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.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Recommended Articles

The feet of a person suffering from foot pain stock photo
Does Medicare Cover Cartiva Implants?
Nov 29, 2022
Close up of a senior clutching their right wrist in pain stock photo
Does Medicare Cover Cala Trio?
Nov 23, 2022
Plastic surgeon handles a silicon implant
Does Medicare Cover Breast Implant Removal?
Jan 5, 2023
Pile of junk in a house, hoarder room pile of household equipment needs clearing out stock photo
Does Medicare Cover Hoarding Cleanup?
Jan 10, 2023
Senior woman receiving an ear exam stock photo
Does Medicare Require a Referral for Audiology Exams?
Nov 22, 2022
Cover image
The Easiest Call You'll Ever Make
Jun 28, 2023
Close up of a woman sitting on a bed experiencing back pain
Does Medicare Cover TENS Units?
Nov 23, 2022
Heart on Heart Rhythm Background Concept stock photo
Does Medicare Cover Cardiac Ablation?
Dec 9, 2022
Nashville city skyline stock image
14 Best Ways for Seniors to Stay Active in Nashville
Mar 10, 2023
Cover image
Can Medicare Advantage Plans be Used Out of State?
Jun 12, 2023
surgeons working over a patient stock image
Does Medicare Cover LVAD Surgery?
Nov 30, 2022
a chart explaining different enrollment periods on medicare
How Do I Sign up for Medicare? A Simple How-To Guide For You
Apr 8, 2022
Hepatitis C stock photo
Does Medicare Cover Hepatitis C Treatment?
Nov 22, 2022
Cover image
Medicare & Ozempic
Jul 20, 2023
Cover image
Fair Square Client Newsletter: AEP Edition
Oct 2, 2023
A women's restroom sign that has been modified to show the stick figure woman needing to use the toilet
Does Medicare Cover Bladder Sling Surgery?
Jan 11, 2023
SIBO (small intestinal bacterial overgrowth) symptoms stock photo
Does Medicare Cover SIBO Testing?
Dec 1, 2022
Seattle Public Market stock image
14 Best Ways for Seniors to Stay Active in Seattle
Mar 10, 2023

More of our articles

13 Best Ways for Seniors to Stay Active in Jacksonville

15 Best Ways for Seniors to Stay Active in Denver

Can Doctors Choose Not to Accept Medicare?

Can I Have Two Primary Care Physicians?

Can I Laminate My Medicare Card?

Can I Use Medicare Part D at Any Pharmacy?

Comparing All Medigap Plans | Chart Updated for 2025

Costco Pharmacy Partners with Fair Square

Do I Need Medicare If My Spouse Has Insurance?

Do You Need Books on Medicare?

Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?

Does Medicare Cover a Spinal Cord Stimulator?

Does Medicare Cover an FMT?

Does Medicare Cover Boniva?

Does Medicare Cover Cold Laser Therapy (CLT)?

Does Medicare Cover COVID Tests?

Does Medicare Cover Diabetic Eye Exams?

Does Medicare Cover Disposable Underwear?

Does Medicare Cover Fosamax?

Does Medicare cover Hyoscyamine?

Does Medicare Cover Incontinence Supplies?

Does Medicare Cover Iovera Treatment?

Does Medicare Cover Jakafi?

Does Medicare Cover Kidney Stone Removal?

Does Medicare Cover Lipoma Removal?

Does Medicare Cover Mental Health?

Does Medicare Cover Mouth Guards for Sleep Apnea?

Does Medicare Cover Nexavar?

Does Medicare Cover Orthodontic Care?

Does Medicare Cover Service Animals?

Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?

Does Medicare Cover Stair Lifts?

Does Medicare Cover the WATCHMAN Procedure?

Does Medicare Cover Wart Removal?

Does Medicare Pay for Bunion Surgery?

Does Medicare Pay for Varicose Vein Treatment?

Does Your Medicare Plan Cover B12 Shots?

Explaining IRMAA on Medicare

Fair Square Bulletin: We're Revolutionizing Medicare

Finding the Best Dental Plans for Seniors

Health Savings Accounts (HSAs) and Medicare

How Can I Get a Replacement Medicare Card?

How Do Medigap Premiums Vary?

How Does Medicare Cover Colonoscopies?

How Does Medicare Pay for Emergency Room Visits?

How Much Does a Medicare Coach Cost?

How Much Does a Pacemaker Cost with Medicare?

How Much Does Medicare Part B Cost in 2025?

How Much Does Open Heart Surgery Cost with Medicare?

How to Apply for Medicare?

How to Enroll in Social Security

Is Balloon Sinuplasty Covered by Medicare?

Is Displacement Affecting Your Medicare Coverage?

Is Emsella Covered by Medicare?

Is Gainswave Covered by Medicare?

Is HIFU Covered by Medicare?

Is Vitrectomy Surgery Covered by Medicare?

Medicare Advantage MSA Plans

Medicare Consulting Services

Medicare Guaranteed Issue Rights by State

Should You Work With A Remote Medicare Agent?

Top 10 Physical Therapy Clinics in San Diego

Welcome to Fair Square's First Newsletter

What Happens to Unused Medicare Set-Aside Funds?

What Is a Medicare Advantage POS Plan?

What Is a Medicare Supplement SELECT Plan?

What is the Medicare ICEP?

What To Do If Your Medicare Advantage Plan Is Discontinued

What's the Deal with Flex Cards?

What's the Difference Between HMO and PPO Plans?

Why Is Medicare So Confusing?

Will Medicare Cover Dental Implants?

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