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The HIV prevention medication PrEP, or pre-exposure prophylaxis, is highly effective when taken as prescribed every day, lowering the risk of sexual transmission and intravenous drug transmission by 99% and 74%, respectively.* Cost is often a barrier to beginning treatment, but thanks to financial resources and expanded insurance coverage, the medication continues to become more affordable.

It can be difficult to navigate the various forms of assistance and determine what you may be eligible for, as well as to understand what insurance providers are legally required to cover. To help, we’ve compiled an overview of PrEP affordability resources for all insurance statuses.

A Guide to PrEP Affordability Resources

The HIV prevention medication PrEP, or pre-exposure prophylaxis, is highly effective when taken as prescribed every day, lowering the risk of sexual transmission and intravenous drug transmission by 99% and 74%, respectively.* Cost is often a barrier to beginning treatment, but thanks to financial resources and expanded insurance coverage, the medication continues to become more affordable.

It can be difficult to navigate the various forms of assistance and determine what you may be eligible for, as well as to understand what insurance providers are legally required to cover. To help, we’ve compiled an overview of PrEP affordability resources for all insurance statuses.

*Effectiveness rates are for oral PrEP. Injectable PrEP is another form of effective HIV prevention.

The Affordable Care Act requires that most private insurance plans and state Medicaid programs cover at least one of the available PrEP options. (There are two FDA-approved brand-name oral medications for PrEP, Truvada® and Descovy®, and a generic option for Truvada called emtricitabine/tenofovir disoproxil fumarate.) This means that, generally speaking, many of those with insurance cannot be charged for PrEP or related medical services, including follow-up doctor’s appointments and testing.

However, since the law only requires that plans cover at least one PrEP option without copays or deductibles, additional steps may be required to get insurance coverage of the version your doctor has prescribed. While they are both effective at preventing HIV, Truvada and Descovy are not identical, and there are cases when one option is a better fit than the other for an individual’s health needs. In such cases, coverage of the preferred version would require an additional approval process called a prior authorization. Alto can coordinate with your provider to support this process and prevent delays in treatment.

If you still have a copay, there are resources to help you manage the costs of PrEP. Your options depend on whether you have private or government-based insurance.

Additional assistance for those with private insurance coverage

Gilead, the manufacturer of Truvada, offers a copay coupon card for eligible individuals with private insurance.

The Patient Advocate Foundation offers copay assistance for PrEP and related medical services to qualifying individuals. Eligibility is income-based and open to a variety of insurance plans.

Additional assistance for those with government insurance

Many states have programs to help individuals with Medicare access PrEP and related medical services at little to no cost. For a closer look at these programs, read What to Know About State-Funded PrEP-DAP Programs.

There are programs to help those without insurance access PrEP and related medical services at little to no cost.

Gilead offers the Advancing Access® Patient Assistance Program to help qualifying individuals without insurance access PrEP free of charge. Eligibility is income-based. Learn more about the application process here.

Many of the state-funded patient assistance programs include support for those without insurance.

The Ready, Set, PrEP program offers the medication free of charge to qualifying individuals without insurance. All are welcome to apply regardless of income status. Learn more about application details here.

If you think PrEP may be right for you, your doctor can write you a prescription. Negative HIV test results are required to begin taking the medication. Additionally, ongoing medical care — including routine tests for HIV and other sexually transmitted infections (STIs) — is required to continue treatment.

If you do not have a provider or are unable to get a prescription from your doctor, the following resources can connect you with a provider who will prescribe PrEP for you:

Alto can help you navigate HIV prevention medication

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with oral PrEP and continue treatment. We’re available to answer any questions you may have between your follow-up appointments.

We can also coordinate with your doctor and your insurance provider to ensure that you’re receiving the best PrEP option for your needs at the best price we can find.

To learn more, reach out any time via 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.

The term “donut hole” refers to a gap in Medicare Part D prescription medication coverage. Once this coverage gap starts, you will likely pay more out of pocket for your medications. Here’s what to know about the Medicare donut hole, including how it may affect the cost of your prescription medications this year.

The Medicare Donut Hole, Explained

Medicare is a federally-run health insurance program for people age 65+ and people with disabilities, regardless of income. It is different from Medicaid, which is a state and federal program that provides health coverage if you have a very low income.

