Medicare pilots tie drug prices to global benchmarks, expand digital care

On December 19, 2025, the Centers for Medicare and Medicaid Services unveiled two experimental programs designed to use international price benchmarks to influence Medicare drug pricing. Named GLOBE and GUARD, the pilots will apply to elements of Medicare Part B and Part D and are presented by the agency as tools to rein in beneficiaries’ out of pocket spending. In parallel, CMS and the Food and Drug Administration announced two digital health initiatives called ACCESS and TEMPO intended to expand technology enabled care, reward patient outcomes, and accelerate adoption of digital devices among Medicare populations.

Agency materials attributed the drug pricing announcement to CMS and described the digital health projects in a Medicare.gov post by Laura Mannweiler. CMS Administrator Dr. Mehmet Oz framed the broader agenda by observing that the Medicare system “hasn’t changed much in decades,” language the agency used to justify a twin strategy of cost containment and modernization.

The public health stakes are high. Bringing international price benchmarks into Medicare pricing could lower costs for older adults and people with disabilities who face steep copays for certain therapies. Reduced out of pocket burdens can improve adherence to chronic disease medications, which in turn affects outcomes for conditions such as diabetes, heart disease, and cancer that disproportionately harm low income and racially marginalized communities. At the same time, significant design details remain unspecified in the initial announcement, leaving clinicians, patient advocates, and safety net providers without clarity on which drugs or therapeutic classes would be affected, how benchmarks will be chosen, or how savings will flow to patients rather than intermediaries.

The digital health pilots were described as efforts to modernize the federal digital health ecosystem, with a focus on chronic care management and measurement of meaningful patient outcomes. ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions, while TEMPO is the Technology Enabled Meaningful Patient Outcomes program. Officials said the programs will explore tech enabled care delivery models, but they did not publish operational details such as eligible populations, provider participation rules, interoperability standards, or data privacy safeguards.

Policy experts said the announcements signal an ambitious two track approach, but they also underscored gaps that could determine whether the programs advance equity or deepen disparities. Implementation choices about which international prices to use, how to handle rare disease therapies with small markets, and how to protect access in rural and underserved areas will disproportionately affect communities that already face barriers to specialty care. Digital pilots carry their own equity risks if devices and remote services are deployed without attention to broadband access, digital literacy, and culturally competent design.

Regulatory and legal questions also loom. CMS did not specify the statutory authorities that would underpin GLOBE and GUARD, nor did it provide timelines or evaluation metrics. For Medicare beneficiaries and advocacy groups the immediate priority will be transparency about the selection criteria, expected savings, and safeguards to ensure patients retain access to clinically necessary medicines.

As CMS and FDA move to operationalize these pilots, public health officials, legislators, clinicians, and community organizations will be watching to see whether the measures reduce financial strain and expand equitable access to innovation, or whether gaps in design and oversight limit their promise.