Shop Alto Essentials to add pharmacy products to any delivery!

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

Alto Pharmacy Technician

Alto Pharmacist

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. 

Be Part of a Great Place to Work — Join Our Team

Hear first-hand from members of the Alto technology teams.

Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

Resting heart rate varies from one individual to another, but the healthy range for an adult is 60-100 beats per minute. In some cases, issues with the heart’s electrical signals that trigger a heartbeat can cause an arrhythmia. This means that the heart beats too quickly, too slowly, or irregularly.

Atrial Fibrillation, Explained

Atrial fibrillation, often referred to as Afib, is a rapid heart rate caused by irregularities in the heart’s upper chambers, or atria. It is the most common type of arrhythmia. Though the condition increases the risk of having a stroke, it is treatable with a combination of medications, lifestyle changes, and non-surgical and surgical procedures. Here’s what to know about the causes, symptoms, and treatment of atrial fibrillation.

The heart’s natural pacemaker, the sinus node, is located in the upper right chamber. It triggers the signal that begins each heartbeat. Normally, the signal travels from the sinus node through the two atria and into a pathway between the upper and lower chambers. As it travels, your heart will contract, transporting blood both to and from the heart.

Atrial fibrillation begins in the heart’s upper chambers. The signals in the atria are irregular, which causes the upper chambers to shake. As signals try to enter the lower chambers, a fast and irregular heart rhythm is produced.

There are different types of atrial fibrillation categorized by their duration.

Paroxysmal Afib lasts for less than a week and typically does not require treatment.

Persistent Afib is continuous, lasting longer than a week but less than a year. Treatment is required.

Permanent Afib is continuous and treatment-resistant.

Most cases of atrial fibrillation stem from issues with the structure of the heart. These structural issues may be caused by coronary artery disease, a heart attack, a congenital heart defect, or heart valve disease. However, it is possible to develop the condition without a history of heart health issues.

The following risk factors are often linked to atrial fibrillation.

Other health conditions including diabetes, chronic kidney disease, lung disease, or sleep apnea

Not all cases of atrial fibrillation have noticeable symptoms. In some cases, one or more of the following symptoms may develop.

As many as 1 in 3 people with Afib may not know that they have the condition. It’s important to understand the condition’s risk factors and discuss your individual risk with your healthcare provider.

Due to the potential for blood clots, atrial fibrillation can lead to a greater risk for stroke. The irregular heart rhythm that characterizes Afib can lead to the accumulation of blood and the formation of clots in the upper chambers. If a clot breaks off from the heart, it may travel to the brain, causing a stroke.

The risk of a stroke related to Afib increases as you age. Having other conditions such as high blood pressure, diabetes, or heart failure in addition to Afib may also increase your risk for a stroke. Staying on track with treatment and following your doctor’s recommendations is the best way to manage this risk.

Many types of atrial fibrillation are treatable. Treatment often consists of a combination of medication, lifestyle changes, and, in some cases, non-surgical procedures or surgery. Several types of medications are used to treat Afib.

These medications prevent the formation of blood clots and treat existing clots. Commonly prescribed antiplatelets and anticoagulants include:

Direct-acting oral anticoagulants (DOACs) such as apixaban (Eliquis®), dabigatran (Pradaxa®), edoxaban (Savaysa®), and rivaroxaban (Xarelto®)

Beta blockers and calcium channel blockers may be used to manage atrial fibrillation by controlling an individual’s heart rate. Commonly used to treat high blood pressure, beta blockers cause the heart to beat more slowly and less forcefully. Examples of beta blockers include:

Calcium channel blockers slow an individual’s heart rate by opening up narrowed blood vessels and increasing blood flow to the heart. They are often prescribed for individuals who have chest pain or high or low blood pressure in addition to Afib. Examples include:

Digoxin may also be prescribed to slow the flow of electrical currents from the atria to the ventricle.

Slowing down the heart rate is often the first goal of atrial fibrillation treatment. If this has been accomplished, a common next step is restoring the rhythm to normal.

Sodium channel blockers including flecainide (Tambocor®), propafenone (Rythmol®), and quinidine work on the heart’s electrical impulses, slowing its ability to conduct electricity.

