ANEXA 1 SUBLISTA A - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 90% DIN PRETUL DE REFER INTA CONFORM DENUMIRILOR COMUNE INTERNATIONALE

(DCI) CORESPUNZATOARE MEDICAMENTELOR DE CARE B ENEFICIAZA ASIGURATII, IN TRATAMENTUL AMBULATORIU CU CONTRIBUTIE PERSONALA DIN H G NR. 720/2008 CU COMPLETARILE SI MODIFICARILE ULTERIOARE VALABILA INCEPAND CU 1 IANUARIE 2012 Nr crt. cod ATC DCI Denumire Comerciala forma farm. concentratie Detinator APP tara det. APP Ambalaj Prescriptie cant/a mbala j Pret amanunt ul 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

1 A02BA02 RANITIDINUM RANITIDIN ARENA 150mg COMPR. 150mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. P-6L 20 4.50 0.225000 0.192543 0.173289 2 A02BA02 RANITIDINUM RANITIDINA 150 mg COMPR. 150mg MAGISTRA C&C S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 4.51 0.225500 0.192543 0.173289

3 A02BA02 RANITIDINUM RANITIDIN COMPR. 150mg SLAVIA PHARM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 4.50 0.225000 0.192543 0.173289 4 A02BA02 RANITIDINUM ZANTAC 150 mg COMPR. FILM. 150mg GLAXO WELLCOME UK LTD. MAREA BRITANIE CUTIE X 2 BLIST. AL/AL X 10 COMPR. FILM. P-6L 20 6.93 0.346500 0.192543 0.173289

5 A02BA02 RANITIDINUM N - RANITIDIN COMPR. FILM. 150mg MEDUMAN SA ROMANIA CUTIE X 1 FLAC. PE X 20 COMPR. FILM. P-6L 20 3.94 0.197000 0.192543 0.173289 6 A02BA02 RANITIDINUM RANITIDINA 150 mg COMPR. FILM. 150mg FILDAS TRADING SRL ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL-VMCH X 10 COMPR. FILM. P-6L 20 4.67 0.233500 0.192543 0.173289

7 A02BA02 RANITIDINUM RANITIDIN 150 mg COMPR. FILM. 150mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 4.50 0.225000 0.192543 0.173289 8 A02BA02 RANITIDINUM RANITIDINA LAROPHARM 150 mg COMPR. FILM. 150mg LAROPHARM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. FILM. P-6L 20 4.50 0.225000 0.192543 0.173289

9 A02BA02 RANITIDINUM RANITIDINA LPH 150 mg COMPR. FILM. 150mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-6L 20 4.51 0.225500 0.192543 0.173289 10 A02BA02 RANITIDINUM RANITIDINA ATB 150 MG COMPR. FILM. 150mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. X 10 COMPR. FILM. P-6L 20 4.50 0.225000 0.192543 0.173289

11 A02BA02 RANITIDINUM RANITIDINA LPH 300 mg COMPR. FILM. 300mg LABORMED PHARMA SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-6L 30 12.85 0.428333 0.385087 0.346578 12 A02BA02 RANITIDINUM RANITIDINA ATB 300 mg COMPR. FILM. 300mg ANTIBIOTICE S.A. ROMANIA CUTIE X 1 BLIST. PVC/AL X 10 COMPR. FILM. P-6L 10 4.28 0.428000 0.385087 0.346578

13 A02BA02 RANITIDINUM RANITIDINA ATB 300 mg COMPR. FILM. 300mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 10 COMPR. FILM. P-6L 20 8.55 0.427500 0.385087 0.346578 14 A02BA02 RANITIDINUM ARNETIN SOL. INJ. 25mg/ml MEDOCHEMIE LTD. CIPRU CUTIE X 5 FIOLE X 2 ML P-RF 5 12.51 2.502000 1.856397 1.670757

