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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
71839-0104-01 71839-0104 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Oct. 15, 2019 In Use
70710-1615-01 70710-1615 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Nov. 1, 2020 In Use
70860-0782-10 70860-0782 Fosaprepitant dimeglumine Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Nov. 30, 2020 In Use
70860-0783-10 70860-0783 Fosaprepitant dimeglumine Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous March 15, 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
72893-0006-01 72893-0006 Levoleucovorin KHAPZORY 300.0 mg/6mL Ancillary Therapy Chemoprotective Antidote Intravenous Jan. 2, 2019 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
59630-0222-07 59630-0222 Naldemedine SYMPROIC 0.2 mg/1 Ancillary Therapy Opioid Antagonist Oral July 5, 2018 Dec. 31, 2020 No Longer Used
59630-0222-30 59630-0222 Naldemedine SYMPROIC 0.2 mg/1 Ancillary Therapy Opioid Antagonist Oral July 5, 2018 Dec. 31, 2020 No Longer Used
59630-0222-90 59630-0222 Naldemedine SYMPROIC 0.2 mg/1 Ancillary Therapy Opioid Antagonist Oral July 5, 2018 Dec. 31, 2020 No Longer Used
60760-0313-10 60760-0313 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 2, 2020 In Use
68788-7705-01 68788-7705 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 1, 2020 In Use
68788-7705-03 68788-7705 Ondansetron Ondansetron 8.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral May 1, 2020 In Use
61314-0866-01 61314-0866 pegfilgrastim-bmez ZIEXTENZO 6.0 mg/.6mL Ancillary Therapy Immunostimulant Colony-Stimulating Factor Subcutaneous Nov. 4, 2019 In Use
53097-0573-60 53097-0573 Dronabinol MARINOL 10.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral March 3, 2021 In Use
53097-0572-60 53097-0572 Dronabinol MARINOL 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral March 3, 2021 In Use
71288-0418-10 71288-0418 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Nov. 15, 2019 In Use
63323-0972-10 63323-0972 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Sept. 5, 2019 In Use
71731-5111-01 71731-5111 Fosaprepitant dimeglumine Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous March 16, 2021 In Use
55150-0299-01 55150-0299 Fosaprepitant dimeglumine Fosaprepitant dimeglumine 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Jan. 12, 2021 In Use
72205-0026-01 72205-0026 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Sept. 5, 2019 In Use
68180-0690-01 68180-0690 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Sept. 25, 2020 In Use
70625-0300-01 70625-0300 Fosaprepitant Dimeglumine Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Nov. 5, 2019 In Use
69639-0105-01 69639-0105 Fosnetupitant and Palonosetron AKYNZEO 260.0 mg/20mL, 0.28 mg/20mL Ancillary Therapy Antiemetic 5HT3 Receptor Anatagonist/Substance P/Neurokinin 1 Intravenous June 15, 2020 In Use
44206-0458-24 44206-0458 HUMAN IMMUNOGLOBULIN G Hizentra 0.2 g/mL Ancillary Therapy Immunostimulant Human Immunoglobulin G Subcutaneous Jan. 1, 2020 In Use
69315-0184-01 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0184-03 69315-0184 Leucovorin calcium Leucovorin calcium 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0185-12 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0185-24 69315-0185 Leucovorin calcium Leucovorin calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0186-24 69315-0186 Leucovorin calcium Leucovorin calcium 15.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
69315-0187-25 69315-0187 Leucovorin calcium Leucovorin calcium 25.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Nov. 16, 2020 In Use
68001-0418-38 68001-0418 Leucovorin Calcium Leucovorin Calcium 350.0 mg/17.5mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 26, 2019 In Use
68001-0417-37 68001-0417 Leucovorin Calcium Leucovorin Calcium 200.0 mg/20mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 26, 2019 In Use
68001-0416-36 68001-0416 Leucovorin Calcium Leucovorin Calcium 100.0 mg/10mL Ancillary Therapy Chemoprotective Antidote Intramuscular, Intravenous Sept. 26, 2019 In Use
72266-0120-01 72266-0120 Levoleucovorin levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous June 25, 2019 In Use
72266-0121-01 72266-0121 Levoleucovorin levoleucovorin 10.0 mg/mL Ancillary Therapy Chemoprotective Antidote Intravenous June 25, 2019 In Use
51662-1367-01 51662-1367 Metoclopramide Metoclopramide 10.0 mg/2mL Ancillary Therapy Antiemetic Dopamine-2 Receptor Antagonist Intramuscular, Intravenous Oct. 14, 2019 In Use
54348-0819-00 54348-0819 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 10, 2019 In Use
54348-0819-02 54348-0819 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 10, 2019 In Use
54348-0819-04 54348-0819 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 10, 2019 In Use
54348-0819-06 54348-0819 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 10, 2019 In Use
54348-0819-08 54348-0819 Ondansetron Ondansetron 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 10, 2019 In Use
47335-0581-40 47335-0581 Amifostine Amifostine 50.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous March 14, 2008 July 31, 2013 No Longer Used
47335-0581-42 47335-0581 Amifostine Amifostine 50.0 mg/mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous March 14, 2008 July 31, 2013 No Longer Used
58178-0017-01 58178-0017 Amifostine Ethyol Ancillary Therapy Chemoprotective Detoxifying Agent Dec. 8, 1995 April 30, 2012 No Longer Used
58178-0017-03 58178-0017 Amifostine Ethyol Ancillary Therapy Chemoprotective Detoxifying Agent Dec. 8, 1995 April 30, 2012 No Longer Used
54092-0064-01 54092-0064 Anagrelide Agrylin Ancillary Therapy Platelet-Reducing Agent PDE-3 Inhibitor Oral March 14, 1997 March 31, 2008 No Longer Used
54868-5385-00 54868-5385 Anagrelide Anagrelide Ancillary Therapy Platelet-Reducing Agent PDE-3 Inhibitor Oral Aug. 15, 2005 June 30, 2011 No Longer Used
54868-5385-01 54868-5385 Anagrelide Anagrelide Ancillary Therapy Platelet-Reducing Agent PDE-3 Inhibitor Oral Aug. 15, 2005 June 30, 2011 No Longer Used

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