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This final rule provides descriptions of the requirements that we would mandate, identifies the payment methodology to be tested, and presents rationales for our decisions and, where relevant, alternatives that we considered

The groups most likely to develop B12-related hair and skin changes are the same ones at risk for deficiency generally: vegans and vegetarians, adults over 50, people on long-term metformin or proton pump inhibitors, anyone who's had bariatric surgery, and people on GLP-1 protocols whose reduced appetite has significantly lowered their overall nutrient intake for an extended period

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