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Blog | Alto Pharmacy

When inflammation persists, it no longer serves a helpful purpose. This type of inflammation, also referred to as chronic inflammation, occurs when your body consistently acts like it’s under attack, releasing white blood cells indefinitely. In the long term, an elevated white blood cell count can affect other organs such as your heart, lungs, and kidneys. Research has also found a connection between chronic inflammation and other chronic diseases including heart disease, diabetes, cancer, Alzheimer’s disease and Crohn’s disease.

Inflammation, Explained

Acute inflammation is the body’s natural way of fighting infections and injuries as part of the healing process. When you have an injury, blood flow increases as your body instinctively releases white blood cells, proteins, and other inflammatory chemicals to protect the wounded area. This leads to redness, swelling, and pain at the site of injury. The body reacts similarly when you have a virus or cold, but in these instances, the blood cells and inflammatory chemicals are released throughout the whole body rather than to one spot. This type of inflammation is good for you, as it allows your body to heal.

But when inflammation persists, it no longer serves a helpful purpose. This type of inflammation, also referred to as chronic inflammation, occurs when your body consistently acts like it’s under attack, releasing white blood cells indefinitely. In the long term, an elevated white blood cell count can affect other organs such as your heart, lungs, and kidneys. Research has also found a connection between chronic inflammation and other chronic diseases including heart disease, diabetes, cancer, Alzheimer’s disease and Crohn’s disease.

Read on for more information about the causes and symptoms of chronic inflammation and how to prevent or treat it.

Causes and symptoms of chronic inflammation

Several known factors can trigger chronic inflammation:

Lifestyle factors including obesity, diet, smoking, alcohol use, stress, and sleep disorders

Autoimmune diseases like type 1 diabetes or lupus, in which the body mistakenly attacks itself

Long-term exposure to pollution, industrial chemicals, or other toxins

Some individuals with this type of inflammation experience fatigue, fever, and joint and muscle pain. However, while there are clear physical signs of acute inflammation, chronic inflammation does not always have visible symptoms.

Your doctor can help determine if you have chronic inflammation. They will likely ask about your symptoms and perform a physical exam as a first step. They may then order additional tests to detect inflammation. These tests look for various indications of inflammation in your body, but they cannot formally diagnose inflammation or any other health condition. Rather, they provide a more comprehensive picture of your health so that your doctor can recommend the best next steps.

Potential tests your doctor may recommend during this process include a C-reactive protein (CRP) test and/or an erythrocyte sedimentation rate (ESR) test. A CRP test identifies your blood levels of CRP, a protein produced in your liver. Chronic and acute inflammation have both been linked to high levels of CRP.

An ESR test examines how quickly your red blood cells sink to the bottom of a test tube, with higher rates of settlement pointing toward more inflammation. Doctors often recommend this test when there is a possibility of high inflammation.

Sometimes these tests may help your doctor diagnose an inflammation-linked condition, such as rheumatoid arthritis or type 2 diabetes.

Chronic inflammation and other health conditions

There is a connection between chronic inflammation and many other health conditions. Inflammation can occur directly as the result of rheumatoid arthritis, which is both an autoimmune condition and an inflammatory disease. If you have rheumatoid arthritis, your immune system attacks your joints — often in your hands, writs, and knees — which leads to inflammation. There is also a direct link between inflammation and other inflammatory diseases, like ulcerative colitis and Crohn’s disease.

Inflammation has also been linked to heart disease and diabetes, but research into this connection is ongoing. While inflammation is more common in individuals with these health conditions, there is not yet definitive evidence that inflammation by itself directly increases your risk for these conditions.

Inflammation in the walls of your blood vessels has been linked to atherosclerosis, the accumulation of fats, cholesterol, and other substances in your arteries. In the long term, atherosclerosis increases your risk for a heart attack or stroke.

Since obesity, smoking, and physical activity are all risk factors for inflammation, heart disease, and diabetes, the overlap of these risk factors likely plays a role in the connection between the conditions. The good news is that a single healthy choice can lower your risk for all three diseases at once.

Your healthcare provider will recommend treatment based on the type of inflammation you have, however not all cases of chronic inflammation require medication.

Two types of medications are commonly used to lower both acute and chronic inflammation: nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil®), aspirin (Bayer®) or naproxen (Aleve®) and oral steroids including prednisone (Deltasone®, Prednicot®), methylprednisolone (Medrol®), and dexamethasone (Decadron®, Dexasone®). Steroid injections can reduce inflammation in a specific joint or muscle and are often used to treat rheumatoid arthritis.