Potassium channel blockers such as amiodarone (Cordarone®, Pacerone®), sotalol (Betapace®), and dofetilide slow the electrical signals responsible for atrial fibrillation.

When taking any medication for atrial fibrillation, it’s important to stay on track with follow-up appointments and inform your doctor of any side effects.

If medications aren’t effective, your doctor may recommend a non-surgical procedure or surgery. Two common non-invasive procedures are electrical cardioversion, which resets the heart rhythm with low-energy shocks, and pulmonary vein ablation, which uses heat or cold energy to block electrical irregularities.

While not all cases of atrial fibrillation are preventable, many of the major risk factors are controllable. In general, practicing a heart-healthy lifestyle can lower your risk for the condition. This includes exercising for at least 150 minutes per week, maintaining a healthy weight, limiting your alcohol intake, and refraining from smoking.

Read How to Prevent Heart Disease at Any Age for more on heart-healthy living.

At Alto, we make it as simple as possible to manage your risk for heart health issues and follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

Reach out any time through in-app messaging or by phone at 1-800-874-5881.

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.

HIV treatment has transformed drastically since the virus was first discovered in the U.S. more than four decades ago. While there is no cure, HIV — short for human immunodeficiency virus — has become a manageable chronic health condition like many others.

The Evolution of HIV Medication

Today, the majority of HIV cases in the U.S. do not progress into AIDS, the most advanced stage of HIV. Not only that, but also 57% of individuals living with HIV are not at risk of transmitting the virus to others.

That’s a testament to the effectiveness of antiretroviral therapy (ART), the frontline treatment for HIV. ART is a combination of medications that keep HIV from replicating, stopping the progression of the virus and preventing transmission.

Take a look at the evolution of treatment for HIV and learn how ART works.

Early HIV medication and the introduction of ART

HIV is a virus that attacks your immune system, making you more vulnerable to other illnesses. It is transmitted through contact with the blood, semen, or vaginal fluids of someone who has HIV. As the virus replicates and spreads, it destroys your CD4 cells, a type of white blood cell that plays a role in your immune system.

The first antiretroviral HIV/AIDS medication, azidothymidine (AZT), was approved to treat HIV in 1987. AZT blocked proteins that allowed the virus to replicate and spread. A so-called “monotherapy” consisting of a single medication, it had promising results in early clinical trials but ultimately proved ineffective in slowing the progression of HIV. This was due in large part to the fact that HIV can quickly change into new forms that are resistant to an individual medication.

The introduction of ART in 1995 was a significant breakthrough. By combining multiple HIV medications, it helped prevent the virus’ resistance to a single medication.

ART is a combination of medications that lower your viral load, which is the amount of HIV in your bloodstream. When taken every day as prescribed, these medications can help individuals with HIV maintain an undetectable viral load, virtually eliminating their risk of transmitting the virus to others. This both preserves the strength of your immune system and protects the health of your sexual partners. Many people living with HIV are able to achieve an undetectable viral load within six months of starting ART.

There are several FDA-approved ART therapies available by prescription. Each medication included in the therapy plays a critical role. Collectively, these medications prevent the virus from replicating, reduce your viral load, increase your CD4 count, and restore your immune system.

Currently, there are five types of medications included in ART therapies.

Nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcription inhibitors (NNRTIs), and protease inhibitors (PIs) prevent HIV from replicating.

Entry or fusion inhibitors prevent HIV from penetrating CD4 cells.

Integrase inhibitors (INSTIs) target a critical step in the replication of the virus, preventing replication after HIV has entered a CD4 cell.

Most of today’s HIV treatment protocols combine three medications from two or more of the five classes above. Medical advancements continue to simplify ART, with medication protocols that consist of a single daily pill or a monthly injection.

Your provider will closely monitor your body’s response to your protocol. Thanks to the variety of options, it is easy to make adjustments as needed if you experience side effects or don’t achieve the desired results.

HIV treatment is critical for anyone living with the virus, regardless of how long they have had it. If you have been diagnosed with HIV, starting ART as quickly as possible is the most important thing you can do to protect your health and others.

