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If CMS determines the criteria set forth in paragraph (c)(4) of this section are met, then CMS will reduce the total rebate amount determined under 427.301(a), if any is owed, for a Part B rebatable biosimilar biological product by 75 percent for the applicable calendar quarter in which the event occurred or began, or the following applicable calendar quarter if the request is submitted less than 60 calendar days before the end of an applicable calendar quarter, and the 3 subsequent applicable calendar quarters

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175,176 This mechanism supports protective autophagy in granulosa cells and cochlear marginal cells during hypoxic stress, which is consistent with the finding that the HIF-1/Beclin1-mediated autophagy pathway confers neuroprotection under hypoxic preconditioning