Limited coverage drugs – aclidinium

Last updated on May 1, 2024

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Generic name	aclidinium
Strength & form	400 mcg dry powder for oral inhalation

Special Authority criteria	Approval period
Diagnosis of chronic obstructive pulmonary disease (COPD) AND Failure after a minimum one-month trial of each of the Regular Benefit long-acting muscarinic receptor antagonist (LAMA) products¹	Indefinite

Special Authority criteria

Approval period

Diagnosis of chronic obstructive pulmonary disease (COPD)

AND

Failure after a minimum one-month trial of each of the Regular Benefit long-acting muscarinic receptor antagonist (LAMA) products¹

Indefinite

Practitioner exemptions

None

Special notes

¹The Regular Benefit LAMA products are the following:
- Tiotropium (Spiriva^® Respimat^®)
- Umeclidinium (Incruse^® Ellipta^®)

Special Authority request form(s)

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HLTH 5362 – COPD form (PDF, 100KB)

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