政府定价药品目录内非处方药和民族药最高零售价格表

序号医保编号药品名称剂型规格单位最高零售价格备注156红霉素软膏剂6g:60mg(1%)支0.95软膏剂8g:80mg(1%)支1.2软膏剂10g:0.1g(1%)支1.4眼膏2g支0.84眼膏2.5g支1.0275磺胺嘧啶银乳膏剂10g:0.1g(1%)支13.3乳膏剂20g:0.2g(1%)支22.7乳膏剂25g:0.25g(1%)支26.9乳膏剂30g:0.3g(1%)支30.9乳膏剂40g:0.4g(1%)支38.5388甲硝唑阴道泡腾片200mg*8片盒6.9阴道泡腾片200mg*10片盒8.5阴道泡腾片200mg*12片盒10.2阴道泡腾片200mg*14片盒11.8阴道泡腾片200mg*16片盒13.4凝胶剂5g:37.5mg支7.0凝胶剂10g:75mg支11.9凝胶剂20g:150mg支20.2490替硝唑阴道泡腾片200mg*8片盒10.4阴道泡腾片250mg*12片盒18.2栓剂100mg*2枚盒5.3栓剂200mg*7枚盒30.3栓剂250mg*5枚盒26.05107克霉唑阴道片150mg*10片盒58.5阴道片500mg*1片盒16.0软膏剂5g:50mg*5支盒3.4软膏剂5g:50mg*7支盒4.6软膏剂5g:150mg(3%)，软塑管支1.0乳膏剂10g:30mg支0.80软膏剂10g:100mg，软塑管支1.2乳膏剂10g:100mg(1%)支1.2乳膏剂10g:300mg(3%)支2.0乳膏剂20g:600mg(3%)支3.4栓剂100mg*10枚盒6.1栓剂150mg枚0.90附件:政府定价药品目录内非处方药和民族药最高零售价格表一、西药部分金额单位：元第1页，共87页序号医保编号药品名称剂型规格单位最高零售价格备注栓剂150mg*3枚盒2.6栓剂150mg*10枚盒8.3膜剂50mg*14片盒18.66108咪康唑软膏剂10g:200mg(2%)支6.8软膏剂15g:300mg(2%)支9.2软膏剂20g:400mg(2%)支11.5软膏剂25g:500mg(2%)支13.6软膏剂40g:800mg(2%)支19.6栓剂100mg*10粒盒11.3栓剂200mg*7枚盒13.6栓剂200mg*10粒盒19.2栓剂200mg*7枚盒21.4西安杨森栓剂400mg:3枚盒28.9西安杨森栓剂1.2g*1枚盒33.8西安杨森7109酮康唑乳膏10g:200mg支8.7乳膏15g:300mg支11.9乳膏15g:300mg支18.6西安杨森洗剂50ml:20mg瓶0.84洗剂50ml:1.042g瓶17.48114特比萘芬软膏剂5g:50mg(1%)支7.3软膏剂10g:100mg(1%)支12.4软膏剂15g:150mg(1%)支16.9软膏剂20g:200mg(1%)支21.1软膏剂5g:50mg(1%)支14.6葛兰素史克9116阿昔洛韦软膏剂10g:100mg(1%)支1.6软膏剂4g:120mg(3%)支1.9软膏剂10g:300mg(3%)支3.8软膏剂15g:450mg(3%)支5.2软膏剂20g:600mg(3%)支6.5软膏剂5g:250mg(5%)支3.3软膏剂15g:750mg(5%)支3.910135小檗碱片剂25mg*1000片盒(瓶)22.6片剂50mg*100片盒(瓶)4.2片剂50mg*1000片盒(瓶)38.4片剂100mg*12片盒0.92片剂100mg*18片盒1.4片剂100mg*20片盒1.5片剂100mg*21片盒1.6片剂100mg*24片盒1.8片剂100mg*27片盒2.0片剂100mg*40片瓶2.9片剂100mg*96片瓶6.8片剂100mg*100片瓶7.1片剂100mg*1000片瓶65.311152甲苯咪唑片剂100mg*6片盒2.3西安杨森片剂250mg*100片瓶3.312153阿苯达唑片剂100mg*10片盒(瓶)5.9第2页，共87页序号医