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