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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
69315-0184-01 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0184-03 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0185-12 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0185-24 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0186-24 69315-0186 Leucovorin calcium Leucovorin calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0187-25 69315-0187 Leucovorin calcium Leucovorin calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
72893-0004-01 72893-0004 Levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 In Use
00781-3201-94 00781-3201 Levoleucovorin Levoleucovorin 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous April 23, 2015 April 30, 2023 No Longer Used
42806-0134-34 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
42806-0134-24 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
62756-0581-40 62756-0581 Amifostine Amifostine 50.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous March 14, 2008 March 31, 2012 No Longer Used
62756-0581-42 62756-0581 Amifostine Amifostine 50.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous March 14, 2008 March 31, 2012 No Longer Used
63323-0710-50 63323-0710 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 18, 2010 In Use
63323-0710-59 63323-0710 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 18, 2010 In Use
63323-0711-00 63323-0711 Leucovorin Calcium Leucovorin Calcium 500.0 mg/50mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 18, 2010 In Use
66220-0017-03 66220-0017 Amifostine Ethyol 500.0 mg/10mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Aug. 1, 2016 Oct. 31, 2020 No Longer Used
68001-0285-22 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Feb. 1, 2021 No Longer Used
68001-0285-28 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Feb. 1, 2021 No Longer Used
68001-0285-29 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Oct. 25, 2016 Feb. 1, 2021 No Longer Used
68001-0285-36 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Feb. 1, 2021 No Longer Used
68001-0285-37 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Feb. 1, 2021 No Longer Used
68001-0285-38 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Oct. 25, 2016 No Longer Used
68001-0285-39 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Oct. 25, 2016 No Longer Used
68001-0285-40 68001-0285 Leucovorin Calcium Leucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Feb. 1, 2021 No Longer Used
68001-0286-38 68001-0286 Leucovorin Calcium Leucovorin 20.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Feb. 1, 2021 No Longer Used
68001-0286-39 68001-0286 Leucovorin Calcium Leucovorin 20.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 1, 2016 Feb. 1, 2021 No Longer Used
72611-0716-01 72611-0716 Dexrazoxane for Injection Dexrazoxane 500.0 mg/50mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Sept. 1, 2020 In Use
72611-0716-72 72611-0716 Dexrazoxane for Injection Dexrazoxane 500.0 mg/50mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous June 1, 2022 In Use
16714-0915-01 16714-0915 LEVOLEUCOVORIN LEVOLEUCOVORIN 250.0 mg/25mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 26, 2018 In Use
45963-0762-57 45963-0762 Levoleucovorin Levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Feb. 14, 2017 July 31, 2019 In Use
67457-0600-20 67457-0600 Levoleucovorin LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Oct. 21, 2015 April 30, 2019 No Longer Used
67457-0601-30 67457-0601 Levoleucovorin LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Oct. 21, 2015 April 30, 2019 No Longer Used
68152-0101-00 68152-0101 Levoleucovorin Fusilev 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 15, 2008 Feb. 28, 2019 No Longer Used
68152-0102-01 68152-0102 Levoleucovorin Fusilev 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 15, 2011 Feb. 28, 2019 No Longer Used
68152-0102-02 68152-0102 Levoleucovorin Fusilev 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 15, 2011 Feb. 28, 2019 No Longer Used
68152-0112-01 68152-0112 levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 In Use
47781-0578-07 47781-0578 Dexrazoxane for Injection Dexrazoxane 500.0 mg/50mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Sept. 1, 2017 Dec. 1, 2021 No Longer Used
66220-0110-01 66220-0110 Dexrazoxane Hydrochloride Totect 500.0 mg/1 Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous July 25, 2017 Oct. 30, 2020 No Longer Used
76310-0002-01 76310-0002 Dexrazoxane Cardioxane 500.0 mg/1 Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous July 28, 2017 In Use
67108-3565-09 67108-3565 Mesna Mesnex 400.0 mg/1 Ancillary Therapy Chemoprotective Detoxifying Agent Oral March 21, 2002 In Use
50742-0464-50 50742-0464 Leucovorin Calcium Leucovorin Calcium 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Nov. 23, 2018 In Use
55390-0308-03 55390-0308 Amifostine Amifostine 500.0 mg/10mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous April 2, 2008 Dec. 31, 2018 No Longer Used
72893-0006-01 72893-0006 Levoleucovorin KHAPZORY 300.0 mg/6mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 Oct. 31, 2023 No Longer Used
51079-0582-01 51079-0582 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Aug. 27, 1997 No Longer Used
51079-0582-05 51079-0582 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Aug. 27, 1997 June 30, 2023 No Longer Used
00703-5140-01 00703-5140 Leucovorin Calcium Leucovorin Calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Feb. 1, 1994 Sept. 30, 2023 No Longer Used
00703-5145-01 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous June 12, 1997 Sept. 30, 2023 No Longer Used
00703-5145-91 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous May 13, 2013 April 30, 2023 No Longer Used
67457-0207-25 67457-0207 Dexrazoxane Dexrazoxane Hydrochloride Ancillary Therapy Chemoprotective Detoxifying Agent Nov. 18, 2011 In Use
67457-0208-50 67457-0208 Dexrazoxane Dexrazoxane Hydrochloride Ancillary Therapy Chemoprotective Detoxifying Agent Nov. 18, 2011 In Use
51991-0942-98 51991-0942 Dexrazoxane Hydrochloride Dexrazoxane 500.0 mg/50mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous June 26, 2017 Aug. 31, 2024 In Use
14335-0340-01 14335-0340 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous May 31, 2023 In Use
14335-0341-01 14335-0341 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intravenous May 31, 2023 In Use
70436-0116-82 70436-0116 Leucovorin calcium Leucovorin Calcium 50.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0117-80 70436-0117 Leucovorin calcium Leucovorin Calcium 100.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0118-80 70436-0118 Leucovorin calcium Leucovorin Calcium 200.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0120-80 70436-0120 Leucovorin calcium Leucovorin Calcium 500.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 10, 2023 In Use
70436-0209-80 70436-0209 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 1, 2023 In Use
70436-0210-80 70436-0210 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 1, 2023 In Use
71288-0160-10 71288-0160 Leucovorin calcium Leucovorin calcium 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0161-20 71288-0161 Leucovorin calcium Leucovorin calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0162-30 71288-0162 Leucovorin calcium Leucovorin calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0163-30 71288-0163 Leucovorin calcium Leucovorin calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
71288-0164-50 71288-0164 Leucovorin calcium Leucovorin calcium 500.0 mg/50mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 19, 2023 In Use
68083-0388-01 68083-0388 Dexrazoxane for Injection Dexrazoxane 250.0 mg/25mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Dec. 16, 2019 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
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
00002-4483-54 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
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
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
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
00085-1235-01 00085-1235 Interferon alfa-2b Intron A Immunotherapy Cytokine Interferon June 4, 1986 Oct. 3, 2010 No Longer Used

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