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["西药部分"]
["药品分类代码","药品分类",{"$nulls":4},"编号","药品名称","剂型","医保支付标准","备注"]
[]
["XA","消化道和代谢方面的药物"]
["XA10",null,"糖尿病用药"]
["XA10B",null,null,"降血糖药物，不含胰岛素"]
["XA10BJ",{"$nulls":3},"胰高血糖素样肽-1（GLP-1）类似物"]
[{"$nulls":5},"乙","TX01","利拉鲁肽","注射剂","410元（3ml:18mg/支，预填充注射笔）","限二甲双胍等口服降糖药或胰岛素控制效果不佳的BMI≥25的患者，并需二级及以上医疗机构专科医师处方。"]
["XB","血液和造血器官药"]
["XB01",null,"抗血栓形成药"]
["XB01A",null,null,"抗血栓形成药"]
["XB01AC",{"$nulls":3},"血小板凝聚抑制剂，肝素除外"]
[{"$nulls":5},"乙","TX02","替格瑞洛","口服常释剂型","8.45元（90mg/片）","限急性冠脉综合症患者，支付不超过12个月。"]
["XB01AD",{"$nulls":3},"酶类"]
[{"$nulls":5},"乙","TX03","重组人尿激酶原","注射剂","1020元（5mg（50万IU）/支）\n","限急性心肌梗死发病12小时内使用。"]
["XB02",null,"抗出血药"]
["XB02B",null,null,"维生素K和其他止血药"]
[{"$nulls":5},"乙","TX04","重组人凝血因子Ⅶa","注射剂","5780元（1mg（50KIU）/支）","限以下情况方可支付：1、凝血因子Ⅷ或Ⅸ的抑制物>5BU的先天性血友病患者。2、获得性血友病患者。3、先天性FVII缺乏症患者。4、具有GPIIb-IIIa和/或HLA抗体和既往或现在对血小板输注无效或不佳的血小板无力症患者。"]
["XC","心血管系统"]
["XC01E",null,null,"其他心脏疾病用药"]
[{"$nulls":5},"乙","TX04","重组人脑利钠肽","注射剂","585元（0.5mg（500U）/瓶）","限二级及以上医疗机构用于规范治疗效果不佳的急性失代偿性心力衰竭短期治疗，单次住院支付不超过3天。"]
["XC03",null,"利尿剂"]
["XC03X",null,null,"其它利尿药"]
[{"$nulls":5},"乙","TX06","托伐普坦","口服常释剂型","99元（15mg/片）\n168.3元（30mg/片）","限明显的高容量性和正常容量性低钠血症（血钠浓度<125mEq/L，或低钠血症不明显但有症状且限液治疗效果不佳），包括伴有心力衰竭/肝硬化以及抗利尿剂激素分泌异常综合征的患者。"]
["XC09",null,"作用于肾素-血管紧张素系统的药物"]
["XC09C",null,null,"血管紧张素Ⅱ拮抗剂的单方药"]
[{"$nulls":5},"乙","TX07","阿利沙坦酯","口服常释剂型","7.05元（240mg/片）\n3.04元（80mg/片）"]
["XJ","全身用抗感染药"]
["XJ01",null,"全身用抗菌药"]
["XJ01X",null,null,"其他抗菌药"]
["XJ01XD",{"$nulls":3},"咪唑衍生物"]
[{"$nulls":5},"乙","TX08","吗啉硝唑氯化钠","注射剂","106元（100ml：500mg吗啉硝唑和900mg氯化钠/瓶）","限二线用药。"]
["XJ02",null,"全身用抗真菌药"]
["XJ02A",null,null,"全身用抗真菌药"]
["XJ02AC",{"$nulls":3},"三唑类衍生物"]
[{"$nulls":5},"乙","TX09","泊沙康唑","口服液体剂","2800元（40mg/ml 105ml/瓶）\n","限以下情况方可支付：1.预防移植后（干细胞及实体器官移植）及恶性肿瘤患者有重度粒细胞缺乏的侵袭性曲霉菌和念球菌感染。2.伊曲康唑或氟康唑难治性口咽念珠菌病。3.接合菌纲类感染。"]
["XL","抗肿瘤药及免疫调节剂"]
["XL01",null,"抗肿瘤药"]
["XL01X",null,null,"其他抗肿瘤药"]
["XL01XC",{"$nulls":3},"单克隆抗体"]
[{"$nulls":5},"乙","TX10","曲妥珠单抗","注射剂","7600元（440mg（20ml）/瓶）","限以下情况方可支付：1.HER2阳性的乳腺癌手术后患者，支付不超过12个月。2.HER2阳性的转移性乳腺癌。3.HER2阳性的晚期转移性胃癌。"]
