فهرست قيمت داروهاي مورد تعهد سازمان بيمه خدمات درماني
قيمتهاي اعلامي‘ حداقل قيمت احراز شده ميباشد
شماره332- تاریخ ارسال1387/08/19
نام توليد كننده و يا توزيع كننده
تاريخ اجراي تغيير قيمت توسط استان
تغيير قيمت
قيمت (ريال)
دوز دارو
شكل دارو
نام دارو
شرط تعهد بيمه
كد دارو
رديف
مختلف
1387/07/21
23,000
20,000
500
For Inj
VANCOMYCIN(AS HCL
بيمارستاني
01276
1765
4,000
3,200
4
Oral Drops
METOCLOPRAMIDE HCL
00840
1131
150
90
250
Tab
METRONIDAZOLE
00845
1144
130
85
ACETAMINOPHEN (PARACETAMOL
02012
8
800
300
ASA MICROCOATED
00112
123
3,000
1,600
20
inj
HYOSCINE .N. BUTYL BROMIDE
00655
859
12,500
Inj. 20 ml
MEGLUMINE COMPOUND 60%
تجويز توسط متخصص
00802
1067
29,000
15,000
MEGLUMINE COMPOUND 76%
00799
1068
350
220
METHOCARBAMOLE
00823
1101
2,300
1,250
10
Inj
METOCLOPRAMIDE(AS HCL OR 2HCL
00839
1133
4,500
TAB
AZITHROMYCIN
به شرط توليد
02407
148
5,000
3,300
Elixir (60 ml
BELLADONNA PB
00135
163
115
80
50
E.C Tab
DICLOFENAC SODIUM
02041
557
66
Coated Tab
FLUORIDE SODIUM
01154
716
شركت سهامي
داروپخش
1384/11/10
1387/07/22
50000
149000
15
For inj
BLEOMYCIN(AS SULFATE
00170
207
دارو پخش
1386/10/20
191000
202000
240
inj.50 ml
IOHEXOL
00699
920
مهشاد رازي
مهشاد رازی
1386/06/01
94000
110000
DESMOPRESSIN ACETATE
01338
494
فردوس
1385/07/25
1350
2000
DICYCLOMINE HCL
00431
562
هلال احمر
1385/12/01
190000
216000
Infu. 5ml
CICLOSPORIN
06685
343
1387/03/29
1810
2050
2160
1600
SET OF SERUM
66661
1548
رازی
1387/06/26
511000
481500
10,000
ASPARAGINASE
00113
اوزان
هجرت
1387/05/19
1387/04/30
66152
41400
46000
ACICLOVIR(AS SODIUM
00022
24
رازي
فرازآوران
فراز آوران
1387/01/21
1387/05/22
53000
92020
96415
100
DACARBAZINE
00376
473
1387/07/23
98000
62000
inj.20 ml
00698
919
1386/12/05
38000
inj.10 ml
00700
922
75000
120000
inj. 20 ml
00701
923
80000
140000
01550
931
30000
60000
00697
918
300,000
301,500
25/50
INHALER
SALMETEROL/FLUTICASONE
04793
1545
قیمت مبنا
1386/02/05
12000
66950
2
MITOMYCIN
00857
1163
1,570,000
6
INJ
PACLITAXEL
02396
1285
2,310,000
2,389,900
02395
1286
1387/07/27
600000
160000
300000
1
Inj.(IV
IMMUNE GLOBULIN
بیمارستانی و یا تجويز توسط متخصص
00919
888
1500000
400000
500000
800000
750000
2.5
00918
889
1800000
480000
900000
3
00920
890
3600000
960000
1200000
3000000
00879
892
6000000
1600000
5000000
01763
893
4950000
5972000
04098
1287
1387/07/25
10000
20768
40
THIOGUANINE
01217
1676
1386/01/01
68
Eqto 50 mg Fe
F .C. Tab
FERROUS SULFATE
00531
686
1387/07/28
INTERFERON BETA
02668
907
شرکت سهامی
173000
74000
DAUNORUBICIN (AS HCL
00384
488
1387/04/09
6500
11000
HEPARIN SODIUM
00625
