Expires 04/01/2021

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Alto Pharmacy Technician

Alto Pharmacist

For Black History Month, we’re recognizing pivotal Black leaders in healthcare who’ve paved the way forward for our country and the Black community.

Services that reduce travel and encourage social distancing are now more essential than ever, not only for vulnerable populations but all of us as members of our communities. Alto’s free same-day doorstep delivery ensures you have safe and reliable access to medications in this time of uncertainty. 

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

Alto / Blog

Here’s why healthy habits are key to improving your health and six ideas to try when you need some “me time.”

6 Science-Backed Ideas for Healthy Living

We know that taking care of our well-being is important, but when work deadlines are calling or the family needs your attention, your own wellness can easily fall to the bottom of your priority list. Fortunately, many healthy lifestyle habits don’t require much time or money, and can even be an enjoyable break from your everyday to-dos. Here’s why healthy habits are key to improving your health and six ideas to try when you need some “me time.”

When we’re overworked, stressed-out, or exhausted, it can be difficult to take care of our own daily maintenance tasks, let alone do activities we enjoy or make time to help others. And when we neglect our own care, it can leave us feeling burnt out, anxious, or depressed—states that affect everything from our performance at work to our relationships at home. 

Studies suggest that carving out “me time” is a key part of a healthy lifestyle. Healthier habits and lifestyle adjustments have been linked to lower levels of stress and higher quality of life, as well as lower levels of morbidity and reduced healthcare costs. And it can start with just a few minutes a day and cost nothing. Here are six science-backed lifestyle practices that your current (and future) self may thank you for. 

1. Practice meditation and mindfulness. 
You don’t need to ascribe to a certain religion or spend a month on a far-flung retreat to meditate or reap its benefits. Numerous studies suggest that even a few minutes a day of meditation can have many health benefits—from helping reduce anxious and stressful thoughts to curbing insomnia. Apps like Headspace or Insight Timer offer meditation basics at low or no cost. You can also ask at your workplace to see if services like Modern Health are offered. 
2. Try breathing practices. 
We know breathing is essential to life, but since it happens automatically, many of us don’t pay much attention to it. But research suggests that certain breathing techniques can help improve everything from your focus to your sleep. Studies have also found that practices like nasal breathing and pursed-lip breathing, as well as the deeper diaphragmatic breathing involved in yoga practices can be helpful in managing symptoms of chronic obstructive pulmonary disease (COPD) as well as asthma. 
3. Cook a meal at home. 
From picking out a new recipe to gathering all the ingredients, cooking at home for yourself or for others can be a relaxing multi-sensory wellness practice. It’s also often a healthier option than grabbing take-out. For this reason, studies suggest it as a top self-care practice to help those with diabetes avoid hospital visits and other health implications.
4. Do something creative. 
When it comes to the arts, you don’t need to have mastered a craft to enjoy it. The act of expressing in an artistic way can be enjoyable regardless of the outcome. And studies show that doing something creative—strumming a guitar, singing to yourself in the shower, or writing creatively—can boost your mood and emotional health as well as contribute to reducing stress and feelings of depression.

6. Stay on top of your medications. 
While this may seem obvious, forgetting to take essential medications is more common than you might think. In fact, studies have shown that up to 20-30% of medications are never filled, and that nearly 50% of medications for chronic disease aren’t taken as prescribed.  Alto can help make sure your prescriptions are delivered on time, as well as connect you with a pharmacist to answer any questions about dosage or side effects.

It's essential to be your own advocate when it comes to your health and well-being, and we’re here to support you with exceptional pharmacy care every step of the way. Talking with your healthcare provider about healthier habits and lifestyle adjustments can be just as important as discussing your medications. 

Our team of patient care pharmacists at Alto is available to chat whenever questions come up. Feel free to reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Despite its reputation, cholesterol is not inherently bad. Our pharmacists explain what is meant by good and bad cholesterol and how to maintain healthy cholesterol levels.

Cholesterol 101: The Good vs. The Bad (And What to Do About It)

Despite its reputation, cholesterol is not inherently bad. In fact, some cholesterol is not only good but necessary for our health. Your body needs cholesterol to build cells, help with digestion, and produce hormones. The problem comes when you have too much of the bad type of cholesterol. This can put you at risk for coronary heart disease, a heart attack, or a stroke. Here’s what you need to know to help keep your cholesterol levels in check and healthy. 

Cholesterol is a soft, waxy, fat-like substance that’s found in your bloodstream and in your cells. Since it doesn’t dissolve in the blood, proteins—called lipoproteins—carry cholesterol to where it is needed in the body. Lipoproteins are made up of cholesterol and triglycerides, which are a type of fat the body uses as an energy source, just like carbohydrates. 

Cholesterol comes from two sources: your liver and certain foods you eat, like meat, poultry, and dairy. Your liver, however, makes all the cholesterol your body needs for your cells, digestion, and hormones.

