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Blog | Alto Pharmacy

Traveling during fertility treatment may feel overwhelming, but it’s definitely doable. While the fertility journey involves many moving parts, careful planning and coordination with your care team can help you take a trip without impacting your treatment. Use the suggestions below to prepare for your travels. 

A Guide to Traveling During Fertility Treatment

Advanced preparation is important when traveling with any medication. Given the complex and time-sensitive nature of fertility treatment, the planning process involves a few more steps.

First, consult your doctor about your plans and make sure your intended travel dates don’t conflict with your treatment. In vitro fertilization (IVF) requires very thorough travel planning, since it entails multiple in-person doctor’s appointments and a very carefully timed egg retrieval. Other treatments such as intrauterine insemination (IUI) may leave more room for flexibility.

Regardless of your specific treatment plan, make sure you are up to date on vaccines and be sure to monitor health-related travel alerts. The CDC advises that women who intend to conceive consult their physician before traveling to a destination with potential exposure to the Zika virus.

Lastly, make sure that you have more than enough of your fertility medication(s) and supplies on hand. Aim for several additional days’ worth. Needles used to inject medications require a prescription in some states, so bring extra to avoid unnecessary hassle.

If you are traveling near an Alto location, same-day delivery of fertility medications and supplies may be available.

Pack your medications and supplies in a carry-on

When traveling by plane, it’s always best to pack important medications and supplies in your carry-on rather than in a checked bag. Bring everything you need to safely administer your medications, including syringes, needles, alcohol swabs, hand sanitizer, gauze, and a sharps disposal container.

While the U.S. Transportation Security Administration (TSA)’s current limit on liquids, gels, and creams in a carry-on is 3.4 ounces (100 milliliters), there are exceptions for medications. Bringing needles onto a plane is acceptable when accompanied by injectable medications.

Give yourself extra time to allow for additional screening of these items. The following tips may help you get through security as efficiently as possible.

Inform the TSA officer that you are carrying more than 3.4 ounces of liquid medication before your screening process begins, if applicable.

Bring a copy of your prescription(s) with you.

Keep all medications and supplies in their original packaging.

Put your medications and supplies in a separate, clear bag, as they will need to be separated from the rest of your belongings.

Store your medications at the appropriate temperature

Refrigeration is essential with many fertility medications. (At Alto, we ensure that medications are held at the right temperature before you receive them and guide you on safe at-home storage.)

Many people use frozen gel packs and insulated medication bags to store fertility medications at an appropriate temperature while traveling. (This approach is particularly useful for air travel.) As you finalize your travel plans, verify that your hotel or other accommodation offers access to a refrigerator or mini fridge.

Choose a flexible and reliable pharmacy partner

Fertility treatment can be stressful, let alone traveling during the process, but we’ll be with you every step of the way. We offer free, same-day delivery of medication and supplies right to your doorstep, and our dedicated fertility team is here to answer any questions you may have before your trip.

Interested in learning more about how Alto can support your fertility treatment? Request a price quote online or reach out through secure in-app messaging or by phone at 1-800-874-5881.

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

If you’re managing a chronic health condition — or multiple conditions — you’re probably familiar with the hassle of filling multiple medications. Not only is it inconvenient to track different refill dates throughout any given month, it makes it much more difficult to prioritize your health, with the potential for missed doses.

To make it as convenient as possible to stay on track with treatment, Alto offers a free medication bundling service that lets you receive all your medications in a single, recurring delivery.

Medication Bundling: One Delivery for All Your Prescriptions

If you’re managing a chronic health condition — or multiple conditions — you’re probably familiar with the hassle of filling multiple medications. Not only is it inconvenient to track different refill dates throughout any given month, it makes it much more difficult to prioritize your health, with the potential for missed doses.

To make it as convenient as possible to stay on track with treatment, Alto offers a free medication bundling service that lets you receive all your medications in a single, recurring delivery.

Medication bundling builds on other tools in the Alto app like auto refills and medication reminders to take the hassle out of living your healthiest life. And like everything at Alto, it bridges innovation with industry-leading care to deliver an exceptional pharmacy experience that puts you first.

While some traditional retail pharmacies offer a similar service, they often require you to do the legwork of coordinating with your doctor and insurance. (Not to mention that there’s the additional inconvenience of traveling to the pharmacy and waiting in line.)

