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Office of Medical Assistance Programs FeeforService, Pharmacy Division Phone 18005378862 Fax 18663270191KRYSTEXXA (pegloticase) PRIOR AUTHORIZATION FORM Prior authorization guidelines for Antihyperuricemics
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Who needs k rystexxa pegloticase prior?
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K rystexxa pegloticase prior is typically prescribed for individuals with severe gout who have not responded well to other treatments.
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It is also used for patients who cannot tolerate or are not suitable candidates for other medications used to treat gout.
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What is k rystexxa pegloticase prior?
KRYSTEXXA (pegloticase) is a medication used to treat chronic gout.
Who is required to file k rystexxa pegloticase prior?
Healthcare providers are required to file KRYSTEXXA prior authorization requests.
How to fill out k rystexxa pegloticase prior?
To fill out KRYSTEXXA prior authorization, healthcare providers need to provide patient information, medical history, and justification for the use of the medication.
What is the purpose of k rystexxa pegloticase prior?
The purpose of KRYSTEXXA prior authorization is to ensure appropriate use of the medication and to determine insurance coverage.
What information must be reported on k rystexxa pegloticase prior?
The prior authorization request must include patient demographics, diagnosis, previous treatments, and healthcare provider information.
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