Getting the medication you need isn’t always as simple as filling a prescription. Navigating insurance complexities—like copays, deductibles, formularies and medication tiers—can add unnecessary stress.

A trusted pharmacy partner like Alto takes the burden off your shoulders. We handle all the insurance details and provide you with clear information to help you understand the process. At Alto, we tackle all of the insurance-related legwork for you and give you the information you need to understand the process.

Below, we’ve answered some common questions about insurance coverage for prescription medications, including how we go above and beyond to ensure that you’re receiving your medications on time and at the lowest price possible.

How do I know how much my medication will cost at Alto?

When you get started with Alto, we automatically pull in any available insurance information we can find. If you have additional coverage, just let us know and we’ll add it to your profile. For each prescription, we check your primary (and secondary) insurance plans to determine your copay and explore any savings opportunities. 

Sometimes, paying cash for your medication can be cheaper than using your insurance. If that’s the case, we’ll present all pricing options so you can make an informed decision.

How does Alto find the lowest price?

We check every savings option possible—automatically, every time. Unlike traditional pharmacies, Alto proactively applies savings like manufacturer coupons, patient assistant programs, and copay cards. We start looking for discount opportunities the moment we receive your prescription, and keep you informed of any savings that require you with the program or manufacturer.

Learn more about how Alto saves you money on your prescriptions.

What if my medication is too expensive?

Here’s another way we differ from traditional pharmacies: we continue searching for more affordable medication options, even after exploring initial savings opportunities. You’re in control, and if you’d like help finding other medications covered by your insurance at better rates, we’ll work with your doctor to evaluate those options.

Insurance companies categorize medications into tiers based on various factors like whether they’re generic or brand-name and how often they’re prescribed. Medications in higher tiers generally include non-preferred brands and specialty medications for rare conditions, and these typically cost more than medications in lower tiers.

Keep in mind, generic medications contain the same active ingredients as their brand-name counterparts, and must meet the same FDA safety, quality, and effectiveness standards. 

I’ve heard of an insurance “formulary.” What does that mean?

Every health insurance plan has a list of covered generic and brand-name medications, called a formulary, which you can locate online or by calling your plan. It includes the tiers mentioned above, indicating which medications are preferred by your insurer and therefore offered at a lower out-of-pocket cost.

When deciding whether to renew your current health insurance coverage or select a different plan for the new year, you may want to check the formularies to determine if your current medications will be covered. Read our previous blog to learn more about what to consider when reviewing insurance coverage options every year.

What if my insurance denies coverage of my medication?

A formulary is a list of medications—both generic and brand-name—that are covered by your health insurance plan. You can usually find it online or by calling your insurance provider. The list includes different tiers, showing which medications are preferred by your insurer and are typically offered at a lower cost to you. 

If you can’t find your medication on the formulary, you may be able to submit a prior authorization to prove its medical necessity and secure coverage through your insurance plan. If a prior authorization is required, we’ll work with your doctor to submit the necessary paperwork. We’ll keep both you and your doctor informed throughout the process, updating you on the status until your insurance provider makes a decision. If the request is denied, we’ll work with your doctor to explore different treatment options.

Read our previous post, ‘What is a Prior Authorization?’ to learn more about how Alto can help you navigate this process.

A pharmacy partner that’s always on your side

At Alto, we go above and beyond to ensure you stay on track with your doctor’s recommendations and get your medication at the best price possible.

Switch to a better pharmacy that offers free same-day delivery, insurance support, and savings opportunities. Reach out any time by phone at 1-800-874-5881 or our in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.