Drug Coverage Lookup

See how a prescription drug is placed across Medicare Part D plan formularies — tier, prior authorization, step therapy, and quantity limits, counted per unique plan.

Mulpleta (Lusutrombopag)

On Part D plan formularies — with restrictions

Found on the formularies of 172 of 5499 Medicare Part D plans in this dataset · Tier 5 · prior authorization on 172 plans (100%) · quantity limits on 74 (43%), counting a plan when at least one form/strength carries the flag.

This is dataset-wide formulary placement (data current through 2026-08-31) — check your specific plan for its current coverage and restrictions.

Found on the formularies of 172 of 5499 Medicare Part D plans in this dataset, but prior authorization appears on 172 of those 172 plans (for at least one form/strength). Check your specific plan for its current rules, and learn what your prescriber needs to submit.

How prior authorization works →

Plan	Tier	Prior Auth	Step Therapy	Qty Limit
Select Health Medicare Essential (HMO) (H1994-001) (UT)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Essential (HMO) (H1994-012) (NV)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Dual (HMO D-SNP) (H1994-015) (UT)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Essential (HMO) (H1994-017) (UT)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare + Kroger (HMO) (H1994-021) (NV)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare + Kroger (HMO) (H1994-022) (UT)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Essential (HMO) (H1994-027) (CO)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Essential (HMO) (H1994-029) (CO)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare + Kroger (HMO) (H1994-030) (CO)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Flex (HMO) (H1994-031) (CO)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare + Kroger (HMO) (H1994-034) (CO)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Active (HMO) (H1994-035) (CO)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Dual (HMO D-SNP) (H1994-040) (NV)	Tier 5	Yes	No	7 per 30 days
Select Health Medicare Wellness (HMO) (H1994-044) (NV)	Tier 5	Yes	No	7 per 30 days
Community Blue Medicare HMO Signature (HMO) (H3384-069) (segment 1) (NY)	Tier 5	Yes	No	None
Community Blue Medicare HMO Signature (HMO) (H3384-069) (segment 2) (NY)	Tier 5	Yes	No	None
Community Blue Medicare HMO Signature (HMO) (H3384-069) (segment 3) (NY)	Tier 5	Yes	No	None
Community Blue Medicare HMO Merit (HMO) (H3384-071) (NY)	Tier 5	Yes	No	None
UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 1) (PA)	Tier 5	Yes	No	7 per 30 days
UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 2) (PA)	Tier 5	Yes	No	7 per 30 days
UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 3) (PA)	Tier 5	Yes	No	7 per 30 days
UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 4) (PA)	Tier 5	Yes	No	7 per 30 days
UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 5) (PA)	Tier 5	Yes	No	7 per 30 days
Community Blue Medicare PPO Signature (PPO) (H3916-037) (segment 2) (PA)	Tier 5	Yes	No	None
Community Blue Medicare PPO Signature (PPO) (H3916-037) (segment 4) (PA)	Tier 5	Yes	No	None

One row per plan — showing 25 of 172 plans; a Yes means the flag applies to at least one form/strength on that plan.

For benefits professionals

Plan sponsors and advisors: formulary-placement and utilization analysis across plans.

For benefits teams: plan formulary analysis →

Source: CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — data current through 2026-08-31 (CMS release 2026-08-26, refreshed monthly). Dataset-wide plan-year formulary placement, not a guarantee of your individual benefit — confirm with your plan or pharmacist.

Data: CMS Monthly Part D formulary files · FDA/RxNorm drug identity · CMS NADAC pricing — CMS Part D formulary data current through 2026-08-31 · source

Machine access — this tool is available as structured data for AI assistants and agents:
GET https://insurewith.ai/tools/drug-coverage/data.json?drug=lusutrombopag