What is meant by good and bad cholesterol?

There are two types of cholesterol: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL is also called “bad cholesterol” because it can build up on the walls of your blood vessels, increasing your risk of a heart attack or stroke. HDL, on the other hand, is considered “good cholesterol” because it can help clear these buildups by removing the bad cholesterol from your body.

Higher levels of HDL cholesterol are associated with a lower risk of atherosclerosis, heart disease, and stroke. So, in general, you want to have higher HDL levels and lower LDL levels to keep your heart healthy. A blood test can measure the amount of each type of cholesterol in your blood. In general, the Cleveland Clinic recommends that you keep your total cholesterol under 200 mg/dL, your LDL cholesterol under 100 mg/dL and your HDL cholesterol over 50 mg/DL for women and under 40 mg/dL for men.

How can I maintain healthy cholesterol levels?

Keeping your cholesterol levels in check and maintaining good heart health primarily comes down to your diet and lifestyle. Here are the American Heart Association’s (AHA) recommendations for what to load up on and what to avoid. 

Whole-grain foods (bread, pasta, brown rice)

Lean meats and poultry without skin. If you choose red meat and pork, select “loin” and “round” options to help minimize the amount of fat. 

Fish like salmon, trout, tuna, and sardines

Unsalted nuts, seeds, and legumes (dried beans or peas)

Non-tropical vegetable oils like olive, corn, canola, or safflower oils

Full-fat dairy products (whole milk, cream, ice cream, butter, and cheese)

Baked goods made with saturated and trans fats like donuts, cakes, and cookies

Foods with “hydrogenated oils” in the ingredients

Tropical oils like coconut, palm, and palm kernel oils

Solid fats like shortening, stick margarine, and lard

What other lifestyle choices can help improve my heart health?

Fortunately, the go-to practices for keeping your heart healthy are a lot of the same ones that are recommended for keeping the rest of your body (and brain) tuned up. Here are four lifestyle choices to consider to support your heart health.

Studies show lacing up those sneakers is key to a healthy heart. Frequent exercise has been associated with a decreased risk of developing cardiovascular disease as well as low blood pressure and higher insulin sensitivity. The AHA recommends at least 150 minutes of moderate-intensity exercise per week like taking a brisk walk in the neighborhood, going for a bike ride, or doing yard work.

2. Reduce stress.
Studies suggest that meditation and mindfulness can help improve everything from your stress levels and blood pressure to your sleep quality and emotional health. Having a furry friend around could also help lower your blood pressure, as well as improve your physical and emotional health by helping you stay more active and social.

3. Get good sleep.
If you’ve ever had a night of poor sleep, you already know the many ways that puts you in a slump. Sleep issues like not sleeping enough, sleep apnea, and insomnia can increase the risk of obesity, high blood pressure, Type 2 diabetes, stroke, and coronary heart disease. Regular exercise, limited screen time before bed, and a consistent sleep schedule can all help improve your sleep. 

Quitting smoking and drinking alcohol in moderation have both been linked to higher levels of good cholesterol. For alcohol, the CDC recommends limiting your intake to 1 drink per day for women and 2 drinks per day for men. 

To learn more about ways to keep your heart healthy, you can also tune into the American Heart Association podcast that covers everything from managing cholesterol to practicing meditation. But before you go about making any major lifestyle changes or if you have concerns about your heart health, it’s important to first consult with your doctor to decide what’s best for you.

It’s important to be your own advocate when it comes to your health and we’re here to support you with exceptional pharmacy care every step of the way. If your doctor prescribes cholesterol-lowering medications or other heart medications, our pharmacists would be happy to walk you through dosage instructions and answer your questions. We’ll also help you get the lowest price by looking for any available savings, as well as deliver your medications to your home for free. Simply tell your doctor to send your new prescription to Alto or contact our care team, and we’ll transfer your existing prescriptions for you.

Reverend Stacey, who is also the Executive Minister at Trinity United Church of Christ in Chicago, sat down with us to share more about the challenges of fertility in the Black community, what fertility care providers can do to create more inclusive experiences, and some of her favorite memories in the history of FFCG. 

Rev. Dr. Stacey L. Edwards-Dunn on Her Mission To Improve Black Fertility Care

When it comes to fertility, there is a lot to navigate—from deciding which treatment option is right for you to figuring out how to afford the costs. In the U.S., about 11% of women experience infertility, and studies suggest that Black women are twice as likely to face infertility as white women. 

Rev. Dr. Stacey L. Edwards-Dunn is trying to change this. After working as a health educator in Chicago and an education director at Planned Parenthood, she founded Fertility for Colored Girls (FFCG) in 2013. As a 501c3, FFCG’s mission is to provide education, awareness, and support to Black women/couples and other women of color who struggle with infertility—something Stacey wished she’d had when she was on her own infertility journey. 

