We took the best parts of the software engineer interview process from the places we’ve previously worked and interviewed, eliminated stuff we thought wasn’t relevant, and added our own special Alto ingredients!

What to Expect When You Interview as a Software Engineer at Alto

Thank you so much for considering an interview at Alto! At Alto, we’ve devoted a considerable amount of time refining how we interview candidates for software engineering roles. As engineers, engineering managers, and recruiters at a rapidly growing company, this is a big part of our jobs and we want to get it right: for the candidate, for ourselves, and for the team. We took the best parts of the interview process from the places we’ve previously worked and interviewed, eliminated stuff we thought wasn’t relevant, and added our own special Alto ingredients. Let’s dive in!

What does a Software Engineer at Alto do?

First and foremost, Alto exists to serve our patients--whether that be via building products, or providing exemplary service. Engineers at Alto are empowered to go the extra mile to make an impact for our patients, medical providers, and amazing pharmacists and care professionals. We are organized into small mission-focused teams where you will be working closely with Product Managers, Designers, Data Analysts, Data Scientists, and our Care team. Alto Engineers enjoy this cross-functional, collaborative environment where everybody has a voice in the direction of the product and the team. Compared to other companies, we are more end-user focused in most of our teams, even those that work primarily on platform and infrastructure.

Our pragmatic focus on impact includes making sure that we fulfill our company value of Patients Come First. We have a strong culture of code reviews, testing, documentation, and knowledge sharing to ensure that the service consistently meets our patients’ and providers’ expectations for quality and reliability.

Developing a Predictive Interview Process to Reduce Unconscious Bias

We want our engineering team to look like our customers — and we strive to serve everybody. Our mission is to fulfill medicine’s true purpose — to improve the quality of life — for everyone who needs it. In order to effectively carry out our mission, we believe our engineering team should reflect the rich diversity of our customers. Our engineers come from all backgrounds and took many varied paths to arrive here: self-taught, coding bootcamps, and top-tier universities. Prior experience ranges from none to decades at large public tech companies with many joining from other startups and consulting/contracting backgrounds. Reflecting this, we’ve put together an interview process that focuses on predicting job success over testing for rarely-used computer science knowledge and encourages hiring diversity of all kinds rather than filtering for a certain type of engineer.

Throughout the interview, we work on problems that are facing Alto today or that we’ve dealt with recently. Our interview questions rarely have a “right” answer, and if you are writing code, any language works. (We spend our time mostly in Javascript, Ruby, and Go.) Occasionally, you will have more than one interviewer in the session. This is likely because one interviewer is shadowing the other to train, get calibrated, and learn how to deliver and interpret the questions while minimizing bias.

This is a quick chat with a recruiter or a hiring manager to further expand on your experience, capabilities, and interests. Based on this, we’ll have a good idea for which team(s) you would be the best match.

This screen aims to validate your technical skills. You’ll be working in a networked IDE (like CoderPad) with an Altoid (what we call ourselves) to write and run code that addresses a typical problem that you might face at Alto. We’re looking for fluency in the language of your choice and some fundamental object-oriented programming design skills. 

This is based on a typical task that you might face at Alto - something like designing or interfacing with an API. You're welcome to use StackOverflow, Google, or any other resources at your disposal—including your interviewer! We’ll be observing how you understand the problem, communicate with your interviewer to develop requirements, and get to working and well-tested code. 

In this section, you’ll spend some time getting to know a problem we have faced. You’ll spend 10-30 minutes working on how to approach and optimize a challenge that impacts our business everyday, then show that you can translate that into working code.

This module varies depending on your experience and interests. For some folks, we dive deeper into software design and learn how you would break up a hypothetical application into core modules. For senior frontend developers, this might be an app architecture challenge. And for senior backend developers, we’ll address systems architecture with an eye toward scalability, observability, and technology choices. In every case, we’re looking closely at how you approached the problem, gathered requirements, and justified your decisions.

The Engineering Manager is trying to deeply understand who you are as an engineer and a person. What do you get excited about? What type of roles do you like taking on within a team or project? What is your career arc and how can you best advance that at Alto? The questions often asked are behavioral or hypothetical in nature, and we love to hear stories about your proudest accomplishments and challenges you’ve overcome.

“I had an amazing interview experience with Alto - although the recruiters were super busy, they made sure to accommodate my timeline," shares Jacinda Zhong, Software Engineer, Core Services at Alto.  "I was really pleased to find out that Alto asks questions based on the type of work I’d be doing - no obscure CS concepts, and questions centered around complex business logic that you’d encounter working at Alto. Before my onsite, my recruiter gave me a call to provide context on what they’d be asking. No gotchas and no surprises, plus lots of detail so that I could be prepared to do my best. So excited to be working here and contributing to a great mission!”

The interviewers get together promptly—we try to do it no later than the next day—to discuss next steps. Prior to our discussion, we individually assess your performance against a rubric that takes into account your level of experience and the requirements for the role.

There is rarely unanimity in the panel. Almost everybody at Alto was discussed in a panel where there were some mix of Yeses and Nos. Often, we ask ourselves questions like, “What is the candidate’s superpower?”, “What will they add to the team?”, and “For which open role are they the best match?” Our hardest decisions are the ones where we all agree that the candidate is somebody we want to work with but we don’t have exactly the right role.

Don’t be surprised if your interview is slightly different from what is described here. We’re constantly refining our process to get to better hiring decisions more quickly and with less bias with regular feedback from candidates, interviewers and recruiters. 

Have you had an interview experience that you thought was exceptional? Let us know at feedback@alto.com.

Sandra Aziz, Alto Pharmacy Launch Manager and Pharmacist in Charge of our Los Angeles location, was recently selected by the University of California San Francisco (UCSF) to receive an “Apple for Excellence in Precepting” award.

