ANEXA 1

Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP
tara det.
APP Ambalaj Prescriptie
cant/
amba
laj
Pret
amanun
tul
maximal
/ambalaj
(RON)
Pret
amanuntul
maximal/UT
(RON)
Val suportata
de CNAS/UT
(RON)Legea
nr. 95/2006 art
213 alin.1 lit.
a) si f)
Val suportata
CNAS/UT
(RON) pt.
Adulti
SE ADAUGA
1329 C03EB01 COMBINATII (SPIRONOLACTONUM+FUROSEMIDUM) DIOCOR 50 mg/20 mg CAPS. 50mg/20mg SANIENCE S.R.L. ROMANIA CUTIE CU 3 BLIST. PVC/AL X 10 CAPS. P6L 30 31.48 1.049333 1.049333 0.944399
SE MODIFICA
214 C03EB01 COMBINATII (SPIRONOLACTONUM+FUROSEMIDUM) DIUREX 50 CAPS. 50mg/20mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-6L 20 23.31 1.165500 1.049333 0.944399
1193 N06AB03 FLUOXETINUM* ROFLUXIN 20 mg CAPS. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 15.12 0.756000 0.566399 0.509759
1192 N06AB03 FLUOXETINUM* MAGRILAN 20 mg CAPS. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-RF 30 17.63 0.587666 0.566399 0.509759
1190 N06AB03 FLUOXETINUM* FLUOXIN 20 mg CAPS. 20mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 7 CAPS. P-RF 14 11.28 0.805714 0.566399 0.509759
1191 N06AB03 FLUOXETINUM* FLUOXIN 20 mg CAPS. 20mg VIM SPECTRUM SRL ROMANIA CUTIE X 4 BLIST. PVC/AL X 7 CAPS. P-RF 28 22.06 0.787857 0.566399 0.509759
1194 N06AB03 FLUOXETINUM* PROZAC 20 mg COMPR. DISP. 20mg ELI LILLY SA SPANIA CUTIE X 2 BLIST. PVC-PE-ACLAR/AL X 14 COMPR. DISP. P-RF 28 36.82 1.315000 0.566399 0.509759
1197 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 39.54 1.318000 0.566399 0.509759
1199 N06AB04 CITALOPRAMUM** DALSAN 40 mg COMPR. FILM. 40mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. AL-PVC/PVDC X 14 COMPR. FILM. P-RF 28 33.59 1.199642 1.132799 1.019519
1200 N06AB05 PAROXETINUM* ARKETIS COMPR. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 23.05 0.768333 0.566399 0.509759
1204 N06AB05 PAROXETINUM* PALUXETIL 20 mg COMPR. FILM. 20mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. DIN AL/PVC X 30 COMPR.FILM. P-RF 30 20.48 0.682666 0.566399 0.509759
1202 N06AB05 PAROXETINUM* SEROXAT 20 mg COMPR. FILM. 20mg SMITHKLINE BEECHAM MAREA BRITANIE CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 34.30 1.143333 0.566399 0.509759
1203 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 23.05 0.768333 0.566399 0.509759
1201 N06AB05 PAROXETINUM* PAROXETIN ATB 20 mg COMPR. FILM. 20 mg ANTIBIOTICE SA ROMANIA CUTIE CU 3 BLIST. DIN PVC-PE-PVDC/AL X 10 COMPR. FILM. PRF 30 23.04 0.768000 0.566399 0.509759
1205 N06AB05 PAROXETINUM* PALUXETIL 40 mg COMPR. FILM. 40mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. DIN AL/PVC X 30 COMPR.FILM. P-RF 30 36.77 1.225666 1.132799 1.019519
1206 N06AB06 SERTRALINUM* SERLIFT 100 mg COMPR. FILM. 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 14 COMPR. FILM. P-RF 28 35.28 1.260000 1.132799 1.019519
1215 N06AB06 SERTRALINUM* SERLIFT 50 mg COMPR. FILM. 50mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 14 COMPR. FILM. P-RF 28 19.54 0.697857 0.566399 0.509759
1216 N06AB06 SERTRALINUM* ASENTRA (R) COMPR. FILM. 50mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. X 7 COMPR. FILM. P-RF 28 22.87 0.816785 0.566399 0.509759
