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Studies suggest that a significant proportion of long-term metformin users may develop biochemical B12 deficiency, though estimates vary widely depending on the population studied, the duration of use, and the B12 threshold applied

[689] We stated in the CY 2025 PFS proposed rule that CMS intends to rely on this payment reconciliation process, through which Part D plan sponsors have an opportunity to correct PDE records flagged by CMS as containing potential outliers, to resolve outliers that would otherwise impact the Part D drug inflation rebate amount calculated under 428.201(a)

June 10, 1953

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Therefore, its worth asking your doctor to also check your active vitamin B12 levels (also known as holotranscobalamin II) and blood or urine levels of methylmalonic acid (5)