April 26, 2019

Delays in Social Security Disability Decisions May Result in Higher Costs to Medicare



MRI showing multiple sclerosisSocial Security disability claimants become eligible for Medicare on the 25th month after they first become eligible for a Social Security disability payment.   For MS patients lacking access to regular review of prescribed medications, these delays may unnecessarily increase suffering and may dramatically increase the cost to the government when a claimant’s disease moves from a relapse-remitting stage to a progressive stage.

Medicare recently announced a breakthrough analysis of MS (Multiple Sclerosis) costs which showed that as the disease progresses, the care costs involved escalate dramatically.  The research firm of JEN Associates and Wyeth conducted a study using a novel computer analysis to sort out MS patients by the stage that their disease was in, basing this on their Medicare payment records.  The result of the study was that this led to a better understanding of MS treatment costs.  The results of the study also indicated how well Medicare could reap more savings if effective treatment could block the advancements of the disease.

Consequently, Teva Pharmaceutical Industries, Ltd. is funding a worldwide study involving 1,350 MS patients in order to determine how safe and effective the medication glatiramer acetate (Copaxone®) for the treatment of the disease.  The standard dose of glatiramer acetate is 20mg but the study is testing a higher dosage of 40mg administered only 3 times per week instead of the daily dosage of the smaller amount.  The study will last a year and has been named the “GALA” Study.

Without getting too technical, the drug glatiramer acetate simulates myelin, a basic protein.  A component of myelin is what insulates the nerve fibers of the brain and the spinal cord against the damaging effects of myelin-damaging T-Cells which is the cause of MS.  The FDA has approved glatiramer acetate for the purposes of reducing relapse frequency in those patients that suffer from relapse-remitting MS.  Additionally, it is administered to those patients who have experienced their first clinical episode that displayed MRI results consistent with MS.

In the US today, some 350,000 Americans are affected by the disease, of which 1/3 of these individuals are Medicare beneficiaries.  If the GALA Study proves out, the lower frequency of a higher dosage could prove beneficial not only to the patient, but to the Medicare budget as well.  The majority of the patients today have the relapsing-remitting form of MS wherein they experience periodic exacerbations of the disease.  However, Multiple Sclerosis can evolve into the “progressive” stage where the symptoms increase in acuteness and continually worsen.

Social Security and Medicare may realize significant savings if MS patients became eligible for Medicare earlier than 2 years from the date of the claimant’s first income benefit payment, or if MS cases were tagged for “fast track” review.

About

Jonathan Ginsberg represents disabled men and women in SSDI and SSI claims filed with the Social Security Administration.

Comments

  1. Hush Pubby says:

    Considering the cost of MS treatment, maybe severe cases of MS should be eligible for the compassionate allowance program

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