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Chronic obstructive pulmonary disease (COPD) is a long-term inflammatory condition that obstructs the airflow from the lungs. Here’s what you need to know about keeping your lungs healthy to avoid or manage COPD. 

Understanding Chronic Obstructive Pulmonary Disease (COPD)

The delicate, branching structures of the lungs bear a striking resemblance to trees. The air you breathe travels down your windpipe, or trachea, and enters the lungs through two large tubes known as bronchi. Just like the roots and limbs of a tree, these tubes divide again and again into smaller bronchioles before finally ending in clusters of tiny air sacs called alveoli—what you might consider the leaves. 

Chronic obstructive pulmonary disease (COPD) is a long-term inflammatory condition that obstructs the airflow from the lungs and makes it difficult to breathe. Although it's the third leading cause of death in the U.S., the good news is that it can be prevented and treated to slow the progression and maintain quality of life. Here’s what you need to know about keeping your lungs healthy to avoid or manage COPD. 

COPD refers to a group of progressive lung diseases, meaning the condition becomes worse over time. The most common are emphysema and chronic bronchitis, and many people with COPD have both of these conditions. 

Emphysema destroys the fragile air sacs in the lungs, which impairs the airflow. The air carrying carbon dioxide out of the body cannot be adequately expelled and some remains trapped in the lungs. Fresh, oxygen-rich air is then blocked from entering the lungs, causing gradually worsening shortness of breath, even while at rest.

According to the Mayo Clinic, most people with emphysema also have bronchitis, which causes inflammation and narrowing of the bronchial tubes. With bronchitis, mucus builds up in the lungs, spurring a persistent cough. 

The CDC reports that sixteen million Americans have trouble breathing due to COPD. However, they estimate that the actual number includes millions more who have not yet been diagnosed. 

In the vast majority of people with COPD, lung damage is caused by cigarette smoking. According to the COPD Foundation, about 90% of people with COPD are current or former smokers. However, damage can also be caused by long-term exposure to irritating gases or particulate matter, including air pollution and workplace exposure to dust, smoke, or fumes. 

An estimated five percent of people with COPD have a deficiency in a protein known as alpha-1-antitrypsin, which causes the lungs to deteriorate and can also affect the liver. People with severe asthma can also progress into COPD. 

The most telling—and distressing—symptom of COPD is difficulty breathing. According to the Mayo Clinic, another major symptom is a constant cough that produces a lot of mucus. Additional symptoms may include chest tightness, wheezing, frequent respiratory infections, and fatigue. Severe COPD can cause swelling in the ankles, legs, and feet and weight loss. 

As a progressive disease, symptoms often begin mildly and may be confused for the common cold. But rather than clearing up after a week or two, the coughing and shortness of breath will continue to worsen over time and make daily activities more difficult. 

Unfortunately, by the time COPD symptoms appear, there may already be significant lung damage. Symptoms will continue to escalate, particularly if smoking or exposure to lung irritants continues. With proper intervention and treatment, however, most people with COPD can slow the disease’s progression and maintain their quality of life. 

People with COPD often experience flare-ups known as exacerbations. During these episodes, symptoms become much more severe for several days or weeks and may require treatment with antibiotics, oral corticosteroids, and even hospitalization. 

Respiratory infections or inflammation triggers—such as air pollution, secondhand smoke, dusts, fumes, or other toxic substances—are common causes of exacerbations. Anyone who experiences a marked increase in coughing, difficulty breathing, or mucus in the lungs should seek immediate medical attention. 

The best way to prevent COPD is to never smoke or stop smoking now. Quitting isn’t easy for most people, so it’s a good idea to enlist your healthcare provider’s support.  They may recommend nicotine replacement products or medications that can help. 

The CDC offers a variety of resources that can help you quit smoking, including a free text message program (text QUIT to 47848) and their quitSTART app, which is available for both Android and iOS. The Mayo Clinic outlines ten tips to help you resist the urge to smoke that you may find helpful as you get started. 

It’s also important to avoid secondhand smoke exposure and occupational exposure to chemical fumes and dust. If you work with any type of lung irritant, the Mayo Clinic advises talking with your supervisor about the best ways to protect yourself, like using respiratory protective equipment. 

Staying active will not only improve your overall health; it will also strengthen your lungs. The American Lung Association recommends getting thirty minutes of moderate physical activity five days a week. Both aerobic and muscle-strengthening exercises will benefit your lungs, so you can include anything from brisk walking to weight lifting to vigorous household cleaning. 

Lastly, make sure to get your annual flu vaccine each fall, as well as a pneumococcal vaccine, to prevent infections that can weaken your lungs. 

