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Blog | Alto Pharmacy

Last month, Alto celebrated the well-deserved promotions of many Altoids across the company. Among those promoted is Elnaz Moshfeghian, who is now Alto’s VP of Strategic Planning & Business Operations. Elnaz shares more about her new role, what she’s most excited about at Alto, and advice she has for those looking to make a career pivot.  

Catching up with Elnaz Moshfeghian, Alto’s new VP of Strategic Planning & Business Operations | Alto

Last month, Alto celebrated the well-deserved promotions of many Altoids across the company. Among those promoted is Elnaz Moshfeghian, who is now Alto’s VP of Strategic Planning & Business Operations.

Elnaz joined Alto in 2016 as a software engineer and when we last connected with her in 2020, she shared her thoughts on building a career in engineering. Since then, Elnaz has pivoted to a truly cross functional, strategy-focused role, where she applies learnings from her engineering experience with her ability to identify opportunities for growth. 

Below, Elnaz shares more about her new role, what she’s most excited about at Alto, and advice she has for those looking to make a career pivot.  

To start, congratulations on your new role! You joined Alto 6.5 years ago, and so much has changed both within the company and the industry at large. Can you tell me a little bit about your journey at Alto? 

I’ve always been attracted to problems that are cross functional and can be solved by bringing together different teams - pharmacists, technicians, logistics, dispatch, sales. I really enjoyed it as an engineer, given that when I joined there were no product managers. We all had to figure out what we were going to build and build it ourselves. I loved working with teams, which is why I pursued the manager track. I noticed pretty quickly that the most interesting and challenging problems rarely came down to technical decisions, but more-so to people and priorities. 

As I grew in my engineering career, and got to lead teams solving problems, I was always searching for how to expand my understanding and impact across the business. I had the opportunity to shift into a strategy and operations role, which allowed me to shadow the CEO and learn a great deal while also identifying the company’s key priorities, understanding how they're doing, and ensuring that they stay on track. The new role allows me to use everything I’ve learned over the last 6.5 years at the company while at the same time, learning a lot from a seasoned leader like Alicia on how to run a business. 

Your previous experience was in engineering, and you didn’t work in healthcare or pharma before joining Alto. What has been the biggest surprise to you since joining the company? 

There are a lot of different hands in healthcare; it's a really complex space and there’s a lot at stake. I’m always mystified by how hard it is to align different parties’ incentives to result in the right outcome for patients. It underscores the importance of Alto’s mission: to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it.

Tell me a little bit about your current role. What are you most excited by? 

I’ve loved seeing how the different pieces of the company connect, and being able to connect the dots when we’re missing something. It’s been really fun to see how a little bit of communication and collaboration can go a long way. I also love thinking about how what we’re doing today could set us up for bigger things in the future, and how we build today in a way that opens a lot of doors for us down the line. 

In your opinion, what are the biggest opportunities for the company? 

There’s always an opportunity to be excellent at the basics. Are we consistently providing the best patient experience? Are we getting patients the best price? Are we saving time for prescribers and their offices? Those are problems that we’ve been solving for a long time, but it just gets more interesting and challenging as we’ve gone into new markets and therapeutic areas, and worked with different kinds of patients and prescribers than we used to. 

Something that I’ve always been intrigued by is - how do you bring more transparency around pricing to prescribers and patients at the earliest possible time, so that they can make the best decisions? It’s something that’s really missing in the industry. It’s not easy to do, and that’s definitely something I think a lot about - ‘How can we be the one who makes it easy for prescribers to know what they’re about to send to the patient, and for the patient to know what their other options are?’ Because a lot of times, what your insurance may cover and what your doctor may prescribe may not always be the best option. There might be other options, and I think a lot of people don’t know to ask about that. 

What are the biggest challenges in the pharmaceutical industry today? 

I think there’s been a lot of great activity from different patient advocacy groups and state governments to regulate the worst of what’s happened in healthcare. It’s been cool to see that take shape over the last five years. The challenge is that it’s very hard to write legislation and force some of these things, and so I’ve honestly gotten more interested in how do you write the right laws and approach regulation in a way that allows innovation to still happen and thrive, and still protects the patient at the end of the day. 

Back to your engineering roots – what advice do you have for young engineers?

