national drug code number gpi generic … drug code number gpi generic name product name gpi 4...

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC078049471 Tobramycin Nebu Soln 300 MG/5ML TOBI Aminoglycosides

53905006504 Tobramycin Nebu Soln 300 MG/5ML TOBI Aminoglycosides

781717156 Tobramycin Nebu Soln 300 MG/5ML TOBRAMYCIN Aminoglycosides


093408563 Tobramycin Nebu Soln 300 MG/5ML TOBRAMYCIN Aminoglycosides


42794000308 Adefovir Dipivoxil Tab 10 MG ADEFOVIR DIPIVOXIL Hepatitis Agents

54569560400 Adefovir Dipivoxil Tab 10 MG HEPSERA Hepatitis Agents

61958050101 Adefovir Dipivoxil Tab 10 MG HEPSERA Hepatitis Agents

003161113 Entecavir Tab 0.5 MG BARACLUDE Hepatitis Agents

003161112 Entecavir Tab 0.5 MG BARACLUDE Hepatitis Agents

003161412 Entecavir Oral Soln 0.05 MG/ML BARACLUDE Hepatitis Agents

085031402 Boceprevir Cap 200 MG VICTRELIS Hepatitis Agents

66435020199 Interferon alfacon‐1 Inj 9 MCG/0.3ML INFERGEN Hepatitis Agents
















54868488700 Peginterferon alfa‐2a Inj 180 MCG/ML PEGASYS Hepatitis Agents

004035009 Peginterferon alfa‐2a Inj 180 MCG/ML PEGASYS Hepatitis Agents

004036030 Peginterferon alfa‐2a Inj 135 MCG/0.5ML PEGASYS PROCLICK Hepatitis Agents

004036530 Peginterferon alfa‐2a Inj 180 MCG/0.5ML PEGASYS PROCLICK Hepatitis Agents

004035730 Peginterferon alfa‐2a Inj 180 MCG/0.5ML PEGASYS Hepatitis Agents

004035239 Peginterferon alfa‐2a Inj Kit 180 MCG/0.5ML PEGASYS Hepatitis Agents

085132302 Peginterferon alfa‐2b For Inj Kit 50 MCG/0.5ML PEG‐INTRON REDIPEN PAK 4 Hepatitis Agents

085132301 Peginterferon alfa‐2b For Inj Kit 50 MCG/0.5ML PEG‐INTRON REDIPEN Hepatitis Agents

085136801 Peginterferon alfa‐2b For Inj Kit 50 MCG/0.5ML PEG‐INTRON Hepatitis Agents












65862029018 Ribavirin Cap 200 MG RIBAVIRIN Hepatitis Agents


66435010118 Ribavirin Cap 200 MG RIBASPHERE Hepatitis Agents










085132704 Ribavirin Cap 200 MG REBETOL Hepatitis Agents
























1

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC54868452102 Ribavirin Cap 200 MG RIBAVIRIN Hepatitis Agents





















49884004532 Ribavirin Tab 200 MG RIBAVIRIN Hepatitis Agents


54868488800 Ribavirin Tab 200 MG COPEGUS Hepatitis Agents

66435010216 Ribavirin Tab 200 MG RIBASPHERE Hepatitis Agents





004008694 Ribavirin Tab 200 MG COPEGUS Hepatitis Agents





074319716 Ribavirin Tab 200 MG MODERIBA Hepatitis Agents


074323956 Ribavirin Tab 400 MG MODERIBA 800 DOSE PACK Hepatitis Agents


16241006956 Ribavirin Tab 400 MG RIBATAB Hepatitis Agents


68382012707 Ribavirin Tab 400 MG !Unknown! Hepatitis Agents


49884033876 Ribavirin Tab 400 MG RIBAPAK Hepatitis Agents

66435010556 Ribavirin Tab 400 MG RIBASPHERE RIBAPAK Hepatitis Agents







68382012907 Ribavirin Tab 600 MG !Unknown! Hepatitis Agents

074328256 Ribavirin Tab 600 MG MODERIBA 1200 DOSE PACK Hepatitis Agents

49884034076 Ribavirin Tab 600 MG RIBAPAK Hepatitis Agents


085131801 Ribavirin Soln 40 MG/ML REBETOL Hepatitis Agents

66435010899 Ribavirin Tab 200 MG & Ribavirin Tab 400 MG Dose Pack RIBASPHERE RIBAPAK Hepatitis Agents


074322456 Ribavirin Tab 200 MG & Ribavirin Tab 400 MG Dose Pack MODERIBA Hepatitis Agents

16241033776 Ribavirin Tab 400 MG & Ribavirin Tab 600 MG Dose Pack RIBATAB Hepatitis Agents

074327156 Ribavirin Tab 400 MG & Ribavirin Tab 600 MG Dose Pack MODERIBA Hepatitis Agents

49884007176 Ribavirin Tab 400 MG & Ribavirin Tab 600 MG Dose Pack RIBAPAK Hepatitis Agents



59676022528 Simeprevir Sodium Cap 150 MG (Base Equivalent) OLYSIO Hepatitis Agents

61958150101 Sofosbuvir Tab 400 MG SOVALDI Hepatitis Agents

51167010003 Telaprevir Tab 375 MG INCIVEK Hepatitis Agents

51167010001 Telaprevir Tab 375 MG INCIVEK Hepatitis Agents

61958090101 Aztreonam Lysine For Inhal Soln 75 MG (Base Equivalent) CAYSTON Anti‐infective Agents ‐ Misc.

006384571 Ertapenem Sodium For IV Inj 1 GM (Base Equivalent) INVANZ Carbapenems

60574310101 Cytomegalovirus Immune Globulin (Human) IV Inj CYTOGAM Immune Serums


44206310110 Cytomegalovirus Immune Globulin (Human) IV Inj !Unknown! Immune Serums


13533063603 Hepatitis B Immune Globulin (Human) IM Inj Soln HYPERHEP B S/D Immune Serums

49999042505 Hepatitis B Immune Globulin (Human) IM Inj Soln NABI‐HB Immune Serums

59730420501 Hepatitis B Immune Globulin (Human) IM Inj Soln NOVAPLUS NABI‐HB Immune Serums







59730420401 Hepatitis B Immune Globulin (Human) IM Inj Soln NOVAPLUS NABI‐HB Immune Serums



2

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC59730420201 Hepatitis B Immune Globulin (Human) IM Inj Soln NABI‐HB Immune Serums


60492005101 Hepatitis B Immune Globulin (Human) Inj Soln HEPAGAM B Immune Serums












54569582800 Immune Globulin (Human) Inj GAMASTAN S/D Immune Serums


52769057622 Immune Globulin (Human) Inj IMMUNE GLOBULIN Immune Serums





14362011502 Immune Globulin (Human) Inj IMMUNE GLOBULIN Immune Serums

61953000301 Immune Globulin (Human) IV Soln 0.5 GM/10ML FLEBOGAMMA Immune Serums

61953000406 Immune Globulin (Human) IV Soln 0.5 GM/10ML FLEBOGAMMA DIF Immune Serums


68209084301 Immune Globulin (Human) IV Soln 1 GM/20ML OCTAGAM Immune Serums



64208823401 Immune Globulin (Human) IV Soln 2.5 GM/50ML GAMMAPLEX Immune Serums

64208823405 Immune Globulin (Human) IV Soln 2.5 GM/50ML GAMMAPLEX Immune Serums

61953000302 Immune Globulin (Human) IV Soln 2.5 GM/50ML FLEBOGAMMA Immune Serums


67467084302 Immune Globulin (Human) IV Soln 2.5 GM/50ML OCTAGAM Immune Serums

68209084302 Immune Globulin (Human) IV Soln 2.5 GM/50ML OCTAGAM Immune Serums


61953000408 Immune Globulin (Human) IV Soln 5 GM/100ML FLEBOGAMMA DIF Immune Serums

64208823402 Immune Globulin (Human) IV Soln 5 GM/100ML GAMMAPLEX Immune Serums




61953000303 Immune Globulin (Human) IV Soln 5 GM/100ML FLEBOGAMMA Immune Serums

61953000304 Immune Globulin (Human) IV Soln 10 GM/200ML FLEBOGAMMA Immune Serums












13533064512 Immune Globulin (Human) IV Soln 1 GM/10ML GAMUNEX Immune Serums

13533064515 Immune Globulin (Human) IV Soln 2.5 GM/25ML GAMUNEX Immune Serums


44206043605 Immune Globulin (Human) IV Soln 5 GM/50ML PRIVIGEN Immune Serums



59730650201 Immune Globulin (Human) IV Soln 5 GM/50ML BIVIGAM Immune Serums

68516162201 Immune Globulin (Human) IV Soln 5 GM/50ML VENOGLOBULIN‐S Immune Serums




59730650301 Immune Globulin (Human) IV Soln 10 GM/100ML BIVIGAM Immune Serums









944262001 Immune Globulin (Human) IV For Soln 0.5 GM GAMMAGARD S/D Immune Serums

944047169 Immune Globulin (Human) IV For Soln 0.5 GM POLYGAM S/D Immune Serums

944262002 Immune Globulin (Human) IV For Soln 2.5 GM GAMMAGARD S/D Immune Serums

053748602 Immune Globulin (Human) IV For Soln 2.5 GM !Unknown! Immune Serums



52769027073 Immune Globulin (Human) IV For Soln 3 GM PANGLOBULIN Immune Serums

44206041603 Immune Globulin (Human) IV For Soln 3 GM CARIMUNE NANOFILTERED Immune Serums

64193025050 Immune Globulin (Human) IV For Soln 5 GM IVEEGAM EN Immune Serums

944047175 Immune Globulin (Human) IV For Soln 5 GM POLYGAM S/D Immune Serums

944265503 Immune Globulin (Human) IV For Soln 5 GM GAMMAGARD S/D IGA LESS TH Immune Serums


3

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC053748605 Immune Globulin (Human) IV For Soln 5 GM GAMMAR‐P I.V. Immune Serums