824
1387/07/29
150,000
1085600
1785300
290000
1320000
PAMIDRONATE (AREDIA
انکولوژیست و روماتولوژیست
و فوق تخصص غدد
01899
1289
هجرت(اکبریه)
1385/03/23
351500
0,5
FLUMAZENIL
00544
710
1387/02/10
1387/08/05
52000
128900
Inj(IM
DIMERCAPROL
00449
579
31500
68000
25
Susp
NITROFURANTOIN
00908
1220
1386/08/17
1387/08/06
57300
32300
Otic.Drops
POLYMYXIN-NH
01024
1396
4100
5000
00624
825
سهامی
1387/03/15
1387/07/17
327000
516000
450000
340000
365000
498000
20%
Infu.(50 ml
ALBUMIN(HUMAN
بیمارستانی و یا تجویز توسط متخصص
00027
33
1387/08/07
60,000
101,000
125
Spray (120 dose
FLUTICASONE
02711
736
1383/10/29
2030
10420
Cap
MEXILETIN
00848
1148
قيمت پايه
1387/08/01
100000
359300
187021
IFOSFAMIDE
00662
871
1387/08/08
33800
23000
368,600
IMATINIB
انکولوژیست
04840
875
1387/04/24
291000
INJ. POWDER
CYTARABINE
01454
471
البرز
1387/05/14
1387/05/21
135000
145800
176000
Nasal spray
05290
734
1386/08/20
1387/02/23
1387/04/08
25000
78000
MITOTANE
00858
1165
1387/01/20
1387/08/12
34000
40000
AMP
IRON POLYMALTOSE
01556
951
0,25
Oral Sol
DIHYDROTACHYSTEROL
00444
573
0
6,000
5
For inj.(wlth preservatlve
METHOTREXATE(AS SODIUM
00827
1104
قیمت پایه
600
Scored.Tab
PREDNISOLONE FORTE
01044
1433
شفا اراد
1386/04/22
1387/03/22
1387/08/13
200000
395089
665000
CARMOSTINE(BICNU
00219
270
60
00841
1132
650
NALIDIXIC ACID
00881
1186
140
Scored Tab
00907
1219
2,000
1,900
OXYMETHOLONE
تجويزتوسط متخصص
00936
1276
275
PHENAZOPYRIDINE HCL
00976
1344
900
750
PABA-K
01026
1281
160
135
PROPANTHELINE BROMIDE
01066
1454
1,350
1,200
SPIRONOLACTONE
02099
1613
SUCRALFATE
01179
1631
700
E .C. Tab
SULFASALAZINE
01183
1639
70
PROPRANOLOL HCL
01067
1459
Scored F. C. Tab
01068
1461
480
400
RIFAMPIN(REFAMPICIN
01101
1505
850
01103
1506
170
110
TERBUTALIN SULFATE
01198
1651
3,700
200,000
For Susp
PENICILLIN V BENZATHINE
00964
1315
9,000
400,000
00965
1314
8,000
7,000
For Oral Sol,(100ml
PENICILLIN V POTASSIUM
00963
1318
440
00966
1316
950
620
SUPPOSITORY
PIROXICAM
02094
1391
55,000
50,000
Top. Cream 500g
SILVER SULFADIAZINE
01128
1552
Powder
SORBITOL
01162
1607
00429
560
200
120
2,5
DIHYDROERGOTAMINE MESYLATE
00442
571
1,5
DIHYDROERGOTOXINE MESYLATE
00443
572
1,450
one-blister
CONTRACEPTIVE HD
00356
436
CONTRACEPTIVE LD
00357
437
230
Adult tab
CO-TRIMOXAZOLE
00339
444
260
TAMOXIFEN(AS CITRATE
01193
1643
TAMOXIFEN
02465
1642
THIORIDAZINE HCL
01221
01220
1679
01222
1681
VITAMIN B1(THIAMINE HCL
01292
1796
320
01293
1797
4,750
3,500
8%
Top. Cream
CALAMINE-D
00190
236
Lotion(60ml
02592
237
1%
Top.Gel
CLINDAMYCIN (AS PHOSPHATE