There are several ways to find a healthcare provider for HIV treatment.

If you have a primary care provider, ask if they offer HIV treatment or can give you a referral.

If you tested for HIV at a clinic, ask if they offer HIV treatment or can give you a referral.

Use HIV.gov’s search tool to find HIV treatment services near you.

Some HIV medications can prevent transmission of the virus to a developing baby. If you or your partner is pregnant, or if you are considering starting a family, let your healthcare provider know so they can recommend the best treatment option.

Taking ART as prescribed in the long term is critical to its effectiveness. That includes not only taking the medication itself, but also attending follow-up appointments and completing lab tests.

If you are having trouble staying on track with treatment, ask your provider or pharmacist for suggestions. Many individuals find it helpful to combine their HIV medication with another daily habit such as brushing their teeth, or to set a reminder on their phone. The Alto app has medication management reminders to help you continue with your treatment.

If you have tested negative for HIV, there are important HIV prevention medications that can help you continue to protect your health.

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken as prescribed. It also reduces the risk of getting HIV from intravenous drug use by about 74%. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners.

Read Debunking Common Myths about PrEP for more on getting started with PrEP.

PEP, or post-exposure prophylaxis, is a medication taken within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. It is only for emergencies and accidental exposures. If you anticipate ongoing risk of exposure to HIV, speak with your doctor about potentially taking PrEP for long-term protection.

Financial resources for HIV treatment and prevention

For many individuals, cost is a barrier to both starting and continuing to take ART and PrEP as prescribed. Fortunately, HIV prevention medication and treatment continue to become more accessible, with generic PrEP options and expanded health insurance coverage of PrEP and ART.

The following resources can also help reduce the cost of HIV treatment and prevention medication:

Patient assistance programs and copay savings cards from medication manufacturers

State-funded PrEP drug assistance programs

Get support navigating HIV treatment and prevention medication

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started and stay on track with ART, PrEP, or PEP. We will coordinate with your healthcare and insurance providers to ensure that you’re receiving the best option for your needs at the best price.

Reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

For the 25 million individuals living with asthma in the U.S., preparing for a trip or time away from home involves a few extra steps. It’s important to pack carefully and make sure you have everything you need to manage your asthma, including medication and medication delivery devices. Additionally, since environmental triggers can worsen certain types of asthma, researching your location and carefully planning your activities and accommodations is key.

A Guide to Traveling With Asthma

Use the suggestions below to prepare for your next trip and read our previous blog, Managing Your Medications While Traveling, for more on what to consider when traveling with medication.

Travel doesn’t always go as expected, so bring more of your asthma medication than you need. Plan ahead to refill your medication in advance of your trip, if needed. If you are prescribed both a quick-relief medication and a longer-term control medication, make sure you have enough of both. Depending on the severity of your asthma symptoms, you may want to order a medical identification bracelet.

Depending on your plans, you may wish to consult with your healthcare provider to discuss how your upcoming travel may impact your overall health or your asthma treatment needs. Ask if there are any recommended vaccines for your trip. 

An asthma action plan documents your individualized treatment plan. It should include what steps to take if your asthma symptoms intensify, a list of your medications and dosages, and your doctor’s contact information. If you have an existing asthma action plan, make sure it’s up to date. If you don’t already have one, work with your doctor to create one before your trip.

View the American Lung Association’s guide on creating an asthma action plan.

Before departing for your trip, review the details of your health insurance plan. Check whether your plan covers doctor’s appointments or emergency visits to a hospital or urgent care in another state or country.

If you are traveling internationally, be mindful that prescription laws vary by country. It’s a good idea to contact the U.S. embassy of the country you’re visiting for more details. Some countries may only allow a 30-day supply for certain medications and/or require you to carry an official prescription or additional information from your doctor with you.

Allergic asthma accounts for approximately 60% of all asthma cases in the U.S. With this type of asthma, inflammation in the airways and the development of asthma symptoms occurs after exposure to allergens. Common allergens, or allergic asthma triggers, include household dust mites, pet dander, and pollen.

