فهرست قيمت داروهاي مورد تعهد سازمان بيمه خدمات درماني
قيمتهاي اعلامي‘ حداقل قيمت احراز شده ميباشد
شماره342- تاریخ ارسال1387/09/10
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
هلال احمر
1387/01/20
1387/08/12
34000
40000
AMP
IRON POLYMALTOSE
تجويز توسط متخصص
01556
951
0
6,000
5
For inj.(wlth preservatlve
METHOTREXATE(AS SODIUM
00827
1104
شفا اراد
1386/04/22
1387/03/22
1387/08/13
200000
395089
665000
100
For inj
CARMOSTINE(BICNU
00219
270
قیمت پایه
85
60
10
Tab
METOCLOPRAMIDE HCL
00841
1132
650
600
500
NALIDIXIC ACID
00881
1186
140
115
Scored Tab
NITROFURANTOIN
00907
1219
قيمت پايه
2,000
1,900
50
OXYMETHOLONE
تجويزتوسط متخصص
00936
1276
350
275
F .C. Tab
PHENAZOPYRIDINE HCL
00976
1344
900
750
PABA-K
01026
1281
160
135
15
Coated Tab
PROPANTHELINE BROMIDE
01066
1454
1,350
1,200
Scored.Tab
SPIRONOLACTONE
02099
1613
240
150
SUCRALFATE
01179
1631
700
E .C. Tab
SULFASALAZINE
01183
1639
90
70
PROPRANOLOL HCL
01067
1459
130
40
Scored F. C. Tab
01068
1461
480
400
Cap
RIFAMPIN(REFAMPICIN
01101
1505
850
300
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
250
For Oral Sol,(100ml
PENICILLIN V POTASSIUM
00963
1318
440
00966
1316
950
620
20
SUPPOSITORY
PIROXICAM
02094
1391
55,000
50,000
Top. Cream 500g
SILVER SULFADIAZINE
01128
1552
800
Powder
SORBITOL
01162
1607
DICYCLOMINE HCL
00429
560
200
120
2,5
DIHYDROERGOTAMINE MESYLATE
00442
571
1,5
DIHYDROERGOTOXINE MESYLATE
به شرط توليد
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
TAB
TAMOXIFEN
02465
1642
THIORIDAZINE HCL
01221
01220
1679
25
01222
1681
VITAMIN B1(THIAMINE HCL
01292
1796
320
220
01293
1797
4,750
3,500
8%
Top. Cream
CALAMINE-D
00190
236
4,500
Lotion(60ml
02592
237
5,000
1%
Top.Gel
CLINDAMYCIN (AS PHOSPHATE
01862
378
3,000
0.05%
LOTION
CLOBETASOL PROPIONATE
02425
386
3,800
Elixir
00430
561
قیمت پايه
Vag.cream
CLOTRIMAZOLE
00325
402
4,000
2,700
Top.Sol
00327
5,500
2%
CREAM VAG
02230
404
20,000
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
125
0,125
S .C. Tab
METHYLERGONOVINE MALEATE
00833
1123
2,500
10%
Inj ( 10 ml
CALCIUM GLUCONATE
00200
245
Inj
CITICOLINE (AS SODIUM
00303
365
METHYLPREDNISOLONE ACETATE
00835
1128
2,100
30
inj
PENTAZOCINE(AS LACTATE
01357
1322
_
2
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
قیمت مبنا
رازی
1387/06/26
375000
625000
500000
12
INTERFERON BETA (REBIF
02666
908
1387/08/11
Chewable Tab
CHILDREN COLD
00260
313
CHLORDIAZEPOXIDE
00267
319
80
00268
2,900
2,300
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
1
ESTRADIOL. VALERATE
00503
649
45
00504
