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附表一：省增补非国家基本药物目录药品最高零售价化学药:序号目录序号品名剂型规格单位最高零售价备注12阿洛西林注射剂1.5g瓶26.7注射剂1g,预灌封注射器组合件（带注射针）瓶23.1注射剂2g(配100ml葡萄糖和一次性使用配药器)瓶36.9注射剂2g,预灌封注射器组合件（带注射针）瓶36.523头孢克洛胶囊250mg*20粒盒/瓶82.7胶囊250mg*24粒盒/瓶98.5片剂250mg*24片盒/瓶98.5分散片125mg*18片盒/瓶49.9分散片250mg*10片盒/瓶46.8颗粒剂100mg*7袋盒15.6颗粒剂100mg*10袋盒21.9颗粒剂100mg*12袋盒26.2颗粒剂125mg*7袋盒18.7颗粒剂250mg*6袋盒27.0颗粒剂500mg*6袋盒47.735头孢羟氨苄分散片125mg*24粒盒/瓶27.5分散片250mg*24片盒/瓶46.8片剂500mg*24片盒/瓶70.6胶囊500mg*24粒盒/瓶70.6颗粒剂125mg*16袋盒/瓶19.8颗粒剂125mg*16袋盒/瓶19.947罗红霉素片剂300mg*3片盒/瓶10.1分散片50mg*24片盒/瓶36.5丽珠集团丽珠制药厂分散片75mg*20片盒/瓶25.8分散片50mg*18片盒/瓶17.3分散片50mg*10片盒/瓶9.8分散片150mg*8片盒/瓶18.5胶囊300mg*3粒盒/瓶10.5软胶囊150mg*10粒盒/瓶29.7软胶囊150mg*12粒盒/瓶35.4软胶囊150mg*24粒盒/瓶69.058乙酰螺旋霉素胶囊200mg*12粒盒/瓶5.069替硝唑阴道泡腾片500mg*2片盒/瓶10711甲苯咪唑片剂100mg*6片盒/瓶2.4812丁卡因冻干粉针25mg瓶16.2冻干粉针25mg（配预灌封注射器）瓶20.3第1页序号目录序号品名剂型规格单位最高零售价备注冻干粉针50mg（配预灌封注射器）瓶31.6913丙泊酚注射剂500mg:50ml(预充式注射器)瓶141注射剂1g:50ml(预充式注射器)瓶266.0注射剂50ml:1g瓶260.0注射剂1g:50ml(预充式注射器)瓶482.0阿斯利康制药有限公司1017复方对乙酰氨基酚片剂8片盒/瓶6.6片剂10片盒/瓶8.1片剂12片盒/瓶9.8片剂20片盒/瓶15.8片剂24片盒/瓶19.0片剂100片盒/瓶25.0复方对乙酰氨基酚(Ⅱ)片剂10片盒/瓶8.5片剂20片盒/瓶16.61118复方氯唑沙宗片剂250mg/300mg*24片盒/瓶25.7片剂150mg/125mg*36片盒/瓶25.0分散片150mg/125mg*24片盒/瓶22.0山东鲁南贝特制药有限公司分散片150mg/125mg*36片盒/瓶32.5山东鲁南贝特制药有限公司分散片150mg/125mg*48片盒/瓶42.9山东鲁南贝特制药有限公司分散片150mg/125mg*24片盒/瓶19.5分散片150mg/125mg*36片盒/瓶28.8分散片150mg/125mg*48片盒/瓶38.0胶囊125mg/150mg*24粒盒/瓶16.9胶囊125mg/150mg*48粒盒/瓶32.91219索米痛（去痛片）片剂100片盒/瓶5.5片剂200片盒/瓶10.7片剂400片盒/瓶20.9片剂1000片盒/瓶50.6片剂2000片盒/瓶98.61321氟桂利嗪胶囊5mg*12粒盒/瓶11.1胶囊5mg*36粒盒/瓶32.0分散片5mg*12片盒/瓶13.8分散片5mg*24片盒/瓶25.01423甲钴胺胶囊0.5mg*12粒盒/瓶16.1胶囊0.5mg*24粒盒/瓶31.4胶囊0.5mg*36粒盒/瓶46.3片剂0.5mg*40片盒/瓶51.2分散片0.5mg*20片盒/瓶34.2分散片0.5mg*30片盒/瓶50.51528氯硝西泮片剂2mg*20片盒/瓶3.6第2页序号目录序号品名