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Despite how widespread infertility is, affecting about 9% of U.S. men and 11% of U.S. women, the condition remains underdiscussed and misunderstood.

Information is critical to making the right decisions throughout your family building journey, but with so many misconceptions about fertility — and so much unsolicited advice — it can be difficult to know the best way forward. To help set the record straight, we’ve debunked several common myths about infertility.

Top Fertility Myths Debunked

Despite how widespread infertility is, affecting about 9% of U.S. men and 11% of U.S. women, the condition remains underdiscussed and misunderstood.

Information is critical to making the right decisions throughout your family building journey, but with so many misconceptions about fertility — and so much unsolicited advice — it can be difficult to know the best way forward. To help set the record straight, we’ve debunked several common myths about infertility.

Myth: Infertility is purely a female health issue

Infertility is often considered a women’s health issue, but in reality, only a third of all infertility cases are exclusively caused by female reproductive factors. Of the remaining two-thirds, half stem from only a male reproductive factor and half stem from a combination of male and female factors or unknown causes.

Male infertility is most often the result of issues with sperm production, including problems with sperm quality and quantity. Fertility treatment can help address both male and female fertility issues. In fact, one reason for the perception of infertility as purely a female health condition is that it is sometimes women who undergo assisted reproductive technology (ART) treatments such as in vitro fertilization (IVF) and intrauterine insemination (IUI) even for a male infertility factor. (Men can be treated for infertility with oral medications or injectable hormone therapy, but these treatments can take six months to a year or more whereas a typical IVF cycle is just two weeks.)

If you and your partner are experiencing challenges conceiving, you both may wish to consult with a doctor about a fertility evaluation to determine the best next steps. Experts recommend seeking an evaluation after six months of trying to conceive if the female partner is over 35 and after a year if the female partner is 35 or younger.

Read Male Infertility: Causes, Symptoms, and Treatment.

Myth: Age doesn’t affect male fertility

Many people are aware that women become less fertile as they age, with a significant decline in the quantity and quality of their eggs from the mid 30s until they eventually reach menopause. Male fertility also declines with age, typically beginning around 35-40. And though the changes men experience are less significant — men never stop producing sperm and may be able to conceive well into their 50s, 60s, or later — a male partner’s age can influence pregnancy rates and how long it takes to conceive.

The age-related decrease in male fertility often stems from changes in sperm quantity and quality. Sperm quantity refers to the amount of sperm produced, while quality refers to its movement, size, and shape. These characteristics are important factors in male fertility, as they affect sperm’s ability to reach and fertilize an egg.

Myth: You’re too young to experience fertility challenges

Given that age is a factor in both male and female infertility cases, it’s understandable to assume that you won’t have difficulty conceiving in your 20s or early 30s. However, infertility affects people of different ages. According to the American Society for Reproductive Medicine, 7% of women between the ages of 20-24 face infertility, as do 9% of women between the ages of 25-29.

Age-related changes in fertility can vary by individual. While fertility typically begins to decline around the ages of 30-35 for most women, it’s possible to enter premature menopause and experience these changes even earlier.

Beyond the variation in age-related fertility issues, there are some causes of infertility entirely unrelated to age, including:

A history of pelvic inflammatory disease, chlamydia, or gonorrhea — conditions that can lead to blocked fallopian tubes

Other health issues including a history of chronic illnesses or cancer of a reproductive organ

Lifestyle factors including smoking and substance use issues

Remember that no one is ever too young to pursue fertility testing, and you are your own best advocate.

Myth: Getting a regular monthly period means you won’t struggle with fertility

Yes, the majority of female infertility cases are caused by problems with ovulation — the release of a mature egg from the ovaries — and a regular period typically indicates that you are ovulating normally. However, there are other drivers of female infertility, and it is possible to struggle to conceive even with a regular menstrual cycle.

Here are some reasons why you might have difficulty conceiving despite getting a regular monthly period:

Structural issues with the uterus or cervix

Endometriosis, a condition in which tissue that should only grow in the uterus implants and grows elsewhere

Silent anovulation*, a condition in which a person does not ovulate despite getting a regular period

Fortunately, there is treatment for a wide range of fertility issues. A fertility evaluation is an important first step toward addressing your specific challenge.

*The majority of anovulation cases are characterized by an irregular period and therefore more easily recognizable, hence why those that include a regular period are referred to as silent cases.

Myth: Couples who naturally conceived previously won’t struggle with fertility in the future

Having an easy time getting pregnant once doesn’t necessarily indicate that you will have the same experience in the future. Infertility may develop at different stages of life, particularly when age is a contributing factor.