944262003 Immune Globulin (Human) IV For Soln 5 GM GAMMAGARD S/D Immune Serums


52769041706 Immune Globulin (Human) IV For Soln 6 GM PANGLOBULIN NF Immune Serums




053748610 Immune Globulin (Human) IV For Soln 10 GM GAMMAR‐P I.V. Immune Serums


944262004 Immune Globulin (Human) IV For Soln 10 GM GAMMAGARD S/D Immune Serums



52769041812 Immune Globulin (Human) IV For Soln 12 GM PANGLOBULIN NF Immune Serums


053759610 Immune Globulin (Human) Subcutaneous Inj 160 MG/ML (16%) VIVAGLOBIN Immune Serums






44206045101 Immune Globulin (Human) Subcutaneous Inj 1 GM/5ML HIZENTRA Immune Serums




944270002 Immune Globulin (Human) IV or Subcutaneous Soln 1 GM/10ML GAMMAGARD LIQUID Immune Serums

76125090001 Immune Globulin (Human) IV or Subcutaneous Soln 1 GM/10ML GAMMAKED Immune Serums

13533080012 Immune Globulin (Human) IV or Subcutaneous Soln 1 GM/10ML GAMUNEX‐C Immune Serums


76125090025 Immune Globulin (Human) IV or Subcutaneous Soln 2.5 GM/25ML GAMMAKED Immune Serums

944270003 Immune Globulin (Human) IV or Subcutaneous Soln 2.5 GM/25ML GAMMAGARD LIQUID Immune Serums

13533080016 Immune Globulin (Human) IV or Subcutaneous Soln 2.5 GM/25ML GAMUNEX‐C Immune Serums

13533080015 Immune Globulin (Human) IV or Subcutaneous Soln 2.5 GM/25ML GAMUNEX‐C Immune Serums














44206030010 Rho D Immune Globulin (Human) Inj 1500 Unt/2ML (300 MCG/2ML) RHOPHYLAC Immune Serums

44206030001 Rho D Immune Globulin (Human) Inj 1500 Unt/2ML (300 MCG/2ML) RHOPHYLAC Immune Serums

944296707 Rho D Immune Globulin (Human) Inj 2500 Unit/2.2ML WINRHO SDF Immune Serums






53270300001 Rho D Immune Globulin (Human) Inj 15000 Unit/13ML WINRHO SDF Immune Serums

944296709 Rho D Immune Globulin (Human) Inj 15000 Unit/13ML WINRHO SDF Immune Serums


562780605 Rho D Immune Globulin (Human) IM Inj 50 MCG MICRHOGAM ULTRA‐FILTERED Immune Serums


13533063106 Rho D Immune Globulin (Human) IM Inj 50 MCG HYPERRHO S/D Immune Serums


562780801 Rho D Immune Globulin (Human) IM Inj 50 MCG MICRHOGAM Immune Serums




13533066106 Rho D Immune Globulin (Human) IM Inj 50 MCG HYPERRHO S/D MINI‐DOSE Immune Serums

562780501 Rho D Immune Globulin (Human) IM Inj 300 MCG RHOGAM ULTRA‐FILTERED PLU Immune Serums



562780726 Rho D Immune Globulin (Human) IM Inj 300 MCG RHOGAM HUMAN Immune Serums


54569439500 Rho D Immune Globulin (Human) IM Inj 300 MCG BAYRHO‐D Immune Serums







60574411401 Palivizumab IM Soln 50 MG/0.5ML SYNAGIS Monoclonal Antibodies

60574411301 Palivizumab IM Soln 100 MG/ML SYNAGIS Monoclonal Antibodies

57665000101 Pegademase Bovine Inj 250 Unit/ML ADAGEN Biologicals Misc

63459039120 Bendamustine HCl For IV Soln 100 MG TREANDA Alkylating Agents

093759941 Temozolomide Cap 5 MG TEMOZOLOMIDE Alkylating Agents

54868534801 Temozolomide Cap 5 MG TEMODAR Alkylating Agents



4

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC085300402 Temozolomide Cap 5 MG TEMODAR Alkylating Agents




















































































085138101 Temozolomide For IV Soln 100 MG TEMODAR Alkylating Agents

5

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC15210040335 Mitoxantrone HCl Inj Conc 20 MG/10ML (2 MG/ML) MITOXANTRONE HCL Antineoplastic Antibiotics

61703034318 Mitoxantrone HCl Inj Conc 20 MG/10ML (2 MG/ML) MITOXANTRONE HCL Antineoplastic Antibiotics





44087152001 Mitoxantrone HCl Inj Conc 20 MG/10ML (2 MG/ML) NOVANTRONE Antineoplastic Antibiotics


703468001 Mitoxantrone HCl Inj Conc 25 MG/12.5ML (2 MG/ML) MITOXANTRONE HCL Antineoplastic Antibiotics





44087152501 Mitoxantrone HCl Inj Conc 25 MG/12.5ML (2 MG/ML) NOVANTRONE Antineoplastic Antibiotics







44087153001 Mitoxantrone HCl Inj Conc 30 MG/15ML (2 MG/ML) NOVANTRONE Antineoplastic Antibiotics



57902024901 Asparaginase Erwinia Chrysanthemi For IM Inj 10000 Unit ERWINAZE Antineoplastic Enzymes

57902024905 Asparaginase Erwinia Chrysanthemi For IM Inj 10000 Unit ERWINAZE Antineoplastic Enzymes

781925394 Azacitidine For Inj 100 MG AZACITIDINE Antimetabolites

67211010201 Azacitidine For Inj 100 MG VIDAZA Antimetabolites



59572010201 Azacitidine For Inj 100 MG VIDAZA Antimetabolites

378251191 Capecitabine Tab 150 MG CAPECITABINE Antimetabolites

004110020 Capecitabine Tab 150 MG XELODA Antimetabolites
























781313980 Decitabine For Inj 50 MG DECITABINE Antimetabolites



62856060001 Decitabine For Inj 50 MG DACOGEN Antimetabolites


58063060050 Decitabine For Inj 50 MG DACOGEN Antimetabolites

024582020 Fludarabine Phosphate Tab 10 MG OFORTA Antimetabolites

002762301 Pemetrexed Disodium For IV Soln 500 MG (Base Equiv) ALIMTA Antimetabolites

024584001 Ziv‐Aflibercept IV Soln 100 MG/4ML (For Infusion) ZALTRAP Antineoplastic ‐ Angiogenesis Inhibitors

024584101 Ziv‐Aflibercept IV Soln 200 MG/8ML (For Infusion) ZALTRAP Antineoplastic ‐ Angiogenesis Inhibitors

50242006001 Bevacizumab IV Soln 100 MG/4ML (For Infusion) AVASTIN Antineoplastic ‐ Angiogenesis Inhibitors

50242006101 Bevacizumab IV Soln 400 MG/16ML (For Infusion) AVASTIN Antineoplastic ‐ Angiogenesis Inhibitors

002766901 Ramucirumab IV Soln 100 MG/10ML (For Infusion) CYRAMZA Antineoplastic ‐ Angiogenesis Inhibitors

002767801 Ramucirumab IV Soln 500 MG/50ML (For Infusion) CYRAMZA Antineoplastic ‐ Angiogenesis Inhibitors

55513095401 Panitumumab IV Soln 100 MG/5ML VECTIBIX Antineoplastic ‐ Antibodies



50242014501 Pertuzumab Soln for IV Infusion 420 MG/14ML (30 MG/ML) PERJETA Antineoplastic ‐ Antibodies

50242005306 Rituximab For IV Inj Conc 10 MG/ML RITUXAN Antineoplastic ‐ Antibodies

50242005121 Rituximab For IV Inj Conc 10 MG/ML RITUXAN Antineoplastic ‐ Antibodies

50242013468 Trastuzumab For IV Soln 440 MG HERCEPTIN Antineoplastic ‐ Antibodies

50242005656 Trastuzumab For IV Soln 440 MG HERCEPTIN Antineoplastic ‐ Antibodies

51144005001 Brentuximab Vedotin For IV Soln 50 MG ADCETRIS Antineoplastic ‐ Antibodies

50242014001 Vismodegib Cap 150 MG ERIVEDGE !Unknown!

469012599 Enzalutamide Cap 40 MG XTANDI Antineoplastic ‐ Hormonal Agents

54569394300 Goserelin Acetate Implant 3.6 MG ZOLADEX Antineoplastic ‐ Hormonal Agents



55592050001 Histrelin Acetate Implant Kit 50 MG VANTAS Antineoplastic ‐ Hormonal Agents

67979050001 Histrelin Acetate Implant Kit 50 MG VANTAS Antineoplastic ‐ Hormonal Agents

6

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC300361224 Leuprolide Acetate Inj 5 MG/ML LUPRON 6‐PACK Antineoplastic ‐ Hormonal Agents

