Breo Ellipta · DIN 02408872 · 100mcg & 25mcg · Blister dry-powder inhaler, 30 doses
Limited Use — Reason for Use code 330, 456 requiredMarketed · checked 2026-09-19
StatusLimited Use — Reason for Use code 330, 456 required
Write on scriptLU code 330, 456 (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 330, 456
Reason for Use code 330
For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 456
For the long-term treatment of patients with moderate to severe chronic obstructive pulmonary disease (COPD-see notes below) who have a history of exacerbations and have had an inadequate response to a long-acting bronchodilator (i.e., long-acting beta-2 agonist (LABA), or long-acting muscarinic antagonist (LAMA)).
Coverage limit:
LU Authorization Period: Indefinite
Coverage limit:
COPD disease severity is based on spirometry, symptoms and disability (see classification below).
Classification
COPD Stages - Symptoms and disability:
Mild: Shortness of breath from COPD when hurrying on the level or walking up a slight hill
Moderate: Shortness of breath from COPD causing the patient to stop after walking approximately 100m (or after a few minutes) on the level
Severe: Shortness of breath from COPD resulting in the patient being too breathless to leave the house, breathless when dressing or undressing (MRC 5), or the presence of chronic respiratory failure or clinical signs of right heart failure
Classification by impairment of lung function:
COPD stage and spirometry (post bronchodilator) FEV1 predicted:
Mild: Greater than or equal to 80 percent
Moderate: 50 to 79 percent
Severe: 30 to 49 percent
Very severe: Less than 30 percent
No interchangeable product listed in the Ontario extract
Breo Ellipta · DIN 02408872
Manufacturer: GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care; listing date 2015-03-31
Health Canada: Marketed since 2013-11-29 · brand BREO ELLIPTA · ATC R03AK10 VILANTEROL AND FLUTICASONE FUROATE · form Powder · route Inhalation · ingredients FLUTICASONE FUROATE 100 MCG/ACT, VILANTEROL (VILANTEROL TRIFENATATE) 25 MCG/ACT · company Glaxosmithkline inc · schedule Prescription
Breo Ellipta: Formulary list price $112.6000/unit (unit not stated in source; not the patient's cost)
Ministry pays: $112.6000 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=89362 · Verify on the e-Formulary ↗ (DIN 02408872)
Source record
DIN 02408872: Breo Ellipta
Raw flags: sec12=Y, sec3=Y
Item: 121200107; group id 224; item number 0402; lccId 00249; manufacturer id GSK
Source form: Blister Pd Inh-30 Dose Pk; strength: 100mcg & 25mcg
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $112.6000; ministry $112.6000
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02408872
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=89362
Shortage status: not checked (no credentials)