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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date (Ascending) Status
80425-0261-01 80425-0261 Dexamethasone Sodium Phosphate Dexamethasone Sodium Phosphate 10.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous Feb. 16, 2023 In Use
80425-0262-01 80425-0262 Triamcinolone acetonide Triamcinolone acetonide 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-articular, Intramuscular Feb. 15, 2023 In Use
80425-0328-01 80425-0328 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral April 24, 2023 In Use
80725-0610-25 80725-0610 Chlorambucil LEUKERAN 2.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard Oral May 15, 2023 In Use
80725-0620-25 80725-0620 Busulfan MYLERAN 2.0 mg/1 Chemotherapy Alkylating Agent Alkylsulfonate Oral May 15, 2023 In Use
80725-0630-25 80725-0630 Thioguanine TABLOID 40.0 mg/1 Chemotherapy Antimetabolite Purine Analog Oral May 15, 2023 In Use
80978-0111-06 80978-0111 Nelarabine injection NELARABINE 250.0 mg/mL Chemotherapy Antimetabolite Purine Analog Intravenous April 12, 2023 In Use
82982-0041-63 82982-0041 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 21, 2023 In Use
82982-0042-15 82982-0042 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 15, 2023 In Use
82982-0059-10 82982-0059 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 28, 2023 In Use
82982-0061-10 82982-0061 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 30, 2023 In Use
81927-0111-01 81927-0111 Nelarabine Nelarabine 5.0 mg/mL Chemotherapy Antimetabolite Purine Analog Intravenous March 15, 2023 In Use
81927-0111-06 81927-0111 Nelarabine Nelarabine 5.0 mg/mL Chemotherapy Antimetabolite Purine Analog Intravenous March 15, 2023 In Use
00069-1311-04 00069-1311 epoetin alfa-epbx RETACRIT 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Dec. 1, 2020 In Use
00069-1311-10 00069-1311 epoetin alfa-epbx RETACRIT 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
00002-4184-30 00002-4184 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Dec. 16, 2016 In Use
00002-7623-01 00002-7623 Pemetrexed disodium Alimta 500.0 mg/20mL Chemotherapy Antimetabolite Folic Acid Analog Intravenous Feb. 13, 2004 In Use
00003-0852-22 00003-0852 Dasatinib Sprycel 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral May 30, 2008 In Use
00006-3066-01 00006-3066 Aprepitant Emend 125.0 mg/1 Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Oral Dec. 17, 2015 In Use
00006-3066-03 00006-3066 Aprepitant Emend 125.0 mg/1 Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Oral Dec. 17, 2015 In Use
00006-4045-00 00006-4045 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4045-01 00006-4045 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4045-41 00006-4045 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4109-01 00006-4109 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4109-02 00006-4109 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4109-09 00006-4109 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4119-01 00006-4119 Human Papillomavirus 9-valent Vaccine, Recombinant GARDASIL 9 40.0 ug/.5mL, 60.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 30.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular Dec. 10, 2014 In Use
00006-4119-03 00006-4119 Human Papillomavirus 9-valent Vaccine, Recombinant GARDASIL 9 40.0 ug/.5mL, 60.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 30.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular Dec. 10, 2014 In Use
00006-4121-01 00006-4121 Human Papillomavirus 9-valent Vaccine, Recombinant GARDASIL 9 40.0 ug/.5mL, 60.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 30.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular Dec. 10, 2014 In Use
00006-4121-02 00006-4121 Human Papillomavirus 9-valent Vaccine, Recombinant GARDASIL 9 40.0 ug/.5mL, 60.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 30.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular Dec. 10, 2014 In Use
00009-0011-03 00009-0011 Hydrocortisone Sodium Succinate Solu-Cortef 100.0 mg/2mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 27, 1955 In Use
00009-0011-04 00009-0011 Hydrocortisone Sodium Succinate Solu-Cortef 100.0 mg/2mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 27, 1955 In Use
00009-0039-06 00009-0039 Methylprednisolone Sodium Succinate Solu-Medrol 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 2, 1959 In Use
00009-0039-28 00009-0039 Methylprednisolone Sodium Succinate Solu-Medrol 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 2, 1959 In Use
00009-0039-30 00009-0039 Methylprednisolone Sodium Succinate Solu-Medrol 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous Aug. 27, 2012 In Use
00009-0039-32 00009-0039 Methylprednisolone Sodium Succinate Solu-Medrol 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 2, 1959 In Use
00009-0039-33 00009-0039 Methylprednisolone Sodium Succinate Solu-Medrol 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 2, 1959 In Use
00009-0047-04 00009-0047 Methylprednisolone Sodium Succinate Solu-Medrol 125.0 mg/2mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 2, 1959 In Use
00009-0047-22 00009-0047 Methylprednisolone Sodium Succinate Solu-Medrol 125.0 mg/2mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 2, 1959 In Use
00009-0047-25 00009-0047 Methylprednisolone Sodium Succinate Solu-Medrol 125.0 mg/2mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous Aug. 27, 2012 In Use
00009-0047-26 00009-0047 Methylprednisolone Sodium Succinate Solu-Medrol 125.0 mg/2mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 2, 1959 In Use
00009-0047-27 00009-0047 Methylprednisolone Sodium Succinate Solu-Medrol 125.0 mg/2mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous April 2, 1959 In Use
00009-0056-02 00009-0056 Methylprednisolone Medrol 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 24, 1957 In Use
00009-0056-04 00009-0056 Methylprednisolone Medrol 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 24, 1957 In Use
00024-5840-01 00024-5840 ziv-Aflibercept Zaltrap 100.0 mg/4mL Chemotherapy Recombinant Fusion Protein VEGF-IgG1 Intravenous Aug. 3, 2012 In Use
00024-5841-01 00024-5841 ziv-Aflibercept Zaltrap 200.0 mg/8mL, 200.0 mg/8mL Chemotherapy Recombinant Fusion Protein VEGF-IgG1 Intravenous Aug. 3, 2012 In Use