At Alto, it’s a whole lot simpler. The entire process takes place in the app, and if your medications are eligible*, we can organize your bundle within seconds.

We’ll get you started with synchronized refills and bundled deliveries in four simple steps.

1. If you have multiple prescriptions on file with Alto that qualify for bundling, you will be automatically prompted to bundle your medications when you log into the Alto app and we’ll sync your refills. (Have prescriptions at other pharmacies? Transfer them to Alto so we can add them to your refill schedule!)

2. We’ll ask you to confirm your medication list and current supply. Let us know if any of your medications are taken on an as-needed basis, or if any are urgently needed.

3. We’ll create a custom timeline for your synchronized refills. Depending on your insurance coverage, this may be once a month or up to every three months. If needed, we’ll schedule a partial fill upfront to avoid a delay in your treatment while we align your refills.

4. We’ll schedule all refills into a single delivery on your behalf and reach out on a recurring basis when your order is ready for delivery. As always, you’ll pick the delivery window that works best for your schedule.

Ready for one easy delivery? Transfer your prescriptions to Alto to start the medication bundling process today.

*Medication bundling is not available for some medications. In addition, some insurance plans may limit automatic refills.

Juvenile idiopathic arthritis (JIA) is the most common form of arthritis that affects children and adolescents. Like adult rheumatoid arthritis (RA), JIA is characterized by pain and inflammation throughout the body as the result of joint inflammation and stiffness.

In contrast to the ongoing nature of RA, some children do outgrow JIA. However, it can impact a growing child’s bone development, so treatment is important.

What to Know About Arthritis in Children

Juvenile idiopathic arthritis (JIA) is the most common form of arthritis that affects children and adolescents. Like adult rheumatoid arthritis (RA), JIA is characterized by pain and inflammation throughout the body as the result of joint inflammation and stiffness.

In contrast to the ongoing nature of RA, some children do outgrow JIA. However, it can impact a growing child’s bone development, so treatment is important.

Here’s what to know about the causes, symptoms, and treatment options of JIA.

Juvenile idiopathic arthritis affects children and adolescents age 16 and under. It may cause joint pain and inflammation anywhere in the body, but most commonly in the hands, knees, ankles, elbows, and wrists.

If untreated, JIA can lead to health complications, including:

Eye health issues such as cataracts or glaucoma, as JIA can cause inflammation in the eyes

More rarely, issues with the kidneys, heart, or endocrine system

The prognosis of JIA varies by individual. About 50% of children and adolescents with the condition fully recover while others continue to experience arthritis symptoms in adulthood. 

All forms of arthritis including JIA fall under the umbrella of autoimmune diseases. These conditions occur when the immune system mistakenly attacks healthy cells and tissues. With arthritis, the immune system acts on the lining of your joints.

The causes of JIA aren’t fully known (idiopathic means unknown). Genetics likely play a component. Some evidence suggests that some children have a gene that leads to the development of JIA when activated by external factors such as a virus or bacteria.

Symptoms of juvenile idiopathic arthritis

Symptoms of JIA can vary from one child to another. Some individuals experience flare-ups, or periods when symptoms intensify, while others have a more chronic experience of the condition.

Pain and inflammation in the joints, most commonly in the hands, knees, ankles, elbows, and wrists. (For many, this symptom frequently occurs in the morning or after sleeping.)

The process of diagnosing JIA often involves several steps, as symptoms may resemble those of other conditions.

A physical exam is typically the starting point, after which a doctor may recommend one or more of the following blood tests to confirm a diagnosis of JIA: 

Antibody tests such as the antinuclear antibody (ANA) test, which measures blood levels of antibodies linked to rheumatic disease

Tests that check for levels of red and white blood cells and platelets - lower levels of red and white blood cells may be indicative of JIA

An erythrocyte sedimentation rate (ESR) test, which examines how quickly your red blood cells sink to the bottom of a test tube - higher rates of settlement may indicate inflammation

A c-reactive protein (CRP) test, which identifies blood levels of CRP, an inflammation-linked protein produced in your liver

A creatinine test, which checks for kidney disease

A rheumatoid factor (RF) test, which checks for rheumatoid factor, an antibody found in about 80% of individuals with rheumatoid arthritis

Imaging tests such as X-rays, CT scans, MRIs, and bone scans may also be used to support a JIA diagnosis.

Treatment for JIA encompasses medications, lifestyle changes, and physical and occupational therapy, with the goal of reducing symptoms and supporting an active life.