If you have allergic asthma, there are steps you can take before your trip to prevent a flare-up of symptoms. For example, when staying in a hotel, request a room that is non-smoking and pet-free. You can also anticipate exposure to pet dander while in transit by contacting your airline or train company and asking about their policies.

There are tools that share your destination’s pollen forecast, including Accuweather and Pollen.com.

Here’s a list of potential asthma medications and medication delivery devices to pack. Some may not be relevant for your treatment plan, and if you’re unsure what to bring, ask your care team. In addition, confirm which temperature your medications should be stored at and take those guidelines into account when packing.

Enough medication for your trip, plus extra

Medication delivery devices including a nebulizer or spacer (if applicable) - if you are traveling by plane, contact your airline in advance to learn how to pack your nebulizer. If traveling internationally, make sure your device will work with power outlets in your destination.

Your health insurance card and provider’s contact information

Medications should always be packed in your carry-on rather than a checked bag. While the U.S. Transportation Security Administration (TSA)’s current limit on liquids, gels, and creams in a carry-on bag is 3.4 ounces (100 milliliters), there are exceptions for medications. Give yourself extra time to allow for screening of these items. If you use a nebulizer, it will likely require additional screening.

Customs officials may ask for proof of your prescription records if your medications don’t have labels or are from another country. If you are traveling internationally, carry physical proof of your prescription to avoid any issues when passing through security or customs. A prescription label or a copy of your prescription will work. (For most inhalers, the prescription label is on the box rather than the inhaler itself.)

While many pharmacy apps allow you to show digital proof of prescription records on your phone, you should have a physical label or prescription copy in case you do not have internet access.

While at your destination, always carry your quick-relief medication with you in case of an emergency. Take appropriate precautions to limit your exposure to asthma triggers. If your allergic asthma symptoms are triggered by poor air quality and pollution, checking daily air quality reports — included on many weather apps and websites — can help you prepare. Avoid exposure to smoke as much as possible.

If you are visiting a location with high temperatures, be sure to stay hydrated and consume enough fluids.

Alto Pharmacy is here every step of the way to make it easy to manage your asthma symptoms and prepare for travel. Our team of pharmacists is available to answer questions about your asthma medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

Reach out by phone at 1-800-874-5881 or in-app messaging to learn how Alto can support your asthma treatment plan.

Living with type 1 or type 2 diabetes does not prevent a healthy pregnancy. Thanks to insulin therapy and effective blood sugar management options, many women with diabetes successfully navigate pregnancy, childbirth, and postpartum. While there are some pregnancy risks and challenges tied to type 1 diabetes specifically, careful planning and proactive diabetes management throughout pregnancy can keep you and your baby healthy.

Navigating Pregnancy With Type 1 or Type 2 Diabetes

Here’s an overview of what pregnancy with type 1 or type 2 diabetes may look like — from fertility to childbirth and beyond — to help you explore your family building options.

Many people with diabetes wonder how the condition will impact their fertility. Having diabetes does not mean you will have more difficulty conceiving. Consistently high blood sugar levels are the main way that diabetes can make it challenging to get pregnant. 

Some research has found that women with type 1 diabetes are more likely to have irregular menstrual cycles or delayed ovulation — factors that affect your fertility — but these health issues are also linked to elevated blood sugar. 

High blood sugar can be managed, and informing your doctor of your plans to build or expand your family early on can help you maintain healthy blood sugar levels before you start trying to conceive.

While every pregnancy carries the possibility of complications, type 1 diabetes is linked to the following.

Preeclampsia — Preeclampsia is a pregnancy complication characterized by high blood pressure that can result in liver or kidney damage. Women with type 1 diabetes may face a greater risk for this complication since they often have higher baseline blood pressure before pregnancy.

Insulin resistance — Hormonal changes during pregnancy can make your body less effective at using insulin, resulting in decreased glucose produced from the liver. (This can lead to the development of gestational diabetes in women without preexisting diabetes during pregnancy.) As the placenta grows, insulin resistance increases. This can affect your blood sugar levels.

Miscarriage — Women with type 1 diabetes have a higher risk for miscarriage — the loss of a baby before 20 weeks — or stillbirth — the loss of a baby after 20 weeks. Birth defects caused by high blood sugar may be a contributing factor.

