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Lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Here's what to know.

What to Know About Lung Cancer Screening

Lung cancer, the leading cause of cancer death among both men and women, is more likely to be cured when detected early. The five-year survival rate is about 60% when the disease is confined to one lung. 

However, the majority of cases are diagnosed after the cancer has already spread to both lungs or other organs, at which point  the five-year survival rate is 20% or less. Delayed diagnoses are due in part to the fact that lung cancer symptoms often do not appear until the disease has progressed to more advanced stages.

This is why lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Some studies have found that screening detects 80% of lung cancer cases at an early stage. Read on to learn more about what to expect during lung cancer screening and whether it may be right for you.

Smoking is the number one cause of lung cancer, contributing to 80-90% of lung cancer fatalities. However, there are additional risk factors to developing lung cancer:

Exposure to radon, a naturally occurring gas that can get trapped in houses and buildings, and the second leading cause of lung cancer

Exposure to asbestos or other carcinogens like uranium, diesel exhaust, and inhaled chemicals in the workplace

Radiation therapy to the chest during cancer treatment

While lung cancer symptoms typically appear once the disease has progressed to a more advanced stage, some people do experience some of the following early signs of lung cancer:

A cough that does not go away or gets worse

Chest pain that often worsens with deep breathing, coughing, or laughing

Infections such as bronchitis and pneumonia that don’t go away or keep coming back

Many of these symptoms overlap with those of other respiratory conditions like COPD, and you should schedule an appointment with your doctor as soon as possible. Even if you do not have lung cancer, it’s important to identify the cause of these symptoms and treat them, if needed.

What happens during lung cancer screening?

During your lung cancer screening, doctors will use a non-invasive test known as a low-dose computerized tomography (LDCT) scan to search for abnormal spots in the lungs that could be cancer. 

During the scan, you will lie still on a long table as it slides through a machine that uses a low level of radiation — about half of what you’re exposed to naturally from the environment every year, and much less than what you’d be exposed to in a standard CT scan — to create images of your lungs. It is painless and will take less than a minute.

If you are experiencing signs of a respiratory infection such as congestion, runny nose, sore throat, and body aches, or if you recently recovered from one, let your doctor know as it may affect the results of an LDCT scan. They will let you know if you should reschedule.

There are several possible outcomes of an LDCT scan. If the screening test detects abnormal spots, often called a nodule, you may need additional tests to determine if you have lung cancer. 

For small nodules, doctors often recommend another LDCT scan after a few months to see if the nodule has grown. If the nodule is bigger, your doctor may order additional testing like a positron emission tomography (PET) scan or a biopsy, a procedure that removes a piece of the nodule for lab testing, to find out if it is cancerous.

In cases where lung cancer screening does not detect any abnormal spots, your doctor may recommend continuing with annual screening depending on your risk.

Since lung cancer screening involves exposure to radiation, doctors primarily reserve screening for people at high risk of developing lung cancer, namely older adults who have smoked heavily for many years. 

The U.S. Preventive Services Task Force (USPSTF) — an independent group of prevention experts who help healthcare providers make informed recommendations for their patients — recommends annual LDCT lung cancer screening for people who meet each of the following criteria:

Have a 20 pack year or more smoking history

Smoke now or have quit within the past 15 years

A “pack year” is defined as smoking an average of one pack of cigarettes per day for a year.  The 20 pack year history threshold could be met by smoking one pack a day for 20 years or two packs a day for 10 years. It’s important to share all the details of your smoking history with your doctor so they can determine if you would benefit from lung cancer screening.

Your doctor may also recommend lung cancer screening if you were treated for lung cancer more than five years ago, have another serious lung disease such as chronic obstructive pulmonary disease (COPD), a family history of lung cancer, or have been exposed to asbestos at work.

They will also take your overall health into account, as lung cancer screening is typically recommended for individuals who would be physically able to tolerate treatment for early-stage lung cancer and lung surgery, if it is needed.

