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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
69448-0016-11 69448-0016 Trastuzumab-strf HERCESSI 420.0 mg/20mL, 420.0 mg/20mL Immunotherapy Monoclonal Antibody HER2 Intravenous Jan 1, 2025 In Use
00085-1388-01 00085-1388 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon Mar 29, 2011 Jan 13, 2016 No Longer Used
57894-0503-01 57894-0503 Daratumumab and hyaluronidase-fihj (human recombinant) Darzalex Faspro 1800.0 mg/15mL, 4.9 mg/15mL, 18.4 mg/15mL, 30000.0 U/15mL, 13.5 mg/15mL, 6.0 mg/15mL, 735.1 mg/15mL Immunotherapy Monoclonal Antibody CD38 Subcutaneous May 1, 2020 In Use
51991-0343-21 51991-0343 Pomalidomide Pomalidomide 2.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb 28, 2026 In Use
59651-0194-21 59651-0194 Pomalidomide Pomalidomide 1.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Oct 30, 2020 In Use
00004-0350-39 00004-0350 Peginterferon alfa-2a Pegasys 180.0 ug/mL Immunotherapy Cytokine Interferon Subcutaneous Oct 16, 2002 Sep 1, 2009 No Longer Used
65219-0672-01 65219-0672 Denosumab BOMYNTRA 70.0 mg/mL Immunotherapy Monoclonal Antibody RANKL Subcutaneous Jun 30, 2025 In Use
00085-1312-01 00085-1312 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon Mar 29, 2011 Jan 13, 2016 No Longer Used
00310-4535-30 00310-4535 Tremelimumab IMJUDO 300.0 mg/15mL Immunotherapy Monoclonal Antibody CTLA-4 Intravenous Oct 21, 2022 In Use
59651-0342-28 59651-0342 Lenalidomide Lenalidomide 2.5 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 6, 2023 In Use
59572-0410-00 59572-0410 Lenalidomide Revlimid 10.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Dec 27, 2005 In Use
59651-0345-01 59651-0345 Lenalidomide Lenalidomide 15.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 6, 2023 In Use
70095-0130-01 70095-0130 Cosibelimab UNLOXCYT 300.0 mg/5mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous Dec 8, 2025 In Use
50242-0260-01 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 Jun 29, 2020 In Use
68727-0950-02 68727-0950 Zanidatamab-hrii ZIIHERA 50.0 mg/mL Immunotherapy Bispecific Antibody HER2 Intravenous Nov 20, 2024 In Use
60505-4535-01 60505-4535 Lenalidomide Lenalidomide 15.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Sep 6, 2022 Mar 8, 2023 In Use
55513-0078-01 55513-0078 Talimogene Laherparepvec Imlygic 1000000.0 [PFU]/mL Immunotherapy Therapeutic Cancer Vaccine Oncolytic Virus Intralesional Nov 2, 2015 In Use
00093-6126-64 00093-6126 Imiquimod Imiquimod Immunotherapy Immunomodulator Dermatological Agent Topical Dec 19, 2013 Apr 30, 2015 No Longer Used
00115-1476-59 00115-1476 Imiquimod Imiquimod 50.0 mg/g Immunotherapy Immunomodulator Dermatological Agent Topical Feb 28, 2011 Jun 1, 2017 No Longer Used
00069-0238-01 00069-0238 Rituximab-pvvr Ruxience 100.0 mg/10mL Immunotherapy Monoclonal Antibody CD20 Intravenous Jan 23, 2020 In Use
43598-0515-01 43598-0515 Lenalidomide Lenalidomide 25.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Sep 6, 2022 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
59651-0196-21 59651-0196 Pomalidomide Pomalidomide 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Oct 30, 2020 In Use

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