Expires 04/01/2021

Specialty Pharmacy

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

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.

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If generic and brand-name medications work the same way, what accounts for the disparity in price? Let’s unravel the facts to discover how this system works. 

What’s the Difference between Generic and Brand-name Medications?

What’s the difference between generic and brand-name medications? 

We tend to feel mistrustful of anything we deem a “knockoff,” assuming we’ll end up with a lesser version of the real thing. With “we get what we pay for” a familiar refrain, we learn to associate better quality with a higher price. So when it comes to generic medications, which can cost 85% less than their brand-name counterparts, it’s no wonder we may cast a suspicious eye. However, unlike a bootleg movie or copycat handbag, generic medications are tightly controlled by the FDA, ensuring they offer the same safety, quality, and results.

Is a generic medication exactly the same as the brand-name version?

According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.” In order to get approval, a generic medication must have the same dosage, strength, safety, manufacturing standards, quality, and effectiveness, and it even needs to be administered in the exact same way.

There is some room for variability between the different versions, however. As C. Michael White, Pharm.D., Professor and Head, Department of Pharmacy Practice, University of Connecticut, explained in an article for the Huffington Post, “the [generic] pill needs to get you within 10 percent above or below the blood concentrations achieved with the brand for the FDA to approve the generic, and in reality, they only usually vary by 3-4 percent in one direction or another. So yes, they are very similar in terms of the active ingredient...Most people will never notice a difference.” According to the FDA, this level of variability is unlikely to have an impact, and could also occur between two batches of the same brand medication. 

Additionally, the inactive ingredients, or the ones with no therapeutic purpose, may differ. Manufacturers might use different binding materials, dyes, and preservatives, but they must prove to the FDA that they’re safe. It is possible, however, that you could be sensitive or allergic to something that’s in one particular version but not another.

How do the different versions come about?

When a brand-name medication enters the market, it is protected by patents and granted a period of exclusivity. In other words, the company that first created the medication has the sole right to sell it for a certain period of time. It takes an incredible amount of money to develop a new medication and see it through the necessary clinical trials—it’s estimated between $2-3 billion per new drug—so this helps drug companies recoup some of that cost. 

Most drugs are granted protection from competition for 5 years, though it can be more or less under certain circumstances. Once the period of exclusivity expires, generic versions of the medication are allowed to seek approval from the FDA to enter the market. 

Why are the generic versions so much cheaper?

Generic medications usually (but not always) cost much less than their brand-name counterparts because they do not have to repeat the expensive research and clinical trials that brand-name drugs undergo to prove they’re safe and effective. Plus, once one or more generic versions enter the market, competition can help drive down the prices. 

So a generic medication can really achieve the same effect for a fraction of the price?

In most cases, yes. According to Harvard Health Publishing, “The bulk of research out there shows that taking the no-name brand not only saves you money, but also provides you with a medication that is just as effective as the original.”

That being said, individual sensitivities can vary, so listen to your body and always report side effects to your doctor. 

If you’re prescribed what is known as a “narrow therapeutic index drug (NTI),” your doctor may recommend that you stick to the brand-name version. That’s because small changes in blood concentration can either render these medications ineffective or possibly cause harm. If you are taking an NTI, such as certain antiseizure medications and blood thinners, it doesn’t mean that you can’t switch to a generic version if it’s available. You’ll want to fully discuss it with your doctor and ensure that you’re closely monitored if you’re cleared to make the switch. 

And again, it’s possible to have sensitivities to a specific version of your medication. If you experience side effects after switching to a generic drug, you may want to consider resuming the brand-name version or trying another generic option. 

Unless your doctor has specified that your prescription is only for the name-brand medication, your pharmacist can suggest a generic option instead. Your insurance company may even require that you take the less expensive generic option or pay the difference for the brand-name version. The team at Alto will always help you find the best price for your prescription by presenting you with all of the options. If you’re curious about whether a generic version is available for any of your current prescriptions, we’d be happy to talk it through with you. Our pharmacists are just a chat, text, or phone call away.

In the world of prescription medications, “brand-name” doesn’t mean better. Most of the time, you can achieve the exact same results for a fraction of the price with a generic drug. According to a report by the IQVIA Institute, generics account for approximately 90% of all prescriptions but only about 20% of the overall costs. They estimate that generic medications saved the U.S. healthcare system $1.67 trillion from 2007 to 2016. If you’re cleared to take a generic version of your prescription, you can do so with full confidence—and hopefully some hefty savings. 