保编号药品名称剂型规格单位最高零售价格备注片剂100mg*100片盒(瓶)54.1片剂200mg*10片盒10.0片剂200mg*2片袋2.6葛兰素史克片剂200mg*10片盒12.1葛兰素史克13155哌嗪片剂50mg*50片瓶0.40片剂200mg*500片瓶10.8片剂500mg*100片盒(瓶)4.6片剂500mg*1000片盒(瓶)42.314156双羟萘酸噻嘧啶片剂300mg*24片袋6.115162阿司匹林肠溶片25mg*60片盒3.5肠溶片25mg*100片瓶5.8肠溶片50mg*30片盒3.1肠溶片50mg*50片瓶5.1肠溶片50mg*30片*2板盒6.0肠溶片50mg*100片瓶9.9肠溶片75mg*10片*2板盒2.9肠溶片100mg*30片盒5.3肠溶片100mg*10片盒6.9德国拜耳肠溶片100mg*30片盒19.8德国拜耳肠溶片250mg*60片盒20.7肠溶片300mg*12片盒5.0肠溶片300mg*24片盒9.8肠溶片300mg*36片盒14.5肠溶片300mg*100片瓶38.9肠溶微丸胶囊75mg*20粒盒(瓶)18.3肠溶微丸胶囊100mg*10粒盒11.716163布洛芬片剂100mg*24片盒1.1片剂100mg*30片盒1.3片剂100mg*40片盒1.7片剂100mg*100片瓶4.2片剂200mg*10片盒0.78片剂200mg*20片盒1.5片剂200mg*24片盒1.8片剂200mg*30片盒2.2片剂200mg*80片瓶5.8片剂200mg*100片瓶7.1片剂300mg*100片瓶9.7片剂400mg*100片瓶12.1胶囊100mg*100粒盒5.9缓释片200mg*20片盒10.7缓释片300mg*20片盒14.6缓释胶囊300mg*6粒盒4.7缓释胶囊300mg*8粒盒6.2缓释胶囊300mg*10粒盒7.7第3页，共87页序号医保编号药品名称剂型规格单位最高零售价格备注缓释胶囊300mg*12粒盒9.2缓释胶囊300mg*14粒盒10.6缓释胶囊300mg*16粒盒12.1缓释胶囊300mg*18粒盒13.6缓释胶囊300mg*20粒盒15.0缓释胶囊300mg*24粒盒17.9缓释胶囊300mg*28粒盒20.8缓释胶囊300mg*120粒盒84.4乳膏剂20g:1g支19.017167氨基葡萄糖胶囊240mg(以氨基葡萄糖计)*10粒盒24.8胶囊240mg(以氨基葡萄糖计)*20粒盒48.4胶囊240mg(以氨基葡萄糖计)*42粒盒99.0胶囊250mg*12粒盒30.5胶囊250mg*20粒盒50.0胶囊250mg*24粒盒59.5胶囊750mg(以氨基葡萄糖计)*10粒盒59.418169贝诺酯片剂200mg*24片盒6.5片剂200mg*36片盒9.7片剂500mg*12片盒6.8片剂500mg*24片盒13.219172对乙酰氨基酚片剂100mg*16片盒0.23片剂100mg*100片瓶1.3片剂160mg*10片盒0.21片剂300mg*12片盒0.40片剂300mg*12片*2板盒0.78片剂300mg*12片*5板盒1.9片剂300mg*100片瓶3.1片剂300mg*1000片盒(瓶)28.5片剂500mg*10片盒0.50片剂500mg*12片盒0.59片剂500mg*20片盒0.97片剂500mg*30片瓶1.4片剂500mg*60片瓶2.8片剂500mg*100片盒(瓶)4.6片剂500mg*400片盒(瓶)17.4片剂500mg*500片盒(瓶)21.6片剂500mg*1000片盒(瓶)42.1片剂650mg*6片盒0.37片剂500mg*2片盒1.2中美天津史克制药片剂500mg*10片盒4.4中美天津史克制药,上海强生制药胶囊300mg*12粒盒1.4第4页，共87页序号医保编号药品名称剂型规格单位最高零售价格备注分散片100mg*10片盒4.0颗粒剂100mg*6袋盒2.1颗粒剂160