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For Black History Month, we’re recognizing pivotal Black leaders in healthcare who’ve paved the way forward for our country and the Black community.

Services that reduce travel and encourage social distancing are now more essential than ever, not only for vulnerable populations but all of us as members of our communities. Alto’s free same-day doorstep delivery ensures you have safe and reliable access to medications in this time of uncertainty. 

Hear first-hand from members of the Alto technology teams.

Alto / Blog

Continuous glucose monitoring (CGM) devices are designed to make diabetes treatment less burdensome. Here’s how it works, who it benefits most, and how you can go about getting a CGM device for yourself. 

Using Your Continuous Glucose Monitoring Device

Diabetes is known as a silent disease because it often advances gradually and nearly imperceptively. Without treatment, diabetes causes abnormally elevated blood sugar levels, a condition that can eventually have life-threatening consequences. The problem is that the signs and symptoms of high blood sugar are often so subtle that they fly completely under the radar. 

For a more in-depth explanation, read, “What’s the Difference between Type 1 and Type 2 Diabetes?”

The Little Device Providing Round-the-Clock Diabetes Care 

To slow the disease’s progression and minimize serious complications, most people with type 1 and type 2 diabetes must use a device to monitor their blood glucose levels regularly. If their blood sugar is too high or too low, medications or lifestyle interventions must be used to keep it within a safe range. People with diabetes can live long and healthy lives by keeping their blood sugar in check. However, it’s not always easy for those with more advanced conditions who may need to test their blood sugar multiple times a day. 

Continuous glucose monitoring (CGM) devices are designed to make diabetes treatment less burdensome on people who require frequent glucose testing or who are on intensive insulin therapy with tight blood sugar control. Here’s how it works, who it benefits most, and how you can go about getting a CGM device for yourself. 

Before CGM, self-monitoring of blood glucose involved using a traditional blood glucose meter (BGM), which provides a single reading by pricking a finger for a sample of blood. CGM devices, on the other hand, collect glucose readings every five minutes throughout the day via a sensor worn on the body with a tiny wire that is inserted under the skin. Rather than testing blood, it measures the amount of glucose present in the fluid between cells, known as interstitial fluid. 

There are several types of CGM devices approved by the FDA for use in the United States. Generally, they consist of a subcutaneous sensor with an attached transmitter, which sends wireless data to a receiver, such as a monitor or mobile app. By taking approximately 288 readings per day, CGM devices can reveal patterns not easily captured by a single finger prick. 

CGM devices also use past data to predict dips or spikes in blood sugar and alert a wearer to take corrective steps. Data is recorded over time, allowing both the wearer and their healthcare providers to monitor blood glucose fluctuations and identify patterns that can help them make better decisions about nutrition, medications, and other lifestyle factors. 

While CGM can have significant advantages for people with both type 1 and type 2 diabetes, it isn’t the right choice for everyone. The devices can be costly and aren’t always covered by insurance. 

However, CGM can be a gamechanger for those who need to test their blood sugar frequently throughout the day. Not only will they avoid the discomfort of multiple finger pricks, but they may also find that the supplies needed for a traditional BGM are actually more costly than a CGM device over time.

It’s important to note that using a CGM device does not mean that you will no longer need to prick your finger at all. Some models may need to be calibrated using a traditional fingerstick glucose meter to ensure accuracy while getting used to the new device.

If you are curious about using a CGM device, your doctor can help you weigh the pros and cons and decide whether it’s the right choice for you. Should you choose to move forward with CGM, your doctor will need to prescribe one of the several FDA-approved devices available.

Once you’ve received your CGM device, you’ll need to insert the sensor just beneath your skin using the provided applicator. Typically, sensors are placed in the abdomen or upper arm. You should be sure to cleanse the insertion area with soap and water or alcohol first and carefully follow the instructions provided with your device. The applicators are designed to make the whole process quick and simple. 

The sensor will remain in place for several days before it needs to be replaced. The exact duration will depend on your model. Recently, a new type of sensor was developed that must be inserted by your healthcare provider but can remain in place for ninety days. Talk with your doctor about which option is best for you. 

If you are using a receiver, you will need to keep it within five to eight feet of the sensor. As long as it remains within range, the sensor will transmit data to the receiver throughout the day and night, usually every five minutes.  Some devices use Bluetooth or cloud-based technology to send glucose readings directly to compatible smartphones or tablets, eliminating the need for a separate receiver.

An alarm will sound if your glucose level goes above or below the target range you’ve set. The monitor or mobile app will also display a line graph showing how your glucose level has changed over the past several hours. 

Your CGM device can also predict future glucose levels based on past data. Arrows on the screen will indicate which direction your glucose level is heading. Over time, this real-time flow of information can help you become more aware of how diabetes affects your body. For example, you might discover that your glucose levels fluctuate after eating certain foods or engaging in strenuous exercise. In addition, your healthcare provider can also use the data to adjust your insulin dosing and optimize your overall diabetes regimen. 

With all this information may come confusion at first. You should expect a bit of a learning curve as you get used to CGM. Alto’s care team and pharmacists are always an easy text message, in-app chat, or phone call away should you have any questions as you learn the ins and outs of your device. In no time at all, you’ll find yourself switching out sensors and analyzing trends with ease. 

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.

We were honored to sit down with Dr. Hildreth to discuss the challenges and opportunities we are facing at this pivotal moment in history. In addition to recounting his inspiring personal story, he shared many profound insights about the COVID-19 pandemic and the state of American healthcare. 

