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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category (Descending) Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
69488-0010-61 69488-0010 Lutetium Lu 177 vipivotide tetraxetan PLUVICTO 27.0 mCi/mL Radiopharmaceutical Radiopharmaceutical PSMA Intravenous March 23, 2022 In Use
00002-8926-01 00002-8926 Olaratumab Lartruvo 10.0 mg/mL Immunotherapy Monoclonal Antibody PDGFR Intravenous Oct. 19, 2016 Nov. 27, 2020 No Longer Used
00003-2327-11 00003-2327 Ipilimumab Yervoy 5.0 mg/mL Immunotherapy Checkpoint Inhibitor CTLA-4 Intravenous March 25, 2011 In Use
00003-2328-22 00003-2328 Ipilimumab Yervoy 5.0 mg/mL Immunotherapy Checkpoint Inhibitor CTLA-4 Intravenous March 25, 2011 In Use
00006-3029-02 00006-3029 Pembrolizumab Keytruda 50.0 mg/2mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Sept. 4, 2014 Dec. 21, 2015 In Use
68152-0103-03 68152-0103 Ibritumomab Tiuxetan Zevalin Immunotherapy Radioimmunotherapy CD20 Feb. 19, 2002 Oct. 26, 2020 In Use
65483-0116-07 65483-0116 Aldesleukin Proleukin 1.1 mg/mL Immunotherapy Cytokine Interleukin-2 Intravenous May 5, 1992 In Use
60505-0501-04 60505-0501 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical Sept. 14, 2012 March 31, 2018 No Longer Used
60505-0501-05 60505-0501 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical Sept. 14, 2012 March 31, 2018 No Longer Used
57894-0421-01 57894-0421 Siltuximab Sylvant 400.0 mg/1 Immunotherapy Monoclonal Antibody Interleukin-6 Antagonists Intravenous April 1, 2014 Jan. 31, 2021 No Longer Used
57894-0420-01 57894-0420 Siltuximab Sylvant 100.0 mg/1 Immunotherapy Monoclonal Antibody Interleukin-6 Antagonists Intravenous April 23, 2014 Jan. 31, 2021 No Longer Used
50242-0333-01 50242-0333 Trastuzumab Herceptin Immunotherapy Monoclonal Antibody HER2 Feb. 10, 2017 Feb. 10, 2017 No Longer Used
50242-0134-68 50242-0134 Trastuzumab Herceptin Immunotherapy Monoclonal Antibody HER2 Sept. 25, 1998 April 30, 2019 No Longer Used
42238-0111-01 42238-0111 Interferon gamma-1b Actimmune 100.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Dec. 1, 2013 Jan. 17, 2018 No Longer Used
42238-0111-12 42238-0111 Interferon gamma-1b Actimmune 100.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Dec. 1, 2013 Jan. 17, 2018 No Longer Used
45802-0076-00 45802-0076 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical April 20, 2010 Aug. 1, 2013 No Longer Used
45802-0076-62 45802-0076 Imiquimod Imiquimod 50.0 mg/1000mg Immunotherapy Immunomodulator Dermatological Agent Topical April 20, 2010 Aug. 1, 2013 No Longer Used
45802-0368-53 45802-0368 Imiquimod Imiquimod 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical July 12, 2012 In Use
45802-0368-62 45802-0368 Imiquimod Imiquimod 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical Nov. 9, 2010 In Use
49281-0880-03 49281-0880 BACILLUS CALMETTE-GUERIN SUBSTRAIN CONNAUGHT LIVE ANTIGEN THERACYS 81.0 mg/3mL Immunotherapy Biological Response Modifier Live Vaccine Intravesical July 22, 2011 May 8, 2017 No Longer Used
50242-0070-01 50242-0070 Obinutuzumab Gazyva 1000.0 mg/40mL Immunotherapy Monoclonal Antibody CD20 Intravenous Nov. 1, 2013 In Use
50242-0070-86 50242-0070 Obinutuzumab Gazyva 1000.0 mg/40mL Immunotherapy Monoclonal Antibody CD20 Intravenous Nov. 4, 2013 In Use
51144-0020-01 51144-0020 ENFORTUMAB VEDOTIN PADCEV 20.0 mg/2mL Immunotherapy Drug Antibody Conjugate Nectin-4 Intravenous Dec. 18, 2019 In Use