While lung cancer screening saves lives — without screening, 70% of lung cancer cases would be detected at a later stage — it carries some risks, like all screening procedures.

First, while the level of radiation you are exposed to during an LDCT scan is not significant, it can potentially become harmful with repeated scans. In addition, when screening for any disease, doctors will sometimes find abnormalities that look cancerous but are not, which is referred to as a false positive. They may also find cancers that grow so slowly they would never lead to symptoms.

The frequency of false positives continues to decline every year. Currently, about 12-14% of lung cancer screenings have a false positive, similar to the rates for mammograms. False positives are even less common with continued annual LDCT screening since it is easier to identify notable changes between the scans. 

Plus, as the technology behind lung cancer screening evolves, doctors have a clearer understanding of who actually needs follow-up testing after the initial LDCT scan. Ultimately, it is important to discuss the benefits and risks of lung cancer screening with your doctor and work together to determine if you would benefit from it.

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. And our team of patient care pharmacists is also here to chat whenever questions come up.

Switch to a better pharmacy for free same-day delivery and support with insurance and savings opportunities. Reach out any time through in-app 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.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable.

Prioritize Your Health with Preventative Care

If you’ve ever waited until you’re sick to see a doctor, you’re not alone. Many adults in the U.S. put off routine doctor’s appointments — sometimes even when they don’t feel well. 

These delays can be serious: according to the Centers for Disease Control and Prevention, up to 40% of all fatalities linked to the five leading causes of death in the U.S. — heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries — could have been prevented. Untreated blood pressure or cholesterol and unhealthy lifestyle habits factors heavily into many of these cases.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable. Preventative care involves a combination of annual check-ups, vaccinations, screenings, and healthy lifestyle habits. 

If you haven’t been to the doctor in a while, don’t get discouraged. The important thing is to get back in the habit. Below is an overview of preventative care for both men and women, with recommendations from our pharmacists for how to ensure you’re prioritizing your health.

There are several important numbers that help your doctor understand your risk for health conditions such as heart disease and diabetes: your body mass index (BMI), blood pressure, cholesterol, and glucose levels.

Being overweight or obese increases your risk for many different health conditions, including high blood pressure, unhealthy cholesterol levels, type 2 diabetes, heart disease, and stroke. 

Body mass index (BMI) is a screening tool that doctors use for obesity. A healthy BMI is typically between 18.5 to 24.9, while a BMI between 25 to 29.9 is considered overweight and a BMI of 30 or higher is obese.

Keep in mind that while a BMI does help doctors understand your general risk for the chronic conditions mentioned above, it is merely a snapshot of your health and doesn’t account for other important health factors including age and genetics. Your healthcare provider can help you understand your overall priorities with preventative care beyond any single number, which is another important reason to stay up to date with doctor’s appointments.

Your blood pressure numbers are one of several factors that can help your doctor predict your risk for heart disease and cardiac events like a heart attack or stroke. There are five different blood pressure ranges recognized by the American Heart Association:

If your blood pressure is in the normal range, you should get screened at least once per year. If your blood pressure is in a higher range, consult with your doctor about recommended screening frequency.

Read our previous blog to learn more about managing blood pressure.

A cholesterol blood test, also called a lipid profile or lipid panel, gives results for several different readings: HDL (good) cholesterol, LDL (bad) cholesterol, triglycerides, and total blood (or serum) cholesterol. Your total cholesterol and HDL cholesterol levels are particularly important in helping your doctor identify if you are at risk for a heart attack or stroke.

A healthy range for total cholesterol is considered to be less than 200 mg/dL

A healthy range for HDL cholesterol is considered to be higher than 40 mg/dL for men and higher than 50 mg/dL for women

A healthy range for LDL cholesterol is considered to be less than 100 mg/dL

These targets are intended to be general guidelines, and each individual’s health needs are different. Having type 2 diabetes, smoking, being overweight, and not getting enough physical activity can affect your cholesterol levels. Your healthcare provider can help you determine your personal targets.

