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項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 15 1020036310 A031107100 16 1020036310 A0311071G0 17 1020036310 A042527100 18 1020036310 A042609100 19 1020036310 AC36668100 SENTA ENTERIC COATED TABLETS 5 (SERRATIOPEPTIDAS E) SENTA ENTERIC COATED TABLETS 5 (SERRATIOPEPTIDAS E)( 鋁箔 ) 井田製井田製 DANSE E.C. TABLETS 10 信東 "S.T."(SERRAPEPTASE ) TARN JINQ E.F.C. TABLETS 10 "CHEN TA" (SERRATIOPEPTIDAS E) DEDEMA E.F.C. TABLETS 5 "STANDARD" (SERRAPEPTASE) 35 1020061982 B016870277 SYKLOFOSFAMID 500 38 1020067327 B018357100 DORYX CAPSULES 39 1020068173 AB48892100 CEXIME CAPSULES 100 (CEFIXIME) SERRAPEPTASE (=SERRATIOPEPTID ASE) 5 SERRAPEPTASE (=SERRATIOPEPTID ASE) 5 SERRAPEPTASE (=SERRATIOPEPTID ASE) 10 SERRAPEPTASE 成大 (=SERRATIOPEPTID 藥品 ASE) 10 SERRAPEPTASE 生達 (=SERRATIOPEPTID 化學 ASE) 5 BAX TER FHF AUL CYCLOPHOSPHAMI DE (MONOHYDRATE) 500 DOXYCYCLINE (HCL) 100 信東觀音 CEFIXIME 100 腸溶錠腸溶錠腸溶腸溶 1 0 102/12/01 1.5 0 102/12/01 1 0 102/12/01 1 0 102/12/01 1.5 0 102/12/01 500 150 0 102/12/01 1.45 0 102/12/01 5.6 0 102/12/01 3 1020070469 B025845100 REOSTEO 35 TABLETS PHA RISEDRONATE RMA SODIUM 35 SCIE NCE -- 207 102/12/01 4 1020070686 B025303297 MOZOBIL SOLUTION FOR PAT HEO PLERIXAFOR 20 /ML 1.2 ML -- 223020 102/12/01 5 1020061790 K000820266 NOVOMIX 30 FLEXPEN NOV INSULIN ASPART 注射 ONO 100 U/ML (UNIT/ML) 劑 300 U (UNIT) 0 253 102/12/01 6 1020061790 K000823266 NOVORAPID FLEXPEN NOV INSULIN ASPART 注射 ONO 100 U/ML (UNIT/ML) 劑 300 U (UNIT) -- 253 102/12/01 7 1020061790 K000908266 NOVOMIX 50 FLEXPEN NOV INSULIN ASPART 注射 ONO 100 U/ML (UNIT/ML) 劑 300 U (UNIT) -- 253 102/12/01 8 1020063499 B025994100 PLETAAL OD TABLETS 50 OTS UKA 口溶 PHA CILOSTAZOL 50 錠 RMA. -- 11.1 102/12/01 第 1 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 9 1020063499 B025993100 PLETAAL OD TABLETS 100 OTS UKA CILOSTAZOL 100 PHA RMA. 口溶錠 -- 19.9 102/12/01 10 1020064804 B0259342AA LEUPLIN DEPOT 1M 3.75 S.C. TAK EDA PHA LEUPROLIDE RMA ACETATE 3.75 CEU TICA 凍晶 3.75 -- 4449 102/12/01 11 1020064902 B0226221G0 SIBELIUM CAPSULES 5( 鋁箔 / 膠箔 ) JASE NK FLUNARIZINE (HCL) 5 -- 2 102/12/01 12 1020062929 A057930100 ATOVA F.C. TABLETS 10 "YU SHENG" 優生 ATORVASTATIN (CALCIUM) 10 -- 17.3 102/12/01 13 1020064072 A057976100 EXEN S.R. TABLETS 400 ETODOLAC 衛達 MICRONIZED 400 製造持續性藥效錠 -- 11.2 102/12/01 14 1020063639 B026063100 OLANZAPINE SANDOZ FILM COATED TABLETS 5 SAN DOZ ILAC OLANZAPINE 5 SAN AYI VE -- 65 102/12/01 15 1020062854 A037557100 DICYCLOMINE TABLETS 10 "SENTAI" 16 1020062205 A057884221 FERRUM 17 1020062581 B025923100 18 1020063159 A0551102CX 19 1020063159 A055110220 20 1020064040 A057992248 21 1020061496 B025899221 22 1020061496 B025899240 "CAPSUGEL" UTROGESTAN SOFT CAPSULE 100 PIZOTAM POWDER FOR I.V. INJ. PIZOTAM POWDER FOR I.V. INJ. LIPO-AB FOR GEMCITABINE SANDOZ 40/ML CONCENTRATE FOR SOLUTION FOR INFUSION GEMCITABINE SANDOZ 40/ML CONCENTRATE FOR SOLUTION FOR INFUSION 仙台製壽元製 CAP SUG EL 東洋 EBE WE EBE WE DICYCLOMINE HCL 10 FERRIC- (HYDROXIDE- SUCROSE COMPLEX) 20 /ML PROGESTERONE 100 PIPERACILLIN SODIUM 2 GM PIPERACILLIN SODIUM 4 GM AMPHOTERICIN B 50 GEMCITABINE HYDROCHLORIDE 40 /ML GEMCITABINE HYDROCHLORIDE 40 /ML 第 2 頁, 共 22 頁錠劑 0 0.5 102/12/01 軟乾粉乾粉凍晶乾粉 5 ML -- 82 102/12/01 -- 9.2 102/12/01 2.25 GM -- 206 102/12/01 4.5 GM -- 377 102/12/01 50 -- 6641 102/12/01 5 ML -- 843 102/12/01 25 ML -- 4654 102/12/01

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 23 1020061496 B025899248 24 1020064412 Y000014235 25 1020063507 A034804100 GEMCITABINE SANDOZ 40/ML CONCENTRATE FOR SOLUTION FOR INFUSION TYSABRI CONCENTRATE FOR SOLUTION FOR INFUSION 300 IPROFEN TABLETS 400 "MACRO" (IBUPROFEN) 26 1020064935 A058017100 RIPAM TABLETS0.5 27 1020062616 B025941100 EPIMATE 100 EBE WE GEMCITABINE HYDROCHLORIDE 40 /ML VET TER PHA natalizumab 20 RMA /ML - FER TIG 50 ML -- 8108 102/12/01 15 ML -- 75000 102/12/01 羅得 IBUPROFEN 400 錠劑 0 0.93 102/12/01 中生 CLONAZEPAM 0.5 生技淡水 TOR REN T TOPIRAMATE 100 錠劑 -- 1.18 102/12/01 -- 33.2 102/12/01 28 1020064575 B026045100 APO-DONEPEZIL FILM TABLETS 5 APO TEX RES DONEPEZIL HCL 5 EAR CH PRIV -- 59 102/12/01 29 1020064577 B026046100 APO-DONEPEZIL FILM-COATED TABLETS 10 APO TEX RES DONEPEZIL HCL 10 EAR CH PRIV -- 69 102/12/01 30 1020064915 B026083100 CORYOL 40 FILM COATED TABLETS SAL UTA S GINKGO BILOBA FOLIUM EXTRACT 40 -- 2.18 102/12/01 31 1020062213 B026051100 SAN DOZ MONTELUKAST ILAC MONTELUKAST SANDOZ 4 SAN (SODIUM) 4 CHEWABLE TABLETS AYI VE 咀嚼錠 -- 15.4 102/12/01 32 1020062179 A057183100 COUGHMEN TABLETS 20 (BENPROPERINE) "ASTAR" 33 1020062900 B025921429 LIPOSIC EYE GEL 34 1020062901 B025929429 LIPOSIC FLUID EYE GEL 安星 BENPROPERINE 製造 PHOSPHATE 20 CARBOMER GER (=CARBOPOL=CAR HAM BOXYPOLYMETHY LENE) 2 /GM CARBOMER GER (=CARBOPOL=CAR HAM BOXYPOLYMETHY LENE) 2 /GM 錠劑 -- 1.1 102/12/01 眼用凝膠劑眼用凝膠劑 10 GM -- 126 102/12/01 10 GM -- 126 102/12/01 35 1020063498 AB44136100 PLETAAL TAB. 50 大塚 