News and Reports | October 1, 2026
P4AD warned exemptions would weaken GLOBE; projected savings fall 96% from $11.9 billion to just $440 million
WASHINGTON, D.C. — The Trump administration has finalized GLOBE, a mandatory Medicare Part B drug pricing model set to begin in early 2027, but the final model is now projected to save just $440 million — a staggering 96% decrease from what CMS originally projected. When GLOBE was proposed in December 2025, CMS estimated the model would save Medicare $11.9 billion over seven years while lowering coinsurance for patients who take affected drugs.
Central to the dramatic reduction is the administration’s decision to allow drugmakers participating in voluntary deals, including the GENEROUS model, to receive waivers from mandatory GLOBE participation. Patients For Affordable Drugs (P4AD) warned CMS about this exact outcome in February. In comments on the proposed rule, P4AD urged CMS not to exempt manufacturers based on voluntary pricing agreements, warning that doing so would “significantly decrease the projected savings” and limit the model’s impact.
The administration moved forward with the carveout anyway. CMS’s own analysis demonstrates their scale: based on an illustrative 2024 list of drugs that would qualify for GLOBE, roughly 19 manufacturers would have been included, but after accounting for the expected waivers, that number falls to four.
“We warned that allowing drug companies to use voluntary deals to escape a mandatory pricing model would weaken GLOBE and reduce savings for patients. They moved forward anyway, and now we’re seeing the result,” said Merith Basey, CEO of Patients For Affordable Drugs. “Drugmakers have secured carveouts that dramatically shrink the reach of GLOBE, while patients on Medicare Part B can still face 20 percent coinsurance for some of the most expensive drugs administered in a doctor’s office with no annual out-of-pocket cap that protects them from these costs. GLOBE was designed to lower those prices and what patients pay, but these pharma-friendly carveouts have undermined that promise. The administration should reverse course and ensure GLOBE delivers the savings it was designed to achieve for patients and taxpayers”
The manufacturer waivers aren’t the only way this final model has been narrowed. The administration also excluded additional prescription drugs, including orphan-only drugs, plasma-derived products, certain cell and gene therapies, as well as biosimilars and their reference products once biosimilar competition begins. Drugs will also leave GLOBE once a Medicare-negotiated price takes effect.
P4AD supported GLOBE because a strong, mandatory model could lower prices for some of Medicare’s most expensive Part B drugs and help ensure patients directly share in those savings. The stakes are significant: traditional Medicare spent nearly $40 billion on physician-administered drugs in 2025, and patients can face 20 percent coinsurance for these high-cost medicines with no annual out-of-pocket cap in Original Medicare.
A mandatory model only works if drugmakers are actually required to participate. And as CMS considers finalizing GUARD, its corresponding model for Medicare Part D, it should not repeat the same mistake by allowing voluntary industry agreements to undermine another mandatory effort to lower drug prices.
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Patients For Affordable Drugs is the only national patient advocacy organization focused exclusively on policies that lower prescription drug prices. We empower and mobilize patients by amplifying their experiences with high drug prices to hold those in power to account and fight to shape and achieve system-changing policies that make prescription drugs affordable for all people in the United States. P4AD does not accept funding from organizations that profit from the development and distribution of drugs. To learn more, visit PatientsForAffordableDrugs.org