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Alto Pharmacy Technician

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Our mission at Alto is to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it.

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

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

Alto / Blog

Utsav Ahuja, software engineer at Alto, shares why he joined the team after a thorough job search that included offers from companies including Google, Dropbox, Amazon, and more.

A software engineer's journey to Alto

After a thorough job search, I recently started working at Alto Pharmacy. In this post, I share why Alto is a special opportunity that I feel privileged to be a part of.‌

Alto is, at its core, a pharmacy. A pharmacy is traditionally defined as: "a store where medicines are prepared and sold." Indeed, Alto satisfies that definition, but it goes further than that. The most obvious way is through same day, courier delivery, but that's just one piece. For example, Alto also handles the complex coordination required between a patient, their healthcare provider, and their insurance.

There were many facets that attracted me to the opportunity in the retail pharmacy industry:

Market size: In 2018, drug spend in the U.S. topped $420 billion, and its only increasing. In 2015, just 3 years prior, it was $364 billion.[1]

Ripe for disruption: Of the top 25 retail pharmacies in the U.S., not a single one was founded after 1976.[2] The 5 largest pharmacies in the U.S. are, on average, 86 years old.

The status quo: The NPS for one of the largest retail pharmacies in the U.S., CVS Pharmacy, is an astoundingly low -5.[3] That's right, negative. For comparison, that's worse than Comcast (-3). Worse still, a recent New York Times article highlighted severe issues at chain pharmacies, caused by chronic understaffing and corporate profit-seeking. One pharmacist reported to a regulator, "I am a danger to the public working for CVS." [4]

Lives at stake: It's estimated that up to 50% of medications are not adhered to, creating up to $300 billion in avoidable drug costs annually.[5] Even worse, it's estimated that more than 125,000 avoidable deaths each year can be attributed to medication non-adherence, more than 3x than from car accidents.[6] Alto's patients' adherence rate is 77%, 30% higher than the industry average.

Delivery: By delivering medication, one Alto Pharmacy can service the equivalent of 400 chain pharmacies. This leads to substantial savings in retail expenses and better utilization of pharmacists and technicians.[7]

Centralized, specialized care: By centralizing pharmacists and the care team, each member can be more specialized in particular therapeutic areas--such as fertility or psychiatry--than the traditional retail pharmacist.

Customer happiness: Alto's NPS is astonishingly high, not just for a pharmacy, but for any customer facing business: over 80.[8] Indeed, Alto's reviews on Yelp are overwhelmingly positive.

Provider Experience: AltoMD, Alto's platform for healthcare providers, saves doctors and other providers on the platform tens of hours of paperwork, coordination, and other administrative tasks each week. The platform also gives visibility into the fill status of patients' medications, something that most providers do not have today.

Extra Mile: Alto coordinates proactively with healthcare providers and insurance to resolve issues, such as submitting prior authorizations and handling billing issues.

Patient first: Alto always puts the patient first. For example, Alto is always looking for the best price for the patient, whether it be through the patient's insurance, using a coupon, or rebates. Even if it reduces--or eliminates--Alto's profit. These cost savings aren't small; by last count, Alto has saved its patients $23 million.

Alignment on mission: Alto is a mission-driven company, and while many companies have missions on the wall, it's rare to see strong alignment on a mission. In every encounter with I had with Altoids, their earnest belief in the company and passion for the work it was doing was unmistakable.

Leadership: Alto's CEO, Matt, and CTO, Jamie, are modest, determined, and passionate. Their humble approach to building a company is a rare breed. For example, consider how Alto started: by buying AG Pharmacy, an independent pharmacy in the Mission District of San Francisco. The reasoning was simple--they needed to truly learn the needs and services a pharmacy fulfilled before they could hope to improve it. Just listen to Matt talk about Alto on recent podcast, and I think you'll understand why I admire, and believe, in them.

Engineering growth. Alto plans on quadrupling its engineering count in 2020. It was exciting for me to be a part of that because I knew that would be a critical period in the company. Furthermore, they had accomplished so much already with fewer than 25 engineers. This was impressive because Alto has to work with 4 distinct parties--insurance companies, healthcare providers, its own operations team, and consumers--and build software that brings them all together.

Ambitious expansion plans: Alto aims to serve 100 million people by 2025. This expansion will allow Alto to redefine the role a pharmacy plays in people's lives.

I'm inspired by Alto's commitment to always put patients first. I'm inspired by the ambition to fix a massive, fundamentally broken industry, piece by piece. But most of all, I'm inspired by the notion that a company can both be a good business and a force for good. We need more of those in our world.

If this inspires you too, I invite you to apply and join us. Even if you're skeptical, I still invite you to apply. I think you'll find an ambitious group of people in service of one mission: to fulfill medicine’s true purpose — to improve the quality of life — for everyone who needs it.

If you have any questions about Alto, or ideas to make it better, please do let me know. I'd love to talk to you.

1. https://drugchannelsinstitute.com/files/2019-PharmacyPBM-DCI-Overview.pdf 

2. Not including mergers and acquisitions. https://www.skainfo.com/reports/most-powerful-pharmacies 

3. https://customer.guru/net-promoter-score/cvs-health 

4. https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html 

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/ 

6. https://www.pillsy.com/articles/medication-adherence-stats 

7. https://blog.alto.com/how-alto-pharmacy-is-using-tech-to-put-patients-first-3be4d1c61013 

8. https://blog.alto.com/https-blog-alto-com-reinventing-the-community-pharmacy-be9d80d48722f 

Why a Software Engineer Turned Down 8 Other Offers to Join the Alto Team

Utsav Ahuja shares why he joined Alto despite offers from companies including Google, Dropbox, Amazon, and more.