703402419 Leuprolide Acetate Inj 5 MG/ML LEUPROLIDE ACETATE Antineoplastic ‐ Hormonal Agents

074364103 Leuprolide Acetate For Inj Kit 3.75 MG LUPRON DEPOT Antineoplastic ‐ Hormonal Agents



54569613600 Leuprolide Acetate Inj Kit 5 MG/ML LEUPROLIDE ACETATE Antineoplastic ‐ Hormonal Agents





300361228 Leuprolide Acetate Inj Kit 5 MG/ML LUPRON 2 WEEK SUPPLY Antineoplastic ‐ Hormonal Agents






024079375 Leuprolide Acetate For Subcutaneous Inj Kit 7.5 MG ELIGARD Antineoplastic ‐ Hormonal Agents

024079379 Leuprolide Acetate For SC Inj Kit 7.5 MG !Unknown! Antineoplastic ‐ Hormonal Agents

074366303 Leuprolide Acetate (3 Month) For Inj Kit 11.25 MG LUPRON DEPOT Antineoplastic ‐ Hormonal Agents




024022205 Leuprolide Acetate (3 Month) For Subcutaneous Inj Kit 22.5MG ELIGARD Antineoplastic ‐ Hormonal Agents

074368303 Leuprolide Acetate (4 Month) For Inj Kit 30 MG LUPRON DEPOT Antineoplastic ‐ Hormonal Agents



024061030 Leuprolide Acetate (4 Month) For Subcutaneous Inj Kit 30 MG ELIGARD Antineoplastic ‐ Hormonal Agents

024060545 Leuprolide Acetate (6 Month) For Subcutaneous Inj Kit 45 MG ELIGARD Antineoplastic ‐ Hormonal Agents


52544015376 Triptorelin Pamoate For IM Susp 3.75 MG TRELSTAR DEPOT Antineoplastic ‐ Hormonal Agents

52544018924 Triptorelin Pamoate For IM Susp 3.75 MG TRELSTAR DEPOT MIXJECT Antineoplastic ‐ Hormonal Agents

52544015302 Triptorelin Pamoate For IM Susp 3.75 MG TRELSTAR DEPOT Antineoplastic ‐ Hormonal Agents

52544018976 Triptorelin Pamoate For IM Susp 3.75 MG TRELSTAR DEPOT MIXJECT Antineoplastic ‐ Hormonal Agents

52544015476 Triptorelin Pamoate For IM Susp 11.25 MG TRELSTAR LA Antineoplastic ‐ Hormonal Agents

52544018824 Triptorelin Pamoate For IM Susp 11.25 MG TRELSTAR LA MIXJECT Antineoplastic ‐ Hormonal Agents

52544018876 Triptorelin Pamoate For IM Susp 11.25 MG TRELSTAR LA MIXJECT Antineoplastic ‐ Hormonal Agents

52544015402 Triptorelin Pamoate For IM Susp 11.25 MG TRELSTAR LA Antineoplastic ‐ Hormonal Agents

55566830301 Degarelix Acetate For Inj 80 MG (Base Equiv) FIRMAGON Antineoplastic ‐ Hormonal Agents






57894015012 Abiraterone Acetate Tab 250 MG ZYTIGA Antineoplastic ‐ Hormonal Agents

59572050121 Pomalidomide Cap 1 MG POMALYST Antineoplastic ‐ Immunomodulators








62856038901 Eribulin Mesylate Inj 1 MG/2ML (0.5 MG/ML) HALAVEN Mitotic Inhibitors

015191012 Ixabepilone For IV Infusion 15 MG IXEMPRA KIT Mitotic Inhibitors

015191113 Ixabepilone For IV Infusion 45 MG IXEMPRA KIT Mitotic Inhibitors

006056840 Vorinostat Cap 100 MG ZOLINZA Antineoplastic Enzyme Inhibitors

173084608 Dabrafenib Mesylate Cap 50 MG (Base Equivalent) TAFINLAR Antineoplastic Enzyme Inhibitors

173084708 Dabrafenib Mesylate Cap 75 MG (Base Equivalent) TAFINLAR Antineoplastic Enzyme Inhibitors

50242009001 Vemurafenib Tab 240 MG (Base Equivalent) ZELBORAF Antineoplastic Enzyme Inhibitors

078059461 Everolimus Tab 2.5 MG AFINITOR Antineoplastic Enzyme Inhibitors


078056661 Everolimus Tab 5 MG AFINITOR Antineoplastic Enzyme Inhibitors






078062661 Everolimus Tab for Oral Susp 2 MG AFINITOR DISPERZ Antineoplastic Enzyme Inhibitors






008117901 Temsirolimus Soln For IV Infusion 25 MG/ML TORISEL Antineoplastic Enzyme Inhibitors

50419017103 Regorafenib Tab 40 MG STIVARGA Antineoplastic Enzyme Inhibitors

50419017101 Regorafenib Tab 40 MG STIVARGA Antineoplastic Enzyme Inhibitors

026848858 Sorafenib Tosylate Tab 200 MG (Base Equivalent) NEXAVAR Antineoplastic Enzyme Inhibitors

50419048858 Sorafenib Tosylate Tab 200 MG (Base Equivalent) NEXAVAR Antineoplastic Enzyme Inhibitors

069055030 Sunitinib Malate Cap 12.5 MG (Base Equivalent) SUTENT Antineoplastic Enzyme Inhibitors



54569598300 Sunitinib Malate Cap 25 MG (Base Equivalent) SUTENT Antineoplastic Enzyme Inhibitors



54868557300 Sunitinib Malate Cap 50 MG (Base Equivalent) !Unknown! Antineoplastic Enzyme Inhibitors

7

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC069098030 Sunitinib Malate Cap 50 MG (Base Equivalent) SUTENT Antineoplastic Enzyme Inhibitors


9850084913 Trametinib Dimethyl Sulfoxide Tab 0.5 MG (Base Equivalent) MEKINIST Antineoplastic Enzyme Inhibitors

173084913 Trametinib Dimethyl Sulfoxide Tab 0.5 MG (Base Equivalent) MEKINIST Antineoplastic Enzyme Inhibitors

9850084813 Trametinib Dimethyl Sulfoxide Tab 2 MG (Base Equivalent) MEKINIST Antineoplastic Enzyme Inhibitors

173084813 Trametinib Dimethyl Sulfoxide Tab 2 MG (Base Equivalent) MEKINIST Antineoplastic Enzyme Inhibitors

597014130 Afatinib Dimaleate Tab 20 MG (Base Equivalent) GILOTRIF Antineoplastic Enzyme Inhibitors



069014501 Axitinib Tab 1 MG INLYTA Antineoplastic Enzyme Inhibitors

069015111 Axitinib Tab 5 MG INLYTA Antineoplastic Enzyme Inhibitors

069013501 Bosutinib Tab 100 MG BOSULIF Antineoplastic Enzyme Inhibitors

069013601 Bosutinib Tab 500 MG BOSULIF Antineoplastic Enzyme Inhibitors

078064070 Ceritinib Cap 150 MG ZYKADIA Antineoplastic Enzyme Inhibitors

069814120 Crizotinib Cap 200 MG XALKORI Antineoplastic Enzyme Inhibitors

069814020 Crizotinib Cap 250 MG XALKORI Antineoplastic Enzyme Inhibitors

003052711 Dasatinib Tab 20 MG SPRYCEL Antineoplastic Enzyme Inhibitors







50242006201 Erlotinib Tab 25 MG TARCEVA Antineoplastic Enzyme Inhibitors








310048230 Gefitinib Tab 250 MG IRESSA Antineoplastic Enzyme Inhibitors

57962014009 Ibrutinib Cap 140 MG IMBRUVICA Antineoplastic Enzyme Inhibitors

57962014012 Ibrutinib Cap 140 MG IMBRUVICA Antineoplastic Enzyme Inhibitors

078040134 Imatinib Mesylate Tab 100 MG (Base Equivalent) GLEEVEC Antineoplastic Enzyme Inhibitors














173075200 Lapatinib Ditosylate Tab 250 MG (Base Equiv) TYKERB Antineoplastic Enzyme Inhibitors

078059287 Nilotinib Cap 150 MG TASIGNA Antineoplastic Enzyme Inhibitors




173080409 Pazopanib HCl Tab 200 MG (Base Equiv) VOTRIENT Antineoplastic Enzyme Inhibitors

76189053560 Ponatinib HCl Tab 15 MG (Base Equiv) ICLUSIG Antineoplastic Enzyme Inhibitors



310782030 Vandetanib Tab 100 MG CAPRELSA Antineoplastic Enzyme Inhibitors

310781030 Vandetanib Tab 100 MG VANDETANIB Antineoplastic Enzyme Inhibitors

310783030 Vandetanib Tab 300 MG VANDETANIB Antineoplastic Enzyme Inhibitors

310784030 Vandetanib Tab 300 MG CAPRELSA Antineoplastic Enzyme Inhibitors

63020004901 Bortezomib For Inj 3.5 MG VELCADE Antineoplastic Enzyme Inhibitors

50881000560 Ruxolitinib Phosphate Tab 5 MG (Base Equivalent) JAKAFI Antineoplastic Enzyme Inhibitors





59923070205 Irinotecan HCl Inj 100 MG/5ML (20 MG/ML) IRINOTECAN Topoisomerase I Inhibitors







009752901 Irinotecan HCl Inj 100 MG/5ML (20 MG/ML) CAMPTOSAR Topoisomerase I Inhibitors











8

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC61703034962 Irinotecan HCl Inj 100 MG/5ML (20 MG/ML) IRINOTECAN Topoisomerase I Inhibitors






007420511 Topotecan HCl Cap 0.25 MG (Base Equiv) HYCAMTIN Topoisomerase I Inhibitors

007420711 Topotecan HCl Cap 1 MG (Base Equiv) HYCAMTIN Topoisomerase I Inhibitors

007420105 Topotecan HCl For Inj 4 MG HYCAMTIN Topoisomerase I Inhibitors

55390037010 Topotecan HCl For Inj 4 MG TOPOTECAN HCL Topoisomerase I Inhibitors




007420101 Topotecan HCl For Inj 4 MG HYCAMTIN Topoisomerase I Inhibitors








60429026501 Hydroxyurea Cap 500 MG HYDROXYUREA Antineoplastics Misc.
















54868136700 Hydroxyurea Cap 500 MG HYDREA Antineoplastics Misc.


003083050 Hydroxyurea Cap 500 MG HYDREA Antineoplastics Misc.


63459017714 Omacetaxine Mepesuccinate For Inj 3.5 MG SYNRIBO Antineoplastics Misc.

54482005301 Procarbazine HCl Cap 50 MG MATULANE Antineoplastics Misc.

54868136600 Procarbazine HCl Cap 50 MG MATULANE Antineoplastics Misc.

004201507 Interferon Alfa‐2A Inj Kit 3 MU/0.5 ML ROFERON‐A Antineoplastics Misc.






339650499 Interferon Alfa‐2B Inj 6000000 U/ML !Unknown! Antineoplastics Misc.

085116801 Interferon Alfa‐2B Inj 6000000 Unit/ML INTRON‐A Antineoplastics Misc.

339650399 Interferon Alfa‐2B Inj 6000000 U/ML !Unknown! Antineoplastics Misc.

085118401 Interferon Alfa‐2B Inj 6000000 U/ML INTRON‐A Antineoplastics Misc.

339650799 Interferon Alfa‐2B Inj 10 MU/ML !Unknown! Antineoplastics Misc.


085117901 Interferon Alfa‐2B Inj 10 MU/ML INTRON‐A Antineoplastics Misc.

085113301 Interferon Alfa‐2B Inj 10000000 Unit/ML INTRON‐A Antineoplastics Misc.


339651499 Interferon Alfa‐2B For Inj 10 MU !Unknown! Antineoplastics Misc.

085057102 Interferon Alfa‐2B For Inj 10000000 Unit INTRON‐A W/DILUENT Antineoplastics Misc.






085124201 Interferon Alfa‐2B Inj Kit 3000000 Unit/0.2ML INTRON‐A Antineoplastics Misc.



54746000101 Interferon Alfa‐n3 Inj 5000000 Unit/ML ALFERON N Antineoplastics Misc.

42238011112 Interferon Gamma‐1B Inj 100 MCG/0.5ML (2000000 Unit/0.5ML) ACTIMMUNE Antineoplastics Misc.




085128703 Peginterferon alfa‐2b For Inj Kit 4 X 444 MCG SYLATRON Antineoplastics Misc.

078049561 Aldesleukin For IV Soln 22000000 Unit PROLEUKIN Antineoplastics Misc.




004025001 Tretinoin Cap 10 MG VESANOID Antineoplastics Misc.

68084007511 Tretinoin Cap 10 MG TRETINOIN Antineoplastics Misc.




64365050201 Bexarotene Cap 75 MG TARGRETIN Antineoplastics Misc.

9

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC187552675 Bexarotene Cap 75 MG TARGRETIN Antineoplastics Misc.

