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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category (Ascending) Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
71288-0155-01 71288-0155 Plerixafor Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 24, 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
71288-0409-05 71288-0409 Palonosetron Hydrochloride Palonosetron Hydrochloride 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Aug. 14, 2023 In Use
73441-0800-04 73441-0800 omidubicel-onlv OMISIRGE Ancillary Therapy Immunostimulant Stem cell mobilizer Intravenous May 1, 2023 In Use
72162-1118-01 72162-1118 Pilocarpine hydrchloride Pilocarpine hydrchloride 5.0 mg/1 Ancillary Therapy Miscellaneous Agent Cholinergic Agonist Oral Oct. 6, 2023 In Use
72205-0249-01 72205-0249 Plerixafor Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 25, 2023 In Use
81952-0911-01 81952-0911 FOSAPREPITANT FOSAPREPITANT 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous July 14, 2023 In Use
82243-1001-01 82243-1001 FOSAPREPITANT FOCINVEZ 150.0 mg/50mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Aug. 30, 2023 In Use
83008-0026-10 83008-0026 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 12, 2023 In Use
83008-0026-65 83008-0026 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 3, 2023 In Use
59353-0002-10 59353-0002 Epoetin alfa-epbx RETACRIT 2000.0 [iU]/mL, 2000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
59353-0003-10 59353-0003 Epoetin alfa-epbx RETACRIT 3000.0 [iU]/mL, 3000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
59353-0004-10 59353-0004 Epoetin alfa-epbx RETACRIT 4000.0 [iU]/mL, 4000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
59353-0010-10 59353-0010 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL, 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
59353-0120-10 59353-0120 Epoetin alfa-epbx RETACRIT 20000.0 [iU]/mL, 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
59353-0220-10 59353-0220 Epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL, 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
60687-0636-01 60687-0636 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 20, 2022 July 31, 2024 In Use
60687-0647-01 60687-0647 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 20, 2022 Aug. 31, 2024 In Use
67457-0833-06 67457-0833 Pegfilgrastim Fulphila 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous July 9, 2018 May 31, 2026 In Use
68084-0220-01 68084-0220 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 1, 2023 In Use
68084-0220-11 68084-0220 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 16, 2012 In Use

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