Given the state of venture capital and the industry, a lot of engineers are going to earlier-stage companies, because there’s a little bit more investment and activity happening. I had to figure that out along the way - how do you operate as the third engineer on the team? Being anyone in an early-stage, small company - and an engineer especially - comes with its own unique challenges and skills. It’s not something there’s a ton of resources around. There’s a lot of resources about how to start a company, but not a lot for how engineers can grow their career at a company at that stage. So, my advice would be to seek out mentorship and cross functional peers from whom you can learn and grow. 

You pivoted from engineering to operations and strategy. What advice do you have for someone looking to make a career change? 

As an engineer, I’ve really focused on making an impact, whether that’s through building a product or shaping the business with what I know, with tech being the backbone. And I think that’s something we don’t talk about as much in engineering - how do you take your skills and really channel them for maximum impact and better understanding of a business? And for people who want to start their own companies someday, taking the path I did could be really valuable. It allows you to be a better entrepreneur and a better contributor if you can see the connection between engineering choices and the systems you’re building, and how they impact your customer and other parties. 

The other piece is being comfortable with wearing a lot of different hats. It’s what really helped my growth, and it’s counter to a lot of advice you get. People will tell you to go deep, get specialized and go down one path. You need to, to some extent; I absolutely had to figure out how to be a better engineer and a better leader. But the most growth for me wasn’t necessarily to stay in engineering – it was to take a turn. Hopefully, I can give colleagues a little more confidence who want to take a turn and increase their impact, growth and learning. 

Catching up with Elnaz Moshfeghian, Alto’s new VP of Strategic Planning & Business Operations 

Staying on track with treatment and fully benefiting from a medication entails more than simply filling a prescription. It requires patients to take an active role in their health journeys, with education, clinical monitoring, and side effect management all necessary for proper drug utilization.

How Alto’s High-Touch Model Supports Patient Engagement

Pharmacists are an invaluable healthcare resource for those with complex treatment plans. Unfortunately, the traditional retail and mail-order models fail to maximize the possibilities of pharmacy care, without opportunities for ongoing engagement with patients. Not only are retail pharmacists often inundated with many tasks, it’s difficult for patients to discuss their health in a crowded store with a line of other customers behind them. And patients receiving their medication by mail often have limited visibility into delivery details or difficulty connecting with the pharmacy team. 

Alto Pharmacy offers a supported and convenient prescription journey at every step. We ensure that our patients have the information they need to get started with specialty medications and feel confident about their care. In addition to providing a simple onboarding experience, we have a team with robust clinical expertise and a high-touch model that allows patients to easily benefit from it.

We are also expanding our reach to fertility patients through our new nationwide* mail-order offering. Patients who receive fertility medications through mail-order experience the same convenience and support as those we serve via local courier delivery, with seamless onboarding, easy and supported medication management, and access to experts. 

And with an integrated and customizable tech stack — including both our proprietary pharmacy management software and our patient app — there are many ways for partners to provide additional engagement and supplement other support programs.

Here’s how Alto’s model enhances medication education and gives you, as a partner, the opportunity to more deeply engage our shared patients.

Alto offers a supportive and simple patient onboarding experience with proactive multichannel communication. We give patients a welcome text or call within 60 minutes of receiving their prescription, guiding them through their first order. Those who need to transfer an existing prescription to Alto can do so within minutes in our app.

If more information is necessary to fill a prescription, we make sure that patients and providers are both fully in the loop. We keep the patient informed at every step of the billing process, offering support with prior authorizations as needed. Through Alto Connect, our free communications portal for providers, clinical teams can view active medication details and quickly understand when additional steps are required to fill a prescription.

Partner Opportunities to Supplement Patient Support

The majority of Alto patients use our app for intake, medication ordering, and delivery scheduling. Not only does this give patients control and convenience in managing their prescriptions, it provides opportunities for additional engagement from partners.

Our flexible technology capabilities allow for many possibilities, including in-app introductions to your medications. In this video, a specialist from our fertility team walks patients through injecting the Gonal-f® RFF Redi-ject® Pen.

Follow-Up and Improving the Patient Experience

Easy onboarding is just the beginning. Alto supports patients at every stage of the prescription journey so that they can get the most benefit from their medication. Our dedicated medication therapy management pharmacists, who focus entirely on disease state education and support for chronic conditions, proactively contact patients who take specialty medications to review their regimens.

We ask if they are experiencing any side effects and track all patient-reported outcomes. As a partner, you can have access to data and insights into your patients’ experience of your medications.

We’re also able to tailor a patient’s treatment to any titration schedule prescribed by their provider. In these cases, we inform the patient of this schedule and change in medication dosage at every step of the treatment.

