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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category (Descending) Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
00069-0293-10 00069-0293 filgrastim-aafi Nivestym 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous March 11, 2019 In Use
00069-0294-10 00069-0294 filgrastim-aafi Nivestym 480.0 ug/1.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous March 11, 2019 In Use
00409-2504-10 00409-2504 Palonosetron Hydrochloride Palonosetron Hydrochloride 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Nov. 14, 2018 In Use
00781-3415-75 00781-3415 Palonosetron Hydrochloride Palonosetron Hydrochloride 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Nov. 26, 2018 In Use
70114-0101-01 70114-0101 pegfilgrastim-cbqv UDENYCA 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 2, 2018 In Use
43598-0771-11 43598-0771 LEVOLEUCOVORIN LEVOLEUCOVORIN 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 26, 2018 In Use
43598-0773-11 43598-0773 LEVOLEUCOVORIN LEVOLEUCOVORIN 250.0 mg/25mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 26, 2018 In Use
63323-0631-10 63323-0631 Leucovorin Calcium Leucovorin Calcium 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jan. 31, 2017 In Use
63323-0631-50 63323-0631 Leucovorin Calcium Leucovorin Calcium 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 27, 2018 In Use
55150-0186-05 55150-0186 Palonosetron Hydrochloride Palonosetron Hydrochloride 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Nov. 6, 2018 In Use
63323-0673-05 63323-0673 Palonosetron Palonosetron 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Sept. 19, 2018 In Use
63323-0673-89 63323-0673 Palonosetron Palonosetron 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Sept. 19, 2018 In Use
67184-0514-01 67184-0514 Palonosetron Hydrochloride Palonosetron 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Sept. 19, 2018 In Use
67184-0515-02 67184-0515 Palonosetron Hydrochloride Palonosetron 0.075 mg/1.5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Sept. 19, 2018 In Use
67457-0317-25 67457-0317 Palonosetron Hydrochloride Palonosetron Hydrochloride 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Sept. 20, 2018 In Use
43598-0255-52 43598-0255 Zoledronic acid Zoledronic acid 4.0 mg/100mL Ancillary Therapy Bisphosphonate Intravenous Jan. 15, 2019 In Use
72266-0101-01 72266-0101 Dexrazoxane for Injection Dexrazoxane 500.0 mg/50mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous March 18, 2019 In Use
60687-0386-21 60687-0386 DRONABINOL DRONABINOL 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Aug. 9, 2018 In Use
00143-9552-01 00143-9552 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous April 20, 2000 In Use
00143-9553-01 00143-9553 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous May 23, 1995 In Use
67457-0530-35 67457-0530 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Jan. 2, 2019 In Use
68083-0278-01 68083-0278 Levoleucovorin levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 20, 2018 In Use
68083-0279-01 68083-0279 Levoleucovorin levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 20, 2018 In Use
72266-0123-25 72266-0123 Ondansetron Ondansetron 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous April 2, 2019 In Use
59572-0711-01 59572-0711 Luspatercept REBLOZYL 25.0 mg/1 Ancillary Therapy Erythropoiesis-Stimulating Agent Subcutaneous Nov. 8, 2019 In Use
55513-0014-01 55513-0014 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent Oct. 1, 2001 Feb. 28, 2009 No Longer Used
55513-0015-01 55513-0014 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent Aug. 19, 2002 April 30, 2009 No Longer Used
55513-0039-01 55513-0039 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent Feb. 18, 2011 Feb. 28, 2009 No Longer Used
55513-0039-04 55513-0039 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent July 23, 2003 Feb. 28, 2009 No Longer Used
55513-0041-01 55513-0041 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent Feb. 18, 2011 Feb. 28, 2009 No Longer Used
55513-0041-04 55513-0041 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent July 23, 2003 Feb. 28, 2009 No Longer Used
55513-0043-01 55513-0043 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent Feb. 18, 2011 Dec. 31, 2008 No Longer Used
55513-0043-04 55513-0043 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent June 1, 2004 Dec. 31, 2008 No Longer Used
55513-0044-01 55513-0044 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent Feb. 18, 2011 Feb. 28, 2009 No Longer Used
55513-0044-04 55513-0044 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent July 23, 2003 Feb. 28, 2009 No Longer Used
55513-0046-01 55513-0046 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent Feb. 18, 2011 April 30, 2009 No Longer Used
55513-0046-04 55513-0046 Darbepoetin alfa Aranesp Ancillary Therapy Erythropoiesis-Stimulating Agent July 23, 2003 April 30, 2009 No Longer Used
51079-0520-01 51079-0520 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 22, 2007 Aug. 31, 2015 No Longer Used
51079-0520-20 51079-0520 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 22, 2007 Aug. 31, 2015 No Longer Used
51079-0520-30 51079-0520 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 22, 2007 Aug. 31, 2015 No Longer Used
51079-0520-56 51079-0520 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 26, 2009 July 31, 2015 No Longer Used
52125-0606-02 52125-0606 Finasteride Finasteride Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral May 29, 2013 March 11, 2014 No Longer Used
52125-0606-19 52125-0606 Finasteride Finasteride Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Sept. 19, 2013 Sept. 19, 2013 No Longer Used
52152-0500-02 52152-0500 Finasteride Finasteride Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral March 28, 2007 Sept. 30, 2013 No Longer Used
52152-0500-08 52152-0500 Finasteride Finasteride Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Jan. 10, 2011 Sept. 30, 2013 No Longer Used
52152-0500-30 52152-0500 Finasteride Finasteride Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral March 28, 2007 Sept. 30, 2013 No Longer Used
63629-1585-01 63629-1585 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 30, 2007 Feb. 28, 2017 No Longer Used
63629-1585-02 63629-1585 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 30, 2007 Feb. 28, 2017 No Longer Used
63629-1585-03 63629-1585 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 30, 2007 Feb. 28, 2017 No Longer Used
63629-1585-04 63629-1585 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 30, 2007 Feb. 28, 2017 No Longer Used

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