Part A: coverage for inpatient hospital visits and skilled nursing facility services

Part B: coverage for physician and outpatient hospital services and durable medical equipment (DME) costs, including insulin pumps, blood sugar test stips, some continuous glucose monitors (CGMs), nebulizers, and oxygen equipment

Part C, also known as Medicare Advantage (MA) plans: offered by private insurance companies to provide the same benefits as Medicare Parts A and B; many also offer prescription coverage similar to Part D

Part D: coverage for prescription medications that are commonly dispensed from the pharmacy including respiratory medications and injectable insulin; may cover insulin patch pumps; you can change Part D plans each year

Part D plans have an annual coverage gap known as the donut hole. Once this begins, you will pay more for your medications until you reach the yearly limit on out-of-pocket costs.

The donut hole begins when your Medicare plan has paid a certain amount toward your prescription medications in a given year. This is sometimes referred to as the initial coverage limit. In 2022, the initial limit for prescription drug coverage on Medicare Part D plans is $4,430/year, an increase from $4,130 in 2021. 

Once in the donut hole, you become responsible for no more than 25% of your medication costs until you hit a certain out-of-pocket threshold and can exit the donut hole. For example, if a medication’s total cost is $100 and you pay a $20 copay during the initial coverage period, you will be responsible for paying $25 — 25% of $100 — while in the donut hole.

The out-of-pocket threshold is the amount of money you have to spend out of pocket before you are allowed to leave the donut hole. In 2022, the out-of-pocket threshold for Part D plans is $7,050, an increase from $6,550 in 2021.

The following count toward your total out-of-pocket costs while in the donut hole:

Out-of-pocket expenses for generic and brand-name medications

After you’ve reached the out-of-pocket threshold, you receive “catastrophic coverage.” During this time, your share of medication costs will drop significantly to either 5% of a medication’s cost or a small copay — whichever is higher.

The minimum copay for a one-month supply of generic medication for Medicare Part D plans in 2022 is $3.95, and the minimum copay for a one-month supply of brand-name medication is $9.85.

Medicare Extra Help offers financial assistance with monthly premiums, annual deductibles, and copay costs related to prescription medications. Eligibility is income-based. Those who receive Medicare Extra Help will not enter the donut hole.

To qualify for the program in 2022, annual income is limited to $20,385 for an individual or $27,465 for a married couple living together.

For more information on Medicare and the donut hole, we suggest exploring the following resources.

www.medicare.gov - includes live chat and 1-800-MEDICARE (1-800-633-4227)

The Medicare and You Handbook - includes key deadlines for enrollment and details on coordinating third party coverage from former employers, the military, and Veterans Affairs.

The Medicare Plan Finder - a trusted source for comparing Medicare coverage options.

Your choice of pharmacy can significantly impact the cost of your medications. At Alto, we prioritize your financial wellness alongside your physical health. Here are some ways we go above and beyond to ensure that you’re receiving your medications at the lowest price possible.

We research all your pricing options once we receive a prescription. If it is cheaper to pay cash for your medications, separate from insurance benefits, we’ll let you know so that you can make an informed choice.

We automatically search for potential sources of savings like manufacturer coupons, patient assistance programs, and copay cards and apply them when applicable. If we find any options that require you to apply directly with the program or manufacturer, we’ll let you know.

We continue searching for less expensive medication options even after we’ve researched savings opportunities, coordinating with your doctor to evaluate these options.

To get started or learn more about Alto, call 1-800-874-5881 or reach out through in-app messaging.

Resources for Affording HIV Medication

The HIV treatment and prevention landscape continues to evolve, with many effective medications. Antiretroviral therapy (ART), the frontline treatment for HIV since 1997, is a combination of medications that lower the amount of HIV in your bloodstream. When taken as prescribed every day, ART can help individuals with HIV achieve and maintain an undetectable viral load. As a result, more than half of all those living with HIV in the U.S. are not at risk of transmitting the virus to others.

On the prevention front, PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%.

For many individuals, cost is a barrier to both starting and continuing to take ART and PrEP as prescribed. Fortunately, HIV prevention medication and treatment continue to become more accessible, with generic PrEP options and expanded health insurance coverage of PrEP and ART. In addition, the following resources, including patient assistance programs and copay savings cards from medication manufacturers, can help reduce the cost of HIV treatment and prevention medication.

Read on to learn more about eligibility for these programs, and revisit our previous post on state-funded PrEP drug assistance programs.