CILOSTAZOL 50 錠劑 -- 11.1 102/12/01 第 3 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 36 1020063498 AB44124100 37 1020062799 AB38605100 38 1020064329 AB45016100 39 1020062799 AB40583100 40 1020062799 AB405831G0 41 1020063347 AB48484100 42 1020063559 AB33091100 43 1020064346 AB45363100 44 1020064346 AB453631G0 45 1020063013 AB57103100 46 1020064153 AB46315100 47 1020064142 AB54967100 PLETAAL TABLETS 100 FADIN F.C. TABLET 20 "STANDARD" (FAMOTIDINE) OMEZOL CAP. 20 (OMEPRAZOLE) GLUZIDE TABLETS 80 "STANDARD" (GLICLAZIDE) GLUZIDE TABLETS 80 "STANDARD" (GLICLAZIDE)( 鋁箔 / 膠箔 ) Glucomin X.R. Tablets 500mg "P.L." LICODIN F.C.TABLET 250 (TICLOPIDINE) FURIDE TABLETS 40 "STANDARD"(FUROS EMIDE) FURIDE TABLETS 40 "STANDARD"(FUROS EMIDE)( 鋁箔 / 膠箔 ) LOSARTAN F.C. TABLETS 50 "CYH" LOSART F.C. TABLETS 50 "STANDARD" (LOSARTAN POTASSIUM) 大塚 CILOSTAZOL 100 生達 FAMOTIDINE 20 生達 OMEPRAZOLE 20 二錠劑 -- 19.9 102/12/01 -- 2.26 102/12/01 -- 5.8 102/12/01 生達 GLICLAZIDE 80 錠劑 -- 1.8 102/12/01 生達 GLICLAZIDE 80 培力 ATOVER F.C. TABLETS 40 P.L. 培力 " 48 1020063559 AB48027100 RIBARIN CAPSULES 49 1020064331 AB43305100 50 1020064184 AB47689100 51 1020064405 AB46237100 52 1020062799 AB28921100 53 1020062799 AB289211G0 NO-TON F.C. TABLETS 500 "STANDARD" Neurtrol F.C. Tablets 300mg CILOPA F.C TABLETS 20 "S.C" PICETAM CAPSULES 400 "STANDARD" (PIRACETAM) PICETAM CAPSULES 400 "STANDARD" (PIRACETAM)( 鋁箔 / 膠箔 ) METFORMIN HCL 500 臺灣東洋 TICLOPIDINE HCL 中壢 250 生達 FUROSEMIDE 40 第二生達 FUROSEMIDE 40 第二中化 LOSARTAN 新豐 POTASSIUM 50 製生達 LOSARTAN 二 POTASSIUM 50 ATORVASTATIN (CALCIUM) 40 臺灣東洋 RIBAVIRIN 200 中壢生達 NABUMETONE 500 化學健亞十全 OXCARBAZEPINE 300 緩釋錠 -- 2.16 102/12/01 -- 5.3 102/12/01 CITALOPRAM 膜衣 HYDROBROMIDE 20 錠生達膠囊 PIRACETAM 400 二劑生達 PIRACETAM 400 二 -- 12.7 102/12/01 -- 12.7 102/12/01 -- 37.9 102/12/01 -- 24.3 102/12/01 -- 4.3 102/12/01 -- 11.4 102/12/01 -- 19.5 102/12/01 -- 1.5 102/12/01 -- 2 102/12/01 第 4 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 54 1020064330 AB22345100 55 1020064330 AB223451G0 56 1020062799 AB31608500 57 1020064805 AB57312100 58 1020062494 AB48863100 59 1020065004 AB57769100 60 1020064014 NB099311G0 TAMEDIN F.C. TABLETS "STANDARD" (CIMETIDINE) TAMEDIN F.C. TABLETS "STANDARD" (CIMETIDINE)( 鋁箔 / 膠箔 ) DOMPEDON SUPPOSITORY 10 "STANDARD" (DOMPERIDONE) ACARBOSE F.C. TABLETS 50 "CYH" BENTOMIN TABLETS 1000 S.C." GLITOS TABLETS 15 SANYL S.C. TABLETS( 鋁箔 / 膠箔 ) 61 1020062799 AB09102100 PROPRANOLOL TABLETS 10 生達 CIMETIDINE 200 生達 CIMETIDINE 200 生達 DOMPERIDONE 10 二中化新豐 ACARBOSE 50 製十全 PROPRANOLOL 62 1020062799 AB091021G0 TABLETS 10 ( 鋁箔 / 生達膠箔 ) 63 1020062799 AB49969100 64 1020063388 AB57318100 65 1020064393 AB55272100 66 1020064393 AB57805100 AMLOBIN TABLETS 10 STANDARD " METFORMIN HCL 1000 中化 PIOGLITAZONE 15 新豐製生達 NICAMETATE 二 CITRATE 50 PROPRANOLOL 生達 HCL 10 PROPRANOLOL HCL 10 生達 AMLODIPINE 二 (BESYLATE) 10 中化 IBESAA F.C. TABLETS IRBESARTAN 300 新豐 300 製 ATORVA FILM- COATED TABLETS 10 STANDARD " (ATORVASTATIN) ATORVA F.C. TAB. 20 "STANDARD" (ATORVASTATIN) 生達 ATORVASTATIN 二 (CALCIUM) 10 生達 ATORVASTATIN 二 (CALCIUM) 20 -- 1.8 102/12/01 -- 2 102/12/01 栓劑 -- 3.39 102/12/01 -- 3.53 102/12/01 錠劑 -- 2.38 102/12/01 錠劑 -- 18.6 102/12/01 糖衣錠 -- 2 102/12/01 錠劑 -- 1.8 102/12/01 錠劑 -- 7.6 102/12/01 -- 18.2 102/12/01 -- 22.2 102/12/01 -- 34.7 102/12/01 67 1020064331 AB31138100 BEFAT F.C. TAB. 200 "STANDARD" (BEZAFIBRATE) 生達 BEZAFIBRATE 200 化學 -- 7.3 102/12/01 68 1020063261 AB47979265 69 1020063261 AB47979277 BOJUM INTRAVENOUS 0.25G BOJUM INTRAVENOUS 0.5G 展旺 MEROPENEM 針劑 TRIHYDRATE 250 展旺 MEROPENEM 針劑 TRIHYDRATE 500 乾粉乾粉 250 -- 382 102/12/01 500 -- 513 102/12/01 70 1020063503 BB25535100 ARBREAST F.C. TAB. 1 (ANASTROZOLE) STA SON PHA ANASTROZOLE 1 RMA CEU TICA -- 94 102/12/01 第 5 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 71 1020062799 AB30647500 DIFENA SUPP. 12.5 "STANDARD" (DICLOFENAC SODIUM) 生達 DICLOFENAC 二 SODIUM 12.5 栓劑 -- 1.75 102/12/01 72 1020063696 AB31881500 73 1020061880 AB57320100 74 1020063015 AC57974100 75 1020063044 AC32706100 76 1020061805 AC55531100 77 1020061592 AC57909100 78 1020063559 AC57216100 VOTALIN SUPPOSITORY 12.5 (DICLOFENAC SODIUM) "P.L." ARIPIPRAZOLE TABLETS 10 "GENOVATE" 培力健亞 DICLOFENAC SODIUM 12.5 ARIPIPRAZOLE 10 PANTOPRAZOLE PANTYL GASTRO- 中化 SODIUM RESISTANT TABLETS 新豐 SESQUIHYDRATE 40 製 40 CAPTOPRI TABLETS 25 (CAPTOPRIL) TANZA F.C. TABLETS 50 C.S." RETONIN F.C. TABLETS 80 LINICOR F.C.T. 500/20 栓劑 -- 1.73 102/12/01 錠劑 -- 88 102/12/01 腸溶 -- 21.7 102/12/01 CAPTOPRIL 25 錠劑 -- 1.51 102/12/01 正和 LOSARTAN 新營 POTASSIUM 50 VALSARTAN 80 健亞 NIACIN (=NICOTINIC ACID) 500 -- 10.7 102/12/01 -- 11.2 102/12/01 -- 12.2 102/12/01 79 1020062858 AC57940100 ROSULATOR F.C. ROSUVASTATIN 十全 TABLETS 10 "S.C." CALCIUM 10 -- 22.4 102/12/01 80 1020061503 AC42511100 81 1020062207 AC57948100 82 1020064936 AC29353209 83 1020064615 AC31213209 84 1020064936 AC29504209 85 1020063263 AC48909100 NOSPASM TABLETS 10 "Y.Y."(PIPOXOLAN) ZOTAN ORALLY DISINTEGRATING TABLETS 0.2 LOFALIN 1000 (CEFOZOLIN SODIUM) LOFATIN 1000 (CEFOXITI N) LOFADINE 1000 (CEPHRADINE) ANSUZOLE F.C TABLETS 1 86 1020061592 AC57858100 CELECOLEN CAPSULES 200 87 1020063698 AC57966100 PINTON SR TABLETS 400 "C.H." PIPOXOLAN HCL 10 中化 TAMSULOSIN HCL 新豐 0.2 製 CEFAZOLIN (SODIUM) 1000 CEFOXITIN (SODIUM) 1000 CEPHRADINE 1000 美時 ANASTROZOLE 1 南投錠劑 -- 3.7 102/12/01 持續性釋放口溶錠乾粉膠囊 CELECOXIB 200 劑正和新營 ETODOLAC 400 第 6 頁, 共 22 頁持續性藥效錠 -- 10 102/12/01 1 GM 0 18 102/12/01 1 GM 0 142 102/12/01 1 GM 0 33.3 102/12/01 -- 94 102/12/01 -- 15.4 102/12/01 -- 11.2 102/12/01

