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 $30.00 $30.00
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 $30.00 $30.00
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 $28.50
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 $27.09
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 $28.50
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 $27.09
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
12484CMPNP HYDROMORPHONEP
hydromorphone hydrochloride 4 mg tablet, 20 (PI, CMI)
2 40 1 $34.70 $30.00 $30.00
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 $33.12 $30.00 $30.00
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
12497RMPNP HYDROMORPHONEP
hydromorphone hydrochloride 2 mg tablet, 20 (PI, CMI)
2 40 1 $30.16 $30.00 $30.00
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 $30.00 $30.00
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 $38.52 $30.00 $30.00
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
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
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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 $30.00 $30.00
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 $30.00 $30.00
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 $28.17
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 $30.00
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 $30.00 $30.00
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 $25.05 $26.36 $29.65
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 $27.75 $29.06 $30.00
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 $28.17
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 $30.00
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 $30.00 $30.00
Available brands
Dilaudid
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  • Legend
  • PPalliative care items
  • aBrand equivalent a
  • DPDentist
  • MPMedical Practitioner
  • NPNurse Practitioner