Many pharmaceutical companies have patient assistance programs (PAPs) to offset the cost of prescription medications for individuals without insurance or with insufficient insurance coverage. If Alto is your pharmacy partner for HIV treatment or prevention, your medication protocol may include medications manufactured by Gilead, which offers the PAP outlined below.

If your medications are manufactured by a different company, contact them directly to learn about any available financial assistance including PAPs.

Gilead's Advancing Access® Patient Assistance Program

Gilead's Advancing Access Patient Assistance Program provides medication free of charge to individuals without insurance who meet program eligibility criteria. There are several ways to learn if you are eligible:

Call 1-800-226-2056 (Monday-Friday, 9 am to 8 pm EST)

Print the enrollment form and submit it via fax

Copay savings cards from pharmaceutical manufacturers can help offset the cost of prescription medications for individuals with insurance. If Alto is your pharmacy partner for HIV treatment or prevention, your medication protocol may include medications manufactured by Gilead or ViiV Healthcare, which offer the copay savings cards below.

If your medications are manufactured by a different company, contact them directly to learn about any available financial assistance including copay savings cards.

Gilead’s Advancing Access copay savings card

Gilead also offers a copay savings card for individuals with insurance to reduce the cost of copays. Those who are enrolled in any state or federally funded prescription medication program such as Medicare Part D and Medicaid, or who are in the Medicare Part D prescription coverage gap, are not eligible.

Learn more about program eligibility and terms and conditions.

The ViiVConnect Savings Card Program helps eligible individuals with commercial insurance save on copay costs for select ViiV Healthcare medications. Those who are enrolled in any state or federally funded prescription medication program such as Medicare Part D and Medicaid, or who are in the Medicare Part D prescription coverage gap, are not eligible.

If you do not have insurance coverage of prescription medications, contact 1-844-588-3288 to learn about additional financial assistance opportunities from ViiV.

Created to help individuals living with chronic health conditions access the treatment they need, the PAN Foundation offers financial assistance for medication costs, copays, and insurance premiums.

Learn what financial assistance you are eligible for.

The Ready, Set, PrEP program provides PrEP at no cost to eligible individuals without insurance coverage of prescription medications.

Learn more about program eligibility and the application process.

Your financial well-being is our priority

At Alto, we understand how stressful it can be to navigate insurance coverage benefits and savings opportunities. We prioritize your financial wellness, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make ART or PrEP as affordable as possible. In addition to automatically applying coupon savings, we’ll connect you with any outside programs that require you to apply directly.

We also offer free, same-day delivery to make it as easy as possible to stay on track with treatment, and our dedicated HIV support team is here to answer any questions you may have about ART or PrEP. Reach out any time via phone at 1-800-874-5881, or in-app messaging.

Millions of individuals with type 1 and type 2 diabetes need insulin every day to keep their blood sugar levels in a healthy range. In recent decades, it has grown increasingly difficult for many to access this life-saving medication, as insulin prices continue to rise.

Managing the Costs of Insulin

Millions of individuals with type 1 and type 2 diabetes need insulin every day to keep their blood sugar levels in a healthy range. In recent decades, it has grown increasingly difficult for many to access this life-saving medication, as insulin prices continue to rise. Take a look at these recent statistics:

The cost of insulin increased by an average of 14% every year from 2012 to 2018.

In 2017, insulin accounted for 20% of all diabetes-related healthcare spending before rebates and discounts and 6.3% after rebates and discounts.

In a 2018 survey on insulin affordability conducted by the American Diabetes Association, 39% of the respondents reported an increase in their insulin costs between 2017 and 2018.

Rising insulin costs can significantly impact an individual’s ability to manage their health. 27% of those surveyed by the ADA said that insulin prices affected how much of the medication they could buy or use. Missed insulin doses can lead to serious health complications including diabetic ketoacidosis.

While insulin access remains a critical issue for many Americans with diabetes, lawmakers have recognized the urgency of lowering insulin costs. In November 2021, the U.S. House of Representatives passed the Build Back Better Act, which caps out-of-pocket copays for insulin at $35 per month. The legislation has yet to pass in the U.S. Senate, but President Joe Biden recently reaffirmed his commitment to lowering insulin costs — and prescription medication costs more broadly — as part of his domestic agenda.

In the meantime, there are a variety of resources to help you manage the costs of insulin, including patient assistance programs and copay savings cards from insulin manufacturers. Here’s more on eligibility for these programs.

