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Insulin pumps have become increasingly widespread in diabetes treatment in recent years due to their convenience and ease of use. Read on for more information about these devices.

The Role of Insulin Pumps in Diabetes Treatment

Both type 1 and type 2 diabetes involve complications with the body’s production of insulin, a hormone produced in the pancreas that converts sugar into energy. People living with type 1 diabetes do not produce any insulin at all, so they have to take insulin every day to keep their blood sugar levels in a healthy range.

Insulin therapy may also play a role in managing type 2 diabetes, since individuals with the condition do not produce a sufficient amount of insulin to regulate blood sugar levels. However, some individuals with early-stage type 2 diabetes are able to manage their blood sugar with other medications and healthy lifestyle habits — make sure to consult with your doctor on the best course of treatment given your needs.

There are several methods available for delivering insulin into the body, including syringes,  insulin pumps, and pens. Insulin pumps have become increasingly widespread in diabetes treatment in recent years due to their convenience and ease of use.

There are a variety of insulin pump options to choose from. Read on for more information about these devices.

What is an insulin pump and how does it work?

An insulin pump is a small electronic device that delivers doses of insulin at specific times. It mimics the activities of a normally functioning pancreas by delivering small, continuous doses of insulin throughout the day and surges of insulin while you eat. You set the schedule, and it is easy to make adjustments if your dosage changes or if you eat or exercise more than usual on any given day.

While an insulin pump’s consistent delivery of insulin is effective in keeping your blood sugar levels within a healthy range, it is still important to check your blood sugar throughout the day using either a blood glucose meter or a continuous glucose monitor (CGM). Some newer insulin pumps are connected to a CGM, which allows for both automated glucose monitoring and insulin delivery.

Many people who use insulin pumps find them to be more convenient than insulin injections, particularly while on the go. Insulin pumps offer the flexibility to work, socialize, or engage in just about any other activity without stepping aside to give yourself an insulin injection. And their automated, adjustable delivery makes it simple to maintain healthy blood sugar levels: not only do you not have to worry about missing a dose, but you can easily add, remove or modify a dose depending on your calorie intake and level of physical activity.

Most insulin pumps are designed to store dosing data, so you and your doctor’s office will have easy access to details about your insulin regimen should you need to make any adjustments to your treatment plan. 

Depending on the type of insulin pump you have, the device may be able to streamline other aspects of diabetes management. In addition to the automated blood sugar readings offered by CGM-connected pumps, some pumps have tools to help with carbohydrate counting. (Monitoring how many carbohydrates you consume is an important aspect of diabetes management as they increase your blood sugar, and your daily insulin dosage depends on your insulin-to-carb ratio.)

Insulin pumps deliver very precise doses of insulin, so there is a low risk of complications. However, it’s important to make sure you know how to properly set up your pump and to continually monitor your blood sugar levels. Your doctor or a diabetes educator can help you get started.

Choosing between an insulin pump and other delivery methods is ultimately a matter of personal preference, but they are often a good fit for children and anyone who has had difficulty remembering the timing of their insulin injections. You may also want to consider using an insulin pump if you absorb food slowly or if you often experience low blood sugar as a result of insulin use (also referred to as an insulin reaction or hypoglycemia). Consult with your doctor to choose the best insulin delivery method for your individual health needs.

Many women who are pregnant or trying to conceive also benefit from the consistent and precise delivery of an insulin pump, as blood sugar management is especially critical while your baby’s major organs develop. If you are pregnant or thinking of becoming pregnant, you may want to ask your doctor if an insulin pump is right for you.

There are two main types of insulin pumps: tubed insulin pumps (sometimes referred to as traditional insulin pumps) and insulin patch pumps. Tubed insulin pumps deliver insulin from a delivery chamber — in this case a container located within the pump — into a tube inserted beneath your skin, usually on the abdomen. (A healthcare professional like your doctor or a diabetes educator can show you how to insert the tubing.) Manufacturers of commonly used tubed insulin pumps include Medtronic and Tandem®.

Insulin patch pumps combine the delivery chamber and tube into a single “pod” placed on your skin with an adhesive patch. Insulin patch pumps do not have any external tubing and are controlled wirelessly. Commonly used patch pumps include Omnipod® and V-Go®.

You can put a tubed insulin pump in your pocket, on your belt, or attach it to a strap beneath your clothes. Insulin patch pumps are most commonly placed directly on your stomach or arm. Both types of insulin pumps require you to change the tubing or pods every one to three days. A diabetes educator or healthcare provider can answer any questions and help you become more comfortable using the device.

What to consider when deciding to use an insulin pump

When talking to your doctor, here are some considerations that may help you determine if an insulin pump is the most convenient way to manage your blood sugar, or your child’s.

An insulin pump may feel slightly more complex than injections, as it involves frequent interactions with technology. Your diabetes care team can help you become more comfortable with the device.