While there is no cure for COPD, treatment can ease symptoms and lower the risk of complications like heart disease, lung cancer, respiratory infections, pulmonary hypertension, and depression. 

COPD can be treated with medications, supplemental oxygen therapy, and surgery. However, many people with mild forms of the disease may only need to quit smoking and avoid other inflammation triggers. 

The most common medications used to treat COPD include: 

Bronchodilators, which usually come in inhalers and relax the muscles around the airways to make breathing easier. 

Inhaled corticosteroids, which help to reduce airway inflammation and prevent exacerbations. 

Oral steroids are sometimes used in short courses during periods of exacerbation to prevent further worsening of symptoms.

Phosphodiesterase-4 inhibitors are used for severe COPD. These medications decrease airway inflammation and relax the airways.

Theophylline may be used when other treatments are ineffective or if cost is a factor. It may help improve breathing and prevent exacerbations but can cause side effects like nausea, headache, rapid heartbeat, and tremors.

Antibiotics may also be used to treat respiratory infections but are generally not recommended for prevention. 

Often, a combination of these medications is used to treat COPD. Inhaled medications are taken using a device called an inhaler, which allows the medication to be absorbed straight into your lungs. If you’re prescribed a new inhaler, one of Alto’s pharmacists can walk you through how to use it.  Not all inhalers work the same way, so learning the proper technique is crucial for ensuring adequate therapy.

People with COPD are also generally prescribed a pulmonary rehabilitation program. These individually tailored programs combine exercise, nutrition advice, and counseling to prevent exacerbations, slow the progression of symptoms, and improve quality of life.

Those with insufficient oxygen reaching their blood may benefit from supplemental oxygen therapy. It involves using a lightweight, portable device to deliver oxygen directly to your lungs as needed.

Surgery may be an option for those with severe COPD, particularly severe emphysema. It’s usually reserved for when other types of treatment have failed. 

Because breathing is so elementary, it’s easy to take it for granted. But so many of the activities we enjoy—and life itself—depend on the healthy function of our lungs. 

When breathing becomes difficult, life can change drastically, so it’s important to find support. That may mean sharing your feelings with a close friend or family member, joining a support group for people with COPD, or enlisting the help of a mental health professional. 

Above all, it’s critical to follow your treatment to avoid worsening symptoms. At Alto, we want to make getting the COPD medications you need as easy as possible, so we offer free hand-delivery, automatic savings investigations, and user-friendly medication management through our website and app. We always have a team of pharmacists on-call to answer your questions by phone, text, or chat, and we’ll even remind you when your inhaler or other medications are due for a refill, then schedule a time to drop them off. 

If you’re interested in learning more about how Alto can support your COPD treatment plan, our team is available from 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.

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.

In this post, we'll share how we identified the problem of failing cypress seeds, what the culprit was, and three ways to make seeding test data more robust.

How to Debug Slow and Failing Cypress Seeds

End-to-end test failing before it even begins? Here’s how we timed, debugged, and sped up our seed data.

At Alto, we use Cypress to test our Rails application end-to-end. As our application grows, so does our end-to-end test suite — along with the seed data it requires. This led us recently to a perplexing problem:  when run in CircleCI, our end-to-end tests would mysteriously time out during the seed step, causing them to fail and block deploys.

Seeds can be painful to debug. They’re typically set up through a single request and, depending on how thorough the tests are, call upon most of the models involved in the application. If a model throws, say, a validation error because of bad seed data, you'll see it in your Cypress logs. If a model hangs, the request often doesn't show up in the logs at all. There's no status code, no error message—all you know is that somewhere, somehow, some process is failing to finish.

In this post, I’ll share how we identified the problem, what the culprit was, and three ways to make seeding test data more robust.

To Identify the Problem, Focus on Your Logs

We started by comparing logs from our failing CircleCI runs with those from local test runs. Turns out, our CircleCI logs in failed runs stopped after a specific log message. 

For example, when our test runs succeeded, the logs looked something like this:

...
LOG: creating model
WARN: foo with id=123 not found
WARN: foo with id=456 not found
WARN: bar with id=789 not found
ERROR: Invalid parameter to function `foobar`
LOG: model created
... rest of logs

But when they failed, they instead looked like this:

. . .
LOG: creating model
WARN: foo with id=123 not found
WARN: foo with id=456 not found
[end of logs]

This let us know where to focus: after the function that looks for foo, but before or during the one that looks for bar. Of course, this only works if you have enough log statements scattered around in the first place. I’d recommend logging the time it takes to create each model in seeds, which has the added benefit of telling you where to start if your seeds are becoming annoyingly slow. 

