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

How Updated CDC Guidelines Can Expand PrEP Access

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

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

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

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

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

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

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

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

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

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

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

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

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

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

What Updated CDC Guidelines Mean for PrEP Access

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

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

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

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

Getting PrEP from a pharmacy under the new laws

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

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

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

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

In addition to the initial baseline testing, you will also have to visit a healthcare provider for follow-up testing while taking PrEP, including:

Sexually transmitted infection testing every 3 to 6 months

Pregnancy testing and discussion of pregnancy plans every 3 months

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

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

PrEP is now more accessible and affordable than ever, no matter which state you live in. Excited? We are, too! 

We will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. In addition to our AAHIVP-certified pharmacist team, you can expect:

Discrete, private packaging and free, same-day delivery

Med syncing support and in-app reminders to stay on track

Pharmacists directly available through phone or within the Alto app

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

Expanded PrEP Access at Pharmacies: What to Know

Learn more about the United State Preventative Service Task Force’s Grade "A" recommendation and what it means for your access to PrEP.

What a USPSTF “A” Recommendation Means for PrEP Access

With a Grade A recommendation from the US Preventive Services Task Force (USPSTF), PrEP — an HIV prevention medication that can lower risk of sexual transmission by 99% when taken daily — is now more accessible than ever. Under the Affordable Care Act, most private insurance plans must cover preventive services with an “A” or “B” recommendation from the USPSTF without copays or deductibles. This means that at least one PrEP option will be available at no cost to qualifying individuals on these plans. 

PrEP’s 2019 Grade A recommendation from the USPSTF was implemented this year. Below, we explain more about the Task Force’s recommendation and what it means for your access to PrEP.

The Importance of Preventive Services and the USPSTF

Preventive care — including medications like PrEP, cancer screenings, immunizations, and more — saves lives. These services can prevent serious diseases or detect them early on, when they are more treatable. It’s critical that doctors understand the effectiveness of these screenings and treatments, and the US Preventive Services Task Force was created to fill that need.

The USPSTF is an independent group of prevention experts whose evidence-based evaluations help healthcare providers make informed recommendations for their patients. The Task Force’s membership has expertise in a range of specialties under the umbrella of primary care and preventive medicine, including internal medicine, behavioral health, obstetrics and gynecology, and more. They assign each recommendation an A, B, C, or D grade or an I statement. Here’s what each recommendation means:

“A” Recommendation: The USPSTF recommends the service. There is high certainty that the net benefit is substantial.

“B” Recommendation: The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

“C” Recommendation: Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.

“D” Recommendation: The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

“I” Statement: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Since preventive services are recommended based on a person’s level of risk for a specific disease or condition, there is variation in individual preventive needs. Your primary care provider will recommend screenings and medications depending upon factors like your family history, age, current health status, and more.

With PrEP, the “A” rating and related insurance coverage applies to individuals who are HIV-negative but at high risk of getting HIV from contracting the virus. That includes:

People whose partner is HIV-positive or unsure of their HIV status

The Affordable Care Act and USPSTF Recommendations

Millions of people in the US don’t receive critical, and often life-saving, preventive services. For many, cost is a big barrier. A 2020 study found that 1 in 3 US families postponed medical care services because of the financial strain. And according to the American Journal of Public Health, in the case of PrEP, fewer than 10% of people who could benefit from the medication are taking it.

The Affordable Care Act provision requiring private insurers to cover Grade “A” and “B” preventive services without copays or deductibles was designed to alleviate this financial burden. The Center for Consumer Information and Insurance Oversight (CCIIO) oversees the implementation of law provisions related to private health insurance, and private insurers have a responsibility to monitor USPSTF recommendations and remain compliant with requirements.

While the new provision is a big step forward for HIV prevention, getting the specific brand of PrEP medication you need may require some additional legwork.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. Truvada and Descovy are both effective at preventing HIV, but they are not identical. Some people may need one version over the other due to preexisting health issues. However, the ACA’s provision only requires health plans to cover at least one of the available PrEP options without copays or deductibles.