The COVID-19 Vaccine & Racial Disparities in Healthcare: A Q&A with Dr. James Hildreth

In August, we announced that Dr. James Hildreth had joined our newly formed Advisory Board as one of its first two anchor members. Dr. Hildreth’s extensive healthcare expertise has been invaluable as we’ve sought to guide Alto into the future and continue reimagining the pharmacy experience. 

A Fascinating Chat with Dr. James Hildreth

Dr. Hildreth is the President and Chief Executive Officer of Meharry Medical College—one of the nation’s oldest and largest historically Black academic health sciences centers. He is internationally renowned for his decades of influential HIV research and is deeply entrenched in our current global health challenge as a member of the FDA’s COVID-19 Vaccine Review Committee.

Can you tell us about your background and professional journey?

I grew up in a small town in Arkansas. It was one of those towns where if the two traffic signals were synchronized, you could drive right through and not even notice it. My father passed away when I was eleven years old. Quite honestly, because we were poor and Black, my father received very little medical attention. That was what prompted me to become interested in medicine.

I had no role models to look to, so I went to the library and read books about medicine. At age thirteen, I read a series of books that ranked your chances of getting into various medical schools. One of the universities was head and shoulders above all the rest, so my life’s work became getting into Harvard University.

To make a long story short, I got scholarships to Harvard, Princeton, Brown, Yale, Stanford, and many other places. But because my research had shown that Harvard was the place to go, that’s where I went. I got a job at the medical school, and the professor who ran the lab was also from Arkansas. He took me under his wing, and suddenly I wanted to be an immunologist. 

It was too late to change my major, but I was hooked. I applied for and was awarded a Rhodes scholarship in 1978, becoming the first Rhodes scholar from Arkansas who was Black. I got my Ph.D. in Immunology then went to Johns Hopkins School of Medicine. 

I planned to become a transplant surgeon until I met my very first patient. She was an African American woman with HIV who had just given birth to a baby who also tested positive. At the time, all we could do was watch them die, and that impacted me deeply enough to change my trajectory. I became an HIV researcher, and I have been studying HIV for the last thirty-eight years. 

I have been President of Meharry Medical College for five years. I feel that my life has come full circle because Meharry’s mission is to give opportunities to individuals who otherwise wouldn’t have them. 

Can you tell us more about Meharry’s mission?

Meharry was founded in 1876, but the story is that in 1826, a young, white teenage boy named Samuel Meharry was driving his salt wagon in the backwoods of Tennessee. His wagon got stuck in the mud, so he knocked on the door of a nearby cabin. An African American family greeted him, gave him a place to stay for the night, and helped him on his way. He promised them that if he ever had any resources, he would do something for Black people. 

Sure enough, fifty years later, he and his four brothers made a gift to a central Tennessee college to start a medical department for African Americans. That department evolved into Meharry Medical College.

To be leading an organization whose purpose is to give opportunities to people who look like me makes me feel that my life has come full circle. Meharry is one of four Black medical schools in the country, and without us, the face of medicine in this country would look very different. We are very proud of our mission and I’m so happy to be leading the organization at this time. 

Given that you’re on the FDA’s Vaccine Review Committee for COVID-19, what is your perspective on how we’ve handled the pandemic to date?

It’s hard to avoid acknowledging how politics have devastated our response to this pandemic. Viruses don’t respect borders, especially when you’re dealing with a pandemic virus. We should have had a nationwide response from the very beginning. Ideally, the whole country should have shut down for several weeks. That would have saved tens of thousands of lives.

What are your thoughts on how the pandemic might unfold going forward?

In my opinion, we’re entering a frightening period because we’re at the base of an exponential rise in cases. It’s essential to understand that for every case we diagnose, there are probably four, if not eight, cases that go undiagnosed. Many people don’t know they have the virus and are spreading it. 

Our country represents four percent of the global population but twenty percent of the people who are dying. That’s unimaginable to me. When you’re dealing with an airborne pathogen that can be transmitted so easily, it is unacceptable and unethical not to have stronger leadership and mandates in place. 

Can you share any insights on potential vaccines and vaccine distribution?

I’m on the FDA committee that will review the data from the drug companies and make recommendations about approval. In a couple of weeks, we will review the Pfizer vaccine. I can tell you that the data from both Moderna and Pfizer are very compelling. Both vaccines appear to be highly effective.

Neither of these vaccines is what we’d call a “sterilizing vaccine,” They will not prevent a person from getting infected, but they will limit the amount of disease that occurs after infection. The other exciting aspect of these vaccines is that they represent a new type: messenger RNA vaccines. Rather than using a protein for the vaccine, we’re using a message that encodes for the protein. There was some doubt if this new type of vaccine would work in humans, but it does. This development will facilitate future vaccines quite nicely. 

By the spring of next year, there will likely be two vaccines approved for use. The question is: who will get those first forty million doses that become available? Healthcare workers will probably get them first, then people in nursing homes and assisted living facilities. Many experts, myself included, are trying to make the case that those most vulnerable to disease and death should be next in line. The CDC has already worked with the states to develop distribution plans, but they are not in line with that thinking. There are going to be a lot of intense discussions in the coming weeks. 

What are the healthcare topics that get you most excited—or keep you up at night—right now?