With 14 chapters across the country spanning urban and suburban communities, and with more opening each year, FFCG provides services including educational programs, grant opportunities, counseling, and monthly support groups where women can share their experiences and receive support.

What are the reasons Black women are almost twice as likely to experience infertility as white women?

There are a few factors behind this. The first is that in the Black community, infertility is a taboo topic. And it’s not something we expect to experience. In our communities, we have believed the hype that Black women are hyper-fertile. Much of this comes from breeding myths during slavery around our ability to be able to give birth. But the reality is, these myths are incorrect. So it begins with how we have been socialized and educated around our own reproductive health and our Black bodies. 

A second reason is that there are many Black women and couples who don’t trust the medical system. And because of this distrust, we’re not accessing health care. We think doctors don’t take us seriously and impose their biases on us. And even today, we still hear stories of Black women and couples having surgeries done on them and being sterilized without permission.

A third reason has to do with research. Most of the research around reproductive health and treatment has primarily been done on white women. So when research shows that in vitro fertilization (IVF) is not as successful with Black women, it’s because the trials haven’t included Black women. Once we start seeing more research done that includes black and brown women and other ethnicities then we’ll be able to tailor treatments better. 

A final reason has to do with marketing. We still have a number of fertility clinics that aren’t including women and babies of color and other ethnicities in their marketing. So Black women and couples don’t see themselves in the marketing and if you can’t see yourself, it makes it harder to feel welcome and to trust that you’ll get quality care. 

In addition to marketing and staffing, what other recommendations do you have for clinicians and fertility care providers to create a more accessible and equitable experience? 

I would say education. The staff working with women of color need to be educated. They need to be equipped with tools on how to be culturally sensitive to the Black women and couples that are coming into their spaces. Something I hear from Black women and couples is they want the doctor and team to partner up with them in their treatment—not to look down on them or talk at them. They want someone to walk with them on their journeys. 

Education can also help staff understand their own biases which, a lot of the time, they’re unaware of. It’s important they know what to say and what not to say to make sure they aren’t deterring Black couples. In addition, Black and other ethnicities need to be represented in executive roles and throughout the organization —from doctors to nurses to lab technicians. Making sure staff is inclusive, diverse, and culturally-educated.

Finally, they need to work with organizations like FFCG, who have their pulse on the community and can help them create relationships with the Black community. And they should be open to having these conversations not just during Black History Month, but all the time.

For the communities you work with and those who might not understand their family building options and the resources available to them, what do you want them to know? 

I want them to know there are multiple paths to parenthood. And though they are all different, they are not deficient. When I educate the women and couples I coach and that come to me, I help them focus on the goal, which is to be parents and to build a family. When you know the goal, then you can understand that you have other natural options, like IVF, intrauterine insemination, donor eggs or donor sperm, domestic adoption, et cetera. 

There is an option and a path that has been designed for everyone and I help them see that. Because when you have options, there are possibilities. I am very intentional about helping to open up the minds of the women and couples that I work with to help them see the goal. Because when you reach the goal of becoming a parent to a child, the reality is that you’re not going to love them any less because it is the child that God has sent you.

Is there a particular memory or moment that stands out for you since you founded Fertility for Colored Girls?

A powerful moment for me was when we gave away our first free IVF [cycle] to a couple. After experiencing a few unsuccessful IVF [rounds], they didn't have any money left and their state of Mississippi doesn’t have insurance toward infertility treatments. So they put their name into our raffle and won. They took the Megabus from Mississippi up to Chicago, Illinois to meet everybody that they had been talking to on the phone during prayer time. 

At this time, I was also one month away from giving birth to my daughter after seven in vitro cycles, so I really felt for them. Now they have five-year-old twins. This was significant because it was the first time we were able to provide physical resources to a couple in need. 

In addition to this, I am always so honored when women and couples call me and tell me they got a positive pregnancy test after IVF, or that their surrogate is pregnant, or their adoption just got approved. Often, I end up finding out before anyone else in their family does. I’m so honored that these women and couples trust me to share their journeys and their hearts. And most of them have never met me in person, they’ve just talked to me on the phone. 

These are women who have cried so many tears in silence and lived so long in shame, and they’ve found a successful path to starting a family. That is what gives me joy and fuels me to keep doing the FFCG work. It reminds me there’s still hope and the work that we are doing is not in vain. 

Is there anything else you’d like to highlight about your work with FFCG and your mission?

I will add that I think you are able to have peace on your [infertility] journey when the mind, body and spirit are aligned. Because if any of those aspects are not aligned everything can really fall apart. Therefore, my approach, and the mission of FFCG, is to minister to each aspect of a person’s life as they are all equally important. 

In addition, it’s important for people to know the resources that are available to them through FFCG—from grants they can apply for to education to support in our prayer circles. Many Black women and couples struggle with having the resources and support to move forward, so I want to make sure they know this.

