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Response: We appreciate MedPAC's concerns, but as MedPAC acknowledges in its comment, the Congress would need to change current law to implement MedPAC's suggestions

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Of these, 48 were non-calcified and 10 were calcified

Early evidence for the potential efficacy of this route was published in 1999, where 18 patients with B12 deficiency treated exclusively with 712 days of 2 mg of sublingual cobalamin daily had 4 times higher B12 levels compared to pre-treatment, reaching therapeutic ranges ( There have also been further studies comparing treatment outcomes from the sublingual route to the more established IM and oral routes

Hydroxocobalamin: Choosing the Right B12 Supplement for Your Needs Ideal Candidate Methylcobalamin is the preferred choice for individuals who require targeted nerve support and rapid neurological benefits