浙江省基本醫(yī)療保險和工傷保險藥品目錄乙類藥品增補品種表.doc

浙江省基本醫(yī)療保險和工傷保險藥品目錄乙類藥品增補品種表（西藥部分）序號醫(yī)保序號藥品名稱劑型支付范圍限定中文名稱英文名稱11.1.1.3呋布西林Furbucillin注射劑21.1.1.3阿莫西林雙氯西林Amoxillin and Dicloxacillin膠囊劑31.1.2.2.2頭孢唑林舒巴坦Cefazolin and Sulbactam注射劑41.1.2.3.1頭孢他美酯Cefetamet Pivoxil片劑限非限定支付的同類藥物無效。51.1.2.3.2頭孢地嗪Cefodizime注射劑限二線抗菌藥物用藥。61.1.4西索米星Sisomicin注射劑71.1.4卡那霉素Kanamycin注射劑81.1.7克拉霉素Clarithromycin緩釋片，膠囊劑，顆粒劑,干混懸劑91.2.1復方磺胺嘧啶Compoud Sulfadiazine片劑101.2.2司帕沙星Sparfloxacin膠囊劑111.3.1對氨基水楊酸異煙肼Sodium Aminosalicylate and Isoniazid片劑121.3.1利福定Rifandine膠囊劑131.4.2兩性霉素B脂質體（脂質體兩性霉素B）Amphotericin B Liposome注射劑限二線抗菌藥物用藥。141.5.1金剛乙胺Rimantadine片劑152.2復方雙氫青蒿素Compoud Dihydroartemisinin片劑163.1丹皮酚Paeonol注射劑173.1右旋布洛芬Dexibuprofen栓劑183.1二氟尼柳Diflunisal膠囊劑193.2復方別嘌醇Compound Allopurinol片劑204復方曲馬多Compound Tramadol片劑215.2普魯卡因腎上腺素Procaine and Epinephrine注射劑226.1蘆丁Rutoside片劑236.2碳酸鈣維生素D3Vitamin D3 and Calcium Carbonate咀嚼片246.2葡萄糖酸鋅Granulae Zinci Gluconatis片劑, 粉劑257.1.1復方氨基酸（8-11）Compound Amino Acid 8-11膠囊劑限慢性肝、腎疾病。268.1特利加壓素Terlipressin注射劑278.2復方倍他米松Compound Betamethasone注射劑288.5.1甘精胰島素Insulin glargine注射劑限內分泌科或內分泌?？漆t(yī)生，且限用于期糖尿病。298.5.1門冬胰島素Insulin aspart注射劑限內分泌科或內分泌?？漆t(yī)生，且限用于期糖尿病。308.5.1賴脯胰島素Insulin lispro注射劑限內分泌科或內分泌?？漆t(yī)生，且限用于期糖尿病。318.5.2.1格列齊特()Gliclazide（）片劑328.8高血糖素Glucagon注射劑338.8伏格列波糖Voglibose片劑348.8木糖醇Xylitoy粉劑限糖尿病腸內營養(yǎng)輔助用藥。359.1雷公藤內酯Triptolide軟膏劑369.1聚肌胞Polyinosinic-Polycytidylic Acid注射劑每個療程不超過2mg26支；每年結算年度使用不超過2個療程。379.2卡介菌多糖、核酸制劑BCG Polysaccharide and Nacleic Acid Preparation注射劑限慢性支氣管炎，哮喘。3810.1.1伊達比星Idarubicin注射劑限急性淋巴細胞性白血病或急性非淋巴細胞性白血病。3910.1.2奈達鉑Nedaplatin注射劑4010.1.4伊立替康Irinotecan注射劑限結腸癌，直腸癌，小細胞肺癌。4110.1.5復方環(huán)磷酰胺CompoundCyclophosphamide片劑4210.3氨磷汀Amifostine注射劑4310.3甘氨雙唑Glycididazole注射劑4411.1地氯雷他定Desloratadine片劑4512.1吡貝地爾Piribedil緩釋片4612.3拉莫三嗪Lamotrigine片劑4712.3奧卡西平Oxcarbazepine片劑4812.4桂哌齊特Cinepazide注射劑4912.4依達拉奉Edarvaone注射劑5012.8多奈哌齊Donepezil膠囊劑限阿爾茨海默病(Alzheimers Disease)5112.8卡巴拉汀Rivastigmine膠囊劑限阿爾茨海默病(Alzheimers Disease)5213.1舒托必利Sultopride片劑5313.2坦度螺酮Tandospirone片劑5413.3米氮平Mirtazapine片劑5514.1厄多司坦Erdosteine膠囊劑5614.1標準桃金娘油Myrtle Standardized膠囊劑5714.2愈酚待因Potassium Guaiacol sulfonate and Codeine Phosphate口服溶液劑5814.2美司坦Mecysteine片劑5914.3塞曲司特Seratrodast片劑6014.3復方甲氧那明Compound Methoxyphenamine膠囊劑6114.3復方異丙托溴銨CompoundIpratropiumBromide吸入劑6215.1.1瑞巴派特Rebamipide片劑6315.1.1尿囊素鋁Aldioxa口服常釋劑型，顆粒劑6415.1.1呱侖酸鈉/L-谷酰胺Sodium gualenate/L-glutamine緩釋控釋劑型6515.1.1丙谷胺Proglumide片劑6615.1.1替普瑞酮Teprenone膠囊劑6715.2米曲菌胰酶Oryz-Aspergillus and Pancreatin片劑6815.3.1屈他維林Drotaverine注射劑6915.5復方牛胎肝提取物CompoundEmbryonicBovineLiverExtract口服常釋劑型7015.5腺苷蛋氨酸Ademetionine注射劑7115.8氨基水楊酸Aminosalicylic Acid腸溶片7215.8酪酸梭菌活菌Clostridum Butyricum片劑，口服散劑限菌群失調。