1207 N06AB06 SERTRALINUM* ASENTRA (R) COMPR. FILM. 100mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. X 7 COMPR. FILM. P-RF 28 40.84 1.458571 1.132799 1.019519
1217 N06AB06 SERTRALINUM* SERTRALINA 50 mg COMPR. FILM. 50mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 20.92 0.697333 0.566399 0.509759
1208 N06AB06 SERTRALINUM* SERTRALINA 100 mg COMPR. FILM. 100mg ARENA GROUP S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 37.64 1.254666 1.132799 1.019519
1218 N06AB06 SERTRALINUM* SETALOFT 50 mg COMPR. FILM. 50mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLISTERE DIN PVC-PVDC/AL X 28 COMPR. FILM. P-RF 28 18.74 0.669285 0.566399 0.509759
1209 N06AB06 SERTRALINUM* SETALOFT 100 mg COMPR. FILM. 100mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLISTERE DIN PVC-PVDC/AL X 28 COMPR. FILM. P-RF 28 34.09 1.217500 1.132799 1.019519
1219 N06AB06 SERTRALINUM* XIMPROVE 50 mg COMPR. FILM. 50mg DR. REDDY'S LABORATORIES ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-RF 28 19.54 0.697857 0.566399 0.509759
1210 N06AB06 SERTRALINUM* XIMPROVE 100 mg COMPR. FILM. 100mg DR. REDDY'S LABORATORIES ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-RF 28 35.28 1.260000 1.132799 1.019519
1220 N06AB06 SERTRALINUM* ZOLOFT 50 mg COMPR. FILM. 50mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU 2 BLIST. PVC/AL X 14 COMPR. FILM. P-RF 28 36.98 1.320714 0.566399 0.509759
1211 N06AB06 SERTRALINUM* ZOLOFT 100 mg COMPR. FILM. 100mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU 2 BLIST. PVC/AL X 14 COMPR. FILM. P-RF 28 68.51 2.446785 1.132799 1.019519
1221 N06AB06 SERTRALINUM* ADJUVIN 50 mg COMPR. FILM. 50mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 30 20.06 0.668666 0.566399 0.509759
1212 N06AB06 SERTRALINUM* ADJUVIN 100 mg COMPR. FILM. 100mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. PRF 30 36.52 1.217333 1.132799 1.019519
1213 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 35.28 1.260000 1.132799 1.019519
1222 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 20.94 0.698000 0.566399 0.509759
1214 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 37.64 1.254666 1.132799 1.019519
1223 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 20.92 0.697333 0.566399 0.509759
1224 N06AB06 SERTRALINUM* ZOLOFT 20 mg/ml CONC. PT. SOL. ORALA 20mg/ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA BRUNA X 60 ML CONC. PT. SOL. ORALA + 1 PIPETA GRADATA P-RF 1 65.61 65.610000 13.593598 12.234238
1225 N06AB08 FLUVOXAMINUM* FEVARIN (R) 100 COMPR. FILM. 100mg ABBOTT HEALTHCARE PRODUCTS B.V. OLANDA CUTIE X 2 BLIST. PVC/PVDC X 15 COMPR. FILM. P-RF 30 48.83 1.627666 0.566399 0.509759
1226 N06AB08 FLUVOXAMINUM* FEVARIN (R) 50 COMPR. FILM. 50mg ABBOTT HEALTHCARE PRODUCTS B.V. OLANDA CUTIE X 2 BLIST. PVC/PVDC X 15 COMPR. FILM. P-RF 30 25.21 0.840333 0.283199 0.254879
SUBLISTA A - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 90% DIN PRETUL DE REFERINTA CONFORM
DENUMIRILOR COMUNE INTERNATIONALE (DCI) CORESPUNZATOARE MEDICAMENTELOR DE CARE BENEFICIAZA ASIGURATII, IN TRATAMENTUL AMBULATORIU CU CONTRIBUTIE PERSONALA DIN HG NR. 720/2008 CU COMPLETARILE
SI MODIFICARILE ULTERIOARE VALABILA INCEPAND CU
02 IUNIE 2014
Pagina 1 din 9
ANEXA 2
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP
tara det.
