Medicare AdvantagePrior AuthMedium impact
Mulpleta® (lusutrombopag) (Revised)
Humana·Hematology, Gastroenterology, Internal Medicine +1 more·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana updated its Mulpleta® (lusutrombopag) prior authorization policy for Medicare Advantage members on April 22, 2026. The policy requires prior authorization for this thrombocytopenia treatment in chronic liver disease patients scheduled for procedures. All three approval criteria must be met: chronic liver disease diagnosis, scheduled procedure requiring platelet transfusion, and initiation 8-14 days before the procedure. Initial and renewal approvals are granted for 3-month periods.
Action Required
By April 22, 2026: Billing and prior authorization teams must implement the following: (1) Update billing system to flag any Mulpleta® claims for Medicare Advantage members and route automatically to prior authorization queue; (2) Create a checklist in the EMR or PA submission form requiring documentation of: chronic liver disease diagnosis, scheduled procedure date, platelet count results (obtained within 2 days of procedure), and confirmation that dosing will begin 8-14 days prior to procedure; (3) Brief providers and clinical staff that Mulpleta® will NOT be approved for off-label use to normalize platelet counts in non-procedural settings; (4) Train front desk and scheduling staff to alert providers when a Medicare Advantage member with CLD is scheduled for an invasive procedure so PA can be submitted with adequate lead time (at least 15 days before procedure date to allow 8-14 day pre-procedure window); (5) Verify current policy status before submission at www.humana.com/PAL for any applicable medical/procedural codes. Claims submitted without required prior authorization will be denied.