Government plans including Medicaid typically cover brand-name PrEP medication while most private insurance companies will cover generic PrEP. If your doctor has prescribed a specific brand of PrEP medication not covered by your insurance, a request for coverage may be required. 

This is called a prior authorization. Alto’s dedicated support team can help you understand the details of your insurance plan and will coordinate closely with your doctor’s office on filing prior authorizations to help you get the medication you need. Call us directly at 1-800-874-5881 to confirm coverage.

Too often, preventive services are inaccessible to those without insurance. Thankfully, patient assistance programs for PrEP help make the medication more affordable for those who are uninsured. For example, Truvada’s manufacturer, Gilead, has a Medical Assistance Program for people without insurance, in addition to a copay card for those with insurance.

Alto will automatically conduct a thorough price investigation to identify these potential sources of financial assistance and ensure you're getting the lowest possible price. We also carry a generic PrEP option that currently runs at $36.60 a month out of pocket.*

Read more about PrEP access and affordability.

Get the PrEP medication you need at the best possible price

Getting PrEP at the most affordable price shouldn’t be a hassle. At Alto, our team will do the research for you and coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option. Our pharmacists have deep expertise in many clinical areas, including patients living with HIV, and those taking PrEP, PEP and HRT medications.

Adherence support with pharmacist lab reminders

Pharmacists directly available through phone or within the Alto app  

We’re hard at work the moment we receive your prescription, handling insurance and prior authorizations, as well as making sure you get your medicine, at the best price, delivered at no additional cost. Reach out any time to get started via phone at 1-800-874-5881 or in-app messaging.

Here’s a quick overview on PrEP access and affordability in light of recent updates.

Getting PrEP for HIV prevention at an affordable cost

Pre-exposure prophylaxis (PrEP) is a medicine that prevents people who are HIV-negative but at high risk of getting HIV from contracting the virus. If you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners, PrEP may be right for you. It also reduces HIV risk in those using intravenous drugs. If taken daily, it lowers the risk of getting HIV from sex and intravenous drug use by about 99% and 74%, respectively.

Cost can be a barrier to starting PrEP, but the life-saving medication is now more accessible than ever, thanks to the recent arrival of generic options and changes to private insurance coverage. Still, given the complexities of navigating healthcare, getting PrEP at the best cost may require a bit of legwork and some familiarity with the landscape. Here’s a quick overview on PrEP access and affordability in light of the recent updates.

There are two FDA-approved medications for PrEP: Truvada® and Descovy®. A generic for Truvada called Emtricitabine/Tenofovir disoproxil fumarate became available in October 2020. 

In general, as more generic options become available, the additional competition typically drives down the price of all options, which is already the case with generic Truvada: a 30-day supply of the brand-name version comes out to $1600-1800, while Alto carries a generic option that currently runs at $36.60 a month out of pocket.

Given that generic medications can cost 85% less than their brand-name equivalents, it’s understandable to wonder if the cost disparity is a reflection of quality. Rest assured that generic Truvada is therapeutically equivalent to the brand-name version: generic medications use the same active ingredients as their brand-name counterparts, and they must meet the same standards for safety, quality, and results in order to get FDA approval.

Read the difference between generic and brand-name medications.

Patient Assistance Programs for Brand-Name PrEP

Despite the equivalent nature of generic and brand-name PrEP, your doctor may choose to prescribe a brand version instead of a generic option for various reasons. If that’s the case, there are resources to help reduce the cost of brand-name PrEP. Patient assistance programs have helped many people access these medications at a low cost or even for free. 

For example, Gilead, the manufacturer of brand-name Truvada, has the Gilead Advancing Access® program, which offers a copay card for those with insurance and a Medical Assistance Program for those who are uninsured. Alto will automatically conduct a thorough price investigation to identify these potential sources of financial assistance and ensure you're getting the lowest possible price.