Why a Software Engineer Turned Down 8 Offers to Join the Alto Team

Jaime Tolbert is a Patient Care Pharmacist based out of Alto’s Denver office. Here she shares what drew her to Alto and how the company is fulfilling its mission to be a better pharmacy.

Delivering the Best Care

Jaime Tolbert is a Patient Care Pharmacist based out of Alto’s Denver office. Here she shares what drew her to Alto and how the company is fulfilling its mission to be a better pharmacy. 

Prior to Alto, I worked in retail pharmacy for 13 years. My patients were the best part of my practice and helping them live healthier and happier lives was very fulfilling. When our company was bought out by CVS, there was a shift from caring about people and their health to a very task based environment. Spending the majority of my day on administrative work, being timed to finish each task, and not having time to really engage with my patients was devastating to me as a health care professional, and my work became less meaningful. One of my former colleagues had taken a position at Alto and shared how much she loved the company and its values. She offered to introduce me around and show me first hand what it was like to work here. I found that Alto puts their patients above all, and really cares about both the people they serve, and their employees. They are open to new ideas and changes, and really listen when you have thoughts and ideas about how to better serve our community or improve processes. 

Coming to Alto meant leaving behind my “family” of patients whom I loved and had worked with for years. Although this was a difficult decision, it is one I would make again in a heartbeat. This company is making a real change in pharmacy and in healthcare. After 6 months, I can honestly say I love to come to work, and I am so thankful every day for the opportunity to be part of something that is changing the face of healthcare. (And, as Alto expands our services in Denver, I am hopeful to bring many of those wonderful people to our company and offer them the personalized care they deserve.)

Working for Alto has brought me back to the reason that I became a pharmacist…to help people and to make a difference. My primary role is to focus on our patients- making sure they understand their medications, have a resource for information to answer all of their questions, and to give them the care that they deserve while keeping them safe from drug interactions or other medical issues. 

As patient care pharmacists, we are problem solvers, detectives, drug information resources, and caring providers of health and wellness to our patients. Regardless of what we do, we want to make sure we are acting in the best interest of the patient. There are instances in which people call in late at night with medication issues such as: their fertility medication has not been stored correctly and they need their injection right away, or their injection did not go as expected and they don’t know how to proceed. In these moments, we have to do some detective work and figure out if the drug is OK to use or not, or make judgement calls on the best course of action for these patients. It can be difficult to remain calm when patients are panicked or confused, but it’s our job to be a voice of reason, a sense of calm in the storm for the patient.

In the 13 years I spent in retail pharmacy, I wasn’t able to go nearly as in-depth with patient care as I do at Alto. In the retail setting, you perform all aspects of the job from start to finish mostly on your own, often within a strict time limit. At Alto, the company has separated the pharmacist role into two teams: a production team and a patient care team. The production pharmacists get to focus solely on medication preparation and inventory management while the patient care pharmacists can focus on patient consultations and clinical recommendations.

We definitely still try to work efficiently, but we have the luxury to take a 30-45 minute phone call to consult our patients and comfort them, if necessary. Some of the medications that we administer, like our fertility meds, can be really overwhelming. We have the benefit of taking time to walk patients through tough moments like their first injection, which is especially helpful on evenings and weekends when their doctor isn’t available.

Unlike the retail setting, all of Alto’s patient care interactions are done through phone calls, text messages, or secure message via our app. This model presents a lot of benefits including more privacy for the patient/pharmacist conversation.  Another benefit is the ability to reference those dialogues with the pharmacy in the event, for example, the patient forgets how the pharmacist advised to take the medication. The model also forces our team to really focus on every aspect of our messaging. We work hard to tailor both how we speak to patients and how we draft messages to ensure our patients feel a strong sense of empathy and can understand their instructions clearly. Our team also shares one voice. If a patient speaks with me about their defective medication on Tuesday, and that patient is then put in touch with one of my colleagues the following Wednesday, they will receive the same quality care and same customer service, and my colleague will have all of their most current information in detailed notes. 

Another unique factor about Alto is the team dynamic. There are 20 patient care pharmacists between the Denver and San Francisco offices. Working alongside other pharmacists every day, I’ve been able to learn so much about pharmacy that I didn’t know before. In a retail setting you're the lone individual making decisions and calls based on your interpretation of a situation.  Now, I have this entire team with varying perspectives to bounce ideas off of or go to for advice if something comes up that I have never dealt with before.

Our supervisors at Alto are also very skilled in identifying their employees’ strengths and inviting them to work on new projects. I really enjoy explaining things to people, so I’ve helped to re-write the training program for our patient care pharmacists; everything from surveys of how my team thinks we should train, to the training schedule, to physical training guides to help develop our new PCPs. That’s an opportunity I never would have had in traditional retail and I am grateful for the opportunity to help expand and train our team. I feel like working as a team is a great way to grow as a pharmacist, and ultimately benefits our patients which is why we are here.

Delivering the Best Care: Why a Veteran Pharmacist Chose to Join the Alto Team 

Marsha Green is a courier with Alto's San Francisco pharmacy. She has been delivering medications to Alto patients for two years. Most recently, as the COVID-19 crisis hit the Bay Area, Marsha has also helped pick up and deliver donations of personal protective equipment (PPE) to local hospitals.

