KRYSTEXXA (PDF)
Defines medical necessity criteria, initial and continued authorization requirements, dosing limits, contraindications, co-administration requirements, approval durations by line of business, and coding guidance for pegloticase (Krystexxa) for commercial, HIM, and Medicaid lines of business.
Added combination use with methotrexate per labeling (co-administration requirement)
Prevention of concomitant use with pegadricase
Extended initial approval duration from 6 to 12 months for Medicaid and HIM
Added newly approved ready-to-use single-dose vial formulation
Removed losartan as a uricosuric agent from therapeutic alternatives
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.