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We believe the quartile-based approach in conjunction with the requirement of at least three Safety of Care measures provides a suitable balance between emphasizing Safety of Care broadly across all hospitals (not just at a few extremely low performers) while also ensuring that only hospitals with demonstrably below-average performance would be subject to Overall Hospital Quality Star Rating reduction

Cyanocobalamin is better absorbed as an injection and may not have dependable absorption when given orally

Safety across the full program was consistently favorable: adverse events, primarily mild headache and gastrointestinal symptoms, occurred at rates comparable to placebo, with no treatment-related discontinuations, no IGF-1 elevation, and no impact on glucose metabolism

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Subcutaneous (SubQ): Injected under the skin, usually around the abdominal area or near the injury site for localized effect