I am a courier at Alto and deliver medications to people at their homes. I’ve been working at Alto as a delivery courier for two years, and I love it - Alto is an awesome company.

The patients are really appreciative, too, which makes my job easier since I mostly interact with patients who are receiving deliveries. Alto goes 110% because the patients know that they wouldn’t have the medicine they need without us, and they show appreciation all the time. It makes me smile when I see how grateful the patients are when they get their delivery.

Is it true you have a family member who also works with Alto?

Yes! Working at Alto is a family affair. My oldest son also works as a courier for Alto. He was working for Alto in Las Vegas and just recently transferred to work here in the Bay Area as a courier. I am a native from San Francisco, and I have three grown boys. It’s fun to be working with my son.

We have entered a new era amid the COVID-19 crisis. How has that impacted you personally and at work?

At first I felt really sad that we are going through this, but I think that everyone in this city is doing everything they can to slow it down.

I’m taking care to make sure I am protecting my health and the health of our customers by wearing gloves and a mask. Alto has been good about setting up procedures to protect me and our customers where I can do a no-contact delivery. Patients are doing their part to follow protocol, and I appreciate that the patients and Alto both do their part to keep me safe.

It’s also been nice to help out by picking up and delivering donations of masks and things for local hospitals.

How have you been supporting Alto’s PPE donation initiative?

When Alto announced their program to pick up PPE donations, I signed up to help. I’ve been picking up donations of masks, gloves and more supplies from individuals around the Bay Area and then delivering them to hospitals. I’ve done about fifty pick-ups of donations over the past couple of weeks.

Every time I drop off donations, the healthcare workers are just ecstatic. It makes me feel good inside that I am doing some good.

I have a funny story related to the donation deliveries. Each day when I pick up the donations I am told where to drop off based on which hospital has the highest need. One day last week I was asked to drop off the PPE donations at St. Mary's Medical Center in San Francisco. My mom worked at St. Mary’s for 32 years and my son, Jason, was the last baby born there. When he was born, they put out a newsletter with a photo of my mom, me and Jason to announce the closure of their pediatrics center. It was so amazing to me that this was all coming full circle when I was asked to deliver donations to them. It brought back good memories and was such a funny coincidence.

I know a lot of folks are losing their jobs right now, and I am grateful to be able to keep doing my work with Alto and helping people out. A lot of patients are really appreciative and have been doing things like leaving out drinks and snacks and masks for me as their delivery person to say thanks. It feels good to have this impact right now.

Learn more about Alto or to sign up for Alto for your prescription delivery here. 
For anyone looking to donate PPE, learn more about Alto’s program here. To request a pickup of donations, fill out this form.

An Altoid Profile: How Marsha Delivers Impact Daily

Rafi Benzaquen is Head of Delivery Operations at Alto Pharmacy and is one of the Alto employees leading the charge on a donation drive for critical personal protective equipment (PPE) for frontline healthcare workers. We caught up with Rafi to learn more about the program and how Alto is giving back to the community in the face of COVID-19. To learn more about the PPE donation program or to request a pickup of supplies, check out our blog here.

What do you do at Alto and what led you to join Alto?

I run our delivery operations at Alto, managing systems to ensure that thousands of patients receive their medications each day. I started my career in strategy consulting and often felt disconnected from the impact of my work which is what led me to start working at startups. I worked on operations and driver support at Uber for over four years. I loved being able to have an impact on the driver experience and saw how much Uber could have an impact on these folks' lives.  

I joined Alto because I was inspired by Alto’s mission to help patients, and I’m able to have an impact in creating jobs and opportunities for couriers.

How did you get involved in efforts to leverage Alto’s work to get donations of PPE to hospitals?

For me, this program is personal. I have friends and family who work in the medical field - my dad is a doctor in New York and my best friend is a doctor in LA. I’ve been hearing from them firsthand what they are dealing with due to COVID-19, such as friends stating: “I have one N95 mask and I have to re-use it.” I have really internalized what is going on and realize how important it is to help.

I feel lucky that I can leverage Alto’s systems and expertise to have an impact here. Our company values include leading from a place of empathy and focusing on impact. I am grateful that our leadership team has enthusiastically supported our efforts to launch this program.

How are you leveraging Alto’s systems and your experience to help organize pickups of PPE donations?

Because of the pharmacy delivery work that we do at Alto, we have the couriers, the reach, and the personnel for this type of program. Our team is collecting info from people who have supplies to donate, coordinating courier routes to collect donations, and then partnering with other organizations such as GetMePPE - Bay Area to help ensure an equitable distribution of donations to the hospitals that have the highest need each day.

Our CEO committed to cover the costs of paying Alto couriers to pick up donations and drop them off at hospitals. Aside from the impact on frontline healthcare personnel, this program has also created more jobs for couriers, many of whom have been laid off by other part-time jobs. We’ve also put processes in place to safeguard courier health when they collect donations and are paying a higher rate for this project. 

What has been the impact of this effort so far?

We launched this offering in the Bay Area just last week and we have already received a great response.  We’ve collected >3,700 masks, >13,500 gloves, as well as sanitizing wipes, hand sanitizer, and goggles to donate to numerous hospitals throughout the Bay Area. We have more pickup times available this week, and I’m excited to see what else we collect.