We see our NPS of 88 as an attestation of our patients’ love and commitment to both Alto and their health. 

Choose Alto Pharmacy for your limited distribution network

Alto’s end-to-end dispensing model is specifically built for specialty and specialty lite products. To learn more about partnering with us, reach out to partnerships@alto.com.

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.

Tech-Based, High-Touch Patient Engagement at Alto

Alto Pharmacy is thrilled to announce that The Honorable Alex M. Azar II, the 24th Secretary of the U.S. Department of Health and Human Services, has joined our board of advisors. Read more here.

Alto Welcomes Secretary Alex M. Azar II to Board of Advisors

Alto Pharmacy is thrilled to announce that The Honorable Alex M. Azar II, the 24th Secretary of the U.S. Department of Health and Human Services, has joined our board of advisors. 

Since its formation in 2020, the Alto board of advisors has provided the company with strategic guidance and helped ensure that our efforts are both impactful and efficient, with services grounded in the highest standards of operational excellence. Secretary Azar brings deep experience in both public health and the private sector, and his personal commitment to the health of all Americans mirrors Alto’s mission and focus on patient outcomes. 

During his tenure as Secretary, Secretary Azar led the historic transformation of the healthcare system in the United States and the HHS’s response to the unprecedented COVID-19 pandemic. He was the architect of Operation Warp Speed, delivering COVID-19 vaccines and therapeutics in record time, and led a team of more than 85,000 employees. Among many other accomplishments, Secretary Azar drove efforts to reduce drug prices, increase private insurance options, bring transparency of price and quality information to healthcare, expand telehealth, enable healthcare provider collaborative care models and remove regulatory barriers to low-cost, high-quality care. 

He has also played significant roles on the global health stage and championing the U.S.’s global health security efforts, including representing the U.S. in the World Health Assembly, working with the WHO to end Ebola outbreaks in the Democratic Republic of the Congo, chairing the most active G7 health ministerial in history in 2020, and convening and leading western hemisphere coordinated efforts to assist with the Venezuelan refugee crisis.

In addition to his public sector work, Secretary Azar served for ten years at Eli Lilly and Company, including five years as president of Lilly USA, LLC, its largest affiliate. He serves on several corporate and advisory boards and is a part-time Adjunct Professor of Business and Senior Executive-in-Residence at the University of Miami Herbert Business School. 

“Alto is honored to welcome Secretary Alex M. Azar II to our board of advisors,” said Alicia Boler Davis, CEO of Alto Pharmacy. “Secretary Azar is one of the most tenured experts in public and private healthcare, and his career-long commitment to improving public health perfectly reflects our top founding value – to put patients first. We are grateful for his service and are excited to leverage his deep experience and learnings as we continue to grow.” 

“Alto’s commitment to its mission of fulfilling medicine’s true purpose — to improve quality of life — for everyone who needs it sets it apart from other pharmacies,” said Secretary Azar. “I’ve dedicated my career to developing solutions for providing and enhancing healthcare outcomes for all, and I look forward to working with the Alto team and the board of advisors to continue doing just that.

Many people take more than one prescription medication to manage a chronic health condition, or multiple conditions. According to the Centers for Disease Control and Prevention, 24% of Americans take three or more medications, and 42% of all adults age 65 and older take five or more prescription medications.

How to Manage Multiple Prescriptions

It can be challenging to manage multiple prescriptions, from remembering to take each dose on time and staying on top of refills, to preventing interactions and side effects. If you take multiple medications, here are some tips to help you stay on track with treatment.

Keep all of your healthcare providers on the same page.

If you see different specialists for different conditions, it’s important that each of them is familiar with your entire medication regimen, including over-the-counter medications or supplements. This is so that they can treat you as effectively as possible, providing insight into the cause of any side effects you may be experiencing and helping you avoid medication interactions.

Make a list of all the prescription medications, over-the-counter medications, and supplements you take, including the dosages, and bring it with you to each doctor’s appointment.

Educate yourself about each medication you take.

Another reason to make a detailed list of all your medications: to ensure you understand what each is used for. Many people find it easier to stay on top of their full regimen when they know why each medication matters.

Informing yourself about your medications can also help you prevent medication interactions and side effects. You should always know the answers to the following questions about any medication you take — your pharmacist is a great resource for information.

Can I take this medication with other medications?

