• HYDROMORPHON INJ 1MG/ML is a Tier 4 brand drug. You pay the following costs at a network pharmacy:

    Peoples Health Choices 65 (HMO-POS) Northshore

    30-Day Supply: $100 at a retail pharmacy


    The costs listed above apply if the drug is covered by Medicare Part D; if the drug is covered by Medicare Part B, the costs may vary. Contact Peoples Health for more information.

    Dispensing limits apply to this drug. This drug is limited to a 1-month supply per prescription.

    An opioid drug used for the treatment of acute pain may be limited to a 7-day supply for members with no recent history of opioid use. This limit is intended to minimize long-term opioid use. For members who are new to the plan and have a recent history of using opioids, the limit may be overridden by the pharmacy when appropriate.

    If you receive Extra Help from Medicare to pay for your prescription drug costs, your costs will be different. You will pay one of the following costs, depending on your level of Extra Help.

    Level 1: $10.35     Level 2: $4.30     Level 3: $0     Level 4: 15% coinsurance

    Extra Help is available for people with limited income and resources. Click here for more information about extra help.

    Click here to view other drugs in this therapeutic category.

    This drug is covered in the coverage gap for Peoples Health Group Medicare (HMO-POS), Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits, Peoples Health Secure Health (HMO-POS D-SNP), and Peoples Health Secure Complete (HMO-POS D-SNP) plan members. Please see your plan's Evidence of Coverage for more information.

Last updated 10/02/2023