附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價...

315
附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價-105/01 A000015421 YEN KUANG EYE DROPS 8.8 A000072100 EPHEDRINE HCL TABELTS 25MG "CENTRAL" 0.56 A000076100 ACETAMINOPHEN TABLETS 0.3 GM "F.Y." 0.25 A000096100 MENNA CAPSULES 0.48 A000111100 ESTRIOL TABLETS "HONTEN" 0.3 A0001191G0 DL-METHYLEPHEDRINE HCL TABLETS 25.MG "F.Y."(鋁箔/膠箔) 1.5 A000137151 BROWN MIXTURE LIQUID (WITHOUT OPIUM) 5.5 A000173100 FUDECOUGH TABLETS 15MG "F.Y." 0.55 A000175100 FUDECOUGH TABLETS 10MG "F.Y." 0.41 A000389100 LUXSON TABLETS 40MG 0.2 A000415100 GASMIN TABLETS "F.Y." 0.3 A000429100 WINON TABLETS 2.25 A000518100 OXYTETRACYCLINE HCL CAPSULES "TAH-AN" 0.81 A000552209 NEOLEWESHUE INJECTION 3.78 A000581212 METHORPHAN INJECTION " K.S." 3.92 A000582212 FUBANOL INJECTION 3.08 A000582221 FUBANOL INJECTION 3.08 A000582238 FUBANOL INJECTION 7.8 A000604151 MEDICON SYRUP 34.8 A000647100 CYTADINE 2MG TABLETS(CYPROHEPTADINE) 0.32 A000822157 FUSOCO SYRUP "L.S." 30.2 A000842100 ENPURIN S.C. TABLETS "VEI MIN" 3.36 A000849100 ERYTHROMYCIN ESTOLATE CAPSULES "LITA" 1.43 A000895100 TRANZEPAM TABLETS 0.8 A001045100 VESSELON CAPSULES "H.L." 1.01 A001046100 MAGNESIUM OXIDE TABLETS 0.13 A001050277 DEXTROSE INJECTION 10% "ASTAR" 21.1 A001143100 PIDONIN TABLETS "N.T." 0.9 A001155100 PHENOBARBITAL TABLETS "JENG SHENG" 0.68 A001177100 LITALON TABLETS "LITA" 2.25 A001217100 DIAZEPAM TABLETS 0.8 A001226100 PREDNISOLONE TABLETS 5MG "S.Y." 0.9 A001398100 NALIDIN TABLETS 500MG "N.C.P." 2.25 A001400100 PROPHYLLIN TABLETS 0.61 A001413100 VALISIN TABLETS 0.8 A001420309 FURAN OINTMENT 0.28 A001437277 AMPICILLIN INJECTION 500 MG "CHI SHENG" 0 A001448100 NOSCAPINE TABLETS "YU SHENG" 0.9 A001563212 DIAZEPAM INJECTION "ORIENTAL" 10.9 A001577100 TRIPYLINE TABLETS 25MG 0.83 A001584100 MAGNESIA TABLETS "WASHINGTON" 0.1 A001604212 HOROMPELIN INJECTION "ORIENTAL" 7.1 A001646100 DIAZEPAM TABLETS "KINGDOM" 0.8 A0016461G0 DIAZEPAM TABLETS(鋁箔) 1.5 A001701238 ANTIMIN INJECTION "C.C.P." 12 A001713100 ENZYME TABLETS "H.C.T." 3.79 A001781100 VANMESON TABLETS 0.75 A001782100 CABETAN S.C. TABLETS 0.4 A001816100 VANTYL TABLETS 0.85 A001833229 DECAMIN INJECTION "ORIENTAL" 17.6 A001850100 AMPICILLIN CAPSULES 250MG "PANBIOTIC" 1.02 A001856100 ERYTHROMYCIN CAPSULES 250MG "WAH FOO" 1.43 A001866100 AMPICILLIN CAPSULES 500MG "PANBIOTIC" 1.38 A001963100 FUNA TABLETS "CURIE" 1.15 1

Upload: others

Post on 12-Sep-2019

34 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

附件二 藥品給付品項暨支付標準表

藥品代碼 藥品英文名稱 支付價-105/01

A000015421 YEN KUANG EYE DROPS 8.8

A000072100 EPHEDRINE HCL TABELTS 25MG "CENTRAL" 0.56

A000076100 ACETAMINOPHEN TABLETS 0.3 GM "F.Y." 0.25

A000096100 MENNA CAPSULES 0.48

A000111100 ESTRIOL TABLETS "HONTEN" 0.3

A0001191G0 DL-METHYLEPHEDRINE HCL TABLETS 25.MG "F.Y."(鋁箔/膠箔) 1.5

A000137151 BROWN MIXTURE LIQUID (WITHOUT OPIUM) 5.5

A000173100 FUDECOUGH TABLETS 15MG "F.Y." 0.55

A000175100 FUDECOUGH TABLETS 10MG "F.Y." 0.41

A000389100 LUXSON TABLETS 40MG 0.2

A000415100 GASMIN TABLETS "F.Y." 0.3

A000429100 WINON TABLETS 2.25

A000518100 OXYTETRACYCLINE HCL CAPSULES "TAH-AN" 0.81

A000552209 NEOLEWESHUE INJECTION 3.78

A000581212 METHORPHAN INJECTION " K.S." 3.92

A000582212 FUBANOL INJECTION 3.08

A000582221 FUBANOL INJECTION 3.08

A000582238 FUBANOL INJECTION 7.8

A000604151 MEDICON SYRUP 34.8

A000647100 CYTADINE 2MG TABLETS(CYPROHEPTADINE) 0.32

A000822157 FUSOCO SYRUP "L.S." 30.2

A000842100 ENPURIN S.C. TABLETS "VEI MIN" 3.36

A000849100 ERYTHROMYCIN ESTOLATE CAPSULES "LITA" 1.43

A000895100 TRANZEPAM TABLETS 0.8

A001045100 VESSELON CAPSULES "H.L." 1.01

A001046100 MAGNESIUM OXIDE TABLETS 0.13

A001050277 DEXTROSE INJECTION 10% "ASTAR" 21.1

A001143100 PIDONIN TABLETS "N.T." 0.9

A001155100 PHENOBARBITAL TABLETS "JENG SHENG" 0.68

A001177100 LITALON TABLETS "LITA" 2.25

A001217100 DIAZEPAM TABLETS 0.8

A001226100 PREDNISOLONE TABLETS 5MG "S.Y." 0.9

A001398100 NALIDIN TABLETS 500MG "N.C.P." 2.25

A001400100 PROPHYLLIN TABLETS 0.61

A001413100 VALISIN TABLETS 0.8

A001420309 FURAN OINTMENT 0.28

A001437277 AMPICILLIN INJECTION 500 MG "CHI SHENG" 0

A001448100 NOSCAPINE TABLETS "YU SHENG" 0.9

A001563212 DIAZEPAM INJECTION "ORIENTAL" 10.9

A001577100 TRIPYLINE TABLETS 25MG 0.83

A001584100 MAGNESIA TABLETS "WASHINGTON" 0.1

A001604212 HOROMPELIN INJECTION "ORIENTAL" 7.1

A001646100 DIAZEPAM TABLETS "KINGDOM" 0.8

A0016461G0 DIAZEPAM TABLETS(鋁箔) 1.5

A001701238 ANTIMIN INJECTION "C.C.P." 12

A001713100 ENZYME TABLETS "H.C.T." 3.79

A001781100 VANMESON TABLETS 0.75

A001782100 CABETAN S.C. TABLETS 0.4

A001816100 VANTYL TABLETS 0.85

A001833229 DECAMIN INJECTION "ORIENTAL" 17.6

A001850100 AMPICILLIN CAPSULES 250MG "PANBIOTIC" 1.02

A001856100 ERYTHROMYCIN CAPSULES 250MG "WAH FOO" 1.43

A001866100 AMPICILLIN CAPSULES 500MG "PANBIOTIC" 1.38

A001963100 FUNA TABLETS "CURIE" 1.15

1

Page 2: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A0019631G0 FUNA TABLETS "CURIE"(鋁箔/膠箔) 1.5

A001997100 TRANSONE TABLETS 0.86

A002076100 RIOTOL TABLETS 0.75

A002086100 WEIERNIN TABLETS "NAN TO" 0.85

A002314221 DIANZEM INJECTION "Y.Y." 10.9

A002321212 BUSCOMINE INJECTION 3.88

A002355229 KANAMYCIN INJECTION "ORIENTAL" 19

A002362100 BROSCO TABLETS "ORIENTAL" 0.96

A002389100 COMPOUND GLYCYRRHIZIAE TABLETS "CURIE" 0.29

A002445100 CLOXAMPICIN CAPSULES 250MG "PANBIOTIC" 1.54

A002555100 MAWEI TABLETS "YU SHENG" 0.15

A002595100 BALON S.C. TABLETS 0.62

A002626100 PROSTEN CAPSULES 0.75

A002635100 GASTROPAN S.C. TABLETS 0.88

A002657229 PROGESTERONE INJECTION 2.5% "ASTAR" 15.6

A002658100 LIUMPIN TABLETS 1.83

A002684100 ILITAN TABLETS "YU SHENG" 0.27

A002760100 THIAN TABLETS "YU SHENG" 0.55

A002856100 FULLPHAGEN TABLETS "F.Y." 0.5

A002921100 MININ S.C. TABLETS "YU SHENG" 0.4

A002994100 KANGCHINMIN CAPSULES "Y.S." 0.89

A003023212 FUYULIN INJECTION "ASTAR" 7.1

A003084100 FUZIN CAPSULES "LITA" 0.96

A003086100 DEXAMETHASONE TABLETS "Y.S." 0.69

A003092100 ASPIRIN TABLETS 500MG "S.Y." 0.45

A003098100 DITHIAZIDE TABLETS 0.65

A0030981G0 DITHIAZIDE TABLETS(鋁箔/膠箔) 1.5

A003107100 URICAN S.C. TABLETS 0.83

A003156212 VITA-6 INJECTION "ANSHIN" 2.89

A003157221 HISTIDINE INJECTION "ANSHIN" 4.69

A003225212 ANCONMIN INJECTION "AN SHIN" 2.4

A003266100 D.X. CAPSULES "LITA" 1.21

A003311100 TRIENZYME CAPSULES "WASHINGTON" 0.9

A003314100 YUNSTAN CAPSULES 0.75

A003326100 PINGIN TABLETS 0.97

A003373321 FLUCONIN OINT. 40.5

A003373329 FLUCONIN OINT. 42

A003386209 ORICORT-IM INJECTION "ORIENTAL" 23

A003386212 ORICORT-IM INJECTION "ORIENTAL" 23.8

A003386229 ORICORT-IM INJECTION 57

A003392100 ISONIAZID TABLETS "V.P.P." 0.2

A003393100 CHLORPROMAZINE HCL S.C. TABLETS 100MG "VPP" 1.5

A003417209 STREPTOMYCIN SULFATE FOR INJECTION 1G "VPP" 0

A003442100 CHLORPHENIRAMINE MALEATE TABLETS "VPP" 0.1

A003446221 ORICORT INJECTION "ORIENTAL" 23.8

A003462100 TAY HOU CHIN S.C. TABLETS 0.96

A003469209 NEOSTIGMINE INJECTION "ASTAR" 4.97

A003551100 PRONALATE TABLETS "PANBIOTIC" 1.17

A003558212 PROPHYLLIN INJECTION "ASTAR" 7

A003572421 CON-F EYE DROPS 18.2

A003621100 DEXCON TABLETS 10MG 0.45

A003622100 HONCALM CAPSULES 0.68

A003633100 BENDA TABLETS "Y.S." 0.17

A003696100 LI-CILLIN CAPSULES 500MG 1.38

A003697417 TETRACYCLINE EYE OINTMENT "OASIS" 7.3

2

Page 3: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A003699212 DEXARON INJECTION 1MG 3.08

A003699229 DEXARON INJECTION 1MG 17.6

A003715271 LEUCOMYCIN INTRAVENOUS INJ 400MG "T.T.Y" 50

A003727100 HITUS CAPSULES 25 MG 0.45

A003759100 INTEAN CAPSULES 0.87

A003764100 LILIAN TABLETS "CURIE" 0.74

A003773100 SWEICON TABLETS "YUNG CHI" 0.85

A003782209 CHLORPHENIRAMINE INJECTION "ASTAR"" 5.4

A003786209 ERGOMETRIN INJECTION "ASTAR" 2.76

A003792100 TOLBUTAMIDE TABLETS "R.S.P.P." 1

A003794100 EPHEDRINE SULFATE CAPSULES "VPP" 0.56

A003851100 RIPOLIN CAPSULES 150MG 2.08

A003852100 RIPOLIN CAPSULES 300MG 9

A003893100 NITROFURANTOIN TABLETS 100MG "R.S.P.P" 0.59

A003902100 SUSWUN TABLETS 0.89

A003911100 AMINOPHYLLINE TABLETS 200MG "VPP" 0.67

A003941421 NARPINA EYE DROPS 12.7

A003948417 ATROPINE EYE OINTMENT 26.9

A003968421 SULOMIN EYE DROPS 7.4

A003968429 SULOMIN EYE DROPS 7.5

A003969417 CODEMYCIN EYE OINTMENT 17.9

A003994421 CON-N EYE-DROPS 14.7

A004001421 PILOCARPINE EYE DROPS 4% 42.7

A004042100 LICOTIN TABLETS "YUNG CHI" 0.56

A004068429 SELEAR EYE DROPS 17.2

A004073221 STACORT-A INJECTION 10MG "STANDARD" 23.8

A004073299 STACORT-A INJECTION 10MG "STANDARD" 4.3

A004099100 MECOSON TABLETS 15MG 0.48

A004115100 GENCAN S.C. TABLETS "YUNG CHI" 0.83

A004156417 VITA A EYE OINTMENT "OASIS" 18

A004166421 COLSAMIN EYE DROPS 12.7

A004188417 F.A.D. EYE OINTMENT 21.8

A004189100 RESERPINE TABLETS "VPP" 0.08

A004219100 BISLAN TABLETS "YUNG SHIN" 0.31

A004223100 SULFISOMEZOLE TABLETS "R.S.P.P." 0.85

A004249100 DYNIN TABLETS 1.03

A004255100 ERYTHROMYCIN ESTOLATE CAPSULES "ASTAR" 1.43

A004263100 ANTICOUGH CAPSULES 0.89

A004276100 EAZIDE TABLETS 0.8

A004287100 POTON CAPSULES 0.75

A004300100 TAWEGEN TABLETS "YUNG CHI" 0.94

A004322229 VITAMIN B COMPLEX INJECTION "VPP" 13.4

A004423100 ESTROMON S.C. TABLETS 2.94

A004441100 DEAN TABLETS 5MG "YUNG CHI" 0.8

A004461100 ANTICOUGH TABLETS 0.46

A004463212 SINTHATO INJECTION 7.1

A004466297 TRICILLIN INJECTION "VPP" 0

A004488421 BISMING EYE DROPS 16.7

A004489417 COLIMYCIN EYE OINTMENT 22

A004490417 CHLORAMPHENICOL OPHTHALMIC OINTMENT 13.3

A004491417 ERYSMYCIN EYE OINTMENT 17.7

A004539157 BOINTUSSIN SOLUTION 20MG/ML (GUAIFENESIN)"BOWLIN" 16.9

A004565209 DECAMIN INJECTION 4MG/ML "ORIENTAL" 6.9

A004565229 DECAMIN INJECTION 4MG/ML "ORIENTAL" 17.6

A004575100 SECOBARBITAL SODIUM CAPSULES "VPP" 1.82

3

Page 4: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A004648100 DECARON TABLETS 0.69

A004703100 CHLORDIAZEPOXIDE HCL CAPSULES 10MG "VPP" 0.68

A004704100 CHLORPHENIRAMINE TABLETS "ASTAR" 0.1

A004776229 AMINOPHYLLINE INJECTION "ASTAR" 6.3

A004813100 ASPIRIN TABLETS "VPP" 0.25

A004820100 CHITOU TABLETS "Y.S." 0.62

A004835100 ECHICON TABLETS "Y.S." 0.37

A004838100 PISULOU CAPSULES "Y.S." 0.87

A004852212 COUGSTIN INJECTION "ASTAR" 4.07

A004853209 TRILIZIN INJECTION "ASTAR" 3.64

A004933100 FUWEININ CAPSULES "Y.S." 0.96

A004957100 KANFUYEN CAPSULES 1.14

A004973321 RINDERON-VA CREAM 0.06% 40.5

A004974416 EYE RINDERON-A OINTMENT 43.5

A004975416 EYE RINDERON-A SOLUTION 33.5

A004977421 YEN SAN EYE DROPS 15.2

A004977429 YEN SAN EYE DROPS 26.8

A005045100 YUNGISUMIN TABLETS "CHEN TA" 0.57

A0050451G0 YUNGISUMIN TABLETS (鋁箔/膠箔) 1.5

A005054100 INDOCINE CAPSULES 0.87

A005090100 ZUCAIN TABLETS "CURIE" 0.44

A005136100 BALAMIN S.C. TABLETS "JEN SHENG" 0.68

A005185100 TRIAMCINOLONE TABLETS "JEN SHENG" 0.89

A005225100 COLCHICINE TABLETS 0.99

A005228100 ZUNCHIN CAPSULES "DAU CHI" 0.68

A005232100 COLD CAPSULES "M.T." 0.5

A005266100 HYDRALAZINE HCL TABLETS "JEN SHENG" 0.71

A005300100 PHENOBARBITAL TABLETS 32MG "VPP" 0.68

A005359100 METRODIN S.C. TABLETS "YUNG CHI" 0

A005445100 PARAFLEX CAPSULES 500MG "PANBIOTIC" 1.76

A005446100 PARAFLEX CAPSULES 250MG "PANBIOTIC" 1.14

A005521421 CODEMYCIN EYE DROPS 18.4

A005592421 CHLORTETRACYCLINE OINTMENT "C.Y." 13.3

A005603221 GLUCAL BLACK INJECTION 21.4

A005616229 DEXAMETHASONE-21 INJECTION 1MG/ML"C.Y." 17.6

A005628229 PHENAMINCAL-B6 INJECTION "C.Y." 6.2

A005753212 THIAMINE HYDROCHLORIDE INJECTION 50MG "ASTAR" 3.25

A005789100 FUSTON TABLETS 100MG "Y.S." 0.28

A005807100 LONFLEX CAPSULES "UNION" 1.14

A005827100 AMINOPHYLINE TABLETS "JEN SHENG" 0.67

A005869155 OPIUM TINCTURE 230

A005936100 SETON TABLETS 100MG (ETHAVERINE) 2.79

A005945100 DEXTROMETHORPHAN TABLETS "JEN SHENG" 0.37

A006171100 HEPI CAPSULES "H.C.T." 0.69

A006187417 COLSAMIN EYE OINTMENT 13.2

A006194100 PRONALOL TABLETS 0.87

A006228100 PENAZOL S.C. TABLETS 0.4

A006232100 MATALMIN TABLETS 0.86

A006245100 KINLIZONE TABLETS 0.73

A006271100 FUCOLE PARAN TABLETS 0.58

A006316100 CENTICON TABLETS 0.48

A006318100 CENTRARIN TABLETS 0.4

A006344100 BUSTON S.C. TABLETS 0.96

A006394100 PYRIDAMOLE S.C. TABLETS 0.9

A006485500 LYBRILE SUPPOSITORIES 2.26

4

Page 5: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A006543100 PREDNISOLONE TABLETS 5MG "CHEN TA" 0.9

A006552100 ALLERMIN TABLETS 4MG 0.11

A006572277 YEIAMIN-X INJECTION 81

A006618100 ZITHINE TABLETS 0.45

A006638100 CHINCHEN TABLETS 3.17

A006691100 UCALON TABLETS 0.5MG "CHEN TA" (DEXAMETHASONE) 0.69

A006696100 DICYCLOMINE TABLETS "C.T." 0.85

A006698100 LONGCORT TABLETS 0.75

A006749209 LONGCORT INJECTION 11.9

A006761100 TRIZYLASE CAPSULES "BOWLIN" 0.9

A006795100 MAGNESIUM OXIDE TABLETS "HONTEN" 0.15

A006819100 CHLORPROMAZINE HCL S.C. TABLETS 50MG "VPP" 0.6

A006820277 SODIUM AMPICILLIN FOR INJECTION 500MG "VPP" 0

A006822100 CHLORPROMAZINE HCL S.C. TABLETS 25MG "VPP" 0.55

A006823100 CHLORPROPAMIDE TABLETS "RSPP" 0.84

A006865100 CLOFIBRATE CAPSULES "HON TEN" 1.09

A006873100 TUNFON TABLETS "H.C.T." 0.99

A006932209 INCHLOMYCIN SODIUM SUCCINATE INJECTION 1GM "C.Y." 12.3

A006943100 TETOCYN CAPSULES 0.82

A006959100 TERIMAN CAPSULES "CHEN TA" 1.62

A006984100 METHYLTESTOSTERONE TABLETS 10MG "VPP" 1.62

A006987100 RIRITON S.C. TABLETS 0.41

A007024100 FUNIONE TABLETS 250MG (METRONIDAZOLE) 1.15

A007037100 CERIATIN TABLETS 0.7

A007038100 PROMIN TABLETS 0.69

A007067100 POLUN S.C. TABLETS "J.S." 0.62

A007073100 REFERLAS CAPSULES 0.87

A007114209 EPHEDRINE SULFATE INJECTION 25MG/ML "VPP" 2.15

A007157100 OXAPAM TABLETS 1

A007167335 KONIF OINTMENT"CHEN TA" 0

A007167377 KONIF OINTMENT"CHEN TA" 0

A007190100 TENSANLIN TABLETS 0.73

A007204229 LIFUTIN INJECTION "ASTAR" 4

A007213100 AMINOPHYLLINE TABLETS "BEYDAR" 0.67

A007243100 EPHEDRINE HCL TABLETS 25MG "VPP" 0.56

A007264100 BETAMETHASONE TABLETS 0.75

A007266100 FUNINTAN S.C. TABLETS "J.S." 0.83

A007362100 CHINACAN TABLETS 0.89

A007374100 MAGNESIUM HYDROXIDE TABLETS "SHINLON" 0.18

A007443323 PARACORT OINTMENT 35.4

A007443329 PARACORT OINTMENT 38.7

A007456100 GETIGON TABLETS 1

A007544221 CHLORPROMAZINE HCL 125MG/5ML "VPP" 3.64

A007605100 BACERON TABLETS 0.77

A007679100 RESPLAMIN TABLETS 1.58

A007681229 DEXASON INJECTION 2MG/ML "LITA" 17.6

A007707100 CANMALIN CAPSULES 1.01

A007715421 LOSEMIN EYE DROPS "OASIS" 18

A007786100 BACIDIM TABLETS "CHI SHENG" 0.9

A007792100 SULFAPRIME TABLETS 0.9

A007819100 ACETAZOLAMAX TABLETS 1.35

A007822100 AMOXICILLIN CAPSULES "PANBIOTIC" 0.99

A007828277 LACTATED RINGER'S INJECTION "ASTAR" 21.1

A007936100 BORGAL TABLETS "LITA" 0.9

A0079441G0 DETTACKS S.C. TABLETS 10 MG "F.Y."(瓶裝/84粒/瓶) 1.5

5

Page 6: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A007973421 NEOSINICIN EYE DROPS 5% "OASIS" 29.9

A007976100 RIKAPARIN CAPSULES 1.3

A008053100 COFGEN TABLETS 0.12

A008061100 WINCOU TABLETS 0.27

A008062100 CINNARIZINE TABLETS 0.69

A008165100 WATOLIN TABLETS 8MG "TF" 0.27

A008192100 BROMOCIX TABLETS 0.4

A008355100 GASLAN TABLETS "CHINTENG" 0.43

A008534209 SCOBTIN INJECTION 9.2

A008541100 TONPHEN TABLETS "H.C" 0.25

A008606100 HISTANTI F.C. TABLETS 0.89

A008645417 PZULEN EYE OINTMENT "OASIS" 15.5

A008661100 TONFONYUANIN CAPSULES "K.N." 0.87

A008676100 BENTEA "JENN MAW" 0.72

A008715100 PRENIN TABLETS 0.9

A008743100 COYENLIN TABLETS "S.C." 0.9

A008757100 BASED TABLETS "CURIE" 0.75

A008840100 BEINSON TABLETS "YUNG CHI" 0.75

A008883100 METHYLTESTOSTERONE CAPSULES "Y.S." 1.62

A008888100 PANTHDAN CAPSULES 0.65

A008896100 WINTYL TABLETS "WINSTON" 1

A008907100 ASVERIN TABLETS 20MG 0.94

A008924321 SUFUCIN OINTMENT "S.T." 28

A008934100 RINMESON TABLETS 0.75

A009010421 NEOCOSON EYE DROPS 21.4

A009038100 BISCO TABLETS 8MG 0.34

A009043100 SUMENCHITON TABLETS 0.86

A009096100 DOUCEIN TABLETS "Y.Y." 1.24

A009104100 APAP TABLETS 0.2

A009106100 BROMINE TABLETS "YUNG SHIN" 0.3

A009111100 SOLCON TABLETS 8MG 0.39

A009115100 PRINCUR F.C. TABLETS 0.51

A009138100 POINSTAN CAPSULES 0.75

A009250500 BISACODYL SUPPOSITORIES "YUNG SHIN" 2.37

A009252100 LUTUTIN TABLETS 0.85

A009255100 GERSCON TABLETS 0.43

A009300100 BETAMETHASONE TABLETS "Y.C." 0.75

A009309100 CHINPIN TABLETS "Y.C." 0.73

A009311100 KONACOTO TABLETS "Y.C." 0.89

A009314100 CHLORTERACYCLINE HCL CAPSULES "Y.C." 0.95

A009352100 HOMALIN TABLETS "SHIN FONG" 0.94

A009367100 AETHOCAF CAPSULES 0.77

A009369100 BISACODYL S.C. TABLETS "HONTEN" 0.4

A009397100 DOXYCYCLINE HCL CAPSULES "Y.C." 1.21

A009463100 AMOXICILLIN CAPSULES "Y.C." 0.99

A009470100 YUNGBAYAN TABLETS "Y.C." 0.9

A009480100 RAMIN CAPSULES 25MG 0.43

A009486417 NEOSONE OPHTHALMIC OINTMENT 43.8

A009616100 GLANEGA TABLETS "MEIDER" 2.25

A009632100 BAKRIN TABLETS 0.9

A009638100 CHANPON TABLETS "Y.C." 1

A009673100 LIMOX CAPSULES 250MG "LITA" 0.99

A009691100 PUKAMIN TABLETS "CHINTENG" 0.32

A009705100 NADON CAPSULES 2.25

A009767100 CLIZEP S.C. TABLETS 1.15

6

Page 7: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A009782100 INDAL TABLETS 0.87

A009791100 CEPHALEXIN CAPSULES "Y.C." 1.14

A0099151G0 METASONE TABLETS "H.S."(鋁箔/膠箔) 1.5

A009941100 WINPICILLIN CAPSULES 500MG "WINSTON" 1.38

A009983100 CYASIN S.C. TABLETS 0.9

A0099831G0 CYASIN S.C. TABLETS(鋁箔/膠箔) 1.5

A009991100 TOUFONG TABLETS 5MG "CHEN TA." 0.8

A010057229 RESPLAMIN INJECTION 20% 19.2

A010079100 CARBETIN TABLETS 0.48

A010082396 REFULEN LIQUID "H.H." 38.4

A010120100 CENTRAL CO-TRIMOXAZOL TABLETS 0.9

A010137100 PREDNISOLONE TABLETS "YUNG CHI" 0.9

A010162100 WINMOX CAPSULES "WINSTON" 0.99

A010184317 DECANEOMYCIN OPHTHALMIC OINTMENT "C.Y." 13.2

A010194100 WINLEX CAPSULES "WINSTON" 1.76

A010204100 FUZINLIN CAPSULES "C.S." 0.79

A0102071G0 INDECIN CAPSULES "H.S."(鋁箔/膠箔) 1.5

A010211100 BRONCOMINE TABLETS "HONTEN" 0.25

A010213100 CEPHALEXIN CAPSULES 250 MG "CHI SHENG" 1.14

A010256100 HUA PAM TABLETS "H.H." 0.8

A010288212 WINCYNON INJECTION "WINSTON" 28.6

A010332100 CINDERAL TABLETS "PATRON" 0.86

A010376421 DECANEOMYCIN OPHTHALMIC SOLUTION 12.7

A010381316 PATRONCORT-F OINTMENT "PATRON" 17.3

A010381329 PATRONCORT-F OINTMENT "PATRON" 42

A010382100 PATOCILLIN CAPSULES "PATRON" 1.92

A010398100 MELLAZINE S.C. TABLETS 50MG 2.1

A010402100 ZINPIN TABLETS 1.7

A010409238 INSELON INJECTION "Y.Y." 14

A010416100 ENTERCON TABLETS 0.28

A010422212 THIAMINE HYDROCHLORIDE INJECTION 50MG "S.Y." 3.58

A010428100 WINHOAMIN S.C. TABLETS 100MG 1.5

A0104461G0 ANZUWEI CAPSULES "H.H."(鋁箔/膠箔) 1.5

A010479100 PONPAI CAPSULES 0.6

A010482100 BENZEL CAPSULES "YUNG CHI" 0.54

A010508221 LONACORT INJECTION 10MG/ML "C.Y." 23.8

A010576100 BROADIN-S TABLETS "EAYUNG" 0.9

A010582100 GYLONOL TABLETS 0.99

A010625100 WINLEX CAPSULES 250MG "WINSTON" 1.14

A010638277 STAMINA INJECTION "CHI SHENG" 19.1

A010648100 PARAFLU CAPSULES "PANBIOTIC" 0.25

A010683100 ACETANIN TABLETS "HONTEN" 0.46

A010689100 LICOMINE TABLETS "WINSTON" 0.32

A010720209 OGECORT SUSPENDED INJECTIONS "Y.Y." 23

A010720221 OGECORT SUSPENDED INJECTIONS "Y.Y." 44.4

A010726100 MELLAZINE S.C. TABLETS 100MG 4.36

A010747100 SUROATE TABLETS "HONTEN" 0.27

A010773100 AMPOLIN CAPSULES 500MG 1.38

A010777340 NIFUCIN OINTMENT "PATRON" 16.2

A010800100 DOXCYCLINE CAPSULES “TAITEN” 1.21

A010823100 TAREIN TABLETS "YUNG CHI" 0.5

A010906229 SUNAMYCIN INJECTION 19

A010928209 TUDIN INJECTION "Y.Y." 1.75

A010939277 SAILISANNA INJECTION "S.Y." 19.5

A011003100 AMOLIN CAPSULES "Y.F." 0.99

7

Page 8: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A011013100 ANTICOLD CAPSULES "PATRON" 0.89

A011014155 COUGH SYRUP "PATRON" 33.2

A011014157 COUGH SYRUP "PATRON" 35.8

A011048100 EXPECTOLIN TABLETS 8MG 0.27

A011075209 SINCORT SUSPENDED INJECTION 13.3

A011075221 SINCORT SUSPENDED INJECTION 43.8

A011075229 SINCORT SUSPENDED INJECTION 57

A011081321 BENISON CREAM 0.1% "GENTLE" 22.5

A011082100 INDOZU E.C. TABLETS "YUNG CHI" 0.87

A011084100 NORSON TABLETS "HONTEN" 0.4

A011093151 COTAINE SYRUP "HEALTH" 18

A011135209 CLOXAMPICILLIN INJECTION 1GM "C.Y." 16.2

A011168100 BETAMETHASONE TABLETS "NCP" 0.75

A011189151 COLISO SYRUP 22.3

A011189157 COLISO SYRUP "WINSTON" 28.8

A011199212 MATOLON INJECTION "Y.A." 7.1

A011308209 BETASONE INJECTION "K.S." 11.9

A0113171G0 ANTI-COUGH TABLETS (瓶裝/56粒/瓶) 1.5

A011341100 GLUVENTIN TABLETS 8MG 0.27

A011344100 AMOXICILLIN CAPSULES 500MG "Y.C." 1.29

A011410100 PAINMEZONE TABLETS 0.91

A011411100 NICOPLAMIN TABLETS 0.83

A011479100 CINNARIZINE TABLETS "JEN SHENG" 0.69

A011482238 POLYVITA INJECTION "Y.Y" 10

A011483100 GASTON TABLETS 0.21

A011489100 PRENPERON S.C. TABLETS 10MG (METOCLOPRAMIDE) 0.69

A011493151 AREMIN COLD SOLUTION 22

A011564335 WANTACORT CREAM "W.T." 61

A011667216 RIFOMYCIN INJECTION "LITA" 61

A011703212 SINCOVLIN INJECTION "ASTAR" 6.5

A011706100 MINXLN TABLETS 0.83

A0117061G0 MINXLN TABLETS(鋁箔/膠箔) 1.5

A011762212 SULIVITA INJECTION 100MG 2.42

A011762238 SULIVITA INJECTION 100MG 8

A011764216 BERINE INJECTION 5

A011786100 COFCON TABLETS 15MG 0.42

A011792100 AMOXCIN CAPSULES "PATRON" 0.99

A011794100 HUSCOL CAPSULES "SHIN FONG" 0.89

A011832209 SEAFAR POWDER 1G FOR INJECTION 15.7

A011832212 SEAFAR POWDER 1G, 2G, 5G, 10G, 20G FOR INJECTION 43.3

A011832221 SEAFAR POWDER 1G, 2G, 5G, 10G, 20G FOR INJECTION 131

A011832229 SEAFAR POWDER 1G, 2G, 5G, 10G, 20G FOR INJECTION 380

A011832238 SEAFAR POWDER 1G, 2G, 5G, 10G, 20G FOR INJECTION 761

A011838417 GENTAMICIN OPHTHALMIC OINTMENT "OASIS" 21

A011850155 CONFLU SYRUP 27.2

A011890212 UCOUGIN-MEI INJECTION 3.92

A011898100 OUCEMIN TABLETS "Y.Y." 0.83

A011921238 CHINLIVITA INJECTION 10

A011926100 COMFORT TABLETS 5MG 0.8

A011928100 PARMINRIN F.C. TABLETS 0.5

A011929100 SOLAX CAPSULES "CHEN TA" 0.9

A011949100 ENTERAN TABLETS "S.C." 0.69

A011969100 PINSU TABLETS 0.45

A011986100 RIOTOL TABLETS 400MG 1.07

A012000100 TRIANPRES S.C. TABLETS "N.C.P." 1.21

8

Page 9: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A012008100 LISALENB TABLETS "BEYDAR" 1.89

A012019212 GENTAMICIN INJECTION "Y.Y." 13.1

A012050299 GENTACIN INJECTION 1.26

A012053212 GENTAMYCIN INJECTION 40MG "ORIENTAL" 13.1

A012053229 GENTAMYCIN INJECTION 40MG "ORIENTAL" 15.4

A012059100 TETRACYCLINE HCL CAPSULES 500MG "Y.C." 0.93

A012080100 PURINOL TABLETS "CURIE" 0.99

A012115100 PROFEN CAPSULES 200MG "SHIN FONG" 0.85

A012147100 SULFATRIM TABLETS "JEN SHENG" 0.9

A012243100 B.H. TABLETS 8MG "LITA" 0.4

A012300329 VEIMINCORT CREAM "VEIMIN" 11.3

A012315100 DICA TABLETS 0.69

A012343100 BUSCIN TABLETS "C.R." 0.96

A012377329 BETTER-INODINE OINTMENT (POVIDONE IODINE) "WEI-MING" 20.2

A012393417 BENEMYCIN EYE OINTMENT "OASIS" 43.8

A012407500 ANTI-GI SUPPOSITORY 7.8

A012446100 BETASON TABLETS 0.5MG "CHEN TA" (BETAMETHASONE) 0.75

A012458100 EURODIN TABLETS 2MG 1.66

A012472100 BROMHEXIN TABLETS "GENTLE" 0.27

A012488100 SULININ TABLETS "K.N." 0.69

A012506100 UPTHASONE TABLETS "JINUP" 0.75

A012524100 MINRID TABLETS "H.H." 0.32

A012552100 CININ TABLETS "N.C.P." 0.69

A012556109 SHECO GRANULES 5.6

A012596100 MECOFAN TABLETS "ASTAR" 0.52

A012646100 GYNEDOL TABLETS 1MG 1.14

A012673100 GASTON TABLETS "ORIENTAL" 0.18

A012675100 CINNARIZINE TABLETS "C.T." 0.69

A012714100 NO-PEIN CAPSULES "P.L." 0.6

A012735212 GENTAMYCIN INJECTION 40MG/ML "C.Y." 13.1

A012735229 GENTAMYCIN INJECTION 40MG/ML "C.Y." 15.4

A012803100 EULIVER S.C. TABLETS "H.H." 0.96

A0128031G0 EULIVER S.C. TABLETS "H.H."(鋁箔) 1.5

A012804100 SUPITON TABLETS "S.C." 0.6

A012807100 OUTINFLAME TABLETS "H.H." 0.85

A012817100 MEICO TABLETS 15MG 0.45

A012825100 NITROGLYCERIN TABLETS 0.6MG "NYSCO" 2.5

A012833100 PYMADON TABLETS "CHINTENG" 0.39

A012837100 HYLAZINE TABLETS "HONTEN" 1.05

A0128371G0 HYLAZINE TABLETS "HONTEN"(鋁箔/膠箔) 1.5

A012876100 BIOTASE TABLETS "YUNG SHIN" 0.73

A012886321 SUNBIN MEDICINE CREAM 5.8

A012886329 SUNBIN MEDICINE CREAM 11.3

A012898100 SERPINE TABLETS "Y.C." 0.71

A012901321 AYGAUSHON OINTMENT "J.H." 15.2

A012910100 IBUFEN TABLETS 200MG 0.58

A012951100 TRIMEZOLE TABLETS 0.9

A012955100 ECON TABLETS 40MG 0.3

A012973421 GENTAMICIN EYE DROPS "OASIS" 17.4

A013078100 JIEE-SUAN-LONG TABLETS 0.73

A013084100 NOSCAPINE TABLETS 20MG "C.S." 0.95

A013091100 MEPENZOLATE TABLETS "S.C." 1

A0130911G0 MEPENZOLATE TABLETS "S.C."(鋁箔/膠箔) 1.5

A013093100 AMPICILLIN CAPSULES 500MG "CHI SHENG" 1.38

A013103109 HISTAPP GRANULES 4.02

9

Page 10: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A013118100 CHLORMEZANONE TABLETS "SHIELD" 0.73

A013126100 HCNORITLE PIPRINHYDRINATE TABLETS 0.42

A013130100 OXELADIN CAP. 0.83

A013133100 GLYCERYL TABLETS "Y.C." 0.34

A013137100 SCOPOMINE TABLETS "C.T." 0.8

A013168100 METOCLOPRAMIDE S.C. TABLETS "ORIENTAL" 0.69

A013180100 NALIDIXIC ACID TABLETS 500MG "SHINLON" 2.25

A013199209 ORCIPRENALINE INJECTION "S.Y." 7.3

A013230100 FUCOLE IBUPROFEN CAPSULES 0.85

A013247100 COBAMAMIDE CAPSULES "C.R." 1.08

A013339151 PANCOPAR SYRUP "BOWLIN" 14.4

A013339157 PANCOPAR SYRUP "BOWLIN" 27.6

A013351100 ACETAMINOPHEN TABLETS "Y.C." 0.2

A013366100 SINZUIN TABLETS "YUNG CHI" 0.9

A013382100 MAGNESIUM OXIDE TABLETS 250MG "VPP" 0.17

A013405100 MEFENAMIC ACID CAPSULES "N.C.P." 0.75

A013415100 IBUPROFEN CAPSULES "H.C." 0.6

A013480100 KANMO CAPSULES "C.S." 0.45

A013491100 SUNSHING COUGH CAPSULES "H.H." 1

A013510338 MESENZIN OINTMENT "Y.C." 46.2

A013511100 CHLOROMEZANONE TABLETS "YUNG CHI" 0.73

A013520321 METHASONE OINTMENT "S.C." 14.9

A013531100 SEDASPA S.C. TABLETS "H.H." 1.15

A013535157 ANTICOUGH SYRUP WITH CODEINE "C.S.P." 24.2

A013548100 HOWELLS TABLETS "C.R." 0.85

A013591100 GRISEOFULVIN TABALETS "Y.C." 2.68

A013612100 IBUPROFEN CAPSULES "HONTEN" 0.79

A013631100 CARBINOXAMINE TAB. 0.5

A013638100 BROMPHENIRAMINE TABLETS "J.S." 0.3

A013644100 LONTEC TABLETS "H.H." 0.89

A013664100 METRONIDAZOLE CAPSULES 250MG "SHINLON" 1.15

A0136641G0 METRONIDAZOLE CAPSULES 250MG "SHINLON"(鋁箔/膠箔) 1.5

A013666100 RELAX ANALGESIC TABLETS 500MG 0.45

A013719100 LIBUSE S.C. TABLETS "JEN SHENG" 1.15

A013720100 MEFENAMIC ACID CAPSULES "JEN SHENG" 0.75

A013723100 CHLORZOXAZONE TABLETS "EAYUNG" 0.86

A013741100 GLYCERYL GUAIACOLATE TABLETS "N.T." 0.33

A013761100 TINIDAZOLE TABLETS "HONTEN" 2.08

A013796100 BETAMETHASONE TABLETS "SHINLON" 0.75

A013876100 IBUPROFEN CAPSULES "S.T." 0.79

A013879100 COLD CAPSULES "S.T." 0.42

A013906238 VITAGEN-SF INJECTION 4.5

A013914100 CETYL TABLETS "S.C." 0.9

A0139141G0 CETYL TABLETS "S.C."(鋁箔/膠箔) 1.5

A013955100 ORCIPRENALINE TABLETS "S.Y." 1.5

A013964238 XYLITOL INJECTION "S.Y." 3.31

A013964277 XYLITOL INJECTION "S.Y." 23.5

A013969100 DEXTROMETHORPHAN TABLETS "Y.C." 0.52

A013990100 CHUWEIYU GRANULES "J.H." 1.32

A014088100 ZUNO-NATHASID TABLETS "Y.C." 2.18

A014093238 GISALCON INJECTION "Y.Y." 9.1

A014111100 PHLOROPROPIOPHENONE CAPSULES "S.T." 1.48

A014118335 FUMEI OINTMENT "IDEAL" 54

A014121100 BROMHEXINE TABLETS "ASTAR" 0.27

A014152212 LINCOMYCIN INJECTION " K.S." 11.4

10

Page 11: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A014152229 LINCOMYCIN INJECTION " K.S." 24.2

A014170100 DEXAMETHASONE TABLETS "YUNG CHI" 0.69

A014171100 CEPHALEXIN CAPSULES "Y.Y." 1.14

A0141841G0 PREDNISOLONE TABLETS "WINSTON"(鋁箔/膠箔) 1.5

A014185100 DEXTROMETHORPHAN TABLETS "WINSTON" 0.37

A014205277 SURPLEX INJECTION "CHI SHENG" 19.1

A014224212 VITAMIN B12 INJECTION "LITA" 7.9

A014224229 VITAMIN B12 INJECTION "LITA" 10.9

A014230100 OXESILIN TABLETS "JOHNSON" 0.38

A0142383AN ZINC OXIDE OINTMENT "WST" 41.8

A014274100 ERYTHROMYCIN CAPSULES "UNION" 1.43

A0142741G0 ERYTHROMYCIN CAPSULES "UNION"(鋁箔/膠箔) 1.5

A014320435 NAZAMINE NASAL DROPS "PATRON" 32.1

A014346100 HYDROCHLOROTHIAZIDE TABLETS "SHINLON" 0.65

A014350212 GENTAMICIN INJECTION 40MG/ML "Y.F." 13.1

A014350299 GENTAMICIN INJ. 40MG/ML 1.26

A014359209 ESTRADIOL CYPIONATE INJECTION "TAI YU" 18.1

A014447100 BROMELAIN ENTERIC S.C. TABLETS "H.C.T." 0.89

A014552265 SORBIT-SALINE INJECTION 27.3

A014552277 SORBIT-SALINE INJECTION 43.2

A014620435 OXYMETAZOLINE SPRAY "CURIE" 6.8

A014622238 FUTIGEN-H INJECTION "S.Y." 9.7

A014623100 ANETHOLE CAPSULES "Y.C." 0.98

A014692100 DEXAMETHASONE TABLETS "PANBIOTIC" 0.69

A014733100 PUSKO S.C. TABLETS "CHEN TA" 0.96

A014739100 ORCIRIMINE CAPSULES "C.R." 0.89

A014746100 SCOPOLAMINE BUTYLBROMIDE CAPSULES "YUNG CHI" 0.88

A014749100 ACETAMINOPHEN TABLETS "JINUP" 0.3

A014756209 PENICILLIN G SODIUM INJECTION "Y.F." 7.83

A014756229 PENICILLIN G SODIUM INJECTION 10000000U "Y.F." 45

A014769100 MEBENDAZOLE TABLETS "Y.C." 1.1

A014783100 MEFENAMIC ACID CAPSULES "WST" 0.75

A014791100 IBUPROFEN CAPSULES 0.85

A014823100 ACETAMINOPHEN TABLETS 500MG "CHI SHENG" 0.28

A014842100 DEXTROMETHORPHAN TABLETS 30MG "LITA" 0.82

A014864100 DEMETHOR TABLETS "CHI SHENG" 0.37

A014865100 IBUFEN TABLETS "S.C." 0.5

A014873100 IBUPROFEN S.C. TABLETS "J.S." 0.71

A014880100 METHYLSCOPOLAMINE METHYLSULFASTE TABLETS "S.Y." 1.11

A014894299 GENTAMICIN INJ. 4% 1.26

A014922100 NOSOUTIN TABLETS "ORIENTAL" 0.89

A014925100 ANETHOLE CAPSULES "LITA" 0.98

A014932100 AMOXICILLIN CAPSULES "Y.Y." 0.99

A015021100 GUAIAZULENE SODIUM SULFONATE TABLETS "YUNG CHI" 0.98

A015029212 CARLMYCIN INJECTION 250MG/ML 4.16

A015029229 CARLMYCIN INJECTION 250MG/ML 19

A015029238 CARLMYCIN INJECTION 250MG/ML 26.6

A015033100 PSEUDOEPHEDRINE TABLETS "CURIE" 0.39

A0150331G0 PSEUDOEPHEDRINE TABLETS "CURIE"(鋁箔/膠箔) 1.5

A015090100 PSEUDOEPHEDRINE HCL TABLETS "HONTEN" 0.7

A015180212 COLISTIN INJECTION "ORIENTAL" 20

A015190100 DIMETHICONE TABLETS "S.Y." 0.25

A015195100 NARCARICIN CAPSULES (BENZBROMARONE) "SWISS" 0.8

A015199100 PYRININ TABLETS "GENTLE" 0.75

A015201100 ANKOCILLIN CAPSULES 500MG "W.F." 1.29

11

Page 12: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A015242100 STOMACHIC TABLETS "PATRON" 2.6

A015269100 SINFLEX CAPSULES 500MG“TAITEN” 1.76

A015277429 PLATINUM EYE SOLUTION 34.4

A015287100 ACETAMINOPHEN TABLETS 500MG "C.S." 0.39

A015291100 CLEMASTINE TABLETS "S.T." 0.6

A015317100 ACETAMINOPHEN TABLETS "N.T." 0.28

A015344100 BROMHEXINE TABLETS 8MG "F.Y." 0.27

A015345100 TRIMESIN TABLETS 0.9

A015346100 ACETAMINOPHEN TABLETS 500MG "F.Y." 0.26

A015354343 SABINA CREAM 44.9

A015359100 ANETHOL TRITHIONE S.C. TABLETS "SHINLON" 0.98

A015376100 PORSUCON S.C. TABLETS "HONTEN" 1.15

A015394100 METHYLSCOPOLAMINE METHYLSULFATE TABLETS "LITA 1.11

A015402212 LINCOMYCIN INJECTION "C.Y." 11.4

A015402229 LINCOMYCIN INJECTION "C.Y." 24.2

A015409100 TAI CHI TABLETS "CURIE" 0.45

A015436100 URSODESOXYCHOLIC ACID TABLETS "Y.Y." 2

A015469100 COLD SUGAR COATING TABLETS "UNIVERSAL" 0.78

A015540100 NORSECON TABLETS "CHINTENG" 0.5

A015553212 GENTAMICIN SULFATE INJECTION 40MG "WINSTON" 13.1

A015553229 GENTAMICIN SULFATE INJECTION 40MG "WINSTON" 15.4

A015566100 STROVITAN S.C. TABLETS 1

A015578100 MEBENDAZOLE TABLETS "CHI SHENG" 1.1

A0155791G0 TRIAMCINOLONE TABLETS 4MG "F.Y."(鋁箔/膠箔) 1.5

A015582277 AMPICLOXACIN INJECTION "TAI YU" 11.1

A015596100 APAP TABLETS 500MG 0.2

A015613209 ORCIPRENALINE INJECTIONS "Y.Y." 7.3

A015616100 BACZINE TABLETS "H.S." 0.9

A015622100 MEBENDAZOLE TABLETS "YUNG CHI" 1.1

A015630100 DEXTROMETHORPHAN S.C. TABLETS "WEI LI" 0.41

A015632209 DEPOT. TESTOESTRADIOL INJECTION "TAI YU" 21.3

A015637100 MEBENDAZOLE TABLETS "C.S." 1.1

A015694100 IBUPROFEN S.C. TABLETS 100MG "F.Y." 0.71

A015698100 TRIMEPRAZINE TARTRATE TABLETS "HONTEN" 0.68

A015703100 LIMOX CAPSULES 500MG "LITA" 1.29

A015748100 ALDIOXA TABLETS "PATRON" (DIHYDROXYALUMINUM ALLANTOINATE) 0.8

A015751100 METHYLSCOPOLAMINE METHYLSULFATE TABLETS 1MG "CHEN TA" 1.11

A015752100 ANETHOLE S.C. TABLETS 25MG "CHEN TA" 0.98

A015762435 KASULO NASAL SPRAY "C.S.P." 32.2

A015815100 FONGMIN CAPSULES "EAYUNG" 0.89

A015829229 LINCOMYCIN INJECTION "CHI SHENG" 24.2

A015829299 LINCOMYCIN INJECTION "CHI SHENG" 1.96

A015833100 AMPICILLIN CAPSULES 500MG "YUNG CHANG" 1.38

A015834100 GLYCERYL GUAIACOLATE TABLETS "M.T." 0.38

A015845216 PENICILLIN G SODIUM INJECTION "Y.F." 25.4

A015845229 PENICILLIN G SODIUM INJECTION 10000000U "Y.F." 45

A015853100 LONG-ONE CAPSULES (FLUOXYMESTERONE)"S.C." 2.46

A015908209 HYDROXYPROGESTERONE CAPROATE INJECTIONS "TAI YU" 30.8

A015912100 SALBUTAMOL TABLETS 4MG "EAYUNG" 0

A015916100 POKITON TABLETS "Y.C." 0.91

A015917209 AMCLOCILLIN INJECTION "TAI YU" 16.2

A015919157 COLD COUGH SOLUTION "C.M." 12.4

A015984100 DIAZEPAM TABLETS 5MG "JEN SHENG" 0.8

A015988229 LINCOMYCIN HYDROCHLORIDE INJECTION "Y.F." 24.2

A015992100 PANATOL TABLETS "M.T." 0.75

12

Page 13: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A016021100 DICYCLOMINE TABLETS "Y.C." 0.85

A016028100 TONPYRON TABLETS "PATRON" 0.74

A016055100 MEBENDAZOLE TABLETS "SHINLON" 1.1

A016065209 DEXAMETHASONE INJECTIONS 4MG "ASTAR" 6.9

A016065229 DEXAMETHASONE INJECTIONS 4MG "ASTAR" 17.6

A016084100 ANTICOUGH CAPSULES "HEALTH" 0.89

A016093100 TONLAN TABLETS 500MG "CHEN TA" 0.29

A016099100 CLOXAMPICIN CAPSULES 500MG "PANBIOTIC" 1.92

A0161411G0 SALBUTAMOL TABLETS 4MG "F.Y."(84粒/瓶) 1.5

A016143100 BROMHEXINE TABLETS "Y.C." 0.27

A016195100 DEXTROMETHORPHAN TABLETS 30MG "CURIE" 0.82

A016220100 ACETAMINOPHEN TABLETS "J.S." 0.36

A016222435 SUBICIN NASAL SPRAY "WINSTON" 23.3

A016223100 PROCHLORPERAZINE MALEATE S.C. TABLETS 5MG "VPP" 0.69

A016247100 MEBENDAZOLE TABLETS "PANBIOTIC" 1.1

A0162471G0 MEBENDAZOLE TABLETS "PANBIOTIC"(鋁箔/膠箔) 1.5

A016248157 NOGESIC SYRUP (ACETAMINOPHEN) "HEALTH" 18

A016298100 CHIAKANG TABLETS "ORIENTAL" 1.28

A016299100 PHLOROPROPIOPHENONE CAPSULES "H.S." 1.48

A016317100 CASCARA S.C. TABLETS 130MG "V.P.P." 0.51

A016318100 CASCARA S.C. TABLETS 250MG "V.P.P." 1.13

A016348100 RHIN TABLETS "GCPC" 0.62

A016350100 ENDURE TABLETS (PROPRANOLOL) "GCPC" 0.87

A016351100 EXTAMINE TABLETS (BROMPHENIRAMINE) "GCPC" 0.32

A016353435 EPHRINE NASAL DROPS (OXYMETAZOLIN) "GCPC" 5

A016373100 ACETAMINOPHEN TABLETS "K.B." 0.72

A016374100 WELIMIN TABLETS "M.T." 0.5

A016390155 ZUTON SYRUP 15MG/ML (ACETAMINOPHEN)"L.S." 23.5

A016392100 BETAMETHASONE TABLETS "HONTEN" 0.75

A016395100 BUCLIZINE TABLETS "C.S." 0.46

A016422100 SEUPHENON TABLETS "A.L." 0.89

A016444100 PRINATE TABLETS "CHINTENG" (PIPRINHYDRINATE) 0.49

A016474100 CEPHALEXIN CAPSULES "TAI YU" 1.14

A016481219 AMPICILLIN INJECTION 500MG "Y.Y." 10.6

A016489100 PSUBITY TABLETS "S.T." 0.42

A016496100 DEXAMETHASONE TABLETS "Y.C." 0.69

A016503100 ISOPRIN TABLETS (ISOXSUPRINE) "P.J." 0.78

A016506100 DEXTROMETHORPHAN HBR TABLETS "P.J." 0.48

A016508100 BISOLDIN TABLETS (BROMHEXINE) "P.J." 0.27

A016509100 ACETAMINOPHEN TABLETS "P.J." 0.48

A016583229 GENTAMICIN INJECTION 40MG/ML "Y.A." 15.4

A016592100 POLYYEN S.C. TABLETS "K.B." 0.89

A016594100 WEI YUNG AN TABLETS "K.B." 0.85

A0165941G0 WEI YUNG AN TABLETS "K.B." (鋁箔/膠箔) 1.5

A016595100 CHOLIGEN S.C. TABLETS "K.B." 0.96

A016672100 METOPELAN S.C. TABLETS (METOCLOPRAMIDE) "P.J. 0.69

A016674100 ITON CAPSULES "N.C.P." 0.5

A016692100 METHYLEPHEDRINE HCL TAB "J.S." 0.42

A016700100 METHYLSCOPOLAMINE METHYLSULFATE TABLETS 1.11

A016712100 ANTISEMIN TABLETS (CYPROHEPTADINE) 0.7

A0167121G0 ANTISEMIN TABLETS (CYPROHEPTADINE)(鋁箔/膠箔) 1.5

A016751100 COLDENIN S.C. TABLETS 0.89

A016816100 CYPRODINE TABLETS (CYPROHEPTADINE HCL) 0.7

A016829100 UPVENA TABLETS 4MG (CARBINOXAMINE)"JINUP" 0.5

A016830100 PAINLAX CAPSULES "JINUP" (DICYCLOMINE) 0.85

13

Page 14: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A016838100 KETOPROFEN CAPSULES 50MG "P.J." 1.76

A016839100 MEBENZOLE TABLETS (MEBENDAZOLE) "H.H." 1.1

A0168391G0 MEBENZOLE TABLETS "H.H."(MEBENDAZOLE)(鋁箔) 1.5

A016862321 TOPCORT CREAM (FLUOCINONIDE)"S.C." 36.1

A016862329 TOPCORT CREAM (FLUOCINONIDE)"S.C." 54

A016873100 YIPAITAN TABLETS 8MG "Y.S." (BROMHEXINE) 0.27

A016879100 WACICORT TABLETS "WST" (TRIAMCINOLONE) 0.89

A016932100 SEUDORIN TABLETS (PSEUDOEPHEDRINE HCL) 0.39

A016944100 IBUPROFEN TABLETS "SHINLON" 0.68

A016951100 LITON ENTERIC-COATED TABLETS (BISACODYL)"Y.C." 0.42

A016963221 SIVKORT STERILE SUSPENSION 40MG (TRIAMCINOLONE) 44.4

A016964100 LISUZONE TABLETS (HYDROCHLOROTHIAZIDE)"Y.C." 0.65

A016969100 CONAMIN TABLETS "GENTLE" 0.89

A017006100 FONES-TON CAPSULES "K.B." 1.02

A017014321 TOPCORT OINTMENT (FLUOCINONIDE) "S.C." 36.1

A017014329 TOPCORT OINTMENT (FLUOCINONIDE) "S.C." 54

A017017100 MEBENDAZOLE TABLETS 1.1

A017084100 IBUPROFEN CAPSULES 0.85

A017088238 GISACON-B12 INJECTION "Y.A" 5

A017107100 DEPAIN TABLETS 0.74

A017121100 MIN'S TABLETS "H.C." (CLEMASTINE) 0.83

A017136100 TONPEN TABLETS "Y.C." 1.07

A017143100 WISH TABLETS 1.5

A017153100 CYPROHEPTADINE HCL TABLETS "SHINLON" 0.7

A017179100 SHULIJN TABLETS " CHEN TA" 0.86

A017199100 TON FONLIN CAPSULES "Y.S." (IBUPROFEN) 0.85

A017200421 DECASON EYE DROPS "OASIS" (DEXAMETHASONE) 14.7

A017205100 SHOUENLIN TABLETS (IBUPROFEN)"Y.Y." 0.85

A017279416 GENTAMICIN EYE DROPS "GCPC" 17.4

A017279421 GENTAMICIN EYE DROPS "GCPC" 17.4

A017291100 PYSTON TABLETS (MEFENAMIC ACID)"SHINLON" 0.75

A017302100 COUGHXIN TABLET 8MG (BROMHEXINE) 0.38

A017308100 KETOPROFEN S.C. TABLETS "HONTEN" 1.76

A017343100 DEXTROMETHORPHAN TABLETS 30MG "EAYUNG" 0.82

A017351100 INDOCIN E.C. TABLETS 25MG "CHEN TA" (INDOMETHACIN) 0.87

A0173531G0 N-METHYLSCOPOLAMINE METHYL SULFATE TABLETS "M.T."(鋁箔/膠箔) 1.5

A017367100 PILINTON CAPSULES "W.F." 3.5

A017383100 ANTICOLD CAPSULES "CHINTENG" 1.17

A017402100 SULNIN CAPSULES "LITA" 0.89

A017438100 IBUPROFEN CAPSULES "WINSTON" 0.55

A017441100 PITONNING TABLETS "CHEN TA" 0.74

A017450100 TINIDAZOLE TABLETS 500MG "H.H." 2.08

A017454423 RINTERON OPHTHALMIC SOLUTION "MAY SEE" 35

A017497100 ROWELCON S.C. TABLETS (METOCLOPRAMIDE) 0.69

A017498100 HANTOLINE TABLETS (MECLIZINE)"Y.C." 0.22

A017543100 COLDEX CAPSULES "KINGDOM" 0.75

A017545100 ANTONE TABLETS 500MG"D.T.S" 0.19

A017568100 ASTHAN S.C. TABLETS "Y.Y" 0.89

A017594100 RIFAMPIN CAPSULES 300MG 3.2

A017632100 CALVAMOX TABLETS "S.C." (MEBENDAZOLE) 1.1

A017711212 VILITOMIN INJECTION 19.9

A017712209 CEFAZOLIN INJECTION 1GM "C.C.P." 12.8

A017713100 MEBENDAZOLE TABLETS "LITA" 1.1

A017733435 SWININ NASAL SPRAYS (OXYMETAZOLINE) "SWISS" 22.8

14

Page 15: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A017794100 PREDNISOLONE TABLETS "L.S." 0.9

A017799100 PAPAVERINE HCL TABLETS 30MG "HONTEN" 1.04

A017805229 KANAMYCIN SULFATE INJECTION "ASTAR" 19

A017805238 KANAMYCIN SULFATE INJECTION "ASTAR" 26.6

A017805299 KANAMYCIN SULFATE INJECTION "ASTAR" 1.33

A017806157 PANCOUDENIN SYRUP "PANBIOTIC" 35.9

A017833277 CEFAZOLIN INJECTION 11.4

A017860100 ZEMIN TABLETS (CLEMASTINE) "PANBIOTIC" 0.6

A017863100 SINOPRIN TABLETS "SHIN FONG" 0.9

A017868100 SUWIMIN TABLETS "CHEN TA"(DICYCLOMINE) 0.85

A017872212 YUOSINCIN INJECTION (DIPYRIDAMOLE)"S.Y." 8.5

A017882163 UNITUSSIN SYRUP " CENTER" 25

A017887100 COBAMAMIDE CAPSULES "Y.C." 1.08

A0178871G0 COBAMAMIDE CAPSULES "Y.C."(鋁箔/膠箔) 1.5

A017919209 TESTOSTERONE CYPIONATE INJECTION "Y.Y." 15.9

A017984100 METOCLOPRAMIDE TABALETS "Y.C." 0.69

A018006100 DIPHACOL S.C. TABLETS "S.C." (DIPHENIDOL) 0.91

A018014100 SOLAXIN TABLET "C.R." 0.9

A018048212 VITAMIN BC INJECTION "LITA" 1.4

A018062100 CHUNBIK TABLETS (MEBENDAZOLE) "K.B." 1.1

A018069100 ANCOTON TABLETS (ACETAMINOPHEN)"H.C." 0.3

A018091100 METHON TABLETS 15MG 0.56

A018098110 SUPERCILLIN (AMOXICILLIN) POWDER FOR ORAL SUSPENSION 31

A018100100 DELUGI TABLETS "WP" (NALIDIXIC ACID) 2.25

A018136100 ACETAMINOPHEN TABLETS "Y.S." 0.28

A018155100 BUCLIZINE TABLETS "P.J." 0.4

A018157329 CROLAX-H CREAM "P.J." 10.1

A018160100 DEHYDRI S.C. TABLETS "P.J." 1.21

A018162100 PAINTYL TABLETS "P.J." 0.45

A018231100 MEPENZOL TABLETS "P.J." 0.64

A018237100 SOFTCOUGH CAPSULES "PANBITOTIC" 1.06

A018250100 CARDIOLOL TABLETS 40MG (PROPRANOLOL) 0.87

A0182501G0 CARDIOLOL TABLETS 40MG (PROPRANOLOL) (鋁箔/膠箔) 1.5

A018255212 U-GENCIN INJECTION 40MG/ML (GENTAMYCIN) 13.1

A018270100 COLDLAX CAPSULES "JINUP" 0.63

A018281100 HUGALIN S.C. TABLETS (DIISOPROPYLAMINE DICHLOROACETATE) "H.H." 1

A018282100 SEPRONIN CAPSULES (KETOPROFEN) "SHITEH" 1.76

A018322321 GENDERON CREAM "PATRON" 13.9

A018322329 GENDERON CREAM "PATRON" 14.2

A018331100 SALBUTAMOL TABLETS "HONTEN" 0.93

A018332100 NOVAZIL TABLETS "S.C." 0.89

A0183321G0 NOVAZIL TABLETS "S.C."(鋁箔/膠箔) 1.5

A018336100 KENACORT TABLETS (TRIAMCINOLONE)"Y.Y." 0.35

A018373100 TATONLIN CAPSULES "Y.S." (MEFENAMIC ACID) 0.75

A018432100 ACETAMINOPHEN TABLETS "WINSTON" 0.61

A018437321 BETASONE CREAM L.S. 11.1

A018437329 BETASONE CREAM L.S. 17

A018437338 BETASONE CREAM L.S. 68

A018444100 CABIDRIN FILM COATED TABLETS "JOHNSON" 0.89

A018460100 BUU SHIEE VITAMINE CAPSULES "H.S."(COBAMAMIDE) 1.08

A018498100 PISANTONG TABLETS "CHINTENG" 1.03

A018555100 PUNORTOR TABLETS "PANBIOTIC" (ACETAMINOPHEN) 0.39

A018559100 LONZUMIN TABLETS "STANDARD" (BUCLIZINE) 0.46

A018570100 MYOLAX TABLETS 500MG (METHOCARBAMOL) "VPP" 1

15

Page 16: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A018572100 KETOPROFEN CAPSULES "CHEN TA" 1.76

A018589209 NEO-ERGO INJECTION "ORIENTAL" 12.5

A018597500 HEMODIN SUPPOSITORIES "PATRON" 5.5

A018609100 ANALGESIC TABLETS 500MG "SOURIREE" (ACETAMINOPHEN) 0.2

A018637100 COLAC E.C. TABLETS "S.C." (BISACODYL) 0.78

A018638100 SUJNLI TABLETS "CHEN TA" 0.73

A018648100 KORYNASE E.C. TABLETS 10MG 2.9

A018659100 ACETAMINOPHEN TABLETS "S.Y." 0.28

A018669212 BETAMETHASONE SUSPENDED INJECTION "GENTLE" 0

A018678100 BIDICON TABLETS (DEXTROMETHORPHAN) 0.82

A0186921G0 MEBENDAZOLE TABLETS "M.T."?]?T??/?????^ 1.5

A018694209 ATROPINE SULFATE INJECTION 1MG/ML "VPP" 3.46

A018696100 BIDYL S.C. TABLETS (BISACODYL) "C.C.P." 0.75

A018705100 ALLOPRIM TABLETS (ALLOPURINOL) "SHINLON" 0.99

A018718100 ANTICOLD CAPSULES "C.R." 0.54

A018738100 SUFFIN TABLETS (PSEUDOEPHEDRINE HCL) "C.R." 0.7

A0187381G0 SUFFIN TABLETS (PSEUDOEPHEDRINE HCL) "C.R."(鋁箔/膠箔) 1.5

A018750100 COLDENIN CAPSULES 0.89

A018771329 TOLDINE OINTMENT "S.T." 35.2

A018772121 KOSULER PASTE (TRIAMCINOLONE) "PANBIOTIC" 28.4

A018772129 KOSULER PASTE (TRIAMCINOLONE) "PANBIOTIC" 57

A018789100 POSTON CAPSULES 250MG "CHEN TA" 0.75

A018791100 SEDENIN TABLETS "MEIDER" 0.74

A018798335 TRICODEX CREAM "C.C.P." 65

A018808100 UPDIAN TABLETS "JINUP" (METRONIDAZOLE) 1.15

A018820299 VITAMIN B COMPLEX INJECTION "WINSTON" 1.59

A018848421 ATROPINE EYE DROPS (ATROPINE SULFATE)"OASIS" 29.9

A018873100 BUCLIZINE TABLETS "H.H." 0.54

A018884265 SUPERCILLIN FOR INJECTION "VPP" 0

A018896100 SALUTOL TABLETS (SALBUTAMOL) "KINGDOM" 0.83

A0188961G0 SALUTOL TABLETS (SALBUTAMOL) "KINGDOM"(鋁箔) 1.5

A018916100 TOPICAINE TABLETS (OXETHAZINE) "Y.C." 0.17

A018926100 TIOPRONIN S.C. TABLETS "S.T." 4.39

A018929100 ANTALGIC TABLETS "H.H." 0.74

A018952333 HEPARINOID OINTMENT "Y.Y." 37.5

A018959100 POLYASE TABLETS "P.J." 0.57

A018985163 PACOUGH SYRUP "PATRON" 25

A018987421 BENOXINATE EYE DROPS "OASIS" 24.8

A019039100 KOCHANIIN TABLETS (CLONIDINE) "S.Y." 1.11

A019040100 AMITRIPTYLINE TABLETS "JINUP" 0.83

A019072100 KETOPROFEN CAPSULES "Y.S." 1.76

A019087100 CLOMIPHENE CAPSULES 50MG "JINUP" 3.78

A019102100 BICOROMIN TABLETS "MEIDER" 0.69

A019115100 PAWINT TABLETS "PATRON" 1.1

A019138100 DIPYRIDAMOLE S.C. TABLETS "SHINLON" 0.9

A019144351 DEHIST LOTION "GCPC" 18.2

A019144355 DEHIST LOTION "GCPC" 26.2

A019150238 VITAPLEX INJECTION "S.Y." 5.3

A019150265 VITAPLEX INJECTION "S.Y." 17.8

A019159100 ACETA TABLETS (ACETAMINOPHEN) "J.H." 0.31

A019178100 ANTIASTHMA CAPSULES 4.13

A019192100 PROPRANOLOL TABLETS "SHINLON" 0.87

A019251100 NEO-ANTIHISTAMINE TABLETS (CHLORPHENIRAMINE) "J.H." 0.13

A019260100 DYS-COLD CAPSULES "H.H." 0.89

16

Page 17: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A0192631G0 MUQUAPIN S.C. TABLETS "H.S." (N-METHYLSCOPOLAMINE

METHYLSULFATE)(鋁箔/膠箔)

1.5

A019269329 SIFUZIN CREAM "YUNG CHANG" 30

A019299135 PANDOL LIQUID (HALOPERIDOL) "PANBIOTIC" 39.4

A019299143 PANDOL LIQUID (HALOPERIDOL) "PANBIOTIC" 45.5

A019299151 PANDOL LIQUID (HALOPERIDOL) "PANBIOTIC" 45.5

A019299157 PANDOL LIQUID (HALOPERIDOL) "PANBIOTIC" 125

A019328100 DEXTROMETORPHAN TABLETS "JEN SHENG" 0.82

A019339100 DIPHENIDOL HCL S.C. TABLETS "J.S." 0.91

A019343100 ACETAMINOPHEN TABLETS "C.T." 0.37

A019348100 KUANIUM S.C. TABLETS "VPP" 1.15

A019350100 PAINLAX TABLETS 20MG (DICYCLOMINE)"JINUP" 1.13

A019353100 STAZYME F.C. TABLETS "STANDARD" 1.82

A019410100 UNCOLA CAPSULES "S.C." 1

A0194101G0 UNCOLA CAPSULES "S.C."(鋁箔/膠箔) 1.5

A019412100 SEDICON TABLETS "YU SHENG" 0.4

A019422335 SCALPHEN OINTMENT (MESULPHEN) "SINPHAR" 40.3

A019444100 MEBENDAZOLE TABLETS "S.Y." 1.1

A019474100 TTMYCIN CAPSULES "WASHINGTON" (TETRACYCILINE HCL) 0.82

A019485100 DEXCHLORPHENIRAMINE TABLETS "HONTEN" 0.42

A019518100 FULOAN CAPSULES (FLUOXYMESTERONE) "N.C.P." 2.46

A019522100 BICOTAN E.C. TABLETS (BISACODYL)"H.C." 0.55

A019535100 BETAMETHASONE TABLETS "ORIENTAL" 0.75

A0195551G0 DIAZEPAM TABLETS "ROYAL" 1.5

A0195571G0 PURINOL TABLETS (ALLOPURINOL) "ROYAL"(鋁箔/膠箔) 1.5

A019577100 BACTALIN TABLETS "S.Y." 0.9

A019600100 NEGACHINE TABLETS (NALIDIXIC ACID) "H.C." 2.25

A019614329 SINPHARDERM-HC CREAM "SINPHAR" 20.1

A019615329 SINQUART CREAM "SINPHAR" 19.3

A019624100 IPROFEN F.C. TABLETS (IBUPROFEN) "ROYAL" 0.84

A019644100 SALBUTOL TABLETS (SALBUTAMOL) "ROYAL" 0.93

A019650100 BROMCO TABLETS (BROMHEXINE) "ROYAL" 0.27

A019659209 BETAMETHASONE INJECTION "Y.Y." 11.9

A019659229 BETAMETHASONE INJECTION "Y.Y." 19.5

A019819100 ANTONIN CAPSULES 1.76

A019864100 ACEDOL TABLETS "ROYAL" 0.45

A019899100 DACTJIN F.C. TABLETS "SHITEH" 0.9

A019937421 FLUOROMETHOLONE EYE DROPS "OASIS" 14

A019945100 KETOPROFEN CAPSULES "N.T." 1.76

A019947100 NOSCAPINE TABLETS "H.C." 0.9

A019949100 ANTI-COUGH CAPSULES "SOURIREE" 1

A019952100 FULIVER S.C. TABLETS "CHEN TA" 1.59

A019961342 NITROFURAZONE OINTMENT "Y.Y." 22.8

A019977100 MESYTOL TABLETS 6MG "CHEN TA" (BETAHISTINE) 0.92

A019985100 KETOPROFEN CAPSULES 50MG "EAYUNG" 0

A020038100 DICLOFENAC E.C. TABLETS "YUNG CHI" 0.9

A020043100 SINOX TABLETS "N.C.P." (MEBENDAZOLE) 1.1

A020044100 SIOFULIN TABLETS (DICLOFENAC) "S.Y." 0.9

A020046100 LESUTON TABLETS "YUNG CHI" 0.74

A020070100 CLOMIFEN CAPSULES (CLOMIPHENE) "ROYAL" 3.78

A020092100 SOOTHING TABLETS "YUNG SHIN"(OXETHAZAINE) 0.73

A020101100 SUFUPIN TABLETS (BUCLIZINE) "YUNG CHANG" 0.72

A0201031G0 DICLOFEN F.C. TABLET (DICLOFENAC) "H.H."(鋁箔/膠箔) 1.5

A0201121G0 TRICOGYL F.C TABLETS (METRONIDAZOLE) "ROYAL"(鋁箔/膠箔) 1.5

A020144100 LIPAIMIN S.C. TABLETS "EAYUNG" 0.89

17

Page 18: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A020148212 HEPATOSWISS IM INJECTION "SWISS" 20.3

A020174100 LOTINTON TABLETS 0.74

A0201741G0 LOTINTON TABLETS(鋁箔/膠箔) 1.5

A020205100 ORONAMINE S.C. TABLETS "C.Y." 0.89

A020215343 SINBABY BABY LOTION "SINPHAR" 12

A020215357 SINBABY BABY LOTION "SINPHAR" 33.7

A020228221 HEPATOSWISS I.V. INJECTION "SWISS" 44

A020256100 SADIXIN TABLETS (NALIDIXIC ACID) "S.Y." 2.25

A020264100 DOZIN TABLETS (NAPROXEN) "YUNG-CHANG" 1.09

A0202851G0 SOLAX CAPSULAS "ROYAL"(鋁箔/膠箔) 1.5

A020288100 CARBELONE TABLETS (CARBENOXOLONE) "ROYAL" 2.48

A020296321 WINSOLVE ANTIFUNGAL CREAM 20.5

A020296329 WINSOLVE ANTIFUNGAL CREAM 37.3

A020299100 LIKANCOCHIEN S.C. TABLETS "ORIENTAL" 1.59

A020309100 SULINTEN TABLETS (FENOTEROL) "S.Y." 0.97

A020338100 ATUSSIN S.C. TABLETS (SODIUM DIBUNATE) "VPP" 1.35

A020340100 DISKO S.C. TABLETS "CHEN TA" 0.83

A020384100 GFMYCIN CAPSULE 125MG (GRISEOFULVIN) "WST" 0.99

A020387100 NAPROXEN TABLETS "YUNG CHI" 1.09

A020435100 DISCO TABLETS (BROMHEXINE) "S.Y." 0.27

A020444100 PARAMOL TABLETS (ACETAMINOPHEN) 0.61

A020455100 MAGNESIUM HYDROXIDE 300MG "CHEN TA" 0.22

A020459100 CP MYCIN CAPSULE 500MG (CEPHALEXIN)"WP" 1.76

A020538238 PLEXVITE INJECTION "ASTAR" 5.3

A020538277 PLEXVITA INJECTION "ASTAR" 19.1

A020557100 ACETOMIN TABLETS 500MG 0.2

A020604100 ALLOPURINOL TABLETS 100MG "CHEN TA" 0.99

A020613100 CLONIDINE TABLETS "H.H." 1.11

A020616100 NITRAZE TABLETS (NITRAZEPAM) "S.C." 0.77

A020684100 HONLOW TABLETS (NAPROXEN) "CURIE" 1.09

A020694429 ENGENE EYE DROPS "PATRON" 49.1

A020707100 DEPYRETIN TABLETS (ACETAMINOPHEN) "VPP" 0.61

A020738100 SOUDIPAN TABLETS (DIAZEPAM) "S.Y." 0.8

A020755100 ERYCIN CAPSULES (ERYTHROMYCIN STEARATE) 1.43

A020781100 TRIAMCINOLONE TABLETS "N.C.P." 0.89

A020801100 LIY'S CAPSULES (LOPERAMIDE)"CURIE" 0.94

A020843212 DICYCLOMINE INJECTION " K.S." 6.4

A020847100 WILCONIN TABLETS "C.Y." 0.85

A0208491G0 LOPERAMIDE TABLETS 2 MG "F.Y."(28粒/瓶裝)(鋁箔/膠箔) 1.5

A020854100 CENSOLIN TABLETS (SALBUTAMOL) "S.C." 0.83

A020857100 ROSTAN CAPSULES "CHEN TA"(B-AESCIN) 4

A0208731G0 CLIXIN F.C. TABLETS "ROYAL"(鋁箔/膠箔) 1.5

A020892343 SINPHARDERM CREAM "SINPHAR" 36.3

A020904100 JYYKO TABLETS 30MG (DEXTROMETHORPHEN) "H.L." 0.82

A020908221 METHOCARBAMOL INJECTION "K.S." 6.2

A0209211G0 CEFENINE S.C. TABLETS (DIPHENIDOL) "H.C."(鋁箔/膠箔) 1.5

A020926329 FUTOCAN CREAM "SHINLON"(FLUCOCINOLONE) 38.7

A020927100 PROPRALOL TABLETS "Y.Y." (PROPRANOLOL) 0.87

A020930100 CYRITIN TABLETS (CINNARIZINE) "SHINLON" 0.69

A020959100 CLONIN CAPSULES (CLOMIPHENE) 3.78

A020968212 BERBERIN INJECTION "K.S." 2.74

A020976100 SEUSTON CAPSULES (MEFENAMIC ACID) 0.75

A020998321 BEGTI CREAM "STANDARD" 15.5

A021010100 LIAID CAPSULES (LOPERAMIDE) "SHIN FONG" 0.94

A021012209 WINZOLIN INJECTION 1G (CEFAZOLIN) "WINSTON" 15.7

18

Page 19: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A021014100 SAUTUN TABLETS (DEXTROMETHORPHAN) "WP" 0.37

A021029100 FULNIN CAPSULES (LOPERAMIDE) "PANBIOTIC" 0.94

A021030212 BIOTIN-H INJECTION 5.8

A021032100 ANTIDIA CAPSULES (LOPERAMIDE) "S.C." 0.94

A021054421 IANSOU OPHTHALMIC SOLUTION 28.8

A021054423 IANSOU OPHTHALMIC SOLUTION 35

A021075229 FUZETAMIN INJECTION 9.1

A021075238 FUZETAMIN INJECTION 9.4

A021109238 HICOVITA INJECTION "GENTLE" 0

A021148100 TRIAMCINOLONE TABLETS "S.Y." 0.89

A021155238 FRUCTOSE INJECTION "S.Y." 3.6

A021155277 FRUCTOSE INJECTION "S.Y." 30.7

A021189212 METOCLOPRAMIDE INJECTION "LITA" 7.1

A021196100 LIPIMIN TABLETS "S.C." (BUCLIZINE) 0.49

A021200100 LOPERAMIDE CAPSULES "CHI SHENG" 0.94

A021201100 FUZINE S.C. TABLETS (TRIFLUOPERAZINE HCL) "SHIN FONG" 1

A021204209 CEFAMON INJECTION (CEFAMANDOLE) "LITA" 55

A021223209 AMPICILLIN INJECTION 1GM (POTENCY)/VIAL "TAI YU" 11.5

A021228100 LOPERADIUM CAPSULES (LOPERAMIDE) "P.J." 0.94

A021241100 METOCLOPRAMIDE HCL S.C. TABLETS 10MG "J.S." 0.69

A021274100 XANPLAMIN TABLETS 150MG (XANTHINOL NICOTINATE) "VPP" 0.83

A0212981G0 COBAMAMIDE CAPSULES "M.T."(鋁箔/膠箔) 1.5

A021372238 PIRACETAM INJECTION "Y.Y." 45.8

A021381100 FUCHEN "CURIE" 3.1

A021390100 HECAMOL TABLETS (ACETAMINOPHEN) "HEALTH" 0.36

A0214061G0 WETONLIN TABLETS "M.T."(鋁箔/膠箔) 1.5

A021418212 WINZOLIN INJECTION 2GM (CEFAZOLIN) "WINSTON" 43.3

A021441100 AMOXICILLIN CAPSULES "TAI YU" 0.99

A021450238 SUNSUVITA INJECTION "S.Y." 9.4

A021455335 XYLMOL OINTMENT "SINPHAR" 52

A021459100 ACTIVE TABLETS (LEVAMISOLE) 2.71

A021480100 CLONIDINE TABLETS "SWISS" 0.8

A0214801G0 CLONIDINE TABLETS "SWISS"(鋁箔/膠箔) 1.5

A021484100 TONCOPIN TABLETS "N.C.P." 1

A021529100 EXTANCIN TABLETS (GLYCERYL GUAIACOLATE) "H.H." 0.38

A021534100 CLEMASTINE CAPSULES ""CHEN TA." 0.6

A021563100 WINMOX CAPSULES 500MG (AMOXICILLIN) "WINSTON" 1.29

A021572421 BELINRON EYE DROPS "M.L.C." 28.8

A021573316 SCHEREE CREAM "BOWLIN" 9.3

A021573324 SCHEREE CREAM "BOWLIN" 19.2

A021586100 DIMENHYDRINATE TABLETS "C.Y." 0.38

A021591100 AMPICILLIN CAPSULES "TAI YU" 1.02

A0216061G0 WINLIPAN CAPSULES (LOPERAMIDE) "WINSTON"(鋁箔) 1.5

A021622100 MEPRAM S.C. TABLETS (METOCLOPRAMIDE) "SHINLON" 0.62

A0216351G0 LIPIN TABLETS (METHYLSCOPOLAMINE METHYLSULFAT) "ROYAL"(鋁箔/膠

箔)

1.5

A0216401G0 GLIDIAB TABLETS 5MG(GLIPIZIDE) (鋁箔盒裝) 0.8

A021670212 DEXAMETHASONE PHOSPHATE INJECTION 5MG " K.S." 17.6

A021670229 DEXAMETHASONE PHOSPHATE INJECTION 5MG " K.S." 18.8

A021693100 LOPERAMIDE CAPSULES "Y.C." 0.94

A021703100 GENLATIN CAPSULES "TAITEN" (LOPERAMIDE) 0.94

A021707100 PERAMIDE CAPSULES (LOPERAMIDE) "KINGDOM" 0.94

A021709212 TRANEXAMIC ACID INJECTION "S.Y." 4.55

A021709221 TRANEXAMIC ACID INJECTION "S.Y." 9.7

A021719438 NASAL SPRAY "NYSCO" 32.7

19

Page 20: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A021731157 ANTISEMIN DRY SYRUP (CYPROHEPTADINE) 22.8

A021748277 6-H.E.S. INJECTION 256

A021776151 CODEPIN SYRUPS "N.C.P." 17.2

A021776157 CODEPIN SOLUTION "N.C.P." 30.1

A021815100 BROMELAIN ENTERIC SUGAR COATED TABLETS "YUNG CHI" 0.89

A021819100 LOPERAMIDE CAPSULES "YUNG CHI" 0.94

A021820100 SERPATHIAZIDE F.C. TABLETS "WST" 0.73

A021832100 TONPASS CAPSULES 250MG (MEFENAMIC ACID) "JINUP" 0.75

A021841100 SUMINCON TABLETS (PIPRINHYDRINATE) "H.H." 0.42

A021853329 DAFRIN CREAM (MICONAZOLE) "SWISS" 37.3

A021855100 COLD S.C. TABLET "H.C." 0.89

A021870100 ASTAR TABLETS (ASPIRIN) "S.Y." 0.46

A021880316 WANT CREAM "HSC" 21.4

A021880321 WANT CREAM "HSC" 27.5

A021880329 WANT CREAM "HSC" 34.5

A021887417 LECORT IN ORAL BASE (TRIAMCINOLONE) 22.7

A021887423 LECORT IN ORAL BASE (TRIAMCINOLONE) 42.7

A021890100 METATU HON TABLETS (DICLOFENAC) "CURIE" 0.9

A0219051G0 WINTEL CAPSULES (TETRACYCLINE METAPHOSPHATE)"WINSTON"(鋁箔) 1.5

A021932100 CLEMASTINE TABLETS "YU SHENG" 0.64

A021960151 COCOSAU SYRUP "Y.Y" 21.1

A021990100 SONCHI TABLETS "CURIE" 2.26

A022010229 HYCOMIN INJECTION "S.Y." (HYDROXOCOBALAMINE) 22

A022023100 FUSO TABLETS "ROYAL" 0.72

A022043100 ALETON TABLETS "YUNG CHI" 0.91

A022050100 EDEPRESS CAPSULES "SHIN FONG" 1.2

A022077100 COLCHICINE TABLETS "N.Y." 0.99

A022078321 ANTIFUNGUS CREAM "GCPC" 42.2

A022083238 NUTRASE INJECTION 20MG (COCARBOXYLASE) 2.4

A022100100 LYZOIN TABLETS (LYSOZYME) "YUNG CHI" 0.92

A022106100 SABUCHAN TABLETS (SALBUTAMOL)"YUNG CHANG" 0.93

A022109100 IMODINE CAPSULES (LOPERAMIDE) "KINK" 0.94

A022117100 PANACON TABLETS 0.26

A022120100 WHITE ANTI-PEPTIC ULCER TABLETS (GEFARNATE) 1.59

A022122100 LACTAM TABLETS (ACETAMINOPHEN) "SINPHAR" 0.39

A022141100 SILIPIN TABLETS "H.H." 0.43

A022187100 COUNTHIN S.C. TABLETS "CHEN TA."(DIPYRIDAMOLE) 0.9

A022191100 CIMETIDINE TABLETS "HSC" 1

A022192321 SEPTON CREAM (BETAMETHASONE DIPROPIONATE) 15.8

A022193321 SEPTON OINTMENT (BETAMETHASONE DIPROPIONATE) 15.8

A022199100 COULITIN TABLETS "ASTAR" 0.89

A022200500 XYLMOL SUPPOSITORY "SINPHAR" 3.24

A022210100 CIWEITIN TABLETS (CIMETIDINE) "CURIE" 1

A0222101G0 CIWEITIN TABLETS (CIMETIDINE) "CURIE"(鋁箔/膠箔) 1.5

A022226212 SULOFAGEN INJECTION 2.59

A022229100 WACO TABLETS (GLYCERYL GUAIACOLATE) "W.P." 0.38

A022259100 PRANOLOL TABLETS (PROPRANOLOL) "H.L." 0.87

A022274100 UFUNIN TABLETS (LOPERAMIDE) 0.94

A0222741G0 UFUNIN TABLETS (LOPERAMIDE) (鋁箔/膠箔) 1.5

A022286100 CINNARINZINE TABLETS "S.Y." 0.69

A022289100 LOPERAMIDE CAPSULES "CHEN TA."" 0.94

A0222891G0 LOPERAMIDE CAPSULES "N.M" (鋁箔/膠箔) 1.5

A022301155 FUMUCIL GRAMULES (ACETYLCYSTEINE) "SWISS" 65

A022319209 PANTOTHENOL INJECTION "S.Y." 4.61

20

Page 21: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A022319212 PANTOTHENOL INJECTION "S.Y." 8

A022339100 ULCUS CAPSULES (SULPIRIDE) "M.S." 1.33

A022348100 HUCOPIN TABLETS "S.Y." 0.51

A022404100 LILITIN TABLETS 1.23

A022407100 KETOPROFEN CAPSULES 50MG "CHI SHENG" 1.76

A022433151 SHOWMIN SYRUP "CURIE" (CYPROHEPTADINE) 17

A022433157 SHOWMIN SYRUP "CURIE" (CYPROHEPTADINE) 22.8

A022434100 NAPROXEN TABLETS "JINUP" 1.09

A022442100 ENLAIN F.C TABLETS 100MG "CHEN TA" 0.95

A022463100 CIMETIDINE TABLETS "SHIN FONG" 1

A022464100 CIMETIDINE TABLETS "CHI SHENG" 1

A022467100 INCALM TABLETS "SINPHAR" 0.65

A022473429 PATEAR EYE LOTIONS "PATRON" 34.2

A022474321 HIRUCORT CREAM "PATRON" 44.6

A022474329 HIRUCORT CREAM "PATRON" 70

A022499100 NYCITON CAPSULES (NIFLUMIC ACID) "CURIE" 2.56

A022507100 LOVEGEN F.C. TABLETS (CONJUGATED ESTROGEN) "ROYAL" 2.94

A022515435 JEN SHENG SUPER EYE LOTION 53

A022525321 CLOMELON CREAM (CLOTRIMAZOLE) "GENTLE" 8.9

A022526500 ASMETHOL SUPPOSITORIES "C.C.P." 3.7

A022529100 BROMPHENIRAMINE TABLETS "TAI YU" 0.25

A022535100 METHASONE TABLETS (BETAMETHASONE) "H.C." 0.75

A022540321 EPIDREM OINTMENT "SINPHAR" 16.2

A0225591G0 ROYAMET F.C. TABLETS (CIMETIDINE) "ROYAL"(鋁箔/膠箔) 1.5

A022586100 ELININ CAPSULES (LOPER AMIDE)"SHINLON" 0.94

A0225861G0 ELININ CAPSULES (LOPER AMIDE)"SHINLON"(鋁箔/膠箔) 1.5

A022595100 POUGENIN CAPSULES (SILYMARIN) 1.38

A022602100 BISCOMP TALBETS "C.R." 0.74

A022611100 PAWSANLON CAPSULES "J.S." 1.08

A022622216 SUWELIN INJECTION (CIMETIDINE)"S.Y." 11.1

A022628100 PIPMA FILM COATED TABLETS (PIPEMIDIC ACID) 3.1

A0226301G0 WINTIN TABLETS (LORAZEPAM) "WINSTON"(鋁箔/膠箔) 1.5

A022634100 DIABITIN TABLETS 5MG (GLIBENCLAMIDE) "VPP" 0.99

A022652100 LOMIFEN CAPSULES (CLOMIPHENE) "SHIN FONG" 3.78

A022657100 HEMA F S.C. TABLETS "S.C." 0.73

A022658100 PRESITON TABLETS 250MG (MEFENAMIC ACID) 0.75

A022664100 AMOXICILLIN CAPSULES 500MG "C.R." 1.29

A022674100 PRESITON TABLETS 500MG (MEFENAMIC ACID) 0.79

A022678100 BRAMIN TABLETS (BROMPHENIRAMIN) "PANBIOTIC" 0.21

A022685100 WERGEN TABLETS (CIMETIDINE) "YUNG CHI" 1

A022686329 CLOMAZOLE CREAM 1% (CLOTRIMAZOLE) "VPP" 17.8

A022689100 AMMONIUM CHLORIDE E.C. TABLETS "W.P." 0.18

A022693329 FLUOCINONIDE OINTMENT "H.S." 54

A022712100 TOLMETIN TABLETS "H.S.C." 5.8

A022719421 CONDRON-DEMISON EYE DROP 14.7

A022722100 BUCOFENE TABLETS "H.C." 0.54

A022729229 GENTAMICIN SULFATE INJECTION "ASTAR" 15.4

A022729238 GENTAMICIN SULFATE INJECTION "ASTAR" 57

A022729299 GENTAMICIN SULFATE INJECTION "ASTAR" 1.26

A022743100 STOGAMET TABLETS (CIMETIDINE) "SWISS" 0.8

A022747100 PISUNIN TABLETS "CHEN TA" 0.45

A0228191G0 LORAZEPAM TABLETS 1 MG "F.Y."."(21粒/瓶)(鋁箔/膠箔) 1.5

A022840209 ATROPINE SULFATE INJCETION "ORIENTAL" 3

A022843100 CHLORMEZANONE TABLETS "S.Y." 0.73

A022872100 GASTROPIN TABLETS "VPP" 0.15

21

Page 22: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A022901100 TRICORT TABLETS (TRIAMCINOLONE) "S.C." 0.89

A022902100 GASTRODIN TABLETS 300MG (CIMETIDINE) 1

A022905100 TRANZANSHOW CAPSULES (TRANEXAMIC ACID)"CURIE" 1.3

A022920417 CHLORSON EYE OINTMENT "OASIS" 18.2

A022928100 ODETIN TABLETS (BUCLIZINE) "VPP" 0.54

A022940209 DEPO-OVADIOL INJECTION "ORIENTAL" 48

A022941100 TRIAMCORT TABLETS "K.B." (TRIAMCINOLONE) 0.89

A022949277 COFLEX INJECTION "S.Y." 71

A022970209 CANHONLIN INJECTION "Y.A." (ANETHOLE TRITHIONE) 10

A022973100 WETIDINE TABLETS (LIMETIDINE) "TAH-AN" 1

A022982100 BISOCU TABLETS (BROMHEXINE)"W.P." 0.27

A022990335 BACITRACIN NEOMYCIN OINTMENT "SHITEH" 17

A022999100 IMOLI CAPSULES (LOPERAMIDE) "N.T." 0.94

A023012321 SINSODERM CREAM "S.Y." 16.2

A023020100 FASTOP TABLETS 200MG "SHITEH" 0.79

A023035321 GYNO-MYCODERIN CREAM (MICONAZOLE) "BOWLIN" 20.5

A023038321 CHAA CREAM (CHLOROHYDROXY ALUMINUM ALLANTOINATE) "H.C.T." 31.4

A023041100 ALLOPURINOL TABLETS "PANBIOTIC" 0.99

A023042100 AMOLIN CAPSULES 500MG (AMOXICILLIN) "Y.F." 1.29

A023100100 AMPICILLIN CAPSULES 250MG "YUNG CHANG" 1.02

A023102100 PONTON TABLETS 500MG (MEFENAMIC ACID) "EVEREST" 0.79

A023109212 CIMETIDINE INJECTION 100MG/ML "Y.Y." 9.9

A023115335 CLOMAZOLE SOLUTION 1% (CLOTRIMAZOLE) "VPP" 45

A023131321 AIFUPO OINTMENT "S.M." 9.4

A023131329 AIFUPO OINTMENT "S.M." 18.1

A023133323 EXTRACOMB CREAM "S.Y." 15.7

A023133329 EXTRACOMB CREAM "S.Y." 19.4

A023133330 EXTRACOMB CREAM 19.4

A023133335 EXTRACOMB CREAM "S.Y." 34.5

A023143100 PSEUBYIRIN TABLETS (PSEUDOEPHEDRINE HCL) "EVEREST" 0.7

A0231431G0 PSEUBYIRIN TABLETS (PSEUDOEPHEDRINE HCL) (鋁箔/膠箔) 1.5

A023148435 WIN-WAY NASAL SPRAY "WINSTON" 36.9

A023150421 EYESMIN EYE DROPS (NEOSTIGMINE METHYLSULFATE) "OASIS" 10.4

A023150429 EYESMIN EYE DROPS (NEOSTIGMINE METHYLSULFATE) "OASIS" 16.7

A023151100 ERGONOVINE MALEATE S.C. TABLETS "C.T." 0.68

A0231511G0 ERGONOVINE MALEATE S.C. TABLETS "C.T." (鋁箔/膠箔) 1.5

A023152100 CAFEGOTAMINE S.C. TABLETS "S.C." 1.07

A023157335 JOYLA CREAM "SINPHAR" 54

A023162100 RE-LIVER CAPSULES "JINUP" 1.35

A023219100 POTON CAPSULES 500MG (MEFENAMIC ACID) "CURIE" 0.79

A023220100 BIOSAREN CAPSULES (TRANEXAMIC ACID) "PANBIOTIC" 1.3

A023230229 RASEMIN INJECTION 10% (TRANEXAMIC ACID) "Y.Y" 31.6

A023231321 CIVIDOID GEL (HEPARINOID) "SINPHAR" 17.5

A023231329 CIVIDOID GEL (HEPARINOID) "SINPHAR" 32.6

A023231338 CIVIDOID GEL (HEPARINOID) "SINPHAR" 37.5

A023250238 K-CILLIN INJECTION 20,000,000 UNITS (POTASSIUM PENICILLIN G)

"VPP"

0

A023257100 FULETIN TABLETS 0.98

A023265277 PAMOXICILLIN INJECTION 500MG (AMOXICILLIN)"C.Y." 20.6

A023281100 CIVIGEN TABLETS "C.R." 1

A023284100 NEWZYME TABLETS "STANDARD" 0.68

A023287100 AMPICILLIN CAPSULES 500MG "TAI YU" 1.38

A023290100 FUPAUCAN CAPSULES (PIPEMIDIC ACID) "UIRIE" 1.68

A023319100 CLEMASTINE TABLETS "CHINTENG" 0.83

A023331100 PYLINATON TABLETS 500MG 0.2

22

Page 23: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A023336329 PASCA GEL "SHIONOGI" 37.6

A023352100 SATINMIN TABLETS "S.C." (CARBINOXAMINE) 0.27

A023356100 SU'S CAPSULES (SULPIRIDE) "CURIE" 1.33

A023380435 YIPI NASAL SOLUTION "HEALTH" 22.1

A0233891G0 DICLOFON S.C. TABLETS (DICLOFENAC) "F.Y."(瓶裝/84粒/瓶) 1.5

A023391100 STROMAFON TABLETS "EAYUNG" 0.32

A023412100 ANQUWEI TABLETS (PIRENZEPINE) "CURIE" 1.77

A023415100 WEIANLIN TABLETS "H.S.C." 0.85

A023424209 HEXOESTROL INJECTION "TAI YU" 7.7

A023434100 LYSOEM TABLETS (LYSOZYME) 1.07

A023483100 KU-WE-RIN TABLETS (CIMETIDINE) "Y.C." 1

A023488100 ULCOGEN TABLETS "S.Y." 0.85

A0234881G0 ULCOGEN TABLETS "S.Y."(鋁箔/膠箔) 1.5

A023490100 SODICON TABLETS "SINPHAR" 0.56

A023492212 DEPO-B12 INJECTION 8.1

A023499100 LOPERAMIDE CAPSULES "J.H." 0.65

A023521100 MAGNESIUM OXIDE TABLETS "KINGDOM" 0.17

A023524100 COSTENE TABLETS (CARBETAPENTANE) "H.H." 0.48

A023531421 BENEMYCIN EYE DROPS "OASIS" 28.8

A023533329 FUNGICIDE CREAM (CLOTRIMAZOLE) "ROYAL" 17.8

A023534100 ROPAL TABLETS (ASPIRIN) "ROYAL" 0.5

A023547209 ANETHOLE INJECTION "K.S." 10

A023562216 ORITAREN INJECTION (DICLOFENAC) "ORIENTAL" 8.4

A023563212 KETOFEN INJECTION (KETOPROFEN) "ORIENTAL" 11.1

A023563216 KETOFEN INJECTION (KETOPROFEN) "ORIENTAL" 11.1

A023572100 WYPIRIDE CAPSULES (SULPIRIDE) "S.P.C." 1.33

A023587421 E E N EYE DROPS "GCPC" 21.9

A023587423 E E N EYE DROPS "GCPC" 35

A0235891G0 LOGMAL CAPSULES (SULPIRIDE) "M.T."(鋁箔/膠箔) 1.5

A023593100 DIPHENIDOL S.C. TABLETS "EAYUNG" 0.91

A023600321 CAMISTEN CREAM (MICONAZOLE) "SINPHAR" 17.6

A023626321 DAFRIN-H CREAM "SWISS" 34.4

A023627100 VENTURIN TABLETS (DIPHENIDOL) "YUNG CHANG" 1.27

A023628212 GASPIN INJECTION (PIRENZEPINE) "GENTLE" 0

A023646100 CEPHALEXIN CAPSULES 1.14

A023652100 BECOLON CAPSULES 0.89

A023654100 DECOUGH CAPSULES (CARBOCISTEINE) 1.34

A023663321 ECONAZOLE TRIAMCINOLONE CREAM “TWI” 11.7

A023663329 ECONAZOLE TRIAMCINOLONE CREAM “TWI” 19.5

A023663335 ECONAZOLE TRIAMCINOLONE CREAM “TWI” 25.8

A023666329 TUAN OINTMENT "S.C." 27.5

A023668212 CLEMASTINE INJECTION "Y.Y." 3.77

A023671100 FENOT TABLETS 2.5MG (FENOTEROL) "S.C." 0.97

A023686100 LYSOZYME TABLETS 90MG "EVEREST" 0.98

A023687321 FUDELIN CREAM "L.S." (FLUOCINONIDE) 36.1

A023715100 CARMIN TABLETS "Y.Y." 0.89

A023743100 PARAMMINE TABLETS 0.65

A023771100 PROCOTON TABLETS (MEFENAMIC ACID) "H.C." 0.79

A023791100 ENLAIN F.C. TABLETS "CHEN TA" 3.13

A023819100 CODECON CAPSULES 0.38

A023839157 CORIGIN SYRUP "S.Y." 34.5

A023844212 STOGAMET INJECTION (CIMETIDINE) "SWISS"200 MG/ML 5.9

A023846100 WINDPIN TABLETS (BETAHISTINE) "YUNG CHI" 1.02

A023862100 FELON CAPSULES (PIROXICAM) "EAYUNG" 1.04

A023876100 LEMISOL TABLETS (LEVAMISOLE) 4.68

23

Page 24: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A023879100 ROTEC TABLETS "F.Y." 0.5

A023912100 BENZOLE TABLETS (MEBENDAZOLE) "HONTEN" 1.1

A023913100 WEICOLIN TABLETS (CIMETIDINE) "W.P." 1

A023925100 COUGDAU TABLETS "NCP" 0.29

A023936100 BISMUTH SUBCARBONATE TABLETS "N.C.P." 0.74

A023954100 ATON TABLETS (ACETAMINOPHEN) "NCP" 0.19

A023967277 CEPHA INJECTION "K.S." 11.4

A023969100 MERO CAPSULES (KETOPROFEN) "NCP" 1.76

A023970100 ERYTHROCIN CAPSULES“TAITEN”(ERYTHROMYCIN ESTOLATES) 1.43

A023973100 ASU CAPSULES "NCP" 1.07

A023978100 BOCYLINE CAPSULES 500MG“TAITEN” 1.07

A023981100 ZIMIN S.C. TABLETS (CHLORCYCLIZINE) "NCP" 0.98

A024004100 BUGIFENE TABLETS "L.E."(BUCLIZINE) 0.54

A024010100 IBUPROFEN F.C. TABLETS 0.97

A0240171G0 CIMEDIN TABLETS (CIMETIDINE) "S.T."(鋁箔/膠箔) 1.5

A024055100 IBUPROFEN F.C. TABLETS "H.C." 0.85

A024077100 CIMEWET TABLETS (CIMETIDINE) "N.C.P." 1

A024098100 BISPLEN TABLETS 20MG "Y.C." (EPRAZINONE DIHYDROCHLORIDE) 0.56

A024103100 TONTARIN F.C. TABLETS (DICLOFENAC) 0.9

A024115100 DICLOFENAC ENTERIC COATED TABLETS "Y.C." 0.9

A024142100 BRENCO TABLETS (FENOTEROL) 0.97

A0241421G0 BRENCO TABLETS (FENOTEROL)(鋁箔) 1.5

A024154100 SULIN TABLETS 5MG (DIAZEPAM) "ORIENTAL" 0.8

A024155100 CHLOPHEDIANOL HCL TABLETS "S.C." 0.92

A024182100 ROXSON TABLETS "Y.Y"(PRIDINOL) 0.92

A024192221 REPACIN LYO-INJECTION (BETA-AESCIN) 37.6

A024195100 ULOPINE TABLETS (PIRENZEPINE DIHYDROCHLORIDE) "PANHIOTIC" 1.77

A024198299 AMIKACIN INJECTION 125MG/ML "N.K." 14.6

A024225338 WHITE CLOUD OINTMENT (FLUOCINONIDE)"C.H." 108

A024227100 IBUPROFEN S.C. TABLETS "C.H." 0.79

A024236100 CARBETAN F.C. TABLETS 30MG "CHINTENG" (CARBETAPENTANE) 0.44

A024239100 NEWTASE TABLETS "CHINTENG" 0.73

A024246100 INOPAO CAPSULES "C.H." 2.22

A024247321 ECOSONE CREAM "M.S." 11.7

A024260100 ELIANINE CAPSULES (SILYMARIN) 1.42

A024261100 ELIAMINE S.C. TABLETS (SILYMARIN) 1.38

A024280100 ANTOXINE TABLETS (DIHYDROERGOTOXINE METHANESULFONATE) "AND" 1.46

A024301100 FIMEPON S.C. TABLETS "H.S." 1.1

A024305100 ULSPAN CAPSULES (SULPIRIDE) 1.33

A024309100 DARAFFIN TABLETETS "S.C." 0.75

A024313100 FRUFE CAPSULES (GRISEOFULVIN) "Y.Y." 1.55

A024330100 PIROCAM CAPSULES (PIROXICAM) 1.04

A024335100 SALBUTAMO TABLETS 4MG (SALBUTAMOL) 0.93

A024338321 TRISONE CREAM 11.7

A024338329 TRISONE CREAM 19.5

A024338335 TRISONE CREAM 25.8

A024350100 RELCON CAPSULES 250MG "YUNG CHI" 1.3

A024362100 BIAUIANLINN "N.C.P" 0.9

A024372100 DEXAMETHASONE TABLETS 0.5MG (DEXAMETHASONE) "L.S." 0.69

A024374100 THIAMPHENICOL CAPSULES 250MG "Y.C." 1.49

A024384100 LORAZEPAM TABLETS 1MG 0.98

A0243841G0 LORAZEPAM TABLETS 1MG (鋁箔/膠箔) 1.5

A024398100 ANAPROX TABLETS (NAPROXEN SODIUM) 1.09

A024433100 FUBININ TABLETS "MEIDER" 0.77

24

Page 25: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A024456100 MEDONIN CAPSULES 10MG "CHEN TA" (SEAPROSE S) 2.9

A024465100 ASPIRIN TABLETS "JOHNSON" 0.45

A024514100 CONICA CAPSULES 400MG "S.T." (PIRACETAM) 1.14

A024519343 A.D.E. CREAM "SINPHAR" 44.9

A024571321 EPARCORT CREAM 11.7

A024571329 EPARCORT CREAM 19.5

A024571338 EPARCORT CREAM 36.2

A024571355 EPARCORT CREAM 135

A024593277 DEXTROSAN INJECTION 19.1

A024596209 ALLERCON INJECIOTN 6.4

A024598100 SIULON TABLETS 0.9

A024599100 ANTI TABLETS 0.72

A024609100 AMIPHEN TABLETS 500MG "SPC" 0.2

A024615100 PICOL F.C. TABLETS (PIPEMIDIC ACID) "ROYAL" 3.1

A024616100 ACETAMINOPHEN TABLETS 500MG "ASTAR" 0.52

A024620212 MULTIVITA INJECTION 20.4

A024620221 MULTIVITA INJECTION 53

A024623100 ACETAMINOPHEN TABLETS 325MG "ASTAR" 0.35

A024644100 WUNTON TABLETS "W.P." 0.91

A024660212 PAPASTIN INJECTION 3.9

A024673265 RINGER INJDECTION "S.Y." 17.7

A024675221 GALLUCAN INJECTION 10.1

A024678100 GALLUCON TABLETS 0.8

A024695100 FUDELLINE TABLETS 0.92

A024706100 SUPIAN TABLETS (PSEUDOEPHEDRINE HCL) 0.7

A0247061G0 SUPIAN TABLETS (PSEUDOEPHEDRINE HCL)(鋁箔/膠箔) 1.5

A024710100 CIMETIDINE TABLETS 200MG "C.T." 1

A0247101G0 CIMETIDINE TABLETS 200MG "C.T." (鋁箔/膠箔) 1.5

A024714100 BIODASE TABLETS "H.H." 0.73

A024750212 CIMETIDINE INJECTION 100MG "ORIENTAL" 9.9

A024758100 LYSOZYME TABLETS 90MG "SPC" 0.98

A024772212 ORISANTIN INJECTION 5MG/ML (DIPYRIDAMOLE) "ORIENTAL" 8.5

A024810100 WEIZAIN TABLETS "HONTEN" 0.65

A024832100 HYPOLAX TABLETS 0.1MG (CLONIDINE) "JINUP" 0.82

A024833100 FLURAZINE S.C. TABLETS 2MG (TRIFLUOPERAZINE) "VPP" 1.03

A024842100 ANTICOLD CAPAULES 0.89

A024845100 AZUMON S.C. TABLETS 1.25MG "CHEN TA" (CONJUGATED ESTROGENS) 2.94

A024856100 CEFLEXIN CAPSULES 250MG (CEPHALEXIN) "VPP" 1.14

A024862100 OROTIN S.C. TABLETS "C.H." 0.64

A024867100 RISCO TABLETS (EPRAZINONE) "Y.C." 0.68

A024878321 PERICON CREAM "CENTURY" 11.7

A024878335 PERICON CREAM "CENTURY" 25.8

A024883212 DICOLOFENAC INJECTION 25MG/ML "H.S." 0

A024889151 CASTEINE SYRUP (S-CARBOXYMETHLCYSTEINE) 59

A024921100 LEPOTIN TABLETS 1MG (CLEMASTINE) 0.71

A024952229 DEXAMETHASONE INJECTION 4MG "Y.Y." 17.6

A024953209 PROGESTERONE INJECTION 25MG "Y.Y." 2.88

A024953229 PROGESTERONE INJECTION 25MG "Y.Y" 15.6

A024957100 ISCAN F.C. TABLETS 200MG (CIMETIDINE) "SPC" 1

A024958100 MINLICK TABLETS (CLEMASTINE) "SPC" 0.6

A024961212 T.T.Y. COLIMYCIN INJECTION 2000000 U (COLISTIN

METHANESULFONATE)

314

A024995100 TACRETON TABLETS 200MG (CIMETIDINE) 1

A025002329 EPICORT CREAM "VEIMIN" 19.5

25

Page 26: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A025015238 SANVITA INJECTION "ASTAR" 10

A025027100 DEXCHLORPHENIRAMINE MALEATE TABLETS 2MG "Y.C." 0.42

A025028100 TRIROGIN TABLETS 1.5MG (DIHYDROERGOTOXINE) 1.46

A025054100 TENOBEC TABLETS 5MG (FENOTEROL) "PANBIOTIC" 1.47

A025081100 RECOUGH TABLETS 20MG "S.C." (EPRAZINONE) 0.72

A025091100 MAGOCAIN TABLETS 0.81

A025108100 NOSCAPINE TABLETS "UNION" 0.9

A025118100 NEUROPAM TABLETS 2MG (LORAZEPAM) "PANBIOTIC" 0.98

A0251181G0 NEUROPAM TABLETS 2MG (LORAZEPAM) "PANBIOTIC"(鋁箔/膠箔) 1.5

A025121100 BISCO TABLETS 12MG (BROMHEXINE) 0.36

A025123100 TRANEXAMIC CAPSULES 250MG "JINUP" 1.3

A025124100 ZINC TABLETS 15MG "GCPC" 1.2

A025125209 CEFAMANDOLE FOR INJECTION 1GM 55

A025136321 MYCOSTEN CREAM 10MG/GM (CLOTRIMAZOLE) "SINPHAR" 8.9

A025136329 MYCOSTEN CREAM 10MG/GM (CLOTRIMAZOLE) "SINPHAR" 17.8

A025149100 LICHANYU TABLETS "HONTEN" 0.48

A025160100 ASPIRIN F.C. TABLETS 500MG "TAI YU" 0.62

A025170100 DEPAIN TABLETS 500MG (ACETAMINOPHEN) "W.P." 0.19

A025194157 KOSOLIN SYRUP 25

A025195100 DYPHACOL TABLETS 0.92

A025201100 TECON CAPSULES 10MG (PIROXICAM) "PANBIOTIC" 1.04

A0252021G0 FELCAM CAPSULES 10MG (PIROXICAM)(鋁箔/膠箔) 1.5

A025209100 COMFORT CAPSULES "S.C." 0.36

A025214100 CHLORPHENIRAMINE MALEATE TABLETS 4MG "W.P." 0.17

A025216229 POLIMIN-B12 INJECTION "Y.Y." 9.1

A025216238 POLIMIN-B12 INJECTION "Y.Y." 9.4

A025218329 KONAZOLE OINTMENT (MICONAZOLE)"Y.Y." 37.3

A025231100 KETOEN CAPSULES 50MG (KETOPROFEN) "SPC" 1.76

A025237321 TRETINOIN CREAM 0.1% 22

A025240100 TAGNESON CAPSULES 50MG (SULPIRIDE) "JINUP" 1.33

A025245209 APRELAZINE INJECTION 20MG/ML (HYDRALAZINE) 27.3

A025245277 APRELAZINE INJECTION 20MG/ML (HYDRALAZINE) 17.2

A025275100 NORSETOA CAPSULES "CHINTENG" 0.5

A025287277 CEFAMANDOLE FOR INJECTION 500MG 29.6

A025291321 SEEDO-SANIN CREAM 11.7

A025291325 SEEDO-SANIN CREAM 12.5

A025304100 COSTAN TABLETS 20MG (EPRAZINONE) "S.T." 0.56

A025309157 CARSTIN SYRUP 20MG/ML (S-CARBOXYMETHYLCYSTEINE) 22.5

A025310100 FUROKAN CAPSULES (PIROXICAM) 1.04

A025323209 BETAMETHASONE INJECTION 4MG/ML "Y.A" 11.9

A025323229 BETAMETHASONE INJECTION 4MG/ML "Y.A" 19.5

A025349100 LICOTIN-A CAPSULES "YUNG CHI" 0.99

A025381100 POSDAN CAPSULES 250MG "K.S." 0.75

A0253961G0 MEFETON F.C. TABLETS 500MG (MEFENAMIC ACID) "S.Y."(瓶裝/84粒/

瓶)

1.5

A025419100 REZINON TABLETS 20MG (EPRAZINONE) 0.7

A025420100 DEXAMETHASONE TABLETS 0.69

A025431100 DIPYRIDAMOLE S.C. TABLETS 75MG"ORIENTAL" 1.44

A025436100 DICLOTON TABLETS 25MG (DICLOFENAC) 0.9

A025445100 NORUOLU TABLETS 5MG (NORETHISTERONE) 1.41

A025471100 MUSZEPIN TABLETS 25MG (PIRENZEPINE HYDROCHLORIDE) 1.77

A025482209 ATROPINE SULFATE INJECTION 2MG/ML "VPP" 3.46

A025487100 LONDEC TABALETS "K.S." 0.45

A025492212 BITAS-H INJECTION "Y.Y." 5.8

A025495100 NAPROXEN TABLETS 250MG "TAH-AN" 1.09

26

Page 27: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A025507277 AMINOL INFUSION "S.T." 273

A025520100 METHOPTERIN TABLETS 2.5MG (METHOTREXATE) 3.17

A025539229 LINCOMYCIN INJECTION 300MG "Y.Y." 24.2

A025555100 BAKTSIN TABLETS "Y.S." 0.9

A025570100 LYSOZYME TABLETS 50MG 0.92

A025581100 RICO CAPSULES "H.H." 0.89

A025582100 EPRANONE TABLETS 20MG (EPRAZINONE) "H.H." 0.72

A025588100 MAXOLONE TABLETS 10MG "Y.Y" 0.69

A025589100 LORAZEPAM TABLETS 1MG "CHEN TA" 0.98

A025596100 TOFOANIN TABLETS 25MG (INDOMETHACIN) 0.87

A025601100 EPRAZINONE TABLETS 30MG "CHINTENG" 0.74

A025610100 LORAZEPAM TABLETS 1MG "S.Y." 0.98

A025621212 TOBRA INJECTION 40MG/ML (TOBRAMYCIN) 37.4

A025624100 PLOCON TABLETS 3MG "Y.Y" 0.64

A025628100 CIMETIDINE TABLETS 200MG 1

A025640100 HONSTRONG TABLETS 1.39

A025654212 METOPERON INJECTION 5MG/ML " K.S." 7.1

A025663100 SUSOUCON CAPSULES 30MG (DEXTROMETHORPHAN) "ORIENTAL" 0.82

A025688100 ANTICON TABLETS 15MG (DEXTROMETHORPHAN) 0.45

A025692100 CODECON CAPSULES "C.S." 0.36

A025706100 STARGEN S.C. TABLETS 100MG (TIOPRONIN) "S.T." 4.39

A025711100 CEFADROXIL CAPSULES 500MG "Y.Y." 2.02

A025715100 ACETIZYME TABLETS 30MG (LYSOZYME) "PANBIOTIC" 0.92

A025718100 FUNTONNON TABLETS 0.79

A025720100 KETOPROFEN CAPSULES 50MG "TAH-AN" 1.76

A025726100 BEROGIN TABLETS 2.5MG (FENOTEROL) "HONTEN" 0.97

A025740100 PIROXICAM CAPSULES 10MG "L.S." 1.04

A025747100 SIDOMON CAPSULES 5MG (FLUOXYMESTERONE) "K.B." 1.25

A025748221 FORSTRONG LYO-INJECTION 5000IU (CHORIONIC GONADOTROPIN) 161

A025760109 CYSTIN POWDER 40MG/GM (ACETYLCYSTEINE) "LITA" 0.84

A025770100 IBUPROFEN TABLETS 100MG 0.71

A025773100 ES MYCIN F.C. TABLETS 500MG (ERYTHROMYCIN STEARATE) "W.P." 3.67

A025778100 TRI-ZYME TABLETS "S.T." 0.73

A025789100 ACTIZYME 90MG CAPSULES (LYSOZYME) 0.98

A025790216 CLOFON INJECTION 25MG/ML (DICLOFENAC) 8.4

A025803209 PROMIN DEPOT-125MG/ML INJECTION "Y.Y." (HYDROXYPROGESTERONE

CAPROATE)

30.8

A025806100 SINDELIN S.C. TABLETS 0.61

A025810209 CEPHA FOR INJECTION 1 GM "K.S." 15.7

A025816329 YEAFULIN CREAM "Y.S" 19.5

A025824100 GASZEPIN TABLETS 25MG (PIRENZEPINE HCL) 1.77

A025828100 PITOCAM CAPSULES 10MG (PIROXICAM) "SPC" 1.04

A0258281G0 PITOCAM CAPSULES 10MG (PIROXICAM) "SPC"(鋁箔/膠箔) 1.5

A025833100 SUSTON CAPSULES 250MG (MEFENAMIC ACID) "Y.C." 0.75

A025848100 ASPIRIN CHEWABLE TABLETS 150MG "SINPHAR" 0.5

A025851100 UNISIN S.C. TABLETS 25MG (DIPYRIDAMOLE) "UNION" 0.9

A025856100 RESCO TABLETS 20MG (EPRAZINONE) "GENTLE" 0.72

A025857100 PARACETAMOL TABLETS 0.36

A025883321 MICONASON CREAM 34.5

A025883335 MICONASON CREAM 91

A025883338 MICONASON CREAM 143

A025921100 REPRACON TABLETS 20MG (EPRAZINONE DIHYDROCHLORIDE) 0.72

A025937100 COEN TABLETS 20MG (EPRAZINONE)"YU SHENG" 0.72

A025939100 ACETIN CAPSULES 200MG (ACETYLCYSTEINE) "MAYER" 2.51

27

Page 28: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A025944100 ESMYCIN F.C. TABLETS 250MG (ERYTHROMYCIN) "W.P." 1.43

A025949100 CYPROHEPTADINE HCL TABLETS 4MG 0.7

A025956100 NORETONE TABLETS 5MG (NORETHINDRONE ACETATE) "SHIN FONG" 1.41

A025959277 CEFAZOLIN FOR INJECTION 500MG "ORIENTAL" 11.4

A025965100 SHYYLOUH TABLETS 25MG (SPIRONOLACTONE) "Y.S." 1.07

A025967500 PHEPIX VAGINAL SUPPOSITORY 150MG (ECONAZOLE) 8.9

A025985100 SUDOGAN S.C. TABLETS "CHEN TA" 0.96

A026008100 PENSALINE S.C. TABLETS 25MG (DIPYRIDAMOLE) "S 0.9

A026019100 CHLORPHENIRAMINE MALEATE TABLETS 4MG 0.1

A026021214 ANTISAMIN INJECTION 100MG/ML (TRANEXAMIC ACID) 9.7

A026021221 ANTISAMIN INJECTION 100MG/ML (TRANEXAMIC ACID) 11.4

A026025100 BININ F.C. TABLET 0.89

A026027100 HEMIDOL TABLETS 2.5MG (INDAPAMIDE) 2.27

A026039100 LOPERAMIDE CAPSULES 2MG 0.94

A026041100 CHUSELIN CAPSULES 250MG (TRANEXAMIC ACID) "Y.S." 1.3

A026043100 MOJUNE TABLETS 25MG (DIPHENIDOL) "K.B." 0.91

A026045100 CEFADROXIL CAPSULES 500MG "Y.C." 2.02

A026056100 A.T. TABLETS 500MG (ACETAMINOPHEN) "LITA" 0.19

A026058209 ALLERMIN INJECTION 3MG/ML (PIPRINHYDIRNATE)"Y.Y." 6.4

A026062100 SUIT CAPSULES 20MG (PIROXICAM) "KINK" 1.11

A026073100 COBACIDE TABLETS 0.9

A026078100 NOSEMIN TABLETS "VPP" 0.78

A026090100 NAPROXEN TABLETS 250MG 1.09

A026102100 IBUPROFEN CAPSULES 200MG 0.79

A026115100 IRIDINE CAPSULES 2MG (LOPERAMIDE) "Y.S." 0.94

A026164100 ASPIRIN CAFFEINE TABLETS "LITA" 0.91

A026185100 ISOPRINOSINE TABLETS 500MG (METHISOPRINOL) "PANBIOTIC" 3.84

A026192100 AMPICILLIN CAPSULES 1.38

A026199100 RIVAPRESS TABLETS 250MG (METHYLDOPA) "PANBIOTIC" 1.8

A026205100 SULFAMETHOXAZOLE TABLETS 500MG "SPC" 0.65

A026232421 CARBOXE ORABASE 20MG (CARBENOXOLONE) "SHITEH" 52

A026269209 KETOPEN INJECTION 20MG/ML (NEFOPAM) 0

A026276100 LYSOZYME CAPSULES 90MG "ORIENTAL" 0.98

A026280100 EACOUG TABLETS 20MG (EPRAZINONE HCL) "NCP" 0.56

A026284100 CEPIN TABLETS 25MG (DIPHENIDOL) "SPC" 0.91

A026287100 NOMA TABLETS "H.H." 1

A026299100 TSUFONLOL TABLETS "S.T." 0.42

A026303100 ZUCERINE TABLETS 250MG (TRANEXAMIC ACID) "LITA" 1.3

A026314100 FUROKAN CAPSULES 20MG (PIROXICAM) 1.11

A026319212 DICYCLOMINE HCL INJECTION 10MG/ML "S.Y." 6.4

A026323100 A.H.BUTON TABLETS 500MG "YU SHENG" 0.47

A0263241G0 PIROCAM CAPSULES 10MG (PIROXICAM)"M.T."(鋁箔/膠箔) 1.5

A026329100 AMMONIUM CHLORIDE E.F.C. TABLETS 500MG "W.P." 0.18

A026338329 CEFUL CREAM "S.C." 41.5

A026346100 BIMINING TABLETS "Y.S." 0.72

A026356100 WINCEF CAPSULES 500MG (CEFADROXIL) "WINSTON" 2.02

A026365100 ENODONE TABLETS "W.P." 3.6

A026390100 ANTIEXPECT TABLETS 20MG "JINUP" (EPRAZINONE HCL) 0.72

A026401277 TPN NO.4 INJECTION 25.5

A026405100 RELIZINE TABLETS "S.C." 0.98

A026407100 DIUREN TABLETS "GCPC" 1.2

A026420265 TPN NO.1 INJECTION "S.T." 25.5

A026420277 TPN NO.1 INJECTION 25.5

A026447212 WINACORT INJECTION 40MG/ML (TRIAMCINOLONE ACETONIDE) "WINSTON" 23.8

28

Page 29: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A026447221 WINACORT INJECTION 40MG/ML (TRIAMCINOLONE ACETONIDE) "WINSTON" 44.4

A026456100 UPANTA TABLETS 25MG (BUCLIZINE) "JINUP" 0.54

A026457100 DIMELON TABLETS 20MG (DIMETHOTHIAZINE) "H.H." 2.86

A026465100 UPMIDIC TABLETS 250MG (PIPEMIDIC ACID) "JINUP" 3.1

A026468429 PILOCARPINE HCL OPHTHALMIC SOLUTION 2% "WU-FU" 37.7

A026476100 EPRACOUGH TABLETS 20MG (EPRAZINONE HCL)"HONTEN" 0.72

A026485212 ASCORBIC ACID INJECTION 250MG/ML "S.Y." 5.4

A026485221 ASCORBIC ACID INJECTION 250MG/ML "S.Y." 5.4

A026487100 LONFADROXIL CAPSULES 250MG (CEFADROXIL) "UNION" 2.02

A026489209 NEFOPAM INJECTION 20MG/ML "S.Y." 10.2

A026500100 BOLTONIN TABLETS 25MG (DICLOFENAC) "CHI SHENG 0.9

A026506212 CIMEWEI INJECTION 100MG/ML (CIMETIDINE) "LITA 9.9

A026509277 LONFAMANDOLE INJECTION 500MG (CEFAMANDOLE)"UNION" 29.6

A026514209 ANTON INJECTION 20MG/ML "Y.A" (NEFOPAM) 10.2

A026532100 BECTON F.C. TABLETS "W.P." 2.09

A026547100 KOPIDIN TABLETS "CHEN TA" 1.04

A026549100 KOUMIN TABLETS 2MG (DEXCHLORPHENIRAMINE) 0.42

A026550100 LYSOZYME TABLETS 90MG "W.P." 0.98

A026551121 FLUTAFIN GRANULES 20MG/GM "SHITEH" (ACETYLCYSTEINE) 1.68

A026559100 DELAMIN TABLETS 2MG (DEXCHLORPHENIRAMINE MALEATE) "STANDARD" 0.33

A026573209 HYCOMINE INJECTION 5MG/ML 8.1

A026573212 HYCOMINE INJECTION 5MG/ML 10.9

A026595100 NONANTICOLD S.C. TABLETS 0.4

A026604429 PILOCARPINE OPHTHALMIC SOLUTION 1% "WU-FU" 27.7

A026631209 LONFAMANDOLE INJECTION 1000MG (CEFAMANDOLE) "UNION" 55

A026633229 LINCOMYCIN HYDROCHLORIDE INJECTION 300MG/ML"ASTAR" 24.2

A026633238 LINCOMYCIN HYDROCHLORIDE INJECTION 300MG/ML"ASTAR" 39.2

A026633299 LINCOMYCIN HYDROCHLORIDE INJECTION 300MG/ML"ASTAR" 1.96

A026636329 ULEX CREAM "SINPHAR" 13.3

A026643100 RESPININE TABLETS 30MG (EPRAZINONE) 0.85

A026647100 WEISU-S TABLETS 0.84

A026651100 WEISU TABLETS "S.Y." 0.2

A026664229 PAMCL INJECTION 50MG/ML "ORIENTAL" 95

A026673100 RESPIRID CAPSULES 40MG "SHIN FONG"(FENSPRIDE) 1.62

A026678100 SULINDAC TABLETS 100MG "W.P." 1.87

A026679100 SULIC TABLETS 200MG (SULINDAC) 1.91

A026711100 TANNALBIN TABLETS 500MG 0.55

A026717100 MUCO CAPSULES 375MG "PATRON" 1.34

A026728100 ZONON E.S.C. TABLETS 50MG (BROMELAIN)"BEYDAR" 0.89

A026742100 UCOL TABLETS 0.85

A026757100 WEILIN TABLETS 0.85

A026770100 PERSANTINE S.C. TABLETS 25MG 0.9

A026793265 GLYCEROL INJECTION "S.Y." 81

A026793266 GLYCEROL INJECTION "S.Y." 81

A026793277 GLYCEROL INJECTION "S.Y." 81

A026798100 BISLAN TABLETS 12MG (BROMHEXINE) "YUNG SHIN" 0.32

A026805100 SUNCHISU TABLETS 2.5MG (FENOTEROL) 0.97

A026834100 PHYLLINTAL TABLETS "T.F." 0.89

A026835100 TINIZOL TABLETS 500MG "K.S." 2.08

A026849100 PYRUDON TABLETS 300MG (ACETAMINOPHEN) "T.F." 0.2

A026851209 FORMAX INJECTION 20MG/ML (NEFOPAM)"N.C.P." 10.2

A026858321 PROPADOM CREAM 0.25MG/GM (BECLOMETHASONE)"N.C.P." 24.1

A026858329 PROPADOM CREAM 0.25MG/GM (BECLOMETHASONE)"N.C.P." 60

29

Page 30: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A026858335 PROPADOM CREAM 0.25MG/GM (BECLOMETHASONE)"N.C.P." 105

A026875100 RIYAZINE CAPSULES "H.S." 1.2

A026880100 INOSINE TABLETS 500MG (METHISOPRINOL) "H.S." 3.84

A026881100 REGASTRIC TABLETS 25MG "JINUP" (PIRENZEPINE) 1.7

A026906321 EPISONE CREAM "S.Y." 11.7

A026906329 EPISONE CREAM "S.Y." 19.5

A026906335 EPISONE CREAM 15GM "S.Y" 25.8

A026908100 RERTOXIN TABLETS 1.5MG (DIHYDROERGOTOXINE) "UNION" 1.46

A026922100 MUCORPIN CAPSULES 375MG "Y.Y." (CARBOCYSTLINE) 1.27

A026927100 LOTAL S.C. TABLETS 50MG (NITROCOLINE) "KINK" 1.53

A026955100 TOLSON CAPSULE 100MG (TOLPERISONE) "Y.Y" 1.42

A026963100 KUSO TABLETS 1.17

A026984100 PEACE TABLETS "YUNG SHIN" 0.98

A027003265 SALINE INJECTION 0.9% (SODIUM CHLORIDE)"S.Y." 18.2

A027007100 SWEET TABLETS 50MG (SULPIRIDE) 1.33

A027013100 R.H.H TABLETS "Y.Y" 1.21

A027021214 SIKACIN INJECTION 100MG/ML "SHITEH" 31.3

A027024100 RECOUGH TABLETS 30MG (EPRAZINONE) "S.C." 0.85

A027035100 ALUFIBRATE CAPSULES 500MG "Y.Y" 2.9

A027040100 DEX-CTM TABLETS 2MG "S.Y." 0.42

A0270441G0 ANTIBLEED CAPSULES 250MG "T.F."(鋁箔/膠箔) 1.5

A027055100 CURRENT TABLETS "Y.Y" 2.01

A027060100 NASALCON TABLETS "N.C.P." 0.89

A027087100 PROBUCOL TABLETS 250MG "PANBIOTIC" 3.33

A027093100 CEFAXIL CAPSULES 500MG (CEFADROXIL) "STANDARD 2.02

A027102100 ACETAMINOPHEN TABLETS 500MG "YUNG CHI" 0.19

A027109100 GRIFULCIN TABLETS 500MG (GRISEOFULVIN) "C.M." 2.68

A027123100 AMOCILLIN CAPSULES 500MG (AMOXICILLIN) "CHI SHENG" 1.29

A027126100 LYSOZYME TABLETS 50MG"EAYUNG" 0.92

A027144151 PEACE SYRUP "YUNG SHIN" 20.2

A027146321 FU-KONG CREAM "T.L.B" 9.9

A027146335 FU-KONG CREAM "T.L.B" 25.8

A027162212 KAWAIPIN INJECTION 5MG/ML (PIRENZEPINE) "S.Y." 26.5

A027174100 LYSOZYME TABLETS 60MG "H.S." 0.98

A027177121 ACTEIN GRANULES 20MG/GM "S.Y." 1.68

A027193321 ECONAZOLE LOTION 1% "MAYER" 23.5

A027206100 ISHUTIN TABLETS 500MG (ISOPRINOSINE) 3.84

A027233500 SAINT-IODINE VAGINAL SUPPOSITORIES 200MG (POVIDONE-IODINE)

"PATRON"

10.7

A0272361G0 TENGAM CAPSULES "MT"(鋁箔/膠箔) 1.5

A027244100 BUMETA TABLETS 1MG (BUMETANIDE) "H.H." 1.3

A027287100 UPROFEN TABLETS 200MG (IBUPROFEN) 0.85

A027289338 UREA CREAM 100MG/GM "YUNG SHIN" 27.9

A027297100 DOMILIUM TABLETS 10MG (TRIFLUOPERAZINE) 1.94

A027300100 SEZEN TABLETS 30MG (NEFOPAM) 3.87

A027307212 U-SODIN INJECTION 2.5MG/ML (VERAPAMIL) 65

A027313100 METHYLSCOPOLAMINE TABLETS 1MG "Y.Y." 0.55

A027329277 LACTATED RINGER'S INJECTION "S.H." 21.1

A027330100 GANIN CAPSULES "N.C.P." 0.89

A027332209 PROASMA INJECTION 100MG/ML (METHOXYPHENAMINE)"Y.Y" 4.24

A027368100 ASGIN F.C. TABLETS (TINIDAZOLE) "S.Y." 2.08

A027372238 KALIMINE-A INJECTION "UNION" 18.7

A027373349 CALAMOL LOTION "VPP" 10.1

A027374100 ARTINE TABLETS 2MG 0.8

A027405100 SILLIVER CAPSULE 70MG (SILYMARIN) "C.M." 1.42

30

Page 31: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A027432100 DARVINE TABLETS 1.34MG (CLEMASTINE) "WEIDAR" 0.83

A027433100 COTINOL TABLETS "WEIDAR" 0.89

A027444100 CARBOTIN CAPSULES 375MG (S-CARBOXYMETHYLCYSTEINE) "WEIDAR" 1.3

A027479435 MEI-LIAN EYE SOLUTION 48.3

A0274921G0 KALIMINE-A S.C. TABLETS 50MG (UNION)(鋁箔/膠箔) 1.5

A027501100 SILIGEN CAPSULES "S.Y" 1.35

A027506100 KANPIAN CAPSULES "C.H." 1.34

A027569100 SOMIN TABLETS 2MG (DEXCHLORPHENIRAMINE) "YUNG SHIN" 0.42

A027624100 LITABAO CAPSULES 1.62

A027676100 LOPID CAPSULES 300MG (GEMFIBROZIL) 1.52

A027687216 LIBAAMIN INJECTION 16.5

A027706100 CLODNIN TABLETS 25MG(CHLOPHEDIANOL)"MEDIDE" 0.92

A027717206 RINDERON SUSPENSION 5MG/ML 11.9

A027718206 RINDERON INJECTION 4MG/ML (BETAMETHASONE) 11.9

A027818100 DEPERMIDE S.C. TABLETS (INDAPAMIDE) 2.27

A027876100 LIVORIN CAPSULES 70MG (SILYMARIN) "WEIDAR" 1.42

A027888100 METHYLTESTOSTERONE TABLETS "HONTEN" 1.62

A027934100 DECOFEN TABLETS "VPP" 0.8

A027936100 BENAMINE CAPSULES 50MG "VPP" 0.45

A027939221 BEESIX INJECTION 100MG/ML (PYRIDOXINE HCL) "VPP" 3.86

A027946100 METHASONE TABLETS 0.25MG (DEXAMETHASONE) "VPP 0.59

A027948212 VANCONIN INJECTION 5MG/ML (DIAZEPAM) "VPP" 10.9

A027956209 CECONINE FOR INJECTION 1G (CEPHALORIDINE) "VPP" 33.5

A027957277 CECONINE FOR INJECTION 0.5G (CEPHALORIDINE) "VPP" 18.8

A027979209 PAMOXICILLIN INJECTION 1GM (AMOXICILLIN) "UNION" 70

A028021321 AIRFUL CREAM 1MG/GM (TRETINOIN) 30.2

A028029100 DIMENHYDRINATE TABLETS 0.66

A028034100 PANALDINE F.C. TABLETS 100MG (TICLOPIDINE) 4.61

A028069100 KYOPINAL F.C. TABLETS (ALCLOFENAC) 5.8

A028080100 LEBUFEN F.C. TABLETS 200MG (FENBUFEN) "S.T." 1.35

A028098100 ACETAMOL TABLETS 500MG (ACETAMINOPHEN) "WEIDAR" 0.41

A028142100 KASTEINE TABLETS 375MG (S-CARBOXYMETHYLCYSTEINE "YUNG SHIN" 1.34

A028149100 TITALAM TABLETS 0.25MG (TRIAZOLAM) 1.93

A028150212 UNIKIN INJECJION 500MG "UNION" (AMIKACIN SULFATE) 34.6

A028151212 UNIKIN INJECTION 250MG(AMIKACIN SULFATE)"UNION" 31.3

A028151229 UNIKIN INJECTION 250MG(AMIKACIN SULFATE)"UNION" 90

A028200100 WINMIDE S.C. TABLETS 2.5MG (INDAPAMIDE) "WINSTON" 2.27

A028254329 LOSUCON CREAM 26.4

A028307100 NINIOL CAPSULES 100MG "CHEN TA"(NITROXOLINE) 2.51

A028315500 HEMOTHOL SUPPOSITORIES 4.5

A028371100 SAFEWAY F.C. TABLETS 200MG (CIMETIDINE) "VPP" 1

A028379100 PIROXICAM CAPSULES 20MG "YUNG CHI" 1.11

A028380100 SULINDAC TABLETS 100MG "Y.C." 1.87

A028517100 PLOTON TABLETS 0.39

A028578329 PIRIGEN CREAM 0.5MG/MG (CLOBETASOL) 17.7

A028581100 FLUNAZINE TABLETS 5MG (FLUNARIZINE) 1.09

A0285811G0 FLUNAZINE TABLETS 5MG (FLUNARIZINE) (鋁箔/膠箔) 1.5

A028606138 COMPOUND GLYCYRRHIZA MIXTURE "KINGDOM" 3.78

A028606159 COMPOUND GLYCYRRHIZA MIXTURE "KINGDOM" 21.3

A028607329 DERMOCURE CREAM 0.5MG/GM (CLOBETASOL)"KINGDOM" 17.7

A028610100 PYRUDON TABLETS 500MG "T.F."(ACETAMINOPHEN) 0.2

A028613148 BISOLVON SOLUTION 2MG/ML (BROMHEXINE HYDROCHLORIDE) 53

A028614100 MEXITIL CAPSULES 100MG (MEXILETINE HYDROCHLORIDE) 3.52

31

Page 32: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A028616329 PIFUSION CREAM 0.5MG/GM "TF"(FLUOCINOIDE) 54

A028642100 CRIPTINE TABLETS 2.5MG (BROMOCRIPTINE) 5.2

A028803100 YIAUKE TABLETS 100MG (MEBENDAZOLE) 0.75

A028922100 FUNOW CAPSULES 400MG (PIRACETAM)"SPC" 1.14

A028938100 PHENOBARBITAL TABLETS 30MG "U.L." 0.68

A0289381G0 PHENOBARBITAL TABLETS 30MG "U.L."(鋁箔/膠箔) 1.5

A028940100 FENBUPOL TABLETS 200MG (FENBUFEN) 1.35

A028942100 METHYLEPHEDRINE HCL TABLETS 25MG "U.L." 0.42

A0289421G0 METHYLEPHEDRINE HCL TABLETS 25MG "U.L."(鋁箔/膠箔) 1.5

A028943100 L.A. TABLET "U.L." 0.69

A028952343 ULEX LOTION 10%(CROTAMITON) 29.7

A028954100 PROGENA SUGAR COATED TABLETS 250MG (PROTHIONAMIDE)"SINPHAR" 5.6

A028957100 DETICON TABLETS 25MG "S.T." (CHLOPHENDIANOL) 0.64

A028976100 NEO-FLU CAPSULES 1

A028982110 ERYMYCIN (ERYTHROMYCIN ESTOLATE) FOR ORAL SUSPENSION "VPP" 48

A029005421 MYROSONE OPHTHALMIC SOLUTION 21.4

A029036100 AMANTADINE CAPSULES 100MG (AMANTADINE)"GENTLE" 3.42

A029210100 TRIDIGESTS TABLETS "T.F." 0.73

A029216100 VITABUTYRIMIN TABLETS "T.F." 0.3

A029217329 ANTIFUNGUO CREAM 10GM 19.5

A029217338 ANTIFUNGUO CREAM 20GM 36.2

A029226100 FUCOLE COLD CAPSULES 0.24

A029244421 TROPICAMIDE OPHTHALMIC SOLUTION 0.5% "WU FU" 18

A029247100 SOURIREE COMCIDIN S.C. TABLETS 0.74

A029249100 U-PIRIDE TABLETS 200MG (SULPIRIDE) 1.99

A029250100 U-PIRIDE TABLETS 50MG (SULPIRIDE) 1.33

A0292501G0 U-PIRIDE TABLETS 50MG (SULPIRIDE) (鋁箔、膠箔) 1.5

A029253100 SOURIREE COM-COLD CO. CAPSULES 0.74

A029278216 CIDIX INJECTION "N.K." 6

A029286329 BIODYNE OINTMENT (POVIDONE IODINE) 20.2

A029292209 ULOTHIN NEUTRAL INJECTION 1.0GM (CEPHALOTHIN) 26.3

A029298338 LEEZE CREAM 50MG/G (BENZOYL PEROXIDE) "ROYAL" 60

A029325100 ESULIN TABLETS 100MG TOLAZAMIDE "C.M." 2.77

A029349100 CIWETIN TABLETS 400MG "CURIE" (CIMETIDINE) 1

A0293491G0 CIWETIN TABLETS 400MG "CURIE" (CIMETIDINE)(鋁箔/膠箔) 1.5

A029351209 URAZONE INJECTION 1GM (CEFOPERAZONE) 170

A029352100 SUTENTEN TABLETS "CHEN TA" 0.45

A029354319 CLOBESOL CREAM 0.5MG "GENTLE" (CLOBETASOL PROPIONATE) 7.3

A029354324 CLOBESOL CREAM 0.5MG "GENTLE" (CLOBETASOL PROPIONATE) 15.8

A029354329 CLOBESOL CREAM 0.5MG "GENTLE" (CLOBETASOL PROPIONATE) 17.7

A029432100 PERSANTIN S.C. TABLETS 50MG (DIPYRIDAMOLE) 1.69

A029470100 DANAZOL CAPSULE 200MG "TAI YU" 11.2

A029473100 ASO TABLETS 500MG (SUCRALFATE) 1.1

A029484100 ALUFATE CHEWING TABLETS 1000MG "C.M." 2.07

A029499100 TERSULTRAN TABLETS 2.5MG (TERBUTALINE) "LITA" 1

A029506309 PERITONEAL DIALYSIS SOLUTION-A "S.T." 31.3

A029511100 MANLSUN CAPSULES 30MG (FLURAZEPAM) 2.93

A029515100 SUCRA TABLETS 500MG "H.H." (SUCRALFATE) 1.1

A029522209 PRODIOL INJECTION "TAI YU" 8.2

A029523289 MENIMYCIN INJECTION 750MG "TAI YU" (CEFUROXIME) 23.5

A029524100 TRIZIN CAPSULES 250MG "TAI YU" (CEFATRIZINE) 7.8

A029563329 NYSUL CREAM 30MG/GM (NIFLUMIC ACID) 16.4

A029590100 CANERCON CAPSULES "T.F." 2.34

32

Page 33: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A029598155 AMANTA SOLUTION 10MG/ML "GENTLE" (AMANTADINE HCL) 103

A029600209 U-SAVE FOR INJECTION 1.0GM 26.1

A029623100 LACEF CAPSULES 500MG "TAI YU" (CEPHRADINE) 2.97

A029631157 PEDOLIN SYRUP "STANDARD" 20.3

A029634151 NOCOUGH SYRUP "SINPHAR" 8.2

A029634157 NOCOUGH SYRUP "SINPHAR" 19.2

A029636100 DIANOL TABLETS 25MG "SINPHAR" (CHLOPHEDIANOL) 0.7

A029704100 DOLCID TABLETS 400MG (PIPEMIDIC ACID) "SINPHAR" 3.19

A029722321 FLUCONIN S CREAM 0.5MG/GM "S.Y." 36.1

A029722329 FLUCONIN S CREAM 0.5MG/GM "S.Y." 54

A029727100 BECAME TABLETS 0.24

A029728277 UNITAX INJ. 0.5GM (CEFOTAXIME SODIUM) "UNION" 62

A029733100 ANSUTAL TABLETS 40MG (FENSPIRIDE) 1.62

A029740100 A.A.C. TABLETS 1.4

A029758110 ACETIN GRANULES 66.67MG/GM "TAI YU" (ACETYLCYSTEINE) 1.68

A029758116 ACETIN GRANULES 66.67MG/GM "TAI YU" (ACETYLCYSTEINE) 1.7

A029766100 PERDAMOLE F.C. TABLETS 75MG "T.F." (DIPYRIDAMOLE) 1.44

A029824100 DIMAX TABLETS 80MG 1.11

A029828100 KASCOAL TABLETS 40MG (DIMETHYLPOLYSILOXANE) 0.43

A029847157 ANSOUHAU SYRUP "H.S." 31.6

A029853100 KANMAU CAPSULES "HS" 0.89

A0298601G0 ISIHTONNIN CAPSULES "HS" 50MG (KETOPROFEN)(鋁箔/膠箔) 1.5

A029863100 SHIKENUOH TABLETS 500MG "HS" 0.28

A029881100 PROPRANOLOL TABLETS 40MG "YUNG SHIN" 0.87

A029889212 CEDOL FOR INJECTION 500MG (CEFAMANDOLE NAFATE) 159

A029903329 INDECIN CREAM (INDOMETHACIN) 18.7

A029906100 FUCOLE NOSPAN TABLETS 15MG 0.55

A029917100 KASCOAL TABLETS 50MG (DIMETHYLPOLYSILOXANE) 0.43

A029949324 AKANA CREAM (BENZOYL PEROXIDE) 28

A029951100 DOTIDONE TABLETS 10MG "CURIL"(DOMPERIDONE) 0.86

A0299511G0 DOTIDONE TABLETS 10MG "CURIL"(DOMPERIDONE)(鋁箔/膠箔) 1.5

A029988100 LICODYNE TABLETS 375MG (CARBOCISTEINE) "Y.C." 1.28

A030058100 EROMYCIN F.C. TABLET 250MG "SHITEH" 1.43

A030123209 INJECTIO NALORPHINE HYDROCHLORIDI 26.7

A030270335 ACNE TREATMENT CREAM 88

A030281209 KOFATOL INJECTION 1.0GM (CEPHAZOLIN) 15.7

A030281277 KOFATOL INJECTION 0.5GM (CEPHAZOLIN) 11.4

A030304100 CHLORPHENIRAMINE MALEATE TABLETS "M.T." 0.1

A0303071G0 DEXAMETHASONE S.C. TABLETS 0.5MG "M.T." (鋁箔/膠箔) 1.5

A030384100 MELON TABLETS 50MG (MEPIRIZOLE) "H.S.C." 1.13

A030385100 SULPIRIDE TABLETS 1.99

A030442212 KETOPROFEN INJECTION 25MG/ML "ASTAR" 11.1

A030453100 CHILDRENS ACETA 80 CHEWABLE TABLETS 0.25

A030456100 DIHYDROCHLOROTHIAZIDE TABLETS "ORIENTAL" 0.65

A030512100 DIAMICRON (GLICLAZIDE) TABLETS 80MG 1.11

A030531343 FOOTCON OINTMENT "STANDARD" 16.3

A0305561G0 YUNGBENRONE TABLET "YUNG SINE"(BENZBROMARONE) (鋁箔膠箔) 1.5

A030563100 OROMIN CAPSULES 0.85

A030590100 BEZALITE TABLETS 200MG (BEZAFIBRATE) 3.49

A030601100 PACOMIN TABLETS 20MG "PATRON" (OXELADIN) 0.74

A030624343 SALICYLIC ACID AND BENZOIC ACID OINTMENT 34

A030634329 RELEX GEL 50MG/G "N.K." (ETOFENAMATE) 29.4

A030634338 RELEX GEL 50MG/G "N.K." (ETOFENAMATE) 50

A030645100 LISUAN TABLETS 8MG (BROMHEXINE) "H.S." 0.27

A030748329 FUDGEN CREAM "H.S." 36.1

33

Page 34: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A030763221 INFUVITA INJECTION 65

A030781209 UNIZONE INJ. 1GM (CEFOPERAZONE) "UNION" 170

A030781277 UNIZONE INJECTION 0.5 GM "UNION" 101

A030783338 MANNIN CREAM 0.5MG/G (CLOBETASOL) "SHITEH" 46.9

A030801212 CHLORAMPHENICOL INJECTION "Y.Y" 9.4

A030811100 AMOXICILLIN CAPSULES 500MG "TAI YU" 1.29

A030816100 CEPHALEXIN CAPSULES 500MG "TAI YU" 1.76

A030836157 MUCO SYRUP 20MG/ML (CARBOCISTEINE) "PATRON" 22.5

A030859421 PHENYLEPRINE HYDROCHLORIDE OPHTHALMIC SOLUTION 10% "WU FU" 53

A030862157 COUGH MIXTURE 24

A030871100 ASKACEF (CEPHRADINE) CAPSULES 500MG "VPP" 2.97

A030873100 FLUTAFIN CAPSULE 200MG (ACEFYLOYSTEINE) 2.51

A030874100 ASKACEF (CEPHRADINE) CAPSULES 250MG "VPP" 1.79

A030895100 ACTIN TABLETS 0.98

A030897209 CEFIN INJECTION 1GM (CEPHRADINE) "TAI YU" 26.1

A0309131AH AUSTIN POWDER (C GLUCOSE)523.1MG (PSYLLIUM HUSK) "GENTLE" 4.51

A030944338 SULON SOLUTION (INDOMENTHACIN) 49.4

A030950421 GETAMIN EYE DROP SOLUTION 29.9

A030950423 GETAMIN EYE DROP SOLUTION 35.7

A030954100 HOKURAMIDE CAP. (COBAMAMIDE) "P.J." 1.02

A030963100 EPILEPTIN (PHENYTOIN) CAPSULES 100MG "VPP" 0.69

A030988209 GANTA INJECTION 140MG/ML (GENTAMICIN)"WINSTON" 15.4

A030988212 GANTA INJECTION 140MG/ML (GENTAMICIN)"WINSTON" 15.4

A030988229 GANTA INJECTION 140MG/ML (GENTAMICIN)"WINSTON" 82

A0309971G0 VENTON TABLETS 50MG(DICLOFENAC) "LITA"(鋁箔/膠箔) 1.5

A031011157 COLIN SOLUTION 22.9

A031017329 PHISODERM ANTI-ACNE GEL 10% 40.1

A031032100 CARDINOL TAB. 100MG (METOPROLOL) "KINGDOM" 3.83

A031043212 CIMEFINE INJECTION 150MG/ML (CIMETIDINE) 11.1

A031055100 COSTINE TAB LETS 10MG (DOMPERIDONE) "K.N." 0.86

A031088100 SINUDIN TABLETS 1

A031094209 UROXIME INJECTION"UNION"(CEFUROXIME) 63

A031094210 UROXIME INJECTION (CEFUROXIME) "UNION" 63

A031094265 UROXIME INJ. 250MG. (CEFUROXIME) "UNION" 23.5

A031094277 UROXIME INJ. 500MG. (CEFUROXIME) "UNION" 23.5

A031094289 UROXIME INJ. 750MG. (CEFUROXIME) "UNION" 23.5

A031100100 U-RITIS TABLETS 500MG (NAPROXEN) 2.41

A031110100 RIKAPARIN CAPSULES 500MG (TRANEXAMIC ACID) "TAIWAN TUNG YANG" 3.89

A031113121 U-CITRA GRANULES 7.8

A031150321 LOCACORTEN OINTMENT 50

A031153100 NOSCAPINE TABLETS "L.S." 0.95

A031174100 SULPYRONE TABLETS 100MG (SULPIRIDE) "EAYUNG" 1.64

A031179100 HYDROCHLOROTHIAZIDE TABLETS 25MG "JEN SHENG" 0.65

A031180100 PROCHLORPERAZINE MALEATE TABLETS 8MG "JEN SHENG" 0.69

A031183100 CHINSALO TABLETS 200MG (BEZAFIBRATE) "EAYUNG" 0

A031187100 SUMIN TABLETS 2MG (DEXCHLORPHENIRAMINE) "CHINTENG" 0.33

A031188329 VOREN EMULGEL (DICLOFENAC) 20.8

A031188338 VOREN EMULGEL (DICLOFENAC) 27.6

A031205100 LENDORMIN TABLETS 250MCG 4.04

A031208229 LIZEPINE LYOPHILIZED INJECTION (PIRENZEPINE) "LITA" 26.5

A031219100 BISTOR CAPSULE (DOXYCYCLINE) "SHITEH" 1.21

A031224100 KETOTIFEN CAPSULES "EAYUNG" 1.21

A031234100 RIFAMPICIN CAPSULES 300MG "R.T." 8.1

34

Page 35: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A031238100 MEBEN CAPSULES 300MG (FENBUFEN) "Y.C." 2.29

A031258421 GENTASONE EYE DROPS "UNION" 29.9

A031263100 KETOFEN TABLETS "H.S.C." (KETOTIFENE) 1.21

A031270100 OXYTETRACYCLINE HYDROCHLORIDE CAPSULES 250MG "R.T" 0.81

A0312701G0 OXYTETRACYCLINE HYDROCHLORIDE CAPSULES 250MG "R.T"(鋁箔) 1.5

A031274212 UNISONE INJECTION 4MG/ML (DEXAMETHASONE) "UNION" 17.6

A031274229 UNISONE INJECTION 4MG/ML (DEXAMETHASONE) "UNION" 17.6

A031276100 TECYTEINE CAPSULES 375MG (CARBOCYSTEINE) "R.T." 1.29

A031290100 LINCOMYCIN HYDROCHLORIDE CAPSULES 500MG "R.T" 5.1

A031291100 KONATON TABLETS 500MG (ACETAMINOPHEN) "KOJAR" 0.25

A031300100 FORMAX ENTERIC-MICRO-ENCAPSULED CAPSULE 50MG "SHITEN"

(DICLOFENAC)

0.93

A0313081G0 TICOQUER TABLETS 100MG (MEBENDANOLE) "R.T."(鋁箔) 1.5

A031323100 SOLANTIN F.C. TABLETS (DIPYRIDAMOLE) 1.44

A031325324 SLIKA B CREAM (ISOCONAZOLE) "MEIDER" 31.4

A031356129 CONTRACID SUSPENSION 20MG/ML (CIMETIDINE) 13.4

A031488100 ERYTHROMYCIN ESTOLATE CAPSULES 250MG "R.T" 1.43

A0314881G0 ERYTHROMYCIN ESTOLATE CAPSULES 250MG "R.T"(?T??) 1.5

A0314891G0 ANKUMIN TABLETS 6MG (BETAHISTINE) "R.T."(鋁箔) 1.5

A031501100 COLFERIN CAPSULES "CHINTENG" 0.5

A031507100 DUORIDONE TABLETS 10MG (DOMPERIDONE) "LITA" 0.86

A0315071G0 DUORIDONE TABLETS 10MG (DOMPERIDONE) "LITA" (鋁箔/膠箔) 1.5

A031513100 ROPECON TABLETS 250MG (PIPEMIDIC ACID) "YUNG CHI" 3.1

A031514100 ASMAC TABLETS 2.5MG (FENOTEROL HBR) "YUNG CHI" 0.97

A031519151 BECANDINE SOLUTION "R.T." 10.3

A031545100 CHLORTETRACYCLINE HYDROCHLORIDE CAPSULES 250MG "R.T." 0.95

A031651417 SCORO ORABASE 22.7

A031671100 SUCOUGH S.C. TABLETS 1.33

A031673100 SOURIREE COM-TRIMETON TABLETS 4MG 0.17

A031675335 CORN REMOVAL 28.6

A031680100 VOMISEDA TABLETS 25MG"SOURIREE" 0.22

A031694100 STOIN TABLETS 10MG (OXETHAZAINE) "KOJAR" 0.72

A031728100 GASTRODIN TABLETS 400MG (CIMETIDINE) "U-LIANG" 1

A031737151 SANCOUGH-CO SYRUP 20.5

A031737157 SANCOUGH-CO SYRUP 25

A031799100 GASCON TABLET 40MG (DIMETHICONE) 0.43

A031800100 ALGITAB CHEWABLE TABLETS 3.41

A031807100 CHINSA TABLETS 200MG "Y.C." (BEZAFIBRATE) 3.49

A031808100 MENYAN S.C. TABLETS 50MG (MEDHYDROLINE) "EAYUNG" 1.02

A031831100 ULECIN CAPSULES 150MG (CLINDAMYCIN) "UNION" 1.26

A031833100 USEMIN CAPSULES 500MG (TRANEXAMIC ACID) "UNION" 3.89

A031837100 PORO TABLETS 80MG (ACETAMINOPHEN) 0.25

A031840421 FLULON EYE DROPS 1MG/ML (FLUOROMETHOLONE) "UNION" 14

A031846212 ULECIN INJECTION 150MG/ML (CLINDAMYCIN) "UNION" 15.8

A031878209 DIMEN INJECTION 50MG/ML (DIMENHYDRINATE) "UNION" 13.9

A031908255 FLUGEN INJECTION 5MG (TINIDAZOLE) "SIU GUAN" 131

A031922338 INDOCIN CREAM 10MG/GM (INDOMETHACIN) "S.Y." 37.8

A031927138 OCTA-VITA DROPS "SOURIREE" 46.4

A031932100 DIAMINE CAPSULES 25MG" SOURIREE"(DIPHENHYDRAMINE HCL) 0.39

A031933100 SOURIREE COMCEB CAPSULES 1MG (CYANOCOBALAMIN) 0.5

A0319331G0 SOURIREE COMCEB CAPSULES 1MG (CYANOCOBALAMIN)(鋁箔) 1.5

A031978329 TRINAZOLE CREAM "YUNG CHI" 0

A031979100 ANTADINE TABLETS 100MG (AMANTADINE) "YUNG CHI" 3.42

A031983265 DITROSE INJECTION 5% (DEXTROSE) "S.Y." 17.8

A031983277 DITROSE INJECTION 5% (DEXTROSE) "S.Y." 19.1

35

Page 36: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A032001100 COSIN TABLETS 20MG "KOJAR" (NOSCAPINE) 0.9

A0320011G0 COSIN TABLETS 20MG "KOJAR" (NOSCAPINE)(鋁箔/膠箔) 1.5

A032004100 MITON FILM COATING TAB. 100MG "KOJAR" (MEPIRIZOLE) 2.17

A032006321 COBESONE CREAM 0.5MG/G (CLOBETASOL) "P.J." 15.8

A032006324 COBESONE CREAM 0.5MG/GM "P.J" 15.8

A032006329 COBESONE CREAM 0.5MG/G (CLOBETASOL) "P.J." 17.7

A032018100 TRANLO TABLETS 15MG"D.T.S" 1

A032027338 TORICAM GEL 5MG/G (PIROXICAM) 31.7

A032045100 ASPIRIN E.F.C.TABLETS 650MG "KOJAR" 0.8

A032050429 ATROPINE SULPHATE OPHTHALMIC SOLUTION 1% "WU FU" 33.9

A032058421 ATROPINE SULPHATE OPHTHALMIC SOLUTION 0.5% "WU FU" 21

A032058429 ATROPINE SULPHATE OPHTHALMIC SOLUTION 0.5% "WU FU" 33.9

A032105321 FUCON CREAM "S.Y." 11.7

A032111100 ACTIRIN TABLETS "SINPHAR" 0.8

A032113100 TOSUMIN TABLETS "WEIDAR" 0.75

A032116100 SERENIN S.C. TABLETS 10MG (OXAZOLAM) "EAYUNG" 0.94

A032124100 C.A.P. CAPSULES "KINGDOM" 0.75

A032125209 PIXTIM INJECTION 20MG/ML (PIROXICAM) "UNION" 17.6

A032125212 PIXTIM INJECTION 20MG/ML (PIROXICAM) "UNION" 17.6

A032135421 TIMOLOL OPHTHALMIC SOLUTION 0.5% "WU-FU" 113

A032136421 TIMOLOL OPHTHALMIC SOLUTION 0.25% "WU-FU" 59

A032162100 SOURIREE COMTON TABLETS 0.45

A032164100 SOURIREE COM-DIASTASE-P S.C. TABLET 0.68

A032170335 ALLERCURE CREAM "SHITEH" 24.9

A032173329 TRIECO CREAM "SHITEH" 19.5

A032173338 TRIECO CREAM "SHITEH" 29

A032175329 INDO CREAM 10MG/GM (INDOMETHACIN) "H.S." 18.7

A032175340 INDO CREAM 10MG/GM (INDOMETHACIN) "H.S." 58

A032208121 EQUSIL GRANULES 20MG/GM (ACETYLCYSTEINE) "LITA" 1.68

A032223151 ACETAMINOPHEN LIQUID 12MG/ML (ACETAMINOPHEN) "STANDARD" 11.4

A032250100 SUPERTIDINE S.C. TABLETS 20MG (FAMOTIDINE) "VPP" 1.62

A032261100 LOPER CAPSULES 2MG (LOPERAMIDE) "H.S." 0.64

A032265100 FLUNEPAN TABLE 2MG (FLUNITRAZEPAM) "PANBIOTIN" 2.36

A032267500 CLOTRIMAZOLE VAG. TAB. (CLOTRIMAZOLE) "PANBIOTIC" 15.2

A032277100 PEESU TABLETS "KOJAR" 0.83

A032287100 SENIDOL TAB. 25MG (DIPHENIDOL) "PANBIOTIC" 0.91

A032292100 PANCOBAMIN CAPSULE 500MCG (MECOBALAMIN) "PANBIOTIC" 1.64

A032295100 CEFADIN CAP 500MG (CEPHRADINE) "STANDARD" 2.97

A032319321 GENTADERM CREAM 22.7

A032320100 ACETAL TABLET 500MG (ACETAMINOPHEN) "PURZER" 0.52

A032323114 FLUCIL GRANULE 40MG/GM (ACETYLCYSTEINE) "PURZER" 1.68

A032323121 FLUCIL GRANULE 40MG/GM (ACETYLCYSTEINE) "PURZER" 1.7

A032325321 METHACIN GEL 10MG/GM (INDOMETHACIN) "PURZER" 13

A032325325 METHACIN GEL 10MG/GM (INDOMETHACIN) "PURZER" 18.2

A032325329 METHACIN GEL 10MG/GM (INDOMETHACIN) "PURZER" 18.7

A032325335 METHACIN GEL 10MG/GM (INDOMETHACIN) "PURZER" 30.9

A032325338 METHACIN GEL 10MG/GM 37.8

A032333100 COLDOL CAPSULE 0.89

A032364100 BEMIDON F.C. TALBETS 50MG (TIARAMIDE) "KOJAR" 1.14

A032368100 KETOTI TABLETS 1MG (KETOTIFEN) "YUNG CHI" 1.21

A032376329 NISOLON GEL 50MG/G (ETOFENAMATE) 29.4

A032416209 PIROCAM INJECTION 20MG/ML (PIROXICAM) 16

A032419329 BETADERM CREAM "SINPHAR" 14.2

A032469100 LONGIAN TABLETS 25MG (BUCLIZINE) 0.54

A032490100 WYEANIN F.C. TABLETS 10MG (DOMPERIDONE) "S.L." 0.86

36

Page 37: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A032492100 TOMIN TABLETS 2MG (DEXCHLORPHENIRAMINE) "KOJAR" 0.42

A032494100 FLUBEN S.C. TABLETS 40MG (FLURBIPROFEN) "EAYUNG" 1.41

A032495100 COWBALIN TABLETS 100MG (MEBENDAZOLE) "KOJAR" 1.1

A0324951G0 COWBALIN TABLETS 100MG "KOJAR" (MEBENDAZOLE)(鋁箔/膠箔) 1.5

A032496100 ALDIN F.C. TABLETS 250MG (METHYLDOPA) "KOJAR" 1.8

A032504100 ANTADINE CAPSULES 100MG (AMANTADINE) "H.L." 3.42

A032514421 TOBEYESON OPHTHALMIC SOLUTION 28.8

A032562319 CLEOSOL CREAM 0.5MG/GM (CLOBETASOL) "GCPC" 7.3

A032572100 SACLONAL TABLETS 10MG (HOMOCHLORCYCLIZINE) "P.J." 0.83

A032573100 MERANOM S.C. TABLETS 25MG (DIPHENIDOL) "P.J." 0.91

A032583100 ANTICOLD CAPSULES "KOJAR" 0.89

A032624212 EUDAMYCIN INJECTION 150MG/ML (CLINDAMYCIN) "U-LIANG" 15.8

A032625157 COSILY LIQUID 650MG/ML (LACTULOSE) "MEIDER" 43.5

A0326311G0 CIMETIDINE TABLETS 400MG "R.T."(鋁箔) 1.5

A032634338 TONDONAC GEL 10MG/GM (DICLOFENAC SODIUM) 27.6

A032695212 CIKETIN INJ. 150MG/ML (CIMETIDINE) "UNION" 11.1

A032702100 BIPERIDEN TABLET 2MG "K.Y." 2.03

A032705221 DOPAMIN INJECTION 10MG/ML (DOPAMINE) "VPP" 21.2

A0327161G0 DOMPERAN TABLETS 10MG (DOMPERIDONE) "SWISS"(30粒/瓶)(60粒/瓶) 1.5

A032722177 YIAUKE GRANULES 100MG/GM (MEBENDAZOLE) "T.F." 63

A032724100 JEFRON S.C. TABLETS 25MG "KYORIN" (DIPHENIDOL) 0.91

A032736238 WILCON LYO-INJECTION 20MG (FAMOTIDINE) "UNION" 31.5

A032760114 ACETYLEINE GRANULES 40MG/GM "H.S." (ACETYLCYSTEINE) 1.68

A032760155 ACETYLEINE GRANULES 40MG/GM "H.S." (ACETYLCYSTEINE) 96

A032761100 MINOCYCLINE CAPSULE 100MG "PANBIOTIC" 5.2

A032774100 SUWEL TABLETS 500MG (SUCRALFATE) 1.1

A032783100 PEDERCON TABLETS 200MG (FLAVOXATE) "YUNG CHI" 4.01

A032792229 DOPAMIN (DOPAMINE) INJECTION 20MG/ML "VPP" 21.2

A032803100 SLEEPING-DEPOT 0.25MG (TRIAZOLAM) "JINUP" 1.93

A032805100 BUTANIDE TABLET 1MG (BUMETANIDE) "LITA" 1.3

A032809500 NOTAREN SUPPOSITORIED 25MG (DICLOFENAC) "PATRON" 2.63

A032848324 DERMOSOL CREAM 0.5MG/G (CLOBETASOL) "PATRON" 15.8

A032848329 DERMOSOL CREAM 0.5MG/G "PATRON" 17.7

A032848335 DERMOSOL CREAM 0.5MG/G "PATRON"(CLOBETASOL) 28.6

A032848338 DERMOSOL CREAM 0.5MG/G "PATRON" 46.9

A032849100 MEZAIN TABLET 5MG (OXETHAZAINE) "STANDARD" 0.38

A032885500 VAZOLE VAGINAL TABLETS 250MG (METRONIDAZOLE)"H.S." 1.96

A032886100 UPDOPA TABLETS 2.5MG (BROMOCRIPTINE) "JINUP" 5.2

A032891100 AMOXICILLIN CAPSULES 500MG "T.F." 1.29

A032898330 GOODLUCK CREAM 0.5MG/GM (CLOBETASONE) 60

A032925157 KALA SOLUTION "YU SHENG" 21.9

A032927100 NOSCAPINE TABLETS 20MG "ROOT" 0.8

A032933100 ASIR TABLETS 20MG (TIPEPIDINE) "YU SHENG" 0.66

A032937500 DICLOFEN SUPPOSITORY 25MG (DICLOFENAC) "H.S." 2.63

A032946100 MINCON CAPSULES "ROOT" 0.92

A032957100 NITROLIR S.C. TABLETS 50MG (NITROXOLINE) "Y.Y" 1.53

A0329691G0 DEANTRAN TABLETS 1MG "R.T."(鋁箔) 1.5

A032971329 YIHFU OINTMENT 0.5MG/GM (CLOBETASOL PROPIONATE)"S.D." 17.7

A033027100 TRICOLINE TABLETS 3MG(TRIMETOQUINO)"S.D." 1.05

A033049100 TALIPIN TABLET 30MG (AMBROXOL) "SWISS" 0.8

A033054100 BROMA-DEL TABLETS 2.5MG (BROMOCRIPITINE) "CCPC" 5.2

A033073100 CASEMYCIN CAPSULES 500MG (CEPHALEXIN) "T.F." 1.76

A033093209 METACIN FOR INJECTION (CEFMETAZOLE) 105

A0330981G0 CIKETIN TABLETS 400MG (CIMETIDINE) "UNION"(鋁箔/膠箔) 1.5

37

Page 38: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A033123100 SEZOLAM CAPSULE 10MG (OXAZOLAM)"CURIE" 0.94

