At Alto, we believe you shouldn’t have to stress over savings. In this blog post, we’ll share how our team works to reduce your cost.

How Alto Saves You Money on Prescriptions

Finding the lowest price for your medications shouldn’t be a hassle. Yet with countless options like rebates, manufacturer coupons, and discount saving programs, knowing where to start can be confusing. Add to that recent headlines that seem unclear and it’s no wonder the search for discounts often leads to frustration. At Alto, we believe you shouldn’t have to stress over how to save on your prescriptions. 

In this blog post, we’ll share how our team works to reduce your cost for most insurance-covered prescriptions. Keep in mind that certain treatment options, such as fertility, often require additional benefits investigation or aren't covered by traditional insurance. If your prescription isn't covered by traditional insurance we can also help with the approval process. But first, let's quickly review how pricing is set. 

Your insurance plan contracts with a pharmacy benefits manager (PBM) whose job is to determine which medications should be covered or not under your insurance plan (even down to the exact dosage and brand that your doctor prescribes). This creates preferred coverage - and therefore pricing - for certain medications.

The PBM negotiates with the drug manufacturers to agree upon a specific price to charge the insurance plan for a medication, the remaining copay that you’ll be responsible for covering, and the PBM’s fee for administering the service.

Pharmacies purchase drugs from third party wholesalers or directly from manufacturers. If you plan to use your pharmacy benefits to pay for your medications, your out-of-pocket price is determined by the PBM+insurance plan. If you’re not using insurance, the pharmacy will provide a cash price.

Some drug manufacturers will also offer coupons, copay cards or financial assistance programs to help patients afford particularly expensive or new-to-the-market medications. 

Confused? Don’t worry. That’s why we’re here to help. 

Need more details? Read Breaking open the black box of medication pricing

We believe medication pricing should be transparent and that you shouldn’t have to investigate savings options on your own. The infographic below compares Alto’s cost saving measures to traditional retail pharmacies and how this impacts your overall cost. 

Every prescription sent to Alto is matched against our database of coupons, copay cards, and other savings options (like manufacturer-sponsored assistance programs). We automatically apply any savings we find so that you can trust you’re always getting the best price. If paying out of pocket will be the cheapest option, we'll be sure to let you know. 
Medications still too expensive? Let us know and we'll work with your doctor to identify alternative medication options, if available. Our price investigation services are completely free. 

A good pharmacy should never leave you to do the pricing legwork on your own. If you’re in the process of finding the right partner for your prescriptions, make sure cost savings assistance is part of the deal. Your financial wellness matters too.

“As a veteran pharmacist, I’ve never witnessed other pharmacies apply the same cost saving services that Alto does automatically,” shares Luisa Nazareno, Patient Care Pharmacist. “Our team understands that price can be a limiting factor in fulfilling prescriptions so we work tirelessly until we can provide our patients the most affordable option. It’s really rewarding to know that we’re helping patients save money and stay on track with their treatment plan.” 

Questions about Alto or pricing on your medications? Our team is available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out by in-app secure messaging or phone.

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

What is a Prior Authorization?

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

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

Medications that may be misused, abused or have adverse effects

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

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

Medical treatments or procedures where medical necessity requires assessment

Why are Prior Authorizations so Important?

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

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

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

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

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

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

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

Questions about Alto or our cost savings approach? Our team is available to answer your questions from 6 am - 9 pm PT Monday - Friday, and 7 am - 6 pm PT on weekends; reach out by phone 1-800-874-5881 or download the mobile app for secure messaging.

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

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

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

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

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

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

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

According to the FDA, this level of variability is unlikely to have an impact, and could also occur between two batches of the same brand medication. 

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

How do the different versions come about?

When a brand-name medication enters the market, it is protected by patents and granted a period of exclusivity. In other words, the company that first created the medication has the sole right to sell it for a certain period of time. 

It takes an incredible amount of money to develop a new medication and see it through the necessary clinical trials—it’s estimated between $2-3 billion per new drug—so this helps drug companies recoup some of that cost. 

