You've attended countless doctor appointments and take multiple medications daily. Yet when you filed for Social Security Disability Insurance (SSDI), questions arose about whether you're truly following your treatment plan. Your prescription history tells a story that medical records alone cannot, proving what treatments you actually followed, not just what doctors recommended.
At Keefe Disability Law, our Boston SSDI lawyers have seen how pharmacy records transform disability cases. While these records alone don't prove disability, they provide crucial supporting evidence when paired with medical documentation of diagnoses and clinical findings.
What Social Security Looks for in Pharmacy Records
When reviewing your Boston SSDI claim, evaluators examine pharmacy records that you, your attorney, and your medical sources submit. SSA primarily reviews records you and your medical sources provide, and may request additional evidence with your SSA-827 authorization.
Under 20 CFR § 404.1530, failure to follow prescribed treatment can result in the denial of SSDI benefits if that treatment would restore your ability to work. Your pharmacy records provide objective proof of treatment compliance. Regular refills demonstrate ongoing symptoms requiring continuous management.
Consider a hypothetical applicant claiming disability due to severe depression. Her psychiatrist prescribed daily medications, but pharmacy records showed refills only every three months instead of monthly. This pattern suggested either non-compliance or less severe symptoms than claimed. Proper documentation explaining these gaps, like temporary use of doctor's samples or insurance coverage issues, would strengthen her case.
How Medication Side Effects Support Your Disability Claim
Medications prescribed to manage one condition often create additional limitations. The Social Security Administration (SSA) must consider medication side effects when assessing your residual functional capacity (RFC).
Imagine an applicant with severe chronic pain who took strong opioid medications at maximum doses. His pharmacy records also listed prescriptions for anti-nausea drugs, stimulants for drowsiness, and stool softeners. The side effects, however, meant he couldn't safely drive or operate machinery due to medication-induced impairment. These secondary limitations, proven through medication history combined with medical documentation, strengthened his case considerably.
Your pharmacy records must connect to medical evidence explaining how side effects impact your daily functioning. The strongest cases include doctor letters or RFC forms linking medication histories to specific limitations.
How to Explain Prescription History Gaps to SSA
Gaps in medication history don't automatically hurt your claim if properly explained through medical documentation. Legitimate reasons include:
- Financial hardship. Many disabled individuals can't afford medications before receiving benefits.
- Insurance changes. Coverage transitions create delays during activation and prior authorization processing, often documented in your medical file.
- Hospitalization. Inpatient treatment means facility staff administer medications, creating retail pharmacy gaps.
- Medication trials. Doctors sometimes discontinue medications to assess necessity or harm, which should appear in treatment notes.
Say a hypothetical applicant had a four-month gap in mental health medication fills. Without explanation, this suggested non-compliance. However, medical records revealed psychiatric hospitalization during that period. The documented hospitalization both explained the gap and proved symptom severity.
Gather and Submit Complete Pharmacy Records
Your disability application should list every pharmacy you've used over several years, at least covering the 12-month duration requirement and providing a longitudinal history of your treatment patterns. Contact each location where you've filled prescriptions and request complete histories showing every medication filled, dates, quantities, and prescribers.
Many Massachusetts residents use multiple sources, including retail chains, mail-order services, and specialty pharmacies for biologics. Missing even one source means incomplete treatment documentation.
Massachusetts also maintains a Prescription Monitoring Program (PMP) for tracking controlled substances. If medical sources provide PMP reports to Social Security, they reveal patterns that evaluators consider. These state databases represent another layer of medication evidence worth including.
Additional Medication Evidence to Provide
Social Security considers all treatments, including over-the-counter (OTC) medications, supplements, inhalers, or insulin injections, that are not always captured in retail pharmacy records. Supplement your pharmacy documentation with self-reports of OTC or non-retail medication use demonstrating ongoing care efforts.
Your medical records should reference these treatments to establish patterns. A medication list from your doctor, noting both prescription and non-prescription therapies, creates a complete picture of your treatment compliance and symptom management attempts.
Experience With Pharmacy Documentation Matters
Social Security disability cases involve numerous documentation requirements. Understanding which pharmacy records matter most and how to present them alongside medical evidence requires experience with SSA procedures.
At Keefe Disability Law, we've represented Massachusetts residents in disability claims for over three decades. We obtain records from all your pharmacy sources, explain gaps before they become problems, and highlight patterns demonstrating disability severity and treatment compliance. Most importantly, we connect your medication histories to medical documentation proving how your conditions and medication side effects limit your functioning.
Your prescription history becomes compelling evidence rather than a potential obstacle when properly integrated with clinical findings, doctor statements, and RFC assessments. Don't let incomplete pharmacy documentation undermine your Boston SSDI claim.
