CommercialPrior AuthMedium impact
Krystexxa (pegloticase)
Blue Cross & Blue Shield of Mississippi·MS · Rheumatology, Nephrology, Internal Medicine·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Krystexxa (pegloticase) policy for chronic gout treatment, requiring prior authorization with specific criteria including failed trials of allopurinol and febuxostat/probenecid, specialist involvement, and administration in healthcare settings prepared for anaphylaxis management.
Action Required
Before January 1, 2026: Billing team must update prior authorization requirements for Krystexxa (pegloticase) HCPCS J2507. Ensure providers document failed trials of allopurinol (3+ months) and febuxostat or probenecid, serum uric acid levels >6mg/dL, specialist consultation, and administration in appropriate healthcare setting. Claims without proper prior authorization will be denied.