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

Why are the generic versions so much cheaper?

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

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

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

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

If you’re prescribed what is known as a “narrow therapeutic index drug (NTI),” your doctor may recommend that you stick to the brand-name version. That’s because small changes in blood concentration can either render these medications ineffective or possibly cause harm. 

If you are taking an NTI, such as certain antiseizure medications and blood thinners, it doesn’t mean that you can’t switch to a generic version if it’s available. You’ll want to fully discuss it with your doctor and ensure that you’re closely monitored if you’re cleared to make the switch. 

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

Unless your doctor has specified that your prescription is only for the name-brand medication, your pharmacist can suggest a generic option instead. Your insurance company may even require that you take the less expensive generic option or pay the difference for the brand-name version. 

The team at Alto will always help you find the best price for your prescription by presenting you with all of the options. If you’re curious about whether a generic version is available for any of your current prescriptions, we’d be happy to talk it through with you. Our pharmacists are just an in-app message or phone call away.

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

Did you know Alto will conduct price investigations for you? Our team is available 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; call 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.

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Your partner in navigating the ins and outs of prescriptions — at no extra cost.

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We’ll search for ways to save you money—including coupons, copay cards, and assistance programs—and apply any savings automatically.

Exhaustive price investigations

Sometimes paying out of pocket is cheaper than your copay. We’ll show you the best option for all your medications.

Transparent pricing options

We work with your doctor and insurance to find you the best price by looking for alternatives when they can save you money.

Coordination with your care team

Have a question about insurance or price coverage? Our pharmacists are just a phone call or message away whenever you need them, even nights and weekends.

Pick the day and time and we'll deliver your medication by hand, right to your door.

Emily's heart medication was going to cost her $487, even with Medicare.

We found her a coupon program that brought it down to $0, and we delivered it to her that night. 

Give yourself access to exceptional care.

We accept most major insurance plans, including government-administered plans, and always work to get you the lowest price we can. Please note that coverage varies by state. For up to date information on coverage in your area call us at 1 (800) 874-5881. 

Nope! Your copay stays the same at Alto. Our team also works behind-the-scenes to find you the best price we can — we’ve saved our patients more than $190 million on their medications.

Will my medications cost more through Alto?

Yes, we accept most FSA/HSA cards! We recommend reaching out to your card issuer to confirm they'll accept transactions from a 90% pharmacy merchant. You can also download your receipts to request reimbursement from your plan by downing your FSA/HSA receipt directly from your Alto account. You can manage your payment options in the Alto app or by calling our team at 1 (800) 874-5881.

Yes, once we process your prescription, you can select one of many free delivery options! We hand-deliver your medications at the time and location that works best for you. We also offer expedited delivery options for when you may need your medication urgently.

You can trust that we’ll work tirelessly to find you the lowest price we can on your medications. We accept most major insurance plans, look for medication savings programs, and offer many fast and reliable delivery options!

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Cost and Insurance | Alto Pharmacy

You can trust Alto will work tirelessly to find you the lowest price on your medications. We accept most major insurance plans, and all our services and delivery are always completely free. Try Alto today!

The lowest prices we can find.

How we save you money

Exhaustive price investigations

Transparent pricing options

Coordination with your care team

Fewer insurance headaches

Free hand-delivery options

Give yourself access to exceptional care.

FAQ

Will I be covered by my insurance?

Will my medications cost more through Alto?

Can I use my FSA/HSA with Alto?

Is courier delivery free?

Believe in a better pharmacy.

The lowest prices we can find.

How we save you money

Exhaustive price investigations

Transparent pricing options

Coordination with your care team

Fewer insurance headaches

Free hand-delivery options

Give yourself access to exceptional care.

FAQ

Will I be covered by my insurance?

Will my medications cost more through Alto?

Can I use my FSA/HSA with Alto?

Is courier delivery free?

From our blog

How Alto Saves You Money on Prescriptions

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

What is a Prior Authorization?

Believe in a better pharmacy.