Secondary infertility occurs when individuals or couples who already have one or more children have difficulty conceiving again. It affects approximately 11% of U.S. couples and is caused by many of the same factors as primary infertility, or difficulty conceiving for the first time.

Regardless of whether you’ve been pregnant previously, don’t delay on seeking a fertility evaluation if you are struggling to conceive.

Myth: If you’re trying to conceive, just relax

It’s commonly assumed that stress makes it more difficult to get pregnant. While chronic stress may affect a person’s ability to conceive, it’s important to remember that infertility is a medical condition, and stress alone is unlikely to drive fertility struggles. In other words, try not to let your stress become a new source of stress.

That said, while healthy stress management isn’t a substitute for fertility treatment, staying mindful of your emotional and mental well-being can only make it easier to navigate the challenges of infertility.

A pharmacy partner for your fertility journey

Fertility treatment can be a challenging journey, but Alto is with you every step of the way. We offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

Interested in learning more about how Alto can support your treatment? Request a price quote online or reach out through secure 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.

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.

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A great pharmacy is so much more than a place where patients fill their prescriptions — it’s a partner in their care. The quality of a pharmacy is especially important for specialty medications, which typically include additional considerations like cost, storage requirements, administration, side effects, and more.

There’s no better judge of pharmacy care than the patients themselves. Alto is an industry leader with an NPS score of 85, positioning patients and caregivers to regard your medication in the highest possible light.

What to Consider When Choosing Your Limited Distribution Drug Partner

A great pharmacy is so much more than a place where patients fill their prescriptions — it’s a partner in their care. The quality of a pharmacy is especially important for specialty medications, which typically include additional considerations like cost, storage requirements, administration, side effects, and more.

There’s no better judge of pharmacy care than the patients themselves. Alto is an industry leader with an NPS score of 85, positioning patients and caregivers to regard your medication in the highest possible light.

Here’s what makes a great patient experience at a specialty pharmacy, and how Alto offers support for specialty medications at every step.

It can be time-consuming and stressful for a patient to get started with any type of medication, from getting that medication covered by insurance to searching for savings opportunities. With limited distribution drugs in particular, there are usually many steps between getting a prescription from a provider and actually beginning treatment, as these medications often require a prior authorization for insurance coverage. And since they are typically more expensive, thorough research into medication cost savings is essential from the standpoint of both a patient’s physical and financial wellness.

Your specialty pharmacy partner should offer the support patients need to access their medications as quickly and affordably as possible. Alto supports the prior authorization process, keeping both patients and providers informed at every step. And with Alto Connect — our free pharmacy communications portal for providers — it’s fast and easy for clinical teams to collaborate with our team on administrative work as needed.

We also conduct price investigations to help patients save on each prescription through manufacturer coupons, assistance programs, and other resources.

Once a medication has been approved by insurance, there shouldn’t be any additional barriers to receiving it. Not only should it be as simple as possible to fill a prescription and place a delivery, patients should be able to trust that their medication will arrive on time, and in the right condition.

Alto’s easy patient onboarding experience features proactive multichannel communication. We send patients a welcome text within 60 minutes of receiving their prescription to help them schedule their first delivery. (Those with a landline will get a call.) And our team is available to answer any questions via in-app messaging or phone.

Our same-day delivery service allows for quick and easy medication access seven days a week, and in-house couriers guarantee reliability and quality. We also offer a free medication bundling service, so those who take multiple medications have the convenience of one easy delivery. And patients are never left wondering where their medication is — the Alto app offers simple and accurate delivery tracking.

Additionally, we use special packaging to ensure that temperature-controlled medications are always stored appropriately before they reach a patient, with clear instructions about safe storage at home. Those who wish to pick up their medication can always visit our pharmacy in person.

Ongoing support with care and patient education is extremely important with specialty medications and limited distribution drugs, which typically require patients to make an ongoing commitment to their health and wellness. Treatment often includes routine testing, clinical monitoring, and side effect management to ensure proper drug utilization and maximize adherence.

So that patients can follow their treatment plan as directed by their doctor, your specialty pharmacy should have robust clinical expertise in specific conditions. It should also have a high-touch model that makes it as easy as possible for patients to benefit from that expertise.

At Alto, patient education and care isn’t a nice-to-have — it’s a must. To ensure that our pharmacists can actively participate in patient health journeys, we have a team of medication therapy management pharmacists who focus entirely on disease state education and support for chronic conditions.

