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In celebration of Hispanic Heritage Month, which takes place from September 15 - October 15 every year, Alto is highlighting the important work of Alto Auténtico, our Latinx employee resource group (ERG).

Get to Know Alto Auténtico, our Latinx ERG

In celebration of Hispanic Heritage Month, which takes place from September 15 - October 15 every year, Alto is highlighting the important work of Alto Auténtico, our Latinx employee resource group (ERG)*. Below, Robert Barahona, Provider Success Specialist and co-leader of Alto Auténtico, shares more about the group’s origins, current initiatives, and plans for the future.

Robert: “Auténtico” means authentic in Spanish, and authenticity is central to the ERG’s mission. The group was created to ensure that Alto’s Latinx team members have a presence and a voice within our company culture, and that they are supported in their professional development with meaningful opportunities to grow at Alto.  

Robert: Our focus is both internal and external. In addition to developing a Latinx community at Alto, we also shape Alto’s product and services so that we’re better serving our Latinx users (more about that later). Much of that work involves building awareness of Latinx history and cultural contributions, as well as bringing attention to negative stereotypes that we want to dismantle.

We use holidays and events like Day of the Dead (November 1st and 2nd) and Cesar Chavez’ birthday (March 31) to share educational resources with our team members. On Cinco de Mayo, we hosted a Zoom happy hour and a taco lunch for all our pharmacies.

For last year’s Hispanic Heritage Month, we invited Dr. Robert Rodriguez, the president of diversity consulting firm DRR Advisors and a thought leader in Latinx talent management, to speak at Alto. He shared about his own journey of repressing his background to assimilate in the workplace to fully embracing his heritage and empowering other Latinx employees to be their authentic selves.

How are we celebrating Hispanic Heritage Month this year?

Robert: We’re focusing on celebrating Latinx intersectionality. It’s important to recognize the diversity within Latinx culture and the important perspectives of Latinx women, LGBTQ+ individuals, and those of mixed heritage, including our Black and Asian members who also identify as Hispanic or Latinx. Every week during Hispanic Heritage Month, we’re educating the full Alto team about a specific group within the broader Latinx community, with resources for additional learning.

What can team members look forward to from Alto Auténtico in the future? 

Robert: We’re really excited to continue to help shape Alto’s services and resources for customers, making our offerings as inclusive as possible. We’re currently working with the operations, product, and marketing teams to establish a bilingual team to support Spanish-speaking individuals using our pharmacy delivery services across all of our communities. 

We’re also launching a mentorship program in which Alto’s junior Latinx team members will be paired with senior Latinx team members for coaching sessions. This is another important step in continuing to invest in our Latinx team members’ professional development.

How can allies recognize Hispanic Heritage Month?

Robert: Great question! I think learning is key. Simply taking the time to educate yourself about the Hispanic and/or Latinx experience — particularly about our diversity as a group — goes a long way toward building trust, which is key to true allyship.

Interested in learning more about the Alto Auténtico employee resource group? Reach out to altoautentico@alto.com and visit alto.com/careers to learn more about our open roles. 

*ERGs are meant to empower community groups within an organization by directly linking decision makers and implementing policies that support the group’s specific needs. The groups often center around a shared identity or experience and focus on building community, providing support, and contributing to its members’ personal and professional well-being. By creating an open forum for employees to come together, discuss challenges and opportunities, and foster a sense of belonging, ERGs help both individuals and organizations thrive.

In celebration of Hispanic Heritage Month, which takes place from September 15 - October 15 every year, Alto is highlighting the important work of Alto Auténtico, our Latinx employee resource group (ERG)

Reproductive endocrinologist Dr. Guy Ringler — a former faculty member at UCLA and an advisory board member at Men Having Babies — was one of the first doctors in the world to help gay men have children through assisted reprodutive technology.

Spotlight on Men Having Babies & Dr. Guy Ringler

There are many ways to start a family and raise a child. And as recent decades have brought forth milestones in marriage equality and the fight for LGBTQ+ rights, the options for LGBTQ+ family building have also expanded.