At the top of our file in db/seeds, we declare the following function to add timings to our CI logs:

@last_time = Time.now
def log_time(label)
    Rails.logger.info("Time [#{label}]: #{(Time.now - @last_time)}")
    @last_time = Time.now
end

We then call the function after each create statement in our seeds:

Product.create!({...params})
log_time(“Product Create”)

This prints logs in the following format:

...log metadata message=Time [Product Create]: 12345
...log metadata message=Time [User Create]: 1102
...log metadata message=Time [Address Create]: 105
...

These logs will help you figure out problematic model create calls, but each model may have a lot going on in its callbacks (before_save, before_commit, after_save, etc). You can follow a similar approach to time those callbacks:

# in the model file
Class Model < ApplicationRecord
	
...

before_save :foo

...

def foo()
   start_time = Time.now
   [ ... things that happen inside the function ]
   Rails.logger.info("Time [foo]: #{(Time.now - start_time)}")
   [ function return statement, if applicable ]
end

It’s important to note that the most time-consuming statements in your seeds often cause the most trouble, but that’s not always the case. If your seeds are hanging due to external API calls, it’s entirely possible for those calls to usually take a short time to complete. If you have hanging tests, I would recommend logging test runs in CircleCI, since you may not be able to find the problem locally. 

Through timing our seeds, we narrowed down our search to five of our most time-intensive models. We were then able to time the individual callbacks within those models. One callback  in particular—containing a call to an external database—raised the most suspicion. It took up most of the time it took to create the model, didn’t return any information needed in our test, and was not mocked or stubbed out. 

Requests to this test database would usually work, however, since we call on it multiple times on every CI run, with concurrent CI runs, these requests would sometimes take a long time to complete, leading to a test timeout. 

In our case, since we were making calls to a hosted database in our tests, we changed our test environment to create and refer to an isolated instance of the database. While this was the best approach for our specific issue, we also explored some other ways of stubbing out API calls and skipping callbacks from your seeds file, which we describe below. Use these approaches with caution, as the more you stub, the less true-to-life your tests will be. 

Ideally, you would have already stubbed out third-party API calls in your code using environment variables. An example approach:	

def do_the_thing()
    if Rails.env.production?
    	[ ...do the thing ]
    else
	[ ...do some fake thing if needed ]
       Rails.logger.info("We theoretically would have done the thing.")
end

However, you can also use Typhoeus to mock third-party api calls in seeds, similar to how you might in a test. Imagine that your Product model makes a call to "https://slack.com/api/foo”. We can then mock that call out as follows:

mock_response = Typhoeus::Response.new({code:’500’, body: {
    “ok”: false,
    “error”: ‘not_authed’
}.to_json})
Typhoeus.stub("https://slack.com/api/foo”).and_return(mock_response)
Product.create!({...params})

Again, I would advise you to stub check for environment variables in your code rather than stub out individual API calls in your seeds and tests. But if for some reason you need to do the latter, it’s possible!

Similarly, you might want to stub out a function you’ve written if it takes a long time to run and doesn’t affect the outcome of your tests. This can’t be stubbed out in the ways we mentioned above since (1) you might need it  for — and hopefully are testing it in  — other tests and (2) it doesn’t have a url. minitest has a tool for this. Imagine you’re trying to stub out some functions from a Photograph model.

require ‘minitest/autorun’

Photograph.stub :fetch_product_photo_url, ‘’ do
   Product.create!({...params})
end

This will return an empty string when Photograph.fetch_product_photo_url is called within the Product model’s callbacks. You can also replace the empty string with anything else you might want the function to return.

Last but not least, it’s possible to skip entire callbacks and validation. I wouldn’t recommend skipping all of them, as that can cause models in your tests to stray very far from how your models actually work, but you may find it useful to skip specific callbacks.

While all the methods that I’ve suggested above are possible and can be useful, remember that stubbing and skipping from your seeds may just be band-aids for issues you have elsewhere. In our case, we could have stubbed out a model function or created an isolated database for testing. While both methods would have been functionally the same, doing the latter allows us to have to worry less about that database in the future—if, for example, we write more functions that depend on it, or update the mocked functions to do more than they currently do. Keeping tests in line with how the product works also keeps it more in line with the actual user experience: if it’s taking a long time to create a model in your seeds, it probably takes a long time for your users, too. 

Since adding timing logs and creating an isolated database to our end-to-end tests, we have a regular source of truth for the efficiency of our models, are able to develop more smoothly with fewer spontaneous test failures, and have more confidence in our ability to quickly pinpoint and resolve seed timeouts in the future. 

