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 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text or the app.

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 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; call or text 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 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. 

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

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.

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 a chat, text, 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 - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; call or text 1-800-874-5881 or download the mobile app for secure messaging.

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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 all medications, including specialty, over-the-counter, brand, and generic. Alto’s pharmacists have deep expertise in many clinical areas, including dermatology, specialty, fertility, HIV/PrEP/HRT, psychiatry, and more.

Yes. We accept all major insurance plans, including government-administered plans, and always work to get you the lowest price.

We coordinate with your doctor to help you manage a wide range of conditions, everything from arthritis to asthma to HIV.

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Alto pharmacy has experts in every aspect of care, from everyday issues to complex conditions. General Health. Diabetes. Heart Health. Sexual Health. Specialty. Try Alto today!

Your doctor’s orders are ours, too.

We’re specialists in medication for:

HIV

Hepatitis C and Infectious Diseases

Asthma and COPD

And more

"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.

Your doctor’s orders are ours, too.

We’re specialists in medication for:

HIV

Hepatitis C and Infectious Diseases

Asthma and COPD

And more

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

From Our Blog

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

What is a Prior Authorization?

All about PrEP for HIV Prevention

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.