The pandemic has revealed something that minority healthcare professionals have known for a long time: there is a wide gap in the health status of Americans. If you are African American or Latinx and live in certain communities, you are much more likely to have certain chronic conditions. This increased risk is related to your zip code, educational attainment, where you work, and what your job might be, but running through all of this is an underlying current of racism. 

We can’t solve the problem until this country has a necessary conversation about the role of racism in every domain of American life. I like the way that Martin Luther King put it. He said that when you have centuries of neglect, suppression, oppression, or denial, there is an interest that accumulates. The answers to these problems are going to be much more expensive and time-consuming than if we had been dealing with them all along. 

No matter what industry we’re in, all of us need to have tough conversations about what race really means. Take, for example, the sequencing of human genomes. African genomes are the ancestral genomes—all of us can link our humanism back to Africa. But of all the hundreds and thousands of genomes that have been sequenced, very few of them come from folks who look like me. 

It’s the same as my experience in medical school in the 1980s. We learned to treat the average, middle-aged white male because that’s who the studies were centered on. The exclusion of certain groups from clinical trials, programs, and conversations has created a wide gap that we now have to close. We need to have every healthcare institution at the table trying to work on it.

On a positive note, as the pandemic reveals these disparities, many organizations are awakening to the fact that there is work to be done. I’m encouraged by what happened after we witnessed the senseless murder of George Floyd. It was a really painful time for me because that could have been me, my son, or my brother. It could have been any one of us. But the response that we witnessed wasn’t just from African Americans and liberals. It seemed to me that people of all different backgrounds and races came together to say that this is unacceptable. It gave me some hope that we can change this and become a better nation.

What opportunities do you see for Alto in the world of healthcare?

I think Alto has a great opportunity to improve people’s quality of life who need to take medications to improve their health status. Before she passed, my mother would complain about how difficult it was to get her prescription medications. The ability to simplify and improve the process for everyone will positively impact a significant population of people. 

I was humbled that you asked me to be in your advisory group. I’m excited about what you’re doing, and I think it’s going to make a big difference for many people. 

As we approach the holidays, I’d like to share something I’ve told my students. The last thing you want to do is create a situation where this is the last holiday you’ll spend with some of your older relatives. Please be mindful that there is a lot of the virus out there, wherever you are in the United States. Please take steps to protect yourselves and your families. Have a wonderful holiday, but if you can, make it virtual.

Note: This interview was conducted in early December 2020. 

This October, a generic version of Truvada became available in the United States for the first time. In this article we'll explain what these means for PrEP users and how Alto can help.

An HIV Prevention Milestone: Truvada Goes Generic

The world of HIV prevention medications is still relatively new. In 2004, Truvada roared onto the scene and drastically changed the future of HIV. While the medication was initially used to treat HIV, in 2012 the FDA approved its use as a form of pre-exposure prophylaxis (PrEP), a daily prescription medication that prevents HIV infection.

When taken as prescribed, Truvada is 99% effective at preventing sexually transmitted HIV infection. It has been shown to potentially cause decreased kidney function and a small amount of bone loss in some individuals. Though studies indicate these side effects are slight, they present a barrier for people with pre-existing renal and bone density issues. Descovy, an updated form of PrEP, was introduced last year with research showing kidney and bone safety improvements over Truvada. 

Truvada and Descovy are both patented and manufactured by Gilead Sciences. Both are considered highly effective, safe, and well-tolerated by most PrEP users. While Descovy is less likely to cause unfavorable changes in kidney and bone blood tests, Truvada has been shown to have a more favorable impact on blood fat levels and lead to less weight gain. The FDA has not yet approved Descovy for cisgender women or transgender men—more studies are still needed. Those who are uncertain which medication is right for them should discuss the options with their healthcare provider. 

For more on PrEP, read “All about PrEP for HIV Prevention.”

This October, a generic version of Truvada became available in the United States for the first time. Why the delay? When a brand-name medication enters the market, it is protected by patents and granted a period of exclusivity. Now that Truvada’s exclusivity period has ended, manufacturers with generic alternatives may seek approval from the FDA. 

Teva Pharmaceuticals was the first manufacturer to receive FDA approval for a generic version of Truvada. More generic versions will likely follow in 2021, increasing competition and driving down the price. 

Curious about how medication versions work? Read “What’s the Difference between Generic and Brand-name Medications?”

By lowering the cost of PrEP, the emergence of generic Truvada will ultimately put less strain on the U.S. healthcare system and help make PrEP more widely accessible to those at risk of HIV infection. Those who switch to generic Truvada will likely see their out-of-pocket costs decrease; however, there may be consequences for people who prefer Descovy—the newer formulation of PrEP.

In the wake of generic Truvada’s arrival, some insurance companies have decided to stop covering Descovy due to higher costs. While the two forms of PrEP may well be interchangeable for many patients, Descovy is not identical to Truvada. A small subset of people may have less desirable outcomes if compelled to switch versions by their insurers. People who need or prefer Descovy, especially because of preexisting renal or bone density issues, will likely need to obtain prior authorization approval and could face higher out-of-pocket costs. 

At Alto, we specialize in handling prior authorizations and performing thorough cost savings investigations. If we notice a change in your out-of-pocket cost, we’ll let you know, and we can work to identify ways to save you money. Here’s a closer look at how your pharmacy, healthcare provider, and insurance company work together to manage your prescriptions. 

