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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
00078-0495-61 00078-0495 Aldesleukin Proleukin 1.1 mg/mL Immunotherapy Cytokine Interleukin-2 Intravenous May 6, 1992 Jan. 1, 2017 No Longer Used
00115-1476-23 00115-1476 Imiquimod Imiquimod 50.0 mg/g Immunotherapy Immunomodulator Dermatological Agent Topical Feb. 28, 2011 June 1, 2017 No Longer Used
00115-1476-59 00115-1476 Imiquimod Imiquimod 50.0 mg/g Immunotherapy Immunomodulator Dermatological Agent Topical Feb. 28, 2011 June 1, 2017 No Longer Used
00085-0539-01 00085-0539 Interferon alfa-2b Intron A Immunotherapy Cytokine Interferon June 4, 1986 July 31, 2016 No Longer Used
00085-0571-02 00085-0571 Interferon alfa-2b Intron A Immunotherapy Cytokine Interferon June 4, 1986 July 31, 2016 No Longer Used
00085-1110-01 00085-1110 Interferon alfa-2b Intron A Immunotherapy Cytokine Interferon June 4, 1986 July 31, 2016 No Longer Used
00085-1287-02 00085-1287 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon March 29, 2011 Jan. 13, 2016 No Longer Used
00085-1287-03 00085-1287 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon March 29, 2011 Jan. 13, 2016 No Longer Used
00085-1312-01 00085-1312 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon March 29, 2011 Jan. 13, 2016 No Longer Used
00085-1312-02 00085-1312 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon March 29, 2011 Nov. 20, 2013 No Longer Used
00085-1388-01 00085-1388 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon March 29, 2011 Jan. 13, 2016 No Longer Used
00085-1388-02 00085-1388 Peginterferon alfa-2b Sylatron Immunotherapy Cytokine Interferon March 29, 2011 Jan. 13, 2016 No Longer Used
73042-0201-01 73042-0201 Naxitamab DANYELZA 40.0 mg/10mL Immunotherapy Monoclonal Antibody GD2 Intravenous Nov. 25, 2020 In Use
74527-0022-02 74527-0022 margetuximab-cmkb MARGENZA 25.0 mg/mL Immunotherapy Monoclonal Antibody HER2 Intravenous Jan. 15, 2021 In Use
74527-0022-03 74527-0022 margetuximab-cmkb MARGENZA 25.0 mg/mL Immunotherapy Monoclonal Antibody HER2 Intravenous Jan. 15, 2021 In Use
00069-0238-01 00069-0238 Rituximab-pvvr Ruxience 100.0 mg/10mL Immunotherapy Monoclonal Antibody CD20 Intravenous Jan. 23, 2020 In Use
00069-0249-01 00069-0249 Rituximab-pvvr Ruxience 500.0 mg/50mL Immunotherapy Monoclonal Antibody CD20 Intravenous Jan. 23, 2020 In Use
00069-0315-01 00069-0315 Bevacizumab-bvzr Zirabev 100.0 mg/4mL Immunotherapy Monoclonal Antibody VEGFR Intravenous Jan. 13, 2020 In Use
00069-0342-01 00069-0342 Bevacizumab-bvzr Zirabev 400.0 mg/16mL Immunotherapy Monoclonal Antibody VEGFR Intravenous Jan. 13, 2020 In Use
73153-0900-01 73153-0900 Lisocabtagene maraleucel BREYANZI Immunotherapy CAR-T CD19 Feb. 5, 2021 In Use
00069-0308-01 00069-0308 trastuzumab-qyyp Trazimera 150.0 mg/7.15mL Immunotherapy Monoclonal Antibody HER2 Intravenous March 10, 2021 In Use
72189-0084-24 72189-0084 IMIQUIMOD IMIQUIMOD 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical March 23, 2020 In Use
50242-0051-10 50242-0051 Rituximab Rituxan 10.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous June 3, 2019 In Use
50242-0051-21 50242-0051 Rituximab Rituxan 10.0 mg/mL Immunotherapy Monoclonal Antibody CD20 Intravenous Nov. 26, 1997 In Use
50242-0103-01 50242-0103 polatuzumab vedotin POLIVY 30.0 mg/1.88mL Immunotherapy Drug Antibody Conjugate CD79b Intravenous Sept. 18, 2020 In Use
