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

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 01 SEPTEMBRIE 2010 Nr concentrati cod ATC DCI denumire comerciala forma farmaceutica crt. e firma detinatoare APP tara detinatoare APP ambalaj cant. presc Ut/amb riptie alaj maximal/a mbalaj (RON) maximal/u T (RON) suportata de (RON)Legea nr. 95/2006 art 213 alin.1 lit. a) si f) suportata (RON) pt. Adulti 349 C08CA01 AMLODIPINUM AMLODIGAMMA 10 mg COMPR. 10mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC- PVDC/AL X 30 COMPR. P-6L 30 5.12 0.170666 0.170666 0.153599 371 C08CA01 AMLODIPINUM AMLODIGAMMA 5 mg COMPR. 5mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30COMPR. P-6L 30 2.56 0.085333 0.085333 0.076799 667 C10AA03 PRAVASTATINUM PRALIP 40 mg COMPR. 40mg SANDOZ SRL ROMANIA CUTIE X 3 BLIST. AL/AL X 10 COMPR. P-6L 30 37.96 1.265333 0.963000 0.866700 101 B01AC05 TICLOPIDINUM TICLODIN COMPR. FILM. 250mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. X 10 COMPR. FILM. P-RF 20 35.44 1.772000 1.194942 1.075448 102 B01AC05 TICLOPIDINUM IPATON COMPR. FILM. 250mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE X 2 BLIST. AL/ PVC X 10 COMPR.FILM. P-RF 20 33.30 1.665000 1.194942 1.075448 288 C07AB05 BETAXOLOLUM BETAC COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 2 BLIST. AL/PVC X 7 COMPR. FILM. P-6L 14 7.40 0.528571 0.426374 0.383737 286 C07AB05 BETAXOLOLUM BETAC COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 30 15.86 0.528666 0.426374 0.383737 287 C07AB05 BETAXOLOLUM BETAC COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 2 BLIST. AL/PVC X 10 COMPR. FILM. P-6L 20 10.57 0.528500 0.426374 0.383737 285 C07AB05 BETAXOLOLUM BETAC COMPR. FILM. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 4 BLIST. AL/PVC X 7 COMPR. FILM. P-6L 28 14.81 0.528928 0.426374 0.383737 485 C09AA03 LISINOPRILUM LISINOPRIL ATB 10 MG COMPR. 10mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 6.26 0.313000 0.200340 0.180306 486 C09AA03 LISINOPRILUM LISINOPRIL ATB 10 MG COMPR. 10mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 9.71 0.323666 0.200340 0.180306 815 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 39.04 2.788571 1.855124 1.669612 816 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 40.62 2.901428 1.855124 1.669612 817 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 22.59 1.411875 0.530035 0.477032 820 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 29.68 1.855000 1.060071 0.954064 819 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 625 mg COMPR. FILM. 500mg+125mg BEECHAM GROUP PLC MAREA BRITANIE CUTIE X 2 BLIST. AL/PVDC-PVC X 7 COMPR. FILM., FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTOA P-RF 14 16.64 1.188571 1.060071 0.954064 821 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 28.00 2.000000 1.060071 0.954064 822 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM ENHANCIN 625 mg COMPR. FILM. 625mg RANBAXY UK LIMITED MAREA BRITANIE CUTIE X 4 FOLII AL-PEJD X 7 COMPR. FILM. P-RF 28 32.99 1.178214 1.060071 0.954064 823 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN 1 g COMPR. FILM. 875mg+125mg BEECHAM GROUP PLC MAREA BRITANIE CUTIE X 2 BLIST. AL/PVDC-PVC X 7 COMPR. FILM., FIECARE BLISTER FIIND INTRODUS INTR-O PUNGA PROTECTOA P-RF 14 29.12 2.080000 1.855124 1.669612 825 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM AUGMENTIN SR COMPR. FILM. ELIB. PREL. 1062,5mg BEECHAM GROUP PLC MAREA BRITANIE CUTIE X 7 BLIST. AL/PVC-AL SAU AL/PP-AL X 4 COMPR. FILM. ELIB. PREL. P-RF 28 67.52 2.411428 2.120142 1.908128 826 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM COMPR. PT. DISPERSIE ORALA/ORODISPERS AMOKSIKLAV QUICKTAB 1000 mg ABILE 1000mg BIOMEDIAL PHARMA S.R.L. ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-RF 14 25.01 1.786428 1.786428 1.607785 827 J01CR02 AMOXICILLINUM + ACIDUM CLAVULANICUM COMPR. PT. DISPERSIE ORALA/ORODISPERS AMOKSIKLAV QUICKTAB 625 mg ABILE 625mg BIOMEDIAL PHARMA S.R.L. ROMANIA CUTIE X 7 BLIST. AL/AL X 2 COMPR. PT. DISPERSIE ORALA/ORODISPERSABILE P-RF 14 16.49 1.177857 1.060071 0.954064 915 J01DD08 CEFIXIMUM EFICEF (R) 200 mg CAPS. 200mg ANTIBIOTICE SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 34.70 3.470000 3.470000 3.123000 1098 M01AB05 DICLOFENACUM RHEUMAVEK SOL. INJ. 25mg/ml FARAN LABORATORIES S.A. GRECIA CUTIE X 5 FIOLE DE STICLA BRUNA PREVAZUTE CU INEL DE RUPERE X 3 ML P-RF 5 6.09 1.218000 1.096200 0.986580 1097 M01AB05 DICLOFENACUM VOLTAREN (R) SOL. INJ. 25mg/ml NOVARTIS PHARMA GMBH GERMANIA CUTIE X 5 FIOLE CU PUNCT DE RUPERE X 3 ML P-RF 5 9.38 1.876000 1.096200 0.986580 1099 M01AB05 DICLOFENACUM TRATUL (R) SOL. INJ. 30mg/ml GEROT PHARMAZEUTIKA GMBH AUSTRIA CUTIE X 1 BLIST PVC X 5 FIOLE DIN STICLA BRUNA X 3 ML SOL. INJ. P-RF 5 14.21 2.842000 1.315440 1.183896 1100 M01AB05 DICLOFENACUM DICLAC SOL. INJ. 75mg HEXAL AG GERMANIA CUTIE X 5 FIOLE X 3 ML SOL. INJ. P-RF 5 6.09 1.218000 1.096200 0.986580 1104 M01AB05 DICLOFENACUM DICLOFENAC AL I.M. SOL. INJ. 75mg/3ml ALIUD PHARMA GMBH GERMANIA CUTIE X 10 FIOLE DIN STICLA INCOLORA X 3ML SOL. INJ. P-RF 10 12.19 1.219000 1.096200 0.986580 1103 M01AB05 DICLOFENACUM DICLOFENAC AL I.M. SOL. INJ. 75mg/3ml ALIUD PHARMA GMBH GERMANIA CUTIE X 5 FIOLE DIN STICLA INCOLORA X 3ML SOL. INJ. P-RF 5 6.09 1.218000 1.096200 0.986580 1102 M01AB05 DICLOFENACUM DICLOFENAC 75 mg SOL. INJ. 75mg/3ml TERAPIA SA ROMANIA CUTIE X 5 FIOLE DIN STICLA BRUNA PREVAZUTE CU PUNCT DE RUPERE X 3 ML P-RF 5 6.09 1.218000 1.096200 0.986580 1105 M01AB05 DICLOFENACUM REFEN 75 mg SOL. INJ./PERF. 25mg/ml STADA HEMOFARM S.R.L. ROMANIA CUTIE CU 5 FIOLE DIN STICLA INCOLORA X 3 ML SOL. INJ./PERF. P-RF 5 4.04 0.808000 0.808000 0.727200 1118 M01AB15 KETOROLACUM TROMETHAMIN KETANOV SOL. INJ. 30mg/ml TERAPIA SA ROMANIA CUTIE X 10 FIOLE X 1 ML P-RF 10 24.68 2.468000 1.461600 1.315440 1117 M01AB15 KETOROLACUM TROMETHAMIN KETOROL SOL. INJ. 30mg/ml DR. REDDY'S LABORATORIES ROMANIA CUTIE X 1 BLIST. X 10 FIOLE DIN STICLA BRUNA X 1 ML SOL. INJ. P-RF 10 19.57 1.957000 1.461600 1.315440 1203 N02AX02 TRAMADOLUM MABRON 50 mg CAPS. 50mg MEDOCHEMIE LTD. CIPRU CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 3.84 0.384000 0.344700 0.310230 1208 N02AX02 TRAMADOLUM TRAMADOL ARENA CAPS. 50mg ARENA GROUP S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 8.97 0.448500 0.344700 0.310230 1199 N02AX02 TRAMADOLUM TRALGIT 50 CAPS. 50mg ZENTIVA A.S. SLOVACIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 5.82 0.291000 0.291000 0.261900 1205 N02AX02 TRAMADOLUM TRAMACALM CAPS. 50mg AC HELCOR SRL ROMANIA CUTIE X 1 BLIST. PVC/AL X 10 CAPS. P-RF 10 3.84 0.384000 0.344700 0.310230 1204 N02AX02 TRAMADOLUM K-ALMA (R) CAPS. 50mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 7.66 0.383000 0.344700 0.310230 1206 N02AX02 TRAMADOLUM TRAMADOL LPH 50 mg CAPS. 50mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 7.66 0.383000 0.344700 0.310230 1201 N02AX02 TRAMADOLUM TRAMADOL AL 50 CAPS. 50mg ALIUD PHARMA GMBH & CO.KG GERMANIA CUTIE X 3 BLIST. X 10 CAPS. P-RF 30 11.49 0.383000 0.344700 0.310230 Pagina 1 din 3

