Medicare Negotiates Prices and Saves People Billions
The Inflation Reduction Act of 2022 made several changes that affect Medicare beneficiaries. One of the most significant empowers Medicare to negotiate the prices of single-source drugs that don’t have generic competition or similar alternatives available. The negotiations are rolling out in rounds.
While most people think of Medicare as a benefit for retired workers receiving Social Security benefits, it’s important to remember that Social Security disability (SSD) recipients are also entitled to Medicare benefits after two years. Here’s what retirees and SSD recipients receiving Medicare benefits can expect.
Round One Drugs
To start, Medicare will be targeting 10 drugs. These 10 drugs alone account for more than $50 billion in Medicare Part D expenditures. Between June of 2022 and May of 2023, more than 8 million Part D participants took at least one of these drugs. Their share of the cost was more than $3.4 billion, or an average of about $412 each.
The first-round drugs are:
Eliquis, for the prevention and treatment of blood clots–more than 3.7 million participants took this drug during that one-year period
Jardiance, for diabetes and heart failure–more than 1.5 million participants took this drug during that one-year period
Xarelto, for prevention and treatment of blood clots–more than 1.3 million participants took this drug during that one-year period
Januvia, for diabetes–more than 850,000 Medicare Part D participants took this drug during that one-year period
Farxiga, for diabetes, heart disease and chronic kidney disease–nearly 800,000 participants took this drug during that one-year period
Entresto, for heart failure–more than 550,000 recipients took this drug during that one-year period
Enbrel, for rheumatoid arthritis, psoriasis, and psoriatic arthritis–nearly 50,000 participants took this drug during that one-year period
Imbruvica, for blood cancers–20,000 recipients took this drug during that one-year period
Stelara, for psoriasis, psoriatic arthritis, Crohn’s disease and ulcerative colitis–more than 20,000 participants took this drug during that one-year period
Fiasp and NovoLog insulin products, for diabetes–more than 750,000 participants took this drug during that one-year period
Medicare recipients can look forward to cost savings starting in 2026. The U.S Department of Health and Human Services has also released final guidance for the second round of negotiations, which will impact 2027 pricing.
Medicare and Social Security Disability (SSD)
The first step toward qualifying for Medicare benefits is to successfully apply for Social Security retirement benefits or SSD benefits. If you are considering applying for SSD or have been denied SSD benefits, Disability Help Group can help. Our experienced advocates have deep knowledge of the SSD application and appeals processes and the type of evidence required to prove your claim. To learn more, call 800-800-3332 or fill out our contact form.
Asthma is increasingly common, in the U.S. and around the world. According to the Asthma and Allergy Foundation of America, about 27 million Americans have asthma. Not everyone who suffers from this condition is disabled. However, the condition can limit your ability to work, and even to attend to other areas of life. Whether or not asthma qualifies you for Social Security disability (SSD) benefits depends in large part on the severity of your symptoms and the limitations they create. In some circumstances, other factors may be considered.
Asthma as a Disability
What is Asthma?
Asthma is a chronic medical condition that narrows the airways through inflammation. The condition can also cause excess mucus in the airways, and muscle constriction. Each of these can decrease the space for air to pass through, making it difficult to breathe. In some people, this condition is relatively minor and can be treated effectively with medication. But the symptoms of asthma can be serious, and even life threatening.
When Is Asthma Disability?
Asthma is listed in the Social Security Blue Book. The listing criteria are technical. To qualify based on the listing requires:
That the applicant have an FEV1 value at or below a specific level. The cut-off level varies based on the applicant’s age, sex, and height. The measurement must be from the same 12-month period as the hospitalizations required by part B.
The applicant must have suffered exacerbations or complications requiring hospitalization within a 12-month period. The hospitalizations must have been at least 30 days apart, and of at least 48 hours in duration.
