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.

We want to support you in preparing for your best health. PrEP, or pre-exposure prophylaxis, is an HIV prevention method that's available by prescription. Learn more about who should take it, how effective it is, and possible side effects.

All about PrEP for HIV Prevention

PrEP, or pre-exposure prophylaxis, is an HIV prevention method that's available by prescription. It isn’t a vaccine, though its purpose is similar. It’s a pill that’s taken every day to protect you from infection if exposed. 

With consistent use, the medicine remains present in the bloodstream of an HIV-negative individual. Then, if they’re exposed to HIV, it will block the invading virus from spreading throughout their body. 

According to the CDC, PrEP has been shown to reduce the risk of getting HIV from sex by 99% with consistent use. And it can even reduce the risk for intravenous drug users by 74% if taken daily.

Anyone who is HIV-negative and at risk for HIV infection can choose to take PrEP. PrEP may be right for you if you have a partner who is HIV positive or you do not know their HIV status, are a man having sex with men, are a trans masculine person having sex with men, are a trans feminine person having sex with men, have sex without condoms, are a sex worker, use injection drugs, or are concerned about HIV infection. Your healthcare provider can let you know if PrEP is the right choice for you.

There are currently two FDA-approved medications for PrEP: Truvada® and Descovy®. Both are oral medications that are only available by prescription. Your doctor will let you know which is best for you. Since PrEP should only be taken by those who are HIV-negative, you will need to take an HIV test before you can receive a prescription and also every three months while you’re taking it. You will also need to take a general blood test every six months. Staying on PrEP is a commitment, but these follow-up appointments are crucial for your health. 

Not all providers and health clinics offer PrEP,  but HIV.gov maintains an HIV Services Locator that will help you find a provider near you. 

Telemedicine is an option that can also make the process more accessible—and many more healthcare providers are offering remote consultations. Telehealth services allow you to schedule a phone or video consultation with your healthcare provider then use at-home test kits to complete any required testing through the mail. Talk to your healthcare provider to learn more about this possibility. 

PrEP is usually covered by most insurance plans, including Medicaid. There are also patient assistance programs that can help you access PrEP at a low cost or even free. The Gilead Advancing Access® program offers a copay coupon card for those with insurance and a Medical Assistance Program for those who are uninsured. They’ll help you find out if you’re eligible and may be able to suggest alternative sources of financial support if you are not. If you’re not sure if your insurer will cover your prescription, our team is here to help. We can inquire on your behalf and ensure you get the lowest price. 

Some people may experience side effects like nausea, diarrhea, headaches, and dizziness, however, they usually subside over time. Serious side effects aren’t common, but you should tell your provider if you notice any unusual symptoms. Your doctor will also be monitoring your blood work.

No—and this is important. PrEP needs time to build up in your bloodstream before it can effectively fend off an HIV infection. It will take a period of continuous use (usually at least one week or one month) before it is fully effective, so talk with your doctor about your specific time frame. If you’re engaging in sexual activity, be sure to use another form of protection in the meantime. You can also speak with a pharmacist at Alto if you have questions about how your medication works. 

And remember—if PrEP isn’t taken every day, there may not be enough of it present in your body to prevent infection. It’s extremely important to be consistent. Also, PrEP only protects against HIV infection, so you’ll need to continue using condoms to protect against other sexually transmitted infections (STIs). 

We recommend talking it over with your provider. If they do write you a prescription for PrEP,  the team at Alto can support you through the process of obtaining your medication. Our pharmacists are always here to answer your questions, from how to take it to what to do if you miss a dose. We’ll also deliver your prescription for free, send you quarterly lab reminders, and show you how to use the Alto app to set up daily reminders to take your pill. 

If it’s right for you, the decision to take PrEP is an important commitment to your health and well-being. We’ll be here to make sure the next steps are as easy as possible. 

We want to support you in preparing for your best health. 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 at 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.

If you’ve been stuck in a cycle of wired nights and exhausted days, your body and mind need help remembering how to relax. These strategies can help you break free from unhealthy sleep patterns and finally get some solid shut-eye. 

Too stressed to sleep? These strategies can help.

