Allegato SUB A)
Lotto
AIC
ATC
PRINCIPIO ATTIVO
Descrizione
FORMA
N Unita Posologiche
MESI 6
PREZZO UNITARIO
PREZZO TOTALE MESI 6
CIG
1
2
038917011
038917035
C01EB18
C01EB18
RANOLAZINA
RANOLAZINA
RANEXA*60CPR 375MG R.P.
RANEXA*60CPR 500MG R.P.
CPR
CPR
24600
11520
€ 0,77
€ 0,77
€ 18.868,20
€ 8.835,84
3978405BA7
397843546B
3
038917050
C01EB18
RANOLAZINA
RANEXA*60CPR 750MG R.P.
CPR
1830
€ 0,77
€ 1.403,61
397846907B
4
039453028
A10BH03
SAXAGLIPTIN CLORIDRATO
ONGLYZA*28CPR RIV 5MG
CPR
41440
€ 1,27
€ 52.732,40
3978485DAB
5
039232020
L02BX02
DEGARELIX ACETATO
FIRMAGON*INIET 120MG POLV+SOLV
FL
3
€ 122,44
€ 367,32
397851566F
6
7
8
039232018
034405011
034208013
L02BX02
D06BB10
N07BB03
DEGARELIX ACETATO
IMIQUIMOD
ACAMPROSATO
FIRMAGON*INIET 80MG POLV+SOLV
ALDARA*CREMA 5% 12BUST 250MG
CAMPRAL*84CPR RIV 333MG
FL
BUST
CPR
179
1518
10458
€ 129,00
€ 3,47
€ 0,24
€ 23.091,00
€ 5.267,46
€ 2.547,26
39785367C3
39785524F8
397856822D
€ 461,820
9
10
11
037793142
039365010
040107029
A10BH01
A10BX07
R03DX07
JANUVIA*28CPR RIV 100MG
VICTOZA*SC 2PEN 3ML 6MG/ML
DAXAS*30CPR RIV 500MCG
CPR
PEN/SIR
CPR
18382
2049
1125
€ 1,28
€ 35,94
€ 1,26
€ 23.547,34
€ 73.641,06
€ 1.420,88
3978591527
3978606189
3978623F8C
€ 470,947
€ 1.472,821
12
039763091
B01AC30
SITAGLIPTIN FOSFATO MONOIDRATO
LIRAGLUTIDE
ROFLUMILAST
CLOPIDOGREL
IDROGENOSOLFATO/ACIDO
ACETILSALICILICO
DUOPLAVIN*28CPR RIV 75MG/100MG
CPR
32228
€ 0,27
€ 8.701,56
3978640D94
13
034946121
A10BG03
Actos 28cpr 45 MG
CPR
1344
€ 0,91
€ 1.226,75
397865277D
14
039260017
L01Xe02
IRESSA * 3X 10CPR RIV 250mg
CPS
4005
€ 73,01
€ 292.409,06
3978663093
€ 20,00000
€ 5.848,181
SIMPONI* SC 1PEN 50mg 0,5 ml
SC. 1 PEN
248
€ 973,18
€ 241.347,40
39786749A4
€ 20,00000
€ 4.826,948
SIMPONI* SC 1 SIR 50mg 0,5 ml
SIR
247
€ 973,18
€ 240.375,46
3978688533
€ 20,00000
€ 4.807,509
CIMZIA* SC 2 SIR 200 mg 1ml + 2 salv
SIR
810
€ 341,53
€ 276.635,25
3978693952
€ 20,00000
€ 5.532,705
TOSTREX* GEL 2MULTID 60g 2% + DOS
TUB
35
€ 27,10
€ 948,34
3978704268
AFINITOR* 30cpr 10mg
CPR
2745
€ 115,52
€ 317.099,93
3978715B79
€ 35,00000
€ 6.341,999
AFINITOR* 30cpr 5mg
CPR
2745
€ 81,22
€ 222.960,84
3978722143
€ 20,00000
€ 4.459,217
AFINITOR* 60cpr 10mg
CPR
1860
€ 115,52
€ 214.865,53
39787318AE
€ 20,00000
€ 4.297,311
pioglitazione cloridrato
GEFITINIB
IMPORTO TASSA
AVCP
CAUZIONE PROVV
€ 1.054,648
GOLIMUMAB
15
039541014
L04AB06
GOLIMUMAB
16
039541038
L04AB06
CERTOLIZUMAB PEGOL
