lusutrombopag 3 MG Oral Tablet [Mulpleta]
lusutrombopag
RxCUI: 2054995
What the CMS Formulary Data Shows for lusutrombopag 3 MG Oral Tablet [Mulpleta]
Per the CMS 2026 Part D formulary file, lusutrombopag 3 MG Oral Tablet [Mulpleta] (RxNorm concept RXCUI 2054995, generic name lusutrombopag) appears on 12 distinct formulary files spanning 109 Medicare Part D plan offerings - 2.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 5 to Tier 5, with a cross-plan average of Tier 5.
Real-world access to lusutrombopag 3 MG Oral Tablet [Mulpleta] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 75% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 28 Part D beneficiaries filled lusutrombopag 3 MG Oral Tablet [Mulpleta] in 2023, with total plan-and-beneficiary spending of $277,673 and an average per-beneficiary annual cost of $9,916.91. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry lusutrombopag 3 MG Oral Tablet [Mulpleta] today.
Coverage Details
- Formularies covering
- 12
- Plans covering
- 109
- Coverage rate
- 2.2%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 75% of formularies
2023 Medicare Spending
- Beneficiaries
- 28
- Total spending
- $277,673
- Avg per beneficiary
- $9,916.91
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering lusutrombopag 3 MG Oral Tablet [Mulpleta]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T5 | Yes | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Security Blue HMO-POS ValueRx (HMO-POS) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Together Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Community Blue Medicare HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Complete Blue HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T5 | Yes | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T5 | Yes | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK BCBSD INC. | T5 | Yes | $0 | DE |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| UPMC for Life HMO Premier Rx (HMO) | UPMC HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC HEALTH COVERAGE, INC. | T5 | Yes | $0 | PA |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T5 | Yes | $0 | MS |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST | T5 | Yes | $0 | NV |
Frequently Asked Questions
Is lusutrombopag 3 MG Oral Tablet [Mulpleta] covered by Medicare Part D?
Yes, lusutrombopag 3 MG Oral Tablet [Mulpleta] is covered by 109 Medicare Part D plans (2.2% of all Part D formularies).
What tier is lusutrombopag 3 MG Oral Tablet [Mulpleta] on Medicare Part D plans?
lusutrombopag 3 MG Oral Tablet [Mulpleta] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does lusutrombopag 3 MG Oral Tablet [Mulpleta] require prior authorization?
100% of Part D formularies require prior authorization for lusutrombopag 3 MG Oral Tablet [Mulpleta]. Step therapy: 0%. Quantity limits: 75%.
How much does Medicare spend on lusutrombopag 3 MG Oral Tablet [Mulpleta]?
In 2023, total Medicare Part D spending on lusutrombopag 3 MG Oral Tablet [Mulpleta] was $277,673, covering 28 beneficiaries. The average spend per beneficiary was $9,916.91.
Read our methodology - how this data is sourced, computed, and verified.