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It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community ofGreat Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

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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High cholesterol is one of the heart disease risk factors that you have control over. Here’s an overview of how to manage high cholesterol through a combination of diet, lifestyle changes, and medication.

How to Manage High Cholesterol: Diet, Medications, and More

Cholesterol isn’t inherently bad. Your body needs the waxy, fat-like substance to produce cell membranes, hormones, and nutrients like vitamin D. But too much of it — especially low-density lipoproteins (LDL) cholesterol, which accumulates in the walls of your blood vessels and is also referred to as “bad” cholesterol — can increase your risk for heart disease and stroke.

The good news? High cholesterol is one of the heart disease risk factors that you have control over. There are many changes you can make to bring down your cholesterol levels, which in turn will strengthen your overall cardiovascular health. Here’s an overview of how to manage high cholesterol through a combination of diet, lifestyle changes, and medication.

How to lower cholesterol levels with diet

There are two sources of cholesterol: your liver and the foods you eat. This means that you can begin to lower your cholesterol simply by paying attention to your diet and limiting high-cholesterol foods.

There are several categories of high-cholesterol foods to pay attention to. Saturated fats, which are typically solid at room temperature, increase levels of LDL cholesterol in your blood. You don’t have to avoid saturated fats altogether, however you should try to decrease your consumption of them. The American Heart Association suggests aiming for a diet in which 5-6% of the total calories consumed come from saturated fat. Common sources of saturated fats include red meat and full-fat dairy products.

Trans fats, also known as partially hydrogenated oils, are mainly formed through an industrial process which causes oil to become solid at room temperature. These fats are considered the least healthy to eat and should be avoided altogether as much as possible. While the Food and Drug Administration has banned food manufacturers from adding trans fats to foods, it’s still a good idea to check the label of the following foods for partially hydrogenated oils (how trans fats appear on nutrition labels): 

Cookies, cakes, and other baked goods, including frozen products

On the other hand, unsaturated fats — found in plant-based oils such as olive oil and canola oil as well as tree nuts like almonds, walnuts, and pecans — can lower high cholesterol levels. Omega-3 fatty acids — found in fish like salmon, mackerel, herring, and tuna — and soluble fiber — found in beans, peas, lentils, oats, and whole grains — will round out a low-cholesterol diet.

Other lifestyle changes can significantly lower your LDL cholesterol levels naturally, including exercising regularly, maintaining a healthy weight, avoiding cigarette smoke, and limiting your alcohol consumption.

Moderate physical activity can help lower LDL cholesterol and increase high-density lipoprotein (HDL) cholesterol, or “good” cholesterol. Aim for about 30 minutes of moderate to intense exercise per day. Everyone’s fitness needs are different, and it’s okay to start slower and work your way up to more vigorous activity.

Being overweight or obese increases your levels of LDL cholesterol, since excess body fat impacts your body’s ability to clear LDL cholesterol from your bloodstream.

Doctors may calculate your body mass index (BMI) to determine if your weight is in a healthy range. Consult your doctor about what a healthy weight is for you, and work together on a diet and fitness plan to help you reach and maintain that weight.

Smoking when you have unhealthy cholesterol levels increases your risk of heart disease even further. In addition, both smoking and vaping lower HDL cholesterol. Quitting can both lower your LDL cholesterol (bad) and increase your HDL cholesterol (good) levels.

If you currently smoke, ask your doctor for smoking cessation resources such as nicotine replacement therapy (NRT), which reduces withdrawal symptoms. If you are a nonsmoker, try to avoid exposure to secondhand smoke.

Too much alcohol can increase your cholesterol levels, so it’s important to limit your intake as you work on managing your cholesterol. The CDC recommends no more than two drinks per day for men and no more than one for women.

How to manage high cholesterol with medication

For some people, diet and exercise may be enough to manage cholesterol levels. In other cases, medication may be necessary to lower LDL cholesterol levels, increase HDL cholesterol levels, or both. There are several different classes of cholesterol medications. Your doctor can advise you on the best option for your needs.