From Pharmacist to Professor: Sandra Aziz Spotlight

Sandra Aziz, Pharmacy Launch Manager and Pharmacist in Charge of our Los Angeles location, was recently selected by the University of California San Francisco (UCSF) to receive an “Apple for Excellence in Precepting” award. This celebrated accolade recognizes Sandra for her contributions to the experiential preceptorship program over the past academic year. In addition to this award, Sandra was recently appointed Assistant Clinical Professor at UCSF!

Preceptors are practicing pharmacists who provide guidance and supervision to pharmacy students. They selflessly act as mentors in addition to their already demanding day-to-day responsibilities. Over the last two years Sandra has mentored ten interns at our Los Angeles pharmacy location. Her responsibilities include building curriculums for their continued learning, and acting as a mentor and coach to help students reach their goals. With Sandra’s guidance, eight students were accepted at their preferred residency/fellowship programs!

Read on to learn more about Sandra, what brought her to Alto and how the Gilmore Girls inspired her.

Congrats on being recognized as an exceptional teacher, role model and mentor! How does it feel? 

It’s really rewarding! I spend a lot of time creating detailed syllabi to provide students with a wide range of learning opportunities at Alto that they likely would not get at another pharmacy. It feels great knowing that students value their experience and learnings with us. Even further, when students are interested in coming back and working at Alto post graduation — that’s the best feeling.

What would you tell pharmacy students considering selecting Alto Pharmacy as a placement site for their rotations? 

If you’re looking to experience how a healthcare technology startup operates, you should absolutely consider Alto!

In this unique learning environment, you will gain a breadth of experience working on projects alongside clinical care staff, engineers, operations managers, and product designers. You will be involved in process improvement projects that improve efficiencies, quality assurance and further preventative healthcare. Ultimately, you will be helping redefine how community pharmacies can serve patients and their communities!

Who is/was an influential person in your life and why? 

I always struggle with this question because growing up, my answer was Lorelai and Rory Gilmore from the TV show Gilmore Girls - two strong, well-spoken women who worked hard to be self-sufficient. 

But the most influential person in my life was my dad; no matter what battle he was facing, he always met it with a smile, kindness, and an awful joke. 

You’ve been with Alto now for three years. What do you enjoy most about being a part of the team? 
My favorite thing about working at Alto is that I get to work with folks from a variety of backgrounds and disciplines on a daily basis: finance, product, engineering, etc. It gives me perspective and allows me to see challenges from various angles and problem solve accordingly. 

And finally, what do you like to do outside of work? 

I love looking at real estate, especially being in LA. My RedFin filter is set to $10M+ and any chance I can get to an open house, I absolutely will. Additionally, I have a sweet little black cat named Noodle whose self-designated play time is 2AM. 

If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

Since 2016, Alto has supported over 20,000 patients through their fertility journey. In this post we'll provide guidance on how to select the right fertility pharmacy. In addition, we'll share the benefits of selecting Alto as your fertility pharmacy. 

What to Consider When Selecting a Fertility Pharmacy

Your Choice of Fertility Pharmacy Matters

Chances are if you’re reading this you’ve made a decision to undergo fertility treatment or know someone who might be soon. To begin with, know that you are not alone. Approximately 1 in 8 women in the US are affected by infertility, and more than 20,000 women have now decided to have their eggs frozen. 

Since 2016, Alto has supported over 20,000 patients through their fertility journey, and several team members have gone through the journey themselves. We know this can be an emotionally, financially, and physically challenging experience. That’s why we believe choosing the right pharmacy can help you avoid additional stress caused by waiting for hours on hold, tracking down your medication delivery, and navigating insurance benefits.

Think of your pharmacy as an extension of the care you receive from your physician. You wouldn’t choose just any fertility clinic, right? The same goes for where you choose to receive your fertility medications. Fertility treatment is stressful enough. Your pharmacy partner should provide the reassurance and reliability you deserve.  

In this post we'll share guidance on how to select the right fertility pharmacy. First, we’ll explain why it's important to use a pharmacy with a strong fertility focus (versus any neighborhood or mail-order pharmacy). And since not all fertility pharmacies are the same, we’ll also offer five considerations to make sure you have the smoothest experience possible. Finally, we’ll share the benefits of selecting Alto as your fertility pharmacy. 

At a minimum, credible and experienced fertility pharmacies will employ:

An expert clinical team: This includes pharmacists who are knowledgeable on and experienced with the medications and dosing unique to fertility treatments.

Temperature controlled packaging: Medications can go bad if they are not shipped or stored at the proper temperature. Fertility pharmacies will provide the appropriate packaging to ensure your medications arrive in good condition. This is especially important in warm climates. 

Proper supplies: Fertility pharmacies will be familiar with the variety of needles/syringes that you may need for your injection. This is crucial because it can be stressful if incorrect supplies are included which may lead to a missed dose. In addition, supplies such as alcohol swabs and disposal containers should always be included.

Learn more: [The View From Both Sides of the Fertility Pharmacy Experience]

Here are five additional things you should consider when selecting a pharmacy partner: 

1) Easy, proactive communication - After your clinic sends your prescription to the pharmacy you’ll likely have questions related to insurance, what to expect when receiving your medications, and most importantly, when they will be ready. For that reason it’s important to take into account what types of communication are offered - phone, text, email, mobile app - and typical response times and operating hours. Pharmacies with weekend/evening support hours are most beneficial in ensuring you’ll get live support when you actually need help.

2) Affordability assistance - Fertility benefits are confusing and it can be hard to understand just how much you’ll need to spend on medications. Most fertility pharmacies will work with leading financing and loan providers and can administer manufacturer discount programs if asked. A great fertility pharmacy will go above and beyond to connect you with financial assistance programs for qualifying prescriptions.