Should I avoid certain foods or drinks when taking this medication?

Are there known potential medication interactions? If so, what signs should I watch for?

Remember, too, that taking a medication as prescribed often means more than simply taking the medication. In many cases, medication therapy also includes testing and clinical monitoring. If you aren’t sure about the details of your treatment plan, including what lab work your medication requires, don’t hesitate to ask your care team for clarification.

Fill your prescriptions at a single pharmacy.

There are many reasons to have a single pharmacy partner. Consolidated medication records allow your pharmacist to offer more effective consulting about interactions and side effects, and to collaborate more easily with your care team.

Filling all your prescriptions at one pharmacy may also simplify medication management. At Alto, we offer a free medication bundling service that syncs your refills so that you receive all your medications in one easy recurring delivery.

Create your preferred medication reminder system.

Medication errors, like missing a dose or taking an extra one, are more common with the more medications you take. There are a variety of tools to help you remember when to take your medication.

Pill organizers, which have compartments for different medications, allow you to quickly determine whether or not you’ve already taken your dose. There are both daily and weekly pill organizers; the best option for you depends on personal preference and how many medications you take.

When using a pill organizer, make a dosage schedule with clear descriptions of each pill to avoid mixing up medications.

Consider setting alarms to help you remember when it’s time for a dose. The Alto app includes custom medication reminders. Many people also find it helpful to link the act of taking their medication to another daily activity, like brushing their teeth or eating breakfast.

It’s also important to find your preferred system for remembering refills. Our app’s medication management features include auto refills and medication bundling.

If you aren’t using a medication management app, check your prescription labels regularly to see how many refills are remaining. Take note of when you will need to call or visit your doctor for a refill and mark it on your calendar.

Checking prescription labels also helps ensure that you aren’t taking expired medication!

Taking multiple medications may increase the possibility of more serious side effects. Even if you experience side effects, you should never stop taking a medication without first consulting your doctor. Rather, keep a log of side effects and discuss them with your doctor. They may be able to recommend adjusting your dosage or safely switching to an alternative medication.

Review your medications with a provider at least once a year.

Treatment needs may evolve with time. To ensure that you are still receiving the best treatment for your needs, review your medication list with a provider at least once a year. This is also an opportunity to discuss any concerns and adjust dosages if necessary.

In addition to an annual review, you should also review your medication regimen with a healthcare professional if you receive a new diagnosis or experience new symptoms of an existing health condition.

Try the Alto app for easy medication management

The Alto app gives you control and convenience in managing your medications, with auto refills, medication bundling, and custom dosing reminders. You can also chat with expert pharmacists to get the answers you need about your treatment, even during nights and weekends.

Today, Alto was named to the 2023 CNBC Disruptor 50. This annual list celebrates the most innovative and game-changing private companies across various industries. We are grateful to be included among these incredible companies, and humbled by this recognition of our business model, operations, and value proposition.

Alto Named to 2023 CNBC’s Disruptor 50 List

At Alto, our mission is to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it. By putting patients first, we’re increasing accessibility to medicine, improving prescription adherence and making a meaningful difference in the lives of patients. 

Today, Alto was named to the 2023 CNBC Disruptor 50. This annual list recognizes private companies that are chasing some of the market’s biggest opportunities, and growing despite a tough capital markets environment and slowing economy. We are grateful to be included among these incredible companies, and humbled by this recognition of our business model, operations, and value proposition.

Despite the challenging economic headwinds that all industries are facing, we’ve remained competitive, agile, and committed to delivering outstanding patient care. Just last year, we launched Essentials from Alto, allowing customers to purchase pharmacy items along with their prescription medication in the Alto pharmacy app. This provides even more access to individuals who are disabled, lack physical mobility, or otherwise can’t reach a pharmacy. 

As we celebrate this achievement, we are also mindful of the challenges that lie ahead. The healthcare industry is complex, and there is still much work to be done to ensure that every patient receives the care they deserve. But with our innovative offerings and unwavering commitment to our customers, we are confident that we can make an even bigger difference. 

Alto Named to 2023 CNBC Disruptor 50 List

Mental health disorders are among the most common health issues, affecting more than 1 in 5 U.S. adults. But despite how widespread these challenges are — and despite greater awareness of them in recent years — the stigma of mental illness remains a significant problem, one that keeps many people from seeking vital support. Of all the U.S. adults living with a mental health disorder, more than half don’t receive treatment.