Heart disease is the leading cause of death for women in the United States. Here’s what our pharmacists think every woman should know about protecting and supporting their hearts. 

What Every Woman Should Know About Heart Health

We’re used to seeing dramatic Hollywood depictions of heart attacks in men. But heart disease is the leading cause of death for women in the United States. The American Heart Association reports that one woman dies of heart disease every minute in America. 

Harvard Health reports that this “heart attack gender gap” can have serious consequences for women. With less awareness of crucial heart-health risk factors and warning signs, many women lack effective prevention strategies or delay life-saving care. 

Though heart disease is deadly, it is also largely preventable. Making heart health part of the conversation for women has the power to save lives. Here’s what our pharmacists think every woman should know about protecting and supporting their hearts. 

The first step in building a heart-health strategy is understanding your individual risk for heart disease. Make sure to undergo any necessary screenings, and discuss risk factors like high blood pressure, high cholesterol, smoking, and age with your doctor at your annual checkup. You’ll want to go over your lifestyle and family history and identify your key health numbers, such as blood pressure, cholesterol, and blood sugar levels. 

According to the American Heart Association, research has uncovered a link between heart disease and pregnancy-related complications. Talk with your doctor if you were diagnosed with diabetes or hypertension during pregnancy or if you had an early delivery. These factors may increase your risk of cardiovascular disease in the future, so it’s essential to be aware and take steps to mitigate that risk. 

All women must understand the signs of a heart attack and the importance of seeking immediate medical attention. Research suggests that women tend to downplay symptoms and delay treatment—a life-threatening issue during a heart attack when every minute counts. 

According to the CDC, the most common signs of a heart attack for both men and women are chest pain or pressure; sharp pain in the jaw, neck, or back; and shortness of breath. However, only about 60% of women experience chest pain or discomfort during a heart attack. Studies suggest that women are more likely to experience less recognizable symptoms like nausea, dizziness, cold sweats, and unexplained fatigue. 

If you experience any discomfort in your chest or upper body or simply feel that something isn’t right, it’s crucial to seek emergency medical attention. Treatment is most effective if given within one hour of the onset of symptoms, so take these symptoms seriously and do not delay care. 

The CDC reports that approximately 200,000 preventable deaths occur each year in the United States due to heart disease and stroke. That’s why it’s so important to put heart-health strategies into place early. Try to augment your diet with plenty of vegetables, fruits, healthy fats, and fiber-rich whole grains while limiting sodium, saturated fats, alcohol, and sugar. Aim for balanced nutrition that you can maintain over time; a little dietary leeway is your best bet for success in the long term. 

Numerous studies have connected poor sleep to heart disease. Not only does a lack of sleep put stress on the body, but it also makes you less likely to exercise and make other healthy choices. If you constantly find yourself cutting back on sleep to tend to your to-do list, it’s time to prioritize rest. 

The American Heart Association recommends getting seven to nine hours of sleep every night to help your body function at its best. Smartphones and other screens are known to disrupt sleep if used at bedtime, so try to power down as early as you can. You might also try using a blue-light blocking filter on your devices at night. Apple devices have a built-in blue-blocking function called “Night Shift,” or you can try out popular apps like Twilight or f.lux. 

It’s also vital that women find ways to manage stress in their daily lives. According to the Mayo Clinic, women's hearts are impacted by stress and depression more than men’s. Stress causes inflammation in the body, which has been linked to heart-health risk factors like high blood pressure and lower “good” HDL cholesterol. It also negatively impacts sleep and may make you less likely to exercise and eat well. 

A comprehensive report on “Stress in America” by the American Psychological Association found that exercise and listening to music were the most popular stress reducers for both men and women. However, women are more likely to find social and sedentary activities relaxing, such as spending time with friends or reading. While daily physical activity is a crucial heart-health strategy, it’s also essential for women to reach out to their social networks and find time to relax and unwind. 

Last year, Harvard Health reported on a recent study, which suggested that women are less likely to be prescribed aspirin, statins, and certain blood pressure medications than men. Experts attribute this discrepancy, in part, to the general lack of awareness about heart disease in women, which can cause both healthcare providers and patients to miss critical warning signs. 

All men and women, regardless of age, should routinely visit their doctor for the necessary heart-health screenings. During these visits, ask your doctor about your individual risk for heart disease, and discuss the risks and benefits of taking cardiovascular medications, if necessary. It’s also crucial to listen to your body and not minimize or explain away any early warning signs of heart trouble. Take any symptoms seriously and seek immediate help. 

