SE MODIFICA. Pagina 1 din 1

ANEXA 1 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 19 IUNIE 2012 Nr. cod ATC DCI Denumire Comerciala forma farm. conce ntratie Detinator APP tara det. APP A Pres. Pret amanuntu l maximal/a (RON) Pret maximal/u T (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 MODIFICA 556 C09CA01 LOSARTANUM LOZAP 50 COMPR. FILM. 50mg ZENTIVA A.S. SLOVACIA CUTIE CU 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-6L 30 19.63 0.654333 0.649906 0.584916 555 C09CA01 LOSARTANUM COZAAR 50 mg COMPR. FILM. 50mg MERCK SHARP & DOHME ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P-6L 28 64.56 2.305714 0.649906 0.584916 714 J01AA02 DOXYCYCLINUM DOXICICLINA ATB 100 mg CAPS. 100 mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 10 CAPS. PRF 10 3.59 0.359000 0.323100 0.290790 716 J01AA02 DOXYCYCLINUM DOXICICLINA 100 mg CAPS. 100mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-RF 10 3.59 0.359000 0.323100 0.290790 717 J01AA02 DOXYCYCLINUM DOXICICLINA CAPS. 100mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 7.00 0.350000 0.323100 0.290790 715 J01AA02 DOXYCYCLINUM DOXICICLINA SANDOZ 100 mg CAPS. 100mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 3.61 0.361000 0.323100 0.290790 718 J01AA02 DOXYCYCLINUM UNIDOX SOLUTAB COMPR. DISP. 100mg ASTELLAS PHARMA EUROPE BV OLANDA CUTIE X 1 BLIST. DIN AL/PVC X 10 COMPR.DISP. P-RF 10 9.58 0.958000 0.323100 0.290790 Pagina 1 din 1

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 19 IUNIE 2012 ANEXA 2 Nr. cod ATC DCI Denumire Comerciala forma farm. concent ratie Detinator APP tara det. APP A Pres. Pret amanuntu l maximal/a (RON) Pret 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 REPUBLICA SLOVACA 1007 C09CA06 CANDESARTANUM CILEXETIL TANDESAR 16 mg COMPR. 16mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P-6L 28 44.87 1.602500 1.602500 0.801250 1008 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 43.24 1.441333 1.441333 0.720666 1009 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL ZENTIVA 16 mg COMPR. 16mg ZENTIVA K.S. REPUBLICA SLOVACA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 48.06 1.602000 1.602000 0.801000 1010 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN SANDOZ 16 mg COMPR. 16mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL CU DESICANT X 28 COMPR. P-6L 28 39.65 1.416071 1.416071 0.708035 1011 C09CA06 CANDESARTANUM CILEXETIL HIPOSTYN 16 mg COMPR. 16mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 42.50 1.416666 1.416666 0.708333 1012 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 81.75 2.725000 2.725000 1.362500 1013 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL ZENTIVA 32 mg COMPR. 32mg ZENTIVA K.S. REPUBLICA SLOVACA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 81.77 2.725666 2.725666 1.362833 1014 C09CA06 CANDESARTANUM CILEXETIL HIPOSTYN 32 mg COMPR. 32mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 71.36 2.378666 2.378666 1.189333 1015 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 33.01 1.100333 1.100333 0.550166 1016 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN SANDOZ 8 mg COMPR. 8mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL CU DESICANT X 28 COMPR. P-6L 28 33.45 1.194642 1.194642 0.597321 1017 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL ZENTIVA 8 mg COMPR. 8mg ZENTIVA K.S. CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 39.02 1.300666 1.299813 0.649906 1018 C09CA06 CANDESARTANUM CILEXETIL HIPOSTYN 8 mg COMPR. 8mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 24.13 0.804333 0.804333 0.402166 1019 C09CA06 CANDESARTANUM CILEXETIL TANDESAR 8 mg COMPR. 8mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P-6L 28 36.46 1.302142 1.299813 0.649906 1020 C10AA05 ATORVASTATINUM XAMARA 20 mg COMPR. FILM. 20mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 34.71 1.157000 1.157000 0.578500 1021 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 1 283.25 283.250000 251.194500 125.597250 1022 N02AX52 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 10 COMPR. FILM. P-RF 10 7.89 0.789000 0.705825 0.352912 1023 N02AX52 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 15.58 0.779000 0.705825 0.352912 SE MODIFICA 77 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) 600 oral (vezi A16AX01) COMPR. FILM. 600mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 6 BLIST. PVC-PVDC/AL. X 10 COMPR. FILM. P-6L 60 130.17 2.169500 2.169500 1.084750 876 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOCTACID (R) 600 HR (vezi A16AX01) COMPR. FILM. 600mg MEDA PHARMA GMBH & CO KG GERMANIA CUTIE X 1 FLAC. X 30 COMPR. FILM. P-6L 30 103.70 3.456666 2.169500 1.084750 76 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOCTACID (R) 600 HR (vezi N07XN03) COMPR. FILM. 600mg MEDA PHARMA GMBH & CO KG GERMANIA CUTIE X 1 FLAC. X 30 COMPR. FILM. P-6L 30 103.70 3.456666 2.169500 1.084750 78 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) 600 oral (vezi A16AX01) COMPR. FILM. 600mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 3 BLIST. PVC-PVDC/AL. X 10 COMPR. FILM. P-6L 30 68.60 2.286666 2.169500 1.084750 78 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) 600 oral (vezi A16AX01) COMPR. FILM. 600mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 3 BLIST. PVC-PVDC/AL. X 10 COMPR. FILM. P-6L 30 68.60 2.286666 2.169500 1.084750 76 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOCTACID (R) 600 HR (vezi N07XN03) COMPR. FILM. 600mg MEDA PHARMA GMBH & CO KG GERMANIA CUTIE X 1 FLAC. X 30 COMPR. FILM. P-6L 30 103.70 3.456666 2.169500 1.084750 876 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOCTACID (R) 600 HR (vezi A16AX01) COMPR. FILM. 600mg MEDA PHARMA GMBH & CO KG GERMANIA CUTIE X 1 FLAC. X 30 COMPR. FILM. P-6L 30 103.70 3.456666 2.169500 1.084750 77 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) 600 oral (vezi A16AX01) COMPR. FILM. 600mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 6 BLIST. PVC-PVDC/AL. X 10 COMPR. FILM. P-6L 60 130.17 2.169500 2.169500 1.084750 81 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) 600 INJEKT (vezi N07XN03) CONC. PT. SOL. PERF. 30mg/ml WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 FIOLE X 20 ML S/P-RF 5 134.35 26.870000 25.817000 12.908500 81 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) 600 INJEKT (vezi N07XN03) CONC. PT. SOL. PERF. 30mg/ml WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 5 FIOLE X 20 ML S/P-RF 5 134.35 26.870000 25.817000 12.908500 877 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) 600 INJEKT (vezi N07XN03) CONC. PT. SOL. PERF. 30mg/ml WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 FIOLE X 20 ML S/P-RF 10 263.89 26.389000 23.235300 11.617650 877 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) 600 INJEKT (vezi N07XN03) CONC. PT. SOL. PERF. 30mg/ml WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 FIOLE X 20 ML S/P-RF 10 263.89 26.389000 23.235300 11.617650 82 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOCTACID 600T (vezi N07XN03) SOL. INJ. 25mg/ml MEDA PHARMA GMBH & CO KG GERMANIA CUTIE X 5 FIOLE X 24 ML SOL.INJ. S/P-RF 5 137.19 27.438000 25.817000 12.908500 Pagina 1 din 3