Statins, also known as HMG CoA reductase inhibitors, act on the liver to prevent cholesterol from forming and limit the overall amount of cholesterol circulating in your bloodstream. They are most effective at lowering LDL cholesterol but can also help increase HDL cholesterol and lower triglycerides, or blood fats.

In most cases, side effects are mild and often disappear as your body adjusts to the medications. Your doctor may order tests on liver function, but liver abnormalities are rare. Statins are not safe to take if you are pregnant or you have chronic liver disease.

Ezetimibe (Zetia®) is a cholesterol absorption inhibitor and the most commonly used non-statin cholesterol medication. Potential side effects include:

This medication is not safe to take during pregnancy or while breastfeeding.

PCSK9 inhibitors bind to a protein found in liver cells to lower LDL cholesterol. They are administered as injections every 2-4 weeks. Commonly prescribed medications in this class include:

The primary side effect is itching, swelling, pain, or bruising at the injection site.

ACL inhibitors act on the liver to block cholesterol production. They are often taken in combination with statins to help further lower LDL in people with heart disease and people with familial heterozygous hypercholesterolemia, a genetic condition that causes high LDL cholesterol.

Commonly prescribed ACL inhibitors include:

Bempedoic acid and ezetimibe (Nexlizet®)

There are several additional medication classes which are not as commonly prescribed but do have a proven mild LDL-lowering action, including fibrates and niacin.

Fibrates are primarily used to lower blood triglyceride levels, however they may also be used to raise HDL and lower LDL cholesterol. 

Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™)

Potential side effects include nausea, stomach pain, and muscle pain.

Niacin is a B vitamin that reduces the liver’s production of blood fats. It is very effective at lowering triglycerides and is sometimes prescribed to lower LDL cholesterol.

Niacin comes in prescription form and as a dietary supplement. The latter is not a replacement for a prescription, and it’s important to only take niacin if your doctor has prescribed it.

Liver function should be closely monitored while taking niacin. If you have diabetes, it’s important to discuss the potential risks and benefits of niacin with your doctor, as it can raise blood sugar levels.

There often are not any visible signs or symptoms of high cholesterol, so the only way to determine your cholesterol levels is through a simple blood test called a lipid profile.

Most adults who are in good health have their cholesterol checked every four to six years. If you have heart disease, diabetes, or a family history of high cholesterol, you will need more frequent screening. Consult with your doctor about recommended screening frequency.

Exceptional pharmacy care to strengthen your health

At Alto, we’re committed to making it as simple as possible to stay on top of your cholesterol-lowering medications. 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-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.

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

How does Alto Pharmacy work with insurance?

Getting the medication you need often involves more than just receiving a prescription from your doctor and filling it at a pharmacy. And navigating the complexities of insurance coverage, from copays and deductibles to formularies and medication tiers, can be a particularly big source of stress.

A great pharmacy partner makes sure you’re never alone in working through the details of your insurance plan’s pharmacy benefits. At Alto, we tackle all of the insurance-related legwork for you and give you the information you need to understand the process.

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

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

When you get started with Alto, we’ll automatically pull in any insurance information we can find. If you have additional coverage, just let us know and we’ll add it to your profile. For each prescription, we’ll check with your primary (and secondary) insurance plan to pull your copay amount — the amount you owe out of pocket for your medications — including any possible savings. (More about that below!)

Sometimes paying cash for your medications, separate from insurance benefits, will be cheaper than your copay. If that’s the case, we’ll let you know the different pricing options so you can make an informed choice.

By checking every available savings option, automatically, every time! Unlike traditional pharmacies, Alto is proactive about applying potential sources of savings like manufacturer coupons, patient assistant programs, and copay cards wherever applicable. We’ll automatically start looking for these opportunities the minute we receive your prescription, and we’ll keep you informed of any savings options that require you to apply directly with the program or manufacturer.