7315.8奧沙拉秦Olsalazine膠囊劑7416.2腺苷Adenosine注射劑7516.4尼索地平Nisoldipine片劑，緩釋膠囊7616.7復方卡托普利Compound Captopril片劑7716.8坎地沙坦酯Candesartan Cilexetil片劑限非限定支付的抗高血壓藥無效或不能耐受病人，心力衰竭，急性心肌梗塞，糖尿病性腎病。7816.9單硝酸異山梨酯Isosorbide Mononitrate緩釋片，分散片7916.11維生素E煙酸酯Vitamin E Nicotinicate膠囊限經飲食控制無效的高脂血癥。8016.11藻酸雙酯鈉Alginic Sodium Diester膠囊劑8116.11彈性酶Elastase Enteric-coated腸溶膠囊劑8216.11多烯酸乙酯Ethyl Polyenoare膠丸8316.12輔酶QCoenzyme Q膠丸8417.3氨苯蝶啶氫氯噻嗪TriamtereneandHydrochlorothiazide片劑8517.4萘哌地爾Naftopidil片劑8618.1白眉蛇毒血凝酶Hemocoagulase注射劑8718.1維生素K4Vitamin K4片劑8818.3右旋糖酐20Dextran 20注射劑8918.4.1多糖鐵復合物Iron Polysaccharide Complex膠囊9018.4.2重組人白細胞介素-11Recombinant Human Interleukin-11注射劑使用其它藥物無效的血小板減少癥，且血小板計數(shù)低于20109/L。9119果糖Fructose注射劑9219轉化糖InvertSugar注射劑9320.1.1.2復方酮康唑Compound Ketoconazole軟膏劑9420.1.1.2復方克霉唑Compound Clotrimazole軟膏劑9520.1.2異維A酸Erythromycin Estolate Suspension凝膠劑9620.1.3鹵米松三氯生Halometasone and Triclosan軟膏劑9720.1.3糠酸莫米松Mometasone Furoate軟膏劑9820.1.4復方爐甘石Compound Calamine散劑9920.1.4雙氯芬酸二乙銨Diclofenac Diethylamine軟膏劑，凝膠劑10020.1.4復方肝素鈉尿囊素Campound Haparin Sodium and Allantoin軟膏劑10120.1.4鈣泊三醇Calcipotriol軟膏劑10220.2.1.1妥布霉素地塞米松Tobramyin-Dexmethasone滴眼劑,眼膏劑10320.2.1.2復方碘苷Compound Idoxuridine眼膏劑10420.2.3四環(huán)素潑尼松CompoundTetracylineandPrednisone眼膏劑10520.2.4氨碘肽Amiotide滴眼劑10620.2.4復方噻嗎洛爾Compound Timolol滴眼劑10720.3呋麻Ephedrine and Nitrofurazone滴鼻劑10820.3復方薄荷腦Compound Menthol吸入劑10920.3西地碘Cydiodine片劑11020.3奈甲唑啉Naphazoline Hydrochloride滴鼻劑11120.5.1米非司酮Mifepristone片劑限子宮肌瘤。11220.5.2雙唑泰Metronidazole栓劑11320.6放射性碘125I化鈉Sodium Iodide125I口服液體劑11420.6锝99mTC焦磷酸鹽Technetium99MTC Pyrophosphate注射劑11521.3復方氯解磷定Compound Pralidoxime Chloride注射劑11622.1.2碘羥拉葡胺MeglumineIoxitalamate注射劑11723金黃色葡萄球菌濾液制劑StaphylococcusAureasFiltratePreparation注射劑限以適應證之一，且每個療程不超過50030支，每個結算年度使用不超過2個療程。骨折及陳舊性骨折；惡性腫瘤放療或化療輔助性治療。1185.3.2.1安痛定Antondine注射劑1195.3.2.2苯甲酸鈉咖啡因Caffeine and Sodium Benzoate注射劑、粉劑1206.1.3復合維生素BCompound Vitamin B注射劑、溶液劑1216.1.4呋喃硫胺Fursultiamine注射劑1226.1.5呋喃硫胺Fursultiamine片劑1236.1.6復方蘆丁Compound Rutoside片劑12410.3.7甲基斑蝥胺Methylcantharidimide片劑12511.1H1.8氯苯那敏Chlorphenamine注射劑12615.3.1.9復方慶大霉素普魯卡因Compound Gentamycin Sulfate膠囊劑12715.5.10葉綠素銅鈉Sodium Cupper Chlorophyllin片劑(膠囊劑)12816.9.11復方羅布麻Compound Apocyne Venete片劑12916.12.12三磷酸腺苷(ATP)Adenosine T