forma farm. concent ratie tara det. APP A Pres. Pret amanuntu l maximal/a (RON) Pret maximal/ut (RON) Val suportata de CNAS/UT (RON)Legea nr. 95/2006 art 213 alin.1 lit. a) si f) Nr. cod ATC DCI Denumire Comerciala Detinator APP 83 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) TURBO-SET (vezi N07XN03) SOL. PERF. 12mg/ml WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 FLACOANE X 50 ML S/P-RF 10 258.17 25.817000 25.817000 12.908500 83 A16AX01 ACIDUM TIOCTICUM (ALFA-LIPOICUM) THIOGAMMA (R) TURBO-SET (vezi N07XN03) SOL. PERF. 12mg/ml WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 10 FLACOANE X 50 ML S/P-RF 10 258.17 25.817000 25.817000 12.908500 206 C07AB12 NEBIVOLOLUM NEBIVOLOL ACTAVIS 5 mg COMPR. 5mg ACTAVIS S.R.L. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 23.20 0.773333 0.773333 0.386666 286 C09CA03 VALSARTANUM DIOVAN 160 mg COMPR. FILM. 160mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P-6L 28 116.60 4.164285 2.599627 1.299813 291 C09CA03 VALSARTANUM DIOVAN 40 mg COMPR. FILM. 40mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28COMPR. FILM. P6L 28 71.91 2.568214 0.649906 0.324953 297 C09CA03 VALSARTANUM WENZELL 80 mg COMPR. FILM. 80mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL-PVDC X 28 COMPR. FILM. P-6L 28 47.37 1.691785 1.299813 0.649906 293 C09CA03 VALSARTANUM VALSARTAN TORRENT 80 mg COMPR. FILM. 80mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P6L 28 47.00 1.678571 1.299813 0.649906 294 C09CA03 VALSARTANUM DIOVAN 80 mg COMPR. FILM. 80mg NOVARTIS PHARMA GMBH GERMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X28COMPR. FILM. P6L 28 91.88 3.281428 1.299813 0.649906 296 C09CA03 VALSARTANUM WENZELL 80 mg COMPR. FILM. 80mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL-PVDC X 30 COMPR. FILM. P-6L 30 50.79 1.693000 1.299813 0.649906 299 C09CA03 VALSARTANUM DIOVAN 3 mg/ml SOL. ORALA 3mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE CU 1 FLAC. DIN STICLA BRUNA X 160 ML SOL. ORALA + 1 TRUSA DE ADMINISTRARE (ADAPTOR PT. FLAC.+1 P-6L 1 41.42 41.420000 7.798882 3.899441 300 C09CA04 IRBESARTANUM DEPALONG 150 mg COMPR. FILM. 150mg MEDANA PHARMA S.A. POLONIA CUTIE CU 2 BLIST. PVC-PCTFE/AL X 14 COMPR. FILM. P6L 28 44.88 1.602857 1.299813 0.649906 301 C09CA04 IRBESARTANUM IRBESARTAN DR. REDDY'S 150 mg COMPR. FILM. 150mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU 2 BLIST. AL/AL X 14 COMPR. FILM. P6L 28 44.94 1.605000 1.299813 0.649906 303 C09CA04 IRBESARTANUM IFIRMASTA 150 mg COMPR. FILM. 150mg KRKA,D.D., NOVO MESTO SLOVENIA CUTIE X BLIST. PVC/PE/PVDC/AL X 28 COMPR. FILM. P-6L 28 37.35 1.333928 1.299813 0.649906 308 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 54.57 1.948928 1.299813 0.649906 309 C09CA04 IRBESARTANUM IRBESARTAN WINTHROP 150mg COMPR. FILM. 150mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 28 COMPR. FILM. (BLIST. PVC/PVDC/AL) P-6L 28 44.88 1.602857 1.299813 0.649906 310 C09CA04 IRBESARTANUM APROVEL 150mg COMPR. FILM. 150mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X BLIST PVC/PVDC/AL X 28 COMPR. FILM. P-6L 28 66.75 2.383928 1.299813 0.649906 321 C09CA04 IRBESARTANUM APROVEL 300mg COMPR. FILM. 300mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X BLIST PVC/PVDC/AL X 28 COMPR. FILM. P-6L 28 88.08 3.145714 2.599627 1.299813 322 C09CA04 IRBESARTANUM IRBEGAMMA 75 mg COMPR. FILM. 75mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC-PVDC/AL X 100 COMPR. FILM. P-6L 100 91.26 0.912600 0.649906 0.324953 325 C09CA06 CANDESARTANUM CILEXETIL ATACAND COMPR. 8mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. P-6L 28 56.10 2.003571 1.299813 0.649906 326 C09CA07 TELMISARTANUM TELMISARTAN ACTAVIS 40mg COMPR. 40 mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. AL/AL X 28 COMPR. P6L 28 39.46 1.409285 1.299813 0.649906 330 C09CA07 TELMISARTANUM MICARDIS 40 mg COMPR. 40mg BOEHRINGER INGELHEIM PHARMA GMBH & CO. KG GERMANIA CUTIE X 28 COMPR. ( BLIST. PA/AL/PVC) P-6L 28 60.70 2.167857 1.299813 0.649906 328 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 39.46 1.409285 1.299813 0.649906 327 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 42.26 1.408666 1.299813 0.649906 329 C09CA07 TELMISARTANUM PRITOR 40 mg COMPR. 40mg BAYER SCHERING PHARMA AG GERMANIA CUTIE X 28COMPR.( BLIST. PERFORATE UNIDOZA PA/AL/PVC ) P-6L 28 64.10 2.289285 1.299813 0.649906 335 C09CA07 TELMISARTANUM MICARDIS 80 mg COMPR. 80mg BOEHRINGER INGELHEIM PHARMA GMBH & CO. KG GERMANIA CUTIE X 28COMPR. ( BLIST. PA/AL/PVC) P-6L 28 77.42 2.765000 2.599627 1.299813 334 C09CA07 TELMISARTANUM PRITOR 80 mg COMPR. 80mg BAYER SCHERING PHARMA AG GERMANIA CUTIE X 28COMPR.( BLIST. PERFORATE UNIDOZA PA/AL/PVC ) P-6L 28 77.42 2.765000 2.599627 1.299813 336 C09CA07 TELMISARTANUM TELMARK 20 mg COMPR. FILM. 20mg GLENMARK PHARMACEUTICALS SRL REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 32.36 1.078666 0.649906 0.324953 338 C09CA07 TELMISARTANUM TELMARK 40 mg COMPR. FILM. 40mg GLENMARK PHARMACEUTICALS SRL REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 42.27 1.409000 1.299813 0.649906 337 C09CA07 TELMISARTANUM TANYDON 40 mg COMPR. FILM. 40mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE CU BLIST. AL/AL X 30 COMPR. FILM. P6L 30 42.27 1.409000 1.299813 0.649906 339 C09CA07 TELMISARTANUM TELMARK 40 mg COMPR. FILM. 40mg GLENMARK PHARMACEUTICALS SRL REPUBLICA CEHA CUTIE CU BLIST. AL/AL X 28 COMPR. FILM. P6L 28 39.46 1.409285 1.299813 0.649906 655 J01MA12 LEVOFLOXACINUM LEVOFLOXACINA ACTAVIS 250 mg COMPR. FILM. 250mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X 1 BLIST. AL/PVC X 7 COMPR. FILM. P-RF 7 17.41 2.487142 2.379600 1.189800 653 J01MA12 LEVOFLOXACINUM LEVOTOR 250 mg COMPR. FILM. 250mg TORRENT PHARMA S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 7 COMPR. FILM. P-RF 7 17.40 2.485714 2.379600 1.189800 680 L04AX01 AZATHIOPRINUM IMURAN (R) COMPR. FILM. 50mg THE WELLCOME FOUNDATION LTD. MAREA BRITANIE CUTIE X 4 BLIST. AL/PVC X 25 COMPR. FILM. S/P-RF 100 80.90 0.809000 0.596699 0.298349 738 M05BA04 ACIDUM ALENDRONICUM ACID ALENDRONIC ACCORD 10 mg COMPR. 10mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC/AL X 28 COMPR. P-6L 28 48.27 1.723928 1.577089 0.788544 739 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 48.27 12.067500 11.039625 5.519812 742 M05BA04 ACIDUM ALENDRONICUM RANOS 70 mg COMPR. 70mg TERAPIA SA ROMANIA CUTIE X 1 BLIST. DIN PAO-PVC-AL/AL X 4 COMPR. P-6L 4 47.66 11.915000 11.039625 5.519812 741 M05BA04 ACIDUM ALENDRONICUM ACID ALENDRONIC BLUEFISH 70 mg COMPR. 70mg BLUEFISH PHARMACEUTICALS AB SUEDIA CUTIE CU BLIST. AL/AL X 2 COMPR. P-6L 2 24.93 12.465000 11.039625 5.519812 744 M05BA04 ACIDUM ALENDRONICUM FOSAMAX 70 mg COMPR. 70mg MERCK SHARP & DOHME ROMANIA CUTIE X 1 BLIST. AL/AL IN PORTOFEL X 2 COMPR. P-6L 2 37.13 18.565000 11.039625 5.519812 743 M05BA04 ACIDUM ALENDRONICUM ACID ALENDRONIC ACCORD 70 mg COMPR. 70mg ACCORD HEALTHCARE LIMITED MAREA BRITANIE CUTIE CU BLIST. OPA -AL-PVC/AL X 4 COMPR. P-6L 4 48.27 12.067500 11.039625 5.519812 747 M05BA06 ACIDUM IBANDRONICUM ACID IBANDRONIC TEVA 150 mg COMPR. FILM. 150 mg TEVA PHARMA B.V. OLANDA CUTIE CU BLIST. DIN PVC/ACLAR/PVC-AL X 1 COMPRIMAT FILMAT P-RF 1 83.20 83.200000 47.312678 23.656339 750 M05BA06 ACIDUM IBANDRONICUM BONVIVA 150mg COMPR. FILM. 150mg ROCHE REGISTRATION LTD. MAREA BRITANIE CUTIE X 1 COMPR. FILM.( BLIST. AL/AL) P-6L 1 129.32 129.320000 47.312678 23.656339 748 M05BA06 ACIDUM IBANDRONICUM MIRDEZEL 150 mg COMPR. FILM. 150mg SANDOZ S.R.L. ROMANIA CUTIE CU 1 BLIST. PA-AL-PVC/AL X 1 COMPR. FILM. P6L 1 61.21 61.210000 47.312678 23.656339 749 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 72.31 72.310000 47.312678 23.656339 751 M05BA06 ACIDUM IBANDRONICUM HOLMEVIS 50 mg COMPR. FILM. 50mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PA/AL/PVC-AL X 28 COMPR. FILM. PRF 28 732.65 26.166071 15.770892 7.885446 752 M05BA06 ACIDUM IBANDRONICUM BONVIVA 3mg/3ml SOL. INJ. IN SERINGA PREUMPLUTA 1mg/1ml ROCHE REGISTRATION LTD. MAREA BRITANIE CUTIE X 1 SERINGA PREUMPLUTA DIN STICLA X 3 ML SOL. INJ. + 1 AC P-6L 1 424.57 424.570000 251.194500 125.597250 756 M05BA07 ACIDUM RISEDRONICUM JUVERITAL 35 mg COMPR. FILM. 35mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 4 COMPR. FILM. P-6L 4 72.55 18.137500 11.039625 5.519812 Pagina 2 din 3 Val suportata CNAS/UT (RON) pt. Adulti

forma farm. concent ratie tara det. APP A Pres. Pret amanuntu l maximal/a (RON) Pret maximal/ut (RON) Val suportata de CNAS/UT (RON)Legea nr. 95/2006 art 213 alin.1 lit. a) si f) Nr. cod ATC DCI Denumire Comerciala Detinator APP 754 M05BA07 ACIDUM RISEDRONICUM OSODENS 35 mg COMPR. FILM. 35mg TERAPIA SA ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 4 COMPR. FILM. P-6L 4 72.55 18.137500 11.039625 5.519812 758 M05BA07 ACIDUM RISEDRONICUM JUVERITAL 35 mg COMPR. FILM. 35mg OZONE LABORATORIES BV OLANDA CUTIE X BLISTER PVC-PE-PVDC/AL X 4 COMPRIMATE FILMATE P-6L 4 72.55 18.137500 11.039625 5.519812 755 M05BA07 ACIDUM RISEDRONICUM OSTEORON 35 mg COMPR. FILM. 35mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X 1 BLIST. PVC- PVDC/AL X 4 COMPR. FILM. P-6L 4 56.66 14.165000 11.039625 5.519812 760 M05BA07 ACIDUM RISEDRONICUM RISENDROS 35 mg COMPR. FILM. 35mg ZENTIVA A.S. CEHIA CUTIE X 1 BLIST. OPA-AL-PVC/AL X 4 COMPR. FILM. P-6L 4 56.69 14.172500 11.039625 5.519812 759 M05BA07 ACIDUM RISEDRONICUM RISEDRONAT TEVA 35 mg COMPR. FILM. 35mg TEVA PHARMACEUTICAL S.R.L. MAREA BRITANIE CUTIE X BLIST. PVC-PVDC/AL X 4 COMPR. FILM. P-6L 4 72.55 18.137500 11.039625 5.519812 753 M05BA07 ACIDUM RISEDRONICUM ACTONEL SAPTAMANAL 35 mg COMPR. FILM. 35mg SANOFI - AVENTIS ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 4 COMPR. FILM. P-6L 4 111.62 27.905000 11.039625 5.519812 761 M05BA07 ACIDUM RISEDRONICUM ACTONEL 75 mg COMPR. FILM. 75mg SANOFI - AVENTIS ROMANIA S.R.L. ROMANIA CUTIE CU 1 BLIST. PVC/AL X 2 COMPR. FILM. P-6L 2 94.97 47.485000 23.656339 11.828169 762 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) FOSAVANCE 70mg/2800UI COMPR. 70mg/2800UI MERCK SHARP & DOHME MAREA BRITANIE CUTIE X 2 COMPR. (1 PLIANT CU BLIST. AL/AL X 2 COMPR.) P-6L 2 47.30 23.650000 11.039625 5.519812 763 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) FOSAVANCE 70mg/2800UI COMPR. 70mg/2800UI MERCK SHARP & DOHME MAREA BRITANIE CUTIE X 4 COMPR. (1 PLIANT CU BLIST. AL/AL X 4 COMPR.) P-6L 4 89.84 22.460000 11.039625 5.519812 764 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) FOSAVANCE 70mg/5600UI COMPR. 70mg/5600UI MERCK SHARP & DOHME MAREA BRITANIE CUTIE X 4 COMPR. (1 PLIANT CU BLIST. AL/AL X 4 COMPR.) P-6L 4 89.84 22.460000 11.039625 5.519812 765 M05BB03 COMBINATII (ACIDUM ALENDRONICUM+COLECALCIFEROLUM) FOSAVANCE 70mg/5600UI COMPR. 70mg/5600UI MERCK SHARP & DOHME MAREA BRITANIE CUTIE X 2 COMPR. (1 PLIANT CU BLIST. AL/AL X 2 COMPR.) P-6L 2 47.30 23.650000 11.039625 5.519812 776 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR (R) COMPR. FILM. 37,5mg+325mg GRUNENTHAL GMBH GERMANIA CUTIE X 5 BLIST. PP OPAC/AL X 10 COMPR. FILM. P-RF 50 57.78 1.155600 0.705825 0.352912 777 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR (R) COMPR. FILM. 37,5mg+325mg GRUNENTHAL GMBH GERMANIA CUTIE X 5 BLIST. PVC OPAC/AL X 10 COMPR. FILM. P-RF 50 57.78 1.155600 0.705825 0.352912 778 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR (R) COMPR. FILM. 37,5mg+325mg GRUNENTHAL GMBH GERMANIA CUTIE X 1 BLIST. PP OPAC/AL X 10 COMPR. FILM. P-RF 10 12.14 1.214000 0.705825 0.352912 779 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR (R) COMPR. FILM. 37,5mg+325mg GRUNENTHAL GMBH GERMANIA CUTIE X 3 BLIST. PVC OPAC/AL X 10 COMPR. FILM. P-RF 30 34.76 1.158666 0.705825 0.352912 780 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR (R) COMPR. FILM. 37,5mg+325mg GRUNENTHAL GMBH GERMANIA CUTIE X 2 BLIST. PVC OPAC/AL X 10 COMPR. FILM. P-RF 20 23.96 1.198000 0.705825 0.352912 781 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR (R) COMPR. FILM. 37,5mg+325mg GRUNENTHAL GMBH GERMANIA CUTIE X 1 BLIST. PVC OPAC/AL X 10 COMPR. FILM. P-RF 10 12.14 1.214000 0.705825 0.352912 782 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR (R) COMPR. FILM. 37,5mg+325mg GRUNENTHAL GMBH GERMANIA CUTIE X 3 BLIST. PP OPAC/AL X 10 COMPR. FILM. P-RF 30 34.76 1.158666 0.705825 0.352912 775 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) ZALDIAR (R) COMPR. FILM. 37,5mg+325mg GRUNENTHAL GMBH GERMANIA CUTIE X 2 BLIST. PP OPAC/AL X 10 COMPR. FILM. P-RF 20 23.96 1.198000 0.705825 0.352912 784 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) LINEROL 37,5 mg/325 mg COMPR. FILM. 37,5mg/325mg PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE CU BLIST. PVC/AL X 20 COMPR. FILM. P-RF 20 15.59 0.779500 0.705825 0.352912 787 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) PADOLTEN 37,5 mg/325 mg COMPR. FILM. 37,5mg/325mg S.C.TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM. P-RF 