To support or donate to Fertility for Colored Girls visit the FFCG site. You can also learn more about the Black Reproductive Endocrinologist and Infertility Specialists making history and bringing hope to their families on 2/25 at 6 pm CT. Register here.

At Alto, we know fertility treatment 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.

Starting Wednesday, February 24, New York City residents can now choose Alto’s same-day doorstep delivery for all of their pharmacy needs. 

Hello, New York City!

Alto extends beyond fertility medication support to offer full-service pharmacy operations in New York City.

Starting today, Wednesday, February 24, New York City residents can now choose Alto’s same-day doorstep delivery for all of 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: 

3 - 5 pm ET for Manhattan to 125th St, 4 - 6 pm ET full service area 

6 - 8 pm ET for Manhattan to 125th St, 7 - 9 pm ET full service area

4 - 6 pm ET for Manhattan to 125th St, 5 - 7 pm ET full service area

Walk-in hours
Need to pick up? Our pharmacy is located at 100 Park Avenue - that's 40th between Park and Madison.
Monday - Friday: 9 am – 7 pm ET
Saturday - Sunday: 10 am - 6 pm ET

New York 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. 

General customer support hours are Monday - Friday 9 am - 12 midnight ET and Saturday - Sunday 10 am - 9 pm ET. Patients can reach out to Alto via phone/text at 1 (800) 874-5881, email 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 currently delivers across the greater Bay Area, Los Angeles, Orange County, Seattle, Denver, Las Vegas, New York City, Houston and Dallas.

The health of your gut can impact everything from your mood to your immunity. Here’s what you need to know and how you can keep your gut healthy.

Why Gut Health Is Key (and How To Improve Yours)

You may have noticed in recent years that the topic of gut health seems to come up a lot more in conversation and health news. Why is that? Over the past decade, scientists have been learning that your gastrointestinal (GI) system—of which your gut is a key part—does a lot more than just move food through your body. And that the health of your gut can impact everything from your mood to your immunity. Here’s what you need to know and how you can keep your gut healthy.

Gut Health 101: What It Is and Why It’s Important

Your body is full of trillions of microorganisms that make up your microbiome. Many of these microorganisms are bacteria. Some are harmful and associated with disease, while others are beneficial and key to your health. The ‘gut microbiome’ refers to the bacteria that live in the part of your GI tract where digestion happens—your large and small intestines—where, at any given time, we have between  300 and 500 different species of bacteria living. 

While everyone’s microbiome is unique, a general indicator of a healthy one is having a diversity of bacteria. In unhealthy people, scientists have observed much less diversity although they don’t know for certain which comes first—the bacteria or the disease. 

Inflammation, which studies point to as the root of many diseases, is kept in check in the gut. When the balance of your microbiome gets out of whack, inflammatory bacteria can take charge and, via metabolites, spread inflammation throughout your body. This can affect your brain, heart, and immune system function as well as your skin, weight, and ability to absorb nutrients. 

Having a healthy gut, on the other hand, has been linked to a stronger immune system, reduced symptoms of depression, lower risks of heart disease and certain cancers, as well as reduced symptoms of arthritis. 

So how do we keep our gut healthy? As with many other aspects of health, it largely boils down to the foods we eat and the lifestyle choices we make. Other factors like medication and emotional stress could also play a role. 

To start improving your gut health, it’s helpful to first look at what might be wreaking havoc on your microbiome. While there are many different symptoms that could point to an unhealthy gut, here are the most common.

Upset stomach
Signs of an upset stomach can include gas, bloating, constipation, diarrhea, and heartburn. When your gut is in balance, these symptoms should reduce, since your gut will have an easier time digesting and eliminating your food.

Poor sleep (or constant fatigue)
Serotonin, the sleep and mood hormone, is mainly produced in the gut. An imbalance in your gut can impair serotonin production and affect the quality of your sleep. 

Weight changes
Poor gut health can affect your body’s ability to absorb nutrients, regulate blood sugar, and store fat. Decreased nutrient absorption can result in the urge to overeat and unintentional weight gain. On the other hand, a bacterial overgrowth in the small intestine could cause weight loss.

Skin irritation
When your gut is inflamed, certain bacteria and toxins can leak out into the body, which could irritate your skin.

Autoimmune conditions
As mentioned earlier, research suggests that an unhealthy gut can lead to an inflammatory response in the body and affect your immune function. This could make you more susceptible to autoimmune diseases like Type 1 diabetes and celiac disease where the body attacks itself rather than harmful invaders. 

Food intolerances
It’s theorized that food intolerances can result from an imbalance in the gut. When you’re intolerant to a certain food, you may experience symptoms like bloating, gas, abdominal pain, and nausea.

A high-sugar diet
Sugar, often linked to inflammation in the body, can decrease the amount of good bacteria in the gut. This can cause more sugar cravings, making the situation worse.

