CAPS. 150mg UPJOHN EESV OLANDA CUTIE X 56 CAPS. (BLIST. PVC/AL) PRF 56 0.857570 0.857570 0.480465
91 W63615001 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 250 mg CAPS. 250mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 CAPS. PRF 14 3.478500 3.478500 1.913642
92 W63615003 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 250 mg CAPS. 250mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 CAPS. PRF 56 2.898750 2.898750 0.000000
93 W63615008 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 250 mg CAPS. 250mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 3.478500 3.478500 1.913642
94 W63615010 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 250 mg CAPS. 250mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 2.898750 2.898750 0.000000
95 W61768001 N03AX16 PREGABALINUM ** PRAGIOLA 300 mg CAPS. 300mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 1.715142 1.715142 0.077715
96 W61768004 N03AX16 PREGABALINUM ** PRAGIOLA 300 mg CAPS. 300mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 1.442857 1.442857 0.000000
97 W63187001 N03AX16 PREGABALINUM ** SIRANALEN 300 mg CAPS. 300mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 1.715142 1.715142 0.057715
98 W63187004 N03AX16 PREGABALINUM ** SIRANALEN 300 mg CAPS. 300mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 1.429285 1.429285 0.000000
99 W63187008 N03AX16 PREGABALINUM ** SIRANALEN 300 mg CAPS. 300mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 1.715142 1.715142 0.057715
100 W63187011 N03AX16 PREGABALINUM ** SIRANALEN 300 mg CAPS. 300mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 1.429285 1.429285 0.000000
101 W65824003 N03AX16 PREGABALINUM ** PREGABALINA VIVANTA 300 mg CAPS. 300mg VIVANTA GENERICS S.R.O., CEHIA CUTIE CU BLIST. PVC-ACLAR/AL X 56 CAPS. PRF 56 1.715142 1.715142 0.587358
102 W66798001 N03AX16 PREGABALINUM ** LYRICA 300 mg CAPS. 300mg UPJOHN EESV OLANDA CUTIE X 14 CAPS. (BLIST. PVC/AL) PRF 14 1.715142 1.715142 1.310572
103 W61763001 N03AX16 PREGABALINUM ** PRAGIOLA 75 mg CAPS. 75mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 0.626428 0.626428 0.000000
104 W61763004 N03AX16 PREGABALINUM ** PRAGIOLA 75 mg CAPS. 75mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 0.606607 0.606607 0.000000
105 W62052001 N03AX16 PREGABALINUM ** PREGABALIN ZENTIVA 75 mg CAPS. 75mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.613750 0.613750 0.000000
106 W62571001 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 75 mg CAPS. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 14 CAPS. PRF 14 0.707785 0.707785 1.129357
107 W62571003 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 75 mg CAPS. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 CAPS. PRF 56 0.707785 0.707785 0.085786
108 W62571008 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 75 mg CAPS. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 14 CAPS. PRF 14 0.707785 0.707785 1.129357
109 W62571011 N03AX16 PREGABALINUM ** PREGABALINA TERAPIA 75 mg CAPS. 75mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 CAPS. PRF 56 0.707785 0.707785 0.085786
110 W63185008 N03AX16 PREGABALINUM ** SIRANALEN 75 mg CAPS. 75mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 14 CAPS. PRF 14 0.635000 0.635000 0.000000
111 W63185011 N03AX16 PREGABALINUM ** SIRANALEN 75 mg CAPS. 75mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 56 CAPS. PRF 56 0.613750 0.613750 0.000000
112 W65242001 N03AX16 PREGABALINUM ** PREGABALIN SANDOZ 75 mg CAPS. 75mg SANDOZ GMBH AUSTRIA CUTIE CU BLIST. PVC/PVDC/AL X 56 CAPS. PRF 56 0.589821 0.589821 0.000000
113 W65822003 N03AX16 PREGABALINUM ** PREGABALINA VIVANTA 75 mg CAPS. 75mg VIVANTA GENERICS S.R.O., CEHIA CUTIE CU BLIST. PVC-ACLAR/AL X 56 CAPS. PRF 56 0.600357 0.600357 0.000000
114 W66796001 N03AX16 PREGABALINUM ** LYRICA 75 mg CAPS. 75mg UPJOHN EESV OLANDA CUTIE X 14 CAPS. (BLIST. PVC/AL) PRF 14 0.707785 0.707785 0.440072
115 W66796002 N03AX16 PREGABALINUM ** LYRICA 75 mg CAPS. 75mg UPJOHN EESV OLANDA CUTIE X 56 CAPS. (BLIST. PVC/AL) PRF 56 0.707785 0.707785 0.334715
116 W64181001 N03AX16 PREGABALINUM ** SIRANALEN 20 mg/ml SOL. ORALA 20mg/ml MEDOCHEMIE LTD. CIPRU CUTIE CU 1 FLAC. PEID CONTINAND 473 ML SOL. ORALA, O SERINGA PT. ADMINISTRARE ORALA, UN ADAPTOR DIN PLASTIC ALB CARE SE ATASEAZA LA FLAC. PRIN IMPINGERE PRF 1 152.730000 152.730000 0.000000
117 W51468002 N03AX17 STIRIPENTOLUM ** DIACOMIT 250mg CAPS. 250mg BIOCODEX FRANTA CUTIE X 1 FLAC. DIN PP X 60 CAPS. P-RF/R 60 12.851833 12.851833 0.000000

Pagina 13 din 37
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)
118 W58592002 N03AX17 STIRIPENTOLUM ** DIACOMIT 500mg CAPS. 500mg BIOCODEX FRANTA CUTIE X 1 FLAC. DIN PP X 60 CAPS. P-RF/R 60 23.143000 23.143000 0.000000
119 W51470002 N03AX17 STIRIPENTOLUM ** DIACOMIT 250mg PULB. PT. SUSP. ORALA 250mg BIOCODEX FRANTA CUTIE X 60 PLICURI HARTIE/AL/PE P-RF/R 60 12.851833 12.851833 0.000000
120 W51471002 N03AX17 STIRIPENTOLUM ** DIACOMIT 500mg PULB. PT. SUSP. ORALA 500mg BIOCODEX FRANTA CUTIE X 60 PLICURI HARTIE/AL/PE P-RF/R 60 23.143000 23.143000 0.000000
121 W63827001 N03AX23 BRIVARACETAMUM ** Ω BRIVIACT 100mg COMPR. FILM. 100mg U.C.B. PHARMA S.A. BELGIA CUTIE CU BLISTERE DIN PVC / PCTFE - AL X 56 COMPRIMATE FILMATE PRF 56 7.782857 7.782857 0.000000
122 W63823001 N03AX23 BRIVARACETAMUM ** Ω BRIVIACT 10mg COMPR. FILM. 10mg U.C.B. PHARMA S.A. BELGIA CUTIE CU BLISTERE DIN PVC / PCTFE - AL X 14COMPRIMATE FILMATE PRF 14 8.118571 8.118571 0.000000
123 W63824001 N03AX23 BRIVARACETAMUM ** Ω BRIVIACT 25mg COMPR. FILM. 25mg U.C.B. PHARMA S.A. BELGIA CUTIE CU BLISTERE DIN PVC / PCTFE - AL X 56 COMPRIMATE FILMATE PRF 56 7.716785 7.716785 0.000000
124 W63825001 N03AX23 BRIVARACETAMUM ** Ω BRIVIACT 50mg COMPR. FILM. 50mg U.C.B. PHARMA S.A. BELGIA CUTIE CU BLISTERE DIN PVC / PCTFE - AL X 56 COMPRIMATE FILMATE PRF 56 7.270178 7.270178 0.000000
125 W63826001 N03AX23 BRIVARACETAMUM ** Ω BRIVIACT 75mg COMPR. FILM. 75mg U.C.B. PHARMA S.A. BELGIA CUTIE CU BLISTERE DIN PVC / PCTFE - AL X 56 COMPRIMATE FILMATE PRF 56 8.220535 8.220535 0.000000
126 W63829001 N03AX23 BRIVARACETAMUM ** Ω BRIVIACT 10mg/ml SOL. ORALA 10mg/ml U.C.B. PHARMA S.A. BELGIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, 300 ML, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PT. COPII (PE) + 1 SERINGA PT. ADMINISTRARE ORALA (PP, PE), GRADATA, A 5 ML SI 10 ML + 1 ADAPTOR PT. SERINGA (PE) PRF 1 431.150000 431.150000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea neurologie şi neurologie pediatrică.

10. BOALA PARKINSON ŞI ALTE AFECŢIUNI NEUROLOGICE - G12

1 W67762001 L01EE04 SELUMETINIBUM **1 KOSELUGO 10 mg CAPS. 10mg ASTRAZENECA AB SUEDIA


CUTIE CU FLAC. DIN PLASTIC DIN HDPE X 60 CAPS. PR 60 450.342666 450.342666 0.000000
2 W67763001 L01EE04 SELUMETINIBUM **1 KOSELUGO 25 mg CAPS. 25mg ASTRAZENECA AB SUEDIA
CUTIE CU FLAC. DIN PLASTIC DIN HDPE X 60 CAPS. PR 60 1,124.085166 1,124.085166 0.000000
3 W06002001 N04AA01 TRIHEXYPHENIDYLUM ROMPARKIN 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 1.577800 1.577800 0.000000
4 W58811002 N04BA02 COMBINATII (LEVODOPUM+BENSERAZIDUM) ** MADOPAR 200mg/50mg COMPR. 200mg+50mg ROCHE ROMANIA SRL ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P-6L 30 1.486666 1.486666 0.000000
5 W03950004 N04BA02 COMBINATII (LEVODOPUM+CARBIDOPUM) ** ISICOM 250 mg/25 mg COMPR. 250mg/25mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE X 10 BLIST. PP/AL X 10 COMPR. P-6L 100 1.149000 1.149000 0.000000
6 W60962001 N04BA02 COMBINATII (LEVODOPUM+CARBIDOPUM) ** DUODOPA 20 mg/ml+5 mg/ml GEL INTESTINAL 20mg/ml+5mg/ml ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE X 7 CASETE BRUNE TRANSPARENTE X 100 GEL INT. IN PUNGA PVC PR 7 426.040000 426.040000 0.000000
7 W61362008 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 100 mg/25 mg/200 mg COMPR. FILM. 100mg/25mg/200mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. ALB DIN PEID X 100 COMPR. FILM. PRF 100 1.360200 1.360200 0.772700
8 W62567004 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** TRIGELAN 100 mg/25 mg/200 mg COMPR. FILM. 100mg/25mg/200mg G.L. PHARMA GMBH AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PRF 100 1.133500 1.133500 0.000000
9 W61363008 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 125 mg/31,25 mg/200 mg COMPR. FILM. 125mg/31,25mg/200mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. ALB DIN PEID X 100 COMPR. FILM. PRF 100 2.328800 2.328800 0.000000
10 W61364008 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 150 mg/37,5 mg/200 mg COMPR. FILM. 150mg/37,5mg/200mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. ALB DIN PEID X 100 COMPR. FILM. PRF 100 1.571160 1.571160 0.561740
11 W62568004 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** TRIGELAN 150 mg/37,5 mg/200 mg COMPR. FILM. 150mg/37,5mg/200mg G.L. PHARMA GMBH AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PRF 100 1.309300 1.309300 0.000000
12 W61366008 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 200 mg/50 mg/200 mg COMPR. FILM. 200mg/50mg/200mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. ALB DIN PEID X 100 COMPR. FILM. PRF 100 1.473960 1.473960 0.658940
13 W62569004 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** TRIGELAN 200 mg/50 mg/200 mg COMPR. FILM. 200mg/50mg/200mg G.L. PHARMA GMBH AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PRF 100 1.228300 1.228300 0.000000
14 W61360008 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 50 mg/12,5 mg/200 mg COMPR. FILM. 50mg/12,5mg/200mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. ALB DIN PEID X 100 COMPR. FILM. PRF 100 1.711320 1.711320 0.421580
15 W62566004 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** TRIGELAN 50 mg/12,5 mg/200 mg COMPR. FILM. 50mg/12,5mg/200mg G.L. PHARMA GMBH AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PRF 100 1.426100 1.426100 0.000000
16 W61361008 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** LEVODOPA/CARBIDOPA/ENTACAPONA TEVA 75 mg/18,75 mg/200 mg COMPR. FILM. 75mg/18,75mg/200mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. ALB DIN PEID X 100 COMPR. FILM. PRF 100 2.328800 2.328800 0.000000
17 W67558001 N04BA03 COMBINATII (LEVODOPUM+CARBIDOPUM+ENTACAPONUM) ** LECIGON 20 mg/5 mg/20 mg/ml GEL INTESTINAL 20mg/5mg/20mg/ml LABSOR PHARMACEUTICALS AB SUEDIA CUTIE CU 7 CARTUSE DIN PP CU PISTON A CATE 47 ML GEL INTESTINAL PR 7 607.414285 607.414285 0.000000
18 W00264001 N04BB01 AMANTADINUM ** VIREGYT-K 100 mg CAPS. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 1 FLAC. X 50 CAPS. P-6L 50 0.493400 0.493400 0.000000
19 W11164002 N04BC01 BROMOCRIPTINUM BROCRIPTIN (N04BC01) DRAJ. 2,5mg BIOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 20 DRAJ. P-RF 40 0.919750 0.919750 0.000000
20 W65198006 N04BC04 ROPINIROLUM ** REQUIP-MODUTAB 2 mg COMPR. CU ELIB. PREL. 2mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC-PE-PVDC/AL-HÂRTIE X 28 COMPR. CU ELIB. PREL. P-RF 28 1.402713 1.402713 0.153001
21 W65199003 N04BC04 ROPINIROLUM ** REQUIP-MODUTAB 4 mg COMPR. CU ELIB. PREL. 4mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC-PE-PVDC/AL-HÂRTIE X 28 COMPR. CU ELIB. PREL. P-RF 28 2.546570 2.546570 0.082001
22 W65200003 N04BC04 ROPINIROLUM ** REQUIP-MODUTAB 8 mg COMPR. CU ELIB. PREL. 8mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC-PE-PVDC/AL-HÂRTIE X 28 COMPR. CU ELIB. PREL. PRF 28 4.087713 4.087713 0.758358
23 W56606002 N04BC04 ROPINIROLUM ** ROLPRYNA EP 2 mg COMPR. CU ELIBERARE PRELUNGITA 2 mg KRKA ,D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA - AL - PVC/AL X 28 COMPR. ELIB. PREL. PRF 28 1.168928 1.168928 0.000000
24 W56607002 N04BC04 ROPINIROLUM ** ROLPRYNA EP 4 mg COMPR. CU ELIBERARE PRELUNGITA 4 mg KRKA ,D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA - AL - PVC/AL X 28 COMPR. ELIB. PREL. PRF 28 2.122142 2.122142 0.000000
25 W56608002 N04BC04 ROPINIROLUM ** ROLPRYNA EP 8 mg COMPR. CU ELIBERARE PRELUNGITA 8 mg KRKA ,D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA - AL - PVC/AL X 28 COMPR. ELIB. PREL. PRF 28 3.406428 3.406428 0.000000
26 W58902002 N04BC04 ROPINIROLUM ** ROPINIROL ACTAVIS 2 mg COMPR. ELIB. PREL. 2mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. ELIB. PREL. PRF 28 1.168928 1.168928 0.000000
27 W68051002 N04BC04 ROPINIROLUM ** ROPINIROL TEVA 2 mg COMPR. ELIB. PREL. 2mg TEVA B.V. OLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. ELIB. PREL. PRF 28 1.168928 1.168928 0.000000
28 W58903002 N04BC04 ROPINIROLUM ** ROPINIROL ACTAVIS 4 mg COMPR. ELIB. PREL. 4mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. ELIB. PREL. PRF 28 2.122142 2.122142 0.000000
29 W68053002 N04BC04 ROPINIROLUM ** ROPINIROL TEVA 4 mg COMPR. ELIB. PREL. 4mg TEVA B.V. OLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. ELIB. PREL. PRF 28 2.122142 2.122142 0.000000
30 W58904002 N04BC04 ROPINIROLUM ** ROPINIROL ACTAVIS 8 mg COMPR. ELIB. PREL. 8mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. ELIB. PREL. PRF 28 3.406428 3.406428 0.000000
31 W68055002 N04BC04 ROPINIROLUM ** ROPINIROL TEVA 8 mg COMPR. ELIB. PREL. 8mg TEVA B.V. OLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. ELIB. PREL. PRF 28 3.406428 3.406428 0.000000
32 W60055001 N04BC05 PRAMIPEXOLUM ** PRAMIPEXOL ZENTIVA 0,18 mgCOMPR. 0,18 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. PRF 30 0.653199 0.653199 0.224134
33 W53525002 N04BC05 PRAMIPEXOLUM ** OPRYMEA 0,18mg COMPR. 0,18mg KRKA D.D. SLOVENIA CUTIE X 30 COMPR. (BLIST. AL/AL) P-RF 30 0.544333 0.544333 0.000000
34 W54712001 N04BC05 PRAMIPEXOLUM ** MEDOPEXOL 0,18 mg COMPR. 0,18mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 0.551000 0.551000 0.000000
35 W60054001 N04BC05 PRAMIPEXOLUM ** PRAMIPEXOL ZENTIVA 0,7 mg COMPR. 0,7 mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. PRF 30 2.546666 2.546666 0.000000
36 W53527002 N04BC05 PRAMIPEXOLUM ** OPRYMEA 0,7mg COMPR. 0,7mg KRKA D.D. SLOVENIA CUTIE X 30 COMPR. (BLIST. AL/AL) P-RF 30 2.290333 2.290333 0.000000
37 W60244001 N04BC05 PRAMIPEXOLUM ** OPRYMEA 0,26mg COMPR. ELIB. PREL. 0,26mg KRKA D.D. SLOVENIA CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-RF 30 0.825000 0.825000 0.000000
38 W54799002 N04BC05 PRAMIPEXOLUM ** MIRAPEXIN 0,52 mg COMPR. ELIB. PREL. 0,52mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P-RF 30 2.009599 2.009599 0.166401
39 W60240001 N04BC05 PRAMIPEXOLUM ** OPRYMEA 0,52mg COMPR. ELIB. PREL. 0,52mg KRKA D.D. SLOVENIA CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-RF 30 1.674666 1.674666 0.000000
40 W54800002 N04BC05 PRAMIPEXOLUM ** MIRAPEXIN 1,05 mg COMPR. ELIB. PREL. 1,05mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P-RF 30 2.409600 2.409600 1.185066
41 W60241001 N04BC05 PRAMIPEXOLUM ** OPRYMEA 1,05mg COMPR. ELIB. PREL. 1,05mg KRKA D.D. SLOVENIA CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-RF 30 2.008000 2.008000 0.000000
42 W60243001 N04BC05 PRAMIPEXOLUM ** OPRYMEA 2,10mg COMPR. ELIB. PREL. 2,10mg KRKA D.D. SLOVENIA CUTIE CU BLISTERE (OPA/AL/DES/PE-AL) X 30 COMPRIMATE CU ELIBERARE PRELUNGITA P-RF 30 3.565000 3.565000 0.000000
43 W54801002 N04BC05 PRAMIPEXOLUM ** MIRAPEXIN 2,1 mg COMPR. ELIB. PREL. 2,1mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE CU 3 BLIST. OPA-AL-PVC/AL X 10 COMPR. CU ELIBERARE PRELUNGITA P-RF 30 4.278000 4.278000 1.895333
44 W62151001 N04BC05 PRAMIPEXOLUM ** OPRYMEA 3,15 mg COMPR. ELIB. PREL. 3,15mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE X BLIST. OPA-AL/DESICANT/PE/AL X 30 COMPR. ELIB. PREL. PRF 30 8.661000 8.661000 0.000000

Pagina 14 din 37
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)
45 W66228002 N04BC07 APOMORFINUM ** Ω APO-GO 10 mg/ml SOL. INJ. IN PEN MULTIDOZA 10mg/ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 5 STILOURI INJECTOARE TIP "PEN" MULTIDOZA X 3 ML SOL. INJ. PRF 5 169.676000 169.676000 0.000000
46 W66227001 N04BC07 APOMORFINUM **1 APO-GO 5 mg/ml SOL. PERF. IN SERINGA PREUMPLUTA UNIDOZA 5mg/ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 5 SERINGI PREUMPLUTE UNIDOZA X 10 ML SOL. PERF. PRF 5 119.630000 119.630000 0.000000
47 W66227002 N04BC07 APOMORFINUM **1 APO-GO 5 mg/ml SOL. PERF. IN SERINGA PREUMPLUTA UNIDOZA 5mg/ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 25 SERINGI PREUMPLUTE UNIDOZA X 10 ML SOL. PERF. PRF 25 108.293600 108.293600 0.000000
48 W66227003 N04BC07 APOMORFINUM **1 APO-GO 5 mg/ml SOL. PERF. IN SERINGA PREUMPLUTA UNIDOZA 5mg/ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 50 SERINGI PREUMPLUTE UNIDOZA X 10 ML SOL. PERF. PRF 50 106.876600 106.876600 0.000000
49 W64036003 N04BC09 ROTIGOTINUM ** NEUPRO 2mg/24h PLASTURE TRANSDERMIC 2mg/24h UCB PHARMA S.A. BELGIA CUTIE X 28 PLASTURI TRANSDERMICI PRF 28 9.370000 9.370000 0.000000
50 W64037003 N04BC09 ROTIGOTINUM ** NEUPRO 4mg/24h PLASTURE TRANSDERMIC 4mg/24h UCB PHARMA S.A. BELGIA CUTIE X 28 PLASTURI TRANSDERMICI PRF 28 12.009642 12.009642 0.000000
51 W64038003 N04BC09 ROTIGOTINUM ** NEUPRO 6mg/24h PLASTURE TRANSDERMIC 6mg/24h UCB PHARMA S.A. BELGIA CUTIE X 28 PLASTURI TRANSDERMICI PRF 28 15.523928 15.523928 0.000000
52 W64039003 N04BC09 ROTIGOTINUM ** NEUPRO 8mg/24h PLASTURE TRANSDERMIC 8mg/24h UCB PHARMA S.A. BELGIA CUTIE X 28 PLASTURI TRANSDERMICI PRF 28 18.011071 18.011071 0.000000
53 W08952005 N04BD01 SELEGILINUM SELEGOS COMPR. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU 5 BLIST. PVC-PCTFE/AL X 10 COMPR. P-6L 50 0.852600 0.852600 0.000000
54 W08952003 N04BD01 SELEGILINUM SELEGOS COMPR. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU 10 BLIST. PVC-PCTFE/AL X 10 COMPR. P-6L 100 0.756600 0.756600 0.000000
55 W62180001 N04BD02 RASAGILINUM ** RASAGILINA RATIOPHARM 1 mg COMPR. 1mg TEVA B.V. OLANDA CUTIE CU BLIST AL/AL X 30 COMPR. PRF 30 2.874799 2.874799 0.051534
56 W62556004 N04BD02 RASAGILINUM ** SAGILIA 1 mg COMPR. 1mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. AL/AL X 30 COMPR. PRF 30 2.874799 2.874799 0.051534
57 W62556010 N04BD02 RASAGILINUM ** SAGILIA 1 mg COMPR. 1mg MEDOCHEMIE LTD CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. PRF 30 2.874799 2.874799 0.051534
58 W62766004 N04BD02 RASAGILINUM ** HIPERAVIA 1 mg COMPR. 1mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 2.395666 2.395666 0.000000
59 W62764004 N04BD02 RASAGILINUM ** RASAGILINA ZENTIVA 1 mg COMPR. 1mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 2.874799 2.874799 0.316201
60 W62982004 N04BD02 RASAGILINUM ** AZILECT 1mg COMPR. 1mg TEVA BV OLANDA CUTIE X 30 COMPR.(BLIST. AL/AL) P-RF 30 2.874799 2.874799 0.626201
61 W59891001 N04BX02 ENTACAPONUM ** ENCAPIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. PRF 30 2.465333 2.465333 0.000000
62 W59891002 N04BX02 ENTACAPONUM ** ENCAPIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. FILM. PRF 60 2.224333 2.224333 0.000000
63 W59891003 N04BX02 ENTACAPONUM ** ENCAPIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 100 COMPR. FILM. PRF 100 2.184700 2.184700 0.000000
64 W63027003 N04BX02 ENTACAPONUM ** ENTACAPONE TEVA COMPR. FILM. 200mg TEVA B.V. OLANDA CUTIE CU 1 FLAC. DIN PEID X 100 COMPR. FILM PRF 100 2.621640 2.621640 0.135460
65 W63177002 N05AH02 CLOZAPINUM ** LEPONEX 100 mg COMPR. 100mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 5 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. PRF 50 1.436200 1.436200 0.000000
66 W68786002 N05AH02 CLOZAPINUM ** LEPONEX 100 mg COMPR. 100mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 5 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. PRF 50 1.436200 1.436200 0.000000
67 W63176002 N05AH02 CLOZAPINUM ** LEPONEX 25 mg COMPR. 25mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 5 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. PRF 50 0.482600 0.482600 0.000000
68 W68785002 N05AH02 CLOZAPINUM ** LEPONEX 25 mg COMPR. 25mg IRLANDA
VIATRIS HEALTHCARE LIMITED CUTIE CU 5 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. PRF 50 0.482600 0.482600 0.000000
69 W60126001 N07XX06 TETRABENAZINUM ** TETMODIS 25 mg COMPR. 25mg AUSTRIA
AOP ORPHAN PHARMACEUTICALS GMBH CUTIE CU 1 FLAC. PEID X 112 COMPR. PRF 112 4.217946 4.217946 0.000000
70 W64492001 N07XX11 PITOLISANTUM ** Ω WAKIX 4,5 mg COMPR. FILM. 4,5mg BIOPROJET PHARMA FRANTA CUTIE CU 1 FLAC. HDPE X 30 COMPR. FILM. PR 30 48.327333 48.327333 0.000000

11. MIASTENIA GRAVIS - G13

1 W05242001 H02AB07 PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
2 W12565002 H02AB07 PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
3 W13686002 H02AB07 PREDNISONUM PREDNISON SINTOFARM 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
4 W53341001 H02AB07 PREDNISONUM PREDNISONA-RICHTER 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
5 W60846001 L04AX01 AZATHIOPRINUM IMURAN 50 mg COMPR. FILM. 50mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. P-RF 100 0.654500 0.654500 0.000000
6 W52868002 N07AA01 NEOSTIGMINI BROMIDUM NEOSTIGMINA LPH 15 mg COMPR. 15mg LABORMED PHARMA SA ROMANIA CUTIE CU BLIST. PVC/AL X 60 COMPR. P-6L 60 1.858666 1.858666 0.000000
7 W57190001 N07AA02 PYRIDOSTIGMINI BROMIDUM MESTINON 60 mg DRAJ. 60mg MEDA AB SUEDIA CUTIE X 1 FLAC. X 20 DRAJ. P-RF 20 0.908500 0.908500 0.000000
8 W68713001 N07AA02 PYRIDOSTIGMINI BROMIDUM MESTINON 60 mg DRAJ. 60mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE X 1 FLAC. DIN STICLA BRUNA, PREVAZUTE CU UN CAPAC DIN PEID X 20 DRAJ. PRF 20 0.908500 0.908500 0.000000

Tratamentul se initiaza de catre medicul in specialitatea neurologie

12. SCLEROZA MULTIPLA - G14

1 W04224001 H02AB04 METHYLPREDNISOLONUM MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 5 BLIST. A-PVC/PVC X 10 COMPR. P-RF 50 0.811200 0.811200 0.000000
2 W65156001 H02AB04 METHYLPREDNISOLONUM MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 5 BLIST. AL-PVC/PVC X 10 COMPR. PRF 50 0.811200 0.811200 0.000000
3 W04222001 H02AB04 METHYLPREDNISOLONUM MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL-PVC/PVC X 10 COMPR. P-RF 20 3.329000 3.329000 0.000000
4 W65157001 H02AB04 METHYLPREDNISOLONUM MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL-PVC/PVC X 10 COMPR. PRF 20 3.329000 3.329000 0.000000
5 W08307001 H02AB04 METHYLPREDNISOLONUM LEMOD SOLU 125 mg PULB+SOLV. PT. SOL. INJ./PERF. 125mg STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. X 2 ML PRF 1 36.290000 36.290000 0.000000
6 W08310001 H02AB04 METHYLPREDNISOLONUM LEMOD SOLU 500 mg PULB+SOLV. PT. SOL. INJ./PERF. 500mg STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. X 7,8 ML PRF 1 98.000000 98.000000 0.000000
7 W05242001 H02AB07 PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
8 W12565002 H02AB07 PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
9 W13686002 H02AB07 PREDNISONUM PREDNISON SINTOFARM 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
10 W53341001 H02AB07 PREDNISONUM PREDNISONA-RICHTER 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
11 W42735002 L01DB07 MITOXANTRONUM ** ONKOTRONE 2 mg/ml CONC. PT. SOL. INJ. 2mg/ml BAXTER ONCOLOGY GMBH GERMANIA CUTIE X 1 FLACON X 10 ML CONC. PT. SOL. INJ. PR 1 630.540000 630.540000 0.000000
12 W60846001 L04AX01 AZATHIOPRINUM IMURAN 50 mg COMPR. FILM. 50mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. P-RF 100 0.654500 0.654500 0.000000

Tratamentul se iniţiază de către medicul din specialitatea neurologie.

Pagina 15 din 37
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

1 W08721001 N03AG01 ACIDUM VALPROICUM + SARURI ORFIRIL LONG 150 mg CAPS. ELIB. PREL. 150mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 1 FLAC. DIN PE X 50 CAPS. CU MINI-COMPR. CU ELIB. PRELUNG. P-6L 50 0.444120 0.444120 0.190680
2 W63234001 N03AG01 ACIDUM VALPROICUM + SARURI CONVULEX 150 mg CAPS. MOI GASTROREZ. 150mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 5 BLIST. PVDC-PVC/AL X 20 CAPS. MOI GASTROREZ. P6L 100 0.370100 0.370100 0.000000
3 W63235001 N03AG01 ACIDUM VALPROICUM + SARURI CONVULEX 300 mg CAPS. MOI GASTROREZ. 300mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 5 BLIST. PVDC-PVC/AL X 20 CAPS. MOI GASTROREZ. P6L 100 0.458100 0.458100 0.000000
4 W64667001 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE CHRONO 300 mg COMPR. ELIB. PREL. 300mg SANOFI ROMANIA SRL ROMANIA CUTIE X 2 FLAC. DIN PP X 50 COMPR. ELIB. PREL. P-6L 100 0.413800 0.413800 0.000000
5 W64666001 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE CHRONO 500 mg COMPR. ELIB. PREL. 500mg SANOFI ROMANIA SRL ROMANIA CUTIE X 1 FLAC. PP X 30 COMPR. ELIB. PREL. P-RF 30 0.641333 0.641333 0.000000
6 W64668001 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE 200 mg COMPR. GASTROREZ. 200mg SANOFI ROMANIA SRL ROMANIA CUTIE X 1 FLAC. DIN PP X 40 COMPR. GASTROREZ. P-6L 40 0.445250 0.445250 0.000000
7 W08325005 N03AG01 ACIDUM VALPROICUM + SARURI ORFIRIL LONG 1000 mg MINICOMPR. ELIB. PREL. 1000mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE X 100 MINIPLICURI. DIN HARTIE/AL/PE CU MINICOMPR. CU ELIB. PRELUNG. P-6L 100 2.098300 2.098300 0.000000
8 W08325001 N03AG01 ACIDUM VALPROICUM + SARURI ORFIRIL LONG 1000 mg MINICOMPR. ELIB. PREL. 1000mg DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 50 MINI-PLICURI DIN HARTIE/AL/PE CU MINI-COMPR. CU ELIB. PRELUNG. P-6L 50 2.212600 2.212600 0.000000
9 W43170001 N03AG01 ACIDUM VALPROICUM + SARURI VALEPIL 200 mg/5 ml SIROP 200mg/5ml ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA CU 100 ML SI O LINGURITA DOZATOARE DUBLA (2,5/5 ML) P-6L 1 44.730000 44.730000 0.000000
10 W64489001 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE 57,64 mg/ml SIROP 57,64mg/ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 1 FLACON X 150 ML + 1 SERINGA PT. ADMIN. ORALA P6L 1 22.790000 22.790000 0.000000
11 W64489002 N03AG01 ACIDUM VALPROICUM + SARURI DEPAKINE 57,64 mg/ml SIROP 57,64mg/ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE X 1 FLACON X 150 ML + 1 LINGURITA DOZATOARE P6L 1 22.790000 22.790000 0.000000
12 W42997002 N03AX09 LAMOTRIGINUM ** LAMOTRIX 100 mg COMPR. 100mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 1.062000 1.062000 0.000000
13 W65105001 N03AX09 LAMOTRIGINUM ** LAMICTAL 100 mg COMPR. 100mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. X 28 COMPR. FILM. P6L 28 1.274400 1.274400 0.183100
14 W42996002 N03AX09 LAMOTRIGINUM ** LAMOTRIX 200 mg COMPR. 200mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 2.166333 2.166333 0.000000
15 W65103003 N03AX09 LAMOTRIGINUM ** LAMICTAL 25 mg COMPR. 25mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR. P6L 28 0.355000 0.355000 0.000000
16 W42995002 N03AX09 LAMOTRIGINUM ** LAMOTRIX 50 mg COMPR. 50mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.630333 0.630333 0.000000
17 W65102001 N03AX09 LAMOTRIGINUM ** LAMICTAL 2 mg COMPR. MAST./DISP. 2mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN PEID X 30 COMPR. MAST./DISP. P6L 30 0.300333 0.300333 0.000000
18 W65101004 N03AX09 LAMOTRIGINUM ** LAMICTAL 5 mg COMPR. MAST./DISP. 5mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. MAST./DISP. P6L 30 0.171666 0.171666 0.000000
19 W65101010 N03AX09 LAMOTRIGINUM ** LAMICTAL 5 mg COMPR. MAST./DISP. 5mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU FLAC. DIN PEID X 30 COMPR. MAST./DISP. P6L 30 0.171666 0.171666 0.000000
20 W06002001 N04AA01 TRIHEXYPHENIDYLUM ROMPARKIN 2 mg COMPR. 2mg TERAPIA SA ROMANIA CUTIE X 5 BLIST. AL/PVC X 10 COMPR. P-6L 50 1.577800 1.577800 0.000000
21 W52419001 N05AD01 HALOPERIDOLUM HALOPERIDOL LAROPHARM 0,5 mg COMPR. 0,5mg LAROPHARM S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.213500 0.213500 0.000000
22 W56620001 N05AD01 HALOPERIDOLUM HALOPERIDOL ROMPHARM 2 mg/ml PIC. ORALE, SOL. 2 mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLACON PEJD CU PICURATOR PEJD X 10 ML PIC. OFT., SOL. PRF 1 8.780000 8.780000 0.000000
23 W61980001 N05AD01 HALOPERIDOLUM HALOPERIDOL ARENA 2 mg/ml PIC. ORALE, SOL. 2mg/ml ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA CARE CONTINE 10 ML PICATURI ORALE, SOL., PREVAZUT CU PICURATOR DIN PEJD PRF 1 8.780000 8.780000 0.000000
24 W03427002 N05AD01 HALOPERIDOLUM HALOPERIDOL - RICHTER 2mg/ml PIC. ORALE-SOL. 2mg/ml GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 1 FLAC. PICURATOR DIN STICLA BRUNA X 10 ML PICATURI ORALE, SOLUTIE P-RF 1 8.780000 8.780000 0.000000
25 W54845001 N05AD01 HALOPERIDOLUM HALOPERIDOL RICHTER 5 mg/ml SOL. INJ. 5mg/ml GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ. P-RF 5 3.038000 3.038000 0.000000
26 W44015001 N05AE03 SERTINDOL ** SERDOLECT 16 mg COMPR. FILM. 16mg H. LUNDBECK A/S DANEMARCA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-RF 28 14.683928 14.683928 0.000000
27 W44017001 N05AE03 SERTINDOL ** SERDOLECT 4 mg COMPR. FILM. 4mg H. LUNDBECK A/S DANEMARCA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 3.739666 3.739666 0.000000
28 W59272007 N05AE04 ZIPRASIDONUM ** ZYPSILA 40 mg CAPS. 40mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 6 BLIST. PVC-PVDC/AL X 10 CAPS. P-RF 60 4.288500 4.288500 0.000000
29 W59273007 N05AE04 ZIPRASIDONUM ** ZYPSILA 60 mg CAPS. 60mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 6 BLIST. PVC-PVDC/AL X 10 CAPS. P-RF 60 4.715666 4.715666 0.000000
30 W59274007 N05AE04 ZIPRASIDONUM ** ZYPSILA 80 mg CAPS. 80mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 6 BLIST. PVC-PVDC/AL X 10 CAPS. P-RF 60 4.361833 4.361833 0.000000
31 W03207001 N05AF01 FLUPENTIXOLUM ** FLUANXOL DEPOT SOL. INJ. 20mg/ml H. LUNDBECK A/S DANEMARCA CUTIE X 10 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ. P-RF 10 7.416000 7.416000 0.000000
32 W12437003 N05AF05 ZUCLOPENTHIXOLUM ** CLOPIXOL 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA CUTIE X 1 FLAC. DIN PEID X 50 COMPR. FILM., INCHIS CU CAPAC CU FILET, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PT. COPII P-RF 50 0.414200 0.414200 0.000000
33 W10638002 N05AF05 ZUCLOPENTHIXOLUM ** CLOPIXOL 20 mg/ml PIC. ORALE-SOL. 20mg/ml H. LUNDBECK A/S DANEMARCA CUTIE X 1 FLAC. + CAPAC SECURIZAT PT. COPII X 20 ML P-RF 1 34.970000 34.970000 0.000000
34 W12431001 N05AF05 ZUCLOPENTHIXOLUM ** CLOPIXOL DEPOT 200 mg/ml SOL. INJ. 200mg/ml H. LUNDBECK A/S DANEMARCA CUTIE X 10 FIOLE X 1 ML P-RF 10 13.687000 13.687000 0.000000
35 W13182005 N05AF05 ZUCLOPENTHIXOLUM ** CLOPIXOL ACUPHASE 50 mg/ml SOL. INJ. 50mg/ml H. LUNDBECK A/S DANEMARCA CUTIE X 5 FIOLE X 1 ML P-RF 5 10.844000 10.844000 0.000000
36 W63177002 N05AH02 CLOZAPINUM ** LEPONEX 100 mg COMPR. 100mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 5 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. PRF 50 1.436200 1.436200 0.000000
37 W68786002 N05AH02 CLOZAPINUM ** LEPONEX 100 mg COMPR. 100mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 5 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. PRF 50 1.436200 1.436200 0.000000
38 W63176002 N05AH02 CLOZAPINUM ** LEPONEX 25 mg COMPR. 25mg MYLAN HEALTHCARE GMBH GERMANIA CUTIE CU 5 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. PRF 50 0.482600 0.482600 0.000000
39 W68785002 N05AH02 CLOZAPINUM ** LEPONEX 25 mg COMPR. 25mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 5 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. PRF 50 0.482600 0.482600 0.000000
40 W52357003 N05AH03 OLANZAPINUM ** ZALASTA 10mg COMPR. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 28 COMPR., (BLISTER OPA/AL/PVC/AL) P-RF 28 0.845357 0.845357 0.000000
41 W52354002 N05AH03 OLANZAPINUM ** ZALASTA 5mg COMPR. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 28 COMPR., (BLISTER OPA/AL/PVC/AL) P-RF 28 0.570000 0.570000 0.000000
42 W08727002 N05AH03 OLANZAPINUM ** ZYPREXA 10 mg COMPR. FILM. 10mg ELI LILLY NEDERLAND BV OLANDA CUTIE X 28 COMPR. FILM. ( BLIST.AL ABUTISATE LA RECE) P-RF 28 0.855856 0.855856 1.647001
43 W55022004 N05AH03 OLANZAPINUM ** LAPOZAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 28 COMPR. FILM. P-RF 28 0.855856 0.855856 2.595572
44 W55022005 N05AH03 OLANZAPINUM ** LAPOZAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-RF 30 0.855856 0.855856 2.595144
45 W55124004 N05AH03 OLANZAPINUM ** OLANZAPINA ACTAVIS 10 mg COMPR. FILM. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-RF 30 0.714000 0.714000 0.000000
46 W62411002 N05AH03 OLANZAPINUM ** BLOONIS 10 mg COMPR. FILM. 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-RF 28 0.855856 0.855856 0.030572
47 W64075002 N05AH03 OLANZAPINUM ** BLOONIS 10 mg COMPR. FILM. 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-RF 28 0.855856 0.855856 0.030572
48 W65592001 N05AH03 OLANZAPINUM ** OLANZAPINA ARENA 10 mg COMPR. FILM. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 4 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. PRF 28 0.855714 0.855714 0.000000
49 W68186004 N05AH03 OLANZAPINUM ** OLANZAPINA TEVA 10 mg COMPR. FILM. 10mg TEVA B.V. OLANDA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. PRF 30 0.714000 0.714000 0.000000
50 W65592009 N05AH03 OLANZAPINUM ** OLANZAPINA ARENA 10 mg COMPR. FILM. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 30 0.855856 0.855856 0.000477
51 W55023004 N05AH03 OLANZAPINUM ** LAPOZAN 15 mg COMPR. FILM. 15mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 28 COMPR. FILM. P-RF 28 3.973285 3.973285 4.532072
52 W08557001 N05AH03 OLANZAPINUM ** ZYPREXA 5 mg COMPR. FILM. 5mg ELI LILLY NEDERLAND BV OLANDA CUTIE X 28 COMPR. FILM. ( BLIST.AL ABUTISATE LA RECE) P-RF 28 0.570000 0.570000 1.501071
53 W55021004 N05AH03 OLANZAPINUM ** LAPOZAN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 28 COMPR. FILM. P-RF 28 0.570000 0.570000 0.977142
54 W55021005 N05AH03 OLANZAPINUM ** LAPOZAN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-RF 30 0.570000 0.570000 0.977333
55 W55122004 N05AH03 OLANZAPINUM ** OLANZAPINA ACTAVIS 5 mg COMPR. FILM. 5mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-RF 30 0.475000 0.475000 0.000000
56 W62412002 N05AH03 OLANZAPINUM ** BLOONIS 5 mg COMPR. FILM. 5mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-RF 28 0.570000 0.570000 0.017142
57 W64076002 N05AH03 OLANZAPINUM ** BLOONIS 5 mg COMPR. FILM. 5mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-RF 28 0.570000 0.570000 0.017142

Pagina 16 din 37
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)
58 W65591001 N05AH03 OLANZAPINUM ** OLANZAPINA ARENA 5 mg COMPR. FILM. 5mg ARENA GROUP S.A. ROMANIA CUTIE CU 4 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. PRF 28 0.566428 0.566428 0.000000
59 W68184004 N05AH03 OLANZAPINUM ** OLANZAPINA TEVA 5 mg COMPR. FILM. 5mg TEVA B.V. OLANDA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. PRF 30 0.475000 0.475000 0.000000
60 W65591009 N05AH03 OLANZAPINUM ** OLANZAPINA ARENA 5 mg COMPR. FILM. 5mg ARENA GROUP S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 30 0.567000 0.567000 0.000000
61 W54601004 N05AH03 OLANZAPINUM ** OLANZAPINA TERAPIA 10 mg COMPR. ORODISPERSABILE 10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 0.855714 0.855714 0.000000
62 W62413002 N05AH03 OLANZAPINUM ** BLOONIS 10 mg COMPR. ORODISPERSABILE 10mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 0.713214 0.713214 0.000000
63 W64077002 N05AH03 OLANZAPINUM ** BLOONIS 10 mg COMPR. ORODISPERSABILE 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 0.713214 0.713214 0.000000
64 W54602004 N05AH03 OLANZAPINUM ** OLANZAPINA TERAPIA 15 mg COMPR. ORODISPERSABILE 15mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 3.857500 3.857500 0.000000
65 W56902001 N05AH03 OLANZAPINUM ** OLANZAPINA ACTAVIS 15 mg COMPR. ORODISPERSABILE 15mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 3.311071 3.311071 0.000000
66 W62414002 N05AH03 OLANZAPINUM ** BLOONIS 15 mg COMPR. ORODISPERSABILE 15mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 3.358928 3.358928 0.000000
67 W64078002 N05AH03 OLANZAPINUM ** BLOONIS 15 mg COMPR. ORODISPERSABILE 15mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 3.358928 3.358928 0.000000
68 W67794001 N05AH03 OLANZAPINUM ** OLANZAPINA TEVA 15 mg COMPR. ORODISPERSABILE 15mg TEVA B.V. OLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE PRF 28 3.311071 3.311071 0.000000
69 W54603004 N05AH03 OLANZAPINUM ** OLANZAPINA TERAPIA 20 mg COMPR. ORODISPERSABILE 20mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 2.239285 2.239285 0.000000
70 W56903001 N05AH03 OLANZAPINUM ** OLANZAPINA ACTAVIS 20 mg COMPR. ORODISPERSABILE 20mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 2.408571 2.408571 0.000000
71 W62415002 N05AH03 OLANZAPINUM ** BLOONIS 20 mg COMPR. ORODISPERSABILE 20mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 2.302142 2.302142 0.000000
72 W64079002 N05AH03 OLANZAPINUM ** BLOONIS 20 mg COMPR. ORODISPERSABILE 20mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 2.302142 2.302142 0.000000
73 W67796001 N05AH03 OLANZAPINUM ** OLANZAPINA TEVA 20 mg COMPR. ORODISPERSABILE 20mg TEVA B.V. OLANDA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE PRF 28 2.408571 2.408571 0.000000
74 W54599004 N05AH03 OLANZAPINUM ** OLANZAPINA TERAPIA 5 mg COMPR. ORODISPERSABILE 5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. ORODISPERSABILE P-RF 28 0.569642 0.569642 0.000000
75 W53870001 N05AH03 OLANZAPINUM ** ZYPADHERA 210mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 210mg ELI LILLY NEDERLAND BV OLANDA CUTIE X 1 FLAC X 210MG PULB. + 1 FLAC. X 3ML SOLVENT PR 1 566.080000 566.080000 0.000000
76 W53871001 N05AH03 OLANZAPINUM ** ZYPADHERA 300mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 300mg ELI LILLY NEDERLAND BV OLANDA CUTIE X 1 FLAC X 300MG PULB. + 1 FLAC. X 3ML SOLVENT PR 1 794.120000 794.120000 0.000000
77 W53872001 N05AH03 OLANZAPINUM ** ZYPADHERA 405mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 405mg ELI LILLY NEDERLAND BV OLANDA CUTIE X 1 FLAC X 405MG PULB. + 1 FLAC. X 3ML SOLVENT PR 1 1,061.410000 1,061.410000 0.000000
78 W63282004 N05AH04 QUETIAPINUM ** UNIQUET 200 mg COMPR. CU ELIB. PREL. 200mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. PRF 60 0.977000 0.977000 0.000000
79 W65804004 N05AH04 QUETIAPINUM ** QUETIAPINA ACCORD 200 mg COMPR. CU ELIB. PREL. 200mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. CU ELIB. PREL. PRF 60 0.935166 0.935166 0.000000
80 W63284004 N05AH04 QUETIAPINUM ** UNIQUET 300 mg COMPR. CU ELIB. PREL. 300mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. PRF 60 1.456500 1.456500 0.000000
81 W65805004 N05AH04 QUETIAPINUM ** QUETIAPINA ACCORD 300 mg COMPR. CU ELIB. PREL. 300mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. CU ELIB. PREL. PRF 60 1.213833 1.213833 0.000000
82 W63286004 N05AH04 QUETIAPINUM ** UNIQUET 400 mg COMPR. CU ELIB. PREL. 400mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. PRF 60 2.478666 2.478666 0.000000
83 W65806004 N05AH04 QUETIAPINUM ** QUETIAPINA ACCORD 400 mg COMPR. CU ELIB. PREL. 400mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. CU ELIB. PREL. PRF 60 2.065666 2.065666 0.000000
84 W63280009 N05AH04 QUETIAPINUM ** UNIQUET 50 mg COMPR. CU ELIB. PREL. 50mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 60 COMPR. ELIB. PREL. PRF 60 0.627500 0.627500 0.000000
85 W63280004 N05AH04 QUETIAPINUM ** UNIQUET 50 mg COMPR. CU ELIB. PREL. 50mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. PRF 60 0.627500 0.627500 0.000000
86 W59533007 N05AH04 QUETIAPINUM ** QUETIAPINA TEVA 150 mg COMPR. ELIB. PREL. 150mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 60 COMPR. CU ELIB. PREL. PRF 60 1.305600 1.305600 0.022900
87 W63039004 N05AH04 QUETIAPINUM ** QUETIAPINA ZENTIVA 150 mg COMPR. ELIB. PREL. 150mg ZENTIVA K.S. CUTIE CU BLIST. PVC-PCTFE/AL X 60 COMPR. ELIB. PREL.
REPUBLICA CEHA PRF 60 1.305600 1.305600 0.290066
88 W65168001 N05AH04 QUETIAPINUM ** SEROQUEL XR 150 mg COMPR. ELIB. PREL. 150mg ASTRAZENECA AB SUEDIA CUTIE CU 6 BLIST. DIN PVC-PCTFE/AL X 10 COMPR. ELIB. PREL. PRF 60 1.305600 1.305600 0.938566
89 W66340004 N05AH04 QUETIAPINUM ** QUETIAPINA ACCORD 150 mg COMPR. ELIB. PREL. 150mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. PRF 60 1.088000 1.088000 0.000000
90 W58674007 N05AH04 QUETIAPINUM ** QUETIAPINA TEVA 200 mg COMPR. ELIB. PREL. 200mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 60 COMPR. CU ELIB. PREL. PRF 60 0.896833 0.896833 0.000000
91 W63040004 N05AH04 QUETIAPINUM ** QUETIAPINA ZENTIVA 200 mg COMPR. ELIB. PREL. 200mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PCTFE/AL X 60 COMPR. ELIB. PREL. PRF 60 1.002000 1.002000 0.000000
92 W58675007 N05AH04 QUETIAPINUM ** QUETIAPINA TEVA 300 mg COMPR. ELIB. PREL. 300mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 60 COMPR. CU ELIB. PREL. PRF 60 1.456599 1.456599 0.134234
93 W63041004 N05AH04 QUETIAPINUM ** QUETIAPINA ZENTIVA 300 mg COMPR. ELIB. PREL. 300mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PCTFE/AL X 60 COMPR. ELIB. PREL. PRF 60 1.456599 1.456599 0.204567
94 W58676007 N05AH04 QUETIAPINUM ** QUETIAPINA TEVA 400 mg COMPR. ELIB. PREL. 400mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 60 COMPR. CU ELIB. PREL. PRF 60 2.340833 2.340833 0.000000
95 W63042004 N05AH04 QUETIAPINUM ** QUETIAPINA ZENTIVA 400 mg COMPR. ELIB. PREL. 400mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PCTFE/AL X 60 COMPR. ELIB. PREL. PRF 60 2.478799 2.478799 0.364534
96 W58673007 N05AH04 QUETIAPINUM ** QUETIAPINA TEVA 50 mg COMPR. ELIB. PREL. 50mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 60 COMPR. CU ELIB. PREL. PRF 60 0.555666 0.555666 0.000000
97 W63038004 N05AH04 QUETIAPINUM ** QUETIAPINA ZENTIVA 50 mg COMPR. ELIB. PREL. 50mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PCTFE/AL X 60 COMPR. ELIB. PREL. PRF 60 0.561833 0.561833 0.000000
98 W66339007 N05AH04 QUETIAPINUM ** QUETIAPINA ACCORD 50 mg COMPR. ELIB. PREL. 50mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PVDC/AL X 60 COMPR. ELIB. PREL. PRF 60 0.541333 0.541333 0.000000
99 W63528001 N05AL01 SULPIRIDUM EGLONYL 50 mg CAPS. 50mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 15 CAPS. PRF 30 0.350333 0.350333 0.000000
100 W63528002 N05AL01 SULPIRIDUM EGLONYL 50 mg CAPS. 50mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 30 CAPS. PRF 30 0.350333 0.350333 0.000000
101 W63529001 N05AL01 SULPIRIDUM EGLONYL 200 mg COMPR. 200mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 12 COMPR. PRF 12 1.954166 1.954166 0.000000
102 W55404001 N05AL05 AMISULPRIDUM ** AMISULPRIDA LPH 200 mg COMPR. 200mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P-RF 30 1.821666 1.821666 0.000000
103 W55435001 N05AL05 AMISULPRIDUM ** MIDORA 200 mg COMPR. 200mg TERAPIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. P-RF 30 1.821666 1.821666 0.000000
104 W64420001 N05AL05 AMISULPRIDUM ** SOLIAN 200 mg COMPR. 200mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. PRF 30 2.042799 2.042799 0.318201
105 W67577002 N05AL05 AMISULPRIDUM ** MASULTAB 200 mg COMPR. 200mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. PRF 30 1.702333 1.702333 0.000000
106 W67577007 N05AL05 AMISULPRIDUM ** MASULTAB 200 mg COMPR. 200mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. PRF 30 1.702333 1.702333 0.000000
107 W62189001 N05AL05 AMISULPRIDUM ** AKTIPROL 400 mg COMPR. 400mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. PRF 30 2.390000 2.390000 0.000000
108 W62189004 N05AL05 AMISULPRIDUM ** AKTIPROL 400 mg COMPR. 400mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. PRF 30 2.390000 2.390000 0.000000
109 W67578002 N05AL05 AMISULPRIDUM ** MASULTAB 400 mg COMPR. 400mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 COMPR. PRF 30 2.669333 2.669333 0.000000
110 W67578007 N05AL05 AMISULPRIDUM ** MASULTAB 400 mg COMPR. 400mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. PRF 30 2.669333 2.669333 0.000000
111 W61038001 N05AL05 AMISULPRIDUM ** MIDORA 400 mg COMPR. FILM. 400mg TERAPIA SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. PRF 30 2.669333 2.669333 0.000000
112 W64419001 N05AL05 AMISULPRIDUM ** SOLIAN 400 mg COMPR. FILM. 400mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. PRF 30 2.642333 2.642333 0.000000
113 W56212003 N05AX08 RISPERIDONUM ** RISPEN 1 COMPR. FILM. 1mg ZENTIVA KS CEHIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 50 0.699600 0.699600 0.000000
114 W58413001 N05AX08 RISPERIDONUM ** RISPERIDONA ARENA 1 mg COMPR. FILM. 1mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL-PVDC X 10 COMPR. FILM. P-RF 20 0.656500 0.656500 0.000000
115 W56213003 N05AX08 RISPERIDONUM ** RISPEN 2 COMPR. FILM. 2 mg ZENTIVA KS CEHIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 50 0.840400 0.840400 0.000000
116 W58414001 N05AX08 RISPERIDONUM ** RISPERIDONA ARENA 2 mg COMPR. FILM. 2mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL-PVDC X 10 COMPR. FILM. P-RF 20 1.008480 1.008480 0.208020
117 W56214003 N05AX08 RISPERIDONUM ** RISPEN 3 COMPR. FILM. 3mg ZENTIVA KS CEHIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 50 0.809600 0.809600 0.000000

