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NDC-11 (Package) NDC-9 (Product) (Ascending) Generic Name Brand Name Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
69238-2088-06 69238-2088 Bexarotene Bexarotene 10.0 mg/g Hormonal Therapy Immunomodulator Retinoic Acid Derivative Topical May 4, 2022 In Use
69238-2122-09 69238-2122 Prednisolone Sodium Phosphate Prednisolone Sodium Phosphate 15.0 mg/5mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 27, 2022 In Use
69306-0400-21 69306-0400 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 18, 2021 In Use
69315-0164-01 69315-0164 Hydroxyurea Hydroxyurea 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral July 9, 2020 In Use
69315-0184-01 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0184-03 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0185-12 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0185-24 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0186-24 69315-0186 Leucovorin calcium Leucovorin calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0187-25 69315-0187 Leucovorin calcium Leucovorin calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69339-0168-03 69339-0168 Gefitinib Gefitinib 250.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor EGFR Oral June 5, 2023 In Use
69339-0171-03 69339-0171 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 24, 2022 In Use
69339-0171-05 69339-0171 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 24, 2022 In Use
69339-0172-03 69339-0172 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 24, 2022 In Use
69339-0172-05 69339-0172 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 24, 2022 In Use
69367-0190-50 69367-0190 Zoledronic Acid Zoledronic Acid 4.0 mg/5mL Ancillary Therapy Bisphosphonate Intravenous Feb. 2, 2023 In Use
69448-0001-05 69448-0001 Mitomycin Mutamycin 5.0 mg/10mL Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Intravenous July 25, 2017 In Use
69448-0002-11 69448-0002 Mitomycin Mutamycin 20.0 mg/40mL Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Intravenous July 25, 2017 In Use
69448-0003-38 69448-0003 Mitomycin Mutamycin 40.0 mg/80mL Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Intravenous July 25, 2017 In Use
69448-0005-12 69448-0005 Carboplatin Paraplatin 10.0 mg/mL Chemotherapy Alkylating Agent Platinum Compound Intravenous Feb. 12, 2020 Aug. 31, 2023 In Use
69448-0005-31 69448-0005 Carboplatin Paraplatin 10.0 mg/mL Chemotherapy Alkylating Agent Platinum Compound Intravenous Feb. 12, 2020 Nov. 30, 2022 In Use
69448-0005-33 69448-0005 Carboplatin Paraplatin 10.0 mg/mL Chemotherapy Alkylating Agent Platinum Compound Intravenous Feb. 12, 2020 Nov. 30, 2022 In Use
69448-0005-34 69448-0005 Carboplatin Paraplatin 10.0 mg/mL Chemotherapy Alkylating Agent Platinum Compound Intravenous Feb. 12, 2020 July 31, 2023 In Use
69448-0005-38 69448-0005 Carboplatin Paraplatin 10.0 mg/mL Chemotherapy Alkylating Agent Platinum Compound Intravenous Aug. 17, 2020 In Use
69448-0014-63 69448-0014 LEUPROLIDE CAMCEVI 42.0 mg/.37g Hormonal Therapy GnRH Agonist Subcutaneous April 5, 2022 In Use
69452-0276-20 69452-0276 Dexamethasone Dexamethasone 2.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Aug. 1, 2023 In Use
69452-0277-20 69452-0277 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Aug. 1, 2023 In Use
69452-0278-20 69452-0278 Dexamethasone Dexamethasone 6.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Aug. 1, 2023 In Use
69452-0350-01 69452-0350 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb. 28, 2022 In Use
69452-0350-11 69452-0350 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb. 28, 2022 In Use
69452-0350-92 69452-0350 Granisetron Hydrochloride Granisetron Hydrochloride 1.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb. 28, 2022 In Use
69468-0151-04 69468-0151 Uridine Triacetate Vistogard 951.0 mg/g Ancillary Therapy Chemoprotective Antidote Oral March 1, 2016 In Use
69468-0151-10 69468-0151 Uridine Triacetate Vistogard 951.0 mg/g Ancillary Therapy Chemoprotective Antidote Oral March 1, 2016 In Use
69468-0151-20 69468-0151 Uridine Triacetate Vistogard 951.0 mg/g Ancillary Therapy Chemoprotective Antidote Oral March 1, 2016 In Use
69488-0003-01 69488-0003 Lutetium Lu 177 dotatate Lutathera 10.0 mCi/mL Chemotherapy Radiopharmaceutical Somatostatin Analog Intravenous Jan. 26, 2018 In Use
69488-0010-61 69488-0010 Lutetium Lu 177 vipivotide tetraxetan PLUVICTO 27.0 mCi/mL Radiopharmaceutical Radiopharmaceutical PSMA Intravenous March 23, 2022 In Use
69539-0019-60 69539-0019 Capecitabine Capecitabine 150.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral July 2, 2018 In Use
69539-0019-99 69539-0019 Capecitabine Capecitabine 150.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral July 2, 2018 In Use
69539-0020-92 69539-0020 Capecitabine Capecitabine 500.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral July 2, 2018 In Use
69539-0020-99 69539-0020 Capecitabine Capecitabine 500.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral July 2, 2018 In Use
69539-0034-01 69539-0034 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Sept. 5, 2019 In Use
69539-0049-92 69539-0049 Abiraterone acetate Abiraterone 250.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor CYP17 Inhibitor Oral July 10, 2019 In Use
69539-0090-30 69539-0090 Erlotinib Hydrochloride Erlotinib Hydrochloride 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor EGFR Oral May 11, 2021 In Use
69539-0091-30 69539-0091 Erlotinib Hydrochloride Erlotinib Hydrochloride 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor EGFR Oral May 11, 2021 In Use
69539-0092-30 69539-0092 Erlotinib Hydrochloride Erlotinib Hydrochloride 150.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor EGFR Oral May 11, 2021 In Use
69539-0115-01 69539-0115 Decitabine Decitabine 50.0 mg/10mL Chemotherapy Antimetabolite Pyrimidine Analog Intravenous Aug. 28, 2019 In Use
69539-0123-01 69539-0123 Thiotepa Thiotepa 15.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard/Ethyleneimine Intracavitary, Intravenous, Intravesical March 4, 2020 In Use
69539-0124-01 69539-0124 Thiotepa Thiotepa 100.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard /Ethylenimine Intracavitary, Intravenous, Intravesical March 4, 2020 In Use
69539-0152-30 69539-0152 Toremifene citrate Toremifene citrate 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Aug. 20, 2020 In Use
69539-0157-01 69539-0157 Paclitaxel Paclitaxel 6.0 mg/mL Chemotherapy Antimitotic Agent Taxane Intravenous Aug. 26, 2020 In Use

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