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["                          28种浙江省大病保险特殊用药详细信息"]
["序号","编码","通用名","商品名","剂型","生产企业","谈判乙方","规格","医保支付标准","现赠药情况","供药点"]
[1,"Db0020181019","阿达木单抗","修美乐","注射剂/预填充式注射笔","AbbVie Ltd","艾伯维医药贸易（上海）有限公司","40mg/0.8ml","6407元/支/盒","连续（累计）购买使用4支，免费供药6支，简称“4+6”，此后以“4+6”模式循环。","老百姓大药房连锁（浙江）"]
[{"$nulls":10},"有限公司衢州店"]
[2,"Db0020181020","尼洛替尼","达希纳","胶襄","Novartis Pharma Schweiz AG","山德士（中国）制药有限公司","200mg*120片","32800元/盒","连续（累计）购买使用3个月，免费供药12个月，简称为“3+12”，此后以“3+12”模式循环。","衢州天福堂医药有限公司新桥街店"]
[{"$nulls":7},"150mg*120片","26240元/盒"]
[3,"Db0020181021","地拉罗司","恩瑞格","分散片","Novartis Pharma Schweiz AG","山德士（中国）制药有限公司","125mg/片（28片/盒）","1800元/盒","连续（累计）购买使用2个月，免费供药6个月；再次连续（累计）购买使用1个月，免费供药3个月，简称“1+3”，此后以“1+3”模式循环。","衢州天福堂医药有限公司新桥街店"]
[4,"Db0020181022","注射用依那西普","恩利","注射剂","Boehringer Ingelheim Pharma GmbH&Co.KG","辉瑞投资有限公司","25mg/瓶","1640元/瓶","连续（累计）购买使用10瓶后，免费供药14瓶；再次申请购买使用6瓶后，免费供药18瓶，简称为“6+18”，此后以“6+18”模式循环。","老百姓大药房连锁（浙江）"]
[{"$nulls":10},"有限公司衢州店"]
[5,"Db0020181023","苹果酸舒尼替尼","索坦","胶襄","Pfizer Italia S.r.l.","辉瑞投资有限公司","12.5mg/粒(28粒/盒)","10600元/盒","肾细胞癌患者连续（累计）购买使用12盒，胃肠间质瘤患者连续（累计）购买使用8盒，免费供药至疾病进展；                                           胰腺神经内分泌瘤患者连续（累计）购买使用8盒，免费供药32盒；再次申请购买使用8盒后，免费供药至疾病进展。","老百姓大药房连锁（浙江）"]
[{"$nulls":10},"有限公司衢州店"]
[6,"Db0020181024","克唑替尼","赛可瑞","胶襄","Pfizer Manufacturing Deutschland GmbH，Betriebsstatte Freiburg","辉瑞投资有限公司","250mg/粒（60粒/盒）","46500元/盒","连续（累计）购买使用3盒(自购阶段不同规格只要满足自购盒数即可)，免费供药9盒；再次申请购买使用1盒后，免费供药至疾病进展。       备注：无论患者实际临床治疗剂量为250mg或200mg，患者在自购阶段满足自购阶段瓶数即可","老百姓大药房连锁（浙江）"]
[{"$nulls":7},"200mg/粒（60粒/盒）(差比价）","39198.10元/盒",null,"有限公司衢州店"]
[7,"Db0020181025","阿昔替尼","英立达","片剂","Pfizer Manufacturing Deutschland GmbH, Betriebsstatte Freiburg","辉瑞投资有限公司","5mg/片（28片/盒）","17500元/盒","1、既往接受细胞因子或其他酪氨酸激酶抑制剂治疗失败的患者：连续（累计）购买使用6盒（自购阶段不同剂量按5mg*28片/盒换算），免费供药18盒；再次申请购买使用2盒后，免费供药至疾病进展。                                       2、至少使用过1个治疗周期索坦的患者（4盒/12.5mg*28粒）连续（累计）购买使用5盒（自购阶段不同剂量按5mg*28片/盒换算）后，免费供药至疾病进展。","老百姓大药房连锁（浙江）"]
