Krystexxa® (pegloticase)

Krystexxa (pegloticase) is covered for adults with chronic gout refractory to conventional therapy and is not allowed to be used concomitantly with oral urate‑lowering drugs. Coverage requires documentation of ≥1 tophus or ≥2 flares/year, serum uric acid >6 mg/dL after a 3‑month xanthine oxidase inhibitor trial (or intolerance/contraindication) and a 3‑month uricosuric trial (unless renal insufficiency), concomitant use of an immunomodulator (methotrexate, leflunomide, azathioprine, or mycophenolate), prescription/consult by a rheumatologist or nephrologist, initial approval for 6 months (renewal 12 months) with reauthorization requiring SUA <6 mg/dL and continued immunomodulator use; recommended dose 8 mg IV every 2 weeks.

"Krystexxa is indicated for the treatment of chronic gout in adult patients refractory to conventional therapy."

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