Did you know Alto will conduct price investigations for you? 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 other qualified health provider with any questions you may have regarding a medical condition.

If you’ve been stuck in a cycle of wired nights and exhausted days, your body and mind need help remembering how to relax. These strategies can help you break free from unhealthy sleep patterns and finally get some solid shut-eye. 

Too stressed to sleep? These strategies can help.

Stress and sleep can form a pretty vicious cycle. No matter how physically exhausted we feel when our heads hit the pillow, we just can’t seem to quiet our racing minds. Then, after tossing and turning our way through the night, we’re way too fatigued to function at our best. This leads to more anxiety...and on and on and on. 

Right now, it’s not just the usual looming deadlines and relationship flare-ups that are keeping us up at night. As we head into fall, our schedules start overflowing, we worry about getting sick, and we often begin getting less sunlight and fresh air. Plus, with the upcoming time change, we’ll lose an hour of much-needed sleep. If your stress level is at an all-time high, you’re not alone. This year, we’re facing a global pandemic, widespread economic uncertainty, and completely upended social norms and routines. 

Stressors like these send our bodies into “fight or flight” mode. Normally, this state of hyperarousal fades away once the threat is gone. But chronic stress causes our nervous system to continually work on overdrive, pumping out hormones that keep us revved up and alert even when it’s time to sleep. 

In the world of mindfulness, we hear a lot about “present moment awareness.” That’s because it’s the one place your stress doesn’t live. If you’re anxious about something, you’re either fixating on a past scenario or worrying about a future event. You’re so stuck looking forward or backward that you can barely focus on the task at hand. The practice of mindfulness is meant to break these toxic thought patterns by helping you become aware of when you’ve drifted from the present moment. In this way, it can actually stop stress in its tracks. 

Try listening to a guided mindfulness meditation as you transition out of “work mode” in the evening or while lying in bed if you can’t sleep. The Insight Timer app is a fantastic resource for free meditations, or try Calm, one of the most popular apps for meditation and sleep. Remember—you can’t change the past or control the future, no matter how many times you turn a situation over in your mind. Your best bet is to try to live where your stress cannot. 

If you often find yourself dreaming about a stressful project or jolting awake with a worrisome thought, a simple journaling practice can help. If your mind is swirling with worries as you fall asleep, you could be carrying that mental load into your dream state. Before you go to sleep, spend some time writing out whatever is on your mind. List out items on your to-do list and journal about any anxieties from your day. The simple act of writing it down will signal to your brain that it’s okay to let it go. That way, your brain can go about its nightly tasks and leave you to sleep in peace.  

According to the American Psychological Association, the body tenses up during a stressful event as a way of protecting us from pain or injury. With chronic stress, however, our muscles never drop their guard and remain continuously tightened. If you’ve ever woken up stiff and groggy after a full night’s sleep, your tense muscles could be the culprit. Try gently encouraging them to relax with a simple nightly body scan. 

Focus your attention on an area of your body and mentally tell it to soften and relax. Begin with the area behind your eyes, followed by your jaw, your neck, and each of your shoulders. Continue like that, relaxing one area of your body at a time. You may find you drift off effortlessly before you’ve made it all the way through. 

It’s important to set up a relaxing atmosphere that will prime your body and mind for deep sleep. Turn off your electronics and keep the lights dim as you get ready for bed. If you sleep near a window, make sure that your curtains are drawn to shield you from any outside light or simply hang a blanket or sheet. The National Sleep Foundation recommends keeping the room temperature between 60 and 67 degrees Fahrenheit for the most sleep-conducive environment. 

If you’re in a busy house or area, white noise or ambient music can help mask any disturbances. The Relax Melodies app lets you create your own unique mix of relaxing music and sound, and the Slumber app has a whole library of sleep-inducing stories and soundscapes. Lastly, if you really want to set the mood for sleep, try a diffuser or pillow mist with relaxing essential oils such as lavender or chamomile. Details like these will be especially helpful as you adjust to the time change at Daylight Savings Time. When your mind associates your bedroom with the feeling of being drowsy, you can hit the pillow a little earlier throughout the week and still easily fall asleep. 

