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NDC-11 (Package) NDC-9 (Product) Generic Name (Ascending) Brand Name Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
68152-0101-00 68152-0101 Levoleucovorin Fusilev 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 15, 2008 Feb. 28, 2019 No Longer Used
68152-0102-01 68152-0102 Levoleucovorin Fusilev 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 15, 2011 Feb. 28, 2019 No Longer Used
68152-0102-02 68152-0102 Levoleucovorin Fusilev 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Sept. 15, 2011 Feb. 28, 2019 No Longer Used
50742-0494-17 50742-0494 Levoleucovorin LEVOLEUCOVORIN 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous May 8, 2018 July 31, 2021 In Use
50742-0495-25 50742-0495 Levoleucovorin LEVOLEUCOVORIN 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous May 8, 2018 June 30, 2021 In Use
72893-0004-01 72893-0004 Levoleucovorin KHAPZORY 175.0 mg/3.5mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 In Use
00781-3201-94 00781-3201 Levoleucovorin Levoleucovorin 175.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intravenous April 23, 2015 April 30, 2023 No Longer Used
72893-0006-01 72893-0006 Levoleucovorin KHAPZORY 300.0 mg/6mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 Oct. 31, 2023 In Use
71288-0105-18 71288-0105 Levoleucovorin calcium Levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 16, 2019 In Use
71288-0105-25 71288-0105 Levoleucovorin calcium Levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 16, 2019 In Use
71288-0104-10 71288-0104 Levoleucovorin calcium Levoleucovorin 50.0 mg/5mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 22, 2019 April 30, 2024 In Use
14335-0340-01 14335-0340 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous May 31, 2023 In Use
14335-0341-01 14335-0341 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Intravenous May 31, 2023 In Use
70436-0209-80 70436-0209 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 1, 2023 In Use
70436-0210-80 70436-0210 Levoleucovorin injection LEVOLEUCOVORIN CALCIUM 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous Aug. 1, 2023 In Use
73153-0900-01 73153-0900 Lisocabtagene maraleucel BREYANZI Immunotherapy CAR-T CD19 Feb. 5, 2021 In Use
00015-3030-20 00015-3030 Lomustine Ceenu 10.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral Dec. 15, 2008 April 15, 2016 No Longer Used
00015-3031-20 00015-3031 Lomustine Ceenu 40.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral Dec. 15, 2008 April 15, 2016 No Longer Used
00015-3032-20 00015-3032 Lomustine Ceenu Chemotherapy Alkylating Agent Nitrosourea Oral Dec. 15, 2008 June 30, 2014 No Longer Used
58181-3030-05 58181-3030 Lomustine Lomustine 10.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral July 29, 2014 Jan. 14, 2016 No Longer Used
58181-3031-05 58181-3031 Lomustine Lomustine 40.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral July 29, 2014 Jan. 14, 2016 No Longer Used
58181-3032-05 58181-3032 Lomustine Lomustine 100.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral Sept. 27, 2013 Jan. 14, 2016 No Longer Used
58181-3043-05 58181-3043 Lomustine Gleostine 5.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral Nov. 5, 2015 June 30, 2018 No Longer Used
58181-3040-05 58181-3040 Lomustine Gleostine 10.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral Aug. 18, 2014 In Use
58181-3041-05 58181-3041 Lomustine Gleostine 40.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral Aug. 18, 2014 In Use
58181-3042-05 58181-3042 Lomustine Gleostine 100.0 mg/1 Chemotherapy Alkylating Agent Nitrosourea Oral Aug. 18, 2014 In Use
00069-0227-01 00069-0227 Lorlatinib Lorbrena 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor ALK/ROS1 Oral Nov. 19, 2018 In Use
00069-0231-01 00069-0231 Lorlatinib Lorbrena 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor ALK/ROS1 Oral Nov. 19, 2018 In Use
63539-0927-01 63539-0927 Lorlatinib Lorbrena 25.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor ALK/ROS1 Oral Jan. 3, 2023 In Use
68727-0712-01 68727-0712 Lurbinectedin ZEPZELCA 0.5 mg/mL Chemotherapy Alkylating Agent Adduct Forming Agent Intravenous June 15, 2020 In Use
59572-0711-01 59572-0711 Luspatercept REBLOZYL 25.0 mg/1 Ancillary Therapy Erythropoiesis-Stimulating Agent Subcutaneous Nov. 8, 2019 In Use
59572-0775-01 59572-0775 Luspatercept Reblozyl 75.0 mg/1 Immunotherapy Erythropoiesis-Stimulating Agent Subcutaneous Nov. 8, 2019 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
64764-0800-28 64764-0800 MARIBAVIR Livtencity 200.0 mg/1 Ancillary Therapy Miscellaneous Agent CMV Antiviral Oral Nov. 23, 2021 In Use
64764-0800-56 64764-0800 MARIBAVIR Livtencity 200.0 mg/1 Ancillary Therapy Miscellaneous Agent CMV Antiviral Oral Nov. 23, 2021 In Use
50742-0477-01 50742-0477 MELPHALAN HYDROCHLORIDE MELPHALAN HYDROCHLORIDE Chemotherapy Alkylating Agent Nitrogen Mustard Feb. 18, 2020 In Use
00904-6012-60 00904-6012 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral June 1, 2009 March 31, 2015 No Longer Used
42254-0110-30 42254-0110 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Dec. 7, 1953 In Use
50090-0294-09 50090-0294 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral June 29, 2016 Jan. 31, 2021 In Use
55289-0924-30 55289-0924 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Oct. 23, 2009 Aug. 3, 2018 No Longer Used
66336-0338-21 66336-0338 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Dec. 7, 1953 In Use
66336-0338-30 66336-0338 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Dec. 7, 1953 In Use
67253-0320-10 67253-0320 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Dec. 7, 1953 Feb. 28, 2021 No Longer Used
67253-0320-36 67253-0320 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Dec. 7, 1953 Feb. 28, 2021 No Longer Used
70518-0223-00 70518-0223 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 15, 2017 Feb. 23, 2019 No Longer Used
70518-0223-01 70518-0223 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 17, 2017 Oct. 3, 2019 No Longer Used
70518-0223-02 70518-0223 METHOTREXATE Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Feb. 17, 2017 Oct. 22, 2019 No Longer Used
54569-1818-09 54569-1818 METHOTREXATE, Methotrexate sodium Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Dec. 7, 1953 In Use
72189-0264-21 72189-0264 METHYLPREDNISOLONE METHYLPREDNISOLONE 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Sept. 13, 2021 In Use

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