We’re also talking to a number of different hospitals and organizations to explore how our expertise and experience managing delivery logistics can help with other efforts to get PPE to frontline healthcare workers.  

I’ve been blown away by how many people have already donated through us and am excited that we are expanding this program to Seattle, Los Angeles and Orange County. I feel really grateful that Alto is working to support our communities who are dealing with the impacts of COVID-19.

I want to thank everyone at Alto who has been involved in this effort. Specifically, Frances Schendle, Hannah Byam, Jaime LaFontaine, Kevin Ruiz, Joe Young, Spencer Armini, Hilary Dalrymple and our amazing couriers who have been instrumental in execution of this program.

To request a pickup of donations, fill out this form.

Powered by People Who Care: An Altoid Profile

People and healthcare providers deserve more from today's healthcare system. See how Alto is building a new kind of pharmacy aimed at improving the pharmacy experience for everyone. Learn more!

Building a Better Pharmacy | Alto Pharmacy

After three months of listening, learning, and living, I am excited to share a bit about what I learned on my journey to join Alto as Chief People Officer. The accomplishments of this team are already extraordinary -- and we’re about to embark on scaling to even greater heights. 

My journey to becoming an Altoid* started in November 2019 when I came onboard with the short-term scope of helping the team get traction on their 90-day goals, hire several leadership key positions, and develop the 2020 People Operating Plan and budget. The experience and the energy of how much we accomplished in a short period were surreal, and  I observed a People team truly committed to delivering an amazing experience to our 400+ Alto employees and contractors. It gave me a clear perspective of the direction I wanted to take my career.

I knew I would select my next opportunity based upon three criteria: the team, the product, and the impact the organization has on society. I appreciate that I have been blessed with opportunities to be a part of some of the world’s top workplaces and brands, including Accenture, Google and Dropbox, and finding my next role would take some awesome soul searching. 

People and healthcare providers deserve more from today’s healthcare system. At Alto, we're building a new kind of pharmacy to cure one of our healthcare system's most startling ills: over 50% of prescriptions are never picked up. Because staying on track with doctor's orders requires more than just delivering pills, we're managing everything from insurance logistics to pricing, late-night questions to supply chain, and anything else that could stand in the way of effective treatment.

Given the importance of this mission, it shouldn’t surprise you that the team at Alto is special. It is a group of pharmacists, fulfillment operators, patient care specialists and partnership managers that are experienced, committed to our mission, and go above and beyond every day for our patients and provider partners. The product suite includes an intuitive platform built in partnership with our patient care and frontline teams using empathy and rigor. 

The impact we’ve had and will continue to have is substantial: our patients fill their prescriptions 30 - 50% more often than with the national chains (“adherence” to those in health care). We’ve helped patients save more than $23M on their medications through automatics savings searches and other programs. And these numbers reflect the impact of just the six markets we’ve launched in (two of which launched just this past month). Imagine what we’ll see as we expand across the US. 

The leadership team is committed to expanding the culture in a meaningful way, and I’ve found the culture to be one built on curiosity and collaboration. Before I arrived, the leadership team aligned on a leadership framework based upon Conscious Leadership. Its’ 15 commitments are by no means new or innovative, but I can honestly say this team’s whole-hearted embrace of open and honest dialogue about where we are and are not fulfilling the commitments is refreshing. This commitment will help us become better both as individual leaders and as a company and serve to further differentiate us as a workplace committed to open and constructive conversation.

For those embarking on a similar journey to find your next opportunity, I share the following:

Take time to reflect -- identify what you love.

Recognize that no opportunity is likely to check all your boxes, even in this HOT HOT market.

Take every meeting. This meant I didn’t have much time off between gigs but I learned a lot.

Seek opportunities to really work with your future team. Not everyone or every company will be open to this kind of interim opportunity but ask for more than just interviews

Ask to attend a regular leadership meeting.

Ask to take a real problem the leadership team is facing and work through it in real life with a member of the leadership team.

We’ve aligned on the five key tenants for the People Team at Alto. They are our north star and will help guide us on this journey.

Our first priority on the People team will be our People: We will have lots of goals and metrics but will always ask: “Is this doing the right thing by our people? Are we improving the quality of the experience they’re having at Alto?” Our team will be available when you need us, and you’ll have an advocate and sounding board any time you need one.

Look across our people’s end-to-end journey to deliver amazing experiences: HR too often stays stuck in our silos of recruiting, employee relations, compensation, benefits or performance management. We will differentiate our workplace and teams by threading the needle through each of those traditional processes to identify the impactful parts of the journey. Our goal is to amplify the joyful moments and support Altoids through difficult ones.

Connect disparate, siloed systems (recruiting, core HR, payroll): To help create a cohesive overall experience for employees and foster collaboration, we will connect disparate siloed systems. We will improve adoption and engagement of these tools and help Altoids learn and grow using world-class technologies to deliver people services and optimize their experience. Finally, connected systems will mean comprehensive data to support visualizations and better decision making by leaders.

Grow smart with efficient processes and automation: We can do a lot of what we want to deliver awesome experiences by adding lots of people, but that wouldn’t be using Alto dollars efficiently. We want to grow smart and scale using lessons learned by the many, many companies who’ve come before us. We’ll measure the efficiency of our processes, operations, and engagement with Altoids and candidates using a myriad of solutions from technology, vendor-partnerships and lean practices across our journeys.

