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Gastrointestinal Disease Since cobalamin–IF complex receptors are located in the ileum, chronic gastrointestinal disease, alimentary lymphoma, and ileum resection can lead to cobalamin deficiency, as these conditions reduce ileum absorption capacity [35]

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The mechanism behind that survival, for many independents, has shifted from insurance-network participation toward cash-price competitiveness — discount programs, direct partnerships with cash-pay platforms, and membership or subscription pricing that doesn't depend on being in a PBM's preferred network at all