62856060210 Bexarotene Cap 75 MG TARGRETIN Antineoplastics Misc.

67457020950 Dexrazoxane For Inj 500 MG DEXRAZOXANE Chemotherapy Rescue/Antidote Agents



013872789 Dexrazoxane For Inj 500 MG ZINECARD Chemotherapy Rescue/Antidote Agents

38423011001 Dexrazoxane For Inj 500 MG TOTECT Chemotherapy Rescue/Antidote Agents

013872589 Dexrazoxane For Inj 500 MG ZINECARD Chemotherapy Rescue/Antidote Agents

68152010100 Levoleucovorin Calcium For IV Inj 50 MG (Base Equiv) FUSILEV Chemotherapy Rescue/Antidote Agents

50633021011 Glucarpidase For IV Inj 1000 UNIT VORAXAZE Chemotherapy Rescue/Antidote Agents

67108356509 Mesna Tab 400 MG MESNEX Chemotherapy Rescue/Antidote Agents

015356302 Mesna Inj 100 MG/ML MESNEX Chemotherapy Rescue/Antidote Agents

55390026601 Mesna Inj 100 MG/ML MESNA Chemotherapy Rescue/Antidote Agents





















50419042301 Levonorgestrel Releasing IUD 20 MCG/24HR (52 MG Total) MIRENA Progestin Contraceptives ‐ IUD

50419042101 Levonorgestrel Releasing IUD 20 MCG/24HR (52 MG Total) MIRENA Progestin Contraceptives ‐ IUD

64011024301 Hydroxyprogesterone Caproate IM in Oil 250 MG/ML MAKENA Progestins

76346007301 Mifepristone Tab 300 MG KORLYM Diabetic Other

76346007302 Mifepristone Tab 300 MG KORLYM Diabetic Other

53150087101 Zoledronic Acid Inj Conc For IV Infusion 4 MG/5ML ZOLEDRONIC ACID Calcium Regulators ‐ Misc.


078038725 Zoledronic Acid Inj Conc For IV Infusion 4 MG/5ML ZOMETA Calcium Regulators ‐ Misc.








078059061 Zoledronic Acid IV Soln 4 MG/100ML ZOMETA Calcium Regulators ‐ Misc.

25021082682 Zoledronic Acid IV Soln 4 MG/100ML ZOLEDRONIC ACID Calcium Regulators ‐ Misc.

078043561 Zoledronic Acid IV Soln 5 MG/100ML RECLAST Calcium Regulators ‐ Misc.




35356035101 Zoledronic Acid IV Soln 5 MG/100ML RECLAST Calcium Regulators ‐ Misc.



47335096241 Zoledronic Acid For IV Soln 4 MG ZOLEDRONIC ACID Calcium Regulators ‐ Misc.

002840001 Teriparatide (Recombinant) Inj 600 MCG/2.4ML FORTEO Calcium Regulators ‐ Misc.

55513071001 Denosumab Inj 60 MG/ML PROLIA Calcium Regulators ‐ Misc.

55513073001 Denosumab Inj 120 MG/1.7ML XGEVA Calcium Regulators ‐ Misc.

67979000201 Histrelin Acetate (CPP) Implant Kit 50 MG SUPPRELIN LA LHRH/GnRH Agonist Analog Pituitary Suppressants

074210803 Leuprolide Acetate For Inj Pediatric Kit 7.5 MG LUPRON DEPOT‐PED LHRH/GnRH Agonist Analog Pituitary Suppressants




300244001 Leuprolide Acetate For Inj Pediatric Kit 15 MG LUPRON DEPOT‐PED LHRH/GnRH Agonist Analog Pituitary Suppressants

074244003 Leuprolide Acetate For Inj Pediatric Kit 15 MG LUPRON DEPOT‐PED LHRH/GnRH Agonist Analog Pituitary Suppressants

074377903 Leuprolide Acetate (3 Month) For Inj Pediatric Kit 11.25 MG LUPRON DEPOT‐PED LHRH/GnRH Agonist Analog Pituitary Suppressants

074969403 Leuprolide Acetate (3 Month) For Inj Pediatric Kit 30 MG LUPRON DEPOT‐PED LHRH/GnRH Agonist Analog Pituitary Suppressants

50242007501 Somatropin Inj 5 MG/2ML NUTROPIN AQ NUSPIN 5 Growth Hormones


50242002220 Somatropin Inj 10 MG/2ML NUTROPIN AQ Growth Hormones

50242004314 Somatropin Inj 10 MG/2ML NUTROPIN AQ PEN Growth Hormones

781300126 Somatropin Inj 5 MG/1.5ML OMNITROPE Growth Hormones

54868614600 Somatropin Inj 5 MG/1.5ML NORDITROPIN NORDIFLEX PEN Growth Hormones


169770421 Somatropin Inj 5 MG/1.5ML NORDITROPIN FLEXPRO Growth Hormones

169776811 Somatropin Inj 5 MG/1.5ML NORDITROPIN CARTRIDGE Growth Hormones







10

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC781300407 Somatropin Inj 10 MG/1.5ML OMNITROPE Growth Hormones







50242007301 Somatropin Inj 20 MG/2ML NUTROPIN AQ PEN Growth Hormones

169770311 Somatropin Inj 30 MG/3ML NORDITROPIN NORDIFLEX PEN Growth Hormones

002733516 Somatropin For Inj 5 MG HUMATROPE COMBO PACK Growth Hormones



002734901 Somatropin For Inj 5 MG HUMATROPE Growth Hormones

013262681 Somatropin For Subcutaneous Inj 5 MG GENOTROPIN Growth Hormones

50242007203 Somatropin For Subcutaneous Inj 5 MG NUTROPIN Growth Hormones

50242001902 Somatropin For Subcutaneous Inj 5 MG NUTROPIN Growth Hormones

013262694 Somatropin For Subcutaneous Inj 5 MG GENOTROPIN Growth Hormones

57844071341 Somatropin For Subcutaneous Inj 5 MG TEV‐TROPIN Growth Hormones

57844071319 Somatropin For Subcutaneous Inj 5 MG TEV‐TROPIN Growth Hormones

781400436 Somatropin For Inj 5.8 MG OMNITROPE Growth Hormones

781401471 Somatropin For Inj 5.8 MG OMNITROPE Growth Hormones

002814701 Somatropin For Inj 6 MG (18 Unit) HUMATROPE Growth Hormones

002814801 Somatropin For Inj 12 MG (36 Unit) HUMATROPE Growth Hormones

013264681 Somatropin For Inj 12 MG (13.8 MG Overfill) GENOTROPIN Growth Hormones



50242001821 Somatropin For Inj 10 MG NUTROPIN Growth Hormones

50242002020 Somatropin For Inj 10 MG NUTROPIN Growth Hormones

002814901 Somatropin For Inj 24 MG HUMATROPE Growth Hormones

54868560100 Somatropin For Inj 0.2 MG GENOTROPIN MINIQUICK Growth Hormones








013265302 Somatropin For Inj 1 MG GENOTROPIN MINIQUICK Growth Hormones





013265802 Somatropin For Inj 2 MG GENOTROPIN MINIQUICK Growth Hormones

44087000401 Somatropin (Non‐Refrigerated) For Subcutaneous Inj 4 MG SEROSTIM Growth Hormones


54569493000 Somatropin (Non‐Refrigerated) For Inj 5 MG SAIZEN Growth Hormones

44087100502 Somatropin (Non‐Refrigerated) For Inj 5 MG SAIZEN Growth Hormones





44087108801 Somatropin (Non‐Refrigerated) For Inj 8.8 MG SAIZEN Growth Hormones

44087108001 Somatropin (Non‐Refrigerated) For Inj 8.8 MG SAIZEN CLICK.EASY Growth Hormones

44087338807 Somatropin (Non‐Refrigerated) For Subcutaneous Inj 8.8 MG ZORBTIVE Growth Hormones

44087008804 Somatropin (Non‐Refrigerated) For Subcutaneous Inj 8.8 MG SEROSTIM Growth Hormones

44087201003 Tesamorelin Acetate For Inj 1 MG (Base Equiv) EGRIFTA !Unknown!




15054104005 Mecasermin Inj 40 MG/4ML (10 MG/ML) INCRELEX Insulin‐Like Growth Factors (Somatomedins)

15054006001 Lanreotide Acetate Extended Release Inj 60 MG/0.2ML SOMATULINE DEPOT Somatostatic Agents




25021045101 Octreotide Acetate Inj 50 MCG/ML (0.05 MG/ML) OCTREOTIDE ACETATE Somatostatic Agents






078018061 Octreotide Acetate Inj 50 MCG/ML (0.05 MG/ML) SANDOSTATIN Somatostatic Agents















11

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC63323037604 Octreotide Acetate Inj 100 MCG/ML (0.1 MG/ML) OCTREOTIDE ACETATE Somatostatic Agents

































