| Anthem Blue Cross (HMO, PPO, EPO) |
| Krystexxa (pegloticase) |
| Drugs for Pain and Fever : Gout Drugs |
- Step Therapy: Gouty Arthritis:
ST Multiple Generics
- Quantity Limit: limit maximum 0.08 mL PER 1 day(s)
- Available only through Specialty Pharmacy; Limited access;
- Prior Authorization: Gouty Arthritis:
Duration: 1 year(s)
Reauthorization Required: Yes
- Gouty Arthritis:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
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