3) Local, timely delivery - Your medication protocol can change even after you start your injections - perhaps your physician wants to add a different trigger shot to prevent over-stimulation or decides to add days to your schedule because of the rate at which your follicles are growing. You can avoid these stressful situations if you select a pharmacy that is local and can promise fast same-day delivery. The last thing you need to worry about is mail-order delays or waiting in line at a pharmacy for hours. 

4) Pharmacist support - You’ll most likely have questions about your fertility medications (i.e. How do I know I’m injecting correctly? My clinic just changed my medications, what do I do?) so think of your fertility pharmacist like an extension of your #TTC community in that they should be an advocate on your side. Make sure the pharmacy you choose offers support and expert resources like guidance on injections, tools for managing your protocol and help understanding medication options - including late at night and on the weekends!

5) Community reviews - Just like you researched clinic and physician reviews, you should do the same with your pharmacy choice. Head to Yelp, Facebook, and any other feedback platform that showcases patient testimonials. Pharmacy experience matters but so does the experience of others. See if any reviews or blogs exist that mention specific fertility pharmacies. You’ll thank yourself (and those before you) for taking the time to do your due diligence. 

The fertility team at Alto will reach out as soon as we get your prescription so you don’t have to worry about waiting on hold or standing in line at a pharmacy. We’ll proactively investigate your insurance coverage, provide options to maximize your benefits and offer qualifying rebate programs. 

And because we know you’re busy with life, we offer a mobile app that allows you to securely schedule your delivery or message a pharmacist if you aren’t able to call us. You can take care of your pharmacy needs wherever you are and on your schedule. Alto pharmacists are always available until 9 pm each night (including weekends) to answer questions. 

When it comes to the time sensitive nature of your treatment, being locally-based makes a critical difference. Medications may be increased, decreased, or stopped altogether. At Alto, patients always receive free, same-day delivery by our own Alto courier team, even on weekends. 

We also offer the ability to select the 2 to 3-hour delivery window that works best for you either at home or work. Once your delivery is scheduled you’ll receive text updates along the way so you know exactly when your courier will arrive.

Your medications are packaged to give you the necessary information to avoid common mistakes (e.g.which meds go into the fridge). And Alto’s dedicated fertility pharmacists are always just a phone call or text away to answer your questions about injections, supplies, and more. So if you're about to inject and suddenly forget something, you don't need to wake up your physician - you can give us a call.

We’ll also follow up with you to remind you about qualifying rebates and provide instructions on how to apply. Our patients find this especially helpful given they have enough to remember. 

Sam shares why serving fertility patients is so rewarding

The team at Alto is ready to be your partner through it all, from your first cycle to your last. Questions about using Alto? Visit alto.com/fertility or give us a call at 1-800-874-5881. Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends. 

What to Consider When Selecting a Fertility Pharmacy 

Switching to Alto is easy and takes only a few minutes. Here's what you can expect to know about savings, free same-day delivery, and access to our expert pharmacists.

How Do I Transfer a Prescription to Alto?

It really is possible. In just a few minutes, your days of standing in line at the pharmacy could be over for good. From now on, your refills will arrive safely at your doorstep exactly when you need them — no more wondering if they’ll make it on time or if they’re even on their way. And you’ll have ongoing support from a team of pharmacists through private chat or text, helping you feel comfortable discussing any health concerns freely. 

You can switch to Alto in minutes using our app, by going online at alto.com, or by calling Alto at 1 (800) 874-5881. 

We’ll contact your current pharmacy to arrange the transfer right away. It may take a few business days to receive your prescription from your old pharmacy, but we’ll keep you up to date along the way. As an alternative, you can ask your doctor to send a new prescription directly to Alto.

Not only are the services we provide at Alto completely free, but we’ll also do our best to identify ways to save you money. It’s true—your copay stays the same when you switch to Alto and there are absolutely no hidden delivery or service fees. We’ll investigate coupons, copay cards, and other savings options in order to find you the best price — we’ve saved our patients more than $23 million on their medications! 

Once your transfer is complete, we’ll reach out with a text or call to schedule your free delivery. You select the delivery date and window that works best for you, and you can follow your courier in real-time as they make their way to your door. Your medications will be hand-delivered by a member of our local courier team. In most instances, you can designate a safe place for your medications to be left in the event you are not home or if you prefer contact-free delivery. 

Finally, if you’re wondering if we carry your medication, the answer is yes. We fill all types of medications, including specialty, over-the-counter, brand, and generic. And if you have questions about your medications, our pharmacists and patient care team are just a text, chat, or an email away - Monday through Friday 9 am - 9 pm PT and Saturday and Sunday from 10 am - 6 pm PT.

If you’re excited about the benefits of switching to Alto — whether it’s the potential savings, free same-day delivery, or easy access to expert pharmacists — there’s no reason to hesitate about transferring your or your family’s prescriptions. We’ve designed the process to be quick and easy. 

Ready to make the switch to a better pharmacy? 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.

How Do I Transfer a Prescription to Alto? 

In July 2020, Catherine Scott joined Alto as Head of IT, responsible for building and leading a high performing IT team. We sat down with Scott to learn more about her plan to build Alto’s IT strategy and support teams focused on End-User Support, Infrastructure & Networks and Business Applications. 

Airbnb’s Former Head of Business Technology Joins Alto

In July 2020, Catherine Scott joined Alto as Head of IT, responsible for building and leading a high performing IT team. Previously, Cat spent five years at AirBnB where she acted as the  Global Head of Business Technology during their worldwide growth and was pivotal in delivering exceptional technology experiences to employees. With this expertise, and over 20 years experience spanning startups to Fortune 500 Companies, we are excited to officially call her an Altoid! 

We sat down with Scott to learn more about her plan to build Alto’s IT strategy and support teams focused on End-User Support, Infrastructure & Networks and Business Applications. 

Welcome to Alto! What excites you most about recently joining the team? 

