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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
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
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
00245-0575-01 00245-0575 Isotretinoin Isotretinoin 40.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral June 25, 2021 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
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
00591-2433-15 00591-2433 Isotretinoin Isotretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral April 29, 2021 In Use
59572-0984-01 59572-0984 Romidepsin Istodax Chemotherapy Enzyme Inhibitor HDAC Intravenous Jan. 4, 2010 In Use
46026-0983-01 46026-0983 Romidepsin Istodax Chemotherapy Enzyme Inhibitor HDAC Intravenous Nov. 5, 2009 May 28, 2010 No Longer Used
59572-0983-01 59572-0983 Romidepsin Istodax Chemotherapy Enzyme Inhibitor HDAC Jan. 4, 2010 In Use
00015-1910-12 00015-1910 Ixabepilone Ixempra Chemotherapy Antitumor Antibiotic Epothilones Intravenous Oct. 16, 2007 Oct. 31, 2017 No Longer Used
70020-1910-01 70020-1910 Ixabepilone Ixempra Chemotherapy Antitumor Antibiotic Epothilones Intravenous Oct. 16, 2007 In Use
00015-1911-13 00015-1911 Ixabepilone Ixempra Chemotherapy Antitumor Antibiotic Epothilones Intravenous Oct. 16, 2007 Oct. 31, 2017 No Longer Used
70020-1911-01 70020-1911 Ixabepilone Ixempra Chemotherapy Antitumor Antibiotic Epothilones Intravenous Oct. 16, 2007 In Use
00002-6902-30 00002-6902 Pirtobrutinib JAYPIRCA 50.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BTK Oral Jan. 27, 2023 In Use
00002-7026-60 00002-7026 Pirtobrutinib JAYPIRCA 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BTK Oral Jan. 27, 2023 In Use
00002-7026-99 00002-7026 Pirtobrutinib JAYPIRCA 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BTK Oral Feb. 15, 2023 In Use
69605-0103-03 69605-0103 Mitomycin JELMYTO Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Instillation May 1, 2020 In Use
72493-0103-03 72493-0103 Mitomycin JELMYTO Chemotherapy Antitumor Antibiotic Alkylating Agent/ Mitomycin Instillation May 1, 2020 In Use
81927-0204-01 81927-0204 Methotrexate JYLAMVO 2.0 mg/mL Chemotherapy Antimetabolite Folic Acid Analog Oral Dec. 15, 2023 In Use
50881-0010-01 50881-0010 Ruxolitinib Jakafi 10.0 mg/1 Chemotherapy Enzyme Inhibitor JAK 1 and JAK 2 (Janus Kinase Inhibitor) Oral Nov. 16, 2011 In Use
50881-0010-60 50881-0010 Ruxolitinib Jakafi 10.0 mg/1 Chemotherapy Enzyme Inhibitor JAK 1 and JAK 2 (Janus Kinase Inhibitor) Oral Nov. 16, 2011 In Use
50881-0005-60 50881-0005 Ruxolitinib Jakafi 5.0 mg/1 Chemotherapy Enzyme Inhibitor JAK 1/2 Oral Nov. 16, 2011 In Use
50881-0015-60 50881-0015 Ruxolitinib Jakafi 15.0 mg/1 Chemotherapy Enzyme Inhibitor JAK 1/2 Oral Nov. 16, 2011 In Use
50881-0020-60 50881-0020 Ruxolitinib Jakafi 20.0 mg/1 Chemotherapy Enzyme Inhibitor JAK 1/2 Oral Nov. 16, 2011 In Use
50881-0025-60 50881-0025 Ruxolitinib Jakafi 25.0 mg/1 Chemotherapy Enzyme Inhibitor JAK 1/2 Oral Nov. 16, 2011 In Use
00173-0898-03 00173-0898 dostarlimab Jemperli 50.0 mg/mL Immunotherapy Checkpoint Inhibitor PD-1 Intravenous April 22, 2021 In Use
00024-5824-11 00024-5824 Cabazitaxel Jevtana Chemotherapy Antimitotic Agent Taxane Intravenous June 17, 2010 In Use
00003-0315-05 00003-0315 TRIAMCINOLONE ACETONIDE KENALOG-80 80.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-Articular, Intramuscular April 12, 2019 In Use
00003-0315-20 00003-0315 TRIAMCINOLONE ACETONIDE KENALOG-80 80.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-Articular, Intramuscular April 12, 2019 In Use
66658-0113-03 66658-0113 Palifermin KEPIVANCE 5.16 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Aug. 4, 2023 In Use
66658-0113-06 66658-0113 Palifermin KEPIVANCE 5.16 mg/1.2mL Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF Intravenous Aug. 4, 2023 In Use
68152-0112-01 68152-0112 levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 In Use
68152-0114-01 68152-0114 levoleucovorin KHAPZORY 300.0 mg/6mL Ancillary Therapy Antiemetic Antidote Intravenous Jan. 2, 2019 In Use
72893-0004-01 72893-0004 Levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 In Use
72893-0006-01 72893-0006 Levoleucovorin KHAPZORY 300.0 mg/6mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 Oct. 31, 2023 No Longer Used
80446-0401-01 80446-0401 TEBENTAFUSP KIMMTRAK 100.0 ug/.5mL Immunotherapy T Cell Receptor (TCR) HLA-A*02:01 Intravenous Jan. 26, 2022 In Use
00310-0610-28 00310-0610 SELUMETINIB KOSELUGO 10.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral June 11, 2021 In Use
00310-0610-60 00310-0610 SELUMETINIB KOSELUGO 10.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral April 16, 2020 In Use
00310-0625-28 00310-0625 SELUMETINIB KOSELUGO 25.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral June 11, 2021 In Use
00310-0625-60 00310-0625 SELUMETINIB KOSELUGO 25.0 mg/1 Chemotherapy MEK Inhibitor MEK 1/2 Oral April 16, 2020 In Use

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