If you are one of the thousands of womxn navigating these changes to your coverage, here’s what you should know about your options.

At Alto, we believe that affordable and equitable access to a medication as basic and fundamental as birth control should be protected by law.

A recent Supreme Court decision has changed the rules that employers must follow when determining what medications will be covered at no-cost by employer-sponsored insurance plans. Per the July 8th decision, employers can now opt out of providing no-cost coverage for contraceptives (previously required under the Affordable Care Act). This change may mean that you now have an increased out-of-pocket costs - or may have no insurance coverage at all - for your birth control medications.

Birth control is essential health care - nine in ten women will use contraceptives in their lifetime. At Alto, we believe that affordable and equitable access to a medication as basic and fundamental as birth control should be protected by law. 

If you are one of the thousands of womxn navigating these changes to your coverage, here’s what you should know about your options:

Generic options - If your current medication now has a high out-of-pocket cost, you can ask your healthcare provider if there are generic options or other alternatives to consider that may be more affordable, while still being safe and effective. 

Coupons and discounts - Ask your pharmacy to confirm they’ve checked for any available manufacturer coupons, copay cards, or savings programs that you may be eligible for.

Health savings account - If you have access to a health savings account (usually available with high deductible health plans), pay for your birth control with your HSA funds. HSA contributions are tax-free.

If you live in one of Alto’s service areas, we will automatically apply any available coupons, search for lower cost alternatives, and coordinate any switches with your healthcare provider so you can have affordable access to your medication, on schedule and without delays. 

Our pharmacies stock dozens of birth control options, all available for free, same-day courier delivery. Reach out to our pharmacists with any questions - we’re available seven days a week via phone, text, email or chat in our app.

1 https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states, https://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-announces-nationwide-fight-for-birth-control

If you are one of the thousands of womxn navigating changes to your coverage, here’s what you should know about your options.

Tips for Navigating Birth Control Costs

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 text or phone at 1-800-874-5881, or in-app 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 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.

Getting PrEP for HIV Prevention at an Affordable Cost

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

Discrete, private packaging and free, same-day delivery

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

Pharmacists directly available through phone, text 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 text or phone at 1-800-874-5881, or in-app messaging.

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You’ve made a commitment to your health, so here’s our commitment to you: free deliveries, quarterly lab reminders, and expert pharmacist support to answer any of your questions.

Your patient care and pharmacist team at Alto has deep experience in your medication regimen. You’re in this for the long haul, and we are, too.

Alto’s very first deliveries were birth control medications. We’ve grown, but our pharmacies still stock hundreds of options for you.

A new diagnosis can bring both reassurance that there’s a plan and worry about what’s next. Alto has all the medication you’ll need to feel in control and on the path to feeling better.

"Alto was a lot easier and always a lot more reliable than going to the pharmacy"

My medicine doesn’t seem to be working.

This acne medicine is upsetting my stomach.

When you have questions about side effects, or are worried about missing a dose, or not sure if you’re administering it correctly — we’re here to lend a hand.

With Alto, you won’t have to fight the lines at the pharmacy. Our couriers hand-deliver your medication to your door, whenever and wherever you need it.

Ask your doctor to send your prescription directly to Alto or ask us to transfer refills from your old pharmacy. We’ll look for any savings, including coupons and assistance programs, and reach out when it’s time to schedule your free delivery.

Yes. As a full-service pharmacy, Alto can fill nearly all medications, including specialty, over-the-counter, brand, and generic. Alto’s pharmacists have deep expertise in many clinical areas, including heart and lung health, diabetes, fertility, HIV/PrEP/HRT, and more.

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

Wellness and prevention, on your terms.

We’re specialists in medication for:

PrEP

Hormone replacement therapy

Birth control

Sexually transmitted infections

"Alto was a lot easier and always a lot more reliable than going to the pharmacy"

Ask your pharmacist, not the Internet.

Free hand-delivery to your door.

FAQs

How does Alto work?

Do you carry my medication?

Will I be covered by my insurance?

Switch to a better pharmacy.

Wellness and prevention, on your terms.

We’re specialists in medication for:

PrEP

Hormone replacement therapy

Birth control

Sexually transmitted infections

"Alto was a lot easier and always a lot more reliable than going to the pharmacy"

From Our Blog

What a USPSTF “A” Recommendation Means for PrEP Access

Getting PrEP for HIV Prevention at an Affordable Cost

Tips for Navigating Birth Control Costs

Ask your pharmacist, not the Internet.

Free hand-delivery to your door.

FAQs

How does Alto work?

Do you carry my medication?

Will I be covered by my insurance?

Switch to a better pharmacy.