Information reflects available records as of October 21, 2026.
GLOBE MODEL: WHAT CMS FINALIZED
On September 30, 2026, the Centers for Medicare & Medicaid Services (CMS) finalized the Global Benchmark for Efficient Drug Pricing (GLOBE) Model. The model changes how rebates are calculated for certain separately payable Medicare Part B drugs. It uses international pricing benchmarks based on prices in 19 economically comparable countries.
The model is mandatory for manufacturers of eligible drugs. It does not require providers to participate. CMS describes the model in its announcement and GLOBE Model FAQ. The Federal Register final rule sets out the model’s detailed requirements.
The model applies to a randomly selected group of eligible people with Original Medicare. CMS estimates the selected areas will cover roughly 25% of people with Original Medicare Part B as their primary coverage. Medicare Advantage enrollees are not part of this group.
The model’s performance period runs from April 1, 2027, through March 31, 2032. January 1, 2027, marks the start of the model’s test period and manufacturer data collection, not the first date when eligible beneficiaries may see reduced coinsurance. The first possible reduction is April 1, 2027.
WHO MAY SEE A PART B COST CHANGE
GLOBE does not change the coverage of Part B drugs or restrict access to them. Providers are not model participants, and Medicare keeps the provider’s allowed payment amount unchanged. If coinsurance is reduced for an eligible beneficiary, Medicare’s payment increases to make up the difference.
For example, CMS illustrates that if an eligible beneficiary’s coinsurance for a covered drug were reduced from 20% to 10%, the beneficiary would pay less while the provider still receives the same allowed amount. This is an example of how the model works, not a prediction of any individual’s coinsurance rate. The applicable reduction will depend on the drug and the claim.
Consider a 70-year-old with Original Medicare and a Medigap plan who receives an infusion at a hospital outpatient clinic. If the person is selected for the GLOBE cohort and the drug appears on the current GLOBE list, the provider may collect less coinsurance. If the provider collects coinsurance before Medicare processes the claim, a partial refund may be due.
The person may see little direct difference if the Medigap policy already covers the applicable Part B coinsurance. Coverage depends on the specific policy. CMS also says that savings from the model may reduce Part B premiums for all Medicare beneficiaries, including those outside the cohort. The timing and amount of any premium effect have not been confirmed.
Analyses of the final rule indicate that its direct out-of-pocket impact may be limited for people whose supplemental coverage already offsets coinsurance. Epstein Becker Green’s review of the final rule notes that exclusions and waivers narrow the model’s reach. CMS’s final estimate projects about $440 million in Medicare Part B net spending savings, down from approximately $11.9 billion estimated in the proposal. The final rule’s analysis indicates that about four manufacturers may be subject to mandatory participation after exclusions and waivers.
The final rule excludes biosimilars and their reference biologicals once a biosimilar enters the U.S. market, orphan-only drugs, plasma-derived products, and certain cell and gene therapies. The quarterly drug list determines whether a specific drug is included.
THE ZIP-CODE SELECTION PROCESS
CMS uses randomly selected geographic areas and beneficiary eligibility rules. Selection is not based on income, health status, or an application. A person cannot opt in. No action is required to join the cohort.
A ZIP code is a way to check whether an address may be within a selected area. CMS plans to publish the ZIP Code list on its GLOBE webpage by January 16, 2027. The agency determines eligibility using the beneficiary’s address of record and coverage status. Two people who live near each other may have different outcomes because geographic location is not the only selection factor.
Once CMS identifies a beneficiary as eligible, moving does not remove the person from the model, as long as Original Medicare remains the primary payer. People who enroll in Original Medicare during the model period may also be eligible if they meet CMS criteria.
Medicare Advantage enrollees are excluded from the GLOBE coinsurance cohort. The model’s direct coinsurance reduction is limited to eligible Original Medicare beneficiaries.
COVERAGE-TYPE CHECK
| Coverage | Possible GLOBE effect |
|---|---|
| Original Medicare with Medigap | Reduced coinsurance may apply if the person is selected and the drug is included. Direct savings may be limited if the Medigap policy covers the applicable coinsurance. |
| Original Medicare without a supplement | A selected beneficiary may owe less coinsurance for an included drug. The reduction depends on the specific drug and claim. |
| Original Medicare with Medicaid as secondary coverage | A beneficiary may qualify if Original Medicare is primary and other eligibility requirements are met. Medicaid may already cover some cost sharing. State-specific coordination should be confirmed. |
| Medicare Advantage | Not included in the GLOBE coinsurance cohort. No direct GLOBE coinsurance reduction applies. |
CMS says all Medicare beneficiaries may experience a Part B premium reduction if the model produces savings. That is a possible indirect effect, not a confirmed premium change or a guarantee of a specific amount.
