Pegloticase (Krystexxa)

Covered: Pegloticase (Krystexxa) is covered for adults with chronic gout refractory to conventional therapy and for compendial off‑label uses (nephrolithiasis, gouty nephropathy); other uses are not supported. Key requirements: must be prescribed by or in consultation with a rheumatologist or nephrologist, initial approval (6 months) requires documented current gout symptoms and inadequate response after a 3‑month trial of allopurinol, febuxostat (Uloric), or a uricosuric (or documented contraindication/intolerance to allopurinol), reauthorization (12 months) requires serum uric acid <6 mg/dL, with recommended dosing 8 mg IV every 2 weeks.

"Approval duration (renewal): 12 months."

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