Breaking the Stigma of Medication For Mental Health Disorders

Anxiety, depression, bipolar disorder, and other mental health disorders are medical conditions. Treating them with medication is no different than lowering cholesterol levels with statins or maintaining balanced blood sugar with insulin. However, there are many misconceptions and negative connotations unique to mental health treatment.

No one should be discouraged from seeking the treatment that they need to feel their best. Here are a few reasons why there is no shame in taking medication for a mental health disorder.

Taking medication doesn’t mean you’re unable to manage your health on your own.

Despite the benefits of psychiatric medication, many people consider it a last resort to explore only after trying therapy and lifestyle habits like mindfulness and exercise. Often, this stems from a misconception that those who take medication for a mental health disorder aren’t working hard enough to manage their problems.

Living with a mental health condition looks different for everyone. While some people are able to manage symptoms of depression or anxiety with therapy and lifestyle changes alone, others need a treatment plan that includes medication.

Given how difficult it can be to seek a mental health diagnosis — not to mention to share your feelings openly with a healthcare professional — taking medication is not at all a sign of weakness. It reflects a commitment to your health and wellness, one to be proud of.

Keep in mind, too, that medication and therapy aren’t mutually exclusive tools, and in deciding to take medication, you’re not choosing between the two. Far from a substitute for therapy, medication is in some cases necessary for therapy to be impactful. For example, many people with a depressive disorder find that they need to first address symptoms with medication in order to benefit from therapy sessions. Research has also affirmed this approach: some studies have found that a combination of therapy and medication is more effective at treating depression and eating disorders than either individual treatment.

It isn’t “taking the easy way out.”

Many who equate medication use with weakness see this treatment option as putting a band-aid over a problem, or taking the easy way out. On the contrary, psychiatric medications are far from a quick fix. Medication therapy can take time and a fair amount of trial and error.

With many of these medications, it can take several weeks or more before you experience the benefits. For example, many selective serotonin reuptake inhibitors (SSRI) — a type of medication commonly used to treat depression and anxiety — take two weeks to begin to have a therapeutic effect, and up to six weeks to reach a full therapeutic effect. This is why it’s important to be patient when starting a new medication, and to continue to take it as prescribed even if you don’t feel like it’s working. If you have concerns after several weeks, speak with your provider.

Also, while a medication may be able to relieve symptoms of a mental health disorder, it is not a cure. Rather, it is often what allows many people to do the challenging work of managing an ongoing condition.

Psychiatric medication is a valid and effective treatment option for a medical condition.

Mental health disorders are medical conditions with physiological components. They are frequently rooted in genetics or an imbalance of chemicals in your brain. Many psychiatric medications adjust the balance of your brain chemistry to relieve symptoms of depression or anxiety. For example, SSRIs like sertraline (Zoloft®), fluoxetine (Prozac®), and escitalopram (Lexapro®) increase serotonin levels. Serotonin and norepinephrine reuptake inhibitors (SNRIs) — another group of medications that includes venlafaxine (Effexor®) and duloxetine (Cymbalta®) — increase serotonin and norepinephrine.

Another common misconception about psychiatric medications is that they will alter your personality or make you less “you.” Many people who take medication find that they actually feel more like themselves with treatment — symptoms of mental health disorders can greatly interfere with your relationships and work and keep you from experiencing a full life.

Like most medications, some medications for anxiety, depression, and other mood disorders do have the potential for side effects. There are a variety of medication options for these conditions, so if you have concerns about side effects associated with one option in particular, your provider can help you explore alternatives.

Keep in mind that each person’s response to medication is unique. If you know someone who had side effects from one medication, it doesn’t mean that you will have the same experience.

A combination of medication and therapy can be an effective treatment option for many mental health disorders. Like determining the best medication for your symptoms, finding the right therapist can take time. Here are some tips.

If you have insurance coverage of therapy sessions, check your insurance company’s provider network as a starting point.

Look through reputable online databases like Psychology Today or the American Psychological Association (APA)’s psychologist locator.

Some therapists offer sliding scale fees to make sessions more affordable.

If you are having thoughts of suicide, need emotional support, or are concerned for a loved one, the 988 Suicide and Crisis Lifeline is available 24 hours a day, seven days a week.

Taking care of your mental health is easier with a reliable pharmacy on your side. Our pharmacists can answer any questions you may have about your medications, and we offer same-day delivery and medication management tools like reminders and auto refills in our app.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

Learn more about national medication shortages affecting people and pharmacist everywhere, what causes shortages, steps you can take if you are affected, and other frequently asked questions. Read on.