Most private insurers are now required to cover at least one PrEP option

As of this January, most private insurance plans must cover PrEP for HIV prevention without charging any out-of-pocket costs. PrEP has received an “A” recommendation from the U.S. Preventive Services Task force, and as such, it must be covered by most private health insurance plans without copays or deductibles.

However, getting approval for a specific brand of PrEP medication may require some additional legwork. The law requires health plans to cover at least one of the available PrEP options without copays or deductibles. That means if your private insurer covers the generic version of Truvada but you need the brand-name version — or vice versa — you’ll need to go through an additional approval process called a prior authorization. This is a request to your insurance company for coverage of certain medications.

After the arrival of generic Truvada, several insurance companies have decided to stop covering Descovy. While these two forms of PrEP are both effective at preventing HIV, they are not identical. Some people may need one version over the other for preexisting health issues. In these cases, you may need prior authorization approval and could potentially face higher out-of-pocket costs. Alto’s dedicated support team will coordinate closely with your doctor’s office on filing prior authorizations to avoid delays with starting PrEP.

Check your formulary for a breakdown of your plan’s PrEP coverage

Every health insurance plan has a list of covered drugs, called a formulary, which you can locate online or by calling your plan. This is where you can find details about which PrEP medications your plan covers. If a medication isn’t on your “open” formulary, you may have the option of submitting a prior authorization. On the other hand, if you have a “closed” formulary, a prior authorization won’t be approved. Your pharmacy can let you know about your options and whether you have an “open” or “closed” formulary.

One thing to be mindful of is that formularies can change as part of insurance renewals every year. When this happens, an insurance plan can request you to switch from one brand to another, or to a generic version. You may want to ask your healthcare provider if there’s a cheaper version of your medication available. If you fill your prescription with Alto, we’ll do the investigating for you and keep you updated on your best options.

Read our previous post on insurance changes to look out for when renewing your plan.

Get the medication you need without delay

At Alto, we believe that financial wellness plays an important role in your overall well-being. We go above and beyond to ensure that we’re providing the most affordable option, so that you can stay on track with the plan your doctor recommends. We’re here to help you understand which PrEP options your insurance covers, and we’ll do the legwork to make sure you get the lowest possible price.

Switch to a better pharmacy for insurance support, price investigations, and same-day delivery. Feel free to reach out any time via phone at 1-800-874-5881 or in-app messaging.

Getting PrEP for HIV Prevention at an Affordable Cost

Here’s what we know so far about the risk of COVID-19 for people with HIV, vaccine safety, and how to protect yourself from contracting COVID-19. 

What the COVID-19 Vaccine Means for Those With HIV

As of March, 2021, over 115 million people worldwide have been diagnosed with COVID-19. As the COVID-19 pandemic persists, many are wondering what the COVID-19 vaccine could mean for the 38 million people who are living with HIV: is it safe or does it pose a greater risk for these individuals? Here’s what we know so far about the risk of COVID-19 for people with HIV, vaccine safety, and how to protect yourself from contracting COVID-19. 

Are people living with HIV at a higher risk for COVID-19? 

Data is limited and experts are still learning exactly how COVID-19 affects those with HIV, but the Centers for Disease Control and Prevention (CDC) says that those who have HIV (and who are also on effective HIV treatment) generally have the same risk of contracting the virus as those who don’t have HIV. 

So, who is at greater risk? The CDC has evidence that shows older adults and people with certain underlying medical conditions like chronic obstructive pulmonary disease (COPD), type 2 diabetes, and a weakened immune system are at an increased risk for more severe cases of COVID-19. And since nearly half of those living with HIV in the United States are over 50 years old, those living with HIV are encouraged to follow all CDC guidelines to reduce the risk of COVID-19 exposure.

Experts have not found any significant evidence that those living with HIV will experience more severe COVID-19 outcomes; studies performed in Spain and in the United States on a Veterans aging cohort both found no difference in susceptibility to the virus in those with HIV.

Are COVID-19 vaccines safe for people living with HIV?

