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The conventional workflow requires sourcing two separate lyophilised vials, reconstituting each with bacteriostatic water, calculating concentrations against differing fill weights, drawing two syringes, and maintaining cold-chain storage for both

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CMS said that In 2017, it acted to phase-out these expenditures, noting “demonstrations have not made a compelling case that federal DSHP funding is necessary to support the continuation of important programs previously operated by the state, and federal DSHP funding is inconsistent with the overall federal-state financial relationship under the Medicaid statute.” According to CMS, the DSHP and DSIP programs have grown from approximately $886 million in 2019 to nearly $2.7 billion in eligible expenditures in 2025, representing increasing costs to the federal government without a sustainable state contribution