Individual treatment plans depend on a child’s symptoms, age, and overall health history.

The following types of medications may be included in a JIA treatment plan:

Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil®) and naproxen (Aleve®) may be used to reduce pain and inflammation during flare-ups. While these medications are available over the counter, your child may need a prescription for a higher dose.

Oral corticosteroids such as prednisone may also be used to reduce inflammation in children with JIA.

Disease-modifying antirheumatic medicines (DMARDs) such as methotrexate (Rheumatrex®) reduce the immune system’s response to triggers, easing inflammation and controlling JIA symptoms.

Injectable biologic DMARDs — which target more specific pathways in the immune system — are also used in the treatment of JIA, typically after other treatments have proven ineffective. Commonly prescribed biologics include abatacept (Orencia®), adalimumab (Humira®), canakinumab (Ilaris®), etanercept (Enbrel®) and tocilizumab (Actemra®).

Sugars, refined carbohydrates, and gluten can contribute to joint pain and inflammation, so it is often recommended for those with any type of arthritis to reduce their intake of these foods. With JIA, there is the additional consideration of incorporating nutrient-rich foods to support a child’s healthy growth and development. Consider speaking with a nutrition specialist to develop a balanced meal plan.

Regular physical activity is another component of managing JIA. Swimming and other water exercises, yoga, and cycling may be a good fit for children and adolescents with the condition. Physical therapy may be involved in treatment to help a child improve muscle and joint function. 

Lastly, it’s important for a child with JIA to get plenty of rest.

JIA is linked to eye inflammation, which can cause more serious eye problems later in life. Staying on track with regular eye exams can prevent and detect potential problems.

Life with juvenile idiopathic arthritis is easier with a reliable pharmacy partner by your side. Our pharmacists have specialized training in arthritis treatment and can answer any questions you may have, from medication side effects to navigating lifestyle changes.

In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with your treatment.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

An asthma attack is an acute flare-up of symptoms defined by sudden shortness of breath and difficulty breathing. Managing asthma attacks includes both proactively responding to symptoms when they arise and staying on track with treatment in the long term. Learn more here.

Treatment and Prevention of Asthma Attacks | Alto Pharmacy

Many individuals with asthma are familiar with the experience of an asthma attack — an acute flare-up of symptoms defined by sudden shortness of breath and difficulty breathing. These exacerbations vary in intensity and require efficient and prompt treatment.

Management of asthma attacks is twofold. To immediately address symptoms in the moment, work with your provider to identify your asthma attack warning signs and establish a treatment strategy. In the longer term, identify and avoid triggers and stay on track with treatment, so as to reduce the frequency and intensity of these flare-ups.

Here’s more on recognizing, treating, and preventing asthma attacks.

Effective management of an asthma attack starts by recognizing the signs and symptoms and understanding what to do when they occur.

While individual experiences of an asthma attack may vary, these are some common signs and symptoms. Your doctor can help you in identifying your individual warning signs of an asthma attack.

The following symptoms of a severe asthma attack warrant immediate medical attention:

Severe breathlessness or wheezing, especially at night or in the early morning

Difficulty speaking due to shortness of breath

No improvement from quick-relief medication

Everyone with asthma should have an asthma action plan that documents their treatment needs, including what steps to take when asthma symptoms intensify. Work with your doctor to create your individual asthma action plan.

If and when you experience a flare-up of asthma symptoms, follow the steps in your treatment plan. If your PEF readings fall between 51% to 79% of your baseline, a common first step is to take quick-relief or “rescue” asthma medications.

These medications are taken on an as-needed basis, as prescribed by your doctor, and relax airway muscles to open the lungs. They relieve shortness of breath and wheezing within minutes and can stop an asthma attack in progress.

Common quick-relief asthma medications include:

Albuterol (ProAir® HFA, Proventil® HFA, and Ventolin® HFA)

Inhalers are the most common form of quick-relief asthma medications. Albuterol and levalbuterol are also available as a liquid solution for nebulizer use.

A quick-relief medication may sufficiently relieve symptoms and improve PEF readings. If symptoms do not improve, emergency medical care may be necessary. Your asthma action plan should help you determine when to seek emergency care.

In many cases, asthma attacks may be preventable. When followed on an ongoing basis, the steps below can help lower your chances of experiencing an asthma attack.

