Krystexxa is the brand name for pegloticase, an enzyme infusion for chronic gout that has not responded to pills like allopurinol or febuxostat. It is not something you pick up at a pharmacy. A nurse infuses it into a vein over at least two hours, every two weeks, and the clinic bills it under your medical benefit rather than your drug benefit.
That structure is why the price looks so unusual. There are two separate bills for every visit, the drug and the administration, and the number the clinic sends you is a gross charge that has little to do with what any insurer actually pays. Everything below was researched on September 4, 2026, using the CMS payment files current that day.
What Does Krystexxa Cost Without Insurance?
Two independent sources price the drug and they land within about 2% of each other. Medicare’s Part B payment limit file effective July 1 through September 30, 2026 sets the allowance for HCPCS code J2507 at $3,929.337 per milligram, which is $31,434.70 for the 8 mg dose the FDA label prescribes. Drugs.com publishes a cash price of $32,114.39 for a single vial.
The third number in the table is the one nobody advertises. In CMS’s national 2024 claims data, providers submitted an average charge of $6,355.86 per milligram, roughly $50,847 for one dose, against a Medicare allowed amount of $3,306.82 per milligram. A self-pay patient with no negotiated rate is quoted from the charge column, not the allowed column.
| Krystexxa cost item | Low | Average | High |
|---|---|---|---|
| Drug only, one 8 mg infusion | $31,435 | $32,114 | $50,847 |
| Infusion administration, 2 hours (CPT 96365 + 96366) | $89 | $265 | $312 |
| One complete visit, drug plus administration | $31,524 | $32,379 | $51,159 |
| Six-month course, 13 infusions | $409,812 | $420,927 | $665,067 |
| Twelve-month course, 26 infusions | $819,624 | $841,854 | $1,330,134 |
| Amgen Commercial Co-Pay Program (commercial insurance required) | $0 | $0 | $0 |
| Amgen Safety Net Foundation free drug, if you qualify | $0 | $0 | $0 |
The Low column is what Medicare allows, the Average column is the published cash price, and the High column is the average charge providers actually submit. Administration figures come from CMS’s 2024 office-setting allowed amount at the low end, the July 2026 hospital outpatient rate in the middle, and the 2024 average submitted charge at the high end.
One reality check on the drug figure: CMS’s Medicare Part B spending file shows Krystexxa at $3,319.64 average spending per milligram across 2024, $26,646.89 per claim, and $257,821.46 per beneficiary for the year, across 1,097 beneficiaries and $282.8 million of total spending. Divide the per-claim figure by the per-milligram figure and you get 8.03 units, which independently confirms that a claim is one 8 mg dose.
What Drives the Price
There is no retail channel and no generic
Krystexxa is the only pegloticase product on the market. CMS’s National Average Drug Acquisition Cost survey, which prices what retail pharmacies pay, returns zero rows for both “Krystexxa” and “pegloticase” under two different search operators, while a control search for allopurinol returns nearly 3,000 rows. That is not a failed search. It is evidence that this drug never touches a retail counter, so there is no pharmacy price to compare and no coupon site that can help.
Where you sit for the infusion
The drug price is the same everywhere, but the administration fee is not. The label requires the infusion to run over no less than 120 minutes, so it bills as CPT 96365 (first hour) plus 96366 (each additional hour). Under the July 2026 hospital outpatient payment file, Medicare pays $217.31 and $47.84 for those two codes, or $265.15 total. In a physician office, CMS’s 2024 national data shows allowed amounts of $60.45 and $19.46, about $89.91. Hospital outpatient departments are paid roughly three times what an office is paid for the identical two hours.
Two bills, sometimes three
Every visit generates a drug charge and an administration charge. The label also calls for premedication with antihistamines and corticosteroids and a serum uric acid test before each infusion, and many practices bill an office visit on top. Ask for the whole quote before you commit, not just the drug line.
Course length
The dose is fixed at 8 mg, so unlike weight-based drugs your per-infusion cost does not change. What changes your total is how many infusions you get. Amgen’s patient site describes 6 to 12 months of every-other-week treatment, which is the difference between roughly $410,000 and roughly $840,000 of drug at list.