0,05
ETHINYLESTRADIOL
00511
658
0,5
00512
659
3,300
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
8
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
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
F.C.Tab./Cap
MEFENAMIC ACID
00794
1062
PHENYTOIN SODIUM
00993
1361
175
01017
1388
195
TETRACYCLINE HCL
01207
1662
THIOTHIXENE
01223
1682
PEARL
VITAMIN D3
01303
1801
INDOMETHACIN
00669
894
1,600
HALOPERIDOL(AS LACTATE
00620
815
3
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
1,250
TRIFLUOPERAZINE(AS 2HCL
01254
1731
2,450
METHOCARBAMOLE
00822
1100
4
BETAMETHASONE (AS DISODIUM PHOSPHATE
00149
189
6000
CALCITONIN
00194
239
1384/11/18
17180
10000
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
60000
101000
Spray (60 dose
FLUTICASONE
01889
737
فردوس
1387/07/27
3000000
2500000
Inj.(IV
IMMUNE GLOBULIN
بیمارستانی و یا تجويز توسط متخصص
00878
891
1387/08/18
190000
205200
Spray
02053
735
رازي
362500
399000
404900
25/125
INHALER
SALMETEROL/FLUTICASONE
04795
1543
مهشاد رازی
40925
50930
59000
12/5
For Infu
DOBUTAMINE(AS HCL
بيمارستاني
00466
595
19,000
ETOMIDATE
01501
665
50000
58500
BECLOMETHASONE DIPROPIONATE
04684
162
داروپخش
1387/08/19
1,100
1,040
ETHOSUXIMIDE
00514
661
800000
540000
1400000
INTERFERON GAMMA
00686
915
هجرت
BROMHEXINE HCL
00178
15,000
10,000
INSULIN ISOPHANE(NPH)Human
00673
901
INSULIN(REGULAR) Human
00674
906
1387/08/20
107000
408000
EPIRUBICIN HCL
00492
632
1386/02/05
521000
00491
631
شفا
6,707
7,820
Sol. For Neubolisation
IPRATROPIUM BROMIDE
00709
945
506,000
501800
For infu
PACLITAXEL
00943
1284
شفاآراد
1387/06/10
5300
5961
4000
FLECAINIDE
00536
698
18000
16500
ACITRETIN
00018
26
88600
70480
Infu
AMINOACID 5%
بيمارستاني و یا تجویز توسط متخصص
00057
2272000
ANTITHYMOCYTE IMMUNOGLOBULIN
00100
112
پخش رازی
2180000
2200000
2080000
INJ. POWDER, LYOPHILIZED
بیماران پیوندی و متخصص
02371
113
7500
6500
BETAXOLOL(AS HCL
00163
197
48000
46000
CAPECITABINE
متخصص خون و انکولوژی
02493
256
مختلف
155
CALCIUM (AS CARBNATE
00198
246
188000
90000
CARBOPLATIN
00215
265
287500
331000
120000
00214
264
1200
780
1000
0,625
CONGUGATED ESTROGENS
00352
431
فرازآوران
فراز آوران
92020
96415
53000
DACARBAZINE
00376
473
170000
143000
125000
66000
DACTINOMYCIN
00378
477
49800
45000
5000
DALTEPARIN SODIUM (FRAGMIN
02259
479
خوارزمی
Syrup(60 ml
01462
543
1772000
2154400
853000
1980000
DOCETAXEL
01716
596
6850000
8617800
3440000
7904700
01478
597
63500
70000
02354
18700
16350
ESTRAMUSTINE SODIUM PHOSPHATE
00505
20000
13000
ETOPOSIDE
00517
666
FLUCONAZOLE
