The CMS GLOBE Model and Part B Drug Coinsurance
A Medicare change starting in 2027 depends partly on a person’s address of record with Medicare. CMS calls it the GLOBE Model.
Reduced coinsurance on GLOBE Model drugs runs from April 1, 2027, to March 31, 2032. The reduction only applies to beneficiaries CMS picks at random. The model cohort will not include beneficiaries who do not have Original Medicare as their primary payer, according to CMS.
What the GLOBE Model Changes
CMS describes the Global Benchmark for Efficient Drug Pricing Model as a mandatory model. It will assess a rebate for certain drugs payable under Original Medicare Part B, and the rebate applies if those prices exceed the prices paid in economically comparable countries.
CMS will test an alternative calculation for pharmaceutical manufacturer rebates under the Medicare Part B Drug Inflation Rebate Program, using a benchmark derived from international pricing information.
The benchmark draws on one of two kinds of data, CMS says: manufacturer-reported international drug net pricing data, or available international drug pricing information from commercially available data sources. Those sources cover economically similar reference countries.
The reference countries CMS names include 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.
Rebates paid by manufacturers will continue to be sent directly to the Medicare Supplementary Medical Insurance Trust Fund.
The participants are on the manufacturing side. Participants in the model are pharmaceutical manufacturers of GLOBE Model drugs, CMS says. Participation is mandatory for manufacturers of Medicare Part B drugs that meet the GLOBE Model drug eligibility criteria and are not otherwise excluded.
Who Can See Reduced Coinsurance
The GLOBE Model reduction only applies to beneficiaries who are randomly selected by CMS to be a part of the GLOBE Model — the group CMS calls the model cohort.
According to the CMS frequently asked questions, the cohort includes Medicare Part B beneficiaries who have Original Medicare as their primary payer. Their address of record in CMS’ Medicare Beneficiary Database also has to fall within randomly selected GLOBE Model geographic areas.
The exclusion is plain. The model cohort will not include beneficiaries who do not have Original Medicare as their primary payer, and CMS gives one example: beneficiaries who have elected Medicare Advantage.
CMS also gives a size. The cohort will represent approximately 25% of Medicare Part B beneficiaries who have Original Medicare as their primary payer. Those are the people whose address of record falls within the randomly selected ZIP Code Tabulation Areas at the time CMS selects beneficiaries for the model cohort.
There is no sign-up step. Beneficiaries cannot and do not have to do anything to be eligible for GLOBE Model reduced coinsurance, CMS says. Eligibility will be determined by CMS at the time a claim for a GLOBE Model drug is processed for Medicare payment.
There will be a published list. CMS will publish on the CMS Model webpage ZIP Codes that help determine if a beneficiary may be in the model cohort, and the GLOBE Model ZIP Codes List will be available by January 16, 2027.
Moving does not undo the selection. Once CMS identifies beneficiaries as eligible for the model, a move or a change in their ZIP Code leaves them in it. They remain eligible for GLOBE Model reduced coinsurance as long as they have Original Medicare as their primary payer.
Nor is the door closed after the start date. Beneficiaries who newly join Original Medicare after the GLOBE Model has started, and whose ZIP Code is on the GLOBE Model ZIP Codes List, may be eligible to be part of the model cohort.
CMS expects the GLOBE Model will reduce the out-of-pocket costs or coinsurance for beneficiaries who receive a GLOBE Model drug. How much depends on the drug, the alternative calculation for manufacturer rebates established, and the beneficiary’s individual circumstances — enrollment in supplemental insurance among them.
Which Drugs the Model Covers
The model focuses on drugs that are administered in a clinical setting, CMS says, such as cancer therapies or drugs used to treat autoimmune conditions and arthritis.
Usually, Part B covers drugs you wouldn’t typically give to yourself, according to Medicare.gov, with examples such as drugs you get at a doctor’s office or in a hospital outpatient setting.
Inside Part B, the model’s drugs sit in a narrower set. Drugs included in the GLOBE Model are a subset of Part B rebatable drugs (single-source drugs and sole-source biological products).
GLOBE Model drugs will be selected from the oncology, rheumatology, immunology, ophthalmology, and endocrinology therapeutic classes (with certain exceptions) where annual Original Medicare spending exceeds $100 million, CMS says. Under the final rule, that $100 million figure applies to the quarter beginning April 1, 2027, and rises in later quarters with the percentage increase in the CPI-U.
CMS determines which drugs meet the model’s eligibility criteria. Those criteria include the drug’s classification, Original Medicare Part B expenditures, and whether the drug is subject to an applicable exclusion.
The list will move. Before each calendar quarter during the model performance period, CMS will publish the GLOBE Model Drug HCPCS Code List on the GLOBE Model webpage. CMS will review and update the list quarterly to reflect drugs added to or removed from the model.
A Claim Under the Model, in CMS’s Example
Start with the ordinary math. In most cases, after you meet the Part B deductible, you pay up to 20% of the Medicare-approved amount for Part B drugs, according to Medicare.gov.
The model changes the split, not the total. Health care providers are not participants in the GLOBE Model, CMS says. Providers administering GLOBE Model drugs to beneficiaries who are selected for the model cohort will not see a reduction in the Medicare allowed amount.
Both things can be true at once. If a GLOBE Model drug is furnished to a GLOBE Model beneficiary, the beneficiary may be eligible for reduced coinsurance. In that case, the Medicare payment will be adjusted upward so that the allowed amount remains constant.
CMS’s own example uses round numbers. If the Original Medicare Part B allowed amount under the GLOBE Model is $100 and the GLOBE Model beneficiary coinsurance percentage is 10%, the provider would receive $90 from Original Medicare instead of $80. The beneficiary would pay $10 instead of $20, maintaining the allowed amount of $100.
| Item in CMS’s example | Amount CMS gives |
|---|---|
| Original Medicare Part B allowed amount under the GLOBE Model | $100 |
| GLOBE Model beneficiary coinsurance percentage | 10% |
| The provider would receive from Original Medicare | $90 (instead of $80) |
| The beneficiary would pay | $10 (instead of $20) |
Source: CMS, GLOBE Model Frequently Asked Questions (example)
The Model’s Dates and Part B Premiums
The GLOBE Model will launch on January 1, 2027, and run through March 31, 2032. Rebate invoicing and reconciliation continue into 2034. Reduced coinsurance amounts for GLOBE Model drugs are in effect from April 1, 2027, to March 31, 2032.
There is also a possible effect, and it is not limited to the cohort. All Medicare beneficiaries may experience a reduction in Part B premiums because of model savings, CMS says.
Beneficiaries who are not in the model cohort will not be eligible for the model coinsurance reduction, but they will be eligible for any Medicare Part B premium savings as a result of the model test.
On access, CMS says the model does not restrict beneficiaries’ access to Original Medicare Part B drugs or other Medicare covered services. CMS will monitor whether there are shifts in drug utilization, including potential shifts from Medicare Part B to Medicare Part D. It will also evaluate whether beneficiary access to drugs changes under the model and monitor for unintended access issues.
How a particular drug, ZIP Code, and supplemental coverage would combine for one person is a question for a qualified professional.
The dates set the order. The GLOBE Model ZIP Codes List arrives by January 16, 2027. Reduced coinsurance amounts take effect on April 1, 2027.
This article is general information, not professional advice. For decisions about your money or health, consult a qualified professional.