The FDA has only authorized six infusions of Pluvicto for the United States. Other countries permit additional rounds. And some few oncologists in the US are giving another round of six under a rubric that is unclear; maybe a clinical trial or some emergency authorization they can get? The Kwon team at Mayo Rochester just told us they are not giving more than one round of six. As for Medicare or private insurance, I have no idea how the extra round is paid for.

Haven't gotten to the question yet of if it is advisable to start on a second round of Pluvicto what the insurance situation is.

Here is my personal situation. I was a clinical trial patient for Norvartis Pharmaceutical in 2021-22 for what became Pluvicto. No insurance was involved. 2 years later, the prostate cancer has returned and I am going through the same 6 Pluvicto treatments again, but this time Medicare and my private insurance in paying. My oncology group worked with and obtained approval from the insurance providers.
So, I'm assuming insurance would NOT pay for the treatments twice (6+6=12). I have heard of, but do not know of anyone personally, except myself repeating the treatments.
Six teatments are about $300,000 plus peripheral costs of maybe $25,000-50,000.