50242-0132-01 50242-0132 Trastuzumab Herceptin 150.0 mg/7.4mL Immunotherapy Monoclonal Antibody HER2 Intravenous Feb. 10, 2017 In Use
50242-0132-10 50242-0132 Trastuzumab Herceptin 150.0 mg/7.4mL Immunotherapy Monoclonal Antibody HER2 Intravenous June 3, 2019 In Use
50242-0917-01 50242-0917 Atezolizumab Tecentriq 1200.0 mg/20mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous May 18, 2016 In Use
50242-0917-86 50242-0917 Atezolizumab Tecentriq 1200.0 mg/20mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous Aug. 11, 2016 In Use
55513-0141-01 55513-0141 trastuzumab-anns Kanjinti 150.0 mg/7.15mL Immunotherapy Monoclonal Antibody HER2 Intravenous Oct. 28, 2019 In Use
55513-0224-01 55513-0224 rituximab-arrx Riabni 100.0 mg/10mL Immunotherapy Monoclonal Antibody CD20 Intravenous Jan. 6, 2021 In Use
55513-0326-01 55513-0326 rituximab-arrx Riabni 500.0 mg/50mL Immunotherapy Monoclonal Antibody CD20 Intravenous Jan. 6, 2021 In Use
65597-0406-01 65597-0406 fam-trastuzumab deruxtecan-nxki Enhertu 100.0 mg/5mL Immunotherapy Drug Antibody Conjugate Topoisomerase I Inhibitor Intravenous Dec. 20, 2019 In Use
00173-0898-03 00173-0898 dostarlimab Jemperli 50.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous April 22, 2021 In Use
00003-3734-13 00003-3734 nivolumab OPDIVO 10.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Dec. 8, 2017 In Use
00078-0958-19 00078-0958 tisagenlecleucel KYMRIAH 60000000.0 1/1 Immunotherapy CAR-T CD19 Intravenous May 1, 2018 In Use
42747-0761-01 42747-0761 mogamulizumab-kpkc POTELIGEO 4.0 mg/mL Immunotherapy Monoclonal Antibody CCR4 Intravenous Aug. 8, 2018 In Use
61755-0008-01 61755-0008 cemiplimab-rwlc LIBTAYO 50.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous Sept. 28, 2018 In Use
00004-0360-09 00004-0360 Peginterferon alfa-2a Pegasys 135.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Nov. 1, 2011 Feb. 8, 2018 No Longer Used
00004-0360-30 00004-0360 Peginterferon alfa-2a Pegasys 135.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Nov. 1, 2011 Jan. 31, 2019 No Longer Used
00004-0352-30 00004-0352 Peginterferon alfa-2a Pegasys Immunotherapy Cytokine Interferon Feb. 22, 2011 Aug. 22, 2011 No Longer Used
00004-0352-39 00004-0352 Peginterferon alfa-2a Pegasys Immunotherapy Cytokine Interferon Oct. 16, 2002 July 31, 2015 No Longer Used
00004-0352-98 00004-0352 Peginterferon alfa-2a Pegasys Immunotherapy Cytokine Interferon Oct. 16, 2002 July 31, 2015 No Longer Used
71287-0219-02 71287-0219 brexucabtagene autoleucel TECARTUS 2000000.0 1/68mL Immunotherapy CAR-T CD19 Intravenous July 24, 2020 In Use
58468-0357-01 58468-0357 Alemtuzumab Campath 30.0 mg/mL Immunotherapy Monoclonal Antibody CD52 Intravenous Nov. 30, 2009 In Use
58468-0357-03 58468-0357 Alemtuzumab Campath 30.0 mg/mL Immunotherapy Monoclonal Antibody CD52 Intravenous Nov. 30, 2009 In Use
71287-0119-02 71287-0119 Axicabtagene ciloleucel Yescarta 2000000.0 1/68mL Immunotherapy CAR-T CD19 Intravenous Oct. 18, 2017 In Use
00052-0602-02 00052-0602 BACILLUS CALMETTE-GUERIN TICE BCG 50.0 mg/50mL Immunotherapy Biological Response Modifier Live Vaccine Intravesical Aug. 24, 1990 In Use
55513-0160-01 55513-0160 Blinatumomab Blincyto Immunotherapy Monoclonal Antibody CD3 (T cells) and CD19 (B cells) Intravenous Dec. 18, 2014 In Use

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