Fair Square Medicare Wordmark

Does Medicare Cover Krystexxa?

The feet of a man suffering from foot pain stock photo

By Daniel Petkevich

Nov 18, 2022

Yes, but how it's covered could save you money

For many Medicare beneficiaries looking for chronic gout treatment, Krystexxa (Pegloticase) can be a critical medication. If you have tried other forms of treatment for your gout with little success, Krystexxa can be a path to a more pain-free life. Krystexxa might be covered by Medicare Part D, and it will be covered by Medicare Part B. But which option saves you more money out-of-pocket? Let's dig deeper.

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

What is Krystexxa?

Krystexxa (Pegloticase) is an FDA-approved treatment for chronic gouty arthritis. It works by breaking down uric acid in the bloodstream, which can reduce inflammation and pain associated with gout. Krystexxa comes in a powder form that is dissolved in water and injected into muscles or under the skin. Other forms of treatment for gout include diet and lifestyle changes, medications such as allopurinol or colchicine, and joint injections of anesthetic or steroid medications. If these other options do not work for you, Krystexxa might be able to help.

Does Medicare Cover Krystexxa?

Medicare Part B covers the cost of many drug therapies, including the cost of Krystexxa. If you have a Part D prescription drug plan, your plan might cover a portion or all of the cost for drugs like Krystexxa, depending on what is in your plan's formulary.

How to get Medicare to cover Krystexxa

Medicare Part B covers the cost of Krystexxa, but you must meet certain criteria to be eligible for coverage. You must have a doctor's prescription for the drug and your doctor must specify that it is medically necessary, as well as provide documentation supporting their medical opinion. Your doctor also needs to certify that you tried other treatments.

If you're getting coverage for your Krystexxa on Part B, you might be responsible for 20% of the cost that Medicare does not cover. If you have a Medicare Supplement plan, that could cover some or all of that 20%. The average cost of could run as high as $60,000 per year, so that 20% could be as much as $12,000.

Medicare Part D might also cover a portion or all of the cost for drugs like Krystexxa. Contact your insurance plan provider to find out and ask if they cover Krystexxa in their formulary.

What are the side effects of Krystexxa?

Krystexxa can cause side effects, including nausea, vomiting, abdominal pain and heartburn. Other possible side effects include anemia, elevated blood pressure, low white blood cell counts and allergic reactions such as itching or hives. It's important to talk to your doctor about any potential risks before starting treatment with Krystexxa.

How to find a doctor who can prescribe Krystexxa

It is important to find a doctor who understands how to use Krystexxa properly and will monitor your progress while you are using it. Ask your primary care provider if they know of any doctors in your area who specialize in gout treatment. You can also search online for physicians who specialize in gout treatment or contact the drug's manufacturer, Savient Pharmaceuticals, to find a doctor near you.

Tips for living with gout

Living with gout can be difficult, but there are some things you can do to make it easier. Eating a healthy diet and exercising regularly can help reduce inflammation and pain associated with gout attacks. Drinking plenty of water helps flush through the uric acid crystals in your system that causes the pain. Avoiding or reducing processed foods, high-purine foods, and alcohol can help reduce the frequency of gout attacks. Lastly, talk to your doctor about other forms of treatment that might be more suitable for you.

Takeaway

In conclusion, Krystexxa (Pegloticase) is an important treatment option for those with chronic gouty arthritis who have not had success with other forms of treatment. Medicare Part B and Part D might cover some or all of the cost of your prescription. You should check in with your doctor to see if Krystexxa is right for you and your plan provider to see how you can receive coverage through Medicare. This content is for informational purposes only. If you have additional questions about your Medicare plan, call one of our experts today at 1-888-376-2028.


Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

Recommended Articles

Cover image

2025 Medicare Price Changes

Oct 30, 2023

Sleep apena stock image

Does Medicare Cover Inspire for Sleep Apnea?

Dec 27, 2022

Cover image

Is Fair Square Medicare Legitimate?

Jul 27, 2023

Cover image

Does Your Plan Include A Free Gym Membership?

Jul 12, 2023

plastic surgeons standing over a patient stock image

Does Medicare Cover Cosmetic Surgery?

Nov 28, 2022

The feet of a man suffering from foot pain stock photo

Does Medicare Cover Krystexxa?

Nov 18, 2022

senior man pondering "which medigap plan should i choose" stock photo

Comparing All Medigap Plans | Chart Updated for 2025

Aug 1, 2022

20 Q's with Fair Square

20 Questions to Ask Your Medicare Agent

Mar 17, 2023

Cover image

What People Don't Realize About Medicare

Mar 27, 2023

Senior couple working at a computer stock image

Do I Need Medicare If My Spouse Has Insurance?