[{"$nulls":5},"乙","TX11","贝伐珠单抗","注射剂","1998元（100mg（4ml）/瓶）","限晚期转移性结直肠癌或晚期非鳞非小细胞肺癌。"]
[{"$nulls":5},"乙","TX12","尼妥珠单抗","注射剂","1700元（10ml：50mg/瓶）","限与放疗联合治疗表皮生长因子受体(EGFR)表达阳性的Ⅲ/Ⅳ期鼻咽癌。"]
[{"$nulls":5},"乙","TX13","利妥昔单抗","注射剂","2418元（100mg/10ml/瓶）\n8289.87元（500mg/50ml/瓶）","限复发或耐药的滤泡性中央型淋巴瘤（国际工作分类B、C和D亚型的B细胞非霍奇金淋巴瘤），CD20阳性Ⅲ-Ⅳ期滤泡性非霍奇金淋巴瘤，CD20阳性弥漫大B细胞性非霍奇金淋巴瘤；最多支付8个疗程。"]
["XL01XE",{"$nulls":3},"蛋白激酶抑制剂"]
[{"$nulls":5},"乙","TX14","厄洛替尼","口服常释剂型","195元（150mg/片）\n142.97元（100mg/片）","限EGFR基因敏感突变的晚期非小细胞肺癌。"]
[{"$nulls":5},"乙","TX15","索拉非尼","口服常释剂型","203元（0.2g/片）","限以下情况方可支付：1.不能手术的肾细胞癌。2.不能手术或远处转移的肝细胞癌。3.放射性碘治疗无效的局部复发或转移性、分化型甲状腺癌。"]
[{"$nulls":5},"乙","TX16","拉帕替尼","口服常释剂型","70元（250mg/片）","限HER2过表达且既往接受过包括蒽环类、紫杉醇、曲妥珠单抗治疗的晚期或转移性乳腺癌。"]
[{"$nulls":5},"乙","TX17","阿帕替尼","口服常释剂型","136元（250mg/片）\n185.5元（375mg/片）\n204.15元（425mg/片）","限既往至少接受过2种系统化疗后进展或复发的晚期胃腺癌或胃-食管结合部腺癌患者。"]
["XL01XW",{"$nulls":3},"蛋白酶体抑制剂"]
[{"$nulls":5},"乙","TX18","硼替佐米","注射剂","6116元（3.5mg/瓶）\n2344.26元（1mg/瓶）","限多发性骨髓瘤、复发或难治性套细胞淋巴瘤患者，并满足以下条件：1、每2个疗程需提供治疗有效的证据后方可继续支付；2、由三级医院血液专科或血液专科医院医师处方；3、与来那度胺联合使用不予支付。"]
["XL01XX",{"$nulls":3},"其他抗肿瘤药"]
[{"$nulls":5},"乙","TX19","重组人血管内皮抑制素","注射剂","630元（15mg/2.4×10^5 U/3ml/支）","限晚期非小细胞肺癌患者。"]
[{"$nulls":5},"乙","TX20","西达本胺","口服常释剂型","385元（5mg/片）","限既往至少接受过一次全身化疗的复发或难治的外周T细胞淋巴瘤（PTCL）患者。"]
["XL02",null,"内分泌治疗用药"]
["XL02B",null,null,"激素拮抗剂及相关药物"]
[{"$nulls":5},"乙","TX21","阿比特龙","口服常释剂型","144.92元（250mg/片）","限转移性去势抵抗性前列腺癌。"]
[{"$nulls":5},"乙","TX22","氟维司群","注射剂","2400元（5ml：0.25g/支）","限芳香化酶抑制剂治疗失败后的晚期、激素受体（ER/PR）阳性乳腺癌治疗。"]
["XL03",null,"免疫兴奋剂"]
["XL03A",null,null,"免疫兴奋剂"]
["XL03AB",{"$nulls":3},"干扰素类"]
[{"$nulls":5},"乙","TX23","重组人干扰素β-1b","注射剂","590元（0.3mg/支）","限常规治疗无效的多发性硬化患者。"]
["XL04",null,"免疫抑制剂"]
["XL04A",null,null,"免疫抑制剂"]
["XL04AA",{"$nulls":3},"选择性免疫抑制剂"]
[{"$nulls":5},"乙","TX24","依维莫司","口服常释剂型","148元（5mg/片）\n87.05元（2.5mg/片）","限以下情况方可支付：1.接受舒尼替尼或索拉非尼治疗失败的晚期肾细胞癌成人患者。2.不可切除的、局部晚期或转移性的、分化良好的（中度分化或高度分化）进展期胰腺神经内分泌瘤成人患者。3.不需立即手术治疗的结节性硬化症相关的肾血管平滑肌脂肪瘤（TSC-AML)成人患者。"]
