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Liste positive des médicaments valable au 1er avril 2010 ... - CNS

Liste positive des médicaments valable au 1er avril 2010 ... - CNS

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Numéro national<br />

Dénomination abrégée Prise en charge conditionnelle Prix public T<strong>au</strong>x<br />

L04AB01 etanercept<br />

0443951 ENBREL 25 MG PDR 4 SRG PREREMPL 0,5 ML 0 0<br />

571,16 100 %<br />

0462263 ENBREL 25 MG PDR 4FL+4SRG+20AIG+4ADAPT 0 0<br />

571,16 100 %<br />

0443996 ENBREL 50 MG PDR 4 SRG PREREMPL 1 ML 0 0<br />

1.133,50 100 %<br />

0399979 ENBREL 50 MG PDR 4FL+4SRG+4ADAPT+4AIG SC 0 0<br />

1.139,43 100 %<br />

0440199 ENBREL PED 25 MG 4 SRG PREREMPL 1 ML 0 0<br />

571,16 100 %<br />

L04AB04 adalimumab<br />

0353001 HUMIRA 40 MG 2 SRG 0,8 ML SC 0 0<br />

1.091,84 100 %<br />

0444301 HUMIRA 40 MG 2 STYLOS 0,8 ML + 2 TAMP 0 0<br />

1.091,84 100 %<br />

L04AD01 ciclosporin<br />

0170661 SANDIMMUN 100 MG 50 CAPS 0 0<br />

207,40 100 %<br />

0102238 SANDIMMUN 100 MG/ML GTTS 50 ML 0 0<br />

207,40 100 %<br />

0170644 SANDIMMUN 25 MG 50 CAPS 0 0<br />

62,97 100 %<br />

0306563 SANDIMMUN INF 250 MG 10 AMP 5 ML PERF 0 0<br />

160,44 100 %<br />

0266051 SANDIMMUN OPTORAL 10 MG 100 CAPS 0 0<br />

55,28 100 %<br />

0317164 SANDIMMUN OPTORAL 100 MG 50 CAPS 0 0<br />

239,96 100 %<br />

0317097 SANDIMMUN OPTORAL 25 MG 50 CAPS 0 0<br />

64,81 100 %<br />

0317133 SANDIMMUN OPTORAL 50 MG 50 CAPS 0 0<br />

122,72 100 %<br />

0198131 SANDIMMUN OPTORAL GTTS 50 ML 0 0<br />

239,96 100 %<br />

L04AD02 tacrolimus<br />

0477719 ADVAGRAF 0,5 MG 50 CAPS 0 0<br />

89,88 100 %<br />

0477767 ADVAGRAF 1 MG 100 CAPS 0 0<br />

262,09 100 %<br />

0477784 ADVAGRAF 5 MG 50 CAPS 0 0<br />

607,81 100 %<br />

0308912 PROGRAFT 0,5 MG 50 CAPS 0 0<br />

89,88 100 %<br />

0250504 PROGRAFT 1 MG 50 CAPS 0 0<br />

134,54 100 %<br />

0250535 PROGRAFT 5 MG 50 CAPS 0 0<br />

604,33 100 %<br />

L04AX01 azathioprine<br />

0056443 IMURAN 50 MG 100 CPR 0 0<br />

32,24 100 %<br />

0168114 IMURAN MITIS 25 MG 100 CPR 0 0<br />

20,98 100 %<br />

M01AB01 indometacin<br />

0034530 DOLCIDIUM 100 MG 12 SUPP 0 0<br />

7,93 80 %<br />

0034544 DOLCIDIUM GE 50 MG 12 SUPP 0 0<br />

6,56 80 %<br />

0056684 INDOCID 100 MG 12 SUPP 0 0<br />

2,53 80 %<br />

0056653 INDOCID 25 MG 100 CAPS 0 0<br />

4,66 80 %<br />

0056605 INDOCID 50 MG 30 CAPS 0 0<br />

2,81 80 %<br />

0056703 INDOCID RET 75 MG 30 CAPS 0 0<br />

4,26 80 %<br />

0056717 INDOCID RET 75 MG 50 CAPS 0 0<br />

5,72 80 %<br />

0185911 INDOMET RATIO 100 MG 10 SUPP 0 0<br />

4,17 80 %<br />

0185924 INDOMET RATIO 100 MG 50 SUPP 0 0<br />

18,24 80 %<br />

0056877 INDOMET RATIO 25 MG 100 CAPS 0 0<br />

6,95 80 %<br />

0056846 INDOMET RATIO 25 MG 20 CAPS 0 0<br />

2,03 80 %<br />

0056863 INDOMET RATIO 25 MG 50 CAPS 0 0<br />

4,68 80 %<br />

0056913 INDOMET RATIO 50 MG 100 CAPS 0 0<br />

9,80 80 %<br />

0056880 INDOMET RATIO 50 MG 20 CAPS 0 0<br />

2,36 80 %<br />

0056894 INDOMET RATIO 50 MG 50 CAPS 0 0<br />

5,30 80 %<br />

0056927 INDOMET RATIO RET 75 MG 20 CAPS RET 0 0<br />

4,50 80 %<br />

0056930 INDOMET RATIO RET 75 MG 50 CAPS RET 0 0<br />

9,09 80 %<br />

M01AB05 diclofenac<br />

0154525 CATAFLAM 50 MG 30 DRG 0 0<br />

10,28 80 %<br />

0031895 DICLAC 100 MG 10 SUPP 0 0<br />

3,47 80 %<br />

0031928 DICLAC 25 MG 100 CPR 0 0<br />

5,45 80 %<br />

0162365 DICLAC 25 MG 20 CPR 0 0<br />

1,49 80 %<br />

0031914 DICLAC 25 MG 50 CPR 0 0<br />

2,98 80 %<br />

0031959 DICLAC 50 MG 10 SUPP 0 0<br />

1,93 80 %<br />

0031945 DICLAC 50 MG 100 CPR 0 0<br />

9,11 80 %<br />

0162379 DICLAC 50 MG 20 CPR 0 0<br />

1,86 80 %<br />

0208335 DICLAC 50 MG 30 SUPP 0 0<br />

4,88 80 %<br />

0031931 DICLAC 50 MG 50 CPR 0 0<br />

4,88 80 %<br />

0031878 DICLAC 75 MG 1 AMP 3 ML IM 0 0<br />

0,77 80 %<br />

0031881 DICLAC 75 MG 5 AMP 3 ML IM 0 0<br />

2,93 80 %<br />

0155519 DICLAC RET 100 MG 100 CPR 0 0<br />

14,00 80 %<br />

0155486 DICLAC RET 100 MG 20 CPR 0 0<br />

3,09 80 %<br />

0155505 DICLAC RET 100 MG 50 CPR 0 0<br />

7,50 80 %<br />

0451886 DICLOFENAC EG 100 MG 12 SUPP 0 0<br />

4,00 80 %<br />

0451872 DICLOFENAC EG 100 MG 30 CPR 0 0<br />

10,86 80 %<br />

Page 53 of 85

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