How to Collect a Coinsurance CMS Won't Let You Compute
CMS finalized the GLOBE Model this morning. Starting April 1, 2027, about a quarter of Original Medicare patients will owe something between 2% and 12% on certain Part B drugs instead of 20%, decided by the ZIP code on file at CMS, determined inside claims processing, and closed to appeal. A hospital asked for the patient list. CMS said the ZIP codes are enough.
4.282 percent.
That is a Medicare beneficiary coinsurance rate, carried to three decimal places, and it sits on page 63049 of today's Federal Register as CMS's own worked example of what an Original Medicare patient will owe on a Part B drug starting April 1, 2027.
The document it sits in is CMS-5545-F, the final rule for the Global Benchmark for Efficient Drug Pricing Model, 181 pages filed as Part IV of this morning's issue at 91 FR 62936. It is mandatory, it is built under section 1115A, and it prices certain Part B drugs against what nineteen other countries pay for them.
Every piece of trade coverage since the public inspection copy went up has been about the international benchmark and the savings estimate. The part that lands in your shop is smaller and much more annoying.
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The impact tables, the code-level detail, and the rest of the analysis sit past this line.
$50 a month, or $500 a year.
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