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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category (Ascending) Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
63323-0734-10 63323-0734 Pamidronate Disodium Pamidronate Disodium 3.0 mg/mL Ancillary Therapy Bisphosphonate Intravenous May 19, 2002 Aug. 27, 2015 No Longer Used
63629-8439-01 63629-8439 Pilocarpine hydrchloride Pilocarpine hydrchloride 5.0 mg/1 Ancillary Therapy Miscellaneous Agent Cholinergic Agonist Oral Feb. 9, 2022 In Use
67457-0390-54 67457-0390 Zoledronic Acid Zoledronic Acid 4.0 mg/5mL Ancillary Therapy Bisphosphonate Intravenous March 10, 2014 In Use
67457-0528-10 67457-0528 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 23, 2019 In Use
67457-0529-20 67457-0529 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous July 23, 2019 In Use
00037-1221-50 00037-1221 Nabilone Cesamet 1.0 mg/1 Ancillary Therapy Antiemetic Cannabinoid Oral March 1, 2010 March 31, 2020 No Longer Used
00051-0022-21 00051-0022 Dronabinol Marinol 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral July 13, 2010 Jan. 31, 2021 No Longer Used
00051-0023-21 00051-0023 Dronabinol Marinol 10.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral July 13, 2010 March 31, 2021 No Longer Used
00591-3591-60 00591-3591 Dronabinol Dronabinol 2.5 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Aug. 11, 1994 May 31, 2019 No Longer Used
00591-3592-60 00591-3592 Dronabinol Dronabinol 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral June 7, 2005 May 31, 2019 No Longer Used
00591-3593-60 00591-3593 Dronabinol Dronabinol 10.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Aug. 11, 1994 Sept. 30, 2019 No Longer Used
20482-0335-30 20482-0335 Dronabinol SYNDROS 5.0 mg/mL Ancillary Therapy Antiemetic CB1/CB2 Oral July 27, 2017 In Use
68084-0174-01 68084-0174 Dronabinol Dronabinol 2.5 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral June 2, 2010 Jan. 31, 2020 No Longer Used
68084-0174-11 68084-0174 Dronabinol Dronabinol 2.5 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral June 2, 2010 Jan. 31, 2020 No Longer Used
68084-0175-11 68084-0175 Dronabinol Dronabinol 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Sept. 23, 2010 Oct. 31, 2019 No Longer Used
68084-0175-21 68084-0175 Dronabinol Dronabinol 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Sept. 23, 2010 Oct. 31, 2019 No Longer Used
00054-0395-13 00054-0395 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2013 In Use
00054-0395-22 00054-0395 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Aug. 1, 2013 In Use
00115-1438-08 00115-1438 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 20, 2015 In Use
00115-1438-10 00115-1438 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 20, 2015 In Use
00591-2292-19 00591-2292 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 20, 2015 May 31, 2019 No Longer Used
00591-2292-30 00591-2292 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 20, 2015 April 30, 2019 No Longer Used
42291-0257-90 42291-0257 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 30, 2015 Nov. 1, 2018 No Longer Used
50090-2285-00 50090-2285 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Jan. 12, 2016 Dec. 31, 2019 In Use
51991-0749-33 51991-0749 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 20, 2015 Sept. 30, 2017 No Longer Used
51991-0749-90 51991-0749 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 20, 2015 Aug. 31, 2019 No Longer Used
60505-3877-03 60505-3877 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 25, 2015 Jan. 31, 2021 No Longer Used
60505-3877-09 60505-3877 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Nov. 25, 2015 Jan. 31, 2021 No Longer Used
63187-0657-30 63187-0657 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Dec. 1, 2018 Dec. 31, 2020 In Use
63187-0657-60 63187-0657 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Dec. 1, 2018 Dec. 31, 2020 In Use
63187-0657-90 63187-0657 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Dec. 1, 2018 Dec. 31, 2020 In Use
69189-0712-01 69189-0712 Dutasteride Avodart 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral March 23, 2015 May 24, 2017 No Longer Used
00074-0541-30 00074-0541 Cyclosporine Gengraf 50.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral June 20, 2016 April 27, 2018 No Longer Used
00185-0932-30 00185-0932 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Jan. 13, 2000 March 31, 2020 No Longer Used
00185-0932-86 00185-0932 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Nov. 21, 2015 March 31, 2020 No Longer Used
00185-0932-87 00185-0932 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Sept. 23, 2014 Nov. 21, 2015 No Longer Used
00185-0933-30 00185-0933 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Jan. 13, 2000 Feb. 28, 2020 No Longer Used
00185-0933-86 00185-0933 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Nov. 21, 2015 Feb. 28, 2020 No Longer Used
00185-0933-87 00185-0933 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Sept. 23, 2014 Nov. 21, 2015 No Longer Used
00591-2222-15 00591-2222 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Dec. 1, 2008 Dec. 31, 2017 In Use
00591-2223-15 00591-2223 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Dec. 1, 2008 Feb. 28, 2018 In Use
00591-2224-55 00591-2224 Cyclosporine Cyclosporine 100.0 mg/mL Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Dec. 1, 2008 July 31, 2016 In Use
55154-6349-00 55154-6349 Cyclosporine Cyclosporine 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Sept. 1, 2010 Oct. 31, 2010 No Longer Used
00078-0387-25 00078-0387 Zoledronic Acid Zometa 4.0 mg/5mL Ancillary Therapy Bisphosphonate Intravenous Aug. 20, 2001 Nov. 30, 2020 No Longer Used
00078-0590-61 00078-0590 Zoledronic Acid Zometa 4.0 mg/100mL Ancillary Therapy Bisphosphonate Intravenous Aug. 20, 2001 Jan. 31, 2020 No Longer Used
00409-4229-01 00409-4229 Zoledronic Acid Zoledronic Acid 4.0 mg/100mL Ancillary Therapy Bisphosphonate Intravenous Oct. 19, 2017 July 30, 2021 In Use
42023-0151-01 42023-0151 Zoledronic Acid Zoledronic Acid 4.0 mg/5mL Ancillary Therapy Bisphosphonate Intravenous March 4, 2013 Feb. 25, 2020 In Use
45963-0440-55 45963-0440 Zoledronic Acid Zoledronic Acid 4.0 mg/5mL Ancillary Therapy Bisphosphonate Intravenous April 13, 2015 May 31, 2019 No Longer Used
53150-0871-01 53150-0871 Zoledronic Acid Zoledronic Acid 4.0 mg/5mL Ancillary Therapy Bisphosphonate Intravenous April 23, 2012 Dec. 31, 2017 No Longer Used
63323-0961-98 63323-0961 Zoledronic Acid Zoledronic Acid 4.0 mg/5mL Ancillary Therapy Bisphosphonate Intravenous Sept. 4, 2014 In Use

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