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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date (Ascending) Package Discontinuation Date Status
00115-1408-03 00115-1408 Methyltestosterone Methyltestosterone 10.0 mg/1 Hormonal Therapy Androgen Oral Sept. 21, 2015 In Use
00115-1408-08 00115-1408 Methyltestosterone Methyltestosterone 10.0 mg/1 Hormonal Therapy Androgen Oral Sept. 21, 2015 In Use
50090-2027-00 50090-2027 Goserelin acetate Zoladex 3.6 mg/1 Hormonal Therapy GnRH Agonist Subcutaneous Sept. 23, 2015 In Use
61786-0417-02 61786-0417 Methotrexate sodium Methotrexate 2.5 mg/1 Chemotherapy Antimetabolite Folic Acid Analog Oral Sept. 23, 2015 Jan. 24, 2017 No Longer Used
68084-0930-25 68084-0930 Hydrocortisone Hydrocortisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Sept. 30, 2015 Sept. 30, 2019 No Longer Used
68084-0879-25 68084-0879 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Sept. 30, 2015 In Use
68084-0879-95 68084-0879 Cyclosporine Cyclosporine 25.0 mg/1 Ancillary Therapy Immunomodulator Calcineurin Inhibitor Oral Sept. 30, 2015 In Use
63187-0561-00 63187-0561 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 1, 2015 In Use
63187-0561-24 63187-0561 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 1, 2015 In Use
63187-0561-30 63187-0561 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 1, 2015 In Use
63187-0561-60 63187-0561 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 1, 2015 In Use
63187-0561-90 63187-0561 Dexamethasone Dexamethasone 4.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 1, 2015 In Use
52125-0957-53 52125-0957 Prednisone Prednisone 10.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 2, 2015 Aug. 25, 2016 No Longer Used
60687-0145-01 60687-0145 Prednisone Prednisone 20.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Oct. 5, 2015 In Use
55513-0098-01 55513-0098 Darbepoetin alfa Aranesp 10.0 ug/.4mL Ancillary Therapy Erythropoiesis-Stimulating Agent Intravenous, Subcutaneous Oct. 6, 2015 In Use
64842-1020-01 64842-1020 Trifluridine and Tipiracil Lonsurf 8.19 mg/1, 20.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral Oct. 7, 2015 In Use
64842-1025-01 64842-1025 Trifluridine and Tipiracil Lonsurf 6.14 mg/1, 15.0 mg/1 Chemotherapy Antimetabolite Pyrimidine Analog Oral Oct. 7, 2015 In Use
69656-0101-02 69656-0101 Rolapitant Varubi 90.0 mg/1 Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Oral Oct. 7, 2015 Oct. 31, 2021 No Longer Used
00093-5655-56 00093-5655 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 9, 2015 In Use
00093-5655-98 00093-5655 Dutasteride Dutasteride 0.5 mg/1 Ancillary Therapy Protective Agent 5-alpha Reductase Inhibitor Oral Oct. 9, 2015 In Use
63629-6812-01 63629-6812 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Oct. 13, 2015 In Use
63629-6812-02 63629-6812 Medroxyprogesterone Acetate Medroxyprogesterone Acetate 10.0 mg/1 Hormonal Therapy Progestin Oral Oct. 13, 2015 In Use
45963-0790-56 45963-0790 Docetaxel Docetaxel 20.0 mg/mL Chemotherapy Antimitotic Agent Taxane Intravenous Oct. 13, 2015 Feb. 28, 2021 No Longer Used
50090-2098-00 50090-2098 Methylprednisolone Acetate Depo-Medrol 40.0 mg/mL Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Intra-Articular, Intralesional, Intramuscular, Soft Tissue Oct. 13, 2015 In Use
00179-1999-88 00179-1999 Estradiol Estradiol 0.5 mg/1 Hormonal Therapy Estrogen Oral Oct. 14, 2015 May 31, 2020 No Longer Used

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