You will need to verify which type of pump(s) your insurance plan covers and decide if those options are the right fit for your needs and budget.

Whether you go with a tubed or patch pump, you’ll have an electronic device attached to your skin, which may take some getting used to. There are lots of ways to make them less visible, if that’s a concern.

If you’re still unsure, remember that you’re allowed to change your mind! While insulin pumps are most commonly used on a continuous basis, the device is not permanently attached to your body, and some people switch to injections for certain periods of time. 

For example, some children with diabetes may use an insulin pump during the school year but take insulin via injections during the summer. There is room for flexibility as long as you discuss your plan with a healthcare professional and follow their recommendations.

Most insurance plans have separate medical and pharmacy benefits. In most cases, professional services provided by your doctor will fall under medical benefits while prescription diabetes medications — including insulin — will fall under pharmacy benefits. 

Pumps, CGMs, and supplies like test strips will likely be covered under a third type of benefits: the Durable Medical equipment (DME) section of your policy. There may be restrictions on the brands or suppliers that are available, and it’s important to check with your specific policy to understand what will be covered and under which sections.

Tubeless patch pumps like Omnipod® and V-Go® are often covered with your pharmacy benefits. If that’s the case, Alto may be able to help you get started with your insulin pump. We will work with your insurance (if applicable) and any third party savings programs so that you can get your insulin pump at the lowest possible price.

A diabetes pharmacy partner you can rely on

At Alto, we believe a pharmacy should be a partner in your diabetes care. We have a dedicated diabetes support team to ensure that you have everything you need to follow through on your individualized treatment plan. Reach out any time by phone at 1-800-874-5881 or 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.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Reproductive endocrinologist Dr. Guy Ringler — a former faculty member at UCLA and an advisory board member at Men Having Babies — was one of the first doctors in the world to help gay men have children through assisted reprodutive technology.

Spotlight on Men Having Babies & Dr. Guy Ringler

There are many ways to start a family and raise a child. And as recent decades have brought forth milestones in marriage equality and the fight for LGBTQ+ rights, the options for LGBTQ+ family building have also expanded.

According to 2019 data from the Williams Institute, almost 29% of people who identify as members of the LGBTQ+ community are raising children, up from 16.2% between 2014 - 2016. That includes a growing number of gay men who’ve had children through surrogacy, a process in which a woman who is not related to the child — a gestational surrogate — carries a baby who is biologically related to one of the fathers and an egg donor.

Breaking down barriers to LGBTQ+ family building

Reproductive endocrinologist Dr. Guy Ringler — a former faculty member at UCLA and an advisory board member at Men Having Babies — was one of the first doctors in the world to help gay men have children through assisted reprodutive technology. Throughout the twenty-five years that he’s been in practice, he’s seen how scientific advances and cultural changes have broken down barriers for gay men interested in parenthood.

“Over two decades ago, when I began my career, people barely understood the concept of surrogacy for gay men,” he says. “It wasn’t as easy to find women who wanted to become surrogates for gay couples. There was still fear about HIV, and there were questions about the impact of surrogacy on a child’s development.”

The landscape looks a lot different today. Thanks to cultural shifts and greater understanding of the science behind surrogacy — and to awareness-raising organizations like Men Having Babies — there are now more options than ever to become a parent regardless of your sexual orientation or gender identity.

“Greater acceptance of the LGBTQ+ community and marriage equality has opened people’s minds and allowed them to see that gay families can thrive, just like any family,” Dr. Ringler says. “Gay men are now able to plan for a future that we once didn’t know was possible.”

Getting to meet prospective fathers at Men Having Babies’ annual conferences is one of Dr. Ringler’s favorite things about working with the organization. He’s observed a greater number of gay men pursuing parenthood at an earlier age.

“I’m so inspired by the next generation of gay men, who are planning their families in their twenties. That simply wasn’t an option when I was their age.”

Men Having Babies and financial assistance for IVF and surrogacy

There are many steps on the road to parenthood for LGBTQ+ individuals and couples: fertility treatments, legal consultation, and financial planning are all required to start a family.

“Having a baby doesn’t just happen for gay men,” Dr. Ringler says. “It takes thoughtful planning and there are many decisions along the way.”

That’s why support from organizations like Men Having Babies is so critical. The organization started as a program at The Center (formerly the NYC LGBT Center) in 2005 and officially became a nonprofit in 2012. Today, Men Having Babies supports thousands of gay men and couples around the world in starting their families through surrogacy, with monthly workshops, annual conferences and financial resources. 

Determining how to pay for IVF and surrogacy is an important part of planning your family. As part of the process, Dr. Ringler suggests mapping out a vision for your family. Knowing how many children you want can help you prepare for the cost: “When you’re making the commitment to start a family as a gay man, think about how you will financially support the decision. It may feel overwhelming, but it’s similar to the process of buying a house. If it’s really important to you, you can find a way to make it work.”

