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
12010DDP	HYDROMORPHONE hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)	0.5	10	0	$29.11	$30.00	$30.00
	Available brands
	Dilaudid

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	$29.11	$30.00	$30.00
	Available brands
	Dilaudid

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	$23.90	$25.21	$28.50
	Available brands
	Dilaudid

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	$22.49	$23.80	$27.09
	Available brands
	Dilaudid

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	$23.90	$25.21	$28.50
	Available brands
	Dilaudid

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	$22.49	$23.80	$27.09
	Available brands
	Dilaudid

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	$34.70	$30.00	$30.00
	Available brands
	Dilaudid

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	$33.12	$30.00	$30.00
	Available brands
	Dilaudida
	HYDROMORPHONE JUNOa
	Hydromorphone-hamelna
	MEDSURGE HYDROMORPHONE 2 mg/1 mLa

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	$30.16	$30.00	$30.00
	Available brands
	Dilaudid

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	$51.52	$30.00	$30.00
	Available brands
	Dilaudid

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	$38.52	$30.00	$30.00
	Available brands
	Dilaudid-HPa
	HYDROMORPHONE JUNO-HPa
	Hydromorphone-hameln-HPa
	MEDSURGE HYDROMORPHONE HP 10 mg/1 mLa

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	$349.53	$30.00	$30.00
	Available brands
	Hikmaa
	Hydromorphone hydrochloride oral solution, USP (Medsurge)a

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	$349.53	$30.00	$30.00
	Available brands
	Hikmaa
	Hydromorphone hydrochloride oral solution, USP (Medsurge)a

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	$349.53	$30.00	$30.00
	Available brands
	Hikmaa
	Hydromorphone hydrochloride oral solution, USP (Medsurge)a

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	$23.57	$24.88	$28.17
	Available brands
	Dilaudid

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	$25.84	$27.15	$30.00
	Available brands
	Dilaudid

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	$34.25	$30.00	$30.00
	Available brands
	Dilaudid

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	$25.05	$26.36	$29.65
	Available brands
	Dilaudida
	HYDROMORPHONE JUNOa
	Hydromorphone-hamelna
	MEDSURGE HYDROMORPHONE 2 mg/1 mLa

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	$27.75	$29.06	$30.00
	Available brands
	Dilaudid-HPa
	HYDROMORPHONE JUNO-HPa
	Hydromorphone-hameln-HPa
	MEDSURGE HYDROMORPHONE HP 10 mg/1 mLa

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
8541MMPNP	HYDROMORPHONE hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)	1	20	0	$23.57	$24.88	$28.17
	Available brands
	Dilaudid

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
8542NMPNP	HYDROMORPHONE hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)	1	20	0	$25.84	$27.15	$30.00
	Available brands
	Dilaudid

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
8543PMPNP	HYDROMORPHONE hydromorphone hydrochloride 8 mg tablet, 20 (PI, CMI)	1	20	0	$34.25	$30.00	$30.00
	Available brands
	Dilaudid