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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class (Ascending) Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
59572-0502-00 59572-0502 Pomalidomide Pomalyst 2.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0502-21 59572-0502 Pomalidomide Pomalyst 2.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0503-00 59572-0503 Pomalidomide Pomalyst 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0503-21 59572-0503 Pomalidomide Pomalyst 3.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0504-00 59572-0504 Pomalidomide Pomalyst 4.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
59572-0504-21 59572-0504 Pomalidomide Pomalyst 4.0 mg/1 Immunotherapy Immunomodulator Thalidomide Analog Oral Feb. 18, 2013 In Use
00074-6463-32 00074-6463 Cyclosporine Modified Gengraf 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 24, 2010 Aug. 31, 2017 No Longer Used
00074-6479-32 00074-6479 Cyclosporine Modified Gengraf 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral May 24, 2010 Sept. 16, 2017 No Longer Used
00172-7310-00 00172-7310 Cyclosporine Modified Cyclosporine Modified 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 29, 2005 March 31, 2017 No Longer Used
00172-7310-46 00172-7310 Cyclosporine Modified Cyclosporine Modified 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 29, 2005 March 31, 2017 No Longer Used
00172-7311-00 00172-7311 Cyclosporine Modified Cyclosporine Modified 50.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral April 28, 2005 Feb. 28, 2017 No Longer Used
00172-7311-46 00172-7311 Cyclosporine Modified Cyclosporine Modified 50.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral April 28, 2005 Feb. 28, 2017 No Longer Used
00172-7312-00 00172-7312 Cyclosporine Modified Cyclosporine Modified 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 29, 2005 March 31, 2017 No Longer Used
00172-7312-46 00172-7312 Cyclosporine Modified Cyclosporine Modified 100.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral March 29, 2005 March 31, 2017 No Longer Used
00832-0285-00 00832-0285 Bexarotene Bexarotene 75.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral July 25, 2018 In Use
69238-1250-01 69238-1250 Bexarotene Bexarotene 75.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Sept. 4, 2018 In Use
00115-1476-23 00115-1476 Imiquimod Imiquimod 50.0 mg/g Immunotherapy Immunomodulator Dermatological Agent Topical Feb. 28, 2011 June 1, 2017 No Longer Used
00115-1476-59 00115-1476 Imiquimod Imiquimod 50.0 mg/g Immunotherapy Immunomodulator Dermatological Agent Topical Feb. 28, 2011 June 1, 2017 No Longer Used
68084-0075-11 68084-0075 Tretinoin Tretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral July 18, 2013 In Use
68084-0075-21 68084-0075 Tretinoin Tretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral July 18, 2013 In Use
00054-0399-25 00054-0399 Bexarotene Bexarotene 75.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Nov. 11, 2020 In Use
72189-0084-24 72189-0084 IMIQUIMOD IMIQUIMOD 12.5 mg/.25g Immunotherapy Immunomodulator Dermatological Agent Topical March 23, 2020 In Use
00591-2433-15 00591-2433 Isotretinoin Isotretinoin 10.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral April 29, 2021 In Use
10631-0133-31 10631-0133 Isotretinoin Absorica 25.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Feb. 17, 2015 In Use
10631-0134-31 10631-0134 Isotretinoin Absorica 35.0 mg/1 Hormonal Therapy Immunomodulator Retinoic Acid Derivative Oral Feb. 17, 2015 In Use

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