Limited Coverage Drugs - Umeclidinium

Generic Name


Umeclidinium 62.5 mcg

Form dry powder for oral inhalation via inhaler
Special Authority Criteria Approval Period

Diagnosis of Chronic Obstructive Pulmonary Disease (COPD), where spirometry measures are:

  • Forced expiratory volume in 1 second (FEV1) as a percentage of predicted value (less than or equal to 65%)
  • Ratio of actual FEV1/forced vital capacity (FVC) (less than 0.7)
  • Inadequate response after a 3 month trial of either:
    • ipratropium at a dose of 12 puffs daily
    • ipratropium and salbutamol combination inhaler (Combivent Respimat) at a dose of 6 puffs daily1


  1. 12 puffs of ipratropium via inhaler is equivalent to 6 puffs of ipratropium via Combivent Respimat inhaler.

Practitioner Exemptions

  • Practitioners in the following specialty are not required to submit a Special Authority request form for coverage: Respirology.

Special Notes

  • In remote areas, where spirometry access is limited, spirometry measurements are to be provided within 6 months.
  • Patients who meet the Special Authority criteria for aclidinium/glycopyrronium/tiotropium will automatically receive coverage of umeclidinium.

Additional Information

  • None

Special Authority Request Form