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Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy.

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Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

Given how accessible pharmacies are in many communities, there’s growing recognition that expanding the role of pharmacists in HIV prevention can help increase PrEP usage. Here’s a high-level overview of the process for getting PrEP from a pharmacy without a doctor’s prescription.

PrEP, or pre-exposure prophylaxis, has tremendous potential to save lives: the HIV prevention medication can lower risk of sexual transmission by 99% when taken daily. But ever since PrEP was first approved by the FDA in 2012, barriers like affordability, lack of access to healthcare systems, and fear of stigma have contributed to low usage rates. According to the American Journal of Public Health, fewer than 10% of people who could benefit from PrEP are taking it.

For many people at risk of contracting HIV, getting PrEP from a primary care provider isn’t an option. They may live far from a doctor, or they may not have a doctor they’re comfortable speaking with about their sexual health. Pharmacists have an opportunity to fill a critical need in expanding access to PrEP, as most people visit a pharmacy 35 times a year on average, and more than 90% of people in the U.S. live within five miles of one. 

Given how accessible pharmacies are in many communities, there’s growing recognition that expanding the role of pharmacists in HIV prevention can help increase PrEP usage. California became the first state to allow pharmacists to prescribe PrEP in 2019, and Colorado became the second in November 2020. Nevada passed a law in June, expected to be implemented in the near future, that will allow pharmacists to prescribe PrEP and provide related services including HIV testing. A handful of other states now have similar legislation underway.

Getting PrEP from a pharmacy under the new laws

If you live in a state with expanded PrEP access, here’s a high-level overview of the process for getting PrEP from a pharmacy without a doctor’s prescription.

A negative HIV test and baseline testing for sexually transmitted infections, hepatitis B, and kidney disease are required to start PrEP. Under the new guidelines, your pharmacy can order the lab work directly through your insurance. If it’s safe for you to start PrEP based on the lab results, your pharmacist will contact you for a consultation to discuss usage and side effects and answer any questions you have.

Most of the legislation limits pharmacist-prescribed PrEP to a 60 or 90-day supply. After that, you will need a doctor’s prescription to continue with PrEP. Check local guidelines for the latest information in your state. The following resources can connect you with a provider who will prescribe PrEP:

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. It also reduces the risk of getting HIV from intravenous drug use by about 74%. Consult with a healthcare professional if you have any questions about whether PrEP is the right choice for you.

In addition to the initial baseline testing, you will also have to visit a healthcare provider for follow-up testing while taking PrEP, including:

Sexually transmitted infection testing every 3 to 6 months

Pregnancy testing and discussion of pregnancy plans every 3 months

HBV DNA testing every 6 to 12 months while taking PrEP if you have hepatitis B

We’ll help you get PrEP at the most affordable price

PrEP is now more accessible and affordable than ever, no matter which state you live in. Excited? We are, too! We’ll update this post when Alto pharmacists at our California and Colorado locations are able to prescribe PrEP.  

Until then, we’re still the best option to fill and deliver your PrEP prescription. We will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. In addition to our AAHIVP-certified pharmacist team, you can expect:

Discrete, private packaging and free, same-day delivery

Med syncing support and in-app reminders to stay on track

Pharmacists directly available through phone, text or within the Alto app

Reach out any time to get started via text or 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.

Expanded PrEP Access at Pharmacies: What to Know

Chronic obstructive pulmonary disease (COPD) is a progressive and long-term inflammatory lung condition characterized by a persistent cough and shortness of breath. Read on to learn more about the stages of COPD, including the symptoms and treatment options for each stage.

What to Know About the Four Stages of COPD

Chronic obstructive pulmonary disease (COPD) is a progressive and long-term inflammatory lung condition characterized by a persistent cough and shortness of breath. While COPD is caused by smoking 85-90% of the time, exposure to secondhand smoke, air pollution, and industrial dust and fumes also contributes to cases. It’s the third leading cause of death in the U.S. and affects more than 15 million Americans.

Detecting COPD early on is critical to slowing the progression of the disease and avoiding serious complications. Doctors use a system called the GOLD Criteria to determine how severe each person’s COPD is. There are four distinct stages of COPD: mild, moderate, severe, and very severe. Your physician will determine your stage based on results from a breathing test called a spirometry, which assesses lung function by measuring how much air you can breathe in and out and how quickly and easily you can exhale. They will also consider the severity of your symptoms and the frequency of flare-ups.

