Dilaudid

Generic: Hydromorphone

2MG, 4MG, 8MG — Solution

OPIOID AGONISTS

Also known as: DILAUDID SOLN 1MG/ML, 2MG/ML DILAUDID SOLN .2MG/ML DILAUDID TABS 2MG, 4MG, 8MG
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 3 - Non-Preferred Brand — — ✓ QL
BCBS Federal Standard Option 2026 Tier 3 - Non-Preferred Brand — — ✓ QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Value 2026 Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Care 2026 Tier 1 - Lowest Cost Generic — — ✓ QL
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 21 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze RD 6000 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Silver 3500 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Bronze 7000 HSA Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Silver 4400 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Silver 3000 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Bronze CMS Standard
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect myDiabetesCare Silver
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Gold 1500 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect myDiabetesCare Bronze
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Gold RD CMS Standard
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Bronze RD CMS Standard
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Gold CMS Standard
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Silver CMS Standard
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Connect Silver RD CMS Standard
via Hydromorphone 		Tier 2 - Generic ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 21 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP)
via Hydromorphone 		Tier 1 - Preferred Generic — — ✓ 2400 per 30 days QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Giveback Open (PPO)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Simple (HMO-POS)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Simple Open (PPO)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Assist Open (PPO)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP)
via Hydromorphone 		Tier 2 - Generic — — ✓ 600 per 30 days QL
Alignment Health Platinum (HMO)
via Hydromorphone 		Tier 3 - Preferred Brand — — ✓ 1440 per 30 days QL
Alignment Health smartHMO (HMO)
via Hydromorphone 		Tier 3 - Preferred Brand — — ✓ 1440 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Hydromorphone 		Tier 3 - Preferred Brand — — ✓ 1440 per 30 days QL
Alignment Health Platinum Select (HMO)
via Hydromorphone 		Tier 3 - Preferred Brand — — ✓ 1440 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Hydromorphone 		Tier 3 - Preferred Brand — — ✓ 1440 per 30 days QL
Alignment Health AVA (PPO)
via Hydromorphone 		Tier 3 - Preferred Brand — — ✓ 1440 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Hydromorphone 		Tier 3 - Preferred Brand — — ✓ 1440 per 30 days QL
Blue Medicare PPO Enhanced (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 1440 per 30 days QL
Blue Medicare Essential Plus (HMO-POS)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 1440 per 30 days QL
Blue Medicare Enhanced (HMO-POS)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 1440 per 30 days QL
Blue Medicare Choice (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 1440 per 30 days QL
Blue Medicare Essential (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 1440 per 30 days QL
Experience Health Medicare Advantage (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 1440 per 30 days QL
Healthy Blue + Medicare (HMO-POS D-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 1440 per 30 days QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Dual (HMO D-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Value Plus (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Prime (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature Care (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Enhanced (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Enhanced (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Enhanced (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature Extra (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature Giveback (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
HealthSpring True Choice (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 2400 per 30 days QL
HealthSpring TotalCare (HMO D-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 2400 per 30 days QL
HealthSpring TotalCare Plus (HMO D-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 2400 per 30 days QL
HealthSpring Preferred (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 2400 per 30 days QL
HealthSpring Preferred Select (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 2400 per 30 days QL
HealthSpring Preferred Savings (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 2400 per 30 days QL
HealthSpring Preferred Plus (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 2400 per 30 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED DUAL 009 NC (HMO D-SNP)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED CORE 001 NC (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED GIVEBACK 002 NC (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED GIVEBACK 012 NC (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED CHOICE 001 NC (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED CHOICE 003 NC (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED CHOICE 005 NC (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Aetna Medicare Signature (HMO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED CHOICE 008 NC (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Hydromorphone 		Tier 4 - Non-Preferred — — ✓ 600 per 30 days QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Hydromorphone 		Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 3 - Non-Preferred Brand — — — None
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