[{"$nulls":7},"1mg/粒（14片/盒）(差比价）","2597.93元/盒",null,"有限公司衢州店"]
[8,"Db0020151004","盐酸多柔比星脂质体","里葆多","注射剂","上海复旦张江生物医药股份有限公司","上海复旦张江生物医药股份有限公司","20mg/10ml/瓶","4000元/瓶","无","老百姓大药房连锁（浙江）"]
[{"$nulls":10},"有限公司衢州店、衢州天福堂医药有限公司新桥街店"]
[9,"Db0020151005","西妥昔单抗","爱必妥","注射剂","德国默克公司（Merck KGaA）","默克雪兰诺有限公司","100mg（20ml）/瓶","3600元/瓶","连续购买使用3个月后经医学评估符合赠药标准，可获得赠药至疾病进展","衢州天福堂医药有限公司新桥街店"]
[10,"Db0020151011","注射用英夫利西单抗","类克","注射剂","Cilag AG","西安杨森制药有限公司","100mg/瓶","4900元/瓶","非低保患者：购买使用4个疗程后，由乙方负责向患者免费供药2个疗程。再次申请并连续购买使用2个疗程产品后，由乙方负责向患者免费供药4个疗程，简称为“2+4”，此后可以“2+4”方式循环申请。","衢州天福堂医药有限公司新桥街店"]
[{"$nulls":9},"低保患者：符合适应症的由乙方负责落实免费供药事宜。"]
[11,"Db0020151014","注射用醋酸兰瑞肽","索马杜林","注射剂","IPSEN PHARMA BIOTECH","博福-益普生（天津）制药有限公司","40mg/支","2800元/支","无","浙江佑安医药零售连锁有限公司"]
[12,"Db0020151015","特立帕肽","复泰奥","注射剂","Lilly France","礼来贸易有限公司","20ug:80ul,2.4ml/支","5200元/支","买6支免费供药7支","衢州天福堂医药有限公司新桥街店"]
[13,"Db0020151016","注射用伊米苷酶","思而赞","注射剂","Genzyme Ireland Ltd","赛诺菲（中国）投资有限公司上海分公司","400u/瓶","20700元/瓶","购买8个月免费供药4个月","无"]
[14,"Db0020151017","盐酸沙丙蝶呤","科望","片剂","Excella GmbH","百傲万里上海生物医药技术咨询有限公司","100mg/片，30片/瓶","7480元/瓶","无","衢州天福堂医药有限公司新桥街店"]
[15,"Db0020181026","乙磺酸尼达尼布","维加特","软胶襄","Boehringer Ingelheim International GmbH","勃林格殷格翰（中国）投资有限公司","150mg/粒（30粒/盒）","9537元/盒","连续（累计）购买使用9盒，免费供药15盒，简称“9+15”，此后以“9+15”模式循环。","衢州天福堂医药有限公司新桥街店"]
[{"$nulls":7},"100mg/粒（30粒/盒）(差比价）","6992元/盒"]
[16,"Db0020181027","培唑帕尼","维全特","片剂","Novartis Pharma Schweiz AG","山德士（中国）制药有限公司","200mg*30片","11700元/盒","连续（累计）购买使用3个月（12盒），免费供药至疾病进展。","衢州天福堂医药有限公司新桥街店"]
[17,"Db0020181028","注射用紫杉醇（白蛋白结合型）","Abraxane","注射剂","Celgene Corporation","百剂神州医药信息咨询（上海）有限公司","100mg（1瓶/盒）","3400元/瓶","无","衢州天福堂医药有限公司新桥街店"]
[18,"Db0020181029","伊布替尼","亿珂","胶襄","Catalent CTS LLC","西安杨森制药有限公司","140mg/90粒","40824元/瓶","连续（累计）购买使用3瓶后，最多免费供药3瓶；再次申请购买使用1瓶后，最多免费供药2瓶，简称为“1+2”，此后以“1+2”模式循环。","衢州天福堂医药有限公司新桥街店"]
[]
[{"$nulls":9},"低保患者：对于经民政部颁发低保证且已领取12个月低保金的低保患者，免费供药可最多获得9瓶，此后申请购买使用1瓶后，最多免费供药2瓶，以“1+2”模式循环。"]
[19,"Db0020181030","维莫非尼","佐博伏","片剂","Roche Pharma (Schweiz) AG","上海罗氏制药有限公司","240mg*56片/盒","10360元/盒","无","老百姓大药房连锁（浙江）"]