62756035240 Octreotide Acetate Inj 1000 MCG/ML (1 MG/ML) OCTREOTIDE ACETATE Somatostatic Agents




078018425 Octreotide Acetate Inj 1000 MCG/ML (1 MG/ML) SANDOSTATIN Somatostatic Agents





62756065240 Octreotide Acetate Inj 1 MG/ML !Unknown! Somatostatic Agents

078034061 Octreotide Acetate For IM Inj Kit 10 MG SANDOSTATIN LAR DEPOT Somatostatic Agents



078063361 Pasireotide Diaspartate Inj 0.3 MG/ML (Base Equiv) SIGNIFOR Somatostatic Agents









009517502 Pegvisomant For Inj 10 MG (As Protein) SOMAVERT Growth Hormone Receptor Antagonists







053245300 Desmopressin Acetate Nasal Soln 1.5 MG/ML STIMATE Posterior Pituitary Hormones



63004871001 Corticotropin Inj Gel 80 Unit/ML H.P. ACTHAR Corticotropin

63004773101 Corticotropin Inj Gel 80 Unit/ML ACTHAR HP Corticotropin

58468004101 Agalsidase beta For IV Soln 5 MG FABRAZYME Metabolic Modifiers

58468004001 Agalsidase beta For IV Soln 35 MG FABRAZYME Metabolic Modifiers

66658010260 Nitisinone Cap 2 MG ORFADIN Metabolic Modifiers



66607010026 Nitisinone Cap 2 MG !Unknown! Metabolic Modifiers









68727040001 Betaine Powder For Oral Solution CYSTADANE Metabolic Modifiers



55513007330 Cinacalcet HCl Tab 30 MG (Base Equiv) SENSIPAR Metabolic Modifiers

12

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC54868561600 Cinacalcet HCl Tab 30 MG (Base Equiv) SENSIPAR Metabolic Modifiers



66780031001 Metreleptin For Subcutaneous Inj 11.3 MG MYALEPT Metabolic Modifiers

58468007001 Laronidase Soln For IV Infusion 2.9 MG/5ML ALDURAZYME Metabolic Modifiers

54092070001 Idursulfase Soln for IV Infusion 6 MG/3ML (2 MG/ML) ELAPRASE Metabolic Modifiers

68135010001 Elosulfase Alfa Soln For IV Infusion 5 MG/5ML (1 MG/ML) VIMIZIM Metabolic Modifiers

68135002001 Galsulfase Soln For IV Infusion 1 MG/ML NAGLAZYME Metabolic Modifiers

58468016001 Alglucosidase Alfa For IV Soln 50 MG LUMIZYME Metabolic Modifiers

58468015001 Alglucosidase Alfa For IV Soln 50 MG MYOZYME Metabolic Modifiers

58468016002 Alglucosidase Alfa For IV Soln 50 MG LUMIZYME Metabolic Modifiers

76325010004 Glycerol Phenylbutyrate Liquid 1.1 GM/ML RAVICTI Metabolic Modifiers

76325010025 Glycerol Phenylbutyrate Liquid 1.1 GM/ML RAVICTI Metabolic Modifiers

76325049603 Sodium Phenylbutyrate Tab 500 MG BUPHENYL Metabolic Modifiers

62592049603 Sodium Phenylbutyrate Tab 500 MG BUPHENYL Metabolic Modifiers

42794008614 Sodium Phenylbutyrate Oral Powder 3 GM/Teaspoonful SODIUM PHENYLBUTYRATE Metabolic Modifiers

76325018864 Sodium Phenylbutyrate Oral Powder 3 GM/Teaspoonful BUPHENYL Metabolic Modifiers

62592018864 Sodium Phenylbutyrate Oral Powder 3 GM/Teaspoonful BUPHENYL Metabolic Modifiers

52276031205 Carglumic Acid Tab 200 MG CARBAGLU Metabolic Modifiers

52276031260 Carglumic Acid Tab 200 MG CARBAGLU Metabolic Modifiers

68135030111 Sapropterin Dihydrochloride Powder Packet 100 MG KUVAN Metabolic Modifiers

68135030122 Sapropterin Dihydrochloride Powder Packet 100 MG KUVAN Metabolic Modifiers

68135030002 Sapropterin Dihydrochloride Soluble Tab 100 MG KUVAN Metabolic Modifiers

76431010501 Lomitapide Mesylate Cap 5 MG (Base Equiv) JUXTAPID !Unknown!



58468019102 Mipomersen Sodium Inj 200 MG/ML KYNAMRO Antihyperlipidemics ‐ Misc.

58468019101 Mipomersen Sodium Inj 200 MG/ML KYNAMRO Antihyperlipidemics ‐ Misc.

50419025003 Riociguat Tab 0.5 MG ADEMPAS !Unknown!


50419025101 Riociguat Tab 1 MG ADEMPAS !Unknown!








55111037290 Sildenafil Citrate Tab 20 MG SILDENAFIL CITRATE Pulmonary Hypertension ‐ Phosphodiesterase Inhibitors


378165777 Sildenafil Citrate Tab 20 MG SILDENAFIL Pulmonary Hypertension ‐ Phosphodiesterase Inhibitors



069419068 Sildenafil Citrate Tab 20 MG REVATIO Pulmonary Hypertension ‐ Phosphodiesterase Inhibitors






















33342012110 Sildenafil Citrate Tab 20 MG SILDENAFIL Pulmonary Hypertension ‐ Phosphodiesterase Inhibitors

069033801 Sildenafil Citrate IV Soln 10 MG/12.5ML (Base Equivalent) REVATIO Pulmonary Hypertension ‐ Phosphodiesterase Inhibitors

66302046760 Tadalafil Tab 20 MG (PAH) ADCIRCA Pulmonary Hypertension ‐ Phosphodiesterase Inhibitors

61958080101 Ambrisentan Tab 5 MG LETAIRIS Pulmonary Hypertension ‐ Endothelin Receptor Antagonists






66215010106 Bosentan Tab 62.5 MG TRACLEER Pulmonary Hypertension ‐ Endothelin Receptor Antagonists

66215010103 Bosentan Tab 62.5 MG TRACLEER Pulmonary Hypertension ‐ Endothelin Receptor Antagonists

66215010203 Bosentan Tab 125 MG TRACLEER Pulmonary Hypertension ‐ Endothelin Receptor Antagonists

66215010206 Bosentan Tab 125 MG TRACLEER Pulmonary Hypertension ‐ Endothelin Receptor Antagonists

66215050130 Macitentan Tab 10 MG OPSUMIT Pulmonary Hypertension ‐ Endothelin Receptor Antagonists

66215050115 Macitentan Tab 10 MG OPSUMIT Pulmonary Hypertension ‐ Endothelin Receptor Antagonists

173051700 Epoprostenol Sodium For Inj 0.5 MG FLOLAN Prostaglandin Vasodilators

703198501 Epoprostenol Sodium For Inj 0.5 MG EPOPROSTENOL SODIUM Prostaglandin Vasodilators

66215040301 Epoprostenol Sodium For Inj 0.5 MG VELETRI Prostaglandin Vasodilators

173051900 Epoprostenol Sodium For Inj 1.5 MG FLOLAN Prostaglandin Vasodilators


13

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC703199501 Epoprostenol Sodium For Inj 1.5 MG EPOPROSTENOL SODIUM Prostaglandin Vasodilators


