Pegloticase (Krystexxa)

Krystexxa (pegloticase) is covered only for adult chronic gout refractory to conventional therapy and for the compendial indications nephrolithiasis and gouty nephropathy; use outside these indications is not supported. Coverage requires rheumatologist or nephrologist prescribing/consultation, documentation of prior 3‑month trials (or contraindication/intolerance) to specified urate‑lowering agents with serum uric acid (sUA) >6 mg/dL, baseline and serial sUA monitoring with reauthorization requiring sUA <6 mg/dL, recommended dosing 8 mg IV every 2 weeks, initial approval 6 months and renewals 12 months.

"Approved Off-label Compendial Use: Gouty nephropathy"

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