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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class Minor Class (Descending) Administration Route Package Effective Date Package Discontinuation Date Status
50742-0495-25 50742-0495 levoleucovorin LEVOLEUCOVORIN 10.0 mg/mL Ancillary Therapy Intravenous May 8, 2018 June 30, 2021 In Use
42747-0327-07 42747-0327 Toremifene Citrate Fareston 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral June 30, 1997 Oct. 27, 2016 In Use
42747-0327-30 42747-0327 Toremifene Citrate Fareston 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral June 30, 1997 In Use
42747-0327-72 42747-0327 Toremifene Citrate Fareston 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral June 30, 1997 In Use
47781-0622-22 47781-0622 Mesna Mesna 100.0 mg/mL Ancillary Therapy Intravenous March 29, 2018 March 1, 2020 In Use
47781-0622-91 47781-0622 Mesna Mesna 100.0 mg/mL Ancillary Therapy Intravenous March 29, 2018 March 1, 2020 In Use
70860-0209-10 70860-0209 mesna Mesna 100.0 mg/mL Ancillary Therapy Intravenous Feb. 28, 2018 In Use
70860-0209-11 70860-0209 mesna Mesna 100.0 mg/mL Ancillary Therapy Intravenous Feb. 28, 2018 In Use
43353-0687-60 43353-0687 conjugated estrogens Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
43353-0688-60 43353-0688 conjugated estrogens Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
49999-0109-00 49999-0109 conjugated estrogens Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral March 21, 2012 Jan. 1, 2013 In Use
49999-0109-30 49999-0109 conjugated estrogens Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral March 21, 2012 Jan. 1, 2013 In Use
49999-0109-90 49999-0109 conjugated estrogens Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral March 21, 2012 June 1, 2012 In Use
53808-0770-01 53808-0770 conjugated estrogens Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral July 1, 2009 In Use
54868-0451-00 54868-0451 conjugated estrogens Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Feb. 8, 2005 May 12, 2014 In Use
54868-0451-02 54868-0451 conjugated estrogens Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Feb. 8, 2005 In Use
54868-0451-06 54868-0451 conjugated estrogens Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Feb. 8, 2005 In Use
69189-1105-01 69189-1105 Estrogens, Conjugated Premarin 0.9 mg/1 Hormonal Therapy Estrogen Oral Aug. 3, 2015 May 24, 2017 No Longer Used
52544-0092-76 52544-0092 Triptorelin Pamoate Trelstar Hormonal Therapy GnRH Agonist March 11, 2010 Oct. 31, 2018 No Longer Used
52544-0153-02 52544-0153 Triptorelin Pamoate Trelstar 3.75 mg/2mL Hormonal Therapy GnRH Agonist Intramuscular June 15, 2000 Oct. 31, 2018 No Longer Used
52544-0154-02 52544-0154 Triptorelin Pamoate Trelstar 11.25 mg/2mL Hormonal Therapy GnRH Agonist Intramuscular June 29, 2001 Oct. 31, 2018 No Longer Used
52544-0156-02 52544-0156 Triptorelin Pamoate Trelstar 22.5 mg/2mL Hormonal Therapy GnRH Agonist Intramuscular March 11, 2010 Oct. 31, 2018 No Longer Used
52544-0188-76 52544-0188 Triptorelin Pamoate Trelstar Hormonal Therapy GnRH Agonist June 29, 2001 Oct. 31, 2018 No Longer Used
52544-0189-76 52544-0189 Triptorelin Pamoate Trelstar Hormonal Therapy GnRH Agonist June 15, 2000 Oct. 31, 2018 No Longer Used
54868-2523-01 54868-2523 Erythropoietin Procrit 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Aug. 11, 1994 In Use
54868-5673-01 54868-5673 Erythropoietin Procrit 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous March 24, 2008 In Use
58468-1849-04 58468-1849 Thyrotropin Alfa Thyrogen Hormonal Therapy Thyroid Stimulating Hormone Nov. 30, 1998 May 30, 2019 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
67296-1562-03 67296-1562 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Oral Jan. 1, 2018 In Use
62559-0540-15 62559-0540 Hydroxyprogesterone Caproate Hydroxyprogesterone Caproate 250.0 mg/mL Hormonal Therapy Progestin Intramuscular June 3, 2016 July 31, 2018 No Longer Used
62559-0540-55 62559-0540 Hydroxyprogesterone Caproate Hydroxyprogesterone Caproate 250.0 mg/mL Hormonal Therapy Progestin Intramuscular June 3, 2016 June 3, 2016 No Longer Used
63323-0735-10 63323-0735 Pamidronate Disodium Pamidronate Disodium 9.0 mg/mL Ancillary Therapy Bisphosphonate Intravenous May 19, 2002 Aug. 27, 2015 In Use
67457-0472-10 67457-0472 Pamidronate Disodium Pamidronate Disodium 3.0 mg/mL Ancillary Therapy Bisphosphonate Intravenous May 10, 2011 Nov. 30, 2018 No Longer Used
70518-0892-00 70518-0892 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Oral Dec. 12, 2017 Jan. 6, 2020 No Longer Used
70518-1042-00 70518-1042 ondansetron hydrochloride ondansetron hydrochloride 4.0 mg/1 Ancillary Therapy Oral March 1, 2018 May 11, 2020 In Use
71837-5844-01 71837-5844 SARGRAMOSTIM Leukine 500.0 ug/mL Ancillary Therapy Intravenous, Subcutaneous May 30, 2018 May 8, 2012 No Longer Used
71837-5844-05 71837-5844 SARGRAMOSTIM Leukine 500.0 ug/mL Ancillary Therapy Intravenous, Subcutaneous May 30, 2018 May 8, 2012 No Longer Used
69189-0078-01 69189-0078 esterified estrogens Menest 0.625 mg/1 Hormonal Therapy Estrogen Oral Nov. 23, 2015 May 24, 2017 No Longer Used
71921-0190-33 71921-0190 Exemestane Exemestane 25.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Jan. 15, 2021 In Use
00093-7620-28 00093-7620 Letrozole Letrozole 2.5 mg/1 Hormonal Therapy Aromatase Inhibitor Oral June 3, 2011 In Use
00093-7620-56 00093-7620 Letrozole Letrozole 2.5 mg/1 Hormonal Therapy Aromatase Inhibitor Oral June 3, 2011 In Use
55289-0908-30 55289-0908 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 5.0 mg/1 Hormonal Therapy Progestin Oral Jan. 27, 2016 June 30, 2022 In Use
55289-0908-42 55289-0908 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 5.0 mg/1 Hormonal Therapy Progestin Oral Jan. 27, 2016 June 30, 2022 In Use
67979-0500-01 67979-0500 Histrelin Acetate Vantas 50.0 mg/1 Hormonal Therapy GnRH Agonist Subcutaneous Nov. 1, 2004 March 31, 2022 No Longer Used
69448-0014-63 69448-0014 LEUPROLIDE CAMCEVI 42.0 mg/.37g Hormonal Therapy GnRH Agonist Subcutaneous March 7, 2022 In Use
63187-0080-18 63187-0080 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral March 25, 2022 In Use
63187-0080-30 63187-0080 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Nov. 1, 2018 In Use
63187-0080-60 63187-0080 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral March 25, 2022 In Use
63187-0080-90 63187-0080 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral March 25, 2022 In Use

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