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 88 1020061592 AC57911100 89 1020062733 AC57962100 90 1020062208 AC57848100 91 1020064185 AC57991100 92 1020064810 AC44541100 93 1020064617 AC38147100 LEVELIN F.C. TABLETS 100 ARIZOLE ORALLY DISINTEGRATING TABLETS 15 FLUOXETINE CAPSULES 20 "CYH" BENSAU SOFT CAPSULES 200 "LOTUS" CETIMIN FILM COATED TABLETS 10 "C.H" GENOL TABLETS 120 (DIBISMUTH TRIOXIDE) TOPIRAMATE 100 中化 ARIPIPRAZOLE 15 新豐製中化 FLUOXETINE (HCL) 新豐 20 製美時 BENZONATATE 200 南投正和 CETIRIZINE 新營 DIHYDROCHLORID E 10 BISMUTH SUBCITRATE COLLOIDAL(=TRIP OTASSIUM DICITRATE BISMUTHATE) 300 口溶錠軟 -- 35.3 102/12/01 -- 77 102/12/01 -- 3.36 102/12/01 -- 3.92 102/12/01 -- 1.5 102/12/01 錠劑 -- 6.3 102/12/01 94 1020063586 AC37054100 STOGAMET TABLETS 400 "SWISS" (CIMETIDINE) CIMETIDINE 400 95 1020063586 AC370541G0 STOGAMET TABLETS 400 "SWISS" (CIMETIDINE)( 鋁箔 / 膠箔 ) CIMETIDINE 400 96 1020063444 AC57986245 EMAZOLE POWDER FOR SOLUTION FOR 生達 ESOMEPRAZOLE /INFUSION 化學 (SODIUM) 40 40 "STANDARD" 凍晶 40 -- 196 102/12/01 97 1020064611 BC26000245 OMEPRAZOLE SANDOZ 40 POWDER FOR SOLUTION FOR INFUSION LEK PHA RMA OMEPRAZOLE 40 CEU TICA LS 凍晶 40 -- 120 102/12/01 98 1020064937 AC23430100 99 1020064617 AC37570109 GASPIN TABLETS (PIRENZEPINE) ULSAMIN FINE GRANULES 900/GM (BASIC ALUMINUM SUCROSE SULFATE) PIRENZEPINE 2HCL 25 SUCRALFATE(=BAS IC ALUMINUM SUCROSE SULFATE) 900 /GM 錠劑 -- 1.71 102/12/01 細粒劑 1 GM 0 3.88 102/12/01 100 1020063044 AC32716100 101 1020064210 AC39969100 DOMPERAN TABLETS DOMPERIDONE 10 10 "SWISS" (DOMPERIDONE) MOTIN TABLETS 10 DOMPERIDONE 10 "Y.J."(DOMPERIDONE ) 第 7 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 102 1020064937 AC17628100 103 1020063044 AC45001100 STOPIN TABLETS (METHYL- SCOPOLAMINE METHYL SULFATE) SPASTEC F.C. TABLETS 50 "SWISS" METHSCOPOLAMIN E METHYLSULFATE 1 PINAVERIUM BROMIDE 50 -- 11.5 102/12/01 104 1020062856 AC16821100 LOPERAMIDE LOPERAMIDE HCL 2 膠囊 CAPSULES "HONTEN" 劑 -- 1.5 102/12/01 105 1020062856 AC168211G0 LOPERAMIDE LOPERAMIDE HCL 2 膠囊 CAPSULES 劑 "HONTEN"( 鋁箔 / 膠箔 ) -- 2 102/12/01 106 1020064810 AC36820100 METFORMIN TABLETS 500 "C.H." 107 1020064075 NC00476209 B-COMPLEX "Y.Y." 108 1020064075 NC00476229 B-COMPLEX "Y.Y." 正和 METFORMIN HCL 新營 500 THIAMINE HCL (=THIAMINE CHLORIDE HYDROCHLORIDE) 60 /ML THIAMINE HCL (=THIAMINE CHLORIDE HYDROCHLORIDE) 60 /ML 1 ML -- 15 102/12/01 10 ML -- 15 102/12/01 109 1020064937 AC16958100 NICOFEROL CAPSULES (TOCOPHEROL NICOTINATE) TOCOPHEROL NICOTINATE 100 -- 1.5 102/12/01 110 1020063044 AC37996100 111 1020061804 AC566901G0 112 1020064617 AC50191162 113 1020064810 AC25272100 114 1020064810 AC25406100 PHOSUNK TABLET 667 "SWISS"(CALCIUM ACETATE) KAI-HO CHEWABLE TABLETS 950 "C.S."( 鋁箔 / 膠箔 ) CALAD CALCIUM SUSPENSION CALCIUM ACETATE 667 正和 CALCIUM CITRATE 新營 950 TRICALCIUM PHOSPHATE 103 /ML 正和 DIPYRIDAMOLE S.C. DIPYRIDAMOLE 25 新營 TABLETS 25 "C.H." PERANSIN F.C. TABLETS 75 (DIPYRIDAMOLE) "C.H." 正和 DIPYRIDAMOLE 75 新營咀嚼錠內服乳劑糖衣錠 -- 2 102/12/01 180 ML -- 188 102/12/01 -- 1.5 102/12/01 -- 1.6 102/12/01 115 1020064936 AC22930212 GEXAMIN TRANEXAMIC ACID 注射 100 /ML 劑 (TRANEXAMIC ACID) 2 ML -- 15 102/12/01 116 1020064810 AC24053100 BLOODFULL S.C. TABLETS "C.H." 正和 FERROUS 新營 FUMARATE 50 糖衣錠 -- 1.5 102/12/01 第 8 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 117 1020064936 AC26576209 HI-OHB12 5/ML (HYDROXOCOBALA MIN) HYDROXOCOBALA MIN (ACETATE) 5 /ML 1 ML -- 15 102/12/01 118 1020063586 AC16457212 HYCOBAL (HYDROXOCOBALA MINE) "SWISS" HYDROXOCOBALA MIN 2.5 /ML 2 ML -- 15 102/12/01 119 1020064616 AC21109229 HICOVITA THIAMINE DISULFIDE 5 /ML 10 ML 0 15 102/12/01 120 1020062857 AC14343100 COBAMAMIDE COBAMAMIDE 0.25 CAPSULES "HONTEN" -- 1.5 102/12/01 121 1020064617 AC11230100 HICOBAL CAPSULES COBAMAMIDE 0.5 -- 1.5 102/12/01 122 1020064810 AC30549100 ANTIFLAN E.S.C. TABLETS 100 (BROMELAIN)"C.H." 