A033126100 FUROL CAPSULES 10MG (BROMOPRIDE) "KOJAR" 1.1

A033153343 BIOFUR ACNE LOTION 50MG/GM "SINPHAR"(SULFUR PRECIPITATED) 16.5

A033166100 BROMPHENIRAMINE MALEATE TABLETS "Y.C." 0.25

A033176100 FLOUOXYMESTERONE CAPSULES 5MG (FLUOXYMESTERINE)"Y.C." 1.25

A033191100 PARKER TABLETS 8MG (BROMHEXINE HCL)"Y.C." 0.27

A033195100 MECLIZINE HCL TABLETS 25MG "Y.C." 0.22

A033207100 PIANT TABLETS 500MG(ACETAMINOPHEN)"ROOT" 0.19

A033214100 UMINON CAPSULES 100MG (MINOCYCLINE) "UNION" 5.2

A033260229 TRANEXAMIC ACID INJECTION 100MG/ML "ASTAR" 31.6

A033261209 PROGESTERONE INJECTION 50MG/ML "ASTAR" 10

A033261229 PROGESTERONE INJECTION 50MG/ML "ASTAR" 32.9

A033268100 E-LICON CAPSULES 1.62

A033269100 BUZETIN CAPSULES 0.91

A033270100 KOPIN TABLETS 0.91

A033272100 IPRON TABLETS 0.91

A033274100 ANCOUGH CAPSULES 3.75

A033282338 LIFULIN OINTMENT "M.T." 111

A033380100 FUCON TABLETS 100MG (PENTOXIFYLLINE) "Y.C." 1.35

A033388100 EUGEN TABLETS "YU SHENG" 0.98

A033389100 DEGISON CAPSULES 25MG "KOJAR" (DANTROLENE) 5.3

A033391100 ANCOU TABLETS 15MG"KOJAR"(DEXTROMETHORPHAN HYDROBROMIDE) 0.37

A033392100 SILYCON CAPSULES 150MG (SILYMARIN)"EAYUNG" 1.5

A033423100 TOFILLINE 100MG S.C. TABLETS "S.L." 1.35

A033436212 CIMETIDINE INJECTION 100MG/ML "ASTAR" 9.9

A033447338 PIROCAN 0.5% GEL "S.Y." 31.7

A033449100 NAPROXEN 250MG TABLETS "Y.S." 1.09

A033456209 UZOLIN INJECTION (CEPHAZOLIN SODIUM)"UNION" 15.7

A033456212 UZOLIN INJ. 2GM (CEPHAZOLIN SODIUM) "UNION" 43.3

A033461100 FENOTIN TABLETS 2.5MG "S.L." 0.97

A033472329 YUREA CREAM "YU SHENG" 20.3

A033474221 GETWAY 10MG INJ. (RANITIDINE)"SWISS" 22.2

A033480100 CLINCIN CAPSULES 150MG (CLINDAMYCIN)"TAIWAN TUNG YANG" 1.26

A033487212 KETOPROFEN INJECTION 50MG/ML "ASTAR" 11.1

A033489100 COFEDENIN TABELTS 22.14MG (TIPEPIDINE HIBENZATE) "C.J." 0.75

A033497100 COLD CAPSULES "SINPHAR" 0.45

A033506100 OXELADINE TABLETS 20MG "SINPHAR" 0.4

A033513100 CIPHMIN TABLETS "SINPHAR " 0.89

A033520329 RINA OINTMENT "SINPHAR" 26.4

A033532100 ANPIRIN TABLETS "SINPHAR" 0.45

A033578338 CLOMOLD OINTMENT 0.5MG/GM (CLOBETASOL PROPIONATE) "T.F." 46.9

A033583229 PROPOR INJECTION 0.1% (PROTOPORPHYRIN)"T.F." 13.9

A033584212 MYANESIN INJECTION 100MG/ML (MEPHENESIN)"T.F." 8.7

A033588100 URIBRONE TABELETS 50MG "W.P." 1.23

A033593211 TRANEXAMIC ACID INJECTION 50MG/ML "T.F." 4.55

A033676100 MULAX TABLETS 10MG (BACLOFEN) "TAIWAN TUNG YANG" 1

A033677335 FORMAX GEL 10MG/GM (DICLOFENAC SODIUM) "SHITEH" 20.8

A033677338 FORMAX GEL 10MG/GM (DICLOFENAC SODIUM) "SHITEH" 27.6

A033677343 FORMAX GEL "SHITEH" 10MG/GM(DICLOFENAC SODIUM) 30.6

A033733100 CEGELIN TABLETS 200MG (BEZAFIBRATE) "YUNG CHI" 3.49

A033740299 HINICOL INJECTION 1.88

A033766212 CAFFEINE & SODIUM BENZOATE INJECTION 100MG/ML "T.F." 7.8

A033773209 TUNNACORT INJECTION 40MG/ML"T.F" 23

A033774100 DAILY-PLUS CHEWABLE TABLET 0.5MG (HYDROXOCOBALAMIN ACETATE

)"SHITEH"

1

38

Page 39: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A033822100 ISOPERDINE TABLETS 40MG "S.L." 1.11

A033854100 NOSCAPINE HYDROCHLORIDE TABLETS "T.F." 0.73

A0338711G0 FORLIVER CAPSULES 150MG "ROOT" (SILYBIN)(鋁箔/膠箔) 1.5

A0338721G0 CIKETIN TABLETS 200MG (CIMETIDINE) "UNION"(鋁箔/膠箔) 1.5

A033890100 LIGAT TABLETS 100MG (URSODEOXYCHOLIC ACID) "TAIWAN TUNG YANG" 2

A0339001G0 SINLIHAUL TABLETS 40MG (PROPRANOLOL) "H.S."(鋁箔/膠箔) 1.5

A033901100 POTAN TABLETS 500MG "H.S." (MEFENAMIC ACID) 0.79

A0339011G0 POTAN TABLETS 500MG "H.S." (MEFENAMIC ACID) (鋁箔/膠箔) 1.5

A033902100 BIESCON CAPSULES 0.89

A033922277 LACT-RINGER INJECTION "S.Y." 21.1

A033925216 DICLOFENAC INJECTION 25MG/ML "ASTAR" 8.4

A033930330 EUNEN CREAM 0.05%(CLOBETASONE) 60

A033932100 TETRACYCLINE HYDROCHLORIDE CAPSULES 500MG "ROOT" 0.93

A0339321G0 TETRACYCLINE HYDROCHLORIDE CAPSULES 500MG "ROOT"(鋁箔) 1.5

A033936100 ILOMYCIN CAPSULES 250MG (ERYTHROMYCIN ESTOLATE) "Y.C" 1.43

A033938329 FUNGIN CREAM 10MG/GM (BIFONAZOLE) "SWISS" 39.6

A033940277 UZOLIN INJECTION 500MG (CEPHAZOLIN) "UNION" 11.4

A033960100 CLEDOMYCIN CAPSULES 150MG (CLINDAMYCIN) "ROOT" 1.26

A033990100 GASAFE F.C. TABLETS 20MG (FAMOTIDINE) 1.62

A034002100 COUSEL TABLETS 20MG "KOJAR"(TIPEPIDINE HIBENZATE) 0.8

A034003100 WANIDINE CAPSULES 200MG (QUINIDINE SULFATE) "WASHINGTON" 3.95

A034010238 DEXTROSE 50% INJECTION "S.Y" 5.7

A034016100 TICLOPINE S.C. TABLETS 100MG (TICLOPIDINE)“EAYUNG” 3.8

A034017100 CABOTIN TABLETS 375MG (CARBOCYSTEINE) "KOJAR" 1.34

A034059100 CIMEFINE F.C. TABLETS 400MG (CIMETIDINE) 1

A0340591G0 CIMEFINE F.C. TABLETS 400MG (CIMETIDINE)(鋁箔/膠箔) 1.5

A034070421 GENTAMYCIN OPHTHALMIC SOLUTION 3MG/ML "WU-FU" 17.4

A034071421 TOBRAMYCIN OPHTHALMIC SOLUTION 3MG/ML "WU-FU" 36.7

A034072100 CIMEFINE F.C. TABLETS 200MG (CIMETIDINE) 1

A034080157 EUGEN LIQUID "YU SHENG" 18.4

A034098100 SOTOCON TABLETS 20MG "CHINTENG"(DEXTROMETHORPHAN) 0.58

A0340981G0 SOTOCON TABLETS 20MG "CHINTENG"(DEXTROMETHORPHAN)(鋁箔/膠箔) 1.5

A0341031G0 PROLIVRIN CAPSULES "ROOT"(鋁箔/膠箔) 1.5

A034111100 BETAHISTANE TABLETS 6MG (BETAHISTINE) "EAYUNG" 0.92

A034119100 POULI CAPSULES "CHINTENG" 0.91

A034127329 ACZO GEL 50MG/GM (BENZOYL PEROXIDE) "SINPHAR" 28

A034129212 LINCOMYCIN 300MG/ML INJECTION "S.Y." 11.4

A034129238 LINCOMYCIN 300MG/ML INJECTION "S.Y." 39.2

A034146329 PIROXIM GEL 0.5% (PIROXICAM) "STANDARD" 15

A034151100 VILLFULL TABLETS 5MG (NORETHINDRONE) 1.41

A034153100 SEFREE CAPSULES 500MG (CEPHRADINE) "PANBIOTIC" 2.97

A034159338 TEIRIA GEL 50MG/GM(ETOFENAMATE) 49.5

A034159345 TEIRIA GEL 50MG/GM(ETOFENAMATE) 71

A034161100 ULIDAN S.C. TABLETS 50MG (NICAMETATE CITRATE) "CENTURY" 0.96

A034169321 EFU CREAM "Y.C" 15.5

A034169330 EFU CREAM "Y.C" 46.3

A0341711G0 FOAN CAPSULES 10MG (OXAZOLAM) "S.C"(鋁箔/膠箔) 1.5

A034172277 KELIN FOR INJECTION (CEFAZOLIN) "TAI YU" 11.4

A034174335 NISOLON GEL 100MG/G (ETOFENAMATE) 33.8

A034179100 IBUFEN TABLETS 400MG (IBUPROFEN) "CURIE" 0.98

A0341791G0 IBUFEN TABLETS 400MG (IBUPROFEN) "CURIE"(鋁箔/膠箔) 1.5

A034222157 MAC SAFE ORAL SUSPENSION 20MG/ML (IBUPROFEN) 49.4

A034224312 ACYCLOVIR CREAM 50MG/GM "KINGDOM" 17.3

39

Page 40: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A034224321 DEVIRO CREAM 50MG/GM (ACYCLOVIR) 41.4

A034255356 EVAC ENEMA 39.6

A034270321 BETACLOSONE CREAM "UNION" 17.7

A034270335 BETACLOSONE CREAM "UNION" 72

A034272100 SEMPER TABLETS 25MG (MECLIZINE) 0.56

A0342831G0 URENIDE TABLETS 1MG (BUMETANIDE) "ROOT"(鋁箔/膠箔) 1.5

A034285100 VILI TABLETS "S.D." 0.84

A034288209 CEPIN FOR INJECTION 26.1

A034301209 U-DOLAN DECANOATE INJ. 50MG/ML (HALOPERIDOL) "U-LIANG" 144

A034304100 PERIDON TABLETS 10MG (DOMPERIDONE) "EAYUNG" 0.86

A034307336 VIVICOME CREAM “S.D” 25.8

A034312100 ISOSORBIDE TABLETS 40MG "TWI" 3.12

A034317229 KANAMYCIN 250MG/ML INJECTION "S.Y" 19

A034329212 UFIN FOR IV INJECTION "UNION"(CEFTRIAXONE) 628

A034329265 UFIN FOR IV INJECTION (CEFTRIAXONE) "UNION" 96

A0343481G0 ANNEUTON TABLETS 80MG (GLICLAZIDE) "ROOT"(鋁箔/膠箔) 1.5

A034372329 FUCON 0.05% CREAM (CLOBETASOL PROPIONATE) "Y.Y." 17.7

A034503429 ARTIFICIAL TEAR "WU-FU" 25.1

A034507277 BABYNNA INJECTION "S.Y" 19.6

A034508338 CLOPAIN GEL 10MG/GM (DICLOFENAC SODIUM) "B & F" 26.4

A034523100 AMOXICILLIN 500MG CAPSULES "PANBIOTIC" 1.29

A0345231G0 AMOXICILLIN 500MG CAPSULES "PANBIOTIC"鋁箔/膠箔 1.5

A034524100 BACLOFEN 10MG "S.Y." 1

A034528100 ERY-B E.C. CAPSULES 250MG (ERYTHROMYCIN) "KINGDOM" 1.43

A034531321 SUGENFU CREAM 10MG/GM (BIFONAZOLE) 23.7

A034535100 SUPELI CAPSULES "KOJAR" 0.78

A0345501G0 GLUPIZIDE TABLETS 5MG "MACRO"(GLIPIZIDE) (鋁箔/膠箔) 1.5

A034558100 BROSOU TABLETS 20MG (TIPEPIDINE) "CHINTENG" 0.8

A034573329 SALOSON 1% EMUGEL (DICLOFENAC) "MEY SEE" 20.8

A034573343 SALOSON 1% EMUGEL (DICLOFENAC) "MEY SEE" 30.6

A034575100 SUCRATE TABLETS 500MG (SUCRALFATE) "KOJAR" 1.1

A034577212 AMIKACIN INJECTION 125MG/ML "S.Y." 31.3

A034577229 AMIKACIN INJECTION 125MG/ML "S.Y." 90

A0345841G0 EASYING FILM COATED TABLETS 25MG (DIPYRIDAMOLE) "ROOT"(鋁箔) 1.5

A034614209 KELIN FOR INJECTION "TAI YU" (CEFAZOLIN) 15.7

A034614212 KELIN FOR INJECTION "TAI YU" (CEFAZOLIN) 43.3

A034614221 KELIN FOR INJECTION "TAI YU" (CEFAZOLIN) 131

A034618343 UNDACID OINTMENT "VPP" 15.5

A034626209 MECO B12 INJECTION 0.5MG/ML (MECOBALAMIN) "ORIENTAL" 7.9

A034632100 DANAL 200MG CAPSULES (DANAZOLE) "ROYAL" 11.2

A034634100 KETOZEN 1MG TABLETS (KETOTIFEN)"S.L." 1.21

A034635100 DERCON 10MG TABLETS (DEMPERIDONE) "YUNG CHI" 0.86

A034636100 BROMHEXIN 8MG TABLETS "EVEREST" 0.27

A034640100 SULPIRIDE 200MG TABLETS "S.Y." 1.99

A034654155 LOSOLVAN 3MG/ML SOLUTION (AMBROXOL) 25

A034660329 SPORTON GEL 100MG/GM (ETOFENAMATE) "C.T." 29.3

A034660338 SPORTON GEL 100MG/GM (ETOFENAMATE) "C.T." 33.8

A034660345 SPORTON GEL 100MG/GM (ETOFENAMATE) "C.T." 74

A034721100 SUFUCON TABLETS 500MG (ACETAMINOPHEN) "ORIENTAL" 0.2

A034723100 FUSTHMA TABLETS 1MG (KETOTIFEN)"S.F." 1.21

A034802100 KING-P CAPSULES "H.S." 0.78

A034813100 BINODONE TABLETS "EVEREST" 0.45

A034818100 GOOD FOR YOU ANTI-COLD CAPSULES 0.45

A034819100 ANLITON TABLETS 500MG (ACETAMINOPHEN) "EVEREST" 0.3

40

Page 41: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A034825157 LOPERAMIDE SYRUP 0.2MG/ML "ORIENTAL" 39.2

A034827100 CAFEMINE TABLETS "M.T." 0.84

A034869329 FULIN CREAM 30MG/GM (NIFLUMIC ACID)"GCPC" 16.4

A034888100 MADOPAR CAPSULES 125MG 3.53

A034889100 MOGADON TABLETS 5MG (NITRAZEPAM) 1.5

A034909100 AMCLO CAPSULES "UNION" 1.92

A034940100 PROPHYLAXIN TABLETS 30MG (PYRIDOSTIGMINE BROMIDE) "VPP" 1.84

A0349441G0 LISEIPIN F.C. TABLETS "ROOT"(鋁箔) 1.5

A034950100 SHITAN TABLETS 8MG (BROMHEXINE) "KOJAR" 0.4

A034960100 MADOPAR TABLETS 250MG 7.7

A034966335 CLOSOL 0.05% CREAM "CHEN TA"(CLOBETASOL PROPIONATE) 28.6

A034968100 SEROLIN CAPSULES 10MG (OXAZOLAM)"W.P." 0.94

A035035317 VIRUN CREAM 50MG/GM (ACYCLOVIR) "H.S." 17.3

A035037329 DICLOFEN GEL 1% (DICLOFENAC) "H.S." 20.8

A035037335 DICLOFEN GEL 1% (DICLOFENAC) "H.S." 20.8

A035037340 DICLOFEN GEL 1% (DICLOFENAC) "H.S." 30.6

A035045100 NOCA TABLETS 15MG (NOSCAPINE) "H.S." 0.69

A035046151 CODERINE SYRUP "C.P." 23.5

A035049212 UFO POWDER FOR INJ. 2GM (FOSFOMYCIN) "UNION" 0

A035049219 UFO POWDER FOR INJECTION (FOSFOMYCIN) "UNION" 0

A035049277 UFO POWDER FOR INJ. 500MG. (FOSFOMYCIN) 0

A035051500 DOMPE SUPPOSITORIES 10MG (DOMPERIDONE) "H.S." 3.37

A035057421 BETTERCIN EYE DROPS 3MG/ML 17.4

A035057429 BETTERCIN EYE DROPS 3MG/ML 37.1

A035071421 BETTERSONE EYE DROPS 29.9

A035071423 BETTERSONE EYE DROPS 35.7

A035071429 BETTERSONE EYE DROPS 41

A035072329 INOTON CREAM 1% (INDOMETHACIN) "WEIDAR" 18.7

A035145100 LOPERAMIDE CAPSULES 2MG "J.A." 0.94

A035149100 YUCHITONMIN CAPSULES "J.A." 0.77

A035150100 SABOLI CAPSULES "J.A." 1.62

A035151100 TINIZIN TABLETS 500MG "J.A." (TINIDAZOLE) 2.08

A035152100 YUCHITONMIN TABLETS "J.A." 1.07

A035153100 TRAVE LAC TABLETS "J.A." 0.57

A035154100 EULON CAPSULES 100MG (TOCOPHEROL NICOTINATE) "J.A." 0.94

A035155100 URITEC CAPSULES 250MG (PIPEMIDIC ACID) "J.A." 3.1

A035157100 BETA-AESCIN CAPSULES 20MG "J.A." 1.95

A035158100 DEMISOLE TABLETS 150MG "J.A."(LEVAMISOLE) 4.68

A035159100 CIMETIN TABLETS 300MG "J.A." (CIMETIDINE) 1

A035160100 PAURAPOL CAPSULES 250MG (METRONIDAZOLE) "J.A." 1.15

A035161100 PROPHYRIN S.C. TABLETS 200MG (PROTOPORPHYRIN) "J.A." 1.24

A035163100 SULPIDIN CAPSULES 50MG "J.A." (SULPIRIDE) 1.33

A035164100 LONGIMIN TABLETS 50MG "J.A." (BUCLIZINE) 0.72

A035165100 TRIRAZINE CAPSULES 2MG (TRIFLUOPERAZINE) "J.A." 1.03

A035176100 LYSOZYME TABLETS 30MG "J.A." 0.92

A0351771G0 ROTILIUM 10MG F.C. TABLETS (DOMPERIDONE) "ROYAL"(鋁箔/膠箔) 1.5

A035188321 EULIGAN CREAM 0.05% "Y.Y." (CLOBETASONE) 26

A035188329 EULIGAN CREAM 0.05% "Y.Y." (CLOBETASONE) 44.4

A035188335 EULIGAN CREAM 0.05% (CLOBETASONE) "Y.Y." 61

A035211100 MEBERINE F.C.TABLET 135MG "T.T.Y" (MEBEVERINE HYDROCHLORIDE) 1.78

A035212100 SIMETHICONE TABLETS 40MG "KOJAR" 0.18

A035235100 SEROL TABLETS 20MG (OXAZOLAM) "KOJAR" 2.04

A035254100 TANTELL TABLETS 5MG (GLIBENCLAMIDE) "EVEREST" 0.99

41

Page 42: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A035277100 URINIS CAPSULES "YY" 1.2

A035281100 PROXEN TABLETS "S.D." (NAPROXEN) 2.41

A035287336 AYFUCO CREAM "ROOT" 25.8

A035293338 TEIMEI CREAM 10MG/GM "U CHU" (CENTELLA ASIATICA) 74

A035324100 METFORMIN TABLETS 500MG "EAYUNG" 1

A0353241G0 METFORMIN TABLETS 500MG "EAYUNG"(鋁箔/膠箔) 1.5

A035366135 FUNWIHU SUSPENSION 20MG/ML (CIMETIDINE) "CHEN TA" 13.4

A035397338 DICLOREN EMULGEL 1% (DICLOFENAC SODIUM) "WEIDAR" 27.6

A035414100 DIARONZIDE TABLETS 80MG (GLICLAZIDE) "CHEN TA" 1.11

A0354141G0 DIARONZIDE TABLETS 80MG (GLICLAZIDE) "CHEN TA"(鋁箔/膠箔) 1.5

A035415100 BEROASMA TABLETS 2.5MG (FENOTEROL) "CHEN TA" 0.97

A035416100 MEILISU S.C. TABLETS (NICERGOLINE)"YY" 3.21

A035418100 LISSES CAPSULES "YY" 0.91

A035423151 PANATOL SOLUTION 24MG/ML "PANBIOTIC" (ACETAMINOPHEN) 15.8

A035423157 PANATOL SOLUTION 24MG/ML "PANBIOTIC" (ACETAMINOPHEN) 18

A035434100 KENBO CAPSULES 150MG (SILYMARIN)"Y.C." 1.5

A035436100 PIERCOL TABLETS 250MG (PIPEMIDIC ACID) 3.1

A035440329 INDOL GEL 10MG/GM "SINPHAR"(INDOMETHACIN) 18.5

A035451330 WAZOLE CREAM 10MG/G (ISOCONAZOLE) "W.P." 55

A035452100 LOPERAMIDE CAPSULES 2MG "JENSHENG" 0.94

A035459417 ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 12.1

A035463100 DECO TABLETS 20MG (DEXTROMETHORPHAN) "S.D." 0.58

A035464421 CHLORAMPHENICOL EYE DROPS 0.25% "OASIS" 11.5

A035473209 ORIZONE POWDER FOR INJECTION (CEFOPERAZONE) "ORIENTAL" 170

A035476500 VORTAGEN SUPPS. 12.5MG (DICLOFENAC) "EVEREST" 1.71

A035486100 KETOFPAN CAPSULE 100MG (KETOPROFEN) "PANBIOTIC" 2.98

A035487321 KETOZOL CREAM 2% "WEIDAR" (KETOCONAZOLE). 14.2

A035500209 NEOBA INJECTION 0.5MG/ML (MECOBALAMINE) "S.Y." 7.9

A035519100 LACEF CAPSULES 250MG (CEPHRADINE) "TAI YU" 1.79

A035546429 SINDECON NASAL SPRAY 0.5MG/ML "STANDARD" (OXYMETAZOLINE) 49.7

A035597421 TROPICAMIDE OPHTHALMIC SOLUTION 4MG/ML "WU-FU" 46.5

A035641238 ANVITA INJECTION "ASTAR" 9.4

A035676338 PAINSTOP GEL 1% "SWISS"(DICLOFENAC) 27.6

A035679212 KETOFEN INJECTION 50MG/ML (KETOPROFEN) "SWISS" 4.8

A035804221 FETODRIN INJECTION 10MG/ML (RITODRINE HYDROCHLORDE)"T.T.Y." 49.8

A035837212 FAMODINE INJECTION 10MG/ML (FAMOTIDINE)"S.Y." 31.5

A035837219 FAMODINE INJECTION 10MG/ML "S.Y." (FAMOTIDINE) 39.4

A035856138 CON-GEL SUSPENSION 7.7

A035856163 CON-GEL SUSPENSION 40.9

A035870335 ISOGEN CREAM 10MG/GM "PURZER" (ISOCONAZOLE) 55

A0358703AH ISOGEN CREAM 10MG/GM "PURZER" (ISOCONAZOLE) 19.9

A035878100 TONLAEN CAPSULE 300MG "CHEN TA" (FENBUFEN) 2.29

A035883329 HYDROCORTISONE CREAM 10MG/GM "SINPHAR" 15

A035889157 KANGSAU SOLUTION 25.8

A035913100 ANLICIDE TABLETS 500MG "ASTAR" (NALIDIXIC ACID) 2.25

A035931212 AMIKACIN 250MG/ML INJECTION "S.Y." 34.6

A035931229 AMIKACIN 250MG/ML INJECTION "S.Y." 151

A035936100 SENIN S.C TABLETS 9.6MG "EAYUNG" 2.02

A035957100 KINGDACIN CAPSULE 300MG (CLINDAMYCIN HYDROCHLORIDE)

"CHI SHENG"

2.13

A035966100 PARKINIDYL TABLETS 5MG (TRIHEXYPHENIDYL) 1

A035967100 PARKINIDYL TABLETS 2MG (TRIHEXYPHENIDYL) 0.8

A035968321 QUARDISONE CREAM 15.4

A035969100 MINOCYCLINE HYDROCHLORIDE 100MG CAPSULE "YY" 5.2

42

Page 43: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A035986100 DEGOUT TABLETS 50MG (BENZBROMARONE) "H.S." 1.23

A035997100 MECO 0.5MG CAPSULES. (MECOBALAMIN) "S.L" 1.64

A036031321 BETAGEN CREAM 13.9

A036031329 BETAGEN CREAM 14.2

A036031335 BETAGEN CREAM 19.6

A036031338 BETAGEN CREAM 19.6

A036041109 SUCA GRANULES FOR SUSPENSION 1GM/1.02GM(SUCRALFATE) 5

A036072100 CLEDOMYCIN CAPSULES 300MG "ROOT" (CLINDAMYCIN) 2.13

A036075100 WEISU CAPSULES 0.78

A036088221 PENTOXILLINE INJECTION 20MG/ML "S.Y." 31.5

A036091100 TAILIWELL TABLETS 200MG (CIMETIDINE) "JENSHENG" 1

A036094157 GUAPHEN SYRUP 20MG/ML (GUAIFENESIN) "CENTER" 16.6

A036094163 GUAPHEN SYRUP 20MG/ML (GUAIFENESIN) "CENTER" 25

A036131100 ILACEN CAPSULE (DIFLUNISAL) 6.9

A036152435 SU SU EYE DROPS "T.F." 29.9

A036154421 SHINE LOOK EYE DROPS "T.F" 11

A036154435 SHINE LOOK EYE DROPS "T.F" 29.9

A036159109 TIPIDINE POWDERS (TIPEPIDINE) 3.05

A036161209 ORICEF INJECTION "ORIENTAL" (CEFAZOLIN) 15.7

A036167212 TRAMADOL INJECTION 50MG/ML "S.Y" 28

A036182151 IBUPROFEN ORAL SUSPENSION 20MG/ML "TWI" 25

A036184100 PICKTON TABLET (BACLOFEN) 1

A036193100 CEPHALEXIN CAPSULES 500MG "YY" 1.76

A036201100 METFORMIN TABLET 500MG "LITA" 1

A0362011G0 METFORMIN TABLET 500MG "LITA"(鋁箔/膠箔) 1.5

A036207338 FLUSAN OINTMENT "T.F." 76

A036224421 TIMOL EYE DROPS 0.25% (TIMOLOL) "UNION" 59

A036242421 TIMOL EYE DROPS 0.5% (TIMOLOL) "UNION" 113

A036243100 GINLOBA FILM COATED TABLETS 9.6MG (GINKGO FLAVONGLYCOSIDE)

"UNION"

2.02

A036263100 ELTROXIN TABLETS 100MCG (THYROXINE SODIUM) 1.35

A036268100 DEXFERIN TABLETS 2MG (DEXCHLORPHENIRAMINE) "JOHNSON" 0.42

A036284212 GENTAMYCIN INJECTION 140MG/ML "S.Y." 15.4

A036284229 GENTAMYCIN INJECTION 140MG/ML"S.Y." 82

A036332143 GIKO DROPS 9.6MG (GYNKGOFLAVONGLYCOSIDE) "H.S." 176

A036338100 HEMOBEND TABLETS 100MG "H.S." (BENZARONE) 2.91

A036340100 GLURENORM TABLETS 30MG (GLIQUIDONE) 2.18

A036349100 UFORMIN TABLETS 500MG 1

A036374100 EULIP TABLETS "W.P." (BEZAFIBRATE) 3.49

A036402209 MENITO INJECTION 50MG/ML (DIMENHYDRINATE) "ORENTAL" 13.9

A036408326 OPPVIR CREAM 50MG/GM (ACYCLOVIR) "S.D." 44.5

A036416421 EYECALM EYE DROPS "SUN YOU" 29.9

A036423127 CHOLESTAMIN POWDER "CHI SHENG" (CHOLEXTYRAMINE RESIN) 14

A036434238 FAMOTIDIN LYO-INJECTION 20MG “TWI” 31.5

A036440118 IBUFINE SYRO 20MG/ML (IBUPROFEN) "EAYUNG" 0

A036440157 IBUFINE SYRO 20MG/ML (IBUPROFEN) "EAYUNG" 0

A036469212 B. B. INJECTION 150MG/ML (CLINDAMYCIN) 12.3

A036480100 ANWENIN TABLETS 500MG(SUCRALFATE) 1.1

A036490100 NOOGICA CAPSULES 400MG"CHEN TA" 1.14

A036500329 SHU-BA-HANI CREAM"CHINTENG" 28.5

A036511100 SPASTOLATE TABLETS "NYSCO" 0.72

A036542100 CULIUM TABLET 3MG "CURIE" (BROMAZEAM) 1.2

A036587329 VORTAGEN EMULGEL 1% (DICLOFENAC SODIUM) "EVEREST" 20.8

A036587338 VORTAGEN EMULGEL 1% (DICLOFENAC SODIUM) "EVEREST" 27.6

A036587343 VORTAGEN EMULGEL 1% 30.6

43

Page 44: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A036587396 VORTAGEN EMULGEL 1% 30.6

A036588100 GINKGO F.C.TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE) "C.H." 2.02

A036591321 RIPA OINTMENT 36.4

A036591345 RIPA OINTMENT 82

A036599100 CADIOPIRIN TABLETS (ASPIRIN) 100MG "VPP" 0.68

A036661100 CERELINE TABLETS 5MG (NICERGOLINE) "ROYAL" 3.21

A036662100 ISCAN F.C. TABLETS 400MG (CIMETIDINE) "S.L" 1

A0366621G0 ISCAN F.C. TABLETS 400MG (CIMETIDINE) "S.L"(鋁箔/膠箔) 1.5

A036663100 KETOTIFEN TABLETS 1MG (KETOTIFEN) "S.Y." 1.21

A036673100 BACLOFEN TABLETS 5MG "S.F." 1

A036676100 LOPERDIN CAPSULES 2MG (LOPERAMIDE) "S.Y." 0.94

A036700421 TROPIN EYE DROPS 0.5% (TROPICAMIDE) "UNION" 18

A036733100 BACOFEN TABLETS 10MG (BACLOFEN) "S.Y." 1

A036739321 VIRHAIL CREAM 5% (ACYCLOVIR) "H.S." 41.4

A036756100 TICLOPIDINE TABLETS 250MG "S.F." 4.63

A036758100 VICAPOLE CAPSULES"H.S." 0.91

A036769100 TONMEX TABLETS 20MG (PIROXICAM) "PANBIOTIC" 1.11

A036772100 FLOCIDAL F.C. TABLETS 100MG (NORFLOXACIN) "VPP" 1.96

A036790100 EXCEL TABLETS 25MG (CAPTOPRIL)"VPP" 1.24

A036813100 MINOLINE CAPSULES 50MG (MINOCYCLINE) 3.43

A036824421 "OASIS" FLUOROMETHOLONE OPH. SUSPEN. 0.02% 16.3

A036824429 "OASIS" FLUOROMETHOLONE OPHTHALMIC. SUSPENSION. 0.02% 78

A036841143 CYPRO SYRUP 0.4MG/ML (CYPROHEPTADINE) "PANBIOTIC" 8.2

A036841151 CYPRO SYRUP 0.4MG/ML"PANBIOTIC" 17

A036841157 CYPRO SYRUP 0.4MG/ML"PANBIOTIC" 22.8

A036844100 BETTERLOCK TABLET 100MG (METOPROLOL) "CURIE" 3.83

A036848100 METFORMIN TABLETS 500MG "S.F." 1

A0368481G0 METFORMIN TABLETS 500MG "S.F."(鋁箔/膠箔) 1.5

A036864151 ACTIN SOLUTION "CHINTENG" 10.3

A036864155 ACTIN SOLUTION "CHINTENG" 17.3

A036867329 KEPANIN GEL 1% (DICLOFENAC) "CHEN TA" 20.8

A036867338 KEPANIN GEL 1% (DICLOFENAC) "CHEN TA" 27.6

A036867343 KEPANIN GEL 1% (DICLOFENAC) "CHEN TA" 30.6

A036885209 MECOBALAMIN INJECTION 0.5MG/ML "ASTAR" 7.9

A036885212 MECOBALAMINE INJECTION 0.5MG/ML "ASTAR" 7.9

A036885221 MECOBALAMIN INJECTION 0.5MG/ML "ASTAR" 8.1

A036894329 CHIN LEIN CREAM "CHINTENG" 19.3

A036905265 NAKAXONE FOR I.V. INJECTION (CEFTRIAXONE) "N.K." 96

A036905277 NAKAXONE FOR I.V. INJECTION (CEFTRIAXONE) "N.K." 96

A036907209 PRIDINOL INJECTION 2MG/ML (PRIDINOL MESILATE) "ASTAR" 12.8

A036915100 URIBENORM TABLETS 100MG "CHEN TA" (BENZBROMARONE) 2.87

A036917100 GLIDIN TABLET 5MG (GLIPIZIDE) "CURIE" 1

A036925338 VETIN GEL 10MG/GM (DICLOFENAC) 27.6

A036951100 A-CONTENT TABLETS 500MG (ACETAMINOPHEN) "H.S." 0.28

A036961100 SUMETON TABLETS 200MG "CHEN TA" (SULINDAC) 1.91

A036962100 PAINSTOP F.C. TABLETS 500 MG "EAYUNG" (MEFENAMIC ACID) 0.79

A036969314 ESTRA GEL 0.6MG/GM (ESTRADIOL) 15

A036984277 Y.F. NO.2 INJECTION "Y.F." 25.5

A037069329 BETA CREAM 0.5MG/GM "S.Y."(BETAMETHASONE) 18.3

A037099100 KETOTIFEN TABLETS 1MG "ASTAR" 1.21

A037127238 SODIUM BICARBONATE INJECTION 70MG/ML "ASTAR" 6

A037162338 DERMALIN CREAM 77

A037212100 PIPEMIC TABLETS 250MG "ASTAR" (PIPEMIDIC ACID) 3.1

A037214421 BETAGEN OPHTHALMIC SOULTION "GCPC" 29.9

A037240329 CORTOLONE CREAM 23.9

44

Page 45: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A037249100 ANLITON TABLETS "EVEREST" 0.82

A037286329 VICORAX CREAM 5% "WEIDAR" 44.5

A037287421 DENECIN EYE DROPS 12.7

A037287429 DENECIN EYE DROPS 34.4

A037309100 NOXACIN 100MG F.C.TABLETS (NORFLOXACIN) "KINGDOM" 1.96

A037355100 DICLOFENAC E.S.C. TABLETS 50MG "YUNG CHI" 0.93

A037384209 CEFOXINE FOR INJECTION (CEFOTAXIME SODIUM) "TAI YU" 91

A037384277 CEFOXINE FOR INJECTION (CEFOTAXIME SODIUM) "TAI YU" 62

A037402100 EFACO TABLETS 20MG (EPRAZINONE) "KOJAR" 0.56

A037431329 INHFUNGUS CREAM "CHEN TA" 19.5

A037431335 INHFUNGUS CREAM "CHEN TA" 25.8

A037500100 LIVERON CAPSULES (SILYMARIN) "H.S." 1.5

A037552100 CELOR CAPSULES 250MG (CEFACLOR) "C.H." 3.21

A037557100 DICYCLOMINE TABLETS 10MG "SENTAI" 0.85

A037565100 TINIJING F.C.TABLETS 500MG "CHINTENG" 2.08

A037580330 CLOSONE CREAM 47.1

A037598116 ACTEIN GRANULES 66.7MG/GM (ACETYLCYSTEINE) "S.Y." 1.7

A037607321 CLOTRIMAZOLE CREAM 20MG/GM "PANBIOTIC" 23.6

A037607329 CLOTRIMAZOLE CREAM 20MG/GM "PANBIOTIC" 60

A037645500 ATHMACON SUPPOSITORIES "H.S." 3.48

A0376542B9 A.S.P.-L INJECTION 900MG (LYSINE ASPIRIN) "ORIENTAL" 9.9

A037661100 TENSIONLEX TABLETS 100MG (ORHENADRINE CITRATE) "PANBIOTIC" 3.18

A037682100 NAPUSIN TABLETS 250MG (NAPROXEN) 1.09

A0376913AK PIROCAM CREAM 10MG/GM 39.9

A037697100 THROUGH TABLETS (SENNOSIDES) 1.12

A037703100 PEDOLIN F.C. TABLETS "STANDARD" 0.81

A037715100 YENTAC TABLET 200MG (SULINDAC) "S.L." 1.91

A037739329 NAZOLE CREAM 2% (KETOCONAZOLE) "S.Y." 14.2

A037739335 NAZOLE CREAM 2% "S.Y."(KETOCONAZOLE) 36.9

A037807100 ACECAINE TABLETS "P.L." 0.74

A037809100 NAPOFEN 1.35

A037816165 SOONER ORAL SOLUTION "CURIE" 39.1

A037838335 SEFUCON CREAM 1% (SILVER SULFADIAZINE) 18.5

A037838338 SEFUCON CREAM 1% (SILVER SULFADIAZINE) 33.2

A037838372 SEFUCON CREAM 1% (SILVER SULFADIAZINE) 286

A037858277 V-CEFRA FOR INJECTION (CEPHRADINE)"VPP" 23.8

A037861100 UNIMARON TAB. 1.23

A037862100 NOPROFEN CAPSULES 200MG (FENOPROFEN) "CURIE" 4.25

A037868100 TORICAM CAPSULES 20MG (PIROXICAM) 1.11

A037899100 GEFANATE CAPSULES 50MG (GEFARNATE) "ROYAL" 1.59

A037923316 MINSONE CREAM 0.5MG/GM "M.H"(CLOBETASONE) 26

A037923321 MINSONE CREAM 0.5MG/GM "M.H"(CLOBETASONE) 26

A037924477 BAXICIN OPHTHALMIC SOLUTION 3MG/ML (NORFLOXACIN) "S.T." 3.16

A037944100 "U CHIU" ANALGESIC CAPLETS 0.74

A037988100 GOUTIL TABLETS 50MG(BENZBROMARONE) 1.23

A038025100 ATIZEPAM TABLETS 0.5MG "P.J." (LORAZEPAM) 0.91

A0380811G0 ANSUTAN CAP.(瓶裝/84粒/瓶) 1.5

A038088100 WERGEN TABLETS 400MG (CIMETIDINE) "YUNG CHI" 1

A038102100 BEZILON TABLETS 200MG (BEZAFIBRATE) 3.49

A038108212 RANIDAC INJECTION 25MG/ML (RANITIDINE) "Y.Y" 24.7

A038113421 PILOCARPINE EYE DROPS 2% "OASIS" 32

A038162100 BEROCOL TABLETS 5MG (TERBUTALINE SULFATE) "PANBIOTIC" 1

A038163116 ACETYL GRANULES 66.67MG/GM (ACETYLCYSTEINE) "CHEN TA" 1.7

A038168100 PROPRANOL TAB. 40MG "SENTAI" (PROPRANOLOL) 0.87

45

Page 46: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A038171321 FUILI CREAM 2% (KETOCONAZOLE) "YY" 14.2

A038181100 GLICTAN TAB 80MG "SL" (GLICLAZIDE ) 1.11

A038189100 CIMEDIN F.C. TABLETS 800MG (CIMETIDINE) "S.T." 10.8

A038211100 POSTON TABLETS 500MG (MEFENAMIC ACID) "CHEN TA" 0.79

A0382111G0 POSTON TABLETS 500MG (MEFENAMIC ACID) "CHEN TA" (鋁箔/膠箔) 1.5

A038241335 KETAZOLE CREAM 20MG/G (KETOCONAZOLE) "UNION" 36.9

A038266100 CODELIN TABLETS "KOJAR" 0.94

A038275116 CHITAN GRANULES 66.67 MG/GM (ACETYLCYSTEINE) "CHINTENG" 1.7

A038276329 KERPHEN CREAM 1% "Y.Y." (DICLOFENAC) 20.8

A038280100 ANSOLIN TABLET 5MG (HALOPERIDOL) "GCPC" 1.87

A038281100 ANSOLIN TABLET 10MG (HALOPERIDOL) "GCPC" 3.17

A038295100 KAPOS TAB. 250MG 1.34

A038356329 SUITERIN CREAM 1% (DICLOFENAC) "EVEREST" 20.8

A038356338 SUITERIN CREAM 1% (DICLOFENAC) "EVEREST" 27.6

A038357100 MEDECOUGH CAPSULES "H.C" 0.99

A0383571G0 MEDECOUGH CAPSULES "H.C"(鋁箔/膠箔) 1.5

A038434100 CO-RELAX TABLETS 20MG "C.M."(BENPROPERINE) 1.11

A038438338 DICLOFENAC EMULGEL 1% "S.Y." 27.6

A038445277 GLUSALINE INJECTION "ASTAR" 19.5

A038450100 ACETIN TABLETS"S.C." 1.32

A038458100 LADIES PEARL S.C. TABLETS 1.25MG (CONJUGATED ESTROGENS) "S.C." 3.2

A038462100 KOMPIMIN TABLETS "S.C." 0.36

A038466100 KOBAMIN TABLETS "S.C" 0.36

A038480100 THI FEN TABLETS 300MG "Y.Y." (TRIMETHOPRIM) 1.96

A0384871G0 CHIANDA TABLETS 0.15MG "CHINTENG" (CLONIDINE)(鋁箔/膠箔) 1.5

A038494100 NALODINE F.C. TABLETS 100MG (TICLOPIDINE) "ROYAL" 3.8

A038498100 METFORMIN F.C. TABLET 500MG "KINGDOM" 1

A0384981G0 METFORMIN F.C. TABLET 500MG "KINGDOM"(鋁箔) 1.5

A038502337 ISOCON-F CREAM "SHITEH" 49.8

A038506100 KYOMUDYNE F.C. TABLETS 250MG (CARBOCYSTEINE) 1.34

A038511321 VAGENT CREAM 10MG/GM (ISOCONAZOLE) "GCPC" 15.6

A0385113AH VAGENT CREAM 10MG/G 19.9

A038523238 DEOSE INJECTION 50MG/ML (DEXTROSE)"ASTAR" 5.6

A038523277 DEOSE INJECTION 50MG/ML (DEXTROSE)"ASTAR" 19.1

A038527100 UNIPRO FILM-COATED TABLETS 750MG (CIPROFLOXACIN) "UNION" 39.5

A038530100 CIMET TABLET 400MG (CIMETIDINE) "CHEN TA" 1

A0385301G0 CIMET TABLET 400MG (CIMETIDINE) "CHEN TA" (鋁箔/膠箔) 1.5

A038531100 CIMET TABLET 200MG (CIMETIDINE) "CHEN TA" 1

A0385311G0 CIMET TABLET 200MG (CIMETIDINE) "CHEN TA"(鋁箔/膠箔) 1.5

A0385561G0 CIMEDIN TABLETS 400MG (CIMETIDINE)(30粒/瓶)(鋁箔/膠箔) 1.5

A038559100 GINKGO S.C. TABLETS 9.6MG 'C.H.(GINKGOFLAVONGLYCOSIDE) 2.02

A038571100 KETOLIN CAP. 10MG 1.04

A038578100 I.B.F.F.C. TABLETS 400MG (IBUPROFEN) "KINGDOM" 0.98

A0385781G0 I.B.F.F.C. TABLETS 400MG "KINGDOM"(IBUPROFEN)(鋁箔) 1.5

A038614216 KOTAN INJECTION 100MG/ML (ACETYLCYSTEINE) "ASTAR" 10.1

A038618209 CLINDAMYCIN INJECTION 150MG/ML "S.Y." 15.8

A0386201G0 MEDROLIN FILM COATED TABLETS 50MG (MEBHYDROLINE) "F.Y."(鋁箔/

膠箔)

1.5

A038657100 ROLFEC CAP 250MG 3.21

A038681100 DIMATAN TABLETS 80MG (GLICLAZIDE) "EAYUNG" 1.11

A038686100 GINBININ S.C. TAB. 9.6MG 2.02

A038687421 NORFLO OPHTHALMIC SOLUTION 3MG/ML (NORFLOXACIN) "UNION" 43.9

A038707238 DOBUTAMINE INJECTION 12.5MG/ML "TWI" 100

46

Page 47: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A038723100 VICARIN CAPSULES "H.S." 1.35

A038737209 PIXICAM I.M. INJECTION 20MG/ML (PIROXICAM)"ORIENTAL" 17.6

A038737212 PIXICAM I.M. INJECTION 20MG/ML (PIROXICAM)"ORIENTAL" 17.6

A038758321 CANSEN CREAM 10MG/GM "F.Y" (CLOTRIMAZOLE) 8.2

A038758338 CANSEN CREAM 10MG/GM "F.Y" (CLOTRIMAZOLE) 39.4

A038760100 KERI CAPSULES 200MG "H.S." (NIFUROXAZIDE) 2.44

A038765209 LUMIATO INJECTION 2.1

A038772443 BERTON NASAL SPRAY 0.1% (OXYMETAZOLINE) "C.M." 99

A038776100 SUWEFUE F.C. TABLET 40MG "H.C"(FAMOTIDINE) 5.7

A038779100 VOLEN E.C. TABLET (DICLOFENAC) "CHEN TA" 0.93

A0387791G0 VOLEN E.C. TABLET (DICLOFENAC) "CHEN TA" (鋁箔/膠箔) 1.5

A038821140 GINLOBA DROPS 9.6 MG/ML (GINKGOFLAVONGLYCOSIDE) "UNION" 133

A038837100 CIMENICE TABLETS 200MG (CIMETIDINE) "JINUP" 1

A038846100 BENZOX TABLETS 2MG (TRIHEXYPHENIDYL) "LITA" 0.8

A0388461G0 BENZOX TABLETS 2MG (TRIHEXYPHENIDYL) "LITA"(鋁箔/膠箔) 1.5

A038848109 TOPCEF GRANULES FOR ORAL SUSPENSION 50MG/ML (CEPHRADINE) 8.1

A038862329 DICLOFEN GEL 10MG/GM (DICLOFENAC) "KOJAR" 20.8

A038862338 DICLOFEN GEL 10MG/GM "KOJAR" 27.6

A038862343 DICLOFEN GEL 10MG/GM "KOJAR" 30.6

A038865100 BETALEN TAB. 100MG 2.87

A038892229 ASPIRIN POWDER FOR INJECTION 0.9GM (LYSINE ACETYLSALICYLATE)

"LITA"

9.9

A038944100 PHOS-CAL F.C. TABLETS 667MG (CALCIUM ACETATE) "W.P." 1.33

A038949209 TATUMCEF POWDER FOR I.V. INJECTION (CEFTAZIDIME) "C.C.P.C." 56

A038972277 AXONECEF FOR IV INJECTION (CEFTRIAXONE) 96

A038974100 SILYVITA CAPSULES 1.02

A038989100 DICLOFENAC SODIUM ENTERIC F.C TABLET 50MG "KINGDOM" 0.93

A038997100 NATOXEN TABLETS 250MG"Y.J."(NAPROXEN) 1.09

A039025100 FANATON TABLETS 500MG (ACETAMINOPHEN) 0.24

A039032212 SULPIRIDE INJ. 25MG/ML 2ML 12.4

A039037100 NEURONIN CAPSULES 2.6

A039045100 MEPRED TABLETS 4MG (METHYLPREDNISOLONE) "F.S." 1.52

A039057110 SUTUN GRANULE 66.67MG/G 1.5G 1.68

A039057116 SUTUN GRANULE 66.67MG/G 3G 1.7

A039065238 SODIUM BICARBONATE INJ. 70MG/ML 20ML 6

A039075100 NAPROXEN F.C. TABLET 500MG "KINGDOM" 2.41

A039078209 ZONCEF FOR INJECTION(CEFOPERAZONE) 1G 170

A039084209 CEPANON FOR INJECTION "TAI YU" (CEFOPERAZONE) 170

A039084277 CEPANON FOR INJECTION "TAI YU"(CEFOPERAZONE) 101

A039138277 KLITOL INJECTION 5% "S.T." (XYLITOL) 23.5

A039139238 KLITOL INJECTION 10% "S.T." (XYLITOL) 3.68

A039146100 SILYGEN CAP. 150MG 1.5

A039155209 CEFAZOLIN INJETCION 1GM "SINPNAR" 15.7

A039169277 L.A. INJECTION 900MG (LYSINE ASPIRIN) "STANDARD" 9.9

A039211100 MAJORMET TABLETS 25/250MG 9.2

A039218100 SOWECAINE TABLETS 5MG "EVEREST" 0.17

A039233100 MEROLIN TAB. 50MG 1.02

A039251277 Y.F. NO.1 INJECTION "Y.F." 25.5

A039252277 Y.F. NO.3 INJECTION "Y.F." 25.5

A039258209 SINFAMANDOL INJECTION 1GM (CEFAMANDOLE) "SINPHAR" 55

A039271100 UNIPRO FILM COATED TABLETS 250MG (CIPROFLOXACIN) "UNION" 7.1

A039277100 IBUFEN TABLETS 400MG (IBUPROFEN) 0.98

A039278271 Y.F. NO.5 INJECTION "Y.F." 25.5

A039278277 YF NO.5 INJECTION 25.5

47

Page 48: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A039279277 Y.F. NO.4 INJECTION "Y.F." 25.5

A039303500 DOMPERID SUPP. 30MG 4.97

A039322100 MENTON TABLETS 500MG (ACETAMINOPHEN)"Y.Y." 0.19

A039323100 METHYLNICE CAPSULES 0.5MG (MECOBALAMIN) "JINUP" 1.64

A039346209 HALDECAN INJ. 50MG 1ML 144

A039347277 SINFOMYCIN INJECTION 0.5GM (FOSFOMYCIN) "SINPHAR" 67

A039349343 VOREN-G GEL 10MG/GM (DICLOFENAC) 30.6

A039349345 VOREN-G GEL 10MG/GM (DICLOFENAC) 30.6

A039366100 BOFEN TABLETS 200MG (IBUPROFEN) 0.97

A039387100 OSTELIN 250MG 1.36

A039408100 GLIUCON TABLETS 5MG (GLIBENCLAMIDE) 0.4

A039484100 OSAMINE CAPSULE 250MG "MARCO"(GLUCOSAMINE SULFATE) 1.41

A039488100 UNIPRO FILM-COATED TABLETS 500MG (CIPROFLOXACIN) "UNION" 9

A039517210 ZINACEF POWDER FOR INJECTION 1.5GM (CEFUROXIME) 67

A039522212 UNIZID FOR INJECTION "UNION"(CEFTAZIDIME) 400

A039522277 UNIZID FOR INJECTION "UNION"(CEFTAZIDIME) 32.3

A039546100 GLUCOBIN TABLETS 500MG "W.P." (METFORMIN) 1

A039567100 KOLININ TABLETS 1MG 0.98

A0395671G0 KOLININ TABLETS 1MG(鋁箔/膠箔) 1.5

A039578100 PROTAB TABLETS 10MG (MEDROXYPROGESTERONE) 1.79

A039586335 CLOTRI SOLUTION 10MG/ML (CLOTRIMAZOLE) "KOJAR" 43.2

A039599100 ESTRA TABLETS 2MG (ESTRADIOL) 1.53

A039603100 OXAZONOL CAPSULES 10MG "Y.J."(OXAZOLAM) 0.94

A039608100 TRENTOLIN E.C. TABLETS 100MG (PENTOXIFYLLINE)"Y.Y." 1.35

A039609151 CYPROMINE SYRUP 0.4MG/ML "W.P." (CYPROHEPTADINE) 17

A039619238 ANKOTON INJECTION "ASTAR" 9.1

A039620321 SYAWE CREAM 50MG/GM (ACYCLOVIR)"MEIDER" 41.4

A039621100 TOZY EXTRA. TAB. 0.87

A039623321 MEXAC OINTMENT 5GM 24.9

A039623329 MEXAC OINTMENT 10GM 29

A039628100 SKIRAX 400MG TAB 7.1

A039629100 SKIRAX TABLETS 200MG (ACYCLOVIR) 5.9

A039630100 CEKOR CAPSULES 250MG (CEFACLOR) "STANDARD" 3.21

A039631216 MUCO-T INJECTION (ACETYLCYSTEINE) "S.Y." 10.1

A039634100 WEILE CAP.500MG 0.93

A039651100 KOLININ TABLETS 2MG 0.98

A0396511G0 KOLININ TABLETS 2MG(鋁箔/膠箔) 1.5

A039661100 NOSCAPINE TABLET 20MG "Y.S." 0.8

A039684209 CEKODIN-A INJECTION (CEPHRADINE) 23.6

A039688100 DIMETINE TABLETS 4MGDIMETINE TABLETS 4MG "EVEREST"

(BROMPHENIRAMINE)

0.25

A039693335 DICLOFE GEL 1% (DICLOFENAC SODIUM) "ROOT" 20.8

A039707151 SYNTIFEN SOLUTION 0.2MG/ML (KETOTIFEN) "S.Y." 45.2

A039722100 CIFLODAL F.C. TABLETS 250MG (CIPROFLOXACIN) "C.C.P.C." 7.1

A039727100 OXEWAY TABLETS 5MG (OXETHAZAINE) 0.17

A039729100 MECIDAL F.C. TABLETS 50MG (MEBHYDROLINE)"Y.Y." 1.02

A039774100 AMANXIN F.C. TABLETS 100MG "Y.J."(AMANTADINE) 3.42

A039776100 AMOCILLIN CAPSULES 250 MG "CHI SHENG" (AMOXICILLIN) 0.99

A039780100 NOSCAPINE TABLETS 10MG "Y.S." 0.69

A039782209 TRICEF FOR IM. INJECTION (CEFTRIAXONE) "SWISS" 189

A039804100 TICOS CAPSULES "CHINTENG" 0.5

A039824100 SUCWAY TAB. 1000MG 2.07

A039831100 DICOREN TABLETS 50MG "SENTAI"(DICLOFENAC) 0.93

A039832335 ACNACYL CREAM 73

A039854100 DEVIRO TABLETS 800MG (ACYCLOVIR) "KINGDOM" 35.7

48

Page 49: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A039858100 IPENTOL CONTROLLED-RELEASE F.C. TABLETS 400 MG

(PENTOXIFYLLINE) "S.Y."

2.11

A039871100 KENTON TAB.200MG 1.91

A039878100 CYLLERMIN TABLETS 4MG (CYPROHEPTADINE HYDROCHLORIDE) 0.7

A0398791G0 VARAPAMIL TABLETS 40MG "F.Y."(21粒/瓶) 1.5

A039944212 SUPREN INJECTION 2MG/ML (ONDANSETRON) "S.T" 171

A039947100 SINSULIN TABLETS 20MG "ASTAR" 2.04

A039956143 PSEU SOLUTION "KOJAR" 5.7

A039956151 PSEU SOLUTION "KOJAR" 10.3

A039956157 PSEU SOLUTION "KOJAR" 18.4

A039964477 SINTAL EYE DROPS 20MG/ML (CROMOLYN SODIUM) "S.T." 2.97

A039971110 U-CLOR FOR ORAL SUSP. 125MG/5ML 60ML 112

A040059210 NETROCIN INJECTION 100MG/ML (NETILMICIN) "S.T." 112

A040064100 MINOSINE CAP. 5.2

A040076100 HALINE TAB. 5MG 1.87

A040084100 SEFREE CAPSULES 250MG (CEPHRADINE) "PANBIOTIC" 1.79

A040098100 MEMIN TABLETS 250MG "SENTAI"(METFORMIN) 1

A040103100 SERVISPOR CAPSULES 500MG "STANDARD"(CEPHALEXIN) 1.76

A040105100 SYNORID TAB. 300MG 2.74

A0401201G0 FRANDYL TABLETS 2.5MG (FENOTEROL HYDROBROMIDE) (鋁箔/膠箔) 0.64

A040130100 TINTEN TABLETS 500MG 0.15

A040158100 UROXATE F.C.TABLETS 200MG "Y.J."(FLAVOXATE) 4.01

A040161143 ANTI-PHEN INFANTS' DROPS 100MG/ML "CENTER" (ACETAMINOPHEN) 34.4

A040163100 HOMELAIN ENTERIC S.C. TABLETS 50MG "H.C" [BROMELAIN] 0.89

A040164151 ANTI-PHEN SYRUP 24MG/ML 15.7

A040170157 MISTURA GLYCYRRHIZAE COMPOSITA (BROWN MIXTURE WITH OPIUM) 21.3

A040171100 CEFADOR TABLETS . 25MG (DIPHENIDOL) "SENTAI" 0.91

A040173100 UROTIN TAB. 50MG 1.23

A0401751G0 LYSOZYME CHLORIDE TABLETS 90MG "F.Y."(鋁箔/膠箔) 1.5

A040184100 AMINOPHYLLINE TABLET 100MG "H.S" 0.67

A040301100 GOLD-OSSA CAPSULE 250MG "SINPHAR" (GLUCOSAMINE SULFATE) 1.42

A0403021G0 DESPUTIN TABLETS 30MG"TAI YU"(AMBROXOL HYDROCHLORIDE)(鋁箔/膠

箔)

1.5

A040307100 IMORA CAPSULES 2MG (LOPERAMIDE)"Y.Y." 0.94

A040369100 UISPAN TABLETS 200MG (SULPIRIDE) "PANBIOTIC" 1.99

A040370100 URANID TAB. 100MG 0.99

A040421100 BLADATON TABLET 200MG "SENTAI" (FLAVOXATE) 4.01

A040423209 CEPONIN INJECTION (CEPHRADINE) "CHI SHENG." 26.1

A040423277 CEPONIN INJ. 23.8

A040427100 CLINDAMYCIN CAP. 150MG 1.26

A040430100 LIDERAL TAB. 40MG 0.87

A040475321 CHIUH-YEANG-SHU OINT. 5G 9

A040475329 CHIUH-YEANG-SHU OINT. 450G 18.1

A040504100 IMOCON CAP.2MG 0.48

A040516100 DIALIUM TABLETS 5MG "Y.J."(DIAZEPAM) 0.8

A040547100 METOL TAB. 100MG 3.83

A040558277 KALY INJ.50MG/ML500ML 23.5

A040559277 FULIN INJECTION "ASTAR" 19.6

A040563100 QUITEN CAPSULE 10MG (UBIDECARENONE) "Y.S." 3.57

A040639100 ERCIN CAPSULES 10MG (UBIDECARENONE) "YUNG CHI" 3.57

A040641100 GLIZIDE TABLETS 5MG (GLIPIZIDE) "S.Y" 1

A0406411G0 GLIZIDE TABLETS 5MG (GLIPIZIDE) "S.Y"(?T??/????) 1.5

A040656100 SPASMO-EUVERNIL F.C. TAB. 3.03

49

Page 50: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A040658100 ASRIN E.C.TABLETS 165MG "H.S." 1

A040659110 CEFACLOR FOR ORAL SUSPENSION 1.5GM 110

A040662100 KASMA TABLETS "KOJAR" 0.51

A040688100 PEITIL CAP. 250MG 1.42

A040689100 ANTON CAP. 200MG 2.44

A040725100 URIMETON TABLETS 200MG (FLAVOXATE) "CHEN TA" 4.01

A040767321 TONEX CREAM 10MG/GM "MEIDER" (PIROXICAM) 11.2

A040767329 TONEX CREAM 10MG/GM (PIROXICAM) "MEIDER" 17.4

A040767335 TONEX CREAM 10MG/GM (PIROXICAM) "MEIDER" 28.5

A040767338 TONEX CREAM 10MG/GM "MEIDER" (PIROXICAM) 28.5

A0407673AK TONEX CREAM 10MG/G 22G 39.9

A040779100 CAPROINE TABLETS 25MG (CAPTOPRIL) "ROYAL" 1.24

A040780335 EPIFU CREAM "SENTAI" 25.8

A040781100 GLUCOFIT F.C.TABLETS 500MG (METFORMIN) "SWISS" 0.8

A040792238 LYSIMIN INJECTION 12

A040810100 MARTRIL CAP. 250MG "M.S." (GLUCOSAMINE SULFATE) 1.42

A040812100 PERILAX SLOW RELEASE F.C.TAB. 400MG 2.11

A040815329 MEFUDAZOLE GEL 0.75% "S.L" 42.5

A040815338 MEFUDAZOLE GEL 0.75% "S.L." 74

A040826100 SUBILIN ENTERIC-COATED CAPSULES 500MG "H.S."(ASPIRIN) 0.8

A040833157 SECORINE SYRUP 24.7

A040897100 GLUCOSAMINE CAP. 250MG 1.38

A040906100 PREA TABLETS 4MG (METHYLPREDNISOLONE) "Y.C." 1.52

A040908100 TINTEN TABLETS "EXTRA" 0.68

A040925100 JEN TON YAN CAPSULES 250MG "D.S." (MEFENAMIC ACID) 0.75

A040949100 CAPOTIL TABLETS 25MG "KINGDOM" (CAPTOPRIL) 1.24

A040972100 AN-LIH CAPSULES 2MG "DS" (LOPERAMIDE) 0.45

A041018100 NIMAPE ENTERIC F.C. TAB. 100MG 1

A041026100 REGITAN TAB. 10MG 0.59

A041032100 PINRIJIN S.C. TAB. 10MG 0.68

A041036100 CINRIZIN TAB. 25MG 0.69

A041047100 COLDAN CAPSULES "KOJAR" 0.89

A041049100 VITABONIN TABLETS "KOJAR" 0.5

A041055100 CEPHA CAPSULE 250MG 1.14

A041056338 ISOCORTANT CREAM "GRAPE" 49.8

A041062100 DERGINPIN TAB. 5MG 0.8

A041068100 ERYTHROMYCIN CAP. 250MG 1.43

A041074100 GULISIN 250MG 1.42

A041168100 KOJARCEFXIL CSPSULES 500MG"KOJOR" 0

A041170100 CHIYUANPIN E.C. TAB. 1.14

A041171100 KOJARDINE CAPSULES 500MG "KOJAR" 0

A041173100 PIPEMIDIC ACID TAB. 250MG 3.1

A041207100 ANEDANE S.C. TAB. 12.5MG 0.83

A041208100 BENZYDAMINE CAP. 50MG 0.74

A041213100 KEZINTEA TAB. 0.89

A041227100 NICERMION S.C. TABLETS 5MG "Y.J."(NICERGOLINE) 3.21

A041237335 COGESAN CREAM 100MG/G 33.8

A041237343 COGESAN CREAM 74

A041237345 COGESAN CREAM 100MG/GM "MEIDER" (ETOFENAMATE) 74

A041250100 GLUC CAP. 250MG "S.Y"(GLUCOSAMINE SULFATE) 1.42

A041251100 MENCHUAN F.C.TABLETS 100MG(TICLOPIDINE) 2.98

A041253100 ARTRIL-S CAP.250MG 1.42

A041258100 INSHEL S.C. TAB. 1.79

A041260100 UROPYRIN S.C.TAB. 100MG 0.78

A041264100 AZUNOL TABLETS 2MG "KOJAR" 0.85

50

Page 51: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A041265100 CEPHALEXIN CAP. 250MG 1.14

A0412651G0 CEPHALEXIN CAPSULES 250MG"KOJAR"(鋁箔/膠箔) 1.5

A041271100 GLUORICS CAPSULES 250MG 1.39

A041278100 CYRONA TABLETS 50MG "MACRO" (CYPROTERONE) 30.8

A041281100 KINTEC TABLETS 20MG "KINGDOM"(ENALAPRIL) 1.74

A041286100 SUCOPANLIN CAP. 10MG 0.96

A041288100 FULCIN S.C. TAB. 12.5MG 0.61

A041328100 SUNLING TABLETS 2MG "KOJAR" 0.83

A041349100 CHIFONEON TAB. 50MG 0.27

A041355321 IMEFU CREAM 450GM 15.5

A041355329 IMEFU CREAM 10GM 23.9

A041355335 IMEFU CREAM 450GM 46.3

A041355338 IMEFU CREAM 450GM 49.8

A041359100 CERGOLINE TAB. 5MG 3.21

A041360100 PINTYLIN TAB. 5MG 2.38

A041379100 SOONANSIN TAB. 0.25

A041428289 ORIXIM POWDER FOR INJECTION "ORIENTAL"(CEFUROXIME) 23.5

A041440100 CHITOGEN CAP.250MG 1.38

A041442100 URINOGEN TABLETS 50MG "S.L." (BENZBROMARONE) 1.23

A0414421G0 URINOGEN TABLETS 50MG "S.L." (BENZBROMARONE)(鋁箔/膠箔) 1.5

A041452338 ANNIE CREAM 49.8

A041464335 ANTIFUNGUS CREAM 25.8

A041474300 HEALING BUCCAL TABLET 0.025MG"SHITEH"(TRIAMICINOLONE

ACETONIDE)

7.4

A041486100 MACOLATE CAP. 250MG 1.42

A041505100 URIMANONE TABLETS 100MG 2.87

A041520100 CUINE CAP. 250MG 1.42

A041526100 BEGUP CAP. 250MG 1.42

A041532100 MEOMIN CAPSULES 500UG "H.S."(MECOBALAMIN) 1.64

A041541100 URSOL TAB. 100MG 2

A0415441G0 MEPAZOLE TABLETS 5MG(30粒/瓶) 1.5

A041599100 FISHDON TAB. 50MG 1.61

A041601100 KIMODIN F.C. TAB. 40MG "KINGDOM"(FAMOTIDINE) 5.7

A041625100 A.C. TAB. 0.98

A041628116 AMOLIN POWDER FOR ORAL SUSPENSION 50MG/ML (AMOXICILLIN) 81

A041636100 BULICU CAPSULES 250MG "S.D."(GLUCOSAMINE SULFATE) 1.42

A041639221 PEXACIN I.V. INJECTION 385

A041651100 KIRADIN F.C.TAB.300MG "KINGDOM"(RANITIDINE) 4.84

A041664100 FLAMQUIT F.C.TABLETS 50MG "SWISS" (DICLOFENAC POTASSIUM) 0.52

A041670335 KEDOFU CREAM 20MG (KETOCONAZOLE)"CHEN TA" 36.9

A041670338 KEDOFU CREAM 20MG (KETOCONAZOLE)"CHEN TA" 36.9

A041672329 ZUME CREAM 41.5

A041676209 TYDINE INJECTION 1000MG "T.T.Y."(CEPHRADINE) 0

A041679100 ATENOL F.C. TABLETS 100MG 1.34

A041681329 BICOS CREAM 68

A041691421 KODOLO ORBASE 0.1% 52

A041724100 NURODIN TABLETS 400MG 1

A041725329 MENLIN CREAM 14.2

A041730100 PICOSULU E.S.C.TABLETS 1.35

A041804100 TIFENIC 200MG TAB. 2.78

A041806335 EUDAMYCIN GEL 1% (CLINDAMYCIN PHOSPHATE) "U-LIANG" 28.3

A041806338 EUDAMYCIN GEL 1% (CLINDAMYCIN PHOSPHATE) "U-LIANG" 55

A041811100 SHYS TAB. 0.5

A041822100 CEPHALEXIN CAPSULES 1.76

A041883100 CAMINE CAP.250MG 1.42

51

Page 52: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A041891100 CEPHA CAPSULES 500MG 1.76

A041894100 CHIAN CAP. 1.42

A041901100 ORETIN S.C. TABLETS 0.4

A041913100 MOBIC TABLETS 7.5MG 2.36

A041914100 MOBIC TABLETS 15MG (MELOXICAM) 8.5

A041929100 NURODIN TAB. 1

A0419291G0 NURODIN TABLETS 200MG "PANBIOTIC" (CIMETIDINE)(鋁箔/膠箔) 1.5

A041933100 METRIL CAPSULES 250MG 1.42

A041941100 SHINLICIN S.C.TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE) "J.S." 2.02

A041947100 POLI TABLETS 30MG (EPRAZINONE HYDROCHLORIDE)"EAYUNG" 0.67

A041952100 BAO-GAN CAPSULES 150MG "CHEN TA"(SILYMARIN) 1.5

A041955100 GLUBON-S CAP.250MG "STANDARD" (GLUCOSAMINE SULFATE) 1.42

A041972321 MORZIN CREAM 10MG/GM (CLOTRIMAZOLE) 8.7

A041975100 SILICON TABLETS 40MG (SIMETHICONE) "EAYUNG" 0

A041979321 BECLOMIN CREAM 18.9

A041979329 BECLOMIN CREAM 56

A041979335 BECLOMIN CREAM 81

A041980321 GENTASON CREAM 13.9

A041980329 GENTASON CREAM 14.2

A041980338 GETASON CREAM 19.6

A041982321 TOLNAMIN CREAM 15.5

A041982329 TOLNAMIN CREAM 19.3

A041982355 TOLNAMIN CREAM 33.4

A041984321 URESON CREAM 8.6

A041984329 URESON CREAM 20.3

A042006323 UCOFU CREAM 17

A042006330 UCOFU CREAM 46.3

A042092100 RIVOSIN F.C. TAB. 9.6MG "S.Y." 2.02

A042125100 CHINOCON TABLETS 1.5MG (DIHYDROERGOTOXINE MESYLATE)"EAYUNG" 1.46

A042129100 BAUSUTONER CAPSULES 0.75

A042136100 SHINSIN CAP. 10MG 3.57

A042138238 VITAMIN C INJECTION 250MG/ML (ASCORBIC ACID) "ORIENTAL" 9.2

A042142155 ALTANT ELIXIR 0.4MG/ML (TRIHEXYPHENIDYL

HYDROCHLORIDE)"PANBIOTIC"

200

A042142157 ALTANT ELIXIR 0.4MG/ML "PANBIOTIC" 205

A042149100 CEFAC CAPSULES 250MG 3.21

A042199271 IBUSINE INJ. 234MG(IBUPROFEN) 100

A042229335 B.& N. EXFUNGUS CREAM 10MG/GM (BIFONAZOLE) 71

A042239100 URSOL CAPSULES 4.33

A042247100 LUMELIN TABLETS 2MG "S.D." 1.53

A042253100 UROTIN TABLETS 100MG 2.87

A042256100 KEEBONS CAPSULES 250MG "C.H."(GLUCOSAMINE SULFATE) 1.36

A042258100 ATENOL F.C. TABLETS 50MG "S.Y." (ATENOLOL) 1.34

A042267151 SPIZ SYRUP 11.4

A042267155 SPIZ SYRUP 17.1

A042280100 DEVIRO TAB. 400MG "KINGDOM"(ACYCLOVIR) 7.1

A042344100 GLUCOSAM CAPSULES 250MG (GLUCOSAMINE SULFATE) "UNION" 1.42

A042346100 PERISAFE TAB. 20MG 1.74

A042350100 KUDONA CAPSULES 250MG "S.Y." (GLUCOSAMINE SULFATE) 1.38

A042366100 MUCAINE TABLETS 1

A042373338 CIPIROID CREAM 250U/GM 37.5

A042379100 I PUU F.C. TABLETS 400MG (IBUPROFEN) "CHEN TA" 0.98

52

Page 53: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A0423791G0 I PUU F.C. TABLETS 400MG (IBUPROFEN) "CHEN TA" (鋁箔/膠箔) 1.5

A042389100 LOVATIN TABLETS 20MG "PANBIOTIC" 4.72

A042395100 DIMICON TAB. 80MG 1.11

A042401100 URINONE TABLETS 100MG (BENZBROMARONE) "EAYUNG" 2.87

A042433100 CEFXIN F.C. TABLETS 125MG "STANDARD" (CEFUROXIME) 6.8

A042435100 BENSAU(BENZONATATE 100MG) SOFT CAPSULE 1.92

A042439100 CEFXIN F.C. TABLETS 250MG "STANDARD" (CEFUROXIME) 6.8

A042441338 BICAEN CREAM 10MG/GM"S.D." 28.5

A042463100 FOR-YOU S.C. TABLETS 25MG 2.7

A042464100 PANFORMIN TABLETS 500MG "PANBIOTIC" (METFORMIN) 1

A0424641G0 PANFORMIN TABLETS 500MG "PANBIOTIC" (METFORMIN)鋁箔/膠箔 1.5

A042494100 COMPOUND MIXTURE OF GLYCYRRHIZA TABLETS 0.15

A042500100 BEDELIN TABLETS 5MG (MEQUITAZINE) "Y.C." 0.96

A042508100 FULULIN TABLETS 10MG "S.D." 1.79

A042516100 GLUNINE CAPSULES 250MG (GLUCOSAMINE SULFATE) "H.C." 1.36

A042585100 PANAZIL F.C. TABLETS 600MG 2.59

A042592100 REGAL-HR TABLETS 4.48

A042601238 ANOL INJECTION 200MG/ML 12.9

A042605100 MEDIKA CAPSULES "CHEN TA" 0.99

A0426051G0 MEDIKA CAPSULES "CHEN TA"(鋁箔/膠箔) 1.5

A042618100 NOFATER CAPSULES 50MG "F.M." (DICLOFENAC SODIUM) 0.93

A042711100 PERISAFE TABLETS 5MG (ENALAPRIL) 1.53

A042712100 PERISAFE TABLETS 10MG (ENALAPRIL) 1.53

A042745100 RITORIN TABLETS 10MG "PANBIOTIC"(RITODRINE HYDROCHLORIDE) 3.73

A042768151 SUCOUGH SYRUP "WINSTON" 13.8

A042806100 PANZYNORM DRAGEES 1.75

A042824100 NOPRISIL TABLETS 10MG (LISINOPRIL) 2.85

A0428291G0 ANTHOLIN CAPSULES "WINSTON"(鋁箔/膠箔) 1.5

A042846314 ESTRADE GEL 0.6MG/GM "S.Y." (ESTRADIOL) 15

A042846343 ESTRADE GEL 0.6MG/GM "S.Y." (ESTRADIOL) 68

A042846348 ESTRADE GEL 0.6MG/GM "S.Y." (ESTRADIOL) 249

A042854151 SAURIN SUSPENSION 20MG/ML "GCPC." (IBUPROFEN) 25

A042854157 SAURIN SUSPENSION 20MG/ML "GCPC." (IBUPROFEN) 49.4

A042859100 PANMOMEL CAPSULE 30MG 2.93

A042869100 FLUNEPAN TABLETS 1MG "PANBIOTIC" (FLUNITRAZEPAM) 1.29

A042870421 TIMOL OPHTHALMIC SOLUTION 5MG/ML 113

A042875100 CO-GOOD CAPSULES 250MG "WINSTON" (GLUCOSAMINE SULFATE) 1.42

A042877326 ACV CREAM 5% (ACYCLOVIR) "CHEN TA" 44.5

A042886100 MEZAPIN TABLETS 100MG "PANBIOTIC" (CLOZAPINE) 8.5

A042909100 ACEPIN TABLETS 400MG "Y.C." (ACEBUTOLOL) 4.44

A0429161G0 SIMELIN F.C. TABLETS 500MG (METFORMIN)(鋁箔/膠箔) 1.5

A0429341G0 SULIN ENTERIC-MICROENCAPSULATED CAPSULES 100MG "WINSTON"

(ASPIRIN)(鋁箔)

1.5

A042941100 MAYJOU TABLETS 0.25GM "F.Y." (MAGNESIUM OXIDE) 0.13

A042954500 DOMPE SUPPOSITORIES 30MG "H.S." (DOMPERIDONE) 4.97

A042955321 ONEPASS CREAM 200MG/G (AZELAIC ACID) 27.5

A042955329 ONEPASS CREAM 200MG/G (AZELAIC ACID) 49.5

A042955330 ONEPASS CREAM 200MG/G (AZELAIC ACID) 54

A042955338 ONEPASS CREAM 200MG/G (AZELAIC ACID) 152

A042955343 ONEPASS CREAM 200MG/G (AZELAIC ACID) 214

A042962421 F.S. OPHTHALMIC SUSPENSION 0.1% 14

A043012421 APTROPION EYE DROPS 5MG/ML 21

A043012429 APTROPION EYE DROPS 5MG/ML 33.9

A043013421 STOMIDE EYE DROPS 5MG/ML 18

53

Page 54: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A043017421 •HYCIN EYE DROPS 21.9

A043031100 SPIZ-H TABLETS "S.T." 0.98

A043049100 UFO TABLETS 5MG "H.S." (ALLYLESTRENOL) 2.87

A043051100 EUCON TABLETS 5MG (GLIBENCLAMIDE) "PANBIOTIC" 0.99

A043052100 MELIN TABLETS 4MG "H.C." (METHYLPREDNISOLONE) 1.52

A043111100 MINOCIN CAPSULES 100MG (MINOCYCLINE HCL) "ROOT" 5.2

A0431141G0 TARLIN TABLETS "S.T"(鋁箔/膠箔) 1.5

A043175100 YEE MAN TABLETS 2MG "S.C." 1.53

A043190100 MECOBAL CAPSULE 0.5MG "TA FONG" 1.64

A043213100 ALLTEC F. C. TABLETS 10MG 0.64

A043215329 CLOBE CREAM "S.L." 47.1

A043216100 DEGOUT TABLETS 100MG "H.S."(BENZBROMARONE) 2.87

A043218100 LOMIN TABLETS 5MG "CHEN TA" 0.96

A043222100 BECANDIN TABLET "DTS" 0.75

A043248421 TRIALON ORAL PASTE 1MG/ML 28.4

A043255423 CINOLONE ORABASE "W.P." 42.7

A043257100 MEFNO TABLET 200MG 1.08

A043262100 GLUSTRONG CAPSULES "YUNG SHIN" 1.42

A043263151 IBUPROFEN SUSPENSION 20MG/ML "WINSTON" 25

A043263157 IBUPROFEN SUSPENSION 20MG/ML "WINSTON" 49.4

A043282500 JINGLE VAGINAL TABLETS 200MG 10.2

A043285321 LIBIDO GEL "MEIDER" 9.1

A043311329 TIFIN 1% CREAM "H.S." 41.3

A043311335 TIFIN 1% CREAM "H.S." 41.3

A043311338 TIFIN 1% CREAM "H.S." 72

A043323151 DUASMA METERED DOSE INHALER 200MCG 577

A043327329 NINERLNIN CREAM "CHEN TA" 47.1

A043327335 NINERLNIN CREAM "CHEN TA" 72

A043327338 NINERLNIN CREAM "CHEN TA" 77

A043335100 POLUPI TABLETS 50MG "PANBIOTIC" 0.87

A043361151 DINCO SYRUP "CENTER" 20.2

A043361157 DINCO SYRUP "CENTER" 29.3

A043361163 DINCO SYRUP "CENTER" 50

A043432100 BRIKEMIN TABLETS 5MG "PATRON" (MEQUITAZINE) 0.96

A043442100 ETODOLAC CAPSULES 200MG "CENTER" 3.82

A043470100 MEKEI TABLETS "PANBIOTIC" 36.9

A043483166 MACOTREIS EFFERESCENT GRANULES 75MG/GM "S.D" 8.3

A043488100 SENNAPUR TABLETS 1.12

A043520100 DIAGLUCON TABLET 80MG (GLICLAZIDE) "T.F." 1.11

A043618165 MAGCY ORAL SOLUTION "S.T" 39.1

A043626343 VOLRAN GEL 1% "C.M" 30.6

A043629100 MEZAPIN TABLETS 25MG 4.2

A043640100 BUCERTIN F.C. TAB."ROYAL" 5.1

A043658238 ORIKERN-A I.V INJ. "ORIENTAL" 10.9

A043659100 NONSED TABLETS 10MG "L.O." 1.02

A043693321 CLOB CREAM 15.8

A043697100 VITAL CAP. 250MG "YU SHENG" 1.42

A043707100 "U-LIANG" U-MISO TABLETS 200MCG (MISOPROSTOL) 10.4

A043733100 U-ERGO TAB. 1.5MG "U-LIANG 1.46

A043760345 PRO GEL 10MG/G "Y.C" (PIROXICAM) 40.7

A043786238 SALCA INJECTION 10.9

A043788321 BISZOLE CREAM "S.L" 23.7

A043788329 BISZOLE CREAM "S.L" 68

A043788338 BISZOLE CREAM "S.L" 81

A0438021G0 LYDICON CAPSULES "ROYAL" 1.5

54

Page 55: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A0438481G0 BRONXIN CAPSULES "WINSTON"(鋁箔) 1.5

A043853329 CB CREAM 47.1

A043853338 CB CREAM 77

A043855100 NORESTRIN TABLETS 3.83

A043858100 DIACRON TABLETS 80MG "GENTLE" 1.11

A043866100 ZETON F.C TABLETS 100MG 3.54

A043868100 UPISIN F.C. TABLETS 25MG 1.4

A043869277 "TTY"MAXTAM INJECTION 500MG(SULBACTAM SODIUM) 124

A043887100 'U-LIANG 'U-PRAVA TAB. 5MG 8.6

A043890100 PUROMIN TABLETS 5MG "TAI YU" 0.98

A0438901G0 PUROMIN TABLETS 5MG "TAI YU"(鋁箔/膠箔) 1.5

A043899500 VAZOLE VAGINAL TAB. 500MG "H.S." 3.73

A043913321 BEFURINE GEL 0.05% "S.L" 15.8

A043913329 BEFURINE GEL 0.05% "S.L" 17.7

A043913338 BEFURINE GEL 0.05% "S.L" 46.9

A043925345 PIPON CREAM 10MG/GM "Y.C." (PIROXICAM) 40.7

A043948100 IBUPROFEN F.C.TABLETS "S.L" 0.98

A0439481G0 IBUPROFEN F.C.TABLETS "S.L"(鋁箔/膠箔) 1.5

A043957100 GEN BO CAP. 35MG "C.H" 1.38

A043959100 "U-LIANG "U-SULAX TAB. 200MG 1.08

A0439591G0 "U-LIANG "U-SULAX TABLETS 200MG(鋁箔/膠箔) 1.5

A043985100 ETODON CAPSULES 200MG "S.L" 3.82

A043988100 JINBERCHANQ TABLETS "T.F." 3.83

A043992100 CHIN NI CHUAN CAP. "JENSHENG." 1.21

A044016100 SINLO ENTERIC-MICROENCAPSULATED CAPSULES 100MG "H.S" (ASPIRIN) 1

A0440161G0 SINLO ENTERIC-MICROENCAPSULATED CAPSULES 100MG "H.S" (ASPIRIN)

(鋁箔/膠箔)

1.5

A044040209 AVAGIN INJECTION 25MG/ML 7.9

A044043348 YULYFORD CREAM "TAI YU" 43.8

A0440671G0 BAYMIN TABLETS 5MG (MEQUITAZINE) "T.F."(鋁箔/膠箔) 1.5

A044069100 ACETYL SALICYLIC ACID TABLETS "T.L.B" 0.24

A044073121 GUAROL GRANULES "S.Y" 6.7

A044074129 COMBIVENT METERED AEROSOL 200DOSE 10ML 255

A044092100 CLINDAMYCIN CAP. 150MG CAP "PATRON" 1.26

A044119421 FUCIN OPHTHALMIC SOLUTION 1MG/ML 14

A044120423 BETACIN OPHTHALMIC SOLUTION 35.7

A044128100 KERO CAPSULE 250MG 3.21

A044189421 GENCIN OPHTHALMIC SOLUTION 17.4

A044194100 KEPROLINE TABLETS 25MG "PATRON" 4.81

A044202100 LAZOL CAPSULES 200MG "S.T" (DANAZOL) 11.2

A044210100 CANCA CAP. 1.42

A044212100 ULIDEN CAPSULES 300MG "SWISS" 3.4

A044241321 DR. PI. A.F CREAM "MEIDER" 18.8

A044241355 DR.PI.A.F CREAM "MEIDER" 140

A044266209 COMPOUND SODIUM CHLORIDE INJ. 31.2

A044266265 COMPOUND SODIUM CHLORIDE INJ. 17.7

A044266277 COMPOUND SODIUM CHLORIDE INJ. 19.9

A044268329 CLINDAMYCIN GEL 10MG/G "T.F" 17.1

A044268335 CLINDAMYCIN GEL 10MG/GM "T.F" 28.3

A044268338 CLINDAMYCIN GEL 10MG/G "T.F" 55

A044279209 DEXTROSE AND SODIUM CHLORIDE INJ. 2.5%/0.45% 30.1

A044279265 DEXTROSE AND SODIUM CHLORIDE INJ. 2.5%/0.45% 18

A044279277 DEXTROSE AND SODIUM CHLORIDE INJ. 2.5%/0.45% 19.6

A044284100 KUBOMINE CAP. 250MG "EVEREST" 1.42

55

Page 56: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A044292277 DEXTROSE AND SODIUM CHLORIDE INJ. 5%/0.33% 19.6

A044294143 RODAMINE SYRUP "W.P." 25.2

A044294151 RODAMINE SYRUP "W.P." 29.5

A044315100 FONITEC TABLETS 20MG "T.F" 1.74

A044367321 BETASON CREAM 0.5MG/GM 15.8

A044367323 BETASON CREAM 0.5MG/GM 18.3

A044367329 BETASON CREAM 0.5MG/GM 18.3

A044367330 BETASON CREAM 0.5MG/GM 18.3

A044394321 BETASOL CREAM 0.5MG/GM 15.8

A044394323 BETASOL CREAM 0.5MG/GM 15.8

A044394324 BETASOL CREAM 0.5MG/GM 15.8

A044394329 BETASOL CREAM 0.5MG/GM 17.7

A044435340 POSULEN EXT SOLUTION "PATRON" 142

A044438100 BETHANCOL TABLETS 25MG 1.93

A044462335 ANTA CREAM 19.6

A044464321 GLINDA GEL 10MG/GM 9.1

A044464323 GLINDA GEL 10MG/GM 15.8

A044464329 GLINDA GEL 10MG/GM 17.1

A044464330 GLINDA GEL 10MG/GM 17.4

A044464335 GLINDA GEL 10MG/GM 28.3

A044464338 GLINDA GEL 10MG/GM 55

A044467321 BETAME OINTMENT 12.6

A044467329 BETAME OINTMENT 25

A044467335 BETAME OINTMENT 74

A044485100 LAIDEC F.C TABLETS 50MG 158

A044571151 ASTOFEN SOLUTION "W.P." 45.2

A044578100 SYNLET ENTERIC-MICROENCAPSULATED CAPSULES 100MG 1

A044600100 CARRY FILM-COATED TABLETS 4MG 31.5

A044611221 GENAXOL INJ. 6MG/ML "UNION" 1028

A044615421 ATROPINE EYE DROPS 0.3% "OASIS" (ATROPINE SULFATE) 11.3

A044615429 ATROPINE EYE DROPS 0.3% "OASIS" (ATROPINE SULFATE) 20.3

A044653100 CA-P TABLETS 667MG "YU SHENG"(CALCIUM ACETATE) 1.33

A044675540 MEFUGEL VAGINAL GEL 0.75% "S.L" 134

A044675596 MEFUGEL VAGINAL GEL 0.75% "S.L" 140

A044805299 HEPAC INJECTION 5000 UNITS/ML "N.K." 1.12

A044810100 ENARIL TABLETS 20MG "WEIDAR" 1.74

A044879100 PSOLE F.C TAB. 4.01

A044969343 CIPROSONE CREAM 0.5MG/GM 31.9

A045067321 FULOSIN CREAM 2% 41.1

A045067326 FULOSIN CREAM 2% 43.4

A045067329 FULOSIN CREAM 2% 52

A045067335 FULOSIN CREAM 2% 119

A045069316 EVERSONE CREAM 0.1% 24.1

A045069321 EVERSONE CREAM 0.1% 26.5

A045069326 EVERSONE CREAM 0.1% 40.4

A045188100 KLARCIN F.C. TABLETS 250MG 4.06

A045228323 MIZTIN CREAM "MEIDER." 15.7

A045228336 MIZTIN CREAM "MEIDER" 35.1

A045233100 NORTIN S.C. TABLETS 4.57

A045246151 SUPO GRANULES FOR ORAL SUSPENSION "WINSTON"

60ML(36GM),41.7MG/GM

31

A0452481G0 SUCONIN CAPSULES 鋁箔/膠箔) 1.5

A045280335 MEDAGEN GEL 7.5% ( KINGDOM) 54

A045280338 MEDAGEN GEL 7.5% ( KINGDOM) 74

A045280343 MEDAGEN GEL 7.5% ( KINGDOM) 134

56

Page 57: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A045306100 AMSHA TABLET 250MG "Y.Y" 3.3

A045308100 YETAN CHEWABLE TABLETS "Y.A" 3.78

A0453511G0 ACTIWE TABLETS "UELIAN" 鋁箔/膠箔) 1.5

A045357335 KENETON GEL 28.5

A045357340 KENETON GEL 39.9

A045357343 KENETON GEL 40.7

A045390421 STROPIN EYE DROPS 0.5% 18

A045408326 PATODERM CREAM 50MG "PATRON" 37.2

A045408335 PATODERM CREAM 50MG "PATRON" 51

A045443245 BELON INJECTION 40MG "ORIENTAL" 0

A045451100 FERALL SOFT CAPSULES 2.07

A045571321 FORMEI CREAM "Y.C" 18.8

A045595316 HONMET OINTMENT 0.1% 24.1

A045595321 HONMET OINTMENT 0.1% 26.5

A045595326 HONMET OINTMENT 0.1% 40.4

A045595335 HONMET OINTMENT 0.1% 82

A045600212 NEUROMIA INJECTION 4.79

A045602100 YUTOPAR TABLETS 10MG 5.6

A045633209 NEW-LYLO INJECTION 1GM 12.3

A045643212 VITAMIN BC COMPLEX INJECTION "ORIENTAL" 1.4

A045650421 NORFOCIN EYE DROPS 0.3% 43.9

A045650429 NORFOCIN EYE DROPS 0.3% 67

A045677100 METICORT TABLETS 2MG "KINGDOM" 1.52

A045778343 CALTRIOL OINTMENT 317

A045887326 OXPIN CREAM 50MG/GM (DOXEPIN) 37.2

A045914416 EYE RINDERON SOLUTION 26.3

A045914421 EYE RINDERON SOLUTION 26.3

A045925326 FUTEN CREAM 2% 43.4

A045925338 FUTEN CREAM 2% 134

A045957321 ANCENT CREAM "Y.C" 25.4

A045957329 ANCENT CREAM "Y.C" 41.3

A045957338 ANCENT CREAM "Y.C" 72

A045974100 DAFUTEN CAPSULES 150MG "S.L" 3.36

A046022100 "U-LIANG" U-PRAVA TABLETS 10MG (PRAVASTATIN SODIUM) 8.6

A046026100 LABETA F.C L TABLETS 100MG "ROYAL" 3.02

A046116355 COLASA ENEMA 40MG/ML 287

A046136412 WETHYCO ORABASE "Y.C." 41

A046140100 BETARL F.C TABLETS 200MG "ROYAL" 3.02

A046143100 ACYLO TABLETS 200 MG (ACYCLOVIR) 5.9

A046170209 UZOLAM INTRAVENOUS INJECTION 5MG/ML "UNION" 16.6

A046170216 UZOLAM INTRAVENOUS INJECTION 5MG/ML "UNION" 34.8

A046170229 UZOLAM INTRAVENOUS INJECTION 5MG/ML "UNION" 203

A046176100 JULILIN CAPSULES 1MG "S.D' 0.25

A046178329 AMYDA GEL 0.75% "Y.Y" 42.5

A046178338 AMYDA GEL 0.75% "Y.Y" 74

A046183529 ZOCON VAGINAL GEL 0.75% "Y.Y" 69

A046183540 ZOCON VAGINAL GEL 0.75% "Y.Y" 134

A046183596 ZOCON VAGINAL GEL 0.75% "Y.Y" 138

A046187329 AZELAC CREAM 20% 49.5

A046187343 AZELAC CREAM 20% 214

A046224143 RESPOR ORAL SOLUTION 1MG/ML 554

A046241155 CARBATOL 20MG/ML MIXTURE 233

A046253100 KORFAN TABLETS 15MG "TAI" 0.69

A046261143 MEPROTIN LIQUID 5UG/ML 25

A046261151 MEPROTIN LIQUID 5UG/ML 37.3

57

Page 58: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A046261157 MEPROTIN LIQUID 5UG/ML 111

A046273100 KORFAN TABLETS 20MG "TAI" 0.95

A046275151 LALLERGY SYRUP "ROYAL" 29.5

A046275157 LALLERGY SYRUP "ROYAL" 68

A046300151 CATEROL LIQUID 5MCG/ML 37.3

A046302363 KWAIE GEL 0.1% 594

A0464431G0 CANTOR DISPERSIBLE TABLETS "Y.C."(鋁箔/膠箔) 1.5

A046453345 FLU RO FEN PATCH 40MG/12GM 6.3

A046487112 TERCANYL NEBULISER SOLUTION 2.5MG/ML 10.5

A046490238 DIPROFEN INJECTION 56

A046490248 DIPROFEN INJECTION 152

A046525100 NUXITAM F.C TABLET 1200MG 2.28

A046562335 METOPZOLE GEL 7.5MG/GM 54

A046564421 "WU-FU" ATROPINE SULPHATE EYE DROPS 0.125% 5.7

A046564429 "WU-FU" ATROPINE SULPHATE EYE DROPS 0.125% 10.4

A046565421 "WU-FU" ATROPINE SULPHATE EYE DROPS 0.25% 11.6

A046565429 "WU-FU" ATROPINE SULPHATE EYE DROPS 0.25% 21

A046582100 GULOR CAPSULES 250MG "WECAM" 1.42

A046584335 ADAMEI GEL "S.C." 58

A046618229 DROPEDOL INJECTION 2.5MG/ML 77

A046633326 LOMEANE CREAM "S.C." 40.4

A046633329 LOMEANE CREAM "S.C." 40.4

A046637457 BESONIN AQUA NASAL SPRAY 32 UG/DOSE 137

A046663100 SULGIN TABLETS 400MG 5.1

A046686100 METO TABLETS 250MG "EB"(METFORMIN) 1

A046689321 BUTEMAX CREAM 34.6

A046689329 BUTEMAX CREAM 55

A046689335 BUTEMAX CREAM 74

A046689355 BUTEMAX CREAM 656

A046691100 METOZONE TABLETS 0.5MG "Y.Y." 4.25

A046732100 GLUCOMET F.C. TABLETS 2.5/500MG 2.19

A046756100 PYSTON TABLET 500MG "S.L." 0.79

A046933100 FLUVOXIN F.C. TABLETS 50MG 9.3

A046936229 OXYTOCIN INJECTION 10IU/ML 6.8

A046999414 UNITAN EYE DROPS 0.05MG/ML "UNION" 381

A047050100 YOUR IRON CAPSULES "S.L." 5.3

A047071212 KOP INJECTION 25.3

A047072221 OXYTOCIN INJECTION 5IU/ML 3.77

A047086100 ANKOMIN F.C. TABLETS 500MG "S.D." 1

A0470861G0 ANKOMIN F.C. TABLETS 500MG "S.D."(鋁箔/膠箔) 1.5

A047089100 METO TABLETS 500MG 1

A047155100 ACIDAM TABLET 1.84

A047157343 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 119

A047157363 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 594

A047171100 INMIDE F.C. TABLETS 2.5MG "E.B." 2.27

A047227100 KETOZINE TABLETS 24MG 3.22

A047236100 DICLOFENAC ENTERIC FILM COATED TABLETS 25MG "LITA" 0.9

A047278100 FORMIN E.F.C.TABLETS 50MG "PANBIOTIC" 0.93

A047281100 DICLOFENAC E.F.C. TABLETS "LITA" 0.93

A047308538 TERCONER VAGINAL CREAM 0.8% "S.L." 148

A047375238 LIPOVAN INJECTION 56

A047375248 LIPOVAN INJECTION 152

A047420100 INMIDE F.C. TABLETS 1.25MG "EB" 1.44

A047487343 CALKIS OINTMENT 375

A047517100 LATRIGINE TABLETS 100MG "KINGDOM" (LAMOTRIGINE) 23.8

58

Page 59: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A047537245 METISOL INJECTION 0

A047556340 FUBODYL Concentrate Solution "Meider" 142

A0475581G0 CIMEWEI TABLETS 400MG "LITA"(鋁箔/膠箔) 1.5

A047571112 Terbuhale Solution for Nebulizing 2.5mg/ml 10.5

A047572100 IFONOL TABLETS 100 MG "ASTAR" 0.99

A047589100 Eago Film Coated Tablets 75 mg 35.3

A047610100 IFONOL TABLETS 300MG "ASTAR" 2.74

A0476121G0 CIMEWEI TABLETS 200MG "LITA"(鋁箔/膠箔) 1.5

A047615157 BESUMIN SYRUP "Y.C" 68

A047618414 LATICOM EYE DROPS "UNION" 537

A047623100 EBASTEL TABLETS 5MG 1.93

A047624100 EBASTEL TABLETS 10MG 4.38

A047628100 VEMARY TABLETS 2MG "JOHNSON" 1.53

A047646100 DINSIA SOFT CAPSULES 300MG 8

A0476531G0 MOCOUGH CAPSULES "LITA"(鋁箔/膠箔) 1.5

A047680100 Decarbay Tablets 50mg "Kingdom" 2.07

A047681321 Palene gel 0.1% "Panbiotic" 19.1

A047681335 Palene gel 0.1% "Panbiotic" 58

A047681343 Palene gel 0.1% "Panbiotic" 119

A047681345 Palene gel 0.1% "Panbiotic" 212

A047681363 Palene gel 0.1% "Panbiotic" 561

A047773329 MUROZO LOTION 0.1% W/W 32.7

A047773343 MUROZO LOTION 0.1% W/W 187

A047784209 ANALAC FOR IV INJECTION 30MG/ML 19.1

A047784212 ANALAC FOR IV INJECTION 30MG/ML 25.3

A047791100 MESUN S.R.M.C. 125MG "UELIAN" 1.44

A047809435 Cromyn Nasal Spray "H.S." 86

A047810329 SPERSIN OINTMENT 78

A047814100 COFONCIN TABLETS 0.5MG "ASTAR" 0.99

A047843143 ZOCOMIN ORAL SOLUTION 0.1%W/V 26.7

A047843151 ZOCOMIN ORAL SOLUTION 0.1%W/V 29.4

A047843157 ZOCOMIN ORAL SOLUTION 0.1%W/V 91

A047846337 Fluzole cream "Royal" 49.8

A047847329 SPALIN OINTMENT 49.7

A047900100 TITON Tablets 60mg "MEIDER" 0.7

A047920329 LANBASON CREAM 0.1% 17

A047920338 LANBASON CREAM 0.1% 40.3

A047922100 Alloprim Tablets 300mg "S.L." 2.74

A047966100 TONE F.C. Tablets 25mg "MEIDER" 1.4

A047994100 SCATEN TABLETS 20MG "MEIDER" 0.73

A048038100 Isoniazid Tablets 300 mg "S.L.." 0.54

A0480381G0 ISONIAZID TABLETS 300 MG "S.L.."(28粒/瓶裝) 1.5

A048060321 Superin cream "Y.C." 34.6

A048060335 Superin cream "Y.C." 74

A048060355 Superin cream "Y.C." 656

A048080263 GEMFLOR FOR INJECTION 794

A048087100 TONE F.C. TABLETS 10MG "MEIDER" 1.39

A048093321 Adalene Gel 0.1% "S.D." 19.1

A048093335 Adalene Gel 0.1% "S.D." 58

A048093343 Adalene Gel 0.1% "S.D." 119

A048093345 Adalene Gel 0.1% "S.D." 212

A048093363 Adalene Gel 0.1% "S.D." 561

A048129100 VERELAN SUSTAINED RELEASE CAPSULES 120MG 5.9

A048149321 Gentesone Cream 22.7

A048149329 Gentesone Cream 30.2

59

Page 60: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A048149335 Gentesone Cream 30.6

A048169100 LICOLONE TABLETS 4MG "ASTAR" 1.52

A048178329 Betapro Cream "Patron" 18.3

A048183100 Riston F.C. Tablets 2mg "CHI SHENG" 14.3

A048188100 Sufolin Tablets 60mg "Astar" 0.7

A048223263 Teicon Lyo I.V. Injection 200mg "Union" 536

A048225321 Debesol Ointment 0.05% 15.8

A048225324 Debesol Ointment 0.05% 15.8

A048225329 Debesol Ointment 0.05% 17.7

A048225338 Debesol Ointment 0.05% 46.9

A048225340 Debesol Ointment 0.05% 49.3

A048225355 Debesol Ointment 0.05% 195

A048244100 Feride Tablets 40mg 1.62

A048252100 Nincolide Tablets 100mg "Kingdom" (Nimesulide) 2.83

A048271100 INLIFE GINKGO BILOBA FILM COATED TABLETS 40MG 2.02

A048277457 BUDES NASAL AQUA (64UG/DOSE) "PANBIOTIC" 165

A048295321 Pindome Gel 0.1% "Kingdom" (Adapalene) 19.1

A048295335 Pindome Gel 0.1% "Kingdom" (Adapalene) 58

A048295343 Pindome Gel 0.1% "Kingdom" (Adapalene) 119

A048295345 Pindome Gel 0.1% "Kingdom" (Adapalene) 212

A048295363 Pindome Gel 0.1% "Kingdom" (Adapalene) 561

A048337143 PERISDONE ORAL SOLUTION 1MG/ML 554

A048339100 SINTAN ENTERIC COATED TABLETS 100MG "MEIDER" 1

A0483391G0 SINTAN ENTERIC COATED TABLETS 100MG "MEIDER"(鋁箔) 1.5

A048342209 SUKERIN FOR I.V INJECTION 30MG/ML "UNION" 19.1

A048342212 SUKERIN FOR I.V INJECTION 30MG/ML "UNION" 25.3

A048345100 BOSU F.C. TABLETS 9.6MG "SOUNLIN" 2.02

A048390209 ANALIF FOR IV INJECTION 19.1

A048390212 ANALIF FOR IV INJECTION 25.3

A0483941G0 COTON TABLETS 500MG "LITA"(鋁箔/膠箔) 1.5

A048397100 Kerloli Capsules 250mg "Panbiotic" 3.21

A048433100 PROTIFEN F.C. TABLETS 1.66

A048442225 Diprofen Injection 20mg/ml 56

A048442229 Diprofen Injection 20mg/ml 56

A048442238 DIPROFEN INJECTION 20MG/ML 105

A048442240 Diprofen Injection 20mg/ml 152

A048442248 Diprofen Injection 20mg/ml 299

A048448345 FUBIPROFEN PLASTER "JENSHENG" 6.3

A048503500 Sokerz suppositories 8.5

A048511335 TEZARAC GEL 0.1% 246

A048511343 Tezarac Gel 0.1% 444

A048512100 NooSafe Film Coated Tablets 800mg 2.55

A048541100 Lustraline Film Coated Tablets 50mg 8.8

A0485421G0 ENCINLO E.M. CAPSULES 100MG "UELIAN" (鋁箔/膠箔) 1.5

A048561238 OLATIN I.V. INJECTION 5MG/ML 5584

A0485851G0 COTON CAPSULES 250MG "LITA"(鋁箔/膠箔) 1.5

A048605100 BE-EASY F.C. TABLETS 200MG "SL" 2.67

A048633100 U-ZEPINE F.C. TABLETS 30MG 15.2

A048641209 Oxacillin Sodium Injection "Union" 0

A048641212 OXACILLIN SODIUM INJECTION "UNION" 0

A048641265 Oxacillin Sodium Injection "Union" 0

A048641277 OXACILLIN SODIUM INJECTION "UNION" 0

A048662100 FUCOLE MINLIFE ORALLY DISINTEGRATING TABLETS 1.03

A048682100 ANXIEDIN TABLETS 2 MG (LORAZEPAM) 0.98

A0486821G0 ANXIEDIN TABLETS 2 MG (LORAZEPAM)(鋁箔/膠箔) 1.5

60

Page 61: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A048685109 Gesure Granules 2.69

A048703100 POLIHEPAR VITA CAPSULES 1.35

A0487491G0 COLCHICINE TABLETS 0.5MG“F.Y.”(鋁箔/膠箔) 1.5

A048756100 SUGANLIN SOFT CAPSULES“F.M” 1.5

A048769240 Heparin Sodium Injection 5000 U/ml 92

A048781100 Metformin Hydrochloride Extended-Release Tablets 500 mg 1.57

A048783345 FO BI PU LUO FUM PATCH 6.3

A048786321 MOFUROATE CREAM 0.1 %〝Y.S.〞 26.5

A048786326 MOFUROATE CREAM 0.1 %〝Y.S.〞 40.4

A048786329 MOFUROATE CREAM 0.1 %〝Y.S.〞 40.4

A048786335 MOFUROATE CREAM 0.1 %〝Y.S.〞 82

A048801100 SEULIN F.C. TABLETS〝S.L.〞 1.45

A048835321 Shuli qing Gel “Sentai” 9.1

A048835329 Shuli qing Gel “Sentai” 17.1

A048835335 Shuli qing Gel “Sentai” 28.3

A048835338 Shuli qing Gel “Sentai” 55

A048840212 Irinotecan Solution for I.V. Infusion “LOTUS” 1806

A048864329 JELNIZOLE GEL 0.75% "PANBIOTIC" 42.5

A048864335 JELNIZOLE GEL 0.75% "PANBIOTIC" 54

A048864338 JELNIZOLE GEL 0.75% "PANBIOTIC" 74

A048864343 JELNIZOLE GEL 0.75% "PANBIOTIC" 134

A0488681G0 SLOSUGAR TABLETS 500 MG(鋁箔/膠箔) 1.5

A048871100 MECOLIN TABLETS 30 MG ”ASTAR” 0.82

A048890166 CARBOTEINE EFFERESCENT GRANULES 8.3

A048894100 MIGOFF TABLETS 10 MG 121

A048895100 PROSTEN F.C. TABLETS "PANBIOTIC" 0.79

A048963321 POLISU CREAM 50 MG/GM“SENTAI” 41.4

A048963329 POLISU CREAM 50 MG/GM“SENTAI” 44.5

A048992421 KIRTOLAC OPHTHALMIC SOLUTION 0.5% 120

A049005221 LINOOPIL INJECTION ”ASTAR” 11.1

A049023100 PIRACETAM FILM COATED TABLETS 1200MG“Y.Y.” 2.55

A049033143 XINGTON DROPS 9.6 MG/ML“PANBIOTIC” 176

A049033151 XINGTON DROPS 9.6 MG/ML“PANBIOTIC” 267

A049033155 XINGTON DROPS 9.6 MG/ML“PANBIOTIC” 432

A049033157 XINGTON DROPS 9.6 MG/ML“PANBIOTIC” 525

A049049100 SULGIN TABLETS 200 MG 1.99

A049051100 KEPINTON S.R. CAPSULES 200MG 3.52

A049058100 RISTON F.C. TABLETS 1 MG "CHI SHENG" 10.1

A049062321 ADAYUNG GEL 0.1% 〝S.L.〞 19.1

A049062335 ADAYUNG GEL 0.1% 〝S.L.〞 58

A049063340 VIMAX FOAMING SOLUTION 120

A0490891G0 ANCOPIN TABLETS "H.S."(鋁箔/膠箔) 1.5

A049108321 KANGFUJING OINTMENT 2 % 41.1

A049108326 KANGFUJING OINTMENT 2 % 43.4

A049108329 KANGFUJING OINTMENT 2 % 52

A049108335 KANGFUJING OINTMENT 2 % 119

A049132100 FUTE F.C. TABLETS 3MG 9.6

A049137221 RACETAM INJECTION 11.1

A049137229 RACETAM INJECTION 33.7

A049137235 RACETAM INJECTION 33.7

A049137238 RACETAM INJECTION 45.8

A049140280 AMOCLAN FOR I.V. INJECTION "UNION" 42.7

A049140297 AMOCLAN FOR I.V. INJECTION "UNION" 135

A049144100 REPANORM TABLETS 1MG”KINGDOM”(REPAGLINIDE) 2.77

A049149209 SIROLAC IV INJECTION 30 MG/ML “SIEHO” 19.1

61

Page 62: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A049149212 SIROLAC IV INJECTION 30 MG/ML “SIEHO” 25.3

A049151255 TEICOIN POWDER FOR I.V. INJECTION 459

A049151263 TEICOIN POWDER FOR I.V. INJECTION 536

A049151271 TEICOIN POWDER FOR I.V. INJECTION 1229

A049152209 OXACILLIN SOIDUM INJECTION “O-S” 38.5

A049152212 OXACILLIN SODIUM INJECTION “O-S” 100

A049152219 OXACILLIN SODIUM INJECTION “O-S” 180

A049152229 OXACILLIN SODIUM INJECTION “O-S” 450

A049152277 OXACILLIN SOIDUM INJECTION “O-S” 19.5

A049213329 CLOGEL GEL 7.5MG/GM 42.5

A049213330 CLOGEL GEL 7.5MG/GM 44.8

A049213335 CLOGEL GEL 7.5MG/GM 54

A049213338 CLOGEL GEL 7.5MG/GM 74

A049213343 CLOGEL GEL 7.5MG/GM 134

A049218121 CRASHTONE GRANULES“PATRON” 7.8

A049255312 ACYVIR CREAM 50MG/G (ACYCLOVIR) 17.3

A049255317 ACYVIR CREAM 50MG/G (ACYCLOVIR) 17.3

A049255319 ACYVIR CREAM 50MG/G (ACYCLOVIR) 17.3

A049255321 ACYVIR CREAM 50MG/G (ACYCLOVIR) 41.4

A049255329 ACYVIR CREAM 50MG/G (ACYCLOVIR) 44.5

A049255343 ACYVIR CREAM 50MG/G (ACYCLOVIR) 431

A049255355 ACYVIR CREAM 50MG/G (ACYCLOVIR) 431

A049279321 FULIJING CREAM“SENTAI” 41.1

A049279326 FULIJING CREAM“SENTAI” 43.4

A049279329 FULIJING CREAM“SENTAI” 52

A049279335 FULIJING CREAM“SENTAI” 119

A049279338 FULIJING CREAM“SENTAI” 134

A049279348 FULIJING CREAM“SENTAI” 337

A049307100 LERPIN F.C. TABLETS 10 MG (LERCANIDIPINE) 7

A049312319 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 7.3

A049312321 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 15.8

A049312323 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 15.8

A049312324 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 15.8

A049312329 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 17.7

A049312335 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 28.6

A049312338 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 46.9

A049312340 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 49.3

A049312355 CLOLUX CREAM 0.5MG/GM〝SENTAI〞 195

A049314221 DOPAR INJECTION 40 MG/ML 21.2

A049388173 CHALIAN POWDER 890

A049395100 TIABINE FILM COATED TABLETS 5MG (TIAGABINE) 14.6

A049396100 MESTROL TABLETS 160 MG 36.9

A049416173 KUZEM POWDER 890

A049418321 POCOMMI CREAM 14.3

A049418323 POCOMMI CREAM 15.7

A049418330 POCOMMI CREAM 19.4

A049418335 POCOMMI CREAM 34.5

A049418336 POCOMMI CREAM 35.1

A049425100 SONIMAX CAPSULES 10MG 3.72

A049426209 MEFLUPIN POWDER FOR INJECTION 0.25G、0.5G、1G“TAI YU” 815

A049426265 MEFLUPIN POWDER FOR INJECTION 0.25G、0.5G、1G“TAI YU” 294

A049426277 MEFLUPIN POWDER FOR INJECTION 0.25G、0.5G、1G“TAI YU” 349

A049501143 LORCHIMIN SYRUP 1MG/ML“T.F.” 25.2

A049501151 LORCHIMIN SYRUP 1MG/ML“T.F.” 29.5

A049501155 LORCHIMIN SYRUP 1MG/ML“T.F.” 68

62

Page 63: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A049520321 DOULISHU CREAM 1MG/GM“SENTAI” 19.1

A049520335 DOULISHU CREAM 1MG/GM“SENTAI” 58

A049520343 DOULISHU CREAM 1MG/GM“SENTAI” 119

A049520345 DOULISHU CREAM 1MG/GM“SENTAI” 212

A049520363 DOULISHU CREAM 1MG/GM“SENTAI” 561

A049523245 OMEPRAZOLE LYO I.V. INJECTION 40MG "LITA" 86

A049554229 LIPOFOL INJECTION 20MG/ML 56

A049554248 LIPOFOL INJECTION 20MG/ML 299

A049559220 CO-TAZO POWDER FOR INJECTION“O-S” 317

A0495592AE CO-TAZO POWDER FOR INJECTION“O-S” 317

A0495592CX CO-TAZO POWDER FOR INJECTION“O-S” 163

A049565321 FUTEZOLE CREAM 1% 23.7

A049565329 FUTEZOLE CREAM 1% 68

A049565335 FUTEZOLE CREAM 1% 71

A049565338 FUTEZOLE CREAM 1% 81

A049580221 POTASSIUM CHLORIDE COMPLEX INJECTION 15%“KINGDOM” 5.8

A049580229 POTASSIUM CHLORIDE COMPLEX INJECTION 15%“KINGDOM” 5.9

A049580238 POTASSIUM CHLORIDE COMPLEX INJECTION 15%“KINGDOM” 8.4

A049601209 PRISUTOMYCIN FOR INJECTION“TAI YU” 45.9

A049601212 PRISUTOMYCIN FOR INJECTION“TAI YU” 45.9

A049601219 PRISUTOMYCIN FOR INJECTION“TAI YU” 88

A049603317 FLUNOLONE OINTMENT 25.9

A049606100 FUTE F.C. TABLETS 1MG 3.51

A049615100 VIDYA FILM COATED TABLETS 4 MG (ROSIGLITAZONE) 23.8

A049624265 DOPAMINE“C.C.P.C.”INJECTION 104

A049652355 TRISEC CREAM 140

A049691421 SUKERIN OPHTHALMIC SOLUTION 0.5%W/V“UNION” 112

A049710321 SOHOUO HYDROPHILIC CREAM 18.8

A049710329 SOHOUO HYDROPHILIC CREAM 46.6

A049710338 SOHOUO HYDROPHILIC CREAM 91

A049711100 ALPUTON TABLETS 300MG "LITA" 2.74

A049712265 IMENAM POWDER FOR IV INJECTION 187

A049712277 IMENAM POWDER FOR IV INJECTION 340

A049718100 SUBININ EFFERVESCENT TABLETS 600 MG 6.6

A049734209 PRIDIN INJECTION 2 MG/ML 12.8

A049752321 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 14.2

A049752329 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 14.2

A049752335 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 36.9

A049752338 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 36.9

A049752355 KETOCO CREAM 20MG/G”PATRON”(KETOCONAZOLE) 407

A049762100 CAFONA TABLETS 15 MG 14.7

A049793321 QUTACIN CREAM 1 MG/GM“YUNZAN” 14.8

A049793329 QUTACIN CREAM 1 MG/GM“YUNZAN” 15.5

A049793335 QUTACIN CREAM 1 MG/GM“YUNZAN” 36.4

A049811209 CEFEPIME POWDER FOR INJECTION "O-S" 349

A049811212 CEFEPIME POWDER FOR INJECTION "O-S" 664

A049811277 CEFEPIME POWDER FOR INJECTION "O-S" 232

A049884421 SUSON OPHTHALMIC SOLUTION“Y.S.” 28.8

A049907321 PEVIGEN OINTMENT 0.5MG/GM (CLOBETASOL PROPIONATE) 15.8

A049914100 AMSOLVON SR TABLET 75MG 2.25

A049924121 QUARTON GRANULES 6.7

A049973100 QUEROPIN FILM COATED TABLETS 100MG“YUNG SHIN” 18.3

A049975100 "U-LIANG" ETOPIN CAPSULES 200 MG 3.82

A049991421 ANKEMIN EYE DROPS“UNION” 24.2

A049991429 ANKEMIN EYE DROPS "UNION" 44.1

63

Page 64: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A049999326 DOFU CREAM 37.2

A049999335 DOFU CREAM 51

A050055100 DINONE CAPSULE 2.5MG 186

A050094321 CONTRIZOL CREAM 18.8

A050094329 CONTRIZOL CREAM 46.6

A050094336 CONTRIZOL CREAM 59

A050094355 CONTRIZOL CREAM 140

A050096100 ETL CAPSULES 200 MG 3.82

A050103100 NISULIN TABLETS 24MG 3.22

A050119100 ANDM EXTENDED RELEASE TABLETS 1.57

A050124163 GUWEI SUSPENSION 20MG/ML 81

A050137255 TECOSID POWDER FOR I.V. INJECTION 0

A050137263 TECOSID POWDER FOR I.V. INJECTION 0

A050137271 TECOSID POWDER FOR I.V. INJECTION 0

A050141321 T.G.B. CREAM 14.3

A050141323 T.G.B. CREAM 15.7

A050141329 T.G.B. CREAM 19.4

A050141330 T.G.B. CREAM 19.4

A050141335 T.G.B. CREAM 34.5

A050141336 T.G.B. CREAM 35.1

A050141338 T.G.B. CREAM 61

A050153100 MENOLON TABLETS 200MG 1.08

A050164209 CEFMAY POWDER FOR INJECTION“TAI YU” 105

A050164212 CEFMAY POWDER FOR INJECTION“TAI YU” 333

A050164277 CEFMAY POWDER FOR INJECTION“TAI YU” 79

A050172100 ANBEINING CAPSULES 1.92

A050176209 CEFEROM POWDER FOR I.V. INJECTION 1GM“TAI YU” 299

A050176212 CEFEROM POWDER FOR I.V. INJECTION 2GM“TAI YU” 565

A050188321 CLENITON GEL 1% 〝S.L.〞 9.1

A050188329 CLENITON GEL 1% 〝S.L.〞 17.1

A050188338 CLENITON GEL 1% 〝S.L.〞 55

A050246151 NOOSAFE 200 MG SOLUTION 32.5

A050253138 SUROTEC SOLUTION 5MG/ML 207

A050258100 STERPINE F.C. TABLETS 10 MG 5.9

A050260100 TONTARIN TABLETS 50MG“S.L”(DICLOFENAC) 0.93

A050339100 ZALE CAPSULES 10MG 3.7

A050424100 VANTYDIN 12 HOUR SR F.C. TABLETS 3.64

A050430100 MEKEI TABLETS 40MG“PANBIOTIC” 11.5

A051028435 SUALLERGIC NASAL SPRAY SOLUTION 65

A051388100 INDAMIDE SR F.C. TABLETS 1.5MG“KINGDOM”(INDAPAMIDE) 2.22

A051391100 CLENSAN TABLETS 16MG 1.44

A051527209 OXACILLIN FOR INJ.1000 MG “GBL” 0

A051527212 OXACILLIN FOR INJ. 2000 MG “GBL” 0

A051527277 OXACILLIN FOR INJ.500 MG “GBL” 0

A051713321 SALISONE OINTMENT 12.6

A051713329 SALISONE OINTMENT 25

A051713335 SALISONE OINTMENT 74

A051713338 SALISONE OINTMENT 81

A051713340 SALISONE OINTMENT 81

A051713343 SALISONE OINTMENT 81

A051719100 PURINOL-300 TABLETS 300MG“ROYAL” 2.74

A051731100 EPILEN F.C. TABLETS 500MG 25.3

A0523571G0 TOLAX TABLETS 400MG(鋁箔/膠箔) 1.5

A052361220 JEITA FOR I.V. INJECTION“UNION” 0

A0523612CX JEITA FOR I.V. INJECTION“UNION” 0

64

Page 65: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A052438148 WITGEN ORAL DROP“LOTUS” 991

A052460100 LIOBIGEN FILM COATED TABLETS“PANBIOTIC” 2.09

A052541100 CAMOSA F.C. TABLET 500MG“UNION” 6.1

A052589100 PIOGO TABLETS 30MG 15

A052613263 TEICOCID LYOPHILIZED FOR IV INJECTION 200MG "BEST" 536

A052618209 OXACILLIN POWDER FOR INJECTION“UNICARE” 0

A052618212 OXACILLIN POWDER FOR INJECTION“UNICARE” 0

A052618265 OXACILLIN POWDER FOR INJECTION“UNICARE” 0

A052618277 OXACILLIN POWDER FOR INJECTION“UNICARE” 0

A054856100 UTAPINE F.C. TABLETS 300MG“UNION” 54

A054860100 EPRAM F.C. TABLETS 20 MG 31.2

A054863100 LOPIRIN ENTERIC-COATED TABLETS 81MG 1

A054972100 MOKAST CHEWABLE TABLETS 5 MG 13.2

A054981321 FLANSON OINTMENT 39.6

A054981329 FLANSON OINTMENT 39.7

A054981335 FLANSON OINTMENT 54

A054981338 FLANSON OINTMENT 76

A054993100 AIDA TABLETS 2MG“H.H.”(BIPERIDEN) 2.03

A055003329 BEING LOTION SOLUTION 1MG/ML 36.5

A055003340 BEING LOTION SOLUTION 1MG/ML 36.5

A055003363 BEING LOTION SOLUTION 1MG/ML 326

A055044100 PLATOUT FILM COATED TABLETS 75MG 35.3

A055286266 HYSON POWDER FOR INJECTION 93

A055290329 MEFREE GEL 0.75% 42.5

A055290335 MEFREE GEL 0.75% 54

A055290338 MEFREE GEL 0.75% 74

A055290343 MEFREE GEL 0.75% 134

A055302100 LIPABO CAPSULES 2.83

A055416100 ON LIVER CAPSULES 1.35

A055899326 FUDOPIN CREAM 50MG/G“PANBIOTIC” 37.2

A055899335 FUDOPIN CREAM 50MG/G“PANBIOTIC” 51

A055915100 KINZAAR F.C. TABLETS 50MG“KINGDOM”(LOSARTAN) 7

A055967100 SIMVA F.C. TABLETS 40MG“UNION” 14.5

A055969255 TEICON POWDER FOR I.V. INJECTION“UNION” 0

A055969263 TEICON POWDER FOR I.V. INJECTION“UNION” 0

A055969271 TEICON POWDER FOR I.V. INJECTION“UNION” 0

A056308100 SUPERCILLIN CAPSULES 500MG 1.29

A056311100 NICORDIL TABLETS 5 MG“S.D.” 4.21

A056650100 CYSERINE CAPSULES 250MG "UNION" 43

A056667100 LECADOPA 25/100 TABLETS 5.4

A056678100 IXEPRAN CAPSULES 50MG "KINGDOM" (MILNACIPRAN) 10.3

A056687209 CEFPIROME POWDER FOR I.V. INJECTION "UNION" 289

A056687212 CEFPIROME POWDER FOE I.V. INJECTION "UNION" 565

A056713312 KOULENING ORALBASE 41

A056713321 KOULENING ORALBASE 52

A056713326 KOULENING ORALBASE 61

A056719100 FUZATAN F.C. TABLETS 50/12.5MG "KINGDOM" 7

A056752100 ASTARIL TABLETS 25MG 1.06

A056760100 LECADOPA 10/100 TABLETS 3.95

A057113321 "SENTAI" COSHIYAN CREAM 14.3

A057113323 "SENTAI" COSHIYAN CREAM 15.7

A057113329 "SENTAI" COSHIYAN CREAM 19.4

A057113330 "SENTAI" COSHIYAN CREAM 19.4

A057113335 "SENTAI" COSHIYAN CREAM 34.5

A057113336 "SENTAI" COSHIYAN CREAM 35.1

65

Page 66: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

A057113338 "SENTAI" COSHIYAN CREAM 61

A057123100 SEDOGREL F.C. TABLETS 75MG "UNION" 35.3

A0571353AK SOFTCAM GEL 10MG/G 39.9

A057139100 SULPIRIDE TABLETS 200MG "LITA" 1.99

A057161135 POLYNISOLONE ORAL SOLUTION "GS" 25

A057161143 POLYNISOLONE ORAL SOLUTION "GS" 34.5

A057161151 POLYNISOLONE ORAL SOLUTION "GS" 58

A057169116 SMECTIN POWDER FOR ORAL SUSPENSION 3G/SACHET 5.3

A057184100 BEGALIN S.C. TABLETS "N.C.P." 0.74

A057202265 MOXACIN INFUSION SOLUTION 400MG/250ML 697

A057253329 HULI GEL 7.5MG/GM "SENTAI" 42.5

A057253330 HULI GEL 7.5MG/GM "SENTAI" 44.8

A057253335 HULI GEL 7.5MG/GM "SENTAI" 54

A057253338 HULI GEL 7.5MG/GM "SENTAI" 74

A057253343 HULI GEL 7.5MG/GM "SENTAI" 134

A057302151 PATADINE ORAL SOLUTION 10MG/ML "CENTER" 32.5

A057302155 PATADINE ORAL SOLUTION 10MG/ML "CENTER" 103

A057323151 NAPOTIN ORAL SUSPENSION "CENTER" 47.4

A057323157 NAPOTIN ORAL SUSPENSION "CENTER" 84

A057373100 SULFIN F.C. TABLETS 200MG (SULFINPYRAZONE) 5.2

A057398209 ARFLIN POWDER FOR I.V. INJECTION "TAI YU" 390

A057398277 ARFLIN POWDER FOR I.V. INJECTION "TAI YU" 242

A057399100 SHITERIN TABLETS 25MG "S.L." 1.06

A057775100 KINCOUGH SUSTAINED RELEASE F.C. TABLET 60MG "KINGDOM"

(DEXTROMETHORPHAN HYDROBROMIDE)

2.16

A057792212 FEVA INJECTION 2% 37.2

A057835321 OMEX CREAM 10MG/GM 54

A057999209 VENAN INJECTGION 1.54

A058000221 VENAN-CALCIUM B6 INJECTION 3.5

A058002221 HISDIN INJECTION 4% 4.69

A058008212 ASCOLIN INJECTION 5.4

A058010212 METALIN-C INJECTION 1.44

A058011209 METHORON INJECTION 6

A058081317 RAXZOR CREAM 5% "Y.C." 17.3

A058118113 INTEMENO GRANULES FOR ORAL SOLUTION 2400MG 8.3

AA10654277 NORM-SALINE INJECTION "OTSUKA"(500ML注射劑裝) 25

AA11711277 10% DEXTROSE INJECTION 25

AA12986277 DEXT-SALINE INJECTION 5:0.3 "OTSUKA" 25

AA19280209 CEFAZOLIN INJECTION 1GM "CHI SHENG" 15.7

AA19280277 CEFAZOLIN INJECTION "CHI SHENG" 15

AA20591277 DEXT-SALINE INJECTION 2.5:0.45 "OTSUKA" 25

AA24516209 "SODIUM CHLORIDE INJECTION 0.9 ""TAI YU"(軟袋裝)。 25.4

AA24516277 SODIUM CHLORIDE INJECTION 0.9% "TAI YU" 25

AA29836209 SALINE INJECTION 0.9% "N.K." (1L) 25.4

AA29836212 SALINE INJECTION 0.9% "N.K." (2L) 72

AA29836255 SALINE INJECTION 0.9% "N.K." (100ML) 22

AA29836265 SALINE INJECTION 0.9% "N.K." (250ML) 22

AA29836277 SALINE INJECTION 0.9% "N.K." (500ML) 25

AA33072212 FAMODINE INJECTION 10MG/ML "N.K." (FAMOTIDINE)【2ML裝】。 34.3

AA36015345 TEIRIA GEL 100MG/GM (ETOFENAMATE)(40GM) 106

AA36176277 0.45% SOLUTIO NATRII CHLORIDI ISOTONICA "CHI-SHENG" 25

AA36418229 DOXOR LYO INJECTION 10MG 515

AA39604209 SALINE INJECTION 0.45% "N.K." 25

AA39604265 SALINE INJECTION 0.45% "N.K." 22

AA39604277 SALINE INJECTION 0.45% "N.K." 25

66

Page 67: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AA42704100 NOBAR TABLETS 5MG (AMLODIPINE BESYLATE)28粒/鋁箔盒裝 6.8

AA43124429 VOLEN OPHTHALMIC SOLUTION 0.1% "WINSTON"(DICLOFENAC SODIUM) 85

AA44598309 NORMAL SALINE SOLUTION "N.K." 24.1

AA44598312 NORMAL SALINE SOLUTION "N.K." 55

AA44598377 NORMAL SALINE SOLUTION "N.K." 18.4

AA45670100 NOVA TABLETS (28粒/鋁箔盒裝) 6.8

AA46640100 GRUMED TABLETS 2MG "STANDARD"(30粒/鋁箔盒裝) 3.44

AA47469100 ARCDONE F.C. TABLETS 5 MG(28粒/鋁箔盒裝)。 76

AA47644100 VALOSINE S.R. CAPSULES 75MG(28粒/鋁箔盒裝) 19.9

AA47702100 ANXOKAST CHEWABLE TABLET 5MG(28粒/鋁箔盒裝) 18.8

AA47792151 LACTULOSE LIQUID "SHUN HWA"(60ML/塑膠瓶裝) 25.7

AA47813100 ANXOKAST F.C. TABLETS 10MG(28粒/鋁箔盒裝) 25.3

AA47895263 TEICOD FOR INJECTION 200MG 728

AA47960100 ANXOKAST CHEWABLE TABLETS 4MG(28粒/鋁箔盒裝) 17.3

AA48007100 PIOGLIT TABLETS 30MG "STANDARD" (PIOGLITAZONE)(30粒/鋁箔盒裝) 22

AA48161145 Sodium Valproate Oral Solution 200mg/ml "Center" (Sodium

Valproate)

237

AA48161154 SODIUM VALPROATE ORAL SOLUTION 200MG/ML "CENTER" (SODIUM

VALPROATE)

514

AA48334100 SMILON F.C. TABLETS 30MG(30粒/鋁箔盒裝)。 21.2

AA48352143 SERIDOL ORAL SOLUTION 1MG/ML "CENTER"(30ML/塑膠瓶裝) 789

AA48661100 ESCIPRO F.C. TABLETS 20 MG “D.T.” (30粒/鋁箔盒裝) 37.6

AA48730100 THROMBIFREE F.C. TABLETS 75 MG(28粒/鋁箔盒裝) 45.8

AA48757100 HYSARTAN F.C. TABLETS 50/12.5MG(28粒/鋁箔盒裝) 9.3

AA48879100 ANXOLIPO F.C. TABLET 10 MG,30粒/鋁箔/膠箔盒裝 19.3

AA49061100 RELINIDE TABLETS 1MG“STANDARD”(REPAGLINIDE)(120粒/鋁箔盒裝) 3.38

AA49097100 AMILLIAN TABLETS 200 MG 〝D.T.〞(30粒鋁箔盒裝) 30.7

AA49116100 PIOTAS TABLETS 30 MG ”P.L.”(30粒/鋁箔盒裝) 22

AA49226100 ANXOLIGHTOR F.C. TABLETS 20 MG (30粒/鋁箔盒裝) 29.8

AA49288100 ANXOLIPO F.C TABLETS 40MG(30粒/鋁箔/膠箔盒裝) 33.9

AA49344100 CARVETONE F.C. TABLETS 75 MG(28粒/鋁箔盒裝) 45.8

AA49429100 U-CHU PIOZON TABLETS 30 MG(30粒/鋁箔盒裝) 21.7

AA49453100 EASYFOR SR CAPSULES 75MG(28粒/鋁箔盒裝) 19.6

AA49500100 PIOTAS TABLETS 15 MG“P.L.”(30粒/鋁箔盒裝) 15.7

AA49543100 ATORIN F.C. TABLET 10MG(28粒/鋁箔盒裝) 19.3

AA49583100 RAFAX XR CAPSULES 75 MG(28粒/鋁箔盒裝) 19.6

AA49610100 COXCO F.C.TABLETS 50MG(28TABLETS/鋁箔盒裝) 9.3

AA49629100 LEEYO F.C. TABLETS 10 MG(28粒/鋁箔盒裝) 21

AA49835100 LOWTAN F.C. TABLETS 50MG“C.H.”(28粒/鋁箔盒裝) 9.3

AA49920100 XADOSIN SR F.C. TABLETS 4 MG(28粒/鋁箔盒裝) 14.9

AA49930100 GLITIS TABLETS 30MG (30粒裝/鋁箔膠箔) 21.7

AA50126100 CLOGREL FILM COATED TABLETS 75MG (CLOPIDOGREL) (28粒/鋁箔盒裝) 45.8

AA52337100 GLUFAST TABLET 10MG (84粒/鋁箔盒裝) 3.86

AA52339219 BOLENIC FOR SOLUTION FOR IV INFUSION 4 MG (凍晶注射劑附加注射

用水)

11032

AA52530100 ATORIN F.C. TABLETS 20MG(28粒/鋁箔盒裝) 29.2

AA55020219 ZOBONIC LYOPHILIZED POWDER FOR SOLUTION FOR I.V. INFUSION 4MG 11032

AA55113206 ISOTERA CONCENTRATE FOR INFUSION 40MG/ML 4322

AA55113212 ISOTERA CONCENTRATE FOR INFUSION 40MG/ML 16298

67

Page 68: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AA55268100 ATORVA FILM-COATED TABLETS 40MG“STANDARD”(ATORVASTATIN)(28粒

/鋁箔盒裝)

33.9

AA55272100 ATORVA FILM-COATED TABLETS 10MG “STANDARD”(ATORVASTATIN)(30

粒/鋁箔盒裝)

19.3

AA55417100 EASYFOR SR CAPSULES 37.5MG(28粒/鋁箔盒裝) 16.3

AA55545261 LEVOFLOXACIN I.V. SOLUTION FOR INFUSION 5MG/ML“CHI SHENG”(玻

璃瓶裝)

816

AA55555100 ANOTROLE F.C. TABLETS 1MG“P.L.”(30粒/鋁箔盒裝)。 81

AA55904100 ARIZOLE TABLETS 10 MG (30粒/鋁箔盒裝) 80

AA56318100 PREVAN FILM-COATED TABLETS 160MG(28粒/鋁箔盒裝) 12.7

AA56320100 PREVAN FILM-COATED TABLETS 80MG(28粒/鋁箔盒裝) 10.1

AA56639100 ESCITALO F.C. TABLETS 10MG(28粒/鋁箔盒裝) 21

AA56670100 VOSAA F.C. TABLETS 80MG(28粒鋁箔盒裝) 10.1

AA56672206 DOFOR CONCENTRATE FOR INFUSION 40MG/ML 4322

AA56672212 DOFOR CONCENTRATE FOR INFUSION 40MG/ML 16298

AA56680100 OLAN ORALLY DISINTEGRATING TABLETS 5MG(28粒/鋁箔盒裝) 67

AA56689100 IBESAA F.C. TABLETS 150MG 9.2

AA56739100 ANXOLIPO F.C. TABLETS 20MG(30粒/鋁箔盒裝) 29.8

AA56761100 MIRTAZAPINE F.C. TABLETS 30MG "CYH"(30粒/鋁箔盒裝) 21.2

AA56776100 DUXETINE CAPSULES 30MG(28粒/鋁箔盒裝) 27

AA56800100 APA-MIRTAZAPINE O.D.T. 30MG (30粒/鋁箔盒裝) 21.2

AA57103100 LOSARTAN F.C. TABLETS 50MG "CYH" (28粒/鋁箔膠箔) 9.3

AA57140100 CLOFREE F.C. TABLETS 75MG "YU SHENG"(30粒/鋁箔盒裝) 46.9

AA57191255 "LEXACIN I.V. SOLUTION FOR INFUSION 5MG/ML ""TAI

YU"(100ML/BOTTLE)

1024

AA57237100 LOSA&HYDRO F.C. TABLETS 50/12.5MG "CYH" (28粒/鋁箔膠箔) 9.3

AA57318100 IBESAA F.C. TABLETS 300MG 15.9

AA57320100 ARIPIPRAZOLE TABLETS 10MG "GENOVATE"(28粒/鋁箔盒裝) 80

AA57321100 OLAN ORALLY DISINTEGRATING TABLETS 10MG【28粒/鋁箔盒裝】 128

AA57343100 VOSAA F.C. TABLETS 160MG(28粒/鋁箔盒裝) 12.7

AA57372100 PITATOR TABLETS 2MG(28粒/鋁箔盒裝) 19.7

AA57380100 VALSARDIN FILM COATED TABLETS 160MG "YUNG SHIN" (28粒鋁箔盒裝) 12.7

AA57381100 VALSARDIN FILM COATED TABLETS 80MG "YUNG SHIN" (28粒鋁箔盒裝) 10.1

AA57409100 UBIXA FILM COATED TABLETS 10MG (28粒/鋁箔盒裝) 128

AA57743100 DUXETINE CAPSULES 60MG(28粒/鋁箔盒裝) 47.3

AA57769100 GLITOS TABLETS 15MG(30粒/鋁箔盒裝) 15.4

AA57770145 DUASMA HFA 200 (BUDESONIDE 200MCG) INHALER 394

AA57774100 ATOVER F.C. TAB. 10MG "P.L."(30粒/鋁箔盒裝) 19.3

AA57786100 BECAVIR F.C. TABLETS 0.5MG(30粒/鋁箔盒裝) 155

AA57802100 ROTY F.C. TABLETS 10MG(28粒/鋁箔盒裝) 23.5

AA57805100 ATORVA F.C. TAB. 20MG "STANDARD" (ATORVASTATIN)(30粒/鋁箔盒裝) 29.8

AA57843100 ROTY F.C. TABLETS 5MG(28粒/鋁箔盒裝) 21.8

AA579194E5 TRISONIN AQUEOUS NASAL SPRAY 55 MCG/DOSE 221

AA57950100 ATOVER F.C. TABLETS 20MG "P.L."(30粒/鋁箔盒裝) 29.2

AA57956221 LEVETIR CONCENTRATE FOR SOLUTION FOR INFUSION 100MG/ML 414

AA57974100 PANTYL GASTRO-RESISTANT TABLETS 40MG(14粒/鋁箔盒裝) 18.4

AA57995100 OLIPINE ORALLY DISINTEGRATING TABLETS 10MG "TAI YU"(28粒/鋁箔

盒裝)

128

AA58055100 APA-BILY TABLETS 10MG(30粒/鋁箔盒裝) 82

AA58570100 ASARTAN F.C. TABLETS 5/80MG (30粒/鋁箔盒裝) 17

AB01641100 CYTADINE TABLETS 4MG 1.5

AB01673100 CINNAZINE TABLETS 1.5

68

Page 69: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB016731G0 CINNAZINE TABLETS((鋁箔/膠箔) 2

AB02368100 NADIS TABLETS 1.5

AB023681G0 NADIS TABLETS(鋁箔/膠箔) 2

AB03318100 PROMERAN F.C. TABLETS 3.84MG 1.5

AB033181G0 PROMERAN F.C. TABLETS 3.84MG (鋁箔/膠箔) 2

AB03552212 PROMERAN INJECTION 15

AB07140100 CHLORZOXAZONE TABLETS "VPP" 1.5

AB071401G0 CHLORZOXAZONE TABLETS "VPP"(鋁箔/膠箔) 2

AB07641100 DELCOPAN TABLETS 30MG 1.5

AB08642209 FUCON INJECTION 15

AB08774100 PONSTAN F.C. TABLETS 1.5

AB09102100 PROPRANOLOL TABLETS 10MG 1.5

AB091021G0 PROPRANOLOL TABLETS 10MG (鋁箔/膠箔) 2

AB14154100 ALLOPURINOL TABLETS "STANDARD" 1.5

AB141541G0 ALLOPURINOL TABLETS "STANDARD" (鋁箔/膠箔) 2

AB14184100 PREDNISOLONE TABLETS "WINSTON" 1.5

AB14422143 CYTADINE SYRUP 0.4MG/ML"STANDARD" 25

AB14422151 CYTADINE SYRUP 0.4MG/ML"STANDARD" 25

AB14422157 CYTADINE SYRUP 0.4MG/ML"STANDARD" 25

AB15842209 CEFAZOLIN INJECTION 1GM "YUNG SHIN" 15.7

AB16887209 "ANTITUSSIVE INJECTION (DEXTROMETHORPHAN) ""TAI YU" 15

AB18251100 CARDIOLOL TABLETS 10MG (PROPRANOLOL) 1.5

AB182511G0 CARDIOLOL TABLETS 10MG (PROPRANOLOL)(鋁箔/膠箔) 2

AB19505209 BUTYSCOL INJECTION "STANDARD" (SCOPOLAMINE) 15

AB19877100 EPBUTOL TABLETS "YU SHENG" (ETHAMBUTOL) 2.61

AB20333100 VOREN ENTERIC COATED TABLETS "YUNG SHIN" (DICLOFENAC) 1.5

AB203331G0 VOREN ENTERIC COATED TABLETS "YUNG SHIN" (DICLOFENAC)(鋁箔/膠

箔)

2

AB20785212 VOREN INJECTION (DICLOFENAC) "YUNG SHIN" 15

AB20785216 VOREN INJECTION (DICLOFENAC) "YUNG SHIN" 15

AB21199100 SULPIRIDE CAPSULES "JOHNSON" 1.66

AB211991G0 SULPIRIDE CAPSULES "JOHNSON"(鋁箔/膠箔) 2

AB22345100 TAMEDIN F.C. TABLETS "STANDARD" (CIMETIDINE) 1.5

AB223451G0 TAMEDIN F.C. TABLETS "STANDARD" (CIMETIDINE)(鋁箔/膠箔) 2

AB22903100 GASTRODIN TABLETS 200MG (CIMETIDINE) 1.5

AB229031G0 GASTRODIN TABLETS 200MG (CIMETIDINE))(鋁箔/膠箔) 2

AB22908100 SPIRONOLACTONE TABLETS "S.C." 1.5

AB229081G0 SPIRONOLACTONE TABLETS "S.C."(鋁箔/膠箔) 2

AB23008100 "CIMETIN TABLETS (CIMETIDINE) ""TAI YU" 1.5

AB23048209 CEZOLIN INJECTION 1GM "SWISS" 15.7

AB23435216 STAREN INJECTION "N.K." (DICLOFENAC) 15

AB24197100 DICLOFENAC E.F.C. TABLETS 25MG"CHINTENG" 1.5

AB241971G0 DICLOFENAC E.F.C. TABLETS 25MG"CHINTENG" (鋁箔/膠箔) 2

AB24516255 "SODIUM CHLORIDE INJECTION 0.9 ""TAI YU"。 22

AB24516265 "SODIUM CHLORIDE INJECTION 0.9 ""TAI YU"。 22

AB24924216 DICLOFENAC SODIUM INJECTION 25MG/ML "S.Y." 15

AB25402100 SOLACON TABLETS 200MG (CHLORZOXAZONE) "STANDARD" 1.5

AB254021G0 SOLACON TABLETS 200MG (CHLORZOXAZONE) "STANDARD"(鋁箔/膠箔) 2

AB25524100 VOREN ENTERIC COATED TABLETS 50MG "YUNG SHIN 1.5

AB255241G0 VOREN ENTERIC COATED TABLETS 50MG "YUNG SHIN"(鋁箔/膠箔) 2

AB25682500 ECONAZOLE NITRATE SUPPOSITORIES 150MG "YUNG SHIN" 12

AB26442100 ANPIN CAPSULES 15MG(SEAPROSE-S) 6.3

AB26462209 PROGESTERONE INJECTION 50MG/ML "TAI YU" 15

AB26462229 PROGESTERONE INJECTION 50MG/ML "TAI YU" 32.9

69

Page 70: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB26653100 DIFENA ENTERIC F.C. TABLETS 25MG "STANDARD" (DICLOFENAC) 1.5

AB27082100 SECORIN CAPSULES 10MG "STANDARD"(OXAZOLAM) 1.62

AB270821G0 SECORIN CAPSULES 10MG (OXAZOLAM) "STANDARD"(鋁箔/膠箔) 2

AB27629100 VOLBRO CAPSULES 2.5MG (BROMOCRIPTINE) 6.9

AB27812212 TAMEDIN INJECTION 100MG/ML "STANDARD"(CIMETIDINE) 15

AB27928212 ROSIS IV INJECTION "VPP" 15

AB28041100 AMIORONE TAB. 200MG (AMIODARONE) 6.6

AB28476100 "ANTITUSSIVE TABLETS 30MG (DEXTROMETHORPHAN) ""TAI YU" 1.5

AB28533100 NOOBICA CAPSULES 400MG "YU SHENG" (PIRACETAM) 1.5

AB285331G0 NOOBICA CAPSULES 400MG "YU SHENG" (PIRACETAM) 2

AB28576216 DIFENA INJECTION 25MG/ML "STANDARD" (DICLOFENAC) 15

AB28649100 SECORIN S.C.TABLET 10MG "STANDARD" (OXAZOLAM) 1.62

AB286491G0 SECORIN S.C.TABLET 10MG "STANDARD" (OXAZOLAM)(鋁箔/膠箔) 2

AB28656500 VOREN SUPPOSITORIES 12.5MG (DICLOFENAC) 5

AB28921100 PICETAM CAPSULES 400MG "STANDARD" (PIRACETAM) 1.5

AB289211G0 PICETAM CAPSULES 400MG "STANDARD" (PIRACETAM)(鋁箔/膠箔) 2

AB29442100 AMANDIN CAPSULES 100MG "YU SHENG" (AMANTADIN) 7.4

AB29443100 TENOL TABLETS 100MG "Y.S." (ATENOLOL) 1.6

AB294431G0 TENOL TABLETS 100MG "Y.S."(ATENOLOL)(鋁箔/膠箔) 2

AB29447209 CEFA INJECTION 15.7

AB29447212 CEFA INJECTION 61

AB29447277 CEFA INJECTION 15

AB29478100 UROSIN FILM COATED TABLETS 100MG (ATENOLOL) 1.6

AB294781G0 UROSIN FILM COATED TABLETS 100MG (ATENOLOL)(鋁箔/膠箔) 2

AB29551100 YUPIN CAPSULES 10MG "YU SHENG" (OXAZOLAM) 1.62

AB29581100 DICENS TABLETS 50MG (DICLOFENAC) 1.5

AB29905100 NOSPAN TABLETS 30MG (DEXTROMETHORPHAN) 1.5

AB29987100 DOMPEDON F.C. TAB. 10MG (DOMPERIDONE)"STANDARD" 1.5

AB30119100 POTARLON FILM COATED TABLETS 500MG (MEFENAMIC ACID) 1.5

AB30122100 POTARLON CAPSULES 250MG (MEFENAMIC ACID) 1.5

AB301221G0 POTARLON CAPSULES 250MG (MEFENAMIC ACID)(鋁箔/膠箔) 2

AB30647500 DIFENA SUPP. 12.5MG "STANDARD" (DICLOFENAC SODIUM) 5

AB30651500 DIFENA SUPP. 25MG "STANDARD" (DICLOFENAC SODIUM) 5

AB30749100 RASITOL TABLETS 40MG (FUROSEMIDE) 1.5

AB307491G0 RASITOL TABLETS 40MG (FUROSEMIDE)(鋁箔/膠箔) 2

AB30917100 DIFENA ENTERIC F.C.TAB. 50MG "STANDARD" (DICLOFENAC) 1.5

AB30970100 MEZIDE TABLETS 80MG "M.S."(GLICLAZIDE) 1.5

AB30999100 PETHO S.C. TABLETS 10MG (PIPETHANATE ETHOBROMIDE)"STANDARE" 1.53

AB309991G0 PETHO S.C. TABLETS 10MG "STANDARE" (PIPETHANATE

ETHOBROMIDE)(鋁箔/膠箔)

2

AB31034377 NORMAL SALINE SOLUTION "OTSUKA" 18.4

AB31086329 SEPTON SOL (BETAMETHASONE DIPROPIONATE) "SHIONOGI" 111

AB31138100 BEFAT F.C. TAB. 200MG "STANDARD" (BEZAFIBRATE) 6.5

AB31176500 VOREN SUPPOSITORIES 25MG (DICLOFENAC) 5

AB31295100 SEANTO CAPSULES 10MG (OXAZOLAM) "KOJAR" 1.62

AB312951G0 SEANTO CAPSULES 10MG (OXAZOLAM) "KOJAR"(鋁箔/膠箔) 2

AB31327212 VESYCA INJECTION 25MG/ML (RANITIDINE) 24.7

AB31447100 SUPERFECT FILM COATING TABLETS 50MG (DICLOFENAC) 1.5

AB31596100 LICODIN F.C. TABLET 100MG (TICLODINE) 4.61

AB31608500 DOMPEDON SUPPOSITORY 10MG "STANDARD" (DOMPERIDONE) 5

AB31881500 VOTALIN SUPPOSITORY 12.5MG (DICLOFENAC SODIUM) "P.L." 5

AB31889100 HESOR TABLETS 30MG "YU SHENG" (DILTIAZEM HYDROCHLORIDE) 1.5

AB31896100 MUSCO TABLETS 30MG "STANDARD" (AMBROXOL HYDROCHLORIDE) 1.5

70

Page 71: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB318961G0 MUSCO TABLETS 30MG "STANDARD" (AMBROXOL HYDROCHLORIDE)(鋁箔/膠

箔)

2

AB31990100 FENCAINE TABLETS 10MG (OXETHAZAINE)"Y.S." 1.5

AB319901G0 FENCAINE TABLETS 10MG (OXETHAZAINE)"Y.S." (鋁箔膠箔) 2

AB32309100 SOCAINE TABLET 1.5

AB323091G0 SOCAINE TABLET(鋁箔/膠箔) 2

AB32312100 PURFEN F.C. TABLET 400MG "PURZER" (IBUPROFEN) 1.5

AB323121G0 PURFEN F.C. TABLET 400MG "PURZER" (IBUPROFEN)(鋁箔/膠箔) 2

AB32315100 DUOCER F.C TABLET 200MG "PURZER" (CIMETIDINE) 1.5

AB323151G0 DUOCER F.C TABLET 200MG "PURZER" (CIMETIDINE)(鋁箔/膠箔) 2

AB32322100 TENOLOL F.C TABLET 100MG (ATENOLOL) "PURZER" 1.6

AB323221G0 TENOLOL F.C TABLET 100MG "PURZER"(ATENOLOL) (鋁箔/膠箔) 2

AB32506100 PIPETO F.C. TAB. 10MG "STANDARD" (PIPERILATE ETHOBROMIDE) 1.53

AB325061G0 PIPETO F.C. TAB. 10MG "STANDARD" (PIPERILATE ETHOBROMIDE)(鋁箔

/膠箔)

2

AB32549209 STAZOLIN INJ. "STANDARD" (CEFAZOLIN) 15.7

AB32549277 STAZOLIN INJ. "STANDARD" (CEFAZOLIN) 15

AB32576216 PAINSTOP INJECTION 25MG/ML (DICLOFENAC) 15

AB32648100 VESYCA FILM COATED TABLETS 150MG (RANITIDINE HYDROCHLORIDE) 1.85

AB326481G0 VESYCA FILM COATED TABLETS 150MG (RANITIDINE HYDROCHLORIDE)(鋁

箔/膠箔)

2

AB32814100 MERO TABLETS 30MG 1.5

AB32926100 DICLOFENAC E.F.C. TABLETS 50MG "CHINTENG" 1.5

AB329261G0 DICLOFENAC E.F.C. TABLETS 50MG "CHINTENG"(鋁箔/膠箔) 2

AB32990238 FADIN LYO-INJECTION 20MG "STANDARD" (FAMOTIDINE) 34.3

AB33029100 ATEOL F.C.TAB. 100MG (ATENOLOL) "STANDARD" 1.6

AB330291G0 ATEOL F.C. TAB. 100MG "STANDARD" (ATENOLOL) (鋁箔/膠箔) 2

AB33064100 IBUPROFEN F.C. TABLETS 400MG "KOJAR" 1.5

AB330641G0 IBUPROFEN F.C. TABLETS 400MG "KOJAR"(鋁箔/膠箔) 2

AB33072219 FAMODINE INJECTION 10MG/ML "N.K." 39.4

AB33072229 FAMODINE INJECTION 10MG/ML "N.K." 44.8

AB33091100 LICODIN F.C.TABLET 250MG (TICLOPIDINE) 4.67

AB33124100 ANLIPIN F.C. TABLETS 100MG (ATENOLOL) "KOJAR" 1.6

AB331241G0 ANLIPIN F.C. TABLETS 100MG (ATENOLOL) "KOJAR"(鋁箔/膠箔) 2

AB33128100 MEFENA F.C.TABLETS 500MG"KOJAR" 1.5

AB331281G0 MEFENA F.C. TABLETS 500MG"KOJAR" (MEFENAMIC ACID)(鋁箔/膠箔) 2

AB33411100 ANCOU TABLETS 30MG "KOJAR" (DEXTROMETHORPHAN) 1.5

AB334111G0 ANCOU TABLETS 30MG "KOJAR"(DEXTROMETHORPHAN)(鋁箔/膠箔) 2

AB33540100 RECEF CAPSULE 250MG "PURZER" (CEPHRADINE) 1.93

AB33541421 ORALOG ORABASE 1MG/GM (TRIAMCINOLONE)"PURZER" 28.4

AB33541423 ORALOG ORABASE 1MG/GM "PURZER"(TRIAMCINOLONE) 42.7

AB33544100 MEPHAN TABLET 30MG "PURZER" (DEXTROMETHORPHAN) 1.5

AB33545100 CLOFEN E.C TABLET 50MG "PURZER" (DICLOFENAC) 1.5

AB33546100 CLOFEN E.C TABLET 25MG "PURZER" (DICLOFENAC) 1.5

AB33571248 RND LYO-INJECTION 50MG "STANDARD" (RANITIDINE) 24.7

AB33698209 VETERIN (CEFAZOLIN) FOR INJECTION "VPP" 15.7

AB33698277 VETERIN (CEFAZOLIN) FOR INJECTION "VPP" 15

AB33699100 VOREN ENTERIC-MICROENCAPSULATED CAPSULES 50MG (DICLOFENAC) 1.5

AB336991G0 VOREN ENTERIC-MICROENCAPSULATED CAPSULES 50MG (DICLOFENAC)(鋁

箔/膠箔)

2

AB33829100 MOTON TABLETS 500MG "YU SHENG" (MEFENAMIC ACID) 1.5

71

Page 72: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB33945216 VOTAN INJECTION 25MG/ML 15

AB33947100 EMETROL TABLET 10MG (DOMPERIDONE) "PURZER" 1.5

AB339471G0 EMETROL TABLET 10MG (DOMPERIDONE) "PURZER""(鋁箔/膠箔) 2

AB34032209 CHEF FOR INJECTION "PURZER" (CEFTRIAXONE) 193

AB34032277 CHEF FOR INJECTION (CEFTRIAXONE) "PURZER" 100

AB34087100 RND F.C. TABLETS 150MG "STANDARD"(RANITIDINE) 1.85

AB340871G0 RND F.C. TABLETS 150MG (RANITIDINE) "STANDARD"(鋁箔/膠箔) 2

AB34096100 GLUCOMINE F.C. TABLETS 500MG "P.L"(METFORMIN) 1.5

AB340961G0 GLUCOMINE F.C. TABLETS 500MG"P.L"( (METFORMIN) 鋁箔/膠箔) 2

AB34110100 AMANTADINE F.C. TABLETS 100MG "KOJAR" 7.4

AB34331209 CEBID FOR INJECTION (CEFOPERAZONE) "PURZER" 241

AB34331277 CEBID FOR INJECTION (CEFOPERAZONE) "PURZER" 104

AB34359100 STERMIN F.C. TABLETS 100MG (ATENOLOL) "S.T." 1.6

AB343591G0 STERMIN F.C. TABLETS 100MG "S.T." (ATENOLOL)(鋁箔/膠箔) 2

AB34364100 PENTOP S.C. TABLETS 100MG (PENTOXIFYLLINE) "Y.S" 1.57

AB34736100 GLICALIN TABLETS 80MG "KOJAR" (GLICLAZIDE) 1.5

AB347361G0 GLICALIN TABLETS 80MG "KOJAR"(GLICLAZIDE)(鋁箔/膠箔) 2

AB348041G0 IPROFEN TABLETS 400MG (IBUPROFEN)"MACRO"(鋁箔/膠箔) 2

AB35054100 LEFENINE F.C.TABLETS 50MG"C.H." (FLURBIPROFEN) 1.54

AB350541G0 LEFENINE F.C.TABLETS 50MG (FLURBIPROFEN) "C.H."(鋁箔/膠箔) 2

AB35169500 CAMAZOLE VAGINAL TABLET 100MG (CLOTRIMAZOLE) "PURZER" 9

AB35179100 LEFENINE F.C. TABLETS 100MG "C.H."(FLURBIPROFEN) 3.54

AB35665100 GLUCOMINE F.C. TABLETS 250MG (METFORMIN) "P.L." 1.5

AB356651G0 GLUCOMINE F.C. TABLETS 250MG "P.L."(METFORMIN)(鋁箔/膠箔) 2

AB35680321 S.Z. CREAM 0.5MG/G "STANDARD" (CLOBETASOL) 15.8

AB35680329 S.Z. CREAM 0.5MG/G "STANDARD" (CLOBETASOL) 17.7

AB35833309 NORMAL SALINE SOLUTION "CHI SHENG" 24.1

AB35833377 NORMAL SALINE SOLUTION "CHI SHENG" 18.4

AB36015338 TEIRIA GEL 100MG/GM (ETOFENAMATE) 35.6

AB36082100 CERO CAPSULES 250MG (CAFACLOR) "S.T." 3.63

AB361291G0 ATENOLOL F.C. TABLETS 50MG "JOHNSON"(鋁箔/膠箔) 2

AB36130100 ATENOLOL F.C. TABLETS 100MG "JOHNSON" 1.6

AB361301G0 ATENOLOL F.C. TABLETS 100MG "JOHNSON" (鋁箔/膠箔) 2

AB36176209 0.45% SOLUTIO NATRII CHLORIDI ISOTONICA "CHI-SHENG" 25

AB36247100 TAMEDIN F.C. TABLET 400MG (CIMETIDINE) "STANDARD" 1.5

AB362471G0 TAMEDIN F.C. TABLET 400MG (CIMETIDINE) "STANDARD"(鋁箔/膠箔) 2

AB36248100 L.F.N. TABLET "C.H." 100MG (FLURBIPROFEN) 3.54

AB36485100 FUKON TABLETS 50MG (FLURBIPROFEN)"KOJAR" 1.54

AB364851G0 FUKON TABLETS 50MG (FLURBIPROFEN)"KOJAR"(鋁箔/膠箔) 2

AB36534100 NOOJOHN CAPSULES 400MG. (PIRACETAM) "JOHNSON" 1.5

AB365341G0 NOOJOHN CAPSULES 400MG. (PIRACETAM) "JOHNSON"(鋁箔/膠箔) 2

AB36751209 SINTRIX FOR INJECTION 1G (CEFTRIAXONE) 193

AB36751212 SINTRIX FOR INJECTION 2G (CEFTRIAXONE) 660

AB36751277 SINTRIX FOR INJECTION 500MG (CEFTRIAXONE) 100

AB36788100 CAPDON TABLETS 25MG "STANDARD" (CAPTOPRIL) 1.57

AB367881G0 CAPDON TABLETS 25MG "STANDARD" (CAPTOPRIL)(鋁箔/膠箔) 2

AB36869100 FAMODINE F.C. TABLETS 40MG (FAMOTIDINE) "N.K." 5.7

AB37126221 ANPO INJECTION 10MG/ML "S.T" (RITODRINE HYDROCHLORIDE) 65

AB37196100 ANPO TABLETS 10MG 5.6

AB37550212 AMINFEC INJECTION 125MG/ML "STANDARD" (AMIKACIN) 32.3

AB37577100 ERA TABLET 0.25MG "T.T.Y." (FLUDIAZEPAM) 2.71

AB37601100 WELIZEN F.C. TABLETS 20MG "N.K." 1.92

72

Page 73: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB376011G0 WELIZEN F.C.TABLETS 20MG "N.K"(鋁箔/膠箔) 2

AB37608100 PIRACETAM CAPSULES 400MG "KOJAR" (PIRACETAM) 1.5

AB376081G0 PIRACETAM CAPSULES 400MG "KOJAR" (PIRACETAM)(鋁箔/膠箔) 2

AB38016100 GEM-S F.C. TABLETS 600MG "S.T." (GEMFIBROZIL) 2.68

AB38019100 VOREN SR FILM COATED TABLETS 100MG (DICLOFENAC) 2.97

AB38075351 CORTEMA ENEMA 1.667MG/ML "PURZER" (HYDROCORTISONE) 67

AB38213100 SINFLO F.C.TAB. 200MG 2.95

AB38288312 DEHERP CREAM 5% "STANDARD"(ACYCLOVIR) 17.3

AB38288321 DEHERP CREAM 5% "STANDARD" (ACYCLOVIR) 46.6

AB38288329 DEHERP CREAM 5% "STANDARD" (ACYCLOVIR) 46.6

AB38332100 UCLOR CAPSULES 250MG (CEFACLOR) 3.63

AB38554100 SINFLO F.C.TAB. 100MG 1.85

AB38574100 POTARLON TABLETS 250MG (MEFENAMIC ACID) 1.5

AB38600100 HESOR TABLETS 60MG (DILTIAZEM HYDROCHIORIDE) "YU SHENG" 2.93

AB38605100 FADIN F.C. TABLET 20MG "STANDARD" (FAMOTIDINE) 1.92

AB386051G0 FADIN F.C. TABLET 20MG (FAMOTIDINE) "STANDARD"(鋁箔/膠箔) 2

AB38610100 BETAFORM F.C. TABLETS (METFORMIN)"M.T." 1.5

AB386101G0 BETAFORM F.C. TABLETS (METFORMIN)"M.T."(鋁箔/膠箔) 2

AB38685100 POTARLON TABLETS 500MG (MEFENAMIC ACID) 1.5

AB38710100 VESYCA FILM COATED TABLETS 300MG (RANITIDINE HYDROCHLORIDE) 5.3

AB38843212 CEFMORE INJECTION "SWISS" (CEFOXITIN SODIUM) 216

AB38867100 ATEOL F.C. TABLETS 50MG "STANDARD" (ATENOLOL) 1.56

AB388671G0 ATEOL F.C. TABLETS 50MG "STANDARD" (ATENOLOL)(鋁箔/膠箔) 2

AB38927323 ZOPES CREAM 50MG/GM "PURZER" (ACYCLOVIR) 46.6

AB39013100 MECO TABLETS 30MG (DEXTROMETHORPHAN) "CHINTENG" 1.5

AB39701151 LACTUL SYRUP 666MG/ML (LACTULOSE) "SINPHAR" 25.7

AB39701166 LACTUL SYRUP 666MG/ML "SINPHAR" (LACTULOSE) 164

AB39701177 LACTUL SYRUP 666MG/ML "SINPHAR" (LACTULOSE) 192

AB39816100 ANLIPIN F.C. TABLETS 50MG (ATENOLOL) "KOJAR" 1.56

AB398161G0 ANLIPIN F.C. TABLETS 50MG (ATENOLOL) "KOJAR"(鋁箔/膠箔) 2

AB39894248 CALCININ INJECTION 50I.U./ML "PURZER" (SALMON CALCITONIN) 101

AB40046100 MINOCYCINE CAP.50MG "KOJAR" 3.68

AB40116255 CALCININ INJECTION 100IU/ML "PURZER" (SALMON CALCITONIN) 141

AB40119100 BENTOMIN TABLETS 850MG "S.C." (METFORMIN) 2.23

AB40517100 TENCAM F.C. TABLETS 20MG "STANDARD" (TENOXICAM) 4.78

AB40583100 GLUZIDE TABLETS 80MG "STANDARD" (GLICLAZIDE) 1.5

AB405831G0 GLUZIDE TABLETS 80MG "STANDARD" (GLICLAZIDE)(鋁箔/膠箔) 2

AB40644100 MINOCYCLINE CAPSULES 100MG "KOJAR" 5.9

AB408351G0 MEFORIN F.C. TABLETS 500MG "JOHNSON" (METFORMIN)(鋁箔/膠箔) 2

AB40982209 CEXITIN FOR INJECTION 1GM "PURZER"(CEFOXITIN) 113

AB40983100 U-CA SOFT CAPSULES 0.5MCG "SINPHAR" (CALCITRIOL) 5.1

AB41037229 LIPO-DOX LIPOSOME INJECTION 2MG/ML (DOXORUBICIN HCL) 12226

AB41070100 KANPO CAPSULES 50MG "KOJAR" (SULPIRIDE) 1.66

AB410701G0 KANPO CAPSULES 50MG "KOJAR"(SULPIRIDE)(鋁箔/膠箔) 2

AB41226100 TRAND CAPSULES 250MG "STANDARD"(TRANEXAMIC ACID) 1.52

AB412261G0 TRAND CAPSULES 250MG "STANDARD"(TRANEXAMIC ACID) (鋁箔/膠箔) 2

AB41233100 GLUBIN F.C. TABLET 500MG "PURZER"(METFORMIN) 1.5

AB412331G0 GLUBIN F.C. TABLET 500MG"PURZER"(METFORMIN)(鋁箔/膠箔) 2

AB41236151 MUSCO SOLUTION 3MG/ML "STANDARD" (AMBROXOL) 25

AB41236155 MUSCO SOLUTION 3MG/ML "STANDARD" (AMBROXOL) 25

AB41236157 MUSCO SOLUTION 3MG/ML "STANDARD" (AMBROXOL) 72

AB41332100 LIPDOWN CAP. 300MG "STANDARD" (GEMFIBROZIL) 1.52

73

Page 74: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB413321G0 LIPDOWN CAPSULES 300MG "STANDARD" (GEMFIBROZIL)(鋁箔/膠箔) 2

AB41378100 PRECONIN TABLETS. 5MG"KOJAR"(PREDNISOLONE) 1.5

AB413781G0 PRECONIN TABLETS 5MG (PREDNISOLONE) "KOJAR"(鋁箔/膠箔) 2

AB41519100 FLUPINE TABLETS 0.25MG "JOHNSON" (FLUDIAZEPAM) 2.71

AB41535100 PENTOP S.R. TABLETS 400MG "YU SHENG" (PENTOXIFYLLINE) 2.2

AB41606100 SINZAC CAPSULES 20MG "S.T." 2.77

AB41641100 NAKAMIDE F.C. TABLETS 2.5MG "N.K."(INDAPAMIDE) 2.27

AB41654100 DIFENA ENTERIC MICROENCAPSULATED CAP. 50MG "STANDARD"

(DICLOFENAC SODIUM)

1.5

AB416541G0 DIFENA ENTERIC MICROENCAPSULATED CAPSULES 50MG

"STANDARD"(DICLOFENAC SODIUM) (鋁箔/膠箔)

2

AB41669100 ACEBOL F.C. TABLET 400MG (ACEBUTOLOL) "STANDARD" 6.2

AB41684238 TENCAM LYOPHILIZED INJECTION 20MG "STANDARD" (TENOXICAM) 31.4

AB41802255 FLUCON I.V. INFUSION 2MG/ML (FLUCONAZOLE) "S.T." 422

AB41956100 CARTALOC TABLETS 100MG "S.C." (METOPROLOL TARTRATE) 4.61

AB42198100 SPASPA CAPSULES 60MG (ALVERINE CITRATE)"MACRO" 2.39

AB42390245 OMEZOL LYO-INJ 40MG "STANDARD" (OMEPRAZOLE) 86

AB42619100 FENOLIP MICRONISED CAPSULES 200MG (FENOFIBRATE)"C.H." 6.5

AB42687100 REGROW SUSTAINED RELEASE F.C. TABLET 60MG 2.52

AB42743100 GENESAFE TABLETS 200MG (MEPHENOXALONE) 1.5

AB427431G0 GENESAFE TABLETS 200MG (MEPHENOXALONE)(鋁箔/膠箔) 2

AB42755100 DEHERP TABLET 200MG "STANDARD" (ACYCLOVIR) 7

AB42855100 SAWTO ENTERIC-MICROENCAPSULATED CAPSULES 50MG "CHINTENG"

(DICLOFENAC SODIUM)

1.5

AB428551G0 SAWTO ENTERIC-MICROENCAPSULATED CAPSULES 50MG "CHINTENG"

(DICLOFENAC SODIUM)(鋁箔/膠箔)

2

AB42884100 FLUCON CAPSULES 150MG "S.T." (FLUCONAZOLE) 61

AB42908100 DIAMIN TABLETS 80MG "S.T." (GLICLAZIDE) 1.5

AB429081G0 DIAMIN TABLETS 80MG "S.T." (GLICLAZIDE)(鋁箔/膠箔) 2

AB42977100 FLUX MICROENCAPSULATED CAPSULES 20MG "STANDARD" (FLUOXETINE) 2.77

AB43122151 MEPTIN LIQUID 52

AB43124421 VOLEN OPHTHALMIC SOLUTION 0.1% (DICLOFENAC SODIUM)"WINSTON" 45.7

AB432231G0 PAINSTOP ENTERIC-MICROENCAPSULATED CAPSULE 50MG "SWISS"

(DICLOFENAC SODIUM)(鋁箔/膠箔)

2

AB43265100 SYNCON TABLET 80MG 1.5

AB432651G0 SYNCON TABLETS 80MG(鋁箔/膠箔) 2

AB43305100 NO-TON F.C. TABLETS 500MG "STANDARD" 3.88

AB43622100 MEPTIN TABLETS 3.79

AB43657100 EUNAC SR F.C. TABLETS 100MG 2.97

AB43680100 BUFEN TABLET 400MG 1.5

AB437001G0 MEPTIN-MINI TABLETS(鋁箔/膠箔) 2

AB43706100 LODITON F. C. TAB. 500MG "STANDARD" 1.5

AB437061G0 LODITON TABLETS 500MG "STANDARD" 2

AB43735112 BUTANYL INHALATION SOLUTION 2.5MG/ML (TERBUTALINE SULFATE) 12.9

AB43837100 DICLOFENAC S.R F.C. TABLETS 2.97

AB43847335 ZALAIN CREAM 2% 100

AB43852100 MIKELAN 5MG TABLETS "T.O.P." 3.17

AB43859100 USPEN TABLETS 100MG "YU SHENG" 8.9

AB43929100 SALAZINE ENTERIC COATED TABLETS 500MG (SULFASALAZINE) "S.T" 2.86

74

Page 75: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB43943412 IPRATRAN INHALATION SOLUTION 0.25MG/ML "S.T."(IPRATROPIUM

BROMIDE)

11.3

AB43991100 LINDACIN CAPSULES 150MG "S.T""(CLINDAMYCIN) 1.5

AB439911G0 LINDACIN CAPSULES 150MG "S.T."(CLINDAMYCIN) (鋁箔/膠箔) 2

AB44046157 "PURZER" FUMIDE ORAL SOLUTION 10MG/ML 110

AB44091100 MEPHENOXALONE TABLETS 200MG "U-CHU." 1.5

AB440911G0 MEPHENOXALONE TABLETS 200MG "U-CHU."(鋁箔/膠箔) 2

AB44098100 FEDIL S.R TABLETS 5MG "STANDARD" 3.29

AB44122100 ACYLO TABLETS 400MG "S.T." (ACYCLOVIR) 7.9

AB44124100 PLETAAL TABLETS 100 16.6

AB44136100 PLETAAL TAB. 50 9.1

AB44280209 SODIUM CHLORIDE INJECTION 0.9% 25.4

AB44280212 SODIUM CHLORIDE INJECTION 0.9% 72

AB44280255 SODIUM CHLORIDE INJECTION 0.9% 22

AB44280265 SODIUM CHLORIDE INJECTION 0.9% 22

AB44280277 SODIUM CHLORIDE INJECTION 0.9% 25

AB44331100 FINTA F.C TABLETS 5MG "N.K" 20.6

AB44371100 AMOPINE TABLETS 5MG "S.T" 6.8

AB44403100 VOREN-K SUGAR COATED TAB. 50MG "YUNG SHIN" 1.5

AB444031G0 VOREN-K SUGAR COATED TABLETS 50MG "YUNG SHIN" (鋁箔/膠箔) 2

AB44434100 DELIBS F.C. TABLETS 50MG 10.8

AB44451500 ZALAIN VAGINAL TABLET 99

AB44466221 PHYXOL INJECTION 6MG/ML "SINPHAR" 1388

AB44466229 PHYXOL INJECTION 6MG/ML "SINPHAR" 1941

AB44466235 PHYXOL INJECTION 6MG/ML "SINPHAR" 2384

AB44466240 PHYXOL INJECTION 6MG/ML "SINPHAR" 8989

AB44466248 PHYXOL INJECTION 6MG/ML "SINPHAR" 22960

AB444662E2 PHYXOL INJECTION 6MG/ML "SINPHAR" 3774

AB444662FG PHYXOL INJECTION 6MG/ML "SINPHAR" 3774

AB44468100 FELOPINE E.R F.C. TABLETS 5MG 3.29

AB44475100 AMPIN TABLETS 5MG 6.8

AB44478100 VOTAN SR F.C TABLETS 100MG 2.97

AB44482143 EXDILA LIQUID 5UG/ML "CENTER" 29

AB44482151 EXDILA LIQUID 5UG/ML "CENTER" 52

AB44482157 EXDILA LIQUID 5MCG/ML "CENTER" 111

AB44508229 OXALIP INJECTION 2426

AB44508238 OXALIP INJECTION 6847

AB44509143 EUFAN SOLUTION 2.5MG/ML "STANDARD" 25

AB44509151 EUFAN SOLUTION 2.5MG/ML "STANDARD" 25

AB44509157 EUFAN SOLUTION 2.5MG/ML "STANDARD" 37.7

AB44510100 EUFAN F.C TABLETS 10MG "STANDARD" 1.51

AB445101G0 EUFAN F.C TABLETS 10MG "STANDARD"(鋁箔/膠箔) 2

AB44607100 AMLOBIN TABLETS 5MG "STANDARD" 6.8

AB44619100 BEXOLO F.C. TABLETS 20MG "S.T" 4.58

AB44685100 ALPRALINE TABLETS 0.5MG "S.T" 1.5

AB446851G0 ALPRALINE TABLETS 0.5MG "S.T"(鋁箔/膠箔) 2

AB44829100 DELCOPAN SR F.C.T 60MG 2.32

AB44832100 TANLEEG F.C. TABLETS 500MG "S.T." (NABUMETONE) 3.88

AB44843100 UROSIN FILM COATED TABLETS 50MG (ATENOLOL) 1.56

AB448431G0 UROSIN FILM COATED TABLETS 50MG (ATENOLOL)(鋁箔/膠箔) 2

AB44997100 VOLNA-K F.C. TABLET 25MG "STANDARD" (DICLOFENAC POTASSIUN) 1.5

AB449971G0 VOLNA-K F.C. TABLET 25MG "STANDARD" (DICLOFENAC POTASSIUM) (鋁

箔/膠箔)

