By Marc Gilman
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Key Takeaways
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CMS has finalized a pilot program, called Globe, that ties what Medicare Part B pays for certain high-cost drugs to prices in 19 other countries with comparable economies. It starts January 1, 2027, and runs as a five-year test through Medicare’s Innovation Center.
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It applies to a narrow slice of medicine — not drug prices broadly. Globe covers Part B drugs specifically: expensive medications administered by a doctor or hospital (think infusions for cancer or autoimmune conditions), not the pills most people pick up at a pharmacy, which fall under Part D instead.
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The final version is much smaller than originally proposed. CMS exempted rare-disease drugs and other medicines after public comment, and more than 20 drugmakers have separately cut their own price deals with the administration — exempting their products if those companies also participate in a parallel Medicaid-focused program. The result: only four manufacturers are actually covered under Globe.
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Projected savings shrank accordingly — from an initial estimate of $11.9 billion down to about $440 million over seven years, according to the administration’s own figures.
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The drug industry’s trade group has called the program unlawful and says it won’t lower patients’ out-of-pocket costs; legal challenges are considered likely. A related program for a different set of drugs, called Guard, hasn’t been finalized yet.
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This doesn’t change anyone’s Medicare coverage or costs today. Globe is a pilot affecting a handful of specific Part B drugs and manufacturers starting in 2026 — it’s not a change to Part B premiums, Part D plans, or the broader structure of Medicare.
What Is Globe, Exactly?
Globe is a new CMS pilot program designed to bring down what Medicare pays for certain high-cost drugs by tying U.S. prices to what 19 other countries with comparable economies pay for the same medications. It’s run through the Center for Medicare and Medicaid Innovation, and it applies specifically to Part B drugs — the expensive medications that doctors or hospitals administer in person, like infusion therapies for cancer or autoimmune disorders, rather than the take-home prescriptions covered under Part D. One example cited in reporting on the program is Entyvio, a Takeda drug used to treat Crohn’s disease and ulcerative colitis.
The program is structured as a five-year experiment covering some patients receiving some of these drugs. If it demonstrates savings for taxpayers without compromising care quality, CMS could expand it nationwide after the pilot period.
CMS administrator Dr. Mehmet Oz framed the rationale directly: “Medicare Part B patients and American taxpayers have paid significantly more for prescription medications than people in comparable countries… we’re taking action to pilot a new approach to lower costs and strengthen the quality of care while preserving medical innovation.”
Why Is the Final Version So Much Smaller Than Originally Proposed?
Globe was first proposed in December, and the version that actually took effect looks considerably narrower:
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Rare disease drugs and other medicines were exempted after CMS reviewed public comments on the original proposal.
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More than 20 pharmaceutical companies have separately negotiated their own price deals directly with the administration. Companies that made those deals are exempt from Globe if they also participate in a parallel program focused on Medicaid pricing.
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The combined effect is that only four manufacturers are actually covered under the final Globe rule — a detail CMS disclosed in a footnote to the rule itself.
That narrowing has real financial consequences: the administration’s own projected savings dropped from an initial $11.9 billion estimate down to roughly $440 million over seven years. Rachel Sachs, a law professor at Washington University in St. Louis, put it plainly: “The set of drugs and potential impact of the program has shrunk dramatically with the scale of these exclusions.”
There’s also a strategic wrinkle worth understanding. Dr. Thomas Hwang of Harvard Medical School’s Cancer Innovation and Regulation Initiative noted that companies with cancer treatments or other drugs heavily used by Medicare’s older population may come out ahead by opting into the Medicaid-focused alternative instead — where they have fewer patients and less exposure — rather than facing Globe’s Medicare-focused pricing. As Hwang described it: “Companies gave a little where it costs them least, to avoid giving a lot where it costs them most.”
What Do Critics and Skeptics Say?
Reactions to Globe span a wide range, and it’s worth laying out the different perspectives rather than just one side:
The pharmaceutical industry’s trade association (PhRMA) has been sharply critical, calling the policy unlawful. A spokesman said: “This policy exceeds agency authority, does nothing to lower patients’ out of pocket costs, and imports foreign prices based on discriminatory value metrics and government price controls that delay, limit, or deny access to new treatments.” Legal challenges from drugmakers are considered likely, and a first-term Trump administration attempt at similar international-pricing policy was ultimately blocked by courts after coming late in that term.
Industry analysts have also been skeptical of the program’s real-world impact. TD Cowen analyst Molly Turco noted that while these pilot programs and deals “draw headlines,” the drug-price negotiation program created under the Biden administration’s 2021 legislation is expected to produce larger discounts than Globe will.
Consumer advocates have raised a different concern — not that Globe goes too far, but that it may not accomplish much for patients. Peter Maybarduk of Public Citizen’s Access to Medicines program said: “The administration is likely to end up wasting more taxpayer money fighting the likely lawsuits on this model than it saves for patients.”
What Does This Mean for You Right Now?
For the overwhelming majority of Medicare beneficiaries, Globe changes nothing in the near term. It’s a narrow pilot covering specific infusion and injectable drugs from four manufacturers, not a change to Part B premiums, Part D formularies, or any Medicare plan’s structure or cost-sharing. If you or a family member currently take one of the Part B drugs affected by Globe, it’s worth knowing the program exists — but there’s no action required on your part, and no coverage change to navigate as a result of this announcement.
The bigger-picture takeaway is that drug pricing policy at the federal level remains an active, contested area — between this pilot, the still-unfinalized Guard program covering a different set of drugs, and the broader Medicare drug price negotiation program already in place from 2021 legislation. Expect more changes in this space, not fewer, over the next few years.
What To Do Next
If you have questions about how a specific medication is covered under your Medicare plan — Part B, Part D, or otherwise — we’re happy to help you understand your actual coverage and costs.
Questions? Call (800) 927-9326 or email
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Source: Liz Essley Whyte and Lizzy Lawrence, “Trump Administration Finalizes Plan to Lower Drug Prices in Medicare,” The Wall Street Journal, September 30, 2026, citing CMS Administrator Dr. Mehmet Oz; Rachel Sachs (Washington University in St. Louis); Dr. Thomas Hwang (Harvard Medical School); Molly Turco (TD Cowen); PhRMA spokesman Chanse Jones; and Peter Maybarduk (Public Citizen).
This article is for general educational purposes only and does not represent an endorsement or criticism of any government program or administration. Figures, eligibility criteria, and timelines described here reflect information available as of publication and are subject to change or correction as more official detail becomes available. This is not tax or legal advice, and is not a solicitation related to this specific payment. This is not an offer of coverage. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Consult Medicare directly at 1-800-MEDICARE for your individual eligibility status.