If your total cholesterol is under 200 mg/dL, you can have your cholesterol checked every 4-6 years. If you are at higher risk for heart disease and stroke, consult your doctor about recommended screening frequency.

Your blood glucose numbers can help your doctor determine if you have diabetes or are at risk for developing it. A blood sugar level under 140 mg/dL (7.8 mmol/L) is typical considered healthy, while a reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) may indicate prediabetes and a reading over 200 mg/dL may indicate diabetes. A discussion of these numbers with your healthcare provider is required for an official diagnosis of diabetes.

Generally speaking, if your blood glucose numbers are under 140 mg/dL, you should get screened at least every three years. If you have prediabetes you will need more frequent screening.

If you have diabetes, your healthcare provider can help you develop individualized targets for healthy blood sugar levels, which may be different from the numbers above. Try not to worry about what “normal” looks like for other people, and focus instead on taking simple actions to control your diabetes and live your healthiest life, like staying active and quitting unhealthy habits.

You should have an annual check-up once per calendar year. This appointment is the foundation of preventative care: since each individual’s risk for specific preventable health conditions may vary, discussing your personal health history and vital signs with your doctor will help you determine which preventative measures to prioritize.

In addition to checking with your physician about which vaccines, screenings, and medical tests you need, ask if your family history indicates an increased risk for any health conditions.

Prevention and screening become more important as you age. Regular colorectal cancer screening is recommended for everyone 50 and over. If you have risk factors like an immediate family member with colorectal cancer, your doctor may suggest earlier screening.

The American Cancer Society recommends annual mammograms for all women between 45 and 54. Some women begin screening for breast cancer as early as age 40 depending on their risk and family history. Women 55 and older can continue with yearly mammograms or switch to every two years. Your doctor can help you determine the right screening frequency for your individual needs. 

Preventative health doesn’t just happen in your doctor’s office. Everyday choices like what you eat and how often you exercise can protect your health for years to come.

Staying active is one of the most important things you can do to prevent cardiovascular disease and maintain a healthy weight. If you’re just starting to figure out your ideal exercise routine, know that you don’t have to exert yourself too hard to reap the benefits of physical activity. Even just 30 minutes of moderate exercise most days of the week can help strengthen your heart.

Everyone should do their best to limit their intake of the following foods, but it’s especially important if you face a greater risk for heart disease or diabetes:

Saturated and trans fats, which can raise your cholesterol

Sodium, which may increase your blood pressure

Sweets and sugar-sweetened beverages, which have been linked to both type 2 diabetes and an increased risk for heart disease

Other things you can do to stay healthy? Chronic stress can elevate your blood pressure, putting you at a greater risk for heart attack and stroke, so try to manage stress in heart-healthy ways like getting enough sleep, maintaining a fulfilling social life, and practicing mindfulness and gratitude. And it’s never a bad time to cut back on your alcohol consumption and quit smoking, if you currently smoke.

Prioritizing your physical and mental well-being today can help you prevent health issues in the future. We’re here to help make that as simple as possible.

At Alto, a pharmacist is your partner in health. If you take medication, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. And our team of patient care pharmacists is available to chat whenever questions come up. Reach out through our in-app messaging or by phone at 1-800-874-5881.

EMD Serono has several patient assistant programs designed to reduce the cost of fertility treatment, including special opportunities for military veterans and cancer survivors.

A Guide to EMD Serono’s Financial Assistance Programs for Fertility Medication

Fertility preservation treatments like egg freezing and IVF are significant investments, both emotionally and financially. Fertility medications used to support egg production, retrievals and implantations often contribute to these expenses. 

At Alto, we support your financial well-being alongside your physical health, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. In addition to automatically applying any coupon savings, we’ll connect you with any outside programs that require you to apply directly.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono. EMD Serono has several patient assistant programs designed to reduce the cost of fertility treatment, including special opportunities for military veterans and cancer survivors.

Read on to learn more details about eligibility for EMD Serono patient assistant programs and how to apply. You can also read our previous post on managing the costs of fertility treatment to learn about Alto’s additional financial support for fertility treatment and medications.

