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You would want to set your GPCI and state medicaid settings for your own company location

Future research should investigate long-term outcomes in high-risk populations, direct comparisons between physiological and pharmacological dosages, cost-effectiveness analyses, and adherence metrics to inform optimal strategies for the prevention and management of vitamin B12 deficiency

Disruptions in the intrinsic factor (IF) pathway, including impaired IF production due to autoimmune conditions (pernicious anemia), damage to the ileum from diseases like Crohns or celiac disease, or surgical resection of the ileum, can severely impair B12 absorption

As with anything related to government agencies, this doesnt happen overnight