US Government Looks Abroad To Tame Medicare Drug Prices With New GUARD, GLOBE Models

Federal health officials are proposing two mandatory payment models aimed at narrowing the gap between U.S. prescription drug prices and those paid in other developed countries, as Medicare spending continues to climb.

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The Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model and the Global Benchmark for Efficient Drug Pricing (GLOBE) Model would require manufacturer rebates when U.S. prices exceed international benchmarks, to lower out-of-pocket costs while maintaining quality of care.

The Centers for Medicare & Medicaid Services (CMS) on Monday outlined GUARD as a five-year model focused on drugs covered under Medicare Part D.

The proposal targets medications whose prices in the U.S. significantly exceed those paid in economically comparable countries, a trend CMS says has accelerated over time.

Under the proposal, GUARD would launch on Jan. 1, 2027, and run through Dec. 31, 2031, with rebate reconciliation extending into 2033. Public comments on the Notice of Proposed Rulemaking are due by Feb. 23, 2026.

CMS cited sharp growth in Medicare prescription drug spending to justify the model. Gross Part D drug spending rose from $121 billion in 2014 to $276 billion in 2023, growing at nearly 10% annually. In 2024, Part D accounted for roughly 30% of total U.S. drug spending.

High drug prices, CMS said, often force older adults to skip or reduce doses, leading to poorer health outcomes and higher downstream costs such as hospitalizations. GUARD would adjust inflation rebate calculations to reflect international pricing, lowering net costs for certain drugs and potentially improving adherence.

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The proposal also includes the GLOBE Model, which would apply a similar international pricing benchmark to certain Medicare Part B drugs, typically administered in clinical settings. These include treatments for cancer, autoimmune diseases, arthritis and other chronic conditions.

GLOBE would begin Oct. 1, 2026, and run through 2031, with reconciliation continuing into 2033. Like GUARD, it would require manufacturer rebates when U.S. prices exceed those paid in comparable countries.

CMS noted that Americans often pay three times more than patients in other developed nations for the same medications, and that Part B drug spending has grown faster than overall national drug spending.

Both models would rely on manufacturer-reported international pricing data or other available sources to establish benchmarks. Rebates would continue to flow into the Medicare Supplementary Medical Insurance Trust Fund.

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