The EMD Serono Compassionate Care program provides discounted medication to eligible self-pay patients pursuing fertility treatment based on financial need or military status. 

Compassionate Care provides discounts off the self-pay price of EMD Serono fertility medications, including: 

for income-based eligible patients, savings of up to 50%

for active, retired, and veteran military, a minimum of 10% off based on income up to 50% off. 

Eligibility is based on your annual gross household income and first-time participation in the Compassionate Care program. 

Compassionate Care covers the following treatments: 

Gonal-f® RFF* Redi-ject™ pen 300 IU, 450 IU and 900 IU

Gonal-f® Multi-Dose vial 450 IU and 1050 IU

The Compassionate Care program is available only at participating pharmacies and patients must present a valid prescription for an eligible drug. The program is available for multiple cycles each calendar year for eligible patients. You must reapply each year.

View additional program details and apply here.

The EMD Serono Compassionate Corps program provides free medication to eligible, uninsured veterans injured in the line of duty or their spouses. To be eligible, you must be a retired military veteran or the spouse of a veteran who meets the following criteria:

Is infertile due to a service-related injury

Is not privately or publicly insured for infertility medications

Has been diagnosed by a physician as infertile and requiring in-vitro fertilization (IVF)/assisted reproductive technology (ART)

Is not eligible for coverage under the Fertility Veterans Act

The program is available for up to two cycles per calendar year. You must reapply each year.

Download the Compassionate Corps application.

If you’re a veteran who does not qualify for Compassionate Corps, you may still qualify for the Compassionate Corps program to receive up to 50% off your medications through the Compassionate Care program.  

Certain types of cancer can affect fertility in both men and women, whether it’s due to the removal of organs related to reproduction or a change in hormone levels following treatment. If you are considering starting a family after your cancer treatment, fertility preservation options can make it easier to conceive.

To help ease the financial burden of this process, EMD Serono donates fertility medications to eligible cancer survivors diagnosed during their reproductive years through the Livestrong Fertility Discount program.

Start the application process on Livestrong’s website to learn if you are eligible.

A fertility pharmacy partner you can rely on

Alto is here to make your experience with fertility preservation treatments as stress-free as possible. We offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

To get a price quote specific to your fertility medication protocol, complete our online form.

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.

Editors's note: this post was originally published in August 2021 and has been updated for accuracy and completeness.

EMD Serono’s Financial Assistance Programs for Fertility Medication

Despite the initial challenges of a type 1 diagnosis, managing your child’s diabetes does get easier. Here’s an overview of the information you need to manage your child’s diagnosis.

How to Manage Your Child’s Type 1 Diabetes Diagnosis

Your child’s type 1 diabetes diagnosis affects the entire family. As a parent, it’s understandable to feel overwhelmed as you get up to speed on their treatment plan, including insulin therapy,  blood glucose testing, and coordinating with your insurance provider.

“There’s so much information thrown at you right away, and we didn’t know what we didn’t know,” shared Lucinda, a Partnership Manager at Alto whose 5-year-old son was diagnosed with type 1 diabetes last year. “Insurance coverage is particularly complicated with diabetes, even for someone who works in healthcare like me, because you’re dealing with so many medications and supplies that aren’t commonly prescribed.”

Despite the initial challenges of a type 1 diagnosis, managing your child’s diabetes does get easier. By staying on top of daily blood sugar management and surrounding your family with a strong support system, your child will be able to have a healthy, active life — and you will be able to find some peace of mind. Here’s an overview of the information you need to manage your child’s type 1 diabetes diagnosis

Type 1 diabetes is an autoimmune disease in which the body mistakenly destroys the pancreas’s insulin-producing cells. Your body needs insulin to properly convert a simple sugar known as glucose into energy. Without insulin, blood sugar levels rise in people with type 1 diabetes, which can cause life-threatening health complications if untreated.

