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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
55513-0206-01 55513-0206 Bevacizumab-awwb MVASI 100.0 mg/4mL, 100.0 mg/4mL Immunotherapy Monoclonal Antibody VEGFR Intravenous June 1, 2018 In Use
55513-0207-01 55513-0207 Bevacizumab-awwb MVASI 400.0 mg/16mL, 400.0 mg/16mL Immunotherapy Monoclonal Antibody VEGFR Intravenous June 1, 2018 In Use
57894-0503-01 57894-0503 Daratumumab and hyaluronidase-fihj (human recombinant) Darzalex Faspro 1800.0 mg/15mL, 4.9 mg/15mL, 18.4 mg/15mL, 30000.0 U/15mL, 13.5 mg/15mL, 6.0 mg/15mL, 735.1 mg/15mL Immunotherapy Monoclonal Antibody CD38 Subcutaneous May 1, 2020 In Use
63459-0303-43 63459-0303 TRASTUZUMAB HERZUMA 150.0 mg/7.15mL Immunotherapy Monoclonal Antibody HER2 Intravenous March 16, 2020 In Use
78206-0148-01 78206-0148 Ontruzant Ontruzant Immunotherapy Monoclonal Antibody HER2 Intravenous June 1, 2021 In Use
63539-0252-02 63539-0252 Elranatamab-bcmm Elrexfio 44.0 mg/1.1mL Immunotherapy Monoclonal Antibody BCMA, CD3 Subcutaneous Aug. 15, 2023 In Use
00069-4494-02 00069-4494 Elranatamab-bcmm Elrexfio 76.0 mg/1.9mL Immunotherapy Monoclonal Antibody BCMA, CD3 Subcutaneous Aug. 15, 2023 In Use
00069-2522-02 00069-2522 Elranatamab-bcmm Elrexfio 44.0 mg/1.1mL Immunotherapy Monoclonal Antibody BCMA, CD3 Subcutaneous Aug. 15, 2023 In Use
50242-0125-01 50242-0125 Glofitamab Columvi 2.5 mg/2.5mL Immunotherapy Monoclonal Antibody CD20, CD3 Intravenous June 15, 2023 In Use
50242-0127-01 50242-0127 Glofitamab Columvi 10.0 mg/10mL Immunotherapy Monoclonal Antibody CD20, CD3 Intravenous June 15, 2023 In Use
82705-0002-01 82705-0002 Epcoritamab-bysp EPKINLY 4.0 mg/.8mL Immunotherapy Monoclonal Antibody CD20, CD3 Subcutaneous May 19, 2023 In Use
82705-0010-01 82705-0010 Epcoritamab-bysp EPKINLY 48.0 mg/.8mL Immunotherapy Monoclonal Antibody CD20, CD3 Subcutaneous May 19, 2023 In Use
55513-0710-01 55513-0710 Denosumab Prolia 60.0 mg/mL Immunotherapy Monoclonal Antibody RANKL Subcutaneous June 5, 2010 In Use
55513-0710-21 55513-0710 Denosumab Prolia 60.0 mg/mL Immunotherapy Monoclonal Antibody RANKL Subcutaneous March 5, 2024 In Use
59630-0222-07 59630-0222 Naldemedine SYMPROIC 0.2 mg/1 Ancillary Therapy Opioid Antagonist Oral July 5, 2018 Dec. 31, 2020 No Longer Used
59630-0222-30 59630-0222 Naldemedine SYMPROIC 0.2 mg/1 Ancillary Therapy Opioid Antagonist Oral July 5, 2018 Dec. 31, 2020 No Longer Used
59630-0222-90 59630-0222 Naldemedine SYMPROIC 0.2 mg/1 Ancillary Therapy Opioid Antagonist Oral July 5, 2018 Dec. 31, 2020 No Longer Used
59385-0041-07 59385-0041 Naldemedine, naldemedine tosylate SYMPROIC 0.2 mg/1 Ancillary Therapy Opioid Antagonist Oral July 1, 2020 In Use
59385-0041-30 59385-0041 Naldemedine, naldemedine tosylate SYMPROIC 0.2 mg/1 Ancillary Therapy Opioid Antagonist Oral June 14, 2019 In Use
64067-0216-01 64067-0216 Methoxsalen UVADEX 20.0 ug/mL Chemotherapy Photosensitizing Agent Psoralen Extracorporeal Feb. 25, 1999 In Use
76128-0155-75 76128-0155 Porfimer sodium Photofrin 75.0 mg/31.8mL Chemotherapy Photosensitizing Agent Cytotoxin Intravenous Dec. 27, 1995 In Use
00378-3266-94 00378-3266 Etoposide Etoposide 50.0 mg/1 Chemotherapy Plant Alkaloid Epipodophyllotoxins Oral Oct. 22, 2001 In Use
44567-0507-01 44567-0507 Teniposide Teniposide 10.0 mg/mL Chemotherapy Plant Alkaloid Epipodophyllotoxins Intravenous April 30, 2013 In Use
16729-0114-08 16729-0114 Etoposide Etoposide 20.0 mg/mL Chemotherapy Plant Alkaloid Epipodophyllotoxins Intravenous March 3, 2015 In Use
16729-0114-11 16729-0114 Etoposide Etoposide 20.0 mg/mL Chemotherapy Plant Alkaloid Epipodophyllotoxins Intravenous March 3, 2015 In Use

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