As a progressive lung disease, COPD symptoms gradually become more severe over time, and people with COPD also grow increasingly susceptible to complications such as heart problems, pulmonary hypertension, and lung cancer. But while there is no cure for the condition, it is treatable: you can slow the progression by working with your doctor to establish a treatment plan and maintaining healthy lifestyle habits like avoiding cigarette smoke, exercising regularly, eating a healthy diet, and getting your yearly flu shot.

Read on to learn more about the stages of COPD, including the symptoms and treatment options for each stage.

The main symptoms of stage 1 COPD are shortness of breath and an ongoing cough, which may be accompanied with mucus. However, these symptoms are so mild that you may not realize you are experiencing them. 

Though stage 1 COPD symptoms are easy to miss, damage to the lungs still occurs. If you have any concerns that you may have COPD, speak with your doctor about an assessment. And if you currently smoke, try to quit as soon as possible to protect your lungs.

In addition to smoking cessation, your doctor may also prescribe a bronchodilator medication, which relaxes airway muscles to ease breathing and is typically taken through an inhaler. Common side effects include dry mouth, dizziness, tremors, runny nose, and throat irritation. If you experience severe side effects like blurry vision, a rapid or irregular heart rate, or an allergic reaction with a rash or swelling, contact your healthcare provider.

You should also stay up to date with yearly flu shots and pneumonia vaccines to avoid worsening of respiratory symptoms and other health complications.

In this stage, previously existing symptoms from stage 1 intensify as airflow limitations progress. Shortness of breath during physical activities is more noticeable, and coughing and mucus production may increase. Other symptoms include wheezing, fatigue, and trouble sleeping.

This is often the stage where you may first become aware of symptoms and seek treatment. Your doctor may prescribe a bronchodilator medication if they haven’t already, along with recommending breathing exercises. Techniques like pursed lip breathing and coordinated breathing can help you exert yourself less during physical activities and maintain an active lifestyle.

In addition to your medications, pulmonary rehabilitation is another common component of treatment for stage 2 COPD. It gives people living with COPD the tools they need to manage their condition, reducing the severity of symptoms and improving their quality of life. At these outpatient exercise and education programs, physical therapists, dietitians, nurses, and other healthcare professionals will share breathing techniques, coping strategies, nutritional advice, and exercise recommendations. Your doctor can help you determine if pulmonary rehabilitation is right for you.

The frequency of your doctor’s appointments depends on the severity of your condition. If symptoms are mild, you may have follow-up appointments every six months, while more severe symptoms will require more frequent monitoring.

At stage 3, lung function has significantly decreased. As the walls of the air sacs in the lungs continue to weaken, it becomes more difficult to take in oxygen and remove carbon dioxide while exhaling.

Previous symptoms are more intense and more noticeable: shortness of breath has worsened, coughing or wheezing occurs more frequently, and you may produce thicker mucus.

You may also experience the following symptoms:

In this stage, you may experience flare-ups when symptoms suddenly become more severe and lung function dramatically changes. During these exacerbations, you may feel greater amounts of mucus clogging your bronchial tubes and sudden constrictions of the muscles around your airways.

Flare-ups are the leading cause of COPD-related hospitalizations, and it’s important to take immediate action if you experience symptoms of a flare-up. Watch out for the following signs:

Wheezing or whistling noises when you breathe

Cognitive impairment including confusion, depression, or memory lapses

As part of your COPD treatment, your doctor will help you develop an action plan for managing flare-ups, including medications. Oral steroids including prednisone, methylprednisolone, and dexamethasone can treat acute COPD exacerbations. Side effects from short-term use of these medications are typically minor, if they occur. 

If you have frequent flare-ups, your doctor may prescribe inhaled corticosteroids including Flovent® HFA and Qvar Redihaler®; expectorants, which thin and loosen mucus; or oxygen therapy. You may also need to see your doctor every two weeks to a month for ongoing monitoring of symptoms.