Macrosomia — Macrosomia refers to a newborn with a higher-than-average birth weight, which can make childbirth more difficult for a mother.

Birth defects affecting your baby’s heart, brain, spine, kidneys, digestive system, limbs, and mouth

In addition, without effective diabetes management, pregnancy can intensify preexisting diabetes-related complications.

These risks are manageable, however, it’s important to prepare for pregnancy in advance of trying to conceive and to stay vigilant about diabetes management throughout this journey. Preconception planning allows you to work toward health goals and ensure that you have an appropriate care team and medication protocol in place.

When planning a pregnancy, consult your healthcare provider before trying to conceive to review your blood sugar levels, make any necessary adjustments to your treatment plan, and evaluate potential diabetes-related health complications. If you become pregnant unexpectedly, contact your provider as soon as you learn of your pregnancy to discuss blood sugar monitoring, medication changes, and other factors that can lower your risk of pregnancy complications.

Here are some action items to focus on in the months leading up to conception. This is intended to be a high-level guide. Consult your care team for a more individualized plan.

Your A1C levels are your average blood sugar levels over a period of two to three months. Your blood sugar levels can impact the development of your baby’s organs during the first 8-12 weeks of your pregnancy, so it’s even more important to maintain healthy blood sugar levels before pregnancy. As you plan for pregnancy, ask your doctor to clarify your A1C goals and how long to maintain them before you try to conceive.

Review your treatment plan and make necessary medication adjustments

Not all medications and supplements are safe to take during pregnancy. Speak with your care team about each medication and supplement you take before trying to conceive. Never stop taking a prescribed medication without first consulting your doctor.

Since there are considerations specific to type 1 diabetes during pregnancy, you may want to look for a healthcare professional who works at the intersection of diabetes treatment and maternal health.

Consider working with an endocrinologist — a physician who treats hormone-related conditions such as diabetes — who focuses on treating pregnant women with diabetes. Alternatively, some OB/GYNs have specialized training in managing diabetes during pregnancy.

You may also benefit from working with a diabetes educator, a healthcare professional certified to coach individuals living with diabetes. They can offer individualized guidance about navigating pregnancy with the condition.

Vigilant monitoring of your insulin needs and blood sugar levels is the most important thing you can do to have a healthy and safe pregnancy. As your pregnancy progresses, pay attention to changes in how much insulin you need. Many women with diabetes experience lower blood sugar during pregnancy. Continue to revisit your treatment plan with your care team and confirm the recommended dosage and frequency of insulin. 

There are diabetes supplies that can make it easier to check your blood sugar more frequently. Many pregnant women with diabetes use a continuous glucose monitor (CGM), an electronic device that collects glucose readings every five minutes throughout the day. Talk to your doctor to learn if a CGM is an appropriate option for you.

Most individuals with diabetes require more insulin throughout pregnancy since insulin resistance typically increases as your pregnancy progresses. You may find it helpful to use an insulin delivery method that eliminates the need for multiple daily injections such as an insulin pump. Additionally, an insulin pen allows for faster administration of insulin injections throughout the day.

Having a birth plan in place can help you prepare for any scenario during labor and delivery. Here is some diabetes-related information to include.

Who will monitor your blood sugar levels during and after labor and delivery?

What diabetes supplies do you need to pack in your bag, if delivering at a hospital or medical facility?

What is the procedure for women who use an insulin pump at your chosen hospital or medical facility? (if applicable)

What is the procedure for women who use a CGM at your chosen hospital or medical facility? (if applicable)

Blood sugar levels can fluctuate during labor and delivery. They often rise during labor but drop just before or immediately after delivery. Your care team can help you prepare for these possibilities. If using an insulin pump or CGM, speak with your doctor about protocol for continuing to wear these devices during delivery.

Many women assume that they will struggle with breastfeeding due to their diabetes. However, you can breastfeed while living with type 1 or type 2 diabetes. The condition may delay breast milk production but this should improve with time.

Keep in mind that breastfeeding takes up energy, which can affect your blood sugar levels and insulin needs. Some research has found that lactation can increase the risk of overnight hypoglycemia, or severely low blood sugar. Make sure that someone around you understands the signs of hypoglycemia and how to address it.

