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NDC-11 (Package) NDC-9 (Product) Generic Name Brand Name (Ascending) Strength SEER*Rx Category Major Class Minor Class Administration Route Package Effective Date Package Discontinuation Date Status
83858-0106-30 83858-0106 Dasatinib PHYRAGO 140.0 mg/1 Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Oral Sept. 1, 2024 In Use
00078-0701-84 00078-0701 Alpelisib PIQRAY 200.0 mg/1 Chemotherapy Enzyme Inhibitor PI3K Oral May 24, 2019 In Use
00078-0708-02 00078-0708 Alpelisib PIQRAY 150.0 mg/1 Chemotherapy Enzyme Inhibitor PI3K Oral May 24, 2019 In Use
00078-0708-91 00078-0708 Alpelisib PIQRAY 150.0 mg/1 Chemotherapy Enzyme Inhibitor PI3K Oral May 24, 2019 In Use
00078-0715-02 00078-0715 Alpelisib PIQRAY Chemotherapy Enzyme Inhibitor PI3K Oral May 24, 2019 In Use
00078-0715-91 00078-0715 Alpelisib PIQRAY Chemotherapy Enzyme Inhibitor PI3K Oral May 24, 2019 In Use
70710-1208-01 70710-1208 Plerixafor PLERIXAFOR 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 28, 2023 In Use
70771-1776-01 70771-1776 Plerixafor PLERIXAFOR 24.0 mg/1.2mL Ancillary Therapy Immunostimulant Stem Cell Mobilizer Subcutaneous July 28, 2023 In Use
69488-0010-61 69488-0010 Lutetium Lu 177 vipivotide tetraxetan PLUVICTO 27.0 mCi/mL Radiopharmaceutical Radiopharmaceutical PSMA Intravenous March 23, 2022 In Use
50242-0105-01 50242-0105 polatuzumab vedotin POLIVY 140.0 mg/7.52mL Immunotherapy Drug Antibody Conjugate CD79b Intravenous June 10, 2019 In Use
50242-0103-01 50242-0103 polatuzumab vedotin POLIVY 30.0 mg/1.88mL Immunotherapy Drug Antibody Conjugate CD79b Intravenous Sept. 18, 2020 In Use
42747-0761-01 42747-0761 mogamulizumab-kpkc POTELIGEO 4.0 mg/mL Immunotherapy Monoclonal Antibody CCR4 Intravenous Aug. 8, 2018 In Use
59651-0491-01 59651-0491 PREDNISOLONE PREDNISOLONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 17, 2023 In Use
59651-0491-50 59651-0491 PREDNISOLONE PREDNISOLONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 17, 2023 In Use
71335-1737-01 71335-1737 Prednisone PREDNISONE 2.5 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Dec. 4, 2020 In Use
71335-1737-02 71335-1737 Prednisone PREDNISONE 2.5 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral Dec. 4, 2020 In Use
71335-1524-00 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use
71335-1524-01 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use
71335-1524-02 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use
71335-1524-03 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use
71335-1524-04 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use
71335-1524-05 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use
71335-1524-06 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use
71335-1524-07 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use
71335-1524-08 71335-1524 Prednisone PREDNISONE 5.0 mg/1 Hormonal Therapy Adrenal Glucocorticoid Corticosteroid Oral March 4, 2020 In Use

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