There are many resources to help alleviate the cost, including Men Having Babies’ Gay Parenting Assistance Program (GPAP) . The program offers different forms of financial support, including:

Discounted and free services donated by more than one hundred leading IVF, surrogacy, egg donation, and legal service providers to prospective parents (Stage I support)

Discounted and donated ancillary services, including fertility medication, escrow services, and insurance resource services (Stage I support)

Cash grants for approved prospective parents based on income eligibility (Stage II support)

Learn more about the criteria for applying to Stage I or Stage II support from the GPAP.

You must be a member of Men Having Babies to receive financial assistance. You can become a member by making an annual donation of $150 or more. Learn more about the membership process.

In addition, EMD Serono offers financial assistance for fertility medications and Family Equality has a list of family-building grants that help LGBTQ+ families afford fertility treatment. Be sure to also ask your fertility clinic or pharmacy about available financial assistance programs and payment plans.

The importance of researching your options

As Dr. Ringler emphasized, gay men building a family through IVF and surrogacy have many decisions to make throughout the process. For that reason, it’s important to thoroughly research your options and to work with a medical team that you trust. Here are some additional considerations to be mindful of as you plan your family.

Understanding the process of IVF and surrogacy

In IVF, eggs and sperm are combined in a laboratory. When gay men conceive through IVF, the sperm will come from one of the fathers and the eggs will come from a donor. Then the fertilized eggs, or embryos, are placed into the uterus of a gestational carrier who will carry the baby to term.

Not only is this an exciting time for expectant dads, as Dr. Ringler notes, but surrogates can play a big role in raising awareness of LGBTQ+ families.

“In my experience, surrogates who are asked when their baby is due while out in public may feel comfortable sharing that they’re having a baby for a gay couple. This helps open up more people’s minds to the possibilities for LGBTQ+ parenthood.”

Understanding your goals for your relationship with your surrogate is one of many key decisions, and there is a spectrum of options. Some couples cultivate intimate relationships with the surrogates while others prefer to remain more detached. There’s no one right choice — it’s all about understanding what’s best for you.

“If your surrogate wants a little distance, that does not mean that they are any less committed to the process,” Dr. Ringler says, adding that it’s important to discuss your preferences in an open discussion with your surrogacy agency.

Deciding who will be biologically related to the child

Another important decision for same-sex male couples is deciding which parent will be genetically related to the child. When heterosexual couples have babies through IVF, both parents can contribute their genetic material, so that the baby is biologically related to both, even when using a gestational carrier. 

But with gay men, only one father can contribute his sperm per pregnancy, so it’s important to discuss this decision with your partner if having a child as a couple. Some fathers fertilize multiple eggs so that both can have a biological connection with one of their children. Taking time to identify your family building goals will allow you and your partner to plan for the financial cost of more than one round of IVF, if you choose to pursue that option.

Keep in mind that you can establish a legal paternal relationship with your child even if you are not biologically related to them. It’s critical to research your state’s laws about legal parentage procedures once your baby is born. Movement Advancement Project’s interactive map on parental recognition laws is a good starting point. 

Be sure to speak with an experienced LGBTQ+ family lawyer in your state before starting the IVF and surrogacy process. There are many forms of financial support to help alleviate the cost of these legal services, like Men Having Babies’ Gay Parenting Assistance Program.

There's a wide selection of available egg donors, and one of the factors to consider as you choose yours is whether they will be anonymous or open. With an open donor, you can more easily answer any questions your child may have about their genetic background. However, some families prefer anonymous donors, and sometimes an anonymous donor’s physical or personality traits better fit your goals. Both paths are viable options, and it all comes down to what’s right for your family.

Regardless of which option you choose, Dr. Ringler notes that you should be prepared to share information with your child about how they were conceived. You can even get creative with how you share their journey: some of Dr. Ringler’s patients have created story books for the whole family to read together, which helps children understand their background and feel proud of who they are.

Seeking support for your family building journey

While there are many paths to take, and many decisions to make, as you build your family, all will lead to the same destination of parenthood.

“I personally had a very close relationship with my mother growing up, and as gay men, we can’t guarantee our children that same experience,” Dr. Ringler says. He notes that if you have an open donor, your child’s biological mother may be able to have a presence in their life, which is another important factor to consider when planning your family.

But regardless of your chosen family structure, “I’ve seen again and again throughout my career that all you need to start a happy, healthy family is love and fun.”

One thing that’s certain: family building as a gay man is much easier to navigate with support from organizations like Men Having Babies. If you’re feeling overwhelmed while planning for a family, remember that you don’t have to go through this journey alone. Men Having Babies understands the challenges specific to building a family as a gay man, and their resources can help you fulfill your dreams of becoming a parent.

Learn how to become a member of Men Having Babies.