1. Follow your treatment plan and take maintenance medications as prescribed (if applicable).

Many individuals with moderate to severe asthma take long-term maintenance medication in addition to a quick-relief medication.

These medications ease inflammation in the airways, preventing exacerbations and controlling symptoms. You must take them as prescribed every day to experience their benefits.

There are two main types of long-term asthma control medications:

Inhaled corticosteroids including Flovent® HFA and Qvar Redihaler® 

Combination inhalers that contain both corticosteroids and long-acting beta agonists (LABAs) including fluticasone and salmeterol (Advair Diskus®); budesonide and formoterol (Symbicort®); mometasone and formoterol (Dulera®); and fluticasone and vilanterol (Breo Ellipta®)

Asthma attacks may be caused by a variety of triggers including:

Each individual has different triggers. To identify yours, make a note of your asthma symptoms as they appear, including environmental factors that may have contributed to them. As you begin to learn your triggers, take necessary precautions to avoid them.

3. Avoid all cigarette smoke, including secondhand and thirdhand smoke.

Everyone with asthma can benefit from limiting their exposure to cigarette smoke, a frequent trigger of asthma attacks.

In addition to refraining from smoking yourself, avoid exposure to secondhand smoke and thirdhand smoke, the residual smoke that remains on clothing or surrounding indoor surfaces. (Don’t hesitate to ask your doctor for smoking cessation resources if needed.)

Allergic asthma accounts for 60% of all asthma cases in the U.S. and is triggered by allergens such as household dust mites, pet dander, and pollen. There are many ways to reduce the presence of allergens in your home, including:

Using the AC rather than opening windows when pollen counts are high

Using a dehumidifier to keep indoor air dry, which will in turn prevent mold growth and dust mites

Vacuuming at least once a week, ideally using a vacuum cleaner with a high-efficiency particulate air (HEPA) filter, which catches smaller particles like allergens

It’s especially important for those with asthma to stay current with vaccines, as respiratory infections like the flu can become more serious and/or trigger asthma symptoms.

Check with your doctor about which vaccines you need. For detailed vaccine recommendations by age group, reference the CDC’s recommended immunization schedules for children and adolescents and adults.

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

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

Treatment and Prevention of Asthma Attacks

Psoriasis is a skin disorder that occurs when new skin cells grow too quickly as the result of immune-related inflammation. It is characterized by thick patches of skin covered with white or silver scales. There are a variety of treatment approaches that help slow down the growth of skin cells and treat symptoms.

Psoriasis, Explained

Here’s what to know about the condition’s causes, symptoms, and treatment options.

Your body typically produces new skin cells over the course of several weeks. For those with psoriasis, new skin cells are formed in days. The excess cells accumulate on the surface of the skin, leading to the development of thick, scaly patches in most psoriasis cases.

Psoriasis scales may develop anywhere on the body. Some people have just a few small flakes on their scalp or elbow while others have larger patches covering much of their skin.

Individuals of all ages, sexes, races, and ethnicities may develop psoriasis. In the U.S., roughly one-third of all psoriasis cases develop before the age of 20. It is a lifelong condition, with the exception of a type of psoriasis that resolves after childhood.

The specific causes of psoriasis aren’t fully understood, however, the immune system, genetics, and environmental factors likely all contribute to its development. If one parent has psoriasis, you are more likely to also develop the condition. If both parents have it, your risk increases further.

Smoking can increase both an individual’s risk of psoriasis and the severity of the condition.

Psoriasis is not contagious and cannot be passed from one person to another.

For most people with psoriasis, symptoms fluctuate over time. Symptoms may be severe for a few days or weeks before clearing up. Some people then go on to experience years without symptoms. The periodic flare-ups are typically triggered by environmental factors such as the following:

Infections including strep throat and skin infections

Weather, especially cold temperatures and dry air

Skin injuries including cuts, scrapes, bug bites, and sunburns

While symptoms of psoriasis can vary significantly from one individual to another, common symptoms include the following:

White or silver scales, also referred to as plaques, on the inflamed patches

Soreness, itching, or burning sensations on or near patches of irritated skin

A basic physical exam is often sufficient in diagnosing psoriasis, as symptoms are both visible and distinct from those of other conditions. 

In cases where a diagnosis is less clear, your doctor may order a biopsy, which is a small sample of your skin. Biopsies are typically performed in a doctor’s office with a local numbing agent.

