GLOBE (Global Benchmark for Efficient Drug Pricing) Model

Americans pay more than four times as much for brand-name prescription drugs as people in other developed countries. Spending for Medicare Part B drugs has grown more rapidly than overall national drug spending, increasing costs for beneficiaries who need these drugs and all Americans.

Drugs included in the GLOBE Model are a subset of Part B rebatable drugs (single-source drugs and sole-source biological products) that are used to treat people with Medicare with conditions where there are potentially avoidable high program expenditures and access barriers due to high costs that likely contribute to deficits in care. 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.

The GLOBE Model focuses on testing an innovative payment model that aims to reduce program expenditures for Medicare Part B while preserving or enhancing beneficiaries’ quality of care.

Aims

The GLOBE Model aims to:

• Reduce out-of-pocket costs for people with Original Medicare Part B and costs incurred by Medicare.
• Ensure people with Original Medicare Part B can continue receiving necessary medications to improve their health and quality of care by improving drug affordability.

Innovation

The GLOBE Model is an innovative payment methodology that tests an alternative to the Medicare Part B drug inflation rebate amount calculation for GLOBE Model drugs using international drug pricing information to identify a benchmark that reflects prices paid in a set of economically comparable countries.

Design

Under the GLOBE Model:

• CMS will test an alternative calculation for pharmaceutical manufacturer rebates under the Medicare Part B Drug Inflation Rebate Program that uses a benchmark derived from international pricing information.
• The benchmark is based on either manufacturer-reported international drug net pricing data or available international drug pricing information from commercially available data sources for economically similar reference countries, including 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.
• Beneficiaries' out-of-pocket costs will be tied to the international benchmark, resulting in reduced drug costs to people covered by Original Medicare Part B who receive GLOBE Model drugs and are selected for inclusion in the model based on the model's geographical area. 
• The Original Medicare Part B payment to providers and suppliers will be adjusted; when the GLOBE Model beneficiary coinsurance reduction applies, the Medicare payment is the allowed amount minus the GLOBE Model beneficiary coinsurance amount, subject to other applicable adjustments.

Participants in the model are pharmaceutical manufacturers of GLOBE Model drugs. Participation is mandatory for manufacturers of Medicare Part B drugs that meet the GLOBE Model drug eligibility criteria and are not otherwise excluded. Participating manufacturers may elect to submit international drug net pricing data voluntarily under the process set forth in the GLOBE Model final rule.

• Press Release: GLOBE Model Proposed Rule
• GLOBE Model Notice of Proposed Rulemaking
• Press Release: GLOBE Model Final Rule
• GLOBE Model Final Rule
• GLOBE Model Frequently Asked Questions