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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
55513-0924-20 55513-0924 Filgrastim Neupogen 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Oct 1, 2025 In Use
59353-0004-10 59353-0004 Epoetin alfa-epbx RETACRIT 4000.0 [iU]/mL, 4000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Jun 18, 2018 In Use
13668-0453-74 13668-0453 Anagrelide Anagrelide 0.5 mg/1, 0.5 mg/1 Ancillary Therapy Platelet-Reducing Agent PDE-3 Inhibitor Oral Jun 30, 2017 In Use
57237-0077-50 57237-0077 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sep 30, 2024 In Use
00172-7310-46 00172-7310 Cyclosporine Modified Cyclosporine Modified 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Mar 29, 2005 Mar 31, 2017 No Longer Used
59353-0010-10 59353-0010 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL, 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Jun 18, 2018 In Use
68001-0285-39 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jul 1, 2016 Oct 25, 2016 No Longer Used
71837-5843-05 71837-5843 SARGRAMOSTIM Leukine 250.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte colony stimulating factor Intravenous, Subcutaneous Sep 1, 2023 In Use
58160-0830-41 58160-0830 Human Papillomavirus Bivalent Vaccine, Recombinant Cervarix 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular Jul 25, 2011 Sep 3, 2013 No Longer Used
59353-0220-10 59353-0220 Epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL, 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov 9, 2020 In Use
31722-0962-60 31722-0962 dronabinol DRONABINOL 10.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Feb 10, 2020 In Use
00173-0489-00 00173-0489 Ondansetron Hydrochloride Zofran 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb 5, 1997 Jun 30, 2019 No Longer Used
55150-0175-01 55150-0175 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Jul 6, 2016 In Use
55700-0952-65 55700-0952 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan 11, 2022 Mar 31, 2025 No Longer Used
58177-0364-22 58177-0364 Ondansetron Ondansetron Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug 1, 2009 Jun 28, 2011 No Longer Used
43598-0771-11 43598-0771 LEVOLEUCOVORIN LEVOLEUCOVORIN 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Sep 26, 2018 In Use
72266-0121-01 72266-0121 Levoleucovorin levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Jun 25, 2019 In Use
63459-0912-11 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov 11, 2013 In Use
61919-0087-30 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug 29, 2019 In Use
00703-7239-31 00703-7239 Ondansetron and Dextrose Ondansetron and Dextrose Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Nov 22, 2006 Mar 31, 2011 No Longer Used
54868-3310-01 54868-3310 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Apr 15, 2002 In Use
55700-0508-30 55700-0508 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Mar 3, 2017 Jun 30, 2019 In Use
00703-7239-39 00703-7239 Ondansetron and Dextrose Ondansetron and Dextrose Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Nov 22, 2006 Mar 31, 2011 No Longer Used
62856-0796-01 62856-0796 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 May 31, 2018 No Longer Used
61314-0304-10 61314-0304 filgrastim-sndz Zarxio 300.0 ug/.5mL, 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Sep 3, 2015 Feb 28, 2021 No Longer Used

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