In stage 4 of COPD, lung function is very low. Stage 3 symptoms worsen and become more persistent. Shortness of breath and chest tightness occur with everyday activities, and it becomes a big effort just to breathe. Hospitalizations for breathing complications, lung infections, or respiratory failure are common during stage 4 COPD, and sudden flare-ups can be life-threatening.

Pulmonary hypertension, a form of high blood pressure that affects the arteries in your lungs and the right side of your heart

There are various treatment options for severe COPD symptoms, including supplemental oxygen, pulmonary rehabilitation, and steroids taken orally, intravenously, or via inhaler. Potential side effects from steroids include swelling in the airways and mouth, muscle weakness, weight loss, fatigue, and increased risk for pneumonia. Read our previous blog to learn more about managing medication side effects, and speak with your doctor if you have questions or concerns.

Supplemental oxygen, or oxygen therapy, helps get more oxygen into your lungs and increases your tolerance for physical activities. There are several devices for oxygen therapy. The most common is a nasal cannula, a device with two small tubes that fit into your nostrils and a connected oxygen tank. Adjusting to supplemental oxygen is a process, but you’ll come to feel more and more comfortable with time. The American Lung Association has helpful resources for anyone starting oxygen therapy.

Lung surgery or lung transplants are also options for some people with severe COPD. Eligibility is based on many factors, including participation in a pulmonary rehabilitation program, lung function tests, and additional considerations such as whether you are strong enough for the procedure and if you smoke. (You cannot be a current smoker for lung surgery eligibility.) Your doctor can help you determine if lung surgery is right for you.

Detecting and treating early-stage COPD is essential to slowing the progression of the disease. If you are experiencing any early warning signs like shortness of breath and a persistent cough, make an appointment with your doctor to determine what’s causing your symptoms. Early COPD screening is especially important if you smoke since you face a greater risk of developing this lung disease.

Many people struggle with quitting smoking, so don’t be afraid to ask your doctor for resources that can help, including nicotine replacement products or medications. The CDC has a variety of smoking cessation resources to help as well.

Get the treatment you need to slow the progression of COPD

Sticking to the treatment your doctor has recommended is critical to avoiding COPD flare-ups and slowing the progression of the disease. At Alto, we make that as easy as possible by offering free hand-delivery, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions by phone, text, or chat.

Reach out via text or phone at 1-800-874-5881 or in-app messaging to learn how Alto can support your COPD treatment plan.

In the event of a hypoglycemia emergency, a hormone called glucagon can help people with diabetes restore their blood sugar to a healthy range. Here’s what to know about hypoglycemia and the purpose of glucagon in diabetes treatment.

The Purpose of Glucagon in Diabetes Treatment

For people with diabetes, monitoring blood sugar levels is a balancing act. In general, diabetes causes higher levels of blood sugar because the body lacks insulin. Without the right treatment, high blood sugar can lead to serious health complications in the long term, including cardiovascular disease, kidney disease, and vision loss.

At the same time, people with diabetes who take insulin as part of their treatment face an increased risk for low blood sugar, or hypoglycemia. This is a serious health concern in its own right, as severe hypoglycemia episodes can lead to seizures or the loss of consciousness.

The role of insulin in diabetes treatment

Insulin can help manage both of the two main types of diabetes, type 1 and type 2 diabetes. People with type 1 diabetes, which often begins during childhood or adolescence, cannot produce any insulin at all, so they need insulin injections every day to control their levels of blood glucose.

Type 2 diabetes, which develops gradually due to a mixture of genetic, lifestyle, and environmental factors, involves two key problems with insulin production: cells in the body become resistant to insulin, and the pancreas cannot produce enough insulin to regulate levels of blood glucose. It may be possible to manage early-stage type 2 diabetes with oral medication and healthy lifestyle habits, but many people with more advanced type 2 diabetes take insulin injections to manage their blood sugar.

Insulin must be injected into the fatty tissue under your skin to reach the bloodstream. It may be administered with a syringe, pen, or pump. Read our previous blog for an overview of insulin in diabetes treatment.

Blood sugar targets and insulin reactions

Blood sugar naturally fluctuates throughout the day depending on calorie intake, physical activity, and other factors including stress and sleep. The goal of insulin therapy is to keep your insulin levels as steady as possible to avoid rapid changes in your blood glucose levels. However, blood sugar can fall outside of the healthy range, even with the right dosage of insulin.