Your provider may refer you to a dermatologist who specializes in the treatment of skin conditions.

While there is no cure for psoriasis, there are many treatments that lessen skin inflammation and scales, remove plaques, and slow down the turnover of skin cells. Your doctor will recommend the best approach for your needs and symptoms, typically starting with less invasive options. 

Topical treatments, or medications applied to the surface of skin, are typically the frontline treatment for psoriasis. They slow down skin cell growth and reduce inflammation. There are several types of topicals:

Corticosteroids are anti-inflammatory agents that reduce swelling and redness, and the most commonly prescribed medications for mild to moderate psoriasis. They are available in many forms, including oils, ointments, creams, lotions, gels, and more. Mild corticosteroid ointments like hydrocortisone are frequently used for sensitive areas while stronger creams and ointments like triamcinolone (Trianex®) and clobetasol (Cormax®, Temovate®) may be used for less sensitive areas or patches that don’t respond to hydrocortisone.

Non-steroid topicals including synthetic forms of vitamin D such as calcipotriene (Dovonex®, Sorilux®) and calcitriol (Vectical®) may be prescribed as an alternative to steroids. Like steroids, these treatments can help control plaques. They may cause less irritation than other treatments.

There are also over-the-counter topical treatments in the form of lotions, foams, tars, shampoos, and more. The active ingredients salicylic acid and coal tar are FDA-approved for psoriasis treatment. Always consult your doctor before beginning an over-the-counter treatment.

Light therapy is often a first line treatment for moderate or severe psoriasis, alone or in tandem with medications. In this treatment, the skin is exposed to controlled amounts of natural or artificial light. There are many types of light therapy, from simple exposure to sunlight to controlled doses of UVB broadband and UVB narrowband light and more. Your doctor can help you determine if these therapies are appropriate for you.

If your symptoms are moderate to severe, or if they haven’t responded to frontline treatments, your doctor may recommend an oral or injected medication. Since some of these medications have the potential for more severe side effects, they are used for short periods of time or alternated with other medications.

Biologics, a class of medications that are derived from antibodies and act on your immune system to prevent inflammation

Retinoids, vitamin A-based treatment typically prescribed in a hospital setting for severe psoriasis. Due to the potential for birth defects, retinoids are not safe to take during pregnancy, or three years prior to pregnancy.

Cyclosporine (Sandimmune®) is an immunosuppressant medication that decreases your immune system’s response to ease psoriasis symptoms. Since it weakens your immune system, it can make you more susceptible to illness.

Methotrexate is another immunosuppressant that may be prescribed as an alternative to cyclosporine. There is the potential for serious side effects with long-term use, but when used in low doses in the short term, side effects are typically mild.

Managing psoriasis is easier with a reliable pharmacy partner by your side. Our pharmacists can answer any questions you may have about treatment, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

We’re thrilled to congratulate Munashe Kaseke, Senior Director of Business Operations, on the release of her debut short story collection, Send Her Back and Other Stories, last month. We recently sat down with Munashe to learn more about her writing journey, the book’s inspiration, and how her time at Alto has impacted her creative process.

Meet Munashe Kaseke, Senior Director of Business Operations and Debut Author

We’re thrilled to congratulate Munashe Kaseke, Senior Director of Business Operations, on the release of her debut short story collection, Send Her Back and Other Stories, last month.

Munashe began the project nearly three years ago as a creative outlet and continued to develop this beautiful collection of short stories during her time at Alto. We recently sat down with Munashe to learn more about her writing journey, the book’s inspiration, and how her time at Alto has impacted her creative process.

Can you tell us more about the book and what inspired you to write it? 

The book is titled Send Her Back and Other Stories. It's a short story collection featuring sixteen distinct Black women, all immigrants from Zimbabwe. It's an intimate, fresh telling of the immigrant experience of Black women in the United States. The stories are varied, awash with both the joys and challenges of discovering a new world.

My characters range from those who are unsure of themselves and struggling with various aspects of the immigration system, to those who are well established, thriving, and in control of their own destiny. I was inspired to write these stories because of not only my own experiences but also those of my friends and immigrant community. The publishing world lacks diversity, and as a Black Zimbabwean immigrant, I felt these stories deserved to be told.

Who did you write the book for and what do you hope people take away from it?  

