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["附件"]
["河南省基本医疗保险第二批重特大疾病医疗保障门诊病种"]
["序号","病种名称","治疗方法","说明"]
[1,"HER2阳性乳腺癌","门诊单克隆抗体药物治疗","限支付曲妥珠单抗费用，并符合以下情况方可支付：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。"]
[null,null,"门诊蛋白激酶抑制剂药物治疗","限支付拉帕替尼费用，并符合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。"]
[null,null,"门诊内分泌治疗","限支付氟维司群费用，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。"]
[2,"晚期胃癌","门诊单克隆抗体药物治疗","限支付曲妥珠单抗费用，并符合以下情况方可支付：HER2阳性的晚期转移性胃癌。"]
[null,null,"门诊蛋白激酶抑制剂药物治疗","限支付阿帕替尼费用，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。"]
[3,"Ⅲ/Ⅳ期鼻咽癌","门诊单克隆抗体药物治疗联合放疗","限支付尼妥珠单抗与放疗费用，表皮生长因子受体(EGFR)表达阳性的Ⅲ/Ⅳ期鼻咽癌。"]
[4,"外周T细胞淋巴瘤","门诊西达本胺药物治疗","限支付西达本胺费用，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。"]
[5,"晚期肾癌","门诊蛋白激酶抑制剂药物治疗","限支付索拉菲尼费用，并符合以下情况：不能手术的肾细胞癌。"]
[null,null,"门诊免疫抑制剂药物治疗","限支付依维莫司费用，并符合以下情况：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。"]
[6,"胰腺神经内分泌瘤","门诊免疫抑制剂药物治疗","限支付依维莫司费用，并符合以下情况：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。"]
[7,"肾血管平滑肌脂肪瘤","门诊免疫抑制剂药物治疗","限支付依维莫司费用，并符合以下情况：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。"]
[8,"肝癌","门诊蛋白激酶抑制剂药物治疗","限支付索拉非尼费用，不能手术或远处转移的肝细胞癌。"]
[9,"甲状腺癌","门诊蛋白激酶抑制剂药物治疗","限支付索拉非尼费用，放射性碘治疗无效的局部复发或转移性、分化型甲状腺癌。"]
[10,"多发性骨髓瘤","门诊免疫抑制剂药物治疗","限支付来那度胺费用。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。"]
[11,"前列腺癌","门诊激素拮抗剂及相关药物治疗","限支付阿比特龙费用，转移性去势抵抗性前列腺癌。"]
[12,"多发性硬化","门诊干扰素药物治疗","限支付重组人干扰素β-1b费用，限常规治疗无效的多发性硬化患者。"]
[13,"黄斑变性","门诊手术治疗","限支付康柏西普费用和手术费用，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。"]
[null,null,"门诊手术治疗","限支付雷珠单抗费用和手术费用，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。"]
[14,"肌萎缩侧索硬化","门诊利鲁唑药物治疗","限支付利鲁唑费用。"]
[15,"原发性免疫球蛋白缺乏症","门诊免疫替补疗法","限支付静脉注射用人免疫球蛋白（PH4）费用。"]
[16,"特发性肺纤维化","门诊免疫抑制剂治疗","限支付吡非尼酮费用。"]