[{"$nulls":10},"有限公司衢州店"]
[20,"Db0020181031","安立生坦","凡瑞克","片剂","PATHEON INC.","葛兰素史克（中国）投资有限公司","5mg*30片/盒","2850元/盒","无","衢州天福堂医药有限公司新桥街店"]
[{"$nulls":7},"10mg*30片/盒(差比价）","4845元/盒"]
[21,"Db0020181032","磷酸芦可替尼","捷恪卫","片剂","Novartis Europharm Limited.英国","山德士（中国）制药有限公司","5mg/片（60片/盒）","6800元/盒","连续（累计）购买使用3个月，免费供药9个月，简称为“3+9”，此后以“3+9”模式循环。","衢州天福堂医药有限公司新桥街店"]
[22,"Db0020181033","克拉屈滨","艾博定","注射剂","海正辉瑞制药有限公司","海正辉瑞制药有限公司","10ml:克拉屈滨10mg与氯化钠90mg","5960元/支","连续（累计）购买使用4支，免费供药1支，简称“4+1”，此后以“4+1”模式循环。","衢州天福堂医药有限公司新桥街店"]
[23,"Db0020181034","甲磺酸奥希替尼","泰瑞沙","片剂","AstraZeneca AB","阿斯利康（无锡）贸易有限公司","80mg/片（30片/盒）","49800元/盒","符合项目医学标准的患者将免费获得药品援助直至疾病进展；非低保病人需全额自费连续服药满3个月（90片），经审批后第一期最多可以获得9个月(270片)的药品援助，到期经项目医生评估，如果患者仍可从药品治疗中获益，需全额自费服药满2个月（60片）后，经审批后，可以获得药品援助直至疾病进展。乙方承诺：适用人群自愿到乙方指定的有资质的第三方检测机构进行T790耐药检测时，费用由乙方承担。","衢州天福堂医药有限公司新桥街店"]
[24,"Db0020181035","盐酸达拉他韦","百立泽","片剂","AstraZeneca Pharmaceuticals LP","中美上海施贵宝制药有限公司","60mg*14片/盒","2622.9元/盒","绩效考核：参保人经24周治疗结束后HCVRNA检测阳性或参保人经24周治疗结束后在12周观察期内HCVRNA检测出现重复阳性，医保基金支付部分由乙方(或乙方合作机构)承担。具体方式由双方另行协商。","衢州市化城平安堂医药零售"]
[{"$nulls":9},"乙方承诺提供免费基线耐药检测。","有限公司、衢州天福堂医药有限公司新桥街店"]
[25,"Db0020181036","阿舒瑞韦","速维普","软胶襄","Catalent Pharma Solutions LLC","中美上海施贵宝制药有限公司","100mg*28粒/盒","267.4元/盒",null,"衢州市化城平安堂医药零售"]
[{"$nulls":10},"有限公司、衢州天福堂医药有限公司新桥街店"]
[26,"Db0020181037","索磷布韦","索华迪","片剂","Gilead Sciences Ireland UC","吉利德（上海）医药科技有限公司","400mg/28片/瓶","11200元/瓶","基因1、3、6型患者连续（累计）购买使用3瓶后，免费供药3瓶。2型患者治疗周期为12周（3瓶），未达到赠药条件。（4、5型国内还没有病例发现）           绩效考核:（1）参保人经24周治疗结束后HCVRNA检测阳性甲方不予支付；（2）参保人经24周治疗结束后在12周观察期内HCVRNA定量检测出现重复阳性，医保基金支付部分由乙方承担，具体方式由双方另行协商。","衢州天福堂医药有限公司新桥街店"]
[{"$nulls":9},"乙方承诺为使用该药的患者提供免费的基因检测费用。"]
[27,"Db0020181038","注射用雷替曲塞",null,"注射剂","南京正大天晴制药有限公司","南京正大天晴制药有限公司","2mg/支","1505元/支","无","衢州天福堂医药有限公司新桥街店"]
[28,"Db0020181039","托珠单抗","雅美罗","注射剂","Roche Pharma (Schweiz) Ltd","上海罗氏制药有限公司","80mg/4ml/支","1500元/支","类风湿性关节炎患者：连续使用2次，为其免费供药2次，之后按此循环。幼年特发性关节炎患者：使用4次免费供药4次，之后按“4+4”模式循环。","老百姓大药房连锁（浙江）"]
[{"$nulls":10},"有限公司衢州店"]