Krystexxa (pegloticase)

Krystexxa (pegloticase) is covered for adult chronic gout refractory to conventional therapy (requiring ≥1 tophus or ≥2 flares/year) and is expressly not to be used in combination with other urate‑lowering drugs (e.g., allopurinol, febuxostat, probenecid). Coverage requires documentation of failed or contraindicated 3‑month trials of a xanthine oxidase inhibitor and a uricosuric (or justified intolerance/renal insufficiency), concomitant use with methotrexate/leflunomide/azathioprine, prescribing by or consultation with a rheumatologist/nephrologist, serum uric acid >6 mg/dL after prior trials (and <6 mg/dL to renew), with initial approval 6 months and renewals 12 months (recommended dose 8 mg IV q2 weeks).

"Indication limited to adult patients (FDA-approved indication: adult patients)."

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