If you have an inflammatory disease, your doctor may recommend medications specifically used to treat that disease. Medication classes commonly used to treat inflammatory diseases include:

Disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate (Rheumatrex®), sulfasalazine (Azulfidine®), and leflunomide (Arava®). These medications can slow the progression of rheumatoid arthritis.

Statins, a type of medication commonly used to treat high cholesterol. They have anti-inflammatory effects and can lower CRP levels.

You can also fight inflammation simply by what you eat. An anti-inflammatory diet includes antioxidant-rich foods like the following: 

Cherries, blueberries, oranges, and other fruits

There are also some foods that have been linked to higher levels of inflammation. If you have chronic inflammation, your doctor may suggest limiting your intake of the foods below as part of your treatment plan:

White bread, pasta, pastries, and other refined carbohydrates

Soda, fruit juices with added sugar, energy drinks, and other beverages high in sugar

Red meat and processed meat like hot dogs and sausage

At Alto, we’re committed to making it as simple as possible to prioritize your health and well-being and stay on top of your medications.  We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

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

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.

In honor of National ERG Day, which falls on November 17 every year, we’re highlighting the important work of Alto’s six ERGs. 

Celebrating National ERG Day at Alto

The history of employee resource groups (ERGs) in the U.S. dates back to the 1960s, when a group of Black employees at Xerox self-organized to discuss their experiences of workplace discrimination and advocate for more inclusive policies. At the time, these networks of employees united by a shared identity or experience were known as affinity groups.

Today, ERGs can be found at companies of all sizes and industries where they play an important role in shaping an inclusive culture and fostering a sense of belonging in the workplace. In honor of National ERG Day, which falls on November 17 every year, we’re highlighting the important work of Alto’s six ERGs. 

At Alto, we believe that every perspective matters, and that diversity fosters creativity and leads to innovation. Our six ERGs are part of our broader commitment to diversity, equity, and inclusion (DEI), both in creating our company culture and delivering an exceptional pharmacy experience.

"At Alto, we’re committed to building and sustaining an inclusive workplace that both supports our employees and helps us deliver on our mission to improve the quality of life for everyone who needs medicine,” shared Ty Bledsoe, Head of Diversity, Equity & Inclusion. “Our ERGs help foster authentic relationships, offer safe spaces for education and conversation, and celebrate the incredible diversity of our Altoids and our communities."

By building community, providing support, and contributing to an individual’s personal and professional well-being, these groups help ensure that every Altoid feels a sense of belonging each day at work and that we appreciate the diversity of the customers we serve.

Here are just a few ways that each Alto ERG contributes to a more inclusive culture and pharmacy experience.

Umoja’s mission is to inform, educate, and empower Black Altoids and allies. The group has deepened Altoids’ understanding of the Black experience by sharing educational resources in support of Black History Month, Juneteenth, and Pride.

They also help our team explore the intersection of identity and healthcare as it relates to our services. After Dr. Reverend Stacey Edwards, founder of Fertility for Colored Girls, spoke at Alto about the fertility journeys of Black families this spring, Umoja continued the conversation by inviting Dr. Temeka Zore, OB GYN and reproductive endocrinologist at Spring Fertility, and Esther Ebeuhi, a licensed doula and birth equity analyst, to speak on Black motherhood.

Alto Auténtico aims to build community among Latinx Altoids and ensure that they have a voice at Alto. In addition to facilitating company-wide learning about the Latinx experience and the diversity within Latinx culture, Alto Auténtico’s mentorship program connects junior and senior Latinx team members for coaching sessions and professional development. The group is also working with Alto’s operations, product, and marketing teams to establish a bilingual team to better support Spanish-speaking individuals using our pharmacy services across our communities.

Proud unites LGBTQ+ Altoids and allies in creating an environment where all Altoids can be their most authentic selves. The group has led Alto in celebrating important LGBTQ+ awareness days with events such as drag queen bingo nights for Pride and LGBTQ+ history month. Two Proud members who identify as bisexual gave a talk for Bi Visibility Day on September 23 and also shared their experiences of coming out in in observance of National Coming Out Day on October 11.

Proud also invites experts to speak at Alto about a range of LGBTQ+ issues. They recently hosted a session with Chris Tompkins, author of Raising LGBTQ Allies: A Parent’s Guide to Changing the Message from the Playground, and a fireside chat with Dr. Lisa Capaldini, who has focused on HIV since the beginning of the epidemic.