Stress can be tricky, so you may need to experiment a bit to find what works for you. If you just can’t seem to break the cycle and a lack of sleep is negatively impacting your mental health, talk to your doctor. There are therapies and medications that can help with insomnia and other sleep disorders. If your doctor does recommend a prescription sleep aid, we’ll be here to help. Let our team take care of the details while you focus on rest.

Ready to take the stress out of your prescriptions? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text or the app.

Too Stressed to Sleep? These Strategies Can Help. 

We want to support you in preparing for your best health. PrEP, or pre-exposure prophylaxis, is an HIV prevention method that's available by prescription. Learn more about who should take it, how effective it is, and possible side effects.

All about PrEP for HIV Prevention

PrEP, or pre-exposure prophylaxis, is an HIV prevention method that's available by prescription. It isn’t a vaccine, though its purpose is similar. It’s a pill that’s taken every day to protect you from infection if exposed. 

With consistent use, the medicine remains present in the bloodstream of an HIV-negative individual. Then, if they’re exposed to HIV, it will block the invading virus from spreading throughout their body. 

According to the CDC, PrEP has been shown to reduce the risk of getting HIV from sex by 99% with consistent use. And it can even reduce the risk for intravenous drug users by 74% if taken daily.

Anyone who is HIV-negative and at risk for HIV infection can choose to take PrEP. PrEP may be right for you if you have a partner who is HIV positive or you do not know their HIV status, are a man having sex with men, are a trans masculine person having sex with men, are a trans feminine person having sex with men, have sex without condoms, are a sex worker, use injection drugs, or are concerned about HIV infection. Your healthcare provider can let you know if PrEP is the right choice for you.

There are currently two FDA-approved medications for PrEP: Truvada® and Descovy®. Both are oral medications that are only available by prescription. Your doctor will let you know which is best for you. Since PrEP should only be taken by those who are HIV-negative, you will need to take an HIV test before you can receive a prescription and also every three months while you’re taking it. You will also need to take a general blood test every six months. Staying on PrEP is a commitment, but these follow-up appointments are crucial for your health. 

Not all providers and health clinics offer PrEP,  but HIV.gov maintains an HIV Services Locator that will help you find a provider near you. 

Telemedicine is an option that can also make the process more accessible—and many more healthcare providers are offering remote consultations. Telehealth services allow you to schedule a phone or video consultation with your healthcare provider then use at-home test kits to complete any required testing through the mail. Talk to your healthcare provider to learn more about this possibility. 

PrEP is usually covered by most insurance plans, including Medicaid. There are also patient assistance programs that can help you access PrEP at a low cost or even free. The Gilead Advancing Access® program offers a copay coupon card for those with insurance and a Medical Assistance Program for those who are uninsured. They’ll help you find out if you’re eligible and may be able to suggest alternative sources of financial support if you are not. If you’re not sure if your insurer will cover your prescription, our team is here to help. We can inquire on your behalf and ensure you get the lowest price. 

Some people may experience side effects like nausea, diarrhea, headaches, and dizziness, however, they usually subside over time. Serious side effects aren’t common, but you should tell your provider if you notice any unusual symptoms. Your doctor will also be monitoring your blood work.

No—and this is important. PrEP needs time to build up in your bloodstream before it can effectively fend off an HIV infection. It will take a period of continuous use (usually at least one week or one month) before it is fully effective, so talk with your doctor about your specific time frame. If you’re engaging in sexual activity, be sure to use another form of protection in the meantime. You can also speak with a pharmacist at Alto if you have questions about how your medication works. 

And remember—if PrEP isn’t taken every day, there may not be enough of it present in your body to prevent infection. It’s extremely important to be consistent. Also, PrEP only protects against HIV infection, so you’ll need to continue using condoms to protect against other sexually transmitted infections (STIs). 

We recommend talking it over with your provider. If they do write you a prescription for PrEP,  the team at Alto can support you through the process of obtaining your medication. Our pharmacists are always here to answer your questions, from how to take it to what to do if you miss a dose. We’ll also deliver your prescription for free, send you quarterly lab reminders, and show you how to use the Alto app to set up daily reminders to take your pill. 

If it’s right for you, the decision to take PrEP is an important commitment to your health and well-being. We’ll be here to make sure the next steps are as easy as possible. 

We want to support you in preparing for your best health. 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.

