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Commercial payers follow similar frameworks but may impose additional utilisation management requirements including prior authorization, step therapy protocols, or quantity limits

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So when I prescribe 1000 mcg daily, I am giving a large dose knowing that the absorption fraction is small

For instance, the NICE guideline says that with total B12 values of over 350 ng/L,0 deficiency is unlikely

[DOI] [PubMed] [Google Scholar] 403.Mabalirajan U., Aich J., Leishangthem G.D., Sharma S.K., Dinda A.K., Ghosh B

Persistent heel pain, worsening symptoms, swelling, numbness, inability to bear weight, repeated injury, or pain that limits normal movement should be reviewed by qualified healthcare professionals, sports medicine clinicians, podiatrists, or physical therapists where relevant