HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12010DDP	HYDROMORPHONE hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)	0.5	10	0	$31.08	$31.60	$31.60
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12016KMPNP	HYDROMORPHONE hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)	0.5	10	0	$31.08	$31.60	$31.60
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12032GDP	HYDROMORPHONE hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)	0.5	10	0	$25.86	$27.31	$30.76
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12045YDP	HYDROMORPHONE hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)	0.5	10	0	$24.46	$25.91	$29.36
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12046BMPNP	HYDROMORPHONE hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)	0.5	10	0	$25.86	$27.31	$30.76
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12047CMPNP	HYDROMORPHONE hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)	0.5	10	0	$24.46	$25.91	$29.36
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	Palliative Care
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12484CMPNP	HYDROMORPHONEP hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)	2	40	1	$36.56	$31.60	$31.60
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	Palliative Care
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12493MMPNP	HYDROMORPHONEP hydromorphone hydrochloride 2 mg/mL injection, 5 x 1 mL ampoules (PI, CMI)	2	10	1	$30.96	$31.60	$31.60
	Available brands
	Dilaudida
	HYDROMORPHONE JUNOa
	Hydromorphone-hamelna
	MEDSURGE HYDROMORPHONE 2 mg/1 mLa

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HYDROMORPHONE

Source	Palliative Care
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12497RMPNP	HYDROMORPHONEP hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)	2	40	1	$32.02	$31.60	$31.60
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	Palliative Care
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12515QMPNP	HYDROMORPHONEP hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)	2	40	1	$53.38	$31.60	$31.60
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	Palliative Care
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12531MMPNP	HYDROMORPHONEP hydromorphone hydrochloride 10 mg/mL injection, 5 x 1 mL ampoules (PI, CMI)	2	10	1	$35.02	$31.60	$31.60
	Available brands
	Dilaudid-HPa
	HYDROMORPHONE JUNO-HPa
	Hydromorphone-hameln-HPa
	MEDSURGE HYDROMORPHONE HP 10 mg/1 mLa

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12559BDP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	0	$434.30	$31.60	$31.60
	Available brands
	Hikmaa

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HYDROMORPHONE

Source	Palliative Care
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12565HMPNP	HYDROMORPHONEP hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	1	$434.30	$31.60	$31.60
	Available brands
	Hikmaa

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12582FMPNP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	0	$434.30	$31.60	$31.60
	Available brands
	Hikmaa

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13796DMPNP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	0	$435.42	$31.60	$31.60
	Available brands
	Hydromorphone hydrochloride oral solution, USP (Medsurge)a

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13799GDP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	0	$435.42	$31.60	$31.60
	Available brands
	Hydromorphone hydrochloride oral solution, USP (Medsurge)a

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HYDROMORPHONE

Source	Palliative Care
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13806PMPNP	HYDROMORPHONEP hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	1	$435.42	$31.60	$31.60
	Available brands
	Hydromorphone hydrochloride oral solution, USP (Medsurge)a

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
14076WMPNP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 500 mL (PI, CMI)	1	500	0	$435.42	$31.60	$31.60
	Available brands
	pms-HYDROmorphone

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
14080CDP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 500 mL (PI, CMI)	1	500	0	$435.42	$31.60	$31.60
	Available brands
	pms-HYDROmorphone

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HYDROMORPHONE

Source	Palliative Care
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
14084GMPNP	HYDROMORPHONEP hydromorphone hydrochloride 1 mg/mL oral liquid, 500 mL (PI, CMI)	1	500	1	$435.42	$31.60	$31.60
	Available brands
	pms-HYDROmorphone

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
5115FDP	HYDROMORPHONE hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)	1	20	0	$25.42	$26.87	$30.32
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
5116GDP	HYDROMORPHONE hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)	1	20	0	$27.69	$29.14	$31.60
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
5117HDP	HYDROMORPHONE hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)	1	20	0	$36.10	$31.60	$31.60
	Available brands
	Dilaudid

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
8420EMPNP	HYDROMORPHONE hydromorphone hydrochloride 2 mg/mL injection, 5 x 1 mL ampoules (PI, CMI)	1	5	0	$24.89	$26.34	$29.79
	Available brands
	Dilaudida
	HYDROMORPHONE JUNOa
	Hydromorphone-hamelna
	MEDSURGE HYDROMORPHONE 2 mg/1 mLa

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HYDROMORPHONE

Source	General Schedule
Body System	NERVOUS SYSTEM > ANALGESICS > OPIOIDS

Caution

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
8421FMPNP	HYDROMORPHONE hydromorphone hydrochloride 10 mg/mL injection, 5 x 1 mL ampoules (PI, CMI)	1	5	0	$26.92	$28.37	$31.60
	Available brands
	Dilaudid-HPa
	HYDROMORPHONE JUNO-HPa
	Hydromorphone-hameln-HPa
	MEDSURGE HYDROMORPHONE HP 10 mg/1 mLa