2

AB45016100 OMEZOL CAP. 20MG (OMEPRAZOLE) 2.51

75

Page 76: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB45041100 BABUROL TABLETS 10MG 3.32

AB45070100 "U-CHU" APRAZO TABLETS 0.5MG (ALPRAZOLAM) 1.5

AB450701G0 "U-CHU" APRAZO TABLETS 0.5MG (ALPRAZOLAM)(鋁箔/膠箔) 2

AB45150100 VOLNA-K F.C. TABLET 50MG "STANDARD" (DICLOFENAC POTASSIUM) 1.5

AB451501G0 VOLNA-K F.C. TABLET 50MG "STANDARD" (DICLOFENAC POTASSIUM) (鋁

箔/膠箔)

2

AB45279100 "U-CHU" ZODEM TABLETS 10MG 2.51

AB45305100 VOREN-K SUGAR COATED TABLETS 25MG "YUNG SHIN" 1.5

AB453051G0 VOREN-K SUGAR COATED TABLETS 25MG "YUNG SHIN"(鋁箔/膠箔) 2

AB45348100 BISO F.C TABLETS 5 MG 3.42

AB45363100 FURIDE TABLETS 40MG "STANDARD"(FUROSEMIDE) 1.5

AB453631G0 FURIDE TABLETS 40MG "STANDARD"(FUROSEMIDE)(鋁箔/膠箔) 2

AB45387100 "PURZER" PROLEAK TABLETS 5MG 20.6

AB45392100 FELPIN EXTENDED RELEASE TABLETS 5MG "S.T" (FELODIPINE) 3.29

AB45415151 IDEFEN SUSPENSION 20MG/ML (IBUPROFEN) 25

AB45415157 IDEFEN SUSPENSION 20MG/ML (IBUPROFEN) 67

AB45416100 POCATHMA-MINI TAB. 25MCG "STANDARD" 1.59

AB454161G0 POCATHMA-MINI TAB. 25MCG "STANDARD"(鋁箔/膠箔) 2

AB45438151 IDOFEN SUSPENSION 20MG/ML "STANDARD" (IBUPROFEN) 25

AB45438157 IDOFEN SUSPENSION 20MG/ML "STANDARD" 67

AB45485430 BESONIN AQUA NASAL SPRAY 100MCG/DOSE 139

AB45485438 BESONIN AQUA NASAL SPRAY 100MCG/DOSE 175

AB45492100 MECATER TABLETS 25MCG (PROCATEROL HYDROCHLORIDE HEMIHYDRATE) 1.59

AB454921G0 MECATER TABLETS 25MCG (PROCATEROL HYDROCHLORIDE

HEMIHYDRATE)(鋁箔/膠箔)

2

AB45592100 "U-CHU" LAMOGIN TABLETS 100MG 24.1

AB45621100 FYNASID F.C TABLETS 5MG 20.6

AB45668100 VALNON E.C TABLETS "S.C." 3.43

AB45704220 TAPIMYCIN INJECTION "YUNG SHIN" 435

AB457042CX TAPIMYCIN INJECTION "YUNG SHIN" 241

AB45725100 LACOXA SR TABLETS 400MG 12.2

AB45844100 CLOFEN-P F.C TABLETS 50MG 1.5

AB458441G0 CLOFEN-P F.C TABLETS 50MG (鋁箔/膠箔) 2

AB45847100 SLUXDIN FILM COATED TABLETS 50MG 9.3

AB45856100 VALPROTINE ENTERIC COATED TABLETS 200MG "PURZER" 3.43

AB45955100 NAKAMIDE SR TABLETS 1.5MG "N.K" 2.48

AB45961100 VALOSINE TABLET 37.5MG (VENLAFAXINE HYDROCHLORIDE) 8.1

AB45993100 ACTEIN EFFERVESCENT TABLETS 600MG 6.6

AB46016100 TAMLOSIN S.R. CAPSULES 0.2MG "STANDARD" 9.6

AB46029100 PRATIN TABLETS 10MG "S.T" (PRAVASTATIN SODIUM) 9.6

AB46074100 GLUSAFE TABLETS 2MG (GLIMEPIRIDE) 3.12

AB46145100 ALEPAN TABLETS 15MG 3.65

AB46173151 PROCAROL LIQUID 5UG/ML 52

AB46184100 TOPEE F.C. TABLETS 150MG 1.95

AB461841G0 TOPEE F.C. TABLETS 150MG(鋁箔/膠箔) 2

AB46237100 CILOPA F.C TABLETS 20MG "S.C" 15.7

AB46242151 WEMPTY SUSPENSION "CENTER" 1MG/ML 27.8

AB46283100 ICOMEIN CAPSULE 100MG "EVEREST" 23.7

AB46315100 LOSART F.C. TABLETS 50MG "STANDARD" (LOSARTAN POTASSIUM) 9.3

AB46480100 STAPIN S.R. TABLETS 5MG 3.29

AB46524100 DIPACHRO S.R. FILM COATED TABLETS 500MG 8.2

AB46613100 "U-CHU" TONEC TABLETS 100MG (ACEC LOFENAC) 5.5

AB46620100 SUPERNIDE TABLETS 1MG "YU SHENG" 3.11

76

Page 77: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB46639457 BESONIN AQUA NASAL SPRAY 64 MCG/DOSE 174

AB46646100 POZOLA ENTERIC F.C. TABLETS 40MG "S.C." 18.4

AB46658100 KLUDONE MR TABLETS 30MG 2.1

AB46661100 DISARTAN CAPSULES 80MG "KINGDOM"(VALSARTAN) 10.1

AB46742100 AMTREL TABLETS 14

AB46749100 EPILRAMATE F.C. TABLETS 100MG 34.2

AB46991157 MEGEST ORAL SUSPENSION 40MG/ML 986

AB46991164 MEGEST ORAL SUSPENSION 40MG/ML 2782

AB47003221 EPICIN INJECTION 634

AB47003229 EPICIN INJECTION 1117

AB47003240 EPICIN INJECTION 3381

AB47070100 GLU-A TABLET 80MG (GLICLAZIDE) 1.5

AB470701G0 GLU-A TABLET 80MG (GLICLAZIDE)(鋁箔/膠箔) 2

AB47071209 KOP INJECTION 23.1

AB47079100 U-CHU LAMOGIN TABLETS 50MG 15.5

AB47147100 PICETAM F.C. TABLETS 1200MG "STANDARD" (PIRACETAM) 2.67

AB47170212 IRINO SOLUTION FOR I.V. INFUSION 2550

AB47170221 IRINO SOLUTION FOR I.V. INFUSION 4997

AB47172100 AMEPIRIDE TABLETS 2.0MG 3.32

AB47228100 FENOLIP-U TABLETS 160MG "C.H." 6.5

AB47273100 VENFORSPINE XR CAPSULES 75MG 18.1

AB47294100 APA-RISDOL F.C. TABLETS 2MG 18.6

AB47307100 GLUCOCAR TABLETS "S.C." 3.27

AB47310100 DOMTOO F.C. TABLETS 10MG (DOMPERIDONE) 1.5

AB473101G0 DOMTOO F.C. TABLETS 10MG (DOMPERIDONE)(鋁箔/膠箔) 2

AB47348100 VATATIN F.C. TABLETS 20MG "STANDARD" 6.7

AB47368100 LANXO CAPSULES 30MG 18.5

AB47372100 INDAP S.R. TABLETS 1.5MG "STANDARD" 2.36

AB47407100 APA-RISDOL F.C. TABLETS 3MG 41.7

AB47419100 APA-RISDOL F.C. TABLETS 1MG 15.5

AB47472100 ABUTOL F.C. TABLETS 400MG (ACEBUTOLOL) 6.2

AB47477100 GATINE CAPSULES 300MG 9.3

AB47532100 ANSURES EXTENDED RELEASE TABLETS 1.71

AB475321G0 ANSURES EXTENDED RELEASE TABLETS(鋁箔/膠箔) 2

AB47538100 BISOL FILM COATED TABLETS 5MG(BISO PROLOL FUMARATE) 3.42

AB47539100 ANAZO F.C. TABLETS 71

AB47553100 DEPATEC 500 MG FILM.COATED.TABLETS"PURZER" 8.2

AB47557229 EPICIN LYO INJECTION 10MG 634

AB47629100 TAMSO SR CAPSULES 0.2MG 9.6

AB47656100 MOPRIDE F.C. TABLETS 5MG 2.45

AB47671100 Glubose Tablet 50mg 3.27

AB47689100 Neurtrol F.C. Tablets 300mg 10

AB47792166 Lactulose Liquid "SHUN HWA" 164

AB47792177 Lactulose Liquid "SHUN HWA" 192

AB47811100 TAGLU F.C. TABLETS 100MG 7

AB47848100 TAGLU F.C. TABLETS 50MG 3.27

AB47872223 GEMMIS INJECTION 38 MG/ML 1086

AB47872243 GEMMIS INJECTION 38 MG/ML 4099

AB47882206 TYXAN INJECTION 4322

AB47882212 TYXAN INJECTION 16298

AB47945100 PBF Mobicam Tablets 7.5mg 2.36

AB47979265 BOJUM INTRAVENOUS INJECTION 0.25G 375

AB47979277 BOJUM INTRAVENOUS INJECTION 0.5G 404

AB47981100 Acarose Tablets 50mg "Standard" (Acarbose) 3.27

AB47984100 CARLIPIN TABLETS 50MG 3.27

77

Page 78: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB47991100 ANXOFIN F.C TABLETS 850MG 2.23

AB48027100 RIBARIN CAPSULES 13.3

AB48089100 DIAMIN MR TABLETS 30MG (GLICLAZIDE) 2.12

AB48130100 C.T.L. XR TABLETS 500MG "C.H." 1.71

AB48190100 Gastroloc Gastro-resistant Tablets 40mg 18.4

AB48229100 ANXOKEN F.C. TABLETS 1000MG 2.28

AB48329248 EPICIN LYO INJECTION 50MG 3381

AB48351100 RISPAL F.C TABLETS 2MG 18.6

AB48439100 PURCON F.C TABLETS 5MG 3.42

AB48484100 Glucomin X.R. Tablets 500mg "P.L." 1.85

AB484841G0 GLUCOMIN X.R. TABLETS 500MG "P.L."(鋁箔/膠箔) 2

AB48506100 EPRAM TABLETS 10MG 19.4

AB48507100 EPILRAMATE FILM-COATED TABLETS 25MG 8.7

AB48586100 PAVATIN PROTECT TABLETS 20MG "STANDARD" (PRAVASTATIN SODIUM) 10.6

AB48643157 IBUPROFEN-FP SUSPENSION 20MG/ML 67

AB48644100 MECHOL TABLETS 20MG "YUNG SHIN" 10.6

AB48649100 Cloflow F.C. tablets 75mg "Standard" (Clopidogrel) 41.9

AB48681100 PAVADIN TABLETS 20MG 10.6

AB48699209 KTOLAC INJECTION 30MG/ML (KETOROLAC) 23.1

AB48751265 PENEM FOR I.V. INJECTION 197

AB48751277 PENEM FOR I.V. INJECTION 427

AB48802265 YOUNAM POWDER FOR IV INJECTION 197

AB48802277 YOUNAM POWDER FOR IV INJECTION 427

AB48836100 RAPMITEC TABLETS 10MG 9

AB48863100 BENTOMIN TABLETS 1000MG “S.C.” 2.28

AB48867100 RIBELITE TABLETS 200MG 27.9

AB48878100 VAKIN CHRONO FILM COATED TABLETS 500 MG 8.2

AB48909100 ANSUZOLE F.C TABLETS 1MG 72

AB48911265 BESTNEM POWDER FOR I.V. INJECTION 197

AB48911277 BESTNEM POWDER FOR I.V. INJECTION 427

AB48969100 THADO CAPSULES 50 MG 253

AB48972100 PERDOPRIL TABLETS 4MG 10

AB48991100 NIRANDIL TABLETS 5 MG (NICORANDIL) “STANDARD” 4.3

AB48993245 PANE FOR IV INJECTION 184

AB49011100 FUNNIX SR TABLETS 150MG 21.2

AB49012100 RISDAL F.C. TABLETS 18.6

AB49020100 MINIVANE F.C. TABLETS 30MG 16.6

AB49021100 PRATIN TABLETS 20 MG 10.6

AB49053143 POCATHMA LIQUID 5UG//ML“STANDARD” 29

AB49053151 POCATHMA LIQUID 5UG/ML“STANDARD” 52

AB49053157 POCATHMA LIQUID 5UG/ML“STANDARD” 111

AB49109100 BAENAZIN TABLETS 100 MG 3.54

AB49110100 NIDIL TABLETS 5 MG“S.C.” 4.3

AB49143100 DEHYPOTIN PROTECT TABLETS 40MG 22.8

AB49145100 LAXYMIG ER TABLETS 500 MG "LOTUS" 8.2

AB49147209 SUPECEF POWDER FOR INJECTION 425

AB49147212 SUPECEF POWDER FOR INJECTION 676

AB49147277 SUPECEF POWDER FOR INJECTION 279

AB49165100 ANXOPONE F.C. TABLETS 200MG 19.8

AB49189100 LOATA TABLETS 50 MG 8.2

AB49225100 GLIMED MR TABLETS 30MG 2.1

AB49240100 SMILON F.C TABLETS 15MG 11.7

AB49342100 URNAL S.R.F.C. TABLETS 0.2 MG 9.6

AB49375220 BETAMYCIN POWDER FOR INJECTION 435

78

Page 79: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB493752AE BETAMYCIN POWDER FOR INJECTION 337

AB493752CX BETAMYCIN POWDER FOR INJECTION 241

AB49454100 PRATIN TABLETS 40 MG (PRAVASTATIN SODIUM) 22.8

AB49466100 GLICLAX SUSTAINED RELEASE TABLETS 30MG 2.11

AB49503100 DEHYPOTIN PROTECT TABLETS 20MG 10.6

AB49517100 GAPATIN F.C. TABLETS 600MG 15.9

AB49518100 NEUROQUEL F.C. TABLETS 100MG 25.9

AB49532100 SUPERNIDE TABLETS 2MG ”YUSHENG” 3.73

AB49551100 LINLIP MICRONISED CAPSULES 200MG”CHINTENG” 6.5

AB49581100 PIOSUGAR TABLETS 30 MG 19.6

AB49599100 BETAFORM TABLETS 850MG ”M.T.”(METFORMIN) 2.23

AB49653100 CALM-EZ F.C. TABLETS 100MG 26.4

AB49656100 MIRTAPINE ORALLY DISINTEGRATING TABLETS 30MG 19.4

AB49696100 LEFLODAL F.C. TABLETS 500 MG 47.7

AB49719100 CLOPID F.C. TABLETS 75 MG“P.L.” 41.9

AB49735265 MEPENEM POWDER FOR INTRAVENOUS INJECTION 375

AB49735277 MEPENEM POWDER FOR INTRAVENOUS INJECTION 404

AB49742100 HILOCA F.C. TABLETS 200MG 36.1

AB49829100 DIABAN TABLETS 100MG “C.H.” 7.5

AB49905100 AZOSIN S.R. TABLETS 10 MG“STANDARD”(ALFUZOSIN HYDROCHLORIDE) 8.6

AB49969100 AMLOBIN TABLETS 10 MG“STANDARD” 6.8

AB50006100 ALFUZO XL TABLETS 10 MG“S.C.” 8.2

AB50083100 CALM-EZ F.C. TABLETS 25MG 13.5

AB50084100 DIABAN TABLETS 50 MG“C.H.” 3.7

AB50115100 QUETIALIN F.C. TABLETS 25MG“KINGDOM” 13.4

AB50142100 HYDROQUINE FILM COATED TABLETS 200MG 2.72

AB50154100 IMMUFINE CAPSULES 250MG 47.6

AB50168100 HOLIGIN S.R. CAPSULES 0.2MG 9.6

AB50204100 CHME CAPSULES 100MG“WECAM” 23.7

AB50206151 PIRACETAM ORAL SOLUTION“CENTER” 37.6

AB50206157 PIRACETAM ORAL SOLUTION“CENTER” 74

AB50206163 PIRACETAM ORAL SOLUTION“CENTER” 102

AB50206164 PIRACETAM ORAL SOLUTION“CENTER” 124

AB50227100 AMBRO SR TABLETS 75MG“C.H.” 2.41

AB50240100 LOWTEN F.C. TABLETS 50 MG 9.3

AB50256209 MEROXIN POWDER FOR INJECTION 875

AB50256265 MEROXIN POWDER FOR INJECTION 375

AB50256277 MEROXIN POWDER FOR INJECTION 404

AB50343209 MELOPEN POWDER FOR INJECTION 1G 875

AB50343265 MELOPEN POWDER FOR INJECTION 0.25G 375

AB50343277 MELOPEN POWDER FOR INJECTION 0.5G 404

AB50431100 HISART F.C. TABLETS 50/12.5MG?§STANDARD??(LOSARTAN POTASSIUM

AND HYDROCHLOROTHIAZIDE)

9.3

AB51029100 SYNTACE TABLETS 10 MG 9

AB51526245 OMEZOL I.V. INFUSION 40MG“STANDARD”(OMEPRAZOLE) 86

AB515971G0 MIROBECT TABLET 50 (鋁箔/膠箔) 2

AB51714100 MIGBOSE F.C. TABLETS 50MG “STANDAED” (MIGLITOL) 3.93

AB51728100 “PURZER” PURTRALINE FILM COATED TABLET 50MG 11.7

AB51732100 ATORIN F.C. TABLETS 40MG 30.3

AB52308100 REGLIDE TABLETS 1 MG 3.11

AB52436100 LOSATER F.C. TABLETS 100MG“CHINTENG” 11.1

AB52446100 QUETIALIN F.C. TABLETS 200MG“KINGDOM”(QUETIAPINE) 34.9

AB52462100 SMARTGEN TAB. 2 MG 3.32

AB52485100 LVTANGSU TABLETS 500MG“KOJAR” 1.5

79

Page 80: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB524851G0 LVTANGSU TABLETS 500MG“KOJAR”(鋁箔/膠箔) 2

AB52548100 TONLIEF F.C. TABLETS 100MG (ACECLOFENAC) 5.3

AB52615100 LEVOCIN F.C. TABLETS 100MG"P.L." 7.7

AB54966100 PRINWIN TABLETS 8MG 16.3

AB54967100 ATOVER F.C. TABLETS 40 MG“P.L.” 30.9

AB54977100 BUPORIN SUSTAINED-RELEASE TABLETS 150MG 21.2

AB55028100 IRBETAN F.C. TABLETS 150 MG 8.4

AB55041100 NEUROQUEL F.C. TABLETS 25MG 13.5

AB55057100 HILOCA F.C. TABLETS 300 MG 59

AB55103100 QUEPINE F.C. TABLET 200MG 36

AB55108100 NARGIN F.C. TABLETS 5MG 3.9

AB55244100 HILOCA F.C. TABLETS 25 MG 13.5

AB55258100 LVTANGSU TABLETS 250MG“KOJAR” 1.5

AB552581G0 LVTANGSU TABLETS 250MG“KOJAR”(鋁箔/膠箔) 2

AB55264209 MEROBIOTIC POWDER FOR IV INJECTION“SLC”1.0GM 875

AB55264265 MEROBIOTIC POWDER FOR IV INJECTION“SLC”250MG 375

AB55264277 MEROBIOTIC POWDER FOR IV INJECTION“SLC”500MG 404

AB55275100 GLUFIT TABLETS 30 MG“YU SHENG” 19.9

AB55276277 IMIBIOTIC POWDER FOR I.V. INJECTION“SLC” 427

AB55298100 KOTANG X.R. TABLETS 500 MG 1.85

AB55406100 SINBISOL FILM COATED TABLETS 5 MG 3.42

AB55536100 SINLUKAST CHEWABLE TABLETS 5MG“KINGDOM”(MONTELUKAST) 17.1

AB55547100 DIVAPRODIUM E.C. TABLETS 500MG“SC” 10.4

AB55557100 VALSART FILM COATED TABLETS 160MG“STANDARD”(VALSARTAN) 12.7

AB55560100 KLUDONE MR TABLETS 60MG 3.89

AB55564100 MOSAD TABLETS 5 MG (MOSAPRIDE) 2.5

AB55582100 DIVOSHOT EXTENDED-RELEASE TABLETS 500MG“TWI” 8.2

AB55585100 VALSART FILM COATED TABLETS 80MG“STANDARD”(VALSARTAN) 10.1

AB55931100 ZOSATAN FILM COATED TABLETS 50 MG 9.3

AB55954100 FEXODINE F.C. TABLETS 60MG“STANDARD”(FEXOFENADINE

HYDROCHLORIDE)

2.67

AB55966220 TAPI MYCIN LYO-INJECTION 435

AB559662CX TAPI MYCIN LYO-INJECTION 241

AB55984100 BISOL F.C. TABLETS 1.25MG 2.92

AB55990100 MOSA F.C. TABLETS 5MG 2.5

AB55991100 MECATER TABLETS 50 MCG 3.79

AB56626100 LFLOCIN F.C. TABLETS 500MG 44.2

AB56661100 LODITON FILM-COATED TABLETS 850MG "STANDARD" 2.23

AB56697100 IRBEPROVEL F.C. TABLETS 150MG 8.2

AB56698343 ZALAIN EXTERNAL GEL 2% 180

AB56718100 ARIPIZOLE TABLETS 10MG 75

AB56724100 QUIAPINE F.C. TABLETS 100MG 25.9

AB56731209 CEFEPIN POWDER FOR IV INJECTION 425

AB56731212 CEFEPIN POWDER FOR IV INJECTION 676

AB56731277 CEFEPIN POWDER FOR IV INJECTION 279

AB56756100 LIFORMIN TABLETS 500MG 1.5

AB567561G0 LIFORMIN TABLETS 500MG(鋁箔/膠箔) 2

AB56773100 DIVAPRODIUM E.C. TABLETS 250MG "SC" 5.1

AB56774100 PANHO ENTERIC F.C. TABLETS 40MG 18.4

AB56782100 BUPION SR TABLETS 150MG 21.2

AB56799100 SU-CHIN FILM COATED TABLETS 117

AB57107100 PROMONE 100MG SOFT CAPSULES "P.L." 8.3

AB57133100 ATOTIN F.C. TABLETS 40MG 30.3

AB57178100 APROTAN F.C. TAB. 150MG "STANDARD" 8.4

AB57191248 "LEXACIN I.V. SOLUTION FOR INFUSION 5MG/ML ""TAI YU" 487

80

Page 81: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB57194100 ROZININ F.C. TABLETS 10MG 21.6

AB57204100 IRBETAN F.C. TABLETS 300MG 14.5

AB57206100 TAMSULOSIN S.R. CAPSULES 0.2MG "CYH" 9.6

AB57217100 GLUCOFIT ER TABLETS 750MG "SWISS" 1.81

AB572171G0 GLUCOFIT ER TABLETS 750MG "SWISS"(鋁箔/膠箔) 2

AB57225100 REPAGLINIDE TABLETS 1MG "CYH" 3.04

AB57234100 OLSAA F.C. TABLETS 20MG 11.6

AB57240209 TYNEN INJECTION 4322

AB57240219 TYNEN INJECTION 16298

AB57244100 GLUPIN TABLETS 850MG 2.23

AB57254100 MOSAPIN F.C. TABLET 5MG "STANDARD" (MOSAPRIDE) 2.5

AB57263100 DEVENLOFE S.R. CAPSULES 75MG 18

AB57267100 ATOTIN F.C. TABLETS 10MG 17.2

AB57268100 LAMIVUDINE " ALVOGEN " TABLETS 100MG 67

AB57275100 RISPERIDONE F.C. TABLETS 2MG "CYH" 18.6

AB57312100 ACARBOSE F.C. TABLETS 50MG "CYH" 3.27

AB57327100 RELINIDE TABLETS 2MG "STANDARD" (REPAGLINIDE) 3.67

AB57337100 ANBUTRINE XL 300MG TABLETS 42.8

AB57339100 BIPROFEN TABLETS 50MG 1.54

AB57351100 ZHIKUI GASTRO-RESISTANT TABLETS 40MG 18.4

AB57361100 LOSIN S.R. TABLETS 400MG 11.1

AB57367100 BAMROL TABLETS 10MG 3.32

AB57415100 DISARTAN CAPSULES 160MG "KINGDOM" (VALSARTAN) 12.7

AB57426100 SINLUKAST F.C. TABLETS 10MG "KINGDOM" (MONTELUKAST) 23

AB57427100 BYRAXO F.C. TABLETS 10MG 120

AB57733100 ARIZOLE TABLETS 15MG 73

AB57740100 ALPRAZOLAM TABLETS 0.5MG "CYH" 1.5

AB577401G0 ALPRAZOLAM TABLETS 0.5MG "CYH"(鋁箔/膠箔) 2

AB57759100 RELUNG F.C. TABLETS 20MG 220

AB57772100 ATORSTIN FILM COATED TABLETS 40MG 30.3

AB57783248 TIGELIN LYOPHILIZED POWDER FOR INJECTION 50MG 1500

AB57791100 FAMOTIDINE F.C. TABLETS 20MG "CYH" 1.92

AB577911G0 FAMOTIDINE F.C. TABLETS 20MG "CYH"(鋁箔/膠箔) 2

AB57819100 CLOPIDOGREL "ALVOGEN" F.C. TABLETS 75MG 41.9

AB57829100 Q-PINE F.C. TABLETS 100MG "TAI YU" 25.9

AB57839100 LEVOFLOXACIN F.C. TABLET 750MG "P.L." 63

AB57845100 GLIMEPINE TABLETS 2MG 3.12

AB57848100 FLUOXETINE CAPSULES 20MG "CYH" 2.77

AB57850100 QUEPINE F.C. TABLET 100MG 26.4

AB57864100 HEIPO F.C. TABLETS 300MG "EVEREST" 14.2

AB57879100 BYRAXO F.C. TABLETS 5MG 61

AB57892100 QUIAPINE F.C. TABLETS 25MG 13.4

AB57923100 LAVUDIN F.C. TABLETS 100MG "STANDARD" (LAMIVUDINE) 69

AB57926100 QUIAPINE F.C. TABLETS 200MG 34.9

AB57930100 ATOVA F.C. TABLETS 10MG "YU SHENG" 17.6

AB57940100 ROSULATOR F.C. TABLETS 10MG "S.C." 21.6

AB57963100 ANBUTRINE XL 150MG TABLETS 21.7

AB57966100 PINTON SR TABLETS 400MG "C.H." 10.9

AB57967100 ATORSTIN FILM COATED TABLETS 10MG 17.2

AB57982248 AMBIL LIPOSOME FOR INJECTION 50MG 6252

AB57991100 BENSAU SOFT CAPSULES 200MG "LOTUS" 3.6

AB57992248 LIPO-AB FOR INJECTION 6144

AB57997100 GLICLAZIDE "ALVOGEN" MR TABLETS 2.15

AB58049100 ATORSTIN FILM COATED TABLETS 20MG 27.1

AB58065209 DOCE INJECTION 20MG/ML, 1ML/VIAL 4322

81

Page 82: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AB58071100 GLIMET F.C. TABLETS 2/500MG 4.72

AB58091100 LIVEPRO F.C. TABLETS 0.5MG 139

AB58093100 PIDOGREL FILM COATED TABLETS 75MG 41.9

AB58173100 KETOFAN S.R. CAPSULES 200MG 6.7

AB58181100 "LEXINPING CAPSULES 30MG "TAI YU" 24.3

AB58253100 CIPROGEN F.C. TABLETS 250MG 9.8

AB58264100 HPS TABLETS 1.66

AB58278100 CINSUTON TABLETS 5MG 6.8

AB58303100 U-CHU CASODOL TABLETS 250MG 3.29

AC00059100 DIAPIN TABLETS 2MG (DIAZEPAM)"PINE LAWER" 1.5

AC000591G0 DIAPIN TABLETS 2MG (DIAZEPAM)"PINE LAWER"(鋁箔/膠箔) 2

AC00060100 DIAPIN TABLETS 5MG (DIAZEPAM) "PINE LAWER" 1.5

AC000601G0 DIAPIN TABLETS 5MG (DIAZEPAM) "PINE LAWER"(鋁箔/膠箔) 2

AC00106100 ERYTHROMYCIN CAPSULES 250MG "KINGDOM" 2.15

AC00118100 EPHEDRINE HCL TABLETS 25 MG "F.Y." 1.5

AC001181G0 EPHEDRINE HCL TABLETS 25 MG "F.Y."(鋁箔/膠箔) 2

AC00119100 DL-METHYLEPHEDRINE HCL TABLETS 25.MG "F.Y." 1.5

AC00162100 SUYI TABLETS "HEALTH" 1.5

AC001621G0 SUYI TABLETS "HEALTH"(鋁箔/膠箔) 2

AC00178100 APREZIN TABLETS "JOHNSON" 1.5

AC001781G0 APREZIN TABLETS "JOHNSON"(84粒/瓶) 2

AC00263209 DEXTROSE AND SODIUM CHLORIDE INJECTION "Y.F." 35

AC00263277 DEXTROSE AND SODIUM CHLORIDE INJECTION "Y.F." 25

AC00373100 PELITIN CAPSULES 1.5

AC00420100 REIZER S.C. TABLETS 100 MG "F.Y." 1.54

AC00480209 ADRENALIN INJECTION 15

AC00605321 FLUCORT-F OINTMENT 0.025% 43.4

AC00638100 SODINATE S.C. TABLETS 1.5

AC00639100 TRYNOL S.C. TABLETS 25MG "JOHNSON" 1.5

AC006391G0 TRYNOL S.C. TABLETS 25MG "JOHNSON" (鋁箔/膠箔) 2

AC00649100 TRYNOL S.C. TABLETS 10MG 1.5

AC00655100 AMINOPHYLLINE TABLETS 0.1GM "F.Y." 1.5

AC00844100 TRANCOLON F.C. TABLETS 7.5MG (MEPENZOLATE BROMIDE) 1.5

AC008441G0 TRANCOLON F.C. TABLETS 7.5MG (MEPENZOLATE BROMIDE)(鋁箔/膠箔) 2

AC00863100 ISOXINE TABLETS 1.5

AC00913100 DECANS TABLETS "C.M." 1.5

AC01041100 SANTIN TABLETS 1.5

AC01047100 URETROPIC TABLETS 1.5

AC010471G0 URETROPIC TABLETS(鋁箔/膠箔) 2

AC01085209 SODIUM CHLORIDE INJECTION "Y.F." 25.4

AC01085255 "SODIUM CHLORIDE INJECTION ""Y.F.""" 22

AC01085265 SODIUM CHLORIDE INJECTION "Y.F." 22

AC01085277 SODIUM CHLORIDE INJECTION "Y.F." 25

AC01086209 GLUCOSE INJECTION 10% "Y.F." 30.9

AC01086277 GLUCOSE INJECTION 10% "Y.F." 25

AC01154100 INDOY CAPSULES 1.5

AC011541G0 INDOY CAPSULES(鋁箔/膠箔) 2

AC01192100 CINBININ TABLETS 1.6

AC011921G0 CINBININ TABLETS(瓶裝/100粒/瓶) 2

AC01386500 INDOMEN SUPPOSITORIES "YUNG SHIN" 5

AC01449100 NALIC TABLETS 2.25

AC01624100 GLYCYRRHIZA AND OPIUM COMPOUND TABLETS 1.5

AC016241G0 GLYCYRRHIZA AND OPIUM COMPOUND TABLETS (鋁箔/膠箔) 2

AC01662100 AMINOPHYLLINE TABLETS 100MG "JOHNSON" 1.5

82

Page 83: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC016621G0 AMINOPHYLLINE TABLETS 100MG "JOHNSON"(鋁箔/膠箔) 2

AC01691100 PULIN S.C. TABLETS 1.5

AC01735100 KAPIN S.C. TABLETS "YU SHENG" 1.5

AC01741100 ASPARA-CA TABLETS 1.5

AC01799100 WE-WANG TABLETS 1.5

AC01806100 PROPRANOLOL TABLETS 40MG 1.5

AC01832209 DEMETHOR INJECTION "CHI SHENG" 15

AC01853277 AMPOLIN INJECTION 500MG 15

AC01941100 SUZIN F.C. TABLETS "YU SHENG" 1.5

AC019411G0 SUZIN F.C. TABLETS "YU SHENG"(鋁箔/膠箔) 2

AC01946100 PREVOMIC S.C. TABLETS 1.5

AC019461G0 PREVOMIC S.C. TABLETS(鋁箔/膠箔) 2

AC02101100 PERONE S.C. TABLETS "JOHNSON" 1.5

AC02112100 UROBENIN S.C. TABLETS 1.5

AC02242100 UNSULON TABLETS "CHINTENG" 2.25

AC02244100 JINLUN TABLETS "CHINTENG" 1.5

AC022441G0 JINLUN TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC02314212 DIANZEM INJECTION "Y.Y." 15

AC02320100 ALEVIATIN TABLETS 1.5

AC023201G0 ALEVIATIN TABLETS(鋁箔/膠箔) 2

AC02328100 BOMIT TABLETS "C.C.P." 1.5

AC02359100 PREDNISOLONE TABLETS "YU SHENG" 1.5

AC02394238 PAMPARA INJECTION 95

AC02444100 ANCILLIN CAPSULES 500MG 1.5

AC02573100 SKELAXINE TABLETS 1.5

AC025731G0 SKELAXINE TABLETS(鋁箔/膠箔) 2

AC02581277 CHIAMINE-S INJECTION 71

AC02589100 DIPORAX S.C. TABLETS 1.99

AC02644100 TONIPIN TABLETS "YU SHENG" 1.5

AC02657209 PROGESTERONE INJECTION 2.5% "ASTAR" 15

AC02756100 YAJUNLO TABLETS "YU SHENG" 1.5

AC02763100 PHENYTOIN TABLETS "JOHNSON" 1.5

AC027631G0 PHENYTOIN TABLETS "JOHNSON"(84粒/瓶) 2

AC027631GA PHENYTOIN TABLETS "JOHNSON"(鋁箔/膠箔) 2

AC02801209 LACTATED RINGER'S B INJECTION "Y.F." 32.6

AC02801277 "LACTATED RINGER'S B INJECTION ""Y.F.""" 25

AC02844100 DL-METHYLEPHEDRINE HCL TABLETS "YU SHENG" 1.5

AC02846100 WANSE S.C. TABLETS "YU SHENG" 1.5

AC02863100 GLIBEN TABLETS 1.5

AC028631G0 GLIBEN TABLETS(鋁箔/膠箔) 2

AC02904100 CYPRODIN TABLETS 1.5

AC02915100 ESUMIN S.C. TABLETS "YU SHENG" 1.5

AC02938100 MEDAZEPAM CAPSULES 1.5

AC02947100 SHITON S.C. TABLETS "YU SHENG" 2.12

AC02956100 YONG WANG CAPSULES "T.F." 1.93

AC02962100 PREIN TABLETS "T.F." 1.5

AC02963100 CALCIUM GLUCONATED 1.5

AC029631G0 "ZM"CALCIUM GLUCONATED TABLETS 2

AC03171100 DECALON TABLETS "YU SHENG" 1.5

AC03206100 PASSTON CAPSULES 1.5

AC03224100 SUROLE CAPSULES 3.26

AC03243100 TRANTHISON TABLETS "YU SHENG" 1.5

AC03244100 ROUMIN TABLETS "YU SHENG" 1.5

AC03245100 EARMIN TABLETS "YU SHENG" 1.5

AC032451G0 EARMIN TABLETS "YU SHENG"(鋁箔/膠箔) 2

83

Page 84: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC03286100 HYLOMYCIN CAPSULES 250MG "SWISS" 2.15

AC032861G0 HYLOMYCIN CAPSULES 250MG "SWISS"(鋁箔/膠箔) 2

AC03291100 PINSAUN TABLETS "YU SHENG" 1.5

AC032911G0 PINSAUN TABLETS "YU SHENG"(鋁箔/膠箔) 2

AC03293212 DIAZEPAM INJECTION 15

AC03355212 DIANLIN INJECTION "N.K." 15

AC03365100 PREDNISOLONE TABLETS 5MG "VPP" 1.5

AC033651G0 PREDNISOLONE TABLETS 5MG "VPP"(鋁箔/膠箔) 2

AC03388100 HYDROCHLOROTHIAZIDE TABLETS "VPP" 1.5

AC033881G0 HYDROCHLOROTHIAZIDE TABLETS "VPP"(鋁箔/膠箔) 2

AC03389100 ACETAZOLAMIDE TABLETS 250MG "VPP" 1.5

AC03403100 NITROFURANTOIN TABLETS "Y.S." 1.5

AC03494100 BETAMETHASONE TABLETS "LITA" 1.5

AC03534100 DESON TABLETS "H.C." 1.5

AC03573221 PLASLLOID INJECTION 15

AC03619209 DEXTROSE IN SALINE INJECTION "SINTONG" 25.9

AC03619277 DEXTROSE IN SALINE INJECTION "SINTONG" 25

AC03700212 DEXARON INJECTION 2MG 15

AC03700229 DEXARON INJECTION 2MG 23.6

AC03703100 EPILON TABLETS "YUNG SHIN" 1.5

AC037031G0 EPILON TABLETS "YUNG SHIN"(鋁箔/膠箔) 2

AC03757100 FEBICON S.C. TABLETS 1.5

AC03775100 ERYTHROMYCIN CAPSULES "YUNG SHIN" 2.15

AC03796229 AMINOPHYLLINE INJECTION "VPP" 15

AC03867209 LIHOSIN INJECTION 15

AC03881209 DEXAMETHASONE INJECTION 23.6

AC03898238 KCL INJECTION "C.C.P." 15

AC03967229 CYANOCOBALAMIN INJECTION "R.S.P.P." 15.5

AC03976100 BISMUTH SUBCARBONATE TABLETS 324MG "VPP" 1.5

AC04052100 JOHNSTAL CAPSULES 1.5

AC04122100 BAOGIN TABLETS 2MG "BOWLIN" 1.5

AC04158100 "HEALTH" PREDINISOLONE TABLETS 1.5

AC041581G0 "HEALTH" PREDINISOLONE TABLETS(鋁箔/膠箔) 2

AC04163100 ESCIN S.C. TABLETS 1.96

AC041631G0 ESCIN S.C. TABLETS(鋁箔/膠箔) 2

AC04194100 LUNGING TABLETS 1.5

AC041941G0 LUNGING TABLETS 2

AC04221100 LICA TABLETS 1.5

AC042211G0 LICA TABLETS(鋁箔/膠箔) 2

AC04222100 BETA-DEXALONE TABLETS 1.5

AC04265100 TONILIN CAP. 250MG 1.64

AC04266100 "NAGOMIN TABLETS (NALIDIXIC ACID)""M.T.""" 2.25

AC042761G0 EAZIDE TABLETS (鋁箔/膠箔) 2

AC04347209 VITAMIN K1 INJECTION "N.K." 15

AC04404100 STUGEIN TABLETS 1.5

AC04411100 TUBAX S.C. TABLETS 6.5

AC04462100 "DEXAMETHASONE TABLETS ""ASTAR""" 1.5

AC04475100 "PREDNISOLONE TABLETS ""ASTAR""" 1.5

AC04484100 SOLIKIN CAPSULES "YUNG SHIN" 1.5

AC04506100 FUCON TABLETS 1.5

AC04514100 DUOCIDE TABLETS 1.5

AC04574100 WINDOL TABLETS 2.25

AC04587238 DEXTRON V INJECTION "N.K." 15

AC04643100 XATONE E.C. TABLETS "F.Y." 1.5

AC04675100 RIF CAPSULES 150MG 5.6

84

Page 85: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC04676100 RIF CAPSULES 300MG 10.1

AC04678277 MORIAMIN-2 INJECTION 70

AC04692100 "COPALIN TABLETS (CHLORMEZANONE) ""M.T.""" 1.5

AC04715100 DIABETIN TABLETS "Y.S." 1.5

AC047151G0 DIABETIN TABLETS "Y.S." (鋁箔/膠箔) 2

AC04722100 CYPRO TABLETS 4MG "F.Y." 1.5

AC04737100 PILIAN TABLETS "Y.S." 1.5

AC047371G0 PILIAN TABLETS "Y.S."(鋁箔/膠箔) 2

AC04761329 SHIELIN POWDER 44.5

AC04763100 HONTAN TABLETS 1.5

AC04771238 MAGNESIUM SULFATE INJECTION "TBC" 21.4

AC04771263 MAGNESIUM SULFATE INJECTION "TBC" 150

AC04778100 LI SHIH NING CAPSULES 25MG (INDOMETHACIN) "C.H." 1.5

AC04815100 "DIAZEPAM TABLETS ""ASTAR""" 1.5

AC04857100 ZIKAN TABLETS "LITA" 1.5

AC04865209 VITAMIN K1 INJECTION 15

AC04899100 NARIZIN TABLETS "JOHNSON" 1.5

AC048991G0 NARIZIN TABLETS "JOHNSON"(鋁箔/膠箔) 2

AC04919100 BAKTAR TABLETS 400MG 1.5

AC049191G0 BAKTAR TABLETS 400MG (鋁箔/膠箔) 2

AC04928321 BETADERM CREAM 26

AC04951209 ATROPINE SULFATE INJECTION "SINTONG" 15

AC04963100 TETRACYCLINE HCL CAPSULES "C.C.P." 1.5

AC049631G0 TETRACYCLINE HCL CAPSULES "C.C.P."(鋁箔/膠箔) 2

AC04975421 EYE RINDERON-A SOLUTION 32.8

AC05041100 NICOXAN TABLETS 1.5

AC05062100 KIDOLEX CAPSULES "KINGDOM" 1.5

AC05200100 PERSINE S.C. TABLETS 25MG 1.5

AC05247100 "METHYLEPHEDRINE HCL TABLETS ""ASTAR""" 1.5

AC05250100 LINAGAN TABLETS 25MG 1.5

AC05272100 HUEI YI CAPSULES "J.H." 2.25

AC05305100 SATAMOL TABLETS 1.5

AC05313100 TRANTAL FILM COATED TABLETS "YUNG SHIN" 1.5

AC05324209 DELTONIN INJECTION "N.K." 16.7

AC05324221 DELTONIN INJECTION "N.K." 16.9

AC05418100 "O.D.K. CAPSULES ""ORIENT""" 2.39

AC05495100 DOINMYCIN CAPSULES 1.5

AC05508100 GLARE CAPSULES "F.Y." 1.5

AC05515100 AMINOPHYLLINE TABLETS "LITA" 1.5

AC05669100 "AMINOPHYLLINE TABLETS ""ASTAR""" 1.5

AC05708100 BROWN MIXTURE TABLETS 1.5

AC057081G0 BROWN MIXTURE TABLETS (84粒/瓶裝) 2

AC05712100 "DIPROPHYLLIN TABLETS ""ASTAR""" 1.5

AC05757100 CHIERHSIN TABLETS 10MG 1.5

AC05811100 STROCAIN TABLETS 1.54

AC058111G0 STROCAIN TABLETS(鋁箔/膠箔) 2

AC05812100 HOMOCLOMIN TABLETS 1.5

AC058121G0 HOMOCLOMIN TABLETS(鋁箔/膠箔) 2

AC05813100 SOLAXIN TABLETS 1.5

AC058131G0 SOLAXIN TABLETS(鋁箔/膠箔) 2

AC05857100 CODEINE PHOSPHATE TABLETS 15MG 1.9

AC05858100 PETHIDINE HYDROCHLORIDE TABLETS 50 MG 5.5

AC05860100 MORPHINE HYDROCHLORIDE TABLETS 10MG 2.8

AC05865100 CODEINE PHOSPHATE TABLETS 30MG 2.4

AC05874209 PETHIDINE HYDROCHLORIDE INJECTION 50MG/ML 20

85

Page 86: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC05886209 MORPHINE HYDROCHLORIDE 20MG/ML 18

AC05889209 CODEINE PHOSPHATE INJECTION 15MG/ML 15

AC05891209 MORPHINE HYDROCHLORIDE INJECTION 10MG/ML 16

AC05896209 IMPERAN INJECTION "N.K." 15

AC05896212 IMPERAN INJECTION "N.K." 15

AC05925100 MERISLON TABLETS 6MG (BETAHISTINE MESILATE) 1.5

AC059251G0 MERISLON TABLETS 6MG (BETAHISTINE MESILATE)(鋁箔/膠箔) 2

AC05954100 COSPANON CAPSULES 1.54

AC059541G0 COSPANON CAPSULES(鋁箔/膠箔) 2

AC05986100 "MENIPERAN TABLETS 5MG ""M.T."" (METOCLOPRAMIDE)" 1.5

AC05987100 INOLIN TABLETS 3MG 1.5

AC06006100 PONSTAL CAPSULES 1.5

AC06373100 HEMAGEN CAPSULES 1.5

AC06554100 ERYTHROMYCIN CAPSULES 250MG "HONTEN" 2.15

AC06645100 METHYLEPHEDRINE TABLETS "TEM CPARP" 1.5

AC06677100 VALEMATE TABLETS 10 MG 1.5

AC06747100 CEPHALEXIN CAPSULES 1.5

AC067471G0 CEPHALEXIN CAPSULES(鋁箔/膠箔) 2

AC06821100 AMPICILLIN CAPSULES 250MG "VPP" 1.5

AC06827100 AMINOPHYLLINE TABLETS 100MG "VPP" 1.5

AC07096209 CYANOCOBALAMIN INJECTION "PANBIOTIC" 15.5

AC07096229 CYANOCOBALAMIN INJECTION "PANBIOTIC" 15.5

AC07175100 PRANOL TABLETS 20MG "JOHNSON" 1.5

AC07233100 DOXYCYCLINE CAPSULES 1.5

AC07256100 PROCID TABLETS 2.83

AC07342100 APULON TABLETS "Y.S." 1.5

AC07371100 VASODILAN TABLETS 1.5

AC07372100 GRISEOFULVIN TABLETS 1.5

AC07454221 GLYMINE INJECTION 15

AC07543100 FOLIC ACID TABLETS "VPC" 1.5

AC075431G0 FOLIC ACID TABLETS "VPC" (鋁箔/膠箔) 2

AC07630212 PULIN INJECTION "YUNG SHIN" 15

AC07673100 PREDNISOLONE TABLETS "P.L." 1.5

AC07680100 LIPHALEXIN CAPSULES 250MG "LITA" 1.5

AC07682229 DEXASON INJECTION 4MG/ML "LITA" 23.6

AC07749100 DELAX TABLETS "SHOU CHAN" 1.5

AC07796100 PETTI CAPSULES 1.5

AC07944100 DETTACKS S.C. TABLETS 10 MG "F.Y." 1.5

AC07974212 LARKMYCIN INJECTION 40MG/ML "LITA" 15

AC07974229 LARKMYCIN INJECTION 40MG/ML "LITA" 16.9

AC08097100 INDOMETHACIN CAPSULES "MEIDER" 1.5

AC08160100 CANON CAPSULES "YUNG SHIN" 1.58

AC08169100 OUTALLERGIN TABLETS "A.L." 1.5

AC08309100 BEGATAL S.C. TABLETS 1.5

AC08310100 RIFAMPICIN CAPSULES 300MG "LITA" 8.1

AC08311100 RIFAMPICIN CAPSULES 150MG "LITA" 4.48

AC08380100 PERISIN S.C. TABLETS "LITA" 1.5

AC08505100 METOPERAN TABLETS "H.C." 1.5

AC08510100 DACOCILIN CAPSULES 250MG 1.5

AC08519100 VALEMATE S.C. TABLETS 10MG 1.5

AC08526100 SZULEN S.C. TABLETS 1.5

AC08536100 "R-WEX TABLETS ""ORIENT""" 1.5

AC08662100 SENFIHU TABLETS 1.5

AC08663100 CHIAOWELGEN S.C. TABLETS 1.5

AC08678335 BETASON-G CREAM "LITA" 19.6

86

Page 87: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC08753100 TRAMEZIN TABLETS "HONTEN" 1.5

AC087531G0 TRAMEZIN TABLETS "HONTEN"(鋁箔/膠箔) 2

AC08764100 COSTOL CAPSULES 1.5

AC08851209 ANCILLINA INJECTION 1GM 15

AC08855100 CHEMIX TABLETS "YUNG SHIN" 1.5

AC08890100 "WINACORT-A TABLETS ""WINSTON""" 1.5

AC08910248 SANYL LYO INJECTION 18.1

AC08912221 ESCIN LYO-INJECTION 37.6

AC08913209 PIPETO INJECTION 15

AC08917100 PULIN COATED TABLETS 5MG 1.5

AC089171G0 PULIN SUGAR COATED TABLETS 5MG(鋁箔/膠箔) 2

AC08928100 DEXAMETHASONE TABLETS "MEIDER" 1.5

AC08956212 GENTAMYCIN INJECTION 15

AC08956299 GENTAMYCIN INJECTION 1.49

AC08957100 "WINCOLD CAPSULES ""WINSTON""" 1.5

AC09067212 KASON INJECTION "YUNG SHIN" 15

AC09086212 GUAIC INJECTION 15

AC09099100 IKODIN CAPSULES 250MG 1.5

AC090991G0 IKODIN CAPSULES 250MG(鋁箔/膠箔) 2

AC09203100 LIBLAN S.C. TABLETS "YUNG SHIN" 1.99

AC09211100 ALUDENE TABLETS 1.5

AC092111G0 ALUDENE TABLETS(鋁箔/膠箔) 2

AC09256100 SOMEPRIM TABLETS 1.5

AC09271277 SORBIT-HARTMANN INJECTION 43.8

AC09275100 VICOMP S.C. TABLETS 1.5

AC09291100 EUCLIDAN TABLETS 50MG 1.5

AC092911G0 EUCLIDAN S.C.TABLETS 50MG(鋁箔/膠箔) 2

AC09299100 LIGILIN CAPSULES 1.54

AC09334100 FUZUIN S.C. TABLETS "CHINGTENG" 1.64

AC093341G0 FUZUIN S.C. TABLETS "CHINGTENG"(鋁箔/膠箔) 2

AC09346212 PYRIDOXAL PHOSPHATE INJECTION 20MG "KYORIN" 15

AC09386100 CYPROMIN TABLETS 1.5

AC09393100 BETAMETHASONE TABLETS "YU SHENG" 1.5

AC09408100 METRONIDAZOLE TABLETS "YU SHENG" 1.64

AC09409100 CO-TRIMOXAZOLE TABLETS "Y.S." 1.5

AC09438212 SINCEN INJECTION 15

AC09453100 CEPHANMYCIN CAPSULES "YUNG SHIN" 1.5

AC09514100 "EGOTAN S.C. TABLETS ""WINSTON""" 1.5

AC09570100 OUTERDZEN S.C. TABLETS "CHINTENG" 1.5

AC095701G0 OUTERDZEN S.C. TABLETS "CHINTENG" (鋁箔/膠箔) 2

AC09587100 FROTIN ENTERIC SUGAR COATED TABLETS 1.64

AC09607100 PREDNISOLONE TABLETS 1.5

AC096071G0 PREDNISOLONE TABLETS(鋁箔/膠箔) 2

AC09609100 AMPICILLIN CAPSULES 500MG "VPP" 1.5

AC096091G0 AMPICILLIN CAPSULES 500MG "VPP"(鋁箔/膠箔) 2

AC09614100 SUYI TABLETS 5MG "HEALTH" 1.5

AC096141G0 SUYI TABLETS 5MG "HEALTH"(鋁箔/膠箔) 2

AC09615100 CYPRODINE TABLETS "MEIDER" 1.5

AC09619100 BISADYL E.C. TABLETS "MEIDER" 1.5

AC096191G0 BISADYL E.C. TABLETS "MEIDER"(鋁箔/膠箔) 2

AC09633255 MANITON INJECTION 39.4

AC09633266 MANITON INJECTION 39.4

AC09633277 MANITON INJECTION 117

AC09645209 STACORT-A INJECTION 40MG "STANDARD" 23

AC09645221 STACORT-A INJECTION 40MG "STSNDARD" 44.4

87

Page 88: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC09654100 DOXYMYCIN CAPSULES "YUNG SHIN" 1.5

AC09683277 XYLITOL INJECTION 5% "KYORIN" 26.7

AC09722100 MEFEINE TABLETS "H.C" 1.5

AC09743100 RIDONRA TABLETS 1.5

AC09754209 B-RED INJECTION "KYORIN" 15.5

AC09763100 BENZAMINE TABLETS 1.5

AC09792100 BENTYL TABLETS 10MG 1.5

AC09915100 METASONE TABLETS "H.S." 1.5

AC09916100 DEXAN TABLETS "H.S." 1.5

AC09982238 DEXTROSE INJECTION 20% "S.Y." 15

AC09987100 CONICINE TABLETS "H.H." 1.5

AC099871G0 CONICINE TABLETS "H.H."(鋁箔/膠箔) 2

AC09990212 "ASCORBIC ACID INJECTION ""S.Y.""" 15

AC09990221 "ASCORBIC ACID INJECTION ""S.Y.""" 15

AC10058100 PROPRANOLOL TABLETS "YU SHENG" 1.5

AC10066277 FRUCTOSE INJECTION 5% 30.7

AC10069277 HARTMANN'S INJECTION 25

AC10139100 PREDSON TABLETS "H.S." 1.5

AC10150212 "DIZEPAM INJECTION ""S.Y.""" 15

AC10168100 DECAN TABLETS "YUNG SHIN" 1.5

AC101681G0 DECAN TABLETS "YUNG SHIN"(鋁箔/膠箔) 2

AC10182209 KANAMYCIN INJECTION "YUNG SHIN" 15

AC10183100 "WITHAMYCIN CAPSULES ""WINSTON""" 1.5

AC10192100 "WINTELLIN CAPSULES ""WINSTON""" 1.5

AC10207100 INDECIN CAPSULES "H.S." 1.5

AC10221321 "WINCORT CREAM ""WINSTON""" 33.3

AC10221329 "WINCORT CREAM ""WINSTON""" 37.9

AC10229100 THIMAZOL S.C. TABLETS "SHUN HWA" 1.5

AC10246100 NITROFURANTOIN E.C. TABLETS 1.5

AC10248100 COOCHIL TABLETS "CHINTENG" 1.5

AC102481G0 COOCHIL TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC10249100 PIWEILIN TABLETS "CHINTENG" 1.5

AC102491G0 PIWEILIN TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC10282100 BACIDE TABLETS "VPP" 1.5

AC102821G0 BACIDE TABLETS "VPP"(鋁箔/膠箔) 2

AC10320277 "ELECTRO-5% DEXTROSE INFUSION SOLUTION ""Y.F.""" 30.3

AC10323100 BIGUNAL TABLETS 50MG 2.66

AC10334100 TONTYL TABLETS "PATRON" 1.5

AC10358100 HERBESSER TABLETS 1.5

AC103581G0 HERBESSER TABLETS(鋁箔/膠箔) 2

AC10365100 AMOXICILLIN CAPSULES 250MG "KINGDOM" 1.5

AC10374100 CINNARIN TABLETS "HONTEN" 1.5

AC103741G0 CINNARIN TABLETS "HONTEN" (鋁箔/膠箔) 2

AC10395100 TRAN TABLETS "YUNG SHIN" 1.5

AC10414417 "EYE WINACORT OINTMENT ""WINSTON""" 22.2

AC10414429 "EYE WINACORT OINTMENT ""WINSTON""" 54

AC10415100 ANCOCILLIN CAPSULES 1.97

AC10431100 CALITH CAPSULES "PATRON" 1.54

AC10446100 ANZUWEI CAPSULES "H.H." 1.5

AC10452221 HISTIDINE INJECTION 15

AC10457212 PANTHOL INJECTION 100MG "Y.Y" 15

AC10478416 "EYE BETASON-N OINTMENT ""WINSTON""" 15.5

AC10487100 HUASWEI TABLETS "H.H." 1.5

AC104871G0 HUASWEI TABLETS "H.H."(鋁箔/膠箔) 2

AC10488100 HUAVINE TABLETS "H.S." 1.5

88

Page 89: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC10489100 HUAROKINE CAPSULES "H.S." 1.5

AC104891G0 HUAROKINE CAPSULES "H.S."(鋁箔/膠箔) 2

AC10491100 NOGERON CAPSULES "PATRON" 1.5

AC10547212 DIAZEPAM INJECTION "LITA" 15

AC10571100 COLIGIN CAPSULES "HEALTH" 1.64

AC10688100 ERYTHROMYCIN (ESTOLATE) 2.15

AC10710100 SERNVITA S.C. TABLETS 50MG "CHINTENG" 1.5

AC10721209 "CYANOCOBALAMINE INJECTIONS ""S.Y.""" 15.5

AC10721229 "CYANOCOBALAMINE INJECTION ""S.Y.""" 15.5

AC10722209 SEKIJIS INJECTION 15

AC10764100 BACDAN TABLETS "PATRON" 1.5

AC10774100 PIMINTON TABLETS "PATRON" 1.5

AC10775100 BRONDIN TABLETS "PATRON" 1.51

AC10802100 PECTRIN S.C. TABLETS 25MG 1.5

AC10812100 HERSUN TABLETS 10MG "F.Y." 1.5

AC10819100 SUPERCILLIN CAPSULES 250MG 1.5

AC108191G0 SUPERCILLIN CAPSULES 250MG "VPP"(鋁箔/膠箔) 2

AC10830212 DIAZEPAM INJECTION 15

AC10848212 PRANOL INJECTION "Y.Y." 15

AC10871277 STIN POWDER FOR INJECTION 5.4

AC10909100 CINNARIZINE TABLETS "YU SHENG" 1.5

AC10914221 LIDOCAINE HCL 2% FOR I.V. INJECTION "LITA" 50

AC10917100 BEHYD TABLETS 1.5

AC109171G0 BEHYD TABLETS(鋁箔/膠箔) 2

AC10941100 FUNGACIN CAPSULES "PATRON" 1.65

AC10992100 PASTON CAPSULES "P.L." 1.5

AC11006100 NICAMET SUGAR COATING TABLETS 1.5

AC11012100 SKETA CAPSULES "PATRON" 1.5

AC110121G0 SKETA CAPSULES "PATRON"(鋁箔/膠箔) 2

AC11047221 METHIOLAMINE-B12 INJECTION "Y.Y." 15

AC11124100 BUTYPON S.C. TABLETS 1.5

AC11125100 KERCORT TABLETS "CHIN TENG" 1.5

AC111251G0 KERCORT TABLETS "CHIN TENG"(鋁箔/膠箔) 2

AC11136209 "VETHASONE INJECTION ""S.Y.""" 16.7

AC11150212 SUOPINCHON INJECTION "S.Y." 15

AC11154100 SEQUITON TABLETS 1.5

AC111541G0 SEQUITON TABLETS(鋁箔/膠箔) 2

AC11193100 TEITHCAN SUGAR COATING TABLETS "CHIN TENG" 1.5

AC111931G0 TEITHCAN SUGAR COATING TABLETS "CHIN TENG"(鋁箔/膠箔) 2

AC11207155 SOMEPRIM GRANULES 111

AC11224100 DOXYNIN CAPSULES "SWISS" 1.5

AC112241G0 DOXYNIN CAPSULES "SWISS"(鋁箔/膠箔) 2

AC11230100 HICOBAL CAPSULES "GENTLE" 1.5

AC11317100 ANTI-COUGH TABLETS 1.5

AC11318100 OLYRRHIZIN S.C TABLETS "MEIDER" 1.5

AC11331212 GENTAMICIN INJECTION "YUNG SHIN" 15

AC11331229 GENTAMICIN INJECTION "YUNG SHIN" 16.9

AC11331238 GENTAMICIN INJECTION "YUNG SHIN" 61

AC11331299 GENTAMICIN INJECTION "YUNG SHIN" 1.49

AC11358100 TRANTIN S.C. TABLETS "YU SHENG" 1.5

AC11420221 NOOPOL INJECTION "N.K." 15

AC11420229 NOOPOL INJECTION "N.K." 33.7

AC11421100 NOOPOL CAPSULES "N.K." 1.5

AC11465212 HUAZIN INJECTION 15

AC11475209 SHINCORT I.M. INJECTION "YUNG SHIN" 23

89

Page 90: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC11475229 SHINCORT I.M. INJECTION "YUNG SHIN" 57

AC11476221 SHINCORT INJECTION "YUNG SHIN" 23.8

AC11476229 SHINCORT INJECTION "YUNG SHIN" 23.8

AC11477212 DECAN INJECTION "YUNG SHIN" 15

AC11518100 NEOMYCIN CAPSULES 250MG 1.96

AC11547100 ALLORIC TABLETS 1.5

AC11552277 DEXTROSE INJECTION 5% "OTSUKA" 25.1

AC11562100 PANTRIM TABLETS "HC" 1.5

AC11570212 SERACIN INJECTION 15

AC11570216 SERACIN INJECTION 15.9

AC11570238 SERACIN INJECTION 61

AC11576212 SWITYL INJECTION "SWISS"

SWITYL INJECTION "SWISS BRAND"

15

AC11644100 CONQUER TABLETS "YUNG SHIN" 1.51

AC116441G0 CONQUER TABLETS "YUNG SHIN" (鋁箔/膠箔) 2

AC11652321 BETTERSONE OINTMENT 16.1

AC11652329 BETTERSONE OINTMENT 16.1

AC11652335 BETTERSONE OINTMENT 19.6

AC11655100 VIVIKA TABLETS "YUNG SHIN" 1.5

AC116551G0 VIVIKA TABLETS "YUNG SHIN"(鋁箔/膠箔) 2

AC11665209 ASTHPIN INJECTION 15

AC11701100 PEIWETSU TABLETS "P.L." 1.5

AC11723277 AMINOL-K INJECTION 81

AC11750212 BIOMIN INJECTION "YUNG SHIN" 15

AC11775212 CHIAOWELGEN INJECTION "SWISS" 15

AC11776212 SWELIUM INJECTION 15

AC11780212 METOPERAN INJECTION 15

AC11782209 ASTHNIL INJECTION 15

AC11795212 CHUCO INJECTION 15

AC11806100 INDOTHAN CAPSULES 1.5

AC11807100 DIPYRON TABLETS 1.5

AC118071G0 DIPYRON TABLETS(鋁箔/膠箔) 2

AC11845209 FRUCTOSE INJECTION 5% "N.K." 38.1

AC11845265 FRUCTOSE INJECTION 5% "N.K." 22

AC11845277 FRUCTOSE INJECTION 5% "N.K." 30.7

AC11865212 BIOVITAS INJECTION 15

AC11886277 "DEXTROSE AND SODIUM CHLORIDE INJECTION ""ASTAR""" 25

AC11931100 PREDNISOLONE TABLETS "MEIDER" 1.5

AC11933277 CEFACIN INJECTION "LITA" 15

AC11964100 TEKILON CAPSULES "P.L." 1.5

AC11982100 NICEFON TABLETS 1.5

AC11983100 ORCITRAN TABLETS "HC" 1.5

AC12050212 GENTACIN INJCETON "S.T." 15

AC12050229 GENTACIN INJECTION "S.T." 16.9

AC12051100 AMOXICILLIN CAPSULES 250MG "C.C.P." 1.5

AC120511G0 AMOXICILLIN CAPSULES 250MG"C.C.P."(鋁箔/膠箔) 2

AC12055100 "MIN-TA-WE TABLETS (DIHYDROXYALUMINUM ALLANTOIN)""M.T.""" 1.5

AC12311221 TROBICIN INJECTION "CHI SHENG" 15

AC12311238 TROBICIN INJECTION "CHI SHENG" 15

AC12318100 YIKANG TABLETS 1.64

AC12371100 "BETAMETHASONE TABLETS ""M.T.""" 1.5

AC12414100 COLIOPAN TABLETS 1.5

AC12443500 INTHACID SUPPOSITORIES "PATRON" 5

AC12447100 BOSCON F.C. TABLETS 10MG "T.F." 1.5

AC12451229 HIDOMIN INJECTION "YUNG SHIN" 15.5

90

Page 91: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC12452100 FLACIL CAPSULES 21.3

AC124581G0 EURODIN TABLETS 2MG(鋁箔/膠箔) 2

AC12474209 DEXAMETHASONE INJECTION 4MG/ML "N.K." 15

AC12474212 DEXAMETHASONE INJECTION 4MG/ML "N.K." 23.6

AC12474229 DEXAMETHASONE INJECTION 4MG/ML "N.K." 23.6

AC12519100 ANETHION S.C. TABLETS 1.5

AC12521212 GENTACIN INJECTION 15

AC12521229 GENTACIN INJECTION 16.9

AC12521299 GENTACIN INJECTION 1.49

AC12527209 SIVKORT SUSPENSION 23

AC12527229 SIVKORT SUSPENSION 23.8

AC12528221 SEVATRIM INJECTION 18.4

AC12551100 SKELIN TABLETS "F.Y." 1.5

AC12603100 METHOMINE TABLETS "H.S." 1.5

AC12639100 TETRACYCLINE HCL TABLETS "C.C.P." 1.5

AC12694100 ULCEN TABLETS "MEIDER" 1.5

AC12703100 SINPRIM F.C. TABLETS "CHINTENG" 1.5

AC127031G0 SINPRIM F.C. TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC12745321 PARMASON CREAM "BOWLIN" 22.5

AC12745329 PARMASON CREAM "BOWLIN" 22.5

AC12745338 PARMASON CREAM "BOWLIN" 42

AC12763100 DEYANJUNN TABLETS 1.5

AC12782100 DOXYCYCLINE CAPSULES 100MG "CSP" 1.5

AC12824277 LOW MOLECULAR DEXTRAN DEXTROSE INJECTION "OTSUKA" 233

AC12828100 ALUZAINE TABLETS 1.5

AC128281G0 ALUZAINE TABLETS(鋁箔/膠箔) 2

AC12831100 MEFEN TABLETS "CHINTENG" 1.5

AC128311G0 MEFEN TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC12858277 DICILLIN INJECTION 500MG 15

AC12860100 NONASMA TABLETS 20MG 1.51

AC12880100 COUGHMIN S.C. TABLETS "KYORIN" 1.5

AC12902100 KUAY WEY HAO TABLETS "J.H." 1.5

AC12975100 SALTOLIN TABLETS "GENTLE" 1.5

AC13054100 QURMININ-H CAPSULES "S.C." 1.5

AC13077100 HUALISHIH CAPSULES "H.S." 1.5

AC13083100 "ISONIAZID TABLETS ""WINSTON""" 1.5

AC130831G0 "ISONIAZID TABLETS ""WINSTON""" 2

AC13089100 SALBUTAMOL TABLETS 1.5

AC13162100 BETAMETHASONE TABLETS "JOHNSON" 1.5

AC13175100 PREDNISOLONE TABLETS "C.H." 1.5

AC13181100 URINTESTIN TABLETS 500MG "VPP" 2.25

AC13229100 AMOXICILLIN CAPSULES "YUNG SHIN" 1.5

AC132291G0 AMOXICILLIN CAPSULES "YUNG SHIN"(鋁箔/膠箔) 2

AC13361100 MEFENAMIC ACID CAPSULES "C.H." 1.5

AC13381100 CORTISONE ACETATE TABLETS 25MG "PING LAWER" 1.5

AC133811G0 CORTISONE ACETATE TABLETS 25MG “PINE LAWER”(鋁箔/膠箔) 2

AC13429100 NEUZYM TABLETS 30MG (LYSOZYME TABLETS 30MG) 1.5

AC13433100 ALLOPURINOL TABLETS "MEIDER" 1.5

AC13509277 DEXSALIN INJECTION "CHI SHENG" 25

AC13547100 "ANETHOL CAPSULES ""M.T.""" 1.5

AC13574238 "TAIBILONE INJECTION ""TAI YU""" 15

AC13575209 "PROGESTERONE INJECTION ""TAI YU" 15

AC13575229 "PROGESTERONE INJECTION ""TAI YU""" 15.6

AC13576229 "KANAMYCIN INJECTION ""TAI YU""" 19

AC13576238 "KANAMYCIN INJECTION ""TAI YU""" 26.6

91

Page 92: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC13576299 "KANAMYCIN INJECTION ""TAI YU""" 1.33

AC13577212 "VITAMIN C INJECTION ""TAI YU""" 15

AC13577229 "VITAMIN C INJECTION ""TAI YU" 15

AC13577238 "VITAMIN C INJECTION ""TAI YU""" 15

AC13578209 "TRIAMCINOLONE SUSPENDED INJECTION 10MG ""TAI YU""" 23

AC13578221 "TRIAMCINOLONE SUSPENDED INJECTION 10MG ""TAI YU""" 23.8

AC13578229 "TRIAMCINOLONE SUSPENDED INJECTION 10MG ""TAI YU""" 23.8

AC13582238 "GLUCAMETHI INJECTION ""TAI YU""" 15

AC13583209 "HYDROXOCOBALAMIN INJECTION ""TAI YU""" 15.5

AC13583229 "HYDROXOCOBALAMIN INJECTION ""TAI YU""" 15.5

AC13627100 RIFAMPICIN CAPSULES "YUNG SHIN" 4.48

AC13634100 DIPYRIDAMOLE S.C. TABLETS "YUNG SHIN" 1.5

AC136341G0 DIPYRIDAMOLE S.C. TABLETS "YUNG SHIN"(鋁箔/膠箔) 2

AC13637212 GENTAMICIN SULFATE INJECTION "ENSAFE" 15

AC13637229 GENTAMICIN SULFATE INJECTION "ENSAFE" 16.9

AC13637238 GENTAMICIN SULFATE INJECTION "ENSAFE" 61

AC13647321 GENTASONE CREAM 39.6

AC13647329 GENTASONE CREAM 39.6

AC13647335 GENTASONE CREAM 39.6

AC13650100 "INAVITA TABLETS ""WINSTON""" 1.5

AC136501G0 "INAVITA TABLETS ""WINSTON""" 2

AC13651229 FELINAMIN INJECTION "CHI SHENG" 15

AC13651238 FELINAMIN INJECTION "CHI SHENG" 15

AC13662100 METRONIDAZOLE CAPSULES "C.H." 1.64

AC13718209 "5%/0.45% DEXTROSE AND SODIUM CHLORIDE INJECTION ""Y.F.""" 35

AC13718277 "5%/0.45% DEXTROSE AND SODIUM CHLORIDE INJECTION ""Y.F.""" 25

AC13722500 METROCIDE VAGINAL SUPPOSITORIES 250MG "T.F." 5

AC13778100 "NO-COUGH CAPSULES ""M.T.""" 1.5

AC137781G0 "NO-COUGH CAPSULES ""M.T.""(鋁箔/膠箔)" 2

AC13801100 DIPYRIDAMOLE S.C. TABLETS "STANDARD" 1.5

AC138011G0 DIPYRIDAMOLE S.C. TABLETS "STANDARD"(鋁箔/膠箔) 2

AC13817265 "AMINOPLEX INJECTION ""TAI YU""" 63

AC13817266 "AMINOPLEX INJECTION ""TAI YU""" 65

AC13817277 "AMINOPLEX INJECTION ""TAI YU""" 70

AC13900100 NALIDIXIC ACID TABLETS 2.25

AC13907238 VITAGEN-S INJECTION 15

AC13912209 DEXAMETHASONE INJECTION "PANBIOTIC" 15

AC13912229 DEXAMETHASONE INJECTION "PANBIOTIC" 23.6

AC13929238 "DEXTROSE-LACTATED RINGER'S INJECTION ""TAI YU""" 15

AC13929265 "DEXTROSE-LACTATED RINGER'S INJECTION ""TAI YU""" 27.2

AC13929277 "DEXTROSE-LACTATED RINGER'S INJECTION ""TAI YU""" 30.3

AC13980238 "DEXTROSE INJECTION 20% ""TAI YU""" 15

AC13980277 "DEXTROSE INJECTION 20% ""TAI YU""" 25

AC13985209 "TESTOSTERONE CYPIONATE INJECTION ""TAI YU""" 30.8

AC14025100 KENTAMIN CAPSULES 1.81

AC140251G0 KENTAMIN CAPSULES (鋁箔/膠箔) 2

AC14030212 "METOCLOPRAMIDE INJECTION ""TAI YU""" 15

AC14079100 CLONIDINE TABLETS "YUNG SHIN" 2.11

AC14081109 CEPHANMYCIN GRANULES "YUNG SHIN" 3.12

AC14148212 HYDROXOCOBALAMIN INJECTION "CHI SHENG" 15.5

AC14148229 HYDROXOCOBALAMIN INJECTION "CHI SHENG" 22

AC14148299 HYDROXOCOBALAMIN INJECTION "CHI SHENG" 2.2

AC14183100 "DEXAMETHASONE TABLETS ""WINSTON""" 1.5

92

Page 93: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC14195100 D.A.A. TABLETS "F.Y." 1.5

AC14205238 SURPLEX INJECTION "CHI SHENG" 15

AC14227100 BETAMETHASONE TABLETS "YUNG SHIN" 1.5

AC142271G5 BETAMETHASONE TABLETS "YUNG SHIN" (84粒/瓶) 2

AC14228100 ALLOPURINOL TABLETS"YUNGSHIN" 1.5

AC142281G0 ALLOPURINOL TABLETS"YUNGSHIN"(鋁箔/膠箔) 2

AC14233100 "RIFAMPICIN CAPSULES ""WINSTON""" 8

AC14241212 "DIPROPHYLLIN INJECTION ""TAI YU""" 15

AC14277100 "SAUSCON TABLETS ""ORIENT""" 1.5

AC14321421 PAMESONE OPHTHALMIC SOLUTION "PATRON" 13.4

AC14325209 "DEXAMETHASONE INJECTION ""TAI YU""" 15

AC14325229 "DEXAMETHASONE INJECTION ""TAI YU""" 23.6

AC14343100 COBAMAMIDE CAPSULES "HONTEN" 1.5

AC14354277 "XYLITOL INJECTION 5% ""TAI YU""" 26.7

AC14355209 "ATROPINE SULFATE INJECTION ""TAI YU""" 15

AC14356209 "TESTOSTERONE PROPIONATE INJECTION ""TAI YU""" 15

AC14357238 "PYRICOBAMIN INJECTION ""TAI YU""" 15

AC14360212 "SKIMITIN INJECTION ""TAI YU""" 15

AC14360238 "SKIMITIN INJECTION ""TAI YU""" 15

AC14361209 "NEOSTIGMINE METHYLSULFATE INJECTION ""TAI YU""" 15

AC14363209 "ERGONOVINE MALEATE INJECTION ""TAI YU""" 15

AC14441221 BLONDA INJECTION 5% (TRANEXAMIC ACID) "C.C.P. 15

AC14449100 COUGH CAPSULES "PATRON" 1.5

AC14456238 "AMINO COMPOSITE INJECTION ""TAI YU""" 15

AC14596500 NYSTATIN VAGINAL TABLETS "YUNG SHIN" 5

AC14622212 FUTIGEN-H INJECTION "S.Y." 15

AC14622221 FUTIGEN-H INJECTION "S.Y." 15

AC14624100 BUPROFEN CAPSULES 400MG "LITA" 1.5

AC14750229 LICOMYCIN INJECTION 300MG/ML "CSP" 0

AC14755100 DIKUTON TABLETS 1.5

AC14756216 PENICILLIN G SODIUM INJECTION 3000000U "Y.F." 25.4

AC14759209 "B-COMPLEX INJECTION ""TAI YU""" 15

AC14759229 "B-COMPLEX INJECTION ""TAI YU""" 15

AC14833100 CHOLAR S.C. TABLETS 25MG "YUNG SHIN" 1.5

AC14845100 FULUCON TABLETS "S.T." 1.5

AC14894212 "GENTAMICIN INJECTION 4% ""TAI YU""" 15

AC14894229 "GENTAMICIN INJECTION 4% ""TAI YU""" 16.9

AC14894238 "GENTAMICIN INJECTION 4% ""TAI YU""" 61

AC14909100 MEFENAMIC ACID CAPSULES 250MG"D.T.S" 1.5

AC14914209 "TRIAMCINOLONE SUSPENDED INJECTION 4% ""TAI YU""" 23

AC14914221 "TRIAMCINOLONE SUSPENDED INJECTION 4% ""TAI YU""" 44.4

AC14914229 "TRIAMCINOLONE SUSPENDED INJECTION 4% ""TAI YU""" 57

AC14915329 FLUCORTONE OINT. 43.4

AC14917100 FERACON F.C. TABLETS 2.04

AC14926212 "BROMHEXINE INJECTION ""S.Y.""" 15

AC14930100 "CHLORZOXAZONE TABLETS ""WINSTON""" 1.5

AC14981209 CLONIDINE INJECTION "YUNG SHIN" 36

AC15024100 METHYLSCOPOLAMINE METHYLSULFATE TABLETS "P.L. 1.57

AC15041100 KETOFEN CAPSULES "H.H." 1.91

AC15056238 "DEXTROSE INJECTION 50% ""TAI YU""" 15

AC15078100 DIPHENIDOL S.C. TABLETS 1.5

AC150781G0 DIPHENIDOL S.C. TABLETS (鋁箔/膠箔) 2

AC15080329 Y.T.M. OINTMENT "TAI YU" 26.6

AC150901G0 PSEUDOEPHEDRINE HCL TABLETS "HONTEN"(鋁箔/膠箔) 2

AC15091100 KETOPROFEN CAPSULES 50MG "F.Y." 1.91

93

Page 94: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC15100100 RIF CAPSULES 450MG 11

AC15118100 "RIFAMPIN CAPSULES 150MG ""WINSTON""" 4.48

AC151951G0 NARCARICIN CAPSULES (BENZBROMARONE)(鋁箔/膠箔) 2

AC15218238 "DEXTROSE INJECTION 5% ""TAI YU""" 15

AC15218255 "DEXTROSE INJECTION 5% ""TAI YU""" 22

AC15218265 "DEXTROSE INJECTION 5% ""TAI YU""" 22

AC15218277 "DEXTROSE INJECTION 5% ""TAI YU""" 25.1

AC15246265 5% DEXTROSE IN 0.33% SALINE INJECTION "SIN TONG" 22

AC15246277 5% DEXTROSE IN 0.33% SALINE INJECTION 25

AC15253209 "PYRIDOXINE HCL INJECTION 100MG/ML ""TAI YU""" 15

AC15253229 "PYRIDOXINE HCL INJECTION 100MG/ML ""TAI YU""" 15

AC15265100 CHLORPROMAZINE TABLETS "Y.Y." 1.54

AC15268100 "DEXAMETHASONE TABLETS ""S.Y.""" 1.5

AC15279209 "DEXAMETHASONE INJECTION 4MG ""TAI YU""" 15

AC15279229 "DEXAMETHASONE INJECTION 4MG ""TAI YU""" 23.6

AC15343221 "HISTIDINE INJECTION ""TAI YU""" 15

AC15368100 DIPHENIDOL SUGAR COATING TABLETS "YUNG SHIN" 1.5

AC15387100 NAPOSIN TABLETS (NAPROXEN)250MG 0.82

AC153871G0 NAPOSIN TABLETS 250MG(NAPROXEN)(鋁箔/膠箔) 2

AC15398100 ASTOMIN S.C. TABLETS 1.51

AC153981G0 ASTOMIN S.C. TABLETS(鋁箔/膠箔) 2

AC15405100 "RIFAMPICIN CAPSULES 450MG ""WINSTON""" 13.6

AC15407229 LINCOMYCIN INJECTION "SINTONG" 27.2

AC15422100 RELAZIDE S.C. TABLETS "STANDARD" 1.5

AC154221G0 RELAZIDE S.C. TABLETS "STANDARD"(鋁箔/膠箔) 2

AC15430238 "SPORMINE INJECTION ""TAI YU""" 15

AC15430265 "SPORMINE INJECTION ""TAI YU""" 22

AC15430266 "SPORMINE INJECTION ""TAI YU""" 25.1

AC15430277 "SPORMINE INJECTION ""TAI YU""" 25.1

AC15467100 DEXAMETHASONE TABLETS 4MG "STANDARD" 1.5

AC15473229 "LINCOMYCIN HCL INJECTION 300MG ""TAI YU""" 27.2

AC15473238 "LINCOMYCIN HCL INJECTION 300MG ""TAI YU""" 39.2

AC15473299 LINCOMYCIN HCL INJ. 300MG 1.96

AC15514209 EPINEPHRINE INJECTION "VPP" 15

AC15522100 CANCIDIN TABLETS 500MG "BOWLIN" (TINIDAZOLE) 2.09

AC15526229 LINCOMYCIN INJECTION "YUNG SHIN" 27.2

AC15529100 DICYCLOMINE TABLETS "D.T.S." 1.5

AC15539238 K.C.L. INJECTION "CHI SHENG" 15

AC15543100 PEICHIA TABLETS "P.L." 1.5

AC155431G0 PEICHIA TABLETS "P.L."(鋁箔)/膠箔 2

AC15561255 MANNITOL INJECTION 20% 100ML"SHUN HWE" 39.4

AC15561266 MANNITOL INJECTION 20% 300ML 39.4

AC15561277 MANNITOL INJECTION 20% "SHUN HWA" 117

AC15579100 TRIAMCINOLONE TABLETS 4 MG "F.Y." 1.5

AC15584299 LINCOMYCIN INJECTION "C.C.P." 1.96

AC15629100 CINNARIZINE TABLETS "CHINTENG" 1.5

AC156291G0 CINNARIZINE TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC15660100 CEPHALEXIN CAPSULES "S.T." 1.82

AC156601G0 CEPHALEXIN CAPSULES "S.T."(鋁箔/膠箔) 2

AC15674100 SESDEN CAPSULES (TIMEPIDIUM) 2.94

AC15697100 LIPHALEXIN CAPSULES 500MG "LITA" 1.82

AC15721100 DIS S.C. TABLETS (DIPHENIDOL) 1.5

AC15791100 TETRACYCLINE HCL CAPSULES 250MG "VPP" 1.5

AC157911G0 TETRACYCLINE HCL CAPSULES 250MG "VPP"(鋁箔/膠箔) 2

AC15837100 PYRAZINAMIDE TABLETS "L.E." 3.74

94

Page 95: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC15843277 CEFAZOLIN INJECTION "YUNG SHIN" 15

AC15849100 CLOMIPHENE CAPSULES 50MG "YU SHENG" 4.98

AC15910100 PIPRINHYDRINATE TABLETS "P.L." 1.5

AC15911209 AMPOLIN INJECTIONS 1000MG 15

AC15987212 "DIAZEPAM INJECTIONS ""TAI YU""" 15

AC16020100 BATHOLIN TABLETS "GENTLE" 1.5

AC16141100 SALBUTAMOL TABLETS 4MG "F.Y." 1.5

AC16144100 CINNARIZINE TABLETS "S.T." 1.5

AC16162100 CO-TRIMO TABLETS "F.Y." 1.5

AC16227100 DOXYCYCLINE CAPSULES "YY" 1.5

AC16303421 DECASON EYE DROPS "KINGDOM" 13.4

AC16322100 HOWEI TABLETS 1.5

AC16336100 "BEYLIYAN TABLETS ""M.T.""" 1.5

AC16349321 "BETASONE CREAM (BETAMETHASONE) ""GCPC""" 19.9

AC16349329 "BETASONE CREAM (BETAMETHASONE) ""GCPC""" 19.9

AC16349335 BETASONE CREAM (BETAMETHASONE) "GCPC" 31.9

AC16378100 AMPICILLIN CAPSULES "SINTONG" 1.5

AC16402338 SILVER SULFADIAZINE CREAM 33.2

AC16402348 SILVER SULFADIAZINE CREAM 44.3

AC16402371 SILVER SULFADIAZINE CREAM 286

AC16402377 SILVER SULFADIAZINE CREAM 519

AC16420100 CHLORZOXAZONE TABLETS "PL." 1.5

AC16432100 ANTON TABLETS 1.57

AC164321G0 ANTON TABLETS (鋁箔/膠箔) 2

AC16449100 CEPHENDOL S.C. TABLETS 25MG (DIPHENIDOL) "F.Y 1.5

AC164491G0 CEPHENDOL S.C. TABLETS 25MG (DIPHENIDOL) "F.Y"(鋁箔/膠箔) 2

AC16457212 HYCOBAL INJECTION (HYDROXOCOBALAMINE) "SWISS" 15.5

AC16464100 PREDNISOLONE TABLETS "P.J." 1.5

AC16476238 "MANNITOL INJECTION ""TAI YU""" 15

AC16476266 "MANNITOL INJECTION ""TAI YU""" 39.4

AC16476277 "MANNITOL INJECTION ""TAI YU""" 117

AC16485100 TONREN CAPSULES "C.M." 1.5

AC16500100 CHYMOTRYPSIN E.C. TABLETS "CHINTENG" 3.78

AC16584209 SALBUTAMOL INJECTION "YUNG SHIN" 15

AC16605299 LINCOMYCIN INJECTION "STANDARD" 1.96

AC16706100 ULEXIN CAPSULES (CEPHALEXIN) 1.5

AC167061G0 ULEXIN CAPSULES (CEPHALEXIN)(鋁箔/膠箔) 2

AC16821100 LOPERAMIDE CAPSULES "HONTEN" 1.5

AC168211G0 LOPERAMIDE CAPSULES "HONTEN"(鋁箔/膠箔) 2

AC16850100 TAR WEING TABLETS (METHYLSCOPOLAMIN METHYL SULFATE)"S.T." 1.57

AC16863212 BISCO INJECTION "STANDARD" (BROMHEXINE) 15

AC16868209 "HYOSCON INJECTION (SCOPOLAMINE BUTYLBROMIDE)""TAI YU""" 15

AC16878229 LINCOMYCIN HYDROCHLORIDE INJECTION "LITA" 27.2

AC16902100 METOPERAN S.C. TABLETS (METOCLOPRAMIDE) "H.C." 1.5

AC16908209 5% DEXTROSE IN 0.225% SALINE INJECTION "S.T." 27.4

AC16908277 5% DEXTROSE IN 0.225% SALINE INJECTION "S.T." 25

AC16913209 CARBENMYCIN INJECTION "YUNG SHIN"(CARBENICILLIN) 78

AC169321G0 SEUDORIN TABLETS (PSEUDOEPHEDRINE HCL)(鋁箔/膠箔) 2

AC16953100 RIFAMPICIN CAPSULES 300MG "YUNG SHIN" 8

AC16958100 NICOFEROL CAPSULES "GENTLE" (TOCOPHEROL NICOTINATE) 1.5

AC16962100 SABUTAL TABLETS (SALBUTAMOL) "SWISS" 1.5

AC16963209 SIVKORT STERILE SUSPENSION 40MG (TRIAMCINOLONE) 23

AC16963212 SIVKORT STERILE SUSPENSION 40MG (TRIAMCINOLONE) 23.8

AC16963229 SIVKORT STERILE SUSPENSION 40MG (TRIAMCINOLONE) 57

AC16972100 SWITYL TABLETS 1.5

95

Page 96: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC17007277 CEFAZOLIN INJECTION 0.5GM "C.C.P." 8

AC17018100 LETANLON S.C. TABLETS (ANETHOLE TRITHIONE) 1.5

AC17022277 HARTMANN'S G INJECTION 43.8

AC17082100 SIDUS TABLETS "F.Y." 1.5

AC17124100 WEYAN TABLETS "M.T." 1.5

AC171241G0 WEYAN TABLETS "M.T." (鋁箔/膠箔) 2

AC17138100 CYHEPDIN TABLETS (CYPROHEPTADINE)"J.H." 1.5

AC17185100 "MEFANA TABLETS (MEFENAMIC ACID) ""GCPC""" 1.5

AC171851G0 "MEFANA TABLETS (MEFENAMIC ACID) ""GCPC""(鋁箔/膠箔)" 2

AC17203100 GLYCYRRIZINE & OPIUM COMPOUND TABLETS "HEALTH" 1.5

AC172031G0 GLYCYRRIZINE & OPIUM COMPOUND TABLETS "HEALTH"(鋁箔/膠箔) 2

AC17245100 MORIEIN TABLETS "D.T.S." (BENZYDAMINE) 1.5

AC17248100 MIGUZETO TABLETS "M.T." 1.5

AC17256100 BETALIN TABLETS (BETAMETHASONE) 1.5

AC17292100 LITONIN TABLETS (TRIAMCINOLONE) 1.5

AC17303238 GLUMINE INJECTION "LITA" (THIAMINE DISULFIDE) 15

AC17328100 DEXTROMETHORPHAN TABLETS 30MG "HONTEN" 1.5

AC173281G0 DEXTROMETHORPHAN TABLETS 30MG "HONTEN"(鋁箔/膠箔) 2

AC17331100 "MEFENAMIC ACID CAPSULES ""WINSTON""" 1.5

AC17350212 DIPYRIDAMOLE INJECTION "STANDARD" 15

AC17353100 N-METHYLSCOPOLAMINE METHYL SULFATE TABLETS 1MG "M.T." 1.57

AC17382100 NORDRON S.C. TABLETS (NORETHINDRONE) 2.12

AC17429100 ISOPRINE S.C. TABLETS (ISOXSUPRINE) 1.5

AC17433100 SULFATRIME TABLETS "J.H." 1.5

AC17508100 KNOWFUL CAPSULES "YUNG SHIN"(PIRACETAM) 1.5

AC175081G0 KNOWFUL CAPSULES "YUNG SHIN"(PIRACETAM)(鋁箔/膠箔) 2

AC17628100 STOPIN TABLETS "GENTLE" (METHYL-SCOPOLAMINE METHYL SULFATE) 1.57

AC17795321 SOFT CREAM 16.1

AC17795329 SOFT CREAM 16.1

AC17795335 SOFT CREAM 19.6

AC17795338 SOFT CREAM 19.6

AC17809100 NOSCOUGH TABLETS "CHINTENG" 1.5

AC178091G0 NOSCOUGH TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC17857100 DE-ASTHMA TABLETS "H.S." 1.5

AC17859100 AMPICILLIN CAPSULES 500MG "KINGDOM" 1.5

AC17866100 SPARTIN TABLETS 1.5

AC17877100 COSUTONE TABLETS "H.H." 1.54

AC17890100 SELADIN CAPSULES 1.5

AC18037100 DIPHENIDOL TABLETS "L.E." 1.5

AC18051100 HALOSTEN TABLETS 1MG (HALOPERIDOL) 1.5

AC18053321 SWISSCORT CREAM "SWISS BRAND" 14.7

AC18061100 COPHYLLINE TABLETS "H.C." 1.5

AC18063321 TOPSYM CREAM (FLUOCINONIDE) 42.4

AC18063329 TOPSYM CREAM (FLUOCINONIDE) 54

AC18063338 TOPSYM CREAM (FLUOCINONIDE) 135

AC18088321 TOPSYM OINTMENT (FLUOCINONIDE) 42.4

AC18088338 TOPSYM OINTMENT (FLUOCINONIDE) 135

AC18097100 "KETOPROFEN CAPSULES ""M.T.""" 1.91

AC18132100 "WETUNLIN TABLETS ""S.Y.""" 1.5

AC18171100 WEICOLA TABLETS "CHINTENG" 1.5

AC181711G0 WEICOLA TABLETS "CHINTENG" (鋁箔/膠箔) 2

AC18183100 RELAPINE TABLETS "C.H." 1.5

AC18204212 SEQUITON INJECTION 15

AC18232100 SUSEMIDE TABLETS (HYDRALAZINE) "HC" 1.61

96

Page 97: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC18240100 PHENYTOIN TABLETS 100MG "VPP" 1.5

AC182401G0 PHENYTOIN TABLETS 100MG"VPP"(鋁箔/膠箔) 2

AC18291212 GENTA-C INJECTION 40MG/ML "GENTLE" 0

AC18291229 GENTA-C INJECTION 40MG/ML "GENTLE" 0

AC18342100 LOBAK TABLETS "CHINTENG" 1.5

AC183421G0 LOBAK TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC18406100 CINNARIZINE TABLETS "C.H." 1.5

AC18411100 MEBENDAZOLE TABLETS "CHINTENG" 1.51

AC18413238 TRITAMIN B12 INJECTION "LITA" 15

AC18416100 "PRO-LIVER S.C. TABLETS ""M.T.""" 1.59

AC18424212 ASCORBIC ACID INJECTION 500MG "SWISS BRAND" 15

AC184441G0 CABIDRIN FILM COATED TABLETS "JOHNSON"(鋁箔/膠箔) 2

AC18451100 G.P.D. CAPSULES "HEALTH" 1.5

AC184511G0 G.P.D. CAPSULES "HEALTH"(鋁箔/膠箔) 2

AC18458100 PROSANOL TABLETS (PROPRANOLOL) 1.5

AC18467100 HALOSTEN TABLETS 2MG (HALOPERIDOL) 1.5

AC18519209 PROMIN INJECTION "N.K." 58

AC18519265 PROMIN INJECTION "N.K." 22.4

AC18519277 PROMIN INJECTION "N.K." 27.5

AC18569100 SPIROTONE TABLETS 25MG "V.P.P." (SPIRONOLACTONE) 1.5

AC185691G0 SPIROTONE TABLETS 25MG "V.P.P." (SPIRONOLACTONE)(鋁箔/膠箔) 2

AC18592100 ECAN CAPSULES (ANETHOLE) "S.T." 1.5

AC18598329 HEMODIN OINTMENT "PATRON" 60

AC18620100 UNDIARRHEA CAPSULES"YUNG SHIN" (LOPERAMIDE) 1.5

AC18646100 DIPHENIDOL S.C. TABLETS "H.S." 1.5

AC186461G0 DIPHENIDOL S.C. TABLETS "H.S."(鋁箔/膠箔) 2

AC18649100 KORYNASE E.C. TABLETS 5MG 3.05

AC18654100 COFFEGOT TABLETS "Y.Y." 1.5

AC18670209 DEXAMETHASONE INJECTION 4MG/ML "GENTLE" 0

AC18670212 DEXAMETHASONE INJECTION 4 MG/ML "GENTLE" 0

AC18670229 DEXAMETHASONE INJECTION 4 MG/ML "GENTLE" 0

AC18679209 DEXAMETHASONE INJECTION 0.5% 23.6

AC18692100 MEBENDAZOLE TABLETS "M.T." 1.51

AC18719100 IMIMINE S.C. TABLETS 25MG "VPP" (IMIPRAMINE) 1.76

AC187191G0 IMIMINE S.C. TABLETS 25MG "VPP" (IMIPRAMINE) (鋁箔/膠箔) 2

AC18726100 GU YEN TABLETS "S.T." 1.5

AC187261G0 GU YEN TABLETS "S.T."(鋁箔/膠箔) 2

AC18756100 ZUTON TABLETS "YU SHENG" 1.5

AC18862100 MEFENAMIC ACID CAPSULES "S.T." 1.5

AC18886100 KETOPROFENE CAPSULES "LITA" 1.91

AC18887100 HOTITON TABLETS 1.5

AC18895100 NYSTATIN CAPSULES "YUNG SHIN" 2.83

AC18905100 THIRIZINE S.C. TABLETS 25MG 1.5

AC18920100 DACTIRAN F.C. TABLETS (PIPERIDOLATE) "KYORIN" 2.02

AC18946209 DEXAMETHASONE INJECTION "Y.Y." 15

AC18946212 DEXAMETHASONE INJECTION "Y.Y." 15

AC18946229 DEXAMETHASONE INJECTION "Y.Y." 23.6

AC18949100 BISACODYL E.C. TABLETS 5MG "VPP" 1.5

AC189491G0 BISACODYL E.C. TABLETS 5MG "VPP"(鋁箔/膠箔) 2

AC18973100 AMPICILLIN CAPSULES 250MG "CSP" 1.5

AC18996100 M.B. TABLETS (MEPENZOLATE BROMIDE) "M.T." 1.5

AC19033100 GEMOX CAPSULES 500MG (AMOXYCILLIN) "GENTLE" 1.5

AC19054100 GEMOX CAPSULES 250MG (AMOXYCILLIN) "GENTLE" 1.5

AC19097100 LOFAXIN CAPSULES 250MG "GENTLE" (CEPHALEXIN) 1.5

97

Page 98: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC19127100 STANOL TABLETS "H.H." (STANOZOLOL) 1.5

AC19135100 AMPICILLIN CAPSULES 500MG "GENTLE" 1.5

AC19137100 ANICAMET S.C. TABLETS (NICAMETATE) "H.C." 1.5

AC19141100 TENING TABLETS (DIAZEPAM) "C.H." 1.5

AC19142100 ACETAZONE TABLETS "J.H." 1.5

AC19154100 CAPDES TABLETS "JOHNSON" 1.5

AC19157100 NIFUTOIN TABLETS "C.H."(NITROFURANTOIN) 1.5

AC19177100 "SUWEILAN TABLETS (METOCLOPRAMIDE) ""S.Y.""" 1.5

AC19210100 ERGOCAFE TABLETS "C.H." 1.5

AC19246100 BONAS E.S. TABLETS (BROMELAIN) 1.5

AC19247100 SILENCE TABLETS "YUNG SHIN" (LORAZEPAM) 1.5

AC192471G0 SILENCE TABLETS "YUNG SHIN"(LORAZEPAM)(鋁箔/膠箔) 2

AC19252100 KETOFEN CAPSULES "J.H." 1.91

AC19254100 DOXYCYCLINE CAPSULES 1.5

AC192541G0 DOXYCYCLINE CAPSULES(鋁箔/膠箔) 2

AC19263100 MUQUAPIN F.C. TABLETS "H.S." (N-METHYLSCOPOLAMINE

METHYLSULFATE)

1.57

AC19275100 SARIN TABLETS "J.H." 1.5

AC19276212 "THIOCTAN INJECTION (THIOCTIC ACID) ""TAI YU""" 15

AC19276221 "THIOCTAN INJECTION (THIOCTIC ACID) ""TAI YU""" 15

AC19280212 CEFAZOLIN INJECTION "CHI SHENG" 61

AC19280221 CEFAZOLIN INJECTION "CHI SHENG" 189

AC19280229 CEFAZOLIN INJECTION "CHI SHENG" 380

AC19280238 CEFAZOLIN INJECTION "CHI SHENG" 761

AC19296238 "DEPAINING INJECTION ""TAI YU""" 15

AC19337100 LIMODIUM TABLETS "H.C." (LOPERAMIDE) 1.5

AC193371G0 LIMODIUM TABLETS "H.C." (LOPERAMIDE)(鋁箔/膠箔) 2

AC19358277 CEFAMANDOLE INJECTION "YUNG SHIN" 32.6

AC19359100 PAINLESS TABLETS "YUNG SHIN" 1.5

AC19360100 ASMELLIN-EPG TABLETS "CHINTENG" 1.5

AC193601G0 ASMELLIN-EPG TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC19362321 TODERMGEN CREAM 26

AC19362329 TODERMGEN CREAM 61

AC19362335 TODERMGEN CREAM 96

AC19411100 DOXYMYCIN ENTERIC COATED TABLETS "YUNG SHIN" 1.5

AC19418100 DECONE TABLETS "SINPHAR"(DEXAMETHASONE) 1.5

AC194181G0 DECONE TABLETS "SINPHAR"(DEXAMETHASONE)(鋁箔/膠箔) 2

AC19419100 PONSTAL CAPSULES 250MG "SINPHAR"(MEFENAMIC ACID) 1.5

AC194191G0 PONSTAL CAPSULES (MEFENAMIC ACID) "SINPHAR" )(鋁箔/膠箔) 2

AC19420100 PONSTAL F.C. TABLETS 500MG "SINPHAR" (MEFENAMIC ACID) 1.5

AC194201G0 PONSTAL F.C. TABLETS 500MG "SINPHAR" (MEFENAMIC ACID)(鋁箔/膠

箔)

2

AC19421100 PONSTAL F.C. TABLETS 250MG "SINPHAR" (MEFENAMIC ACID) 1.5

AC19445100 KPHADOL TABLETS "SWISS" (DIPHENIDOL) 1.5

AC194451G0 KPHADOL TABLETS "SWISS" (DIPHENIDOL)(鋁箔/膠箔) 2

AC19461100 METHYLDOPA F.C. TABLETS "JOHNSON" 2.47

AC19495100 LORAZEPAM TABLETS 1MG "LITA" 1.5

AC19503100 SINPHADOL S.C. TABLETS "SINPHAR" (DIPHENIDOL) 1.5

AC195031G0 SINPHADOL S.C. TABLETS "SINPHAR" (DIPHENIDOL)(?T??/????) 2

AC19506100 DISCO TABLETS (DIPHENIDOL) 1.5

AC19548100 "ASRITIN TABLETS (ORCIPRENALINE) ""ROYAL""" 1.51

AC19549100 "TELINCOL TABLETS ""ROYAL""" 1.5

AC195491G0 "TELINCOL TABLETS ""ROYAL""(鋁箔/膠箔)" 2

AC19553100 HALOLIUM TABLETS (HALOPERIDOL) "ROYAL" 1.5

98

Page 99: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC19556100 CYPRO TABLETS (CYPROHEPTADINE) "ROYAL" 1.5

AC195561G0 CYPRO TABLETS (CYPROHEPTADINE) "ROYAL"(鋁箔/膠箔) 2

AC19557100 "PURINOL TABLETS (ALLOPURINOL) ""ROYAL""" 1.5

AC19558100 "NAPROXEN TABLETS ""ROYAL""" 1.5

AC19562100 TOROFEN CAPSULES (KETOPROFEN) "STANDARD" 1.91

AC19573100 CLOMIPHENE TABLETS "PEILI" 4.98

AC19579100 LIMIN TABLETS (NITRAZEPAM) "YU SHENG" 1.5

AC19595100 INDALGIN CAPSULES 25MG (INDOMETHACIN) "VPP" 1.5

AC195951G0 INDALGIN CAPSULES 25MG (INDOMETHACIN) "VPP"(鋁箔/膠箔) 2

AC19596100 IBUPROFEN TABLETS 400MG "HONTEN" 1.5

AC195961G0 IBUPROFEN TABLETS 400MG "HONTEN" (鋁箔/膠箔) 2

AC19610100 ROITONIN S.C. TABLETS (DICLOFENAC) "JOHNSON" 1.5

AC19616321 BETAMETHASONE OINTMENT "SINPHAR" 19.9

AC19616329 BETAMETHASONE OINTMENT "SINPHAR" 19.9

AC19620100 NAPROXEN TABLETS "SINPHAR" 1.5

AC19625100 PISANTA CAPSULES (PIRACETAM) "ROYAL" 1.5

AC196251G0 PISANTA CAPSULES (PIRACETAM) "ROYAL"(鋁箔/膠箔) 2

AC19627100 PESADIN F.C TABLETS (DIPYRIDAMOLE) "ROYAL" 1.5

AC196271G0 PESADIN F.C TABLETS (DIPYRIDAMOLE) "ROYAL"(鋁箔/膠箔) 2

AC19636100 CLEANSERA CAPSULES (TOCOPHERYL NICOTINATE) "ROYAL" 1.5

AC19639100 PROPRA TABLETS (PROPRANOLOL) "ROYAL" 1.5

AC196391G0 PROPRA TABLETS (PROPRANOLOL) "ROYAL"(鋁箔/膠箔) 2

AC19640100 "ALKANTIN TABLETS ""ROYAL""" 1.5

AC196401G0 "ALKANTIN TABLETS ""ROYAL""(鋁箔/膠箔)" 2

AC19643100 "DORISON TABLETS (DEXAMETHASONE) ""ROYAL""" 1.5

AC196431G0 "DORISON TABLETS (DEXAMETHASONE) ""ROYAL""(鋁箔/膠箔)" 2

AC19649100 "JACIDE TABLETS ""ROYAL""" 1.5

AC19654299 KANAMYCIN INJECTION "YUNG SHIN" 1.33

AC19656100 AZUNEN TABLETS "MEIDER" (GUAIAZULENE) 1.5

AC19665100 LORAZEPAM TABLETS 0.5MG "LITA" 1.5

AC19706100 DIFENDOL S.C. TABLETS "JOHNSON" 1.5

AC197061G0 DIFENDOL S.C. TABLETS "JOHNSON"(84粒/瓶) 2

AC19709100 MESCO TABLETS "J.H." (METHYLSCOPOLAMINE METHYLSULFATE) 1.57

AC19749100 PRIMRAN F.C. TABLETS (METOCLOPRAMIDE) "ROYAL" 1.5

AC197491G0 PRIMRAN F.C. TABLETS (METOCLOPRAMIDE) "ROYAL"(鋁箔/膠箔) 2

AC19764212 STOPNIN INJECTION 5MG "KYORIN" 15

AC19769100 LOPERAMIDE CAPSULES "H.H." 1.5

AC197691G0 LOPERAMIDE CAPSULES "H.H."(鋁箔/膠箔) 2

AC19786100 TIDAZOL F.C. TABLETS (TINIDAZOLE) "STANDARD" 2.09

AC19799212 "PYRIDOXAL PHOSPHATE INJECTION ""TAI YU""" 15

AC19800100 DECALIN TABLETS (DEXAMETHASONE)"C.H." 1.5

AC19865100 MEMODIN TABLETS (DIPHENIDOL) "ROYAL" 1.5

AC198651G0 MEMODIN TABLETS (DIPHENIDOL) "ROYAL"(鋁箔/膠箔) 2

AC19875100 CARDOLOL TABLETS 40MG "V.P.P." (PROPRANOLOL) 1.5

AC198751G0 CARDOLOL TABLETS 40MG (PROPRANOLOL) "V.P.P."(鋁箔/膠箔) 2

AC19895100 CARDITONIN S.C. TABLETS 25MG (DIPYRIDAMOLE) "VPP" 1.5

AC198951G0 CARDITONIN S.C. TABLETS 25MG (DIPYRIDAMOLE) "VPP" (鋁箔/膠箔) 2

AC19904421 "WINMEGEN OPHTHALMIC SOLUTION ""WINSTON""" 12.3

AC19904429 "WINMEGEN OPHTHALMIC SOLUTION ""WINSTON""" 19.3

AC19904435 "WINMEGEN OPHTHALMIC SOLUTION ""WINSTON""" 34.5

AC19915421 DELONE EYE DROP "SINPHAR" 13.4

AC19915429 DELONE EYE DROPS "SINPHAR" 34.4

AC19935265 VELIP INFUSION SOLUTION "N.K." 27.2

AC19935277 VELIP INFUSION SOLUTION "N.K." 30.3

99

Page 100: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC19941277 "VITAMINOPLEX INJECTION ""TAI YU""" 122

AC19962277 "AMINOPLEXYTOL INJECTION ""TAI YU""" 81

AC19970100 THIAMPHENICOL CAP. 250MG "P.J." 1.52

AC19976100 RIFAMPIN CAPSULES 300MG "VPP" 8

AC19982100 AMOXICILLIN CAPSULES 500MG "KINGDOM" 1.5

AC19984100 COBAMAMIDE CAPSULES "C.H." 1.5

AC199841G0 COBAMAMIDE CAPSULES "C.H."(鋁箔/膠箔) 2

AC19987100 BROAIN S.C. TABLETS (BROMELAIN) "CHIN TENG" 1.5

AC199871G0 BROAIN S.C. TABLETS (BROMELAIN) "CHIN TENG"(鋁箔/膠箔) 2

AC20018100 CANTIL TABLETS "C.H." 1.5

AC20022100 TERBULINE TABLETS "H.C." (TERBUTALINE) 1.5

AC20037100 SONGORA F.C TABLETS (NICAMETATE) "ROYAL" 1.5

AC200371G0 SONGORA F.C TABLETS "ROYAL"(NICAMETATE)(鋁箔/膠箔) 2

AC20058100 LIDERIUM CAPSULES (LOPERAMIDE) 1.5

AC200581G0 LIDERIUM CAPSULES (LOPERAMIDE)(鋁箔/膠箔) 2

AC20059100 LOPERAM CAPSULES (LOPERAMIDE) "JOHNSON" 1.5

AC200591G0 LOPERAM CAPSULES (LOPERAMIDE) "JOHNSON"(鋁箔/膠箔) 2

AC20069100 TONIFEN CAPSULES (MEFENAMIC ACID) "ROYAL" 1.5

AC200691G0 TONIFEN CAPSULES (MEFENAMIC ACID) "ROYAL"鋁箔盒裝 2

AC20080212 BIOCON INJECTION "GENTLE" 0

AC20084100 FENOTEROL TABLETS "YUNG SHIN" 1.5

AC20096100 SULQUINYL CAPSULES (SULPIRIDE) "PATRON" 1.66

AC20102321 "TRIACT CREAM ""GCPC""" 14.7

AC20102323 "TRIACT CREAM ""GCPC""" 16.1

AC20102329 TRIACT CREAM "GCPC" 20.2

AC20102335 TRIACT CREAM "GCPC" 35.1

AC20102336 "TRIACT CREAM ""GCPC""" 35.1

AC20102338 TRIACT CREAM "GCPC" 61

AC20103100 DICLOFEN F.C. TABLETS "H.S."(DICLOFENAC) 1.5

AC20109100 "ROYADRIN TABLETS ""ROYAL""" 1.5

AC20111100 TRISDOWN F.C TABLETS "ROYAL" 1.5

AC201111G0 TRISDOWN F.C. TABLETS "ROYAL"(鋁箔/膠箔) 2

AC20112100 "TRICOGYL F.C TABLETS (METRONIDAZOLE) ""ROYAL""" 1.64

AC20115100 TRIDERGEN TABLETS (DIHYDROERGOTOXINE MESYLATE)" ROYAL " 1.54

AC20116100 "URODIX TABLETS (NALIDIXIC ACID) ""ROYAL""" 2.25

AC20118212 GURON-BC INJECTION "GENTLE" 0

AC20118221 GURON-BC INJECTION "GENTLE" 0

AC20137100 IBUPROFEN F.C. TABLETS 400MG "SINPHAR" 1.5

AC20159100 HO CULAR TABLETS (LOPERAMIDE) "P.L." 1.5

AC20257100 "MEFENAMIC ACID CAPSULE ""A.S.""" 1.5

AC20276348 UBURN CREAM (SILVER SULFADIAZINE) 44.3

AC20276365 UBURN CREAM (SILVER SULFADIAZINE) 151

AC20276377 UBURN CREAM (SILVER SULFADIAZINE) 519

AC20279100 ANCHEN TABLETS "J.H." (MEBENDAZOLE) 1.51

AC20285100 "SOLAX CAPSULES ""ROYAL""" 1.5

AC20286100 "SUSPAN F.C TABLETS (SCOPOLAMINE BUTYL BROMIDE) "" ROYAL """ 1.5

AC20287100 CINATIN TABLETS (CINNARIZINE) "ROYAL" 1.5

AC202871G0 CINATIN TABLETS (CINNARIZINE) "ROYAL"(鋁箔/膠箔) 2

AC20291100 OXETHAINE TABLETS "H.C." 1.5

AC20295500 ANTIFUNGAL VAGINAL TABLETS "YUNG SHIN"(MICONAZOLE) 5.3

AC20359209 "瑞士"KPHADOL INJECTION "SWISS" (DIPHENIDOL) 15

AC20359212 KPHADOL INJECTION "SWISS" (DIPHENIDOL) 15

AC20368100 NAPROXEN TABLETS "JOHNSON" 1.5

AC20405100 AMCLOCIN CAPSULE "KINGDOM" 1.97

100

Page 101: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC20420100 BININ-U TABLETS 2MG (HALOPERIDOL) 1.5

AC204201G0 BININ-U TABLETS 2MG (HALOPERIDOL)(鋁箔/膠箔) 2

AC20433100 MEFENAMIC CAPSULES "UNION" 1.5

AC20441421 KINGMIN OPHTHALMIC SOLUTION "KINGDOM" (SULFAMETHOXAZOLE) 12

AC20441429 KINGMIN OPHTHALMIC SOLUTION (SULFAMETHOXAZOLE) "KINGDOM" 12

AC20441435 KINGMIN OPHTHALMIC SOLUTION "KINGDOM" 15.4

AC20451100 ALOPRINOL TABLETS (ALLOPURINOL) "JOHNSON" 1.5

AC204511G0 ALOPRINOL TABLETS (ALLOPURINOL) "JOHNSON"(鋁箔/膠箔) 2

AC20453212 "DIPROPHYLLINE INJECTION ""S.Y.""" 15

AC20485100 JOHNSTAL FILM COATED TABLETS (MEFENAMIC ACID)"JOHNSON" 1.5

AC20520100 YU-MIN TABLETS "YU SHENG" 1.5

AC20573221 POTASSIUM CHLORIDE INJECTION 15% 15

AC20573229 POTASSIUM CHLORIDE INJECTION 15% 15

AC20573238 POTASSIUM CHLORIDE INJECTION 15% 15

AC20638209 CEFADOL INJECTION 1GM (CEFAMANDOLE) 60

AC20638277 CEFADOL INJECTION 0.5GM (CEFAMANDOLE) 32.6

AC20700100 "KETOPROFEN CAPSULES ""WINSTON""" 1.91

AC20713100 DIABEN TABLETS "ROYAL" (GLIBENCLAMIDE) 1.5

AC207131G0 DIABEN TABLETS "ROYAL" (GLIBENCLAMIDE)(鋁箔/膠箔) 2

AC20715100 SINTON TABLETS "CHINTENG" (NAPROXEN) 1.5

AC20758100 COTAMIDE CAPSULES "H.C." (COBAMAMIDE) 1.5

AC20791100 PYRAZODINE S.C. TABLETS "C.H."(PHENAZOPYRIDINE) 1.5

AC20832100 DL-METHYLEPHEDRINE HCL TABLETS "C.L" 1.5

AC20842209 ESTRADIOL INJECTION"T.F." 15

AC20846100 CONEST S.C. TABLETS "C.H."(CONJUGATED ESTROGEN) 2.94

AC20849100 LOPERAMIDE TABLETS 2 MG "F.Y." 1.5

AC20860100 SINSOLAX TABLETS 2.45

AC20871100 PROPRA TABLETS 10MG (PROPRANOLOL) "ROYAL" 1.5

AC208711G0 PROPRA TABLETS 10MG (PROPRANOLOL) "ROYAL"(鋁箔/膠箔) 2

AC20873100 "CLIXIN F.C TABLETS ""ROYAL""" 1.99

AC20879151 HALOLIUM DROPS "ROYAL" 68

AC20893100 SINAL TABLETS "SINPHAR" (PROPRANOLOL) 1.5

AC20894100 URINOL TABLETS (ALLOPURINOL) "SINPHAR" 1.5

AC208941G0 URINOL TABLETS (ALLOPURINOL) "SINPHAR"(鋁箔/膠箔) 2

AC20900100 SIRIN S.C. TABLETS (SILYMARIN) "Y. S." 1.57

AC209001G0 SIRIN S.C. TABLETS (SILYMARIN) "Y. S." (鋁箔/膠箔) 2

AC20910100 DOLCOL FILM COATING TABLETS 250MG 5.3

AC20911100 SONCO TABLETS "ROYAL" 1.5

AC209111G0 SONCO TABLETS "ROYAL"(鋁箔/膠箔) 2

AC20921100 CEFENINE S.C. TABLETS (DIPHENIDOL) "H.C." 1.5

AC20936100 MUSLAX-A TABLETS "C.C.P." 1.5

AC20964329 SCABI CREAM (GAMMA-BHC) "KINGDOM" 100

AC21020212 ORPHENADRINE INJECTION "Y.Y." 15

AC21036100 LOTAMIN TABLETS "SWISS" (PROCHLORPERAZINE) 1.5

AC21063100 LOPEDIN CAPSULES "STANDARD" (LOPERAMIDE) 1.5

AC21078100 CINNARIZINE TABLETS 50MG "M.T." 1.5

AC21109229 HICOVITA INJECTION "GENTLE" 0

AC21111151 "KODAPIN SYRUP ""ROYAL""" 25

AC21117100 ERGOFEIN CAPSULES "PATRON" 1.5

AC21190100 LOPERAMIDE CAPSULES "LITA" 1.5

AC21213100 DICLOCIN CAPSULES "KINGDOM" (DICLOXACILLIN) 1.5

AC21265100 "LIVERGEN CAPSULES ""ROYAL""" 1.5

AC21281212 KETOPROFEN I.M INJECTION "Y.Y." 15

AC21290100 "FLOPROPIONE CAPSULES ""M.T.""" 1.58

AC21298100 COBAMAMIDE CAPSULES "M.T." 1.5

101

Page 102: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC21316100 "SALBUTAMOL TABLETS ""M.T.""" 1.5

AC21328100 SILYGEN CAPSULES "STANDARD" 1.5

AC213281G0 SILYGEN CAPSULES "STANDARD"(鋁箔/膠箔) 2

AC21343238 POTASSIUM PHOSPHATE INJECTION "U.L." 49.9

AC21372221 PIRACETAM INJECTION "Y.Y." 15

AC21399100 NAPROXEN TABLETS "LITA" 1.5

AC21406100 WETONLIN TABLETS "M.T." 1.5

AC21462100 ZECOL TABLETS 1.5

AC214621G0 ZECOL TABLETS (30粒/瓶)(84粒/瓶) 2

AC21490100 HESTAZIN TABLETS"HEALTH"(TRIFLUOPERAZINE) 1.5

AC21491100 IZAN E.C. TABLETS 100MG (BROMELAIN) "LITA" 1.5

AC21495100 ATIPAM TABLETS (LORAZEPAM) "ROYAL" 1.5

AC214951G0 ATIPAM TABLETS (LORAZEPAM) "ROYAL"(鋁箔/膠箔) 2

AC21507100 OXECAIN TABLETS "YU SHENG" 1.5

AC21539100 RISONIN CAPSULES "D.T.S." 3.42

AC21552100 SUNTONIN CAPSULES "STANDARD" 1.5

AC21566100 PYDAMOLE S.C. TABLETS (DIPYRIDAMOLE)"H.C." 1.5

AC21603100 HEMALOL TABLETS (PROPRANOLOL) "SWISS" 1.5

AC21606100 "WINLIPAN CAPSULES (LOPERAMIDE) ""WINSTON""" 1.5

AC21607100 ALDOPA FILM COATED TABLETS (METHYLDOPA) "YUNG SHIN" 2.47

AC21611100 "DEXAMETHASONE TABLETS ""M.T.""" 1.5

AC21614100 SPOLINE S.C. TABLETS "H.C." (SCOPOLAMINE BUTYLBROMIDE) 1.5

AC21629265 TAITA NO.3 INJECTION "OTSUKA" 27.2

AC21629277 TAITA NO.3 INJECTION "OTSUKA" 30.3

AC21630265 TAITA NO.2 INJECTION "OTSUKA" 27.2

AC21630277 TAITA NO.2 INJECTION "OTSUKA" 30.3

AC21632265 TAITA NO.1 INJECTION "OTSUKA" 27.2

AC21632277 TAITA NO.1 INJECTION "OTSUKA" 30.3

AC21635100 "LIPIN TABLETS (METHYLSCOPOLAMINE METHYLSULFAT) ""ROYAL""" 1.57

AC21652143 MINTAPP SYRUP "SINPHAR" 25.6

AC21652151 MINTAPP SYRUP "SINPHAR" 31.3

AC21652155 MINTAPP SYRUP "SINPHAR" 72

AC21652157 MINTAPP SYRUP "SINPHAR" 72

AC21656100 TEOLLIN TABLETS "YU SHENG" 1.5

AC21678151 CODIN P SYRUP "SINPHAR" 25

AC21678157 CODIN P SYRUP "SINPHAR" 25

AC21681100 GRAMAZINE TABLETS 500MG (NALIDIXIC ACID) "JOHSON" 2.25

AC21684100 CLONIDINE TABLETS "JOHNSON" 2.11

AC21706100 RIFAMPIN CAPSULES 450MG "VPP" 13.6

AC21709238 "TRANEXAMIC ACID INJECTION ""S.Y.""" 34.5

AC21730209 LIFOXITIN INJECTION (CEFOXITIN) "LITA" 113

AC21730212 LIFOXITIN INJECTION (CEFOXITIN) "LITA" 216

AC21754100 COLCIN TABLETS (COLCHICINE) 1.5

AC217541G0 COLCIN TABLETS (COLCHICINE)(鋁箔/膠箔) 2

AC21756209 "SCODEXIN INJECTION ""TAI YU""" 15

AC21758100 MEDICON-A CAPSULES 1.5

AC217581G0 MEDICON-A CAPSULES(鋁箔/膠箔) 2

AC21767100 DIPHENIDOL S.C. TABLETS 1.5

AC217671G0 DIPHENIDOL S.C. TABLETS(鋁箔/膠箔) 2

AC21792100 "CHLORZOXAZONE TABLETS ""ASTAR""" 1.5

AC21830100 "LOPERAMIN TABLETS (LOPERAMIDE) ""M.T.""" 1.5

AC21845321 "BEAUTYSKIN CREAM ""ROYAL""" 26

AC21845329 BEAUTYSKIN CREAM "ROYAL" 61

AC21871100 MEBEZOL TABLETS (MEBENDAZOLE) "JOHNSON" 1.51

102

Page 103: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC21875100 IMODE CAPSULES (LOPERAMIDE) "YU SHENG" 1.5

AC21882100 NINGILON CAPSULES "P.L." 1.78

AC21883263 AMINOL 12X INJECTION "S.T" 108

AC21883265 AMINOL 12X INJECTION "S.T" 114

AC21886100 "BETAMETHASONE TABLETS ""S.Y.""" 1.5

AC21887416 LECORT IN ORAL BASE (TRIAMCINOLONE) 18.5

AC21887421 LECORT IN ORAL BASE (TRIAMCINOLONE) 28.4

AC21887429 LECORT IN ORAL BASE (TRIAMCINOLONE) 64

AC21893209 "METHYLERGONOVINE INJECTION ""TAI YU""" 19.4

AC21905100 WINTEL CAPSULES (TETRACYCLINE METAPHOSPHATE)"WINSTON" 1.5

AC21923100 SODIUM BICARBONATE TABLETS "ASTAR" 1.5

AC21924321 MY COMB CREAM "SINPHAR" 14.7

AC21924323 MY COMB CREAM "SINPHAR" 16.1

AC21924329 MY COMB CREAM "SINPHAR" 20.2

AC21924336 MY COMB CREAM "SINPHAR" 35.1

AC21924338 MY COMB CREAM "SINPHAR" 61

AC21959209 "BETAMETHASONE INJECTION ""TAI YU""" 16.7

AC21959221 "BETAMETHASONE INJECTION ""TAI YU""" 16.9

AC21959229 "BETAMETHASONE INJECTION ""TAI YU""" 19.5

AC21961100 CEPHADROXIL CAPSULES "LITA" 2.2

AC21965100 "LYSOZYME TABLETS 30MG ""M.T.""" 1.5

AC21978221 URAMIN INJECTION (DOPAMINE) 25.8

AC21981417 NINCORT ORAL GEL (TRIAMCINOLONE) "SINPHAR" 23.8

AC21981421 NINCORT ORAL GEL (TRIAMCINOLONE) "SINPHAR" 28.4

AC21981423 NINCORT ORAL GEL (TRIAMCINOLONE) "SINPHAR" 42.7

AC21994100 VI JANE CAPSULES (FLUOXYMESTERONE) "S.T." 2.46

AC21996100 "OPIUM AND GLYCYRRHIZA MIXTURE TABLETS ""ASTAR""" 1.5

AC219961G0 "OPIUM AND GLYCYRRHIZA MIXTURE TABLETS ""ASTAR""(鋁箔/膠箔)" 2

AC22010212 "HYCOMIN INJECTION ""S.Y."" (HYDROXOCOBALAMINE)" 15.5

AC22036100 WINII TABLETS (DIAZEPAM) "WINSTON" 1.5

AC22049209 "DIPHENHYDRAMINE HCL INJECTION ""TAI YU""" 15

AC22069100 SILYMARIN CAPSULES "P.L." 1.57

AC22084100 "TECOLIN TABLETS ""ROYAL""" 1.5

AC22096151 APPITAMINE SYRUP "S.Y." 25

AC22096157 APPITAMINE SYRUP 25

AC22105100 ULEXIN CAPSULES 500MG (CEPHALEXIN) 1.82

AC221051G0 ULEXIN CAPSULES 500MG (CEPHALEXIN)(?T??/????) 2

AC22123100 IMOLEX CAPSULES (LOPERAMIDE) "SINPHAR" 1.5

AC221231G0 IMOLEX CAPSULES (LOPERAMIDE) "SINPHAR" (鋁箔/膠箔) 2

AC22128100 "DIAZEPAM TABLETS ""TAI YU""" 1.5

AC22150100 CHICOUGH TABLETS (DEXTROMETHORPHAN) "H.C." 1.5

AC22189100 CIMETINE TABLETS "PATRON" 1.5

AC22198421 GENTAMICIN EYE DROPS "SINPHAR" 22

AC22207100 DICLOFEN TABLETS "H.C." (DICLOFENAC) 1.5

AC22209100 ANROKIN TABLETS "H.C." (CHLORZOXAZONE) 1.5

AC222091G0 ANROKIN TABLETS "H.C." (CHLORZOXAZONE)(鋁箔/膠箔) 2

AC22211100 STAPAM TABLETS (LORAZEPAM) "STANDARD" 1.5

AC222111G0 STAPAM TABLETS (LORAZEPAM) "STANDARD"(鋁箔/膠箔) 2

AC22223100 IBUPROFEN TABLETS "S.Y." 1.5

AC22225100 NICE FILM COATED TABLETS (NITROXOLINE)"YUNG SHIN" 1.69

AC22227100 BICODIN TABLETS "STANDARD" 1.5

AC222271G0 BICODIN TABLETS "STANDARD"(鋁箔/膠箔) 2

AC22265100 OXACAIN TABLETS (OXETHAZAINE)"M.T." 1.5

AC222651G0 OXACAIN TABLETS "M.T."(OXETHAZAINE) (鋁箔/膠箔) 2

103

Page 104: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC22272209 BININ-U INJECTION (HALOPERIDOL) 25.3

AC22296100 CIMETIN TABLETS (CIMETIDINE) "JOHNSON" 1.5

AC222961G0 CIMETIN TABLETS "JOHNSON"(CIMETIDINE)(鋁箔/膠箔) 2

AC22297135 BININ-U SOLUTION (HALOPERIDOL) 68

AC22297157 BININ-U SOLUTION (HALOPERIDOL) 125

AC22314100 RADI-K TABLETS "BOWLIN" (POTASSIUM GLUCONATE) 1.89

AC22340321 TOTUSAN OINTMENT 20

AC22340329 TOTUSAN OINTMENT 30.9

AC22340335 TOTUSAN OINTMENT 41.8

AC22343277 LOFALIN INJECTION 500MG "GENTLE" (CEFAZOLIN) 0

AC22357100 LYCOZE TABLETS "H.C." (LYSOZYME) 1.5

AC223571G0 LYCOZE TABLETS "H.C." (LYSOZYME)(鋁箔/膠箔) 2

AC22392321 NEOSONE CREAM "GCPC" 24.1

AC22392329 NEOSONE CREAM "GCPC" 30

AC22393221 RASEMIN INJECTION "Y.Y." (TRAREXAMIC ACID) 15

AC22408100 C.M.T. TABLETS "BOWLIN" (CIMETIDINE) 1.5

AC22441100 WINPRON TABLETS 250MG (NAPROXEN) "WINSTON" 1.5

AC22444100 TIGAWET TABLETS "H.C." (CIMETIDINE) 1.5

AC224441G0 TIGAWET TABLETS "H.C." (CIMETIDINE)(鋁箔/膠箔) 2

AC22448100 DOLAN TABLETS 2.45

AC22459209 GENTAMICIN INJECTION 140MG/ML "GENTLE" 0

AC22459212 GENTAMICIN INJECTION 140MG/ML "GENTLE" 0

AC22459229 GENTAMICIN INJECTION 140MG/ML "GENTLE" 0

AC22461238 "LICOTON INJECTION ""S.Y.""" 15

AC22465212 CIMETIDINE INJECTION "CHI SHENG" 15

AC22470100 "DEXAMETHASONE TABLETS ""TAI YU""" 1.5

AC22476216 FUMUCIL INJECTION (ACETYLCYSTEINE) 15

AC22501100 EBUTOL F.C. TABLETS 400MG "VPP" (ETHAMBUTOL) 2.32

AC22534100 COLICINE TABLETS "H.C." (COLCHICINE) 1.5

AC22554100 "GERIUM CAPSULES (LOPERAMIDE) ""ROYAL""" 1.5

AC225541G0 "GERIUM CAPSULES (LOPERAMIDE) ""ROYAL""(鋁箔/膠箔)" 2

AC22557100 REASON TABLETS (LYSOZYME) "ROYAL" 1.5

AC225571G0 "REASON TABLETS (LYSOZYME) ""ROYAL""(鋁箔/膠箔)" 2

AC22559100 "ROYAMET F.C. TABLETS (CIMETIDINE) ""ROYAL""" 1.5

AC22565212 "KETOPROFEN INJECTION ""S.Y.""" 15

AC22565216 "KETOPROFEN INJECTION ""S.Y.""" 15

AC22565238 KETOPROFEN INJECTION "S.Y." 25.6

AC22568212 CIMETIDINE INJECTION "N.K." 15

AC22568216 CIMETIDINE INJECTION "NK" 15

AC22569100 CIMETIDINE TABLETS 200MG "T.F." 1.5

AC22572100 TETRACYCLINE HCL CAPSULES 500MG "SWISS" 1.54

AC225721G0 TETRACYCLINE HCL CAPSULES 500MG "SWISS"(鋁箔/膠箔) 2

AC22582212 LICOXIN INJECTION 300MG/ML "GENTLE" (LINCOMYCIN) 0

AC22582229 LICOXIN INJECTION 300MG/ML "GENTLE" (LINCOMYCIN) 0

AC22588209 BENAMINE INJECTION 30MG/ML (DIPHENHYDRAMINE HCL) "VPP" 15

AC22608212 ORFLEX INJECTION "GENTLE" (ORPHENADRINE) 0

AC22622212 "SUWELIN INJECTION (CIMETIDINE)""S.Y.""" 15

AC22630100 "WINTIN TABLETS (LORAZEPAM) ""WINSTON""" 1.5

AC226341G0 DIABITIN TABLETS 5MG "VPP" (GLIBENCLAMIDE) (鋁箔/膠箔) 2

AC22641100 ROSIS TABLETS 40MG "VPP" (FUROSEMIDE) 1.5

AC226411G0 ROSIS TABLETS 40MG "VPP" (FUROSEMIDE)(鋁箔/膠箔) 2

AC22656100 "DICYCLOMINE TABLETS ""S.Y.""" 1.5

AC22666209 "DEXTROSE 5% AND SODIUM CHLORIDE 0.33% INJECTION ""Y.F.""" 35

104

Page 105: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC22666277 "DEXTROSE 5% AND SODIUM CHLORIDE 0.33% INJECTION ""Y.F.""" 25

AC22682265 TAITA NO.5 INJECTION "OTSUKA" 27.2

AC22682271 TAITA NO.5 INJECTION "OTSUKA" 30.3

AC22682277 TAITA NO.5 INJECTION "OTSUKA" 30.3

AC22701266 ALLAMIN INJECTION 3% ISOTONIC "KYORIN" 65

AC22701277 ALLAMIN INJECTION ISOTONIC "KYORIN" 70

AC22723100 "DIPYRIDAMOLE TABLETS ""TAI YU""" 1.5

AC227431G0 STOGAMET TABLETS "SWISS" (CIMETIDINE)(鋁箔/膠箔) 2

AC22746100 "SUWELIN TABLETS (CIMETIDINE)""S.Y.""" 1.5

AC22786100 SPOLIN TABLETS (LORAZEPAM) "H.H." 1.5

AC227861G0 SPOLIN TABLETS (LORAZEPAM) "H.H."(鋁箔/膠箔) 2

AC22796212 KETOPROFEN I.M. INJECTION 50MG/ML "Y.Y." 15

AC22801100 CONSPIN TABLETS (TOLPERISONE) "H.H." 1.63

AC22814229 GENTAMYCIN SULFATE INJECTION 40MG/ML "T.F." 16.9

AC22815100 LORAZEPAM TABLETS 0.5 MG "F.Y." 1.5

AC228151G0 LORAZEPAM TABLETS 0.5 MG "F.Y."(鋁箔/膠箔) 2

AC22816100 LORAZIN TABLETS "JOHNSON" (LORAZEPAM) 1.5

AC228161G0 LORAZIN TABLETS "JOHNSON" (LORAZEPAM)(84粒/瓶裝及鋁箔/膠箔) 2

AC22819100 LORAZEPAM TABLETS 1 MG "F.Y." 1.5

AC22836100 DEFENSE FILM COATED TABLETS (CIMETIDINE) "YUNG SHIN" 1.5

AC228361G0 DEFENSE FILM COATED TABLETS "YUNG SHIN"(CIMETIDINE)(鋁箔/膠箔) 2

AC22852100 DIPHENIDOL F.C. TABLETS "SHOU CHAN" 1.5

AC22867421 MYCOMB OTIC DROPS "SINPHAR" 55

AC22876100 LYSOZYME TABLETS 30MG "P.L." 1.5

AC22879100 DHAA TABLETS 100MG (DIHYDROXY ALUMINUM ALLANTOINATE)"H.C.T." 1.5

AC22890100 MILISHER TABLETS (LYSOZYME) "H.S." 1.5

AC22930212 GEXAMIN INJECTION "GENTLE" (TRANEXAMIC ACID) 0

AC22952289 UCEFAXIM INJECTION 750MG (CEFUROXIME) 23.5

AC22960100 ZINGA TABLETS (ZINC GLUCONATE) "BOWLIN" 1.5

AC22964100 NARCARICIN CAPSULES 100MG (BENZBROMARONE) "SWISS" 2.88

AC22971100 PAINSTOP CAPSULES (DICLOFENAC) "SWISS" 1.5

AC22987100 PRIMPERAN FILM COATED TABLETS (METOCLOPRAMIDE 1.5

AC229871G0 PRIMPERAN FILM COATED TABLETS (METOCLOPRAMIDE)(鋁箔/膠箔) 2

AC22995100 CIMETIDINE TABLETS 200MG "F.Y." 1.5

AC229951G0 CIMETIDINE TABLETS 200MG "F.Y."(鋁箔/膠箔) 2

AC23023209 CEPHEN INJECTION (DIPHENIDOL) "Y.Y." 15

AC23023212 CEPHEN INJECTION (DIPHENIDOL) "Y.Y." 15

AC23028100 DA CON WEI TABLETS "C.M."(CIMETIDINE) 1.5

AC23037100 CARDOLOL TABLETS 10MG (PROPRANOLOL) "VPP" 1.5

AC230371G0 CARDOLOL TABLETS 10MG (PROPRANOLOL) "VPP" (28粒/瓶裝及鋁箔/膠

箔)

2

AC23054100 CEPHEN S.C. TABLETS "Y.Y." 1.5

AC23087212 MEGATO INJECTION (CIMETIDINE) "GENTLE" 0

AC23110100 MEGATO TABLETS "GENTLE"(CMETIDINE) 1.5

AC23114212 SERACIN INJECTION 6% (GENTAMYCIN SULFATE) "SWISS" 15.9

AC23135100 TAGASONE TABLETS "Y.Y."(CIMETIDINE) 1.5

AC231351G0 TAGASONE TABLETS "Y.Y." (CIMETIDINE)(鋁箔/膠箔) 2

AC23156221 ZUCERIN INJECTION "LITA" (TRANEXAMIC ACID) 15

AC23169500 CLOMAZOLE VAGINAL TABLETS 100MG "VPP" (CLOTRIMAZOLE) 9

AC23186100 "BETAMETHASONE TABLETS ""ASTAR""" 1.5

105

Page 106: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC23194100 SABUMOL TABLETS "H.C." (SALBUTAMOL) 1.5

AC231941G0 SABUMOL TABLETS "H.C." (SALBUTAMOL)(鋁箔/膠箔) 2

AC23196100 PIZEPIN TABLETS "STANDARD" (PIRENZEPINE 2HCL) 1.79

AC23230221 RASEMIN INJECTION 10% "Y.Y" (TRANEXAMIC ACID) 15

AC23234100 "DOGEN TABLETS (PIPEMIDIC ACID) ""M.T.""" 5.3

AC23239100 AMOXICILLIN CAPSULES 500MG "S.T." 1.5

AC232391G0 AMOXICILLIN CAPSULES 500MG "S.T."(鋁箔/膠箔) 2

AC23264100 AMOXICILLIN CAPSULES 250MG "S.T." 1.5

AC232641G0 AMOXICILLIN CAPSULES 250MG "S.T."(鋁箔/膠箔) 2

AC23297100 "METICON TABLETS 30MG (DEXTROMETHORPHAN) ""S.Y.""" 1.5

AC23309100 AFUCO TABLETS 100MG 1.5

AC23312277 AMINOGEN X INJECTION "N.K." 132

AC23318100 DIFENDIN TABLETS (DIPHENIDOL) "CHINTENG" 1.5

AC233181G0 DIFENDIN TABLETS (DIPHENIDOL) "CHINTENG"(鋁箔/膠箔) 2

AC23320100 "YUMENIN TABLETS (NITROFURANTOIN) ""TAI YU""" 1.5

AC23321100 PYDAMOLE S.C. TABLETS 12.5MG (DIPYRIDAMOLE) "H.C." 1.5

AC23322100 POSTON CAPSULES (MEFENAMIC ACID) "H.C." 1.5

AC23341216 VENTON INJECTION "LITA" (DICLOFENAC) 15

AC23342100 "LORAT TABLETS (LORAZEPAM) ""M.T.""" 1.5

AC23353100 PARANADRINE TABLETS "S.C." 1.5

AC23359238 SUNLILIN INJECTION "S.Y." 15

AC23370100 ANZEPAM TABLETS 0.5MG (LORAZEPAM) "KINGDOM" 1.5

AC233701G0 ANZEPAM TABLETS 0.5MG (LORAZEPAM) "KINGDOM"(鋁箔/膠箔) 2

AC23374212 "CIMETINE INJECTION 100MG/ML (CIMETIDINE) ""TAI YU""" 15

AC23389100 DICLOFON S.C. TABLETS (DICLOFENAC) "F.Y." 1.5

AC23397100 EACO TABLETS 30MG (DEXTROMETHORPHAN) 1.5

AC23422238 GLYGEN-M INJECTION "N.K." 15

AC23430100 GASPIN TABLETS "GENTLE" (PIRENZEPINE) 1.79

AC23445209 "TRAVELLIN INJECTION ""TAI YU""" 15

AC23466100 TRIFLUOPERAZINE HCL TABLETS "S.C." 1.5

AC23479209 "DEXAMETHASONE INJECTION 1MG/ML ""TAI YU""" 15

AC23479229 "DEXAMETHASONE INJECTION 1MG/ML ""TAI YU""" 17.6

AC23479299 "DEXAMETHASONE INJECTION 1MG/ML ""TAI YU""" 0.75

AC23491100 SODICON-G TABLETS "SINPHAR" 1.5

AC234911G0 SODICON-G TABLETS "SINPHAR"(鋁箔/膠箔) 2

AC23508100 DALCONE TABLETS "H.H." (PIPEMIDIC ACID) 5.3

AC23532100 LIZEPINE TABLETS (PIRENZEPINE DIHYDROCHLORIDE) 1.79

AC23565100 LYSOZYME TABLETS 50MG "SINPHAR" 1.5

AC23589100 LOGMAL CAPSULES (SULPIRIDE) "M.T 1.66

AC23592100 CIMETIDINE TABLETS 200MG"D.T.S" 1.5

AC23599100 PELIN CAPSULES (DL-ALPHA-TOCOPHEROL NICOTINATE) 1.5

AC23606100 PEPTIDIN (R) TABLETS 1.5

AC236061G0 PEPTIDIN (R) TABLETS(鋁箔/膠箔) 2

AC23616100 SEDENTON TABLETS 1.5

AC23624271 PAREMENTAL A INJECTION "C.C.P." 49

AC23625271 PAREMENTAL-B INJECTION "C.C.P." 49

AC23631321 TOPICON CREAM (FLUCLOROLONE) 29.5

AC23635100 RITESONE CAPSULES (ERYTHROMYCIN ESTOLATE) 2.15

AC23644100 PERITIN FILM COATED TABLETS 25MG "Y.C." (DIPYRIDAMOLE) 1.5

AC23645100 HECODEN TABLETS 1.5

AC23648100 DOXYCYCLINE CAPSULES 1.5

AC23655100 SALBUTAMOL TABLETS 1.5

AC23662329 ECOSONE CREAM "BOWLIN" 21.8

AC23662330 ECOSONE CREAM "BOWLIN" 25.6

AC23662335 ECOSONE CREAM "BOWLIN" 36.2

106

Page 107: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC23670100 PIROCAM CAPSULES "GENTLE" (PIROXICAM) 1.5

AC23683100 REPACIN F.C TABLETS (BETA-AESCIN) "ROYAL" 1.96

AC23708100 ESCIN S.C. TABLETS (BETA-AESIN) 1.96

AC23711321 PIDELON CREAM "N.K." 11.7

AC23711329 PIDELON CREAM "N.K." 21.8

AC23711335 PIDELON CREAM "N.K." 36.2

AC23711338 PIDELON CREAM "N.K." 36.2

AC23723100 TRIAMCINOLONE TABLETS "C.H." 1.5

AC23733263 GLYCETOSE INJECTION "S.T." 70

AC23733266 GLYCETOSE INJECTION "S.T." 83

AC23733277 GLYCETOSE INJECTION "S.T." 94

AC23736100 PIROCAM CAPSULES "SWISS" (PIROXICAM) 1.5

AC237361G0 PIROCAM CAPSULES (PIROXICAM) "SWISS"(鋁箔/膠箔) 2

AC23752221 KNOWFUL INJECTION "YUNG SHIN" (PIRACETAM) 15

AC23756100 LOPERAMIDE CAPSULES 1.5

AC237561G0 LOPERAMIDE CAPSULES(鋁箔/膠箔) 2

AC23763100 LYZOTOSE TABLETS (LYSOZYME) 1.5

AC23764100 CLONIDINE TABLETS 2.11

AC23769100 MEFENAMA CAPSULES "Y.C." (MEFENAMIC ACID) 1.5

AC23773100 FOLDCAM CAPSULES (PIROXICAM) "CHINTHENG" 1.5

AC237731G0 FOLDCAM CAPSULES (PIROXICAM) "CHINTHENG"(鋁箔/膠箔) 2

AC23775100 COLISTIN SULFATE CAPSULES 6.7

AC23785100 ASCOPINE TABLETS "YU SHENG" 1.5

AC23789100 TRANCOSU TABLETS 4.13

AC23790100 FENOTER TABLETS (FENOTEROL) "LITA" 1.5

AC23793100 LIVERALL S.C. TABLETS 1.59

AC23796500 ECORIN VAGINAL SUPPOSITORY (ECONAZOLE) "H.C.T." 12

AC23820100 CITIDINE TABLETS (CIMETIDINE) 1.5

AC238201G0 CITIDINE TABLETS (CIMETIDINE)(鋁箔/膠箔) 2

AC23822100 DEPHEDOL F.C. TABLETS 25MG (DIPHRNIDOL) 1.5

AC23825100 SPLOTIN TABLETS (SULPIRIDE) 1.66

AC23833100 SWEI TABLETS "YU SHENG" 1.5

AC23845100 CHIERHSIN-40MG TABLETS 1.5

AC23850100 AN-AN TABLETS 2.45

AC23857100 LORAZEPAM TABLETS 1.5

AC23870100 AMMONIUM CHLORIDE E.C. TABLETS "HEALTH" 1.5

AC23889100 KONSUL TABLETS (PRIDINOL) "LITA" 1.5

AC23890277 AMINOL-V INJECTION "S.T." 118

AC23901100 PYROCAM CAPSULES 10MG (PIROXICAM) "F.Y." 1.5

AC23904100 "LIDONIN TABLETS (DICLOFENAC) ""TAI YU""" 1.5

AC23918100 FLUZINE TABLETS 5MG(FLUNARIZINE)"STANDARD" 1.62

AC239181G0 FLUZINE TABLETS "STANDARD" (FLUNARIZINE) 5MG(鋁箔/膠箔) 2

AC23920100 BROPIN F.C. TABLETS (BROMOPRIDE) "STANDARD" 1.5

AC239201G0 BROPIN F.C. TABLETS (BROMOPRIDE) "STANDARD"(鋁箔/膠箔) 2

AC23996100 PIROXICAM CAPSULES "S.C." 1.5

AC23998100 ALUFIBRATE CAPSULES 2.9

AC23999100 BACIDE CAPSULES (PIPEMIDIC ACID) "S.C." 2.06

AC24005100 TEPEZINE F.C. TABLETS (TRIFLUOPERAZINE HCL) 1.5

AC24006271 TBC NO.8A INJECTION 56

AC24014221 TRANSACID INJECTION (TRANEXAMIC ACID) 15

AC24014229 TRANSACID INJECTION (TRANEXAMIC ACID) 15

AC24014238 TRANSACID INJECTION (TRANEXAMIC ACID) 34.5

AC24017100 CIMEDIN TABLETS (CIMETIDINE) "S.T." 1.5

AC24018100 NIFEPIN CAPSULES (NIFEDIPINE) "ROYAL" 2

AC24020100 POUDERCAM CAPSULES "H.S." 1.55

107

Page 108: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC24023100 ANJAL TABLETS "YU SHENG" 1.5

AC24029263 MORIAMIN-SN INJECTION 156

AC24029277 MORIAMIN-SN INJECTION 212

AC24040209 KONSUL INJECTION "LITA" (PRIDINOL) 15

AC24053100 BLOODFULL S.C. TABLETS "C.H." 1.5

AC24063100 FENOTEROL HBR TABLETS 2.5MG "S.C." 1.5

AC24073212 CIMEDIN INJECTION (CIMETIDINE) "S.T." 15

AC24076100 PRANOL F.C. TABLETS (PROPRANOLOL) 1.5

AC24078100 PRIDINOL TABLETS "P.L." 1.5

AC24085100 "WEIBAMYCIN CAPSULES ""TAI YU"" (DOXYCYCLINE)" 1.5

AC24104100 HERSUN TABLETS 40MG (PROPRANOLOL HYDROCHLORIDE)"F.Y." 1.5

AC24113209 "DEXTROSE AND SODIUM CHLORIDE INJECTION 5%/0.9% ""Y.F.""" 25.9

AC24113277 "DEXTROSE AND SODIUM CHLORIDE INJECTION 5%/0.9% ""Y.F.""" 25

AC24127100 DICLOFEN TABLETS (DICLOFENAC) 1.5

AC24132100 AMOXICILLIN CAPSULES 500MG 1.5

AC241321G0 AMOXICILLIN CAPSULES 500MG.(鋁箔/膠箔) 2

AC24175100 REAZONE TABLETS 1.5

AC24187100 TRENTAL DRAGEE 100MG (PENTOXIFYLLINE) 1.57

AC241871G0 TRENTAL DRAGEE 100MG (PENTOXIFYLLINE)(鋁箔/膠箔) 2

AC24196100 PIPEMID TABLETS 250MG "Y.C."(PIPEMIDIC ACID) 5.3

AC24198212 AMIKACIN INJECTION 125MG/ML "N.K." 32.3

AC24199100 NAROXIN TABLETS "H.C" (NAPROXEN) 1.5

AC24203216 ACETYLCYSTEINE INJECTION 100MG/ML "LITA" 15

AC24212238 0.45% SODIUM CHLORIDE INJECTION 15

AC24212277 SODIUM CHLORIDE INJECTION 0.45% "S.T." 25

AC242122D9 SODIUM CHLORIDE INJECTION 0.45% "S.T." (塑膠軟袋裝) 85

AC24229100 PRIMRAM S.C. TABLETS (METOCLOPRAMIDE) "C.H." 1.5

AC24251100 LITAZIN CAPSULES (PIPEMIDIC ACID) "LITA" 2.06

AC24258277 TAITA NO.4 INJECTION 35.6

AC24266100 DIYUN TABLETS (DIPHENIDOL) "S.T." 1.5

AC24269100 BUSKOBUN S.C. TABLETS C.H." (HYOSCINE BUTYLBROMIDE) " 1.5

AC24270100 PISON CAPSULES "C.H." 1.91

AC24271100 ISMEDINE TABLETS (GUANETHIDINE SULFATE) "C.H." 1.5

AC24272100 ERGO-M S.C. TABLETS "C.H."(ERGOMETRINE MALEATE) 1.5

AC24277100 SULYANG CAPSUES (SULPIRIDE) "S.T." 1.66

AC24282100 TREN CAPSULES 250MG (TRANEXAMIC ACID) "YUNG SHIN" 1.52

AC24310100 RESERZIDE S.C. TABLETS 1.5

AC243101G0 RESERZIDE S.C. TABLETS(鋁箔/膠箔) 2

AC24319221 TREN INJECTION 100MG (TRANEXAMIC ACID) "YUNG SHIN" 15

AC24329100 LIROCAM CAPSULE (PIROXICAM) "LITA" 1.5

AC24369100 FELVITEN S.C. TABLETS "C.H."

(ANETHOLE)

1.5

AC24375100 GRISEOFULVIN TABLETS 250MG 1.65

AC24385100 LOPERAMIDE CAPSULES 1.5

AC24431100 PAOWEIAN TABLETS 200MG "C.H." (CIMETIDINE ) 1.5

AC24441100 CODEM CAPSULES "C.H." 1.5

AC24463100 ANXIEDIN TABLETS 0.5MG (LORAZEPAM) 1.5

AC244631G0 ANXIEDIN TABLETS 0.5MG (LORAZEPAM)(鋁箔/膠箔) 2

AC24474100 LIDIN TABLETS 300MG (LITHIUM CARBONATE) 1.54

AC24488100 PROAZINE TABLETS (PROCHLORPERAZINE MALEATE) 1.5

AC24490100 PIPERAN CAPSULES (PIPEMIDIC ACID )"YU SHENG" 5.3

AC24493100 TEANLANG TABLETS 0.75MG 1.5

AC24494100 LISOME TABLETS 30MG "HONTEN" (LYSOZYME) 1.5

AC24509100 FLURAZINE F.C. TABLETS 5MG "VPP" (TRIFLUOPERAZINE) 1.5

AC24516210 "SODIUM CHLORIDE INJECTION 0.9% ""TAI YU""" 43.9

108

Page 109: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC24516212 "SODIUM CHLORIDE INJECTION 0.9% ""TAI YU""" 72

AC24516216 "SODIUM CHLORIDE INJECTION 0.9% ""TAI YU""" 86

AC24516248 "SODIUM CHLORIDE INJECTION 0.9% ""TAI YU""" 15

AC24536100 PROPRANOLOL HYDROCHLORIDE TABLETS "C.H." 1.5

AC24592100 SULMIN TABLETS 1.5

AC24597100 ALLERCON TABLETS 1.5

AC24667265 RINGER INJECTION 22

AC24667277 RINGER INJECTION 25

AC24673277 "RINGER INJDECTION ""S.Y.""" 25

AC24696216 "DICLOFENAC INJECTION 25MG ""TAI YU""" 15

AC24703100 "SULPI CAPSULES 50MG (SULPIRIDE) ""WINSTON""" 1.66

AC247031G0 SULPI CAPSULES 50MG (SULPIRIDE) "WINSTON"(鋁箔/膠箔) 2

AC24708100 SORIN TABLETS 200MG "YUNG SHIN" (CHLORZOXAZONE) 1.5

AC247081G0 SORIN TABLETS 200MG "YUNG SHIN" (CHLORZOXAZONE)(鋁箔/膠箔) 2

AC24726100 PARAS TABLETS "YUNG SHIN" 1.5

AC24740100 "LYSOZYME TABLETS 100MG ""M.T.""" 1.5

AC24742100 MILISHER TABLETS 100MG "H.H." (LYSOZYME) 1.5

AC24751221 POTASSIUM CHLORIDE INJECTION 15% "KINGDOM" 15

AC24752321 "TOSEN OINTMENT ""M.S.""" 20

AC24754100 ZECOLIN TABLETS 250MG 1.52

AC24756277 "DEXTROSE INJECTION 10% ""TAI YU""" 25

AC24766100 "HETEL CAPSULES (CLOMIPHENE)""M.T.""" 4.98

AC24789100 ERYMYCIN CAPSULES 250MG (ERYTHROMYCIN ESTOLATE) "VPP" 2.15

AC24817100 BROTHINE TABLETS 2.5MG (TERBUTALINE SULFATE) 1.5

AC24837100 "TONIFEN F.C. TABLETS 500MG (MEFENAMIC ACID) "" ROYAL """ 1.5

AC248371G0 "TONIFEN F.C. TABLETS 500MG (MEFENAMIC ACID) "" ROYAL """ 2

AC24838100 RIFAMPICIN CAPSULES 8.1

AC24840209 CEMANDOLE INJECTION (CEFAMANDOLE) 60

AC24841100 CLOMIPHENE CAPSULES 50MG "Y.C." 4.98

AC24843100 CHIMIN TABLETS 0.5MG "Y.C." (BETAMETHASONE) 1.5

AC24866100 HYTERGEN TABLETS 1.5MG "Y.C." 1.54

AC24877100 STANOZOLOL TABLETS 2MG "C.H." 1.5

AC24881100 "KIDNIN CAPSULES 250MG (PIPEMIDIC ACID) ""WINSTON""" 5.3

AC24885100 ANXIEDIN TABLETS 1MG (LORAZEPAM) 1.5

AC248851G0 ANXIEDIN TABLETS 1MG (LORAZEPAM)(鋁箔/膠箔) 2

AC24888100 CEFLEXIN CAPSULES 500MG "VPP" (CEPHALEXIN) 1.82

AC248881G0 CEFLEXIN CAPSULES 500MG (CEPHALEXIN) "VPP"(鋁箔/膠箔) 2

AC24894100 ETHAMBUTOL TABLETS 400MG "L.E." 2.32

AC24936100 ERGODAN F.C. TABLETS 1.5

AC24937100 ENBRAIN TABLETS 1.5MG (DIHYDROERGOTOXINE MESYLATE) 1.54

AC24942209 SALTOLIN INJECTION "GENTLE" (SALBUTAMOL) 0

AC24943100 LORAPAM TABLETS 1MG "HC" 1.5

AC24944100 SPIRZIDE TABLETS 1.5

AC24952209 DEXAMETHASONE INJECTION 4MG "Y.Y." 15

AC24952212 DEXAMETHASONE INJECTION 4MG/ML "Y.Y." 23.6

AC24964100 MORCASIN TABLETS "SINPHAR" 1.5

AC249641G0 MORCASIN TABLETS "SINPHAR"(鋁箔/膠箔) 2

AC24974100 MERIS SC TABLETS (BETAHISTINE) 1.5

AC24986265 GLYCEROL INJECTION "N.K." 83

AC24986266 GLYCEROL INJECTION "N.K." 83

AC24986277 GLYCEROL INJECTION 94

AC24987100 CENDMYCIN CAPSULES 500MG (CEFADROXIL) "KINGDOM" 2.2

AC24990271 TBC NO.8B INJECTION 49

AC24991100 DIPHENIDOL S.C.TABLETS 25MG "C.H" 1.5

109

Page 110: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC25017100 "YULANTYL TABLETS ""TAI YU""" 1.5

AC25020100 ERYSTAC CAPSULES 250MG (ERYTHROMYCIN STEARATE) "KINGDOM" 2.15

AC25025100 NYSTATIN TABLETS 500000 UNITS "Y.C." 2.83

AC25058100 VANCONIN TABLETS 2MG (DIAZEPAM) "VPP" 1.5

AC250581G0 VANCONIN TABLETS 2MG (DIAZEPAM) "VPP" (鋁箔/膠箔) 2

AC25061100 MEPENATE TABLETS 1.5

AC25079100 COMBICILLIN CAPSULES "C.R." 4.97

AC25083100 UCEFA CAPSULES 500MG (CEFADROXIL) 2.2

AC25095100 "WINTIDINE TABLETS 200MG (CIMETIDINE) ""WINSTON" 1.5

AC25096100 DIAZEPAM TABLETS 2MG "H.C" 1.5

AC25104277 "FRUCERINTONE INTECTION ""TAI YU""" 94

AC25110100 DEXTROLAMINE CAPSULES "S.C." 1.5

AC25128417 GENTAMYCIN OPHTH. OINTMENT 3MG/GM"GCPC" 21

AC25128421 GENTAMYCIN OPHTH. OINTMENT 3MG/GM "GCPC" 27

AC25130100 NOFLAGMA CAPSULES 50MG (LYSOZYME) "YUNG SHIN" 1.5

AC25163100 DECA TABLETS 0.75MG (DEXAMETHASONE) "S.T." 1.5

AC25164219 BUNISEX INJECTION 0.5MG "Y.Y."(BUMETANIDE) 47.1

AC25191100 WINSUMIN S.C. TABLETS 50MG (CHLORPROMAZINE HCL) 1.5

AC25196100 EASYGO TABLETS "S.T." 1.5

AC25202100 FELCAM CAPSULES 10MG (PIROXICAM) 1.5

AC25217500 ANTIFUNGAL VAGINAL TABLETS 100MG "S.C." (MICONAZOLE) 5.3

AC25223100 TOEEFON TABLETS 250MG (MEFENAMIC ACID) "T.F." 1.5

AC25224100 ORIBIRA TABLETS "ORIENTAL" 4.72

AC25230100 DOGWEISU CAPSULES 50MG (SULPIRIDE) 1.66

AC25243100 ERGOXIN TABLETS 1.5MG (DIHYDROERGOTOXINE METHANESULFONATE)

"S.C."