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

Here’s another way we’re different from traditional pharmacies: we’ll continue searching for less expensive medication options even after we’ve researched savings opportunities.  You’re in the driver’s seat, and if you would like support in identifying other medication options that may be covered by your insurance at better rates, we’ll work with your doctor to evaluate those choices.

Insurance companies categorize medications into tiers based on various factors such as whether the medications are generic or brand-name and how frequently they are prescribed. Medications in higher tiers generally include non-preferred brands and specialty medications for rare conditions, and these typically cost more than medications from a lower formulary tier.

Keep in mind that generic medications use the same active ingredients as their brand-name counterparts, and they must meet the same standards for safety, quality, and results in order to get FDA approval.

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

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

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

What if my insurance denies coverage of my medication?

If a medication isn’t on the formulary at all, you may have the option of submitting a prior authorization to prove the medical necessity of the medication and gain coverage from your insurance plan.

If a prior authorization is needed, we can work with your doctor to submit the necessary paperwork. We’ll keep both you and your doctor in the loop throughout the process so you know the current status of the request until your insurance provider has made a decision. If your prior authorization request is denied, we will work with your doctor to either process an appeal or find a different treatment option.

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

A pharmacy partner that’s always on your side

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

Switch to a better pharmacy for free same-day delivery and support with insurance and savings opportunities. Reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

How Does Alto Pharmacy Work with Health Insurance? We Answer Your Top Questions.

How Alto Pharmacy works with health insurance

How does Alto Pharmacy work with insurance? We answer your top questions.

What Updated CDC Guidelines Mean for PrEP Access

For the first time since 2017, the U.S. Centers for Disease Control and Prevention (CDC) is updating its guidelines for PrEP, a medication that can lower risk of sexual transmission of HIV by 99% when taken daily. The new guidelines — which inform local healthcare policies and doctors’ decision-making processes — address key barriers to PrEP access, including a lack of provider awareness about PrEP and patient reluctance to disclose sexual activity or drug use. 

Moving forward, the CDC has recommended that healthcare providers share information about PrEP with any patient who is sexually active, and that any patient can receive a prescription for PrEP if requested.

Here is some additional context about the forthcoming updates, which should go into effect before the end of the year, pending revisions based upon feedback from experts.

According to the Human Rights Campaign, 1 in 3 healthcare providers has not heard about PrEP. There are countless others who are aware of the medication but don’t have all the facts.

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

Some healthcare professionals also falsely believe that PrEP and condom use are mutually exclusive. Many people have felt shamed when asking for PrEP due to their healthcare provider’s stigmatized perceptions of traditional PrEP users. 

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

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

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

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

Under current CDC guidelines, patients must share personal details about their sexual health or drug use with their doctors to get a PrEP prescription. However, many people at risk of contracting HIV don’t feel like they can speak openly with their healthcare providers, particularly LGBTQIA+ people of color, who face multiple forms of discrimination. 

Too often, this leads to negative health outcomes and disparities in HIV rates. The CDC’s new proposed guidelines for PrEP account for the fact that some patients may not feel comfortable disclosing personal information about their sexual health or drug use. 

While conversations between doctors and patients about PrEP will initially cover a patient’s sexual health history, the CDC is recommending that any patient can receive a prescription for PrEP if requested. This means that you can get PrEP without disclosing personal information related to your risk for HIV, another big step forward for PrEP access and HIV prevention.

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

Alto will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. And you can connect directly with pharmacists who have expertise in HIV prevention and treatment 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.

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.

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

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

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.

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

How to Make the Most of the Alto Pharmacy App

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

Download the Alto Pharmacy app today to get started. 

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

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

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

As soon as your prescription is ready, we’ll send a text or give you a call to schedule your free delivery. It’s really that simple.

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

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

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

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

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

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

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

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

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

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

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

We take your privacy seriously - our in-app messaging is built with industry-standard encryption and data security practices. Our pharmacists and care team are just a text, chat, or an email away: Monday through Friday 6 am - 9 pm PT ( 9 am - 12 midnight ET) and Saturday and Sunday from 7 am - 6 pm PT (10 am - 9 pm ET).

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