Note that the symptoms and severity of this condition and response to treatment may vary over time. So, the Social Security Administration (SSA) may re-evaluate to determine whether a person receiving SSD benefits for asthma is still disabled.
If you don’t meet the listing criteria, it may still be possible to secure SSD benefits. The process is a bit more complex, and takes into account factors such as your age, educational level, and past work experience. For example, if you are an older worker whose work experience is limited to high-exertion physical labor, you will be more likely to be found to be disabled than if you are a 30-year-old accountant or officer manager.
Get Help with Your SSD Claim for Asthma
Most SSD claims are initially denied. Ensuring that you complete your application fully and accurately and the right type and amount of documentation can make a big difference. Our experienced disability benefits advocates know the process inside out, and have a solid understanding of what the SSA is looking for. To learn more about how we can help with your SSD application or appeal, call 800-800-3332 right now or fill out our contact form.
Poor Sleep Quality May Make Alzheimer’s Disease Conditions Worse
Alzheimer’s disease is a cognitive disability that gradually reduces a patient’s ability to remember and process information. The condition can cause many symptoms, including inability to sleep and disturbances in normal sleep patterns. Researchers are now looking at these sleep disturbances as a clue to how Alzheimer’s damages the cognitive function of those afflicted with the disease.
A new study published in the Journal of Alzheimer’s Disease has found that chemical changes in the brain can be caused by the sleep disturbances commonly associated with Alzheimer’s. Researchers at the University of California-Irvine studied how common Alzheimer’s sleep patterns, which include being awake for 40 percent or more of normal sleep hours and sleeping during the day, may affect memory problems.
Studies have also suggested that sleep patterns earlier in life may contribute to later dementia risk. Both insufficient sleep and sleeping longer than average have been linked to a greater likelihood of developing dementia. However, it has been hard to determine whether these sleep changes contribute to the disease or simply reflect early symptoms.
The research simulated jet-lag style sleep disturbances by altering the normal light and dark times with a shortened dark period, causing the Alzheimer’s-inflicted mice used in the study to have disturbed sleeping patterns. The mice with disturbed sleeping patterns showed significant learning impairments compared to the mice with normal circadian rhythm cycles.
Further research has found that the sleep disturbances led to a decrease in glutathione levels in brain cells. Glutathione is an antioxidant that assists in the prevention of damage to essential cellular components in the brain. A deficiency in this antioxidant can cause redox changes in brain cells, which can affect brain metabolism and inflammation. These conditions are related to the progression of Alzheimer’s, and if medications could target and prevent redox reactions, it could lead to new treatment options.
Does Alzheimer’s qualify for Social Security Disability benefits?
Alzheimer’s disease is just one of many cognitive disorders that can qualify a person for Social Security disability benefits. If you or a loved one can no longer work and earn a living due to a mental disorder or cognitive decline, the Disability Help Group is here to assist with your case. Contact us online or call us at 1-(800)-800-3332 to schedule a consultation with our disability advocates!
ADHD isn’t specifically listed in the Social Security Blue Book, but that’s okay. There is a general listing for neurodevelopmental disorders that may be applied. And, meeting a listed condition is just one way of qualifying for Social Security disability (SSD) benefits. A worker can qualify for SSD if they can show that:
They have accrued sufficient work credits and recent work credits to qualify for SSD benefits, and
They have a diagnosed medical condition or conditions that are expected to last at least 12 months, and
ADHD, or attention-deficit hyperactivity disorder, is a mental health condition that is common in children. According to the Centers for Disease Control and Prevention (CDC), more than 11% of U.S. children between the ages of 3 and 17 have been diagnosed with ADHD. For many people, these symptoms persist into adulthood.
ADHD in adulthood can make it difficult to earn a living, due to symptoms such as:
Disorganization
Difficulty prioritizing
Poor impulse control
Trouble following through
Mood swings
Problems focusing on a task
However, most adults with ADHD can and do work. To receive SSD benefits for ADHD, the applicant will have to show that the condition (or the condition combined with one or more other medical conditions) prevents them from engaging in substantial gainful activity.