Women of Alto + Allies (WOAA) helps create an inclusive community for women at Alto with mentorship and networking opportunities that advance their leadership potential. Their newly launched initiative, WOAA Project Spotlight, celebrates female-identifying team members who have helped us deliver on our mission while living our values, and a quarterly webinar series shares how various self-identifying Altoid women launched their careers.

Working Parents + Allies facilitates discussion and collaboration in celebration of our working parents. The ERG has led Alto in supporting working parents with a variety of initiatives, including a community event with the Kids & Art Foundation’s Purvi Shah in honor of Bereaved Parents Month this July; an “Ask a Parent Anything” Slack advice hotline for parents, caretakers, and allies; and free access to Outschool’s live online classes for kids ages 3-18.

And with their second annual Holiday Giveback Program, which donates gifts to kids and families in need through Marine Toys for Tots and the Boys & Girls Club of America, Working Parents + Allies is an example of how our ERGs look for opportunities to give back and show support beyond the immediate Alto community.

During Asian American Pacific Islander month, the Asians ERG shared resources for individuals like Modern Health's Healing Asian Communities Circles and highlighted community groups for volunteerism and donations.

To learn more about any of our employee resource groups, contact the emails below.

Women of Alto + Allies: womensERG@alto.com

Working Parents & Allies: parents@alto.com

Visit alto.com/careers to learn more about our open roles and join us in delivering industry-leading pharmacy care.

Alto Connect is the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go.

Introducing Alto Connect

Big news from the team here at Alto: today we launched Alto Connect, the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go! You’ll also see the new Alto Connect brand on our desktop portal, formerly known as AltoMD: new name, same great pharmacy services.

The Alto Connect mobile app is the next evolution of Alto’s custom-built provider communications center, formerly known as AltoMD. Alto was the first pharmacy in the United States to offer a prescriber-focused pharmacy communication platform when the original desktop-based AltoMD product launched in March 2016. Since then, more than 500 doctors offices have integrated Alto Connect into their daily workflows and prescription management. 

Doctors offices who work with Alto Pharmacy can now access Alto Connect across all of their devices, providing greater flexibility and convenience for monitoring prescriptions on busy days spent juggling patient consultations and other business needs. Instead of spending hours on the phone or fighting with the fax machine, Alto Connect provides instant access to prescription information and pharmacy messaging, and Alto Connect users can move seamlessly between the two platforms throughout their workday.

With Alto Connect, clinical staff can view all current prescriptions at Alto Pharmacy, including delivery status, out-of-pocket costs and refills. You'll never have to wonder if a patient picked up their prescription or stayed on track with their refills between visits - our system tells you exactly where every prescription stands for every patient.

Have a question for our pharmacy team? Curious about insurance coverage, delivery times, or other aspects of our service? Our team is here to help! You can send us a general message or ask a question specific to one of your patient's prescriptions. 

Alto Connect's push and email notifications alert you when a prescription needs additional information to move forward — most commonly, a clinical clarification or additional data needed for a prior authorization. We'll only alert you when we're certain we need your team's input, so you can stay focused on your patients.

Using AltoMD on your computer today? Nothing changes other than the name! Ready to try Alto Connect mobile for yourself? Scan the QR code above to download the app - your AltoMD login works on the mobile app. 

Need help setting up an Alto Connect account or want training for your staff? Reach out to providersuccess@alto.com.

We’re excited to welcome Ramiah Martin to Alto as Vice President, Operations & Supply Chain. Here’s more on what drew him to Alto and the opportunities he’s most excited about, in his own words. 

Meet Ramiah Martin, VP, Operations & Supply Chain

We’re excited to welcome Ramiah Martin to Alto as Vice President, Operations & Supply Chain. Prior to joining Alto, Ramiah was Senior Director of Operations at Amazon, where he developed the strategic vision for the company’s operations and led a cross-functional team in implementing new processes and technologies to streamline use of resources.

His dedication to continually improving the customer experience is matched by a passion for healthcare change, and we could not be more thrilled to have Ramiah on the team. Here’s more on what drew him to Alto and the opportunities he’s most excited about, in his own words. 

Welcome to Alto! What inspired you to join the team?

When I first learned about Alto, its mission and values stood out to me first and foremost. I immediately felt a strong connection with the company’s mission of improving the quality of people’s lives through medicine and its commitment to putting customers first.