Evolve our culture to one filled with curiosity, collaboration, inclusivity, creativity and workplace with intentional design, actions, and reinforcing behaviors: Delivering a workplace that is more diverse, inclusive and equitable requires thoughtful frameworks starting with attracting talent, defining behaviors creating an inclusive environment where all communities and people feel they belong, and rewarding and growing people equitably based upon their results and how they achieve them.

My hope in sharing these reflections is that some will learn from my experience and therefore do one or two better in the search for their next opportunity.

The future of work is about us all learning and growing faster than we did before. If any of this interests you, reach out, connect or apply online to one of our positions now (or in the future). To learn more take a look at our brand video and then apply today!

Alto Rebrand Sizzle Video

*We affectionately refer to Alto employees as “Altoids.”

People and healthcare providers deserve more from today's healthcare system. See how Alto is building a new kind of pharmacy aimed at improving the pharmacy experience for everyone.

Stephanie Curry is famous at Alto. No, she’s not related to Steph Curry, she’ll say right upfront, but Stephanie is known at work for her joyful, carefree singing that echoes through our Alto Pharmacy headquarters in San Francisco. She brightens our day. And among Alto’s patients, Stephanie is beloved for her reliable, friendly service, delivering medications to their doorsteps — along with big, warm hugs.

Q: What do you do at Alto and how did you learn about Alto?

A: I drive for Alto and deliver medications to patients’ homes, six days a week. I’ve worked all my life from delivering newspapers when I was 11 to being a nursing assistant in home care centers and to driving for Uber. When I heard about Alto, that I could deliver medications to patients, I applied and got the job! I’ve been driving for Alto for almost two years and I love that it gives me space to do my thing and I get to see patients.

Q: Tell us about some of the patients that are most memorable to you?

A: There’s a patient I’ve been delivering medications to for months, and usually it’s a family member or caregiver who answers the door. I see the medical equipment so I figure the patient is ill or bed ridden. But then one day, I drive up to the house and I see this elderly woman, sitting on the porch. It’s the patient and she’s waiting for me! She told me that she hears my friendly voice every time I come and that she wanted to come out to meet me in person and tell me how much she appreciated me. She gave me a big hug and that’s how I started to get to know her.

Editor’s note: At Alto, we’ve heard from countless patients who have also been touched by Stephanie. Not only the patients, but often the patient’s caregivers, children and dogs look forward to Stephanie’s Alto deliveries.

Q: Do you know all your patients by name?

A: I work the East Bay regularly so I get to know the roads, the houses and the patients pretty well. Whenever I see a patient, I always greet them by name, like “Hello, Miss Maria”. No one taught me that — I just think it’s natural really, the only way to communicate with one another. People already have so much going on, having to take medications — they don’t want to feel like another number. So I want them to know that I know them. I love that this company is about dealing with people — it’s personal, you know who you can talk is a live person, you can see their face.

Q: And what makes you memorable to patients?

A: My hugs. A lot of patients ask me for hugs, and I don’t hesitate. Oh, and my car. Patients tell me that when they get a notification from Alto that their delivery is a few minutes away, they look out the window. They always know it’s me when I step out of my shiny, black Lincoln car. I know it’s not a typical car for a courier, but I love it. My husband bought it for me and he’s the love of my life. We were married 31 years and we have three beautiful children together. So I drive that car wherever I go.

Q: What do you do for fun, outside of Alto?

A: I love to play Bingo — I’m the Bingo Queen, I just came back from Vegas. I also love to cook. I used to run a restaurant in Sacramento and my family raves about my Gumbo. I just live, enjoy life, because as I tell my friends and family, you can’t take nothing with you when you leave!

Delivering Care to Patients: An Altoid Profile

How Alto Pharmacy provided support and peace of mind during my embryo freezing process

My Fertility Preservation Story

I’m 33 years old and have been married for three years. I don’t have any children yet, but have always known I wanted a family. I have spent much of my career working in healthcare and have most recently worked at an education startup. I’m passionate about doing work that empowers women.

Many of my friends have gone through the egg freezing process, and my husband and I visited a clinic last year to learn more about our own fertility health and to explore the option of egg freezing as a future backup plan. The clinic we chose uses Alto for their fertility pharmacy services and referred me once we decided to go through a round of embryo freezing.

I had a great experience with Alto. The entire journey of learning about fertility preservation, deciding whether or not to go through with a procedure, and then starting the process is really stressful and often left me feeling like I needed a lot more information and guidance than was readily available. With Alto, everything about getting my prescriptions filled and finding answers to my questions was straightforward and dependable.

At my very first appointment, the clinical team decided to start me on medications that same night. I signed up with Alto, and they delivered my medications same-day within the span of a few hours. The customer service reps at Alto were really helpful and worked with an urgency that I appreciated given how out of control I felt in that initial phase of the treatment plan.

What I liked most about Alto was how dependable they were. When you’re going through a fertility preservation process, your prescription and medication needs change every few days for the duration of the treatment. There were several times where I got a prescription in the morning from my physician and needed to get the delivery that same day. Each time, Alto did a great job of making sure the medication was processed, scheduled for delivery and delivered on time. I didn’t have to stress that something would go wrong and the whole process would be messed up.

I also found that I could rely on Alto to help fill knowledge gaps about what was happening with my care. Each delivery included documents to explain exactly what the medications were for, something that wasn’t always clear when I got a prescription from the doctor. I appreciated Alto’s focus on customer service. They proactively reached out to give me updates about what to expect next, ensure my questions were answered, and even did small gestures like including a few caramels in each delivery that, while small, were appreciated.

