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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
69452-0350-11 69452-0350 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb 28, 2022 In Use
21695-0745-12 21695-0745 Dexamethasone Dexamethasone 2.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Aug 26, 1982 In Use
69452-0350-92 69452-0350 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb 28, 2022 In Use
69468-0151-10 69468-0151 Uridine Triacetate Vistogard 951.0 mg/g Ancillary Therapy Chemoprotective Antidote Oral Mar 1, 2016 In Use
69468-0151-20 69468-0151 Uridine Triacetate Vistogard 951.0 mg/g Ancillary Therapy Chemoprotective Antidote Oral Mar 1, 2016 In Use
69488-0003-01 69488-0003 Lutetium Lu 177 dotatate Lutathera 10.0 mCi/mL Chemotherapy Radiopharmaceutical Somatostatin Analog Intravenous Jan 26, 2018 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
69539-0019-60 69539-0019 Capecitabine Capecitabine 150.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral Jul 2, 2018 In Use
69539-0019-99 69539-0019 Capecitabine Capecitabine 150.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral Jul 2, 2018 In Use
69539-0020-92 69539-0020 Capecitabine Capecitabine 500.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral Jul 2, 2018 In Use
69539-0049-92 69539-0049 Abiraterone acetate Abiraterone 250.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor CYP17 Inhibitor Oral Jul 10, 2019 In Use
69539-0090-30 69539-0090 Erlotinib Hydrochloride Erlotinib Hydrochloride 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor EGFR Oral May 11, 2021 In Use
69639-0101-01 69639-0101 Netupitant and Palonosetron Akynzeo 300.0 mg/1, 0.5 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Anatagonist/Substance P/Neurokinin 1 Oral Oct 13, 2014 In Use
69639-0102-01 69639-0102 Fosnetupitant and Palonosetron AKYNZEO 260.0 mg/1, 0.28 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Anatagonist/Substance P/Neurokinin 1 Intravenous Apr 20, 2018 In Use
69639-0120-01 69639-0120 Mechlorethamine hydrochloride VALCHLOR 0.012 g/60g Chemotherapy Alkylating Agent Nitrogen Mustard TOPICAL Nov 8, 2018 In Use
21695-0896-10 21695-0896 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Aug 9, 1996 In Use
69918-0720-10 69918-0720 Arsenic Trioxide ARSENIC TRIOXIDE 1.0 mg/mL Chemotherapy Miscellaneous Agent PML/RARa Intravenous Nov 14, 2018 In Use
21695-0896-20 21695-0896 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Aug 9, 1996 In Use
21695-0896-30 21695-0896 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Aug 9, 1996 In Use
66658-0113-03 66658-0113 Palifermin KEPIVANCE 5.16 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Aug 4, 2023 In Use
00069-0284-03 00069-0284 Palbociclib Ibrance 75.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Mar 30, 2020 In Use
00310-1350-95 00310-1350 Osimertinib Tagrisso 80.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor EGFR Oral Mar 15, 2019 In Use
21695-0952-05 21695-0952 Methylprednisolone Acetate Depo-Medrol 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intralesional, Intramuscular, Intrasynovial, Soft Tissue May 28, 1959 In Use
69668-0120-20 69668-0120 Prednisone Deltasone 20.0 mg/20mg Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Aug 31, 2015 In Use
63629-4014-07 63629-4014 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Mar 20, 2013 In Use

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