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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
55111-0137-81 55111-0137 Isotretinoin ZENATANE 40.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral March 26, 2013 In Use
69238-1017-03 69238-1017 Isotretinoin Isotretinoin 30.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Oct. 2, 2017 In Use
69238-1174-03 69238-1174 Isotretinoin Isotretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Oct. 2, 2017 In Use
00555-0808-02 00555-0808 Tretinoin Tretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral June 26, 2007 In Use
68462-0792-01 68462-0792 Tretinoin Tretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Dec. 23, 2016 In Use
00172-7313-20 00172-7313 Cyclosporine Cyclosporine 100.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 29, 2005 In Use
54868-5522-00 54868-5522 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Feb. 10, 2006 In Use
54868-6232-00 54868-6232 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Feb. 10, 2011 In Use
55390-0122-10 55390-0122 Cyclosporine Cyclosporine Ancillary Therapy Immunomodulator Calcineurin Inhibitor Intravenous Dec. 15, 1999 Feb. 29, 2012 No Longer Used
60505-0354-01 60505-0354 Cyclosporine Cyclosporine Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Aug. 1, 2005 Jan. 31, 2012 No Longer Used
62584-0827-11 62584-0827 Cyclosporine Cyclosporine Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Dec. 11, 2009 Sept. 30, 2011 No Longer Used
62584-0827-21 62584-0827 Cyclosporine Cyclosporine Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Dec. 11, 2009 Sept. 30, 2011 No Longer Used
00074-3108-32 00074-3108 Cyclosporine Gengraf 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Nov. 1, 2015 In Use
00074-3109-32 00074-3109 Cyclosporine Gengraf 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Nov. 1, 2015 In Use
00078-0274-22 00078-0274 Cyclosporine NeOral 100.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral July 14, 1995 In Use
55154-2395-00 55154-2395 Cyclosporine Modified Gengraf 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 1, 2013 In Use
69238-1175-03 69238-1175 Isotretinoin Isotretinoin 20.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Oct. 2, 2017 In Use
69238-1176-03 69238-1176 Isotretinoin Isotretinoin 40.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Oct. 2, 2017 In Use
59572-0501-00 59572-0501 Pomalidomide Pomalyst 1.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0501-21 59572-0501 Pomalidomide Pomalyst 1.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0502-00 59572-0502 Pomalidomide Pomalyst 2.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0502-21 59572-0502 Pomalidomide Pomalyst 2.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
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
68084-0075-11 68084-0075 Tretinoin Tretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral July 18, 2013 In Use
68084-0075-21 68084-0075 Tretinoin Tretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral July 18, 2013 In Use
00054-0399-25 00054-0399 Bexarotene Bexarotene 75.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Nov. 11, 2020 In Use
72189-0084-24 72189-0084 IMIQUIMOD IMIQUIMOD 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical March 23, 2020 In Use
00591-2433-15 00591-2433 Isotretinoin Isotretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral April 29, 2021 In Use
00591-2434-15 00591-2434 Isotretinoin Isotretinoin 20.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral April 29, 2021 In Use
00591-2451-15 00591-2451 Isotretinoin Isotretinoin 25.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral April 29, 2021 In Use
00591-2501-15 00591-2501 Isotretinoin Isotretinoin 35.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral April 29, 2021 In Use
00591-2435-15 00591-2435 Isotretinoin Isotretinoin 30.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral April 29, 2021 In Use
00591-2436-15 00591-2436 Isotretinoin Isotretinoin 40.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral April 29, 2021 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

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