I was compelled by the opportunity to truly make a positive impact and help transform an industry that is both in need of improvement and slow to evolve. Through my previous experiences in operations management at Amazon and UPS, I know that streamlined processes can have a massive impact on a company’s results. At Alto, all of those efforts to innovate and maximize efficiency are in the service of driving broader change within pharmacy and healthcare.

I also appreciated that Alto is intentional about investing in talent representative of the communities we serve. As we continue to grow, and our customer base diversifies, it’s critical to have that diversity represented in the people building our new model for pharmacy care.

What is the focus of your role and what opportunities are you excited about?

As Vice President of Operations & Supply Chain, I’m focused on creating a scalable and sustainable organization, ensuring that as we grow, we continue to deliver an exceptional experience for our customers.

We have a great opportunity to ensure that individuals who have been historically underserved by medicine receive the standard of care that they deserve. I believe in the product — we make it as simple as possible to manage your health and learn more about medication and pricing, and our customers’ medication adherence rates are far above industry standards. I know there’s a lot more we can accomplish, and it’s a privilege to lead a team that’s united by a bold vision for healthcare.

I love movies, except for horror (Michael Jackson's “Thriller” video and Children of the Corn scarred me). I will go to the movies by myself as long as I have my Cherry Coke. It’s my way of shutting off my brain for an hour or two and relaxing.

You can find more information about Ramiah or connect with him directly on LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

October is American Pharmacist Month, a time to celebrate the critical role that pharmacists and pharmacy technicians play within healthcare.

Celebrating American Pharmacist Month At Alto

October just might be our favorite month of the year, and for a good reason: it’s American Pharmacist Month, a time to celebrate the critical role that pharmacists and pharmacy technicians play within healthcare.

Pharmacists are one of the most accessible healthcare professionals, seeing people 5 to 8 times more frequently per year than primary care providers. And as such, they are integral to your overall health and well-being. 

You may not realize all the responsibilities that a pharmacist’s role encompasses. In addition to filling your prescriptions, they also educate on medication usage, advocate for changes that improve care, and problem solve clinical, ethical, managerial, economic, and legal compliance issues, becoming a trusted resource to the individuals they care for. Extensive training and education are required to enter the profession: a pharmacist must earn a doctorate in Pharmacy and complete state-specific licensing requirements before becoming licensed to practice pharmacy.

At many traditional retail pharmacies, each pharmacist is expected to tackle a broad assortment of tasks that often leave them feeling overwhelmed and stressed, like managing transactions for customers, answering questions about where non-pharmacy items are stocked, and contacting insurance companies on top of ensuring prescriptions are dispensed properly and safely. At Alto, however, pharmacists align with one of several practice areas — fulfillment, customer care, and onboarding — so that they are able to focus on specific aspects of pharmacist practice and deliver exceptional care to Alto’s customers.

Fulfillment pharmacists are responsible for inventory management, medication preparation, physical quality checks, and dispensing, all to make sure the right medication arrives at your door, on schedule. Our customer care pharmacists review prescriptions for accuracy and for potential complications with other medications on file; provide individualized consultations on dosing, side effects and other concerns; and partner with healthcare providers on clinical recommendations. And our onboarding pharmacists — a relatively new role at Alto — are a bridge to an individual's broader team, supporting healthcare providers and ensuring continuity of care between prescriber and pharmacy.

“At Alto, we are proud of our customer-focused services and forward-thinking means of providing those services,” shares Ashley Lee, Onboarding Pharmacist. “Being a pharmacist at Alto gives me the unique opportunity to not only practice patient care, but also to design it to be meaningful to as many individuals in need as possible. The innovation never stops here at Alto.”

How Alto pharmacists serve our communities

There’s no shortage of opportunities for a pharmacist to support an individual with their medication needs or to be a partner in their health journey alongside their doctor’s office, family and other support networks. Here are just a few of the many roles that Alto pharmacists fulfill.

Literally. Our pharmacists are educators who mentor other pharmacists-in-training. Sandra Aziz, Pharmacy Compliance Program and Training Manager, is responsible for training new Pharmacy Managers and Supervisors at our dispensing sites, ensuring they have the resources needed to be effective managers and to oversee their pharmacy location’s compliance program and daily operations.

Sandra also manages our internship programs for pharmacy students. Alto offers an immersive 10-week Pharmacy Operations Management summer internship program for eligible students at Howard University’s School of Pharmacy (HUCOP). The program provides an opportunity to gain a breadth of experience across clinical pharmacy care, operations, and business development. Students also have the opportunity to actively influence Alto’s software development and implement ideas that further preventative healthcare and pharmacist involvement in community health.