An insulin reaction — also referred to as hypoglycemia — is when your blood glucose levels drop below a healthy range after taking insulin. The main causes of hypoglycemia are not eating enough or exercising too much. The timing of your insulin dose can also cause blood sugar to drop.

For many people with diabetes, hypoglycemia occurs when their blood sugar is less than 70 mg/dL. However, diabetes treatment plans are individualized, and you may have a different blood sugar target range. Your healthcare provider can help you develop your own targets and determine what too low means for you.

Individual reactions to low blood sugar vary, so it’s important to take note of your symptoms as they occur and learn your own signs of hypoglycemia. Below are common signs to watch for.

Coordination problems, clumsiness, and confusion

The only way to confirm that you are experiencing hypoglycemia is to check your blood sugar with a blood glucose meter or a continuous glucose monitor (CGM). However, if you are experiencing signs of low blood sugar and unable to check blood sugar levels, treat symptoms with high-sugar foods or drinks.

The 15-15 rule for treating mild hypoglycemia

Generally speaking, mild hypoglycemia occurs when your blood sugar is between 55-69 mg/dL. It can often be treated by following the 15-15 rule: eat fifteen grams of carbohydrates to restore blood sugar levels to a healthy range and check your levels again after fifteen minutes. If your blood sugar is still below 70 mg/dL or your own personal target, eat fifteen more grams of carbohydrates. Repeat these steps until your blood sugar is back to normal, then eat a meal or snack to maintain it.

Consuming the following items may help raise your blood sugar:

4 ounces (½ cup) of juice or regular soda (not diet)

Young children with diabetes typically need less than 15 grams of carbohydrates to raise low blood sugar. If your child has diabetes, work with your healthcare provider to develop an individualized treatment plan.

Severe hypoglycemia and the purpose of glucagon

Severely low blood sugar — 55 mg/dL or less for many people with diabetes — cannot be treated with the 15-15 rule. This is where glucagon comes into play. The purpose of glucagon is to restore blood sugar during these episodes of severe hypoglycemia.

Ideally, working with your doctor to monitor blood sugar levels can help you avoid severe hypoglycemia. However, it’s important to be prepared in the event of an emergency. Glucagon is available by prescription and can be administered as a nasal spray or injection. There are several FDA-approved medication options for glucagon, including GlucaGen®, Eli Lilly’s Glucagon Emergency Kit for Low Blood Sugar, Gvoke®, ZEGALOGUE®, and a generic option approved in December 2020.

 If you have a glucagon prescription, check the expiration date and make sure there’s at least a year of remaining shelf life. Friends, family, co-workers, and anyone else you spend a lot of time with should know where to find your glucagon and how to administer it. Make sure they also know to contact a doctor immediately after emergency glucagon administration.

Blood sugar monitoring and preventing hypoglycemia

Regular monitoring of blood sugar can help you stay within your target range and understand how factors like food, physical activity, medications, and stress affect your blood sugar levels. Depending on your insulin dosage, you may need to check and record your blood sugar multiple times a day, including before and after meals and at bedtime. Your doctor will let you know when to check your blood sugar. It's important to follow the schedule your doctor has recommended and to keep a daily record of your blood sugar levels.

If you find that your blood sugar often falls below your normal range, share your blood sugar numbers with your healthcare provider, along with any relevant information on physical activity and diet. They can help you identify patterns and recommend adjustments to your treatment to keep your blood sugar in balance.

We’re here to support your diabetes care plan

We understand how overwhelming diabetes treatment may feel at first. While health risks like hypoglycemia can be serious, a strong care team can help you stay on top of blood sugar monitoring and confidently manage your diabetes.

Alto is more than just a pharmacy — we’re 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. Learn more here or reach out at any time via text or phone at 1-800-874-5881 or in our app.

Protect your brain health in the long term by prioritizing a heart-healthy lifestyle today. Here are five actions that can help you prevent cognitive decline and cardiovascular disease.

The Link Between Heart and Brain Health | Alto Pharmacy

When the brain doesn’t function as it should, it can lead to challenges with memory, movement, thoughts, and speech. Many people around the world know firsthand how devastating these brain health problems can be: dementia — a general term for an aging-related decline in cognitive abilities — currently affects 50 million people worldwide. 

