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We are finalizing, with a minor modification for consistency and clarity, our proposal to specify under new paragraph (l)(3) of 425.610 provisions for how CMS determines whether to apply an alternative performance payment limit or loss recoupment limit if an ACO has fewer than 5,000 assigned beneficiaries in BY1, BY2, or BY3, in conducting financial reconciliation for each performance year, for agreement periods beginning on or after January 1, 2027

Any cell line may be affected, but thrombocytopenia seems to be a particular issue

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This route is preferred when the goal is systemic peptide exposure rather than topical mucosal contact