While type 1 diabetes can be diagnosed in adults, the majority of cases develop during childhood (the condition was once referred to as juvenile diabetes). In some cases, symptoms appear in children less than a year old.

Blood sugar levels typically rise very quickly as the condition develops. Some of the common initial symptoms of type 1 diabetes include increased thirst, frequent urination, extreme hunger, weight loss, and fatigue. Your child may feel very sick within two to three weeks following the onset of the condition.

Insulin therapy is the cornerstone of treatment for type 1 diabetes. Since individuals with type 1 diabetes don’t produce any insulin at all, they need to take insulin every day to maintain healthy blood sugar levels.

Insulin is most commonly administered with a syringe, but additional methods of delivery include insulin pumps and pens. There are five main types of insulin categorized by how quickly they work and how long they last: rapid-acting, regular or short-acting, intermediate-acting, long-acting, and ultra long-acting. 

It’s important to work with your child’s healthcare provider to find the right insulin dosage, as taking too much or too little can cause rapid changes in blood glucose levels. Many people with diabetes need to take a combination of rapid or short-acting and long-acting insulins throughout the day. This best replicates the natural actions of a normally functioning pancreas, which releases a continual supply of insulin with additional bursts when you eat.

Read our previous blog to learn more about getting started with insulin therapy.

The goal of insulin therapy is to keep your child’s blood sugar in a healthy range. For people without diabetes, a typical blood sugar range is 70 to 125 mg/dL when fasting. People with diabetes should typically try to stay between 70 to 180 mg/dL. 

Your child’s healthcare provider will let you know what your child’s blood sugar target range is. Individual blood sugar targets will vary depending on factors like age, physical activity, and the severity of the condition. It will likely change as your child grows.

Daily testing is the only way to ensure that your child’s blood sugar is within their target range. It will also offer insight into how food and physical activity affect your child’s blood sugar levels throughout the day.

As with insulin therapy, checking your child’s blood sugar using a blood glucose meter will become routine. You will likely need to check and record your child’s blood sugar several times throughout the day, including before meals and snacks, before and after exercise, and before bed. Logging results from blood sugar tests is very important for noticing patterns and determining if any adjustments to your child’s treatment are necessary. Apps like Glucose and mySugr are helpful tools that allow you to identify trends over time.

Your doctor will advise you on your child’s individual needs with blood sugar monitoring. You may have to check their blood sugar levels more frequently when they are sick, if their routine changes, or if they start a new medication. A continuous glucose monitoring (CGM) device, which measures blood sugar every few minutes through a temporary or implanted sensor inserted under the skin, is helpful for individuals who need to monitor blood sugar levels more closely. Consult with your child’s healthcare provider about whether or not a CGM device is appropriate.

Carbohydrates increase blood sugar levels more than any other nutrient, so monitoring how many carbs your child consumes every day is another important aspect of blood sugar management.

Advanced meal planning is important, as your child’s daily insulin dosage is based on their insulin-to-carb ratio. They should be able to eat a variety of foods so long as you carefully plan out meals and spread their carb intake throughout the day.

Your child’s healthcare provider can help you determine your child’s target carb ratio. While this is a healthy baseline to aim for, blood sugar naturally fluctuates throughout the day. There may be times when additional carbs are needed to treat low blood sugar, or when extra insulin is required to bring high blood sugar levels down.

By no means should a type 1 diabetes diagnosis prevent your child from staying active. In fact, exercise offers individuals with type 1 diabetes additional benefits like lowering blood sugar and improving insulin sensitivity. 

However, exercise may sometimes cause a drop in blood sugar levels, so it’s important to check blood sugar levels beforehand. Stock up on carbohydrate-rich snacks such as dried fruits, trail mix, or granola bars to treat low blood sugar, keeping in mind that physical activity is often more unplanned and spontaneous with children and adolescents than it is with adults. 

The American Diabetes Association recommends giving 5-15 grams of carbs, depending on your child’s age and weight, for every 30 minutes of sustained physical activity in tandem with frequent monitoring of blood sugar levels.