10 7.89 0.789000 0.705825 0.352912 786 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) PADOLTEN 37,5 mg/325 mg COMPR. FILM. 37,5mg/325mg S.C.TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 20 COMPR. FILM. P-RF 20 15.59 0.779500 0.705825 0.352912 785 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) LINEROL 37,5 mg/325 mg COMPR. FILM. 37,5mg/325mg PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE CU BLIST. PVC/AL X 10 COMPR. FILM. P-RF 10 7.90 0.790000 0.705825 0.352912 783 N02AX52 COMBINATII (TRAMADOLUM+PARACETAMOLUM) LINEROL 37,5 mg/325 mg COMPR. FILM. 37,5mg/325mg PHARMACEUTICAL WORKS POLPHARMA SA POLONIA CUTIE CU BLIST. PVC/AL X 30 COMPR. FILM. P-RF 30 23.36 0.778666 0.705825 0.352912 Val suportata CNAS/UT (RON) pt. Adulti SE ELIMINA 399 C10AA05 ATORVASTATINUM XAMARA 20 mg COMPR. FILM. 20mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 50 COMPR. FILM. P-6L 50 34.71 0.694200 0.694200 0.347100 751 M05BA06 ACIDUM IBANDRONICUM* HOLMEVIS 50 mg COMPR. FILM. 50mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PA/AL/PVC-AL X 28 COMPR. FILM. PRF 28 732.65 26.166071 15.898660 7.949330 Pagina 3 din 3

ANEXA 3 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 PENTRU CARE DECONTAREA SE FACE PE BAZA PROTOCOALELOR TERAPEUTICE CU MONITORIZAREA PRESCRIERII ŞI CONSUMULUI PRIN COMISIILE PARITARE; MEDICAMENTELE DIN ACEASTĂ SUBLISTĂ SE ELIBEREAZĂ PRIN FARMACII CU CIRCUIT DESCHIS PE BAZĂ DE PRESCRIPŢIE MEDICALĂ CU REŢINERE ÎN FARMACIE ( P-RF) DIN HG NR. 720/2008 CU MODIFICARILE SI COMPLETARILE ULTERIOARE VALABILĂ ÎNCEPÂND CU 19 IUNIE 2012 CONCE NTRATI NR.CRT COD ATC DCI Denumire Comerciala FORMA FARMACEUTICA E DETINATOR APP TARA DET. APP AMBALAJ Pres. Cant. PRET AMANUN TUL MAXIMA L (RON) PRET AMANUNT UL MAXIMAL/ UT (RON) VAL.SUPOR TATAT CNAS/ UT(RON)- LEGEA NR. 95/2006 ART 213 alin.(1) lit. a) si f) VAL.SUP ORTATAT CNAS/ UT (RON) PT. ADULTI 1.INSUFICIENTA CARDIACA CRONICA(CLASA III SAU IV NYHA) - G 1 SE ADAUGA 244 C09CA06 CANDESARTANUM CILEXETIL HIPOSTYN 16 mg COMPR. 16mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 42.50 1.416666 1.416666 1.416666 245 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL ZENTIVA 16 mg COMPR. 16mg ZENTIVA K.S. REPUBLICA SLOVACA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 48.06 1.602000 1.602000 1.602000 246 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN SANDOZ 16 mg COMPR. 16mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL CU DESICANT X 28 COMPR. P-6L 28 39.65 1.416071 1.416071 1.416071 247 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 43.24 1.441333 1.441333 1.441333 248 C09CA06 CANDESARTANUM CILEXETIL TANDESAR 16 mg COMPR. 16mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P-6L 28 44.87 1.602500 1.602500 1.602500 249 C09CA06 CANDESARTANUM CILEXETIL HIPOSTYN 32 mg COMPR. 32mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 71.36 2.378666 2.378666 2.378666 250 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL ZENTIVA 32 mg COMPR. 32mg ZENTIVA K.S. REPUBLICA SLOVACA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 81.77 2.725666 2.725666 2.725666 251 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 81.75 2.725000 2.725000 2.725000 252 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN CILEXETIL ZENTIVA 8 mg COMPR. 8mg ZENTIVA K.S. REPUBLICA SLOVACA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. P6L 30 39.02 1.300666 0.965199 0.965199 253 C09CA06 CANDESARTANUM CILEXETIL TANDESAR 8 mg COMPR. 8mg TERAPIA SA ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. P-6L 28 36.46 1.302142 0.965199 0.965199 254 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 33.01 1.100333 0.965199 0.965199 255 C09CA06 CANDESARTANUM CILEXETIL CANDESARTAN SANDOZ 8 mg COMPR. 8mg SANDOZ SRL ROMANIA CUTIE CU BLIST. AL/AL CU DESICANT X 28 COMPR. P-6L 28 33.45 1.194642 0.965199 0.965199 256 C09CA06 CANDESARTANUM CILEXETIL HIPOSTYN 8 mg COMPR. 8mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. PVC/PVDC-AL X 30 COMPR. P6L 30 24.13 0.804333 0.804333 0.804333 SE MODIFICA 85 C07AB12 NEBIVOLOLUM NEBIVOLOL ACTAVIS 5 mg COMPR. 5mg ACTAVIS S.R.L. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 23.20 0.773333 0.593142 0.593142 241 C09CA06 CANDESARTANUM CILEXETIL ATACAND COMPR. 16mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. P-6L 28 66.74 2.383571 1.699285 1.699285 242 C09CA06 CANDESARTANUM CILEXETIL ATACAND 32 mg COMPR. 32mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. AL-PVC/PVDC X 14 COMPR. P-6L 28 117.40 4.192857 2.854399 2.854399 243 C09CA06 CANDESARTANUM CILEXETIL ATACAND COMPR. 8mg ASTRAZENECA AB SUEDIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. P-6L 28 56.10 2.003571 0.965199 0.965199 Pagina 1 din 3

CONCE NTRATI NR.CRT COD ATC DCI Denumire Comerciala FORMA FARMACEUTICA E 5. HEPATITA AUTOIMUNA - G5 DETINATOR APP SE ADAUGA TARA DET. APP AMBALAJ Pres. Cant. PRET AMANUN TUL MAXIMA L (RON) PRET AMANUNT UL MAXIMAL/ UT (RON) VAL.SUPOR TATAT CNAS/ UT(RON)- LEGEA NR. 95/2006 ART 213 alin.(1) lit. a) si f) VAL.SUP ORTATAT CNAS/ UT (RON) PT. ADULTI 10 L04AX01 AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PR 100 78.89 0.788900 0.788900 0.788900 9. EPILEPSIE - G11 SE MODIFICA 72 N03AX09 LAMOTRIGINUM LAMOTRIN 50 mg COMPR. DISP. 50mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. DISPERSABILE P-6L 30 16.95 0.565000 0.565000 0.565000 83 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 60 159.80 2.663333 2.663333 2.663333 112 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 89.22 1.487000 1.487000 1.487000 165 N03AX14 LEVETIRACETAMUM LEVETIRACETAM ACTAVIS GROUP 100mg/ml SOL. ORALA 100 mg/ml ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU UN FLACON DIN STICLA BRUNA A 300ML, PREVAZUT CU SISTEM DE INCHIDERE SECURIZAT PT. COPII, CU PRF 1 147.72 147.720000 147.720000 147.720000 167 N03AX14 LEVETIRACETAMUM TRUND 100 mg/ml SOL. ORALA 100mg/ml GLENMARK PHARMACEUTICALS SRL REPUBLICA SLOVACA CUTIE CU 1 FLAC DIN STICLA BRUNA X 300 ML SOL. ORALA + 1 SERINGA DOZATOARE (PP,PE) DE 10 ML SI UN AD PRF 1 147.72 147.720000 147.720000 147.720000 11. MIASTENIA GRAVIS - G13 SE ADAUGA 23 L04AX01 AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PR 100 78.89 0.788900 0.788900 0.788900 12. SCLEROZA MULTIPLA - G14 SE ADAUGA 28 L04AX01 AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PR 100 78.89 0.788900 0.788900 0.788900 13. BOLI PSIHICE (SCHIZOFRENIE, TULBURARI SCHIZOTIPALE SI DELIRANTE, TULBURARI AFECTIVE MAJORE, TULBURARI PSIHOTICE ACUTE SI BOLI PSIHICE COPII, AUTISM) - G15 SE MODIFICA 39 N03AX09 LAMOTRIGINUM LAMOTRIN 50 mg COMPR. DISP. 50mg ACTAVIS GROUP HF. ISLANDA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. DISPERSABILE P-6L 30 16.95 0.565000 0.565000 0.565000 102 N05AH03 OLANZAPINUM OLANZAPINA DR. REDDY'S 10 mg COMPR. ORODISPERSABILE 10mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 35 COMPR. ORODISPERSABILE P-RF 35 171.82 4.909142 4.909142 4.909142 152 N05AH04 QUETIAPINUM SETININ 100 mg COMPR. FILM. 100mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC/AL X 60 COMPR. FILM. P-RF 60 79.30 1.321666 1.321666 1.321666 Pagina 2 din 3

