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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
00004-0360-09 00004-0360 Peginterferon alfa-2a Pegasys 135.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Nov 1, 2011 Feb 8, 2018 No Longer Used
00310-4611-50 00310-4611 Durvalumab Imfinzi 500.0 mg/10mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous May 1, 2017 In Use
00480-1242-28 00480-1242 Lenalidomide Lenalidomide 5.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 3, 2022 In Use
78206-0148-01 78206-0148 Ontruzant Ontruzant Immunotherapy Monoclonal Antibody HER2 Intravenous Jun 1, 2021 In Use
29336-0610-12 29336-0610 Imiquimod Aldara Immunotherapy Immunomodulator Dermatological Agent Topical Sep 24, 2010 Jan 31, 2015 No Longer Used
42238-0111-12 42238-0111 Interferon gamma-1b Actimmune 100.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Dec 1, 2013 Jan 17, 2018 No Longer Used
42747-0761-01 42747-0761 mogamulizumab-kpkc POTELIGEO 4.0 mg/mL Immunotherapy Monoclonal Antibody CCR4 Intravenous Aug 8, 2018 In Use
45802-0076-62 45802-0076 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical Apr 20, 2010 Aug 1, 2013 No Longer Used
45802-0368-53 45802-0368 Imiquimod Imiquimod 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical Jul 12, 2012 In Use
76282-0697-48 76282-0697 Lenalidomide Lenalidomide 5.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Sep 6, 2022 In Use
49281-0880-03 49281-0880 BACILLUS CALMETTE-GUERIN SUBSTRAIN CONNAUGHT LIVE ANTIGEN THERACYS 81.0 mg/3mL Immunotherapy Biological Response Modifier Live Vaccine Intravesical Jul 22, 2011 May 8, 2017 No Longer Used
50242-0088-01 50242-0088 ADO-Trastuzumab Emtansine Kadcyla 20.0 mg/mL, 20.0 mg/mL Immunotherapy Drug Antibody Conjugate HER2 Intravenous Feb 22, 2013 In Use
50242-0103-01 50242-0103 polatuzumab vedotin POLIVY 30.0 mg/1.88mL Immunotherapy Drug Antibody Conjugate CD79b Intravenous Sep 18, 2020 In Use
50242-0132-01 50242-0132 Trastuzumab Herceptin 150.0 mg/7.4mL Immunotherapy Monoclonal Antibody HER2 Intravenous Feb 10, 2017 In Use
50242-0132-10 50242-0132 Trastuzumab Herceptin 150.0 mg/7.4mL Immunotherapy Monoclonal Antibody HER2 Intravenous Jun 3, 2019 In Use
50242-0245-01 50242-0245 Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Phesgo 30000.0 U/15mL, 1200.0 mg/15mL, 600.0 mg/15mL Immunotherapy Monoclonal Antibody HER2 Subcutaneous Jun 29, 2020 In Use
50242-0245-86 50242-0245 Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Phesgo 30000.0 U/15mL, 1200.0 mg/15mL, 600.0 mg/15mL Immunotherapy Monoclonal Antibody HER2 Subcutaneous May 3, 2021 In Use
50242-0260-86 50242-0260 Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Phesgo 20000.0 U/10mL, 600.0 mg/10mL, 600.0 mg/10mL Immunotherapy Monoclonal Antibody HER2 Subcutaneous May 3, 2021 In Use
50242-0333-01 50242-0333 Trastuzumab Herceptin Immunotherapy Monoclonal Antibody HER2 Feb 10, 2017 Feb 10, 2017 No Longer Used
00006-3026-02 00006-3026 Pembrolizumab Keytruda 25.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Jan 15, 2015 In Use
50242-0051-21 50242-0051 Rituximab Rituxan 10.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous Nov 26, 1997 In Use
51144-0003-01 51144-0003 Tisotumab vedotin TIVDAK 40.0 mg/4mL Immunotherapy Drug Antibody Conjugate Tissue factor Intravenous Sep 20, 2021 In Use
51144-0020-01 51144-0020 ENFORTUMAB VEDOTIN PADCEV 20.0 mg/2mL Immunotherapy Drug Antibody Conjugate Nectin-4 Intravenous Dec 18, 2019 In Use
76282-0701-48 76282-0701 Lenalidomide Lenalidomide 25.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Sep 6, 2022 In Use
83257-0003-01 83257-0003 Trastuzumab-dkst OGIVRI 420.0 mg/20mL Immunotherapy Monoclonal Antibody HER2 Intravenous Oct 1, 2023 In Use

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