At Alto, we’re proud to support Men Having Babies, and we’re happy to be a part of your family building journey if fertility prescription medications become part of your plan. Reach out any time to get started though the Alto app  or phone at 1-800-874-5881.

Get an inside look at the patients team at Alto Pharmacy to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

Get to Know the Team That Builds Alto's Customer-Facing Apps

Imagine an app that allows you to buy things and have them delivered to you the same day, for free. Now take that app and put it in a highly regulated space like pharmacy. You face the challenge not only of building an e-commerce platform from scratch, but also of navigating medication pricing, federal and state regulations, and patient safety—and that's just the way the Patients Team likes it.

"It's a really exciting and fun problem to solve," says Mike Riess, the team's Engineering Manager. Software Engineer Angelique Nehmzow agrees: "There's a really strong product and design aspect, like more traditional startups, but then everything gets a little bit more interesting because it's healthcare."

Below, we chat with the team to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

What does the Patients Team do at Alto? 

Ask anyone on the team why they joined, and chances are, they'll tell you they wanted to be on the product team closest to Alto's customers: "We really try to own the customer experience," says Peter Zeng, the latest Software Engineer to join the team. "If a customer is coming to the web app, or they're coming to our mobile app, we want to make sure that they're able to onboard with us as easily and conveniently as possible."

The team is also responsible for the customer experience beyond onboarding, from the moment a customer schedules a medication for delivery to the time that it shows up on their doorstep. "We already offer great services like free, same-day delivery and cost savings. The Patients Team empowers customers to make the most of our offering," Nehmzow explains. "You can see what prescriptions you have, check on the status of your order, and schedule automatic refills. In a more traditional pharmacy, you don't get that kind of visibility. You have to call them up or even wait in line in person. At Alto, it's a different experience."

What was it like in the team's early days?

Today, there are eleven engineers on the team working to build that better end-to-end experience—but it wasn't always that way. When the team first formed in 2019, it consisted of just three members: Riess, Brian McRae, and Andy Lau, all of whom are still on the team.

"The first priority for us was just stabilizing the foundations," Riess says of the team's early days. Every other week, the three team members, along with Alto co-founders Matt Gamache-Asselin and Jamie Karraker, would meet to audit the app's core flows. "For the first three months we probably didn't make it through some flow at least 50% of the time," Riess recalls. "There would be a ton of bugs in the onboarding experience, things that weren't working with the flows or navigation or deep linking."

Among the team's first projects was a redesign of the checkout flow. "There was a lot of work to be done to streamline the checkout flow, which is pretty much the main function of the app," says McRae, who initially joined the team as a software engineer and later transitioned into product management. "We had to make it easier to add a payment, add your addresses, everything you need to do to schedule your prescription for delivery."

"The growth of the team, in terms of both size and stability of the platform, has allowed us to swing at more interesting bets for the company," Riess says. In particular, the Patients Team has turned their attention toward experiences personalized for specific medical conditions.

"Different customers have different needs. A customer who wishes to start a family will have a different experience than a customer who needs to order their routine heart medications that they've been taking for the last eight years,” McRae says. “The challenge for us is how we serve all these customers well through the app."

"I think that's where Alto can be such a differentiator," Riess adds. "A world-class pharmacy experience is about so much more than just dispensing medications. We want to build tools for customers that help them get the most out of their medications—everything from simple videos teaching them how to perform injections safely at home to the ability to synchronize deliveries for multiple prescriptions for managing complex health conditions."

With these new projects on the horizon, engineers have ample opportunity to focus on the areas that excite them most. "We're full-stack and mobile and web," Nehmzow says. "Part of the team focuses more on experimentation, iterating quickly, and using data to make decisions. Part of the team focuses more on platform work, tooling, and improving the developer experience. There are a lot of areas to explore and contribute to."

One spring night, the Patients Team gathered in a back yard in San Francisco’s Mission District for short ribs and an impressive spread of side dishes. "Kudos to Robbi, who's the grill master. I just provide the grill!" Nehmzow says, laughing. While the team barbecue was the first time some members had met in person, Zeng notes that the team has been supportive of one another even while working remotely during the pandemic.

"The first real project that I was assigned to was working with the communications system. Before writing my first piece of code, I spent two weeks exploring what already exists and understanding the different parts of the system," Zeng says. "I've been really impressed with how understanding my teammates have been. They make the space for you to learn all the different pieces of code we own."

That culture of support is by design, reflected in the six principles—complete with matching emojis—at the top of the #patients-team Slack channel: "Empower each other," "be an owner," "find the path," "learn by doing," "embrace complexity," and "foster trust." 

While these principles echo Alto's company-wide values, they are unique to the Patients Team. "For a long time, we were the only external-facing product team at Alto," Riess says. "These principles were intended to be this motivation around how we win. It's a combination of how we treat each other, how we reason about decision making, and how we approach solving a problem that's never existed before."

