ANEXA 1 SUBLISTA A - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 90% DIN PRETUL DE REFERINTA CONFORM DENUMIRILOR COMUNE INTERNATIONALE (DCI) CORESPUNZ

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3 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 APRILIE 2010 Nr crt. codifatc den_internationala denumire formaf concentratie Firma detinatoare tara forma ambalare prescriere SE ADAUGA cant/a mbalaj Pret amanuntul Pret maximal/a mbalaj (RON) amanuntul maximal/u T (RON) Val suportat a de CNAS/U T (RON)Le gea nr. Val 95/2006 art 213 alin.1 lit. a) si f) suportata CNAS/UT (RON) pt. Adulti 1556 A02BA03 FAMOTIDINUM QUAMATEL (R) 40 mg COMPR. FILM. 40mg GEDEON RICHTER PLC UNGARIA CUTIE X 1 BLIST. X 14 COMPR. FILM. P-6L C02CA04 DOXAZOSINUM ANIPROSIN 2 mg (vezi C02CA04) COMPR. 2 mg LABORMED PHARMA S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L C02CA04 DOXAZOSINUM ANIPROSIN 2 mg (vezi C02CA04) COMPR. 2 mg LABORMED PHARMA S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L C02CA04 DOXAZOSINUM ANIPROSIN 4 mg (vezi C02CA04) COMPR. 4mg LABORMED PHARMA S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L C02CA04 DOXAZOSINUM ANIPROSIN 4 mg (vezi C02CA04) COMPR. 4mg LABORMED PHARMA S.A. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L N05AD01 HALOPERIDOLUM HALOPERIDOL 1 mg COMPR. 1mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF N05AD01 HALOPERIDOLUM HALOPERIDOL 2 mg COMPR. 2mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF A02BC01 OMEPRAZOLUM NOVOGAST 20 mg CAPS. GASTROREZ. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 FOLII AL/PE X 10 CAPS. GASTR. P-6L C02CA04 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 2mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L C02CA04 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 2mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L C02CA04 DOXAZOSINUM DOXAZOSIN 2 MEDOCHEMIE (vezi G04CAN1) COMPR. 2mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 7 COMPR. P-6L C02CA04 DOXAZOSINUM DOXAZOSIN 2 MEDOCHEMIE (vezi G04CAN1) COMPR. 2mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 7 COMPR. P-6L C02CA04 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 4mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDE/AL X 10 COMPR. P-6L C02CA04 DOXAZOSINUM DOXAZOSIN 4 MEDOCHEMIE (vezi G04CAN1) COMPR. 4mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 7 COMPR. P-6L C02CA04 DOXAZOSINUM DOXAZOSIN 4 MEDOCHEMIE (vezi G04CAN1) COMPR. 4mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 7 COMPR. P-6L C02CA04 DOXAZOSINUM KAMIREN (vezi G04CAN1) COMPR. 4mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. PVC-PVDE/AL X 10 COMPR. P-6L N06AX16 VENLAFAXINUM** IVRYX 150mg CAPS. ELIB. PREL. 150 mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE X 2 BLIST. PCV-ACLAR/AL X 14 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** EFECTIN ER 150 mg CAPS. ELIB. PREL. 150mg WYETH LEDERLE PHARMA GMBH AUSTRIA CUTIE X 1 BLIST. ACLAR/PE/PVC/AL X 28 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAFAXINA ACTAVIS 150 mg CAPS. ELIB. PREL. 150mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC/AL X 28 CAPS. CU ELIB. PREL. P-RF Pagina 1 din