APP Ambalaj Prescriptie
cant/
amba
laj
Pret
amanun
tul
maximal
/ambalaj
(RON)
Pret
amanuntul
maximal/UT
(RON)
Val suportata
de CNAS/UT
(RON)Legea
nr. 95/2006 art
213 alin.1 lit.
a) si f)
SE ADAUGA
1172 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 29.54 0.984666 0.984666
1173 N06AB10 ESCITALOPRAMUM** ESCITALOPRAM-TEVA 10 mg COMPR. FILM. 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P-RF 30 22.51 0.750333 0.750333
1174 N06AB10 ESCITALOPRAMUM** ESCITALOPRAM-TEVA 20 mg COMPR. FILM. 20mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P-RF 30 43.57 1.452333 1.452333
1175 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 OLINGURITA DOZATOARE GRADATA LA 2,5 ML SI 5 ML X 120 ML SOL. P6L 1 10.88 10.880000 10.880000
SE MODIFICA
401 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HYDROCHLOROTHIAZIDE WINTHROP 300mg/12,5mg COMPR. FILM 300mg/12,5mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 2 BLIST. PVC/PVDC/AL X 14 COMPR. FILM. P-6L 28 33.70 1.203571 1.129017
402 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 33.70 1.203571 1.129017
406 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HIDROCLOROTIAZIDA RANBAXY 150 mg/12,5 mg COMPR. FILM. 150mg/12,5mg RANBAXY (U.K.) LIMITED MAREA BRITANIE CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 35.50 1.267857 1.129017
416 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HIDROCLOROTIAZIDA RANBAXY 300 mg/25 mg COMPR. FILM. 300mg/25mg RANBAXY (U.K.) LIMITED MAREA BRITANIE CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 68.91 2.461071 1.129017
413 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HIDROCLOROTIAZIDA RANBAXY 300 mg/12,5 mg COMPR. FILM. 300mg/12,5mg RANBAXY (U.K.) LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC-ACLAR/AL X 28 COMPR. FILM. P6L 28 68.91 2.461071 1.129017
409 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN/ HYDROCHLOROTHIAZIDE TEVA 300 mg/12,5 mg COMPR. FILM. 300 mg/12,5mg TEVA PHARMA B.V. OLANDA CUTIE X BLIST. AL/AL X 28 COMPR. FILM. P-6L 28 51.49 1.838928 1.129017
408 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRPREZIDE 300 mg/12,5 mg COMPR. FILM. 300 mg/12,5 mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. DIN PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 46.28 1.542666 1.129017
410 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRPREZIDE 300 mg/25 mg COMPR. FILM. 300 mg/25 mg ACTAVIS GROUP PTC EHF. IRLANDA CUTIE CU BLIST. DIN PVC-PVDC/AL X 30 COMPR. FILM. P6L 30 55.16 1.838666 1.129017
405 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IFIRMACOMBI 150mg/12,5mg COMPR. FILM. 150mg/12,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 39.59 1.319666 1.129017
411 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IFIRMACOMBI 300mg/12,5mg COMPR. FILM. 300mg/12,5mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 73.91 2.463666 1.129017
415 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IFIRMACOMBI 300mg/25mg COMPR. FILM. 300mg/25mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. DIN OPA/AL/PVC/AL X 30 COMPR. FILM. P6L 30 73.91 2.463666 1.129017
407 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HIDROCLOROTIAZIDA RANBAXY 150 mg/12,5 mg COMPR. FILM. 150mg/12,5mg RANBAXY (U.K.) LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC-ACLAR/AL X 28 COMPR. FILM. P6L 28 35.50 1.267857 1.129017
412 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HIDROCLOROTIAZIDA RANBAXY 300 mg/12,5 mg COMPR. FILM. 300mg/12,5mg RANBAXY (U.K.) LIMITED MAREA BRITANIE CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 68.91 2.461071 1.129017
417 C09DA04 COMBINATII (IRBERSARTANUM+HYDROCHLOROTHIAZIDUM) IRBESARTAN HIDROCLOROTIAZIDA RANBAXY 300 mg/25 mg COMPR. FILM. 300mg/25mg RANBAXY (U.K.) LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC-ACLAR/AL X 28 COMPR. FILM. P6L 28 68.91 2.461071 1.129017
431 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) PRITOR PLUS 80mg/25mg COMPR. 80mg/25mg BAYER SCHERING PHARMA AG GERMANIA CUTIE X 28COMPR.( BLIST. PA/AL/PVC SAU PA/PA/AL/PVC/AL PERFORATE UNIDOZA) P-6L 28 104.85 3.744642 1.129017