The Lilly Cares® Foundation Patient Assistance Program

The Lilly Cares Foundation Patient Assistance Program provides free insulin and glucagon products for individuals who have Medicare Part D or no health insurance coverage and meet certain income requirements.

Learn more about program terms and conditions and the application process.

The Novo Nordisk® Patient Assistance Program

The Novo Nordisk Patient Assistance Program provides insulin and other diabetes medications at no cost to individuals who have Medicare or no health insurance coverage and whose total household income is at or below 400% of the federal poverty level.

Sanofi Patient Connection provides Sanofi medications including insulin at no cost to individuals whose total household income is at or below 400% of the federal poverty level.

The Lilly Insulin Value Program offers all Lilly insulins at $35 per month to individuals with commercial health insurance or no health insurance coverage. Download the copay card here.

Sanofi offers a copay savings card for those with insurance as well as the Valyou Savings Program for those without insurance, which offers Sanofi insulin at $99 per month. Learn more about Sanofi savings opportunities.

Novo Nordisk offers savings cards that reduce copays for a variety of insulin products. Get more details here.

At Alto, we understand how stressful it can be to navigate insurance coverage benefits and savings opportunities. We prioritize your financial wellness, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your insulin and other 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.

We also offer free, same-day delivery to simplify your diabetes management, and our dedicated diabetes support team is here to answer any questions you may have. Get started or learn more about Alto, reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

Diabetes educators are healthcare professionals with extensive knowledge of diabetes who have been certified to coach individuals living with the condition. Read on to learn more about how they can help with your diabetes treament.

What Does a Diabetes Educator Do and How Can They Help You?

Diabetes management involves a lot of information — about diet, exercise, medications, blood sugar monitoring, and other components of treatment. Some of this information may be new, and it’s understandable to feel overwhelmed if you or your child has been diagnosed with type 1 or type 2 diabetes. That’s why there are diabetes educators — specialized healthcare professionals — who are here to offer support at every step of the way.

Diabetes educators are healthcare professionals with extensive knowledge of diabetes who have been certified to coach individuals living with the condition. Their credentials — which are awarded by a national certification organization called the Certification Board for Diabetes Care and Education — must be renewed every five years. This ensures that they are familiar with the latest breakthroughs in treatment, including any updates in insulin therapy or supplies and medications.

They’re here to help you learn how to administer insulin and use diabetes supplies like glucose meters and continuous glucose monitoring devices to monitor your blood sugar. They can also help with insurance navigation, support programs, and connecting you with others living with diabetes. Additionally, diabetes educators can address lifestyle questions about the daily challenges of living with diabetes, such as “how can I design a meal plan that’s right for me?” and “should I take any precautions when exercising?” to help you feel informed about your diagnosis. 

In addition to helping make day-to-day life with diabetes more manageable, research has found that a diabetes education program can lower your risk for diabetes-related health complications like kidney damage. 

Beyond providing relevant information about your diabetes diagnosis, a diabetes educator can help you make lifestyle changes to strengthen your health. They meet each of their clients where they are to develop an individualized diabetes management plan.

A diabetes education program is most effective when it addresses specific goals. The Association of Diabetes Care & Education Specialists (ADCES) has identified several key areas of diabetes care that a diabetes educator’s work can focus on, including the following:

Healthy, balanced eating is a big component of managing your diabetes, as carbohydrate intake is one of several factors that affect your blood sugar levels, along with physical activity and insulin. However, having diabetes doesn’t mean that you have to give up your favorite meals altogether. A diabetes educator can help you understand which foods to limit and guide you in meal planning to spread your carb intake throughout the day.

In addition to the overall health benefits of exercise, like strengthening heart function and lowering stress, physical activity helps individuals with type 1 or type 2 diabetes maintain a healthy weight and manage blood sugar levels.

It’s much easier to achieve your fitness goals when they are clearly defined, and your diabetes educator is here to help bring specificity to your exercise plan. Since the key to sticking with a fitness routine is choosing activities you actually enjoy, your diabetes educator will help you find a moderate-intensity workout that you can see yourself doing three or four days a week (swimming, jogging, brisk walking, and dancing are a few options.) Remember that it’s okay to take it slow when starting out and build your way up to more intensity.

Keeping track of your blood sugar levels is a critical part of your diabetes management plan, as the goal of insulin therapy is to keep your blood glucose levels in a healthy range. By regularly monitoring your blood sugar, you will be able to understand the effectiveness of your medications and determine if you need to make any changes. This can also offer insight into how diet and physical activity affect your blood sugar levels throughout the day.