As heartbreaking as it is to watch an aging loved one lose their ability to remember, communicate, and process information, there is some good news. Researchers are learning more and more about dementia, and prioritizing heart health may lower a person’s risk of cognitive decline.

How the heart affects brain functionality

Dementia is a progressive, aging-related deterioration of cognitive function caused by a group of diseases. The two most common types are Alzheimer’s disease, which accounts for 60-80% of all dementia cases, and vascular dementia, which accounts for about 10% of all dementia cases and is linked to strokes and other problems with blood flow to the brain.

The link between heart health and vascular dementia is well-established. Researchers have long known that damage to the arteries — blood vessels that transport oxygen-rich blood from the heart to the rest of the body — can lead to strokes and the subsequent cognitive decline in vascular dementia.

And now, there’s increasing evidence that key risk factors for cardiovascular disease and strokes, including obesity, high blood pressure, high cholesterol, and diabetes, can lead to the development of Alzheimer’s disease. Studies have also found that a high percentage of people with Alzheimer’s disease also have cardiovascular disease.

1. Get moving, even for a short amount of time.

Not only will a physically active lifestyle lower your risk for heart disease, it can also benefit the brain. Research has found that people who are more physically active face a lower risk for Alzheimer’s disease.

Exercising for 30 to 60 minutes several days a week may increase the size of your hippocampus, the part of the brain linked to memory formation. If you’re in the beginning stages of planning a fitness routine, start by dividing your workout into smaller pieces. Two fifteen-minute walks in a day, or even a few bursts of jumping jacks, can help you reach your weekly target.

2. Stay on top of blood pressure screening — and limit your sodium intake.

High blood pressure, also known as hypertension, is a leading risk factor for heart disease and can lead to a heart attack or stroke. It also may contribute to a person’s risk of cognitive decline — research has found that high blood pressure can negatively impact parts of the brain responsible for thinking and memory.

High blood pressure can be treated, but early detection is important. Many people don’t experience noticeable symptoms until the condition has progressed significantly. It’s important to get regular blood pressure tests, especially if you have a known heart condition or a family history of heart disease. Consult with your doctor about recommended testing frequency.

Eating less salt is a simple way to take care of both your heart and your brain, as high sodium intake can increase blood pressure. The American Heart Association suggests capping your sodium intake at 1,500 mg/day. Make it a habit to check nutrition labels while grocery shopping and opt for low-sodium options when possible.

Learn more about managing blood pressure.

3. Adopt healthy lifestyle habits to prevent or control diabetes.

If you are one of the millions of Americans living with type 2 diabetes, a disease in which the body struggles to convert sugar, or glucose, into energy, you may also face a greater risk for several forms of dementia. The high glucose levels in people with diabetes damage blood vessels throughout the body, which can increase a person’s risk of vascular dementia. There is also evidence that adults with type 2 diabetes — the most common form of diabetes — have a higher risk of developing Alzheimer’s disease later in life.

If you have diabetes, it’s important to stay on top of your treatment plan and follow your healthcare provider’s recommendations for monitoring blood glucose.

And if you don’t have diabetes, it’s still important to discuss your diabetes risk with your doctor. An estimated 88 million adults in the U.S. have prediabetes, a condition in which blood sugar levels are higher than normal but still below the range for a diabetes diagnosis. Fortunately, prediabetes is reversible, and simple lifestyle changes can prevent it from progressing into type 2 diabetes.

Learn more about the preventive measures you can take to prevent prediabetes.

Sleep deprivation affects you both mentally and physically. It is linked to health issues that can increase your risk for heart disease, including high blood pressure and type 2 diabetes, as well as dementia.

If you’ve struggled to get enough rest, you’re not alone. More than 1 in 3 adults in the U.S. say they get less than the recommended seven hours of sleep per night. There are steps you can take to improve your sleep hygiene. Start by switching to decaf in the afternoons and evenings, avoiding late-night meals, and trying to wake up and wind down at consistent times.

Learn how to manage stress-related sleeping issues.

Having a strong social network and participating in activities with others can improve many areas of your health. Social isolation can increase an older person’s risk of dementia by about 50%, and loneliness has been linked to poor cardiovascular health.