正和 BROMELAIN 100 新營腸溶糖衣錠 -- 1.5 102/12/01 123 1020063014 AC57890209 EPINEPHRINE 1/ML "CYH" 中化 EPINEPHRINE 注射新豐 (=ADRENALIN=EPIR 劑製 ENAMINE) 1 /ML 1 ML -- 15 102/12/01 124 1020063944 AC10914221 125 1020064810 AC18183100 126 1020064810 AC24536100 127 1020063044 AC32711100 LIDOCAINE HCL 2% FOR I.V. "LITA" RELAPINE TABLETS "C.H." PROPRANOLOL HYDROCHLORIDE TABLETS "C.H." CAPTOPRI TABLETS 12.5 (CAPTOPRIL) LIDOCAINE HCL 20 /ML 5 ML -- 50 102/12/01 正和新營 RESERPINE 0.1 正和 PROPRANOLOL 新營 HCL 10 錠劑 -- 1.6 102/12/01 CAPTOPRIL 12.5 錠劑 -- 5.3 102/12/01 128 1020063640 BC26048100 LOSARTAN SANDOZ COMP FILM COATED TABLET 50/12.5 LEK PHA RMA LOSARTAN CEU POTASSIUM 50 TICA LS -- 10.7 102/12/01 129 1020062531 AC57950100 ATOVER F.C. ATORVASTATIN 培力 TABLETS 20 "P.L." (CALCIUM) 20 -- 30.8 102/12/01 130 1020063044 AC40787100 SORIALEN F.C.TABLETS 10 "SWISS" (METHOXSALEN) METHOXSALEN 10 -- 18.6 102/12/01 131 1020064069 AC46633321 LOMEANE CREAM "S.C." 十全 MOMETASONE FUROATE 1 /GM 乳膏劑 5 GM -- 39.5 102/12/01 132 1020062856 NC13083100 ERGOLATE TABLETS 133 1020064075 AC18946209 DEXAMETHASONE "Y.Y." ERGONOVINE MALEATE 0.2 DEXAMETHASONE (SODIUM PHOSPHATE) 2 /ML 1 ML -- 15 102/12/01 第 9 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 134 1020064616 AC18670209 DEXAMETHASONE 4/ML 135 1020062979 AC18946212 DEXAMETHASONE "Y.Y." 136 1020064075 AC18946229 DEXAMETHASONE "Y.Y." 137 1020064616 AC18670229 138 1020064868 AC45923100 139 1020064613 AC43726245 140 1020064613 AC43726265 141 1020064613 AC43726277 142 1020064613 AC43726209 143 1020063387 AC578111G0 DEXAMETHASONE 4 /ML METICORT TABLETS 4 "KINGDOM" (METHYLPREDNISOL ONE) MEPRON POWDER FOR 0.04GM MEPRON POWDER FOR INJ. 0.25G MEPRON INJ. 0.5G MEPRON POWDER FOR INJ.1G PREDNISOLONE TABLETS 5 "CYH"( 鋁箔 / 膠箔 ) DEXAMETHASONE PHOSPHATE (SODIUM) 4 /ML DEXAMETHASONE PHOSPHATE (SODIUM) 2 /ML DEXAMETHASONE (SODIUM PHOSPHATE) 2 /ML DEXAMETHASONE PHOSPHATE (SODIUM) 4 /ML 盈盈 METHYLPREDNISO 生技 LONE 4 144 1020062856 AC04763100 HONTAN TABLETS 145 1020064615 AC52553289 146 1020064615 AC52553210 147 1020064936 AC22343277 148 1020063944 AC11933277 149 1020063944 AC11933209 150 1020064614 AC49881277 151 1020064614 AC49881209 152 1020064614 AC49881212 SULAMPI POWDER FOR IV 750 SULAMPI POWDER FOR IV 1500 LOFALIN 500 (CEFAZOLIN) CEFACIN "LITA" CEFACIN "LITA" MACEPIM POWDER FOR I.V. (500) MACEPIM POWDER FOR I.V. (1GM) MACEPIM POWDER FOR I.V. (2GM) METHYLPREDNISO LONE (SODIUM SUCCINATE) 40 METHYLPREDNISO LONE (SODIUM SUCCINATE) 250 METHYLPREDNISO LONE (SODIUM SUCCINATE) 500 METHYLPREDNISO LONE (SODIUM SUCCINATE) 1 GM 中化 PREDNISOLONE 5 新豐製 METHIMAZOLE 5 SULBACTAM (SODIUM) 0.25 GM SULBACTAM (SODIUM) 0.5 GM CEFAZOLIN (SODIUM) 500 CEFAZOLIN (SODIUM) 500 CEFAZOLIN (SODIUM) 1000 CEFEPIME HCL (EQ TO CEFEPIME) 500 CEFEPIME (AS HYDROCHLORIDE) 1 GM 1 ML -- 15 102/12/01 2 ML -- 15 102/12/01 10 ML -- 15 102/12/01 10 ML -- 16 102/12/01 錠劑 -- 1.59 102/12/01 乾粉乾粉乾粉乾粉 40 0 52 102/12/01 250 0 203 102/12/01 500 0 233 102/12/01 1 GM 0 1085 102/12/01 乾粉乾粉乾粉乾粉乾粉乾粉乾粉 CEFEPIME HCL (EQ 注射 TO CEFEPIME) 2 GM 劑第 10 頁, 共 22 頁 750 0 96 102/12/01 1.5 GM 0 102 102/12/01 500 -- 15 102/12/01 500 -- 15 102/12/01 1 GM -- 18.4 102/12/01 500 -- 284 102/12/01 1 GM -- 456 102/12/01 2 GM -- 761 102/12/01

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 153 1020064615 AC30560277 154 1020063944 AC33935277 155 1020064615 AC27325209 156 1020063944 AC33935209 157 1020064646 AC27325212 158 1020063944 AC33935212 159 1020064646 AC55249265 160 1020064646 AC55249277 161 1020064646 AC55249209 162 1020064615 AC52592209 163 1020064615 AC52592212 164 1020064615 AC50081277 165 1020064614 AC50081209 166 1020064614 AC50081212 167 1020064613 AC38777277 168 1020064613 AC38777209 169 1020064075 AC46297209 170 1020064937 AC38353100 LOFORAN 0.5G (CEFOTAXI ME SODIUM) CEFTAM 0.5GM,1GM,2GM (CEFOTAXIME SODIUM) "LITA" LOFORAN FOR 1GM (CEFOTAXIME SODIUM) CEFTAM 0.5GM,1GM,2GM (CEFOTAXIME SODIUM) "LITA" LOFORAN FOR 2GM (CEFOTAXI ME SODIUM) CEFTAM 0.5GM,1GM,2GM (CEFOTAXIME SODIUM) "LITA" LOTIAM POWDER FOR IV INJ. 250 LOTIAM POWDER FOR IV INJ. 500 LOTIAM POWDER FOR IV INJ. 1000 CEPIROM POWDER FOR I.V. 1G CEPIROM POWDER FOR I.V. 2G CEFADIME POWDER FOR IV CEFADIME POWDER FOR IV CEFADIME POWDER FOR IV GIBICEF POWDER FOR (CEFUROXIME) GIBICEF POWDER FOR (CEFUROXIME) CLP POWDER FOR 1GM "Y.Y" TOPCEF CAPSULES 250 (CEPHRADINE) CEFOTAXIME (SODIUM) 500 CEFOTAXIME (SODIUM) 500 CEFOTAXIME (SODIUM) 1 GM CEFOTAXIME (SODIUM) 1 GM CEFOTAXIME (SODIUM) 2 GM CEFOTAXIME (SODIUM) 2 GM CEFOTIAM (2HCL) 250 CEFOTIAM (2HCL) 500 CEFOTIAM (2HCL) 1 GM CEFPIROME (SULFATE) 1000 CEFPIROME (SULFATE) 2000 CEFTAZIDIME 500 CEFTAZIDIME 1000 CEFTAZIDIME 2000 CEFUROXIME (SODIUM) 500 CEFUROXIME (SODIUM) 1 GM CEPHALEXIN (SODIUM) 1000 CEPHRADINE MONOHYDRATE 250 第 11 頁, 共 22 頁乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉 500 0 106 102/12/01 500 -- 106 102/12/01 1 GM 0 160 102/12/01 1 GM -- 160 102/12/01 2 GM -- 476 102/12/01 2 GM -- 476 102/12/01 250 -- 60 102/12/01 500 -- 108 102/12/01 1 GM -- 195 102/12/01 1 GM 0 363 102/12/01 2 GM 0 572 102/12/01 500 0 42.6 102/12/01 1 GM 0 77 102/12/01 2 GM -- 546 102/12/01 500 0 28.7 102/12/01 1 GM 0 178 102/12/01 1 GM -- 93 102/12/01 0 2.03 102/12/01