Thank you! I’ll start by sharing that I am excited by companies that have a strong mission. This was an important consideration for joining Airbnb.  When contemplating what was next, I knew that this was a primary driver for my next move.  Alto’s mission - to improve the quality of life for everyone - very much resonated with me. 

Aside from that, my conversations with Altoids during the hiring process reflected a sense of passion and humility that I found to be rare in a successful company. There is a culture of really intelligent, driven individuals here that are unpretentious about their accomplishments. 

Likewise, any time I evaluate an opportunity for growth, I assess the impact that I can have based on my experience. Given my background in consulting, startups, and Fortune 500 companies, I found Alto’s goals to be in line with my ability to improve efficiency and help IT mature into being viewed as a critical enabler to our business.

You were the Global Head of Business Technology (Products) at Airbnb for 5 years. How did this experience shape your outlook on strategic growth and what was the most important lesson that you learned? 

When I joined Airbnb the IT organization was in its infancy. We were present in 192 countries and yet there were only six people assigned to the global team.  It was imperative to create a global strategy quickly that would both enable the hyper-growth of the company and consider how to scale in a cost effective way.

I think the key takeaway is that IT is everywhere. It's a foundational layer supporting how everything functions. Thinking about IT early in a company’s lifecycle is essential, but above that you have to ensure everything is thought of from a scalable perspective. If we only build for right now there will inevitably be a technical rework later so making sure the IT services are both built for increased volume and still cost effective is important.

Can you share a little bit about your goals at Alto for the remainder of the year? 

Right now I’m very focused on what I would call core/foundational IT (network infrastructure, IT support function, etc.) -- essentially the programs that are the enablers for everyone. I’m also working closely with Alto’s Director of Security to ensure that we continue to protect our patients' data with the utmost level of reliability. 

Next year I’d love to start addressing  how IT can enable more business return on investment. For example, managing and implementing 3rd party applications. Typically, and this was the same at Airbnb, if everyone is going off and buying different, potentially duplicative, applications, we start to leave money on the table and can have disjointed data and compromise security. This is where IT starts to become a case for ROI and business benefit. 

I’ll actually contend that Alto is a forward thinking in recognizing the importance of IT. Because of this, I know I’ll be able to create positive benefits because we’ll be in front of the curve. At the end of the day, if we can grow in a thoughtful manner, we’ll arrive at a place where we’ll have a really high performing IT organization that contributes to the bottom line. 

You know, my motto is to “embrace the adventure.” I love spending time outdoors, whether hiking, skiing, or sailing, so it really resonates in my professional life as well. I feel excited about developing an IT strategy that will ensure high quality services both in our sites and remotely, protect our internal data, maximize productivity of our workforce, and ultimately contribute to the company mission of improving the quality of life for everyone.

The good news is, having done this before, I don’t think there’s anything that’s a surprise yet. During the interview process, I knew that this role would require another ground-up build and that it would require a strategic and thoughtful leader. Having said that, the results are always less about me and more about what the team has been able to do and how we have contributed to Alto’s success.

On that note, how would your prior teams describe you? 

I think, or hope, my team would say that I’m incredibly supportive in removing anything that is keeping them from being able to achieve maximum impact or create maximum value for the company. I define myself as authentic, trustworthy and driven -- and value those qualities in others. I definitely have a high bar for excellence and want my team to be successful at performing but at the same time, I’m also there to help when needed and support their professional development. 

Stylistically I’ve always been a leader where I kind of exist to support others and provide thought leadership. You are nothing without your team. To quote Steve Jobs, "It doesn't make sense to hire smart people and tell them what to do; we hire smart people so they can tell us what to do." This philosophy is one that has always resonated with me. 

How do you feel about technology changing our work culture given the current climate of COVID-19? 

Alto is the first job where I joined having never met a single team member in person. It’s definitely changed things up but I’m pretty comfortable with it at this point. Looking forward though, I think it’s important to consider how we can recreate the “magic” that happens in person when a number of our workforce is remote. 

COVID highlighted the significance of innovative IT related to remote work and collaboration that is essential for everyone. That area of creativity is where I think IT will fundamentally shift how we continue to work and communicate with one another in what may be an increasingly remote workforce. 

Are you working on any passion projects outside of Alto at the moment? 

Yes! I’m very passionate about animals and am currently looking to rescue another dog. Aside from that, I’m recently new to the Tahoe, CA, area so hope to become more embedded in community volunteering. 

My other personal passion project is actually an overhaul remodel on our Tahoe house which has required a fair amount of architecture and engineering for my husband and myself. It’s a fun project that keeps us constantly engaged with one another. 

What would you say to someone interested in joining the Alto team, specifically in a technology driven role? 

Just do it, it’s an amazing opportunity! I believe so strongly in what Alto is doing. If you ever have an opportunity to work for a company that is founder-led you should make it happen. There is a palpable passion that resonates throughout a company when the founders are present. It’s an experience worth doing because it creates a belief and excitement around the company that might not happen otherwise. 

For more information on Scott, or to connect with her directly, reach out via LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers. 

Airbnb’s Former Head of Business Technology Joins Alto 

Rather than letting every cough or sniffle cause a panic, let’s sort through the most likely symptoms of the three respiratory illnesses to look out for this season: the cold, flu, and COVID-19.

Cold, Flu, or COVID-19? Your Seasonal Symptom Guide

For most of the year, we’ve had one virus on our minds. But as cold and flu season moves into full swing, an onslaught of new symptoms could sow confusion. Rather than letting every cough or sniffle cause a panic, let’s sort through the most likely symptoms of the three respiratory illnesses to look out for this season: the cold, flu, and COVID-19.

We can usually get an idea of what the flu season holds in store for us by studying recent flu activity in the Southern Hemisphere. This year, reported infection rates were 99% below normal, which epidemiologists credit to the fact that people were wearing masks, social distancing, and washing their hands frequently. The same precautions that prevent the spread of the coronavirus will also stop the flu (and the common cold too).

