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["2025年湖南省“双通道”单行支付管理药品\n长处方管理清单"]
["序号","类别","通用名","目录剂型","医保限定支付范围","属于哪个系统/哪种慢性病"]
[1,"西药","阿布昔替尼片","片剂","限其他系统治疗(如激素或生物制剂)应答不佳或不适宜上述治疗的难治性、中重度特应性皮炎成人和12岁及以上青少年患者。","其他：特应性皮炎"]
[2,"西药","阿普米司特片","片剂","限符合接受光疗或系统性治疗指征的中度至重度斑块状银屑病的成人患者。","风湿免疫系统：银屑病"]
[3,"西药","艾考恩丙替片","片剂","限艾滋病病毒感染。","其他：艾滋病"]
[4,"西药","艾米替诺福韦片","片剂","限慢性乙型肝炎成人患者。","消化系统：慢性病毒性肝炎"]
[5,"西药","艾诺韦林片","片剂","限艾滋病病毒感染。","其他：艾滋病"]
[6,"西药","艾曲泊帕乙醇胺片","片剂","限：1.既往对糖皮质激素、免疫球蛋白等治疗反应不佳的成人和6岁及以上儿童慢性免疫性(特发性)血小板减少症(ITP)患者；2.既往对免疫抑制治疗缓解不充分的重型再生障碍性贫血(SAA)患者。","血液系统：血小板减少症包括(ITP)"]
[7,"西药","安立生坦","口服常释剂型",null,"循环系统：肺动脉高压"]
[8,"西药","巴瑞替尼片","片剂","限：1.诊断明确的类风湿关节炎经传统DMARDs治疗3-6个月疾病活动度下降低于50%者；2.对一种或多种既往传统合成或生物DMARDs应答不佳或不耐受的2岁及以上活动性幼年特发性关节炎患者，包括：(1)多关节型幼年特发性关节炎(多关节型类风湿因子阳性[RF+]或阴性[RF-]，扩展型少关节炎),(2)附着点炎相关关节炎,(3)幼年银屑病关节炎。可单药使用或与甲氨蝶呤联合用药。","风湿免疫系统：类风湿关节炎"]
[9,"西药","比克恩丙诺片","片剂","限艾滋病病毒感染。","其他：艾滋病"]
[10,"西药","丙酚替诺福韦","口服常释剂型",null,"消化系统：慢性病毒性肝炎"]
[11,"西药","波生坦分散片","分散片","限3-12岁特发性或先天性肺动脉高压患者。","循环系统：肺动脉高压"]
[12,"西药","波生坦片","片剂","限WHO功能分级Ⅱ级-Ⅳ级的肺动脉高压(WHO第1组)的患者。","循环系统：肺动脉高压"]
[13,"西药","德拉马尼片","片剂","限耐多药结核患者。","其他；结核病"]
[14,"西药","地拉罗司","口服常释剂型",null,"血液系统；地中海贫血"]
[15,"西药","富马酸贝达喹啉片","片剂","限耐多药结核患者。","其他：结核病"]
[16,"西药","富马酸二甲酯肠溶胶囊","胶囊","限成人复发型多发性硬化(RMS)。","神经系统：多发性硬化"]
[17,"西药","甘露特钠胶囊","胶囊","限轻度至中度阿尔茨海默病。","神经系统：阿茨海默病"]
[18,"西药","枸橼酸托法替布缓释片","缓释片",null,"风湿免疫系统：类风湿性关节炎、强直性脊柱炎、银屑病"]
[19,"西药","海曲泊帕乙醇胺片","片剂","限：1.既往对糖皮质激素、免疫球蛋白等治疗反应不佳的慢性原发免疫性血小板减少症(ITP)成人患者；2.对免疫抑制治疗(IST)疗效不佳的重型再生障碍性贫血(SAA)成人患者。","血液系统：再生障碍贫血、血小板减少症"]
[20,"西药","环硅酸锆钠散","口服散剂","限成人高钾血症。","泌尿系统：慢性肾脏疾病（CKD1-5期），血液透析"]
[21,"西药","甲苯磺酸艾多沙班片","片剂","限华法林治疗控制不良或出血高危的非瓣膜性房颤、深静脉血栓、肺栓塞患者。","循环系统;心律失常"]
[22,"西药","克立硼罗软膏","软膏剂","限3月龄及以上的轻度至中度特应性皮炎患者。","其他：特异性皮炎"]
