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Am J Prev Med

The initial drug that CMS will use to calculate the inflation rebate amount ratio is the initial drug identified in accordance with 447.509(a)(4)(iii)(B) of this chapter for the last quarter of the applicable period or, if an initial drug was not identified in the last quarter, the initial drug identified for a quarter most recently in that applicable period

In these situations, patients may have high B12 on blood work but still exhibit neurological symptoms of deficiency (tingling, numbness, cognitive changes)