Pegloticase (Krystexxa)

Pegloticase (Krystexxa) is covered for adults with chronic gout refractory to conventional therapy and for compendial uses (nephrolithiasis, gouty nephropathy) when prescribed or consulted by a rheumatologist/nephrologist; patients without required prior trials, documented current gout symptoms (for chronic gout), or pediatric patients are excluded. Key requirements: initial approval needs documentation of current gout symptoms (for gout) and a ≥3‑month trial with allopurinol, febuxostat (Uloric), or a uricosuric (or documented intolerance/contraindication), initial approval is 6 months (renewal 12 months), reauthorization requires serum uric acid <6 mg/dL on therapy, dosing is 8 mg IV every 2 weeks, and full documentation of trials, dates, provider specialty, and lab values is required.

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