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For state Medicaid agencies that opt to participate in the model, implementation will be on a rolling basis from May 1, 2026 through January 1, 2027

O-Acetyl (N,N-dimethyl-D6 98%)-L-Carnitine HCl salt CAS number: 2692624-01-2 Identifiers CAS Index Name: 1-Propanaminium, 2-(acetyloxy)-3-carboxy-N-methyl-N,N-di(methyl-d3)-, inner salt, hydrochloride (1:1), (2R)- Molecular formula: C 9 H 11 D 6 NO 4 .ClH Molecular weight: 245.73 Smiles: Cl.O=C(OC(CC(=O)[O-])C[N+](C)(C)C)C Isomeric Smiles: C(C(CC([O-])=O)OC(C)=O)[N+](C([2H])([2H])[2H])(C([2H])([2H])[2H])C.Cl InChI: InChI=1S/C9H17NO4.ClH/c1-7(11)14-8(5-9(12)13)6-10(2,3)4;/h8H,5-6H2,1-4H3;1H/t8-;/m1./s1/i2D3,3D3

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This elitist strategy prevented loss of high-quality solutions while allowing the majority of the population to undergo evolutionary modification