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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
00004-0365-09 00004-0365 Peginterferon alfa-2a Pegasys 180.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Nov. 1, 2011 In Use
00004-0365-30 00004-0365 Peginterferon alfa-2a Pegasys 180.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Nov. 1, 2011 In Use
50242-0145-01 50242-0145 Pertuzumab Perjeta 30.0 mg/mL Immunotherapy Monoclonal Antibody HER2 Intravenous June 8, 2012 In Use
59572-0501-00 59572-0501 Pomalidomide Pomalyst 1.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0501-21 59572-0501 Pomalidomide Pomalyst 1.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0502-00 59572-0502 Pomalidomide Pomalyst 2.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0502-21 59572-0502 Pomalidomide Pomalyst 2.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0503-00 59572-0503 Pomalidomide Pomalyst 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0503-21 59572-0503 Pomalidomide Pomalyst 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0504-00 59572-0504 Pomalidomide Pomalyst 4.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0504-21 59572-0504 Pomalidomide Pomalyst 4.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
57894-0505-05 57894-0505 Daratumumab Darzalex IV 100.0 mg/5mL Immunotherapy Monoclonal Antibody CD38 Intravenous Oct. 15, 2021 In Use
57894-0505-20 57894-0505 Daratumumab Darzalex IV 100.0 mg/5mL Immunotherapy Monoclonal Antibody CD38 Intravenous Oct. 15, 2021 In Use
71287-0220-02 71287-0220 brexucabtagene autoleucel TECARTUS 1000000.0 1/68mL Immunotherapy CAR-T CD19 Intravenous Oct. 1, 2021 In Use
44087-3535-01 44087-3535 Avelumab Bavencio 20.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous March 23, 2017 In Use
72187-0401-01 72187-0401 Tagraxofusp Elzonris 1000.0 ug/mL Immunotherapy Fusion Protein IL3/ CD123 Intravenous Jan. 18, 2019 In Use
73380-4700-01 73380-4700 MOXETUMOMAB PASUDOTOX LUMOXITI 1.0 mg/mL Immunotherapy Drug Antibody Conjugate CD22 Intravenous May 15, 2020 In Use
50242-0245-01 50242-0245 Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Phesgo 30000.0 U/15mL, 1200.0 mg/15mL, 600.0 mg/15mL Immunotherapy Monoclonal Antibody HER2 Subcutaneous June 29, 2020 In Use
50242-0245-86 50242-0245 Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Phesgo 30000.0 U/15mL, 1200.0 mg/15mL, 600.0 mg/15mL Immunotherapy Monoclonal Antibody HER2 Subcutaneous May 3, 2021 In Use
50242-0260-01 50242-0260 Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Phesgo 20000.0 U/10mL, 600.0 mg/10mL, 600.0 mg/10mL Immunotherapy Monoclonal Antibody HER2 Subcutaneous June 29, 2020 In Use
50242-0260-86 50242-0260 Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Phesgo 20000.0 U/10mL, 600.0 mg/10mL, 600.0 mg/10mL Immunotherapy Monoclonal Antibody HER2 Subcutaneous May 3, 2021 In Use
51144-0003-01 51144-0003 Tisotumab vedotin TIVDAK 40.0 mg/4mL Immunotherapy Drug Antibody Conjugate Tissue factor Intravenous Sept. 20, 2021 In Use
00003-2328-22 00003-2328 Ipilimumab Yervoy 5.0 mg/mL Immunotherapy Checkpoint Inhibitor CTLA-4 Intravenous March 25, 2011 In Use
00006-3029-02 00006-3029 Pembrolizumab Keytruda 50.0 mg/2mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Sept. 4, 2014 Dec. 21, 2015 In Use
68152-0103-03 68152-0103 Ibritumomab Tiuxetan Zevalin Immunotherapy Radioimmunotherapy CD20 Feb. 19, 2002 Oct. 26, 2020 In Use
