Ultibro Breezhaler · DIN 02418282 · 110mcg & 50mcg · Inh Pd-capsule
Limited Use — Reason for Use code 459 requiredMarketed · checked 2026-09-02
StatusLimited Use — Reason for Use code 459 required
Write on scriptLU code 459 (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 459
Reason for Use code 459
For the long-term treatment of patients with moderate to severe chronic obstructive pulmonary disease (COPD-see notes below) who 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 tables 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
Ultibro Breezhaler · DIN 02418282
Manufacturer: Novartis Pharma Canada Inc.; listing date 2015-05-28
Health Canada: Marketed since 2014-03-05 · brand ULTIBRO BREEZHALER · ATC R03AL04 INDACATEROL AND GLYCOPYRRONIUM BROMIDE, R03AL04 INDACATEROL AND GLYCOPYRRONIUM BROMIDE · form Capsule · route Inhalation · ingredients GLYCOPYRRONIUM (GLYCOPYRRONIUM BROMIDE) 50 MCG, INDACATEROL (INDACATEROL MALEATE) 110 MCG · company Novartis pharmaceuticals canada inc · schedule Prescription
Ultibro Breezhaler: Formulary list price $2.5830/unit (unit not stated in source; not the patient's cost)
Ministry pays: $2.5830 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=90285 · Verify on the e-Formulary ↗ (DIN 02418282)
Source record
DIN 02418282: Ultibro Breezhaler
Raw flags: sec12=Y, sec3=Y
Item: 121200108; group id 229; item number 0408; lccId 00252; manufacturer id NOV
Source form: Inh Pd-Cap; strength: 110mcg & 50mcg
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $2.5830; ministry $2.5830
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02418282
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=90285
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=02418282
Shortage record checked 2026-09-13T08:10:21.292534+00:00