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of this final rule): ++ Require Shared Savings Program ACOs to report the APP Plus quality measure set (section III.G.4.b.(2)(a) of this final rule)

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Here's how to do it right: WRONG technique (common mistakes): Tilting head back (solution drips down throat) Sniffing hard immediately after spray (bypasses absorption) Spraying too fast (nose can't absorb volume) Using only one nostril (saturation limits absorption) Spraying with head in wrong position CORRECT technique (follow exactly): Step 1: Preparation Blow nose gently (clear passages) Let nasal spray warm to room temperature (5 min from fridge) Shake bottle gently Prime pump if not used recently (2 sprays into air) Step 2: Head position Stand or sit upright Tilt head SLIGHTLY FORWARD (not back!) This is critical - prevents throat drainage Keep spray bottle upright Step 3: Spray technique Insert nozzle into one nostril (shallow, not deep) Close other nostril with finger Breathe in GENTLY through nose Press pump firmly (one spray) DO NOT sniff hard - gentle breath only Step 4: After spray Keep head slightly forward for 30-60 seconds Breathe normally through mouth Let peptide absorb into nasal mucosa Avoid sniffing deeply (reduces absorption) Avoid swallowing immediately Step 5: Alternate nostrils Wait 1-2 minutes Switch to other nostril Repeat spray technique Distribute dose across both nostrils Example: 4 total sprays = 2 per nostril Complete dosing sequence example (4mg PT-141): Spray 1: Right nostril hold 1 minute Spray 2: Left nostril hold 1 minute Spray 3: Right nostril hold 1 minute Spray 4: Left nostril hold 1 minute Total time: ~5 minutes Total dose: 4mg Why this matters: Wrong technique = swallowed peptide = destroyed in stomach = zero effect Correct technique = nasal absorption = systemic effect = money well spent Technique difference is success vs complete failure Timing and frequency When to dose: Empty stomach preferred (no food in nose, but general absorption better) Time relative to desired effect (e.g., PT-141: 1-3 hours before) Consistent timing if daily dosing Before bed common for cognitive peptides How often: Depends on peptide and half-life PT-141: As needed (hours before activity) Semax: 1-3 times daily typically Follow peptide-specific protocols Consistency matters for daily peptides Avoiding tolerance: Some peptides build tolerance (use cyclically) Others fine for continuous use Peptide-dependent Generally: cycles better than continuous Take breaks periodically Dosing adjustments for nasal vs injection You can't use the same dose

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