Low blood sugar is also known as hypoglycemia. For many individuals with diabetes, hypoglycemia occurs when their blood sugar is less than 70 mg/dL. However, diabetes treatment plans are individualized, and your child may have a different blood sugar target range, so be sure to consult with your child’s physician.

There are many reasons why blood sugar may fall, including not eating enough, exercising too much, taking too much insulin, or not taking insulin at the right time. Initial signs of hypoglycemia include feeling sweaty, shaky, and hungry. As blood sugar drops further, additional symptoms include feeling weak, having difficulty walking or seeing clearly, getting disoriented, and having seizures.

If you notice any of these symptoms in your child, check their blood sugar and treat immediately with fast-acting sources of glucose, including fruit snacks, juice boxes, glucose tabs, or glucose gels. In cases of severe hypoglycemia — 55 mg/dL or less for many individuals with diabetes — glucagon can be used to restore blood sugar.

On the other end of the spectrum, a blood sugar of 180 mg/dL or higher is usually considered hyperglycemia or high blood sugar. It frequently occurs when too little insulin is taken for the amount of carbs consumed, but factors like illness, stress, and hormonal changes can also lead to hyperglycemia. Common signs include extreme thirst, frequent urination, or increased hunger.

If you notice any of these hyperglycemia symptoms in your child, check their blood sugar levels and follow the treatment plan your doctor has recommended, which may include a dose of rapid acting insulin, water, or other carbohydrate-free beverages.

A crucial step to preparing for emergency hypoglycemia or hyperglycemia is informing your child’s school of their type 1 diabetes diagnosis. View the JDRF’s back to school checklist for more on what your child’s teachers should know.

You never have to be alone on this journey. In addition to your child’s clinical team, other parents of children with diabetes, who know exactly what you’re going through, are a powerful resource. And for Lucinda and her family, growing a strong support network has been invaluable.

“Your child’s diabetes diagnosis changes everything in your life, and that’s the part that people don’t always get to discuss at the doctor’s office,” she said. “I wish I had known to connect with other parents of children with type 1 diabetes immediately.”

Visit the caregiving section of the American Diabetes Association’s online Support Community to start building your own network of parents who are also managing their children’s diabetes.

It’s also important to have a pharmacy that will advocate for your child’s care, as the condition involves a steep learning curve with medications and supplies.

“I never felt supported by a pharmacy until I used Alto for my son’s diabetes medications,” Lucinda said. “Questions about insurance coverage are handled seamlessly, and as a busy working mom, it’s so helpful to be able to quickly schedule a delivery in the app.”

She added, “With diabetes, any pharmacy missteps like improper medication packaging or storage can be life-threatening. It brings me so much peace of mind to know that I never have to worry about that with Alto.”

A diabetes pharmacy partner you can rely on

Alto is with you every step of the way in managing your child’s diabetes. We make it simple to follow the treatment plan your child’s doctor recommends, with proper packaging of temperature-controlled medications and free same-day delivery right to your doorstep.

We also offer extra support to address the challenges that are specific to managing diabetes, like getting started with insulin therapy. Our pharmacists are available to walk you through your child’s first insulin doses and discuss any symptoms or side effects to determine if an adjustment is needed.

And since a diabetes diagnosis brings lots of new insurance terminology related to your child’s medications and supplies, we compiled a guide that breaks down the key insurance terms you’re likely to encounter. We’ll tackle the administrative legwork, too, coordinating with your doctor’s office and submitting any necessary paperwork, so that you can focus on your child’s care instead of phone calls with your insurance provider.

Get started or learn more about Alto by reaching out at any time via phone at 1-800-874-5881 or in-app 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.

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 by 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.

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

How Updated CDC Guidelines Can Expand PrEP Access

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

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

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

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

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

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

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

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

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

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

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

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

What Updated CDC Guidelines Mean for PrEP Access

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

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

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

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

Getting PrEP from a pharmacy under the new laws

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

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

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

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