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FLUTICASONE FUROATE & UMECLIDINIUM BROMIDE & VILANTEROL TRIFENATATE

All products: Limited Use (codes 567)

Other products in the same Health Canada class (R03A, R03AL) — coverage varies; not interchangeable

  • Aclidinium + formoterol (Duaklir Genuair): limited Use 459
  • Budesonide + formoterol + glycopyrronium (Breztri Aerosphere): limited Use 638
  • Glycopyrronium + indacaterol (Ultibro Breezhaler): limited Use 459
  • Umeclidinium + vilanterol (Anoro Ellipta): limited Use 459
  • Salbutamol (Teva-Salbutamol Sterinebs P.F.): general benefit, Limited Use 256, 257, 258, 259, Limited Use 265, 266, 267, 268, Not a benefit
  • Terbutaline (Bricanyl Turbuhaler): general benefit

8 more in the class list below

Trelegy Ellipta · DIN 02474522 · 100mcg & 62.5mcg & 25mcg · dry-powder inhaler, 30 doses

Limited Use — Reason for Use code 567 requiredMarketed · checked 2026-09-19
StatusLimited Use — Reason for Use code 567 required
Write on scriptLU code 567 (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 567
Reason for Use code 567 For the long-term, once daily, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema and to reduce exacerbations of COPD in patients with a history of exacerbations in patients who require a combination of an inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and a long-acting beta2-adrenergic agonist (LABA). Coverage limit: LU Authorization Period: Indefinite
No interchangeable product listed in the Ontario extract
Trelegy Ellipta · DIN 02474522 Manufacturer: GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care; listing date 2019-09-30 Health Canada: Marketed since 2018-05-30 · brand TRELEGY ELLIPTA · ATC R03AL08 VILANTEROL, UMECLIDINIUM BROMIDE AND FLUTICASONE FUROATE · form Powder · route Inhalation · ingredients FLUTICASONE FUROATE 100 MCG/ACT, UMECLIDINIUM (UMECLIDINIUM BROMIDE) 62.5 MCG/ACT, VILANTEROL (VILANTEROL TRIFENATATE) 25 MCG/ACT · company Glaxosmithkline inc · schedule Prescription
Check this DIN again · Health Canada product record

Trelegy Ellipta: Formulary list price $137.6700/unit (unit not stated in source; not the patient's cost)

Ministry pays: $137.6700 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=96469 · Verify on the e-Formulary ↗ (DIN 02474522)

Source record
DIN 02474522: Trelegy Ellipta Raw flags: sec12=Y, sec3=Y Item: 121200114; group id 223; item number 0401; lccId 00321; manufacturer id GSK Source form: Pd Inh-30 Dose Pk; strength: 100mcg & 62.5mcg & 25mcg Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $137.6700; ministry $137.6700 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02474522 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=96469 Therapeutic Notes (formulary) Prescribers should be informed and stay current with a drug's official indications in accordance with Health Canada's approved product monograph.
Shortage status: not checked (no credentials)
Other drugs in the same formulary class (12:12 Sympathomimetic (Adrenergic) Agents) and how they are covered

Matched class: 12:12 Sympathomimetic (Adrenergic) 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: EPINEPHRINE HCL, TERBUTALINE SULFATE Some products covered without a code (check the product listing): ORCIPRENALINE SULFATE, SALBUTAMOL 12:12 Sympathomimetic (Adrenergic) Agents

ACLIDINIUM BROMIDE & FORMOTEROL FUMARATE DIHYDRATE

· 1 products · Limited Use, codes 459 · strengths: 400mcg & 12mcg · Metered Dose Pd Inh-60 Dose Pk

BUDESONIDE&GLYCOPYRRONIUM (GLYCOPYRRONIUM BROMIDE)&FORMOTEROL FUMARATE DIHYDRATE

· 1 products · Limited Use, codes 638 · strengths: 160mcg & 7.2mcg & 5mcg/Act · Metered Dose Inh-120 Dose Pk