Sandra also launched our Introductory Pharmacy Practice Experiences (IPPE) and Advanced Pharmacy Practice Experiences (APPE) programs, which allow students from pharmacy schools across the country to select Alto as a practice site. While at Alto, they are exposed to highly skilled and entrepreneurial pharmacists, engineers, and operations experts with whom they can partner to challenge, reinvent, and improve pharmacy. 

“It’s been really rewarding to see more pharmacy students expressing interest in our programs,” Sandra said. “We have a rare opportunity to give students an experiential learning experience that you won’t find at any other pharmacy. At Alto, our pharmacists work cross-functionally across operations, engineering, and design to build a better, more intuitive community pharmacy from the ground up. We focus on challenges faced by patients, providers, and payers, and find solutions that optimize experience, transparency, and health outcomes.”

Read our previous post, 'From Pharmacist to Professor: Sandra Aziz Spotlight'.

They’re also here to teach you! Our pharmacists are happy to chat on the phone for however long you need to offer individualized support. Many customers use these one-on-one consultations to learn how to give themselves injections as part of fertility treatment or diabetes management or to confirm special storage or dosing instructions, but our pharmacists are happy to share their expertise on any question related to your prescriptions or health needs.

For example, did you know that our pharmacists are experts on managing side effects? As a bridge between you and your doctor, our pharmacists review all of your current medications to identify any potential symptoms or medication interactions, and they’re available to talk through any questions or concerns.

Lawmakers in several states have recognized the accessibility of pharmacists and their potential to play an even larger role in healthcare, specifically in the HIV prevention space. California became the first state to allow pharmacists to prescribe HIV prevention medication like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in 2019, and Colorado became the second in November 2020. 

“As healthcare providers in the community, there is a big opportunity for us as pharmacists to play a critical role in HIV prevention and help increase accessibility to medications like PrEP and PEP,” explains Susan Sun, Specialty Pharmacist. “It’s been wonderful to see growing recognition of a pharmacist’s impact even outside of the healthcare community, and the recent legislation that allows pharmacists to prescribe in some states is just a start. It’s a privilege for pharmacists to be a part of these exciting changes and make HIV prevention easier for others.”

In honor of American Pharmacist Month, we’d like to say a big and heartfelt thank you to our incredible team of 175+ pharmacists. Each of you plays a critical role in the wellbeing of our customers, the strength of our provider relationships and the quality of our service — we’re grateful for your hard work all year long. 

Here are just a few of the faces responsible for providing exceptional pharmacist care at Alto!

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

We’re excited to welcome Christopher Tidball to the Alto team as Director of Product Management, Supply Chain & Fulfillment. Learn more about his passions both in and outside of work and what drew him to Alto.

Introducing Christopher Tidball, Director of Product Management - Supply Chain & Fulfillment

We’re excited to welcome Christopher Tidball to the Alto team as Director of Product Management, Supply Chain & Fulfillment. Most recently, Christopher led a large team of product managers, engineers and program managers at Amazon to power the company’s most complex fulfillment operations. 

As Alto continues to expand our geographic footprint and customer base, Christopher’s nearly 20 years of industry experience will support us in scaling our systems, so that we can continue to deliver the same high standards of care and service to even more communities.

We recently sat down with Christopher to learn more about his passions both in and outside of work, what drew him to Alto, and the operational opportunities he’s most excited about. 

Before a recruiter ever reached out to me about a role at Alto, my wife and I were very satisfied customers. We had been on a long journey of trying to start a family, and that ultimately led us to a fertility clinic that recommended Alto. We had a great experience from day one: the app was easy to use, the same-day deliveries from couriers were always on time, and Alto’s pharmacists walked us through the various medications in our delivery and answered all of our questions. 

Alto’s focus on the customer experience was immediately clear, and I made a mental note that this was the type of company I’d like to work for. Fast forward a few months later, a recruiter reached out and introduced me to the leadership team whose passion and experience sold me on leaving Amazon to come here.

As the Director of Product Management - Supply Chain and Fulfillment, I'll focus on the technology investments that can help us continue to grow and offer exceptional service to our customers. “Supply chain” covers a lot of ground: procurement, inventory, pharmacy operations, delivery, and more. There are tons of opportunities to automate processes to make it easier for Altoids to run the business, especially as we grow and expand. 