4 1454 N06AX16 VENLAFAXINUM** JARVIS 150 mg CAPS. ELIB. PREL. 150mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAGAMMA 150 mg CAPS. ELIB. PREL. 150mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PCTF/AL X 100 CAPS. CU ELIB. PREL. P-RF/S N06AX16 VENLAFAXINUM** VENLAGAMMA 150 mg CAPS. ELIB. PREL. 150mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PCTF/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ELIFY EP 150 mg CAPS. ELIB. PREL. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** NOPEKAR 150 mg CAPS. ELIB. PREL. 150mg OZONE LABORATORIES BV OLANDA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ADOXA EP 150 mg CAPS. ELIB. PREL. 150mg RANBAXY (UK) LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ALVENTA 150mg CAPS. ELIB. PREL. 150mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** FOBILESS 150 mg CAPS. ELIB. PREL. 150mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VELAXIN 150 mg CAPS. ELIB. PREL. 150mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** IVRYX 75mg CAPS. ELIB. PREL. 75 mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE X 2 BLIST. PCV-ACLAR/AL X 14 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** EFECTIN ER 75 mg CAPS. ELIB. PREL. 75mg WYETH LEDERLE PHARMA GMBH AUSTRIA CUTIE X 1 BLIST. ACLAR/PE/PVC/AL X 28 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAGAMMA 75 mg CAPS. ELIB. PREL. 75mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PCTF/AL X 100 CAPS. CU ELIB. PREL. P-RF/S N06AX16 VENLAFAXINUM** VENLAFAXINA ACTAVIS 75 mg CAPS. ELIB. PREL. 75mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC/AL X 28 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** JARVIS 75 mg CAPS. ELIB. PREL. 75mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAGAMMA 75 mg CAPS. ELIB. PREL. 75mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PCTF/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ELIFY EP 75 mg CAPS. ELIB. PREL. 75mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ADOXA EP 75 mg CAPS. ELIB. PREL. 75mg RANBAXY (UK) LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** FOBILESS 75 mg CAPS. ELIB. PREL. 75mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** NOPEKAR 75 mg CAPS. ELIB. PREL. 75mg OZONE LABORATORIES BV OLANDA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VELAXIN 75 mg CAPS. ELIB. PREL. 75mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 CAPS. CU ELIB. PREL P-RF N06AX16 VENLAFAXINUM** ALVENTA 75 mg CAPS. ELIB. PREL. 75mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. ELIB. PREL. P-RF Pagina 2 din 2

5 SUBLISTA B - LISTA MEDICAMENTELOR CU NIVEL DE COMPENSARE 50% DIN PRETUL DE REFERINTA CONFORM ANEXA 2 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 APRILIE 2010 Nr. crt codifatc den_internationala denumire formaf concentr atie Firma detinatoare tara forma ambalare prescriere SE ADAUGA cant/a mbala j Pret amanun tul maxima l/ambal aj (RON) Pret amanunt ul maximal/ UT (RON) Val suportata de CNAS/UT (RON)Leg ea nr. 95/2006 art 213 alin.1 lit. a) si f) Val suportat a CNAS/U T (RON) pt. Adulti 790 D07AD01 CLOBETASOLUM* DERMOVATE CREMA 0,05% GLAXOWELLCOME UK LTD. MAREA BRITANIE CUTIE X 1 TUB X 25 G P-RF D07AD01 CLOBETASOLUM* DERMOVATE UNGUENT 0,05% GLAXOWELLCOME UK LTD. MAREA BRITANIE CUTIE X 1 TUB X 25 G P-RF A02BX02 SUCRALFATUM SUCRALAN (R) COMPR. 1g LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X 2 BLIST. AL/PVC TRANSPARENTE, ALBASTRUI X 10 COMPR. P-6L D07AD01 CLOBETASOLUM* DERMOVATE 0,5 mg/g CREMA 0,5mg/g GLAXO WELLCOME UK LTD. MAREA BRITANIE CUTIE CU 1 TUB AL X 25 G CREMA P-RF H01AC01 SOMATROPINUM***# NORDITROPIN SIMPLEX x 10mg/1,5ml SOL. INJ. 10mg/1,5ml NOVO NORDISK A/S DANEMARCA CUTIE X 1 CARTUS DIN STICLA X 1,5 ML SOL. INJ. P-RF S01CA01 COMBINATII (TOBRAMYCINUM +DEXAMETAZONUM) TOBRADEX ( R ) PICATURI OFT.-SUSP. 1mg+3mg ALCON COUVREUR NV BELGIA CUTIE X 1 FLACON PICURATOR PEJD X 5 ML P-RF

6 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 APRILIE 2010 NR.CRT COD ATC DENUMIRE COMUNA INTERNATIONALA DENUMIRE COMERCIALA FORMA FARMACEUTICA CONCENTRATIE FIRMA DETINATOARE TARA DETINATOARE FORMA AMBALAJ PRESC CANT FL 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 ORTATA T CNAS/ UT (RON) PT. ADULTI 4. HEPATITELE CRONICE DE ETIOLOGIE VIRALA B, C şi D - G4 14 B03XA01 EPOETINUM ALFA** EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA** EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA** EPREX (R) UI SOL. INJ UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE X 1 FLACON DIN STICLA X 1 ML S/P-RF Tratamentul se initiază de către medicul în specialitatea gastroenterologie / boli infectioase si nefrologie (doar pentru pacientii cu afectare renala consecutiva infectiei cu virusuri hepatitice) 7. CIROZA HEPATICA - G7 23 B03XA01 EPOETINUM ALFA** EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA** EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA** EPREX (R) UI SOL. INJ UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE X 1 FLACON DIN STICLA X 1 ML S/P-RF Pagina 1 din 4