Medication Shortages, Explained | Alto Pharmacy

Few things are more frustrating — or frightening — than being unable to access the medication your doctor has prescribed. But it has become a common experience in recent years, as medication shortages remain a persistent healthcare challenge in the U.S. And if you take medication, you may be familiar with the panic of struggling to find enough of what you need.

Not only are these shortages incredibly frustrating and debilitating, they are also confusing and unpredictable, arising seemingly at random, and with little known about an anticipated resolution.

While Alto will always go above and beyond to bring you your medications without delay, these shortages are beyond our control, and we share your frustrations and concerns. To provide more clarity and context as to why these shortages occur — and why, unfortunately, there are few short-term solutions — we’ve compiled answers to some of the questions we hear most frequently.

Like every pharmacy across the country — as well as many around the world — Alto has been affected by medication shortages in the last few years. Each pharmacy’s stock fluctuates in tandem with demand, so if you call multiple pharmacies, it’s possible that one will have a greater supply of an affected medication than another on any given day. But ultimately, no pharmacy is immune to these challenges, and if a medication is in short supply, each pharmacy may feel the impact at some point.

If Alto currently does not carry your medication and you would like to transfer your prescription to another pharmacy, be sure to call that new pharmacy to confirm availability of your medication — medication shortages often impact most pharmacies within a specific region. 

The causes of medication shortages are complex, with multiple, and often intersecting, factors at play.

Any issues that affect the production of a medication may lead to reduced supply. This includes disruptions to manufacturing, like when Hurricane Maria damaged production sites in Puerto Rico in 2017.

Covid is another example of how a natural disaster or global crisis can disrupt medication production. The United States relies heavily on other countries for the raw ingredients needed to manufacture a medication.* This leaves us incredibly vulnerable to changes in workforce capacity or manufacturing activities overseas.

*As of 2019, only 28% of our country’s supply of active pharmaceutical ingredients (APIs) — the substances directly responsible for a medication’s therapeutic benefits — were manufactured domestically.

Even when manufacturing circumstances are ideal, rising demand for a medication can lead to low supply. This winter’s difficult cold and flu season, with high cases of Covid, the flu, and R.S.V., contributed to a decreased supply of children’s formulations of ibuprofen, acetaminophen, and several commonly prescribed antibiotics.

Adderall®, a stimulant used to treat attention-deficit/hyperactivity disorder, is another medication whose demand has increased in recent years. Prescriptions for the medication increased by 15.1% in 2020, in comparison to a 7.4% increase in 2019. This comes after a surge in new ADHD diagnoses, which more than doubled between 2007 and 2016 and continue to rise. Worker shortages and production delays experienced by Teva, a leading manufacturer of Adderall, have added additional pressure and compounded the challenges.

High demand has also contributed to recent shortages of the diabetes medications Ozempic® and Wegovy®,  as they have been increasingly prescribed for weight loss.

Addressing increased demand is often easier said than done. Most generic manufacturers decide how much of a medication to produce at the beginning of the year, with virtually no flexibility, so it isn’t an option to simply make more. This is why there is often a seasonal pattern to shortages, with many intensifying at the end of the year.

In the case of Adderall, a Schedule II controlled substance, the Drug Enforcement Administration (DEA) imposes strict production quotas to prevent misuse. With quotas based on estimates, our manufacturing system isn't prepared to respond to unexpected factors like the recent rise in ADHD diagnoses. 

Why are shortages happening more frequently?

Medication shortages are in the headlines more these days, but they are not a new occurrence. They have steadily increased since 2006, becoming a public health crisis in more recent years. The American Society of Health-System Pharmacists (ASHP) reports that, at the end of 2022, ongoing and active shortages were the highest they’ve been since 2014.

The growing intensity of these shortages reflects the strain that Covid put on our entire healthcare system — which we still haven’t fully recovered from — along with other unpredictable healthcare patterns, like growing demand for ADHD medications.

Are certain medications more likely to be affected than others?

Ultimately, any medication can go into shortage, but some types are more prone to recurring supply chain issues.

Medication shortages frequently occur with commonly used (and low-profit) generic medications — like the antibiotic amoxicillin — as pharmaceutical companies have little financial incentive to produce more of them.

Some injectable generics are especially vulnerable to shortages. Fewer manufacturers make these medications, so any production disruption can become a larger issue.