1198 N02AX02 TRAMADOLUM TRAMAL (R) CAPS. 50mg GRUNENTHAL GMBH GERMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 11.79 0.589500 0.344700 0.310230 1202 N02AX02 TRAMADOLUM TRAMADOL AL 50 CAPS. 50mg ALIUD PHARMA GMBH & CO.KG GERMANIA CUTIE X 1 BLIST. X 10 CAPS. P-RF 10 3.84 0.384000 0.344700 0.310230 1207 N02AX02 TRAMADOLUM URGENDOL CAPS. 50mg MEDICAROM GROUP SRL ROMANIA CUTIE X 1 BLIST. X 10 CAPS. P-RF 10 3.81 0.381000 0.344700 0.310230 1209 N02AX02 TRAMADOLUM TRAMAL UNO 100 mg CAPS. ELIB. PREL. 100mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 10 17.35 1.735000 0.689402 0.620461 1211 N02AX02 TRAMADOLUM TRAMAL UNO 100 mg CAPS. ELIB. PREL. 100mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 30 CAPS. CU ELIB. PREL. P-RF 30 47.28 1.576000 0.689402 0.620461 1210 N02AX02 TRAMADOLUM TRAMAL UNO 100 mg CAPS. ELIB. PREL. 100mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 20 CAPS. CU ELIB. PREL. P-RF 20 33.41 1.670500 0.689402 0.620461 1212 N02AX02 TRAMADOLUM TRAMAL UNO 100 mg CAPS. ELIB. PREL. 100mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 50 CAPS. CU ELIB. PREL. P-RF/S 50 71.47 1.429400 0.689402 0.620461 1213 N02AX02 TRAMADOLUM TRAMAL UNO 150 mg CAPS. ELIB. PREL. 150mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 10 26.02 2.602000 1.034104 0.930693 1216 N02AX02 TRAMADOLUM TRAMAL UNO 150 mg CAPS. ELIB. PREL. 150mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 50 CAPS. CU ELIB. PREL. P-RF/S 50 107.20 2.144000 1.034104 0.930693 1215 N02AX02 TRAMADOLUM TRAMAL UNO 150 mg CAPS. ELIB. PREL. 150mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 30 CAPS. CU ELIB. PREL. P-RF 30 68.55 2.285000 1.034104 0.930693 1214 N02AX02 TRAMADOLUM TRAMAL UNO 150 mg CAPS. ELIB. PREL. 150mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 20 CAPS. CU ELIB. PREL. P-RF 20 48.48 2.424000 1.034104 0.930693 1217 N02AX02 TRAMADOLUM TRAMAL UNO 200 mg CAPS. ELIB. PREL. 200mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 10 CAPS. CU ELIB. PREL. P-RF 10 32.48 3.248000 1.378804 1.240923 1219 N02AX02 TRAMADOLUM TRAMAL UNO 200 mg CAPS. ELIB. PREL. 200mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 30 CAPS. CU ELIB. PREL. P-RF 30 77.94 2.598000 1.378804 1.240923 1218 N02AX02 TRAMADOLUM TRAMAL UNO 200 mg CAPS. ELIB. PREL. 200mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 20 CAPS. CU ELIB. PREL. P-RF 20 58.30 2.915000 1.378804 1.240923 1220 N02AX02 TRAMADOLUM TRAMAL UNO 200 mg CAPS. ELIB. PREL. 200mg GRUNENTHAL GMBH GERMANIA CUTIE X BLIST. PVC-PVDC/AL X 50 CAPS. CU ELIB. PREL. P-RF/S 50 121.12 2.422400 1.378804 1.240923 1223 N02AX02 TRAMADOLUM TRAMADOL 50 mg COMPR. 50mg OZONE LABORATORIES LTD. MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 7.66 0.383000 0.344700 0.310230 1222 N02AX02 TRAMADOLUM TRAMADOL EEL COMPR. 50mg BIO EEL SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 7.66 0.383000 0.344700 0.310230 1221 N02AX02 TRAMADOLUM TRAMAG 50 COMPR. 50mg MAGISTRA C & C ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 7.66 0.383000 0.344700 0.310230 1224 N02AX02 TRAMADOLUM TRAMADOL 50 mg COMPR. 50mg OZONE LABORATORIES PHARMA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 7.66 0.383000 0.344700 0.310230 1228 N02AX02 TRAMADOLUM TRALGIT SR 100 COMPR. ELIB. PREL. 100mg ZENTIVA AS SLOVACIA CUTIE X 1 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 10 6.29 0.629000 0.629000 0.566100 1229 N02AX02 TRAMADOLUM TRALGIT SR 100 COMPR. ELIB. PREL. 100mg ZENTIVA AS SLOVACIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 30 18.86 0.628666 0.628666 0.565799 1231 N02AX02 TRAMADOLUM NOAX UNO 100 mg COMPR. ELIB. PREL. 100mg CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 3 BLIST. DIN PVC-PVDC/AL X 10 COMPR.ELIM.PREL. P-RF 30 39.43 1.314333 0.689402 0.620461 1230 N02AX02 TRAMADOLUM NOAX UNO 100 mg COMPR. ELIB. PREL. 100mg CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 1 BLIST. DIN PVC-PVDC/AL X 5 COMPR.ELIM.PREL. P-RF 5 7.40 1.480000 0.689402 0.620461 1227 N02AX02 TRAMADOLUM TRALGIT SR 100 COMPR. ELIB. PREL. 100mg ZENTIVA AS SLOVACIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 50 32.48 0.649600 0.649600 0.584640 1233 N02AX02 TRAMADOLUM TRALGIT SR 150 COMPR. ELIB. PREL. 150mg ZENTIVA AS SLOVACIA CUTIE X 1 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 10 21.00 2.100000 1.034104 0.930693 1232 N02AX02 TRAMADOLUM TRALGIT SR 150 COMPR. ELIB. PREL. 150mg ZENTIVA AS SLOVACIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 30 33.48 1.116000 1.034104 0.930693 1234 N02AX02 TRAMADOLUM TRALGIT SR 200 COMPR. ELIB. PREL. 200mg ZENTIVA AS SLOVACIA CUTIE X 1 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 10 27.44 2.744000 1.378804 1.240923 1235 N02AX02 TRAMADOLUM NOAX UNO 200 mg COMPR. ELIB. PREL. 200mg CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 1 BLIST. DIN PVC-PVDC/AL X 10 COMPR.ELIB. PREL. P-RF 10 20.05 2.005000 1.378804 1.240923 1236 N02AX02 TRAMADOLUM NOAX UNO 200 mg COMPR. ELIB. PREL. 200mg CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 3 BLIST. DIN PVC-PVDC/AL X 10 COMPR.ELIB. PREL. P-RF 30 51.71 1.723666 1.378804 1.240923 1237 N02AX02 TRAMADOLUM NOAX UNO 300 mg COMPR. ELIB. PREL. 300mg CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 1 BLIST. X PVC-PVDC/AL X 10 COMPR. ELIB. PREL. P-RF 10 27.86 2.786000 2.068208 1.861387 1238 N02AX02 TRAMADOLUM NOAX UNO 300 mg COMPR. ELIB. PREL. 300mg CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 3 BLIST. X PVC-PE-ACLAR/AL X 10 COMPR. ELIB. PREL. P-RF 30 76.29 2.543000 2.068208 1.861387 1239 N02AX02 TRAMADOLUM TRADOLAN 50 mg COMPR. FILM. 50mg LANNACHER HEILMITTEL GES.M.B.H. AUSTRIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR.FILM. P-RF 30 10.62 0.354000 0.344700 0.310230 1240 N02AX02 TRAMADOLUM TRAMAL RETARD 100 mg COMPR. FILM. ELIB. PREL. 100mg GRUNENTHAL