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 171 1020064936 AC30559277 172 1020064613 AC38711209 173 1020064613 AC38711212 174 1020063043 AC11224100 175 1020063043 AC112241G0 176 1020062856 AC06554100 177 1020063188 AC57875212 178 1020063188 AC57875219 179 1020064616 AC22459229 180 1020064613 AC48508265 181 1020063694 AC48802265 LOFADINE 500 (CEPHRADINE) CEPHRADINE 500 CEFAMID FOR CEPHRADINE 1000 CEFAMID FOR CEPHRADINE 2000 DOXYNIN CAPSULES "SWISS" DOXYNIN CAPSULES "SWISS"( 鋁箔 / 膠箔 ) ERYTHROMYCIN CAPSULES 250 "HONTEN" FOCIMYCIN POWDER FOR FOCIMYCIN POWDER FOR DOXYCYCLINE (HCL) 100 DOXYCYCLINE (HCL) 100 GENTAMICIN 140/ML GENEM FOR YOUNAM POWDER FOR IV 乾粉乾粉 ERYTHROMYCIN 膠囊 (ESTOLATE) 250 劑永信台中 FOSFOMYCIN 2 GM 幼獅永信台中 FOSFOMYCIN 幼獅 (SODIUM) 4 GM GENTAMICIN (SULFATE) 140 /ML IMIPENEM 250 展旺針劑 IMIPENEM 250 182 1020064614 AC48508277 Genem for Injection IMIPENEM 500 183 1020063694 AC48802277 184 1020064616 AC22582212 185 1020064616 AC22582229 186 1020064614 AC49155265 187 1020063694 AC50343265 188 1020064614 AC49155277 189 1020063694 AC50343277 YOUNAM POWDER FOR IV LICOXIN 300/ML (LINCOMYCIN) LICOXIN 300/ML (LINCOMYCIN) MEXOPEM POWDER FOR 展旺針劑 IMIPENEM 500 LINCOMYCIN (HCL) 300 /ML LINCOMYCIN (HCL) 300 /ML MEROPENEM TRIHYDRATE 250 展旺 MEROPENEM MELOPEN POWDER 針劑 TRIHYDRATE 250 FOR 0.25G MEXOPEM POWDER FOR MELOPEN POWDER FOR 0.5G MEROPENEM TRIHYDRATE 500 展旺 MEROPENEM 針劑 TRIHYDRATE 500 第 12 頁, 共 22 頁乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉乾粉 500 -- 25.7 102/12/01 1 GM -- 33.7 102/12/01 2 GM -- 145 102/12/01 -- 1.5 102/12/01 -- 2 102/12/01 -- 1.93 102/12/01 2 GM -- 231 102/12/01 4 GM -- 416 102/12/01 10 ML 0 82 102/12/01 250 0 208 102/12/01 250 -- 208 102/12/01 500 -- 403 102/12/01 500 -- 403 102/12/01 2 ML -- 16.9 102/12/01 10 ML 0 22 102/12/01 250 0 340 102/12/01 250 -- 340 102/12/01 500 -- 426 102/12/01 500 -- 416 102/12/01

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 190 1020063694 AC50343209 191 1020064937 AC16020100 192 1020064614 AC48590263 MELOPEN POWDER FOR 1G BATHOLIN TABLETS Teiconin powder for I.V. Injection 展旺 MEROPENEM 針劑 TRIHYDRATE 1 GM TRIMETHOPRIM 80 TEICOPLANIN 200 乾粉 1 GM -- 958 102/12/01 乾粉 200 -- 654 102/12/01 193 1020063394 BC26074271 TEICOPLANIN SANDOZ POWDER FOR LEK PHA RMA TEICOPLANIN 400 CEU TICA LS 凍晶 400 -- 1442 102/12/01 194 1020064614 AC48590271 195 1020064613 AC37290277 196 1020064615 AC37290209 197 1020062855 AC24494100 TEICONIN POWDER FOR I.V. TEICOPLANIN 400 VANCO POWDER FOR VANCOMYCIN (VANCOMYCIN) (HCL) 500 VANCO POWDER FOR VANCOMYCIN (VANCOMY (HCL) 1 GM CIN) LISOME TABLETS 30 "HONTEN" (LYSOZYME) LYSOZYME (CHLORIDE) 30 乾粉乾粉乾粉 400 -- 1442 102/12/01 500 0 104 102/12/01 1 GM 0 409 102/12/01 198 1020063936 BC26026229 DOXORUBICIN "ALVOGEN" SOLUTION FOR 2/ML GEN EPH DOXORUBICIN HCL 注射 ARM 2 /ML 劑 S.A. 10 ML -- 619 102/12/01 199 1020063936 BC26026248 DOXORUBICIN "ALVOGEN" SOLUTION FOR 2/ML GEN EPH DOXORUBICIN HCL 注射 ARM 2 /ML 劑 S.A. 50 ML -- 4118 102/12/01 200 1020062123 AC49563100 201 1020063586 AC422161G0 202 1020063043 AC38622100 203 1020063043 AC386221G0 204 1020063586 AC32576216 FURIL CAPSULES "LOTUS" FLAMQUIT F.C.TABLETS 25 "SWISS" (DICLOFENAC POTASSIUM)( 鋁箔 / 膠箔 ) PAINSTOP E.C. TABLET 50 "SWISS" (DICLOFENAC) PAINSTOP E.C. TABLET 50 "SWISS" (DICLOFENAC)( 鋁箔 / 膠箔 ) PAINSTOP 25/ML (DICLOFENAC) 美時 TEGAFUR 南投 (=FTORAFUR) 100 DICLOFENAC POTASSIUM 25 DICLOFENAC SODIUM 50 DICLOFENAC SODIUM 50 DICLOFENAC SODIUM 25 /ML 第 13 頁, 共 22 頁 -- 58 102/12/01 -- 2 102/12/01 3 ML -- 15 102/12/01

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 205 1020062857 AC19596100 IBUPROFEN TABLETS 400 "HONTEN" IBUPROFEN 400 206 1020062857 AC195961G0 IBUPROFEN TABLETS 400 "HONTEN" ( 鋁箔 / 膠箔 ) IBUPROFEN 400 207 1020064210 AC38327100 REFEN TABLETS 200 "Y.J."(TIAPROFENIC ACID) 208 1020063586 AC48630100 SUMAKIN CAPSULES TIAPROFENIC ACID 200 CHLORZOXAZONE 150 209 1020063586 AC486301G0 SUMAKIN CHLORZOXAZONE CAPSULES( 鋁箔 / 膠箔 ) 150 CHLORZOXAZONE 210 1020062857 NC02319100 NINLAXIN TABLETS 200 211 1020062857 NC023191G0 NINLAXIN TABLETS( 鋁箔 / 膠箔 ) 212 1020064936 AC22608212 213 1020064656 AC343261G0 214 1020062855 NC00799100 215 1020061434 AC57913216 216 1020064810 AC19210100 ORFLEX (ORPHENADRINE) URICIN TABLETS 50 (BENZBROMARONE) ( 鋁箔 / 膠箔 ) COLCINE TABLETS "HONTEN" KEYBONE 1/ML ERGOCAFE TABLETS "C.H." 217 1020062856 NC11865100 ERGOFFEINE TABLETS "HONTEN" CHLORZOXAZONE 200 ORPHENADRINE CITRATE 30 /ML BENZBROMARONE 50 錠劑 -- 3.06 102/12/01 -- 1.5 102/12/01 -- 2 102/12/01 2 ML -- 15 102/12/01 COLCHICINE 0.5 南光 IBANDRONIC ACID 1 /ML 正和 ERGOTAMINE 新營 TARTRATE 1 ERGOTAMINE TARTRATE 1 3 ML -- 2674 102/12/01 218 1020064936 AC26266209 ANOPAIN 20/ML (NEFOPAM) NEFOPAM HCL 20 /ML 1 ML -- 15 102/12/01 219 1020062897 AC57956221 LEVETIR CONCENTRATE FOR SOLUTION FOR INFUSION 100/ML 聯亞生技 LEVETIRACETAM 新竹 100 /ML 二 5 ML -- 369 102/12/01 220 1020062856 NC13419100 PHENOBARBITAL TABLETS "HONTEN" 221 1020062856 NC134191G0 PHENOBARBITAL TABLETS "HONTEN" ( 鋁箔 / 膠箔 ) 222 1020063559 AC45701221 ALEVIATIN 聯亞生技新竹二 PHENOBARBITAL 30 PHENOBARBITAL 30 