“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 when the agency announced a new mandatory payment model on September 30. The model, called GLOBE, reaches about a quarter of people with Original Medicare, and the rule that creates it does not say where they live. No ZIP code appears in it.
A random draw of ZIP Code Tabulation Areas decides who is in
The final rule, published in the Federal Register on October 2, 2026 as document 2026-20281 (91 FR 62936), calls GLOBE “a new mandatory Medicare payment model under section 1115A of the Social Security Act.” Inclusion turns on geography, and the rule says how the geography is picked: “The GLOBE Model geographic areas will be determined through a random selection of ZIP Code Tabulation Areas (ZCTAs).”
The rule puts the size of the resulting group at “approximately 25 percent of beneficiaries who are enrolled in OM Part B,” meaning Original Medicare Part B. CMS’s September 30 announcement describes the same share as approximately 25 percent of Medicare beneficiaries with Original Medicare as their primary coverage, living in randomly selected geographic areas.
The full rule text lists no ZIP codes and no ZCTA count
The absence is specific. In the full text of the rule, no individual ZIP code or ZCTA is named. The text states that the regulation “does not state an exact number of ZCTAs to be selected.” The only quantity attached to the draw is the roughly 25 percent of Part B enrollees it is expected to produce.
Nor does CMS’s own GLOBE Model page, last modified October 1, 2026, carry a list. That page describes GLOBE as “a mandatory model that will assess a rebate for certain drugs payable under Original Medicare Part B if the prices exceed those paid in economically comparable countries.” It says out-of-pocket costs will be tied to the international benchmark for people “selected for inclusion in the model based on the model’s geographical area,” and it shows no geographic areas.
The promise to post the list on a website, with no date
The rule does commit CMS to publishing the selection. It states that CMS “will post accessible technical documentation, user-friendly fact sheets, FAQs, the GLOBE Model Drug HCPCS Level II Code List, and the model geographic areas on the GLOBE Model website.” The geographic areas are one item in a list of materials, and the sentence carries no posting date. Neither the rule nor the model page read for this piece gives one.
The same sentence names a second list that will be published, the drug code list. GLOBE applies to separately payable Part B drugs and biological products, which are mostly medications given by a clinician, and it excludes biosimilars, orphan-only drugs, plasma-derived products and certain cell and gene therapies, according to the CMS announcement. The rule ties the covered drugs to a Healthcare Common Procedure Coding System code with Original Medicare Part B spending above $100 million. So two lookups will eventually decide whether the model touches a given patient: whether the home ZCTA was drawn, and whether the drug is on the code list.
Address of record, no notice, no opt-out
The rule describes how a person lands in the group. Before the model’s performance period, and “no more frequently than monthly thereafter,” CMS “will identify beneficiaries for inclusion in the model cohort by determining whether the beneficiary’s address of record falls within the GLOBE Model geographic areas.” Membership is therefore tied to an address on file, and it can be recalculated as often as every month.
The rule also closes off the usual routes for a person to learn about or leave a model: “CMS will not require direct beneficiary notification or establish a beneficiary opt-out because inclusion in the model does not require beneficiaries to enroll or take any action.” The only publication the rule describes for the geographic areas is the website posting.
January 1 and April 1, 2027 mark different steps
Two start dates circulate, and the documents agree once read closely. The rule takes effect November 30, 2026. The model page says GLOBE “will launch on January 1, 2027, and run through March 31, 2032, with rebate invoicing and reconciliation continuing into 2034.” The rule’s detail is that January 1, 2027 is when collection of voluntary manufacturer-submitted international drug pricing data begins, and April 1, 2027 is when the five-year performance period starts and beneficiary coinsurance changes and adjusted payments take effect. The CMS announcement likewise says reduced out-of-pocket costs could begin April 1, 2027.
The Federal Register document is the record of what CMS committed to on October 2: random selection of ZCTAs, a Part B share of about 25 percent, a website posting for the geographic areas and no date for it.
A drug code list and a ZIP list that cannot be matched yet
The GLOBE final rule leaves two lookups unpublished, the model geographic areas and the drug code list, and sets no date for either. Until both appear, an Original Medicare patient who receives infused or injected drugs has no way to tell whether the model applies. The practical job in the meantime is keeping an organized record of what each of those drugs costs.
The Medicare Cost & Coverage Protection Kit is a 10-page kit with a medication and cost tracker and the prior-authorization appeal steps, so the record and any coverage denial can be handled in one place.
Keep a running record of clinician-administered drug costs while the ZIP list stays unposted →
This piece was drafted with AI assistance; the quotations were checked against the Federal Register final rule 2026-20281 and CMS’s GLOBE Model page and announcement.
