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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
71335-2079-00 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-01 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-02 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-03 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-04 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-05 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-06 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-07 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-08 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2079-09 71335-2079 PREDNISONE Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 2, 2022 In Use
71335-2088-01 71335-2088 PREDNISONE Prednisone 2.5 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 16, 2022 In Use
71335-2088-02 71335-2088 PREDNISONE Prednisone 2.5 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 16, 2022 In Use
71335-2108-00 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-01 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-02 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-03 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-04 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-05 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-06 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-07 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-08 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2108-09 71335-2108 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 6, 2022 In Use
71335-2120-01 71335-2120 Pilocarpine hydrchloride Pilocarpine hydrchloride 5.0 mg/1 Ancillary Therapy Miscellaneous Agent Cholinergic Agonist Oral June 20, 2022 In Use
71335-2122-01 71335-2122 PREDNISONE Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 28, 2022 In Use
71335-2122-02 71335-2122 PREDNISONE Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 28, 2022 In Use
71335-2122-03 71335-2122 PREDNISONE Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 28, 2022 In Use
71731-5111-01 71731-5111 Fosaprepitant dimeglumine Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous March 16, 2021 In Use
71731-6121-01 71731-6121 Fulvestrant Fulvestrant 50.0 mg/mL Hormonal Therapy Estrogen Receptor Antagonist Intramuscular April 1, 2021 In Use
71777-0390-01 71777-0390 LAROTRECTINIB VITRAKVI 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor TRK Oral Nov. 26, 2018 In Use
71777-0391-01 71777-0391 LAROTRECTINIB VITRAKVI 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor TRK Oral Nov. 26, 2018 In Use
71777-0392-01 71777-0392 LAROTRECTINIB VITRAKVI 20.0 mg/mL Chemotherapy Tyrosine Kinase Inhibitor TRK Oral Nov. 26, 2018 In Use
71779-0115-01 71779-0115 duvelisib Copiktra 15.0 mg/1 Chemotherapy Enzyme Inhibitor PI3K Oral Sept. 25, 2018 In Use
71779-0115-02 71779-0115 duvelisib Copiktra 15.0 mg/1 Chemotherapy Enzyme Inhibitor PI3K Oral Sept. 25, 2018 In Use
71779-0125-01 71779-0125 duvelisib Copiktra 25.0 mg/1 Chemotherapy Enzyme Inhibitor PI3K Oral Sept. 25, 2018 In Use
71779-0125-02 71779-0125 duvelisib Copiktra 25.0 mg/1 Chemotherapy Enzyme Inhibitor PI3K Oral Sept. 25, 2018 In Use
71837-5843-05 71837-5843 SARGRAMOSTIM Leukine 250.0 ug/mL Ancillary Therapy Intravenous, Subcutaneous May 30, 2018 In Use
71837-5844-01 71837-5844 SARGRAMOSTIM Leukine 500.0 ug/mL Ancillary Therapy Intravenous, Subcutaneous May 30, 2018 May 8, 2012 No Longer Used
71837-5844-05 71837-5844 SARGRAMOSTIM Leukine 500.0 ug/mL Ancillary Therapy Intravenous, Subcutaneous May 30, 2018 May 8, 2012 No Longer Used
71839-0104-01 71839-0104 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Oct. 15, 2019 In Use
71872-7205-01 71872-7205 Dexamethasone sodium phosphate Dexamethasone sodium phosphate 10.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous Feb. 13, 2020 In Use
71872-7239-01 71872-7239 Dexamethasone Sodium Phosphate Dexamethasone Sodium Phosphate 100.0 mg/10mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intramuscular, Intravenous Feb. 15, 2021 In Use
71905-0400-11 71905-0400 Dexamethasone Dexabliss 1.5 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral April 9, 2020 In Use
71921-0190-33 71921-0190 Exemestane Exemestane 25.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Jan. 15, 2021 In Use
71930-0017-30 71930-0017 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 11, 2018 In Use
71930-0017-52 71930-0017 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb. 6, 2020 In Use
71930-0018-30 71930-0018 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 11, 2018 In Use
71930-0018-52 71930-0018 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Feb. 6, 2020 In Use
71997-0100-01 71997-0100 DEXAMETHASONE Dexycu 517.0 ug/.005mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid INTRAOCULAR Oct. 1, 2018 Oct. 1, 2018 No Longer Used
72064-0110-30 72064-0110 avapritinib Ayvakit 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor PDGFR, KIT, CSFR1 Oral Jan. 9, 2020 In Use
72064-0120-30 72064-0120 avapritinib Ayvakit 200.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor PDGFR, KIT, CSFR1 Oral Jan. 9, 2020 In Use

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