While it’s essential to be your own advocate when it comes to your health, we’re here to support you with exceptional pharmacy care every step of the way. If you are prescribed medications for your heart, our pharmacists would be happy to walk you through dosage instructions and answer your questions. We’ll look for any available savings so you can be sure you’re getting the lowest price, and we’ll deliver your medications to your home for free. Simply tell your doctor to send your new prescription to Alto or contact our care team, and we’ll transfer your existing prescriptions for you. 

Here’s what you need to know about potential changes to your coverage when your plan updates on January 1st. 

What You Need to Know About Your Insurance in the New Year

With a new year comes new insurance benefits, copay costs, and deductible resets. Here’s what you need to know about potential changes to your coverage when your plan updates on January 1st. 

It is common for insurance companies to adjust their rates and offerings each year and then allow people to select new plans or renew their current coverage. The process enables insurers to update their plans based on inflation, the introduction of new medications, and other market changes. It also provides each of us an opportunity to assess and adapt our health insurance needs every year. 

If you had health insurance this past year, you likely went through an “open enrollment” period in the fall. During that time, you learned how your plan was changing and which key benefits would continue. You then had the opportunity to renew your current plan for another year or switch to a new option altogether. 

Why are insurance renewals important right now?

Most health insurance plans operate on a calendar year, meaning any changes take effect on January 1st. We recommend reviewing any recent changes to your plan to avoid unwelcome surprises later in the year. 

Which insurance updates might impact me the most?

As you review your yearly changes, you’ll want to make special note of the following, as these updates could affect your budget: 

Your premium is the cost of your health insurance plan each month. It’s common for your premium to change slightly from year to year, so be sure to double-check if yours is going up.

Your deductible is the amount you have to pay for healthcare services before your insurance starts to help cover the costs. For example, if your deductible is $2,500, you will need to pay that amount for covered services on your own before your copay kicks in. Your deductible resets at the beginning of the year, which could mean a significant uptick in your healthcare expenses until you spend enough to cover your deductible. Make sure to budget accordingly. 

Your copays and coinsurance—the amount you’ll owe for healthcare services after you’ve exceeded your deductible—may also change. Different types of health services can have different copays, so look closely at the ones you think you’ll use most often. 

A formulary is a list of generic and brand-name medications that are covered by your insurance company. The list includes tiers that indicate which medication versions are preferred by your insurer and therefore offered at a lower out-of-pocket cost for you. 

If you have current prescriptions, you’ll want to make sure that your plan still covers your specific medications. You may also want to find out if there is a cheaper version of your medication available that you can discuss with your healthcare provider. If you fill your prescription with Alto, we’d be happy to investigate the options for you and let you know if there are alternatives that could lower your costs. 

For more on decoding common insurance terms, we recommend this helpful glossary from JDRF. 

What can I do if I find out my medications are more expensive?

Combing through insurance updates can be confusing, especially if you discover that you have to pay more for your medications this year. If copay changes and deductible resets affect your out-of-pocket expenses, we’ll search for any available savings, so you’ll know you’re getting the lowest price. 

If your insurance company requires a written request from your doctor to keep you on the same medication because of formulary tier changes, we’ll work with your doctor to proactively file the paperwork. Plus, we’ll keep you informed the whole way. 

Read more about prior authorizations and how we can help here. 

Yes! Your updated health insurance plan may come with new benefits that can save you money and enhance your health. Look for bonus perks like free annual exams and preventative care; discounts on fitness and nutrition programs, gym memberships, chiropractic care, and massage; savings on health products; and reduced vision care rates. Often, people forget to use these benefits, which can mean money left on the table.

As you make your health plan for the coming year, don’t forget the benefits of choosing a better pharmacy. With a simple switch to Alto, you’ll get insurance support, price investigations, and your medications hand-delivered for free. Plus, you can call or text our pharmacists any time for quick advice. If 2020 saw you waiting in line or on hold to access pharmacy support, let this be the year that the care you need comes directly to you.

Ready to switch to a better pharmacy? 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.

If you’re considering fertility treatment for the first time, it’s important to understand the financial hurdles you may be facing. In this article, we’ll explore some of the financial options available and how we at Alto can help. 

Managing the Costs of Fertility Treatment

For hopeful parents who are struggling to conceive, the costs of pursuing fertility treatment can often seem insurmountable. Though assisted reproductive technology (ART) makes it possible for many people experiencing infertility to become parents, the emotional and financial stakes are high. 

If you’re considering fertility treatment for the first time, it’s important to understand the financial hurdles you may be facing. However, there are ways to manage or lower the costs so you can move forward on your path to becoming a parent. In this article, we’ll explore some of the financial options available to intended parents pursuing ART and how we at Alto can help. 

