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Ontario coverage, price, criteria word for word, Health Canada status and shortages for one product

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RIFABUTIN

All products: Limited Use (codes 103, 104)

Other products in the same Health Canada class (J04A, J04AB) — coverage varies; not interchangeable

  • Rifampin (Rofact): general benefit
  • Ethambutol (Myambutol): general benefit, Not a benefit

Mycobutin · DIN 02063786 · 150mg · capsule

Limited Use — Reason for Use code 103, 104 requiredMarketed · checked 2026-09-20
StatusLimited Use — Reason for Use code 103, 104 required
Write on scriptLU code 103, 104 (patient must meet the criteria below)
Patient paysPatient pays: program not supplied; amount cannot be determined.
Private plan unknown: ask. If yes, check its coverage and payer coordination; if no, see the public routes below.
Ontario Limited Use criteria — code 103, 104
Coverage limit: For the prevention of Mycobacterium Avium Intracellular (MAI) in: Reason for Use code 103 Patients with a CD4+ cell count less than 200/mm3 with an AIDS-defining diagnosis; Coverage limit: LU Authorization Period: 1 year Reason for Use code 104 Patients with a CD4+ cell count less than 100/mm3 without an AIDS-defining diagnosis. Coverage limit: LU Authorization Period: 1 year
No interchangeable product listed in the Ontario extract
Mycobutin · DIN 02063786 Manufacturer: Pfizer Canada Inc.; listing date 1996-10-01 Health Canada: Marketed since 2005-02-16 · brand MYCOBUTIN · ATC J04AB04 RIFABUTIN · form Capsule · route Oral · ingredients RIFABUTIN 150 MG · company Atlantic nanofend group ltd. · schedule Prescription
Check this DIN again · Health Canada product record

Mycobutin: Formulary list price $6.3342/unit (unit not stated in source; not the patient's cost)

Ministry pays: $6.3342 per source unit.

Source explanation: The formulary price is what ODB pays; the cash price at the counter is set by the pharmacy.

Formulary data: Ontario extract of Aug 26, 2026 · Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=18081 · Verify on the e-Formulary ↗ (DIN 02063786)

Source record
DIN 02063786: Mycobutin Raw flags: sec12=Y, sec3=Y Item: 081600018; group id 56; item number 0114; lccId 00005; manufacturer id PFI Source form: Cap; strength: 150mg Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $6.3342; ministry $6.3342 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02063786 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=18081
Shortage status: not checked (no credentials)
Other drugs in the same formulary class (08:16 Antitubercular Agents) and how they are covered

Matched class: 08:16 Antitubercular Agents

Drug-class inventory only. Lists recorded Ontario formulary products, not every Canadian medication; does not recommend treatment. Covered without a code on the Ontario formulary: RIFAMPIN Some products covered without a code (check the product listing): ETHAMBUTOL HCL 08:16 Antitubercular Agents

RIFAMPIN

· 2 products · General benefit · strengths: 150mg, 300mg · Cap

ETHAMBUTOL HCL

· 4 products · Listed, not a benefit (2), General benefit (2) · strengths: 100mg, 400mg · Tab Source: formulary-ed43-front-matter.txt Part V; ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26; class 08:16
Full class listing Related classes: 08:08 Anthelmintics, 08:12 Antibiotics, 08:14 Antifungals, 08:18 Antivirals, 08:20 Plasmodicides (Antimalarials), 08:24 Sulfonamides, 08:30 Antiprotozoals, 08:32 Trichomonacides, 08:36 Urinary Anti-Infectives, 08:40 Miscellaneous Anti-Infectives Same formulary class, not same indication: class membership alone does not establish equivalent uses.
Other drugs whose Health Canada label lists a similar indication: disseminated mycobacterium avium complex
From Health Canada product monographs; label wording only, not a treatment recommendation. Matching is lexical and uses one held product label per generic; formulations and qualifying criteria may differ. No displayed matched alternative is a general benefit. AZITHROMYCIN · Listed, not a benefit (6), General benefit (21), Limited Use, codes 549 (1) Prevention of Disseminated Mycobacterium Avium Complex (MAC) Disease Azithromycinalone or in combination with rifabutin at its approved dose, is indicated for the prevention of disseminated Mycobacterium avium complex (MAC) disease in persons with advanced HIV infections (MAC) disease in persons with advanced HIV infections (see 14 Clinical Trials). PM: https://pdf.hres.ca/dpd_pm/00085669.PDF; date AUG 7, 2026; DIN 02261634; fetched 2026-09-10 Product monograph Coverage source: ON formulary extract 2026-08-26
What the Health Canada label says it is for
1. INDICATIONS MYCOBUTIN (rifabutin) is indicated for: • the prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection (CD4+ cell count 200/mm3 with an AIDS defining diagnosis, or CD4+ cell count  100/mm3 without an AIDS defining diagnosis). To reduce the development of drug-resistant bacteria and maintain the effectiveness of MYCOBUTIN and other antibacterial drugs, MYCOBUTIN should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. 1.1 Pediatrics Pediatrics (<18 years of age): Based on the data submitted and reviewed by Health Canada, the safety and efficacy of MYCOBUTIN in pediatric patients has not been established; therefore, Health Canada has not authorized an indication for pediatric use. See 7.1.3 Pediatrics. 1.2 Geriatrics Geriatrics (≥65 years of age): No data are available to Health C… https://pdf.hres.ca/dpd_pm/00073866.PDF PM date: SEPT 24, 2003 Source product: MYCOBUTIN; DIN 02063786; fetched 2026-09-10 Product monograph posted by Health Canada; excerpt for lookup only.