15 A02BA02 RANITIDINUM ZANTAC SOLUTIE INJECTABILA SOL. INJ. 25mg/ml GLAXO WELLCOME UK LTD. MAREA BRITANIE CUTIE X 5 FIOLE X 2 ML SOL. INJ. P-RF 5 14.76 2.952000 1.856397 1.670757 16 A02BA03 FAMOTIDINUM FAMODIN 20 COMPR. FILM. 20mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 8.78 0.292666 0.192543 0.173289

17 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 5.79 0.193000 0.192543 0.173289 18 A02BA03 FAMOTIDINUM QUAMATEL 20 mg COMPR. FILM. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-6L 28 9.34 0.333571 0.192543 0.173289

19 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 7.63 0.254333 0.254333 0.228899 20 A02BA03 FAMOTIDINUM FAMODIN 40 COMPR. FILM. 40mg AC HELCOR PHARMA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 12.17 0.405666 0.385087 0.346578

21 A02BA03 FAMOTIDINUM QUAMATEL 40 mg COMPR. FILM. 40mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 14 COMPR. FILM. P-6L 14 9.34 0.667142 0.385087 0.346578 22 A02BA03 FAMOTIDINUM QUAMATEL 20 mg PULB+SOLV. PT. SOL. INJ./PERF. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 5 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERFUZ. + 5 FIOLE DIN STCLA INCOLORA X 5 S/P-RF 5 24.35 4.870000 4.870000 4.383000

23 A02BA04 NIZATIDINUM NIZATIDIN VIM SPECTRUM 150 mg CAPS. 150mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-6L 20 18.01 0.900500 0.192543 0.173289 24 A02BC01 OMEPRAZOLUM RISEK CAPS. ENTER. 20mg GULF PHARMACEUTICAL IND. (JUPHAR) ROMANIA CUTIE X 1 FLAC. X 14 CAPS. ENTER. P-6L 14 14.28 1.020000 0.696696 0.627026

25 A02BC01 OMEPRAZOLUM OMEPRAZOL BIOFARM 20 mg CAPS. GASTROREZ. 20mg BIOFARM S.A. ROMANIA CUTIE X 1 FLAC. PEID X 28 CAPS. GASTROREZ. P-6L 28 20.31 0.725357 0.696696 0.627026 26 A02BC01 OMEPRAZOLUM OMEPRAZOL BIOFARM 20 mg CAPS. GASTROREZ. 20mg BIOFARM S.A. ROMANIA CUTIE X 1 FLAC. PEID X 14 CAPS. GASTROREZ. P-6L 14 10.71 0.765000 0.696696 0.627026

27 A02BC01 OMEPRAZOLUM ULTOP CAPS. GASTROREZ. 20mg KRKA D.D. SLOVENIA CUTIE X 1 FLAC. PE X 14 CAPS. GASTROREZ. P-6L 14 14.28 1.020000 0.696696 0.627026 28 A02BC01 OMEPRAZOLUM OMEPRAZOL 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 14.28 1.020000 0.696696 0.627026

29 A02BC01 OMEPRAZOLUM OMEPRAZOL LPH 20 mg CAPS. GASTROREZ. 20mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. GASTROREZ. P-6L 20 12.65 0.632500 0.632500 0.569250 30 A02BC01 OMEPRAZOLUM OMERAN 20 CAPS. GASTROREZ. 20mg EUROPHARM SA ROMANIA CUTIE X 4 BLIST. AL/AL X 7 CAPS. GASTROREZ. P-6L 28 21.17 0.756071 0.696696 0.627026

31 A02BC01 OMEPRAZOLUM OMERAN 20 CAPS. GASTROREZ. 20mg EUROPHARM SA ROMANIA CUTIE X 2 BLIST. AL/AL X 7 CAPS. GASTROREZ. P-6L 14 14.08 1.005714 0.696696 0.627026 32 A02BC01 OMEPRAZOLUM OMEPRAZOL 20 mg CAPS. GASTROREZ. 20mg SLAVIA PHARM SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 CAPS. GASTROREZ. P-6L 30 22.42 0.747333 0.696696 0.627026

33 A02BC01 OMEPRAZOLUM OMEPRAZOL TERAPIA 20 mg CAPS.