If You Have Health Insurance, Start There

Unfortunately, not all insurance plans cover fertility treatments. As you dig into your plan’s details, you may find that some options are covered with contingencies, while others are not covered at all. It’s best to contact your insurance provider for an in-depth explanation of your fertility coverage. 

Be prepared to ask questions about whether your plan covers diagnostic testing, medications, treatments, and consultations. Ask if there is a cap on coverage or a waiting period required to try certain treatments. You want to walk away with a comprehensive understanding of what your out-of-pocket costs might be.

Several states have enacted legislation that requires insurance providers to cover infertility treatments. The American Society of Reproductive Medicine maintains this online database with information by state.

Many fertility clinics now offer no- or low-interest financing. As you seek out the clinic that’s right for you, inquire about what cost-assistance services are available. It’s perfectly reasonable to seek out a clinic that makes you feel confident and fits your budget.

There are also companies that provide personal loans specifically for fertility treatments, with flexible monthly payment options. At Alto, we’ve worked with companies like Lending Club and CapExMD to help our customers get the fertility medications they need. Most companies allow you to apply online and some even provide budgeting tools on their websites so you can get an idea of what your monthly payments might be. 

There are grants available through government programs, nonprofits, and private companies that can help cover fertility treatment costs. Many are designed to benefit intended parents who demonstrate financial need while others were created to support specific groups, such as veterans or the LGBTQ+ community. There are even some that will award money to those willing to share their infertility story. 

These grants won’t usually cover all of your costs, but they can provide a significant boost. CoFertility keeps a database of fertility grants and other funding opportunities, as does RESOLVE: The National Infertility Association. 

Fertility medications can represent a significant portion of your total treatment costs. At Alto, we’ll always advocate for you to ensure you get the lowest possible prices on your medications. We’ll run a thorough insurance benefits investigation and if your insurer requests a prior authorization, we can work with your doctor’s office to submit it on your behalf. Plus, we’ll remind you to collect any available manufacturer rebates with a monthly email.

If you’re uninsured, we can help you apply for income-based assistance programs like the Compassionate Care Program, which could help you save up to 75% off your fertility medications if you qualify. Even if you are still in the planning stages of your fertility journey, the earlier you can apply to the program, the better. Ideally, you will want to have approval before your fertility prescriptions are sent to your pharmacy. 

We accept ACH (direct) payments and offer a one percent discount for anyone who prefers this option over using their credit card. And don’t forget—with Alto, delivery of your medications is always completely free.

With mail-order pharmacies, you usually have to order your fertility medications all at once to ensure your precisely timed doses don’t get hung up in the mail. Because it’s difficult to predict exactly how much medication you will need, you often end up ordering excess. Not only will these leftovers add to your out-of-pockets costs, but you’ll also end up with wasted medication that you'll have to dispose of when you're done with treatment.

When you fill your prescriptions with Alto, we’ll hand-deliver your medications from our local fulfillment centers. That means we can deliver your medications every few days, avoiding overorders and minimizing how much you spend. 

Finally, we know that your time is the most valuable resource you have, so we’re focused on giving as much back to you as we can. Send us a simple text when you have a question, and keep all your medication information—plus expert advice—at your fingertips using our mobile app. You can also schedule refills and track your shipments from our pharmacy to your doorstep in real time. If you suddenly need to add a day of injections, there’s no need to stress or go running to the pharmacy. We’ll handle the details and coordinate delivery to your doorstep. 

If you’re interested in learning more, you can request a price quote online. Our care team and fertility specialists would be happy to answer your questions about navigating fertility medications. We know that the start of your ART journey can feel full of uncertainty, but we’re here to do whatever we can to make the process easier and more affordable. 

For more on choosing the right fertility pharmacy for your journey, read, “What to Consider When Selecting a Fertility Pharmacy.”

While it’s not always possible to predict the course of your fertility treatment, it can be helpful to set goals and parameters. Is there a maximum number of in vitro fertilization (IVF) cycles you’re willing or able to try? Are there other options you’d like to pursue first, such as intrauterine insemination (IUI)? What are the scenarios where you might try using donors or a gestational carrier, or consider fostering or adoption?

Once you have an idea of your budget, coverage options, and potential out-of-pocket costs, create a roadmap that outlines your treatment goals in relation to your financial, physical, and emotional well-being. 

Remember—dealing with infertility issues can take an emotional toll, especially if some options feel out of reach financially. Know that you are not alone, and there is a community of other hopeful parents you can lean on. Support groups like RESOLVE and The Fertility Tribe offer virtual meetups and online community groups. It’s also essential to lean on loved ones for emotional support during this time. The journey you’re taking isn’t easy, but you certainly won’t be walking it alone. 

