Limited Coverage Drugs – fluticasone furoate in combination with umeclidinium and vilanterol

Generic Name

fluticasone furoate-umeclidinium-vilanterol

Strength

fluticasone furoate 100 mcg/umeclidinium 62.5 mcg/vilanterol 25 mcg

Form

dry powder for oral inhalation

Special Authority Criteria

Approval Period

Diagnosis of moderate to very severe1 chronic obstructive pulmonary disease (COPD) where spirometry measures are as follows:

  • A post-bronchodilator fixed ratio of forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) < 0.70

AND

  • A post-bronchodilator FEV1 < 80% predicted

AND

Who have a history of exacerbations as follows:

  • History of ≥ 2 moderate exacerbations defined as requiring a prescribed antibiotic and/or using systemic glucocorticoids in the previous 12 months

OR

  • History of ≥ 1 severe exacerbation defined as requiring a hospital admission or emergency department visit in the previous 12 months

AND

Inadequate response after a minimum 6-month trial of either

  • a combination of long-acting muscarinic receptor antagonist (LAMA) and long-acting beta agonist (LABA)

OR

  • a combination of inhaled corticosteroids (ICS) and LABA

Notes:

1Moderate to very severe COPD is defined as follows:

  • Moderate COPD is defined as 50% < FEV1 < 80% predicted
  • Severe COPD is defined as 30% < FEV1 < 50% predicted
  • Very severe COPD is defined as FEV1 < 30% predicted

Indefinite

Practitioner Exemptions

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

Special Notes

  • In remote areas, where spirometry access is limited, spirometry measurements are to be provided within 6 months.

Special Authority Request Form(s)