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	$434.76	$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
12565HMPNP	HYDROMORPHONEP hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	1	$434.76	$31.60	$31.60
	Available brands
	Hikmaa

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	$434.76	$31.60	$31.60
	Available brands
	Hikmaa

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	$532.70	$31.60	$31.60
	Available brands
	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
13799GDP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	0	$532.70	$31.60	$31.60
	Available brands
	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
13806PMPNP	HYDROMORPHONEP hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL (PI, CMI)	1	473	1	$532.70	$31.60	$31.60
	Available brands
	Hydromorphone hydrochloride oral solution, USP (Medsurge)a