Pagina 17 din 37
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)
118 W58415001 N05AX08 RISPERIDONUM ** RISPERIDONA ARENA 3 mg COMPR. FILM. 3mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL-PVDC X 10 COMPR. FILM. P-RF 20 0.971520 0.971520 0.944480
119 W56215003 N05AX08 RISPERIDONUM ** RISPEN 4 COMPR. FILM. 4 mg ZENTIVA KS CEHIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 50 1.395800 1.395800 0.000000
120 W57800001 N05AX08 RISPERIDONUM ** RISPERIDONA MEDOCHEMIE 4 mg COMPR. FILM. 4mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 20 COMPR. FILM. PRF 20 1.674960 1.674960 0.506540
121 W58416001 N05AX08 RISPERIDONUM ** RISPERIDONA ARENA 4 mg COMPR. FILM. 4mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL-PVDC X 10 COMPR. FILM. P-RF 20 1.674960 1.674960 0.742040
122 W13666002 N05AX08 RISPERIDONUM ** RISPOLEPT CONSTA 25 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 25mg JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE CU 1 FLACON PULBERE PT SUSP. INJ. CU ELIB. PREL., O SERINGA PRE-UMPLUTA CU 2 ML SOLVENT + 2 ACE S/P-RF 1 383.870000 383.870000 0.000000
123 W13667002 N05AX08 RISPERIDONUM ** RISPOLEPT CONSTA 37,5 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 37,5mg JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE CU 1 FLACON PULBERE PT SUSP. INJ. CU ELIB. PREL., O SERINGA PRE-UMPLUTA CU 2 ML SOLVENT + 2 ACE S/P-RF 1 504.130000 504.130000 0.000000
124 W13833002 N05AX08 RISPERIDONUM ** RISPOLEPT CONSTA 50 mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 50mg JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE CU 1 FLACON PULBERE PT SUSP. INJ. CU ELIB. PREL., O SERINGA PRE-UMPLUTA CU 2 ML SOLVENT + 2 ACE PRF 1 588.700000 588.700000 0.000000
125 W68775001 N05AX08 RISPERIDONUM ** OKEDI 100 mg PULB+SOLV. PT. SUSP. INJ. CU ELIB. PREL. 100mg LABORATORIOS FARMACEUTICOS ROVI SA SPANIA KIT CU 1 SERINGA PREUMPLUTA CU 100 MG PULBERE + 1 SERINGA PREUMPLUTA CU 0,490 ML SOLVENT + 2 ACE PRF 1 1,164.220000 1,164.220000 0.000000
126 W67590001 N05AX08 RISPERIDONUM ** RISPERIDONA TEVA 25 mg PULB+SOLV. PT. SUSP. INJ. CU ELIB. PREL. 25mg TEVA B.V. OLANDA CUTIE CU 1 PACHET CU 1 DOZA CARE CONTINE 1 TAVITA CU: 1 FLAC. DIN STICLA+1 SERINGA PREUMPLUTA DIN STICLA CU 2 ML SOLV.+ADAPTOR FLAC.+2 ACE TERUMO SURGUARD®3 PT. INJECTARE I.M. PRF 1 460.644000 460.644000 180.996000
127 W67591001 N05AX08 RISPERIDONUM ** RISPERIDONA TEVA 37,5 mg PULB+SOLV. PT. SUSP. INJ. CU ELIB. PREL. 37,5mg TEVA B.V. OLANDA CUTIE CU 1 PACHET CU 1 DOZA CARE CONTINE 1 TAVITA CU: 1 FLAC. DIN STICLA+1 SERINGA PREUMPLUTA DIN STICLA CU 2 ML SOLV.+ADAPTOR FLAC.+2 ACE TERUMO SURGUARD®3 PT. INJECTARE I.M. PRF 1 588.040000 588.040000 0.000000
128 W67592001 N05AX08 RISPERIDONUM ** RISPERIDONA TEVA 50 mg PULB+SOLV. PT. SUSP. INJ. CU ELIB. PREL. 50mg TEVA B.V. OLANDA CUTIE CU 1 PACHET CU 1 DOZA CARE CONTINE 1 TAVITA CU: 1 FLAC. DIN STICLA+1 SERINGA PREUMPLUTA DIN STICLA CU 2 ML SOLV.+ADAPTOR FLAC.+2 ACE TERUMO SURGUARD®3 PT. INJECTARE I.M. PRF 1 504.640000 504.640000 0.000000
129 W68774001 N05AX08 RISPERIDONUM ** OKEDI 75 mg PULB+SOLV. PT. SUSP. INJ. CU ELIB. PREL. 75mg LABORATORIOS FARMACEUTICOS ROVI SA SPANIA KIT CU 1 SERINGA PREUMPLUTA CU 75 MG PULBERE + 1 SERINGA PREUMPLUTA CU 0,383 ML SOLVENT + 2 ACE PRF 1 991.680000 991.680000 0.000000
130 W08728003 N05AX08 RISPERIDONUM ** RISPOLEPT 1 mg/ml SOL. ORALA 1mg/ml JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE X 1 FLACON DIN STICLA BRUNA X 30 ML SOL. ORALA + 1 PIPETA P-RF 1 19.240000 19.240000 0.000000
131 W61492003 N05AX12 ARIPIPRAZOLUM ** ARYZALERA 10mg COMPR. 10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.228333 1.228333 0.000000
132 W61847007 N05AX12 ARIPIPRAZOLUM ** ARIPIPRAZOL TEVA 10 mg COMPR. 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.355199 1.355199 0.464134
133 W62245006 N05AX12 ARIPIPRAZOLUM ** ARICOGAN 10 mg COMPR. 10mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.129333 1.129333 0.000000
134 W62048001 N05AX12 ARIPIPRAZOLUM ** ARIPIPRAZOLE ZENTIVA 10 mg COMPR. 10mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA/AL/PVC/AL (BLISTER AL-AL) X 28 COMPR. PRF 28 1.197857 1.197857 0.000000
135 W62250002 N05AX12 ARIPIPRAZOLUM ** ZYKALOR 10 mg COMPR. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.355199 1.355199 1.851801
136 W62259003 N05AX12 ARIPIPRAZOLUM ** ARIPIPRAZOL STADA 10 mg COMPR. 10mg STADA M&D SRL ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. PRF 28 1.355199 1.355199 1.600872
137 W61493003 N05AX12 ARIPIPRAZOLUM ** ARYZALERA 15mg COMPR. 15mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.828666 1.828666 0.000000
138 W61848007 N05AX12 ARIPIPRAZOLUM ** ARIPIPRAZOL TEVA 15 mg COMPR. 15mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.716333 1.716333 0.000000
139 W62251002 N05AX12 ARIPIPRAZOLUM ** ZYKALOR 15 mg COMPR. 15mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.725333 1.725333 0.000000
140 W62260003 N05AX12 ARIPIPRAZOLUM ** ARIPIPRAZOL STADA 15 mg COMPR. 15mg STADA M&D SRL ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. PRF 28 1.617500 1.617500 0.000000
141 W62049001 N05AX12 ARIPIPRAZOLUM ** ARIPIPRAZOLE ZENTIVA 15 mg COMPR. 15mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA/AL/PVC/AL (BLISTER AL-AL) X 28 COMPR. PRF 28 1.727142 1.727142 0.000000
142 W62246006 N05AX12 ARIPIPRAZOLUM ** ARICOGAN 15 mg COMPR. 15mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 1.630666 1.630666 0.000000
143 W61849007 N05AX12 ARIPIPRAZOLUM ** ARIPIPRAZOL TEVA 20 mg COMPR. 20mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 11.559000 11.559000 0.000000
144 W61850007 N05AX12 ARIPIPRAZOLUM ** ARIPIPRAZOL TEVA 30 mg COMPR. 30mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. PRF 30 9.356666 9.356666 0.000000
145 W61718002 N05AX12 ARIPIPRAZOLUM ** ASTORET 10 mg COMPR. ORODISPERSABILE 10mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. DETASABIL (PEEL-OF) DIN PA/AL/PVC-AL X 28 COMPR. ORODISPERSABILE PRF 28 1.355199 1.355199 0.129443
146 W61719002 N05AX12 ARIPIPRAZOLUM ** ASTORET 15 mg COMPR. ORODISPERSABILE 15mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. DETASABIL (PEEL-OF) DIN PA/AL/PVC-AL X 28 COMPR. ORODISPERSABILE PRF 28 1.941000 1.941000 0.006500
147 W65091001 N05AX12 ARIPIPRAZOLUM ** ABILIFY MAINTENA 400mg PULB. + SOLV. PT. SUSP. INJ. CU ELIB. PREL. 400mg OLANDA
OTSUKA PHARMACEUTICAL NETHERLANDS B.V. CUTIE CU 1 FL. CU PULB.,1 FL. DE 2 ML CU SOLV., 1SERINGA LUER-LOCK DE 3 ML CU AC HYPODERMIC SECURIZAT DE CALIBRU 21,DE 38 MM PREATASAT,1SERINGA JETABILA DE 3 ML CU VÂRF LUER-LOCK,1ADAPTOR PT. FLAC. SI 3 ACE HIPODERMICE SECURIZATE PRF 1 978.300000 978.300000 0.000000
148 W65237002 N05AX13 PALIPERIDONUM ** PARNIDO 3 mg COMPR. ELIB. PREL. 3mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONTINAND 30 COMPRIMATE CU ELIBERARE PRELUNGITA PRF 30 4.266000 4.266000 0.000000
149 W65238002 N05AX13 PALIPERIDONUM ** PARNIDO 6 mg COMPR. ELIB. PREL. 6mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONTINAND 30 COMPRIMATE CU ELIBERARE PRELUNGITA PRF 30 8.141000 8.141000 0.000000
150 W65239002 N05AX13 PALIPERIDONUM ** PARNIDO 9 mg COMPR. ELIB. PREL. 9mg KRKA D.D., NOVO MESTO SLOVENIA CUTIE CU BLISTERE DIN OPA-AL-PVC/AL CONTINAND 30 COMPRIMATE CU ELIBERARE PRELUNGITA PRF 30 8.141000 8.141000 0.000000
151 W68386001 N05AX13 PALIPERIDONUM ** BYANNLI 1000mg SUSP. INJ. CU ELIB. PREL. 1000mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 1 AC PRF 1 8,798.030000 8,798.030000 0.000000
152 W57259001 N05AX13 PALIPERIDONUM ** XEPLION SUSP. INJ. CU ELIB. PREL. 100mg JANSSEN CILAG INTERNATIONALL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 2 ACE PR 1 1,072.410000 1,072.410000 0.000000
153 W57260001 N05AX13 PALIPERIDONUM ** XEPLION SUSP. INJ. CU ELIB. PREL. 150mg JANSSEN CILAG INTERNATIONALL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 2 ACE PR 1 1,530.270000 1,530.270000 0.000000
154 W62903001 N05AX13 PALIPERIDONUM ** TREVICTA 175 mg SUSP. INJ. CU ELIB. PREL. 175mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 2 ACE PRF 1 1,949.670000 1,949.670000 0.000000
155 W62904001 N05AX13 PALIPERIDONUM ** TREVICTA 263 mg SUSP. INJ. CU ELIB. PREL. 263mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 2 ACE PRF 1 2,562.020000 2,562.020000 0.000000
156 W62905001 N05AX13 PALIPERIDONUM ** TREVICTA 350 mg SUSP. INJ. CU ELIB. PREL. 350mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 2 ACE PRF 1 3,069.920000 3,069.920000 0.000000
157 W57257001 N05AX13 PALIPERIDONUM ** XEPLION SUSP. INJ. CU ELIB. PREL. 50mg JANSSEN CILAG INTERNATIONALL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 2 ACE PR 1 673.610000 673.610000 0.000000
158 W62906001 N05AX13 PALIPERIDONUM ** TREVICTA 525 mg SUSP. INJ. CU ELIB. PREL. 525mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 2 ACE PRF 1 4,440.970000 4,440.970000 0.000000
159 W68385001 N05AX13 PALIPERIDONUM ** BYANNLI 700mg SUSP. INJ. CU ELIB. PREL. 700mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 1 AC PRF 1 6,060.050000 6,060.050000 0.000000
160 W57258001 N05AX13 PALIPERIDONUM ** XEPLION SUSP. INJ. CU ELIB. PREL. 75mg JANSSEN CILAG INTERNATIONALL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA SI 2 ACE PR 1 902.780000 902.780000 0.000000
161 W64027003 N05AX15 CARIPRAZINUM ** Ω REAGILA 1,5 mg CAPS. 1,5mg GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. PVC/PE/PVDC/AL X 28 CAPS. PRF 28 9.571071 9.571071 0.000000
162 W64028003 N05AX15 CARIPRAZINUM ** Ω REAGILA 3 mg CAPS. 3mg GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. PVC/PE/PVDC/AL X 28 CAPS. PRF 28 9.571071 9.571071 0.000000
163 W64029001 N05AX15 CARIPRAZINUM ** Ω REAGILA 4,5 mg CAPS. 4,5mg GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. PVC/PE/PVDC/AL X 28 CAPS. PRF 28 9.571071 9.571071 0.000000
164 W64030001 N05AX15 CARIPRAZINUM ** Ω REAGILA 6 mg CAPS. 6mg GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. PVC/PE/PVDC/AL X 28 CAPS. PRF 28 9.571071 9.571071 0.000000
165 W43706001 N06AB04 CITALOPRAMUM ** LINISAN 20 mg COMPR. FILM. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 1.617000 1.617000 0.000000
166 W13298008 N06AB10 ESCITALOPRAMUM ** CIPRALEX 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA CUTIE X 2 BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 14 COMPR. FILM. P-RF 28 0.599142 0.599142 0.784786
167 W55522003 N06AB10 ESCITALOPRAMUM ** LENUXIN 10 mg COMPR. FILM. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-RF 28 0.599142 0.599142 0.483358
168 W55813002 N06AB10 ESCITALOPRAMUM ** SERODEPS 10mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. POLIAMIDA/AL/PVC-AL X 28 COMPR. FILM. P-RF 28 0.599142 0.599142 0.000143
169 W59746003 N06AB10 ESCITALOPRAMUM ** ESTAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 14 COMPR. FILM. PRF 14 0.567142 0.567142 0.000000
170 W59746005 N06AB10 ESCITALOPRAMUM ** ESTAN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. PRF 28 0.567500 0.567500 0.000000
171 W60685003 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM ACTAVIS 10 mg COMPR. FILM. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVDC/PVDC/AL X 28 COMPR. FILM. PRF 28 0.499285 0.499285 0.000000
172 W60692004 N06AB10 ESCITALOPRAMUM ** ELICEA 10 mg COMPR. FILM. 10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. PRF 30 0.599142 0.599142 0.000191
173 W61414004 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM ATB 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. FILM. PRF 28 0.599142 0.599142 0.376572
174 W68274003 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM TEVA 10 mg COMPR. FILM. 10mg TEVA B.V. OLANDA CUTIE CU BLIST. PVDC/PVDC/AL X 28 COMPR. FILM. PRF 28 0.499285 0.499285 0.000000
175 W60686003 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM ACTAVIS 20 mg COMPR. FILM. 20mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVDC/PVDC/AL X 28 COMPR. FILM. PRF 28 1.054285 1.054285 0.000000
176 W68276003 N06AB10 ESCITALOPRAMUM ** ESCITALOPRAM TEVA 20 mg COMPR. FILM. 20mg TEVA B.V. OLANDA CUTIE CU BLIST. PVDC/PVDC/AL X 28 COMPR. FILM. PRF 28 1.054285 1.054285 0.000000
177 W13019001 N06AX05 TRAZODONUM ** TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 1 BLIST. AL/PVC X 20 COMPR. ELIB. PREL. P-RF 20 1.450000 1.450000 0.000000

Pagina 18 din 37
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)
178 W13019004 N06AX05 TRAZODONUM ** TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 6 BLIST. AL/PVC X 10 COMPR. ELIB. PREL. P-RF 60 1.250833 1.250833 0.000000
179 W13019002 N06AX05 TRAZODONUM ** TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 3 BLIST. AL/PVC X 20 COMPR. ELIB. PREL. P-RF 60 1.250833 1.250833 0.000000
180 W13019003 N06AX05 TRAZODONUM ** TRITTICO AC 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 2 BLIST. AL/PVCX 10 COMPR. ELIB. PREL. P-RF 20 1.450000 1.450000 0.000000
181 W66418003 N06AX05 TRAZODONUM ** TRITTICO EP 150 mg COMPR. ELIB. PREL. 150mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE CU 3 BLIST. PVC-PVDC/AL OPAC ALB X 10 COMPR. ELIB. PREL. PRF 30 1.404000 1.404000 0.000000
182 W66419003 N06AX05 TRAZODONUM ** TRITTICO EP 300 mg COMPR. ELIB. PREL. 300mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE CU 3 BLIST. PVC-PVDC/AL OPAC ALB X 10 COMPR. ELIB. PREL. PRF 30 2.525000 2.525000 0.000000
183 W08616002 N06AX05 TRAZODONUM ** TRITTICO AC 75 mg COMPR. ELIB. PREL. 75mg ACR ANGELINI FRANCESCO S.P.A. ITALIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. ELIB. PREL. P-RF 30 0.765333 0.765333 0.000000
184 W57667003 N06AX14 TIANEPTINUM ** LYXIT 12,5 mg COMPR. FILM. 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN PVC-PVDC/AL X 30 COMPR. FILM. PRF 30 0.587000 0.587000 0.000000
185 W57667005 N06AX14 TIANEPTINUM ** LYXIT 12,5 mg COMPR. FILM. 12,5 mg ARENA GROUP S.A. ROMANIA CUTIE CU BLIST. DIN PVC-PVDC/AL X 90 COMPR. FILM. PRF 90 0.533444 0.533444 0.000000
186 W60648003 N06AX14 TIANEPTINUM ** NOBIXAL 12,5 mg COMPR. FILM. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. FILM. PRF 30 0.587000 0.587000 0.000000
187 W60648008 N06AX14 TIANEPTINUM ** NOBIXAL 12,5 mg COMPR. FILM. 12,5mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/ACLAR-AL X 30 COMPR. FILM. PRF 30 0.587000 0.587000 0.000000
188 W41558001 N06AX14 TIANEPTINUM ** COAXIL 12,5 mg DRAJ. 12,5mg FRANTA
LES LABORATOIRES SERVIER CUTIE X 1 BLIST. AL/PVC X 30 DRAJ. P-RF 30 0.640132 0.640132 0.301868
189 W58756003 N06AX16 VENLAFAXINUM ** ELIFY EP 150 mg CAPS. ELIB. PREL. 150 mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST PVC/AL X 30 CAPS.CU ELIB. PREL. PRF 30 0.848799 0.848799 0.532867
190 W67116002 N06AX16 VENLAFAXINUM ** EFECTIN EP 150 mg CAPS. ELIB. PREL. 150 mg UPJOHN EESV OLANDA CUTIE CU BLIST. DIN PVC/AL X 28 CAPS. ELIB. PREL. PRF 28 0.848799 0.848799 1.060843
191 W52122001 N06AX16 VENLAFAXINUM ** VELAXIN 150 mg CAPS. ELIB. PREL. 150mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC/PVDC-AL X 28 CAPS. ELIB. PREL. P-RF 28 0.848799 0.848799 0.717272
192 W52962005 N06AX16 VENLAFAXINUM ** ALVENTA 150mg CAPS. ELIB. PREL. 150mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. ELIB. PREL. P-RF 30 0.707333 0.707333 0.000000
193 W55396001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA EP 150 mg CAPS. ELIB. PREL. 150mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 30 0.848799 0.848799 0.717534
194 W53268003 N06AX16 VENLAFAXINUM ** FOBILESS 37,5 mg CAPS. ELIB. PREL. 37,5mg AUSTRIA
LANNACHER HEILMITTEL GES.M.B.H. CUTIE X BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF 30 0.761333 0.761333 0.000000
195 W55395001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA EP 37,5 mg CAPS. ELIB. PREL. 37,5mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 30 0.913599 0.913599 0.146067
196 W58755003 N06AX16 VENLAFAXINUM ** ELIFY EP 75 mg CAPS. ELIB. PREL. 75 mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. PRF 30 0.498799 0.498799 0.288534
197 W67115002 N06AX16 VENLAFAXINUM ** EFECTIN EP 75 mg CAPS. ELIB. PREL. 75 mg UPJOHN EESV OLANDA CUTIE CU BLIST. DIN PVC/AL X 28 CAPS. ELIB. PREL. PRF 28 0.498799 0.498799 0.575486
198 W52123001 N06AX16 VENLAFAXINUM ** VELAXIN 75 mg CAPS. ELIB. PREL. 75mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC/PVDC-AL X 28 CAPS. ELIB. PREL. P-RF 28 0.498799 0.498799 0.629772
199 W52961005 N06AX16 VENLAFAXINUM ** ALVENTA 75 mg CAPS. ELIB. PREL. 75mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. ELIB. PREL. P-RF 30 0.415666 0.415666 0.000000
200 W53269003 N06AX16 VENLAFAXINUM ** FOBILESS 75 mg CAPS. ELIB. PREL. 75mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF 30 0.498799 0.498799 0.346201
201 W55397001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA EP 75 mg CAPS. ELIB. PREL. 75mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 30 0.498799 0.498799 0.593201
202 W55398001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA 37,5 mg COMPR. 37,5mg ARENA GROUP S.A. ROMANIACUTIE X 3 BLIST. PVC-PE- PVDC/AL X 10 COMPR. P-RF 30 0.913599 0.913599 0.986067
203 W55399001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA 50 mg COMPR. 50mg ARENA GROUP S.A. ROMANIACUTIE X 3 BLIST. PVC-PE- PVDC/AL X 10 COMPR. P-RF 30 1.916666 1.916666 0.000000
204 W55400001 N06AX16 VENLAFAXINUM ** VENLAFAXINA ARENA 75 mg COMPR. 75mg ARENA GROUP S.A. ROMANIACUTIE X 3 BLIST. PVC-PE- PVDC/AL X 10 COMPR. P-RF 30 0.498799 0.498799 1.510201
205 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 0.658800 0.658800 1.082628
206 W61820005 N06AX21 DULOXETINUM ** DULSEVIA 30 mg CAPS. GASTROREZ. 30mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. PRF 30 0.658800 0.658800 0.000200
207 W62006001 N06AX21 DULOXETINUM ** DULOXETINA DR. REDDY'S 30 mg CAPS. GASTROREZ. 30mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-PE-ACLAR/AL X 28 CAPS. GASTROREZ. PRF 28 0.658800 0.658800 1.668700
208 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 0.657500 0.657500 0.000000
209 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 0.658800 0.658800 0.129057
210 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 0.658800 0.658800 0.512271
211 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 0.549000 0.549000 0.000000
212 W62054002 N06AX21 DULOXETINUM ** DULOXETINE ZENTIVA 30 mg CAPS. GASTROREZ. 30mg ZENTIVA, K.S. CUTIE CU BLIST. PVC/PVDC/AL X 28 CAPS. GASTROREZ.
REPUBLICA CEHA PRF 28 0.657500 0.657500 0.000000
213 W68407006 N06AX21 DULOXETINUM ** DULOXETINA TERAPIA 30 mg CAPS. GASTROREZ. 30mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 0.658800 0.658800 0.000200
214 W68407018 N06AX21 DULOXETINUM ** DULOXETINA TERAPIA 30 mg CAPS. GASTROREZ. 30mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. PRF 30 0.658800 0.658800 0.000200
215 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 1.317600 1.317600 1.201685
216 W61821005 N06AX21 DULOXETINUM ** DULSEVIA 60 mg CAPS. GASTROREZ. 60mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL[PEID-PE-DESICANT-PEID-AL-PE X 30 CAPS. GASTROREZ. PRF 30 1.317600 1.317600 0.000066
217 W62055001 N06AX21 DULOXETINUM ** DULOXETINE ZENTIVA 60 mg CAPS. GASTROREZ. 60mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PCTFE/AL X 28 CAPS. GASTROREZ. PRF 28 1.107142 1.107142 0.000000
218 W62302003 N06AX21 DULOXETINUM ** DULOXETINA STADA 60 mg CAPS. GASTROREZ. 60mg STADA M&D SRL ROMANIA CUTIE CU BLIST. PVC-PCTFE-PVC/AL X 28 CAPS. GASTROREZ. PRF 28 1.266785 1.266785 0.000000
219 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 1.317600 1.317600 0.442066
220 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 1.098000 1.098000 0.000000
221 W62055002 N06AX21 DULOXETINUM ** DULOXETINE ZENTIVA 60 mg CAPS. GASTROREZ. 60mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/PVDC/AL X 28 CAPS. GASTROREZ. PRF 28 1.107142 1.107142 0.000000
222 W68409006 N06AX21 DULOXETINUM ** DULOXETINA TERAPIA 60 mg CAPS. GASTROREZ. 60mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 CAPS. GASTROREZ. PRF 30 1.317600 1.317600 0.000066
223 W68409018 N06AX21 DULOXETINUM ** DULOXETINA TERAPIA 60 mg CAPS. GASTROREZ. 60mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. GASTROREZ. PRF 30 1.317600 1.317600 0.000066
224 W60935001 N06AX26 VORTIOXETINUM ** Ω BRINTELLIX 10mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA CUTIE X BLISTER TRANSPARENT PVC/PVDC/AL X 28 COMPRIMATE FILMATE PRF 28 4.696785 4.696785 0.000000
225 W60999001 N06AX26 VORTIOXETINUM ** Ω BRINTELLIX 20mg COMPR. FILM. 20mg H. LUNDBECK A/S DANEMARCA CUTIE X BLISTER TRANSPARENT PVC/PVDC/AL X 28 COMPRIMATE FILMATE P-RF 28 7.650714 7.650714 0.000000
226 W60998001 N06AX26 VORTIOXETINUM ** Ω BRINTELLIX 5mg COMPR. FILM. 5mg H. LUNDBECK A/S DANEMARCA CUTIE X BLISTER TRANSPARENT PVC/PVDC/AL X 28 COMPRIMATE FILMATE P-RF 28 2.475714 2.475714 0.000000
227 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 5.604000 5.604000 2.646000
228 W62698001 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACTAVIS 10 mg CAPS. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC-PVDC-PVC/AL X 7 CAPS. PR 7 5.604000 5.604000 3.013142
229 W63559001 N06BA09 ATOMOXETINUM ** BITINEX 10 mg CAPS. 10mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 7 CAPS. PRF 7 5.604000 5.604000 1.501714
230 W65181001 N06BA09 ATOMOXETINUM ** STRATTERA 10 mg CAPS. 10mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 7 CAPS. PRF 7 5.604000 5.604000 4.653142
231 W65385002 N06BA09 ATOMOXETINUM ** ATOFAB 10 mg CAPS. 10mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 10 CAPS. PRF 10 4.670000 4.670000 0.000000
232 W65742001 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACCORD 10 mg CAPS. 10mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PE/PCTFE-AL X 7 CAPS. PRF 7 5.604000 5.604000 2.711714
233 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 5.706000 5.706000 2.644000
234 W62699001 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACTAVIS 18 mg CAPS. 18mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC-PVDC-PVC/AL X 7 CAPS. PR 7 5.706000 5.706000 3.554000
235 W63560001 N06BA09 ATOMOXETINUM ** BITINEX 18 mg CAPS. 18mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 7 CAPS. PRF 7 5.706000 5.706000 1.755428
236 W65186001 N06BA09 ATOMOXETINUM ** STRATTERA 18 mg CAPS. 18mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 7 CAPS. PRF 7 5.706000 5.706000 4.789714
237 W65386002 N06BA09 ATOMOXETINUM ** ATOFAB 18 mg CAPS. 18mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 10 CAPS. PRF 10 4.755000 4.755000 0.000000

Pagina 19 din 37
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)
238 W65743001 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACCORD 18 mg CAPS. 18mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PE/PCTFE-AL X 7 CAPS. PRF 7 5.706000 5.706000 2.769714
239 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 5.403199 5.403199 2.521086
240 W62700002 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACTAVIS 25 mg CAPS. 25mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC-PVDC-PVC/AL X 28 CAPS. PR 28 5.403199 5.403199 2.186086
241 W63561003 N06BA09 ATOMOXETINUM ** BITINEX 25 mg CAPS. 25mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 28 CAPS. PRF 28 5.403199 5.403199 0.382872
242 W65185003 N06BA09 ATOMOXETINUM ** STRATTERA 25 mg CAPS. 25mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 28 CAPS. PRF 28 5.403199 5.403199 3.799301
243 W65387005 N06BA09 ATOMOXETINUM ** ATOFAB 25 mg CAPS. 25mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 30 CAPS. PRF 30 4.502666 4.502666 0.000000
244 W65744002 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACCORD 25 mg CAPS. 25mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PE/PCTFE-AL X 28 CAPS. PRF 28 5.403199 5.403199 3.080015
245 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 5.564799 5.564799 2.607701
246 W62701002 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACTAVIS 40 mg CAPS. 40mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC-PVDC-PVC/AL X 28 CAPS. PR 28 5.564799 5.564799 2.266272
247 W63562003 N06BA09 ATOMOXETINUM ** BITINEX 40 mg CAPS. 40mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 28 CAPS. PRF 28 5.564799 5.564799 0.479486
248 W65184003 N06BA09 ATOMOXETINUM ** STRATTERA 40 mg CAPS. 40mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 28 CAPS. PRF 28 5.564799 5.564799 3.637701
249 W65388005 N06BA09 ATOMOXETINUM ** ATOFAB 40 mg CAPS. 40mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 30 CAPS. PRF 30 4.637333 4.637333 0.000000
250 W65745002 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACCORD 40 mg CAPS. 40mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PE/PCTFE-AL X 28 CAPS. PRF 28 5.564799 5.564799 2.923058
251 W62702001 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACTAVIS 60 mg CAPS. 60mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC-PVDC-PVC/AL X 28 CAPS. PR 28 5.577199 5.577199 2.268158
252 W63563003 N06BA09 ATOMOXETINUM ** BITINEX 60 mg CAPS. 60mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 28 CAPS. PRF 28 5.577199 5.577199 0.480301
253 W65183003 N06BA09 ATOMOXETINUM ** STRATTERA 60 mg CAPS. 60mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 28 CAPS. PRF 28 5.577199 5.577199 3.625301
254 W65389005 N06BA09 ATOMOXETINUM ** ATOFAB 60 mg CAPS. 60mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 30 CAPS. PRF 30 4.647666 4.647666 0.000000
255 W65465005 N06BA09 ATOMOXETINUM ** ATOMOXETINA AUROBINDO 60 mg CAPS. 60mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 CAPS. PRF 28 5.272142 5.272142 0.000000
256 W65746002 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACCORD 60 mg CAPS. 60mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PE/PCTFE-AL X 28 CAPS. PRF 28 5.577199 5.577199 2.910658
257 W62703001 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACTAVIS 80 mg CAPS. 80mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC-PVDC-PVC/AL X 28 CAPS. PR 28 11.388856 11.388856 0.598644
258 W65180003 N06BA09 ATOMOXETINUM ** STRATTERA 80 mg CAPS. 80mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 28 CAPS. PRF 28 11.388856 11.388856 0.598644
259 W65747002 N06BA09 ATOMOXETINUM ** ATOMOXETINA ACCORD 80 mg CAPS. 80mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PE/PCTFE-AL X 28 CAPS. PRF 28 9.490714 9.490714 0.000000
260 W65182001 N06BA09 ATOMOXETINUM ** STRATTERA 4 mg/ml SOL. ORALA 4mg/ml ELI LILLY NEDERLAND BV OLANDA CUTIE CU 1 FLAC. DIN STICLA DE CULOARE BRUNA CU 100 ML SOL. ORALA+1 DISPOZITIV CARE CONTINE O SERINGA PT. ADMINISTRARE ORALA DE 10 ML GRADATA PT. FIECARE MILILITRU SI UN ADAPTOR PT. STICLA DIN PEJD PRF 1 241.700000 241.700000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea psihiatrie şi psihiatrie pediatrică/neuropsihiatrie infantilă.

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

1 W52398001 N06DA02 DONEPEZILUM ** YASNAL 10 mg COMPR. FILM. 10mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU, BLIST., DIN OPA-AL-PVC/AL CU 28 COMPR. FILM. P-RF 28 1.305714 1.305714 0.000000
2 W53425001 N06DA02 DONEPEZILUM ** DAVIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 1.479666 1.479666 0.000000
3 W53425002 N06DA02 DONEPEZILUM ** DAVIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 30 1.479666 1.479666 0.000000
4 W54141002 N06DA02 DONEPEZILUM ** DONECEPT 10 MG COMPR. FILM. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X BLIST. PVC/AL X 28 COMPR. FILM. P-RF 28 1.233214 1.233214 0.000000
5 W55613001 N06DA02 DONEPEZILUM ** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. P-RF 28 1.479856 1.479856 2.051215
6 W55613002 N06DA02 DONEPEZILUM ** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 50 COMPR. FILM. P-RF 50 1.479856 1.479856 1.868744
7 W55613003 N06DA02 DONEPEZILUM ** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. P-RF 56 1.479856 1.479856 1.868715
8 W55613004 N06DA02 DONEPEZILUM ** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 60 COMPR. FILM. P-RF 60 1.479856 1.479856 1.868810
9 W55613005 N06DA02 DONEPEZILUM ** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 98 COMPR. FILM. P-RF 98 1.479856 1.479856 1.868817
10 W55613006 N06DA02 DONEPEZILUM ** DOSPELIN 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 100 COMPR. FILM. P-RF 100 1.479856 1.479856 1.868744
11 W68085002 N06DA02 DONEPEZILUM ** DONECEPT 10 mg COMPR. FILM. 10mg TEVA B.V. OLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 1.233214 1.233214 0.000000
12 W52397001 N06DA02 DONEPEZILUM ** YASNAL 5 mg COMPR. FILM. 5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL CU 28 COMPR. FILM. P-RF 28 1.089428 1.089428 0.000214
13 W53424001 N06DA02 DONEPEZILUM ** DAVIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 1.089428 1.089428 0.000572
14 W53424002 N06DA02 DONEPEZILUM ** DAVIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 30 1.089428 1.089428 0.000572
15 W54140002 N06DA02 DONEPEZILUM ** DONECEPT 5 MG COMPR. FILM. 5mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X BLIST. PVC/AL X 28 COMPR. FILM. P-RF 28 0.907857 0.907857 0.000000
16 W55612001 N06DA02 DONEPEZILUM ** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. P-RF 28 1.089428 1.089428 0.984857
17 W55612002 N06DA02 DONEPEZILUM ** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 50 COMPR. FILM. P-RF 50 1.089428 1.089428 1.286572
18 W55612003 N06DA02 DONEPEZILUM ** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. P-RF 56 1.089428 1.089428 1.204500
19 W55612004 N06DA02 DONEPEZILUM ** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 60 COMPR. FILM. P-RF 60 1.089428 1.089428 1.163405
20 W55612005 N06DA02 DONEPEZILUM ** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 98 COMPR. FILM. P-RF 98 1.089428 1.089428 1.163633
21 W55612006 N06DA02 DONEPEZILUM ** DOSPELIN 5 mg COMPR. FILM. 5mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 100 COMPR. FILM. P-RF 100 1.089428 1.089428 1.163472
22 W68084002 N06DA02 DONEPEZILUM ** DONECEPT 5 mg COMPR. FILM. 5mg TEVA B.V. OLANDA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 0.907857 0.907857 0.000000
23 W56596002 N06DA02 DONEPEZILUM ** YASNAL 10 mg COMPR. ORODISPERSABILE 10 mg KRKA D.D. SLOVENIA CUTIE CU BLIST. OPA/AL/PVC SI FOLIE PET-AL TIP "PEEL-OPEN" A CATE 28 COMPR. ORODISP. PRF 28 1.479856 1.479856 0.000144
24 W43353002 N06DA02 DONEPEZILUM ** ARICEPT EVESS COMPR. ORODISPERSABILE 10mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. ORODISPERSABILE PRF 28 1.479856 1.479856 2.648001
25 W64847002 N06DA02 DONEPEZILUM ** ARICEPT EVESS COMPR. ORODISPERSABILE 10mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 14 COMPR. ORODISPERSABILE PRF 28 1.479856 1.479856 2.648001
26 W60990002 N06DA03 RIVASTIGMINUM ** RIDAXIN 1,5 mg CAPS. 1,5mg NEOLA PHARMA S.R.L. ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAPS. P-RF/R 56 0.927000 0.927000 0.374607
27 W54536002 N06DA03 RIVASTIGMINUM ** NIMVASTID 1.5mg CAPS. 1.5mg KRKA ,D.D., NOVO MESTO SLOVENIA CUTIE X BLIST. PVC/PVDC/AL X 28 CAPSULE P-RF/R 28 0.772500 0.772500 0.000000
28 W54537001 N06DA03 RIVASTIGMINUM ** NIMVASTID 3mg CAPS. 3mg KRKA ,D.D., NOVO MESTO SLOVENIA CUTIE X BLIST. PVC/PVDC/AL X 28 CAPSULE P-RF/R 28 1.240357 1.240357 0.000000
29 W60991002 N06DA03 RIVASTIGMINUM ** RIDAXIN 3 mg CAPS. 3mg NEOLA PHARMA S.R.L. ROMANIA CUTIE CU 4 BLIST. PVC/AL X 14 CAPS. P-RF/R 56 1.361785 1.361785 0.000000
30 W54541001 N06DA03 RIVASTIGMINUM ** NIMVASTID 4.5 mg COMPR. ORODISPERSABILE 4.5mg KRKA ,D.D., NOVO MESTO SLOVENIA CUTIE X BLIST.UNIDOZA OPA/AL/PVC/PET/AL X (28 X 1) COMPR. ORODISPESABILE P-RF/R 28 1.745714 1.745714 0.000000
31 W54542001 N06DA03 RIVASTIGMINUM ** NIMVASTID 6mg COMPR. ORODISPERSABILE 6mg KRKA ,D.D., NOVO MESTO SLOVENIA CUTIE X BLIST.UNIDOZA OPA/AL/PVC/PET/AL X (28 X 1) COMPR. ORODISPESABILE P-RF/R 28 2.328214 2.328214 0.000000

Pagina 20 din 37
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)
32 W64475008 N06DA03 RIVASTIGMINUM ** EXELON 13,3 mg/24h 13,3mg/24h
PLASTURE TRANSDERMIC NOVARTIS EUROPHARM LTD. IRLANDA CUTIE X 30 PLICURI DIN HÂRTIE/PET/PE/AL/PA X 1 PLASTURE TRANSDERMIC PR 30 6.352666 6.352666 0.000000
33 W60439002 N06DA03 RIVASTIGMINUM ** EVERTAS 4,6 mg/24 h PLASTURE TRANSDERMIC 4,6mg/24h ZENTIVA, K.S. REPUBLICA CEHA CUTIE X 30 PLICURI DIN MATERIAL MULTILAMINAT DIN HARTIE/TEREFTALAT DE POLIETILENA/ALUMINIU/PILIACRILONITRIL PREVAZUTE CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 1 PLASTURE TRANSDERMIC PRF 30 2.842333 2.842333 0.000000
34 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 3.410799 3.410799 0.147534
35 W60440002 N06DA03 RIVASTIGMINUM ** EVERTAS 9,5 mg/24 h PLASTURE TRANSDERMIC 9,5mg/24h ZENTIVA, K.S. REPUBLICA CEHA CUTIE X 30 PLICURI DIN MATERIAL MULTILAMINAT DIN HARTIE/TEREFTALAT DE POLIETILENA/ALUMINIU/PILIACRILONITRIL PREVAZUTE CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 1 PLASTURE TRANSDERMIC PRF 30 4.304666 4.304666 0.000000
36 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 3.727666 3.727666 0.000000
37 W55333001 N06DA03 RIVASTIGMINUM ** RIVASTIGMINA TEVA 2 mg/ml SOL. ORALA 2mg/ml TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 1 FLACON DIN STICLA BRUNA CU CAPACIT. 125ML X 120ML SOLUTIE ORALA, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII, CU O SERINGA DOZATOARE GRADATA DIN PP SI UN ADAPTOR DIN PE P-RF 1 336.984000 336.984000 122.236000
38 W62196002 N06DA03 RIVASTIGMINUM ** RIVASTIGMINA SANDOZ 2mg/ml SOL. ORALA 2mg/ml SANDOZ GMBH AUSTRIA CUTIE CU FLAC. DIN STICLA BRUNA A 120 ML SOL.ORALA + SERINGA DOZATOARE PR 1 280.820000 280.820000 0.000000
39 W57106013 N06DA04 GALANTAMINUM ** GALSYA 16 mg CAPS. ELIB. PREL. 16mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 CAPS. CU ELIB. PREL. PRF 30 3.308666 3.308666 0.000000
40 W57107013 N06DA04 GALANTAMINUM ** GALSYA 24 mg CAPS. ELIB. PREL. 24mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 CAPS. CU ELIB. PREL. PRF 30 3.732333 3.732333 0.000000
41 W57105013 N06DA04 GALANTAMINUM ** GALSYA 8 mg CAPS. ELIB. PREL. 8mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 30 CAPS. CU ELIB. PREL. PRF 30 2.098666 2.098666 0.000000
42 W41503001 N06DA04 GALANTAMINUM ** REMINYL 4 mg/ml SOL. ORALA 4mg/ml JANSSEN-PHARMACEUTICA NV BELGIA CUTIE X 1 FLACON X 100 ML + 1 PIPETA DOZATOARE P-RF 1 134.540000 134.540000 0.000000
43 W12136004 N06DX01 MEMANTINUM ** EBIXA 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA CUTIE X 56 COMPR. FILM. (BLIST. AL/PP) P-RF/R 56 0.586628 0.586628 1.602300
44 W59817001 N06DX01 MEMANTINUM ** NEMDATINE 10mg COMPR. FILM. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLISTERE DIN PVC/PVDC-AL X 28 COMPRIMATE FILMATE PR 28 0.586628 0.586628 0.143014
45 W60183005 N06DX01 MEMANTINUM ** MEMANTINA TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 56 COMPR. FILM. PR 56 0.531785 0.531785 0.000000
46 W60183015 N06DX01 MEMANTINUM ** MEMANTINA TERAPIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 56 COMPR. FILM. PR 56 0.531785 0.531785 0.000000
47 W60192007 N06DX01 MEMANTINUM ** MEMANTINA ATB 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. PR 56 0.586628 0.586628 0.027122
48 W60672010 N06DX01 MEMANTINUM ** MEMANTINA LANNACHER HEILMITTEL 10 mg COMPR. FILM. 10mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 70 COMPR. FILM. PR 70 0.488857 0.488857 0.000000
49 W61445005 N06DX01 MEMANTINUM ** MANTOMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. TRANSPARENT PVC-PE-PVDC/AL X 56 COMPR. FILM. PRF 56 0.586628 0.586628 0.709800
50 W61445014 N06DX01 MEMANTINUM ** MANTOMED 10 mg COMPR. FILM. 10mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PA-AL-PVC/AL X 56 COMPR. FILM. PRF 56 0.586628 0.586628 0.709800
51 W64525001 N06DX01 MEMANTINUM ** MARIXINO 10mg COMPR. FILM. 10mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE X BLISTER PVC/PVDC/AL X 56 COMPRIMATE FILMATE PR 56 0.531785 0.531785 0.000000
52 W59818001 N06DX01 MEMANTINUM ** NEMDATINE 20mg COMPR. FILM. 20mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLISTERE DIN PVC/PVDC-AL X 28 COMPRIMATE FILMATE PR 28 1.933885 1.933885 0.170757
53 W60184001 N06DX01 MEMANTINUM ** MEMANTINA TERAPIA 20 mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. PR 28 1.933571 1.933571 0.000000
54 W60184009 N06DX01 MEMANTINUM ** MEMANTINA TERAPIA 20 mg COMPR. FILM. 20mg TERAPIA SA ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 28 COMPR. FILM. PR 28 1.933571 1.933571 0.000000
55 W60193002 N06DX01 MEMANTINUM ** MEMANTINA ATB 20 mg COMPR. FILM. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PR 28 1.768571 1.768571 0.000000
56 W60671010 N06DX01 MEMANTINUM ** MEMANTINA LANNACHER HEILMITTEL 20 mg COMPR. FILM. 20mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 70 COMPR. FILM. PR 70 1.611571 1.611571 0.000000
57 W61446005 N06DX01 MEMANTINUM ** MANTOMED 20 mg COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. TRANSPARENT PVC-PE-PVDC/AL X 56 COMPR. FILM. PRF 56 1.933885 1.933885 0.295579
58 W61446014 N06DX01 MEMANTINUM ** MANTOMED 20 mg COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PA-AL-PVC/AL X 56 COMPR. FILM. PRF 56 1.933885 1.933885 0.295579
59 W56770002 N06DX01 MEMANTINUM ** EBIXA 5mg/doza PICATURI ORALE - SOL. 5mg/doza H LUNDBECK A/S DANEMARCA CUTIE X 1 FLACON DIN STICLA BRUNA CU POMPA DOZATOARE X 50 ML SOLUTIE P-RF/R 1 129.732000 129.732000 43.978000
60 W60646004 N06DX01 MEMANTINUM ** MEMANTINA TEVA 10 mg/ml SOL. ORALA 10 mg/ml TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA + SERINGA DOZATOARE A 50 ML SOL. ORALA PR 1 108.110000 108.110000 0.000000