According to 2019 data from the Williams Institute, almost 29% of people who identify as members of the LGBTQ+ community are raising children, up from 16.2% between 2014 - 2016. That includes a growing number of gay men who’ve had children through surrogacy, a process in which a woman who is not related to the child — a gestational surrogate — carries a baby who is biologically related to one of the fathers and an egg donor.

Breaking down barriers to LGBTQ+ family building

Reproductive endocrinologist Dr. Guy Ringler — a former faculty member at UCLA and an advisory board member at Men Having Babies — was one of the first doctors in the world to help gay men have children through assisted reprodutive technology. Throughout the twenty-five years that he’s been in practice, he’s seen how scientific advances and cultural changes have broken down barriers for gay men interested in parenthood.

“Over two decades ago, when I began my career, people barely understood the concept of surrogacy for gay men,” he says. “It wasn’t as easy to find women who wanted to become surrogates for gay couples. There was still fear about HIV, and there were questions about the impact of surrogacy on a child’s development.”

The landscape looks a lot different today. Thanks to cultural shifts and greater understanding of the science behind surrogacy — and to awareness-raising organizations like Men Having Babies — there are now more options than ever to become a parent regardless of your sexual orientation or gender identity.

“Greater acceptance of the LGBTQ+ community and marriage equality has opened people’s minds and allowed them to see that gay families can thrive, just like any family,” Dr. Ringler says. “Gay men are now able to plan for a future that we once didn’t know was possible.”

Getting to meet prospective fathers at Men Having Babies’ annual conferences is one of Dr. Ringler’s favorite things about working with the organization. He’s observed a greater number of gay men pursuing parenthood at an earlier age.

“I’m so inspired by the next generation of gay men, who are planning their families in their twenties. That simply wasn’t an option when I was their age.”

Men Having Babies and financial assistance for IVF and surrogacy

There are many steps on the road to parenthood for LGBTQ+ individuals and couples: fertility treatments, legal consultation, and financial planning are all required to start a family.

“Having a baby doesn’t just happen for gay men,” Dr. Ringler says. “It takes thoughtful planning and there are many decisions along the way.”

That’s why support from organizations like Men Having Babies is so critical. The organization started as a program at The Center (formerly the NYC LGBT Center) in 2005 and officially became a nonprofit in 2012. Today, Men Having Babies supports thousands of gay men and couples around the world in starting their families through surrogacy, with monthly workshops, annual conferences and financial resources. 

Determining how to pay for IVF and surrogacy is an important part of planning your family. As part of the process, Dr. Ringler suggests mapping out a vision for your family. Knowing how many children you want can help you prepare for the cost: “When you’re making the commitment to start a family as a gay man, think about how you will financially support the decision. It may feel overwhelming, but it’s similar to the process of buying a house. If it’s really important to you, you can find a way to make it work.”

There are many resources to help alleviate the cost, including Men Having Babies’ Gay Parenting Assistance Program (GPAP) . The program offers different forms of financial support, including:

Discounted and free services donated by more than one hundred leading IVF, surrogacy, egg donation, and legal service providers to prospective parents (Stage I support)

Discounted and donated ancillary services, including fertility medication, escrow services, and insurance resource services (Stage I support)

Cash grants for approved prospective parents based on income eligibility (Stage II support)

Learn more about the criteria for applying to Stage I or Stage II support from the GPAP.

You must be a member of Men Having Babies to receive financial assistance. You can become a member by making an annual donation of $150 or more. Learn more about the membership process.

In addition, EMD Serono offers financial assistance for fertility medications and Family Equality has a list of family-building grants that help LGBTQ+ families afford fertility treatment. Be sure to also ask your fertility clinic or pharmacy about available financial assistance programs and payment plans.

The importance of researching your options

As Dr. Ringler emphasized, gay men building a family through IVF and surrogacy have many decisions to make throughout the process. For that reason, it’s important to thoroughly research your options and to work with a medical team that you trust. Here are some additional considerations to be mindful of as you plan your family.

