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Occasionally used off-label for fibromyalgia, restless leg syndrome, anxiety Pharmacokinetics Absorption: Oral, dose-dependent bioavailability (decreases at higher doses) Distribution: Not highly protein-bound Metabolism: Minimal hepatic metabolism Excretion: Renal (adjust dose in renal impairment) Half-life: 57 hours Adverse Effects Common: dizziness, somnolence, ataxia, fatigue Less common: peripheral edema, tremor, blurred vision Rare: hypersensitivity reactions, mood changes Pregnancy / Lactation Pregnancy: Limited human data

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The commenter also indicated that although Medicare Advantage is not a market-based system, the proposal would create an opportunity for negotiations to reflect market dynamics even if the immediate impact of the proposal is minimal due to the current extremely close correlation between the MS-DRG relative weights and the MA rates