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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
00310-4611-50 00310-4611 Durvalumab Imfinzi 500.0 mg/10mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous May 1, 2017 In Use
31722-0261-01 31722-0261 LENALIDOMIDE LENALIDOMIDE 20.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral May 11, 2023 In Use
00480-1246-21 00480-1246 Lenalidomide Lenalidomide 25.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Mar 3, 2022 In Use
57894-0502-20 57894-0502 Daratumumab Darzalex 100.0 mg/5mL Immunotherapy Monoclonal Antibody CD38 Intravenous Nov 16, 2015 Nov 30, 2026 In Use
00781-7152-13 00781-7152 Imiquimod Imiquimod Immunotherapy Immunomodulator Dermatological Agent Topical Feb 28, 2011 May 31, 2014 No Longer Used
76282-0697-48 76282-0697 Lenalidomide Lenalidomide 5.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Sep 6, 2022 In Use
29336-0610-12 29336-0610 Imiquimod Aldara Immunotherapy Immunomodulator Dermatological Agent Topical Sep 24, 2010 Jan 31, 2015 No Longer Used
29336-0610-24 29336-0610 Imiquimod Aldara Immunotherapy Immunomodulator Dermatological Agent Topical Jun 24, 2011 Jun 24, 2011 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
45802-0368-62 45802-0368 Imiquimod Imiquimod 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical Nov 9, 2010 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
50242-0051-10 50242-0051 Rituximab Rituxan 10.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous Jun 3, 2019 In Use
50242-0070-01 50242-0070 Obinutuzumab Gazyva 1000.0 mg/40mL Immunotherapy Monoclonal Antibody CD20 Intravenous Nov 1, 2013 In Use
50242-0087-01 50242-0087 ADO-Trastuzumab Emtansine Kadcyla 20.0 mg/mL, 20.0 mg/mL Immunotherapy Drug Antibody Conjugate HER2 Intravenous Feb 22, 2013 In Use
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
50242-0105-01 50242-0105 polatuzumab vedotin POLIVY 140.0 mg/7.52mL Immunotherapy Drug Antibody Conjugate CD79b Intravenous Jun 10, 2019 In Use
50242-0053-06 50242-0053 Rituximab Rituxan 10.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous Nov 26, 1997 In Use
50242-0145-01 50242-0145 Pertuzumab Perjeta 30.0 mg/mL Immunotherapy Monoclonal Antibody HER2 Intravenous Jun 8, 2012 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
50242-0260-01 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
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
50242-0917-86 50242-0917 Atezolizumab Tecentriq 1200.0 mg/20mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous Aug 11, 2016 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
00093-6126-64 00093-6126 Imiquimod Imiquimod Immunotherapy Immunomodulator Dermatological Agent Topical Dec 19, 2013 Apr 30, 2015 No Longer Used

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