Understanding the process of IVF and surrogacy

In IVF, eggs and sperm are combined in a laboratory. When gay men conceive through IVF, the sperm will come from one of the fathers and the eggs will come from a donor. Then the fertilized eggs, or embryos, are placed into the uterus of a gestational carrier who will carry the baby to term.

Not only is this an exciting time for expectant dads, as Dr. Ringler notes, but surrogates can play a big role in raising awareness of LGBTQ+ families.

“In my experience, surrogates who are asked when their baby is due while out in public may feel comfortable sharing that they’re having a baby for a gay couple. This helps open up more people’s minds to the possibilities for LGBTQ+ parenthood.”

Understanding your goals for your relationship with your surrogate is one of many key decisions, and there is a spectrum of options. Some couples cultivate intimate relationships with the surrogates while others prefer to remain more detached. There’s no one right choice — it’s all about understanding what’s best for you.

“If your surrogate wants a little distance, that does not mean that they are any less committed to the process,” Dr. Ringler says, adding that it’s important to discuss your preferences in an open discussion with your surrogacy agency.

Deciding who will be biologically related to the child

Another important decision for same-sex male couples is deciding which parent will be genetically related to the child. When heterosexual couples have babies through IVF, both parents can contribute their genetic material, so that the baby is biologically related to both, even when using a gestational carrier. 

But with gay men, only one father can contribute his sperm per pregnancy, so it’s important to discuss this decision with your partner if having a child as a couple. Some fathers fertilize multiple eggs so that both can have a biological connection with one of their children. Taking time to identify your family building goals will allow you and your partner to plan for the financial cost of more than one round of IVF, if you choose to pursue that option.

Keep in mind that you can establish a legal paternal relationship with your child even if you are not biologically related to them. It’s critical to research your state’s laws about legal parentage procedures once your baby is born. Movement Advancement Project’s interactive map on parental recognition laws is a good starting point. 

Be sure to speak with an experienced LGBTQ+ family lawyer in your state before starting the IVF and surrogacy process. There are many forms of financial support to help alleviate the cost of these legal services, like Men Having Babies’ Gay Parenting Assistance Program.

There's a wide selection of available egg donors, and one of the factors to consider as you choose yours is whether they will be anonymous or open. With an open donor, you can more easily answer any questions your child may have about their genetic background. However, some families prefer anonymous donors, and sometimes an anonymous donor’s physical or personality traits better fit your goals. Both paths are viable options, and it all comes down to what’s right for your family.

Regardless of which option you choose, Dr. Ringler notes that you should be prepared to share information with your child about how they were conceived. You can even get creative with how you share their journey: some of Dr. Ringler’s patients have created story books for the whole family to read together, which helps children understand their background and feel proud of who they are.

Seeking support for your family building journey

While there are many paths to take, and many decisions to make, as you build your family, all will lead to the same destination of parenthood.

“I personally had a very close relationship with my mother growing up, and as gay men, we can’t guarantee our children that same experience,” Dr. Ringler says. He notes that if you have an open donor, your child’s biological mother may be able to have a presence in their life, which is another important factor to consider when planning your family.

But regardless of your chosen family structure, “I’ve seen again and again throughout my career that all you need to start a happy, healthy family is love and fun.”

One thing that’s certain: family building as a gay man is much easier to navigate with support from organizations like Men Having Babies. If you’re feeling overwhelmed while planning for a family, remember that you don’t have to go through this journey alone. Men Having Babies understands the challenges specific to building a family as a gay man, and their resources can help you fulfill your dreams of becoming a parent.

Learn how to become a member of Men Having Babies.

At Alto, we’re proud to support Men Having Babies, and we’re happy to be a part of your family building journey if fertility prescription medications become part of your plan. Reach out any time to get started though the Alto app  or 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.

Get an inside look at the patients team at Alto Pharmacy to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

Get to Know the Team That Builds Alto's Customer-Facing Apps

Imagine an app that allows you to buy things and have them delivered to you the same day, for free. Now take that app and put it in a highly regulated space like pharmacy. You face the challenge not only of building an e-commerce platform from scratch, but also of navigating medication pricing, federal and state regulations, and patient safety—and that's just the way the Patients Team likes it.