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 

When it comes to critical pharmacy needs, patients with diabetes often feel like they’re navigating the complexities of their care paths with very little control or clarity. That’s why we feel it’s important to highlight how Alto can help provide relief in managing your medications.  

The Best Pharmacy for Your Diabetes Care

Millions of Americans suffer from endocrine disorders, caused when hormone levels are either too high or too low or when the body doesn’t react to hormones the way it’s supposed to. Some of the most common endocrine disorders include Type 1 and Type 2 Diabetes (which affect over 30 million Americans), thyroid disorders (over 20 million Americans) and osteoporosis (10 million Americans). When it comes to critical pharmacy needs, patients with endocrine disorders often feel like they’re navigating the complexities of their care paths with very little control or clarity. With so many medications, prescriptions are often filled at different times, resulting in numerous trips to the pharmacy and disruptions to daily life. That’s why we feel it’s important to highlight how Alto can help provide relief in managing your medications.  

Meet Josh. Josh has Type 2 diabetes, an endocrine disorder that affects the way his body processes blood sugar (glucose). He visits his local pharmacy two-to-three times a week to pick up his various medications and medical supplies, which are each filled at different times. When he’s at the pharmacy, he is faced with long drive-thru lines or crowded store aisles and phones ringing off the hook. There have been times when Josh has arrived to pick up one of his medications or his insulin pump only to find out that they are no longer covered by his health insurance. Along with the burden of scheduling various pick-ups and dealing with unexpected costs, Josh worries there will be a time when he needs one of his critical medications, and he won’t be able to reach his pharmacist for help. 

Many of the brand-name medications commonly prescribed to diabetes patients simply aren’t covered by health insurance plans or come with strange restrictions. Patients can arrive at their pharmacy to find that their medication is only covered for their first “x” doses, or in some cases, not covered at all. Left with the stressful decision of whether to pay higher-than-expected prices or return home empty-handed this can often deter treatment from starting on time.

No guaranteed access to medication or their pharmacist

People living with diabetes often suffer from multiple comorbidities, increasing the complexity and number of their medications. With so many medications, prescriptions are often filled at different times, resulting in numerous trips to the pharmacy and disruptions to daily life. Retail pharmacists can be difficult to get a hold of, especially with the increasingly long lists of administrative tasks they are asked to complete. Diabetes medications are critical: missing one dose or experiencing one contraindication can be life-threatening. Added time spent waiting for a pharmacist to answer can be stressful and, in some cases, dangerous.

Doctors are often kept in the dark along with their patients when it comes to costs and insurance- based restrictions on medications. The current system is designed such that doctors often have to perform investigative work and complete prior authorizations with insurance in order to get a patient’s medication covered, meaning hours of extra calls and paperwork. When someone like Josh has an issue with the cost of their medication, they can’t simply swap it out for a new one. They have to connect with their doctor who can perform the necessary research to find them a new medication.

At Alto, we believe that everyone deserves exceptional pharmacy care. We are here to reduce the stress and confusion that comes with navigating insurance, and we offer transparent, consistent communication so you always understand your options. Our specialty pharmacy team will help sync your many medications into one delivery, get you set up on automatic refills, and work with your doctor on any prior authorizations needed for your medications.

Our pharmacists and billing specialists work with doctors and health insurers proactively to ensure the medications you are prescribed will be covered. We take on the investigative work and communicate the cost upfront so there are no surprises. We ensure you get the best prices on your medications - including branded oral and injectable medications - and we automatically apply any coupons or copay cards.

We’ve created a team of patient care pharmacists who are solely dedicated to answering questions and walking patients through their medications, so you’ll never spend 40 minutes waiting on hold. We provide real-time support via our mobile app or over the phone seven days a week, including evenings. If you have questions around a refill or need a refresher on injection instructions, you have direct access to help.

We deliver medications directly to your doorstep - for free! - and eliminate those dreaded, numerous trips to the pharmacy with crowded aisles, long wait times and no sense of privacy.

With Alto you’re always in control over when you want to receive your medications. Simply choose the delivery window that’s best for you and track your courier in real time. 

Ready to get started or want to learn more about Alto? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text or the app.

Erik Gregorio Cruz, Micaela Moss, and Jordane Thomas joined Alto this summer as the company’s first engineering interns! Here they share their learnings, accomplishments, and their advice for future Alto interns.