I used to have a chronic disease, chronic idiopathic urticaria (hives), that required a specialty medication, and I had a really difficult time dealing with pharmacies and ensuring I got my medication correctly. I had to see one doctor to prescribe the medication, go in person to pick up the medication at a specialty pharmacy and then drive it in a cooler to a second, different doctor to administer it. With Alto, it was so much easier and straightforward to make sure I received my medications when I needed them, without having to leave home.

Alto was easy to work with and dependable which is so important and helpful. While the outcomes of my procedure were not what I had hoped for, I have no complaints at all with my experience with Alto. I would definitely recommend Alto to a friend considering egg freezing or IVF treatments.

Alto is the West Coast’s leading fertility pharmacy with more than 15,000 patients served. We’re open evenings and weekends, offer free delivery seven days a week, and will always work to help you find the best price. Interested in using Alto’s services for your fertility medications? Ask your doctor to send your prescriptions to Alto or give us a call at 1 (800) 874–5881.

This post was written by Rebecca G., a San Francisco Bay area operations and community builder, and Alto fertility patient.

Our mission is to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it. That takes a dedicated team of mission-driven, value-minded people. Read on to figure out if Alto is the right career move for you.

Help Us Shape the Future of Healthcare

Working at Alto isn’t just a job. For every team member, from product designers to pharmacists to patient care gurus, Alto is a means to a fulfilling career focused on making a difference in the lives of people who rely on prescription medicine to lead healthy, happy lives. In the process, we’re also changing an industry that has long gone unchecked.

At the highest level, Alto is a pharmacy. But we are not a traditional pharmacy. Instead of operating dozens of small-volume distribution sites across a metro area like chain pharmacies, we own and operate high-volume pharmacy fulfillment centers staffed by small, highly efficient teams supported by proprietary technology. We have one fulfillment center per metro area that we serve, including San Francisco, Los Angeles, and Orange County, and a centralized operations facility in Denver. Out of our fulfillment centers, we process and fill prescription orders and deliver directly to patients’ homes or offices by way of our free, same-day courier service.

On top of the convenience and accessibility of same-day delivery, Alto has three product pillars that allow us to deliver an exceptional experience to our users: the Alto Patient app, Alto MD, and Wunderbar. Learn more about our products and our industry-disrupting business model.

Alto is the world’s most patient-centric pharmacy. Our goal is not simply to distribute prescription medications but to improve patients’ health outcomes and their quality of life and to make those improvements accessible to everybody.

To get to that point, we need to understand what’s preventing patients from accessing all the benefits medicine has to offer. We believe it’s especially important to address the high-level problem of non-adherence, which is when patients don’t take the medication they’re prescribed. It also means learning how to scale our technology and processes to bring our products to more people in current and new markets. To achieve both of these things, we need to first scale our team. Learn more about Alto’s potential for growth and plans for the future, and how our team contributes to our success.

Loving what you do starts with doing something you believe in. It’s enriched by working alongside people who share your goals in an environment conducive to your work style and aspirations. At the foundation of Alto’s culture is our mission; our core values like acting empathically, thinking rigorously, making impact, staying humble, and putting patients first; the diverse backgrounds of our team members; and the supportive but highly autonomous way we get work done. Learn more about the Alto’s values and culture through the eyes of our CTO and co-founder, Jamie Karraker.

If Alto sounds like an environment you would thrive in, we would love to hear from you! We’re always on the lookout for great people to fill in our product, design, engineering, analytics, people, recruiting, finance, sales, business operations, logistics, pharmacy, and patient care teams. Check out our open positions to see if there is an opportunity that’s right for you!

Are You Right for Alto?

Why Mission-Driven Software Engineers Hold the Key to Alto’s Continued Success

Alto is the world’s most people-centric pharmacy. Our goal is not simply to distribute medications but to improve health outcomes and quality of life. What’s more, we want to make those improvements accessible to everybody.

To get to that point, we need to understand what is preventing people from accessing all the benefits medicine has to offer. We believe it’s especially important to address non-adherence, which is when people don’t take medications as prescribed. Non-adherence is a national problem that causes 125,000 avoidable deaths per year (more than three times the number of car accident deaths) and $300 billion in avoidable medical costs (more than half the money spent on pharmacy as a whole).

It also means learning how to scale our technology and processes to bring our products to a bigger swath of the population. To achieve both of these things, we need to first scale our engineering team.

Because of our unique business model, Alto is positioned to pursue three exciting growth vectors:

New Therapeutic Specialties: In addition to our general pharmacy capabilities, we have developed specialized expertise and infrastructure for managing complex treatments like fertility, dermatology, HIV, psychiatry, and other therapies that come with sticky coordination issues and unique considerations. We have made it easier than ever for people to navigate these treatment areas, but there is more we can do. Our team has identified 26 additional treatment areas that could benefit from specialized technology and processes. Mastering those areas is high on our to-do list.

New Geographic Markets: By expanding into the top 50 U.S. cities, we could potentially serve 55% of the country’s population. If we expand to the top 100 cities, our coverage would increase to 70%.

