LUGPA Policy Update: New Medicare Drug Pricing Reforms and What They Mean for Independent Urology Practices

December 2025 

CMS has released the Maximum Fair Prices (MFPs) for the second round of Medicare drug price negotiations: 15 additional high-expenditure Part D drugs, whose negotiated prices will take effect in January 2027.

This round includes several oncology and chronic-disease therapies used across Medicare, including Xtandi, a key advanced prostate-cancer treatment. CMS projects that if these prices had been in place this year, Medicare would have saved $12 billion and seniors would have saved an estimated $685 million out of pocket.

While this cycle includes some widely used primary-care medications such as GLP-1s, the most significant urology-specific development is the negotiated price reduction for Xtandi, which carries potential implications for advanced prostate-cancer care delivered by independent practices.

More than 5 million Medicare beneficiaries used at least one drug on this year’s negotiation list.

Urology Specific Highlights of the New Negotiated Prices (Effective CY 2027)

Xtandi – Astellas/Pfizer (Prostate Cancer)

• Negotiated price: $7,004
• 48% reduction from 2024 list price
• Used by 35,000 Medicare patients
• Primary urology relevance: potential effects on ASP, buy-and-bill economics, and practice-level oncology operations.

Why This Matters for LUGPA Members

1. Direct Implications for Urologic Oncology

The inclusion of Xtandi in the negotiated drug prices represents a significant development for urologists who manage advanced prostate cancer.

Members should monitor potential impacts on:

• ASP-based reimbursement trends
• Buy-and-bill cash flow and margins
• Practice acquisition costs and specialty pharmacy dynamics
• Manufacturer contracting changes

Manufacturers have already raised concerns about long-term “downstream effects,” which may complicate distribution or contracting models for office-based practices.

2. Effects on Patient Access, Adherence, and Out-of-Pocket Costs

Lower cost-sharing for high-cost therapies may:

• Improve adherence to complex treatment regimens
• Reduce financial toxicity for cancer patients
• Encourage earlier acceptance of recommended therapies

This may strengthen continuity of care and reduce avoidable complications in prostate cancer and related conditions, but the impacts remain to be seen.

3. Precedent for Future Negotiations—More Oncology Drugs Likely

CMS will select another 15 drugs by February 1 for the next negotiation cycle.
Given Medicare’s top spending categories, urology oncology practices should anticipate:

• The possibility of more advanced prostate cancer agents entering negotiation
• Intensifying pressure on specialty-drug pricing models
• Continued attention to high-cost therapies administered in physician offices

Negotiation is becoming a multi-year process with a growing scope.

4. Potential Cross-Pressure on the Buy-and-Bill Model

While new negotiated prices directly affect Part D drugs, policymakers may seek future alignment across Part B and Part D, potentially affecting:

• In-office drug administration
• Infusion economics
• Site-of-care differential reimbursements
• Practice financial sustainability

Urologists should prepare for policy proposals that revisit Part B drug reimbursement.

5. Political and Regulatory Momentum

Drug pricing has been a central policy priority across administrations. The Trump Administration has indicated support for deeper concessions, particularly on high-spend therapies.

This suggests that:

• Negotiation authority may expand
• Oncology drugs will remain a priority target
• Practices should expect unstable and rapidly shifting reimbursement dynamics

LUGPA will continue to:

• Analyze emerging impacts on urologic oncology
• Advocate to protect independent practice care models
• Provide members with detailed updates as CMS prepares for the 2027 rollout and the next round of drug selections