As the team looks toward the future, those principles have never been more relevant: "We have a goal and an area we want to focus on, but in terms of which projects we're going to do, it's not a top-down thing," Nehmzow says. "It's very much, 'We're going to figure out how to solve this problem together, even when it's difficult.' That's my favorite part about the team."

The Patients Team is hiring! Learn more about open positions here.

The face of fertility treatment continues to evolve, with more and more LGBTQ+ couples and individuals seeking to become parents. Learn more about the fertility considerations specific to TGNB individuals.

Fertility Options for Transgender, Gender-Queer, and Nonbinary (TGNB) Individuals

The face of fertility treatment continues to evolve, with more and more LGBTQ+ couples and individuals seeking to become parents. Transgender, gender-queer, and nonbinary (TGNB) individuals have multiple options for starting a family, including fertility preservation treatment and using a donor or surrogate for several or more of the components of biological conception. Below, we explain more about the fertility considerations specific to TGNB individuals and potential paths to explore as you plan to start a family.

Each person’s journey to parenthood looks different. Transgender, gender-queer, and nonbinary individuals have specific factors to consider in planning for a family, as the biological process of transitioning may affect your ability to conceive.

Many transgender and nonbinary individuals take hormones like testosterone, estrogen, and testosterone blockers, or anti-androgens, while transitioning. Testosterone suppresses feminine physical traits and induces masculine ones in transgender men and some nonbinary individuals, such as facial and body hair and a deeper voice. Estrogen increases feminine characteristics like breast development and facial and body hair reduction in transgender women and some nonbinary individuals.

Researchers are still learning about the impact of testosterone and estrogen therapy on long-term reproductive function. While prolonged testosterone and estrogen use often stop sperm production and ovulation, respectively, some evidence, like a 2019 study on transgender fertility from Boston IVF, suggests that these effects are reversible upon discontinuation of the treatment.

Based on eight years of patient data, the Boston IVF study found that transgender men who underwent egg freezing for fertility preservation had similar egg yields as cisgender women, or women whose sex assigned at birth was female. More than half of the study’s transgender male participants had taken testosterone before pursuing ovarian stimulation treatment, all of whom had discontinued use of the hormone for an average of four months prior to starting their egg freezing cycle.

While the study’s results affirm that hormone therapy may not necessarily prevent you from having children biologically, every person’s situation is different. If you are considering hormone therapy and want to have children in the future, consult with your doctor about the possibility of freezing your eggs or sperm for future use, a process we explain in more detail below.

In addition, there is currently no definitive evidence that testosterone therapy will prevent individuals assigned female sex at birth from becoming pregnant. Depending on your ideal timeline for starting a family, you may also want to discuss contraception options with your healthcare provider.

For many transgender and nonbinary individuals, gender confirmation surgery is an important aspect of transitioning. It plays a crucial role in addressing gender dysphoria, the distress caused by the disconnect between your gender identity and the sex you were assigned at birth.

Depending on the circumstances, gender confirmation surgery may permanently affect your reproductive function. For instance, hysterectomies are performed in some female-to-male transitions, which prevents the possibility of carrying a child in the future. The removal of testicles during a male-to-female transition may also impact your ability to have biological children.

By planning for the future and discussing your reproductive options with your healthcare provider before undergoing gender confirmation surgery, you may be able to preserve your fertility options.

Fertility preservation treatment for TGNB individuals

Many transgender and nonbinary individuals choose to preserve their eggs or sperm for future use before beginning the biological process of transitioning. Sperm freezing helps transgender women plan for a future family before starting estrogen therapy. 

This is a fairly simple process in which a sperm sample is either surgically retrieved or collected by the person freezing their sperm. Doctors will then analyze that initial sperm sample to determine if additional samples are needed. Your sperm will then be stored in vials with cryoprotectant agents that will help ensure its long-term viability.

In egg freezing, transgender men take fertility medications to stimulate egg production. Once the eggs are developed, your doctor will retrieve them from you in a minimally invasive procedure. Your eggs can then be frozen and stored for later use. Depending on how many eggs are yielded, you may have to undergo more than one cycle of egg freezing.

Read our previous blog to learn more about what to expect during egg freezing.

Fertility treatment and conception options

Transgender and nonbinary individuals and families have multiple options for having children biologically, including intrauterine insemination (IUI) and in vitro fertilization (IVF).

In IUI, transgender women can use their frozen sperm and have it placed into their partner’s or a surrogate’s uterus. If you elect to use a surrogate, they will also take on the role of egg donor, meaning that they will be the biological mother of your child.

In IVF, eggs and sperm are combined in a laboratory. The fertilized eggs, or embryos, are then placed into the uterus with the potential outcome of a pregnancy. As with IUI, transgender individuals have multiple options with IVF. 