["XL04AX",{"$nulls":3},"其他免疫抑制剂"]
[{"$nulls":5},"乙","TX25","来那度胺","口服常释剂型","866元（10mg/片）\n1101.99元（25mg/片）","限曾接受过至少一种疗法的多发性骨髓瘤的成年患者，并满足以下条件：1、每2个疗程需提供治疗有效的证据后方可继续支付；2、由三级医院血液专科或血液专科医院医师处方；3、与硼替佐米联合使用不予支付。"]
["XN","神经系统药物"]
["XN05",null,"精神安定药"]
["XN05A",null,null,"抗精神病药"]
["XN05AH",{"$nulls":3},"二氮卓类、去甲羟二氮卓类和硫氮杂卓类"]
[{"$nulls":5},"乙","TX26","喹硫平","缓释控释剂型","3.72元（50mg/片）\n10.76元（200mg/片）\n14.68元（300mg/片）"]
["XN06",null,"精神兴奋药"]
["XN06A",null,null,"抗抑郁药"]
["XN06AB",{"$nulls":3},"选择性5-羟色胺再摄取抑制剂"]
[{"$nulls":5},"乙","TX27","帕罗西汀","肠溶缓释片","4.59元（12.5mg/片）\n7.8元（25mg/片）"]
["XS","感觉器官药物"]
["XS01",null,"眼科用药"]
["XS01L",null,null,"眼血管病用药"]
[{"$nulls":5},"乙","TX28","康柏西普","眼用注射液","5550元（10mg/ml 0.2ml/支）","限50岁以上湿性年龄相关性黄斑变性患者，并符合以下条件：1.需三级综合医院眼科或二级及以上眼科专科医院医师处方；2.病眼基线矫正视力0.05-0.5；3.事前审查后方可用，初次申请需有血管造影及OCT（全身情况不允许的患者可以提供OCT血管成像）证据；4.每眼累计最多支付9支，每个年度最多支付4支。"]
[{"$nulls":5},"乙","TX29","雷珠单抗","注射剂","5700元（10mg/ml 0.2ml/支、10mg/ml 0.165ml/支（预充式））","限50岁以上湿性年龄相关性黄斑变性患者，并符合以下条件：1.需三级综合医院眼科或二级及以上眼科专科医院医师处方；2.病眼基线矫正视力0.05-0.5；3.事前审查后方可用，初次申请需有血管造影及OCT（全身情况不允许的患者可以提供OCT血管成像）证据；4. .每眼累计最多支付9支，每个年度最多支付4支。"]
["XV","杂类"]
["XV03",null,"其他治疗药物"]
["XV03A",null,null,"其他治疗药物"]
["XV03AE",{"$nulls":3},"高血钾和高磷血症治疗药"]
[{"$nulls":5},"乙","TX30","司维拉姆","口服常释剂型","8.1元（800mg/片）","限透析患者高磷血症。"]
[{"$nulls":5},"乙","TX31","碳酸镧","咀嚼片","14.65元（500mg/片）\n19.98元（750mg/片）\n24.91元（1000mg/片）","限透析患者高磷血症。"]

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["中药部分"]
["药品分类代码","药品分类",{"$nulls":4},"编号","药品名称","支付标准","备注"]
[]
["ZA","内科用药"]
["ZA12",null,"祛瘀剂"]
["ZA12H",null,null,"化瘀通脉剂"]
[{"$nulls":5},"乙","TZ01","银杏二萜内酯葡胺注射液","316元（5ml/支，含银杏二萜内酯25mg）","限二级及以上医疗机构脑梗死恢复期患者，单次住院最多支付14天。"]
[{"$nulls":5},"乙","TZ02","银杏内酯注射液","79元（2ml/支，含萜类内酯10mg）","限二级及以上医疗机构脑梗死恢复期患者，单次住院最多支付14天。"]
["ZC","肿瘤用药"]
["ZC01",null,"抗肿瘤药"]
[{"$nulls":5},"乙","TZ03","复方黄黛片","10.5元（0.27g/片）","限初治的急性早幼粒细胞白血病。"]
["ZC02",null,"肿瘤辅助用药"]
[{"$nulls":5},"乙","TZ04","注射用黄芪多糖","278元（250mg/瓶）","限二级及以上医疗机构肿瘤患者，单次住院最多支付14天。"]
[{"$nulls":5},"乙","TZ05","参一胶囊","6.65元（含人参皂苷Rg3 10mg/粒）","限原发性肺癌、肝癌化疗期间同步使用。"]