Pegloticase (Krystexxa)

Covered for adults with chronic gout refractory to conventional therapy (FDA‑approved) and for compendial uses of nephrolithiasis and gouty nephropathy; not covered if the diagnosis/required criteria are absent or for pediatric patients. Key requirements: prescribing/consultation by a rheumatologist or nephrologist, documented prior therapy failures (chronic gout: 3‑month trials of ≥2 listed agents or contraindication/intolerance to both allopurinol and febuxostat; nephrolithiasis/gouty nephropathy: 3‑month trial of allopurinol or febuxostat or contraindication/intolerance to both), evidence of inadequate response (serum uric acid >6 mg/dL) for initial approval, reauthorization requires serum uric acid <6 mg/dL and continuation to maintain response, initial approval ≤6 months and renewals ≤12 months (dosing expected 8 mg IV every 2 weeks).

"Initial authorization for chronic gout requires current symptoms of gout (e."