(UroToday.com) The 2026 North Central Section of the AUA annual meeting featured a policy session and a presentation by Dr. Matthew Lee discussing the impact of generic abiraterone on Medicare Part D spending in advanced prostate cancer. Novel oral androgen receptor pathway inhibitors (ARPIs) have improved patient survival in advanced prostate cancer; however, these drugs carry substantial financial toxicity, which may compromise patient adherence. In 2019, the total annual spending on metastatic prostate cancer was $5.2 – $8.2 billion.
Generic drug alternatives are traditionally associated with lower costs and improved adherence, although some controversy exists. Abiraterone acetate was FDA-approved in 2011 for mCRPC and in 2018 for mCSPC, and was originally sold by Johnson and Johnson as Zytiga. A generic formulation of abiraterone acetate became available in the United States in 2018. Enzalutamide was FDA-approved in 2012 for mCRPC and in 2019 for mCSPC and sold by Pfizer as Xtandi, with no generic option available. At the 2026 North Central Section of the AUA annual meeting, Dr. Lee and colleagues characterized Medicare spending on branded versus generic abiraterone to estimate the impact of generic adoption on cost and access.
Medicare Part D data (2013-2023) were analyzed for all abiraterone formulations and compared to enzalutamide. Key outcomes included the cost to the patient, the cost per fill, and the annual cost savings:
Annual percent change was analyzed using the Joinpoint Regression Program.
Total Medicare spending on abiraterone increased from $470 million to $1.5 billion from 2013-2018 (annual percent change 19.3%, p = 0.02), decreasing to $910 million in 2023 (annual percent change -10.4%, p = 0.06). From 2013-2023, the number of beneficiaries receiving abiraterone grew from 14,188 to 46,411 (annual percent change 12.3%, p < 0.01). From 2013-2017, the annual cost per beneficiary increased from $33,094 to $48,978 (annual percent change 12.2%, p = 0.02), decreasing to $19,610 in 2023 (annual percent change -17.7%, p < 0.01). Per-refill cost of generic abiraterone decreased significantly after 2018 (annual percent change -17.2%, p = 0.01). Generic abiraterone yielded cumulative Medicare savings of $7.3 billion from 2018-2023. In contrast, enzalutamide displayed steady increases in Medicare spending (2023: $2.6 billion; annual percent change 18.5%, p < 0.01) and per-beneficiary cost (annual percent change 9.3%, p < 0.01) throughout the study period:
Dr. Lee concluded his presentation discussing the impact of generic abiraterone on Medicare Part D spending in advanced prostate cancer with the following take-home messages:
Generic abiraterone adoption led to significant reductions in Medicare spending and cost per beneficiary, while simultaneously increasing access
These benefits were not seen with enzalutamide, which does not have a generic
This underscores the importance of timely generic entry in controlling Medicare spending while expanding access to life-prolonging therapeutics
Presented by: Matthew Lee, MD, Urologist, Mayo Clinic, Rochester, MN
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Augusta, GA, @zklaassen_md on Twitter during the 2026 North Central Section of the American Urological Association (AUA) Annual Meeting, Wailea, HI, Wed, Oct 14 – Sat, Oct 17, 2026.