HALOPERIDOL

HALOPERIDOL (12519X)

haloperidol 5 mg/mL injection, 10 x 1 mL ampoules
12519X
Body System:
Manner of administration:Injection
Palliative Care
Restricted Benefit

Restriction

Indication: For use in patients receiving palliative care
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 10 # of repeats: 2 DPMQ: $24.99 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
HALOPERIDOL MEDSURGE
Serenace

HALOPERIDOL (2761H)

haloperidol 500 microgram tablet, 100
2761H
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 5 DPMQ: $17.26 Max safety net: $18.74 General Patient Charge: $21.53
Available brands
Serenace

HALOPERIDOL (2763K)

haloperidol 2 mg/mL oral liquid, 100 mL
2763K
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $24.31 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Serenace

HALOPERIDOL (2767P)

haloperidol 1.5 mg tablet, 100
2767P
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 5 DPMQ: $17.61 Max safety net: $19.09 General Patient Charge: $21.88
Available brands
Serenace

HALOPERIDOL (2768Q)

haloperidol 5 mg/mL injection, 10 x 1 mL ampoules
2768Q
Body System:
Manner of administration:Injection
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 10 # of repeats: 0 DPMQ: $24.99 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
HALOPERIDOL MEDSURGE
Serenace

HALOPERIDOL (2770T)

haloperidol 5 mg tablet, 50
2770T
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 50 # of repeats: 5 DPMQ: $17.47 Max safety net: $18.95 General Patient Charge: $21.74
Available brands
Serenace

HALOPERIDOL (3456X)

haloperidol 5 mg/mL injection, 10 x 1 mL ampoules
3456X
Body System:
Manner of administration:Injection
Prescriber Bag
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 10 # of repeats: 0 DPMQ: $24.99 Max safety net: $0.00 General Patient Charge: Nil
Available brands
HALOPERIDOL MEDSURGE
Serenace