GMBH GERMANIA CUTIE X 1 BLIST. AL/PVDC X 10 COMPR. FILM. CU ELIB. PREL. P-RF 10 9.68 0.968000 0.689402 0.620461 1241 N02AX02 TRAMADOLUM TRAMAL RETARD 150 mg COMPR. FILM. ELIB. PREL. 150mg GRUNENTHAL GMBH GERMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 COMPR.FILM. CU ELIB. PREL. P-RF 10 21.97 2.197000 1.034104 0.930693 1242 N02AX02 TRAMADOLUM TRAMADOL RETARD 150 mg COMPR. FILM. ELIB. PREL. 150mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. ELIB. PREL. P-RF 30 41.47 1.382333 1.034104 0.930693 1243 N02AX02 TRAMADOLUM TRAMAL RETARD 200 mg COMPR. FILM. ELIB. PREL. 200mg GRUNENTHAL GMBH GERMANIA CUTIE X 1 BLIST. PVC-PVDC/AL X 10 COMPR.FILM. ELIB. PREL. P-RF 10 28.12 2.812000 1.378804 1.240923 1244 N02AX02 TRAMADOLUM TRAMADOL RETARD 200 mg COMPR. FILM. ELIB. PREL. 200mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. ELIB. PREL. P-RF 30 53.07 1.769000 1.378804 1.240923 1246 N02AX02 TRAMADOLUM TRALGIT PIC. ORALE, SOL. 100mg/ml ZENTIVA A.S. SLOVACIA CUTIE X 1 FLACON DIN STICLA BRUNA X 10 ML PIC. ORALE, SOL. P-RF 1 12.57 12.570000 6.894026 6.204624 1245 N02AX02 TRAMADOLUM TRALGIT PIC. ORALE, SOL. 100mg/ml ZENTIVA A.S. SLOVACIA CUTIE X 1 FLACON DIN STICLA BRUNA X 96 ML PIC. ORALE, SOL. P-RF 1 100.21 100.210000 66.182664 59.564398 1248 N02AX02 TRAMADOLUM TRAMAL (R) PICATURI ORALE-SOL. 100mg/ml GRUNENTHAL GMBH GERMANIA CUTIE X 1 FLACON PICURATOR X 10 ML P-RF 1 7.73 7.730000 6.894026 6.204624 1252 N02AX02 TRAMADOLUM TRAMADOL SOL. INJ. 50mg/ml KRKA D.D. SLOVENIA CUTIE X 5 FIOLE X 1 ML S/P-RF 5 4.92 0.984000 0.831149 0.748034 1346 N05BA08 BROMAZEPAMUM* BROMAZEPAM SLAVIA 3 mg COMPR. 3mg SLAVIA PHARM SRL ROMANIA CUTIE X 1 BLIST. AL/PVC X 10 COMPR. P-RF 10 2.19 0.219000 0.079672 0.071705 1387 N06AB03 FLUOXETINUM* MAGRILAN 20 mg CAPS. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 CAPS. P-RF 30 17.60 0.586666 0.564401 0.507961 1388 N06AB03 FLUOXETINUM* ROFLUXIN 20 mg CAPS. 20mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 15.07 0.753500 0.564401 0.507961 1384 N06AB03 FLUOXETINUM* FLUOXIN 20 mg CAPS. 20mg VIM SPECTRUM SRL ROMANIA CUTIE X 2 BLIST. PVC/AL X 7 CAPS. P-RF 14 11.25 0.803571 0.564401 0.507961 1385 N06AB03 FLUOXETINUM* FLUOXIN 20 mg CAPS. 20mg VIM SPECTRUM SRL ROMANIA CUTIE X 4 BLIST. PVC/AL X 7 CAPS. P-RF 28 22.00 0.785714 0.564401 0.507961 1389 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 36.73 1.311785 0.564401 0.507961 1394 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 39.46 1.315333 0.564401 0.507961 1396 N06AB04 CITALOPRAMUM** CITALORAN 40 mg COMPR. FILM. 40mg RANBAXY UK LIMITED MAREA BRITANIE CUTIE X 2 BLIST. PVDC-PVC/AL X 14 COMPR. FILM. P-RF 28 33.50 1.196428 1.128802 1.015922 1398 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 33.50 1.196428 1.128802 1.015922 1399 N06AB05 PAROXETINUM* ARKETIS COMPR. 20mg MEDOCHEMIE LTD. CIPRU CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-RF 30 22.99 0.766333 0.564401 0.507961 1400 N06AB05 PAROXETINUM* SEROXAT 20 mg COMPR. FILM. 20mg SMITHKLINE BEECHAM PLC MAREA BRITANIE CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 34.22 1.140666 0.564401 0.507961 1404 N06AB05 PAROXETINUM* REXETIN COMPR. FILM. 20mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 46.06 1.535333 0.564401 0.507961 1403 N06AB05 PAROXETINUM* PAROXETIN TEVA 20 mg COMPR. FILM. 20mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. TRANSPARENTE DIN PVC-PVDC/AL X 30 COMPR. FILM. P-RF 30 22.99 0.766333 0.564401 0.507961 1402 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 22.99 0.766333 0.564401 0.507961 1401 N06AB05 PAROXETINUM* PALUXETIL 20 mg COMPR. FILM. 20mg HEXAL AG GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 22.99 0.766333 0.564401 0.507961 1405 N06AB05 PAROXETINUM* PALUXETIL 40 mg COMPR. FILM. 40mg HEXAL AG GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 61.55 2.051666 1.128802 1.015922 1406 N06AB06 SERTRALINUM* ZOLOFT 100 mg COMPR. FILM. 100mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-RF 28 68.35 2.441071 1.128802 1.015922 1407 N06AB06 SERTRALINUM* SERLIFT 100 mg COMPR. FILM. 100mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 14 COMPR. FILM. P-RF 28 35.19 1.256785 1.128802 1.015922 1414 N06AB06 SERTRALINUM* SERTRALINA BIOGALENICA 100 mg COMPR. FILM. 100mg LABORATOARELE PROF.DR.MORAIT S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-RF 28 35.19 1.256785 1.128802 1.015922 1416 N06AB06 SERTRALINUM* SERTRALIN 100 mg COMPR. FILM. 100mg LABORMED PHARMA S.A. ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-RF 28 43.24 1.544285 1.128802 1.015922 1415 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 35.19 1.256785 1.128802 1.015922 1413 N06AB06 SERTRALINUM* ASERTIN 100 mg COMPR. FILM. 100mg BMF PHARM S.R.L. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 37.55 1.251666 1.128802 1.015922 1412 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 34.00 1.214285 1.128802 1.015922 1411 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 37.55 1.251666 1.128802 1.015922 1410 N06AB06 SERTRALINUM* SERTRALIN SANDOZ 100 mg COMPR. FILM. 100mg HEXAL AG GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 37.71 1.257000 1.128802 1.015922 1408 N06AB06 SERTRALINUM* ASENTRA (R) COMPR. FILM. 100mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. X 7 COMPR. FILM. P-RF 28 40.75 1.455357 1.128802 1.015922 1409 N06AB06 SERTRALINUM* STIMULOTON (R) 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 35.19 1.256785 1.128802 1.015922 1417 N06AB06 SERTRALINUM* ZOLOFT 50 mg COMPR. FILM. 50mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-RF 28 36.89 1.317500 0.564401 0.507961 1427 N06AB06 SERTRALINUM* SERTRALIN 50 mg COMPR. FILM. 50mg LABORMED PHARMA S.A. ROMANIA CUTIE X 2 BLIST. PVC-PVDC/AL X 14 COMPR. FILM. P-RF 28 23.11 0.825357 0.564401 0.507961 1426 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 19.49 0.696071 0.564401 0.507961 1425 N06AB06 SERTRALINUM* SERTRALINA BIOGALENICA 50 mgcompr. FILM. 50mg LABORATOARELE PROF.DR.MORAIT S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-RF 28 19.49 0.696071 0.564401 0.507961 1424 N06AB06 SERTRALINUM* ASERTIN 50 mg COMPR. FILM. 50mg BMF PHARM S.R.L. ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 21.12 0.704000 0.564401 0.507961 1423 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 18.69 0.667500 0.564401 0.507961 Pagina 2 din 3