In addition to helping you get comfortable with your blood sugar monitoring devices, a diabetes educator will help you find your preferred system for logging blood sugar levels, whether it’s an app like mySugr, Health2Sync, or Diabetes Connect, or a physical notebook. They can also work with you on understanding how additional factors like food intake, physical activity, and stress levels impact blood sugar.

There are a variety of available diabetes medications, and each person’s needs are different. Individuals with type 1 diabetes take insulin every day to maintain healthy blood sugar levels. Some individuals with type 2 diabetes take insulin as well, while others take oral or injectable medication to help their bodies use insulin more effectively. 

In addition, some people with diabetes also take blood pressure or cholesterol-lowering medications to lower their risk of diabetes-related complications. A diabetes educator can help you understand the purpose of these medications, walk you through insulin injections, and help you manage side effects.

It’s important to speak with your doctor before making any changes to your medication timing or dosages. Your diabetes educator can be a great resource in helping you determine if you need to discuss any potential medication adjustments with your doctor.

Diabetes affects you both physically and emotionally, and it’s important to take care of your mental health in addition to staying on track with medications and blood sugar monitoring. In fact, feeling emotionally balanced while living with diabetes will strengthen your physical well-being too, as too much stress may increase your blood glucose levels.

To help you find your preferred coping strategies, a diabetes educator will generally steer you away from unhealthy habits — drinking, smoking, and withdrawing from social connections — and guide you toward healthier ones like meditating, journaling, and building a support network. It also helps to go easy on yourself as you work towards fitness goals and celebrate small wins.

Insurance coverage for diabetes education programs

Diabetes education programs are covered by Medicare and most private health insurers. However, a formal referral from your doctor is often required to get coverage. In addition, your diabetes education program must meet certain standards set by the U.S. Department of Health.

The ADCES has a map to help you search for an accredited diabetes education program near you.

We’re here to support your diabetes care plan

Just like your diabetes educator and other members of your support team, Alto will be here to help you manage your diabetes diagnosis. In fact, many diabetes educators, who understand how important it is to have a reliable diabetes pharmacy partner, refer their patients to us.

"When I refer patients to Alto, it's one thing they don't have to worry about."

We make it simple to follow your diabetes treatment plan, with proper packaging of temperature-controlled medications and free same-day delivery right to your doorstep. We’ll also tackle any insurance-related legwork too to ensure that you get the medication and supplies you need at the best possible price.

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

Many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply.

What to Know About State-Funded PrEP-DAP Programs

Cost is often a barrier to starting PrEP, a medication that can lower your risk of sexual transmission of HIV by 99% when taken daily. Fortunately, the HIV prevention landscape is rapidly evolving, and PrEP is now more accessible than ever.

As of this January, most private insurance plans must cover PrEP for HIV prevention without charging any out-of-pocket costs. In addition, many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply for state-funded PrEP drug assistance programs — also referred to as PrEP-DAP or PrEP-AP programs —  in four of the states that Alto serves.

The State of California’s PrEP Assistance Program (PrEP-AP) helps cover PrEP-related medical expenses, with different benefits for individuals without insurance, those with private insurance, and those with Medicare.

You can receive Truvada®, one of the two FDA-approved PrEP medications, free of charge through Gilead’s Advancing Access® Program. California’s PrEP-AP will also provide financial assistance with all other medications on the PrEP-AP formulary for HIV prevention and treatment of sexually transmitted infections (STIs) and the following PrEP-related medical services:

To be eligible for the assistance, you must receive all PrEP-related medical services at approved locations within the California Department of Public Health’s Office of AIDS PrEP-AP Provider Network. Search for a California PrEP-AP provider or enrollment site near you. 

Gilead’s Co-Payment Assistance Program covers up to $7,200 of Truvada® copays per calendar year. Once you’ve met this threshold, California’s PrEP-AP will cover any remaining PrEP copays for the rest of the calendar year, in addition to assistance for out-of-pocket costs for PrEP-related medical services and all other medication on the PrEP-AP formulary for HIV prevention and STI treatment. To be eligible for assistance with PrEP-related medical services, you must see a provider in your insurance plan’s network.

If you have prescription medication coverage through Medicare, you are not eligible for financial assistance from Gilead, but California’s PrEP-AP offers financial assistance with copays for all medications on the PrEP-AP formulary including Truvada®.

