When does this change take effect?

This change is effective Apr 1, 2026.

Medicare AdvantageCoverageMedium impact

MA08.060g, Pegloticase (Krystexxa®)

Q: Who is affected by this change?

This affects Independence Blue Cross Rheumatology, Internal Medicine, Family Medicine providers on Medicare Advantage plans.

Independence Blue Cross·Rheumatology, Internal Medicine, Family Medicine·Pharmacy

Effective date

Apr 1, 2026

We identified it

Jun 19, 2026

Days to comply

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Summary

Medicare Advantage policy MA08.060g for Pegloticase (Krystexxa®) has been reissued with updates effective April 1, 2026. This is a pharmacy policy affecting coverage or authorization requirements for this gout medication, though specific changes are not detailed in the summary provided.

Action Required

Action needed

By April 1, 2026: Review the complete MA08.060g policy at the provided URL to determine specific changes to Pegloticase (Krystexxa®) coverage requirements. Update prior authorization procedures and billing protocols as specified in the full policy. Ensure staff are trained on any new documentation or coverage criteria.

Related policy hubs

Independence Blue Cross policies Rheumatology Internal Medicine Family Medicine