Still, experts are urging everyone to get their flu shot this year. More people getting sick could cause more than just confusion over symptoms. It could put a strain on testing supplies and medical care. Getting your flu shot will not only make you less likely to get sick with the flu, but it can also reduce the severity of your symptoms if you do get sick.

There’s a reason we call it “the common cold.” According to the American Lung Association, most adults come down with two to four colds per year. With more than 200 viruses that can cause the common cold floating around out there, it’s not all that surprising. Here are the main symptoms most cold sufferers can look forward to: 

The CDC reports that a cold usually begins gradually with a sore throat and a runny nose and then progresses to include coughing and sneezing. It is rare for cold symptoms to include fever, and diarrhea is not considered a symptom of a cold. 

There is no cure for the common cold, but most people recover within 7-10 days. The best way to feel better is to rest and drink plenty of fluids, although over-the-counter cold medications can help ease your symptoms. Since colds are contagious, try to be mindful and cover up when you cough or sneeze. 

The flu tends to hit us like a ton of bricks. Unlike the more gradual onset of a cold, flu symptoms are known to appear suddenly and with force. Along with a tell-tale fever often comes headaches, body aches, and a general feeling of exhaustion. 

The CDC reports that the following symptoms are common with the flu:

Vomiting and diarrhea (more common in children)

You may have noticed that the common cold shares some of these symptoms. Deciphering the differences is not always cut and dry. Generally, it’s that “hit by a bus” feeling that differentiates the flu. If you’re suddenly sidelined by a fever, chills, aches, and pains, you’re probably not dealing with a cold. It’s important to note, however, that not everyone experiences fever with the flu. 

Your healthcare provider can determine if you have the flu with a simple swab test. As with a cold, you should drink plenty of fluids and try to rest. You should feel better after a few days. Antiviral drugs can be used to reduce symptoms and shorten the amount of time you are sick. Antiviral medications are available by prescription only and work best when started soon after you get sick. When you send your prescription directly to Alto, we can make sure you get your flu medication delivered safely to your home that very same day. 

Here’s where our symptom detective work gets really tricky. Not only are the symptoms of COVID-19 all over the map, many of them closely mimic those of the flu. The coronavirus has confounded experts by showing up in strange and disparate ways. The only true way to know if you have symptoms of coronavirus infection is to get tested, but there are a few red flags to watch out for.

What’s so confusing is that COVID-19 is a respiratory illness like the cold and flu, but it’s not only a respiratory illness. Experts consider it to be a multi-organ disease. Symptoms may appear from head to toe, range from mild to severe, and often come on gradually. While there isn’t a clear set of symptoms that always distinguishes COVID-19, these four seem to be the most common:

The CDC also lists the following symptoms of COVID-19:

Shortness of breath or difficulty breathing

Interestingly, a sudden loss of smell or taste seems to be emerging as a defining symptom of coronavirus infection. While it doesn’t occur in every patient, some studies have indicated that nearly 65% of people with COVID-19 experience this symptom. Additionally, while you may be accustomed to having your temperature checked when you visit a restaurant or store, fever is a common symptom of COVID-19, but by no means always present. About 55% of all infections are accompanied by a fever. 

The rule of thumb is this: if you think your symptoms could be COVID-19, you should act as if you’ve been infected until you can be tested. Call your doctor right away and self-quarantine while you monitor your symptoms and wait for further instructions. It’s crucial that you take every precaution to ensure you don’t transmit the virus to anyone else.  According to the CDC, you should also be on alert for more dangerous symptoms, which include trouble breathing, pain or pressure in the chest, bluish lips or face, confusion or incoherence, and an inability to wake or stay awake. Seek emergency medical care if any of these symptoms occur.

Coronavirus infections tend to last longer than the flu, but those with mild cases should recover on their own in about two weeks. Even if you have only mild symptoms, you need to call your doctor and self-quarantine immediately. With more severe cases, doctors may provide patients with intravenous fluids, medicines to reduce a fever, or oxygen to help with breathing.

If all you know is that you’re feeling terrible, give your doctor a call. Generally speaking, if you’re sniffly, sneezy, and slightly rundown, you’re probably battling the common cold. If you suddenly come down with a fever or chills, body aches, and heavy fatigue, the flu may be to blame. However, with COVID-19 so tricky to identify, it’s vital that you rule it out whenever troubling symptoms crop up. 

If you have questions about which medications can help you deal with your seasonal symptoms, our pharmacists are standing by. And if you do come down with the flu, we can hand-deliver your antiviral medication quickly and safely, while you stay home and get that all-important rest. 

Want Alto by your side this cold and flu season? 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 another qualified health provider with any questions you may have regarding a medical condition.

We combed through the latest advice from the experts to give you some actionable steps that may help protect your health.  

Managing Diabetes During COVID-19

Pre-existing condition. These two words have echoed across news broadcasts and government briefings about COVID-19, stirring up fears in those living with chronic disease. But as we’ve gathered data and learned more about the novel coronavirus, a clearer picture has emerged. We now better understand how people with underlying medical conditions like diabetes can take careful precautions to decrease their likelihood of getting sick. 

According to the ADA, it does not appear that people with diabetes are more likely to get COVID-19. They do, however, have a higher risk of developing serious symptoms and severe complications that require hospitalization if exposed. This increased risk makes prevention and early detection critical. 

If you are living with diabetes, it’s important to focus on what you can control right now. In addition to following the CDC’s prevention guidelines, which include wearing a mask, washing your hands frequently, and avoiding unnecessary social contact, you can manage your risk by planning ahead. With this in mind, we combed through the latest advice from the experts to give you some actionable steps that may help protect your health.  