If you do not have prescription medication coverage through Medicare, you are eligible to enroll in Gilead’s Patient Assistance Program and receive Truvada® free of charge. In addition, California’s PrEP-AP will provide assistance with all other medications on the PrEP-AP formulary.

Anyone who has outpatient coverage through Medicare is also eligible to receive assistance from California’s PrEP-AP for PrEP-related medical services. However, you must see a provider in your plan’s network.

To be eligible for California’s PrEP-AP, you must:

Have a negative HIV test dated within six months of the PrEP-AP application

Have an annual Modified Adjusted Gross Income (MAGI) that does not exceed 500% of the Federal Poverty Level based on family size and household income

Not be fully covered by Medi-Cal or other third party payers

Be enrolled in the manufacturer's assistance program, if eligible

Colorado’s Public Health Intervention Program (PHIP) helps cover PrEP expenses for anyone living in Colorado who has an income less than 500% of the Federal Poverty Level.

If you have insurance, you must apply for the Gilead copay card to receive the assistance. If you do not have insurance, you must apply for Gilead’s Advancing Access program and see an approved PHIP-PrEP medical provider.

You can apply online or by mail. You must provide the following documents:

Proof of income (one month's worth of paystubs, award letter, etc.)

Gilead Co-Pay Card, if you have insurance

PHIP is not eligible for those with Colorado Medicaid. However, if you have Colorado Medicaid, your PrEP costs should be covered at a $1-3 copay for both medication and related medical services.

The New York State Department of Health’s AIDS Institute has a PrEP assistance program for individuals without insurance. The program covers the cost of PrEP-related medical services including HIV testing, counseling, STI testing, and primary care services. The cost of PrEP itself will be covered through manufacturer-sponsored patient assistance programs, to which healthcare providers affiliated with the program can help you apply.

Eligibility is based on financial and medical need. Learn more about how to apply and search for a New York State PrEP-AP provider near you.

Washington State’s PrEP Drug Assistance Program (PrEP-DAP) provides financial assistance with  PrEP and related medical services.

The program covers the cost of Truvada®. The Washington Department of Public Health contracts with Ramsell Corp® to provide pharmacy benefits for program participants. You must use a pharmacy contracted with Ramsell for PrEP-DAP to receive the financial assistance (Alto is contracted with Ramsell).

In addition, Washington’s PrEP-DAP also covers many of the PrEP-related lab and medical services including baseline and monitoring tests for STIs, kidney function, and Hepatitis B. If you have insurance, the program covers your portion of insurance deductibles, copays, and coinsurance up to a certain limit. To confirm the current maximum amount of financial assistance for individuals with insurance, call 360-236-3412 or 877-376-9316 (toll free) or email PrEPDAP@doh.wa.gov.

If you do not have insurance, the program will cover all of the costs up to the maximum amount of covered services.

To be eligible for Washington’s PrEP-DAP, you must live in Washington State, test negative for HIV, and meet one of several defined risk factors, described in more detail here.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and Emtricitabine 200 mg/Tenofovir 300 mg (generic Truvada, which became available in October 2020). PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. It also reduces the risk of getting HIV from intravenous drug use by about 74%. Consult with a healthcare professional if you have any questions about whether PrEP is the right choice for you.

A negative HIV test is required before starting PrEP. Your doctor or pharmacist may also recommend additional tests to ensure that it’s safe for you to use PrEP. Initial baseline testing may include:

You will also have to visit a healthcare provider while taking PrEP for follow-up testing including:

Pregnancy testing and discussion of pregnancy plans every 3 months

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

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

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. We offer discrete, private packaging and free, same-day delivery along with in-app reminders to stay on track. And our pharmacists — who have deep expertise in many clinical areas, including HIV treatment and prevention — are directly available through phone or within the Alto app to answer any questions.

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

Why We Prioritize Diversity at Alto

The Alto team has been growing quickly, doubling in the last 6 months, and we are thinking a lot about the importance of diversity to building a world-class company. We are putting a lot of time and energy into making sure we build a diverse team and an inclusive culture, and one of the foundational discussions we’ve had is why diversity matters to us. Aside from the fundamental ethical reasons, having a diverse team is particularly important for us as a healthcare company because it allows us to to empathize with our patients, innovate on our product, and hire the best teammates who share our values.

I wrote an internal post codifying how we prioritize diversity, which we presented at an all-hands meeting, and subsequently in every new hire’s onboarding.

