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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
00078-1217-61 00078-1217 Lutetium Lu 177 vipivotide tetraxetan PLUVICTO 27.0 mCi/mL Radiopharmaceutical Radiopharmaceutical PSMA Intravenous Jan 15, 2026 In Use
69488-0010-61 69488-0010 Lutetium Lu 177 vipivotide tetraxetan PLUVICTO 27.0 mCi/mL Radiopharmaceutical Radiopharmaceutical PSMA Intravenous Mar 23, 2022 In Use
45802-0076-00 45802-0076 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical Apr 20, 2010 Aug 1, 2013 No Longer Used
00085-4347-01 00085-4347 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon Aug 30, 2014 Oct 18, 2020 In Use
45802-0368-62 45802-0368 Imiquimod Imiquimod 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical Nov 9, 2010 In Use
55513-0207-21 55513-0207 Bevacizumab-awwb MVASI 400.0 mg/16mL, 400.0 mg/16mL Immunotherapy Monoclonal Antibody VEGFR Intravenous Jun 27, 2025 In Use
00480-4018-21 00480-4018 Pomalidomide Pomalidomide 1.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 2, 2026 In Use
31722-0772-21 31722-0772 Pomalidomide Pomalidomide 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb 28, 2026 In Use
60505-4497-02 60505-4497 Pomalidomide Pomalidomide 1.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 11, 2026 In Use
00085-1287-03 00085-1287 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon Mar 29, 2011 Jan 13, 2016 No Longer Used
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
50242-0108-86 50242-0108 Rituximab and hyaluronidase Rituxan Hycela 2000.0 U/mL, 2000.0 U/mL, 120.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Subcutaneous Jun 23, 2017 In Use
57894-0515-01 57894-0515 AMIVANTAMAB and HYALURONIDASE-lpuj (HUMAN RECOMBINANT) Rybrevant Faspro 2400.0 mg/15mL, 30000.0 mg/15mL Immunotherapy Monoclonal Antibody EGFR, MET Subcutaneous Feb 13, 2026 In Use
63304-0044-01 63304-0044 Lenalidomide Lenalidomide 15.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 4, 2023 In Use
00085-1133-01 00085-1133 Interferon alfa-2b Intron A 19.2 ug/.5mL Immunotherapy Cytokine Interferon Intralesional, Intramuscular, Subcutaneous Jun 4, 1986 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
00480-2601-21 00480-2601 Pomalidomide Pomalidomide 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 2, 2026 In Use
00480-4035-21 00480-4035 Pomalidomide Pomalidomide 4.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 2, 2026 In Use
00004-0352-98 00004-0352 Peginterferon alfa-2a Pegasys Immunotherapy Cytokine Interferon Oct 16, 2002 Jul 31, 2015 No Longer Used
00006-3026-04 00006-3026 Pembrolizumab Keytruda 25.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Aug 1, 2019 In Use
59572-0503-21 59572-0503 Pomalidomide Pomalyst 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb 18, 2013 In Use
44087-3535-01 44087-3535 Avelumab Bavencio 20.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous Mar 23, 2017 In Use
00173-0896-01 00173-0896 Belantamab Blenrep 50.0 mg/mL Immunotherapy Drug Antibody Conjugate BCMA Intravenous Aug 5, 2020 Jun 30, 2024 No Longer Used
00004-0360-30 00004-0360 Peginterferon alfa-2a Pegasys 135.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Nov 1, 2011 Jan 31, 2019 No Longer Used
55513-0955-01 55513-0955 Panitumumab Vectibix 200.0 mg/10mL Immunotherapy Monoclonal Antibody EGFR Intravenous Oct 10, 2006 Feb 28, 2010 No Longer Used

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