1418 N06AB06 SERTRALINUM* SERLIFT 50 mg COMPR. FILM. 50mg TERAPIA SA ROMANIA CUTIE X 2 BLIST. X 14 COMPR. FILM. P-RF 28 19.49 0.696071 0.564401 0.507961 1422 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 20.88 0.696000 0.564401 0.507961 1421 N06AB06 SERTRALINUM* SERTRALIN SANDOZ 50 mg COMPR. FILM. 50mg HEXAL AG GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 20.77 0.692333 0.564401 0.507961 1420 N06AB06 SERTRALINUM* STIMULOTON (R) 50 mg COMPR. FILM. 50mg EGIS PHARMACEUTICALS P.L.C. MAREA BRITANIE CUTIE X 3 BLIST. X 10 COMPR. FILM. P-RF 30 20.89 0.696333 0.564401 0.507961 1419 N06AB06 SERTRALINUM* ASENTRA (R) COMPR. FILM. 50mg KRKA D.D. SLOVENIA CUTIE X 4 BLIST. X 7 COMPR. FILM. P-RF 28 22.82 0.815000 0.564401 0.507961 1428 N06AB06 SERTRALINUM* ZOLOFT (R) CONC. PT. SOL. ORALA 20mg/ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 1 FLAC. DIN STICLA BRUNA X 60 ML CONC. PT. SOL. ORALA+ 1 PIPETA P-RF 1 65.47 65.470000 13.545635 12.191071 1429 N06AB08 FLUVOXAMINUM* FEVARIN (R) 100 COMPR. FILM. 100mg SOLVAY PHARMACEUTICALS BV OLANDA CUTIE X 2 BLIST. PVC/PVDC X 15 COMPR. FILM. P-RF 30 48.73 1.624333 0.564401 0.507961 1430 N06AB08 FLUVOXAMINUM* FLUVOXAMINE TEVA 100 mg COMPR. FILM. 100mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 32.73 1.091000 0.564401 0.507961 1431 N06AB08 FLUVOXAMINUM* FEVARIN (R) 50 COMPR. FILM. 50mg SOLVAY PHARMACEUTICALS BV OLANDA CUTIE X 2 BLIST. PVC/PVDC X 15 COMPR. FILM. P-RF 30 25.15 0.838333 0.282200 0.253980 1432 N06AB08 FLUVOXAMINUM* FLUVOXAMINE TEVA 50 mg COMPR. FILM. 50mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. P-RF 30 16.33 0.544333 0.282200 0.253980 Pagina 3 din 3

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 01 SEPTEMBRIE 2010 ANEXA2 Nr cod ATC DCI denumire comerciala crt. forma farmaceutica concentratie firma detinatoare APP tara detinatoa re APP ambalaj presc riptie cant. Ut/amb alaj maximal/a mbalaj (RON) maximal/u T (RON) suportata de (RON)Legea nr. 95/2006 art 213 alin.1 lit. a) si f) suportata (RON) pt. Adulti 817 B01AC04 CLOPIDOGRELUM** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. CEHIA CUTIE X 1 FLAC. DIN STICLA INCOLORA X 90 COMPR. FILM. P-RF 90 241.83 2.687000 2.687000 1.343500 818 C10AA07 ROSUVASTATINUM ROXARDIO 10 mg COMPR. FILM. 10mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 69.33 2.476071 1.444500 0.722250 819 C10AA07 ROSUVASTATINUM ROXARDIO 20 mg COMPR. FILM. 20mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 102.15 3.648214 2.889000 1.444500 820 C10AA07 ROSUVASTATINUM ROSTAT 40 mg COMPR. FILM. 40mg GEDEON RICHTER PLC. UNGARIA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 109.45 3.648333 3.648333 1.824166 821 C10AA07 ROSUVASTATINUM ROXARDIO 5 mg COMPR. FILM. 5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 62.39 2.228214 0.722250 0.361125 130 B01AX05 FONDAPARINUX SODIUM**# ARIXTRA 10mg/0,8ml 132 B01AX05 FONDAPARINUX SODIUM**# ARIXTRA 5mg/0,4ml SOL. INJ. IN SERINGA PREUMPLUTA 10mg/0,8ml GLAXO GROUP LTD. SOL. INJ. IN SERINGA PREUMPLUTA 5mg/0,4ml GLAXO GROUP LTD. MAREA BRITANIE MAREA BRITANIE CUTIE X 10 SERINGI PREUMPLUTE X 0,8 ML SOL. INJ., PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA, DE CU P-RF 10 651.90 65.190000 65.190000 32.595000 CUTIE X 10 SERINGI PREUMPLUTE X 0,4 ML SOL. INJ., PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA, DE CU P-RF 10 458.30 45.830000 36.669375 18.334687 299 C10AA07 ROSUVASTATINUM ROSUVASTATINA SANDOZ 10 mg COMPR. FILM. 10mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 69.33 2.476071 1.444500 0.722250 303 C10AA07 ROSUVASTATINUM ROSUVASTATINA SANDOZ 20 mg COMPR. FILM. 20mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 102.15 3.648214 2.889000 1.444500 308 C10AA07 ROSUVASTATINUM ROSUVASTATINA SANDOZ 5 mg COMPR. FILM. 5mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. OPA-AL-PVC/AL X 28 COMPR. FILM. P-6L 28 62.39 2.228214 0.722250 0.361125 683 N06AB10 ESCITALOPRAMUM** CIPRALEX 5 mg COMPR. FILM. 5mg H. LUNDBECK A/S DANEMARCA CUTIE X 2 BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 14 COMPR. FILM. P-RF 28 49.56 1.770000 0.564977 0.282488 33 A02BC02 PANTOPRAZOLUM CONTROLOC 40mg LIOFILIZAT PENTRU SOLUTIE INJECTABILA LIOF. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 1 FLAC. LIOF. PT. SOL. INJ. S/P-RF 1 33.53 33.530000 19.293000 9.646500 34 A02BC02 PANTOPRAZOLUM PANTOPRAZOL NYCOMED I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. S/P-RF 1 21.79 21.790000 19.293000 9.646500 37 A02BC02 PANTOPRAZOLUM DYSPEX I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. S/P-RF 1 21.45 21.450000 19.293000 9.646500 38 A02BC02 PANTOPRAZOLUM DYSPEX I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 5 (5 X 1) FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. S/P-RF 5 98.60 19.720000 19.293000 9.646500 40 A02BC02 PANTOPRAZOLUM PANTOSAL I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 1 FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. S/P-RF 1 21.62 21.620000 19.293000 9.646500 42 A02BC02 PANTOPRAZOLUM PANTOSAL I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 20 ( 20 X 1) FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ., AMBALAJ SPITALICESC S/P-RF 20 374.71 18.735500 18.735500 9.367750 41 A02BC02 PANTOPRAZOLUM PANTOSAL I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 5 (5 X 1) FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ. S/P-RF 5 99.37 19.874000 19.293000 9.646500 39 A02BC02 PANTOPRAZOLUM DYSPEX I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 20 ( 20 X 1) FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ., AMBALAJ SPITALICESC S/P-RF 20 372.10 18.605000 18.605000 9.302500 35 A02BC02 PANTOPRAZOLUM PANTOPRAZOL NYCOMED I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 5 ( 5 X 1) FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ., AMBALAJ SPITALICESC S/P-RF 5 100.15 20.030000 19.293000 9.646500 36 A02BC02 PANTOPRAZOLUM PANTOPRAZOL NYCOMED I.V. 40 mg PULB. PT. SOL. INJ. 40mg NYCOMED GMBH GERMANIA CUTIE X 20 ( 20 X 1) FLAC. DIN STICLA INCOLORA CU PULB. PT. SOL. INJ., AMBALAJ SPITALICESC S/P-RF 20 377.32 18.866000 18.866000 9.433000 53 A02BC05 ESOMEPRAZOLUM NEXIUM 40 mg PULB. PT. SOL. INJ./PERF. 40mg ASTRAZENECA AB SUEDIA CUTIE X 10 FLACOANE LIOF. PT. SOL. INJ./PERF. S/P-RF 10 296.78 29.678000 25.723993 12.861996 55 A02BX02 SUCRALFATUM VENTER COMPR. 1g KRKA D.D. SLOVENIA CUTIE X 5 BLIST. X 10 COMPR. P-6L 50 15.92 0.318400 0.313700 0.156850 54 A02BX02 SUCRALFATUM GASTROFAIT COMPR. 