How Insurance Companies Manage Medication Costs

Unsurprisingly, insurance companies tend to favor the cheapest version of a medication with similar efficacy. One way insurers encourage less expensive alternatives is through prior authorizations—a restriction that requires doctors to request that the insurance company cover certain medications. Not every prescription is subject to a prior authorization, but it’s commonly used when a doctor prescribes a brand-name drug with a generic available. The doctor must prove to the insurer why the specific version they prescribed is medically necessary. 

In most cases, prior authorizations are intended to ensure the safest and most cost-effective medication is used. However, they often require extensive paperwork and multiple phone calls from doctors’ offices, which can become a drain on time and resources for busy offices and clinics or cause delays in getting your prescription. 

For more on how the process works, read, “What is a Prior Authorization?”

Finding out that you need a prior authorization can feel daunting, but the right pharmacy partner will navigate the complexities for you. At Alto, we proactively file prior authorizations when they’re needed, taking the weight off the shoulders of both you and your doctor. We have a dedicated support team that works closely with your doctor’s office to obtain approval from your insurance company, and we’ll keep you updated throughout the whole process. 

After securing approval, we’ll conduct a thorough price investigation to identify sources of financial assistance and ensure you're getting the lowest possible price. We do all of this at no cost to you—we believe everyone should have access to the medications they need at an affordable price.

If you’re concerned about continued coverage for your preferred form of PrEP, we’re here to offer support. Our HIV specialists and care team are available from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends through secure messaging in our mobile app, or by texting or calling 1-800-874-5881. 

For an inside perspective on sales at Alto, we sat down with Craig Thompson, our Vice President of Sales, to learn about his experience at Alto and his advice for qualified sales professionals looking to join the team.

An Inside Look at a Sales Career with Alto

Why Our Sales Team is Central to Our Mission at Alto

Like so many big ideas, Alto began with a question: what if we reimagined the pharmacy experience to make people happier and healthier? Improvements were begging to be made: not only were most people and providers frustrated and dissatisfied with the status quo,  but medication non-adherence—when people don’t take the medication they’re prescribed—has hovered at 50%. In addition to $300 billion in avoidable medical costs, non-adherence is estimated to cause approximately 125,000 preventable deaths per year in the United States. 

With these problematic statistics in mind, Alto set out to do more than just dispense and deliver medications. Our mission is to fulfill medicine’s true purpose: to improve the quality of life for everyone who needs it. We aim to make our better pharmacy experience available to 100 million people by 2025 and we’ve raised over $350 million—including more than $250 million at the beginning of the year—in pursuit of this goal. 

To reach more people and expand into new markets, we are building a strong, mission-driven sales team to help forge the way. For an inside perspective on sales at Alto, we sat down with Craig Thompson, our Vice President of Sales, to learn about his experience at Alto and his advice for qualified sales professionals looking to join the team.

Can you tell us about your own career path and why you joined Alto?

Prior to joining Alto, I spent about 20 years in the medical device space. Early on, I worked for a few different companies before landing at Abbott Vascular where I started as a sales representative, led trainings across the U.S. as the Director of Medical Education, then pivoted back to become VP of Sales. I always envisioned that my next role would be a bigger version of that position; one where I could swing big and settle in for the long haul. 

What intrigued me about Alto was the size of the market. We spend more than $330 billion on prescription drugs a year in the U.S., but it didn’t seem like anyone was nailing the pharmacy experience, especially from the patient’s perspective. When I met Matt, Alto’s CEO, I was impressed by his patient-centered mission and his humble approach. The opportunity to build something from the ground up really appealed to me. I also loved the idea of working alongside a team of high caliber people with diverse professional backgrounds.

Alto represents a true convergence of healthcare and technology. Moving from medical devices or pharmaceuticals and coming here, you learn new ways to communicate and have access to new technology and resources.  We have our eyes on the future and a vision for how we want to scale. By keeping a strong focus, we’ve more than doubled our revenue each year for the past few years. As we continue to expand into major markets across the U.S., we’re looking to bring in highly talented people with existing relationships to build out our sales team. 

While we've delivered fantastic growth over the last few years, we're still in a phase of evolution where a new member of the team can have a meaningful impact on our organization. This is an ideal opportunity to take part in building something new and to know that as you help build a better business, you’re also helping to improve people’s and healthcare professionals’ lives. Not only have we leveled up the patient experience with our app, but we’re also making the pharmacy experience easier for healthcare professionals. Alto is uniquely suited for those who care about benefiting the stakeholders we work with. It’s genuinely all about the mission.

What makes a successful partnership manager at Alto? 

We’re looking for builders—creative people who can operate in ambiguity and thrive in a startup environment. Working at Alto is an opportunity to build new territories and make a real difference for people. It’s for those who want to create novel solutions rather than work with rails around them. We need innovative people with existing relationships who are motivated by Alto’s mission to improve lives. 

What exciting challenges await a potential team member? 

We're really at the tip of the iceberg as far as the products that we are bringing forward. There's a ton of work to be done as we consider how we can continue to meet the needs of both people and health care professionals. We’re always working to develop services and technology that can help impact adherence rates, improve the overall quality of life for people, and make physicians' lives easier by reducing the burden that exists on their teams from insurance companies. 

There will be a ton of opportunities for people to come in, demonstrate success, and find fulfilling professional paths. One of my visions for the coming year is to develop additional resources dedicated to professional and personal growth and implement programs with specific learning tracks. 

We work cross-functionally and are always open to learning new ways of operating and finding success. If you’re excited by the opportunity to create something new rather than inherit an existing territory, we’d love to hear from you. 