You don’t necessarily have to keep your gut under a daily microscope, but following some general health practices—from keeping a balanced diet to getting a good night’s sleep—can go a long way. Your healthcare practitioner can also give gut health recommendations. Here are some common lifestyle choices that research shows can improve gut health. 

Chronic stress can wreak havoc on your whole body, including your gut. Some ways to reduce stress can include exercise, meditation, yoga, connecting with friends or family, and decreasing caffeine consumption.

Having a good pre-bed routine can be as important as the sleep itself. Your pre-bed routine could include minimizing screen time and exercise. In terms of the ideal amount of sleep to log, the National Sleep Foundation has recommendations based on your age. 

3. Avoid smoking
Studies have found that smoking can increase the amount of potentially harmful bacteria in your gut, while decreasing the amount of good bacteria. It’s also been shown to affect heart and lung health, as well as increase your risk of cancer. 

Water helps everything from digestion to carrying nutrients to your cells. And it can help maintain the balance of good bacteria in your gut. Drinking at least four to six cups a day is recommended. 

5. Take a probiotic or prebiotic
Probiotics are live, good bacteria that can come in pill form or from foods like yogurt. Though the science is still out on the extent of the pills efficacy, there seems to be a general consensus that adding a probiotic can be a good idea to help restore your gut’s balance. Prebiotics are the food that probiotics can eat and are usually fiber-rich. Having prebiotics in your gut can help promote the growth of the good bacteria. 

6. Exercise regularly 
Working out may help increase gut health by growing the diversity of good bacteria in your gut. How much should you exercise? For general adults, the recommendation is at least 150 minutes a week or 20 minutes per day. 

Minimize the amount of foods in your diet that are processed or high in sugar or fat—all of which can lead to increased inflammation in the body. When it comes to gut-healthy foods, diversity is key. Here’s what studies show are best for your gut:

Fiber-rich foods like legumes, beans, peas, oats, bananas, asparagus, and berries

Fermented foods like kimchi, sauerkraut, yogurt, kombucha, tempeh, miso, and kefir

Garlic and onion which may also help minimize the risks of certain cancers as well as boost the immune system

Collagen-rich or collagen-boosting foods like salmon, bone broth, mushrooms, egg whites, and cashews

Gut health can be key to helping everything from your brain to your immune system function properly. To keep your gut microbiome healthy, a key place to start is with a balanced diet as well as healthy lifestyle practices. Even though we can’t see our gut, there are many symptoms that can help let us know when ours is out of balance and needs some attention. 

If you are concerned about the potential effects of your medications on your gut health, talk to an Alto pharmacist. Our team of patient care pharmacists are ready to help whenever health questions come up. Reach out any time via text, phone call (1-800-874-5881), or in-app messaging.

Why Gut Health Is Key (and How To Improve Yours) 

5 Black Healthcare Leaders to Know

At Alto, part of our work is to redefine the modern pharmacy to make sure patients from all backgrounds have reliable, affordable access to the medications they need. This extends to fostering a culture of inclusion in healthcare and honoring the Black leaders who have transformed the medical field. For Black History Month, we’re recognizing pivotal Black leaders in healthcare who’ve paved the way forward for our country and the Black community.

Black Healthcare Leaders Who’ve Paved The Way 

Dating back to the 19th century, there have been many Black individuals who, despite discrimination and prejudice, have made a profound impact in healthcare. From hospital bedsides to the front lines of the abolitionist and suffragist movements, here are five Black pioneers in healthcare you should know.

James McCune Smith: The first Black doctor in the U.S. 

When James McCune Smith showed potential and promise at a young age, his parish collectively raised funds so he could afford to attend university. Because of his race, he wasn’t allowed to attend school in the U.S., so he earned his baccalaureate, master’s, and medical degrees from the University of Glasgow in Scotland. 

Not only did Smith become the first Black doctor to practice medicine in the U.S., but he was also the first Black physician to publish articles in U.S. medical journals. In addition, he penned and edited articles for abolitionist newspapers including “A Lecture on the Haitian Revolution” (1841) and “The Destiny of the People of Color” (1843). He worked closely with Frederick Douglass and the two founded the National Council of Colored People. As a highly-educated Black physician and scholar, Smith was a key figure in not only abolishing slavery, but also in helping make its success credible.

Mary Eliza Mahoney: The first Black licensed nurse in the US

Mary Mahoney, born to freed slaves in 1845, learned the importance of racial equality at a young age. This became her reason for pursuing nursing school: to fight for and serve women and the Black community.

After years as a janitor, cook, and washer woman at the New England Hospital for Women and Children, she was accepted into their nursing program. The program was so demanding that only four of 42 students finished—Mahoney was one of them. And with that she made history as the first Black woman to become a licensed nurse. 

