Limited Coverage Drugs - Hydromorphone Injection

Generic Name

hydromorphone

Strength

50 mg/mL 

Form

injection

Special Authority Criteria

Approval Period

Relief of severe pain in patients who require subcutaneously, intravenously or intramuscularly administered opioids in doses or concentrations higher than those usually needed.

1 year

Practitioner Exemptions

  • No practitioner exemptions.

Special Notes

  • Hydromorphone 10 mg/mL and 20 mg/mL are available as regular benefits on the PharmaCare formulary for the indication of severe pain only.
     
  • Hydromorphone 50 mg/mL is a benefit for the treatment of severe pain under Plans B and P.

Special Authority Request Form(s)