424 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) PRITOR PLUS 80mg/12,5mg COMPR. 80mg/12,5mg BAYER SCHERING PHARMA AG GERMANIA CUTIE X 28COMPR.( BLIST. PA/AL/PVC PERFORATE) P-6L 28 79.57 2.841785 1.129017
423 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) MICARDISPLUS 80/25mg COMPR. 80/25mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 28 COMPR. (BLIST. PA/AL/PVC/AL SAU PA/PA/AL/PVC/AL) P-6L 28 104.85 3.744642 1.129017
422 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) MICARDISPLUS 80/12,5mg COMPR. 80/12,5mg BOEHRINGER INGELHEIM INTERNATIONAL GMBH GERMANIA CUTIE X 28COMPR. ( BLIST. PA/AL/PVC) P-6L 28 77.42 2.765000 1.129017
436 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMISARTAN/HIDROCLOROTIAZIDA TERAPIA 80 mg/25 mg COMPR. 80mg/25mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28X1 COMPR. P6L 28 69.38 2.477857 1.129017
435 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMISARTAN/HIDROCLOROTIAZIDA TERAPIA 80 mg/25 mg COMPR. 80mg/25mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR. P6L 28 69.38 2.477857 1.129017
430 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMISARTAN/HIDROCLOROTIAZIDA TERAPIA 80 mg/12,5 mg COMPR. 80mg/12,5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28X1 COMPR. P6L 28 52.99 1.892500 1.129017
429 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMISARTAN/HIDROCLOROTIAZIDA TERAPIA 80 mg/12,5 mg COMPR. 80mg/12,5mg TERAPIA S.A. ROMANIA CUTIE CU BLIST. AL/AL X 28 COMPR. P6L 28 52.99 1.892500 1.129017
434 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMARK PLUS 80mg/25mg COMPR. 80mg/25mg GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-AL-OPA/AL X 30 COMPRIMATE P-6L 30 73.02 2.434000 1.129017
428 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMARK PLUS 80mg/12,5mg COMPR. 80mg/12,5mg GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU BLIST. PVC-AL-OPA/AL X 30 COMPRIMATE P-6L 30 56.77 1.892333 1.129017
433 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 41.71 1.390333 1.129017
420 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 73.02 2.434000 1.129017
418 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 43.24 1.544285 1.129017
419 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 56.77 1.892333 1.129017
421 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 53.68 1.917142 1.129017
426 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMISARTAN/HIDROCLOROTIAZIDA EGIS 80 mg/12,5 mg COMPR. 80mg/12,5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. AL/AL X 28 COMPR. P6L 28 35.00 1.250000 1.129017
427 C09DA07 COMBINATII (TELMISARTANUM+HYDROCHLOROTHIAZIDUM) TELMISARTAN/HIDROCLOROTIAZIDA DR. REDDY'S 80 mg/12,5 mg COMPR. 80mg/12,5mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. P6L 28 52.99 1.892500 1.129017
964 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 90.38 3.227857 1.132799
1145 R06AX27 DESLORATADINUM DESLORATADINA ALVOGEN 0,5 mg/ml SOL. ORALA 0,5mg/ml ALVOGEN IPCO S.A.R.L LUXEMBURG CUTIE CU1 FLAC. DINSTICLA BRUNA A 120 ML SOL. ORALA + 1 LINGURITA DOZATOARE SAUOSERINGA DOZATOAR P6L 1 13.31 13.310000 12.000000
1148 R06AX27 DESLORATADINUM AERIUS 0,5mg/ml SOL. ORALA 0,5mg/ml MERCK SHARP&DOHME LTD. MAREA BRITANIE CUTIE X 1 FLACON X 120 ML SOL. ORALA + LIGURITA DOZATOARE DE 2,5 ML SI 5 ML P-RF 1 16.73 16.730000 12.000000
1149 R06AX27 DESLORATADINUM DYNID 0,5 mg/ml SOL. ORALA 0,5mg/ml GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU1 FLAC. DINSTICLA BRUNA X 150 ML SOL. ORALA + 1 LINGURITA DOZATOARE SAUOSERINGA DOZATOAR P6L 1 16.86 16.860000 15.000000
1143 R06AX27 DESLORATADINUM DESLORATADINA SANDOZ 0.5 mg/ml SOL. ORALA 0,5 mg/ml SANDOZ S.R.L. ROMANIA CUTIE CU1 FLAC. DINSTICLA BRUNA CUCAPACITATEA DE 125 ML X 120 ML, SOL. ORALA + LINGURITA DOZATOAR P6L 1 13.31 13.310000 12.000000
SUBLISTA B - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 50% DIN PRETUL DE REFERINTA CONFORM
DENUMIRILOR COMUNE INTERNATIONALE (DCI) ALE MEDICAMENTELOR DE CARE BENEFICIAZA ASIGURATII, IN TRATAMENTUL AMBULATORIU CU CONTRIBUTIE PERSONALA DIN HG NR. 720/2008 CU MODIFICARILE SI
COMPLETARILE ULTERIOARE VALABILA INCEPAND CU 02 IUNIE 2014
Pagina 2 din 8
Nr. crt cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP
tara det.
APP Ambalaj Prescriptie
cant/
amba
laj
Pret
amanun
tul
maximal
/ambalaj
(RON)
Pret
amanuntul
maximal/UT
(RON)
Val suportata
de CNAS/UT
(RON)Legea
nr. 95/2006 art
213 alin.1 lit.
a) si f)
1147 R06AX27 DESLORATADINUM DESLORATADINA TEVA 0,5 mg/ml SOL. ORALA 0,5mg/ml TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU 1 FLAC. DIN STICLA + 1 LINGURA DOZATOARE DIN PEID GRADATA LA DOZE DE 2,5 ML SI 5 ML X 120 M P6L 1 13.31 13.310000 12.000000
1144 R06AX27 DESLORATADINUM AERIUS 0,5mg/ml SOL. ORALA 0,5mg/ml SP EUROPE BELGIA CUTIE X 1 FLACON X 120 ML SOL. ORALA + LIGURITA DOZATOARE DE 2,5 ML SI 5 ML P-RF 1 16.73 16.730000 12.000000
1146 R06AX27 DESLORATADINUM DYNID 0,5 mg/ml SOL. ORALA 0,5mg/ml GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU1 FLAC. DINSTICLA BRUNA X 120 ML SOL. ORALA + 1 LINGURITA DOZATOARE SAUOSERINGA DOZATOAR P6L 1 13.31 13.310000 12.000000
Pagina 3 din 8

Val suportata
CNAS/UT
(RON) pt.
Adulti
0.492333
0.375166
0.726166
5.440000
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.564508
0.566399
6.000000
6.000000
7.500000
6.000000
Pagina 4 din 8
Val suportata
CNAS/UT
(RON) pt.
Adulti
6.000000
6.000000
6.000000
Pagina 5 din 8
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP
TARA
DET. APP AMBALAJ Prescriptie
cant/
amba
laj
PRET
AMANU
NTUL
MAXIMA
L
(RON)
PRET
AMANUNTUL
MAXIMAL/UT
(RON)
VAL.SUPORT
ATAT CNAS/
UT(RON)-
LEGEA NR.
95/2006 ART
213 alin.(1) lit.
a) si f)
VAL.SUPORT
ATAT CNAS/
UT (RON)
PT. ADULTI
SE ADAUGA
202 N03AX17 STIRIPENTOLUM** DIACOMIT 500mg CAPS. 500mg BIOCODEX FRANTA CUTIE X 1 FLAC. DIN PP X 60 CAPS. P-RF/R 60 1,513.60 25.226666 25.226666 25.226666
203 N03AX17 STIRIPENTOLUM** DIACOMIT 250mg CAPS. 250mg BIOCODEX FRANTA CUTIE X 1 FLAC. DIN PP X 60 CAPS. P-RF/R 60 776.40 12.940000 12.940000 12.940000
204 N03AX17 STIRIPENTOLUM** DIACOMIT 250mg PULB. PT. SUSP. ORALA 250mg BIOCODEX FRANTA CUTIE X 60 PLICURI HARTIE/AL/PE P-RF/R 60 776.40 12.940000 12.940000 12.940000
205 N03AX17 STIRIPENTOLUM** DIACOMIT 500mg PULB. PT. SUSP. ORALA 500mg BIOCODEX FRANTA CUTIE X 60 PLICURI HARTIE/AL/PE P-RF/R 60 1,513.60 25.226666 25.226666 25.226666
SE MODIFICA
100 N03AX11 TOPIRAMATUM** TOPAMAX 50 mg COMPR. FILM. 50mg JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 27.58 0.985000 0.768399 0.768399
76 N03AX11 TOPIRAMATUM** TOPAMAX 100 mg COMPR. FILM. 100mg JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 40.80 1.457142 1.173999 1.173999
77 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 29.35 0.978333 0.978333 0.978333
90 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 11.29 0.376333 0.376333 0.376333
101 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 19.21 0.640333 0.640333 0.640333
81 N03AX11 TOPIRAMATUM** TOPRAN 25 mg COMPR. FILM. 25mg TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 60 COMPR. FILM. P-6L 60 53.96 0.899333 0.451599 0.451599