Above all, remember that you aren’t alone in navigating the challenges of type 1 or type 2 diabetes during pregnancy. In addition to your care team and loved ones, the following organizations can help you connect with other women who understand this experience.

Beyond Type 1 and Beyond Type 2 are global online communities for individuals living with diabetes.

JDRF is a destination for type 1 diabetes support and community, with opportunities to connect locally with those affected by type 1 diabetes.

A diabetes pharmacy partner you can rely on

At Alto, we make it as easy as possible to manage diabetes throughout your family building journey. We offer free, same-day delivery of medications and supplies right to your doorstep, and our dedicated diabetes team is here to answer any questions you may have.

Reach out any time via phone at 1-800-874-5881, or in-app messaging.

Redux is great for managing client state: it allows data to be synchronized across the whole app, reduces prop drilling, and makes it easier to understand when state changes occur.

Server state is a different story. Sure, it’s nice to have data available everywhere in our app, which is why we tend to fetch data from the server and dump it into our Redux store. But because our client application doesn't own that server data, it’s hard to know when it has become stale. And what if multiple components trigger calls to fetch the same data? How do you dedupe requests? How do you decide when to refetch?

Why We Switched to React Query for Managing Server State

Redux is great for managing client state: it allows data to be synchronized across the whole app, reduces prop drilling, and makes it easier to understand when state changes occur.

Server state is a different story. Sure, it’s nice to have data available everywhere in our app, which is why we tend to fetch data from the server and dump it into our Redux store. But because our client application doesn't own that server data, it’s hard to know when it has become stale. And what if multiple components trigger calls to fetch the same data? How do you dedupe requests? How do you decide when to refetch?

Below, we’ll dive into how we’re using React Query at Alto to solve these problems and achieve separation of client and server state.

The Old Way: Fetch Server Data and Store It in State

Historically, we would fetch data and set the response in our React component state.

fetchUser(params) {
 this.setState({ isLoading: true });
 
 return getUser(params)
   .then(({ data }) => {
     this.setState({
       isLoading: false,
       user: data.user,
     });
   })
   .catch(() => {
     toaster.toast({ title: 'Something went wrong...' });
     this.setState({ isLoading: false });
   });
}

To make that data accessible from other components, we’d set that data in the global Redux store. This works fine, except that you have to manage your own loading state, the logic for when and when not to make the request, updating the store when mutating data on the server, and knowing when data is stale.

The React Query Way: Fetch and Cache Server Data

With React Query, fetching data and using that data is more declarative.

const { data, error, isLoading } = useQuery(
 // This is our Query Key, which is unique per query so that React
 // Query can manage the cache for us.
 ['user', { userId }],
 
 // This is our Query Function that actually does the data fetching.
 // We can use anything we want: built-in fetch, axios, etc.
 fetchUser({ userId }),
 
 // This query will not execute until the userId exists.
 { enabled: !!userId },
);

Here, we define our query for a user with a Query Key and a Query Function. The Query Key is unique per query, so React Query can manage our cache for us, and if any part of the Query Key changes, the query will automatically fetch new data. In this example, if the user ID changes, the query will fetch new data for that specific user and store that data in the cache.

Naming is hard, but caching is harder. React Query gives us caching of server data out of the box with cache invalidation and request deduping. If we use this same query with the same Query Key in another component, it'll check the cache: if the data is already there, React Query will simply return it, avoiding extra network requests!

Additionally, useQuery runs wherever you use it — no more fetching data when a component mounts. You just use the query and display the data when it’s ready. The cherry on top? The query returns status updates by default, so we don’t need to store isLoading in component state all the time.

Three Optimizations We Get With React Query

When we rebuilt Alto Connect, our web app for healthcare providers, we found impactful benefits in using React Query to help us manage server state instead of using Redux. Alto Connect provides instant access to patient and prescription information and enables messaging with the pharmacy. Because healthcare providers need to quickly switch between patients and clinics, caching data is important to provide a delightfully fast experience. Apart from the cache, what other optimizations do we get by using React Query? Below are a few that helped us.

