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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
63459-0910-36 63459-0910 tbo-filgrastim Granix 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous March 2, 2015 In Use
63459-0912-01 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 11, 2013 In Use
63459-0912-11 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 11, 2013 In Use
63459-0912-12 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 11, 2013 In Use
63459-0912-15 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 11, 2013 In Use
63459-0912-17 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous March 2, 2015 In Use
63459-0912-18 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Jan. 7, 2015 In Use
63459-0912-36 63459-0912 tbo-filgrastim Granix 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous March 2, 2015 In Use
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
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
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
43598-0308-23 43598-0308 Plerixafor Plerixafor 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous Nov. 6, 2023 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
83257-0005-41 83257-0005 Pegfilgrastim-jmdb Fulphila 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Oct. 1, 2023 In Use
70114-0130-01 70114-0130 pegfilgrastim-cbqv UDENYCA 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Dec. 22, 2023 In Use
73491-0627-01 73491-0627 Efbemalenograstim alfa-vuxw RYZNEUTA 20.0 mg/mL Immunotherapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Nov. 23, 2023 In Use
54868-5229-00 54868-5229 Pegfilgrastim Neulasta Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Feb. 23, 2006 Dec. 31, 2011 No Longer Used
55513-0190-01 55513-0190 Pegfilgrastim Neulasta 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous April 1, 2002 In Use
00024-5862-01 00024-5862 Plerixafor Mozobil 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous Sept. 1, 2013 In Use
50419-0002-33 50419-0002 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Sept. 5, 1991 Sept. 21, 2012 No Longer Used
50419-0050-14 50419-0050 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 5, 1991 Sept. 21, 2012 No Longer Used
50419-0050-30 50419-0050 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 5, 1991 Sept. 21, 2012 No Longer Used
54868-3188-00 54868-3188 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Dec. 1, 1996 June 30, 2012 No Longer Used
58468-0181-01 58468-0181 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 15, 2010 Dec. 31, 2013 No Longer Used
58468-0181-02 58468-0181 Sargramostim Leukine Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor March 15, 2010 Dec. 31, 2013 No Longer Used
61314-0866-01 61314-0866 pegfilgrastim-bmez ZIEXTENZO 6.0 mg/.6mL Ancillary Therapy Immunostimulant Colony-Stimulating Factor Subcutaneous Nov. 4, 2019 In Use
44206-0458-24 44206-0458 HUMAN IMMUNOGLOBULIN G Hizentra 0.2 g/mL Ancillary Therapy Immunostimulant Human Immunoglobulin G Subcutaneous Jan. 1, 2020 In Use
54868-2522-00 54868-2522 Filgrastim Neupogen 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous June 8, 1994 In Use
54868-2522-01 54868-2522 Filgrastim Neupogen 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous June 8, 1994 In Use
54868-3050-00 54868-3050 Filgrastim Neupogen 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous Aug. 14, 2006 In Use
54868-5020-00 54868-5020 Filgrastim Neupogen 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous March 11, 2004 In Use
00069-0291-01 00069-0291 filgrastim-aafi Nivestym 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Sept. 24, 2018 In Use
00069-0291-10 00069-0291 filgrastim-aafi Nivestym 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Sept. 24, 2018 In Use
00069-0292-01 00069-0292 filgrastim-aafi Nivestym 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Sept. 24, 2018 In Use
00069-0292-10 00069-0292 filgrastim-aafi Nivestym 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Sept. 24, 2018 In Use

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