HYDROMORPHONE

HYDROMORPHONE (12559B)

hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL
12559B
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: 473 # of repeats: 0 DPMQ: $434.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hikma

HYDROMORPHONE (12565H)

hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL
12565H
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: 1 Max qty units: 473 # of repeats: 1 DPMQ: $434.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hikma

HYDROMORPHONE (12582F)

hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL
12582F
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: 473 # of repeats: 0 DPMQ: $434.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hikma

HYDROMORPHONE (13796D)

hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL
13796D
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: 473 # of repeats: 0 DPMQ: $532.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydromorphone hydrochloride oral solution, USP (Medsurge)

HYDROMORPHONE (13799G)

hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL
13799G
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: 473 # of repeats: 0 DPMQ: $532.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydromorphone hydrochloride oral solution, USP (Medsurge)

HYDROMORPHONE (13806P)

hydromorphone hydrochloride 1 mg/mL oral liquid, 473 mL
13806P
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: 1 Max qty units: 473 # of repeats: 1 DPMQ: $532.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydromorphone hydrochloride oral solution, USP (Medsurge)