Dec 19, 2022

woman sitting on sofa feeling pain in her foot at home stock photo

Does Medicare Cover Qutenza?

Jan 13, 2023

senior man receiving dental care stock photo

Will Medicare Cover Dental Implants?

Jun 2, 2022

Myelofibrosis stock image

Does Medicare Cover Jakafi?

Dec 12, 2022

Senior person holding tissue roll near a toilet bowl, using walker to walk to the bathroom stock photo

Does Medicare Cover Oxybutynin?

Dec 2, 2022

Cover image

What is Plan J?

Jul 14, 2025

senior man on a phone call stock image

What is a Medicare Beneficiary Ombudsman?

Apr 11, 2023

senior african american man feeling pain in his knees from arthritis while on a couch stock photo

How Much Does Xeljanz Cost with Medicare?

Jan 25, 2023

Person receiving a vaccine stock photo

Is the Shingles Vaccine Covered by Medicare?

Nov 17, 2022

More of our articles

Can I Choose Marketplace Coverage Instead of Medicare?

Can I Have Two Primary Care Physicians?

Can I Laminate My Medicare Card?

Can I switch From Medicare Advantage to Medigap?

Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?

Can Medicare Help with the Cost of Tyrvaya?

Do All Hospitals Accept Medicare Advantage Plans?

Do I Need to Renew My Medicare?

Do You Need Books on Medicare?

Does Medicare Cover a Spinal Cord Stimulator?

Does Medicare Cover Bladder Sling Surgery?

Does Medicare Cover Cataract Surgery?

Does Medicare Cover Chiropractic Visits?

Does Medicare Cover Cold Laser Therapy (CLT)?

Does Medicare Cover Compounded Medications?

Does Medicare Cover COVID Tests?

Does Medicare cover Deviated Septum Surgery?

Does Medicare Cover Driving Evaluations?

Does Medicare Cover Exercise Physiology?

Does Medicare Cover Fosamax?

Does Medicare Cover Geri Chairs?

Does Medicare Cover Home Heart Monitors?

Does Medicare Cover Inqovi?

Does Medicare Cover Iovera Treatment?

Does Medicare Cover Ketamine Infusion for Depression?

Does Medicare Cover Mental Health?

Does Medicare Cover Ofev?

Does Medicare Cover Physicals & Blood Work?

Does Medicare Cover Robotic Surgery?

Does Medicare Cover RSV Vaccines?

Does Medicare Cover TENS Units?

Does Medicare Cover Tymlos?

Does Medicare Cover Wart Removal?

Does Medicare Cover Xiafaxan?

Does Medicare Cover Zilretta?

Does Medicare Have Limitations on Hospital Stays?

Does Medicare Pay for Funeral Expenses?

Does Medicare pay for Opdivo?

Does Medicare Pay for Varicose Vein Treatment?

Does Retiring at Age 62 Make Me Eligible for Medicare?

Does Your Medicare Plan Cover B12 Shots?

Explaining the Different Enrollment Periods for Medicare

Finding the Best Vision Plans for Seniors

Health Savings Accounts (HSAs) and Medicare

How Do I Sign up for Medicare? A Simple How-To Guide For You

How Does Medicare Pay for Emergency Room Visits?

How Much Does Medicare Part A Cost in 2025?

How Much Does Medicare Part B Cost in 2025?

How Much Does Rexulti Cost with Medicare?

How to Apply for Medicare?

How to Become a Medicare Agent

How to Choose a Medigap Plan

How Your Employer Insurance and Medicare Work Together

Is Balloon Sinuplasty Covered by Medicare?

Is Botox Covered by Medicare?

Medicare 101

Medigap Plan N vs. Plan G — Which One Fits You in 2025?

Medigap vs. Medicare Advantage

Saving Money with Alternative Pharmacies & Discount Programs

Should You Work With A Remote Medicare Agent?

The Easiest Call You'll Ever Make

The Fair Square Bulletin: October 2023

Top 10 Physical Therapy Clinics in San Diego

What Are Medicare Part B Excess Charges?

What If I Don't Like My Plan?

What Is a Medicare Advantage POS Plan?

What Is the Medicare Birthday Rule in Nevada?

What's the Deal with Flex Cards?

When Can You Change Medicare Supplement Plans?

When to Choose Medicare Advantage over Medicare Supplement

Why You Should Keep Your Medigap Plan

Will Medicare Cover it?

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.

Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2025

Terms of Use
Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M

Fair Square Medicare

FSM symbol - 50