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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name (Descending) Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
72893-0004-01 72893-0004 Levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 In Use
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
66658-0113-03 66658-0113 Palifermin KEPIVANCE 5.16 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Aug. 4, 2023 In Use
66658-0113-06 66658-0113 Palifermin KEPIVANCE 5.16 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Aug. 4, 2023 In Use
00003-0315-05 00003-0315 TRIAMCINOLONE ACETONIDE KENALOG-80 80.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-Articular, Intramuscular April 12, 2019 In Use
00003-0315-20 00003-0315 TRIAMCINOLONE ACETONIDE KENALOG-80 80.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-Articular, Intramuscular April 12, 2019 In Use
00024-5824-11 00024-5824 Cabazitaxel Jevtana Chemotherapy Antimitotic Agent Taxane Intravenous June 17, 2010 In Use
00173-0898-03 00173-0898 dostarlimab Jemperli 50.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous April 22, 2021 In Use
50881-0010-01 50881-0010 Ruxolitinib Jakafi 10.0 mg/1 Chemotherapy Enzyme Inhibitor JAK 1 and JAK 2 (Janus Kinase Inhibitor) Oral Nov. 16, 2011 In Use
50881-0010-60 50881-0010 Ruxolitinib Jakafi 10.0 mg/1 Chemotherapy Enzyme Inhibitor JAK 1 and JAK 2 (Janus Kinase Inhibitor) Oral Nov. 16, 2011 In Use

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