01862
378
0.05%
LOTION
CLOBETASOL PROPIONATE
02425
386
3,800
Elixir
00430
561
قیمت پايه
Vag.cream
CLOTRIMAZOLE
00325
402
2,700
Top.Sol
00327
5,500
2%
CREAM VAG
02230
404
16,720
2% (13
Nasal Spray
CROMOLYNSODIUM
01749
450
FLURAZEPAM(AS HCL
00558
732
HYDROCORTISONE
00638
IMIPRAMINE HCL
00664
881
00665
882
LIOTHYRONINE SODIUM
00763
1024
F. C. Tab
METFORMIN HCL
00817
1094
METHIMAZOLE
00821
1099
0,125
S .C. Tab
METHYLERGONOVINE MALEATE
00833
1123
2,500
10%
Inj ( 10 ml
CALCIUM GLUCONATE
00200
245
CITICOLINE (AS SODIUM
00303
365
METHYLPREDNISOLONE ACETATE
00835
1128
2,100
30
PENTAZOCINE(AS LACTATE
01357
1322
_
Inj.4ml
ONDANSETRON(AS HCL
به شرط توليدوباتجويزمتخصص
02092
1268
2,400
DESOXYCORTICOSTERONE ACETATE
00390
497
Top.Cream
KETOCONAZOLE
00725
973
Susp. 240 ml
MAGNESIUM HYDROXIDE
00777
1045
SYRUP
LORATADINE
02011
1034
14,000
12,000
Susp(120 ml
00882
1185
2,350
0,05 %
Nasal Drops
NAPHAZOLINE HCL OR NITRATE
00886
1191
0,2 %
Top cream
NITROFURAZONE
00909
1222
375000
625000
12
INTERFERON BETA (REBIF
02666
908
1387/08/11
Chewable Tab
CHILDREN COLD
00260
313
CHLORDIAZEPOXIDE
00267
319
00268
2,900
CIMETIDIME(AS HCL
00291
348
F.C Tab
CIPROFLOXACIN(AS HCL
00295
352
00296
353
CLEMASTINE (AS FUMARATE
00307
369
S. C. Tab
DESIPRAMINE HCL
00388
492
DIAZEPAM
00417
547
00419
75
55
00420
546
DIMENHYDRINATE
00448
578
43
DIPHENOXILATE
00457
586
ESTRADIOL. VALERATE
00503
649
45
00504
0,05
ETHINYLESTRADIOL
00511
658
00512
659
0,025 %
FLUOCINOLONE ACETONIDE
00546
711
Top .oint
00545
712
FLUPHENAZINE 2HCL
00553
729
00554
730
FUROSEMIDE
00571
753
Top Oint
HYDROCORTISONE ACETATE
00640
842
79
ALUMINIUM MG
00048
54
44
ASA(ACETYLSALICYLIC ACID
00106
124
83
E. C. Tab
01395
126
95
BETAHISTINE 2HCL
00148
184
0,1%
Ophth. Oint
BETAMETHASONE DISODIUM PHOSPHATE
00151
194
BIPERIDEN HCL
00164
199
BISACODYL
00167
202
5,300
Top.Oint
BURN OINTMENT (FOR MINOR BURNS
00183
228
-
LEVOTHYROXINE SODIUM
02067
1009
0,1
00751
1008
1,000
27
Sachet
ORS
00933
1269
180
RANITIDINE(AS HCL
01093
1497
THEOPHILLINE SR
01209
1671
25,000
Coated Chewable Tab
VITAMIN A
01287
1782
190
01289
1784
TRIAMTERENE-H
01252
1724
ISOXSUPRINE HCL
00721
967
22,000
17,600
ITRACONAZOLE
00722
968
16,900
MUPIROCIN
00875
1175
PHENOBARBITAL
00979
1345
00980
1346
00982
1347
%20%
ZINC OXIDE
01316
1814
11,500
Vag.Cream
TRIPLE SULFA
01264
1740
0,05%
sol
TRETINOIN
01246
1712
4,200
01696
1711
2,600
0,025%
01244
1710
TOLNAFTATE
01236
1694
3%
TETRACYCLINE HCL
01208
1664
210
IODOQUINOL (DIIODOHYDROXYQUINOLINE
00416
917
132
INDOMETHACIN SR