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

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

1 W04224001 H02AB04 METHYLPREDNISOLONUM (5) MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 5 BLIST. A-PVC/PVC X 10 COMPR. P-RF 50 0.811200 0.811200 0.000000
2 W65156001 H02AB04 METHYLPREDNISOLONUM (5) MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 5 BLIST. AL-PVC/PVC X 10 COMPR. PRF 50 0.811200 0.811200 0.000000
3 W04222001 H02AB04 METHYLPREDNISOLONUM (5) MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL-PVC/PVC X 10 COMPR. P-RF 20 3.329000 3.329000 0.000000
4 W65157001 H02AB04 METHYLPREDNISOLONUM (5) MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL-PVC/PVC X 10 COMPR. PRF 20 3.329000 3.329000 0.000000
5 W68692001 L01AA01 CYCLOPHOSPHAMIDUM CICLOFOSFAMIDA DR. REDDY'S 1000 mg/2ml CONC. PT. SOL. INJ./PERF. 1000mg/2ml DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 FLAC. DIN STICLA TUBULARA, INCOLORA, CU CAPACITATE DE 2 ML, CU CONC. PT. SOL. PERF./INJ. PR 1 506.850000 506.850000 0.000000
6 W68693001 L01AA01 CYCLOPHOSPHAMIDUM CICLOFOSFAMIDA DR. REDDY'S 2000 mg/4ml CONC. PT. SOL. INJ./PERF. 2000mg/4ml DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 FLAC. DIN STICLA TUBULARA, INCOLORA, CU CAPACITATE DE 5 ML, CU CONC. PT. SOL. PERF./INJ. PR 1 724.850000 724.850000 0.000000
7 W68691001 L01AA01 CYCLOPHOSPHAMIDUM CICLOFOSFAMIDA DR. REDDY'S 500 mg/ml CONC. PT. SOL. INJ./PERF. 500mg/ml DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 FLAC. DIN STICLA TUBULARA, INCOLORA, CU CAPACITATE DE 2 ML, CU CONC. PT. SOL. PERF./INJ. PR 1 268.580000 268.580000 0.000000
8 W12490001 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 50 mg DRAJ. 50mg BAXTER ONCOLOGY GMBH GERMANIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 DRAJ. P-RF 50 1.240400 1.240400 0.000000
9 W52215001 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 200 mg PULB. PT. SOL. INJ. / PERF. 200mg ACTAVIS S.R.L. ROMANIA CUTIE X 1 FLAC. PULB. PT. SOL. PERF./INJ S 1 59.270000 59.270000 0.000000
10 W64372001 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 200 mg PULB. PT. SOL. PERF./INJ. 200mg TEVA B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA INCOLORA PULB. PT. SOL. PERF./INJ PR 1 59.270000 59.270000 0.000000
11 W64422001 L01XC02 RITUXIMABUM **1 BLITZIMA 100 mg CONC. PT. SOL. PERF. 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 FLAC. DIN STICLA X 10 ML (100 MG RITUXIMAB IN 10 ML-10MG/ML) PR 2 647.007999 647.007999 22.507001
12 W64512001 L01XC02 RITUXIMABUM **1 RIXATHON 100 mg CONC. PT. SOL. PERF. 100mg SANDOZ GMBH AUSTRIA CUTIE CU 2 FLAC. DIN STICLA DE 10 ML X 100 MG RITUXIMAB PR 2 550.985000 550.985000 0.000000
13 W64512002 L01XC02 RITUXIMABUM **1 RIXATHON 100 mg CONC. PT. SOL. PERF. 100mg SANDOZ GMBH AUSTRIA CUTIE CU 3 FLAC. DIN STICLA DE 10 ML X 100 MG RITUXIMAB PR 3 539.173333 539.173333 0.000000
14 W64385001 L01XC02 RITUXIMABUM **1 MABTHERA 100 mg CONC. PT. SOL. PERF. 10mg/ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 2 FLACOANE X 10 ML CARE CONTIN 100 MG RITUXIMABUM PR 2 647.007999 647.007999 170.307001
15 W64421001 L01XC02 RITUXIMABUM **1 BLITZIMA 500 mg CONC. PT. SOL. PERF. 500mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 1 FLAC. DIN STICLA X 50 ML (500 MG RITUXIMAB IN 50 ML-10MG/ML) PR 1 3,142.002000 3,142.002000 158.208000
16 W64386001 L01XC02 RITUXIMABUM **1 MABTHERA 500 mg CONC. PT. SOL. PERF. 500mg ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 FLACON X 50 ML (500MG RITUXIMAB IN 50ML- 10MG/ML) PR 1 3,142.002000 3,142.002000 838.288000
17 W64513001 L01XC02 RITUXIMABUM **1 RIXATHON 500 mg CONC. PT. SOL. PERF. 500mg SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA DE 50 ML X 500 MG RITUXIMAB PR 1 2,653.760000 2,653.760000 0.000000
18 W64513002 L01XC02 RITUXIMABUM **1 RIXATHON 500 mg CONC. PT. SOL. PERF. 500mg SANDOZ GMBH AUSTRIA CUTIE CU 2 FLAC. DIN STICLA DE 50 ML X 500 MG RITUXIMAB PR 2 2,618.335000 2,618.335000 0.000000
19 W57242001 L04AA26 BELIMUMABUM **1 BENLYSTA PULB. PT. CONC. PT. SOL. PERF. 120 mg GLAXO GROUP LIMITED MAREA BRITANIE CUTIE CU 1 FL. DIN STICLA A 5ML X 120MG S 1 747.340000 747.340000 0.000000
20 W65195001 L04AA26 BELIMUMABUM **1 BENLYSTA PULB. PT. CONC. PT. SOL. PERF. 120 mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FL. DIN STICLA A 5ML X 120MG PR 1 747.340000 747.340000 0.000000
21 W57243001 L04AA26 BELIMUMABUM **1 BENLYSTA PULB. PT.CONC. PT.SOL. PERF. 400mg GLAXO GROUP LIMITED MAREA BRITANIE CUTIE CU 1 FL. DIN STICLA A 20ML X 400MG S 1 2,336.790000 2,336.790000 0.000000
22 W65197001 L04AA26 BELIMUMABUM **1 BENLYSTA PULB. PT.CONC. PT.SOL. PERF. 400mg GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 FL. DIN STICLA A 20ML X 400MG PR 1 2,336.790000 2,336.790000 0.000000
23 W64404001 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 162mg SOL. INJ. IN SERINGA PREUMPLUTA 162mg ROCHE REGISTRATION GMBH GERMANIA CUTIE CU 4 SERINGI PREUMPLUTE SISTEM DE PROTECTIE PENTRU AC A CATE 0.9ML SOL. PR 4 809.025000 809.025000 0.000000
24 W60846001 L04AX01 AZATHIOPRINUM IMURAN 50 mg COMPR. FILM. 50mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. P-RF 100 0.654500 0.654500 0.000000
25 W54357001 P01BA02 HYDROXYCHLOROQUINUM PLAQUENIL® COMPR. FILM. 200mg SANOFI - AVENTIS ROMANIA S.R.L. ROMANIA CUTIE X 6 BLIST. X 10 COMPR. FILM. P-6L 60 0.648166 0.648166 0.000000

Pagina 21 din 37
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 W62084002 P01BA02 HYDROXYCHLOROQUINUM PLAQUENIL 200 mg COMPR. FILM. 200mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 4 BLISTERE DIN PVC/AL X 15 COMPR. FILM. P-6L 60 0.648166 0.648166 0.000000

Tratamentul se iniţiază şi se monitorizează de către medicul în specialitatea reumatologie, nefrologie, boli infecţioase, pediatrie sau medicină internă, iar pentru medicamentele corespunzătoare DCI RITUXIMABUM şi de către medicul în specialitatea pneumologie.

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

1 W07440001 A07EC01 SULFASALAZINUM SULFASALAZINA EN 500 mg COMPR. GASTROREZ. 500mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P-6L 50 0.722000 0.722000 0.000000
2 W59162002 A07EC01 SULFASALAZINUM SALAZIDIN GR 500 mg COMPR. GASTROREZ. 500mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P6L 50 0.722000 0.722000 0.000000
3 W57960002 H02AB01 BETAMETHASONUM DIPROPHOS SUSP. INJ. 7mg/ml MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE CU 1 FIOLE DIN STICLA TIP I X 1 ML SUSP. INJ. PRF 1 22.680000 22.680000 0.000000
4 W68208002 H02AB01 BETAMETHASONUM DIPROPHOS SUSP. INJ. 7mg/ml ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 FIOLE DIN STICLA TIP I X 1 ML SUSP. INJ. PRF 1 22.680000 22.680000 0.000000
5 W04224001 H02AB04 METHYLPREDNISOLONUM (5) MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 5 BLIST. A-PVC/PVC X 10 COMPR. P-RF 50 0.811200 0.811200 0.000000
6 W65156001 H02AB04 METHYLPREDNISOLONUM (5) MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 5 BLIST. AL-PVC/PVC X 10 COMPR. PRF 50 0.811200 0.811200 0.000000
7 W04222001 H02AB04 METHYLPREDNISOLONUM (5) MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL-PVC/PVC X 10 COMPR. P-RF 20 3.329000 3.329000 0.000000
8 W65157001 H02AB04 METHYLPREDNISOLONUM (5) MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL-PVC/PVC X 10 COMPR. PRF 20 3.329000 3.329000 0.000000
9 W65904001 L01BA01 METHOTREXATUM JYLAMVO 2 mg/ml SOL. ORALA 2mg/ml THERAKIND (EUROPE) LIMITED IRLANDA CUTIE CU 1 FLAC. DIN STICLA, CU ADAPTOR DIN PEJD PENTRU FLACON SI O SERINGA DOZATOARE DIN PP X 60 ML SOL. ORALA PR 1 870.530000 870.530000 0.000000
10 W55460001 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE WINTHROP 10mg COMPR. FILM. 10mg SANOFI- AVENTIS DEUTSCHLAND GMBH GERMANIA CUTIE X 1 FLAC. PEID X 30 COMPR. FILM. PR 30 2.178000 2.178000 0.000000
11 W62663003 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ARENA 10 mg COMPR. FILM. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. PEID, CU CAPACITATEA DE 30 ML X 30 COMPR. FILM. PR 30 2.198000 2.198000 0.000000
12 W62663004 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ARENA 10 mg COMPR. FILM. 10mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. PEID, CU CAPACITATEA DE 40 ML X 100 COMPR. FILM. PR 100 1.914000 1.914000 0.000000
13 W65126001 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ZENTIVA COMPR. FILM. 10mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 FLAC. PEID X 30 COMPR. FILM. PR 30 2.178000 2.178000 0.000000
14 W56602005 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDA SANDOZ 20 mg COMPR. FILM. 20 mg SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLACON PEID CU CAPAC PP DESICANT X 30 COMPR. FILM. PR 30 2.833333 2.833333 0.000000
15 W55461001 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE WINTHROP 20mg COMPR. FILM. 20mg SANOFI- AVENTIS DEUTSCHLAND GMBH GERMANIA CUTIE X 1 FLAC. PEID X 30 COMPR. FILM. PR 30 3.399999 3.399999 0.466001
16 W60267002 L04AA13 LEFLUNOMIDUM ** LEFLON 20 mg COMPR. FILM. 20mg NEOLA PHARMA SRL ROMANIA CUTIE CU BLIST. PA-AL-PVC/AL X 30 COMPR. FILM. PR 30 3.399999 3.399999 0.636334
17 W62664003 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ARENA 20 mg COMPR. FILM. 20mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. PEID, CU CAPACITATEA DE 30 ML X 30 COMPR. FILM. PR 30 3.399999 3.399999 0.636334
18 W62664004 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ARENA 20 mg COMPR. FILM. 20mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. PEID, CU CAPACITATEA DE 40 ML X 100 COMPR. FILM. PR 100 3.399999 3.399999 0.399001
19 W65128001 L04AA13 LEFLUNOMIDUM ** LEFLUNOMIDE ZENTIVA COMPR. FILM. 20mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 1 FLAC. PEID X 30 COMPR. FILM. PR 30 3.399999 3.399999 0.466001
20 W51399001 L04AD01 CICLOSPORINUM SANDIMMUN NEORAL 25 mg CAPS. MOI 25mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 BLIST. X 5 CAPS. MOI PR 50 1.789800 1.789800 0.000000
21 W51398001 L04AD01 CICLOSPORINUM SANDIMMUN NEORAL 50 mg CAPS. MOI 50mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 BLIST. X 5 CAPS. MOI PR 50 3.281200 3.281200 0.000000
22 W60846001 L04AX01 AZATHIOPRINUM IMURAN 50 mg COMPR. FILM. 50mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. P-RF 100 0.654500 0.654500 0.000000
23 W68112002 L04AX03 METHOTREXATUM METHOTREXAAT PCH 2,5 mg COMPR. 2,5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 3 BLIST. X 10 COMPR. PR 30 1.098000 1.098000 0.000000
24 W68338004 L04AX03 METHOTREXATUM METOTREXAT SANDOZ 2,5 mg (vezi L01BA01) COMPR. 2,5mg SANDOZ S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN PP X 50 COMPR. PR 50 0.993600 0.993600 0.000000
25 W68338006 L04AX03 METHOTREXATUM METOTREXAT SANDOZ 2,5 mg (vezi L01BA01) COMPR. 2,5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 50 COMPR. PR 50 0.993600 0.993600 0.000000
26 W62233002 L04AX03 METHOTREXATUM NAMAXIR 10 mg SOL INJ. IN SERINGA PREUMPLUTA 10mg ISLANDA
ACTAVIS GROUP PTC EHF. CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,40 ML SOL. INJ. PR 4 49.710000 49.710000 0.000000
27 W64737002 L04AX03 METHOTREXATUM NORDIMET 10 mg SOL INJ. IN SERINGA PREUMPLUTA 10mg NORDIC GROUP BV OLANDA 4 (4X1) SERINGI PREUMPLUTE+8 (4X2) TAMPOANE CU ALCOOL (AMBALAJ MULTIPLU) PR 4 59.652000 59.652000 8.630500
28 W68057002 L04AX03 METHOTREXATUM NAMAXIR 10 mg SOL INJ. IN SERINGA PREUMPLUTA 10mg TEVA B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,40 ML SOL. INJ. PR 4 49.710000 49.710000 0.000000
29 W63589004 L04AX03 METHOTREXATUM METORTHRIT 10 mg/ml SOL INJ. IN SERINGA PREUMPLUTA 10mg/ml ROMPHARM COMPANY S.R.L. ROMANIA PR
CUTIE CU 1 BLIST. DIN PVC/AL CU O SERINGA PREUMPLUTA DIN STICLA INCOLORA, CU CAPACITATEA DE 1 ML, CARE CONTINE 1 ML SOL. INJ. SI UN AC STERIL PENTRU INJECTIE, PENTRU ADMINISTRARE SUBCUTANATA 1 55.370000 55.370000 0.000000
30 W63589001 L04AX03 METHOTREXATUM METORTHRIT 10 mg/ml SOL INJ. IN SERINGA PREUMPLUTA 10mg/ml ROMPHARM COMPANY S.R.L. ROMANIA PR
CUTIE CU 1 BLIST. DIN PVC/AL CU O SERINGA PREUMPLUTA DIN STICLA INCOLORA, CU CAPACITATEA DE 1 ML, CARE CONTINE 0,75 ML SOL. INJ. SI UN AC STERIL PENTRU INJECTIE, PENTRU ADMINISTRARE SUBCUTANATA 1 51.264000 51.264000 19.626000
31 W63589010 L04AX03 METHOTREXATUM METORTHRIT 10 mg/ml SOL INJ. IN SERINGA PREUMPLUTA 10mg/ml ROMPHARM COMPANY S.R.L. ROMANIA PR
CUTIE CU 1 BLIST. DIN PVC/AL CU O SERINGA PREUMPLUTA DIN STICLA INCOLORA, CU CAPACITATEA DE 2,25 ML, CARE CONTINE 2 ML SOL. INJ. SI UN AC STERIL PENTRU INJECTIE, PENTRU ADMINISTRARE SUBCUTANATA 1 91.431000 91.431000 46.809000
32 W63589007 L04AX03 METHOTREXATUM METORTHRIT 10 mg/ml SOL INJ. IN SERINGA PREUMPLUTA 10mg/ml ROMPHARM COMPANY S.R.L. ROMANIA PR
CUTIE CU 1 BLIST. DIN PVC/AL CU O SERINGA PREUMPLUTA DIN STICLA INCOLORA, CU CAPACITATEA DE 2,25 ML, CARE CONTINE 1,5 ML SOL. INJ. SI UN AC STERIL PENTRU INJECTIE, PENTRU ADMINISTRARE SUBCUTANATA 1 74.994000 74.994000 13.256000
33 W66270001 L04AX03 METHOTREXATUM NORDIMET 12,5 mg SOL INJ. IN SERINGA PREUMPLUTA 12,5mg NORDIC GROUP BV OLANDA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA X 0,5 ML SOL. INJ. + 2 TAMPOANE DE ALCOOL PR 1 90.870000 90.870000 0.000000
34 W66270002 L04AX03 METHOTREXATUM NORDIMET 12,5 mg SOL INJ. IN SERINGA PREUMPLUTA 12,5mg NORDIC GROUP BV OLANDA CUTIE CU (4X1) SERINGI PREUMPLUTE + 8 (4X2) TAMPOANE (AMBALAJ MULTIPLU) PR 4 80.160000 80.160000 0.000000
35 W62235002 L04AX03 METHOTREXATUM NAMAXIR 15 mg SOL INJ. IN SERINGA PREUMPLUTA 15mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,38 ML SOL. INJ. PR 4 62.495000 62.495000 0.000000
36 W64738001 L04AX03 METHOTREXATUM NORDIMET 15 mg SOL INJ. IN SERINGA PREUMPLUTA 15mg NORDIC GROUP BV OLANDA 1 SERINGA PREUMPLUTA DIN STICLA + 2 TAMPOANE CU ALCOOL PR 1 74.994000 74.994000 21.796000
37 W64738002 L04AX03 METHOTREXATUM NORDIMET 15 mg SOL INJ. IN SERINGA PREUMPLUTA 15mg NORDIC GROUP BV OLANDA 4 (4X1) SERINGI PREUMPLUTE+8 (4X2) TAMPOANE CU ALCOOL (AMBALAJ MULTIPLU) PR 4 74.994000 74.994000 16.498500
38 W68058002 L04AX03 METHOTREXATUM NAMAXIR 15 mg SOL INJ. IN SERINGA PREUMPLUTA 15mg TEVA B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,38 ML SOL. INJ. PR 4 62.495000 62.495000 0.000000
39 W64739001 L04AX03 METHOTREXATUM NORDIMET 17,5 mg SOL INJ. IN SERINGA PREUMPLUTA 17,5mg NORDIC GROUP BV OLANDA 1 SERINGA PREUMPLUTA DIN STICLA + 2 TAMPOANE CU ALCOOL PR 1 109.610000 109.610000 0.000000
40 W62237002 L04AX03 METHOTREXATUM NAMAXIR 20 mg SOL INJ. IN SERINGA PREUMPLUTA 20mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,50 ML SOL. INJ. PR 4 76.192500 76.192500 0.000000
41 W64740001 L04AX03 METHOTREXATUM NORDIMET 20 mg SOL INJ. IN SERINGA PREUMPLUTA 20mg NORDIC GROUP BV OLANDA 1 SERINGA PREUMPLUTA DIN STICLA + 2 TAMPOANE CU ALCOOL PR 1 91.431000 91.431000 27.599000
42 W64740002 L04AX03 METHOTREXATUM NORDIMET 20 mg SOL INJ. IN SERINGA PREUMPLUTA 20mg NORDIC GROUP BV OLANDA 4 (4X1) SERINGI PREUMPLUTE+8 (4X2) TAMPOANE CU ALCOOL (AMBALAJ MULTIPLU) PR 4 91.431000 91.431000 17.871500
43 W68059002 L04AX03 METHOTREXATUM NAMAXIR 20 mg SOL INJ. IN SERINGA PREUMPLUTA 20mg TEVA B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,50 ML SOL. INJ. PR 4 76.192500 76.192500 0.000000
44 W64741001 L04AX03 METHOTREXATUM NORDIMET 22,5 mg SOL INJ. IN SERINGA PREUMPLUTA 22,5mg NORDIC GROUP BV OLANDA 1 SERINGA PREUMPLUTA DIN STICLA + 2 TAMPOANE CU ALCOOL PR 1 126.450000 126.450000 0.000000
45 W62239002 L04AX03 METHOTREXATUM NAMAXIR 25 mg SOL INJ. IN SERINGA PREUMPLUTA 25mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,63 ML SOL. INJ. PR 4 90.392500 90.392500 0.000000
46 W64742001 L04AX03 METHOTREXATUM NORDIMET 25 mg SOL INJ. IN SERINGA PREUMPLUTA 25mg NORDIC GROUP BV OLANDA 1 SERINGA PREUMPLUTA DIN STICLA + 2 TAMPOANE CU ALCOOL PR 1 108.471000 108.471000 22.039000
47 W68060002 L04AX03 METHOTREXATUM NAMAXIR 25 mg SOL INJ. IN SERINGA PREUMPLUTA 25mg TEVA B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,63 ML SOL. INJ. PR 4 90.392500 90.392500 0.000000
48 W62232002 L04AX03 METHOTREXATUM NAMAXIR 7,5 mg SOL INJ. IN SERINGA PREUMPLUTA 7,5mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,30 ML SOL. INJ. PR 4 42.720000 42.720000 0.000000
49 W68056002 L04AX03 METHOTREXATUM NAMAXIR 7,5 mg SOL INJ. IN SERINGA PREUMPLUTA 7,5mg TEVA B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA INCOLORA, PREVAZUTE CU AC PT. INJECTIE SI TAMPON CU ALCOOL A 0,30 ML SOL. INJ. PR 4 42.720000 42.720000 0.000000
50 W63805002 L04AX03 METHOTREXATUM NORDIMET 10 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 10mg NORDIC GROUP BV OLANDA AMBALAJ MULTIPLU: 4(4X1)STILOURI INJECTOR (PEN) PREUMPLUTE (0,4 ML) CU AC ATASAT PR 4 59.652000 59.652000 8.630500
51 W63806002 L04AX03 METHOTREXATUM NORDIMET 12,5 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 12,5mg NORDIC GROUP BV OLANDA AMBALAJ MULTIPLU: 4(4X1)STILOURI INJECTOR (PEN) PREUMPLUTE (0,5 ML) CU AC ATASAT PR 4 80.760000 80.760000 0.000000
52 W63807002 L04AX03 METHOTREXATUM NORDIMET 15 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 15mg NORDIC GROUP BV OLANDA AMBALAJ MULTIPLU: 4(4X1)STILOURI INJECTOR (PEN) PREUMPLUTE (0,6 ML) CU AC ATASAT PR 4 74.994000 74.994000 14.773500
53 W63808002 L04AX03 METHOTREXATUM NORDIMET 17,5 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 17,5mg NORDIC GROUP BV OLANDA AMBALAJ MULTIPLU: 4(4X1)STILOURI INJECTOR (PEN) PREUMPLUTE (0,7 ML) CU AC ATASAT PR 4 100.237500 100.237500 0.000000

Pagina 22 din 37
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)
54 W63809002 L04AX03 METHOTREXATUM NORDIMET 20 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 20mg NORDIC GROUP BV OLANDA AMBALAJ MULTIPLU: 4(4X1)STILOURI INJECTOR (PEN) PREUMPLUTE (0,8 ML) CU AC ATASAT PR 4 91.431000 91.431000 16.276500
55 W63810002 L04AX03 METHOTREXATUM NORDIMET 22,5 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 22,5mg NORDIC GROUP BV OLANDA AMBALAJ MULTIPLU: 4(4X1)STILOURI INJECTOR (PEN) PREUMPLUTE (0,9 ML) CU AC ATASAT PR 4 114.597500 114.597500 0.000000
56 W58316004 L04AX03 METHOTREXATUM METOTREXAT EBEWE 10 mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE PR 1 59.652000 59.652000 12.348000
57 W58316001 L04AX03 METHOTREXATUM METOTREXAT EBEWE 10 mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 0,75 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJ PR 1 51.264000 51.264000 4.596000
58 W58316010 L04AX03 METHOTREXATUM METOTREXAT EBEWE 10 mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 2,0 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE PR 1 91.431000 91.431000 43.439000
59 W58316007 L04AX03 METHOTREXATUM METOTREXAT EBEWE 10 mg/ml SOL. INJ. IN SERINGA PREUMPLUTA 10mg/ml EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA X 1,5 ML SOL INJ. + AC DE UNICA FOLOSINTA PT. INJE PR 1 74.994000 74.994000 28.636000
60 W63730001 M01AB05 DICLOFENACUM DICLOREUM 150 mg CAPS. ELIB. PREL. 150mg ALFASIGMA S.P.A. ITALIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. ELIB. PREL. P6L 20 2.962000 2.962000 0.000000
61 W53220001 M01AB05 DICLOFENACUM DICLOFENAC DUO PHARMASWISS 75 mg CAPS. ELIB. PREL. 75mg PHARMASWISS CESKA REPUBLIKA S.R.O. CEHIA CUTIE X 3 BLIST. PVC/PVDC/AL X 10 CAPS. ELIB. PREL. P-6L 30 0.631666 0.631666 0.000000
62 W67013001 M01AB05 DICLOFENACUM DICLOFENAC DUO PHARMASWISS 75 mg CAPS. ELIB. PREL. 75mg BAUSCH HEALTH IRELAND LIMITED IRLANDA CUTIE CU 3 BLIST. PVC/PVDC/AL X 10 CAPS. ELIB. PREL. P6L 30 0.631666 0.631666 0.000000
63 W51307002 M01AB05 DICLOFENACUM REFEN RETARD 100 mg COMPR. CU ELIB. PREL. 100mg STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. CU ELIB. PREL. P-6L 20 0.578000 0.578000 0.000000
64 W02472002 M01AB05 DICLOFENACUM DICLOTARD 100 mg COMPR. CU ELIB. PREL. 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P-6L 20 0.693600 0.693600 0.230900
65 W51307003 M01AB05 DICLOFENACUM REFEN RETARD 100 mg COMPR. ELIB. PREL. 100mg STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P6L 20 0.578000 0.578000 0.000000
66 W54364001 M01AB05 DICLOFENACUM DICLOFENAC ARENA 25 mg COMPR. GASTROREZ. 25mg ARENA GROUP SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P-6L 30 0.435666 0.435666 0.000000
67 W02459003 M01AB05 DICLOFENACUM DICLOFENAC 50 mg COMPR. GASTROREZ. 50mg TERAPIA SA ROMANIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. GASTROREZ. P-6L 20 0.241599 0.241599 0.374901
68 W54363004 M01AB05 DICLOFENACUM DICLOFENAC ARENA 50 mg COMPR. GASTROREZ. 50mg ARENA GROUP SA ROMANIA CUTIE CU 1 BLIST. PVC/AL X 30 COMPR. GASTROREZ. P-6L 30 0.201333 0.201333 0.000000
69 W60292001 M01AB05 DICLOFENACUM DICLOFENAC HELCOR 50 mg COMPR. GASTROREZ. 50mg A.C. HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. GASTROREZ. P-6L 20 0.241599 0.241599 0.373401
70 W55024001 M01AB05 DICLOFENACUM REFEN 75 mg SOL. INJ./PERF. 25mg/ml STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 3 ML SOL. INJ./PERF. P-RF 5 3.458000 3.458000 0.000000
71 W14114001 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDANTE X 3 SUPOZ. P-6L 6 0.868800 0.868800 0.274533
72 W12288001 M01AB05 DICLOFENACUM DICLOFENAC SINTOFARM 100 mg SUPOZ. 100mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6L 10 0.868800 0.868800 3.120200
73 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 0.724000 0.724000 0.000000
74 W14114003 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ. P6L 6 0.868800 0.868800 0.274533
75 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 2.568333 2.568333 0.000000
76 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 3.081999 3.081999 0.000001
77 W54357001 P01BA02 HYDROXYCHLOROQUINUM PLAQUENIL® COMPR. FILM. 200mg SANOFI - AVENTIS ROMANIA S.R.L. ROMANIA CUTIE X 6 BLIST. X 10 COMPR. FILM. P-6L 60 0.648166 0.648166 0.000000
78 W62084002 P01BA02 HYDROXYCHLOROQUINUM PLAQUENIL 200 mg COMPR. FILM. 200mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 4 BLISTERE DIN PVC/AL X 15 COMPR. FILM. P-6L 60 0.648166 0.648166 0.000000

Tratamentul se iniţiază de către medicul din specialitatea reumatologie, nefrologie, medicină internă, pediatrie, reabilitare medicală şi dermatovenerologie.

17. SPONDILITA ANKILOZANTA - G 19

1 W07440001 A07EC01 SULFASALAZINUM SULFASALAZINA EN 500 mg COMPR. GASTROREZ. 500mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P-6L 50 0.722000 0.722000 0.000000
2 W59162002 A07EC01 SULFASALAZINUM SALAZIDIN GR 500 mg COMPR. GASTROREZ. 500mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 5 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P6L 50 0.722000 0.722000 0.000000
3 W57960002 H02AB01 BETAMETHASONUM DIPROPHOS SUSP. INJ. 7mg/ml MERCK SHARP & DOHME ROMANIA S.R.L. ROMANIA CUTIE CU 1 FIOLE DIN STICLA TIP I X 1 ML SUSP. INJ. PRF 1 22.680000 22.680000 0.000000
4 W68208002 H02AB01 BETAMETHASONUM DIPROPHOS SUSP. INJ. 7mg/ml ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 FIOLE DIN STICLA TIP I X 1 ML SUSP. INJ. PRF 1 22.680000 22.680000 0.000000
5 W63730001 M01AB05 DICLOFENACUM DICLOREUM 150 mg CAPS. ELIB. PREL. 150mg ALFASIGMA S.P.A. ITALIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. ELIB. PREL. P6L 20 2.962000 2.962000 0.000000
6 W53220001 M01AB05 DICLOFENACUM DICLOFENAC DUO PHARMASWISS 75 mg CAPS. ELIB. PREL. 75mg PHARMASWISS CESKA REPUBLIKA S.R.O. CEHIA CUTIE X 3 BLIST. PVC/PVDC/AL X 10 CAPS. ELIB. PREL. P-6L 30 0.631666 0.631666 0.000000
7 W67013001 M01AB05 DICLOFENACUM DICLOFENAC DUO PHARMASWISS 75 mg CAPS. ELIB. PREL. 75mg BAUSCH HEALTH IRELAND LIMITED IRLANDA CUTIE CU 3 BLIST. PVC/PVDC/AL X 10 CAPS. ELIB. PREL. P6L 30 0.631666 0.631666 0.000000
8 W51307002 M01AB05 DICLOFENACUM REFEN RETARD 100 mg COMPR. CU ELIB. PREL. 100mg STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. CU ELIB. PREL. P-6L 20 0.578000 0.578000 0.000000
9 W02472002 M01AB05 DICLOFENACUM DICLOTARD 100 mg COMPR. CU ELIB. PREL. 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P-6L 20 0.693600 0.693600 0.230900
10 W51307003 M01AB05 DICLOFENACUM REFEN RETARD 100 mg COMPR. ELIB. PREL. 100mg STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P6L 20 0.578000 0.578000 0.000000
11 W54364001 M01AB05 DICLOFENACUM DICLOFENAC ARENA 25 mg COMPR. GASTROREZ. 25mg ARENA GROUP SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. GASTROREZ. P-6L 30 0.435666 0.435666 0.000000
12 W02459003 M01AB05 DICLOFENACUM DICLOFENAC 50 mg COMPR. GASTROREZ. 50mg TERAPIA SA ROMANIA CUTIE CU 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. GASTROREZ. P-6L 20 0.241599 0.241599 0.374901
13 W54363004 M01AB05 DICLOFENACUM DICLOFENAC ARENA 50 mg COMPR. GASTROREZ. 50mg ARENA GROUP SA ROMANIA CUTIE CU 1 BLIST. PVC/AL X 30 COMPR. GASTROREZ. P-6L 30 0.201333 0.201333 0.000000
14 W60292001 M01AB05 DICLOFENACUM DICLOFENAC HELCOR 50 mg COMPR. GASTROREZ. 50mg ROMANIA
A.C. HELCOR PHARMA S.R.L. CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. GASTROREZ. P-6L 20 0.241599 0.241599 0.373401
15 W55024001 M01AB05 DICLOFENACUM REFEN 75 mg SOL. INJ./PERF. 25mg/ml STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 3 ML SOL. INJ./PERF. P-RF 5 3.458000 3.458000 0.000000
16 W14114001 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDANTE X 3 SUPOZ. P-6L 6 0.868800 0.868800 0.274533
17 W12288001 M01AB05 DICLOFENACUM DICLOFENAC SINTOFARM 100 mg SUPOZ. 100mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII PVC/PE X 5 SUPOZ. P-6L 10 0.868800 0.868800 3.120200
18 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 0.724000 0.724000 0.000000
19 W14114003 M01AB05 DICLOFENACUM CLAFEN 100 mg SUPOZ. 100mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA PVC/PE X 6 SUPOZ. P6L 6 0.868800 0.868800 0.274533
20 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 2.568333 2.568333 0.000000
21 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 3.081999 3.081999 0.000001

Tratamentul se iniţiază de către medicul din specialitatea reumatologie sau reabilitare medicală.

18. BOLI ENDOCRINE ŞI METABOLICE - G 22

Pagina 23 din 37
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 W66278001 A16AX03 NATRII PHENYLBUTYRATE ** AMMONAPS 500mg COMPR. 500mg IMMEDICA PHARMA AB SUEDIA CUTIE X 1 FLAC DIN PEID X 250 COMPR. P-RF/R 250 13.319120 13.319120 0.000000
2 W66621001 A16AX09 GLYCEROLI PHENYLBUTYRAS ** Ω RAVICTI 1,1 g/ml LICHID ORAL 1,1g/ml IMMEDICA PHARMA AB SUEDIA 1 FLAC. A 25 ML LICHID ORAL SI 1 ADAPTOR PENTRU CAPACUL FARA FILET AL FLACONULUI CARE POATE FI REÎNCHIS, ÎN FIECARE CUTIE
PR 1 881.550000 881.550000 0.000000
3 W66769001 A16AX16 GIVOSIRANUM **1 Ω GIVLAARI 189 mg/ml SOL INJ. 189mg/ml ALNYLAM NETHERLANDS B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA X 1 ML SOL. INJ. PR 1 180,696.580000 180,696.580000 0.000000
4 W67432001 A16AX18 LUMASIRANUM **1 Ω OXLUMO 94,5 mg/0,5 ml SOL INJ. 94,5mg/0,5ml ALNYLAM NETHERLANDS B.V. OLANDA CUTIE CU UN FLACON DIN STICLA X 0,5ML SOLUTIE INJECTABILA PR 1 361,116.630000 361,116.630000 0.000000
5 W62419001 C10AX13 EVOLOCUMABUM ** Ω REPATHA 140 mg 140mg
SOL INJ. IN PEN PREUMPLUT AMGEN EUROPE B.V. OLANDA CUTIE CU 2 PENURI SURECLICK PREUMPLUTE PRF 2 954.455000 954.455000 0.000000
6 W62403002 C10AX14 ALIROCUMABUM ** Ω PRALUENT 150 mg 150mg
SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT SANOFI - AVENTIS GROUPE FRANTA CUTIE X 2 STILOURI INJECTOARE (PEN) PREUMPLUT X 1ML PRF 2 996.600000 996.600000 0.000000
7 W62401002 C10AX14 ALIROCUMABUM ** Ω PRALUENT 75 mg 75mg
SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT SANOFI - AVENTIS GROUPE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN-URI) PREUMPLUTE X 1 ML PRF 2 996.600000 996.600000 0.000000
8 W69333002 C10AX14 ALIROCUMABUM ** Ω PRALUENT 150 mg 150mg
SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN-URI) PREUMPLUTE X 1 ML PRF 2 996.600000 996.600000 0.000000
9 W69335001 C10AX14 ALIROCUMABUM ** Ω PRALUENT 300 mg 300mg
SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 1 STILOU INJECTOR (PEN) PREUMPLUT X 2ML PRF 1 1,978.510000 1,978.510000 0.000000
10 W69331002 C10AX14 ALIROCUMABUM ** Ω PRALUENT 75 mg 75mg
SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN-URI) PREUMPLUTE X 1 ML PRF 2 996.600000 996.600000 0.000000
11 W00716002 G02CB03 CABERGOLINUM ** DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. X 2 COMPR. P-RF 2 11.112000 11.112000 0.388000
12 W00716001 G02CB03 CABERGOLINUM ** DOSTINEX COMPR. 0,5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. X 8 COMPR. P-RF 8 9.260000 9.260000 0.000000
13 W65037001 G02CB03 CABERGOLINUM ** DOSTINEX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 2 COMPR. P6L 2 11.112000 11.112000 0.388000
14 W65037002 G02CB03 CABERGOLINUM ** DOSTINEX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 8 COMPR. P6L 8 9.260000 9.260000 0.000000
15 W65037003 G02CB03 CABERGOLINUM ** DOSTINEX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. DIN PEID, INCHIS CU CAPAC DIN PP CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 2 COMPR. P6L 2 11.112000 11.112000 0.388000
16 W65037004 G02CB03 CABERGOLINUM ** DOSTINEX 0,5 mg COMPR. 0,5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. DIN PEID, INCHIS CU CAPAC DIN PP CU SISTEM DE INCHIDERE SECURIZAT PENTRU COPII X 8 COMPR. P6L 8 9.260000 9.260000 0.000000
17 W42027002 H01AX01 PEGVISOMANTUM **1 SOMAVERT 10 mg PULB+SOLV. PT. SOL. INJ. 10mg PFIZER LIMITED MAREA BRITANIE CUTIE CU 30 FLAC. CU PULB. + 30 SERINGI PREUMPLUTE CONTINAND 1 ML PR 30 272.896000 272.896000 0.000000
18 W64864001 H01AX01 PEGVISOMANTUM **1 SOMAVERT 10 mg PULB+SOLV. PT. SOL. INJ. 10mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 30 FLAC. CU PULB. + 30 SERINGI PREUMPLUTE CONTINAND 1 ML PR 30 272.896000 272.896000 0.000000
19 W42029003 H01AX01 PEGVISOMANTUM **1 SOMAVERT 20 mg PULB+SOLV. PT. SOL. INJ. 20mg PFIZER LIMITED MAREA BRITANIE CUTIE CU 30 FLAC. CU PULB. + 30 SERINGI PREUMPLUTE CONTINAND 1 ML PR 30 543.430333 543.430333 0.000000
20 W64865001 H01AX01 PEGVISOMANTUM **1 SOMAVERT 20 mg PULB+SOLV. PT. SOL. INJ. 20mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 30 FLAC. CU PULB. + 30 SERINGI PREUMPLUTE CONTINAND 1 ML PR 30 543.430333 543.430333 0.000000
21 W53992002 H01BA02 DESMOPRESSINUM MINIRIN MELT 120 mcg LIOF. ORAL 120mcg FERRING GMBH GERMANIA CUTIE X 3 BLIST. AL/AL X 10 UNITATI DOZATE LIOF. ORAL P-RF 30 6.642333 6.642333 0.000000
22 W53991002 H01BA02 DESMOPRESSINUM MINIRIN MELT 60 mcg LIOF. ORAL 60mcg FERRING GMBH GERMANIA CUTIE X 3 BLIST AL/AL X 10 UNITATI DOZATE LIOF. ORAL P-RF 30 3.502000 3.502000 0.000000
23 W42954002 H01CB02 OCTREOTIDUM **1 SANDOSTATIN LAR 10 mg PULB. SI SOLV. PT. SUSP. INJ. 10mg NOVARTIS PHARMA GMBH GERMANIA PR
CUTIE CU 1 FLAC. CU PULBERE (MICROSFERE) + 1 SERINGA PREUMPLUTA CU 2 ML SOLVENT + ADAPTOR PT. FLACON+1 AC PT. INJECTARE CU SISTEM DE SIGURANTA 1 581.560000 581.560000 0.000000
24 W42955002 H01CB02 OCTREOTIDUM **1 SANDOSTATIN LAR 20 mg PULB. SI SOLV. PT. SUSP. INJ. 20mg NOVARTIS PHARMA GMBH GERMANIA PR
CUTIE CU 1 FLAC. CU PULBERE (MICROSFERE) + 1 SERINGA PREUMPLUTA CU 2 ML SOLVENT + ADAPTOR PT. FLACON+1 AC PT. INJECTARE CU SISTEM DE SIGURANTA 1 1,108.700000 1,108.700000 0.000000
25 W42956002 H01CB02 OCTREOTIDUM **1 SANDOSTATIN LAR 30 mg PULB. SI SOLV. PT. SUSP. INJ. 30mg NOVARTIS PHARMA GMBH GERMANIA PR
CUTIE CU 1 FLAC. CU PULBERE (MICROSFERE) + 1 SERINGA PREUMPLUTA CU 2 ML SOLVENT + ADAPTOR PT. FLACON+1 AC PT. INJECTARE CU SISTEM DE SIGURANTA 1 701.440000 701.440000 0.000000
26 W59079001 H01CB02 OCTREOTIDUM **1 SANDOSTATIN 100 micrograme/ml SOL. INJ./PERF. 0,1mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ./PERF. PR 5 9.040000 9.040000 0.000000
27 W58628001 H01CB03 LANREOTIDUM **1 SOMATULINE AUTOGEL 120 mg SOL. INJ. IN SERINGA PREUMPLUTA 120mg IPSEN PHARMA FRANTA PR
CUTIE CU 1 SERINGA PREUMPLUTA DIN PE DE 0,5 ML, CU SISTEM DE SIGURANTA AUTOMAT CU OPRITOR PENTRU PISTON SI AC DIN OTEL INOXIDABIL, ACOPERIT CU CAPAC DIN PLASTIC. FIECARE SERINGA PREUMPLUTA ESTE FIXATA IN TAVITA DIN PLASTIC SI AMBALATA IN FOLIE LAMIN. 1 4,890.270000 4,890.270000 0.000000
28 W66950001 H01CB05 PASIREOTIDUM ** SIGNIFOR 20 mg PULB+SOLV. PT. SUSP. INJ. 20mg RECORDATI RARE DISEASES FRANTA PRF
1 FLAC. (DIN STICLA) DE CULOARE MARONIE, CU PULB. PT. SUSP. INJ. SI O SERINGA (DIN STICLA) PREUMPUTA, CU SOLVENT+1 ADAPTOR PT. FLAC. SI UN AC DE PROIECTAT PT. INJECTARE IN SIGURANTA 1 10,160.100000 10,160.100000 0.000000
29 W66951001 H01CB05 PASIREOTIDUM ** SIGNIFOR 40 mg PULB+SOLV. PT. SUSP. INJ. 40mg RECORDATI RARE DISEASES FRANTA PRF
1 FLAC. (DIN STICLA) DE CULOARE MARONIE, CU PULB. PT. SUSP. INJ. SI O SERINGA (DIN STICLA) PREUMPUTA, CU SOLVENT+1 ADAPTOR PT. FLAC. SI UN AC DE PROIECTAT PT. INJECTARE IN SIGURANTA 1 10,542.710000 10,542.710000 0.000000
30 W66952001 H01CB05 PASIREOTIDUM ** SIGNIFOR 60 mg PULB+SOLV. PT. SUSP. INJ. 60mg RECORDATI RARE DISEASES FRANTA PRF
1 FLAC. (DIN STICLA) DE CULOARE MARONIE, CU PULB. PT. SUSP. INJ. SI O SERINGA (DIN STICLA) PREUMPUTA, CU SOLVENT+1 ADAPTOR PT. FLAC. SI UN AC DE PROIECTAT PT. INJECTARE IN SIGURANTA 1 11,660.100000 11,660.100000 0.000000
31 W67087003 H01CB05 PASIREOTIDUM ** SIGNIFOR 0,3 mg SOL INJ. 0,3mg RECORDATI RARE DISEASES FRANTA CUTIE CU 30 FIOLE DIN STICLA A 1ML X 0,3 MG PR 30 232.062000 232.062000 0.000000
32 W67088003 H01CB05 PASIREOTIDUM ** SIGNIFOR 0,6 mg SOL INJ. 0,6mg RECORDATI RARE DISEASES FRANTA CUTIE CU 30 FIOLE DIN STICLA A 1ML X 0,6 MG PR 30 272.597000 272.597000 0.000000
33 W67090003 H01CB05 PASIREOTIDUM ** SIGNIFOR 0,9 mg SOL INJ. 0,9mg RECORDATI RARE DISEASES FRANTA CUTIE CU 30 FIOLE DIN STICLA A 1ML X 0,9 MG PR 30 272.597000 272.597000 0.000000
34 W66284001 H02AA02 FLUDROCORTISONUM ASTONIN H 0,1 mg COMPR. 0,1mg MERCK ROMANIA SRL ROMANIA CUTIE CU 1 FLAC. DIN PP DE CULOARE ALBA X 50 COMPR. PRF 50 1.969200 1.969200 0.000000
35 W05242001 H02AB07 PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
36 W12565002 H02AB07 PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
37 W13686002 H02AB07 PREDNISONUM PREDNISON SINTOFARM 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
38 W53341001 H02AB07 PREDNISONUM PREDNISONA-RICHTER 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
39 W68137001 H02AB09 HYDROCORTISONUM HYDROCORTISONE ROUSSEL 10 mg COMPR. 10mg BIO EEL S.R.L. ROMANIA CUTIE CU 1 BLIST. X 25 COMPR. PRF 25 1.035600 1.035600 0.000000
40 W68176001 H02AB09 HYDROCORTISONUM ALKINDI 0,5 mg 0,5mg
GRANULE AMBALATE ÎN CAPSULE CARE TREBUIE DESCHISE DIURNAL EUROPE B.V OLANDA CUTIE CU UN FLACON X 50 CAPSULE PRF 50 3.386400 3.386400 0.000000
41 W68177001 H02AB09 HYDROCORTISONUM ALKINDI 1 mg 1mg
GRANULE AMBALATE ÎN CAPSULE CARE TREBUIE DESCHISE DIURNAL EUROPE B.V OLANDA CUTIE CU UN FLACON X 50 CAPSULE PRF 50 6.773200 6.773200 0.000000
42 W68178001 H02AB09 HYDROCORTISONUM ALKINDI 2 mg 2mg
GRANULE AMBALATE ÎN CAPSULE CARE TREBUIE DESCHISE DIURNAL EUROPE B.V OLANDA CUTIE CU UN FLACON X 50 CAPSULE PRF 50 12.412400 12.412400 0.000000
43 W68179001 H02AB09 HYDROCORTISONUM ALKINDI 5 mg 5mg
GRANULE AMBALATE ÎN CAPSULE CARE TREBUIE DESCHISE DIURNAL EUROPE B.V OLANDA CUTIE CU UN FLACON X 50 CAPSULE PRF 50 28.905800 28.905800 0.000000
44 W58639001 H02AB09 HYDROCORTISONUM HIDROCORTIZON HF 500 mg PULB. + SOLV. PT. SOL. INJ./PERF. 500mg STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 20 ML, INCHIS CU DOP DIN CAUCIUC GRI, ETANSAT CU CAPSA DIN ALUMINIU, CONTINAND PULB. PT. SOL. INJ./PERF. SI 1 FIOLA CU 4 ML SOLV. PR/PRF 1 40.630000 40.630000 0.000000
45 W66429001 H02AB09 HYDROCORTISONUM HIDROCORTIZON ROMPHARM 100 mg PULB. PT. SOL. INJ./PERF. 100mg S.C. ROMPHARM COMPANY S.R.L ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCHIS CU DOP DIN CAUCIUC BROMOBUTILIC SI SIGILAT CU CAPAC DIN PLASTIC SI CAPSA DETASABILA DIN AL X PULB. PT. SOL. INJ./PERF. PRF 1 9.030000 9.030000 0.000000
46 W58638001 H02AB09 HYDROCORTISONUM HIDROCORTIZON HF 100 mg PULB. SI SOLV. PT. SOL. INJ./PERF. 100mg STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA, CU CAPACITATEA DE 5 ML, INCHIS CU DOP DIN CAUCIUC GRI, ETANSAT CU CAPSA DE ALUMINIU, CONTINAND PULB. PT. SOL.INJ./PERF. SI O FIOLA CU 2 ML SOLV. PR/PRF 1 9.030000 9.030000 0.000000
47 W44080001 H02AB09 HYDROCORTISONUM HYDROCORTISONE SUCCINAT SODIC EIPICO 100 mg PULB+SOLV. PT. SOL. INJ./PERF. 100mg E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU DOP DIN CAUCIUC BUTILIC, SIGILAT CU O CAPSA DIN AL ACOPERITA CU UN DISC DE PP DE CULOARE PORTOCALIU DESCHIS CONTINAND PULB. PENTRU SOL. INJ. + FIOLA DIN STICLA INCOLORA A 2 ML SOLV. PREVAZUTA CU INEL DE RUPERE PRF 1 9.030000 9.030000 0.000000
48 W51922003 H02AB09 HYDROCORTISONUM HIDROCORTIZON ZENTIVA 19.6mg/5ml SOL. INJ. 19,6mg/5ml ZENTIVA S.A. ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA, CU CAPACITATEA DE 5 ML (CU INEL DE RUPERE SAU PUNCT DE RUPERE) X 1 ML SOL. A + 5 FIOLE DIN STICLA BRUNA CU CAPACITATEA DE 5ML (CU INEL DE RUPERE SAU PUNCT DE RUPERE) X 4 ML SOL. B PRF 5 7.000000 7.000000 0.000000
49 W67515002 H03AA01 LEVOTHYROXINUM EUTHYROX 125 µg COMPR 125 µg MERCK ROMANIA SRL ROMANIA CUTIE CU 4 BLISTERE DIN PVC/AL A CÂTE 25 COMPRIMATE P6L 100 0.231300 0.231300 0.000000
50 W66292003 H03AA01 LEVOTHYROXINUM EUTHYROX 100µg COMPR. 100µg MERCK ROMANIA SRL ROMANIA CUTIE CU 4 BLIST. PVC/AL X 25 COMPR. P6L 100 0.182000 0.182000 0.000000
51 W66294002 H03AA01 LEVOTHYROXINUM EUTHYROX 150µg COMPR. 150µg MERCK ROMANIA SRL ROMANIA CUTIE CU 4 BLIST. PVC/AL X 25 COMPR. P6L 100 0.254200 0.254200 0.000000
52 W66291003 H03AA01 LEVOTHYROXINUM EUTHYROX 25µg COMPR. 25µg MERCK ROMANIA SRL ROMANIA CUTIE CU 4 BLIST. PVC/AL X 25 COMPR. P6L 100 0.114200 0.114200 0.000000
53 W66293002 H03AA01 LEVOTHYROXINUM EUTHYROX 50µg COMPR. 50µg MERCK ROMANIA SRL ROMANIA CUTIE CU 4 BLIST. PVC/AL X 25 COMPR. P6L 100 0.144400 0.144400 0.000000
54 W67516002 H03AA01 LEVOTHYROXINUM EUTHYROX 75 µg COMPR. 75 µg MERCK ROMANIA SRL ROMANIA CUTIE CU 4 BLISTERE DIN PVC/AL A CÂTE 25 COMPRIMATE P6L 100 0.181800 0.181800 0.000000
55 W61162002 H03AA01 LEVOTHYROXINUM ACCU-THYROX 100 micrograme/5 ml SOL. ORALA 100micrograme/5ml GALENICA S.A. GRECIA CUTIE CU 2 FLAC. DIN STICLA BRUNA CONTINAND 75 ML SOL. ORALA SI 1 SERINGA DOZATOARE DE 5 ML GRADATA LA 0,1 ML SI 1 ADAPTOR PT. FLACON SAU O LINGURITA DUBLA DIN PLASTIC DE 2,5/5 ML P6L 2 21.560000 21.560000 0.000000
56 W61160002 H03AA01 LEVOTHYROXINUM ACCU-THYROX 25 micrograme/5 ml SOL. ORALA 25micrograme/5ml GALENICA S.A. GRECIA CUTIE CU 2 FLAC. DIN STICLA BRUNA CONTINAND 75 ML SOL. ORALA SI 1 SERINGA DOZATOARE DE 5 ML GRADATA LA 0,1 ML SI 1 ADAPTOR PT. FLACON SAU O LINGURITA DUBLA DIN PLASTIC DE 2,5/5 ML P6L 2 20.085000 20.085000 0.000000
57 W61161002 H03AA01 LEVOTHYROXINUM ACCU-THYROX 50 micrograme/5 ml SOL. ORALA 50micrograme/5ml GALENICA S.A. GRECIA CUTIE CU 2 FLAC. DIN STICLA BRUNA CONTINAND 75 ML SOL. ORALA SI 1 SERINGA DOZATOARE DE 5 ML GRADATA LA 0,1 ML SI 1 ADAPTOR PT. FLACON SAU O LINGURITA DUBLA DIN PLASTIC DE 2,5/5 ML P6L 2 20.085000 20.085000 0.000000
58 W66151004 H03CA01 KALII IODIDUM JODID 100 micrograme COMPR. 100micrograme MERCK ROMANIA SRL ROMANIA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. PRF 100 0.208500 0.208500 0.000000
59 W69337001 H05AA02 TERIPARATIDUM ** TERIPARATIDE SUN 20 micrograme/80 microlitri SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 20micrograme/80microlitri SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA CUTIE CU 1 CARTUS PREVAZUT CU UN PISTON (CAUCIUC HALOBUTILIC) ASAMBLAT INTR-UN STILOU INJECTOR PREUMPLUT CARE CONTINE 2,4 ML SOL. INJ. PR 1 893.508000 893.508000 408.482000
60 W68665001 H05AA02 TERIPARATIDUM ** TERIPARATID LABORMED 20 micrograme/80 microlitri SOL INJ. IN STILOU INJECTOR PREUMPLUT 20micrograme/80microlitri LABORMED PHARMA S.A. ROMANIA CUTIE CU 1 CARTUS PREVAZUT CU UN PISTON (CAUCIUC HALOBUTILIC) ASAMBLAT INTR-UN STILOU INJECTOR PREUMPLUT CARE CONTINE 2,4 ML SOL. INJ. PRF 1 893.508000 893.508000 0.482000

