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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
72189-0415-30 72189-0415 ANASTROZOLE ANASTROZOLE 1.0 mg/1 Hormonal Therapy Aromatase Inhibitor Oral Jan. 30, 2023 In Use
72189-0468-15 72189-0468 Dexamethasone Dexamethasone 1.5 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 4, 2023 In Use
72189-0468-21 72189-0468 Dexamethasone Dexamethasone 1.5 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral May 4, 2023 In Use
72974-0120-01 72974-0120 Relugolix Orgovyx 120.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor GnRH Receptor Antagonist Oral Dec. 18, 2020 In Use
72974-0120-97 72974-0120 Relugolix Orgovyx 120.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor GnRH Receptor Antagonist Oral Oct. 21, 2021 In Use
72974-0120-95 72974-0120 Relugolix Orgovyx 120.0 mg/1 Hormonal Therapy Androgen Receptor Inhibitor GnRH Receptor Antagonist Oral Jan. 27, 2023 In Use
80425-0075-01 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0075-02 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0075-03 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0075-04 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0075-05 80425-0075 Ondansetron HCL Ondansetron HCL 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0228-01 80425-0228 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Jan. 11, 2023 In Use
80425-0230-01 80425-0230 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 11, 2023 In Use
80425-0231-01 80425-0231 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 11, 2023 In Use
80425-0242-02 80425-0242 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 11, 2023 In Use
80425-0255-01 80425-0255 Methylprednisolone Methylprednisolone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Jan. 11, 2023 In Use
80425-0328-01 80425-0328 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral April 24, 2023 In Use
80725-0610-25 80725-0610 Chlorambucil LEUKERAN 2.0 mg/1 Chemotherapy Alkylating Agent Nitrogen Mustard Oral May 15, 2023 In Use
80725-0620-25 80725-0620 Busulfan MYLERAN 2.0 mg/1 Chemotherapy Alkylating Agent Alkylsulfonate Oral May 15, 2023 In Use
80725-0630-25 80725-0630 Thioguanine TABLOID 40.0 mg/1 Chemotherapy Antimetabolite Purine Analog Oral May 15, 2023 In Use
82982-0041-63 82982-0041 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Feb. 21, 2023 In Use
82982-0042-15 82982-0042 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 15, 2023 In Use
82982-0059-10 82982-0059 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 28, 2023 In Use
82982-0061-10 82982-0061 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral March 30, 2023 In Use
00002-4184-02 00002-4184 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Dec. 16, 2016 Jan. 1, 2023 In Use
00002-4184-07 00002-4184 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Dec. 16, 2016 Nov. 30, 2019 In Use
00002-4184-30 00002-4184 Raloxifene Hydrochloride Evista 60.0 mg/1 Hormonal Therapy Selective Estrogen Receptor Modulator (SERM) Oral Dec. 16, 2016 In Use
00003-0852-11 00003-0852 Dasatinib Sprycel 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral June 3, 2009 Jan. 26, 2011 In Use
00003-0852-22 00003-0852 Dasatinib Sprycel 100.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral May 30, 2008 In Use
00006-3066-01 00006-3066 Aprepitant Emend 125.0 mg/1 Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Oral Dec. 17, 2015 In Use
00006-3066-03 00006-3066 Aprepitant Emend 125.0 mg/1 Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Oral Dec. 17, 2015 In Use
00009-0056-02 00009-0056 Methylprednisolone Medrol 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 24, 1957 In Use
00009-0056-03 00009-0056 Methylprednisolone Medrol 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 24, 1957 April 30, 2008 In Use
00009-0056-04 00009-0056 Methylprednisolone Medrol 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 24, 1957 In Use
00009-0056-05 00009-0056 Methylprednisolone Medrol 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 24, 1957 Dec. 30, 2007 In Use
00046-1100-51 00046-1100 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 April 30, 2020 In Use
00046-1100-52 00046-1100 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Nov. 11, 2019 In Use
00046-1100-81 00046-1100 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
00046-1100-91 00046-1100 Estrogens, Conjugated Premarin 0.3 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
00046-1102-51 00046-1102 Estrogens, Conjugated Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 May 22, 2020 In Use
00046-1102-52 00046-1102 Estrogens, Conjugated Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Feb. 10, 2020 In Use
00046-1102-81 00046-1102 Estrogens, Conjugated Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
00046-1102-91 00046-1102 Estrogens, Conjugated Premarin 0.625 mg/1 Hormonal Therapy Estrogen Oral Jan. 1, 2006 In Use
00046-1104-51 00046-1104 Estrogens, Conjugated Premarin 1.25 mg/1 Hormonal Therapy Estrogen Oral Sept. 1, 2004 April 30, 2013 In Use
00046-1104-81 00046-1104 Estrogens, Conjugated Premarin 1.25 mg/1 Hormonal Therapy Estrogen Oral Sept. 1, 2004 In Use
00046-1104-91 00046-1104 Estrogens, Conjugated Premarin 1.25 mg/1 Hormonal Therapy Estrogen Oral Sept. 1, 2004 In Use
00074-7269-50 00074-7269 Cyclosporine Gengraf 100.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 25, 2010 In Use
00078-0240-15 00078-0240 Cyclosporine Sandimmune 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 2, 1990 In Use
00078-0240-61 00078-0240 Cyclosporine Sandimmune 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 22, 2010 In Use
00078-0241-15 00078-0241 Cyclosporine Sandimmune 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 2, 1990 In Use

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