17
039539010
L04AB05
18
037314034
G03BA03
19
039398045
L01XE10
TESTOSTERONE 20 MG
EVEROLIMUS
EVEROLIMUS
20
039398019
L01XE10
EVEROLIMUS
21
039398058
L01XE10
22
039945011
L01XE11
PAZOPANIB
VOTRIENT* fl 30cpr riv 200mg
CPR
6090
€ 25,96
€ 158.097,50
39787410F1
€ 20,00000
€ 3.161,950
L01XE10
PAZOPANIB
VOTRIENT* fl 30cpr riv 400mg
CPR
5220
€ 51,92
€ 271.025,27
3978749789
€ 20,00000
€ 5.420,505
D11AH04
ALITRETINOINA
TOCTINO 30 cpr 30mg
cps
1980
€ 12,45
€ 24.660,23
3978757E21
23
24
0388490030
€ 493,205
Allegato SUB A)
Lotto
AIC
ATC
PRINCIPIO ATTIVO
Descrizione
FORMA
N Unita Posologiche
MESI 6
PREZZO UNITARIO
PREZZO TOTALE MESI 6
CIG
25
0388490016
D11AH04
ALITRETINOINA
BETAINA
ANIDRA
TOCTINO 30 cpr 10mg
cps
1980
€ 12,45
€ 24.660,23
3978766591
26
033797014
A16AA06
CYSTADANE 1 gr POLV
FLAC
30
€ 404,32
€ 12.129,60
3978778F75
ESAPENT 1000
CPS
9000
€ 0,42
€ 3.784,05
39787887B8
NEBID 100/MG/4ML
FL
16
€ 69,09
€ 1.105,44
39788055C0
TESTOGEL 5GR 30 BS
BS
360
€ 1,06
€ 380,16
397882998D
DETRUSITOL 4 MG
CPS
336
€ 1,10
€ 369,82
39788380FD
LIORESAL 10 MG
CPS
600
€ 0,14
€ 82,80
3978846795
MOGADON CPR
CPS
200
€ 0,18
€ 35,00
3978855F00
DELTACORTENE 5 MG CPR
CPR
200
€ 0,09
€ 17,60
3978859251
KINERET 100 MG
AROVIT GTT.FLAC
SIR
FLAC
400
15
€ 30,38
€ 3,50
€ 12.152,80
€ 52,50
3978869A8F
39788792D2
IMPORTO TASSA
AVCP
CAUZIONE PROVV
€ 493,205
OMEGA POLIENOICI
27
027617024
C10AX06
TESTOSTERONE UNDECANOATO
28
03705101
G03BA03
TESTOSTERONE
29
037314010
G03BA03
TOLTERODINA L-TARTRATO
30
034168169
G04BD07
BACLOFENE
31
022999015
M03BX01
NITRAZEPAM
32
020731081
G01AX99
PREDNISONE
33
010089011
HO2AB07
ANAKINRA
34
35
035607023
004880023
L04AC03
A11CA01
36
036694026
A16ZX05
37
025371016
38
39
RETINOLO PALMITATO
WILZIN 50 MG
CPS
625
€ 1,23
€ 767,50
3978890BE3
D01AC20
ZINCO ACETATO
DIFLUCORTOLONE VALERATO +
ISOCONAZOLO NITRATO
TRAVOCORT CREMA TUBO 20 GR
TUB
50
€ 5,00
€ 250,00
39788960DA
024753028
041157013
J02AX01
J06BA01
FLUCITOSINA
I g UMANA NORMALE SC
ANCOTIL 2,5 GR/ML CONF. X 5 FL
Hizentra 1gr 5 ml
FL
50
25
€ 36,10
€ 50,40
€ 1.804,85
€ 1.260,00
3978904772
3978909B91
40
041157049
J06BA01
I g UMANA NORMALE SC
Hizentra 2gr 10 ml
40
€ 100,80
€ 4.032,00
3978918301
41
041157102
J06BA01
I g UMANA NORMALE SC
Hizentra 4 gr 20ml
35
€ 201,60
€ 7.056,00
3978929C12
TRABECTEDINA
YONDELIS 0,25 MG POLV. PER SOL. EV 1
FL
15
€ 1.979,53
€ 29.692,95
39789372AF
42
038165027
L01CX01
FL
€ 593,859