91 N03AX11 TOPIRAMATUM** TOPRAN 50 mg COMPR. FILM. 50mg TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 60 COMPR. FILM. P-6L 60 97.27 1.621166 0.768399 0.768399
67 N03AX11 TOPIRAMATUM** TOPRAN 100 mg COMPR. FILM. 100mg TERAPIA SA ROMANIA CUTIE X 1 FLAC. DIN PEID X 60 COMPR. FILM. P-6L 60 165.90 2.765000 1.173999 1.173999
92 N03AX11 TOPIRAMATUM** TOPIRAMAT TEVA 50 mg COMPR. FILM. 50mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P-RF 30 53.67 1.789000 0.768399 0.768399
82 N03AX11 TOPIRAMATUM** TOPIRAMAT TEVA 25 mg COMPR. FILM. 25mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P-RF 30 29.21 0.973666 0.451599 0.451599
68 N03AX11 TOPIRAMATUM** TOPIRAMAT TEVA 100 mg COMPR. FILM. 100mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. DIN OPA-AL-PVC/AL X 30 COMPR. FILM. P-RF 30 90.25 3.008333 1.173999 1.173999
83 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 40.26 0.671000 0.451599 0.451599
93 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 69.19 1.153166 0.768399 0.768399
69 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 60 103.38 1.723000 1.173999 1.173999
84 N03AX11 TOPIRAMATUM** LUSITRAX 25 mg COMPR. FILM. 25mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE CU BLIST. PVC-PCTFE-PVC/AL-PVDC X 30 COMPR. FILM. P-RF 30 20.83 0.694333 0.451599 0.451599
94 N03AX11 TOPIRAMATUM** LUSITRAX 50 mg COMPR. FILM. 50mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE CU BLIST. PVC-PCTFE-PVC/AL-PVDC X 30 COMPR. FILM. P-RF 30 35.46 1.182000 0.768399 0.768399
70 N03AX11 TOPIRAMATUM** LUSITRAX 100mg COMPR. FILM. 100mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE CU BLIST. PVC-PCTFE-PVC/AL-PVDC X 30 COMPR. FILM. P-RF 30 52.46 1.748666 1.173999 1.173999
71 N03AX11 TOPIRAMATUM** TORLEPTA 100 mg COMPR. FILM. 100mg GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-RF 30 80.21 2.673666 1.173999 1.173999
85 N03AX11 TOPIRAMATUM** TORLEPTA 25 mg COMPR. FILM. 25mg GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-RF 30 26.67 0.889000 0.451599 0.451599
95 N03AX11 TOPIRAMATUM** TORLEPTA 50 mg COMPR. FILM. 50mg GLENMARK PHARMACEUTICALS S.R.O. REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P-RF 30 44.81 1.493666 0.768399 0.768399
86 N03AX11 TOPIRAMATUM** TOPIRAMAT BLUEFISH 25 mg COMPR. FILM. 25mg BLUEFISH PHARMACEUTICALS AB SUEDIA CUTIE CU BLIST. AL/AL X 60 COMPR. FILM. P-RF 60 51.29 0.854833 0.451599 0.451599
96 N03AX11 TOPIRAMATUM** TOPIRAMAT BLUEFISH 50 mg COMPR. FILM. 50mg BLUEFISH PHARMACEUTICALS AB SUEDIA CUTIE CU BLIST. AL/AL X 60 COMPR. FILM. P-RF 60 84.54 1.409000 0.768399 0.768399
97 N03AX11 TOPIRAMATUM** TOPIRAMAT BLUEFISH 50 mg COMPR. FILM. 50mg BLUEFISH PHARMACEUTICALS AB SUEDIA CUTIE CU 1 FLAC. PEID X 60 COMPR. FILM. P-RF 60 84.54 1.409000 0.768399 0.768399
