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Interestingly, it can take years for B12 stores to deplete to a point where a deficiency becomes apparent: Vitamin B12 deficiency affects multiple systems, and sequelae vary in severity from mild fatigue to severe neurologic impairment

Prescription plans can change what tier a particular drug is assigned to at any time

ACR Open Rheumatol .May 2022;4(5):464-469

Comment: A commenter sought CMS guidance on its plans to ensure consistency across the Medicare Shared Savings Program (MSSP) in applying the revised definitions, providing updated technical specifications and training resources, and monitoring the impact of these changes on MSSP performance scores