Pagina 24 din 37
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)
61 W68665002 H05AA02 TERIPARATIDUM ** TERIPARATID LABORMED 20 micrograme/80 microlitri SOL INJ. IN STILOU INJECTOR PREUMPLUT 20micrograme/80microlitri LABORMED PHARMA S.A. ROMANIA CUTIE CU 3 CARTUSE PREVAZUTE CU UN PISTON (CAUCIUC HALOBUTILIC) ASAMBLATE INTR-UN STILOU INJECTOR PREUMPLUT CARE CONTINE 2,4 ML SOL. INJ. PRF 3 893.508000 893.508000 1.128666
62 W55488001 H05AA02 TERIPARATIDUM ** FORSTEO 20µg/80µl SOL. INJ. 20µg/80µl ELI LILLY NEDERLAND BV OLANDA CUTIE X 1 STILOU INJECTOR (PEN) PREUMPLUT X 2,4 ML (28 DOZE X 20 ΜCG/80ΜCL) P-RF 1 893.508000 893.508000 0.192000
63 W66024001 H05AA02 TERIPARATIDUM ** MOVYMIA 20 micrograme/80 microlitri SOL. INJ. 20micrograme/80microlitri STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 1 CARTUS DIN STICLA PREVAZUT CU OPRITOR PENTRU PISTON SI DISC DE SIGILARE, AMBALAT IN TAVITA DE PLASTIC SIGILATA X 2,4 ML SOL. INJ. PRF 1 838.060000 838.060000 0.000000
64 W66024002 H05AA02 TERIPARATIDUM ** MOVYMIA 20 micrograme/80 microlitri SOL. INJ. 20micrograme/80microlitri GERMANIA
STADA ARZNEIMITTEL AG CUTIE CU 3 CARTUSE DIN STICLA PREVAZUTE CU OPRITOR PENTRU PISTON SI DISC DE SIGILARE, AMBALATE IN TAVITE DE PLASTIC SIGILATE X 2,4 ML SOL. INJ. PRF 3 814.010000 814.010000 0.000000
65 W65771001 H05AA02 TERIPARATIDUM ** TERROSA 20 micrograme/80 microlitri SOL. INJ. 20micrograme/80microlitri GEDEON RICHTER PLC. UNGARIA CUTIE CU 1 CARTUS PREVAZUT CU UN OPRITOR PENTRU PISTON SI DISC DE X 2,4 ML SOL. INJ PRF 1 744.590000 744.590000 0.000000
66 W67938001 H05AA03 PARATHYROID HORMONE **1 Ω NATPAR 100 micrograme/doza PULB.+SOLV.PT.SOL.INJ. 100micrograme/doza Shire Pharmaceuticals Ireland Limited IRLANDA CUTIE CU 2 CARTUSE; FIECARE CARTUS DIN SUPORTUL PENTRU CARTUS DE CULOARE ALBASTRA CONTINE 1400 MICROGRAME HORMON PARATIROIDIAN (ADNR) SUB FORMA DE PULBERE IN PRIMA CAMERA SI 1000 MICROLITRI DE SOLVENT IN A DOUA CAMERA (CEEA CE CORESPUNDE LA 14 DOZE) PR 2 13,987.390000 13,987.390000 0.000000
67 W68223001 H05AA03 PARATHYROID HORMONE **1 Ω NATPAR 100 micrograme/doza PULB.+SOLV.PT.SOL.INJ. 100micrograme/doza IRLANDA
TAKEDA PHARM. INTERNATIONAL AG IRELAND BRANCH CUTIE CU 2 CARTUSE; FIECARE CARTUS DIN SUPORTUL PENTRU CARTUS DE CULOARE ALBASTRA CONTINE 1400 MICROGRAME HORMON PARATIROIDIAN (ADNR) SUB FORMA DE PULBERE IN PRIMA CAMERA SI 1000 MICROLITRI DE SOLVENT IN A DOUA CAMERA (CEEA CE CORESPUNDE LA 14 DOZE) PR 2 13,987.390000 13,987.390000 0.000000
68 W67941001 H05AA03 PARATHYROID HORMONE **1 Ω NATPAR 25 micrograme/doza PULB.+SOLV.PT.SOL.INJ. 25micrograme/doza Shire Pharmaceuticals Ireland Limited IRLANDA CUTIE CU 2 CARTUSE; FIECARE CARTUS DIN SUPORTUL PENTRU CARTUS DE CULOARE MOV CONTINE 350 MICROGRAME HORMON PARATIROIDIAN (ADNR) SUB FORMA DE PULBERE ÎN PRIMA CAMERA SI 1000 MICROLITRI DE SOLVENT ÎN A DOUA CAMERA (CEEA CE CORESPUNDE LA 14 DOZE) PR 2 13,987.390000 13,987.390000 0.000000
69 W68220001 H05AA03 PARATHYROID HORMONE **1 Ω NATPAR 25 micrograme/doza PULB.+SOLV.PT.SOL.INJ. 25micrograme/doza IRLANDA
TAKEDA PHARM. INTERNATIONAL AG IRELAND BRANCH CUTIE CU 2 CARTUSE; FIECARE CARTUS DIN SUPORTUL PENTRU CARTUS DE CULOARE MOV CONTINE 350 MICROGRAME HORMON PARATIROIDIAN (ADNR) SUB FORMA DE PULBERE IN PRIMA CAMERA SI 1000 MICROLITRI DE SOLVENT IN A DOUA CAMERA (CEEA CE CORESPUNDE LA 14 DOZE) PR 2 13,987.390000 13,987.390000 0.000000
70 W67940001 H05AA03 PARATHYROID HORMONE **1 Ω NATPAR 50 micrograme/doza PULB.+SOLV.PT.SOL.INJ. 50micrograme/doza Shire Pharmaceuticals Ireland Limited IRLANDA CUTIE CU 2 CARTUSE; FIECARE CARTUS DIN SUPORTUL PENTRU CARTUS DE CULOARE ROSIE CONTINE 700 MICROGRAME HORMON PARATIROIDIAN (ADNR) SUB FORMA DE PULBERE ÎN PRIMA CAMERA SI 1000 MICROLITRI DE SOLVENT ÎN A DOUA CAMERA (CEEA CE CORESPUNDE LA 14 DOZE) PR 2 13,987.390000 13,987.390000 0.000000
71 W68221001 H05AA03 PARATHYROID HORMONE **1 Ω NATPAR 50 micrograme/doza PULB.+SOLV.PT.SOL.INJ. 50micrograme/doza IRLANDA
TAKEDA PHARM. INTERNATIONAL AG IRELAND BRANCH CUTIE CU 2 CARTUSE; FIECARE CARTUS DIN SUPORTUL PENTRU CARTUS DE CULOARE ROSIE CONTINE 700 MICROGRAME HORMON PARATIROIDIAN (ADNR) SUB FORMA DE PULBERE IN PRIMA CAMERA SI 1000 MICROLITRI DE SOLVENT IN A DOUA CAMERA (CEEA CE CORESPUNDE LA 14 DOZE) PR 2 13,987.390000 13,987.390000 0.000000
72 W67939001 H05AA03 PARATHYROID HORMONE **1 Ω NATPAR 75 micrograme/doza PULB.+SOLV.PT.SOL.INJ. 75micrograme/doza Shire Pharmaceuticals Ireland Limited IRLANDA CUTIE CU 2 CARTUSE; FIECARE CARTUS DIN SUPORTUL PENTRU CARTUS DE CULOARE GRI CONTINE 1050 MICROGRAME HORMON PARATIROIDIAN (ADNR) SUB FORMA DE PULBERE ÎN PRIMA CAMERA SI 1000 MICROLITRI DE SOLVENT ÎN A DOUA CAMERA (CEEA CE CORESPUNDE LA 14 DOZE) PR 2 13,987.390000 13,987.390000 0.000000
73 W68222001 H05AA03 PARATHYROID HORMONE **1 Ω NATPAR 75 micrograme/doza PULB.+SOLV.PT.SOL.INJ. 75micrograme/doza IRLANDA
TAKEDA PHARM. INTERNATIONAL AG IRELAND BRANCH CUTIE CU 2 CARTUSE; FIECARE CARTUS DIN SUPORTUL PENTRU CARTUS DE CULOARE GRI CONTINE 1050 MICROGRAME HORMON PARATIROIDIAN (ADNR) SUB FORMA DE PULBERE IN PRIMA CAMERA SI 1000 MICROLITRI DE SOLVENT IN A DOUA CAMERA (CEEA CE CORESPUNDE LA 14 DOZE) PR 2 13,987.390000 13,987.390000 0.000000
74 W66757001 J02AB02 KETOCONAZOLUM ** Ω KETOCONAZOLE HRA 200 mg COMPR. 200mg HRA PHARMA RARE DISEASES FRANTA CUTIE CU 6 BLIST. PVC/AL X 10 COMPR. PR/PRF 60 43.730666 43.730666 0.000000
75 W55639001 M05BX04 DENOSUMAB ** PROLIA SOL. INJ. IN SERINGA PREUMPLUTA 60mg/ml AMGEN EUROPE B.V. OLANDA CUTIE X 1 SERINGA PREUMPLUTA DIN STICLA (IN BLISTER) CU AC SI PROTECTIE AUTOMATA PT. AC P-RF 1 679.710000 679.710000 0.000000
76 W65286001 M05BX05 BUROSUMABUM **1 Ω CRYSVITA 10 mg SOL INJ. 10mg/ml KYOWA KIRIN HOLDINGS B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA (CONTINE BUROSUMAB 10 MG IN 1 ML SOL.) PR 1 12,526.450000 12,526.450000 0.000000
77 W65287001 M05BX05 BUROSUMABUM **1 Ω CRYSVITA 20 mg SOL INJ. 20mg/ml KYOWA KIRIN HOLDINGS B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA (CONTINE BUROSUMAB 20 MG IN 1 ML SOL.) PR 1 24,982.070000 24,982.070000 0.000000
78 W65288001 M05BX05 BUROSUMABUM **1 Ω CRYSVITA 30 mg SOL INJ. 30mg/ml KYOWA KIRIN HOLDINGS B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA (CONTINE BUROSUMAB 30 MG IN 1 ML SOL.) PR 1 37,437.690000 37,437.690000 0.000000
79 W11164002 N04BC01 BROMOCRIPTINUM BROCRIPTIN (N04BC01) DRAJ. 2,5mg BIOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 20 DRAJ. P-RF 40 0.919750 0.919750 0.000000

Pagina 25 din 37
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)
19. BOALA WILSON - G23

1 W61063002 M01CC01 PENICILLAMINUM ** (4) CUPRIPEN 250mg CAPS. 250mg CN UNIFARM S.A. ROMANIA CUTIE X 3 BLIST. X 10 CAPS. PRF 30 2.943666 2.943666 0.000000

Tratamentul se iniţiază de către medicul din specialitatea endocrinologie, neurologie sau neurologie pediatrică.

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

1 W51230001 B03AC02 COMPLEX DE HIDROXID DE FER (III) SUCROZA ** VENOFER 100 mg fer/5 ml SOL. INJ./PERF. 100mg/5ml VIFOR FRANCE S.A. FRANTA CUTIE X 5 FIOLE X 5 ML S/P-RF 5 59.218000 59.218000 0.000000
2 W52283002 B03XA01 EPOETINUM ALFA ** BINOCRIT 2000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/1,0ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMPLUTE X 1ML SOL. INJ. PR 6 57.956666 57.956666 0.000000
3 W55046001 B03XA01 EPOETINUM ALFA ** BINOCRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,75ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,75ML SOL. INJ. PR 1 651.340000 651.340000 0.000000
4 W57497004 B03XA01 EPOETINUM ALFA ** EPREX 40000 UI/ml SOL. INJ. IN SERINGA PREUMPLUTA 40 000UI/ml JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 1,022.664000 1,022.664000 262.556000
5 W55048001 B03XA01 EPOETINUM ALFA ** BINOCRIT 40000 UI/1 ml SOL. INJ. IN SERINGA PREUMPLUTA 40000 UI/1 ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 1ML SOL. INJ. PR 1 852.220000 852.220000 0.000000
6 W52285002 B03XA01 EPOETINUM ALFA ** BINOCRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml SANDOZ GMBH AUSTRIA CUTIE X 6 SERINGI PREUMPLUTE X 0,4ML SOL. INJ. PR 6 105.705000 105.705000 0.000000
7 W64395002 B03XA01 EPOETINUM BETA ** NEORECORMON 10000 UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/0,6ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 6 SERINGI PREUMPLUTE X 0,6 ML SOL. INJ. + 6 ACE PR 6 326.240000 326.240000 0.000000
8 W64396002 B03XA01 EPOETINUM BETA ** NEORECORMON 2000 UI/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 6 SERINGI PREUMPLUTE X 0,3 ML SOL. INJ. X 6 ACE PR 6 56.261666 56.261666 0.000000
9 W64397001 B03XA01 EPOETINUM BETA ** NEORECORMON 30000 UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 30000 UI/0,6ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 SERINGA PRE-UMPLUTA X 0,6 ML + 1 AC PR 1 1,163.530000 1,163.530000 0.000000
10 W64398002 B03XA01 EPOETINUM BETA ** NEORECORMON 4000 UI/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 6 SERINGI PREUMPLUTE X 0,3 ML SOL. INJ. + 6 ACE PR 6 102.505000 102.505000 0.000000
11 W64399002 B03XA01 EPOETINUM BETA ** NEORECORMON 5000 UI/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 6 SERINGI PREUMPLUTE X 0,3 ML SOL. INJ. + 6 ACE PR 6 144.476666 144.476666 0.000000
12 W60969001 B03XA01 EPOETINUM ZETA ** RETACRIT 10000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/1,0ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 1ML SOL. INJ. PR 1 245.910000 245.910000 0.000000
13 W64987001 B03XA01 EPOETINUM ZETA ** RETACRIT 10000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 10000UI/1,0ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 245.910000 245.910000 0.000000
14 W60964001 B03XA01 EPOETINUM ZETA ** RETACRIT 2000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,6ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,6ML SOL. INJ. PR 1 60.840000 60.840000 0.000000
15 W64990001 B03XA01 EPOETINUM ZETA ** RETACRIT 2000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 2000UI/0,6ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. PR 1 60.840000 60.840000 0.000000
16 W60967001 B03XA01 EPOETINUM ZETA ** RETACRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,75ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,75ML SOL. INJ. PR 1 659.210000 659.210000 0.000000
17 W64991001 B03XA01 EPOETINUM ZETA ** RETACRIT 30000UI/0,75ml SOL. INJ. IN SERINGA PREUMPLUTA 30000UI/0,75ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,75 ML SOL. INJ. PR 1 659.210000 659.210000 0.000000
18 W60965001 B03XA01 EPOETINUM ZETA ** RETACRIT 3000UI/0,9ml SOL. INJ. IN SERINGA PREUMPLUTA 3000UI/0,9ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,9ML SOL. INJ. PR 1 80.990000 80.990000 0.000000
19 W64992001 B03XA01 EPOETINUM ZETA ** RETACRIT 3000UI/0,9ml SOL. INJ. IN SERINGA PREUMPLUTA 3000UI/0,9ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,9 ML SOL. INJ. PR 1 80.990000 80.990000 0.000000
20 W60966001 B03XA01 EPOETINUM ZETA ** RETACRIT 40000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 40000UI/1,0ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 1ML SOL. INJ. PR 1 876.590000 876.590000 0.000000
21 W64993001 B03XA01 EPOETINUM ZETA ** RETACRIT 40000UI/1,0ml SOL. INJ. IN SERINGA PREUMPLUTA 40000UI/1,0ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 876.590000 876.590000 0.000000
22 W60973001 B03XA01 EPOETINUM ZETA ** RETACRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,4ML SOL. INJ. PR 1 107.970000 107.970000 0.000000
23 W64994001 B03XA01 EPOETINUM ZETA ** RETACRIT 4000UI/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 4000UI/0,4ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,4 ML SOL. INJ. PR 1 107.970000 107.970000 0.000000
24 W60972001 B03XA01 EPOETINUM ZETA ** RETACRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL. INJ. PR 1 133.170000 133.170000 0.000000
25 W64995001 B03XA01 EPOETINUM ZETA ** RETACRIT 5000UI/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 5000UI/0,5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. PR 1 133.170000 133.170000 0.000000
26 W60971001 B03XA01 EPOETINUM ZETA ** RETACRIT 6000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI/0,6ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,6ML SOL. INJ. PR 1 153.590000 153.590000 0.000000
27 W64996001 B03XA01 EPOETINUM ZETA ** RETACRIT 6000UI/0,6ml SOL. INJ. IN SERINGA PREUMPLUTA 6000UI/0,6ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. PR 1 153.590000 153.590000 0.000000
28 W60970001 B03XA01 EPOETINUM ZETA ** RETACRIT 8000UI/0,8ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI/0,8ml HOSPIRA UK LIMITED MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA X 0,8ML SOL. INJ. PR 1 304.810000 304.810000 0.000000
29 W64997001 B03XA01 EPOETINUM ZETA ** RETACRIT 8000UI/0,8ml SOL. INJ. IN SERINGA PREUMPLUTA 8000UI/0,8ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 SERINGA PREUMPLUTA X 0,8 ML SOL. INJ. PR 1 304.810000 304.810000 0.000000
30 W41530002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 100mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 100mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,5 ML P-RF/R 4 640.115000 640.115000 0.000000
31 W41522002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 10mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 10mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,4 ML P-RF/R 4 79.912500 79.912500 0.000000
32 W41524002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 20mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 20mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,5 ML P-RF/R 4 138.357500 138.357500 0.000000
33 W41525002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 30mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 30mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,3 ML P-RF/R 4 218.422500 218.422500 0.000000
34 W41526002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 40mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 40mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,4 ML P-RF/R 4 266.452500 266.452500 0.000000
35 W41533001 B03XA02 DARBEPOETINUM ALFA ** ARANESP 500mcg/ml SOL. INJ. IN SERINGA PREUMPLUTA 500mcg/ml AMGEN EUROPE BV OLANDA CUTIE X 1 SERINGA PREUMPLUTA A 1 ML X 1 ML P-RF/R 1 3,028.900000 3,028.900000 0.000000
36 W41527002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 50mcg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 50mcg/0,5ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,5 ML P-RF/R 4 352.230000 352.230000 0.000000
37 W41528002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 60mcg/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 60mcg/0,3ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,3 ML P-RF/R 4 379.785000 379.785000 0.000000
38 W41529002 B03XA02 DARBEPOETINUM ALFA ** ARANESP 80mcg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 80mcg/0,4ml AMGEN EUROPE BV OLANDA CUTIE X 4 SERINGI PREUMPLUTE A 1 ML X 0,4 ML P-RF/R 4 500.495000 500.495000 0.000000
39 W64391001 B03XA03 METOXI-POLIETILENGLICOL EPOETINA BETA ** MIRCERA 100 micrograme/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 100µg/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 SERINGA PREUMPLUTA X 0,3 ML SOL. INJ. PR 1 776.610000 776.610000 0.000000
40 W64392001 B03XA03 METOXI-POLIETILENGLICOL EPOETINA BETA ** MIRCERA 150 micrograme/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 150µg/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 SERINGA PREUMPLUTA X 0,3 ML SOL. INJ. PR 1 1,114.350000 1,114.350000 0.000000
41 W64389001 B03XA03 METOXI-POLIETILENGLICOL EPOETINA BETA ** MIRCERA 50 micrograme/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 50 µg/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 SERINGA PREUMPLUTA X 0,3 ML SOL. INJ. PR 1 416.510000 416.510000 0.000000
42 W64390001 B03XA03 METOXI-POLIETILENGLICOL EPOETINA BETA ** MIRCERA 75 micrograme/0,3ml SOL. INJ. IN SERINGA PREUMPLUTA 75µg/0,3ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 SERINGA PREUMPLUTA X 0,3 ML SOL. INJ. PR 1 599.980000 599.980000 0.000000
43 W66510001 C03XA01 TOLVAPTAN ** Ω JINARC 15mg + JINARC 45mg COMPR. FARA CONCENTRATIE OTSUKA PHARMACEUTICAL NETHERLANDS B.V. OLANDA CUTIE CU BLIST. X 56 COMPRIMATE (28 X 15 MG + 28 X 45 MG) PR 1 2,680.140000 2,680.140000 0.000000
44 W66511001 C03XA01 TOLVAPTAN ** Ω JINARC 30mg + JINARC 60mg COMPR. FARA CONCENTRATIE OTSUKA PHARMACEUTICAL NETHERLANDS B.V. OLANDA CUTIE CU BLIST. X 56 COMPRIMATE (28 X 30 MG + 28 X 60 MG) PR 1 3,984.780000 3,984.780000 0.000000
45 W66512001 C03XA01 TOLVAPTAN ** Ω JINARC 30mg + JINARC 90mg COMPR. FARA CONCENTRATIE OTSUKA PHARMACEUTICAL NETHERLANDS B.V. OLANDA CUTIE CU BLIST. X 56 COMPRIMATE (28 X 30 MG + 28 X 90 MG) PR 1 5,289.420000 5,289.420000 0.000000
46 W66451005 C09CA04 IRBESARTANUM ** COMPR.
IRBESARTAN AUROBINDO 150 mg 150mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. P6L 28 0.492500 0.492500 0.000000
47 W66452005 C09CA04 IRBESARTANUM ** COMPR.
IRBESARTAN AUROBINDO 300 mg 300mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. P6L 28 0.985714 0.985714 0.000000
48 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 0.591000 0.591000 0.234000
49 W59580002 C09CA04 IRBESARTANUM ** IRBESARTAN ZENTIVA 150mg COMPR. FILM. 150mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 0.591000 0.591000 0.119000
50 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 0.591000 0.591000 0.806333
51 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 0.591000 0.591000 0.897928

Pagina 26 din 37
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)
52 W63000003 C09CA04 IRBESARTANUM ** IRBESARTAN TEVA 150 mg COMPR. FILM. 150mg TEVA B.V. OLANDA CUTIE X BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P-6L 28 0.567857 0.567857 0.000000
53 W65123002 C09CA04 IRBESARTANUM ** IRBESARTAN ZENTIVA 150mg COMPR. FILM. 150mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 0.591000 0.591000 0.119000
54 W66400006 C09CA04 IRBESARTANUM ** APROVEL 150mg COMPR. FILM. 150mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM. P6L 30 0.591000 0.591000 0.806333
55 W69393006 C09CA04 IRBESARTANUM ** APROVEL 150mg COMPR. FILM. 150mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM. P6L 30 0.591000 0.591000 0.806333
56 W63001003 C09CA04 IRBESARTANUM ** IRBESARTAN TEVA 300 mg COMPR. FILM. 300 mg TEVA B.V. OLANDA CUTIE X BLIST. PVC/PVDC/AL X 28 COMPR. FILM. P-6L 28 0.954642 0.954642 0.000000
57 W54082003 C09CA04 IRBESARTANUM ** IRBESARTAN TERAPIA 300 mg COMPR. FILM. 300mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL, X 28 COMPR. FILM. P-6L 28 1.145570 1.145570 0.180858
58 W59581002 C09CA04 IRBESARTANUM ** IRBESARTAN ZENTIVA 300mg COMPR. FILM. 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 1.005000 1.005000 0.000000
59 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 1.145570 1.145570 0.697430
60 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 1.145570 1.145570 0.696930
61 W65124002 C09CA04 IRBESARTANUM ** IRBESARTAN ZENTIVA 300mg COMPR. FILM. 300mg ZENTIVA K.S. REPUBLICA CEHA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 1.005000 1.005000 0.000000
62 W66401007 C09CA04 IRBESARTANUM ** APROVEL 300mg COMPR. FILM. 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM. P6L 30 1.145570 1.145570 0.697430
63 W69394007 C09CA04 IRBESARTANUM ** APROVEL 300mg COMPR. FILM. 300mg SANOFI WINTHROP INDUSTRIE FRANTA CUTIE X BLIST PVC/PVDC/AL X 30 COMPR. FILM. P6L 30 1.145570 1.145570 0.697430
64 W05242001 H02AB07 PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
65 W12565002 H02AB07 PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
66 W13686002 H02AB07 PREDNISONUM PREDNISON SINTOFARM 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
67 W53341001 H02AB07 PREDNISONUM PREDNISONA-RICHTER 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
68 W63199002 H05BX02 PARICALCITOLUM ** ZEMPLAR 1 microgram CAPS. MOI 1micrograme ABBVIE SPAIN S.L.U. SPANIA CUTIE CU 4 BLIST. PVC/FLUOROPOLIMER/AL X 7 CAPS. MOI PRF 28 9.778214 9.778214 0.000000
69 W63198001 H05BX02 PARICALCITOLUM ** ZEMPLAR 5 micrograme/ml SOL. INJ. 5micrograme/ml ABBVIE SPAIN S.L.U. SPANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA TIP I X 1 ML SOL. INJ. PR 5 64.372000 64.372000 0.000000
70 W63198003 H05BX02 PARICALCITOLUM ** ZEMPLAR 5 micrograme/ml SOL. INJ. 5micrograme/ml ABBVIE SPAIN S.L.U. SPANIA CUTIE CU 5 FLAC. DIN STICLA INCOLORA TIP I X 1 ML SOL. INJ. PR 5 64.372000 64.372000 0.000000
71 W12490001 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 50 mg DRAJ. 50mg BAXTER ONCOLOGY GMBH GERMANIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 DRAJ. P-RF 50 1.240400 1.240400 0.000000
72 W51399001 L04AD01 CICLOSPORINUM SANDIMMUN NEORAL 25 mg CAPS. MOI 25mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 BLIST. X 5 CAPS. MOI PR 50 1.789800 1.789800 0.000000
73 W51398001 L04AD01 CICLOSPORINUM SANDIMMUN NEORAL 50 mg CAPS. MOI 50mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 BLIST. X 5 CAPS. MOI PR 50 3.281200 3.281200 0.000000
74 W60846001 L04AX01 AZATHIOPRINUM IMURAN 50 mg COMPR. FILM. 50mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. P-RF 100 0.654500 0.654500 0.000000
75 W12240001 V06DDN1 COMBINATII (AMINOACIZI) ** KETOSTERIL COMPR. FILM. FARA CONCENTRATIE FRESENIUS KABI DEUTSCHLAND GMBH GERMANIA CUTIE X 5 BLIST. DIN PVC/AL X 20 COMPR. FILM. P-RF 100 2.244500 2.244500 0.000000

Tratamentul se initiaza de catre medicul in specialitatea nefrologie.

21. BOLI DEGENERATIVE ALE OCHIULUI (GLAUCOM ŞI BOLI MACULARE) - G 26

1 W53830001 S01EC03 DORZOLAMIDUM DORZOPT 20 mg/ml PIC. OFT., SOL 20mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE X 1 FLAC. PEJD X 5 ML PIC. OFT., SOL P-RF 1 18.540000 18.540000 0.000000
2 W61012001 S01EC03 DORZOLAMIDUM DORZOLAMIDA ARENA 20 mg/ml PIC. OFT., SOL. 20mg/ml ARENA GROUP S.A. ROMANIA CUTIE CU 1 FLAC. ALB, OPAC DIN PE DE DENSITATE MEDIE, CU CAPACITATEA DE 10 ML, PREVAZUT CU PICURATOR SIGILAT SI UN CAPAC ASAMBLATE DIN 2 PIESE, CU 5 ML PIC. OFT., SOL. P6L 1 18.540000 18.540000 0.000000
3 W62676002 S01EC03 DORZOLAMIDUM TRUSOPT 20 mg/ml PIC. OFT., SOL. 20mg/ml SANTEN OY FINLANDA CUTIE CU 1 FLACON DIN PEJD X 5 ML PIC. OFT., SOL. P6L 1 22.248000 22.248000 4.952000
4 W64500001 S01EC04 BRINZOLAMIDUM AZOPT 10mg/ml PICATURI OFT.-SUSP. 10mg/ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 FLAC. PEJD X 5 ML P6L 1 29.450000 29.450000 0.000000
5 W55649001 S01ED01 TIMOLOLUM TIMOLOL ROMPHARM 5 mg/ml PIC. OFT.,SOL. 5mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE CU 1 FLAC. DIN PEJD PREVAZUT CU PICURATOR DIN PEJD CARE CONTINE 5 ML PIC. OFTALMICE, SOL. P-6L 1 6.750000 6.750000 0.000000
6 W44059001 S01ED01 TIMOLOLUM TIMOLOL EIPICO 2,5 mg/ml PICATURI OFT.-SOL. 2,5mg/ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE CU 1 FLAC. PEJD, PREVAZUT CU APLICATOR PT. PICURARE X 5 ML PIC. OFT., SOL. P-6L 1 4.010000 4.010000 0.000000
7 W44058002 S01ED01 TIMOLOLUM TIMOLOL EIPICO 5 mg/ml PICATURI OFT.-SOL. 5mg/ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE CU 1 FLAC. PEJD, PREVAZUT CU APLICATOR PT. PICURARE X 5 ML PIC. OFT., SOL. P-6L 1 6.750000 6.750000 0.000000
8 W69082001 S01ED02 BETAXOLOLUM BETOPTIC S 2,5 mg/ml PICATURI OFT., SUSP. 2,5mg/ml IMMEDICA PHARMA AB SUEDIA CUTIE CU 1 FLAC. TRANSPARENT DIN PEJD PREVAZUT CU PICURATOR TRANSPARENT DIN PEJD X 5 ML PIC. OFT. SUSP. P6L 1 16.890000 16.890000 0.000000
9 W52116001 S01ED05 CARTEOLOLUM FORTINOL EP 2% PIC. OFTALMICE CU ELIB. PREL. 20mg/ml DR. GERHARD MANN CHEM.PHARM.FABRIK GMBH GERMANIA CUTIE X 1 FLAC. DIN PEJD X 3 ML PIC. OFTALMICE CU ELIB. PREL. P-6L 1 13.900000 13.900000 0.000000
10 W64501001 S01ED51 COMBINATII ( BRINZOLAMIDUM + TIMOLOLUM) ** AZARGA PIC. OFT. SUSP. 10mg/ml+5mg/ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 FLAC. X 5 ML SUSP. OFT. PRF 1 62.400000 62.400000 0.000000
11 W63939001 S01ED51 COMBINATII (BIMATOPROSTUM + TIMOLOLUM) BIMATOPROST/TIMOLOL ROMPHARM 0,3 mg/5 mg/ml PIC. OFT. 0,3mg/5mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLAC. PEJD PREVAZUT CU PICURATOR DIN PEJD X 3 ML PIC. OFT., SOL. PRF 1 55.250000 55.250000 0.000000
12 W68400001 S01ED51 COMBINATII (BIMATOPROSTUM + TIMOLOLUM) ECBIRIO 0,3 mg/5 mg/ml PIC. OFT., SOL. 0,3mg/5mg/ml SIFI S.P.A. ITALIA CUTIE CU 1 FLAC. MULTIDOZA DIN PEJD DE CULOARE ALBA, PREVAZUT CU PICURATOR DIN PEID X 3 ML SOL.OFT. PRF 1 55.800000 55.800000 0.000000
13 W68605001 S01ED51 COMBINATII (BIMATOPROSTUM + TIMOLOLUM) VIZIMACO 0,3 mg/ml+5 mg/ml PIC. OFT., SOL. 0,3mg/ml+5mg/ml BAUSCH + LOMB IRELAND LIMITED IRLANDA CUTIE CU 1 FLAC. DIN PEJD, CU CAPACITATEA DE 5 ML, PREVAZUT CU PICURATOR DIN PEID SI SILICON X 3 ML PIC. OFT., SOL. PRF 1 65.200000 65.200000 0.000000
14 W66265001 S01ED51 COMBINATII (DORZOLAMIDUM+TIMOLOLUM) SIFIOPT 20 mg/5 mg/ml PIC. OFT., SOL. 20mg/5mg/ml SIFI S.P.A. ITALIA CUTIE CU 1 FLAC. PE ALB, OPAC +PICURATOR PEJD X 5 ML PIC. OFT. SOL. PRF 1 33.710000 33.710000 0.000000
15 W65460001 S01ED51 COMBINATII (DORZOLAMIDUM+TIMOLOLUM) COSOPT FARA CONSERVANT 20 mg/ml+5 mg/ml PIC. OFT., SOL. 20mg/ml+5mg/ml SANTEN OY FINLANDA CUTIE CU 1 FLAC. DIN PEJD CU CAPACITATEA DE 10 ML PREVAZUT CU PICURATOR NOVELIA DIN PEID CU PIC. OFT., SOL. P6L 1 94.120000 94.120000 0.000000
16 W62674002 S01ED51 COMBINATII (DORZOLAMIDUM+TIMOLOLUM) COSOPT 20 mg/l + 5 mg/ml PIC. OFT.-SOL. 20mg/ml+5mg/ml SANTEN OY FINLANDA CUTIE CU 1 FLACON DIN PEJD X 5 ML PIC. OFT., SOL. P6L 1 40.452000 40.452000 0.598000
17 W60653001 S01ED51 COMBINATII (LATANOPROSTUM+TIMOLOLUM) GLAUTAN PLUS 50 micrograme/ml + 5 mg/ml PIC. OFT., SOL 50 micrograme/ml + 5 mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE X 1 FLACON DIN PEJD CU PICURATOR DIN PEJD INCHIS CU CAPAC DIN PEID X 2.5ML PICATURI OFTALMICE- P6L 1 33.432000 33.432000 2.358000
18 W67350001 S01ED51 COMBINATII (LATANOPROSTUM+TIMOLOLUM) XALCOM 50 micrograme/ml+5 mg/ml PIC. OFT., SOL. 50 micrograme/ml+5 mg/ml UPJOHN EESV OLANDA CUTIE CU 1 FLAC. PEJD CU CAPACITATE 5 ML, PREVAZUT CU PICURATOR DIN PEJD SAU PEMD X 2,5 ML PIC. OFT. SOL. P6L 1 27.860000 27.860000 0.000000
19 W65442001 S01ED51 COMBINATII (LATANOPROSTUM+TIMOLOLUM) FIXANPOST 50 micrograme/ml+5 mg/ml PICATURI OFT.-SOL., IN RECIPIENT UNIDOZA 50micrograme/ml+5mg/ml LABORATOIRES THEA FRANTA CUTIE CU 6 PLICURI DIN PP/AL/POLIESTER A CATE 5 RECIPIENTE UNIDOZA DIN PEJD CE CONTIN FIECARE 0,2 ML PIC. OFT., SOL. P6L 30 3.193333 3.193333 0.000000
20 W64002001 S01ED51 COMBINATII (TRAVOPROSTUM+TIMOLOLUM) PIC. OFT., SOL. 40micrograme/ml+5mg/ml
TRAVOPROST/TIMOLOL ZENTIVA 40 micrograme/ml+5 mg/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 45.288000 45.288000 3.562000
21 W68429001 S01ED51 COMBINATII (TRAVOPROSTUM+TIMOLOLUM) KIVIZIDIALE 40 de micrograme/ml+5 mg/mlPIC. OFT., SOL. 40micrograme/ml+5mg/ml BAUSCH + LOMB IRELAND LIMITED IRLANDA CUTIE CU 1 FLAC. MULTIDOZA DIN PP, PREVAZUT CU POMPA (PP,PEID,PEJD) X 2,5 ML PIC. OFT., SOL. P6L 1 45.288000 45.288000 1.492000
22 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 37.740000 37.740000 0.000000
23 W59365001 S01EE01 LATANOPROSTUM SIFITAN 50 micrograme/ml PIC. OFT., SOL 50micrograme/ml NTC S.R.L. ITALIA CUTIE CU 1 FLAC. PEJD X 2,5 ML PIC. OFT., SOL. P6L 1 32.060000 32.060000 0.000000
24 W54876001 S01EE01 LATANOPROSTUM UNILAT 50 micrograme/ml PIC. OFT., SOL. 50micrograme/ml UNIMED PHARMA SPOL. S.R.O. CUTIE CU 1 FLAC. PICURATOR PE X 2,5 ML PIC. OFT., SOL. P-6L
REPUBLICA SLOVACA 1 34.590000 34.590000 0.000000
25 W56354001 S01EE01 LATANOPROSTUM ARULATAN 50 micrograme/ml PIC. OFT., SOL. 50micrograme/ml DR. GERHARD MANN CHEM.PHARM.FABRIK GMBH GERMANIA CUTIE CU 1 FLAC. PEJD CU DOP PICURATOR PEID X 2,5 ML PIC. OFT., SOL. P-6L 1 36.560000 36.560000 0.000000
26 W59511003 S01EE01 LATANOPROSTUM MONOPOST 50 micrograme/ml 50micrograme/ml
PIC. OFT., SOL., IN RECIPIENT UNIDOZA LABORATOIRES THEA FRANTA CUTIE CU 30 (6X5) RECIPIENTE UNIDOZA DIN PEID AMBALATE INTR-UN PLIC LAMINAT DIN COPOLIMER/ALUMINIU/POLIETILENA/HÂRTIE A CÂTE 0,2 MILILITRI PIC. OFT., SOL. P6L 30 1.800333 1.800333 0.000000
27 W59511010 S01EE01 LATANOPROSTUM MONOPOST 50 micrograme/ml 50micrograme/ml
PIC. OFT., SOL., IN RECIPIENT UNIDOZA LABORATOIRES THEA FRANTA CUTIE CU 30 (3X10) RECIPIENTE UNIDOZA DIN PEJD AMBALATE CÂTE 10 ÎN 3 PLICURI LAMINATE DIN COPOLIMER-AL-PE-HÂRTIE A CATE 0,2 MILILITRI PIC. OFT., SOL. P6L 30 1.800333 1.800333 0.000000
28 W57240001 S01EE01 LATANOPROSTUM GLAUTAN 0,05 mg/ml PIC. OFT.,SOL. 0,05mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE CU 1 FLAC. PEJD CU CAPACITATEA DE 5 ML+PICURATOR DIN PEJD, CU CAPAC DE SIGURANTA DIN PEJD X 2,5 ML PIC. OFT., SOL. P6L 1 32.060000 32.060000 0.000000
29 W67251001 S01EE01 LATANOPROSTUM XALATAN 50 µg/ml PICATURI OFT., SOL. 50µg/ml UPJOHN EESV OLANDA CUTIE CU 1 FLAC. PICURATOR DIN PE CONTINÂND 2,5 ML PICATURI OFTALMICE, SOLUTIE, PREVAZUT CU CAPAC CU FILET SI CAPAC SUPLIMENTAR DE PROTECTIE DIN PE P6L 1 36.030000 36.030000 0.000000
30 W60652003 S01EE03 BIMATOPROSTUM BIMAGAN 0,3 mg/ml PIC. OFT., SOL 0,3 mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE X 1 FLACON ALB DIN PEJD CU PICURATOR DIN PEJD SI CAPAC CU INEL DE SIGURANTA DIN PEID X 3ML PICATURI OFTALMICE , SOLUTIE PRF 1 51.220000 51.220000 0.000000

Pagina 27 din 37
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)
31 W61822003 S01EE03 BIMATOPROSTUM BIMAGAN 0,1 mg/ml PIC. OFT., SOL. 0,1mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU UN FLACON DIN PEJD CU PICURATOR DIN PEJD SI CAPAC VERDE- ALBASTRUI DIN PEÎD A 3 ML PICATURI OFTALMICE, SOLUTIE PRF 1 47.400000 47.400000 13.630000
32 W68880001 S01EE03 BIMATOPROSTUM LUMIGAN 0,1mg/ml PIC. OFT., SOL. 0,1mg/ml ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE X 1 FLAC. DIN PEJD X 3 ML PIC. OFT. SOL. P-RF 1 39.500000 39.500000 0.000000
33 W68253001 S01EE03 BIMATOPROSTUM AMIRIOX 0,3 mg/ml PIC. OFT., SOL. 0,3mg/ml SIFI S.P.A. ITALIA CUTIE CU 1 FLAC. PEJD CU CAPACITATEA DE 5 ML, CU APLICATOR DIN PEID X 3 ML PIC. OFT., SOL. PRF 1 51.220000 51.220000 0.000000
34 W55458001 S01EE03 BIMATOPROSTUM LUMIGAN 0,1mg/ml PIC. OFT.,SOL. 0,1mg/ml ALLERGAN PHARMACEUTICALS IRELAND IRLANDA CUTIE X 1 FLAC. DIN PEJD X 3 ML PIC. OFT. SOL. P-RF 1 39.500000 39.500000 0.000000
35 W64506001 S01EE04 TRAVOPROSTUM IZBA PIC. OFT., SOL 30micrograme/ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 FLAC. A 4 ML X 2,5 ML DE TRAVOPROST, PICATURI OFTALMICE, SOLUTIE PRF 1 79.270000 79.270000 0.000000
36 W61045001 S01EE04 TRAVOPROSTUM TRAVOPROST ZENTIVA 40 micrograme/ml PIC. OFT., SOL. 40micrograme/ml ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU 1 FLAC. TRANSLUCID DIN PP CU CAPACITATEA DE 5 ML, CU PICURATOR TRANSPARENT DIN PEJD A 2 ,5 ML PIC. OFT. SOL. P6L 1 50.740000 50.740000 0.000000
37 W66428001 S01EE04 TRAVOPROSTUM TRAVOCOM 40 micrograme/ml PIC. OFT., SOL. 40micrograme/ml S.C. ROMPHARM COMPANY S.R.L ROMANIA CUTIE CU 1 FLAC. DIN PEID PREVAZUT CU PICURATOR DIN PEJD X 2,5 ML PIC. OFT., SOL. P6L 1 43.450000 43.450000 0.000000
38 W62677001 S01EE05 TAFLUPROSTUM ** Ω SAFLUTAN 15 micrograme/ml PIC. OFT., SOL., FIOLA UNIDOZA 15micrograme/ml SANTEN OY FINLANDA CUTIE CU 3 PUNGI A CATE 10 FIOLE UNIDOZA DIN PEJD X 0,3 ML PIC. OFT., SOL. (30 FIOLE) PRF 30 2.279000 2.279000 0.000000
39 W63881001 S01LA05 AFLIBERCEPTUM ** Ω EYLEA 40mg/ml SOL INJ. 40mg/ml BAYER AG PR
GERMANIA CUTIE X 1 FLACON DIN STICLA CU SOLUTIE INJECTABILA+1 AC CU FILTRU 1 3,101.240000 3,101.240000 0.000000
40 W66674001 S01LA06 BROLUCIZUMABUM ** Ω BEOVU 120 mg/ml SOL INJ. IN SERINGA PREUMPLUTA 120mg/ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 SERINGA PREUMPLUTA (0,165 ML SOLUTIE STERILA) PR 1 3,009.370000 3,009.370000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea oftalmologie.