"It's a really exciting and fun problem to solve," says Mike Riess, the team's Engineering Manager. Software Engineer Angelique Nehmzow agrees: "There's a really strong product and design aspect, like more traditional startups, but then everything gets a little bit more interesting because it's healthcare."

Below, we chat with the team to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

What does the Patients Team do at Alto? 

Ask anyone on the team why they joined, and chances are, they'll tell you they wanted to be on the product team closest to Alto's customers: "We really try to own the customer experience," says Peter Zeng, the latest Software Engineer to join the team. "If a customer is coming to the web app, or they're coming to our mobile app, we want to make sure that they're able to onboard with us as easily and conveniently as possible."

The team is also responsible for the customer experience beyond onboarding, from the moment a customer schedules a medication for delivery to the time that it shows up on their doorstep. "We already offer great services like free, same-day delivery and cost savings. The Patients Team empowers customers to make the most of our offering," Nehmzow explains. "You can see what prescriptions you have, check on the status of your order, and schedule automatic refills. In a more traditional pharmacy, you don't get that kind of visibility. You have to call them up or even wait in line in person. At Alto, it's a different experience."

What was it like in the team's early days?

Today, there are eleven engineers on the team working to build that better end-to-end experience—but it wasn't always that way. When the team first formed in 2019, it consisted of just three members: Riess, Brian McRae, and Andy Lau, all of whom are still on the team.

"The first priority for us was just stabilizing the foundations," Riess says of the team's early days. Every other week, the three team members, along with Alto co-founders Matt Gamache-Asselin and Jamie Karraker, would meet to audit the app's core flows. "For the first three months we probably didn't make it through some flow at least 50% of the time," Riess recalls. "There would be a ton of bugs in the onboarding experience, things that weren't working with the flows or navigation or deep linking."

Among the team's first projects was a redesign of the checkout flow. "There was a lot of work to be done to streamline the checkout flow, which is pretty much the main function of the app," says McRae, who initially joined the team as a software engineer and later transitioned into product management. "We had to make it easier to add a payment, add your addresses, everything you need to do to schedule your prescription for delivery."

"The growth of the team, in terms of both size and stability of the platform, has allowed us to swing at more interesting bets for the company," Riess says. In particular, the Patients Team has turned their attention toward experiences personalized for specific medical conditions.

"Different customers have different needs. A customer who wishes to start a family will have a different experience than a customer who needs to order their routine heart medications that they've been taking for the last eight years,” McRae says. “The challenge for us is how we serve all these customers well through the app."

"I think that's where Alto can be such a differentiator," Riess adds. "A world-class pharmacy experience is about so much more than just dispensing medications. We want to build tools for customers that help them get the most out of their medications—everything from simple videos teaching them how to perform injections safely at home to the ability to synchronize deliveries for multiple prescriptions for managing complex health conditions."

With these new projects on the horizon, engineers have ample opportunity to focus on the areas that excite them most. "We're full-stack and mobile and web," Nehmzow says. "Part of the team focuses more on experimentation, iterating quickly, and using data to make decisions. Part of the team focuses more on platform work, tooling, and improving the developer experience. There are a lot of areas to explore and contribute to."

One spring night, the Patients Team gathered in a back yard in San Francisco’s Mission District for short ribs and an impressive spread of side dishes. "Kudos to Robbi, who's the grill master. I just provide the grill!" Nehmzow says, laughing. While the team barbecue was the first time some members had met in person, Zeng notes that the team has been supportive of one another even while working remotely during the pandemic.

"The first real project that I was assigned to was working with the communications system. Before writing my first piece of code, I spent two weeks exploring what already exists and understanding the different parts of the system," Zeng says. "I've been really impressed with how understanding my teammates have been. They make the space for you to learn all the different pieces of code we own."

That culture of support is by design, reflected in the six principles—complete with matching emojis—at the top of the #patients-team Slack channel: "Empower each other," "be an owner," "find the path," "learn by doing," "embrace complexity," and "foster trust." 