72 N03AX11 TOPIRAMATUM** TOPIRAMAT BLUEFISH 100 mg COMPR. FILM. 100mg BLUEFISH PHARMACEUTICALS AB SUEDIA CUTIE CU BLIST. AL/AL X 60 COMPR. FILM. P-RF 60 142.68 2.378000 1.173999 1.173999
73 N03AX11 TOPIRAMATUM** TOPIRAMAT BLUEFISH 100 mg COMPR. FILM. 100mg BLUEFISH PHARMACEUTICALS AB SUEDIA CUTIE CU 1 FLAC. PEID X 60 COMPR. FILM. P-RF 60 142.68 2.378000 1.173999 1.173999
87 N03AX11 TOPIRAMATUM** TOPIRAMAT EGIS 25 mg COMPR. FILM. 25mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC/PVDC/AL X 60 COMPR. FILM. PRF 60 48.19 0.803166 0.451599 0.451599
98 N03AX11 TOPIRAMATUM** TOPIRAMAT EGIS 50 mg COMPR. FILM. 50mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC/PVDC/AL X 60 COMPR. FILM. PRF 60 74.80 1.246666 0.768399 0.768399
74 N03AX11 TOPIRAMATUM** TOPIRAMAT EGIS 100 mg COMPR. FILM. 100mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC/PVDC/AL X 60 COMPR. FILM. PRF 60 133.79 2.229833 1.173999 1.173999
88 N03AX11 TOPIRAMATUM** NEXTOP 25 mg COMPR. FILM. 25mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 27.57 0.919000 0.451599 0.451599
9. EPILEPSIE - G11
ANEXA 3
SECIUNEA C1 - LISTA MEDICAMENTELOR CU PROCENT DE COMPENSARE 100% DIN PREUL DE REFERIN CONFORM
DCI-urilor UTILIZATE N TRATAMENTUL AMBULATORIU AL UNOR GRUPE DE BOLI PENTRU CARE DECONTAREA SE FACE PE BAZA PROTOCOALELOR TERAPEUTICE CU MONITORIZAREA PRESCRIERII I CONSUMULUI PRIN COMISIILE PARITARE;
MEDICAMENTELE DIN ACEAST SUBLIST SE ELIBEREAZ PRIN FARMACII CU CIRCUIT DESCHIS PE BAZ DE PRESCRIPIE MEDICAL CU REINERE N FARMACIE ( P-RF)
DIN HG NR. 720/2008 CU MODIFICARILE SI COMPLETARILE ULTERIOARE
VALABIL NCEPND CU 02 IUNIE 2014
Pagina 6 din 11
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP
TARA
DET. APP AMBALAJ Prescriptie
cant/
amba
laj
PRET
AMANU
NTUL
MAXIMA
L
(RON)
PRET
AMANUNTUL
MAXIMAL/UT
(RON)
VAL.SUPORT
ATAT CNAS/
UT(RON)-
LEGEA NR.
95/2006 ART
213 alin.(1) lit.
a) si f)
VAL.SUPORT
ATAT CNAS/
UT (RON)
PT. ADULTI
99 N03AX11 TOPIRAMATUM** NEXTOP 50 mg COMPR. FILM. 50mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 50.82 1.694000 0.768399 0.768399
75 N03AX11 TOPIRAMATUM** NEXTOP 100 mg COMPR. FILM. 100mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 87.16 2.905333 1.173999 1.173999
89 N03AX11 TOPIRAMATUM** TOPAMAX 25 mg COMPR. FILM. 25mg JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 16.21 0.578928 0.451599 0.451599
SE ADAUGA
345 N06AB10 ESCITALOPRAMUM** ESCITALOPRAM-TEVA 20 mg COMPR. FILM. 20mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P-RF 30 43.57 1.452333 1.452333 1.452333
346 N06AB10 ESCITALOPRAMUM** ESCITALOPRAM-TEVA 10 mg COMPR. FILM. 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P-RF 30 22.51 0.750333 0.750333 0.750333
SE MODIFICA
301 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 90.38 3.227857 0.900399 0.900399
SE ADAUGA
118 N06DX01 MEMANTINUM*** ZENMEM 20 mg COMPR. ORODISPERSABILE 20mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL-PET-HARTIE X 28 COMPR. ORODISPERSABILE PR 28 212.70 7.596428 7.596428 7.596428