PHENYTOIN (SODIUM) 50 /ML 5 ML -- 73 102/12/01 223 1020063043 AC39597100 SWITANE TABLET 2 "SWISS" (TRIHEXYPHENIDYL) TRIHEXYPHENIDYL HCL (=BENZHEXOL HYDROCHLORIDE) 2 第 14 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 224 1020063043 AC395971G0 SWITANE TABLET 2 "SWISS" (TRIHEXYPHENIDYL) ( 鋁箔 / 膠箔 ) TRIHEXYPHENIDYL HCL (=BENZHEXOL HYDROCHLORIDE) 2 225 1020064656 AC295031G0 226 1020063586 AC22272209 227 1020064656 AC429191G0 BROPAN TABLETS 3 BROMAZEPAM 3 (BROMAZEPAM)( 鋁箔 / 膠箔 ) BININ-U (HALOPERIDOL) HALOPERIDOL 5 /ML DOFLEX TABLETS 200)(ME MEPHENOXALONE PHENOXALONE)( 鋁箔 200 / 膠箔 ) 228 1020062856 NC13075100 NOVOMIT TABLETS 229 1020062856 NC130751G0 NOVOMIT TABLETS( 鋁箔 / 膠箔 ) 230 1020062855 AC25230100 231 1020064943 AC296351G0 232 1020062857 AC10374100 233 1020062857 AC103741G0 DOGWEISU CAPSULES 50 (SULPIRIDE) CINNARIZINE TABLETS "YUNG SHIN"( 鋁箔 / 膠箔 ) CINNARIN TABLETS "HONTEN" CINNARIN TABLETS "HONTEN" ( 鋁箔 / 膠箔 ) PROCHLORPERAZI NE ((DI)MALEATE) 5 PROCHLORPERAZI NE ((DI)MALEATE) 5 SULPIRIDE 50 永信台中 CINNARIZINE 25 幼獅 CINNARIZINE 25 CINNARIZINE 25 1 ML -- 23.2 102/12/01 -- 1.6 102/12/01 234 1020062857 AC150901G0 PSEUDOEPHEDRINE PSEUDOEPHEDRINE HCL TABLETS HCL 60 "HONTEN"( 鋁箔 / 膠箔 ) 235 1020062857 AC08753100 TRAMEZIN TABLETS "HONTEN" METHYLEPHEDRIN E DL- HCL 30 236 1020062857 AC087531G0 TRAMEZIN TABLETS METHYLEPHEDRIN "HONTEN"( 鋁箔 / 膠箔 ) E DL- HCL 30 237 1020064936 AC24942209 SALTOLIN (SALBUTAMOL) SALBUTAMOL (SULFATE) 0.5 /ML 1 ML 0 15 102/12/01 238 1020063586 AC22476216 239 1020062855 AC17328100 240 1020062855 AC173281G0 FUMUCIL (ACETYLCYSTEINE) ACETYLCYSTEINE 100 /ML DEXTROMETHORPHA DEXTROMETHORP N TABLETS 30 HAN HBR 30 "HONTEN" DEXTROMETHORPHA DEXTROMETHORP N TABLETS 30 HAN HBR 30 "HONTEN"( 鋁箔 / 膠箔 ) 3 ML -- 15 102/12/01 241 1020063665 AC17204163 BROWN MIXTURE LIQ. (WITH OPIUM) "HEALTH" 健康製 GLYCYRRHIZA EXTRACT 0.12 ML/ML 內服液劑 200 ML -- 28.1 102/12/01 第 15 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 242 1020064616 AC20080212 243 1020064810 AC34518100 BIOCON COFEN 1 TABLETS (KETOTIFEN) "C.H." 244 1020063043 AC48146100 Minieton Tablets 245 1020063043 AC481461G0 MINIETON TABLETS( 鋁箔 / 膠箔 ) 246 1020063043 AC481461G1 MINIETON TABLETS(14 粒 / 瓶 ) 247 1020063043 AC481461G2 MINIETON TABLETS(28 粒 / 瓶 ) 248 1020063043 AC481461G4 MINIETON TABLETS(56 粒 / 瓶 ) 249 1020062355 AC49334421 250 1020062355 AC48471421 251 1020064617 AC52558416 252 1020064617 AC52558421 253 1020064801 AD47792166 254 1020064801 AD47792177 CURZOLAN EYE DROPS ANZOMIN EYE DROPS LOMOLAN OPHTHALMIC SOLUTION 0.25% GENTLE" LOMOLAN OPHTHALMIC SOLUTION 0.25% GENTLE" Lactulose Liquid "SHUN HWA" Lactulose Liquid "SHUN HWA" CHLORPHENIRAMI NE MALEATE 1 /ML 正和 KETOTIFEN 新營 (FUMARATE) 1 MEQUITAZINE 5 MEQUITAZINE 5 MEQUITAZINE 5 MEQUITAZINE 5 MEQUITAZINE 5 麥迪 ANTAZOLINE HCL 森桃 0.5 /ML 園麥迪 ANTAZOLINE 森桃 PHOSPHATE 0.15 園 /ML 順華順華 TIMOLOL (MALEATE) 2.5 /ML TIMOLOL (MALEATE) 2.5 /ML LACTULOSE 600 /ML LACTULOSE 600 /ML 2 ML -- 15 102/12/01 錠劑 -- 1.85 102/12/01 點眼液劑點眼液劑點眼液劑點眼液劑內服液劑內服液劑 5 ML -- 31.6 102/12/01 5 ML -- 30 102/12/01 3 ML 0 71 102/12/01 5 ML 0 94 102/12/01 300 ML -- 182 102/12/01 500 ML -- 199 102/12/01 255 1020065006 B022214229 LEUCOVORIN CALCIUM 50/ML "DBL" HOS PIRA AUS TRA LIA FOLINATE (CALCIUM)=LEUCO VORIN(CALCIUM) 10 /ML 10 ML 0 145 102/12/01 256 1020066795 A058060100 VITAMIN B COMPLEX S.C. TABLETS "F.Y." 元宙 THIAMINE DISULFIDE 50 糖衣錠 -- 1.09 102/12/01 257 1020065000 A058005255 GLUCOSE 5% 永豐 DEXTROSE 50 /ML 100 ML -- 12.7 102/12/01 258 1020065000 A058005265 GLUCOSE 5% 永豐 DEXTROSE 50 /ML 250 ML -- 17.1 102/12/01 259 1020065000 A058005277 GLUCOSE 5% 永豐 DEXTROSE 50 /ML 500 ML -- 17.1 102/12/01 260 1020065000 A058005209 GLUCOSE 5% 永豐 DEXTROSE 50 /ML 1 L (LITER) -- 26.5 102/12/01 261 1020065000 A058007238 BICARBONA 永豐 SODIUM BICARBONATE 70 /ML 20 ML -- 5 102/12/01 第 16 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 262 1020062536 A057951100 263 1020081663 A057994100 264 1020062842 A057939100 450 1020001971 A055945100 ANCOM TABLETS "D.T.S." COLON TABLETS "D.T.S" RECIN TABLETS 2"D.T.S" ALLEVO F.C. TABLETS 5 CBC " 羅得羅得 451 1020002011 A001799100 WE-WANG TABLETS 榮山 452 1020002011 A044120423 BETACIN OPHTHALMIC SOLUTION DEXAMETHASONE 0.5 PREDNISOLONE 5 錠劑 -- 0.6 102/12/01 錠劑 -- 0.5 102/12/01 羅得 DIAZEPAM 2 錠劑 -- 0.4 102/12/01 中生 LEVOCETIRIZINE 生技 DIHYDROCHLORID 淡水 E 5.00 榮山 453 1020002011 A045340321 BASOL CREAM 榮山 454 1020002011 A045340324 BASOL CREAM 榮山 455 1020002011 A045340335 BASOL CREAM 榮山 456 1020002011 A045340338 BASOL CREAM 榮山 457 1020002011 A045340399 BASOL CREAM 榮山 458 1020002014 A036416421 459 1020002023 A024488100 460 1020029758 A031796100 461 1020029758 A0317961G0 EYECALM EYE DROPS "STANDARD" PROAZINE TABLETS (PROCHLORPERAZIN E MALEATE) OXOLA TABLETS 100 "KOJAR" (OXOLAMINE CITRATE) OXOLA TABLETS 100 "KOJAR" (OXOLAMINE CITRATE) ( 鋁箔 / 膠箔 ) 生達合誠國嘉國嘉 462 1020029758 A032002100 MEBLIN 國嘉 463 1020029758 A0320021G0 464 1020029758 