Krystexxa® (Pegloticase) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Krystexxa for adults with chronic, symptomatic gout refractory to conventional therapy (e.g., ≥2 flares/year, ≥1 tophus, or chronic gouty arthropathy) and excludes use for asymptomatic hyperuricemia. Coverage requires baseline sUA >6 mg/dL, documented failure/intolerance of BOTH allopurinol and febuxostat after ≥3 months at maximally appropriate doses, prescriber must be a Rheumatologist or Nephrologist, FDA‑label dosing with pre‑infusion sUA monitoring and discontinuation if pre‑infusion sUA >6 mg/dL, demonstration of clinical response for reauthorization, submission of labs/prior‑therapy documentation, and approvals are limited to ≤12 months.

"Symptomatic gout with at least 1 gouty tophus."

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