7 Tratamentul se inițiază de către medicul in specialitatea gastroenterologie sau boli infectioase 8. Leucemii, limfoame, aplazie medulara, gamapatii monoclonale maligne, mieloproliferari cronice si tumori maligne, sindroame mielodisplazice - G10 37 B03XA01 EPOETINUM ALFA** EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA** EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. S/P-RF N02AA01 MORPHYNUM VENDAL (R) RETARD 30 mg COMPR. FILM. ELIB. PREL. 30mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. ELIB. PREL. P-TS N02AA01 MORPHYNUM VENDAL (R) RETARD 60 mg COMPR. FILM. ELIB. PREL. 60mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. FILM. ELIB. PREL. P-TS B03XA01 EPOETINUM ALFA** EPREX (R) UI SOL. INJ UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE X 1 FLACON DIN STICLA X 1 ML S/P-RF N02AA01 MORPHYNUM MST CONTINUS 30 mg COMPR. FILM. ELIB. MODIF. 30mg MUNDIPHARMA GES.M.B.H AUSTRIA CUTIE X 2 BLIST. PVC-PVDC/AL X 30 COMPR. FILM. CU ELIB. MOD. P-TS N02AA01 MORPHYNUM VENDAL (R) RETARD 30 mg COMPR. FILM. ELIB. PREL. 30mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. ELIB. PREL. P-TS Tratamentul se initiaza de catre medicul in specialitatea oncologie sau hematologie 13. BOLI PSIHICE (SCHIZOFRENIE, TULBURARI SCHIZOTIPALE SI DELIRANTE, TULBURARI AFECTIVE MAJORE, TULBURARI PSIHOTICE ACUTE SI BOLI PSIHICE COPII, AUTISM) - G15 SE ADAUGA 256 N05AD01 HALOPERIDOLUM HALOPERIDOL 1 mg COMPR. 1mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF N05AD01 HALOPERIDOLUM HALOPERIDOL 2 mg COMPR. 2mg ARENA GROUP SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF N06AX16 VENLAFAXINUM** IVRYX 150mg CAPS. ELIB. PREL. 150 mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE X 2 BLIST. PCV-ACLAR/AL X 14 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** EFECTIN ER 150 mg CAPS. ELIB. PREL. 150mg WYETH LEDERLE PHARMA GMBH AUSTRIA CUTIE X 1 BLIST. ACLAR/PE/PVC/AL X 28 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAGAMMA 150 mg CAPS. ELIB. PREL. 150mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PCTF/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** JARVIS 150 mg CAPS. ELIB. PREL. 150mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAFAXINA ACTAVIS 150 mg CAPS. ELIB. PREL. 150mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC/AL X 28 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAGAMMA 150 mg CAPS. ELIB. PREL. 150mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PCTF/AL X 100 CAPS. CU ELIB. PREL. P-RF/S N06AX16 VENLAFAXINUM** ELIFY EP 150 mg CAPS. ELIB. PREL. 150mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ALVENTA 150mg CAPS. ELIB. PREL. 150mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** FOBILESS 150 mg CAPS. ELIB. PREL. 150mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** NOPEKAR 150 mg CAPS. ELIB. PREL. 150mg OZONE LABORATORIES BV OLANDA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ADOXA EP 150 mg CAPS. ELIB. PREL. 150mg RANBAXY (UK) LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VELAXIN 150 mg CAPS. ELIB. PREL. 150mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** IVRYX 75mg CAPS. ELIB. PREL. 75 mg ROMASTRU TRADING S.R.L. ROMANIA CUTIE X 2 BLIST. PCV-ACLAR/AL X 14 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** EFECTIN ER 75 mg CAPS. ELIB. PREL. 75mg WYETH LEDERLE PHARMA GMBH AUSTRIA CUTIE X 1 BLIST. ACLAR/PE/PVC/AL X 28 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAFAXINA ACTAVIS 75 mg CAPS. ELIB. PREL. 75mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC/AL X 28 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** JARVIS 75 mg CAPS. ELIB. PREL. 75mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VENLAGAMMA 75 mg CAPS. ELIB. PREL. 75mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PCTF/AL X 100 CAPS. CU ELIB. PREL. P-RF/S Pagina 2 din

