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

Mental health stock photo

Does Medicare Cover Mental Health?

Oct 12, 2022

Dripping medication stock photo

Does Medicare Cover Ketamine Infusion for Depression?

Nov 23, 2022

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

Does Medicare Cover Qutenza?

Jan 13, 2023

alphabet_soup

How to Choose a Medigap Plan

Jan 10, 2023

bearded man holding his head in confusion looking at his laptop stock image

Why Is Medicare So Confusing?

Apr 19, 2023

Saving money against a stopwatch stock image

What is the 8-Minute Rule on Medicare?

Dec 21, 2022

Illustrated representation of medical marijuana, using a prescription bottle with a marijuana leaf on the front.

Does Medicare Cover Medical Marijuana?

Jan 6, 2023

Screenshot 2025-03-19 at 5.02.46 PM

2024 Fair Square NPS Report

Mar 19, 2025

Kansas farm stock photo

Medicare Savings Programs in Kansas

Mar 22, 2023

Cover image

Will Medicare Cover it?

Oct 3, 2023

Heart on Heart Rhythm Background Concept stock photo

Does Medicare Cover the WATCHMAN Procedure?

Dec 1, 2022

Leg bones and knees, 3d rendering. stock photo

Does Medicare Cover Fosamax?

Nov 30, 2022

cartoon hospital and male doctor stock image

Can I Have Two Primary Care Physicians?

Oct 3, 2022

Cover image

How to Become a Medicare Agent

Aug 30, 2023

Medicare Enrollment Periods stock image

Explaining the Different Enrollment Periods for Medicare

Feb 3, 2023

A cartoon signpost with HMO and PPO pointing in opposite directions

What's the Difference Between HMO and PPO Plans?

Dec 1, 2022

Cover image

How Are Medicare Star Ratings Determined?

Sep 6, 2023

Close up top view of a woman showing a round-shaped Lipoma fatty tumor on an open palm stock photo

Does Medicare Cover Lipoma Removal?

Dec 8, 2022

More of our articles

13 Best Ways for Seniors to Stay Active in Columbus

13 Best Ways for Seniors to Stay Active in Philadelphia

13 Best Ways for Seniors to Stay Active in Phoenix

14 Best Ways for Seniors to Stay Active in Nashville

15 Best Ways for Seniors to Stay Active in Denver

2024 Cost of Living Adjustment

2024 Fair Square Client Retention and Satisfaction Report

2025 Medicare Price Changes

Can I Change My Primary Care Provider with an Advantage Plan?

Can I switch From Medicare Advantage to Medigap?

Can I Use Medicare Part D at Any Pharmacy?

Costco Pharmacy Partners with Fair Square

Does Medicare Cover Bariatric Surgery?

Does Medicare Cover Breast Implant Removal?

Does Medicare Cover Cala Trio?

Does Medicare Cover Cartiva Implants?

Does Medicare Cover Chiropractic Visits?

Does Medicare Cover Cold Laser Therapy (CLT)?

Does Medicare Cover Diabetic Eye Exams?

Does Medicare Cover Exercise Physiology?

Does Medicare Cover Hearing Aids?

Does Medicare Cover Home Heart Monitors?

Does Medicare cover Hyoscyamine?

Does Medicare Cover Inqovi?

Does Medicare Cover Jakafi?

Does Medicare Cover Krystexxa?

Does Medicare Cover Light Therapy for Psoriasis?

Does Medicare Cover Linx Surgery?

Does Medicare Cover LVAD Surgery?

Does Medicare Cover Macular Degeneration?

Does Medicare Cover Mouth Guards for Sleep Apnea?

Does Medicare Cover Nexavar?

Does Medicare Cover Nuedexta?

Does Medicare Cover Ofev?

Does Medicare Cover Orthodontic Care?

Does Medicare Cover Piqray?

Does Medicare Cover PTNS?

Does Medicare Cover SI Joint Fusion?

Does Medicare Cover Urodynamic Testing?

Does Medicare Cover Vitamins?

Does Your Plan Include A Free Gym Membership?

Everything About Your Medicare Card + Medicare Number

Finding the Best Vision Plans for Seniors

Health Savings Accounts (HSAs) and Medicare

How Do Medicare Agents Get Paid?

How Do Medigap Premiums Vary?

How Does the End of the COVID-19 Public Health Emergency Affect Your Medicare?

How Much Does a Medicare Coach Cost?

How Much Does Medicare Cost?

How Much Does Medicare Part A Cost in 2025?

How Much Does Medicare Part B Cost in 2025?

How Much Does Trelegy Cost with Medicare?

How to Apply for Medicare?

How to Enroll in Social Security

Is Emsella Covered by Medicare?

Is Vitrectomy Surgery Covered by Medicare?

Last Day to Change Your Medicare Part D Plan

Medicare Explained

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

Moving? Here’s What Happens to Your Medicare Coverage

Plan G vs. Plan N

The Fair Square Bulletin: October 2023

Turning 65 and Thinking of Keeping COBRA? Here’s Why It Usually Backfires

What Are Medicare Part B Excess Charges?

What Is a Medicare Supplement SELECT Plan?

What Is Medical Underwriting for Medigap?

What is Plan J?

What To Do If Your Medicare Advantage Plan Is Discontinued

What to Do When Your Doctor Leaves Your Network

What You Need to Know About Creditable Coverage

When to Choose Medicare Advantage over Medicare Supplement

Which Medigap Policies Provide Coverage for Long-Term Care?

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