Small acts of connection — from volunteering or joining a book club to catching up with friends virtually or in person — will lead to a more fulfilling life today and can help strengthen your cardiovascular and cognitive functioning for years to come.

To give your brain an extra boost, look for group activities that keep your mind moving, too. Challenging the mind with stimulating logic games, or by learning a new language or taking up a new hobby, can strengthen your brain in both the short and long term.

We’re here to help you prioritize heart health and cognitive health

At Alto, we’re committed to making it as simple as possible to stay on top of your medications for blood pressure, diabetes, or other conditions. We offer same-day delivery and medication management tools like reminders and auto refills  in our app. And our team of pharmacists are always here to answer your questions by phone, text, or chat, and will even remind you when your medications are due for a refill.

Reach out any time via text or phone at 1-800-874-5881 or in our app.

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies.

Alto Pharmacy Named Great Place to Work®

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits. This important recognition is a testament to the dedication of the entire Alto team and the vision of our founders to create a healthcare company truly anchored on the needs and experiences of the customer.

80% of our team says that Alto is a great place of work, compared to just 59% of employees at  other companies that participated in this year’s assessment. Here are other key takeaways from our team’s’ responses:

93% of our team members say that you are made to feel welcome when you join Alto.

88% say that people care about each other here.

86% say that they are able to take time off from work when needed.

Every company has its own unique culture, but there are two things that all great workplaces share: trust in company leadership and a strong sense of pride in the work. For many Alto team members, being part of a mission-driven company is one of the best parts of working here. 

Our mission — to improve the quality of life for everyone who needs medicine — guides us in every business decision, every day. From fostering an inclusive culture that invests in talent from the same communities as our patients, to building a pharmacy model that meets individuals where they are in their health journey, everything we do at Alto is anchored on delivering meaningful change. 

When asked what makes Alto a great place to work, our team members emphasized our guiding company values — including our commitment to putting patients first and leading with empathy — and getting to spend each workday with colleagues who are also inspired and motivated by those values.

“Our bold, patient-centered mission creates a powerful level of empathy across the entire team,” shared Rob Anderson, Alto’s Head of Talent . “The people who work here are one of the best parts of coming into work, and one of the top reasons our workplace is so rewarding.”

And taking care of our team members is just as important as ensuring we leave no patient behind. In response to the past year’s unprecedented challenges, we introduced Alto Recharge Week, which includes expanded time off for all team members. This reset period allows team members to unplug and recharge, and it’s also a small show of  appreciation for how they supported our patients and healthcare providers throughout these challenging times.  

It’s an exciting moment to be part of Alto’s mission. Since our founding in 2015, we’ve been focused on delivering a totally new model of pharmacy care. Our community-based, courier-first pharmacy model simplifies the entire prescription process and is tailored to each patient’s unique needs, leading to better  outcomes, healthier lives, and happier customers. And with every year, Alto’s impact continues to grow:

More than 36 million individuals now live within Alto’s free same-day courier service zones. 

In the past twelve months, we opened new locations in New York City, Houston, Dallas, and San Jose and expanded our coverage areas in Seattle, Las Vegas, and Denver. 

We've expanded our specialized resources for patients living with diabetes and managing heart and lung conditions .

We’ve accomplished so much over the past six years, and we’re still just getting started.

“I don’t know a single person who hasn’t needed something from a pharmacy at some point, and there’s still so many people across the country who have yet to experience our unique community pharmacy experience,” Alto’s Recruiting Manager Lauren Binet said. “That potential for impact is incredibly motivating.”

As our geographic footprint has grown, so has our team. In the past two years alone, we’ve quadruped our team to more than 1,000 Altoids!

View open roles in design, engineering, IT, sales, patient care, and more.

About Great Place to Work Certification™

Great Place to Work® Certification™ is the most definitive “employer-of-choice” recognition that companies aspire to achieve. It is the only recognition based entirely on what employees report about their workplace experience – specifically, how consistently they experience a high-trust workplace. Great Place to Work Certification is recognized worldwide by employees and employers alike and is the global benchmark for identifying and recognizing outstanding employee experience. Every year, more than 10,000 companies across 60 countries apply to get Great Place to Work-Certified.

