Pluvicto (lutetium Lu 177 vipivotide tetraxetan) (New)

Immediately: Billing and clinical teams must establish prior authorization workflow for Pluvicto administration in Louisiana Medicaid patients. 1) Contact Humana at the number listed in the policy to obtain prior authorization requirements, submission procedures, and approval timelines. 2) Update billing software and EMR to flag all Pluvicto claims for Louisiana Medicaid requiring prior auth submission before treatment. 3) Educate oncology providers and nuclear medicine staff that prior authorization must be obtained before patient scheduling. 4) Implement prior auth documentation requirements in treatment planning. Failure to obtain prior authorization will result in claim denials for Louisiana Medicaid members.