She earned many accolades in healthcare, became a member of the American Nurses Association (ANA), and co-founded the National Association of Colored Graduate Nurses (NACGN), where she was an elected leader. The NACGN was later absorbed into the ANA in 1951. Mahoney spent her days caring for those in need at the hospital and her nights campaigning for women’s suffrage. Her efforts were so influential that after her death, she was inducted into the National Women’s Hall of Fame alongside her fellow suffragists in Seneca Falls, NY. 

Dr. James Hildreth: President & CEO of Meharry Medical College 

A leader in immunology, Dr. James Hildreth leads Meharry Medical College in Nashville, Tennessee — one of only four Black medical schools in the country. Their mission is to create more opportunities in medicine for the Black community. Hildreth is renowned around the globe for his decades of influential HIV research as well as his work to fight the global COVID-19 pandemic. He was recently appointed to the FDA’s COVID-19 Vaccine Review Committee.

Hildreth earned his Bachelor’s at Harvard, his Ph.D. in immunology from Oxford and became the first Rhodes scholar from Arkansas who was Black. He joined the Advisory Board at Alto in August to help reimagine the pharmacy experience as one of its two anchor members. 

Phill Wilson has lived with HIV for over 30 years and lost his partner, Chris Brownlie, to the virus in 1989. Ten years later, he founded the Black Aids Institute (BAI) to ensure Black communities receive the information they need for prevention and treatment. The BAI has been leading the fight to end HIV in Black communities for over two decades and is the only national HIV/AIDS think tank focused exclusively on Black people. 

In 2010, President Barack Obama appointed Wilson to the President’s Advisory Council on HIV/AIDS. Over the last three decades Wilson has amassed countless national and international accolades, including the Ford Foundation’s award in Leadership for a Changing World.

Anna Louise James: One of the first Black female pharmacists

The daughter of a Virginia slave who escaped to Connecticut, Anna Louise James grew up in Old Saybrook, Connecticut, where she became the first Black woman in the state to earn a pharmacy license. She ran her own pharmacy and, when her brother-in-law—one of only two Black pharmacists in the state—was drafted in World War I, he asked her to run his pharmacy. 

She renamed it James Pharmacy and was known to everyone as “Miss James.” More than a place to pick up medicine, her pharmacy was a central gathering spot for the community. Miss James ran the pharmacy for 50 years and today, the building still stands and is listed on the National Register of Historic Places.

Our work to redefine the modern pharmacy begins with recognizing and honoring past and present Black leaders in healthcare. The leaders who’ve not only advanced the field of medicine, but who continue to break down barriers to help ensure equal access for all. Interested in making a difference at Alto? Follow us on LinkedIn to learn more or visit our Careers page for open roles.

At Alto, we’re obsessed with our mission to improve quality of life for everyone who needs the help of medicine. Our mission guides us in all we do and every decision we make. 

Our mission and diversity work are tied together with one word from our mission -- everyone. Too often, only those with significant resources access the best and benefit from innovation in healthcare. We see it everyday in the data. Too many among us continue to struggle with solvable challenges, in our own wellbeing and in the larger healthcare system. These statements and environments have existed in the workplace as well, influencing the products, services, and policies that steer how the organization works for all of us.  Our work is to make Alto different.  Our work is to build and sustain an inclusive culture.  Our work is to attract, develop, reward and retain talent from all the communities we serve as patients and build a product that supports everyone. 

Today marks another step in our diversity, equity, and inclusion journey as we release our first annual diversity report. We share it because this work is central to our mission and in doing so, we use transparency to hold ourselves accountable, as well as hopefully play a part in raising expectations and norms throughout the healthcare and technology industries.

In 2020, across the company we saw a 13ppt increase in women and 7ppt increase in underrepresented groups (Black, Hispanic/LatinX and Native professionals).

As for women in leadership, we saw increases of 3ppts in Women Managers and 1ppt in Product, Engineering and Design driven by both hiring and promotion. At the leadership level, 32% of leaders identify as women.

In 2020, we saw 10ppt increase across our underrepresented managers to 13% Black, 16% Hispanic/LatinX, 2% Native/Indigenious.  In the leadership group, we saw an 8ppt increase to 15% Black and 2% Hispanic/LatinX. 

In 2020, we also established our Alto Advisory Board and our first two anchor members, who will help guide Alto towards our mission, advise on key decisions, and support strategic initiatives. We’ve formed the Advisory Board to support our leadership as we navigate the regulatory landscape, launch new features to modernize the pharmacy experience, and adhere to the highest standards of operational excellence and patient care.  

Dr. Hildreth is the President and Chief Executive Officer of Meharry Medical College, one of the nation’s oldest and largest private historically Black academic health sciences centers. He received his Bachelor’s degree from Harvard University, his Ph.D. in immunology from Oxford University as a Rhodes Scholar, and his medical degree from Johns Hopkins School of Medicine. He was the first Black American in the 125-year history of Johns Hopkins School of Medicine to earn full professorship with tenure and is internationally known for his influential HIV research.