How to Make the Most of Your Engineering Internship — Advice From Alto's First Interns

Erik Gregorio Cruz, Micaela Moss, and Jordane Thomas joined Alto this summer as the company’s first engineering interns! In their three months with us they blazed the trail for future Alto interns while adjusting to a new norm of fully remote work during the global pandemic. Here they share their learnings, accomplishments, and advice for future Alto interns.

Coming out of a bootcamp program rather than a traditional Computer Science degree program, Micaela hoped to find a company open to non-traditional educational paths. “I know that a company that is welcoming of bootcamp grads values diversity, inclusivity, and mentorship.” 

For Erik, it came down to his interview experience: “Everyone seemed to really enjoy their experience and really believed in the mission they were working on.” Micaela agreed, adding that it also ultimately came down to the people for her. “You can tell a lot about a company’s culture based on what the people who interview you are like,” she said. “From the recruiter to the engineers, everyone was incredibly friendly and a joy to interact with.”

What was the most fun moment of your internship? (That is, assuming you had fun!)

Virtual team lunches were a highlight for all 3 interns. However, one special moment during Micaela’s internship actually came from resolving a ticket that involved writing an end-to-end (E2E) test—something she was not looking forward to. “I was dreading it for two reasons: First, I do not particularly enjoy writing tests—I’d rather write the code that passes them—and second, I had never worked with Cypress before. Several hours later, after reading lots of documentation, studying previously written E2E tests, and getting stumped by a hidden selector, I managed to write the test. When I finally ran it and got to watch the video as it clicked on buttons and filled out inputs, I became instantly enchanted. I may have run it several more times just to watch it, smiling like a goofball, knowing that this test that I had created would be run every time code was pushed and merged.” 

In addition to their respective engineering managers, whom the interns had weekly 1:1s with, each intern was also assigned a dedicated mentor, who committed at least 5 hours a week of dedicated support to their interns over Slack and Zoom. Mentors were able to provide historical and business context, help interns get ramped up on Alto’s tech stack, codebase, and tools, and pair program as needed. “Working with my mentor definitely made me more productive,” said Jordane.

The mentors added that working with the interns actually helped them improve their ability to articulate technical concepts, as well as their ability to talk through technical challenges with others more effectively in their day to day work.

What was it like interning during the pandemic and being fully remote?

“I found myself setting up ‘Hey, there’s a pandemic, and this is crazy, so let’s get introduced virtually, maybe?’ meetings,” said Micaela. “Although, as someone who is horrible with names, it is worth noting that a silver lining to being entirely remote is having everyone’s name in the corner of their zoom video. That, and sweatpants everyday!” 

Erik and Jordane agreed that being remote required a little extra effort. Alto’s engineering office is based in SF, and since they weren’t required to be physically in-office this summer due to the pandemic, both Erik and Jordane were based in other time zones. “In the beginning I was starting my day at 9am EST/6am PST, but if I got stuck I would have to wait until West Coast working hours before I could reach out,” explained Jordane. With time, “I picked up a different working rhythm that worked better for everyone.”

While Jordane was surprised by just “how friendly and accessible everyone was,” Erik was surprised by how quickly he was able to actually deploy code. 

Acknowledging that her chosen career path has a history of gender imbalance, Micaela shared that she “was pleasantly surprised” to have both a female manager and a female mentor. “It was a great experience getting to have two strong female role models to learn from during my internship.”

Micaela and Jordane were both on the Pharmacy Platform team, which defines best practices and processes that promote a future-forward and scalable way of development. The platform team provides tools, libraries, and services that make development work at Alto and enable all of Alto's engineers to write performant code. Erik was on the Pharmacy Supply Chain team, which enables a better, faster experience for patients by ensuring the right medications get out the door, on time, and at the lowest cost possible.

Erik’s mentor, Eric Leite, helped us understand what Erik contributed to the Pharmacy Supply Chain team: “Sometimes our operations workflow requires manual intervention to resolve issues. We use an extendable admin interface to help us navigate the more complex issues. Erik created an add-on to this application that helped our on-call team work more efficiently. We can now resolve a specific kind of complex insurance claim issue by using his add-on to guide us through the multi-day resolution process. Erik learned about our supply chain operations workflow, how insurance claims are processed, how to model out a problem using Ruby on Rails, and how to write effective tests using RSpec.”