I’m sharing this publicly in hopes that it can help frame how other companies discuss the business case for diversity.

Most of any success I’ve had comes down to luck. My family prioritized education and had money to spend on it. I went to an elite prep school, then MIT, then had my first ever job at Facebook. Each step led to the next, with a lot of help along the way. In my time in Silicon Valley, I’ve seen the limits of my well-off, millennial, straight, white, male perspective. I’ve seen the ways that my type of privilege leads to the proliferation of companies building photo sharing apps and other tools that make life easier for the 1%. The massive changes in technology in the last decade have dramatically increased my quality of life, but those who don’t share my privilege have not seen nearly the benefit. Healthcare is clearly broken and hasn’t seen many improvements from improving technology, and many of those most affected by bad healthcare are also the most underserved by the tech industry. We founded Alto to use our backgrounds in tech and our skill sets to try to give some of the benefits of technology to those underserved by the current state of the healthcare industry.

I can have a hard time understanding the thoughts and feelings of our diverse patient base, given my life story and the fact that I’ve never had prescriptions. In the early days of Alto, we primarily dispensed birth control. We thought it was a good beachhead market of young, tech-savvy users, with a long lifetime of monthly refills. We discovered very quickly that birth control has a lot of different brands, some much more expensive than the generic equivalents. I assumed everyone would want the cheaper form, given that they have chemically identical active ingredients. Fortunately, though, some of our earliest teammates were women, and they helped me understand that when dealing with hormones, small differences can really affect how you feel. We then asked our patients about side effects they’d encountered switching to generics and found out how common these issues really were, and how frustrating it could be when the pharmacy tried to switch them to a generic. Now, we make sure to stock every brand of birth control.

In trying to empathize with our patients and my teammates here at Alto, I have seen firsthand the benefits of a diversity of backgrounds and perspectives. We realize that we are a company founded by millennial white males from relatively privileged backgrounds. This makes it even more pressing that we focus our energy on building a diverse team and inclusive culture.

Diversity means many different things to different people, so I think it’s important to define exactly what we mean here. What we’re really after is diversity of thought and skills applied towards a singular mission with unifying values. It’s not always easy to know whether someone has a different way of thinking about the world, so we often use proxies to accomplish this. By attempting to build a team with a broad representation of ability, age, education, gender, race, ethnicity, religion, sexual orientation, socio-economic status, and personality type, we can hopefully build a team that also brings a diversity of thought and experiences.

As a pharmacy, we have one of the most diverse user bases of any product. Almost everyone uses the pharmacy at some point in their life, and so the population of people that we serve is just as diverse as the entire population. We serve patients of every age, race, religion, gender, sexual orientation, ability, and socio-economic status. Having a diverse team allows us to understand and empathize with the people Alto serves. We are building the best pharmacy for everybody, everywhere.

One of our core values is “Patients come first,” and in order to truly embody that value, it is imperative that we have a diverse team. Whether we are designing a new feature to improve our fertility onboarding flow, or talking through a complex prior authorization with an elderly medicare patient who knows English only as a second language, having a diverse team helps us to put ourselves in our patients’ shoes and empathize with their challenges.

As a healthcare company, we are often interacting with patients when they are at their most vulnerable.

We have a responsibility to our patients, and the best way to serve them is to be sensitive to their needs and experiences.

Real innovation happens when you combine people from diverse backgrounds, with different skill sets, to solve a hard problem together. Research has shown over and over the positive effect of diversity on innovation (here, here), and diversity played a key role in many of the greatest inventions of all time. The transistor, a critical building block of the modern computer, was invented at Bell Labs in the 1940s, by a diverse group of scientists and engineers. According to Walter Isaacson,

“The lesson of Bell Labs is that most feats of sustained innovation cannot and do not occur in an iconic garage or the workshop of an ingenious inventor. They occur when people of diverse talents and mind-sets and expertise are brought together.”

Fixing the broken pharmacy industry is an extremely difficult challenge, and we will need a broad range of people, with different ways of thinking, to help solve it. An engineer can quickly write code to automate a tedious task that a pharmacist has to do everyday, like looking up patients to reach out to those who may want a consultation. A pharmacy technician can easily help a designer figure out what the right packaging looks like for fertility ancillary items. By building a team where people with different backgrounds, skill sets, and ways of thinking collaborate daily, eat lunch with each other, and form relationships, we enable more of these interactions, where teammates help solve each other’s problems from different perspectives.

