CMS has finalized a mandatory test that uses prices paid in other wealthy countries to recalculate what drug manufacturers owe Medicare for certain clinician-administered Part B drugs. The final model is later, narrower and projected to save far less than the version proposed in December 2025. What it changes for a patient depends on where that patient lives.
What CMS finalized
Primary recordOn September 30, 2026, CMS announced the final Global Benchmark for Efficient Drug Pricing (GLOBE) Model (CMS; Federal Register). The model:
- tests an alternative way of calculating Medicare Part B drug inflation rebates for certain separately payable Part B drugs and biologicals, using international pricing information to set a benchmark that reflects prices in economically comparable countries;
- runs for five years, from January 1, 2027, to March 31, 2032, with manufacturer rebate invoicing and reconciliation continuing to March 31, 2034;
- applies to Original Medicare beneficiaries living in a randomly selected set of geographic areas covering about 25 percent of beneficiaries whose primary coverage is Original Medicare;
- excludes biosimilars and their reference biologicals once a biosimilar enters the market, and also excludes orphan-only drugs, plasma-derived products and certain cell and gene therapies, the last three in response to public comments;
- tells affected beneficiaries they may begin to see lower out-of-pocket costs from April 1, 2027.
What changed between proposal and final
| Feature | Proposed (December 2025) | Final (September 30, 2026) |
|---|---|---|
| Start | October 1, 2026 | January 1, 2027 |
| Performance period ends | September 30, 2031 | March 31, 2032 |
| Reconciliation ends | September 30, 2033 | March 31, 2034 |
| Exclusions | Narrower set | Adds orphan-only drugs, plasma-derived products, certain cell and gene therapies; biosimilars and reference biologics after biosimilar entry |
| Projected savings | $8.4 billion (Original Medicare Part B) | $440 million overall |
Becker's Hospital Review reports the final-rule savings estimate, the $8.4 billion proposal figure, and a reference set of 19 countries; it also reports a breakdown of $298 million in Original Medicare Part B savings and $288 million in Medicare Advantage payment savings, offset in part by $147 million in premium effects (Becker's).
AnalysisA projected saving that falls by roughly 95 percent between proposal and final rule is the headline the announcement does not carry. The narrowing is not hidden; it is the arithmetic consequence of the exclusions CMS adopted and the later start. Readers who saw December's figures should not carry them forward.
Follow the money
- The drug is administered. A clinician gives a separately payable, single-source Part B drug to an Original Medicare beneficiary in a model area. Medicare pays under the existing Part B method.
- The benchmark is computed. CMS derives an international benchmark from prices in economically comparable countries.
- The rebate is calculated. Where the U.S. price exceeds the benchmark, GLOBE produces an alternative rebate amount for that drug. In the proposed design, the GLOBE amount was in addition to any existing Part B inflation rebate (Reed Smith on the proposal).
- The manufacturer pays CMS. Rebates are invoiced to and paid by the manufacturer.
- The beneficiary's cost-sharing falls. CMS says affected beneficiaries may see lower out-of-pocket costs from April 1, 2027.
- The trust fund keeps the difference. Medicare's net saving is the rebate collected, less the cost of reduced cost-sharing and premium effects.
What GLOBE does not do
- It does not change the list price a manufacturer charges.
- It does not reach Part D pharmacy drugs. A companion Part D model, GUARD, was proposed alongside GLOBE in December 2025; its status is reported separately.
- It applies only to Original Medicare beneficiaries in the selected areas.
- It is not the separate Medicaid arrangement, GENEROUS, under which states have signed agreements on international benchmarking for Medicaid drug pricing.
Why physicians should read the final rule, not the press release
GLOBE drugs are, by definition, clinician-administered: oncology infusions, rheumatology and ophthalmology injectables, and similar products. Practices that buy and bill these products will need three answers the announcement does not give: which drugs are on the final model list, whether their area is among the selected 25 percent, and whether a provider's total Part B payment for a model drug changes when the beneficiary's cost-sharing is reduced. KPS Gill, MD will report each answer from the final rule.
A note on the record
When this article was prepared, CMS's own GLOBE model page still described the model "as proposed," launching October 1, 2026 (CMS model page). The September 30 announcement supersedes those dates. When two pages from the same agency disagree, the later formal announcement controls.