Once we’ve queried for some data, it gets entered into our cache, so we can utilize that cached data when using the same query in a different component or when fetching new data for a stale query in the background.

React Query is configured with aggressive but sane defaults and considers cached data as stale. Stale queries will always query for new data when the following criteria are met:

The query is optionally configured with a refetch interval

The fetching for new data when the browser window or tab is refocused is especially useful because the healthcare providers using Alto Connect often switch between multiple browser tabs. If there’s an update to a task, status, or message while they’re checking a patient’s medical chart, it will be immediately reflected in the UI when they come back to Alto Connect.

We also set a refetch interval for our queries involving messages. In the old app, we used WebSockets to enable real-time messaging. Although it’s possible to integrate WebSockets with React Query, we opted for a polling solution instead. Because our app isn’t a real-time messaging application, and we don’t need messages to show up immediately, we set a refetch interval on our messages query to poll for new messages every 30 seconds.

const { data, error, isLoading } = useQuery(
 ['user', { userId }, 'messages'],
 fetchMessages({ userId }),
 {
   // This query is disabled from automatically running if we don’t have a userId
   enabled: !!userId,
 
   // Refetch every 30 seconds
   refetchInterval: 30000,
 
   // Continue to refetch while the tab/window is in the background
   refetchIntervalInBackground: true,
 },
);

This is where the enabled option, which disables a query when it evaluates to false, is particularly powerful. We can pause polling for messages if we route to another page and we know that we won’t make any unnecessary requests if there isn’t a valid userId. We don’t have to worry about closing any socket connections or manually clearing an interval.

Most web apps have some sort of navigation menu, and if you already measure or understand your user behavior, you can prefetch data before users even navigate to a different page. Custom hooks makes it easy to expose a function to prefetch data:

export const usePrefetchUsers = () => {
 const queryClient = useQueryClient();
 const prefetchUsers = async () => {
   await queryClient.prefetchQuery(
     ['users'],
     fetchUsers,
   );
 };
 
 return { prefetchUsers };
};

We prefetch queries when users mouseover or hover over a navigation item so that when they navigate to the next page, the data is either actively being fetched or is already in the cache waiting.

We’ve been talking a lot about queries, but what about mutating data? Mutations, in contrast to queries, are imperative. While queries run automatically when we use them, we need to fire a mutation method in order to run mutations. And in order for our user experience to feel snappy, we can optimistically update the cache and then invalidate it after successfully executing the mutation. useMutation gives us some nice side-effect handlers to deal with every stage of the mutation lifecycle. Now when the user sends a message, that new message is immediately reflected in the UI and we keep the data in sync by invalidating the cache and refetching the messages.

With Redux, we needed to build out solutions to each challenge of managing server state. React Query, on the other hand, gives us those tools right out of the box. We no longer need to worry about when to invalidate or fetch new data, making the user experience more predictable — and the developer experience more enjoyable.

Resources for Affording HIV Medication

The HIV treatment and prevention landscape continues to evolve, with many effective medications. Antiretroviral therapy (ART), the frontline treatment for HIV since 1997, is a combination of medications that lower the amount of HIV in your bloodstream. When taken as prescribed every day, ART can help individuals with HIV achieve and maintain an undetectable viral load. As a result, more than half of all those living with HIV in the U.S. are not at risk of transmitting the virus to others.

On the prevention front, PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%.

For many individuals, cost is a barrier to both starting and continuing to take ART and PrEP as prescribed. Fortunately, HIV prevention medication and treatment continue to become more accessible, with generic PrEP options and expanded health insurance coverage of PrEP and ART. In addition, the following resources, including patient assistance programs and copay savings cards from medication manufacturers, can help reduce the cost of HIV treatment and prevention medication.

Read on to learn more about eligibility for these programs, and revisit our previous post on state-funded PrEP drug assistance programs.

Many pharmaceutical companies have patient assistance programs (PAPs) to offset the cost of prescription medications for individuals without insurance or with insufficient insurance coverage. If Alto is your pharmacy partner for HIV treatment or prevention, your medication protocol may include medications manufactured by Gilead, which offers the PAP outlined below.

