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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
59572-0503-00 59572-0503 Pomalidomide Pomalyst 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0503-21 59572-0503 Pomalidomide Pomalyst 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0504-00 59572-0504 Pomalidomide Pomalyst 4.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0504-21 59572-0504 Pomalidomide Pomalyst 4.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
00591-2832-01 00591-2832 Bexarotene Bexarotene 75.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Nov. 11, 2021 In Use
00245-0570-01 00245-0570 Isotretinoin Isotretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
00245-0571-01 00245-0571 Isotretinoin Isotretinoin 20.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
00245-0573-01 00245-0573 Isotretinoin Isotretinoin 30.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
68308-0570-30 68308-0570 Isotretinoin Isotretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
68308-0571-30 68308-0571 Isotretinoin Isotretinoin 20.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
68308-0573-30 68308-0573 Isotretinoin Isotretinoin 30.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 21, 2021 In Use
68308-0575-30 68308-0575 Isotretinoin Isotretinoin 40.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 3, 2021 In Use
10631-0133-31 10631-0133 Isotretinoin Absorica 25.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Feb. 17, 2015 In Use
10631-0134-31 10631-0134 Isotretinoin Absorica 35.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Feb. 17, 2015 In Use
00024-5843-01 00024-5843 Sargramostim Leukine 250.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Nov. 5, 2013 Dec. 30, 2021 No Longer Used
00024-5843-05 00024-5843 Sargramostim Leukine 250.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous May 1, 1991 Dec. 30, 2021 No Longer Used
00024-5844-01 00024-5844 Sargramostim Leukine 500.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Dec. 1, 1996 Dec. 30, 2021 No Longer Used
00024-5844-05 00024-5844 Sargramostim Leukine 500.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Dec. 1, 1996 Dec. 30, 2021 No Longer Used
44206-0456-21 44206-0456 HUMAN IMMUNOGLOBULIN G Hizentra 0.2 g/mL Ancillary Therapy Immunostimulant Human Immunoglobulin G Subcutaneous Jan. 1, 2020 In Use
44206-0456-94 44206-0456 HUMAN IMMUNOGLOBULIN G Hizentra 0.2 g/mL Ancillary Therapy Immunostimulant Human Immunoglobulin G Subcutaneous Jan. 1, 2020 In Use
44206-0457-22 44206-0457 Human Immunoglobulin G Hizentra 0.2 g/mL Ancillary Therapy Immunostimulant Human Immunoglobulin G Subcutaneous Jan. 1, 2020 In Use
44206-0457-95 44206-0457 Human Immunoglobulin G Hizentra 0.2 g/mL Ancillary Therapy Immunostimulant Human Immunoglobulin G Subcutaneous Jan. 1, 2020 In Use
55513-0192-01 55513-0192 Pegfilgrastim Neulasta Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous Feb. 20, 2015 In Use
55513-0209-01 55513-0209 Filgrastim Neupogen 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Oct. 2, 2000 In Use
55513-0209-10 55513-0209 Filgrastim Neupogen 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Oct. 2, 2000 In Use
55513-0209-91 55513-0209 Filgrastim Neupogen 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Oct. 2, 2000 In Use
55513-0530-01 55513-0530 Filgrastim Neupogen 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous May 19, 1997 In Use
55513-0530-10 55513-0530 Filgrastim Neupogen 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous May 19, 1997 In Use
55513-0546-01 55513-0546 Filgrastim Neupogen 480.0 ug/1.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous April 7, 1997 In Use
55513-0546-10 55513-0546 Filgrastim Neupogen 480.0 ug/1.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous April 7, 1997 In Use
55513-0924-01 55513-0924 Filgrastim Neupogen 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Oct. 2, 2000 In Use
55513-0924-10 55513-0924 Filgrastim Neupogen 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Oct. 2, 2000 In Use
55513-0924-91 55513-0924 Filgrastim Neupogen 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Oct. 2, 2000 In Use
00944-2620-01 00944-2620 Human Immunoglobulin G GAMMAGARD Ancillary Therapy Immunostimulant Human Immunoglobulin G May 1, 1998 May 1, 1998 In Use
00944-2620-02 00944-2620 Human Immunoglobulin G GAMMAGARD Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 July 18, 2015 In Use
00944-2620-03 00944-2620 Human Immunoglobulin G GAMMAGARD Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 Sept. 2, 2015 In Use
00944-2620-04 00944-2620 Human Immunoglobulin G GAMMAGARD Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 Sept. 2, 2015 In Use
00944-2623-02 00944-2623 Human Immunoglobulin G, Immune Globulin Intravenous (Human) GAMMAGARD Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 June 21, 2014 In Use
00944-2625-03 00944-2625 Human Immunoglobulin G, Immune Globulin Intravenous (Human) GAMMAGARD Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 June 21, 2014 In Use
00944-2627-04 00944-2627 Human Immunoglobulin G, Immune Globulin Intravenous (Human) GAMMAGARD Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 June 21, 2014 In Use
00944-2655-03 00944-2655 Human Immunoglobulin G Gammagard S/D Ancillary Therapy Immunostimulant Human Immunoglobulin G May 10, 1994 May 10, 1994 In Use
00944-2655-04 00944-2655 Human Immunoglobulin G Gammagard S/D Ancillary Therapy Immunostimulant Human Immunoglobulin G Jan. 3, 2011 Aug. 26, 2015 In Use
58468-0140-01 58468-0140 Plerixafor Mozobil 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous Dec. 15, 2008 March 23, 2018 No Longer Used
61314-0304-01 61314-0304 filgrastim-sndz Zarxio 300.0 ug/.5mL, 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Sept. 3, 2015 Feb. 28, 2021 No Longer Used
61314-0304-10 61314-0304 filgrastim-sndz Zarxio 300.0 ug/.5mL, 300.0 ug/.5mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Sept. 3, 2015 Feb. 28, 2021 No Longer Used
61314-0312-01 61314-0312 filgrastim-sndz Zarxio 480.0 ug/.8mL, 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Sept. 3, 2015 Feb. 28, 2021 No Longer Used
61314-0312-10 61314-0312 filgrastim-sndz Zarxio 480.0 ug/.8mL, 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Sept. 3, 2015 Feb. 28, 2021 No Longer Used
70121-1569-07 70121-1569 Filgrastim RELEUKO 300.0 ug/mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Feb. 25, 2022 In Use
70121-1571-07 70121-1571 Filgrastim RELEUKO 480.0 ug/1.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Feb. 25, 2022 In Use
70121-1627-01 70121-1627 Pegfilgrastim FYLNETRA 6.0 mg/.6mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Subcutaneous May 31, 2022 In Use

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