Informační číselník Svazu zdravotních pojišťoven České republiky

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Informační číselník Svazu zdravotních pojišťoven ČR únor 2012Kód Název Doplněk názvu DRZ ZEM LIM1 OME1 IND1 UHR1 MFC Doplatek ZAP1 EKV1 EKV20027820 ENBREL 25 MG INJ PSO LQF 4X25MG-L+PS+S+J0027907 ENBREL 25 MG INJ SOL 4X0.5ML/25MG-PSÚhradaPFI GB S P 12 929,91 15 919,64 2 989,73 0,00 918,02PFI GB S P 12 970,17 15 900,52 2 930,35 0,00 920,88L04AB02 parent. Infliximab0027283 REMICADE 100 MG INF PLV SOL 1X100MG CEO NL S P 14 941,58 14 941,58 0,00 0,00 896,49L04AB04 parent. Adalimumab0027918 HUMIRA 40 MG INJ SOL 2X0.8ML/40MG ACJ GB S P 25 546,76 25 920,00 373,24 0,00 926,070025566 HUMIRA 40 MG INJ SOL 2X0.8ML/40MG ACJ GB S P 25 546,76 25 920,00 373,24 0,00 926,07L04AB05 parent. Kertolizumab-pegol0149645 CIMZIA 200 MG INJ SOL 2X1ML UCB B S P 24 761,24 30 612,10 5 850,86 0,00 928,55L04AB06 parent. Golimumab0149566 SIMPONI 50 MG INJ SOL 1X0.5ML JAL NL S P 28 233,85 48 406,68 20 172,83 0,00 903,480149564 SIMPONI 50 MG INJ SOL 1X0.5ML JAL NL S P 28 233,85 48 406,68 20 172,83 0,00 903,48L04AC05 parent. Ustekinumab0167600 STELARA 45 MG INJ SOL 1X0.5ML JAI B S P 77 814,11 93 676,34 15 862,23 0,00 864,600500964 STELARA 45 MG INJ SOL 1X0.5ML JAI B S P 77 814,11 93 676,34 15 862,23 0,00 864,60L04AC07 parent. Tocilizumab0500968 ROACTEMRA 20 MG/ML INF CNC SOL1X10ML/200MG0500970 ROACTEMRA 20 MG/ML INF CNC SOL1X20ML/400MG0500967 ROACTEMRA 20 MG/ML INF CNC SOL4X4ML/80MG0500969 ROACTEMRA 20 MG/ML INF CNC SOL4X10ML/200MG0500971 ROACTEMRA 20 MG/ML INF CNC SOL4X20ML/400MG0500966 ROACTEMRA 20 MG/ML INF CNC SOL1X4ML/80MGRRG GB S P 10 745,26 12 283,89 1 538,63 0,00 1 128,25RRG GB S P 21 490,53 23 689,29 2 198,76 0,00 1 128,25RRG GB S P 17 192,42 19 783,19 2 590,77 0,00 1 128,25RRG GB S P 42 981,06 48 453,70 5 472,64 0,00 1 128,25RRG GB S P 85 962,11 96 237,52 10 275,41 0,00 1 128,25RRG GB S P 4 298,11 5 151,09 852,98 0,00 1 128,26L04AC08 parent. Kanakinumab0149771 ILARIS 150 MG INJ PLV SOL 1X150MG NEH GB S P 284 828,64 333 516,21 48 687,57 0,00 5 086,28L04AD01 p.o. Cyklosporin0162024 CICLOSPORIN MYLAN 50 MG POR CPS MOL 50X50MG GNS GB 1 397,43 1 397,43 0,00 0,00 167,690010184 EQUORAL 50 MG POR CPS MOL 50X50MG TCO CZ 1 397,43 1 906,23 508,80 0,00 167,690145438 CYCLAID 50 MG POR CPS MOL 50X50MG MXP CZ 1 397,43 2 463,72 1 066,29 0,00 167,690015641 SANDIMMUN NEORAL 50 MG POR CPS MOL 50X50MG NAI CZ 1 397,43 2 705,61 1 308,18 0,00 167,69Vysvětlivky: UHR1 – úhrada, MFC – konečná cena, Doplatek – maximální doplatek, ZAP1 – započitatelný doplatek, Úhrada EKV1, EKV2 – vypočtená úhrada za 1 ODTD nebo 1 DDDStránka 170 z 278