While these principles echo Alto's company-wide values, they are unique to the Patients Team. "For a long time, we were the only external-facing product team at Alto," Riess says. "These principles were intended to be this motivation around how we win. It's a combination of how we treat each other, how we reason about decision making, and how we approach solving a problem that's never existed before."

As the team looks toward the future, those principles have never been more relevant: "We have a goal and an area we want to focus on, but in terms of which projects we're going to do, it's not a top-down thing," Nehmzow says. "It's very much, 'We're going to figure out how to solve this problem together, even when it's difficult.' That's my favorite part about the team."

The Patients Team is hiring! Learn more about open positions here.

Many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply.

What to Know About State-Funded PrEP-DAP Programs

Cost is often a barrier to starting PrEP, a medication that can lower your risk of sexual transmission of HIV by 99% when taken daily. Fortunately, the HIV prevention landscape is rapidly evolving, and PrEP is now more accessible than ever.

As of this January, most private insurance plans must cover PrEP for HIV prevention without charging any out-of-pocket costs. In addition, many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply for state-funded PrEP drug assistance programs — also referred to as PrEP-DAP or PrEP-AP programs —  in four of the states that Alto serves.

The State of California’s PrEP Assistance Program (PrEP-AP) helps cover PrEP-related medical expenses, with different benefits for individuals without insurance, those with private insurance, and those with Medicare.

You can receive Truvada®, one of the two FDA-approved PrEP medications, free of charge through Gilead’s Advancing Access® Program. California’s PrEP-AP will also provide financial assistance with all other medications on the PrEP-AP formulary for HIV prevention and treatment of sexually transmitted infections (STIs) and the following PrEP-related medical services:

To be eligible for the assistance, you must receive all PrEP-related medical services at approved locations within the California Department of Public Health’s Office of AIDS PrEP-AP Provider Network. Search for a California PrEP-AP provider or enrollment site near you. 

Gilead’s Co-Payment Assistance Program covers up to $7,200 of Truvada® copays per calendar year. Once you’ve met this threshold, California’s PrEP-AP will cover any remaining PrEP copays for the rest of the calendar year, in addition to assistance for out-of-pocket costs for PrEP-related medical services and all other medication on the PrEP-AP formulary for HIV prevention and STI treatment. To be eligible for assistance with PrEP-related medical services, you must see a provider in your insurance plan’s network.

If you have prescription medication coverage through Medicare, you are not eligible for financial assistance from Gilead, but California’s PrEP-AP offers financial assistance with copays for all medications on the PrEP-AP formulary including Truvada®.

If you do not have prescription medication coverage through Medicare, you are eligible to enroll in Gilead’s Patient Assistance Program and receive Truvada® free of charge. In addition, California’s PrEP-AP will provide assistance with all other medications on the PrEP-AP formulary.

Anyone who has outpatient coverage through Medicare is also eligible to receive assistance from California’s PrEP-AP for PrEP-related medical services. However, you must see a provider in your plan’s network.

To be eligible for California’s PrEP-AP, you must:

Have a negative HIV test dated within six months of the PrEP-AP application

Have an annual Modified Adjusted Gross Income (MAGI) that does not exceed 500% of the Federal Poverty Level based on family size and household income

Not be fully covered by Medi-Cal or other third party payers

Be enrolled in the manufacturer's assistance program, if eligible

Colorado’s Public Health Intervention Program (PHIP) helps cover PrEP expenses for anyone living in Colorado who has an income less than 500% of the Federal Poverty Level.

If you have insurance, you must apply for the Gilead copay card to receive the assistance. If you do not have insurance, you must apply for Gilead’s Advancing Access program and see an approved PHIP-PrEP medical provider.

You can apply online or by mail. You must provide the following documents:

Proof of income (one month's worth of paystubs, award letter, etc.)

Gilead Co-Pay Card, if you have insurance

PHIP is not eligible for those with Colorado Medicaid. However, if you have Colorado Medicaid, your PrEP costs should be covered at a $1-3 copay for both medication and related medical services.

The New York State Department of Health’s AIDS Institute has a PrEP assistance program for individuals without insurance. The program covers the cost of PrEP-related medical services including HIV testing, counseling, STI testing, and primary care services. The cost of PrEP itself will be covered through manufacturer-sponsored patient assistance programs, to which healthcare providers affiliated with the program can help you apply.