What areas of the business are you most excited about?

The operations side has always been exciting to me—it's where the magic happens. At the end of the day, if we don't have sustainable, efficient ways to fulfill the promises we make to our customers, we won't survive. 

Alto has a great business model, and many happy customers to show for it, but there’s always room to continue to innovate and improve the delivery experience. It's one of the few in-person interactions we have with the customer and we want to make it exceptional.

Tell us about life outside of Alto. Are you doing anything interesting at the moment?

I'm a pilot in training — I'm about 75% of the way to getting my single-engine license. I live in Seattle so the aerial views of the city, Puget Sound, and the Cascade Mountains are absolutely breathtaking. Flying gives you a sense of freedom that reminds me of when I first got my driver's license.

You can find more information about Christopher or connect with him directly on LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

The Next Evolution of Our Company Values

A lot has changed at Alto since Matt and I first set out to transform the pharmacy experience back in 2015. (For one thing, we no longer work out of a storage closet.) In the past two years alone, we’ve quadrupled our team to more than 1,000 Altoids and opened new locations in Denver, Las Vegas, Seattle, New York City, Houston, Dallas, San Jose and San Diego.

Our mission — improving the quality of life for everyone who needs medicine — will never change, but a team of 1,000 needs a different recipe for success than one of 100. And as our team continues to grow, along with our geographic footprint, we’ve revisited our core values so that we can move forward with intention and clarity during this next phase of Alto’s journey.

Here are the values that guide our work today.

This was at the top of our founding values, and it’s still here. In fact, our resolve to put patients first has only gotten stronger — not because it’s what is best for the business, but because it is our only reason for being in business. Each member of our team strives to build a world where healthcare companies truly prioritize the needs of their patients, and we’ll do everything in our power to make that a reality.

My personal favorite of all our new values, dancing in the storm is about embracing the bumps in the road — and there are many when you’re taking on challenges within healthcare — and recognizing that you can always choose joy. We strive to help our teammates do the same by infusing a little bit of levity and laughter into the workday. It only takes one person to start a dance party!

Humility is not thinking less of yourself, but thinking of yourself less. Nor is it the absence of strong opinions, but the willingness to learn and change our minds. Sometimes our ego takes over — that’s only human. But we try to be mindful of it, and willing to let go of our ego and instead put our mission, customers, and teammates ahead of ourselves.

We view ourselves as creators of our circumstances, responsible for our actions and our own well-being. When we don’t like an outcome, we don’t project blame onto others or ourselves, but rather take radical responsibility for how we created the situation. More than any other value, this is an opportunity for deep internal reflection, and by practicing it consistently, we can maximize our own individual growth.

We say what is true for us in the moment, even when it is uncomfortable. We support our teammates to do the same by recognizing the validity of their experience and not taking it personally. Leading with candor isn’t always easy, but it feels much better to live authentically and honestly and to work with others who do as well. Candor doesn't have to be angry or hurtful - it can be kind and binding, compassionate and respectful.

It’s easy to become paralyzed by fear, overwhelmed by all of the possibilities in a complex situation. So unless a decision involves customer or employee safety, we don’t wait for perfect information. We trust our intuition and common sense and simply forge ahead, knowing that mistakes are in fact one of the best ways to learn.

There are no shortcuts or silver bullets in an industry as complex as healthcare. The way to achieve transformational change is through continuous improvement over a long period of time. When we’re overwhelmed by the magnitude of what we’re trying to accomplish, we remember that what each of us does adds up — one step at a time, one customer at a time — and that with small but steady progress we can accomplish great feats.

As a company grows, issues no longer affect a few customers, but a few thousand. It’s tempting to only look at trends and aggregates, but we know this is a trap. Greater distance from individual examples creates more opportunity for misunderstanding, bias, and incorrect assumptions. So we look beyond surface-level data and dive deep into the details. Only then can we fully understand an issue to its core.

Values themselves are just words, and the words themselves are not that important. What’s important is how we live them day in and day out, and the culture they support. In the months ahead, we’ll continue to integrate these values into the fabric of our company processes, our products, our customers’ experiences, and our work lives. And this work is not something just a few leaders or HR team members do - every Altoid has a hand in bringing these values to life and co-creating our culture.

Build Tomorrow’s Pharmacy with Us — Join Our Team

If you are passionate about creating a great company culture, 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.

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

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 or through our app, and will even remind you when your medications are due for a refill.

Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging!

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.

How Alto Pharmacy works with health insurance

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