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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 Status
72819-0153-02 72819-0153 Mitomycin Mitomycin 20.0 mg/40mL Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Intravenous April 25, 2022 In Use
72819-0154-04 72819-0154 Mitomycin Mitomycin 40.0 mg/80mL Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Intravenous April 25, 2022 In Use
72974-0120-01 72974-0120 Relugolix Orgovyx 120.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor GnRH Receptor Antagonist Oral Dec. 18, 2020 In Use
72974-0120-97 72974-0120 Relugolix Orgovyx 120.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor GnRH Receptor Antagonist Oral Oct. 21, 2021 In Use
72974-0120-95 72974-0120 Relugolix Orgovyx 120.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor GnRH Receptor Antagonist Oral Jan. 27, 2023 In Use
80425-0075-01 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0075-02 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0075-03 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0075-04 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0075-05 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0230-01 80425-0230 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 11, 2023 In Use
80425-0231-01 80425-0231 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 11, 2023 In Use
80425-0242-02 80425-0242 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 11, 2023 In Use
80425-0255-01 80425-0255 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 11, 2023 In Use
80425-0261-01 80425-0261 Dexamethasone Sodium Phosphate Dexamethasone Sodium Phosphate 10.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous Feb. 16, 2023 In Use
80425-0262-01 80425-0262 Triamcinolone acetonide Triamcinolone acetonide 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-articular, Intramuscular Feb. 15, 2023 In Use
80425-0328-01 80425-0328 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral April 24, 2023 In Use
80725-0610-25 80725-0610 Chlorambucil LEUKERAN 2.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard Oral May 15, 2023 In Use
80725-0620-25 80725-0620 Busulfan MYLERAN 2.0 mg/1 Chemotherapy Alkylating Agent Alkylsulfonate Oral May 15, 2023 In Use
80725-0630-25 80725-0630 Thioguanine TABLOID 40.0 mg/1 Chemotherapy Antimetabolite Purine Analog Oral May 15, 2023 In Use
80978-0111-06 80978-0111 Nelarabine injection NELARABINE 250.0 mg/mL Chemotherapy Antimetabolite Purine Analog Intravenous April 12, 2023 In Use
82982-0041-63 82982-0041 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 21, 2023 In Use
82982-0042-15 82982-0042 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 15, 2023 In Use
82982-0059-10 82982-0059 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 28, 2023 In Use
82982-0061-10 82982-0061 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 30, 2023 In Use
81927-0111-01 81927-0111 Nelarabine Nelarabine 5.0 mg/mL Chemotherapy Antimetabolite Purine Analog Intravenous March 15, 2023 In Use
81927-0111-06 81927-0111 Nelarabine Nelarabine 5.0 mg/mL Chemotherapy Antimetabolite Purine Analog Intravenous March 15, 2023 In Use
00069-1311-04 00069-1311 epoetin alfa-epbx RETACRIT 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Dec. 1, 2020 In Use
00069-1311-10 00069-1311 epoetin alfa-epbx RETACRIT 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
00002-4184-02 00002-4184 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Dec. 16, 2016 Jan. 1, 2023 In Use
00002-4184-07 00002-4184 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Dec. 16, 2016 Nov. 30, 2019 In Use
00002-4184-30 00002-4184 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Dec. 16, 2016 In Use
00002-7623-01 00002-7623 Pemetrexed disodium Alimta 500.0 mg/20mL Chemotherapy Antimetabolite Folic Acid Analog Intravenous Feb. 13, 2004 In Use
00002-7623-61 00002-7623 Pemetrexed disodium Alimta 500.0 mg/20mL Chemotherapy Antimetabolite Folic Acid Analog Intravenous July 24, 2012 March 30, 2015 In Use
00003-0852-11 00003-0852 Dasatinib Sprycel 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral June 3, 2009 Jan. 26, 2011 In Use
00003-0852-22 00003-0852 Dasatinib Sprycel 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral May 30, 2008 In Use
00004-0350-09 00004-0350 Peginterferon alfa-2a Pegasys 180.0 ug/mL Immunotherapy Cytokine Interferon Subcutaneous Oct. 16, 2002 June 30, 2025 In Use
00004-0350-39 00004-0350 Peginterferon alfa-2a Pegasys 180.0 ug/mL Immunotherapy Cytokine Interferon Subcutaneous Oct. 16, 2002 Sept. 1, 2009 In Use
00004-0357-30 00004-0357 Peginterferon alfa-2a Pegasys 180.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous March 29, 2011 June 30, 2024 In Use
00004-0357-99 00004-0357 Peginterferon alfa-2a Pegasys 180.0 ug/.5mL Immunotherapy Cytokine Interferon Subcutaneous Aug. 22, 2011 Sept. 19, 2014 In Use
00006-3066-01 00006-3066 Aprepitant Emend 125.0 mg/1 Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Oral Dec. 17, 2015 In Use
00006-3066-03 00006-3066 Aprepitant Emend 125.0 mg/1 Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Oral Dec. 17, 2015 In Use
00006-4045-00 00006-4045 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4045-01 00006-4045 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4045-41 00006-4045 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4109-01 00006-4109 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4109-02 00006-4109 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4109-06 00006-4109 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 May 6, 2011 In Use
00006-4109-09 00006-4109 Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant GARDASIL 40.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular June 8, 2006 In Use
00006-4119-01 00006-4119 Human Papillomavirus 9-valent Vaccine, Recombinant GARDASIL 9 40.0 ug/.5mL, 60.0 ug/.5mL, 40.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 20.0 ug/.5mL, 30.0 ug/.5mL Ancillary Therapy Protective Agent HPV Vaccine Intramuscular Dec. 10, 2014 In Use

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