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As described in the example in the CY 2025 PFS proposed rule (89 FR 61977), if CMS receives a likely to be in shortage rebate reduction request for a generic Part D rebatable drug that was submitted on August 15, 2024, and that generic Part D rebatable drug is currently in shortage from September 15, 2025, until May 15, 2028, CMS will apply a 75 percent reduction in the total rebate amount for the duration of the applicable period for which the likely to be in shortage rebate reduction request was granted (that is, October 1, 2024, to September 30, 2025), and then would apply the shortage reduction as set forth in 428.301, beginning with a reduction of 75 percent for a generic Part D rebatable drug for the applicable period beginning October 1, 2025, followed by a reduction of 50 percent for the applicable period beginning October 1, 2026, and a 25 percent reduction for the applicable period beginning October 1, 2027

However, this approach can introduce sparsity into the model

B12 is crucial for a healthy brain and immune system

Doskey, C

We explained that we considered whether to account for the possibility that the improper payment amounts would be appealed, and the amount redetermined, as part the proposed methodology, but did not propose a related approach