I dedicated this book to immigrants, women, and people of color because I hoped they would feel seen in this collection. I also hope that those who don't identify with one or more of these categories become more empathetic from reading this book. Ultimately though, I write for myself first and foremost. I enjoy the process of world-building and character development. I believe the best writers initially write for an audience of one, and when they're satisfied with their work, then they can begin considering how to share it with the world. 

What did you learn when writing the book? 

I had a group of beta readers throughout the writing process and it was cool to learn — through these readers — that many of my characters’ particular struggles and joys are much more universal, reflecting the experiences of immigrants and people of color around the world.

I also learned that there are many aspects of the U.S. immigration system that I assume are common knowledge, as well as many immigrants’ struggle of belonging and search for identity. I was astonished to learn how much of this was new to my American friends.

I wrote the first story almost three years ago. I didn't intend for these stories to become a book —  I was simply writing about whatever was on my mind at the time, with no timeline to completion. After the fifth story, I noticed an emerging theme, and that's when I first considered that these works might belong in a collection. Editing was the longest part of the process. From developmental edits to copy edits, it probably took a good year and half to get these stories publishing-ready

How did working at Alto impact your writing process?

When you love your job, it fuels creativity outside of work. It's hard to be creative or passionate about a hobby when you're burned out. I'm certain that had I not been at a company and in a role that provided great work-life balance, there is no way I would've been able to dedicate my weekends and evenings to writing and editing.

Some of my biggest supporters have been Altoids. When I released the book, I received multiple messages from Altoids telling me what their favorite stories were. Both Matt and Jamie (our founders) have been incredibly supportive as well — from the time they first learned about my creative writing passion almost a year ago, they have cheered me on and checked in on the book’s progress. 

Anything else you'd like to leave us with? 

I hope that more Americans engage with multicultural and Own Voice fiction. This is such a rich space full of promising emerging voices that I believe will help shift the country's conscience for good. I challenge you to intentionally seek out and add a few books by diverse authors to your reading list every year — don't leave it to chance.

Munashe’s book is available here. Learn more about the author at munashekaseke.com.

We’re thrilled to congratulate Munashe Kaseke, Senior Director of Business Operations, on the release of her debut short story collection, Send Her Back and Other Stories. We recently sat down with Munashe to learn more about her writing journey, the book’s inspiration, and how her time at Alto has impacted her creative process.

The Alto product and engineering team has long been focused on initiatives that improve our unit profitability. Now that we’ve laid a strong foundation, we've started to think about our next big bets: How do we expand our services beyond delivering prescriptions? How do we test new value-add offerings quickly and iteratively? That’s where the incubation team comes in.

Meet the Innovation Team Building Alto's Next Big Bets

The Alto product and engineering team has long been focused on initiatives that improve our unit profitability. Now that we’ve laid a strong foundation, we've started to think about our next big bets: How do we expand our services beyond delivering prescriptions? How do we test new value-add offerings quickly and iteratively? That’s where the innovation team comes in.

Newly launched in 2022, the team is small and scrappy by design. We’re a product manager, two engineers, a part-time designer, and a part-time manager with a single mission: to launch at least two significant new business experiments per year. If an experiment is successful, we’ll scale it into a full workstream before handing it off to a stand-alone product team.

We started with over-the-counter (OTC) medications. OTCs, or medications you can buy without a prescription, like Advil, are high-margin products that users are accustomed to purchasing at traditional, brick-and-mortar pharmacies. The goal of this experiment was to assess how much interest users have in adding OTCs to their order while checking out in the Alto app. We set a target conversion rate and offered OTCs only from our San Jose pharmacy, which is less busy than our San Francisco pharmacy but close enough to engineers in San Francisco for in-person troubleshooting.

Our initial hypothesis: if we present users with a small selection of OTCs targeted to their needs (based on the prescriptions in their cart), they’ll be more likely to convert. With support from our pharmacy partners, we carefully curated a recommendation algorithm that would suggest nine OTCs based on the medications already in the user’s cart.

In the interest of lean experimentation, we wanted a scrappy technical solution that could be implemented quickly while meeting our high user experience standards and minimizing operational risk. We settled on the following architecture:

We prioritized creating a clean API for Alto’s customer-facing app and using as much of our current infrastructure as possible. Although OTCs are distinct from prescriptions, we decided to reuse our existing prescription model rather than build a new one from scratch. This allowed us to leverage existing systems and operational workflows, reducing engineering time and risk of regression.