22. PEMFIGUS - G 27

1 W63171002 H02AB02 DEXAMETHASONUM DEXAMETAZONA KRKA 20 mg COMPR. 20mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 20 COMPR. PRF 20 6.795500 6.795500 0.000000
2 W63169002 H02AB02 DEXAMETHASONUM DEXAMETAZONA KRKA 4 mg COMPR. 4mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 20 COMPR. PRF 20 1.720000 1.720000 0.000000
3 W59780001 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU UN SUPORT CU 10 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 10 0.929000 0.929000 0.000000
4 W59780003 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU UN SUPORT CU 25 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 25 0.914000 0.914000 0.000000
5 W59780004 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 100 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. PRF 100 0.823800 0.823800 0.000000
6 W59780005 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU UN SUPORT CU 10 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. PRF 10 1.667520 1.667520 0.150480
7 W59780007 H02AB02 DEXAMETHASONUM DEXAMETAZONA ROMPHARM 4 mg/ml SOL. INJ. 4mg/ml ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 25 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. PRF 25 1.667520 1.667520 0.024480
8 W44063002 H02AB02 DEXAMETHASONUM DEXAMETHASONE SODIUM PHOSPHATE 8 mg/2 ml SOL. INJ. 8mg/2ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 100 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. P-RF 100 1.389600 1.389600 0.000000
9 W44063001 H02AB02 DEXAMETHASONUM DEXAMETHASONE SODIUM PHOSPHATE 8 mg/2 ml SOL. INJ. 8mg/2ml E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. P-RF 5 1.667520 1.667520 0.148480
10 W08299001 H02AB02 DEXAMETHASONUM DEXAMED 8 mg/2 ml SOL. INJ. 8mg/2ml MEDOCHEMIE LTD. CIPRU CUTIE X 10 FIOLE DIN STICLA BRUNA X 2 ML SOL. INJ. P-RF 10 1.667520 1.667520 0.150480
11 W04224001 H02AB04 METHYLPREDNISOLONUM MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 5 BLIST. A-PVC/PVC X 10 COMPR. P-RF 50 0.811200 0.811200 0.000000
12 W65156001 H02AB04 METHYLPREDNISOLONUM MEDROL A 16 mg COMPR. 16mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 5 BLIST. AL-PVC/PVC X 10 COMPR. PRF 50 0.811200 0.811200 0.000000
13 W04222001 H02AB04 METHYLPREDNISOLONUM MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL-PVC/PVC X 10 COMPR. P-RF 20 3.329000 3.329000 0.000000
14 W65157001 H02AB04 METHYLPREDNISOLONUM MEDROL 32 mg COMPR. 32mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL-PVC/PVC X 10 COMPR. PRF 20 3.329000 3.329000 0.000000
15 W08307001 H02AB04 METHYLPREDNISOLONUM LEMOD SOLU 125 mg PULB+SOLV. PT. SOL. INJ./PERF. 125mg STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. X 2 ML PRF 1 36.290000 36.290000 0.000000
16 W08310001 H02AB04 METHYLPREDNISOLONUM LEMOD SOLU 500 mg PULB+SOLV. PT. SOL. INJ./PERF. 500mg STADA HEMOFARM S.R.L. ROMANIA CUTIE X 1 FLAC. LIOF. + 1 FIOLA SOLV. X 7,8 ML PRF 1 98.000000 98.000000 0.000000
17 W05242001 H02AB07 PREDNISONUM PREDNISON MCC 5 mg COMPR. 5mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
18 W12565002 H02AB07 PREDNISONUM PREDNISON ARENA 5 mg COMPR. 5mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
19 W13686002 H02AB07 PREDNISONUM PREDNISON SINTOFARM 5 mg COMPR. 5mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 0.175000 0.175000 0.000000
20 W53341001 H02AB07 PREDNISONUM PREDNISONA-RICHTER 5 mg COMPR. 5mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL./PVC X 10 COMPR. P-RF 20 0.175000 0.175000 0.000000
21 W68707001 J04BA02 DAPSONUM (4) DISULONE COMPR. DIVIZ. 100mg BIO EEL S.R.L. ROMANIA CUTIE X 100 COMPR. DIVIZIBILE PRF 100 1.239100 1.239100 0.000000
22 W68692001 L01AA01 CYCLOPHOSPHAMIDUM CICLOFOSFAMIDA DR. REDDY'S 1000 mg/2ml CONC. PT. SOL. INJ./PERF. 1000mg/2ml DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 FLAC. DIN STICLA TUBULARA, INCOLORA, CU CAPACITATE DE 2 ML, CU CONC. PT. SOL. PERF./INJ. PR 1 506.850000 506.850000 0.000000
23 W68693001 L01AA01 CYCLOPHOSPHAMIDUM CICLOFOSFAMIDA DR. REDDY'S 2000 mg/4ml CONC. PT. SOL. INJ./PERF. 2000mg/4ml DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 FLAC. DIN STICLA TUBULARA, INCOLORA, CU CAPACITATE DE 5 ML, CU CONC. PT. SOL. PERF./INJ. PR 1 724.850000 724.850000 0.000000
24 W68691001 L01AA01 CYCLOPHOSPHAMIDUM CICLOFOSFAMIDA DR. REDDY'S 500 mg/ml CONC. PT. SOL. INJ./PERF. 500mg/ml DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 1 FLAC. DIN STICLA TUBULARA, INCOLORA, CU CAPACITATE DE 2 ML, CU CONC. PT. SOL. PERF./INJ. PR 1 268.580000 268.580000 0.000000
25 W12490001 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 50 mg DRAJ. 50mg BAXTER ONCOLOGY GMBH GERMANIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 DRAJ. P-RF 50 1.240400 1.240400 0.000000
26 W52215001 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 200 mg PULB. PT. SOL. INJ. / PERF. 200mg ACTAVIS S.R.L. ROMANIA CUTIE X 1 FLAC. PULB. PT. SOL. PERF./INJ S 1 59.270000 59.270000 0.000000
27 W64372001 L01AA01 CYCLOPHOSPHAMIDUM ENDOXAN 200 mg PULB. PT. SOL. PERF./INJ. 200mg TEVA B.V. OLANDA CUTIE CU 1 FLAC. DIN STICLA INCOLORA PULB. PT. SOL. PERF./INJ PR 1 59.270000 59.270000 0.000000
28 W51399001 L04AD01 CICLOSPORINUM SANDIMMUN NEORAL 25 mg CAPS. MOI 25mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 BLIST. X 5 CAPS. MOI PR 50 1.789800 1.789800 0.000000
29 W51398001 L04AD01 CICLOSPORINUM SANDIMMUN NEORAL 50 mg CAPS. MOI 50mg NOVARTIS PHARMA GMBH GERMANIA CUTIE X 10 BLIST. X 5 CAPS. MOI PR 50 3.281200 3.281200 0.000000
30 W60846001 L04AX01 AZATHIOPRINUM IMURAN 50 mg COMPR. FILM. 50mg ASPEN PHARMA TRADING LIMITED IRLANDA CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. P-RF 100 0.654500 0.654500 0.000000

Tratamentul se iniţiază de către medicul în specialitatea dermatologie.

23. BOALA GAUCHER - G 29

1 W69543003 A16AB02 IMIGLUCERASUM **1 CEREZYME 400U PULB. PT. CONC. PT. SOL. PERF. 400U SANOFI B.V. TARILE DE JOS CUTIE X 1 FLAC. PULB. PT. CONC. PT. SOL. PERF. PR 1 6,295.020000 6,295.020000 0.000000
2 W08253003 A16AB02 IMIGLUCERASUM **1 CEREZYME 400U PULB. PT.CONC. PT.SOL. PERF. 400U GENZYME EUROPE BV OLANDA CUTIE X 1 FLAC. PULB. PT. CONC. PT. SOL. PERF. PR 1 6,295.020000 6,295.020000 0.000000
3 W61994001 A16AB10 VELAGLUCERASE ALFA **1 VPRIV 400 unitati PULB. PT. SOL. PERF. 400unitati IRLANDA
Shire Pharmaceuticals Ireland Limited 5 FLAC. DIN STICLA X 400 UNITATI PULBERE PT. SOL. PERF. PR 5 5,196.836000 5,196.836000 0.000000
4 W68150001 A16AB10 VELAGLUCERASE ALFA **1 VPRIV 400 unitati PULB. PT. SOL. PERF. 400unitati IRLANDA
TAKEDA PHARMACEUTICALS INTERNATIONAL AG IRELAND BR 5 FLAC. DIN STICLA X 400 UNITATI PULBERE PT. SOL. PERF. PR 5 5,196.836000 5,196.836000 0.000000
5 W65802002 A16AX06 MIGLUSTATUM **1 MIGLUSTAT ACCORD 100 mg CAPS. 100mg ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU BLIST. PVC-PE-PCTFE/AL X 84X1 PR 84 134.548095 134.548095 0.000000
6 W63456001 A16AX10 ELIGLUSTAT **1 CERDELGA 84 mg CAPS. 84mg GENZYME EUROPE B.V., OLANDA CUTIE CU BLIST. DIN PETG/COC.PETG/PCTFE-ALUMINIU X 56 CAPS. PR 56 1,558.946428 1,558.946428 0.000000

Pagina 28 din 37
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)
După precizarea diagnosticului de către laboratoarele de specialitate, tratamentul se iniţiază de către medicul din specialitatea gastroenterologie, hematologie, neurologie, neurologie pediatrică şi pediatrie.

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

1 W56642001 J01AA02 DOXYCYCLINUM DOXICICLINA ATB 100 mg CAPS. 100 mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 0.530000 0.530000 0.000000
2 W02885004 J01AA02 DOXYCYCLINUM DOXICICLINA ARENA 100 mg CAPS. 100mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 0.531000 0.531000 0.000000
3 W12701001 J01AA07 TETRACYCLINUM TETRACICLINA ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST., AL/PVC X 10 CAPS. P-RF 20 0.428500 0.428500 0.000000
4 W56910001 J01AA07 TETRACYCLINUM TETRACICLINA ATB 250 mg CAPS. 250mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. PRF 20 0.514200 0.514200 0.256300
5 W00574005 J01CE01 BENZYLPENICILLINUM PENICILINA G SODICA ATB 1000000UI PULB. PT. SOL. INJ. 1 000 000ui ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN STICLA CU PULB. PT. SOL. INJ. PRF 100 10.954500 10.954500 0.000000
6 W00574004 J01CE01 BENZYLPENICILLINUM PENICILINA G SODICA ATB 1000000UI PULB. PT. SOL. INJ. 1 000 000ui ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. SOL. INJ. P-RF 1 13.145400 13.145400 3.374600
7 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 11.663000 11.663000 0.000000
8 W58283004 J01CE01 BENZYLPENICILLINUM PENICILINA G POTASICA ATB 1000000 UI PULB. PT. SOL. INJ. 1000000ui ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. SOL. INJ. P-RF 1 13.145400 13.145400 3.374600
9 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 11.663000 11.663000 0.000000
10 W58283005 J01CE01 BENZYLPENICILLINUM PENICILINA G POTASICA ATB 1000000 UI PULB. PT. SOL. INJ. 1000000ui ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN STICLA CU PULB. PT. SOL. INJ. P-RF/S 100 10.954500 10.954500 0.000000
11 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 12.853000 12.853000 0.000000
12 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 12.853000 12.853000 0.000000
13 W00576005 J01CE01 BENZYLPENICILLINUM PENICILINA G SODICA ATB 400000 UI PULB. PT. SOL. INJ. 400 000ui ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN STICLA CU PULB. PT. SOL. INJ. PRF 100 8.676500 8.676500 0.000000
14 W00576004 J01CE01 BENZYLPENICILLINUM PENICILINA G SODICA ATB 400000 UI PULB. PT. SOL. INJ. 400 000ui ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. SOL. INJ. P-RF 1 10.411800 10.411800 2.428200
15 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 9.385200 9.385200 0.000000
16 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 10.353000 10.353000 0.000000
17 W41595001 J01CE02 PHENOXYMETHYLPENICILLINUM OSPEN 1000 COMPR. FILM. 1000000ui SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. AL/PVC-PVDC X 12 COMPR. FILM. P-RF 12 0.660000 0.660000 0.000000
18 W41594003 J01CE02 PHENOXYMETHYLPENICILLINUM OSPEN 1500 COMPR. FILM. 1500000ui SANDOZ GMBH AUSTRIA CUTIE X 2 BLIST. AL/PVC-PVDC X 6 COMPR. FILM. P-RF 12 0.890000 0.890000 0.000000
19 W41596001 J01CE02 PHENOXYMETHYLPENICILLINUM OSPEN 500 COMPR. FILM. 500000ui SANDOZ GMBH AUSTRIA CUTIE X 1 BLIST. AL/PVC-PVDC X 12 COMPR. FILM. P-RF 12 0.355833 0.355833 0.000000
20 W55413001 J01CE02 PHENOXYMETHYLPENICILLINUM OSPEN 400.000 U.I./5 ml SUSP. ORALA 400.000U.I./5ml SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 60 ML SUSP. ORALA CU CAPAC SI LINGURITA DOZATOARE P-RF 1 11.370000 11.370000 0.000000
21 W55416003 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA, CAPACITATE 10 ML CONTINAND PULB. PT. SUSP. INJ. I.M. P-RF 1 39.391320 39.391320 7.628680
22 W55416001 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA, CAPACITATE 10 ML CONTINAND PULB. PT. SUSP. INJ. I.M. PRF 50 33.534800 33.534800 0.000000
23 W55416002 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA CUTIE CU 100 FLAC. DIN STICLA INCOLORA, CAPACITATE 10 ML CONTINAND PULB. PT. SUSP. INJ. I.M. P-RF 100 32.826100 32.826100 0.000000
24 W55416004 J01CE08 BENZATHINI BENZYLPENICILLINUM MOLDAMIN 1200000 UI PULB. PT. SUSP. INJ. 1200000UI ANTIBIOTICE S.A. ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA, CAPACITATE 10 ML CONTINAND PULB. PT. SUSP. INJ. I.M. PRF 10 39.145000 39.145000 0.000000
25 W57455001 J01DD08 CEFIXIMUM EFICEF 100 mg CAPS. 100mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 2.851000 2.851000 0.000000
26 W13701001 J01DD08 CEFIXIMUM EFICEF 200 mg CAPS. 200mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 5.219000 5.219000 0.000000
27 W68974005 J01DD08 CEFIXIMUM CEFIXIMA STADA 200 mg COMPR. FILM. 200mg STADA M&D SRL ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 10 COMPR. FILM. PRF 10 5.080000 5.080000 0.000000
28 W60256001 J01DD08 CEFIXIMUM XIFIA 400mg COMPR. FILM. 400mg INN-FARM D.O.O. SLOVENIA CUTIE CU UN BLISTER PVC-PVDC/AL X 5 COMPRIMATE FILMATE PRF 5 10.394400 10.394400 1.599600
29 W60256003 J01DD08 CEFIXIMUM XIFIA 400mg COMPR. FILM. 400mg INN-FARM D.O.O. SLOVENIA CUTIE CU 2 BLISTERE PVC-PVDC/AL A CATE 5 COMPRIMATE FILMATE PRF 10 10.394400 10.394400 0.250600
30 W68975007 J01DD08 CEFIXIMUM CEFIXIMA STADA 400 mg COMPR. FILM. 400mg STADA M&D SRL ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 10 COMPR. FILM. PRF 10 8.662000 8.662000 0.000000
31 W61965002 J01DD08 CEFIXIMUM XIFIA 100 mg/5 ml GRANULE PT. SUSP. ORALA 100mg/5ml INN-FARM D.O.O. SLOVENIA CUTIE CU 1 FLAC. DIN STICLA BRUNA, CU CAPCITATEA DE 150 ML CARE CONTINE 53 G GRAN. PT. SUSP. ORALA+1 MASURA DOZATOARE DIN PP PT. MASURAREA VOLUMULUI DE SOLVENT GRADATA LA 66 ML+1 SERINGA DOZATOARE DIN PLASTIC A 5 ML, GRADATA DE LA 0,5 ML PANA LA 5 ML PRF 1 96.710000 96.710000 0.000000
32 W61210001 J01FA01 ERYTHROMYCINUM ERITROMICINA ATB 200 mg COMPR. 200mg ANTIBIOTICE SA ROMANIA CUTIE CU 2 BLIST. AL/PVC X 10 COMPR. PRF 20 0.924500 0.924500 0.000000
33 W00517001 J01FA10 AZITHROMYCINUM SUMAMED 250 mg CAPS. 250mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 1 BLIST. PVC-PVDC/AL X 6 CAPS. P-RF 6 3.645999 3.645999 1.960667
34 W64359001 J01FA10 AZITHROMYCINUM SUMAMED 250 mg CAPS. 250mg TEVA B.V. OLANDA CUTIE CU 1 BLIST. PVC-PVDC/AL X 6 CAPS. P-RF 6 3.645999 3.645999 1.960667
35 W00518001 J01FA10 AZITHROMYCINUM SUMAMED 125 mg COMPR. FILM. 125mg PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 1 BLIST. AL/PVC X 6 COMPR. FILM. P-RF 6 5.270000 5.270000 0.000000
36 W64356001 J01FA10 AZITHROMYCINUM SUMAMED 125 mg COMPR. FILM. 125mg TEVA B.V. OLANDA CUTIE CU 1 BLIST. PVC/AL X 6 COMPR. FILM. PRF 6 5.270000 5.270000 0.000000
37 W42879004 J01FA10 AZITHROMYCINUM AZITROMICINA SANDOZ 250 mg COMPRIMATE FILMATE COMPR. FILM. 250mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. X 6 COMPR. FILM. P-RF 6 3.038333 3.038333 0.000000
38 W42878001 J01FA10 AZITHROMYCINUM AZITROMICINA SANDOZ 500 mg COMPRIMATE FILMATE COMPR. FILM. 500mg SANDOZ S.R.L. ROMANIA CUTIE X 1 BLIST. X 3 COMPR. FILM. P-RF 3 3.990000 3.990000 0.000000
39 W43486001 J01FA10 AZITHROMYCINUM AZIBIOT 500 mg COMPR. FILM. 500mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 1 BLIST. AL/PVC X 3 COMPR. FILM. P-RF 3 4.788000 4.788000 2.325333
40 W52840001 J01FA10 AZITHROMYCINUM AZITROMICINA TERAPIA 500 mg COMPR. FILM. 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PVC-ACLAR/AL X 3 COMPR. FILM. P-RF 3 4.788000 4.788000 2.325333
41 W52840002 J01FA10 AZITHROMYCINUM AZITROMICINA TERAPIA 500 mg COMPR. FILM. 500mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. PA-AL-PVC/AL X 3 COMPR. FILM. P-RF 3 4.788000 4.788000 2.325333
42 W57032001 J01FA10 AZITHROMYCINUM AZITROX 500 mg COMPR. FILM. 500mg ZENTIVA K.S. CEHIA CUTIE X 1 BLIST. AL/PVC X 3 COMPR. FILM. P-RF 3 4.788000 4.788000 1.122000
43 W60406001 J01FA10 AZITHROMYCINUM AZITROMICINA ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE CU 1 BLIST. AL/PVC X 3 COMPR. FILM. PRF 3 4.788000 4.788000 2.325333
44 W64357001 J01FA10 AZITHROMYCINUM SUMAMED 500 mg COMPR. FILM. 500mg TEVA B.V. OLANDA CUTIE CU 1 BLIST. PVC/AL X 3 COMPR. FILM. PRF 3 4.788000 4.788000 6.158666
45 W66687001 J01FA10 AZITHROMYCINUM AZITROMICINA ROMPHARM 500 mg PULB. PT. SOL. PERF. 500mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA TRANSPARENTA PRF 1 43.230000 43.230000 0.000000
46 W66687002 J01FA10 AZITHROMYCINUM AZITROMICINA ROMPHARM 500 mg PULB. PT. SOL. PERF. 500mg ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 5 FLAC. DIN STICLA TRANSPARENTA PRF 5 36.374000 36.374000 0.000000
47 W42901001 J01FA10 AZITHROMYCINUM AZITROMICINA SANDOZ 100 mg/5 ml PULB. PT. SUSP. ORALA 100mg/5ml SANDOZ SRL ROMANIA CUTIE CU 1 FLAC. PEID + 1 SERINGA DOZATOARE DIN PE/PP (10 ML) GRADATA IN DIVIZIUNI DE 0,25 ML CONTINAND PULB. PT 20 ML (400 MG) SUSP. ORALA P-RF 1 22.370000 22.370000 0.000000
48 W42877002 J01FA10 AZITHROMYCINUM AZITROMICINA SANDOZ 200 mg/5 ml PULB. PT. SUSP. ORALA 200 mg/5 ml SANDOZ SRL ROMANIA CUTIE CU 1 FLAC. PEID + 1 SERINGA DOZATOARE DIN PE/PP (10 ML) GRADATA IN DIVIZIUNI DE 0,25 ML CONTINAND PULB. PT 20 ML (800 MG) SUSP. ORALA P-RF 1 18.090000 18.090000 0.000000
49 W00520001 J01FA10 AZITHROMYCINUM SUMAMED FORTE PULB. PT. SUSP. ORALA 200mg/5ml PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 1 FLAC. DIN PEID CU PULB. PT. 30 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-RF 1 40.250000 40.250000 0.000000
50 W64358002 J01FA10 AZITHROMYCINUM SUMAMED FORTE 200 mg/5 ml PULB. PT. SUSP. ORALA 200mg/5ml TEVA B.V. OLANDA CUTIE CU 1 FLAC. DIN PEID CONTINAND PULB. PT. 30 ML SUSP. ORALA, O SERINGA PT. ADMINISTRARE ORALA DIN PE/PS SAU PP/PP SI O LINGURITA DOZATOARE PRF 1 40.250000 40.250000 0.000000
51 W00520003 J01FA10 AZITHROMYCINUM SUMAMED FORTE PULB. PT. SUSP. ORALA 200mg/5ml PLIVA LJUBLJANA D.O.O. SLOVENIA CUTIE X 1 FLAC. DIN PEID CU PULB. PT. 37,5 ML SUSP. ORALA + SERINGA SI LINGURITA DOZATOARE P-RF 1 49.980000 49.980000 0.000000
52 W64358003 J01FA10 AZITHROMYCINUM SUMAMED FORTE 200 mg/5 ml PULB. PT. SUSP. ORALA 200mg/5ml TEVA B.V. OLANDA CUTIE CU 1 FLAC. DIN PEID CONTINAND PULB. PT. 37,5 ML SUSP. ORALA, O SERINGA PT. ADMINISTRARE ORALA DIN PE/PS SAU PP/PP SI O LINGURITA DOZATOARE PRF 1 49.980000 49.980000 0.000000
53 W53281001 J01FA10 AZITHROMYCINUM AZITROX 200 mg/5 ml PULB. PT. SUSP. ORALA 200mg/5ml ZENTIVA S.A. ROMANIA CUTIE CU 1 FLAC. DIN PEÎD PREVAZUT CU SISTEM DE ÎNCHIDERE SECURIZAT PT COPII DIN PP,CONTINÂND PULBERE PENTRU 15 ML SUSPENSIE ORALA RECONSTITUITA,1 LINGURITA DOZATOARE, 1 SERINGA PENTRU ADMINISTRARE ORALA CU CAPACITATEA DE 10 ML, 1 MASURA DOZATOARE P-RF 1 18.430000 18.430000 0.000000
54 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 4.633000 4.633000 0.000000
55 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 0.803000 0.803000 0.000000
56 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 0.901000 0.901000 0.000000

Pagina 29 din 37
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)
57 W01288001 J01MA02 CIPROFLOXACINUM CIPROLEN 250 mg COMPR. FILM. 250mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.915000 0.915000 0.000000
58 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 0.915000 0.915000 0.000000
59 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 0.915000 0.915000 0.000000
60 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 0.915500 0.915500 0.000000
61 W65056001 J01MA02 CIPROFLOXACINUM CIFRAN 250 mg COMPR. FILM. 250mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. PRF 10 0.915000 0.915000 0.000000
62 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 0.803000 0.803000 0.000000
63 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 0.967200 0.967200 0.386800
64 W44076001 J01MA02 CIPROFLOXACINUM CIPROCIN 500 mg COMPR. FILM. 500mg E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 10 0.967200 0.967200 0.565800
65 W01289001 J01MA02 CIPROFLOXACINUM CIPROLEN 500 mg COMPR. FILM. 500mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.967200 0.967200 0.779800
66 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 0.967200 0.967200 0.779800
67 W12545001 J01MA02 CIPROFLOXACINUM CIPRO QUIN 500 mg COMPR. FILM. 500mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 10 0.967200 0.967200 0.779800
68 W54039001 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 10 0.967200 0.967200 0.779800
69 W54039002 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ARENA 500 mg COMPR. FILM. 500mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 20 0.967200 0.967200 0.724300
70 W65057001 J01MA02 CIPROFLOXACINUM CIFRAN 500 mg COMPR. FILM. 500mg TERAPIA S.A. ROMANIA CUTIE CU 1 BLIST. PVC/PVDC-AL X 10 COMPR. FILM. PRF 10 0.967200 0.967200 0.779800
71 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 0.806000 0.806000 0.000000
72 W42772001 J01MA02 CIPROFLOXACINUM CIPRINOL 750 mg COMPR. FILM. 750mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 1 BLIST. AL/PVC-PVDC X 10 COMPR. FILM. P-RF 10 4.633000 4.633000 0.000000
73 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 4.633000 4.633000 0.000000
74 W01275001 J01MA02 CIPROFLOXACINUM CIPRINOL 100 mg/10 ml CONC. PT. SOL. PERF. 100mg/10ml KRKA D.D. SLOVENIA CUTIE X 5 FIOLE X 10 ML PR 5 4.444000 4.444000 0.000000
75 W60268001 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA ZENTIVA 10 mg/ml CONC. PT. SOL. PERF. 100mg/10ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA PREVAZUTE CU INEL DE RUPERE X 10 ML PR 5 4.444000 4.444000 0.000000
76 W68020002 J01MA02 CIPROFLOXACINUM CIPROFLOXACINA VIOSER 2 mg/ml SOL. PERF. 2mg/ml GRECIA CUTIE CU 10 FLAC. TRANSPARENTE DIN PEJD X 200 ML SOL. PERF. PR
VIOSER S.A. PARENTERAL SOLUTIONS INDUSTRY 10 17.925000 17.925000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea dermatologie şi obstetrică-ginecologie (pentru gonoree şi infecţia cu Chlamidia).

IMUNOSUPRESOARE SELECTIVE - G31


25. BOALA CRONICĂ INFLAMATORIE INTESTINALĂ ŞI SINDROM DE INTESTIN SCURT - G31a

1 W68911001 A16AX08 TEDUGLUTIDUM **1 REVESTIVE PULB.+SOLV. PT. SOL. INJ. 1,25mg TAKEDA PHARMACEUTICALS INTERNATIONAL AG IRELAND BR IRLANDA AMBALAJ CU 28 FLACOANE DE PULBERE SI 28 SERINGI PREUMPLUTE PR 28 1,474.482857 1,474.482857 0.000000
2 W68912001 A16AX08 TEDUGLUTIDUM **1 REVESTIVE PULB.+SOLV. PT. SOL. INJ. 5mg TAKEDA PHARMACEUTICALS INTERNATIONAL AG IRELAND BR IRLANDA AMBALAJ CU 1 FLACON DE PULBERE SI O SERINGA PREUMPLUTA PR 1 3,044.480000 3,044.480000 0.000000
3 W68912002 A16AX08 TEDUGLUTIDUM **1 REVESTIVE PULB.+SOLV. PT. SOL. INJ. 5mg TAKEDA PHARMACEUTICALS INTERNATIONAL AG IRELAND BR IRLANDA AMBALAJ CU 28 FLACOANE DE PULBERE SI 28 SERINGI PREUMPLUTE PR 28 2,976.158928 2,976.158928 0.000000
4 W66585001 A16AX08 TEDUGLUTIDUM **1 REVESTIVE PULB+SOLV. PT. SOL. INJ 1,25mg Shire Pharmaceuticals Ireland Limited IRLANDA AMBALAJ CU 28 FLACOANE DE PULBERE SI 28 SERINGI PREUMPLUTE PR 28 1,474.482857 1,474.482857 0.000000
5 W66586001 A16AX08 TEDUGLUTIDUM **1 REVESTIVE PULB+SOLV. PT. SOL. INJ 5mg Shire Pharmaceuticals Ireland Limited IRLANDA AMBALAJ CU 1 FLACON DE PULBERE SI O SERINGA PREUMPLUTA PR 1 3,044.480000 3,044.480000 0.000000
6 W66586002 A16AX08 TEDUGLUTIDUM **1 REVESTIVE PULB+SOLV. PT. SOL. INJ 5mg Shire Pharmaceuticals Ireland Limited IRLANDA AMBALAJ CU 28 FLACOANE DE PULBERE SI 28 SERINGI PREUMPLUTE PR 28 2,976.158928 2,976.158928 0.000000
7 W63432001 L04AA29 TOFACITINIB **1 Ω XELJANZ 5 mg COMPR. FILM. 5mg PFIZER LIMITED MAREA BRITANIE CUTIE CU 4 BLISTERE DIN AL/PVC/AL X 14 COMPR. FILM. PR 56 56.136428 56.136428 0.000000
8 W65118001 L04AA29 TOFACITINIB **1 Ω XELJANZ 5 mg COMPR. FILM. 5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 4 BLISTERE DIN AL/PVC/AL X 14 COMPR. FILM PR 56 56.136428 56.136428 0.000000
9 W61129001 L04AA33 VEDOLIZUMABUM **1 ENTYVIO 300mg PULB. PT.CONC. PT.SOL. PERF. 300mg TAKEDA PHARMA A/S DANEMARCA CUTIE CU 1 FLACON X 300MG PULBERE PENTRU CONCENTRAT PENTRU SOLUTIE PERFUZABILA PR 1 6,714.400000 6,714.400000 0.000000
10 W66899001 L04AA33 VEDOLIZUMABUM **1 ENTYVIO 108 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 108mg TAKEDA PHARMA A/S DANEMARCA 1 STILOU INJECTOR (PEN) PREUMPLUT CARE CONTINE 108 MG VEDOLIZUMAB PR 1 1,731.740000 1,731.740000 0.000000
11 W57617003 L04AB02 INFLIXIMABUM **1 REMICADE 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 3 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 3 1,016.856000 1,016.856000 727.154000
12 W60071001 L04AB02 INFLIXIMABUM **1 REMSIMA 100mg PULB. PT. CONC. PT. SOL. PERF. 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 847.380000 847.380000 0.000000
13 W64826001 L04AB02 INFLIXIMABUM **1 INFLECTRA 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 868.740000 868.740000 0.000000
14 W65000001 L04AB02 INFLIXIMABUM **1 ZESSLY 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 901.380000 901.380000 0.000000
15 W66531005 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 SERINGI PREUMPLUTE CU PROTECTIE PENTRU AC+ 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
16 W66531007 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 1STILOU INJECTOR PREUMPLUT + 2 TAMPOANE DE ALCOOL PR 1 1,628.440000 1,628.440000 0.000000
17 W66531008 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 STILOURI INJECTOARE PREUMPLUTE + 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
18 W66531009 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 4 STILOURI INJECTOARE PREUMPLUTE + 4 TAMPOANE DE ALCOOL PR 4 1,575.325000 1,575.325000 0.000000
19 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 1,001.268000 1,001.268000 114.142000
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 2 953.870000 953.870000 0.000000
21 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 834.390000 834.390000 0.000000
22 W64711001 L04AB04 ADALIMUMABUM **1 HUMIRA 80 mg SOL INJ. IN PEN PREUMPLUT 80mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 1 BLIST. CE CONTINE UN PEN PREUMPLUT (0,8 ML SOLUTIE STERILA) SI DOUA TAMPOANE CU ALCOOL. PR 1 2,396.655999 2,396.655999 216.444001
23 W64674001 L04AB04 ADALIMUMABUM **1 HUMIRA 20 mg SOL INJ. IN SERINGA PREUMPLUTA 20mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 1 BLIST. CE CONTINE 2 SERINGI PREUMPLUTE (0,2 ML SOLUTIE STERILA) SI DOUA TAMPOANE CU ALCOOL PR 2 520.545000 520.545000 0.000000
24 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 1,001.268000 1,001.268000 4.337000
25 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg OLANDA
SAMSUNG BIOEPIS NL B.V. CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 953.870000 953.870000 0.000000
26 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 1,001.268000 1,001.268000 5.067000
27 W68332001 L04AB04 ADALIMUMABUM **1 HUKYNDRA 80 mg SOL INJ. IN SERINGA PREUMPLUTA 80mg/0,8ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 1 SERINGA PREUMPLUTA AMBALATA INTR-UN BLISTER DIN PVC/PE X 0,8ML SOL. INJ. + 1 TAMPOAN ALCOOL PR 1 2,396.655999 2,396.655999 1,249.224001
28 W69241001 L04AB04 ADALIMUMABUM **1 YUFLYMA 80 mg SOL INJ. IN SERINGA PREUMPLUTA 80mg/0,8ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA 1 SERINGA PREUMPLUTA (0,8 ML SOLUTIE STERILA) CU 2 TAMPOANE ALCOOL PR 1 2,321.020000 2,321.020000 0.000000
29 W67469002 L04AB04 ADALIMUMABUM **1 YUFLYMA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 PENURI PREUMPLUTE + 2 TAMPOANE ALCOOL PR 2 860.230000 860.230000 0.000000
30 W68331002 L04AB04 ADALIMUMABUM **1 HUKYNDRA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 2 STILOURI PREUMPLUTE AMBALATE INTR-UN BLISTER DIN PVC/PE X 0,4ML SOL. INJ. + 2 TAMPOANE ALCOOL PR 2 1,001.268000 1,001.268000 99.502000
31 W69244001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL. INJ. IN PEN PREUMPLUT 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 PENURI PRE-UMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,001.268000 1,001.268000 4.197000
32 W69242001 L04AB04 ADALIMUMABUM **1 YUFLYMA 80 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 80mg/0,8ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA 1 STILOU PREUMPLUT (0,8 ML SOLUTIE STERILA) CU 2 TAMPOANE ALCOOL PR 1 2,230.070000 2,230.070000 0.000000
33 W69242002 L04AB04 ADALIMUMABUM **1 YUFLYMA 80 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 80mg/0,8ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA 3 STILOURI PREUMPLUTE (0,8 ML SOLUTIE STERILA), FIECARE CU CÂTE 1 TAMPON ALCOOL PR 3 1,997.213333 1,997.213333 0.000000

Pagina 30 din 37
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)
34 W64276001 L04AC05 USTEKINUMAB **1 STELARA 90 mg SOL INJ. IN SERINGA PREUMPLUTA 90mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 SERINGA DE STICLA CU CAPACITATE DE 1 ML X 1 ML SOL. PR 1 10,972.810000 10,972.810000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea gastroenterologie, gastroenterologie pediatrică şi medicină internă.

Pagina 31 din 37
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

1 W64386001 L01XC02 RITUXIMABUM **1 MABTHERA 500 mg CONC. PT. SOL. PERF. 500mg ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 FLACON X 50 ML (500MG RITUXIMAB IN 50ML- 10MG/ML) PR 1 3,142.002000 3,142.002000 838.288000
2 W64513001 L01XC02 RITUXIMABUM **1 RIXATHON 500 mg CONC. PT. SOL. PERF. 500mg SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA DE 50 ML X 500 MG RITUXIMAB PR 1 2,653.760000 2,653.760000 0.000000
3 W64513002 L01XC02 RITUXIMABUM **1 RIXATHON 500 mg CONC. PT. SOL. PERF. 500mg SANDOZ GMBH AUSTRIA CUTIE CU 2 FLAC. DIN STICLA DE 50 ML X 500 MG RITUXIMAB PR 2 2,618.335000 2,618.335000 0.000000
4 W65570001 L04AA24 ABATACEPTUM **1 ORENCIA 250 mg PULB. PT.CONC. PT.SOL. PERF. 250mg BRISTOL-MYERS SQUIBB PHARMA EEIG IRLANDA CUTIE X 1 FLAC. X 250 MG PULB. + 1 SERINGA S 1 1,418.820000 1,418.820000 0.000000
5 W65571005 L04AA24 ABATACEPTUM **1 ORENCIA 125 mg/ml SOL INJ. IN SERINGA PRE-UMPLUTA 125mg/ml BRISTOL-MYERS SQUIBB PHARMA EEIG IRLANDA CUTIE CU 4 SERINGI PREUMPLUTE DIN STICLA CU AC CU GARDA X 125 MG/ML SOL INJ. PR 4 975.760000 975.760000 0.000000
6 W65572001 L04AA24 ABATACEPTUM **1 ORENCIA 125 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 125mg BRISTOL-MYERS SQUIBB PHARMA EEIG IRLANDA 4 STILOURI INJECTOARE (PEN-URI) PREUMPLUTE PR 4 975.760000 975.760000 0.000000
7 W66577001 L04AA29 TOFACITINIB **1 XELJANZ 11 mg COMPR. ELIB. PREL. 11mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 4 BLIST. DIN ALU/PVC/ALU X 7 COMPR. ELIB. PREL. PR 28 120.042500 120.042500 0.000000
8 W66577002 L04AA29 TOFACITINIB **1 XELJANZ 11 mg COMPR. ELIB. PREL. 11mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 13 BLIST. DIN ALU/PVC/ALU X 7 COMPR. ELIB. PREL. PR 91 118.290659 118.290659 0.000000
9 W63432001 L04AA29 TOFACITINIB **1 XELJANZ 5 mg COMPR. FILM. 5mg PFIZER LIMITED MAREA BRITANIE CUTIE CU 4 BLISTERE DIN AL/PVC/AL X 14 COMPR. FILM. PR 56 56.136428 56.136428 0.000000
10 W65118001 L04AA29 TOFACITINIB **1 XELJANZ 5 mg COMPR. FILM. 5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 4 BLISTERE DIN AL/PVC/AL X 14 COMPR. FILM PR 56 56.136428 56.136428 0.000000
11 W65630001 L04AA37 BARICITINIBUM **1 OLUMIANT 2 mg COMPR. FILM. 2mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC/PE/PCTFE/ALU X 35 COMPR. FILM. PR 35 121.130571 121.130571 0.000000
12 W63493001 L04AA37 BARICITINIBUM **1 OLUMIANT 4 mg COMPR. FILM. 4mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC/PE/PCTFE/ALU X 35 COMPR. FILM. PR 35 120.833142 120.833142 0.000000
13 W66589001 L04AA44 UPADACITINIBUM **1 RINVOQ 15 mg COMPR. ELIB. PREL. 15mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU BLISTERE CALENDARISTICE DIN PVC/PE/PCTFE/AL X 28 COMPRIMATE CU ELIBERARE PRELUNGITA PR 28 111.413571 111.413571 0.000000
14 W61297001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 377.530000 377.530000 0.000000
15 W64809001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 FLAC. + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PT. FLAC. + 8 TAMPOANE CU ALCOOL MEDICINAL PR 4 377.530000 377.530000 0.000000
16 W63832001 L04AB01 ETANERCEPTUM **1 ERELZI 50 mg SOL INJ. 50mg SANDOZ GMBH AUSTRIA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE PR 4 535.832500 535.832500 0.000000
17 W65221001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
18 W64810001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 370.355000 370.355000 0.000000
19 W64811002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
20 W64812002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
21 W65222001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL. INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
22 W61299001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 370.355000 370.355000 0.000000
23 W61300002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
24 W61303002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
25 W57617003 L04AB02 INFLIXIMABUM **1 REMICADE 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 3 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 3 1,016.856000 1,016.856000 727.154000
26 W60071001 L04AB02 INFLIXIMABUM **1 REMSIMA 100mg PULB. PT. CONC. PT. SOL. PERF. 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 847.380000 847.380000 0.000000
27 W64826001 L04AB02 INFLIXIMABUM **1 INFLECTRA 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 868.740000 868.740000 0.000000
28 W65000001 L04AB02 INFLIXIMABUM **1 ZESSLY 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 901.380000 901.380000 0.000000
29 W66531005 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 SERINGI PREUMPLUTE CU PROTECTIE PENTRU AC+ 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
30 W66531007 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 1STILOU INJECTOR PREUMPLUT + 2 TAMPOANE DE ALCOOL PR 1 1,628.440000 1,628.440000 0.000000
31 W66531008 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 STILOURI INJECTOARE PREUMPLUTE + 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
32 W66531009 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 4 STILOURI INJECTOARE PREUMPLUTE + 4 TAMPOANE DE ALCOOL PR 4 1,575.325000 1,575.325000 0.000000
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 1,001.268000 1,001.268000 114.142000
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 2 953.870000 953.870000 0.000000
35 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 834.390000 834.390000 0.000000
36 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 1,001.268000 1,001.268000 4.337000
37 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 2 953.870000 953.870000 0.000000
38 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 1,001.268000 1,001.268000 5.067000
39 W67469002 L04AB04 ADALIMUMABUM **1 YUFLYMA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 PENURI PREUMPLUTE + 2 TAMPOANE ALCOOL PR 2 860.230000 860.230000 0.000000
40 W68331002 L04AB04 ADALIMUMABUM **1 HUKYNDRA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 2 STILOURI PREUMPLUTE AMBALATE INTR-UN BLISTER DIN PVC/PE X 0,4ML SOL. INJ. + 2 TAMPOANE ALCOOL PR 2 1,001.268000 1,001.268000 99.502000
41 W69244001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL. INJ. IN PEN PREUMPLUT 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 PENURI PRE-UMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,001.268000 1,001.268000 4.197000
42 W54992001 L04AB05 CERTOLIZUMAB PEGOL **1 CIMZIA SOL. INJ. IN SERINGA PREUMPLUTA 200 mg UCB PHARMA SA BELGIA CUTIE X 2 SERINGI PREUMPLUTE DIN STICLA CU PISTON A 1 ML + 2 TAMPOANE CU ALCOOL P-RF/R 2 1,622.090000 1,622.090000 0.000000
43 W57619001 L04AB06 GOLIMUMAB **1 SIMPONI 50 mg SOL. INJ. 50mg/0,5ml JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML PR 1 3,391.700000 3,391.700000 0.000000
44 W64403003 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 20mg/ml CONC. PT. SOL. PERF. 20mg/ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 FLAC X 10 ML CONC. PT. SOL. PERF. PR 1 1,201.300000 1,201.300000 0.000000
45 W64403005 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 20mg/ml CONC. PT. SOL. PERF. 20mg/ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 FLAC X 20 ML CONC. PT. SOL. PERF. PR 1 2,331.750000 2,331.750000 0.000000
46 W64403001 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 20mg/ml CONC. PT. SOL. PERF. 20mg/ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 FLAC X 4 ML CONC. PT. SOL. PERF. PR 1 523.030000 523.030000 0.000000
47 W64404001 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 162mg SOL. INJ. IN SERINGA PREUMPLUTA 162mg ROCHE REGISTRATION GMBH GERMANIA CUTIE CU 4 SERINGI PREUMPLUTE SISTEM DE PROTECTIE PENTRU AC A CATE 0.9ML SOL. PR 4 809.025000 809.025000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea reumatologie, medicină internă, nefrologie (pentru pacienţii cu afectare renală) şi reabilitarea medicală.

27. ARTROPATIA PSORIAZICA - G31c

1 W66577001 L04AA29 TOFACITINIB **1 Ω XELJANZ 11 mg COMPR. ELIB. PREL. 11mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 4 BLIST. DIN ALU/PVC/ALU X 7 COMPR. ELIB. PREL. PR 28 120.042500 120.042500 0.000000
2 W66577002 L04AA29 TOFACITINIB **1 Ω XELJANZ 11 mg COMPR. ELIB. PREL. 11mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 13 BLIST. DIN ALU/PVC/ALU X 7 COMPR. ELIB. PREL. PR 91 118.290659 118.290659 0.000000
3 W63432001 L04AA29 TOFACITINIB **1 Ω XELJANZ 5 mg COMPR. FILM. 5mg PFIZER LIMITED MAREA BRITANIE CUTIE CU 4 BLISTERE DIN AL/PVC/AL X 14 COMPR. FILM. PR 56 56.136428 56.136428 0.000000
4 W65118001 L04AA29 TOFACITINIB **1 Ω XELJANZ 5 mg COMPR. FILM. 5mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 4 BLISTERE DIN AL/PVC/AL X 14 COMPR. FILM PR 56 56.136428 56.136428 0.000000

Pagina 32 din 37
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)
5 W61297001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 377.530000 377.530000 0.000000
6 W64809001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 FLAC. + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PT. FLAC. + 8 TAMPOANE CU ALCOOL MEDICINAL PR 4 377.530000 377.530000 0.000000
7 W63832001 L04AB01 ETANERCEPTUM **1 ERELZI 50 mg SOL INJ. 50mg SANDOZ GMBH AUSTRIA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE PR 4 535.832500 535.832500 0.000000
8 W65221001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
9 W64810001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 370.355000 370.355000 0.000000
10 W64811002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
11 W64812002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
12 W65222001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL. INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
13 W61299001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 370.355000 370.355000 0.000000
14 W61300002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
15 W61303002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
16 W57617003 L04AB02 INFLIXIMABUM **1 REMICADE 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 3 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 3 1,016.856000 1,016.856000 727.154000
17 W60071001 L04AB02 INFLIXIMABUM **1 REMSIMA 100mg PULB. PT. CONC. PT. SOL. PERF. 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 847.380000 847.380000 0.000000
18 W64826001 L04AB02 INFLIXIMABUM **1 INFLECTRA 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 868.740000 868.740000 0.000000
19 W65000001 L04AB02 INFLIXIMABUM **1 ZESSLY 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 901.380000 901.380000 0.000000
20 W66531005 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 SERINGI PREUMPLUTE CU PROTECTIE PENTRU AC+ 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
21 W66531007 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 1STILOU INJECTOR PREUMPLUT + 2 TAMPOANE DE ALCOOL PR 1 1,628.440000 1,628.440000 0.000000
22 W66531008 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 STILOURI INJECTOARE PREUMPLUTE + 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
23 W66531009 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 4 STILOURI INJECTOARE PREUMPLUTE + 4 TAMPOANE DE ALCOOL PR 4 1,575.325000 1,575.325000 0.000000
24 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 1,001.268000 1,001.268000 114.142000
25 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 2 953.870000 953.870000 0.000000
26 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 834.390000 834.390000 0.000000
27 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 1,001.268000 1,001.268000 4.337000
28 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 2 953.870000 953.870000 0.000000
29 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 1,001.268000 1,001.268000 5.067000
30 W67469002 L04AB04 ADALIMUMABUM **1 YUFLYMA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 PENURI PREUMPLUTE + 2 TAMPOANE ALCOOL PR 2 860.230000 860.230000 0.000000
31 W68331002 L04AB04 ADALIMUMABUM **1 HUKYNDRA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 2 STILOURI PREUMPLUTE AMBALATE INTR-UN BLISTER DIN PVC/PE X 0,4ML SOL. INJ. + 2 TAMPOANE ALCOOL PR 2 1,001.268000 1,001.268000 99.502000
32 W69244001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL. INJ. IN PEN PREUMPLUT 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 PENURI PRE-UMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,001.268000 1,001.268000 4.197000
33 W54992001 L04AB05 CERTOLIZUMAB PEGOL **1 CIMZIA SOL. INJ. IN SERINGA PREUMPLUTA 200 mg UCB PHARMA SA BELGIA CUTIE X 2 SERINGI PREUMPLUTE DIN STICLA CU PISTON A 1 ML + 2 TAMPOANE CU ALCOOL P-RF/R 2 1,622.090000 1,622.090000 0.000000
34 W57619001 L04AB06 GOLIMUMAB **1 SIMPONI 50 mg SOL. INJ. 50mg/0,5ml JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML PR 1 3,391.700000 3,391.700000 0.000000
35 W64460001 L04AC10 SECUKINUMABUM **1 COSENTYX 150 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 150 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 STILOU PREUMPLUT (STILOU SENSO READY) X 1ML SOL. INJ. PR 1 2,366.560000 2,366.560000 0.000000
36 W64460002 L04AC10 SECUKINUMABUM **1 COSENTYX 150 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 150 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 2 STILOURI PREUMPLUTE (STILOU SENSO READY) X 1ML SOL. INJ. PR 2 2,331.135000 2,331.135000 0.000000
37 W67211001 L04AC10 SECUKINUMABUM **1 COSENTYX 300 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 300mg/2ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 STILOU PREUMPLUT (STILOU UNOREADY) X 2ML SOL. INJ. PR 1 4,662.280000 4,662.280000 0.000000
38 W68000001 L04AC13 IXEKIZUMABUM **1 TALTZ SOL INJ. IN STILOU PREUMPLUT 80mg ELI LILLY AND COMPANY (IRELAND) LIMITED IRLANDA CUTIE CU 1 STILOU INJECTOR PREUMPLUT PR 1 4,120.560000 4,120.560000 0.000000
39 W65090002 L04AC16 GUSELKUMABUM **1 Ω TREMFYA 100 mg SOL INJ. 100mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 STILOU INJECTOR (PEN ) PREUMPLUT PR 1 8,568.570000 8,568.570000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea reumatologie şi reabilitare medicală.

