UCR 308: Hot Topics from the UPTP — XIAFLEX Costs, PAE Audits, UA Denials, Biosimilars, and Payer AI

October 16, 2026

In this episode, Scott, Mark, and Dr. Ray Painter share what they heard at the October meeting of the Urology Pharma and Tech Pioneer (UPTP) group—a monthly forum where urology practices from around the country compare notes on new technology, payer behavior, and office workflows. They discuss XIAFLEX acquisition costs now running above ASP plus six and how practices are moving away from buy-and-bill toward specialty pharmacy or other acquisition options, with a reminder that some states, such as New Jersey, restrict in-office dispensing. They review payer-specific payment problems with INLEXZO and ZUSDURI, early Medicare claim sampling, UPIC and RAC record requests, and Anthem prior authorization questions around prostatic artery embolization, and denials for PCR, quantitative urinalysis, and routine dipstick UA. The conversation also covers Altaviva, eCoin, biosimilars, appeal turnaround times of 90 to 120 days, and payers' growing use of AI in claims processing. The key takeaway: documentation and communication—inside the practice and across the urology community—are the foundation for getting paid in an environment that is changing MAC by MAC and payer by payer.