Only 4 Drugmakers Left in GLOBE Model as $11.9B Savings Falls to $440M

For biopharma leaders, the final GLOBE rule creates a two-tier market: sign a separate MFN agreement with the White House and avoid mandatory Part B price-setting, or remain among the shrinking pool of four companies still subject to the model. The footnote does not name those four, but it defines the new regulatory dividing line for commercial strategy and market access. With $11.9 billion in projected savings erased to $440 million, the mandatory model is now less a cost-control threat than a lever pushing companies toward negotiated deals.

On September 30, 2026, the Department of Health and Human Services finalized the GLOBE hospital drug pricing model, a Trump administration initiative intended to cut what Medicare Part B pays for physician-administered drugs. A footnote in the final rule signals the program may apply to as few as four manufacturers after HHS waived participation requirements for any company that signed a separate most favored nation pricing agreement with the White House. That administrative choice shifts GLOBE from a broad-based pricing mechanism into a narrow residual program, and it converts the administration's MFN deals into a de facto exemption pathway for the world's largest drugmakers.

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HHS now projects $440 million in Medicare Part B savings over the model period, down 96.3% from $11.9 billion in the proposed rule.

The numbers make the narrowed scope concrete. HHS now projects $440 million in Medicare Part B savings over the model period, down 96.3% from $11.9 billion in the proposed rule. HHS did not respond to questions about what drove the reduction, but the footnote indicates that more than two dozen drugmakers including Pfizer, Eli Lilly and Novo Nordisk have already signed MFN agreements. Because those signatories are waived from GLOBE, only four unnamed manufacturers would remain subject to the model's price-setting requirements. This interplay suggests the savings collapse is less an analytical revision than a structural consequence of exemption design.

For pharmaceutical manufacturers, the final rule creates a two-tier regulatory environment. Signing an MFN agreement with the White House offers a way to avoid GLOBE's mandatory Part B price controls, which creates a powerful incentive to negotiate separate terms. Companies that have not signed face being part of a small, visible cohort of four still subject to the model. The fact that the rule does not name those four manufacturers leaves the industry, hospitals and investors unable to assess the competitive or financial impact squarely. That opacity may itself become a pressure point, as the remaining companies could face heightened scrutiny or targeted pressure to sign MFN deals.

For hospitals and Medicare beneficiaries, the narrower application has direct fiscal consequences. Hospital drug costs under Part B are a significant driver of outpatient spending, and the original proposed rule's $11.9 billion estimate implied meaningful relief. The revised $440 million estimate is too small to materially change Medicare Part B spending trajectories or hospital pharmacy budgets. Providers that hoped GLOBE would create uniform downward pressure on drug acquisition costs may now see those savings concentrated only among a limited set of products from non-MFN manufacturers. Beneficiaries, meanwhile, may see minimal change in cost-sharing for high-volume Part B drugs from the exempted major manufacturers.