[23,"西药","拉米夫定多替拉韦片","片剂","限艾滋病病毒感染。","其他：艾滋病"]
[24,"西药","来迪派韦索磷布韦片","片剂","限成人和12至<18岁青少年的慢性丙型肝炎病毒(HCV)感染。","消化系统：慢性病毒性肝炎"]
[25,"西药","利奥西呱片","片剂","限：1.术后持续性或复发性慢性血栓栓塞性肺动脉高压(CTEPH)或不能手术的CTEPH，且(WHO FC)为II-III的患者；2.动脉性肺动脉高压(PAH)且(WHO FC)为II-III患者的二线用药。","循环系统：肺动脉高压"]
[26,"西药","利鲁唑口服混悬液","口服液体剂","限肌萎缩侧索硬化(ALS)。","神经系统：运动神经元病"]
[27,"西药","磷酸芦可替尼片","片剂","限：1.中危或高危的原发性骨髓纤维化(PMF)(亦称为慢性特发性骨髓纤维化)、真性红细胞增多症继发的骨髓纤维化(PPV-MF)或原发性血小板增多症继发的骨髓纤维化(PET-MF)的成年患者；2.对糖皮质激素或其他系统治疗应答不充分的12岁及以上急性移植物抗宿主病(急性GVHD)或慢性移植物抗宿主病(慢性GVHD)患者。","其他：器官和组织移植状态"]
[28,"西药","磷酸依米他韦胶囊","胶囊","限与索磷布韦片联合，用于治疗成人基因1型非肝硬化慢性丙型肝炎。","消化系统：慢性病毒性肝炎"]
[29,"西药","罗沙司他","口服常释剂型","限慢性肾脏病(CKD)引起的贫血。","泌尿系统：慢性肾脏疾病（CKD1-5期）血液透析，腹膜透析"]
[30,"西药","氯苯唑酸软胶囊","胶囊","限成人野生型或遗传型转甲状腺素蛋白淀粉样变性心肌病(ATTR-CM)。","循环系统：心肌病"]
[31,"西药","马昔腾坦片","片剂","限WHO功能分级II级-III级的肺动脉高压(WHO第1组)的患者。","循环系统：肺动脉高压"]
[32,"西药","司来帕格片","片剂","限WHO功能分级II级-III级的肺动脉高压(WHO第1组)的患者。","循环系统：肺动脉高压"]
[33,"西药","司维拉姆","口服常释剂型",null,"泌尿系统：慢性肾脏疾病（CKD1-5 期）、血液透析"]
[34,"西药","索磷布韦维帕他韦片","片剂","限成人慢性丙型肝炎病毒(HCV)感染。","消化系统：慢性病毒性肝炎"]
[35,"西药","索磷维伏片","片剂","限既往接受过含直接抗病毒药物(DAA)方案、无肝硬化或伴代偿性肝硬化(Child-Pugh A)的成人慢性丙型肝炎病毒(HCV)感染。","消化系统：慢性病毒性肝炎"]
[36,"西药","碳酸镧","咀嚼片",null,"泌尿系统：慢性肾脏疾病（CKD1-5 期）、血液透析"]
[37,"西药","特立氟胺片","片剂","限常规治疗无效的多发性硬化患者。","神经系统：多发性硬化症"]
[38,"西药","托法替布","口服常释剂型",null,"风湿免疫系统：强直性脊柱炎，银屑病，类风湿关节炎"]
[39,"西药","乌帕替尼缓释片","缓释片","限：1.12岁及以上患者难治性、中重度特应性皮炎的二线治疗；2.活动性银屑病关节炎成人患者的二线治疗；3.中重度活动性类风湿关节炎成人患者的二线治疗；4.对一种或多种TNF抑制剂应答不佳或不耐受或禁忌的中度至重度活动性溃疡性结肠炎成人患者；5.对一种或多种TNF抑制剂应答不佳或不耐受或禁忌的中度至重度活动性克罗恩病成人患者；6.对非甾体抗炎药(NSAID)应答不佳且存在客观炎症征象(表现为C反应蛋白[CRP]升高和/或磁共振成像[MRI]异常)的活动性放射学阴性中轴型脊柱关节炎(nr-axSpA)成人患者；7.对一种或多种TNF抑制剂应答不佳或不耐受的活动性强直性脊柱炎(AS，放射学阳性中轴型脊柱关节炎)成人患者。","风湿免疫系统：银屑病、类风湿关节炎  强直性脊柱炎、脊柱关节炎\n消化系统：克罗恩、溃疡性结肠炎\n其他：特应性皮炎\n\n\n                  "]
