MedicaidPrior AuthMedium impact
Krystexxa® (pegloticase) (New)
Humana·IN · Rheumatology, Internal Medicine, Family Medicine·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Krystexxa (pegloticase) for treatment of refractory chronic gout, effective March 1, 2026. The policy requires six specific criteria to be met including diagnosis of chronic gout, baseline uric acid >6 mg/dL, concurrent methotrexate therapy, absence of G6PD deficiency, and failure of conventional therapy including allopurinol.
Action Required
Before March 1, 2026: Billing team must implement prior authorization requirements for Krystexxa (pegloticase) for Indiana Medicaid patients. Update billing system to flag these requests and create documentation checklist for providers including chronic gout diagnosis, baseline uric acid levels >6 mg/dL, methotrexate therapy documentation, G6PD deficiency screening, and proof of allopurinol/febuxostat treatment failure. Ensure providers understand the six required criteria must be documented before administration.