Pegloticase (Krystexxa)

Pegloticase (Krystexxa) is covered for FDA‑approved chronic gout in adults refractory to conventional therapy and for compendial off‑label uses (nephrolithiasis, gouty nephropathy) when prescribed by or in consultation with a rheumatologist or nephrologist; non‑compendial indications and pediatric use are not covered. Coverage requires documentation of prior adequate trials (typically ≥3 months) of specified urate‑lowering agents (e.g., allopurinol, febuxostat, or a uricosuric) with serum uric acid >6 mg/dL or documented contraindication/intolerance to allopurinol, documentation of current gout symptoms for chronic gout, baseline and follow‑up serum uric acid values, dosing per guidance (8 mg IV every 2 weeks), initial approval limited to 6 months (12‑month renewals), and reauthorization requires on‑treatment serum uric acid <6 mg/dL.

"Alternatively, documentation of a contraindication or intolerance to a trial of allopurinol for chronic gout."