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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name (Ascending) Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
00009-0050-02 00009-0050 Medroxyprogesterone Acetate Provera 10.0 mg/1 Hormonal Therapy Progestin Oral Dec. 1, 1959 Nov. 30, 2021 In Use
00009-0050-11 00009-0050 Medroxyprogesterone Acetate Provera 10.0 mg/1 Hormonal Therapy Progestin Oral Dec. 1, 1959 Nov. 30, 2021 In Use
62484-0020-01 62484-0020 Purixan Purixan 20.0 mg/mL Chemotherapy Antimetabolite Purine Analog Oral April 28, 2014 In Use
62484-0020-02 62484-0020 Purixan Purixan 20.0 mg/mL Chemotherapy Antimetabolite Purine Analog Oral April 28, 2014 In Use
73207-0101-30 73207-0101 Ripretinib QINLOCK 50.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor KIT, PDGFRA Oral May 15, 2020 In Use
73207-0101-31 73207-0101 Ripretinib QINLOCK 50.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor KIT, PDGFRA Oral May 15, 2020 In Use
57902-0860-03 57902-0860 Samarium SM 153 Lexidronam Quadramet 50.0 mCi/mL Ancillary Therapy Radiopharmaceutical Samarium Sm 153 Intravenous May 19, 1997 In Use
11994-0016-01 11994-0016 samarium Sm 153 lexidronam Quadramet 50.0 mCi/mL Ancillary Therapy Radiopharmaceutical Samarium Sm 153 Intravenous May 19, 1997 In Use
59572-0711-01 59572-0711 Luspatercept REBLOZYL 25.0 mg/1 Ancillary Therapy Erythropoiesis-Stimulating Agent Subcutaneous Nov. 8, 2019 In Use
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
70121-1570-07 70121-1570 Filgrastim RELEUKO 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Feb. 25, 2022 In Use
70121-1570-01 70121-1570 Filgrastim RELEUKO 480.0 ug/.8mL Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor Intravenous, Subcutaneous Feb. 25, 2022 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
00069-1311-04 00069-1311 epoetin alfa-epbx RETACRIT 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Dec. 1, 2020 In Use
00069-1311-10 00069-1311 epoetin alfa-epbx RETACRIT 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
00069-1305-10 00069-1305 epoetin alfa-epbx RETACRIT 2000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1307-10 00069-1307 epoetin alfa-epbx RETACRIT 4000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1308-10 00069-1308 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1309-04 00069-1309 epoetin alfa-epbx RETACRIT 40000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1309-10 00069-1309 epoetin alfa-epbx RETACRIT 40000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1306-10 00069-1306 epoetin alfa-epbx RETACRIT 3000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
00069-1318-04 00069-1318 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Dec. 1, 2020 In Use
00069-1318-10 00069-1318 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
59353-0002-10 59353-0002 Epoetin alfa-epbx RETACRIT 2000.0 [iU]/mL, 2000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
59353-0003-10 59353-0003 Epoetin alfa-epbx RETACRIT 3000.0 [iU]/mL, 3000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
59353-0004-10 59353-0004 Epoetin alfa-epbx RETACRIT 4000.0 [iU]/mL, 4000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
59353-0010-10 59353-0010 epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL, 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous June 18, 2018 In Use
59353-0120-10 59353-0120 Epoetin alfa-epbx RETACRIT 20000.0 [iU]/mL, 20000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
59353-0220-10 59353-0220 Epoetin alfa-epbx RETACRIT 10000.0 [iU]/mL, 10000.0 [iU]/mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Nov. 9, 2020 In Use
00002-2980-26 00002-2980 Selpercatinib RETEVMO 80.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor VEGFR Oral May 8, 2020 In Use
00002-2980-60 00002-2980 Selpercatinib RETEVMO 80.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor VEGFR Oral May 8, 2020 In Use
00002-3977-60 00002-3977 Selpercatinib RETEVMO 40.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor VEGFR Oral May 8, 2020 In Use
71332-0005-01 71332-0005 Olutasidenib REZLIDHIA 150.0 mg/1 Chemotherapy Enzyme Inhibitor IDH1 Oral Dec. 1, 2022 In Use
00591-2367-01 00591-2367 Raloxifene Hydrochloride Raloxifene 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral June 18, 2015 In Use
00591-2367-10 00591-2367 Raloxifene Hydrochloride Raloxifene 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral June 18, 2015 In Use
00591-2367-30 00591-2367 Raloxifene Hydrochloride Raloxifene 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral June 18, 2015 In Use
69189-2367-01 69189-2367 Raloxifene Hydrochloride Raloxifene 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral May 9, 2016 May 24, 2017 No Longer Used
65162-0057-03 65162-0057 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 20, 2016 In Use
65162-0057-09 65162-0057 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 20, 2016 In Use
65162-0057-10 65162-0057 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 20, 2016 In Use
65162-0057-11 65162-0057 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 20, 2016 In Use
65162-0057-33 65162-0057 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 20, 2016 In Use
65162-0057-50 65162-0057 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Jan. 20, 2016 In Use
65862-0709-01 65862-0709 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Aug. 28, 2015 In Use
65862-0709-03 65862-0709 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Aug. 28, 2015 In Use
65862-0709-10 65862-0709 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Aug. 28, 2015 In Use
65862-0709-22 65862-0709 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Aug. 28, 2015 In Use
65862-0709-30 65862-0709 Raloxifene Hydrochloride Raloxifene Hydrochloride 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Aug. 28, 2015 In Use

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