New Clinical Partnerships: Alto facilitates coordination between our team, healthcare providers, insurance companies, and the people taking the medications. In the process, we improve workflows and health outcomes. That offers a powerful benefit to clinics, medical groups, and hospital systems. Because of that reputation, we currently have a waiting list of healthcare providers who want to partner with us. That’s more demand than we can keep up with, which isn’t such a terrible problem.

When Opportunity and Demand Exceed Capacity

Alto is in a fortunate position. It is rare among companies to have multiple compounding growth vectors and a reserve of would-be partners angling for our product. We are not demand constrained, we are operationally constrained, and even then, we continue to double our business every six to nine months — just not as quickly as our potential promises.

Scaling up as a means of reaching our potential is an exciting challenge we’re already tackling. In late 2018, we closed our Series C, giving us the fuel we need to build out our engineering team and develop the technology and processes that will make our continued growth possible. That work will entail fleshing out each of our existing product areas, scaling them, and identifying and solving even more deep-rooted industry issues through better technology and better processes.

Currently, Alto boasts a small but talented and agile engineering team staffed by individuals who honed their experience at some of the biggest names in tech like Facebook, Google, Uber, 23andMe, MIT, Stanford, and Berkeley. All of our engineers are relatively senior, so everyone has autonomy and ownership over their projects. It’s a collaborative, supportive, mission-driven environment, which is how we’ve been able to build so much in a relatively short period of time.

Up until now, we have been deliberate about keeping the team small, but we’ve reached an inflection point. In the next 18 months, we’re looking to increase the engineering team four-fold. With our new team in place, we will be in a great position to focus on our objectives: building and perfecting our operational efficiencies and product scalability.

We’re approaching the challenge of scalability from a few angles:

One is automation. We want to take the algorithms that are in our employees’ heads and put them into code, so they can focus more on caring for patients rather than logistics. We’ve done a bunch of automation work already, but there’s a lot left to do.

We’re also intent on designing tools to help our own team be more efficient with their time, which will mean better UX, better UI, more batching, and less context switching.

The third angle is self-service, and it’s the one we’re focused most intently on. Right now, there is significant human interaction between our team and consumers because we want to make sure consumers have the information they need to make optimal healthcare decisions. In our next phase of growth, we want to automate that process without losing any transparency or depriving a consumer of any agency, no matter their technological competence.

Essentially, we want to build the pharmacy version of TurboTax (without the part about lobbying to keep the system broken). With the right prompts and information, TurboTax walks users through the U.S. tax system, which is huge and complicated. In effect, the user becomes totally self-servicing. We want to do the same for the people who use Alto. That said, not everybody is proficient or comfortable with technology. In the spirit of accessibility and inclusivity, it will still be important that everyone who uses Alto also has the option to speak to a real, knowledgeable, and friendly person to get their questions answered and needs met. We have a responsibility as a healthcare provider to take care of all our patients, no matter how tech-savvy they might be, but for these patients we can still use technology to enable our team to get the patient the best possible option, quickly and easily.

Our engineering team is working toward products with even more expertise built in. In the process, we will also make our operations more efficient and more scalable, unblocking barriers to expansion in existing markets, new markets, and new verticals.

When we succeed at that alignment, we stand to change the nature of the industry. To get there, we will continue to grow our engineering team with right-fit, world-class talent that not only has the skillset to take Alto to the next level but also the values to keep us aligned and mission-driven in the process.

Learn more about Alto’s company values and mission-driven work culture.

To Alto’s CTO, an ethical, altruistic, supportive workplace is everything.

Every morning (ok, most mornings), I wake up motivated — eager, even — to get out of bed and go to work. But it’s not because I am some super-performing success-bot. This is not another blog post about a c-level executive’s otherworldly, highly-meticulous-yet-seemingly-effortless morning routine, and I have no prescriptive regimen for staying happy and mindful while still managing to “get it all done.” I only have one piece of advice, but it is one that has served me (and my mornings) well:

Work with people who share your passion and values.

At Alto, the company I co-founded in 2015, everyone, from me (the CTO) to product engineers to part-time prescription couriers, is dedicated to the same mission and vision. Every day, we strive to improve health outcomes by optimizing technology and processes to become the world’s most people-centric pharmacy. I am never not excited to work alongside the few hundred Alto employees that daily act in concert to support the success of our company and make a difference in the lives of people who use Alto.

Underlying this relentless drive toward mission and vision is a set of shared core values that defines our internal culture:

Patients come first — even before our bottom line and industry partners. We will always prioritize the wellbeing of the people who use Alto to manage their prescription medications.

Leave no person behind. It’s more important to be good for all than to be great for a select few.

Start with empathy. We strive deeply to understand the thoughts and feelings of everyone we interact with.

Focus on impact. We prioritize impact over activity and focus on the work that makes the biggest strides toward our goals.

Think rigorously. We’re open to changing our minds and never hesitate to question assumptions and first principles. There is nothing sacred about the status quo.

Be humble. Our work — however expert, technical, or specialized — is in service of our team, the people who use Alto, and the greater good. Everyone’s contributions count, and no one is too important to take out the trash, so to speak. And we are certainly not above other players in the industry whose mission to help patients aligns with our own.

For me and my teammates, it’s extremely fulfilling to contribute to this smart, caring, talented team working tirelessly to help so many people. Everyone’s role is different but invaluable, and our efforts have real meaning. I can say with confidence that working in this environment makes a huge difference in how I carry myself, because I know from previous professional experiences what the opposite looks and feels like.

