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There are exceptions to the productivity standards that can be made based on individual circumstances that is at the discretion of the MAC

Specifically, CMS is proposing to codify with limited modification policies set forth in guidance for the Medicare Prescription Drug Inflation Rebate Program by adding new parts 427 and 428 to title 42, chapter IV of the Code of Federal Regulations for Part B and Part D, respectively, and welcomes comments on these proposals

Hence, this review aimed to provide evidence that smoking has a mutagenic effect on sperm and how this subsequently affects male fertility