浙江省基本医疗保险和工伤保险药品目录乙类药品增补品种表.doc

浙江省基本医疗保险和工伤保险药品目录乙类药品增补品种表（西药部分）序号医保序号药品名称剂型支付范围限定中文名称英文名称11.1.1.3呋布西林Furbucillin注射剂21.1.1.3阿莫西林双氯西林Amoxillin and Dicloxacillin胶囊剂31.1.2.2.2头孢唑林舒巴坦Cefazolin and Sulbactam注射剂41.1.2.3.1头孢他美酯Cefetamet Pivoxil片剂限非限定支付的同类药物无效。51.1.2.3.2头孢地嗪Cefodizime注射剂限二线抗菌药物用药。61.1.4西索米星Sisomicin注射剂71.1.4卡那霉素Kanamycin注射剂81.1.7克拉霉素Clarithromycin缓释片，胶囊剂，颗粒剂,干混悬剂91.2.1复方磺胺嘧啶Compoud Sulfadiazine片剂101.2.2司帕沙星Sparfloxacin胶囊剂111.3.1对氨基水杨酸异烟肼Sodium Aminosalicylate and Isoniazid片剂121.3.1利福定Rifandine胶囊剂131.4.2两性霉素B脂质体（脂质体两性霉素B）Amphotericin B Liposome注射剂限二线抗菌药物用药。141.5.1金刚乙胺Rimantadine片剂152.2复方双氢青蒿素Compoud Dihydroartemisinin片剂163.1丹皮酚Paeonol注射剂173.1右旋布洛芬Dexibuprofen栓剂183.1二氟尼柳Diflunisal胶囊剂193.2复方别嘌醇Compound Allopurinol片剂204复方曲马多Compound Tramadol片剂215.2普鲁卡因肾上腺素Procaine and Epinephrine注射剂226.1芦丁Rutoside片剂236.2碳酸钙维生素D3Vitamin D3 and Calcium Carbonate咀嚼片246.2葡萄糖酸锌Granulae Zinci Gluconatis片剂, 粉剂257.1.1复方氨基酸（8-11）Compound Amino Acid 8-11胶囊剂限慢性肝、肾疾病。268.1特利加压素Terlipressin注射剂278.2复方倍他米松Compound Betamethasone注射剂288.5.1甘精胰岛素Insulin glargine注射剂限内分泌科或内分泌专科医生，且限用于期糖尿病。298.5.1门冬胰岛素Insulin aspart注射剂限内分泌科或内分泌专科医生，且限用于期糖尿病。308.5.1赖脯胰岛素Insulin lispro注射剂限内分泌科或内分泌专科医生，且限用于期糖尿病。318.5.2.1格列齐特()Gliclazide（）片剂328.8高血糖素Glucagon注射剂338.8伏格列波糖Voglibose片剂348.8木糖醇Xylitoy粉剂限糖尿病肠内营养辅助用药。359.1雷公藤内酯Triptolide软膏剂369.1聚肌胞Polyinosinic-Polycytidylic Acid注射剂每个疗程不超过2mg26支；每年结算年度使用不超过2个疗程。379.2卡介菌多糖、核酸制剂BCG Polysaccharide and Nacleic Acid Preparation注射剂限慢性支气管炎，哮喘。3810.1.1伊达比星Idarubicin注射剂限急性淋巴细胞性白血病或急性非淋巴细胞性白血病。3910.1.2奈达铂Nedaplatin注射剂4010.1.4伊立替康Irinotecan注射剂限结肠癌，直肠癌，小细胞肺癌。4110.1.5复方环磷酰胺CompoundCyclophosphamide片剂4210.3氨磷汀Amifostine注射剂4310.3甘氨双唑Glycididazole注射剂4411.1地氯雷他定Desloratadine片剂4512.1吡贝地尔Piribedil缓释片4612.3拉莫三嗪Lamotrigine片剂4712.3奥卡西平Oxcarbazepine片剂4812.4桂哌齐特Cinepazide注射剂4912.4依达拉奉Edarvaone注射剂5012.8多奈哌齐Donepezil胶囊剂限阿尔茨海默病(Alzheimers Disease)5112.8卡巴拉汀Rivastigmine胶囊剂限阿尔茨海默病(Alzheimers Disease)5213.1舒托必利Sultopride片剂5313.2坦度螺酮Tandospirone片剂5413.3米氮平Mirtazapine片剂5514.1厄多司坦Erdosteine胶囊剂5614.1标准桃金娘油Myrtle Standardized胶囊剂5714.2愈酚待因Potassium Guaiacol sulfonate and Codeine Phosphate口服溶液剂5814.2美司坦Mecysteine片剂5914.3塞曲司特Seratrodast片剂6014.3复方甲氧那明Compound Methoxyphenamine胶囊剂6114.3复方异丙托溴铵CompoundIpratropiumBromide吸入剂6215.1.1瑞巴派特Rebamipide片剂6315.1.1尿囊素铝Aldioxa口服常释剂型，颗粒剂6415.1.1呱仑酸钠/L-谷酰胺Sodium gualenate/L-glutamine缓释控释剂型6515.1.1丙谷胺Proglumide片剂6615.1.1替普瑞酮Teprenone胶囊剂6715.2米曲菌胰酶Oryz-Aspergillus and Pancreatin片剂6815.3.1屈他维林Drotaverine注射剂6915.5复方牛胎肝提取物CompoundEmbryonicBovineLiverExtract口服常释剂型7015.5腺苷蛋氨酸Ademetionine注射剂7115.8氨基水杨酸Aminosalicylic Acid肠溶片7215.8酪酸梭菌活菌Clostridum Butyricum片剂，口服散剂限菌群失调。