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: $25.23 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: $17.66 Max safety net: $19.20 General Patient Charge: $21.99
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: $24.56 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: $18.01 Max safety net: $19.55 General Patient Charge: $22.34
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: $25.23 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: $17.87 Max safety net: $19.41 General Patient Charge: $22.20
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: $25.23 Max safety net: $0.00 General Patient Charge: Nil
Available brands
HALOPERIDOL MEDSURGE
Serenace