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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class Minor Class Administration Route (Ascending) Package Effective Date Package Discontinuation Date Status
63187-0256-10 63187-0256 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Dec. 28, 2022 In Use
63187-0256-15 63187-0256 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Dec. 28, 2022 In Use
69784-0712-04 69784-0712 Dutasteride AVODART 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Dec. 15, 2022 In Use
69784-0712-15 69784-0712 Dutasteride AVODART 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Dec. 15, 2022 In Use
70518-3612-00 70518-3612 Finasteride Finasteride 5.0 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Jan. 8, 2023 In Use
70518-3615-00 70518-3615 HYDROXYUREA HYDROXYUREA 500.0 mg/1 Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Oral Jan. 10, 2023 In Use
80425-0074-04 80425-0074 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 16, 2020 In Use
80425-0074-01 80425-0074 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 16, 2020 In Use
80425-0074-02 80425-0074 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 16, 2020 In Use
80425-0074-03 80425-0074 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 16, 2020 In Use
80425-0074-05 80425-0074 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Sept. 16, 2020 In Use
80425-0222-01 80425-0222 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 12, 2023 In Use
80425-0227-01 80425-0227 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 11, 2023 In Use
80739-0812-12 80739-0812 Adagrasib KRAZATI 200.0 mg/1 Immunotherapy RAS Inhibitor KRAS G12C Oral Dec. 12, 2022 In Use
80739-0812-18 80739-0812 Adagrasib KRAZATI 200.0 mg/1 Immunotherapy RAS Inhibitor KRAS G12C Oral Dec. 12, 2022 In Use
00378-3097-85 00378-3097 everolimus everolimus 5.0 mg/1 Chemotherapy Enzyme Inhibitor mTOR Oral Dec. 15, 2022 In Use
00904-3571-61 00904-3571 Megestrol Acetate Megestrol Acetate 40.0 mg/1 Hormonal Therapy Progestin Analog Oral Feb. 16, 2004 July 31, 2023 In Use
16714-0671-01 16714-0671 Ondansetron Hydrochloride Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 28, 2007 Oct. 31, 2016 In Use
16714-0671-02 16714-0671 Ondansetron Hydrochloride Ondansetron 4.0 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Nov. 28, 2007 In Use
48102-0051-01 48102-0051 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 1, 2021 Dec. 31, 2023 In Use
48102-0051-20 48102-0051 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 1, 2021 June 1, 2021 In Use
48102-0051-40 48102-0051 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral June 1, 2021 June 1, 2021 In Use
50090-0091-00 50090-0091 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Nov. 28, 2014 In Use
51079-0582-01 51079-0582 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Aug. 27, 1997 In Use
51079-0582-05 51079-0582 Leucovorin Calcium Leucovorin Calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Aug. 27, 1997 June 30, 2023 In Use
51991-0005-33 51991-0005 Exemestane Exemestane 25.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Dec. 19, 2019 Dec. 31, 2022 In Use
51991-0005-90 51991-0005 Exemestane Exemestane 25.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Nov. 15, 2020 In Use
55154-4949-00 55154-4949 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 13, 2003 In Use
55154-4949-09 55154-4949 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 13, 2003 Oct. 31, 2012 In Use
60505-0133-00 60505-0133 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 29, 2002 In Use
60505-0133-01 60505-0133 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 29, 2002 Dec. 31, 2022 In Use
60505-0133-02 60505-0133 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 29, 2002 Dec. 31, 2022 In Use
60505-0134-00 60505-0134 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 29, 2002 In Use
60505-0134-01 60505-0134 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 29, 2002 Dec. 31, 2022 In Use
60505-0134-02 60505-0134 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 29, 2002 Dec. 31, 2022 In Use
61919-0087-10 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 29, 2019 In Use
61919-0087-15 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 29, 2019 In Use
61919-0087-20 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 10, 2017 In Use
61919-0087-30 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Aug. 29, 2019 In Use
61919-0087-60 61919-0087 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 10, 2017 In Use
61919-0326-21 61919-0326 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Sept. 18, 2019 In Use
61919-0326-05 61919-0326 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 1, 2014 In Use
61919-0326-30 61919-0326 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Sept. 19, 2022 In Use
63539-0688-03 63539-0688 palbociclib Ibrance 125.0 mg/1 Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Oral March 30, 2020 In Use
70934-0259-21 70934-0259 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 25, 2019 In Use
70934-0259-30 70934-0259 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 4, 2019 In Use
70934-0259-42 70934-0259 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral April 17, 2019 In Use
73150-0200-12 73150-0200 umbralisib UKONIQ 260.2 mg/1 Chemotherapy Enzyme Inhibitor PI3Kδ, CK1ε, ABL1, CXCL12, CCL19 Oral Feb. 5, 2021 July 31, 2023 In Use
76346-0073-01 76346-0073 Mifepristone Korlym 300.0 mg/1 Hormonal Therapy Antiprogestin Cortisol Receptor Blocker Oral Feb. 17, 2012 In Use
76346-0073-02 76346-0073 Mifepristone Korlym 300.0 mg/1 Hormonal Therapy Antiprogestin Cortisol Receptor Blocker Oral Feb. 17, 2012 In Use

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