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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
80739-0812-12 80739-0812 Adagrasib KRAZATI 200.0 mg/1 Immunotherapy RAS Inhibitor KRAS G12C Oral Dec. 12, 2022 In Use
80739-0812-18 80739-0812 Adagrasib KRAZATI 200.0 mg/1 Immunotherapy RAS Inhibitor KRAS G12C Oral Dec. 12, 2022 In Use
50242-0159-01 50242-0159 Mosunetuzumab Lunsumio 1.0 mg/mL Immunotherapy Monoclonal Antibody CD20, CD3 Intravenous Dec. 22, 2022 In Use
50242-0142-01 50242-0142 Mosunetuzumab Lunsumio 30.0 mg/30mL Immunotherapy Monoclonal Antibody CD20, CD3 Intravenous Dec. 22, 2022 In Use
00006-3061-00 00006-3061 Fosaprepitant Dimeglumine Emend 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Feb. 3, 2017 In Use
00006-3061-01 00006-3061 Fosaprepitant Dimeglumine Emend 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Feb. 3, 2017 In Use
00378-3097-85 00378-3097 everolimus everolimus 5.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Dec. 15, 2022 In Use
16714-0671-02 16714-0671 Ondansetron Hydrochloride Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 28, 2007 In Use
50090-0091-00 50090-0091 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Nov. 28, 2014 In Use
50090-2098-00 50090-2098 Methylprednisolone Acetate Depo-Medrol 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-Articular, Intralesional, Intramuscular, Soft Tissue Oct. 13, 2015 In Use
50242-0918-01 50242-0918 Atezolizumab TECENTRIQ 840.0 mg/14mL Immunotherapy Checkpoint Inhibitor PD-L1 Intravenous March 8, 2019 In Use
51079-0582-01 51079-0582 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Aug. 27, 1997 In Use
51991-0005-90 51991-0005 Exemestane Exemestane 25.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Nov. 15, 2020 In Use
55154-2353-05 55154-2353 Metoclopramide Hydrochloride Metoclopramide 5.0 mg/mL Ancillary Therapy Antiemetic Dopamine-2 Receptor Antagonist Intramuscular, Intravenous Sept. 22, 2009 In Use
55154-4949-00 55154-4949 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 13, 2003 In Use
60505-0133-00 60505-0133 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 29, 2002 In Use
60505-0134-00 60505-0134 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 29, 2002 In Use
61919-0087-10 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 29, 2019 In Use
61919-0087-15 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 29, 2019 In Use
61919-0087-20 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 10, 2017 In Use
61919-0087-30 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 29, 2019 In Use
61919-0087-60 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 10, 2017 In Use
61919-0326-21 61919-0326 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Sept. 18, 2019 In Use
61919-0326-05 61919-0326 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 2014 In Use
61919-0326-30 61919-0326 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Sept. 19, 2022 In Use
63539-0688-03 63539-0688 palbociclib Ibrance 125.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 30, 2020 In Use
70934-0259-21 70934-0259 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 25, 2019 In Use
70934-0259-30 70934-0259 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 4, 2019 In Use
70934-0259-42 70934-0259 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral April 17, 2019 In Use
76346-0073-01 76346-0073 Mifepristone Korlym 300.0 mg/1 Hormonal Therapy Antiprogestin Cortisol Receptor Blocker Oral Feb. 17, 2012 In Use
76346-0073-02 76346-0073 Mifepristone Korlym 300.0 mg/1 Hormonal Therapy Antiprogestin Cortisol Receptor Blocker Oral Feb. 17, 2012 In Use
00023-5902-04 00023-5902 Triptorelin Pamoate Trelstar Hormonal Therapy GnRH Agonist June 15, 2000 In Use
00023-5904-12 00023-5904 Triptorelin Pamoate Trelstar Hormonal Therapy GnRH Agonist June 29, 2001 In Use
00023-5906-23 00023-5906 Triptorelin Pamoate Trelstar Hormonal Therapy GnRH Agonist March 11, 2010 In Use
00115-1696-06 00115-1696 Hydrocortisone Hydrocortisone 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 30, 2007 In Use
00115-1697-01 00115-1697 Hydrocortisone Hydrocortisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 30, 2007 In Use
00115-1700-01 00115-1700 Hydrocortisone Hydrocortisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 30, 2007 In Use
13925-0166-04 13925-0166 Prednisolone Sodium Phosphate Prednisolone Sodium Phosphate 5.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 18, 2013 In Use
16714-0070-02 16714-0070 fulvestrant FULVESTRANT 50.0 mg/mL Hormonal Therapy Estrogen Receptor Antagonist Intramuscular Aug. 23, 2021 In Use
16714-0890-01 16714-0890 LEVOLEUCOVORIN LEVOLEUCOVORIN 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 26, 2018 In Use
17856-0090-01 17856-0090 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Jan. 11, 2021 In Use
17856-0691-01 17856-0691 Ondansetron Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 28, 2021 In Use
17856-0691-02 17856-0691 Ondansetron Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 28, 2021 In Use
17856-0691-04 17856-0691 Ondansetron Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 28, 2021 In Use
17856-0691-05 17856-0691 Ondansetron Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 28, 2021 In Use
17856-0691-06 17856-0691 Ondansetron Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 28, 2021 In Use
17856-0691-07 17856-0691 Ondansetron Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 28, 2021 In Use
17856-0691-08 17856-0691 Ondansetron Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb. 10, 2021 In Use
17856-0759-01 17856-0759 Prednisolone Sodium Phosphate Prednisolone Sodium Phosphate 15.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 20, 2021 In Use
17856-0759-02 17856-0759 Prednisolone Sodium Phosphate Prednisolone Sodium Phosphate 15.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 20, 2021 In Use

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