These pharmacists regularly contact patients who take multiple medications or specialty medications to review their regimen by phone. During these calls, our pharmacists ensure that patients understand the purpose of each medication they’re taking and are staying on track with necessary testing.

Coupled with medication management tools like auto refills and medication bundling, our disease state education keeps patients coming back to Alto month after month, improving adherence for the long term.

Choose Alto Pharmacy for your limited distribution network

Alto’s end-to-end dispensing model is specifically built for specialty and specialty lite products. To learn more about partnering with us, reach out to partnerships@alto.com.

Generic medications, which can cost an average of 80-85% less than their brand-name counterparts, have made treatment more accessible for many, improving medication adherence and health outcomes. They currently account for 90% of all prescription medications dispensed in the United States.

Frequently Asked Questions About Generic Medications

Despite the extensive use and effectiveness of generic medications, they are often a source of confusion. To help demystify how these medications work — and how they differ from branded options — we’ve compiled answers to commonly asked questions.

A generic medication has the same active-ingredient formula — and the same therapeutic benefits — as an already marketed brand-name equivalent, typically for a much lower cost. It can be considered an equal substitute for its branded version.

There are generic options for both over-the-counter and prescription medications. For example, ibuprofen is the generic name for Advil® and Motrin®, and acetaminophen is the generic name for Tylenol®. 

Are there any differences between generic and brand-name medications?

In order to become available for use, a generic medication must undergo a rigorous approval process from the U.S. Food and Drug Administration (FDA). Generic medication manufacturers must demonstrate that their product is equivalent to the brand version in several key ways:

It contains the same active ingredient — the substance in a medication formula directly responsible for that medication’s clinical benefits

It has the same strength, dosage form, and administration method

Given these similarities, a generic will not produce different side effects than its branded counterpart.   

A generic medication can differ from its brand-name counterpart in ways that do not affect its safety or effectiveness. This includes differences in appearance, such as shape, size, and color, as well as inactive ingredients, like binding materials, dyes, and preservatives. In fact, given trademark and branding laws, a generic has to look at least slightly different from the branded option.

If a generic has been approved, the FDA has determined its inactive ingredients are safe. However, there is the possibility that you are sensitive or allergic to an inactive ingredient contained in one version but not the other. 

Why do generic medications cost less than brand-name medications?

A common misconception about generic versions of medication is that their lower cost means that they don’t meet the same standards as their brand-name equivalents. There are two main reasons why generic medications are more affordable, and they have nothing to do with quality.

The cost of developing a new medication and then bringing it to market is very high. Manufacturers of an original brand-name medication have to spend millions of dollars on clinical trials and marketing. Companies making generics don’t have to go through the same process and can charge much less for their medications as a result.

Secondly, generics create marketplace competition, further driving down medication costs. This is especially true when multiple generic options have entered the market.

Does every brand-name medication have a generic equivalent?

No. A generic medication cannot be produced until the patent on the original brand-name option expires. The current term of a medication patent is 20 years. Periods of market exclusivity and the testing and approval process also factor into the timeline for developing a generic.

To find out if there is a generic option for your medication, check with your pharmacist or search the FDA’s catalog of approved medications.

Will my insurance cover both versions of a medication?

Insurance coverage varies by plan, but in general, many companies offer better coverage of generic medications due to their lower cost. Some plans don’t cover branded options unless there is no generic equivalent. Always verify the details of your insurance coverage before filling a prescription.

Can a pharmacist substitute a generic for a brand-name medication?

In most states, pharmacists are allowed to automatically substitute a generic for a brand-name medication when filling your prescription unless your doctor has instructed them not to.

There are some exceptions, however. Some medications have a narrow therapeutic window, which means that they require careful dosing and often frequent monitoring. (They may be referred to as narrow therapeutic index (NTI) drugs.) Some people are more sensitive to the differences between generic and brand-name NTIs than others. For this reason, a pharmacist will often consult with a provider before making a substitution for one of these medications.

If I started taking a brand-name medication, can I switch to the generic version?

Generally speaking, yes — since generics are bioequivalent to their branded counterparts, with the same safety, quality, and effectiveness, you can easily switch between versions. However, NTIs may require additional consideration. Your provider or pharmacist can help clarify any questions or concerns you may have about switching to a generic.

Questions about generic medications? Ask away!

As your pharmacy partner, we’re here to give you all the information you need to feel confident taking your medication. If you have questions about generic options, side effects, or anything else related to your treatment, reach out through in-app messaging.