8 232 N06AX16 VENLAFAXINUM** VENLAGAMMA 75 mg CAPS. ELIB. PREL. 75mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PCTF/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ELIFY EP 75 mg CAPS. ELIB. PREL. 75mg MEDOCHEMIE LTD. CIPRU CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** NOPEKAR 75 mg CAPS. ELIB. PREL. 75mg OZONE LABORATORIES BV OLANDA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 CAPS. ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** ADOXA EP 75 mg CAPS. ELIB. PREL. 75mg RANBAXY (UK) LIMITED MAREA BRITANIE CUTIE CU BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** FOBILESS 75 mg CAPS. ELIB. PREL. 75mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X BLIST. PVC/AL X 30 CAPS. CU ELIB. PREL. P-RF N06AX16 VENLAFAXINUM** VELAXIN 75 mg CAPS. ELIB. PREL. 75mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 CAPS. CU ELIB. PREL P-RF N06AX16 VENLAFAXINUM** ALVENTA 75 mg CAPS. ELIB. PREL. 75mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE CU BLIST. PVC-PVDC/AL X 30 CAPS. ELIB. PREL. P-RF Tratamentul se initiaza de catre medicul in specialitatea psihiatrie 14. DEMENTE(DEGENERATIVE, VASCULARE, MIXTE) - G N06DA02 DONEPEZILUM*** DONEPEZIL TEVA 10 mg COMPR. ORODISPERSABILE 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 28 COMPR. ORODISP. P-RF N06DA02 DONEPEZILUM*** DONEPEZIL TEVA 5 mg COMPR. ORODISPERSABILE 5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 28 COMPR. ORODISP. P-RF N06DA02 DONEPEZILUM*** ARICEPT (R) 10 mg COMPR. FILM. 10mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. PVC/AL X 14 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ZILDON 10mg COMPR. FILM. 10mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** DAVIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** DAVIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** DONEPEZIL TEVA 10 mg COMPR. FILM. 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALDEMIZ 10 mg COMPR. FILM. 10mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 30 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALDEMIZ 10 mg COMPR. FILM. 10mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALZEPIL 10 mg COMPR. FILM. 10mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALZEPIL 10 mg COMPR. FILM. 10mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALZEPIL 10 mg COMPR. FILM. 10mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 56 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALZEPIL 10 mg COMPR. FILM. 10mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** DONECEPT 10 MG COMPR. FILM. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X BLIST. PVC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** PRIDIA 10 mg COMPR. FILM. 10mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** TUADIN 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 9 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** TUADIN 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 6 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** TUADIN 10 mg COMPR. FILM. 10mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ARICEPT (R) 5 mg COMPR. FILM. 5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** DAVIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ZILDON 5 mg COMPR. FILM. 5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** DAVIA 5 mg COMPR. FILM. 5mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** DONEPEZIL TEVA 5 mg COMPR. FILM. 5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALDEMIZ 5 mg COMPR. FILM. 5mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 30 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALDEMIZ 5 mg COMPR. FILM. 5mg DR. REDDY'S LABORATORIES ROMANIA CUTIE CU BLIST. PVC-ACLAR/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALZEPIL 5 mg COMPR. FILM. 5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. OPA-AL-PVC/AL X 56 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALZEPIL 5 mg COMPR. FILM. 5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALZEPIL 5 mg COMPR. FILM. 5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 56 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ALZEPIL 5 mg COMPR. FILM. 5mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. PVC-PVDC/AL X 28 COMPR. FILM. P-RF Pagina 3 din

