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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
00310-4505-25 00310-4505 Tremelimumab IMJUDO 25.0 mg/1.25mL Immunotherapy Checkpoint Inhibitor CTLA-4 Intravenous Oct 21, 2022 In Use
00003-2328-22 00003-2328 Ipilimumab Yervoy 5.0 mg/mL Immunotherapy Checkpoint Inhibitor CTLA-4 Intravenous Mar 25, 2011 In Use
00006-3026-04 00006-3026 Pembrolizumab Keytruda 25.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Aug 1, 2019 In Use
50242-0917-01 50242-0917 Atezolizumab Tecentriq 1200.0 mg/20mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous May 18, 2016 In Use
72579-0121-01 72579-0121 Tislelizumab, Tislelizumab-jsgr TEVIMBRA 10.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Mar 14, 2024 In Use
00006-5083-01 00006-5083 Pembrolizumab and berahyaluronidase alfa-pmph KEYTRUDA QLEX 2000.0 U/mL, 165.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Subcutaneous Sep 19, 2025 In Use
83718-0000-01 83718-0000 Toripalimab-tpzi LOQTORZI 240.0 mg/6mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Oct 27, 2023 In Use
00003-3774-12 00003-3774 Nivolumab Opdivo 10.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Dec 22, 2014 In Use
00006-3026-02 00006-3026 Pembrolizumab Keytruda 25.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Jan 15, 2015 In Use
00006-3029-02 00006-3029 Pembrolizumab Keytruda 50.0 mg/2mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Sep 4, 2014 Dec 21, 2015 In Use
50242-0933-01 50242-0933 Atezolizumab and hyaluronidase-tqjs Tecentriq Hybreza 1875.0 mg/15mL, 30000.0 U/15mL Immunotherapy Checkpoint Inhibitor PD-L1 Subcutaneous Sep 12, 2024 In Use
00003-3756-14 00003-3756 nivolumab OPDIVO 10.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Aug 30, 2021 In Use
50242-0933-86 50242-0933 Atezolizumab and hyaluronidase-tqjs Tecentriq Hybreza 1875.0 mg/15mL, 30000.0 U/15mL Immunotherapy Checkpoint Inhibitor PD-L1 Subcutaneous Sep 12, 2024 In Use
00003-2327-11 00003-2327 Ipilimumab Yervoy 5.0 mg/mL Immunotherapy Checkpoint Inhibitor CTLA-4 Intravenous Mar 25, 2011 In Use
00310-4500-12 00310-4500 Durvalumab Imfinzi 120.0 mg/2.4mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous May 1, 2017 In Use
72893-0004-01 72893-0004 Levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan 2, 2019 In Use
00054-4498-10 00054-4498 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Feb 22, 1993 In Use
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
63323-0710-59 63323-0710 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sep 18, 2010 In Use
16714-0915-01 16714-0915 LEVOLEUCOVORIN LEVOLEUCOVORIN 250.0 mg/25mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 26, 2018 In Use
70121-1099-01 70121-1099 Levoleucovorin Levoleucovorin 50.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intravenous Feb 13, 2017 In Use
70860-0209-11 70860-0209 Mesna Mesna 100.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Feb 28, 2018 In Use
25021-0815-67 25021-0815 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Dec 1, 2013 Sep 30, 2020 In Use
70121-1572-01 70121-1572 Levoleucovorin Levoleucovorin Calcium 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 8, 2017 In Use
42806-0358-01 42806-0358 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Apr 16, 2020 In Use

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