TARA DET. APP AMBALAJ Pres. Cant. CONCE NTRATI NR.CRT COD ATC DCI Denumire Comerciala FORMA FARMACEUTICA E DETINATOR APP 15. COLAGENOZE MAJORE (LUPUS ERITEMATOS SISTEMIC, SCLERODERMIE, POLI/DERMATOMICOZA, VASCULITE SISTEMICE) - G 17 SE ADAUGA PRET AMANUN TUL MAXIMA L (RON) PRET AMANUNT UL MAXIMAL/ UT (RON) VAL.SUPOR TATAT CNAS/ UT(RON)- LEGEA NR. 95/2006 ART 213 alin.(1) lit. a) si f) VAL.SUP ORTATAT CNAS/ UT (RON) PT. ADULTI 8 L04AX01 AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PR 100 78.89 0.788900 0.788900 0.788900 16. POLIARTRITA REUMATOIDA, ARTROPATIA PSORIAZICA SI ARTRITA JUVENILA - G 18 SE ADAUGA 71 L04AX01 AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PR 100 78.89 0.788900 0.788900 0.788900 20. BOALA CRONICA DE RINICHI - faza predializa - G 25 SE ADAUGA 70 L04AX01 AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PR 100 78.89 0.788900 0.788900 0.788900 22. PEMFIGUS - G 27 SE ADAUGA 40 L04AX01 AZATHIOPRINUM IMMUNOPRIN 75 mg COMPR. FILM. 75mg EBEWE PHARMA GES.M.B.H. NFG KG AUSTRIA CUTIE CU 1 FLAC. PEID X 100 COMPR. FILM. PR 100 78.89 0.788900 0.788900 0.788900 Pagina 3 din 3

ANEXA 4 SECŢIUNEA C2 - LISTA MEDICAMENTELOR CU PROCENT DE COMPENSARE 100% din pret de decontare - conform denumirilor comune internaţionale corespunzătoare medicamentelor de care beneficiaza asiguratii inclusi in programele nationale de sănătate cu scop curativ in tratamentul ambulatoriu si spitalicesc DIN HG NR. 720/2008 CU MODIFICARILE SI COMPLETARILE ULTERIOARE SI ORDINUL MS NR. 1275/2011 CU MODIFICARILE SI COMPLETARILE ULTERIOARE VALABILĂ ÎNCEPÂND CU 19 IUNIE 2012 Nr. farmace e Firma Tara A U.T. U.T. P1: PROGRAMUL NATIONAL DE BOLI TRANSMISIBILE A) SUBPROGRAMUL DE TRATAMENT SI MONITORIZARE A PERSOANELOR CU INFECTIE HIV/SIDA si TRATAMENTUL POSTEXPUNERE 1 A07AA11 RIFAXIMINUM NORMIX 200 mg COMPR. FILM. 200mg ALFA WASSERMANN SPA ITALIA CUTIE X 3 BLIST. AL/PVC A CATE 12 COMPR. FILM. P-RF 36 72.18 2.005000 2.005000 91.26 2.535000 2.535000 2 A07AA11 RIFAXIMINUM NORMIX 200 mg COMPR. FILM. 200mg ALFA WASSERMANN SPA ITALIA CUTIE X 1 BLIST. AL/PVC X 12 COMPR. FILM. P-RF 12 24.49 2.040833 2.040833 33.10 2.758333 2.758333 3 A07AA11 RIFAXIMINUM NORMIX 100mg/5ml GRAN. PT. SUSP. ORALA 100mg/5ml ALFA WASSERMANN SPA ITALIA CUTIE X 1 FLAC. GRAN. PT. 60 ML SUSP. ORALA + 1 MASURA DOZATOARE MARCATA LA 5, 10 SI 15 ML P-RF 1 14.14 14.140000 14.140000 19.11 19.110000 19.110000 4 D01AC02 MICONAZOLUM MICONAZOL NITRAT 2% CREMA 2% SLAVIA PHARM SRL ROMANIA CUTIE X 1 TUB X 20 G P-RF 1 5.05 5.050000 5.050000 6.83 6.830000 6.830000 5 D01AC02 MICONAZOLUM MEDACTER CREMA 2% FARAN LABORATORIES S.A. GRECIA CUTIE X 1 TUB X 30G P-RF 1 6.34 6.340000 6.340000 8.57 8.570000 8.570000 6 D01AC02 MICONAZOLUM MICONAL ECOBI CREMA 20mg/g FARMACEUTICI ECOBI S.A.S ITALIA CUTIE X 1 TUB DIN AL X 30 G CREMA P-RF 1 7.04 7.040000 7.040000 9.51 9.510000 9.510000 7 D06BB03 ACICLOVIRUM CLOVIRAL (R) 5% CREMA 5% ANTIBIOTICE SA ROMANIA CUTIE X 1 TUB AL. X 12 G P-RF 1 4.73 4.730000 4.730000 6.39 6.390000 6.390000 8 D06BB03 ACICLOVIRUM ZOVIRAX CREMA 5% THE WELLCOME FOUNDATION LTD. MAREA BRITANIE CUTIE X 1 TUB X 5G CREMA P-RF 1 15.58 15.580000 4.416000 21.06 21.060000 5.976000 9 D06BB03 ACICLOVIRUM ACICLOVIR 50mg/g CREMA 5% GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 1 TUB X 5 G CREMA P-RF 1 3.68 3.680000 3.680000 4.98 4.980000 4.980000 10 D06BB03 ACICLOVIRUM ACICLOVIR 50mg/g CREMA 5% GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 1 TUB X 15 G CREMA P-RF 1 5.62 5.620000 4.176000 7.60 7.600000 5.640000 11 D06BB03 ACICLOVIRUM ACICLOVIR MK CREMA 5% FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB AL X 7,5 G P-RF 1 3.10 3.100000 3.100000 4.19 4.190000 4.190000 12 D06BB03 ACICLOVIRUM ACICLOVIR MK CREMA 5% FITERMAN PHARMA S.R.L. ROMANIA CUTIE X 1 TUB AL X 15 G P-RF 1 4.98 4.980000 4.176000 6.73 6.730000 5.640000 13 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 3.48 3.480000 3.480000 4.70 4.700000 4.700000 14 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 4.97 4.970000 4.176000 6.72 6.720000 5.640000 15 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 4.97 4.970000 4.176000 6.72 6.720000 5.640000 16 D06BB03 ACICLOVIRUM ACICLOVIR HYPERION CREMA 50mg/g HYPERION S.A. ROMANIA CUTIE X 1 TUB DIN AL X 15 G CREMA P-RF 1 5.42 5.420000 4.176000 7.33 7.330000 5.640000 17 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 4.41 0.735000 0.735000 5.96 0.993333 0.993333 18 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 4.23 1.410000 1.410000 5.72 1.906666 1.906666 19 G01AF04 MICONAZOLUM MEDACTER CREMA VAG. 2% FARAN LABORATORIES S.A. GRECIA CUTIE X 1 TUB X 78 G P-RF 1 14.33 14.330000 12.372000 19.37 19.370000 16.716000 20 G01AF04 MICONAZOLUM MICONAL ECOBI CREMA VAG. 20mg/g FARMACEUTICI ECOBI S.A.S ITALIA CUTIE X 1 TUB DIN AL X 78 G CREMA VAGINALA + CANULA P-RF 1 10.31 10.310000 10.310000 13.93 13.930000 13.930000 21 G01AF04 MICONAZOLUM MICONAL ECOBI OVULE 50mg FARMACEUTICI ECOBI S.A.S ITALIA CUTIE X 3 FOLII PREFORMATE PVC/PE X 5 OVULE P-RF 15 6.66 0.444000 0.444000 9.00 0.600000 0.600000 22 G01AF04 MICONAZOLUM MICONAL ECOBI SOL. VAGINALA 2mg/ml FARMACEUTICI ECOBI S.A.S ITALIA CUTIE X 5 FLACOANE DIN PEJD X 150 ML SOL. VAG. + 5 CANULE P-RF 5 13.32 2.664000 2.664000 18.00 3.600000 3.600000 23 J01CF04 OXACILLINUM OXACILINA ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 5.25 0.262500 0.262500 7.10 0.355000 0.355000 24 J01CF04 OXACILLINUM OXACILINA ARENA 250 mg CAPS. 250mg ARENA GROUP SA ROMANIA CUTIE X 100 BLIST. AL/PVC X 10 CAPS. P-RF/S 1000 242.55 0.242550 0.242550 296.11 0.296110 0.296110 25 J01CF04 OXACILLINUM OXACILINA 250 mg CAPS. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 5.59 0.279500 0.279500 7.55 0.377500 0.355332 26 J01CF04 OXACILLINUM OXACILINA 250 mg CAPS. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 100 BLIST. AL/PVC X 10 CAPS. P-RF/S 1000 257.71 0.257710 0.257710 314.61 0.314610 0.314610 27 J01CF04 OXACILLINUM OXACILINA FARMEX 250 mg CAPS. 250mg FARMEX COMPANY SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 4.98 0.249000 0.249000 6.73 0.336500 0.336500 28 J01CF04 OXACILLINUM OXACILINA SANDOZ 250 mg CAPS. 250mg SANDOZ SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 5.70 0.285000 0.285000 7.70 0.385000 0.355332 29 J01CF04 OXACILLINUM OXACILINA FORTE LPH 500 mg CAPS. 500mg LABORMED PHARMA S.A. ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 4.58 0.458000 0.355512 6.19 0.619000 0.434016 30 J01CF04 OXACILLINUM OXACILINA ARENA 500 mg CAPS. 500mg ARENA GROUP SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 4.58 0.458000 0.355512 6.19 0.619000 0.434016 31 J01CF04 OXACILLINUM OXACILINA FORTE 500 mg CAPS. 500mg FARMEX COMPANY SRL ROMANIA CUTIE X 50 BLIST. AL/PVC X 10 CAPS. P-RF/S 500 195.09 0.390180 0.355512 238.17 0.476340 0.434016 32 J01CF04 OXACILLINUM OXACILINA FORTE 500 mg CAPS. 500mg FARMEX COMPANY SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 8.26 0.413000 0.355512 11.17 0.558500 0.434016 33 J01CF04 OXACILLINUM OXACILINA SANDOZ 500 mg CAPS. 500mg SANDOZ SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 5.21 0.521000 0.355512 7.04 0.704000 0.434016 34 J01CF04 OXACILLINUM OXACILINA 500 mg CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 100 BLIST. X 10 CAPS. P-RF/S 1000 296.26 0.296260 0.296260 361.68 0.361680 0.361680 35 J01CF04 OXACILLINUM OXACILINA 500 mg CAPS. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-RF 10 5.10 0.510000 0.355512 6.89 0.689000 0.434016 36 J01CF04 OXACILLINUM OXACILINA ANTIBIOTICE 500 mg PULB. PT. SOL. INJ./PERF. I.M./I.V. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. I.M./I.V. P-RF 1 2.46 2.460000 2.460000 3.33 3.330000 3.330000 37 J01CF04 OXACILLINUM OXACILINA ANTIBIOTICE 500 mg PULB. PT. SOL. INJ./PERF. I.M./I.V. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. I.M./I.V. P-RF/S 100 237.08 2.370800 2.370800 289.43 2.894300 2.894300 38 J01CF04 OXACILLINUM OXACILINA ANTIBIOTICE 1 g PULB. PT. SOL. INJ./PERF.I.M./I.V. 1g ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. I.M./I.V. P-RF/S 100 376.06 3.760600 3.760600 448.06 4.480600 4.480600 39 J01CF04 OXACILLINUM OXACILINA ANTIBIOTICE 1 g PULB. PT. SOL. INJ./PERF.I.M./I.V. 1g ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. I.M./I.V. P-RF 1 3.94 3.940000 3.940000 5.33 5.330000 5.330000 40 J01CR01 AMPICILLINUM + SULBACTAM AMPIPLUS (R) 1,5 g PULB. PT. SOL. INJ. 1g+500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. PULB. PT. SOL. INJ. X 1,5 G P-RF 1 18.68 18.680000 15.210480 25.25 25.250000 17.495040 41 J01CR01 AMPICILLINUM + SULBACTAM AMPIPLUS (R) 1,5 g PULB. PT. SOL. INJ. 1g+500mg ANTIBIOTICE SA ROMANIA CUTIE X 50 FLAC. PULB. PT. SOL. INJ. X 1,5 G P-RF/S 50 633.77 12.675400 12.675400 728.96 14.579200 14.579200 42 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN SR 1000 mg/62,5 mg COMPR. ELIB. PREL. 1000mg/62,5mg BEECHAM GROUP PLC MAREA BRITANIE CUTIE CU 7 BLIST. AL/PVC-AL X 4 COMPR. ELIB. PREL. P-RF 28 34.28 1.224285 1.224285 44.84 1.601428 1.601428 43 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM MEDOCLAV 1000 mg COMPR. FILM. 1000mg MEDOCHEMIE LTD. CIPRU CUTIE X 2 BLIST. AL-PVC/AL X 7 COMPR. FILM. P-RF 14 31.12 2.222857 1.203428 40.71 2.907857 1.626000 44 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 29.92 2.137142 1.203428 39.13 2.795000 1.626000 45 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM MEDOCLAV 375 mg COMPR. FILM. 250mg+125mg MEDOCHEMIE LTD. CIPRU CUTIE X 4 BLIST. X 4 COMPR. FILM. P-RF 16 16.74 1.046250 1.046250 22.63 1.414375 1.414375 46 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM ENHANCIN 500 mg/125mg COMPR. FILM. 500 mg/125 mg RANBAXY UK LIMITED MAREA BRITANIE CUTIE X 4 FOLII AL-PEJD X 7 COMPR. FILM. P-RF 28 24.47 0.873928 0.686570 33.07 1.181071 0.928285 47 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 500/125 mg COMPR. FILM. 500/125mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 14 8.01 0.572142 0.572142 10.83 0.773571 0.773571 48 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM MEDOCLAV 625 mg COMPR. FILM. 500mg+125mg MEDOCHEMIE LTD. CIPRU CUTIE X 4 BLIST. X 4 COMPR. FILM. P-RF 16 22.01 1.375625 0.686570 29.75 1.859375 0.928285 Pagina 1 din 48

farmace e Firma Tara A U.T. U.T. 49 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 500 mg/125 mg COMPR. FILM. 500mg/125mg BEECHAM GROUP PLC MAREA BRITANIE CUTIE CU 2 BLIST. PVC-PVDC/AL X 7 COMPR. FILM., FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTO P-RF 14 11.33 0.809285 0.686570 15.32 1.094285 0.928285 50 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 2 x 625 mg COMPR. FILM. 625mg LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 1 BLIST. AL/AL X 14 COMPR. FILM. P-RF 14 20.76 1.482857 0.686570 28.06 2.004285 0.928285 51 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 875 mg/125 mg COMPR. FILM. 875mg/125mg BEECHAM GROUP PLC MAREA BRITANIE CUTIE CU 2 BLIST. PVC-PVDC/AL X 7 COMPR. FILM., FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTO P-RF 14 19.50 1.392857 1.203428 26.35 1.882142 1.626000 52 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 875 mg/125 mg COMPR. FILM. 875mg/125mg ANTIBIOTICE S.A. ROMANIA CUTIE CU 2 BLIST. PA-AL-PVC/AL X 7 COMPR. FILM. P-RF 14 14.04 1.002857 1.002857 18.97 1.355000 1.355000 53 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV QUICKTAB 1000 mg COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE 1000mg BIOMEDIAL PHARMA S.R.L. ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-RF 14 18.55 1.325000 1.203428 25.07 1.790714 1.626000 54 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV QUICKTAB 625 mg COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE 625mg BIOMEDIAL PHARMA S.R.L. ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-RF 14 12.23 0.873571 0.686570 16.53 1.180714 0.928285 55 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 1,2 g PULB. PT. SOL. INJ./PERF. 1,2g ANTIBIOTICE SA ROMANIA CUTIE X 1 FLACON CU PULB. PT. SOL. INJ. / PERF. P-RF 1 5.10 5.100000 5.100000 6.89 6.890000 6.700920 56 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 1,2 g PULB. PT. SOL. INJ./PERF. 1.2g ANTIBIOTICE SA ROMANIA CUTIE X 100 FLACOANE CU PULB. PT. SOL. INJ. / PERF. P-RF/S 100 477.30 4.773000 4.773000 558.41 5.584100 5.584100 57 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOXIPLUS 1,2 g PULB. PT. SOL. INJ./PERF. 1.2g ANTIBIOTICE SA ROMANIA CUTIE X 50 FLACOANE CU PULB. PT. SOL. INJ. / PERF. P-RF/S 50 246.03 4.920600 4.920600 300.35 6.007000 6.007000 58 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM MEDOCLAV 156,25 mg/5 ml PULB. PT. SUSP. ORALA 125mg+31,25/5ml MEDOCHEMIE LTD. CIPRU CUTIE X 1 FLAC. CU PULB. PT. 100ML SUSP. ORALA + LINGURITA DOZATOARE P-RF 1 11.02 11.020000 10.380000 14.90 14.900000 14.028000 59 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 8.65 8.650000 8.650000 11.69 11.690000 11.690000 60 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM MEDOCLAV FORTE 312,5mg/5ml