1g E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 5 BLIST. AL/PVC X 4 COMPR. P-6L 20 6.18 0.309000 0.309000 0.154500 56 A02BX05 BISMUTHI SUBCITRAS DE - NOL COMPR. FILM. 120mg ASTELLAS PHARMA EUROPE BV OLANDA CUTIE X 5 BLIST. AL/AL X 8 COMPR. FILM. P-6L 40 39.86 0.996500 0.313700 0.156850 78 B01AB04 DALTEPARINUM**# FRAGMIN 10000 UI/0,4 ml SOL. INJ. 10000UI/0,4ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 5 BLIST. X 1 SERINGA X 0,4 ML SOL. INJ. S/P-RF 5 125.68 25.136000 25.136000 12.568000 79 B01AB04 DALTEPARINUM**# FRAGMIN 10000 UI/ml SOL. INJ. 10000ui/ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 SUPORTURI TERMOFORMATATE X 5 FIOLE X 1 ML S/P-RF 10 266.21 26.621000 26.621000 13.310500 80 B01AB04 DALTEPARINUM**# FRAGMIN 12500 UI/0,5 ml SOL. INJ. 12500 UI/0,5ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 5 BLIST. X 1 SERINGA X 0,5 ML SOL. INJ. S/P-RF 5 170.47 34.094000 33.753333 16.876666 81 B01AB04 DALTEPARINUM**# FRAGMIN15000 UI/0,6 ml SOL. INJ. 15000ui/0,6ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 5 BLIST. INDIVIDUALE CONTINAND FIECARE 1 SERINGA PREUMPLUTA X 0,6 ML SOL. INJ. S/P-RF 5 206.39 41.278000 40.504000 20.252000 82 B01AB04 DALTEPARINUM**# FRAGMIN 18000 UI/0,72 ml SOL. INJ. 18000 UI/0,72ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 5 BLIST. X 1 SERINGA X 0,72 ML SOL. INJ. S/P-RF 5 234.71 46.942000 46.942000 23.471000 83 B01AB04 DALTEPARINUM**# FRAGMIN 2500 UI/0,2 ml SOL. INJ. 2500ui/0,2ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 10 BLIST. INDIVIDUALE CONTINAND FIECARE 1 SERINGA PREUMPLUTA X 0,2 ML S/P-RF 10 77.41 7.741000 6.750666 3.375333 84 B01AB04 DALTEPARINUM**# FRAGMIN 5000 UI/0,2 ml SOL. INJ. 5000ui/0,2ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 10 BLIST. INDIVIDUALE CONTINAND FIECARE 1 SERINGA PREUMPLUTA X 0,2 ML S/P-RF 10 141.82 14.182000 13.501333 6.750666 85 B01AB04 DALTEPARINUM**# FRAGMIN 7500 UI/0,3 ml SOL. INJ. 7500ui/0,3ml PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 10 BLIST. INDIVIDUALE CONTINAND FIECARE 1 SERINGA PREUMPLUTA X 0,3 ML S/P-RF 10 202.52 20.252000 20.252000 10.126000 Pagina 1 din 2

86 B01AB05 ENOXAPARINUM**# CLEXANE 2000ui anti-xa/0,2ml SOL. INJ. 2000ui anti-xa/0,2ml LAB. AVENTIS FRANTA CUTIE X 10 SERINGI PREUMPLUTE X 0,2 ML SOL. INJ. S/P-RF 10 72.76 7.276000 6.750666 3.375333 87 B01AB05 ENOXAPARINUM**# CLEXANE 4000ui anti-xa/0,4ml SOL. INJ. 4000ui anti-xa/0,4ml LAB. AVENTIS FRANTA CUTIE X 10 SERINGI PREUMPLUTE X 0.4 ML SOL. INJ. S/P-RF 10 144.23 14.423000 13.501333 6.750666 88 B01AB05 ENOXAPARINUM**# CLEXANE 6000ui anti-xa/0,6ml SOL. INJ. 6000ui anti-xa/0,6ml LAB. AVENTIS FRANTA CUTIE X 10 SERINGI PREUMPLUTE X 0,6 ML SOL. INJ. S/P-RF 10 187.44 18.744000 18.744000 9.372000 89 B01AB05 ENOXAPARINUM**# CLEXANE 8000ui anti-xa/0,8ml SOL. INJ. 8000ui anti-xa/0,8ml LAB. AVENTIS FRANTA CUTIE X 2 SERINGI PREUMPLUTE X 0,8 ML SOL. INJ. S/P-RF 2 52.07 26.035000 26.035000 13.017500 CUTIE X 10 SERINGI PREUMPLUTE DIN STICLA, PREVAZUTE CU 90 B01AB06 NADROPARINUM**# FRAXIPARINE (R) 2850 UI anti-factor Xa/0,3 ml SOL. INJ. 2850 ui AFXa/0,3ml GLAXO GROUP LTD. MAREA BRITANIE DISPOZITIV DE PROTECTIE A ACULUI X 0,3 ML S/P-RF 10 75.24 7.524000 6.750666 3.375333 91 B01AB06 NADROPARINUM**# FRAXIPARINE (R) 3800 UI anti-factor Xa/0,4 ml SOL. INJ. 3800 ui AFXa/0,4ml GLAXO GROUP LTD. CUTIE X 10 SERINGI PREUMPLUTE DIN STICLA, PREVAZUTE CU MAREA BRITANIE DISPOZITIV DE PROTECTIE A ACULUI X 0,4 ML S/P-RF 10 103.22 10.322000 9.000886 4.500443 92 B01AB06 NADROPARINUM**# FRAXIPARINE (R) 5700 UI anti-factor Xa/0,6 ml SOL. INJ. 5700 ui AFXa/0,6ml GLAXO GROUP LTD. CUTIE X 10 SERINGI PREUMPLUTE DIN STICLA, PREVAZUTE CU MAREA BRITANIE DISPOZITIV DE PROTECTIE A ACULUI X 0,6 ML S/P-RF 10 132.15 13.215000 13.215000 6.607500 93 B01AB06 NADROPARINUM**# FRAXIPARINE (R) 7600 UI anti-factor Xa/0,8 ml SOL. INJ. 7600 ui AXa/0,8ml GLAXO GROUP LTD. CUTIE X 10 SERINGI PREUMPLUTE DIN STICLA, PREVAZUTE CU MAREA BRITANIE DISPOZITIV DE PROTECTIE A ACULUI X 0,8 ML S/P-RF 10 189.31 18.931000 18.001773 9.000886 94 B01AB08 REVIPARINUM**# CLIVARIN (R) 1432UI/0,25 ml SOL. INJ. 1432ui/0,25ml ABBOTT GMBH&CO.KG GERMANIA CUTIE X 2 BLIST. X 5 SERINGI PREUMPLUTE UNIDOZA X 0,25ML S/P-RF 10 84.26 8.426000 6.760104 3.380052 95 B01AB08 REVIPARINUM**# CLIVARIN (R) 3436 UI/0,6 ml SOL. INJ. 3436ui/0,6ml ABBOTT GMBH&CO.KG GERMANIA CUTIE X 1 BLIST X 5 SERINGI PREUMPLUTE UNIDOZA X 0,60 ML S/P-RF 5 101.17 20.234000 16.220488 8.110244 97 B01AB10 TINZAPARINUM**# INNOHEP SOL. INJ. 10000u ANTIF. Xa/ml LEO PHARMACEUTICAL PRODUCTS DANEMARCA CUTIE X 10 FLAC. DIN STICLA INCOLORA X 2 ML SOL. INJ. (10000 U-AXA) S/P-RF 10 534.94 53.494000 38.575233 19.287616 96 B01AB10 TINZAPARINUM**# INNOHEP SOL. INJ. 10000u ANTIF. Xa/ml LEO PHARMACEUTICAL PRODUCTS DANEMARCA CUTIE X 2 SERINGI PREUMPLUTE X 0.45 ML SOL. INJ. (4500 U-AXA) S/P-RF 2 35.03 17.515000 8.679426 4.339713 98 B01AB10 TINZAPARINUM**# INNOHEP SOL. INJ. 10000u ANTIF. Xa/ml LEO PHARMACEUTICAL PRODUCTS DANEMARCA CUTIE X 2 SERINGI PREUMPLUTE X 0.35 ML SOL. INJ. (3500 U-AXA) S/P-RF 2 26.07 13.035000 6.750666 3.375333 101 B01AB10 TINZAPARINUM**# INNOHEP SOL. INJ. 20000u ANTIF. Xa/ml LEO PHARMACEUTICAL PRODUCTS DANEMARCA CUTIE X 10 FLAC. DIN STICLA INCOLORA X 2ML SOL. INJ. (20000 U-AXA) S/P-RF 10 1,110.78 111.078000 77.150473 38.575236 99 B01AB10 TINZAPARINUM**# INNOHEP SOL. INJ. 20000u ANTIF. Xa/ml LEO PHARMACEUTICAL PRODUCTS DANEMARCA CUTIE X 2 SERINGI PREUMPLUTE X 0,50 ML SOL. IN. (10000 U-AXA) S/P-RF 2 73.48 36.740000 19.287613 9.643806 100 B01AB10 TINZAPARINUM**# INNOHEP SOL. INJ. 20000u ANTIF. Xa/ml LEO PHARMACEUTICAL PRODUCTS DANEMARCA CUTIE X 2 SERINGI PREUMPLUTE X 0,70 ML SOL. IN. (14000 U-AXA) S/P-RF 2 102.92 51.460000 27.002666 13.501333 102 B01AB10 TINZAPARINUM**# INNOHEP SOL. INJ. 20000u ANTIF. Xa/ml LEO PHARMACEUTICAL PRODUCTS DANEMARCA CUTIE X 2 SERINGI PREUMPLUTE X 0,90 ML SOL. IN. (18000 U-AXA) S/P-RF 2 126.78 63.390000 34.717713 17.358856 105 B01AC04 CLOPIDOGRELUM** PLAVIX 300mg COMPR. FILM. 300mg SANOFI PHARMA - BRISTOL MYERS SQUIBB FRANTA CUTIE X 30X1 COMPR. FILM. (BLIST. AL/AL PERFORATE UNIDOZA) P-RF 30 779.14 25.971333 19.119085 9.559542 110 B01AC04 CLOPIDOGRELUM** EGITROMB 75 mg COMPR. FILM. 75mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. OPA-AL-PVDC/AL X 28 COMPR. FILM. P-RF 28 79.33 2.833214 2.833214 1.416607 131 B01AX05 FONDAPARINUX SODIUM**# ARIXTRA 2,5mg/0,5ml SOL. INJ. IN SERINGA PREUMPLUTA 2,5mg/0,5ml GLAXO GROUP LTD. SOL. INJ. IN SERINGA PREUMPLUTA 7,5mg/0,6ml GLAXO GROUP LTD. MAREA BRITANIE MAREA BRITANIE CUTIE X 10 SERINGI PREUMPLUTE X 0,5 ML SOL. INJ., PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA, DE CU P-RF 10 233.24 23.324000 22.128500 11.064250 CUTIE X 10 SERINGI PREUMPLUTE X 0,6 ML SOL. INJ., PREVAZUTE CU UN SISTEM AUTOMAT DE SIGURANTA, DE CU P-RF 10 651.90 65.190000 65.190000 32.595000 133 B01AX05 FONDAPARINUX SODIUM**# ARIXTRA 7,5mg/0,6ml 154 C04AE02 NICERGOLINUM NICERIUM (R) 15 CAPS. ELIB. MODIF. 