GLOBE Part B Drug Payment Model Final Rule
What Changes for Buy-and-Bill Practices Starting 2027
Summary of the Rule or Edit Change
CMS finalized the Global Benchmark for Efficient Drug Pricing (GLOBE) Model on September 30, 2026 (CMS-5545-F). The final rule was published in the Federal Register on October 2, 2026 and takes effect November 30, 2026. It's a mandatory payment model under section 1115A of the Social Security Act that changes how Part B drug inflation rebates are calculated for certain single-source drugs and sole-source biologicals.
The participants are drug manufacturers, not providers. They pay rebates to Medicare based on international price data from 19 reference countries, including Canada, Germany, Japan and the United Kingdom. The model covers drugs in seven USP categories: antigout agents, antineoplastics, blood products and modifiers, central nervous system agents, immunological agents, metabolic bone disease agents and ophthalmic agents. A drug has to have more than $100 million in Original Medicare Part B spending over a 12-month period. CMS excluded drugs with a negotiated maximum fair price, orphan-only drugs, cell and gene therapies and plasma-derived products.
The timeline is longer than the proposal. The model begins January 1, 2027 with a one-quarter voluntary manufacturer reporting period, and the performance period runs from April 1, 2027 through March 31, 2032. CMS delayed the start to allow for changes to Medicare's claims processing systems.
Here's what reaches your claims. CMS will pick a random set of ZIP codes covering about 25% of Original Medicare Part B beneficiaries who have Medicare as their primary payer. When a patient in those areas receives a covered drug, coinsurance is reduced and Medicare's payment rises by the same amount. In CMS's own example, a $100 allowed amount normally pays $80 from Medicare and $20 from the patient. With a reduced 10% coinsurance, Medicare pays $90 and the patient owes $10. Providers don't enroll, and they keep buying and billing and getting separate payment under Part B. CMS won't send individual notices to beneficiaries in the model.
Action Required for Billing Teams
- Check your drug list. Compare the HCPCS codes you bill most against the final GLOBE drug code list when CMS posts it. Oncology, rheumatology, ophthalmology and immunology practices are most likely to be affected.
- Don't collect the standard 20%. From April 1, 2027, patients in selected areas may owe less on included drugs, so your estimates and point-of-service collections need to follow the claim, not a fixed percentage.
- Watch remittances. Expect lower patient coinsurance and higher Medicare payment on affected claim lines, and post them without treating the shift as an error.
- Ask secondary payers how they'll respond. Smaller coinsurance means smaller secondary payments, so check how Medigap and other secondary plans adjust.
- Keep coordination of benefits clean. Patients with employer coverage as primary aren't in the model, so a correct payer order matters.
- Fix unit and modifier errors now. Model data is built from claims, and drug claims with wrong units or missing JW and JZ modifiers are the first to be questioned.
Verifiable References
- Federal Register. Global Benchmark for Efficient Drug Pricing (GLOBE) Model, final rule (CMS-5545-F), published October 2, 2026. federalregister.gov/d/2026-20281
- CMS. GLOBE Model. cms.gov/priorities/innovation/innovation-models/globe
- AJMC. CMS Finalizes Mandatory GLOBE Model to Test Lower Part B Drug Costs. ajmc.com/view/cms-finalizes-mandatory-globe-model-to-test-lower-part-b-drug-costs
- CMS. Medicare Part B Drug Average Sales Price. cms.gov/medicare/payment/part-b-drugs/asp-pricing-files
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