The gap between billed and allowed
The single most useful number on this page is the 92% spread between the average submitted charge ($6,355.86 per mg) and the Medicare allowed amount ($3,306.82 per mg) in 2024 claims. That gap is not a mistake. It is the standard structure of buy-and-bill drug billing, and it is exactly what a self-pay patient is asking a clinic to give up. Note that the national J2507 rows rest on 957 beneficiaries in the office setting, a small denominator, so treat them as a solid national average rather than a precise local prediction.
Cash Price vs. Insurance
For most services on this site, paying cash sometimes beats using insurance. Krystexxa is not one of them. At $31,000 or more every two weeks, no self-pay discount closes the gap between a cash price and a covered benefit, and there is no direct-to-patient purchase channel at all.
That makes the practical question different. It is not “should I pay cash” but “what is the fastest route to coverage or free drug.” Medicare’s own math shows why: Part B coinsurance on J2507 is set at 18.356% rather than the usual 20% because of the inflation rebate program, which works out to about $721 per infusion for a beneficiary with Part B, against roughly $31,400 for someone with nothing.
If you are uninsured and already sitting on a bill, treat it as a hospital bill rather than a drug bill. Ask for an itemized statement, check the charges against the figures above, and go through the same steps you would use on any large facility bill. Our guides to reading an itemized hospital bill and negotiating medical bills both apply directly here.
How to Pay Less
Start with the Amgen Safety Net Foundation, not a coupon. This is the only route that actually zeroes the drug for an uninsured patient. The foundation supplies Amgen medicines at no cost to patients who have lived in the U.S. or its territories for six months or longer, have no insurance coverage, and meet income limits. Its published 2026 household income guidelines run on two product-specific tiers: the lower tier caps a household of one at $47,880 and a household of four at $99,000, and the higher tier caps them at $79,800 and $165,000. Enrollment lasts up to 12 months and there is no fee to apply.
Do not count on the copay card. The Amgen Commercial Co-Pay Program terms require the patient to be commercially insured with financial responsibility for part of the cost. Uninsured and cash-paying patients are excluded outright, as is anyone on Medicare, Medicaid, Medigap, VA, TRICARE or DoD coverage. Residents of Massachusetts and Rhode Island are also excluded from administration support specifically.
Move the infusion out of the hospital. If a hospital outpatient department is quoting you the visit, ask whether a rheumatology office or a freestanding infusion center can give the same drug. On the administration side alone that is a roughly three-to-one difference at Medicare rates, and the facility fee a hospital adds does not exist in an office.
Ask the hospital for charity care before you agree to a payment plan. Nonprofit hospitals are required to have written financial assistance policies, and a six-figure infusion course is exactly the situation they are designed for. See how hospital charity care works for what to ask and what documents to gather.
Check the posted price before you accept a quote. Hospitals must publish machine-readable price files and consumer price lists. Our guide to hospital price transparency explains how to find the file for a specific hospital, and the fair price checker gives you a benchmark to argue from.
Do not stop the cheap drugs on your own. Oral gout medicines are a fraction of this price, and many people move between them. If cost is driving the decision, the numbers on colchicine and allopurinol are worth knowing before you talk to your doctor, though the choice itself is a clinical one, not a budget one.
The Bottom Line
Krystexxa is a $31,435 to $32,114 drug per dose before anyone touches a needle, and a 6 to 12 month course runs into the hundreds of thousands of dollars. The infusion fee is small by comparison but still swings three-to-one between an office and a hospital.
The pattern here is the same one that shows up on other clinic-administered biologics like Prolia and on iron infusions: the drug is billed under the medical benefit, the gross charge is roughly twice what any payer allows, and the manufacturer’s copay card is built for insured patients only. For an uninsured patient the real lever is the free-drug program, and the second lever is where you sit down for the two hours.
All figures on this page were researched September 4, 2026. The CMS payment limits cited are effective July 1 through September 30, 2026 and are built on first-quarter 2026 average sales price data. They reset on October 1, 2026, as do the hospital outpatient rates, so re-check them after that date.