This is an exciting time to join the team at Alto. As we continue to forge new territory, expand into new markets, and develop our specialty areas, we’re already on track to achieve $1 billion in annual recurring revenue by 2021. To maintain this trajectory, we’re looking to grow our team with highly skilled individuals who align with our values and are motivated to create change. There is abundant opportunity to not only achieve success but find fulfillment by working toward a mission that positively impacts people’s lives.  

If you've found yourself considering embarking on a new adventure, we’d be thrilled to have you consider Alto as your next career milestone. Visit our careers page to see if we're actively hiring in your city. If you're not quite ready to make a move, join our talent community and follow us on LinkedIn to stay apprised of upcoming opportunities. 

If generic and brand-name medications work the same way, what accounts for the disparity in price? Let’s unravel the facts to discover how this system works. 

What’s the Difference between Generic and Brand-name Medications?

What’s the difference between generic and brand-name medications? 

We tend to feel mistrustful of anything we deem a “knockoff,” assuming we’ll end up with a lesser version of the real thing. With “we get what we pay for” a familiar refrain, we learn to associate better quality with a higher price. So when it comes to generic medications, which can cost 85% less than their brand-name counterparts, it’s no wonder we may cast a suspicious eye. However, unlike a bootleg movie or copycat handbag, generic medications are tightly controlled by the FDA, ensuring they offer the same safety, quality, and results.

Is a generic medication exactly the same as the brand-name version?

According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.” In order to get approval, a generic medication must have the same dosage, strength, safety, manufacturing standards, quality, and effectiveness, and it even needs to be administered in the exact same way.

There is some room for variability between the different versions, however. As C. Michael White, Pharm.D., Professor and Head, Department of Pharmacy Practice, University of Connecticut, explained in an article for the Huffington Post, “the [generic] pill needs to get you within 10 percent above or below the blood concentrations achieved with the brand for the FDA to approve the generic, and in reality, they only usually vary by 3-4 percent in one direction or another. So yes, they are very similar in terms of the active ingredient...Most people will never notice a difference.” According to the FDA, this level of variability is unlikely to have an impact, and could also occur between two batches of the same brand medication. 

Additionally, the inactive ingredients, or the ones with no therapeutic purpose, may differ. Manufacturers might use different binding materials, dyes, and preservatives, but they must prove to the FDA that they’re safe. It is possible, however, that you could be sensitive or allergic to something that’s in one particular version but not another.

How do the different versions come about?

When a brand-name medication enters the market, it is protected by patents and granted a period of exclusivity. In other words, the company that first created the medication has the sole right to sell it for a certain period of time. It takes an incredible amount of money to develop a new medication and see it through the necessary clinical trials—it’s estimated between $2-3 billion per new drug—so this helps drug companies recoup some of that cost. 

Most drugs are granted protection from competition for 5 years, though it can be more or less under certain circumstances. Once the period of exclusivity expires, generic versions of the medication are allowed to seek approval from the FDA to enter the market. 

Why are the generic versions so much cheaper?

Generic medications usually (but not always) cost much less than their brand-name counterparts because they do not have to repeat the expensive research and clinical trials that brand-name drugs undergo to prove they’re safe and effective. Plus, once one or more generic versions enter the market, competition can help drive down the prices. 

So a generic medication can really achieve the same effect for a fraction of the price?

In most cases, yes. According to Harvard Health Publishing, “The bulk of research out there shows that taking the no-name brand not only saves you money, but also provides you with a medication that is just as effective as the original.”

That being said, individual sensitivities can vary, so listen to your body and always report side effects to your doctor. 

If you’re prescribed what is known as a “narrow therapeutic index drug (NTI),” your doctor may recommend that you stick to the brand-name version. That’s because small changes in blood concentration can either render these medications ineffective or possibly cause harm. If you are taking an NTI, such as certain antiseizure medications and blood thinners, it doesn’t mean that you can’t switch to a generic version if it’s available. You’ll want to fully discuss it with your doctor and ensure that you’re closely monitored if you’re cleared to make the switch. 

And again, it’s possible to have sensitivities to a specific version of your medication. If you experience side effects after switching to a generic drug, you may want to consider resuming the brand-name version or trying another generic option. 

Unless your doctor has specified that your prescription is only for the name-brand medication, your pharmacist can suggest a generic option instead. Your insurance company may even require that you take the less expensive generic option or pay the difference for the brand-name version. The team at Alto will always help you find the best price for your prescription by presenting you with all of the options. If you’re curious about whether a generic version is available for any of your current prescriptions, we’d be happy to talk it through with you. Our pharmacists are just a chat, text, or phone call away.

In the world of prescription medications, “brand-name” doesn’t mean better. Most of the time, you can achieve the exact same results for a fraction of the price with a generic drug. According to a report by the IQVIA Institute, generics account for approximately 90% of all prescriptions but only about 20% of the overall costs. They estimate that generic medications saved the U.S. healthcare system $1.67 trillion from 2007 to 2016. If you’re cleared to take a generic version of your prescription, you can do so with full confidence—and hopefully some hefty savings. 

Did you know Alto will conduct price investigations for you? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; call or text 1-800-874-5881 or download the mobile app for secure 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 other qualified health provider with any questions you may have regarding a medical condition.

When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

What’s the Difference between Type 1 and Type 2 Diabetes?