mg*10袋盒5.0颗粒剂160mg*10袋盒7.8昆明贝克诺顿制药颗粒剂300mg*6袋盒3.3颗粒剂2g:100mg*10袋盒2.4颗粒剂10g:500mg*10袋盒8.1咀嚼片80mg*30片盒13.8咀嚼片160mg*15片盒12.0咀嚼片500mg*10片盒(瓶)19.420175复方对乙酰氨基酚片剂10片盒(瓶)8.2片剂12片盒(瓶)9.8片剂20片盒(瓶)16.0片剂100片盒(瓶)75.421176复方氯唑沙宗片剂氯唑沙宗125mg,对乙酰氨基酚150mg*9片盒(瓶)5.4片剂氯唑沙宗125mg,对乙酰氨基酚150mg*24片盒(瓶)13.9片剂氯唑沙宗125mg,对乙酰氨基酚150mg*24片盒(瓶)20.0山东鲁南贝特制药片剂氯唑沙宗125mg,对乙酰氨基酚150mg*36片盒(瓶)20.5片剂氯唑沙宗250mg,对乙酰氨基酚300mg*3片盒(瓶)3.2片剂氯唑沙宗250mg,对乙酰氨基酚300mg*9片盒(瓶)9.2片剂氯唑沙宗250mg,对乙酰氨基酚300mg*24片盒(瓶)23.622178氨酚咖黄烷胺片剂12片盒(瓶)8.6片剂24片盒(瓶)16.823178氨酚美伪麻与苯酚伪麻片剂复方盒(瓶)10.924178氨酚伪麻片剂对乙酰氨基酚325mg,盐酸伪麻黄碱30mg*9片盒(瓶)12.3片剂对乙酰氨基酚325mg,盐酸伪麻黄碱30mg*10片盒(瓶)13.6片剂对乙酰氨基酚325mg,盐酸伪麻黄碱30mg*12片盒(瓶)16.2片剂对乙酰氨基酚500mg,盐酸伪麻黄碱30mg*10片盒(瓶)15.0片剂对乙酰氨基酚500mg,盐酸伪麻黄碱30mg*12片盒(瓶)17.925178氨酚伪麻美那敏片剂10片盒(瓶)9.126178氨酚伪麻那敏片剂含对乙酰氨基酚325mg,盐酸伪麻黄碱30mg,马来酸氯苯那敏2mg*10片盒(瓶)7.7第5页，共87页序号医保编号药品名称剂型规格单位最高零售价格备注片剂含对乙酰氨基酚325mg,盐酸伪麻黄碱30mg,马来酸氯苯那敏2mg*12片盒(瓶)9.2片剂含对乙酰氨基酚325mg,盐酸伪麻黄碱30mg,马来酸氯苯那敏2mg*24片盒(瓶)17.9胶囊265mg*6粒盒(瓶)4.2胶囊265mg*12粒盒(瓶)8.3咀嚼片含对乙酰氨基酚160mg,盐酸伪麻黄碱15mg,马来酸氯苯那敏1mg*12片盒(瓶)6.6咀嚼片含对乙酰氨基酚160mg,盐酸伪麻黄碱15mg,马来酸氯苯那敏1mg*24片盒(瓶)12.927178氨咖黄敏片剂250mg*12片盒3.6胶囊250mg*10粒盒3.2胶囊250mg*12粒盒3.828178氨咖愈敏口服溶液60ml瓶9.6口服溶液100ml瓶15.429178贝敏伪麻片剂12片盒(瓶)17.130178布洛伪麻片剂布洛芬200mg,盐酸伪麻黄碱30mg*6片盒(瓶)5.9片剂布洛芬200mg,盐酸伪麻黄碱30mg*12片盒(瓶)11.5分散片布洛芬200mg,盐酸伪麻黄碱30mg*12片盒(瓶)15.0分散片布洛芬50mg,盐酸伪麻黄碱7.5mg*12片盒(瓶)5.2胶囊布洛芬200mg,盐酸伪麻黄碱30mg*10粒盒(瓶)9.8胶囊布洛芬200mg,盐酸伪麻黄碱30mg*12粒盒(瓶)11.7颗粒剂布洛芬200mg,盐酸伪麻黄碱30mg*9包盒(瓶)10.531178酚咖片剂对乙酰氨基酚500mg,咖啡因65mg*10片盒(瓶)8.2片剂对乙酰氨基酚500mg,咖啡因65mg*12片盒(瓶)9.832178酚麻美敏片剂乙酰氨基酚325mg,盐酸伪麻黄碱30mg,氢溴酸右美沙芬10mg,马来酸氯苯那敏2mg*10片盒(瓶)9.6片剂乙酰氨基酚325mg,盐酸伪麻黄碱30mg,氢溴酸右美沙芬15mg,马来酸氯苯那敏2mg*10片盒(瓶)12.5胶囊162.5mg(以对乙酰胺基酚计)*10粒盒(瓶)5.7第6页，共87页序号医保编号药品名称剂型规格单位最高零售价格备注胶囊162.5mg(以对乙酰