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A 12-month authorization applies

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Am J Physiol Endocrinol Metab 2004;287:E1209E1215

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Some individuals experience negative reactions and the worsening of symptoms when they begin thiamine repletion therapies using the more biologically available formulations like thiamine tetrahydrofurfuryl disulfide (TTFD)

The result is a catch-22: patients must persist long enough to demonstrate clinical benefit, yet the financial burden often prevents that persistence, undermining the very outcomes needed to justify reimbursement