Put very simply, diabetes is a health issue that affects how the body converts food into energy. This simple understanding is complicated, however, by the fact that it’s actually a term for several conditions. When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

Your cells use a simple sugar called glucose for energy. Your body obtains it by breaking down the carbohydrates that you eat. Once the glucose enters your bloodstream, your pancreas releases insulin in response, which promptly helps move the sugar out of your blood and into your cells. In a person with diabetes, however, one of the following things happens: 

The pancreas does not produce any insulin at all

The body doesn’t respond to insulin in the right way, which is known as “insulin resistance.”

Without treatment, a person with diabetes will develop a condition called high blood sugar, which is just as it sounds—too much glucose in the blood. This can lead to serious and even life-threatening complications such as heart disease, vision loss, kidney disease, or nerve damage. There is currently no cure for diabetes, but it can be managed through lifestyle interventions and, depending on the type, oral medication and/or insulin injections. 

According to the Centers for Disease Control and Prevention (CDC), over 34 million Americans, or about 1 in 11, have diabetes. In addition, it’s estimated that 1 in 3 adults are currently at serious risk of developing type 2 diabetes, meaning more than 40% of American adults are in some way affected by this disease. In case you glossed over that last statistic, we’ll let it sink in again. Experts believe that nearly half of all American adults have either diabetes or prediabetes. 

To understand this disease’s startling prevalence, let’s take a look at how and why each type occurs. 

Type 1 diabetes: The immune system on the attack

Type 1 diabetes is an autoimmune condition that occurs when the body mistakenly attacks the pancreas with antibodies. This destroys the pancreas’s insulin-producing cells, meaning people with type 1 diabetes don't produce any insulin at all and must rely on insulin injections to control their blood sugar. 

Because type 1 diabetes commonly begins in childhood, it used to be known as juvenile-onset diabetes. However, it can happen at any age to people of all races and body sizes. The CDC estimates that it affects nearly 1.6 million Americans, making it much rarer than type 2 diabetes.

Symptoms of type 1 diabetes usually come on very quickly and can include excessive thirst or hunger, frequent urination, sweating, nausea or vomiting, and weight loss. The cause is unknown, but genetics plays a role and those with a family history of type 1 diabetes are at increased risk. If you experience these symptoms, it’s important to contact your doctor right away.

Type 2 diabetes: A silently growing epidemic

In the case of type 2 diabetes, the pancreas is usually able to produce some insulin. The problem is either that it’s not enough insulin or the body isn’t able to use it properly. This means glucose doesn’t easily reach the body’s cells to provide essential fuel. 

Type 2 accounts for over 90% of all people with diabetes. It develops over the course of many years due to a mix of genetic, lifestyle, and environmental factors. Unlike in the case of type 1 diabetes, those at risk for type 2 can often prevent its onset through lifestyle interventions such as losing weight, eating healthy, and staying active. 

This high-risk phase is known as prediabetes, and occurs when a person’s blood sugar levels are significantly elevated, but not high enough for a type 2 diagnosis. It’s estimated that more than 88 million adults have prediabetes and 85% of them have no idea. 

So how do you determine if you’re within this group? Well, you could be at higher risk of prediabetes if you are:

Black, Hispanic/Latino, American Indian, Asian American, or Pacific Islander (The reasons are not yet understood, but researchers have found varying rates of diabetes among different racial and ethnic groups)

High blood pressure or take medication for it

Low HDL cholesterol and/or high triglycerides

Been diagnosed with Polycystic Ovary Syndrome (PCOS)

Falling into just one of these categories puts you at higher risk, however they do not mean that a diagnosis is in your future. Staying active and eating well is the best way to lower your risk.

Indicators of type 2 diabetes include tingling in the hands and feet, excessive hunger or thirst, fatigue, frequent urination, slow-healing cuts and bruises, and blurry vision. Quite often, however, there are no symptoms at all or they develop very gradually. If you’re feeling uncertain, talk to your doctor. They may recommend an A1C blood test to check your average blood sugar levels over the past few months. The American Diabetes Association offers a free one-minute test that can help you or a loved one learn more about your risk. They also provide a variety of tools focused on preventing or managing a diagnosis, from recipes to fitness plans.

Since a type 1 diabetes diagnosis means you cannot produce your own insulin, you will require regular insulin injections and frequent testing of your blood sugar levels. Even with an insulin prescription, meal planning and daily exercise will help to further regulate your blood sugar. The important thing to remember is that this disease is manageable and it doesn’t have to mean being held back in life. The American Diabetes Association puts out a magazine called Diabetes Forecast that’s full of information, recipes, and fitness tips and there are many online communities you can join for advice and support.

Managing your insulin prescription might feel overwhelming at first, but the team of pharmacists at Alto will have your back, answering your questions and ensuring the seamless delivery of your insulin and other medications. 

Treatment for type 2 diabetes works a little differently for everyone. You may need to take oral medications or insulin injections, or you might be able to manage it with lifestyle changes alone. 

Oftentimes, treatment includes a mix of several oral medications and/or insulin. To minimize confusion over multiple prescriptions, the Alto app can help you easily manage everything in one place and set up automatic refills. Not to mention, our team of pharmacists will always be standing by to offer guidance. 

But whether you need a prescription or not, eating right and exercising will be extremely important parts of your life with type 2 diabetes. A healthy lifestyle will help keep your blood sugar stable, maintain healthy cholesterol levels, and control your blood pressure. The American Diabetes Association offers free resources that can help you get started, and you certainly won’t be alone. There are many millions of people currently living and thriving with type 2 diabetes around the world. An online community is a great place to start connecting.