Micaela and Jordane, both on the Pharmacy Platform team, worked on optimizing performance and cleaning up legacy code. For instance, Jordane helped standardize Alto’s frontend by increasing adoption of our component library. “Although this was a relatively straight-forward task that didn’t require much problem solving, it did require a lot of endurance,” said Jordane. “I had to edit and test changes to over 300 files by hand. There were many times I could have broken [the platform], and changes needed to be made very carefully.”

What is the biggest learning you are taking away from this experience?

“The biggest learning I am taking away from this experience is nicely summed up by the grail knight in Indiana Jones and the Last Crusade: ‘You have chosen...wisely.’” said Micaela. “I knew I enjoyed software engineering when I was learning it, or when I was working on my personal projects, but that can change when it becomes a job. After spending the summer as a software engineering intern at Alto, I can say with confidence that I have chosen...wisely.”

Jordane discovered that “engineering isn’t just innovation,” as he came into the experience believing; “it’s also investigation.” When we asked the interns’ mentors and managers what they had learned from the interns, they all recognized the genuine curiosity the interns brought into their respective teams and projects, which helped them to see Alto’s codebase through new eyes. They also gushed about the excitement the interns had when pushing to production for the first time.

What words of wisdom would you give to future Alto interns?

All three agreed: ask as many questions as you need to! “Over communicate, and just relax & enjoy the process!” offered Jordane. Erik agreed sharing, “Do not be afraid to reach out when you get stuck. Reaching out for help is essential.” 

“An internship is all about learning and growing,” said Micaela, “so take advantage of the wisdom and experience of your peers. They have a lot to offer!”

Ashley Qian, the Senior Engineer who mentored Micaela, advised, “Know your limits! Take breaks! Find something else to enjoy other than software engineering because your work is not your life, and your life is not work. Surround yourself with people who are your advocates and go to bat for you, and if you find yourself in a system or an environment that does not support you, try to understand what your boundaries are, and leave if you can. You always have a shoulder to lean on if that's the case, here, with the friends you've made at Alto!

Interested in being an intern at Alto? Check out our careers page HERE.

A new diabetes diagnosis can come as a shock—and then comes the avalanche of information. Here are a few things you should know now to feel empowered about your health.

Managing Your New Diabetes Diagnosis

A new diabetes diagnosis can come as a shock—and then comes the avalanche of information. While it’s completely understandable to feel overwhelmed, we assure you, your confidence will grow as you get a good grasp on the basics. Here are a few things you should know now to feel empowered about your health.

There are many genetic and environmental factors that played a role in your diagnosis. Having diabetes means your body isn’t functioning as it should, and that is not your fault. What matters is what you can do to improve your outcome going forward. 

Diabetes isn’t curable, but it is absolutely manageable. With care and consistency, you can live a long and healthy life. Though there can be very serious consequences if the disease progresses without treatment, know that these outcomes are largely avoidable. Commit now to following your treatment plan and learning everything you can about your diagnosis. You won’t be alone—our pharmacists and care specialists will be there to help. Your lifestyle will play a large role in managing this disease and that’s great news. It means you have power over your future health.

At first, keeping track of your health stats may make your head spin. Know that it gets easier, and soon you’ll be a well-versed pro. To start, the National Institutes of Health (NIH) recommends getting to know three important numbers:

A1C - This blood test will provide insight into your blood sugar levels over the past few months so you’ll know if your treatment has been working. 

Blood pressure - Diabetes puts you at a higher risk of heart disease, so it’s important to keep this number in a healthy range.

Cholesterol  - Diabetes and high cholesterol often go together, which can further increase your risk of heart disease. 

Your doctor can help you understand what your target numbers should be and how you can stay within a safe range. Your goal numbers will be unique to you, so be sure to fully discuss them with your healthcare provider and set up a plan for regular testing and checkups. 

You’ll likely need to test your blood sugar on your own, either throughout the day or from time to time. This will help you determine how your medications, specific foods, and certain types of exercise impact your blood sugar levels, as well as other factors like stress. Your doctor will let you know how often you should test and what your target range should be. 

Logging your results will help you notice patterns and see your progress. The Diabetes Teaching Center at the University of California, San Francisco offers a free, printable logbook that can help you get started. You can also use an app like Glucose, or mySugr which will take care of much of the work for you, allowing you to set reminders and view trends over time. 