Transgender men can use their own eggs or those of their partner or a donor to have the fertilized embryo implanted into their own uterus. The sperm may come from their partner or a donor. Alternatively, their partner or a gestational carrier may have the embryos implanted into their uterus. (A gestational carrier carries and delivers a child for an individual or couple and is not genetically related to that child whereas a surrogate offers both her eggs and uterus.)

Transgender women can have their sperm fertilized with eggs from their partner or a donor. Then, their partner or a gestational carrier may have the embryos implanted into their uterus.

IVF is a more complicated process than IUI from a medical standpoint, as it involves more fertility medications and an egg retrieval process. However, IUI can be more emotionally and legally complicated if you are using a surrogate. Take time to research all of your options so that you can determine the best one for your needs and know what to expect going in.

If you are exploring using a donor or surrogate, it’s critical to research your state’s laws about legal parentage procedures once your baby is born. In some states, a surrogate may automatically receive parental rights after your child’s birth since they are the biological mother, which will have to be legally terminated. Explore Movement Advancement Project’s interactive map on parental recognition laws as a starting point. You should also speak with an experienced LGBTQ+ family lawyer in your state before starting the process.Learn more about these paths to parenthood, including the related legal aspects.

Fertility treatment is a significant investment, both financially and emotionally. Determining how to pay for these expenses is an important part of planning your family. There are many resources such as EMD Serono’s financial assistance programs for fertility medications. Family Equality council also has a list of family-building grants that help LGBTQ+ families afford fertility treatment. Be sure to ask your fertility clinic about available financial assistance programs and payment plans.

At Alto, we’re committed to doing whatever we can to minimize stress during fertility treatment, including supporting your financial well-being. If fertility medications are a part of your path to parenthood, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible.

Read our previous post on managing the costs of fertility treatment.

A fertility pharmacy partner you can rely on

Alto is here to support your journey with starting a family. We know that there are many paths to parenthood and that each individual or family’s needs are different. Our team of patient care pharmacists has experience working with the TGNB community, and we’ll be here at every step of the way if you choose to pursue any of the fertility treatments described above. We also offer discrete, private packaging and free, same-day delivery to keep stress at minimum during this special time in your life.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

The U.S. Centers for Disease Control and Prevention (CDC) has updated its guidelines for PrEP, a medication that can lower risk of sexual transmission of HIV by 99% when taken daily. The new guidelines — which will inform local healthcare policies and doctors’ decision-making processes — recommend that healthcare providers share information about PrEP with any patient who is sexually active, and that they prescribe PrEP for any patient who requests it. Here’s what to expect from the changes.

How Updated CDC Guidelines Can Expand PrEP Access

PrEP usage has historically been low despite the medication’s effectiveness. In 2020, just 25% of those who could benefit from PrEP were taking it.

Under the former guidelines, many doctors only shared information about PrEP with patients who presently have multiple partners or a partner who is HIV-positive or unsure of their HIV status. In reality, more people could benefit from PrEP, including those who are single and sexually active.

Under the new guidelines, anyone who is sexually active should receive PrEP information from their healthcare provider, including adolescents. Given that many traditional sex education programs in schools throughout the U.S. aren’t providing LGBTQIA+ youth with the resources they need to stay safe and healthy, the new guidelines are also an important step toward more inclusive sexual education.

Opening up the conversation about HIV prevention to more individuals aligns with what Dr. Lisa Sterman, MD, MPH, shared during a conversation with Alto in October 2020.

“A lot of people may think, ‘I’m not at risk’ or, ‘that’s not my group of people,’” Sterman said. “The way I teach it is: if you’ve ever had sex, you’re at risk for HIV. If you’ve ever shared drug needles, you’re at risk for HIV. Everyone should know their status.”

Addressing fear of discrimination or stigma at the doctor’s office

Previously, many individuals were asked to disclose personal information about their sexual health or drug use in order to receive a PrEP prescription. However, many people at risk of contracting HIV don’t feel like they can speak openly with their healthcare providers, particularly LGBTQIA+ people of color, who face multiple forms of discrimination. This barrier to PrEP access has kept many individuals from starting the medication and contributed to racial disparities in HIV rates: according to 2016 CDC data, white individuals accounted for 69% of PrEP use, while Latinx and Black individuals accounted for 13% and 11%, respectively.

The new guidelines aim to make PrEP more accessible for those who may be reluctant to share information about potentially stigmatized behavior with their healthcare providers. While conversations between doctors and patients about PrEP may initially cover a patient’s sexual health history, the CDC has recommended that anyone should receive a prescription for PrEP if requested.

There are more FDA-approved medication options for PrEP than ever before: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. The following resources can connect you with a provider who will prescribe PrEP for you:

Alto will coordinate with your doctor and your insurance provider, if applicable, to ensure you’re receiving the best PrEP option for your needs at the best price. 

Editor’s Note: This post was originally published in July 2021 and has been updated for accuracy and completeness.