1.54

AC252431G0 ERGOXIN TABLETS 1.5MG "S.C." (DIHYDROERGOTOXINE

METHANESULFONATE) (鋁箔/膠箔)

2

AC25254100 LYSOZYME TABLETS 90MG "S.C." 1.5

AC25272100 DIPYRIDAMOLE S.C. TABLETS 25MG "C.H." 1.5

AC25273100 PIMICOL TABLETS 250MG (PIPEMIDIC ACID) 5.3

AC25279100 SUPERZYME TABLETS 90MG 1.5

AC25290100 PIROX CAPSULES 10MG "Y.C."(PIROXICAM) 1.5

AC25291329 SEEDO-SANIN CREAM 21.8

AC25291335 SEEDO-SANIN CREAM 36.2

AC25301100 OXO CAPSULES "YUNG SHIN" (OXOLAMINE CITRATE) 1.5

AC253011G0 OXO CAPSULES (OXOLAMINE CITRATE) "YUNG SHIN"(鋁箔/膠箔) 2

AC25314100 NIFLUCIL CAPSULES 250MG "Y.C." (NIFLUMIC ACID) 2.57

AC25316100 TRANEXMIN CAPSULES 250MG "CHINTENG" (TRANEXAMIC ACID) 1.52

AC253161G0 TRANEXMIN CAPSULES 250MG "CHINTENG" (TRANEXAMIC ACID)(鋁箔/膠

箔)

2

AC25355266 FRUCEROL INJECTION 83

AC25355277 FRUCEROL INJECTION 94

AC25365100 "ESIDAR S.C. TABLETS ""M.T.""" 1.5

AC253651G0 "ESIDAR S.C. TABLETS ""M.T.""(鋁箔/膠箔)" 2

AC25396100 MEFETON F.C. TABLETS 500MG 1.5

AC25406100 PERANSIN F.C. TABLETS 75MG (DIPYRIDAMOLE) "C.H." 1.83

AC25426212 PYRIDOXAL PHOSPHATE INJECTION 10MG/ML "Y.Y." 15

AC25427100 DISOPYRAMIDE CAPSULES 100MG "F.Y." 5

AC25443100 KONSHIEN CAPSULES "YU SHENG" 1.5

AC25446100 PIROXIM CAPSULES 10MG (PIROXICAM) "STANDARD" 1.5

AC254461G0 PIROXIM CAPSULES 10MG (PIROXICAM) "STANDARD" (鋁箔/膠箔) 2

AC25447100 ANSRON FILM COATED TABLETS 100MG 4

AC25449114 AMIYU GRANULES 13.9

AC25452100 ZUCON TABLETS 25MG "Y.Y." (DICLOFENAC) 1.5

110

Page 111: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC25456100 HOWELL TABLETS 100MG "H.C." (DIHYDROXYALUMINUM ALLANTOINATE) 1.5

AC25460100 TRANEXAMIC ACID 250MG CAPSULES 1.52

AC25466100 LEVAZOL TABLETS 40MG (LEVAMISOLE) "S.T." 2.71

AC25467100 LYZINE TABLETS 50MG (LYSOZYME) "S.T." 1.5

AC25485209 "DEXTROSE 5% AND SODIUM CHLORIDE 0.225% INJECTION ""Y.F.""" 27.4

AC25485277 "DEXTROSE 5% AND SODIUM CHLORIDE 0.225% INJECTION ""Y.F.""" 25

AC25504421 YECOLON ORABESE (TRIAMCINOLONE) 28.4

AC25504423 YECOLON ORABASE (TRIAMCINOLONE) 42.7

AC25517100 THECOUGHEN TABLETS "T.F." 1.5

AC25525100 KODERLIN TABLETS "MEIDER" 1.5

AC25528277 KALTOSE INJECTION "N.K." 115

AC25541100 SILYMARIN F.C. TABLETS 35MG 1.57

AC255411G0 SILYMARIN F.C. TABLETS 35MG(鋁箔/膠箔) 2

AC25547100 REMEXIN TABLETS "S.T." 2.01

AC25548100 PIZEPINE TABLETS 25MG (PIRENZEPINE DIHYDROCHLORIDE) 1.79

AC25550263 AMIYU INJECTION 130

AC25567321 ECONALONE CREAM "SINPHAR" 11.7

AC25567329 ECONALONE CREAM "SINPHAR" 21.8

AC25571100 SPANTON TABLETS"HC" 1.5

AC25586100 LORAZEPAM TABLETS 1MG "C.H." 1.5

AC25590100 LYSOZYME CHLORIDE TABLETS 50MG "CHINTENG" 1.5

AC255901G0 LYSOZYME CHLORIDE TABLETS 50MG "CHINTENG"(鋁箔/膠箔) 2

AC25595229 LINCOMYCIN HCL INJECTION 300MG/ML "T.F." 27.2

AC25595238 LINCOMYCIN HCL INJECTION 300MG/ML"TF" 39.2

AC25617100 CEFADROXIL CAPSULES 500MG "Y.S." 2.2

AC25623100 LOVAMIN TABLETS 1MG "T.F." 1.5

AC25629100 DICYCLOMINE TABLETS 10MG "Y.Y" 1.5

AC25643100 SIGAMET F.C. TABLETS 200MG "SINPHAR" (CIMETIDINE) 1.5

AC256431G0 SIGAMET F.C. TABLETS 200MG (CIMETIDINE) "SINPHAR"(鋁箔/膠箔) 2

AC25644100 PRIMLAN TABLETS 10MG (METOCLOPRAMIDE) "P.L." 1.5

AC25659100 CEFADROXIL CAPSULES 500MG "S.T." 2.2

AC25675277 MALTOSE INJECTION 10% "N.K." 130

AC25686100 POSHINLEN F.C. TABLETS 25MG "H.S." 1.5

AC256861G0 POSHINLEN F.C. TABLETS 25MG"H.S." (鋁箔/膠箔) 2

AC25698100 PIPEMIDON CAPSULES 250MG"T.F." (PIPEMIDIC ACID) 5.3

AC25714100 CIWIDINE TABLETS 200MG 1.5

AC25716100 TRANEXAMIN CAPSULES 250MG (TRANEXAMIC ACID) "S.C." 1.52

AC25717317 "ECONOL-T CREAM ""GCPC""" 11.7

AC25717321 "ECONOL-T CREAM ""GCPC""" 11.7

AC25717329 "ECONOL-T CREAM ""GCPC""" 21.8

AC25717335 "ECONOL-T CREAM ""GCPC""" 36.2

AC25739100 ERYTHROMYCIN STEARATE FILM COATED TABLETS 250MG "SHITEH" 2.15

AC25754100 PICOTAM CAPSULES 400MG GENTLE (PIPEMIDIC ACID) 5.3

AC25840100 ATENOL F.C. TABLETS 100MG (ATENOLOL) 1.6

AC258401G0 ATENOL F.C. TABLETS 100MG (ATENOLOL)(鋁箔/膠箔) 2

AC25841100 ANTIMIGRAINE FILM COATED TABLETS "T.F." 1.5

AC258411G0 ANTIMIGRAINE FILM COATED TABLETS "T.F."(鋁箔/膠箔) 2

AC25842100 TRANEXIC TABLETS 250MG "L.E." (TRANEXAMIC ACID) 1.52

AC25844209 METHYLERGONOVINE MALEATE INJECTION 0.2MG/ML "Y.Y." 19.4

AC25847100 AISOPENT TABLETS 20MG"T.F." (ORCIPRENALINE) 1.51

AC25849212 METOCLOPRAMIDE INJECTION "Y.Y." 15

111

Page 112: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC25866100 AMOXICILLIN CAPSULES 500MG "YUNG SHIN" 1.5

AC258661G0 AMOXICILLIN CAPSULES 500MG "YUNG SHIN" (鋁箔/膠箔) 2

AC25871100 PIROXICAM CAPSULES 10MG "Y.Y." 1.5

AC25882100 LYCOSU TABLETS 50MG 1.5

AC25897216 MUCOCIL INJECTION 100MG/ML "GENTLE" (ACETYLCYSTEINE) 0

AC25902277 MALTOSE INJECTION 10% 130

AC25905100 KODAPIN F.C. TABLETS 1.5

AC25918212 DICYCLOMINE INJECTION 10MG/ML "Y.Y" 15

AC25925100 ANCOGEN TABLETS "H.H." 1.5

AC259251G0 ANCOGEN TABLETS "H.H."(鋁箔/膠箔) 2

AC25941100 DECAMIN TABLETS 4MG (CYPROHEPTADINE HCL) "S.Y." 1.5

AC25977125 AMOXICILLIN GRANULES 200MG/GM "YUNG SHIN" 31

AC25983277 FRUCTOSE INJECTION 5% "CHI SHENG" 30.7

AC26002100 CODEMIN CAPSULES "S.T." 1.91

AC26007100 NOFLAGMA TABLETS 90MG (LYSOZYME) "YUNG SHIN" 1.5

AC26026100 TRAXEMIN CAPSULES 250MG (TRANEXAMIC ACID) "S.T." 1.52

AC26028238 CONBIHOL INJECTION "LITA" 15

AC26032100 ALMEDOPA TABLETS 250MG (L-ALPHA-METHYL DOPA) "UNION" 2.47

AC26079100 BROMAZIN TABLETS 6MG (BROMAZEPAM) 2.89

AC26080100 BROMAZIN TABLETS 3MG (BROMAZEPAM) 1.58

AC260801G0 BROMAZIN TABLETS 3MG "JOHNSON"(BROMAZEPAM)(鋁箔/膠箔) 2

AC26082238 KACILEN INJECTION 15

AC26089100 "SU-FU-DOU TABLETS 500MG (TINIDAZOLE)""M.T.""" 2.09

AC26093100 TRANEXAMIC ACID 500MG TABLETS "F.S." 3.89

AC26105100 ELISTIN TABLETS 1.5MG "STANDARD" (DIHYDROERGOTOXINE MESYLATE) 1.54

AC261051G0 ELISTIN TABLETS 1.5MG "STANDARD" (DIHYDROERGOTOXINE

MESYLATE)(鋁箔/膠箔)

2

AC26114100 EMODINE CAPSULES 1.5

AC26118209 SOON INJECTION "YUNG SHIN" 15

AC26121100 COBICIN TABLETS "YU SHENG" 1.5

AC26123151 ANTICA SYRUP 25

AC26123157 ANTICA SYRUP 25

AC26124100 GAWEI TABLETS 200MG (CIMETIDINE) "YU SHENG" 1.5

AC261241G0 GAWEI TABLETS 200MG (CIMETIDINE) "YUSHENG" (鋁箔/膠箔) 2

AC26127100 NAPOXEN TABLETS 250MG 1.5

AC26128340 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 35.5

AC26128348 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 44.3

AC26128363 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 150

AC26128365 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 151

AC26128377 SULFASIL CREAM 1% (SILVER SULFADIAZINE) "VPP" 519

AC26133100 SUCAFATE TABLETS 500MG (BASIC ALUMINUM SUCROSE SULFATE) 1.5

AC26138100 TOLPERISONE TABLETS 100MG "S.C." 1.63

AC26144100 CLONIDINE TABLETS 0.15MG "C.H." 2.11

AC26154100 BUDEMA TABLETS 1MG (BUMETANIDE) "S.T." 2.23

AC26155329 "ECONAT CREAM ""WINSTON""" 21.8

AC26173212 "TRANEXAMIC ACID INJECTION 50MG ""TAI YU""" 15

AC26173221 "TRANEXAMIC ACID INJECTION 50MG ""TAI YU""" 15

AC26175100 URODINE F.C. TABLETS 100MG "T. F." (PHENAZOPYRIDINE) 1.5

AC26176100 PESUGEN CAPSULES 10MG (PIROXICAM) "S.T." 1.5

AC26233100 FLUNAZON CAPSULES 5MG (FLUNARIZINE) "N.K." 1.62

AC262331G0 FLUNAZON CAPSULES 5MG (FLUNARIZINE) "N.K." 2

AC26234500 KANEZIN VAGINAL TABLETS 100MG (CLOTRIMAZOLE) 9

AC26256100 FUTON E.C. TABLETS 25MG 1.5

AC262561G0 FUTON E.C. TABLETS 25MG (鋁箔/膠箔) 2

112

Page 113: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC26259100 TININ TABLETS 500MG (TINIDAZOLE) "S.C." 2.09

AC26261100 METHISINE TABLETS 500MG (METHISOPRINOL) "UNION" 5.9

AC26263100 VIRUX TABLETS 500MG (METHISOPRINOL) 5.9

AC26265209 AVTON INJECTION 20MG/ML (NEFOPAM) "N.K." 15

AC26266209 ANOPAIN INJECTION 20MG/ML "GENTLE" (NEFOPAM) 0

AC26272100 CAPAIN F.C. TABLETS 30MG (NEFOPAM) "YUNG SHIN 3.87

AC26278100 NOSCAPINE TABLETS 15MG "SINPHAR" 1.31

AC26289100 P.P.C. CAPSULES 1.5

AC262891G0 P.P.C. CAPSULES(鋁箔/膠箔) 2

AC26308321 "CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE) ""WINSTON""" 17.2

AC26308340 "CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE) ""WINSTON""" 35.5

AC26308348 "CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE) ""WINSTON""" 44.3

AC26308365 "CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE) ""WINSTON""" 151

AC26308372 "CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE) ""WINSTON""" 286

AC26308377 "CANFLAME CREAM 10MG/GM (SILVER SULFADIAZINE) ""WINSTON""" 519

AC26324100 "PIROCAM CAPSULES 10MG (PIROXICAM)""M.T.""(鋁箔/膠箔)" 1.5

AC26328100 NEWMAZOLE TABLETS 10MG (CARBIMAZOLE) 1.5

AC263281G0 NEWMAZOLE TABLETS 10MG (CARBIMAZOLE)(鋁箔/膠箔) 2

AC26330100 TRANEXAM TABLETS 250MG (TRANEXAMIC ACID) 1.52

AC26343321 ECONOL CREAM 1% "GCPC" 14.8

AC26343329 ECONOL CREAM 1% "GCPC" 28.6

AC26357265 "DEXTROSE-SALINE INJECTION ""TAI YU""" 22

AC26357277 "DEXTROSE-SALINE INJECTION ""TAI YU""" 25

AC26361100 PIROCAM CAPSULES 10MG 1.5

AC26363100 MUSCONE TABLETS 50MG (TOPERISONE) "SHIN FONG" 1.61

AC26380216 FORMIN INJECTION 25MG/ML (DICLOFENAC) "PZNBIOTIC" 15

AC26385100 NEFOPAM TABLETS 30MG "S.T." 3.87

AC26400277 TBC NO.2 INJECTION 30.3

AC26402277 TBC NO.3 INJECTION 30.3

AC26410216 DICLODENAC INJECTION 25MG/ML "Y.Y" 15

AC26425100 ININ TABLETS 2MG "YU SHENG" 1.5

AC26430100 METICON-A CAP. 1.5

AC26439100 LONFADROXIL CAPSULES 500MG (CEFADROXIL) "UNION" 2.2

AC26440100 ERGOTIN TABLETS 1.5MG (DIHYDROERGOTOXINE) "C.H." 1.68

AC26454100 DEASTHMA TABLETS 2.5MG (FENOTEROL) "S.T." 1.5

AC26461100 PIROXIM CAPSULES 20MG (PIROXICAM) "STANDARD" 1.55

AC26485238 ASCORBIC ACID INJECTION 250MG/ML "S.Y." 15

AC26504123 LYSOZYME GRANULE FOR ORAL SYRUP 10% "SINPHAR" 8.4

AC26511100 "LICOU TABLETS ""S.Y.""" 1.5

AC26526100 DOGMATYL FILM COATED TABLETS 50MG (SULPIRIDE) 1.66

AC26552212 "HYCOMIN-S INJECITON 5MG/ML (HYDROXOCOBALAMIN) ""S.Y.""" 15.5

AC26554321 STADERM CREAM "STANDARD" 11.7

AC26554329 STADERM CREAM "STANDARD" 21.8

AC26554335 STADERM CREAM "STANDARD" 36.2

AC26556100 SULFINPYRAZONE CAPSULES 100MG "S.C." 4

AC26563500 FASTIN VAGINAL TABLETS 200MG (CLOTRIMAZOLE) 11.2

AC26572212 "HYDROXOBAM INJECTION 2.5MG/ML (HYDROXOCOBALAMIN) ""TAI YU""" 15.5

113

Page 114: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC26572229 "HYDROXOBAM INJECTION 2.5MG/ML (HYDROXOCOBALAMIN) ""TAI YU""" 22

AC26576209 HI-OHB12 INJECTION 5MG/ML "GENTLE" (HYDROXOCOBALAMIN) 0

AC26583100 TIBICAN TABLETS 500MG (TINIDAZOLE) 2.09

AC26588100 SPAGASGEL TABLETS 3.34

AC26642212 BROMHEXINE INJECTION 2MG/ML "Y.Y" 15

AC26644100 "DICOK E.C. TABLETS 25MG (DICLOFENAC)""M.T.""" 1.5

AC266441G0 "DICOK E.C. TABLETS 25MG (DICLOFENAC)""M.T.""(鋁箔/膠箔)" 2

AC26649100 HELOSON CAPSULES (ERYTHROMYCIN) "HEALTH" 2.15

AC26677100 SULINDEC TABLETS 200MG "S.T." 2.03

AC26683100 SULINDA TABLETS 100MG (SULINDAC) 2.03

AC26686209 LICOPAM INJECTION 20MG/ML (NEFOPAM) "Y.Y." 15

AC26703338 "SILVA-SULFA 1% CREAM (SILVER SULFADIAZINE) ""GCPC""" 33.2

AC26703340 SILVA-SULFA 1% CREAM 35.5

AC26703348 SILVA-SULFA 1% CREAM 44.3

AC26703363 SILVA-SULFA 1% CREAM 150

AC26703365 SILVA-SULFA 1% CREAM 151

AC26703371 SILVA-SULFA 1% CREAM 286

AC26703372 SILVA-SULFA 1% CREAM 286

AC26703377 SILVA-SULFA 1% CREAM 519

AC26741100 DAMIN TABLETS 1MG (PRAZOSIN) 1.54

AC267411G0 DAMIN TABLETS 1MG (PRAZOSIN)(鋁箔/膠箔) 2

AC26763100 NICE SUGAR COATED TABLETS 100MG (NITROXOLINE) "YUNG SHIN" 2.74

AC26772238 "SODIUM BICARBONATE INJECTION 70MG/ML ""TAI YU""" 15

AC26804209 METHASONE INJECTION 5MG/ML (DEXAMETHASONE PHOSPHATE) "VPP" 23.6

AC26817255 SABS INJECTION FOR IV INFUSION 5MG/ML 77

AC26817266 SABS INJECTION FOR IV INFUSION 5MG/ML 160

AC268341G0 PHYLLINTAL TABLETS "T.F."."(鋁箔/膠箔) 2

AC26861329 PECIGEN CREAM "VPP" 21.8

AC26861338 PECIGEN CREAM "VPP" 36.2

AC26870100 FELCAM CAPSULES 10MG (PIROXICAM) "VPP" 1.5

AC268701G0 FELCAM CAPSULES 10MG (PIROXICAM) "VPP"(鋁箔/膠箔) 2

AC26872100 BENDOL F.C. TABLETS 1.5

AC26883100 CODEPINE TABLETS 1.5

AC26926216 ENCORE INJECTION 100MG/ML (ACETYLCYSTEINE) 15

AC26946100 PIROCAM CAPSULES 20MG (PIROXICAM) 1.55

AC269461G0 PIROCAM CAPSULES 20MG (PIROXICAM)(鋁箔/膠箔) 2

AC26961265 "SALINE-TROSE INJECTION ""TAI YU""" 22

AC26961277 "SALINE-TROSE INJECTION ""TAI YU""" 25

AC26974100 PYDINOL TABLETS (PRIDINOL) 1.5

AC26975100 DOXEPIN CAPSULES 25MG "S.C." 2.05

AC269751G0 DOXEPIN CAPSULES 25MG "S.C."(鋁箔/膠箔) 2

AC26976100 DOGMATYL FILM COATED TABLETS 200MG (SULPIRIDE) 2.33

AC26990209 BETASON INJECTION 4MG/ML "LITA" (BETAMETHASONE) 16.7

AC26990229 BETASON INJECTION 4MG/ML "LITA" (BETAMETHASONE) 19.5

AC27003277 "SALINE INJECTION 0.9% (SODIUM CHLORIDE)""S.Y.""" 25

AC27011100 THRONE ENTERIC SUGAR COATED TABLETS 100MG "YUNG SHIN" 1.57

AC270111G0 THRONE ENTERIC SUGAR COATED TABLETS 100MG "YUNG SHIN"(鋁箔/膠

箔)

2

AC27016209 "VITAMIN C INJECTION 100MG/ML ""TAI YU""" 15

AC27016221 "VITAMIN C INJECTION 100MG/ML ""TAI YU""" 15

AC27034100 DICLOFEN E.C. TABLETS 50MG (DICLOFENAC) "H.H." 1.5

AC27044100 ANTIBLEED CAPSULES 250MG "T.F." (TRANEXAMIC ACID) 1.52

114

Page 115: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC27049212 HYCOBAMIN INJECTION 2.5MG "Y.Y." 15.5

AC27068100 SUZYME TABLETS 90MG "YU SHENG"(LYSOZYME) 1.5

AC27088100 DICLOPHEN TABLETS 25MG"D.T.S" 1.5

AC27090263 AMINOL-RF INJECTION "S.T." 130

AC27110100 RHINOX CAPSULES "SINPHAR" 1.5

AC271101G0 RHINOX CAPSULES "SINPHAR"(鋁箔/膠箔) 2

AC27131100 FONING CAPUSLES "UNION" 1.5

AC27137255 "RINGER'S SOLUTION FOR INJECTION ""TAI YU""" 22

AC27137265 "RINGER'S SOLUTION FOR INJECTION ""TAI YU""" 22

AC27137277 "RINGER'S SOLUTION FOR INJECTION ""TAI YU""" 25

AC27163100 TRANEX CAPSULES 250MG (TRANEXAMIC ACID) 1.52

AC27164100 "TON-PASS FILM COATED TABLETS 500MG (MEFENAMIC ACID) ""TAI

YU"""

1.5

AC27170209 CEFADIN INJECTION "STANDARD" (CEPHRADINE) 26.1

AC27170277 CEFADIN INJECTION (CEPHRADINE) "STANDARD" 25.8

AC27172100 QUINIDINE SULFATE TABLETS 200MG "U-LIANG" 3.95

AC27196100 KOCAT TABLETS 1.5

AC27210212 "SURSO INJECTION ""S.Y.""" 15

AC27221100 LEUCOMYCIN CAPSULES 250MG "CENTER" 2.44

AC27234100 TRIMETHOPRIM TABLETS 100MG "PATRON" 1.5

AC27236100 TENGAM CAPSULES "MT" 1.5

AC27246277 HARTMANN-SORBITOL INJECTION "S.T." 43.8

AC27254100 ANOPAIN TABLETS 30MG (NEFOPAM) "GENTLE" 3.87

AC27280212 HUSTEN INJECTION "Y.Y" 15

AC27317100 ESUSIN S.C. TABLETS 20MG "M.T." 1.96

AC27325209 LOFORAN FOR INJECTION 1GM (CEFOTAXIME SODIUM) "GENTLE" 0

AC27325212 LOFORAN FOR INJECTION 2GM "GENTLE"(CEFOTAXIME SODIUM) 0

AC27328277 CONAMIN INJECTION "N.K." 70

AC27338100 CLOMIPHENE TABLET 50MG "YUNG SHIN" 4.98

AC27356221 HEMOCLOT INJECTIONS 10% (TRANEXAMIC ACID) 15

AC27361100 DITROPAN TABLETS 5MG (OXYBUTYNIN) 2.75

AC27407100 SILUMA CAPSULE "M.T." 1.5

AC27413100 CAPETAN TABLETS 30MG (CARBETAPENTANE) "WEIDAR" 1.5

AC27418100 PRO F.C.TABLETS 200MG 6.6

AC27434100 BETASONE TABLETS 0.6MG (BETAMETHASONE) "WEIDAR" 1.5

AC27435100 SADAMOL TABLETS 4MG (SALBUTAMOL) "WEIDAR" 1.5

AC27436100 LOPAM TABLETS 1MG "WEIDAR" 1.5

AC274361G0 LOPAM TABLETS 1MG "WEIDAR"(鋁箔/膠箔) 2

AC27437100 METHOCON TABLETS 30MG "WEIDAR" (DEXTROMETHORPHAN) 1.5

AC27438100 ISOBIDE TABLETS 10MG "WEIDAR" 1.5

AC274381G0 ISOBIDE TABLETS 10MG "WEIDAR"(鋁箔/膠箔) 2

AC27439100 NEDIPIN CAPSULES 10MG (NIFEDIPINE) "WEIDAR" 2

AC27440100 ETHAVIN TABLETS 100MG (ETHAVERINE) "WEIDAR" 2.79

AC27443100 PIRODENE CAPSULES 20MG "WEIDAR" (PIROXICAM) 1.55

AC27445100 SANDEL S.C. TABLETS 50MG "WEIDAR" (DIPYRIDAMOLE) 1.69

AC274451G0 SANDEL S.C. TABLETS 50MG (DIPYRIDAMOLE) "WEIDAR"(鋁箔/膠箔) 2

AC27446100 BENOTON TABLETS 30MG "WEIDAR" (NEFOPAM) 3.87

AC27448100 SLOSAT TABLETS "WEIDAR" 2.27

AC27449100 LOPICOL F.C. TABLETS 250MG (PROBUCOL) "WEIDAR 3.33

AC27450100 PROLAX TABLETS 250MG "WEIDAR" (CHLORZOXAZONE) 1.5

AC27451100 SULORIL TABLETS 100MG "WEIDAR" (SULINDAC) 2.03

AC27452100 ATENOL TABLETS 50MG (ATENOLOL) "WEIDAR" 1.56

AC274521G0 ATENOL TABLETS 50MG (ATENOLOL) "WEIDAR"(鋁箔/膠箔) 2

AC27456238 ROLIKAN INJECTION (SODIUM BICARBONATE) 15

115

Page 116: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC27456263 ROLIKAN INJECTION (SODIUM BICARBONATE) 28.8

AC27456265 ROLIKAN INJECTION 35.2

AC27457100 LIPOLAR CAPSULES 10MG (BROMOPRIDE) "S.T." 1.5

AC27459100 DEPROLAC TABLETS 2.87MG "WEIDAR" (BROMOCRIPTINE) 6.9

AC27476100 SCRAT TABLETS 500MG 1.5

AC27492100 KALIMINE-A S.C. TABLETS 50MG (UNION) 1.5

AC27499100 SILYME-V CAPSULES "Y.Y" 1.5

AC27504100 POULICAN CAPSULES 1.5

AC275041G0 POULICAN CAPSULES(鋁箔/膠箔) 2

AC27505100 TALCAN CAPSULES "S.T." 1.5

AC27508100 SIMALON CAPSULES 1.5

AC275081G0 SIMALON CAPSULES(鋁箔/膠箔) 2

AC27513100 U-CLOR CAPSULES 250MG (CEFACLOR) "U.L." 3.63

AC27519321 BETAGEN CREAM "SWISS" 16.1

AC27519329 BETAGEN CREAM "SWISS" 16.1

AC27519335 BETAGEN CREAM "SWISS" 19.6

AC27519338 BETAGEN CREAM "SWISS" 19.6

AC27528100 METHON TABLETS 30MG (DEXTROMETHORPHAN) "C.C.P." 1.5

AC27531100 PROMETIN S.C. TABLETS 5 (METOCLOPRAMIDE) 1.5

AC275311G0 PROMETIN S.C. TABLETS 5 (METOCLOPRAMIDE)(鋁箔/膠箔) 2

AC27557500 STATIN VAGINAL TABLETS 100,000 UNITS "STANDARD" (NYSTATIN) 5

AC27558100 SELADIN TABLETS 250MG (NAPROXEN) "YUNG SHIN" 1.5

AC275581G0 SELADIN TABLETS 250MG "YUNG SHIN" (NAPROXEN)(鋁箔/膠箔) 2

AC27568100 ZIMARON TABLETS 50MG (BENZBROMARONE) "S.T." 1.5

AC275681G0 ZIMARON TABLETS 50MG (BENZBROMARONE) "S.T." (鋁箔/膠箔) 2

AC27577212 BUSIX INJECTION 0.25MG/ML (BUMETANIDE) "S.T." 15

AC27598100 FUCOU CAPSULES "H.S." 1.5

AC275981G0 FUCOU CAPSULES "H.S."(鋁箔/膠箔) 2

AC27638209 CLAVOX FOR INJECTION 1.0 GM (CEFOTAXIME) 166

AC27638277 CLAVOX FOR INJECTION 0.5 GM (CEFOTAXIME) 116

AC27646216 FUKAN INJECTION "Y.Y." 15

AC276761G0 LOPID CAPSULES 300MG (GEMFIBROZIL)(鋁箔/膠箔) 2

AC27716209 NOVAMIN INJECTION 5MG/ML (PROCHLORPERAZINE) 15.3

AC27718209 RINDERON INJECTION 4MG/ML (BETAMETHASONE) 16.7

AC27737216 CITRUGEN INJECTION "STANDARD" 24

AC27775100 SINROX F.C TABLETS 40MG (VERAPAMIL) 1.66

AC277751G0 SINROX F.C TABLETS 40MG (VERAPAMIL)(鋁箔/膠箔) 2

AC27776100 GRISEN TABLETS 500MG (GRISEOFULVIN) "VPP" 2.68

AC27849100 LOWEN TABLETS 0.5MG (LORAZEPAM) "C.C.P." 1.5

AC278491G0 LOWEN TABLETS 0.5MG (LORAZEPAM) "C.C.P."(鋁箔/膠箔) 2

AC27850212 DUPIN INJECTION 5MG/ML (DIAZEPAM) "C.C.P." 15

AC27851255 MEDAZOLE INJECTION FOR INTRAVENOUS INFUSION 0.5%

(METRONIDAZOLE)

77

AC27864212 AMIKACIN INJECTION 250MG/ML "N.K." 52

AC27864229 AMIKACIN INJECTION 250MG/ML "N.K." 210

AC27887100 FLUNAZINE TABLETS 5MG "H.C."(FLUNARIZINE) 1.62

AC27940100 BEESIX TABLETS 50MG (PYRIDOXINE HCL) "VPP" 1.5

AC27943100 VANCONIN TABLETS 5MG "VPP" 1.5

AC279431G0 VANCONIN TABLETS 5MG "VPP(鋁箔/膠箔) 2

AC27971100 MISPANTON CAPSULES 500MG "C.M."(MEFENAMIC ACID) 1.5

AC28013100 CLOMID TABLETS 50MG "SHIONOGI"(CLOMIFENE) 4.98

AC28014100 PIPERA CAPSULES 200MG "WEIDAR" (PIPEMIDIC ACID) 2.06

AC28015100 TRIPRIM TABLETS 100MG (TRIMETHOPRIM) "WEIDAR" 1.5

AC28016100 TINIZOL TABLETS 500MG (TINIDAZOLE) "WEIDAR" 2.09

116

Page 117: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC28017100 DICLOREN E.C. TABLETS 50MG (DICLOFENAC) "WEIDAR" 1.5

AC28032100 VETRIMIL S.C. TABLETS 40MG (VERAPAMIL) 1.66

AC28033100 SUCWAY TABLETS 500MG (SUCRALFATE) 1.5

AC28047212 SAVOX INJECTION 125MG/ML (AMIKACIN) 32.3

AC28047229 SAVOX INJECTION 125MG/ML (AMIKACIN) 90

AC28054100 FUYOU TABLETS 1.5

AC28066100 HEBOVITA TABLETS 1.2

AC28078100 SULPIN F.C. TABLETS 200MG "S.T." (SULPIRIDE) 2.33

AC28079100 BUSIX TABLETS 1.0MG (BUMETANID) "S.T." 2.23

AC28099210 FUROXIME FOR INJECTION "S.T." (CEFUROXIME) 67

AC28099265 FUROXIME FOR INJECTION "S.T." (CEFUROXIME) 23.5

AC28099289 FUROXIME FOR INJECTION "S.T." (CEFUROXIME) 23.5

AC28131100 ALAT CAPSULES 5MG (NIFEDIPINE) "YUNG SHIN" 2

AC28136100 SELADIN TABLETS 500MG (NAPROXEN) "YUNG SHIN" 3.26

AC28140100 RIPIN CAPSULE 300MG 8

AC28160100 ANDIZA FILM COATED TABLETS 25MG (DIPHENIDOL) 0.52

AC281601G0 ANDIZA FILM COATED TABLETS 25MG(DIPHENIDOL)(鋁箔/膠箔) 2

AC28168338 SILVADENE CREAM 1% (SILVER SULFADIAZINE) 33.2

AC28168348 SILVADENE CREAM 1% (SILVER SULFADIAZINE) 44.3

AC28168371 SILVADENE CREAM 1% (SILVER SULFADIAZINE) 286

AC28171100 SOOTHER TABLETS 1MG (KETOTIFEN) 1.12

AC28210100 INFLAMNIL TABLETS 100MG (TRIMETHOPRIM) 1.5

AC282101G0 INFLAMNIL TABLETS 100MG (TRIMETHOPRIM)(瓶裝/56粒/瓶)、(鋁箔/

膠箔)

2

AC28218100 LOPELA CAPSULES 2MG (LOPERAMIDE) "WEIDAR" 1.5

AC28245100 GLIBIDE TABLETS 5MG "WEIDAR" (GLIBENCLAMIDE) 1.5

AC282451G0 GLIBIDE TABLETS 5MG "WEIDAR" (GLIBENCLAMIDE)(鋁箔/膠箔) 2

AC28283100 SUFUNI CAPSULES 5MG (FLUNARIZINE) 1.62

AC282831G0 SUFUNI CAPSULES 5MG (FLUNARIZINE) (鋁箔/膠箔) 2

AC28284100 COCOBITA F.C. TABLETS 30MG "T.F." (CARBETAPENTANE) 1.5

AC28318100 TEGANSIA TABLETS 40MG (FENSPIRIDE) "MEIDER" 1.81

AC28321100 UPROFEN TABLETS 400MG (IBUPROFEN) 1.5

AC28332100 GAIN-TONIN TABLETS 10MG (DOMPERIDONE)"MEIDER" 1.5

AC28333100 LUCKYHEPA CAPSULES "YUNG SHIN" 1.5

AC283331G0 LUCKYHEPA CAPSULES (鋁箔/膠箔) 2

AC28341500 GYNOMYCODERIN VAGINAL TABLETS 100MG (MICONAZOE NITRATE) 5.3

AC28350212 ACEMYCIN INJECTION 100MG/ML (AMIKACIN) "YUNG SHIN" 32.3

AC28461100 DOMPE TABLETS 10MG "H.H." (DOMPERIDONE) 1.5

AC284611G0 DOMPE TABLETS 10MG "H.H." (DOMPERIDONE)(鋁箔/膠箔) 2

AC28462100 CRIP CAPSULES 2.5MG (BROMOCRIPTINE)"H.H." 6.9

AC28475277 GLYBRAIN INJECTION 94

AC28477212 ACEMYCIN INJECTION 250MG/ML (AMIKACIN) "YUNG SHIN" 52

AC28477229 ACEMYCIN INJECTION 250MG/ML (AMIKACIN) "YUNG SHIN" 210

AC28478209 "CHLORPHENIRAMINE INJECTION 5MG/ML ""TAI YU""" 15

AC28482100 VILIABES S.C. TABALETS "JOHNSON" 1.5

AC28518209 PLOTON INJECTION 15

AC28535277 POTACOL-R INJECTION 115

AC28538209 C.P.Z. INJECTION 1GM "STANDARD" (CEFOPERAZONE) 241

AC28542265 PANTOGEN INJECTION "SINTONG" 22

AC28542277 PANTOGEN INJECTION "SINTONG" 25.1

AC28560255 METRONIDAZOLE INJECTION 5MG/ML 77

AC28560263 METRONIDAZOLE INJECTION 5MG/ML 92

AC28562321 CLOBETASOL OINTMENT 0.5MG/GM "SINPHAR" 15.8

AC28562324 CLOBETASOL OINTMENT 0.5MG/GM "SINPHAR" 15.8

AC28562329 CLOBETASOL OINTMENT 0.5MG/GM "SINPHAR" 17.7

117

Page 118: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC28592100 PAROTIN S.C. TABLETS 75MG "Y.S." (DIPYRIDAMOLE) 1.83

AC285921G0 PAROTIN S.C. TABLETS 75MG "Y.S." (DIPYRIDAMOLE)(鋁箔/膠箔) 2

AC28605216 VETIN INJECTION 25MG/ML (DICLOFENAC) 15

AC28606157 COMPOUND GLYCYRRHIZA MIXTURE "KINGDOM" 27.9

AC28606163 COMPOUND GLYCYRRHIZA MIXTURE "KINGDOM" 28.7

AC28615500 ECOZOL VAGINAL TABLETS 150MG "WEIDAR" (ECONAZOLE) 12

AC28618100 SUTONLEN TABLETS 1.5

AC28619100 ANTIRHEUMATIC CAPSULES 200MG "T.F."(FLUFENAMIC ACID) 1.77

AC28623100 TOEEFON CAPSULES 500MG "T.F." 1.5

AC286231G0 TOEEFON CAPSULES 500MG "T.F." (鋁箔/膠箔) 2

AC28648100 KETIBRON CAPSULES 1MG (KETOTIFEN) "WEIDAR" 1.75

AC286481G0 KETIBRON CAPSULES 1MG (KETOTIFEN) "WEIDAR"(鋁箔/膠箔) 2

AC28650209 CETAX INJECTION "STANDARD" (CEFOTAXIME) 166

AC28650277 CETAX INJECTION "STANDARD" (CEFOTAXIME) 116

AC28779100 MEROLIN TABLETS 50MG (MEBHYDROLINE)"H.S." 1.5

AC287791G0 MEROLIN TABLETS 50MG "H.S."(MEBHYDROLINE)"H.S."(鋁箔/膠箔) 2

AC28799100 PYRAZEN TABLETS 500MG "SINPHAR" (PYRAZINAMIDE) 3.74

AC28801100 HALDOLIN TABLETS 5MG "WEIDAR" (HALOPERIDOL) 2.5

AC28804500 MULTIDON SUPPOSITORY 25MG (DICLOFENAC) 5

AC28805500 MULTIDON SUPPOSITORY 12.5MG (DICLOFENAC) 5

AC28925321 ECONAZINE CREAM 11.7

AC28925329 ECONAZINE CREAM 21.8

AC28927100 LIPITIN TABLETS "T.F." (LOPERAMIDE) 1.5

AC28945100 AMINOPHYLLINE TABLETS 100MG "U.L." 1.5

AC289451G0 AMINOPHYLLINE TABLETS 100MG "U.L."(鋁箔/膠箔) 2

AC28958100 CHOLEXAMIN TABLETS 200MG (NICOMOL) 3.58

AC28965100 SUTA CAPSULES 300MG"C.M."(FENBUFEN) 2.34

AC29008100 DICLOFENAC SODIUM TABLETS 25MG "S.C." 1.5

AC29034100 METHYCOBAL CAPSULES 250UG "EISAI"(MECOBALAMIN) 1.76

AC290341G0 METHYCOBAL CAPSULES 250UG "EISAI"(MECOBALAMIN)(鋁箔/膠箔) 2

AC29037100 RELAX CAPSULES "H.S." 5

AC29061209 HATERMAS INJECTION "N.K." 79

AC29061277 HATERMAS INJECTION "N.K." 43.8

AC29078209 SHINFOMYCIN INJECTION (CEFOPERAZONE) 241

AC29079100 ZIEFMYCIN CAPSULES 250MG (DICLOXACILLIN) 1.5

AC29080100 BROBEN S.C. TABLETS 400MG (IBUPROFEN)"Y.S." 1.5

AC29085245 MEDASON FOR INJECTION 56

AC29085258 MEDASON FOR INJECTION 151

AC29085265 MEDASON FOR INJECTION 195

AC29085277 MEDASON FOR INJECTION 249

AC29086100 SOFTIN TABLETS 10MG "Y.S." (BROMOPRIDE) 1.5

AC29090100 TONFUL TABLETS 5

AC29106100 BEHYD RA TABLETS 2.67

AC29108209 BABYSALT INJECTION "N.K." 35

AC29108265 BABYSALT INJECTION "N.K." 22

AC29108266 BABYSALT INJECTION "N.K." 24.9

AC29108277 BABYSALT INJECTION "N.K." 25

AC29132100 ENSOQONE CAPSULES 50MG"T.F." (ESCIN) 2.89

AC29172100 CEPHANMYCIN CAPSULES 500MG(CEPHALEXIN) 1.82

AC291721G0 CEPHANMYCIN CAPSULES 500MG(CEPHALEXIN) (鋁箔/膠箔) 2

AC29213500 FUNGICIDON VAGINAL SUPPOSITORIES 150MG "T.F." (ECONAZOLE) 12

AC29220100 FENSPIRIDE TABLETS 40MG "P.L." 1.81

AC29227100 DEXADROL TABLETS (DEXAMETHASONE)"T.F." 1.5

118

Page 119: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC29231277 ANOPIRIN INJECTION 500MG "GENTLE" (ACETYLSALICYLIC ACID) 0

AC29251100 SERENIN TABLETS 10MG "S.T." (OXAZOLAM) 1.62

AC29252100 "LIDONIN E.C. TABLETS 50MG (DICLOFENAC)""TAI YU""" 1.5

AC29276277 AMINOPOLY-H INJECTION 184

AC29279321 BESTASOL CREAM (CLOBETASOL) 15.8

AC29279324 BESTASOL CREAM (CLOBETASOL) 15.8

AC29279329 BESTASOL CREAM (CLOBETASOL) 17.7

AC29279340 BESTASOL CREAM (CLOBETASOL) 88

AC29301100 CANCLIOL TABLETS 100MG (METOPROLOL) 4.61

AC29313100 BETAPRESS TABLETS 100MG "S.D." (METOPROLOL) 4.61

AC29320100 AMIZIDE TABLETS "STANDARD" 2.49

AC29323277 ASPARIN INJECTION 500MG "N.K." (ASPIRIN) 15

AC29327100 WEISDIN F.C. TABLETS 400MG "WEIDAR" (CIMETIDINE) 1.5

AC293271G0 WEISDIN F.C. TABLETS 400MG "WEIDAR" (CIMETIDINE) (鋁箔/膠箔) 2

AC29330277 NAKO NO.4 INJECTION "N.K." 30.3

AC29331277 NAKO NO.2 INJECTION "N.K." 30.3

AC29332277 NAKO NO.3 INJECTION "N.K." 30.3

AC29333265 NAKO NO.1 INJECTION "H.K." (塑膠軟袋) 27.2

AC29333277 NAKO NO.1 INJECTION "H.K." 30.3

AC29334277 NAKO NO.5 INJECTION "N.K." 30.3

AC29337100 DICLAZIDE TABLETS 80MG "WEIDAR" (GLICLAZIDE) 1.5

AC293371G0 DICLAZIDE TABLETS 80MG "WEIDAR" (GLICLAZIDE)(鋁箔/膠箔) 2

AC29343429 NEOSTIGMINE METHYLSULFATE OPHTHALMIC SOLUTION (O.N.S.D.) 0.01% 15.4

AC29345100 FLAGYL ORAL TABLETS 250MG (METRONIDAZOLE) 1.64

AC293451G0 FLAGYL ORAL TABLETS 250MG (METRONIDAZOLE)(鋁箔/膠箔) 2

AC29353209 LOFALIN INJECTION 1000MG "GENTLE" (CEFOZOLIN SODIUM) 0

AC29354321 CLOBESOL CREAM 0.5MG "GENTLE" (CLOBETASOL PROPIONATE) 15.8

AC29355100 STACAINE TABLETS "STANDARD" 1.64

AC293551G0 STACAINE TABLETS "STANDARD"(鋁箔/膠箔) 2

AC29356100 MERISLON TABLETS 12MG (BETAHISTINE MESYLATE) 1.5

AC293561G0 MERISLON TABLETS 12MG (BETAHISTINE MESYLATE)(鋁箔/膠箔) 2

AC29371100 THIAMCOL CAPSULES 250MG "UNION" (THIAMPHENICOL) 1.52

AC29374100 DIEN E.C. TABLETS 50MG "S.T." (DICLOFENAC) 1.5

AC29375100 CAMAPINE TABLETS 200MG "P.L." (CARBAMAZEPINE) 2.79

AC29378100 SUMOFEN E.C. TABLETS 50MG (DICLOFENAC) 1.5

AC29417263 TALAMIN-E INJECTION "CHI SHENG" 86

AC29418100 PIECHAN TABLETS "T.F." 1.5

AC294321G0 PERSANTIN S.C. TABLETS 50MG (DIPYRIDAMOLE) (鋁箔/膠箔) 2

AC29436100 SINDIPINE MICROENCAPSULATED CAPSULE 10MG (NIFEDIPINE) "Y.S." 2

AC29437100 FENSCIN TABLETS 40MG "YU SHENG" (FENSPIRIDE) 1.81

AC29440100 FUNAZINE TABLETS 10MG "WEIDAR" (FLUNARIZINE) 4.02

AC29455266 PAREN-AID NO. 1 INJECTION "OTSUKA" 62

AC29457271 PAREN-AID NO. 2 INJECTION "OTSUKA" 67

AC29457283 PAREN-AID NO. 2 INJECTION "OTSUKA" 152

AC29458271 PAREN-AID NO.3 INJECTION "OTSUKA" 67

AC29458283 PAREN-AID NO.3 INJECTION "OTSUKA" 152

AC29465100 METISONE TABLETS 2MG "S.T." (METHYLPREDNISOLONE) 1.66

AC29475265 FRUCEOL INJECTION "CHI SHENG" 83

AC29476100 LUTIN R CAPSULES 10MG (OXAZOLAM) 1.62

AC294761G0 LUTIN R CAPSULES 10MG (OXAZOLAM)(鋁箔/膠箔) 2

AC29496209 PU-I NO.2 INJECTION "CHI SHENG" 27.4

AC29496265 PU-I NO.2 INJECTION "CHI SHENG" 22

119

Page 120: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC29496277 PU-I NO.2 INJECTION "CHI SHENG" 25

AC29503100 BROPAN TABLETS 3MG "GENTLE" (BROMAZEPAM) 1.58

AC295031G0 BROPAN TABLETS 3MG "GENTLE" (BROMAZEPAM)(鋁箔/膠箔) 2

AC29504209 LOFADINE INJECTION 1000MG "GENTLE" (CEPHRADINE) 0

AC29510100 BACCIDAL F.C. TABLETS (NORFLOXACIN) 2.44

AC29513100 ANTIGLUCON TABLETS 5MG "T.F." (GLIBENCLAMIDE) 1.5

AC295131G0 ANTIGLUCON TABLETS 5MG"T.F."(GLIBENCLAMIDE) (鋁箔/膠箔) 2

AC29517277 "ELECTROSE INJECTION ""TAI YU""" 25

AC29521100 C.M.T. TABLETS 400MG (CIMETIDINE) 1.5

AC29544100 "FLUFENAMIC ACID CAPSULES ""M.T.""" 1.77

AC29545100 "METOCO TABLETS(METOCLOPRAMIDE)""M.T.""" 1.5

AC29546100 "METHYLTESTOSTERONE CAPSULES 10MG ""M.T.""" 1.93

AC29549100 "SUGENT CAPSULES 10MG (CHLORDIAZEPOXIDE HYDROCHLORIDE

)""M.T."""

1.5

AC295491G0 "SUGENT CAPSULES 10MG (CHLORDIAZEPOXIDE HYDROCHLORIDE

)""M.T.""(鋁箔/膠箔)"

2

AC29558500 SHOREN SUPPOSITORIES 12.5MG "T.F." (DICLOFENAC) 5

AC29559500 SHOREN SUPPOSITORIES 25MG "T.F." (DICLOFENAC) 5

AC29562100 OXY TABLETS 100MG "S.T." (OXOLAMINE CITRATE) 1.5

AC29572100 SUZIN CAPSULES 5MG (FLUNARIZINE) "STANDARD" 1.62

AC295721G0 SUZIN CAPSULES 5MG "STANDARD"(FLUNARIZINE)(鋁箔/膠箔) 2

AC29574329 SONGI OINTMENT "STANDARD" 25.5

AC29575100 SUZIN CAPSULES 10MG (FLUNARIZINE) "STANDARD" 4.02

AC29576100 SERELAM CAPSULES 10MG "WEIDAR" (OXAZOLAM) 1.62

AC29594100 ZECO TABLETS 100MG "YU SHENG" (OXOLAMIN CITRATE) 1.5

AC29599100 U-SAVE CAPSULES 250MG (CEPHRADINE) 1.93

AC29601100 PREDNISOLONE TABLETS 5MG 1.5

AC296011G0 PREDNISOLONE TABLETS 5MG(鋁箔/膠箔) 2

AC29608500 SUMOFEN SUPPOSITORY 12.5MG (DICLOFENAC) 5

AC29609500 SUMOFEN SUPPOSITORY 25MG (DICLOFENAC) 5

AC29611100 "MEFENAMIC ACID CAPSULES ""M.T.""" 1.5

AC29613100 MEBENDAZOLE TABLETS 100MG "S.T." 1.51

AC296131G0 MEBENDAZOLE TABLETS 100MG "S.T."(鋁箔/膠箔) 2

AC29617100 UROXATE TABLETS 200MG (FLAVOXATE)"WEIDAR" 4.84

AC29627100 TINIDAZOLE FILM COATED TABLETS "YUNG SHIN" 2.09

AC29630100 METHYCOBAL CAPSULES 500UG "EISAI"(MECOBALAMIN) 1.76

AC296301G0 METHYCOBAL CAPSULES 500UG "EISAI"(MECOBALAMIN) (鋁箔/膠箔) 2

AC29635100 CINNARIZINE TABLETS "YUNG SHIN" 1.5

AC296351G0 CINNARIZINE TABLETS "YUNG SHIN"(鋁箔/膠箔) 2

AC29702100 AMANDINE TABLETS 100MG "H.H." (AMANTADINE) 7.4

AC29726500 CHLOTIN VAGINAL SUPPOSITORIES "YUNG SHIN" 5

AC29729100 SUCRAL TABLETS 500MG "VPP" (SUCRALFATE) 1.5

AC297291G0 SUCRAL TABLETS 500MG "VPP" (鋁箔/膠箔) 2

AC29735100 TIATENOL TABLETS 100MG "T.F." 1.6

AC297351G0 TIATENOL TABLETS 100MG "T.F." (ATENOLOL) (鋁箔/膠箔) 2

AC29736100 ULSAWE TABLETS 500MG "T.F."(SUCRALFATE) 1.5

AC29738209 SUNTOSE INJECTION 0.45% "N.K." 35

AC29738277 SUNTOSE INJECTION 0.45% "N.K." 25

AC29739329 TOPSYM LOTION (FLUOCINONIDE) 77

AC29739338 TOPSYM LOTION (FLUOCINONIDE) 149

AC29742277 BIOLYTE NO.4 INJECTION "CHI SHENG" 30.3

AC29743277 BIOLYTE NO.3 INJECTION "CHI SHENG" 30.3

AC29744277 BIOLYTE NO.2 INJECTION "CHI SHENG" 30.3

AC29746209 EUJUM INJECTION 5MG/ML (PROSTAGLANDIN F2) 201

120

Page 121: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC29747100 FOCUS CAPSULES 10MG (PIROXICAM) 1.5

AC297471G0 FOCUS CAPSULES 10MG (PIROXICAM)(鋁箔/膠箔) 2

AC29748100 CINCA S.C. TABLETS 50MG "Y.S." (NICAMETATE) 1.5

AC29752100 ALLERGEN TABLETS 50MG "S.T." (MEBHYDROLIN) 1.5

AC29753100 STONE TABLETS 500MG "S.T." (MEFENAMIC ACID) 1.5

AC29754100 MUSOLIN TABLETS "S.D." 1.58

AC29755500 EKONA VAGINAL SUP. (ECONAZOLE) 12

AC29759100 BAESUKANG CAPSULES 0.5MG"C.M." (METHYLCOBALAMIN) 1.76

AC29760421 "GARABETA EYE DROPS ""WINSTON""" 39.7

AC29784100 ERGOMETRINE TABLETS 0.2MG "YUNG SHIN" 1.5

AC297841G0 ERGOMETRINE TABLETS 0.2MG "YUNG SHIN"(鋁箔/膠箔) 2

AC29789321 EXELDERM CREAM (SULCONAZOLE) 36.1

AC29789329 EXELDERM CREAM (SULCONAZOLE) 61

AC29789338 EXELDERM CREAM (SULCONAZOLE) 118

AC29790329 EXELDERM SOLUTION (SULCONAZOLE) 70

AC29791212 PITAMYCIN INJECTION 2GM (PIPERACILLIN SODIUM) 45.9

AC29791219 PITAMYCIN INJECTION 4GM (PIPERACILLIN SODIUM) 88

AC29793100 MULER TABLETS 200MG (FENBUFEN) "GENTLE" 1.5

AC29794100 SENTA TABLETS 250MG (DIFLUNISAL)"GENTLE" 6.9

AC29796100 ENZIL FILM COATED TABLETS 100MG (AMANTADINE) 7.4

AC29797100 CIWEI TABLETS 200MG "H.H." (CIMETIDINE) 1.5

AC297971G0 CIWEI TABLETS 200MG "H.H." (CIMETIDINE)(鋁箔/膠箔) 2

AC29798100 CIWEI TABLETS 400MG "H.H." (CIMETIDINE) 1.5

AC297981G0 CIWEI TABLETS 400MG "H.H."(CIMETIDINE)(鋁箔/膠箔) 2

AC29804100 SHPYNJA TABLETS "C.M." 5.9

AC29805100 DEURON TABLETS 50MG "YU SHENG" (BENZBROMARONE) 1.5

AC298051G0 DEURON TABLETS 50MG "YU SHENG" (BENZBROMARONE)(鋁箔/膠箔) 2

AC29810100 TRILONE TABLETS 4MG "H.H." (TRIAMCINOLONE) 1.5

AC298101G0 TRILONE TABLETS 4MG "H.H." (TRIAMCINOLONE)(鋁箔/膠箔) 2

AC29811100 KALIPION CAPSULES 250MG "YUNG SHIN" (CLOFIBRATE) 1.5

AC29812100 SCOTON TABLETS 400MG (IBUPROFEN) 1.5

AC29823100 AMANTEC CAPSULES 100MG (AMANTADINE) 7.4

AC29833100 KAICIDE TABLETS 600MG (PRAZIQUANTEL) 118

AC29834209 SUNTOSE INJECTION 5% "N.K." 25.9

AC29834265 SUNTOSE INJECTION 5% "N.K." 22

AC29834277 SUNTOSE INJECTION 5% "N.K." 25

AC29835209 GITOSE INJECTION 5% "N.K." 26.3

AC29835238 GITOSE INJECTION 5% "N.K." 15

AC29835255 GITOSE INJECTION 5% "N.K." 22

AC29835265 GITOSE INJECTION 5% "N.K." 22

AC29835277 GITOSE INJECTION 5% "N.K." 25.1

AC29837209 HAFORMAN INJECTION "N.K." 32.6

AC29837255 HAFORMAN INJECTION "N.K." 22

AC29837265 HAFORMAN INJECTION "N.K." 22

AC29837277 HAFORMAN INJECTION "N.K." 25

AC29838277 GITOSE INJECTION 10% "N.K." 25

AC29852329 "SFUSONE CREAM 5MG/G (TRIAMCINOLONE ACETONIDE) ""H.S.""" 52

AC29859100 "COCHILIN CAPSULES ""HS""" 1.5

AC298591G0 "COCHILIN CAPSULES ""HS""(鋁箔/膠箔)" 2

AC29860100 "ISIHTONNIN CAPSULES 50MG (KETOPROFEN) ""HS""" 1.91

AC29866100 "HIRANIN CAPSULES 350MG (CARISOPRODOL) ""HS""" 4.32

AC29867100 "ANTIRHEUMATIC CAPSULES 25MG (INDOMETHACIN) ""HS""" 1.5

AC298671G0 "ANTIRHEUMATIC CAPSULES 25MG ""HS""(INDOMETHACIN)(鋁箔/膠箔)" 2

121

Page 122: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC29874100 "VOTONNIN CAPSULES 25MG (DICLOFENAC) ""HS""" 1.5

AC298741G0 "VOTONNIN CAPSULES 25MG (DICLOFENAC) ""HS""(鋁箔/膠箔)" 2

AC29875100 "HOW NAMIN CAPSULES ""HS""" 1.5

AC298751G0 "HOW NAMIN CAPSULES ""HS""(鋁箔/膠箔)" 2

AC29882100 SOCHIN FILM COATED TABLETS 60MG (PANTETHINE) 2.42

AC29885100 TOEEFON FILM COATED TABLETS 500MG "T.F." 1.5

AC29889209 CEDOL FOR INJECTION 500MG (CEFAMANDOLE NAFATE) 60

AC29889277 CEDOL FOR INJECTION 500MG (CEFAMANDOLE NAFATE) 32.6

AC29907151 "CODENIN SYRUP ""H.S.""" 25

AC29907157 "CODENIN SYRUP ""H.S.""" 28.8

AC29929100 "METHYLTESTOSTERONE CAPSULES 10MG (METHYLTESTOSTERONE) ""HS""" 1.93

AC29931100 "CHANSIAN CAPSULES 5MG (PREDNISOLONE) ""HS""" 1.5

AC29933100 "TIBILIN S.C. TABLETS ""HS""" 1.5

AC29960265 SUNTOSE INJ. "N.K." 2.5% 22

AC29960277 SUNTOSE INJ. "N.K." 2.5% 25

AC29961100 "MIDE TABLETS 500MG (PYRAZINAMIDE)""WINSTON""" 3.74

AC29984209 HARINGER INJECTION "N.K." 31.4

AC29984238 HARINGER INJECTION "N.K." 15

AC29984255 HARINGER INJECTION "N.K." 22

AC29984265 HARINGER INJECTION "N.K." 22

AC29984277 HARINGER INJECTION "N.K." 25

AC30054212 ORPHENADRINE INJECTION "YUNG SHIN" 15

AC30120100 CINTSU SUGAR COATED TABLETS 40MG (VERAPAMIL)"YUNG SHIN" 1.66

AC301201G0 CINTSU SUGAR COATED TABLETS 40MG "YUNG SHIN"(VERAPAMIL) (鋁箔/

膠箔)

2

AC30257100 AMANDA F.C. TABLETS 100MG "WEIDAR" (AMANTADINE) 7.4

AC30268212 DEFENSE INJECTION 150MG/ML (CIMETIDINE) 15

AC30305100 LITANGEN TABLETS 250MG (CHLORPROPAMIDE)" M.T." 1.5

AC303051G0 LITANGEN TABLETS 250MG (CHLORPROPAMIDE)" M.T."(鋁箔/膠箔) 2

AC30307100 DEXAMETHASONE S.C. TABLETS 0.5MG "M.T." 1.5

AC30308100 "SULUGEN S.C. TABLETS 100MG (PHENAZOPYRIDINE)""M.T.""" 1.5

AC30309100 "NAUEAN TABLETS (CINNARIZINE)""M.T.""" 1.5

AC303091G0 "NAUEAN TABLETS (CINNARIZINE)""M.T.""(鋁箔/膠箔)" 2

AC30310100 "THINTHIN CAPSULES 10MG (HYOSCINE-N-BUTYL BROMIDE)""M.T.""" 1.5

AC30311100 "DEXAMETHASONE TABLETS ""M.T.""" 1.5

AC30312100 NITROFURANTOIN CAPSULES 100MG "M.T." 1.5

AC30319100 VEKAIN TABLETS (R) 1.5

AC30383135 HALDOMIN ORAL SOLUTION (HALOPERIDOL) 68

AC30383155 HALDOMIN ORAL SOLUTION (HALOPERIDOL) 125

AC303961G0 COLCHICINE TABLETS 0.5MG "SHIONOGI"(鋁箔/膠箔) 2

AC30415100 MINISON TABLETS 1MG (PRAZOSIN) 1.54

AC30417209 LYBRILE INJECTION (ACETYLSALICYLIC ACID) 15

AC30452100 CAPOMIL TABLETS 25MG (CAPTOPRIL)"WEIDAR" 1.57

AC304521G0 CAPOMIL TABLETS 25MG "WEIDAR" (CAPTOPRIL)(鋁箔/膠箔) 2

AC30465329 EPISONE SOLUTION (BETAMETHASONE) 38.2

AC30466100 IBUPROFEN FILM COATED TABLETS 400MG "YUNG SHIN" 1.5

AC304661G0 IBUPROFEN FILM COATED TABLETS 400MG "YUNG SHIN"(鋁箔/膠箔) 2

AC30467100 ASUMALIFE CAPSULES 1MG (KETOTIFEN) 1.75

AC304671G0 ASUMALIFE CAPSULES 1MG (KETOTIFEN) (鋁箔/膠箔) 2

AC30507100 DIAZEPAM TABLETS 2MG "YUNG SHIN" 1.5

AC305071G0 DIAZEPAM TABLETS 2MG "YUNG SHIN"(鋁箔/膠箔) 2

122

Page 123: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC30510100 DIAZEPAM TABLETS 5MG "YUNG SHIN" 1.5

AC30513100 MORESAFE TABLETS 5MG (ALLYLESTRENOL) 2.95

AC30521212 RASITOL INJECTION 10MG/ML (FUROSEMIDE) 15

AC30526100 "SPIRONOLACTONE TABLETS ""ROYAL""" 1.5

AC305261G0 "SPIRONOLACTONE TABLETS ""ROYAL""(鋁箔/膠箔)" 2

AC30532100 ASTIFEN TABLETS 1MG (KETOTIFEN) "VPP" 1.75

AC30535209 LEPHOCIN INJECTION 1GM (CEFOXITIN) 113

AC30538500 ECOVAL SUPPOSITORY 50MG (ECONAZOLE) "P.L." 11.9

AC30545100 INFLU CAPSULES 100MG (AMANTADINE) 7.4

AC30549100 ANTIFLAN E.S.C. TABLETS 100MG (BROMELAIN)"C.H." 1.5

AC30556100 YUNGBENRONE TABLET (BENZBROMARONE) "LITA" 1.5

AC30557100 DICLOFENAC E.S.C. TABLETS 50MG"F.Y." 1.5

AC30559277 LOFADINE INJECTION 500MG"GENTLE" (CEPHRADINE) 0

AC30560277 LOFORAN INJECTION 0.5G "GENTLE"(CEFOTAXIME SODIUM) 0

AC30581100 THIOPHENICOL F.C. TABLET 250MG "SHITEH" 1.52

AC30587100 TEGOL TABLETS 200MG "YU SHENG" (CARBAMAZEPINE) 2.79

AC30591500 VOTALIN SUPPOSITORY 50MG (DICLOFENAC) 6.6

AC30605100 MAMICON CAPSULES 1MG "PATRON" (KETOTIFEN) 1.75

AC30607100 ESIDRI S.C. TABLETS (R) 1.5

AC306071G0 ESIDRI S.C. TABLETS (R)(鋁箔/膠箔) 2

AC30610100 INROLIN TABLETS 50MG (MEBBYDROLINE) "YU SHENG" 1.5

AC30611100 KATIFEN TABLETS 1MG (KETOTIFEN) "YU SHENG" 1.75

AC30612100 SULINTON TABLETS 200MG )"Y.S."(SULINDAC) 2.03

AC30614100 DOPERAN CAPSULES 400MG (PIPEMIDIC ACID) "Y.S." 5.3

AC30615100 ISOMIL S.C. TABLETS 40MG (VERAPAMIL) "Y.S." 1.66

AC306151G0 ISOMIL S.C. TABLETS 40MG (VERAPAMIL) "Y.S."(鋁箔/膠箔) 2

AC30618100 BROMAZAEPAM TABLETS (BROMAZEPAM) 1.58

AC30619100 D.M.P. TABLETS (DOMPERIDONE) 1.5

AC306191G0 D.M.P. TABLETS (DOMPERIDONE)(鋁箔/膠箔) 2

AC30620289 CEFUROXIME INJECTION 750MG 20.2

AC30622321 LOCASALEN OINTMENT (R) 39.6

AC30622335 LOCASALEN OINTMENT (R) 60

AC30629100 NAKASSER TABLET 30MG (DILTIAZEM.HCL) "N.K." 1.5

AC306291G0 NAKASSER TABLET 30MG "N.K."(DILTIAZEM HCL)(鋁箔/膠箔) 2

AC30641100 YUNGKEN FILM COATED TABLETS 200MG (FLAVOXATE) 4.84

AC30642100 DEFENSE FILM COATED TABLET 400MG (CIMETIDINE) 1.5

AC306421G0 DEFENSE FILM COATED TABLET 400MG (CIMETIDINE)(鋁箔/膠箔) 2

AC30648100 "SUTAN CAPSULES 500MG (MEFENAMIC ACID) ""H.S.""" 1.5

AC306481G0 "SUTAN CAPSULES 500MG ""H.S.""(MEFENAMIC ACID)(鋁箔/膠箔)" 2

AC30649100 "DAWEISON TAB. 10MG (DOMPERIDONE) ""H.S.""" 1.5

AC306491G0 "DAWEISON TAB. 10MG (DOMPERIDONE) ""H.S.""(鋁箔/膠箔)" 2

AC30650100 "HITOLIN TABLETS 100MG (MEBENDAZOLE) ""H.S.""" 1.51

AC30693100 KETOFEN TAB. "H.C." (KETOTIFENE) 1.75

AC30694100 DICOKAN TABLETS 30MG "T.F." (DEXTROMETHORPHAN) 1.5

AC30695100 CORTICORD TABLETS 4MG (TRIAMCINOLONE) "T.F." 1.5

AC30697100 LYSIX TABLETS 40MG "T.F." (FUROSEMIDE) 1.5

AC306971G0 LYSIX TABLETS 40MG "T.F." (FUROSEMIDE)(鋁箔/膠箔) 2

AC30698100 GLICRON TABLETS 80MG (GLICLAZIDE) "YU SHENG" 1.5

AC30712100 "LAVOCOHERE TAB. 200MG ""WINSTON"" (LABETALOL)" 3.24

AC30740100 RITALIN TABLETS 10MG (METHYLPHENIDATE) 2.66

AC30741100 WEITUL F.C. TABLETS 10MG "WEIDAR"(DOMPERIDONE) 1.5

AC30742100 APRESOLINE (R) S.C. TABLETS 25MG (HYDRALAZINE) 1.61

AC30743100 APRESOLINE (R) S.C. TABLETS 50MG (HYDRALAZINE) 1.61

AC30754321 HUPICON CREAM "Y.Y." 11.7

123

Page 124: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC30754329 HUPICON CREAM "Y.Y." 21.8

AC30754335 HUPICON CREAM "Y.Y." 36.2

AC30766100 "CLOESTIN TABLETS 200MG (BEZAFIBRATE) ""H.S.""" 6.5

AC30767100 "KANYENING CAPSULES 300MG (FENBUFEN) ""H.S.""" 2.34

AC30791209 CETAXIMA INJECTION 0.5GM,1GM (CEFOTAXIME SODIUM) 166

AC30791277 CETAXIMA INJECTION 0.5GM (CEFOTAXIME SODIUM) 116

AC30800221 NICEWE INJ. 10MG/ML "N.K." (RANITIDINE HCL) 24.7

AC30803100 DITROPAN TABLETS 2.5MG (OXYBUTYNIN) 1.84

AC30837100 "ANRIGIN TABLETS 100MG (AMANTADINE HCL) ""H.S.""" 7.4

AC30838335 "KOTASON CREAM 0.5MG/G (CLOBETASOL) ""H.S.""" 28.6

AC30865100 LINDAC TABLETS 200MG (SULINDAC) "S.C." 2.03

AC30879100 APRESOLIN S.C. TABLETS 10MG (HYDRALAZINE) 1.5

AC30881100 ZADITEN TABLETS 1MG (KETOTIFEN) 1.75

AC30882100 PARLODEL TABLETS 2.5MG (BROMOCRIPTINE) 6.9

AC30883100 BRINERDIN S.C. TABLETS 3.2

AC30888100 TAGAWEI TABLETS 400MG "Y.S."(CIMETIDINE) 1.5

AC308881G0 TAGAWEI TABLETS 400MG "Y.S." (CIMETIDINE)(鋁箔/膠箔) 2

AC30889100 KOBAL CAPSULES 0.5MG "WEIDAR" (MECOBALAMIN) 1.76

AC308891G0 KOBAL CAPSULES 0.5MG "WEIDAR" (MECOBALAMIN)(鋁箔/膠箔) 2

AC30890100 ULSATE TABLETS 500MG (SUCRALFATE) "WEIDAR" 1.5

AC30894100 TOFRANIL S.C. TABLETS 25MG (IMIPRAMINE HYDROCHLORIDE) 1.76

AC308941G0 TOFRANIL S.C. TABLETS 25MG (IMIPRAMINE HYDROCHLORIDE)(鋁箔/膠

箔)

2

AC30896100 "EUMI TABLETS 100MG ""H.S."" (TRIMETHOPRIM)" 1.5

AC308961G0 "EUMI TABLETS 100MG ""H.S."" (TRIMETHOPRIM)(鋁箔/膠箔)" 2

AC30916100 "KOTOGEN TABLETS 50MG ""H.S."" (BENZBROMARONE)" 1.5

AC30936100 FOSELIN TABLETS 10MG (DOMPERIDONE) 1.5

AC30940100 YUNGFU CAPSULES 30MG (TIMEPIDIUM BROMIDE) 2.94

AC30945100 HYDERGINE TABLETS 1.5MG (DIHYDROERGOTOXINE MESYLATE) 1.54

AC309451G0 HYDERGINE TABLETS 1.5MG (DIHYDROERGOTOXINE MESYLATE)(鋁箔/膠

箔)

2

AC30964100 SHOREN ENTERIC FILM COATED TABLETS 25MG"T.F." 1.5

AC30967100 SHOREN ENTERIC FILM COATED TABLETS 50MG "T.F." 1.5

AC309701G0 MEZIDE TABLETS 80MG "M.S."(GLICLAZIDE) (鋁箔/膠箔) 2

AC30975100 DOMETON TABLET 100MG "N.K." (SULINDAC) 2.03

AC30984100 INFAXIL CAPSULES 500MG (CEPHADROXIL) 2.2

AC30987100 "REBAMOL TABLETS 500MG (METHOCARBAMOL) "" WINSTON """ 1.5

AC30989329 "RICH CREAM 20MG/G (KETOCONAZOLE) ""WINSTON""" 14.2

AC30989335 "RICH CREAM 20MG/G (KETOCONAZOLE) ""WINSTON""" 38.5

AC30994151 AMTADINE SYRUP 10MG/ML(AMANTADINE) 32.5

AC30994155 AMTADINE SYRUP 10MG/ML(AMANTADINE) 103

AC30996100 KETIMIN TABLETS 1MG (KETOTIFEN) 1.75

AC30997100 VENTON TAB. 50MG"LITA"(DICLOFENAC) 1.5

AC31000100 INFLAMNIL TABLET 300MG (TRIMETHOPRIM) 2.05

AC31003151 COUGH MIXTURE A SOLUTION "CHI SHENG" 25

AC31003159 COUGH MIXTURE A SOLUTION "CHI SHENG" 25

AC31004151 COUGH MIXTURE B SYRUP 25

AC31004159 COUGH MIXTURE B SYRUP 27.2

AC31006100 TREPIN CAPSULES 250MG (TRANEXAMIC ACID) "Y.Y" 1.52

AC31008421 "ZENICORTINE OPHTHALMIC SUSPENSION ""WINSTON""" 38.8

AC31020100 UNIDAC F.C. TABLETS 200MG (SULINDAC)"UNION" 2.03

AC31036155 EA TEN ORAL SOLUTION (TRIHEXYPHENIDYL) 203

AC31049157 "COUGEL SYRUP ""H.S.""" 45.2

AC31050100 VIRACON TABLETS 100MG "Y.Y." (AMANTADINE) 7.4

AC31053100 HEADGEN TABLETS (DIHYDROERGOTOXINE MESYLATE) 1.54

124

Page 125: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC310531G0 HEADGEN TABLETS (DIHYDROERGOTOXINE MESYLATE) (鋁箔/膠箔) 2

AC31054100 ARRING TABLETS 0.25MG (TRIAZOLAM) 1.96

AC310541G0 ARRING TABLETS 0.25MG (TRIAZOLAM) (鋁箔/膠箔) 2

AC31058100 FLUFEN S.C. TABLETS 50MG (FLURBIPROFEN) "WEIDAR" 1.54

AC310581G0 FLUFEN S.C. TABLETS 50MG "WEIDAR" (FLURBIPROFEN)(鋁箔/膠箔) 2

AC31072100 UNIFRADINE CAPSULES 250MG (CEPHRADINE) "UNION" 1.93

AC310721G0 UNIFRADINE CAPSULES 250 MG (CEPHRADINE)(鋁箔/膠箔) 2

AC31073100 UNIFRADINE CAPSULES 500MG (CEPHRADINE) "UNION" 3.13

AC31095100 KIDOLEX CAPSULES 500MG (CEPHALEXIN) "KINGDOM" 1.82

AC31101100 "LOLIAN CAPSULES 150MG ""H.S."" (SILYBIN)" 1.64

AC311011G0 "LOLIAN CAPSULES 150MG ""H.S."" (SILYBIN)(鋁箔/膠箔)" 2

AC31119100 AMANTADINE SULFATE CAPSULES 100MG "HCT" 7.4

AC31154212 HYCOMB INJECTION 10MG (HYDROXOCOBALAMIN) 15.5

AC31165100 ATADIN CAP. 100MG "STANDARD" (AMANTADINE) 7.4

AC31168100 ISORMOL TABLET 20MG (ISOSORBIDE) "TAIWAN TUNG YANG" 1.61

AC311681G0 ISORMOL TABLET 20MG (ISOSORBIDE) "TAIWAN TUNG YANG"(?T??/????) 2

AC31171100 CLINDAMYCIN CAPSULES 150MG "KINGDOM" 1.5

AC31185100 DIFLUINE F.C. TABLETS 250MG "CHINTENG" (DIFLUNISAL) 6.9

AC31186100 DEANGER TABLETS 10MG "S.C."(TRIFLUOPERAZINE) 2.34

AC31189100 TRIMCORT TABLETS 100MG (TRIMETHOPRIM) "YUNG SHIN" 1.5

AC31190100 LICHEIN CAPSULES 0.5MG (MECOBALAMIN) "CHINTENG" 1.76

AC311901G0 LICHEIN CAPSULES 0.5MG (MECOBALAMIN) "CHINTENG")(鋁箔/膠箔) 2

AC31193151 SUNSO SYRUP 25

AC31193157 SUNSO SYRUP 25

AC31194100 RANIDINE F.C.TAB. "S.T." (RANITIDINE) 1.85

AC311941G0 RANIDINE F.C.TAB. (RANITIDINE) "S.T."(鋁箔/膠箔) 2

AC31213209 LOFATIN INJECTION 1000MG "GENTLE"(CEFOXITIN) 0

AC31223100 ATENO F.C. TABLETS 100MG (ATENOLOL) "CHINTENG" 1.6

AC312231G0 ATENO F.C. TABLETS 100MG (ATENOLOL) "CHINTENG"(鋁箔/膠箔) 2

AC31225100 ACERINE S.C. TABLETS 5MG (NICERGOLINE) "WEIDAR" 3.45

AC31226100 LATOL F.C.TABLET "STANDARD" 200MG (LABETALOL) 3.24

AC31228100 EFOSIN S.C. TABLETS 50MG "KOJAR" (DIPYRIDAMOLE) 1.69

AC312281G0 EFOSIN S.C. TABLETS 50MG (DIPYRIDAMOLE) "KOJAR" 2

AC31259100 UNITADIN CAPSULES 100MG (AMANTADINE) "UNION" 7.4

AC31260100 HODRIN TABLETS 1.5MG (DIHYDROERGOTOXINE MESYLATE) "WEIDAR" 1.54

AC312601G0 HODRIN TABLETS 1.5MG "WEIDAR"(DIHYDROERGOTOXINE MESYLATE)(鋁箔

/膠箔)

2

AC31280100 DANOL CAPSULES 200MG "WEIDAR" (DANAZOL) 11.4

AC31282100 MARION TABLETS 10MG "LITA" 6.4

AC31284100 CHAZE TABLETS 200MG "CHINTENG" (BEZAFIBRATE) 6.5

AC31292100 SANWELL F.C. TABLETS 200MG (CIMETIDINE) "KOJAR" 1.5

AC312921G0 SANWELL F.C. TABLETS 200MG "KOJAR" (CIMETIDINE) 鋁箔/膠箔 2

AC31302319 MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE) "WINSTON" 7.3

AC31302321 MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE) "WINSTON" 15.8

AC31302323 MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE) "WINSTON" 15.8

AC31302324 MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE) "WINSTON" 15.8

AC31302329 MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE) "WINSTON" 17.7

AC31302335 MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE) "WINSTON" 28.6

AC31302338 MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE) "WINSTON" 47

AC31302340 MULTIGIVE CREAM 0.5MG/G (CLOBETASOL PROPIONATE) "WINSTON" 88

125

Page 126: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC31303319 "MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""

7.3

AC31303321 "MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""

15.8

AC31303324 "MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""

15.8

AC31303329 "MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""

17.7

AC31303335 "MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""

28.6

AC31303338 "MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""

47

AC31303340 "MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""

88

AC31303355 "MULTIGIVE OINTMENT 0.5MG/G (CLOBETASOL PROPIONATE)

""WINSTON"""

195

AC31307100 "DECOLD CAPSULES 100MG (AMANTADINE) wR.T.""" 7.4

AC31308100 "TICOQUER TABLETS 100MG (MEBENDANOLE) ""R.T.""" 1.51

AC31309100 IMIN TABLETS YUNG "SHIN"(METHISOPRINOL) 5.9

AC31317421 ACOLON ORABASE 1MG/G (DEXAMETHASONE) "MEIDER" 55

AC31321335 SLIKA A CREAM "MEIDER" 47.3

AC313213AH SLIKA A CREAM "MEIDER" 24.5

AC31349100 UNEW F.C. TABLETS 2.5MG "CHINTENG"(BROMOCRIPTINE) 6.9

AC31368212 CLINCIN INJ. "N.K." 150MG/ML (CLINDAMYCIN) 15.8

AC31446324 "CLOTASOL CREAM 0.5MG/GM (CLOBETASOL) ""R.T""" 15.8

AC31446329 "CLOTASOL CREAM 0.5MG/GM (CLOBETASOL) ""R.T""" 17.7

AC31446335 "CLOTASOL CREAM 0.5MG/GM""R.T"" (CLOBETASOL)" 28.6

AC31446338 "CLOTASOL CREAM 0.5MG/GM""R.T"" (CLOBETASOL)" 47

AC31446340 "CLOTASOL CREAM 0.5MG/GM""R.T"" (CLOBETASOL)" 88

AC31450100 HALOPIN TABLETS 5MG "JOHNSON" (HALOPERIDOL) 2.5

AC31451100 BENZHEXOL TABLETS 5MG "JOHNSON" (TRIHEXYPHENIDYL HCL) 1.5

AC314511G0 BENZHEXOL TABLETS 5MG "JOHNSON" (TRIHEXYPHENIDYL HCL)(84粒) 2

AC31476100 ETUMINE TABLETS 40MG (CLOTIAPINE) 6.8

AC31481100 SILIRIN CAPSULES 150MG (SILYMARIR) "CHINTENG" 1.64

AC314811G0 SILIRIN CAPSULES 150MG "CHINTENG" (SILYMARIR)(鋁箔/膠箔) 2

AC31482100 SEROMIN S.C. TABLETS 10MG (NICERGOLIN) "Y.S." 6.4

AC31489100 "ANKUMIN TABLETS 6MG (BETAHISTINE) ""R.T.""" 1.5

AC31493100 "CHIPHONE TABLETS 100MG (BENZBROMARONE) ""R.T.""" 2.88

AC31505100 HALIN TABLETS 5MG "YU SHENG" (HALOPERIDOL) 2.5

AC31508209 "PIROCAN INJECTION 20MG (PIROXICAM) ""SIU GUAN""" 22.4

AC31508212 "PIROCAN INJECTION 20MG (PIROXICAM) ""SIU GUAN""" 22.4

AC31515100 "ELININ TABLETS 20MG (OXAZOLAM) ""R.T.""" 2.04

AC31521221 PENTAL INJECTION 20MG/ML "LITA" 54

AC31525100 "LILONTON CAPSULE 400MG (PIRACETAM) ""SIU GUAN""" 1.5

AC31526221 "LILONTON INJECTION 200MG (PIRACETAM) ""SIU GUAN""" 15

AC31526229 "LILONTON INJECTION 200MG (PIRACETAM) ""SIU GUAN""" 33.7

AC31534100 STABLE (HYDRALAZINE) TABLETS 25MG "VPP" 1.61

AC315341G0 STABLE (HYDRALAZINE) TABLETS 25MG "VPP"(鋁箔/膠箔) 2

AC31535100 ULSAFE F.C.TABLETS 150MG(RANITIDINE HYDROCHLORIDE) 1.85

AC31536100 PICOLIN F.C. TABLETS 250MG "KOJAR" (PIPEMIDIC ACID) 5.3

AC31537100 SINGEN F.C.TABLETS 40MG "KOJAR" (VERAPAMIL) 1.66

AC315371G0 SINGEN F.C.TABLETS 40MG (VERAPAMIL) "KOJAR"(鋁箔/膠箔) 2

AC31540100 STABLE (HYDRALAZINE) TABLETS 10MG "VPP" 1.5

126

Page 127: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC315401G0 STABLE (HYDRALAZINE) TABLETS 10MG "VPP" (90粒/瓶裝及鋁箔/膠箔) 2

AC31544100 KODAZOL CAPSULES 200MG "KOJAR" (DANAZOL) 11.4

AC31592100 MEWELLIN F.C. TABLETS 10MG "KOJAR"(DOMPERIDONE) 1.5

AC315921G0 MEWELLIN F.C. TABLETS 10MG (DOMPERIDONE) "KOJAR"(鋁箔/膠箔) 2

AC31593100 FURNAZM TABLETS 5MG "CHINTENG"(FLUNARIZINE) 1.62

AC315931G0 FURNAZM TABLETS 5MG "CHINTENG"(FLUNARIZINE) (鋁箔/膠箔) 2

AC31609100 LIGISIN F.C. TABLETS 200MG "KOJAR" (BEZAFIBRATE) 6.5

AC31614423 STACORT DENTAL PASTE 1MG/G "STANDARD" (TRIAMCINOLONE) 42.7

AC31628277 AMINOLEBAN INJECTION 220

AC31630209 CETAME FOR INJECTION "SWISS" (CEFOTAXIME) 166

AC31630212 CETAME FOR INJECTION "SWISS" (CEFOTAXIME) 542

AC31630265 CETAME FOR INJECTION "SWISS" (CEFOTAXIME) 98

AC31630277 CETAME FOR INJECTION "SWISS" (CEFOTAXIME) 116

AC31641100 FEVILON TABLETS 200MG "LITA" (BEZAFIBRATE) 6.5

AC31651421 SCORO ORABASE 1MG/G (TRIAMCINOLONE) "MEIDER" 28.4

AC31651423 SCORO ORABASE 1MG/G (TRIAMCINOLONE) "MEIDER" 42.7

AC31656100 WEISU TABLETS 400MG (CIMETIDINE) "S.D." 1.5

AC316561G0 WEISU TABLETS 400MG (CIMETIDINE) "S.D."(鋁箔/膠箔) 2

AC31658100 FORKNOW TABLETS 10MG (FLUNARIZINE) "YUNG SHIN" 4.02

AC31659100 BUTIN TABLETS 2.5MG (BROMOCRIPTINE) 6.9

AC31660100 ANTISSVES CAPSULES "CHINTENG" 1.5

AC316601G0 ANTISSVES CAPSULES "CHINTENG"(鋁箔/膠箔) 2

AC31662100 AXOL TABLETS 30MG (AMBROXOL) "YUNG SHIN" 1.5

AC31666100 CATIN TABLETS 100MG "KOJAR" (TRIMETHOPRIM) 1.5

AC316661G0 CATIN TABLETS 100MG (TRIMETHOPRIM) "KOJAR"(鋁箔/膠箔) 2

AC31667100 NIFU CAPSULES 250MG "KOJAR" (NIFLUMIC ACID) 2.57

AC31676100 COMPESOLON TABLETS 5MG "PINE LAWER" (PREDNISOLONE) 1.5

AC316761G0 COMPESOLON TABLETS 5MG "PINE LAWER" (PREDNISOLONE) (鋁箔/膠箔) 2

AC31690100 FETISMA TABLETS 2.5MG "KOJAR" (FENOTEROL) 1.5

AC316901G0 FETISMA TABLETS 2.5MG (FENOTEROL) "KOJAR"(鋁箔/膠箔) 2

AC31695209 BUFENCON INJECTION 19.5

AC31695221 BUFENCON INJECTION 19.5

AC31753100 B.M.O. TABLETS 1.5

AC31757157 B.M.O LIQUID 27.9

AC31770100 LIDONIN TABLETS 10MG (DOMPERIDONE) "S.D." 1.5

AC31778100 PROXEN TABLETS 375MG (NAPROXEN) "TAIWAN TANABE" 2.32

AC31796100 OXOLA TABLETS 100MG "KOJAR" (OXOLAMINE CITRATE) 1.5

AC317961G0 OXOLA TABLETS 100MG "KOJAR" (OXOLAMINE CITRATE) (鋁箔/膠箔) 2

AC31801100 KETOSMA CAPSULES 1MG "KOJAR" (KETOTIFEN) 1.75

AC318011G0 KETOSMA CAPSULES 1MG "KOJAR" (KETOTIFEN)(鋁箔/膠箔) 2

AC31809100 CATON TAB "C.H." 3.6

AC31823100 BENZSIN TABLETS 50MG "KOJAR" (BENZBROMARONE) 1.5

AC318231G0 BENZSIN TABLETS 50MG (BENZBROMARONE) "KOJAR" (鋁箔/膠箔) 2

AC31824100 CIMEWELL F.C. TABLETS 400MG "KOJAR" (CIMETIDINE) 1.5

AC318241G0 CIMEWELL F.C. TABLETS 400MG "KOJAR" (CIMETIDINE) (鋁箔/膠箔) 2

AC31825100 BECASONE TABLETS 0.6MG "KOJAR" (BETAMETHASONE) 1.5

AC31835289 CEFLOUR INJECTION 0.75GM "YUNG SHIN" (CEFUROXIME) 23.5

AC31853100 GENXATE F.C. TABLETS 200MG "Y.S." (GLAVOXATE) 4.84

AC31882209 U-SAVE-A FOR INJECTION (CEPHRADINE) 26.1

AC31882277 U-SAVE-A FOR INJECTION (CEPHRADINE) 25.8

127

Page 128: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC31894100 ASTHAN TABLETS 1MG (KETOTIFEN) "P.L" 1.75

AC318941G0 ASTHAN TABLETS 1MG (KETOTIFEN) "P.L"(鋁箔/膠箔) 2

AC31895100 MELLERZIN S.C. TABLETS 50MG (THIORIDAZINE) "P.L" 2.31

AC31906100 BARLOLIN CAPSULE 2.5MG "SWISS" (BROMOCRIPTINE) 6.9

AC31907100 "NEOBA CAPSULES 500MCG (METHYL COBALAMINE) ""S.Y.""" 1.76

AC31912100 AMBROXOL TABLETS 30MG "CHINTENG" 1.5

AC319121G0 AMBROXOL TABLETS 30MG "CHINTENG"(鋁箔/膠箔) 2

AC31938157 COMPOUND GLYCYRRHIZA MIXTURE SOL. "WITH OPIUM " "CENTER" 27.9

AC31938163 COMPOUND GLYCYRRHIZA MIXTURE SOLUTION (WITH OPIUM) "CENTER" 28.7

AC31952100 FUNASIN CAPSULES 5MG "KOJAR" (FLUNARIZINE) 1.62

AC319521G0 FUNASIN CAPSULES 5MG "KOJAR" (FLUNARIZINE)(鋁箔/膠箔) 2

AC31953100 SULISOU CAPSULES 250MG "KOJAR" (CHENODEOXYCHOLIC ACID) 8.7

AC31954100 BEZIN TABLETS 200MG (BEZAFIBRATE) "S.D." 6.5

AC31976500 STAZOL VAG. SUPP. 150MG "STANDARD" (ECONAZOLE) 12

AC31977100 FLUOXYMESTERONE CAPSULES 5MG "C.H." (FLUOXYMESTERONE) 2.39

AC31983238 "DITROSE INJECTION 5% (DEXTROSE) ""S.Y.""" 15

AC31988100 MOTURIN TALBETS 10MG "Y.S." (DOMPERIDONE) 1.5

AC31989100 MELZIN S.C. TALBETS 25MG "Y.S." (THIORIDAZINE) 1.5

AC31991100 UTELAX TABLETS 10MG (RITODRINE HYDROCHLORIDE) "WEIDAR" 5.6

AC31993100 BESUTIN TABLETS 6MG "Y.S." (BETAHISTINE) 1.5

AC31999100 MUCOBRON TABLETS 30MG "WEIDAR" (AMBROXOL HYDROCHLORIDE) 1.5

AC319991G0 MUCOBRON TABLETS 30MG "WEIDAR" (AMBROXOL HYDROCHLORIDE)(鋁箔/

膠箔)

2

AC32000100 PENTOSIN E.S.C.TABLETS 100MG "KOJAR" (PENTOXIFYLLINE) 1.57

AC320001G0 PENTOSIN E.S.C.TABLETS 100MG "KOJAR"(PENTOXIFYLLINE)(鋁箔/膠

箔)

2

AC32002100 MEBLIN TABLETS 50MG"KOJAR"(MEBHYDROLIN) 1.5

AC320021G0 MEBLIN TABLETS 50MG "KOJAR"(MEBHYDROLIN)(鋁箔/膠箔) 2

AC32003100 NAPOSIN TABLETS 250MG "KOJAR" (NAPROXEN) 1.5

AC320031G0 NAPOSIN TABLETS 250MG "KOJAR" (NAPROXEN)(鋁箔/膠箔) 2

AC32007100 ETOSCOL TABLETS 0.5MG (HEXOPRENALINE) 1.55

AC32014100 EUZIP TABLETS 50MG (NICAMETATE) 1.5

AC320141G0 EUZIP TABLETS 50MG (NICAMETATE)(鋁箔/膠箔) 2

AC32028100 VITAMIN B12 TALBETS 1MG "JOHNSON" 1.5

AC32029100 FLURAZIN F.C. TABLETS 5MG "JOHNSON" (TRIFLUOPERAZINE) 1.5

AC320291G0 FLURAZIN F.C. TALBETS 5MG "JOHNSON" (TRIFLUOPERAZINE)(鋁箔/膠

箔)

2

AC32042100 TRIALAM TABLETS 0.25MG (TRIAZOLAM) "WEIDER" 1.96

AC32046100 DIPYRIDAMOLE S.C. TABLETS 75MG "YUNG SHIN" 1.83

AC320461G0 DIPYRIDAMOLE S.C. TABLETS 75MG "YUNG SHIN"(鋁箔/膠箔) 2

AC32047100 YUREN E.F.C.TABLETS 50MG "Y.S."(DICLOFENAC SODIUM) 1.5

AC32051321 BETAMETHASONE OINTMENT 0.5MG/GM "SINPHAR" 19.9

AC32051329 BETAMETHASONE OINTMENT 0.5MG/GM "SINPHAR" 19.9

AC32053100 PENTAL S.C.TABLETS 100MG (PENTOXIFYLLINE) "JOHNSON" 1.57

AC320531G0 PENTAL S.C.TABLETS 100MG (PENTOXIFYLLINE) "JOHNSON"(84粒) 2

AC320531GA PENTAL S.C.TABLETS 100MG "JOHNSON" (PENTOXIFYLLINE)(鋁箔/膠箔) 2

AC32054100 LICOS TABLETS 50MG (PIPERIDOLATE) "MEIDER" 2.02

AC32070317 EYME CREAM "CHINTENG" 11.7

AC32070321 EYME CREAM "CHINTENG" 11.7

AC32070329 EYME CREAM "CHINTENG" 21.8

AC32070330 EYME CREAM "CHINTENG" 25.6

AC32070335 EYME CREAM "CHINTENG" 36.2

AC32070338 EYME CREAM "CHINTENG" 36.2

128

Page 129: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC32070355 EYME CREAM "CHINTENG" 135

AC32105329 "FUCON CREAM ""S.Y.""" 21.8

AC32105335 "FUCON CREAM ""S.Y.""" 36.2

AC32112100 COLIMAN S.C. TABLETS 100MG (CHLORPROMAZINE) "P.L." 1.54

AC32114100 BENZBROMARONE TABLETS 50MG "CHIN TENG" 1.5

AC321141G0 BONZBROMARONE TABLETS 50MG "CHIN TENG")(鋁箔/膠箔) 2

AC32117100 APOLIN TABLETS 25MG "T.S." (HYDRALAZINE) 1.61

AC321171G0 APOLIN TABLETS 25MG "Y.S."(HYDRALAZINE)(鋁箔/膠箔) 2

AC32118212 EUKACIN INJECTION 250MG/ML (AMIKACIN) "U-LIANG" 52

AC32118229 EUKACIN INJECTION 250MG/ML (AMIKACIN) "U-LIANG" 210

AC32122255 SATA INJECTION FOR INTRAVENOUS INFUSION 5MG/ML "S.T."

(TINIDAZOLE)

133

AC32137100 TIDACT CAPSULES 150MG (CLINDAMYCIN) 1.5

AC321371G0 TIDACT CAPSULES 150MG (CLINDAMYCIN)(鋁箔/膠箔) 2

AC32171221 AGGLUTEX INJECTION 1000U./ML (HEPARIN SODIUM) 38.3

AC32171299 AGGLUTEX INJECTION 1000U. (HEPARIN SODIUM) 2.88

AC32172221 AGGLUTEX INJECTION 5000U/ML (HEPARIN SODIUM) 30.6

AC32172240 AGGLUTEX INJECTION 5000U./ML (HEPARIN SODIUM) 92

AC32172248 AGGLUTEX INJECTION 5000U./ML (HEPARIN SODIUM) 170

AC32172299 AGGLUTEX INJECTION 5000IU/ML(HEPARIN SODIUM) 2.88

AC32181335 C.P.P. CREAM 500MCG/G (CLOBETASOL) "SWISS" 28.6

AC32181338 C.P.P. CREAM 500MCG/G (CLOBETASOL) "SWISS" 47

AC32181340 C.P.P. CREAM 500MCG/G (CLOBETASOL) "SWISS" 88

AC32182100 DANAZOL CAPSULES 200MG "SWISS"(DANAZOL) 11.4

AC32217321 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 19.9

AC32217323 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 19.9

AC32217329 SHIN-SHIN CREAM"SWISS" 0.5MG (BETAMETHASONE) 19.9

AC32217330 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 19.9

AC32217335 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 31.9

AC32217343 SHIN-SHIN CREAM "SWISS"0.5MG (BETAMETHASONE) 31.9

AC322501G0 SUPERTIDINE F.C. TABLETS 20MG "VPP" (FAMOTIDINE)(鋁箔/膠箔) 2

AC32251212 "AMIKACIN INJECTION 250MG/ML ""TAI YU""" 52

AC32251229 "AMIKACIN INJECTION 250MG/ML ""TAI YU""" 210

AC32263212 GENTAMYCIN INJECTION 40MG/ML "S.Y." (GENTAMYCIN) 15

AC32263229 "GENTAMYCIN INJECTION 40MG/ML (GENTAMYCIN)""S.Y.""" 16.9

AC32263238 "GENTAMYCIN INJECTION 40MG/ML ""S.Y."" (GENTAMYCIN)" 61

AC32264321 "CLOBETA CREAM 500MCG ""S.Y."" (CLOBETASOL 17-PROPIONATE)" 15.8

AC32264324 "Clobeta Cream 500mcg""S.Y.""(Clobetasol 17-Propionate)" 15.8

AC32264329 "CLOBETA CREAM 500MCG ""S.Y."" (CLOBETASOL 17-PROPIONATE)" 17.7

AC32264335 "CLOBETA CREAM 500MCG ""S.Y."" (CLOBETASOL 17-PROPIONATE)" 28.6

AC32264338 "CLOBETA CREAM 500MCG ""S.Y."" (CLOBETASOL 17-PROPIONATE)" 47

AC32264340 CLOBETA CREAM 500MCG (CLOBETASOL 17-PROPIONATE) "S.Y." 88

AC32275100 CEPORIN TABLETS 25MG (CAPTOPRIL) "S.T." 1.57

AC322751G0 CEPORIN TABLETS 25MG (CAPTOPRIL) "S.T."(鋁箔/膠箔) 2

AC32278100 CLOZENE CAPSULES 7.5MG (CLORAZEPATE) "WEIDAR" 2.93

AC32282421 CHLORAMPHENICOL OPHTHALMIC SOLUTION 0.25% "KINGDOM" 12

AC32282429 CHLORAMPHENICOL OPHTHALMIC SOLUTION 0.25% "KINGDOM" 14.1

AC32283429 PILOCARPINE OPHTHALMIC SOLUTION 2% "KINGDOM" 37.7

AC32283435 PILOCARPINE OPHTHALMIC SOLUTION 2% "KINGDOM" 83

AC32284429 PILOCARPINE OPHTHALMIC SOLUTION 1% "KINGDOM" 27.7

129

Page 130: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC32284435 PILOCARPINE OPHTHALMIC SOLUTION 1% "KINGDOM" 60

AC32286100 ANTIASTH SLOW RELEASE TABLETS 225MG (AMINOPHYLLINE) 3.22

AC32288321 "FUTUSOA CREAM ""S.Y.""" 16.1

AC32288329 "FUTUSOA CREAM ""S.Y.""" 16.1

AC32288338 "FUTUSOA CREAM ""S.Y.""" 19.6

AC32311100 DANALOL CAPSULE 200MG (DANAZOL) "PURZER" 11.4

AC32313100 REFEXIN CAPSULE 500MG "PURZER" (CEPHALEXIN) 1.82

AC323131G0 REFEXIN CAPSULE 500MG "PURZER" (CEPHALEXIN)(鋁箔/膠箔) 2

AC32314100 DUOCER F.C TABLET 400MG (CIMETIDINE) "PURZER" 1.5

AC323141G0 DUOCER F.C TABLET 400MG (CIMETIDINE) "PURZER"(鋁箔/膠箔) 2

AC32317209 SEZOLIN FOR INJECTION "PURZER" (CEFAZOLIN) 15.7

AC32324100 RECEF CAPSULE 500MG "PURZER"(CEPHRADINE) 3.13

AC32327100 LONINE CAPSULES 200MG (ETODOLAC) 4.52

AC32332100 TIARAM TABLETS 100MG "H.H." (TIARAMIDE) 1.5

AC32334209 RECEF-A FOR INJECTION (CEPHRADINE) 26.1

AC32334277 RECEF-A FOR INJECTION (CEPHRADINE) 25.8

AC32336100 HOMOMIN TABLETS 10MG "Y.Y" (HOMOCHLORCYCLIZINE) 1.5

AC323361G0 HOMOMIN TABLETS 10MG "Y.Y" (HOMOCHLORCYCLIZINE)(鋁箔/膠箔) 2

AC32340100 NIXO TABLETS 5MG (NICERGOLINE) "H.H." 3.45

AC32350221 TRANDATE INJECTION 5MG/ML (LABETALOL) 83

AC32353100 NICAN F.C. TABLETS 50MG (NICAMETATE) "CHIN TENG" 1.5

AC323531G0 NICAN F.C. TABLETS 50MG "CHIN TENG" (NICAMETATE)(鋁箔/膠箔) 2

AC32358100 DOMPER TABLETS 10MG (DOMPERIDONE) 1.5

AC32361100 UROL TABLETS 200MG "H.H" (FLAVOXATE) 4.84

AC32363100 "COPU TABLETS 50MG ""WINSTON"" (CARBENOXOLONE)" 2.48

AC32367100 WEICHILIN TABLETS 150MG (RANITIDINE HYDROCHLORIDE) 1.85

AC323671G0 WEICHILIN TABLETS 150MG (鋁箔/膠箔) 2

AC32369209 MECOBAL INJECTION 500MCG/ML (MECOBALAMIN) 0

AC32369212 MECOBAL INJECTION 500MCG/ML (MECOBALAMIN) 0

AC32372100 CONSLIFE SUGAR COATED TABLETS 1.5

AC323721G0 CONSLIFE SUGAR COATED TABLETS(鋁箔/膠箔) 2

AC32378500 FEMSTAT VAGINAL SUPPOSITORY 100MG (BUTOCONAZOLE) 26

AC32380100 TERLAM CAPSULE 10MG 1.62

AC32385321 FULIAN CREAM "MEIDER" 22.1

AC32385329 FULIAN CREAM "MEIDER" 53

AC32385335 FULIAN CREAM "MEIDER" 87

AC32413100 MEFEN F.C TABLETS 500MG (MEFENAMIC ACID) "CHINTENG" 1.5

AC324131G0 MEFEN F.C TABLETS 500MG (MEFENAMIC ACID) "CHINTENG" (鋁箔/膠

箔)

2

AC32437100 NORMABRAIN F.C. TABLETS 800MG (PIRACETAM) 2.55

AC32524100 MOKOTAM TABLETS 30MG "Y.S."(AMBROXOL) 1.5

AC32528151 TRIMERIN SYRUP 28

AC32530100 SOLANTIN S.C. TABLETS 25MG (DIPYRIDAMOLE) 0.48

AC325301G0 SOLANTIN S.C. TABLETS 25MG (DIPYRIDAMOLE)(鋁箔/膠箔) 0.48

AC32535100 TRIMERIN TABLETS 1.5

AC32561100 URINOL TABLETS 200MG (FLAVOXATE) "ROYAL" 4.84

AC32562321 CLEOSOL CREAM 5GM 15.8

AC32562324 "CLEOSOL CREAM 0.5MG/GM ""GCPC""" 15.8

AC32562329 "CLEOSOL CREAM 0.5MG/GM (CLOBETASOL) ""GCPC""" 17.7

AC32562335 CLEOSOL CREAM 0.5MG/GM (CLOBETASOL) "GCPC" 28.6

AC32562338 "CLEOSOL CREAM 0.5MG/GM ""GCPC"" (CLOBETASOL0" 47

AC32562340 "CLEOSOL CREAM 0.5MG/GM (CLOBETASOL) ""GCPC""" 88

130

Page 131: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC32571338 SILIVERZINE CREAM 10MG/GM (SULFADIAZINE SILIVER)"SINP HAR" 33.2

AC32571348 SILIVERZINE CREAM 10MG/GM (SULFADIAZINE SILVER)"SINP HAR" 44.3

AC32571363 SILIVERZINE CREAM 10MG/GM (SULFADIAZINE SILVER)"SINP HAR" 150

AC32571365 SILIVERZINE CREAM 10MG/GM (SULFADIAZINE SILVER)"SINP HAR" 151

AC32571371 "SINPHAR" SILVERZINE CREAM 10MG/GM (SULFADIAZINE SILVER) 286

AC32571372 "SINPHAR" SILIVERZINE CREAM 10MG/GM (SULFADIAZINE SILVER) 286

AC32571377 "SINPHAR" SILIVERZINE CREAM 10MG/GM (SULFADIAZINE SILVER) 519

AC32579100 DEBLEEDING CAPSULES 250MG "C.L" 1.52

AC32584100 BININ-U TABLETS 5MG (HALOPERIDOL) 2.5

AC32601335 MYCOCIN CREAM 47.3

AC32619100 NIDOLIUM TABLETS 10MG (DOMPERIDONE) "SINPHAR" 1.5

AC326191G0 NIDOLIUM TABLETS 10MG (DOMPERIDONE) "SINPHAR"(鋁箔/膠箔) 2

AC32625151 COSILY LIQUID 650MG/ML (LACTULOSE) "MEIDER" 25.7

AC32625166 COSILY LIQUID 650MG/ML "MEIDER" (LACTULOSE) 164

AC32631100 "CIMETIDINE TABLETS 400MG ""R.T.""" 1.5

AC32632100 SPINAX TABLETS 10.0MG "WEIDAR" (BACLOFEN) 1.5

AC326321G0 SPINAX TABLETS 10.0MG "WEIDAR" (BACLOFEN) (鋁箔/膠箔) 2

AC32640212 TIDACT INJECTION 150MG/ML (CLINDAMYCIN) 15.8

AC32642100 "GIKO FILM-COATED TABLETS 9.6MG

(GYNKGOFLAVONGLYCOSIDE)""H.S."""

2.24

AC32649100 "SWEGA TABLETS 400MG (CIMETIDINE) ""H.S.""" 1.5

AC326491G0 "SWEGA TABLETS 400MG ""H.S.""(CIMETIDINE) (鋁箔/膠箔)" 2

AC32651100 "KETIFEN TABLETS 1MG (KETOTIFEN) ""H.S.""" 1.75

AC32684321 VIRLESS CREAM 5% 46.6

AC32704221 DOPAMIN (DOPAMINE) INJECTION 40MG/ML "VPP" 25.8

AC32706100 CAPTOPRI TABLETS 25MG (CAPTOPRIL) 1.57

AC32710100 "MECON TABLETS 30MG (DEXTROMETHORPHAN) ""H.S.""" 1.5

AC32711100 CAPTOPRI TABLETS 12.5MG (CAPTOPRIL) 1.57

AC32716100 DOMPERAN TABLETS 10MG "SWISS" (DOMPERIDONE) 1.5

AC32723100 PAPIROR E.C. TABLETS 100MG (PENTOXYFYLLINE) "KYORIN" 1.57

AC327231G0 PAPIROR E.C. TABLETS 100MG (PENTOXYFYLLINE) "KYORIN"(鋁箔/膠

箔)

2

AC32729100 SHERY E.C. TABLETS 100MG "H.S." (PENTOXIFYLLINE) 1.57

AC327291G0 SHERY E.C. TABLETS 100MG "H.S." (PENTOXIFYLLINE)(鋁箔/膠箔) 2

AC32785321 ACYCLOVIR CREAM 50MG/GM "U. CHU." 46.6

AC32800500 DICLOREN SUPPOSITORIES 12.5MG "WEIDAR" (DICLOFENAC) 5

AC32801100 ALAT CAPSULES 10MG (NIFEDIPINE) 2

AC32812321 CLOMOLD CREAM 0.5MG/GM"T.F." 15.8

AC32812338 CLOMOLD CREAM 0.5MG/GM 47

AC32815100 DEPRESS TABLETS "CHINTENG" 1.5

AC32816100 "NASCO TABLETS ""H.S.""" 1.5

AC328161G0 "NASCO TABLETS ""H.S.""(鋁箔/膠箔)" 2

AC32825100 MENTONG TABLETS "CHINTENG" 1.57

AC32828338 SIGEL CREAM 10MG/G "C.H." (SILVER SULFADIAZINE) 33.2

AC32831100 DESUMIDE TABLETS 100MG (TOLAZAMIDE) "H.S." 2.77

AC32833100 GEMD CAPSULES 300MG "YUNG SHIN" (GEMFIBROZIL) 1.52

AC328331G0 GEMD CAPSULES 300MG "YUNG SHIN"(GEMFIBROZIL) (鋁箔/膠箔) 2

AC32834100 MOLIN TABLETS 10MG (DOMPERIDONE)"T.F." 1.5

AC32851100 ADERNAN TABLETS 50MG (HYDRALAZINE) 1.61

AC32856329 WEICORT-N CREAM "WEIDAR" 37.9

AC32876100 HERBESSER TABLETS 60MG 2.93

AC32877100 "VOLEN E.C. TABLET 50MG (DICLOFENAC) ""WINSTON""" 1.5

AC32880100 AMBROXOL TABLETS 30MG "KOJAR" 1.5

131

Page 132: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC328801G0 AMBROXOL TABLETS 30MG "KOJAR"(鋁箔/膠箔) 2

AC32881321 E.F. CREAM 16.1

AC32881329 E.F. CREAM 24.5

AC32881330 E.F. CREAM 12GM 47.3

AC32881338 E.F. CREAM 20GM 60

AC32882321 SALIC OINTMENT 12.6

AC32882329 SALIC OINTMENT 25.5

AC32882335 SALIC OINTMENT 81

AC32882338 SALIC OINTMENT 81

AC32882340 SALIC OINTMENT 81

AC32882343 SALIC OINTMENT 81

AC32892500 MOLIN SUPPOSITORY 10MG "T.F." 5

AC32893100 ERYMYCIN FILM COATED TABLETS 500MG"T.F" 3.67

AC32917209 PIROCAM INJ. 20MG/ML (PIROXICAM) "N.K" 22.4

AC32917212 PIROCAM INJ. 20MG/ML (PIROXICAM) "N.K" 22.4

AC32918100 NICEWE FC TAB 300MG (RANITIDINE) "N.K." 5.3

AC32934151 LIKANCOUGH LIQUID 25

AC32934157 LIKANCOUGH LIQUID 25

AC32938323 CHEMIN OINTMENT 0.25%(DESOXIMETASONE)"H.S." 32.1

AC32938329 CHEMIN OINTMENT 0.25%(DESOXIMETASONE)"H.S." 73

AC32938338 CHEMIN OINTMENT 0.25%(DESOXIMETASONE)"H.S." 103

AC32942100 DEMIL TABLETS 2.5MG "KOJAR" (BROMOCRIPTINE) 6.9

AC32943100 "NIFAN CAPSULES 250MG (NIFLUMIC ACID) ""H.S.""" 2.57

AC32945100 "TUENSILIN TABLETS 2.5MG (FENOTEROL)""ROOT""" 1.5

AC32949100 "SUCROXINE TABLETS ""ROOT""" 1.5

AC32950100 "POUWEPIN TABLETS 200MG (CIMETIDINE)""ROOT""" 1.5

AC32951100 "COYENPIN TABLETS 25MG (DICLOFENAC)""ROOT""" 1.5

AC32952100 "PANMITIN TABLETS 100MG (TRIMETHOPRIM)""ROOT""" 1.5

AC32969100 "DEANTRAN TABLETS 1MG ""R.T.""" 1.75

AC32970100 SANTITEN TABLETS 1MG(KETOTIFEN)"S.D." 1.75

AC32985100 COLIBRATE TABLET 200MG 6.5

AC32988329 ECORT CREAM "WEIDAR" 21.8

AC32989209 MECOBAL INJECTION 0.5MG/ML"T.F" 15.5

AC32989221 MECOBAL INJECTION 0.5MG/ML"T.F" 15.5

AC33023100 "SULOWEILIN TABLETS ""ROOT"" 1.5

AC330231G0 "SULOWEILIN TABLETS ""ROOT""(鋁箔/膠箔)" 2

AC33048100 NAPTON S.R. TABLETS 750MG "B&F" (NAPROXEN) 4.51

AC330491G0 TALIPIN TABLET 30MG "SWISS" (AMBROXOL)(鋁箔/膠箔) 2

AC33052100 "ANCOUGH TABLETS 100MG (OXOLAMINE CITRATE)""ROOT""" 1.5

AC33063321 JINRIH CREAM 50MG/GM "CHINTENG"(ACYCLOVIR) 46.6

AC33074321 KENALON CREAM "T.F." 14.7

AC33079100 "PIROXICAM TABLETS 20MG ""H.S.""" 1.55

AC330791G0 "PIROXICAM TABLETS 20MG ""H.S.""(鋁箔/膠箔)" 2

AC33080100 PROTANON TABLETS 5MG "Y.S" (ALLYLESTRENOL) 2.95

AC33081100 KEFEN TABLETS 1MG "H.S" (KETOTIFEN) 1.75

AC330811G0 KEFEN TABLETS 1MG "H.S" (KETOTIFEN)(鋁箔/膠箔) 2

AC33082100 ULCERBAN TABLETS 500MG (SUCRALFATE) 1.5

AC33093277 METACIN FOR INJECTION (CEFMETAZOLE) 88

AC33098100 CIKETIN TABLETS 400MG (CIMETIDINE) "UNION" 1.5

AC33122100 DICLOFEN ENTERIC FILM COATING TABLETS 50MG "KOJAR"

(DICLOFENAC)

1.5

AC331221G0 DICLOFEN ENTERIC FILM COATING TABLETS 50MG "KOJAR"(

DICOLFENAC)(鋁箔/膠箔)

2

AC33125100 FUCOTIN F.C. TABLETS 200MG "KOJAR" (FLAVOXATE) 4.84

AC33140100 FREE S.C. TABLETS 1.5

132

Page 133: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC33149209 S-60 INJECTION (CEPHRADINE) 26.1

AC33149277 S-60 INJECTION (CEPHRADINE) 25.8

AC33157100 WEISUFU TABLETS "CHIN TENG" 1.5

AC331571G0 WEISUFU TABLETS "CHIN TENG" (鋁箔/膠箔) 2

AC33163100 CO-TRIZOL TABLETS "Y.C." 1.5

AC33170100 SHUAYAN TABLETS 0.5MG (DEXAMETHASONE)"Y.C." 1.5

AC33171100 ANSWET TABLETS 5MG (NITRAZEPAM) "Y.C." 1.5

AC33172100 HEITOMIN S.C. TABLETS "Y.C." 1.5

AC33175100 MENICON TABLETS 30MG (DEXTROMETHORPHAN)"Y.C." 1.5

AC33178100 MEZOLE TABLETS 100MG "Y.C." (MEBENDAZOLE) 1.51

AC33180100 SU KU TA TABLETS "Y.C." 1.5

AC33184100 PRITHMOW TABLETS 5MG (PREDNISOLONE)"Y.C." 1.5

AC33185100 TERICO-S .TABLETS 250MG (METRONIDAZOLE) "Y.C." 1.64

AC33187100 TRIAMCINOLONE TABLETS 4MG (TRIAMCINOLONE)"Y.C." 1.5

AC33190100 SONZIN TABLETS 250MG "Y.C." (CHLORZOXAZONE) 1.5

AC33194100 OROLISIN F.C. TABLETS "Y.C." 1.5

AC33196100 HOUNOW TABLETS 15MG (CINNARIZINE)"Y.C." 1.5

AC33197100 NALIDIXIC ACID TABLETS 500MG (NALIDIXIC ACID )"Y.C." 2.25

AC33201100 SEPHYLLINE TABLETS 100MG (PENTOXIFYLLINE) 1.57

AC33203100 YUETAN TABLETS 30MG (AMBROXOL)"S.D." 1.5

AC33204100 "AMBROXOL TABLETS 30MG ""R.T.""" 1.5

AC332041G0 "AMBROXOL TABLETS 30MG ""R.T.""(鋁箔/膠箔)" 2

AC33208100 "HEXOPAL TABLETS 100MG (PENTOXIPHYLLINE)""R.T""" 1.57

AC33220100 ACTIRIN CAPSULES 10MG "Y.C." (OXAZOLAM) 1.62

AC33223229 TRACE ELEMENT INJECTION "C.C.P.C" 95

AC33224100 DILTISSER TABLETS 30MG "C.C.C.P." (DILTIAZEM HYDROCHLORIDE) 0.95

AC332241G0 DILTISSER TABLETS 30MG "C.C.P." (DILTIAZEM

HYDROCHLORIDE)(?T??/????)

2

AC33225100 CEFSPAN CAPSULE 100MG (CEFIXIME) 5.5

AC33253329 E-FLOW CREAM "M.T." 21.8

AC33253335 E-FLOW CREAM "M.T." 36.2

AC33253338 E-FLOW CREAM "M.T." 36.2

AC33253355 E-FLOW CREAM "M.T." 135

AC33258321 BETAMAZOLE CREAM 5GM 22.1

AC33258329 BETAMAZOLE CREAM "GCPC" 53

AC33258335 BETAMAZOLE CREAM "GCPC" 87

AC33258338 BETAMAZOLE CREAM "GCPC" 87

AC33260221 "TRANEXAMIC ACID INJECTION 100MG/ML ""ASTAR""" 15

AC33285151 FUSOSHU SYRUP "M.T" 25

AC33288329 "FLUSIN CREAM 0.05% 10GM ""M.T""" 54

AC33304100 IBUPROFEN F.C. TABLETS 400MG "C.H." 1.5

AC33321212 NICEWE INJECTION 25MG/ML "N.K." (RANITIDINE HYDROCHLORIDE) 24.7

AC33376212 GENTAMYCIN INJECTION 140MG/ML "T.F" 16.9

AC33376229 GENTAMYCIN INJECTION 140MG/ML "T.F." 82

AC33377321 URESON CREAM 8.6

AC33377329 URESON CREAM 20.3

AC33377335 URESON CREAM 46.5

AC33377336 URESON CREAM 46.5

AC33382100 CLINDAMYCIN CAPSULES 150MG "T.F" 1.5

AC33387100 SURIN TABLETS 200MG "YU SHENG" (SULPIRIDE) 2.33

AC33390100 SOMILIN TABLETS 0.25MG (TRIAZOLAM)"KOJAR" 1.96

AC333901G0 SOMILIN TABLETS 0.25MG (TRIAZOLAM)"KOJAR" 2

AC33415100 AMBROXOL TABLETS 30MG "SINPHAR" 1.5

133

Page 134: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC334151G0 AMBROXOL TABLETS 30MG "SINPHAR"(鋁箔/膠箔) 2

AC33425266 SUNNYTOL INFUSION 20% "N.K" (MANNITOL) 39.4

AC33429238 PITRESSIN INJECTION 20 UNITS/ML (ARGININE VASOPRESSIN) 234

AC33433100 "SINSULIN CAPSULES 10MG ""ASTAR""" 1.62

AC33435100 "CIMETIDINE TABLETS 200MG ""ASTAR""" 1.5

AC33445229 MITOXANTRONE INJECTION 2MG/ML "KINGDOM" 4160

AC33453100 MECOMIN CAPSULES 0.5MG (MECOBALAMIN)"Y.C." 1.76

AC334531G0 MECOMIN CAPSULES 0.5MG "Y.C." (MECOBALAMIN)(鋁箔/膠箔) 2

AC33457100 CLINDAMYCIN CAPSULES 150MG "C.C.P." 1.5

AC33459100 NOXACIN CAPSULES 100MG (NORFLOXACIN)"GENTLE" 2.44

AC33460100 NOXACIN CAPSULES 400MG (NORFLOXACIN) "GENTLE" 42.9

AC33468100 SILIMIN CAPSULES 150MG (SILYMARIN) "KOJAR" 1.64

AC334681G0 SILIMIN CAPSULES 150MG (SILYMARIN) "KOJAR" 2

AC33471100 BORYMYCIN CAPSULES 100MG (MINOCYCLINE) 5.9

AC33493100 "GENUPROXIN TABLETS 250MG (NAPROXEN) ""GCPC""" 1.5

AC33495100 SALBUTAMOL TABLETS 4MG "SINPHAR" 1.5

AC33496100 UCOLAR CAPSULES 100MG(TOCOPHEROL NICOTINATE)"SINPHAR" 1.5

AC33498100 CINNARIZINE CAPSULES 25MG "SINPHAR" 1.5

AC33502100 RONGIFENE TABLETS 50MG "SINPHAR" (BUCLIZINE) 1.5

AC33504100 IBUPROFEN TABLETS 400MG "SINPHAR" 1.5

AC335041G0 IBUPROFEN TABLETS 400MG "SINPHAR"(鋁箔/膠箔) 2

AC33510100 RIBRIN CAPSULES 10MG "SINPHAR" (CHLORDIAZEPOXIDE HCL) 1.5

AC33511100 TSUNG YAN S.C. TABLETS "SINPHAR" 1.5

AC33518100 AN ANTLER HORMON CAPSULES "SINPHAR" 1.93

AC33529100 ANETHOLE CAPSULES 25MG "SINPHAR" 1.5

AC33531100 LYSOZYME TABLETS 90MG "SINPHAR" 1.5

AC33533100 ETHAVERINE CAPSULES 100MG)"SINPHAR" (ETHAVERINE HCL) 2.79

AC33534100 N-METHYLSCOPOLAMINE METHYLSULFATE S.C TABLETS 1MG "SINPHAR" 1.57

AC33537100 PROHEPAM CAPSULES "SINPHAR" 1.59

AC33547212 ANTHIMIN INJECTION "T.F." 15

AC33548212 C-B COMPLEX INJECTION "T.F." 15

AC33549238 NEO METHION B INJECTION "T.F." 15

AC33551100 DIAZEPAM TABLETS 2MG "SINPHAR" 1.5

AC33553100 PRIPERIM S.C. TABLETS 10MG "SINPHAR" (METOCLOPRAMIDE) 1.5

AC33554100 INDOMETHACIN CAPSULES 25MG "SINPHAR" 1.5

AC33557100 METRONIDAZOLE TABLETS 250MG "SINPHAR" 1.64

AC33558212 NEO HUSTEN INJECTION "T. F." 15

AC33560212 BERBENOL INJECTION "T.F." 15

AC33561221 ANTI-ULCER INJECTION "T.F." 15

AC33562238 GLUCRON DEXTROSE INJECTION "T.F." 15

AC33563212 ANTICO INJECTION 5MG/ML (DEXTROMETHORPHAN) "T.F." 15

AC33564212 OBALLERGEN-H INJECTION "T.F." 15

AC33566209 RE-HISTAMIN INJECTION 30MG/ML (DIPHENHYDRAMINE)"T.F." 15

AC33569212 DIPHYLLIN M INJECTION 150MG/ML (DIPROPHYLLINE)"T.F." 15

AC33572212 CLINDAMYCIN INJECTION 150MG "C.C.P.C." 12.3

AC33582238 SODIUM ACETATE INJECTION 4MEQ/ML "KINGDOM" 28

AC33586238 SALSOBROCAROSE INJECTION "T.F." 15

AC33589212 "RANNINE INJECTION 25MG/ML (RANITIDINE)""S.Y.""" 24.7

AC33590312 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 17.3

AC33590316 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 17.3

AC33590317 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 17.3

AC33590319 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 17.3

AC33590321 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 46.6

AC33590323 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 46.6

134

Page 135: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC33590325 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 46.6

AC33590326 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 46.6

AC33590329 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 46.6

AC33590355 "DEVIRUS CREAM 50MG/G (ACYCLOVIR) ""WINSTON""" 431

AC33591100 THIAMPHENICOL CAPSULES 250MG "Y.C." 1.52

AC33593221 TRANEXAMIC ACID INJECTION 50MG/ML "T.F." 15

AC33594212 METOPERAN INJECTION 5MG/ML "T.F." (METOCLOPRAMIDE) 15

AC33595212 FUROSEMIDE IV INJECTION 10MG/ML "T.F." 15

AC33597212 DIAZEPAM INJECTION 5MG/ML "T.F." 15

AC33598209 PAOSU COAN INJECTION 20MG/ML "T.F." (SCOPOLAMINE) 15

AC33664100 MESYREL TABLETS 50MG "LOTUS" 1.93

AC33675100 DECLOT F.C. TABLETS 100MG "WEIDAR" (TICLOPIDINE) 4.61

AC33700238 PLUSAMIN INJECTION "T.F." 15

AC33701100 MEFENA CAPSULES 250MG (MEFENAMIC ACID) "KOJAR" 1.5

AC337011G0 MEFENA CAPSULES 250MG (MEFENAMIC ACID) "KOJAR" (鋁箔/膠箔) 2

AC33729329 ISORADIN CREAM "YUNG SHIN" 24.5

AC33730321 MYCOSON CREAM 10MG/G (BIFONAZOLE) "S.Y." 34.3

AC33730329 MYCOSON CREAM 10MG/G (S.Y.) (BIFONAZOLE) 74

AC33730335 MYCOSON CREAM 10MG/G (BIFONAZOLE) "S.Y." 75

AC33730338 MYCOSON CREAM 10MG/G (BIFONAZOLE) "S.Y." 81

AC33738320 DEVIRO OPHTHALMIC OINTMENT 3% (ACYCLOVIR) "KINGDOM" 427

AC33738321 DEVIRO OPHTHALMIC OINTMENT 3% (ACYCLOVIR) "KINGDOM" 427

AC33757238 GLUCOSE INJECTION 50% "T.F." 15

AC33758212 TAURINE B INJECTION "T.F." 15

AC33760212 ANTIDOTALGEN INJECTION "T.F." 15

AC33761209 EPIRENAMIN HYDROCHLORIDE INJECTION 1MG/ML (EPINEPHRINE)"T.F." 15

AC33763209 ATROPINE SULFATE INJECTION 1MG/ML "T.F." 15

AC33773229 TUNNACORT INJECTION 40MG/ML "T.F." 57

AC33823100 PREDNISOLONE 5MG TABLETS "Y.Y." 1.5

AC338231G0 PREDNISOLONE 5MG TABLETS "Y.Y." (鋁箔/膠箔) 2

AC338231G5 PREDNISOLONE 5MG TABLETS "Y.Y."(84粒/瓶) 2

AC33825100 NIGOLINE TABLETS 10MG "Y.C." (NICERGOLINE) 6.4

AC33830329 HUAN HSI CREAM 0.6MG/GM (ESTRADIOL) "CHINTENG" 61

AC33862100 METROCIDE CAPSULES 250MG "T.F."(METRONIDAZOLE) 1.64

AC33866221 OBALLERCAL INJECTION "T.F." 15

AC33867209 EPHEDRIN INJECTION 40MG/ML "T.F." 15

AC33871100 "FORLIVER CAPSULES 150MG ""ROOT"" (SILYBIN)" 1.64

AC33872100 CIKETIN TABLETS 200MG (CIMETIDINE) "UNION" 1.5

AC33873229 OXOCIN INJECTION 10IU/ML "T.F." (OXYTOCIN) 15

AC33876221 REHISTACAL B6 INJECTION "T.F." 15

AC33883100 EXSOL CAPSULES 100MG "Y.Y."(OXOLAMINE CITRATE) 1.5

AC338831G0 EXSOL CAPSULES 100MG (OXOLAMINE CITRATE) "Y.Y."(鋁箔/膠箔) 2

AC33887321 ENFULON CREAM 1MG/GM (DIFLUCORTOLONE) "GCPC" 14.9

AC33887329 "ENFULON CREAM 1MG/GM (DIFLUCORTOLONE) ""GCPC""" 50

AC33887343 ENFULON CREAM 1MG/GM(DIFLUCORTOLONE)"GCPC" 85

AC33892100 "TRANEXAMIC ACID TABLETS 250MG ""ASTAR""" 1.52

AC33894100 DECA TABLETS 0.75MG "KOJAR" (DEXAMETHASONE) 1.5

AC338941G0 DECA TABLETS 0.75MG (DEXAMETHASONE)"KOJAR"(鋁箔/膠箔) 2

AC33896100 SUWEIDA TABLETS 10MG (DOMPERIDONE)"S.C." 1.5

AC33900100 SINLIHAUL TABLETS 40MG (PROPRANOLOL) "H.S." 1.5

AC33910100 CAPTOPIN TABLETS 25MG "B & F"(CAPTOPRIL) 1.57

AC33915100 CAPTOPIN TABLETS 12.5MG "B & F" (CAPTOPRIL) 1.57

135

Page 136: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC33920209 PHENOBITAL INJECTION 100MG/ML "T.F." (PHENOBARBITAL) 15

AC33927100 L.K.T E.C. TABLETS 50MG "C.H." 1.5

AC33929100 LARPAM TABLETS 2MG (LORAZEPAM) "S.D." 1.5

AC339291G0 LARPAM TABLETS 2MG (LORAZEPAM) "S.D."(鋁箔/膠箔) 2

AC33933100 CARBIZO TABLETS 10MG (CARBIMAZOLE) "YU SHENG" 1.5

AC33934100 LIPLOW F.C. TABLETS 200MG (BEZAFIBRATE) "H.S." 6.5

AC33935209 CEFTAM INJECTION 0.5GM,1GM,2GM (CEFOTAXIME SODIUM) "LITA" 166

AC33935212 CEFTAM INJECTION 0.5GM,1GM,2GM (CEFOTAXIME SODIUM) "LITA" 542

AC33935277 CEFTAM INJECTION 0.5GM,1GM,2GM (CEFOTAXIME SODIUM) "LITA" 116

AC33938335 FUNGIN CREAM 10MG/GM "SWISS" (BIFONAZOLE) 75

AC33939100 ABROXOL TABLETS 30MG (AMBROXOL HYDROCHLORIDE) "JOHNSON" 1.5

AC339391G0 ABROXOL TABLETS 30MG (AMBROXOL HYDROCHLORIDE) "JOHNSON"(鋁箔/

膠箔)

2

AC33943321 CHENG HOU CREAM "C.T" 14.7

AC33943323 CHENG HOU CREAM "C.T" 16.1

AC33943329 CHENG HOU CREAM "C.T" 20.2

AC33943335 CHENG HOU CREAM "C.T" 35.1

AC33943336 CHENG HOU CREAM "C.T" 35.1

AC33943338 CHENG HOU CREAM "C.T" 61

AC33950100 N.F.S. F.C.T. 100MG "C.H."(NORFLOXACIN) 2.44

AC33959100 DROWSY TABLETS 0.25MG "H.S" 1.96

AC339591G0 DROWSY TABLETS 0.25MG "H.S"(鋁箔/膠箔) 2

AC33961100 IPUFEN F.C. TABLETS 400MG "CHINTENG"(IBUPROFEN) 1.5

AC339611G0 IPUFEN F.C. TABLETS 400MG "CHINTENG"(IBUPROFEN)(鋁箔/膠箔) 2

AC33962100 COTAZYM CAPSULES 1.5

AC33968417 CLEO EYE DROP 3MG/ML "PURZER"(TOBRAMYCIN) 37.9

AC33971100 MENTON TABLETS 10MG "H.C" (DOMPERIDONE) 1.5

AC33998165 MAGVAC ORAL SOLUTION 42.9

AC34000151 AXOL LIQUID 3MG/ML (AMBROXOL) "YUNG SHIN" 25

AC34004321 ISOCORT CREAM (5G) 16.1

AC34004329 ISOCORT CREAM (10G) 24.5

AC34008329 BESOL CREAM 0.05% (CLOBETASOL) "C.H." 17.7

AC34011421 LENSPURE EYE DROP "SINPHAR" 39.7

AC34014100 NOYAN TABLETS 375MG "WEIDAR" (NAPROXEN) 2.32

AC34015317 "ANCLOZIN CREAM 50MG/GM (ACYCLOVIR) ""ROOT""" 17.3

AC34015321 "ANCLOZIN CREAM 50MG/GM (ACYCLOVIR) ""ROOT""" 46.6

AC34018100 DECA TABLETS 0.5MG "KOJAR" (DEXAMETHASONE) 1.5

AC340181G0 DECA TABLETS 0.5MG (DEXAMETHASONE) "KOJAR"(鋁箔/膠箔) 2

AC34040321 S.S. CREAM 16.1

AC34040329 S.S. CREAM 24.5

AC34040330 S.S. CREAM 47.3

AC34040335 S.S. CREAM 47.3

AC34040336 S.S. CREAM 47.3

AC34040338 S.S. CREAM 60

AC34061500 ISOGEN VAG. TABLET 100MG (ISOCONAZOLE) "PURZER" 5.4

AC34078100 NYSIN S.C. TABLETS 100MG "CHINTENG"(NITROXOLINE) 2.74

AC34079100 VESUTON F.C TABLETS 10MG "CHINTENG"(SCOPOLAMINE) 1.5

AC340791G0 VESUTON F.C TABLETS 10MG "CHINTENG"(SCOPOLAMINE) (鋁箔/膠箔) 2

AC34082100 FUROFEN TABLETS 50MG "M.S."(FLURBIPROFEN) 1.54

AC34088100 KANTUU TABLETS 10MG "CHINTENG"(DOMPERIDONE) 1.5

AC340881G0 KANTUU TABLETS 10MG "CHINTENG"(DOMPERIDONE) (鋁箔/膠箔) 2

AC34089417 "AYCO IN ORABASE 1MG/GM (TRIAMCINOLONE ACETONIDE) ""ROOT""" 23.8

136

Page 137: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC34089421 "AYCO IN ORABASE 1MG/GM (TRIAMCINOLONE ACETONIDE) ""ROOT""" 28.4

AC34089423 "AYCO IN ORABASE 1MG/GM (TRIAMCINOLONE ACETONIDE) ""ROOT""" 42.7

AC34090100 MILIX CAPSULES 2.5MG "M.S." (INDAPAMIDE) 2.27

AC34103100 "PROLIVRIN CAPSULES ""ROOT""" 1.5

AC34105100 SINTON TABLETS 375MG (NAPROXEN) "CHIN TENG" 2.32

AC34108209 PIROCAM INJECTION 20MG/ML (PIROXICAM) "GENTLE" 0

AC34112100 LOPETIN CAPSULES 2MG (LOPERAMIDE) "KOJAR" 1.5

AC341121G0 LOPETIN CAPSULES 2MG (LOPERAMIDE) "KOJAR"(鋁箔/膠箔) 2

AC34114212 META C-B INJECTION "T.F." 15

AC34120100 WEIZIP TABLETS 500MG (SUCRALFATE) 1.5

AC341201G0 WEIZIP TABLETS 500MG (SUCRALFATE)(鋁箔/膠箔) 2

AC34123100 YUTODIN TABLET 10MG (RITODRINE HCL) "PURZER" 5.6

AC34124321 GENTAMYCIN CREAM 1MG/GM "SINPHAR" 20

AC34124335 GENTAMYCIN CREAM 1MG/GM "SINPHAR" 49.4

AC34128321 CLOTRISONE CREAM 22.1

AC34128329 CLOTRISONE CREAM 53

AC34128335 CLOTRISONE CREAM 87

AC34128338 CLOTRISONE CREAM 87

AC34129229 "LINCOMYCIN 300MG/ML INJECTION ""S.Y.""" 27.2

AC34157100 CERETAL S.C. TAB. 400MG "S.T." (PENTOXIFYLLINE) 2.2

AC34165265 NEPHROCARE INJECTION 5.4% "N.K." 142

AC34166255 HEPACARE INJECTION 8% "N.K." 96

AC34166277 HEPACARE INJECTION 8% "N.K." 220

AC34171100 FOAN CAPSULES 10MG "S.C" (OXAZOLAM) 1.62

AC34222151 MAC SAFE ORAL SUSPENSION 20MG/ML (IBUPROFEN) 25

AC34240100 SUSA TABLETS 2.5MG (FENOTEROL) "H.S." 1.5

AC342401G0 SUSA TABLETS 2.5MG (FENOTEROL) "H.S."(鋁箔/膠箔) 2

AC34243100 TON LIN CAPSULES 10MG "CHINTENG" (FLUOXYMESTERONE) 2.46

AC34244100 CORIN TABLETS 100MG "CHINTENG" (OXOLAMINE CITRATE) 1.5

AC34283100 "URENIDE TABLETS 1MG (BUMETANIDE) ""ROOT""" 2.23

AC34300100 TENSOLIN TABLET "T.F" 5.9

AC34306321 KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE) "CHINTENG" 15.8

AC34306323 KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE) "CHINTENG" 15.8

AC34306324 KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE) "CHINTENG" 15.8

AC34306329 KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE) "CHINTENG" 17.7

AC34306335 KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE) "CHINTENG" 28.6

AC34306338 KEC. JEN OINTMENT 0.05% (CLOBETASOL PROPIONATE) "CHINTENG" 47

AC34308100 TONLIN TABLETS 200MG (FLAVOXATE) "S.D." 4.84

AC34314100 RECALM TABLETS "STANDARD" 1.5

AC343141G0 RECALM TABLETS "STANDARD"(鋁箔/膠箔) 2

AC34323100 COWEMIN TABLETS 300MG (CIMETIDINE) "CHINTENG" 1.5

AC343231G0 COWEMIN TABLETS 300MG (CIMETIDINE) "CHINTENG"(鋁箔/膠箔) 2

AC34326100 URICIN TABLETS 50MG "GENTLE" (BENZBROMARONE) 1.5

AC343261G0 URICIN TABLETS 50MG (BENZBROMARONE) "GENTLE"(鋁箔/膠箔) 2

AC34329209 UFIN FOR I.V. INJ. 1GM (CEFTRIAXONE) "UNION" 193

AC34348100 "ANNEUTON TABLETS 80MG (GLICLAZIDE) ""ROOT""" 1.5

AC34354100 YURO F.C. TABLETS 100MG "YU SHENG"(NITROXOLINE) 2.74

137

Page 138: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC34355321 CYCLOUIR CREAM 50MG/GM "T.F" 46.6

AC34358100 DEFEN CAPSULE 1MG (KETOTIFEN) "PURZER" 1.75

AC343581G0 DEFEN CAPSULE 1MG (KETOTIFEN) "PURZER"(鋁箔/膠箔) 2

AC34363229 AMIKACIN INJECTION 250MG/ML (AMIKACIN) "C.C.P.C." 210

AC34366100 OXYBAN TABLETS 5MG "WEIDAR" (OXYBUTYNIN) 2.75

AC34373100 AERISIN TABLETS 30MG (DILTIAZEM) "YUAN CHOU" 1.5

AC34375100 TIMEN CAPSULES 30MG "WEIDAR" (TIMEPIDIUM BROMIDE) 2.94

AC34504100 PAWEGON 200MG TABLETS (CIMETIDINE) "EVEREST" 1.5

AC34511100 "LISUMEN CAPSULES 30MG ""ASTAR""" 5.3

AC34518100 COFEN 1MG TABLETS (KETOTIFEN) "C.H." 1.75

AC34534100 SOLOFEN TABLETS 10MG (BACLOFEN) 1.5

AC345341G0 SOLOFEN TABLETS 10MG (BACLOFEN)(鋁箔/膠箔) 2

AC34545314 WIPOIDO CREAM 15

AC34545329 WIPOIDO CREAM 61

AC34545343 WIPOIDO CREAM 85

AC34545348 WIPOIDO CREAM 249

AC34547100 "MEFENAMIC ACID TABLETS 500MG ""M.T""" 1.5

AC345471G0 "MEFENAMIC ACID TABLETS 500MG ""M.T""鋁箔/膠箔" 2

AC34550100 Glupizide Tablets 5mg 〝MACRO〞 (Glipizide) 1.5

AC34551100 SULIMEN TABLETS 100MG "KOJAR" (SULINDAC) 2.03

AC34553100 NICARPINE S.C. TABLETS 20MG (NICARDIPINE) "P.L" 2.28

AC34556100 SOU-AN CAPSULES "CHINTENG" 1.5

AC34557100 ZU-U TABLETS 100MG "CHINTENG" (BENZARONE) 2.91

AC34559100 KETOTIFEN TABLETS 1MG "CHINTENG" 1.75

AC345591G0 KETOTIFEN TABLETS 1MG "CHINTENG"(鋁箔/膠箔) 2

AC34564100 LIVER CHOLINE S.C. TABLETS "EVEREST" 1.5

AC345641G0 LIVER CHOLINE S.C. TABLETS "EVEREST"(鋁箔/膠箔) 2

AC34569340 BESONG SCALP SOLUTION 1MG/ML "SINPHAR"(BETAMETHASONE) 39.1

AC34579216 GARA INJECTION 40MG/ML (GENTAMYCIN SULFATE) 15.9

AC34579229 GARA INJECTION 40MG /ML (GENTAMYCIN SULFATE) 16.9

AC34579299 GARA INJ. 40MG/ML (GENTAMYCIN IULFATE) 1.49

AC34583100 VIRLESS TABLETS 200MG "YUNG SHIN" (ACYCLOVIR) 7

AC34584100 "EASYING FILM COATED TABLETS 25MG (DIPYRIDAMOLE) ""ROOT""" 1.5

AC34585500 NYDASIN VAGINAL SUPPOSITORIES "WEIDAR" 5

AC34598100 CAPTROL TABLET 25MG "PURZER" (CAPTOPRIL) 1.57

AC345981G0 CAPTROL TABLET 25MG "PURZER"(CAPTOPRIL) (鋁箔/膠箔) 2

AC34608100 EULICA TABLETS 50MG (NICAMETATE) "S.D." 1.5

AC34610100 RELAC TABLETS 5MG (BUSPIRONE) "UNION" 1.54

AC34613100 "MODRON TABLETS 50MG (ORPHENADRINE) ""TAI YU""" 1.5

AC34621100 GLUTROL TABLET 5MG (GLIPIZIDE) "PURZER" 1.5

AC346211G0 GLUTROL TABLET 5MG (GLIPIZIDE) "PURZER""(鋁箔/膠箔) 2

AC34633100 MANTA 100MG CAPSULES (AMANTADINE) "C.H." 7.4

AC34637100 BAFEN 10MG TABLETS (BACLOFEN) 1.5

AC34641100 LEZECON CAPSULES 30MG "Y.C." (TIMEPIDIUM) 2.94

AC34643421 GENDERON OPHTHALMIC SOLUTION "PATRON" 39.7

AC34648209 LOMANDOLE FOR INJECTION "GENTLE" (CEFAMANDOLE) 0

AC34648212 LOMANDOLE FOR INJECTION "GENTLE"(CEFAMANDOLE) 0

AC34648277 LOMANDOLE FOR INJECTION "GENTLE" (CEFAMANDOLE) 0

AC34654151 LOSOLVAN 3MG/ML SOLUTION (AMBROXOL) 25

AC34654157 LOSOLVAN 3MG/ML SOLUTION(AMBROXOL) 72

AC34658100 ME DROLINE 50MG S.C. TABLETS "C.H." (MEBHYDROLIN) 1.5

AC34670100 FOLACIN F.C. TABLETS 5MG (FOLIC ACID) "JOHNSON" 1.5

AC346701G0 FOLACIN F.C. TABLETS 5MG (FOLIC ACID) "JOHNSON" (鋁箔/膠箔) 2

138

Page 139: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC34726323 CLOTASONE CREAM 0.5MG/GM "M.S."(CLOBETASOL) 15.8

AC34727100 MEGEJOHN TABLETS 40MG 11.5

AC34764500 DICLOFEN SUPPOSITORIES 12.5MG (DICLOFENAC)"H.S" 5

AC34799100 MEDRONE TABLETS 10MG "WEIDAR" (MEDROXYPROGESTERONE) 2.97

AC34804100 "Iprofen Tablets 400mg ""MACRO"" (Ibuprofen)" 1.5

AC34805100 SUTOLIN TABLETS 250MG (NAPROXEN) "S.D." 1.5

AC348051G0 SUTOLIN TABLETS 250MG (NAPROXEN) "S.D."(鋁箔/膠箔) 2

AC34806100 FORPHEN FILM COATED TABLETS 100MG (FLURBIPROFEN) "YUNG SHIN" 3.54

AC34811100 LOPERADINE CAPSULES 2MG "EVEREST" (LOPERAMIDE) 1.5

AC34821321 AMELON CREAM "EVEREST" 11.7

AC34821329 AMELON CREAM "EVEREST" 21.8

AC34822100 TINIZOLE F.C. TABLETS 500MG (TINIDAZOLE) "JOHNSON" 2.09

AC34824100 URIDRON F.C. TABLETS 200MG (FLAVOXATE) "JOHNSON" 4.84

AC34829100 BENKORINE TABLETS 20MG (BENPROPERINE) "PFOSHEN" 1.5

AC34834330 ISUCON CREAM "PATRON" 47.3

AC34854100 MACALOL SOFT CAPSULES 0.25UG "F.M." 2.66

AC34859100 PACOALON CAPSULES "H.S." 1.5

AC348591G0 PACOALON CAPSULES "H.S."(鋁箔/膠箔) 2

AC34862100 AMSOL TABLETS 30MG "Y.Y." (AMBROXOL) 1.5

AC348621G0 AMSOL TABLETS 30MG "Y.Y." (AMBROXOL)(鋁箔/膠箔) 2

AC34880100 CAPTOLIN TABLETS 25MG (CAPTOPRIL) "KOJAR" 1.57

AC348801G0 CAPTOLIN TABLETS 25MG (CAPTOPRIL) "KOJAR"(鋁箔/膠箔) 2

AC34883329 CLODAI CREAM "CHINTENG" 53

AC34885100 ERYTHROMYCIN ETHYLSUCCINATE CAPSULES 250MG "P.L." 2.15

AC34893100 GLIMICON TABLETS 80MG "Y.C." (GLICLAZIDE) 1.5

AC34896100 "LIME TABLETS 0.25MG (TRIAZOLAM) ""H.S.""" 1.96

AC34898100 "VOLTON ENTERIC-COATED TABLETS 50MG (DICLOFENAC) ""H.S.""" 1.5

AC348981G0 "VOLTON ENTERIC-COATED TABLETS 50MG (DICLOFENAC) ""H.S.""(鋁箔

/膠箔)"

2

AC34900100 DOXYCYCLINE CAPSULES 100MG "P.L." 1.5

AC34901100 COLISTIN SULFATE CAPSULES 1,000,000 U "P.L" 6.7

AC34904139 MYCOSTATIN FOR ORAL SUSPENSION 100,000 UNITS/ML (NYSTATIN) 98

AC34911329 DERMOLEX CREAM 0.5MG/GM (CLOBETASOL)"PURZER" 17.7

AC34911338 DERMOLEX CREAM 0.5MG/GM "PURZER" (CLOBETASOL) 47

AC34921321 ISO COSAN CREAM "PFOSHEN" 16.1

AC34921329 ISO COSAN CREAM "PFOSHEN" 24.5

AC34922100 GLIN TABLETS 2.5MG (TERBUTALINE SULFATE) 1.5

AC34924100 FENOL TABLETS 2.5MG "CHINTENG"(FENOTEROL) 1.5

AC34927100 TICLOUD F.C. TABLETS 100MG 4.61

AC34944100 "LISEIPIN F.C. TABLETS ""ROOT"" 1.5

AC34952100 HAUANMIN TABLETS 0.25MG "CHIN TENG" (TRIAZOLAM) 1.96

AC349521G0 HAUANMIN TABLETS 0.25MG (TRIAZOLAM)"CHIN TENG")(鋁箔/膠箔) 2

AC34957421 Fulone 0.1% eye drops 14

AC34957429 Fulone 0.1% eye drops 77

AC34969100 SERECIN CAPSULES 10MG "YY" (OXAZOLAM) 1.62

AC34978500 DICLOPHEN SUPPOSITORY 12.5MG (DICLOFENAC) "DTS" 5

AC34979100 "DERZIQU TABLETS 400MG (CIMETIDINE) ""M.T.""" 1.5

AC349791G0 "DERZIQU TABLETS 400MG (CIMETIDINE) ""M.T.""(鋁箔)" 2

AC34980500 DICLOPHEN SUPPOSITORY 25MG "DTS" 5

AC34986100 "CUNTONG TABLETS 20MG (PIROXICAM) ""ROOT""" 1.55

AC35009100 OXYTYNIN TABLETS 5MG "CHINETENG" (OXYBUTYNIN) 2.75

139

Page 140: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC35011100 "BUSP TABLETS 10MG (BUSPIRONE) ""H.S.""" 3.81

AC35035316 VIRUN CREAM 50MG/GM (ACYCLOVIR) "H.S." 17.3

AC35055321 BECYLIC OINTMENT 12.6

AC35055329 BECYLIC OINTMENT 25.5

AC35055335 BECYLIC OINTMENT 81

AC35055338 BECYLIC OINTMENT 81

AC35060100 AMGICOL 30MG TABLETS (AMBROXOL) "ROYAL" 1.5

AC350601G0 AMGICOL 30MG TABLETS (AMBROXOL) "ROYAL"(鋁箔/膠箔) 2

AC35065100 BIGAST TABLETS 1000MG "Y.C." (SUCRALFATE) 2.27

AC35068100 MYCOME TABLETS 125MG "SWISS" (MICONAZOLE) 11.4

AC35069100 "Blasec Tablets 5mg ""MACRO"" (Oxybutynin)" 2.75

AC35087100 BENZARONE TABLETS 100MG "C.H." 2.91

AC35088500 VETIN SUPPOSITORIES 12.5MG (DICLOFENAC) "C.C.P.C." 5

AC35129100 "SURING TABLETS ""ROOT"" 1.54

AC35140337 TEMENAZOLE CREAM 60

AC35140365 TEMENAZOLE CREAM 585

AC35177100 "ROTILIUM 10MG F.C. TABLETS (DOMPERIDONE) ""ROYAL""" 1.5

AC35178100 KETOMIN CAPSULES 1MG "EVEREST" (KETOTIFEN) 1.75

AC35180100 FENOTEC TABLETS 2.5MG (FENOTEROL) "EVEREST" 1.5

AC35182209 CETAZONE INJECTION "S.T." (CEFMETAZOLE) 108

AC35182212 CETAZONE INJECTION "S.T." (CEFMETAZOLE) 333

AC35182277 CETAZONE INJECTION (CEFMETAZOLE) "S.T." 88

AC35183321 KETOCONAZOLE CREAM 20MG/GM "SINPHAR" 14.2

AC35183329 KETOCONAZOLE CREAM 20MG/GM "SINPHAR" 14.2

AC35183335 KETOCONAZOLE CREAM 20MG/GM "SINPHAR" 38.5

AC35183338 KETOCONAZOLE CREAM 20MG/GM "SINPHAR" 38.7

AC35184100 "TUSOLOC TABLETS 2.5MG (TERBUTALINE SULFATE) ""MACRO""" 1.5

AC35194100 SULPIRIDE TABLETS 200MG "Y.Y" 2.33

AC35195100 MELLERZIN SC.TABLETS 100MG (THIORIDAZINE) "P.L." 4.36

AC35213100 SALINE S.C. TABLETS 50MG "EVEREST" (NICAMETATE) 1.5

AC352131G0 SALINE S.C. TABLETS 50MG (NICAMETATE) "EVEREST" (90粒/瓶)

(鋁箔/膠箔)

2

AC35255100 ADEC TABLETS 100MG (MEBENDAZOLE) "EVEREST" 1.51

AC35256100 SULNINE CAPSULES 10MG "EVEREST" (OXAZOLAM) 1.62

AC352561G0 SULNINE CAPSULES 10MG (OXAZOLAM) "EVEREST"(90/瓶) 2

AC35266238 GITOSE 20% INJECTION "N.K." (DEXTROSE) 15

AC35267238 GITOSE 50% INJECTION (DEXTROSE) ".N.K." 15

AC35269209 KETOFPAN FOR I.M.INJECTION 50MG (KETOPROFEN) "PANBIOTIC" 15

AC35269212 KETOFPAN FOR I.M.INJECTION 50MG (KETOPROFEN) "PANBIOTIC" 15

AC35278100 UROCON TABLETS 5MG "STANDARD" (OXYBUTYNIN) 2.75

AC35282100 POWEGON F.C.T. 400MG "EVEREST" (CIMETIDINE) 1.5

AC352821G0 POWEGON F.C.T. 400MG "EVEREST" (CIMETIDINE) (鋁箔/膠箔) 2

AC35285100 "SOONWAY TABLETS 10MG (SCOPOLAMINE) ""ROOT""" 1.5

AC35287321 "AYFUCO CREAM ""ROOT"" 11.7

AC35287329 "AYFUCO CREAM ""ROOT""" 21.8

AC35287330 "AYFUCO CREAM ""ROOT"" 25.6

AC35287335 AYFUCO CREAM "ROOT" 36.2

AC35287338 AYFUCO CREAM 36.2

AC35291212 "FEBIN INJECTION 25MG/ML ""TAI YU"" (KETOPROFEN)" 15

AC35336100 URINSU TABLETS 200MG (FLAVOXATE)"YY" 4.84

AC35355100 "PARTANE TABLETS 5MG ""MACRO"" (TRIHEXYPHENIDYL

HYDROCHLORIDE)"

1.5

AC35363338 MYCOSON EXTERNAL SOLUTION 10MG/ML "S.Y." (BIFONAZOLE) 99

AC35363345 MYCOSON EXTERNAL SOLUTION 10MG/ML "S.Y." (BIFONAZOLE) 129

AC35365100 GENOLIN TABLETS 10MG "YY" (DOMPERIDONE) 1.5

140

Page 141: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC353651G0 GENOLIN TABLETS 10MG "YY" (DOMPERIDONE)(鋁箔/膠箔) 2

AC35367100 WESIPIN F.C.TABLETS 100MG "EVEREST" (ATENOLOL) 1.6

AC353671G0 WESIPIN F.C.TABLETS 100MG (ATENOLOL) "EVEREST"(鋁箔/膠箔) 2

AC35370100 DECORON TABLETS 0.5MG "EVEREST" (DEXAMETHASONE) 1.5

AC35390100 NAPOTON TABLETS 500MG (NAPROXEN) "YY" 3.26

AC35391321 ACLOVIR CREAM 50MG/GM "SINPHAR"(ACYCLOVIR) 46.6

AC35398100 TRIVEMIN TABLETS 1.56

AC35399100 "NAPROXEN TABLETS 500MG ""ASTAR""" 3.26

AC35410100 "NAPROXEN TABLETS 250MG ""ASTAR""" 1.5

AC35411100 "CIMETIDINE TABLETS 400MG ""ASTAR""" 1.5

AC35412100 CEPHALEXIN TABLETS 500MG "S.T." 1.82

AC35417100 GINTEC FILM COATED TABLET 2.24

AC35420100 SMARTEN TABLETS 25MG "H.S." (CAPTOPRIL) 1.57

AC354201G0 SMARTEN TABLETS 25MG (CAPTOPRIL)"H.S."(鋁箔/膠箔) 2

AC35422100 BACLOFEN TABLETS 10MG "C.H." 1.5

AC35424127 CHOLES POWDER "S.D." (CHOLESTYRAMINE RESIN) 15.4

AC35430209 BINISON INJ. 50MG/ML "SWISS"(HALOPERIDOL) 156

AC35430216 BINISON INJ. 50MG/ML "SWISS"(HALOPERIDOL) 312

AC35439100 "ANTIFAT TABLETS 200MG (BEZAFIBRATE) ""ASTAR""" 6.5

AC35445100 TINSAN F.C. TABLETS 9.6MG "CHINTENG" (GINKGOFLAVONGLYCOSIDE) 2.24

AC35455151 SALBUTAMOL SYRUP 0.4MG/ML "C.H." 25.2

AC35462100 "SEGININE TABLETS 5MG (SELEGILINE) ""MACRO""" 3.64

AC35467100 "NEWIN TABLETS 5MG (OXYBUTYNIN) ""ROOT""" 2.75

AC35477100 "PADALIN TABLETS 100MG ""MACRO"" (MEBEVERINE)" 2.2

AC35487338 KETOZOL CREAM 2% "WEIDAR" (KETOCONAZOLE) 38.7

AC35488221 SONTAC INJECTION 10MG/ML "T.F." 24.7

AC35502100 BACLOFEN TABLETS 5MG "C.H." 1.5

AC35506100 EYZU F.C. TABLETS 0.625MG "CHINTENG" (CONJUGATED ESTROGENS) 1.85

AC355061G0 EYZU F.C. TABLETS 0.625MG (CONJUGATED ESTROGENS)

"CHINTENG")(鋁箔/膠箔)

2

AC35514100 FUJEN F.C. TABLETS 500MG (TINIDAZOLE) "S.D." 2.09

AC35515100 MYLIN F.C. TABLETS 9.6MG (GINKGOFLAVON GLYCOSIDE) "S.D." 2.24

AC35544321 V.F. CREAM 50MG/GM (ACYCLOVIR) "SWISS" 46.6

AC35634100 PARAMINE CAPSULE "EVEREST" 1.5

AC356341G0 PARAMINE CAPSULE "EVEREST"(鋁箔/膠箔) 2

AC35638100 BADUSON F.C.TABLETS 200MG (FLAVOXATE) "C.C.P.C" 4.84

AC35639309 "N.S. IRRIGATION ""Y.F.""" 24.1

AC35639312 "N.S. IRRIGATION ""Y.F.""" 55

AC35639316 "N.S. IRRIGATION ""Y.F.""" 68

AC35639377 "N.S. IRRIGATION ""Y.F.""" 18.4

AC35649100 "IPROFEN 400MG F.C.T ""ROYAL""" 1.5

AC356491G0 "IPROFEN 400MG F.C.T ""ROYAL""(鋁箔/膠箔)" 2

AC35651151 IBUPROFEN SYRUP 20MG/ML (IBUPROFEN) "C.H." 25

AC35656100 "SULPIRIDE TABLETS 200MG ""ASTAR""" 2.33

AC35668209 "DIPHENIDOL INJECTION 20MG/ML ""S.Y.""" 15

AC35670100 GLIPIN TABLET 5MG (GLIPIZIDE) "SWISS" 1.5

AC35671209 FLUCAN INJECTION 25MG/ML (FLUPAHEAZINE) "SWISS" 81

AC35671219 FLUCAN INJECTION 25MG/ML (FLUPAHEAZINE) "SWISS" 235

AC35678100 WECOLI TABLET 10MG "YY"(BETHANECHOL CHLORIDE) 1.5

AC356781G0 WECOLI TABLET 10MG"YY"( (BETHANECHOL CHLORIDE) (鋁箔/膠箔) 2

AC35691100 BININ-U TABLET 10MG (HALOPERIDOL) 3.28

141

Page 142: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC35692100 DOXYMYCIN ENTERIC COATED CAPSULES 100MG "YUNG

SHIN"(DOXYCYCLINE)

1.5

AC35696335 FREE GEL 7.5MG/GM "SWISS"(METRONIDAZOLE) 57

AC35696338 FREE GEL 7.5MG/GM (METRONIDAZOLE) "SWISS" 74

AC35697335 ZUMELIN CREAM 20MG/GM "H.S." (KETOCONAZOLE) 38.5

AC35697338 ZUMELIN CREAM 20MG/GM "H.S."(KETOCONAZOLE) 38.7

AC35702100 FRAGIVIX TABLETS 100MG (BENZARONE) "S.D." 2.91

AC35705100 BONSTAN F.C. TABLET 500MG "EVEREST" (MEFENAMIC ACID) 1.5

AC357051G0 BONSTAN F.C. TABLET 500MG (MEFENAMIC ACID) "EVEREST"(鋁箔/膠

箔)

2

AC35788321 NYCINDIN CREAM 14.7

AC35788330 NYCINDIN CREAM 20.2

AC35788335 NYCINDIN CREAM 35.1

AC35788336 NYCINDIN CREAM 35.1

AC35795100 GLICLA TABLETS 80MG "CHINTENG" (GLICLAZIDE) 1.5

AC357951G0 GLICLA TABLETS 80MG "CHINTENG" (GLICLAZIDE) (鋁箔/膠箔) 2

AC35806100 GLUPIZIDE TABLETS 5MG (GLIPIZIDE)"S.D." 1.5

AC35817100 BECANTEX S.C.TABLET 30MG "C.H." (SODIUM DIBUNATE) 1.5

AC358171G0 BECANTEX S.C.TABLET 30MG "C.H." (SODIUM DIBUNATE)(鋁箔/膠箔) 2

AC35831209 CETALIN FOR INJECTION (CEFTRIAXONE)"CHI SHENG" 193

AC35831277 CETALIN FOR INJECTION (CEFTRIAXONE)"CHI SHENG" 100

AC35835100 MEDNIN TABLETS 4MG "H.S." (METHYLPREDNISOLONE) 1.66

AC35836100 CAPROINE TABLETS 50MG "ROYAL" (CAPTOPRIL) 5.2

AC35838100 GEMBIT CAPSULES 300MG (GEMFIBROZIL) 1.52

AC358381G0 GEMBIT CAPSULES 300MG (GEMFIBROZIL)(鋁箔/膠箔) 2

AC35844100 SEPHROS CAPSULES 500MG (CEPHRADINE) "YUNG SHIN" 3.13

AC35845100 M.F.N. F.C.T. 500MG (MEFENAMIC ACID) "C.H." 1.5

AC35868100 MINOCYCLINE CAPSULE 100MG "CCPC" 5.9

AC35869329 EFUCON GEL 7.5MG/GM (METRONIDAZOLE) 43.2

AC35869330 EFUCON GEL 7.5MG/GM (METRONIDAZOLE) 44.8

AC35869335 EFUCON GEL 7.5MG/GM (METRONIDAZOLE) 57

AC35879100 SEPRIDE TABLETS 200MG (SULPIRIDE) "M.S." 2.33

AC35888321 "SALINSE OINTMENT ""GCPC""" 39.6

AC35888329 SALINSE OINT. 39.7

AC35888335 "SALINSE OINTMENT ""GCPC""" 60

AC35890100 CLINDAMYCIN HYDROCHLORIDE 150MG CAP "YY" 1.5

AC35891100 AJULATE SOFT CAPSULE 10MG "F.M." (NIFEDIPINE) 2

AC35893209 XYLITOL INJECTION 5% "N.K." 44.9

AC35893238 XYLITOL INJECTION 5% "N.K." 15

AC35893265 XYLITOL INJECTION 5% "N.K." 22

AC35893277 XYLITOL INJECTION 5% "N.K." 26.7

AC35912100 LITION CAPSULES 10MG (PHENOXYBENZAMINE HYDROCHLORIDE) 2.39

AC35929209 LISACEF FOR INJECTION (CEPHRADINE) 1G "S.T." 26.1

AC35929277 LISACEF FOR INJECTION (CEPHRADINE) 500MG "S.T." 25.8

AC35955100 S.C.F. TABLET 1000MG "C.H." (SUCRALFATE) 2.27

AC35960100 "CLOZE TABLETS 100MG (BENZARONE) ""ROOT""" 2.91

AC35961100 SULMATYL TABLETS 100MG (SULPIRIDE)"P.L" 2.33

AC35963100 SULMATYL TABLETS 200MG (SULPIRIDE)"P.L." 2.33

AC35974100 P.U.N.F.C.TABLET 400MG "C.H." (CIMETIDINE) 1.5

AC35977321 "CYCLOVIR CREAM 50MG/GM (ACYCLOVIR) ""S.Y.""" 46.6

AC35977329 "CYCLOVIR CREAM 50MG/GM ""S.Y."" (ACYCLOVIR)" 46.6

AC35981100 AMBRON TABLET 30MG "F.Y"(AMBROXOL) 1.5

AC359811G0 AMBRON TABLET 30MG (AMBROXOL) "F.Y"(鋁箔/膠箔) 2

AC35989100 LIBRAX S.C. TABLETS 1.99

142

Page 143: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC35991209 ROLES POWDER FOR INJECTION 1GM "GENTLE" (CEPHALEXIN) 0

AC35996100 PERTIAZEM TABLETS 30MG (DILTIAZEM HYDROCHLORIDE)"ROYAL" 1.5

AC359961G0 PERTIAZEM TABLETS 30MG (DILTIAZEM HYDROCHLORIDE)"ROYAL" (鋁箔/

膠箔)

2

AC36004100 "IBUPROFEN TABLETS 400MG ""ASTAR""" 1.5

AC36006100 ULCERTOP F.C. TABLET 300MG "B&F" (DIBISMUTH TRIOXIDE) 6.3

AC36008100 MESTINON S.C. TABLETS 60MG (PYRIDOSTIGMINE BROMIDE) 4.92

AC36014277 "0.45% SODIUM CHLORIDE INJECTION ""Y.F.""" 25

AC36020100 TEGRETOL TABLETS 200MG (CARBAMAZEPINE) 2.79

AC36034100 "SILYMARIN CAPSULES 70MG ""TAI YU""" 1.57

AC36044129 CIGAMATE SUSPENSION 20MG/ML "SINPHAR" (CIMETIDINE) 25

AC36049109 BABYATE ORAL ELECTROLYTE MAINTENANCE SOLUTION 46.3

AC36049165 BABYATE ORAL ELECTROLYTE MAINTENANCE SOLUTION 28.6

AC36049177 BABYATE ORAL ELECTROLYTE MAINTENANCE SOLUTION 46.3

AC36060100 DE-SPASM CAPSULES 30MG "H.S." (TIMEPIDIUM BROMIDE) 2.94

AC36069100 "MOREN E.F.C. TABLET 50MG (DICLOFENAC SODIUM) ""ROYAL""" 1.5

AC360691G0 "MOREN E.F.C. TABLET 50MG (DICLOFENAC SODIUM) ""ROYAL""(鋁箔/

膠箔)"

2

AC36083100 DUBLECON TABLETS "EVEREST" 1.5

AC36084421 "CORKELIN ORAL GEL 1MG/GM ""M.S"" (TRIAMCINOLONE)" 28.4

AC36084429 "CORKELIN ORAL GEL 1MG/GM ""M.S"" (TRIAMCINOLONE)" 64

AC36092329 XAMACID CREAM 30.8

AC36098100 A.P.N. TABLETS 100MG "C.H." (ALLOPURINOL) 1.5

AC36099100 DICLOFENAC E.F.C. TABLETS 25MG "KOJAR" 1.5

AC360991G0 DICLOFENAC E.F.C. TABLETS 25MG "KOJAR"(鋁箔/膠箔) 2

AC36105100 NAPOSIN C.R. TABLETS 750MG (NAPROXEN) 4.51

AC36129100 ATENOLOL F.C. TABLETS 50MG "JOHNSON" 1.56

AC36132100 BLOODNONE CAPSULES 250MG (TRANEXAMIC ACID) "EVEREST" 1.52

AC36151100 MUBROXOL TABLETS 30MG (AMBROXOL) "C.C.P.C" 0.8

AC361511G0 MUBROXOL TABLETS 30MG (AMBROXOL) "C.C.P.C" (鋁箔/膠箔) 2

AC36157100 "URIMARONE TABLETS 50MG (BENZBROMARONE) ""ASTAR""" 1.5

AC36160110 AMOLIN POWDER FOR ORAL SUSPENSION (AMOXICILLIN) 31

AC36162100 PIROCAM CAPSULES 20MG "KOJAR" (PIROXICAM) 1.55

AC361621G0 PIROCAM CAPSULES 20MG "KOJAR" (PIROXICAM)(鋁箔/膠箔) 2

AC36172157 SECODRINE-C SYRUP 35.1

AC36174321 "BETAGEN CREAM ""GCPC""" 16.1

AC36174329 BETAGEN CREAM 10G 16.1

AC36174335 "BETAGEN CREAM ""GCPC""" 19.6

AC36174338 BETAGEN CREAM"GCPC"20GM 19.6

AC36178100 PIROCAM CAPSULES 10MG "KOJAR" 1.5

AC361781G0 PIROCAM CAPSULES 10MG "KOJAR" (PIROXICAM)(鋁箔/膠箔) 2

AC36181321 "VACORT CREAM ""GCPC""" 16.1

AC36181329 "VACORT CREAM""GCPC""" 24.5

AC36181335 "VACORT CREAM ""GCPC""" 47.3

AC36181338 "VACORT CREAM ""GCPC""" 60

AC36192100 NIXO TABLETS 10MG "H.S." (NICERGOLINE) 6.4

AC36195100 ZUSENLU TABLETS 12MG "CHINTENG"(BETAHISTINE) 1.5

AC361951G0 ZUSENLU TABLETS 12MG "CHINTENG"(BETAHISTINE)(鋁箔/膠箔) 2

AC36204100 BICANOL TABLETS 500MG "CHINTENG" (METFORMIN) 1.5

AC362041G0 BICANOL TABLETS 500MG (METFORMIN) "CHINTENG"(鋁箔/膠箔) 2

AC36214100 CITAMET F.C. TABLETS 400MG "Y.C." (CIMETIDINE) 1.5

AC362141G0 CITAMET F.C TABLETS 400MG "YC" (CIMETIDINE)(鋁箔/膠箔) 2

AC36215100 PARKRYL TABLETS "M.S."(SELEGILINE) 3.64

AC36216100 CHIWEGON TABLETS "EVEREST" 1.5

AC36237100 LINTON F.C. TABLETS 10MG "KOJAR" (HYOSCINE BUTYLBROMIDE) 1.5

143

Page 144: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC362371G0 LINTON F.C. TABLETS 10MG "KOJAR" (HYOSCINE BUTYLBROMIDE)(鋁箔/

膠箔)

2

AC36240100 "GLIZIDE TABLETS 80MG ""H.S."" (GLICLAZIDE)" 1.5

AC362401G0 "GLIZIDE TABLETS 80MG ""H.S."" (GLICLAZIDE) (鋁箔/膠箔)" 2

AC36241100 "TIMEPIN TABLETS 30MG ""H.S."" (TIMEPIDIUM)" 2.94

AC36252100 "NITRAZEPAM TABLETS 5MG ""ASTAR""" 1.5

AC36266100 MELICIN CAPSULES 100MG (MINOCYCLINE) "H.S." 5.9

AC36267100 ANAZIN TABLETS 50MG (FLURBIPROFEN) "SHOU CHAN" 1.54

AC362671G0 ANAZIN TABLETS 50MG (FLURBIPROFEN) "SHOU CHAN" (鋁箔/膠箔) 2

AC36280100 REPININ TABLETS 5MG "H.C" (OXYBUTYNIN) 2.75

AC36281100 CYCLIN CAPSULE 100MG "PURZER" (MINOCYCLINE) 5.9

AC36283100 MUSCOFEN TABLETS 10MG "H.C" (BACLOFEN) 1.5

AC36312100 TOCOLIN F.C.T. 30MG "EVEREST" (CARBETAPENTANE CITRATE) 1.5

AC36315321 CLOBETASOL CREAM 0.5MG/GM "SINPHAR" 15.8

AC36315324 CLOBETASOL CREAM 0.5MG/GM "SINPHAR" 15.8

AC36315329 CLOBETASOL CREAM 0.5MG/GM "SINPHAR" 17.7

AC36315340 CLOBETASOL CREAM 0.5MG/GM "SINPHAR" 88

AC36322100 ETHOS CAPSULES 100MG (MECLOFENAMIC ACID) 2.18

AC36330151 "PURZER" VENTOL LIQUID 5.34MG/ML (THEOPHYLLINE) 25

AC36345255 PROXACIN INFUSION SOLUTION 2MG/ML (CIPROFLOXACIN) 628

AC363491G0 UFORMIN TABLETS 500MG (鋁箔/膠箔) 2

AC36350500 BISADYL SUPPOSITORIES 10MG (BISACODYL) "MEIDER" 5

AC36356100 TIDACT CAPSULES 300MG (CLINDAMYCIN) 2.86

AC36357329 SAN-TON GEL 100MG/GM "CHINTENG" (ETOFENAMATE) 29.3

AC36360100 VORTAGEN E.C. TAB. 50MG "EVEREST" (DICLOFENAC) 1.5

AC36367100 "AMITON TABLETS ""H.S.""" 2.49

AC36370100 CLONICE TABLETS 5MG"T.F." (OXYBUTYNIN) 2.75

AC36385100 MESCO CAPSULES 500UG (MECOBALAMIN) "YY" 1.76

AC363851G0 MESCO CAPSULES 500UG "YY"(MECOBALAMIN)(鋁箔/膠箔) 2

AC36389100 LEGAFEN TABLETS "Y.C" (BACLOFEN) 1.5

AC36395100 GLIGLUCON TABLETS 5MG (GLIPIZIDE) "ROYAL" 1.5

AC363951G0 GLIGLUCON TABLETS 5MG (GLIPIZIDE) "ROYAL"(鋁箔/膠箔) 2

AC36396100 MENCHUAN TABLET 100MG (TICLOPIDINE) 4.61

AC36399100 SILYGEN-F.S.C. TABLETS 35MG "H.C." (SILYMARIN) 1.57

AC36403100 STAYBAN TAB. 50MG "YC" (FLURBIPROFEN) 1.54

AC364031G0 STAYBAN TABLETS 50MG“Y.C.” (FLURBIPROFEN(鋁箔/膠箔) 2

AC36410100 MODONE TABLETS 10MG "EVEREST" (DOMPERIDONE) 1.5

AC364101G0 MODONE TABLETS 10MG "EVEREST" (DOMPERIDONE)(鋁箔/膠箔) 2

AC36413329 SEU-SU CREAM 1MG/GM "CHINTENG" (TRIAMCINOLONE ACETONIDE) 12.1

AC36420209 SISOGEN INJECTION 50MG/ML (SISOMICIN) "GENTLE" 0

AC36420212 SISOGEN INJECTION 50MG/ML (SISOMICIN) "GENTLE" 0

AC36422100 MEPRIM TABLETS 100MG. (TRIMETHOPNIM) "JOHNSON" 1.5

AC36425100 KERFENMYCIN CAPSULES 500MG (CEFACLOR) 8

AC36426100 KERFENMYCIN CAPSULES 250MG (CEFACLOR) 3.63

AC36427100 "BACLOFEN TABLETS 10MG ""ASTER""" 1.5

AC36430100 COAN CAPSULES 250MG "S.C." (NIFLUMIC ACID) 2.57

AC36431100 GLIBETIN TABLETS 5MG (GLIPIZIDE)"JOHNSON" 1.5

AC36454100 MEZOLIN CAPSULES "EVEREST" 1.5

AC364541G0 MEZOLIN CAPSULES "EVEREST"(鋁箔/膠箔) 2

AC36475100 CIRCULON F.C. TABLETS 9.6MG "PBF" (GINKGOFLAVON GLYCOSIDES) 2.24

AC36481312 ANTIVIRS CREAM 50MG/GM 17.3

AC36481317 ANTIVIRS CREAM 50MG/GM 17.3

AC36481321 "ANTIVIRS CREAM 50MG/GM (ACYCLOVIR) ""GCPC""" 46.6

144

Page 145: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC36481325 ANTIVIRS CREAM 50MG/GM"GCPC"(ACYCLOVIR) 46.6

AC36481329 ANTIVIRS CREAM 50MG/GM (ACYCLOVIR) "GCPC" 46.6

AC36483100 CLEAROL CAPSULES 300MG "H.S" (GEMFIBROZIL) 1.52

AC364831G0 CLEAROL CAPSULES 300MG "H.S"(GEMFIBROZIL)(鋁箔/膠箔) 2

AC36484100 METIPINE TABLETS 300MG "KOJAR"(TRIMETHOPRIM) 2.05

AC36503100 CONAPIN TABLET 1.54

AC365031G0 CONAPIN TABLET(鋁箔/膠箔)(21粒/瓶) 2

AC36506100 "SUNPYLON TABLETS 50MG ""MACRO"" (SULPIRIDE)" 1.66

AC365061G0 "SUNPYLON TABLETS 50MG ""MACRO"" (SULPIRIDE)(鋁箔/膠箔)" 2

AC36508100 OFLOCIN F.C. TABLETS. 100MG (OFLOXACIN) "H.S." 1.85

AC36574110 CERO GRANULES FOR SYRUP 50MG/ML "S.T." (CEFACOLR) 109

AC36576477 GENTAX EYE DROPS 3MG/ML "MEDICINE" (GENTAMICIN) 1.04

AC36580100 SUXEN FILM COATED TABLETS 750MG (CIPROFLOXACIN) 39.5

AC36597209 TRADOL INJECTION 50MG/ML "GENTLE"(TRAMADOL HYDROCHLORIDE) 0

AC36597212 TRADOL INJECTION 50MG/ML (TRAMADOL HYDROCHLORIDE) "GENTLE" 0

AC36600100 TOWELL TABLETS "EVEREST" 1.5

AC366001G0 TOWELL TABLETS "EVEREST"(鋁箔/膠箔) 2

AC36601221 "GINTEC INJECTION 0.84MG/ML ""S.Y."" (GINKGOFLAVONGLYCOSIDE)" 30.7

AC36612100 PEPTOSOL TABLET 120MG "SINPHAR" (DIBISMUTH TRIOXIDE) 6.3

AC36632421 SINTROPIC OPHTHALMIC SOLUTION 10MG/ML (TROPICAMIDE) "SINPHAR" 76

AC36644100 "ATROGEM TABLETS 200MG(TIAPROFENIC ACID) ""MACRO""" 3.27

AC36654477 FUSONE EYE DROPS 1MG/ML "MEDICINE" (BETAMETHASONE) 2.36

AC36657121 K-CITRATE GRANULES "GENTLE" 8.3

AC36667100 NOCIGEN CAPSULES 100MG "SWISS" (MINOCYCLINE) 5.9

AC36669221 ULCERTIN INJECTION 10MG/ML (FAMOTIDINE) "SWISS" 39.4

AC36675100 ELP CAPSULES 50MG (ALPRENOLOL HYDROCHLORIDE) "S.D." 6.6

AC36677100 DALMADORM CAPSULES 30MG (FLURAZEPAM) 5.3

AC36679100 DALMADORM CAPSULES 15MG (FLURAZEPAM) 4.49

AC36693100 LISACEF CAPSULES 250MG (CEPHRADINE) "S.T." 1.93

AC36736100 "ROYAMET F.C.TABLETS 400MG (CIMETIDINE) ""ROYAL""" 1.5

AC367361G0 "ROYAMET F.C.TABLETS 400MG (CIMETIDINE) ""ROYAL""(鋁箔/膠箔)" 2

AC36740212 "KETOFEN-S INJECTION 50MG/ML (KETOPROFEN) ""S.Y.""" 15

AC36749100 SOMA CAPSULES "STANDARD" 1.5

AC367491G0 SOMA CAPSULES "STANDARD"(鋁箔/膠箔) 2

AC36753100 "SAFE CAPSULES 2MG (LOPERAMIDE) ""TAI YU""" 1.5

AC36757100 COUDE CAPSULES "S.D." 1.5

AC36759151 KOUSULIN SYRUP "M.T" 25

AC36759157 KOUSULIN SYRUP "M.T" 52

AC36763209 CEFOPIN INJECTION (CEFOPERAZONE) 241

AC36763212 CEFOPIN INJECTION (CEFOPERAZONE) 262

AC36763277 CEFOPIN INJECTION (CEFOPERAZONE) 104

AC36765321 "PRURINON CREAM""M.S" 22.1

AC36783100 S.N.A. CAPSULES 10MG "C.H." (FLUNARIZINE) 4.02

AC36785100 ASFEN TABLETS 1MG "STANDARD" (KETOTIFEN) 1.75

AC36787338 "SILIVERINE CREAM 10MG/GM ""S.Y"" (SILVER SULFADIAZINE)" 33.2

AC36794100 PROCAL TABLETS 667MG (CALCIUM ACETATE) "PL" 1.87

AC367941G0 PROCAL TABLETS 667MG (CALCIUM ACETATE) "PL"(?T??/????) 2

AC36815100 MINOLINE CAPSULES 100MG "S.T" (MINOCYCLINE) 5.9

AC36816100 "ANSOCAINE TABLETS ""ASTAR""" 1.5

AC36817100 CIMETIDINE TABLET 400MG"T.F." 1.5

AC36820100 METFORMIN TABLETS 500MG "C.H." 1.5

145

Page 146: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC368201G0 METFORMIN TABLETS 500MG "C.H."(鋁箔/膠箔) 2

AC36825316 YUTAM CREAM 50MG/GM "YU SHENG"(ACYCLOVIR) 17.3

AC36836100 CONJUESTROGEN F.C TABLETS 0.625MG 1.85

AC36840100 BENDOPA CAPSULES "WEIDAR" 3.64

AC36845100 DECORON F.C. TABLET 0.75MG "EVEREST" (DEXAMETHASONE) 1.5

AC36853100 ACE-CAL TABLETS 667 MG (CALCIUM ACETATE) "MACRO" 1.87

AC36854100 "GINKO TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE) ""S.Y.""" 2.24

AC36862100 DIABES TABLETS 5MG (GLIPIZIDE) "P.L." 1.5

AC36863500 DOMPER SUPPOSITORIES 10MG (DOMPERIDONE) 5

AC36865321 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 28

AC36865329 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 54

AC36865330 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 54

AC36865338 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 152

AC36865343 LEO CREAM 200MG/GM 〝MACRO〃(AZELAIC ACID) 215

AC36868212 VITAMIN C INJECTION 250MG/ML "Y.Y." 15

AC36868221 VITAMIN C INJECTION 250MG/ML "Y.Y." 15

AC36892100 HOU WE MING F.C. TABLETS 200MG "CHINTENG" (CIMETIDINE) 1.5

AC368921G0 HOU WE MING F.C. TABLETS 200MG (CIMETIDINE) "CHINTENG"(鋁箔/膠

箔)

2

AC36905209 NAKAXONE FOR I.V. INJECTION (CEFTRIAXONE) "N.K." 193

AC36926100 VETIN E.C. TABLETS 25MG. (DICLOFENAC) 1.5

AC36927100 VETIN E.C. TABLETS 50MG. (DICLOFENAC) 1.5

AC36935100 SEDAMIN F.C. TABLETS 100MG. (ATENOLOL) "C.C.P.C." 1.2

AC36940100 MERO CAPSULE 100MG (MINOCYCLINE) "KINGDOM" 5.9

AC36963321 BENCOGEN CREAM 39.6

AC36963329 BENCOGEN CREAM 39.6

AC36964100 UROBENIN S.C. TABLET 100MG "SWISS" (PHENAZOPYRIDINE) 1.5

AC36966100 CARTIL TABLETS 30MG (DILTIAZEM HYDROCHLORIDE) 1.5

AC369661G0 CARTIL TABLETS 30MG (DILTIAZEM HCL)(鋁箔/膠箔) 2

AC36967212 "FEBIN INJECTION 50MG/ML (KETOPROFEN) ""TAI YU""" 15

AC36971100 CLINDAMYCIN CAPSULE 300MG "KINGDOM" 2.86

AC37004248 CIPROFLO INFUSION SOLUTION 2MG/ML "S.Y." (CIPROFLOXACIN) 288

AC37004255 CIPROFLO INFUSION SOLUTION 2MG/ML "S.Y." (CIPROFLOXACIN) 628

AC37029100 "NIFUROX CAPSULES 200MG (NIFUROXAZIDE) ""H.S.""" 2.48

AC37042329 FLUTHASONE CREAM "CHINTENG" 39.7

AC37053209 PIROXICAM INJECTION 20MG/ML "Y.Y" 22.4

AC37053212 PIROXICAM INJECTION 20MG/ML "Y.Y" 22.4

AC37054100 STOGAMET TABLETS 400MG "SWISS" (CIMETIDINE) 1.5

AC370541G0 STOGAMET TABLETS 400MG "SWISS" (CIMETIDINE)(鋁箔/膠箔) 2

AC37062209 PANCOBAMIN INJECTION 0.5MG/ML (MECOBALAMIN) "PANBIOTIC" 15.5

AC37062221 PANCOBAMIN INJECTION 0.5MG/ML (MECOBALAMIN) "PANBIOTIC" 15.5

AC37063421 TRACORT ORABASE 1MG/GM (TRIAMCINOLONE ACETONIDE)"PATRON" 28.4

AC37064209 CEFE INJECTION "SWISS" (CEFMETAZOLE) 108

AC37064212 CEFE INJECTION "SWISS" (CEFMETAZOLE) 333

AC37064265 CEFE INJECTION "SWISS" (CEFMETAZOLE) 41.8

AC37064277 CEFE INJECTION "SWISS" (CEFMETAZOLE) 88

AC37067329 CLOSONE CREAM 53

AC37067335 CLOSONE CREAM 87

AC37069321 "BETA CREAM ""SINPHAR""" 19.9

AC37069335 "BETA CREAM ""SINPHAR""" 31.9

AC37069343 "BETA CREAM ""SINPHAR""" 31.9

AC37074321 CETALA CREAM 1% "Y.Y." (CENTELLA ASIATICA) 36.4

AC37074329 CETALA CREAM 1% "Y.Y." (CENTELLA ASIATICA) 64

AC37074335 CETALA CREAM 1% "Y.Y." (CENTELLA ASIATICA) 64

AC37074338 CETALA CREAM 1% "Y.Y." (CENTELLA ASIATICA) 90

146

Page 147: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC37078321 BALINSE OINTMENT 5GM 12.6

AC37078329 "BALINSE OINTMENT ""GCPC""" 25.5

AC37078335 "BALINSE OINTMENT ""GCPC""" 81

AC37078338 BALINSE OINTMENT "GCPC" 81

AC37078340 BALINSE OINTMENT "GCPC" 81

AC37082100 IMOLEX TABLETS 2MG "SINPHAR"(LOPERAMIDE) 1.5

AC370821G0 IMOLEX TABLETS 2MG "SINPHAR"(LOPERAMIDE)(鋁箔/膠箔) 2

AC37093329 EASY ACNE SOLUTION 10MG/ML (CLINDAMYCIN) 19.6

AC37093338 EASY ACNE SOLUTION 10MG/ML (CLINDAMYCIN) 30.8

AC37093343 EASY ACNE SOLUTION 10MG/ML (CLINDAMYCIN) 99

AC37096321 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 15.8

AC37096324 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 15.8

AC37096329 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 17.7

AC37096335 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 28.6

AC37096338 DEFULIN CREAM 0.05% "EVEREST" (CLOBETASOL PROPIONATE) 47

AC37125100 LISACEF CAPSULES 500MG "S.T." (CAPHRADINE) 3.13

AC37128323 EUCLOBE CREAM 0.5MG/GM 15.8

AC37128329 EUCLOBE CREAM 0.5MG/GM 17.7

AC37128338 EUCLOBE CREAM 0.5MG/GM 47

AC37134329 B.B. GEL 1% (CLINDAMYCIN) 17.9

AC37134335 B.B. GEL 1% (CLINDAMYCIN) 28.3

AC37134338 B.B. GEL 1% (CLINDAMYCIN) 83

AC37134343 B.B. GEL 1% (CLINDAMYCIN) 186

AC37139316 C.B ACYLETE CREAM 50MG/GM (ACYCLOVIR) 17.3

AC37139321 C.B ACYLETE CREAM 50MG/GM (ACYCLOVIR) 46.6

AC37140100 BEFON TABLETS 10MG "M.S." (BACLOFEN) 1.5

AC37141100 BEFON TABLETS 5MG "M.S."(BACLOFEN) 1.5

AC37157100 MEHYMINE TABLETS 50MG "CHINTENG" (MEBHYDROLIN) 1.5

AC371571G0 MEHYMINE TABLETS 50MG "CHINTENG" (MEBHYDROLIN)(鋁箔/膠箔) 2

AC37162321 DERMALIN CREAM 22.1

AC37162329 DERMALIN CREAM 53

AC37162330 DERMALIN CREAM 53

AC37162335 DERMALIN CREAM 87

AC37166100 SIN TONG E.F.C TABLETS 100MG "CHINTENG" (PENTOXYFYLLINE) 1.57

AC37167100 RINA CAPSULES "P.L." 12.1

AC37190100 "NIROZIDE CAPSULES 200MG (NIFROXAZIDE) ""ROYAL""" 2.48

AC37200209 KEPRO INJECTION 50MG/ML "T.F." 15

AC37200212 KEPRO INJECTION 50MG/ML (KETOPROFEN) 15

AC37204100 CALATEC TABLETS 25MG (CAPTOPRIL) 0.83

AC37216221 EUBRAIN INJECTION 200MG/ML (PIRACETAM) 15

AC37217100 EUBRAIN CAPSULES 400MG (PIRACETAM) 1.5

AC372171G0 EUBRAIN CAPSULES 400MG (PIRACETAM)(鋁箔/膠箔) 2

AC37224100 ASMALIN TABLETS 2.5MG (FENOTEROL) 1.5

AC372241G0 ASMALIN TABLETS 2.5MG (FENOTEROL)(鋁箔/膠箔) 2

AC37225100 WECOLI TABLETS 25MG (BETHANECHOL CHLORIDE) "YY" 2.11

AC37227100 CEFACLOR CAPSULES 250MG "KINGDOM" 3.63

AC37228329 LEVALONE CREAM 24.5

AC37228336 LEVALONE CREAM "EVEREST" 47.3

AC37228338 LEVALONE CREAM 60

AC37229100 CINTSU S.R.F.C. TABLETS 240MG (VERAPAMIL) "YUNG SHIN" 7

AC37246212 KETOPROFEN INJECTION 50MG/ML "N.K." 15

AC37252212 KETOPROFEN I.M. INJECTION 25MG/ML "N.K." 15

AC37252216 KETOPROFEN I.M. INJECTION 25MG/ML "N.K." 15

AC37255100 LIVER HOW CAPSULES "CHINTENG" 1.5

AC372551G0 LIVER HOW CAPSULES "CHINTENG"(鋁箔/膠箔) 2

147

Page 148: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC37257100 "DEGITON F.C. TABLETS 400MG (IBUPROFEN) ""ROOT""" 1.5

AC372571G0 "DEGITON F.C. TABLETS 400MG (IBUPROFEN) ""ROOT""(鋁箔/膠箔)" 2

AC37286321 VICORAX CREAM 5% "WEIDAR" 46.6

AC37288321 SWIVAZIN CREAM 10MG/GM (CENTELLA ASIATICA) 36.4

AC37288335 SWIVAZIN CREAM 10MG/GM (CENTELLA ASIATICA) 64

AC37288337 SWIVAZIN CREAM 10MG/GM (CENTELLA ASIATICA) 90

AC37290209 VANCO POWDER FOR INJECTION "GENTLE"(VANCOMYCIN) 0

AC37290277 VANCO POWDER FOR INJECTION (VANCOMYCIN) "GENTLE" 0

AC37292100 "NICER TABLETS 10MG (NICERGOLINE) ""H.S.""" 6.4

AC37301157 ZECOL SYRUP 25

AC37311321 AROMA CREAM 20MG/G 14.2

AC37311329 AROMA CREAM 20MG/G 14.2

AC37311335 AROMA CREAM 20MG/G 38.5

AC37311338 AROMA CREAM 20MG/G 38.7

AC37311355 AROMA CREAM 20MG/GM (KETOCONAZOLE) 407

AC37314321 CLINDAMYCIN GEL 10MG/GM "C.C.P.C." 9.1

AC37314338 CLINDAMYCIN GEL 10MG/GM "C.C.P.C." 83

AC37344100 BOKEY ENTERIC-MICROENCAPSULATED CAPSULES 100MG (ASPIRIN) 1.5

AC373441G0 BOKEY ENTERIC-MICROENCAPSULATED CAPSULES 100MG (ASPIRIN) (鋁

箔/膠箔)

2

AC37352100 HOPAN TABLETS 0.5MG "KOJAR" (HALOPERIDOL) 1.5

AC373521G0 HOPAN TABLETS 0.5MG (HALOPERIDOL) "KOJAR"(鋁箔/膠箔) 2

AC37368100 FLUFEN FILM COATED TABLETS 250MG (ALUMINUM FLUFENAMATE) "P.L" 3.66

AC37375100 GINKON FILM COATED TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE) 2.24

AC37376100 SULORIL TABLETS 200MG "WEIDAR" (SULINDAC) 2.03

AC37378100 TRIMSOAN TABLETS 3MG (TRIMETOQUINOL) "CHINTENG" 1.5

AC373781G0 TRIMSOAN TABLETS 3MG (TRIMETOQUINOL) "CHINTENG" (鋁箔/膠箔) 2

AC37386314 LADIOL GEL 0.6MG/GM "SIMPHAR"(ESTRADIOL) 15

AC37386343 LADIOL GEL 0.6MG/GM (ESTRADIOL) "SINPHAR" 85

AC37390100 U-SAVE CAPSULES 500MG "U-LIANG"(CEPHRADINE) 3.13

AC37396100 BRANDYL TABLETS 2.5MG (TERBUTALINE SULFATE) "C.C.P.C." 1.5

AC373961G0 BRANDYL TABLETS 2.5MG "C.C.P.C." (TERBUTALINE SULFATE)(鋁箔/膠

箔)

2

AC37441100 BIPERIN TABLETS 2MG (BIPERIDEN) "UNION" 2.19

AC37497100 SELEGYL TABLETS 5MG "SWISS" (DEPRENYL) 3.64

AC37498221 "FENSIN INJECTION 8MG/ML (FENSPIRIDE) ""S.Y.""" 15

AC37501329 "ISOLON CREAM ""H.S.""" 24.5

AC37501335 "ISOLON CREAM ""H.S.""" 47.3

AC37510329 SONA CREAM 24.5

AC37510335 SONA CREAM 47.3

AC37520100 CAPHOS TABLETS 667MG "M.S."(CALCIUM ACETATE) 1.87

AC37523100 CEPHALEXIN F.C.TABLET 500MG "S.T." 1.82

AC37527100 GLEUTON TABLETS 5MG (GLYBURIDE) "YU SHENG" 1.5

AC375271G0 GLEUTON TABLETS 5MG "YU SHENG" (GLYBURIDE)(鋁箔/膠箔) 2

AC37549100 TRENTINE F.C. TABLETS 9.6MG "N.K." 2.24

AC37551100 KINTHREE FILM TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE) "EVEREST" 2.24

AC37556100 VICIN CAPSULE 150MG "PURZER" (CLINDAMYCIN) 1.5

AC37563321 SAFELON CREAM "EVEREST" 22.1

AC37570109 ULSAMIN FINE GRANULES 900MG/GM (BASIC ALUMINUM SUCROSE

SULFATE)

3.65

AC37579100 FLU-D TABLETS 200MG 245

148

Page 149: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC37580321 CLOSONE CREAM 22.1

AC37580329 CLOSONE CREAM 53

AC37580335 CLOSONE CREAM 87

AC37586100 GINKOBA F.C.TABLETS 9.6MG "ROYAL"(GINKGOFLAVONGLYCOSIDE) 2.24

AC37592148 COJALIN SYRUP "CHINTENG" 25

AC37595100 "NAFXEN TABLETS 500MG (NAPROXEN) ""TAI YU""" 3.26

AC37596109 SUCRALFATE GRANULES 900MG/GM "SINPHAR" 3.65

AC37603100 VALTAFEN ENTERIC F.C. TABLET 50MG "SINPHAR"(DICLOFENAC) 1.5

AC376031G0 VALTAFEN ENTERIC F.C. TABLETS 50MG "SINPHAR"(DICLOFENAC)(鋁箔/

膠箔)

2

AC37622321 DERMALEAN GEL 10MG/GM "B&F"(CLINDAMYCIN) 9.1

AC37622323 DERMALEAN GEL 10MG/GM "B&F"(CLINDAMYCIN) 16

AC37622329 DERMALEAN GEL 10MG/GM "B&F"(CLINDAMYCIN) 17.9

AC37622330 DERMALEAN GEL 10MG/GM "B&F"(CLINDAMYCIN) 18.5

AC37622335 DERMALEAN GEL 10MG/GM 28.3

AC37632151 SCONIN ORAL SUSPENSION 20MG/ML 25

AC37632157 SCONIN ORAL SUSPENSION 20MG/ML 67

AC37637157 POWEGON SUSPENSION 20MG/ML "EVEREST" (CIMETIDINE) 66

AC37644100 EFOSIN S.C TABLETS 25MG "KOJAR" (DIPYRIDAMOLE) 1.5

AC376441G0 EFOSIN S.C TABLETS 25MG "KOJAR" (DIPYRIDAMOLE)(鋁箔/膠箔) 2

AC37651100 CEGOLIN F.C. TABLETS 9.6MG (GINKFLAVONGLYCOSIDE) "WEIDAR" 2.24

AC37652100 SEAPRO CAPSULES 10MG (SEAPROSE) "CHINTENG" 3.05

AC37656100 SCOPINE F.C. TABLETS 10MG "EVEREST" (SCOPOLAMINE BUTYLBROMIDE) 1.5

AC37668153 CIRLITON DROPS 9.6MG(GINKGOFLAVONGLYCOSIDES)"Y.Y." 320

AC37669143 EUMED DROPS 9.6MG/ML(GINGOFLAVONGLYCOSIDES) 176

AC37669151 EUMED DROPS 9.6MG/ML(GINGOFLAVONGLYCOSIDES) 267

AC37669155 EUMED DROPS 9.6MG/ML(GINGOFLAVONGLYCOSIDES) 432

AC37669157 EUMED DROPS 9.6MG/ML(GINGOFLAVONGLYCOSIDES) 525

AC37675100 "BACONE TABLETS 10MG ""H.S."" (BACLOFEN)" 1.5

AC376751G0 "BACONE TABLETS 10MG ""H.S."" (BACLOFEN)(鋁箔/膠箔)" 2

AC37679100 BEENRONE TABLETS 50MG "YUNG SHIN" (BENZBROMARONE) 1.5

AC376791G0 BEENRONE TABLETS 50MG "YUNG SHIN" (BENZBROMARONE)(鋁箔/膠箔) 2

AC37680100 ANLIN CAPSULES 10MG "CHINTENG" (OXAZOLAM) 1.62

AC376801G0 ANLIN CAPSULES 10MG "CHINTENG" (OXAZOLAM)(鋁箔/膠箔) 2

AC37685100 GEMD FILM COATED TABLETS 600MG (GEMFIBROZIL) 2.68

AC37687100 SENIN FILM-COATED TABLET 9.6MG "RURZER"(GYNKGOFLAVONGLYCOSIDE) 2.24

AC37688245 CIPROFLO INFUSION SOLUTION 10MG/ML "S.Y."(CIPROFLOXACIN) 1003

AC37689100 AELOCON S.C. TABLETS "EVEREST" 1.5

AC376891G0 AELOCON S.C. TABLETS "EVEREST"(鋁箔/膠箔) 2

AC37691329 PIROCAM CREAM 10MG/GM(PIROXICAM) 17.6

AC37691336 PIROCAM CREAM 10MG/GM 28.5

AC37691338 PIROCAM CREAM 10MG/GM(PIROXICAM) 28.5

AC37691340 PIROCAM CREAM 10MG/GM(PIROXICAM) 39.9

AC37691345 PIROCAM CREAM 10MG/GM(PIROXICAM) 40.8

AC37691355 PIROCAM CREAM 10MG/GM(PIROXICAM) 225

AC37696100 HOPAN TABLETS 5MG "KOJAR" (HALOPERIDOL) 2.5

AC37702100 KERSAN TABLETS 100MG (ASPIRIN) "CHINTENG" 1.5

AC37712100 "PARTANE TABLETS 2MG ""MACRO"" (TRIHEXYPHENIDYL

HYDROCHLORIDE)"

1.5

AC37720100 URSOLIC TABLETS 100MG (URSODEOXYCHOLIC ACID) 2.69

AC37722221 RANIDINE INJETION 10MG/ML (RANTIDINE) "S.T." 24.7

149

Page 150: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC37740100 BONSTAN CAPSULES 250MG "EVEREST"(MEFENAMIC ACID) 1.5

AC37741212 TRICEF FOR I.V. INJECTION "SWISS" (CEFTRIAXAXONE) 660

AC37741265 TRICEF FOR I.V. INJECTION "SWISS" (CEFTRIAXAXONE) 100

AC37833100 APUZIN TABLETS 50MG (CAPTOPRIL) 5.2

AC37835100 APUZIN TABLETS 25MG (CAPTOPRIL) 1.57

AC37840500 ECONAZOLE VAGINAL SUPPOSITORY 150MG "SINPHAR" 12

AC37866421 SINTROPIC OPHTHALMIC SOLUTION 5MG/ML "SINPHAR"(TROPICAMIDE) 29.2

AC37874421 EUXINC ORABASE 0.1% 55

AC37874426 EUXINC ORABASE 0.1% 61

AC37875100 "AMBROXOL TABLETS 30MG ""S.Y.""" 1.5

AC37876100 POKEN CAP. 1.64

AC37878500 VALTAFEN SUPPOSITORY 12.5MG (DICLOFENAC) "SINPHAR" 5

AC37902100 SULIRAM TABLETS 200MG "F.Y."(SULINDAC) 2.03

AC37909329 TONIN GEL 100MG/GM (ETOFENAMATE) 29.3

AC37909335 TONIN GEL 100MG/GM (ETOFENAMATE) 34.1

AC37909338 TONIN GEL 100MG/GM (ETOFENAMATE) 35.6

AC37909345 TONIN GEL 100MG/GM (ETOFENAMATE) 106

AC37928100 ATENOL F.C. TABLETS 100MG (ATENOLOL) "WEIDAR" 1.6

AC379281G0 ATENOL F.C. TABLETS 100MG (ATENOLOL) "WEIDAR"(鋁箔/膠箔) 2

AC37934100 SYNOTEC TABLETS 200MG (TIAPROFENIC ACID) 3.27

AC37945100 CIMETIN F.C. TABLETS 400MG "JOHNSON" (CIMETIN) 1.5

AC379451G0 CIMETIN F.C. TABLETS 400MG "JOHNSON" (CIMETIDINE)(56粒/瓶) 2

AC379881G0 GOUTIL TABLETS 50MG (BENZBROMARONE)(鋁箔/膠箔) 2

AC37991100 WEIDOS F.C. TABLET 300MG "WEIDAR" (RANITIDINE) 5.3

AC37996100 PHOSUNK TABLET 667MG "SWISS"(CALCIUM ACETATE) 1.87

AC379961G0 PHOSUNK TABLET 667MG "SWISS" (CALCIUM ACETATE)(鋁箔/膠箔) 2

AC37997100 MODIPANOL TABLET 2MG "SWISS"(FLUNITRAZEPAM) 2.45

AC38013500 ECOVALE SUPPOSITORIES 150 MG "P.L." (ECONAZOLE) 12

AC38023100 UROPRIL TABLETS 100MG (ALLOPURINOL) "T.F." 1.5

AC380231G0 UROPRIL TABLETS 100MG (ALLOPURINOL) "T.F."(鋁箔/膠膠) 2

AC38030100 PROCAM CAPSULES 150MG "EVEREST" (SILYMARIN) 1.64

AC380301G0 PROCAM CAPSULES 150MG (SILYMARIN) "EVEREST"(膠箔/鋁箔) 2

AC38034100 BISOL F.C.TABLET 300MG (DIBISMUTH TRIOXIDE) "PURZER" 6.3

AC38049321 CENTALLA OINTMENT "SINPHAR" 42.5

AC38049338 CENTALLA OINTMENT "SINPHAR" 132

AC38053212 GETWAY INJECTION 25 MG/ML (RANITIDINE) 24.7

AC38055100 FUAN TABLETS 5MG "CHINTENG"(MEDROXYPROGESTERONE) 1.57

AC380551G0 FUAN TABLETS 5MG "CHINTENG"(MEDROXYPROGESTERONE)(鋁箔/膠箔) 2

AC38056100 "Blasec Tablets 2.5mg ""MACRO"" (Oxybutynin)" 1.84

AC38073314 "ESTRAD GEL 0.06% (ESTRADIOL) ""H.S.""" 15

AC38073343 "ESTRAD GEL 0.06% (ESTRADIOL) ""H.S.""" 85

AC38076100 BENZU TABLETS 3MG "CHINTENG" (BROMAZEPAM) 1.58

AC380761G0 BENZU TABLETS 3MG (BROMAZEPAM) "CHINTENG"(鋁箔/膠箔) 2

AC38081100 ANSUTAN CAPSULES"F.Y." 1.5

AC38089100 SUXEN FILM COATED TABLETS 250MG (CIPROFLOXACIN) 9.8

AC38090100 SUXEN FILM COATED TABLETS 500MG (CIPROFLOXACIN) 13.1

AC38091100 TENGEN TABLETS "MACRO" 4.97

AC38097100 HEPANAT CAPSULES 150MG (SILYMARIN) 1.64

AC38098209 FOCUS IM INJECTION 20MG/ML (PIROXICAM) 22.4

AC38104100 Pyrazinamide Tablets 500mg "P.L." 4.68

AC38132100 SALALIN TABLETS 250MG"KOJAR" (CHLORZOXAZONE) 1.5

AC381321G0 SALALIN TABLETS 250MG "KOJAR" (CHLORZOXAZONE)(鋁箔/膠箔) 2

150

Page 151: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC38134100 SILYMA CAPSULES 150MG (SILYMARIN) 1.64

AC381341G0 SILYMA CAPSULES 150MG (SILYMARIN)(鋁箔/膠箔) 2

AC38135209 TRAMED INJECTION 50MG/ML (TRAMADOL HYDROCHLORIDE) "SWISS" 28.2

AC38135212 TRAMED INJECTION 50MG/ML (TRAMADOL HYDROCHLORIDE) "SWISS" 39.1

AC38145212 TRAMTOR INJECTION 50MG/ML (TRAMADOL HYDROCHLORIDE) 39.1

AC38147100 GENOL TABLETS 120MG "GENTLE" (DIBISMUTH TRIOXIDE) 6.3

AC38154100 AJULATE SOFT CAPSULES 5MG (NIFEDIPINE) "F.M." 2

AC38158100 ERYTH F.C. TABLET 500 MG "LONG LIFE" 3.67

AC38159321 AZOL-CORT CREAM 16.1

AC38159335 AZOL-CORT CREAM 47.3

AC38180100 COHEAL CAPSULES "STANDARD" 1.5

AC381801G0 COHEAL CAPSULES "STANDARD" (鋁箔/膠箔) 2

AC38184321 TRIDERMSONE CREAM 18.9

AC38184329 TRIDERMSONE CREAM 50

AC38184338 TRIDERMSONE CREAM 99

AC38185212 SUWELIN INJ. 150MG/ML 2ML 15

AC38186100 YIPA CAPSULES 0.5MG "KOJAR" 1.76

AC381861G0 YIPA CAPSULES 0.5MG (MECOBALAMIN) "KOJAR" (鋁箔/膠箔) 2

AC38188100 DICLOFEN F.C.TABLET 50MG "H.C."(DICLOFENAC) 1.5

AC38192212 TAIBAMIN INJECTION 5MG/ML "TAI YU" (HYDROXOCOBALAMINE) 15.5

AC38194100 HEARTQUINONE CAPSULES 10MG (UBIDECARENONE) "S.D." 3.57

AC38204100 CABUDAN TABLETS 25MG 1.57

AC382041G0 CABUDAN TABLETS 25MG (CAPTOPRIL) "S.Y."(鋁箔/膠箔) 2

AC38229263 CALCIUM GLUCONATE INJECTION 10% "C.C.P.C." 270

AC38235100 PROCANPEN S.C TABLETS "CHINTENG" 1.59

AC38244100 HOPAN TABLETS 10MG "KOJAR" (HALOPERIDOL) 3.28

AC38247100 CIMETIDINE TABLETS 400MG "D.T.S" 1.5

AC38259100 NIFUGEN CAP. 200MG 2.48

AC38260100 JINBO FILM-COATING TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE) "YU-

SHENG"

2.24

AC38283309 SALINE SOLUTION "S.T" 24.1

AC38283312 SALINE SOLUTION "S.T" 55

AC38283316 SALINE SOLUTION "S.T" 68

AC38283377 SALINE SOLUTION "S.T" 18.4

AC38284238 BUTAMINE INJECTION 12.5MG/ML (DOBUTAMINE) 182

AC38286100 THIAMPHENICOL CAPSULES 250MG "KINGDOM" 1.52

AC38291100 WEIMOK F.C. TABLETS 40MG (FAMOTIDINE) "WEIDAR" 5.7

AC38300329 SMOOTH CREAM 10MG/GM 64

AC38317209 DRAMINE INJECTION 50MG/ML (DIMENHYDRINATE) "S.Y." 15

AC38327100 REFEN TABLETS 200MG "Y.J."(TIAPROFENIC ACID) 3.27

AC38330277 "SODIUM CHLORIDE INJECTION 3% ""Y.F.""" 25

AC38353100 TOPCEF CAPSULES 250MG (CEPHRADINE) 1.93

AC38368100 SUPEROCIN F.C. TABLETS 500MG "WEIDAR" (CIPROFLOXACIN) 13.1

AC38419100 STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS" 1.5

AC384191G0 STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"(鋁箔/膠箔) 2

AC384191G1 STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"(14粒/瓶) 2

AC384191G2 STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"28粒/瓶) 2

AC384191G4 STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"(56粒/瓶) 2

AC384191G6 STOGAMET F.C. TABLETS 300MG (CIMETIDINE) "SWISS"(112粒/瓶) 2

AC38422100 CARTIL TABLETS 60MG (DILTIAZEM HYDROCHLORIDE) 2.93

AC38426100 ANTIDIA CAPSULES 200MG (NIFUROXAZIDE) "S.D." 2.48

AC38427321 RAMIN CREAM "EVEREST" 18.9

AC38427329 RAMIN CREAM "EVEREST" 50

151

Page 152: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC38427336 RAMIN CREAM "EVEREST" 59

AC38427338 RAMIN CREAM "EVEREST" 99

AC38427355 RAMIN CREAM "EVEREST" 145

AC38446100 BUSPAN TABLETS 10MG (SCOPOLAMINE BUTYLBROMIDE)"S.C" 1.5

AC38453100 TRIMPRIM TABLETS 100MG (TRIMETHOPRIM) "S.C" 1.5

AC38454100 CIMETIDINE TABLETS 200MG "S.C" 1.5

AC384541G0 CIMETIDINE TABLETS 200MG "S.C"(鋁箔/膠箔) 2

AC38460100 PIROCAM TABLETS 20MG (PIROXICAM) "S.C" 1.55

AC38464100 ASTHMA TABLETS "S.C" 1.5

AC38465100 DIALICON TABLETS "S.C" 1.5

AC384651G0 DIALICON TABLETS "S.C"(鋁箔/膠箔) 2

AC38472169 ALUZAINE SUSPENSION "STANDARD" 81

AC38474100 SPANIL TABLETS 135MG (MEBEVERINE HYDROCHLORIDE) "ROYAL" 2.2

AC38479100 "GINKGO BILOBA F.C. TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDE)""RO

OT"""

2.24

AC38487100 CHIANDA TABLETS 0.15MG "CHINTENG" (CLONIDINE) 2.11

AC38493100 PAS CALCIUM F.C. TABLETS 500MG (CALCIUM PAMINOSALICYLATE)

"P.L."