Stress and sleep can form a pretty vicious cycle. No matter how physically exhausted we feel when our heads hit the pillow, we just can’t seem to quiet our racing minds. Then, after tossing and turning our way through the night, we’re way too fatigued to function at our best. This leads to more anxiety...and on and on and on. 

Stressors like anxiety and worry send our bodies into “fight or flight” mode. Normally, this state of hyperarousal fades away once the threat is gone. But chronic stress causes our nervous system to continually work on overdrive, pumping out hormones that keep us revved up and alert even when it’s time to sleep. 

In the world of mindfulness, we hear a lot about “present moment awareness.” That’s because it’s the one place your stress doesn’t live. If you’re anxious about something, you’re either fixating on a past scenario or worrying about a future event. You’re so stuck looking forward or backward that you can barely focus on the task at hand. The practice of mindfulness is meant to break these toxic thought patterns by helping you become aware of when you’ve drifted from the present moment. In this way, it can actually stop stress in its tracks. 

Try listening to a guided mindfulness meditation as you transition out of “work mode” in the evening or while lying in bed if you can’t sleep. The Insight Timer app is a fantastic resource for free meditations, or try Calm, one of the most popular apps for meditation and sleep. If your employer offers access to Modern Health you might also try their “Body Scan for Sleep” in-app meditation.

Remember—you can’t change the past or control the future, no matter how many times you turn a situation over in your mind. Your best bet is to try to live where your stress cannot. 

If you often find yourself dreaming about a stressful project or jolting awake with a worrisome thought, a simple journaling practice can help. If your mind is swirling with worries as you fall asleep, you could be carrying that mental load into your dream state. Before you go to sleep, spend some time writing out whatever is on your mind. List out items on your to-do list and journal about any anxieties from your day. The simple act of writing it down will signal to your brain that it’s okay to let it go. That way, your brain can go about its nightly tasks and leave you to sleep in peace.  

According to the American Psychological Association, the body tenses up during a stressful event as a way of protecting us from pain or injury. With chronic stress, however, our muscles never drop their guard and remain continuously tightened. If you’ve ever woken up stiff and groggy after a full night’s sleep, your tense muscles could be the culprit. Try gently encouraging them to relax with a simple nightly body scan. 

Focus your attention on an area of your body and mentally tell it to soften and relax. Begin with the area behind your eyes, followed by your jaw, your neck, and each of your shoulders. Continue like that, relaxing one area of your body at a time. You may find you drift off effortlessly before you’ve made it all the way through. 

It’s important to set up a relaxing atmosphere that will prime your body and mind for deep sleep. Turn off your electronics and keep the lights dim as you get ready for bed. If you sleep near a window, make sure that your curtains are drawn to shield you from any outside light or simply hang a blanket or sheet. The National Sleep Foundation recommends keeping the room temperature between 60 and 67 degrees Fahrenheit for the most sleep-conducive environment. 

If you’re in a busy house or area, white noise or ambient music can help mask any disturbances. The Relax Melodies app lets you create your own unique mix of relaxing music and sound, and the Slumber app has a whole library of sleep-inducing stories and soundscapes. Lastly, if you really want to set the mood for sleep, try a diffuser or pillow mist with relaxing essential oils such as lavender or chamomile. Details like these will be especially helpful as you adjust to the time change at Daylight Savings Time. When your mind associates your bedroom with the feeling of being drowsy, you can hit the pillow a little earlier throughout the week and still easily fall asleep. 

Stress can be tricky, so you may need to experiment a bit to find what works for you. If you just can’t seem to break the cycle and a lack of sleep is negatively impacting your mental health, talk to your doctor. There are therapies and medications that can help with insomnia and other sleep disorders. If your doctor does recommend a prescription sleep aid, we’ll be here to help. Let our team take care of the details while you focus on rest.

Ready to take the stress out of your prescriptions? Our team is available to answer your questions through in-app secure messaging or phone.

Too Stressed to Sleep? These Strategies Can Help. 

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Kaiser Permanente insurance plans maintain a restricted network of pharmacies for prescription fulfillment. If you carry Kaiser Permanente insurance, you won’t be able to use Kaiser prescription benefits to pay for the medications that you transfer to Alto. You can choose to pay out-of-pocket at Alto - our prices are still competitive! - and seek reimbursement from your health plan, however Alto cannot guarantee reimbursement.

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