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	$435.42	$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	$435.42	$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
14076WMPNP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 500 mL (PI, CMI)	1	500	0	$435.42	$31.60	$31.60
	Available brands
	pms-HYDROmorphone

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
14080CDP	HYDROMORPHONE hydromorphone hydrochloride 1 mg/mL oral liquid, 500 mL (PI, CMI)	1	500	0	$435.42	$31.60	$31.60
	Available brands
	pms-HYDROmorphone

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	$24.89	$26.34	$29.79
	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	$26.92	$28.37	$31.60
	Available brands
	Dilaudid-HPa
	HYDROMORPHONE JUNO-HPa
	Hydromorphone-hameln-HPa
	MEDSURGE HYDROMORPHONE HP 10 mg/1 mLa