The Adderall shortage illustrates that low stock of a single medication can create a class-wide issue. For many people with ADHD, switching to another medication has proven challenging, as alternatives grow scarce too. This is also the case with Ozempic and other diabetes medications.

Medication shortages are rooted in factors that are far beyond any one person’s control, and unfortunately, there is little we can do to prevent them. Industry experts have proposed solutions, including ramping up domestic production of key pharmaceutical ingredients and building a more resilient medical supply chain. These aren’t quick fixes, and government action is needed for meaningful progress.

What can I do to navigate a medication shortage?

While many medication shortages are unavoidable, there are steps you can take to potentially minimize their stress and impact.

You can track medication shortages on the U.S. Food & Drug Administration or ASHP websites to learn more about a medication’s supply.

To give yourself more time to figure out a short-term solution — such as switching to an alternative medication — refill your medication as far in advance as you can. In some cases, it may be possible to get a 90-day supply of your medication, though this isn’t always an option for controlled substances, and your insurance plan may also limit coverage of refills.

If your medication is in scarce supply, speak with your doctor about alternatives. In addition to taking a different medication, you may be able to switch to a different dose or formulation. Many medications require that you safely taper off of them, which is another reason it’s important to stay on top of refills and ideally learn about supply issues before the last minute.

If an alternative medication costs more or is not covered by your insurance plan, there are resources to help alleviate some of the burden, including coupons, manufacturer-sponsored copay cards, and patient assistance programs. Alto is here to support your savings investigations, and we also suggest reaching out to your insurance provider and verifying your plan’s details — they may be required to cover a branded option if a generic is unavailable.

Our team can answer any questions you have about your medications. We also offer same-day delivery and medication management tools like reminders and auto refills to make it as simple as possible to stay on track with treatment.

Learn more about national medication shortages affecting people and pharmacist everywhere, what causes shortages, steps you can take if you are affected, and other frequently asked questions.

The time to prepare for seasonal allergies is earlier than you might expect, as taking medications before everything is in bloom can help significantly to control symptoms. This year, you may want to consider ramping up your prevention efforts even earlier than usual: one consequence of climate change and rising temperatures worldwide is a longer growing season and higher levels of pollen in the air.

Why It’s Never Too Early to Prepare for Seasonal Allergies

The commonly used over-the-counter (OTC) medications below can help make allergy season more manageable — and many are available for purchase at the Essentials Store in our app! To browse the selection, tap the "Store" icon along the bottom of the Alto mobile app or the "Store" icon in your account on desktop.

Over-the-counter allergy medications to take preventatively

Nasal corticosteroid sprays prevent inflammation to reduce allergy symptoms such as stuffiness, sneezing, and a runny nose. Common OTC options include:

When taken in advance, these medications can potentially prevent the onset of allergy symptoms altogether. Many health experts suggest taking them about four weeks before the official start of allergy season, the specific timing of which depends on where you live.

For many people who experience seasonal allergies, symptoms typically first appear when trees start to release pollen in late winter and early spring. However, this pattern is changing as winter temperatures rise, and the timing of pollination also varies by region. To make the best plan, check local pollen levels and consult with your provider.

These medications block histamine, a chemical that your immune system releases during an allergic reaction. You may take them up to two weeks before the start of allergy season, as a preventative measure, but they can also be taken on an as-needed basis if you experience symptoms. They offer fast relief, taking anywhere from 15 minutes to two hours to go into effect.

Some antihistamines, including Benadryl® (diphenhydramine), can cause drowsiness and are not recommended to take before driving or other activities that require your attention.

The following antihistamines are less likely to cause drowsiness:

Not all allergy medications can be taken preventatively. While decongestants like Afrin® (oxymetazoline) and Sudafed® (pseudoephedrine) are effective at relieving congestion, they should only be taken on a short-term basis. Longer-term use may worsen allergy symptoms.

When to see a specialist for allergy symptoms

Remember that it may take time and a bit of trial and error to find the best relief for your allergies. If you experience regular symptoms after exploring a few options, work with your provider to find the best solution for your needs.

You may benefit from consulting a specialist such as an allergist or immunologist. These healthcare professionals can help identify more specific allergy triggers. They can also facilitate even more treatment options, including a preventative treatment called immunotherapy, which exposes you to allergens so that you become less sensitive to them. Immunotherapy comes in the form of both allergy shots and sublingual tablets placed beneath the tongue.

