HYDROMORPHONE

HYDROMORPHONE (12045Y)

hydromorphone hydrochloride 2 mg tablet, 20
12045Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 0.5 Max qty units: 10 # of repeats: 0 DPMQ: $24.87 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilaudid

HYDROMORPHONE (12047C)

hydromorphone hydrochloride 2 mg tablet, 20
12047C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 0.5 Max qty units: 10 # of repeats: 0 DPMQ: $24.87 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilaudid

HYDROMORPHONE (12497R)

hydromorphone hydrochloride 2 mg tablet, 20
12497R
Body System:
Manner of administration:Oral
Palliative Care
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 11697)

Indication: Severe pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 40 # of repeats: 1 DPMQ: $32.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilaudid

HYDROMORPHONE (5115F)

hydromorphone hydrochloride 2 mg tablet, 20
5115F
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 20 # of repeats: 0 DPMQ: $25.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilaudid

HYDROMORPHONE (8541M)

hydromorphone hydrochloride 2 mg tablet, 20
8541M
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids for less than 12 months

Restriction

Indication: Severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids for more than 12 months

Restriction

Indication: Severe pain
Treatment phase: Continuing PBS treatment after 1 June 2020
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 20 # of repeats: 0 DPMQ: $25.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilaudid