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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
68083-0484-01 68083-0484 MITOMYCIN MITOMYCIN 20.0 mg/40mL Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Intravenous Oct. 20, 2021 In Use
55150-0271-01 55150-0271 Cyclophosphamide Cyclophosphamide 1.0 g/5mL Chemotherapy Alkylating Agent Nitrogen Mustard Intravenous Aug. 25, 2021 In Use
55150-0270-01 55150-0270 Cyclophosphamide Cyclophosphamide 500.0 mg/2.5mL Chemotherapy Alkylating Agent Nitrogen Mustard Intravenous Aug. 25, 2021 In Use
68083-0483-01 68083-0483 MITOMYCIN MITOMYCIN 5.0 mg/10mL Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Intravenous Oct. 20, 2021 In Use
51662-1539-01 51662-1539 ONDANSETRON ONDANSETRON 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 6, 2021 In Use
42254-0110-30 42254-0110 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Dec. 7, 1953 In Use
64764-0800-28 64764-0800 MARIBAVIR Livtencity 200.0 mg/1 Ancillary Therapy Miscellaneous Agent CMV Antiviral Oral Nov. 23, 2021 In Use
64764-0800-56 64764-0800 MARIBAVIR Livtencity 200.0 mg/1 Ancillary Therapy Miscellaneous Agent CMV Antiviral Oral Nov. 23, 2021 In Use
79802-0200-30 79802-0200 belumosudil Rezurock 200.0 mg/1 Chemotherapy Rho Kinase Inhibitor ROCK 1, ROCK2 Oral July 16, 2021 In Use
00245-0570-01 00245-0570 Isotretinoin Isotretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
00245-0571-01 00245-0571 Isotretinoin Isotretinoin 20.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
00245-0573-01 00245-0573 Isotretinoin Isotretinoin 30.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
00378-0005-85 00378-0005 Everolimus Everolimus 2.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Oct. 1, 2021 In Use
00378-0006-85 00378-0006 Everolimus Everolimus 3.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Oct. 1, 2021 In Use
00378-0007-85 00378-0007 Everolimus Everolimus 5.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Oct. 1, 2021 In Use
16729-0542-35 16729-0542 Fluorouracil Fluorouracil 50.0 mg/g Chemotherapy Antimetabolite Pyrimidine Analog Topical Nov. 11, 2021 In Use
36000-0326-02 36000-0326 palonosetron hydrochloride Palonosetron Hydrochloride 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Nov. 12, 2021 In Use
50742-0521-10 50742-0521 Cyclophosphamide CYCLOPHOSPHAMIDE 200.0 mg/mL Chemotherapy Alkylating Agent Nitrogen Mustard Intravenous Nov. 19, 2021 In Use
51991-0824-28 51991-0824 Everolimus Everolimus 10.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Oct. 1, 2021 In Use
63323-0926-88 63323-0926 Romidepsin Romidepsin Chemotherapy Enzyme Inhibitor HDAC Intravenous Oct. 12, 2021 In Use
63629-5269-00 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Jan. 5, 2021 In Use
63629-5269-01 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral March 21, 2014 In Use
63629-5269-02 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Aug. 13, 2014 In Use
63629-5269-03 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Jan. 26, 2016 In Use
63629-5269-04 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral June 20, 2018 In Use
63629-5269-05 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Dec. 1, 2021 In Use
63629-5269-06 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral June 25, 2018 In Use
63629-5269-07 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Nov. 20, 2019 In Use
00409-3414-01 00409-3414 Metoclopramide Metoclopramide 5.0 mg/mL Ancillary Therapy Antiemetic Dopamine-2 Receptor Antagonist Intramuscular, Intravenous Feb. 2, 2006 In Use
00409-4759-01 00409-4759 Ondansetron Ondansetron 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Nov. 7, 2006 In Use
00555-0484-01 00555-0484 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral June 30, 1990 In Use
00555-0484-02 00555-0484 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral June 30, 1990 In Use
00555-0484-05 00555-0484 Leucovorin Calcium Leucovorin Calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral June 30, 1990 In Use
00641-6078-01 00641-6078 Ondansetron Ondansetron 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Dec. 26, 2006 In Use
00641-6078-25 00641-6078 Ondansetron Ondansetron 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Dec. 26, 2006 In Use
00641-6080-01 00641-6080 Ondansetron Ondansetron 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Dec. 26, 2006 In Use
00641-6080-25 00641-6080 Ondansetron Ondansetron 2.0 mg/mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intramuscular, Intravenous Dec. 26, 2006 In Use
00703-4502-04 00703-4502 Metoclopramide Metoclopramide 5.0 mg/mL Ancillary Therapy Antiemetic Dopamine-2 Receptor Antagonist Intramuscular, Intravenous Dec. 1, 1991 In Use
00703-3321-01 00703-3321 Octreotide Acetate Octreotide Acetate 500.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Nov. 14, 2005 In Use
00703-3321-04 00703-3321 Octreotide Acetate Octreotide Acetate 500.0 ug/mL Hormonal Therapy Somatostatin Analog Intravenous, Subcutaneous Nov. 14, 2005 In Use
00703-5145-01 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous June 12, 1997 In Use
00703-5145-91 00703-5145 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous May 13, 2013 In Use
00781-3201-94 00781-3201 Levoleucovorin Levoleucovorin 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous April 23, 2015 In Use
10544-0046-20 10544-0046 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 17, 2013 In Use
10544-0046-30 10544-0046 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral July 7, 2011 In Use
10544-0046-42 10544-0046 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 15, 2011 In Use
16729-0034-10 16729-0034 Letrozole Letrozole 2.5 mg/1 Hormonal Therapy Aromatase Inhibitor Oral June 2, 2011 In Use
16729-0034-15 16729-0034 Letrozole Letrozole 2.5 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Dec. 31, 2014 In Use
10631-0133-31 10631-0133 Isotretinoin Absorica 25.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Feb. 17, 2015 In Use
10631-0134-31 10631-0134 Isotretinoin Absorica 35.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Feb. 17, 2015 In Use

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