$2.3 billion to $80 million: CMS shrinks GLOBE drug model

CMS estimates the final version of Medicare’s GLOBE drug pricing model will cut Part B spending by about $80 million a year, according to the final rule published in the Federal Register on Oct. 2, 2026. The proposed rule of Dec. 23, 2025 put that figure at about $2.3 billion. The model also starts a quarter later and leaves out three groups of drugs.

CMS announced the final model on Sept. 30, 2026, and the rule takes effect Nov. 30, 2026. GLOBE, short for Global Benchmark for Efficient Drug Pricing, is mandatory for the makers of drugs it covers. It changes how Medicare figures the Part B inflation rebates those drugmakers owe, using prices in 19 other wealthy countries as the benchmark.

What changed from the proposal

• Start date. CMS proposed an Oct. 1, 2026 start, with five performance years ending Sept. 30, 2031. The final model starts Jan. 1, 2027 with a three month window for drugmakers to send in international price data. Rebates and lower coinsurance begin April 1, 2027, and the last performance year ends March 31, 2032. CMS moved the dates after commenters said the proposed timeline was too short to get ready.
• Drugs left out. The final rule adds three exclusions in response to comments. They cover drugs whose only approved uses are for rare diseases, cell and gene therapies on the FDA’s approved list, and plasma derived products. Biosimilars and the biologics they copy stay out once a biosimilar launches, as proposed.
• Fewer drugmakers. The proposal used 40 manufacturers as a deliberately high count. The final rule estimates 19 at the start. CMS also plans to waive GLOBE for a drugmaker in any quarter it takes part in the voluntary GENEROUS Medicaid model. With those waivers, the rule’s own count falls to four manufacturers.
• Savings. Every estimate fell. Here are CMS’s figures for the life of the model, before Part B premium effects, proposed and then final:
  • Original Medicare Part B: $8.4 billion, now $298 million.
  • Medicare Advantage: $7.5 billion, now $288 million.
  • Medicaid: almost $1.0 billion, now $39 million.
  • Yearly Part B savings: about $2.3 billion, now about $80 million.

By our math, the yearly estimate is more than 96% smaller. How we got 96%: $80 million is 3.5% of $2.3 billion, so the yearly figure fell by about 96.5%. Both numbers are CMS’s own, from the proposed and final rules. CMS says the drop comes from the policies it finalized, including the new exclusions, and from newer claims data. Its overall estimate is $440 million in Part B net savings over the model’s run, after a $147 million offset from lower Part B premiums.

What stayed the same

• Who is in it. The model applies to people in Original Medicare who live in randomly chosen areas covering about 25% of Original Medicare Part B enrollees. Medicare Advantage members aren’t in the test.
• Which drugs. GLOBE covers Part B drugs in seven drug classes with more than $100 million in Original Medicare Part B spending over 12 months. Those classes made up 91% of Original Medicare Part B rebatable drug spending in 2024, CMS said.
• The countries. The benchmark draws on Australia, Austria, Belgium, Canada, the Czech Republic, Denmark, France, Germany, Ireland, Israel, Italy, Japan, the Netherlands, Norway, South Korea, Spain, Sweden, Switzerland and the United Kingdom.
• The rebate. A drugmaker owes the larger of two amounts: the gap between the drug’s Part B price and the GLOBE benchmark, or the regular Part B inflation rebate.

What patients in the model pay

Part B drugs are the ones clinicians give in an office or hospital, such as infusions for cancer. People in the model get a lower coinsurance on covered drugs starting April 1, 2027. Using 2024 data for its sample drug list, CMS says 94% of those drugs would carry coinsurance between 2% and 12%, compared with the standard 20%.

For scale, Original Medicare spent $81.90 billion on Part B drugs in 2025, according to the final rule. CMS received 20,168 comments on the proposal, 157 of them unique.

GLOBE is one of several Innovation Center tests Medicare is running at once, alongside the WISeR prior authorization test. The Part B changes come as people weigh their 2027 coverage during Medicare open enrollment, which runs through Dec. 7. Details are on the CMS GLOBE Model page.