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 make the process stressful and confusing.

A trusted pharmacy partner like Alto takes that burden off your shoulders. We handle the insurance details, keep you informed, and make sure you understand each step. From navigating coverage to finding cost-saving options, Alto manages the legwork so you can focus on your health.

Below, we’ve answered some of the most common questions about insurance coverage for prescription medications, including how we work to ensure your medications arrive on time and at the lowest possible cost.

How much will my medication cost at Alto?

When you get started with Alto, we automatically gather any available insurance information for your account. 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 identify any potential savings opportunities. 

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

How does Alto find the lowest price?

We automatically check every savings option for your prescriptions—every single time. Unlike traditional pharmacies, we proactively apply discounts such as manufacturer coupons, patient assistance programs, and copay cards. 

From the moment we receive your prescription, we start looking for every possible way to lower your costs. If any savings require action on your part, we’ll keep you informed every step of the way. 

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

What if my medication is too expensive?

Unlike traditional pharmacies, we continue searching for more affordable medication options even after initial savings opportunities have been applied. 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 factors like whether they’re generic or brand-name and how commonly they’re prescribed. Medications in higher tiers typically include non-preferred brands and specialty medications for rare conditions, and they generally cost more than medications in lower tiers.

Keep in mind that 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 typically find online or by contacting your plan. The formulary includes tiers that indicate which medications are preferred by your insurer and often result in lower out-of-pocket costs.

When deciding whether to renew your current health insurance coverage or select a different plan for the new year, it’s a good idea to check the formularies to ensure your current medications are covered. Read our previous blog to learn more about what to consider when reviewing insurance coverage options each year.

What if my insurance denies coverage of my medication?

If your medication isn’t listed on your plan’s formulary, you may still be able to submit a prior authorization to prove its medical necessity and secure coverage.

If a prior authorization is required, we’ll work closely 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 collaborate with your doctor to explore alternative 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 help you stay on track with your doctor’s recommendations while getting your medications at the best price possible.

Switch to a better pharmacy offering free same-day delivery, insurance support, and savings opportunities. Reach out anytime by phone at 1-800-874-5881 or via 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.