51144-0030-01 51144-0030 ENFORTUMAB VEDOTIN PADCEV 30.0 mg/3mL Immunotherapy Drug Antibody Conjugate Nectin-4 Intravenous Dec. 18, 2019 In Use
55513-0955-01 55513-0955 Panitumumab Vectibix 200.0 mg/10mL Immunotherapy Monoclonal Antibody EGFR Intravenous Oct. 10, 2006 Feb. 28, 2010 No Longer Used
59572-0402-00 59572-0402 Lenalidomide Revlimid 2.5 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral May 9, 2012 In Use
59572-0402-28 59572-0402 Lenalidomide Revlimid 2.5 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral May 9, 2012 In Use
59572-0405-00 59572-0405 Lenalidomide Revlimid 5.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Dec. 27, 2005 In Use
59572-0405-28 59572-0405 Lenalidomide Revlimid 5.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral March 3, 2009 In Use
59572-0410-00 59572-0410 Lenalidomide Revlimid 10.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Dec. 27, 2005 In Use
59572-0410-28 59572-0410 Lenalidomide Revlimid 10.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral March 3, 2009 In Use
59572-0415-00 59572-0415 Lenalidomide Revlimid 15.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral July 7, 2006 In Use
59572-0415-21 59572-0415 Lenalidomide Revlimid 15.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral July 7, 2006 In Use
59572-0420-00 59572-0420 Lenalidomide Revlimid 20.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral June 10, 2013 In Use
59572-0420-21 59572-0420 Lenalidomide Revlimid 20.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral June 10, 2013 In Use
59572-0425-00 59572-0425 Lenalidomide Revlimid 25.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral July 7, 2006 In Use
59572-0425-21 59572-0425 Lenalidomide Revlimid 25.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral March 3, 2009 In Use
62856-0603-01 62856-0603 Denileukin diftitox Ontak 150.0 ug/mL Immunotherapy Cytokine Interleukin-2 Intravenous Nov. 1, 2013 Nov. 1, 2013 No Longer Used
63459-0103-10 63459-0103 Rituximab-abbs Truxima 10.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous May 4, 2020 In Use
63459-0104-50 63459-0104 Rituximab-abbs Truxima 10.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous May 4, 2020 In Use
63459-0305-47 63459-0305 TRASTUZUMAB HERZUMA Immunotherapy Monoclonal Antibody HER2 March 16, 2020 In Use
00085-4347-01 00085-4347 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon Aug. 30, 2014 Oct. 18, 2020 In Use
00085-4348-01 00085-4348 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon March 29, 2011 Oct. 18, 2020 In Use
00085-4349-01 00085-4349 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon March 29, 2011 Oct. 18, 2020 In Use
57894-0502-05 57894-0502 Daratumumab Darzalex 100.0 mg/5mL Immunotherapy Monoclonal Antibody CD38 Intravenous Nov. 16, 2015 In Use
57894-0502-20 57894-0502 Daratumumab Darzalex 100.0 mg/5mL Immunotherapy Monoclonal Antibody CD38 Intravenous Nov. 16, 2015 In Use
00003-3756-14 00003-3756 nivolumab OPDIVO 10.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Aug. 30, 2021 In Use
57894-0505-05 57894-0505 Daratumumab Darzalex IV 100.0 mg/5mL Immunotherapy Monoclonal Antibody CD38 Intravenous Oct. 15, 2021 In Use
57894-0505-20 57894-0505 Daratumumab Darzalex IV 100.0 mg/5mL Immunotherapy Monoclonal Antibody CD38 Intravenous Oct. 15, 2021 In Use
71287-0220-02 71287-0220 brexucabtagene autoleucel TECARTUS 1000000.0 1/68mL Immunotherapy CAR-T CD19 Intravenous Oct. 1, 2021 In Use

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