KRYSTEXXA® (Pegloticase)
Order Form

KRYSTEXXA® (pegloticase)

KRYSTEXXA® (pegloticase) is an infusion medication used to treat adults with uncontrolled chronic gout. Medication should be administered 8mg every two weeks for no less than 120 minutes. Medical providers should test uric acid levels prior to treatment and during each infusion. Gout preventive measures should be taken for at least the first six months of infusion therapy with KRYSTEXXA®.

Please refer to the full prescribing information.

Note: Please speak with your healthcare provider for more information if you think this therapy might be right for you.

How do I make a referral or transition my treatment to Infusion Associates?

1. Ask your healthcare provider to fax us a completed order form for your medication, clinical notes, demographics and your insurance card to (833) 996-4888.

2. Providers can find order forms on our medications page.

3. One of our intake specialists will contact your healthcare provider to confirm receipt of your referral.

4. We will then verify benefits, obtain any required prior authorizations, and contact you to schedule an appointment.