A diabetes diagnosis can be daunting, but it never has to mean missing out on life. Remember, we’ll be here to help you understand your medications and set up a delivery plan that fits into your schedule. 

Looking for a partner to help you manage your prescriptions? Our team is available to answer your questions from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text, or the app.

The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

In this post we’ll define what a prior authorization is, 3 tips to plan for them, and how Alto provides support in the process.

What is a Prior Authorization?

Imagine going to your doctor’s office and receiving a treatment plan only to learn that your medication or procedure needs approval, commonly referred to as a prior authorization (PA). This might seem odd given that your physician recommended your prescription or procedure as the best option. However, the approval isn’t required from your doctor but rather your insurance company. This is to ensure that the treatment complies with their coverage standards. 

A prior authorization is a request to your insurance company for coverage of certain medications or medical procedures. You can think of a prior authorization as the “green light” to proceeding with your physician’s recommended treatment plan. Insurance companies typically require this approval process for the following situations: 

Medications that may be misused, abused or have adverse effects

Medications that are new to market and not yet listed on insurance formularies (i.e. may be at a higher cost than other drugs that are similar/more cost effective) 

Medications that your doctor prescribed to treat a condition other than those officially approved by the FDA, also known as "off-label use”

Medical treatments or procedures where medical necessity requires assessment

Why are Prior Authorizations so Important?

A recent study shows that 1 in 4 doctors believe the prior authorization process has a disadvantageous effect on their patients’ well-being due to delays caused in treatment. Despite this, prior authorizations remain a key part in gaining insurance approval. Put simply, this is their way of “gatekeeping” cost effective coverage appropriate for each patient. 

At Alto, we understand why insurance companies want extra due diligence on expensive or risky medications, but we don't think patients should have to navigate this complicated world on their own. And these hurdles/hoops should never substantially delay access to treatment. That’s why we proactively file prior authorizations when they are needed, ensuring there are no delays. In fact, we have a dedicated support team who works closely with your doctor’s office the moment a prescription comes in that requires approval. We’ll also always keep both you and your physician in the loop throughout the process so you know the current status of the request. 

Ask your doctor if a prior authorization might be necessary when discussing treatment 

Consider a pharmacy, like Alto, that is action-oriented in filing prior authorizations (and we offer this support for free!)

Don’t be discouraged by the process. While this might be an extra step it’s likely to save you from paying full-price. 

Regardless of whether or not you may need a prior authorization now, it’s helpful to understand what to expect so that you are prepared. In the event that the prior authorization request is denied, we will work directly with your doctor to either process an appeal or find covered alternative treatments so that you don't have to. 

In some cases such as fertility medications, we will help you to understand your out-of-pocket costs and to identify alternative sources of financial assistance to ensure you're getting the best possible prices. Gaining access to your medications isn’t limited by a prior authorization, and with the right pharmacy partner you can feel confident that you’ll have an advocate on your side. 

Questions about Alto or our cost savings approach? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text or the app.

In this post we'll explain what causes medication side effects, how to manage them, and provide 5 suggestions to remedy. 

How to Manage Medication Side Effects

From the occasional skin rash to more chronic illnesses such as diabetes, prescription drugs are often critical in treating or even preventing symptoms and improving overall quality of life. All medications carry the potential for complications or other symptoms known as side effects. From periodic nausea or upset stomach to more adverse effects such as liver or heart problems, each medication carries its own potential for introducing ailments unrelated to the original diagnosis. In this post we'll explain what causes side effects, how to manage them, and provide 5 suggestions to remedy. 

What is a medication side effect and why does it matter?

Put simply, medication side effects are unexpected reactions that can occur as a result of using a prescription, over the counter medication or herbal supplement. There are two types of side effects: common and adverse. Common side effects are generally described as “normal” after-effects of treatment such as constipation, dizziness, dry mouth, headaches and skin rash. Adverse side effects are much more serious and can include internal bleeding, kidney damage and heart dysfunction among other symptoms. 

The main difference is that common side effects are unwanted, but known, while adverse side effects are unintended, and often not accounted for in treatment plans. Side effects can vary with all medications, so it’s important to understand what is common and what is adverse with the particular medication you are taking. Side effects are also not always dose dependent, meaning that they can occur at any dose or strength; some side effects, however, are worse or more pronounced the higher the dose. It's always important to take the medication as prescribed by your provider and to not increase your dose without first consulting your physician.

1) Communicate with your healthcare professional: Informing your healthcare provider of any allergies or known reactions to medications before starting a new medication can reduce the possibility of side effects. Be sure to also include all disease states past and present as this will help your doctor make the best choice for your medical care. New patient intake forms or patient portals usually provide an opportunity to list any known reactions to medications. Otherwise, be sure to update your doctor if anything has changed since your last visit. 

2) Discuss current medications: Transparency is key for all members of your healthcare team. If you have multiple doctors or pharmacies for different treatment plans, be sure to keep them each informed of all your current medications, including over the counter medications such as pain relievers and wellness supplements such as multi-vitamins or herbal supplements. Full-service pharmacies like Alto make it easier to track all of your medication needs in one place.

3) Review the patient package insert (PPI) included with your prescriptions: All prescriptions include a PPI that contains information on the medication, indications and usage, contraindications, warnings, precautions, and dosage administration. This is a quick way to reference any possible side effects so that you know what to be on the lookout for. Take the time to read it and reach out to your prescribing physician or pharmacist with any questions. 