Generic medications, which can cost an average of 80-85% less than their brand-name counterparts, have made treatment more accessible for many, improving medication adherence and health outcomes. They currently account for 90% of all prescription medications dispensed in the United States.

Despite the extensive use and effectiveness of generic medications, they are often a source of confusion. To help demystify how these medications work — and how they differ from branded options — we’ve compiled answers to commonly asked questions.

Fertility treatments such as in vitro fertilization (IVF) typically include injectable medications. If you’re anxious about self-administering your injections, you’re not alone. Nerves are common, especially the first few times.

Knowing what to expect often makes the process easier to navigate. To help you feel confident in following your treatment plan, we’ve compiled important information about the two types of injections commonly used during a cycle: subcutaneous and intramuscular injections. Here’s what to know.

The Difference Between Intramuscular and Subcutaneous Injections During IVF

Fertility treatments such as in vitro fertilization (IVF) typically include injectable medications. If you’re anxious about self-administering your injections, you’re not alone. Nerves are common, especially the first few times.

Knowing what to expect often makes the process easier to navigate. To help you feel confident in following your treatment plan, we’ve compiled important information about the two types of injections commonly used during a cycle: subcutaneous and intramuscular injections. Here’s what to know.

The majority of fertility medications are administered as subcutaneous injections. In this technique, a medication is injected into a layer of tissue between your skin and muscle.

Subcutaneous injections differ from intramuscular injections in several key ways:

Injection site: The most common subcutaneous injection site for fertility medication is in the lower abdomen, at least one to two inches away from your navel. The front of your thigh is another potential option. In both cases, the medication can be easily injected into the fatty tissue beneath the skin without the risk of being injected into the muscle.

Injection supplies: The needle used for subcutaneous injections is shorter and thinner than the one used for an intramuscular injection. Needle thickness ranges from 27 gauge to 31 gauge. (Thickness is inversely related to the size of the gauge, so a smaller gauge corresponds to a thicker needle and a larger gauge corresponds to a thinner needle.) The length can range from 0.3” to 0.5”.

In addition to fertility medications, these medications are also administered as subcutaneous injections:

How to administer a subcutaneous injection

1. Clean the injection site with an alcohol pad and allow the area to air dry.

2. Use your non-dominant hand to grasp a one to two-inch fold of skin between your thumb and index finger at the injection site.

3. Hold the syringe in your dominant hand like a pencil, and insert the entire length of the needle into the pinched skin at a 90-degree angle. You can insert the needle at a 45-degree angle if you have less fat on your body.

4. Push on the plunger in a slow and steady motion until all of the medication is injected. When done, release the pinched skin and gently withdraw the needle.

5. Discard the used needle and syringe into your sharps container.

You may see a small drop of liquid come out of the injection site. This is normal and not cause for concern. You can wipe it with gauze or a tissue if necessary.

Your fertility medication protocol may include intramuscular injections, which deliver a medication into your muscle. This technique is also commonly used for many vaccines.

Progesterone, a “transfer medication” that supports successful embryo implantation in IVF, is a good example of a fertility medication commonly administered as an intramuscular injection, though there are other progesterone formulations that can be used vaginally or orally.

Intramuscular injections differ from subcutaneous injections in several key ways:

Injection site: In this technique, a medication is injected deep into a muscle. The upper, outer part of the buttocks is the most common intramuscular injection site for fertility medications. (This can be difficult to reach when self-injecting — we have tips below to help!)

Injection supplies: The needle used for intramuscular injections is longer and thicker than the one used for a subcutaneous injection. Needle thickness ranges from 18 gauge to 25 gauge. (Thickness is inversely related to the size of the gauge, so a smaller gauge corresponds to a thicker needle and a larger gauge corresponds to a thinner needle.) The length can range from 1” to 2” depending on your body mass index (BMI).

In addition to fertility medications and vaccines, these medications are also administered as intramuscular injections:

Some hormones, including testosterone and contraceptive hormones

How to administer an intramuscular injection

2. Hold the syringe in your dominant hand between your thumb and fingers, as if you were holding a pen.

3. Firmly stretch the skin at the injection site with your thumb and index finger on your non-dominant hand.

4. Insert the entire length of the needle into the stretched skin at a 90-degree angle with one swift motion, similar to a dart.

5. Stabilize the syringe with your free hand and pull back slightly on the plunger. If you see blood return, do not inject the medication and withdraw the needle. Remove the needle and change to a new one. Repeat the injection process at another injection site.