10148010101 Iloprost Inhalation Solution 10 MCG/ML VENTAVIS Prostaglandin Vasodilators









66302020602 Treprostinil Inhalation Solution 0.6 MG/ML TYVASO REFILL Prostaglandin Vasodilators

66302020603 Treprostinil Inhalation Solution 0.6 MG/ML TYVASO Prostaglandin Vasodilators

66302020601 Treprostinil Inhalation Solution 0.6 MG/ML TYVASO STARTER Prostaglandin Vasodilators

66302010101 Treprostinil Sodium Inj 1 MG/ML (Base Equiv) REMODULIN Prostaglandin Vasodilators

66302010201 Treprostinil Sodium Inj 2.5 MG/ML (Base Equiv) REMODULIN Prostaglandin Vasodilators



50242004062 Omalizumab For Inj 150 MG XOLAIR Antiasthmatic ‐ Monoclonal Antibodies

944288401 Alpha1‐Proteinase Inhibitor (Human) Inj 1000 MG/50ML GLASSIA Alpha‐Proteinase Inhibitor (Human)

944280201 Alpha1‐Proteinase Inhibitor (Human) For IV Soln 400 MG ARALAST NP Alpha‐Proteinase Inhibitor (Human)

944280101 Alpha1‐Proteinase Inhibitor (Human) For IV Soln 400 MG ARALAST Alpha‐Proteinase Inhibitor (Human)

49669580001 Proteinase Inhibitor (Human) For IV Soln 400 MG ARALAST Alpha‐Proteinase Inhibitor (Human)


13533060130 Alpha1‐Proteinase Inhibitor (Human) For IV Soln 500 MG PROLASTIN Alpha‐Proteinase Inhibitor (Human)


49669580002 Proteinase Inhibitor (Human) For IV Soln 800 MG ARALAST Alpha‐Proteinase Inhibitor (Human)


944280102 Alpha1‐Proteinase Inhibitor (Human) For IV Soln 800 MG ARALAST Alpha‐Proteinase Inhibitor (Human)


13533070002 Alpha1‐Proteinase Inhibitor (Human) For IV Soln 1000 MG PROLASTIN‐C Alpha‐Proteinase Inhibitor (Human)


13533060135 Alpha1‐Proteinase Inhibitor (Human) For IV Soln 1000 MG PROLASTIN Alpha‐Proteinase Inhibitor (Human)

053720102 Alpha1‐Proteinase Inhibitor (Human) For IV Soln 1000 MG ZEMAIRA Alpha‐Proteinase Inhibitor (Human)

13533070001 Alpha1‐Proteinase Inhibitor (Human) For IV Soln 1000 MG PROLASTIN‐C Alpha‐Proteinase Inhibitor (Human)

51167020002 Ivacaftor Tab 150 MG KALYDECO Cystic Fibrosis Agents

50242010039 Dornase Alfa Inhal Soln 1 MG/ML PULMOZYME Cystic Fibrosis Agents

50242010040 Dornase Alfa Inhal Soln 1 MG/ML PULMOZYME Cystic Fibrosis Agents

64764030020 Vedolizumab For IV Solution 300 MG ENTYVIO Inflammatory Bowel Agents

50474070062 Certolizumab Pegol For Inj Kit 2 X 200 MG CIMZIA Inflammatory Bowel Agents

50474071079 Certolizumab Pegol Inj Kit 2 X 200 MG/ML CIMZIA Inflammatory Bowel Agents

50474071081 Certolizumab Pegol Inj Kit 6 X 200 MG/ML CIMZIA STARTER KIT Inflammatory Bowel Agents

57894003001 Infliximab For IV Inj 100 MG REMICADE Inflammatory Bowel Agents

68875010102 Teduglutide (rDNA) For Inj Kit 5 MG GATTEX !Unknown!




378904001 Cysteamine Bitartrate Cap 50 MG CYSTAGON Cystinosis Agents




50458056001 Paliperidone Palmitate IM Extended‐Release Susp 39 MG/0.25ML INVEGA SUSTENNA Benzisoxazoles


50458056201 Paliperidone Palmitate IM Extend‐Release Susp 117 MG/0.75ML INVEGA SUSTENNA Benzisoxazoles

50458056301 Paliperidone Palmitate IM Extended‐Release Susp 156 MG/ML INVEGA SUSTENNA Benzisoxazoles


50458030911 Risperidone Microspheres For Inj 12.5 MG RISPERDAL CONSTA Benzisoxazoles

50458030611 Risperidone Microspheres For Inj 25 MG RISPERDAL CONSTA Benzisoxazoles

50458030711 Risperidone Microspheres For Inj 37.5 MG RISPERDAL CONSTA Benzisoxazoles

50458030811 Risperidone Microspheres For Inj 50 MG RISPERDAL CONSTA Benzisoxazoles

002765801 Olanzapine Pamoate For Extended Rel IM Susp 210 MG (Base Eq) ZYPREXA RELPREVV Dibenzapines






59148001871 Aripiprazole IM For Extended Release Susp 300 MG ABILIFY MAINTENA Quinolinone Derivatives

59148001971 Aripiprazole IM For Extended Release Susp 400 MG ABILIFY MAINTENA Quinolinone Derivatives

67386042101 Tetrabenazine Tab 12.5 MG XENAZINE Movement Disorder Drug Therapy

67386042201 Tetrabenazine Tab 25 MG XENAZINE Movement Disorder Drug Therapy

68546031730 Glatiramer Acetate Inj Kit 20 MG/ML COPAXONE Multiple Sclerosis Agents



68546032512 Glatiramer Acetate Soln Prefilled Syringe 40 MG/ML COPAXONE Multiple Sclerosis Agents

44087002203 Interferon Beta‐1a Inj 22 MCG/0.5ML (12MU/ML) (44 MCG/ML) REBIF Multiple Sclerosis Agents

44087332201 Interferon Beta‐1a Inj 22 MCG/0.5ML (12MU/ML) (44 MCG/ML) REBIF REBIDOSE Multiple Sclerosis Agents



44087334401 Interferon Beta‐1a Inj 44 MCG/0.5ML (24MU/ML) (88 MCG/ML) REBIF REBIDOSE Multiple Sclerosis Agents


44087018801 Interferon Beta‐1a Inj 6 X 8.8 MCG/0.2ML & 6 X 22 MCG/0.5ML REBIF REBIDOSE TITRATION Multiple Sclerosis Agents

44087882201 Interferon Beta‐1a Inj 6 X 8.8 MCG/0.2ML & 6 X 22 MCG/0.5ML REBIF TITRATION PACK Multiple Sclerosis Agents

59627000103 Interferon Beta‐1a For IM Inj Kit 30MCG (33MCG(6.6 MU)/Vial) AVONEX Multiple Sclerosis Agents

59627000104 Interferon Beta‐1a For IM Inj Kit 30MCG (33MCG(6.6 MU)/Vial) AVONEX Multiple Sclerosis Agents

59627000207 Interferon Beta‐1a IM Inj Kit 30 MCG/0.5ML AVONEX Multiple Sclerosis Agents

14

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC59627000205 Interferon Beta‐1a IM Inj Kit 30 MCG/0.5ML AVONEX Multiple Sclerosis Agents

59627000304 Interferon Beta‐1a IM Inj Kit 30 MCG/0.5ML AVONEX PEN Multiple Sclerosis Agents

50419052325 Interferon Beta‐1b For Inj 0.3 MG BETASERON Multiple Sclerosis Agents

50419052335 Interferon Beta‐1b For Inj Kit 0.3 MG BETASERON Multiple Sclerosis Agents


078056999 Interferon Beta‐1b For Inj Kit 0.3 MG EXTAVIA Multiple Sclerosis Agents





58468021101 Teriflunomide Tab 7 MG AUBAGIO Multiple Sclerosis Agents

58468021002 Teriflunomide Tab 14 MG AUBAGIO Multiple Sclerosis Agents

64406000801 Natalizumab for IV Inj Conc 300 MG/15ML TYSABRI Multiple Sclerosis Agents

59075073015 Natalizumab for IV Inj Conc 300 MG/15ML TYSABRI Multiple Sclerosis Agents

64406000703 Dimethyl Fumarate Capsule DR Starter Pack 120 MG & 240 MG TECFIDERA STARTER PACK Multiple Sclerosis Agents

64406000501 Dimethyl Fumarate Capsule Delayed Release 120 MG TECFIDERA Multiple Sclerosis Agents

64406000602 Dimethyl Fumarate Capsule Delayed Release 240 MG TECFIDERA Multiple Sclerosis Agents

10144042760 Dalfampridine Tab SR 12HR 10 MG AMPYRA Multiple Sclerosis Agents

078060751 Fingolimod HCl Cap 0.5 MG (Base Equiv) GILENYA Multiple Sclerosis Agents

59075072310 Ziconotide Acetate Intrathecal Inj 500 MCG/20ML (25 MCG/ML) PRIALT Analgesics‐Peptide Channel Blockers

18860072310 Ziconotide Acetate Intrathecal Inj 500 MCG/20ML (25 MCG/ML) PRIALT Analgesics‐Peptide Channel Blockers

18860072210 Ziconotide Acetate Intrathecal Inj 500 MCG/5ML PRIALT Analgesics‐Peptide Channel Blockers

59075072210 Ziconotide Acetate Intrathecal Inj 500 MCG/5ML PRIALT Analgesics‐Peptide Channel Blockers

66658023401 Anakinra Subcutaneous Inj 100 MG/0.67ML KINERET Interleukin‐1 Receptor Antagonist (IL‐1Ra)






074937402 Adalimumab Inj Kit 20 MG/0.4ML HUMIRA Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

54868482200 Adalimumab Inj Kit 40 MG/0.8ML (50 MG/ML) HUMIRA Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

58118994802 Adalimumab Inj Kit 40 MG/0.8ML (50 MG/ML) HUMIRA PEN Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

074433902 Adalimumab Inj Kit 40 MG/0.8ML (50 MG/ML) HUMIRA PEN Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

074433906 Adalimumab Inj Kit 40 MG/0.8ML (50 MG/ML) HUMIRA PEN‐CROHNS DISEASE Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

074379902 Adalimumab Inj Kit 40 MG/0.8ML (50 MG/ML) HUMIRA Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

074433907 Adalimumab Inj Kit 40 MG/0.8ML (50 MG/ML) HUMIRA PEN‐PSORIASIS STAR Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

57894035001 Golimumab IV Soln 50 MG/4ML SIMPONI ARIA Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

57894007002 Golimumab Subcutaneous Inj 50 MG/0.5ML SIMPONI Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

57894007001 Golimumab Subcutaneous Inj 50 MG/0.5ML SIMPONI Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

57894007101 Golimumab Subcutaneous Inj 100 MG/ML SIMPONI Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

57894007102 Golimumab Subcutaneous Inj 100 MG/ML SIMPONI Anti‐TNF‐alpha ‐ Monoclonoal Antibodies

58406043501 Etanercept Subcutaneous Inj 50 MG/ML ENBREL Soluble Tumor Necrosis Factor Receptor Agents



58406044504 Etanercept Subcutaneous Inj 50 MG/ML ENBREL SURECLICK Soluble Tumor Necrosis Factor Receptor Agents

58406044501 Etanercept Subcutaneous Inj 50 MG/ML ENBREL SURECLICK Soluble Tumor Necrosis Factor Receptor Agents

58406045504 Etanercept Subcutaneous Inj 25 MG/0.5ML ENBREL Soluble Tumor Necrosis Factor Receptor Agents

58406045501 Etanercept Subcutaneous Inj 25 MG/0.5ML ENBREL Soluble Tumor Necrosis Factor Receptor Agents

58406042541 Etanercept For Subcutaneous Inj Kit 25 MG ENBREL Soluble Tumor Necrosis Factor Receptor Agents



003218811 Abatacept Subcutaneous Inj 125 MG/ML ORENCIA Selective Costimulation Modulators

003218831 Abatacept Subcutaneous Inj 125 MG/ML ORENCIA Selective Costimulation Modulators

003218710 Abatacept For IV Soln 250 MG ORENCIA Selective Costimulation Modulators

61755000101 Rilonacept For Inj 220 MG ARCALYST Interleukin‐1 Blockers

078058261 Canakinumab For Inj 180 MG ILARIS !Unknown!

50242013501 Tocilizumab IV Inj 80 MG/4ML ACTEMRA !Unknown!



069100101 Tofacitinib Citrate Tab 5 MG (Base Equivalent) XELJANZ !Unknown!

59572063106 Apremilast Tab 30 MG OTEZLA !Unknown!

59572063006 Apremilast Tab 30 MG OTEZLA !Unknown!

54396080101 Pegloticase Inj 8 MG/ML (For IV Infusion) KRYSTEXXA Gout Agents

67386011101 Vigabatrin Tab 500 MG SABRIL GABA Modulators

67386021165 Vigabatrin Powd Pack 500 MG SABRIL GABA Modulators

62794025513 Apomorphine Hydrochloride Inj 10 MG/ML APOKYN Antiparkinson Dopaminergics








15054053006 AbobotulinumtoxinA For Inj 300 Unit DYSPORT Neuromuscular Blocking Agent ‐ Neurotoxins



54868412300 OnabotulinumtoxinA For Inj 100 Unit BOTOX Neuromuscular Blocking Agent ‐ Neurotoxins



10454071010 RimabotulinumtoxinB Inj 2500 Unit/0.5ML MYOBLOC Neuromuscular Blocking Agent ‐ Neurotoxins

10454071110 RimabotulinumtoxinB Inj 5000 Unit/ML MYOBLOC Neuromuscular Blocking Agent ‐ Neurotoxins

59075071210 RimabotulinumtoxinB Inj 5000 Unit/ML MYOBLOC Neuromuscular Blocking Agent ‐ Neurotoxins

10454071210 RimabotulinumtoxinB Inj 10000 Unit/2ML MYOBLOC Neuromuscular Blocking Agent ‐ Neurotoxins

259160501 IncobotulinumtoxinA For Inj 50 Unit XEOMIN Neuromuscular Blocking Agent ‐ Neurotoxins

259161001 IncobotulinumtoxinA For Inj 100 Unit XEOMIN Neuromuscular Blocking Agent ‐ Neurotoxins

15

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC85836015153 Cross‐Linked Hyaluronate Intra‐articular Gel 30 MG/3ML GEL‐ONE Viscosupplements

