Medicare's GLOBE Model Is Final. Here Is What Changes at the Infusion Chair.
CMS will tie rebates on certain physician-administered Part B drugs to prices in 19 other countries, starting in January for about a quarter of Original Medicare beneficiaries. Manufacturers are the participants, but the billing changes reach practices.
The Centers for Medicare and Medicaid Services finalized the Global Benchmark for Efficient Drug Pricing Model, known as GLOBE, on Sept. 30. The model is aimed at drug manufacturers, not physicians. But because it targets drugs that are administered in a clinical setting, it will show up in oncology, rheumatology and ophthalmology practices that bill Medicare Part B for infusions and injections.
How the model works
GLOBE tests a different way of calculating the rebates manufacturers already owe under the Medicare Part B Drug Inflation Rebate Program. For selected drugs, CMS will compare the price to Original Medicare with a benchmark derived from what economically comparable countries pay. When the Medicare price exceeds that benchmark, the manufacturer pays a rebate, and those rebates go to the Medicare Supplementary Medical Insurance Trust Fund, according to CMS.
The reference countries are 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. The benchmark uses either international net pricing data that manufacturers choose to report or pricing information from commercial data sources.
Participation is mandatory for manufacturers of Part B drugs that meet the model's criteria. Eligible drugs are single-source drugs and sole-source biologicals in oncology, rheumatology, immunology, ophthalmology and endocrinology where annual Original Medicare spending exceeds $100 million, with certain exceptions.
What was carved out
The final rule excludes biosimilars and their reference biologics once a biosimilar enters the U.S. market. In a change from the proposed rule made in response to public comments, it also excludes orphan-only drugs, plasma-derived products and certain cell and gene therapies, CMS said in its announcement.
The model is aimed at manufacturers, but the coinsurance change lands at the front desk of every practice that bills an affected drug.
Who is affected, and when
The model starts Jan. 1, 2027, and runs through March 31, 2032, with rebate invoicing and reconciliation continuing until March 31, 2034. It applies only to Original Medicare beneficiaries who live in a randomly selected set of geographic areas covering approximately 25 percent of people with Original Medicare as their primary coverage.
For those beneficiaries, coinsurance on GLOBE drugs will be tied to the international benchmark rather than the usual amount. CMS says the reduced coinsurance applies from April 1, 2027, to March 31, 2032. When the reduction applies, the Medicare payment to the provider or supplier is the allowed amount minus the GLOBE beneficiary coinsurance amount, subject to other applicable adjustments.
What practices should do now
The coinsurance change begins April 1, 2027, which gives billing offices about six months. Practices that administer Part B drugs in the targeted classes should check CMS's model materials to see whether their patients fall in the selected areas, confirm with their billing vendor or practice management system how GLOBE coinsurance will be calculated and displayed, and update the cost estimates staff give patients before treatment. Financial counselors should expect two patients receiving the same drug to owe different amounts depending on where they live.
CMS frames the model in affordability terms. "Medicare Part B patients and American taxpayers have paid significantly more for prescription medications than people in comparable countries," CMS Administrator Dr. Mehmet Oz said in the announcement. The agency cites an analysis by the HHS Office of the Assistant Secretary for Planning and Evaluation finding that Part B drug spending grew nearly four times as fast as drug spending across all payers between 2008 and 2021.
CMS has posted the final rule and frequently asked questions on the GLOBE model page. Practice administrators should read the FAQs before January, not after the first remittance arrives.
Marcus Bell covers health policy, reimbursement, and regulation for The Script Pad.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