6. If there is no blood return, the needle is inserted properly and you can slowly inject the medication.

7. Push on the plunger in a slow and steady motion until all of the medication is injected. When done, quickly withdraw the needle and dispose of the used needle and syringe into the sharps container.

8. Apply pressure to the injection site with gauze or a tissue. You may see some light bleeding.

9. Gently massage the skin afterwards to reduce discomfort and help your body absorb the medication.

Injection site reactions are one of the most common side effects during IVF, and you should expect to experience some soreness, redness, or bruising at the site of injection. This reaction will typically resolve itself within a few days.

If you are self-administering an intramuscular injection, ice the skin beforehand to keep soreness and bruising to a minimum. Massaging the area afterwards can help reduce soreness. For medications injected daily, such as progesterone, using a light heating pad after the injection can also alleviate discomfort.

Icing is not necessary for subcutaneous injections.

Intramuscular injections are typically administered in the upper, outer part of the buttocks. Since this can be difficult to reach, consider asking for assistance from your partner, a friend, or a family member. If you need to self-inject, try standing in front of a mirror for a better view of the injection site. You can also ask a nurse or another clinic staff member to circle the injection site on your body so that you can find it more easily.

With both injection techniques, it is best practice to rotate the injection site.

Want personalized injection guides at your fingertips?

Alto is more than just a pharmacy — we’re a partner in your fertility journey, and we offer a variety of resources to ensure that you’re never alone in navigating treatment.

In our injection guide videos, experienced pharmacists from our fertility team walk you through the entire process, from preparation to proper injection technique and safe sharps disposal. And you won’t have to sift through dozens of videos: as an Alto customer, you have your own unique playlist in the app, with videos for your specific medications.

Interested in learning more about how Alto can support your treatment? Request a price quote online or reach out through in-app messaging.

Learn more about national medication shortages affecting people and pharmacist everywhere, what causes shortages, steps you can take if you are affected, and other frequently asked questions. Read on.

Medication Shortages, Explained | Alto Pharmacy

Few things are more frustrating — or frightening — than being unable to access the medication your doctor has prescribed. But it has become a common experience in recent years, as medication shortages remain a persistent healthcare challenge in the U.S. And if you take medication, you may be familiar with the panic of struggling to find enough of what you need.

Not only are these shortages incredibly frustrating and debilitating, they are also confusing and unpredictable, arising seemingly at random, and with little known about an anticipated resolution.

While Alto will always go above and beyond to bring you your medications without delay, these shortages are beyond our control, and we share your frustrations and concerns. To provide more clarity and context as to why these shortages occur — and why, unfortunately, there are few short-term solutions — we’ve compiled answers to some of the questions we hear most frequently.

Like every pharmacy across the country — as well as many around the world — Alto has been affected by medication shortages in the last few years. Each pharmacy’s stock fluctuates in tandem with demand, so if you call multiple pharmacies, it’s possible that one will have a greater supply of an affected medication than another on any given day. But ultimately, no pharmacy is immune to these challenges, and if a medication is in short supply, each pharmacy may feel the impact at some point.

If Alto currently does not carry your medication and you would like to transfer your prescription to another pharmacy, be sure to call that new pharmacy to confirm availability of your medication — medication shortages often impact most pharmacies within a specific region. 

The causes of medication shortages are complex, with multiple, and often intersecting, factors at play.

Any issues that affect the production of a medication may lead to reduced supply. This includes disruptions to manufacturing, like when Hurricane Maria damaged production sites in Puerto Rico in 2017.

Covid is another example of how a natural disaster or global crisis can disrupt medication production. The United States relies heavily on other countries for the raw ingredients needed to manufacture a medication.* This leaves us incredibly vulnerable to changes in workforce capacity or manufacturing activities overseas.

*As of 2019, only 28% of our country’s supply of active pharmaceutical ingredients (APIs) — the substances directly responsible for a medication’s therapeutic benefits — were manufactured domestically.

Even when manufacturing circumstances are ideal, rising demand for a medication can lead to low supply. This winter’s difficult cold and flu season, with high cases of Covid, the flu, and R.S.V., contributed to a decreased supply of children’s formulations of ibuprofen, acetaminophen, and several commonly prescribed antibiotics.

Adderall®, a stimulant used to treat attention-deficit/hyperactivity disorder, is another medication whose demand has increased in recent years. Prescriptions for the medication increased by 15.1% in 2020, in comparison to a 7.4% increase in 2019. This comes after a surge in new ADHD diagnoses, which more than doubled between 2007 and 2016 and continue to rise. Worker shortages and production delays experienced by Teva, a leading manufacturer of Adderall, have added additional pressure and compounded the challenges.