Jennifer Kent served as the Director for the California Department of Health Care Services, where she led the second largest public healthcare system in the nation, with an annual budget of over $100B and serving over 13 million Californians. She oversaw the administration of 24 managed care plans as well as 56 county behavioral health plans. She has also held leadership roles in the Health & Human Services Agency, Governor's Office and has experience in the private sector as a lobbyist, consultant, and association executive. She has more than 15 years of health administration and policy experience in California.

Alto created our DEI strategy with our team aligned to four pillars – Hire, Include, Develop, and Invest.  Each pillar's actions tie to our people and our business. This means the return on investment is clear and goals are aligned to business outcomes.

Medical Health Care Premiums and Part Time Health Care Benefits in SF: 

In order to increase access and affordability to critical health-care services, we asked our broker to offer a special mid-year open enrollment 2020, reducing premiums for most plans by 5%. We reduced out-of-pocket maximums and speciality office visits by an average of 37%. We reduced co-insurance as well as costs for labs, x-Rays, and emergency room visits for our Cigna plan by 50%. Finally, prescriptions copays were reduced by 25% for Brand medications and 75% for Generic prescriptions. This benefits the employee with direct access to care and a better employee experience as compared to direct contribution to the city fund.

We increased our paid parental leave across all US locations to 8 weeks (up from 6 in 2020) for all parents requesting leave as of January 1st.  Throughout 2020 parents and other caregivers were impacted significantly as schools, daycare, and caregivers were closed, isolated, or unable to rely on pre-covid support. We offered laptops to parents who couldn’t afford them for each child to participate in remote learning.  We offered expanded benefits above and beyond FFCRA. Finally, we offered paid sessions for remote learning, tutoring, and experiences for parents and caregivers.

Finally, in December we launched Modern Health with 6 paid coach/therapy sessions and access to a digital wellbeing library and resources to all Altoids.

We launched six ERGs in 2020. Formalizing the work of our original Diversity Committee into six groups: Umoja (Black), Auténtico (LatinX/Hispanic), Women, Proud (LGBTQIA+), Asian/Pacific Islander, and Working Parents. These groups are focused on building community with both those who identify and allies. They support our education, development and investment in our communities. Each has been given a budget, an executive sponsor, and access to other company resources.

We recognized as a leadership team that we needed to educate ourselves. We were not going to rely on those from underrepresented communities to educate us. We embarked on four three-hour sessions focused on learning about diversity and inclusive language, naming our privilege, and starting the work each of us wanted to do. It was only after these sessions, with clear self-awareness and awakening; that began the work of empowering other leaders -- managers and other Altoids on this journey. There is more work to be done, as Neil Frye, Chief People Officer, mentioned in his blog post in late 2020 -- this is not a sprint, nor is it a marathon; it is life-long work.

Focus on Latinx Senior Manager to VP talent; with targeted outreach, activation and networking for opportunistic and open hiring

Expand employee resource group events throughout the year supporting inclusive environment, educating and investing in our communities

Get to full participation in DEI Workshops and launch additional sessions like What’s My Privilege and Moving to Action across the company

Explore new partnerships with Community & Higher Ed Institutions (i.e. Historically Black Colleges and Universities, Hispanic Serving Institutions, etc.)

2020 Diversity, Equity & Inclusion Report

Justin Moy, Senior Software Engineer at Alto, explains how the engineering team developed a staging environment strategy that could keep up with our growing organization.

Creating Sandboxes: How to Make It Easy for Your Engineering and Product Teams

When we formed our Infrastructure team in 2020, our charter centered on scale, reliability, and the developer experience. Our first priority? Developing a staging environment strategy that could keep up with our growing organization.

Initially, we had a set of command-line tools for staging environments that could be run from an engineer’s workstation. However, this approach required significant manual effort to create and manage an environment which led to inconsistencies like outdated data and lack of full application coverage and integration. The required workstation dependencies and maintenance added to the overhead. These tools were also different from the ones used to create a production environment, causing drift between the two.

To address these issues, we focused on improving our tooling to create consistent and reproducible results for both our staging and production environments. Here are the five steps we took to get there:

Luckily, we were already here. Our deployment process involved creating and deploying Docker containers and using a Procfile to run specific parts of our applications (think separating out web and workers). Packaging our applications as immutable Docker images allowed us to ship consistent and portable code. These images are run as containers which can be executed on separate hosts and scaled independently of each other.

We wanted to increase our observability, mature our internal monitoring, and maintain our infrastructure in a more consistent and reproducible manner. Kubernetes, and its automated container orchestration (deployment, scaling, and management), allowed us to accomplish all of the above goals.

It was easy for us to get started in Kubernetes thanks to Kind, which allowed us to run clusters locally. This increased development speed and reduced the friction of learning a new external provider.