Learn more about the United State Preventative Service Task Force’s Grade "A" recommendation and what it means for your access to PrEP.

What a USPSTF “A” Recommendation Means for PrEP Access

With a Grade A recommendation from the US Preventive Services Task Force (USPSTF), PrEP — an HIV prevention medication that can lower risk of sexual transmission by 99% when taken daily — is now more accessible than ever. Under the Affordable Care Act, most private insurance plans must cover preventive services with an “A” or “B” recommendation from the USPSTF without copays or deductibles. This means that at least one PrEP option will be available at no cost to qualifying individuals on these plans. 

PrEP’s 2019 Grade A recommendation from the USPSTF was implemented this year. Below, we explain more about the Task Force’s recommendation and what it means for your access to PrEP.

The Importance of Preventive Services and the USPSTF

Preventive care — including medications like PrEP, cancer screenings, immunizations, and more — saves lives. These services can prevent serious diseases or detect them early on, when they are more treatable. It’s critical that doctors understand the effectiveness of these screenings and treatments, and the US Preventive Services Task Force was created to fill that need.

The USPSTF is an independent group of prevention experts whose evidence-based evaluations help healthcare providers make informed recommendations for their patients. The Task Force’s membership has expertise in a range of specialties under the umbrella of primary care and preventive medicine, including internal medicine, behavioral health, obstetrics and gynecology, and more. They assign each recommendation an A, B, C, or D grade or an I statement. Here’s what each recommendation means:

“A” Recommendation: The USPSTF recommends the service. There is high certainty that the net benefit is substantial.

“B” Recommendation: The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

“C” Recommendation: Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.

“D” Recommendation: The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

“I” Statement: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Since preventive services are recommended based on a person’s level of risk for a specific disease or condition, there is variation in individual preventive needs. Your primary care provider will recommend screenings and medications depending upon factors like your family history, age, current health status, and more.

With PrEP, the “A” rating and related insurance coverage applies to individuals who are HIV-negative but at high risk of getting HIV from contracting the virus. That includes:

People whose partner is HIV-positive or unsure of their HIV status

The Affordable Care Act and USPSTF Recommendations

Millions of people in the US don’t receive critical, and often life-saving, preventive services. For many, cost is a big barrier. A 2020 study found that 1 in 3 US families postponed medical care services because of the financial strain. And according to the American Journal of Public Health, in the case of PrEP, fewer than 10% of people who could benefit from the medication are taking it.

The Affordable Care Act provision requiring private insurers to cover Grade “A” and “B” preventive services without copays or deductibles was designed to alleviate this financial burden. The Center for Consumer Information and Insurance Oversight (CCIIO) oversees the implementation of law provisions related to private health insurance, and private insurers have a responsibility to monitor USPSTF recommendations and remain compliant with requirements.

While the new provision is a big step forward for HIV prevention, getting the specific brand of PrEP medication you need may require some additional legwork.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. Truvada and Descovy are both effective at preventing HIV, but they are not identical. Some people may need one version over the other due to preexisting health issues. However, the ACA’s provision only requires health plans to cover at least one of the available PrEP options without copays or deductibles.

Government plans including Medicaid typically cover brand-name PrEP medication while most private insurance companies will cover generic PrEP. If your doctor has prescribed a specific brand of PrEP medication not covered by your insurance, a request for coverage may be required. 

This is called a prior authorization. Alto’s dedicated support team can help you understand the details of your insurance plan and will coordinate closely with your doctor’s office on filing prior authorizations to help you get the medication you need. Call us directly at 1-800-874-5881 to confirm coverage.

Too often, preventive services are inaccessible to those without insurance. Thankfully, patient assistance programs for PrEP help make the medication more affordable for those who are uninsured. For example, Truvada’s manufacturer, Gilead, has a Medical Assistance Program for people without insurance, in addition to a copay card for those with insurance.

Alto will automatically conduct a thorough price investigation to identify these potential sources of financial assistance and ensure you're getting the lowest possible price. We also carry a generic PrEP option that currently runs at $36.60 a month out of pocket.*

Read more about PrEP access and affordability.

