Limited coverage drugs – indacaterol-glycopyrronium-mometasone furoate

Last updated on August 27, 2024

Generic name

indacaterol-glycopyrronium-mometasone furoate

Strength

150 mcg indacaterol - 50 mcg glycopyrronium - 160 mcg mometasone furoate

Form

powder hard capsules for inhalation

Special Authority criteria

Approval period

Diagnosis of asthma

AND

Inadequate response with a maintenance combination of an optimal dose of a long-acting beta-2 agonist (LABA) AND a moderate to high dose of an inhaled corticosteroid

AND

Have experienced one or more asthma exacerbations in the previous 12 months1

Indefinite

Practitioner exemptions

  • Respirologists and allergists are invited to apply for individual specialist exemption from completing the SA form. A Collaborative Prescribing Agreement is available for respirologists and allergists practicing in B.C. by invitation only.

Special notes

  1. Clinically significant asthma exacerbation is defined as worsening of asthma symptoms, requiring administration of systemic corticosteroids (i.e., intravenous steroids or oral corticosteroids for at least 3 days), and/or an emergency department visit, and/or hospitalization.

Special Authority request form