High demand has also contributed to recent shortages of the diabetes medications Ozempic® and Wegovy®,  as they have been increasingly prescribed for weight loss.

Addressing increased demand is often easier said than done. Most generic manufacturers decide how much of a medication to produce at the beginning of the year, with virtually no flexibility, so it isn’t an option to simply make more. This is why there is often a seasonal pattern to shortages, with many intensifying at the end of the year.

In the case of Adderall, a Schedule II controlled substance, the Drug Enforcement Administration (DEA) imposes strict production quotas to prevent misuse. With quotas based on estimates, our manufacturing system isn't prepared to respond to unexpected factors like the recent rise in ADHD diagnoses. 

Why are shortages happening more frequently?

Medication shortages are in the headlines more these days, but they are not a new occurrence. They have steadily increased since 2006, becoming a public health crisis in more recent years. The American Society of Health-System Pharmacists (ASHP) reports that, at the end of 2022, ongoing and active shortages were the highest they’ve been since 2014.

The growing intensity of these shortages reflects the strain that Covid put on our entire healthcare system — which we still haven’t fully recovered from — along with other unpredictable healthcare patterns, like growing demand for ADHD medications.

Are certain medications more likely to be affected than others?

Ultimately, any medication can go into shortage, but some types are more prone to recurring supply chain issues.

Medication shortages frequently occur with commonly used (and low-profit) generic medications — like the antibiotic amoxicillin — as pharmaceutical companies have little financial incentive to produce more of them.

Some injectable generics are especially vulnerable to shortages. Fewer manufacturers make these medications, so any production disruption can become a larger issue.

The Adderall shortage illustrates that low stock of a single medication can create a class-wide issue. For many people with ADHD, switching to another medication has proven challenging, as alternatives grow scarce too. This is also the case with Ozempic and other diabetes medications.

Medication shortages are rooted in factors that are far beyond any one person’s control, and unfortunately, there is little we can do to prevent them. Industry experts have proposed solutions, including ramping up domestic production of key pharmaceutical ingredients and building a more resilient medical supply chain. These aren’t quick fixes, and government action is needed for meaningful progress.

What can I do to navigate a medication shortage?

While many medication shortages are unavoidable, there are steps you can take to potentially minimize their stress and impact.

You can track medication shortages on the U.S. Food & Drug Administration or ASHP websites to learn more about a medication’s supply.

To give yourself more time to figure out a short-term solution — such as switching to an alternative medication — refill your medication as far in advance as you can. In some cases, it may be possible to get a 90-day supply of your medication, though this isn’t always an option for controlled substances, and your insurance plan may also limit coverage of refills.

If your medication is in scarce supply, speak with your doctor about alternatives. In addition to taking a different medication, you may be able to switch to a different dose or formulation. Many medications require that you safely taper off of them, which is another reason it’s important to stay on top of refills and ideally learn about supply issues before the last minute.

If an alternative medication costs more or is not covered by your insurance plan, there are resources to help alleviate some of the burden, including coupons, manufacturer-sponsored copay cards, and patient assistance programs. Alto is here to support your savings investigations, and we also suggest reaching out to your insurance provider and verifying your plan’s details — they may be required to cover a branded option if a generic is unavailable.

Our team can answer any questions you have about your medications. We also offer same-day delivery and medication management tools like reminders and auto refills to make it as simple as possible to stay on track with treatment.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

Learn more about national medication shortages affecting people and pharmacist everywhere, what causes shortages, steps you can take if you are affected, and other frequently asked questions.

The time to prepare for seasonal allergies is earlier than you might expect, as taking medications before everything is in bloom can help significantly to control symptoms. This year, you may want to consider ramping up your prevention efforts even earlier than usual: one consequence of climate change and rising temperatures worldwide is a longer growing season and higher levels of pollen in the air.

Why It’s Never Too Early to Prepare for Seasonal Allergies

The commonly used over-the-counter (OTC) medications below can help make allergy season more manageable — and many are available for purchase at the Essentials Store in our app! To browse the selection, tap the "Store" icon along the bottom of the Alto mobile app or the "Store" icon in your account on desktop.

Over-the-counter allergy medications to take preventatively

Nasal corticosteroid sprays prevent inflammation to reduce allergy symptoms such as stuffiness, sneezing, and a runny nose. Common OTC options include:

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