00671
897
Double Scored Tab
ISONIAZID
00712
954
510
00713
955
ISOSORBIDE DINITRATE
00717
962
KETOTIFEN(AS FUMARATE
00727
976
550
420
ped supp
ACETAMINOPHEN(PARACETAMOL
00006
11
520
325
Supp
00008
00427
556
00428
555
INDOMETHACIN
00668
895
00670
896
CHOLESTYRAMINE
00283
336
F.C.Tab./Cap
MEFENAMIC ACID
00794
1062
PHENYTOIN SODIUM
00993
1361
175
01017
1388
195
01207
1662
THIOTHIXENE
01223
1682
PEARL
VITAMIN D3
01303
1801
00669
894
HALOPERIDOL(AS LACTATE
00620
815
Sterile Eye Drops
GENTAMICIN (AS SULFATE
00589
770
24,000
28,000
Vag.Douche
POVIDONE IODINE
01843
1415
Vag. gel(80 g
01038
1416
3,600
Lotion
BETAMETHASONE (AS VALERATE
00159
3,400
0,1%(15
Top . Oint
00160
192
00161
191
3,750
0,5%
Top . Gel
01016
1390
AMITRIPTYLINE HCI
00066
72
185
ERGOTAMINE-C
00493
634
FAMOTIDINE
00527
679
00528
680
470
GEMFIBROZIL
00584
764
01520
765
GRISEOFULVIN
00613
809
IBUPROFEN
00658
863
00659
864
138708/11
PHENOBARBITAL SODIUM
00977
1349
Inj.(2ml
01094
1498
1,500
Inj(1 ml
TRAMADOL HCL
02708
1699
TRIAMCINOLONE ACETONIDE
01248
1717
Top Olnt
01249
1718
4,700
3,250
TRIAMCINOLONE N.N
01251
1719
64
TRIHEXYPHENIDYL HCL
01258
1734
VERAPAMIL.HCL
01279
1770
1387/08/15
BETAMETHASONE LA
00153
196
1387/08/16
2,800
0,5% (10
ATROPINE SULFATE
00118
141
PROGESTERONE
01057
1444
2,200
01058
1445
1387/03/13
14000
3500
6/5
Inj.(IM
THIETHYLPERAZINE(AS OIMALEATE
01216
1675
TRIFLUOPERAZINE(AS 2HCL
01254
1731
2,450
00822
1100
BETAMETHASONE (AS DISODIUM PHOSPHATE
00149
189
6000
CALCITONIN
00194
239
1384/11/18
17180
02312
238
LOPERAMIDE HCL
01848
1030
48
LORAZEPAM
00771
1036
56
00772
1037
65
OXAZEPAM
00934
1274
PERPHENAZINE
00972
1337
00973
1338
63
00975
1339
PRAZOSIN(AS HCL
01043
1422
1800
2100
PYRIMETHAMINE
01083
1481
101000
Spray (60 dose
01889
737
2500000
00878
891
1387/08/18
205200
Spray
02053
735
پخش رازی
1387/02/09
1387/08/14
2180000
2200000
2080000
INJ. POWDER, LYOPHILIZED
ANTITHYMOCYTE IMMUNOGLOBULIN
بیماران پیوندی و متخصص
02371
113
362500
399000
404900
25/125
04795
1543
40925
50930
59000
12/5
For Infu
DOBUTAMINE(AS HCL
00466
595
19,000
ETOMIDATE
01501
665
58500
BECLOMETHASONE DIPROPIONATE
04684
162
1387/08/19
1,100
1,040
ETHOSUXIMIDE
00514
661
540000
1400000
INTERFERON GAMMA
00686
915
BROMHEXINE HCL
00178
INSULIN ISOPHANE(NPH)Human
00673
901
INSULIN(REGULAR) Human
00674
906
1387/08/20
107000
408000
EPIRUBICIN HCL
00492
632
521000
00491
631
شفا
6,707
7,820
Sol. For Neubolisation
IPRATROPIUM BROMIDE
00709
945
506,000
501800
For infu
00943
1284
شفاآراد
1387/06/10
5300
5961
4000
FLECAINIDE
00536
698