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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class (Ascending) Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
63459-0920-59 63459-0920 tbo-filgrastim GRANIX 480.0 ug/1.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 7, 2018 In Use
63459-0918-59 63459-0918 tbo-filgrastim GRANIX 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 7, 2018 In Use
76961-0101-01 76961-0101 Eflapegrastim-xnst Rolvedon 13.2 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte colony stimulating factor Subcutaneous Oct. 18, 2022 In Use
70114-0120-01 70114-0120 Pegfilgrastim-cbqv UDENYCA 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous March 6, 2023 In Use
70121-1568-07 70121-1568 Filgrastim RELEUKO 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Feb. 25, 2022 In Use
70121-1568-01 70121-1568 Filgrastim RELEUKO 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Feb. 25, 2022 In Use
70383-0073-01 70383-0073 MOTIXAFORTIDE ACETATE Aphexda 62.0 mg/1.7mL Ancillary Therapy Immunostimulant Stem cell mobilizer Subcutaneous Sept. 8, 2023 In Use
82737-0073-01 82737-0073 Motixafortide Aphexda 62.0 mg/1.7mL Ancillary Therapy Immunostimulant Stem cell mobilizer Subcutaneous Sept. 8, 2023 In Use
00480-4320-01 00480-4320 Plerixafor Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 28, 2023 In Use
55150-0356-01 55150-0356 Plerixafor Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 24, 2023 In Use
65219-0284-12 65219-0284 PLERIXAFOR Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous June 22, 2023 In Use
70121-1694-02 70121-1694 Plerixafor Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 25, 2023 In Use
70710-1208-01 70710-1208 Plerixafor PLERIXAFOR 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 28, 2023 In Use
70771-1776-01 70771-1776 Plerixafor PLERIXAFOR 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 28, 2023 In Use
71288-0155-01 71288-0155 Plerixafor Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 24, 2023 In Use
73441-0800-04 73441-0800 omidubicel-onlv OMISIRGE Ancillary Therapy Immunostimulant Stem cell mobilizer Intravenous May 1, 2023 In Use
72205-0249-01 72205-0249 Plerixafor Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 25, 2023 In Use
83257-0005-41 83257-0005 Pegfilgrastim Fulphila 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous July 28, 2023 In Use
67457-0833-06 67457-0833 Pegfilgrastim Fulphila 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous July 9, 2018 May 31, 2026 In Use
71837-5843-05 71837-5843 SARGRAMOSTIM Leukine 250.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte colony stimulating factor Intravenous, Subcutaneous Sept. 1, 2023 In Use
50242-0717-01 50242-0717 Cobimetinib Cotellic 20.0 mg/1 Chemotherapy MAPK/MEK Inhibitor BRAF Oral Nov. 10, 2015 In Use
50242-0717-86 50242-0717 Cobimetinib Cotellic 20.0 mg/1 Chemotherapy MAPK/MEK Inhibitor BRAF Oral Nov. 10, 2015 In Use
00173-0849-13 00173-0849 Trametinib Mekinist 0.5 mg/1 Chemotherapy MEK Inhibitor BRAF Oral June 17, 2013 Dec. 31, 2016 No Longer Used
00173-0858-13 00173-0858 Trametinib Mekinist 1.0 mg/1 Chemotherapy MEK Inhibitor BRAF Oral June 17, 2013 Oct. 5, 2015 No Longer Used
70255-0010-02 70255-0010 BINIMETINIB MEKTOVI 15.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral June 27, 2018 In Use
70255-0010-03 70255-0010 BINIMETINIB MEKTOVI 15.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral June 27, 2018 In Use
00173-0848-13 00173-0848 Trametinib Mekinist 2.0 mg/1 Chemotherapy MEK Inhibitor BRAF Oral June 17, 2013 Dec. 31, 2016 No Longer Used
00173-0848-65 00173-0848 Trametinib Mekinist 2.0 mg/1 Chemotherapy MEK Inhibitor BRAF Oral June 17, 2013 Nov. 30, 2016 No Longer Used
00310-0610-28 00310-0610 SELUMETINIB KOSELUGO 10.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral June 11, 2021 In Use
00310-0610-60 00310-0610 SELUMETINIB KOSELUGO 10.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral April 16, 2020 In Use
00310-0625-28 00310-0625 SELUMETINIB KOSELUGO 25.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral June 11, 2021 In Use
00310-0625-60 00310-0625 SELUMETINIB KOSELUGO 25.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral April 16, 2020 In Use
00078-1161-47 00078-1161 Trametinib Mekinist 0.05 mg/mL Chemotherapy MEK Inhibitor BRAF Oral March 16, 2023 In Use
00078-0666-15 00078-0666 Trametinib Mekinist 0.5 mg/1 Chemotherapy MEK Inhibitor BRAF Oral March 17, 2016 Oct. 31, 2023 In Use
00078-0668-15 00078-0668 Trametinib Mekinist 2.0 mg/1 Chemotherapy MEK Inhibitor BRAF Oral March 17, 2016 April 30, 2024 In Use
00024-5150-10 00024-5150 Rasburicase Elitek Ancillary Therapy Metabolic Agent Enzyme July 12, 2002 In Use
00024-5151-75 00024-5151 Rasburicase Elitek Ancillary Therapy Metabolic Agent Enzyme June 1, 2006 In Use
49315-0007-10 49315-0007 Arsenic trioxide Arsenic trioxide 2.0 mg/mL Chemotherapy Miscellaneous Agent PML/RARa Intravenous Sept. 3, 2019 In Use
63459-0601-06 63459-0601 Arsenic Trioxide Trisenox 2.0 mg/mL Chemotherapy Miscellaneous Agent PML/RARa Intravenous Dec. 22, 2017 In Use
00574-0792-01 00574-0792 pilocarpine hydrchloride pilocarpine hydrchloride 5.0 mg/1 Ancillary Therapy Miscellaneous Agent Cholinergic Agonist Oral Aug. 24, 2020 In Use
14789-0600-10 14789-0600 Arsenic Trioxide Arsenic Trioxide 1.0 mg/mL Chemotherapy Miscellaneous Agent PML/RARa Intravenous Nov. 19, 2018 In Use
00555-0882-02 00555-0882 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral Oct. 19, 1998 In Use
49884-0724-01 49884-0724 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral Feb. 24, 1999 In Use
54868-4773-00 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4773-01 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4773-02 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4773-03 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
54868-4773-04 54868-4773 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral April 11, 2003 In Use
55154-7143-00 55154-7143 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral Aug. 12, 2008 In Use
49315-0005-10 49315-0005 Arsenic trioxide Arsenic trioxide 1.0 mg/mL Chemotherapy Miscellaneous Agent PML/RARa Intravenous Nov. 14, 2018 In Use

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