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 $29.11 $30.42 $34.96
Available brands
Dilaudid
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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
12016KMPNP HYDROMORPHONE
hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)
0.5 10 0 $29.11 $30.42 $34.96
Available brands
Dilaudid
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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
12032GDP HYDROMORPHONE
hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)
0.5 10 0 $23.90 $25.21 $29.75
Available brands
Dilaudid
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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
12045YDP HYDROMORPHONE
hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)
0.5 10 0 $22.49 $23.80 $28.34
Available brands
Dilaudid
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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
12046BMPNP HYDROMORPHONE
hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)
0.5 10 0 $23.90 $25.21 $29.75
Available brands
Dilaudid
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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
12047CMPNP HYDROMORPHONE
hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)
0.5 10 0 $22.49 $23.80 $28.34
Available brands
Dilaudid
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HYDROMORPHONE

Source Palliative Care
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
12473LMPNP HYDROMORPHONEP
hydromorphone hydrochloride 16 mg modified release tablet, 14 (PI, CMI)
2 28 0 $80.66 $42.50 $42.50
Available brands
Jurnista
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HYDROMORPHONE

Source Palliative Care
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
12482YMPNP HYDROMORPHONEP
hydromorphone hydrochloride 8 mg modified release tablet, 14 (PI, CMI)
2 28 0 $55.52 $42.50 $42.50
Available brands
Jurnista
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HYDROMORPHONE

Source Palliative Care
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
12484CMPNP HYDROMORPHONEP
hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)
2 40 1 $34.70 $36.01 $40.55
Available brands
Dilaudid
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HYDROMORPHONE

Source Palliative Care
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
12493MMPNP HYDROMORPHONEP
hydromorphone hydrochloride 2 mg/mL injection, 5 x 1 mL ampoules (PI, CMI)
2 10 1 $38.64 $39.95 $42.50
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
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
12496QMPNP HYDROMORPHONEP
hydromorphone hydrochloride 4 mg modified release tablet, 14 (PI, CMI)
2 28 0 $47.80 $42.50 $42.50
Available brands
Jurnista
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HYDROMORPHONE

Source Palliative Care
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
12497RMPNP HYDROMORPHONEP
hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)
2 40 1 $30.16 $31.47 $36.01
Available brands
Dilaudid
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HYDROMORPHONE

Source Palliative Care
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
12515QMPNP HYDROMORPHONEP
hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)
2 40 1 $51.52 $42.50 $42.50
Available brands
Dilaudid
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HYDROMORPHONE

Source Palliative Care
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
12531MMPNP HYDROMORPHONEP
hydromorphone hydrochloride 10 mg/mL injection, 5 x 1 mL ampoules (PI, CMI)
2 10 1 $45.86 $42.50 $42.50
Available brands
Dilaudid-HPa
HYDROMORPHONE JUNO-HPa
Hydromorphone-hameln-HPa
MEDSURGE HYDROMORPHONE HP 10 mg/1 mLa
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HYDROMORPHONE

Source Palliative Care
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
12535RMPNP HYDROMORPHONEP
hydromorphone hydrochloride 64 mg modified release tablet, 14 (PI, CMI)
2 28 0 $229.46 $42.50 $42.50
Available brands
Jurnista
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HYDROMORPHONE

Source Palliative Care
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
12543EMPNP HYDROMORPHONEP
hydromorphone hydrochloride 32 mg modified release tablet, 14 (PI, CMI)
2 28 0 $135.38 $42.50 $42.50
Available brands
Jurnista
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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
12559BDP HYDROMORPHONE
hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)
1 473 0 $349.53 $42.50 $42.50
Available brands
Hikmaa
Hydromorphone hydrochloride oral solution, USP (Medsurge)a
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HYDROMORPHONE

Source Palliative Care
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
12565HMPNP HYDROMORPHONEP
hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)
1 473 1 $349.53 $42.50 $42.50
Available brands
Hikmaa
Hydromorphone hydrochloride oral solution, USP (Medsurge)a
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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
12582FMPNP HYDROMORPHONE
hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)
1 473 0 $349.53 $42.50 $42.50
Available brands
Hikmaa
Hydromorphone hydrochloride oral solution, USP (Medsurge)a
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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
5115FDP HYDROMORPHONE
hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)
1 20 0 $23.57 $24.88 $29.42
Available brands
Dilaudid
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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
5116GDP HYDROMORPHONE
hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)
1 20 0 $25.84 $27.15 $31.69
Available brands
Dilaudid
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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
5117HDP HYDROMORPHONE
hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)
1 20 0 $34.25 $35.56 $40.10
Available brands
Dilaudid
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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
8420EMPNP HYDROMORPHONE
hydromorphone hydrochloride 2 mg/mL injection, 5 x 1 mL ampoules (PI, CMI)
1 5 0 $27.81 $29.12 $33.66
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
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 $31.42 $32.73 $37.27
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
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
8541MMPNP HYDROMORPHONE
hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)
1 20 0 $23.57 $24.88 $29.42
Available brands
Dilaudid
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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
8542NMPNP HYDROMORPHONE
hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)
1 20 0 $25.84 $27.15 $31.69
Available brands
Dilaudid
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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
8543PMPNP HYDROMORPHONE
hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)
1 20 0 $34.25 $35.56 $40.10
Available brands
Dilaudid
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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
9299KMPNP HYDROMORPHONE
hydromorphone hydrochloride 4 mg modified release tablet, 14 (PI, CMI)
1 14 0 $32.39 $33.70 $38.24
Available brands
Jurnista
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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
9406CMPNP HYDROMORPHONE
hydromorphone hydrochloride 8 mg modified release tablet, 14 (PI, CMI)
1 14 0 $36.25 $37.56 $42.10
Available brands
Jurnista
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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
9407DMPNP HYDROMORPHONE
hydromorphone hydrochloride 16 mg modified release tablet, 14 (PI, CMI)
1 14 0 $48.82 $42.50 $42.50
Available brands
Jurnista
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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
9408EMPNP HYDROMORPHONE
hydromorphone hydrochloride 32 mg modified release tablet, 14 (PI, CMI)
1 14 0 $75.74 $42.50 $42.50
Available brands
Jurnista
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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
9409FMPNP HYDROMORPHONE
hydromorphone hydrochloride 64 mg modified release tablet, 14 (PI, CMI)
1 14 0 $120.72 $42.50 $42.50
Available brands
Jurnista
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  • Legend
  • PPalliative care items
  • aBrand equivalent a
  • DPDentist
  • MPMedical Practitioner
  • NPNurse Practitioner