9 29 N06DA02 DONEPEZILUM*** DONECEPT 5 MG COMPR. FILM. 5mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X BLIST. PVC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** PRIDIA 5 mg COMPR. FILM. 5mg LABORMED PHARMA S.A. ROMANIA CUTIE CU BLIST. PVC-PE-PVDC/AL X 28 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** TUADIN 5 mg COMPR. FILM. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 6 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** TUADIN 5 mg COMPR. FILM. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 9 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** TUADIN 5 mg COMPR. FILM. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF N06DA02 DONEPEZILUM*** ARICEPT EVESS COMPR. ORODISPERSABILE 10mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC-PVDC-PE-PVDC-PVC X 14 COMPR. ORODISPERSABILE P-RF N06DA02 DONEPEZILUM*** ARICEPT EVESS COMPR. ORODISPERSABILE 5mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC-PVDC-PE-PVDC-PVC X 14 COMPR. ORODISPERSABILE P-RF Tratamentul se initiaza de catre medicul in specialitatea psihiatrie, neurologie sau geriatrie 20. BOALA CRONICA DE RINICHI - faza predializa - G B03XA01 EPOETINUM ALFA** EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA** EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA** EPREX (R) UI SOL. INJ UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE X 1 FLACON DIN STICLA X 1 ML S/P-RF Tratamentul se initiaza de catre medicul in specialitatea nefrologie. Medicamentele specifice se prescriu numai pentru pacientii inclusi in Programul National de supleere a functiei renale la bolnavii cu insuficienta renala cronica. 21. GLAUCOM - G 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 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 Tratamentul se initiaza de catre medicul in specialitatea oftalmologie Pagina 4 din 4

10 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. 426/2009 VALABILĂ ÎNCEPÂND CU 19 APRILIE 2010 Nr. crt Grupa terapeu tica Denumire generica Denumire comerciala Forma farmaceu tica Concentr atie / U.T. Firma Tara Ambalaj al U.T. Prescr. Cantitate Pret cu ridicata maximal / ambalaj Pret cu amanuntul maximal / ambalaj Pret cu amanuntul maximal / U.T. = Pret de decontare / U.T. P3: PROGRAMUL NATIONAL DE ONCOLOGIE 45 L01BC05 GEMCITABINUM** GEMZAR (R) 1 g PULB. PT. SOL. PERF. 1g LILLY FRANCE SAS FRANTA CUTIE X 1FLAC. PULB. PT. SOL. PERF. S L01BC05 GEMCITABINUM** GEMZAR (R) 200 mg PULB. PT. SOL. PERF. 200mg LILLY FRANCE SAS FRANTA CUTIE X 1 FLAC. PULB. PT. SOL. PERF. S P6.7: SINDROM PRADER WILLI 3 H01AC01 SOMATROPINUM** NORDITROPIN SIMPLEX x 10mg/1,5ml SOL. INJ. 10mg/1,5ml NOVO NORDISK A/S DANEMARCA CUTIE X 1 CARTUS DIN STICLA X 1,5 ML SOL. INJ. P-RF P10: PROGRAM NATIONAL DE SUPLEERE A FUNCTIEI RENALE LA BOLNAVII CU INSUFICIENTA RENALA CRONICA 43 B03XA01 EPOETINUM ALFA EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA EPREX (R) UI SOL. INJ UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE X 1 FLACON DIN STICLA X 1 ML S/P-RF P9: PROGRAM NATIONAL DE TRANSPLANT DE ORGANE, TESUTURI SI CELULE DE ORIGINE UMANA Pagina 1 din 2

11 P9.1: TRANSPLANT MEDULAR 37 B03XA01 EPOETINUM ALFA EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA EPREX (R) UI SOL. INJ UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE X 1 FLACON DIN STICLA X 1 ML S/P-RF P9: PROGRAM NATIONAL DE TRANSPLANT DE ORGANE, TESUTURI SI CELULE DE ORIGINE UMANA P9.4: TRANSPLANT RENAL combinat RINICHI si PANCREAS 35 B03XA01 EPOETINUM ALFA EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA EPREX (R) UI SOL. INJ UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE X 1 FLACON DIN STICLA X 1 ML S/P-RF P9: PROGRAM NATIONAL DE TRANSPLANT DE ORGANE, TESUTURI SI CELULE DE ORIGINE UMANA P9.7: TRATAMENTUL STARII POSTTRANSPLANT IN AMBULATORIU A PACIENTILOR TRANSPLANTATI 19 B03XA01 EPOETINUM ALFA EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA EPREX UI SOL. INJ. IN SERINGA PREUMPLUTA UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE CU 1 SERINGA PREUMPLUTA X 1 ML SOL. INJ. S/P-RF B03XA01 EPOETINUM ALFA EPREX (R) UI SOL. INJ UI JOHNSON & JOHNSON D.O.O. SLOVENIA CUTIE X 1 FLACON DIN STICLA X 1 ML S/P-RF Pagina 2 din 2