15mg HEXAL AG GERMANIA CUTIE X 3 BLIST. PP/AL X 10 CAPS. ELIB. MODIF. P-6L 30 27.83 0.927666 0.574312 0.287156 155 C04AE02 NICERGOLINUM NICERIUM (R) 30 UNO CAPS. ELIB. MODIF. 30mg HEXAL AG GERMANIA CUTIE X 3 BLIST. PP/AL X 10 CAPS. ELIB. MODIF. P-6L 30 51.26 1.708666 1.148624 0.574312 156 C04AE02 NICERGOLINUM NICERGOLINA LPH 10 mg COMPR. FILM. 10mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 13.42 0.447333 0.382874 0.191437 157 C04AE02 NICERGOLINUM GRALIN 10 mg COMPR. FILM. 10mg LABORMED PHARMA S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. FILM. P-6L 30 13.42 0.447333 0.382874 0.191437 158 C04AE02 NICERGOLINUM SERMION COMPR. FILM. 30mg PFIZER EUROPE MA EEIG MAREA BRITANIE CUTIE X 2 BLIST. PVC-PVDC/AL-PVC X 15 COMPR. FILM P-6L 30 48.19 1.606333 1.148624 0.574312 159 C04AE02 NICERGOLINUM NICERGOLINA LPH 30 mg COMPR. FILM. 30mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 32.37 1.079000 1.079000 0.539500 160 C04AE02 NICERGOLINUM GRALIN 30 mg COMPR. FILM. 30mg LABORMED PHARMA S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. FILM. P-6L 30 32.37 1.079000 1.079000 0.539500 161 C04AE02 NICERGOLINUM NICERGOLINA LPH 5 mg COMPR. FILM. 5mg LABORMED PHARMA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 15 COMPR. FILM. P-6L 30 6.75 0.225000 0.191437 0.095718 162 C04AE02 NICERGOLINUM GRALIN 5 mg COMPR. FILM. 5mg LABORMED PHARMA S.A. ROMANIA CUTIE X 2 BLIST. PVC/AL X 15 COMPR. FILM. P-6L 30 6.75 0.225000 0.191437 0.095718 163 C04AE02 NICERGOLINUM NICERIUM (R) 10 DRAJ. 10mg HEXAL AG GERMANIA CUTIE X 1 BLIST. AL/PVC X 25 DRAJ. P-6L 25 14.08 0.563200 0.382874 0.191437 164 C04AE02 NICERGOLINUM SINERGOLIN 10 DRAJ. 10mg SINTOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 DRAJ. P-6L 20 9.06 0.453000 0.382874 0.191437 166 C04AE02 NICERGOLINUM SINERGOLIN 30 DRAJ. 30mg SINTOFARM SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 DRAJ. P-6L 20 21.54 1.077000 1.077000 0.538500 165 C04AE02 NICERGOLINUM SINERGOLIN 30 DRAJ. 30mg SINTOFARM SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 DRAJ. P-6L 30 32.31 1.077000 1.077000 0.538500 167 C04AX07 VINCAMINUM OXYBRAL SR 30 mg CAPS. ELIB. PREL. 30mg GLAXOSMITHKLINE (GSK) SRL ROMANIA CUTIE X 1 BLIST. AL/PVC-PVDC X 10 CAPS. CU ELIB. PREL. P-6L 10 9.24 0.924000 0.596835 0.298417 169 C04AX07 VINCAMINUM VINCAMINA DRAJ. 10mg BIOFARM SA ROMANIA CUTIE X 1 BLIST. AL/PVC X 20 DRAJ. P-6L 20 6.09 0.304500 0.198945 0.099472 194 C07AB12 NEBIVOLOLUM NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC- PE- PVDC/AL X 10 COMPR. P-6L 30 26.81 0.893666 0.852749 0.426374 298 C10AA07 ROSUVASTATINUM ROSUCARD 10 mg COMPR. FILM. 10mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 63.27 2.109000 1.444500 0.722250 302 C10AA07 ROSUVASTATINUM ROSUCARD 20 mg COMPR. FILM. 20mg ZENTIVA K.S. REPUBLICA CEHA CUTIE CU BLIST. OPA-AL-PVC/AL X 30 COMPR. FILM. P-6L 30 99.34 3.311333 2.889000 1.444500 398 G03FA14 COMBINATII** FEMOSTON (R) conti 1/5 COMPR. FILM. SOLVAY PHARMACEUTICALS BV OLANDA CUTIE X 1 BLIST. X 28 COMPR. FILM. P-RF 28 31.57 1.127500 1.127500 0.563750 399 G03FA15 ESTRADIOLUMVALERAT+DIENOGEST** KLIMODIEN DRAJ. BAYER SCHERING PHARMA AG GERMANIA CUTIE X 1 BLIST. X 28 DRAJ. P-RF 28 34.12 1.218571 1.173035 0.586517 400 G03FA17 COMBINATII** ANGELIQ COMPR. FILM. BAYER SCHERING PHARMA AG GERMANIA CUTIE X 1 BLIST. CALENDARISTIC PVC/AL X 28 COMPR. FILM. P-RF 28 68.22 2.436428 1.173035 0.586517 446 G04CB01 FINASTERIDUM* PROSCAR 5 mg COMPR. FILM. 5mg MERCK SHARP & DOHME ROMANIA CUTIE X 1 BLIST. PVC/PE/PVD-AL X 14 COMPR.FILM. P-6L 14 33.19 2.370714 1.171791 0.585895 452 G04CB01 FINASTERIDUM* FINANORM 5 mg COMPR. FILM. 5mg ICN POLFA RZESZOW S.A. POLONIA CUTIE CU BLIST. PVC-PVDC/AL X 100 COMPR. FILM. P-6L/S 100 111.35 1.113500 1.113500 0.556750 450 G04CB01 FINASTERIDUM* FINASTERIDE TEVA 5mg COMPR. FILM. 5mg TEVA PHARMACEUTICAL S.R.L. ROMANIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P-6L 30 35.09 1.169666 1.169666 0.584833 449 G04CB01 FINASTERIDUM* FINASTERIDA BIOGALENICA 5 mg COMPR. FILM. 5mg LABORATOARELE PROF.DR.MORAIT S.R.L. ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. FILM. P-6L 28 32.83 1.172500 1.171791 0.585895 447 G04CB01 FINASTERIDUM* PROSCAR 5 mg COMPR. FILM. 5mg MERCK SHARP & DOHME ROMANIA CUTIE X 2 BLIST. PVC/PE/PVD-AL X 14 COMPR.FILM. P-6L 28 64.21 2.293214 1.171791 0.585895 451 G04CB01 FINASTERIDUM* FINANORM 5 mg COMPR. FILM. 5mg ICN POLFA RZESZOW S.A. POLONIA CUTIE CU BLIST. PVC-PVDC/AL X 30 COMPR. FILM. P-6L 30 35.18 1.172666 1.171791 0.585895 448 G04CB01 FINASTERIDUM* TAREDOX 5 mg COMPR. FILM. 5mg DR. REDDY'S LABORATORIES ROMANIA CUTIE X 2 BLIST. AL/AL X 14 COMPR. FILM. P-6L 28 32.83 1.172500 1.171791 0.585895 453 G04CB02 DUTASTERIDUM* AVODART 0,5 mg CAPS. MOI 0,5mg GLAXOSMITHKLINE (GSK) SRL ROMANIA CUTIE X 3 BLIST.PVC-PVDC/AL X 10 CAPS. MOI P-6L 30 95.39 3.179666 1.171791 0.585895 483 J01DD14 CEFTIBUTENUM CEDAX CAPS. 400mg SCHERING PLOUGH EUROPE BELGIA CUTIE X 5 BLIST. X 1 CAPS. P-RF 5 70.33 14.066000 14.066000 7.033000 681 N06AB10 ESCITALOPRAMUM** CIPRALEX 10 mg COMPR. FILM. 10mg H. LUNDBECK A/S DANEMARCA CUTIE X 1 BLIST. ALB PVC-PE-PVDC/AL X 14 COMPR. FILM. P-RF 14 61.81 4.415000 1.128802 0.564401 682 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 90.16 3.220000 1.128802 0.564401 794 S01AA11 GENTAMICINUM GENTAMICIN SULPHATE PIC. OFT., SOL 0,3% E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLACON X 10ML P-RF 1 4.70 4.700000 4.700000 2.350000 795 S01AA12 TOBRAMYCINUM TOBROM 3 mg/ml PIC. OFT., SOL 3mg/ml ROMPHARM COMPANY SRL ROMANIA CUTIE C 1 FLAC. PEJD X 5 ML PIC. OFT. SOL P-RF 1 4.07 4.070000 4.070000 2.035000 796 S01AA12 TOBRAMYCINUM TOBISOL PIC. OFT., SOL. 0,3% E.I.P.I.CO. MED S.R.L. ROMANIA CUTIE X 1 FLACON X 5 ML PIC. OFT., SOL. P-RF 1 4.08 4.080000 4.072500 2.036250 797 S01AA12 TOBRAMYCINUM TOBREX PIC. OFT.,SOL. 3mg/ml ALCON COUVREUR NV BELGIA CUTIE X 1 FLACON DIN PEJD CU PICURATOR X 5 ML PIC. OFTALMICE, SOL. P-RF 1 11.28 11.280000 4.072500 2.036250 798 S01AA12 TOBRAMYCINUM TOBREX 2 X PICATURI OFT.-SOL. 0,3% ALCON COUVREUR NV BELGIA CUTIE X 1 FLAC. PEID CU PICURATOR DIN PEID X 5 ML P-RF 1 20.75 20.750000 4.072500 2.036250 799 S01AA12 TOBRAMYCINUM TOBREX (R) UNG. OFT. 0,3% ALCON COUVREUR NV BELGIA CUTIE X 1 TUB DIN AL X 3,5 G UNGUENT OFTALMIC P-RF 1 8.61 8.610000 3.054375 1.527187 Pagina 2 din 2