[40,"西药","西尼莫德片","片剂","限成人复发型多发性硬化的患者。","神经系统：多发性硬化症"]
[41,"西药","盐酸芬戈莫德胶囊","胶囊","限10岁及以上患者复发型多发性硬化(RMS)的患者。","神经系统：多发性硬化症"]
[42,"西药","盐酸可洛派韦胶囊","胶囊","限基因 1、2、3、6 型成人慢性丙型肝炎。","消化系统：慢性病毒性肝炎"]
[43,"西药","伊马替尼","口服常释剂型",null,"血液系统：骨髓增生异常综合征"]
[44,"西药","乙磺酸尼达尼布软胶囊","胶囊","限：1.特发性肺纤维化(IPF)；2.系统性硬化病相关间质性肺疾病(SSc-ILD)；3.具有进行性表型的慢性纤维化性间质性肺疾病。","呼吸系统：肺纤维化"]
[45,"西药","艾诺米替片","片剂","限艾滋病病毒感染。","其它：艾滋病"]
[46,"西药","氨己烯酸口服溶液用散","散剂","限婴儿痉挛症。","神经系统：癫痫"]
[47,"西药","奥磷布韦片","片剂","限基因 1、2、3、6 型成人慢性丙型肝炎。","消化系统：慢性病毒性肝炎"]
[48,"西药","恩那度司他片","薄膜衣片","限非透析的成人慢性肾脏病(CKD)患者。","泌尿系统：慢性肾脏疾病（CKD1-5期）"]
[49,"西药","盐酸奥扎莫德胶囊","胶囊","限成人复发型多发性硬化。","神经系统：多发性硬化症"]
[50,"西药","蔗糖羟基氧化铁咀嚼片","咀嚼片","限：1.接受血液透析(HD)或腹膜透析(PD)的成人慢性肾脏病(CKD)患者；2.12岁及以上CKD4-5期(定义为肾小球滤过率<30 mL/min/1.73 m²)或接受透析的CKD儿科患者。","泌尿系统：慢性肾脏疾病（CKD1-5期），血液透析，腹膜透析"]
[51,"西药","贝前列素钠缓释片","缓释片","限WHO功能分级Ⅰ级-Ⅲ级的肺动脉高压(PAH，WHO第1组)的患者，以改善患者的运动能力。","循环系统：肺动脉高压"]
[52,"西药","本维莫德乳膏","乳膏剂","限成人轻至中度稳定性寻常型银屑病的局部治疗。","风湿免疫系统：银屑病\n"]
[53,"西药","布地奈德肠溶胶囊","胶囊","限具有进展风险的原发性免疫球蛋白A肾病(IgAN)成人患者。","泌尿系统：慢性肾炎"]
[54,"西药","布立西坦片","片剂","限16岁及以上癫痫患者部分性发作的单药治疗和添加治疗。","神经系统：癫痫"]
[55,"中成药","参乌益肾片","片剂","限慢性肾衰竭患者。","泌尿系统：慢性肾脏疾病（CKD1-5期）"]
[56,"西药","氘可来昔替尼片","片剂","限适合系统治疗或光疗的成年中重度斑块状银屑病患者。","风湿免疫系统：银屑病"]
[57,"西药","地拉罗司颗粒","颗粒剂","限：1.年龄大于2岁的β-地中海贫血患者；2.10岁及10岁以上非输血依赖性地中海贫血综合征患者。","血液系统：地中海贫血"]
[58,"西药","对氨基水杨酸肠溶颗粒","颗粒剂",null,"其他：结核病"]
[59,"西药","多拉米替片","片剂","限艾滋病病毒感染。","其他：艾滋病"]
[60,"西药","甲磺酸贝舒地尔片","片剂","限对糖皮质激素或其他系统治疗应答不充分的12岁及以上慢性移植物抗宿主病患者。","其他：器官和组织移植状态"]
[61,"西药","玛伐凯泰胶囊","胶囊","限纽约心脏协会(NYHA)心功能分级Ⅱ-Ⅲ级的梗阻性肥厚型心肌病(oHCM)成人患者。","循环系统：心肌病"]
[62,"中成药","桑枝总生物碱片","片剂",null,"内分泌和代谢性疾病：糖尿病（含慢性并发症）"]
[63,"西药","司替戊醇干混悬剂","干混悬剂","限婴儿严重肌阵挛性癫痫(SMEI，Dravet综合征)患者。","神经系统：癫痫"]