4) Contact your pharmacist: Pharmacists are responsible for patient safety and often act as the bridge between a patient and physician when there are questions about a patient's medications. Pharmacists review all of a patient's current medications to identify any potential adverse effects, and are available to answer questions about your medications' intended use and effects. Look for pharmacies that make it easy for you to ask questions; Alto's pharmacists are available via phone, text and secure message in our mobile app.

5) Be open to alternatives: Stay in contact with your doctor to discuss potential changes to your treatment plan if side effects present a problem. Your physician can evaluate other medications or treatment options if appropriate; simply forgoing treatment without consultation with your healthcare provider presents additional risks and is not advised.

Keep in mind that not all medications will produce side effects and not all side effects will be significant enough to change the course of your treatment. It’s important to pay attention to how you are feeling both before and after taking prescribed medications and to always stay in touch with a healthcare provider to discuss any unexpected symptoms or changes. For more information on how to manage your medications check out this article from Alto.  

Looking for a partner to help you manage your prescriptions? Our team is available to answer your questions from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text, or theapp.

A personal health journey with hyperthyroidism, Graves’ Disease, and Horner's Syndrome led Alto's Head of Talent to improve the patient pharmacy experience.

Alto's Head of Talent Shares His Personal Health Journey

As a patient, I dreaded my pharmacy experience. So I joined Alto to change it. 

My first sign of hyperthyroidism showed up when I was 20 and my struggle with pharmacies started soon after. It would be more than a decade before I found a way to be a part of solving this industry’s problems.

When I first heard about the opportunity at Alto in 2019, I actually laughed. Why would I want to work at a pharmacy? I hated pharmacies. But the recruiter I was working with convinced me to reconsider and after speaking to Jamie, one of the founders, I understood. Alto was unlike any other pharmacy out there. In fact, they weren’t just a pharmacy. They were on a mission to improve patients’ quality of life. I jumped at the chance to fix a broken industry that is hungry for innovation.

I had just come back from a trip to New York and went for a routine run around the neighborhood. I was so drained after running one mile that I had to stop and sit down. This didn’t make sense; at 20, I was in the best shape of my life. As the next few weeks went on, the symptoms worsened: severe chest pain, shortness of breath, and anxiety attacks. Being the stubborn athlete I am, I pushed through it, until one day, I blacked out during a run and woke up lying face down in the dirt. Around that same time, I developed a lazy eye and finally decided to go to the doctor.

After that delayed visit I was diagnosed with hyperthyroidism, Graves’ Disease, and Horner's Syndrome. My standing heart rate was 105, or about 50 BPM more than it should have been! I'm so thankful for my family members and the doctors who acted quickly to get me medical care. While my treatment plan was straight-forward, my experience as a patient on prescription medications became a nightmare. I quickly learned how inconvenient, impersonal, and non-patient-centric the pharmaceutical industry was.

I tried pharmacy after pharmacy, and the issues and frustrations remained the same. My script would be sent to the wrong address, or I’d receive the wrong dosage and brand of medication, even though my medication never changed! It became so routine that once a month, I’d block off two hours to talk through my refill requests with the pharmacy. But like clockwork, the same problems would reoccur—year after year after year. Having told my story to tons of other patients and caretakers, I know I’m not alone in this experience.

Like any disappointed customer in the 2000s, I took to the internet to learn more. What I found was alarming. The NPS scores for the leading pharmacies are abysmal. CVS Pharmacy, one of the largest retail pharmacies, has an NPS score of -10. Yes, negative ten. It's also estimated that up to 50% of medications are not taken as prescribed, creating up to $300 billion in avoidable drug costs annually. Even worse, it's estimated that more than 125,000 preventable deaths each year can be attributed to medication non-adherence. That's three times more than deaths from car accidents nationally!

While there was comfort in knowing others felt my pain and were experiencing the same frustrations, I was angry that there wasn't anything being done about it. I was frustrated, both as a patient and as a civilian, and didn’t know how to try to solve the problem. 

Meanwhile, after graduating college, I began my career in Michigan, where I’m from. Working for a recruiting agency, Aerotek, I was hiring for all sorts of roles—from machine operators to janitors—but I always had an interest in tech.  I found out about Barracuda Networks, a security tech company with an office in Ann Arbor. I originally joined to build their data protection division from 20 to 250. Their office was about 20 people and it needed to grow to 250. I had a ton to learn—when I started, I didn’t even know what a software engineer was! My role evolved quickly, eventually broadening to manage all tech recruiting across the U.S. and later, to building their first international recruiting team.

After almost five years, I started to look at other companies. Quora had been a long-time favorite product of mine. I loved that they connected knowledge with people all over the world. The perspectives I found were genuine, diverse, and fascinating. On Quora, there are professors, industry experts, and people who just got out of prison, sharing their knowledge and experience. I joined Quora to grow their team and jumped into the consumer internet space for the first time. Working there, I learned how to refine and scale processes to enable hiring for balanced and diverse teams. At a certain point though, I was ready for a new challenge, to move outside of an advertising-based business model, and to be in a steep learning curve again.

I had no idea where I wanted to go next. Looking around the Bay Area, I felt that with so many smart, capable people in tech, we could be doing more. I didn’t agree with a lot of what I was seeing, especially in terms of the kinds of problems that were getting the most investment, time, and resources. I’d spent almost 10 years building my career and didn’t even know if I wanted to stay in tech. I’d lost touch with a sense of purpose and meaningful legacy. 

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