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 01 SEPTEMBRIE 2010 Nr cod ATC DCI denumire comerciala crt. forma farmaceutica concentratie firma detinatoare APP tara detinatoar e APP ambalaj prescri ptie cant. Ut/a mbal aj amanu ntul maxima l/ambal aj (RON) maximal/u T (RON) suportata de (RON)Lege a nr. 95/2006 art 213 alin.1 lit. a) si f) suportata (RON) pt. Adulti 1.INSUFICIENTA CARDIACA CRONICA(CLASA III SAU IV NYHA) - G 1 77 C07AB12 NEBIVOLOLUM** NOLET 5 mg COMPR. 5mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC- PE- PVDC/AL X 10 COMPR. P-6L 30 26.81 0.893666 0.492500 0.492500 175 C09AA03 LISINOPRILUM RANOLIP COMPR. 10mg RANBAXY U.K. LIMITED MAREA BRITANIE CUTIE X 3 BLIST. X 10 COMPR. P-6L 30 14.95 0.498333 0.313000 0.313000 176 C09AA03 LISINOPRILUM LISIREN 10 mg COMPR. 10mg AC HELCOR SRL ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 10.72 0.536000 0.313000 0.313000 LISINOPRIL SANDOZ 10 177 C09AA03 LISINOPRILUM mg COMPR. 10mg HEXAL AG GERMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 10.28 0.342666 0.313000 0.313000 179 C09AA03 LISINOPRILUM LISINOPRIL 10 MEDO COMPR. 10mg MEDOCHEMIE ROMANIA SRL ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 14.41 0.480333 0.313000 0.313000 182 C09AA03 LISINOPRILUM LISINOPRIL ATB 10 MG COMPR. 10mg ANTIBIOTICE SA ROMANIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. P-6L 30 9.71 0.323666 0.313000 0.313000 183 C09AA03 LISINOPRILUM TONOLYSIN 10 mg COMPR. 10mg GEDEON RICHTER ROMANIA SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 14 COMPR. P-6L 28 15.42 0.550714 0.313000 0.313000 181 C09AA03 LISINOPRILUM LISINOPRIL ATB 10 MG COMPR. 10mg ANTIBIOTICE SA ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-6L 20 6.26 0.313000 0.313000 0.313000 LISINOPRIL ACTAVIS 10 180 C09AA03 LISINOPRILUM mg COMPR. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE CU BLIST. PVC/AL X 30 COMPR. P-6L 30 12.84 0.428000 0.313000 0.313000 178 C09AA03 LISINOPRILUM LISIGAMMA 10 mg COMPR. 10mg WORWAG PHARMA GMBH & CO. KG GERMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. P-6L 30 16.12 0.537333 0.313000 0.313000 3. BOLNAVI CU PROCEDURI INTERVENTIONALE PERCUTANE, NUMAI DUPA IMPLANTAREA UNEI PROTEZE ENDOVASCULARE (STENT)- G3 534 B01AC04 CLOPIDOGRELUM*** TROMBEX 75 mg COMPR. FILM. 75mg ZENTIVA K.S. CEHIA CUTIE X 1 FLAC. DIN STICLA INCOLORA X 90 COMPR. FILM. P-RF 90 241.83 2.687000 2.440000 2.440000 514 B01AC04 CLOPIDOGRELUM*** EGITROMB 75 mg COMPR. FILM. 75mg EGIS PHARMACEUTICALS P.L.C. UNGARIA CUTIE CU BLIST. OPA-AL-PVDC/AL X 28 COMPR. FILM. P-RF 28 79.33 2.833214 2.440000 2.440000 4. HEPATITELE CRONICE DE ETIOLOGIE VIRALA B, C şi D - G4 54 L03AA02 FILGRASTIMUM (G-CSF)** ZARZIO 30MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 60MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL P-RF/R 1 197.42 197.420000 197.420000 197.420000 Pagina 1 din 4

55 L03AA02 FILGRASTIMUM (G-CSF)** ZARZIO 48MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 96MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL P-RF/R 1 317.78 317.780000 317.780000 317.780000 38 L03AA02 FILGRASTIMUM (G-CSF)** NEUPOGEN (R) SOL. INJ. 30MU/0,5ml AMGEN EUROPE B.V. OLANDA CUTIE X 1 SERINGA PRE-UMPLUTA X 0,5 ML S/P-RF 1 325.26 325.260000 197.420000 197.420000 39 L03AA02 FILGRASTIMUM (G-CSF)** NEUPOGEN (R) SOL. INJ. 48MU/0,5ml AMGEN EUROPE B.V. OLANDA CUTIE X 1 SERINGA PRE-UMPLUTA X 0,5 ML S/P-RF 1 512.98 512.980000 317.780000 317.780000 40 L03AA02 FILGRASTIMUM (G-CSF)** TEVAGRASTIM 30MUI/0,5ml SOL. INJ./PERF. 300mcg/0,5ml TEVA GENERICS GMBH GERMANIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. SAU PERF. S/P-RF/R 1 260.83 260.830000 197.420000 197.420000 7. CIROZA HEPATICA - G7 82 L03AA02 FILGRASTIMUM (G-CSF)** ZARZIO 30MU/0,5ml 83 L03AA02 FILGRASTIMUM (G-CSF)** ZARZIO 48MU/0,5ml SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 60MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL P-RF/R 1 197.42 197.420000 197.420000 197.420000 SOL. INJ. /PERF. IN SERINGA PREUMPLUTA 96MU/ml SANDOZ GMBH AUSTRIA CUTIE X 1 SERINGA PREUMPLUTA X 0,5ML SOL P-RF/R 1 317.78 317.780000 317.780000 317.780000 66 L03AA02 FILGRASTIMUM (G-CSF)** NEUPOGEN (R) SOL. INJ. 30MU/0,5ml AMGEN EUROPE B.V. OLANDA CUTIE X 1 SERINGA PRE-UMPLUTA X 0,5 ML S/P-RF 1 325.26 325.260000 197.420000 197.420000 67 L03AA02 FILGRASTIMUM (G-CSF)** NEUPOGEN (R) SOL. INJ. 48MU/0,5ml AMGEN EUROPE B.V. OLANDA CUTIE X 1 SERINGA PRE-UMPLUTA X 0,5 ML S/P-RF 1 512.98 512.980000 317.780000 317.780000 CUTIE X 1 SERINGA PREUMPLUTA X 0,5 ML SOL. INJ. 68 L03AA02 FILGRASTIMUM (G-CSF)** TEVAGRASTIM 30MUI/0,5ml SOL. INJ./PERF. 300mcg/0,5ml TEVA GENERICS GMBH GERMANIA SAU PERF. S/P-RF/R 1 260.83 260.830000 197.420000 197.420000 8. Leucemii, limfoame, aplazie medulara, gamapatii monoclonale maligne, mieloproliferari cronice si tumori maligne, sindroame mielodisplazice - G10 139 N02AX02 TRAMADOLUM MABRON 50 mg CAPS. 50mg MEDOCHEMIE LTD. CIPRU CUTIE X 1 BLIST. AL/PVC X 10 CAPS. P-RF 10 3.84 0.384000 0.291000 0.291000 135 N02AX02 TRAMADOLUM TRALGIT 50 CAPS. 50mg ZENTIVA A.S. SLOVACIA CUTIE X 2 BLIST. AL/PVC X 10 CAPS. P-RF 20 5.82 0.291000 0.291000 0.291000 159 N02AX02 TRAMADOLUM TRAMADOL 50 mg COMPR. 50mg OZONE LABORATORIES LTD. MAREA BRITANIE CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 7.66 0.383000 0.383000 0.383000 160 N02AX02 TRAMADOLUM TRAMADOL 50 mg COMPR. 50mg OZONE LABORATORIES PHARMA S.A. ROMANIA CUTIE X 2 BLIST. AL/PVC X 10 COMPR. P-RF 20 7.66 0.383000 0.383000 0.383000 161 N02AX02 TRAMADOLUM TRAMADOLOR (R) 100 ID COMPR. ELIB. MODIF. 