A033468100 MEBLIN TABLETS 50 國嘉 "KOJAR"(MEBHYDRO LIN)( 鋁箔 / 膠箔 ) SILIMIN CAPSULES 150 (SILYMARIN) "KOJAR" 國嘉 BUTYLSCOPOLAMI NE BROMIDE (=HYOSCINE BUTYLBROMIDE) 2.00 GENTAMICIN (SULFATE) 3.00/ML CLOBETASOL PROPIONATE 0.50/GM CLOBETASOL PROPIONATE 0.50/GM CLOBETASOL PROPIONATE 0.50/GM CLOBETASOL PROPIONATE 0.50/GM CLOBETASOL PROPIONATE 0.50/GM GENTAMICIN (SULFATE) 3.00/ML PROCHLORPERAZI NE ((DI)MALEATE) 5.00 OXOLAMINE CITRATE 100 OXOLAMINE CITRATE 100 MEBHYDROLIN (NAPADISYLATE) 50 MEBHYDROLIN (NAPADISYLATE) 50 SILYMARIN (FRUCTUS CARDUI MARIAE EXTRACT) 150.00 5.4 0 102/12/01 錠劑 0.86 0 102/12/01 點眼液劑乳膏劑乳膏劑乳膏劑乳膏劑乳膏劑點眼液劑 6 ML 28 0 102/12/01 5 GM 19.8 0 102/12/01 7 GM 19.8 0 102/12/01 15 GM 30.6 0 102/12/01 20 GM 52 0 102/12/01 1 GM 0.8 0 102/12/01 5 ML 39.8 0 102/12/01 錠劑 0.6 0 102/12/01 錠劑 0.69 0 102/12/01 錠劑 1.5 0 102/12/01 錠劑 1.04 0 102/12/01 錠劑 1.5 0 102/12/01 1.16 0 102/12/01 第 17 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 465 1020029758 A039859143 466 1020029758 A039859151 467 1020029758 A039859157 468 1020029758 A039859199 469 1020029969 A041270100 470 1020036289 AC42900482 CYPROH SOLUTION 0.4/ML (CYPROHEPTADINE HYDROCHLORIDE) "KOJAR" CYPROH SOLUTION 0.4/ML 60ML CYPROH SOLUTION 0.4/ML (CYPROHEPTADINE HYDROCHLORIDE) "KOJAR" 國嘉國嘉國嘉 CYPROHEPTADINE HCL 0.4 /ML CYPROHEPTADINE HCL 0.4 /ML CYPROHEPTADINE HCL 0.4 /ML CYPRON SOLUTION 0.4/ML CYPROHEPTADINE "KOJAR"(CYPROHEPT 國嘉 HCL 0.4 /ML ADINE HYDROCHLORIDE) KUETONBILY TABLETS 10 "KOJAR" (DICYCLOMINE HYDROCHLORIDE) CADOTIN NASAL SPRAY 50IU "STANDARD" (SALMON CALCITONIN) 國嘉 DICYCLOMINE HCL 10.00 生達 CALCITONIN 化學 SALMON 550 IU/ML 內服液劑內服液劑內服液劑內服液劑 30 ML 3 0 102/12/01 60 ML 17.6 0 102/12/01 120 ML 21.7 0 102/12/01 1 ML 0.07 0 102/12/01 錠劑 1 0 102/12/01 鼻用氣化噴霧劑 700 IU 693 0 102/12/01 471 1020057616 B023413209 HAEMOPRESSIN 1 WUL FING TERLIPRESSIN- PHA ACETATE RMA (=GLYPRESSIN) 1 GMB H 乾粉 1 1374 0 102/12/01 475 1020066857 B013887100 476 1020068282 A019793212 477 1020068282 A019793221 478 1020068282 A019793229 479 1020068282 A019793238 480 1020068282 A026380216 CABAGIN-U TABLETS KO "KOWA" WA ICOTON "PANBIOTIC" ICOTON "PANBIOTIC" ICOTON "PANBIOTIC" ICOTON "PANBIOTIC" FORMIN 25/ML (DICLOFENAC) "PZNBIOTIC" VITAMIN U (=METHYLMETHIO NINE SULFONIUM CHLORIDE) 25 GLYCYRRHIZATE 臺灣 AMMONIUM SALT 汎生 (=GLYCAMIL) 2 /ML GLYCYRRHIZATE 臺灣 AMMONIUM SALT 汎生 (=GLYCAMIL) 2 /ML GLYCYRRHIZATE 臺灣 AMMONIUM SALT 汎生 (=GLYCAMIL) 2 /ML GLYCYRRHIZATE 臺灣 AMMONIUM SALT 汎生 (=GLYCAMIL) 2 /ML 臺灣 DICLOFENAC 汎生 SODIUM 25 /ML 糖衣錠 1.28 0 102/12/01 2 ML 4.68 0 102/12/01 5 ML 7.7 0 102/12/01 10 ML 14 0 102/12/01 20 ML 18.4 0 102/12/01 3 ML 6 0 102/12/01 第 18 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 481 1020068282 A036768209 482 1020068282 A036768212 483 1020068282 A038615209 484 1020068282 A038615212 485 1020068282 A038615265 486 1020068282 A038615277 TONMEX 20/ML (PIROXICAM) "PANBIOTIC" TONMEX 20/ML (PIROXICAM) "PANBIOTIC" CEFIN FOR I.V. (CEFTRIAXONE) "PANBIOTIC" CEFIN FOR I.V. (CEFTRIAXONE) "PANBIOTIC" CEFIN FOR I.V. (CEFTRIAXONE) "PANBIOTIC" CEFIN FOR I.V. (CEFTRIAXONE) "PANBIOTIC" 487 1020068553 A003903100 PELION TABLETS 488 1020068553 A012081100 SPIRON TABLETS 489 1020068553 A0120811G0 SPIRON TABLETS( 鋁箔 / 膠箔 ) 490 1020068956 A023131321 AIFUPO OINTMENT "S.M." 491 1020068956 A023131329 AIFUPO OINTMENT "S.M." 492 1020068956 A023131372 AIFUPO OINTMENT "S.M." 493 1020068956 A023131399 AIFUPO OINTMENT "S.M." 494 1020068956 A039663100 495 1020068956 A0396631G0 496 1020068956 A039683100 497 1020068956 A0396831G0 498 1020068956 A048835321 499 1020068956 A048835329 CIMETIN TABLETS 400 "SENTAI" (CIMETIDINE) CIMETIN TABLETS 400 "SENTAI" (CIMETIDINE)( 鋁箔 / 膠箔 ) CIMETIN TABLETS 200 "SENTAI" (CIMETIDINE) CIMETIN TABLETS 200 "SENTAI" (CIMETIDINE)( 鋁箔 / 膠箔 ) Shuli qing Gel Sentai " Shuli qing Gel Sentai " 臺灣 PIROXICAM 20 汎生 /ML 臺灣 PIROXICAM 20 汎生 /ML CEFTRIAXONE 乾粉臺灣 (DISODIUM 3.5 H2O) 注射汎生 1 GM 劑 CEFTRIAXONE 乾粉臺灣 (DISODIUM 3.5 H2O) 注射汎生 2 GM 劑 CEFTRIAXONE 乾粉臺灣 (DISODIUM 3.5 H2O) 注射汎生 0.25 GM 劑 CEFTRIAXONE 乾粉臺灣 (DISODIUM 3.5 H2O) 注射汎生 500 劑居禮 CYPROHEPTADINE 化學 HCL 4.00 居禮 SPIRONOLACTONE 化學 25.00 居禮 SPIRONOLACTONE 化學 25.00 PREDNISOLONE 昱任 1.25/GM PREDNISOLONE 昱任 1.25/GM PREDNISOLONE 昱任 1.25/GM PREDNISOLONE 昱任 1.25/GM 仙台 CIMETIDINE 藥品 400.00 工業仙台 CIMETIDINE 藥品 400.00 工業仙台 CIMETIDINE 藥品 200.00 工業仙台 CIMETIDINE 藥品 200.00 工業仙台製仙台製 CLINDAMYCIN (PHOSPHATE) 10.00/GM CLINDAMYCIN (PHOSPHATE) 10.00/GM 1 ML 14.7 0 102/12/01 2 ML 14.7 0 102/12/01 1 GM 333 0 102/12/01 2 GM 642 0 102/12/01 250 119 0 102/12/01 500 117 0 102/12/01 錠劑 0.6 0 102/12/01 錠劑 1.1 0 102/12/01 錠劑 1.5 0 102/12/01 5 GM 9.5 0 102/12/01 10 GM 18.1 0 102/12/01 450 GM 739 0 102/12/01 1 GM 0.85 0 102/12/01 錠劑 1 0 102/12/01 錠劑 1.5 0 102/12/01 錠劑 1 0 102/12/01 錠劑 1.5 0 102/12/01 5 GM 10.2 0 102/12/01 10 GM 18.7 0 102/12/01 第 19 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 500 1020068956 A048835335 501 1020068956 A048835338 502 1020068956 A048835399 Shuli qing Gel Sentai " Shuli qing Gel Sentai " Shuli qing Gel Sentai " 503 1020070349 B016870277 SYKLOFOSFAMID 500 504 1020070356 A011652321 BETTERSONE OINTMENT 505 1020070356 A011652329 BETTERSONE OINTMENT 506 1020070356 A011652335 BETTERSONE OINTMENT 507 1020070356 A011652372 BETTERSONE OINTMENT 508 1020070356 A011652399 BETTERSONE OINTMENT 仙台仙台仙台 BAX TER 509 1020070356 A035055321 BECYLIC OINTMENT 510 1020070356 A035055329 BECYLIC OINTMENT 511 1020070356 A035055335 BECYLIC OINTMENT 512 1020070356 A035055338 BECYLIC OINTMENT 513 1020070356 A035055399 BECYLIC OINTMENT 514 1020070356 A042362329 515 1020070356 A042362345 PIROCAM GEL 10/GM "M.S." (PIROXICAM) PIROCAM GEL 10/GM "M.S."