Eligibility is based on financial and medical need. Learn more about how to apply and search for a New York State PrEP-AP provider near you.

Washington State’s PrEP Drug Assistance Program (PrEP-DAP) provides financial assistance with  PrEP and related medical services.

The program covers the cost of Truvada®. The Washington Department of Public Health contracts with Ramsell Corp® to provide pharmacy benefits for program participants. You must use a pharmacy contracted with Ramsell for PrEP-DAP to receive the financial assistance (Alto is contracted with Ramsell).

In addition, Washington’s PrEP-DAP also covers many of the PrEP-related lab and medical services including baseline and monitoring tests for STIs, kidney function, and Hepatitis B. If you have insurance, the program covers your portion of insurance deductibles, copays, and coinsurance up to a certain limit. To confirm the current maximum amount of financial assistance for individuals with insurance, call 360-236-3412 or 877-376-9316 (toll free) or email PrEPDAP@doh.wa.gov.

If you do not have insurance, the program will cover all of the costs up to the maximum amount of covered services.

To be eligible for Washington’s PrEP-DAP, you must live in Washington State, test negative for HIV, and meet one of several defined risk factors, described in more detail here.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and Emtricitabine 200 mg/Tenofovir 300 mg (generic Truvada, which became available in October 2020). 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. It also reduces the risk of getting HIV from intravenous drug use by about 74%. Consult with a healthcare professional if you have any questions about whether PrEP is the right choice for you.

A negative HIV test is required before starting PrEP. Your doctor or pharmacist may also recommend additional tests to ensure that it’s safe for you to use PrEP. Initial baseline testing may include:

You will also have to visit a healthcare provider while taking PrEP for follow-up testing including:

Pregnancy testing and discussion of pregnancy plans every 3 months

HBV DNA testing every 6 to 12 months while taking PrEP if you have hepatitis B

We’ll help you get PrEP at the most affordable price

Alto will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. We offer discrete, private packaging and free, same-day delivery along with in-app reminders to stay on track. And our pharmacists — who have deep expertise in many clinical areas, including HIV treatment and prevention — are directly available through phone or within the Alto app to answer any questions.

Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure 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.

Starting Monday, August 16, residents of the San Diego metro area can now choose Alto's same-day doorstep delivery for their pharmacy needs.

Hello, San Diego!

Alto's launch in San Diego extends our free, same-day pharmacy delivery model to even more Californians.

Starting today, August 15th, residents of the San Diego metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

At Alto, we believe it’s our job to ensure you have your medications at the best price, on time and with the support you need. We bring pharmacy to you - no more waiting in line, making an extra trip, or finding out your prescription isn’t ready to be picked up after you’ve already arrived. Our free doorstep delivery means your medications come directly to you on the day and time you select, and most medications are available the same-day. Stay up to date on your courier’s progress with text alerts or in our mobile app. 

Starting a new medication or doing an injection for the first time? Message a pharmacist with your questions, even in the evenings and on weekends. And we’re a full service pharmacy - we stock all major brand, generic, over-the-counter and specialty medications, meaning your entire family’s pharmacy needs can be managed in the Alto app and coordinated into one delivery.

Courier delivery windows
Monday - Friday: 6 - 9 pm PT (6:30 - 9:30 pm PT for outlying areas)
Saturday - Sunday: 2 - 5 pm PT (2:30 - 5:30 pm PT for outlying areas)

Walk-in hours
Monday - Friday: 9 am – 7 pm PT
Saturday - Sunday: 8:00 am - 4:30 pm pT

San Diego residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax). 

Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch. 

Need to pick up? Our pharmacy is located at 4240 Kearny Mesa Road, Suite 107.

General customer support hours are Monday - Friday 6 am - 9 pm PT and Saturday - Sunday 7 am - 6 pm PT. Patients can reach out to Alto via phone at 1 (800) 874-5881 or app.