Stock up on allergy medications at the Alto Essentials Store

Purchase allergy season essentials like Claritin, Flonase, Zyrtec, Allegra and more right from your Alto account! You can order Essentials products whenever you need them, or add them to your next prescription delivery.

If your allergy symptoms persist even after preventative steps and exploring OTC options, we can support your treatment plan. We’ll coordinate with your doctor and insurance to offer your medications at the best price we can find, and our expert pharmacists are available via in-app messaging to answer any questions you may have about symptoms or side effects.

Some prescription medications used to treat chronic conditions or manage pain also carry the potential for dependence and misuse. These medications fall into a different category than most and are classified as controlled substances.

Managing a Prescription for a Controlled Substance

The distinction between controlled and non-controlled substances is an important one, as controlled substances are more heavily regulated than other prescription medications. There are limits on refills, and additional steps may also be required to get your prescription. Specific restrictions depend on factors such as your insurance plan’s benefits and the laws in your state. For example, many insurance providers limit the quantity of a controlled medication that they will cover over a given period of time.

Read on to learn how to manage your prescription for a controlled substance.

Controlled substances are regulated under federal law. The category includes both prescription medications and illegal drugs.

These substances are further categorized into five schedules, based on factors including their medical use, safety, and potential for misuse or dependency, with Schedule I substances being the most regulated.

Schedule I substances have no currently accepted medical use and are defined by the U.S. Drug Enforcement Administration (DEA) as having a high potential for misuse. Substances categorized into this schedule include heroin, ecstasy, and marijuana.

Schedule II substances are defined by the DEA as having a high potential for misuse and severe psychological or physical dependence. Substances categorized into this schedule include both illegal drugs such as cocaine and methamphetamine as well as prescription medications such as meperidine (Demerol®), oxycodone (OxyContin®), fentanyl, Dexedrine®, Adderall®, and Ritalin®.

Schedule III substances are defined by the DEA as having a moderate to low potential for physical and psychological dependence. Substances categorized into this schedule include some codeine-containing products, like Tylenol® with codeine; ketamine; anabolic steroids; and testosterone.

Schedule IV substances are defined by the DEA as having a low potential for misuse and a low risk of dependence. Substances categorized into this schedule include alprazolam (Xanax®), diazepam (Valium®), lorazepam (Ativan®), zolpidem (Ambien®), and Tramadol (ConZip®, Ultram®).

Schedule V substances are defined by the DEA as having an even lower potential for misuse than Schedule IV substances. Substances categorized into this schedule contain limited quantities of certain narcotics, including Robitussin AC®, Lomotil®, Motofen®, Lyrica®, and Parepectolin®.

Under federal law, there is a 30-day limit on the supply of any controlled substance. Additional federal restrictions on filling or refilling controlled substances vary by schedule. Some states may have additional restrictions or requirements for filling a controlled substance prescription. Here’s a brief overview.

No refills are allowed for schedule II substances. A new prescription from your healthcare provider is required for every fill.

Some states require a hand-written prescription with a provider’s signature.

Some states have expiration dates for Schedule II prescriptions, but there isn’t a federal law.

You are allowed to refill a prescription for these medications with a provider’s authorization.

If your provider has authorized refills, you are typically allowed up to five refills in six months. After five refills, a new prescription is required.

A prescription for a Schedule III, IV, or V medication expires after six months. After six months, a new prescription is required regardless of how many refills are left.

Tips for safe use of a controlled medication

If you are prescribed a controlled substance, it is especially important to keep track of your medication supply and take your medication only as directed. Never adjust the frequency or dose of your medication without consulting your provider. Make sure that anyone who prescribes a medication for you is aware of any other medications you take.

Be aware that some providers ask patients to sign a written agreement to ensure safe use of controlled substances like pain medication. These agreements may require that you only fill your prescription at one pharmacy and don’t take controlled substances prescribed by another provider.

Filling a prescription for a controlled substance at Alto

Given the additional regulations of controlled substances, these medications are currently not eligible for auto refills or medication bundling at Alto. Your convenience and safety is our priority, and we hope to expand these services to include controlled substances in the future.

Delivery of these medications requires a signature from you or an authorized signer. To add an authorized signer to your Alto account, head to Account > Delivery Addresses > Edit Address > Delivery Instructions in the Alto app.

In states where a written prescription is required to fill a controlled medication, these prescriptions cannot be transferred to Alto from another pharmacy.

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