Yes. According to the United Nations Program on HIV/AIDS (UNAIDS), the COVID-19 vaccines currently being developed or approved by regulators are believed to be safe for most people, including those living with HIV. The COVID-19 vaccines, like other vaccines, undergo the same safety tests and are required to meet rigorous standards. 

Regulators have not yet found any evidence that people living with HIV are at a greater risk from the COVID-19 vaccine in terms of side effects than anyone else.

How does the vaccine work and what symptoms could I expect?

In a recent virtual town hall on COVID-19 and HIV hosted by Getting to Zero San Francisco, experts confirmed that the COVID-19 vaccine has been proven to help reduce the severity of illness from the virus. The vaccine could also prevent infection, reduce transmission, and lead to healthier communities. 

The COVID-19 vaccines work by helping our bodies develop immunity to the virus that causes COVID-19 without us having to actually contract the illness. The different vaccines work in slightly different ways to protect us, but all generally leave the body with a supply of cells that remember how to fight the virus in the future.

After receiving the COVID-19 vaccine, the process of building immunity can result in some people experiencing mild symptoms like a sore arm and mild fever or chills in the days following vaccination. If you have any pain or discomfort, you can talk to your doctor or pharmacist about over-the-counter medications.

How can people with HIV protect themselves from COVID-19?

As you’ve likely heard, the best way to keep from getting sick is simply to avoid exposure to the virus. Everyone, including people living with HIV, should keep taking everyday actions like wearing a mask, staying six feet away from those who don’t live with you, and avoiding crowds, to help avoid contracting and spreading COVID-19.

If you have HIV and are taking your HIV medicine, it’s important to continue doing so and follow any advice from your healthcare provider. This will help keep your immune system healthy and ready to fight off any infection. The CDC also recommends lifestyle practices like eating healthy foods, getting at least eight hours of sleep per night, and minimizing stress as much as you can.

If you develop any symptoms that indicate you might have COVID-19, the CDC recommends calling your healthcare provider and getting tested. Most people have mild illness and can recover at home. If you do develop severe symptoms, the CDC recommends you get emergency medical care immediately.

At Alto, we’re committed to ensuring you receive you medications safely and on time throughout the COVID-19 pandemic. Our pharmacy locations are fully stocked and our pharmacists are on hand to answer any questions and provide ongoing access to support and advice. Reach out to our HIV specialty team through secure in-app messaging or phone at 1-800-874-5881. 

In May 2020, a major clinical trial found that injections of long-acting cabotegravir, an antiviral medication, were highly successful at preventing HIV when taken as a form of pre-exposure prophylaxis (PrEP). We take a closer look at the study to find out what’s likely giving cabotegravir the edge and what this means for the future of PrEP.

What We Know about Injectable PrEP for HIV Prevention

The world of HIV prevention is rapidly changing, with many milestones in recent years. PrEP, or pre-exposure prophylaxis, lowers risk of sexual transmission of HIV by 99% when taken daily, and has helped prevent many new infections since it was approved by the FDA in 2012. There are several FDA-approved oral options — Truvada®, Descovy®,  and a generic for Truvada — and as of December 2021, PrEP is now available as an injectable treatment option called cabotegravir (Apretude®).

Learn more about PrEP in All About PrEP for HIV Prevention.

Health experts believe this latest breakthrough could significantly increase PrEP use and adherence, as clinical studies found that cabotegravir resulted in 69% fewer new cases of HIV than Truvada, a daily pill. Read on to learn what this means for the future of PrEP.

Cabotegravir is a long-acting PrEP medication administered by injection every eight weeks. Prior to cabotegravir’s FDA approval, two parallel clinical trials assessed its safety and efficacy: HPTN 083 and HPTN 084. HPTN 083 looked at men who have sex with men (MSM) and transgender women, while HPTN 084 focused on cisgender women.

Each study randomly assigned participants to one of two arms: half were given a placebo injection and daily Truvada, while the other half received long-acting cabotegravir injections and a daily placebo pill. While both forms of HIV prevention medication are safe and effective, injectable cabotegravir was found to be 69% more effective at lowering HIV transmission rates among MSM and trans women and 89% more effective among cisgender women compared to the daily pill.