Evidence of Disability Due to ADHD
A successful SSD claim for ADHD starts with evidence of an ADHD diagnosis from a qualified psychiatrist or psychologist. This diagnosis should be backed up with the medical professional’s testing results, notes, questionnaires, and records of medications and other treatments attempted or currently in use.
The applicant will also need to show that the symptoms of ADHD are actually impacting their ability to earn a living. Some possible sources of this information include past work records and statements from others in the applicant’s life who witness day-to-day limitations.
To meet the listing criteria for a neurodevelopmental disorder, the applicant must show:
ONE of the following:
Frequent distractibility, difficulty sustaining attention and difficulty organizing tasks
Hyperactive and impulsive behaviors
Significant difficulties learning and using academic skills
Recurrent motor movement or vocalization
AND extreme limitation of one or marked limitation of two of the following:
Ability to understand, remember, and apply information
Capacity to interact with others
Ability to concentrate, persist, or maintain pace
Ability to adapt or manage oneself
However, an applicant who doesn’t meet the criteria may still qualify under a more holistic assessment. The best way to get reliable information about pursuing SSD benefits for adult ADHD is to talk to an experienced disability benefits advocate. To get started, call 800-800-3332 or fill out our contact form.
Like most mental health issues, bipolar disorder may or may not qualify you for Social Security disability (SSD) benefits. The outcome of an SSD claim based on bipolar disorder will depend on the nature and severity of the symptoms.
Bipolar Disorder is Listed in the Social Security Blue Book
The Social Security Blue Book lists a wide range of medical conditions that may qualify a person for SSD benefits, along with criteria for qualification. Bipolar disorder is covered by section 12.04 of the Blue Book. To qualify for SSD based on the Blue Book listing for bipolar disorder, the applicant must:
Have diagnosed bipolar disorder that is characterized by at least three of the following symptoms and limitations:
Pressured speech
Flight of ideas
Inflated self-esteem
Decreased need for sleep
Distractibility
Involvement in activities likely to have negative consequences, which the applicant fails to recognize
Increase in goal-directed activity or psychomotor agitation
AND
Extreme limitation of one or marked limitation of two of the following:
Ability to understand, remember, or apply information
Ability to interact with others
Ability to concentrate, persist, or maintain pace
Ability to adapt or manage themself
OR
The bipolar disorder is “serious and persistent
For purposes of the Blue Book listing, “serious and persistent” means that there is a medically documented history of the disorder spanning at least two years, with evidence that:
Medical treatment and/or therapy is ongoing and diminishes the signs and symptoms of the disorder, AND
The applicant has limited ability to adapt to changes in environment or new demands
Evidence of Symptoms and Limitations
As you can see, the requirements to meet the Blue Book listing for bipolar disorder are very specific. An applicant must generally provide thorough documentation from medical providers, in addition to their own detailed questionnaire and information provided by those who have an opportunity to observe the applicant in day-to-day life. Knowing what type of evidence is necessary and how to obtain it can mean the difference between approval and denial of your SSD claim.
SSD Benefits for Bipolar Disorder When You Don’t Meet the Listing Requirements
In some circumstances, an applicant who does not meet the listing requirements may still qualify for SSD benefits for bipolar disorder–especially if the applicant has one or more additional conditions that also contribute to their inability to work. This involves a more complex analysis that takes into account factors such as the applicant’s capacity to perform work, their age, their educational level, and their past work experience.
Get Help Pursuing SSD Benefits for Bipolar Disorder
Most SSD claims are initially denied. Assembling the right evidence and presenting it properly can make all the difference. Whether you’re just filing an SSD application or have been denied benefits and want to appeal, an experienced disability benefits advocate can be your best resource. To learn more, call 800-800-3332 right now or fill out our contact form.