The world is full of very real stressors right now. It’s easy to let healthy habits slip when you’re anxious or under pressure, however, it’s more important than ever to stay on top of your health. The ADA advises that your risk of experiencing severe illness from COVID-19 is likely to be lower if your diabetes is well-managed. Dr. Janaki Vakharia, MD, clinical fellow in the Endocrinology Division at Massachusetts General Hospital, explains, "Studies have reported that patients with well-controlled diabetes who have been hospitalized for COVID-19 have a higher rate of survival. Better controlled diabetes is also associated with lower markers of inflammation, which may explain this better rate.” 

Do your best to stick to the care plan you’ve created with your doctor—keep taking your insulin and/or other medication, test and track your blood glucose, exercise at home, and maintain a healthy diet. Make sure you have enough medication on hand to last you several weeks and continue your doctor’s appointments virtually if telemedicine is an option. 

In his FAQs about Diabetes + COVID-19 for Johns Hopkins Medicine, Mohammed Al-Sofiani, MBBS, MSc, writes, “I strongly encourage all people with diabetes to make sure that they have enough supply of insulin and all the tools they typically use to manage their glucose...I also encourage people with diabetes to avoid going to the clinics or pharmacies unless it is for urgent matters.”

You should never have to risk your health to obtain your insulin and other medications. That’s why we offer free contactless delivery when you fill your prescription through Alto. Simply let us know where and when to drop it off, and we’ll make sure your medications and supplies arrive safely. 

We’re about to enter cold and flu season. More viruses going around means more chances of getting sick so experts are urging everyone to get a flu shot. This year, a sore throat or runny nose could produce more anxiety than usual, but try not to let yourself slide into fearful thinking. Stay home and report your symptoms to your doctor, especially if you experience a fever, dry cough, or shortness of breath. There is a wide range of symptoms associated with the onset of COVID-19, but the CDC offers this list as well as an interactive coronavirus self-checker. Mild symptoms can often be managed and monitored from home, but don’t make that decision without your doctor. 

If you develop any emergency warning signs for COVID-19, seek medical attention immediately. According to the CDC, these emergency signs include difficulty breathing, chest pain or pressure, confusion or inability to arouse, or bluish lips or face, though they stress that severe symptoms of any kind should be immediately reported to your medical provider. 

Preparing for the possibility of getting sick is especially important right now. The ADA recommends having enough supplies to last you several weeks in case you are symptomatic and unable to leave your home. If you do get sick and your doctor has recommended that you remain at home, take that as good news and try to focus your attention on resting while keeping an eye on your glucose levels and symptoms. 

Remember—any infection, including COVID-19, will likely cause your blood glucose levels to start rising. It’s important to pay close attention to your blood sugar, continue taking your medications, and drink plenty of fluids to prevent dehydration. If your blood sugar becomes hard to manage and your body doesn’t have enough insulin, you are at risk of developing diabetic ketoacidosis (DKA). The ADA advises that if your blood sugar has registered high (greater than 240mg/dL) more than twice in a row, you should use an over-the-counter kit to test your urine for ketones. If ketones are present, call your doctor right away. 

Continuing to take your insulin and other medications must be your top priority, so be sure that you don’t risk running out. According to ADA, the leading manufacturers of insulin and other supplies are not reporting any impact on their manufacturing and distribution capabilities due to COVID-19. There have been, however, widespread reports of mail delays that could affect the timely delivery of mail-order prescription drugs. 

When you fill your prescriptions through Alto, we’ll coordinate your refills automatically, then one of our couriers will hand-deliver them to your home. Your prescriptions will never change hands during the delivery process and you can designate a safe place for your courier to leave your medications for contact-free drop-offs. 

Finally, if like so many you are currently experiencing unemployment, loss of insurance, or economic hardship, there are options to get help. The ADA offers this list of resources and the team at Alto is always here to help you find options that can save you money. Reach out to us at any time via text, phone call (1-800-874-5881), or in-app messaging.

So many of us are feeling anxious and uncertain right now, and that can interfere with our ability to sleep well, manage stress, and practice self-care. Be sure to keep in touch with the people you love and talk to them about your fears. Joining an online community for people with diabetes can also help you get the emotional support you need. 

We're here to support you through COVID-19 with free home delivery. 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.

In honor of National Coming Out day our Proud Employee Resource Group sat down with Altoid Nicholas Satow, Partnerships Manager HIV/PreP, to learn about his own personal experience and his advice for others on coming out.

Coming Out with Pride: Nicholas Satow Shares His Story

This year marks the 32nd anniversary of National Coming Out Day, a time to support lesbian, gay, bisexual, queer, and transexual individuals. In honor of this awareness day our Proud Employee Resource Group sat down with Altoid Nicholas Satow, Partnerships Manager HIV/PrEP, to learn about his own personal experience and his advice for others on coming out. ERG’s are voluntary, employee-led groups that foster a diverse, inclusive workplace aligned with organizational mission, values, goals, business practices, and objectives.

Q: Tell us a little about your coming out experience. When did it happen and who did you first tell? 

A: My coming out story starts with the story of my best friend. We met in third grade and were just 15-years-old when she came out to me. She was a star basketball player and met a girl from an opposing high school team 45 miles away. We quickly turned 16, and without our parents’ knowledge, we were driving 90 miles round trip every weekend to go see her girlfriend and hang out with a group of kids who didn’t know anyone from our school district. The 45 miles of distance made her feel safe from our friends and family finding out about her double life.

Leading a double life and constantly hiding our whereabouts started to wear on us. Especially for her after family and friends started becoming suspicious. Who is this girl you’re always on the phone with? Why are there so many miles on your car? Where are you going? Her fear of being outed or disowned started to build as rumors began to circulate between friends and family.