100mg HEXAL AG GERMANIA CUTIE X 1 BLIST. X 10 COMPR. ELIB. MODIF. P-RF 10 6.29 0.629000 0.628666 0.628666 162 N02AX02 TRAMADOLUM TRAMADOL (R) RETARD COMPR. ELIB. PREL. 100mg KRKA D.D. SLOVENIA CUTIE X 3 BLIST. X 10 COMPR. ELIB. PREL. P-RF 30 18.88 0.629333 0.628666 0.628666 164 N02AX02 TRAMADOLUM TRALGIT SR 100 COMPR. ELIB. PREL. 100mg ZENTIVA AS SLOVACIA CUTIE X 1 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 10 6.29 0.629000 0.628666 0.628666 167 N02AX02 TRAMADOLUM NOAX UNO 100 mg COMPR. ELIB. PREL. 100mg CSC PHARMACEUTICALS HANDELS GMBH CSC PHARMACEUTICALS HANDELS GMBH AUSTRIA CUTIE X 3 BLIST. DIN PVC-PVDC/AL X 10 COMPR.ELIM.PREL. P-RF 30 39.43 1.314333 0.628666 0.628666 CUTIE X 1 BLIST. DIN PVC-PVDC/AL X 5 COMPR.ELIM.PREL. P-RF 5 7.40 1.480000 0.628666 0.628666 166 N02AX02 TRAMADOLUM NOAX UNO 100 mg COMPR. ELIB. PREL. 100mg AUSTRIA 163 N02AX02 TRAMADOLUM TRALGIT SR 100 COMPR. ELIB. PREL. 100mg ZENTIVA AS SLOVACIA CUTIE X 5 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 50 32.48 0.649600 0.628666 0.628666 165 N02AX02 TRAMADOLUM TRALGIT SR 100 COMPR. ELIB. PREL. 100mg ZENTIVA AS SLOVACIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. ELIB. PREL. P-RF 30 18.86 0.628666 0.628666 0.628666 176 N02AX02 TRAMADOLUM TRAMAL RETARD 100 mg COMPR. FILM. ELIB. PREL. 100mg GRUNENTHAL GMBH GERMANIA CUTIE X 1 BLIST. AL/PVDC X 10 COMPR. FILM. CU ELIB. PREL. P-RF 10 9.68 0.968000 0.628666 0.628666 TRAMADOL RETARD 150 COMPR. FILM. 178 N02AX02 TRAMADOLUM mg ELIB. PREL. 150mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. ELIB. PREL. P-RF 30 41.47 1.382333 1.116000 1.116000 180 N02AX02 TRAMADOLUM TRAMADOL RETARD 200 mg COMPR. FILM. ELIB. PREL. 200mg KRKA D.D. NOVO MESTO SLOVENIA CUTIE X 3 BLIST. AL/PVC X 10 COMPR. FILM. ELIB. PREL. P-RF 30 53.07 1.769000 1.723666 1.723666 188 N02AX02 TRAMADOLUM TRAMADOL SOL. INJ. 50mg/ml KRKA D.D. SLOVENIA CUTIE X 5 FIOLE X 1 ML S/P-RF 5 4.92 0.984000 0.976000 0.976000 Pagina 2 din 4

13. BOLI PSIHICE (SCHIZOFRENIE, TULBURARI SCHIZOTIPALE SI DELIRANTE, TULBURARI AFECTIVE MAJORE, TULBURARI PSIHOTICE ACUTE SI BOLI PSIHICE COPII, AUTISM) - G15 207 N06AB10 ESCITALOPRAMUM** CIPRALEX 5 mg COMPR. FILM. 5mg H. LUNDBECK A/S DANEMARCA CUTIE X 2 BLIST. TRANSPARENTE PVC-PE-PVDC/AL X 14 COMPR. FILM. P-RF 28 49.56 1.770000 1.770000 1.770000 112 N05AX08 RISPERIDONUM** SPRING 1 mg COMPR. FILM. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 20 10.28 0.514000 0.347500 0.347500 114 N05AX08 RISPERIDONUM** SPRING 1 mg COMPR. FILM. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE X 6 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 60 30.29 0.504833 0.347500 0.347500 113 N05AX08 RISPERIDONUM** SPRING 1 mg COMPR. FILM. 1mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 30 15.41 0.513666 0.347500 0.347500 129 N05AX08 RISPERIDONUM** SPRING 2 mg COMPR. FILM. 2mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 20 21.66 1.083000 0.744500 0.744500 130 N05AX08 RISPERIDONUM** SPRING 2 mg COMPR. FILM. 2mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 30 32.48 1.082666 0.744500 0.744500 131 N05AX08 RISPERIDONUM** SPRING 2 mg COMPR. FILM. 2mg ANTIBIOTICE S.A. ROMANIA CUTIE X 6 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 60 62.64 1.044000 0.744500 0.744500 150 N05AX08 RISPERIDONUM** SPRING 3 mg COMPR. FILM. 3mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 20 34.37 1.718500 1.151666 1.151666 151 N05AX08 RISPERIDONUM** SPRING 3 mg COMPR. FILM. 3mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 30 51.50 1.716666 1.151666 1.151666 152 N05AX08 RISPERIDONUM** SPRING 3 mg COMPR. FILM. 3mg ANTIBIOTICE S.A. ROMANIA CUTIE X 6 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 60 96.30 1.605000 1.151666 1.151666 171 N05AX08 RISPERIDONUM** SPRING 4 mg COMPR. FILM. 4mg ANTIBIOTICE S.A. ROMANIA CUTIE X 2 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 20 46.87 2.343500 1.583666 1.583666 173 N05AX08 RISPERIDONUM** SPRING 4 mg COMPR. FILM. 4mg ANTIBIOTICE S.A. ROMANIA CUTIE X 6 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 60 128.05 2.134166 1.583666 1.583666 172 N05AX08 RISPERIDONUM** SPRING 4 mg COMPR. FILM. 4mg ANTIBIOTICE S.A. ROMANIA CUTIE X 3 BLIST. PVC-PE-PVDC/AL X 10 COMPR. FILM. P-RF 30 67.89 2.263000 1.583666 1.583666 14. DEMENTE(DEGENERATIVE, VASCULARE, MIXTE) - G 16 77 N06DA02 DONEPEZILUM*** DONEPEZIL TEVA 10 mg 78 N06DA02 DONEPEZILUM*** DONEPEZIL TEVA 5 mg COMPR. ORODISPERSAB ILE 10mg TEVA PHARMACEUTICALS S.R.L. ROMANIA COMPR. ORODISPERSAB ILE 5mg TEVA PHARMACEUTICALS S.R.L. ROMANIA CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 28 COMPR. ORODISP. P-RF 28 247.68 8.845714 8.845714 8.845714 CUTIE CU BLIST. TIP CALENDAR OPA-AL-PVC/AL X 28 COMPR. ORODISP. P-RF 28 198.10 7.075000 7.075000 7.075000 76 N06DX01 MEMANTINUM*** EBIXA (R) 10 mg/g PIC. ORALE, SOL. 10mg/g H. LUNDBECK A/S DANEMARCA CUTIE X 1 FLACON, DIN STICLA BRUNA, PICURATOR X 100 G SOLUTIE P-RF/R 1 719.40 719.400000 377.230000 377.230000 1 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 28 357.96 12.784285 6.090357 6.090357 17 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 30 231.43 7.714333 6.090357 6.090357 15 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 30 248.27 8.275666 6.090357 6.090357 14 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 28 232.57 8.306071 6.090357 6.090357 12 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 56 341.06 6.090357 6.090357 6.090357 11 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 28 170.53 6.090357 6.090357 6.090357 10 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 56 341.06 6.090357 6.090357 6.090357 9 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 28 170.53 6.090357 6.090357 6.090357 13 N06DA02 DONEPEZILUM*** DONECEPT 10 MG COMPR. FILM. 10mg ACTAVIS GROUP PTC EHF. ISLANDA CUTIE X BLIST. PVC/AL X 28 COMPR. FILM. P-RF 28 170.55 6.091071 6.090357 6.090357 8 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 28 171.42 6.122142 6.090357 6.090357 16 N06DA02 DONEPEZILUM*** COGNEZIL 10 mg COMPR. FILM. 10mg GLENMARK PHARMACEUTICALS SRL REPUBLICA CEHA CUTIE X 4 BLIST. AL/PVC X 7 COMPR. FILM. P-RF 28 170.55 6.091071 6.090357 6.090357 7 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 90 677.82 7.531333 6.090357 6.090357 6 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 60 475.50 7.925000 6.090357 6.090357 5 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 30 249.27 8.309000 6.090357 6.090357 4 N06DA02 DONEPEZILUM*** DAVIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC/AL X 10 COMPR. FILM. P-RF 30 249.29 8.309666 6.090357 6.090357 2 N06DA02 DONEPEZILUM*** ZILDON 10mg COMPR. FILM. 10mg SANDOZ S.R.L. ROMANIA CUTIE CU BLIST. PVC/AL X 28 COMPR. FILM. P-RF 28 171.42 6.122142 6.090357 6.090357 3 N06DA02 DONEPEZILUM*** DAVIA 10 mg COMPR. FILM. 10mg TERAPIA SA ROMANIA CUTIE X 3 BLIST. PVC-PVDC/AL X 10 COMPR. FILM. P-RF 30 249.29 8.309666 6.090357 6.090357 18 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 28 304.77 10.884642 5.130357 5.130357 Pagina 3 din 4