剂型规格单位最高零售价备注片剂2mg*40片盒/瓶7.0片剂2mg*48片盒/瓶8.31629单硝酸异山梨酯软胶囊10mg*24粒盒/瓶18.0片剂20mg*36片盒/瓶35.2片剂20mg*60片盒/瓶54.71730氨氯地平胶囊5mg*20粒盒/瓶72.3片剂5mg*16片盒/瓶58.3片剂5mg*21片盒/瓶75.7分散片5mg*12片盒/瓶57.5分散片5mg*20片盒/瓶94.0分散片5mg*24片盒/瓶112.01831非洛地平片剂2.5mg*36片盒/瓶21.2片剂2.5mg*48片盒/瓶27.2片剂5mg*40片盒/瓶39.81932厄贝沙坦片剂75mg*10片盒/瓶21.9片剂150mg*10片盒/瓶37.7分散片75mg*20片盒/瓶55.72034左旋氨氯地平片剂2.5mg*7片盒/瓶33.0片剂2.5mg*10片盒/瓶46.5片剂2.5mg*12片盒/瓶55.5片剂2.5mg*14片盒/瓶64.4片剂2.5mg*20片盒/瓶90.7片剂2.5mg*28片盒/瓶125.0片剂5mg*7片盒/瓶56.1片剂5mg*10片盒/瓶79.0片剂5mg*14片盒/瓶109.0片剂5mg*20片盒/瓶154.02135替米沙坦片剂20mg*28片盒/瓶46.4片剂40mg*28片盒/瓶78.9片剂80mg*28片盒/瓶134.1片剂80mg*28片盒/瓶186.0上海勃林格殷格翰药业有限公司2236贝那普利片剂5mg*7盒/瓶12.4片剂5mg*28片盒/瓶47.22337复方卡托普利片剂24片盒/瓶1.82438氯沙坦钾片剂50mg*7片盒/瓶45.0片剂50mg*14片盒/瓶87.7片剂100mg*7盒/瓶76.5胶囊50mg*7粒盒/瓶45.0胶囊50mg*14粒盒/瓶87.72542阿托伐他汀片剂10mg*10片盒/瓶48.8胶囊20mg*7粒盒/瓶58.82643非诺贝特软胶囊200mg*12粒（微粒化制剂）盒/瓶48.6软胶囊200mg*10粒（微粒化制剂）盒/瓶40.5第3页序号目录序号品名剂型规格单位最高零售价备注非诺贝特胶囊(Ⅱ)胶囊200mg*12粒盒/瓶48.6非诺贝特片(Ⅲ)包层片160mg*10片盒/瓶56.02744曲美他嗪片剂20mg*15片盒/瓶25.0片剂20mg*20片盒/瓶32.8片剂20mg*24片盒/瓶37.9片剂20mg*48片盒/瓶73.9片剂20mg*60片盒/瓶96.02846复方愈创木酚磺酸钾口服溶液100ml瓶3.9口服溶液2000ml瓶27.3口服溶液2500ml瓶31.22947复方磷酸可待因溶液口服溶液60ml瓶11.0口服溶液100ml瓶17.7口服溶液120ml瓶20.3口服溶液150ml瓶25.7口服溶液180ml瓶30.4口服溶液10ml*30袋盒55.0口服溶液10ml*12袋盒22.7口服溶液10ml*15袋盒28.2口服溶液10ml*150袋盒259.0复方磷酸可待因口服溶液Ⅲ口服溶液120ml瓶25.03048布地奈德混悬剂1mg:2ml支20.4阿斯利康制药有限公司鼻用喷雾剂7.68mg*120喷支69.0气雾剂20mg(100ug/喷)瓶84.03150丙卡特罗片剂25ug*12片盒/瓶12.6片剂25ug*50片盒/瓶50.13251泮托拉唑肠溶片20mg*14片盒/瓶74.6肠溶片40mg*8片盒/瓶74.0肠溶片40mg*10片盒/瓶91.8肠溶片40mg*12片盒/瓶109.4肠溶片40mg*16片盒/瓶144.0肠溶胶囊40mg*12粒盒/瓶109.0第4页序号目录序号品名剂型规格单位最高零售价备注肠溶胶囊40mg*10粒盒/瓶91.8肠溶胶囊20mg*8粒（微丸）盒/瓶48.3肠溶胶囊20mg*12粒（微丸）盒/瓶71.4肠溶胶囊20mg*14粒（微丸）盒/瓶82.8肠溶胶囊20mg*16粒（微丸）盒/瓶94.2注射剂40mg(冻干粉，配套包装预灌封注射器，带注射针）瓶71.23352铝碳酸镁片剂500mg*