If your medications are manufactured by a different company, contact them directly to learn about any available financial assistance including PAPs.

Gilead's Advancing Access® Patient Assistance Program

Gilead's Advancing Access Patient Assistance Program provides medication free of charge to individuals without insurance who meet program eligibility criteria. There are several ways to learn if you are eligible:

Call 1-800-226-2056 (Monday-Friday, 9 am to 8 pm EST)

Print the enrollment form and submit it via fax

Copay savings cards from pharmaceutical manufacturers can help offset the cost of prescription medications for individuals with insurance. If Alto is your pharmacy partner for HIV treatment or prevention, your medication protocol may include medications manufactured by Gilead or ViiV Healthcare, which offer the copay savings cards below.

If your medications are manufactured by a different company, contact them directly to learn about any available financial assistance including copay savings cards.

Gilead’s Advancing Access copay savings card

Gilead also offers a copay savings card for individuals with insurance to reduce the cost of copays. Those who are enrolled in any state or federally funded prescription medication program such as Medicare Part D and Medicaid, or who are in the Medicare Part D prescription coverage gap, are not eligible.

Learn more about program eligibility and terms and conditions.

The ViiVConnect Savings Card Program helps eligible individuals with commercial insurance save on copay costs for select ViiV Healthcare medications. Those who are enrolled in any state or federally funded prescription medication program such as Medicare Part D and Medicaid, or who are in the Medicare Part D prescription coverage gap, are not eligible.

If you do not have insurance coverage of prescription medications, contact 1-844-588-3288 to learn about additional financial assistance opportunities from ViiV.

Created to help individuals living with chronic health conditions access the treatment they need, the PAN Foundation offers financial assistance for medication costs, copays, and insurance premiums.

Learn what financial assistance you are eligible for.

The Ready, Set, PrEP program provides PrEP at no cost to eligible individuals without insurance coverage of prescription medications.

Learn more about program eligibility and the application process.

Your financial well-being is our priority

At Alto, we understand how stressful it can be to navigate insurance coverage benefits and savings opportunities. We prioritize your financial wellness, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make ART or PrEP as affordable as possible. In addition to automatically applying coupon savings, we’ll connect you with any outside programs that require you to apply directly.

We also offer free, same-day delivery to make it as easy as possible to stay on track with treatment, and our dedicated HIV support team is here to answer any questions you may have about ART or PrEP. Reach out any time via phone at 1-800-874-5881, or in-app messaging.

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.

It’s understandable to feel overwhelmed after receiving a diagnosis of chronic obstructive pulmonary disease (COPD) — living with a chronic lung disease brings changes to many aspects of life. Many people don’t realize that the condition is highly treatable, and that there are things you can do to slow the progression of COPD. To help you better understand and manage your COPD, let’s take a look at five common misconceptions surrounding this lung disease.

Misconception About COPD

Chronic obstructive pulmonary disease refers to a group of progressive lung diseases. The two primary diseases under this umbrella are chronic bronchitis and emphysema. Most people with COPD have both conditions, but it’s possible to have just one.

Chronic bronchitis and emphysema affect the lungs in different ways. Chronic bronchitis causes inflammation in the airways leading to your lungs, which leads to a chronic cough and increased mucus. Emphysema destroys your lungs’ fragile air sacs, or alveoli, obstructing airflow. When alveoli become damaged, the lungs cannot fully expel air carrying carbon dioxide out of the body, so some of it remains trapped in your lungs. Oxygen-rich air is then blocked from entering the lungs, which causes gradually worsening shortness of breath.

Blog

Atrial Fibrillation, Explained

The Evolution of HIV Medication

A Guide to Traveling With Asthma

Navigating Pregnancy With Type 1 or Type 2 Diabetes

Why We Switched to React Query for Managing Server State

Resources for Affording HIV Medication

5 Misconceptions About COPD

Alto Pharmacy Announced as One of Forbes Best Startup Employers for the Second Consecutive Year!

Understanding the Different Types of Asthma

What is an autoimmune disease?

Managing the Costs of Insulin

Managing Type 2 Diabetes at Any Age

Switch to a better pharmacy.