7315.8奥沙拉秦Olsalazine胶囊剂7416.2腺苷Adenosine注射剂7516.4尼索地平Nisoldipine片剂，缓释胶囊7616.7复方卡托普利Compound Captopril片剂7716.8坎地沙坦酯Candesartan Cilexetil片剂限非限定支付的抗高血压药无效或不能耐受病人，心力衰竭，急性心肌梗塞，糖尿病性肾病。7816.9单硝酸异山梨酯Isosorbide Mononitrate缓释片，分散片7916.11维生素E烟酸酯Vitamin E Nicotinicate胶囊限经饮食控制无效的高脂血症。8016.11藻酸双酯钠Alginic Sodium Diester胶囊剂8116.11弹性酶Elastase Enteric-coated肠溶胶囊剂8216.11多烯酸乙酯Ethyl Polyenoare胶丸8316.12辅酶QCoenzyme Q胶丸8417.3氨苯蝶啶氢氯噻嗪TriamtereneandHydrochlorothiazide片剂8517.4萘哌地尔Naftopidil片剂8618.1白眉蛇毒血凝酶Hemocoagulase注射剂8718.1维生素K4Vitamin K4片剂8818.3右旋糖酐20Dextran 20注射剂8918.4.1多糖铁复合物Iron Polysaccharide Complex胶囊9018.4.2重组人白细胞介素-11Recombinant Human Interleukin-11注射剂使用其它药物无效的血小板减少症，且血小板计数低于20109/L。9119果糖Fructose注射剂9219转化糖InvertSugar注射剂9320.1.1.2复方酮康唑Compound Ketoconazole软膏剂9420.1.1.2复方克霉唑Compound Clotrimazole软膏剂9520.1.2异维A酸Erythromycin Estolate Suspension凝胶剂9620.1.3卤米松三氯生Halometasone and Triclosan软膏剂9720.1.3糠酸莫米松Mometasone Furoate软膏剂9820.1.4复方炉甘石Compound Calamine散剂9920.1.4双氯芬酸二乙铵Diclofenac Diethylamine软膏剂，凝胶剂10020.1.4复方肝素钠尿囊素Campound Haparin Sodium and Allantoin软膏剂10120.1.4钙泊三醇Calcipotriol软膏剂10220.2.1.1妥布霉素地塞米松Tobramyin-Dexmethasone滴眼剂,眼膏剂10320.2.1.2复方碘苷Compound Idoxuridine眼膏剂10420.2.3四环素泼尼松CompoundTetracylineandPrednisone眼膏剂10520.2.4氨碘肽Amiotide滴眼剂10620.2.4复方噻吗洛尔Compound Timolol滴眼剂10720.3呋麻Ephedrine and Nitrofurazone滴鼻剂10820.3复方薄荷脑Compound Menthol吸入剂10920.3西地碘Cydiodine片剂11020.3奈甲唑啉Naphazoline Hydrochloride滴鼻剂11120.5.1米非司酮Mifepristone片剂限子宫肌瘤。11220.5.2双唑泰Metronidazole栓剂11320.6放射性碘125I化钠Sodium Iodide125I口服液体剂11420.6锝99mTC焦磷酸盐Technetium99MTC Pyrophosphate注射剂11521.3复方氯解磷定Compound Pralidoxime Chloride注射剂11622.1.2碘羟拉葡胺MeglumineIoxitalamate注射剂11723金黄色葡萄球菌滤液制剂StaphylococcusAureasFiltratePreparation注射剂限以适应证之一，且每个疗程不超过50030支，每个结算年度使用不超过2个疗程。骨折及陈旧性骨折；恶性肿瘤放疗或化疗辅助性治疗。1185.3.2.1安痛定Antondine注射剂1195.3.2.2苯甲酸钠咖啡因Caffeine and Sodium Benzoate注射剂、粉剂1206.1.3复合维生素BCompound Vitamin B注射剂、溶液剂1216.1.4呋喃硫胺Fursultiamine注射剂1226.1.5呋喃硫胺Fursultiamine片剂1236.1.6复方芦丁Compound Rutoside片剂12410.3.7甲基斑蝥胺Methylcantharidimide片剂12511.1H1.8氯苯那敏Chlorphenamine注射剂12615.3.1.9复方庆大霉素普鲁卡因Compound Gentamycin Sulfate胶囊剂12715.5.10叶绿素铜钠Sodium Cupper Chlorophyllin片剂(胶囊剂)12816.9.11复方罗布麻Compound Apocyne Venete片剂12916.12.12三磷酸腺苷(ATP)Adenosine T