Mulpleta

Generic: lusutrombopag

3MG — Tablet

Also known as: MULPLETA TABS 3MG

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 5 - Non-Preferred Specialty	—	—	✓	QL
BCBS Federal Standard Option 2026	Tier 5 - Non-Preferred Specialty	—	—	✓	QL

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026	Tier 5 - Specialty	✓	—	✓	PA \| QL
BCBSNC Blue Value 2026	Tier 5 - Specialty	✓	—	✓	PA \| QL
BCBSNC Blue Advantage 2026	Tier 5 - Specialty	✓	—	✓	PA \| QL
BCBSNC Blue Care 2026	Tier 5 - Specialty	✓	—	✓	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 5 - Specialty	✓	—	✓	PA \| QL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL