Fill out the form, sign, and submit online through DocuSign®.
Fill out the form, then download, sign, and fax the form to 877-633-9522 OR email it to GOUTABYS@amgen.com.
Once your patient is enrolled in the program, you will receive a comprehensive summary of your patient’s benefits.
All trademarks appearing herein are the property of their respective owners.
Whether your patient needs personalized support, insurance and financial assistance, or helpful resources, the Amgen By Your Side team is here to help them throughout their treatment journey.
Patient support
Infusion Logistics Assistance
Insurance Benefits Investigation
Financial Assistance
*KRYSTEXXA is indicated to be administered in a healthcare setting by professionals trained to manage serious allergic reactions.1 Potential use of home infusion must be determined by healthcare professionals’ assessment of individual patient needs.
† For eligible patients.
Explore everything Amgen By Your Side offers to your appropriate patients
Monday through Friday, 8 AM to 8 PM ET
1-877-633-9521
KRYSTEXXA makes it easy to help patients start treatment with payor forms and reimbursement codes. >
There are several steps that will help prepare patients for infusion and ensure proper administration of KRYSTEXXA.
Gout Flares: An increase in gout flares is frequently observed upon initiation of anti-hyperuricemic therapy, including KRYSTEXXA. Gout flare prophylaxis with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended starting at least 1 week before initiation of KRYSTEXXA therapy and lasting at least 6 months, unless medically contraindicated or not tolerated.
Congestive Heart Failure: KRYSTEXXA has not been formally studied in patients with congestive heart failure, but some patients in the pre-marketing placebo-controlled clinical trials experienced exacerbation. Exercise caution in patients who have congestive heart failure and monitor patients closely following infusion.
The most commonly reported adverse reactions (≥5%) are:
KRYSTEXXA co-administration with methotrexate trial:
KRYSTEXXA with methotrexate: gout flares, arthralgia, COVID-19, nausea, and fatigue; KRYSTEXXA alone: gout flares, arthralgia, COVID-19, nausea, fatigue, infusion reaction, pain in extremity, hypertension, and vomiting.
KRYSTEXXA pre-marketing placebo-controlled trials:
gout flares, infusion reactions, nausea, contusion or ecchymosis, nasopharyngitis, constipation, chest pain, anaphylaxis, and vomiting.
KRYSTEXXA® (pegloticase) is indicated for the treatment of chronic gout in adult patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated.
Limitations of Use: KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia.
Please see Full Prescribing Information, including Boxed Warning.