Founded in 2015, Alto is a patient-centric digital pharmacy based committed to the health and wellbeing of you and your family. We provide free same-day delivery to your door seven days a week for prescriptions, but, more importantly, offer cost transparency, personalized in-app and phone support, and real-time coordination with doctors and insurance companies to get you the care that you need. Alto is headquartered in San Francisco with offices in Denver and Dallas, and currently delivers across the greater Bay Area, Los Angeles, Orange County, San Diego, Seattle, Denver, Las Vegas, New York City, Houston, Dallas, and Austin.

Editor’s Note: This post was originally published in August 2021 and has been updated for accuracy and completeness.

Lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Here's what to know.

What to Know About Lung Cancer Screening

Lung cancer, the leading cause of cancer death among both men and women, is more likely to be cured when detected early. The five-year survival rate is about 60% when the disease is confined to one lung. 

However, the majority of cases are diagnosed after the cancer has already spread to both lungs or other organs, at which point  the five-year survival rate is 20% or less. Delayed diagnoses are due in part to the fact that lung cancer symptoms often do not appear until the disease has progressed to more advanced stages.

This is why lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Some studies have found that screening detects 80% of lung cancer cases at an early stage. Read on to learn more about what to expect during lung cancer screening and whether it may be right for you.

Smoking is the number one cause of lung cancer, contributing to 80-90% of lung cancer fatalities. However, there are additional risk factors to developing lung cancer:

Exposure to radon, a naturally occurring gas that can get trapped in houses and buildings, and the second leading cause of lung cancer

Exposure to asbestos or other carcinogens like uranium, diesel exhaust, and inhaled chemicals in the workplace

Radiation therapy to the chest during cancer treatment

While lung cancer symptoms typically appear once the disease has progressed to a more advanced stage, some people do experience some of the following early signs of lung cancer:

A cough that does not go away or gets worse

Chest pain that often worsens with deep breathing, coughing, or laughing

Infections such as bronchitis and pneumonia that don’t go away or keep coming back

Many of these symptoms overlap with those of other respiratory conditions like COPD, and you should schedule an appointment with your doctor as soon as possible. Even if you do not have lung cancer, it’s important to identify the cause of these symptoms and treat them, if needed.

What happens during lung cancer screening?

During your lung cancer screening, doctors will use a non-invasive test known as a low-dose computerized tomography (LDCT) scan to search for abnormal spots in the lungs that could be cancer. 

During the scan, you will lie still on a long table as it slides through a machine that uses a low level of radiation — about half of what you’re exposed to naturally from the environment every year, and much less than what you’d be exposed to in a standard CT scan — to create images of your lungs. It is painless and will take less than a minute.

If you are experiencing signs of a respiratory infection such as congestion, runny nose, sore throat, and body aches, or if you recently recovered from one, let your doctor know as it may affect the results of an LDCT scan. They will let you know if you should reschedule.

There are several possible outcomes of an LDCT scan. If the screening test detects abnormal spots, often called a nodule, you may need additional tests to determine if you have lung cancer. 

For small nodules, doctors often recommend another LDCT scan after a few months to see if the nodule has grown. If the nodule is bigger, your doctor may order additional testing like a positron emission tomography (PET) scan or a biopsy, a procedure that removes a piece of the nodule for lab testing, to find out if it is cancerous.

In cases where lung cancer screening does not detect any abnormal spots, your doctor may recommend continuing with annual screening depending on your risk.

Since lung cancer screening involves exposure to radiation, doctors primarily reserve screening for people at high risk of developing lung cancer, namely older adults who have smoked heavily for many years. 

The U.S. Preventive Services Task Force (USPSTF) — an independent group of prevention experts who help healthcare providers make informed recommendations for their patients — recommends annual LDCT lung cancer screening for people who meet each of the following criteria:

Have a 20 pack year or more smoking history

Smoke now or have quit within the past 15 years

A “pack year” is defined as smoking an average of one pack of cigarettes per day for a year.  The 20 pack year history threshold could be met by smoking one pack a day for 20 years or two packs a day for 10 years. It’s important to share all the details of your smoking history with your doctor so they can determine if you would benefit from lung cancer screening.