Behind the API, we opted to store our OTC formulary and associated metadata in in-memory data structures:

ADVIL = SkuId.new(sku: '...', sku_type: '...').freeze
CLARITIN = SkuId.new(sku: '...', sku_type: '...').freeze
FISH_OIL = SkuId.new(sku: '...', sku_type: '...').freeze
...
METADATA_BY_SKU_ID = {
  ADVIL.hash_code => {
    image_url: '...',
    name: 'Advil Ibuprofen 200mg Coated Tablets',
    quantity_description: '100 tablets',
    product_description: 'Easy to swallow powerful pain reliever for headaches, joint and muscle pain.',
  },
  CLARITIN.hash_code => {
    image_url: '...',
    name: 'Claritin 24 Hour Allergy Tablets',
    quantity_description: '30 tablets',
    product_description: 'Non-drowsy, 24 hour relief of symptoms due to allergies: sneezing, runny nose, itchy and watery eyes.',
  },
  FISH_OIL.hash_code => {
    image_url: '...',
    name: 'Fish Oil 500mg Softgels',
    quantity_description: '130 softgels',
    product_description: 'Dietary supplement with EPA and DHA omega-3 fatty acids to support heart health and maintain normal triglyceride levels.',
  },
  ...
}.freeze

This gave us a nice balance of speed and flexibility. We knew that we could optimize once we had established our OTC offering and gained an understanding of how it would evolve within Alto.

The results of phase 1 were a bit disappointing, but very interesting: the conversion rate of users who checked out with an OTC was just under our target. However, nearly half of all users who saw the experience would scroll down to peruse all nine OTCs that were offered.

Based on this positive sign of engagement, we hypothesized that perhaps we just weren’t showing the right OTC products to the user. For phase 2, we decided to scrap the limited recommendations and allow users to explore an entire catalog of OTCs.

Phase 2 required categorizing our list of OTCs into buckets such as “Top Sellers,” “Covid Care,” and “Allergy & Asthma.” We built a new fetch_categorized endpoint to return our OTC catalog structured by category, adding search functionality into the client so that users could quickly filter for a specific product. This search field was also heavily tracked with analytics events to help us learn which products to add to our catalog in the future.

This new experience immediately outperformed phase 1. After a few performance improvements (speeding up our catalog and product image load times), we eventually hit our target conversion rate — even managing to surpass it on some weeks!

Our eventing did show that a significant number of users with multiple prescriptions or smaller screens were not even seeing the OTCs in Cart, as they were pushed below the fold. We tried experimenting with alternate spots to show our catalog:

1. An interstitial that shows after Cart and before Checkout - this didn’t perform any better than the control and was quickly scrapped.

2. A single carousel at the top of Cart - this out-performed the control but at the cost of our guardrail metric. With a decrease in the overall checkout rate, we decided to stick with the control for now.

This phase of UI experimentation validated that our users wanted an offering of categorized OTCs. However, our initial technical solution wouldn’t scale as we rolled out to more of our pharmacies. The following questions led us to this conclusion.

How might we support changes to our OTC catalog on a per-pharmacy basis?

Given factors such as inventory, geography-related price sensitivities, and experimentation, we wanted to make sure that we could tweak the OTC experience for users getting deliveries from a specific pharmacy.

In the status quo implementation, that would have likely meant adding an additional layer to our data structures like so:

SKUS_BY_PHARMACY_AND_CATEGORY = {
  SF_PHARMACY_ID => [
    AddOnOtcCategoryType::TopSellers => [
      IHEALTH,
      FLONASE,
      ASPIRIN,
      ...
    ],
    ...
  ],
  ...
}

We weren’t worried about memory space limits given our relatively small number of pharmacies and OTC catalog. We were concerned, however, that each modification would require an engineer to go in and make code changes, get PR approval, and wait for a full deploy for the update to go live. This would be a bad use of engineering time, and our CI/CD process would become a bottleneck to otherwise quick modifications.

How might we add and remove OTCs from our catalog?

Similarly, we knew that adding and removing OTCs from our catalog would also be a somewhat regular workflow. There are some other considerations when adding a new OTC (Is it in our product database? Do we need any new procurement/inventory workflows to make sure it gets stocked in our pharmacies? Do we have a nice image to render in the app?), but we wanted to automate the technical side as much as possible — or at least be able to automate it.

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