It was a Saturday night, and we were halfway through our 45 mile drive home. She broke down in tears and started to share terrifying thoughts she’d been having. She said she couldn’t take the pressure of the double life anymore and the rumors circulating at school. She felt extremely overwhelmed, isolated, and scared. Thoughts of teenage suicide and stories I had heard of queer teens taking their own lives started to consume my mind. Even though I wasn’t ready to come out of the closet yet, I knew in that moment my friend needed me more than ever. I felt responsible for her loneliness and selfish for making her go through this journey alone. She said, “I can’t take this anymore. I can’t live like this,” Staring at the road ahead, I said, “You need to stay strong. You make me strong.” I turned and looked at her and said, “I’m gay, too.” This was the first time I said those words out loud. It was terrifying and relieving at the same time. It was the first time I felt authentically me. 

It’s 15+ years later, and we’ve helped each other get through many scary thoughts and tough times, come out of the closet to friends and family (sometimes while sitting side-by-side) and navigate difficult romantic relationships as we learned what it was like to be a young gay person in Cleveland, Ohio.

Q: How did you feel as a result of coming out? 

A: After coming out to my best friend, I felt a sense of relief and companionship. Our double lives became more of a shared experience and a lot easier to manage, knowing we had each other to rely on. I also started to feel more comfortable coming out to other friends. At 18, I came out to all my friends. At 22, I came out to my parents and family.

Q: What resources, support groups, or communities did you rely on when coming out? 

A: At the time, I wasn’t aware of any resources or support groups, so this wasn’t something I utilized. Another best friend’s older brother was gay, so I learned a lot from him, and he took me out to introduce me to the community and become comfortable in my own skin.

Q: What advice would you give to others? 

A: The best advice I’d give to LGBTQIA+ youth is to find a support system of like-minded individuals and come out when you feel it’s safe to do so. If you’re in an environment where you feel your mental or physical safety could be jeopardized, don’t come out until those dangers are gone. If being disowned, financially cut-off, or assaulted is a possible reality, make sure you have somewhere safe to go where your basic needs can be met. There will always be people who won’t accept you for who you are, but there will be even more who will support you. You just need to find that community. 

Q:  Why is it important for you to work at a company that values diversity in all forms?

A: Companies that support diversity help us evolve into a more accepting society. When people are exposed to colleagues who are different from them, they get to know each other on a personal level and start to realize that we are all more similar than different. I believe these experiences translate into the way people treat others outside of work and how they raise their children.

At Alto, we believe in a world where every perspective matters and that diversity fosters creativity and creates innovation. We welcome candidates of all backgrounds, skill sets, and experiences. To learn more, read Why We Prioritize Diversity at Alto. 

For more information on how to make your workplace safe and equitable for all, read 11 Simple Ways You (Yes, You!) Can Make Your Workplace More LGBTQ Inclusive. 

If you or someone you know is considering coming out, we encourage you to review these resources: 

Parents, Families, and Friends of Lesbians and Gays (PFLAG) Recommended Reading: Coming Out

Coming Out with Pride: Nicholas Satow Shares His Story 

Nicholas Satow (center) with Camp Lightbulb leaders

Every year, we look forward to October, when we get a whole month to honor the extraordinary work of the pharmacists and pharmacy technicians at Alto and around the world.

Celebrating National Pharmacist Month at Alto

Every year, we look forward to October, when we get a whole month to honor the extraordinary work of the pharmacists and pharmacy technicians at Alto and around the world. National Pharmacist Month is a time to celebrate the many ways that pharmacy professionals positively impact their communities. At Alto, we get an intimate look at how pharmacists improve the health and well-being of others every single day through their expertise and exceptional care.

This year’s theme is “Essential Providers, Accessible Care,” recognizing the vital roles that pharmacists and pharmacy technicians are playing on the front lines of healthcare during the COVID-19 pandemic. From the common cold to chronic disease, pharmacists are always there to answer important health questions and make sure medications are not only accessible but used safely and effectively.

National Pharmacist Month is a great time to show your appreciation for the pharmacy professionals who help with your medications. It’s also an opportunity to learn more about the depth of their expertise. For example, did you know that becoming a pharmacist requires a doctorate degree? Pharmacists are not only experts on medication management, they also serve as patient educators, perform laboratory studies and health screenings, and act as skillful problem solvers. Whether we’re facing an acute issue or a chronic condition, many of us turn to our pharmacists to suggest supplements, over-the-counter medicines, or lifestyle adjustments that can help us feel better. 

In addition to our month-long celebration of pharmacy professionals, the third Tuesday of October has its own special designation: National Pharmacy Technician Day. On this day, we recognize the unique and invaluable contributions of pharmacy technicians. A critical part of any healthcare team, pharmacy technicians work closely with pharmacists to make sure patients get the medications they need. Technicians not only assist in the preparation and distribution of medications, but they also work directly with community members to collect patient information and help process billing claims.

Both pharmacists and pharmacy technicians are essential in providing us with access to safe and effective treatment when health issues arise. This year, more than ever, we are grateful for their steadfast dedication to your care. 

In honor of the 116 incredible men and women who perform these vital roles at Alto, here are five facts you may not know about the pharmacy profession:

October 12th is Women Pharmacists Day! About 55% of pharmacists are women, making pharmacy a predominantly female field. 

Pharmacists are the most frequently visited healthcare providers in America. They can be found working in a variety of settings—from hospitals to the neighborhood pharmacy—and we turn to them most often for health advice. 

The world’s oldest prescriptions were etched into tablets around 2100 B.C

Benjamin Franklin is considered one of the founding fathers of pharmacy. He helped to establish the first public hospital and hospital pharmacy in the United States. 

Agatha Christie, the crime novelist, worked as an apothecary’s assistant, or what we would now call a pharmacy technician. Her interest in medicine was apparent in much of her writing, inspiring her many plot lines about poisoning and disease. 

We at Alto could not be more proud of our incredible pharmacists and pharmacy technicians. Through your skills as educators and guides, you uplift the health and well-being of the communities you serve. 