28. SPONDILOARTRITA AXIALĂ - G31d

1 W61297001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 377.530000 377.530000 0.000000
2 W64809001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 FLAC. + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PT. FLAC. + 8 TAMPOANE CU ALCOOL MEDICINAL PR 4 377.530000 377.530000 0.000000
3 W63832001 L04AB01 ETANERCEPTUM **1 ERELZI 50 mg SOL INJ. 50mg SANDOZ GMBH AUSTRIA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE PR 4 535.832500 535.832500 0.000000
4 W65221001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
5 W64810001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 370.355000 370.355000 0.000000
6 W64811002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
7 W64812002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
8 W65222001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL. INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
9 W61299001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 370.355000 370.355000 0.000000
10 W61300002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
11 W61303002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
12 W57617003 L04AB02 INFLIXIMABUM **1 REMICADE 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 3 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 3 1,016.856000 1,016.856000 727.154000
13 W60071001 L04AB02 INFLIXIMABUM **1 REMSIMA 100mg PULB. PT. CONC. PT. SOL. PERF. 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 847.380000 847.380000 0.000000
14 W64826001 L04AB02 INFLIXIMABUM **1 INFLECTRA 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 868.740000 868.740000 0.000000
15 W65000001 L04AB02 INFLIXIMABUM **1 ZESSLY 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 901.380000 901.380000 0.000000
16 W66531005 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 SERINGI PREUMPLUTE CU PROTECTIE PENTRU AC+ 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
17 W66531007 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 1STILOU INJECTOR PREUMPLUT + 2 TAMPOANE DE ALCOOL PR 1 1,628.440000 1,628.440000 0.000000
18 W66531008 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 STILOURI INJECTOARE PREUMPLUTE + 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000

Pagina 33 din 37
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)
19 W66531009 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 4 STILOURI INJECTOARE PREUMPLUTE + 4 TAMPOANE DE ALCOOL PR 4 1,575.325000 1,575.325000 0.000000
20 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 1,001.268000 1,001.268000 114.142000
21 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 2 953.870000 953.870000 0.000000
22 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 834.390000 834.390000 0.000000
23 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 1,001.268000 1,001.268000 4.337000
24 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg OLANDA
SAMSUNG BIOEPIS NL B.V. CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 953.870000 953.870000 0.000000
25 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 1,001.268000 1,001.268000 5.067000
26 W67469002 L04AB04 ADALIMUMABUM **1 YUFLYMA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 PENURI PREUMPLUTE + 2 TAMPOANE ALCOOL PR 2 860.230000 860.230000 0.000000
27 W68331002 L04AB04 ADALIMUMABUM **1 HUKYNDRA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 2 STILOURI PREUMPLUTE AMBALATE INTR-UN BLISTER DIN PVC/PE X 0,4ML SOL. INJ. + 2 TAMPOANE ALCOOL PR 2 1,001.268000 1,001.268000 99.502000
28 W69244001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL. INJ. IN PEN PREUMPLUT 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 PENURI PRE-UMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,001.268000 1,001.268000 4.197000
29 W54992001 L04AB05 CERTOLIZUMAB PEGOL **1 CIMZIA SOL. INJ. IN SERINGA PREUMPLUTA 200 mg UCB PHARMA SA BELGIA CUTIE X 2 SERINGI PREUMPLUTE DIN STICLA CU PISTON A 1 ML + 2 TAMPOANE CU ALCOOL P-RF/R 2 1,622.090000 1,622.090000 0.000000
30 W57619001 L04AB06 GOLIMUMAB **1 SIMPONI 50 mg SOL. INJ. 50mg/0,5ml JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML PR 1 3,391.700000 3,391.700000 0.000000
31 W64460001 L04AC10 SECUKINUMABUM **1 COSENTYX 150 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 150 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 STILOU PREUMPLUT (STILOU SENSO READY) X 1ML SOL. INJ. PR 1 2,366.560000 2,366.560000 0.000000
32 W64460002 L04AC10 SECUKINUMABUM **1 COSENTYX 150 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 150 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 2 STILOURI PREUMPLUTE (STILOU SENSO READY) X 1ML SOL. INJ. PR 2 2,331.135000 2,331.135000 0.000000
33 W67211001 L04AC10 SECUKINUMABUM **1 COSENTYX 300 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 300mg/2ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 STILOU PREUMPLUT (STILOU UNOREADY) X 2ML SOL. INJ. PR 1 4,662.280000 4,662.280000 0.000000
34 W68000001 L04AC13 IXEKIZUMABUM **1 Ω TALTZ SOL INJ. IN STILOU PREUMPLUT 80mg ELI LILLY AND COMPANY (IRELAND) LIMITED IRLANDA CUTIE CU 1 STILOU INJECTOR PREUMPLUT PR 1 4,120.560000 4,120.560000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea reumatologie, medicină internă şi reabilitare medicală.

Pagina 34 din 37
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 - G31e

1 W65570001 L04AA24 ABATACEPTUM **1 ORENCIA 250 mg PULB. PT.CONC. PT.SOL. PERF. 250mg BRISTOL-MYERS SQUIBB PHARMA EEIG IRLANDA CUTIE X 1 FLAC. X 250 MG PULB. + 1 SERINGA S 1 1,418.820000 1,418.820000 0.000000
2 W61297001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 377.530000 377.530000 0.000000
3 W64809001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 FLAC. + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PT. FLAC. + 8 TAMPOANE CU ALCOOL MEDICINAL PR 4 377.530000 377.530000 0.000000
4 W63832001 L04AB01 ETANERCEPTUM **1 ERELZI 50 mg SOL INJ. 50mg SANDOZ GMBH AUSTRIA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE PR 4 535.832500 535.832500 0.000000
5 W65221001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
6 W64810001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 370.355000 370.355000 0.000000
7 W64811002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
8 W64812002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
9 W65222001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL. INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
10 W61299001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 370.355000 370.355000 0.000000
11 W61300002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
12 W61303002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
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 1,001.268000 1,001.268000 114.142000
14 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 2 953.870000 953.870000 0.000000
15 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 834.390000 834.390000 0.000000
16 W64674001 L04AB04 ADALIMUMABUM **1 HUMIRA 20 mg SOL INJ. IN SERINGA PREUMPLUTA 20mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 1 BLIST. CE CONTINE 2 SERINGI PREUMPLUTE (0,2 ML SOLUTIE STERILA) SI DOUA TAMPOANE CU ALCOOL PR 2 520.545000 520.545000 0.000000
17 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 1,001.268000 1,001.268000 4.337000
18 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg OLANDA
SAMSUNG BIOEPIS NL B.V. CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 953.870000 953.870000 0.000000
19 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 1,001.268000 1,001.268000 5.067000
20 W67469002 L04AB04 ADALIMUMABUM **1 YUFLYMA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 PENURI PREUMPLUTE + 2 TAMPOANE ALCOOL PR 2 860.230000 860.230000 0.000000
21 W68331002 L04AB04 ADALIMUMABUM **1 HUKYNDRA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 2 STILOURI PREUMPLUTE AMBALATE INTR-UN BLISTER DIN PVC/PE X 0,4ML SOL. INJ. + 2 TAMPOANE ALCOOL PR 2 1,001.268000 1,001.268000 99.502000
22 W69244001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL. INJ. IN PEN PREUMPLUT 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 PENURI PRE-UMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,001.268000 1,001.268000 4.197000
23 W57619001 L04AB06 GOLIMUMAB **1 SIMPONI 50 mg SOL. INJ. 50mg/0,5ml JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML PR 1 3,391.700000 3,391.700000 0.000000
24 W64403003 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 20mg/ml CONC. PT. SOL. PERF. 20mg/ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 FLAC X 10 ML CONC. PT. SOL. PERF. PR 1 1,201.300000 1,201.300000 0.000000
25 W64403005 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 20mg/ml CONC. PT. SOL. PERF. 20mg/ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 FLAC X 20 ML CONC. PT. SOL. PERF. PR 1 2,331.750000 2,331.750000 0.000000
26 W64403001 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 20mg/ml CONC. PT. SOL. PERF. 20mg/ml ROCHE REGISTRATION GMBH GERMANIA CUTIE X 1 FLAC X 4 ML CONC. PT. SOL. PERF. PR 1 523.030000 523.030000 0.000000
27 W64404001 L04AC07 TOCILIZUMABUM **1 ROACTEMRA 162mg SOL. INJ. IN SERINGA PREUMPLUTA 162mg ROCHE REGISTRATION GMBH GERMANIA CUTIE CU 4 SERINGI PREUMPLUTE SISTEM DE PROTECTIE PENTRU AC A CATE 0.9ML SOL. PR 4 809.025000 809.025000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea reumatologie, pediatrie şi reabilitare medicală.

30. PSORIAZIS CRONIC SEVER (PLĂCI) - G31f

1 W66653001 L04AA32 APREMILASTUM **1 Ω OTEZLA COMPR. FILM. 30mg AMGEN EUROPE B.V. OLANDA CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. PR 56 48.320892 48.320892 0.000000
2 W66652001 L04AA32 APREMILASTUM **1 Ω OTEZLA COMPR. FILM. FARA CONCENTRATIE AMGEN EUROPE B.V. OLANDA PACHET DE INITIERE CU BLIST. PVC/AL INCLUS INTR-UN CARD 4X10 MG+4 X 20 MG+19 X 30 MG COMPR. FILM. PR 1 1,351.190000 1,351.190000 0.000000
3 W61297001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 FLACOANE + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PENTRU FLACOANE + 8 TAMPOANE CU ALCOOL P-RF/R 4 377.530000 377.530000 0.000000
4 W64809001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg PULB. + SOLV. PT. SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 FLAC. + 4 SERINGI PREUMPLUTE + 4 ACE + 4 ADAPTOARE PT. FLAC. + 8 TAMPOANE CU ALCOOL MEDICINAL PR 4 377.530000 377.530000 0.000000
5 W63832001 L04AB01 ETANERCEPTUM **1 ERELZI 50 mg SOL INJ. 50mg SANDOZ GMBH AUSTRIA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE PR 4 535.832500 535.832500 0.000000
6 W65221001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 SERINGI PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
7 W64810001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. 25mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 370.355000 370.355000 0.000000
8 W64811002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
9 W64812002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. 50mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL MEDICINAL PR 4 642.999000 642.999000 94.776000
10 W65222001 L04AB01 ETANERCEPTUM **1 BENEPALI 50 mg SOL. INJ. 50mg SAMSUNG BIOEPIS NL B.V. OLANDA CUTIE CU 4 STILOURI INJECTOARE (PEN) PREUMPLUTE A CATE 50 MG PR 4 614.767500 614.767500 0.000000
11 W61299001 L04AB01 ETANERCEPTUM **1 ENBREL 25mg SOL. INJ. (INSERINGA PREUMPLUTA) 25mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 370.355000 370.355000 0.000000
12 W61300002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. (INSERINGA PREUMPLUTA) 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 SERINGI PREUMPLUTE X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
13 W61303002 L04AB01 ETANERCEPTUM **1 ENBREL 50mg SOL. INJ. IN STILOU INJECTOR PREUMPLUT 50mg PFIZER LIMITED MAREA BRITANIE CUTIE X 4 STILOURI INJECTOARE PREUMPLUTE (PEN) X 4 TAMPOANE CU ALCOOL P-RF/R 4 642.999000 642.999000 94.776000
14 W57617003 L04AB02 INFLIXIMABUM **1 REMICADE 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg JANSSEN BIOLOGICS B.V. OLANDA CUTIE X 3 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 3 1,016.856000 1,016.856000 727.154000
15 W60071001 L04AB02 INFLIXIMABUM **1 REMSIMA 100mg PULB. PT. CONC. PT. SOL. PERF. 100mg CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 847.380000 847.380000 0.000000
16 W64826001 L04AB02 INFLIXIMABUM **1 INFLECTRA 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 868.740000 868.740000 0.000000
17 W65000001 L04AB02 INFLIXIMABUM **1 ZESSLY 100 mg PULB. PT. CONC. PT. SOL. PERF. 100mg SANDOZ GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA CU PULB. PT. CONC. PT. SOL. PERF. PR 1 901.380000 901.380000 0.000000
18 W66531005 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 SERINGI PREUMPLUTE CU PROTECTIE PENTRU AC+ 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
19 W66531007 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 1STILOU INJECTOR PREUMPLUT + 2 TAMPOANE DE ALCOOL PR 1 1,628.440000 1,628.440000 0.000000
20 W66531008 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 STILOURI INJECTOARE PREUMPLUTE + 2 TAMPOANE DE ALCOOL PR 2 1,593.010000 1,593.010000 0.000000
21 W66531009 L04AB02 INFLIXIMABUM **1 REMSIMA 120mg SOL INJ. 120mg/ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 4 STILOURI INJECTOARE PREUMPLUTE + 4 TAMPOANE DE ALCOOL PR 4 1,575.325000 1,575.325000 0.000000

Pagina 35 din 37
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)
22 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 1,001.268000 1,001.268000 114.142000
23 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 2 953.870000 953.870000 0.000000
24 W64999001 L04AB04 ADALIMUMABUM **1 HYRIMOZ 40 mg SOL INJ. IN PEN PREUMPLUT 40mg/0,8ml SANDOZ GMBH AUSTRIA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CONTINAND 0,8 ML SOL. PR 2 834.390000 834.390000 0.000000
25 W64711001 L04AB04 ADALIMUMABUM **1 HUMIRA 80 mg SOL INJ. IN PEN PREUMPLUT 80mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 1 BLIST. CE CONTINE UN PEN PREUMPLUT (0,8 ML SOLUTIE STERILA) SI DOUA TAMPOANE CU ALCOOL. PR 1 2,396.655999 2,396.655999 216.444001
26 W64674001 L04AB04 ADALIMUMABUM **1 HUMIRA 20 mg SOL INJ. IN SERINGA PREUMPLUTA 20mg ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA CUTIE CU 1 BLIST. CE CONTINE 2 SERINGI PREUMPLUTE (0,2 ML SOLUTIE STERILA) SI DOUA TAMPOANE CU ALCOOL PR 2 520.545000 520.545000 0.000000
27 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 1,001.268000 1,001.268000 4.337000
28 W65223001 L04AB04 ADALIMUMABUM **1 IMRALDI SOL INJ. IN SERINGA PREUMPLUTA 40mg OLANDA
SAMSUNG BIOEPIS NL B.V. CUTIE CU 2 SERINGI PREUMPLUTE, FIECARE CU CÂTE 1TAMPON CU ALCOOL PR 2 953.870000 953.870000 0.000000
29 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 1,001.268000 1,001.268000 5.067000
30 W68332001 L04AB04 ADALIMUMABUM **1 HUKYNDRA 80 mg SOL INJ. IN SERINGA PREUMPLUTA 80mg/0,8ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 1 SERINGA PREUMPLUTA AMBALATA INTR-UN BLISTER DIN PVC/PE X 0,8ML SOL. INJ. + 1 TAMPOAN ALCOOL PR 1 2,396.655999 2,396.655999 1,249.224001
31 W69241001 L04AB04 ADALIMUMABUM **1 YUFLYMA 80 mg SOL INJ. IN SERINGA PREUMPLUTA 80mg/0,8ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA 1 SERINGA PREUMPLUTA (0,8 ML SOLUTIE STERILA) CU 2 TAMPOANE ALCOOL PR 1 2,321.020000 2,321.020000 0.000000
32 W67469002 L04AB04 ADALIMUMABUM **1 YUFLYMA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA CUTIE CU 2 PENURI PREUMPLUTE + 2 TAMPOANE ALCOOL PR 2 860.230000 860.230000 0.000000
33 W68331002 L04AB04 ADALIMUMABUM **1 HUKYNDRA 40 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 40mg/0,4ml STADA ARZNEIMITTEL AG GERMANIA CUTIE CU 2 STILOURI PREUMPLUTE AMBALATE INTR-UN BLISTER DIN PVC/PE X 0,4ML SOL. INJ. + 2 TAMPOANE ALCOOL PR 2 1,001.268000 1,001.268000 99.502000
34 W69244001 L04AB04 ADALIMUMABUM **1 AMGEVITA 40 mg SOL. INJ. IN PEN PREUMPLUT 40mg/0.8ml AMGEN EUROPE B.V. OLANDA CUTIE CU 2 PENURI PRE-UMPLUTE CE CONTIN 40 MG ADALIMUMAB IN 0,8 ML SOLUTIE (50 MG/ML) PR 2 1,001.268000 1,001.268000 4.197000
35 W69242001 L04AB04 ADALIMUMABUM **1 YUFLYMA 80 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 80mg/0,8ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA 1 STILOU PREUMPLUT (0,8 ML SOLUTIE STERILA) CU 2 TAMPOANE ALCOOL PR 1 2,230.070000 2,230.070000 0.000000
36 W69242002 L04AB04 ADALIMUMABUM **1 YUFLYMA 80 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 80mg/0,8ml CELLTRION HEALTHCARE HUNGARY KFT. UNGARIA 3 STILOURI PREUMPLUTE (0,8 ML SOLUTIE STERILA), FIECARE CU CÂTE 1 TAMPON ALCOOL PR 3 1,997.213333 1,997.213333 0.000000
37 W54992001 L04AB05 CERTOLIZUMAB PEGOL **1 CIMZIA SOL. INJ. IN SERINGA PREUMPLUTA 200 mg UCB PHARMA SA BELGIA CUTIE X 2 SERINGI PREUMPLUTE DIN STICLA CU PISTON A 1 ML + 2 TAMPOANE CU ALCOOL P-RF/R 2 1,622.090000 1,622.090000 0.000000
38 W53884001 L04AC05 USTEKINUMAB **1 STELARA 45 SOL. INJ. 45mg/0,5ml JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE X 1 FLAC. X 0,5 SOL. INJ. P-RF/R 1 10,771.420000 10,771.420000 0.000000
39 W67964001 L04AC10 SECUKINUMABUM **1 COSENTYX 75 mg SOL INJ. IN SERINGA PREUMPLUTA 150mg/ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. PR 1 1,442.590000 1,442.590000 0.000000
40 W64460001 L04AC10 SECUKINUMABUM **1 COSENTYX 150 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 150 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 STILOU PREUMPLUT (STILOU SENSO READY) X 1ML SOL. INJ. PR 1 2,366.560000 2,366.560000 0.000000
41 W64460002 L04AC10 SECUKINUMABUM **1 COSENTYX 150 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 150 mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 2 STILOURI PREUMPLUTE (STILOU SENSO READY) X 1ML SOL. INJ. PR 2 2,331.135000 2,331.135000 0.000000
42 W67211001 L04AC10 SECUKINUMABUM **1 COSENTYX 300 mg SOL INJ. IN STILOU INJECTOR PREUMPLUT 300mg/2ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 STILOU PREUMPLUT (STILOU UNOREADY) X 2ML SOL. INJ. PR 1 4,662.280000 4,662.280000 0.000000
43 W68000001 L04AC13 IXEKIZUMABUM **1 TALTZ SOL INJ. IN STILOU PREUMPLUT 80mg ELI LILLY AND COMPANY (IRELAND) LIMITED IRLANDA CUTIE CU 1 STILOU INJECTOR PREUMPLUT PR 1 4,120.560000 4,120.560000 0.000000
44 W65090001 L04AC16 GUSELKUMABUM **1 TREMFYA 100 mg SOL INJ. 100mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 SERINGA PREUMPLUTA PR 1 8,718.200000 8,718.200000 0.000000
45 W65090002 L04AC16 GUSELKUMABUM **1 TREMFYA 100 mg SOL INJ. 100mg JANSSEN-CILAG INTERNATIONAL NV BELGIA CUTIE CU 1 STILOU INJECTOR (PEN ) PREUMPLUT PR 1 8,568.570000 8,568.570000 0.000000
46 W66238001 L04AC17 TILDRAKIZUMABUM **1 ILUMETRI 100 mg SOL. INJ. IN SERINGA PREUMPLUTA 100mg/ml ALMIRALL, S.A. SPANIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR 1 13,262.250000 13,262.250000 0.000000
47 W66053001 L04AC18 RISANKIZUMABUM **1 SKYRIZI 75 mg SOL. INJ. IN SERINGA PREUMPLUTA 75mg/0,83ml ABBVIE DEUTSCHLAND GMBH & CO. KG GERMANIA PR
CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA, CU AC FIXAT INTR-UN SISTEM DE PROTECTIE AUTOMATA A ACULUI X 0,83 ML SOL. INJ. (75 MG RISANKIZUMAB) + 2 TAMPOANE CU ALCOOL 2 6,713.670000 6,713.670000 0.000000

Tratamentul se iniţiază de către medicul în specialitatea dermatologie.

31 DERMATITA ATOPICĂ - G31g

1 W66535001 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 300 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 150mg/ml SANOFI - AVENTIS GROUPE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE X 2 ML SOL. INJ. IN PEN PREUMPLUT PR 2 2,974.885000 2,974.885000 0.000000
2 W66695001 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 200 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 175mg/ml SANOFI - AVENTIS GROUPE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE X 1,14 ML SOL. INJ. IN PEN PREUMPLUT PR 2 2,974.885000 2,974.885000 0.000000
3 W69342001 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 300 mg SOL. INJ. IN SERINGA PREUMPLUTA 150mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA TRANSPARENTA DE TIP 1 SILICONATA, CU UN AC FIX DIN OTEL INOXIDABIL,CU PERETE SUBTIRE X 2 ML SOL. INJ. IN SERINGA PREUMPLUTA PR 2 2,657.530000 2,657.530000 0.000000
4 W69342002 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 300 mg SOL. INJ. IN SERINGA PREUMPLUTA 150mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA TRANSPARENTA DE TIP 1 SILICONATA, CU UN AC FIX DIN OTEL INOXIDABIL, CU SCUT PENTRU AC, CU PERETE SUBTIRE X 2 ML SOL. INJ. IN SERINGA PREUMPLUTA PR 2 2,657.530000 2,657.530000 0.000000
5 W66694001 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 200 mg SOL. INJ. IN SERINGA PREUMPLUTA 175mg/ml SANOFI-AVENTIS GROUPE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE CU SCUT PT. AC X 1,14 ML SOL. PR 2 2,657.530000 2,657.530000 0.000000
6 W69344001 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 200 mg SOL. INJ. IN SERINGA PREUMPLUTA 175mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE CU SCUT PT. AC X 1,14 ML SOL. PR 2 2,657.530000 2,657.530000 0.000000
7 W65623001 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 300 mg SOL. INJ. IN SERINGA PREUMPLUTA 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA TRANSPARENTA DE TIP 1 SILICONATA, CU UN AC FIX DIN OTEL INOXIDABIL CU PERETE SUBTIRE X 2 ML SOL. INJ. IN SERINGA PREUMPLUTA PR 2 2,657.530000 2,657.530000 0.000000
8 W65623002 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 300 mg SOL. INJ. IN SERINGA PREUMPLUTA 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA TRANSPARENTA DE TIP 1 SILICONATA, CU UN AC FIX DIN OTEL INOXIDABIL, CU SCUT PENTRU AC, CU PERETE SUBTIRE X 2 ML SOL. INJ. IN SERINGA PREUMPLUTA PR 2 2,657.530000 2,657.530000 0.000000
9 W69343001 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 300 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 150mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CU CAPAC ROTUND SI O FEREASTRA DE VIZUALIZARE OVALA ÎNCONJURATA CU O SAGEATA X 2 ML SOL. INJ. IN PEN PREUMPLUT PR 2 2,974.885000 2,974.885000 0.000000
10 W69345001 D11AH05 DUPILUMABUM **1 Ω DUPIXENT 200 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 175mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CU CAPAC ROTUND SI O FEREASTRA DE VIZUALIZARE OVALA ÎNCONJURATA CU O SAGEATA X 1,14 ML SOL. INJ. IN PEN PREUMPLUT PR 2 2,974.885000 2,974.885000 0.000000
11 W65630001 L04AA37 BARICITINIBUM **1 Ω OLUMIANT 2 mg COMPR. FILM. 2mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC/PE/PCTFE/ALU X 35 COMPR. FILM. PR 35 121.130571 121.130571 0.000000
12 W63493001 L04AA37 BARICITINIBUM **1 Ω OLUMIANT 4 mg COMPR. FILM. 4mg ELI LILLY NEDERLAND BV OLANDA CUTIE CU BLIST. PVC/PE/PCTFE/ALU X 35 COMPR. FILM. PR 35 120.833142 120.833142 0.000000

32. AFECȚIUNI PULMONARE CRONICE - G31h

1 W63059001 B02AB02 INHIBITOR ALFA1 PROTEINAZA UMANA **1 RESPREEZA 1000 mg PULB+SOLV. PT. SOL. PERF. 1000mg CSL BEHRING GMBH GERMANIA FLAC. DIN STICLA (TIP I) CU 1000 MG PULB. SI 1 FLAC. DIN STICLA (TIP I) CU 20 ML APA PT. PREPARATE INJ. PR 1 1,498.140000 1,498.140000 0.000000
2 W66535001 D11AH05 DUPILUMABUM ** DUPIXENT 300 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 150mg/ml SANOFI - AVENTIS GROUPE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE X 2 ML SOL. INJ. IN PEN PREUMPLUT PR 2 2,974.885000 2,974.885000 0.000000
3 W66695001 D11AH05 DUPILUMABUM ** DUPIXENT 200 mg SOL INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 175mg/ml SANOFI - AVENTIS GROUPE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE X 1,14 ML SOL. INJ. IN PEN PREUMPLUT PR 2 2,974.885000 2,974.885000 0.000000
4 W69342001 D11AH05 DUPILUMABUM ** DUPIXENT 300 mg SOL. INJ. IN SERINGA PREUMPLUTA 150mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA TRANSPARENTA DE TIP 1 SILICONATA, CU UN AC FIX DIN OTEL INOXIDABIL,CU PERETE SUBTIRE X 2 ML SOL. INJ. IN SERINGA PREUMPLUTA PR 2 2,657.530000 2,657.530000 0.000000
5 W69342002 D11AH05 DUPILUMABUM ** DUPIXENT 300 mg SOL. INJ. IN SERINGA PREUMPLUTA 150mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA TRANSPARENTA DE TIP 1 SILICONATA, CU UN AC FIX DIN OTEL INOXIDABIL, CU SCUT PENTRU AC, CU PERETE SUBTIRE X 2 ML SOL. INJ. IN SERINGA PREUMPLUTA PR 2 2,657.530000 2,657.530000 0.000000
6 W66694001 D11AH05 DUPILUMABUM ** DUPIXENT 200 mg SOL. INJ. IN SERINGA PREUMPLUTA 175mg/ml SANOFI-AVENTIS GROUPE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE CU SCUT PT. AC X 1,14 ML SOL. PR 2 2,657.530000 2,657.530000 0.000000
7 W69344001 D11AH05 DUPILUMABUM ** DUPIXENT 200 mg SOL. INJ. IN SERINGA PREUMPLUTA 175mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE CU SCUT PT. AC X 1,14 ML SOL. PR 2 2,657.530000 2,657.530000 0.000000
8 W65623001 D11AH05 DUPILUMABUM ** DUPIXENT 300 mg SOL. INJ. IN SERINGA PREUMPLUTA 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA TRANSPARENTA DE TIP 1 SILICONATA, CU UN AC FIX DIN OTEL INOXIDABIL CU PERETE SUBTIRE X 2 ML SOL. INJ. IN SERINGA PREUMPLUTA PR 2 2,657.530000 2,657.530000 0.000000
9 W65623002 D11AH05 DUPILUMABUM ** DUPIXENT 300 mg SOL. INJ. IN SERINGA PREUMPLUTA 300mg SANOFI-AVENTIS GROUPE FRANTA CUTIE CU 2 SERINGI PREUMPLUTE DIN STICLA TRANSPARENTA DE TIP 1 SILICONATA, CU UN AC FIX DIN OTEL INOXIDABIL, CU SCUT PENTRU AC, CU PERETE SUBTIRE X 2 ML SOL. INJ. IN SERINGA PREUMPLUTA PR 2 2,657.530000 2,657.530000 0.000000
10 W69343001 D11AH05 DUPILUMABUM ** DUPIXENT 300 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 150mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CU CAPAC ROTUND SI O FEREASTRA DE VIZUALIZARE OVALA ÎNCONJURATA CU O SAGEATA X 2 ML SOL. INJ. IN PEN PREUMPLUT PR 2 2,974.885000 2,974.885000 0.000000
11 W69345001 D11AH05 DUPILUMABUM ** DUPIXENT 200 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 175mg/ml SANOFI WINTHROP INDUSTRIE FRANTA CUTIE CU 2 STILOURI INJECTOARE (PEN) PREUMPLUTE CU CAPAC ROTUND SI O FEREASTRA DE VIZUALIZARE OVALA ÎNCONJURATA CU O SAGEATA X 1,14 ML SOL. INJ. IN PEN PREUMPLUT PR 2 2,974.885000 2,974.885000 0.000000
12 W61689002 L01XE31 NINTEDANIBUM ** OFEV 100 mg CAPS. MOI 100mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA AMBALAJ CU 60X1 CAPSULE MOI ÎN BLISTERE PERFORATE DIN ALUMINIU PENTRU ELIBERAREA UNUI UNITATII DOZATE PR 60 92.068666 92.068666 0.000000

Pagina 36 din 37
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 W61690002 L01XE31 NINTEDANIBUM ** OFEV 150 mg CAPS. MOI 150mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA AMBALAJ CU 60X1 CAPSULE MOI ÎN BLISTERE PERFORATE DIN ALUMINIU PENTRU ELIBERAREA UNUI UNITATII DOZATE PR 60 167.366166 167.366166 0.000000
14 W65487001 R03DX05 OMALIZUMABUM ** XOLAIR 150 mg SOL INJ. 150mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. PR/PRF 1 1,168.600000 1,168.600000 0.000000
15 W65486001 R03DX05 OMALIZUMABUM ** XOLAIR 75 mg SOL INJ. 75mg NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU 1 SERINGA PREUMPLUTA X 0.5 ML SOL. INJ. PR/PRF 1 724.350000 724.350000 0.000000
16 W66202001 R03DX10 BENRALIZUMABUM ** FASENRA 30 mg SOL. INJ. IN STILOU INJECTOR (PEN) PREUMPLUT 30mg ASTRA ZENECA AB SUEDIA CUTIE CU 1 STILOU INJECTOR (PEN) PREUMPLUT DE UNICA FOLOSINTA X 1 ML SOL. INJ. PR/PRF 1 8,756.120000 8,756.120000 0.000000

33. G31i SINDROAME FEBRILE PERIODICE ASOCIATE CU CRIOPIRINĂ

1 W67341001 L04AC08 CANAKINUMABUM **1 ILARIS 150 mg/ml SOL INJ. 150mg/ml NOVARTIS EUROPHARM LTD. IRLANDA CUTIE CU UN FLACON X 1ML SOLUTIE INJECTABILA PR 1 51,921.700000 51,921.700000 0.000000

NOTA:
- Pentru medicamentele corespunzătoare acestei secţiuni, iniţierea tratamentului se face de către medicul de specialitate, altul decât medicul de familie, excepţie făcând medicamentele din G1 "Insuficienţa cardiacă cronică (clasa III
sau IV NYHA)" corespunzătoare DCI: DIGOXINUM, HYDROCHLOROTHIAZIDUM, FUROSEMIDUM, SPIRONOLACTONUM, METOPROLOLUM, BISOPROLOLUM şi CARVEDILOLUM şi medicamentele din G10 "Medicamente de
suport pentru afecţiuni oncologice, hematologice şi pentru terapia durerii" corespunzătoare DCI: MORPHYNUM, OXYCODONUM,DIHYDROCODEINUM, PETHIDINUM, FENTANYLUM, TRAMADOLUM, METHADONUM, CODEINUM,
pentru care iniţierea tratamentului poate fi efectuată şi de către medicul de familie.
- Medicamentele corespunzătoare DCI COMBINATII (SACUBITRILUM+VALSARTANUM) de la punctul G1 se adresează pacienţilor adulţi cu insuficienţă cardiacă cronică, indiferent de clasa Nyha.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu ** se efectuează pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sănătăţii.
- Medicamentul corespunzător DCI-ului notat cu (3) se livrează împreună cu solventul.
- Medicamentele corespunzătoare DCI-urilor notate cu (4) se importă cu avizul Agenţiei Naţionale a Medicamentului şi a Dispozitivelor Medicale din România.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu (5) se utilizează numai pentru cazurile fără răspuns terapeutic la prednisonum.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu β se efectuează în baza contractelor cost-volum-rezultat încheiate.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu Ω se efectuează în baza contractelor cost-volum încheiate.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu **1 se efectuează pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sănătăţii şi pot fi administrate şi în regim de
spitalizare de zi.
- Medicamentele corespunzătoare DCI DAPAGLIFLOZINUM şi DCI EMPAGLIFLOZINUM de la punctul G1 se adresează şi pacienţilor adulţi cu insuficienţă cardiacă cronică, clasa II NYHA.

Pagina 37 din 37
ANEXA 2d

SECŢIUNEA C3 - LISTA DE MEDICAMENTE CU PROCENT DE COMPENSARE 100% DIN PREȚUL 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, REPUBLICATA, CU MODIFICARILE SI COMPLETARILE ULTERIOARE,
VALABILĂ ÎNCEPÂND CU 01 AUGUST 2023

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


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

1 W02902002 A03AD02 DROTAVERINUM NO - SPA 40 mg/2 ml SOL. INJ. 40mg/2ml CHINOIN PRIVATE CO. LTD. UNGARIA CUTIE X 25 FIOLE X 2ML SOL. INJ. P-RF 25 1.250400 1.250400 0.000000
2 W64401002 A03AD02 DROTAVERINUM NO-SPA 40 mg/2 ml SOL. INJ. 40mg/2ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 25 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE X 2 ML SOL. INJ. PRF 25 1.250400 1.250400 0.000000
3 W67971002 A03AD02 DROTAVERINUM NO-SPA 40 mg/2 ml SOL. INJ. 40mg/2ml OPELLA HEALTHCARE ROMANIA SRL ROMANIA CUTIE CU 25 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE X 2 ML SOL. INJ. PRF 25 1.250400 1.250400 0.000000
4 W67400001 A03BA01 ATROPINUM SULFAT DE ATROPINA ACCORD 0,1 mg/ml SOL INJ. IN SERINGA PREUMPLUTA 0,1mg/ml ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU O SERINGA PREUMPLUTA DE 5 ML DIN STICLA CU GRADATII DE 0,5 ML (DE LA 0 ML LA 5 ML) PR 1 51.280000 51.280000 0.000000
5 W67400002 A03BA01 ATROPINUM SULFAT DE ATROPINA ACCORD 0,1 mg/ml SOL INJ. IN SERINGA PREUMPLUTA 0,1mg/ml ACCORD HEALTHCARE POLSKA SP. Z O.O. POLONIA CUTIE CU O SERINGA PREUMPLUTA DE 10 ML DIN STICLA CU GRADATII DE 1 ML (DE LA 0 ML LA 10 ML) PR 1 2.452800 2.452800 56.727200
6 W60351002 A03BA01 ATROPINUM SULFAT DE ATROPINA TAKEDA 1 mg/ml SOL. INJ. 1mg/ml TAKEDA GMBH GERMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA CU INEL DE RUPERE X 1 ML SOL. INJ. PR 5 2.044000 2.044000 0.000000
7 W43286001 A03DA02 COMBINATII ALGIFEN 500 mg/5 mg/0,1 mg COMPR. 500mg/5mg/0,1mg ZENTIVA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.477500 0.477500 0.000000
8 W01509001 A03DA02 COMBINATII PIAFEN COMPR. FARA CONCENTRATIE ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 0.573000 0.573000 0.582500
9 W43285003 A03DA02 COMBINATII ALGIFEN 500 mg/2 mg/0,02 mg/ml SOL. INJ. 500mg/2mg/0,02mg/ml ZENTIVA SA ROMANIA PRF
CUTIE CU 5 FIOLE DIN STICLA BRUNA, CU INEL DE RUPERE SAU CU PUNCT DE RUPERE SAU CU INEL DE RUPERE SI 2 INELE COLORATE PE GÂTUL FIOLEI (GALBEN SI ALB), A CÂTE 5 ML SOL. INJ. 5 8.096000 8.096000 0.000000
10 W43285004 A03DA02 COMBINATII ALGIFEN 500 mg/2 mg/0,02 mg/ml SOL. INJ. 500mg/2mg/0,02mg/ml ZENTIVA SA ROMANIA PRF
CUTIE CU 10 FIOLE DIN STICLA BRUNA, CU INEL DE RUPERE SAU CU PUNCT DE RUPERE SAU CU INEL DE RUPERE SI 2 INELE COLORATE PE GÂTUL FIOLEI (GALBEN SI ALB), A CÂTE 5 ML SOL. INJ. 10 7.222000 7.222000 0.000000
11 W43285001 A03DA02 COMBINATII ALGIFEN SOLUTIE INJECTABILA SOL. INJ. FARA CONCENTRATIE ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 5 ML SOL. INJ. P-RF 5 8.096000 8.096000 0.000000
12 W01529001 A05BAN3 COMBINATII ASPATOFORT CONC. PT. SOL. PERF. FARA CONCENTRATIE TERAPIA SA ROMANIA CUTIE CU 10 FIOLE X 10 ML CONC. PT. SOL. PERF. P-RF 10 9.130000 9.130000 0.000000
13 W64179001 A06AD65 COMBINATII PLENVU PULB. PT. SOL. ORALA FARA CONCENTRATIE NORGINE B.V. OLANDA CUTIE CU 1 SINGUR TRATAMENT CARE CONTINE PLICURI CU PULBERE PENTRU SOL. ORALA (DOZA 1 - UN PLIC, DOZA 2 - UN PLIC A SI UN PLIC B) PRF 1 55.296000 55.296000 12.564000
14 W66208001 A06AD65 COMBINATII FORTRANS PULB. PT. SOL. ORALA FARA CONCENTRATIE IPSEN CONSUMER HEALTHCARE FRANTA CUTIE CU 4 PLICURI DIN HARTIE-AL-PE X 73,69 G PULB. PT. SOL. ORALA P-RF 1 46.080000 46.080000 0.000000
15 W66223001 A06AD65 COMBINATII CLENSIA PULB. PT. SUSP. ORALA FARA CONCENTRATIE ADDENDA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 8 PLICURI (4 PLICURI A (MARI) + 4 PLICURI B (MICI)) DIN HARTIE-AL-PE CARE CONTIN PULB. PT. SOL. ORALA, CORESP. UNEI SINGURE CURE DE TRATAMENT PRF 1 55.296000 55.296000 7.514000
16 W05420003 A11CA01 RETINOLUM VITAMINA A 50000 ui CAPS. MOI 50000ui PHARCO IMPEX 93 S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 12 CAPS. MOI P-6L 24 0.410416 0.410416 0.000000
17 W60620001 A11CA01 RETINOLUM VITAMINA A FORTE BIOFARM 50000 UI CAPS. MOI 50000ui BIOFARM SA ROMANIA CUTIE CU 2 BLIST. PVC/AL X 15 CAPS. MOI P6L 30 0.492499 0.492499 0.069501
18 W08876001 A11CA01 RETINOLUM VITAMINA A BIOFARM 20mg/ml PIC. ORALE, SOL. 20mg/ml BIOFARM SA ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 10 ML PIC. ORALE, SOL. P-6L 1 13.040000 13.040000 0.000000
19 W66949003 A11CC05 COLECALCIFEROLUM VIGANTOLETTEN 1000 COMPR. 1000UI P&G HEALTH GERMANY GMBH GERMANIA CUTIE CU 2 BLIST. AL/PVC X 15 COMPR. P6L 30 0.480666 0.480666 0.000000
20 W66948001 A11CC05 COLECALCIFEROLUM VIGANTOLETTEN 500 COMPR. 500UI P&G HEALTH GERMANY GMBH GERMANIA CUTIE CU 1 BLIST. AL/PVC X 30 COMPR. P6L 30 0.413000 0.413000 0.000000
21 W66947001 A11CC05 COLECALCIFEROLUM VIGANTOL OIL 0,5 mg/ml PIC. ORALE, SOL. 0,5mg/ml P&G HEALTH GERMANY GMBH GERMANIA CUTIE CU 1 FLAC. DIN STICA BRUNA A 10 ML PICATURI ORALE SOLUTIE, PREVAZUT CU PICURATOR DIN PE P6L 1 25.150000 25.150000 0.000000
22 W53793001 A11CC05 COLECALCIFEROLUM VITAMINA D3 BIOFARM 18000UI/ml PIC. ORALE, SOL. 18000UI/ml BIOFARM S.A. ROMANIA CUTIE CU 1 FLAC. PICURATOR DIN STICLA BRUNA X 10 ML PIC. ORALE, SOL. P-6L 1 10.860000 10.860000 0.000000
23 W56759001 A11DA01 THIAMINUM VITAMINA B1 ZENTIVA 100 mg/2 ml SOL. INJ. 100mg/2ml ZENTIVA SA ROMANIA P-RF
CUTIE CU 5 FIOLE DIN STICLA INCOLORA CU INEL DE RUPERE SAU CU PUNCT DE RUPERE SAU CU INEL DE RUPERE SI DOUA INELE (ALBASTRU SI VERDE) X 2 ML SOL. INJ. 5 6.348000 6.348000 0.000000
24 W62898002 A11DA03 BENFOTIAMINUM NEUROSSEN 300 mg COMPR. FILM. 300mg AAA-PHARMA GMBH GERMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P6L 30 2.871000 2.871000 0.000000
25 W66482006 A11DA03 BENFOTIAMINUM TIAVELLA 300 mg COMPR. FILM. 300mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 2.917666 2.917666 0.000000
26 W01610002 A11DBN1 COMBINATII MILGAMMA N CAPS. MOI FARA CONCENTRATIE WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 BLIST. PVC/PVDC X 10 CAPS. MOI P-6L 50 1.088000 1.088000 0.000000
27 W56297001 A11DBN1 COMBINATII NEUROMULTIVIT COMPR. FILM. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. FILM. P-6L 20 0.530160 0.530160 0.047840
28 W56297002 A11DBN1 COMBINATII NEUROMULTIVIT COMPR. FILM. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 5 BLIST. PVC/AL X 20 COMPR. FILM. P-6L 100 0.441800 0.441800 0.000000
29 W56297010 A11DBN1 COMBINATII NEUROMULTIVIT COMPR. FILM. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 2 BLIST. AL/AL X 10 COMPR. FILM. P-6L 20 0.530160 0.530160 0.047840
30 W56297011 A11DBN1 COMBINATII NEUROMULTIVIT COMPR. FILM. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 10 BLIST. AL/AL X 10 COMPR. FILM. P-6L 100 0.441800 0.441800 0.000000
31 W42092002 A11DBN1 COMBINATII MILGAMMA 100+100mg DRAJ. 100mg+100mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 4 BLIST. PVC-PVDC/AL X 15 DRAJ. P-6L 60 1.740166 1.740166 0.000000
32 W01731002 A11DBN1 COMBINATII MILGAMMA (vezi B03BA51) DRAJ. FARA CONCENTRATIE WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 BLIST. PVC/PVDC X 10 DRAJ. P-6L 50 1.153600 1.153600 0.000000
33 W01731002 A11DBN1 COMBINATII MILGAMMA (vezi B03BA51) DRAJ. FARA CONCENTRATIE WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 BLIST. PVC/PVDC X 10 DRAJ. P-6L 50 1.153600 1.153600 0.000000
34 W41647001 A11DBN1 COMBINATII MILGAMMA NA SOL. INJ. FARA CONCENTRATIE WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 1 ML P-RF 5 4.440000 4.440000 0.000000
35 W68013001 A11GA01 ACIDUM ASCORBICUM VITAMINA C ARENA 100 mg/ml SOL INJ. 100mg/ml ARENA GROUP S.A. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE A CATE 5 ML SOL. INJ. PRF 5 5.472240 5.472240 0.671760
36 W68014001 A11GA01 ACIDUM ASCORBICUM VITAMINA C ARENA 200 mg/ml SOL INJ. 200mg/ml ARENA GROUP S.A. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA CU PUNCT DE RUPERE A CATE 5 ML SOL. INJ. PRF 5 19.548000 19.548000 0.000000
37 W58389001 A11GA01 ACIDUM ASCORBICUM ACID ASCORBIC ARENA 750 mg SOL INJ. 750mg ARENA GROUP S.A. ROMANIA CUTIE CU 5 FIOLE DIN STICLA BRUNA X 5 ML SOL. INJ. PRF 5 8.035200 8.035200 1.546800
38 W65755001 A11GA01 ACIDUM ASCORBICUM VITAMINA C MESFARMA 100 mg/ml SOL INJ./PERF. 100mg/ml MESFARMA SRL ROMANIA CUTIE CU 5 BLIST. PVC A CATE 10 FIOLE X 5 ML SOL. INJ./PERF. PR 50 4.560200 4.560200 0.000000
39 W67594002 A11GA01 ACIDUM ASCORBICUM VITAMINA C ZENTIVA 100 mg/ml SOL INJ./PERF. 100mg/ml ZENTIVA S.A. ROMANIA CUTIE CU 1 BLIST. PVC CARE CONTINE 10 FIOLE DIN STICLA INCOLORA, CU CAPACITATEA DE 5 ML CARE CONTIN SOL. INJ./PERF. PRF 10 5.472240 5.472240 0.914760
40 W52512001 A11GA01 ACIDUM ASCORBICUM VITAMINA C ARENA 750 mg SOL. INJ. 750mg ARENA GROUP S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA X 5 ML SOL. INJ. P-RF 5 6.696000 6.696000 0.000000
41 W69261001 A11GA01 ACIDUM ASCORBICUM VITAMINA C MESFARMA 100 mg/ml SOL. INJ./PERF. 100mg/ml GALENIKA INTERNATIONAL KFT. UNGARIA CUTIE CU 5 BLIST. DIN PVC A CATE 10 FIOLE BRUNE DIN STICLA HIDROLITICA, CU INEL DE RUPERE X 5 ML SOL. INJ./PERF. PR 50 4.560200 4.560200 0.000000
42 W56760001 A11HA02 PYRIDOXINUM VITAMINA B6 ZENTIVA 250 mg COMPR. 250mg ZENTIVA SA ROMANIA CUTIE X 1 FLAC. DIN PE X 20 COMPR. P-6L 20 0.721800 0.721800 0.660200
43 W42822002 A11HA02 PYRIDOXINUM VITAMINA B6 ARENA 250 mg COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE CU 2 BLIST. DIN FOLIE PVC ALBA OPACA/AL X 10 COMPR. P6L 20 0.601500 0.601500 0.000000
44 W42822003 A11HA02 PYRIDOXINUM VITAMINA B6 ARENA 250 mg COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE CU 5 BLIST. DIN FOLIE PVC ALBA OPACA/AL X 10 COMPR. P6L 50 0.601800 0.601800 0.000000
45 W56758001 A11HA02 PYRIDOXINUM VITAMINA B6 ZENTIVA 250 mg/5 ml SOL. INJ. 250mg/5ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA CU INEL DE RUPERE X 5 ML SOL. INJ. P-RF 5 8.570000 8.570000 0.000000