Your doctor may also recommend lung cancer screening if you were treated for lung cancer more than five years ago, have another serious lung disease such as chronic obstructive pulmonary disease (COPD), a family history of lung cancer, or have been exposed to asbestos at work.

They will also take your overall health into account, as lung cancer screening is typically recommended for individuals who would be physically able to tolerate treatment for early-stage lung cancer and lung surgery, if it is needed.

While lung cancer screening saves lives — without screening, 70% of lung cancer cases would be detected at a later stage — it carries some risks, like all screening procedures.

First, while the level of radiation you are exposed to during an LDCT scan is not significant, it can potentially become harmful with repeated scans. In addition, when screening for any disease, doctors will sometimes find abnormalities that look cancerous but are not, which is referred to as a false positive. They may also find cancers that grow so slowly they would never lead to symptoms.

The frequency of false positives continues to decline every year. Currently, about 12-14% of lung cancer screenings have a false positive, similar to the rates for mammograms. False positives are even less common with continued annual LDCT screening since it is easier to identify notable changes between the scans. 

Plus, as the technology behind lung cancer screening evolves, doctors have a clearer understanding of who actually needs follow-up testing after the initial LDCT scan. Ultimately, it is important to discuss the benefits and risks of lung cancer screening with your doctor and work together to determine if you would benefit from it.

At Alto, we go above and beyond to help you stay on track with your doctor’s recommendations, getting you the medication you need at the best price possible. And our team of patient care pharmacists is also here to chat whenever questions come up.

Switch to a better pharmacy for free same-day delivery and support with insurance and savings opportunities. Reach out any time through in-app messaging or by phone at 1-800-874-5881.

EMD Serono has several patient assistant programs designed to reduce the cost of fertility treatment, including special opportunities for military veterans and cancer survivors.

A Guide to EMD Serono’s Financial Assistance Programs for Fertility Medication

Fertility preservation treatments like egg freezing and IVF are significant investments, both emotionally and financially. Fertility medications used to support egg production, retrievals and implantations often contribute to these expenses. 

At Alto, we support your financial well-being alongside your physical health, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. In addition to automatically applying any coupon savings, we’ll connect you with any outside programs that require you to apply directly.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono. EMD Serono has several patient assistant programs designed to reduce the cost of fertility treatment, including special opportunities for military veterans and cancer survivors.

Read on to learn more details about eligibility for EMD Serono patient assistant programs and how to apply. You can also read our previous post on managing the costs of fertility treatment to learn about Alto’s additional financial support for fertility treatment and medications.

The EMD Serono Compassionate Care program provides discounted medication to eligible self-pay patients pursuing fertility treatment based on financial need or military status. 

Compassionate Care provides discounts off the self-pay price of EMD Serono fertility medications, including: 

for income-based eligible patients, savings of up to 50%

for active, retired, and veteran military, a minimum of 10% off based on income up to 50% off. 

Eligibility is based on your annual gross household income and first-time participation in the Compassionate Care program. 

Compassionate Care covers the following treatments: 

Gonal-f® RFF* Redi-ject™ pen 300 IU, 450 IU and 900 IU

Gonal-f® Multi-Dose vial 450 IU and 1050 IU

The Compassionate Care program is available only at participating pharmacies and patients must present a valid prescription for an eligible drug. The program is available for multiple cycles each calendar year for eligible patients. You must reapply each year.

View additional program details and apply here.

The EMD Serono Compassionate Corps program provides free medication to eligible, uninsured veterans injured in the line of duty or their spouses. To be eligible, you must be a retired military veteran or the spouse of a veteran who meets the following criteria:

Is infertile due to a service-related injury

Is not privately or publicly insured for infertility medications

Has been diagnosed by a physician as infertile and requiring in-vitro fertilization (IVF)/assisted reproductive technology (ART)

EMD Serono’s Financial Assistance Programs for Fertility Medication

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What to Know About Lung Cancer Screening

A Guide to EMD Serono’s Financial Assistance Programs for Fertility Medication

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Unboxing Your Fertility Medications from Alto Pharmacy

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