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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
42806-0133-24 42806-0133 Leucovorin Calcium Leucovorin Calcium 10.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral Jan. 1, 2021 In Use
71205-0908-00 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 16, 2021 In Use
71205-0908-11 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 16, 2021 In Use
71205-0908-30 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 16, 2021 In Use
71205-0908-55 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 16, 2021 In Use
71205-0908-60 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 16, 2021 In Use
71205-0908-90 71205-0908 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 5.0 mg/1 Ancillary Therapy Chemoprotective Antidote Oral July 16, 2021 In Use
72205-0083-01 72205-0083 Fosaprepitant Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous May 12, 2020 In Use
00006-3941-01 00006-3941 Fosaprepitant Dimeglumine Emend 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Nov. 19, 2010 In Use
00006-3941-32 00006-3941 Fosaprepitant Dimeglumine Emend 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous Nov. 12, 2010 In Use
31722-0165-31 31722-0165 Fosaprepitant dimeglumine Fosaprepitant 150.0 mg/5mL Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Intravenous July 29, 2021 In Use
72266-0235-01 72266-0235 Dexrazoxane for Injection Dexrazoxane 250.0 mg/25mL Ancillary Therapy Chemoprotective Detoxifying Agent Intravenous Nov. 1, 2021 In Use
63629-8862-01 63629-8862 Dronabinol Dronabinol 10.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Sept. 30, 2021 In Use
63629-8861-01 63629-8861 Dronabinol Dronabinol 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Sept. 30, 2021 In Use
51662-1539-01 51662-1539 ONDANSETRON ONDANSETRON 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral Oct. 6, 2021 In Use
64764-0800-28 64764-0800 MARIBAVIR Livtencity 200.0 mg/1 Ancillary Therapy Miscellaneous Agent CMV Antiviral Oral Nov. 23, 2021 In Use
64764-0800-56 64764-0800 MARIBAVIR Livtencity 200.0 mg/1 Ancillary Therapy Miscellaneous Agent CMV Antiviral Oral Nov. 23, 2021 In Use
36000-0326-02 36000-0326 palonosetron hydrochloride Palonosetron Hydrochloride 0.25 mg/5mL Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Intravenous Nov. 12, 2021 In Use
80425-0072-01 80425-0072 Ondansetron 4mg, Ondansetron HCL Ondansetron HCL 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0072-02 80425-0072 Ondansetron 4mg, Ondansetron HCL Ondansetron HCL 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0072-03 80425-0072 Ondansetron 4mg, Ondansetron HCL Ondansetron HCL 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0072-04 80425-0072 Ondansetron 4mg, Ondansetron HCL Ondansetron HCL 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
80425-0072-05 80425-0072 Ondansetron 4mg, Ondansetron HCL Ondansetron HCL 4.0 mg/1 Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Oral July 31, 2007 In Use
00378-8170-91 00378-8170 Dronabinol Dronabinol 2.5 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Nov. 1, 2011 March 31, 2016 No Longer Used
00378-8171-91 00378-8171 Dronabinol Dronabinol 5.0 mg/1 Ancillary Therapy Antiemetic CB1/CB2 Oral Nov. 1, 2011 June 30, 2016 No Longer Used

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