(PIROXICAM) 516 1020070356 A042798309 BENOVATE SOLUTION 1/ML 517 1020070356 A042798329 BENOVATE SOLUTION 1/ML 518 1020070356 A042798363 BENOVATE SOLUTION 1/ML CLINDAMYCIN (PHOSPHATE) 10.00/GM CLINDAMYCIN (PHOSPHATE) 10.00/GM CLINDAMYCIN (PHOSPHATE) 10.00/GM CYCLOPHOSPHAMI DE (MONOHYDRATE) 500 (VALERATE) 1.00/GM (VALERATE) 1.00/GM (VALERATE) 1.00/GM (VALERATE) 1.00/GM (VALERATE) 1.00/GM (DIPROPIONATE) 0.50/GM (DIPROPIONATE) 0.50/GM (DIPROPIONATE) 0.50/GM (DIPROPIONATE) 0.50/GM (DIPROPIONATE) 0.50/GM PIROXICAM 10.00/GM PIROXICAM 10.00/GM (VALERATE) 1.00/ML (VALERATE) 1.00/ML (17-VALERATE) 1.00/ML 外用液劑外用液劑外用液劑 15 GM 32.9 0 102/12/01 20 GM 68 0 102/12/01 1 GM 0.43 0 102/12/01 500 0 150 102/12/01 5 GM 12.5 0 102/12/01 10 GM 16 0 102/12/01 15 GM 41.4 0 102/12/01 450 GM 865 0 102/12/01 1 GM 1.18 0 102/12/01 5 GM 15 0 102/12/01 10 GM 28 0 102/12/01 15 GM 80 0 102/12/01 20 GM 42.9 0 102/12/01 1 GM 1.39 0 102/12/01 10 GM 23.6 0 102/12/01 40 GM 45.5 0 102/12/01 1 L (LITER) 1293 0 102/12/01 10 ML 45.4 0 102/12/01 200 ML 326 0 102/12/01 第 20 頁, 共 22 頁

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 519 1020070356 A042798399 BENOVATE SOLUTION 1/ML (VALERATE) 1.00/ML 外用液劑 1 ML 0.86 0 102/12/01 METAPROTERENOL 520 1020070356 A043696151 KOPIN SOLUTION SULFATE(=ORCIPRE 內服 NALINE SULFATE) 液劑 0.50/ML 60 ML 10.3 0 102/12/01 METAPROTERENOL 521 1020070356 A043696199 KOPIN SOLUTION SULFATE(=ORCIPRE 內服 NALINE SULFATE) 液劑 0.50/ML 1 ML 0.16 0 102/12/01 522 1020070356 A045341321 BADINE CREAM 523 1020070356 A045341329 BADINE CREAM 524 1020070356 A045341399 BADINE CREAM 525 1020070356 A048376321 Benafine Cream 526 1020070356 A048376329 Benafine Cream 527 1020070356 A048376335 Benafine Cream 528 1020070356 A048376355 Benafine Cream 529 1020070356 A048376399 Benafine Cream 530 1020070356 A049919323 531 1020070356 A049919329 532 1020070356 A049919330 533 1020070356 A049919399 534 1020070616 N001451100 535 1020070654 A042905338 536 1020070654 A042905343 537 1020070654 A042905345 ALEDO GEL 10/GM ALEDO GEL 10/GM ALEDO GEL 10/GM ALEDO GEL 10/GM DL- METHYLEPHEDRINE HCL TABLETS PIROXICAM GEL 1.0% "N.W." PIROXICAM GEL 1.0% "N.W." PIROXICAM GEL 1.0% "N.W." (DIPROPIONATE) 0.50/GM (DIPROPIONATE) 0.50/GM (DIPROPIONATE) 0.50/GM BUTENAFINE HCL 10.00/GM BUTENAFINE HCL 10.00/GM BUTENAFINE HCL 10.00/GM BUTENAFINE HCL 10.00/GM BUTENAFINE HCL 10.00/GM CLINDAMYCIN (PHOSPHATE) 10.00/GM CLINDAMYCIN (PHOSPHATE) 10.00/GM CLINDAMYCIN (PHOSPHATE) 10.00/GM CLINDAMYCIN (PHOSPHATE) 10.00/GM 大豐製藥 METHYLEPHEDRIN 股份 E DL- HCL 25 有限公司內外內外內外 PIROXICAM 10 /GM PIROXICAM 10 /GM PIROXICAM 10 /GM 第 21 頁, 共 22 頁乳膏劑乳膏劑乳膏劑乳膏劑乳膏劑乳膏劑乳膏劑乳膏劑 5 GM 18.3 0 102/12/01 10 GM 18.3 0 102/12/01 1 GM 0.94 0 102/12/01 5 GM 42.3 0 102/12/01 10 GM 77 0 102/12/01 15 GM 83 0 102/12/01 100 GM 745 0 102/12/01 1 GM 4.02 0 102/12/01 6 GM 18.7 0 102/12/01 10 GM 18.7 0 102/12/01 12 GM 19.6 0 102/12/01 1 GM 0.43 0 102/12/01 錠劑 0 0.21 102/12/01 20 GM 0 32.9 102/12/01 30 GM 0 45.5 102/12/01 40 GM 0 45.5 102/12/01

項次發文號健保代碼藥品名稱牌成分及含量劑型規格量原核定價新核定價生效日期 538 1020070688 A029511100 MANLSUN CAPSULES 中美 FLURAZEPAM 30 (FLURAZEPAM) 製 (HCL) 30 0 3.48 102/12/01 539 1020081731 AC45445415 CALCININ NASAL SPRAY 200I.U "PURZER" CALCITONIN 瑞安 SALMON 2200 觀音 IU/ML 鼻用噴液劑 2.8 KIU 1052 0 102/12/01 540 1020081732 AC46648415 CASPRAY NASAL SPRAY 200 I.U. CALCITONIN 中化 SALMON 2200 新豐 IU/ML 鼻用噴液劑 2.8 KIU 1206 0 102/12/01 541 1020081733 AC47376415 CADOTIN NASAL SPRAY 200IU "STANDARD" (CALCITONIN- SALMON) CALCITONIN 生達 SALMON 2200 化學 IU/ML 鼻用噴液劑 2.8 KIU 1188 0 102/12/01 542 1020081734 B0181614A1 MIACALCIC NASAL SPRAY 100I.U. NOV CALCITONIN ARTI SALMON 1100 S IU/ML 鼻用氣化噴霧劑 1.4 KIU 1723 0 102/12/01 543 1020081735 B022448415 MIACALCIC NASAL SPRAY 200 I.U. NOV ARTI CALCITONIN S SALMON 2200 PHA IU/ML RMA SAS 鼻用氣化噴霧劑 2.8 KIU 1204 0 102/12/01 544 1020081736 B024721415 APO-CALCITONIN NASAL SPRAY 200IU APO TEX CALCITONIN INC. SALMON 2200 - IU/ML RIC HMO 鼻用噴液劑 2.8 KIU 1186 0 102/12/01 545 1020036465 B023749209 INVANZ 1G LAB ORA TOIR ERTAPENEM ES SODIUM 1000 MER CK 凍晶 1 GM 1390 1189 102/12/01 546 1020036465 B024758255 ERAXIS FOR 100 PHA RMA CIA ANIDULAFUNGIN & 122 UPJ OHN C 凍晶 100 3574 3261 102/12/01 第 22 頁, 共 22 頁