PULB. PT. SUSP. ORALA 250mg+62,5mg/5ml MEDOCHEMIE LTD. CIPRU CUTIE X 1 FLAC. DIN STICLA BRUNA CU PULB. PT. 100 ML SUSP. P-RF 1 16.36 16.360000 16.360000 22.11 22.110000 22.110000 61 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 2x PULB. PT. SUSP. ORALA 400mg+57mg/5ml LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 1 FLAC. DIN STICLA BRUNA CU PULB. PT. 70 ML SUSP.ORALA + SERINGA DOZATOARE P-RF 1 9.57 9.570000 9.570000 12.93 12.930000 12.930000 62 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 2x PULB. PT. SUSP. ORALA 400mg+57mg/5ml LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 1 FLAC. DIN STICLA BRUNA CU PULB. PT. 35 ML SUSP.ORALA + SERINGA DOZATOARE P-RF 1 4.78 4.780000 4.780000 6.46 6.460000 6.460000 63 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN BIS 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml SMITHKLINE BEECHAM PLC MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 35 ML SUSP. ORALA + 1 SERINGA PT. ADM. ORALA P-RF 1 7.36 7.360000 5.736000 9.95 9.950000 7.752000 64 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN BIS 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml SMITHKLINE BEECHAM PLC MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 70 ML SUSP. ORALA + MASURA DOZATOARE P-RF 1 14.72 14.720000 11.484000 19.89 19.890000 15.516000 65 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN BIS 400 mg/57 mg/5 ml PULB. PT. SUSP. ORALA 400mg/57mg/5ml SMITHKLINE BEECHAM PLC MAREA BRITANIE CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. 35 ML SUSP. ORALA + MASURA DOZATOARE P-RF 1 7.36 7.360000 5.736000 9.95 9.950000 7.752000 66 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN (R) ES PULB. PT. SUSP. ORALA 600 mg/42,9mg/5ml SMITHKLINE BEECHAM PLC MAREA BRITANIE CUTIE X 1 FLACON DIN STICLA CU PULB. PT. 100 ML SUSP. ORALA + 1 MASURA DOZATOARE P-RF 1 26.22 26.220000 26.220000 34.30 34.300000 34.300000 67 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM ENHANCIN 250 mg/ 62,5 mg/5 ml PULB. PT.SUSP. ORALA 250 mg/ 62,5 mg/5 ml RANBAXY UK LIMITED MAREA BRITANIE CUTIE X 1 FLAC. DIN PEID CU PULB. PT. SUSP. ORALA MARCAT PT. 100ML+ MASURA DOZATOARE P-RF 1 16.80 16.800000 16.800000 22.71 22.710000 22.710000 68 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AMOKSIKLAV 312,5mg/5ml PULB. PT.SUSP. ORALA 312,5mg/5ml LEK PHARMACEUTICALS D.D. SLOVENIA CUTIE X 1 FLAC. DIN STICLA BRUNA CU 25 G PULB. PT. 100 ML SUSP. ORALA + LINGURITA DOZATOARE P-RF 1 17.77 17.770000 17.770000 24.02 24.020000 24.020000 69 J01CR05 PIPERACILLINUM + TAZOBACTAMUM TAZOCIN 4,5 LIOF. PT. SOL. INJ. FARA CONCENTRATIE PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 12 FLAC. CU LIOF. PT. SOL. INJ. S/P-RF 12 692.90 57.741666 46.081000 793.41 66.117500 54.043000 70 J01CR05 PIPERACILLINUM + TAZOBACTAMUM TAZOCIN 2,25 LIOF. PT. SOL. INJ. FARA CONCENTRATIE WYETH LEDERLE PHARMA GMBH AUSTRIA CUTIE X 12 FLAC. CU LIOF. PT. SOL. INJ. S/P-RF 12 401.14 33.428333 23.533200 475.39 39.615833 28.729200 71 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILINA/TAZOBACTAN ACTAVIS 2 g/0,25 g PULB. PT. SOL. INJ./PERF. 2g/0,25g ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 12 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. S 12 265.28 22.106666 22.106666 323.86 26.988333 26.988333 72 J01CR05 PIPERACILLINUM + TAZOBACTAMUM ZOPECILIN 2 g/0,25 g PULB. PT. SOL. INJ./PERF. 2g/0,25g ROMASTRU TRADING SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 30 ML CU PULB. PT. SOL. INJ./PERF. S 1 22.93 22.930000 22.930000 30.99 30.990000 28.729200 73 J01CR05 PIPERACILLINUM + TAZOBACTAMUM ZOPECILIN 2 g/0,25 g PULB. PT. SOL. INJ./PERF. 2g/0,25g ROMASTRU TRADING SRL ROMANIA CUTIE CU 12 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 30 ML CU PULB. PT. SOL. INJ./PERF. S 12 265.41 22.117500 22.117500 324.01 27.000833 27.000833 74 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PERASIN 2g/0,25 g PULB. PT. SOL. INJ./PERF. 2g/0,25g ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 30 ML CU PULB. PT. SOL. INJ./PERF. S 1 22.93 22.930000 22.930000 30.99 30.990000 28.729200 75 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILINA/TAZOBACTAM MYLAN 2g/0,25 g PULB. PT. SOL. INJ./PERF. 2g/0,25g MYLAN S.A.S. FRANTA CUTIE CU 1 FLAC. DIN STICLA INCOLORA A 10 ML CU PULB. PT. SOL. INJ./PERF. S 1 22.93 22.930000 22.930000 30.99 30.990000 28.729200 76 J01CR05 PIPERACILLINUM + TAZOBACTAMUM BACTACIN 2 g/0,25 g PULB. PT. SOL. INJ./PERF. 2g/0,25g TERAPIA SA ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 20 ML CU PULB. PT. SOL. INJ./PERF. S 1 22.93 22.930000 22.930000 30.99 30.990000 28.729200 77 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 2g/0,25g PULB. PT. SOL. INJ./PERF. 2g/0,25g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 10 FLAC. DIN STICLA INCOLORA (CAPACITATE 50 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 10 386.57 38.657000 23.533200 459.51 45.951000 28.729200 78 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 2g/0,25g PULB. PT. SOL. INJ./PERF. 2g/0,25g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA (CAPACITATE 10 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 1 20.32 20.320000 20.320000 27.47 27.470000 27.470000 79 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 2g/0,25g PULB. PT. SOL. INJ./PERF. 2g/0,25g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 5 FLAC. DIN STICLA INCOLORA (CAPACITATE 10 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 5 99.83 19.966000 19.966000 126.23 25.246000 25.246000 80 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 2g/0,25g PULB. PT. SOL. INJ./PERF. 2g/0,25g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 10 FLAC. DIN STICLA INCOLORA (CAPACITATE 10 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 10 196.11 19.611000 19.611000 239.41 23.941000 23.941000 81 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 2g/0,25g PULB. PT. SOL. INJ./PERF. 2g/0,25g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA (CAPACITATE 50 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 1 40.65 40.650000 23.533200 53.17 53.170000 28.729200 82 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 2g/0,25g PULB. PT. SOL. INJ./PERF. 2g/0,25g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 5 FLAC. DIN STICLA INCOLORA (CAPACITATE 50 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 5 196.11 39.222000 23.533200 239.41 47.882000 28.729200 83 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILINA/TAZOBACTAN ACTAVIS 4 g/0,5 g PULB. PT. SOL. INJ./PERF. 4g/0,5g ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 12 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERF. S 12 460.81 38.400833 38.400833 540.43 45.035833 45.035833 84 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PERASIN 4g/0,5 g PULB. PT. SOL. INJ./PERF. 4g/0,5g ANTIBIOTICE S.A. ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 48 ML CU PULB. PT. SOL. INJ./PERF. S 1 40.93 40.930000 40.930000 53.53 53.530000 53.530000 85 J01CR05 PIPERACILLINUM + TAZOBACTAMUM ZOPECILIN 4 g/0,5 g PULB. PT. SOL. INJ./PERF. 4g/0,5g ROMASTRU TRADING SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 48 ML CU PULB. PT. SOL. INJ./PERF. S 1 40.93 40.930000 40.930000 53.53 53.530000 53.530000 86 J01CR05 PIPERACILLINUM + TAZOBACTAMUM ZOPECILIN 4 g/0,5 g PULB. PT. SOL. INJ./PERF. 4g/0,5g ROMASTRU TRADING SRL ROMANIA CUTIE CU 12 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 48 ML CU PULB. PT. SOL. INJ./PERF. S 12 460.81 38.400833 38.400833 540.43 45.035833 45.035833 87 J01CR05 PIPERACILLINUM + TAZOBACTAMUM BACTACIN 4 g/0,5 g PULB. PT. SOL. INJ./PERF. 4g/0,5g TERAPIA SA ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU CAPACITATEA DE 50 ML CU PULB. PT. SOL. INJ./PERF. S 1 40.93 40.930000 40.930000 53.53 53.530000 53.530000 88 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 4g/0,5g PULB. PT. SOL. INJ./PERF. 4g/0,5g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 1 FLAC DIN STICLA INCOLORA (CAPACITATE 50 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 1 40.93 40.930000 40.930000 53.53 53.530000 53.530000 89 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 4g/0,5g PULB. PT. SOL. INJ./PERF. 4g/0,5g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 5 FLAC. DIN STICLA INCOLORA (CAPACITATE 50 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 5 197.45 39.490000 39.490000 241.05 48.210000 48.210000 90 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILLINUM/TAZOBACTAMUM KABI 4g/0,5g PULB. PT. SOL. INJ./PERF. 4g/0,5g S.C. FRESENIUS KABI S.R.L. ROMANIA CUTIE X 10 FLAC. DIN STICLA INCOLORA (CAPACITATE 50 ML) CONTINAND PULB. PT. SOL. INJ/PERF S 10 389.01 38.901000 38.901000 462.17 46.217000 46.217000 91 J01CR05 PIPERACILLINUM + TAZOBACTAMUM PIPERACILINA/TAZOBACTAM MYLAN 4g/0,5 g PULB. PT. SOL. INJ./PERF. 4g/0,5g MYLAN S.A.S. FRANTA CUTIE CU 1 FLAC. DIN STICLA INCOLORA A 50 ML CU PULB. PT. SOL. INJ./PERF. S 1 40.94 40.940000 40.940000 53.55 53.550000 53.550000 92 J01DD04 CEFTRIAXONUM NOVOSEF 500 mg i.m. PULB. + SOLV. PT. SOL. INJ. 500mg ZENTIVA S.A. ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA X 15 ML CONTINAND PULB. PT. SOL. INJ. I.M.+ 1 FIOLA DIN STICLA P-RF 1 4.47 4.470000 4.470000 6.04 6.040000 6.040000 93 J01DD04 CEFTRIAXONUM CEFTRIAXONA ACTAVIS 1 g PULB. PT. SOL. INJ. 1 g ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 5 FLACOANE DIN STICLA INCOLORA X 20 ML, CU SIST. SIG. "FLIP - OFF" CU PULB. PT. SOL. INJ. PR 5 46.17 9.234000 7.224000 60.39 12.078000 9.768000 94 J01DD04 CEFTRIAXONUM NOVOSEF 500mg i.v. PULB. PT. SOL. INJ. I.V./PERF. 500mg ZENTIVA S.A. ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA X 15ML CONTINAND PULB. PT. SOL INJ./PERF. + 1 FIOLA DIN STICLA I S/P-RF 1 4.47 4.470000 4.470000 6.04 6.040000 6.040000 95 J01DD04 CEFTRIAXONUM OFRAMAX 1000 mg PULB. PT. SOL. INJ./PERF. 1000mg TERAPIA SA ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA, CU CAPACITATEA DE 15 ML CU PULB. PT. SOL. INJ./PERF. S 50 456.00 9.120000 7.224000 535.19 10.703800 9.768000 96 J01DD04 CEFTRIAXONUM CEFORT 1 g PULB. PT. SOL. INJ./PERF. 1g ANTIBIOTICE SA ROMANIA CUTIE X 10 FLAC. CU PULB. PT. SOL. INJ./PERF. S/P-RF 10 133.84 13.384000 7.224000 163.39 16.339000 9.768000 97 J01DD04 CEFTRIAXONUM SEFTRION 1 g PULB. PT. SOL. INJ./PERF. 1g E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERFZ. S/P-RF 1 10.31 10.310000 7.224000 13.94 13.940000 9.768000 98 J01DD04 CEFTRIAXONUM CEFTRIAXONA ACTAVIS 2 g PULB. PT. SOL. INJ./PERF. 2 g ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU 5 FLACOANE DIN STICLA INCOLORA X 20 ML, CU SIST. SIG. "FLIP - OFF" CU PULB. PT. SOL. INJ./P PR 5 90.67 18.134000 15.528000 114.64 22.928000 20.988000 99 J01DD04 CEFTRIAXONUM CEFORT 250 mg PULB. PT. SOL. INJ./PERF. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 50 FLAC. CU PULB. PT. SOL. INJ.PERF. S/P-RF 50 262.42 5.248400 5.248400 320.36 6.407200 6.407200 100 J01DD04 CEFTRIAXONUM OFRAMAX 250 mg PULB. PT. SOL. INJ./PERF. 250mg TERAPIA SA ROMANIA CUTIE CU 50 FLAC. DIN STICLA INCOLORA, CU CAPACITATEA DE 5 ML CU PULB. PT. SOL. INJ./PERF. S 50 246.03 4.920600 4.920600 300.35 6.007000 6.007000 101 J01DD04 CEFTRIAXONUM CEFORT 250 mg PULB. PT. SOL. INJ./PERF. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 10 FLAC. CU PULB. PT. SOL.INJ./PERF. S/P-RF 10 54.63 5.463000 5.463000 69.07 6.907000 6.907000 102 J01DD04 CEFTRIAXONUM CEFORT 250 mg PULB. PT. SOL. INJ./PERF. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. CU PULB. PT. SOL. INJ.PERF. S 100 505.00 5.050000 5.050000 588.60 5.886000 5.886000 103 J01DD04 CEFTRIAXONUM CEFORT 250 mg PULB. PT. SOL. INJ./PERF. 250mg ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ.PERF. S/P-RF 1 5.48 5.480000 5.480000 7.41 7.410000 7.063200 104 J01DD04 CEFTRIAXONUM MEDAXONE 2 g PULB. PT. SOL. INJ./PERF. 2g MEDOCHEMIE LTD. CIPRU CUTIE X 10 FLACOANE X 2 G PULB. PT. SOL. INJ./PERF. S/P-RF 10 210.87 21.087000 15.528000 257.43 25.743000 20.988000 105 J01DD04 CEFTRIAXONUM CEFORT 2 g PULB. PT. SOL. INJ./PERF. 2g ANTIBIOTICE SA ROMANIA CUTIE X 10 FLAC. CU PULB. PT. SOL. INJ./PERF. S/P-RF 10 228.45 22.845000 15.528000 278.89 27.889000 20.988000 106 J01DD04 CEFTRIAXONUM SEFTRION 500 mg PULB. PT. SOL. INJ./PERF. 500mg E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ./PERFZ. S/P-RF 1 7.74 7.740000 5.364000 10.46 10.460000 7.248000 107 J01DD04 CEFTRIAXONUM CEFORT 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 100 FLAC. CU PULB. PT. SOL. INJ./PERF. S/P-RF 100 792.54 7.925400 5.364000 902.02 9.020200 7.248000 108 J01DD04 CEFTRIAXONUM CEFORT 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 1 FLAC. CU PULB. PT. SOL. INJ./PERF. S/P-RF 1 8.75 8.750000 5.364000 11.82 11.820000 7.248000 109 J01DD04 CEFTRIAXONUM CEFORT 500 mg PULB. PT. SOL. INJ./PERF. 500mg ANTIBIOTICE SA ROMANIA CUTIE X 50 FLAC. CU PULB. PT. SOL. INJ./PERF. S/P-RF 50 412.34 8.246800 5.364000 487.60 9.752000 7.248000 110 J01DD04 CEFTRIAXONUM SEFTRION 2 g PULB. PT. SOL. PERF. 2g EIPICO MED SRL ROMANIA CUTIE CU 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. PERF. P-RF 1 12.94 12.940000 12.940000 17.49 17.490000 17.490000 111 J01DD04 CEFTRIAXONUM ROCEPHIN (R) PULB. PT. SOL. PERF. 2g ROCHE ROMANIA S.R.L. ROMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU CAPCITATEA DE 50ML CONTINAND PULB. PT. SOL. PERFUZ. S/P-RF 1 44.01 44.010000 15.528000 57.56 57.560000 20.988000 Pagina 2 din 48