Dysport Therapeutic · DIN 02460203 · 300U/Vial · Pd injection-vial
Limited Use — Reason for Use code 130, 412, 413 requiredMarketed · checked 2026-09-20
StatusLimited Use — Reason for Use code 130, 412, 413 required
Write on scriptLU code 130, 412, 413 (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 130, 412, 413
Coverage limit:
Dysport Therapeutic should be administered personally by a neurologist, pediatrician, or a physician with equivalent post-graduate training and experience with neuromuscular disorders.
Reason for Use code 130
To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults.
Coverage limit:
LU Authorization Period: 1 year
Reason for Use code 412
For the management of focal spasticity, due to stroke or spinal cord injury in adults.
Coverage limit:
LU Authorization Period: 1 year
Reason for Use code 413
For the treatment of focal spasticity secondary to cerebral palsy in patients two years of age or older.
Coverage limit:
LU Authorization Period: 1 year
No interchangeable product listed in the Ontario extract
Dysport Therapeutic · DIN 02460203
Manufacturer: Ipsen Limited; listing date 2018-09-27
Health Canada: Marketed since 2022-04-06 · brand DYSPORT THERAPEUTIC · ATC M03AX01 BOTULINUM TOXIN · form Powder for solution · route Intramuscular · ingredients ABOBOTULINUMTOXINA 300 UNIT/VIAL · company Ipsen biopharmaceuticals canada inc · schedule Prescription, Schedule d
Dysport Therapeutic: Formulary list price $385.5600/unit (unit not stated in source; not the patient's cost)
Ministry pays: $385.5600 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=94749 · Verify on the e-Formulary ↗ (DIN 02460203)
Source record
DIN 02460203: Dysport Therapeutic
Raw flags: sec12=Y, sec3=Y
Item: 929200001; group id 1047; item number 2401; lccId 00308; manufacturer id IPS
Source form: Pd Inj-Vial Pk; strength: 300U/Vial
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $385.5600; ministry $385.5600
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02460203
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=94749
Shortage status: not checked (no credentials)