What Updated CDC Guidelines Mean for PrEP Access

In this post we’ll take you on a tour of our app including how to transfer and pay for a prescription, schedule upcoming deliveries, and message a pharmacist, all from your device. 

How to Make the Most of the Alto Pharmacy App

The Alto app puts pharmacy at your fingertips. With a nearly perfect customer rating, it’s one more way we make managing your medications easier and convenient. In this post we’ll take you on a tour of our app including how to transfer and pay for a prescription, schedule upcoming deliveries, and message a pharmacist, all from your device. 

Download the Alto Pharmacy app today to get started. 

Have prescriptions at other pharmacies? It’s now even easier to transfer your prescriptions to Alto -  just take a photo of your current medication’s label and we’ll do the rest! Select “Add medications” from the main page in the app and upload a photo that clearly shows: 

Our team will coordinate the transfer, search for any savings on your medications, and reach out when it’s time to schedule your free delivery.

At the doctor’s office? Tell them your pharmacy of choice is Alto and show the staff our handy pharmacy info card. It’s available in the top left corner (click the Info Card icon) and pick the Alto location closest to you.  

As soon as your prescription is ready, we’ll reach out within the hour to schedule your free delivery. It’s really that simple.

With our latest iOS app release, you can now check out with Apple Pay. This feature allows you to make contactless, secure purchases. To set up Apple Pay on your device, follow these instructions. 

You can also manage other payment options (including FSA/HSA, debit and credit cards, and automatic funds transfer) in the Payment Methods menu in your Account settings. And Android users - we didn’t forget you. 

Our free, same-day courier delivery model means you’ll never need to go to the pharmacy again. Pick the day and delivery window that works best and let us know if we should deliver to your home or office. You can designate a safe place for packages to be left if you won’t be home. We also offer contact-free signature capture for those expensive medications. 

Your medications will be hand-delivered by a member of our local courier team. Not sure if we deliver to your neighborhood? View our full list of locations here.

Busy schedules mean it can be hard to remember when to take your medications. With custom medication reminders, it’s easier to stay on top of your prescriptions. Head to “Reminders,” select the prescription you’d like to set a reminder for and input the specifics of your medication’s schedule: day(s) of the week, time(s) of day, amounts.

You’ll receive a push notification at the scheduled time and once you've taken your medication, you can check off the dose in the app to track your progress. To turn on push notifications select “Settings” on your phone, tap “Notifications,” and select “Allow notifications” for the Alto app.

Future You will thank you when you turn on Auto Refills for recurring medications to automatically receive refill deliveries right on schedule. Plans change? We’ll confirm the delivery ahead of time in case there’s anything you need to update. 

From your Meds list: open an active prescription to view medication details, your last copay and next available delivery date. Turn on Auto Refills to receive your next delivery a few days before your current supply runs out.

From your cart: turn on Auto Refills during checkout so your next delivery is automatically scheduled.

From your Account settings: view and edit details for all active eligible medications, enroll eligible medications,* and schedule deliveries in the Auto Refill menu.

Questions about coverage, copays or medication side effects? First time taking an injectable medication? Our pharmacists are available to provide advice via in-app secure messaging. 

We take your privacy seriously - our in-app messaging is built with industry-standard encryption and data security practices. Our pharmacists and care team are just an in-app message chat, or an email away: 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends.

We’re here to support you with exceptional pharmacy care every step of the way. Our team will look for any available savings to help you get the lowest price, and we’ll deliver your medications to your home for free. 

You can also switch to Alto in minutes by going online at alto.com or by calling us at 1(800) 874-5881. For more information on how to transfer a prescription to Alto visit here.

*Automatic refills are only available for prescription medications that have refills remaining on the prescription and are not available for controlled substances. Some insurance plans may also limit automatic refills.

Editor’s Note: This post was originally published in April 2021 and has been updated for accuracy and completeness.

How to Make the Most of the Alto Pharmacy App 

Here’s what we know so far about the risk of COVID-19 for people with HIV, vaccine safety, and how to protect yourself from contracting COVID-19. 

What the COVID-19 Vaccine Means for Those With HIV

As of March, 2021, over 115 million people worldwide have been diagnosed with COVID-19. As the COVID-19 pandemic persists, many are wondering what the COVID-19 vaccine could mean for the 38 million people who are living with HIV: is it safe or does it pose a greater risk for these individuals? Here’s what we know so far about the risk of COVID-19 for people with HIV, vaccine safety, and how to protect yourself from contracting COVID-19. 

Are people living with HIV at a higher risk for COVID-19? 

Data is limited and experts are still learning exactly how COVID-19 affects those with HIV, but the Centers for Disease Control and Prevention (CDC) says that those who have HIV (and who are also on effective HIV treatment) generally have the same risk of contracting the virus as those who don’t have HIV. 

