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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class (Ascending) Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
55390-0009-01 55390-0009 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote June 8, 2000 June 30, 2013 No Longer Used
55390-0051-10 55390-0051 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote May 1, 1996 Aug. 31, 2013 No Longer Used
55390-0052-10 55390-0052 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote May 1, 1996 Aug. 31, 2014 No Longer Used
55390-0053-01 55390-0053 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote May 1, 1996 April 30, 2014 No Longer Used
55390-0054-01 55390-0054 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote June 8, 2000 Feb. 28, 2015 No Longer Used
55390-0818-10 55390-0818 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote June 28, 1996 Aug. 31, 2014 No Longer Used
55390-0824-01 55390-0824 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote June 28, 1996 April 30, 2014 No Longer Used
55390-0825-01 55390-0825 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote Sept. 28, 2001 May 31, 2013 No Longer Used
55390-0826-01 55390-0826 Leucovorin Calcium Leucovorin Calcium Ancillary Therapy Chemoprotective Antidote Sept. 28, 2001 June 30, 2013 No Longer Used
53270-0101-01 53270-0101 Levoleucovorin Fusilev Ancillary Therapy Chemoprotective Antidote Aug. 15, 2008 Feb. 24, 2010 No Longer Used
55390-0045-01 55390-0045 Mesna Mesna Ancillary Therapy Chemoprotective Detoxifying Agent Feb. 23, 2004 July 31, 2012 No Longer Used
55390-0266-01 55390-0266 Mesna Mesna Ancillary Therapy Chemoprotective Detoxifying Agent Jan. 9, 2004 July 31, 2012 No Longer Used
55390-0347-01 55390-0347 Mesna Mesna Ancillary Therapy Chemoprotective Detoxifying Agent March 3, 2008 July 31, 2012 No Longer Used
63323-0733-10 63323-0733 Mesna Mesna 100.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Sept. 5, 2001 In Use
63323-0733-11 63323-0733 Mesna Mesna 100.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Sept. 5, 2001 In Use
00002-4483-54 00002-4483 Abemaciclib Verzenio 50.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Oct. 6, 2017 In Use
00078-0860-01 00078-0860 Ribociclib Kisqali 200.0 mg/1, 200.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 13, 2017 In Use
63539-0688-03 63539-0688 palbociclib Ibrance 125.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 30, 2020 In Use
63539-0284-03 63539-0284 palbociclib Ibrance 75.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 30, 2020 In Use
63539-0486-03 63539-0486 palbociclib Ibrance 100.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 30, 2020 In Use
00078-0909-61 00078-0909 Ribociclib and letrozole Kisqali Femara Co-pack Chemotherapy, Hormonal Therapy Cyclin Dependent Kinase Inhibitor CDK 4/6 + Hormonal Oral May 4, 2017 In Use
00078-0916-61 00078-0916 letrozole and ribociclib Kisqali Femara Co-pack Chemotherapy, Hormonal Therapy Cyclin Dependent Kinase Inhibitor CDK 4/6 + Hormonal Oral May 4, 2017 In Use
00078-0923-61 00078-0923 letrozole and ribociclib Kisqali Femara Co-pack Chemotherapy, Hormonal Therapy Cyclin Dependent Kinase Inhibitor CDK 4/6 + Hormonal Oral May 4, 2017 In Use
00078-0867-14 00078-0867 Ribociclib Kisqali 200.0 mg/1, 200.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 13, 2017 In Use
00078-0867-42 00078-0867 Ribociclib Kisqali 200.0 mg/1, 200.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 13, 2017 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 March 13, 2017 In Use
00078-0874-63 00078-0874 Ribociclib Kisqali 200.0 mg/1, 200.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 13, 2017 In Use
00069-0688-03 00069-0688 palbociclib Ibrance 125.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 30, 2020 In Use
00069-0486-03 00069-0486 Palbociclib Ibrance 100.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 30, 2020 In Use
73462-0101-01 73462-0101 Trilaciclib Cosela 300.0 mg/20mL Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Intravenous Feb. 12, 2021 In Use
00002-5337-54 00002-5337 Abemaciclib Verzenio 150.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Oct. 6, 2017 In Use
00002-5337-63 00002-5337 Abemaciclib Verzenio 150.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 5, 2020 In Use
00069-0284-03 00069-0284 Palbociclib Ibrance 75.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 30, 2020 In Use
00002-4815-54 00002-4815 Abemaciclib Verzenio 100.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Oct. 6, 2017 In Use
00002-6216-54 00002-6216 Abemaciclib Verzenio 200.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Oct. 6, 2017 In Use
00069-0187-21 00069-0187 Palbociclib Ibrance 75.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Feb. 3, 2015 In Use
00069-0188-21 00069-0188 Palbociclib Ibrance 100.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Feb. 3, 2015 In Use
00069-0189-21 00069-0189 Palbociclib Ibrance 125.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Feb. 3, 2015 In Use
63539-0189-11 63539-0189 Palbociclib Ibrance 125.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral Feb. 3, 2015 In Use
49663-0001-06 49663-0001 Cysteamine bitartrate PROCYSBI 25.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral April 30, 2013 Feb. 28, 2019 No Longer Used
49663-0002-25 49663-0002 Cysteamine bitartrate PROCYSBI 75.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral April 30, 2013 Feb. 28, 2019 No Longer Used
00378-9040-01 00378-9040 Cysteamine bitartrate Cystagon 50.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral Aug. 15, 1994 Sept. 4, 2018 In Use
00378-9040-05 00378-9040 Cysteamine bitartrate Cystagon 50.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral April 11, 2005 In Use
00378-9045-01 00378-9045 Cysteamine bitartrate Cystagon 150.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral Aug. 15, 1994 Sept. 4, 2018 In Use
00378-9045-05 00378-9045 Cysteamine bitartrate Cystagon 150.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral April 11, 2005 In Use
75987-0140-13 75987-0140 Cysteamine bitartrate PROCYSBI 75.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral Feb. 14, 2020 In Use
75987-0140-14 75987-0140 Cysteamine bitartrate PROCYSBI 75.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral Feb. 14, 2020 In Use
75987-0145-13 75987-0145 Cysteamine bitartrate PROCYSBI 300.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral Feb. 14, 2020 In Use
75987-0145-14 75987-0145 Cysteamine bitartrate PROCYSBI 300.0 mg/1 Chemotherapy Cystine-Depleting Agent Oral Feb. 14, 2020 In Use
00004-0350-09 00004-0350 Peginterferon alfa-2a Pegasys 180.0 ug/mL Immunotherapy Cytokine Interferon Subcutaneous Oct. 16, 2002 June 30, 2025 In Use

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