Topic

Krystexxa (pegloticase)

A collection of 16 issues

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide (2025)

Answer Box: Getting Krystexxa Approved by Aetna CVS Health in Ohio Fastest path to approval: Submit prior authorization with complete documentation showing failure of both allopurinol and febuxostat, normal G6PD test results, and rheumatologist prescription. Aetna typically decides within 72 hours of receiving complete documentation. If denied, you have 180

Renewing Krystexxa (Pegloticase) Coverage with Aetna CVS Health in North Carolina: 2025 Requirements and Timeline

Answer Box: Krystexxa Renewal Quick Guide Aetna CVS Health requires annual prior authorization renewal for Krystexxa (pegloticase) in North Carolina. Start renewal 2-4 weeks before expiration. Key requirements: serum uric acid levels below 6 mg/dL, documented clinical improvement, and rheumatologist prescribing. If denied, use North Carolina's Smart

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in Pennsylvania: Complete Coding, Appeals & Timeline Guide

Answer Box: Your Fastest Path to Krystexxa Coverage To get Krystexxa (pegloticase) covered by Aetna CVS Health in Pennsylvania: Submit a prior authorization with ICD-10 code M1A.*** (chronic gout), HCPCS J2507 (8 units per dose), documented failure of allopurinol and febuxostat, G6PD test results, and methotrexate co-therapy plan. If denied,

Renewing Krystexxa (Pegloticase) Coverage with Cigna in North Carolina: Complete Guide for 2025

Answer Box: Renewing Krystexxa Coverage with Cigna in North Carolina Cigna requires prior authorization renewal for Krystexxa (pegloticase) every 12 months with strict documentation of ongoing response. Start your renewal 2-4 weeks before expiration to avoid treatment gaps. Essential requirements: serum uric acid levels below 6 mg/dL before infusions,

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in Illinois: Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Krystexxa Covered by Aetna CVS Health in Illinois To get Krystexxa (pegloticase) covered by Aetna CVS Health in Illinois, you must first document failure of both allopurinol and febuxostat for at least 3 months each at maximum tolerated doses. Submit a prior authorization through CVS Specialty with

How Long Does It Take to Get Krystexxa (Pegloticase) Approved by UnitedHealthcare in Florida? Complete Timeline Guide

Answer Box: Getting Krystexxa Approved by UnitedHealthcare in Florida Standard timeline: 15 days for prior authorization decision, 7 days for appeals. UnitedHealthcare requires prior authorization for Krystexxa (pegloticase) through OptumRx, with strict requirements including G6PD testing, documented failure of standard gout medications, and rheumatology specialist prescribing. First step today: Have