So, who is at greater risk? The CDC has evidence that shows older adults and people with certain underlying medical conditions like chronic obstructive pulmonary disease (COPD), type 2 diabetes, and a weakened immune system are at an increased risk for more severe cases of COVID-19. And since nearly half of those living with HIV in the United States are over 50 years old, those living with HIV are encouraged to follow all CDC guidelines to reduce the risk of COVID-19 exposure.

Experts have not found any significant evidence that those living with HIV will experience more severe COVID-19 outcomes; studies performed in Spain and in the United States on a Veterans aging cohort both found no difference in susceptibility to the virus in those with HIV.

Are COVID-19 vaccines safe for people living with HIV?

Yes. According to the United Nations Program on HIV/AIDS (UNAIDS), the COVID-19 vaccines currently being developed or approved by regulators are believed to be safe for most people, including those living with HIV. The COVID-19 vaccines, like other vaccines, undergo the same safety tests and are required to meet rigorous standards. 

Regulators have not yet found any evidence that people living with HIV are at a greater risk from the COVID-19 vaccine in terms of side effects than anyone else.

How does the vaccine work and what symptoms could I expect?

In a recent virtual town hall on COVID-19 and HIV hosted by Getting to Zero San Francisco, experts confirmed that the COVID-19 vaccine has been proven to help reduce the severity of illness from the virus. The vaccine could also prevent infection, reduce transmission, and lead to healthier communities. 

The COVID-19 vaccines work by helping our bodies develop immunity to the virus that causes COVID-19 without us having to actually contract the illness. The different vaccines work in slightly different ways to protect us, but all generally leave the body with a supply of cells that remember how to fight the virus in the future.

After receiving the COVID-19 vaccine, the process of building immunity can result in some people experiencing mild symptoms like a sore arm and mild fever or chills in the days following vaccination. If you have any pain or discomfort, you can talk to your doctor or pharmacist about over-the-counter medications.

How can people with HIV protect themselves from COVID-19?

As you’ve likely heard, the best way to keep from getting sick is simply to avoid exposure to the virus. Everyone, including people living with HIV, should keep taking everyday actions like wearing a mask, staying six feet away from those who don’t live with you, and avoiding crowds, to help avoid contracting and spreading COVID-19.

If you have HIV and are taking your HIV medicine, it’s important to continue doing so and follow any advice from your healthcare provider. This will help keep your immune system healthy and ready to fight off any infection. The CDC also recommends lifestyle practices like eating healthy foods, getting at least eight hours of sleep per night, and minimizing stress as much as you can.

If you develop any symptoms that indicate you might have COVID-19, the CDC recommends calling your healthcare provider and getting tested. Most people have mild illness and can recover at home. If you do develop severe symptoms, the CDC recommends you get emergency medical care immediately.

At Alto, we’re committed to ensuring you receive you medications safely and on time throughout the COVID-19 pandemic. Our pharmacy locations are fully stocked and our pharmacists are on hand to answer any questions and provide ongoing access to support and advice. Reach out to our HIV specialty team through secure in-app messaging or phone at 1-800-874-5881. 

At Alto, we’re obsessed with our mission to improve quality of life for everyone who needs the help of medicine. Our mission guides us in all we do and every decision we make. 

Our mission and diversity work are tied together with one word from our mission -- everyone. Too often, only those with significant resources access the best and benefit from innovation in healthcare. We see it everyday in the data. Too many among us continue to struggle with solvable challenges, in our own wellbeing and in the larger healthcare system. These statements and environments have existed in the workplace as well, influencing the products, services, and policies that steer how the organization works for all of us.  Our work is to make Alto different.  Our work is to build and sustain an inclusive culture.  Our work is to attract, develop, reward and retain talent from all the communities we serve as patients and build a product that supports everyone. 

Today marks another step in our diversity, equity, and inclusion journey as we release our first annual diversity report. We share it because this work is central to our mission and in doing so, we use transparency to hold ourselves accountable, as well as hopefully play a part in raising expectations and norms throughout the healthcare and technology industries.

Blog

The Role of Insulin Pumps in Diabetes Treatment

Spotlight on Men Having Babies & Dr. Guy Ringler

Get to Know the Team That Builds Alto's Customer-Facing Apps

Fertility Options for Transgender, Gender-Queer, and Nonbinary (TGNB) Individuals

How Updated CDC Guidelines Can Expand PrEP Access

How to Make the Most of the Alto Pharmacy App

What the COVID-19 Vaccine Means for Those With HIV

2020 Diversity, Equity & Inclusion Report

Creating Sandboxes: How to Make It Easy for Your Engineering and Product Teams

Using Your Continuous Glucose Monitoring Device

How to Debug Slow and Failing Cypress Seeds

The COVID-19 Vaccine & Racial Disparities in Healthcare: A Q&A with Dr. James Hildreth

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