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 insomnia frequently go hand in hand. Racing thoughts are difficult to quiet no matter how physically exhausted you may be when your head hits the pillow. Then, tossing and turning through the night leaves you too fatigued to function at your best the next day, fueling more anxiety and sleeplessness.

There’s a physiological reason for this. Stressors like anxiety and worry can send the body into fight or flight mode. This state of hyperarousal usually fades once the threat is gone. But chronic stress keeps the nervous system in overdrive, pumping out hormones that keep you alert even when it’s time to rest.

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

There’s one place stress doesn’t live: the present. Anxiety typically means fixating on the past or worrying about the future. In focusing on awareness of the present moment, the practice of mindfulness helps you understand when your mind starts to drift from what’s happening right now. Not only can this stop stress in its tracks, by incorporating mindfulness into your routine, you can begin to shift your thought patterns in the longer term.

It’s easy to bring more mindfulness into your life. Just a few minutes of meditation or breathing exercises each day can make a big difference. There are many meditation and mindfulness apps to explore including Insight Timer, which has a library of more than 10,000 free meditations.

Find yourself having stressful dreams or jolting awake in a panic? You could be having trouble letting go of the day’s worries. If that’s the case, experiment with a simple journaling practice to lighten some of the mental load. Before bedtime, take a moment to write down whatever is on your mind, whether it’s tomorrow’s to-do list or anxieties left over from a busy morning. The simple act of putting it onto paper signals to your brain that it can move on (and leave you to sleep in peace!).

The body naturally tenses up during stressful events to protect us from pain or injury. But with chronic stress, 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, tense muscles could be the culprit. You can gently encourage them to relax with a quick 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, neck, and shoulders. Continue on, relaxing one part of your body at a time. You may drift off effortlessly before even making it all the way through. 

Create a relaxing atmosphere to prime your body and mind for deep, uninterrupted sleep. Turn off electronics and keep the lights dim as you get ready for bed. If you sleep near a window, draw your curtains or pull down the blinds to keep outside light from getting in.

Consider temperature as well. The National Sleep Foundation recommends keeping your room between 60 and 67 degrees Fahrenheit to promote a good night’s sleep.

If you’re in a busy neighborhood or have family members or roommates with a later bedtime, white noise or ambient music can help mask disruptive sounds. The Relax Melodies app lets you create your own unique mix of relaxing music and sound, and the Slumber app has a library of sleep-conducive stories and soundscapes.

Ask your provider for additional resources

Stress can be difficult to manage, and it may take some trial and error to figure out what helps you sleep better. If you’re struggling to break the cycle after experimenting with different tactics and find that the sleep deprivation is negatively impacting your mental health, it may be time to talk to your doctor. There are therapy techniques and medications that can help treat insomnia, other sleep disorders, or mental health disorders that contribute to your sleeplessness. If your doctor recommends medication, we’ll be here to help.

Take the stress out of medication management

Alto Pharmacy makes it simple to live your healthiest life by providing an easier, more supportive, and more affordable prescription experience. Our pharmacists are here with information and answers, even during nights and weekends. And the Alto app gives you control and convenience in managing your medications, with auto refills, medication bundling, and custom dosing reminders.

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.

Too Stressed to Sleep? These Strategies Can Help. 

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