In most cases, you’ll need to take medication. With type 1 diabetes, you’ll require some form of insulin therapy—either injections or an insulin pump. Treatment can be quite varied for type 2 diabetes. You may need insulin, oral medications, both, or none at all. Your doctor may also prescribe medications for high blood pressure or cholesterol.

It’s important to know that type 2 diabetes is a progressive disease, and your treatment may change over time. However, changes in your prescription are not an indication that you’re failing somehow. Your goal should be focused on maintaining normal blood sugar levels and keeping those important numbers in a healthy range, not on which medications you’re taking. 

We know this is a lot to take in, so the patient care pharmacists at Alto can provide you with a free consultation to discuss your medications. From answering questions about side effects to helping you set up dosage reminders, we’ll help you feel confident and informed. 

Food and exercise affect your blood sugar levels, so you’ll need to pay close attention to both. It’s not just about what you eat, but the size of your meals and the balance of carbohydrates, protein, and fats. You don’t need to cut out carbs completely, but you’ll likely need to learn to count them to make managing your blood sugar easier. The CDC offers a great breakdown of how this works and enlisting the help of a registered dietician can take some of the pressure off as you learn. 

Like the rest of your care plan, this will become more and more effortless with time. At least for now, we recommend finding resources with recipes that are designed specifically for diabetes. The American Diabetes Association’s Food Hub and Eating Well’s Diabetes Diet Center are excellent places to begin. 

In addition to the testing we already described, you should plan to get a yearly physical and eye exam and see a dentist every six months. Diabetes complications can cause damage to your eyes, nerves, kidneys, and gums, but controlling your blood sugar and getting regular check-ups will help you detect any issues early and prevent these problems.

It’s important to let those closest to you know about your diagnosis. There will be times when you get frustrated or discouraged, so make sure you have someone to confide in when you need support. 

To get a better idea of what a happy and healthy life with diabetes can look like, join some of the many online communities that are available on almost every social media platform. Try searching “diabetes” within Facebook’s groups or exploring the American Diabetes Association’s online Support Community to start connecting with others who can truly understand what you’re experiencing. 

Lastly, if you think you might be experiencing depression, or your mental health is suffering in any way, please seek out help from a mental health professional. Ask your doctor if they can refer you to someone who specializes in chronic health conditions. Please don’t try to go it alone, there is so much support available to you. 

We know there’s a lot to unravel with a new health diagnosis, but this information is meant to empower you to thrive. While you undertake the task of learning and adjusting, we’d be happy to take care of your prescriptions—walking you through your first insulin injection to delivering medications right to your door. 

Interested in switching to Alto? We’ll handle the transfer. Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text or the app.

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

How to avoid postal delays and pharmacy lines with Alto

Concerned about Mail Delays tying up your Prescriptions? There’s a Better Way.

With the pandemic pushing many to avoid lines at the pharmacy, more Americans than ever are receiving their prescriptions through the mail. Last year, over 170 million prescriptions were filled by mail in the United States. According to a recent report, that number has increased by 20% since the onset of COVID-19. 

Recently, sweeping policy changes within the United States Postal Service have led to significant delays, with everything from Amazon packages to mail-order prescriptions becoming increasingly bogged down. Now, two U.S. Senators are voicing serious concerns, saying the delays are putting the health of millions of Americans at risk. 

Switch to a better pharmacy and enjoy free same-day delivery

In a recent investigation of five major pharmacies offering mail-order service, Senators Robert Casey (D-PA) and Elizabeth Warren (D-Mass.) found an increase in average delivery times ranging from 18-32%. That means millions of people with chronic conditions like diabetes, heart disease, and asthma are facing a dangerous dilemma. They can either risk unnecessary exposure to COVID-19 knowing they are especially vulnerable to the virus or possibly go without life-saving medications for days due to delays in the mail. 

Alarmed by the striking slow down, Jacqueline W. Fincher, MD, President of the American College of Physicians, released a statement cautioning that “a delay in receiving a necessary prescription could be life-threatening. My patients who rely on their insulin, or their inhalers, or any other type of medication can’t wait weeks to see whether or not their prescription will be delivered.”

This situation is certainly troubling, however, at Alto, we promise to deliver a better experience. Here’s why our courier service is the best method for ensuring your prescriptions arrive safely and on time.

