Liste des médicaments commercialisés au Luxembourg - CNS

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Numéro national Dénomination abrégée mode de conditions de OD RMP PCC Prix ex-usine Prix public Taux délivrance prescription 0145025 G03AB08 TRIODENE 3*21 DRG R 6 14 7,54 13,57 80 0519921 QLAIRA 3*28 CPR R 6 14 27,47 38,21 80 G03AC03 levonorgestrel 0072139 MICROLUT 3*35 DRG R 6 14 4,70 10,03 80 G03AC06 medroxyprogesterone 0029835 DEPO PROVERA 150 MG 1 SRG 1 ML IM RR 0 0 3,30 8,29 0 0590795 SAYANA 104 MG 1 SRG PREREMPLIE 0,65 ML RR 0 0 13,00 22,33 0 G03AC08 etonogestrel 0262651 IMPLANON NXT 68 MG 1 SET RR RM 0 0 125,84 139,53 0 G03AC09 desogestrel 0643689 CELEA 75 MCG 13*28 CPR R 6 14 43,81 55,04 80 0574645 CELEA 75 MCG 28 CPR R 0 0 4,81 8,27 0 0574659 CELEA 75 MCG 3*28 CPR R 6 14 11,55 19,84 80 0643675 CELEA 75 MCG 6*28 CPR R 6 14 21,21 31,76 80 0252414 CERAZETTE 75 MCG 28 CPR R 0 0 6,02 10,34 0 0252428 G03AD01 CERAZETTE 75 MCG 3*28 CPR R 6 14 15,60 25,97 80 0280209 NORLEVO 0,75 MG 2 CPR P 0 0 0,00 9,57 0 0409736 NORLEVO 1,5 MG 1 CPR P 0 0 5,58 9,58 0 0295523 POSTINOR 0,75 MG 2 CPR P 0 0 5,06 8,70 0 0421761 G03AD02 POSTINOR 1,5 MG 1 CPR P 0 0 5,57 9,57 0 0520756 ELLAONE 30 MG 1 CPR RR 0 0 18,59 29,05 0 G03BA03 testosterone 0326552 ANDROGEL 50 MG 10 SACH 5 G RR 0 0 18,83 29,30 0 0326597 ANDROGEL 50 MG 30 SACH 5 G RR 0 0 43,68 55,10 0 0465851 ITNOGEN 2% GEL 60 G RR 0 0 38,05 49,10 0 0456981 NEBIDO 250 MG/ML 1 AMP 4 ML IM RR C 0 0 100,00 112,91 80 0482428 SUSTANON 250 MG 1 AMP 1 ML RR 0 0 4,74 10,09 80 0314681 SUSTANON 250 MG 6 FL 1 ML RR 0 0 28,44 37,61 80 0398582 TESTIM 50 MG GEL 30 TUBES 5 G RR 0 0 43,86 55,09 0 0338472 TESTOCAPS 40 MG 120 CAPS RR 0 0 33,54 44,46 0 0338411 TESTOCAPS 40 MG 60 CAPS RR 0 0 20,96 31,50 80 G03BB01 mesterolone 0095164 PROVIRON 25 MG 50 CPR RR 0 0 0,00 10,19 80 G03BB02 androstanolone 0143969 ANDRACTIM 2,5% GEL 80 G RR 0 0 11,99 20,60 80 Page 92 of 230
Numéro national Dénomination abrégée mode de conditions de OD RMP PCC Prix ex-usine Prix public Taux délivrance prescription G03CA03 estradiol 0290821 AERODIOL 150 MCG/D SPRAY 3 FL 60 D RR 0 0 28,06 39,42 0 0260447 CLIMARA 50 12 PATCH RR 0 0 18,13 28,59 80 0220729 CLIMARA 50 4 PATCH RR 0 0 0,00 12,98 80 0226168 DERMESTRIL 100 8 PATCH RR 0 0 9,80 16,83 80 0350321 DERMESTRIL 25 26 PATCH RR 0 0 12,99 22,32 80 0350334 DERMESTRIL 50 26 PATCH RR 0 0 18,24 28,69 80 0269071 DERMESTRIL SEPTEM 25 12 PATCH RR 0 0 11,01 18,91 80 0269098 DERMESTRIL SEPTEM 50 12 PATCH RR 0 0 15,43 25,80 80 0256928 ESTRAMON 100 8 MG 6 PATCH RR 0 0 6,10 15,76 80 0256864 ESTRAMON 25 2 MG 6 PATCH RR 0 0 2,99 12,35 80 0256895 ESTRAMON 50 4 MG 6 PATCH RR 0 0 4,29 13,78 80 0262505 ESTREVA 0,1 % GEL 50 G RR 0 0 2,39 7,04 80 0238575 ESTROFEM 1 MG 3*28 CPR RR 0 0 16,37 26,77 80 0176438 ESTROFEM 2 MG 3*28 CPR RR 0 0 16,37 26,77 80 0444346 OESTROGEL 0,06% GEL 2*100 G RR 0 0 6,81 12,66 80 0081513 OESTROGEL 0,06% GEL 80 G RR 0 0 2,21 6,94 80 0328462 PROGYNOVA 1 MG 3*28 DRG RR 0 0 3,26 8,24 80 0328476 PROGYNOVA 2 MG 3*28 DRG RR 0 0 4,08 9,26 80 0539341 SYSTEN TTS 3,2 MG 24 PATCH RR 0 0 20,29 30,80 80 0157625 VAGIFEM 25 MCG 15 CPR VAG + APPL RR 0 0 11,26 19,35 80 0183754 ZUMENON 2 MG 3*28 CPR RR 0 0 15,24 25,60 80 G03CA04 estriol 0000112 AACIFEMINE 0,5 MG 15 OV RR 0 0 3,73 6,41 80 0000076 AACIFEMINE 2 MG 30 CPR RR 0 0 3,41 8,42 80 0000109 AACIFEMINE CREME 15 G RR 0 0 5,97 10,26 80 0186689 ORTHOGYNEST DEPOT 6 OV 193552 RR 0 0 5,43 9,33 80 G03CX01 tibolone 0500821 HERIA 2,5 MG 28 CPR RR 0 0 10,67 20,90 0 0508541 HERIA 2,5 MG 3*28 CPR RR 0 0 37,24 46,64 0 0508555 HERIA 2,5 MG 6*28 CPR RR 0 0 64,91 74,63 0 0524884 LIVIAL 2,5 MG 28 CPR RR 0 0 14,54 24,89 0 0211618 LIVIAL 2,5 MG 3*28 CPR RR 0 0 36,12 47,11 0 G03DA02 medroxyprogesterone 0095116 PROVERA 10 MG 30 CPR RR 0 0 4,59 9,90 80 0139496 PROVERA 5 MG 24 CPR RR 0 0 2,28 7,03 80 G03DA04 progesterone 0252981 CRINONE 8% GEL VAG 15 APPL RR 0 0 37,50 48,54 0 0094251 PROGESTOGEL GEL 80 G RR 0 0 3,22 5,54 80 0123966 UTROGESTAN 100 MG 30 CAPS RR 0 0 4,33 9,57 80 0123983 UTROGESTAN 100 MG 90 CAPS RR 0 0 12,91 20,27 80 Page 93 of 230
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