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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 (Ascending) Package Discontinuation Date Status
57664-0021-97 57664-0021 Isotretinoin Isotretinoin 20.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Dec. 29, 2020 In Use
57664-0022-97 57664-0022 Isotretinoin Isotretinoin 25.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Dec. 29, 2020 In Use
57664-0023-97 57664-0023 Isotretinoin Isotretinoin 30.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Dec. 29, 2020 In Use
57664-0024-97 57664-0024 Isotretinoin Isotretinoin 35.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Dec. 29, 2020 In Use
57664-0025-97 57664-0025 Isotretinoin Isotretinoin 40.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Dec. 29, 2020 In Use
57377-0060-01 57377-0060 Testosterone, USP and Anastrozole Testozole 4.0 mg/1, 60.0 mg/1 Hormonal Therapy Androgen/Aromatase Inhibitor Subcutaneous Jan. 1, 2021 In Use
67296-1413-01 67296-1413 Dexamethasone Dexamethasone 6.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 2021 In Use
67296-1413-02 67296-1413 Dexamethasone Dexamethasone 6.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 2021 In Use
67296-1413-04 67296-1413 Dexamethasone Dexamethasone 6.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 2021 In Use
42806-0134-34 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
42806-0134-24 42806-0134 Leucovorin Calcium Leucovorin Calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
67296-1331-07 67296-1331 Prednisone Prednisone 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 2021 In Use
67296-0902-02 67296-0902 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 1, 2021 In Use
42806-0133-21 42806-0133 Leucovorin Calcium Leucovorin Calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
42806-0133-24 42806-0133 Leucovorin Calcium Leucovorin Calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
63629-5269-00 63629-5269 Anastrozole Anastrozole 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Jan. 5, 2021 In Use
68788-7833-02 68788-7833 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 5, 2021 In Use
70700-0278-97 70700-0278 Melphalan hydrochloride Melphalan hydrochloride Chemotherapy Alkylating Agent Nitrogen Mustard Intravenous Jan. 6, 2021 In Use
70518-1585-01 70518-1585 Ondansetron Hydrochloride Ondansetron Hydrochloride 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 6, 2021 Aug. 11, 2021 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
70518-2982-00 70518-2982 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 7, 2021 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
72143-0231-30 72143-0231 ISOTRETINOIN ACCUTANE 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Jan. 11, 2021 Dec. 31, 2023 No Longer Used
72143-0233-30 72143-0233 ISOTRETINOIN ACCUTANE 30.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Jan. 11, 2021 Jan. 31, 2024 No Longer Used
72143-0234-30 72143-0234 ISOTRETINOIN ACCUTANE 40.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Jan. 11, 2021 Dec. 31, 2023 No Longer Used
63020-0536-30 63020-0536 ponatinib hydrochloride Iclusig 10.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral Jan. 11, 2021 In Use
51662-1297-03 51662-1297 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-articular, Intralesional, Intramuscular, Intravenous, Soft Tissue Jan. 11, 2021 In Use
59651-0523-01 59651-0523 Fosaprepitant dimeglumine Fosaprepitant dimeglumine 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Jan. 12, 2021 In Use
82238-0018-01 82238-0018 FOSAPREPITANT DIMEGLUMINE FOSAPREPITANT DIMEGLUMINE 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Jan. 12, 2021 In Use
55150-0299-01 55150-0299 Fosaprepitant dimeglumine Fosaprepitant dimeglumine 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Jan. 12, 2021 In Use
51655-0493-49 51655-0493 PredniSONE PredniSONE 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 13, 2021 In Use
00143-9204-01 00143-9204 Docetaxel Docetaxel 20.0 mg/mL Chemotherapy Antimitotic Agent Taxane Intravenous Jan. 14, 2021 In Use
00143-9205-01 00143-9205 Docetaxel Docetaxel 20.0 mg/mL Chemotherapy Antimitotic Agent Taxane Intravenous Jan. 14, 2021 In Use
71921-0190-33 71921-0190 Exemestane Exemestane 25.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Jan. 15, 2021 In Use
70518-2993-00 70518-2993 Bicalutamide Bicalutamide 50.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor Non-Steroidal Oral Jan. 15, 2021 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
70518-2994-00 70518-2994 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 17, 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
17856-0759-04 17856-0759 Prednisolone Sodium Phosphate Prednisolone Sodium Phosphate 15.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 20, 2021 In Use
17856-0759-05 17856-0759 Prednisolone Sodium Phosphate Prednisolone Sodium Phosphate 15.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 20, 2021 In Use
16729-0436-30 16729-0436 Fulvestrant FULVESTRANT 250.0 mg/5mL Hormonal Therapy Estrogen Receptor Antagonist Intramuscular Jan. 21, 2021 In Use
71335-1772-06 71335-1772 Methotrexate Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Jan. 21, 2021 In Use
68382-0245-05 68382-0245 Imatinib mesylate Imatinib mesylate 400.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral Jan. 21, 2021 In Use
68382-0245-06 68382-0245 Imatinib mesylate Imatinib mesylate 400.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral Jan. 21, 2021 In Use
68382-0245-16 68382-0245 Imatinib mesylate Imatinib mesylate 400.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral Jan. 21, 2021 In Use
68382-0245-78 68382-0245 Imatinib mesylate Imatinib mesylate 400.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral Jan. 21, 2021 In Use
68382-0244-05 68382-0244 Imatinib mesylate Imatinib mesylate 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral Jan. 21, 2021 In Use
68382-0244-16 68382-0244 Imatinib mesylate Imatinib mesylate 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral Jan. 21, 2021 In Use

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