65483-0116-07 65483-0116 Aldesleukin Proleukin 1.1 mg/mL Immunotherapy Cytokine Interleukin-2 Intravenous May 5, 1992 In Use
60505-0501-04 60505-0501 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical Sept. 14, 2012 March 31, 2018 No Longer Used
60505-0501-05 60505-0501 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical Sept. 14, 2012 March 31, 2018 No Longer Used
57894-0421-01 57894-0421 Siltuximab Sylvant 400.0 mg/1 Immunotherapy Monoclonal Antibody Interleukin-6 Antagonists Intravenous April 1, 2014 Jan. 31, 2021 No Longer Used
57894-0420-01 57894-0420 Siltuximab Sylvant 100.0 mg/1 Immunotherapy Monoclonal Antibody Interleukin-6 Antagonists Intravenous April 23, 2014 Jan. 31, 2021 No Longer Used
50242-0333-01 50242-0333 Trastuzumab Herceptin Immunotherapy Monoclonal Antibody HER2 Feb. 10, 2017 Feb. 10, 2017 No Longer Used
50242-0134-68 50242-0134 Trastuzumab Herceptin Immunotherapy Monoclonal Antibody HER2 Sept. 25, 1998 April 30, 2019 No Longer Used
42238-0111-01 42238-0111 Interferon gamma-1b Actimmune 100.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Dec. 1, 2013 Jan. 17, 2018 No Longer Used
42238-0111-12 42238-0111 Interferon gamma-1b Actimmune 100.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Dec. 1, 2013 Jan. 17, 2018 No Longer Used
45802-0076-00 45802-0076 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical April 20, 2010 Aug. 1, 2013 No Longer Used
45802-0076-62 45802-0076 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical April 20, 2010 Aug. 1, 2013 No Longer Used
45802-0368-53 45802-0368 Imiquimod Imiquimod 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical July 12, 2012 In Use
45802-0368-62 45802-0368 Imiquimod Imiquimod 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical Nov. 9, 2010 In Use
49281-0880-03 49281-0880 BACILLUS CALMETTE-GUERIN SUBSTRAIN CONNAUGHT LIVE ANTIGEN THERACYS 81.0 mg/3mL Immunotherapy Biological Response Modifier Live Vaccine Intravesical July 22, 2011 May 8, 2017 No Longer Used
50242-0070-01 50242-0070 Obinutuzumab Gazyva 1000.0 mg/40mL Immunotherapy Monoclonal Antibody CD20 Intravenous Nov. 1, 2013 In Use
50242-0070-86 50242-0070 Obinutuzumab Gazyva 1000.0 mg/40mL Immunotherapy Monoclonal Antibody CD20 Intravenous Nov. 4, 2013 In Use
51144-0020-01 51144-0020 ENFORTUMAB VEDOTIN PADCEV 20.0 mg/2mL Immunotherapy Drug Antibody Conjugate Nectin-4 Intravenous Dec. 18, 2019 In Use
51144-0030-01 51144-0030 ENFORTUMAB VEDOTIN PADCEV 30.0 mg/3mL Immunotherapy Drug Antibody Conjugate Nectin-4 Intravenous Dec. 18, 2019 In Use
55513-0955-01 55513-0955 Panitumumab Vectibix 200.0 mg/10mL Immunotherapy Monoclonal Antibody EGFR Intravenous Oct. 10, 2006 Feb. 28, 2010 No Longer Used
59572-0402-00 59572-0402 Lenalidomide Revlimid 2.5 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral May 9, 2012 In Use
59572-0402-28 59572-0402 Lenalidomide Revlimid 2.5 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral May 9, 2012 In Use
59572-0405-00 59572-0405 Lenalidomide Revlimid 5.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Dec. 27, 2005 In Use
59572-0405-28 59572-0405 Lenalidomide Revlimid 5.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral March 3, 2009 In Use
59572-0410-00 59572-0410 Lenalidomide Revlimid 10.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Dec. 27, 2005 In Use
59572-0410-28 59572-0410 Lenalidomide Revlimid 10.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral March 3, 2009 In Use

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