02128
705
27500
59360
FLUORESCEIN SODIUM
00547
715
10500
3000
FLUOROURACIL
00550
720
البرز
1387/05/21
1387/08/01
145800
176000
135000
Nasal spray
05290
734
محیا دارو
1900
HYDROXYUREA
00648
853
شرکت سهامی
MESNA
00814
1090
459000
433000
For inj.( without preservatlve
00826
1103
مهشاد رازي
شفا آراد
295300
318500
81500
NIMODIPINE
00904
1217
6600
6150
25000
PANCREATIN FORT
00945
1292
154500
137000
VIAL
PANTOPRAZOLE
بیمارستانی
02336
1295
اکتوورکو
2000
CAP
PENICILLAMINE
01714
1306
2850
2500
PIMOZIDE
01009
1376
195000
164400
0.5
inj.(Vacclne
PNEUMOCOCCAL VACCINE POLYVALENT
01020
1392
البرز-ثامن
9000
POTASSIUM CHLORIDE
00941
1404
1700
1550
550
PROPAFENONE HCL
01777
1451
382179
85000
Inj.(5ml
TENIPOSIDE
01195
1645
938000
1020000
895000
3.75
For Inj
TRIPTORELIN
01266
1742
VALPROATE SODUIM
01724
1756
1386/04/03
1800
2100
PYRIMETHAMINE
01083
1481
1386/06/28
5450
PHENOXYBENZAMINE HCL
00984
1352
Ophth oint
01206
1663
2,750
Inj.2 ml
PROMETHAZINE HCL
01061
1448
7,500
50%
MAGNESIUM SULFATE 7H20
00780
1048
00440
570
DIPHENHYDRAMINE COMPOUND
00456
585
DIPHENHYDRAMIN HCL
00454
582
Oral Sol
EXPECTORANT CODEINE
00524
672
Inj.2 ml - 20mg
00587
768
Inj.1ml - 40mg
00590
767
2,600
1,800
Inj.2ml - 80mg
00592
766
30%
METHYL SALICYLATE
00831
1118
75%
Top. Gel
METRONIDAZOLE
01590
1142
00997
1364
Susp
PYRVINIUM(AS PAMOATE
01085
1483
290
253
TRAZODONE HCL
01242
1707
Top. cream
00313
383
Top . Oint(15g
00314
384
00326
401
COATED TAB
DEXTROMETORPHAN HBR
00407
508
Syrup
DEXTROMETHORPHAN HBR
00405
506
4,100
Syrup (60 ml
DEXTROMETHORPHAN-P
00408
507
1 %
DICLOFENAC SODIUM
00426
551
00425
553
ALUMINIUM HYDROXIDE(AS DRIED GEL
00045
52
7,700
ALUMINIUM MG S
00049
58
AMLODIPINE (AS BESYLATE
00070
74
ANTIHISTAMINE DECONGESTANT
00098
106
325
00109
127
165
00111
00176
219
CHLORPHENIRAMINE MALEATE
00275
328
1387/08/23
4500
(400/80)
00341
442
1386/04/20
1387/08/25
4800
NIACINAMIDE
00896
1205
1386/08/20
28000
23400
CYCLOPHOSPHAMIDE
00368
460
FERROUS SULFATE-F
02048
690
1387/01/21
FERROUS SULFATE
01506
687
1385/02/18
1387/08/26
19200
21300
00566
1387/07/06
15500
17000
NOREPINEPHRINE BITARTRATE
01620
1244
INJ 5 ML
ALFENTANIL
01151
42
1% (10
00121
142
1385/10/23
95000
89200
100000
2,5%
Inj (2ml
PATENT BLUE V
00955
1303
سهامی
1387/03/15
1387/07/17
1387/08/06 1387/08/25 1387/08/25
327000
516000
450000
550000
548000
20%
Infu.(50 ml
ALBUMIN(HUMAN
بیمارستانی و یا تجویز توسط متخصص
00027
33
1383/07/12
1387/05/06
1387/08/27
8250
31000
8800
0/2
ISOPROTERENOL HCL
01558
959
27000
32500
PROCARBAZINE(AS HCL
01055
1443