Pagina 1 din 5
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. amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)
46 W56757001 A11HA02 PYRIDOXINUM VITAMINA B6 ZENTIVA 50 mg/2ml SOL. INJ. 50mg/2ml ZENTIVA SA ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA, PREVAZUTE CU INEL DE RUPERE SAU PUNCT DE RUPERE SAU CU INEL DE RUPERE SI 2 INELE COLORATE PE GATUL FIOLEI PT. IDENTIFICARE X 2 ML SOL. INJ. P-RF 5 6.348000 6.348000 0.000000
47 W51342001 A11HA03 TOCOFEROLUM VITAMINA E 400 mg CAPS. MOI 400mg PHARCO IMPEX 93 S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 12 CAPS. MOI P-6L 24 0.997500 0.997500 0.000000
48 W57681001 A12AA03 CALCII GLUCONAS GLUCONAT DE CALCIU 94mg/ml SOL. INJ. 94mg/ml B. BRAUN MELSUNGEN AG GERMANIA CUTIE X 20 FIOLE DIN PEJD X 10 ML SOL. INJ. P-RF 20 3.561000 3.561000 0.000000
49 W60222003 A12AA03 CALCII GLUCONAS GLUCONAT DE CALCIU ZENTIVA 95 mg/ml SOL. INJ. 95mg/ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE X 10 ML SOL. INJ. P-RF 5 4.273200 4.273200 1.954800
50 W00868001 A16AA01 LEVOCARNITINUM CARNIL (R) SOL. ORALA 100mg/ml ANFARM HELLAS S.A. PHARMACEUTICALS GRECIA CUTIE X 10 FLACOANE DIN STICLA BRUNA, ACOPERITE CU UN CAPAC DIN AL. X 10 ML P-6L 10 3.705000 3.705000 0.000000
51 W61534002 A16AXN1 DIVERSE ACTOVEGIN 200 mg DRAJ. 200mg TAKEDA AUSTRIA GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 50 DRAJ. P6L 50 3.246200 3.246200 0.000000
52 W61535001 A16AXN1 DIVERSE ACTOVEGIN 200 mg/5 ml SOL. INJ. 200mg/5ml TAKEDA AUSTRIA GMBH AUSTRIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA CU PUNCT DE RUPERE X 5 ML SOL. INJ. PR 5 24.330000 24.330000 0.000000
53 W57392002 B02BX01 ETAMSYLATUM ETAMSILAT ZENTIVA 250mg SOL. INJ. 250mg/2ml ZENTIVA S.A ROMANIA CUTIE X 5 FIOLE X 2 ML SOL. INJ. P-RF 5 11.548000 11.548000 0.000000
54 W00831001 B02BX02 CARBAZOCHROMI SALICYLAS ADRENOSTAZIN 1,5 mg/5 ml SOL. INJ./PERF. 1,5mg/5ml TERAPIA SA ROMANIA CUTIE CU 5 FIOLE X 5 ML SOL. INJ./PERF. P-RF 5 7.790000 7.790000 0.000000
55 W01714003 B03AD02 COMBINATII FERRETAB 50 mg+0,5 mg CAPS. ELIB. PREL. 50mg+0,5mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. ELIB. PREL. P-6L 30 0.423720 0.423720 0.039613
56 W01714005 B03AD02 COMBINATII FERRETAB 50 mg+0,5 mg CAPS. ELIB. PREL. 50mg+0,5mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 10 BLIST. PVC/AL X 10 CAPS. ELIB. PREL. P6L 100 0.353100 0.353100 0.000000
57 W01713001 B03AD03 COMBINATII (FERROSI SULFAS+ACIDUM FOLICUM) TARDYFERON FOL 80 mg+0,350 mg COMPR. ELIB. PREL. 80mg+0,350mg PIERRE FABRE MEDICAMENT FRANTA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P-6L 30 0.576333 0.576333 0.000000
58 W51229001 B03AD04 COMBINATII MALTOFER FOL 100 mg/0,35 mg COMPR. MAST. 100mg/0,35mg VIFOR FRANCE S.A. FRANTA CUTIE X 3 BLIST. AL/PA-AL-PVC X 10 COMPR. MAST. P-6L 30 0.935666 0.935666 0.000000
59 W60902001 B03AE10 COMBINATII TOT'HEMA SOL. ORALA FARA CONCENTRATIE LABORATOIRE INNOTECH INTERNATIONAL FRANTA CUTIE X 20 FIOLE X 10 ML P-6L 20 1.441500 1.441500 0.000000
60 W56756001 B03BA01 CYANOCOBALAMINUM SOL. INJ.
VITAMINA B12 ZENTIVA 1000µg/ml 1000µg/ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA X 1 ML SOL INJ. P-RF 5 8.422000 8.422000 0.000000
61 W56761001 B03BA01 CYANOCOBALAMINUM VITAMINA B12 ZENTIVA 50µg/ml SOL. INJ. 50µg/ml ZENTIVA SA ROMANIA P-RF
CUTIE CU 5 FIOLE DIN STICLA INCOLORA, CU 1 INEL DE RUPERE SAU CU PUNCT DE RUPERE SI 2 INELE COLORATE (ALBASTRU SI PORTOCALIU) PE GATUL FIOLEI PENTRU IDENTIFICARE X 1 ML SOL. INJ. 5 8.982000 8.982000 0.000000
62 W62871001 C01EA01 ALPROSTADILUM ** ALPROSTADIL "REMEDIA" 500 µg CONC. PT. SOL. PERF. 500µg ROMANIA
FARMACEUTICA REMEDIA DISTRIBUTION&LOGISTICS S.R.L. PR
CUTIE CU 5 FIOLE DIN STICLA BRUNA, CU INEL DE RUPERE DE CULOARE GALBENA, A CÂTE 1 ML CONCENTRAT PENTRU SOL. PERF. 5 239.280000 239.280000 130.622000
63 W67256001 C01EA01 ALPROSTADILUM ** PROSTIN VR 500 mcg/1 ml SOL INJ. 500mcg/1ml PFIZER ROMANIA S.R.L. ROMANIA CUTIE CU 1 FIOLA A 1 ML SOL. INJ. PR 1 199.400000 199.400000 0.000000
64 W56319001 C05AA01 COMBINATII HEMORZON 20 mg/10 mg/8,3 mg SUPOZ. 20mg/10mg/8,3mg ANTIBIOTICE SA ROMANIA CUTIE CU 2 FOLII TERMOSUDATE OPACE PVC/PE X 3 SUPOZ. P-6L 6 3.210000 3.210000 0.000000
65 W56319003 C05AA01 COMBINATII HEMORZON 20 mg/10 mg/8,3 mg SUPOZ. 20mg/10mg/8,3mg ANTIBIOTICE SA ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA OPACA PVC/PE X 6 SUPOZ. P6L 6 3.210000 3.210000 0.000000
66 W01826001 C05AA01 COMBINATII HEMORZON 10 mg/5 mg/4 mg/g UNGUENT 10mg/5mg/4mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 18 G UNG. P-6L 1 27.400000 27.400000 0.000000
67 W67017001 C05AA08 COMBINATII ULTRAPROCT SUPOZITOARE SUPOZ. FARA CONCENTRATIE KARO PHARMA AB SUEDIA CUTIE CU 2 FOLII AL/PE X 5 SUPOZ. PRF 10 2.952000 2.952000 0.000000
68 W67016002 C05AA08 COMBINATII ULTRAPROCT UNGUENT RECTAL UNGUENT RECTAL FARA CONCENTRATIE KARO PHARMA AB SUEDIA CUTIE X 1 TUB AL X 30 G + 1 CANULA PEJD PRF 1 49.540000 49.540000 0.000000
69 W54548001 C05AD01 COMBINATII DOXIPROCT 40 mg+20 mg/g UNGUENT RECTAL 40mg+20mg/g OM PHARMA S.A. PORTUGALIA CUTIE X 1 TUB DIN AL X 30 G UNGUENT RECTAL + CANULA APLICATOARE P-6L 1 27.630000 27.630000 0.000000
70 W68798001 C05AD01 COMBINATII DOXIPROCT 40 mg+20 mg/g UNGUENT RECTAL 40mg+20mg/g OMEDICAMED UNIPESSOAL LDA PORTUGALIA CUTIE CU 1 TUB DIN AL X 30 G UNGUENT RECTAL + CANULA APLICATOARE DIN PE P6L 1 27.630000 27.630000 0.000000
71 W00727001 C05BX01 CALCII DOBESILAS DOXILEK 500 mg CAPS. 500mg LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 3 BLIST. AL/PVC. X 10 CAPS. P-6L 30 1.430333 1.430333 0.000000
72 W63052001 C05CA54 TROXERUTINUM (COMBINATII) GINKOR FORT CAPS. FARA CONCENTRATIE TONIPHARM FRANTA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 1.320666 1.320666 0.000000
73 W61201001 C07AA05 PROPRANOLOLUM ** Ω HEMANGIOL 3,75 mg/ml SOL. ORALA 3,75 mg/ml PIERRE FABRE DERMATOLOGIE FRANTA CUTIE X 1 FLACON DIN STICLA BRUNA X 120ML SOLUTIE ORALA PR 1 889.170000 889.170000 0.000000
74 W69409001 C07AA05 PROPRANOLOLUM ** Ω HEMANGIOL 3,75 mg/ml SOL. ORALA 3,75 mg/ml PIERRE FABRE MEDICAMENT FRANTA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 120 ML SOLUTIE ORALA PR 1 889.170000 889.170000 0.000000
75 W63888002 C08CA06 NIMODIPINUM NIMOTOP 30 mg COMPR. FILM. 30mg BAYER AG GERMANIA CUTIE CU 10 BLIST. AL/PP X 10 COMPR. FILM. P-RF 100 0.769400 0.769400 0.000000
76 W63888004 C08CA06 NIMODIPINUM NIMOTOP 30 mg COMPR. FILM. 30mg BAYER AG GERMANIA CUTIE CU 10 BLIST. DIN PVC-PVDC/AL A X 10 COMPR. FILM. PRF 100 0.769400 0.769400 0.000000
77 W63887002 C08CA06 NIMODIPINUM NIMOTOP 10 mg/50 ml SOL. PERF. 10mg/50ml BAYER AG GERMANIA AMBALAJ MULTIPLU (FOLIE DE PLASTIC ETICHETATA) CU 5 CUTII A CÂTE 1 FLAC. DIN STICLA, TIP II, DE CULOARE BRUNA A 50 ML SOL. PERF. SI CÂTE 1 PERFUZOR DIN PE PR 5 32.606000 32.606000 0.000000
78 W66058002 D01AC05 ISOCONAZOLUM TRAVOGEN 10 mg/g CREMA 10mg/g INTENDIS GMBH GERMANIA CUTIE X 1 TUB DIN AL X 30 G CREMA PRF 1 21.200000 21.200000 0.000000
79 W66598002 D01AC05 ISOCONAZOLUM TRAVOGEN 10 mg/g CREMA 10mg/g LEO PHARMA A/S DANEMARCA CUTIE X 1 TUB DIN AL X 30 G CREMA PRF 1 21.200000 21.200000 0.000000
80 W08541001 D01AC05 ISOCONAZOLUM IZOCON 10 mg/g CREMA 10mg/g ROMINKO S.A. ROMANIA CUTIE X 1 TUB DIN AL X 25 G CREMA P-RF 1 11.930000 11.930000 0.000000
81 W41982001 D01AC08 KETOCONAZOLUM KETOCONAZOL CREMA 2% TIS FARMACEUTIC SA ROMANIA CUTIE X 1 TUB PEJD X 15 G P-RF 1 3.880000 3.880000 0.000000
82 W67030001 D01AC08 KETOCONAZOLUM KETOCONAZOL FITERMAN 20 mg/g CREMA 20 mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE CU 1 TUB AL X 20 G CREMA PRF 1 5.190000 5.190000 0.000000
83 W57514001 D01AC08 KETOCONAZOLUM NIZORAL 20 mg/g CREMA 20mg/g JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE CU 1 TUB DIN AL X 15 G CREMA PRF 1 4.656000 4.656000 2.294000
84 W66059001 D01AC20 COMBINATII TRAVOCORT 10 mg/1 mg/1 g CREMA 10mg/1mg/1g INTENDIS GMBH GERMANIA CUTIE CU 1 TUB DIN AL X 30 G CREMA P6L 1 32.330000 32.330000 0.000000
85 W66599001 D01AC20 COMBINATII TRAVOCORT 10 mg/1 mg/1 g CREMA 10mg/1mg/1g LEO PHARMA A/S DANEMARCA CUTIE CU 1 TUB DIN AL X 30 G CREMA P6L 1 32.330000 32.330000 0.000000
86 W01868001 D05AXN1 COMBINATII ASORIAN 0,415 mg/ml+2,595 mg/ml+103,800 mg/ml SOL. CUT. 0,415mg/ml+2,595mg/ml+103,800m BIOFARM SA ROMANIA CUTIE X 1 FLACON X 100 ML P-RF 1 19.540000 19.540000 0.000000
87 W03176001 D07AC04 FLUOCINOLONI ACETONIDUM FLUOCINOLON ACETONID LAROPHARM 0,25 mg/g UNGUENT 0,25mg/g LAROPHARM SRL ROMANIA CUTIE X 1 TUB AL X 20 G P-RF 1 9.780000 9.780000 0.000000
88 W01894001 D07CB01 COMBINATII (TRIAMCINOLONUM+NEOMICINUM+NYSTATINUM) NIDOFLOR CREMA FARA CONCENTRATIE ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB X 15 G P-RF 1 26.190000 26.190000 0.000000
89 W52916002 D07CC02 COMBINATII (FLUOCINOLONUM+GENTAMICINUM) FLUOCINOLON G FITERMAN 0,25 mg/+1 mg/g CREMA 0,25mg/+1mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB DIN AL X 35 G CREMA P-RF 1 16.630000 16.630000 0.000000
90 W52916001 D07CC02 COMBINATII (FLUOCINOLONUM+GENTAMICINUM) FLUOCINOLON G FITERMAN 0,25 mg/+1 mg/g CREMA 0,25mg/+1mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB DIN AL X 20 G CREMA P-RF 1 9.520000 9.520000 0.000000
91 W61211001 D07CC02 COMBINATII (TRIAMCINOLONUM+NEOMICINUM) FLUOCINOLON N ATB 0,25 mg/5 mg/g UNGUENT 0,25mg/5mg/g ANTIBIOTICE SA ROMANIA CUTIE CU 1 TUB DIN AL X 18 G UNG. PRF 1 15.410000 15.410000 0.000000
92 W13665001 D07XB02 COMBINATII (TRIAMCINOLONUM+CHLORQUINALDOLUM) TRIAMCINOLON S ATB 1 mg/30 mg/g CREMA 1mg/30mg/g ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB X 15 G P-RF 1 23.110000 23.110000 0.000000
93 W68210001 D07XC01 COMBINATII (BETAMETHASONUM +ACIDUM SALICYILICUM) DIPROSALIC 0,64 mg+20 mg/g SOL. CUT. 0,64mg+20mg/g ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN PEJD, DE CULOARE ALBA, PREVAZUT CU PICURATOR DIN PEJD X 30 ML SOL. CUT. PRF 1 17.330000 17.330000 0.000000
94 W68209001 D07XC01 COMBINATII (BETAMETHASONUM +ACIDUM SALICYILICUM) DIPROSALIC 0,64 mg+30 mg/g UNGUENT 0,64 mg+30 mg/g ORGANON BIOSCIENCES S.R.L. ROMANIA CUTIE CU 1 TUB DIN AL X 15 G UNGUENT PRF 1 11.080000 11.080000 0.000000
95 W57647001 D07XC01 COMBINATII (BETAMETHASONUM+ACIDUM SALICYLICUM) DIPROSALIC 0,64 mg+20 mg/g SOL. CUT. 0,64mg+20mg/g MERCK SHARP & DOHME ROMANIA CUTIE X 1 FLACON DIN PEID X 30 ML SOL. CUT., PREVAZUT CU PICURATOR P-RF 1 17.330000 17.330000 0.000000
96 W54922001 D07XC01 COMBINATII (BETAMETHASONUM+ACIDUM SALICYLICUM) SAL-EKARZIN 0,50 mg/30 mg pe gram UNGUENT 0,50mg/30mg pe gram ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 TUB AL X 15 G UNGUENT P-RF 1 26.960000 26.960000 0.000000
97 W57646001 D07XC01 COMBINATII (BETAMETHASONUM+ACIDUM SALICYLICUM) DIPROSALIC 0,64 mg+30 mg/g UNGUENT 0,64 mg+30 mg/g MERCK SHARP & DOHME ROMANIA CUTIE X 1 TUB DIN AL X 15 G UNGUENT P-RF 1 11.080000 11.080000 0.000000
98 W52917001 D07XCN1 COMBINATII (FLUOCINOLONUM+DEXPANTHENOLUM) FLUOCINOLON D FITERMAN 0,25 mg+50 mg/g CREMA 0,25mg+50mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE CU 1 TUB AL X 20 G CREMA P-RF 1 9.520000 9.520000 0.000000
99 W63161001 D10AF52 COMBINATII (ERYTHROMYCINUM+ZINCI ACETAS DIHYDRICUS) ZINERYT 40 mg/12 mg/ml PULB. + SOLV. SOL. CUT. 40mg/12mg/ml LEO PHARMA A/S DANEMARCA CUTIE CU 1 FLAC. DIN PEÎD, CU APLICATOR SI CAPAC DIN PP CARE CONTINE PULBERE CUTANATA SI 1 FLAC. DIN PEÎD, CU APLICATOR SI CAPAC DIN PP CARE CONTINE SOLVENT, PENTRU 30 ML SOLUTIE CUTANATA PRF 1 40.190000 40.190000 0.000000
100 W67797001 D10AF52 COMBINATII (ERYTHROMYCINUM+ZINCI ACETAS DIHYDRICUS) ZINERYT 40 mg/12 mg/ml PULB. + SOLV. SOL. CUT. 40mg/12mg/ml CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU 1 FLAC. DIN PEÎD, CU APLICATOR SI CAPAC DIN PP CARE CONTINE PULBERE CUTANATA SI 1 FLAC. DIN PEÎD, CU APLICATOR SI CAPAC DIN PP CARE CONTINE SOLVENT, PENTRU 30 ML SOLUTIE CUTANATA PRF 1 40.190000 40.190000 0.000000

Pagina 2 din 5
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. amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)
101 W63162001 D11AH01 TACROLIMUSUM PROTOPIC 0,03% UNGUENT 0,03% LEO PHARMA A/S DANEMARCA CUTIE X 1 TUB X 10 G PR 1 39.530000 39.530000 0.000000
102 W63163001 D11AH01 TACROLIMUSUM PROTOPIC 0,1% UNGUENT 0,1% LEO PHARMA A/S DANEMARCA CUTIE X 1 TUB X 10 G PR 1 41.960000 41.960000 0.000000
103 W57974002 D11AH02 PIMECROLIMUS ELIDEL 10 mg/g CREMA 10mg/g MEDA PHARMA GMBH & CO KG GERMANIA CUTIE X 1 TUB AL X 30 G CREMA P-RF 1 130.080000 130.080000 0.000000
104 W68696003 D11AH02 PIMECROLIMUS ELIDEL 10 mg/g CREMA 10mg/g VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 1 TUB AL X 30 G CREMA PRF 1 130.080000 130.080000 0.000000
105 W63536001 G01AF01 METRONIDAZOLUM FLAGYL 500 mg OVULE 500mg SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 2 FOLII TERMOSUDATE PE/PVC X 5 OVULE P-RF 10 1.000000 1.000000 0.000000
106 W63415001 G01BA COMBINATII (METRONIDAZOLUM+NYSTATINUM+NEOMICINUM+HYDROCORTISONUM) ZIFEX COMPLEX OVULE FARA CONCENTRATIE ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FOLIE TERMOSUDATA DIN PVC/PE X 7 OVULE PRF 7 6.390000 6.390000 0.000000
107 W01963001 G01BA COMBINATII (TERNIDAZOLUM+NEOMICINUM+NYSTATINUM+PREDNISOLONUM) TERGYNAN FLORA COMPR. VAG. FARA CONCENTRATIE LAB. BOUCHARA-RECORDATI FRANTA CUTIE X 1 FOLIE HARTIE/PE/AL/PE X 10 COMPR. VAG. P-RF 10 3.302000 3.302000 0.000000
108 W53997001 G03GA02 MENOTROPINUM MENOPUR 75 UI PULB. + SOLV. PT. SOL. INJ. 75UI FERRING GMBH GERMANIA CUTIE X 10 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. + 10 FIOLE X 1 ML SOLV. PT. SOL. INJ. PR 10 83.962000 83.962000 0.000000
109 W60841001 G03GA02 MENOTROPINUM MENOPUR 1200 UI PULB. SI SOLV. PT. SOL. INJ. 1200UI FERRING GMBH GERMANIA CUTIE CU 1 FLAC. CU PULB. PT SOL. INJ., 2 SERINGI PRE-UMPLUTE CU SOLV. PENTRU RECONSTITUIRE, 1 AC PENTRU RECONSTITUIRE SI 18 SERINGI DE UNICA FOLOSINTA PENTRU ADMINISTRARE, GRADATE ÎN UNITATI FSH/LH CU ACE PRE-FIXATE PR 1 1,396.080000 1,396.080000 0.000000
110 W60840001 G03GA02 MENOTROPINUM MENOPUR 600 UI PULB. SI SOLV. PT. SOL. INJ. 600UI FERRING GMBH GERMANIA CUTIE CU 1 FLAC. CU PULB. PT. SOL. INJ., 1 SERINGA PRE-UMPLUTA CU SOLV. PT. RECONSTITUIRE, 1 AC PENTRU RECONSTITUIRE SI 9 SERINGI DE UNICA FOLOSINTA PENTRU ADMINISTRARE, GRADATE ÎN UNITATI FSH/LH CU ACE PRE-FIXATE PR 1 732.880000 732.880000 0.000000
111 W64578003 G03GA02 MENOTROPINUM MERIOFERT 150 UI PULB+SOLV. PT. SOL. INJ. 150UI IBSA FARMACEUTICI ITALIA S.R.L. ITALIA CUTIE CU 10 SETURI CARE CONTIN: FLACOANE CU PULB. PT. SOL. INJ. SI FIOLE CU SOLVENT PT. SOL. INJ. PR 10 168.783000 168.783000 0.000000
112 W64577003 G03GA02 MENOTROPINUM MERIOFERT 75 UI PULB+SOLV. PT. SOL. INJ. 75UI IBSA FARMACEUTICI ITALIA S.R.L. ITALIA CUTIE CU 10 SETURI CARE CONTIN: FLACOANE CU PULB. PT. SOL. INJ. SI FIOLE CU SOLVENT PT. SOL. INJ. PR 10 82.263000 82.263000 0.000000
113 W57400001 H01AC03 MECASERMINUM **1 INCRELEX 10mg/ml SOL. INJ. 10mg/ml IPSEN PHARMA FRANTA CUTIE X 1 FLAC X 4ML SOL. INJ. PR 1 2,659.640000 2,659.640000 0.000000
114 W10690001 H03AA03 COMBINATII NOVOTHYRAL (R) 100 COMPR. 100mcg+20mcg MERCK KGAA GERMANIA CUTIE X 4 BLIST. AL/PP X 25 COMPR. P-6L 100 0.384100 0.384100 0.000000
115 W66150001 H03AA03 COMBINATII NOVOTHYRAL 100/20 micrograme COMPR. 100micrograme/20micrograme MERCK ROMANIA SRL ROMANIA CUTIE X 4 BLIST. AL/PP X 25 COMPR. P6L 100 0.384100 0.384100 0.000000
116 W65525002 J01DB04 CEFAZOLINUM ZOLINEF 1 g PULB. PT. SOL. INJ./PERF. 1g ROMANIA
MEDOCHEMIE ROMANIA SRL PRF
CUTIE CU 10 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 10 ML, INCHIS CU DOP DIN CAUCIUC BROMOBUTILIC SI CAPSA DETASABILA DIN AL CU PULB. PT. SOL. INJ./PERF. 10 6.454000 6.454000 0.000000
117 W69077001 J01DB04 CEFAZOLINUM CEFAZOLINA ATB 1 g PULB. PT. SOL. INJ./PERF. 1g ANTIBIOTICE S.A.
ROMANIA PRF
CUTIE CU 10 FLAC. DIN STICLA INCOLORA, CU CAPACIATEA DE 10 ML CARE CONTIN PULB. PT. SOL. INJ./PERF. 10 7.623000 7.623000 0.000000
118 W53787002 J01DD62 COMBINATII (CEFOPERAZONUM+SULBACTAMUM) SULCEF 1000 mg/1000 mg PULB. PT. SOL. INJ./PERF. 1000mg/1000mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA CONTINAND PULB. PT. SOL. INJ./PERF. S/P-RF 10 32.671000 32.671000 0.000000
119 W60633001 J01EB05 SULFAFURAZOLUM SULFAFURAZOL ARENA 500 mg COMPR. 500mg ARENA GROUP SA ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P-RF 20 1.487000 1.487000 0.000000
120 W62087001 J01GB03 GENTAMICINUM GENTAMICINA EIPICO 40 mg/ml SOL INJ. 40mg/ml E.I.P.I.CO MED S.R.L. ROMANIA CUTIE CU 3 FLAC. DIN STICLA TIP I INCOLORA CU CAPACITATEA DE 2,5 ML, CONTINAND 2 ML SOL. INJ. PRF 3 1.263333 1.263333 0.000000
121 W03308001 J01GB03 GENTAMICINUM GENTAMICIN KRKA 40 mg/1 ml SOL. INJ. 40mg/ml KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 10 FIOLE DIN STICLA INCOLORA X 1 ML SOL. INJ. P-RF 10 0.943000 0.943000 0.000000
122 W03309001 J01GB03 GENTAMICINUM GENTAMICIN KRKA 80 mg/2 ml SOL. INJ. 80mg/2ml KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 10 FIOLE DIN STICLA INCOLORA X 2 ML SOL. INJ. P-RF 10 1.268000 1.268000 0.000000
123 W52501003 J01XB01 COLISTINUM COLISTINA ATB 1.000.000 UI PULB. PT. SOL. INJ./PERF. 1000000ui ANTIBIOTICE SA ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA, ÎNCHISE CU DOP DIN CAUCIUC HALOBUTILIC, SIGILAT CU CAPSA DIN ALUMINIU PREVAZUTA CU DISC FLIP-OFF DIN POLIPROPILENA, CONTINÂND PULB. PENTRU SOL. INJ./PERF. PR 10 38.706000 38.706000 0.000000
124 W08947008 J02AC03 VORICONAZOLUM ** VFEND 200mg COMPR. FILM. 200mg PFIZER LIMITED MAREA BRITANIE CUTIE X 28 COMPR. FILM. (BLIST.PVC/AL) P-RF 28 23.319199 23.319199 52.899372
125 W61628005 J02AC03 VORICONAZOLUM ** VORICONAZOL ZENTIVA 200 mg COMPR. FILM. 200mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 19.600714 19.600714 0.000000
126 W61628006 J02AC03 VORICONAZOLUM ** VORICONAZOL ZENTIVA 200 mg COMPR. FILM. 200mg ZENTIVA, K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. PRF 30 19.432666 19.432666 0.000000
127 W64073003 J02AC03 VORICONAZOLUM ** VERRIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 14 COMPR. FILM. PRF 14 23.319199 23.319199 6.767229
128 W64073005 J02AC03 VORICONAZOLUM ** VERRIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 23.319199 23.319199 4.235443
129 W64073008 J02AC03 VORICONAZOLUM ** VERRIA 200 mg COMPR. FILM. 200mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. PRF 56 23.319199 23.319199 2.974372
130 W64931001 J02AC03 VORICONAZOLUM ** VFEND 200 mg COMPR. FILM. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 23.319199 23.319199 52.899372
131 W65715001 J02AC03 VORICONAZOLUM ** VORICONAZOLE ACCORD 200 mg COMPR. FILM. 200mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU BLIST. PVC/AL X 28 COMPR. PRF 28 23.319199 23.319199 16.420801
132 W64072003 J02AC03 VORICONAZOLUM ** VERRIA 50 mg COMPR. FILM. 50mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 14 COMPR. FILM. PRF 14 28.775000 28.775000 0.000000
133 W64072005 J02AC03 VORICONAZOLUM ** VERRIA 50 mg COMPR. FILM. 50mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. PRF 28 26.225714 26.225714 0.000000
134 W64072008 J02AC03 VORICONAZOLUM ** VERRIA 50 mg COMPR. FILM. 50mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. PRF 56 24.980535 24.980535 0.000000
135 W41889001 J02AC03 VORICONAZOLUM ** VFEND 40 mg/ml PULB. PT. SUSP. ORALA 40mg/ml PFIZER LIMITED MAREA BRITANIE CUTIE X 1 FLAC. PEID DE 100ML X 45 G PULB. PT. SUSP. ORALA + 1 MASURA DOZATOARE (23 ML) + 1 SERINGA PT. ADM. ORALA (5 ML) + 1 ADAPTOR P-RF 1 1,934.780000 1,934.780000 0.000000
136 W64930001 J02AC03 VORICONAZOLUM ** VFEND 40 mg/ml PULB. PT. SUSP. ORALA 40mg/ml PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. PEID DE 100ML X 45 G PULB. PT. SUSP. ORALA + 1 MASURA DOZATOARE (23 ML) + 1 SERINGA PT. ADM. ORALA (5 ML) + 1 ADAPTOR PRF 1 1,934.780000 1,934.780000 0.000000
137 W63845001 J02AC05 ISAVUCONAZOLUM ** CRESEMBA 100 mg CAPS. 100mg BASILEA MEDICAL LTD MAREA BRITANIE CUTIE CU BLIST. AL/AL X 14 CAPS. PRF 14 199.629285 199.629285 0.000000
138 W65622001 J02AC05 ISAVUCONAZOLUM ** CRESEMBA 100 mg CAPS. 100mg BASILEA PHARMACEUTICA DEUTSCHLAND GMBH GERMANIA CUTIE CU 2 BLIST. AL/AL X 7 CAPS. PRF 14 199.629285 199.629285 0.000000
139 W67584001 J06BB16 PALIVIZUMABUM ** SYNAGIS 50 mg/ 0,5 ml SOL INJ. 100mg/ml ASTRAZENECA AB SUEDIA CUTIE CU 1 FLAC. DE 0,5 ML CARE CONTINE 50 MG PALIVIZUMAB. PRF 1 1,896.720000 1,896.720000 0.000000
140 W04988001 M01AA01 PHENYLBUTAZONUM FENILBUTAZONA 250 mg SUPOZ. 250mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII TERMOSUDATE PVC/PE X 5 SUPOZ. P-6L 10 3.728000 3.728000 0.000000
141 W66170001 M01AA01 PHENYLBUTAZONUM FENILBUTAZONA SINTOFARM 250 mg SUPOZ. 250mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII TERMOSUDATE PVC/PE X 5 SUPOZ. P6L 10 3.728000 3.728000 0.000000
142 W59221003 M01AB55 COMBINATII TRATUL PLUS CAPS. GASTROREZ. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 CAPS. GASTROREZ. P-6L 30 0.695333 0.695333 0.000000
143 W59221004 M01AB55 COMBINATII TRATUL PLUS CAPS. GASTROREZ. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X 5 BLIST. PVC-PVDC/AL X 10 CAPS. GASTROREZ. P-6L 50 0.659800 0.659800 0.000000
144 W64231003 M01AB55 COMBINATII NEODOLPASSE 0,30 mg+0,12 mg/ml SOL. PERF. 0,30mg+0,12mg/ml FRESENIUS KABI ROMANIA SRL ROMANIA CUTIE CU 10 FLAC. DIN STICLA INCOLORA X 250 ML SOL. PERF. PR 10 35.314000 35.314000 0.000000
145 W65281002 M01AB55 ARTHROTEC 75 mg/0,2 mg
COMBINATII (DICLOFENACUM+MISOPROSTOLUM ) COMPR. GASTROREZ. 75mg+0,200mg PFIZER EUROPE MA EEIG BELGIA CUTIE X 2 BLIST. AL X 10 COMPR. GASTROREZ. P-6L 20 2.004000 2.004000 0.000000
146 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 3.073333 3.073333 0.000000
147 W14016001 M01AB55 COMBINATII (PARACETAMOLUM+DICLOFENACUM) ACECLOFEN 500 mg/50 mg SUPOZ. 500mg+50mg ANTIBIOTICE SA ROMANIA CUTIE X 2 FOLII TERMOSUDATE AL/PE X 3 SUPOZ. P-6L 6 3.073333 3.073333 0.000000
148 W02034002 M01AB55 DICLOFENACUM+MISOPROSTOLUM ARTHROTEC 75 COMPR. GASTROREZ. 75mg+0,200mg PFIZER EUROPE MA EEIG CUTIE X 2 BLIST. AL X 10 COMPR. GASTROREZ. P-6L
MAREA BRITANIE 20 2.004000 2.004000 0.000000
149 W61050001 M01AE01 IBUPROFENUM CALMOLIN ARENA 400 mg CAPS. 400mg ARENA GROUP S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 CAPS. P6L 20 0.742500 0.742500 0.000000
150 W13106001 M01AE01 IBUPROFENUM PADUDEN SR 300 mg CAPS. ELIB. PREL. 300mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. ELIB. PREL. P-6L 10 4.294000 4.294000 0.000000
151 W62191001 M01AE01 IBUPROFENUM BRUFEN RETARD 800 mg COMPR. ELIB. PREL. 800mg BGP PRODUCTS AB SUEDIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. CU ELIB. PREL. P6L 30 0.978000 0.978000 0.000000
152 W68650001 M01AE01 IBUPROFENUM BRUFEN RETARD 800 mg COMPR. ELIB. PREL. 800mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. CU ELIB. PREL. P6L 30 0.978000 0.978000 0.000000
153 W62192002 M01AE01 IBUPROFENUM BRUFEN 400 mg COMPR. FILM. 400mg BGP PRODUCTS AB SUEDIA CUTIE CU BLIST. AL/PVC X 30 COMPR. FILM. P6L 30 0.718666 0.718666 0.000000
154 W62192005 M01AE01 IBUPROFENUM BRUFEN 400 mg COMPR. FILM. 400mg BGP PRODUCTS AB SUEDIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 0.718666 0.718666 0.000000
155 W68648002 M01AE01 IBUPROFENUM BRUFEN 400 mg COMPR. FILM. 400mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU BLIST. AL/PVC X 30 COMPR. FILM. P6L 30 0.718666 0.718666 0.000000

Pagina 3 din 5
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. amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)
156 W68648005 M01AE01 IBUPROFENUM BRUFEN 400 mg COMPR. FILM. 400mg VIATRIS HEALTHCARE LIMITED IRLANDA P6L
CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. 30 0.718666 0.718666 0.000000
157 W65626001 M01AE01 IBUPROFENUM IBUPROFEN AUROBINDO 600 mg COMPR. FILM. 600 mg ROMANIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM. P6L
AUROBINDO PHARMA ROMANIA S.R.L. 10 0.341000 0.341000 0.000000
158 W66486001 M01AE01 IBUPROFENUM IBUPROFEN AMRING 600 mg COMPR. FILM. 600mg AMRING FARMA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVCAL X 10 COMPR. FILM. P6L 20 0.409200 0.409200 0.680300
159 W66862001 M01AE01 IBUPROFENUM IBUPROFEN B. BRAUN 200 mg SOL. PERF. 200mg B. BRAUN MELSUNGEN AG GERMANIA PRF 10
CUTIE CU 10 FLAC. DIN PEJD PREVAZUTE CU INCHIDERE TIP TWINCAP (CAPAC CU DOUA PORTURI DE ACCES) A CATE 50 ML 27.861000 27.861000 0.000000
160 W66862002 M01AE01 IBUPROFENUM IBUPROFEN B. BRAUN 200 mg SOL. PERF. 200mg B. BRAUN MELSUNGEN AG GERMANIA PRF 20
CUTIE CU 20 FLAC. DIN PEJD PREVAZUTE CU INCHIDERE TIP TWINCAP (CAPAC CU DOUA PORTURI DE ACCES) A CATE 50 ML 26.156000 26.156000 0.000000
161 W63757001 M01AE01 IBUPROFENUM IBUPROFEN B. BRAUN 400 mg SOL. PERF. 400mg B. BRAUN MELSUNGEN AG GERMANIA PRF 10
CUTIE CU 10 FLAC. PEJD PREVAZUTE CU INCHIDERE TIP TWINCAP (CAPAC CU DOUA PORTURI DE ACCES) A CATE 100 ML 17.604000 17.604000 0.000000
162 W67253003 M01AE01 IBUPROFENUM IBUPROFEN KABI 400 mg SOL. PERF. 400mg FRESENIUS KABI ROMANIA SRL ROMANIA CUTIE CU 40 FLAC. DIN PEJD A 100 ML SOL. PERF. PRF 40 21.124800 21.124800 0.102450
163 W63800001 M01AE01 IBUPROFENUM IBUPROFEN B. BRAUN 600 mg SOL. PERF. 600mg B. BRAUN MELSUNGEN AG GERMANIA PRF 10
CUTIE CU 10 FLAC. DIN PEJD PREVAZUTE CU INCHIDERE TIP TWINCAP (CAPAC CU DOUA PORTURI DE ACCES) X 100 ML 29.420000 29.420000 0.000000
164 W64400001 M01AE01 IBUPROFENUM ALGIN BABY 100 mg/5 ml SUSP. ORALA 100mg/5ml SANOFI ROMANIA S.R.L. ROMANIA PRF 1
CUTIE CU 1 FLAC DIN STICLA BRUNA X 100 ML SUSP. ORALA, CONSTITUIT DIN CAPAC INTERN SI CAPAC EXTERN DIN PP, PREVAZUT CU ADAPTOR PT. SERINGA DIN PE SI O SERINGA DOZATOARE PE/PS GRADATA LA FIECARE 0,25 ML, PT. MASURAREA VOLUMELOR PANA LA 6 ML 20.196000 20.196000 0.004000
165 W64400002 M01AE01 IBUPROFENUM ALGIN BABY 100 mg/5 ml SUSP. ORALA 100mg/5ml SANOFI ROMANIA S.R.L. ROMANIA PRF 1
CUT IE CU 1 FLAC. DIN ST ICLA BRUNA X 100 ML SUSP. ORALA, CONST IT UIT DIN CAPAC INT ERN DIN PE SI CAPAC EXT ERN DIN PP, PREVAZUT CU ADAPT OR PT . SERINGA DIN PE SI O SERINGA DOZAT OARE PE/PS GRADAT A LA FIECARE 0,25 ML, PT . MASURAREA VOLUMELOR PANA LA 6 ML 20.196000 20.196000 0.004000
166 W67972001 M01AE01 IBUPROFENUM ALGIN BABY 100 mg/5 ml SUSP. ORALA 100mg/5ml OPELLA HEALTHCARE ROMANIA SRL ROMANIA PRF 1
CUTIE CU 1 FLAC DIN STICLA BRUNA X 100 ML SUSP. ORALA, CONSTITUIT DIN CAPAC INTERN SI CAPAC EXTERN DIN PP, PREVAZUT CU ADAPTOR PT. SERINGA DIN PE SI O SERINGA DOZATOARE PE/PS GRADATA LA FIECARE 0,25 ML, PT. MASURAREA VOLUMELOR PANA LA 6 ML 20.196000 20.196000 0.004000
167 W67972002 M01AE01 IBUPROFENUM ALGIN BABY 100 mg/5 ml SUSP. ORALA 100mg/5ml OPELLA HEALTHCARE ROMANIA SRL ROMANIA PRF 1
CUT IE CU 1 FLAC. DIN ST ICLA BRUNA X 100 ML SUSP. ORALA, CONST IT UIT DIN CAPAC INT ERN DIN PE SI CAPAC EXT ERN DIN PP, PREVAZUT CU ADAPT OR PT . SERINGA DIN PE SI O SERINGA DOZAT OARE PE/PS GRADAT A LA FIECARE 0,25 ML, PT . MASURAREA VOLUMELOR PANA LA 6 ML 20.196000 20.196000 0.004000
168 W62190001 M01AE01 IBUPROFENUM BRUFEN 20 mg/ml SUSP. ORALA 20mg/ml BGP PRODUCTS AB SUEDIA P6L 1
CUTIE CU 1 FLAC. DIN PET DE CULOARE BRUNA CU CAPAC DIN AL SI SIGILIU DIN PEJD + SERINGA DOZATOARE DIN PP DE 5 ML, A 100 ML SUSP. ORALA 16.830000 16.830000 0.000000
169 W68649001 M01AE01 IBUPROFENUM BRUFEN 20 mg/ml SUSP. ORALA 20mg/ml VIATRIS HEALTHCARE LIMITED IRLANDA P6L 1
CUTIE CU 1 FLAC. DIN PET DE CULOARE BRUNA CU CAPAC DIN AL SI SIGILIU DIN PEJD + SERINGA DOZATOARE DIN PP DE 5 ML, A 100 ML SUSP. ORALA 16.830000 16.830000 0.000000
170 W00167001 M01AG01 ACIDUM MEFENAMICUM VIDAN 500 mg COMPR. FILM. 500mg VIANEX SA GRECIA CUTIE X 3 BLIST. AL/PVC X 8 COMPR. FILM. P-6L 24 1.390416 1.390416 0.000000
171 W41953001 M01AH04 PARECOXIBUM DYNASTAT 40mg PULB. PT. SOL. INJ. 40mg PFIZER LIMITED MAREA BRITANIE CUTIE X 10 FLAC. X 40 MG PULB. PT. SOL. INJ. S/P-RF 10 35.061000 35.061000 0.000000
172 W64924001 M01AH04 PARECOXIBUM DYNASTAT 40 mg PULB. PT. SOL. INJ. 40mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 10 FLAC. X 40 MG PULB. PT. SOL. INJ. PRF 10 35.061000 35.061000 0.000000
173 W60375001 M03BB03 CHLORZOXAZONUM CLORZOXAZONA ARENA 250 mg COMPR. 250mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.292666 0.292666 0.000000
174 W66127002 M03BB03 CHLORZOXAZONUM CLORZOXAZONA-RICHTER 250 mg COMPR. 250mg GEDEON RICHTER ROMANIA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P6L 20 0.351199 0.351199 0.111801
175 W58624003 N02AA59 COMBINATII ( PARACETAMOLUM + CODEINUM) ULTRACOD 500 mg/30 mg COMPR. 500 mg/30 mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. PRF 30 1.348000 1.348000 0.000000
176 W51721001 N02AA59 COMBINATII ( PARACETAMOLUM+CODEINUM) PARADOREN 500mg/30mg COMPR. 500mg+30mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 1.484500 1.484500 0.000000
177 W61948001 N02AJ08 COMBINATII (IBUPROFENUM+CODEINUM) BRUFEN PLUS 400 mg/30 mg COMPR. FILM. 400mg/30mg BGP PRODUCTS AB SUEDIA CUTIE CU BLIST. AL/PVDC-PVC/PVDC X 30 COMPR. FILM. PRF 30 1.154000 1.154000 0.000000
178 W66551001 N02AJ08 COMBINATII (IBUPROFENUM+CODEINUM) BRUFEN PLUS 400 mg/30 mg COMPR. FILM. 400mg/30mg IRLANDA
MYLAN IRE HEALTHCARE LIMITED CUTIE CU BLIST. AL/PVDC-PVC/PVDC X 30 COMPR. FILM. PRF 30 1.154000 1.154000 0.000000
179 W68662001 N02AJ08 COMBINATII (IBUPROFENUM+CODEINUM) BRUFEN PLUS 400 mg/30 mg COMPR. FILM. 400mg/30mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU BLIST. AL/PVDC-PVC/PVDC X 30 COMPR. FILM. PRF 30 1.154000 1.154000 0.000000
180 W42786002 N02BB02 METAMIZOLUM NATRIUM ALGOCALMIN 500 mg COMPR. 500mg ZENTIVA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.545500 0.545500 0.000000
181 W41738001 N02BB02 METAMIZOLUM NATRIUM ALINDOR 500 mg COMPR. 500mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-RF 20 0.545500 0.545500 0.000000
182 W08609001 N02BB02 METAMIZOLUM NATRIUM NOVOCALMIN 500 mg COMPR. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. P-RF 20 0.545500 0.545500 0.000000
183 W57650001 N02BB02 METAMIZOLUM NATRIUM ALGOZONE 500mg COMPR. 500mg LABORMED PHARMA S.A. ROMANIA CUTIE X 2 BLIST.PVC-PVDC/AL A CATE 10 COMPR. P-RF 20 0.545500 0.545500 0.000000
184 W65928001 N02BB02 METAMIZOLUM NATRIUM CENTRALGIN 500 mg COMPR. 500mg S.C. SINTOFARM S.A. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. PRF 20 0.545500 0.545500 0.000000
185 W68840002 N02BB02 METAMIZOLUM NATRIUM ALGOCALMIN 500 mg COMPR. FILM. 500mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 20 COMPR. FILM. PRF 20 0.654600 0.654600 0.223900
186 W61617002 N02BB02 METAMIZOLUM NATRIUM LOCAMIN 500 mg/ml PIC. ORALE, SOL. 500mg/ml STADA ARZNEIMITTEL AG GERMANIA PRF 1
CUTIE CU 1 FLAC. DIN STICLA BRUNA, PREVAZUT CU PICURATOR DIN PEJD SI CAPAC DIN PEID/PP SECURIZAT PT. COPII X 50 ML PIC. ORALE,SOL. 26.052000 26.052000 7.988000
187 W66957002 N02BB02 METAMIZOLUM NATRIUM ALGOCALMIN 500 mg/ml PIC. ORALE, SOL. 500mg/ml ZENTIVA, K.S. REPUBLICA CEHA PRF 1
CUTIE CU FLACON DIN STICLA BRUNA, CU CAPACITATE DE 50 ML, PREVAZUT CU PICURATOR DIN PEJD SI CAPAC PREVAZUT CU SISTEM DE SIGURANA PENTRU COPII DIN PEÎD/PP, CARE CONTINE 50 ML PICATURI ORALE, SOLUTIE 21.710000 21.710000 0.000000
188 W66616002 N02BB02 METAMIZOLUM NATRIUM ALVOTOR 500 mg/ml PIC. ORALE, SOL. 500mg/ml BIOEEL SRL ROMANIA PRF 1
CUTIE CU 1 FLAC. DIN STICLA BRUNA, PREVAZUT CU PICURATOR DIN PEJD A 20 ML PIC. ORALE, SOL. 15.190000 15.190000 0.000000
189 W68587002 N02BB02 METAMIZOLUM NATRIUM ALVOTOR 500 mg/ml PIC. ORALE, SOL. 500mg/ml BIOEEL MANUFACTURING S.R.L. ROMANIA PRF 1
CUTIE CU 1 FLAC. DIN STICLA BRUNA, PREVAZUT CU PICURATOR DIN PEJD A 20 ML PIC. ORALE, SOL. 15.190000 15.190000 0.000000
190 W66616004 N02BB02 METAMIZOLUM NATRIUM ALVOTOR 500 mg/ml PIC. ORALE, SOL. 500mg/ml BIOEEL SRL ROMANIA PRF 1
CUTIE CU 1 FLAC. DIN STICLA BRUNA, PREVAZUT CU PICURATOR DIN PEJD A 100 ML PIC. ORALE, SOL. 35.100000 35.100000 0.000000
191 W68587004 N02BB02 METAMIZOLUM NATRIUM ALVOTOR 500 mg/ml PIC. ORALE, SOL. 500mg/ml BIOEEL MANUFACTURING S.R.L. ROMANIA PRF 1
CUTIE CU 1 FLAC. DIN STICLA BRUNA, PREVAZUT CU PICURATOR DIN PEJD A 100 ML PIC. ORALE, SOL. 35.100000 35.100000 0.000000
192 W42787003 N02BB02 METAMIZOLUM NATRIUM ALGOCALMIN 1 g/2 ml SOL. INJ. 1g/2ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA CU INEL DE RUPERE X 2 ML SOL. INJ. P-RF 5 1.422240 1.422240 0.041760
193 W42787002 N02BB02 METAMIZOLUM NATRIUM ALGOCALMIN 1 g/2 ml SOL. INJ. 1g/2ml ZENTIVA S.A. ROMANIA P-RF 10
CUTIE CU 10 FIOLE DIN STICLA BRUNA, CU INEL DE RUPERE SAU CU PUNCT DE RUPERE SAU CU INEL DE RUPERE ALB SI UN INEL (GALBEN) PE GATUL FIOLEI X 2 ML SOL. INJ. 1.422240 1.422240 0.042760
194 W66590001 N02BB02 METAMIZOLUM NATRIUM METAMIZOL KALCEKS 500 mg/ml SOL. INJ. 500 mg/ml AS KALCEKS LETONIA CUTIE CU 5 FIOLE CU CAPACITATEA DE 2 ML SOL. INJ. PRF 5 1.422240 1.422240 0.047760
195 W66590002 N02BB02 METAMIZOLUM NATRIUM METAMIZOL KALCEKS 500 mg/ml SOL. INJ. 500 mg/ml AS KALCEKS LETONIA CUTIE CU 10 FIOLE CU CAPACITATEA DE 2 ML SOL. INJ. PRF 10 1.422240 1.422240 0.261760
196 W66590003 N02BB02 METAMIZOLUM NATRIUM METAMIZOL KALCEKS 500 mg/ml SOL. INJ. 500 mg/ml AS KALCEKS LETONIA CUTIE CU 100 FIOLE CU CAPACITATEA DE 2 ML SOL. INJ. PRF 100 1.185200 1.185200 0.000000
197 W66590004 N02BB02 METAMIZOLUM NATRIUM METAMIZOL KALCEKS 500 mg/ml SOL. INJ. 500 mg/ml AS KALCEKS LETONIA CUTIE CU 5 FIOLE CU CAPACITATEA DE 5 ML SOL. INJ. PRF 5 1.617600 1.617600 0.144400
198 W66590005 N02BB02 METAMIZOLUM NATRIUM METAMIZOL KALCEKS 500 mg/ml SOL. INJ. 500 mg/ml AS KALCEKS LETONIA CUTIE CU 10 FIOLE CU CAPACITATEA DE 5 ML SOL. INJ. PRF 10 1.617600 1.617600 0.146400
199 W66590006 N02BB02 METAMIZOLUM NATRIUM METAMIZOL KALCEKS 500 mg/ml SOL. INJ. 500 mg/ml AS KALCEKS LETONIA CUTIE CU 100 FIOLE CU CAPACITATEA DE 5 ML SOL. INJ. PRF 100 1.348000 1.348000 0.000000
200 W57866001 N02BB02 METAMIZOLUM NATRIUM NOVOCALMIN 300 mg SUPOZ. 300mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 FOLII TERMOSUDATE, OPACE DIN PVC/PE X 6 SUPOZ. PRF 12 1.692000 1.692000 0.064666
201 W66196001 N02BB02 METAMIZOLUM NATRIUM TISALGIN 300 mg SUPOZ. 300mg TIS FARMACEUTIC S.A. ROMANIA CUTIE CU 2 BLIST. PVC/PE X 3 SUPOZ. PRF 6 1.410000 1.410000 0.000000
202 W66196002 N02BB02 METAMIZOLUM NATRIUM TISALGIN 300 mg SUPOZ. 300mg TIS FARMACEUTIC S.A. ROMANIA CUTIE CU 2 BLIST. PVC/PE X 5 SUPOZ. PRF 10 1.410000 1.410000 0.000000
203 W68139001 N05CD08 MIDAZOLAMUM MIDAZOLAM KALCEKS 1 mg/ml SOL INJ./PERF. 1mg/ml PHARMNET PLUS S.R.L. ROMANIA CUTIE CU 10 FIOLE A 5 ML SOL. INJ./PERF. PR 10 10.494000 10.494000 0.000000
204 W67320001 N05CD08 MIDAZOLAMUM MIDAZOLAM HYPERICUM 5 mg/ml SOL INJ./PERF. 5mg/ml HYPERICUM S.R.L. ROMANIA CUTIE CU 10 FIOLE DIN STICLA INCOLORA TIP I A CATE 10 ML SOL. INJ./PERF. PR 10 27.419000 27.419000 0.000000
205 W67954022 N05CD08 MIDAZOLAMUM MIDAZOLAM HAMELN 5 mg/ml SOL INJ./PERF. 5mg/ml HAMELN PHARMA GMBH GERMANIA CUTIE CU 10 FIOLE A CATE 10 ML SOL. INJ./PERF. PRF 10 31.856000 31.856000 0.000000
206 W68896001 N05CD08 MIDAZOLAMUM BUCCOLAM 10 mg SOL. BUCOFARINGIANA 10mg LABORATORIOS LESVI, S.L. SPANIA CUTIE CU 4 SERINGI PREUMPLUTE X 2 ML SOLUTIE PENTRU ADMINISTRARE ORALA PRF 4 109.642500 109.642500 0.000000
207 W68893001 N05CD08 MIDAZOLAMUM BUCCOLAM 2,5 mg SOL. BUCOFARINGIANA 2,5mg LABORATORIOS LESVI, S.L. SPANIA CUTIE CU 4 SERINGI PREUMPLUTE X 0,5 ML SOLUTIE PENTRU ADMINISTRARE ORALA PR 4 112.182500 112.182500 0.000000
208 W68894001 N05CD08 MIDAZOLAMUM BUCCOLAM 5 mg SOL. BUCOFARINGIANA 5mg LABORATORIOS LESVI, S.L. SPANIA CUTIE CU 4 SERINGI PREUMPLUTE X 1 ML SOLUTIE PENTRU ADMINISTRARE ORALA PRF 4 108.402500 108.402500 0.000000
209 W68895001 N05CD08 MIDAZOLAMUM BUCCOLAM 7,5 mg SOL. BUCOFARINGIANA 7,5mg LABORATORIOS LESVI, S.L. SPANIA CUTIE CU 4 SERINGI PREUMPLUTE X 1,5 ML SOLUTIE PENTRU ADMINISTRARE ORALA PRF 4 109.642500 109.642500 0.000000
210 W66102001 N05CD08 MIDAZOLAMUM MIDAZOLAM SUN 1 mg/ml 1mg/ml
SOL. INJ. /PERF. IN SERINGA PREUMPLUTA SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. OLANDA PRF 1
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 32.902800 32.902800 70.387200

