Does Medicare Cover Ismo?
This article was updated on: 05/28/2019
If you have angina, or chest pain, your doctor may recommend treatment with Ismo, or its generic equivalent, isosorbide mononitrate, according to the National Institutes for Health. There is generally no Medicare coverage for Ismo, unless you are enrolled in stand-alone Medicare Part D prescription drug coverage or Medicare Advantage Prescription Drug plan that covers Ismo.
Will Medicare cover Ismo?
According to the National Institutes of Health (NIH), Ismo is in a class of drugs known as nitrates. It works by widening and relaxing the blood vessels, reducing the work burden on the heart. Ismo is used in patients with coronary artery disease to prevent angina, but it isn’t used to treat an angina attack that has already started. It’s also not intended for use before physical activity. Your doctor may prescribe other medications to prevent chest pain from physical activity or to treat chest pain that has already started.
If you are enrolled in Original Medicare (Part A and Part B), there is generally no coverage for prescription drugs such as Ismo that you take at home. If you receive Ismo while being treated as an inpatient in a hospital or nursing home during a covered stay, Part A may cover it, subject to applicable deductibles and coinsurance amounts.
Ismo for treatment at home may be covered if you have Medicare Part D prescription drug coverage. You can check your plan’s formulary, or list of covered medications, to see if it pays for Ismo or any other medications you take on a daily basis. A plan’s formulary may change at any time. When required by law, you will receive notice from your plan of changes to the formulary. If you haven’t signed up for a Medicare Prescription Drug Plan yet, you can use the Find Plans button on this page to search for plans that may cover Ismo; the button opens a tool that lets you enter your prescription drugs.
Medicare Part D prescription drug coverage is offered by private insurance companies that contract with Medicare; each is able to make its own formulary decisions, subject to Medicare guidelines, which state that all plans must cover a range of certain commonly prescribed medications to treat most illnesses and conditions. Plans may change their formularies from time to time, but they must notify you in writing when necessary. If your formulary drops coverage for Ismo in the future, you can to talk to your doctor about other, similar medications to treat your angina.
How do I enroll in Medicare Part D coverage for prescription drugs such as Ismo?
You must be eligible for Medicare and enrolled in Part A and/or Part B to enroll in a stand-alone Medicare Part D Prescription Drug Plan, and you must live within the plan’s service area.
Another way to get coverage for Ismo and other medications by enrolling in a Medicare Advantage plan that includes Part D coverage for prescription drugs, sometimes called a Medicare Advantage Prescription Drug plan. Like stand-alone Medicare Prescription Drug Plans, Medicare Advantage Prescription Drug plans are offered by private insurance companies. As well as prescription drug coverage, Medicare Advantage Prescription Drug plans cover Part A and Part B benefits, except hospice care, which Part A covers. Medicare Advantage could be an “all in one” answer to your health-care coverage. You still need to continue paying your monthly Part B premium, as well as any premium the plan may charge.
Learn more about eligibility for Medicare Advantage and Medicare Prescription Drug Plans, and enrollment periods for these plans.
Prescription drug coverage is optional under Medicare. Still, it may be a good idea to enroll in Medicare Part D prescription drug coverage as soon as you are eligible, unless you have equal or better coverage for prescription drugs through another source, such as an employer plan. If you wait, you may have to pay a late-enrollment penalty with your monthly premiums for as long as you are enrolled in a plan.
I’m available to answer any questions you may have about Medicare coverage for Ismo and any other medications you take regularly. You can request information via email or schedule a phone call at your convenience by clicking one of the links. To see a list of plans in your area that you may qualify for, click the Compare Plans or Find Plans buttons.