Krystexxa

Generic: pegloticase

8MG/50ML, 8MG — Vial

Also known as: KRYSTEXXA SOLN 8MG/ML KRYSTEXXA SOLN 8MG/50ML, 8MG/ML

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 4 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 4 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 4 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - HDHP 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	—	PA