6.5

AC38500100 GLICRON TABLETS 80MG (GLICLAZIDE) 1.5

AC38504100 CALOWLIN TABLETS 667MG (CALCIUM ACETETE) "U-LIANG" 1.87

AC385041G0 CALOWLIN TABLETS 667MG (CALCIUM ACETETE) "U-LIANG"(鋁箔/膠箔) 2

AC38509348 U-BURNDIN CREAM "U-LIANG" 56

AC38509377 U-BURNDIN CREAM"U-LIANG" 480

AC38510100 SUME TABLETS 2MG 2.45

AC38524321 ENCORT CREAM 0.1% "EVEREST" (TRIAMCINOLONE ACETONIDE) 5.8

AC38524329 ENCORT CREAM 0.1% "EVEREST" (TRIAMCINOLONE ACETONIDE) 12.1

AC38524335 ENCORT CREAM 0.1% "EVEREST" (TRIAMCINOLONE ACETONIDE) 15.1

AC38528100 CIFLODAL F.C. TABLETS 500MG (CIPROFLOXACIN) "C.C.P.C." 13.1

AC38544265 CEKONIN FOR INJECTION (CEFUROXIME)"SWISS" 23.5

AC38555255 CINOLONE IV INFUSION 2MG/ML 628

AC38556100 CIMEDIN TABLETS 400MG (CIMETIDINE) 1.5

AC38575100 MABAL CAPSULES 0.5MG "YU SHENG" (MECOBALAMIN) 1.76

AC38604329 ANKAJEN CREAM 5% "C.H."(ACYCLOVIR) 46.6

AC38612100 AN LIN TABLETS 2MG (FLUNITRAZEPAM) 2.45

AC38615209 CEFIN FOR I.V. INJECTION (CEFTRIAXONE) "PANBIOTIC" 193

AC38615212 CEFIN FOR I.V. INJECTION (CEFTRIAXONE) "PANBIOTIC" 660

AC38615265 CEFIN FOR I.V. INJECTION (CEFTRIAXONE) "PANBIOTIC" 100

AC38615277 CEFIN FOR I.V. INJECTION (CEFTRIAXONE) "PANBIOTIC" 100

AC38616100 MECOMIN CAPSULES 0.5MG (MECOBALAMIN) "LITA" 1.76

AC38620100 MEDROLIN F.C. TABLETS 50MG "F.Y." 1.5

AC38622100 PAINSTOP E.C. TABLET 50MG "SWISS" (DICLOFENAC) 1.5

AC386221G0 PAINSTOP E.C. TABLET 50MG "SWISS" (DICLOFENAC)(鋁箔/膠箔) 2

AC38650100 AKIN TABLETS 2MG (BIPERIDEN) "H.S." 2.19

AC38652212 V-GENTA INJECTION 40MG/ML (GENTAMICIN SULFATE) "VPP" 15

AC38663421 DELOLOL OPHTHALMIC SOLUTION 5MG/ML (TIMOLOL) "SINPHAR" 172

AC38664421 DELOLOL OPHTHALMIC SOLUTION 2.5MG/ML (TIMOLOL) "SINPHAR" 73

AC38680100 VOLV TABLETS 500MG (METFORMIN) 1.5

AC386801G0 VOLV TABLETS 500MG (MOTFORMIN)(鋁箔/膠箔) 2

AC38691100 NAROTON TABLETS 275MG "H.S." (NAPAROXEN SODIUM) 1.5

AC38711209 CEFAMID FOR INJECTION "GENTLE" 0

AC38711212 CEFAMID FOR INJECTION "GENTLE" 0

AC38712321 TOPIDIN CREAM 14.7

AC38712335 TOPIDIN CREAM 35.1

AC38722100 COS TABLETS "CHINTENG" 1.5

152

Page 153: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC387221G0 COS TABLETS "CHINTENG"(鋁箔/膠箔) 2

AC38724209 MECOMIN INJECTION 0.5MG/ML "LITA" (MECOBALAMIN) 15.5

AC38724221 MEC0MIN INJECTION 0.5MG/ML "LITA" (MECOBALAMIN) 15.5

AC38747100 CINOLONE F.C. TABLET 250MG 9.8

AC38761100 MELICIN CAPSULES 50MG "H.S." (MINOCYCLINE) 3.68

AC38763100 N-WAY TABLETS 400MG (CIMETIDINE) "MEIDER" 1.5

AC38764100 N-WAY TABLETS 200MG "MEIDER"(CIMETIDINE) 1.5

AC38766100 METHYLPREDNISOLONE TABLETS 4MG "YUNG SHIN" 1.66

AC387661G0 METHYLPREDNISOLONE TABLETS 4MG "YUNG SHIN"(鋁箔/膠箔) 2

AC38777209 GIBICEF POWDER FOR INJECTION (CEFUROXIME) 0

AC38777277 GIBICEF POWDER FOR INJECTION (CEFUROXIME) 0

AC38785212 QUICRAN INJECTION 25MG/ML(RANITIDINE) 24.7

AC38819100 ROMICON-A CAPSULES "KINGDOM" 1.5

AC388191G0 ROMICON-A CAPSULES "KINGDOM"(鋁箔/膠箔) 2

AC38833100 SIGAMET F.C. TABLETS 400MG (CIMETIDINE) "SINPHAR" 1.5

AC38840100 SILYGEN-H CAPSULE 150MG "H.C." (SILYMARIN) 1.64

AC38850151 COLDYNIL SOLUTION 25

AC38850157 COLDYNIL SOLUTION 25

AC38851100 "TECON TABLETS 200MG (TIAPROFENIC ACID) ""M.T.""" 3.27

AC38856100 GINKON F.C. TABLET 9.6MG (GINKGOFLAVONE GLYCOSIDE) "JOHNSON" 2.24

AC38868100 PAINSTOP E.C. TABLETS 25MG (DICLOFENAC)"SWISS" 1.5

AC388681G0 PAINSTOP E.C. TABLETS 25MG "SWISS" (DICLOFENAC)(鋁箔/膠箔)(21

粒/瓶)(28粒/瓶)(42粒/瓶)(84粒/瓶)(112粒/瓶)(168粒/瓶)

2

AC38870321 KETONA CREAM 20MG/GM "KOJAR" (KETOCONAZOLE) 14.2

AC38870329 KETONA CREAM 20MG/GM "KOJAR"(KETOCONAZOLE) 14.2

AC38870335 KETONA CREAM 20MG/GM "KOJAR" (KETOCONAZOLE) 38.5

AC38870338 KETONA CREAM 20MG/GM"KOJAR" (KETOCONAZOLE) 38.7

AC38870355 KETONA CREAM 20MG/GM (KETOCONAZOLE) "KOJAR" 407

AC38873100 MEQUIT TABLETS 5MG "YU SHENG "(MEQUITAZINE) 1.52

AC38890100 VEWON TABLETS 5MG (FLUOXYMESTERONE) "YUNG SHIN" 2.39

AC38891100 BIGACON FILM COATED TABLETS 200MG"YUNG SHIN" (CIMETIDINE) 1.5

AC388911G0 BIGACON FILM COATED TABLETS 200MG"YUNG SHIN" (CIMETIDINE)(鋁箔

/膠箔)

2

AC38923100 BALAX TABLETS 10MG "YU SHENG" (BACLOFEN) 1.5

AC38925100 GIBBER S.C. TABLETS 9.6MG "Y.Y"(GINKGOFLAVONGLYCOSIDE) 2.24

AC38926100 SINSO F.C TABLETS. 40MG "CHINTENG" (VERAPAMIL) 1.66

AC38935263 MAGNESIUM SULFATE INJECTION 100MG/ML"C.C.P.C." 150

AC38946100 BEBENLINE F.C. TABLETS 135MG (MEBEVERINE HYDROCHLORIDE) 2.2

AC38948100 5-HTP CAPSULE 100MG "C.C.P.C."(OXITRIPTAN) 36.9

AC38949212 TATUMCEF POWDER FOR INJECTION "C.C.P.C."(CEFTAZIDIME) 400

AC38949277 TATUMCEF POWDER FOR INJECTION"C.C.P.C." (CEFTAZIDIME) 32.3

AC38954100 MEGATO TABLETS 400MG "GENTLE"(CIMETIDINE) 1.5

AC38955100 METISONE TABLETS 4MG (METHYLPREDNISOLONE) "S.D." 1.66

AC38956100 SOLIKY TABLETS 200MG 2.03

AC38980421 LAN-YEN EYE DROPS "YY" 39.7

AC38980429 LAN-YEN EYE DROPS "YY" 49.7

AC38982321 ROYALSENSE ACNE GEL 10MG/GM "SINPHAR" (CLINDAMYCIN) 9.1

AC38982329 ROYALSENSE ACNE GEL 10MG/GM "SINPHAR"(CLINDAMYCIN) 17.9

AC38982335 ROYALSENSE ACNE GEL 10MG/GM (CLINDAMYCIN) "SINPHAR" 28.3

AC38982338 ROYALSENSE ACNE GEL 10MG/GM "SINPHAR"(CLINDAMYCIN) 83

AC38983100 NOMPIN TABLETS 20MG (NOSCAPINE) "CHINTENG" 1.5

AC389831G0 NOMPIN TABLETS 20MG (NOSCAPINE) "CHINTENG"(鋁箔/膠箔) 2

AC38992100 PROCA TABLETS 667MG "BOWLIN" (CALCIUM ACETATE) 1.87

153

Page 154: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC38996100 NIFECARDIA CAPSULES 10MG (NIFEDIPINE) 1.55

AC39007100 "ARAX TABLETS 25MG (HYDROXYZINE HYDROCHLORIDE) ""ASTAR""" 1.5

AC390071G0 "ARAX TABLETS 25MG (HYDROXYZINE HYDROCHLORIDE) ""ASTAR""(鋁箔/

膠箔)"

2

AC39012100 ASUMALIFE TABLETS 1MG (KETOTIFEN) 1.75

AC39033477 ANME EYE DROPS 0.5% 9

AC39034477 ANME EYE DROPS 0.25% 4.08

AC39035100 QUICRAN F.C. TABLETS 300MG (RANITIDINE HYDROCHLORIDE) 5.3

AC39039321 YUHEALFU CREAM "S.C." 22.1

AC39039329 YUH EEL FU CREAM "S.C"10GM 53

AC39039335 YUH EEL FU CREAM 15GM 87

AC39039338 YUH EEL FU CREAM 20GM 87

AC39040212 KETIN INJECTION 50MG (KETOPROFEN) 15

AC39042100 DIMOLE S.C. TABLETS 25MG "EVEREST" (DIPYRIDAMOLE) 1.5

AC390421G6 DIMOLE S.C. TABLETS 25MG "EVEREST" (DIPYRIDAMOLE)(90顆) 2

AC39048123 KERFENMYCIN GRAN. FOR ORAL SUSP. 250MG/GM 73

AC39054100 UBIHEART CAPSULES 10MG(UBIDECARENONE)"JENN MAW" 3.57

AC39058209 LIMADOL INJECTION 50MG/ML (TRAMADOL HCL) "N.K." 28.2

AC39058212 LIMADOL INJECTION 50MG/ML (TRAMADOL HCL) "N.K." 39.1

AC39069100 MEFENTIN CAPSULES 250MG (MEFENAMIC ACIA) "C.C.P.C." 1.5

AC390691G0 MEFENTIN CAPSULES 250MG (MEFENAMIC ACIA) "C.C.P.C."(鋁箔/膠箔) 2

AC39074100 MINOINE ANTIBIOTIC CAP. 100MG "C.H." (MINOCYCLINE) 5.9

AC39082209 VIOHEPATIN INJECTION 0.5MG/ML (MECOBALAMIN) 15.5

AC39082212 VIOHEPATIN INJECTION 0.5MG/ML (MECOBALAMIN) 15.5

AC39087100 TRENFYLLINE S.R.F.C. TABLETS 400MG (PENTOXIFYLLINE) 1.82

AC39094209 CEFODUR FOR INJECTION (CEFOPERAZONE) "VPP" 241

AC39094212 CEFODUR FOR INJECTION (CEFOPERAZONE) "VPP" 262

AC39094277 CEFODUR FOR INJECTION (CEFOPERAZONE) "VPP" 104

AC39120100 AELICON CAPSULES 200MG (NIFURXAZIDE) Y.C." 2.48

AC39137212 NEOPHYLLIN INJECTION 150MG/ML "S.T." (DYPHYLLINE) 15

AC39144100 CLAZIDE TABLETS 80MG "JOHNSON" (GLICLAZIDE) 1.5

AC39170100 CIPROFLOXACIN F.C. TABLETS 500MG "KINGDOM" 13.1

AC39217100 WEIDOS F.C. TABLETS 150MG "WEIDAR" (RANITIDINE) 1.85

AC392171G0 WEIDOS F.C. TABLETS 150MG "WEIDAR" (RANITIDINE)(鋁箔/膠箔) 2

AC39220100 PASHIN F.C. TABLETS 25MG (CLOMIPRAMINE) "S.D." 2.7

AC39221100 BUISLINE TABLETS 10MG "H.S." (BUSPIRONE) 3.81

AC39223209 CEFULIN FOR INJECTION (CEFTAZIDIME) 63

AC39223212 CEFULIN FOR INJECTION (CEFTAZIDIME) 400

AC39223277 CEFULIN FOR INJECTION (CEFTAZIDIME) 32.3

AC39229100 IEJYHHAO TABLETS 100MG "S.C." (BENZARONE) 2.91

AC39239100 BROEN-C ENTERIC F.C. TABLETS "N.K." 5

AC39240100 WEISUN TABLETS 400MG (CIMETIDINE) "EVEREST" 1.5

AC39257100 SULPYRIDE F.C. TABLETS 200MG "H.C"(SULPIRIDE) 2.33

AC39293100 SUROLE CAPSULE 50MG (CLOMIPHENE) "STANDARD" 4.98

AC39304100 ESTROMON F.C.TABLETS 0.625MG "STANDARD" 1.85

AC393041G0 ESTROMON F.C.TABLETS 0.625MG "STANDARD"(鋁箔/膠箔) 2

AC39305100 RINDARON TABLETS 0.5MG"EVEREST" (BETAMETHASONE) 1.5

AC39306338 AG-S COMPLEX CREAM 56

AC39306348 AG-S COMPLEX CREAM 56

AC39306377 AG-S COMPLEX CREAM 480

AC39307100 DELIPIC TABLETS 20MG (LOVASTATIN) "STANDARD" 4.72

AC39312100 URICIN TABLETS 100MG (BENZBROMARONE) 2.88

AC39315100 ACYLETE TABLETS 400MG (ACYCLOVIR) 7.9

154

Page 155: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC39318212 ONZOD INJ. 2MG/ML 2ML 191

AC39319209 TONCAM INJECTION 20MG/ML (PIROXICAM) "CHI SHENG" 22.4

AC39319212 TONCAM INJECTION 20MG/ML (PIROXICAM) "CHI SHENG" 22.4

AC39345421 MORCASIN OPHTHALMIC SOLUTION 40MG/ML (SULFAMETHOXAZOLE)

"SINPHAR"

12

AC39345435 MORCASIN OPHTHALMIC SOLUTION 40MG/ML (SULFAMETHOXAZOLE)

"SINPHAR"

15.4

AC39350500 DICLOFEN SUPPOSITORY 25MG "KOJAR" (DICLOFENAC) 5

AC39351500 DICLOFEN SUPPOSITORY 12.5MG "KOJAR"(DICLOFENAC) 5

AC39368100 VIRLESS TABLETS 800MG (ACYCLOVIR) "YUNG SHIN" 35.9

AC39385100 BOLAXIN F.C. TABLETS 500MG (METHOCARBAMOL) "Y.Y" 1.5

AC393851G0 BOLAXIN F.C. TABLETS 500MG (METHOCARBAMOL) "Y.Y"(鋁箔/膠箔) 2

AC39392221 LYO-POVIGENT INJECTION 65

AC39396100 DISPEC TAB 40MG 1.5

AC39397100 ANFLUPIN TAB 100MG 3.54

AC39401100 ENALATEC TABLETS 20MG (ENALAPRIL) 1.36

AC394011G0 ENALATEC TABLETS 20MG (ENALAPRIL)(鋁箔/膠箔) 2

AC39403100 LOZUTIN TABLETS 20MG (LOVASTATIN) 4.72

AC39407100 MEKIN TABLETS 5MG "S.C." 1.52

AC394071G0 MEKIN TABLETS 5MG "S.C." (MEQUITAZINE)(鋁箔/膠箔) 2

AC394081G0 GLIUCON TABLETS 5MG (GLIBENCLAMIDE)(鋁箔/膠箔) 0.4

AC39409100 TRIVEGEN F.C. TABLETS "ROYAL" 2.17

AC39414100 SINTEC TABLETS 20MG "S.T."(ENALAPRIL) 1.89

AC394141G0 SINTEC TABLETS 20MG "S.T." (ENALAPRIL)(鋁箔/膠箔) 2

AC39429329 TORICAM GEL 10MG/G (PIROXICAM) 17.6

AC39429338 TORICAM GEL 10MG/G (PIROXICAM) 28.5

AC39429343 TORICAM GEL 10MG/G (PIROXICAM) 40.8

AC39429345 TORICAM GEL 10MG/G (PIROXICAM) 40.8

AC394293AK TORICAM GEL 10MG/G (PIROXICAM) 39.9

AC39431100 DOPADINE F.C. TABLET 100MG (AMANTADINE) "SWISS" 7.4

AC39432438 BECOTON NASAL SPRAY 0.42MG/GM (BECLOMETHASONE) "B&F" 118

AC39518100 SUFEN TABLETS 200MG (TIAPROFENIC ACID ) 3.27

AC39519100 TETRALIN CAPSULES 250MG "KOJAR" (TERACYCLINE HYDROCHLO-RIDE) 1.5

AC395191G0 TETRALIN CAPSULES 250MG (TERACYCLINE HYDROCHLO-RIDE)

"KOJAR"(鋁箔/膠箔)

2

AC39523100 OFCIN FILM COATED TABLETS 400MG (OFLOXACIN) 25.1

AC39537100 SILYMIN CAPSULE 150MG "SWISS"(SILYMARIN) 1.64

AC395371G0 SILYMIN CAPSULE 150MG (SILYMARIN) "SWISS"(鋁箔/膠箔) 2

AC39547100 CENTAL F.C. TABLETS 100MG 1.57

AC39553100 ETOFAT CAPSULES "STANDARD" 3.23

AC39560100 BACIZIDE CAPSULES 200MG (NIFUROXAZIDE) "S.C." 2.48

AC39561100 LIHOSIN F.C. TABLETS 10MG (SCOPOLAMINE BUTYLBROMIDE) 0.55

AC395611G0 LIHOSIN F.C. TABLETS 10MG (SCOPOLAMINE BUTYLBROMIDE)(鋁箔/膠

箔)

2

AC39575100 KERSYN F.C. TABLETS 100MG (TICLOPIDINE) "CHINTENG" 4.61

AC39584100 MEBEVER F.C. TABLETS 135MG "SINPHAR"(MEBEVERINE HYDROCHLORIDE) 2.2

AC395841G0 MEBEVER F.C. TABLETS 135MG "SINPHAR"(MEBEVERINE

HYDROCHLORIDE)(鋁箔/膠箔)

2

AC39589100 DEGOUT TABLETS 0.5MG (CLOCHICINE) "CHINTENG" 1.5

AC395891G0 DEGOUT TABLETS 0.5MG (CLOCHICINE) "CHINTENG"(鋁箔/膠箔) 2

AC39595100 SANPO CAPSULES 2MG (LOPERAMIDE) "CHINTENG" 1.5

AC395951G0 SANPO CAPSULES 2MG (LOPERAMIDE) "CHINTENG" (鋁箔/膠箔) 2

155

Page 156: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC39596321 CHENFU CREAM 20MG/GM"CHINTENG" (KETOCONAZOLE) 14.2

AC39596329 CHENFU CREAM 20MG/GM"CHINTENG" (KETOCONAZOLE) 14.2

AC39596335 CHENFU CREAM 20MG/GM"CHINTENG" (KETOCONAZOLE) 38.5

AC39596338 CHENFU CREAM 20MG/GM"CHINTENG" (KETOCONAZOLE) 38.7

AC39597100 SWITANE TABLET 2MG "SWISS" (TRIHEXYPHENIDYL) 1.5

AC395971G0 SWITANE TABLET 2MG "SWISS" (TRIHEXYPHENIDYL)(鋁箔/膠箔) 2

AC39598212 VEINTONIC INJECTION 0.84MG/ML "SWISS" (GINKGOFLAVONEGLYCOSIDE) 24.5

AC39600100 MINO CAPSULES 100MG "CHINTENG" (MINOCYCLINE HYDROCHLORIDE) 5.9

AC39601100 ASACOR TABLETS 20MG 4.72

AC39614338 BIFONA TOPICAL SOLUTION 10MG/ML "S.C." (BIFONAZOLE) 105

AC39614345 BIFONA TOPICAL SOLUTION 10MG/ML "S.C." (BIFONAZOLE) 129

AC39615100 CIMETIDINE TAB. 400MG 1.5

AC396151G0 CIMETIDINE TABLETS. 400MG "S.C."(鋁箔/膠箔) 2

AC39616321 AN HAO CREAM 50MG/GM "S.C." (ACYCLOVIR) 46.6

AC39616329 AN HAO CREAM 50MG/GM "S.C." (ACYCLOVIR) 46.6

AC396203AH SYAWE CREAM 50MG/GM (ACYCLOVIR)"MEIDER" 46.6

AC39623335 MEXAC OINTMENT 15G 62

AC39625100 FELDEMIN CAPSULES 20MG "EVEREST" (PIROXICAM) 1.55

AC396251G0 FELDEMIN CAPSULES 20MG "EVEREST" (PIROXICAM)(鋁箔/膠箔) 2

AC39626209 ANXICAM INJECTION 2MG/ML (LORAZEPAM) "SWISS" 15

AC39660277 SALINE INJECTION 3% "N.K." 25

AC39682100 METERONE TABLETS 10MG (MEDROXYPROGESTERONE ACETATE) 2.97

AC39684277 CEKODIN-A INJECTION (CEPHRADINE) 25.8

AC39689209 FOLSMYCIN POWDER FOR INJECTION "YUNG SHIN" (FOSFOMYCIN) 120

AC39689212 FOLSMYCIN POWDER FOR INJECTION "YUNG SHIN"(FOSFOMYCIN) 223

AC39689219 FOLSMYCIN POWDER FOR INJECTION (FOSFOMYCIN) "YUNG SHIN" 373

AC39689277 FOLSMYCIN POWDER FOR INJECTION "YUNG SHIN" (FOSFOMYCIN) 67

AC39692100 WEISU F.C. TABLETS 200MG "KOJAR" (SULINDAC) 2.03

AC396942CX TAZOCIN LYO-INJECTION 241

AC39703100 LABTAL F.C. TABLETS 200MG (LABETALOL) "SINPHAR" 3.24

AC39718100 DICLOFENAC SODIUM E.F.C.TAB. 1.5

AC39719100 ENZDASE ENTERIC F.C. TABLETS 10MG (SERRATIOPEPTIDASE) 1.5

AC39725100 MECOBALAMINE CAPSULES 0.5MG "S.C." 1.76

AC397251G0 MECOBALAMINE CAPSULES 0.5MG "S.C."(鋁箔/膠箔) 2

AC39728100 MOTALINE TAB. 10MG 1.5

AC39731100 JOINTELL CAPSULES 300MG "EVEREST" (GEMFIBROZIL) 1.52

AC39734100 DICRON TABLETS 80MG "S.Y."(GLICLAZIDE) 1.5

AC39740100 KENCORT TABLETS 4MG "EVEREST"(TRIAMCINOLONE) 1.5

AC39769100 ROSUP CAPSULES 25MG (LOXAPINE) "SWISS" 4.07

AC39772100 VOKER FILM COATES TABLETS 40MG (FAMOTIDINE) 5.7

AC39775100 NAPTON F.C. TABLETS 275MG (NAPROXEN SODIUM) "B&F" 1.5

AC39778100 SEPIRONE TABLETS 10MG 3.81

AC39782265 TRICEF FOR IM. INJECTION (CEFTRIAXONE) "SWISS" 100

AC39782277 TRICEF FOR IM. INJECTION (CEFTRIAXONE) "SWISS" 100

AC39788100 EGOLDER TABLETS 60MG "H.S." 1.5

AC397881G0 EGOLDER TABLETS 60MG "H.S." (鋁箔/膠箔) 2

AC39790100 BENRONE TABLETS100MG "WEIDAR" (BENZBROMARONE) 2.88

AC39793100 OFLODAL F.C. TABLETS 100MG (OFLOXACIN) 1.85

AC39797100 OFCIN FILM COATED TABLETS 200MG (OFLOXACIN) 2.95

AC39798100 OFCIN FILM COATED TABLETS 100MG (OFLOXACIN) 1.85

AC39812321 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 11.2

AC39812329 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 17.6

AC39812335 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 28.5

156

Page 157: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC39812338 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 28.5

AC39812340 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 39.9

AC39812343 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 40.8

AC39812345 ENTON GEL10MG/GM "CHINTENG" (PIROXICAM) 40.8

AC39812355 ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 225

AC398123AK ENTON GEL 10MG/GM (PIROXICAM) "CHINTENG" 39.9

AC39819100 OXACIN F.C. TABLETS 200MG "CHINTENG" (OFLOXACIN) 2.95

AC39822100 ESTRADE TABLETS 2MG(ESTRADIOL) 1.77

AC398221G0 ESTRADE TABLETS 2MG (ESTRADIOL)(鋁箔/膠箔) 2

AC39830212 GENTAMICIN INJECTION 40MG/ML "N.K." 15

AC39830229 GENTAMICIN INJECTION 40MG/ML "N.K." 16.9

AC39830238 GENTAMICIN INJECTION 40MG/ML "N.K." 61

AC39851100 CYMA CAPSULES "CHINTENG" 1.5

AC398511G0 CYMA CAPSULES."CHINTENG" (鋁箔/膠箔) 2

AC39855100 DRINGEN S.C. TABLETS 10MG "EVEREST"(METOCLOPRAMIDE) 1.5

AC39859143 CYPROH SOLUTION 0.4MG/ML "KOJAR" (CYPROHEPTADINE

HYDROCHLORIDE)

25

AC39859151 CYPROH SOLUTION 0.4MG/ML "KOJAR" (CYPROHEPTADINE

HYDROCHLORIDE)

25

AC39859157 CYPROH SOLUTION 0.4MG/ML "KOJAR" (CYPROHEPTADINE

HYDROCHLORIDE)

25

AC39863100 GINCARE FILM COATED TABLETS 9.6MG (GINKGOFLAVONGLYCOSIDES) 2.24

AC39867100 ANZEN ENTERIC F.C. TABLET "S.C." (SERRATIOPEPTIDASE) 1.5

AC39879100 VARAPAMIL TABLETS 40MG "F.Y." 1.66

AC39880129 SPEEDON POWDER "N.K."(LACTITOL) 8.5

AC39880138 SPEEDON POWDER (LACTITOL) "N.K." 14.1

AC39893100 IBUPROFEN TABLETS 400MG "F.Y" 1.5

AC398931G0 IBUPROFEN TABLETS 400MG "F.Y."(鋁箔/膠箔) 2

AC39896100 "SINSULIN TABLETS 10MG ""ASTAR""" 1.62

AC398961G0 "SINSULIN TABLETS 10MG ""ASTAR""(鋁箔/膠箔)" 2

AC39910100 POSMETAN F.C.TAB. 1.5

AC39928100 KOWELL TABLETS 2MG "EVEREST" 1.5

AC399281G0 KOWELL TABLETS 2MG "EVEREST"(鋁箔/膠箔) 2

AC39931100 KOJARCLINDA CAPSULES 150“KOJAR” (CLINDAMYCIN HYDROCHLORIDE) 1.5

AC399311G0 KOJARCLINDA CAPSULES 150“KOJAR” (CLINDAMYCIN

HYDROCHLORIDE)(鋁箔/膠箔)

2

AC39932100 LOMIDINE TABLETS 10MG (LORATADINE) "H.S." 1.5

AC399321G0 LOMIDINE TABLETS 10MG (LORATADINE) "H.S."(鋁箔/膠箔) 2

AC39940209 CEFT-S FOR I.V INJECTION (CEFTRIAXONE )"STANDARD" 193

AC39940277 CEFT-S FOR I.V INJECTION (CEFTRIAXONE )"STANDARD" 100

AC39944219 SUPREN INJECTION 2MG/ML"S.T." (ONDANSETRON) 217

AC39945100 N.F.S. F.C. TABLETS 200MG "C.H." (NORFLOXACIN) 2.44

AC39950100 KOJARCLINDA CAPSULES 300MG "KOJAR" (CLINDAMYCIN) 2.86

AC39953500 DOMPERID SUPPOSITORY 10MG "KOJAR" (DOMPERIDONE) 5

AC39962100 DAMIN CAPSULES 2MG (PRAZOSIN HYDROCHLORIDE) "S.C." 3.53

AC39969100 MOTIN TABLETS 10MG "Y.J."(DOMPERIDONE) 1.5

AC39974100 SINTEC TABLETS 5MG "S.T." (ENALAPRIL) 1.89

AC399741G0 SINTEC TABLETS 5MG "S.T." (ENALAPRIL)(鋁箔/膠箔) 2

AC39979100 ANLIN TABLETS 5MG "EVEREST"(DIAZEPAM) 1.5

AC40011100 ACEMET CAPSULES 60MG (ACEMETACIN) 1.69

AC400111G0 ACEMET CAPSULES 60MG (ACEMETACIN)(鋁箔/膠箔) 2

AC40038100 SCHNIN F.C.TABLETS 9.6MG (GINKGOFLAVON GLYCOSIDE) 1.74

AC40042100 NEUQUINON S.C. TABLETS 10MG 3.57

157

Page 158: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC40045277 SORLATE INJECTION "CHI SHENG" 43.8

AC40047100 BENTOMIN TABLETS 500MG "S.C." (METFORMIN) 1.5

AC400471G0 BENTOMIN TABLETS 500MG "S.C."(METFORMIN)(鋁箔/膠箔) 2

AC40051100 AZU TABLETS 2 MG(AZULENE) "S.D." 1.5

AC40062100 WELLHEALTH F.C.TAB.300MG 6.3

AC40065100 FANCIN CAPSULES 500MG "EVEREST"(TINIDAZOLE) 2.09

AC40073151 CO-BO SYRUP "D.J." 25

AC40085100 BUISLINE TABLETS 5MG "H.S."(BUSPIRONE) 1.54

AC400851G0 BUISLINE TAB.5MG "H.S."(BUSPIRONE)(鋁箔/膠箔) 2

AC40090100 ACYLETE TABLETS 200MG (ACYCLOVIR) 7

AC40091100 AZOL-FLUCON CAPSULES 150MG(FLUCONAZOLE) 61

AC40096162 ALL-RIGHT CALCIUM SUSPENSION "STANDARD" 172

AC40099214 EUCOL LYOPHILIZED INJECTION 2.5G "STANDARD" 362

AC40106100 SYNORID TABLETS 100MG (ALLOPURINOL) 1.5

AC401061G0 SYNORID TABLETS 100MG (ALLOPURINOL)(鋁箔/膠箔) 2

AC40121100 NAPOSIN ENTERIC F.C. TABLETS 500MG (NAPROXEN) 3.26

AC40122100 NAPOSIN ENTERIC F.C. TABLETS 250MG (NAPROXEN) 1.5

AC40123100 TERBELINE TAB. 2.5MG 1.5

AC40124100 METERONE TABLETS 5MG (MEDROXYPROGESTERONE ACETATE) 1.57

AC40134100 SEPIRONE TABLETS 5 MG 1.54

AC40147100 PURSIN F.C. TABLET 500MG "PURZER" (IBUPROFEN LYSINATE) 1.78

AC401471G0 PURSIN F.C. TABLET 500MG "PURZER" (IBUPROFEN LYSINATE)(鋁箔/膠

箔)

2

AC40148100 FLUZEPAM TABLETS 2MG (FLUNITRAZEPAM) 2.45

AC40149321 E.T CREAM 11.7

AC40149329 E.T CREAM 21.8

AC40149335 E.T CREAM 36.2

AC40150338 AN FU CREAM "C.H." 56

AC40151321 YI-FU CREAM "S.C." 16.1

AC40151329 YI-FU CREAM "S.C." 24.5

AC40151335 YI-FU CREAM "S.C." 47.3

AC40152100 HOMAGYL TABLETS 50MG "H.C" (SULPIRIDE) 1.66

AC40168100 SIDALAT SOFT CAP. 10MG 2

AC401681G0 SIDALAT SOFT CAPSULES 10MG "CHINTENG" (NIFEDIPINE) (鋁箔/膠箔) 2

AC40174100 BENZRO CAPSULES "C.H." 2.88

AC40175100 LYSOZYME CHLORIDE TABLETS 90MG "F.Y." 1.5

AC40196100 JIAWILLER F.C.TABLET 20MG "C.L" [FAMOTIDINE] 1.92

AC40198100 MESYREL TABLET 150MG "M.S."(TRAZODONE HYDROCHLORIDE) 12.8

AC40206100 VOKER FILM COATED TABLET 20MG(FAMOTIDINE) 1.92

AC402061G0 VOKER FILM COATED TABLET 20MG(FAMOTIDINE)(鋁箔/膠箔) 2

AC40207100 FENOT TAB. 2.5MG 1.5

AC402071G0 "FENOT TAB. 2.5MG""H.S.""(FENOTEROL HYDROBROMIDE)(鋁箔/膠箔)" 2

AC40232100 JIACANG TABLETS 1.5

AC402321G0 JIACANG TABLETS(鋁箔/膠箔) 2

AC40233100 GLIX TABLETS 5MG (GLIPIZIDE) "YUNG SHIN" 1.5

AC402331G0 GLIX TABLETS 5MG (GLIPIZIDE) "YUNG SHIN"(鋁箔/膠箔) 2

AC40245321 KOJARCORT CREAM "KOJAR" 11.7

AC40245329 KOJARCORT CREAM "KOJAR" 21.8

AC40245335 KOJARCORT CREAM "KOJAR" 36.2

AC40245338 KOJARCORT CREAM "KOJAR" 36.2

AC40245355 KOJARCORT CREAM"KOJAR" 135

AC40249100 MEVOLING TABLETS 200MG (SULPIRIDE) "KOJAR" 2.33

AC40265100 DAZID TABLETS "H.S" 1.5

158

Page 159: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC40292500 CARESS SUPPOSITORIES "MEIDER" 5

AC40293100 "URICAM TABLETS 50MG ""TAI YU"" (BENZBROMARONE)" 1.5

AC40294100 HYBOZIDE TAB 50MG 1.5

AC40300100 POULICAN-U SOFT CAPSULE 150MG "SINPHAR"(SILYMARIN) 1.64

AC40302100 DESPUTIN TAB 30MG 1.5

AC40333100 OSTALFA SOFT CAPSULES 0.25UG "F.M."(ALFACALCIDOL) 4.91

AC40334100 MACALOL SOFT CAPSULES 0.5UG "F.M."(CALCITRIOL) 5.1

AC40352100 DANAMIN CAPSULES 100MG "CHIHTENG"(DANAZOL) 11.1

AC40356100 CLOMI CAPSULES 25MG "CHINTENG"(CLOMIPRAMINE) 2.7

AC40358345 FLUR DI FEN PATCH 40MG/12GM 6.4

AC40363100 VOREN E.C. TABLETS 75MG (DICLOFENAC SODIUM) 1.5

AC40399100 FORFLOW SUSTAINEDRELEASED TABLETS 400MG "M.S."(PENTOXIFYLLINE) 2.2

AC40424100 PAR YIH TABLETS 5MG "C.H." (OXYBUTYNIN CHLORIDE) 2.75

AC40426100 S.K.J.CAPSULES 250MG "C.H."(ERYTHOMYCIN) 2.15

AC40428100 EDEPIN TABLETS 5MG "SWISS" (AMILORIDE) 2.88

AC40429100 SUPEROCIN F.C. TABLETS 250MG "WEIDAR" (CIPROFLOXACIN

HYDROCHLORIDE)

9.8

AC40458321 AESCIN GEL 15MG/G "C.H."(ESCIN) 35.8

AC40458338 AESCIN GEL 15MG/G "C.H."(ESCIN) 111

AC40513100 BUEDOR TABLETS 1MG "S.C." (BUMETANIDE) 2.23

AC40523100 CIRZODONE TABLET 100MG "SINPHAR" (TRAZODONE HYDROCHLORIDE) 4.14

AC40532100 ENOLI CAPSULES 400MG "CHINTENG" (PIRACETAN) 1.5

AC405321G0 ENOLI CAPSULES 400MG "CHINTENG" (PIRACETAN)(鋁箔/膠箔) 2

AC40536100 IBUPROFEN TABLETS 400MG "SWISS" 1.5

AC405361G0 IBUPROFEN TABLETS 400MG "SWISS"(鋁箔/膠箔) 2

AC405361G2 IBUPROFEN TABLETS 400MG "SWISS"(28粒/瓶) 2

AC405361G4 IBUPROFEN TABLETS 400MG "SWISS"(56粒/瓶) 2

AC405361G6 IBUPROFEN TABLETS 400MG "SWISS"(112粒/瓶) 2

AC40542100 BACCIDAL F.C 200MG 2.44

AC40544100 CLOPRAN F.C. TABLETS 25MG (CLOMIPRAMINE) 2.7

AC40545100 SUSINE F.C.TABLETS 200MG (SULPIRIDE) "SWISS" 2.33

AC40564100 IBUPROFEN F.C.TABLETS 400MG "SWISS" 1.5

AC405641G0 IBUPROFEN F.C. TABLETS 400MG "SWISS"(鋁箔/膠箔) 2

AC405641G2 IBUPROFEN F.C. TABLETS 400MG "SWISS"(28粒/瓶) 2

AC405641G4 IBUPROFEN F.C. TABLETS 400MG "SWISS"(56粒/瓶) 2

AC405641G6 IBUPROFEN F.C. TABLETS 400MG "SWISS"(112粒/瓶) 2

AC40567100 LOPERATIN TABLETS 2MG "EVEREST"(LOPERAMIDE) 1.5

AC40568100 GINGONIN F.C. TABLETS 40MG "Y.C." (GINKGOFLAVONGLYCOSIDES) 2.24

AC40569321 CONAZOL CREAM 20MG /GM "STANDARD"(KETOCONAZOLE) 14.2

AC40569335 CONAZOL CREAM 20MG /GM "STANDARD"(KETOCONAZOLE) 38.5

AC40569338 CONAZOL CREAM 20MG /GM (KETOCONAZOLE) "STANDARD" 38.7

AC40573100 NYSTATIN CAPSULES 500000UNITS "CHIN TENG" 2.83

AC40575100 EBUFEN F.C.TABLETS 400MG (IBUPROFEN) "S.C" 1.5

AC40576100 ZINBOSS TABLETS "C.H." (ZINC GLUCONATE) 1.5

AC40580100 EDENIL TABLETS 2.49

AC40643100 S.K.J.TABLETS 500MG "C.H." (ERYTHROMYCIN ESTOLATE) 3.67

AC40649100 MEBERINE TABLETS 135MG (MEBEVERINE HCL) "Y.C." 2.2

AC40651500 YI-FU VAGINAL TABLETS 100MG (ISOCONAZOLE) "S.C." 5.4

AC40653100 EXTACOL TAB. 200MG 2.56

AC40655100 DEXTROLAMINE TABLETS 20MG (DEXTROMETHORPHAN HYDROBROMIDE)

"S.C."

1.21

AC40666248 FLUCON FOR IV INJECTION 361

159

Page 160: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC40666255 FLUCON FOR IV INJECTION 422

AC40685100 "COYENPIN E.C.TABLETS 50MG (DICLOFENAC SODIUM) ""ROOT""" 1.5

AC406851G0 "COYENPIN E.C.TABLETS 50MG (DICLOFENAC SODIUM) ""ROOT"(鋁箔/膠

箔)"

2

AC40686100 DICLOFEN ENTERIC-MICRO-ENCAPSULED CAPSULES 50MG "H.S."

(DICLOFENAC SODIUM)

1.5

AC406861G0 DICLOFEN ENTERIC-MICRO-ENCAPSULED CAPSULES 50MG (DICLOFENAC

SODIUM) "H.S."(鋁箔/膠箔)

2

AC40699100 GINKGOCENTRATE F.C. TABLET 9.6MG "SINPHAR"

(GINKGOFLAVONGLYCOSIDES)

2.24

AC40706151 SORTUSS COUGH LIQUID "CENTER" 25

AC40706157 SORTUSS COUGH LIQUID "CENTER" 25

AC40715100 BACLOFEN TABLETS 10MG "JOHNSON" 1.5

AC40716100 BACLOFEN TABLETS 5MG"JOHNSON" 1.5

AC407161G0 BACLOFEN TABLETS 5MG"JOHNSON"(84粒/瓶) 2

AC40724421 KOSA ORABASE 0.1% (DEXAMETHASONE) "STANDARD" 55

AC40765129 LIQUID BROWN MIXTURE (WITH OPIUM) "CENTER" 25

AC40765151 LIQUID BROWN MIXTURE (WITH OPIUM) "CENTER" 25

AC40765157 LIQUID BROWN MIXTURE (WITH OPIUM) "CENTER" 26.9

AC40765163 LIQUID BROWN MIXTURE (WITH OPIUM) "CENTER" 30.2

AC40767343 TONEX CREAM 10MG/GM (PIROXICAM) "MEIDER" 40.8

AC40767345 TONEX CREAM 10MG/GM "MEIDER" (PIROXICAM) 40.8

AC40774100 ANTON TAB. 250MG "EVEREST"(DIFLUNISAL) 6.9

AC40776100 ROLAX TABLETS 10MG "EVEREST" (BACLOFEN) 1.5

AC40778321 LEDERNIN OINTMENT "EVEREST" 11.7

AC40778329 LEDERNIN OINTMENT "EVEREST" 21.8

AC40778335 LEDERNIN OINTMENT "EVEREST" 36.2

AC407811G0 GLUCOFIT F.C.TABLETS 500MG "SWISS" (METFORMIN) (鋁箔/膠箔) 2

AC407811G4 GLUCOFIT F.C.TABLETS 500MG "SWISS" (METFORMIN) (60粒/瓶) 2

AC407811G7 GLUCOFIT F.C.TABLETS 500MG "SWISS" (METFORMIN) (168粒/瓶) 2

AC40782100 LIVERON S.C.TABLETS 25MG "EVEREST" (ANETHOL) 1.5

AC40783100 TRANCOSIL TABLETS 200MG "EVEREST" (CHLORMEZANONE) 1.5

AC40787100 SORIALEN F.C.TABLETS 10MG "SWISS" (METHOXSALEN) 18.5

AC40790100 MEDORONE TABLETS 5MG (NORETHINDRONE ACETATE) "S.C." 2.12

AC40791100 CYPROH TABLETS 4MG "KOJAR" (CYPROHEPTADINE HYDROCHLORIDE) 1.5

AC407911G0 CYPROH TABLETS 4MG (CYPROHEPTADINE HYDROCHLORIDE "KOJAR"(鋁箔/

膠箔)

2

AC40794100 COSOPIN TABLETS "CHINTENG" 1.5

AC407941G0 COSOPIN TABLETS "CHINTENG" (鋁箔/膠箔) 2

AC40796321 TRIMALON CREAM 11.7

AC40796329 TRIMALON CREAM 21.8

AC40796335 TRIMALON CREAM 36.2

AC40808321 KEPOLINE OINTMENT 5% "EVEREST" (ACYCLOVIR) 46.6

AC40813209 GLYCAL-AMIN INJECTION 264

AC40813277 GLYCAL-AMIN INJECTION 185

AC408132A1 GLYCAL-AMIN INJECTION 370

AC40825100 ZINCO TABLETS 78MG (ZINC GLUCONATE) "ROYAL" 1.5

AC40835100 MEFORIN F.C.TAB. 500MG 1.5

AC40864100 U-CA SOFT CAPSULE 0.25MCG (CALCITRIOL) "SINPHAR" 2.66

AC40868321 KETOSONE CREAM 20MG/GM "PBF" (KETOCONAZOLE) 14.2

AC40868329 KETOSONE CREAM 20MG/GM "PBF" (KETOCONAZOLE) 14.2

AC40868335 KETOSONE CREAM 20MG/GM "PBF" (KETOCONAZOLE) 38.5

AC40870100 BROWN MIXTURE TABLETS (WITH OPIUM) "CENTER" 1.5

AC408701G0 BROWN MIXTURE TABLET (WITH OPIUM) "CENTER"(鋁箔/膠箔) 2

160

Page 161: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC40871100 COMPOUND GLYCYRRHIZA MIXTURE TABLET "CENTER" 1.5

AC408711G0 COMPOUND GLYCYRRHIZA MIXTURE TABLET "CENTER"(鋁箔/膠箔) 2

AC40881100 LINCO CAPSULES 500MG"S.Y"(LINCOMYCIN HYDROCHLORIDE) 5.5

AC40887100 TNYH TABLETS 10MG "CHIN TENG" (OXETHAZAINE) 1.5

AC40892100 NALOXEN F.C. TABLETS 550MG "PBF"(NAPROXEN SODIUM) 3.26

AC40894100 LIVORIN CAPSULES 150MG "WEIDAR" (SILYMARIN) 1.64

AC408941G0 LIVORIN CAPSULES 150MG (SILYMARIN) "WEIDAR" (鋁箔/膠箔) 2

AC40974500 CLOMAZOLE VAGINAL TABLETS 500MG "VPP" (CLOTRIMAZOLE) 16

AC40977100 SWITANE TABLETS 5MG "SWISS" (TRIHEXYPHENIDYL) 1.5

AC409771G0 SWITANE TABLETS 5MG "SWISS" (TRIHEXYPHENIDYL)(鋁箔/膠箔) 2

AC40979100 MEQAZINE TABLETS 5MG "Y.C." (MEQUITAZINE) 1.52

AC40986100 WEIMOK F.C.TAB. 20MG "WEIDAR" (FAMOTIDINE) 1.92

AC41013209 CETA FOR INJECTION "CHI SHENG"(CEFTAZIDIME) 63

AC41013277 CETA FOR INJECTION "CHI SHENG"(CEFTAZIDIME) 32.3

AC41017100 ERGOLOID TAB. 1.5MG 1.54

AC41019100 BIPER TABLETS 2MG "S.C."(BIPERIDEN) 2.19

AC41020100 MESURIN TABLETS 2MG"S.C"(METHYLPREDNISOLONE) 1.66

AC41022100 CHUNLIN CAPSULES "ROOT"(NIFUROXAZIDE) 2.48

AC41023100 BUFEN TABLET 200MG "CHINTENG" (FENBUFEN) 1.5

AC41024100 FREE TAB.2MG 2.19

AC41025100 TOLIZOLE CAP. 250MG 1.64

AC410251G0 TOLIZOLE CAPSULES 250MG"KOJAR"(METRONIDAZOLE)(鋁箔/膠箔) 2

AC41029100 TRIAMCINOLONE TABLETS 4MG "KOJAR" 1.5

AC41030100 SUBILIN TAB. 60MG 1.5

AC410301G0 SUBILIN TABLETS 60MG "KOJAR" 8PSEUDOEPHEDRINE

HYDROCHLORIDE)(鋁箔/膠箔)

2

AC41038100 PENPHYLLINE FILM-COATED SUSTAINED-RELEASE TABLETS 400MG

(PENTOXIFYLLINE)

2.2

AC41039100 GLU ZIN TAB. 1.5

AC41040438 BELAX AQUA NASAL SPRAY 0.42MG/GM 118

AC41041100 UCOCAL TAB. 950MG 2.03

AC41057321 "CLOBA CREAM 0.5MG/GM ""S.Y."" (CLOBETASONE)" 39.8

AC41057329 CLOBA CREAM 0.5MG/GM "S.Y." (CLOBETASONE) 44.4

AC41057330 CLOBA CREAM 0.5MG/GM"S.Y" 70

AC41057335 CLOBA CREAM 70

AC41057343 CLOBA CREAM 30GM 121

AC41058100 NIFEPINE SUSTAINED RELEASE 20MG F.C.T "ROYAL" 5

AC41063100 AMADINE CAPSULE 100MG "KOJAR" (AMANTADINE HYDROCHLORIDE) 7.4

AC41065100 ANEDANE CAPSULES 25MG "KOJAR" (ANETHOLE) 1.5

AC41069100 TRAN CAPSULES 250MG "KOJAR" 1.52

AC410691G0 TRAN CAPSULES 250MG "KOJAR"(鋁箔/膠箔) 2

AC41167100 SUKEYEN CAPSULES 50MG "KOJAR" (KETOPROFEN) 1.91

AC411671G0 SUKEYEN CAPSULES 50MG (KETOPROFEN)(鋁箔/膠箔) 2

AC41169100 KOJAZYME TABLETS 90MG "KOJAR" 1.5

AC411691G0 KOJAZYME TABLETS 90MG "KOJAR"(鋁箔/膠箔) 2

AC41174277 TALAMIN-HEPA INJECTION 220

AC41220100 ASPLATELET E.C. CAPSULE 100MG "PBF" (ASPIRIN) 1.5

AC41224100 SUCAN CAPSULES 150MG "YU SHENG" (SILYMARIN) 1.64

AC412241G0 SUCAN CAPSULES 150MG "YU SHENG" (SILYMARIN)(鋁箔/膠箔) 2

AC41225100 BIWEISHI F.C. TAB. 120MG 6.3

AC41229321 "CLEODACIN GEL 10MG/GM ""S.Y.""(CLINDAMYCIN PHOSPHATE)" 9.1

AC41229329 "CLEODACIN GEL 10MG/GM ""S.Y.""(CLINDAMYCIN PHOSPHATE)" 17.9

AC41229335 CLEODACIN GEL 15GM 28.3

AC41229338 CLEODACIN GEL 10MG/GM"S.Y."(CLINDANMYEIN PHOSPHATE) 83

AC41229343 CLEODACIN GEL30GM 186

161

Page 162: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC41230100 FENOTEROL TAB. 2.5MG 1.5

AC41234151 IBUFEN SUSPENSION 20MG/ML "C.H."(IBUPROFEN) 25

AC41234157 IBUFEN SUSPENSION 20MG/ML "C.H."(IBUPROFEN) 67

AC41238100 HICATROL SOFT CAPSULES 0.5UG "CHINTENG"(CALCITRIOL) 5.1

AC41239100 HICALOL SOFT CAPSULES 0.25UG "CHINTENG"(CALCITRIOL) 2.66

AC41247100 CARPINE TABLETS 200MG "S.T."(CARBAMAZEPINE) 2.79

AC41268100 KANYEN CAPSULES 200MG "KOJAR" (FLUFENAMIC ACID) 1.77

AC412681G0 KANYEN CAPSULES 200MG "KOJAR" (FLUFENAMIC ACID)(鋁箔/膠箔) 2

AC41269100 PRIPRAM TABLETS 5MG "KOJAR" (METOCLOPRAMIDE HYDROCHLORIDE) 1.5

AC41270100 KUETONBILY TABLETS 10MG "KOJAR" (DICYCLOMINE HYDROCHLORIDE) 1.5

AC41275151 TRACESLIN SYRUP 0.4MG/ML (SALBUTAMOL SULFATE) 25.2

AC41280100 KINXETIN CAPSULES 20MG "KINGDOM"(FLUOXETINE) 2.77

AC41284100 INTESTICIN TAB. 1.5

AC41296100 TENTON CAPSULES 25MG "KOJAR" (INDOMETHACIN) 1.5

AC412961G0 TENTON CAPSULES 25MG (INDOMETHACIN) "KOJAR"(鋁箔/膠箔) 2

AC41314151 BISUN ANTI-COUGH SYRUP 25

AC41314157 BISUN ANTI-COUGH SYRUP 52

AC41316100 COLCHICINE TABLETS 0.5MG "S.T." 1.5

AC413161G0 COLCHICINE TABLETS 0.5MG "S.T."(鋁箔/膠箔) 2

AC41318100 ASUTAF F.C. TABLET "Y.C." 1.5

AC41329100 SUNLING TABLETS 4MG "KOJAR" (SALBUTAMOL) 1.5

AC41330100 ASTREX CAPSULES 200MG (CETRAXATE) 7.5

AC41338100 JUXAC CAP.20MG 2.77

AC41342238 VASOSIN INJECTION 20UNITS/ML "PURZER"(ARGININE VASOPRESSIN) 234

AC41344100 PIROCAN CAP. 10MG 1.5

AC41350100 TRAZO F.C. TABLETS 100MG "C.H." (TRAZODONE HYDROCHLORIDE) 4.14

AC41352100 ULSTOP F.C. TABLETS 20MG "C.H." (FAMOTIDINE) 1.92

AC413521G0 ULSTOP F.C. TABLETS 20MG "C.H." (FAMOTIDINE)(鋁箔/膠箔) 2

AC41358100 MEDLIN TAB. 4MG 1.66

AC413581G0 MEDLIN TABLETS 4MG "KOJAR" (METHYLPREDNISOLONE) (鋁箔/膠箔) 2

AC41373100 AMANDIN CAP. 100MG"T.F."(AMANTADINE) 7.4

AC41380100 INOLIM TABLETS 3MG "KOJAR"(TRIMETOQUINOL) 1.5

AC41391100 KINAZOLE CAPSULES 150MG "KINGDOM" (FLUCONAZOLE) 61

AC41420100 SILIBIN CAP. 70MG 1.57

AC414201G0 "SILIBIN CAPSULES 70MG"H.S." (SILYMARIN)(鋁箔/膠箔) 2

AC41429100 NAPROXEN SODIUM TABLETS 275MG "S.C." 1.52

AC41430100 ENALATEC TAB. 5MG 1.89

AC41435100 FEPRON CAPSULES 200MG(FENOPROFEN)"Y.Y." 4.83

AC41437321 YA FU CREAM "STANDARD" 14.7

AC41437335 YA FU CREAM "STANDARD" 35.1

AC41443209 U-VANCO INJECTION 500MG 1GM(VANCOMYCIN) "U-LIANG" 317

AC41443277 U-VANCO INJECTION 500MG 1GM(VANCOMYCIN) "U-LIANG" 101

AC41445100 "TTY"BUSROON TABLETS 10MG (BUSPIRONE HYDROCHLORIDE) 3.81

AC41454100 SOTER TABLETS 2.5MG "CHINTENG" (TERBUTALINE) 1.5

AC414541G0 SOTER TABLETS 2.5MG "CHINTENG" (TERBUTALINE)(鋁箔/膠箔) 2

AC41465100 KINAX TAB. 1MG "KINGDOM"(ALPRAZOLAM) 3.44

AC41476100 KOJASPOL FILM COATED TABLETS 9.6MG "KOJAR" 2.24

AC41481151 DOMPEDON SUSPENSION 1MG/ML "STANDARD" (DOMPERIDONE) 27.8

AC41482321 TOLFENE CREAM "CHINTENG" 20

AC41482329 TOLFENE CREAM "CHINTENG" 30.9

162

Page 163: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC41482335 TOLFENE CREAM "CHINTENG" 41.8

AC41488100 FYLIN RETARD F.C.TABLETS 400MG "C.H."(PENTOXIFYLLINE) 2.2

AC41492265 VIRLESS INJ. 505

AC41497100 ATINOL F.C. TABLETS 100MG 1.6

AC414971G0 ATINOL F.C TABLET 100MG (ATENOLOL) "S.Y." (鋁箔/膠箔) 2

AC41499100 CIRZODONE TABLET 50MG "SINPHAR" (TRAZODONE HYDROCHLORIDE) 1.93

AC41511100 ENCINE E.M. CAPSULES 100MG "EVEREST" 1.5

AC415111G0 ENCINE E.M. CAPSULES 100MG "EVEREST"(鋁箔/膠箔) 2

AC41514321 PIROCAN GEL 10MG/GM 5GM 11.2

AC41514329 PIROCAN GEL 10G 17.6

AC41514335 PIROCAN GEL 15GM 28.5

AC41514338 PIROCAN GEL 20G 28.5

AC41514343 PIROCAN GEL 10MG/GM 30G 40.8

AC41518100 MEBLIN TABLETS 50MG "S.C."(MEBHYDROLIN) 1.5

AC41530100 WEICON-BI TAB. 300MG 6.3

AC41536100 SODAN TABLETS 100MG "C.H."(URSODESOXYCHOLIC ACID) 2.69

AC41537321 GENTA CREAM 0.1%(GENTAMICIN SULFATE)"CHINTENG" 20

AC41537329 GENTA CREAM 0.1% "CHINTENG"(GENTAMICIN SULFATE) 20

AC41537335 GENTA CREAM 0.1%(GENTAMICIN SULFATE)"CHINTENG" 49.4

AC41540100 LUNAR F.C. TABLETS“MACRO” 7.8

AC41542100 OXACIN F.C.TABLETS 100MG "CHINTENG" (OFLOXACIN) 1.85

AC41543265 TALAMIN-NEPHRO INJECTION 203

AC41544100 MEPAZOLE TABLETS 5MG 1.5

AC41545100 ALDACTIN TABLETS 1.5

AC415451G0 ALDACTIN TABLETS(鋁箔/膠箔) 2

AC41547100 MOREFINE F.C. TABLETS 100MG "VPP"(CHLORPROMAZINE

HYDROCHLORIDE)

1.54

AC41548100 ANGINAR F.C. TABLETS 25MG "PURZER" (DIPYRIDAMOLE) 1.5

AC415481G0 ANGINAR F.C. TABLETS 25MG "PURZER" "(DIPYRIDAMOLE) (鋁箔/膠

箔)

2

AC41554100 NORAXIN F.C. TABLETS 200MG "STANDARD" (NORFLOXACIN) 2.44

AC415541G0 NORAXIN F.C. TABLETS 200MG "STANDARD" (NORFLOXACIN)(鋁箔/膠箔) 2

AC41557100 TLRAMTOR CAPSULES 50MG "PATRON"(TRAMADOL)HYDROCHLORIDE 3.88

AC41558335 ETO GEL 100MG/GM (ETOFENAMATE) 34.1

AC41558345 ETO GEL 100MG/GM (ETOFENAMATE) 106

AC41560100 TRAZO F.C. TABLETS 50MG "C.H."(TRAZODONE HYDROCHORIDE) 1.93

AC415601G0 TRAZO F.C. TABLETS 50MG "C.H."(TRAZODONE HYDROCHLORIDE)(鋁箔/

膠箔)

2

AC41561277 LYTOL INFUSION 43.8

AC41563100 GLIGEN TABLETS 80MG "H.C" (GLICLAZIDE) 1.5

AC41568265 TALAMIN-HBC INJECTION 270

AC41568277 TALAMIN-HBC INJECTION 442

AC41570321 FLUSALIC OINTMENT "SINPHAR" 39.6

AC41570335 FLUSALIC OINTMENT "SINPHAR" 60

AC41574100 CARMAPINE C.R.TAB. 400MG 8.6

AC41577100 DESTONE TAB. 540MG "N.K" (POTASSIUM CITRATE) 4.52

AC41597100 CONTAN TABLETS 5MG "CHINTENG" (GLIPIZIDE) 1.5

AC41605100 L.K.T. E.C. TABLETS 25MG "C.H."(DICLOFENAC SODIUM) 1.5

AC41631100 KETO FILM COATED TABLETS 10MG (KETOROLAC) 5.8

AC41633363 BETASONE SOLUTION 0.1% "CHINTENG" (BETAMETHASONE VALEARATE) 326

AC41638100 ANLIN TABLETS 2MG "EVEREST" (DIAZEPAM) 1.5

AC41640100 BEMARON TABLETS 100MG "S.C."(BENZBROMARONE) 2.88

AC41645100 TRAZATE CAPSULES 200MG "SINPHAR" (CETRAXATE) 7.5

163

Page 164: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC41659100 ANZA TABLETS "CHINTENG" 2.49

AC416641G0 FLAMQUIT F.C.TABLETS 50MG "SWISS" (DICLOFENAC POTASSIUM)(鋁箔/

膠箔)

2

AC41673100 SULFIN TABLETS 100MG (SULFINPYRAZONE) "TTY" 4

AC41732416 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 18.5

AC41732417 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 23.8

AC41732421 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 28.4

AC41732423 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 42.7

AC41732429 SEU-SU ORAL BASE 0.1% (TRIAMCINOLONE ACETONIDE) 64

AC41734100 LISHIN TAB. 200MG 2.33

AC41749100 ZATIZEN TABLETS 1MG "S.C."(KETOTIFEN) 1.75

AC417501G0 GLIBUDON F. C. TABLETS 500MG(METFORMIN HYDROCHLORIDE)(鋁箔/

膠箔)

0.8

AC41751248 CIXA IV INFUSION SOLUTION 2MG/ML "STANDARD" (CIPROFLOXACIN) 288

AC41751255 CIXA IV INFUSION SOLUTION 2MG/ML "STANDARD" (CIPROFLOXACIN) 628

AC41753321 AZEIC-A CREAM 200MG/GM "SINPHAR" (AZELAIC ACID) 28

AC41753329 AZEIC-A CREAM 200MG/GM "SINPHAR."(AZELAIC ACID) 54

AC41753330 AZEIC-A CREAM 200MG/GM "SINPHAR" (AZELAIC ACID) 54

AC41754209 CETAZINE INJ. "STANDARD" (CEFTAZIDIME) 63

AC41797321 WOLEN CREAM 26

AC41797329 WOLEN CREAM 61

AC41797335 WOLEN CREAM 96

AC41805100 DIABAC TAB 5MG 1.5

AC41807100 NOGOUT TABLETS 100MG "SINPHAR"(BENZBROMARONE) 2.88

AC41814100 ASPICORE ENTERIC-MICROENCAPSULATED CAP. 100MG

(ASPIRIN)"WEIDAR"

1.5

AC418141G0 ASPICORE ENTERIC-MICROENCAPSULATED CAP. 100MG

(ASPIRIN)"WEIDAR"(鋁箔/膠箔)

2

AC41816100 LIMY CAPSULES 10MG (PHENOXYBENZAMINE HYDROCHLORIDE) 2.39

AC41823209 ASPIRIN INJECTION (LYSINE ASPIRIN) "CHI SHENG" 15

AC41823277 ASPIRIN INJ. 15

AC41831100 PATRICIN F.C. TABLETS 200MG "Y.C." (FLAVOXATE) 4.84

AC41832100 BACTON TABLETS 10MG "S.C."(BACLOFEN) 1.5

AC41833100 DILTAREN E.C. TABLETS 50MG "Y.C." 1.5

AC41835100 WEID TAB. 300MG 1.5

AC41836255 METROCIDE INJECTION 5MG/ML "TA FONG"(METRONIDAZOLE) 77

AC41837100 LIPOLIN CAPSULES 100MG (FENOFIBRATE) "P.L" 3.26

AC41838100 "CHUM F.C. TABLETS 135MG (MEBEVERINE HYDROCHLORIDE) ""ROOT""" 2.2

AC41840338 ISOCONA CREAM "STANDARD" 60

AC41877100 PUSHINLIN F.C. TAB. 75MG 1.83

AC41881100 CALACET TABLET 667MG "SINPHAR" (CALCIUM ACETATE) 1.87

AC41882100 FAMO F.C. TABLET 40MG "S.T." (FAMOTIDINE) 5.7

AC41885335 IFLUCON OINT"C.H." 47.3

AC41918100 MENISONE TABLETS 4MG (METHYLPREDNISOLONE) "P.L." 1.66

AC41919100 USOL TABLETS 100MG "S.D." (URSODESOXYCHOLIC ACID) 2.69

AC41926100 WEMET TABLETS 300MG "Y.C." (DIBISMUTH TRIOXIDE) 6.3

AC41927100 SELEZIN TAB. 5MG 3.64

AC41930100 "GASO F.C. TABLET 10MG ""S.Y"" (PIPERILATE ETHOBROMIDE)" 1.53

AC41931100 NILPID F.C.TABLETS 300MG"SWISS"(GEMFIBROZIL) 1.52

AC419311G0 NILPID F.C.TABLETS 300MG"SWISS"(GEMFIBROZIL) 28粒、56粒及112粒

/瓶裝暨鋁箔/膠箔

2

AC41934321 L.G.T CREAM 10MG/GM "S.C."(CENTELLA ASIATICA) 36.4

164

Page 165: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC41934329 L.G.T. CREAM 10MG/GM "S.C."(CENTELLA ASIATICA) 64

AC41934337 L.G.T CREAM 10MG/GM"S.C."(CENTELLA ASIATICA) 90

AC41934338 L.G.T CREAM 10MG/GM"S.C."(CENTELLA ASIATICA) 90

AC41944100 OXIPAN TABLETS 5MG "EVEREST"(OXYBUTYNIN CHLORIDE) 2.75

AC41948100 PROSU TABLETS 2MG "CHINTENG"(ESTRADIOL) 1.77

AC41962100 EVERONE CAPSULES 20MG "EVEREST"(METHYLTESTOSTERONE) 1.93

AC41987100 IBUTIN F.C.TABLETS 400MG "EVEREST"(IBUPROFEN) 1.5

AC41989212 ADENOZER INJECTION 3MG/ML "PURZER" (ADENOSINE) 137

AC41990321 USON CREAM 2.5MG/GM 32.1

AC41990329 USON CREAM 2.5MG/GM 73

AC41990338 USON CREAM 2.5MG/GM 103

AC41990343 USON CREAM 2.5MG/GM 140

AC41992100 BROMARONE TABLETS 50MG "H.C" (BENZBROMARONE) 1.5

AC41994100 BROMARONE TABLETS 100MG "H.C" [BENZBROMARONE] 2.88

AC41995100 BENZON TABLETS 50MG "S.T." (BENZBROMARONE) 1.5

AC419951G0 BENZON TABLETS 50MG "S.T." (BENZBROMARONE)(鋁箔/膠箔) 2

AC41997100 FLUENE CAPSULES 50MG "PURZER" (FLUCONAZOLE) 37.2

AC42001100 FLUXEN CAPSULES 20MG "W.S"(FLUOXETINE) 2.77

AC42017100 NONCOUGH CAP. 1.5

AC42026100 COVINA F.C. TABLETS. 3.83

AC42029321 IDIF CREAM 16.1

AC42029329 IDIF CREAM 24.5

AC42029335 IDIF CREAM 47.3

AC42090209 CEFZON FOR INJECTION "STANDARD" 108

AC42090277 CEFZON FOR INJECTION "STANDARD" 88

AC42091209 SINTUM FOR INJ. 63

AC42091212 SINTUM FOR INJ. 400

AC42091277 SINTUM FOR INJ. 32.3

AC42096100 SQUMIN TABLET 5MG "STANDARD" (MEQUITAZINE) 1.52

AC42103100 SUTAIN TABLET 200MG "EVEREST" (TIAPROFENIC ACID) 3.27

AC42104100 LORA TABLET 10MG 1.5

AC42139100 YUPAR TABLETS 10MG "H.C" [RITODRINE HCI] 5.6

AC42141238 GENDOBU INJECTION 12.5MG/ML (DOBUTAMINE) 182

AC42145100 BACFEN TABLETS 10MG (BACLOFEN) "S.T" 1.5

AC42147100 EURICON TAB. 100MG (BENZBROMARONE) 2.88

AC42174121 GUARINA GRANULES 6.9

AC42203100 ZIMARON TABLETS 100MG (BENZBROMARONE)"S.D." 2.88

AC42204100 PIPOXIN TABLETS 10MG"S.C."(PIPOXOLAN) 3.77

AC42210100 GENURSO TABLETS 100MG (URSODESOXYCHOLIC ACID) 2.69

AC42212321 KANDO CREAM 200MG/G "C.H."[AZELAIC ACID] 28

AC42214326 ICHDERM CREAM 50MG/GM "M.S."(DOXEPIN) 53

AC42214335 ICHDERM CREAM 50MG/GM "M.S." (DOXEPIN) 74

AC42216100 FLAMQUIT F.C.TABLETS 25MG "SWISS" (DICLOFENAC POTASSIUM) 1.5

AC422161G0 FLAMQUIT F.C.TABLETS 25MG "SWISS" (DICLOFENAC POTASSIUM)(鋁箔/

膠箔)

2

AC42218100 NORCOL TABLETS 20MG "S.C." (BENPROPERINE) 1.5

AC42221100 SUSAN TABLETS 1.5

AC422211G0 SUSAN TABLETS 50MG(鋁箔/膠箔) 2

AC42222100 SYNDOMAN CAPSULES 30MG (FLURAZEPAM HYDROCHLORIDE)"S.T." 5.3

AC42223265 PROLYTE INJECTION 27.2

AC42223277 PROLYTE INJECTION 30.3

AC42227100 SYNDOMAN CAPSULES 15MG (FLURAZEPAM HYDROCHLORIDE)"S.T." 4.49

AC42240100 SUWELIN TABLETS 400MG 1.5

AC42244100 GEMBRIL F.C.TAB. 600MG 2.68

AC42257100 QUITAZINE TABLETS 5MG "H.C" (MEQUITAZINE) 1.52

165

Page 166: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC42261248 VENOLIPID INJECTION 20% "CHI SHENG" 172

AC42261255 VENOLIPID INJECTION 20% "CHI SHENG" 235

AC42261265 VENOLIPID INJECTION 20% "CHI SHENG" 279

AC42262265 VENOLIPID INJECTION 10% "CHI SHENG" 235

AC42263100 BENDOPAR CAP. 250MG 8.4

AC42269321 BETASAY OINTMENT "SINPHAR" 12.6

AC42269329 BETASAY OINTMENT "SINPHAR" 25.5

AC42271421 DEXA ORABASE 0.1% "SINPHAR" (DEXAMETHASONE) 55

AC42272100 ROWAPRAXIN F.C. TABLETS 10MG (PIPOXOLAN) 3.77

AC42273100 NORAXIN F.C.TABLET 400MG "STANDARD"(NORFLOXACIN) 42.9

AC42274100 BENDOPAR CAP. 125MG 3.64

AC42339321 BIFONAZOLE CREAM 1% "SINPHAR" 34.3

AC42339323 BIFONAZOLE CREAM 1% "SINPHAR" 40.4

AC42340100 FUWEHO CAPSULES 200MG "CHINTENG" (CETRAXATE) 7.5

AC42347100 MOCLOD F.C. TABLETS 150MG 2.53

AC42362329 "PIROCAM GEL 10MG/GM ""M.S."" (PIROXICAM)" 17.6

AC42362345 "PIROCAM GEL 10MG/GM ""M.S.""(PIROXICAM)" 40.8

AC423661G0 MUCAINE TABLETS (鋁箔/膠箔) 2

AC42368219 ONDAN INJECTION 2MG/ML "STANDARD" (ONDANSETRON) 217

AC42374209 U-RON FOR I.V. INJECTION 193

AC42374212 U-RON FOR I.V. INJECTION 660

AC42374277 U-RON FOR I.V. INJECTION 100

AC42375100 N.F.S. CAPSULES 400MG "C.H."(NORFLOXACIN) 42.9

AC42378100 GENZOSIN TABLET 2MG (DOXAZOSIN MESYLATE) 1.97

AC42380100 MILIX TABLETS 1.25MG "M.S." (INDAPAMIDE) 1.69

AC42394100 HEXOLINE TABLETS 0.5MG "S.C."(HEXOPRENALINE) 1.55

AC42412209 KETO INJECTION 30MG/ML (KETOROLAC) 23.1

AC42412212 KETO INJECTION 30MG/ML (KETOROLAC) 48.4

AC42414209 LICEF-A FOR INJECTION "S.T" (CEPHRADINE) 26.1

AC42414277 LICEF-A FOR INJECTION "S.T" (CEPHRADINE) 25.8

AC42416100 FUWEIDIN F.C.TABLETS 40MG "S.D."[FAMOTIDINE] 5.7

AC42448100 CLOPINE TABLETS 100MG"SWISS"(CLOZAPINE) 8.9

AC42449216 CVVH SOLUTION A "S.T." 144

AC42459100 NORAXIN F.C. TABLET 100MG"STANDARD" (NORFLOXACIN) 2.44

AC42461100 FUSEN ENTERIC MICROENCAPSULATED CAPSULES 100MG"CHINTENG" 1.5

AC424611G0 FUSEN ENTERIC MICROENCAPSULATED CAPSULES 100MG"CHINTENG" (鋁

箔)

2

AC42501321 BOLOVER CREAM 0.1% 30.2

AC42501329 DERMA-E CREAM 39.6

AC42507100 TIPROFEN TABLETS 200MG 3.27

AC42511100 NOSPASM TABLETS 10MG "Y.Y."(PIPOXOLAN) 3.77

AC42512100 VORTAGEN E.M. CAPSULS 50MG "EVEREST" (DICLOFENAC SODIUM) 1.5

AC425121G0 VORTAGEN E.M. CAPSULS 50MG "EVEREST" (DICLOFENAC

SODIUM)(?T??/????)

2

AC42513100 SETON CAPSULES 10MG "CHINTENG"(PHENOXYBENZAMINE HYDROCHLORIDE) 2.39

AC42514100 GENDERGIN TABLETS 0.5MG (ALPRAZOLAM) 1.5

AC425141G0 GENDERGIN TABLET 0.5MG (ALPRAZOLAM)(鋁箔/膠箔) 2

AC42521100 FOGLUGEN DISPERSIBLE-20 TABLETS 20MG "S.T." 1.55

AC425211G0 FOGLUGEN DISPERSIBLE-20 TABLETS 20MG "S.T." (PIROXICAM)(鋁箔/

膠箔)

2

AC42526100 MEQAZINE TABLETS 5MG "H.S."(MEQUITAZINE) 1.52

AC42533100 PAINLAX CAPSULES 50MG "PBF" (TRAMADOL) 3.88

AC42534100 MORPHINE SULFATE SUSTAINED-RELEASE F.C. TABLETS 30MG "PPCD" 12.5

166

Page 167: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC42535100 SANCIN F.C. TABLET 50MG "S.C."(DIPYRIDAMOLE) 1.69

AC425351G0 SANCIN F.C. TABLET 50MG "S.C."(DIPYRIDAMOLE) (鋁箔/膠箔) 2

AC42536100 SEVINA F.C. TABLETS 3.83

AC425371G0 AMPRAZO TABLETS 0.5 MG (ALPRAZOLAM)(鋁箔/膠箔) 2

AC42538100 "MEQUITINE TABLETS 5MG""WINSTON""" 1.52

AC42539100 LESLIPID TABLETS 20MG "H.C."(LOVASTATIN) 4.72

AC42554230 ANESVAN INJECTION 10MG/ML "CHI SHENG"(PROPOFOL) 64

AC42554238 ANESVAN INJECTION 10MG/ML "CHI SHENG"(PROPOFOL) 64

AC42554248 ANESVAN INJECTION 10MG/ML "CHI SHENG"(PROPOFOL) 203

AC42556100 ARICEPT F.C. TABLETS 5MG 76

AC42558100 LOVAST TABLETS 20MG "H.S." (LOVASTATIN) 4.72

AC42570100 FLOXT CAPSULES. 20MG "C.L" 2.77

AC42584100 SYNBOT TABLETS 20MG 1.89

AC425841G0 SYNBOT TABLETS 20MG (ENALAPRIL MALEATE)(鋁箔/膠箔) 2

AC42588100 "VOLEN ENTERIC-MICROENCAPSULATED CAPSULES. 50MG (DICLOFENAC

SODIUM) ""WINSTON"""

1.5

AC42601266 ANOL INJECTION 200MG/ML (MANNITOL) "ASTAR" 39.4

AC42601277 ANOL INJECTION 200MG/ML (MANNITOL) "ASTAR" 117

AC42602100 PAIN WILL PASS TABLETS 200MG 3.27

AC42621100 CLOPINE TABLETS 25MG "SWISS" (CLOZAPINE) 4.99

AC42623277 HESPANDER INJECTION 256

AC42626100 FINSKA TABLETS 10MG 0.8

AC426261G0 FINSKA TABLETS 10MG(鋁箔/膠箔) 2

AC42627100 LOVASTA TABLETS 20MG 4.72

AC42629500 METROCIDE VAGINAL SUPPOSITORIES 500MG "T.F." 5

AC42646100 ESZO TABLETS 2MG(ESTAZOLAM)"S.T." 1.66

AC426461G0 ESZO TABLETS 2MG "S.T." (ESTAZOLAM)(鋁箔/膠箔) 2

AC42656100 CETIZINE F. C. TABLETS 10MG (CETIRIZINE) 1.5

AC42657100 PINFAN TABLETS 0.25MG "M.S." (FLUDIAZEPAM) 2.71

AC42659100 ILOKA F.C TABLETS 2.5MG "YUNG SHIN" (INDAPAMIDE) 2.27

AC42660100 ANBICYN F.C.TABLETS 625MG 5.2

AC42686100 KINAX TABLETS 0.5MG "KINGDOM"(ALPRAZOLAM) 1.5

AC426861G0 KINAX TABLETS 0.5MG "KINGDOM"(ALPRAZOLAM)(鋁箔/膠箔) 2

AC42697280 ANBICYN POWDER FOR INJECTION 43.2

AC42697297 ANBICYN POWDER FOR INJECTION 135

AC42708321 "FOOHOL CREAM 10MG/GM ""ROOT"" (BIFONAZOLE)" 34.3

AC42708329 "FOOHOL CREAM 10MG/GM ""ROOT"" (BIFONAZOLE)" 74

AC42708335 "FOOHOL CREAM 10MG/GM ""ROOT"" (BIFONAZOLE)" 75

AC42722100 CALGALIN TABLETS 667MG "WINSTON"(CALCIUM ACETATE) 1.87

AC427221G0 CALGALIN TABLETS 667MG (CALCIUM ACETATE) "WINSTON"(鋁箔膠箔) 2

AC42725321 NATIFIN CREAM 1% "CHINTENG" (NAFTIFIN) 25.4

AC42725329 NATIFIN CREAM 1% "CHINTENG" (NAFTIFIN) 45.2

AC42725338 NATIFIN CREAM 1% "CHINTENG" (NAFTIFIN) 92

AC42746265 VENOLIPID INJECTION MCT/LCT 10% "CHI SHENG" 215

AC42748100 MECOLA F.C. TABLETS 20MG "S.D."(BENPROPERINE) 1.5

AC42749100 ILOKA F.C. TABLETS 1.25MG "YUNG SHIN" (INDAPAMIDE) 1.69

AC42752100 OFLODAL F.C. TABLETS 200MG (OFLOXACIN) 2.95

AC42754100 EURICON TAB. 50MG (BENZBROMARONE) 1.5

AC427541G0 EURICON TAB. 50MG (BENZBROMARONE)(鋁箔/膠箔) 2

AC42756216 ANSULLINA POWDER FOR INJECTION 178

AC42756289 ANSULLINA POWDER FOR INJECTION 96

AC42764335 PIPO CREAM 10MG/GM "EVEREST" (PIROXICAM) 28.5

AC42764343 PIPO CREAM 10MG/GM "EVEREST" (PIROXICAM) 40.8

AC42764345 PIPO CREAM 10MG/GM "EVEREST" (PIROXICAM) 40.8

167

Page 168: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC42764355 PIPO CREAM 10MG/GM "EVEREST" (PIROXICAM) 225

AC42766100 LIPO CAPSULES 300MG "GENTLE" (URSODEOXYCHOLIC ACID) 4.39

AC42770100 MUACTION SUSTAINED RELEASE TABLETS 100MG "M.S." (TRAMADOL

HYDROCHLORIDE)

4.98

AC42774100 ANSIN E.C. TABLETS 100MG "EVEREST" (ASPIRIN) 1.5

AC42775100 FENOFIBRATE CAPSULES 100MG "S.C." 3.26

AC42798329 BENOVATE SOLUTION 1MG/ML 38.2

AC42798363 BENOVATE SOLUTION 1MG/ML 326

AC42800255 VENOLIPID INJECTION MCT/LCT 20% "CHI SHENG" 215

AC42800265 VENOLIPID INJECTION MCT/LCT 20% "CHI SHENG" 225

AC42802151 SYNMIN SYRUP 0.4MG/ML "S.T." (CYPROHEPTADINE HYDROCHLORIDE) 25

AC42802157 SYNMIN SYRUP 0.4MG/ML "S.T." (CYPROHEPTADINE HYDROCHLORIDE) 25

AC42823421 BIOMICIN OPHTHALMIC SOLUTION 0.3% "WINSTON" 37.9

AC42826100 SYNPID CAPSULES 100MG "S.Y." (FENOFIBRATE) 3.26

AC42828209 PICILLINA POWDER FOR INJECTION (PIPERACILLIN SODIUM) 45.9

AC42828212 PICILLINA POWDER FOR INJECTION (PIPERACILLIN SODIUM) 37.7

AC42828219 PICILLINA POWDER FOR INJECTION (PIPERACILLIN SODIUM) 88

AC42829100 "ANTHOLIN CAPSULES ""WINSTON""" 1.5

AC42830100 TICLOPIDINE HCL 4.67

AC42831151 ALBUTEROL SYRUP 0.4MG/ML "CENTER" (SALBUTAMOL) 25.2

AC42837100 UXETINE CAPSULES 20MG (FLUOXETINE) 2.08

AC42840100 AMLO TABLETS 5MG "S.Y."(AMLODIPINE) 6.8

AC42844338 ALCOS-ANAL OINTMENT 48.1

AC42856100 SHUANE TABLETS 200MG "S.C." (MEPHENOXALONE) 1.5

AC42860100 GENADINE TABLET 10MG (LORATADINE) 0.8

AC428601G0 GENADINE TABLET 10MG (LORATADINE)(鋁箔/膠箔) 2

AC42863100 FAMO F.C. TAB. 20MG "S.T." (FAMOTIDINE) 1.92

AC428631G0 FAMO F.C. TAB. 20MG (FAMOTIDINE) "S.T."(鋁箔/膠箔) 2

AC42874100 GENZOSIN TABLET 4MG (DOXAZOSIN MESYLATE) 7.8

AC42879214 GENSO INJECTION 10MG/ML (ATRACURIUM) 61

AC42883100 TARNIN TABLETS 50MG "S.C."(CHLORPROTHIXENE HYDROCHLORIDE) 5.2

AC42887100 "CETIZIN F. C. TABLETS 10MG ""H.S.""(CETIRIZINE)" 1.5

AC428871G0 "CETIZIN F. C. TABLETS 10MG ""H.S.""(CETIRIZINE) (鋁箔/膠箔)" 2

AC42888100 GLIC TABLETS 80MG "S.C." (GLICLAZIDE) 1.5

AC42899100 GENIQUIN FILM COATED TABLETS 200MG (HYDROXYCHLOROQUINE

SULFATE)

2.4

AC42903100 NINKO F.C. TABLETS 40MG "STANDARD" (GINKGOFLAVONE GLYCOSIDE) 2.24

AC42906100 TRAZONE TABLETS 100MG "S.T." (TRAZODONE HYDROCHLORIDE) 4.14

AC42916100 SIMELIN F.C. TABLETS 500MG (METFORMIN) 1.5

AC42917100 LOLATE TABLETS 5MG"MACRO" (AMLODIPINE) 6.8

AC42919100 DOFLEX TABLETS 200MG "GENTLE" (MEPHENOXALONE) 1.5

AC429191G0 DOFLEX TABLETS 200MG)"GENTLE"(MEPHENOXALONE)(鋁箔/膠箔) 2

AC42932151 ATHMIN SYRUP (KETOTIFEN) "CENTER" 47.6

AC42934100 "SULIN ENTERIC-MICROENCAPSULATED CAPSULES 100MG ""WINSTON""

(ASPIRIN)"

1.5

AC42936100 TEZOPIN TABLETS 2MG "WEIDAR" (TERAZOSIN) 3.04

AC42944100 CONWU TABLETS 25MG "W.S." 4.81

AC42946100 SULMATYL FILM COATED TABLETS 50MG (SULPIRIDE) "P.L." 1.66

AC429461G0 SULMATYL FILM COATED TABLETS 50MG (SULPIRIDE) "P.L."(鋁箔/膠

箔)

2

AC42948100 GENDERGIN TABLET 0.25MG (ALPRAZOLAM) 1.5

168

Page 169: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC429481G0 GENDERGIN TABLET 0.25MG (ALPRAZOLAM)(鋁箔/膠箔) 2

AC42957100 EUTAC F.C. TABLETS 150MG "S.T." (MECLOBEMIDE) 2.53

AC42966100 MUGADINE CAPSULES 100MG (MEXILETINE HYDROCHLORIDE) 3.52

AC42967100 SINCER TABLETS 400MG (ACEBUTOLOL) 6.2

AC42974100 JANCIN SOFT CAPSULES 100MG "CHINTENG." (TOCOPHEROL NICOTINATE) 1.5

AC42990100 BEZAFIBRATE TABLETS 200MG(BEZAFIBRATE)"Y.Y." 6.5

AC42997100 KINFLOCIN F.C. TABLETS 200MG "KINGDOM" (OFLOXACIN) 2.95

AC42999100 "WINCETOL F.C.TAB. 400MG ""WINSTON"" (ACEBUTOLOL)" 6.2

AC43000248 GENAZOLE IV INJECTION 2MG/ML (FLUCONAZOLE) 361

AC43000255 GENAZOLE IV INJECTION 2MG/ML (FLUCONAZOLE) 422

AC43000263 GENAZOLE IV INJECTION 2MG/ML (FLUCONAZOLE) 1009

AC43003321 "CHU-FU CREAM ""WINSTON""" 18.9

AC43003329 "CHU-FU CREAM ""WINSTON""" 50

AC43003336 "CHU-FU CREAM ""WINSTON""" 59

AC43003338 "CHU-FU CREAM ""WINSTON""" 99

AC43003355 "CHU-FU CREAM ""WINSTON""" 145

AC43016100 SELINE TABLETS 5MG (SELEGILINE) 3.64

AC43018100 ZUMIN F.C.TABLETS 50MG "YUNG SHIN" (MEBHYDROLIN) 1.5

AC43026100 TIA TON TABLETS 200MG "Y.Y." (TIAPROFENIC ACID) 3.27

AC43038100 ASLEX TABLETS 200MG (MEPHENOXALONE) "SIEHO" 1.5

AC43040100 PEYSAN F.C. TABLETS 75MG "S.C." (DIPYRIDAMOLE) 1.83

AC430401G0 PEYSAN F.C. TABLETS 75MG "S.C." (DIPYRIDAMOLE) (鋁箔/膠箔) 2

AC43045100 LOPAR TABLETS 5MG "STANDARD" (SELEGILINE HCL) 3.64

AC43046100 CANLIN M.CAPSULES 300MG "EVEREST"(URSODEXOXYCHOLIC ACID) 4.39

AC43048100 SETIZIN F. C. TABLETS 10MG "H.S."(CETIRIZINE) 0.64

AC43071100 CINTSU F.C. TABLETS 80MG (VERAPAMIL) 3.95

AC43074100 TONSARIC TABLETS 100MG "S.T." (ALLOPURINOL) 1.5

AC430741G0 TONSARIC TABLETS 100MG "S.T." (ALLOPURINOL)(鋁箔/膠箔) 2

AC43080100 LASCAINE TABLETS 1.66

AC43112321 FLUNIDE CREAM 0.5MG/GM 42.4

AC43112329 FLUNIDE CREAM 0.5MG/GM 54

AC43112338 FLUNIDE CREAM 0.5MG/GM 135

AC43112355 FLUNIDE CREAM 0.5MG/GM 477

AC43114100 TARLIN TABLETS "S.T" 1.5

AC43116343 "PIROCAM GEL 10MG/GM ""M.T."" (PIROXICAM)" 40.8

AC43116345 "PIROCAM GEL 10MG/GM ""M.T."" (PIROXICAM)" 40.8

AC43116355 PIROCAM GEL 10MG/GM (PIROXICAM) "M.T." 225

AC43118100 TOPIMO TABLETS 2MG "S.C."(PIMOZIDE) 7.6

AC43120321 TRANCINE CREAM 1MG/GM 5.8

AC43120329 TRANCINE CREAM 1MG/ML 12.1

AC43120335 TRANCINE CREAM 1MG/ML 15.1

AC43138321 "BIFOZOL CREAM 10MG/GM ""GCPC""" 34.3

AC43138329 "BIFOZOL CREAM 10MG/GM ""GCPC""" 74

AC43138335 "BIFOZOL CREAM 10MG/GM ""GCPC""" 75

AC43138338 BIFOZOL CREAM 10MG/GM "GCPC" 81

AC43139100 HOCOTON TABLETS 100MG "H.C" 1.5

AC43141100 BEENRONE TABLETS 100MG (BENZBROMARONE) 2.88

AC43142100 FOSEN EFC TABLETS 100MG "CHINTENG" 1.5

AC43144100 LIFEN F.C. T. 500MG (IBUPROFEN LYSINE) "EVEREST" 1.78

AC43152151 IBUPROFEN ORAL SUSPENSION 20MG/ML "CENTER" 25

AC43152157 IBUPROFEN ORAL SUSPENSION 20MG/ML "CENTER" 67

AC43160151 SOLTAN LIQUID 3MG/ML "CENTER" 25

AC43160155 SOLTAN LIQUID 3MG/ML "CENTER" 25

169

Page 170: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC43160157 SOLTAN LIQUID 3MG/ML "CENTER" 72

AC43161500 ALCOS-ANAL SUPPOSITORIES 5

AC43177100 TADIN TABLETS 80MG 1.5

AC43180345 FUBIFEN PAP "F.M" 40MG/10GM 6.3

AC43184421 VISCONE EYE DROPS 0.1% "SINPHAR" 14

AC43184429 VISCONE EYE DROPS 0.1% "SINPHAR" 77

AC43187100 "GINKON TABLETS 9.6MG (GINKGOFLAVON GLYCOSIDE) ""M.T.""" 2.24

AC43188100 TERADRIN TABLETS 2MG "S.Y." (TERAZOSIN) 3.04

AC43189151 STROLIN LIQUID 0.5MG/ML "CENTER" 26.3

AC431901G0 MECOBAL CAPSULE 0.5MG (MECOBALAMIN) "TA FONG"(鋁箔/膠箔) 2

AC43205100 MINRO TABLETS 5MG "CHINTENG" 1.52

AC432051G0 MINRO TABLETS 5MG "CHINTENG"(鋁箔/膠箔) 2

AC43210100 GENOPRIL TABLETS 20MG 5

AC43212100 JULRIN ENTERIC-COATED TABLETS 1.5

AC432131G0 ALLTEC F. C. TABLETS 10MG(鋁箔/膠箔) 2

AC432131G1 ALLTEC F. C. TABLETS 10MG (14粒/瓶) 2

AC432131G2 ALLTEC F. C. TABLETS 10MG (28粒/瓶) 2

AC43214345 FOCUS GEL 10MG/GM (PIROXICAM) 40.8

AC43223100 PAINSTOP ENTERIC-MICROENCAPSULATED CAPSULE 50MG "SWISS"

(DICLOFENAC SODIUM)

0.52

AC43254100 ANTACHE ENTERIC COATED TABLETS 100MG 1.5

AC432571G0 MEFNO TABLET 200MG(鋁箔/膠箔 ) 2

AC43285329 LIBIDO GEL "MEIDER" 17.9

AC43285335 LIBIDO GEL "MEIDER" 28.3

AC43285338 LIBIDO GEL "MEIDER" 83

AC43285343 LIBIDO GEL "MEIDER" 186

AC43286100 DALPAM CAPSULE 15MG (FLURAZEPAM) 4.49

AC43293100 UZOL CAPSULES 50MG "C.H." (FLUCONAZOLE) 37.2

AC43294100 WINIFUL F.C. TABLETS 40MG "EVEREST" 5.7

AC43302100 ZEFFIX TABLETS 100MG 75

AC43306100 CETIA TABLETS 10MG "S.T." 1.5

AC433061G0 CETIA TABLETS 10MG "S.T."(鋁箔/膠箔) 2

AC43309100 ASPA E. M.C.100MG "YU SHENG" (ASPIRIN) 1.5

AC433091G0 ASPA E. M.C.100MG "YU SHENG" (ASPIRIN)(鋁箔/膠箔) 2

AC43316100 SOVERINE CAPSULES 60MG "S.C." 2.39

AC43317100 CONMY TABLETS 2MG "S.T." 3.04

AC43323145 DUASMA METERED DOSE INHALER 200MCG 394

AC43326100 SPASMOL CAPSULES 60MG 2.39

AC43328100 WEREN ENTERIC-MICROENCAPSULATED CAPSULE 50MG "YU SHENG" 1.5

AC433281G0 WEREN ENTERIC-MICROENCAPSULATED CAPSULE 50MG "YU SHENG"(鋁箔/

膠箔)

2

AC43330100 GENOPRIL 10MG TABLETS 3.66

AC433351G0 POLUPI TABLET 50MG "PANBIOTIC"(鋁箔/膠箔) 2

AC43339100 FUMAY CAPSULES 50MG "STANDARD" 37.2

AC43362151 SUTUSSI LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) 25

AC43362157 SUTUSSI LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) 25

AC43362163 SUTUSSI LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) 25

AC43364100 COXINE TABLETS 20MG (ISOSORBIDE MONONITRATE) 1.61

AC433641G0 COXINE TABLETS 20MG (ISOSORBIDE MONONITRATE)(鋁箔/膠箔) 2

AC43366100 ULIDEN TABLETS 100MG "SWISS" 1.57

AC43397100 MERINE F.C. TABLETS 135MG "Y.Y." 2.2

AC43403100 CEMINE F.C. TABLETS 10MG "S.C." 1.5

AC434031G0 CEMINE F. C. TABLETS 10MG "S.C."(鋁箔/膠箔) 2

AC43408100 "EASCO CAPSULES ""WINSTON""" 1.5

AC43431100 MESYREL TABLETS 25MG "M.S." 1.5

170

Page 171: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC43436151 IBULIN SUSPENSION 20MG/ML (IBUPROFEN) "S.T" 25

AC43436157 IBULIN SUSPENSION 20MG/ML (IBUPROFEN) "S.T." 67

AC43437100 MINO TABLETS 5MG "EVEREST" 1.52

AC43443100 NOXALONE TABLETS 500MG 4.71

AC43445100 OMELON ENTERIC-MICROENCAPSULATED CAPSULES 20MG 2.51

AC43448309 "Normal Saline Solution ""Tai Yu""" 24.1

AC43448312 "Normal Saline Solution ""Tai Yu""" 55

AC43448316 "Normal Saline Solution ""Tai Yu""" 68

AC43448377 "Normal Saline Solution ""Tai Yu""" 18.4

AC43458100 SUTONDIN 20MG F.C. TABLETS "H.S." 4.78

AC43459500 LICOMILE VAGINAL TABLETS 100MG "H.S." (ISOCONAZOLE) 5.4

AC43460100 GENCLONE F.C.T. 7.5MG 2.89

AC43467100 DOXAZON TABLETS 2MG "S.C." 2.93

AC43473100 BRONCOLIN TABLETS 1.5

AC43474100 MELONE TABLETS 16MG 3.51

AC43493345 FLURBI PAP "D.S" 6.4

AC43496421 "SERENE OPHTHALMIC SOLUTION ""WINSTON""" 13.4

AC43499100 ESOMIN TABLETS 2MG "P.L." 1.66

AC434991G0 ESOMIN TABLETS 2MG "P.L."(鋁箔/膠箔) 2

AC43501100 WINIFUL F.C.TABLETS 20MG (FAMOTIDINE) "EVEREST" 1.92

AC435011G0 WINIFUL F.C. TABLETS 20MG (FAMOTIDINE) "EVEREST"(鋁箔/膠箔) 2

AC435201G0 DIAGLUCON TABLET 80MG (GLICLAZIDE) "T.F."(鋁箔/膠箔) 2

AC43523100 FLURONIN CAPSULES 20MG "YUNG SHIN" 2.77

AC43527100 AVERINE CAPSULES 60MG "ROYAL" 2.39

AC43545100 ACEO CAPSULES 60MG " 1.69

AC435451G0 ACEO CAPSULES 60MG(鋁箔/膠箔) 2

AC43572414 SALDOLIN INHALATION SOLUTION 2MG/ML "S.T."(SALBUTAMOL) 6.3

AC43573100 SANCOS TABLETS 4.72

AC43574438 BELAX AQUA NASAL SPRAY 100MCG/DOSE (1MG/GM) 234

AC43588143 CYPROMIN SOLUTION 0.4MG/ML "CENTER" 25

AC43588151 CYPROMIN SOLUTION 0.4MG/ML "CENTER" 25

AC43588157 CYPROMIN SOLUTION 0.4MG/ML "CENTER" 25

AC43589421 FLUORONE OPHTHALMIC SOLUTION 1.0MG/ML "PATRON"

(FLUOROMETHOLONE)

14

AC43589429 FLUORONE OPHTHALMIC SOLUTION 1.0MG/ML "PATRON"

(FLUOROMETHOLONE)

77

AC43591321 ID CREAM 16.1

AC43591329 ID CREAM 24.5

AC43591335 ID CREAM 47.3

AC43591338 ID CREAM 60

AC43597100 CAMADOL CAPSULES 50MG (TRAMADOL HCL) 3.88

AC43598100 ATENO F.C. TABLETS 50MG 1.56

AC435981G0 ATENO F.C. TABLETS 50MG)(鋁箔/膠箔) 2

AC43601421 PICON EYE DROPS 0.5%"Y.Y." 29.2

AC43601429 PICON EYE DROPS 0.5%"Y.Y." 36.5

AC43602416 "CHEER ORABASE 1MG/GM ""WINSTON""" 18.5

AC43602417 "CHEER ORABASE 1MG/GM ""WINSTON""" 23.8

AC43602421 "CHEER ORABASE 1MG/GM ""WINSTON""" 28.4

AC43602423 "CHEER ORABASE 1MG/GM ""WINSTON""" 42.7

AC43602429 "CHEER ORABASE 1MG/GM ""WINSTON""" 64

AC43619423 "SENCORT OPHTHALMIC SOLUTION ""WINSTON""" 35

AC43621321 B.C.G CREAM 18.9

AC43621329 B.C.G CREAM 50

AC43621336 B.C.G. CREAM 59

171

Page 172: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC43621338 B.C.G CREAM 99

AC43624100 "ABCOT CHEWABLE TABLETS 20MG ""WINSTON""" 1.5

AC43625100 WESON TABLETS 2MG "EVEREST" 3.04

AC43627100 MESOLONE TABLETS 2MG "H.C" 1.66

AC43630100 YUSIN F.C TABLETS 75MG 1.83

AC43632100 MELETIN CAPSULES 100MG "S.T." (MEXILETINE) 3.52

AC43633100 TOLESIN F.C. TABLETS 150MG "S.T." 1.95

AC43634100 TRAZONE TABLETS 50MG "S.T." (TRAZODONE HCL) 1.93

AC43635100 BAXICIN F.C. TABLETS 200MG "S.T." (NORFLOXACIN) 2.44

AC43637100 NOGOUT TABLETS 50MG "SINPHAR." 1.5

AC43641100 "SUROTEN TABLETS 200MG ""ROYAL"" (TIAPROFENIC ACID)" 3.27

AC43642421 SHOWMIN EYE DROPS 0.01% 12

AC43642429 SHOWMIN EYE DROPS 0.01% 15.4

AC43656100 KINZOSIN TABLETS 2MG (TERAZOSIN) "KINGDOM" 3.04

AC43661151 LECOTIN SOLUTION (0.2MG/ML LOPERAMIDE HCL) 25.5

AC43662100 TENSEN FILM COATING TABLETS 5MG "CHINTENG" 20.6

AC43663100 ASCOTYL ENTERIC-MICROENCAPSULATED CAPSULES 100MG "STANDARD" 1.5

AC436631G0 ASCOTYL ENTERIC-MICROENCAPSULATED CAPSULES 100MG "STANDARD"(鋁

箔)

2

AC43664100 ESPIN E. M.CAPSULES 100MG (ASPIRIN) 1.5

AC436641G0 ESPIN E. M.CAPSULES 100MG "EVEREST" (ASPIRIN)(鋁箔/膠箔) 2

AC43667421 TIMIN EYE DROPS 0.5% 172

AC43679421 GENELIN OPHTHALMIC SOLUTION "PATRON" 32.8

AC43681421 "SMILE ORABASE 1MG/G ""WINSTON""" 55

AC43681426 "SMILE ORABASE 1MG/G ""WINSTON""" 61

AC43682100 "PWP TABLETS 200MG ""ROOT""" 1.5

AC43688100 LOTTON CAPSULES "C.M." 4.52

AC43692321 JIA MEI CREAM "S.C" 25.4

AC43692329 JIA MEI CREAM "S.C" 45.2

AC43692335 JIA MEI CREAM "S.C" 50

AC43692338 JIA MEI CREAM "S.C." 92

AC43695100 CERIN F. C. TABLETS 10MG "EVEREST" (CETIRIZINE) 1.5

AC436951G0 CERIN F. C. TABLETS 10MG "EVEREST" (CETIRIZINE)(鋁箔/膠箔) 2

AC43696151 KOPIN SOLUTION 25

AC43698100 UFUR CAPSULE 67

AC43699421 CORSUM ORALBASE 0.1% (DEXAMETHASONE) 55

AC43699426 CORSUM ORALBASE 0.1% (DEXAMETHASONE) 61

AC43700100 MEPTIN-MINI TABLETS 1.59

AC43703100 UMENI F.C.T. "EVEREST" 3.83

AC43704100 ATINOL F.C. TABLETS 50MG 1.56

AC437041G0 ATINOL F.C. TABLETS 50MG "S.Y." (ATENOLOL)(鋁箔/膠箔) 2

AC43705100 FLUX MICROENCAPSULATED CAP.10MG "STANDARD" 2.12

AC43708100 YIPO S.C.T 0.625MG "EVEREST" 1.85

AC43726209 MEPRON POWDER FOR INJ.1G "GENTLE" 0

AC43726245 MEPRON POWDER FOR INJECTION 0.04GM"GENTLE" 0

AC43726265 MEPRON POWDER FOR INJ. 0.25G "GENTLE" 0

AC43726277 MEPRON INJ. 0.5G "GENTLE" 0

AC43727100 MEDNIN TABLETS 2MG (METHYLPREDNISOLONE) "H.S" 1.66

AC43728100 "UTRILIX CAPSULE 2.5MG ""ROOT""" 2.27

AC43729100 LEGAN TABLETS 2.69

AC43730151 ASWELL SOLUTION 1MG/ML 26.2

AC43730157 ASWELL SOLUTION 1MG/ML 62

172

Page 173: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC43731321 ANTISCAR CREAM 24.9

AC43731329 ANTISCAR CREAM 30.8

AC43731335 ANTISCAR CREAM 62

AC43736100 SUTONDIN F.C. TABLETS 10MG "H.S" (TENOXICAM) 2.4

AC43740100 TONI F.C. TABLETS 500MG (IBUPROFEN LYSINE) "EVEREST" 1.78

AC43744100 KINLOFT F.C.TABLETS 50MG (SERTRALINE) "KINGDOM" 11.7

AC43747421 FLOXIN OPHTHALMIC SOLUTION 3.0MG/ML "PATRON" 63

AC43758100 UCOJN TABLETS 5.2

AC43759100 KIMODIN F.C.TAB. 20MG "KINGDON" (FAMOTIDINE) 1.92

AC43761100 METHYLONE TABLETS 4MG (METHYLPREDNISOLONE) 1.66

AC43764421 GEMIN EYE DROPS "Y.Y" 22

AC43764429 GEMIN EYE DROPS "Y.Y" 37.1

AC43765100 KINXABEN TAB. 2MG "KINGDOM" DOXAZOSIN 2.93

AC43770100 "EXCELIN TABLETS 4MG (METHYLPREDNISOLONE) ""WINSTON.""" 1.66

AC43771100 KIRADIN F.C. TABLETS 150MG "KINGDON" (RANITIDINE) 1.85

AC43802100 "LYDICON CAP. ""ROYAL""" 1.5

AC43806100 MODIPANOL TABLETS 1MG "SWISS" 1.55

AC43818100 SYMITEC F.C TABLETS 10MG "S.D" 1.5

AC438181G0 SYMITEC F.C TABLETS 10MG "S.D"(鋁箔/膠箔) 2

AC43823100 NATON-S.R TAB. 750MG "EVEREST" 4.51

AC43824100 TRAMED CAPSULES 50MG "SWISS" 3.88

AC43832321 BEFONE CREAM 34.3

AC43832329 BEFONE CREAM 74

AC43832335 BEFONE CREAM 75

AC43833151 AMSOVAN SOLUTION 3MG/ML 25

AC43833157 AMSOVAN SOLUTION 3MG/ML 72

AC43835480 MESA INHALATION SOLUTION 200MG/ML "N.K" 40

AC43842100 OKWE ENTERIC-MICROENCAPSULATED CAPSULE 40 MG "N.K." 15.1

AC43843421 FLUORONE OPHTHALMIC SOLUTION 0.2MG/ML "PATRON" 17.8

AC43848100 "BRONXIN CAPSULES ""WINSTON""" 1.91

AC43850100 "CIMETIN F.C TABLETS 400MG ""TAI YU""" 1.5

AC43851100 "TON-PASS CAPSULES 250MG ""TAI YU.""" 1.5

AC43854321 CD GEL 9.1

AC43854329 CD GEL 17.9

AC43854335 CD GEL 28.3

AC43854338 CD GEL 83

AC43854343 CD GEL 186

AC43857100 ZUSAWTO E.M. CAPSULES 1.5

AC43860100 ELAM TABLETS 2MG "EVEREST" 1.66

AC438601G0 ELAM TABLETS 2MG "EVEREST"(鋁箔/膠箔) 2

AC43861100 SYNFLEX TABLETS 200MG 1.5

AC43862100 COFARIN TAB 1MG "GENTLE" 3.6

AC43867100 ALVERINE CAPSULES 60MG "EVEREST" 2.39

AC43892100 "CBC"BIORIX F.C TABLETS 150MG 2.53

AC43893100 "IBUPROFEN FILM COATED TABLETS 600MG ""WINSTON""" 1.78

AC43896100 MEITAN F.C.TABLETS 50MG "EVEREST" 1.5

AC438961G0 MEITAN F.C.TABLETS 50MG "EVEREST"(鋁箔/膠箔) 2

AC43898100 FLU-D CAPSULES 150MG 61

AC43900100 BAXICIN F.C. TABLETS 100MG "S.T"(NORFLOXACIN) 2.44

AC43914321 TICARE CERAM 16.1

AC43914329 TICARE CERAM 24.5

AC43914335 TICARE CERAM 47.3

AC43914336 TICARE CERAM 47.3

AC43914338 TICARE CERAM 60

AC43924338 SHUJEN GEL 10MG/G "T.F." 28.5

173

Page 174: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC43924345 SHUJEN GEL 10MG/G "T.F." 40.8

AC43927100 GOULESS TABLETS 50MG "STANDARD" (BENZBROMARONE) 1.5

AC439271G0 GOULESS TABLETS 50MG "STANDARD" (BENZBROMARONE)(鋁箔/膠箔) 2

AC43928100 TOPCEF CAPSULES 500MG "GENTLE" 3.13

AC43931100 FELOPINE E.R. F.C. TABLET 10MG 5.1

AC43932100 CEDOL S.C. TABLETS "P.L" 1.5

AC439321G0 CEDOL S.C. TABLETS "P.L"(鋁箔/膠箔) 2

AC43935100 FAMOSTER F.C. TABLETS 20MG "T.F" 1.92

AC43937100 FONZAC CAPSULES 20MG (FLUOXETINE) "T.F." 2.77

AC43939100 MEP TABLET 1.66

AC43941100 "SPICA CAPSULES 250MG (TRANEXAMIC ACID) ""WINSTON""" 1.52

AC43945129 SCRAT SUSPENSION "STANDARD" 25

AC43945157 SCRAT SUSPENSION "STANDARD" 78

AC43949100 VENSI CAPSULES 5.3

AC43950100 TANATRIL TAB. 5MG 7.9

AC43951100 TANATRIL TAB. 10MG 9

AC43954100 YUGEN FILM COATING TABLETS 3.83

AC43956100 GEN BO CAPSULES 150MG "C.H" 1.64

AC43961100 TERAZOSIN TABLETS 2MG "U-CHU" 3.04

AC43970100 NITREN TABLETS 3.06

AC43971100 LOSAGEN CAPSULES 25MG "PATRON" 4.07

AC43972100 LABISU TABLETS 100MG "S.D" 4.61

AC43978209 "SOROCAM INJECTION 20MG/ML ""TAI YU""" 22.4

AC43978212 "SOROCAM INJECTION 20MG/ML ""TAI YU""" 22.4

AC43981321 NEOCOMB CREAM 14.7

AC43981330 NEOCOMB CREAM 20.2

AC43983321 "GRIST CREAM ""WINSTON""" 14.7

AC43983323 "GRIST CREAM ""WINSTON""" 16.1

AC43983329 "GRIST CREAM ""WINSTON""" 20.2

AC43983330 "GRIST CREAM ""WINSTON""" 20.2

AC43983335 "GRIST CREAM ""WINSTON""" 35.1

AC43983336 "GRIST CREAM ""WINSTON""" 35.1

AC43983338 "GRIST CREAM ""WINSTON""" 61

AC43990100 SUCOUGH F.C TABLET 20MG "YC" 1.5

AC44011100 GENDERGIN-SR TAB. 1MG 2.24

AC44012321 MENTAX CREAM 1% "SINPHAR" 36.5

AC44012329 MENTAX CREAM 1% "SINPHAR" 68

AC44012335 MENTAX CREAM 1% "SINPHAR" 82

AC44012355 MENTAX CREAM 1% "SINPHAR" 836

AC44014100 USERM TABLETS, 100MG 1.63

AC44022100 NIMED TAB. 100MG "LOTUS" 3.13

AC44023143 CETIRIZINE ORAL SOLUTION 1MG/ML "CENTER" 36.6

AC44023151 CETIRIZINE ORAL SOLUTION 1MG/ML "CENTER" 37

AC44023157 CETIRIZINE ORAL SOLUTION 1MG/ML "CENTER" 125

AC44029100 KINZOLAM TABLETS 2MG 1.66

AC440291G0 KINZOLAM TABLETS 2MG(鋁箔/膠箔) 2

AC44031100 ANPURIN TAB. 100MG "H.S" (ALLOPURINOL) 1.5

AC440311G0 ANPURIN TABLETS 100MG "H.S" (ALLOPURINOL)(鋁箔/膠箔) 2

AC44034121 SOONMELT POWDER FOR SYRUP 62.5MG/ML 160

AC44037100 "NINGIST TABLETS 200MG ""WINSTON""" 1.5

AC44038100 SONLI CAPSULES 1.5

AC440381G0 SONLI CAPSULES (鋁箔/膠箔) 2

AC44039500 ZOLGEN VAGINAL TABLETS 100MG "Y.Y." 5.4

AC44041100 MEITIFEN SUSTAINED RELEASE F.C. TABLETS 75MG "EEVEREST" 2.94

174

Page 175: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC44042100 FLUXEN CAPSULES 10MG "W.S." 2.12

AC44060480 SIRUTA INHALATION SOLUTION 200MG/ML "S.T."(MESNA) 40

AC44061100 RIFAMPICIN CAPSULE 300MG 8

AC44063100 TERASIN TABLETS 2MG "PURZER" 3.04

AC44064321 FUSOTEX CREAM 20MG/GM "PATRON" 55

AC44064326 FUSOTEX CREAM 20MG/GM "PATRON" 55

AC44064329 FUSOTEX CREAM 20MG/GM "PATRON" 58

AC44064335 FUSOTEX CREAM 20MG/GM "PATRON" 154

AC44064348 FUSOTEX CREAM 20MG/GM "PATRON" 337

AC44065321 GOODGEN GEL 10MG/GM "PATRON" (PIROXICAM) 11.2

AC44065338 GOODGEN GEL 10MG/GM "PATRON" (PIROXICAM) 28.5

AC44065345 GOODGEN GEL 10MG/GM "PATRON." (PIROXICAM) 40.8

AC44067100 BAYMIN TABLETS 5MG "T.F" (MEQUITAZINE) 1.52

AC44070280 SOONMELT FOR INTRAVENOUS INJECTION 47.9

AC44070297 SOONMELT FOR INTRAVENOUS INJECTION 142

AC44078100 "PRENILONE TABLETS 5MG ""TAI YU"" (PREDNISOLONE)" 1.5

AC44083151 CENTERTHEO LIQUID 5.34MG//ML "CENTER" 25

AC44083157 CENTERTHEO LIQUID 5.34MG//ML "CENTER" 28.9

AC44084321 CLINGENE-T GEL 10MG/G "PATRON" 9.1

AC44084329 CLINGENE-T GEL 10MG/GM "PATRON" 17.9

AC44084335 CLINGENE-T GEL 10MG/GM "PATRON" 28.3

AC44084338 CLINGENE-T GEL 10MG/GM "PATRON" 83

AC44086100 SUDORXAN TABLETS 200MG 1.5

AC44088238 MEJUOLINE INJECTION "N.K." 15

AC44090221 DOPAVATE INJECTION 40MG/ML 25.8

AC44093209 AVAPYRA INJECTION 15

AC44094100 DICOKAN-A CAP. "T.F" 1.5

AC44113100 ESDIAN F.C. TABLETS 7.8

AC44114100 SUFLEX TABLETS 200MG "YUNG SHIN" 1.5

AC441141G0 SUFLEX TABLETS 200MG "YUNG SHIN"(鋁箔/膠箔) 2

AC44115100 MEQUITAZINE TABLETS 5MG "U-CHU" 1.52

AC441151G0 MEQUITAZINE TABLETS 5MG "U-CHU"(鋁箔/膠箔) 2

AC44117329 CLOBEGEN CREAM "WEIDAR" 50

AC44123114 SOONMELT POWDER FOR SYRUP 31.25MG/ML 84

AC44127100 ALLOPURINOL TABLETS 300MG "U-CHU" 2.74

AC44140100 YURINOM TABLETS 100MG "T.F"(BENZBROMARONE) 2.88

AC44141321 GENTAMYCIN CREAM 0.1% 20

AC44141329 GENTAMYCIN CREAM 0.1% 20

AC44141335 GENTAMYCIN CREAM 0.1% 49.4

AC44161100 LISINOPRIL TABLETS 10MG "U-CHU" 3.66

AC44162100 SPASVERINE CAP. 60MG "PATRON" 2.39

AC44163100 SWINORIN F.C. TABLETS 50MG "SWISS" 1.56

AC44164421 SHINSOX VISCOUS EYE DROP 10MG/ML "PATRON" 65

AC44165100 SINGSONG CAPSULES 25MG 2.16

AC44167421 "FOXONE OPHTHALMIC SUSPENSION 1MG/ML ""WINSTON""" 14

AC44167429 "FOXONE OPHTHALMIC SUSPENSION 1MG/ML ""WINSTON""" 77

AC44169110 AMOXICILLIN POWDER FOR ORAL SUSPENSION 25MG/ML (AMOXICILLIN

TRIHYDRATE)

31

AC44172100 GELID TABLETS 80MG "H.S." (GLICLAZIDE) 1.5

AC441721G0 GELID TABLETS 80MG "H.S."(GLICLAZIDE)(鋁箔/膠箔) 2

AC44174100 MUSOLAX F.C. TABLETS 150MG 1.95

AC441741G0 MUSOLAX F.C. TABLETS 150MG(鋁箔/膠箔) 2

AC44175100 FOPO TABLETS 7.8

AC44176100 THROMKEY ENTERIC-MICROENCAPSULATED CAPSULES 100MG

(ASPIRIN)"SWISS"

0.66

175

Page 176: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC441761G0 THROMKEY ENTERIC-MICROENCAPSULATED CAPSULES 100MG (ASPIRIN)

"SWISS" (鋁箔/膠箔)

0.66

AC44186100 "CISBILE CAPSULES 300MG ""WINSTON""" 4.39

AC44187209 BIPIDEN INJECTION 34.8

AC44196100 FEROMINE CAPSULES 10MG "H.S" 2.39

AC44197100 "SAVORY CAPSULES 60MG ""WINSTON""" 2.39

AC44201100 DORISIN F.C. TABLET "S.C" 2.24

AC44203100 HAVINA F.C TABLETS 3.44

AC44208421 TOCIN OPHTHALMIC SOLUTION 0.3% "PATRON" 37.9

AC44209100 SPASTIN TABLETS "EVEREST" 2.73

AC44213100 SYNTERON TABLETS 50MG 38.9

AC44223100 LIKEJHN CAPSULES 250MG "C.H" 2.44

AC44241329 DR.PI.A.F CREAM "MEIDER" 50

AC44241336 DR.PI.A.F CREAM "MEIDER" 59

AC44241338 DR.PI.A.F. CREAM "MEIDER" 99

AC44245421 LANYUNG EYE DROPS 0.1% "Y.Y" 45.7

AC44245429 LANYUNG EYE DROPS 0.1% "Y.Y" 85

AC44248100 FOLINA TABLETS 15MG 17.6

AC44250100 IZYMIN F. C. TABLETS 10MG "H.S" 1.5

AC442501G0 IZYMIN F. C. TABLETS 10MG "H.S"(鋁箔/膠箔) 2

AC44252329 B.C.CREAM 100

AC44253100 USER TAB. "T.F" (TIAPROFENIC ACID) 3.27

AC44254100 BETHANECHOL TABLETS 25MG "JOHNSON" 2.11

AC44261100 RICH CAPSULES 30MG "N.K" 18.5

AC44264421 CHLORODECA OPHTHALMIC SOLUTION "PATRON" 51

AC44267100 "COTENIN CAP. ""TAI YU""" 1.5

AC44268321 CLINDAMYCIN GEL 10MG/G "T.F" 9.1

AC44270100 OKWE CAP. 20MG "N.K" 2.51

AC44272100 FORMOROL TAB. "S.C" 2.37

AC44281100 GABALON TAB. 5MG 1.5

AC44282100 DICLOREN E.M. CAPSULES 50MG "WEIDAR" 1.5

AC442821G0 DICLOREN E.M. CAP. 50MG "WEIDAR"(鋁箔/膠箔) 2

AC44295100 EDIOL F.C TABLATS 1MG 2.27

AC44297100 KINFLOCIN F.C. TABLETS 100MG "KINGDON" (OFLOXACIN) 1.85

AC44298421 DEXAMETHASONE EYE DROPS 0.1% "SINPHAR" 14.7

AC44299429 BETONASE AQUEOUS NASAL SPRAY 50UG/SPRAY 118

AC44300100 UROSE CAPSULES 300MG 4.39

AC443151G0 FRONITEC TABLETS 20MG "T.F."(鋁箔/膠箔) 2

AC44317100 BUWECON TAB. 0.125MG "YUNG SHIN" 2.45

AC44320100 BASORLIN TABLETS 200MG "T.F" 1.5

AC44321151 SULFACOTRIM SUSPENSION "CENTER" 28

AC44332212 FENTANYL INJECTION 0.05MG/ML "PPCD" 20

AC443381G0 COLONIL F.C. TABLETS 135MG "SWISS"(鋁箔/膠箔) 2

AC44365100 DAMPURINE TABLETS 25MG 1.89

AC44366100 URICIN F.C. TABLETS 250MG "H.S" 4.06

AC44374100 YOU-JET F.C. TABLETS 50MG 11.7

AC44396151 MINLIFE SYRUP 1MG/ML 31.3

AC44402100 KINSCAR F.C TABLETS 5MG "KINGDON" 20.6

AC44414100 CLATINE TABLET 10MG "STANDAND"(LORATADINE) 1.5

AC444141G0 CLATINE TABLET 10MG "STANDAND"(鋁箔/膠箔) 2

AC44418100 THEOLIN S.R. TABLETS "PEI.LI" 1.72

AC444181G0 THEOLIN S.R. TABLETS "PEI.LI"(鋁箔/膠箔) 2

AC44419100 GLYCON TABLETS 80MG "SWISS" 1.5

AC44420100 LANDING TABLETS 20MG "YUNG SHIN" 1.89

AC444201G0 LANDING TABLETS 20MG "YUNG SHIN"(?T??/????) 2

176

Page 177: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC44421100 YAMTAC S.C. TABLETS 20MG 1.92

AC44436221 MIDAZO AMPOULE 5MG/5ML 24.3

AC44437209 MIDAZO AMPOULE 5MG/ML 24.3

AC44437216 MIDAZO AMPOULE 5MG/ML 38.6

AC44437229 MIDAZO AMPOULE 5MG/ML 203

AC44449100 AVERINE TABLETS 40MG 2.73

AC44450100 MEITAN F.C TABLETS 25MG "EVEREST" 1.5

AC444501G0 MEITAN F.C TAB. 25MG "EVEREST" (鋁箔/膠箔) 2

AC44459100 MUXALON TABLETS 200MG“H.S.” 1.5

AC44461100 LOW-LIP MICRONISED CAPSULES 3.26

AC44463100 SEMI-NAX F.C. TAB. 10MG "D.T" 2.51

AC44469100 ULYMIN TABLET 30MG 2.06

AC44470100 FLURONIN CAP. 10MG "YUNG SHIN" 2.12

AC44477100 SAFEPRIL TABLETS 10MG "STANDARD" 3.66

AC44479100 CLARICIN F.C. TABLETS 250MG "P.L" 4.06

AC44480100 LANDING TABLETS 10MG "YUNG SHIN" 1.89

AC444801G0 LANDING TABLETS 10MG "YUNG SHIN"(鋁箔/膠箔) 2

AC44481100 BIOZOLE TABLET 20MG 2.51

AC44483421 CHLORAMPHENICOL 0.25% EYE DROPS "SINPHAR" 12

AC44483429 CHLORAMPHENICOL 0.25% EYE DROPS "SINPHAR" 14.1

AC44484100 CLINDAMYCIN HCL CAPSULES 300MG "Y.Y" 2.86

AC44498100 TELIN S.R TAB. 200MG "STANDARD" 1.62

AC444981G0 TELIN S.R TABLETS 200MG "STANDARD"(鋁箔/膠箔) 2

AC44500109 GASTINE GRANULES 20MG/GM "PURZER" 6.6

AC44505321 DECENT CREAM 1% 25.4

AC44505329 DECENT CREAM 1% 45.2

AC44505335 DECENT CREAM 1% 50

AC44505338 DECENT CREAM 1% 92

AC44507100 FENOX TAB. 500MG 4.71

AC44541100 CETIMIN FILM COATED TABLETS 10MG "C.H" 1.5

AC445411G0 CETIMIN FILM COATED TABLETS 10MG "C.H"(鋁箔/膠箔) 2

AC44542100 NABUTON FILM COATED TABLETS 500MG "YUNG SHIN" 3.88

AC44546100 VANIPEN TABLETS 0.5MG 1.5

AC445461G0 VANIPEN TABLETS 0.5MG(鋁箔/膠箔) 2

AC44547100 TELOWSIN TABLETS 2MG "YUNG SHIN" 3.04

AC44548209 "LACTATED RINGER INJECTION ""TAI YU""" 32.6

AC44548265 "LACTATED RINGER INJECTION ""TAI YU""" 22

AC44548277 "LACTATED RINGER INJECTION ""TAI YU""" 25

AC44567100 SAXOBIN TAB. 2MG 2.93

AC44572100 FOXATE F.C TABLETS 200MG 4.84

AC44573321 ACURE GEL 0.1% 20

AC44573335 ACURE GEL 0.1% 83

AC44573343 ACURE GEL 0.1% 174

AC44573345 ACURE GEL 0.1% 232

AC44573363 ACURE GEL 0.1% 799

AC44574100 COUSOTIN CAPSULES 1.5

AC445741G0 COUSOTIN CAPSULES(鋁箔/膠箔) 2

AC44575100 FEPINE E.R. TABLETS 5MG "WECAM" 3.29

AC44577100 TORLEX TABLETS 50MG "YUNG SHIN" 1.93

AC445771G0 TORLEX TABLETS 50MG "YUNG SHIN"(鋁箔/膠箔) 2

AC44595100 MINLIFE TABLETS 10MG 1.5

AC445951G0 MINLIFE TABLETS 10MG(鋁箔/膠箔) 2

AC44597100 COXINE SR TABLETS 40MG 3.31

AC44601221 FORMOXOL INJECTION 1388

AC44601229 FORMOXOL INJECTION 1941

177

Page 178: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC44601240 FORMOXOL INJECTION 8989

AC446012FG FORMOXOL INJECTION 3774

AC44602100 BIDOPAR TABLETS 25/250MG 12.3

AC44605100 ZOLNOX F.C. TABLETS 10MG 2.51

AC44606100 CEPHANMYCIN FILM COATED TAB. 500MG 1.82

AC44620417 ENT OINTMENT 62

AC44620421 ENT OINTMENT 62

AC44621100 DOSABIN TABLETS 2MG 2.93

AC44622100 SETINE F.C TAB.20MG "STANDARD" 10.6

AC44630100 PINAVEN F.C. TABLETS 50MG 10.8

AC44631100 FELOPINE- S.R TABLETS 5MG 3.29

AC44649321 AZEL CREAM 28

AC44649329 AZEL CREAM 54

AC44649330 AZEL CREAM 54

AC44650100 ROBATROL CAPSULES 200MG 13.3

AC44672100 TAXIFEN FILM COATED TAB. 10MG "YUNG SHIN" 3.06

AC44680100 FLU-D CAPSULES 50MG 37.2

AC44682100 CAMISAN TABLETS 250MG "S.T." (TERBINAFINE) 13.8

AC44683100 TERFINE TABLETS 250MG "N.K" 13.8

AC44684100 ZOLMAN F.C. TAB. 10MG "S.C" 2.51

AC44687100 AMILO TABLETS 10MG 6.8

AC44689100 THOIN S.R.M.C 250MG "EVEREST" 1.72

AC446891G0 THOIN S.R.M.C. 250MG "EVEREST"(鋁箔/膠箔) 2

AC44710100 CETY FILM COATED TABLETS 10MG 1.5

AC447101G0 CETY FILM COATED TABLETS 10MG (鋁箔/膠箔) 2

AC44713100 SOONMELT FILM COATED TABLETS 375MG 6.8

AC44715100 ECYCLE F.C.TABLETS 8MG "Y.Y." 1.5

AC44731100 LONGCARDIO(CARVEDILOL) TABLETS 25MG 6.2

AC44733100 COLIROCIN F.C TAB. 250MG 4.06

AC44777100 DEKU FC TAB. 500MG 3.88

AC44781100 DETOSIV SUSTAINED RELEASE TABLETS 60MG "LOTUS" 2.16

AC44801100 "IBU TABLETS ""ROOT""" 1.5

AC448011G0 "IBU TABLETS ""ROOT""(鋁箔/膠箔)" 2

AC44805221 HEPAC INJECTION 5000UNITS/ML "N.K" 30.6

AC44805240 HEPAC INJECTION 5000UNITS/ML "N.K" 92

AC44805248 HEPAC INJECTION 5000UNITS/ML "N.K" 170

AC44807100 OXAMIDE TABLETS 30MG "S.T" 2.06

AC44809248 SEFORCE INJECTION 2MG/ML "N.K" 288

AC44809255 SEFORCE INJECTION 2MG/ML "N.K" 628

AC44809263 SEFORCE INJECTION 2MG/ML "N.K" 1003

AC448101G0 ENARIL TABLETS 20MG "WEIDAR"(鋁箔/膠箔) 2

AC44824277 HIPOLY INJECTION "N.K" 30.3

AC44826100 ZOPIDEM F.C. TABLETS 10MG "STANDARD" 2.51

AC44827340 ZOLCHIN LIQUID "Y.Y" 142

AC44828100 NAKAMIDE F.C. TABLETS 1.25MG "N.K" 1.69

AC44850100 ALOZIDE TABLETS 2.49

AC44853100 DOPHILIN TABLETS 2MG "S.T" 2.93

AC44877100 FERRIAN CHEWABLE TABLETS 3.9

AC44878100 BORY MYCIN PELLET-FILLED CAPSULES 50MG 3.68

AC44882100 NIAN TABLETS 10MG "Y.Y." 3.06

AC44916100 LABUTON F.C TABLETS 500MG "WEIDAR" 3.88

AC44917100 KOMENI F.C TABLETS "EVEREST" 3.44

AC44919321 BELOLIN CREAM 0.5MG/GM (CLOBETASOL) 15.8

AC44919324 BELOLIN CREAM 0.5MG/GM 15.8

AC44919329 BELOLIN CREAM 0.5MG/GM(CLOBETASOL) 17.7

178

Page 179: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC44919335 BELOLIN CREAM 0.5MG/GM(CLOBETASOL) 28.6

AC44919338 BELOLIN CREAM 0.5MG/GM(CLOBETASOL) 47

AC44919340 BELOLIN CREAM 0.5MG/GM (CLOBETASOL) 88

AC44920100 STAWEI TABLETS 1.64

AC449201G0 STAWEI TABLETS (鋁箔/膠箔) 2

AC44921100 PUTAN CHEWABLE TABLETS "Y.Y." 3.9

AC44924100 THOIN SUSTAINED-RELEASE MICROSPHERES CAP. 125MG "EVEREST" 1.51

AC449241G0 THOIN SUSTAINED-RELEASE MICROSPHERES CAPSULES 125MG

"EVEREST""(鋁箔/膠箔)

2

AC44925100 AMPIN TAB. 10MG 6.8

AC44951100 FORMAX RETARD SLOW RELEASE FILM-COATING TAB.75MG "SHITEH" 2.94

AC44969321 CIPROSONE CREAM 0.5MG/GM 19.9

AC44969329 CIPROSONE CREAM 0.5MG/GM 19.9

AC44969335 CIPROSONE CREAM 0.5MG/GM 31.9

AC44970143 LEDAMIN SYRUP 1MG/ML "CENTER" (LORATADINE) 25.6

AC44970151 LEDAMIN SYRUP 1MG/ML "CENTER"(LORATADINE) 31.3

AC44971312 ACLOR CREAM 5% "Y.Y." 17.3

AC44971316 ACLOR CREAM 5% "Y.Y." 17.3

AC44971317 ACLOR CREAM 5% "Y.Y." 17.3

AC44971319 ACLOR CREAM 5% "Y.Y." 17.3

AC44971321 ACLOR CREAM 5% "Y.Y." 46.6

AC44971329 ACLOR CREAM 5% "Y.Y" 46.6

AC44972100 KALIJYUN CAPSULES 150MG "C.H" 1.5

AC44973321 FUGEN CREAM 2% "Y.Y" 55

AC44973326 FUGEN CREAM 2% "Y.Y" 55

AC44973329 FUGEN CREAM 2% "Y.Y" 58

AC44973335 FUGEN CREAM 2% "Y.Y" 154

AC44973338 FUGEN CREAM 2% "Y.Y" 160

AC44974229 ANGIDIL INJECTION 0.1% 211

AC44975329 ZA CREAM 200MG/GM 54

AC44976100 PEIFLAM FILM COATED TAB. "P.L" 1.5

AC449761G0 PEIFLAM FILM COATED TAB. "P.L"(鋁箔/膠箔) 2

AC44977100 GOWELL TABLETS "WECAN" 1.5

AC449771G0 GOWELL TABLETS "WECAM"(鋁箔/膠箔) 2

AC44980100 DEALLERGY F.C TAB. 1.5

AC44998100 ZOLOTIN FILM COATED TABLETS 20MG 6.5

AC45000100 AZUGEN TABLETS 2MG "WECAM" 1.5

AC450001G0 AZUGEN TABLETS 2MG "WECAM" (鋁箔/膠箔) 2

AC45001100 SPASTEC F.C. TABLETS 50MG "SWISS" 10.8

AC45013100 DOXTER TABLETS 2MG 2.93

AC45017321 COMYBOR CREAM 10MG/GM(BIFONAZOLE) 34.3

AC45017329 COMYBOR CREAM 10MG/GM(BIFONAZOLE) 74

AC45017335 COMYBOR CREAM 10MG/GM(BIFONAZOLE) 75

AC45017338 COMYBOR CREAM 10MG/GM (BIFONAZOLE) 81

AC45020100 MUSGUD TABLETS 10MG "LOTUS" 4.23

AC45031100 IWELL TABLETS "EVEREST" 1.5

AC450311G0 IWELL TABLETS "EVEREST"(鋁箔/膠箔) 2

AC45037421 NORFU EYE DROPS 0.3% 63

AC45037429 NORFU EYE DROPS 0.3% 83

AC45039100 XADOSIN TAB. 2MG 1.97

AC45040100 FENSIREN CAPSULES 40MG "YUNG SHIN" 1.81

AC45062421 KARTEOL OPHTHALMIC SOLUTION 1% "KINGDOM"(CARTEOLOL HCL) 188

AC45085100 AMLODINE TABLETS 6.8

AC45090100 SELADIN ENTERIC COATED TABLETS 500MG 3.26

AC45101421 KARTEOL OPHTHALMIC SOLUTION 2% "KINGDOM"(CARTEOLOL HCL) 200

179

Page 180: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC45102100 E WEI AN CAPSULES 15MG "N.K." 16.6

AC45105321 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL ) 15.8

AC45105324 BELOLIN OINTMENT 0.5MG/GM 15.8

AC45105329 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL) 17.7

AC45105335 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL) 28.6

AC45105338 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL ) 47

AC45105340 BELOLIN OINTMENT 0.5MG/GM (CLOBETASOL ) 88

AC45128238 VITATICANIN-G INJECTION 15

AC45144100 SAXOBIN TABLET 1MG 2.93

AC45145421 "FOXONE OPHTHALMIC SUSPENSION 0.2MG/ML ""WINSTON""" 17.8

AC45145423 "FOXONE OPHTHALMIC SUSPENSION 0.2MG/ML ""WINSTON""" 23.2

AC45145429 "FOXONE OPHTHALMIC SUSPENSION 0.2MG/ML ""WINSTON""" 78

AC45146421 SUZOLE EYE DROPS "Y.Y" 12

AC45146429 SUZOLE EYE DROPS "Y.Y" 12

AC45146435 SUZOLE EYE DROPS "Y.Y" 15.4

AC45147100 ZOPIM F.C. TABLETS 10MG "S.T."(ZOLPIDEM) 2.51

AC45154221 TRANSAMIN INJECTION "DAIICHI SANKYO" 15

AC45155100 ZOLDOX F.C. TAB. 10MG "WEIDAR" 2.51

AC45172100 Vastril Tablets 10mg 3.66

AC45178100 LUNGTEC TAB. 10MG 3.32

AC45179100 WEMENI F.C TAB. "WECAM" 3.44

AC45181100 SYNNA TABLETS 4.97

AC45182100 PHENEULIN CAP. 10MG "YUNG SHIN" 2.39

AC45183412 ZINE ORABASE 0.1% 41

AC45183421 ZINE ORABASE 0.1% 55

AC45183426 ZINE ORABASE 0.1% 61

AC45186321 KOLINCIN GEL 10MG/G 9.1

AC45186323 KOLINCIN GEL 10MG/G 16

AC45186329 KOLINCIN GEL 10MG/G 17.9

AC45186335 KOLINCIN GEL 10MG/G 28.3

AC45186338 KOLINCIN GEL 10MG/G 83

AC45186343 KOLINCIN GEL 10MG/G 186

AC45187100 YAWAHO TABLETS 6.8

AC45201100 CIPROFLO F.C. TABLET 500MG 13.1

AC45203100 LOSA F.C. TABLETS 50MG 9.3

AC45205321 BECLOSOL GEL 15.8

AC45205324 BECLOSOL GEL 15.8

AC45226100 SALA F.C. TABLETS 750MG "N.K" 4.91

AC45228338 MIZTIN CREAM "MEIDER" 61

AC45230100 PIPEINE F.C. TAB. "S.C" 1.53

AC45245321 CIPROSONE OINTMENT 0.5MG/GM 19.9

AC45245329 CIPROSONE OINTMENT 0.5MG/GM 19.9

AC45245335 CIPROSONE OINTMENT 0.5MG/GM 31.9

AC45247100 DOBECON SUGAR COATED TAB. 100MG "YUNG SHIN" 2.2

AC45248100 SUCONIN CAPSULES 1.5

AC45249321 BADINE OINTMENT 19.9

AC45249329 BADINE OINTMENT 19.9

AC45250100 OMP E.C CAPSULES 20MG (OMEPRAZOLE) 2.51

AC45251129 SCOTON ORAL SUSPENSION 25

AC45251151 SCOTON ORAL SUSPENSION 25

AC45251157 SCOTON ORAL SUSPENSION 67

AC45254100 SYNBOT TAB. 5MG 1.89

AC452541G0 SYNBOT TAB. 5MG(鋁箔/膠箔) 2

AC45267100 U-CHU ACEO CAPSULES RETARD 90MG 3.13

AC45276100 SOONMELT FILM COATED TABLETS 625MG 6.6

180

Page 181: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC45289321 BETASALIC OINTMENT 12.6

AC45289329 BETASALIC OINTMENT 25.5

AC45289335 BETASALIC OINTMENT 81

AC45289338 BETASALIC OINTMENT 81

AC45290100 MECON TABLETS 7.5MG 2.36

AC45293417 KAMIN EYE DROPS 0.3% "Y.Y" 37.9

AC45293421 KAMIN EYE DROPS 0.3% "Y.Y" 37.9

AC45307421 SHOWEN EYE DROPS 0.25% "Y.Y" 12

AC45307429 SHOWEN EYE DROPS 0.25% "Y.Y" 14.1

AC45310263 AMIPAREN INJECTION 10% W/V 158

AC45310271 AMIPAREN INJECTION 10% W/V 248

AC45311100 BEDASON TABLETS "S.C" 1.5

AC45312100 LIDAMOLE F.C TABLETS "S.C" 1.5

AC45331221 GENETAXYL CREM LESS INJECTION 1388

AC45331229 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 1941

AC45331235 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 2384

AC45331240 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 8989

AC45331248 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 22960

AC453312E2 GENETAXYL CREM LESS INJECTION 6MG/ML (PACLITAXEL) 3774

AC45334100 MIDORINE TABLETS "P.L" 3.43

AC45337321 BASOL OINTMENT 15.8

AC45337324 BASOL OINTMENT 15.8

AC45337335 BASOL OINTMENT 28.6

AC45337338 BASOL OINTMENT 47

AC45338157 CONSRINE SYRUP 28.8

AC45339280 AMOCLAVUNIN FOR INTRAVENOUS INJECTION 0.6GM "TAI YU" 0

AC45339297 AMOCLAVUNIN FOR INTRAVENOUS INJECTION 1.2GM "TAI YU" 0

AC45340321 BASOL CREAM 15.8

AC45340324 BASOL CREAM 15.8

AC45340335 BASOL CREAM 28.6

AC45340338 BASOL CREAM 47

AC45341321 BADINE CREAM 19.9

AC45341329 BADINE CREAM 19.9

AC45342100 CLONOPAM TABLETS 0.5MG "KINGDOM"(CLONAZEPAM) 1.5

AC453421G0 CLONOPAM TABLETS 0.5MG "KINGDOM"(CLONAZEPAM)(鋁箔/膠箔) 2

AC45343100 CARIMYCIN FILM COATED TABLETS 250MG 4.06

AC45345100 CLONOPAM TABLETS 2MG "KINGDOM" 2.66

AC45346100 KER KER CAPSULES "S.C." 1.5

AC45349329 BESALIC OINTMENT 25.5

AC45349335 BESALIC OINTMENT 81

AC45349338 BESALIC OINTMENT 81

AC45349343 BESALIC OINTMENT 81

AC45351100 ACTIWE TABLETS "UELIAN" 1.5

AC45354100 BETARUN F.C TABLETS 20MG 4.58

AC45355209 DROPEL INJECTION 2.5MG/ML 15

AC45357345 KENETON GEL 40.8

AC453573AK KENETON GEL 39.9

AC45358100 DEFLAM-K F.C. TABLETS 25MG "KINGDOM" (DICLOFENAC POTASSIUM) 1.5

AC453581G0 DEFLAM-K F.C. TABLETS 25MG "KINGDOM" (DICLOFENAC POTASSIUM)(鋁

箔/膠箔)

2

AC45361321 D.F. CREAM 1MG/GM 14.9

AC45361329 D.F CREAM 1MG/GM 50

AC45361343 D.F CREAM 1MG/GM 85

AC45362212 FE-BACK INJECTION 2% "N.K." 38.5

181

Page 182: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC45362221 FE-BACK INJECTION 2% "N.K." 79

AC45374100 DOWN-LIP MICRONISED CAPSULES 200MG 6.5

AC45375100 MELOCAM TABLETS "P.L" 2.36

AC45379114 ANBICYN POWDER FOR SYRUP 31.25MG/ML 84

AC45380100 KITAPRAM F.C. TABLETS 20MG "KINGDOM" (CITALOPRAM) 15.7

AC45381100 LOTE E.C TABLETS 100MG 26.9

AC45382100 "MINING TABLETS 5MG ""TAI YU""" 1.52

AC45383100 BAFEN TABLETS 5MG 1.5

AC453831G0 BAFEN TABLETS 5MG(鋁箔/膠箔) 2

AC453831G5 BAFEN TABLETS 5MG(84粒/瓶) 2

AC45385100 MOPIK TABLETS 7.5MG "N.K" 2.36

AC45386529 SUTROL GEL-VAGINAL 69

AC45386540 SUTROL GEL-VAGINAL 134

AC45388321 BECLOSOL OINTMENT 15.8

AC45388324 BECLOSOL OINTMENT 15.8

AC45407100 MELOXIN TABLETS 7.5MG 2.36

AC45409277 "LAG FOR INJECTION 500MG ""TAI YU""" 15

AC45412100 NOOPOL F.C. TABLETS 1200MG "N.K." 2.67

AC45414100 ZAPINE TABLETS 100MG "S.T" 8.9

AC45437100 ANWU ENTERIC COATED TABLETS 50MG (FLUVOXAMINE MALEATE) 9.8

AC45439100 SPASLAX TABLETS 4MG 8.7

AC45441100 MELICAM TABLETS 7.5MG "KINGDOM" 2.36

AC45447429 ALLERCORT NASAL AQUA 50UG/DOSE "STANDARD" (BUDESONIDE) 131

AC45448100 AMILO TABLETS 5MG 6.8

AC45450100 LICHIA TABLETS "L.E" 1.5

AC454501G0 LICHIA TABLETS "L.E"(鋁箔/膠箔) 2

AC45489100 MIXAPIN TABLETS 25MCG "H.S" 1.59

AC454891G0 MIXAPIN TABLETS 25MCG "H.S"(鋁箔/膠箔) 2

AC45494221 YUTOPAR INJECTION 10MG/ML 65

AC45510100 POLO SR TABLET 10MG "N.K" 5.1

AC45538251 UROKINASE INJECTION 60,000I.U. "YAO CHIH HSIANG" 1010

AC45539100 NOSMA SUSTAINED-RELEASE MICROSPHERES CAPSULES 125MG "WECAM" 1.51

AC455391G0 NOSMA SUSTAINED-RELEASE MICROSPHERES CAPSULES 125MG "WECAM"(鋁

箔/膠箔)

2

AC45541100 STIDINE TABLETS 2MG "KINGDOM" (TIZANIDINE) 1.99

AC45543100 "JENAC CAPSULES ""ROOT.""" 4.52

AC45552100 MEDRONE TABLETS 5MG "WEIDAR" 1.57

AC455521G0 MEDRONE TABLETS 5MG "WEIDAR"(鋁箔/膠箔) 2

AC45553321 NIFFULENE GEL 0.1% "PHARMAX" 19.5

AC45553335 NIFFULENE GEL 0.1% "PHARMAX" 80

AC45553343 NIFFULENE GEL 0.1% "PHARMAX" 139

AC45553345 NIFFULENE GEL 0.1% "PHARMAX" 212

AC45553363 NIFFULENE GEL 0.1% "PHARMAX" 717

AC45556321 GENCIN CREAM 20

AC45556329 GENCIN CREAM 20

AC45556335 GENCIN CREAM 49.4

AC45557100 LOTARIN TABLETS 10MG "WEIDAR" 1.5

AC455571G0 LOTARIN TABLETS 10MG "WEIDAR"(鋁箔/膠箔) 2

AC45571329 FORMEI CREAM "Y.C" 50

AC45571336 FORMEI CREAM "Y.C." 59

AC45571338 FORMEI CREAM "Y.C" 99

AC45581100 PAROXE F.C TABLETS 20MG 10.6

AC45582100 RIPEDON F.C. TABLETS 2MG "STANDARD" 18.6

AC45590100 BACLOSPAS TABLETS 10MG 1.5

182

Page 183: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC45591100 BACLOSPAS TABLETS 5MG 1.5

AC45599345 ANTIPAIN PATCH "SHENG CHUN" (FLURBIPROFEN) 40MG/12GM 6.3

AC45620100 BAMBEROL TAB. 10MG "S.C" 3.32

AC45645248 FLUENE IV INJECTION 2MG/ML "PURZER" 361

AC45646100 DEGLU TABLETS 50MG "LOTUS" 3.27

AC45648100 MECORDA TABLETS "S.C" 1.5

AC45649100 "TONZOUGE F.C TABLETS 400MG ""TAI YU""" 1.5

AC45653100 BIOKIN F.C. TABLET 9.6MG "MEIDER" 2.24

AC45667314 ELISONE CREAM 24.1

AC45667316 ELISONE CREAM 24.1

AC45667321 ELISONE CREAM 41.3

AC45667326 ELISONE CREAM 44.9

AC45667329 ELISONE CREAM 44.9

AC45667335 ELISONE CREAM 122

AC45671100 CEFLOUR FILM COATED TABLETS 250MG 6.8

AC45672321 "MOSONE CREAM ""H.S""" 41.3

AC45672329 "MOSONE CREAM ""H.S""" 44.9

AC45672335 "MOSONE CREAM ""H.S""" 122

AC45676421 PREDILONE OPH. SOL. 1% "KINGDOM" 78

AC45685412 NEO SMILE ORABASE 41

AC45685421 NEO SMILE ORABASE 55

AC45685426 NEO SMILE ORABASE 61

AC45696355 COLASA ENEMA 20MG/ML 192

AC45699100 CEFIXMYCIN CAPSULE 100MG "YUNG SHIN" 5.5

AC45700100 UROTROL F.C TABLETS 15MG 6.5

AC45701221 ALEVIATIN INJECTION 72

AC45703100 CHITIAN TABLETS 80MG "C.H." 1.5

AC45705100 BERIAN F.C. TABLETS "N.K." 1.5

AC45706143 LORADIN SYRUP "H.S" 25.6

AC45706151 "LORADIN SYRUP ""H.S""" 31.3

AC45706155 "LORADIN SYRUP ""H.S""" 72

AC45708100 CANASE CAPSULES 1.5

AC457081G0 CANASE CAPSULES(鋁箔/膠箔) 2

AC45719423 BESONIN AQUA NASAL SPRAY 50MCG/DOSE 89

AC45719429 BESONIN AQUA NASAL SPRAY 50MCG/DOSE 131

AC45721421 ANTOL EYE DROPS 0.3% 12

AC45721429 ANTOL EYE DROPS 0.3% 20.3

AC45722100 "ELAC CAPSULES 200MG ""ROYAL""" 4.52

AC45731421 KINGCORT OPH. SOL. 0.125% "KINGDOM" (PREDNISOLONE SODIUM

PHOSPHATE)

63

AC45733100 ASMATIN TABLETS "SINPHAR" 1.5

AC457331G0 ASMATIN TABLETS "SINPHAR"(鋁箔/膠箔) 2

AC45748100 SINCLAZIDE TABLETS 80MG "SINPHAR" 1.5

AC45751321 PROMISONE CREAM "START" 19.9

AC45751335 PROMISONE CREAM "START" 31.9

AC45751343 PROMISONE CREAM "START" 31.9

AC45752100 SLEEPMAN TABLETS 2.51

AC45755100 SPASLAX TABLETS 2MG 1.99

AC45756100 SUPCAL TABLETS 667MG "N.K." 1.87

AC45757100 EBUFEN F.C.TAB. 600MG "S.C" 1.78

AC45777100 TAZAC CAPSULES 150MG 6.9

AC45779100 MODIPANOL F.C TABLETS 1MG "SWISS" 1.55

AC457791G0 MODIPANOL F.C TABLETS 1MG "SWISS"(鋁箔/膠箔) 2

AC45780100 "DOLOC CAPSULES 200MG ""MACRO""" 4.52

AC45781100 AZAMUN FILM COATED TABLETS 50MG 20.5

183

Page 184: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC45782321 CLOBESONE CREAM "START" 15.8

AC45782324 CLOBESONE CREAM "START" 15.8

AC45800100 CHENCOUGH CAPSULES "S.C." 1.5

AC45801421 CIROXIN OPHTHALMIC SOLUTION 0.3% "PATRON" 119

AC45807100 CITAO TABLETS 20MG (CITALOPRAM) 15.7

AC45809421 FLUCASON OPHTHALMIC SUSPENSION 0.1% "KINGDOM"

(FLUOROMETHOLONE)

14

AC45809429 FLUCASON OPHTHALMIC SUSPENSION 0.1% "KINGDOM"

(FLUOROMETHOLONE)

77

AC45822100 XETINE-P F.C TABLETS 20MG 10.6

AC45825321 DANCE CREAM 41.3

AC45825329 DANCE CREAM 44.9

AC45825335 DANCE CREAM 122

AC45827100 SUCAM CAPSULES 50MG "EVEREST" 10.8

AC45851321 IN-QUADEICREN CREAM 14.7

AC45851323 IN-QUADEICREN CREAM 16.1

AC45851329 IN-QUADEICREN CREAM 20.2

AC45851335 IN-QUADEICREN CREAM 35.1

AC45851336 IN-QUADEICREN CREAM 35.1

AC45851338 IN-QUADEICREN CREAM 61

AC45855100 FERICH CAPSULES "PHARMOSA" 3.58

AC45859421 CIPCIN EYE DROPS 0.3% "YY" 110

AC45860100 PEIFLAM FILM COATED TABLETS 25MG "P.L" 1.5

AC45863100 FEDCEN SUSTAINED RELEASE TABLETS 120MG "LOTUS" 2.19

AC45892100 LAVOL TABLETS 5MG 5.9

AC45915326 ANTIDOXE CREAM "S.C." 45.3

AC45915335 ANTIDOXE CREAM "S.C." 60

AC45917321 CLOBA OINTMENT 39.8

AC45917329 CLOBA OINTMENT 44.4

AC45917330 CLOBA OINMENT 70

AC45917335 CLOBA OINTMENT 70

AC45919321 CONFUMIN CREAM "H.S." 62

AC45919335 CONFUMIN CREAM "H.S." 169

AC45921100 FERROSAN TABLETS "S.C." 3.9

AC45923100 METICORT TABLETS 4MG "KINGDOM" (METHYLPREDNISOLONE) 1.66

AC45925321 FUTEN CREAM 2% 55

AC45925329 FUTEN CREAM 2% 58

AC45926100 NAKASSER SR CAPSULES 120MG "N.K." (DILTIAZEM HCL) 6.3

AC45950100 FUNGITECH TABLETS 250MG "SINPHAR" 13.8

AC45951100 DIBECINE CAPSULES "S.C" 2.39

AC45952100 TOPESON F.C. TABLETS 150MG "STANDARD" 1.95

AC45956100 ENPUROL TAB. "Y.C" 2.74

AC45957335 ANCENT CREAM "Y.C" 50

AC45958100 MOGEN ENTERIC-MICROENCAPSULATED CAPSULES 50MG "WECAM" 1.5

AC459581G0 MOGEN ENTERIC-MICROENCAPSULATED CAPSULES 50MG "WECAM"(鋁箔/膠

箔)

2

AC45959100 NOVAMIN TABLETS 1.5

AC45960435 SINOMIN OPHTHALMIC SOLUTION 15.4

AC45962100 ENPEX CAPSULES 1.64

AC459621G0 ENPEX CAPSULES "Y.C."(鋁箔/膠箔) 2

AC45965100 KETO ENTERIC-MICROENCAPSUIATED CAP. 10MG 5.8

AC45967100 RINDERON TABLETS 1.5

AC45971100 ARHEUMA TABLETS 20MG "LOTUS" 56

AC45972100 DENOSIN FILM-COATED TABLETS 5MG "LOTUS" 4.18

AC45973100 NEPHRONORM S.C. TABLETS 4.12

184

Page 185: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC45975100 ROYATEC TABLET "ROYAL." 1.89

AC45994100 SUBIC TABLETS 7.5MG 2.36

AC46012321 BEAUTYFACE GEL "H.S" 19.5

AC46012335 BEAUTYFACE GEL "H.S" 80

AC46012343 BEAUTYFACE GEL "H.S" 139

AC46012345 BEAUTYFACE GEL "H.S" 212

AC46012363 BEAUTYFACE GEL "H.S" 717

AC46013100 ZOLON FILM COATED TABLETS 7.5MG(ZOPICLONE) 2.89

AC46018100 FUPROSTATE TABLETS 33.1

AC46028100 FLUITRAN TABLETS 1.5

AC460281G0 FLUITRAN TABLETS(鋁箔/膠箔) 2

AC46030100 KEROLAC FILM COATED TABLETS 10MG 5.8

AC46039238 EVERMIN-F INJECTION 2.5MG/ML "N.K" 15

AC46045100 LACIPIL TABLETS 2MG 6.1

AC46046100 LACIPIL TABLETS 4MG 7.6

AC46049100 SETONLIN F.C.TAB. "Y.C" 1.78

AC460491G0 SETONLIN F.C. TABLETS "Y.C."(鋁箔/膠箔) 2

AC46050100 MELOCAM TABLETS 7.5MG 2.36

AC46067100 PROTASE ENTERIC COATED CAPSULES "YUNG SHIN" 4.66

AC46068100 SUNIME TABLETS 5MG "EVERESR" 5.9

AC46069417 CHLORLYMIN OPHTHALMIC OINTMENT 1% "KINGDOM" (CHLORAMPHENICOL) 13.3

AC46069421 CHLORLYMIN OPHTHALMIC OINTMENT 1% "KINGDOM" (CHLORAMPHENICOL) 13.3

AC46070100 MEZIDE MR TAB. 30MG "LOTUS" 2.07

AC46072100 ACEMET RETARD CAPSULES 90MG (ACEMETACIN) 3.01

AC46077100 ADARONE TABLETS 200MG 6.6

AC46100143 CLATINE SYRUP 1MG/ML "STANDARD" 25.6

AC46100151 CLATINE SYRUP 1MG/ML "STANDARD" 31.3

AC46100155 CLATINE SYRUP 1MG/ML "STANDARD" 72

AC46101321 CONLIFU OINTMENT 2% 55

AC46102100 RISDON F.C. TABLETS 2MG "WEIDAR" 18.6

AC46103421 FLUCASON OPHTHALMIC SUSPENSION0.02% "KINGDOM" FLUOROMETOLONE 17.8

AC46103429 FLUCASON OPHTHALMIC SUSPENSION0.02% "KINGDOM" FLUOROMETOLONE 78

AC46105100 PICEDIN CAPSULES 400MG 1.5

AC46117143 LOTADIN SYRUP 1MG/ML (LORATADINE) 25.6

AC46117151 LOTADIN SYRUP 1MG/ML (LORATADINE) 31.3

AC46118100 B.H.L. TABLETS 2MG 1.5

AC46136421 WETHYCO ORABASE "Y.C" 55

AC46153321 EUROTECH ACNE GEL (5 GM) 9.1

AC46153329 EUROTECH ACNE GEL (10 GM) 17.9

AC46153338 EUROTECH ACNE GEL (20 GM) 83

AC46154100 LITHCAN CAPSULES 300MG 1.54

AC461541G0 LITHCAN CAPSULES 300 MG(28粒及84粒/瓶裝暨鋁箔/膠箔) 2

AC46164100 TOSPIN TABLETS 5MG (TROSPIUM) 2.86

AC46166100 TEDALIN CHEWABLE TABLETS "Y.C" 3.9

AC46173143 PROCAROL LIQUID 5UG/ML 29

AC46189423 "SUYENIN ORAL BASE ""H.S""" 42.7

AC46199100 FORSINE F.C TABLETS 10MG 5

AC46204100 BAMBUVENT TABLETS 10MG 3.32

AC46223421 KELAC OPHTHALMIC SOLUTION 0.5% "PATRON" 112

AC46225100 IROTEX CHEWABLE TABLETS "ROYAL" 3.9

AC46226265 UROKINASE INJECTION 250,000I.U. "YAO CHIH HSIANG" 3519

185

Page 186: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC46236100 B.H.L. TABLETS 5MG 1.5

AC46245100 DINIDOL S.C. TABLETS 25MG 1.5

AC462451G0 DINIDOL S.C. TABLETS 25MG(鋁箔/膠箔) 2

AC46246100 LANPO CAPSULES 30MG "EVEREST" 18.5

AC46254100 SPAGASTIN TABLETS 3.34

AC46257421 ATROPINE EYE DROPS 0.3%"SINPHAR"(ATROPINE SULFATE) 12

AC46258500 JETOO SUPPOSITORIES "MEIDER" 5

AC46259412 DRXALINE ORAL PASTE 1MG/GM 41

AC46259421 DRXALINE ORAL PASTE 1MG/GM 55

AC46282143 DEALLERGY ORAL SOLUTION 0.1% W/V 36.6

AC46282151 DEALLERGY ORAL SOLUTION 0.1% W/V 37

AC46285209 MIDATIN INJECTION 5MG/ML 24.3

AC46285212 MIDATIN INJECTION 5MG/ML "N.K." 29

AC46285216 MIDATIN INJECTION 5MG/ML 38.6

AC46285221 MIDATIN INJECTION 5MG/ML "N.K." 58

AC46285229 MIDATIN INJECTION 5MG/ML "N.K." 203

AC46285237 MIDATIN INJECTION 5MG/ML "N.K." 263

AC46286100 LOTE E.C. TABLETS 50MG "N.K." 9.8

AC46289321 MAYDO GEL "ROOT" 19.1

AC46289335 MAYDO GEL "ROOT" 76

AC46289343 MAYDO GEL "ROOT" 139

AC46290321 FEELING GEL 0.1% 19.1

AC46290335 FEELING GEL 0.1% 76

AC46290363 FEELING GEL 0.1% 686

AC46297209 CLP POWDER FOR INJECTION 1GM "Y.Y" 83

AC46298238 DOBUHA INJECTION 12.5MG/ML 182

AC46302321 KWAIE GEL 0.1% 19.2

AC46302335 KWAIE GEL 0.1% 78

AC46302343 KWAIE GEL 0.1% 139

AC46302345 KWAIE GEL 0.1% 212

AC46303100 INTESLET TABLETS 0.125MG 2.45

AC46312100 PBF MOBICAM TABLETS 15MG 8.5

AC46314321 TIFFORLY GEL 19.6

AC46314335 TIFFORLY GEL 78

AC46314343 TIFFORLY GEL 139

AC46314345 TIFFORLY GEL 212

AC46314363 TIFFORLY GEL 717

AC46318335 FUTISONE OINTMENT (0.005%) 94

AC46320321 CLINDA GEL 1% "Y.Y" 9.1

AC46320329 CLINDA GEL 1% "Y.Y" 17.9

AC46322100 POLYWEI TABLETS 1.64

AC463221G0 POLYWEI TABLETS (鋁箔/膠箔) 2

AC46348209 KEROLAC INJECTION 30MG/ML 23.1

AC46348212 KEROLAC INJECTION 30MG/ML 48.4

AC46349316 MOMO CREAM 24.1

AC46349321 MOMO CREAM 41.3

AC46349326 MOMO CREAM 44.9

AC46349329 MOMO CREAM 44.9

AC46349335 MOMO CREAM 122

AC46350100 BODOPINE CAPSULES 'Y.C" 4.52

AC46351100 Dimotil Repe Tablets "Meider" 2.49

AC46385100 ETOLAC XL TABLET 500MG "STANDARD" 10.4

AC46386100 LOXOL SR TABLETS 75MG 2.61

AC46401100 POLYCAIN TABLETS 1.64

AC46402100 SIMVATIN FILM COATING TABLETS 200MG 6.7

186

Page 187: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC46403100 Sincapin Tablets 20mg "Sinphar" 1.29

AC464031G0 SINCAPIN TABLETS 20MG "SINPHAR"(鋁箔/膠箔) 2

AC46404100 SYNTREND TABLETS 25MG 6.2

AC46417214 EULIGEN LYOPHILIZED INJECTION 2.5GM 362

AC46417221 EULIGEN LYOPHILIZED INJECTION 5GM 623

AC46417229 EULIGEN LYOPHILIZED INJECTION 10GM 1314

AC46419314 ELOFUTE CREAM 0.1% 24.1

AC46419321 ELOFUTE CREAM 0.1% 41.3

AC46419326 ELOFUTE CREAM 0.1% 44.9

AC46419329 ELOFUTE CREAM 0.1% 44.9

AC46419335 ELOFUTE CREAM 0.1% 122

AC46420100 CLOFEN-P F.C TABLETS 25MG 1.5

AC46423100 GABEMID TABLETS 5MG 1.5

AC464231G0 GABEMID TABLETS 5MG(鋁箔/膠箔) 2

AC46424100 FINASTATE F.C. TABLETS 5MG "H.S." 20.6

AC46431143 ALLTEC ORAL SOLUTION (0.1%) 36.6

AC46431157 ALLTEC ORAL SOLUTION (0.1%) 125

AC46439100 Nakasser SR Capsules 90mg "N.K."(diltiazem Hcl) 6.3

AC46440100 COMEWELL TABLETS "Y.C" 1.5

AC464401G0 COMEWELL TABLETS "Y.C"(鋁箔/膠箔) 2

AC46443100 CANTOR DISPERSIBLE TABLETS "Y.C." 1.55

AC46444151 NAPTON SUSPENSION 47.4

AC46444157 NAPTON SUSPENSION 84

AC46447100 TIZALIN TABLETS 2MG "GENTLE" 1.99

AC46448317 TRIMYZOLE CREAM 11.7

AC46448321 TRIMYZOLE CREAM 11.7

AC46448329 TRIMYZOLE CREAM 21.8

AC46448335 TRIMYZOLE CREAM 36.2

AC46448355 TRIMYZOLE CREAM 135

AC46451345 DISPAIN PATCH "T.S." 6.4

AC46456100 CORTISONE ACETATE TABLETS 25MG "WEAL-CHANCE" 1.5

AC464561G0 CORTISONE ACETATE TABLETS 25MG "WEAL-CHANCE"(鋁箔/膠箔) 2

AC46457263 Gipamine Injection 3mg/ml "N.K." 259

AC46458100 GLYCOPYRODYN TABLETS 1MG 4.43

AC46459345 FLUAN PATCH "LI KANG" (FLURBIPROFEN) 6.4

AC46460100 SALAFLOW FILM COATED TABLETS 5mg 18.5

AC46461100 MESOLONE TABLETS "Y.C." 1.66

AC464631G0 PREDNISOLONE TABLETS 5MG "WEAL-CHANCE"(鋁箔/膠箔) 2

AC46486100 CARMAPINE C.R. FILM COATED TABLETS 200MG "P.L."