Helm makes it easy to manage packaged applications in Kubernetes. Some community-provided applications include: NGINX for load balancing and reverse proxying HTTP and other traffic; Prometheus and Cortex for metrics, monitoring, alerting, and dashboarding, Loki for logs; and Sentry for exceptions.

In order to ease the integration with other infrastructure components, enable rapid deployment, and, most importantly, provide us with the consistency and reproducibility we wanted, we created and deployed Helm charts for our applications.

From here, we could stamp out our applications for developer use in sandbox environments: complete end-to-end environments, separate from production, that enable engineers to rapidly develop and test their code. And if an engineer is working on multiple features, they can spin up multiple sandbox environments and manage their applications and data independently of each other. Victory!

We had already created pipelines in Concourse to automatically deploy and upgrade our infrastructure Helm charts. To eliminate the manual toil of spinning up new environments and to reduce the friction around sandbox adoption for our engineers, we extended these automated pipelines by building a Git-driven continuous deployment pipeline. When an engineer created a commit to a repo defining the state of a sandbox, our Concourse job would apply these changes.

At this point, we could deploy environments that resembled production but were separate from production and other sandbox environments. They connected to the rest of our observability stack, including metrics, logs, traces, and exceptions.

As we prepared to scale to the rest of the product and engineering organization, we focused on the following ideas: further reducing manual toil, removing barriers to entry, reducing cost, and optimizing the development workflow. The diagram below shows our sandbox architecture.

In Kubernetes, an operator acts on custom resources in order to automate a task or set of tasks. The custom resource allows us to create a well-defined entity and extend configurability options to users. The operator allows us to customize individual sandbox environments based on changes to the custom resource.

We utilized Kubebuilder to create our operator and CRD (custom resource definition). Kubebuilder was a great starting point and provides tools to ease rapid development of a new operator.

Using this pattern, we could easily perform CRUD operations (create, read, update, delete) on a custom resource using standard tools like kubectl, and the operator would handle updating our deployments in Kubernetes. These updates could include: updates to application configuration, deploying a new Docker container, injecting different secrets, etc. This flexibility allows for testing of many different scenarios like: developing a new feature, reproducing a bug, upgrading frameworks, and security and load testing.

Increase adoption by removing barriers to entry (admin web UI)

We built a web UI so users would be able to deploy sandboxes intuitively and easily without extensive knowledge of the underlying tools. The web UI interacts with our custom resource and lets the operator handle updates. It allows our teammates—both engineers and non-engineers—to easily spin up their own environments for development, demo, or training purposes without modifying production data.

In addition, we show helpful information about a sandbox to a user. This includes links to each of our applications; pre-filtered logs, metrics, tracing, and exceptions; and commands to connect to specific applications to ease debugging.

Because the sandbox environments are integrated with our monitoring stack, we have the full metrics and logging that we expect from our applications. We created an autoscaler service that performs queries against this information and scales our sandbox environments up and down. We’re able to decrease our costs by over 90% when these environments are not in use and are able to quickly scale them back up when they are being used.

Optimize the development workflow (image updater)

An additional feature we built into our sandbox environment is the ability to follow a feature branch in our applications. When an engineer pushes a commit to a pull request in Github, a corresponding sandbox will automatically update to this commit. This reduces several manual steps in the development workflow and allows engineers to test their code in near-to real time.

Sandbox environments have made an impact on the engineering organization and beyond.

Engineers can quickly desk check new code in a production-like environment during code reviews.

Shared sandboxes reduce the blast radius of bug bashes.

Non-engineers can spin up sandboxes to demo or provide training on features without impacting production data via the Admin UI. This has proven particularly useful for Product Managers and Designers on the team to be able to play with product features and better understand how they work in order to suggest improvements.

Teams have built use case scenarios into their applications. This allows easy reproducibility of critical paths and functionality.

With these five steps—Containerize, Kubernetes-ize, Helm-ify, Automate, Optimize—we’ve laid the foundation for deploying all of our environments in an automated and consistent manner. In addition to applying many of our learnings to improve our production environment, we successfully built core infrastructure that our engineers, product managers, and designers use each month to test their changes and reduce production downtime.

Interested in learning more about engineering at Alto? Follow us on LinkedIn. 

Starting Monday, February 1, residents of the greater Houston metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs.

Hello, Houston!

Alto’s launch in the Houston market extends our industry-leading patient care model to Texas.

Starting Monday, February 1, residents of the greater Houston metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

Courier delivery windows
Monday - Friday: 6 - 9 pm CT
Saturday - Sunday: 2 - 5 pm CT

Walk-in hours
Monday - Friday: 9 am – 7 pm CT
Saturday - Sunday: 10 am - 5:30 pm CT

Houston area 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 4950 Terminal Street, Suite 200, in Bellaire.

General customer support hours are Monday - Friday 9 am - 11 pm CT and Saturday - Sunday 10 am - 7 pm CT. Patients can reach out to Alto via phone/text at 1 (800) 874-5881, email or app.

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