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

woman sitting up in bed experiencing back pain stock photo

Does Medicare Cover a Spinal Cord Stimulator?

Nov 19, 2022

An elderly couple discusses their healthcare and insurance needs with another woman stock image

Medicare Guaranteed Issue Rights by State

Feb 10, 2023

cartoon hospital and male doctor stock image

Can I Have Two Primary Care Physicians?

Oct 3, 2022

Cover image

What People Don't Realize About Medicare

Mar 27, 2023

heart surgery stock image

How Much Does Open Heart Surgery Cost with Medicare?

Jan 27, 2023

Model of the lungs with the diseased part. Cancer or Ground glass opacity GGO. stock photo

Does Medicare pay for Opdivo?

Nov 23, 2022

senior man with his glasses in his hand working in front of his laptop stock photo

Can I Change Medicare Advantage Plans Any Time? | Medicare Plans

Sep 19, 2022

Older woman during an eye exam

Does Medicare Cover Diabetic Eye Exams?

Jan 11, 2023

Dames Point Bridge in Jacksonville, Florida stock image

13 Best Ways for Seniors to Stay Active in Jacksonville

Mar 3, 2023

Male doctor with his arms crossed stock image

Can Doctors Choose Not to Accept Medicare?

Dec 8, 2022

Teenager Helping his Grandfather at Home stock photo

Does Medicare Cover Geri Chairs?

Dec 7, 2022

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

Cover image

Can I Use Medicare Part D at Any Pharmacy?

Aug 28, 2023

Cover image

How Much Does a Medicare Coach Cost?

Mar 20, 2023

An illustrated image of a cartoon man using giant scissors to cut the "T" in the word "Tax"

How to Deduct Medicare Expenses from Your Taxes

Dec 28, 2022

senior man holding up his medicare card stock photo

Everything About Your Medicare Card + Medicare Number

May 12, 2022

Medicare research stock image

Medicare Consulting Services

Apr 3, 2023

COVID-19 at home test stock image

Does Medicare Cover COVID Tests?

Dec 21, 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

14 Best Ways for Seniors to Stay Active in Washington, D.C.

2024 Cost of Living Adjustment

Building the Future of Senior Healthcare

Can Medicare Help with the Cost of Tyrvaya?

Do Medicare Supplement Plans Cover Dental and Vision?

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

Does Medicare Cover Breast Implant Removal?

Does Medicare Cover Cervical Disc Replacement?

Does Medicare Cover Chiropractic Visits?

Does Medicare cover Deviated Septum Surgery?

Does Medicare Cover Driving Evaluations?

Does Medicare Cover ESRD Treatments?

Does Medicare Cover Fosamax?

Does Medicare Cover Hepatitis C Treatment?

Does Medicare Cover Hoarding Cleanup?

Does Medicare Cover Incontinence Supplies?

Does Medicare Cover Inqovi?

Does Medicare Cover Inspire for Sleep Apnea?

Does Medicare Cover Iovera Treatment?

Does Medicare Cover Light Therapy for Psoriasis?

Does Medicare Cover Linx Surgery?

Does Medicare Cover Macular Degeneration?

Does Medicare Cover Mental Health?

Does Medicare Cover Nexavar?

Does Medicare Cover Nuedexta?

Does Medicare Cover Orthodontic Care?

Does Medicare Cover Penile Implant Surgery?

Does Medicare Cover Piqray?

Does Medicare Cover Service Animals?

Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?

Does Medicare Cover SI Joint Fusion?

Does Medicare Cover TENS Units?

Does Medicare Cover Tymlos?

Does Medicare Cover Urodynamic Testing?

Does Medicare Cover Vitamins?

Does Medicare Have Limitations on Hospital Stays?

Explaining IRMAA on Medicare

Fair Square Client Newsletter: AEP Edition

Finding the Best Dental Plans for Seniors

How Can I Get a Replacement Medicare Card?

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

How Do Medigap Premiums Vary?

How Does Medicare Cover Colonoscopies?

How Much Does a Pacemaker Cost with Medicare?

How Much Does Medicare Cost?

How Much Does Medicare Part B Cost in 2025?

How Much Does Rexulti Cost with Medicare?

How Much Does Xeljanz Cost with Medicare?

How Often Can I Change Medicare Plans?

How to Become a Medicare Agent

How to Enroll in Social Security

Is Emsella Covered by Medicare?

Is Fair Square Medicare Legitimate?

Is Gainswave Covered by Medicare?

Is Vitrectomy Surgery Covered by Medicare?

Medicare Advantage Plans for Disabled People Under 65

Medigap vs. Medicare Advantage

Saving Money with Alternative Pharmacies & Discount Programs

The Fair Square Bulletin: October 2023

Top 10 Physical Therapy Clinics in San Diego

Welcome to Fair Square's First Newsletter

What Is Medical Underwriting for Medigap?

What is the 8-Minute Rule on Medicare?

What to Do When Your Doctor Doesn't Take Medicare

What You Need to Know About Creditable Coverage

What's the Deal with Flex Cards?

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