We have hired many of the best people from the tech and healthcare industries, from many different backgrounds. We want to keep doing that.

Most A-players who share our values do not want to work on a team as the only member of a small minority. Neither do they want to work on a team of only people like themselves.

By recruiting a world-class, diverse team, we are in turn enabling ourselves to recruit more world-class, diverse people. It has a compounding effect.

Many of the most talented people who share our company values of empathy, humility, and putting patients first also enjoy working with teammates with different backgrounds and experiences. We enjoy learning from each other and being open minded, and believe that we learn things from each other that actually make us better at our jobs. We feel that a diverse team makes us happier and more productive, and that the best people who share our values feel this way too.

We are all working at Alto because we care about helping people and care about making the world a better place. It is well-known the tech industry has a massive problem with under-representation. Women are under-represented by a factor of 4, and Black and Latino minorities are under-represented by a factor of 2. Women leave tech at more than twice the rate men do, and women are under-represented in leadership positions in tech by a factor of 10.

A study by the Kapor Institute earlier this year found that the primary reason women and under-represented minorities leave their jobs was due to unfairness in the workplace. At Alto, we value fairness and equality as important moral foundations, and work to promote those values in the workplace. We find it sickening to read over and over again about sexual harassment, stereotyping, and unfair treatment in the tech industry, and we want to do something about it. By actively committing to diversity and inclusion at Alto, we hope to do our small part in helping to change the industry for the better.

This post is all about the “why” when thinking about diversity at Alto, and in the future we will be sharing more about what we are actually doing to make sure that we have a diverse team and inclusive culture. We’ve put a lot of work into diversity and inclusion so far, and made some great progress, but we understand there is always more we can do and this is a challenge that will never be “done.” This post is intended only to lay the foundation for taking initiative to improve diversity here at Alto. Without actual changes this is all just talk.

As a mission-driven healthcare company, there are clearly many important reasons why we care about diversity. It helps us empathize with our patients, innovate on our product, hire the best teammates, and change the tech industry for the better. We are growing quickly, so now is the time to double down on our commitment to having a diverse team. It is not something that happens on its own, and will take a lot of work from all of us to foster the inclusive environment in which a diverse team thrives, but we wholeheartedly believe it will be worth it.

The following are the most common reasons for a high copay.

Deciphering Your Copay — What Your Pharmacy Isn’t Telling You

You see your doctor and he or she writes you a new prescription, sending it electronically to your pharmacy of choice. You then receive a call from your pharmacy and the copay is much higher than you anticipated.

Your jaw drops. You find yourself thinking that something must be wrong with this calculation. How did your doctor think you could afford this drug?… Did the pharmacy apply your insurance correctly?… Is this for a whole year’s worth of medication?

If you find yourself in this situation, you are not alone.

There isn’t one simple answer to this question, but hopefully this article will help you understand the potential causes of a high copay and recognize which one might apply to you. The following are the most common reasons for a high copay:

If you notice your prescription drug costs escalate at the beginning of a new year, your deductible is the most likely culprit. With a deductible, patients will pay the majority of the cost of their medications out of pocket until a certain dollar amount has been reached. This amount varies significantly by plan and can range anywhere from the low hundreds to thousands. Once you hit this set amount, your typical copays will return and remain until the start of the next calendar year.

Copayment or drug coverage tiers are a way that insurance companies categorize drugs, and those from higher tiers will most likely cost you more than those from a lower tier. For instance, a brand name drug in Tier 3 will cost you more out of pocket than a generic alternative in Tier 1. Speciality drugs, or those prescribed as treatment for rare or serious medical conditions are commonly at the highest tier, and therefore, are also the most expensive. It is important to note that not all prescription insurance plans utilize tiers, and tiers differ immensely across various plans.

3. The drug requires a Prior Authorization

Oftentimes, insurance companies will reject claims for specialty, brand, or expensive medications without a Prior Authorization in place. A Prior Authorization, or PA, is an appeal process that, if accepted, will result in your Insurance covering a portion of your prescription costs. A PA may require your doctor to submit prerequisite therapy information and diagnosis, and ultimately, justify the reason he or she is requesting this treatment for you.

The important thing to note about PAs is that many drugs that require PAs are also more costly and specialized to begin with, which may affect your out of pocket cost even after it is approved by your insurance.

The following are the most common reasons for a high copay:

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