CHECK YOUR SITUATION
- Confirm the coverage type. Check whether coverage is Original Medicare with or without Medigap, Original Medicare with Medicaid as secondary coverage, or Medicare Advantage.
- Check the address after January 16, 2027. Compare the address of record with the GLOBE ZIP Code list published by CMS. The list can indicate possible eligibility; CMS makes the final determination.
- Check the drug. Review the current quarterly GLOBE HCPCS Code List on the CMS GLOBE webpage. Drug inclusion can change by quarter.
- Ask about upfront coinsurance. Before paying coinsurance in advance, ask the provider whether the claim can be processed first. A partial refund may be due if excess coinsurance was collected from an eligible beneficiary.
- Review supplemental coverage. If a Medigap policy covers Part B coinsurance, the direct change may be minimal. The policy’s terms should be confirmed. Possible Part B premium effects are separate.
- Report access concerns. CMS says beneficiaries who believe access to a Part B drug has changed because of GLOBE can contact 1-800-MEDICARE.
TIMELINE AND LITIGATION STATUS
| Date | Event |
|---|---|
| September 30, 2026 | CMS finalized the GLOBE Model. |
| October 2, 2026 | Final rule published in the Federal Register. |
| October 7, 2026 | PhRMA filed a lawsuit against HHS and CMS in federal district court, challenging the model’s statutory authority and constitutionality. |
| January 1, 2027 | Model test period and manufacturer data collection begin. |
| By January 16, 2027 | CMS is expected to publish the ZIP Code list. |
| April 1, 2027 | First possible reduced coinsurance for eligible beneficiaries. |
| March 31, 2032 | End of the five-year performance period. |
| March 31, 2034 | End of rebate invoicing and reconciliation period. |
PhRMA’s lawsuit seeks to set aside the model before its January 2027 start. A court ruling could affect implementation, but the outcome and timing have not been confirmed. The pending case does not change the need to review coverage, drug lists, and billing details as CMS publishes them.
The practical timing is important: the first possible coinsurance change is April 1, not January 1. GLOBE-related reduced coinsurance should therefore not appear on January 2027 claims. Any Part B premium effect is separate, and CMS has not confirmed when or how much beneficiaries may see.
FINDING AND VERIFYING A MEDICARE-FOCUSED AGENT
A Medicare-focused insurance agent can help explain how Original Medicare, Medigap, Medicare Advantage, and drug coverage relate to a person’s situation. VerifiedAgent’s state directory provides a starting point for researching agents. Available state listings include Florida, Texas, and Arizona.
Insurance agents are licensed by states. There is no single national insurance license. A National Producer Number (NPN) is a national identifier assigned to an individual or business entity. It is distinct from a state license number. An NPN alone does not establish an active state license, Medicare-specific authority, or appointment to sell a particular plan. The NIPR NPN lookup and the relevant state insurance department can be used to check records.
A directory profile is a research record, not proof of current licensure or appointment. For example, the VerifiedAgent profile for Cherelee Jensen lists an NPN and Medicare-related categories. The listing and its recorded information should be independently confirmed with the appropriate state regulator and, where relevant, the plan or carrier.
QUESTIONS FOR A MEDICARE AGENT
- Could my Part B drug costs change in 2027 under GLOBE?
- Do I have Original Medicare or Medicare Advantage?
- Does my Medigap policy cover the applicable Part B coinsurance?
- How can I check whether CMS selected my address for the GLOBE cohort?
- How can I confirm whether my drug is on the current quarterly list?
- What should I do if coinsurance changes or I believe drug access has been affected?
- What is your NPN, and where can I confirm your active state license?
Available records show that GLOBE may reduce coinsurance for a randomly selected group of eligible Original Medicare beneficiaries receiving included Part B drugs, with the first possible change beginning April 1, 2027. The final model is narrower than proposed, and its direct effect may be limited for people with supplemental coverage. CMS may also reduce Part B premiums for all beneficiaries if savings occur. Current eligibility, drug inclusion, coverage terms, licensing, and litigation status should be independently confirmed.