10片盒/瓶9.0片剂500mg*20片盒/瓶17.6片剂500mg*24片盒/瓶21.0片剂500mg*30片盒/瓶26.0片剂500mg*36片盒/瓶30.93453复方庆大霉素普鲁卡因胶囊12粒盒/瓶6.8胶囊24粒盒/瓶13.3胶囊36粒盒/瓶19.73554兰索拉唑片剂15mg*12片盒/瓶54.1肠溶片15mg*6片盒/瓶27.7肠溶片15mg*8片盒/瓶40.2肠溶片15mg*12片盒/瓶54.1肠溶片15mg*18片盒/瓶82.0肠溶片15mg*20片盒/瓶97.4肠溶片15mg*24片盒/瓶95.0肠溶片15mg*28片盒/瓶134.7肠溶片30mg*16片盒/瓶133.5肠溶胶囊15mg*7粒盒/瓶35.4肠溶胶囊15mg*14粒盒/瓶69.1肠溶胶囊30mg*6粒盒/瓶51.9肠溶胶囊30mg*10粒盒/瓶84.9肠溶胶囊30mg*12粒盒/瓶101.03657甘草酸二铵注射剂10ml:50mg支6.03759非那雄胺片剂1mg*28片盒/瓶225片剂1mg*10片盒/瓶83.23860黄酮哌酯片剂200mg*6片盒/瓶7.13962琥珀酸亚铁片剂100mg*24片盒/瓶32.84063富马酸亚铁片剂200mg*100片盒/瓶24.0胶囊200mg*120粒盒/瓶30.9第5页序号目录序号品名剂型规格单位最高零售价备注4164曲克芦丁片剂60片盒/瓶2.04266肌苷注射剂600mg:100ml(塑瓶)瓶18.0注射剂500mg:100ml(软袋)袋17.0片剂200mg*60片盒/瓶5.94368维生素B4片剂25mg*100盒/瓶9.54471格列齐特分散片40mg*20片盒/瓶10.0缓释胶囊30mg*30粒盒/瓶42.0缓释胶囊30mg*20粒盒/瓶28.4缓释片30mg*15片盒/瓶15.14572阿卡波糖片剂50mg*45片盒/瓶89.8胶囊50mg*45盒/瓶89.84673瑞格列奈片剂1mg*30盒/瓶48.3片剂2mg*30盒/瓶82.14774格列美脲胶囊2mg*20粒盒/瓶43.1片剂1mg*36片盒/瓶44.7片剂2mg*18片盒/瓶38.94875罗格列酮片剂2mg*10片盒/瓶21.5片剂2mg*20片盒/瓶41.9片剂2mg*28片盒/瓶58.1片剂2mg*30片盒/瓶61.9片剂4mg*10片盒/瓶36.7片剂4mg*18片盒/瓶64.6片剂4mg*24片盒/瓶85.2片剂4mg*28片盒/瓶98.8片剂4mg*30片盒/瓶105.7分散片4mg*6片盒/瓶29.1分散片4mg*12片盒/瓶56.8分散片4mg*24片盒/瓶110.0胶囊4mg*6粒盒/瓶22.4胶囊4mg*12粒盒/瓶43.74976吡格列酮片剂15mg*9片盒/瓶37.1片剂15mg*21片盒/瓶83.9片剂30mg*14片盒/瓶96.5分散片15mg*14片盒/瓶73.7分散片15mg*28片盒/瓶143.6分散片15mg*30片盒/瓶153.0分散片15mg*35片盒/瓶178.2分散片30mg*7片盒/瓶64.3分散片30mg*14片盒/瓶125.4胶囊15mg*12粒盒/瓶48.9胶囊15mg*20粒盒/瓶80.15079氯雷他定片剂10mg*6片盒/瓶17.2片剂10mg*9片盒/瓶25.0片剂10mg*10片盒/瓶26.0分散片10mg*10片盒/瓶36.5胶囊10mg*8粒盒/瓶22.7第6页序号目录序号品名剂型规格单位最高零售价备注5180酮替芬分散片1mg*24片盒/瓶23.65281环孢素软胶囊10mg*60盒/瓶197.9软胶囊25mg*30盒/瓶205.4软胶囊100mg*50粒盒/瓶971.0胶囊25mg*30盒/瓶197.1胶囊25mg*48盒/瓶310.05383脂肪乳注射液（C14-24)注射剂250ml:50g（非PVC多层共挤膜双口管）袋55.1注射剂50mg*500ml(10%)软袋袋54.4注射剂50mg*250ml(20%)瓶49.1注射剂5