SE MODIFICA
105 N06DX01 MEMANTINUM*** COGNOMEM 10 mg COMPR. FILM. 10mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. PR 56 160.86 2.872500 2.872500 2.872500
113 N06DX01 MEMANTINUM*** COGNOMEM 20 mg COMPR. FILM. 20mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. PVC/AL X 56 COMPR. FILM. PR 56 425.42 7.596785 7.596785 7.596785
115 N06DX01 MEMANTINUM*** ZENMEN 10 mg COMPR. ORODISPERSABILE 10mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL-PET-HARTIE X 28 COMPR. ORODISPERSABILE PR 28 80.42 2.872142 2.872142 2.872142
SE ADAUGA
52 H01CB05 PASIREOTIDUM** SIGNIFOR 0,9 mg SOL INJ. 0,9mg NOVARTIS EUROPHARM LTD. MAREA BRITANIE CUTIE CU 30 FIOLE DIN STICLA A 1ML X 0,9 MG PR 30 9,264.78 308.826000 308.826000 308.826000
53 H01CB05 PASIREOTIDUM** SIGNIFOR 0,3 mg SOL INJ. 0,3mg NOVARTIS EUROPHARM LTD. MAREA BRITANIE CUTIE CU 30 FIOLE DIN STICLA A 1ML X 0,3 MG PR 30 7,863.11 262.103666 262.103666 262.103666
54 H01CB05 PASIREOTIDUM** SIGNIFOR 0,6 mg SOL INJ. 0,6mg NOVARTIS EUROPHARM LTD. MAREA BRITANIE CUTIE CU 30 FIOLE DIN STICLA A 1ML X 0,6 MG PR 30 8,674.14 289.138000 289.138000 289.138000
SE MODIFICA
24 S01EE01 LATANOPROSTUM UNILAT 50 micrograme/ml PIC. OFT., SOL. 50micrograme/ml UNIMED PHARMA SPOL. S.R.O. REPUBLICA SLOVACA CUTIE CU 1 FLAC. PICURATOR PE X 2,5 ML PIC. OFT., SOL. P-6L 1 51.50 51.500000 30.876000 30.876000
26 S01EE01 LATANOPROSTUM GLAUTAN 0,05 mg/ml PIC. OFT.,SOL. 0,05mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE CU1 FLAC. PEJD CUCAPACITATEA DE 5 ML+PICURATOR DINPEJD, CUCAPAC DE SIGURANTA DINPEJD X2,5 ML PIC. OFT., SOL. P6L 1 25.73 25.730000 25.730000 25.730000
27 S01EE01 LATANOPROSTUM XALATAN (R) PICATURI OFT.-SOL. 0,005% PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLACON PICURATOR PE X 2,5 ML P-6L 1 75.25 75.250000 30.876000 30.876000
21. GLAUCOM - G 26
18. BOLI ENDOCRINE (GUSA ENDEMICA, INSUFICIENTA SUPRARENALA CRONICA, DIABETUL INSIPID, MIXEDEMUL ADULTULUI, TUMORI HIPOFIZARE CU EXPANSIUNE SUPRASELARA SI TUMORI NEUROENDOCRINE) - G 22
13. BOLI PSIHICE (SCHIZOFRENIE, TULBURARI SCHIZOTIPALE SI DELIRANTE, TULBURARI AFECTIVE MAJORE, TULBURARI PSIHOTICE ACUTE SI BOLI PSIHICE COPII, AUTISM) - G15
14. DEMENTE(DEGENERATIVE, VASCULARE, MIXTE) - G 16
Pagina 7 din 11
NR.CRT COD ATC DCI Denumire Comerciala forma farm. concentratie DETINATOR APP
TARA
DET. APP AMBALAJ Prescriptie
cant/
amba
laj
PRET
AMANU
NTUL
MAXIMA
L
(RON)
PRET
AMANUNTUL
MAXIMAL/UT
(RON)
VAL.SUPORT
ATAT CNAS/
UT(RON)-
LEGEA NR.
95/2006 ART
213 alin.(1) lit.
a) si f)
VAL.SUPORT
ATAT CNAS/
UT (RON)
PT. ADULTI
28 S01EE01 LATANOPROSTUM XALOPTIC PICATURI OFT.-SOL. 0,005% PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE X 1 FLACON PICURATOR PEJD X 2,5 ML PIC. OFT. SOL. P-6L 1 46.18 46.180000 30.876000 30.876000
Pagina 8 din 11