The federal government has finalized a Medicare drug pricing experiment that will cover about one in four people in Original Medicare, and the people picked will not be told. The Centers for Medicare & Medicaid Services (CMS) chose them by drawing ZIP code areas at random. The agency says there is no way to opt out.

CMS published the final rule for the Global Benchmark for Efficient Drug Pricing Model, known as the GLOBE Model, in the Federal Register on October 2, 2026, at 91 FR 62936. The regulations take effect on November 30, 2026.

How the ZIP code draw works

The rule says the geographic areas will be “determined through a random selection of ZIP Code Tabulation Areas.” The people living inside those areas make up the test group. CMS sizes that group at approximately 25 percent of beneficiaries enrolled in Original Medicare Part B.

That is a quarter of Original Medicare, not a quarter of everyone on Medicare. People in Medicare Advantage plans and cost plans are left out of the group by the rule. The trade publication AJMC describes it as about 25 percent of beneficiaries who have Original Medicare as their primary coverage.

The rule does not publish a list of the chosen ZIP codes. CMS says it will identify each beneficiary by the address of record and check whether that address falls inside a selected area. A move can therefore change which group a person is in.

The people affected are those in Original Medicare who take Part B drugs, the medicines given in a doctor’s office or infusion center rather than picked up at a pharmacy counter. The first thing to check is the address Medicare has on file. The second is whether any drug in the treatment plan is one of the expensive Part B medicines the model covers.

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No notice, no opt-out, no appeal

The rule is plain on all three points. CMS “will not require direct beneficiary notification or establish a beneficiary opt-out,” the final rule states. The same text says the selection of the test group is not subject to appeal under section 1115A(d)(2) of the Social Security Act.

The mandatory part falls on drug makers, not patients. All manufacturers of the covered Part B drugs must take part, while doctors and suppliers who give the drugs are not participants. Patients are simply placed in the group by where they live.

The rule treats this as a benefit, since people in the test group pay less, and that is why it needs no sign-up. It also means a patient outside the drawn ZIP codes pays the usual rate for the same drug. CMS lists Nicholas Minter as the contact for the model, at [email protected] and (410) 786-8914.

What changes on the Part B bill

The test has two start dates. The GLOBE Model begins on January 1, 2027, when drug makers start submitting data on a voluntary basis. The five performance years, when the lower coinsurance applies, run from April 1, 2027 through March 31, 2032. AJMC reports the same period for the reduced coinsurance, which is why the pricing test reaches patients on April 1, 2027 rather than on New Year’s Day.

For a person in the test group, coinsurance on a covered drug drops. The rule’s example is a drug with a $100 Medicare-allowed amount, where coinsurance is “reduced to 10 percent (instead of the usual 20 percent),” so $10 instead of $20. CMS projects that 94 percent of the illustrative model drugs would carry coinsurance between 2 percent and 12 percent.

Medicare.gov says Part B coverage in 2026 usually leaves 20 percent of the Medicare-approved amount to pay after a $283 yearly deductible, with a monthly premium of $202.90 for most people. Those are the 2026 figures, and the page carries no 2027 numbers yet.

The model covers single-source Part B drugs and sole-source biologicals with more than $100 million in Original Medicare Part B spending over a 12-month stretch. The rule leaves out orphan-only drugs, plasma-derived products and certain cell and gene therapies. AJMC says the drugs center on oncology, rheumatology, immunology, ophthalmology and endocrinology.

Drug makers are tied to prices in 19 reference countries. CMS estimates the model will produce $177 million in total out-of-pocket savings for beneficiaries and about $440 million in net Medicare Part B savings across the seven-year payment period. Those are projections, not payments, and CMS publishes no headcount of the people inside the test.

The savings reach only the drawn group. Patients in the other three quarters of Original Medicare pay the standard 20 percent on the same drugs, with nothing in the rule that lets them in.

Where to check costs before April 2027

Anyone on Original Medicare who relies on an expensive Part B drug has two practical jobs before spring. One is confirming the address on file with Medicare. The other is working out what the 20 percent share would be if the ZIP code is not drawn, and whether state help could cover it.

Medicare.gov describes the Medicare Savings Programs, which are run by each state. The Qualified Medicare Beneficiary program covers Part B premiums, deductibles, coinsurance and copayments. The 2026 limits are $1,350 a month in income and $9,950 in resources for one person, and $1,824 and $14,910 for a couple. The page adds that some states use different rules and urges people to apply even if they doubt they qualify.

That help does not depend on where a person lives in the draw, since it is tied to income and resources. The Federal Register’s CMS listing showed no stay or correction to the GLOBE rule through October 16, 2026.

Taking an expensive Part B drug in 2027?

The ZIP code draw cannot be checked in advance, and it cannot be appealed. A patient on a costly Part B infusion who lands outside the chosen areas still faces 20 percent of the bill from April 1, 2027, while a person in a drawn area may owe half that on a covered drug.

Because the draw is out of any patient’s hands, the cost help that applies to everyone matters more. The Medicare Cost & Coverage Protection Kit gathers the 51 state Medicare cost-help packs, so a household can see which programs pay Medicare premiums and cut drug bills where it lives. It also explains the new Part D out-of-pocket cap, and its Beat a Denial section covers what to do when coverage is refused.

Get the state cost-help packs and drug-cost tracker for a 2027 Part B bill →

More Financial Reading

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• The New $6,000 Senior Deduction and 14 More Tax Moves for Retirees

This article was produced with AI assistance and edited for accuracy against the sources linked above.