Same-day, contactless delivery: We skip the mail, preferring to hand-deliver your medications that very day. We also provide contactless drop-offs to ensure everyone stays safe.

Zero risk of in-transit delays: Your prescriptions will never change hands during the delivery process, increasing not only speed, but safety as well

Convenient scheduling: Select from multiple 3-hour delivery windows that work best with your schedule

Real-time tracking: Stay updated throughout the delivery process via text or follow along in real-time in the Alto app.

Always free - There are never any hidden fees—your delivery is completely free. 

We’re committed to helping you lead a healthier life by providing swift and safe access to the medicine you need. Making the switch to Alto is easy. We’ll handle the transfer.

Concerned about Mail Delays Tying up Your Prescriptions? There’s a Better Way.

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.

When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

What’s the Difference between Type 1 and Type 2 Diabetes?

Put very simply, diabetes is a health issue that affects how the body converts food into energy. This simple understanding is complicated, however, by the fact that it’s actually a term for several conditions. When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

Your cells use a simple sugar called glucose for energy. Your body obtains it by breaking down the carbohydrates that you eat. Once the glucose enters your bloodstream, your pancreas releases insulin in response, which promptly helps move the sugar out of your blood and into your cells. In a person with diabetes, however, one of the following things happens: 

The pancreas does not produce any insulin at all

The body doesn’t respond to insulin in the right way, which is known as “insulin resistance.”

Without treatment, a person with diabetes will develop a condition called high blood sugar, which is just as it sounds—too much glucose in the blood. This can lead to serious and even life-threatening complications such as heart disease, vision loss, kidney disease, or nerve damage. There is currently no cure for diabetes, but it can be managed through lifestyle interventions and, depending on the type, oral medication and/or insulin injections. 

According to the Centers for Disease Control and Prevention (CDC), over 34 million Americans, or about 1 in 11, have diabetes. In addition, it’s estimated that 1 in 3 adults are currently at serious risk of developing type 2 diabetes, meaning more than 40% of American adults are in some way affected by this disease. In case you glossed over that last statistic, we’ll let it sink in again. Experts believe that nearly half of all American adults have either diabetes or prediabetes. 

To understand this disease’s startling prevalence, let’s take a look at how and why each type occurs. 

Type 1 diabetes: The immune system on the attack

Type 1 diabetes is an autoimmune condition that occurs when the body mistakenly attacks the pancreas with antibodies. This destroys the pancreas’s insulin-producing cells, meaning people with type 1 diabetes don't produce any insulin at all and must rely on insulin injections to control their blood sugar. 

Because type 1 diabetes commonly begins in childhood, it used to be known as juvenile-onset diabetes. However, it can happen at any age to people of all races and body sizes. The CDC estimates that it affects nearly 1.6 million Americans, making it much rarer than type 2 diabetes.

Symptoms of type 1 diabetes usually come on very quickly and can include excessive thirst or hunger, frequent urination, sweating, nausea or vomiting, and weight loss. The cause is unknown, but genetics plays a role and those with a family history of type 1 diabetes are at increased risk. If you experience these symptoms, it’s important to contact your doctor right away.

Type 2 diabetes: A silently growing epidemic

In the case of type 2 diabetes, the pancreas is usually able to produce some insulin. The problem is either that it’s not enough insulin or the body isn’t able to use it properly. This means glucose doesn’t easily reach the body’s cells to provide essential fuel. 

Type 2 accounts for over 90% of all people with diabetes. It develops over the course of many years due to a mix of genetic, lifestyle, and environmental factors. Unlike in the case of type 1 diabetes, those at risk for type 2 can often prevent its onset through lifestyle interventions such as losing weight, eating healthy, and staying active. 

This high-risk phase is known as prediabetes, and occurs when a person’s blood sugar levels are significantly elevated, but not high enough for a type 2 diagnosis. It’s estimated that more than 88 million adults have prediabetes and 85% of them have no idea. 

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How to Make the Most of Your Engineering Internship — Advice From Alto's First Interns

Managing Your New Diabetes Diagnosis

Concerned about Mail Delays Tying up Your Prescriptions? There’s a Better Way.

From Pharmacist to Professor: Sandra Aziz Spotlight

What’s the Difference between Type 1 and Type 2 Diabetes?

How Alto Saves You Money on Prescriptions

Aging Well at any Age: Our Pharmacists Weigh in

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