(CARBAMAZEPINE)

2.53

AC46488100 KARBOSE TABLETS "Y.C' 3.27

AC46489100 TIZAN TABLETS 2MG "S.C." 1.99

AC46538100 MILIX SR TABLETS 1.5MG "LOTUS" 2.5

AC46540316 FUMESONE CREAM 1MG/GM 24.1

AC46540321 FUMESONE CREAM 1MG/GM 41.3

AC46540326 FUMESONE CREAM 1MG/GM 44.9

AC46540329 FUMESONE CREAM 1MG/GM 44.9

AC46540335 FUMESONE CREAM 1MG/GM 122

AC46544210 SUBACILLIN INJECTION "YUNG SHIN" 96

AC46546100 MEXTON F.C. TABLETS 500MG "MEIDER 1.5

AC46549100 GENBOU F.C. TABLET 50MG 9.8

AC46560100 SOPID-400MG FILM COATED TABLETS 5.9

AC46563100 ZIPSOON F.C. TABLETS 10MG 2.51

AC46584321 ADAMEI GEL "S.C." 19.5

AC46584363 ADAMEI GEL "S.C." 737

187

Page 188: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC46585151 "EISO LIQUID 5.34 MG/ML""H.S.""" 25

AC46585157 "EISO LIQUID 5.34 MG/ML""H.S.""" 28.9

AC46587100 A.M.Z. TABLETS 1.5

AC465871G0 A.M.Z. TABLETS 2

AC46588100 FUITEN F.C. TABLETS "MEIDER" 1.5

AC46604100 MELOCAM TABLETS 15MG "P.L." 8.5

AC46605421 SUPERDEX ORABASE 0.1% 55

AC46606100 SITALO F.C. TABLETS 20MG (CITALOPRAM) 15.7

AC46612100 WITGEN TABLETS 10MG "LOTUS" 14.5

AC46614135 KIDSOLONE ORAL SOLUTION "CENTER" 25

AC46614143 KIDSOLONE ORAL SOLUTION "CENTER" 34.5

AC46614151 KIDSOLONE ORAL SOLUTION "CENTER" 59

AC46618212 DROPEDOL INJECTION 2.5MG/ML 15

AC46633321 LOMEANE CREAM "S.C." 41.3

AC46633335 LOMEANE CREAM "S.C." 122

AC46634100 ROZOXIN F.C. TABLETS 100MG 7.3

AC46638100 KLARITH F.C. TABLETS 500MG 21.7

AC46643100 BASAZYDE CAPSULES 750MG "LOTUS" 6.9

AC46647100 GLIPID TABLETS 2MG 2.11

AC46656100 CALIFE TABLETS 15MG "N.K." 17.6

AC46659100 FUXIDOL S.C. TABLETS 14.1

AC46677100 "SORDINING CAPSULES ""TAI YU""" 1.5

AC46681100 SYNTAM F.C. TABLETS 1200MG 2.67

AC46682100 MUSLEX TABLETS 5

AC466872CX PISUTAM POWDER FOR INJECTION 164

AC46697100 "SHINMING TABLETS 4MG ""TAI YU""" 1.66

AC46699100 SYNTREND TABLETS 6.25MG 4.08

AC46702100 ANTI-TUBE F.C. TABLETS 500MG "L.E." 6.1

AC46703151 CENPROFEN ORAL SUSPENSION 20MG/ML "CENTER"(60 ML) 25

AC46706100 MOODYTEC S.C. TABLETS 14.1

AC46707321 OXIZOLE CREAM "S.C." 54

AC46729100 ERISPAN-S TABLETS 0.25MG 2.71

AC46733100 GLUCOMET F.C. TABLETS 5/500MG 2.66

AC46744340 "TOGIAM CONCENTRATE LIQUID ""H.S.""" 142

AC46746100 SELARS TABLETS 30MG "Y.Y." 3.65

AC46758100 LA FERRUM CHEWABLE TABLETS 100MG 3.9

AC46759100 MOCALM S.C. TABLET 3.08

AC46766100 GLIMARYL TABLETS 2MG (GLIMEPIRIDE) 2.55

AC46867100 CATACOR TABLETS "Y.C." 3.17

AC46869209 GLYCOPYRODYN INJECTION 0.2MG/ML 15

AC46899421 SALUTE OPHTHALMIC SOLUTION "KINGDOM" 13

AC46899429 SALUTE OPHTHALMIC SOLUTION "KINGDOM" 27.4

AC46902412 IPRASTHMA NEBULISER SOLUTION 0.25MG/ML 11.3

AC46903100 YITUNGYEN F.C. TABLETS 400MG 1.5

AC469031G0 YITUNGYEN F.C. TABLETS 400MG 2

AC46929100 CODICON-U CAPSULES "SINPHAR" 1.5

AC469291G0 CODICON-U CAPSULES "SINPHAR"(鋁箔/膠箔) 2

AC46930421 CATOL EYE DROPS 1% 188

AC46931421 CATOL EYE DROPS 2% 200

AC46937100 URMARON TABLETS "Y.C." 2.88

AC46938100 MENISON TABLETS 2MG "P.L" 1.66

AC46939321 FUSIK CREAM "Y.C." 55

AC46939335 FUSIK CREAM "Y.C." 154

AC46940100 INCO F.C. TABLET "S.Y." 5.8

AC46978100 MESLON TABLETS 12MG "JOHNSON" 1.5

188

Page 189: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC469781G0 MESLON TABLETS 12MG "JOHNSON"(84粒/瓶) 2

AC46985100 POCATO CAPSULES 25UG (PROCATEROL) 1.59

AC469851G0 POCATO CAPSULES 25UG (PROCATEROL)(鋁箔/膠箔) 2

AC46989100 ARICEPT F.C. TABLETS 10MG 76

AC46990421 EYEHELP EYE DROPS 0.01% 12

AC46990429 EYEHELP EYE DROPS 0.01% 15.4

AC46991161 MEGEST ORAL SUSPENSION 40MG/ML 1276

AC46995100 RAMITACE CAPSULE 2.5MG "ROYAL" 9

AC46998321 GENUVATE OINTMENT "GCPC" 15.8

AC46998323 "GENUVATE OINTMENT ""GCPC""" 15.8

AC46998324 "GENUVATE OINTMENT ""GCPC""" 15.8

AC46998329 GENUVATE OINTMENT "GCPC" 17.7

AC46998335 GENUVATE OINTMENT "GCPC" 28.6

AC46998338 "GENUVATE OINTMENT ""GCPC""" 47

AC46998340 "GENUVATE OINTMENT ""GCPC""" 88

AC47002100 FONOSIL TABLETS 10MG "STANDARD" (FOSINOPRIL SODIUM) 5

AC47028321 EUTISEN CREAM 36.9

AC47028335 EUTISEN CREAM 84

AC47029500 POSULINE SUPPOSITORIES "P.L." 8.8

AC47031100 PRUSC FILM COATED TABLETS 5MG 20.6

AC47044100 AKINFREE TABLETS 2MG 2.19

AC47045100 "NORHEUM TABLETS ""ROOT""" 1.5

AC47049100 DIABETROL SR TABLETS 10MG 2.38

AC47074326 DOSPIN CREAM "H.S." 45.3

AC47074335 DOSPIN CREAM "H.S." 61

AC47075321 CLINDACIN GEL 9.1

AC47075323 CLINDACIN GEL 16

AC47075329 CLINDACIN GEL 17.9

AC47075330 CLINDACIN GEL 18.5

AC47075335 CLINDACIN GEL 28.3

AC47075338 CLINDACIN GEL 83

AC47075343 CLINDACIN GEL 186

AC47076329 ZYNOC SOLUTION 1% 70

AC47078100 BON JOUR TABLETS 7.5MG(MELOXICAM) 2.36

AC47090100 VENFORSPINE TABLETS 37.5MG 7.4

AC47092100 NILASEN TABLETS 16MG 1.56

AC470921G0 NILASEN TABLETS 16MG(鋁箔/膠箔) 2

AC47093100 ALOPINE TABLETS 5MG "WEIDAR" 6.8

AC47114100 FAXINE TABLETS 37.5MG 8.6

AC47117421 GENDERMIN OPH. SOLUTION 0.3% "KINGDOM" (GENTAMICIN SULFATE) 22

AC47117429 GENDERMIN OPH. SOLUTION 0.3% "KINGDOM" (GENTAMICIN SULFATE) 37.1

AC47124416 GENDERMIN OPHTHALMIC OINTMENT 3MG/GM "KINGDOM" (GENTAMICIN

SULFATE)

21

AC47124417 GENDERMIN OPHTHALMIC OINTMENT 3MG/GM "KINGDOM" (GENTAMICIN

SULFATE)

21

AC47124421 GENDERMIN OPHTHALMIC OINTMENT 3MG/GM "KINGDOM" (GENTAMICIN

SULFATE)

27

AC47126151 CARDIACIN ELIXIR 50MCG/ML "CENTER" 94

AC47129100 NATENIDE F.C. TABLETS 60MG "STANDARD" 3.52

AC47144321 KAFUTINEA CREAM 25.4

AC47144329 KAFUTINEA CREAM 45.2

AC47144335 KAFUTINEA CREAM 50

AC47144338 KAFUTINEA CREAM 92

189

Page 190: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC47148100 MONO-GETIC F.C.T. 750MG "JOHNSON" 4.91

AC47157321 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 19.5

AC47157335 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 80

AC47157345 DELPAC GEL 1MG/GM "MEIDER" (ADAPALENE) 212

AC47176100 BUSACON TABLETS 0.125MG 2.45

AC47179143 PROCATIN LIQUID 29

AC47179151 PROCATIN LIQUID 52

AC47181100 HIPURIC TABLETS "Y.C." 1.5

AC471811G0 HIPURIC TABLETS "Y.C.(鋁箔/膠箔) 2

AC47182255 PEDICARE INJECTION 10% (W/V) 227

AC47182265 PEDICARE INJECTION 10% (W/V) 488

AC47230100 ECOMIN TABLETS 5MG "JOHNSON" 1.52

AC472301G0 ECOMIN TABLETS 5MG "JOHNSON" (56粒/瓶裝) 2

AC472301GA ECOMIN TABLETS 5MG "JOHNSON"(鋁箔/膠箔) 2

AC47231100 GLUNORMAL TABLETS 30MG "Y.Y." 2.18

AC47232100 NILASEN TABLETS 24MG 3.37

AC47258100 DONGLU TABLETS 2MG "ANXO" 2.23

AC47265100 REMEMBER F.C. TABLETS 8MG 34.8

AC47266100 NETCOSE F.C. TABLETS 120MG "C.H." 3.8

AC47268100 MEROCAM TABLETS 7.5MG "H.S." (MELOXICAM) 2.36

AC47270100 IROME CAPSULES 150MG 3.58

AC47272100 MESLON TABLETS 6MG "JOHNSON" 1.5

AC472721G0 MESLON TABLETS 6MG "JOHNSON"(84粒/瓶) 2

AC47276255 PEDICARE INJECTION 6% W/V "N.K." 208

AC47280500 GYNOX VAGINAL TABLETS 500MG 16

AC47289321 FUCIMYCIN CREAM 55

AC47289326 FUCIMYCIN CREAM 55

AC47289329 FUCIMYCIN CREAM 58

AC47289335 FUCIMYCIN CREAM 154

AC47289338 FUCIMYCIN CREAM 160

AC47289348 FUCIMYCIN CREAM 337

AC47290100 SPITERIN F.C. TABLETS 2MG "KINGDOM" (RISPERIDONE) 18.6

AC47291421 BETTER EYE DROPS 0.5% (TROPICAMIDE) 29.2

AC47295100 CARVO TABLETS 25MG 6.2

AC47306100 ESLAM TABLETS 1MG "JOHNSON" 1.55

AC47309100 DESBLUE S.C. TABLETS 3.08

AC47312321 "GENAF CREAM ""GCPC""" 25.4

AC47312329 "GENAF CREAM ""GCPC""" 45.2

AC47312335 "GENAF CREAM ""GCPC""" 50

AC47312338 "GENAF CREAM ""GCPC""" 92

AC47314421 BRIMO OPHTHALMIC SOLUTION 0.2% "PATRON" 220

AC47341100 MELSTATIN TABLETS 20MG 10.6

AC47346100 DIZYNIL TABLET 8MG 1.5

AC473461G0 DIZYNIL TABLET 8MG(鋁箔/膠箔) 2

AC47370417 ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% "KINGDOM" 12.1

AC47371100 TODO CAPSULES 200MG "JOHNSON" 4.52

AC47374100 MELUX TABLETS 200MG "JOHNSON" 1.5

AC473741G0 MELUX TABLETS 200MG "JOHNSON"(鋁箔/膠箔) 2

AC47398421 "SUBICAN OPHTHALMIC SOLUTION ""WINSTON""" 29.2

AC47399100 MELUX TABLETS 500MG "JOHNSON" 4.71

AC47400100 LAMTA TABLETS 50MG (LAMOTRIGINE) 15.5

AC47403121 NISAN GRANULES 5GM "JOHNSON" 6.9

AC47405321 OXICONE CREAM 54

AC47406321 DERMOFUTE CREAM 15.8

AC47406323 DERMOFUTE CREAM 15.8

190

Page 191: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC47406324 DERMOFUTE CREAM 15.8

AC47406329 DERMOFUTE CREAM 17.7

AC47406335 DERMOFUTE CREAM 28.6

AC47406338 DERMOFUTE CREAM 47

AC47406340 DERMOFUTE CREAM 88

AC47406355 DERMOFUTE CREAM 195

AC47418100 SURIDE F.C. TABLETS 200MG "EB" (SULPIRIDE) 2.33

AC47432329 EUROTECH UREA CREAM 40% 45.2

AC47432343 EUROTECH UREA CREAM 40% 117

AC47434100 CARLATREND TABLETS 25MG "KINGDOM" (CARVEDILOL) 6.2

AC47442212 FAMOSTER INJECTION 10MG/ML "TF" 34.3

AC47443161 ITRAZOLE ORAL SOLUTION "H.S." 1079

AC47444100 UROSO TABLETS 100MG "JOHNSON" 2.69

AC47446100 VASOCARD CAPSULES "Y.C." 2.39

AC47456100 HOTE CHEWABLE TABLETS 100MG 3.9

AC47457100 TRAMADOL RETARD TABLETS 100MG "U-CHU" 5.7

AC47460100 CARDILO TABLETS 25MG "S.T." 6.2

AC47461100 MELICAM TABLETS 15MG "KINGDOM" (MELOXICAM) 8.5

AC47473421 ATROPIN EYE DROPS 0.125% "SINPHAR" 12

AC47476100 HAMGO F.C. TABLETS 1200MG "Y.C." 2.67

AC47479100 ESLAM TABLETS 2MG "JOHNSON" 1.66

AC474791G0 ESLAM TABLETS 2MG "JOHNSON" (鋁箔/膠箔) 2

AC47480100 ACPURIN TABLETS 300MG "MEIDER" 2.74

AC47482100 SANTEROL TABLETS 25 μG 1.59

AC47485100 AMARINE TABLETS 2MG "KINGDOM" 2.77

AC47486197 HAMGO GRANULES FOR ORAL SOLUTION 1200MG "Y.C." 4.88

AC47502238 DETOXNAC INJECTION 200 MG/ML 280

AC47510100 CARDIOL TABLETS 25MG "YUNG SHIN" 6.2

AC47511100 MESHIN TABLETS 500MG "MEIDER" 4.71

AC47516100 CRAVIT F.C. TAB 500MG 50

AC47518138 CENFENOL SOLUTION 5 MG/ML "CENTER" 207

AC47519100 MEPRO TABLETS 100MG 11.1

AC47521414 LANOPROST OPHTHALMIC SOLUTION 0.005% (LATANOPROST) 438

AC47534100 PANTAZOL GASTRO-RESISTANT TABLETS "Y.C." 18.4

AC47536100 FEDISYN E.R. F.C. TABLETS 5 MG 3.29

AC47540329 MOMESONE LOTION 0.1% W/W 32.7

AC47550500 EBODYL SUPPOSITORIES 8.8

AC47551209 Laston Injection 30 mg/ml (Ketorolac Tromethamine) 23.1

AC47551212 Laston Injection 30 mg/ml (Ketorolac Tromethamine) 48.4

AC47558100 CIMEWEI TABLETS 400MG "LITA" 1.5

AC47560209 Inco Injection 23.1

AC47561100 Mono-getic F.C.T. 500mg "Johnson" 4.56

AC47568100 Latrigine Tablets 50 mg "Kingdom" 15.5

AC47569100 PISANTA TABLETS "ROYAL" 2.67

AC47570100 Rayor Tablets "Cosmic" 2.38

AC47590100 ISOLIN F.C. TABLETS 500MG "JOHNSON" 5.9

AC47594100 ILIMIN FILM COATED TABLETS 850MG "S.D" 2.23

AC47596321 Dermofute Ointment 15.8

AC47596323 Dermofute Ointment 15.8

AC47596324 Dermofute Ointment 15.8

AC47596329 Dermofute Ointment 17.7

AC47596335 Dermofute Ointment 28.6

AC47596338 Dermofute Ointment 47

AC47596340 Dermofute Ointment 88

AC47596355 Dermofute Ointment 195

191

Page 192: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC47606100 KAMART TABLETS "Y.C." 1.69

AC47611500 Subodyl Suppositories 8.8

AC47612100 CIMEWEI TABLETS 200MG "LITA" 1.5

AC47615143 BESUMIN SYRUP "Y.C" 25.6

AC47615151 BESUMIN SYRUP "Y.C" 31.3

AC47615155 BESUMIN SYRUP "Y.C" 72

AC47619100 ANWASHU TABLETS 2.45

AC47621221 COVORIN INJECTION 10MG/ML 101

AC47621229 COVORIN INJECTION 10MG/ML 145

AC47622421 Laimin Eye Drops 2% "Y.Y." 15.9

AC47622429 Laimin Eye Drops 2% "Y.Y." 30.2

AC47625316 Momesone Ointment 0.1% 24.1

AC47625321 Momesone Ointment 0.1% 41.3

AC47625326 Momesone Ointment 0.1% 44.9

AC47625329 Momesone Ointment 0.1% 44.9

AC47625335 Momesone Ointment 0.1% 122

AC47626248 Amocure Injection 0.2mg/ml 718

AC47631100 Glunat Tablets 60mg 3.52

AC47632100 Amcopine Tablets 10mg "H.S." (Amlodipine) 6.8

AC47633414 Centesol Inhalation Solution 2mg/ml "Center" 6.3

AC47638100 Zapline Film Coated Tablets 50mg 11.7

AC47639100 MONPHELON TABLETS "Y.C" 4.71

AC47640329 Eurotech Pimple Cream 54

AC47641421 Topimide Ophthalmic Solution 0.5% "Kingdom" (Tropicamide) 29.2

AC47643100 "Shuful Tablet ""H.S.""" 10.8

AC47647223 UROKINASE INJECTION 6000I.U. "YAO CHIH HSIANG" 191

AC47648100 DOSIN TABLETS 10MG 1.5

AC476481G0 DOSIN TABLETS 10MG(鋁箔/膠箔) 2

AC47653100 MOCOUGH CAPSULES "LITA" 1.5

AC47655100 TONLEX F.C. TABLETS 750MG 12.4

AC47672229 Conpac Injection 2500IU/ml 193

AC47676248 Ciflogen Injection 2mg/ml 288

AC47676263 Ciflogen Injection 2mg/ml 1003

AC47678209 PAINOFF INJECTION 15MG/ML 15

AC47678212 PAINOFF INJECTION 15MG/ML 23.1

AC47679100 Knowful Film Coated Tablets 1200mg 2.67

AC47687100 Henformin F.C. Tablet 850mg 2.23

AC47690100 RISDONE TABLETS 2MG "S.T." (RISPERIDONE) 18.6

AC47692316 Momesone Cream 0.1% W/W 24.1

AC47692321 Momesone Cream 0.1% W/W 41.3

AC47692326 Momesone Cream 0.1% W/W 44.9

AC47692329 Momesone Cream 0.1% W/W 44.9

AC47692335 Momesone Cream 0.1% W/W 122

AC47698100 Klarith F.C. Tablets 250mg 4.06

AC47700321 Antimax cream 1% "H.S." 34.6

AC47700329 Antimax cream 1% "H.S." 57

AC47700335 Antimax cream 1% "H.S." 74

AC47700355 Antimax cream 1% "H.S." 668

AC47717417 CINDECASON OPHTHALMIC OINTMENT "KINGDOM" 13.2

AC47718212 Painoff Injection 30 mg/ml 48.4

AC47722321 "OLENA GEL ""WINSTON""" 19.1

AC47722335 "OLENA GEL ""WINSTON""" 76

AC47722343 "OLENA GEL ""WINSTON""" 139

AC47722345 "OLENA GEL ""WINSTON""" 212

AC47722363 "OLENA GEL ""WINSTON""" 686

192

Page 193: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC47750100 NATENIDE F.C. TABLETS 120MG "STANDARD" 3.8

AC47771100 Lafuzo XL prolonged release tablets 10 mg 8.3

AC47772100 BONY Tablets "Y.C." 3.46

AC47775100 ZOLOTIN F.C. TABLETS 40MG 15.7

AC47782100 Mucolow SR Tablets 75mg "LOTUS" 2.3

AC47785100 DEFLAM-K F.C. TABLETS 50MG (DICLOFENAC POTASSIUM) "KINGDOM" 1.5

AC47787100 FLEXER F.C. TABLETS 10MG 4.23

AC47788100 MEPRO TABLETS 500MG 53

AC47789100 DANOW TABLETS "Y.C." 2.27

AC47790100 AMADM TABLETS 2.0MG 2.8

AC47793100 SPITERIN F.C. TABLETS 1MG "KINGDOM" (RISPERIDONE) 15.5

AC47812263 TECOPIN FOR IV INJECTION "N.K." 728

AC47812271 Tecopin for IV Injection "N.K." 1585

AC47828209 MYRON POWDER FOR INJECTION 875

AC47828277 MYRON POWDER FOR INJECTION 296

AC47833529 Formenin Vaginal Gel 0.75% 69

AC47833540 Formenin Vaginal Gel 0.75% 139

AC47833596 Formenin Vaginal Gel 0.75% 163

AC47834335 EUTISEN OINTMENT 0.005% 94

AC47840100 "Iprofen 600mg F.C. Tablet ""Royal""" 1.78

AC47841321 SOFUNI OINTMENT 2% 55

AC47841326 SOFUNI OINTMENT 2% 55

AC47841329 SOFUNI OINTMENT 2% 58

AC47841335 SOFUNI OINTMENT 2% 154

AC47870151 "IBU SUSPENSION ""ROOT""" 25

AC47870157 "IBU SUSPENSION ""ROOT""" 67

AC47871100 Hanazide MR Tablets 2.25

AC47874100 SINCLOTE CAPSULES 400MG "SINPHAR" 47.4

AC47875500 FUBODYL Vaginal Suppositories 13

AC47877100 Lax Capsules 5

AC47878100 "Tonfuse Tablets 50mg ""H.S.""" 3.27

AC47879455 AZELA NASAL SPRAY 0.1% W/V 134

AC47879457 AZELA NASAL SPRAY 0.1% W/V 151

AC47884100 TOLTON CAPSULES 5

AC47885321 Dermasafe Ointment 64

AC47885335 Dermasafe Ointment 124

AC47889209 "Kethonixine Injection ""Tai Yu""" 15

AC47889212 "Kethonixine Injection ""Tai Yu""" 15

AC47890100 NASAGA F.C TABLETS "Y.C" 2.32

AC47893500 ATYL Vaginal suppositories 13

AC47894100 CARVIO TABLET 25MG 6.2

AC47901100 "BIOME" SILYMARIN CAPSULES 150MG (SILYMARIN) 1.64

AC479011G0 "BIOME" SILYMARIN CAPSULES 150MG (SILYMARIN)(鋁箔/膠箔) 2

AC47902277 10%W/V RHEOMACRODEX IN GLUCOSE INJECTION 233

AC47905100 GATY FILM-COATED TABLET 600MG 14.4

AC47906314 FURO CREAM "PATRON" 24.1

AC47906316 FURO CREAM "PATRON" 24.1

AC47906321 Furo Cream "Patron" 41.3

AC47906326 Furo Cream "Patron" 44.9

AC47906329 Furo Cream "Patron" 44.9

AC47906335 Furo Cream "Patron" 122

AC47909100 THIONA F.C. TABLETS 250MG "JOHNSON" 5.6

AC47910100 Pipemi Capsules 400mg "Patron" 5.3

AC47912314 "Pydercon Cream 0.1% ""Winston""" 24.1

193

Page 194: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC47912316 "Pydercon Cream 0.1% ""Winston""" 24.1

AC47912321 "Pydercon Cream 0.1% ""Winston""" 41.3

AC47912326 "Pydercon Cream 0.1% ""Winston""" 44.9

AC47912329 "Pydercon Cream 0.1% ""Winston""" 44.9

AC47912335 "Pydercon Cream 0.1% ""Winston""" 122

AC47913100 Gestrin Capsule 2.5mg "P.L." 186

AC47915321 NAFINE CREAM 25.4

AC47915329 NAFINE CREAM 45.2

AC47915335 NAFINE CREAM 50

AC47915338 NAFINE CREAM 92

AC47924100 ZOSTATIN F.C TABLETS 20MG "S.C" 6.7

AC47925100 DIVODIUM (DIVALPROEX SODIUM) ENTERIC-COATED TABLETS 250MG 5.1

AC47928100 Sivasin Film Coated Tablets 20mg 6.7

AC47937321 TACROLI OINTMENT 0.1% "H.S." 202

AC47937329 Tacroli Ointment 0.1% "H.S." 428

AC47937343 Tacroli Ointment 0.1% "H.S." 1156

AC47950100 U-Chu Ebastin Tablets 10mg 0

AC47953100 HIROS S.R.M. CAPSULES "EVEREST" 2.33

AC47954335 Troza Topical Gel 0.1% 280

AC47954343 Troza Topical Gel 0.1% 462

AC47955100 Phenomine Capsules 10mg 2.39

AC47961100 Alpragin Tablets 2mg 5.6

AC47964321 Sumelo cream 34.6

AC47964329 Sumelo cream 55

AC47964335 Sumelo cream 74

AC47964355 Sumelo cream 668

AC479661G0 TONE F.C. TABLETS 25MG "MEIDER"(鋁箔/膠箔) 2

AC47977321 "Fluson cream ""ROOT""" 36.9

AC47977335 "Fluson cream ""ROOT""" 84

AC47980421 CARTOLOL EYE DROPS 1% 188

AC47982100 Gaty film-coated tablets 800mg 21.5

AC47983209 Antifect injection "Standard" 425

AC47983277 Antifect injection "Standard" 279

AC47989100 SPITERIN F.C. Tablets 3mg "Kingdom" (Risperidone) 41.7

AC47990421 Rosumin Eye Drops 15.9

AC47990429 Rosumin Eye Drops 30.2

AC47995321 SERGEN CREAM "BASECO" 34.6

AC47995329 SERGEN CREAM "BASECO" 55

AC47995335 SERGEN CREAM "BASECO" 74

AC47995355 SERGEN CREAM "BASECO" 668

AC47996100 DAPAMIDE S.R. F.C TABLETS 1.5MG 2.12

AC48005421 Sightclear Eye Drops "Sinphar" 12

AC48005429 Sightclear Eye Drops "Sinphar" 16.9

AC48022113 NUXITAM GRANULES FOR ORAL SOLUTION 2400MG 8.6

AC48023335 Flusalic Ointment 60

AC48024100 Mucopd Effervescent Tablets 600mg 6.6

AC48028100 MELOXICAM TABLETS 15MG "S.D." 8.5

AC48032321 Ankorme Cream "S.C." 34.6

AC48032329 Ankorme Cream "S.C." 55

AC48032335 Ankorme Cream "S.C." 75

AC48032355 Ankorme Cream "S.C." 694

AC48034316 "Mena Ointment 0.1% ""Winston""" 24.1

AC48034321 "Mena Ointment 0.1% ""Winston""" 41.3

AC48034326 "Mena Ointment 0.1% ""Winston""" 44.9

AC48034329 "Mena Ointment 0.1% ""Winston""" 44.9

194

Page 195: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC48034335 "Mena Ointment 0.1% ""Winston""" 122

AC48035100 "Suyuni Tablets 0.5mg ""Tai Yu""" 1.5

AC48039321 Nafdin Cream 25.4

AC48039329 Nafdin Cream 45.2

AC48039335 Nafdin Cream 50

AC48039338 Nafdin Cream 92

AC48041100 PERISDONE F.C TABLETS 2MG "RAYAL" 18.6

AC48055100 TOPINMATE TABLETS 100MG "LOTUS" 32.2

AC48056100 Lanpo Capsules 15mg "EVEREST" 16.6

AC48057100 Anxotos Tablets 30mg 16.4

AC48059100 Hepa-V Capsule 1.64

AC48060329 Superin cream "Y.C." 57

AC48061421 Sussmine Ophthalmic Solution 12

AC48061429 Sussmine Ophthalmic Solution 15.4

AC48062100 PLATON FILM-COATED TABLETS 75MG 40.8

AC48064100 LESYN F.C. TABLETS 4MG 7.5

AC48066343 KOSIAN TOPICAL CREAM 0.1% 462

AC48069343 Scepos scalp solution 487

AC48071100 Erin Tablets 0.25 mg 2.71

AC48081100 KUWEIHAU "Chin Teng" 1.5

AC480811G0 KUWEIHAU "CHIN TENG" (鋁箔/膠箔) 2

AC48082197 SYNTAM GRANULES FOR ORAL SOLUTION 1200 MG 4.37

AC48083265 TILAM FOR INJECTION 0

AC48083277 TILAM FOR INJECTION 0

AC48086100 JOMARIN CAPSULES 150MG "JOHNSON" 1.64

AC480861G0 JOMARIN CAPSULES 150MG "JOHNSON"(84粒) 2

AC480861GA JOMARIN CAPSULES 150MG "JOHNSON"(鋁箔/膠箔) 2

AC480871G0 TONE F.C. TABLETS 10MG "MEIDER"(鋁箔/膠箔) 2

AC48088321 FUSIDIC ACID CREAM "PBF" 55

AC48088326 FUSIDIC ACID CREAM "PBF" 55

AC48088329 FUSIDIC ACID CREAM "PBF" 58

AC48088335 FUSIDIC ACID CREAM "PBF" 154

AC48088338 FUSIDIC ACID CREAM "PBF" 160

AC48088348 FUSIDIC ACID CREAM "PBF" 337

AC48095100 Glucout Tablets 50 mg "Weidar" 3.27

AC48099100 TOPINMATE TABLETS 25 MG "LOTUS" 8.2

AC48119100 Enapril Tab. 20mg "standard" (Enalapril maleate) 1.89

AC481191G0 ENAPRIL TAB. 20MG "STANDARD" (ENALAPRIL MALEATE)(鋁箔) 2

AC48121100 GLIPIRIDE TABLETS 2MG "YUNG SHIN" 2.84

AC48122100 NARIX SR F.C. TABLETS 1.5 MG 2.35

AC48125100 Cetipo E.R. F.C. Tablets "S.C." 2.33

AC48127100 Diltelan Capsules 90mg 6.3

AC48128100 Diltelan Capsules 120mg 6.3

AC481301G0 C.T.L. XR TABLETS 500MG "C.H."(鋁箔/膠箔) 2

AC48146100 Minieton Tablets 1.52

AC481461G0 MINIETON TABLETS(鋁箔/膠箔) 2

AC481461G1 MINIETON TABLETS(14粒/瓶) 2

AC481461G2 MINIETON TABLETS(28粒/瓶) 2

AC481461G4 MINIETON TABLETS(56粒/瓶) 2

AC48148340 POLILEN EXT SOLUTION "BASECO" 142

AC48150100 Nuspas Tablets 0.125mg "Kingdom" 2.45

AC48152100 LIV-UP Capsule 200mg "Greenpharm" 11.7

AC48159100 Niyan Tablets 100mg "S.C." 2.85

AC48162321 Dexison Ointment 0.25% 32.1

AC48166321 "Genusone Cream ""GCPC""" 39.8

195

Page 196: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC48166330 Genusone Cream "GCPC" 70

AC48167209 BAIN INJECTION 10MG/ML 44.2

AC48168100 CARDIOL TABLETS 6.25MG "YUNG SHIN" 4.08

AC48171100 SILIMA CAPSULES 150MG "PINE LAWER" 1.64

AC481711G0 SILIMA CAPSULES 150MG “PINE LAWER”(鋁箔/膠箔) 2

AC48176100 Tizaflex Tablets 2mg 1.99

AC481761G0 TIZAFLEX TABLETS 2MG(鋁箔/膠箔) 2

AC48177329 yafu cream "Y.C." 45.2

AC48177343 yafu cream "Y.C." 117

AC48178321 Betapro Cream "Patron" 19.9

AC48181100 VENINA TABLETS 6.5

AC48182100 MEGEJOHN TABLETS 160MG 38

AC48184209 NALOXONE INJECTION "G.B.L." 0.4MG/ML 303

AC481881G0 "SUFOLIN TABLETS 60MG ""ASTAR""(鋁箔/膠箔)" 2

AC48189265 Culin Powder for I.V. Injection 197

AC48189277 Culin Powder for I.V. Injection 427

AC48191100 THYROID-S TABLETS 100UG "JOHNSON" 1.5

AC481911G0 THYROID-S TABLETS 100UG "JOHNSON"(鋁箔/膠箔)(56粒/瓶) 2

AC48193321 Demaclean Gel 1% (Clindamycin) 9.1

AC48193323 Demaclean Gel 1% (Clindamycin) 16

AC48193329 Demaclean Gel 1% (Clindamycin) 17.9

AC48193335 Demaclean Gel 1% (Clindamycin) 28.3

AC48193338 DEMACLEAN GEL 1% (CLINDAMYCIN) 83

AC48193343 Demaclean Gel 1% (Clindamycin) 186

AC48195421 Timolol Eye Drops 0.25% "MEDICINE" (Timolol) 73

AC48216100 RISDONE TABLETS 1 MG (RISPERIDONE) 15.5

AC48220421 SIPROXAN OTIC DROPS 68

AC48222145 Obucort Swinghaler 394

AC48228100 Acaben Tab 50mg "Royal" 3.27

AC48243100 HEANA F.C. TABLETS 3.44

AC48245209 GIFRO POWDER FOR INJECTION 0

AC48245210 GIFRO POWDER FOR INJECTION 0

AC48245265 GIFRO POWDER FOR INJECTION 0

AC48245277 GIFRO POWDER FOR INJECTION 0

AC48245289 GIFRO POWDER FOR INJECTION 0

AC48248277 Methylprednisolone Injection 500mg "Yung Shin" 249

AC48251421 TROPINE EYE DROPS 0.3% "MEDICINE" (ATROPINE SULFATE) 12

AC48251429 TROPINE EYE DROPS 0.3% "MEDICINE" (ATROPINE SULFATE) 20.3

AC48266100 NOBBY F.C. TABLETS 1200MG 2.67

AC48267245 Methylprednisolone Injection 40mg "Yung Shin" 56

AC48268421 ANTOL EYE DROPS 0.125%"Y.Y' 12

AC48268429 ANTOL EYE DROPS 0.125%"Y.Y' 12

AC48272100 MeHo Tablets "Y.C." 1.66

AC48275100 Factive Tablets 320mg 120

AC48276343 BECANEX Ointment 627

AC48280100 """ROOT"" K.U.N. Tablet" 1.5

AC482801G0 """ROOT"" K.U.N. TABLET(鋁箔/膠箔)" 2

AC48284100 Stomacine Tablets 500mg 1.5

AC482841G0 STOMACINE TABLETS 500MG(鋁箔/膠箔) 2

AC48285321 NISKIN Cream "Chin Teng" 28

AC48285329 NISKIN Cream "Chin Teng" 54

AC48285338 NISKIN Cream "Chin Teng" 152

AC48285343 NISKIN Cream "Chin Teng" 215

AC48286321 Anefree Gel 0.1% 19.5

AC48286343 Anefree Gel 0.1% 139

196

Page 197: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC48286345 ANEFREE GEL 0.1% 212

AC48287100 COGME-A CAPSULES 1.5

AC48293100 COLONCURE E.C.T. 400MG "JOHNSON" 12.1

AC48308100 "Ancuton Tablets 30mg ""Tai Yu""" 3.87

AC48309100 Carvio Tablets 6.25mg 4.08

AC48310100 JOHNPIRIN E.M. CAPSULES 100MG "JOHNSON" 1.5

AC48313100 Lodipine Tablets 5mg "Kingdom" 6.8

AC48319329 "Genfuxen Solution ""Winston""" 70

AC48320100 KOLAX TABLETS "Y.C" 5

AC48323100 Femina Tablets "Y.C." 1.5

AC483231G0 FEMINA TABLETS "Y.C."(鋁箔/膠箔) 2

AC48325100 UNICLONE F.C TABLETS 7.5MG "UNION" 2.89

AC48326321 Gamicin Cream 20

AC48326335 Gamicin Cream 49.4

AC48327143 Risdine Oral Solution 1mg/ml 657

AC48333100 Glutazone Tablets 30mg 16.4

AC48336100 TONAC CAPSULES "LITA" 4.52

AC48343100 BRICARDYL TABLETS 2.5MG "JOHNSON" 1.5

AC48344100 COLIAN CAPSULES 25MG "JOHNSON" 2.05

AC48347209 TISAN FOR I.V. POWDER INJECTION 0

AC48347212 TISAN FOR I.V. POWDER INJECTION 0

AC48347277 TISAN FOR I.V. POWDER INJECTION 0

AC48349165 Magca Oral Solution 42.9

AC48352151 SERIDOL ORAL SOLUTION 1MG/ML "CENTER" 1114

AC48354421 THAMIC OTIC SOLUTION 0.3% 60

AC48355100 Flusine Tablets 83

AC48358321 Desosone Cream 0.25% 32.1

AC48358329 Desosone Cream 0.25% 73

AC48358338 Desosone Cream 0.25% 103

AC48358343 Desosone Cream 0.25% 140

AC48359314 MENTASONE CREAM 24.1

AC48359316 MENTASONE CREAM 24.1

AC48359321 MENTASONE CREAM 41.3

AC48359326 MENTASONE CREAM 44.9

AC48359335 MENTASONE CREAM 122

AC48362429 DIPRINE EYE DROPS 0.1% "Y.Y" 170

AC48363100 Musgud Tablets 5mg "LOTUS" 2.98

AC48365114 Atrolin Unit Dose Ampoule Inhalation Solution 20.3

AC48376321 Benafine Cream 34.6

AC48376329 Benafine Cream 55

AC48376335 Benafine Cream 68

AC48376355 Benafine Cream 668

AC48377100 PLESTAR TABLETS 100MG 14

AC48384265 Eropem for Intravenous Injection 0

AC48384277 Eropem for Intravenous Injection 0

AC48385112 TITANYL SOLUTION FOR NEBULIZING 2.5MG/ML "CENTER" 12.9

AC48389421 ALMINTO EYE DROPS "KINGDOM" 21

AC48389429 Alminto Eye Drops "Kingdom" 54

AC48391314 Metsone Cream 0.1% "Sinphar" 24.1

AC48391316 Metsone Cream 0.1% "Sinphar" 24.1

AC48391321 Metsone Cream 0.1% "Sinphar" 41.3

AC48391326 Metsone Cream 0.1% "Sinphar" 44.9

AC48391329 Metsone Cream 0.1% "Sinphar" 44.9

AC48391335 Metsone Cream 0.1% "Sinphar" 122

AC48394100 COTON TABLETS 500MG "LITA" 1.5

197

Page 198: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC48396321 KHOIOU CREAM 1.5MG "CHINTENG" 698

AC48426221 Folina Injection 10mg/ml 101

AC48426229 FOLINA INJECTION 10MG/ML 145

AC48428100 FENLO E.M. CAPSULES 50MG "UELIAN" 1.5

AC48431421 Topimide Ophthalmic Solution 1% "Kingdom" (Topicamide) 76

AC48432129 Lotical Powder 8.5

AC48435321 "Udaxen Cream 1% ""Winston""" 34.6

AC48435329 "Udaxen Cream 1% ""Winston""" 54

AC48435335 "Udaxen Cream 1% ""Winston""" 70

AC48435355 "Udaxen Cream 1% ""Winston""" 668

AC48436100 TALEX SUGAR COATED TABLETS "Y.C." 2.49

AC48437329 U Soft Cream 40.0% 45.2

AC48437343 U Soft Cream 40.0% 117

AC48440421 Oxybupro Eye Drops 0.05% "MEDICINE" (Oxybuprocaine HCl) 20.5

AC48441500 JOPHUN VAGINAL TABLETS 100MG "JOHNSON" 5.3

AC48445229 MYDILL Injection 0.1% 211

AC48446100 SOKEZ TABLETS 20MG "CHINTENG" 1.5

AC48447100 URIDIN F.C. TABLETS 2MG 10.9

AC48459245 "OMEPRON 40MG IV INFUSION ""ROYAL""" 86

AC48461314 MOLISON CREAM "BASECO" 24.1

AC48461316 MOLISON CREAM "BASECO" 24.1

AC48461321 MOLISON CREAM "BASECO" 41.3

AC48461326 MOLISON CREAM "BASECO" 44.9

AC48461329 MOLISON CREAM "BASECO" 44.9

AC48461335 MOLISON CREAM "BASECO" 122

AC48467100 UTAPINE F.C. TABLET 200MG "UNION" 32.2

AC48469100 MECHOL TABLETS 10MG "YUNG SHIN" 9.6

AC48471421 ANZOMIN EYE DROPS 21

AC48471429 ANZOMIN EYE DROPS 54

AC48472100 Fallep Tablets 2mg 2.45

AC48473417 GINPOL GEL 47.8

AC48473423 GINPOL GEL 74

AC48473429 GINPOL GEL 124

AC48499100 Fibrolaxin Tablets 10mg "Patron" 4.13

AC48500100 SURIDE F.C. Tablets 400mg "EB" (Sulpiride) 5.9

AC48505321 FLUTICOSONE CREAM "S.C." 36.9

AC48505335 FLUTICOSONE CREAM "S.C." 84

AC48510100 Dicron MR Tablets 30mg 1.99

AC48513100 Melstatin tablet 40mg 22.8

AC48514100 COSLAN CAPSULES "Y.C" 1.5

AC48516100 ROSIZONE FILM COATED TABLETS 4MG 26

AC48517100 NooSafe 1200 mg Film Coated Tablets 2.67

AC48520100 IPU FILM COATED TABLETS 600MG "CHINTENG" 1.78

AC485201G0 IPU FILM COATED TABLETS 600MG "CHINTENG"(鋁箔/膠箔) 2

AC48542100 ENCINLO E.M. CAPSULES 100MG "UELIAN" 1.5

AC48545100 ASGACON TABLETS 50MCG "YUNG SHIN" 3.79

AC48553209 Kidoton I.V. Injection 30mg/ml "Standard" (Ketorolac) 23.1

AC48554421 DORZOMIDE OPHTHALMIC SOLUTION 2% 273

AC48555100 LEGAN CAPSULES 300MG "CHINTENG" 4.39

AC48556100 Alpragin S.R. Tablets 1mg 2.26

AC48557100 FINARIDE FILM COATED TABLETS 5MG "YUNG SHIN" 20.6

AC48558100 Arheuma Tablets 10mg "LOTUS" 45.4

AC48559100 "AMLOPINE TABLETS 5MG ""TAI YU""" 6.8

AC48560100 Amaride Tablets 2.88

AC48561229 OLATIN I.V. INJECTION 5MG/ML 2290

198

Page 199: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC48564100 Deurinol Tablets 300mg 2.74

AC48565209 TOKELAN I.V. INJECTION 30MG/ML 23.1

AC48565212 TOKELAN I.V. INJECTION 30MG/ML 48.4

AC48566209 "TONFUPIN INJECTION ""TAI YU""" 15

AC48567277 CEFIM POWDER FOR INJECTION 500MG 279

AC48569100 BRICARDYL TABLETS 5mg "JOHNSON" 1.5

AC48572100 YOU Tie Chewable Tablets "Chinteng" 3.9

AC48573100 CYCLOCIN CAPSULES "P.L" 44.1

AC48574263 TAPLANIN FOR IV INJECTION 0

AC48574271 TAPLANIN FOR IV INJECTION 0

AC48575100 THRONE SUSTAINED-RELEASE SUGAR-COATED TABLETS 400MG 2.2

AC48581421 Norcin Eye Drops 0.3% "Sinphar" 63

AC48582335 "Can Ointment ""ROOT""" 94

AC48584100 VEINCURRENT F.C. TABLETS 40MG "T.F." 2.24

AC48585100 COTON CAPSULES 250MG "LITA" 1.5

AC48587212 IRICAN SOLUTION FOR I.V. INFUSION "SINPHAR" 2369

AC48587221 Irican Solution for I.V. Infusion "Sinphar" 4639

AC48589209 OTRIL I.V. INJECTION 335

AC48589216 OTRIL I.V. INJECTION 717

AC48590263 Teiconin powder for I.V. Injection 0

AC48590271 TEICONIN POWDER FOR I.V. INJECTION 0

AC48592100 PMS Sugar-Coated Tablets 0.625mg "Yung Shin" 1.85

AC48599100 MANOTIN F.C. TABLETS 10MG 12.7

AC48600100 CALNELPRESS TABLETS 5MG 6.8

AC48601100 Milpran Capsules 50mg 10.6

AC48602100 DIAZONE TABLETS 15MG "C.H" 12.9

AC48608100 SIMVA F.C TABLETS 20MG "UNION" 6.7

AC48612100 MIRTINE F.C. TABLETS 30MG 13.9

AC48624412 DEMA ORABASE 0.1% "PATRON" 41

AC48624421 DEMA ORABASE 0.1% "PATRON" 55

AC48624426 DEMA ORABASE 0.1% "PATRON" 61

AC48629100 RISDON F.C. TABLETS 1MG "WEIDAR" 15.5

AC48630100 SUMAKIN CAPSULES 1.5

AC486301G0 SUMAKIN CAPSULES(鋁箔/膠箔) 2

AC48635455 AZETIN NASAL SPRAY 140MCG/DOSE 141

AC48635457 AZETIN NASAL SPRAY 1MG/ML(0.14MG/DOSE) 151

AC48636457 BUNO NASAL AQUA 64ΜG/DOSE "JOHNSON"(64MCG/DOSE/120DOSE) 165

AC48637100 ELEGANT S.R. CAPSULES 0.2mg "JOHNSON" 9.6

AC48643151 IBUPROFEN-FP SUSPENSION 20MG/ML 25

AC48646100 FORASMA TABLETS 40 MCG 2.37

AC48658345 KOTTON PATCH “CHI-HUANG”(FLURBIPROFEN) 6.4

AC48660100 Tansin Tablets 1mg 〝EVEREST〞 2.77

AC48663100 LINOOPIL CAPSULES “ASTAR” 1.5

AC48666500 SENZOLE VAGINAL TABLETS 100MG “JOHNSON” 5.4

AC48676100 "SUPLAX TABLETS ""H.S.""" 1.66

AC486761G0 SUPLAX TABLETS "H.S."(鋁箔/膠箔) 2

AC48678145 HECALIS SOLUTION 237

AC48680321 ADAGENE-T GEL ”BASECO” 19.1

AC48680335 ADAGENE-T GEL ”BASECO” 76

AC48680343 ADAGENE-T GEL ”BASECO” 139

AC48680345 ADAGENE-T GEL ”BASECO” 212

AC48680363 ADAGENE-T GEL ”BASECO” 686

AC48684100 MECHOL TABLETS 40MG 〝YUNG SHIN〞 22.8

AC48686143 CENZOFT CONCENTRATE SOLUTION 20 MG/ML“CENTER”(30 ML) 243

AC48686151 CENZOFT CONCENTRATE SOLUTION 20 MG/ML“CENTER”(60 ML) 566

199

Page 200: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC48687100 EUGINE F.C. TABLETS 20 MG 〝H.S.〞 10.6

AC48689100 CURGAN CAPSULES 150MG (SILYMARIN) 1.64

AC48690100 "SURMAX TABLETS ""H.S.""" 4.71

AC48691100 MERONIN ORALLY DISINTEGRATING TABLETS 15 MG 10.6

AC48697100 ZEPANC TABLETS 2.66

AC48701412 ITRAPIN NEBULIZER SOLUTION 0.25 MG/ML“CENTER” 11.3

AC48701438 Itrapin Nebulizer Solution 0.25 mg/ml“Center” 43.7

AC48722251 UROKINASE-GREEN CROSS INJ. 60,000 IU 1010

AC48727113 SYNTAM GRANULES FOR ORAL SOLUTION 2400 MG 8.5

AC48731100 CAFONIA TABLETS“Y.C.” 17.6

AC48734100 Slosugar F.C. Tablets 1000 mg 2.28

AC48747100 MIRTAN TABLETS 30MG "UNION" 16.9

AC48749100 COLCHICINE TABLETS 0.5MG“F.Y.” 1.5

AC48753100 PIOTA TABLETS 30 MG 16.6

AC48754100 DIKINEX REPE S.C. TABLETS 2.49

AC48758100 ACCUFEN F.C. TABLETS "Y.Y." 1.78

AC48764321 ACNE-CURE GEL "MACRO" 18.3

AC48764335 ACNE-CURE GEL "MACRO" 76

AC48764343 ACNE-CURE GEL "MACRO" 139

AC48764345 ACNE-CURE GEL "MACRO" 212

AC48764363 ACNE-CURE GEL "MACRO" 686

AC48765100 Bloodlet Tablets 15mg“Yung Shin” 17.6

AC48770143 LOSTA SYRUP 1 MG/ML 25.6

AC48770151 LOSTA SYRUP 1 MG/ML 31.3

AC48770157 LOSTA SYRUP 1 MG/ML 72

AC48771321 Clobecin Cream“Patron” 18.9

AC48771329 CLOBECIN CREAM“PATRON” 50

AC48771338 CLOBECIN CREAM“PATRON” 99

AC48772100 ANXOMINE TABLET 2MG 3.32

AC487811G0 METFORMIN HYDROCHLORIDE EXTENDED-RELEASE TABLETS 500 MG(鋁箔/

膠箔)

2

AC48784113 NOCETAM GRANULES FOR ORAL SOLUTION 2400 MG 〝LITA〞 8.4

AC48793421 TROPICAN OPHTHALMIC SOLUTION 0.5% "PATRON" 29.2

AC48799345 FUBOFEN PATCH 〝YING CHUAN〞(FLURBIPROFEN) 6.4

AC48800100 MESACLON ENTERIC FILM COATED TABLETS 400 MG 12.1

AC48803212 ZEDIPINE INJECTION 1MG/ML 51

AC48803229 ZEDIPINE INJECTION 1MG/ML 223

AC48803240 ZEDIPINE INJECTION 1MG/ML 488

AC48804438 "BECLOMASE AQUEOUS NASAL SPRAY "" H.S.""" 234

AC48808100 ECYCLE F.C. TABLETS 16MG“Y.Y.” 1.56

AC48809209 KYTRON I.V. INJECTION 1MG/ML 335

AC48809216 KYTRON I.V. INJECTION 1MG/ML 717

AC48810100 CALFOLIN TABLETS 15MG “JOHNSON” 17.6

AC48811100 Anyou F.C. Tablets“ROOT” 3.08

AC48812421 APINE OPHTHALMIC SOLUTION 0.125%“PATRON” 12

AC48812429 APINE OPHTHALMIC SOLUTION 0.125%“PATRON” 12

AC48813100 SIMVATENIN F.C. TABLETS 20MG “KINGDOM”(SIMVASTATIN) 6.7

AC48814100 OXAZE TABLETS 3.65

AC48816100 ACLONAX TABLETS 1.5

AC488161G0 ACLONAX TABLETS(鋁箔/膠箔) 2

AC48830100 "WELLMAX TABLETS ""H.S.""" 1.5

AC488301G0 "WELLMAX TABLETS ""H.S.""(鋁箔/膠箔)" 2

AC48831209 CHI SHENG NO. 2 INJECTION 42.9

AC48831277 CHI SHENG NO. 2 INJECTION 30.3

AC48833100 AMCOPINE TABLETS 5MG "H.S"(AMLODIPINE) 6.8

200

Page 201: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC48834209 CEFIM POWDER FOR INJECTION 1 GM 425

AC48837100 MIXAPIN TABLETS 50MCG "H.S" 3.79

AC48838229 OPATIN I.V. INJECTION 5MG/ML 2733

AC48839100 FULIN F.C.T.“ROOT” 5.4

AC48840221 Irinotecan Solution for I.V. Infusion “LOTUS” 4741

AC48842412 COENKASU ORALBASE 1MG 41

AC48842421 COENKASU ORALBASE 1MG 55

AC48842426 COENKASU ORALBASE 1MG 61

AC48844100 SICAN CAPSULES 150 MG “ASTAR” 1.64

AC48845100 MOODYTEC S.C. TABLETS 1 MG 5.4

AC48846100 GLUFAR TABLETS 2.0MG "H.S" 2.82

AC48855100 Dibose Tablets “Y.C.” 7

AC48856265 MEIROP POWDER FOR IV INJECTION 0

AC48856277 MEIROP POWDER FOR IV INJECTION 0

AC48859100 AMLOPINE TABLETS 5 MG 〝S.D.〞 6.8

AC48862300 TECORO TABLETS 0.025MG "EVEREST" 7.4

AC48865100 ANXOWEN TABLETS 1.5

AC48868100 SLOSUGAR TABLETS 500 MG 1.5

AC48873209 CHI SHENG NO. 3 INJECTION 42.9

AC48873277 CHI SHENG NO. 3 INJECTION 30.3

AC48882229 NICARPINE I.V INJECTION 1MG/ML "P.L" 223

AC48884321 AMOCOAT NAIL LACQUER " H.S " 695

AC48891321 ADARIN GEL 0.1% 19.1

AC48891335 ADARIN GEL 0.1% 80

AC48891343 ADARIN GEL 0.1% 139

AC48891345 ADARIN GEL 0.1% 212

AC48891363 ADARIN GEL 0.1% 717

AC48892100 CEXIME CAPSULES 100 MG (CEFIXIME) 5.5

AC48896209 CHI SHENG NO.4 INJECTION 42.9

AC48896277 CHI SHENG NO. 4INJECTION 30.3

AC48897326 DOXEFEN CREAM 50MG/GM 45.3

AC48897335 DOXEFEN CREAM 50MG/GM 61

AC48898100 LITACARBOSE TABLETS 50MG "LITA" 3.27

AC48900421 CROMO EYE DROPS 2% (CROMOLYN SODIUM)“MEDICINE” 15.9

AC48900429 CROMO EYE DROPS 2% (CROMOLYN SODIUM)“MEDICINE” 30.2

AC48905100 BIOCOR FILM COATED TABLETS 5MG 3.42

AC48908100 ANTILON F.C. TABLETS "Y.C." 4.92

AC48910100 URIMIN TABLETS 1000MG "Y.C." 2.28

AC48925421 CO-DORZOMIDE OPHTHALMIC SOLUTION 322

AC48926100 SIMVA F.C TABLETS 20MG 6.7

AC48927417 TOTIFEN OPHTHALMIC SOLUTION 0.025% ”PATRON” 49.9

AC48927421 TOTIFEN OPHTHALMIC SOLUTION 0.025% ”PATRON” 70

AC48929100 MEQUIMIN TABLETS 5 MG 1.52

AC489291G0 MEQUIMIN TABLETS 5 MG(鋁箔/膠箔) 2

AC48934151 MIRATE LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) “CENTER” 25

AC48934157 MIRATE LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) “CENTER” 25

AC48934163 MIRATE LIQUID 0.8 MG/ML (BUTAMIRATE CITRATE) “CENTER” 25

AC48937157 SUCRALFATE ORAL SUSPENSION 100MG/ML (SUCRALFATE) "CENTER 78

AC48941212 HEROCAN CONC. SOLUTION FOR I.V. INFUSION 20MG/ML 2370

AC48941221 HEROCAN CONC. SOLUTION FOR I.V. INFUSION 20MG/ML 5369

AC48960209 CHI SHENG NO.1 INJECTION 42.9

AC48960277 CHI SHENG NO.1 INJECTION 30.3

AC48961251 ROFEW I.V.INFUSION SOLUTION 200MG/ML 208

AC48965421 SITROMIN EYE DROPS 0.005%”KINGDOM” 12

AC48965429 SITROMIN EYE DROPS 0.005%”KINGDOM” 16.9

201

Page 202: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC48996100 BLUE-UP F.C. TABLETS 1MG 15.5

AC48997100 SPALYTIC TABLETS 0.125MG "H.S." 2.45

AC48999421 SITROMIN EYE DROPS 0.01% ”KINGDOM” 12

AC48999429 SITROMIN EYE DROPS 0.01% ”KINGDOM” 15.4

AC49000212 OCILLINA POWDER FOR INJECTION 100

AC49000277 OCILLINA POWDER FOR INJECTION 25

AC49001265 CARPEM FOR INTRAVENOUS INJECTION 375

AC49001277 CARPEM FOR INTRAVENOUS INJECTION 404

AC49008100 CITAZOL TABLETS 50MG“STANDARD” 7.5

AC49016421 KINTROPINE EYE DROPS 0.125%“KINGDOM” 12

AC49016429 KINTROPINE EYE DROPS 0.125%“KINGDOM” 12

AC49018100 COXINE C.R. F.C. TABLETS 60 MG 3.98

AC49024100 KHOTONGFENG TABLETS 300MG 〝CHINTENG〞 2.74

AC49026143 TIRIZIN ORAL SOLUTION 1MG/ML 36.6

AC49026151 TIRIZIN ORAL SOLUTION 1MG/ML 37

AC49026157 TIRIZIN ORAL SOLUTION 1MG/ML 125

AC49028165 POTAMAGCID SOLUTION “CENTER” 42.9

AC49029151 ANTIMIN SYRUP 25

AC49029157 ANTIMIN SYRUP 25

AC49032463 NOSECONE AQUA NASAL SPRAY 0.42MG/GM“JOHNSON” 118

AC49050329 UREA CREAM 40%“F.Y.” 45.2

AC49050343 UREA CREAM 40%“F.Y.” 117

AC49054100 ZOMIANNE F.C. TABLETS 7.5 MG 2.89

AC49055100 OMEPROTECT ENTERIC MICROENCAPSULATED CAPSULES 20MG”ANGEL” 2.51

AC49057100 AMOCURE F.C. TABLETS 30 MG 21.3

AC49059100 KONAX EXTENDED-RELEASE F.C. TABLETS 60 MG 2.24

AC49060100 ISOMIN F.C. TABLETS 21

AC49072100 GLIPIRIDE TABLETS 1MG “YUNG SHIN” 1.94

AC49073100 BLUE-UP F.C. TABLETS 3MG 41.7

AC49076100 IBUPROFEN CAPSULES 400MG ”PATRON” 1.5

AC49077209 KETOROLAC FOR IV INJECTION30MG/ML“T.F.” 23.1

AC49078100 MIRZAPINE F.C. TABLETS 30MG "KINGDOM" (MIRTAZAPINE) 16.9

AC49080321 GENRITE CREAM 1MG/G 20

AC49080335 GENRITE CREAM 1MG/G 49.4

AC49083100 BISCOR F.C TABLETS 5MG "KINGDOM" 3.42

AC49084100 SOTALON CAPSULES 10MG 3.83

AC49085100 PITAZONE TABLET 30 MG 16.6

AC49089100 ANCOPIN TABLETS "H.S." 1.5

AC49090277 SULTAM FOR INJECTION 500MG (SULBACTAM SODIUM) 0

AC49092100 LOXU TABLETS 15MG 8.5

AC49095421 FLOZOLIN OPHTHALMIC SOLUTION ”PATRON” 30.6

AC49099100 DESDIN FILM-COATED TABLETS 5MG 3.24

AC49100229 ANESVAN 2% INJECTION “CHI SHENG” 64

AC49100248 ANESVAN 2% INJECTION “CHI SHENG” 314

AC49105100 UNDIZZ TABLETS“Y.C.” 1.56

AC49107345 TIE SHR SHU PAP 〝P.Y〞 6.3

AC49112100 FLURAN TABLETS 50 MG ”ASTAR” 1.54

AC49114100 DAYCOSE M.R. TABLETS 30 MG "WEIDAR" 2.02

AC49115209 CHI SHENG NO.5 INJECTION 42.9

AC49115265 CHI SHENG NO.5 INJECTION 27.2

AC49115271 CHI SHENG NO.5 INJECTION 30.3

AC49115277 CHI SHENG NO.5 INJECTION 30.3

AC49127412 LAVISOL ORALBASE 41

AC49127421 LAVISOL ORALBASE 55

202

Page 203: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC49127426 LAVISOL ORALBASE 61

AC49129321 GENTERMAY CREAM 20

AC49129335 GENTERMAY CREAM 49.4

AC49130209 PHEL POWDER FOR INJECTION 1 GM 83

AC49131100 RISDONE TABLETS 3MG“S.T.”(RISPERIDONE) 41.7

AC49133100 LAMTA TABLETS 100 MG (LAMOTRIGINE) 24.1

AC49134321 GENTERMAY OINTMENT 20

AC49134335 GENTERMAY OINTMENT 49.4

AC49142100 METERLON TABLETS “Y.C.” 1.5

AC49146100 MOPIK TABLETS 15 MG 〝N.K.〞 8.5

AC49150265 SUPERNEM POWDER FOR INJECTION 197

AC49150277 SUPERNEM POWDER FOR INJECTION 427

AC49153100 OXBU EXTENDED-RELEASE TABLETS 5MG 7.7

AC49155265 MEXOPEM POWDER FOR INJECTION 0

AC49155277 MEXOPEM POWDER FOR INJECTION 0

AC49163321 CHYNDACIN GEL 9.1

AC49163323 CHYNDACIN GEL 16

AC49163329 CHYNDACIN GEL 17.9

AC49163330 CHYNDACIN GEL 18.5

AC49163335 CHYNDACIN GEL 28.3

AC49163338 CHYNDACIN GEL 83

AC49163343 CHYNDACIN GEL 186

AC49166100 ONSLEEP CAPSULES 10MG “STANDARD”(ZALEPLON) 3.96

AC49177209 GRANTRON I.V. INJECTION 1 MG/ML 335

AC49177216 GRANTRON I.V. INJECTION 1 MG/ML 717

AC49178100 PERIPIL TABLETS 4 MG 10

AC49183112 TERBUTE SOLUTION FOR NEBULIZING 2.5MG/ML 12.9

AC49184100 MELOXIN TABLETS 15MG 8.5

AC49186421 KINTROPINE EYE DROPS 0.25%”KINGDOM” 12

AC49186429 KINTROPINE EYE DROPS 0.25%”KINGDOM” 21

AC49188100 RACEPHENICOL TABLETS "Y.C." 1.52

AC49190100 SIVASIN FILM COATED TABLETS 40MG 15.7

AC49193100 CATILON TABLETS 40MG 3.72

AC49202100 MODUP SUSTAINED-RELEASE CAPSULES 25 MG 7.4

AC49204100 LITACARBOSE TABLETS 100MG" LITA " 7

AC49209421 SAFIN OPHTHALMIC SOLUTION "PATRON" 13

AC49209429 SAFIN OPHTHALMIC SOLUTION "PATRON" 27.4

AC49210335 TAZAROTENE GEL 0.1%“S.C.” 246

AC49210343 TAZAROTENE GEL 0.1%“S.C.” 472

AC49211138 NOPANT RESPIRATOR SOLUTION 126

AC49217100 ZODENOX FILM COATED TABLETS 10MG“YUNG SHIN” 2.51

AC49223100 ANTICOUGH TABLETS“CHINTENG” 1.5

AC492231G0 ANTICOUGH TABLETS“CHINTENG”(鋁箔/膠箔) 2

AC49224100 COTOL F.C. TABLETS 75MG "EVEREST" 39.6

AC49237100 TONLEX F.C. TABLETS 500MG 3.88

AC49239335 TAZOTEN CREAM "H.S." 246

AC49239343 TAZOTEN CREAM "H.S." 459

AC49247209 PROCHLOZINE INJECTION 5MG/ML "T.F" 15.3

AC49260229 ISOCIN INJECTION 0.1% 211

AC49261100 LIMECRO CAPSULES 3.52

AC49264100 POWECON TABLETS 2.45

AC49266100 LABEDIN F.C. TABLETS 200MG 3.24

AC49275209 OMIDA INJECTION 5MG/ML 24.3

AC49275212 OMIDA INJECTION 5MG/ML 29

AC49275216 OMIDA INJECTION 5MG/ML 38.6

203

Page 204: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC49275221 OMIDA INJECTION 5MG/ML 58

AC49275229 OMIDA INJECTION 5MG/ML 203

AC49275237 OMIDA INJECTION 5MG/ML 263

AC49276245 CINOLONE IV INFUSION 10 MG/ML 1003

AC49277416 TILOL OPHTHALMIC SOLUTION 0.25% ”PATRON” 71

AC49277421 TILOL OPHTHALMIC SOLUTION 0.25% ”PATRON” 73

AC49278100 MONTEXIN CHEWABLE TABLETS 5 MG 15.8

AC49280321 ADAPALENE GEL 0.1%“SINPHAR” 19.6

AC49280335 ADAPALENE GEL 0.1%“SINPHAR” 83

AC49280343 ADAPALENE GEL 0.1%“SINPHAR” 142

AC49280345 ADAPALENE GEL 0.1%“SINPHAR” 232

AC49280363 ADAPALENE GEL 0.1%“SINPHAR” 737

AC49283100 ASAZIPAM FILM COATED TABLETS 50MG 25.7

AC49284414 TILOL OPHTHALMIC SOLUTION 0.5% ”PATRON” 172

AC49284421 TILOL OPHTHALMIC SOLUTION 0.5% ”PATRON” 172

AC49289100 TIABINE FILM COATED TABLETS 10MG 26.7

AC49291100 ALPRAGIN S.R. TABLETS 0.5 MG 1.5

AC49303100 CHLOGUIN F.C. TABLETS 200MG“WEIDAR” 2.72

AC49304263 TARCONIN FOR I.V. INJECTION 200MG“STANDARD”(TEICOPLANIN) 728

AC49305100 KLARITH XL TABLETS 500MG 27

AC49306100 NICODIL TABLETS 5MG 4.3

AC49308100 GLUNAT TABLETS 120 MG 3.8

AC49309209 AVACAN INJECTION”ASTAR” 15

AC49313329 BUTEDERM CREAM 1% 59

AC49313335 BUTEDERM CREAM 1% 81

AC49319321 ANDOPIN GEL 0.1%“P.L.” 20

AC49319335 ANDOPIN GEL 0.1%“P.L.” 86

AC49319343 ANDOPIN GEL 0.1%“P.L.”(30G) 174

AC49319363 ANDOPIN GEL 0.1%“P.L.” 858

AC49320382 LIDOPAT PATCH 5% 49.2

AC49322100 BUPROTRIN SUSTAINED RELEASE F.C. TABLETS 150MG 〝ROYAL〞 19.9

AC49328421 KETORO OPHTHALMIC SOLUTION 0.5% "PATRON" 120

AC49329100 NOMI-NOX F.C. TABLETS 5MG 64

AC49331151 LACOLY SOLUTION“CENTER” 25.7

AC49331166 LACOLY SOLUTION“CENTER” 164

AC49331177 LACOLY SOLUTION“CENTER” 192

AC49333100 LIFENOZ-U TABLETS 160MG 6.5

AC49334421 CURZOLAN EYE DROPS 26.7

AC49334429 CURZOLAN EYE DROPS 45.5

AC49335100 BACLON 10MG TABLETS 1.5

AC49337321 BUNAFINE CREAM 1% “P.L.”(5G) 36.5

AC49337329 BUNAFINE CREAM 1% “P.L.”(10G) 67

AC49337335 BUNAFINE CREAM 1% “P.L.”(15G) 82

AC49337355 BUNAFINE CREAM 1% “P.L.”(100G) 694

AC49338321 FLUTISONE CREAM 36.9

AC49338335 FLUTISONE CREAM 84

AC49339321 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 55

AC49339326 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 55

AC49339329 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 58

AC49339335 FUSIDIC ACID CREAM 20MG/GM "SINPHAR" 154

AC49339338 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 160

AC49339348 FUSIDIC ACID CREAM 20MG/GM “SINPHAR” 337

AC49343100 MESTROL TABLETS 40 MG 11.5

AC49345100 ZONIN S.C. TABLETS 50MG 11.4

204

Page 205: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC49348100 EPALON F.C. TABLETS 10MG 70

AC49351421 COMOLYN OPHTHALMIC SOLUTION 2%“PATRON” 15.9

AC49351429 COMOLYN OPHTHALMIC SOLUTION 2%“PATRON” 30.2

AC49357335 FUL LEE CREAM 0.1%(W/W)”CHINTENG” 246

AC49357343 FUL LEE CREAM 0.1%(W/W)”CHINTENG” 444

AC49358100 UDILOL TABLETS 6.25MG 4.08

AC49360100 BEZOSTATIN F.C. TABLETS 40 MG“S.C.” 15.7

AC49362100 MINLIFE-P SUSTAINED RELEASE FILM COATED TABLETS 3.12

AC49367100 PADELIN TABLETS “PATRON” (LORAZEPAM) 1.5

AC49368421 NOFOXIN EYE DROPS 0.3% “MEDICINE”(NORFLOXACIN) 63

AC49368429 NOFOXIN EYE DROPS 0.3% “MEDICINE”(NORFLOXACIN) 83

AC49369114 BESMATE INHALATION SOLUTION 20.3

AC49372100 SORDUR CONTROLLED-RELEASE TABLETS 60MG 3.98

AC49373100 PEDEN RETARD TABLETS 4 MG 2.88

AC49374100 COSPIRIT F.C. TABLETS 400MG 48.4

AC49376100 FELO E.R. TABLETS 2.5MG“EVEREST” 3.29

AC49388121 CHALIAN POWDER 11.4

AC49390209 SUKETON I.V. INJECTION“TAI YU” 23.1

AC49390212 SUKETON I.V. INJECTION“TAI YU” 48.4

AC49397100 MEQUITAZINE TABLETS 5MG“SINPHAR” 1.52

AC49416135 KUZEM POWDER 32.3

AC49419421 CATELOL OPHTHALMIC SOLUTION 1.0%“PATRON” 188

AC49421100 JOLINDAC TABLETS 200 MG“JOHNSON” 2.03

AC49422321 BETACLOGEN CREAM“SINPHAR” 18.9

AC49422329 BETACLOGEN CREAM“SINPHAR” 50

AC49422336 BETACLOGEN CREAM“SINPHAR” 59

AC49422338 BETACLOGEN CREAM“SINPHAR” 99

AC49422355 BETACLOGEN CREAM“SINPHAR” 145

AC49423100 SONAPLON CAPSULES 10MG "D.T" 4.83

AC49424100 JALUMEN CAPSULES 10MG 3.86

AC49428100 JEXIT S.C. TABLETS“JOHNSON” 3.08

AC49446100 CARBATIN F.C. TABLETS 800 MG 23.4

AC49447321 TOCOCLEAN GEL 9.1

AC49447323 TOCOCLEAN GEL 16

AC49447329 TOCOCLEAN GEL 17.9

AC49447330 TOCOCLEAN GEL 18.5

AC49447335 TOCOCLEAN GEL 28.3

AC49447338 TOCOCLEAN GEL 83

AC49447343 TOCOCLEAN GEL 186

AC49451221 ENHANCIR INJECTION 0.84 MG/ML“Y.Y.” 30.7

AC49452100 VOROTAL F.C. TABLETS 500 MG 47.7

AC49457100 GLUCOFIT ER TABLETS 500 MG ”SWISS” 1.71

AC49459423 GINSOL GEL 74

AC49459429 GINSOL GEL 124

AC49461100 U-MIRTARON F.C. TABLETS 30 MG“S.C.” 17.5

AC49465100 CARBATIN CAPSULES 300 MG 8.3

AC49467100 ANXILET FILM COATED TABLETS 2MG 18.6

AC49469100 CARLATREND TABLETS 6.25MG”KINGDOM”(CARVEDILOL) 4.08

AC49470151 COCOPINE SYRUP“CENTER” 25

AC49470157 COCOPINE SYRUP“CENTER” 28.8

AC49471329 ZORIA CREAM 40%"EVEREST" 45.2

AC49471343 ZORIA CREAM 40%"EVEREST" 117

AC49493100 EPALON F.C. TABLETS 5 MG 70

AC49494100 Kertonbose Tablets 50 mg 3.27

AC49496100 UTAPINE F.C. TABLET 100MG“UNION” 24

205

Page 206: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC49502100 FLUCOGUS CAPSULES 150MG"H.S." (FLUCONAZOLE) 61

AC49504100 BISO F.C. TABLETS 1.25 MG 2.92

AC49505248 VOROTAL IV SOLUTION FOR INFUSION 5MG/ML 469

AC49505255 VOROTAL IV SOLUTION FOR INFUSION 5MG/ML 853

AC49506321 GAMICIN OINTMENT 20

AC49506335 GAMICIN OINTMENT 49.4

AC49514100 IBIMO C.R.F.C. TABLETS 60 MG“S.C.” 3.98

AC49515100 AMORFAN FILM COATED TABLETS 10 MG 1.51

AC49516100 FELOEN EXTENDED-RELEASE FILM-COATED TABLETS 6.3

AC49521100 YUROBEN F.C. TABLETS 600MG“Y.S.” 1.78

AC49522100 INSURE CONTROLLED-RELEASE TABLETS 60MG”KINGDOM” 3.98

AC49525100 D.P.L. CAPSULES“Y.Y.” 1.5

AC495251G0 D.P.L. CAPSULES“Y.Y.”(鋁箔/膠箔) 2

AC49526100 LIMUS F.C. TABLETS 25 MG 12.6

AC49527100 LESYN F.C. TABLETS 2 MG 5.2

AC49530421 FLUZOCON EYE DROPS 30.6

AC49531100 METFORMIN TABLETS 850MG“KINGDOM” 2.23

AC49535100 SIMATIN F.C TABLETS 80MG 33.5

AC495361G0 CARDIOPIRIN ENTERIC COATED TABLETS 100MG (ASPIRIN)(鋁箔/膠箔) 2

AC49542265 CIPENEM POWDER FOR IV INJECTION (250MG/ 250MG) 197

AC49542277 CIPENEM POWDER FOR IV INJECTION (500MG/500MG) 427

AC49544100 KENCO F. C. TABLETS 5MG”CHINTENG” 3.42

AC49545100 FLEXER F.C. TABLETS 5 MG 2.8

AC49549100 DIAZONE TABLETS 30MG“C.H.” 16.6

AC49550221 CHENDAY INJECTION 5MG/ML 83

AC49556100 YOU-JET F.C. TABLETS 100 MG 25.1

AC49558420 DEVIRUS OPHTHALMIC OINTMENT 427

AC49558421 DEVIRUS OPHTHALMIC OINTMENT 427

AC49560100 POLITONE TABLETS 30MG (PIOGLITAZONE) 17

AC49561421 PREDNICONE OPHTHALMIC SUSPENSION 1 % 78

AC49562277 PENTAMO INJECTION 10 % 448

AC49563100 FURIL CAPSULES "LOTUS" 58

AC49564100 COUGIN F.C. TABLETS 10MG "H.S." 1.51

AC495641G0 COUGIN F.C. TABLETS 10MG "H.S."(鋁箔/膠箔) 2

AC49568100 TORAMATE FILM COATED TABLETS 100MG 32.3

AC49574100 UTAPINE F.C. TABLETS 25MG“UNION” 12.9

AC49577100 FUTE F.C. TABLETS 0.5MG 2.85

AC49579100 PRECOSE TABLETS 50MG 3.27

AC49582245 LOMETIN 40 MG I.V. INFUSION 86

AC49593100 TALLSEA TABLETS“S.C.” 1.66

AC495931G0 TALLSEA TABLETS“S.C.”(鋁箔/膠箔) 2

AC49598321 ANTIMYCOLIN CREAM 54

AC49605100 MILPRAN CAPSULES 25 MG 6.8

AC49609100 DIFAN F.C. TABLETS 10MG“Y.Y.” 1.51

AC49619100 CIFLOGEN F.C. TABLETS 500 MG 13.1

AC49621100 MONTEXIN CHEWABLE TABLETS 4 MG 15.8

AC49622100 FENSPIREL TABLETS 40MG“S.D.” 1.81

AC49623100 BIOCOR FILM COATED TABLETS 10 MG 7.1

AC49625100 ROSIGLIT F.C. TABLETS 4MG“STANDARD”(ROSIGLITAZONE) 25.8

AC49627151 MERCATER LIQUID 5UG/ML (PROCATEROL HYDROCHLORIDE HEMIHYDRATE) 52

AC49627157 MECATER LIQUID 5 UG/ML(PROCATEROL HYDROCHLORIDE HEMIHYDRATE) 111

AC49628143 CETIRIZINE ORAL SOLUTION“SINPHAR” 36.6

206

Page 207: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC49628151 CETIRIZINE ORAL SOLUTION“SINPHAR” 37

AC49628157 CETIRIZINE ORAL SOLUTION“SINPHAR” 125

AC49634100 MERONIN ORALLY DISINTEGRATING TABLETS 30MG 18.9

AC49636100 LOTEPIN S.C. TABLETS 50 MG 11.4

AC49638100 GATINE CAPSULES 100 MG 3.33

AC49640100 TERCO TABLETS”PATRON” 1.5

AC49648100 MELOXICAM TABLETS 7.5 MG“S.D.” 2.36

AC49650100 BETACOR F.C. TABLETS 5MG“STANDARD”(BISOPROLOL HEMIFUMARATE) 3.42

AC49651248 LEFLODAL I.V. SOLUTION FOR INFUSION 5MG/ML 458

AC49651255 LEFLODAL I.V. SOLUTION FOR INFUSION 5MG/ML 958

AC49652329 TRISEC CREAM 50

AC49652336 TRISEC CREAM 59

AC49652338 TRISEC CREAM 99

AC49654338 AGSDINE CREAM 56

AC49654348 AGSDINE CREAM 56

AC49654377 AGSDINE CREAM 480

AC49655210 AMBACILLIN POWDER FOR INJECTION 96

AC49655216 AMBACILLIN POWDER FOR INJECTION 178

AC49655289 AMBACILLIN POWDER FOR INJECTION 96

AC49657100 COSPIRIT F.C. TABLETS 200MG 28.4

AC49659100 ANFORMIN TABLETS 850MG 2.23

AC49661100 LIPIDOFF F.C. TABLETS 20MG 6.7

AC49663100 TRIDINE TABLETS 1.5

AC49666100 RAPNOTIC F.C. TABLETS 10MG "H.S." 2.51

AC49667100 DEMARE CAPSULES 10 MG 4.89

AC49670335 KARAC CREAM 246

AC49670343 KARAC CREAM 447

AC49672100 SIMATIN F.C. TABLETS 20MG 6.7

AC49689209 BUPRENORPHINE INJECTION 0.3MG/ML ”O-S” 86

AC49695265 EASYDOPA INJECTION 130

AC49695277 EASYDOPA INJECTION 315

AC49697100 GLUCOBOSE TABLETS 50MG"H.S." 3.27

AC49699100 SIMATIN F.C. TABLETS 10MG 5.9

AC49700100 ESTIMIN F.C. TABLETS 5MG ”KINGDOM”(EBASTINE) 1.93

AC49704100 DISFECT F.C. TABLETS 250MG 60

AC49707100 CONTEXIN CAPSULES“ASTAR” 1.5

AC49709335 TARAC TOPICAL CREAM 0.05%“PURZER” 232

AC49709343 TARAC TOPICAL CREAM 0.05%“PURZER” 417

AC49713157 REMALTIN ORAL SOLUTION “CENTER” 282

AC49713164 REMALTIN ORAL SOLUTION “CENTER” 470

AC497131FI REMALTIN ORAL SOLUTION “CENTER” 1015

AC49731316 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 26

AC49731321 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 39.8

AC49731329 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 44.4

AC49731330 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 70

AC49731335 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 70

AC49731343 PILOSO CREAM 0.05%(CLOBETASONE)“PATRON” 121

AC49738100 SUKERIN F.C. TABLETS 10MG“UNION” 5.8

AC49739100 LOSENTA F.C. TABLETS 50MG 9.3

AC49740321 APALENE GEL 0.1% "EVEREST" 19.5

AC49740335 APALENE GEL 0.1% "EVEREST" 80

AC49740343 APALENE GEL 0.1% "EVEREST" 139

AC49740345 APALENE GEL 0.1% "EVEREST" 212

AC49740363 APALENE GEL 0.1% "EVEREST" 717

207

Page 208: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC49741100 QUEROPIN FILM COATED TABLETS 200MG“YUNG SHIN” 31.7

AC49743216 DEPAVENT INJECTION 100MG/ML 251

AC49743219 DEPAVENT INJECTION 100MG/ML(4ML) 306

AC49743221 DEPAVENT INJECTION 100MG/ML 367

AC49743229 DEPAVENT INJECTION 100MG/ML 696

AC49744321 B.&N. BACTERMIN OINTMENT 64

AC49744335 B.&N. BACTERMIN OINTMENT 124

AC49751100 CODEVERINE TABLETS”PATRON” 1.5

AC49754209 SETRON I.V. INJECTION 1 MG/ML 335

AC49754216 SETRON I.V. INJECTION 1 MG/ML 717

AC49755100 RAMILY TABLETS 10MG 9

AC49756100 MOREEZ COMPLEX TABLETS 9

AC49758157 “PPCD”MORPHINE SULFATE ORAL SOLUTION 2MG/ML 240

AC49760100 PEALETON SUSTAINED RELEASE F.C. TABLETS 120MG“YUNG SHIN” 2.03

AC49763100 NOLIDIN TABLETS“Y.C.” 3.34

AC49764100 NEO-VIS TABLETS“SWISS” 1.6

AC497641G0 NEO-VIS TABLETS“SWISS”(168粒/瓶裝)(鋁箔/膠箔) 2

AC49766100 GASTERIN TABLETS“Y.C.” 2.15

AC49767100 CODEINE-T TABLETS“SINPHAR” 1.5

AC497671G0 CODEINE-T TABLETS“SINPHAR”(鋁箔/膠箔) 2

AC49769100 FINASPRO F.C. TABLETS 5MG 20.6

AC49770221 NOESIN INJECTION“TAI YU”(PIRACETAM) 15

AC49770229 NOESIN INJECTION“TAI YU”(PIRACETAM) 33.7

AC49786343 TAROTE CREAM 1MG/GM”PATRON” 444

AC49787100 COVAXIN TABLETS 70MG 221

AC49788100 GETRAN TABLETS 2.5MG“TAI YU” 1.5

AC49792100 SO. H. F. C. TABLETS“ROOT” 6.7

AC49798100 LANDUET TABLETS 10MG/25MG 10.5

AC49799100 LANDUET TABLETS 5MG/12.5MG 1.5

AC49804329 MYCONXIN CREAM 0.5% 69

AC49805100 VENFAXIME S.R. CAPSULES 75MG“EVEREST” 17.2

AC49808100 SYNPID MICRONIZED CAPSULES 200 MG 6.5

AC49812100 SOLMIN CAPSULES 10MG“C.H.” 3.89

AC49831100 NOBISIN F.C 1200MG TABLETS“TAI YU” 2.67

AC49833100 LEVOZINE F.C. TABLETS 5MG“STANDARD”(LEVOCETIRIZINE

DIHYDROCHLORIDE)

3.86

AC49840100 TORAMATE FILM COATED TABLETS 50MG 16.9

AC49841100 SIMPOTIN F.C. TABLETS 20 MG“WEIDAR” 6.7

AC49842321 THREE-UNITE CREAM“F.Y.” 18.9

AC49842329 THREE-UNITE CREAM“F.Y.” 50

AC49842336 THREE-UNITE CREAM“F.Y.” 59

AC49842338 THREE-UNITE CREAM“F.Y.” 99

AC49842355 THREE-UNITE CREAM“F.Y.” 145

AC49843100 SUELODE TABLETS 400 MG 5.9

AC49844151 BUTAMIRATE LIQUID 1.5 MG/ML“CENTER” 25

AC49844157 BUTAMIRATE LIQUID 1.5 MG/ML“CENTER” 25

AC49844163 BUTAMIRATE LIQUID 1.5 MG/ML“CENTER” 30.8

AC49848345 FU-TONG PROFEN PLASTER 6.4

AC49851100 CIDINCOR FILM COATED TABLETS 1.25 MG 2.92

AC49853316 FUNOCIN CREAM 0.5MG/G "PATRON" 36.3

AC49853321 FUNOCIN CREAM 0.5MG/G "PATRON" 42.4

AC49853329 FUNOCIN CREAM 0.5MG/G "PATRON" 54

AC49853335 FUNOCIN CREAM 0.5MG/G "PATRON" 54

AC49853338 FUNOCIN CREAM 0.5MG/G "PATRON" 135

208

Page 209: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC49853355 FUNOCIN CREAM 0.5MG/G "PATRON" 477

AC49854100 ALPRAGIN TABLETS 1.0 MG 3.44

AC49857221 WENTIN INJECTION 10MG/ML“T.F.” 65

AC49858100 VACYLESS FILM COATED TABLETS 500 MG 72

AC49859212 SETORAL INJECTION 0.3MG 456

AC49861100 TORAMATE FILM COATED TABLETS 25MG 8.5

AC49863321 CHIZOCIN CREAM 25.4

AC49863329 CHIZOCIN CREAM 45.2

AC49863335 CHIZOCIN CREAM 50

AC49863338 CHIZOCIN CREAM 92

AC49864321 FULTIN CREAM 0.05% 36.9

AC49864335 FULTIN CREAM 0.05% 84

AC49876100 WINLOPINE EXTENDED RELEASE TABLETS 5MG 3.29

AC49877321 B-GENCIN CREAM“SINPHAR” 39.6

AC49877329 B-GENCIN CREAM“SINPHAR” 39.6

AC49877335 B-GENCIN CREAM“SINPHAR” 39.6

AC49881209 MACEPIM POWDER FOR I.V. INJECTION(1GM) 0

AC49881212 MACEPIM POWDER FOR I.V. INJECTION(2GM) 0

AC49881277 MACEPIM POWDER FOR I.V. INJECTION(500MG) 0

AC49883321 SOFTNSUPPLE OINTMENT 39.6

AC49883335 SOFTNSUPPLE OINTMENT 60

AC49887100 DEPRESSOR F.C. TABLETS 50MG"H.S." 9.3

AC49888329 SINPHARDERM KERATOLYTIC CREAM 40%“SINPHAR” 45.2

AC49888343 SINPHARDERM KERATOLYTIC CREAM 40%“SINPHAR” 117

AC49889100 MONTEXIN FILM COATED TABLETS 10 MG (MONTELUKAST) 19.7

AC49890212 INNOCAN CONC. SOLUTION FOR I.V. INFUSION 20MG/ML 2368

AC49890221 INNOCAN CONC. SOLUTION FOR I.V. INFUSION 20MG/ML 5369

AC49891151 LAXUS LIQUID 25.7

AC49891166 LAXUS LIQUID 164

AC49891177 LAXUS LIQUID 192

AC49899100 NOBELIN F.C. TABLETS 500 MG 26.1

AC49901263 EASYDOBU INJECTION 1MG/ML 189

AC49901265 EASYDOBU INJECTION 1MG/ML 209

AC49901277 EASYDOBU INJECTION 1MG/ML 434

AC49903335 TARAC TOPICAL CREAM 0.1%“PURZER” 280

AC49903343 TARAC TOPICAL CREAM 0.1%“PURZER” 475

AC49904100 ACETEC TABLETS 4 MG 10

AC49906321 SANMASU CREAM 1.0%“EVEREST” 34.6

AC49906329 SANMASU CREAM 1.0%“EVEREST” 55

AC49906335 SANMASU CREAM 1.0%“EVEREST” 76

AC49906355 SANMASU CREAM 1.0%“EVEREST” 668

AC49908421 TIMOLOL EYE DROPS 0.5% 〝MEDICINE〞(TIMOLOL) 172

AC49915100 CIDINCOR FILM COATED TABLETS 2.5 MG 2.92

AC49917321 BUTEFIN CREAM 10MG/G“PATRON” 34.6

AC49917329 BUTEFIN CREAM 10MG/G“PATRON” 55

AC49917335 BUTEFIN CREAM 10MG/G“PATRON” 74

AC49917355 BUTEFIN CREAM 10MG/G“PATRON” 668

AC49918100 LAMIDINE F.C. TABLETS 100 MG 65

AC49919321 ALEDO GEL 10MG/GM 9.1

AC49919323 ALEDO GEL 10MG/GM 16

AC49919329 ALEDO GEL 10MG/GM 17.9

AC49919330 ALEDO GEL 10MG/GM 18.5

AC49922100 MINIVANE F.C. TABLETS 45MG 26.3

AC49929100 "RIPUNIN TABLETS 100MG ""TAI YU"" (ALLOPURINOL)" 1.5

AC49932417 BIOMICIN STERILE OPHTHALMIC OINTMENT 106

209

Page 210: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC49934321 FUSKIN CREAM 20MG/GM 55

AC49934329 FUSKIN CREAM 20MG/GM 58

AC49934335 FUSKIN CREAM 20MG/GM 154

AC49934338 FUSKIN CREAM 20MG/GM 160

AC49934348 FUSKIN CREAM 20MG/GM 337

AC49953100 SOANDINE CAPSULES 5MG 2.75

AC49957100 VOLV EXTENDED-RELEASE TABLETS 750MG 1.9

AC49958100 CALMDOWN SUSTAINED-RELEASE CAPSULES 37.5MG 12.8

AC49960100 JALUMEN CAPSULES 5 MG 2.72

AC49962321 FUSIGEN CREAM 20MG/GM 55

AC49962326 FUSIGEN CREAM 20MG/GM 55

AC49962329 FUSIGEN CREAM 20MG/GM 58

AC49962335 FUSIGEN CREAM 20MG/GM 154

AC49962338 FUSIGEN CREAM 20MG/GM 160

AC49962348 FUSIGEN CREAM 20MG/GM 337

AC49963100 WINLOPINE EXTENDED RELEASE TABLETS 10MG 5.1

AC49966100 AMLODINE TABLETS 10MG 6.8

AC49967100 CLOFIX F.C. TABLETS 75MG 40.3

AC49974321 ANEFREE CREAM 0.1% 19.5

AC49974335 ANEFREE CREAM 0.1% 82

AC49974343 ANEFREE CREAM 0.1% 141

AC49974345 ANEFREE CREAM 0.1% 226

AC49974363 ANEFREE CREAM 0.1% 737

AC49977209 YUPIME POWDER FOR INJECTION 425

AC49977212 YUPIME POWDER FOR INJECTION 676

AC49977277 YUPIME POWDER FOR INJECTION 279

AC49990209 CEFEMAX POWDER FOR I.V. INJECTION (1 GM) 425

AC49990212 CEFEMAX POWDER FOR I.V. INJECTION (2 GM) 676

AC49990277 CEFEMAX POWDER FOR I.V. INJECTION (500 MG) 279

AC49992100 BROPAN TABLETS 1.5MG 1.58

AC49995100 REGLINIDE TABLETS 1MG“YUNG SHIN” 3

AC49997100 SIMATIN F.C. TABLETS 40 MG 15.7

AC50002265 CILAPEN POWDER FOR IV INJECTION 0

AC50002277 CILAPEN POWDER FOR IV INJECTION 0

AC50008100 URACARE TABLETS 10MG 5.7

AC50009100 "RIPUNIN TABLETS 300MG ""TAI YU"" (ALLOPURINOL)" 2.74

AC50010100 MOTEN F.C. TABLETS 10MG“JOHNSON” 1.5

AC500101G0 MOTEN F.C. TABLETS 10MG“JOHNSON”(鋁箔/膠箔) 2

AC50011100 CILOPA F.C. TABLETS 40 MG“S.C.” 27.9

AC50013100 GELSO TABLETS 25MG (DIPHENIDOL)“TAI YU” 1.5

AC50014312 CLOVIR CREAM 50MG/GM“PATRON” 17.3

AC50014316 CLOVIR CREAM 50MG/GM“PATRON” 17.3

AC50014317 CLOVIR CREAM 50MG/GM“PATRON” 17.3

AC50014319 CLOVIR CREAM 50MG/GM“PATRON” 17.3

AC50014321 CLOVIR CREAM 50MG/GM“PATRON” 46.6

AC50014329 CLOVIR CREAM 50MG/GM“PATRON” 46.6

AC50014343 CLOVIR CREAM 50MG/GM“PATRON” 431

AC50014355 CLOVIR CREAM 50MG/GM“PATRON” 431

AC50015100 SODIUM BICARBONATE TABLETS 0.3 GM“Y.C.” 1.5

AC500151G0 SODIUM BICARBONATE TABLETS 0.3 GM“Y.C.”(鋁箔/膠箔) 2

AC50016100 MINIVANE F.C. TABLETS 15MG“SYNRAY” 9.6

AC50018311 FENTANYL TRANSDERMAL PATCH 25 UG/HR "PPCD" 220

AC50027100 PLEYA TABLETS 100 MG 14.1

AC50032100 MOBUFEN TABLETS 1.78

AC50034100 PLESTAR TABLETS 50MG 7.6

210

Page 211: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC50036100 GAPATIN CAPSULES 400MG 11.6

AC50042212 COSTIM POWDER FOR INJECTION 2,000,000 IU 0

AC50043100 BEFREE TABLETS 15 MG 12.9

AC50054100 FUTE F.C. TABLETS 5MG 25.3

AC50057100 SPICA CAPSULES 500MG 3.89

AC50061100 BITEVEN F.C. TABLETS 5 MG 3.42

AC50062100 QUEROPIN FILM COATED TABLETS 300MG“YUNG SHIN” 54

AC50063265 MEROPEM INTRAVENOUS INJECTION“YUNG SHIN” 375

AC50063277 MEROPEM INTRAVENOUS INJECTION“YUNG SHIN” 404

AC50078321 DERMACA CREAM 16.1

AC50078329 DERMACA CREAM 16.1

AC50078335 DERMACA CREAM 19.6

AC50078338 DERMACA CREAM 19.6

AC50080100 "GLUCODUE TABLETS ""H.S.""" 2.28

AC50081209 CEFADIME POWDER FOR IV INJECTION 0

AC50081212 CEFADIME POWDER FOR IV INJECTION 0

AC50081277 CEFADIME POWDER FOR IV INJECTION 0

AC50086100 ATORCAL F.C. TABLETS 40 MG“S.C.” 28

AC50087100 FENDOWN F.C. TABLETS 160MG 6.5

AC50089100 SYNSEQ TABLETS 4.97

AC50090100 CODEPINE TABLETS 1.5

AC50091100 SYNCON MR TABLETS 30 MG 2.25

AC50092421 SINLIN OPHTHALMIC SOLUTION“SINPHAR” 13

AC50092429 SINLIN OPHTHALMIC SOLUTION“SINPHAR” 27.4

AC50095100 MAFARIN TABLETS 5 MG 4.98

AC50104100 BACFLOCIN F.C. TABLETS 500 MG 45.1

AC50105100 DEMARE CAPSULES 5MG 3.09

AC50114100 REVELIN CAPSULES 4.5 MG 33.6

AC50116100 SKYTON F.C. TABLETS 25MG 1.5

AC501161G0 SKYTON F.C. TABLETS 25MG (鋁箔/膠箔) 2

AC501161G4 SKYTON F.C. TABLETS 25MG(56粒/瓶) 2

AC501161G5 SKYTON F.C. TABLETS 25MG (84粒/瓶) 2

AC501161G6 SKYTON F.C. TABLETS 25MG (112粒/瓶) 2

AC50123100 LOCEMINE F.C. TABLETS 5 MG“S.C.” 3.36

AC50124138 GUWEI SUSPENSION 20MG/ML 25

AC50127100 TONBISHU F.C. TABLETS 600MG 1.78

AC50128316 AMFULAN CREAM 0.05%“EVEREST” 36.3

AC50128321 AMFULAN CREAM 0.05%“EVEREST” 42.4

AC50128329 AMFULAN CREAM 0.05%“EVEREST” 54

AC50128335 AMFULAN CREAM 0.05%“EVEREST” 54

AC50128338 AMFULAN CREAM 0.05%“EVEREST” 135

AC50128355 AMFULAN CREAM 0.05%“EVEREST” 477

AC50130100 ANXOTOS TABLETS 15 MG 12.6

AC50132321 AMI CREAM "EVEREST" 28

AC50132329 AMI CREAM "EVEREST" 54

AC50132330 AMI CREAM "EVEREST" 54

AC50132338 AMI CREAM "EVEREST" 152

AC50132343 AMI CREAM "EVEREST" 215

AC50135100 PASPERTASE F.C. TABLETS 2.49

AC50136100 MYKYO TABLETS 0.5MG (METOLAZONE) 4.35

AC50138100 FELO E.R. F.C. TABLETS 10MG "EVEREST" 5.1

AC50140100 IMMURIN SOFT GELATIN CAPSULE 100 MG 136

AC50145100 XYZINE F.C. TABLETS 5MG 3.36

AC50152100 GENCARI TABELETS 350MG 4.32

AC50163100 DESCHU TABLETS 5MG 3.96

211

Page 212: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC50165100 REMECIN F.C. TABLETS 5MG 61

AC50170321 DESONE CREAM 0.25%“PATRON” 32.1

AC50170329 DESONE CREAM 0.25%“PATRON” 73

AC50170338 DESONE CREAM 0.25%“PATRON” 103

AC50170343 DESONE CREAM 0.25%“PATRON” 140

AC50173100 NAGLIX FILM COATED TABLETS 120MG“YUNG SHIN” 4.04

AC50174100 Ticlod F.C. Tablets 100 mg 4.61

AC50177100 Maxipril 10mg Tablets 9

AC50179100 SPASMOTIN TABLETS“SINPHAR” 2.45

AC50181100 GLIDIER EXTENDED RELEASE TABLETS 5 MG (GLIPIZIDE) 1.56

AC501811G0 GLIDIER EXTENDED RELEASE TABLETS 5 MG (GLIPIZIDE)(鋁箔/膠箔) 2

AC50182100 METHIMAZOLE TABLETS 5MG "JOHNSON" 1.5

AC501821G0 METHIMAZOLE TABLETS 5MG "JOHNSON"(鋁箔/膠箔) 2

AC50186100 COPE TABLETS 20MG“EVEREST” 1.5

AC50191162 CALAD CALCIUM SUSPENSION 172

AC50206177 PIRACETAM ORAL SOLUTION“CENTER” 260

AC50207209 CEPIRO POWDER FOR I.V. INJECTION 1GM 312

AC50207212 CEPIRO POWDER FOR I.V. INJECTION 1GM, 2GM 565

AC50208321 TURNSTYLE ANALGESIA GEL“SINPHAR” 11.2

AC50208329 TURNSTYLE ANALGESIA GEL“SINPHAR” 17.6

AC50208335 TURNSTYLE ANALGESIA GEL“SINPHAR” 28.5

AC50208338 TURNSTYLE ANALGESIA GEL“SINPHAR” 28.5

AC50208340 TURNSTYLE ANALGESIA GEL“SINPHAR” 39.9

AC50208343 TURNSTYLE ANALGESIA GEL“SINPHAR” 40.8

AC50208345 TURNSTYLE ANALGESIA GEL“SINPHAR” 40.8

AC502083AK TURNSTYLE ANALGESIA GEL“SINPHAR” 39.9

AC50209151 IEPAIN SUSPENSION 20MG/ML“EVEREST” 25

AC50209157 IEPAIN SUSPENSION 20MG/ML“EVEREST” 67

AC50210100 RHYNORM FILM COATED TABLETS 150 MG 10.8

AC50214343 SILCIKIS OINTMENT 395

AC50219209 SEPIROM POWDER FOR I.V. INJECTION 1000MG 0

AC50222100 DIPERTASE F.C. TABLETS 2.49

AC50223100 NAIZHU TABLETS 2 MG“S.D.” 3.32

AC50225212 LOW CALCIUM (2.5 MEQ/L) PERITONEAL DIALYSIS SOLUTION WITH 1.5%

DEXTROSE “CHI SHENG”

184

AC50237100 "WECAM" ELLIC SUSTAINED RELEASE F.C. TABLETS 75MG 2.94

AC50241100 CLOTINIL F.C. TABLETS 75MG 39.9

AC50243121 Elimi-K Powder 11.4

AC50243173 Elimi-K Powder 925

AC50254100 RIXIA TABLETS 0.5MG“MACRO”(METOLAZONE) 4.35

AC50261100 “T.F.”SU-TON TABLETS 1.66

AC50262321 EASY ACNE GEL 0.1% (ADAPALENE) 19.5

AC50262335 EASY ACNE GEL 0.1% (ADAPALENE) 82

AC50262343 EASY ACNE GEL 0.1% (ADAPALENE) 142

AC50262345 EASY ACNE GEL 0.1% (ADAPALENE) 232

AC50262363 EASY ACNE GEL 0.1% (ADAPALENE) 737

AC50263100 DOXTER TABLETS 4 MG 7.8

AC50273100 REWISE F.C. TABLETS 10MG 70

AC50340100 SODIUM BICARBONATE TABLETS 0.6 GM“Y.C.” 1.5

AC503401G0 SODIUM BICARBONATE TABLETS 0.6 GM“Y.C.”(鋁箔/膠箔) 2

AC50342100 AXOL SUSTAINED RELEASE TABLETS 75MG“YUNG SHIN” 2.65

AC50423100 MAFARIN TABLETS 2.5 MG 4.11

AC50425100 CYLIDER CAPSULES 250MG 43

AC50426100 ROVENDIA F.C. TABLETS 4MG 23.5

212

Page 213: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC50428219 NOREPINE INJECTION 145

AC50432100 TAKEPRON CAPSULE 30 MG 18.5

AC50768209 KYOTIL IV INJECTION 1MG/ML 335

AC50768216 KYOTIL IV INJECTION 1MG/ML 717

AC50769100 GLICRON MR TABLETS 30 MG 2.02

AC50772100 MYCROS TABLETS 0.5MG 4.35

AC50866100 MYCOCEP CAPSULES 250MG 47.6

AC50874100 FE MIN FILM COATED TABLETS 60MG “CHINTENG” 2.34

AC50880209 CEFEPIME INJECTABLE “TBC” 425

AC50880212 CEFEPIME INJECTABLE “TBC” 676

AC50880277 CEFEPIME INJECTABLE “TBC” 279

AC51022100 FERICH FORTE CAPSULES 5.6

AC51034271 TEICOD FOR INJECTION 400MG 1585

AC51036220 PISUTAM LYO FOR INJECTION 435

AC510362CX PISUTAM LYO FOR INJECTION 241

AC51192100 MUPOD TABLETS 200 MG“S.C.” 27

AC51195100 DIGALO TABLETS 1 MG“YU SHENG” 2.38

AC51196421 SHU KOU YAN ORAL PASTE 1MG/ G 28.4

AC51196429 SHU KOU YAN ORAL PASTE 1MG/ G 64

AC51197100 DESORA F.C. TABLETS 5 MG“YU SHENG” 3.7

AC51198100 FUSODATE F.C. TABLET 250MG“YUHSIN” 60

AC51203100 LEVOZAL TABLETS 5MG “MACRO” 3.41

AC51389100 NODIZY TABLETS 16 MG 1.56

AC51392430 BUDESON AQUA NASAL SPRAY 100 MCG/DOSE“WEIDAR” 131

AC51392438 BUDESON AQUA NASAL SPRAY 100 MCG/DOSE“WEIDAR” 175

AC515211A5 FENOTEROL INHALATION SOLUTION“CENTER” 7.8

AC51522321 ESARIN GEL 28.6

AC51522338 ESARIN GEL 94

AC51523100 MAXATIN TABLETS 40 MG 22.8

AC51524100 CARBATIN CAPSULES 100 MG 3.25

AC51531143 ASGACON LIQUID 5MCG/ML 29

AC51531151 ASGACON LIQUID 5MCG/ML 52

AC51531157 ASGACON LIQUID 5MCG/ML 111

AC51533209 VANLYO POWDER FOR INJECTION “TAI YU”(VANCOMYCIN) 317

AC51533277 VANLYO POWDER FOR INJECTION “TAI YU”(VANCOMYCIN) 101

AC51598100 ATOTY F.C. TABLETS 10 MG 14.5

AC51715100 LEVOFLOXACIN F.C. TABLET 500MG “UNION” 41.3

AC517173CS FENTANYL TRANSDERMAL PATCH 50 ΜCG/HR “PPCD” 430

AC51718100 NEPES F.C. TABLETS 10MG 73

AC51729100 EVY F.C. TABLETS 10MG 16.5

AC52113100 DONGLU TABLETS 4MG 3.74

AC52114100 DEUNI F.C. TABLETS 25MG “EVEREST” 1.5

AC521141G0 DEUNI F.C. TABLETS 25MG “EVEREST”(鋁箔/膠箔) 2

AC52116151 TAMBROXOL SOLUTION 3MG/ML 25

AC52116155 TAMBROXOL SOLUTION 3MG/ML 25

AC52120265 MOFLODAL INFUSION SOLUTION 400MG/250ML 697

AC52122416 CORTIBOND ORABASE 18.5

AC52122417 CORTIBOND ORABASE 23.8

AC52122421 CORTIBOND ORABASE 28.4

AC52122423 CORTIBOND ORABASE 42.7

AC52122429 CORTIBOND ORABASE 64

AC52301100 LIPIMINUS F.C TABLETS 40MG 28.3

AC52345100 SILYMARIN CAPSULES "S.C" 1.64

AC523451G0 SILYMARIN CAPSULES "S.C"(鋁箔/膠箔) 2

AC52347100 RIBELITE TABLETS 50MG“SYNRAY” 9.3

213

Page 214: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC52351100 REWISE F.C. TABLETS 5MG 61

AC52354100 NEOCETIN F.C TABLETS 5MG 3.73

AC52357100 TOLAX TABLETS 400MG 1.5

AC52416338 ESECIN GEL 1.5%“P.L.” 111

AC52416343 ESECIN GEL 1.5%“P.L.” 136

AC52428100 ACERINE S.C. TABLETS 10 MG“WEIDAR” 6.4

AC52430100 METERONE TABLETS 500 MG 53

AC52432100 PENTIXOL F.C. TABLETS 14.1

AC52433100 DIMOFAN F.C. TABLETS 1.51

AC52438143 WITGEN ORAL DROP“LOTUS” 534

AC52452100 TUBERGONE F.C. TABLETS 500MG 6.1

AC52453209 TERLISSIN INJECTION 1MG 1107

AC52464155 OXYPINE ORAL SUSPENSION〝CENTER〞 414

AC52464165 OXYPINE ORAL SUSPENSION〝CENTER〞 978

AC52465100 SIMVA F.C. TABLETS 40MG 15.7

AC52473212 PERITONEAL DIALYSIS SOLUTION WITH 1.5% DEXTROSE“CHI SHENG” 184

AC524741G0 PSEUDOEPHEDRINE HCL TABLETS 30MG“PBF” (鋁箔/膠箔) 2

AC52475100 ETODOLAC CAPSULES 200MG“SINPHAR” 4.52

AC52478151 XANLIN LIQUID 5.34MG/ML 25

AC52478157 XANLIN LIQUID 5.34MG/ML 28.9

AC52479100 KEZHI FILM COATED TABLETS 40MG 15.7

AC52481100 AN-COUGH CAPSULES“H.S.” 1.5

AC52520100 DU.Q TABLETS 10MG“ROOT” 6.8

AC52522100 CANAFI F.C. TABLETS“Y.C.” 39.6

AC52532100 CETIRIZINE F.C. TABLETS 10MG“SINPHAR” 1.5

AC525321G0 CETIRIZINE F.C. TABLETS 10MG“SINPHAR”(鋁箔/膠箔) 2

AC52533100 CHUTAN SR TABLETS 75MG 2.25

AC52534100 GLIBUDON XR TABLETS 750 MG 1.79

AC525341G0 GLIBUDON XR TABLETS 750 MG(鋁箔/膠箔) 2

AC52537100 RIZATAN TABLET 5MG“UNION” 64

AC52540121 K-Stone Granules 8.3

AC52544277 0.298% KCL IN 0.9% NACL INJECTION“TBC” 26.7

AC52551277 0.149% KCL IN 0.9% NACL INJECTION“TBC” 26.7

AC52553210 SULAMPI POWDER FOR IV INJECTION1500MG 0

AC52553289 SULAMPI POWDER FOR IV INJECTION 750MG 0

AC52555417 TETRACYCLINE OPHTHALMIC OINTMENT“WINSTON” 7.3

AC52555421 TETRACYCLINE OPHTHALMIC OINTMENT“WINSTON” 17.5

AC52558416 LOMOLAN OPHTHALMIC SOLUTION 0.25%“GENTLE” 0

AC52558421 LOMOLAN OPHTHALMIC SOLUTION 0.25%“GENTLE” 0

AC52559100 MAFARIN TABLETS 1 MG 3.6

AC52565263 TEIYU FOR I.V. INJECTION“TAI YU” 728

AC52565271 TEIYU FOR I.V. INJECTION“TAI YU” 1585

AC52566157 RIVAST ORAL SOLUTION“CENTER” 1559

AC52568100 SYNZAR F.C. TABLETS 50/12.5 MG 9.3

AC52569421 TROPINE EYE DROPS 0.125% 〝MEDICINE〞(ATROPINE SULFATE) 12

AC52569429 TROPINE EYE DROPS 0.125% 〝MEDICINE〞(ATROPINE SULFATE) 12

AC52575100 FLUCOLIN CAPSULES 250 MG 1.6

AC525751G0 FLUCOLIN CAPSULES 250 MG (鋁箔/膠箔) 2

AC52581100 JOINLO TABLETS 40MG "EVEREST" 22.8

AC52588100 LIMINO F.C. TABLETS 5 MG“H.S.” 3.57

AC52592209 CEPIROM POWDER FOR I.V. INJECTION 1G 0

AC52592212 CEPIROM POWDER FOR I.V. INJECTION 2G 0

AC52593100 KOVAN F.C. TABLETS 80MG 10.1

AC52612100 DOPINE TABLETS 10MG“H.H.” 1.5

214

Page 215: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC52614100 LOSAPIN F.C TABLETS 50MG "WEIDAR" 9.3

AC52616100 LUXTAB F.C. TABLETS 4 MG (LACIDIPINE) 6.5

AC52617100 NODOFF F.C. TABLETS 5MG 56

AC52620100 MENBER TABLETS 5MG“H.H.” 1.52

AC54641209 D.S.E.L. INJECTION“TAI YU” 42.9

AC54641277 "D.S.E.L. INJECTION ""TAI YU""" 30.3

AC54643100 COCINE TABLETS“H.H.”(COLCHICINE) 1.5

AC54647277 SULBACTAM POWDER FOR INJECTION 500 MG“C.C.P.C.” 124

AC54857100 AMALIN TABLETS 4MG“C.H.” 3.82

AC54859100 SIPO TABLETS 10MG "EVEREST" 9

AC548631G0 LOPIRIN ENTERIC-COATED TABLETS 81MG(鋁箔/膠箔) 2

AC54971421 SHUCOMING EYE GEL 101

AC54973100 MELINE TABLETS 50MG (MEBHYDROLINE) 1.5

AC54974100 WUTANNING CAPSULES 300MG“KOJAR” 4.39

AC54975100 METERONE TABLETS 100 MG 11.1

AC54979100 URICIN F.C. TABLETS 500MG“H.S.” 21.7

AC54980100 CITAO-S F.C. TABLETS 10 MG 18.8

AC54983100 REVINA TABLETS 4.97

AC54985100 ASPIRE ENTERIC-MICROENCAPSULATED CAPSULES 100 MG 1.5

AC549851G0 ASPIRE ENTERIC-MICROENCAPSULATED CAPSULES 100 MG(鋁箔/膠箔) 2

AC549901G0 PSEUDOEPHEDRINE HCL TABLETS 60MG“PBF” (鋁箔/膠箔) 2

AC54992100 VACYLESS FILM COATED TABLETS 1G 128

AC55005100 PREWELL SUSTAINED-RELEASE TABLETS 150MG“MACRO” 19.2

AC55010100 TILOR TABLETS 50 MG 8

AC55011100 ROSITAL F.C. TABLETS 4MG 23.8

AC55012100 SINMARON O.D. TABLETS 30MG 18.2

AC55013100 NEPES F.C. TABLETS 5 MG 70

AC55014151 TONINE SUSPENSION 1MG/ML 27.8

AC55021100 NOSMA S.R.M.C. 250MG“WECAM” 1.72

AC55025219 NOREPINEPHRINE INJECTION 4MG/4ML“TAI YU” 145

AC55026100 CLOPIDOGREL F.C. TABLETS 75 MG“C.Y.H.” 41.9

AC55029100 SUSEI TABLETS 2.5MG“H.H.”(FENOTEROL) 1.5

AC55043100 CLINDAMYCIN CAPSULES 300MG“PBF” 2.86

AC55051100 MISUL TABLETS 200 MG 28.4

AC551041G0 UN-IMPEDE E.F.C. TABLETS 81MG“MACRO”(鋁箔/膠箔) 2

AC55109113 NOOPOL GRANULES FOR ORAL SOLUTION 2400MG 8.9

AC55110220 PIZOTAM POWDER FOR I.V. INJ. 0

AC551102CX PIZOTAM POWDER FOR I.V. INJ. 0

AC55114212 LOW CALCIUM (2.5 MEQ/L) PERITONEAL DIALYSIS SOLUTION WITH

4.25% DEXTROSE“CHI SHENG”

184

AC55115212 PERITONEAL DIALYSIS SOLUTION WITH 4.25% DEXTROSE“CHI SHENG” 184

AC55118100 URIEF CAPSULES 4 MG 7

AC55121209 LOFETA POWDER FOR IV INJ. 1G 0

AC55121212 LOFETA POWDER FOR IV INJ. 2G 0

AC55121265 LOFETA POWDER FOR IV INJ. 250MG 0

AC55121277 LOFETA POWDER FOR IV INJ. 0.5G 0

AC55123100 PANZYME FILM-COATED TABLETS 212.5/5MG“STANDARD”(PANCREATIN

212.5MG+METOCLOPRAMIDE HCL 5MG)

2.49

AC55227100 ARIPLE TABLETS 10MG 67

AC55231343 CALSKIN SCALP SOLUTION 487

AC55232100 KETEN E.M.C. 10MG“EVEREST” 5.8

AC55233100 CLINDAMYCIN CAPSULES 150MG“PBF” 1.5

AC55238500 POLININ VAGINAL SUPPOSITORIES“P.L.” 13

215

Page 216: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC55243100 OKPINE F.C. TABLETS 5MG 56

AC55245100 QUETIA TABLETS 200 MG 34.2

AC55248100 CETON S.R.M. CAPSULES“WECAM” 2.33

AC55249209 LOTIAM POWDER FOR IV INJ. 1000MG 0

AC55249265 LOTIAM POWDER FOR IV INJ. 250 MG 0

AC55249277 LOTIAM POWDER FOR IV INJ. 500 MG 0

AC55250321 LIDALENE GEL 18.3

AC55250335 LIDALENE GEL 76

AC55250343 LIDALENE GEL 139

AC55250345 LIDALENE GEL 212

AC55250363 LIDALENE GEL 686

AC55252155 LEVIM ORAL SOLUTION 100 MG/ML 526

AC55252166 LEVIM ORAL SOLUTION 100 MG/ML 1632

AC55260421 TOBACIN EYE DROPS 0.3%“MEDICINE”(TOBRAMYCIN) 37.9

AC55263197 NOOPOL GRANULES FOR ORAL SOLUTION 1200MG 4.88

AC55266100 SODIUM VALPROATE F.C. TABLETS 200MG“SUC” 3.43

AC55267157 MEGATUS ORAL SUSPENSION 40MG/ML 930

AC55269100 HUACOSE TABLETS 100MG 2.77

AC55271100 COFARIN TABLETS 5 MG“GENTLE” 4.98

AC55277421 SULMEZOLE EYE DROPS 4%“MEDICINE”(SULFAMETHOXAZOLE SODIUM) 12

AC55277429 SULMEZOLE EYE DROPS 4%“MEDICINE”(SULFAMETHOXAZOLE SODIUM) 12

AC55277435 SULMEZOLE EYE DROPS 4%“MEDICINE”(SULFAMETHOXAZOLE SODIUM) 15.4

AC55283100 LETAMPIN F.C. TABLETS 500MG 25.6

AC55284100 BUPOPIN SR TABLETS 150 MG 19.7

AC55291212 PERITONEAL DIALYSIS SOLUTION WITH 2.5% DEXTROSE“CHI SHENG” 184

AC55292212 PERITONEAL DIALYSIS SOLUTION WITH 2.5% DEXTROSE“CHI SHENG” 184

AC55295221 BONECARE CONCENTRATE FOR SOLUTION FOR INFUSION 4MG/5ML 9245

AC55296100 LOSTAN F.C. TABLETS 50MG 9.3

AC55297321 CLEARCIN GEL 9.1

AC55297323 CLEARCIN GEL 16

AC55297329 CLEARCIN GEL 17.9

AC55297330 CLEARCIN GEL 18.5

AC55297335 CLEARCIN GEL 28.3

AC55297338 CLEARCIN GEL 83

AC55297343 CLEARCIN GEL 186

AC552981G0 KOTANG X.R. TABLETS 500 MG(鋁箔/膠箔) 2

AC55299100 MULAXIS TABLETS 200MG 1.5

AC552991G0 MULAXIS TABLETS 200MG(鋁箔/膠箔) 2

AC55404316 FUISU CREAM 36.3

AC55404321 FUISU CREAM 42.4

AC55404329 FUISU CREAM 54

AC55408100 TERODINE F.C. TABLETS 2 MG 11.4

AC55419277 TEMO 6% SOLUTION FOR INFUSION 251

AC55425329 SHU LE FU CREAM 0.05% 17.7

AC55425335 SHU LE FU CREAM 0.05% 28.6

AC55425338 SHU LE FU CREAM 0.05% 47

AC55426100 MINLO F.C. TABLETS 5MG“EVEREST” 3.36

AC55427100 TYRAME TABLETS 100MG (TIARAMIDE) 1.5

AC55428100 PROGREL F.C. TABLETS 75 MG 39.6

AC55530100 GATAMINE F.C. TABLETS 8MG 34.4

216

Page 217: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC55531100 TANZA F.C. TABLETS 50MG“C.S.” 9.3

AC55534100 BETETRIM S.R. FILM-COATED TABLETS 150MG 19.7

AC55538100 ARIN F.C. TABLET 10MG“PURZER”(DONEPEZIL HCL) 69

AC55539265 EZDOPA INJECTION 3.2 MG/ML 229

AC55539277 EZDOPA INJECTION 3.2 MG/ML 406

AC55540100 LESYN F.C. TABLETS 6 MG 10

AC55541100 TAMEDINE TABLETS 400MG (CIMETIDINE) 1.5

AC55544100 ARIKA TABLETS 15MG 67

AC55545248 LEVOFLOXACIN I.V. SOLUTION FOR INFUSION 5MG/ML“CHI SHENG” 469

AC55545255 LEVOFLOXACIN I.V. SOLUTION FOR INFUSION 5MG/ML“CHI SHENG” 816

AC55546321 WART DEL CREAM 698

AC55552100 “ROOT”DU. Q 5 MG TABLETS 6.8

AC55553343 CALSKIN OINTMENT 521

AC55554166 AZITHROM POWDER FOR ORAL SUSPENSION 140

AC55554180 AZITHROM POWDER FOR ORAL SUSPENSION 268

AC55554197 AZITHROM POWDER FOR ORAL SUSPENSION 477

AC555541B9 AZITHROM POWDER FOR ORAL SUSPENSION 357

AC55556100 AMSULPIN TABLETS 200MG 29.1

AC55558100 LOSATER F.C. TABLETS 50MG“CHINTENG” 9.3

AC55561100 IRINA TABLETS 6.5

AC55563100 LAVEZOL CAPSULES 30 MG“WEIDAR” 18.5

AC55565100 MOSPEW F.C. TABLETS 5MG“H.S.” 2.5

AC55566100 MOSAPULIN FILM COATED TABLETS 5MG 2.5

AC55567100 PUSADE F.C. TABLETS 5MG 2.5

AC55568100 PERISCON F.C. TABLETS 5 MG 2.5

AC55569100 MOSDE F.C. TABLETS 5MG 2.5

AC55570100 WELSTRONG TABLETS 5 MG 2.5

AC55571100 MOSAPE F.C. TABLETS 5MG 2.42

AC55572100 Weymosa F.C. Tablets 5mg“S.C.” 2.5

AC55575209 UBITRON I.V. INJECTION 1 MG/ML 335

AC55575216 UBITRON I.V. INJECTION 1 MG/ML (3 ML) 717

AC55576100 HANLOSIN S.R.O.D. TABLETS 0.2 MG 9.6

AC55577114 IPRATRAMOL INHALATION SOLUTION 〝CENTER〞 20.3

AC55583100 ATORCAL F.C. TABLETS 20MG“S.C.” 24.5

AC55584100 MOZAPRY F.C. TABLETS 5 MG 2.5

AC55888100 FOLIC ACID TABLETS 5MG“Y.Y.” 1.5

AC558881G0 FOLIC ACID TABLETS 5MG“Y.Y.”(鋁箔/膠箔) 2

AC558881G2 FOLIC ACID TABLETS 5MG“Y.Y.”(30粒/瓶) 2

AC55889100 KANTEC CAPSULES“Y.C.” 3.52

AC55890100 HEARTOACE CAPSULES 100MG“Y.Y.” 5

AC55892209 CEFDIME FOR IV INJECTION 63

AC55892212 CEFDIME FOR IV INJECTION 400

AC55892265 CEFDIME FOR IV INJECTION 20.8

AC55892277 CEFDIME FOR IV INJECTION 32.3

AC55894100 PLAQUIL F.C. TABLETS 200 MG "Y.C." 2.72

AC55895100 ATORCAL F.C. TABLETS 10MG“S.C.” 14.5

AC55896100 FELO E.R. F.C. TABLETS 5MG“EVEREST” 3.29

AC55901100 BRISTIN TABLETS“Y.C.” 1.5

AC55902100 MESACOL TABLETS 25MG“Y.C.” 2.11

AC55905100 DOFEN CAPSULES 1.91

AC55906100 PENLEX TABLETS 5MG“Y.C.” 2.86

AC55907100 SPASFEN TABLETS“Y.C.”25MG (BACLOFEN) 8.7

AC55908100 PONTAN F.C. TABLETS 500MG“Y.Y.” 1.5

217

Page 218: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC55909421 DELLERGY EYE DROPS“Y.Y.” 26.7

AC55909429 DELLERGY EYE DROPS“Y.Y.” 45.5

AC55910100 MEXAZOL TABLETS“Y.C.” 1.5

AC55913209 VOMSTOP I.V. INJECTION 1MG/ML 335

AC55913216 VOMSTOP I.V. INJECTION 1MG/ML 717

AC55916100 “T.F.”SU-MIN F.C.T 180MG 6.2

AC55917100 MYSOZYME TABLETS 100MG (LYSOZYME) 1.5

AC55920100 BERON F.C.TABLETS 8MG“EVEREST” 3.46

AC55924100 RIVOPAM TABLETS 2MG“Y.Y.” 2.66

AC55925100 LISEN F.C. TABLETS 200MG“Y.Y.” 2.72

AC55926100 TARACTEN TABLETS 50MG“Y.Y.” 5.2

AC55927100 DELIPID CAPSULES 300MG“Y.Y.” 3.23

AC55928100 LEVIM FILM COATED TABLETS 500 MG 25.6

AC55934229 ORECTALIP IV INJECTION 5MG/ML“SINPHAR” 2670

AC55934238 ORECTALIP IV INJECTION 5MG/ML“SINPHAR” 6069

AC55934245 ORECTALIP IV INJECTION 5MG/ML“SINPHAR” 9844

AC55939100 EXMEM FILM-COATED TABLETS 10 MG 15.2

AC55940321 HONEX OINTMENT 14.9

AC55940329 HONEX OINTMENT 50

AC55941100 TONTIN TABLETS 200MG“Y.Y.” 6.9

AC55945100 ALLEVO F.C. TABLETS 5MG“CBC” 3.41

AC55947100 TANFU TABLETS 100MG“KOJAR” 2.69

AC55949209 TONYUAN FOR I.V. INJECTION 30MG/ML"Y.Y." 23.1

AC55949212 TONYUAN FOR I.V. INJECTION 30MG/ML "Y.Y." 48.4

AC55950100 COSAR F.C. TABLETS 50 MG 9.3

AC55951423 VICEMER EYE GEL 0.2%“KINGDOM”(CARBOMER) 74

AC55951429 VICEMER EYE GEL 0.2%“KINGDOM”(CARBOMER) 124

AC55952100 ATOTY F.C. TABLETS 20 MG 24.9

AC55953100 SETRON F.C. TABLETS 1MG 232

AC55956100 LIPIMINUS F.C. TABLETS 20MG 24.9

AC55957100 LISIPRIL TABLETS 10 MG“S.D.” 3.66

AC55958221 ENBOSUN INJECTION 0.84MG/ML 30.7

AC55961100 CARISOMA TABLETS 250 MG 3.29

AC55963100 ANPUROL TABLETS 100MG (ALLOPURINOL) 1.5

AC55965100 ZOLMIN CAPSULES 5MG“C.H.” 2.69

AC55974100 SUPERIDE TABLETS 200MG“KINGDOM”(AMISULPRIDE) 25.9

AC55981209 JUSTIAM POWDER FOR INTRAVENOUS INJECTION 0

AC55981277 JUSTIAM POWDER FOR INTRAVENOUS INJECTION 0

AC55985100 METFOPIN F.C. TABLETS 850MG 2.23

AC55987100 YESINDON TABLETS 25 MG 6.2

AC55989421 LEMIN EYE DROPS“KINGDOM” 14.7

AC56296255 CAKEEP 5MG/100ML SOLUTION FOR INFUSION 10108

AC56299100 METINA TABLETS 2.01

AC56306100 "PPCD"MORPHINE SULFATE TABLETS 15MG 3.3

AC56313100 BENECOL TABLETS“Y.C.”50MG 3.98

AC56314100 PODO CAPSULES 20 MG 1.55

AC56316100 TAMOS CAPSULES 100 MG 3368

AC56317100 ACTEIN EFFERVESCENT TABLETS 1200MG 11.1

AC56319100 LIPIMINUS F.C.TABLETS 10MG 14.9

AC56321100 NORINA TABLETS 5MG 2.12

AC56629100 LECITOL XL FILM-COATED TABLETS 80MG 15.6

AC56633100 CONIEL F.C. TABLETS 4MG 3.82

AC56643100 BIBI-U CAPSULES 150MG 1.5

AC566431G0 BIBI-U CAPSULES 150MG(鋁箔/膠箔) 2

AC56645100 NODOFF F.C. TABLETS 10MG "SYNRAY" 106

218

Page 219: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC56646100 AREZIL ODT TABLETS 5 MG "STANDARD" 59

AC56647100 SOTREL CAPSULES 13.8

AC56652100 METDIA E. R. TABLETS 500MG 1.57

AC56657209 CETICIN FOR IV INJECTION 343

AC56657212 CETICIN FOR IV INJECTION 691

AC56657265 CETICIN FOR IV INJECTION 106

AC56657277 CETICIN FOR IV INJECTION 192

AC56659100 PACLONE CAPSULES 1.5

AC56660100 FLUXEL F.C. TABLETS 3.08

AC56662100 BELOTON F. C. TABLETS 5MG 3.36

AC56663421 ALMIDINE OPHTHALMIC SOLUTION 0.15% "KINGDOM" (BRIMONIDINE) 219

AC56663429 ALMIDINE OPHTHALMIC SOLUTION 0.15% "KINGDOM" (BRIMONIDINE) 410

AC56666100 FUWELL F.C. TABLET 40MG "GOOD FOR YOU" 5.7

AC56669100 ROSITAZONE F.C. TABLETS 4MG 23.8

AC56673265 N.T.G. PREMIXED INJECTION 0.2MG/ML 369

AC56673277 N.T.G. PREMIXED INJECTION 0.2MG/ML 664

AC56679100 MUXA TABLETS 500MG "H.S." 4.71

AC56681100 LADIPINE F.C. TABLETS 4MG 6.5

AC56682100 ATOROTY F.C. TABLETS 10MG 15.2

AC56688100 FLAVO TABLETS 200MG 4.84

AC56690100 KAI-HO CHEWABLE TABLETS 950MG "C.S." 2.03

AC566901G0 KAI-HO CHEWABLE TABLETS 950MG "C.S."(鋁箔/膠箔) 2

AC56692100 U-CHU PIOZON TABLETS 15MG 13.1

AC56693100 ALISA F.C. TABLETS 3.93

AC56700421 ALMONINE OPHTHALMIC SOLUTION 0.2% "KINGDOM" (BRIMONIDINE) 231

AC56701100 UFREE ER TABLETS 750 MG 42.7

AC56702100 UFREE ER TABLETS 500 MG 30.9

AC56706100 TRACETON FILM COATED TABLETS 6.2

AC56707161 MEMARY ORAL SOLUTION "CENTER" 557

AC56708100 ABIMAY TABLETS 20MG 101

AC56711321 FUSIDINE CREAM 55

AC56711326 FUSIDINE CREAM 55

AC56711329 FUSIDINE CREAM 58

AC56711335 FUSIDINE CREAM 154

AC56711338 FUSIDINE CREAM 160

AC56711348 FUSIDINE CREAM 337

AC56712100 EPINE F.C. TABLETS 25MG 12.4

AC56716100 JIANGHO TABLETS 10MG 6.8

AC56720100 SYNPID F.C TABLETS 160MG 6.5

AC56725161 TALOPRAM ORAL SOLUTION "CENTER" 339

AC56725164 TALOPRAM ORAL SOLUTION "CENTER" 540

AC56726100 ARIPLE TABLETS 20MG 92

AC56730100 ANASTROZOLE F.C. TABLETS 1MG "SINPHAR" 60

AC56733100 HARKIN TABLETS "Y.C." 3.37

AC56734265 EASY-ISOSORBIDE INJECTION 0.01% 795

AC56734277 EASY-ISOSORBIDE INJECTION 0.01% 1431

AC56735100 TOPLAX FILM-COATED TABLETS 50MG 1.61

AC56736100 NOBELIN XR F.C. TABLETS 750MG 42.3

AC56737100 DONEZIL F.C TABLETS 5MG 59

AC56738100 MIXRE CAPSULES 25MG 75

AC56745100 TESAA TABLETS 40MG 10.3

AC56746100 BREXA F.C. TABLETS 10MG 108

AC56750248 BACFLOCIN I.V. SOLUTION FOR INFUSION 5MG/ML 508

219

Page 220: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC56750255 BACFLOCIN I.V. SOLUTION FOR INFUSION 5MG/ML 930

AC56751100 ALLEDINE F.C. TABLETS 180MG 6

AC56754100 FENOFIBRATE CAPSULE 200MG "S.C." 6.5

AC56755100 SINMARON O.D. TABLETS 15MG 10.6

AC56757100 FENSCO TABLETS "Y.C." 1.81

AC56759220 PIPE & TAZO POWDER FOR INJECTION "CYH" 435

AC567592CX PIPE& TAZO POWDER FOR INJECTION "CYH" 241

AC56767143 LEVOCETIRIZINE ORAL SOLUTION "CENTER" 25

AC56767151 LEVOCETIRIZINE ORAL SOLUTION "CENTER" 42.1

AC56767157 LEVOCETIRIZINE ORAL SOLUTION "CENTER" 83

AC56770143 SPITERIN ORAL SOLUTION 1MG/ML "KINGDOM" (RISPERIDONE) 649

AC56770151 SPITERIN ORAL SOLUTION 1MG/ML "KINGDOM" (RISPERIDONE) 1093

AC56771345 DANAFEN PLASTER "T.S." 6.3

AC56778100 SALICRET F.C. TABLETS 5MG 18.8

AC56780100 MICAPINE F.C. TABLETS 10MG 7.5

AC56784100 CALWELL CHEWABLE TABLETS "MACRO" 2.03

AC56785100 MONTEKA CHEWABLE TABLETS 5MG 15.5

AC56787100 OKPINE F.C. TABLETS 10MG 108

AC56789100 JFS FCT "ROOT" 180MG 5.9

AC56790100 FLUGALIN TABLETS "Y.C." 3.54

AC56791100 LIPIKON F.C. TABLETS 10MG 14.5

AC56794100 XYRIZINE F.C. TABLETS 5MG "KINGDOM" (LEVOCETIRIZINE) 3.41

AC56798321 TAIYA NAIL LACQUER 695

AC56801100 SERULINE F.C. TABLETS 50MG "ROYAL" 11.7

AC56804100 SIMVASTATIN F.C. TABLETS 20MG "CYH" 6.7

AC56806100 SINTY F.C. TABLETS 40MG 15.7

AC56807421 CHICALING GEL 127

AC57101100 LEVOPING F.C. TABLETS 500MG 41.9

AC57102100 NITROLIN F.C. TABLETS 100MG "Y.Y." 2.74

AC57104100 SUPRIDE F.C. TABLETS 5MG "MACRO" 2.43

AC571061G0 ZHITI TABLETS 60MG(鋁箔/膠箔) 2

AC57111100 LURIDE TABLETS 50MG "LITA" 1.66

AC57114100 AMLODIPINE TABLETS 5MG "CYH" 6.8

AC57115100 JFS FCT "ROOT" 60MG 2.29

AC57116100 LOSARZIDE F.C. TABLETS 50/12.5MG 9.3

AC57117100 GLIMEPIRIDE TABLETS 2MG "CYH" 2.82

AC57121100 LORAPSEUDO SR F.C. TABLETS 5/120MG "CYH" 3.12

AC57122100 NSTEINE EFFERVESCENT TABLETS 600MG 6.6

AC57126100 PAVATIN PROTECT TABLETS 40MG "STANDARD" (PRAVASTATIN SODIUM) 22.8

AC57127100 FEXOFENADINE F.C. TABLETS 60MG "CYH" 2.41

AC57128100 CARVEDILOL TABLETS 25MG "CYH" 6.2

AC57130100 ROTLIP FILM-COATED TABLETS 10MG 19.6

AC57131100 ARIFY TABLETS 10MG "STANDARD" (ARIPIPRAZOLE) 69

AC57135321 SOFTCAM GEL 10MG/G 11.2

AC57135329 SOFTCAM GEL 10MG/G 17.6

AC57135335 SOFTCAM GEL 10MG/G 28.5

AC57135336 SOFTCAM GEL 10MG/G 28.5

AC57135338 SOFTCAM GEL 10MG/G 28.5

AC57135340 SOFTCAM GEL 10MG/G 39.9

AC57135343 SOFTCAM GEL 10MG/G 40.8

AC57135345 SOFTCAM GEL 10MG/G 40.8

AC57135355 SOFTCAM GEL 10MG/G 225

AC57138100 EPINE F.C. TABLETS 200MG 32.2

AC57142100 ARIFY TABLETS 15MG "STANDARD" (ARIPIPRAZOLE) 69

220

Page 221: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC57143417 KINZATEN OPHTHALMIC SOLUTION 0.25MG/ML "KINGDOM" (KETOTIFEN) 49.9

AC57143421 KINZATEN OPHTHALMIC SOLUTION 0.25MG/ML "KINGDOM" (KETOTIFEN) 70

AC57147100 ALLEDINE F.C. TABLETS 60MG 2.34

AC57153100 CO-DAIANXO CAPSULES 80/12.5MG 10.1

AC57157338 AI-SHU JHONG GEL 15MG/G "S.D." 111

AC57168100 TANG BI TUO TABLETS 100MG "Y.Y." 2.77

AC57170100 LORAPSEUDO 24H SR F.C. TABLETS 10/240MG "CYH" 7.4

AC57171100 "U-LIANG" EUTOMIN TABLETS 1000MG 2.28

AC57172100 "U-LIANG" EUTOMIN TABLETS 850MG 2.23

AC57173100 MOXICIN F.C. TABLETS 400MG 89

AC57176100 KEZHI FILM COATED TABLETS 20MG 6.7

AC57177100 GLIBUDON TABLETS 500MG 1.5

AC571771G0 GLIBUDON TABLETS 500MG(鋁箔/膠箔) 2

AC57182343 CALPONEX OINTMENT 521

AC57183100 "COUGHMEN TABLETS 20MG (BENPROPERINE) ""ASTAR""" 1.5

AC57185248 CRAVIT IV SOLUTION FOR INFUSION 5MG/ML 542

AC57185255 CRAVIT IV SOLUTION FOR INFUSION 5MG/ML 1024

AC57185261 CRAVIT IV SOLUTION FOR INFUSION 5MG/ML 874

AC57188100 TANLIXOL S.R. CAPSULES 75MG 2.3

AC57192100 QUETIALIN F.C. TABLETS 100MG "KINGDOM" (QUETIAPINE) 24

AC57196100 GAPATIN CAPSULES 100MG "SYNRAY" 3.33

AC57199100 ZONEGRAN FILM-COATED TABLETS 100 MG 18.8

AC57213100 OLZAPINE F.C. TAB. 10MG 109

AC57216100 LINICOR F.C.T. 500/20MG 11.2

AC57219100 NIFEDIPINE S.R.F.C. TABLETS 30MG "CYH" 8.1

AC57220248 LFLOCIN IV SOLUTION FOR INFUSION 5MG/ML 469

AC57220255 LFLOCIN IV SOLUTION FOR INFUSION 5MG/ML 885

AC57221221 HESHARIN INJECTION 5000 IU/ML "TAI YU" 38.3

AC57221240 HESHARIN INJECTION 5000 IU/ML "TAI YU" 92

AC57221248 HESHARIN INJECTION 5000 IU/ML "TAI YU" 170

AC57222221 HESHARIN INJECTION 1000 IU/ML "TAI YU" 38.3

AC57222229 HESHARIN INJECTION 1000 IU/ML "TAI YU" 40.8

AC57226100 MUSINE TABLETS "H.S." 1.66

AC572261G0 MUSINE TABLETS "H.S."(鋁箔/膠箔) 2

AC57229351 BECLOSOL WASH SHAMPOO 0.5MG/G 226

AC57229358 BECLOSOL WASH SHAMPOO 0.5MG/G 471

AC57231100 EPINE F.C. TABLETS 300MG 54

AC57232100 Depressure Film Coated Tablets 80mg 10.1

AC57235100 ROOPRIL TABLETS 2.5MG "S.C." 9

AC57236100 IBUPROFEN F.C. TABLETS 600MG "C.H." 1.78

AC572361G0 IBUPROFEN F.C. TABLETS 600MG "C.H." 2

AC57238100 CORTA F.C. TABLETS "Y.C." 2.22

AC57239100 FREKEY F.C. TABLETS 100MG "EVEREST" 5.2

AC57241421 CARTOLOL EYE DROPS 2% "MEDICINE" (CARTEOLOL HCL) 200

AC57242100 BACFLOCIN F.C. TABLETS 100MG 7.3

AC57246100 SYNBOT TABLETS 10MG 1.89

AC57248343 CALCITOL CREAM 521

AC57249100 BIDERMIN CAPSULES "Y.C." 1.91

AC57250100 KERIS TABLETS 350MG 4.32

AC57259100 LEPRAM F.C. TABLETS 10MG "KINGDOM" (ESCITALOPRAM) 17.6

AC57261100 SINPRAZOLE ENTERIC F.C. TABLETS 20MG "KINGDOM" (RABEPRAZOLE) 13.1

AC57262321 CIVIDOID CREAM "SINPHAR" 17.5

221

Page 222: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC57262329 CIVIDOID CREAM "SINPHAR" 32.6

AC57262333 CIVIDOID CREAM "SINPHAR" 37.5

AC57262338 CIVIDOID CREAM "SINPHAR" 37.5

AC57262345 CIVIDOID CREAM "SINPHAR" 109

AC57264100 DIPACHRO S.R. FILM COATED TABLETS 300MG 5.7

AC57265100 METFORMIN F.C. TABLETS 850MG "C.H." 2.23

AC57269100 THALI CAPSULES 50MG 248

AC57270100 MOBUFEN TABLETS 400MG "S.C." 1.5

AC57271100 FUWELL F.C. TABLETS 20MG "GOOD FOR YOU" 1.92

AC57274100 LANSOPRAZOLE CAPSULES 30MG "CYH" 18.5

AC57276255 POTASSIUM CHLORIDE INJECTION 1MEQ/ML "TBC" 26.7

AC57278263 TARGONIN FOR IV INJECTION 0

AC57278271 TARGONIN FOR IV INJECTION 0

AC57280100 "T.F." SU-MIN F.C. TABLETS 60MG 2.37

AC57281245 PANTYL FOR I.V. INJECTION 40MG 167

AC57282100 LILONTON F.C. TABLETS 1200MG 2.67

AC57284100 MIRTINE ORALLY DISINTEGRATING TABLETS 30MG 16.6

AC57285209 MEROPENEM POWDER FOR INJECTION "CYH" 875

AC57285265 MEROPENEM POWDER FOR INJECTION "CYH" 375

AC57285277 MEROPENEM POWDER FOR INJECTION "CYH" 404

AC57286277 VANCOMYCIN FOR I.V. INJECTION 500MG "CYH" 101

AC57288100 DOXAZON TABLETS 4MG "S.C." 7.8

AC57289216 ANCARE INJECTION 100MG/ML 15

AC57292100 LIPAOSHU TABLETS 400MG "KOJAR" 7.9

AC57297100 FENADIN F.C. TABLETS 60MG "WEIDAR" 2.32

AC57298100 NOBELIN (R) XR F.C. TABLETS 500MG 30.9

AC57300100 LEVOFLOXACIN F.C. TABLETS 100MG "CYH" 7.3

AC57304100 QUETIA F.C. TABLETS 100MG 24.6

AC57306100 ZOLPIDEM F.C. TABLETS 10MG "CYH" 2.51

AC57308100 ALLREX TABLETS "Y.C." 5.7

AC57313255 HYDROCORTISONE POWDER FOR INJECTION 100MG"S.T." 0

AC57314235 CARBOPLATIN IV INJECTION 10MG/ML "SINPHAR" 2632

AC573142AP CARBOPLATIN IV INJECTION 10MG/ML "SINPHAR" 5949

AC57316113 CETAM GRANULES FOR ORAL SOLUTION 2400MG "Y.C." 8.5

AC57317277 0.149% KCL IN 5% DEXTROSE AND 0.33% NACL INJECTION "TBC" 30.3

AC57322100 ENVIR F.C. TABLETS 0.5MG 137

AC57325100 AMLOBENTREL TABLET 14.1

AC57326100 GLIBOS F.C. TABLETS 100MG 7

AC57329421 CROMOMIN EYE DROPS "SINPHAR" 15.9

AC57329429 CROMOMIN EYE DROPS "SINPHAR" 30.2

AC57341100 ARIPRAZOLE TABLETS 10MG "KINGDOM" (ARIPIPRAZOLE) 68

AC57342100 VOSAA F.C. TABLETS 320MG 30.5

AC57345221 ZODONIC CONCENTRATE FOR SOLUTION FOR INFUSION 4MG/5ML "YUNG

SHIN"

9373

AC57348100 RUNESDA-S F.C. TABLETS 2MG 2.62

AC57349100 RUNESDA-S F.C. TABLETS 3MG 2.89

AC57350100 RUNESDA-S F.C. TABLETS 1MG 1.5

AC573501G0 RUNESDA-S F.C. TABLETS 1MG(鋁箔/膠箔) 2

AC57352100 VALANVIR FILM COATED TABLETS 500MG 72

AC57353100 VALANVIR FILM COATED TABLETS 1GM 128

AC57356100 LESITON CAPSULES 5MG 10.3

AC57359100 RABETT E.F.C. TABLETS "Y.C." 13.1

AC57363100 LETAMPIN F.C. TABLETS 250MG 15.5

AC57364100 ARIPIPRAZOLE TABLETS 15MG "GENOVATE" 69

AC57366100 PLUSDMAX TABLETS "SINPHAR" 221

222

Page 223: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC57370100 PINVIO TABLETS 12.5MG 4.52

AC57371100 KOVAN PLUS Film Coated Tablets 80/12.5mg 〝MACRO〞 10.1

AC57374277 LYACETY POWDER FOR INJECTION "CYH" 15

AC57376248 LEVOFOR IV SOLUTION FOR INFUSION 5MG/ML 469

AC57376255 LEVOFOR IV SOLUTION FOR INFUSION 5MG/ML 816

AC57376261 LEVOFOR IV SOLUTION FOR INFUSION 5MG/ML 816

AC57377100 MIXRE CAPSULES 18MG 70

AC57378100 ANSUMYCIN TABLETS 250MG "YUNG SHIN" 35.1

AC57382100 ALBIFINE TABLETS 20MG (ARIPIPRAZOLE) 100

AC57383100 ESCITALO F.C. TABLETS 5MG 10.1

AC57385151 ANTIFLAM ORAL SOLUTION "CHI SHENG" 58

AC57387100 JIANGMIN E.R. F.C. TABLETS "S.C." 7.9

AC57388277 INFUHES 6% SOLUTION FOR INFUSION "TAI YU" 228

AC57392100 TORODINE F.C. TABLETS 2MG "KINGDOM" (TOLTERODINE) 11.1

AC57397100 ADENO TABLETS "Y.C." 1.5

AC573971G0 ADENO TABLETS "Y.C."(鋁箔/膠箔) 2

AC57400100 COLOLEX. TABLETS 20MG 10.1

AC57401100 MIXRE CAPSULES 40MG 70

AC57403100 PATAMIN F.C. TABLETS 100MG "Y.C." 3.5

AC57404100 ACHELEX TABLETS "SINPHAR" 5

AC57410100 OLSAA F.C. TABLETS 40MG 19.4

AC57413100 PERDOPRIL TABLETS 8MG 16.3

AC57417277 0.298% KCL IN 5% DEXTROSE AND 0.9% NACL INJECTION "TBC" 30.3

AC57418277 0.149% KCL IN 5% DEXTROSE AND 0.9% NACL INJECTION "TBC" 30.3

AC57421100 MOXIFLOXACIN "ALVOGEN" FILM-COATED TABLETS 400MG 89

AC57729100 NORCOL F.C. TABLETS 20MG "S.C." 1.5

AC577291G0 NORCOL F.C. TABLETS 20MG "S.C."(鋁箔/膠箔) 2

AC57730100 CLEANLIP CAPSULE 100MG 3.26

AC57731100 RAKINSON TABLETS "CENTER" 90

AC57732100 LENOZOLE F.C. TABLETS 2.5MG 43.4

AC57738265 VIRLESS LYOPHILIZED I.V. INFUSION 250MG "YUNG SHIN"

(ACYCLOVIR)

505

AC57741100 JOINLO TABLET 20MG "EVEREST" 10.6

AC57745151 DOXYCOUGH SYRUP "CENTER" 25

AC57745157 DOXYCOUGH SYRUP "CENTER" 25

AC57747100 DAMPURINE TABLETS 50MG 3.98

AC57748277 0.298% KCL IN 5% DEXTROSE INJECTION "TBC" 30.3

AC57749255 HYDROCORTISONE INJECTION 100MG "CYH" 35.3

AC57753209 OXACILLIN POWDER FOR INJECTION "CYH" 38.6

AC57753212 OXACILLIN POWDER FOR INJECTION "CYH" 100

AC57753265 OXACILLIN POWDER FOR INJECTION "CYH" 17.1

AC57753277 OXACILLIN POWDER FOR INJECTION "CYH" 25

AC57761151 SYNTAM ORAL SOLUTION 200 MG/ML 32.5

AC57761157 SYNTAM ORAL SOLUTION 200 MG/ML 74

AC57761163 SYNTAM ORAL SOLUTION 200 MG/ML 102

AC57761164 SYNTAM ORAL SOLUTION 200 MG/ML 124

AC57762210 AMSULBER POWDER FOR INJECTION "CYH" 96

AC57762216 AMSULBER POWDER FOR INJECTION "CYH" 178

AC57762289 AMSULBER POWDER FOR INJECTION "CYH" 96

AC57763100 MONTEKA CHEWABLE TABLETS 4MG 15.5

AC57777100 UTRAPHEN F.C. TABLETS 37.5MG/325MG "STANDARD" (TRAMADOL HCL +

ACETAMINOPHEN)

6.2

AC57779100 TRAMACET F.C. TABLETS 6.2

AC57782100 E-ULCER ENTERIC F.C. TABLETS 20MG "S.C." 13.1

AC57784277 0.149%KCL IN 5% DEXTROSE INJECTION "TBC" 30.3

223

Page 224: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC57788212 DIAZEPAM INJECTION 5MG/ML "CYH" 15

AC57789100 SU-AN TABLETS 400MG "T.F." 1.5

AC57790100 PANTOPRO GASTRO-RESISTANT TABLETS 40MG 18.4

AC57793100 DIAZEPAM TABLETS 5MG "CYH" 1.5

AC57794245 PANOLE FREEZE-DRIED POWDER FOR INJECTION 174

AC57797100 AM-DAIANXO F.C. TABLETS 5/80MG 16.8

AC57798100 ASCOFEN F.C. TABLETS 100MG "STANDARD" (ACECLOFENAC) 5.2

AC57799100 DIABECON F.C. TABLETS 15/850MG "YUNG SHIN" 13.6

AC57800100 MIXRE CAPSULES 10MG 70

AC57803100 ROTY F.C. TABLETS 20MG 30.5

AC57804151 TONESTOP LIQUID 0.8MG/ML 25

AC57806100 ZOVASTIN F.C. TABLETS 40MG 15.7

AC57808138 SYNVENT HFA 100 (ALBUTEROL 100MCG) LNHALER 131

AC57809100 ROLIPOSTATIN 10MG F.C. TABLETS "MACRO" 19.6

AC57811100 PREDNISOLONE TABLETS 5MG "CYH" 1.5

AC578111G0 PREDNISOLONE TABLETS 5MG "CYH"(鋁箔/膠箔) 2

AC57814100 LOATA TABLETS 100MG 14.3

AC57817100 LEVOTINE F.C. TABLETS 5MG "TAI YU" 3.36

AC57818100 COMFORTINE F.C.T. 50MG 10.8

AC57821100 IRSAR F.C. TABLET 300MG 13.6

AC57822248 LEVOLOSACIN FOR I.V. INFUSION 5MG/ML 456

AC57822255 LEVOLOSACIN FOR I.V. INFUSION 5MG/ML 816

AC57822261 LEVOLOSACIN FOR I.V. INFUSION 5MG/ML 816

AC57823209 VITAMIN B12 INJECTION 1000MCG/ML "CHI SHENG" 15.5

AC57823229 VITAMIN B12 INJECTION 1000MCG/ML "CHI SHENG" 15.5

AC57830221 ZOBONIC CONCENTRATE FOR SOLUTION FOR INFUSION 4MG/5ML 9629

AC57832421 BETAME EYE DROPS 0.1% "MEDICINE" (BETAMETHASONE SODIUM

PHOSPHATE)

26.3

AC57838100 DOSABIN XL TABLETS 4MG "STANDARD" (DOXAZOSIN MESYLATE) 13.9

AC57840100 CLAROCID XL TABLETS 500MG "PURZER" 25.2

AC57842100 ZIROCIN F.C. TABLETS 250MG 35.1

AC57844209 PIPERACILLIN POWDER FOR INJECTION "CYH" 45.9

AC57844212 PIPERACILLIN POWDER FOR INJECTION "CYH" 45.9

AC57844219 PIPERACILLIN POWDER FOR INJECTION "CYH" 88

AC57847209 DEXAMETHASONE INJECTION 0.5% "CYH" 23.6

AC57852100 LORATADINE TABLETS 10MG "CYH" 1.5

AC57853100 IRON BEAUTY CHEWABLE TABLETS 100MG "C.H." 3.9

AC57856100 ENVIR F.C. TABLETS 1MG 149

AC57857100 MONTELUKAST F.C. TABLETS 10MG "CYH" 19.7

AC57858100 CELECOLEN CAPSULES 200MG 12.5

AC57859500 MEKECIN VAGINAL TABLETS 200MG (CLOTRIMAZOLE) 11.2

AC57860100 REPASS F.C. TABLETS 1/500MG 2.96

AC57861100 MEGLIDE F.C. TABLETS 1/500MG 2.84

AC57862100 UROSAN CAPSULES 59

AC57865100 GASOTIN F.C. TABLETS 5MG "YU SHENG" 2.43

AC57872100 PIOGLITAZONE "ALVOGEN" TABLETS 30MG 17

AC57875212 FOCIMYCIN POWDER FOR INJECTION 223

AC57875219 FOCIMYCIN POWDER FOR INJECTION 373

AC57877280 AMOCLAV IV POWDER FOR INJECTION "CYH" 47.9

AC57877297 AMOCLAV IV POWDER FOR INJECTION "CYH" 142

AC57880100 ROPICIN F.C. TABLETS 10MG 19.7

AC57881421 EMENTIN OPHTHALMIC SOLUTION 54

AC57883100 EVOXAC (CEVIMELINE HCL) CAPSULES 30MG 23.2

AC57884221 FERRUM INJECTION 72

AC57887100 DILTIAZEM TABLETS 30MG "CYH" 1.5

224

Page 225: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC57889209 PROGESTERONE INJECTION "CHI SHENG" 15

AC57889229 PROGESTERONE INJECTION "CHI SHENG" 15.6

AC57890209 EPINEPHRINE INJECTION 1MG/ML "CYH" 15

AC57891100 DIPYRIDAMOLE S.C. TABLETS 25MG "CYH" 1.5

AC578911G0 DIPYRIDAMOLE S.C. TABLETS 25MG "CYH"(鋁箔/膠箔) 2

AC57897100 PIOGLITAZONE "ALVOGEN" TABLETS 15MG 13.4

AC57902100 AMBROXOL TABLETS 30MG "CYH" 1.5

AC57904421 DESALONE EYE DROPS 0.1% "MEDICINE" 14.7

AC57905100 MONKAST CHEWABLE TABLETS 5MG 16.1

AC57907100 TRENXAMIC TABLETS 500MG "Y.Y." 3.89

AC57909100 RETONIN F.C. TABLETS 80MG 10.1

AC57910100 MOSFLOW FILM COATED TABLETS 400MG 89

AC57911100 LEVELIN F.C. TABLETS 100MG 32.9

AC57913216 KEYBONE INJECTION 1MG/ML 2674

AC57915100 LEEVK F.C. TABLETS 100MG 500

AC57921100 GLIPIZIDE TABLETS 5MG "CYH" 1.5

AC579211G0 GLIPIZIDE TABLETS 5MG "CYH"(鋁箔/膠箔) 2

AC57924500 FUKEAN VAGINAL TABLETS 100,000UNITS (NYSTATIN) 5

AC57925100 VIBOX F.C. TABLETS 500MG 72

AC57929100 HAXASIN XL TABLETS 4MG 13.7

AC57936109 MEGRAN GRANULES 1000 MG 102

AC57937177 MEGRAN GRANULES 500 MG 53

AC57939100 RECIN TABLETS 2MG"D.T.S" 1.5

AC57944100 DOWN LIP-U TABLETS 160MG 6.5

AC57948100 ZOTAN ORALLY DISINTEGRATING TABLETS 0.2MG 9.6

AC57951100 ANCOM TABLETS "D.T.S." 1.5

AC57962100 ARIZOLE ORALLY DISINTEGRATING TABLETS 15MG 67

AC57964100 COYUE F.C. TABLETS 10MG 112

AC57965100 REMECIN F.C. TABLETS 10MG "SYNRAY" 64

AC57970421 Santone Ophthalmic Solution 0.125% 12

AC57970429 Santone Ophthalmic Solution 0.125% 12

AC57971209 NOLBAXOL INJECTION 20MG/ML "YUNG SHIN" 4322

AC57971219 NOLBAXOL INJECTION 20MG/ML "YUNG SHIN" 16298

AC57972155 LEVOTAM ORAL SOLUTON 100MG/ML "CENTER" 526

AC57972161 LEVOTAM ORAL SOLUTON 100MG/ML "CENTER" 964

AC57972166 LEVOTAM ORAL SOLUTON 100MG/ML "CENTER" 1656

AC57973335 YIBANING OINTMENT 62

AC57976100 EXEN S.R. TABLETS 400MG 10

AC57977100 RANITIDINE F.C. TABLETS 150MG "CYH" 1.85

AC579771G0 RANITIDINE F.C. TABLETS 150MG "CYH"(鋁箔/膠箔) 2

AC57979100 METFORMIN "ALVOGEN" F.C. TABLET 850MG 2.23

AC57980416 ORALFIX ORAL BASE 18.5

AC57980421 ORALFIX ORAL BASE 28.4

AC57980423 ORALFIX ORAL BASE 42.7

AC57980429 ORALFIX ORAL BASE 64

AC57985221 EPIRUDO INJECTION 2MG/ML "SINPHAR" 634

AC57985229 EPIRUDO INJECTION 2MG/ML "SINPHAR" 1117

AC57985240 EPIRUDO INJECTION 2MG/ML "SINPHAR" 3381

AC57986245 EMAZOLE POWDER FOR SOLUTION FOR INJECTION/INFUSION 40MG

"STANDARD"