Want to express your gratitude to the pharmacists at Alto? You can reach out by phone, text, or through the app to say thanks and brighten their day. 

At Alto, we value effective communication across all teams. In our latest blog post software engineer Eric Leite shares how he set out to make it easier to understand how our repositories change over time while minimizing disruption to engineers’ existing workflows.

How (and Why) We’re Standardizing our Commit Messages

Have you ever tried to debug a production issue by looking at your commit history, only to find a bunch of commits that don’t seem to be connected to any specific feature? Or maybe you've pulled the latest version of a dependency and noticed a bug that wasn’t there before?

It’s hard to pinpoint where a problem might have begun if your project (or its dependencies) don’t rely on standards to commit and release code. This was a problem I set out to tackle in my organization: How can we make it easier to understand how our repositories change over time while minimizing disruption to engineers’ existing workflows?

At Alto, we value effective communication. We keep our pharmacists and operations team in the loop about every new feature we release to production on a daily basis. We also announce changes to our codebase in a dedicated Slack channel to keep our engineers informed. But that raises the question: How do we ensure that someone doesn’t forget to make an announcement? And can we reduce the time we spend writing one up? Introducing a commit standard would enable us to use automated tooling that makes communication about code changes effortless.

Consider an open-source repository with hundreds of contributors. Project owners often adopt standards and industry best practices because it makes the project easier to maintain as the number of contributors increases. Eventually, our engineering team will grow to this point—and, just like in an open-source project, we can’t expect engineers to retain all of our conventions in their heads when they contribute. Standardizing commit messages eliminates one of the many variables around how we commit code. It can give engineers more confidence in their releases, build trust in our codebase, and increase productivity.

Many engineers have a distinct working style. If you propose a change to their everyday workflow, you will likely encounter some resistance. That’s why identifying and working with key stakeholders before you introduce a new process can help ensure its success. One way to do this is to chart stakeholders on two axes—influence in the organization and interest in the project:

I used this chart to decide how I would direct my communication with the team. Folks who fell into the “low influence” and “low interest” quadrants didn’t need to be involved in the whole process. Instead, I kept them informed by using project-specific slack channels and documentation in Notion to communicate status updates and summarize meetings. Topics that required a team decision were discussed verbally rather than using Slack to avoid potential miscommunications.

The more likely someone was to push back on the project or give me valuable feedback, the more involved they were. I included those who fell into the “high influence” and “high interest” quadrants in almost every meeting. These folks served as a kind of litmus test for my ideas. They typically had high standards and expectations and needed to be convinced that a change was worthwhile if they were going to get behind it. Keeping people like this involved in the discussion is a great way to ensure that your initiative will produce value for your organization.

In a perfect world, we’d have standardized commits in every repository. However, given that Alto is a fast-moving startup, foundational changes need to be rolled out incrementally to minimize churn, validate impact, and allow us space to learn and iterate. There’s often not enough time or resources to do everything, and going all-in on something may require more effort than it’s worth.

We began by identifying the knowledge gaps we currently have about commit standardization and how we could iteratively validate the required process changes. We initially considered beta testing with the production app that runs our day to day operations because it had the most contributors and the most to gain from standardization. However, we didn’t want to risk blocking the majority of our team or experimenting with a project that was critical to business operations. The next best option was our internal component library—it had fewer contributors, so fewer engineers would be blocked if something went wrong, and more projects depended on it, so the potential impact would still be significant.

Given that one of our company values is to Focus On Impact, and that internal changes like this are difficult to measure, we quantified our level of success or failure using a team survey. We sent out a series of questions at the start of the project asking the team to rate their satisfaction with our current commit, review, and release processes. We plan to compare these results with a follow-up survey to measure changes in ease of committing code, confidence in releasing, and our developer NPS.

After closing our knowledge gaps and getting a baseline understanding of how the team felt about our release processes, we decided to adjust the scope to include the following changes:

Commit Standardization (i.e., formatting and enforcement of commit titles)

Versioned Release Automation (i.e., automatic version cuts, changelogs, and notifications)

We looked toward existing open source solutions to make these changes because we were on a tight schedule. There were many options to choose from, so narrowing them down to a shortlist before presenting them to the team helped speed up the decision-making process. The best tools for the job will depend on your engineering organization, of course, but we prioritized maturity, flexibility, and compatibility with our existing workflows during our evaluation.

We landed on the Conventional Commits standard because it has been vetted and used extensively in other projects, and a whole ecosystem of release tooling has been built around it. It also has a short learning curve, is flexible enough to work with all our repositories, and only enforces the bare minimum necessary to generate semantic versions based on commit titles.

Blog

Traditional vs. Online Pharmacies: How Alto Built Something Better

New Articles

The Disproportionate Impact of HIV in America

Your Heart Health Playbook During COVID-19

Diversity At Alto: Building an Inclusive Healthcare Company and Culture

COVID-19

Managing Diabetes During COVID-19

Navigating HIV Treatment and Prevention During COVID-19

Engineering at Alto

What to Expect When You Interview as a Software Engineer at Alto

How (and Why) We’re Standardizing Our Commit Messages

Fertility

What to Consider When Selecting a Fertility Pharmacy

Fertility Patient Story: Tiffany Shares Her Experience with Alto

Health

Cold, Flu, or COVID-19? Your Seasonal Symptom Guide

Heart Health Warning Signs to Watch Out For

Products

New From Alto: Medication Reminders & Auto Refills

Take Control of Your Prescriptions With New Features in the Alto App

Company

Airbnb’s Former Head of Business Technology Joins Alto

Hello, New York!

Culture

Coming Out with Pride: Nicholas Satow Shares His Story

From Pharmacist to Professor: Sandra Aziz Spotlight

Industry

How Do I Transfer a Prescription to Alto?

Celebrating National Pharmacist Month at Alto

Switch to a better pharmacy.