35356003403 Hylan Intra‐articular Inj 8 MG/ML SYNVISC Viscosupplements

68115053503 Hylan Intra‐articular Inj 8 MG/ML SYNVISC Viscosupplements

59676036001 Hyaluronan Intra‐articular Inj 15 MG/ML ORTHOVISC Viscosupplements



8024072412 Sodium Hyaluronate Intra‐articular Inj 20 MG/2ML HYALGAN Viscosupplements




55566410001 Sodium Hyaluronate Intra‐articular Inj 20 MG/2ML EUFLEXXA Viscosupplements





8363776101 Sodium Hyaluronate Intra‐articular Inj 25 MG/2.5ML SUPARTZ Viscosupplements





55513000201 Darbepoetin Alfa‐Polysorbate 80 Soln Inj 25 MCG/ML ARANESP ALBUMIN FREE Hematopoietic Growth Factors


55513009001 Darbepoetin Alfa‐Polysorbate 80 Soln Inj 25 MCG/0.42ML ARANESP ALBUMIN FREE SURE Hematopoietic Growth Factors

55513005701 Darbepoetin Alfa‐Polysorbate 80 Soln Inj 25 MCG/0.42ML ARANESP ALBUMIN FREE Hematopoietic Growth Factors































55513009701 Darbepoetin Alfa‐Polysorbate 80 Soln Inj 500 MCG/ML ARANESP ALBUMIN FREE SURE Hematopoietic Growth Factors


59676030202 Epoetin Alfa Inj 2000 Unit/ML PROCRIT Hematopoietic Growth Factors

55513012610 Epoetin Alfa Inj 2000 Unit/ML EPOGEN Hematopoietic Growth Factors




























16

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC59676032004 Epoetin Alfa Inj 20000 Unit/ML PROCRIT Hematopoietic Growth Factors









64764061010 Peginesatide Acetate Soln Inj 10 MG/ML OMONTYS Hematopoietic Growth Factors

64764062020 Peginesatide Acetate Soln Inj 20 MG/2ML OMONTYS Hematopoietic Growth Factors

54868252201 Filgrastim Inj 300 MCG/ML NEUPOGEN Hematopoietic Growth Factors




55513054601 Filgrastim Inj 480 MCG/1.6ML (300 MCG/ML) NEUPOGEN Hematopoietic Growth Factors










55513019001 Pegfilgrastim Inj 6 MG/0.6ML NEULASTA Hematopoietic Growth Factors

54868522900 Pegfilgrastim Inj 6 MG/0.6ML NEULASTA Hematopoietic Growth Factors

50419059501 Sargramostim Inj 500 MCG/ML LEUKINE Hematopoietic Growth Factors







024584305 Sargramostim Lyophilized For Inj 250 MCG LEUKINE Hematopoietic Growth Factors





58394000401 Oprelvekin For Inj 5 MG NEUMEGA Hematopoietic Growth Factors





007464313 Eltrombopag Olamine Tab 12.5 MG (Base Equiv) PROMACTA Hematopoietic Growth Factors

007464013 Eltrombopag Olamine Tab 25 MG (Base Equiv) PROMACTA Hematopoietic Growth Factors



55513022101 Romiplostim For Inj 250 MCG NPLATE Hematopoietic Growth Factors

55513022201 Romiplostim For Inj 500 MCG NPLATE Hematopoietic Growth Factors

58468014001 Plerixafor Subcutaneous Inj 24 MG/1.2ML (20 MG/ML) MOZOBIL Stem Cell Mobilizers

024586201 Plerixafor Subcutaneous Inj 24 MG/1.2ML (20 MG/ML) MOZOBIL Stem Cell Mobilizers

58468106001 Alglucerase IV Soln 80 Unit/ML CEREDASE Agents for Gaucher Disease

58468198301 Imiglucerase For Inj 200 Unit CEREZYME Agents for Gaucher Disease

58468466301 Imiglucerase For Inj 400 Unit CEREZYME Agents for Gaucher Disease

66215020190 Miglustat Cap 100 MG ZAVESCA Agents for Gaucher Disease

66215020118 Miglustat Cap 100 MG ZAVESCA Agents for Gaucher Disease

069010601 Taliglucerase Alfa For Inj 200 Unit ELELYSO Agents for Gaucher Disease

54092070104 Velaglucerase Alfa For Inj 400 Unit VPRIV Agents for Gaucher Disease

641246041 Heparin Sodium (Porcine) Inj 5000 Unit/ML HEPARIN SODIUM Heparins And Heparinoid‐Like Agents


























17

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC63739090128 Heparin Sodium (Porcine) Inj 5000 Unit/ML HEPARIN SODIUM Heparins And Heparinoid‐Like Agents

62856010101 Dalteparin Sodium Inj 10000 Unit/ML FRAGMIN Heparins And Heparinoid‐Like Agents


62856025001 Dalteparin Sodium Inj 2500 Unit/0.2ML FRAGMIN Heparins And Heparinoid‐Like Agents














548563100 Enoxaparin Sodium Inj 30 MG/0.3ML ENOXAPARIN SODIUM Heparins And Heparinoid‐Like Agents


075801310 Enoxaparin Sodium Inj 30 MG/0.3ML LOVENOX Heparins And Heparinoid‐Like Agents





























































54868583500 Enoxaparin Sodium Inj 100 MG/ML LOVENOX Heparins And Heparinoid‐Like Agents


781350069 Enoxaparin Sodium Inj 100 MG/ML ENOXAPARIN SODIUM Heparins And Heparinoid‐Like Agents



18

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC781311969 Enoxaparin Sodium Inj 100 MG/ML ENOXAPARIN SODIUM Heparins And Heparinoid‐Like Agents

































781312293 Enoxaparin Sodium Inj 300 MG/3ML ENOXAPARIN SODIUM Heparins And Heparinoid‐Like Agents

075803001 Enoxaparin Sodium Inj 300 MG/3ML LOVENOX Heparins And Heparinoid‐Like Agents



955101601 Enoxaparin Sodium Inj 300 MG/3ML ENOXAPARIN SODIUM Heparins And Heparinoid‐Like Agents

67211034253 Tinzaparin Sodium Inj 20000 anti‐Xa Unit/ML INNOHEP Heparins And Heparinoid‐Like Agents




60505607800 Fondaparinux Sodium Inj 2.5 MG/0.5ML FONDAPARINUX SODIUM Heparins And Heparinoid‐Like Agents


35356007810 Fondaparinux Sodium Inj 2.5 MG/0.5ML ARIXTRA Heparins And Heparinoid‐Like Agents







35356007910 Fondaparinux Sodium Inj 5 MG/0.4ML ARIXTRA Heparins And Heparinoid‐Like Agents



55111067902 Fondaparinux Sodium Inj 5 MG/0.4ML FONDAPARINUX SODIUM Heparins And Heparinoid‐Like Agents




























944130101 Antihemophilic Factor (Human) For Inj 220‐400 Unit MONARC‐M Antihemophilic Products


944293501 Antihemophilic Factor (Human) For Inj 220‐400 Unit HEMOFIL M Antihemophilic Products

19

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC944293001 Antihemophilic Factor (Human) For Inj 220‐400 Unit HEMOFIL M Antihemophilic Products

13533066520 Antihemophilic Factor (Human) For Inj 250 Unit KOATE‐DVI Antihemophilic Products

026066420 Antihemophilic Factor (Human) For Inj 250 IU !Unknown! Antihemophilic Products


944394002 Antihemophilic Factor (Human) For Inj 250 Unit HEMOFIL M Antihemophilic Products

68516460001 Antihemophilic Factor (Human) For Inj 250‐500 Unit ALPHANATE Antihemophilic Products

















68516460002 Antihemophilic Factor (Human) For Inj 1000‐1500 Unit ALPHANATE Antihemophilic Products







053765601 Antihemophilic Factor (Human) For Inj Kit 250 Unit MONOCLATE‐P Antihemophilic Products






944284110 Antihemophilic Factor (Recombinant) For Inj 220‐400 Unit RECOMBINATE Antihemophilic Products















58394000702 Antihemophilic Factor (Recombinant) For Inj Kit 250 Unit REFACTO Antihemophilic Products


026037220 Antihemophilic Factor (Recombinant) For Inj Kit 250 Unit KOGENATE FS Antihemophilic Products


026379220 Antihemophilic Factor (Recombinant) For Inj Kit 250 Unit KOGENATE FS BIO‐SET Antihemophilic Products

053813001 Antihemophilic Factor (Recombinant) For Inj Kit 250 Unit HELIXATE FS Antihemophilic Products






























20

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC026378770 Antihemophilic Factor (Recombinant) For Inj Kit 3000 Unit KOGENATE FS Antihemophilic Products