100

AC57989100 NONIN TABLETS 4MG 3.74

AC57994100 COLON TABLETS "D.T.S" 1.5

AC57996245 WENICE LYOPHILIZED INJECTION 40MG 174

AC57998151 APRAZ ORAL SOLUTION "CENTER" 368

AC57998161 APRAZ ORAL SOLUTION "CENTER" 830

225

Page 226: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC58001229 AMINOPHYLLINE INJECTION 2.5% 15

AC58004238 GLUCOSE INJECTION 20% "Y.F." 15

AC58005209 GLUCOSE INJECTION 5% 26.3

AC58005238 GLUCOSE INJECTION 5% 15

AC58005255 GLUCOSE INJECTION 5% 22

AC58005265 GLUCOSE INJECTION 5% 22

AC58005277 GLUCOSE INJECTION 5% 25.1

AC58006229 CALGLON I.V. INJECTION 15

AC58007238 BICARBONA INJECTION 15

AC58017100 RIPAM TABLETS0.5MG 1.5

AC580171G0 RIPAM TABLETS 0.5MG(鋁箔/膠箔) 2

AC58021421 CARLEO EYE DROPS 2% 200

AC58022265 MOSFLOW INFUSION SOLUTION 400MG/250ML 730

AC58023321 BEROLIN CREAM "F.Y." 15.8

AC58023329 BEROLIN CREAM "F.Y." 17.7

AC58023335 BEROLIN CREAM "F.Y." 28.6

AC58023338 BEROLIN CREAM "F.Y." 47

AC58023340 BEROLIN CREAM "F.Y." 88

AC58023355 BEROLIN CREAM "F.Y." 195

AC58025100 TAMOS CAPSULES 20MG 725

AC58027100 PAINOFF ENTERIC - MICROENCAPSULATED CAPSULE 10MG 5.8

AC58028100 ZYPINE FILM COATED TABLETS 5MG 55

AC58030100 EXECELA TABLETS 'Y.C" 3.29

AC58033238 5-FU INJECTION 50MG/ML 115

AC58033248 5-FU INJECTION 50MG/ML 230

AC58033255 5-FU INJECTION 50MG/ML 414

AC58034100 PEXO TABLETS 0.25MG 11.2

AC58035248 CALIFE LYOPHILIZED INJECTION 50MG 101

AC58036100 ABIMAY TABLETS 15MG 70

AC58037162 BOCA CALCIUM EMULSION "LONG LIFE" 172

AC58038100 ZAPRINSE F.C. TABLETS 5MG "KINGDOM" (OLANZAPINE) 55

AC58039100 LAVIDINE F.C. TABLETS 100MG "PURZER" 66

AC58041100 ATOTY F.C. TABLETS 40MG 29.1

AC58044100 LFLOCIN F.C. TABLETS 100MG 7.2

AC58048100 COMLAX TABLETS 5

AC58050412 ORACURE ORABASE 41

AC58050421 ORACURE ORABASE 55

AC58050426 ORACURE ORABASE 61

AC58053265 MOFACIN INFUSION SOLUTION 400MG/250ML 730

AC58057421 SANTONE OPHTHALMIC SOLUTION 1% 29.9

AC58057429 SANTONE OPHTHALMIC SOLUTION 1% 33.9

AC58058421 SANTONE OPHTHALMIC SOLUTION 0.5% 21

AC58058429 SANTONE OPHTHALMIC SOLUTION 0.5% 33

AC58059421 SANTONE OPHTHALMIC SOLUTION 0.3% 12

AC58059429 SANTONE OPHTHALMIC SOLUTION 0.3% 20.3

AC58060100 VITAMIN B COMPLEX S.C. TABLETS "F.Y." 1.5

AC580601G0 VITAMIN B COMPLEX S.C. TABLETS "F.Y."(鋁箔/膠箔) 2

AC58061100 DENSET S.C. TABLETS "BORA" 3.08

AC58063100 CANLEAVER F.C. TABLETS 0.5MG 137

AC58064100 DIYAVAL F.C. TABLETS 80MG "S.C." 10.1

AC58066209 ISOTERA INJECTION CONCENTRATE 20MG/ML 4322

AC58066219 ISOTERA INJECTION CONCENTRATE 20MG/ML 16298

AC58067100 ROSUTOR FILM-COATED TABLETS 10MG 20.1

AC58068100 REPADE TABLETS 2MG (REPAGLINIDE) 3.64

AC58069100 POSTONE EXTENDED RELEASE TABLETS 540MG 4.52

226

Page 227: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC58070100 QSTAR FILM COATED TABLETS 9.1

AC58072100 METFORMIN TABLET 500MG "S.G." 1.5

AC58074209 ANTIPIME INJECTION 425

AC58074277 ANTIPIME INJECTION 279

AC58075100 ADAPINE S.R.F.C. TAB. 30MG "STANDARD" 8.1

AC58078100 PITAVOL F.C.TABLETS 2MG 16.9

AC58081312 RAXZOR CREAM 5% "Y.C." 17.3

AC58081316 RAXZOR CREAM 5% "Y.C." 17.3

AC58081321 RAXZOR CREAM 5% "Y.C." 46.6

AC58085100 DITAN F.C. TABLETS 160MG 12.7

AC58088100 NONIN TABLETS 1MG 1.94

AC58090100 DAIANXO F.C. TABLETS 160MG 12.7

AC58092100 DIASET TABLETS 100MG 7.5

AC58094229 FOLEP INJECTION 5MG/ML "YUNG SHIN" 2268

AC58094238 FOLEP INJECTION 5MG/ML "YUNG SHIN" 6180

AC58094245 FOLEP INJECTION 5MG/ML "YUNG SHIN" 9494

AC58096265 AVERON INFUSION SOLUTION 400MG/250ML 705

AC58098100 CROSUTY F.C. TABLETS 5MG 18.3

AC58104343 CALFINE OINTMENT 627

AC58106100 Q-PINE F.C. TABLETS 200MG "TAI YU" 31

AC58108100 ARPIZO TABLET 10MG 69

AC58112100 AMOTEN F.C. TABLETS 5/80MG 15

AC58113100 FERRIN CAPSULES "Y.C." 5.6

AC58114100 優落寧膜衣錠15毫克 6.5

AC58116157 RISTIG ORAL SOLUTION 2MG/ML 1559

AC58121100 GLIMARYL TABLETS 4MG (GLIMEPIRIDE) 3.81

AC58122100 LOTIFEN TABLETS 1MG"JOHNSON" 1.75

AC58129417 TETRACYCLINE HYDROCHLORIDE OPHTHALMIC OINTMENT "GCPC" 7.3

AC58129421 TETRACYCLINE HYDROCHLORIDE OPHTHALMIC OINTMENT "GCPC" 17.5

AC58130277 CHIAMIN-A INJECTION 118

AC58135100 RIPAM TABLETS 2MG 2.66

AC58137100 ARPIZO TABLET 15MG 68

AC58138100 ATOTINE TABLETS 40MG "Y.Y." 72

AC58145100 COSLIN F.C. TABLETS 25MG "JOHNSON" 2.7

AC58146209 CEPHALEXIN 1G FOR INJECTION "TBC" 83

AC58147100 SIGRA FILM COATED TABLETS 20MG 218

AC58156209 BROSYM FOR INJECTION 297

AC58162221 NOWSHIN INJECTION 200MG/ML "T.F." 15

AC58168100 OPICET F.C. TABLETS 6.2

AC58169100 APOSA F.C. TAB. 150MG (IRBESARTAN) 7.7

AC58170100 VAKS F.C. TAB 160MG 12.7

AC58171100 IDOFEN TABLETS 400MG "STANDARD"(IBUPROFEN) 1.5

AC58174100 FLUPEN F.C. TABLETS 3MG "JOHNSON" 14.1

AC58177100 EMA F.C.TABLETS 100MG "JOHNSON" 7.4

AC58188100 WINPAIN F.C. TABLETS 6.2

AC58189100 SLANPINE ORODISPERSIBLE TABLETS 5MG 55

AC58190100 VAKS F.C. TABLETS 80MG 10.1

AC58191100 VAKS F.C.TABLETS 320MG 30.5

AC58194216 UNVOMIT IV INJECTION 717

AC58196245 ESOMELONE POWDER FOR SOLUTION FOR INJECTION / INFUSION 40MG 94

AC58197100 CLARTHROCIN F.C. TABLETS 500MG 21.7

AC58199100 BESITAN F.C. TABLETS 150MG "S.C." 7.7

AC58202100 ZCOUGH SOFT CAPSULES 100MG 2.06

AC58203100 RABE ENTERIC FILM COATED TABLETS 20MG 13

227

Page 228: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC58204100 "OLIPINE ORALLY DISINTEGRATING TABLETS 5MG "TAI YU" 54

AC58207100 Simvatin Film Coating Tablets 40mg 15.7

AC58208100 YALOP E.R. F.C. TABLETS 5MG "S.C." 3.29

AC58209329 HIGH-XYLMOL OINTMENT "SINPHAR" 60

AC58210335 DALEMEI GEL 0.1% 80

AC58211100 ATOTIN F.C. TABLETS 20MG 24

AC58212209 SAFEROME POWDER FOR I.V. INJECTION 1G "STANDARD" 299

AC58213100 DECOLONE TABLETS 1.5

AC58217100 ECOPAIN CAPSULES 200MG 12.1

AC58220100 STOPAIN CAPSULES "M.T." 1.5

AC582201G0 STOPAIN CAPSULES "M.T."(鋁箔/膠箔) 2

AC58223382 MEDISUPER PATCH 5% 49.2

AC58225221 ZOLEBONIC CONCENTRATE FOR SOLUTION FOR INFUSION 4MG/5ML 9336

AC58228329 FLUCO-U CREAM 45.2

AC58228343 FLUCO-U CREAM 117

AC58229421 OFOXIN EYE DROPS 0.3% "MEDICINE" 144

AC58231100 BESTAN 150MG FILM-COATED TABLETS 7.7

AC58233100 UBIXA FILM COATED TABLETS 5MG 55

AC58234100 EBY F.C. TABLETS 600MG 1.78

AC582341G0 EBY F.C. TABLETS 600MG(鋁箔/膠箔) 2

AC58235100 BESTAN 300MG FILM-COATED TABLETS 13.6

AC58239100 CRAIGO F.C. TABLETS 200MG 32.2

AC58240100 TOFRANIL S.C. TABLETS 10 MG 1.76

AC582401G0 TOFRANIL S.C. TABLETS 10 MG(鋁箔/膠箔) 2

AC58241100 MIGLU F.C. TABLETS 50MG (MIGLITOL) 3.93

AC58244100 CARIDOL TABLETS "Y.C." 4.32

AC58245119 MONKAST ORAL GRANULES 4MG 15.8

AC58248255 1.49% POTASSIUM CHLORIDE IN WATER INJECTION "TBC" 26.7

AC58252100 ZOPIMEN F.C. TABLETS 10MG 2.51

AC58256100 PAROXIN F.C. TABLETS 20MG 10.6

AC58257100 LOFORMIN FILM-COATED TABLETS 850MG (METFORMIN) 2.23

AC58258100 PRINDO TABLETS 8MG 16.3

AC58263100 MOSARAN F.C. TAB. 5MG (MOSAPRIDE) 2.42

AC58265100 RECKACIN F.C. TABLETS 250MG 60

AC58267312 CLOVIR OINTMENT 5% 17.3

AC58267316 CLOVIR OINTMENT 5% 17.3

AC58267317 CLOVIR OINTMENT 5% 17.3

AC58267321 CLOVIR OINTMENT 5% 46.6

AC58268100 CANDIS TABLETS 8MG 8.1

AC58269100 CENIDOL TABLETS 25MG "Y.J." (DIPHENIDOL) 1.5

AC58270100 CROSUTY F.C. TABLETS 10MG 19.7

AC58271209 PAINDOCINE INJECTION 30MG/ML 23.1

AC58271212 PAINDOCINE INJECTION 30MG/ML 48.4

AC58273100 LASOVAN F.C. TABLETS 80MG "C.H." 10.1

AC58275100 RASALINE TABLETS 1MG "STANDARD" (RASAGILINE) 86

AC58277100 PRODERA F.C. TABLETS 40MG 1.5

AC58280100 METFOPIN F.C. TABLETS 500MG 1.5

AC582801G0 METFOPIN F.C. TABLETS 500MG 2

AC58282100 ROSTATIN F.C. TABLETS 10MG "STANDARD" 20.1

AC58283100 XEIRDA F.C. TABLETS 40MG 72

AC58287143 LEVOZINE ORAL SOLUTION 0.5MG/ML "STANDARD" 25

AC58287151 LEVOZINE ORAL SOLUTION 0.5MG/ML "STANDARD" 42.1

AC58287157 LEVOZINE ORAL SOLUTION 0.5MG/ML "STANDARD" 83

AC58288100 IVIC FILM-COATED TABLETS 100MG 500

AC58291100 ROSUSTIN FILM COATED TABLETS 10MG 20.1

228

Page 229: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC58292100 LYGABA HARD CAPSULE 75MG "STANDARD" 20

AC58294100 ECOPAIN CAPSULES 100MG 10.9

AC58300157 BROWN MIXTURE LIQ. (WITH OPIUM) "HEALTH" 27.9

AC58300163 BROWN MIXTURE LIQ. (WITH OPIUM) "HEALTH" 28.7

AC58302100 COTRMA F.C. TABLETS 6.2

AC58307277 DEXT-SALINE INJECTION "OTSUKA" 25

AC58310100 LERKA F.C. TABLETS 10MG 7.7

AC58314265 N.T.G. PREMIXED INJECTION 0.4MG/ML 664

AC58315100 ROSUSTIN FILM COATED TABLETS 20MG 30.5

AC58316100 ROSUSTIN FILM COATED TABLETS 5MG 18.3

AC58318421 ODICON EARDROPS 55

AC58319421 TILLO 0.5% OPHTHALMIC SOLUTION 172

AC58324277 RINGER'S INJECTION "OTSUKA" 25

AC58327421 ANTOL EYE DROPS 1% "Y.Y." 29.9

AC58327429 ANTOL EYE DROPS 1% "Y.Y." 33.9

AC58330221 POTASSIUM CHLORIDE INJECTION 15% "TAI YU" 15

AC58330229 POTASSIUM CHLORIDE INJECTION 15% "TAI YU" 15

AC58330238 "POTASSIUM CHLORIDE INJECTION 15%""TAI YU""" 15

AC58331421 TROPINE EYE DROPS 0.5% (ATROPINE SULFATE) 21

AC58331429 TROPINE EYE DROPS 0.5% (ATROPINE SULFATE) 33

AC58333100 NEWCALM SUSTAINED - RELEASE CAPSULES 75MG 17.2

AC58334100 ENTIGIN FILM COATED TABLETS 1MG 165

AC58335100 ENTIGIN FILM COATED TABLETS 0.5MG 128

AC58336100 ESCITALO F.C. TABLETS 20MG 31.2

AC58337100 LOZEPAM CAPSULES 30MG 5.3

AC58340100 MONKAST F.C. TABLETS 10MG 19.8

AC58342421 COMALOL 0.25% OPHTHALMIC SOLUTION 73

AC58345216 IBANDRONATE INJECTION "TAI YU" 2501

AC58346100 ESCITALO F.C. TABLETS 15MG 25.6

AC58348255 HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION 100MEQ/L "YF" 26.7

AC58350100 BEGLIPIN TABLETS 30MG 16.6

AC58356100 APA-CYMBA CAPSULES 60MG 41.9

AC58359248 HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION 400MEQ/L "YF" 26.7

AC58359255 HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION 400MEQ/L "YF" 26.7

AC58360100 DALISOON F.C. TABLETS 5MG "STANDARD" (SOLIFENACIN SUCCINATE) 26.9

AC58361100 ACLOPAIN F.C. TABLETS 100MG 5.3

AC58362255 HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION 300MEQ/L "YF" 26.7

AC58363248 HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION 200MEQ/L "YF" 26.7

AC58363255 HIGHLY CONCENTRATED POTASSIUM CHLORIDE INJECTION 200MEQ/L "YF" 26.7

AC58364421 RESCULA EYE DROPS 477

AC58366100 ATORSIN F.C. TABLETS 40MG 28.3

AC58367343 CALPOBET OINTMENT 627

AC58370100 AM-DAIANXO F.C. TABLETS 10/160MG 29

AC58373100 LIPAOSHU TABLETS 200MG "KOJAR" 7

AC58376100 LUDIOMIL FILM-COATED TABLETS 25MG 4.81

AC58381100 A-LITAMIN TABLETS "CBC" 1.5

AC58382219 IBUPROFEN INJECTION 100MG/ML 100

AC58382226 IBUPROFEN INJECTION 100MG/ML 180

229

Page 230: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC58384100 ROSU F.C. TABLETS 10MG 20.1

AC58388100 MYGLIN F.C. TABLETS 3.93

AC58390100 HEPAMARIN CAPSULES "Y.C 1.57

AC583901G0 HEPAMARIN CAPSULES "Y.C."(鋁箔/膠箔) 2

AC58391100 ECOXIA F.C. TABLET 60MG 15.3

AC58396100 ROVASTIN F.C. TABLETS 10MG "Y.C." 20.1

AC58401100 LIPIKON F.C. TABLETS 20MG 24.9

AC58402100 ASTHLAX TABLETS "H.S." 1.5

AC584021G0 ASTHLAX TABLETS "H.S."(鋁箔/膠箔) 2

AC58405100 LIMESON TABLETS "Y.C." 1.5

AC584051G0 LIMESON TABLETS "Y.C."(鋁箔/膠箔) 2

AC58411100 ROSULIP F.C. TABLETS 10MG "C.H." 20.1

AC58518100 BENPRO F.C. TABLETS 20MG "JOHNSON" (BENPROPERINE) 1.5

AC58521243 WESFOR LYOPHILIZED INJECTION 30MG 212

AC58523100 LVTANGSU TABLETS 850MG"KOJAR" 2.23

AC58524321 ECOSIN CREAM "C.H." 11.7

AC58524329 ECOSIN CREAM "C.H." 21.8

AC58524335 ECOSIN CREAM "C.H." 36.2

AC58524338 ECOSIN CREAM "C.H." 36.2

AC58529245 ESOMYL POWDER FOR I.V. INJECTION AND INFUSION 40MG 94

AC58530100 FICOUGH CAPSULES 1.5

AC58532100 SU GEI TABLETS 10MG "D.T.S." 1.5

AC58533143 SORIMINE ORAL SOLUTION "C.H." 25

AC58533151 SORIMINE ORAL SOLUTION "C.H." 42.1

AC58533157 SORIMINE ORAL SOLUTION "C.H." 83

AC58534100 METFORMIN F.C. TABLETS 500MG "CYH" 1.5

AC585341G0 METFORMIN F.C. TABLETS 500MG "CYH"(鋁箔/膠箔) 2

AC58537100 VALEN F.C. TABLETS 160MG 12.7

AC58538100 TOPALESS F.C. TABLETS 100MG 30.9

AC58541100 HEPURI F.C. TABLETS 1MG 147

AC58542100 HEPURI F.C. TABLETS 0.5MG 141

AC58543100 LORAZIN TABLETS 0.5MG "JOHNSON" 1.5

AC58546151 BUTMIRA LIQUID 0.8MG/ML 25

AC58548100 TAMLOSIN D TABLETS 0.2MG 9.6

AC58549100 COSATEN TABLETS "Y.C." 4.13

AC58551100 CARELAX TABLETS 350MG 4.32

AC58555421 DORZOPT OPHTHALMIC SOLUTION 2% 254

AC58559100 ANXICAM TABLETS 1MG 1.5

AC585591G0 ANXICAM TABLETS 1MG(鋁箔/膠箔) 2

AC58560100 ANXICAM TABLETS 0.5MG 1.5

AC585601G0 ANXICAM TABLETS 0.5MG(鋁箔/膠箔) 2

AC58561100 ANXICAM TABLETS 2MG 1.5

AC585611G0 ANXICAM TABLETS 2MG(鋁箔/膠箔) 2

AC58566238 DOBUTAMINE INJECTION 12.5MG/ML "GENVAX" 182

AC58571209 PROGESTERONE INJECTION 25MG/ML "T.F." 15

AC58573100 PERIPIL PLUS TABLETS 8.6

AC58575265 MOLA INFUSION SOLUTION 400MG/250ML 666

AC58577100 SOONAN TABLETS 10MG (DICYCLOMINE HYDROCHLORIDE) 1.5

AC58579100 LIPIKON F.C. TABLETS 40MG 27.2

AC58580219 PEXEDA INJECTION 6077

AC58580238 PEXEDA INJECTION 27368

AC58581209 PHYXOTERE 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 4322

AC58581219 PHYXOTERE 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 16298

AC58581223 PHYXOTERE 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 17601

AC58585100 ARIPIZOLE TABLETS 15MG 66

230

Page 231: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

AC58586100 ARIPIZOLE TABLETS 20MG 88

AC58589100 MOCOLAX TABLETS "Y.C." 4.6

AC58592100 RESEDEN TABLETS "Y.C." 2.56

AC58596100 OMESAR F.C. TABLETS 20MG 11.5

AC58597100 TEMPO TABLETS 6.6

AC58601100 BLADOWN CAPSULES 100MG 47.2

AC58604100 ASAID FILM-COATED TABLETS 100MG 5.2

AC58605100 ROSUVASTATIN F.C. TABLETS 10MG "GENVAX" 18.9

AC58606255 0.745% KCL IN 5% DEXTROSE AND 0.33% NACL INJECTION "TBC" 26.7

AC58612100 TRIKLOR TABLETS 2MG 1.5

AC586121G0 TRIKLOR TABLETS 2MG(鋁箔/膠箔) 2

AC58617100 SPALEX TABLETS 5MG 2.86

AC58618100 SPALEX TABLETS 10MG 5.7

AC58620100 GLUVIA F.C. TABLETS 100MG 22.4

AC58621100 ROTLIP FILM-COATED TABLETS 20MG 30.5

AC58622100 ROTLIP FILM-COATED TABLETS 5MG 17.4

AC58623100 ACLONAC F.C. TABLETS 100MG 5.2

AC58624100 PRODERA F.C. TABLETS 10MG 1.5

AC58628100 Q-PINE XR EXTENDED-RELEASE TABLETS 200MG "TAI YU" 44.7

AC58633100 PITARTY F.C. TABLETS 4MG 24.2

AC58635277 0.149% KCL IN 5% DEXTROSE AND 0.45% NACL INJECTION "TBC" 26.7

AC58639100 ZULITOR TABLETS 4MG 24.2

AC58641100 DITAN F.C. TABLETS 80MG 10.1

AC58646209 ANTABINE LYOPHILIZED POWDER FOR INJECTION 4099

AC58646263 ANTABINE LYOPHILIZED POWDER FOR INJECTION 1086

AC58648100 PITARTY F.C. TABLETS 2MG 16

AC58649245 PANZOLEC LYO-INJ 40MG (PANTOPRAZOLE) 160

AC58768100 OLSAR F.C. TABLETS 20MG 11.5

AC58777424 MOMENASE AQUEOUS NASAL SPRAY 50MCG/DOSE 179

AC58778100 BECAVIR F.C. TABLETS 1MG 144

AC58779421 GINZA EYE DROPS 26.7

AC58780229 MIFIRY INJECTION 47.4

AC58780248 MIFIRY INJECTION 117

AC58780255 MIFIRY INJECTION 211

AC58791414 LANPROTAN 50UG/ML (0.005%) 414

B001973421 SANCOBA EYE DROPS 17.5

B008217100 VENALOT DEPOT DRAGEES 6.6

B008644100 LAC-B GRANULAR POWDER 2.6

B008780100 SENNOSIDE TABLETS "SAWAI" 1.12

B009391100 ERISPAN TABLETS 0.25MG 2.71

B010085100 SLOW-K TABLETS 600MG 1.48

B010641100 VIARTRIL-S CAPSULES 6.1

B010671340 NITRODERM TTS 5 27.7

B010829100 UBEQUINON CAPSULES 10MG 3.57

B010940100 YOUTETHINE TABLETS 100MG 3.5

B011143343 SELSUN SUSPENSION 2.5% 28.9

B012164100 JOLETHIN TABLETS 0.77

B0121641G0 JOLETHIN TABLETS(鋁箔/膠箔) 1.5

B012225209 PROTERNOL-L INJECTION 190

B013497100 UTROGESTAN CAPSULES 8.3

B015374100 MARSTHINE TAB. 0.6

B015525321 CLOTRASONE CREAM 17.7

B015749221 DOPAMINE HYDROCHLORIDE INJECTION 40MG/ML "HOSPIRA" 21.2

B016066100 ALUSA TABLETS 1.11

B016241121 BIOCHETASI EFFERVESCENT GRANULES 2.8

231

Page 232: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

B016336209 TRH INJECTION "TANABE" 1152

B016350212 VERPAMIL 2.5MG/ML INJECTION 65

B016581100 DIAFORMIN TABLETS 500MG 1

B016846100 MECOBALAMIN TABLETS 500 "TOWA" 1.64

B017039316 IODOSORB POWDER 61

B017081124 NORMACOL GRANULES 9.1

B017091435 TEARS NATURALE 59

B017121417 DURATEARS STERILE OPH OINT 84

B017218124 NORMACOL PLUS GRANULES 7.8

B017219100 CLARITYNE TABLET 1.27

B017369255 INTRALIPID 20% INJECTION "KABI VITRUM" 230

B017369265 INTRALIPID 20% INJECTION "KABI VITRUM" 261

B017603335 DUOFILM 179

B018018100 ATEHEXAL 50 FILM TABLET 1.34

B018156277 VANCOCIN CP. 500MG 101

B018189214 TRANSAMIN INJECTION 10% 15

B018541100 CLOZARIL TABLETS 25MG 4.99

B018580299 ADRIBLASTINA RAPID DISSOLUTION 10MG 50

B018652435 LIQUIFILM TEARS 62

B018669255 FOY FOR INJECTION 203

B018719100 TRANEXAMIC ACID TABLETS "YOHSHIN" 3.89

B018720238 PROMOSTAN FOR INJECTION 385

B018737212 CEREBROLYSIN AMPOULES 89

B018737229 CEREBROLYSIN AMPOULES 334

B018797100 SENOKOT TABLETS 0.86

B018813100 TOCONIJAST CAPSULES 2.41

B018901100 NORGESIC TABLET "3M" 2.26

B019087100 ATANAAL CAPSULES 2.59

B019120299 PHARMORUBICIN RAPID DISSOLUTION 10MG 63

B019484416 BACTROBAN NASAL OINTMENT 2% W/W 51

B019595426 SURVANTA 200MG/8ML/VIAL INTRATRACHEAL SUSPENSION 13787

B019889335 CANDIPLAS CREAM 134

B020276100 RIDRASE TABLETS 3.33

B020329100 ZYRTEC FILM COATED TABLETS 10MG 1.5

B020354100 COUMADIN TABLETS 1MG 3.6

B020392100 CLARINASE REPETABS TABLETS 3.12

B020435240 BIOCHETASI FREEZE-DRIED AMPOULES 42.7

B020516100 COUMADIN TABLETS 5MG 4.98

B020548100 TAMBOCOR TABLET 100MG 10.6

B020549248 CALCO INJECTION 50IU 99

B020707221 NAVOBAN I.V. INJECTION 5MG/5ML 370

B020735429 ARTELAC EYE DROPS 119

B020881221 ETOPOSIDE-TEVA 20MG/ML 237

B020881229 ETOPOSIDE-TEVA 20MG/ML 1486

B020917100 CORACTEN CAPSULES "SPANSULE" 4.84

B020935221 LEUCOVORIN-TEVA INJECTION 10MG/ML 101

B020935229 LEUCOVORIN-TEVA INJECTION 10MG/ML 136

B020935238 LEUCOVORIN-TEVA INJECTION 10MG/ML 420

B020935248 LEUCOVORIN TEVA INJECTION 10MG/ML 1039

B020937238 ABIPLATIN INJECTION 0.5MG/ML 70

B020937255 ABIPLATIN INJECTION 0.5MG/ML 350

B020937263 ABIPLATIN INJECTION 0.5MG/ML 357

B021047221 CARBOPLATIN SOLUTION 10MG/ML 841

B021047235 CARBOPLATIN SOLUTION 10MG/ML 1485

B0210472AP CARBOPLATIN SOLUTION 10MG/ML 3200

232

Page 233: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

B021053435 CATALIN-K FOR OPHTHALMIC 84

B021277429 VIDISIC GEL 124

B021336121 SUCRATE GEL SUSPENSION 14.9

B021354421 OFLOVID OPHTHALMIC SOLUTION 144

B021369329 CANDIPLAS H CREAM 41.5

B021369338 CANDIPLAS H CREAM 143

B021393421 FLUOROMETOLONE OPHTHALMIC SUSPENTION 0.02% T 16.3

B021393429 FLUOROMETOLONE OPHTHALMIC SUSPENTION 0.02% T 78

B021394421 FLUOROMETOLONE OPHTHALMIC SUSPENTION 0.1% T 14

B021394429 FLUOROMETOLONE OPHTHALMIC SUSPENTION 0.1% T 77

B021417329 MUNDISAL GEL 81

B021432338 RHEUMON GEL 53

B0214581BD FYBOGEL ORGANGE SACHET 4.51

B021515321 BRUMIXOL CREAM 95

B021515329 BRUMIXOL CREAM 99

B0215491CC CARBOMIX GRANULES FOR SUSPENSION "NORIT" 435

B021839143 ZYRTEC ORAL SOLUTION 0.1% W/V 36.6

B021839151 ZYRTEC ORAL SOLUTION 0.1% W/V 37

B022048206 TAXOTERE CONCENTRATE AND SOLVENT FOR SOLUTION FOR INFUSION 4322

B022048212 TAXOTERE CONCENTRATE AND SOLVENT FOR SOLUTION FOR INFUSION 16298

B022087299 HEPARIN "LEO" 1.28

B022143100 INDERAL TABLETS 10MG 1.5

B022231151 CLARITYNE SYRUP 31.3

B022323100 ZYPREXA FILM COATED TABLETS 2.5MG 42

B022357100 VESANOID SOFT GELATIN CAPSULES 10MG 141

B022385500 PROCTOSEDYL SUPPOSITORIES 5.8

B022386335 PROCTOSEDYL OINTMENT 70

B022441500 DULCOLAX SUPP 10MG (BISACODYL) 5

B022482238 RECOFOL INJECTION 10MG/ML 56

B022482248 RECOFOL INJECTION 10MG/ML 152

B022482255 RECOFOL INJECTION 10MG/ML 299

B022737500 PENTASA SUPPOSITORIES 1GM 40.2

B022809100 ATARAX 25MG FILM-COATED TABLETS 1.5

B022812100 ISMN STADA 1.32

B022825209 CEFROM POWDER FOR I.V INJECTION 1GM 356

B022826240 HEPARIN SODIUM-FRESENIUS INJECTION 5000IU/ML 92

B022826299 HEPARIN SODIUM-FRESENIUS INJECTION 5000IU/ML 1.28

B022827221 HEPARIN SODIUM-FRESENIUS INJECTION 1000IU/ML 38.3

B022828100 BETAMAC T50 1.33

B022853212 CAPD/DPCA 11 STAY SAFE PERITONEAL DIALYSIS SOLUTION 184

B022853214 CAPD/DPCA 11 STAY SAFE PERITONEAL DIALYSIS SOLUTION 201

B022853221 CAPD/DPCA 11 STAY SAFE PERITONEAL DIALYSIS SOLUTION 284

B022854212 CAPD/DPCA 12 STAY SAFE PERITONEAL DIALYSIS SOLUTION 184

B022854214 CAPD/DPCA 12 STAY SAFE PERITONEAL DIALYSIS SOLUTION 201

B022854221 CAPD/DPCA 12 STAY SAFE PERITONEAL DIALYSIS SOLUTION 284

B022855212 CAPD/DPCA 10 STAY SAFE PERITONEAL DIALYSIS SOLUTION 184

B022855214 CAPD/DPCA 10 STAY SAFE PERITONEAL DIALYSIS SOLUTION 201

B022855221 CAPD/DPCA 10 STAY SAFE PERITONEAL DIALYSIS SOLUTION 284

B023004100 PLETAAL 50MG TAB. 9.1

B023043500 OEKOLP FORTE OVULA 0.5MG 12.8

B023417100 HEPAWELL TAB. 1.5

B023436221 EPOSIN CONCENTRATE FOR INFUSION SOLUTION 20MG/ML 237

B023436240 EPOSIN CONCENTRATE FOR INFUSION SOLUTION 20MG/ML 3343

233

Page 234: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

B023496229 RECOFOL 20MG/ML EMULSION FOR INFUSION 56

B023496248 RECOFOL 20MG/ML EMULSION FOR INFUSION 299

B023546335 BETNOVATE-N OINTMENT 42.3

B023547321 BETNOVATE-N CREAM 21.5

B023554100 PANAMAX TABLETS 500MG (ACETAMINOPHEN) 0.72

B023585100 FLUDARA ORAL FILM-COATED TABLETS 922

B023592100 INSOPIN TAB. 7.5MG 2.66

B023601100 PROGEFFIK CAPSULES 8.3

B023602100 PANADOL TABLETS FOR CHILDREN 80MG (ACETAMINOPHEN) 0.72

B023604100 TOCO N 200 SOFT CAP. 2.41

B023630100 INDIVINA TAB. 1MG/5MG 6.5

B023631100 INDIVINA TAB. 2MG/5MG 6.5

B023678100 PANADOL COLD & FLU CAPLETS 0.86

B023681421 DEXAGEL EYE DROPS 101

B0237061E4 SPIRIVA 18MCG INHALATION POWDER HARD CAPSULE WITH HANDIHALER

DEVICE ( 30CAP)

1502

B023724110 VIARTRIL-S POWDER FOR ORAL SOLUTION 34.4

B023780235 BLENAMAX 15U, POWDER FOR INJECTION 1265

B023810329 ISOTREXIN GEL 92

B023901216 BALANCE 1.5% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL DIALYSIS

SOLUTION

146

B023906216 BALANCE 4.25% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL

DIALYSIS SOLUTION

146

B023907216 BALANCE 2.3% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL DIALYSIS

SOLUTION

146

B024033100 DILACAN SILYMARIN 150MG SOFT CAPSULE 1.5

B024183100 SEROQUEL TABLETS 300MG 65

B024213240 HIDONAC INJECTION 422

B024216100 ALCALROLE CAPSULE 0.25 2.66

B024280145 GIONA EASYHALER 200MCG/DOSE 366

B024297100 PRAVASTATIN NA TABLETS 5 KN 8.6

B0243292FB STRUCTOKABIVEN EMULSION FOR INFUSION(依仿單含熱量1100Kcal) 874

B0243292FC STRUCTOKABIVEN EMULSION FOR INFUSION(依仿單含熱量1600Kcal) 1230

B0243292FD STRUCTOKABIVEN EMULSION FOR INFUSION(依仿單含熱量2100Kcal) 1661

B024330429 Liposic eye gel 124

B0243382FE STRUCTOKABIVEN PERIPHERAL EMULSION FOR INFUSION(依仿單含熱量

830Kcal)

606

B0243382FF STRUCTOKABIVEN PERIPHERAL EMULSION FOR INFUSION(依仿單含熱量

1300Kcal)

874

B024476221 Paclitaxel-Teva,concentrate for solution for Infusion 6mg/ml 1028

B024476240 PACLITAXEL-TEVA,CONCENTRATE FOR SOLUTION FOR INFUSION 6MG/ML 8989

B024476248 Paclitaxel-Teva,concentrate for solution for Infusion 6mg/ml 22960

B0244762E2 Paclitaxel-Teva,concentrate for solution for Infusion 6mg/ml 2932

B024534100 Simgal film-coated tablets 40mg 14.5

B024535100 Simgal film-coated tablets 20mg 6.5

B024588100 Tevanate Tablets 70mg 150

B024684100 EVOXAC CAPSULES 23.2

B024700268 CUBICIN INJECTION (CARDINAL HEALTH) 2801

234

Page 235: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

B024700277 CUBICIN INJECTION (CARDINAL HEALTH) 3522

B024899214 NUTRIFLEX LIPID PERI 2500ML(依仿單含熱量1910Kcal) 1273

B024901214 NUTRIFLEX LIPID SPECIAL 2500ML(依仿單含熱量2950Kcal) 2356

B0249012BH NUTRIFLEX LIPID SPECIAL 1875ML(依仿單含熱量2215Kcal) 1660

B024919277 LIPOPLUS 20% 352

B024981229 OXALIPLATIN PCH 5 MG/ML, CONCENTRATE FOR SOLUTION FOR INFUSION 2238

B024981238 OXALIPLATIN PCH 5 MG/ML, CONCENTRATE FOR SOLUTION FOR INFUSION 5584

B025004213 BYETTA INJECTION 0.25 MG/ML“USA” 2875

B025004297 BYETTA INJECTION 0.25 MG/ML“USA” 2853

B025208100 CO-TAREG FILM COATED TABLETS 160/12.5MG 10.5

B025220100 ONGLYZA FILM-COATED TABLETS 2.5MG 15.9

B025221100 ONGLYZA FILM-COATED TABLETS 5MG 26.5

B025222100 CLOPILET 35.3

B025280221 LIGNOCAINE HCL-FRESENIUS INJECTION 2 % 50

B025307100 LOSARTAN-TEVA F.C. TABLETS 50MG 7

B025312100 GABANTIN 600 F.C. TABLET 13.4

B025313100 GABANTIN 800 F.C. TABLET 18.6

B025315100 AZILECT 1MG TABLETS 103

B025320277 VITAFUSAL SOLUTION FOR INFUSION 231

B025353235 BLEOMYCIN-TEVA POWDER FOR SOLUTION FOR INJECTION 15U 1265

B025412100 MEDOSTATIN 40MG TABLETS 7

B025440100 VIMOVO DELAYED RELEASE TABLETS 500MG/20MG 9.5

B025453100 KOMBIGLYZE XR TABLETS 5MG/1000MG 23

B025454100 KOMBIGLYZE XR TABLETS 5MG/500MG 23

B025455100 KOMBIGLYZE XR TABLETS 2.5MG/1000MG 13.2

B025504221 EPIRUBICIN-TEVA 2MG/ML, SOLUTION FOR INFUSION 501

B025504240 EPIRUBICIN-TEVA 2MG/ML, SOLUTION FOR INFUSION 2359

B025517229 VINBLASTINE TEVA 1MG/ML, SOLUTION FOR INJECTION 613

B025618421 TIMOC EYE DROPS 0.5% 113

B025730312 FENISTIL PENCIVIR (FOR COLD SORE) CREAM 203

B025757100 DIFICID FILM-COATED TABLET 200MG 3138

B025840240 ADRIM INJECTION 2458

B025921429 LIPOSIC EYE GEL 124

B025929429 LIPOSIC FLUID EYE GEL 124

B025941100 EPIMATE 100 28.8

B026083100 CORYOL 40MG FILM COATED TABLETS 2.02

B026103100 EPIMATE 50MG 15.2

B026261100 PMS-RISEDRONATE 35MG TABLETS 193

B026296221 BW-FOLIN 10MG/ML SOLUTION FOR INJECTION 101

B026296229 BW-FOLIN 10MG/ML SOLUTION FOR INJECTION 136

B026296238 BW-FOLIN 10MG/ML SOLUTION FOR INJECTION 420

B026296248 BW-FOLIN 10MG/ML SOLUTION FOR INJECTION 1039

B026296255 BW-FOLIN 10MG/ML SOLUTION FOR INJECTION 1900

BA18095248 CIPROXIN INF. SOL. 50ML/100MG (50毫升/瓶裝) 288

BA18095255 CIPROXIN INF. SOL. 100ML/200MG (100毫升/瓶裝) 628

BA18095263 CIPROXIN INF. SOL. 200ML/400MG(200毫升/瓶裝) 1003

BA21344100 ADALAT CC 30MG (30粒鋁箔/盒裝) 8.1

BA22951100 ADALAT OROS 30 (30粒鋁箔/盒裝) 8.1

BA24468100 BARACLUDE TABLETS 1MG (30粒鋁箔/盒裝) 181

BA24469100 BARACLUDE TABLETS 0.5MG (30粒鋁箔/盒裝) 155

BA24634100 LOSACAR 50 TABLETS(28粒/鋁箔盒裝) 9.3

BA25104100 ALENDRONATE SANDOZ 70MG TABLETS(4粒/鋁箔盒裝) 221

235

Page 236: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BA25109100 BICALUTAMIDE SANDOZ 50MG FILM COATED TABLETS(28粒/鋁箔盒裝) 132

BA25200100 TULIP 10MG FILM COATED TABLETS(30粒/鋁箔盒裝) 19.3

BA25201100 TULIP 40MG FILM COATED TABLETS(30粒/鋁箔盒裝) 33.9

BA25209100 ZYDUS TOPIRAMATE TABLETS 100 MG(28粒/鋁箔盒裝) 38.1

BA25218100 ZYDUS ARIPIPRAZOLE TABLETS 10 MG(28粒/鋁箔盒裝) 82

BA25308100 BIGSENS-XR 500 TABLETS(鋁箔盒裝/60粒瓶裝) 1.85

BA253081G0 BIGSENS-XR 500 TABLETS(28粒/鋁箔盒裝) 2

BA25337100 TULIP 20MG FILM COATED TABLETS(30粒/鋁箔盒裝) 29.8

BA25589100 LOSACAR 100 TABLETS【28粒/鋁箔盒裝】 11.1

BA25797100 ROBESTAR SANDOZ FILM-COATED TABLETS 5MG(30粒/鋁箔盒裝) 21.8

BA25798100 ROBESTAR SANDOZ FILM-COATED TABLETS 10MG(30粒/鋁箔盒裝) 23.5

BA25813100 OLANZAPINE TABLETS 10MG(30粒/鋁箔盒裝) 130

BA25842100 OLANZAPINE TABLETS 5MG(30粒/鋁箔盒裝) 67

BA25845100 REOSTEO 35MG TABLETS(4粒/鋁箔盒裝) 219

BA26108100 LETARA FILM-COATED TABLETS 2.5MG(30粒/鋁箔盒裝) 47.4

BA26189100 ESOMEPSUN 40MG TABLETS "SUNYET"(28粒/鋁箔盒裝 ) 15.1

BA26206100 LETROZOLE "ALVOGEN"FCT 2.5MG(30粒/鋁箔盒裝) 47.4

BA26264100 OZAPEX ORODISPERSIBLE TABLETS 5MG(28粒/鋁箔盒裝) 67

BA26352100 ALFATAM CAPSULE 0.4MG(28粒/鋁箔盒裝) 17.9

BB17692100 CIPROXIN 250, FILM-COATED TABLETS 9.8

BB17742277 VANCOMYCIN HYDROCHLORIDE FOR INJECTION 500MG ,USP 101

BB20786100 GLUCOBAY TABLETS 50MG 3.27

BB20787100 GLUCOBAY TABLETS 100MG 7

BB21062100 CIPROXIN FILM-COATED TABLETS 500MG 13.1

BB21157221 TAXOL (PACLITAXEL) INJECTION 30MG/5ML 1388

BB211572E2 TAXOL (PACLITAXEL) INJECTION 30MG/5ML 3774

BB21777277 MAXIPIME INJECTABLE 500MG 279

BB21962100 ADALAT RETARD F.C.TABLETS 20MG 5

BB22387100 NATRILIX SR FILM-COATED TABLETS 1.5MG 2.65

BB22650100 CURAM FILM-COATED TABLETS 625MG 6.6

BB22672100 LODOPIN TABLETS 25MG 7.1

BB22673100 LODOPIN TABLETS 50MG 13.1

BB23503100 DIAMICRON MR TAB. 2.34

BB24023100 EVISTA 60MG FILM COATED TABLETS 40.1

BB24292100 MEL-OD 15 TABLETS (MELOXICAM TABLETS) 8.5

BB24489100 MEL-OD 7.5 Tablets(Meloxicam tablets) 2.36

BB24545100 Serlin 50 Tablets 11.7

BB24617212 IRINOTECAN INJECTION CONCENTRATE 2439

BB24617221 Irinotecan Injection Concentrate 5066

BB24808100 CURAM 1000MG FILM-COATED TABLETS 9.4

BB24847280 CURAM POWDER FOR INJECTION 500/100 MG, 1000/200 MG 47.9

BB24847297 CURAM POWDER FOR INJECTION 500/100 MG, 1000/200 MG 142

BB24898100 AMLODAC 5 TABLETS 6.8

BB24958100 DACTIVE 10 TABLETS 2.51

BB25093100 ZYTHROCIN 250 TABLETS 35.1

BB25098100 RAMEY 10 TABLETS 9

BB25132297 MOXICLAV 1200MG POWDER FOR INJECTION 142

BB25183212 DBL GEMCITABINE FOR INJECTION 8108

BB25183263 DBL GEMCITABINE FOR INJECTION 1086

BB25250220 PIPERACILLIN/TAZOBACTAM SANDOZ POWDER FOR INJECTION 435

BB252502CX PIPERACILLIN/TAZOBACTAM SANDOZ POWDER FOR INJECTION 241

BB25266100 DIAMICRON MR TABLETS 60 MG 4.33

BB25369100 ZYDUS ESCITALOPRAM OXALATE TABLETS 10 MG 19.4

BB25465100 APO-QUETIAPINE TABLETS 300MG 58

236

Page 237: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BB25466100 APO-QUETIAPINE TABLETS 200MG 34.9

BB25467100 APO-QUETIAPINE TABLETS 25MG 13.4

BB25535100 ARBREAST F.C. TAB. 1MG (ANASTROZOLE) 74

BB25600212 HOSPIRA DOCETAXEL INJECTION 4322

BB25600226 HOSPIRA DOCETAXEL INJECTION 16298

BB25653100 APO-QUETIAPINE TABLETS 100MG 25.9

BB25828100 LEVOZYD 500 (LEVOFLOXACIN TABLETS 500MG) 44.8

BB25864100 JUBILANT OLANZAPINE ORODISPERSIBLE TABLETS 10MG 117

BB25865100 JUBILANT OLANZAPINE ORODISPERSIBLE TABLETS 5MG 61

BB25968221 EPIRUBICIN "ALVOGEN" 2MG/ML INJECTION SOLUTION 634

BB25968240 EPIRUBICIN "ALVOGEN" 2MG/ML INJECTION SOLUTION 3381

BB26001100 TOPIZ 50 18

BB26025209 "Ceftriaxone ""Alvogen"" 1g Powder for solution for IV

Injection"

193

BB26026221 DOXORUBICIN "ALVOGEN" SOLUTION FOR INJECTION 2MG/ML 515

BB26026229 DOXORUBICIN "ALVOGEN" SOLUTION FOR INJECTION 2MG/ML 619

BB26026240 DOXORUBICIN "ALVOGEN" SOLUTION FOR INJECTION 2MG/ML 2458

BB26026248 DOXORUBICIN "ALVOGEN" SOLUTION FOR INJECTION 2MG/ML 4118

BB26409100 ALVOPREL FILM COATED TABLET 300MG 14.5

BB26410100 ADEMPAS FILM-COATED TABLETS 0.5MG 1261

BB26411100 ADEMPAS FILM-COATED TABLETS 1.0MG 1261

BB26412100 ADEMPAS FILM-COATED TABLETS 1.5MG 1261

BB26413100 ADEMPAS FILM-COATED TABLETS 2.0MG 1261

BB26414100 ADEMPAS FILM-COATED TABLETS 2.5MG 1261

BC01878255 CYTOSAR FREEZE-DRIED POWDER FOR INJECTION 100MG 109

BC01879277 CYTOSAR FREEZE-DRIED POWDER FOR INJECTION 500MG 347

BC03077100 RIVOTRIL 0.5MG TABLET 1.5

BC03078100 RIVOTRIL 2MG TABLET 2.66

BC04248245 SOLU-MEDROL STERILE POWDER 40MG 56

BC04249258 SOLU-MEDROL STERILE POWDER 125MG 151

BC04405421 LACRIMIN OPHTHALMIC SOLUTION 20.5

BC044571G0 LEXOTAN TABLETS 3MG(鋁箔/膠箔) 2

BC044591G0 LEXOTAN TABLETS 1.5MG(鋁箔/膠箔) 2

BC04858100 FLUANXOL 3MG film coated tablets 14.1

BC04922277 STERILE SOLU-MEDROL 249

BC04923100 FLUANXOL 1MG film coated tablets 5.4

BC05037209 FLUANXOL DEPOT 1ML 247

BC05176100 BURINEX TABLETS 1MG 2.23

BC05728429 MYDRIN-P 75

BC05819100 PROGYLUTON S.C. TABLETS 3.93

BC05827100 DECARIS TABLETS (CHILDREN) 8.7

BC06049100 SECTRAL TABLETS 400MG 6.2

BC07107421 MYDRIN-M 48.9

BC07125100 BEZALIP COATED TABLETS 6.5

BC071521G0 GLUCOPHAGE TABLETS(鋁箔/膠箔) 2

BC07538100 LONITEN 10MG 9.2

BC08790209 CLOPIXOL DEPOT 200MG/ML 361

BC09100100 VOLTAREN SR 100 2.97

BC09115100 MYLERAN BUSULPHAN TABLETS 2MG 6.9

BC09145100 ALKERAN MELPHALAN TABLETS 2MG 19.2

BC09146100 LEUKERAN CHLORAMBUCIL TABLETS 2MG 12.3

BC09147100 IMURAN AZATHIOPRINE TABLETS 50MG B.P. 24.4

BC09554100 LANOXIN DIGOXIN TABLETS 0.25MG B.P. 1.75

BC09714212 LANOXIN DIGOXIN INJECTION 0.5MG B.P. 37.9

BC09768209 DIPROSPAN INJECTION 19.5

237

Page 238: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC09768221 DIPROSPAN INJECTION 19.5

BC09796100 MADOPAR 250 TABLETS "ROCHE" 8.4

BC11051100 PANAGESIC TABLETS 3.87

BC112121G0 ISMO 20(鋁箔/膠箔) 2

BC11225100 COSTI TABLETS 1.5

BC112251G0 COSTI TABLETS(鋁箔/膠箔) 2

BC11315100 DEANXIT DRAGEES 3.08

BC11326265 ZOVIRAX I.V. 505

BC11917277 DESFERAL VIALS 500MG 266

BC11978100 DEVODIL TABLETS 1.66

BC119781G0 DEVODIL TABLETS(鋁箔/膠箔) 2

BC12258248 FUNGIZONE INTRAVENOUS 575

BC125401G0 REMYCIN CAPSULES 100MG(鋁箔/膠箔) 2

BC12554100 ANDROCUR 38.9

BC12601100 ENDOXAN SUGAR-COATED TABLETS 7.5

BC12640221 PROTAMINE SULPHATE LEO PHARMA 1400 ANTI-HEPARIN IU/ML SOLUTION

FOR INJECTION AND INFUSION

128

BC126761G0 LOPERIUM TABLETS 2MG(鋁箔/膠箔) 2

BC12873100 MINIDIAB TABLETS 5MG 1.5

BC128731G0 MINIDIAB TABLETS 5MG(鋁箔/膠箔) 2

BC12946100 PROVERA 10MG 2.97

BC12963177 ISOBIDE SOLUTION 1101

BC13020100 DENEREL TABLETS 1.75

BC13027148 SANDIMMUN NEORAL ORAL SOLUTION 100MG/ML 7941

BC13049209 SANDIMMUN CONCENTRATE FOR INTRAVENOUS INFUSION 117

BC13059238 DAUNOBLASTINA 20MG FOR INJECTION 457

BC13071321 VIRU-MERZ SEROL GEL 345

BC13086121 KALIMATE POWDER 11.4

BC13116343 OESTROGEL GEL 85

BC13138421 CYCLOGYL 1% 83

BC13139421 CYCLOGYL 2% 144

BC13148214 TRACRIUM INJECTION 61

BC13159209 METHERGIN (R) AMPOULES 0.2MG/1ML 19.4

BC13304429 ALLERGOPOS EYE DROPS 54

BC13397100 METHERGIN (R) SUGER-COATED TABLETS 8.8

BC13409100 AKAMON TABLETS 3MG 1.58

BC134091G0 AKAMON TABLETS 3MG(鋁箔/膠箔) 2

BC13994100 CLOPIXOL TABLETS 10MG 12.4

BC14029100 SERMION TABLETS 5MG 3.45

BC14287255 ANEGYN INJECTION 0.5%W/V 77

BC14822100 CORDARONE TABLETS 6.6

BC14823100 SPASMONAL CAPSULES 2.39

BC14837123 KONSYL 8.9

BC14860100 PROVERA 5MG (MEDROXYPROGESTERONE ACETATE) TABLETS 1.57

BC14861216 CORDARONE INJECTION 68

BC14899100 DEPAKINE GASTRO-RESISTANT TABLET 200MG 3.43

BC14902145 DEPAKINE ORAL SOLUTION 237

BC14966100 ROACCUTANE "ROCHE" SOFT GELATIN CAPSULES 20MG 61

BC14967100 ROACCUTANE "ROCHE" SOFT GELATIN CAPSULES 10MG 37.9

BC15031277 "ROCEPHIN ""ROCHE"" FOR I.V. INJECTION 500MG" 100

BC15040209 "ROCEPHIN ""ROCHE"" FOR I.V. INJECTION 1g" 193

BC15152100 ECTOPAL CAPSULES 11.4

BC15234209 "VITAMIN B12 INJECTIONS 1000 ""KOBAYASHI""" 15.5

BC15290100 SERMION TABLETS 10MG 6.4

BC15292421 ARTEOPTIC 2% OPHTHALMIC SOLUTION 200

238

Page 239: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC15293421 ARTEOPTIC 1% OPHTHALMIC SOLUTION 188

BC15321100 CLOPIXOL TABLETS 25MG 26.6

BC15387255 "HOSPIRA" METRONIDAZOLE INJECTION 5MG/ML 77

BC15467209 SUSTANON 191

BC15478255 MIACALCIC AMPOULES 100I.U./ML 141

BC15875212 TRAMAL INJECTION 39.1

BC15880100 TADEX TABLETS 10MG 3.06

BC15906229 ANTREX 3MG/ML 101

BC15979209 PLEGISOL 482

BC16028100 TEGRETOL CR 200MG FILM-COATED TABLETS (DIVISIBLE) 2.79

BC16033100 TEGRETOL CR 400MG FILM-COATED TABLETS (DIVISIBLE) 10

BC160661G0 ALUSA TABLETS(鋁箔/膠箔) 2

BC16080100 PINDOLOL TABLETS "TOWA" 4.02

BC16094100 BEZALIP RETARD COATED TABLETS 12.5

BC16194100 TREXAN 2.5MG TABLETS 4.82

BC16229500 ALBOTHYL VAGINAL SUPPOSITORIES (OVULES) 13

BC16295100 NEUQUINON SUGAR-COATED TABLETS 3.57

BC16450500 FAKTU SUPPOSITORIES 8.8

BC16477100 CALMDAY 5MG,SUGAR COATED TABLETS 3.9

BC16483435 ISOPTO CARPINE 2% 83

BC16504100 FERRUM HAUSMANN CHEWABLE TABLETS 3.9

BC16528100 MILLIBAR CAPUSLES 2.27

BC16548421 TOBREX STERILE OPHTHALMIC SOLUTION 37.9

BC165811G0 DIAFORMIN TABLETS 500MG(鋁箔/膠箔) 2

BC16642421 MAXIDEX 14.7

BC16704248 MIACALCIC INJECTION 50 MRC-U/ML (50IU /ML) 101

BC16710421 MYDRIACYL 0.5 % OPHTHALMIC SOLUTION (R) 29.2

BC16711421 MYDRIACYL 1% 76

BC16717100 NOVOFEN TABLETS 10MG 3.06

BC16732335 MEDODERMONE OINTMENT 28.6

BC16732340 MEDODERMONE OINTMENT 88

BC16738335 MEDODERMONE CREAM 28.6

BC16738340 MEDODERMONE CREAM 88

BC16754100 SYKLOFOSFAMID S.C. TABLETS 50MG 5.9

BC16765421 MAXITROL STERILE OPH SOLUTION 121

BC16784100 TIADEN TABLETS 2.49

BC16792100 CAMCOLIT-400 FILM COATED TABLETS 4.39

BC168461G0 MECOBALAMIN TABLETS 500 "TOWA" (鋁箔/膠箔) 2

BC16851417 TOBREX EYE OINTMENT 106

BC16863100 TRAMAL 50 CAPSULES 3.88

BC16876417 MAXITROL STERILE OPHTHALMIC OINTMENT 151

BC16888100 DENEX TABLETS 100MG 4.61

BC16894435 NATACYN 5% OPHTHALMIC SUSPENSION 1800

BC16898100 CONVULEX 300MG CAPSULES 8

BC16904100 CONVULEX 150 SOFT CAPSULES 3.13

BC16973100 JUVELA N SOFT CAPSULES 200MG 2.54

BC16998100 CONVULEX 500MG CAPSULES 10.4

BC16999100 MECOBALAMIN TABLETS 500μg 1.76

BC17057209 PROSTIN VR PEDIATRIC 500 MICROGRAMS PER ML 1765

BC17077100 MADOPAR HBS "ROCHE" CAPSULES 125MG 5.6

BC17090100 CONCOR 10 7.1

BC17118100 ANPEC 40 TABLETS 1.66

BC17124221 "ANEXATE AMPOULE ""ROCHE""" 910

BC17125100 CONCOR 5 MG 3.42

BC17140100 OLBETAM 250MG CAPSULES 7

239

Page 240: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC17161158 ZOVIRAX SUSPENSION 783

BC17196100 MECOLAMIN CAPSUL 1.76

BC17214112 BRICANYL SOLUTION FOR NEBULIZING 2.5MG/ML 12.9

BC17283100 METALCAPTASE 300 13.4

BC17292100 ANPEC 80 F.C. TABLETS 3.95

BC17312210 CAPD 3 PERITONEAL DIALYSIS SOLUTION 157

BC17312212 CAPD 3 PERITONEAL DIALYSIS SOLUTION 184

BC17312221 CAPD3 PERITONEAL DIALYSIS SOLUTION 284

BC17400421 ECONOPRED PLUS 1% 78

BC17407100 DICETEL 50MG FILM COATED TABLETS 10.8

BC17410421 BETOPTIC TM STERILE OPHTHALMIC SOLUTION 172

BC17450100 RULID 150MG FILM COATED TABLET 10.9

BC17469100 PLENDIL EXTWNDED RELEASE TABLETS 10MG 5.1

BC17481289 ZINACEF 750MG INJECTION "GLAXO" 23.5

BC17488100 PLENDIL TABLETS 5MG 3.29

BC17525277 FORTUM 500MG FOR INJECTION "GLAXO" 32.3

BC17528126 VENTOLIN INHALER (80DOSE) 98

BC17528138 VENTOLIN INHALER (200DOSE) 131

BC17530212 "ZANTAC INJECTION 25MG/ML ""GLAXO""" 24.7

BC17531265 ZINACEF 250MG INJECTION "GLAXO" 23.5

BC17536100 VENTOLIN TABLETS 2MG 1.5

BC17538209 FORTUM 1GM FOR INJECTION "GLAXO" 63

BC17577100 "DORMICUM FILM-COATED TABLETS 7.5MG ""ROCHE""" 3.85

BC17586100 PRESOLOL TABLETS 200 MG 3.24

BC17598100 ALKIXA TABLETS 100mg 1.5

BC17664100 HYTRIN 2MG TABLETS 3.04

BC17728265 GLYCEROSTERIL 10% 93

BC17819265 NEPHROSTERIL INFUSION SOLUTION 203

BC17835255 METRONIDAZOL FRESENIUS 77

BC17852100 ZINNAT TABLET 250MG 6.8

BC17867210 CAPD 2 PERITONEAL DIALYSIS SOLUTION 157

BC17867212 CAPD 2 PERITONEAL DIALYSIS SOLUTION 184

BC17867214 CAPD 2 PERITONEAL DIALYSIS SOLUTION 201

BC17867221 CAPD 2 PERITONEAL DIALYSIS SOLUTION 284

BC17869100 FLUANXOL 5MG film coated tablets 25.3

BC17873209 SANDOSTATIN AMPOULES 0.1MG/ML 414

BC18008255 LIPOVENOS 20% EMULSION FOR INTRAVENOUS INFUSION 235

BC18008265 LIPOVENOS 20% EMULSION FOR INTRAVENOUS INFUSION 279

BC18017100 ATEHEXAL 100 FILM TABLET 1.6

BC18151100 FUTRAFUL CAPSULES 21.3

BC18155100 AUGMENTIN TABLETS 375MG 6.8

BC18158100 IMOVANE TABLETS 7.5MG 2.89

BC18167255 SOLU-CORTEF STERILE POWDER 100MG 35.3

BC18189229 TRANSAMIN INJECTION 10% 34.5

BC18196210 CAPD 4 PERITONEAL DIALYSIS SOLUTION 157

BC18196212 CAPD 4 PERITONEAL DIALYSIS SOLUTION 184

BC18196214 CAPD 4 PERITONEAL DIALYSIS SOLUTION 201

BC18196221 CAPD 4 PERITONEAL DIALYSIS SOLUTION 284

BC18205338 VENTOLIN RESPIRATOR SOLUTION 126

BC18215500 PROSTIN E2 VAGINAL TABLETS 314

BC18231100 GLUCOPHAGE TABLET 850MG 2.23

BC18273100 KETOSTERIL TABLETS 21

BC18279100 PHYLLOCONTIN CONTINUS TABLETS 3.22

BC18304280 AUGMENTIN FOR INTRAVENOUS INJECTION 600MG, 1.2GM (600MG/VIAL) 47.9

240

Page 241: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC18304297 AUGMENTIN FOR INTRAVENOUS INJECTION 600MG, 1.2GM (1.2G/VIAL) 142

BC18307255 LIPOFUNDIN MCT/LCT 20% I.V. INFUSION 215

BC18307265 LIPOFUNDIN MCT/LCT 20% I.V. INFUSION 225

BC18308255 LIPOFUNDIN MCT/LCT 10% I.V. INFUSION "B. BRAUN" 185

BC18308265 LIPOFUNDIN MCT/LCT 10% I.V. INFUSION 215

BC18308277 LIPOFUNDIN MCT/LCT 10% I.V. INFUSION 225

BC18333421 FLAREX 0.1% STERILE OPHTHALMIC SUSPENSION 14

BC18348155 CONVULEX SYRUP 50MG/ML 135

BC18364421 FLUCON 0.1% STERILE OPHTHALMIC SUSPENSION 14

BC18368417 MAXIDEX OINTMENT 91

BC18369100 ACLIN TABLETS 100MG 2.03

BC18384277 AMINOPLASMAL-10% E 212

BC18425100 ALEPAM 15 TABLET 3.65

BC18426100 ALEPAM 30TABLET 3.65

BC18433114 AUGMENTIN FOR SYRUP 84

BC18479212 HOLOXAN (2GM) 2700

BC18485271 UROMITEXAN INJECTION 175

BC18540248 HERBESSER INJECTION 50MG 392

BC18542100 CLOZARIL TABLETS 100MG 8.9

BC18580229 ADRIBLASTINA RAPID DISSOLUTION 10MG 515

BC18584100 ZOFRAN TABLETS 8MG 181

BC18585212 ZOFRAN INJECTION 2MG/ML 191

BC18585219 ZOFRAN INJECTION 2MG/ML 217

BC18617421 TOBRADEX OPHTHALMIC SUSPENSION 123

BC18638100 GISTELINK TABLETS 200MG 4.84

BC18646421 POLY-PRED LIQUIFILM OPHTHALMIC SUSPENSION 74

BC18654421 1% PRED FORTE OPHTHALMIC SUSPENSION 78

BC18656429 FML LIQUIFILM OPHTHALMIC SUSPENSION 77

BC18664421 BUNOLGAN LIQUIFILM STERILE OPHTHALMIC SOLUTION 0.5%W/V 133

BC18666421 0.12% PRED MILD OPHTHALMIC SUSPENSION 36.5

BC18692277 HAES-STERIL 10% 448

BC18699100 KALURIL TABLETS 5MG 2.88

BC18741100 ATIVAN TABLETS 0.5MG 1.5

BC187411G0 ATIVAN TABLETS 0.5MG 2

BC18771223 UROKINASE-GCC INJ. 6000IU 191

BC18776421 BETOPTIC S STERILE OPHTHALMIC SUSPENSION 163

BC18790248 DIFLUCAN IV INJECTION 361

BC18833229 CALCIUMFOLINAT-EBEWE INJECTION 10MG/ML 145

BC18842100 NIMOTOP F.C. TABLETS 30MG 21.3

BC18843248 NIMOTOP INFUSION SOLUTION 0.02%W/V 718

BC18857100 PIETENALE TABLETS 100mg 4.61

BC18863412 ATROVENT NEBULISER SOLUTION 0.5MG/2ML IN UNIT-DOSE VIALS 11.3

BC18873238 CISPLATIN-EBEWE 0.5MG/ML INJECTION 70

BC18873255 CISPLATIN-EBEWE 0.5MG/ML INJECTION 350

BC18876221 METHOTREXAT "EBEWE" 480

BC18876229 METHOTREXAT "EBEWE" 869

BC18876248 METHOTREXAT "EBEWE" 4735

BC18878221 EBETREXAT 10MG/ML 89

BC18883335 BACTROBAN OINTMENT 124

BC18925100 BARBLOC 5MG TABLETS 4.02

BC18926100 BARBLOC 15MG TABLETS 12.2

BC18952100 PK-MERZ FILM-COATED TABLETS 7.4

BC18960100 LEVOHALTE TABLETS 11.7

BC18979229 MILLISROL INJECTION 47.4

241

Page 242: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC18979255 MILLISROL INJECTION 227

BC19000100 MST CONTINUS TABLETS 60MG 80

BC19001100 MST CONTINUS TABLETS 30MG 53

BC19086100 UNASYN TABLETS 13.6

BC19089100 CIBACEN 5MG FILM-COATED TABLETS 8.3

BC19107321 FUCIDIN OINTMENT 2% 55

BC19108100 FUCIDIN TABLETS 60

BC19109219 BURINEX INJECTION 0.5MG/ML 47.1

BC19114340 STIEMYCIN SOLUTION 140

BC19116321 FUCIDIN CREAM 55

BC19116335 FUCIDIN CREAM 154

BC19119248 PHARMORUBICIN RAPID DISSOLUTION 50MG 3381

BC19120229 PHARMORUBICIN RAPID DISSOLUTION 10MG 634

BC19122412 DEXALTIN ORAL PASTE 41

BC19122421 DEXALTIN ORAL PASTE 55

BC19124235 BLEOCIN FOR INJECTION 15MG 1265

BC19190100 DIVINA TABLETS 4.97

BC19191221 BLEOCIN FOR INJECTION 5MG 515

BC19238100 ACERTIL TABLETS 4MG 10

BC19259421 TIMOPTOL OPHTHALMIC SOLUTION 0.5% 172

BC19279265 TIENAM INJECTION 197

BC19279277 TIENAM INJECTION 427

BC19316109 KRESTIN 176

BC19320100 LAMISIL TABLETS 250MG 13.8

BC19327500 OVESTIN VAGINAL SUPPOSITORIES 0.5MG 12.8

BC19337135 HALDOL DROPS 68

BC19337143 HALDOL DROPS 68

BC19338209 HALDOL INJECTION 25.3

BC19339100 GENURIN 200MG 4.84

BC19362100 APO-CIMETIDINE 400MG TABLETS 1.5

BC19363100 APO-CIMETIDINE 200MG TABLETS 1.5

BC19364100 APO-CIMETIDINE 300MG TABLETS 1.5

BC19376221 "FRAGMIN 5 80

BC19378229 "FRAGMIN 2 193

BC19379214 "FRAGMIN 2 74

BC19408100 ACLIN 200 TABLETS 2.03

BC19410429 ALLERGOCROM EYE DROPS 30.2

BC194201A5 ZINNAT SUSPENSION 125MG 120

BC19456221 "DORMICUM ""ROCHE"" AMPOULES 5MG/5ML" 24.3

BC19457209 "DORMICUM ""ROCHE"" AMPOULES 5MG/ML" 24.3

BC19457216 "DORMICUM ""ROCHE"" AMPOULES 5MG/ML" 38.6

BC19475209 HALDOL DECANOAS 156

BC19488343 SKINOREN CREAM 215

BC19489533 PREMARIN VAGINAL CREAM 219

BC19489547 PREMARIN VAGINAL CREAM 406

BC194932AA LEUPLIN DEPOT 3.75MG S.C. INJECTION 4282

BC19499100 APO-HALOPERIDOL 10MG TABLET 3.28

BC19500100 APO-HALOPERIDOL 5MG TABLETS 2.5

BC19501100 APO-HALOPERIDOL 2MG TABLETS 1.5

BC19507100 MINAX 50 TABLETS 3.83

BC19508100 MINAX 100 TABLETS 4.61

BC19536414 VENTOLIN NEBULES 5MG PER 2.5ML INHALATION SOLUTION 6.3

BC19538100 GASTRO-TIMELETS 5.8

BC19557100 UNIPHYLLIN CONTINUS TABLETS 400MG 4.64

BC19567100 XANTHIUM 400MG CAPSULE 4.64

242

Page 243: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC19624100 XANTHIUM 200MG CAPSULES. 1.62

BC196241G0 XANTHIUM 200MG CAPSULES.(鋁箔/膠囊) 2

BC19626100 SIRDALUD TABLETS 2MG 1.99

BC19631100 APO-CAPTO 12.5MG TABLETS 1.57

BC19632100 APO-CAPTO 25MG TABLETS 1.57

BC19749100 SALAZOPYRIN EN-TABS 2.86

BC19763100 NITROCONTIN CONTINUS TABLETS 2.6MG 5.1

BC19768100 ALFAROL CAPSULES 0.25UG 4.91

BC19810100 DAPA-TABS 2.5MG 2.27

BC19836100 RYTMONORM 300MG FILM COATED TABLETS 21.2

BC19842100 SYSCOR 10, FILM-COATED TABLETS 22.6

BC19843100 ARATAC 100 TABLETS 2.05

BC19845221 ZAVEDOS 5MG 3747

BC19855100 ADALAT 10 CAPSULES 2

BC19856100 ADALAT 5 CAPSULES 2

BC19879100 SYNTOCRIPTINE TABLETS 6.9

BC19883100 MYDOCALM COATED TABLETS 1.95

BC19884100 SYSCOR 5, FILM-COATED TABLETS 17.4

BC19885100 CARDIZEM RETARD 90MG 6.3

BC19916245 LOSEC 40MG I.V. INJECTION 86

BC19918100 RYTMONORM 150MG FILM COATED TABLETS 10.8

BC19924221 PICIBANIL 5KE 2460

BC19947100 PRAMIN TABLETS 10MG 1.5

BC19953100 ISOPTIN SR 240MG FILM COATED TABLETS 7

BC19955209 KYTRIL 3MG IN 3ML 335

BC19955216 KYTRIL 3MG IN 3ML 717

BC19997245 LOSEC 40MG I.V. INFUSION 86

BC19999100 GLYADE 80MG TABLETS 1.5

BC20021229 PERDIPINE INJECTION 1MG/ML 223

BC20022335 LOMEXIN CREAM 2% 100

BC20037100 ZOCOR 20MG F.C.T. 6.7

BC20042335 LOMEXIN SPRAY 2% 117

BC20053500 LOMEXIN VAGINAL SUPPOSITORY 200MG 41.3

BC20144210 UNASYN IM/IV FOR INJECTION 0.75G & 1.5G 96

BC20144289 UNASYN IM/IV FOR INJECTION 0.75G & 1.5G 96

BC20157100 CATAFLAM 25MG SUGAR-COATED TABLETS 1.5

BC201571G0 CATAFLAM 25MG SUGAR-COATED TABLETS 2

BC20158100 CATAFLAM 50MG SUGAR-COATED TABLETS 1.5

BC20162100 SINEMET 25/250 TABLETS 12.3

BC20174100 BETALOC ZOK 100MG TABLETS 8.3

BC20198100 PROSCAR (FINASTERIDE) 5MG TABLET 20.6

BC20200314 ELOMET CREAM 0.1% 24.1

BC20200321 ELOMET CREAM 0.1% 41.3

BC20230343 DAIVONEX OINTMENT 521

BC20238100 CARDOL 160MG TABLETS 8.6

BC20249343 CLEOCIN T GEL 1% 186

BC20251100 SINEMET 25/100 TABLETS 5.6

BC20254100 COPONENT TABLET 2.28

BC20256116 BREXIN SACHETS 12.7

BC20266277 ERYTHROCIN LACTOBIONATE-I.V. 168

BC20295100 VALPRO 500 ENTERIC COATED TABLETS 10.4

BC20299100 VALPRO 200 ENTERIC COATED TABLETS 3.43

BC20323100 APO-RANITIDINE 150MG F.C. TABLETS 1.85

BC20389300 AFTACH 8.3

BC20452100 DILATREND TABLETS 25MG 6.2

243

Page 244: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC20454438 BECLOMET NASAL AQUA 100 MCG/DOSE NASAL SPRAY 234

BC20509100 LAMICTAL TABLETS 50MG 15.5

BC20510100 LAMICTAL TABLETS 100MG 24.1

BC20553100 ELMESATT TABLET 2MG 3.32

BC20554100 IMDUR CONTROLLED-RELEASE TABLETS 60MG 3.98

BC20576100 EUPHYLLIN RETARD FILM-COATED TABLETS 250MG 1.72

BC20630100 NITROCONTIN CONTINUS TABLETS 6.4 MG 9.3

BC20666221 AREDIA FOR INJECTION 3MG/ML 1378

BC20674100 CYTOTEC (MISOPROSTOL) 200MCG 11.2

BC20705100 NAVOBAN CAPSULES 5MG 362

BC20706265 AMINOSTERIL N HEPA 8% INFUSION SOLUTION 144

BC20706277 AMINOSTERIL N HEPA 8% INFUSION SOLUTION 220

BC20798100 KLIOGEST 3.83

BC20802100 NITROSTAT 0.6MG 2.92

BC20824209 MINIRIN SOLUTION FOR INJECTION 4MCG/ML 329

BC20825209 GLYPRESSIN 1MG 1107

BC20826100 MINIRIN TABLETS 0.1MG 41.7

BC208272AA DECAPEPTYL CR 4028

BC20843100 TRISEQUENS 3.83

BC20862100 CIPRAM TABLETS 20MG 15.7

BC20882100 VEPESID CAPSULES 50MG 372

BC20895100 VOLTAREN RETARD 75MG SLOW RELEASE FILM-COATED TABLETS 2.94

BC20903209 DEPO-PROVERA S.A.S. 150 MG/ML 121

BC20915417 TOBRADEX STERILE OPHTHALMIC OINTMENT 110

BC20932221 XYLOCAINE 2% FOR INTRAVENOUS INJECTION 50

BC20936238 CAVERJECT STERILE POWDER 585

BC20940209 NUTRIFLEX PERI 40/80 378

BC20943221 LASTET INJECTION 254

BC20951343 CLEOCIN T TOPICAL 1% SOLUTION 99

BC209712CX TAZOCIN 241

BC20975209 NUTRIFLEX 70/240 421

BC20975210 NUTRIFLEX 70/240 726

BC20990100 SALCOAT CAP. FOR SPRAY(0.05MG/266.65MG) 9.5

BC20991100 SIGMART TABLETS 5MG 4.3

BC20992100 SIGMART TABLETS 2.5MG 4.3

BC20999100 MYCOBUTIN 93

BC21026229 MITOMYCIN-C KYOWA 10MG 545

BC21027100 NEUROTOL SLOW TABLETS 300 MG 5.4

BC21028100 NEUROTOL SLOW TABLETS 200MG 2.53

BC21032229 LEUNASE INJECTION (10,000 K.U.) 986

BC21033100 KALMA TABLETS 0.50MG 1.5

BC21034100 KALMA TABLETS 1MG 3.44

BC21035100 KALMA TABLETS 0.25MG 1.5

BC21036221 LEUNASE INJECTION (5000K.U.) 548

BC21043100 FLORINEF TABLETS 0.1MG 7.6

BC21073248 ALKERAN INJECTION 1358

BC21083500 ASACOL SUPPOSITORIES 25.6

BC21093100 LAMICTAL DISPERSIBLE/CHEWABLE TABLETS 5MG 7.3

BC21128229 PRIMACOR I.V. INJECTION 387

BC21140100 XANAX TABLETS 0.5MG 1.5

BC211401G0 XANAX TABLETS 0.5MG(鋁箔/膠箔) 2

BC21144145 BUVENTOL EASYHALER 200MCG/DOSE INHALATION POWDER 416

BC21148429 BECONASE AQUEOUS NASAL SPRAY 118

BC21149100 PLENDIL EXTENDED RELEASE TABLETS 2.5MG 3.29

BC21150100 FARLUTAL TAB. 500MG 53

244

Page 245: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC21159100 SINEQUAN CAPSULES 25MG 2.05

BC21162100 SINEQUAN CAPSULES 10MG 1.62

BC211621G0 SINEQUAN CAPSULES 10MG(鋁箔/膠箔) 2

BC21165100 NOOTROPIL FILM-COATED TABLETS 1200MG 2.67

BC21174100 ALFACALCIDOL SOFT CAPSULES 0.25TY 4.91

BC21175100 ALFACALCIDOL SOFT CAPSULES 0.5 TY 9.8

BC21188100 SANDIMMUN NEORAL SOFT GELATIN CAP. 100MG 136

BC21189100 SANDIMMUN NEORAL SOFT GELATIN CAP. 25MG 41.2

BC21191216 SOMATOSAN 3MG FOR I.V. INFUSION "CURAMED" 1459

BC21198100 LESCOL CAPSULES 20MG 14.7

BC21199100 LESCOL CAPSULES 40MG 18.7

BC21218145 BECLOMET EASYHALER 200MCG/DOSE 472

BC21220100 MINIPRESS TABLET 2MG 3.53

BC21221100 MINIPRESS TABLET 1MG 1.54

BC212211G0 MINIPRESS TABLET 1MG(鋁箔/膠箔) 2

BC21223110 SEREVENT EVOHALER 25MCG/DOSE 464

BC21223116 SEREVENT EVOHALER 25MCG/DOSE 563

BC21224229 FENTANYL INJ. 0.05MG/ML 98

BC21234100 XANAX TABLETS 0.25MG 1.5

BC212341G0 XANAX TABLETS 0.25MG(鋁箔/膠箔) 2

BC21236212 ZOFRAN INJECTION 2MG/ML 191

BC21236219 ZOFRAN INJECTION 2MG/ML 217

BC21253100 SEGLOR 5MG CAPSULES 10.3

BC21263100 ZACTIN CAPSULES 20MG 2.77

BC21269421 TIMOLOL-POS EYE DROPS 0.5% 172

BC21270421 TIMOLOL-POS EYE DROPS 0.25% 73

BC21281100 KINSON TABLET 5.6

BC21298100 UNIPHYLLIN CONTINUS TABLETS 300MG 4.44

BC21303100 MIKELAN LA CAPSULES 15MG 13.6

BC21304263 ENDOXAN INJECTION 78

BC21304277 ENDOXAN INJECTION 156

BC21309435 PIRENOXINE FOR OPHTHALMIC T 64

BC21319100 DYNACIRC SRO CAPSULES 5MG 9.7

BC21325138 AIROMIR INHALER 100mcg/dose 131

BC21333216 STILAMIN 3MG 1459

BC21379265 UROKINASE-GCC INJECTION 250,000 I.U. 3519

BC21397251 NOOTROPIL I.V. INFUSION SOLUTION 200MG/ML 208

BC21416100 PACIFEN 25 TAB. 8.7

BC21422100 RANTUDIL CAPSULES 60MG 1.69

BC21423100 PACIFEN 10MG TAB. 1.5

BC21427345 TRAUMON GEL 106

BC21439212 ADENOCOR INJECTION 3MG/ML 137

BC21446421 CUSIMOLOL 0.5% STERILE EYE DROPS 172

BC21454100 TIOGAM TABLETS 200mg 3.27

BC21477423 FLIXONASE AQUEOUS NASAL SPRAY 50MCG/METERED SPRAY 168

BC21518426 SOFRADEX DROPS 61

BC21526100 DIMETRIOSE CAPSULES 186

BC21530100 "KERLONE 20MG 4.58

BC21531100 STILNOX F.C. TAB. 10MG 2.51

BC21536100 SEROXAT F.C. TABLETS 20MG 10.6

BC21545414 TIMOPTOL XE 0.5% OPHTHALMIC SOLUTION 172

BC21547116 SEREVENT ACCUHALER 50MCG/DOSE 892

BC21571100 NORVASC TABLETS 5MG 6.8

BC21575222 SUPREMON INJECTABLE SOLUTION 1349

BC21576221 DOXORUBICIN HYDROCHLORIDE INJECTION 2MG/ML "DBL" 515

245

Page 246: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC21576240 DOXORUBICIN HYDROCHLORIDE INJECTION 2MG/ML "DBL" 2458

BC21613100 ROXANE 75MG 12.3

BC21625100 TEMGESIC SUBLINGUAL TABLETS 0.2MG 22

BC21626209 TEMGESIC INJ. 0.3MG/ML 86

BC21628421 KARY UNI OPHTHALMIC SUSPENSION 29.8

BC21641100 DOXABEN TABLET 2MG 2.93

BC21643100 DOXABEN* TABLET 1MG 2.93

BC21644100 SINEMET CR 50/200 TABLETS 13.5

BC21663100 HALDOL TABLETS 5MG 2.5

BC21676100 DIFLUCAN CAPSULE 150MG 61

BC21686429 SUPREMON NASAL SOLUTION 2188

BC21689221 FLUOROURACIL INJECTION VIAL "DBL" 25.6

BC21689229 FLUOROURACIL INJECTION VIAL "DBL" 45.6

BC21689248 FLUOROURACIL INJECTION VIAL "DBL" 230

BC21695209 CYTARABINE INJECTION 100MG/ML "DBL" 109

BC21695221 CYTARABINE INJECTION 100MG/ML "DBL" 347

BC21695238 CYTARABINE INJECTION 100MG/ML "DBL" 1385

BC21696212 METHOTREXATE INJECTION "DBL" 89

BC21698100 XANAX XR EXTENDED-RELEASE TABLETS 0.5MG 1.5

BC216981G0 XANAX XR EXTENDED-RELEASE TABLETS 0.5MG(鋁箔/膠箔) 2

BC21699100 XANAX XR EXTENDED-RELEASE TABLETS 1MG 2.47

BC21701235 CARBOPLATIN INJECTION "DBL" 2632

BC217012AP CARBOPLATIN INJECTION "DBL" 5949

BC21713229 METHOTREXATE INJECTION BP 100MG/ML 869

BC21726100 HALCION TABLETS 0.25MG 1.96

BC217261G0 HALCION TABLETS 0.25MG(鋁箔/膠箔) 2

BC21729100 DIAFORMIN TAB. 2.23

BC21754100 NAPAMIDE F.C TABLETS 2.5MG 2.27

BC21757100 CELLCEPT CAPSULES 250MG 47.6

BC21776209 MAXIPIME INJ. (CEFEPIME) 425

BC21779100 DIFLUCAN CAPSULE 50MG 37.2

BC21780100 ZOLOFT FILM COATED TABLETS 50MG 11.7

BC21782248 CISPLATIN INJECTION "DBL" 350

BC21782255 CISPLATIN INJECTION "DBL" 350

BC21784335 METROGEL 0.75% 57

BC21784343 METROGEL 0.75% 134

BC21785335 NIZORAL CREAM2% 38.5

BC21788100 VALTREX TABLETS 500MG 72

BC21790100 ZAVEDOS CAPSULE 5MG 1494

BC21808100 BONEFOS CAPSULES 400MG 47.4

BC21809221 BONEFOS 60MG/ML CONCENTRATE FOR PARENTERAL INFUSION 733

BC21824435 ALLERGOCROM NASAL SPRAY SOLUTION 2.8MG/SPRAY 15ML 65

BC21830180 ZITHROMAX POWDER FOR ORAL SUSPENSION 268

BC21840100 TRAMAL RETARD 100MG 5.9

BC21845277 VANCOMYCIN HYDROCHLORIDE FOR INJECTION "DBL" 101

BC21847100 SABRIL FILM-COATED TABLETS 500MG 25.9

BC21848263 TARGOCID 200MG FOR INJECTION (I.M.I.V.) 728

BC21874414 MINIRIN NASAL SPRAY 10UG/DOSE 1791

BC21879248 SODIUM NITROPRUSSIDE FOR INTRAVENOUS INFUSION "DBL" 265

BC21880229 VINBLASTINE SULFATE INJECTION 1MG/ML "DBL" 625

BC21905100 RILUTEK 50MG TABLETS 158

BC21914100 COZAAR F.C.TAB. 50MG 9.3

BC21921135 FLIXOTIDE ACCUHALER 250MCG/DOSE 500

BC21927100 RIFINAH 300 S. C. TABLETS 13.5

BC21928100 RIFINAH 150 S.C. TABLETS 7.5

246

Page 247: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC21989138 PULMICORT TURBUHALER 200MICROGRAMS/DOSE 336

BC21989145 PULMICORT TURBUHALER 200MICROGRAMS/DOSE 394

BC21992229 LEUSTATIN INJECTION 9014

BC22008100 DEPAKINE CHRONO 500MG FILM COATED TABLETS 8.2

BC22013219 LEVOPHED BITARTRATE 145

BC22016100 KYTRIL 1MG F.C.TABLETS 232

BC22022255 AMINOSTERIL INFANT 6% W/V FOR INTRAVENOUS INFUSION 208

BC22023255 AMINOSTERIL INFANT 10% W/V FOR INTRAVENOUS INFUSION 227

BC22034343 DAIVONEX CREAM 521

BC22043100 PROGRAF CAPSULES 1MG 114

BC22044100 PROGRAF CAPSULES 5MG 480

BC22047209 VINCRISTINE SULPHATE INJECTION 1MG/1ML "DBL" 306

BC22049109 PULMICORT RESPULES 1MG/2ML NEBULISING SUSPENSION FOR

INHALATION

62

BC22060100 RIFATER S.C.TAB. 11.5

BC22064100 PROZAC 20MG DISPERSIBLE 2.77

BC22071100 DILATREND TAB. 6.25MG 4.08

BC22082148 BRICANYL TURBUHALER 0.5MG/DOSE 178

BC22082155 BRICANYL TURBUHALER 0.5MG/DOSE 334

BC22087240 HEPARIN "LEO" 92

BC22094143 RISPERDAL ORAL SOLUTION 1MG/ML 790

BC22097100 FOLIROMIN FILM-COATED TAB. 50MG 2.24

BC22107421 TRUSOPT OPHTHALMIC SOLUTION 2% 318

BC22115265 MEPEM INTRAVENOUS INJECTION 0.25G/VIAL 375

BC22115277 MEPEM INTRAVENOUS INJECTION 0.5G/VIAL 404

BC22117100 NEOTIGASON CAPSULES 25MG 71

BC22118100 NEOTIGASON CAPSULES 10MG 37.2

BC22124100 ACCUPRIL F.C. TABLETS 10 MG 9.8

BC22126100 ACCUPRIL F.C. TABLETS 20 MG 14.1

BC22131263 DACARBAZINE FOR INJECTION 200MG 879

BC22132229 METHOTREXATE INJECTION 1G/10ML "DBL" 869

BC221372CS ZOLADEX 3.6MG DEPOT 4311

BC22139100 PANTOLOC GASTRO-RESISTANT TAB. 40MG 18.4

BC221431G0 INDERAL TABLETS 10MG(84粒/瓶) 2

BC22144100 APO-ATENOL 100MG TABLETS 1.6

BC22151100 ZESTRIL TABLETS 5MG 3.66

BC22152100 ZESTRIL TABLETS 10MG 3.66

BC22154100 NOLVADEX TABLETS 10MG 3.06

BC22156100 PAXAM 2 TABLET 2.66

BC22158100 APO-ATENOL 50MG TABLETS 1.56

BC22159100 TENORMIN TABLETS 100MG 1.6

BC221591G0 TENORMIN TABLETS 100MG(鋁箔/膠箔) 2

BC22160100 TENORMIN TABLETS 50MG 1.56

BC221601G0 TENORMIN TABLETS 50MG(鋁箔/膠箔) 2

BC22177203 CLEXANE INJECTION 130

BC22179100 FAMVIR 84

BC22193100 ELDEPRYL TABLETS 10MG 6.5

BC22198209 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE 168

BC22198210 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE 157

BC22198212 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE 184

BC22198214 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE 201

BC22198221 DIANEAL PD-2 PERITONEAL DIALYSIS SOLUTION 2.5% DEXTROSE

"BAXTER"

286

BC22199209 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE 168

BC22199210 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE 157

247

Page 248: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC22199212 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE 184

BC22199214 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE 201

BC22199221 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION 1.5% DEXTROSE

"BAXTER"

286

BC22208100 TEGRETOL TABLETS 200MG 2.79

BC22211100 ELDEPRYL TABLETS 5MG 3.64

BC22214221 LEUCOVORIN CALCIUM INJECTION 50MG/5ML "DBL" 101

BC22214229 LEUCOVORIN CALCIUM INJECTION 50MG/5ML "DBL" 145

BC22215209 NAVELBINE 10MG/ML INJECTION SOLUTION 1374

BC22215221 NAVELBINE 10MG/ML INJECTION SOLUTION 6850

BC22218209 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25% DEXTROSE

"BAXTER"

168

BC22218210 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25% DEXTROSE

"BAXTER"

157

BC22218212 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25% DEXTROSE

"BAXTER"

184

BC22218214 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25% DEXTROSE

"BAXTER"

201

BC22218221 DIANEAL PD-2, PERITONEAL DIALYSIS SOLUTION WITH 4.25% DEXTROSE

"BAXTER"

286

BC22229100 AZATHIOPRINE 50 PCH TAB. 21.5

BC22232277 CYMEVENE LYOPHILIZED IV INJECTION 500MG/VIAL 1512

BC222332D1 ZOLADEX LA 10.8MG DEPOT 15208

BC22251229 ACICLOVIR INTRAVENOUS INFUSION "DBL" 505

BC22251238 ACICLOVIR INTRAVENOUS INFUSION "DBL" 856

BC22282100 ARIMIDEX TABLETS 1MG 81

BC22283421 TARIVID OTIC SOLUTION 75

BC22297210 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 1.5% DEXTROSE "BAXTER"

157

BC22297212 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 1.5% DEXTROSE "BAXTER"

184

BC22297214 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 1.5% DEXTROSE "BAXTER"

201

BC22297221 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 1.5% DEXTROSE "BAXTER"

286

BC22298210 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 4.25% DEXTROSE "BAXTER"

157

BC22298212 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 4.25% DEXTROSE "BAXTER"

184

BC22298214 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 4.25% DEXTROSE "BAXTER"

201

BC22298221 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 4.25% DEXTROSE "BAXTER"

286

BC22299210 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 2.5% DEXTROSE "BAXTER"

157

BC22299212 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 2.5% DEXTROSE "BAXTER"

184

BC22299214 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 2.5% DEXTROSE "BAXTER"

201

BC22299221 DIANEAL LOW CALCIUM (2.5MEQ/L) PERITONEAL DIALYSIS SOLUTION

WITH 2.5% DEXTROSE "BAXTER"

286

BC22310100 FARESTON TABLETS 60MG 25.8

BC22318265 CLAFORAN IV INJECTION 0.25G 98

BC22319209 CLAFORAN IV INJECTION 0.5/1.0G 166

BC22319277 CLAFORAN IV INJECTION 0.5/1.0G 116

248

Page 249: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC22320212 CLAFORAN IV INJECTION 2.0G 542

BC22324100 ZYPREXA FILM COATED TABLETS 5MG 68

BC22326100 ZYPREXA FILM COATED TABLETS 10MG 131

BC22337100 PAXAM TABLETS 0.5MG 1.5

BC22342100 PENTASA PROLONGED-RELEASE TABLETS 500MG 10.7

BC22354280 CLEXANE INJECTION 152

BC22365100 UNIPHYLLIN CONTINUS TABLETS 200MG 1.62

BC22366100 SEFTEM CAPSULES 17.3

BC22372421 CILOXAN STERILE OPHTHALMIC SOLUTION 119

BC22376100 PLAQUENIL TABLETS 200MG 2.72

BC22380221 TRENTAL INJECTION 54

BC22393277 "B.BRAUN" AMINOPLASMAL HEPA 10% 281

BC22395271 DEPAKINE LYOPHILIZED INJECTION 400MG/VIAL 334

BC22398100 ACCOLATE TABLETS 20MG 19.6

BC22408100 XELODA TABLETS 150MG 31

BC22409100 XELODA TABLETS 500MG 103

BC22420100 KLARICID FILM-COATED 500MG TABLETS 21.7

BC22438100 APO-FLUOXETINE CAPSULES 20MG 2.77

BC224421G0 DAONIL TABLETS 5MG(鋁箔/膠箔) 2

BC224471E1 AUGMENTIN SYRUP 457MG/5ML /35ML 81

BC22449219 HYCAMTIN 4MG INJECTION 8781

BC22462100 FEMARA FILM-COATED TABLETS 2.5MG 47.4

BC22473212 CAMPTO CONC. SOLUTION FOR I.V. INFUSION 2729

BC22473221 CAMPTO CONC. SOLUTION FOR I.V. INFUSION 5677

BC22483277 DESFERRIOXAMINE MESYLATE FOR INJECTION 500MG "DBL" 266

BC225015FR MIRENA (LEVONORGESTREL 20UG/24H) INTRAUTERINE SYSTEM 4195

BC22507100 TOPAMAX FILM-COATED TABLETS 50MG 20.1

BC22508100 TOPAMAX FILM-COATED TABLETS 100MG 38.1

BC22509100 TOPAMAX FILM-COATED TABLETS 25MG 9.6

BC22510100 TOPAMAX FILM-COATED TABLETS 200MG 73

BC22535100 LASIX TABLETS 40MG 1.5

BC225351G0 LASIX TABLETS 40MG(鋁箔/膠箔) 2

BC22540414 XALATAN 50UG/ML (0.005%) 518

BC22542100 SEROQUEL TABLETS 100MG 29.1

BC22543100 SEROQUEL TABLETS 25MG 14.9

BC22544100 SEROQUEL TABLETS 200MG 38.8

BC22551100 APROVEL 150MG FILM-COATED TABLETS 9.2

BC22553100 BETAC TABLETS 20MG 4.58

BC22559173 RESONIUM-A POWDER 925

BC22587321 DIFFERIN GEL 0.1% 22.9

BC22587335 DIFFERIN GEL 0.1% 96

BC22593100 ATANAAL CAPSULE 5 2

BC22600321 ESPERSON OINTMENT 0.25% 32.1

BC22600329 ESPERSON OINTMENT 0.25% 73

BC22606248 AGGRASTAT CONCENTRATE FOR INFUSION 7425

BC22610100 ALDACTONE TABLETS 25MG 1.5

BC226101G0 ALDACTONE TABLETS 25MG(鋁箔/膠箔) 2

BC22612100 AUGMENTIN 1G F.C. TABLETS 9.4

BC22617100 DURIDE CR TABLETS 60MG 3.98

BC22622100 SIBELIUM CAPSULES 5MG 1.62

BC226221G0 SIBELIUM CAPSULES 5MG(鋁箔/膠箔) 2

BC22635421 ALPHAGAN OPHTHALMIC SOLUTION 0.2% 275

BC22641100 NOVONORM 1MG TABLETS 3.42

BC22653421 ACULAR OPHTHALMIC SOLUTION 0.5% W/V 126

BC22654100 LIPANTHYL 200M CAP. 6.5

249

Page 250: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC22655243 SANDOSTATIN LAR MICROSPHERES FOR INJECTION 30MG 48487

BC22657238 SANDOSTATIN LAR MICROSPHERES FOR INJECTION 20MG 36228

BC22658100 DOSTINEX TABLETS 0.5MG 135

BC22662100 GLYFORMIN 500 TABLETS 1.5

BC226621G0 GLYFORMIN 500 TABLETS(鋁箔/膠箔) 2

BC22663100 GLYFORMIN 850 TABLETS 2.23

BC22671100 AMARYL 2.0 TABLETS 3.47

BC22678100 CARDIZEM UNOTARD PROLONGED RELEASE TABLETS 180MG 12

BC22681212 EXACIN INJECTION 200 166

BC22722100 SELGENE TAB. 5MG 3.64

BC22725100 PRIMOLUT-NOR TABLETS 5 MG 2.12

BC22726100 METHOTREXATE SODIUM TABLETS 2.5MG 4.82

BC22727209 BUSCOPAN AMPOULES 15

BC22728100 SURGAM TABLET 200MG 3.27

BC22732248 FLUDARA LYOPHILIZED IV INJECTION 6050

BC22754329 NERISONE FATTY OINTMENT 50

BC22767100 Risperdal Film Coated Tablet 1mg 15.5

BC22768100 RISPERDAL Film Coated TABLET 2MG 18.6

BC22769100 Risperdal Film Coated Tablet 3mg 41.7

BC22770221 NIMBEX INJECTION 2MG/ML 61

BC22778100 SINGULAIR FILM COATED TABLETS 10MG 25.6

BC22779100 SINGULAIR CHEWABLE TAB. 5MG 19

BC22781100 PARIET ENTERIC-COATED TABLETS 10 MG 10.9

BC22782100 PARIET ENTERIC-COATED TABLETS 20MG 14.1

BC22783100 DETRUSITOL F.C. TAB. 2MG 13.4

BC22784100 DETRUSITOL F.C. TAB. 1MG 9.2

BC22786100 ACTIVELLE 3.44

BC22790238 INNOHEP INJ. 10000 ANTI-XA IU/ML IN VIALS 374

BC22792406 FLIXOTIDE NEBULES 0.5MG/2ML 62

BC22793412 FLIXOTIDE NEBULES 2MG/2ML 122

BC22796421 OFTALMOLOSA CUSI GENTAMICIN 0.3% 27

BC22803100 CASODEX TABLETS 50MG 132

BC228121G0 ISMN STADA 20(鋁箔/膠箔) 2

BC22816100 SPORANOX CAPSULES 100MG 23.7

BC228204E5 NASACORT AQ 221

BC22821100 NEURONTIN CAPSULES 300MG 10.2

BC22822100 NEURONTIN CAPSULES 400MG 12.4

BC22823100 NEURONTIN CAPSULES 100MG 3.89

BC22840212 LASIX 20MG SOLUTION FOR INJECTION 15

BC22842100 ARTHROTEC 75 TABLET 6.8

BC22843100 APROVEL 300MG FILM-COATED TABLETS 15.9

BC22856421 EMADINE STERILE OPHTHALMIC SOLUTION 66

BC22858100 EXELON CAP. 3MG 36.2

BC22859100 EXELON CAP. 6MG 36.2

BC22861100 EXELON CAP. 1.5MG 36.2

BC22863100 EXELON CAP. 4.5MG 36.2

BC22868238 FRESOFOL 1% MCT/LCT 64

BC22868248 FRESOFOL 1% MCT/LCT 203

BC22874255 LIPOVENOES MCT 20% EMULSION FOR INFUSION 215

BC22874265 LIPOVENOES MCT 20% EMULSION FOR INFUSION 225

BC22877100 DIANE-35 S.C. TABLETS 7.8

BC22882100 REQUIP FILM-COATED TAB. 0.25MG 6.3

BC22883100 REQUIP FILM-COATED TAB. 1MG 16.7

BC22884100 REQUIP FILM-COATED TAB. 2MG 26.8

BC22885100 REQUIP FILM-COATED TABLETS 5MG 68

250

Page 251: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC22886100 LIPITOR FILM-COATED TABLETS 10MG 19.5

BC22889100 LIPITOR FILM-COATED TABLETS 40MG 34.1

BC22890100 LIPITOR FILM-COATED TABLETS 20MG 30

BC22893100 LIPIGEM TABLETS. 600MG 2.68

BC22915212 "BAXTER" NUTRINEAL PD4 WITH 1.1% AMINO ACID 312

BC22917100 XATRAL XL 10MG 8.7

BC22919351 CLEOCIN T TOPICAL LOTION 1% 223

BC22923277 LIPOVENOES MCT 10% EMULSION FOR INFUSION 225

BC22924424 NASONEX AQUEOUS NASAL SPRAY 199

BC22927100 MEDOVIR 400MG TABLETS 7.9

BC22931116 CURAM POWDER FOR ORAL SUSPENSION 312.5MG/5ML 88

BC22932100 PLAVIX FILM-COATED TABLETS 75MG 47.1

BC22934421 AZOPT 1% STERILE OPHTHALMIC SUSPENSION 308

BC22962100 CONTROLOC GASTRO-RESISTANT TABLETS 20MG 14.8

BC22982216 SOMATOSTATIN 3MG FERRING 1459

BC22987421 ELEBLOC 2% EYE CROPS 200

BC22989100 HYZAAR F.C TAB. 50/12.5MG 9.3

BC22995100 ESTRACYT CAPSULES 140MG 52

BC22996277 AMINOPLASMAL 10% 212

BC22997100 PROGOR CAPSULE 180MG 12

BC23000216 APO-GO PEN 10MG/ML 1120

BC23001100 PROGOR CAPSULE 120MG 6.3

BC23010100 ALLEGRA TABLETS 180MG 7.2

BC23012500 MYCORIL 100 VAGINAL TABLETS 9

BC23016100 ALLEGRA 60MG TAB. 2.87

BC23029100 ONEALFA TABLET 1.0 MCG 13.7

BC23031100 ONEALFA TABLET 0.5MCG 9.8

BC23057151 RAPAMUNE ORAL SOLUTION 1MG/ML 8994

BC230601E4 OXIS TURBUHALER 9UG/DOSE 874

BC23071100 FRISIUM TABLET 10MG 3.01

BC23074163 BEROTEC N 100MCG/PUFF METERED AEROSOL 146

BC23076277 2.5% DEXTROSE AND 0.45% SODIUM CHLORIDE INJECTION USP 25

BC23078100 KLARICID XL TAB. 500MG 27

BC23086100 PROGRAF CAPSULES 0.5MG 63

BC23087209 NORMAL SALINE (SODIUM CHLORIDE INTRAVENOUS INFUSION B.P.) 25.4

BC23097100 AROMASIN SUGAR COATED TABLETS 25MG 57

BC23105209 AZACTAM FOR INJECTION 488

BC23105277 AZACTAM FOR INJECTION 303

BC23106277 5% GLUCOSE INTRAVENOUS INFUSION B.P. 25.1

BC23109100 CO-DIOVAN 80/12.5 FILN COATED TAB. 10.1

BC23115435 CUSICROM 4% NASAL SPRAY 86

BC23116277 AMINOPLASMAL- 5% E 118

BC23125100 MIZOLLEN FILM-COATED TAB. 10MG 8.7

BC23128100 BLOPRESS TAB. 8MG 9.7

BC23133100 ONEALFA TAB. 0.25MCG 4.91

BC23134100 TRAMADOL 50 STADA CAPSULES 3.88

BC23135100 HYDREA CAPSULES 500MG 18.7

BC23150377 FLAMAZINE CREAM 519

BC23161100 MICARDIS TABLETS 80MG 20.1

BC23162100 MICARDIS TABLETS 40MG 12

BC23167100 FOSAMAX TABLETS 70MG 221

BC23177100 CELEBREX CAPSULE 200MG 14.4

BC23178212 PRIMPERAN 10MG/2ML INJECTABLE SOLUTION 15

BC23179100 DETANTOL R.F.C TAB. 3MG 8.3

BC23181100 ZYVOX TABLETS 600MG 1395

251

Page 252: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC23186266 ZYVOX INJECTION 1642

BC23196100 NEURAMIN CAPSULES 500UG 1.76

BC23202127 SERETIDE 100 ACCUHALER INHALATION POWDER 60DOSE 727

BC23203137 SERETIDE 250 ACCUHALER INHALATION POWDER 60DOSE 946

BC23206100 ACTOS TAB. 30MG 22.1

BC23207100 ACTOS TABLETS 15MG 15.8

BC23208100 REBETOL CAPSULE 13.7

BC23210212 "BAXTER"CLINIMIX N14G30E SOLUTION FOR INFUSION 703

BC23215100 FENOGAL 200MG LIDOSE 6.5

BC23218210 "BAXTER"CLINIMIX N17G35E SOLUTION FOR INFUSION 539

BC23220100 CO-DIOVAN 160/12.5 FILM COATED TABLETS 12.7

BC23221100 NEXIUM TAB. 40MG 15.1

BC23223100 AVELOX FILM-COATED TAB. 400MG 106

BC23224210 "BAXTER"CLINIMIX N9G15E SOLUTION FOR INFUSION 437

BC23225100 NEXIUM TAB.20MG 4.75

BC23232100 ASACOL TABLETS 12.1

BC23244100 STARLIX FILM-COATED TAB. 60MG 3.52

BC23245100 STARLIX FILM-COATED TAB. 120MG 4.09

BC23248100 COMTAN FILM-COATED TAB. 200MG 22.1

BC23257100 ZITHROMAX 250M TABLETS 35.1

BC232621EL SYMBICORT TURBUHALER 80/4.5UG/DOSE 120 DOSES/BOT 1063

BC232651E7 SYMBICORT TURBUHALER 160/4.5UG/DOSE 120 DOSES/BOT 1186

BC23266100 COAPROVEL 150MG/12.5MG FILM-COATED TABLETS 7.7

BC23267100 COAPROVEL 300MG/12.5MG FILM-COATED TABLES 13.7

BC23276100 REMERON TABLET 15MG 11.8

BC23277100 REMERON TABLET 45MG 28.3

BC23278100 REMERON TAB. 30MG 21.3

BC23279100 MIRAPEX TAB. 0.125MG 6.8

BC23280100 MIRAPEX TAB. 0.25MG 12

BC23282100 MIRAPEX TAB. 1MG 44.3

BC23291100 GLIVEC CAPSULES 100MG 626

BC23293100 ZANIDIP F.C TAB. 10MG 8.4

BC23298263 GEMZAR 1086

BC23306245 PANTOLOC I.V 201

BC233104E8 PULMICORT NASAL AQUA 64UG/DOSE 120DOSE 179

BC23323100 TEMODAL CAPSULES 20MG 792

BC23324100 TEMODAL CAPSULES 100MG 3761

BC23335100 MESULID TAB. 100MG 3.37

BC23337421 COSOPT OPHTHALMIC SOLUTION 403

BC23340265 "BAXTER" DOPAMINE HYDROCHLORIDE AND 5% DEXTROSE INJECTION

(1600MCG/ML)

130

BC23341265 "BAXTER" DOPAMINE HCL AND 5% DEXTROSE INJ. (800MCG/ML) 106

BC23345321 PROTOPIC OINTMENT 0.03% 219

BC23345329 PROTOPIC OINTMENT 0.03% 439

BC23345343 PROTOPIC OINTMENT 0.03% 1353

BC23346321 PROTOPIC OINTMENT 0.1% 239

BC23346329 PROTOPIC OINTMENT 0.1% 507

BC23346343 PROTOPIC OINTMENT 0.1% 1417

BC23349116 SMECTA,POWDER FOR ORAL SUSPENSION 6.4

BC23357114 COMBIVENT UDV INHALATION SOLUTION 20.3

BC23361265 """BAXTER"" DOPAMINE HYDROCHLORIDE AND 5% DEXTROSE INJECTION

(3200MCG/ML)"

229

BC23363100 RAPAMUNE TABLETS 1MG 146

BC23369100 REMINYL FILM COATED TABLETS 4MG 33.3

BC23370100 REMINYL FILM COATED TABLETS 8MG 34.8

252

Page 253: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC23371100 REMINYL FILM COATED TABLETS 12MG 34.8

BC23373100 DIOVAN FILM-COATED TAB. 80MG 10.1

BC23374100 DIOVAN FILM-COATED TABLETS 160MG 12.7

BC23380100 TOPAMAX SPRINKLE CAP. 15MG 6.6

BC23381100 TOPAMAX SPRINKLE CAP. 25MG 9.6

BC23382100 TOPAMAX SPRINKLE CAP. 50MG 20.1

BC23388248 AMBISOME FOR INJECTION 6182

BC23396221 ANZATAX INJECTION CONCENTRATE 1388

BC23396240 ANZATAX INJECTION CONCENTRATE 8989

BC23396248 ANZATAX INJECTION CONCENTRATE 22960

BC233962E2 ANZATAX INJECTION CONCENTRATE 3774

BC23398100 SINGULAIR CHEWABLE TAB. 4MG 17.4

BC23403343 SILKIS OINTMENT 375

BC23404221 FLUORO-URACIL GERMANY 32

BC23404229 FLUORO-URACIL GERMANY 57

BC23404238 FLUORO-URACIL GERMANY 115

BC23414110 CURAM POWDER FOR ORAL SUSPENSION 84

BC23422414 TRAVATAN OPHTHALMIC SOLUTION 0.004% 539

BC23428100 WELLBUTRIN SUSTAINED-RELEASE TABLET 150MG 24

BC23462129 FORLAX 10GM 6.8

BC23468255 INTEGRILIN INJECTION 0.75MG/ML 3299

BC23470100 GEODON CAPSULES 60MG 45.6

BC23471100 GEODON CAPSULES 40MG 45.6

BC23473129 BERODUAL N METERED AEROSOL 301

BC23479235 VISUDYNE POWDER FOR SOLUTION FOR INFUSION 15MG/VIAL 41941

BC23480127 SERETIDE 50 EVOHALER 120DOSE 727

BC23481157 SERETIDE 250 EVOHALER 120DOSE 1267

BC23482137 SERETIDE 125 EVOHALER 120DOSE 946

BC23484100 UFT CAPSULES 58

BC23485248 CANCIDAS INJECTION 50MG 8542

BC23489100 ZITROMAX AVIUM 600 129

BC23492100 SOLIAN TAB. 200MG 30.7

BC23493100 SOLIAN TABLET 50MG 11.1

BC23506100 ZOCOR 40MG F.C.TABLETS 15.7

BC23518100 TRITACE 2.5MG TABLETS 9

BC23521421 ALEGYSAL OPHTHALMIC SOLUTION 77

BC23522100 TRILEPTAL FILM COATED TABLETS 600MG 19.7

BC23524100 TRILEPTAL FILM COATED TABLETS 300MG 11

BC23537414 XALACOM EYE DROPS 656

BC23538123 TRILEPTAL 6% ORAL SUSPENSION(100ML) 414

BC23538135 TRILEPTAL 6% ORAL SUSPENSION(250ML) 1062

BC23546321 BETNOVATE-N OINTMENT 5GM 24.1

BC23548100 SALAGEN TABLETS 5MG 23.2

BC23556100 LESCOL XL FILM-COATED TABLETS 80MG 16.8

BC23557329 ISOTREX CREAM 0.1% 60

BC23557345 ISOTREX CREAM 0.1% 220

BC23559100 MEGLUCON 500 FILM-COATED TABLETS 1.5

BC23564100 NOTEN 50MG TAB. 1.56

BC23568100 DETRUSITOL SR PROLONGED-RELEASE CAPSULES 4MG 30.1

BC23570100 EFEXOR XR 150MG CAPSULES 65

BC23571100 EFEXOR XR 75MG CAPSULES 20

BC23572100 ORFARIN TABLETS 5MG 3.78

BC23573100 ORFARIN TABLETS 3MG 2.13

BC23596100 MEVALOTIN PROTECT 40MG TABLETS 22.8

BC23597100 MEVALOTIN PROTECT 20MG TABLETS 10.6

253

Page 254: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC23603100 TRITACE 10MG TABLETS 9

BC23613335 DIFFERIN CREAM 0.1% 96

BC23614129 ATROVENT N 20MCG/PUFF METERED AEROSOL 170

BC23615100 ARAVA 10MG FILM-COATED TABLETS 46.1

BC23617100 ARAVA 100MG FILM-COATED TABLETS 376

BC23632100 INDIVINA TABLET 1MG/2.5MG 6.5

BC23633221 PAMISOL CONCENTRATED INJECTION 3MG/ML 1378

BC23633229 PAMISOL CONCENTRATED INJECTION 3MG/ML 1579

BC23634229 PAMISOL CONCENTRATED INJECTION 9MG/ML 3719

BC23635229 PAMISOL CONCENTRATED INJECTION 6MG/ML 3719

BC23645329 ELIDEL 1% CREAM 379

BC23645335 ELIDEL 1% CREAM 15GM 491

BC23645343 ELIDEL 1% CREAM 30GM 794

BC23646100 VFEND FILM-COATED TABLETS 200MG 1287

BC23647100 VFEND FILM-COATED TABLETS 50MG 366

BC23648263 VFEND 200MG FOR SOLUTION FOR INJECTION 4497

BC23649100 MICARDIS PLUS TABLETS 80/12.5 MG 16.8

BC23654100 MICARDIS PLUS TABLETS 40/12.5MG 9.6

BC23655100 COZAAR F.C. TABLETS 100MG 11.1

BC23661100 SILVINOL TABLETS 5M 4.3

BC23671100 NEURONTIN F.C TABLETS 800MG 26.5

BC23672100 NEURONTIN F.C. TABLETS 600MG 17.5

BC23687212 "BAXTER" EXTRANEAL PERITONEAL DIALYSIS SOLUTION WITH 7.5%

ICODEXTRIN

334

BC23688421 QUINAX STERILE OPHTHALMIC SOLUTION 45.8

BC23688435 QUINAX STERILE OPHTHALMIC SOLUTION 144

BC23695421 ALPHAGAN P OPHTHALMIC SOLUTION 0.15% 263

BC23695429 ALPHAGAN P OPHTHALMIC SOLUTION 0.15% 513

BC23697100 CETIRIZIN HEXAL BEI ALLERGIEN FILM-COATED TABLETS 10MG 1.5

BC23708100 "ABBOTT" ISOPTIN 40MG FILM COATED TABLETS 1.66

BC237081G0 "ABBOTT" ISOPTIN 40MG FILM COATED TABLETS (鋁箔/膠箔) 2

BC237092EP KABIVEN PI, EMULSION FOR INFUSION(依仿單含熱量1000KCAL) 914

BC237092ES KABIVEN PI, EMULSION FOR INFUSION(依仿單含熱量1400KCAL) 1248

BC237102EQ KABIVEN EMULSION FOR INFUSION(依仿單含熱量900KCAL) 917

BC237102ER KABIVEN EMULSION FOR INFUSION(依仿單含熱量1400KCAL) 1152

BC237102ET KABIVEN EMULSION FOR INFUSION(依仿單含熱量1900KCAL) 1357

BC23711100 DOXABEN XL TABLETS 4MG 14.9

BC23712265 AVELOX INFUSION SOLUTION 400MG/250ML 833

BC23728248 CRAVIT IV SOLUTION FOR INFUSION 5MG/ML 542

BC23728255 CRAVIT IV SOLUTION FOR INFUSION 5MG/ML 1024

BC23729100 CRAVIT 500MG F.C. TABLETS 50

BC23730100 MEGLUCON 850 FILM-COATED TABLETS 2.23

BC23731100 CONCERTA EXTENDED RELEASE TABLETS 18MG 35

BC23733219 ZOMETA POWDER FOR SOL. FOR INFUSION 11161

BC23735100 ZOLDEM 10 F.C. TAB. 2.51

BC23737100 MYFORTIC 180MG GASTRO-RESISTANT TAB. 48

BC23738100 MYFORTIC 360MG GASTRO-RESISTANT TAB. 92

BC23740429 IMIGRAN NASAL SPRAY 10MG 181

BC23741438 IMIGRAN NASAL SPRAY 20MG 182

BC23749209 INVANZ 1G INJECTION 959

BC23755123 FLIXOTIDE EVOHALER 50 MCG 213

BC23756210 MOBIC INJ. 15MG/1.5ML 30.3

BC23757100 PRETERAX SCORED TABLETS 11

BC23758100 ACERTIL PLUS TABLETS 10.6

BC23770100 LIPANTHYL SUPRA 160MG FILM-COATED TABLET 6.5

254

Page 255: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC23771100 GINKOID TABLETS 2.24

BC23773321 CUTIVATE CREAM 0.05% (FLUTICASONE) 36.9

BC23773335 CUTIVATE CREAM 0.05% (FLUTICASONE) 84

BC23779100 MXL CAPSULES 60MG 95

BC23781421 TIMOLAST 0.5% OPHTHALMIC GEL FORMING SOLUTION 172

BC23782421 TIMOLAST 0.25% OPHTHALMIC GEL FORMING SOLUTION 73

BC23785229 BUSULFEX INJECTION 7331

BC23792100 XYZAL FILM-COATED TABLETS 5MG 4.72

BC23793421 ZADITEN 0.25MG/ML EYE DROPS 83

BC237941EW KLARICID PAEDIATRIC SUSPENSION 125MG/5ML,70ML 255

BC23799100 BETALOC ZOK 25MG 5.4

BC23800221 DOBUJECT 50MG/ML CONCENTRATE FOR PARENTERAL INFUSION 182

BC23808100 IRESSA FILM-COATED TABLETS 250MG 1251

BC23839340 DERMOVATE CREAM 88

BC23840340 DERMOVATE OINTMENT 88

BC23854343 ZORAC TOPICAL CREAM 0.1% 531

BC23855335 ZORAC TOPICAL CREAM 0.05% 290

BC23855343 ZORAC TOPICAL CREAM 0.05% 522

BC23857240 RISPERDAL CONSTA 25MG SUSPENSION FOR I.M INJECTION 3260

BC23858248 RISPERDAL CONSTA 50MG SUSPENSION FOR I.M INJECTION 5838

BC238592EV RISPERDAL CONSTA 37.5MG SUSPENSION FOR I.M INJECTION 4355

BC23873209 FLUCLOXIN INJECTION 81

BC23873277 FLUCLOXIN INJECTION 42.8

BC23878209 AMINOFLUID 303

BC23880100 CONCERTA EXTENDED RELEASE TABLETS 36MG 62

BC23885100 HEPRIN CAPSULES 1.57

BC23888100 KEPPRA FILM-COATED TABLETS 250MG 18.6

BC23889100 KEPPRA FILM-COATED TABLETS 500MG 29.1

BC23898100 FLUIMUCIL A 600MG EFFERVESCENT TABLETS 6.6

BC23901212 BALANCE 1.5% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL DIALYSIS

SOLUTION

201

BC23901214 BALANCE 1.5% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL DIALYSIS

SOLUTION

226

BC23906212 BALANCE 4.25% GLUCOSE, 1.75MMOL/L CALCIUM, PERITONEAL DIALYSIS

SOLUTION

201

BC23907212 BALANCE 2.3% GLUCOSE, 1.75MMOL/L CALCIUM, PERITONEAL DIALYSIS

SOLUTION

201

BC23907214 BALANCE 2.3% GLUCOSE, 1.75 MMOL/L CALCIUM, PERITONEAL DIALYSIS

SOLUTION

226

BC23912100 ZYPREXA ZYDIS 10MG ORODISPERSIBLE TABLETS 131

BC23913100 ZYPREXA ZYDIS 5MG ORALLY DISINTEGRATING TABLETS 68

BC23917100 ULTRACET TABLETS 6.2

BC23919100 AGGRENOX MEDIFIED RELEASE CAPSULES 7.8

BC23920100 HEPSERA TABLETS 173

BC23921100 PMS-ZOPICLONE 7.5MG TABLETS 2.89

BC23922100 CO-DIOVAN 160/25 FILM-COATED TABLETS 12.7

BC23923251 SOMATULINE AUTOGEL 60MG PROLONGED RELEASE SOLUTION FOR

INJECTION IN PRE-FILLED SYRINGE

26533

BC23924254 SOMATULINE AUTOGEL 90MG PROLONGED RELEASE SOLUTION FOR

INJECTION IN PRE-FILLED SYRINGE

39678

BC23925257 SOMATULINE AUTOGEL 120MG PROLONGED RELEASE SOLUTION FOR

INJECTION IN PRE-FILLED SYRINGE

48835

BC23936343 DAIVOBET OINTMENT 674

BC23952100 AVODART SOFT CAPSULES 0.5MG 38.8

BC23959100 LEXAPRO TABLETS 5MG 12.1

255

Page 256: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC23960100 LEXAPRO TABLETS 10MG 21.8

BC23964453 OTOZAMBON EAR DROPS 106

BC23969216 FLUIMUCIL 300MG/3ML INJECTABLE SOLUTION 15

BC23970100 SIMVAHEXAL FILM-COATED TABLETS 20MG 6.7

BC23974126 MONUROL 3G GRANULES 130

BC239801E7 SYMBICORT TURBUHALER 320/9UG/DOSE 60 DOSES/BOT 1186

BC23981100 ARCOXIA TABLET 90MG 16.6

BC23983100 ARCOXIA TABLET 60MG 16.6

BC23985100 EMEND CAPSULES 80MG 687

BC23986100 EMEND CAPSULES 125MG 687

BC23999100 CONCERTA EXTENDED RELEASE TABLETS 27MG 48.1

BC24002212 PRECEDEX INJECTION 100MCG/ML 938

BC24005100 GLUCOVANCE TABLETS 500MG/2.5MG 2.66

BC24006100 GLUCOVANCE TABLETS 500MG/5MG 2.66

BC24009100 REMERON SOL TAB. 30MG 21.3

BC24015100 CITALOPRAM HEXAL FILM-COATED TABLETS 20MG 15.7

BC24016100 LOXAMINE TAB.20MG 10.6

BC24025100 ASPIRIN PROTECT 100 1.5

BC240251G0 ASPIRIN PROTECT 100(鋁箔/膠箔) 2

BC24027100 GLIVEC FILM-COATED TABLETS 100MG 626

BC24039100 CONCOR 1.25 2.92

BC24041277 GELOFUSINE 240

BC24046100 OTSUKA ABILIFY TABLETS 5MG 44.8

BC24047100 OTSUKA ABILIFY TABLETS 10MG 83

BC24048100 OTSUKA ABILIFY TABLETS 15MG 83

BC24049100 OTSUKA ABILIFY TABLETS 20MG 111

BC24050100 OTSUKA ABILIFY TABLETS 30MG 111

BC24058100 EZETROL TABLETS 10MG 36.1

BC24062229 ISOKET SOLUTION 0.1% SOLUTION FOR INFUSION 211

BC24069100 RISPERDAL QUICKLET ORODISPERSIBLE TABLETS 1MG 15.5

BC24071100 VALCYTE FILM-COATED TABLETS 450MG 840

BC24074235 PARAPLATIN IV INJECTION 2632

BC240742AP PARAPLATIN IV INJECTION 5949

BC24079245 NEXIUM POWDER FOR INJECTION AND INFUSION 40MG 119

BC24081238 PROPOFOL-LIPURO 1% 64

BC24081248 PROPOFOL-LIPURO 1% 203

BC24083229 ZYPREXA 10MG POWDER FOR SOLUTION FOR INJECTION 334

BC24084277 ALIMTA (PEMETREXED FOR INJECTION) 500MG 34210

BC24111100 HEMONIA CAPSULES 3.58

BC24129100 CRESTOR 20MG FILM-COATED TABLETS 38.2

BC24131100 CRESTOR 10MG FILM-COATED TABLETS 23.7

BC24134119 SINGULAIR ORAL GRANULES 4MG 17.4

BC24139414 TRAVATAN 40 MICROGRAMS/ML EYE DROPS, SOLUTION 539

BC24154229 FENTANYL-FRESENIUS INJECTION 0.05 MG/ML 98

BC24171100 STALEVO FILM-COATED TABLETS 100/25/200MG 25

BC24172100 STALEVO FILM-COATED TABLETS150/37.5/200MG 25

BC24173100 STALEVO FILM-COATED TABLETS 50/12.5/200MG 25

BC24179209 AMINOVEN 10% SOLUTION FOR INFUSION 384

BC24180265 AMINOVEN 5% SOLUTION FOR INFUSION 109

BC24180277 AMINOVEN 5% SOLUTION FOR INFUSION 118

BC24185100 GASTER D TABLETS 20MG 1.92

BC241851G0 GASTER D TABLETS 20MG(鋁箔/膠箔) 2

BC24189100 GLUCOPHAGE TABLETS 1000MG 2.28

BC24196255 CLINOLEIC 20% EMULSION FOR INFUSION 215

BC24196265 CLINOLEIC 20% EMULSION FOR INFUSION 225

256

Page 257: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC24203265 SYNTHAMINE 14, 8.5% AMINO ACID IV INFUSION WITHOUT

ELECTROLYTE, SOLUTION FOR INFUSION 8.5% W/V

151

BC24205100 SOLIAN 400MG FILM-COATED SCORED TABLET 62

BC242064CR RESTASIS OPHTHALMIC EMULSION 0.05% 47.7

BC24210100 REMERON SOLTAB 45MG 28.3

BC24211421 BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 220

BC24212100 DOXACOR TABLETS 2MG 2.93

BC24215100 CELLCEPT F.C. TABLETS 500MG 90

BC24218100 CELAPRAM TABLETS 20MG 15.7

BC24219212 NUTRINEAL PD4 WITH 1.1% AMINO ACID SOLUTION 312

BC24220100 EBIXA FILM-COATED TABLETS 10MG 18

BC24228248 FRESOFOL 2% MCT/LCT 314

BC24229100 CONCERTA EXTENDED RELEASE TABLETS 54MG 68

BC24239100 CYMBALTA 60MG 47.3

BC24240100 CYMBALTA 30MG 27

BC24250100 VYTORIN TABLETS 10/20 MG 37.5

BC24252100 VYTORIN TABLETS 10/10 MG 23.7

BC24256100 SEROXAT CR TABLETS 12.5MG 14.3

BC24260277 VOLUVEN 6% SOLUTION FOR INFUSION 251

BC24268100 NAVELBINE 30MG, SOFT CAPSULE 3499

BC24269100 NAVELBINE 20MG, SOFT CAPSULE 2499

BC24270209 OLICLINOMEL N7-1000 E EMULSION FOR INFUSION(依仿單含熱量

1200KCAL)

986

BC24270210 OLICLINOMEL N7-1000 E EMULSION FOR INFUSION(依仿單含熱量

1800KCAL)

1373

BC24270212 OLICLINOMEL N7-1000 E EMULSION FOR INFUSION(依仿單含熱量

2400KCAL)

1884

BC24271209 OLICLINOMEL N6-900 E EMULSION FOR INFUSION(依仿單含熱量

1015KCAL)

874

BC24271210 OLICLINOMEL N6-900 E EMULSION FOR INFUSION(依仿單含熱量

1525KCAL)

1273

BC24271212 OLICLINOMEL N6-900 E EMULSION FOR INFUSION(依仿單含熱量

2030KCAL)

1697

BC24272100 TAKEPRON OD 15MG TABLETS 16.6

BC24273100 TAKEPRON OD 30MG TABLETS 18.5

BC24274100 REMINYL PROLONGED RELEASE CAPSULES 16MG 91

BC24275100 REMINYL PROLONGED RELEASE CAPSULES 8MG 73

BC24276100 REMINYL PROLONGED RELEASE CAPSULES 24MG 91

BC24289212 TRAMAZAC IV INJECTION 50MG/ML 39.1

BC24294421 COMBIGAN EYE DROPS 470

BC24301212 VOMIZ for IV INJECTION 2MG/ML 191

BC24301219 VOMIZ for IV INJECTION 2MG/ML 217

BC24304100 ACERTIL TABLETS 8MG 16.3

BC24306100 INSPRA F.C. TABLETS 50MG 30

BC243091G0 PEROFEN 400 F.C. TABLETS(鋁箔/膠箔) 2

BC24313212 OLICLINOMEL N5-800E EMULSION FOR INFUSION(依仿單含熱量

1825KCAL)

1490

BC24318316 DERMOTASONE cream 24.1

BC24318321 DERMOTASONE cream 41.3

BC24318326 DERMOTASONE cream 44.9

BC24318329 DERMOTASONE cream 44.9

BC24318335 DERMOTASONE cream 122

BC24320100 LAMOTRIX 100mg Tablets 24.1

BC24321209 FLUMARIN FOR INJECTION 1G 372

BC24326100 REMERON SOLTAB 15MG 11.8

257

Page 258: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC24328321 FUDIN ointment 55

BC24328326 FUDIN ointment 55

BC24328329 FUDIN ointment 58

BC24328335 FUDIN ointment 154

BC24332421 RELESTAT OPHTHALMIC SOLUTION 0.05% 96

BC24339100 SIMVAHEXAL 40MG FILMTABLETTEN FILM-COATED TABLETS 15.7

BC24340100 TRAMADOL SANDOZ UNO 200MG RETARDTABLETTEN 11.2

BC24347248 UROKINASE-GCC INJECTION 50,000 I.U. 1010

BC24353238 PROVIVE 1% Injection 64

BC24353248 PROVIVE 1% Injection 203

BC24353255 PROVIVE 1% Injection 314

BC24364100 Norvasc Tablets 10mg 6.8

BC24368100 Zoloft Film coated tablets 100mg 25.1

BC24371271 Targocid 400 mg for Injection (I.M.I.V.) 1585

BC24379100 Apo-Citalopram Film-coated Tablets 40mg 27.9

BC24380100 Imigran FDT Tablets 50mg 186

BC243822AA Diphereline P.R. 3.75mg 4028

BC24391100 CADUET 5MG/10MG TABLET 24.7

BC24392100 CADUET 5MG/20MG TABLET 38.6

BC24398421 CRAVIT OPHTHALMIC SOLUTION 125

BC24403100 Harnalidge D tablets 0.2mg 9.6

BC24405100 Apo-Paroxetine Tablets 30mg 28.9

BC24407100 Tarceva Film-Coated tablets 150mg 1251

BC24408100 Apo-Citalopram Tablets 20mg 15.7

BC24410100 Tarceva Film-Coated tablets 100mg 834

BC24421100 EFEXOR XR 37.5MG SUSTAINED-RELEASE CAPSULES 16.3

BC24427221 Epirubicin Hydrochloride For IV Injection 634

BC24427240 Epirubicin Hydrochloride For IV Injection 3381

BC24436100 Vesicare film-coated tablets 10mg 32.7

BC24437100 Vesicare film-coated tablets 5mg 32.7

BC24443248 TYGACIL (TIGECYCLINE) 50MG LYOPHILIZED POWDER 1667

BC24444100 Perofen 600 F.C. Tablets 1.78

BC24452100 Clarinase 24 Hour Extended Release Tablets 7.4

BC24453148 Clenil 250 mcg Pressurised Inhalation Solution 566

BC24459100 AVANDAMET F.C.TABLETS 2MG/500MG "SPAIN" 14.2

BC24460100 Apo-Paroxetine 20mg 10.6

BC24464100 APO-DIVALPROEX 250MG 5.1

BC24472209 Vinorelbine Injection Concentrate 1374

BC24472221 Vinorelbine Injection Concentrate 6850

BC24480100 Fosamax Plus Tablets 221

BC244881G0 Perofen F.C. Tablets 400mg 2

BC24492100 Tramazac Capsules (Tramadol HCl Capsules) 3.88

BC24497100 OLMETEC FILM COATED TABLETS 20MG 12.9

BC24509248 Mycamine for Injection 50mg/vial 1796

BC24514100 Strattera 10mg Hard Capsules 84

BC24515100 Strattera 18mg Hard Capsules 84

BC24516100 Strattera 25mg Hard Capsules 84

BC24517100 Strattera 40mg Hard Capsules 84

BC24518100 Strattera 60mg Hard Capsules 84

BC24519255 SMOFLIPID 20% EMULSION FOR INFUSION 226

BC24519265 SMOFLIPID 20% EMULSION FOR INFUSION 231

BC24519277 SMOFLIPID 20% EMULSION FOR INFUSION 352

BC24521100 OLMETEC PLUS 20/25MG, FILM COATED TABLETS 11.8

BC24524100 MELOX 15mg Tablets 8.5

258

Page 259: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC245282CN DIPHERELINE P.R. 11.25MG POWDER AND SOLVENT FOR SUSPENSION FOR

INJECTION(IM) 3-MONTH PROLONGED RELEASE FORM

11979

BC24530100 pms-MIRTAZAPINE Tablets 30mg 16.9

BC24532100 Trandate Tablets 200mg 3.24

BC24539100 Risperdal Film Coated Tablets 4mg 57

BC24544100 TRIAPIN 5MG SLOW-RELEASE TABLETS 12.7

BC24557248 Ciprofloxacin Claris IV Infusion 0.2% w/v 288

BC24557255 Ciprofloxacin Claris IV Infusion 0.2% w/v 628

BC24557263 Ciprofloxacin Claris IV Infusion 0.2% w/v 1003

BC24563229 ELOXATIN 5MG/ML,CONCENTRATE FOR SOLUTION FOR INFUSION 2754

BC24563238 ELOXATIN 5MG/ML,CONCENTRATE FOR SOLUTION FOR INFUSION 7373

BC24563245 ELOXATIN 5MG/ML,CONCENTRATE FOR SOLUTION FOR INFUSION 11868

BC24565277 CUBICIN INJECTION 3522

BC24570100 UROCIT-K 10MEQ TABLET 9.9

BC24580100 Ultidep 20 Tablets 15.7

BC24583321 BIFONA-Z CREAM 34.3

BC24583329 BIFONA-Z CREAM 74

BC24583335 BIFONA-Z CREAM 75

BC24584100 GLUCOPHAGE FILM-COATED TABLETS 850MG 2.23

BC24585309 DIVIGEL 0.1% GEL 7.5

BC24592100 BLOPRESS 16MG PLUS 12.5MG TABLETS 14.1

BC24593100 SUTENT CAPSULES 12.5MG 1315

BC24594100 SUTENT CAPSULES 25MG 2622

BC24595100 SUTENT CAPSULES 50MG 4719

BC24597100 CRESTOR 5MG FILM-COATED TABLETS 21.8

BC24601100 Apo-Divalproex Tablets 500mg 10.4

BC24603100 Exjade 125mg dispersible tablets 211

BC24611100 ASACOL 800MG GASTRO-RESISTANT TABLETS 23.9

BC24622100 REVATIO 20MG FILM-COATED TABLETS 239

BC24625212 Irinotel Injection 2290

BC24625221 IRINOTEL INJECTION 4693

BC24626100 Apo-Zopiclone Tablets 7.5mg 2.89

BC246291G0 Cinnaron 25 Tablets 2

BC24630216 BONVIVA 3MG/3ML SOLUTION FOR INJECTION 3127

BC24638221 FYTOSID FOR IV INJECTION 254

BC24643100 HYZAAR FC TABLETS 100/12.5 MG 11.1

BC24645100 DIOVAN FILM-COATED TABLETS 40MG 7.3

BC24646100 BLOPRESS 8MG PLUS 12.5MG TABLETS 9.7

BC24651161 KEPPRA ORAL SOLUTION 100MG/ML 1049

BC24651166 KEPPRA ORAL SOLUTION 100MG/ML 1846

BC24655100 DIOVAN FILM-COATED TABLETS 320MG 30.5

BC24656112 ZMAX EXTENDED-RELEASE POWDER FOR ORAL SUSPENSION 357

BC24657421 EQUITON EYE-DROPS 154

BC24662100 SEBIVO 600MG FILM-COATED TABLETS 107

BC24668100 JANUVIA 100 MG F.C. TABLETS 28

BC24677100 STILNOX CR TABLET 6.25 MG 4.42

BC24679209 “BAXTER” OLICLINOMEL N4-550E EMULSION FOR INFUSION (依仿單含

熱量610KCAL)

606

BC24679210 “BAXTER” OLICLINOMEL N4-550E EMULSION FOR INFUSION(依仿單含

熱量910KCAL)

777

BC24679212 “BAXTER” OLICLINOMEL N4-550E EMULSION FOR INFUSION(依仿單含

熱量1215KCAL)

1092

BC24690100 VIREAD TABLETS 165

BC24692255 ACLASTA 5MG/100ML SOLUTION FOR INFUSION 11503

259

Page 260: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC24701248 OXITAN LYOPHILIZED POWDER FOR INJECTION 2238

BC24701255 OXITAN LYOPHILIZED POWDER FOR INJECTION 5898

BC24702100 LEPAX FILM-COATED TABLETS 5MG 12.1

BC24708100 Eltroxin Tablets 100mcg 〝Germany〞 1.5

BC24725100 ACERTIL FILM-COATED TABLETS 5 MG 10

BC24727100 NEXAVAR FILM-COATED TABLETS 200MG 1092

BC24730100 Isosorbide Mononitrate Extended-Release Tablets 3.98

BC24731100 INVEGA EXTENDED RELEASE TABLETS 6MG 147

BC24732100 INVEGA EXTENDED RELEASE TABLETS 3MG 82

BC24738221 INTAXEL INJECTION 1388

BC24738248 INTAXEL INJECTION 22960

BC247382BE INTAXEL INJECTION 19898

BC247382FG INTAXEL INJECTION 3774

BC24742100 COAPROVEL FILM-COATED TABLETS 300MG/25MG 13.7

BC24743321 BENCORT CREAM 39.6

BC24743329 BENCORT CREAM 39.6

BC24743335 BENCORT CREAM 39.6

BC24750100 LUVOX 50, FILM-COATED TABLETS 9.8

BC24758255 ERAXIS FOR INJECTION 100MG 2714

BC24762221 ANTHRACIN FOR IV INJECTION 634

BC24762240 ANTHRACIN FOR IV INJECTION 3381

BC24766414 DUOTRAV EYE DROPS, SOLUTION 727

BC24770100 CERTICAN 0.25MG TABLETS 91

BC24771100 CERTICAN 0.75MG TABLETS 262

BC24772100 CERTICAN 0.5MG TABLETS 184

BC24780100 AVANDIA F.C. TABLET 4MG "SPAIN" 27.5

BC24785221 ALOXI SOLUTION FOR INJECTION 886

BC24786151 ALVESCO 160 INHALER 524

BC24789255 Metronidazole Injection USP 0.5% w/v 77

BC24790209 CEFTRIAXONE SANDOZ POWDER FOR IV INJECTION 193

BC24790212 CEFTRIAXONE SANDOZ POWDER FOR IV INJECTION 660

BC24790277 CEFTRIAXONE SANDOZ POWDER FOR IV INJECTION 100

BC24791100 XET 20 TABLETS 10.6

BC24792321 TAMICORT CREAM 18.9

BC24792329 TAMICORT CREAM 50

BC24792336 TAMICORT CREAM 59

BC24792338 TAMICORT CREAM 99

BC24794100 SPRYCEL FILM-COATED TABLETS 50MG 1361

BC247973AI DUROGESIC D-TRANS TRANSDERMAL PATCH 100 MCG/H 745

BC24800100 SPRYCEL TABLETS 70MG 1695

BC24804235 KEMOCARB INJECTION 2632

BC248042AP KEMOCARB INJECTION 5949

BC24806316 CYCLOVAX 5% CREAM 17.3

BC24806317 CYCLOVAX 5% CREAM 17.3

BC24806321 CYCLOVAX 5% CREAM 46.6

BC24806326 CYCLOVAX 5% CREAM 46.6

BC24811255 Ciprofloxacin Injection 628

BC24813100 SPRYCEL FILM-COATED TABLETS 20MG 545

BC24823100 EXFORGE FILM-COATED TABLET 10/160MG 27.6

BC24824100 EXFORGE FILM-COATED TABLET 5/80MG 17

BC24827100 FLUCOZYD 200 CAPSULES 245

BC24829210 CAPD/DPCA 19 SOLUTION FOR PERITONEAL DIALYSIS 157

BC24829212 CAPD/DPCA 19SOLUTION FOR PERITONEAL DIALYSIS 184

BC24829214 CAPD/DPCA 19 SOLUTION FOR PERITONEAL DIALYSIS 201

BC24829221 CAPD/DPCA 19 SOLUTION FOR PERITONEAL DIALYSIS 284

260

Page 261: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC24830210 CAPD/DPCA 17 SOLUTION FOR PERITONEAL DIALYSIS 157

BC24830212 CAPD/DPCA 17 SOLUTION FOR PERITONEAL DIALYSIS 184

BC24830214 CAPD/DPCA 17 SOLUTION FOR PERITONEAL DIALYSIS 201

BC24830221 CAPD/DPCA 17 SOLUTION FOR PERITONEAL DIALYSIS 284

BC24831212 CAPD/DPCA 18 SOLUTION FOR PERITONEAL DIALYSIS 184

BC24831214 CAPD/DPCA 18 SOLUTION FOR PERITONEAL DIALYSIS 201

BC24831221 CAPD/DPCA 18 SOLUTION FOR PERITONEAL DIALYSIS 284

BC24834100 TASIGNA CAPSULES 200 MG 1019

BC24839100 ACTOSMET 15/850MG FILM COATED TABLETS 13.6

BC248403CM DUROGESIC D-TRANS TRANSDERMAL PATCH 75 ΜCG/H 610

BC248423CS DUROGESIC D-TRANS TRANSDERMAL PATCH 50UG/H 670

BC24844255 Fluconazole Infusion 422

BC24846209 GEMITA FOR I.V. LYOPHILIZED INJECTION 4099

BC24846263 GEMITA FOR I.V. LYOPHILIZED INJECTION 1086

BC248491C5 SERETIDE 50/500 ACCUHALER, INHALATION POWDER 1267

BC24850248 OXALIPLATINE-MYLAN 5MG/ML POWDER FOR SOLUTION FOR INFUSION 2331

BC24850255 OXALIPLATINE-MYLAN 5MG/ML POWDER FOR SOLUTION FOR INFUSION 6180

BC24853297 TORISEL CONCENTRATE AND DILUENT FOR SOLUTION FOR INFUSION 28873

BC24855100 ACERTIL FILM-COATED TABLETS 10 MG 16.3

BC24856100 VOMIZ TABLETS 8 MG 181

BC24857109 Ulban A Gran. 3.65

BC24863100 CLOPIDOGREL WINTHROP FILM-COATED TABLETS 39.6

BC24868100 ZYSIM 80 TABLETS 33.5

BC24869277 HESTAR-200 PENTASTARCH 10% 448

BC248703B9 DUROGESIC D-TRANS TRANSDERMAL PATCH 12 ΜCG/H 188

BC24874255 ALIMTA FOR INJECTION 100MG 7597

BC24876100 AMARYL M FILM-COATED TABLETS 2/500MG 4.43

BC248774FK AVAMYS NASAL SPRAY 260

BC24878100 TYKERB TABLETS 250MG 502

BC24883100 RASILEZ FILM-COATED TABLET 300MG 39.1

BC24884100 RASILEZ FILM-COATED TABLET 150MG 27.5

BC24885100 SEROQUEL XR TM 400 MG EXTENDED-RELEASE TABLETS 93

BC24886100 SEROQUEL XR TM 300 MG EXTENDED-RELEASE TABLETS 66

BC24887100 SEROQUEL XR TM 200 MG EXTENDED-RELEASE TABLETS 49.7

BC24894100 ADVAGRAF 0.5MG PROLONGED-RELEASE HARD CAPSULES 59

BC24895100 ADVAGRAF 5MG PROLONGED-RELEASE HARD CAPSULES 471

BC24896100 ADVAGRAF 1MG PROLONGED-RELEASE HARD CAPSULES 108

BC248992A5 NUTRIFLEX LIPID PERI 1250ML(依仿單含熱量955KAL) 821

BC248992BH NUTRIFLEX LIPID PERI 1875ML(依仿單含熱量1435KCAL) 1236

BC249012A5 NUTRIFLEX LIPID SPECIAL 1250ML(依仿單含熱量1475KCAL) 1259

BC24919255 LIPOPLUS 20% 229

BC24919265 LIPOPLUS 20% 229

BC24920212 BALANCE 2.3% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS

201

BC24921212 BALANCE 4.25% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS

201

BC24922212 BALANCE 1.5% GLUCOSE, 1.25 MMOL/L CALCIUM, SOLUTION FOR

PERITONEAL DIALYSIS

201

BC24923100 METOZ 5 TABLETS 14.3

BC24926355 PENTASA ENEMAS 1G/100ML 107

BC24929100 SEVIKAR 5/20MG FILM COATED TABLETS 14.3

BC24933312 NEUPRO TRANSDERMAL PATCH 2MG/24H 64

BC24934319 NEUPRO TRANSDERMAL PATCH 4MG/24H 87

261

Page 262: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC24935323 NEUPRO TRANSDERMAL PATCH 6MG/24H 114

BC24936326 NEUPRO TRANSDERMAL PATCH 8MG/24H 132

BC24947100 OTSUKA ABILIFY DISCMELT 10MG ORALLY DISINTEGRATING TABLETS 83

BC24961109 PENTASA SACHET, PROLONGED RELEASE GRANULES, 1G 22.7

BC24962112 PENTASA SACHET, PROLONGED RELEASE GRANULES, 2G 41.3

BC24967100 CARVEDILOL HEXAL TABLETS 25MG 6.2

BC24968100 CO-DIOVAN 320/25 FILM-COATED TABLET 30.5

BC24969100 CO-DIOVAN 320/12.5 FILM-COATED TABLET 30.5

BC24970238 KEMOPLAT INJECTION 70

BC24970255 KEMOPLAT INJECTION 350

BC24976100 MIRTAZAPINE SANDOZ 30 MG ORODISPERSIBLE TABLETS 16.9

BC24977414 Mikelan LA Ophthalmic Solution 2% 200

BC24978414 Mikelan LA Ophthalmic Solution 1% 188

BC24979100 APO-METHYLPHENIDATE TABLETS 20MG 4.22

BC24989100 STALEVO FILM-COATED TABLETS 200/50/200MG 25.2

BC24991129 NEXIUM 10MG GASTRO-RESISTANT GRANULES FOR ORAL SUSPENSION 20.7

BC24995100 LYRICA HARD CAPSULE 75MG 22.3

BC24998100 OTSUKA ABILIFY DISCMELT 15MG ORALLY DISINTEGRATING TABLETS 83

BC25001100 SEROQUEL XR TM 50 MG EXTENDED-RELEASE TABLETS 25.8

BC25005100 OLMETEC FILM COATED TABLETS 40MG 22.3

BC25006321 Bencort Cream 39.6

BC25006329 Bencort Cream 39.6

BC25006335 Bencort Cream 39.6

BC25013351 CLOBEX 500ΜG/G SHAMPOO 226

BC25013358 CLOBEX 500ΜG/G SHAMPOO 471

BC25016100 APO-METHYLPHENIDATE Tablets 10mg 2.66

BC25021100 MINIRIN MELT 60 UG 33.6

BC25033161 SPIRIVA RESPIMAT 2.5MCG, SOLUTION FOR INHALATION 1661

BC25034100 APO-CLOPIDOGREL 75MG FILM-COATED TABLET 39.6

BC25040100 JANUMET 50/1000 MG FILM-COATED TABLETS 15

BC25041100 JANUMET 50/850 MG FILM-COATED TABLETS 15

BC25043100 JANUMET 50/500 MG FILM-COATED TABLETS 13.7

BC25045100 PRETERAX 2.5 MG/0.625 MG 11

BC25046100 ACERTIL PLUS 5 MG/1.25 MG 10.8

BC25059100 MIRTAZAPINE SANDOZ 45 MG ORODISPERSIBLE TABLETS 24.8

BC25061151 SOLIAN ORAL SOLUTION 100MG/ML 1230

BC25065100 TOPIRAMATE SANDOZ FC TABLETS 100MG 31.8

BC25066265 FINIBAX FOR INJECTION 0.25G 357

BC25068248 LEVOX IV SOLUTION FOR INFUSION 456

BC25068255 LEVOX IV SOLUTION FOR INFUSION 829

BC25070100 CARVEDILOL HEXAL TABLETS 12.5MG 4.52

BC25071100 TARCEVA FILM-COATED TABLETS 150MG“ITALY” 1251

BC25072100 EXFORGE FILM-COATED TABLET 5/160MG 23.5

BC25073100 LEXAPRO FILM-COATED TABLETS 15MG 30.7

BC25074100 LEXAPRO FILM-COATED TABLETS 20MG 37.6

BC25075255 FLUCONAZOLE INJECTION 422

BC25075263 FLUCONAZOLE INJECTION 1009

BC25077100 TARCEVA FILM-COATED TABLETS 100MG“ITALY” 834

BC25078100 LAMIDUS 50 TABLETS 15.5

BC25079277 TETRASPAN 10% SOLUTION FOR INFUSION 403

BC25080277 TETRASPAN 6% SOLUTION FOR INFUSION 251

BC25087100 PMS-BICALUTAMIDE 50MG F.C. TABLETS 106

BC25090100 LEPAX FILM-COATED TABLETS 10MG 21

262

Page 263: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC25091277 VOLULYTE 6% SOLUTION FOR INFUSION 251

BC250921FL FOSTER 877

BC25095100 BLOPRESS TABLETS 16 MG 14.1

BC25103321 TAMICORT CREAM 18.9

BC25103329 TAMICORT CREAM 50

BC25103336 TAMICORT CREAM 59

BC25103338 TAMICORT CREAM 99

BC25106100 WELLBUTRIN XL 150 MG TABLET “CANADA” 24

BC25113255 Exomax IV Injection 422

BC25114100 CLOPIDOGREL SANDOZ 75 MG FILM-COATED TABLETS 39.6

BC25115421 AZARGA EYE DROPS, SUSPENSION 415

BC25118100 REQUIP PD 2MG PROLONGED RELEASE TABLET 19.7

BC25119100 REQUIP PD 4MG PROLONGED RELEASE TABLET 40.7

BC25120100 REQUIP PD 8MG PROLONGED RELEASE TABLET 76

BC25126206 ARIXTRA 2.5MG/0.5ML SOLUTION FOR INJECTION ,PRE-FILLED SYRINGE 315

BC25129100 XARELTO FILM-COATED TABLETS 10MG 73

BC25143100 TROZET FILM-COATED TABLETS 2.5 MG 40

BC25144100 TOPIRAMATE SANDOZ FC TABLETS 25MG 7.9

BC25145100 TOPIRAMATE SANDOZ FC TABLETS 50MG 16

BC251502FF SMOFKABIVEN PERIPHERAL EMULSION FOR INFUSION(依仿單含熱量

1300KCAL)

1051

BC251502FN SMOFKABIVEN PERIPHERAL EMULSION FOR INFUSION(依仿單含熱量

1000KCAL)

834

BC25158100 INVEGA EXTENDED RELEASE TABLETS 9MG 161

BC25159343 XAMIOL GEL 645

BC25160100 WELLBUTRIN XL 300MG TABLETS 45.7

BC25161100 CO-RASILEZ 150/25MG FILM-COATED TABLETS 27.5

BC25162100 CO-RASILEZ 150/12.5MG FILM-COATED TABLETS 27.5

BC25163100 CO-RASILEZ 300/12.5MG FILM-COATED TABLETS 39.1

BC25164100 CO-RASILEZ 300/25MG FILM-COATED TABLETS 39.1

BC25165100 AFINITOR 5MG TABLETS 1807

BC25166100 AFINITOR 10MG TABLETS 3328

BC25172265 AMINOPLASMAL NEO 5% E 109

BC25172277 AMINOPLASMAL NEO 5% E 118

BC25173277 AMINOPLASMAL NEO 10% 212

BC25174277 AMINOPLASMAL NEO 10% E 212

BC25179209 BFLUID INJECTION 351

BC25179277 BFLUID INJECTION 204

BC25182100 Metfogamma 850mg Film Coated Tablets 2.23

BC25183209 DBL GEMCITABINE FOR INJECTION 4099

BC25184100 IRBESARTAN WINTHROP FILM-COATED TABLETS 150MG 7.7

BC25185100 IRBESARTAN WINTHROP FILM-COATED TABLETS 300MG 13.6

BC251932CN LEUPLIN DEPOT 3M 11.25MG S.C. INJECTION 10038

BC25197100 TAREG 160MG FILM COATED TABLETS 12.7

BC25198100 AMLODIPINE SANDOZ 10 MG TABLETS 6.8

BC25199100 AMLODIPINE SANDOZ 5 MG TABLETS 6.8

BC25202100 Amlodipine besilate - Teva 5mg Tablets 6.8

BC252032BJ SMOFKABIVEN EMULSION FOR INFUSION(依仿單含熱量2700KCAL) 2367

BC252032FB SMOFKABIVEN EMULSION FOR INFUSION(依仿單含熱量1100KCAL) 946

BC252032FC SMOFKABIVEN EMULSION FOR INFUSION(依仿單含熱量1600KCAL) 1307

BC252032FD SMOFKABIVEN EMULSION FOR INFUSION(依仿單含熱量2200KCAL) 1892

BC25206100 BYPRO FILM-COATED TABLETS 50 MG 110

BC25207100 CO-TAREG FILM COATED TABLETS 80/12.5MG 10.1

BC25210100 TAREG 80MG FILM COATED TABLETS 10.1

263

Page 264: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC25211100 ZYSIM 10 TABLETS 5.9

BC25214100 REVLIMID CAPSULES 25MG 8746

BC25215100 REVLIMID CAPSULES 15MG 8746

BC25216100 REVLIMID CAPSULES 10MG 8746

BC25217100 REVLIMID CAPSULES 5MG 8545

BC25219166 SEBIVO ORAL SOLUTION 20MG/ML 1249

BC25224100 MULTAQ 400MG FILM-COATED TABLETS 58

BC252251G0 REMETHAN 25 EC TABLETS(鋁箔/膠箔) 2

BC25227221 Dopamine HCl-Fresenius 200mg/5ml Infusion 25.8

BC25232100 ZYVERIN 200MG CAPSULES 13.3

BC252343FA EXELON PATCH 5 78

BC25242100 TS-1 CAPSULES 25MG 217

BC25243100 TS-1 CAPSULES 20MG 193

BC25244100 HYCAMTIN CAPSULES 0.25MG 454

BC25245100 HYCAMTIN CAPSULES 1MG 1711

BC25246243 TAKEPRON INTRAVENOUS 30MG 266

BC25248143 APO-RISPERIDONE SOLUTION, 1MG/ML 675

BC25249100 CILOSTAZOL TABLETS 50MG 8.2

BC25251100 AREMED 1 FC TABLETS 62

BC25253100 MIRAPEX 0.75MG PROLONGED-RELEASE TABLETS 35.2

BC25257100 Estelle-35 Film Coated Tablets 7.8

BC25258100 MIRAPEX 0.375MG PROLONGED-RELEASE TABLETS 19.5

BC25259100 MIRAPEX 3.0MG PROLONGED-RELEASE TABLETS 136

BC25260100 MIRAPEX 1.5MG PROLONGED-RELEASE TABLETS 63

BC25261100 MIRAPEX 4.5MG PROLONGED-RELEASE TABLETS 204

BC25262100 VENLAFAXINE SANDOZ 150MG PROLONGED RELEASE CAPSULES 52

BC25272100 REVOLADE FILM-COATED TABLETS 25MG 1344

BC25274194 POSANOL 40 MG/ML ORAL SUSPENSION 13936

BC25278212 Pancuronium Bromide-Fresenius 4mg/2ml Injection 60

BC25279100 OLANDUS 10 TABLETS (OLANZAPINE TABLETS) 110

BC25282443 ONBREZ BREEZHALER 150 MCG INHALATION POWDER, HARD CAPSULE 933

BC25288100 ANASTROZOLE TABLETS 1 MG 62

BC25289209 TAXOTERE 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 4322

BC25289219 TAXOTERE 20MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 16298

BC25290100 AMISULPRIDE WINTHROP TABLETS 50MG 9.3

BC25291100 AMISULPRIDE WINTHROP TABLETS 200MG 25.9

BC25294416 LUMIGAN OPHTHALMIC SOLUTION 0.01% 514

BC25302166 DUPHALAC ORAL SOLUTION 164

BC25303297 MOZOBIL SOLUTION FOR INJECTION 223020

BC25306100 GALVUS TABLETS 50MG 13.5

BC25311100 CURAM 1000MG DISPERSIBLE TABLETS 9.4

BC25316221 KEPPRA CONCENTRATE FOR SOLUTION FOR INFUSION 100MG/ML 414

BC25317100 TASIGNA CAPSULES 150MG 660

BC25321100 MYCOPHENOLATE SANDOZ 500 MG FILM-COATED TABLETS 90

BC25322219 LEVOPHED INJECTION 145

BC25326100 COPLAVIX FILM COATED TABLETS 75MG/100MG 41.2

BC25332100 RITALIN LA CAPSULES 10MG 23.2

BC25333100 RITALIN LA CAPSULES 20MG 35

BC25334100 RITALIN LA CAPSULES 30MG 48.1

BC25335100 RITALIN LA CAPSULES 40MG 64

BC25336100 VENLAFAXINE SANDOZ 75MG PROLONGED RELEASE CAPSULES 16.9

BC25338220 DBL PIPERACILLIN AND TAZOBACTAM FOR INJECTION 435

BC253382CX DBL PIPERACILLIN AND TAZOBACTAM FOR INJECTION 241

BC25342100 ZYDUS IRBESARTAN TABLETS USP 150 MG 7.6

BC25350100 LIVALO TABLETS 2MG 20.1

264

Page 265: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC25351100 MEZAVANT XL, 1200MG GASTRO-RESISTANT, PROLONGED RELEASE

TABLETS

35

BC25352100 MADOPAR 125 CAPSULES“ITALY” 3.64

BC25360200 OZURDEX (DEXAMETHASONE INTRAVITREAL IMPLANT) 0.7MG 39932

BC25364100 APO-ALENDRONATE 70MG TABLETS 221

BC25377414 TAFLOTAN OPHTHALMIC SOLUTION 550

BC25386221 PRISMASOL 4MMOL/LPOTASSIUM,SOLUTION FOR HAEMOFILTRATION AND

HAEMODIALYSIS

292

BC25387221 PRISMASOL B0,SOLUTION FOR HAEMOFILTRATION AND HAEMODIALYSIS 292

BC25388221 PRISMASOL 2MMOL/LPOTASSIUM,SOLUTION FOR HAEMOFILTRATION AND

HAEMODIALYSIS

292

BC25391100 CATAPRES TABLETS 75 μg 2.11

BC25394206 INVEGA SUSTENNA PROLONGED RELEASE SUSPENSION FOR INTRAMUSCULAR

INJECTION 100MG/ML

5328

BC25394207 INVEGA SUSTENNA PROLONGED RELEASE SUSPENSION FOR INTRAMUSCULAR

INJECTION 100MG/ML

9081

BC25394209 INVEGA SUSTENNA PROLONGED RELEASE SUSPENSION FOR INTRAMUSCULAR

INJECTION 100MG/ML

9321

BC25394210 INVEGA SUSTENNA PROLONGED RELEASE SUSPENSION FOR INTRAMUSCULAR

INJECTION 100MG/ML

11160

BC25401255 INNOMUSTINE INJECTION 10434

BC25409100 PERINDOPRIL SANDOZ 4MG TABLET 10

BC25413100 HARNALIDGE OCAS PROLONGED RELEASE TABLETS 0.4 MG 17.9

BC25414221 SUCROFER INJECTION 75

BC25416100 TRAMAZAC XL 200 TABLETS 11.2

BC25418100 EXFORGE HCT FILM COATED TABLETS 5/160/25MG 21.1

BC25419100 EXFORGE HCT FILM COATED TABLETS 5/160/12.5 MG 21.1

BC25420100 EXFORGE HCT FILM COATED TABLETS 10/160/12.5MG 24.8

BC25421100 EXFORGE HCT FILM COATED TABLETS 10/160/25MG 24.8

BC25423100 DUODART CAPSULES 42

BC25427100 FEBURIC 80 MG FILM COATED TABLETS 24.3

BC25429100 MIRAPEX PROLONGED-RELEASE TABLETS 2.25MG 101

BC25430100 MIRAPEX PROLONGED-RELEASE TABLETS 3.75MG 170

BC25433100 VOTRIENT (PAZOPANIB HCL) FILM-COATED TABLETS 200MG 677

BC25442100 RAPAMUNE TABLETS 0.5 MG 81

BC25446100 TWYNSTA TABLETS 80/5 MG 20.1

BC25447100 TWYNSTA TABLETS 80/10 MG 20.1

BC25451100 VALDOXAN FILM-COATED TABLETS 25MG 37.3

BC25452100 Apo-Tramadol/ Acet 37.5/ 325mg tablets 6.2

BC25458100 PRADAXA CAPSULES 150 MG 49.6

BC25459100 PRADAXA CAPSULES 110 MG 49.6

BC25480100 GALVUS MET 50/500 FILM-COATED TABLETS 13.5

BC25481100 GALVUS MET 50/850 FILM-COATED TABLETS 13.5

BC25482100 GALVUS MET 50/1000 FILM-COATED TABLETS 13.5

BC25486100 ZYDUS OXCARBAZEPINE TABLETS 300MG 8.8

BC25489209 VINELBINE INJECTION 1374

BC25489221 VINELBINE INJECTION 6850

BC25492100 SEVIKAR HCT 20/5/12.5MG 14.3

BC25493100 SEVIKAR HCT 40/5/25MG 24.8

BC25494100 SEVIKAR HCT 40/5/12.5MG 24.8

BC25495100 SEVIKAR HCT 40/10/12.5MG 24.8

BC25496100 SEVIKAR HCT 40/10/25MG 24.8

BC25501100 LOSACAR-H TABLETS 9.3

BC25508100 APO-ESCITALOPRAM 20MG TABLETS 31.2

265

Page 266: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC25509100 TEMAZO CAPSULES 20MG 670

BC25510100 TEMAZO CAPSULES 250MG 6571

BC25515221 EPIRUBICIN "EBEWE" 2MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

634

BC25515240 EPIRUBICIN "EBEWE" 2MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

3381

BC25518100 AKURIT-4 16.5

BC25519100 AKURIT-3 8.2

BC25522261 EMEND IV 150MG POWDER FOR INJECTION 2043

BC25533100 ELTROXIN TABLETS 50 MCG 1.5

BC25537100 TRAJENTA 5MG FILM-COATED TABLETS 24.5

BC25551229 DBL OXALIPLATIN CONCENTRATE FOR INFUSION 2331

BC25551238 DBL OXALIPLATIN CONCENTRATE FOR INFUSION 6380

BC255532A5 NUTRIFLEX OMEGA SPECIAL(依仿單含熱量1475KCAL) 1259

BC25558212 DOCETAXEL“EBEWE”10 MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

4322

BC25558226 DOCETAXEL“EBEWE”10 MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

16298

BC25559217 VELCADE POWDER FOR SOLUTION FOR INJECTION 36914

BC25563277 Cymevene Lyophilized IV Injection 500mg/Vial 1512

BC25594100 LIPANTHYL PENTA 145 MG FILM-COATED TABLET 6.5

BC25603221 CYTARINE INJECTION 347

BC25605100 COPEGUS FILM-COATED TABLETS 200 MG 13.3

BC25607333 Hirudoid Cream 300mg/100g 37.5

BC25607345 Hirudoid Cream 300mg/100g 109

BC25612243 LEUPLIN DEPOT 6 M 30 MG S.C. INJECTION 14960

BC25624100 "Apo-Citalopram Tablets 20mg ""Etobicoke""" 15.7

BC25626235 CARBOPLATIN "EBEWE" 10MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

2632

BC256262AP CARBOPLATIN "EBEWE" 10MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

5949

BC25629277 TETRAHES 6% INTRAVENOUS INFUSION 247

BC25631229 OXITAN INJECTION 2203

BC25631238 OXITAN INJECTION 5898

BC25634100 GLUCOPHAGE FILM-COATED TABLETS 1000MG 2.28

BC25635100 GLUCOPHAGE FILM-COATED TABLETS 500MG 1.5

BC25647100 XARELTO FILM-COATED TABLETS20MG 73

BC25648100 XARELTO FILM-COATED TABLETS15 MG 73

BC25649100 METOZ 2.5 TABLETS 7.9

BC25650100 FAXIVEN FILM COATED TABLET (50+12.5) MG 9.3

BC25654248 OXAHPQ INJECTION 5MG/ML, LYOPHILISATE FOR SOLUTION FOR

INFUSION

2286

BC25654255 OXAHPQ INJECTION 5MG/ML, LYOPHILISATE FOR SOLUTION FOR

INFUSION

6180

BC25674100 CARVEDILOL HEXAL TABLETS 6.25MG 4.08

BC25676209 MEROPENEM SANDOZ POWDER FOR SOLUTION FOR INJECTION OR INFUSION

1000MG

875

BC25676277 MEROPENEM SANDOZ POWDER FOR SOLUTION FOR INJECTION OR INFUSION

500MG

404

BC25678100 TEMAZO CAPSULES 100MG 3183

BC25681209 GEMITA LYOPHILIZED FOR INJECTION 4099

BC25681263 GEMITA LYOPHILIZED FOR INJECTION 1086

BC25684100 CELECOXIB SANDOZ CAPSULE 200MG 12.1

BC25690100 FLUCOZYD CAPSULES 150 MG 61

BC25691100 BRILINTA FILM-COATED TABLETS 90 MG 31.2

266

Page 267: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC256961G0 DULCOLAX ENTERIC SUGAR COATED TABLET 5MG(鋁箔/膠箔) 2

BC25699100 Moxiclav 1G F.C. Tablets 9.4

BC25700100 RASILAMLO 150MG/5MG FILM-COATED TABLETS 27.5

BC25701100 RASILAMLO 150MG/10MG FILM-COATED TABLETS 27.5

BC25702100 RASILAMLO 300MG/5MG FILM-COATED TABLETS 38.6

BC25703100 RASILAMLO 300MG/10MG FILM-COATED TABLETS 38.6

BC25706209 GRANISETRON KABI 1MG/ML, CONCENTRATE FOR SOLUTION FOR

INJECTION/INFUSION

335

BC25706216 GRANISETRON KABI 1MG/ML, CONCENTRATE FOR SOLUTION FOR

INJECTION/INFUSION

717

BC25708209 NEOPAREN NO.1 INJECTION 1L 400

BC25708210 NEOPAREN NO.1 INJECTION 1.5L 540

BC25708212 NEOPAREN NO.1 INJECTION 2L 625

BC257091G0 BUSCOPAN SUGAR COATED TABLETS 10MG(鋁箔/膠箔) 2

BC25712100 LEVETIRACETAM TABLETS 500MG 26.7

BC25713100 Lendormin (R) 0.25mg Tablets 4.04

BC25717100 VIVIANT FILM-COATED TABLET 20MG 43.2

BC25724209 CEFEPIME SANDOZ POWDER FOR SOLUTION FOR INJECTION 1G 425

BC25724277 CEFEPIME SANDOZ POWDER FOR SOLUTION FOR INJECTION 0.5G 279

BC25725100 LEVOFLOXACIN SANDOZ FILM-COATED TABLETS 500MG 41.3

BC25728212 IRINOTECAN BIOPRO 20MG/ML, CONCENTRATE FOR SOLUTION FOR

INFUSION

2290

BC25728221 IRINOTECAN BIOPRO 20MG/ML, CONCENTRATE FOR SOLUTION FOR

INFUSION

4693

BC25729148 Bisolvon (R) Solution 2mg/ml 53

BC25744229 KEMOPLAT INJECTION 1MG/ML 70

BC25744248 KEMOPLAT INJECTION 1MG/ML 350

BC25746100 MOBIC (R) TABLETS 7.5MG 2.36

BC25747100 MOBIC (R) TABLETS 15MG 8.5

BC25754100 AZAMUN FILM COATED TABLETS 50MG 20.5

BC25756100 EDARBI TABLETS 40MG 16.9

BC25765212 IRINOTECAN SANDOZ 20MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

2183

BC25765221 IRINOTECAN SANDOZ 20MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

4541

BC25765235 IRINOTECAN SANDOZ 20MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

9617

BC25765240 IRINOTECAN SANDOZ 20MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

15920

BC25766100 VALAZYD 160 TABLETS 12.7

BC25781255 VIDAZA POWDER FOR SUSPENSION FOR INJECTION 15423

BC25782248 FLUDARABINE BIOPRO 25MG/ML, POWDER FOR SOLUTION FOR

INJECTION/INFUSION

5189

BC25783100 APO-PANTOPRAZOLE 40MG ENTERIC COATED TABLETS 18.4

BC25787100 IRBESARTAN HYDROCHLOROTHIAZIDE WINTHROP FILM-COATED TABLET

150MG/12.5MG

7.7

BC25788100 IRBESARTAN HYDROCHLOROTHIAZIDE WINTHROP FILM-COATED TBALET

300MG/25MG

13.6

BC25789100 Apo-Citalopram Tablets 40mg 27.9

BC25791209 TOPOTECAN SANDOZ 1MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 2034

BC25791216 TOPOTECAN SANDOZ 1MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 6104

BC25791219 TOPOTECAN SANDOZ 1MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 7325

267

Page 268: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC25792100 TRAJENTA DUO 2.5/850MG FILM-COATED TABLETS 14.7

BC25793100 TRAJENTA DUO 2.5/500MG FILM-COATED TABLETS 14.7

BC25794100 TRAJENTA DUO 2.5/1000MG FILM-COATED TABLETS 14.7

BC25796100 ROBESTAR SANDOZ FILM-COATED TABLETS 20MG 30.5

BC25804100 APO-ESOMEPRAZOLE ENTERIC COATED TABLET 40MG 12.6

BC25807100 PHAROXIFENE (RALOXIFENE) FILM-COATED TABLETS 60MG 34.5

BC25810100 LIVALO TABLETS 4MG 30.3

BC25812209 ZYGRAF INJECTION (TACROLIMUS INJECTION 5MG/ML) 702

BC25817100 MONTEZYD TABLETS 5MG (MONTELUKAST CHEWABLE TABLETS 5MG) 15.8

BC258203FP SANCUSO TRANSDERMAL PATCH 3.1MG/24HOURS 2072

BC25829100 SINLUE CHEWABLE TABLETS 5MG 15.6

BC25830100 SINLUE CHEWABLE TABLETS 4MG 14.4

BC25840221 ADRIM INJECTION 515

BC25849100 VOMIZ FILM COATED TABLETS 4MG 100

BC25856414 LATANOPROST OPHTHALMIC SOLUTION 0.005% 441

BC25863100 Ibuprofen Sandoz Film coated Tablet 600mg 1.78

BC25873100 CLOPISTAD 40.8

BC25877100 DAFIRO 5/160MG FILM-COATED TABLETS 20.7

BC25879100 IRBESARTAN SANDOZ 150MG FILM COATED TABLETS 7.6

BC25882253 FIRMAGON 80MG, POWDER AND SOLVENT FOR SOLUTION FOR INJECTION 4801

BC25883257 FIRMAGON 120MG, POWDER AND SOLVENT FOR SOLUTION FOR INJECTION 4801

BC25886100 DEXILANT DELAYED RELEASE CAPSULES 30MG 22.4

BC25887100 DEXILANT DELAYED RELEASE CAPSULES 60MG 23.8

BC25890100 MOSMASS TABLETS 70MG 221

BC25893100 APO-PRAMIPEXOLE 0.25MG TABLETS 10.1

BC25897100 IRBESARTAN SANDOZ 300MG FILM COATED TABLETS 13.3

BC25898209 VINORELBINE SANDOZ 10MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

1374

BC25898221 VINORELBINE SANDOZ 10MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

6850

BC25899221 GEMCITABINE SANDOZ 40MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

1086

BC25899240 GEMCITABINE SANDOZ 40MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

4099

BC25899248 GEMCITABINE SANDOZ 40MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

8108

BC25900100 APO-OLANZAPINE ODT 5MG 55

BC25901100 APO-OLANZAPINE ODT 10MG 109

BC25902209 NEOPAREN NO.2 INJECTION 1L 415

BC25902210 NEOPAREN NO.2 INJECTION 1.5L 560

BC25902212 NEOPAREN NO.2 INJECTION 2L 707

BC25913100 DAFIRO 5/80MG FILM-COATED TABLETS 15

BC25914100 LAMIDUS 100 TABLETS 24.1

BC25923100 "CAPSUGEL" UTROGESTAN SOFT CAPSULE 100MG 8.3

BC25924100 MONTEZYD TABLETS 4MG 15.8

BC259342AA Leuplin Depot 1M 3.75mg S.C. Injection 4282

BC25936245 PANTOPRAZOLE SANDOZ 40MG POWDER FOR SOLUTION FOR INJECTION 170

BC25937100 MONTELUKAST SANDOZ 5MG CHEWABLE TABLETS 15.6

BC25938100 XALKORI CAPSULES 250MG 3156

BC25939100 XALKORI CAPSULES 200MG 2722

BC25944100 AMTURNIDE 300/10/25MG FILM-COATED TABLETS 39.1

BC25945100 AMTURNIDE 300/10/12.5MG FILM-COATED TABLETS 39.1

268

Page 269: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC25946100 AMTURNIDE 300/5/25MG FILM-COATED TABLETS 39.1

BC25947100 AMTURNIDE 300/5/12.5MG FILM-COATED TABLETS 39.1

BC25948100 AMTURNIDE 150/5/12.5MG FILM-COATED TABLETS 27.5

BC25965100 CONVERIUM 300MG TABLETS 12.9

BC25967209 VANCOMYCIN SANDOZ POWDER FOR SOLUTION FOR INJECTION 317

BC25967277 VANCOMYCIN SANDOZ POWDER FOR SOLUTION FOR INJECTION 101

BC25972100 ZYDUS LANS DR 30 18.5

BC25980100 SINLUE F.C. TABLET 10MG 19.8

BC25981100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 200MCG 275

BC25982100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 400MCG 330

BC25983100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 600MCG 395

BC25984100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 800MCG 485

BC25985100 PAINKYL FENTANYL (BUCCAL SOLUBLE FILMS) 1200MCG 585

BC25993100 PLETAAL OD TABLETS 100MG 16.6

BC25994100 PLETAAL OD TABLETS 50MG 9.1

BC26000245 OMEPRAZOLE SANDOZ 40MG POWDER FOR SOLUTION FOR INFUSION 86

BC26002421 DORZOSTILL EYE-DROPS 2% 275

BC26028100 LIPISTAD 20 24.9

BC260293C8 EXELON PATCH 10 80

BC26031100 GIOTRIF FILM-COATED TABLETS 20 MG 1438

BC26032100 GIOTRIF FILM-COATED TABLETS 30 MG 1438

BC26033100 GIOTRIF FILM-COATED TABLETS 40 MG 1438

BC26034100 GIOTRIF FILM-COATED TABLETS 50 MG 1438

BC26037100 JURNISTA PROLONGED-RELEASE TABLETS 8MG 135

BC26042100 Sibelium Tablets 5mg 1.62

BC26043100 ZELBORAF FILM-COATED TABLETS 240MG (VEMURAFENIB) 1214

BC26045100 APO-DONEPEZIL FILM TABLETS 5MG 61

BC26046100 APO-DONEPEZIL FILM-COATED TABLETS 10MG 65

BC26048100 LOSARTAN SANDOZ COMP FILM COATED TABLET 50/12.5 MG 9.3

BC26050229 OXALIPLATIN SANDOZ 5MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

2203

BC26050238 OXALIPLATIN SANDOZ 5MG/ML CONCENTRATE FOR SOLUTION FOR

INFUSION

5898

BC26051100 MONTELUKAST SANDOZ 4MG CHEWABLE TABLETS 14.4

BC26063100 OLANZAPINE SANDOZ FILM COATED TABLETS 5MG 54

BC26064100 "CAPSUGEL" UTROGESTAN SOFT CAPSULE 200MG 16.5

BC26065209 GEMCITABINE TEVA POWDER FOR SOLUTION FOR INFUSION 4099

BC26065212 GEMCITABINE TEVA POWDER FOR SOLUTION FOR INFUSION 8108

BC26065263 GEMCITABINE TEVA POWDER FOR SOLUTION FOR INFUSION 1086

BC26074271 TEICOPLANIN SANDOZ POWDER FOR INJECTION 1585

BC26077100 ITRACONAZOLE SANDOZ HGC 100MG 23.7

BC26082100 ACC 600 EFFERVESCENT TABLETS 6.6

BC26090100 PHARACETAM FILM-COATED TABLET 1000MG 44.8

BC26093205 SIGNIFOR 0.3MG/ML SOLUTION FOR INJECTION IN AMPOULE 2161

BC26094228 SIGNIFOR 0.6MG/ML SOLUTION FOR INJECTION IN AMPOULE 2435

BC26095208 SIGNIFOR 0.9MG/ML SOLUTION FOR INJECTION IN AMPOULE 2500

BC26097100 CORALAN FILM-COATED TABLETS 5 MG 26.5

BC26098100 CORALAN FILM-COATED TABLETS 7.5 MG 26.5

BC26104100 PANTOPRAZOL SANDOZ 40MG GASTRO-RESISTANT TABLETS 18.4

BC26105100 MONTELUKAST SANDOZ 10MG FILM-COATED TABLETS 19.8

BC26106245 ESOMEPRAZOLE SANDOZ POWDER FOR SOLUTION FOR INJECTION/INFUSION

40MG

94

BC26109100 GLUCOVANCE 500MG/2.5MG FILM-COATED TABLETS 2.22

BC26110100 GLUCOVANCE 500MG/5MG FILM-COATED TABLETS 2.22

BC26124100 ELIQUIS FILM-COATED TABLET 2.5MG 37

269

Page 270: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC26127100 LETROZOLE-TEVA 2.5MG TABLETS 40

BC26128100 ZYDUS LANS DR 15 16.6

BC26132100 FLUVASTATIN XL PROLONGED RELEASE FILM-COATED TABLETS 80MG 14

BC26133100 ELIQUIS FILM-COATED TABLET 5MG 37

BC26136100 FOSAMAX PLUS TABLETS 70MG/5600 IU 221

BC26139100 ZYTIGA TABLETS 250MG 893

BC26140212 HALAVEN 0.5MG/ML SOLUTION FOR INJECTION 12715

BC26147100 FLUVASTATIN XL FILM-COATED TABLETS 80MG 14

BC26153100 Moxiclav 625mg F.C. Tablets 6.6

BC26155100 OLANZAPINE SANDOZ FILM COATED TABLETS 10MG 104

BC26156255 Ciprofloxacin Sandoz 2mg/ml Solution for Infusion 628

BC26157400 SEEBRI BREEZHALER 50 MICROGRAM, INHALATION POWDER HARD

CAPSULES(30 CAP.)