Would you like to learn more about how Alto can help you manage your fertility treatment costs? Visit alto.com/fertility or give us a call at 1-800-874-5881. Our team is available 9 am - 9 pm PT Monday - Friday, and 10 am - 6 pm PT on weekends. We’re ready to be your partner through it all, from your first cycle to your last. 

At Alto, we believe that staying on top of your health should be as simple as possible. Here’s how we’re applying this philosophy to feeling our best this winter and creating healthy habits that we can cultivate all year long. 

Alto’s Guide to Wellness in the New Year

It’s easy to feel jaded about setting health goals for the new year. We often enter January with optimism and big intentions, only to find our new habits slipping within days or weeks. But let’s not give up on our health goals altogether. The sense of renewal at the start of the year can be a powerful motivator—provided we don’t saddle ourselves with unreasonable expectations and an “all-or-nothing” attitude. 

At Alto, we believe that staying on top of your health should be as simple as possible. That’s why we built a pharmacy that delivers medications and expert advice directly to you. Here’s how we’re applying this philosophy to feeling our best this winter and creating healthy habits that we can cultivate all year long. 

According to U.S. News & World Report, 80% of New Year's resolutions fail by mid-February. It’s not that we’re incapable of making meaningful changes. It’s that the way we’re accustomed to making resolutions doesn’t set us up for success. 

If you haven’t been exercising at all during quarantine, setting a goal to work out for an hour every day may not be practical. Instead, behavioral scientist, Susan Weinschenk Ph.D., outlines three critical steps for building new habits that stick: start with a small and specific action, tie it to an existing habit, and make it easy to accomplish during the first week. 

Rather than saying you’ll “exercise more” or become a hardcore workout enthusiast overnight, resolve to enjoy your morning coffee while walking, then increase your daily walk by ten minutes the next week. When you anchor your intention to an existing action, you give your brain a natural cue to put it into practice. And since the key to solidifying your new habit is repetition, starting with an easy action will create self-trust and allow you to expand on your goal over time. 

During the darker winter months, you may find your mood dropping along with the temperature. According to the Mayo Clinic, these seasonal bouts of melancholy are likely related to reduced exposure to sunlight, which can upset your circadian rhythm and cause serotonin (the “happy hormone”) levels to dip. 

To combat the effects of winter depression, try to keep your home as bright as possible by keeping curtains and blinds open and sitting closer to well-lit windows when you can. Be sure to spend some time outside every day, even if the weather is cold or the sky is grey. The morning is an especially potent time to get outside and walk around. 

Though it is tempting to go into full hibernation mode, excess sleep can make the issue worse. Try to stick to your usual sleep schedule and get some form of physical activity every day. If you find that your appetite and sleep patterns are adversely affected, or your symptoms interfere with your daily responsibilities, reach out to your doctor or a mental health professional. There are treatments available that can help make the seasonal shift much more manageable. 

Despite your best intentions, your health goals can become sidelined by the season’s viral villains: the common cold and flu. Neither is curable, so a solid prevention strategy is your best bet for staying well. Getting your annual flu shot and following COVID-19 precautions such as wearing a mask and social distancing will undoubtedly help, but your last line of defense is your immune system. 

Experts at the Cleveland Clinic recommend incorporating immune-boosting foods into your winter menu to help your body dispatch any seasonal invaders. Fill your grocery cart with a wide range of colorful fruits and vegetables to ensure you consume a full arsenal of antioxidants. Be sure to stock up on raw garlic, which contains antiviral compounds, along with vitamin-C-rich foods like citrus fruits, peppers, broccoli, and kiwis.

According to the Mayo Clinic, people who don’t get enough sleep are more likely to succumb to sickness after being exposed to a virus. Aim for seven to eight hours of sleep per night to support healthy infection-fighting antibodies and cells. We’ve compiled these tips for getting the nightly rest you need when sleep is elusive.

Unfortunately, no matter how many antioxidant-rich foods you eat, it’s not always possible to avoid coming down with a cold or flu. If you can’t stomach one more raw garlic clove and you’re simply feeling miserable, over-the-counter (OTC) medications can help ease your symptoms and reduce the amount of time you feel knocked off your feet. 

Here are the medications our pharmacists recommend to help you feel better fast.

Not sure why you’re feeling so sick? Read “Cold, Flu, or COVID-19? Your Seasonal Symptom Guide” for clues. If you think you may have symptoms of COVID-19, it’s important to avoid contact with others and call your medical provider right away. 

