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It is quite possible that stomach/GI/liver metabolism breaks down the peptide such that a therapeutic dose is not achieved in target tissues

FDA statement Semaglutide receptor-engagement model - PeptideFox semaglutide explainer, Chapter 6

What sets DR

The second time that an ACO's benchmark is adjusted based on the ACO's regional service area expenditures, CMS calculates the regional adjustment using either the 50 percent of the difference between the average per capita amount of expenditures for the ACO's regional service area and the average per capita amount of the ACO's rebased historical benchmark if the ACO is determined to have lower spending than the ACO's regional service area ( 425.656(e)(2)(i))