1225

BC26168100 STIVARGA FILM-COATED TABLETS 40MG 1168

BC26169100 PRAVAFEN 40MG/160MG HARD CAPSULES 20.6

BC26173100 TRACLEER FILM COATED TABLETS 62.5MG 1607

BC26174100 TRACLEER FILM COATED TABLETS 125MG 1607

BC26179100 UNISIA 8MG/5MG TABLETS 11.5

BC26185238 Propofol-Lipuro 1% 64

BC26188100 PHAVIR FILM-COATED TABLETS 500MG 72

BC26190100 CLOPIDOGREL-TEVA 75MG FILM-COATED TABLETS 39.6

BC26193100 APO-ATOMOXETINE CAPSULES 25MG 69

BC26194100 APO-ATOMOXETINE CAPSULES 10MG 69

BC26195100 APO-ATOMOXETINE CAPSULES 18MG 69

BC26196100 APO-ATOMOXETINE CAPSULES 40MG 69

BC26197100 APO-ATOMOXETINE CAPSULES 60NG 69

BC26198100 BICALUTAMIDE-TEVA FILM-COATED TABLETS 50MG 110

BC26201248 Fluconazole Sandoz 2mg/ml Solution for infusion 361

BC26201255 Fluconazole Sandoz 2mg/ml Solution for infusion 422

BC26201263 Fluconazole Sandoz 2mg/ml Solution for infusion 1009

BC26209100 EDARBYCLOR TABLET 40MG/12.5MG 17.4

BC26210100 EDARBYCLOR TABLET 40MG/25MG 17.4

BC26213100 REPAGLINID JUBILANT TABLET 1MG 2.84

BC26214100 ESOMEPRAZOL SANDOZ 40MG GASTRO RESISTANT TABLETS 12

BC26216100 BETMIGA PROLONGED-RELEASE TABLETS 50MG 37

BC26217100 BETMIGA PROLONGED-RELEASE TABLETS 25MG 37

BC26219100 XELJANZ FILM-COATED TABLETS 5MG 562

BC26224100 EXEMESTANE "ALVOGEN" F.C. TABLETS 25MG 48.8

BC26226100 ROSUVASTATIN-TEVA FILM-COATED TABLETS 5MG 18.3

BC26233100 PRADAXA CAPSULES 75MG 27.5

BC26236100 OSTIRAL FILM COATED TABLET 60MG 33.3

BC26239100 BICALUTAMIDE "ALVOGEN" FILM COATED TABLETS 50MG 110

BC26240209 Vaxcel Ceftriaxone-1g Injection 193

BC26241100 RIBUTIN CAPSULE 150MG 74

BC26244100 PHARODINE IR FILM-COATED TABLETS 2MG 11.1

BC26246100 WAKA-OLANZAPINE ODT 10 109

BC26247100 WAKA-OLANZAPINE ODT 5 55

BC26252100 NOKLOT 75 (CLOPIDOGREL TABLETS USP 75MG) 39.6

BC26262220 ALVOTAZ POWDER FOR SOLUTION FOR INJECTION 435

BC262622CX ALVOTAZ POWDER FOR SOLUTION FOR INJECTION 241

BC26269100 REPAGLINID JUBILANT TABLETS 2MG 3.66

BC26270100 BICALUTAMIDE-ACEPHARM FILM COATED TABLETS 50MG 110

BC26272100 WALKIN 35MG FILM-COATED TABLET 219

BC26274100 NIFEDIPINE EXTENDED RELEASE TABLETS(OROS) 30MG "SUNYET" 8.1

BC26284100 VIMPAT 50MG FILM-COATED TABLETS 33.8

270

Page 271: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC26285100 VIMPAT 100MG FILM-COATED TABLETS 63

BC26286100 VIMPAT 150MG FILM-COATED TABLETS 91

BC26287100 VIMPAT 200MG FILM-COATED TABLETS 120

BC26289100 WAKA-QUETIAPINE XR 200 42

BC26290100 WAKA-QUETIAPINE XR 300 55

BC26292443 STRIVERDI RESPIMAT 2.5 MICROGRAM SOLUTION FOR INHALATION 1041

BC26297100 VALPROATE SODIUM / VALPROIC ACID SANDOZ PROLONGED-RELEASE

TABLET 500MG

8.2

BC26298100 NESINA TABLETS 25MG 24.3

BC26299100 NESINA TABLETS 12.5MG 13.5

BC26300100 NESINA TABLETS 6.25MG 6.7

BC26301443 ULTIBRO BREEZHALER 110/50 MICROGRAM, INHALATION POWDER HARD

CAPSULES

1611

BC26302321 AXCEL ACYCLOVIR CREAM 46.6

BC26304225 ELIGARD 7.5 MG, POWDER AND SOLVENT FOR SOLUTION FOR INJECTION 4282

BC263052FQ ELIGARD 22.5 MG, POWDER AND SOLVENT FOR SOLUTION FOR INJECTION 10038

BC263062AP ELIGARD 45 MG, POWDER AND SOLVENT FOR SOLUTION FOR INJECTION 14960

BC26307209 TOPOTECAN BIOPRO POWDER FOR CONCENTRATE FOR SOLUTION FOR

INFUSION

2034

BC26307219 TOPOTECAN BIOPRO POWDER FOR CONCENTRATE FOR SOLUTION FOR

INFUSION

7244

BC26308100 VORICONAZOLE SANDOZ FILM-COATED TABLETS 50MG 300

BC26309100 VORICONAZOLE SANDOZ FILM-COATED TABLETS 200MG 1083

BC26310100 ZETLAM 63

BC26313100 LETERO FILM COATING TABLET 2.5MG 40

BC26315143 ANORO ELLIPTA 55/22 MCG INHALATION POWDER 1502

BC26318143 RELVAR ELLIPTA 92/22 MCG INHALATION POWDER 861

BC26321100 LOSARTAN JUBILANT FILM-COATED TABLET 50MG 9.3

BC26322100 LOSARTAN JUBILANT FILM-COATED TABLET 100MG 11.1

BC26328100 FYCOMPA FILM-COATED TABLETS 2MG 64

BC26329100 FYCOMPA FILM-COATED TABLETS 4MG 125

BC26330100 FYCOMPA FILM-COATED TABLETS 8MG 144

BC26331100 LAMIDUS 25 TABLETS 7.3

BC26332100 PMS-ROSUVASTATIN 20MG TABLETS 30.5

BC26334209 DAXOTEL INJECTION CONCENTRATE 20MG/ML 4322

BC26334219 DAXOTEL INJECTION CONCENTRATE 20MG/ML 16298

BC26335100 TORPIDO FILM COATED TABLETS 75MG 39.6

BC26337100 VORICONAZOLE MYLAN 200MG 1083

BC26343157 FLUTIFORM 50/5 MCG PER ACTUATION PRESSURISED, INHALATION,

SUSPENSION

705

BC26344157 FLUTIFORM 250/10MCG PER ACTUATION PRESSURISED, INHALATION,

SUSPENSION

1190

BC26345157 FLUTIFORM 125/5 MCG PER ACTUATION PRESSURISED, INHALATION,

SUSPENSION

851

BC26346277 CEFTRIAXONE KABI 0.5G POWDER FOR SOLUTION FOR INJECTION 100

BC26347209 CEFTRIAXONE KABI 1G POWDER FOR SOLUTION FOR INJECTION 193

BC26349297 ALVOCLAV POWDER FOR SOLUTION FOR INJECTION 1000MG/200MG 142

BC26350100 LIPISTAD 10 14.9

BC26363100 PMS-LEFLUNOMIDE 10MG TABLETS 38.8

BC26364100 PMS-LEFLUNOMIDE 20MG TABLETS 56

BC26367100 APO-ROSUVASTATIN TABLET 20MG 30.5

BC26368100 APO-ROSUVASTATIN TABLET 10MG 19.7

271

Page 272: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC26369100 TELCARD 80 16.8

BC26372221 FIVOFLU INJECTION 50MG/ML 25.6

BC26372229 FIVOFLU INJECTION 50MG/ML 45.6

BC26376100 POSANOL TABLETS 100MG 696

BC26379100 APO-RIVASTIGMINE CAPSULES 1.5MG 30.6

BC26380100 APO-RIVASTIGMINE CAPSULES 3MG 30.6

BC26381100 APO-RIVASTIGMINE CAPSULES 4.5MG 30.6

BC26382100 APO-RIVASTIGMINE CAPSULES 6MG 30.6

BC26383100 VATIVIO FILM-COATED TABLETS 100MG 500

BC26385255 ZOLDRIA 4MG/100ML SOLUTION FOR INFUSION 8928

BC26387235 CAXATIN SOLUTION FOR INTRAVENOUS INFUSION 10MG/ML 2632

BC26391100 LOSARTAN TEVAPHARM FILM COATED TABLETS 50MG 9.3

BC26396100 RABEPRAZOLE SODIUM GASTRO RESISTANT MYLAN 20MG 11.8

BC26397100 MYCOPHENOLATE MOFETIL TEVA HARD CAPSULES 250MG 47.6

BC26398100 IRBESARTAN 300MG+HYDROCHLOROTHIAZIDE 25MG SANDOZ FILM COATED

TABLET

12.9

BC26399100 IRBESARTAN 150MG+HYDROCHLOROTHIAZIDE 12.5MG SANDOZ FILM COATED

TABLET

7.5

BC26400100 IRBESARTAN 300MG+HYDROCHLOROTHIAZIDE 12.5MG SANDOZ FILM COATED

TABLET

12.9

BC26401100 TORVACARD 40MG, FILM-COATED TABLETS 28.3

BC26415100 LERCANIDIPINE MYLAN 10MG 7

BC26420100 OXYNORM IMMEDIATE RELEASE CAPSULES 20MG 35

BC26421100 OXYNORM IMMEDIATE RELEASE CAPSULES 5MG 14.5

BC26422100 OXYNORM IMMEDIATE RELEASE CAPSULES 10MG 20

BC26426100 TORVACARD 10MG, FILM-COATED TABLETS 14.9

BC26427100 TORVACARD 20MG, FILM-COATED TABLETS 24.9

BC26429100 DONEPEZIL JUBILANT FILM-COATED TABLET 5MG 59

BC26432100 OXYCONTIN CONTROLLED-RELEASE TABLETS 10 MG 40

BC26434100 OXYCONTIN CONTROLLED-RELEASE TABLETS 20 MG 76

BC26436100 OXYCONTIN CONTROLLED-RELEASE TABLETS 40 MG 134

BC26446100 ZYSAR 16 (CANDESARTAN CILEXETIL TABLETS 16MG) 11.2

BC26447100 PRAMIPEXOLE DIHYDROCHLRODIE TABLETS MYLAN 0.25MG 10.1

BC26449100 PRAMIPEXOLE-ACEPHARM TABLETS 0.25MG 9.6

BC26452100 PMS-DESMOPRESSIN TABLETS 0.2MG 48

BC26453100 PMS-DESMOPRESSIN TABLETS 0.1MG 33.3

BC26455100 VALACYCLOVIR MYLAN 500MG 72

BC26463100 OLMESARTAN SANDOZ FILM COATED TABLET 20MG 10.3

BC26464100 OLMESARTAN SANDOZ FILM COATED TABLET 40MG 17.8

BC26465100 DAFIRO HCT 5/160/12.5MG FILM-COATED TABLETS 20.7

BC26466100 DAFIRO HCT 5/160/25MG FILM-COATED TABLETS 20.7

BC26467100 DAFIRO HCT 10/160/12.5MG FILM-COATED TABLETS 24.8

BC26468100 DAFIRO HCT 10/160/25MG FILM-CATED TABLETS 24.8

BC26472100 ZYSAR 8 (CANDESARTAN CILEXETIL TABLETS 8MG) 7.7

BC26485100 AZICINE CAPSULES 250MG 35.1

BC26496100 CANDESARTAN AND HYDROCHLOROTHIAZIDE MYLAN 16MG/12.5MG 11.2

BC26497100 ROSUVASTATIN MYLAN 10MG 18.9

BC26503100 TELCARD 40 9.6

BC26504100 PMS-ROSUVASTATIN 10MG TABLETS 18.9

BC26505100 PMS-ROSUVASTATIN 5MG TABLETS 17.4

BC26506151 IBUFEN SYRUP 25

BC26516100 FINASTERIDE-TEVA 5MG FILM-COATED TABLETS 20.6

BC26520100 SEVIKAR 5/40MG FILM COATED TABLETS 24.7

BC26521100 SEVIKAR 10/40MG FILM COATED TABLETS 24.7

BC26526209 MEROPENEM "ALVOGEN" POWDER FOR SOLUTION FOR IV INJECTION 875

272

Page 273: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

BC26526277 MEROPENEM "ALVOGEN" POWDER FOR SOLUTION FOR IV INJECTION 404

BC26543100 ALVOSTAT FILM COATED TABLETS 10MG 18.9

BC26544100 ALVOSTAT FILM COATED TABLETS 20MG 30.5

BC26557100 TELCARD 20 5.2

J000006212 ANTIVENIN OF TR. MUCROSQUAMATUS AND TR. GRAMINEUS

(LYOPHILIZED)

7900

J000009212 ANTIVENIN OF B. MULTICINCTUS AND N. NAGA ATRA (LYOPHILIZED) 7900

J000010209 ANTIVENIN OF D. ACUTUS (LYOPHILIZED) 7900

J000089209 TETANUS TOXOID ALUM PRECIPITATED "KUO KWANG" 66

J000089299 TETANUS TOXOID ALUM PRECIPITATED "KUO KWANG" 16.5

K000285214 CYTOTECT BIOTEST 24468

K000285221 CYTOTECT BIOTEST 2446

K000471221 ATG-FRESENIUS S 100MG/ 5ML 8261

K000471229 ATG-FRESENIUS S 200MG /10ML 13627

K000489221 REOPRO (ABCIXIMAB 2MG/ML) 11740

K000578248 "CSL" ALBAPURE 20 1212

K000620209 EPREX INJECTION 2000U/ML 199

K000620212 EPREX INJECTION 2000 U/ML 396

K000648209 RECORMON SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 1000IU 199

K000650237 PROLEUKIN FOR INJECTION 11935

K000653299 HUMULIN 70/30 100 IU/ML 0.3

K000657299 HUMULIN N (NPH HUMAN INSULIN RECOMBINANT DNA ORIGIN) ISOPHANE

SUSPENSION) 100I.U.//ML

0.29

K000663299 HUMULIN R (REGULAR HUMAN INSULIN RECOMBINANT DNA ORIGIN

INJECTION) 100 I.U./ML

0.29

K000682299 MIXTARD 30 0.3

K000700220 ROFERON-A (SOLUTION FOR INJECTION) 621

K000700223 ROFERON-A (SOLUTION FOR INJECTION) 830

K000714229 METALYSE INJECTION 50MG(10KU) 37670

K000739266 ACTRAPID 100 I.U./ML 124

K000739299 ACTRAPID 100 I.U./ML 0.3

K000744238 ACTILYSE INJECTION 20MG 8248

K000760299 INSULATARD 0.27

K000761210 FASTURTEC POWDER AND SOLVENT FOR CONCENTRATE FOR SOLUTION FOR

INFUSION 1.5MG/ML

2676

K000875221 RECORMON SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 5000IU 910

K000876212 RECORMON SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 2000IU 396

K000938248 EYLEA AFLIBERCEPT (RCH) 40 MG/ML SOLUTION FOR INTRAVITREAL

INJECTION PRE-FILLED SYRINGE (H2O2 STERILIZED)

26337

K000940229 RECORMON SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 10000 IU

"VETTER, GERMANY"

1604

KC00069248 BISEKO 1800

KC00079265 PLASBUMIN -5 1519

KC00197238 NORMAL SERUM ALBUMIN(HUMAN) PLASBUMIN-25 616

KC00197248 NORMAL SERUM ALBUMIN(HUMAN) PLASBUMIN-25 1519

KC00198265 PLASMANATE 1600

KC00271248 BUMINATE 25% ALBUMIN (HUMAN) USP, 25% SOLUTION "BAXTER" 1519

KC00274212 HEPATECT CP INJECTION 3504

KC00274229 HEPATECT CP INJECTION 18594

KC00285229 CYTOTECT CP BIOTEST 6042

273

Page 274: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

KC00285248 CYTOTECT BIOTEST 31387

KC00303248 ALBUMINAR-25 1480

KC00308240 THYMOGLOBULINE (ANTITHYMOCYTE IMMUNOGLOBULIN OF RABBIT ORIGIN) 7631

KC00319299 KOATE-DVI ANTIHEMOPHILIC FACTOR (HUMAN) 500IU, 1000IU 14.5

KC00320299 KOATE-DVI ANTIHEMOPHILIC FACTOR (HUMAN) 250IU 14.5

KC003692BC BCG IMMUNOTHERAPEUTIC IMMUCYST 4572

KC00375248 ALBUTEIN 25% SOLUTION 1519

KC00380229 ALBIOMIN 20% 230

KC00380238 ALBIOMIN 20% 460

KC00380248 ALBIOMIN 20% 1212

KC00380255 ALBIOMIN 20% 1963

KC00400248 ALBUMINAR-20 1212

KC00426299 HAEMATE P 1000I.U. 19.1

KC00427299 HAEMATE P 500I.U. 19.1

KC00428299 BERIATE 17.9

KC00430299 HAEMATE P 250IU 19.1

KC00439209 HAEMOCOMPLETTAN P 2058

KC00452206 HEPATITIS B IMMUNE GLOBULIN(HUMAN) HYPERHEP B S/D 2690

KC00452209 HEPATITIS B IMMUNE GLOBULIN(HUMAN) HYPERHEP B S/D 4941

KC00452221 HEPATITIS B IMMUNE GLOBULIN (HUMAN) HYPERHEP B S/D 23782

KC00461265 TETANUS IMMUNE GLOBULIN (HUMAN), HYPERTET S/D 1440

KC00462209 RHO (D) IMMUNE GLOBULIN (HUMAN), HYPERRHO S/D FULL DOSE 2528

KC00487248 ALBUTEIN 20% SOLUTION 1212

KC00491248 HUMAN ALBUMIN 20% "BEHRING" 1212

KC00497277 ALPHANINE SD COAGULATION FACTOR IX(HUMAN) 7550

KC00520277 BERIPLEX P/N 250/500 6200

KC00525299 BOTOX (BOTULINUM TOXIN TYPE A) PURIFIED NEUROTOXIN COMPLEX

"ALLERGAN"

63

KC00580216 EPREX INJECTION 10000IU/ML 790

KC00580219 EPREX INJECTION 10000IU/ML 758

KC00580221 EPREX INJECTION 10000IU/ML 1300

KC00580223 EPREX INJECTION 10000IU/ML 1404

KC00580224 EPREX INJECTION 10000IU/ML 1474

KC00580226 EPREX INJECTION 10000IU/ML 1872

KC00580227 EPREX INJECTION 10000IU/ML 1895

KC00580229 EPREX INJECTION 10000IU/ML 2051

KC00581209 EPREX INJECTION 2000IU/ML 199

KC00582212 EPREX INJECTION 4000IU/ML 396

KC00595266 HUMALOG MIX 25 100IU/ML (3ML) 261

KC00596266 HUMALOG MIX 50 100IU/ML ( 3ML) 261

KC00601265 BETAFERON 250MCG(8MIU)(INTERFERON BETA-1B) 1948

KC00608299 BENEFIX[RFIX] COAGULATION FACTOR IX (RECOMBINANT) 21

KC00615239 SAIZEN 8MG CLICK EASY 3610

KC00618266 BERININ P (BLOOD COAGULATION FACTOR IX .HUMAN PASTEURIZED) 4530

KC00618280 BERININ P (BLOOD COAGULATION FACTOR IX .HUMAN PASTEURIZED) 9060

KC00621212 EPREX INJECTION 4000 U/ML 396

KC00621219 EPREX INJECTION 4000 U/ML 758

KC00622216 EPREX INJECTION 10000 U/ML 790

KC00622219 EPREX INJECTION 10000 U/ML 758

KC00622221 EPREX INJECTION 10000 U/ML 1300

KC00622223 EPREX INJECTION 10000 U/ML 1404

KC00622226 EPREX INJECTION 10000 U/ML 1872

274

Page 275: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

KC00622229 EPREX INJECTION 10000 U/ML 2051

KC006252B5 HERCEPTIN VIAL 440MG 59396

KC00630299 ALPHANATE 250IU 17.9

KC00631299 ALPHANATE 1000IU 17.9

KC00641299 KOGENATE FS, ANTIHEMOPHILIC FACTOR (RECOMBINANT), FORMULATED

WITH SUCROSE

25.4

KC00642299 KOGENATE FS.ANTIHEMOPHILIC FACTOR, (RECOMBINANT) FORMULATED

WITH SUCROSE 500IU/VIAL

25.9

KC00643209 HEPATITIS B IMMUNOGLOBULIN P "BEHRING" 4941

KC00643221 HEPATITIS B IMMUNOGLOBULIN P "BEHRING" 23782

KC00644299 ALPHANATE 500IU 17.9

KC00645221 RECORMON SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 5000IU 910

KC00646212 RECORMON SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 2000IU 396

KC00647229 RECORMON SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 10000IU 1604

KC00653209 HUMULIN 70/30 100 IU/ML 300

KC00657209 HUMULIN N (NPH HUMAN INSULIN RECOMBINANT DNA ORIGIN) ISOPHANE

SUSPENSION) 100I.U.//ML

295

KC00663209 HUMULIN R (REGULAR HUMAN INSULIN RECOMBINANT DNA ORIGIN

INJECTION) 100 I.U./ML

295

KC00667255 PEG-INTRON POWDER FOR INJECTION 100MCG/VIAL 4013

KC00669248 PEG-INTRON POWDER FOR INJECTION 50MCG/VIAL 2248

KC00670282 "FILGRASTIM INJECTION M300 2040

KC00672248 FLEBOGAMMA 5% 4500

KC00672255 FLEBOGAMMA 5% 9000

KC00672263 FLEBOGAMMA 5% 18000

KC00674253 PEG-INTRON POWDER FOR INJECTION 80MCG/VIAL 3377

KC00675257 PEG-INTRON POWDER FOR INJECTION 120MCG/VIAL 4363

KC00677243 NORDITROPIN SIMPLEXX INJECTION 10MG/1.5ML 6704

KC00678235 NORDITROPIN SIMPLEXX INJECTION 5MG/1.5ML 2408

KC00682209 MIXTARD 30 300

KC00683236 GENOTROPIN 5.3MG 2408

KC00697266 INSULATARD PENFILL 124

KC00699229 MABTHERA SOLUTION FOR IV INFUSION 8132

KC00699248 MABTHERA SOLUTION FOR IV INFUSION 38887

KC00700216 ROFERON-A (SOLUTION FOR INJECTION) 405

KC00709248 RECORMON MULTIDOSE POWDER AND SOLVENT FOR SOL. FOR INJECTION

50000IU

7321

KC00711280 FILGRASTIM INJECTION 150 μG/0.6ML 1575

KC00712266 FILGRASTIM INJECTION 75 μG/0.3ML 763

KC00713240 ENBREL (ETANERCEPT) 25MG 3834

KC00728266 LANTUS 100U/ML, SOLUTION FOR INJECTION 454

KC00729266 NOVORAPID PENFILL 3ML 100U/ML 253

KC00733277 PROFILNINE SD 6200

KC00735209 GLUCAGEN 1MG 800

KC00739209 ACTRAPID 100 IU/ML 300

KC00740299 KOGENATE FS.ANTIHEMOPHILIC FACTOR, (RECOMBINANT) FORMULATED

WITH SUCROSE 250IU/VIAL

25.4

KC00743248 ACTILYSE INJECTION 18559

KC00745209 LANTUS 100 UNITS/ML SOLUTION FOR INJECTION, 10ML VIAL 1239

KC00746209 “BAXTER” FEIBA 50U/ML 38249

KC00747277 “BAXTER”FEIBA 25U/ML 19100

KC00755248 GRANOCYTE 50 497

275

Page 276: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

KC00756265 GRANOCYTE 250 2120

KC00757255 GRANOCYTE 100 834

KC00760209 INSULATARD 271

KC00768266 NOVOMIX 30 PENFILL 3ML 100U/ML 253

KC00774280 IMMUNINE PURIFIED FACTOR IX CONCENTRATE, VIRUS-INACTIVATED 600

IU

9060

KC00776283 HUMIRA 40MG SOLUTION FOR INJECTION, PRE-FILLED SYRINGE 14933

KC00777248 PLASBUMIN-20 1212

KC00787216 FORTEO FOR INJECTION 14861

KC00788277 PEGASYS PREFILLED SYRINGES 135MCG/0.5ML 3484

KC00789277 PEGASYS PREFILLED SYRINGES 180MCG/0.5ML 4200

KC00795266 HUMALOG U-100 261

KC00796229 GAMUNEX 1800

KC00796240 GAMUNEX 4500

KC00796248 GAMUNEX 9000

KC00796255 GAMUNEX 18000

KC00796263 GAMUNEX 36000

KC00800243 RECORMON SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 30000IU 5187

KC00803266 APIDRA 100 U/ML SOLUTION FOR INJECTION 261

KC00807219 AVASTIN INJECTION 9097

KC00810266 LEVEMIR FLEX PEN 454

KC00812248 SYNAGIS INJECTION 50MG 16451

KC00820266 NOVOMIX 30 FLEXPEN 253

KC00823266 NOVORAPID FLEXPEN 253

KC00828238 Eprex Injection 40000 IU/ml 4125

KC00828245 Eprex Injection 40000 IU/ml 7453

KC00835261 XOLAIR 150 MG POWDER AND SOLVENT FOR SOLUTION FOR INJECTION 16038

KC00836299 “BAXTER”ADVATE 500 IU POWDER AND SOLVENT FOR INJECTION 26.1

KC00837299 “BAXTER”ADVATE 250 IU POWDER AND SOLVENT FOR INJECTION 26.1

KC00838299 “BAXTER”ADVATE 1000 IU POWDER AND SOLVENT FOR INJECTION 26.1

KC00841248 "TBSF" HUMAN IMMUNOGLOBULIN FOR INTRAVENOUS USE 5400

KC00841263 "TBSF" HUMAN IMMUNOGLOBULIN FOR INTRAVENOUS USE 19440

KC00842248 "TBSF" (20%) HUMAN ALBUMIN SOLUTION 1212

KC00842255 "TBSF" (20%) HUMAN ALBUMIN SOLUTION 1963

KC00843277 "TBSF" HIGH PURITY FACTOR IX CONCENTRATE 7550

KC00844299 "TBSF" HIGH PURITY FACTOR VIII CONCENTRATE 17.9

KC00846248 ENBREL 50MG SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 7268

KC00851240 ENBREL 25MG SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 3834

KC00852299 XYNTHA 500 IU 23

KC00853299 XYNTHA 250 IU 23

KC00854299 XYNTHA 1000 IU 23

KC00857244 HUMATROPE FOR INJECTION 12 MG(36 IU) 8546

KC00867295 MIRCERA SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 75

MCG/0.3ML

3931

KC00868248 MIRCERA SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 50

MCG/0.3ML

2912

KC00869255 MIRCERA SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE 100

MCG/0.3ML

5241

KC00870299 DYSPORT, POWDER FOR INJECTION 17.7

KC00871277 PEGASYS PRE-FILLED SYRINGES 135 MCG/0.5 ML 3484

KC00872277 PEGASYS PRE-FILLED SYRINGES 180 MCG/0.5 ML 4200

KC00874219 AVASTIN INJECTION 9097

KC00877238 ERBITUX 5MG/ML SOLUTION FOR INFUSION 6894

276

Page 277: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

KC00878248 NOVOSEVEN RT 26255

KC00879205 LUCENTIS 10MG/ML SOLUTION FOR INJECTION 26637

KC008792FM LUCENTIS 10MG/ML SOLUTION FOR INJECTION 26637

KC00894214 RABIPUR PCEC RABIES VACCINES BEHRING POWDER AND SOLVENT FOR

SOLUTION FOR INJECTION

1450

KC00895248 “BAXTER”KIOVIG 100 MG/ML SOLUTION FOR INFUSION 9000

KC00895255 “BAXTER”KIOVIG 100 MG/ML SOLUTION FOR INFUSION 18000

KC00895263 “BAXTER”KIOVIG 100 MG/ML SOLUTION FOR INFUSION 36000

KC00896243 OMNITROPE 10MG/1.5ML SOLUTION FOR INJECTION(30IU) 6704

KC00897265 ORENCIA LYOPHILIZED POWDER FOR IV INFUSION 250MG 10162

KC00898266 HUMALOG MIX 25 100U/ML KWIKPEN 261

KC00899266 HUMALOG MIX 50 100U/ML KWIKPEN 261

KC00900266 HUMALOG 100U/ML KWIKPEN 261

KC00905261 ILARIS 150 MG POWDER FOR SOLUTION FOR INJECTION 428021

KC00907219 ACTEMRA SOLUTION FOR INFUSION 4409

KC00907229 ACTEMRA SOLUTION FOR INFUSION 10124

KC00907238 ACTEMRA SOLUTION FOR INFUSION 21776

KC00908266 NOVOMIX 50 FLEXPEN 253

KC00909266 NOVOMIX 50 PENFILL 253

KC00911206 SIMPONI TM (GOLIMUMAB),SOLUTION FOR INJECTION 32292

KC00913277 "TBSF" PROTHROMBIN COMPLEX CONCENTRATE 4586

KC00914216 VICTOZA 1786

KC00918209 PROLIA 6307

KC00919280 NEULASTA 20116

KC00920206 STELARA SOLUTION FOR INJECTION 100329

KC00922248 HUMAN ALBUMIN 200G/L BAXTER 1212

KC00923248 "BAXTER" FLEXBUMIN 25%, ALBUMIN (HUMAN), USP, 25% SOLUTION 1480

KC00923255 "BAXTER" FLEXBUMIN 25%, ALBUMIN (HUMAN), USP, 25% SOLUTION 2208

KC009242FO XGEVA 11093

KC00926248 UMAN ALBUMIN SOLUTION FOR INFUSION 20% 1212

KC00926255 UMAN ALBUMIN SOLUTION FOR INFUSION 20% 1963

KC009272B4 NPLATE INJECTION 18816

KC00928229 MABTHERA SOLUTION FOR INFUSION 8132

KC00928248 MABTHERA SOLUTION FOR INFUSION 38887

KC00929277 PEGASYS PRE-FILLED PEN 180MCG/0.5ML 4200

KC00930277 PEGASYS PRE-FILLED PEN 135MCG/0.5ML 3484

KC00932244 SAIZEN 12 MG(36IU) SOLUTION FOR INJECTION 8546

KC00933251 SAIZEN 20 MG (60IU) SOLUTION FOR INJECTION 12818

KC00936248 EYLEA AFLIBERCEPT (RCH) 40 MG/ML SOLUTION FOR INTRAVITREAL

INJECTION VIAL

26337

KC00945258 ORENCIA (ABATACEPT) INJECTION FOR SUBCUTANEOUS USE 125MG PER

SYRINGE(125MG/ML)

5970

KC00950206 NESP INJECTION PLASTIC SYRINGE 180 MCG/0.5 ML 7996

KC00951206 NESP INJECTION PLASTIC SYRINGE 120 MCG/0.5 ML 5923

KC00952206 NESP INJECTION PLASTIC SYRINGE 60MCG/0.5ML 3290

KC00953206 NESP INJECTION PLASTIC SYRINGE 40MCG/0.5ML 1587

KC00954206 NESP INJECTION PLASTIC SYRINGE 30MCG/0.5ML 1251

KC00955206 NESP INJECTION PLASTIC SYRINGE 20 MCG/0.5 ML 1030

KC00956206 NESP INJECTION PLASTIC SYRINGE 10 MCG/0.5 ML 515

KC00957206 STELARA TM SOLUTION FOR INJECTION 100329

KC009612B5 HERCEPTIN VIAL 440MG 59396

KC00974277 PEGASYS PREFILLED SYRINGES 135MCG/0.5ML 3484

KC00975277 PEGASYS PREFILLED SYRINGES 180MCG/0.5ML 4200

277

Page 278: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

N000107100 BETTY CAPSULES 0.24

N000162100 CHLORPHENIRAMINE MALEATE TABLETS "JOHNSON" 0.1

N000181100 DEXICONE "STANDARD" 0.29

N000218100 OROTOMINE S.C. TABLETS 0.5

N000235212 ACTIVE B1 INJECTION 0.5% "Y.Y." 2.4

N000282100 STIGMIN-C TABLETS "JOHNSON" 0.28

N000307100 ERGOLAR CAFFEINE TABLETS "NCP" 1.07

N000338100 TRANZANONE TABLETS "STANDARD" 0.73

N000370100 SPARTE TABLETS 0.46

N000460100 VALETAN TABLETS "JOHNSON" 0.55

N000465100 TRIPYLINE TABLETS 0.49

N000475209 DL-METHYL EPHEDRINE HCL INJECTION 4% "Y.Y." 2.73

N000589209 YOBRAMIN INJECTION "ASTAR" 7.9

N000589229 YOBRAMIN INJECTION "ASTAR" 10.9

N000608100 DESTRINALIS CAPSULES "KINGDOM" 1.15

N000686238 20% DEXTROSE INJECTION "ASTAR" 5.6

N000687238 50% DEXTROSE INJECTION "ASTAR" 5.7

N000694100 MELLAZINE S.C. TABLETS 25MG 0.88

N000703100 GASNONE TABLETS 0.43

N000824212 DEXSOPHAN INJECTION "Y.Y." 3.34

N000825209 BIHYPER INJECTION 0.25% "Y.Y." 4.48

N000884100 POLENIN TABLETS 0.9

N000990100 QUINIDINE SULFATE CAPSULES "NYSCO" 3.95

N001004209 TESTO INJECTION "ASTAR" 4

N001007100 CHINTAN TABLETS "C.M." 0.77

N001065100 CHE SU S.C. TABLETS 0.96

N001246209 VITAMIN B COMPLEX INJECTION "ASTAR" 4.54

N001246229 VITAMIN B COMPLEX INJECTION "ASTAR" 13.4

N001319229 LITOCIN INJECTION 6.8

N001500100 MEDICON TABLETS 15MG 0.89

N001510100 IS-BLOOD S.C. TABLETS 4

N001539100 NINRU S.C. TABLETS 0.59

N001585238 AMINOL INJECTION 8.1

N001633100 AMPOLIN CAPSULES 1.02

N001682221 VITACICOL INJECTION 500MG 5.4

N001728100 DIMENHYDRINATE TABLETS 50MG "JOHNSON" 0.48

N001758100 DESPAS S.C. TABLETS 0.96

N001816100 MAGNESIUM HYDROXIDE TABLETS 324MG "JOHNSON" 0.23

N001849100 DELCOPAN TABLETS 10MG "JOHNSON" 0.45

N001878221 WESCO INJECTION 4.69

N001929100 DECASON TABLETS 0.69

N001934209 UABASIN INJECTION 6.3

N001993209 ANTALL INJECTION 3.87

N001997209 PROGESTERONE INJECTION 25MG "SINTONG" 4.8

N002000221 HECIRAMIN INJECTION 4.86

N002051212 ALISIN INJECTION 2.4

N002055212 ASIPHYLLINE-M INJECTION 3.5

N002089209 MERO INJECTION 10MG 4.32

N002199100 ERYTHROMYCIN-L CAPSULES "SINTONG" 1.43

N002253100 URSOCID TABLETS "T.F." 1.93

N002266265 AMPOLIN INJECTION 5.9

N002332212 RUBOLIN INJECTION 2.5% 18.2

N002355277 YEIAMIN-2 INJECTION 65

N002454100 BALISA S.C. TABLETS 0.59

N002637100 LIPAN CHEWABLE TABLETS 0.78

278

Page 279: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

N0026371G0 LIPAN CHEWABLE TABLETS(鋁箔/膠箔) 1.5

N002638100 VENAMINE TABLETS 0.18

N002640100 IMENTON TABLETS 1.56

N002643100 FULIES S.C. TABLETS 0.89

N002654100 PRENISONE TABLETS 0.9

N002676100 TINTEN TABLETS 0.25

N002707209 INJECTIO NOSTIGMINAE METHYLSULFATIS 0.025% "Y.Y." 1.37

N002709212 CYCLONAMINE INJECTION "Y.Y." 28.6

N002722151 GLYCERINUM IODI COMPOSITUM "Y.Y." 12

N002893100 ALLERMIN TABLETS 0.11

N002958277 SODIUM CHLORIDE INJECTION "C.C.P." 18.9

N002984209 PETOL INJECTION 4.61

N002989100 INAH TABLETS 100MG 0.2

N003003221 LIDOCAINE HCL INJ. 2% "S.T" 20.8

N003061212 SINTOMIN INJECTION 3.4

N003061221 SINTOMIN INJECTION 4.68

N003068212 VITA-B1 INJECTION 20MG 2.4

N003074212 VITACICOL INJECTION 100MG 5.4

N003107209 HORMON-M 25MG INJECTION 4

N003187209 VITAMIN B1 INJECTION 100MG "C.C.P." 4.48

N003190209 BARTROPIN INJECTION 2.1

N003316100 DIHYDROCHL OZIDE TABLETS. 0.65

N003335238 BLUTON INJECTION 20% "C.C.P." 5.6

N003354100 VISTARIL CAPSULES 1.06

N003376209 KAIIPAN INJECTION "Y.Y." 9.2

N003378100 FULON VAGINAL TABLETS 1.96

N003449100 TABELLAE EPHEDRINI HYDROCHLORIDI "Y.Y." 0.56

N003458121 SULFANILAMIDE "Y.Y." 11.5

N003516100 BUSCOTON S.C. TABLETS 0.88

N003657100 THIAGEN F S.C. TABLETS 50MG 0.73

N003659100 IMIPRAMINE CAPSULES 1.4

N003776100 ASCORBIC ACID S.C. TABLETS 200MG 0.4

N003841100 MUSLELAX TABLETS 0.73

N003944100 ARTANE TABLETS 5MG 1.5

N003947100 ARTANE TABLETS 2MG 1.5

N004003423 LEDERCORT CREAM WITH NEOMYCIN 0.1% 37.9

N004008209 BUFFERED PENICILLIN G FOR INJECTION 1000000 U "Y.F." 6.9

N004248212 INJECTIO AMINOPHYLLIN 12.5% "Y.Y." 6.3

N004348100 ASTHMIN TABLETS 0.36

N004458271 PROCILLIN INJ. 400000 U 6.6

N004485100 WINHOAMIN S.C. TABLETS 25MG 0.55

N004487100 PAPAVERINE TABLETS 0.6

N004492100 PRESOLONE TABLETS 0.9

N004497100 DEXAMETHASONE TABLETS 0.69

N004498100 PROMETHAZINE S.C. TABLETS 0.3

N004499100 WINHOAMIN S.C. TABLETS 50MG 0.6

N004509100 SODIUM BICARBONATE TABLETS 1.44

N0045121G0 DEMESON TABLETS 0.5MG "F.Y."(瓶裝/42粒/瓶)、(瓶裝/84粒/瓶) 1.5

N0045161G0 SLEEP TABLETS 5MG "F.Y."(28粒/瓶)(鋁箔/膠箔) 1.5

N004550321 C.B. OINTMENT "STRONG" 9

N004612100 ANTOLON TABLETS 1.42

N004707100 SORAFLEX TABLETS 0.86

N004715100 LIVARIUM S.C. TABLETS 0.68

N004717100 ALEVIATIN & LUMINAL TABLETS 0.69

279

Page 280: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

N004730157 CO-TUSSIN COUGH SYRUP "KINGDOM" 34.1

N004781100 MECLIZINE TABLETS 25MG "F.Y." 0.56

N004844100 NALITOMYLON TABLETS 500MG 2.25

N004901209 NANNISMON-DEPOT INJECTION "CHI SHENG"

00

21.3

N004905299 B-COMPLEX INJECTION "CHI SHENG" 1.13

N004923212 SOSAPHYLLINE INJECTION "CHI SHENG" 7

N004944221 INJECTIO HEXAMINI 24% "Y.Y." 4.86

N004959100 TRAVEZIN TABLETS "H.L." 0.22

N004963100 HEXIN TABLETS "H.L." 1

N004968100 DECOTON TABLETS "H.L." 0.69

N004971100 RELAXIN TABLETS "H.L." 0.86

N004974100 TRANFLEX TABLETS 0.73

N004979100 HIRMAZINE TABLETS 25MG 1.6

N005124100 VENA TABLETS 0.43

N005223100 LONTOMIN COMPOUND S.C. TABLETS "F.Y." 0.5

N0052291G0 ANATEN TABLETS 10MG "F.Y."(21粒/瓶.84粒/瓶) 1.5

N0052361G0 PYRESON TABLETS(瓶裝/84粒/瓶) 1.5

N0052451G0 COLSIN 5MG TABLETS "F.Y."(21粒/瓶.84粒/瓶) (鋁箔/膠箔) 1.5

N005328209 DEXAROID INJECTION 4 MG "CHI SHENG" 6.9

N005328229 DEXAROID INJECTION 4 MG "CHI SHENG" 17.6

N005328299 DEXAMESONE INJECTION 4MG "CHI SHENG." 1.51

N005337238 50% GLUCOS INJECTION "CHI SHENG" 5.7

N005337263 50% GLUCOSE INJECTION "CHI SHENG" 19.1

N005337277 50% GLUCOS INJECTION "CHI SHENG" 39.9

N005438100 TRANKINSON TABLETS "H.L." 0.73

N005454100 PROCHLORPERAZINE MALEATE TABLETS 0.69

N005458100 A.D.A. TABLETS 0.9

N005461342 HEMORRHOIDS OINTMENT 25.8

N005509100 LONTOMIN TABLETS 2.5MG "F.Y." 0.17

N005854100 PRENIN TABLETS "H.L." 0.9

N005874100 HYDROCHLOROTHIAZIDE TABLETS "H.L." 0.65

N005881100 OROTIN S.C. TABLETS 0.38

N005894343 DIBUTON ANESTHETIC OINTMENT 24.1

N006061209 DEPOT HORMON-F INJECTION 18.1

N006164100 WINCONIN TABLETS "S.C." 1

N006183100 ERYTHROMYCIN E CAPSULES 1.43

N006184100 TETRACYCLINE CAPSULES 250MG "Y.F." 0.82

N006186100 SINDILIUM TABLETS "H.L." 0.8

N006235100 LUMBELLA TABLETS 0.19

N006279340 KINGLENIC OINTMENT "KINGDOM" 22.2

N0063101G0 ANATEN CAPSULES 10MG "F.Y."(21粒/瓶.84粒/瓶) 1.5

N006377229 AMINOPHYLLIN INJECTION "ORIENTAL" 6.3

N006379212 PROPHYLLIN M INJECTION 7

N006487212 TONPHYLLINE INJECTION "N.K." 4.65

N006511209 DEPOT HORMON-MF INJECTION 21.3

N006516212 STRONG VITA-B INJECTION 4.48

N006517238 TICANIN INJECTION 4

N006519238 VITATICAMIN-T INJECTION 4.5

N006530209 SINSERPINE INJECTION 3.47

N006532209 DEPOT HORMON-M INJECTION 20

N006732209 COMYCIN INJECTION 15

N006734100 PURE CALCIUM TABLETS 0.32

N006770212 LITAMIN INJECTION "LITA" 2.4

N006795221 THIOCTIN INJECTION "LITA" 3.88

280

Page 281: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

N006797238 METHOMINE INJECTION "LITA" 6

N006815209 PHENAMIN INJECTION "LITA" 5.4

N006845209 NE0-BENAMIN INJECTION 5.4

N006853100 ADJUST S.C. TABLETS 0.68

N006854212 PHENINE-H INJECTION 4.2

N006858212 VITAMIN C INJECTION "ORIENTAL" 5.4

N006862221 MAGENSTIN INJECTION 4.69

N006864212 ORISERPINE INJECTION 1.87

N006941209 KANAMYCIN SULFATE INJECTION 1GM "Y.F." 15

N007182212 ANTICOUGH INJECTION "LITA" 5.4

N007190221 HISTICOL INJECTION "LITA" 2.72

N007276100 PRELON TABLETS 0.9

N007342212 VITACICOL FORTE INJECTION 5.4

N007484335 KESEZINE OINTMENT "N.C.P." 6.5

N007484338 KESEZINE OINTMENT "N.C.P." 18.2

N007570100 PYRAZINAMIDE TABLETS 0.25GM 1.61

N007588100 ISONIAZID TABLETS "KINGDOM" 0.2

N007609209 ASMATHIN INJECTION "LITA" 6.1

N007626100 SCONIN S.C. TABLETS "N.C.P." 0.96

N007655100 NEO-WEIAN TABLETS 5.2

N007695338 BENAZON OINTMENT "KINGDOM" 48.9

N007704440 ORIMYCETIN OTIC SOLUTION 70

N007724221 THIOCTOSAN INJECTION 3.88

N007734212 SCOPOMIN INJECTION "ASTAR" 9.2

N007755421 SUPER SALOON EYE LOTION 13

N007755429 SUPER SALOON EYE LOTION 27.1

N007870100 PROCIL TABLETS 0.87

N0078701G0 PROCIL TABLETS(鋁箔/膠箔) 1.5

N007872100 ERGONOVINE MALEATE TABLETS 0.68

N007888100 TASPAN TABLETS 0.74

N007897100 AMPICILLIN CAPSULES 250MG "CHI SHENG" 1.02

N008029100 METHACID CAPSULES 0.87

N008035212 CILNIN INJECTION "ASTAR" 5.4

N008039209 DIPHENHYDRAMINE HCL INJECTION "ASTAR" 3

N008387209 METHODEX G INJECTION 2.72

N008387212 METHODEX G INJECTION 4

N008389212 METHIVITAN-S INJECTION 3

N008393209 METHOXINE M INJECTION 4.44

N008393212 METHOXINE M INJECTION 8

N008737340 UNDECYL OINTMENT (STRONG ANTIMYCOTIC OINTMENT) 18.1

N008799229 DEXAMESONE INBJECTION 10MG 17.6

N008978100 TRANCOL TABLETS 0.73

N008979100 DEXASONE TABLETS 0.69

N009046100 DOCAN TABLETS 0.9

N009048100 CURIEMYLON TABLETS 500MG 2.25

N009051100 METHOXIN TABLETS "ORIENTAL" 0.54

N009053238 METHIVITAN INJECTION 6

N009057100 MAGELIN TABLETS 0.5

N009059100 DEXASOLON TABLETS 0.69

N009094100 SMA TABLETS 0.51

N009095100 TOLYVITA S.C. TABLETS 0.38

N009096100 ANEMATON S.C. TABLETS 0.58

N009174238 VITATICANIN-T 4.68

N009187100 DL-METHYLEPHEDRINE HCL TABLETS 0.42

N009201209 SCONIN INJECTION " K.S." 8.3

281

Page 282: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

N009208100 CHOZINE TABLETS (METRONIDAZOLE) "N.C.P." 1.15

N009215340 HEMORRHOIDS OINTMENT "N.C.P." 45.2

N009236100 SULFADIAZINE TABLETS 1.26

N009417277 LACTATED RINGER'S INJECTION "C.C.P." 21.1

N009541100 THININ TABLETS 50MG "N.C.P." 2.1

N009583100 CHLORAMINE PROLONGSULES CAPSULES 0.95

N009585100 OROGLYMIN TABLETS S.C. 0.89

N0095851G0 OROGLYMIN TABLETS S.C.(鋁箔/膠箔) 1.5

N009643100 NIULACKMIN TABLETS 0.23

N009683212 PROTOSIN "ASTAR" 18.2

N009702100 MERGON TABLETS "N.C.P." 0.68

N009741238 NEO-BILNIN F 100 INJECTION "ASTAR" 5.3

N009747238 PALGIN INJECTION "ASTAR" 8

N009748209 MECOFAN INJECTION "ASTAR" 2.56

N009750209 ESTRADIOL BENZOATE INJECTION "ASTAR" 4.49

N009753209 METHYL EPHEDRINE INJECTION "ASTAR" 2.73

N009754277 RINGER'S INJECTION "ASTAR" 19.9

N009769229 SULMIN INJECTION 15

N009772209 VITAKEY INJECTION 4.54

N009772229 VITAKEY INJECTION 13

N009773212 SIULON INJECTION 6.5

N009774212 B. C. COMPLEX INJECTION 1.45

N009775238 SIUVITA INJECTION 8

N009796277 RINGER'S SOLUTION "C.C.P." 19.9

N009839238 PANTOSAN INJECTION 7.7

N009847100 ERGONOVINE MALEATE TABLETS 0.68

N009937212 BIO-B INJECTION 2.72

N009939100 FUSONE TABLETS 0.39

N009940238 LACT SALINE INJECTION 3.62

N009940277 LACT SALINE INJECTION 25.5

N010308100 METHATIN CAPSULES 0.87

N010365209 BLUTON 5% INJECTION 26.3

N010365277 BLUTON 5% INJECTION 19.1

N010577321 RINDERON-V CREAM 0.06% 33.8

N010645100 REX CAPSULES 1.62

N010755157 SEDACOUGH 23.3

N010862100 BISMUTH SUBCARBONATE TABLETS "WASHINGTON" 0.74

N010867100 CASCARA SAGRADA EXTRACT TABLETS 0.13GM 0.46

N010913238 NEO-METHIOVITA INJECTION "ASTAR" 6

N010915238 NEO-BILNIN INJECTION "ASTAR" 4.48

N011066100 NOSCAPINE TABLETS "JEN SHENG" 0.73

N011069100 DOANG TABLETS "JEN SHENG" 0.66

N011074100 VASONIN S.C. TABLETS 12.5MG "JEN SHENG" 0.61

N011093100 BISATON TABLETS 0.3

N011096100 SCOPAM S.C. TABLETS "JEN SHENG" 0.96

N011097100 ROLIMIN S.C. TABLETS 0.73

N011100100 DIMETHICON TABLETS 20MG "JEN SHENG" 0.3

N011122342 NEOMYCIN OINTMENT 16.4

N011147355 CALAMAUM LOTION 16.3

N011147357 CALAMAUM LOTION 24.8

N011224100 HONCALM S.C. TABLETS 0.68

N011233100 METHACIN TABLETS 0.87

N011238100 NOSCAPIN TABLETS "HONTEN" 0.69

N011241100 CHLORPHENIRAMINE MALEATE TABLETS "HONTEN" 0.14

N011267229 DEXAMETHASONE-21-P INJECTION "ASTAR" 17.6

282

Page 283: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

N011267299 DEXAMETHASONE-21-P INJECTION "ASTAR" 0.75

N011290100 ONE-RESEM S.C. TABLETS 1.26

N011556100 PREDNISOLON TABLETS "ORIENTAL" 0.9

N011557209 PROGESTERONE INJECTION "ORIENTAL" 10

N011585100 AMPICILLIN CAPSULES "SINTONG" 1.02

N0116071G0 PREDNISOLONE TABLETS "SINTONG" (84粒/瓶) 1.5

N011693100 ASPIRIN TABLETS "SHIN LON" 0.35

N011747155 COUGH SYRUP WITH CODEINE "CBC" 33.9

N011759100 BALONMEN CAPSULES 0.68

N011760100 PREKILINEN TABLETS 0.9

N011832100 VITA-SINATOMIN CAPSULES "N.C.P." 2.34

N012059221 GLIAGEN-H INJECTION "Y.Y." 3.08

N012059238 GLIAGEN-H INJECTION "Y.Y." 7.8

N012061212 GICIMYCIN-I.V. INJECTION "Y.Y" 12.3

N012086433 NAZAL SPRAY "JEN SHENG" 17.6

N012089100 BELLATON TABLETS "JEN SHENG" 0.72

N012090100 CHOMOZIN S.C. TABLETS 250MG "JEN SHENG" 1.15

N012091100 MUSLAXIN TABLETS 200MG "JEN SHENG" 0.86

N012092100 OSMIN TABLETS 0.77

N012113100 FOLIC ACID TABLETS 0.68

N012168100 DIGESTIN TABLETS 0.45

N012173329 PAONIMIN OINTMENT 9.9

N012329100 ISONICOTINIC ACID HYDRAZIDE TABLETS 100MG "WASHINGTON" 0.2

N012343266 MANNITOL INJECTION "SINTONG" 39.4

N012702212 BILCININ INJECTION "ASTAR" 4

N012916100 MECLIZINE HCL TABLETS 25MG "JOHNSON" 0.4

N012936100 DEXAMETHASONE TABLETS "JEN SHENG" 0.69

N012940100 CHLORPHENIRAMINE MALEATE TABLETS 4MG "JEN SHENG" 0.1

N012942100 INDOMECIN CAPSULES "JEN SHENG" 0.87

N012948100 SERPANIN TABLETS 0.08

N013071100 SUSUI TABLETS 0.77

N013076100 BENDAZOL S.C. TABLETS 0.74

N013079100 PAPAVERIN TABLETS "HONTEN" 0.6

N013081100 TOPALLERGY S.C. TABLETS 0.4

N013082100 METHYL TESTOSTERONE CAPSULES "HONTEN" 1.62

N013084100 OROTIN S.C. TABLETS 0.5

N013093100 DEXAMETHASONE TABLETS "SENTAI" 0.69

N013187100 CONTERIN CAPSULES 0.89

N013302100 WINTOLON TABLETS "JEN SHENG" 2.25

N013307100 EPHEDRINUM TABLETS 0.56

N013417100 SORELESS TABLETS 0.72

N013422100 SRONIN S.C. TABLETS 0.73

N0134221G0 SRONIN S.C. TABLETS(鋁箔/膠箔) 1.5

N013475100 FERROUS SULFATE S.C. TABLETS 324MG "WASHINGTON" 0.9

N013481100 PREDNISOLONE TABLETS "WASHINGTON" 0.9

N013488100 AETOMIN TABLETS "S.C." 0.66

N013550100 TRIMIN TABLETS "SWISS" 0.6

N013611299 HEPAPLEX-B "Y.Y" 9.4

N013617243 YINGAN CA INJECTION 16.9

N013675100 UROZOLE TABLETS 250MG "JEN SHENG" 0.55

N013678100 SOFTRAN TABLETS 100MG "JEN SHENG" 0.73

N013679100 PROPANTHELINE BROMIDE S.C. TABLETS 15MG "JEN SHENG" 0.55

N013697100 KINGCORT TABLETS 0.9

N013698100 ANTICOFEN CAPSULES "KINGDOM" 1.6

N013702100 PREDNISOLONE "KUANG NAN" 0.9

283

Page 284: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

N013857100 TECOSIN TABLETS 0.89

N013928100 ATROPINE SULFATE TABLETS "SHIN LON" 0.23

N013929100 ISONIAZID TABLETS "SHIN LON" 0.2

N0139291G0 ISONIAZID TABLETS 100MG"SHIN LON"(84粒/瓶裝) 1.5

N013999100 GEEL S.C. TABLETS 1.15

N014938100 PHENOBARBITAL TABLETS 30MG "CENTRAL" 0.68

N015223100 PAPAVERINE HCL TABLETS 30MG "JEN SHENG" 1.04

N015343221 SHINMIOCHIEN INJECTION 8.9

N015352212 CONTAMIN INJECTION "Y.Y." 6.4

N015357155 COUTHY SYRUP 38.6

N015357159 COUTHY SYRUP 38.6

N015750100 BROWN MIXTURE OPIUM TABLETS 0.16

N015829100 PROCHLORPERAZINE MALEATE TABLETS "ORIENTAL" 0.69

N015943209 ESTOL-DEPOT INJECTION "ASTAR" 18.1

N0161401G0 DIAZEPAM TABLETS 5 MG “KINGDOM”(鋁箔) 1.5

N016151100 WEI LIAN S.C. TABLETS 0.62

N016423221 ASCORBIC ACID INJECTION "ASTAR" 5.4

N016499100 CANALON TABLETS 0.69

N016524100 ENITOL F.C. TABLETS 0.83

N016528100 NOSCAPINE TABLETS"LITA" 0.73

N0165281G0 NOSCAPINE TABLETS"LITA"(鋁箔/膠箔) 1.5

N016598212 DAIBINAL INJECTION 5

N016598221 DAIBINAL INJECTION 5

N016638329 ANCINALON OINT. 10G 26.4

N016638335 ANCINALON OINT. 10G 41.3

N016698100 HEAMIN TABLETS "HEALTH" 0.1

N016758212 CHLORAMPHENICOL INJECTION "K.S." 6.5

N016770100 SINTABEX S.C. TABLETS 1.78

N016775238 POKANVIT INJECTION 6

N016803100 WINTEN CAPSULES "CURIE" 1.34

N016925100 ANTOCHIN CAPSULES 0.87

NA05612212 FURSEMIDE INJECTION "N.K." 【2ML裝】 15

NA15737209 SOLUTIO NATRII CHLORIDI ISOTONICA "CHI SHENG" 25.4

NA15737265 SOLUTIO NATRII CHLORIDE ISOTONICA "CHI SHENG" 22

NA15737277 SOLUTIO NATRII CHLORIDI ISOTONICA "CHI SHENG"(軟袋及塑膠瓶) 25

NB00220100 DEXAMETHASONE TABLETS 0.5MG "STANDARD" 1.5

NB00711100 PREDONINE TABLETS 1.5

NB007111G0 PREDONINE TABLETS(鋁箔/膠箔) 2

NB00979100 BUTYSCOL S.C. TABLETS 1.5

NB009791G0 BUTYSCOL S.C. TABLETS(鋁箔/膠箔) 2

NB01043100 PONSTAN KAPSEALS 1.5

NB09931100 SANYL S.C. TABLETS 1.5

NB099311G0 SANYL S.C. TABLETS(鋁箔/膠箔) 2

NB15737212 SOLUTIO NATRII CHLORIDI ISOTONICA "CHI SHENG" 72

NC00007100 HEXIN TABLETS 1.5

NC00055100 BET TABLETS 1.5

NC00084100 ANNA F COATED TABLETS 1.5

NC00094100 LIBULIN COATED TABLETS 1.5

NC00102100 UROPRIN COATED TABLETS 100MG 1.5

NC00140100 ERGOTON FILM COATED TABLETS "JOHNSON" 1.5

NC00141100 HYCHLOZIDE TABLETS 1.5

NC001411G0 HYCHLOZIDE TABLETS (84粒/瓶) 2

NC001411GA HYCHLOZIDE TABLETS(鋁箔/膠箔) 2

NC00164100 ISONIAZIDE TABLETS 1.5

284

Page 285: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

NC001641G0 ISONIAZIDE TABLETS(鋁箔/膠箔) 2

NC00198100 SINCEN TABLETS 1.5

NC00230100 DICETAMIN CAPSULES 1.5

NC00258100 PELONINE CAPSULES "JOHNSON" 1.5

NC00261100 JOHNLAX ENTERIC COATED TABLETS "JOHNSON" 1.5

NC002611G0 JOHNLAX ENTERIC COATED TABLETS "JOHNSON"(鋁箔/膠箔) 2

NC00276100 SUN SEE TABLETS "JOHNSON" 1.5

NC00278100 DEXAZONE TABLETS "JOHNSON" 1.5

NC00286100 KINZANONE TABLETS "JOHNSON" 1.5

NC00294155 BENTYLINE GRANULES "JOHNSON" 49.6

NC00337209 NEOSTIGMINE INJECTION "CHI SHENG" 15

NC00394100 HEXAZIN TABLETS "JOHNSON" 1.5

NC00457100 ISOPRIN TABLETS "JOHNSON" 1.5

NC00459100 R.H.H. TABLETS "JOHNSON" 1.5

NC00476209 B-COMPLEX INJECTION "Y.Y." 15

NC00476229 B-COMPLEX INJECTION "Y.Y." 15

NC00480209 BASSON INJECTION 1% "Y.Y." 15

NC00509100 FUCON CAPSULES 1.5

NC00577209 LACTATED RINGER'S INJECTION"SINTONG" 32.6

NC00577277 LACTATED RINGER'S INJECTION "SINTONG" 25

NC00587212 THIOCTIC ACID INJECTION 0.5% "Y.Y." 15

NC00588209 "SODIUM CHLORIDE INJECTION ""ASTAR""" 25.4

NC00588210 SODIUM CHLORIDE INJECTION "ASTAR." 43.9

NC00588212 "SODIUM CHLORIDE INJECTION ""ASTAR.""" 72

NC00588216 SODIUM CHLORIDE INJECTION "ASTAR." 86

NC00588265 "SODIUM CHLORIDE INJECTION ""ASTAR.""" 22

NC00588277 "SODIUM CHLORIDE INJECTION ""ASTAR""" 25

NC00701212 KOTIN INJECTION "N.K." 15

NC00702100 MUSCLAX TABLETS 100MG 1.5

NC00781100 HALOPIN TABLETS "JOHNSON" 1.5

NC00799100 COLCINE TABLETS "HONTEN" 1.5

NC00805100 DL-METHYLEPHEDRINE HCL TABLETS "JOHNSON" 1.5

NC00817100 DILANTIN KAPSEALS 1.5

NC00827212 CHLORAMIN INJECTION "Y.Y." 15

NC00847500 FROTIN SUPPOSITORIES 5

NC00849100 SOLLON TABLETS "JOHNSON" 1.5

NC00874212 BERBERINE HCL INJECTION 0.2% "Y.Y." 15

NC01073500 CHILDREN'S SENTIN SUPPOSITORIES 5

NC01109100 THYROID TABLETS 64MG "JOHNSON" 1.5

NC011091G0 THYROID TABLETS 64MG "JOHNSON"(鋁箔/膠箔) 2

NC01204151 COUSIN SYRUP 25

NC01320238 SALSOROITIN INJECTION "CHI SHENG" 17.1

NC01451100 DL-METHYLEPHEDRINE HCL TABLETS 1.5

NC01503100 TAEE S.C. TABLETS 5MG 1.5

NC01542100 TETRACYCLINE HCL CAPSULES "KINGDOM" 1.5

NC015421G0 TETRACYCLINE HCL CAPSULES "KINGDOM"(鋁箔/膠箔) 2

NC01580100 PROPHYLLINE TABLETS 1.5

NC01595100 ALUNLAN CAPSULES 1.5

NC01647277 ANCILLINA INJECTION 500MG 15

NC01681209 STREPTOMYCIN INJECTION 1GM "TBC" 0

NC01727100 SODIUM BICARBONATE COMPOUND TABLETS "JOHNSON" 1.5

NC01730500 METROZOLE LOCAL TABLETS "JOHNSON" 5

NC01736100 PHENOBARBITAL TABLETS 30MG "JOHNSON" 1.5

NC017361G0 PHENOBARBITAL TABLETS 30MG "JOHNSON"(鋁箔/膠箔) 2

NC01749100 ERGOMETRINE MALEATE TABLETS 0.2MG "JOHNSON" 1.5

285

Page 286: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

NC017491G0 ERGOMETRINE MALEATE TABLETS0.2MG "JOHNSON"(瓶裝/21粒/瓶) 2

NC01752100 FRONIL S.C. TABLETS "JOHNSON" 1.76

NC017521G0 FRONIL S.C. TABLETS "JOHNSON" (鋁箔/膠箔) 2

NC01757221 CANBIN -C INJECTION 15

NC01774100 CHLORPHENIRAMINE MALEATE TABLETS 8MG "JOHNSON 1.5

NC01780100 BENTYLINE-S TABLETS "JOHNSON" 1.5

NC01783100 UROGEN S.C. TABLETS "JOHNSON" 1.5

NC017831G0 UROGEN S.C. TABLETS "JOHNSON" (瓶裝/42粒/瓶) 2

NC01790100 MUSCOL TABLETS 200MG "JOHNSON" 1.5

NC01794100 BETHANECHOL CHLORIDE TABLETS 10MG "JOHNSON" 1.5

NC01796100 METHYLTESTOSTERONE TABLETS 10MG "JOHNSON" 1.93

NC01803100 AMINOPHYLLINE TABLETS 200MG "JOHNSON" 1.5

NC01807100 PELONINE-R TABLETS "JOHNSON" 1.5

NC01808100 BISMUTH SUBCARBONATE TABLETS 324MG "JOHNSON" 1.5

NC01811100 METROZOLE ORAL S.C. TABLETS "JOHNSON" 1.64

NC01817100 NOSCOTIN TABLETS 20MG "JOHNSON" 1.29

NC01820100 BENTYLINE TABLETS "JOHNSON" 1.5

NC01822100 FERROUS GLUCO-B S.C. TABLETS 1.5

NC018221G0 FERROUS GLUCO-B S.C. TABLETS(鋁箔/膠箔) 2

NC01851100 CHYMOSIN TABLETS "JOHNSON" 1.5

NC01870238 DABION INJECTION 25MG 15

NC01976209 VAGOSTIN INJECTION 15

NC02046209 DESPAS INJECTION 15

NC02090209 PHYTONADIONE INJECTION 10MG "TBC" 15

NC02121100 SENLIS TABLETS 1.5

NC02124100 AMMONIUM CHLORIDE ENTRIC S.C. TABLETS 1.5

NC02211100 SCOMINE S.C. TABLETS 10MG "JOHNSON" 1.5

NC02213100 PELONINE TABLETS "JOHNSON" 1.5

NC02256238 TILISE-DEXTROSE INJECTION "N.K." 15

NC02277212 TILISE INJECTION "N.K." 15

NC02319100 NINLAXIN TABLETS 1.5

NC023191G0 NINLAXIN TABLETS(鋁箔/膠箔) 2

NC02342212 DESMAN INJECTION 17.4

NC02368100 BILIMYCIN CAPSULES "SWISS BRAND" 1.5

NC02473100 INDOME CAPSULES 25MG "F.Y." 1.5

NC02479100 PENICILLIN V TABLETS 400000U "C.C.P." 1.69

NC024791G0 PENICILLIN V TABLETS 400000U "C.C.P."(鋁箔/膠箔) 2

NC02507212 SINPHYLLIN INJECTION 15

NC02531100 DONISON TABLETS 1.5

NC025311G0 DONISON TABLETS(鋁箔/膠箔) 2

NC02535100 VITAPOLY TABLETS 1.5

NC02589100 PAPAVERINE HCL TABLETS 30MG "JOHNSON" 1.5

NC02593100 INDOMIN TABLETS 1.5

NC02596100 NEO-WEITUPIN TABLETS 1.5

NC02597100 KOLISIDE TABLETS 25MG 1.5

NC02599100 VOLIMIN TABLETS 1.5

NC02613100 PROPANLINE S.C. TABLETS 1.5

NC02704209 INJECTIO ATROPINI SULFATIS 0.05% "Y.Y." 15

NC02781240 LYO-DONISON INJECTION 17.4

NC02789209 KATIMIN "1" INJECTION 10MG 15

NC02791100 DIHYDRODIAZID TABLETS 1.5

NC027911G0 DIHYDRODIAZID TABLETS(鋁箔/膠箔) 2

NC02812212 MELERMIN-H INJECTION 15

NC02816209 ALLERMIN INJECTION 1.92

NC02888212 LYOVITA-B12 INJECTION 15.3

286

Page 287: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

NC02967209 INJECTIO DIPHENHYDRAMINI HYDROCHLORIDI 3% "Y.Y." 15

NC02980277 3% SODIUM CHLORIDE INJECTION "SINTONG" 25

NC03002209 CHLORPHENIRAMINE MALEATE INJECTION 5MG "SINTONG" 15

NC03055238 BLUTON INJECTION 50% "C.C.P" 15

NC03055277 BLUTON INJECTION 50% "C.C.P." 39.9

NC03058238 VITAGEN INJECTION "S.T." 20% 15

NC03063238 VITACAL INJECTION 15

NC03067209 COMBEPLEX INJECTION 15

NC03067229 COMBEPLEX INJECTION 15

NC03097100 DEXAMETHASONE TABLETS "C.C.P." 1.5

NC030971G0 DEXAMETHASONE TABLETS "C.C.P."(鋁箔/膠箔) 2

NC03159100 OLYMPIC HORMONE CAPSULES 2.73

NC03182209 ERGOVIN INJECTION 15

NC03196221 ALLECIUM B6 INJECTION 12

NC03213221 ASCORMIN INJECTION 15

NC033541G0 VISTARIL CAPSULES(鋁箔/膠箔) 2

NC03379100 KIBO TABLETS 1.5

NC03414100 GRUVIN TABLETS 1.5

NC034141G0 GRUVIN TABLETS(鋁箔/膠箔) 2

NC03418100 NEO-VIBON-S S.C. TABLETS 1.5

NC03419100 ANCILLIN CAPSULES 1.5

NC034191G0 ANCILLIN CAPSULES(鋁箔/膠箔) 2

NC034491G0 TABELLAE EPHEDRINI HYDROCHLORIDI "Y.Y."(鋁箔/膠箔) 2

NC03540212 METHON-S INJECTION 15

NC03633100 TABELLAE AMINOPHYLLINAE 100MG "Y.Y." 1.5

NC036331G0 TABELLAE AMINOPHYLLINAE 100MG "Y.Y."(鋁箔/膠箔) 2

NC03667100 L.A. TABLETS "JOHNSON" 1.5

NC036671G0 L.A. TABLETS "JOHNSON"(瓶裝/42粒/瓶) 2

NC036671GA L.A. TABLETS "JOHNSON"(鋁箔/膠箔) 2

NC03675100 A.H.P. TABLETS "JOHNSON" 1.5

NC036751G0 A.H.P. TABLETS "JOHNSON"(鋁箔/膠箔) 2

NC03676100 SLEEPIN TABLETS "JOHNSON" 1.5

NC036761G0 SLEEPIN TABLETS "JOHNSON"(鋁箔/膠箔) 2

NC03893100 PEITAON S.C. TABLETS 1.5

NC04085100 ALINAMIN-F 50 S.C. TABLETS 1.5

NC040851G0 ALINAMIN-F 50 S.C. TABLETS(鋁箔/膠箔) 2

NC04135277 GLUCOSE INJECTION 50% 39.9

NC04245100 TABELLAE DL-METHYL EPHEDRINE HCL "Y.Y." 1.5

NC042451G0 TABELLAE DL-METHYL EPHEDRINE HCL "Y.Y."(鋁箔/膠箔) 2

NC04385100 WINSUMIN F.C. TABLETS 12.5MG 1.5

NC04510100 ANIMIN S.C. TABLETS 4MG "F.Y." 1.5

NC04512100 DEMESON TABLETS 0.5MG "F.Y." 1.5

NC04516100 SLEEP TABLETS 5MG "F.Y." 1.5

NC04517100 COLSIN TABLETS 2MG "F.Y." 1.5

NC045171G0 COLSIN TABLETS 2MG "F.Y."(鋁箔/膠箔) 2

NC04548151 ASTHMIN SUSPENSION "PEDIATRIC" 25

NC04582238 SODIUM BICARBONATE INJECTION "CHI SHENG" 15

NC04586238 5% SAL-BRON INJECTION "CHI SHENG" 15

NC04587209 LIQUOR RINGER INJECTION "CHI SHENG" 31.4

NC04587265 LIQUOR RINGER INJECTION "CHI SHENG" 22

NC04587277 LIQUOR RINGER INJECTION "CHI SHENG" 25

NC04780100 FULLSERPINE TABLETS 0.25MG "F.Y." 1.5

NC04799100 CAPSULAE TYTRACYCLINI HYDROCHLOIDI 250MG "Y.Y." 1.5

NC04875100 DIAPINE TABLETS 2MG "JOHNSON" 1.5

NC048751G0 DIAPINE TABLETS 2MG "JOHNSON"(鋁箔/膠箔) 2

287

Page 288: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

NC04899238 LACTATE RINGER'S INJECTION "CHI SHENG" 15

NC04899277 LACTATE RINGER'S INJECTION "CHI SHENG" 25

NC04904238 GLUCO-METHIONIN B INJECTION 15

NC04905209 B-COMPLEX INJECTION "CHI SHENG" 15

NC04922229 AMINOPHYLLIN INJECTION "CHI SHENG" 15

NC049281G0 DAILYCARE ACTIBEST S.C. TABLETS(鋁箔/膠箔) 2

NC05038100 DIPOXIDO CAPSULES "JOHNSON" 1.5

NC050381G0 DIPOXIDO CAPSULES "JOHNSON"(84粒/瓶) 2

NC05040100 PROCHLORPERAZINE MALEATE TABLETS "JOHNSON" 1.5

NC05042100 INDOMESA CAPSULES "JOHNSON" 1.5

NC050421G0 INDOMESA CAPSULES "JOHNSON"(鋁箔/膠箔) 2

NC05069100 DEXAMETHASONE TABLETS " Y.Y." 1.5

NC05072100 BAYU TABLETS 1.5

NC050721G0 BAYU TABLETS(鋁箔/膠箔) 2

NC05219100 TRICON S.C. TABLETS "F.Y." 1.64

NC05225100 SODIUM BICARBONATE TABLETS 0.3 GM "F.Y." 1.5

NC052251G0 SODIUM BICARBONATE TABLETS 0.3 GM "F.Y."(鋁箔/膠箔) 2

NC05226100 SODIUM BICARBONATE TABLETS 0.6 GM "F.Y." 1.5

NC052261G0 SODIUM BICARBONATE TABLETS 0.6 GM "F.Y."(鋁箔/膠箔) 2

NC05229100 ANATEN TABLETS 10MG "F.Y." 1.5

NC05236100 PYRESON TABLETS"F.Y." 1.5

NC05245100 COLSIN 5MG TABLETS "F.Y." 1.5

NC05246100 DIWODON TABLETS "F.Y." 1.5

NC05257100 I.N.A.H. TABLETS 100 MG "F.Y." 1.5

NC052571G0 I.N.A.H TABLETS 100 MG "F.Y."(鋁箔/膠箔) 2

NC05334209 INJECTION DEXTROSIET SODII CHLORIDI "CHI SHENG" 25.9

NC05334238 INJECTION DEXTROSIET SODII CHLORIDI "CHI SHENG" 15

NC05334277 INJECTION DEXTROSIET SODII CHLORIDI "CHI SHENG" 25

NC05339238 20% GLUCOS INJECTION "CHI SHENG" 15

NC05340238 5% CALCIUM CHLORIDE INJECTION "CHI SHENG" 15

NC05342209 5% GLUCOS INJECTION "CHI SHENG" 26.3

NC05342238 5% GLUCOS INJECTION "CHI SHENG" 15

NC05342265 5% GLUCOS INJECTION "CHI SHENG" 22

NC05342277 5% GLUCOS INJECTION "CHI SHENG" 25.1

NC05344209 VITAMIN C INJECTION "CHI SHENG" 15

NC05344221 VITAMIN C INJECTION "CHI SHENG" 15

NC05347265 PU-I REPLENISHER NO.1 "CHI SHENG" 22

NC05347277 PU-I REPLENISHER NO.1 "CHI SHENG" 25

NC05348209 HYSCOPAN INJECTION "CHI SHENG" 15

NC05351209 10% GLUCOSE INJECTION "CHI SHENG" 30.9

NC05351277 10% GLUCOSE INJECTION "CHI SHENG" 25

NC05396100 NEOMYCIN CAP 1.96

NC05508100 NALIDIN TABLETS 0.5GM "F.Y." 2.25

NC05616100 WINSUMIN F.C. TABLETS 25MG "JOHNSON" 1.5

NC056161G0 WINSUMIN F.C. TABLETS 25MG "JOHNSON" (84粒/瓶裝) 2

NC05932100 PHENOBARBITAL TABLETS 32 MG "F.Y." 1.5

NC059321G0 PHENOBARBITAL TABLETS 32 MG "F.Y." (鋁箔/膠箔) 2

NC06021100 O.G.S.C. TABLETS "JOHNSON" 1.5

NC06066209 VITAGEN INJECTION 5% 26.3

NC06066238 VITAGEN INJECTION 5% 15

NC06066255 VITAGEN INJECTION 5% 22

NC06066265 VITAGEN INJECTION 5% 22

NC06066277 VITAGEN INJECTION 5% 25.1

NC06067238 VITAGEN INJECTION 50% 15

NC06067266 VITAGEN INJECTION 50% 39.9

288

Page 289: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

NC06163100 PRESURIN TABLETS "S.C." 1.5

NC06255100 DURACRIN TABLETS 1.5

NC062551G0 DURACRIN TABLETS(鋁箔/膠箔) 2

NC06256100 PYRAZINAMIDE TABLETS 0.5GM 3.74

NC06263100 BISMUTH SUBCARBONATE TABLETS 1.5

NC062631G0 "BISMUTH SUBCARBONATE TABLETS""GCPC""(鋁箔/膠箔)" 2

NC06271100 COLCHICINE TABLETS 0.5MG "KINGDOM" 1.5

NC062711G0 COLCHICINE TABLETS "KINGDOM"0.5MG(鋁箔/膠箔) 2

NC06303212 CURMINE-B INJECTION "LITA" 15

NC06306100 DEXASON TABLETS 0.5MG "LITA" 1.5

NC06310100 ANATEN CAPSULES 10MG "F.Y." 1.5

NC06480238 NEO-VITABOSE INJECTION "CHI SHENG" 15

NC06489212 POSINTIN INJECTION 15

NC06513212 VITACICOL INJECTION 15

NC06514265 DEXTROSE IN SALINE INJECTION 22

NC06514277 DEXTROSE IN SALINE INJECTION 25

NC06528221 VENACALO-B6 INJECTION 15

NC06650209 CYANOCOBALAMIN INJECTION 1000MCG/ML "N.K." 15.5

NC06650229 CYANOCOBALAMIN INJECTION 1000MCG/ML "N.K." 15.5

NC06766100 CHLORTETRACYCLINE HCL CAPSULES 250MG "LITA" 1.5

NC06780100 OXYTETRACYCLINE HCL CAPSULES 250MG "LITA" 1.5

NC06812212 VITAMIN C INJECTION "LITA" 15

NC07189212 DIPHYLLINE INJECTION "LITA" 15

NC07262209 RINGER'S SOLUTION 31.4

NC07262277 RINGER'S SOLUTION 25

NC07380100 ALINAMIN-F 100 S.C. TABLETS 2.7

NC07547100 FOLIC ACID TABLETS 1.5

NC075471G0 "FOLIC ACID TABLETS 5MG""GCPC""(鋁箔/膠箔)" 2

NC07548100 "ACETAZOLAMIDE TABLETS ""N.Y.""" 1.5

NC08061209 EPHEDRINE HYDROCHLORIDE INJECTION 15

NC08138100 TRICOZIDE TABLETS "JOHNSON" 1.5

NC081381G0 TRICOZIDE TABLETS "JOHNSON"(鋁箔/膠箔) 2

NC08167100 INDOMEN CAPSULES "Y.S." 1.5

NC081671G0 INDOMEN CAPSULES "Y.S."(鋁箔/膠箔) 2

NC08479100 MEDEMON CAPSULES 1.93

NC08792238 METHICOSE INJECTION 15

NC08800209 DEXAMESONE INJECTION 4MG "T.F." 15

NC08800229 DEXAMESONE INJECTION 4MG/ML "T.F." 23.6

NC09234277 AMINOL-S INJECTION 71

NC09768238 KANCAL-G INJECTION 15

NC09840209 BUSTON INJECTION 15

NC09857100 CORTISONE TABLETS 1.5

NC09994229 ASIPHYLLINE INJECTION 15

NC09997209 ISOTONIC SODIUM CHLORIDE SOLUTION(塑膠瓶) 25.4

NC09997277 ISOTONIC SODIUM CHLORIDE SOLUTION(玻璃瓶/塑膠瓶) 25

NC10002212 "T.F." VITACIN INJECTION 15

NC10004212 VITAMIN B1 INJECTION 15

NC10213212 BISOTIN INJECTION "N.K." 15

NC10222209 ESCOPAN INJECTION "N.K." 15

NC10468100 DUPIN TABLETS 0.48

NC104681G0 DUPIN TABLETS(鋁箔/膠箔) 2

NC10563100 MEVAPERAN S.C. TABLETS 1.5

NC10886209 PREDNISOLONE INJECTION "T.F." 15

NC10887229 AMINOPHYLLIN INJECTION "T.F." 15

NC10896209 VITAMIN B6 INJECTION 50MG "G.L." 15

289

Page 290: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

NC10908238 PYRIDO-CALCIUM INJECTION 15

NC11133417 NEOBACIN OPHTHALMIC OINTMENT 33.5

NC11357209 DEXARON INJECTION 15

NC11357229 DEXARON INJECTION 23.6

NC11607100 PREDNISOLONE TABLETS "SINTONG" 1.5

NC11747151 COUGH SYRUP WITH CODEINE "CBC" 25

NC11865100 ERGOFFEINE TABLETS "HONTEN" 1.5

NC11931435 BIOMYCIN NASAL SPRAY "CBC" 33.4

NC11948100 DECAZON TABLETS "CBC" 1.5

NC11950100 KEETOMIN S.C. TABLETS "CBC" 1.5

NC12059212 GLIAGEN-H INJECTION "Y.Y." 15

NC12165100 ULCERMIN TABLETS "HC" 1.5

NC12342421 LIXAMIN EYE DROPS 13.4

NC12342429 LIXAMIN EYE DROPS 34.4

NC12380221 POTASSIUM CHLORIDE INJECTION "SINTONG" 15

NC12714100 DOMISUI-N TABLETS 5MG "CBC" 1.5

NC12722100 CO-CASTRONIN TABLETS "CBC" 1.5

NC12732100 ERGONOVINE MALEATE TABLETS 0.2MG "CBC" 1.5

NC12914100 DIAPINE TABLETS 5MG "JOHNSON" 1.5

NC129141G0 DIAPINE TABLETS 5MG "JOHNSON"(鋁箔/膠箔) 2

NC12925209 B-COMPLEX INJECTION "N.K." 15

NC12925229 B-COMPLEX INJECTION "N.K." 15

NC13075100 NOVOMIT TABLETS 1.5

NC130751G0 NOVOMIT TABLETS(鋁箔/膠箔) 2

NC13083100 ERGOLATE TABLETS 1.5

NC13141209 VITAGEN INJECTION 10% "S.T." 30.9

NC13141277 VITAGEN INJECTION 10% "S.T." 25

NC13247151 ANTICO SYRUP WITH CODEINE 25

NC13247157 ANTICO SYRUP WITH CODEINE 25

NC13404100 PREDNISOLONE TABLETS "CHINTENG" 1.5

NC134041G0 PREDNISOLONE TABLETS "CHINTENG"(鋁箔/膠箔) 2

NC13419100 PHENOBARBITAL TABLETS "HONTEN" 1.5

NC134191G0 PHENOBARBITAL TABLETS "HONTEN"(鋁箔/膠箔) 2

NC13507321 PRESOLON OINTMENT 10.2

NC13507329 PRESOLON OINTMENT 18.5

NC13507340 PRESOLON OINTMENT 41.6

NC13508329 BIOMYCIN OINTMENT "CBC" 14.2

NC13508338 BIOMYCIN OINTMENT "CBC" 28.8

NC13508345 BIOMYCIN OINTMENT "CBC" 50

NC13551100 SWISSMYLON TABLETS 2.25

NC13611209 HEPAPLEX-B INJECTION "Y.Y" 15

NC13619212 ANTICOUGH INJECTION "Y.Y." 15

NC13906100 TONFONRIN TABLETS "SWISS" 1.5

NC13913100 TETRACYCLINE HCL CAPSULES 250MG "SWISS" 1.5

NC139131G0 TETRACYCLINE HCL CAPSULES 250MG "SWISS"(鋁箔/膠箔) 2

NC14145100 LIBMIN 1.5

NC14268100 METHYL TESTOSTERONE CAPSULES "SWISS" 1.93

NC142681G0 METHYL TESTOSTERONE CAPSULES "SWISS"(鋁箔/膠箔) 2

NC14286100 CHITOUNEN TABLETS "SWISS" 1.5

NC14296100 DEXAMETHASONE "SWISS" 1.5

NC14312100 NEO ZINE TABLETS 2MG "SWISS" 1.5

NC14318100 BOGEN-50 S.C. TABLETS 1.5

NC14321100 REZOXIN TABLETS 1.5

NC14793155 BROCIN CODEINE SYRUP 43.5

NC15066100 ASNIN TABLETS "JOHNSON" 1.5

290

Page 291: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

NC15101100 KOVIN TONG TABLETS 1.5

NC151011G0 KOVIN TONG TABLETS (鋁箔/膠箔) 2

NC15235100 PREDNISOLONE TABLETS "CHUNG MEI" 1.5

NC15343212 SHINMIOCHIEN INJECTION 15

NC15375212 STOMALLIN INJECTION 15

NC15392100 TRANSAMIN CAPSULES 1.52

NC15685100 INDERSHIN CAPSULES 1.5

NC156851G0 INDERSHIN CAPSULES(鋁箔/膠箔) 2

NC15951157 CODECOL SYRUP 33.2

NC16157100 IMINE S.C. TABLETS 1.76

NC161571G0 IMINE S.C. TABLETS)(鋁箔/膠箔) 2

NC16158100 WEIZEL S.C. TABLETS 1.5

NC161581G0 WEIZEL S.C. TABLETS(鋁箔/膠箔) 2

NC16234100 FUDECHAN S.C. TABLETS 25MG 1.5

NC16235277 BLUPLEX INJECTION 25.1

NC16332100 RUMIL TABLETS 1.5

NC163321G0 RUMIL TABLETS(鋁箔/膠箔) 2

NC16430421 TETRACYCLINE HCL OPHTHALMIC OINTMENT 1% "KINGDOM" 17.5

NC164304A9 TETRACYCLINE HCL OPHTHALMIC OINTMENT 1% "KINGDOM" 7.3

NC16545100 CALOMIDE S.C. TABLETS 250UG 1.5

NC165451G0 CALOMIDE S.C. TABLETS 250UG(鋁箔/膠箔) 2

NC16644100 SURISHIA TABLETS 1.5

NC166441G0 SURISHIA S.C. TABLETS(鋁箔/膠箔) 2

NC16648100 COLONRAITAI TABLETS "CHINTENG" 1.5

NC166481G0 COLONRAITAI TABLETS "CHINTENG"(鋁箔/膠箔) 2

NC16650100 DL-METHYLEPHEDRINE HCL TABLETS 1.5

NC166501G0 DL-METHYLEPHEDRINE HCL TABLETS(鋁箔/膠箔) 2

NC16652100 BISMUTH SUBCARBONATE TABLETS "CHINTENG" 1.5

NC166521G0 BISMUTH SUBCARBONATE TABLETS(鋁箔/膠箔) 2

NC16654421 MING MEI EYE DROPS "Y.Y." 13.4

NC16654429 MING MEI EYE DROPS "Y.Y." 34.4

NC16669209 HYDROXOCOBALAMIN INJECTION "Y.Y." 15.5

NC16669229 HYDROXOCOBALAMIN INJECTION "Y.Y." 15.5

NC16719212 COLMIN INJECTION 15

NC16799100 VITAMIN K1 TABLETS 1.5

NC167991G0 VITAMIN K1 TABLETS(鋁箔/膠箔) 2

NC16929100 SHINSHINPEN F.C. TABLETS "CHINTENG" 1.5

NC169291G0 SHINSHINPEN F.C. TABLETS "CHINTENG"(鋁箔/膠箔) 2

NC16986209 HYDROXOCOBALAMIN INJECTION "T.F." 15.5

NC16986229 HYDROXOCOBALAMIN INJETION "T.F." 15.5

TPN0101209 CPN-A 0.37

TPN0102297 CPN-B 0.5

TPN0103209 CPN-C 0.47

TPN0104297 CPN-D 0.63

TPN0105277 TPN-1 0.7

TPN01062D3 CPN-A2 0.46

TPN01072D4 CPN-B2 0.55

TPN01082D3 CPN-C2 0.55

TPN01092D4 CPN-D2 0.69

TPN01102D3 CPN-E 0.48

TPN01112D4 CPN-F 0.56

TPN01122D4 CPN-G 0.69

TPN01132D5 CPN-G2 0.82

TPN01142D4 CPN-H 0.7

TPN01152D5 CPN-H2 0.84

291

Page 292: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN0117299 20 mEq in 100mL 0.9﹪NaCl 0.13

TPN0118299 20 mEq in 500mL 0.9﹪NaCl 0.03

TPN0119299 10 mEq in Taita No.5 0.1

TPN0120299 10MEQ KCL IN DEXT-SALINE 500ML 0.03

TPN0121299 20MEQ KCL IN 5% DEXTROSE 100ML 0.12

TPN0122299 20MEQ KCL IN 5% DEXTROSE 50ML 0.11

TPN0123299 TPN-NEO 1.37

TPN0124299 TPN-ADULT 0.72

TPN0125299 TPN-ADULT-BCAA RIBH 0.38

TPN0126299 TPN-PED 0.64

TPN0127299 NEO_STARTER 7.5 0.74

TPN0128299 NEO_STARTER 10 0.75

TPN0201209 TCVH1 0.69

TPN0202209 TCVH2 0.81

TPN0203209 TCVH3 0.54

TPN0204209 TCVHH 0.56

TPN0205209 TCVHR 0.5

TPN0301255 TPNP-1 0.38

TPN0302209 TPNP-10 0.26

TPN0303263 TPNP-2 0.29

TPN0304266 TPNP-3 0.26

TPN0305271 TPNP-4 0.25

TPN0306277 TPNP-5 0.24

TPN0307280 TPNP-6 0.27

TPN0308282 TPNP-7 0.27

TPN0309283 TPNP-8 0.26

TPN03102B9 TPNP-9 0.26

TPN0311212 TPNP-100 0.86

TPN0312212 TPN-105 0.9

TPN0313212 TPN-110 0.93

TPN0314209 TPN-20 0.47

TPN0315209 TPN-25 0.54

TPN0316212 TPN-30 0.37

TPN0317212 TPN-35 0.41

TPN0318212 TPN-40 0.44

TPN0319212 TPN-45 0.48

TPN0320212 TPN-50 0.51

TPN0321212 TPN-55 0.55

TPN0322212 TPN-60 0.58

TPN0323212 TPN-65 62

TPN0324212 TPN-70 0.65

TPN0325212 TPN-75 0.69

TPN0326212 TPN-80 0.72

TPN0327212 TPN-85 0.76

TPN0328212 TPN-90 0.79

TPN0329212 TPN-95 0.83

TPN0330299 D5-0.45%S 500ML(含K+10MEQ) 0.04

TPN0331299 D5-0.33%S 500ML(含K+6MEQ) 0.04

TPN0332299 NS 100ML(含K+20MEQ) 0.13

TPN0333299 D5W 100ML(含K+20MEQ) 0.12

TPN0334299 NS 50ML(含K+50MEQ) 0.12

TPN0335299 D5W 50ML(含K+50MEQ) 0.1

TPN0336299 D10W 500ML(含K+10MEQ) 0.04

TPN04012C0 TPAI-1 0.64

TPN04022A5 TPAI-2 0.76

292

Page 293: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN04032CP TPAI-3 0.38

TPN0404209 TPAI-4 0.72

TPN0405209 TPAI-5 0.49

TPN04062CQ TPPI-1 0.68

TPN04072CR TPPI-2 0.83

TPN04082CR TPPI-3 0.86

TPN0409299 TPNA-1 (1224ML) 署立新竹醫院 0.56

TPN0410299 TPNA-2 (1019ML) 署立新竹醫院 0.64

TPN0411299 TPNA-3 (1524ML) 署立新竹醫院 0.62

TPN0412299 TPNA-4 (1160ML) 署立新竹醫院 0.73

TPN0413299 TPNA-5 (1229ML) 署立新竹醫院 0.64

TPN0414299 TPNA-6 (1924ML) 署立新竹醫院 0.48

TPN0415299 TPNA-7 (1924ML) 署立新竹醫院 0.46

TPN0416299 KNO2 (1000ML) 署立新竹醫院 0.54

TPN0417299 KNO4 (1000ML) 署立新竹醫院 0.73

TPN0418299 KR01 (1000ML) 署立新竹醫院 0.53

TPN0419299 TPPI-4 (126ML) 署立新竹醫院 0.33

TPN0420299 TPPI-5 (106ML) 署立新竹醫院 0.47

TPN0421299 TPPI-6 (106ML) 署立新竹醫院 0.5

TPN0422299 PED-1 100ML 署立新竹醫院 0.91

TPN0423299 PED-2 100ML 署立新竹醫院 0.91

TPN0424299 PED-3 100ML 署立新竹醫院 1.05

TPN0425299 PED-4 100ML 署立新竹醫院 1.05

TPN0426299 PED-5 100ML 署立新竹醫院 1.06

TPN0427299 PED-6 100ML 署立新竹醫院 1.07

TPN0501209 TPN-1 0.79

TPN0502297 TPN-2 0.94

TPN05032CS TPN-3 0.87

TPN05042CT TPN-R 0.8

TPN0505297 TPN-H 0.72

TPN0506255 TPN-P1 1.1

TPN0507255 TPN-P2 1.31

TPN0508255 TPN-P3 1.52

TPN0509299 TPN-H (臺安醫院) 1200ML 0.55

TPN0510299 TPN-RHD (臺安醫院) 1009ML 0.7

TPN0511299 KCL 10MEQ IN D5W 250ML 0.08

TPN0512299 KCL 20MEQ IN D5W 250ML 0.09

TPN0513299 KCL 20MEQ IN D5/NS 500ML 0.05

TPN0601211 TPNA 0.48

TPN0602211 TPNB 0.42

TPN0603211 TPNC 0.46

TPN0604211 TPND 0.46

TPN0605211 TPNE 0.45

TPN0606211 TPNF 0.56

TPN06072CU PPNSOL. 0.56

TPN06082A8 TPN-X 0.45

TPN07012CV TPN-1 0.76

TPN0702297 TPN-2 0.83

TPN07032CW TPN-3 0.86

TPN07042CX TPN-4 0.38

TPN07052A6 TPN-5 0.65

TPN0706261 TPN-6 1.5

TPN0707299 TPN7(STANDARD TPN) 1019ML (國泰綜合醫院) 0.32

TPN0708299 TPN8(HIGH PROTEIN TPN) 1165ML (國泰綜合醫院) 0.36

293

Page 294: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN0709299 TPN9(PERIPHERAL PARENTALNUTRITION) 1265ML (國泰綜合醫院) 0.21

TPN0710299 TPN 10 0.51

TPN0711299 TPN B 0.39

TPN0712299 TP08 1000ML 0.46

TPN0801209 TPN RENAL 0.53

TPN0802209 TPN STANARD 0.91

TPN0803209 TPN HN 1

TPN0804209 TPN PERIPHERAL 0.5

TPN0805209 TPN HEPATIC 0.88

TPN0806299 D5W 100ML(含K+20MEQ) 0.12

TPN0807299 N/S 100ML(含K+20MEQ) 0.13

TPN0808299 D5 0.225% 500ML(含K+10MEQ) 0.03

TPN0809299 D5S 500ML(含K+20MEQ) 0.03

TPN0901209 TPN-A 0.34

TPN0902209 TPN-C 0.38

TPN0903209 TPN-E 0.62

TPN09042CY TPN-PED1 1.3

TPN09052CZ TPN-PED2 1.68

TPN09062D1 TPN-PED3 2.14

TPN09072D2 TPN-PED4 1.27

TPN0908299 TPNF 1300ML/BOT. 0.38

TPN0909299 TPN-G 0.33

TPN0910299 TPN-H 0.37

TPN1001209 TPN-A 0.44

TPN1002209 TPN-B 0.57

TPN1003209 TPN-C 0.64

TPN1004209 TPN-D 0.65

TPN1005209 TPN-E 0.67

TPN1006209 TPN-F 0.74

TPN1007209 TPN-G 0.71

TPN1008209 TPN R.F. 0.46

TPN1009209 TPN H.F. 0.53

TPN1010299 TPN N SOLN 1000ML/BAG 0.39

TPN1011299 TPN 1 (奇美醫院) 0.6

TPN1012299 TPN J (奇美醫院) 0.77

TPN1013299 TPN K(奇美醫院) 0.91

TPN1014299 TPN L(奇美醫院) 1.02

TPN1015299 KABIVEN PI 1.44L/BAG 0.71

TPN1016299 SMOFKABIVEN-TPN 0.67

TPN1101209 TPNA 0.48

TPN1102209 TPNB 0.75

TPN1103209 TPNC 0.8

TPN1104209 TPND 0.81

TPN1105209 TPNE 0.82

TPN1106209 TPNF 0.83

TPN1201209 TPNA-20 0.34

TPN1202209 TPNA-30 0.41

TPN1203209 TPNA-35 0.44

TPN1204209 TPNA-40 0.47

TPN1205209 TPNA-45 0.5

TPN1206209 TPNA-50 0.53

TPN1207209 TPNR-20 0.48

TPN1208209 TPNR-30 0.59

TPN1209209 TPNR-35 0.66

294

Page 295: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN1210209 TPNR-40 0.73

TPN1211209 TPNR-45 0.8

TPN1212209 TPNR-50 0.87

TPN1213209 TPNH-20 0.55

TPN1214209 TPNH-30 0.71

TPN1215209 TPNH-35 0.8

TPN1216209 TPNH-40 0.88

TPN1217209 TPNH-45 0.97

TPN1218209 TPNH-50 1.06

TPN1219255 TPNP-10 1.26

TPN1220263 TPNP-20 0.89

TPN1221266 TPNP-30 0.77

TPN1222271 TPNP-40 0.71

TPN1223277 TPNP-50 0.67

TPN1224280 TPNP-60 0.65

TPN1225282 TPNP-70 0.63

TPN1226283 TPNP-80 0.62

TPN12272B9 TPNP-90 0.6

TPN1228209 TPNP-100 0.6

TPN1229299 TPN C-9 1512ML/BAG 0.33

TPN1230299 TPN C-17 1512ML/BAG 0.39

TPN1231299 小兒TPN F-1 0.39

TPN1301209 TPN-A 0.64

TPN1302209 TPN-B 0.59

TPN1303209 TPN-C 0.58

TPN1304209 TPN-D 0.56

TPN1305209 TPN-E 0.52

TPN1306209 TPN-F 0.7

TPN1307209 TPN-G 1.03

TPN1308209 TPN-H 0.77

TPN1309209 TPN-I 0.57

TPN1310209 TPN-J 0.54

TPN1311209 TPN-K 0.71

TPN1312209 TPN-X 0.6

TPN1313299 TPN-H2 0.58

TPN1314299 TPN-J2 0.42

TPN1315299 TPN-K2 0.54

TPN1401209 5%TPN-PED 1000ML/BOT 0.47

TPN1402209 7.5%TPN-PED 1000ML/BOT 0.48

TPN1403209 10%TPN-PED 1000ML/BOT 0.6

TPN1404209 12.5%TPN-PED 1000ML/BOT 0.63

TPN1405209 20%TPN-PED 0.73

TPN1406209 5%PEDIATRIC TPN 1000ML/BOT 0.27

TPN1407209 7.5%PEDIATRIC TPN 1000ML/BOT 0.27

TPN1408209 10%PEDIATRIC TPN 1000ML/BOT 0.33

TPN1409209 12.5%PEDIATRIC TPN 1000ML/BOT 0.33

TPN1410209 20%PEDIATRIC TPN 1000ML/BOT 0.35

TPN1411209 10%ADULT TPN 1000ML/BOT 0.31

TPN1412209 15%ADULT TPN 1000ML/BOT 0.48

TPN1413209 20%ADULT TPN 1000ML/BOT 0.48

TPN1414209 25%ADULT TPN 1000ML/BOT 0.49

TPN1415209 30%ADULT TPN 1000ML/BOT 0.5

TPN1416209 35%ADULT TPN 1000ML/BOT 0.5

TPN1417297 20%ADULT TPN 1200ML/BOT 0.6

TPN1418209 LOW-PROTEIN 5% 0.15

295

Page 296: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN1419209 LOW-PROTEIN 7.5% 0.16

TPN1420209 LOW-PROTEIN 10% 0.16

TPN1421209 LOW-PROTEIN 12.5% 0.16

TPN1422209 LOW-PROTEIN 20% 0.17

TPN1423209 LOW-PROTEIN ADULT PTN 0.47

TPN1424209 HEPATIC FAILURE TPN 0.72

TPN1425209 RENAL FAILURE 20% TPN 0.79

TPN1426299 ADULT TPN-C 17.5% 1502.5ML 0.43

TPN1427299 ADULT TPN-C 7.5% 1502.5ML 0.35

TPN1428299 ADULT TPN-N 24% 1500ML 0.5

TPN15012D6 STANDARD TPN18% 0.82

TPN15022D7 STANDARD TPN+FAT18% 0.96

TPN15032D6 HIGH N TPN18% 0.76

TPN15042D7 HIGH N TPN+FAT18% 0.92

TPN15052D6 RENAL TPN18% 0.79

TPN15062D7 RENAL TPN+FAT18% 0.94

TPN15072D6 HEPATIC TPN18% 0.77

TPN15082D7 HEPATIC TPN+FAT18% 0.91

TPN15092D7 PERIPHERAL TPN12% 0.92

TPN1510259 PEDIATRIC TPN 1.07

TPN1524299 40MEQ KCL + N/S 500ML 0.04

TPN1525299 10MEQ KCL + TAITA NO5 400ML 0.08

TPN1526299 10MEQ KCL + 0.33 % G/S 500ML 0.04

TPN1527299 10MEQ KCL + 5 % G/S 500ML 0.04

TPN1528299 10MEQ KCL + 0.225 % G/S 500ML 0.04

TPN1529299 20 MEQ KCL IN CVVH A SOL’N 3000ML 0.05

TPN1530299 10MEQ KCL IN 2.5/0.45 % G/S 500ML 0.04

TPN1531299 100MEQ KCL 高濃度IN 50ML WATER FOR INJECTION (100ML/BT) 0.15

TPN1533299 5 ML KCL +5 ML K3PO4 IN H/S 500ML 0.07

TPN1534299 7.5ML KCL +7.5 ML K3PO4 IN H/S500ML 0.08

TPN1535299 10MEQ KCL+ GLUCOSE 5% 500ML 0.04

TPN1536299 20MEQ KCL IN 90ML GLUCOSE 5% (100ML/BT) 0.06

TPN16012D8 TPN-A 0.71

TPN16022D8 TPN-B 0.71

TPN1603209 TPN-C 0.5

TPN16042D9 TPN-D 0.52

TPN16052E1 TPN-E 0.52

TPN16062E2 TPN-F 0.61

TPN1607299 0.92

TPN1608299 0.99

TPN17012E3 TPN-A SOLUTION 0.29

TPN17022E3 TPN-B SOLUTION 0.37

TPN17032E3 TPN-D SOLUTION 0.46

TPN17042E3 TPN-E SOLUTION 0.38

TPN17052E3 TPN-F SOLUTION 0.55

TPN17062E3 TPN-G SOLUTION 0.66

TPN17072E4 PEDIATRIC TPN-A SOLUTION 0.35

TPN17082E4 PEDIATRIC TPN-B SOLUTION 0.43

TPN17092E4 PEDIATRIC TPN-C SOLUTION 0.32

TPN17102E4 PEDIATRIC TPN-D SOLUTION 0.3

TPN1711299 PEDIATRIC TPN-A SOLUTION 0.64

TPN1712299 PEDIATRIC TPN-B SOLUTION 0.79

TPN1713299 PEDIATRIC TPN-C SOLUTION 0.52

TPN1714299 PEDIATRIC TPN-D SOLUTION 0.52

TPN1715299 TPN-H SOLUTION (新光紀念醫院) 0.48

296

Page 297: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN1716299 PEDIATRIC TPN-A SOLUTION (新光醫院) 0.64

TPN1717299 PEDIATRIC TPN-B SOLUTION (新光醫院) 0.8

TPN1718299 PEDIATRIC TPN-C SOLUTION (新光醫院) 0.51

TPN1719299 PEDIATRIC TPN-D SOLUTION (新光醫院) 0.51

TPN1720299 PEDIATRIC TPN-F 0.55

TPN1721299 PEDIATRIC TPN-G 0.69

TPN1722299 PEDIATRIC TPN-H 0.42

TPN1723299 Pediatric TPN- I 0.52

TPN1724299 PEDIATRIC TPN-J 0.51

TPN18012E5 TPN-1 0.6

TPN18022E6 TPN-2 0.59

TPN18032E7 TPN-3 0.38

TPN18042E7 TPN-4 0.38

TPN18052E5 TPN-5 0.61

TPN18062E6 TPN-6 0.6

TPN18072E8 TPN-7 0.63

TPN18082E9 TPN-8 0.62

TPN18092F1 TPN-9 0.81

TPN1810299 TPN-10 (沙鹿童綜合醫院) 0.47

TPN1811299 TPN-11 (沙鹿童綜合醫院) 0.41

TPN1812299 TPN-12 童綜合醫院 0.47

TPN1813299 TPN-13童綜合醫院 0.41

TPN1814299 TPN-14童綜合醫院 1.5

TPN1815299 TPN兒科配方(2) 0.84

TPN1816299 PPN肝功能不全配方(3) 0.27

TPN1817299 PPN肝功能不全配方(4) 0.21

TPN1818299 PPN腎功能不全配方(3) 0.28

TPN1819299 PPN腎功能不全配方(4) 0.2

TPN1901209 T15 0.4

TPN1902209 TPN-TH 0.7

TPN1903209 TR 0.75

TPN1904299 T.N (高雄中和紀念醫院) 1.3

TPN1905299 TPN-T16 1000ML 0.44

TPN2001280 TPNA 0.71

TPN2002280 TPNB 0.71

TPN2003277 PPNA 0.61

TPN2004255 NPN1 0.41

TPN20052AV NPN2 0.55

TPN2006257 NPN3 0.66

TPN20072AW NPN4 0.76

TPN2008265 NPN5 0.75

TPN2117212 CSM 2040 0.73

TPN2117277 CSM 2040 0.73

TPN2118299 CSM 0815 2000ML/BTL 0.27

TPN2119299 CSM 1015 2000ML/BTL 0.28

TPN2120299 CSM 1220 2000ML/BTL 0.34

TPN2121299 CSM 1520 2000ML/BTL 0.34

TPN2122299 CSM 1730 2000ML/BTL 0.46

TPN2123299 CSM 2030 2000ML/BTL 0.47

TPN2124299 CSR 2515 2000ML/BTL 0.36

TPN2125299 CSH 2020 2000ML/BTL 0.43

TPN2126299 CSP 0515 500ML/BTL 0.76

TPN2127299 CSP 0815 500ML/BTL 0.76

TPN2128299 CSP 1015 500ML/BTL 0.77

TPN2129299 CSP 1020 500ML/BTL 0.99

297

Page 298: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN2130299 CSP 1220 500ML/BTL 0.99

TPN2131299 CSP 1530 500ML/BTL 0.99

TPN2132299 CSP 1730 500ML/BTL 1.43

TPN2133299 CSP 2030 500ML/BTL 1.43

TPN2134299 CSM1530 2000ML/BTL 0.47

TPN2135299 CSM2530 2000ML/BTL 0.48

TPN2136299 CSM2540 2000ML/BTL 0.6

TPN2137299 CSM2040 2000ML/BTL 0.59

TPN2138299 CSM 1030PPN 517.3ML (孫中山先生紀念醫院) 0.95

TPN2139299 CSM1335START 621.1ML (孫中山先生紀念醫院) 0.9

TPN2140299 CSM2540NORMAL 931.1ML (孫中山先生紀念醫院) 0.71

TPN2141299 CSM1640NORMAL 751.1ML (孫中山先生紀念醫院) 0.85

TPN2142299 CSM1540NORMAL 731.1ML (孫中山先生紀念醫院) 0.88

TPN2143299 CSM2535NORMAL 881.1ML (孫中山先生紀念醫院) 0.67

TPN2144299 CSM1730NORMAL 671.1ML (孫中山先生紀念醫院) 0.77

TPN2145299 CSM1530NORMAL 631.1ML (孫中山先生紀念醫院) 0.82

TPN2146299 CSM1070HP 931.1ML (孫中山先生紀念醫院) 1.07

TPN2147299 CSM1170HP 951.1ML (孫中山先生紀念醫院) 1.04

TPN2148299 CSM1270HP 971.1ML (孫中山先生紀念醫院) 1.02

TPN2149299 CSM2050STRESS 931.1ML (孫中山先生紀念醫院) 0.82

TPN2150299 CSM2345STRESS 941.1ML (孫中山先生紀念醫院) 0.76

TPN2151299 CSH1640HEPAIC 851.1ML (孫中山先生紀念醫院) 0.77

TPN2152299 CSH1740HEPAIC 871.1ML (孫中山先生紀念醫院) 0.75

TPN2153299 CSR1740HD 912.1ML (孫中山先生紀念醫院) 0.76

TPN2154299 CSR1640HD 892.1ML (孫中山先生紀念醫院) 0.78

TPN2155299 CSR2530NHD 927.1ML (孫中山先生紀念醫院) 0.6

TPN2156299 CSR2825NHD 930.2ML (孫中山先生紀念醫院) 0.53

TPN2157299 CSP2040 408.6ML (孫中山先生紀念醫院) 1.56

TPN2158299 CSP1740 378.6ML (孫中山先生紀念醫院) 1.67

TPN2159299 CSP2030 358.6ML (孫中山先生紀念醫院) 1.41

TPN2160299 CSP1530 308.6ML (孫中山先生紀念醫院) 1.62

TPN2161299 CSP1330 288.6ML (孫中山先生紀念醫院) 1.72

TPN2162299 CSP1225 258.6ML (孫中山先生紀念醫院) 1.66

TPN2163299 CSP1220 228.6ML (孫中山先生紀念醫院) 1.59

TPN2164299 CSN2030 43.2ML (孫中山先生紀念醫院) 1.07

TPN2165299 CSN1530 34.2ML (孫中山先生紀念醫院) 1.35

TPN2166299 CSN1330 30.2ML (孫中山先生紀念醫院) 1.52

TPN2167299 CSN1225 28.2ML (孫中山先生紀念醫院) 1.62

TPN2168299 CSN1220 28.2ML (孫中山先生紀念醫院) 1.62

TPN2201209 TPN-A 0.3

TPN2202209 TPN-B 0.46

TPN2203209 TPN-C 0.46

TPN2204209 TPN-D 0.47

TPN2205263 PED. TPN-A 0.34

TPN2206263 PED. TPN-B 0.35

TPN2207263 PED. TPN-C 0.44

TPN2208263 PED. TPN-D 0.54

TPN23012F2 TPN 0.34

TPN23022F3 TPN 0.42

TPN23032F4 TPN 0.68

TPN2304299 TPNI 1202ML/BAG 0.58

TPN2305299 TPN II 702ML/BAG 0.48

TPN2306299 TPN III 1802ML/BAG 0.81

TPN2307299 TPN IV 1421ML/BAG 0.46

TPN2308299 TPN 8 0.58

298

Page 299: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN2309299 TPN 9 0.54

TPN2310299 TPN 10 0.63

TPN2311299 TPN 11 0.54

TPN2401209 TPN-NORMAL 1000ML/BOT 0.5

TPN2402209 TPN 0.64

TPN2403209 TPN 0.33

TPN25012F2 TPN 0.53

TPN25022F3 TPN 0.67

TPN25032F5 TPN 0.78

TPN25042F6 TPN 0.86

TPN25052F6 TPN 0.56

TPN25062F3 TPN 0.62

TPN25072F6 TPN 0.62

TPN25082F4 TPN 0.37

TPN25092F4 TPN 0.43

TPN25102F7 TPN 0.38

TPN26012F8 TPN-A 0.6

TPN26022F8 TPN-B 0.6

TPN27012F9 TPN 1.02

TPN27022F9 1.02

TPN27032FA 0.93

TPN27042FA TPN 0.93

TPN27052F9 TPN 0.84

TPN27062FK TPN-N 0.84

TPN27072FL TPN-I 0.71

TPN27082FM TPN-T 0.61

TPN27092FN TPN-C 0.55

TPN27102G9 TPN-P1 447.55ML/BOT 0.83

TPN27112GA TPN-P2 748.5ML/BOT 0.79

TPN27122GB TPN-P3 1501.65ML/BOT 0.79

TPN27132GC TPN-P4 2295.7ML/BOT 0.63

TPN27142GD TPN-P5 3166.25ML/BOT 0.68

TPN27152GE TPN 0.75

TPN27162GF TPN-P7 5049.7ML/BOT 0.79

TPN27172GG TPN-P8 6463.5ML/BOT 0.81

TPN2718299 TPN-P9 222.55ML/BOT 1.54

TPN2719299 TPN-P10 373.5ML/BOT 1.52

TPN2720299 TPN-P11 751.65ML/BOT 1.51

TPN2721299 TPN-P12 1295.7ML/BOT 1.48

TPN2722299 TPN-P13 1916.25ML/BOT 1.06

TPN2723299 TPN-P14 2506.2ML/BOT 1.13

TPN2724299 TPN-P15 3049.7ML/BOT 1.27

TPN2725299 TPN-P16 3963.5ML/BOT 1.28

TPN2726299 CPN-5 601ML/BOT 0.63

TPN2727299 CPN-6 602ML/BOT 0.64

TPN2728299 CPN-7 601ML/BOT 0.65

TPN2729299 CPN-8 602ML/BOT 0.67

TPN2730299 CPN-9 501ML/BOT 0.61

TPN2731299 CPN-10 502ML/BOT 0.62

TPN2732299 CPN-11 601ML/BOT 0.71

TPN2733299 CPN-12 602ML/BOT 0.72

TPN2734299 PED TPN (三軍總醫院) 302ML 1.06

TPN2735299 CPN-NORMAL 0.63

TPN2736299 CPN-HIGH PROTEIN 0.72

TPN2737299 CPN-RENAL PROTEIN 0.48

299

Page 300: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN2738299 CPN-LIVER PROTEIN 0.32

TPN2739299 PED CPN-1 INJ 0.83

TPN2740299 PED CPN-2 INJ(6~12M) 0.9

TPN2741299 PED CPN-3 INJ(1~7Y) 0.44

TPN2742299 PED CPN-4 INJ(7~12Y) 0.44

TPN2743299 PED CPN-5 INJ(12~18Y) 0.41

TPN2744299 PED PPN-1 INJ(<6M) 0.45

TPN2745299 PED PPN-2 INJ(6~12M) 0.42

TPN2746299 PED PPN-3 INJ(1~7Y) 0.22

TPN2747299 PED PPN-4 INJ(7~12Y) 0.26

TPN2748299 PED PPN-5 INJ(12~18Y) 0.25

TPN2749299 CPN-NORMAL 0.64

TPN2750299 CPN-HIGH PROTEIN 0.74

TPN2751299 CPN-RENAL PROTEIN 0.52

TPN2752299 CPN-LIVER PROTEIN 0.34

TPN2753299 PED CPN-1 INJ(<6M) 0.89

TPN2754299 PED CPN-2 INJ(6~12M) 0.96

TPN2755299 PED CPN-3 INJ(1~7Y) 0.47

TPN2756299 PED CPN-4 INJ(7~12Y) 0.47

TPN2757299 PED CPN-5 INJ(12~18Y) 0.43

TPN2758299 PED PPN-1 INJ(<6M) 0.48

TPN2759299 PED PPN-2 INJ(6~12M) 0.46

TPN2760299 PED PPN-3 INJ(1~7Y) 0.24

TPN2761299 PED PPN-4 INJ(7~12Y) 0.28

TPN2762299 PED PPN-5 INJ(12~18Y) 0.27

TPN28012FB TPN-A 0.71

TPN28022FC TPN-B 0.64

TPN28032FD TPN-C 0.54

TPN28042FE TPN-D 0.51

TPN28052FF TPN-E 0.48

TPN28062FB TPN-F 0.47

TPN2807209 PPN-A 0.37

TPN2808209 PPN-B 0.37

TPN2809209 PPN-C 0.37

TPN2810209 PPN-D 0.37

TPN28112AV PPN-E 0.51

TPN2812209 PPN-F 0.4

TPN2813209 PPN-G 0.4

TPN2814209 PPN-H 0.4

TPN2815209 PPN-I 0.4

TPN28162AV PPN-J 0.54

TPN28172AV PPN-K 0.54

TPN2901209 TPN A 0.74

TPN2902209 TPN B 0.79

TPN2903209 TPN C 0.74

TPN2904209 TPN D 0.8

TPN2905209 TPN E 0.66

TPN2906209 TPN F 0.67

TPN2907209 TPN G 0.75

TPN2908209 TPN H 0.58

TPN2909209 TPN I 0.71

TPN2910209 TPN J 0.74

TPN30012FH TPN-1 0.47

TPN30022FI TPN-2 0.55

TPN30032FJ TPN-3 0.65

300

Page 301: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN3004299 FORMULAL 1 台北醫學大學附醫 0.79

TPN3005299 FORMULAL 2 台北醫學大學附醫 0.85

TPN3006299 FORMULAL 3 台北醫學大學附醫 0.77

TPN3007299 FORMULAL 4 台北醫學大學附醫 0.58

TPN3008299 FORMULAL 5 台北醫學大學附醫 0.62

TPN3009299 FORMULAL 6 台北醫學大學附醫 0.92

TPN3010299 FORMULAL 7 台北醫學大學附醫 0.98

TPN3011299 FORMULAL 8 台北醫學大學附醫 0.89

TPN3012299 KCL 10MEQ IN D5S 500ML 0.04

TPN3013299 KCL 20MEQ IN D5S 500ML 0.04

TPN3014299 KCL 40MEQ IN D5S 100ML 0.16

TPN3015299 KCL 10MEQ IN 5% GLUCOSE 500ML 0.04

TPN3016299 KCL 20MEQ IN 5% GLUCOSE 500ML 0.04

TPN3017299 KCL 40MEQ IN 5% GLUCOSE 100ML 0.2

TPN3018299 KCL 40MEQ IN 0.9% NACL 100ML 0.22

TPN3101209 TPN-A 1000ML/BOT 0.79

TPN3102209 TPN-B 1000ML/BOT 0.94

TPN3103209 TPN-C 1000ML/BOT 0.31

TPN3104209 TPN-D 1000ML/BOT 0.9

TPN3105209 TPN-E 1000ML/BOT 0.63

TPN3106299 TPN-P (慈濟醫院) 1.3

TPN32012F0 PN-P1 1518ML/BOT 0.79

TPN32022F0 PN-P2 1518ML/BOT 0.8

TPN32032F0 PN-P3 1518ML/BOT 0.83

TPN32042FP PN-P4 1768/BOT 0.88

TPN32052FQ PN-P5 2728ML/BOT 0.69

TPN32062FQ PN-P6 2728ML/BOT 0.7

TPN32072FQ PN-P7 2728ML/BOT 0.71

TPN32082FR PN-P8 2978ML/BOT 0.75

TPN32092FS PN-A1 1318ML/BOT 0.8

TPN32102FS PN-A2 1318ML/BOT 0.86

TPN32112FT PN-A3 1568ML/BOT 0.93

TPN32122FU PN-A4 2328ML/BOT 0.68

TPN32132FU PN-A5 2328ML/BOT 0.71

TPN32142FW PN-A6 2578ML/BOT 0.77

TPN32152FS PN-N1 1318ML/BOT 0.69

TPN32162FU PN-N2 2328ML/BOT 0.56

TPN32172FX PN-L1 1618ML/BOT 0.82

TPN32182FY PN-L2 1868ML/BOT 0.91

TPN32192FZ PN-L3 2428ML/BOT 0.62

TPN32202G1 PN-L4 2678ML/BOT 0.7

TPN32212FX PN-L5 1618ML/BOT 0.8

TPN32222FY PN-L6 1868ML/BOT 0.91

TPN32232FZ PN-L7 2428ML/BOT 0.61

TPN32242G1 PN-L8 2678ML/BOT 0.7

TPN32252G2 PN-R1 1368ML/BOT 0.75

TPN32262FY PN-R2 1868ML/BOT 0.92

TPN32272FZ PN-R3 2428ML/BOT 0.64

TPN32282G1 PN-R4 2678ML/BOT 0.71

TPN32292G3 PN-C1 1218ML/BOT 0.83

TPN32302G4 PN-T1 918ML/BOT 0.76

TPN32312G4 PN-T2 918ML/BOT 0.78

TPN32322G5 PN-T3 2128ML/BOT 0.5

TPN32332G5 PN-T4 2128ML/BOT 0.51

TPN32342G6 PN-T5 818ML/BOT 0.85

301

Page 302: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN32352G6 PN-T6 818ML/BOT 0.88

TPN32362FU PN-T7 2328ML/BOT 0.54

TPN32372FU PN-T8 2328ML/BOT 0.55

TPN3238299 TPN 1 0.81

TPN3239299 TPN 2 0.8

TPN3240299 TPN 3 1.04

TPN3241299 TPN 4 0.92

TPN3242299 TPN 5 1.01

TPN3243299 TPN 6 1.09

TPN3244299 TPN 7 1.82

TPN3245299 TPN 8 1.42

TPN3246299 TPN2-A 0.52

TPN3247299 TPN3-A 0.48

TPN3248299 TPN3-B 0.61

TPN3249299 TPN-1A 0.45

TPN3250299 TPN-1B 0.45

TPN3251299 TPN-2B 0.42

TPN3252299 TPN-4A 0.38

TPN3253299 TPN-9A 0.6

TPN3254299 TPN1-A 48/100(818ML) 0.5

TPN3255299 TPN1-B 63/100(1318ML) 0.45

TPN3256299 TPN2-A 70/240(1018ML) 0.54

TPN3257299 TPN2-B 72/150(1218ML) 0.45

TPN3258299 PPN3-A 40/80(1018ML) 0.5

TPN3259299 PPN3-B (GLYCEROL)(518ML) 0.6

TPN3260299 PPN3-C 46/103/41(1466ML) 0.66

TPN3261299 TPN4-A 18/100(668ML) 0.43

TPN34012G7 TPN-A1904ML/BAG 0.41

TPN34022G7 TPN-B1904ML/BAG 0.41

TPN34032G7 TPN-C1904ML/BAG 0.47

TPN34042G7 TPND1904ML/BAG 0.47

TPN34052G8 TPN-E1804ML/BAG 0.54

TPN34062G8 TPN-F1804ML/BAG 0.54

TPN34072G8 TPN-G1804ML/BAG 0.47

TPN3408299 TPN-G1 1816ML (台北巿立仁愛醫院) 0.54

TPN3409299 TPN-G2 1816ML (台北巿立仁愛醫院) 0.49

TPN3410299 TPN-A 1916ML (台北巿立仁愛醫院) 0.46

TPN3411299 TPN-B 1916ML (台北巿立仁愛醫院) 0.4

TPN3412299 TPN-C 1914ML (台北巿立仁愛醫院) 0.45

TPN3413299 TPN-D 1914ML (台北巿立仁愛醫院) 0.39

TPN3414299 TPN-E 1814ML (台北巿立仁愛醫院) 0.51

TPN3415299 TPN-F 1814ML (台北巿立仁愛醫院) 0.45

TPN3501280 TPN A 600ML/BOT 0.57

TPN3502280 TPN B 600ML/BOT 0.57

TPN3503299 START (豐原醫院) 0.88

TPN3504299 NORMAL (豐原醫院) 0.83

TPN3505299 HP (豐原醫院) 1.07

TPN3506299 PPN (豐原醫院) 0.9

TPN3507299 HEPAIC (豐原醫院) 0.91

TPN3508299 HD (豐原醫院) 0.97

TPN3509299 NHD (豐原醫院) 0.62

TPN3510299 NHO (豐原醫院) 2.4

TPN3511299 PED (豐原醫院) 2.98

TPN3512299 TPN 1 (豐原醫院) 0.7

TPN3513299 TPN 2 (豐原醫院) 0.47

302

Page 303: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN3514299 TPN 3 (豐原醫院) 0.65

TPN3515299 TPN 4 (豐原醫院) 0.41

TPN3516299 TPN 5 (豐原醫院) 0.6

TPN3517299 TPN 6 (豐原醫院) 0.62

TPN3518299 TPN 7 (豐原醫院) 0.62

TPN3601209 TPN-1-A 1000ML/BAG 0.76

TPN3602210 TPN-2 1500ML/BAG 0.55

TPN3603210 TPN-3 1500ML/BAG 0.66

TPN3604210 TPN-4 1500ML/BAG 0.67

TPN3605210 TPN-5 1500ML/BAG 0.78

TPN3606210 TPN-6 1500ML/BAG 0.79

TPN3607210 TPN-7 1500ML/BAG 0.8

TPN3608210 TPN-8 1500ML/BAG 0.97

TPN3609210 TPN I-B 1500ML/BAG 0.72

TPN3610212 TPN-9 2000ML/BAG 0.7

TPN3611212 TPN-10 2000ML/BAG 0.71

TPN3612212 TPN-C 2000ML/BAG 0.7

TPN3613209 TPN II-A 1000ML/BAG 0.52

TPN3614212 TPN II-B 2000ML/BAG 0.45

TPN3615299 FORMULA 1 (????????????????) 0.41

TPN3616299 FORMULA 2 (????????????????) 0.36

TPN3617299 FORMULA 3 (????????????????) 0.41

TPN3618299 FORMULA 4 (????????????????) 0.36

TPN3619299 FORMULA 5 (????????????????) 0.68

TPN3620299 FORMULA 6 (????????????????) 0.48

TPN3621299 KCL 10MEQ IN N/S 500ML 0.06

TPN3622299 KCL 20MEQ IN N/S 500ML 0.09

TPN3623299 KCL 30MEQ IN N/S 500ML 0.12

TPN3624299 KCL 40MEQ IN N/S 500ML 0.15

TPN3625299 KCL 10MEQ IN D2.5%/S0.45% 500ML 0.07

TPN3626299 KCL 20MEQ IN D2.5%/S0.45% 500ML 0.09

TPN3627299 KCL 30MEQ IN D2.5%/S0.45% 500ML 0.12

TPN3628299 KCL 40MEQ IN D2.5%/S0.45% 500ML 0.15

TPN3629299 KCL 10MEQ IN D10W 500ML 0.08

TPN3630299 KCL 20MEQ IN D10W 500ML 0.11

TPN3631299 KCL 30MEQ IN D10W 500ML 0.14

TPN3632299 KCL 40MEQ IN D10W 500ML 0.16

TPN3633299 KCL 20MEQ IN NUTRIFLEX 1000ML 0.4

TPN3634299 KCL 40MEQ IN NUTRIFLEX 1000ML 0.43

TPN3635299 KCL 60MEQ IN NUTRIFLEX 1000ML 0.45

TPN3636299 KCL 10MEQ IN N/S 1000ML 0.04

TPN3637299 KCL 10MEQ IN D2.5%/S0.45% 1000ML 0.04

TPN3638299 KCL 10MEQ IN TAITA N0.5 400ML 0.11

TPN3639299 K3PO4 5ML IN N/S 500ML 0.06

TPN3640299 K3PO4 5ML IN D2.5%/S0.45% 500ML 0.06

TPN3641299 KCL 6MEQ IN N/S 500ML 0.05

TPN3642299 KCL 20MEQ IN N/S 1000ML 0.05

TPN3643299 KCL 30MEQ IN N/S 1000ML 0.07

TPN3644299 KCL 40MEQ IN N/S 1000ML 0.08

TPN3645299 KCL 60MEQ IN N/S 1000ML 0.11

TPN3646299 KCL 80MEQ IN N/S 1000ML 0.14

TPN3647299 KCL 14MEQ IN N/S 1000ML 0.04

TPN3648299 KCL 20MEQ IN D2.5%/ 0.05

TPN3649299 KCL 30MEQ IN D2.5%/S0.45% 1000ML 0.07

TPN3650299 KCL 40MEQ IN D2.5%/ S0.45% 1000ML 0.08

303

Page 304: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN3651299 KCL 60MEQ IN D2.5%/ S0.45% 1000ML 0.11

TPN3652299 KCL 80MEQ IN D2.5%/ S0.45% 1000ML 0.14

TPN3653299 KCL 10MEQ IN AMINOFLUID 0.32

TPN3654299 KCL 20MEQ IN AMINOFLUID 1000ML 0.33

TPN3655299 KCL 30MEQ IN AMINOFLUID 1000ML 0.35

TPN3656299 KCL 40MEQ IN AMINOFLUID 1000ML 0.36

TPN3657299 KCL 60MEQ IN AMINOFLUID 0.38

TPN3658299 KCL 10MEQ IN DEXTROSE 5% 500ML 0.06

TPN3659299 KCL 20MEQ IN DEXTROSE 5% 500ML 0.09

TPN3660299 KCL 40MEQ IN DEXTROSE 5% 500ML 0.14

TPN3661299 KCL 10MEQ IN DEXTROSE 5% 1000ML 0.04

TPN3662299 KCL 20MEQ IN DEXTROSE 5% 1000ML 0.05

TPN3663299 KCL 20MEQ IN TIATA NO.5 400ML 0.14

TPN3664299 KCL 40MEQ IN TIATA NO.5 400ML 0.21

TPN3665299 CPN-1 1001ML 0.35

TPN3666299 CPN-2 1201ML 0.32

TPN3667299 CPN-3 1502ML 0.29

TPN3668299 CPN-4 1902ML 0.26

TPN3669299 CPN-5 1201ML 0.28

TPN3670299 PED-1 371ML 0.24

TPN3701299 ADULT-A 1000ML/BAG 0.55

TPN3702299 ADULT-B 1000ML/BAG 0.62

TPN3703299 ADULT-C 1000ML/BAG 0.74

TPN3704299 ADULT-D 1000ML/BAG 0.63

TPN3705299 ADULT-E 1000ML/BAG 0.59

TPN3706299 ADULT-F 1000ML/BAG 0.57

TPN3707299 CHILD-A 1000ML/BAG 0.32

TPN3708299 CHILD-B 1000ML/BAG 0.45

TPN3709299 CHILD-C 1000ML/BAG 0.52

TPN3710299 CHILD-D 1000ML/BAG 0.53

TPN3711299 CHILD-E 1000ML/BAG 0.54

TPN3712299 CHILD-F 1000ML/BAG 0.55

TPN3801299 TPN I 1004ML/BAG 0.47

TPN3802299 TPN II 1204ML/BAG 0.6

TPN3803299 TPN III 1204ML/BAG 0.6

TPN3804299 TPN IV 1204ML/BAG 0.61

TPN3805299 TPN V 889ML/BAG 0.84

TPN3806299 TPN VI 739ML/BAG 1.01

TPN3807299 TPN VII 889ML/BAG 0.85

TPN3808299 TPN VIII 739ML/BAG 1.02

TPN3809299 TPN 1X 342.5ML/BAG 0.66

TPN3810299 TPN X 342.5ML/BAG 1

TPN3811299 TPN XI 342.5ML/BAG 0.98

TPN3812299 TPN 1 0.47

TPN3813299 TPN 2 0.6

TPN3814299 TPN 3 0.51

TPN3815299 TPN 5 0.6

TPN3816299 TPN 6 0.73

TPN3817299 TPN I 1057CC 0.26

TPN3818299 TPN II 1307CC 0.29

TPN3819299 TPN III 1307CC 0.38

TPN3820299 TPN IV 1307CC 0.62

TPN3901299 TPNS1 1405ML/PKG 0.64

TPN3902299 TPNS2 2005ML/PKG 0.6

TPN3903299 TPNS3 2605ML/PKG 0.57

304

Page 305: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN3904299 TPNH1 1555ML/PKG 0.8

TPN3905299 TPNH2 1955ML/PKG 0.66

TPN3906299 TPNH3 2355ML/PKG 0.57

TPN3907299 TPNR1 1455ML/PKG 0.77

TPN3908299 TPNR2 2055ML/PKG 0.66

TPN3909299 TPNR3 2055ML/PKG 0.62

TPN3910299 TPN HN1 1655ML/PKG 0.82

TPN3911299 TPN HN2 2255ML/PKG 0.74

TPN3912299 TPN PED-1 226ML/PKG 0.72

TPN3913299 TPNS1 1461ML/PKG 0.78

TPN3914299 TPNS2 2061ML/PKG 0.7

TPN3915299 TPNS3 2661ML/PKG 0.66

TPN3916299 TPNH1 1561ML/PKG 0.81

TPN3917299 TPNH2 1961ML/PKG 0.68

TPN3918299 TPNH3 2361ML/PKG 0.59

TPN3919299 TPN R1 1461ML/PKG 0.78

TPN3920299 TPN R2 2061ML/PKG 0.71

TPN3921299 TPN R3 2661ML/PKG 0.66

TPN3922299 TPN H1 1661ML/PKG 0.83

TPN3923299 TPN H2 2261ML/PKG 0.75

TPN3924299 TPN PED-1 0.83

TPN3925299 TPN S1 1461ML 0.77

TPN3926299 TPN S2 2061ML 0.7

TPN3927299 TPN S3 2661ML 0.65

TPN3928299 TPN H1 1561ML 0.8

TPN3929299 TPN H2 1961ML 0.67

TPN3930299 TPN H3 2361ML 0.58

TPN3931299 TPN R1 1461ML 0.77

TPN3932299 TPN R2 2061ML 0.69

TPN3933299 TPN HN1 1261ML 0.75

TPN3934299 TPN HN2 1761ML 0.62

TPN3935299 TPN HN3 2261ML 0.49

TPN3942299 TPN KC 2064ML 0.87

TPN3943299 TPN KP 1451ML 0.87

TPN3953299 TPN HN1 1.04

TPN3954299 TPN HN2 1.02

TPN3955299 PPN LP 0.7

TPN3956299 PPN NP 0.45

TPN3957299 TPNS1(1456ML) 0.49

TPN3958299 TPNS2(2056ML) 0.45

TPN3959299 TPNH1(1556ML) 0.44

TPN3960299 TPNR1(1456ML) 0.45

TPN3961299 TPNS1DL (1206ML) 0.4

TPN3962299 TPNS2DL(1806ML) 0.38

TPN3963299 TPNH1DL(1306ML) 0.35

TPN3964299 TPNR1DL(1206ML) 0.36

TPN3965299 TPNHN1DL(1006ML) 0.49

TPN3966299 TPNHN2DL(1506ML) 0.47

TPN4001299 TPNA1 1051.3ML/BAG. 0.62

TPN4002299 TPNA2 1051.8ML/BAG. 0.66

TPN4003299 TPNA3 1051.5ML/BAG. 0.8

TPN4004299 TPNA4 765ML/BAG. 0.73

TPN4005299 TPNA5 1085ML/BAG. 0.44

TPN4006299 TPNB1 1015ML/BAG. 0.72

TPN4007299 TPNP1 109ML/BAG. 1.27

305

Page 306: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN4008299 TPNP2 100ML/BAG. 1.39

TPN4009299 TPNP3 100ML/BAG. 1.55

TPN4010299 TPNP4 100ML/BAG. 1.56

TPN4011299 TPNP5 100ML/BAG. 1.83

TPN4012299 TPNB2 0.47

TPN4013299 KCL 10MEQ IN D5S 500ML 0.04

TPN4014299 KCL 20MEQ IN D5S 500ML 0.04

TPN4015299 KCL 6MEQ IN D5.33%S 500ML 0.04

TPN4016299 KCL 4MEQ IN TAITA NO.2 500ML 0.08

TPN4017299 KCL 40MEQ IN D5W 100ML 0.2

TPN4101299 TPN-A 1200ML/PKG 0.57

TPN4102299 TPN-B 1300ML/PKG 0.63

TPN4103299 TPN-C 500ML/PKG 0.56

TPN4104299 TPN-D 1600ML/PKG 0.74

TPN4105299 TPNE (阮綜合醫院) 0.41

TPN4106299 TPN-1 1228ML (阮綜合醫院) 0.69

TPN4107299 TPN-2 1914ML (阮綜合醫院) 0.47

TPN4108299 TPN-3 1228ML (阮綜合醫院) 0.65

TPN4109299 TPN-4 1914ML (阮綜合醫院) 0.41

TPN4110299 TPN-5 1243ML (阮綜合醫院) 0.69

TPN4111299 TPN-6 1518ML (阮綜合醫院) 0.61

TPN4112299 TPN-7 2022ML (阮綜合醫院) 0.61

TPN4113299 TPN-1A 0.61

TPN4114299 TPN-1B 0.44

TPN4115299 TPN-2A 0.4

TPN4116299 TPN-3A 0.37

TPN4117299 TPN-4A 0.98

TPN4201299 TPN-A 607ML/PKG 0.67

TPN4202299 TPN-B 600ML/PKG 0.57

TPN4203299 TPN-C 957ML/PKG 0.42

TPN4204299 TPN-D 950ML/PKG 0.36

TPN4205299 TPN-E 657ML/PKG 0.69

TPN4206299 TPN-F 650ML/PKG 0.6

TPN4207299 TPN-G 607ML/PKG 0.67

TPN4208299 TPN-H 600ML/PKG 0.57

TPN4209299 TPNI 950ML/BOT 0.36

TPN4210299 TPNJ 1007ML/BOT 0.4

TPN4211299 TPN-K (南雲醫院) 500ML 0.62

TPN4212299 TPN-L (南雲醫院) 600ML 0.53

TPN4213299 TPN-M (南雲醫院) 600ML 0.53

TPN4214299 TPN-N (南雲醫院) 550ML 0.52

TPN4215299 TPN-O (南雲醫院) 650ML 0.45

TPN4216299 TPN-P (南雲醫院) 650ML 0.45

TPN4217299 TPN-Q (南雲醫院) 600ML 0.48

TPN4218299 TPN-R (南雲醫院) 600ML 0.48

TPN4227299 TPN-A 0.26

TPN4228299 TPN-B 0.27

TPN4229299 TPN-C 0.26

TPN4230299 TPN-D 0.27

TPN4301299 TPN S1 1500ML/PKG 0.51

TPN4302299 TPN S2 2100ML/PKG 0.49

TPN4303299 TPN H1 1300ML/PKG 0.62

TPN4304299 TPN H2 2050ML/PKG 0.56

TPN4305299 TPN R1 1800ML/PKG 0.43

TPN4306299 TPN R2 950ML/PKG 0.35

306

Page 307: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN4307299 TPN HNI 2000ML/PKG 0.62

TPN4308299 TPN PPNI 1200ML/PKG 0.41

TPN4309299 TPN KC 1549ML/PKG 0.88

TPN4310299 TPN KP 1449ML/PKG 0.74

TPN4311299 TPN NP 1009ML/PKG 0.44

TPN4312299 TPN NC 1009ML/PKG 0.48

TPN4401299 TPNA1 1742ML/PKG 0.91

TPN4402299 TPNA2 1942ML/PKG 0.94

TPN4403299 TPN B 1192ML/PKG 1.11

TPN4404299 TPN C 1842ML/PKG 0.91

TPN4405299 TPN E1 1542ML/PKG 1

TPN4406299 TPN E2 2042ML/PKG 0.91

TPN4501299 TPN-S 0.67

TPN4502299 TPN-H 0.73

TPN4503299 TPN-R 0.79

TPN4504299 TPN-H.N 0.61

TPN4505299 TPN-1 1.35

TPN4506299 TPN-2 1.21

TPN4601299 TPNA 2007ML/BOT 0.71

TPN4602299 TPNB 2257ML/BOT 0.58

TPN4603299 TPNC 2257ML/BOT 0.71

TPN4604299 TPNCHF 1507ML/BOT 0.73

TPN4605299 TPNRF 1507ML/BOT 0.52

TPN4606299 TPNL 1507ML/BOT 0.67

TPN4607299 PPN 1 153ML/BOT 0.9

TPN4608299 PPN 2 203ML/BOT 1.01

TPN4609299 PPN 3 453ML/BOT 1.26

TPN4610299 PPN 1 803ML/BOT 1.21

TPN4611299 PPN C 1503ML/BOT 0.92

TPN4706299 TPN F 620ML 0.6

TPN4707299 TPN G 620ML 0.6

TPN4708299 TPN G 620ML 0.6

TPN4709299 TPN I 520ML 0.74

TPN4710299 TPN F (新樓醫院) 0.6

TPN4711299 TPN G(新樓醫院) 0.6

TPN4712299 TPN H(新樓醫院) 0.6

TPN4713299 TPN I(新樓醫院) 0.73

TPN4714299 TPN J(新樓醫院) 0.4

TPN4715299 TPN K(新樓醫院) 0.41

TPN4716299 TPNP (新樓醫院) 0.53

TPN4717299 TPN-1 (新樓醫院) 1218ML 0.64

TPN4718299 TPN-2 (新樓醫院) 1916ML 0.49

TPN4719299 TPN-3 (新樓醫院) 1218ML 0.59

TPN4720299 TPN-4 (新樓醫院) 1916ML 0.43

TPN4721299 TPN-5 (新樓醫院) 1243ML 0.59

TPN4723299 TPN-7 (2012ML) 新樓醫院 0.35

TPN4727299 TPN A 1112ML 0.53

TPN4728299 TPN B 1412ML 0.4

TPN4729299 TPN C 1012ML 0.4

TPN4730299 TPN D 1212ML 0.49

TPN4731299 TPN E 1312ML 0.34

TPN4732299 TPN-6 1512ML 0.45

TPN4733299 TPN-8 1512ML 0.35

TPN4734299 TPN9 1012ML 0.38

TPN4735299 TPN X 0.41

307

Page 308: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN4736299 TPN N 0.4

TPN4801299 TPN A 0.58

TPN4802299 TPN B 0.58

TPN4803299 TPN C 0.75

TPN4804299 TPN H 0.61

TPN4805299 TPN R 0.41

TPN4901299 FORMULA 1 0.82

TPN4902299 FORMULA 2 0.64

TPN4903299 FORMULA 3 0.5

TPN4904299 FORMULA 4 0.73

TPN4905299 FORMULA 5 0.85

TPN4906299 FORMULA 6 0.66

TPN4907299 FORMULA 7 0.67

TPN4908299 FORMULA 8 0.72

TPN4909299 FORMULA 9 0.88

TPN4910299 FORMULA 10 0.83

TPN4911299 FORMULA 11 0.36

TPN4912299 FORMULA 12 0.64

TPN4913299 FORMULA 13 0.4

TPN4914299 FORMULA 14 0.61

TPN5001299 TPN A (為恭) 0.38

TPN5002299 TPN B (為恭) 0.38

TPN5003299 TPN C (為恭) 0.68

TPN5004299 TPN D (為恭) 0.57

TPN5005299 TPN E (為恭) 0.37

TPN5006299 TPN P (為恭) 0.57

TPN5007299 CPN 1 (為恭) 0.6

TPN5008299 CPN 2 (為恭) 0.68

TPN5009299 CPN 3 (為恭) 0.69

TPN5010299 CPN 4 (為恭) 0.72

TPN5011299 CPN 5 (為恭) 0.44

TPN5012299 CPN 6 (為恭) 0.45

TPN5013299 CPN 7 (為恭) 0.55

TPN5109299 NEOA (羅東博愛醫院) 0.61

TPN5110299 NEOB(羅東博愛醫院) 0.71

TPN5111299 NEOC(羅東博愛醫院) 0.76

TPN5112299 NEOD(羅東博愛醫院) 0.8

TPN5113299 NEOA(D10W-BASED)(羅東博愛醫院) 0.57

TPN5114299 NEOB(D10W-BASED)(羅東博愛醫院) 0.69

TPN5115299 NEOC(D10W-BASED)(羅東博愛醫院) 0.75

TPN5116299 NEOD(D10W-BASED)(羅東博愛醫院) 0.78

TPN5201299 TPNA-1000 (慈濟大林綜合醫院) 999.05ML 0.6

TPN5202299 TPNB-1000 (慈濟大林綜合醫院) 1001ML 0.78

TPN5203299 TPNC-1000 (慈濟大林綜合醫院) 1006ML 0.44

TPN5204299 TPND-1000 (慈濟大林綜合醫院) 898.1ML 0.79

TPN5206299 TPNP-1000 (慈濟大林綜合醫院) 984.84ML 1.11

TPN5209299 TPNE-1000 0.47

TPN5210299 TPNF-1000 0.35

TPN5301299 TPN-A (1104ML) 屏東基督教醫院 0.47

TPN5302299 TPN-B (1214ML) 屏東基督教醫院 0.55

TPN5303299 TPN-C (1214ML) 屏東基督教醫院 0.51

TPN5304299 TPN-D (1914ML) 屏東基督教醫院 0.44

TPN5305299 TPN-E (1914ML) 屏東基督教醫院 0.42

TPN5306299 TPN-F (1514ML) 屏東基督教醫院 0.55

TPN5307299 TPN-G (2014ML) 屏東基督教醫院 0.53

308

Page 309: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN5308299 TPN-H (1136ML) 屏東基督教醫院 0.4

TPN5309299 TPN-N (1070ML) 屏東基督教醫院 0.66

TPN5401299 TPNA-1 1229ML (伍倫綜合醫院) 0.64

TPN5402299 TPNA-2 1229ML (伍倫綜合醫院) 0.6

TPN5403299 TPNA-3 1024ML (伍倫綜合醫院) 0.69

TPN5404299 TPNA-4 1524ML (伍倫綜合醫院) 0.62

TPN5405299 TPNA-5 1924ML (伍倫綜合醫院) 0.48

TPN5406299 TPNA-6 1924ML (伍倫綜合醫院) 0.42

TPN5407299 TPNA-7 1254ML (伍倫綜合醫院) 0.58

TPN5501299 TPN-1 1226ML (署立雲林醫院) 0.62

TPN5502299 TPN-2 1226ML (署立雲林醫院) 0.58

TPN5503299 TPN-3 1914ML (署立雲林醫院) 0.44

TPN5504299 TPN-4 1914ML (署立雲林醫院) 0.39

TPN5505299 TPN-5 1144ML (署立雲林醫院) 0.61

TPN5506299 TPN-6 1016ML (署立雲林醫院) 0.61

TPN5507299 CPN-A2 0.46

TPN5508299 CPN-B2 0.51

TPN5509299 CPN-G 0.53

TPN5510299 CPN-G2 0.49

TPN5511299 TPN-11 1.38

TPN5512299 TPN1 100ML 0.93

TPN5513299 KCL 10MEQ IN DEXT-SALINE 500ML 0.04

TPN5514299 KCL 10MEQ IN TAITA NO.5 400ML 0.11

TPN5515299 KCL 20MEQ IN 0.9%NS 100ML 0.19

TPN5516299 KCL 20MEQ IN 5% DEXTROSE 100ML 0.17

TPN5517299 KCL 20MEQ IN 5% DEXTROSE 50ML 0.2

TPN5601299 TPN-1 1231ML 東港安泰醫院 0.65

TPN5602299 TPN-2 1231ML 東港安泰醫院 0.61

TPN5603299 TPN-3 1019ML 東港安泰醫院 0.65

TPN5604299 TPN-4 1524ML 東港安泰醫院 0.62

TPN5605299 TPN-5 2024ML 東港安泰醫院 0.59

TPN5606299 TPN-6 1926ML 東港安泰醫院 0.48

TPN5607299 TPN-7 1926ML 東港安泰醫院 0.47

TPN5608299 TPN-8 1256ML 東港安泰醫院 0.67

TPN5609299 TPN-9 946ML 東港安泰醫院 0.49

TPN5610299 TPN-10 1026ML 東港安泰醫院 0.57

TPN5611299 TPN-11 1526ML 東港安泰醫院 0.48

TPN5612299 TPN-12 1323ML 東港安泰醫院 0.62

TPN5613299 TPN-13 1066ML 東港安泰醫院 0.56

TPN5614299 TPN-14 1926ML 東港安泰醫院 0.51

TPN5615299 tpn 1457ml 0.89

TPN5701299 TPN-1 0.56

TPN5702299 TPN-2 0.45

TPN5703299 TPN-3 0.51

TPN5704299 TPN-4 0.44

TPN5705299 TPN-5 0.49

TPN5706299 TPN-6 0.42

TPN5707299 TPN-7 0.6

TPN5708299 TPN-8 0.42

TPN5709299 TPN-9 0.5

TPN5710299 TPN-10 0.5

TPN5801299 TPN-A1 0.71

TPN5802299 TPN-A2 0.71

TPN5803299 TPN-B1 0.66

TPN5804299 TPN-B2 0.67

309

Page 310: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN5805299 TPN-C 0.71

TPN5806299 TPN-D 0.55

TPN5807299 TPN-E 0.69

TPN5808299 TPN-F 0.69

TPN5809299 TPN-G 0.6

TPN5810299 TPN-M 0.51

TPN5811299 TPN-H 0.75

TPN5812299 TPN-L 0.76

TPN5813299 TPN-K2 0.68

TPN5814299 TPN-K1 0.69

TPN5815299 TPN-R 0.73

TPN5816299 TPN-KN 1.36

TPN5817299 TPN-KR 0.71

TPN5818299 TPN-KH 0.71

TPN5819299 TPN-1 0.68

TPN5820299 TPN-2 0.52

TPN5821299 TPN-3 0.44

TPN5822299 TPN-4 1.01

TPN5823299 TPN-5 0.96

TPN5824299 TPN-P 0.99

TPN5825299 TPN-Q 0.48

TPN5826299 TPN-KX 0.5

TPN5827299 TPN-B3 0.46

TPN5828299 TPN-R2 0.49

TPN5829299 TPN-H2 0.42

TPN5830299 TPN-6 0.7

TPN5831299 TPN-S 0.93

TPN5832299 TPN-P1(817ML) 0.5

TPN5833299 TPN-P2(1037ML) 0.53

TPN5834299 TPN-PH(1067ML) 0.44

TPN5835299 TPN-PR(967ML) 0.56

TPN5836299 TPN-N7(1506ML) 0.97

TPN5901299 TPN-STD1 1012ML 0.49

TPN5902299 TPN-STD2 1112ML 0.47

TPN5903299 TPN-STD3 1412ML 0.48

TPN5904299 TPN-STD4 1612ML 0.52

TPN5907299 TPN-1 1800ML 0.2

TPN5908299 TPN-2 1500ML 0.28

TPN5909299 TPN-RENAL 1361ML 0.63

TPN5910299 TPN-HEPATIC 1772ML 0.46

TPN5915299 TPN-STD5 0.42

TPN5924299 TPN-PED A 0.16

TPN5925299 TPN-PED B 0.2

TPN5926299 TPN-PED C 0.2

TPN5927299 TPN-PED D 0.2

TPN5928299 TPN-NEO E 0.75

TPN5929299 TPN-NEO F 0.82

TPN5930299 TPN-NEO G 0.82

TPN5931299 TPN-NEO H 0.82

TPN6001299 TPN-1 1219ML 0.61

TPN6002299 TPN-2 1911ML 0.43

TPN6003299 TPN-3 1219ML 0.57

TPN6004299 TPN-4 1911ML 0.38

TPN6005299 TPN-5 1238.4ML 0.6

TPN6006299 TPN-6 1519ML 0.62

310

Page 311: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN6007299 TPN-7 2019ML 0.59

TPN6101299 PPN 550.6ML 0.96

TPN6102299 START 440.3ML 0.95

TPN6103299 NORMAL1 738ML 0.74

TPN6104299 NORMAL2 788ML 0.76

TPN6105299 NORMAL3 838ML 0.79

TPN6106299 HN 938ML 0.93

TPN6107299 HEPATIC 921ML 0.59

TPN6108299 HD 896.9ML 0.62

TPN6109299 MHD 963.6ML 0.29

TPN6110299 NEO 1 1.39

TPN6111299 NEO 2 1.53

TPN6112299 NEO 3 128.84ML 1.72

TPN6113299 NEO 4 155.84ML 1.85

TPN6114299 NEO 5 373.8ML 1.56

TPN6115299 NEO 6 478.8ML 1.76

TPN6116299 TPNPED 1 785.8ML 0.88

TPN6117299 TPNPED 2 888.8ML 0.91

TPN6118299 CTPNS2 0.34

TPN6201299 TPN-G 1559ML 0.97

TPN6202299 TPN-H 2074ML 0.89

TPN6301299 TPN A 0.51

TPN6302299 TPN B 0.63

TPN6303299 TPN C 0.65

TPN6304299 TPN D 0.33

TPN6305299 TPN E 0.28

TPN6306299 TPN P 1.09

TPN6401299 TPN-B2 0.45

TPN6402299 TPN-A1 0.43

TPN6403299 TPN-A2 0.47

TPN6404299 TPN-A3 0.38

TPN6405299 TPN-A4 0.48

TPN6406299 新生兒TPN-P1 0.76

TPN6407299 小兒TPN-P2 1.49

TPN6408299 KCL-1D5S 0.04

TPN6409299 KCL-2D5S 0.04

TPN6410299 KCL-1D5W 0.04

TPN6411299 KCL-2D5W 0.04

TPN6412299 KCL-3D5W 0.05

TPN6413299 KCL-4D5W 0.05

TPN6414299 KCL-1HS 0.04

TPN6415299 KCL-2HS 0.05

TPN6416299 KCL-3HS 0.05

TPN6417299 KCL-4HS 0.06

TPN6418299 KCL-1D5S33 0.04

TPN6419299 KCL-2D5S33 0.05

TPN6420299 KCL-3D5S33 0.05

TPN6421299 KCL-4D5S33 0.06

TPN6422299 KCL-1T5 0.11

TPN6423299 KCL-2T5 0.12

TPN6424299 KCL-3T5 0.12

TPN6425299 KCL-4T5 0.13

TPN6426299 KCL-1T2 0.09

TPN6427299 KCL-2T2 0.09

TPN6428299 KCL-1D10 0.04

311

Page 312: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN6429299 KCL-2D10 0.05

TPN6430299 KCL-3D10 0.05

TPN6431299 KCL-4D10 0.06

TPN6432299 KCL-3D5S 0.05

TPN6433299 KCL-4D5S 0.05

TPN6434299 KCL-2N 0.19

TPN6435299 TPN-A2S 0.63

TPN6436299 KCL-3N 0.07

TPN6437299 KCL-4N 0.07

TPN6438299 TPN-A3S 0.78

TPN6439299 TPN-B1 0.6

TPN6440299 KCL-1LR(505ML) 0.06

TPN6441299 KCL-2LR(510ML) 0.08

TPN6501299 TPN-N 0.5

TPN6502299 TPN-C 0.41

TPN6503299 PPN-K2 0.25

TPN6504299 PPN-K3 0.22

TPN6505299 CPN-M 0.51

TPN6506299 CPN-A 0.18

TPN6507299 TPNA-N 0.5

TPN6508299 TPNA-C 0.42

TPN6509299 TPNA-M 0.51

TPN6510299 TPNA-A 0.36

TPN6601299 TPN-S 0.55

TPN6602299 TPN-H 0.34

TPN6603299 TPN-R 0.39

TPN6604299 TPN-N 0.59

TPN6605299 TPN-P1 1.21

TPN6606299 TPN-P2 1.45

TPN6607299 TPN-P3 1.05

TPN6608299 TPN-PN 0.63

TPN6609299 TPN-C 0.42

TPN6701299 TPN-A 0.41

TPN6702299 TPN-B 0.41

TPN6703299 PPN 0.38

TPN6704299 TPN-N 0.8

TPN6801299 DIVNI01標準 0.49

TPN6802299 DIVNI02腎功能不佳限水 0.34

TPN6803299 DIVNI03肝功能不佳 0.3

TPN6804299 DIVNI04小兒配方 0.12

TPN6805299 DTPNI10 0.42

TPN6806299 DTPNI20 0.53

TPN6807299 DTPNI40 0.42

TPN6808299 DTPNI50 0.35

TPN6809299 DTPNI60 0.62

TPN6810299 DTPNI70 0.31

TPN6901299 TPN-REGULAR 0.69

TPN6902299 TPN-HD 0.97

TPN6903299 TPN-HEPA 0.66

TPN6904299 TPN-RF 0.79

TPN6905299 TPN-FLUID 0.77

TPN6906299 OLICLINOMEL N4-550E 0.63

TPN6907299 OLICLINOMEL N7-1000 1.01

TPN7001299 TPN A 0.53

TPN7002299 TPN B 0.4

312

Page 313: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

TPN7003299 TPN C 0.4

TPN7004299 TPN D 0.49

TPN7005299 TPN E 0.34

TPN7006299 TPN 6 0.45

TPN7007299 TPN 8 0.35

TPN7008299 TPN 9 0.38

TPN7009299 TPN X 0.41

TPN7010299 TPN N 0.4

V000015238 Copaxone 20mg Solution for Injection 1063

VC00001129 STIMOL ORAL SOLUTION 1GM/10ML 39.4

VC00002100 DIMAVAL CAPSULES 330

VC00003221 DIMAVAL INJECTION SOLUTION 1698

VC00005100 KELFER CAPSULES 500MG 60

VC00006100 CARNITENE 1GM TAB (LEVOCANITINE CHEW TAB 1GM/TAB ) 132

VC00007100 AGRYLIN 0.5MG CAPSULES 161

VC00010100 PROVIGIL TABLETS 200MG 166

VC00011138 VENTAVIS NEBULISER SOLUTION 1105

VC00012100 TRACLEER FILM COATED TABLETS 62.5MG 1892

VC00013100 TRACLEER FILM COATED TABLETS 125MG 1892

VC00014209 CARNITENE INJECTION 1G/5ML 543

VC00017277 FLOLAN INJECTION 0.5MG 650

VC00020100 AFINITOR 5 MG TABLETS 1848

VC00021100 AFINITOR 2.5 MG TABLETS 1026

VC00023100 VOLIBRIS FILM-COATED TABLETS 10MG 3784

VC00024100 VOLIBRIS FILM-COATED TABLETS 5MG 3784

VC00025100 GILENYA HARD CAPSULES 0.5MG 1972

VC00026100 XENAZINE 25MG 97

VC00027100 XENAZINE 12.5MG 53

W000005229 ASADIN INJ. 1MG/ML (ARSENIC TRIOXIDE) 1171

W000006100 THADO CAPSULES 50MG 271

W000008100 WILIZIN CAPSULES 25MG 30

W000009100 WILIZIN CAPSULES 50MG 54

WC00001100 PURE SODIUM BENZOATE CAP. 250MG 30

WC00007100 ZINCA CAPSULES 50MG 54

WC00010100 Zinca Capsules 25 mg 30

WC00011100 DIMERSU CAPSULES 200 MG 420

WC00015221 L-CARNIT "SHINER" INJECTION 1G/5ML 543

X000002155 UCEPHAN ORAL SOLUTION (10% SODIUM BENZONATE + 10% SODIUM

PHENYLLACETATE)

385

X000003110 PROGLYCEM 50MG/ML 30ML/BTL 403

X000004100 LYSODREN 500MG TAB.(MITOTANE 500MG/TAB) 37.15

X000005162 NEUTRAL PHOSPHATE POWDER 4.5GM 180ML ORAL SOLN(榮總) 36

X000009100 BUPHENYL TAB. 500MG (SOD. PHENYLBUTYRATE 500MG)(UCYCLYD PHARMA

INC.)

241

X000014238 DANTROLENE 20MG IV 5000

X000025177 JOULICE SOLUTION 500ML(台大) 169

X000028156 SUCRAID ORAL SOLUTION (SACROSIDASE ORAL SOLUTION 8500I.U./ML

118ML/BTL.) NUTRAMAX PRODUCTS

17850

X000032255 IMUKIN(INTERFERON GAMMA 1B)100UG(3MIU)/0.5ML 4325

X000033100 SYPRINE 250MG CAP. 42.5

X000037100 CYSTAGON CAP. 150MG 95

X000042255 BICNU (CARMUSTINE (BCNU)) 100MG 1800

X000046177 NEUTRAL PHOSPHATE ORAL SOLUTION 500ML (NA2HPO4 28GM NAHPO4

18GM)台中榮總

46.3

X000047129 LEVOCARNITIN ORAL SOLUTION (1GM/10ML/BOT) 146

313

Page 314: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

X000048177 NA-PHOSPHATE ORAL SOLUTION 500ML 155.68

X000051243 L-ARGININE HCL INJ. 250MG/ML 30ML/VIAL 612.56

X000054163 NEUTRAL PHOSPHATE ORAL SOLUTION (29MG PHSOPHATE/ML) 200ML 27.44

X000057162 NEUTRAL PHOSPHATE ORAL SOLUTION 180ML 35.91

X000060292 ZADAXIN INJ. 5000

X000063100 K-PHOS NO.2 6.63

X000065172 VSL#3 450 BILLION BACTERIA/PACKET 150

X000067162 CYSTADANE POWDER FOR ORAL SOL N 1GM/SCOOPFUL (BETAINE

ANHYDROUS)(ORPHAN MEDICAL,INC.)

32067

X000071110 PROGLYCEM 50MG/ML 30ML/BOT 958

X000073163 JOULIE'S SOLUTION 200ML/BOT 78.7

X000074100 ZAVESCA CAPSULES 100MG (MIGLUSTAT) GALEN LIMITED 3787

X000075248 MYOZYME 50MG/VIAL 33893

X000076221 NAGLAZYME INJ. 5MG/5ML/VIAL(GALSULFASE) BIOMARIN

PHARMACEUTICAL

81600

X000077100 ORFADIN CAP 2MG(NITISINONE) SWEDISH ORPHAN INTERNATIONAL AB 996

X000078238 REMODULIN INJ. 1.0MG/ML 20ML 42016

X000083121 TOBI NEBULIZER SOLUTION (TOBRAMYCIN) 300MG/5ML/AMP 2151

X000085100 TRIENTINE DIHYDROCHLORIDE 300MG 234

X000087100 MERKAPTOPURIN TABLETS 50MG 18.7

X000087229 GLYCERYL TRINITRATE (NITROGLYCERIN) CONCENTRATE INJECTION

50MG/10ML/AMP

211

X000095100 KUVAN TABLETS 924

X000096248 AMMONUL INJ 50ML 101159

X000097238 ILOMEDIN-20 1105

X000103100 LYSODREN TAB. 266

X000106243 SOLIRIS INJECTION(ECULIZUMAB) 181380

X000107226 LEUSTATIN (CLADRIBINE) 8MG/8ML/VIAL 8013

X000110213 BICILLIN L-A DISPOSABLE SYRINGE (PENICILLIN G BENZATHINE

INJECTABLE SUSPENSION) 2,400,000IU/4ML/SYRINGE)

800

X000116248 ONCOTICE (CONTAINING 2-8×10^8 CFU TICE BCG)(專案進口) 4552

X000120238 REMODULIN INJ. 5.0MG/ML 20ML 189072

X000121238 GLATIRAMER ACETATE(COPAXONE) 20MG SOLUTION FOR INJECTION, PRE-

FILLED SYRINGE

1063

X000123100 CARBAGLU TABLETS 200MG 2524

X000125100 BH4 (TETRAHYDRO-BIOPTERIN TABLETS) 10MG 73

X000126214 VERORAB 1100

X000127266 HYPERRAB S/D 4224

X000128210 HYPERRAB S/D 18720

X000129209 FAVIRAB 2300

X000132100 OPSUMIT FILM COATED TABLETS 10MG 3784

X000133248 MYOZYME 50MG/VIAL 33893

X000134209 GONADORELIN ACETATE 1ML/AMP, 5AMP/BOX 1212

X000135237 PROLEUKIN FOR INJECTION 11935

X000136209 COLOMYCIN (COLISITIN 1000000 IU) 174

X000137212 COLOMYCIN (COLISITIN 2000000 IU) 314

X000138100 PROVIGIL TABLETS 200MG 166

X000139209 PROTERNOL-L INJECTION 190

X000140100 COUMADIN TABLETS 1MG 3.6

Y0000012AK REBIF 22 MICROGRAMS(6MIU) 2545

Y000006263 CEREZYME 200UNITS 39758

Y000009219 INCRELEX INJECTION 22745

Y000014235 TYSABRI CONCENTRATE FOR SOLUTION FOR INFUSION 300MG 73666

YC000022E3 REBIF 44 MICROGRAMS (12MIU) 3127

314

Page 315: 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱 支付價 …™„件二_藥品... · 附件二 藥品給付品項暨支付標準表 藥品代碼 藥品英文名稱

藥品代碼 藥品英文名稱 支付價-105/01

YC00004217 REPLAGAL IMG/ML CONCENTRATION FOR SOLUTION FOR INFUSION 100467

YC00005296 FABRAZYME 35MG INJ. 181173

YC00007221 ALDURAZYME CONCENTRATED SOLUTION 31539

YC00008221 ALDURAZYME CONCENTRATED SOLUTION 31539

YC00010229 NORMOSANG 25MG/ML CONCENTRATE FOR SOLUTION FOR INFUSION 24997

YC00011216 ELAPRASE (IDURSULFASE) INJECTION 92601

YC000132CI REBIF SOLUTION FOR INJECTION 132 MICROGRAMS (36MIU) 8442

YC00015271 CEREZYME 400U 66684

Z000001209 ANTIVENIN OF D.RUSSELLII (LYOPHILIZED) 7900

315