While the news about injectable PrEP is undoubtedly a reason for excitement, oral PrEP continues to offer highly effective prevention for anyone at risk of HIV infection. When taken as prescribed, Truvada® and Descovy® are highly effective at lowering risk of transmission. (The rate of HIV acquisition in the studies was low overall, providing further proof of Truvada’s well-studied effectiveness.) However, many people find it difficult to remember to take a pill every day, and inconsistent use of oral PrEP can sharply reduce its effectiveness. The addition of a long-acting injectable form of PrEP offers an opportunity to improve adherence among those who have trouble with a daily regimen or simply find an injection every eight weeks preferable. 

As Debra Birnkrant, M.D., director of the Division of Antivirals in the FDA’s Center for Drug Evaluation and Research, said in December, “This injection, given every two months, will be critical to addressing the HIV epidemic in the U.S., including helping high-risk individuals and certain groups where adherence to daily medication has been a major challenge or not a realistic option.”

Alto is here every step of the way to make it as easy as possible to follow the treatment plan your doctor recommends. Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with oral PrEP. We will coordinate with your doctor and your insurance provider, if applicable, to ensure that you’re receiving the best PrEP option for your needs at the best price, and the Alto app can help you stay on track with tools like reminders and auto refills.

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

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

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 to answer your questions 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends. Download the mobile app for secure messaging or call 1-800-874-5881. 

Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today. In this blog post we'll share an overview of the options as well as how Alto can help you in the path to parenting.

A Guide to LGBTQ+ Family Building

As advances in assisted reproductive technology (ART) and fertility preservation treatment open up new pathways to parenthood, more members of the LGBTQ+ community are choosing to have children than ever before, both as couples and individuals. A 2019 survey from Family Equality found that 63% of LGBTQ+ millennials were considering becoming first-time parents or adding to their growing families.

With many possibilities to consider — including different reproductive procedures and donor options — as well as additional legal complexities to account for, thoughtful research is part of the process. The guide below offers a starting point as you explore your options.

Many LGBTQ+ parents have children by using a donor egg or embryo and/or donor sperm.

Donor sperm allows same-sex female couples and individuals with female anatomy to have biological children through intrauterine insemination (IUI) or in vitro fertilization (IVF), reproductive procedures described in more detail below. The donor can be someone you know (known) or found through an agency (anonymous).

Donor eggs allow same-sex male couples and individuals with male anatomy to have biological children through IVF. Like sperm donors, an egg donor can be known or anonymous. 

It is also an option to use a donor embryo, which is an egg that has already been fertilized by sperm, as some individuals choose to donate unused embryos from an egg freezing or IVF cycle.

Your family building journey may also include a surrogate or gestational carrier, who carries the pregnancy to term and gives birth. Though these terms are sometimes used interchangeably, there is an important distinction: a surrogate offers both eggs and uterus and often plays a role in IUI whereas a gestational carrier has the embryo implanted into her uterus but is not genetically related to the child.

If you are using a surrogate or gestational carrier, think about the type of relationship you’d like to have with them. Some couples become very close with their surrogates while others value more distance. The most important thing is to honor your needs.

Additionally, as part of your planning, determine which aspects of your surrogate or gestational carrier’s medical care you’ll be financially responsible for.

There are two main reproductive procedures to consider: intrauterine insemination (IUI) and in vitro fertilization (IVF).

Intrauterine insemination (IUI) is a simple medical procedure in which sperm is placed directly into the uterus by using a small tube that passes through the cervix. It may be part of the family building journey for both male and female same-sex couples, as well as individuals with female anatomy having a baby on their own. Male same-sex couples pursuing IUI must use a surrogate who will be genetically related to the child.

In the process of in vitro fertilization (IVF), eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. It may include donor sperm, donor eggs, or donor embryos.

