The Centers for Medicare & Medicaid Services (CMS) has issued a final rule creating the GLOBE Model, which it calls "a new mandatory Medicare payment model". The rule is on public inspection, not yet published, and scheduled to be published in the Federal Register on October 2, 2026.
What changes for people on Medicare
Only some patients are included: people enrolled in Part B with Original Medicare (the traditional program) as primary payer who live in randomly chosen ZIP codes holding about 25 percent of such beneficiaries. Medicare Advantage members are left out.
When someone there gets a covered Part B drug, coinsurance can fall below the usual 20 percent. CMS's example: $10 instead of $20 on a $100 allowed amount. CMS says 94 percent of its illustrative drugs would land between 2 and 12 percent; people with supplemental insurance may not directly benefit. CMS says inclusion "does not require beneficiaries to enroll or take any action".
CMS's impact analysis says the model will lower the Part B premium for all beneficiaries. Because Medicare Advantage rates will reflect the model from 2028 rate setting, it says those plans will likely need to reduce supplemental benefits.
What it does to drug payment
Manufacturers already owe rebates on certain Part B drugs whose prices rise faster than inflation. GLOBE adds a calculation against an international benchmark: the higher of the lowest price among reference countries (including Canada, France, Germany, Japan and the United Kingdom) in commercially available pricing data, adjusted for each country's GDP per person, or a weighted average of net prices manufacturers choose to submit. Rebates are paid into Medicare's Part B trust fund account. When coinsurance is cut, Medicare pays the provider more to make up the difference.
Who and what is covered
Participation is mandatory for makers of covered drugs, though CMS says it intends to waive that for quarters in which a maker takes part in a separate voluntary Medicaid model, GENEROUS. Covered drugs are single-source drugs and sole-source biologics in seven classes, including cancer and eye drugs, with Original Medicare Part B allowed charges above a $100 million threshold over 12 months (inflation-adjusted later). Rare-disease-only drugs, cell and gene therapies, plasma products and drugs with a negotiated Medicare price are excluded. The rule's drug list is illustrative; CMS will post the real list quarterly.
The dates
- November 30, 2026: rule effective.
- January 1, 2027: model starts, with voluntary manufacturer price data.
- By January 16, 2027 (75 days before April 1, by this desk's count): CMS must post the ZIP code list.
- April 1, 2027: first of five performance years, when coinsurance changes apply. The last ends March 31, 2032.
What it does not say
The document names no ZIP codes and no final drug list. It covers Part B only; CMS says a separate proposed model, GUARD, addresses Part D drugs. CMS estimates $298 million in Original Medicare Part B net savings over the model before Part B premium changes, down from $8.4 billion estimated for the proposal.