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

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

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

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

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

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

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