When my co-founder Matt and I started Alto in 2015, we were both software engineers at Parse, a Facebook-owned company. Having spent years in Silicon Valley, we were already jaded by the tech ecosystem and were ready for a change. In thinking about what we wanted to pursue next in our lives, we noticed that other companies were not working on society’s most meaningful problems; they were focused on catering to the 1%. In contrast, we wanted to use our time and skills to build something that makes a tangible, positive impact on the daily lives of all people, especially those ignored by the tech industry.

And so, we found ourselves drawn to healthcare — a big, broken industry that affects most people negatively, especially the underprivileged. We did a lot of research to figure out what our wedge into healthcare would be, and pharmacy jumped out to us. Essentially, pharmacy is the healthcare industry’s consumer product, and consumer products just happens to be our area of expertise.

If you think about it, pharmacy is a product not unlike Facebook; almost everybody in the country uses at some point in their life. But evidence suggests it’s generally a bad one. The net promoter score of chain pharmacies is somewhere in the vicinity of -10. That’s shockingly bad. (For reference, American Airlines has a net promoter score of four.) Our research also found that more than 35% of all medications sent to pharmacies are never picked up as a result of some upstream issue.

It became clear to us that none of the pharmacy incumbents thought of themselves like a product, and especially not one that is consumer focused. None of them had the mindset to prioritize and optimize the user experience, which is the mindset Silicon Valley applies to photo-sharing apps and ad optimization tools and all sorts of other products we aren’t so passionate about. Instead, pharmacy incumbents focus on extracting value from the system and pushing the cost off onto patients. In that gap, we saw opportunity — and a moral imperative.

Today, Alto is making pharmacy convenient, accessible, and user-friendly. We make it easy for consumers to get information on their medications so that they can make informed healthcare decisions. To get there, we have built and continually work to improve a robust set of user-facing and internal tools to guide consumers through the complex and often barrier-laced process of prescription procurement, payer authorization, and medication fulfillment.

Because health outcomes are what we care about, we’re not pushing pills for profit. We are just as happy if a patient pursues an alternative therapy so long as it is in his or her best clinical interest. Our unique business and operational models make that possible.

In disrupting an industry that can be predatory to the most vulnerable among us, I am proud to say Alto attracts some of the most ethical, altruistic talent I have ever worked with. They make coming to work a pleasure and a privilege, and that makes all the difference, not just in my mornings but also my professional satisfaction and overall well-being. If any of that resonates with you, you might be just our type.

"Work With People Who Share Your Passion"

At Alto, we’re putting patients first with free, same-day medication delivery; always-there, cost-saving support from our dedicated pharmacists and care team; and a cheerful online interface where people can conveniently manage all their prescriptions. Here’s how we make it work.

How Alto Pharmacy Is Using Tech to Put Patients First

Above all, Alto Pharmacy strives to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it. In working toward that mission, we’re building technology to disrupt the healthcare industry, which has long deprioritized the patient experience. At Alto, we’re putting patients first with free, same-day medication delivery; always-there, cost-saving support from our dedicated pharmacists and care team; and a cheerful online interface where people can conveniently manage all their prescriptions. Here’s how we make it work.

At the highest level, Alto is a pharmacy. But we are not a traditional pharmacy. Instead of operating dozens of small-volume distribution sites across a metro area like chain pharmacies, we own and operate high-volume pharmacy fulfillment centers staffed by small, highly efficient teams supported by proprietary technology. We have one fulfillment center per metro area that we serve, including San Francisco, Los Angeles, and Orange County, and a headquarters in Denver, where we are centralizing and growing our care operations team. Out of our fulfillment centers, we process and fill prescription orders and hand deliver them directly to patients’ homes or offices. About seven million people fall within the delivery zone of our San Francisco fulfillment center alone. In Southern California, our delivery radius covers another 20 million people.

Our model is made possible thanks to three Alto products:

With the easy-to-use Alto Patient app, people can consult a friendly and knowledgeable Alto pharmacist, schedule deliveries, and otherwise manage and learn more about their medications. Through the Alto Patient app, our care team also works with people to find them ways to save on their prescription costs.

AltoMD is our physician-facing product that allows physicians to easily manage the pharmacy needs of their patients that use Alto. The beauty of AltoMD is that it simplifies the workflows of the medical practices that use it. The typical clinic spends an average of 20 hours of administrative time per physician, per week, just on pharmacy workflows. In relieving practices of many of these administrative tasks, Alto reduces the likelihood of human error and redirects physicians’ time and energies back to their patients. In turn, Alto helps ensure treatment adherence and a better overall healthcare experience, making it a win-win for physicians and patients alike.

Wunderbar is the internal technology our pharmacists and care teams use to manage their workflows. It also controls the robots that fill every prescription order. Wunderbar was built and continues to be improved in house, giving us a strong foundation to grow and scale.

My co-founder, Matt Gamache-Asselin, and I came up with the idea for Alto in 2015, when we were working as software engineers at Parse, a Facebook-owned company. By then, our years in Silicon Valley had left us jaded and disillusioned with a tech industry that had lost sight of what really matters. We watched companies pour their resources into addressing the not-so-meaningful problems of the 1% while the broader population went underserved by many of the technological innovations being developed. We wanted to use our time, energy, and experience in consumer products to build something with the potential to have tangible, positive impact on the lives of all people. That led us first to healthcare — a big, broken industry with a terrible reputation — and then, more specifically, to pharmacy.

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