Get the PrEP medication you need at the best possible price

Getting PrEP at the most affordable price shouldn’t be a hassle. At Alto, our team will do the research for you and coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option. Our pharmacists have deep expertise in many clinical areas, including patients living with HIV, and those taking PrEP, PEP and HRT medications.

Adherence support with pharmacist lab reminders

We’re hard at work the moment we receive your prescription, handling insurance and prior authorizations, as well as making sure you get your medicine, at the best price, delivered at no additional cost. Reach out any time to get started via text or phone at 1-800-874-5881, or in-app messaging.

It’s okay, and very understandable, to feel overwhelmed after a diabetes diagnosis, or to wonder, what now? This guide from Alto Pharmacy offers a starting point as you build a strong foundation of information.

New diabetes diagnosis? Here’s what to know.

A diabetes diagnosis marks the beginning of a new health journey that involves some significant changes to your routine. Insulin and blood sugar tests become a part of your day-to-day life, not to mention all of the new insurance terminology related to diabetes medications. 

It’s okay, and very understandable, to feel overwhelmed after a diagnosis, or to wonder, what now? When dealing with any challenge, it’s important to take everything one step at a time. Diabetes is no different. The journey will likely feel much more manageable once you’re familiar with the key terms and have a good grasp of your diabetes pharmacy needs. The guide below offers a starting point as you build a strong foundation of information.

Diabetes Pharmacy 101: Key Insurance Terms

Diabetes treatment involves coordination with your doctor’s office, your insurance provider, and your pharmacy. You’ll probably start to hear the following terms as you work closely with each of them.

A flat amount set by your insurance plan that you are required to pay for healthcare services, procedures and treatments, including prescriptions. These amounts can vary based on the type of service and whether your doctor is considered in-network with your insurance plan. For example, you may have a copay of $30 for your doctor visit, $20 for one kind of prescription, and $50 for another type of prescription.

Many manufacturers of diabetes medications and supplies make their treatments more affordable through coupons, rebates, savings cards, trial offers, and free samples. Some of these savings options require you to register with the manufacturer (often on a website) or receive the coupons or samples directly from your doctor. You will generally need to do your own research to understand what savings options are available for the medications or supplies you’ve been prescribed. Alto automatically conducts thorough price investigations to identify potential savings.

Sometimes an insurance plan decides that they won’t cover the cost of a treatment, procedure, or medication. This is called a denial. These are some of the common reasons for it:

Your insurance plan doesn’t believe the requested treatment is medically necessary

The requested treatment is considered experimental

There are typos or errors on the insurance claim

The requesting doctor is out of network for your plan

A referral or prior authorization is required

At Alto, we’ll look into the reasons for a denial and work with your doctor to either process an appeal or find covered alternatives.

If you are prescribed an insulin pump or continuous glucose monitor (CGM), or need supplies like test strips, they will likely be covered under the Durable Medical equipment (DME) section of your policy. There may be restrictions on the brands or suppliers that are available.

Formulary, also called a Drug List or Formulary List

A list of prescription medications that your insurance plan will cover, including both brand name and generic options. They will be grouped by tier. Tier 1 usually includes generic medications and will have the lowest out-of-pocket costs. As you move up the formulary’s tiers, the costs will increase. If your prescription is not on the formulary at all, that means it is not covered by your insurance plan. 

Formularies can change as part of your annual insurance renewal. For example, your previous type of insulin may be in a different tier on the plan’s updated formulary, meaning you’ll pay more out-of-pocket to stay on that particular brand. Read our previous post on insurance changes to look out for when renewing your plan.

Insurance companies generally consider a treatment plan to be medically necessary when it follows accepted clinical guidelines and practice. To determine this, your insurer is likely considering whether the proposed treatment is:

Clinically appropriate in terms of type and frequency

Generally considered effective given the diagnosis

Not more costly than other options that are likely to produce the same result

Not selected just for convenience to you or your doctor

Patient Assistance Programs, also called PAPs or Diabetes Care Programs, are financial assistance programs created and managed by the manufacturers of diabetes medications and supplies. These programs are intended for people without insurance or when copays are prohibitively expensive. Keep in mind that these types of discount programs may result in your medication costs not counting toward your insurance plan’s deductible. Alto will search for these potential sources of financial assistance as part of our price investigation and ensure you’re getting the lowest possible price.

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