When pursuing IUI or IVF as an LGBTQ+ couple, you’ll have to decide which parent will be genetically related to the child. If you intend to have multiple children so that you and your partner can each have a biological connection to them, you’ll want to account for multiple courses of IUI or IVF during your financial planning.

Some LGBTQ+ couples explore reciprocal IVF, or co-maternity, an option for female same-sex couples as well as transgender men with female reproductive organs. In this process, one partner’s egg is implanted into the other partner’s uterus. While only one partner will be genetically related to their child, reciprocal IVF allows both individuals to actively participate in the pregnancy.

Gender affirmation treatment may affect a person’s ability to conceive in the future. Egg and sperm freezing allow transgender and nonbinary individuals to preserve their fertility options and have biological children after treatment or surgery, if they choose to.

Sperm freezing is a relatively simple process in which a sperm sample is collected or surgically retrieved by a doctor. It may be used before estrogen therapy or gender confirmation surgery.

In egg freezing, fertility medications are taken to stimulate egg production. Once the eggs are developed, your doctor will retrieve them from you in a minimally invasive procedure. Your eggs can then be frozen and stored for later use. Depending on how many eggs are yielded, you may have to undergo more than one cycle of egg freezing. This process may be used before testosterone therapy or gender confirmation surgery.

Note that while gender confirmation surgery can permanently affect reproductive function, researchers are still learning about the long-term impact of testosterone and estrogen therapy on fertility. Prolonged testosterone and estrogen use often stop sperm production and ovulation, respectively, but some evidence suggests that these effects may be reversible upon discontinuation of treatment. We encourage you to discuss your reproductive goals and options with your healthcare provider before pursuing gender confirmation treatment, so that you can have as much flexibility in your family building journey as possible.

Take a closer look at fertility options for transgender and nonbinary individuals.

ART and fertility preservation are often significant financial investments, and determining how to pay for treatment is an important part of planning.

Family Equality Council shares this list of family-building grants that can help make ART more affordable. Your clinic may also offer financial assistance programs and payment plans. At Alto, we have resources to help you understand your fertility benefits, compare the costs of cash pricing, learn about financing, or apply for assistance programs.

Read A Financial Planning Guide for Egg Freezing.

If you are exploring the use of a donor or surrogate, it’s critical to research your state’s laws about legal parentage procedures once your baby is born. In some states, a surrogate may automatically receive parental rights after your child’s birth since they are the biological mother, which will have to be legally terminated.

There are more legal complexities to navigate when using a known donor rather than an anonymous one, as an anonymous donor has already surrendered their parental rights.

Explore Movement Advancement Project’s interactive map on parental recognition laws as a starting point. You should also speak with an experienced LGBTQ+ family lawyer in your state before starting the process.

Choose the right fertility pharmacy partner

Alto is here to support your family building journey. We know that there are many paths to parenthood and that each individual or family’s needs are different. Our team of fertility-trained pharmacists has experience working with the LGBTQ+ community, and we’ll be here at every step of the way if you choose to pursue any of the above fertility treatments. We also offer discrete, private packaging and same-day delivery to keep stress at minimum during this special time in your life.

To learn more, request a price quote online or reach out through secure in-app messaging.

A Guide to LGBTQ+ Family Building Options

The Disproportionate Impact of HIV in America

It has been a year full of seismic shifts. A series of core-shaking events ranging from a global pandemic to an upwelling of the Black Lives Matter movement has exposed deeply entrenched inequities in our society. 

We need only look at the statistics emerging from the COVID-19 pandemic to see these inequities at work. According to the CDC, Americans who are Black, Hispanic/Latinx, American Indian, and Alaskan Native are nearly three times more likely to become infected with COVID-19 than white Americans and approximately five times more likely to be hospitalized due to infection. 

Rather than being an anomaly, studies have revealed a health gap between white Americans and Americans of color so wide that it has been named a public health crisis. This divide is perhaps most evident in the disproportionate impact of the HIV epidemic.