INDACATEROL & GLYCOPYRRONIUM

· 1 products · Limited Use, codes 459 · strengths: 110mcg & 50mcg · Inh Pd-Cap

UMECLIDINIUM & VILANTEROL

· 1 products · Limited Use, codes 459 · strengths: 62.5mcg & 25mcg · Blister Pd Inh-30 Dose Pk

SALBUTAMOL

· 20 products · Limited Use, codes 265, 266, 267, 268 (4), Listed, not a benefit (8), Limited Use, codes 256, 257, 258, 259 (1), General benefit (7) · strengths: 1mg/mL, 2mg/mL, 5mg/mL, 100mcg/Metered Dose, 2mg, 4mg · Inh Sol- 2.5mL Pk, Inh Sol-10mL Pk, Inh-200 dose Pk, Tab

TERBUTALINE SULFATE

· 2 products · General benefit · strengths: 0.5mg/Dose · Inh-100 Dose Pk, Inh-120 Dose Pk

BUDESONIDE & FORMOTEROL FUMARATE DIHYDRATE

· 2 products · Limited Use, codes 330 · strengths: 100mcg/6mcg, 200mcg/6mcg · Pd Inh-120 Dose Pk

FLUTICASONE FUROATE & VILANTEROL

· 2 products · Limited Use, codes 330, 456 (1), Limited Use, codes 330 (1) · strengths: 100mcg & 25mcg, 200mcg & 25mcg · Blister Pd Inh-30 Dose Pk

FORMOTEROL FUMARATE

· 1 products · Limited Use, codes 132 · strengths: 12mcg/Cap · Inh Pd-Device Pk

FORMOTEROL FUMARATE DIHYDRATE

· 2 products · Limited Use, codes 132 · strengths: 6mcg/Metered Dose, 12mcg/Metered Dose · Pd Inh-60 Dose Pk

INDACATEROL

· 1 products · Limited Use, codes 443 · strengths: 75mcg · Inh Pd-Cap

MOMETASONE FUROATE & FORMOTEROL FUMARATE DIHYDRATE

· 2 products · Limited Use, codes 330 · strengths: 100mcg & 5mcg, 200mcg & 5mcg · Metered Dose Inh-120 Dose Pk Source: formulary-ed43-front-matter.txt Part V; ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26; class 12:12 and 4 more
Full class listing Related classes: 12:04 Parasympathomimetic (Cholinergic) Agents, 12:08 Parasympatholytic (Cholinergic Blocking) Agents, 12:20 Skeletal Muscle Relaxants Same formulary class, not same indication: class membership alone does not establish equivalent uses.
What the Health Canada label says it is for
1 INDICATIONS TRELEGY ELLIPTA (fluticasone furoate/umeclidinium/vilanterol) is a combination of an inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and a long-acting beta2-adrenergic agonist (LABA). COPD TRELEGY ELLIPTA 100/62.5/25 mcg is indicated in adult patients who are not adequately treated by a combination of an ICS/LABA or a combination of a LAMA/LABA: • for the long-term, once daily, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema (see 14 CLINICAL TRIALS). • to reduce exacerbations of COPD in patients with a history of exacerbations (see 14 CLINICAL TRIALS). TRELEGY ELLIPTA is not indicated for the relief of acute bronchospasm (see 7 WARNINGS AND PRECAUTIONS, General). Asthma TRELEGY ELLIPTA 100/62.5/25 mcg and 200/62.5/25 mcg are indicated for the long-term, once-daily, maintenance treatment of asthma in patients aged 18 years and older who are not adequately controlled with a maintenance combination of a medium or high dose of an ICS and a LABA (see 14 CLINICAL TRIALS). TRELEGY ELLIPTA is not indicated for … https://pdf.hres.ca/dpd_pm/00072451.PDF PM date: April 3, 2018 Source product: TRELEGY ELLIPTA; DIN 02474522; fetched 2026-09-10 Product monograph posted by Health Canada; excerpt for lookup only.