944296010 Antihemophilic Factor rAHF‐PFM For Inj 250 Unit ADVATE Antihemophilic Products





























58394001201 Antihemophilic Factor Recombinant PAF For Inj Kit 250 Unit XYNTHA Antihemophilic Products

58394002203 Antihemophilic Factor Recombinant PAF For Inj Kit 250 Unit XYNTHA SOLOFUSE Antihemophilic Products












053762005 Antihemophilic Factor/VWF (Human) For Inj 250‐500 Unit HUMATE‐P Antihemophilic Products



67467018201 Antihemophilic Factor/VWF (Human) For Inj 500‐500 Unit WILATE Antihemophilic Products




67467018202 Antihemophilic Factor/VWF (Human) For Inj 1000‐1000 Unit WILATE Antihemophilic Products




68516460501 Antihemophilic Factor/VWF (Human) For Inj 250 Unit ALPHANATE/VON WILLEBRAND Antihemophilic Products








64193022203 Antiinhibitor Coagulant Complex For Inj FEIBA VH IMMUNO Antihemophilic Products


64193022502 Antiinhibitor Coagulant Complex For Inj FEIBA NF Antihemophilic Products







169720101 Coagulation Factor VIIa (Recomb) For Inj 1 MG (1000 MCG) NOVOSEVEN RT Antihemophilic Products


169706001 Coagulation Factor VIIa (Recomb) For Inj 1.2 MG (1200 MCG) NOVOSEVEN Antihemophilic Products









68516360002 Coagulation Factor IX For Inj 250‐1500 Unit ALPHANINE SD Antihemophilic Products

21

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC053766801 Coagulation Factor IX For Inj 250 Unit MONONINE Antihemophilic Products

053766802 Coagulation Factor IX For Inj 500 Unit MONONINE Antihemophilic Products

68516360402 Coagulation Factor IX For Inj 500 Unit ALPHANINE SD Antihemophilic Products











58394000306 Coagulation Factor IX (Recombinant) For Inj 250 Unit BENEFIX Antihemophilic Products

944302602 Coagulation Factor IX (Recombinant) For Inj 250 Unit RIXUBIS Antihemophilic Products




















64406091101 Coagulation Factor IX (Recomb) (rFIXFc) For Inj 500 Unit ALPROLIX Antihemophilic Products




026062620 Factor IX Complex For Inj 500 U !Unknown! Antihemophilic Products

68516320401 Factor IX Complex For Inj 500 Unit PROFILNINE SD Antihemophilic Products






026062650 Factor IX Complex For Inj 1000 U !Unknown! Antihemophilic Products




64193024402 Factor IX Complex For Inj 200‐1200 Unit BEBULIN VH Antihemophilic Products

64193044502 Factor IX Complex For Inj 200‐1200 Unit BEBULIN Antihemophilic Products

944058101 Factor IX Complex For Inj 700‐3900 Unit PROPLEX T FACTOR IX COMP Antihemophilic Products

68516320003 Factor IX Complex For Inj 1000‐1500 Unit PROFILNINE SD Antihemophilic Products

169701301 Coagulation Factor XIII A‐Subunit For Inj 2000‐3125 Unit TRETTEN Antihemophilic Products

63833891510 Fibrinogen Conc (Human) Inj Approximately 1 GM (900‐1300 MG) !Unknown! Antihemophilic Products

63833891501 Fibrinogen Conc (Human) Inj Approximately 1 GM (900‐1300 MG) RIASTAP Antihemophilic Products

63833089151 Fibrinogen Conc (Human) Inj Approximately 1 GM (900‐1300 MG) RIASTAP Antihemophilic Products

13533060320 Antithrombin III (Human) For Inj 500 Unit THROMBATE III W/10 ML STE Plasma Proteins

944099601 Antithrombin III (Human) For Inj 500 IU !Unknown! Plasma Proteins

13533060321 Antithrombin III (Human) For Inj 500 Unit THROMBATE III W/10 ML STE Plasma Proteins

944417505 Protein C Concentrate (Human) For IV Soln 500 Unit CEPROTIN Human Protein C

944417510 Protein C Concentrate (Human) For IV Soln 1000 Unit CEPROTIN Human Protein C

25682000101 Eculizumab IV Soln 10 MG/ML (For Infusion) SOLIRIS Complement Inhibitors

42227008105 C1 Esterase Inhibitor (Human) For IV Inj 500 Unit CINRYZE Complement Inhibitors

63833082502 C1 Esterase Inhibitor (Human) For IV Inj Kit 500 Unit BERINERT Complement Inhibitors

54092070202 Icatibant Acetate Inj 30 MG/3ML (Base Equivalent) FIRAZYR !Unknown!

54092070203 Icatibant Acetate Inj 30 MG/3ML (Base Equivalent) FIRAZYR !Unknown!

47783010101 Ecallantide Inj 10 MG/ML KALBITOR !Unknown!

023334807 Dexamethasone Intravitreal Implant 0.7 MG OZURDEX Ophthalmic Steroids

24208041601 Fluocinolone Acetonide Intravitreal Implant 0.59 MG RETISERT Ophthalmic Steroids

61755000502 Aflibercept Intravitreal Inj 2 MG/0.05ML (40 MG/ML) EYLEA Ophthalmic ‐ Angiogenesis Inhibitors

68782000101 Pegaptanib Sodium Intravitreous Inj 0.3 MG/90 Microliter MACUGEN Ophthalmic ‐ Angiogenesis Inhibitors

68782000102 Pegaptanib Sodium Intravitreous Inj 0.3 MG/90 Microliter MACUGEN Ophthalmic ‐ Angiogenesis Inhibitors

50242008201 Ranibizumab Intravitreal Inj 0.3 MG/0.05ML (6 MG/ML) LUCENTIS Ophthalmic ‐ Angiogenesis Inhibitors

50242008001 Ranibizumab Intravitreal Inj 0.5 MG/0.05ML (10 MG/ML) LUCENTIS Ophthalmic ‐ Angiogenesis Inhibitors

078043761 Verteporfin For IV Soln 15 MG (2 MG/ML) VISUDYNE Ophthalmic Photodynamic Therapy Agents



145380001 Acitretin Cap 10 MG w/ Moisturizer Kit SORIATANE CK Antipsoriatics

145430001 Acitretin Cap 25 MG w/ Moisturizer Kit SORIATANE CK Antipsoriatics

469002104 Alefacept For IM Inj 15 MG AMEVIVE Antipsoriatics




50242005801 Efalizumab For Subcutaneous Inj Kit 125 MG (150 MG) RAPTIVA Antipsoriatics

22

NATIONAL DRUG

CODE NUMBER GPI GENERIC NAME PRODUCT NAME GPI 4 SEGMENT DESC50242005804 Efalizumab For Subcutaneous Inj Kit 125 MG (150 MG) RAPTIVA Antipsoriatics

57894006002 Ustekinumab Inj 45 MG/0.5ML STELARA Antipsoriatics

57894006003 Ustekinumab Inj 45 MG/0.5ML STELARA Antipsoriatics

57894006103 Ustekinumab Inj 90 MG/ML STELARA Antipsoriatics

62856060422 Bexarotene Gel 1% TARGRETIN Antineoplastic or Premalignant Lesion Agents ‐ Topical

64365050401 Bexarotene Gel 1% TARGRETIN Antineoplastic or Premalignant Lesion Agents ‐ Topical

99207050030 AbobotulinumtoxinA (Glabellar Lines) For Inj 300 Unit DYSPORT Glabellar Lines (Frown Lines) Agents

023923250 OnabotulinumtoxinA (Cosmetic) For Inj 50 Unit BOTOX COSMETIC Glabellar Lines (Frown Lines) Agents



9978000199 Cultured Skin Substitute ‐ Disk APLIGRAF Wound Care Products

703846309 Deferoxamine Mesylate For Inj 500 MG DEFEROXAMINE MESYLATE Antidotes



083380104 Deferoxamine Mesylate For Inj 500 MG DESFERAL Antidotes






63323059930 Deferoxamine Mesylate For Inj 2 GM DEFEROXAMINE MESYLATE Antidotes

078034751 Deferoxamine Mesylate For Inj 2 GM DESFERAL Antidotes



078034761 Deferoxamine Mesylate For Inj 2 GM DESFERAL Antidotes




078046815 Deferasirox Tab For Oral Susp 125 MG EXJADE Antidotes ‐ Chelating Agents



52609000601 Deferiprone Tab 500 MG FERRIPROX Antidotes ‐ Chelating Agents

63459030042 Naltrexone For IM Extended Release Susp 380 MG VIVITROL Opioid Antagonists

65757030001 Naltrexone For IM Extended Release Susp 380 MG VIVITROL Opioid Antagonists

67457022700 Cosyntropin For Inj 0.25 MG COSYNTROPIN Diagnostic Drugs




548590000 Cosyntropin For Inj 0.25 MG CORTROSYN Diagnostic Drugs




58468184904 Thyrotropin Alfa For Inj 1.1 MG THYROGEN Diagnostic Drugs

173051801 Glycine Diluent for Injection STERILE DILUENT FOR FLOLA Liquid Vehicles

703925809 Glycine Diluent for Injection STERILE DILUENT FOR EPOPR Liquid Vehicles

66887000301 Collagenase Clostridium Histolyticum For Inj 0.9 MG XIAFLEX Enzymes

89114085003 Dextranomer‐Sodium Hyaluronate Inj Gel 50‐15 MG/ML SOLESTA !Unknown!

59572020514 Thalidomide Cap 50 MG THALOMID Immunomodulators










59572040228 Lenalidomide Caps 2.5 MG REVLIMID Immunomodulators

59572040200 Lenalidomide Caps 2.5 MG REVLIMID Immunomodulators

59572040500 Lenalidomide Cap 5 MG REVLIMID Immunomodulators













009722402 Lymphocyte Immune Globulin Anti‐Thymocyte G Inj 50 MG/ML(Eq) ATGAM Immunosuppressive Agents

009722401 Lymphocyte Immune Globulin Anti‐Thymocyte G Inj 50 MG/ML(Eq) ATGAM Immunosuppressive Agents

58468008001 Anti‐Thymocyte Globulin For IV Soln 25 MG (Lymphocyte IG) THYMOGLOBULIN Immunosuppressive Agents

62053053425 Anti‐Thymocyte Globulin For IV Soln 25 MG (Lymphocyte IG) THYMOGLOBULIN Immunosuppressive Agents

49401010101 Belimumab For IV Soln 120 MG BENLYSTA !Unknown!

49401010201 Belimumab For IV Soln 400 MG BENLYSTA !Unknown!

23

national drug code number gpi generic … drug code number gpi generic name product name gpi 4...

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