The Story of HIV, Told Through the Numbers

Advances in HIV treatment and prevention over the past several decades are reason to feel hopeful. The number of people infected with HIV each year has plummeted by more than two-thirds since the height of the epidemic in the 1980s, and we’ve dramatically transformed the outlook for those living with HIV. However, our efforts to combat the HIV epidemic have stalled in the face of a serious issue—HIV prevention and treatment are not accessible to everyone who needs them. 

According to the CDC, Black Americans are the most affected racial or ethnic group with a lifetime HIV risk of one in twenty for men and one in forty-eight for women (compared to an overall risk of one in ninety-nine for all Americans). Gay and bisexual Black men have been hit hardest of all: it’s estimated that if current infection rates continue, one in two will contract HIV in their lifetime. Gay and bisexual Hispanic/Latino men face a similarly distressing statistic, with an estimated one in four at risk of HIV infection. 

These numbers paint a bleak picture, yet Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, offers hope. “As alarming as these lifetime risk estimates are,” he says, “they are not a foregone conclusion. They are a call to action.”

There is a complex set of socioeconomic factors—such as income, housing, and occupation—that impact a person’s risk of contracting HIV and affect the quality of care they receive. In the United States, HIV infections are mainly concentrated in urban areas and among those of a lower socioeconomic status. 

Like COVID-19 and HIV, poverty rates in the United States reveal clear racial and ethnic disparities. The data shows that one in four Black Americans and Native Americans live in poverty and one in five Hispanics/Latinos. For white Americans, the number is one in ten. 

There are significant barriers to accessing quality healthcare for those living in poverty, including financial insecurity and fear of discrimination. Many services that help to decrease HIV transmission rates—such as prevention education, substance abuse counseling, STI treatment, and antiretroviral therapy (ART)—remain mostly out of reach for these communities. In this way, the people who are most vulnerable to HIV infection continue to face an ever-growing risk. 

An HIV diagnosis today is vastly different than it once was. With antiretroviral therapy (ART), a person living with HIV can suppress the virus and stop the progression of HIV disease. Not only will maintaining viral suppression help them stay healthy, but it also means they will have effectively no risk of transmitting HIV to others. 

For those at risk of infection, pre-exposure prophylaxis (PrEP), an HIV prevention method available by prescription, can virtually eliminate that risk. However, unless we ensure HIV prevention, testing, and treatment are widely available and affordable, we will continue to see tens of thousands of new infections year after year. 

Want to learn more about PrEP? We explain the basics in “All About PrEP for HIV Prevention.”

These are significant issues to tackle, but we can each do our part by talking with our doctors if we’ve never had an HIV test or if we think we may be at risk of infection. We can support organizations like NMAC and Black AIDS Institute that work to make HIV services more accessible to communities of color. And we can encourage our elected officials to help fight HIV through government funding and programs. 

Lastly, we should avoid perpetuating the fear and stigma that’s often associated with HIV. When we talk about HIV openly and neutrally, we help create a culture where everyone feels safe to seek testing and care. 

Looking for a supportive partner to help manage your HIV medications? We’re here for you. Our HIV specialist team is available to answer your questions 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends. Download the mobile app for secure messaging or call 1-800-874-5881. 

We are building a pharmacy where every patient matters and is included. To do that, we need to foster a culture and company that is committed to challenging existing racism, injustice and prejudice, in order to create a culture and service that is inclusive. 

Blog

How Updated CDC Guidelines Can Expand PrEP Access

Expanded PrEP Access at Pharmacies: What to Know

What a USPSTF “A” Recommendation Means for PrEP Access

Getting PrEP for HIV Prevention at an Affordable Cost

What the COVID-19 Vaccine Means for Those With HIV

What We Know about Injectable PrEP for HIV Prevention

An HIV Prevention Milestone: Truvada Goes Generic

A Guide to LGBTQ+ Family Building Options

The Disproportionate Impact of HIV in America

Diversity At Alto: Building an Inclusive Healthcare Company and Culture

Navigating HIV Treatment and Prevention During COVID-19

HIV Health Spotlight: A conversation about PrEP with Dr. Lisa Sterman

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