00046-1100-52 00046-1100 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Nov. 11, 2019 In Use
00046-1100-81 00046-1100 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
00046-1100-91 00046-1100 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
00046-1102-52 00046-1102 Estrogens, Conjugated Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Feb. 10, 2020 In Use
00046-1102-81 00046-1102 Estrogens, Conjugated Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
00046-1102-91 00046-1102 Estrogens, Conjugated Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
00046-1104-81 00046-1104 Estrogens, Conjugated Premarin 1.25 mg/1 Hormonal Therapy Estrogen Oral Sept. 1, 2004 In Use
00046-1104-91 00046-1104 Estrogens, Conjugated Premarin 1.25 mg/1 Hormonal Therapy Estrogen Oral Sept. 1, 2004 In Use
00069-1305-10 00069-1305 epoetin alfa-epbx RETACRIT 2000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1307-10 00069-1307 epoetin alfa-epbx RETACRIT 4000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1308-10 00069-1308 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1309-04 00069-1309 epoetin alfa-epbx RETACRIT 40000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1309-10 00069-1309 epoetin alfa-epbx RETACRIT 40000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1306-10 00069-1306 epoetin alfa-epbx RETACRIT 3000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1318-04 00069-1318 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Dec. 1, 2020 In Use
00069-1318-10 00069-1318 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
00074-7269-50 00074-7269 Cyclosporine Gengraf 100.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 25, 2010 In Use
00078-0109-01 00078-0109 Cyclosporine Sandimmune 50.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Intravenous Nov. 14, 1983 In Use
00078-0109-61 00078-0109 Cyclosporine Sandimmune 50.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Intravenous Aug. 10, 2012 In Use
00078-0180-01 00078-0180 Octreotide Acetate Sandostatin 50.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Oct. 21, 1988 In Use
00078-0180-61 00078-0180 Octreotide Acetate Sandostatin 50.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Aug. 13, 2012 In Use
00078-0181-01 00078-0181 Octreotide Acetate Sandostatin 100.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Oct. 21, 1988 In Use
00078-0181-61 00078-0181 Octreotide Acetate Sandostatin 100.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Aug. 13, 2012 In Use
00078-0182-01 00078-0182 Octreotide Acetate Sandostatin 500.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Oct. 21, 1988 In Use
00078-0182-61 00078-0182 Octreotide Acetate Sandostatin 500.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Aug. 13, 2012 In Use
00078-0240-15 00078-0240 Cyclosporine Sandimmune 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 2, 1990 In Use
00078-0240-61 00078-0240 Cyclosporine Sandimmune 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 22, 2010 In Use
00078-0241-15 00078-0241 Cyclosporine Sandimmune 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 2, 1990 In Use
00078-0241-61 00078-0241 Cyclosporine Sandimmune 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 22, 2010 In Use
00078-0246-15 00078-0246 Cyclosporine NeOral 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 14, 1995 In Use
00078-0246-61 00078-0246 Cyclosporine NeOral 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Aug. 13, 2012 In Use
00078-0248-15 00078-0248 cyclosporine NeOral 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 14, 1995 In Use
00078-0248-61 00078-0248 cyclosporine NeOral 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Aug. 13, 2012 In Use
00078-0566-51 00078-0566 Everolimus Afinitor 5.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral March 31, 2009 In Use
00078-0566-61 00078-0566 Everolimus Afinitor 5.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral March 22, 2010 In Use
00078-0567-51 00078-0567 Everolimus Afinitor 10.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral March 31, 2009 In Use
00078-0567-61 00078-0567 Everolimus Afinitor 10.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral March 22, 2010 In Use
00078-0594-51 00078-0594 Everolimus Afinitor 2.5 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral July 9, 2010 In Use
00078-0594-61 00078-0594 Everolimus Afinitor 2.5 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral July 9, 2010 In Use
00078-0620-51 00078-0620 Everolimus Afinitor 7.5 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral July 29, 2011 In Use
00078-0620-61 00078-0620 Everolimus Afinitor 7.5 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral July 29, 2011 In Use
00078-0626-51 00078-0626 Everolimus Afinitor 2.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Aug. 29, 2012 In Use
00078-0626-61 00078-0626 Everolimus Afinitor 2.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Aug. 29, 2012 In Use
00078-0627-51 00078-0627 Everolimus Afinitor 3.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Aug. 29, 2012 In Use
00078-0627-61 00078-0627 Everolimus Afinitor 3.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Aug. 29, 2012 In Use
00078-0628-51 00078-0628 Everolimus Afinitor 5.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Aug. 29, 2012 In Use
00078-0628-61 00078-0628 Everolimus Afinitor 5.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Aug. 29, 2012 In Use
00078-0669-13 00078-0669 Ofatumumab Arzerra 20.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous Feb. 1, 2016 In Use
00078-0669-61 00078-0669 Ofatumumab Arzerra 20.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous Feb. 1, 2016 In Use
00078-0698-02 00078-0698 RYDAPT Rydapt 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor FLT3 Oral April 28, 2017 In Use
00078-0698-19 00078-0698 RYDAPT Rydapt 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor FLT3 Oral April 28, 2017 In Use
00078-0698-51 00078-0698 RYDAPT Rydapt 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor FLT3 Oral April 28, 2017 In Use
00078-0698-99 00078-0698 RYDAPT Rydapt 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor FLT3 Oral April 28, 2017 In Use
00078-0709-56 00078-0709 Capmatinib TABRECTA 150.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor MET Oral May 6, 2020 In Use

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