Informační číselník Svazu zdravotních pojišťoven ČR únor 2012Kód Název Doplněk názvu DRZ ZEM LIM1 OME1 IND1 UHR1 MFC Doplatek ZAP1 EKV1 EKV20010183 EQUORAL 25 MG POR CPS MOL 50X25MG TCO CZ 1 044,49 1 044,49 0,00 0,00 250,680162018 CICLOSPORIN MYLAN 25 MG POR CPS MOL 50X25MG GNS GB 1 048,54 1 048,54 0,00 0,00 251,650145433 CYCLAID 25 MG POR CPS MOL 50X25MG MXP CZ 1 048,54 1 339,50 290,96 0,00 251,650015640 SANDIMMUN NEORAL 25 MG POR CPS MOL 50X25MG NAI CZ 1 048,54 1 340,65 292,11 0,00 251,650162030 CICLOSPORIN MYLAN 100 MG POR CPS MOL 50X100MG GNS GB 2 192,95 2 192,95 0,00 0,00 131,580157503 CYCLAID 100 MG/ML POR SOL 1X50ML/5GM MXP CZ 2 192,95 3 259,82 1 066,87 0,00 131,580006408 EQUORAL POR SOL 1X50ML/5GM TCO CZ 2 192,95 3 357,71 1 164,76 0,00 131,580010185 EQUORAL 100 MG POR CPS MOL 50X100MG TCO CZ 2 192,95 3 692,90 1 499,95 0,00 131,580016309 SANDIMMUN NEORAL 100 MG/ML POR SOL 1X50ML/5GM NAI CZ 2 192,95 4 278,45 2 085,50 0,00 131,580145443 CYCLAID 100 MG POR CPS MOL 50X100MG MXP CZ 2 192,95 4 566,72 2 373,77 0,00 131,580015642 SANDIMMUN NEORAL 100 MG POR CPS MOL 50X100MG NAI CZ 2 192,95 4 701,95 2 509,00 0,00 131,58L04AD02 p.o. Takrolimus0057629 PROGRAF 5 MG POR CPS DUR 30X5MG AEA CZ P 8 222,21 8 222,21 0,00 0,00 274,070029710 ADVAGRAF 5 MG POR CPS PRO 30X5MG AEV NL P 9 117,44 9 946,52 829,08 0,00 303,910057628 PROGRAF 1 MG POR CPS DUR 60X1MG AEA CZ P 3 479,70 3 479,70 0,00 0,00 289,980029707 ADVAGRAF 1 MG POR CPS PRO 60X1MG AEV NL P 3 646,98 3 865,59 218,61 0,00 303,920059693 PROGRAF 0,5 MG POR CPS DUR 30X0.5MG AEA CZ P 1 075,67 1 075,67 0,00 0,00 358,560029703 ADVAGRAF 0,5 MG POR CPS PRO 30X0.5MG AEV NL P 1 221,93 1 415,27 193,34 0,00 407,31L04AX01 p.o. Azathioprin0122102 IMMUNOPRIN 50 MG POR TBL FLM 100X50MG EBP A 469,21 493,97 24,76 24,76 14,080165000 IMURAN 50 MG POR TBL FLM 100X50MG AUO D 469,21 667,25 198,04 24,76 14,080049024 IMURAN 50 MG POR TBL FLM 100X50MG AUO D 469,21 667,25 198,04 24,76 14,080164999 IMURAN 50 MG POR TBL FLM 100X50MG AUO D 469,21 667,25 198,04 24,76 14,080014318 IMURAN 50 MG POR TBL FLM 100X50MG AUO D 469,21 667,25 198,04 24,76 14,080023323 AZAPRINE 50 MG POR TBL FLM 100X50MG TCO CZ 469,21 810,08 340,87 24,76 14,080144764 IMMUNOPRIN 75 MG POR TBL FLM 100X75MG EBP A 555,62 722,16 166,54 37,14 11,110172001 IMURAN 25 MG POR TBL FLM 100X25MG AUO D 325,51 465,52 140,01 12,38 19,530014317 IMURAN 25 MG POR TBL FLM 100X25MG AUO D 325,51 465,52 140,01 12,38 19,530164998 IMURAN 25 MG POR TBL FLM 100X25MG AUO D 325,51 465,52 140,01 12,38 19,530049023 IMURAN 25 MG POR TBL FLM 100X25MG AUO D 325,51 465,52 140,01 12,38 19,530023322 AZAPRINE 25 MG POR TBL FLM 100X25MG TCO CZ 351,22 465,52 114,30 12,38 21,07Úhrada0144766 IMMUNOPRIN 100 MG POR TBL FLM100X100MGEBP A 740,64 943,68 203,04 49,52 111,10L04AX03 p.o. Methotrexát (pouze perorální)0157121 METHOTREXAT EBEWE 5 MG TABLETY POR TBL NOB 50X5MG EBP A E ONK,HEM,REV,DER,GYN172,25 326,67 154,42 12,65 1,97Vysvětlivky: UHR1 – úhrada, MFC – konečná cena, Doplatek – maximální doplatek, ZAP1 – započitatelný doplatek, Úhrada EKV1, EKV2 – vypočtená úhrada za 1 ODTD nebo 1 DDDStránka 171 z 278
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Informační číselník Svazu zdravotních pojišťoven České republiky

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