When you’re sick, your nose can alternately feel like a leaky faucet and a blocked pipe. If you have nasal or sinus congestion, a decongestant, such as pseudoephedrine, can help. For a runny nose or postnasal drip, an antihistamine may do the trick. 

Just keep in mind that antihistamines may make you drowsy, while decongestants may keep you awake. Decongestants come in both oral and spray or drop form. If you’re considering a nasal spray or drops, don’t use them for more than three days in a row, or you may end up even stuffier than you were before (due to a condition called rebound congestion). 

If you’re taking other medications, talk to your doctor or pharmacist before starting a decongestant or antihistamine. Adverse interactions are possible with some medications, such as those that treat heart disease. If you’re an Alto customer, simply reach out by phone, text, or in-app chat, and one of our pharmacists can help determine which medicine may be right for you.

A raw, scratchy throat is often the first painful signal that a cold or flu is coming on. However, it could also be a sign of something more serious, such as a streptococcus bacterial infection (strep throat). Talk with your doctor if the pain in your throat is persistent, severe, or if you have trouble swallowing. For milder soreness, over-the-counter pain medications such as ibuprofen or acetaminophen may help.

Medicated lozenges and gargles that contain oral anesthetics/analgesics such as phenol and benzocaine are also available. These products can provide temporary pain relief for your throat. Just don’t use them for more than a few days in a row. You want to remain aware of whether the pain is progressing and may need a doctor’s attention.  

Coughing from time to time is your body’s way of clearing out your lungs. But constant coughing can be a nuisance at best and pretty painful at worst. 

If your cough is wet, you’ll need an expectorant, which will help to loosen mucus in your chest and throat. Guaifenesin is the active ingredient in OTC cough syrups designed to clear congestion from your airways. 

For a dry cough that just won’t quit, look for a cough suppressant, also known as an antitussive. Cough suppressants help to relieve your cough by blocking the cough reflex. A common antitussive ingredient you’ll see on the shelf is dextromethorphan. 

Though fevers aren’t fun, they’re actually an encouraging sign that your immune system is mobilizing to fight off an infection. According to the Mayo Clinic, except for very young or old individuals, generally healthy people don’t need to take medication to lower their temperature if it’s under 102 degrees Fahrenheit. However, if you’re feeling uncomfortable, a pain-and-fever reducer like acetaminophen or ibuprofen can help with your fever and also soothe muscle aches. 

For When It All Hits You Like a Ton of Bricks

Of course, coming down with a cold or flu is often so unbearable because it brings on a slew of uncomfortable symptoms all at once. Rather than keeping a pile of medications on hand, you can seek out one of the many multi-ingredient “cold and flu” medicines.  

These all-in-one options seem to have endless variations. In reality, they all contain different combinations of the four ingredients we’ve covered: decongestants, pain and fever reducers, cough suppressants, and expectorants. Once you know which basic components to look for, you will notice that there is really no difference between brand name and generic versions of these medicines—except that the generic version is often much cheaper. 

Just keep in mind that combination cold and flu medications often have more ingredients than you need to treat your symptoms, putting you at greater risk of side effects and overdosing. Make a note of the active ingredients in every OTC medication you take and never double up on medications containing the same ones. If only one symptom is truly bothering you, it’s best to stick to medicine that only relieves that specific discomfort. 

When in doubt, talk to your pharmacist. The team at Alto is on call to discuss which medications will be most effective and safe. We’re available from 9 am - 9 pm PT Monday - Friday, and 10 am - 6 pm PT on weekends; download the mobile app for secure messaging, or call or text 1-800-874-5881.

Remember—keep wearing your mask and social distancing to prevent the spread of COVID-19. It will also help keep you safe from catching a cold and flu. Get plenty of sunshine, prioritize sleep, and spice up your meals with immune-boosting foods. With these precautions in place, we hope you’ll be enjoying a healthy winter season ahead. 

Whether you’re pregnant, trying to conceive, or thinking about adding to your family, experts recommend starting to take a prenatal vitamin right away. Here’s what you should know if you’re ready to take a prenatal vitamin for the first time.

Blog

Understanding Chronic Obstructive Pulmonary Disease (COPD)

Using Your Continuous Glucose Monitoring Device

How to Debug Slow and Failing Cypress Seeds

What Every Woman Should Know About Heart Health

What You Need to Know About Your Insurance in the New Year

Managing the Costs of Fertility Treatment

Alto’s Guide to Wellness in the New Year

What to Look for in a Prenatal Vitamin

7 Unusual Heart Health Risk Factors

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

An HIV Prevention Milestone: Truvada Goes Generic

The Lowdown on Healthy Blood Pressure

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