| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 69315-0185-24 | 69315-0185 | Leucovorin calcium | Leucovorin calcium | 10.0 mg/1 | Ancillary Therapy | Chemoprotective | Antidote | Oral | Nov 16, 2020 | In Use | |
| 53270-0101-01 | 53270-0101 | Levoleucovorin | Fusilev | Ancillary Therapy | Chemoprotective | Antidote | Aug 15, 2008 | Feb 24, 2010 | No Longer Used | ||
| 71288-0105-25 | 71288-0105 | Levoleucovorin calcium | Levoleucovorin | 10.0 mg/mL | Ancillary Therapy | Chemoprotective | Antidote | Intravenous | Aug 16, 2019 | In Use | |
| 70860-0209-10 | 70860-0209 | Mesna | Mesna | 100.0 mg/mL | Ancillary Therapy | Chemoprotective | Detoxifying Agent | Intravenous | Feb 28, 2018 | In Use | |
| 25021-0201-10 | 25021-0201 | Mesna | Mesna | 100.0 mg/mL | Ancillary Therapy | Chemoprotective | Detoxifying Agent | Intravenous | Dec 1, 2010 | In Use | |
| 70436-0210-80 | 70436-0210 | Levoleucovorin injection | LEVOLEUCOVORIN CALCIUM | 10.0 mg/mL | Ancillary Therapy | Chemoprotective | Antidote | Intravenous | Aug 1, 2023 | In Use | |
| 00703-5145-91 | 00703-5145 | Leucovorin Calcium | Leucovorin Calcium | 350.0 mg/17.5mL | Ancillary Therapy | Chemoprotective | Antidote | Intramuscular, Intravenous | May 13, 2013 | Apr 30, 2023 | No Longer Used |
| 55390-0009-01 | 55390-0009 | Leucovorin Calcium | Leucovorin Calcium | Ancillary Therapy | Chemoprotective | Antidote | Jun 8, 2000 | Jun 30, 2013 | No Longer Used | ||
| 00054-4496-25 | 00054-4496 | Leucovorin Calcium | Leucovorin Calcium | 5.0 mg/1 | Ancillary Therapy | Chemoprotective | Antidote | Oral | Feb 22, 1993 | In Use | |
| 68152-0102-02 | 68152-0102 | Levoleucovorin | Fusilev | 10.0 mg/mL | Ancillary Therapy | Chemoprotective | Antidote | Intravenous | Sep 15, 2011 | Feb 28, 2019 | No Longer Used |
| 52125-0453-02 | 52125-0453 | Leucovorin Calcium | Leucovorin Calcium | 5.0 mg/1 | Ancillary Therapy | Chemoprotective | Antidote | Oral | Mar 12, 2013 | Mar 12, 2014 | No Longer Used |
| 47781-0622-22 | 47781-0622 | Mesna | Mesna | 100.0 mg/mL | Ancillary Therapy | Chemoprotective | Detoxifying Agent | Intravenous | Mar 29, 2018 | Mar 1, 2020 | In Use |
| 69468-0151-20 | 69468-0151 | Uridine Triacetate | Vistogard | 951.0 mg/g | Ancillary Therapy | Chemoprotective | Antidote | Oral | Mar 1, 2016 | In Use | |
| 58178-0017-03 | 58178-0017 | Amifostine | Ethyol | Ancillary Therapy | Chemoprotective | Detoxifying Agent | Dec 8, 1995 | Apr 30, 2012 | No Longer Used | ||
| 42806-0134-24 | 42806-0134 | Leucovorin Calcium | Leucovorin Calcium | 15.0 mg/1 | Ancillary Therapy | Chemoprotective | Antidote | Oral | Jan 1, 2021 | In Use | |
| 69468-0151-10 | 69468-0151 | Uridine Triacetate | Vistogard | 951.0 mg/g | Ancillary Therapy | Chemoprotective | Antidote | Oral | Mar 1, 2016 | In Use | |
| 50742-0464-50 | 50742-0464 | Leucovorin Calcium | Leucovorin Calcium | 10.0 mg/mL | Ancillary Therapy | Chemoprotective | Antidote | Intramuscular, Intravenous | Nov 23, 2018 | In Use | |
| 72893-0004-01 | 72893-0004 | Levoleucovorin | KHAPZORY | 175.0 mg/3.5mL | Ancillary Therapy | Chemoprotective | Antidote | Intravenous | Jan 2, 2019 | In Use | |
| 00703-4805-03 | 00703-4805 | Mesna | Mesna | 100.0 mg/mL | Ancillary Therapy | Chemoprotective | Detoxifying Agent | Intravenous | May 1, 2002 | Jan 31, 2013 | No Longer Used |
| 68152-0102-01 | 68152-0102 | Levoleucovorin | Fusilev | 10.0 mg/mL | Ancillary Therapy | Chemoprotective | Antidote | Intravenous | Sep 15, 2011 | Feb 28, 2019 | No Longer Used |
| 47781-0622-91 | 47781-0622 | Mesna | Mesna | 100.0 mg/mL | Ancillary Therapy | Chemoprotective | Detoxifying Agent | Intravenous | Mar 29, 2018 | Mar 1, 2020 | In Use |
| 55390-0347-01 | 55390-0347 | Mesna | Mesna | Ancillary Therapy | Chemoprotective | Detoxifying Agent | Mar 3, 2008 | Jul 31, 2012 | No Longer Used | ||
| 42806-0133-21 | 42806-0133 | Leucovorin Calcium | Leucovorin Calcium | 10.0 mg/1 | Ancillary Therapy | Chemoprotective | Antidote | Oral | Jan 1, 2021 | In Use | |
| 00078-0874-21 | 00078-0874 | Ribociclib | Kisqali | 200.0 mg/1, 200.0 mg/1 | Chemotherapy | Cyclin Dependent Kinase Inhibitor | CDK 4/6 | Oral | Mar 13, 2017 | 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 |
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