4,200
TESTOSTERONE ENANTATE
01200
1653
01201
1654
0,05%
TRETINOIN
01245
1709
00340
445
FC Double Scored Tab
ETHAMBUTOL HCL
00508
655
6,500
4,900
FURAZOLIDONE
00569
748
00570
752
02134
751
LIDOCAINE - H
00762
1010
Inj.(5 ml
LIDOCAINE HCL
01573
1015
00753
1016
METHYLTESTOSTERONE
00838
1130
FC scored Tab
NORTRIPTYLINE(AS HCL
00922
1248
3,900
Ped.drop
ACETAMINOPHEN (PARACETAMOL
00003
ALPRAZOLAM
00040
49
01382
Inj(2ml
AMIKACIN(AS SULFATE
00053
4,400
3,960
00054
62
Supp
ANTIHEMORRHOID
00097
104
00166
204
420
Ped. Supp
00168
203
1387/02/09
1387/02/21
1387/08/28
4967000
1500000
3520000
4438000
Intratracheal Suspension
BERACTANT
بیمارستانی -فوق تخصص نوزادان
02372
181
1387/04/30
30000
32000
HALOPERIDOL(AS DECANOATE
00616
814
دارودرمان پارس
1387/08/29
8,800
INJ
FENTANYL
10376
684
1387/02/01
Aerosol(200dose
SALBUTAMOL
01115
1533
شركت سهامي
فرازاوران
اوزان
شرکت تخصصی
1385/02/24
1387/06/31
1387/05/13
3390
2883
5700
MELPHALAN
00803
1074
دارو درمان پارس
74,000
02158
1111
2300
2180
RIBAVIRIN
01891
1502
1387/05/24
180000
542200
MEROPENEM
بیمارستانی و متخصص
05629
1081
277200
03283
1082
مهشادرازی
1387/03/19
820
MINOXIDIL
00855
1161
01018
1389
3,200
00995
1363
دارو پخش
42,000
30,000
Aerosol
01449
448
1387/08/30
2900
2656
01778
1452
1385/08/16
1387/09/03
1350
5%
SODIUM CHLORIDE
01110
1586
1450
AMANTADINE HCL
00051
5,700
5% 250
INJ. SOL
DEXTROSE
06425
524
6,800
Infu 250ml
DEXTROSE 5% NACI 0.9%
02040
535
1383/08/12
1387/09/05
1600
5900
CHLORAMBUCIL
00262
314
1386/07/18
150000
400000
DANTROLENE SODIUM
00382
485
1386/02/08
1387/09/04
42500
34430
39500
PROCAINAMIDE HCL
01054
1442
1387/03/12
01949
1460
1387/02/10
DICLOFENAC SODIUM S.R
01464
559
1387/09/06
1,300
1,750
BUSULFAN
00186
233
VITAMIN D3 (COLECALCIFEROL
01304
1787
1387/09/09
8000
7400
00047
0,3 %
00297
354
ارمغان دارو
01993
558
00431
562
Oral Drops
DIMETHICONE(ACTIVATED
01132
581
68
Eqto 50 mg Fe
00531
686
4200
FERROUS SULFATE 7H2O
00530
688
11000
HEPARIN SODIUM
00625
824
4100
00624
825
5500
3300
Ophth.Oint
00639
840
298000
284000
370
inj. 50 ml
IOPROMIDE
02146
939
قاسم ايران
0.025%
DROPS, SOL
KETOTIFEN
05975
974
45800
38400
Top. Sol
METHOXSALEN
00829
1115
PREDNISOLONE FORTE
01044
1433
1300
Ophth Oint
SIMPLE EYE OINT
01134
1553
TROPICAMIDE
تجويز توسط متخصص چشم
01267
1746
12000
01742
1747
1387/09/07
1,220
Eff . Tab
CALCIUM FORTE
00199
244
7,200
Mouthwash
CHLORHEXIDINE GLUCONATE
00270
321
38,000
00353
433
1,25
00354
432
8200
22500
DIGOXIN
00438
567
583. 5
PIPERAZINE HEXAHYDRATE(AS CITRATE
01012
1384
BARIUM SULFATE
01334
157