Pagina 4 din 5
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. amba referinta / UT compensare 100% din din pretul de


cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) pretul de referinta) referinta)
211 W66103001 N05CD08 MIDAZOLAMUM MIDAZOLAM SUN 2 mg/ml 2mg/ml
SOL. INJ. /PERF. IN SERINGA PREUMPLUTA OLANDA
SUN PHARMACEUTICAL INDUSTRIES EUROPE B.V. 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 1 114.490000 114.490000 0.000000
212 W66371001 N05CD08 MIDAZOLAMUM MIDAZOLAM BAXTER 1 mg/ml SOL. INJ./PERF. 1mg/ml BAXTER HOLDING B.V. OLANDA CUTIE CU 5 FIOLE DIN STICLA X 5 ML SOL. INJ./PERF. PRF 5 12.592800 12.592800 4.633200
213 W67777002 N05CD08 MIDAZOLAMUM MIDAZOLAM DESITIN 10 mg SOLUTIE BUCOFARINGIANA 10 mg/2ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 4 SERINGI PREUMPLUTE DIN PP, PENTRU ADMINISTRARE ORALA, DE CULOAREA CHIHLIMBARULUI,FARA AC, PREVAZUTE CU PISTON DIN PP SI CAPAC DIN PEÎD, AMBALATE ÎN CÂTE UN TUB PROTECTOR DIN PLASTIC PRF 4 125.457500 125.457500 0.000000
214 W67774002 N05CD08 MIDAZOLAMUM MIDAZOLAM DESITIN 2,5 mg SOLUTIE BUCOFARINGIANA 2,5 mg/0.5ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 4 SERINGI PREUMPLUTE DIN PP, PENTRU ADMINISTRARE ORALA, DE CULOAREA CHIHLIMBARULUI,FARA AC, PREVAZUTE CU PISTON DIN PP SI CAPAC DIN PEÎD, AMBALATE ÎN CÂTE UN TUB PROTECTOR DIN PLASTIC PRF 4 125.457500 125.457500 0.000000
215 W67775002 N05CD08 MIDAZOLAMUM MIDAZOLAM DESITIN 5 mg SOLUTIE BUCOFARINGIANA 5 mg/1ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 4 SERINGI PREUMPLUTE DIN PP, PENTRU ADMINISTRARE ORALA, DE CULOAREA CHIHLIMBARULUI,FARA AC, PREVAZUTE CU PISTON DIN PP SI CAPAC DIN PEÎD, AMBALATE ÎN CÂTE UN TUB PROTECTOR DIN PLASTIC PRF 4 125.457500 125.457500 0.000000
216 W67776002 N05CD08 MIDAZOLAMUM MIDAZOLAM DESITIN 7,5 mg SOLUTIE BUCOFARINGIANA 7,5 mg/1,5ml DESITIN ARZNEIMITTEL GMBH GERMANIA CUTIE CU 4 SERINGI PREUMPLUTE DIN PP, PENTRU ADMINISTRARE ORALA, DE CULOAREA CHIHLIMBARULUI,FARA AC, PREVAZUTE CU PISTON DIN PP SI CAPAC DIN PEÎD, AMBALATE ÎN CÂTE UN TUB PROTECTOR DIN PLASTIC PRF 4 125.457500 125.457500 0.000000
217 W63237002 N05CD13 CINOLAZEPAMUM GERODORM 40 mg COMPR. 40mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 3 BLIST. AL/PVDC-PVC X 10 COMPR. PRF 30 0.972666 0.972666 0.000000
218 W43107002 N06BA04 METHYLFENIDATUM ** CONCERTA 18 mg COMPR. CU ELIB. PREL. 18mg JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE CU 1 FLAC. DIN PEID X 30 COMPR. ELIB. PREL. PR, PS 30 1.923666 1.923666 0.000000
219 W43108002 N06BA04 METHYLFENIDATUM ** CONCERTA 36 mg COMPR. CU ELIB. PREL. 36mg JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE CU 1 FLAC. DIN PEID X 30 COMPR. ELIB. PREL. PR, PS 30 3.213666 3.213666 0.000000
220 W43109002 N06BA04 METHYLFENIDATUM ** CONCERTA 54 mg COMPR. CU ELIB. PREL. 54mg JANSSEN PHARMACEUTICA N.V. BELGIA CUTIE CU 1 FLAC. DIN PEID X 30 COMPR. ELIB. PREL. PR, PS 30 5.584666 5.584666 0.000000
221 W58095001 N06BX02 PYRITINOLUM ENCEPHABOL 100 mg DRAJ. 100mg MERCK KGAA GERMANIA CUTIE CU 5 BLIST. PVC/AL X 10 DRAJ. P6L 50 0.659200 0.659200 0.000000
222 W58096001 N06BX02 PYRITINOLUM ENCEPHABOL 200 mg DRAJ. 200mg MERCK KGAA GERMANIA CUTIE CU 5 BLIST. PVC/AL X 10 DRAJ. P6L 50 1.441400 1.441400 0.000000
223 W59741001 N06BX02 PYRITINOLUM ENCEPHABOL 80,5 mg/5 ml SUSP. ORALA 80,5mg/5ml MERCK KGAA GERMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 200 ML + 1 LINGURITA DOZATOARE DIN PP ALBA, CU GRADATII LA 1,25 ML, 2,5 ML, 5 ML P6L 1 50.410000 50.410000 0.000000
224 W08294002 N07CA02 CINNARIZINUM CINARIZINA ARENA 25 mg CAPS. 25mg ARENA GROUP SA ROMANIA CUTIE X 4 BLIST. AL/PVC X 10 CAPS. P-6L 40 0.278700 0.278700 0.123550
225 W10590001 N07CA02 CINNARIZINUM STUGERON 25 mg COMPR. 25mg TERAPIA SA ROMANIA CUTIE X 4 BLIST. X 10 COMPR. P-6L 40 0.232250 0.232250 0.000000
226 W13160002 N07CA02 CINNARIZINUM CINARIZINA LAROPHARM 25 mg COMPR. 25mg LAROPHARM SRL ROMANIA CUTIE CU 3 BLIST. AL/PVC X 20 COMPR. P-6L 60 0.232333 0.232333 0.000000
227 W52931002 P03AX01 BENZYLUM BENZOICUM BENZOAT DE BENZIL FITERMAN 250 mg/g CREMA 250mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB DIN AL X 50 G CREMA P-RF 1 9.520000 9.520000 0.000000
228 W52931004 P03AX01 BENZYLUM BENZOICUM BENZOAT DE BENZIL FITERMAN 250 mg/g CREMA 250mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE CU 1 TUB DIN AL X 150 G CREMA PRF 1 28.550000 28.550000 0.000000
229 W52931001 P03AX01 BENZYLUM BENZOICUM BENZOAT DE BENZIL FITERMAN 250 mg/g CREMA 250mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB DIN AL X 35 G CREMA P-RF 1 5.780000 5.780000 0.000000
230 W52931003 P03AX01 BENZYLUM BENZOICUM BENZOAT DE BENZIL FITERMAN 250 mg/g CREMA 250mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE CU 1 TUB DIN AL X 100 G CREMA PRF 1 19.030000 19.030000 0.000000
231 W57359001 R01AD07 TIXOCORTOLUM PIVALONE 0,9mg/pulverizare SPRAY NAZAL SUSPENSIE 0,9mg/pulverizare PFIZER EUROPE MA EEG MAREA BRITANIE CUTIE X 1 FLACON X 10 ML + POMPA DOZATOARE + APLICATOR NAZAL P-RF 1 13.900000 13.900000 0.000000
232 W65041001 R01AD07 TIXOCORTOLUM PIVALONE 0,9mg/pulverizare SPRAY NAZAL SUSPENSIE 0,9mg/pulverizare PFIZER EUROPE MA EEIG BELGIA CUTIE CU 1 FLAC. X 10 ML + POMPA DOZATOARE + APLICATOR NAZAL PRF 1 13.900000 13.900000 0.000000
233 W59773001 R01ADN1 COMBINATII (BETAMETHASONUM+TETRYZOLINUM) BIORINIL 0,5mg/1 mg/ ml SPRAY NAZ.,SUSP. 0,5 mg/1 mg/ ml THEA FARMA SPA ITALIA CUTIE X 1 FLACON X 10 ML SPRAY NAZAL, SUSP. PREVAZUT CU NEBULIZATOR P-RF 1 58.510000 58.510000 0.000000
234 W64698004 R01BA52 COMBINATII (DESLORATADINUM+ PSEUDOEPHEDRINE) AERINAZE 2,5mg/120mg COMPR. ELIB. MODIF. 2,5mg/120mg MERCK SHARP & DOHME OLANDA CUTIE CU 10 COMPR. ELIB. MODIF. (BLIST.PCTFE/PVC/AL) PRF 10 3.254000 3.254000 0.000000
235 W67696004 R01BA52 COMBINATII (DESLORATADINUM+ PSEUDOEPHEDRINE) AERINAZE 2,5mg/120mg COMPR. ELIB. MODIF. 2,5mg/120mg N.V. ORGANON OLANDA CUTIE CU 10 COMPR. ELIB. MODIF. (BLIST.PCTFE/PVC/AL) PRF 10 3.254000 3.254000 0.000000
236 W62181006 R01BA52 COMBINATII (LORATADINUM+PSEUDOEFEDRINUM) CLARINASE 5 mg/120 mg COMPR. ELIB. MODIF. 5mg/120mg BAYER S.R.L. ROMANIA CUTIE CU 2 BLIST. OPA-AL-PE/LDPE-AL X 7 COMPR. ELIB. MODIF. P6L 14 1.923571 1.923571 0.000000
237 W60632001 R03CA02 EPHEDRINI HYDROCHLORIDUM EFEDRINA ZENTIVA 50 mg/ ml SOL. INJ. 50mg/ml ZENTIVA S.A. ROMANIA CUTIE X 5 FIOLE CU INEL DE RUPERE X 1ML SOL. INJ PRF 5 14.564000 14.564000 0.000000
238 W53020001 R05CB01 ACETYLCYSTEINUM FLUIMUCIL 20 mg/ml PEDIATRIC SOL. ORALA 20mg/ml ZAMBON S.P.A. ITALIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 100 ML SOL. ORALA + MASURA DOZATOARE (5 SI 10 ML) P-RF 1 16.670000 16.670000 0.000000
239 W53016001 R05CB01 ACETYLCYSTEINUM FLUIMUCIL 300 mg/3 ml 300mg/3ml
SOL.INJ./INHAL.NEBULIZ./INSTILATIE ENDOTRAHEOBRON. ZAMBON S.P.A. ITALIA CUTIE X 5 FIOLE DIN STICLA X 3 ML SOL.INJ/SOL.PT.INHALAT PRIN NEBULIZATOR/SOL.PT.INSTILATIE ENDOTRAH PR 5 5.390000 5.390000 0.000000
240 W63537001 R05CB03 CARBOCISTEINUM RHINATHIOL 100 mg/5 ml PENTRU COPII SIROP 100 mg/5 ml SANOFI ROMANIA S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA DE TIP III X 125 ML SIROP + LINGURITA DOZATOARE DE 5 ML PRF 1 22.480000 22.480000 0.000000
241 W67973001 R05CB03 CARBOCISTEINUM RHINATHIOL 100 mg/5 ml PENTRU COPII SIROP 100 mg/5 ml ROMANIA
OPELLA HEALTHCARE ROMANIA SRL CUTIE CU 1 FLAC. DIN STICLA INCOLORA DE TIP III X 125 ML SIROP + LINGURITA DOZATOARE DE 5 ML PRF 1 22.480000 22.480000 0.000000
242 W07656001 R05CB03 CARBOCISTEINUM FLUIDOL 100mg/5ml SIROP 100mg/5ml TIS FARMACEUTIC SA ROMANIA CUTIE CU 1 FLAC. DIN PET A 100 ML SIROP SI O LINGURITA DUBLA DOZATOARE GRADATA LA 2,5 SI 5 ML P-RF 1 5.240000 5.240000 0.000000
243 W52326001 R06AD02 PROMETHAZINUM ROMERGAN SIROP 5mg/5ml BIOFARM S.A. ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 50 ML SIROP + MASURA DOZATOARE P-RF 1 15.190000 15.190000 0.000000
244 W13788001 R06AE05 MECLOZINUM EMETOSTOP 30 mg COMPR. 30mg SPECIFAR SA GRECIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. P-RF 10 0.903000 0.903000 0.000000
245 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 55.840000 55.840000 0.000000
246 W52861001 R06AX13 LORATADINUM LORATADINA BIOFARM 5mg/5ml SIROP 5mg/5ml BIOFARM S.A. ROMANIA P6L
CUTIE CU 1 FLAC. DIN STICLA BRUNA CONTINAND 100 ML SIROP + MASURA DOZATOARE DIN PP, CU GRADATII DE LA 2,5 LA 20 ML 1 13.390000 13.390000 0.000000
247 W41624001 S01AA24 KANAMYCINUM KANAMICINA SULFAT 1% UNG. OFT. 1% ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB AL X 6 G P-RF 1 23.110000 23.110000 0.000000
248 W66119001 S01AA24 KANAMYCINUM KANAMICINA ATB 10 mg/g UNG. OFT. 10mg/g ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB AL X 6 G PRF 1 23.110000 23.110000 0.000000
249 W59768001 S01BA07 FLUOROMETHOLONUM FLUMETOL S 2 mg/ml PICATURI OFT.SUSP. 2mg/ml THEA FARMA SPA ITALIA CUTIE X 1 FLACON PEJD X 10ML PIC. OFT. SUSP. P-RF 1 63.890000 63.890000 0.000000
250 W67014001 S01BC01 INDOMETACINUM INDOCOLLYRE 1 mg/ml PICATURI OFT., SOL. 1mg/ml BAUSCH HEALTH IRELAND LIMITED IRLANDA CUTIE X 1 FLACON PICURATOR DIN POLIETILENA X 5 ML PICATURI OFT., SOL. P6L 1 25.960000 25.960000 0.000000
251 W68507001 S01BC01 INDOMETACINUM INDOCOLLYRE 1 mg/ml PICATURI OFT., SOL. 1mg/ml BAUSCH + LOMB IRELAND LIMITED IRLANDA CUTIE X 1 FLACON PICURATOR DIN POLIETILENA X 5 ML PICATURI OFT., SOL. P6L 1 25.960000 25.960000 0.000000
252 W69018001 S01GX08 KETOTIFENUM KETAZED 0,25 mg/ml PIC. OFT., SOL. 0,25mg/ml HORUS PHARMA FRANTA PRF
CUTIE CU 1 FLAC. DIN PEID DE CULOARE ALBA CU CAPACITATEA DE 10 ML PREVAZUT CU PICURATOR 3K® A 28 MCL, CONTINAND 10 ML PIC. OFT. SOL. 1 51.760000 51.760000 0.000000
253 W10587001 S02CA05 COMBINATII SOLUTIE AURICULARA CU CLORAMFENICOL SI FLUOCINOLON SOL. AURICULARA FARA CONCENTRATIE BIOFARM SA ROMANIA CUTIE X 1 FLAC DIN STICLA BRUNA+APLICATOR TIP PIPETA X 10 ML SOL. AURICULARA P-RF 1 11.000000 11.000000 0.000000
254 W02268001 S02CA05 COMBINATII (CHLORAMPHENICOLUM+FLUOCINOLONUM+LIDOCAINUM) OTIS-T PICATURI AURICULARE, SOL. FARA CONCENTRATIE TIS FARMACEUTIC SA ROMANIA CUTIE X 1 FLACON DIN PE X 10 ML PIC. AURICULARE, SOL. P-RF 1 9.240000 9.240000 0.000000

NOTĂ:
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu ** se efectuează pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sănătăţii.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu **1 se efectuează pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sănătăţii şi pot fi
administrate şi în regim de spitalizare de zi.
- Medicamentele din această sublistă corespund DCI-urilor din nomenclatorul de produse, altele decât cele din sublistele A, B, sublista C secţiunea C1 şi sublista D. Pentru categoriile de asiguraţi
menţionate în această sublistă, medicamentele corespunzătoare denumirilor comune internaţionale din sublista A, sublista B, secţiunea C1 a sublistei C şi sublista D se vor acorda în regim de compensare
de 100% la preţ de referinţă, indiferent de indicaţia pentru care sunt prevăzute în aceste subliste.

Pagina 5 din 5
ANEXA 2e

SUBLISTA D - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 20% DIN PRETUL DE REFERINTA CONFORM
DENUMIRILOR COMUNE INTERNATIONALE (DCI) CORESPUNZATOARE MEDICAMENTELOR DE CARE BENEFICIAZA ASIGURATII, IN TRATAMENTUL AMBULATORIU CU SI FARA CONTRIBUTIE
PERSONALA DIN HG NR. 720/2008, REPUBLICATA, CU MODIFICARILE SI COMPLETARILE ULTERIOARE,
VALABILA INCEPAND CU 01 AUGUST 2023

Contributie maxima Val. maxima suportata de Contributie maxima


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

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

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


Nr crt.

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

1 W03078002 A02BA03 FAMOTIDINUM FAMODIN 20 mg COMPR. FILM. 20mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.261500 0.201166 0.052300 0.410366
2 W42868002 A02BA03 FAMOTIDINUM FAMOTIDINA ZENTIVA 20mg COMPR. FILM. 20mg ZENTIVA S.A ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.261500 0.617833 0.052300 0.827033
3 W42867001 A02BA03 FAMOTIDINUM FAMOTIDINA ZENTIVA 40 mg COMPR. FILM. 40mg ZENTIVA S.A ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.523000 0.000000 0.104600 0.418400
4 W03079002 A02BA03 FAMOTIDINUM FAMODIN 40 mg COMPR. FILM. 40mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 0.523000 0.000000 0.104600 0.418400
5 W42867002 A02BA03 FAMOTIDINUM FAMOTIDINA ZENTIVA 40 mg COMPR. FILM. 40mg ZENTIVA S.A ROMANIA CUTIE CU 3 BLIST.DIN PVC-PE-PVDC/AL A CATE 10 COMPR. FILM. P-6L 30 0.523000 0.000000 0.104600 0.418400
6 W54839001 A02BA03 FAMOTIDINUM QUAMATEL 20 mg PULB+SOLV. PT. SOL. INJ./PERF. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 5 FLACOANE DIN STICLA INCOLORA CU PULBERE PENTRU SOLUTIE INJ./PERF. + 5 FIOLE DIN STICLA INCOLORA X 5ML SOLV. PENTRU UZ PARENTERAL S/P-RF 5 7.366000 0.000000 1.473200 5.892800
7 W44052002 A02BX02 SUCRALFATUM GASTROFAIT COMPR. 1g E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 5 BLIST. AL/PVC X 4 COMPR. P-6L 20 1.054000 0.000000 0.210800 0.843200
8 W69081001 A03AA04 MEBEVERINUM DUSPATALIN 200 mg CAPS. CU ELIB. PREL. 200mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 3 BLIST. X 10 CAPS. ELIB. PREL. P6L 30 0.992666 0.000000 0.198533 0.794133
9 W69081002 A03AA04 MEBEVERINUM DUSPATALIN 200 mg CAPS. CU ELIB. PREL. 200mg VIATRIS HEALTHCARE LIMITED IRLANDA CUTIE CU 2 BLIST. X 15 CAPS. ELIB. PREL. P6L 30 0.992666 0.000000 0.198533 0.794133
10 W62373001 A03AA04 MEBEVERINUM DUSPATALIN 200 mg CAPS. ELIB. PREL. 200mg BGP PRODUCTS B.V. OLANDA CUTIE X 3 BLIST. X 10 CAPS. ELIB. PREL. P-6L 30 0.992666 0.000000 0.198533 0.794133
11 W62373002 A03AA04 MEBEVERINUM DUSPATALIN 200 mg CAPS. ELIB. PREL. 200mg BGP PRODUCTS B.V. OLANDA CUTIE X 2 BLIST. X 15 CAPS. ELIB. PREL. P-6L 30 0.992666 0.000000 0.198533 0.794133
12 W64562002 A03AA04 MEBEVERINUM DUSPATALIN 200 mg CAPS. ELIB. PREL. 200mg MYLAN HEALTHCARE B.V. OLANDA CUTIE CU 2 BLIST. X 15 CAPS. ELIB. PREL. P6L 30 0.992666 0.000000 0.198533 0.794133
13 W64562001 A03AA04 MEBEVERINUM DUSPATALIN 200 mg CAPS. ELIB. PREL. 200mg MYLAN HEALTHCARE B.V. OLANDA CUTIE CU 3 BLIST. X 10 CAPS. ELIB. PREL. P6L 30 0.992666 0.000000 0.198533 0.794133
14 W04080002 A03AA04 MEBEVERINUM COLOSPASMIN 100 mg drajeuri DRAJ. 100mg E.I.P.I.CO. MED SRL ROMANIA CUTIE X 2 BLIST., AL/PVC X 10 DRAJ. P-6L 20 0.496333 0.382167 0.099266 0.779234
15 W51982001 A03AA05 TRIMEBUTINUM TRIMEBUTIN MCC 100 mg COMPR. 100mg MAGISTRA C & C ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 0.490333 0.000000 0.098066 0.392267
16 W52004001 A03AA05 TRIMEBUTINUM COLPERIN 100 mg COMPR. 100mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. P-6L 30 0.490333 0.000000 0.098066 0.392267
17 W42800002 A03AA05 TRIMEBUTINUM IBUTIN 300 mg COMPR. ELIB. PREL. 300mg ZENTIVA SA ROMANIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P-6L 20 1.471004 1.197496 0.294200 2.374300
18 W08438001 A03AA05 TRIMEBUTINUM DEBRIDAT 100 mg COMPR. FILM. 100mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 0.490333 0.000000 0.098066 0.392267
19 W65034001 A03AA05 TRIMEBUTINUM DEBRIDAT 100 mg COMPR. FILM. 100mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 2 BLIST. AL/PVC X 15 COMPR. FILM. P6L 30 0.490333 0.000000 0.098066 0.392267
20 W59465001 A03AA05 TRIMEBUTINUM DEBRIDAT 200 mg COMPR. FILM. 200mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.980668 0.561665 0.196133 1.346200
21 W65035001 A03AA05 TRIMEBUTINUM DEBRIDAT 200 mg COMPR. FILM. 200mg PFIZER EUROPE MA EEIG BELGIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.980668 0.561665 0.196133 1.346200
22 W07832001 A03AA05 TRIMEBUTINUM DEBRIDAT GRAN. PT. SUSP. ORALA 24mg/5ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. DIN STICLA BRUNA X 152,5 G GRANULE PT. 250ML SUSP. + MASURA DOZATOARE P-6L 1 21.360000 0.000000 4.272000 17.088000
23 W65036001 A03AA05 TRIMEBUTINUM DEBRIDAT 24 mg/5 ml GRAN. PT. SUSP. ORALA 24mg/5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 152,5 G GRANULE PT. 250ML SUSP. + MASURA DOZATOARE GRADATA P6L 1 21.360000 0.000000 4.272000 17.088000
24 W07832002 A03AA05 TRIMEBUTINUM DEBRIDAT GRAN. PT. SUSP. ORALA 24mg/5ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. DIN STICLA BRUNA X 76,25 G GRANULE PT. 125ML SUSP. + MASURA DOZATOARE P-6L 1 10.680000 6.890000 2.136000 15.434000
25 W65036002 A03AA05 TRIMEBUTINUM DEBRIDAT 24 mg/5 ml GRAN. PT. SUSP. ORALA 24mg/5ml PFIZER EUROPE MA EEIG BELGIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 76,25 G GRANULE PT. 125ML SUSP. + SERINGA DOZATOARE GRADATA P6L 1 10.680000 6.890000 2.136000 15.434000
26 W12227001 A03FA03 DOMPERIDONUM MOTILIUM 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. X 10 COMPR. FILM. P-6L 10 0.187250 0.393750 0.037450 0.543550
27 W61966003 A03FA03 DOMPERIDONUM DOMOTIL 10 mg COMPR. ORODISPERSABILE 10mg LABORMED PHARMA S.A. ROMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. ORODISPERSABILE P6L 30 0.187250 1.230750 0.037450 1.380550
28 W62898002 A11DA03 BENFOTIAMINUM ** NEUROSSEN 300 mg COMPR. FILM. 300mg AAA-PHARMA GMBH GERMANIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P6L 30 2.871000 0.000000 0.574200 2.296800
29 W66482006 A11DA03 BENFOTIAMINUM ** TIAVELLA 300 mg COMPR. FILM. 300mg G.L. PHARMA GMBH AUSTRIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 2.882666 0.035000 0.576533 2.341133
30 W01610002 A11DBN1 COMBINATII ** MILGAMMA N CAPS. MOI FARA CONCENTRATIE WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 BLIST. PVC/PVDC X 10 CAPS. MOI P-6L 50 0.441800 0.646200 0.088360 0.999640
31 W56297001 A11DBN1 COMBINATII ** NEUROMULTIVIT COMPR. FILM. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 1 BLIST. PVC/AL X 20 COMPR. FILM. P-6L 20 0.441800 0.136200 0.088360 0.489640
32 W56297002 A11DBN1 COMBINATII ** NEUROMULTIVIT COMPR. FILM. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 5 BLIST. PVC/AL X 20 COMPR. FILM. P-6L 100 0.441800 0.000000 0.088360 0.353440
33 W56297010 A11DBN1 COMBINATII ** NEUROMULTIVIT COMPR. FILM. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 2 BLIST. AL/AL X 10 COMPR. FILM. P-6L 20 0.441800 0.136200 0.088360 0.489640
34 W56297011 A11DBN1 COMBINATII ** NEUROMULTIVIT COMPR. FILM. FARA CONCENTRATIE LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 10 BLIST. AL/AL X 10 COMPR. FILM. P-6L 100 0.441800 0.000000 0.088360 0.353440
35 W42092002 A11DBN1 COMBINATII ** MILGAMMA 100+100mg DRAJ. 100mg+100mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 4 BLIST. PVC-PVDC/AL X 15 DRAJ. P-6L 60 1.740166 0.000000 0.348033 1.392133
36 W01731002 A11DBN1 COMBINATII ** MILGAMMA (vezi B03BA51) DRAJ. FARA CONCENTRATIE WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 BLIST. PVC/PVDC X 10 DRAJ. P-6L 50 1.153600 0.000000 0.230720 0.922880
37 W41647001 A11DBN1 COMBINATII ** MILGAMMA NA SOL. INJ. FARA CONCENTRATIE WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 1 ML P-RF 5 4.440000 0.000000 0.888000 3.552000
38 W13661001 C01EB15 TRIMETAZIDINUM TRIMETAZIDINA LPH 35 mg COMPR. CU ELIB. PREL. 35mg LABORMED PHARMA SA ROMANIA CUTIE CU 6 BLIST. PVC-PVDC/AL X 10 COMPR. CU ELIB. PREL. P-6L 60 0.512000 0.000000 0.102400 0.409600
39 W07058001 C01EB15 TRIMETAZIDINUM PREDUCTAL MR 35 mg COMPR. ELIB. MODIF. 35mg LES LABORATOIRES SERVIER FRANTA CUTIE X 2 BLIST. AL/PVC X 30 COMPR. FILM. ELIB. MODIF. P-6L 60 0.512166 0.184167 0.102433 0.593900
40 W59722004 C01EB15 TRIMETAZIDINUM MODUXIN MR 35 mg COMPR. ELIB. PREL. 35mg ROMANIA CUTIE CU BLIST. AL/PVC X 30 COMPR. CU ELIB. PRELUNG. P6L
GEDEON RICHTER ROMANIA SA 30 0.512166 0.000500 0.102433 0.410233
41 W42406002 C01EB15 TRIMETAZIDINUM DILATAN MR 35 mg COMPR. ELIB. PREL. 35mg TERAPIA S.A. ROMANIA CUTIE CU 6 BLIST. PVC-PE-PVDC/AL X 10 COMPR. ELIB. PREL. P6L 60 0.512000 0.000000 0.102400 0.409600
42 W41842001 C01EB15 TRIMETAZIDINUM TRIMETAZIDINA LPH 20 mg COMPR. FILM. 20mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 20 COMPR. FILM. P-6L 60 0.292666 0.043167 0.058533 0.277300
43 W54945001 C01EB15 TRIMETAZIDINUM PREDUCTAL 20 mg COMPR. FILM. 20mg LES LABORATOIRES SERVIER FRANTA CUTIE CU 2 BLIST. PVC/AL X 30 COMPR. FILM. P-6L 60 0.292666 0.148834 0.058533 0.382967
44 W04516004 C04AE02 NICERGOLINUM SERMION COMPR. FILM. 30mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. PVC-PVDC/AL-PVC X 15 COMPR. FILM P-6L 30 1.422666 0.312334 0.284533 1.450467
45 W42841001 C04AE02 NICERGOLINUM NICERGOLINA LPH 30 mg COMPR. FILM. 30mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 1.110333 0.000000 0.222066 0.888267
46 W63062001 C04AE02 NICERGOLINUM NICERGOLINA SLAVIA 30 mg COMPR. FILM. 30mg SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 15 COMPR. FILM. P6L 30 1.110333 0.000000 0.222066 0.888267
47 W65107002 C04AE02 NICERGOLINUM SERMION COMPR. FILM. 30mg BELGIA CUTIE CU 2 BLIST. PVC-PVDC/AL-PVC X 15 COMPR. FILM P6L
PFIZER EUROPE MA EEIG 30 1.422666 0.312334 0.284533 1.450467
48 W67204002 C04AE02 NICERGOLINUM SERMION 30 mg COMPR. FILM. 30mg UPJOHN EESV OLANDA CUTIE CU 2 BLIST. PVC-PVDC/AL-PVC X 15 COMPR. FILM P6L 30 1.422666 0.312334 0.284533 1.450467
49 W52057002 C04AE02 NICERGOLINUM SINERGOLIN 30 DRAJ. 30mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-6L 30 1.422666 1.881667 0.284533 3.019800
50 W52057001 C04AE02 NICERGOLINUM SINERGOLIN 30 DRAJ. 30mg SINTOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 DRAJ. P-6L 20 1.422666 2.180834 0.284533 3.318967
51 W06107003 C04AX07 VINCAMINUM VINCAMINA 10 mg DRAJ. 10mg BIOFARM SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 DRAJ. P-6L 20 0.652000 0.000000 0.130400 0.521600

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

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 20% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
52 W66812002 C05CA53 DIOSMINUM (COMBINATII) ** DETRALEX 1000 mg COMPR. FILM. 1000mg LES LABORATOIRES SERVIER FRANTA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 2.135333 0.000000 0.427066 1.708267
53 W11615001 C05CA53 DIOSMINUM (COMBINATII) ** DETRALEX 500 mg COMPR. FILM. 500mg LES LABORATOIRES SERVIER FRANTA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 1.101916 0.102750 0.220383 0.984283
54 W60988002 C09DB07 COMBINATII (CANDESARTANUM CILEXETIL+AMLODIPINUM) ** CARAMLO 16 mg/10 mg COMPR. 16 mg/10 mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN PVC-PE-PVDC/AL X 28 COMPRIMATE P6L 28 1.047856 0.000001 0.209571 0.838286
55 W60988003 C09DB07 COMBINATII (CANDESARTANUM CILEXETIL+AMLODIPINUM) ** CARAMLO 16 mg/10 mg COMPR. 16 mg/10 mg ZENIVA K.S. REPUBLICA CEHA CUTIE CU BLISTERE DIN PVC-PE-PVDC/AL X 30 COMPRIMATE P6L 30 1.047333 0.000000 0.209466 0.837867
56 W66363004 C09DB07 COMBINATII (CANDESARTANUM CILEXETIL+AMLODIPINUM) ** CARAMLO 16 mg/5 mg COMPR. 16mg/5mg ZENTIVA K.S. REP. CEHA CUTIE CU BLIST. TRANSPARENT DIN PVC-PE-PVDC/AL X 56 COMPR. P6L 56 0.846344 0.105263 0.169268 0.782339
57 W60987002 C09DB07 COMBINATII (CANDESARTANUM CILEXETIL+AMLODIPINUM) ** CARAMLO 8 mg/5 mg COMPR. 8 mg/5 mg ZENTIVA KS REPUBLICA CEHA CUTIE CU BLISTERE DIN PVC-PE-PVDC/AL X 28 COMPRIMATE P6L 28 0.523928 0.000000 0.104785 0.419143
58 W60987003 C09DB07 COMBINATII (CANDESARTANUM CILEXETIL+AMLODIPINUM) ** CARAMLO 8 mg/5 mg COMPR. 8 mg/5 mg ZENTIVA KS REPUBLICA CEHA CUTIE CU BLISTERE DIN PVC-PE-PVDC/AL X 30 COMPRIMATE P6L 30 0.523928 0.000072 0.104785 0.419215
59 W58770010 C10AX06 ACID OMEGA-3-ESTERI ETILICI 90 ** TEVOCOR 1000 mg CAPS. MOI 1000 mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 30 CAPS. PRF 30 1.642666 0.000000 0.328533 1.314133
60 W13986001 C10AX06 ACID OMEGA-3-ESTERI ETILICI 90 ** OMACOR 1000 mg CAPS. MOI 1000mg PRONOVA BIOPHARMA NORGE A.S. NORVEGIA FALC. DIN PEID X 28 CAPS. MOI P-RF 28 1.797225 0.154560 0.359445 1.592340
61 W65280001 C10AX06 ACID OMEGA-3-ESTERI ETILICI 90 ** OMACOR 1000 mg CAPS. MOI 1000mg BASF AS NORVEGIA CUTIE CU 1 FLAC. PEID X 28 CAPS. MOI PRF 28 1.797225 0.154560 0.359445 1.592340
62 W60557001 D06BB03 ACICLOVIRUM ACICLOVIR-RICHTER 50mg/g CREMA 50mg/g GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 1 TUB AL X 5 G CREMA PRF 1 3.728333 4.531667 0.745666 7.514334
63 W58038002 D06BB03 ACICLOVIRUM ACICLOVIR TERAPIA 50 mg/g CREMA 50mg/g TERAPIA S.A. ROMANIA CUTIE CU 1 TUB DIN AL A 5 G CREMA PRF 1 3.728333 6.291667 0.745666 9.274334
64 W64910001 D06BB03 ACICLOVIRUM ACEVIREX 50 mg/g CREMA 50mg/g GLAXOSMITHKLINE (IRELAND) LIMITED IRLANDA CUTIE CU 1 TUB DIN AL X 5 G CREMA PRF 1 3.728333 14.391667 0.745666 17.374334
65 W53041001 D06BB03 ACICLOVIRUM ACICLOVIR TIS 50mg/g CREMA 50mg/g TIS FARMACEUTIC SA ROMANIA CUTIE X 1 TUB DIN PEJD X 15 G CREMA P-RF 1 11.185000 0.375000 2.237000 9.323000
66 W55128001 D06BB03 ACICLOVIRUM ACICLOVIR SLAVIA 50 mg/g CREMA 50mg/g SLAVIA PHARM S.R.L. ROMANIA CUTIE CU 1 TUB AL X 15 G CREMA P-RF 1 11.185000 3.485000 2.237000 12.433000
67 W58038001 D06BB03 ACICLOVIRUM ACICLOVIR TERAPIA 50 mg/g CREMA 50mg/g TERAPIA S.A. ROMANIA CUTIE CU 1 TUB DIN AL X 15 G CREMA PRF 1 11.185000 1.145000 2.237000 10.093000
68 W60557002 D06BB03 ACICLOVIRUM ACICLOVIR-RICHTER 50mg/g CREMA 50mg/g GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 1 TUB AL X 15 G CREMA PRF 1 11.060000 0.000000 2.212000 8.848000
69 W66137002 D06BB03 ACICLOVIRUM ACICLOVIR FITERMAN 50 mg/g CREMA 50mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB AL X 15 G PRF 1 7.810000 0.000000 1.562000 6.248000
70 W67305002 D06BB03 ACICLOVIRUM ACICLOVIR ROMPHARM 50 mg/g CREMA 50mg/g ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 1 TUB DIN AL X 15 G CREMA PRF 1 11.185000 1.285000 2.237000 10.233000
71 W66137001 D06BB03 ACICLOVIRUM ACICLOVIR FITERMAN 50 mg/g CREMA 50mg/g FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB AL X 7,5 G PRF 1 3.880000 0.000000 0.776000 3.104000
72 W05099002 M01AC01 PIROXICAMUM PIROXSAL 20 mg COMPR. 20mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST.PVC/ AL X 10 COMPR. P-6L 20 0.665549 0.788951 0.133109 1.321391
73 W12442003 M01AC01 PIROXICAMUM FLAMEXIN COMPR. 20mg CHIESI FARMACEUTICI SPA ITALIA CUTIE X 3 BLIST. PVC-PDVC/AL-LAC PVDC X 10 COMPR. P-6L 30 0.665549 0.429117 0.133109 0.961557
74 W05092002 M01AC01 PIROXICAMUM PIROXICAM LAROPHARM 20 mg COMPR. 20mg LAROPHARM SRL ROMANIA CUTIE X 1 BLIST., PVC/AL X 20 COMPR. P-6L 20 0.665549 0.788951 0.133109 1.321391
75 W53944002 M01AC01 PIROXICAMUM PIROXICAM ARENA 20 MG COMPR. 20mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.665549 0.788951 0.133109 1.321391
76 W59471001 M01AC01 PIROXICAMUM PIROXICAM HELCOR 20 mg COMPR. 20mg AC HELCOR PHARMA S.R.L. ROMANIA CUTIE CU 2 BLIST. PVC/AL X 10 COMPR. P6L 20 0.665549 0.788951 0.133109 1.321391
77 W12441001 M01AC01 PIROXICAMUM FLAMEXIN (R) PULB. PT. SOL. ORALA 20mg/plic CHIESI FARMACEUTICI SPA ITALIA CUTIE X 20 PLICURI DUBLU COMPARTIMENTAT X 3 G PULB. PT. SOL. ORALA P-6L 20 0.665549 1.008451 0.133109 1.540891
78 W09001001 M01AC01 PIROXICAMUM PIROXICAM SINTOFARM 20 mg SUPOZ. 20mg SINTOFARM SA ROMANIA CUTIE X 2 FOLII TERMOSUDATE X 5 SUPOZ. P-6L 10 2.909750 1.079250 0.581950 3.407050
79 W04449002 M01AE02 NAPROXENUM REUXEN 250 mg COMPR. 250mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.453600 0.504900 0.090720 0.867780
80 W04450002 M01AE02 NAPROXENUM REUXEN 500 mg COMPR. 500mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.907200 0.617300 0.181440 1.343060
81 W66457002 M01AE02 NAPROXENUM NAPROXEN AUROBINDO 500 mg COMPR. 500mg AUROBINDO PHARMA ROMANIA S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 10 COMPR. P6L 10 0.530000 0.000000 0.106000 0.424000
82 W59074003 M01AE02 NAPROXENUM NALDOREX 275 mg COMPR. FILM. 275mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.498960 0.937040 0.099792 1.336208
83 W59075003 M01AE02 NAPROXENUM NALDOREX 550 mg COMPR. FILM. 550mg KRKA, D.D., NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P6L 30 0.665000 0.000000 0.133000 0.532000
84 W08513001 M01AX17 NIMESULIDUM LEMESIL 100 mg COMPR. 100mg ANFARM HELLAS S.A. GRECIA CUTIE CU 2 BLIST. PVC-PVDC/AL X 10 COMPR. P-RF 20 0.453600 0.050400 0.090720 0.413280
85 W08886001 M01AX17 NIMESULIDUM NIMESULID MCC 100 mg COMPR. 100mg MAGISTRA C & C ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-RF 10 0.453600 0.050400 0.090720 0.413280
86 W42589001 M01AX17 NIMESULIDUM NIMESULID SLAVIA COMPR. 100mg SLAVIA PHARM SRL ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 COMPR. P-RF 10 0.453600 0.050400 0.090720 0.413280
87 W43252002 M01AX17 NIMESULIDUM APONIL 100 mg COMPR. 100mg MEDOCHEMIE LTD CIPRU CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 0.453600 0.050400 0.090720 0.413280
88 W43252001 M01AX17 NIMESULIDUM APONIL 100 mg COMPR. 100mg MEDOCHEMIE LTD CIPRU CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-RF 10 0.453600 0.050400 0.090720 0.413280
89 W51945001 M01AX17 NIMESULIDUM NIMESULIDA ARENA 100 mg COMPR. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-RF 10 0.453600 0.050400 0.090720 0.413280
90 W63141001 M01AX17 NIMESULIDUM AULIN 100 mg COMPR. 100mg ANGELINI PHARMA ÖSTERREICH GMBH AUSTRIA CUTIE CU BLIST. AL/PVC X 10 COMPR. PRF 10 0.453600 0.293400 0.090720 0.656280
91 W63142009 M01AX17 NIMESULIDUM AULIN 100 mg GRAN. PT. SUSP. ORALA 100mg/plic ANGELINI PHARMA ÖSTERREICH GMBH AUSTRIA CUTIE CU 15 PLICURI DIN AL/HÂRTIE/PE SAU AL/HÂRTIE/PE/FOLIE SURLYN A CÂTE 2 G GRANULE PENTRU SUSPENSIE ORALA PRF 15 0.453600 0.281066 0.090720 0.643946
92 W61456002 M01AX17 NIMESULIDUM NIMELID 100 mg/plic GRANULE PT. SUSP. ORALA 100mg/plic ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 10 PLICURI DIN FOLIE MULTISTRAT (HARTIE/AL/PE) X 2 G GRANULE PT. SUSP. ORALA PRF 10 0.453600 0.050400 0.090720 0.413280
93 W61456003 M01AX17 NIMESULIDUM NIMELID 100 mg/plic GRANULE PT. SUSP. ORALA 100mg/plic ROMPHARM COMPANY S.R.L. ROMANIA CUTIE CU 30 PLICURI DIN FOLIE MULTISTRAT (HARTIE/AL/PE) X 2 G GRANULE PT. SUSP. ORALA PRF 30 0.453600 0.049733 0.090720 0.412613
94 W54833001 M03BX04 TOLPERISONUM ** MYDOCALM 150 mg COMPR. FILM. 150mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P-6L 30 0.663666 0.000000 0.132733 0.530933
95 W54832001 M03BX04 TOLPERISONUM ** MYDOCALM 50 mg COMPR. FILM. 50mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P-6L 30 0.370462 0.642871 0.074092 0.939241
96 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 28.460000 0.000000 5.692000 22.768000
97 W57485004 M05BA06 ACIDUM IBANDRONICUM * OSAGRAND 150 mg COMPR. FILM. 150mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 1 BLIST. PVC-PVDC/AL X 1 COMPR. FILM. P6L 1 28.460000 0.000000 5.692000 22.768000
98 W63021001 M05BA06 ACIDUM IBANDRONICUM * ACID IBANDRONIC TEVA 150 mg COMPR. FILM. 150mg TEVA B.V. OLANDA CUTIE CU BLIST. DIN PVC/ACLAR/PVC-AL X 1 COMPRIMAT FILMAT P6L 1 26.060000 0.000000 5.212000 20.848000
99 W65656001 M05BA06 ACIDUM IBANDRONICUM * ACID IBANDRONIC ACCORD 3 mg SOL INJ. IN SERINGA PREUMPLUTA 3mg ACCORD HEALTHCARE S.L.U. SPANIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA SI 1 AC PT. INJECTARE PR/P6L 1 67.380000 29.040000 13.476000 82.944000
100 W57484001 M05BA06 ACIDUM IBANDRONICUM * OSAGRAND 3 mg/3 ml SOL. INJ. 3mg/3ml ZENTIVA K.S. REPUBLICA CEHA CUTIE CU 1 FIOLA DIN STICLA INCOLORA X 3 ML SOL. INJ. P6L 1 67.380000 55.470000 13.476000 109.374000
101 W57932001 M05BA06 ACIDUM IBANDRONICUM * OSSICA 3 mg SOL. INJ. IN SERINGA PREUMPLUTA 3mg GEDEON RICHTER PLC. UNGARIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA A 3 ML SOL. INJ. + 1 AC PT. INJECTIE P6L 1 67.380000 49.880000 13.476000 103.784000
102 W67509001 M09AX01 ACIDUM HIALURONICUM ** HYALGAN 20 mg/2 ml SOL. INJ. IN SERINGA PREUMPLUTA 20mg/2ml FIDIA FARMACEUTICI SPA ITALIA CUTIE CU 1 SERINGA PREUMPLUTA DIN STICLA INCOLORA, CU DOP DIN ELASTOMER SI OPRITOR X 2 ML SOL. INJ. PRF 1 145.960000 0.000000 29.192000 116.768000
103 W51336001 N03AE01 CLONAZEPAMUM RIVOTRIL 0,5 mg COMPR. 0,5mg ROCHE ROMANIA S.R.L. ROMANIA CUTIE X 1 FLAC. DIN STICLA BRUNA X 50 COMPR. P-RF 50 0.061750 0.128450 0.012350 0.177850
104 W68924001 N03AE01 CLONAZEPAMUM RIVOTRIL 0,5 mg COMPR. 0,5mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 50 COMPR. PRF 50 0.061750 0.128450 0.012350 0.177850
105 W55375001 N03AE01 CLONAZEPAMUM RIVOTRIL 2 mg COMPR. 2mg ROCHE ROMANIA S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 30 COMPR. P-RF 30 0.247000 0.000000 0.049400 0.197600
106 W68923001 N03AE01 CLONAZEPAMUM RIVOTRIL 2 mg COMPR. 2mg CHEPLAPHARM ARZNEIMITTEL GMBH GERMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 30 COMPR. PRF 30 0.247000 0.000000 0.049400 0.197600
107 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 0.313562 0.606771 0.062712 0.857621
108 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 0.313562 0.036688 0.062712 0.287538
109 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 0.313562 0.152938 0.062712 0.403788
110 W05045001 N06BX03 PIRACETAMUM PIRACETAM MCC 400mg COMPR. 400mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 0.313562 0.138438 0.062712 0.389288

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

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

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


Nr crt.

tara det. amba referinta / UT din pretul de compensare 20% din pretul din pretul de
cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP APP Ambalaj laj (RON) referinta) de referinta) referinta)
111 W54455002 N06BX03 PIRACETAMUM PIRACETAM SINTOFARM 400 mg COMPR. 400mg SINTOFARM SA ROMANIA CUTIE X 4 BLIST. PVC/AL X 10 COMPR. P-6L 40 0.313562 1.082438 0.062712 1.333288
112 W60657001 N06BX03 PIRACETAMUM PIRACETAM LAROPHARM 400 mg COMPR. 400mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 0.313562 0.152438 0.062712 0.403288
113 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 0.313562 0.152438 0.062712 0.403288
114 W60618002 N06BX03 PIRACETAMUM PIRACETAM-RICHTER 400 mg COMPR. FILM. 400mg GEDEON RICHTER ROMANIA S.A. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 COMPR. FILM. P6L 30 0.301333 0.000000 0.060266 0.241067
115 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 0.449444 0.000000 0.089888 0.359556
116 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 0.282500 0.000000 0.056500 0.226000
117 W42904001 N06BX03 PIRACETAMUM MEMOTAL 1 g/5 ml SOL. INJ. 1g/5ml ZENTIVA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA CU INEL DE RUPERE X 5 ML SOL. INJ. P-RF 5 7.717999 0.000001 1.543599 6.174401
118 W66739002 R03AK14 COMBINATII (INDACATEROLUM+MOMETASONUM) ATECTURA BREEZHALER 125 micrograme/127,5 micrograme PULB. DE INHAL. CAPSULE 125micrograme/127,5micrograme NOVARTIS EUROPHARM LTD. IRLANDA AMBALAJ UNIC CARE CONTINE 30X1 CAPS. SI 1 INHALATOR PRF 30 3.506903 0.953097 0.701380 3.758620
119 W66740002 R03AK14 COMBINATII (INDACATEROLUM+MOMETASONUM) ATECTURA BREEZHALER 125 micrograme/260 micrograme PULB. DE INHAL. CAPSULE 125micrograme/260micrograme NOVARTIS EUROPHARM LTD. IRLANDA AMBALAJ UNIC CARE CONTINE 30X1 CAPS. SI 1 INHALATOR PRF 30 4.508333 0.000000 0.901666 3.606667
120 W66738002 R03AK14 COMBINATII (INDACATEROLUM+MOMETASONUM) ATECTURA BREEZHALER 125 micrograme/62,5 micrograme PULB. DE INHAL. CAPSULE 125micrograme/62,5micrograme NOVARTIS EUROPHARM LTD. IRLANDA AMBALAJ UNIC CARE CONTINE 30X1 CAPS. SI 1 INHALATOR PRF 30 2.604141 0.408525 0.520828 2.491838
121 W63143002 R05CB15 ERDOSTEINUM ** ERDOMED 300 mg CAPS. 300mg ANGELINI PHARMA ÖSTERREICH GMBH AUSTRIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 CAPS. P-6L 20 2.089000 0.000000 0.417800 1.671200
122 W63143001 R05CB15 ERDOSTEINUM ** ERDOMED 300 mg CAPS. 300mg ANGELINI PHARMA ÖSTERREICH GMBH AUSTRIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 CAPS. P-6L 10 2.096500 0.022500 0.419300 1.699700
123 W63144001 R05CB15 ERDOSTEINUM ** ERDOMED 175 mg/5 ml PULB. PT. SUSP. ORALA 175mg/5ml ANGELINI PHARMA ÖSTERREICH GMBH AUSTRIA CUTIE CU 1 FLAC. DIN STICLA BRUNA A 50 G PULB. PT. OBTINEREA A 100 ML SUSP. ORALA + 1 MASURA DOZATOARE DIN PP P-6L 1 40.750000 0.000000 8.150000 32.600000

NOTĂ:
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu * se iniţiază de către medicul de specialitate în limita competenţei şi poate fi prescris în continuare de medicul de familie pe baza scrisorii medicale emise de medicul de specialitate.
- Tratamentul cu medicamentele corespunzătoare DCI-urilor notate cu ** se efectuează pe baza protocoalelor terapeutice elaborate de comisiile de specialitate ale Ministerului Sănătăţii.

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