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Alto Pharmacy Technician

Alto Pharmacist

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. 

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Blog | Alto Pharmacy

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.

Alto Connect is our physician-facing product that allows physicians to easily manage the pharmacy needs of their patients that use Alto. The beauty of Alto Connect 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.

Our research revealed that no pharmacy incumbents think of themselves as consumer product companies. Unlike the Facebooks of the world, which are constantly optimizing how people use their products, pharmacy incumbents deprioritize it. We saw that gap as an opportunity to use our technical expertise to bring a people-focused mindset to the industry.

Back then, neither Matt nor I had any pharmacy experience. So, we left our jobs and dove in headfirst. After raising some capital, we purchased and ran a mom-and-pop operation, A-G Pharmacy, that had been serving San Francisco’s Mission District for more than 50 years.

We learned by fire how pharmacies work (and don’t). Soon enough, it became clear to us that despite caring about their patients, the A-G team wasn’t able to give them the best possible experience because they didn’t have the right tools. They were using antiquated software that required clumsy, inefficient work-arounds like relying on analog typewriters to create prescription labels. Because they didn’t have a streamlined operation, patients didn’t receive a streamlined experience.

We further discovered that technology wasn’t connecting the right stakeholders across the industry either. Pharmacy transactions require coordination between the physicians choosing the medication, the insurance companies paying for the medication, the pharmacies filling the orders, and the patients ultimately using the medications. The industry standard has been to conduct that coordination by fax and phone. That makes coordination slow, disjointed, and prone to things falling through the cracks. Patients take the brunt of those issues.

It became clear to us that Alto’s software needed to deeply integrate with and connect the disparate systems that stakeholders use. We also wanted to give stakeholders tools to solve other workflow issues not being addressed by their existing systems. And so Alto’s suite of products came to be.

A single Alto fulfillment center can serve as many people as 400 chain pharmacy locations, and we do it with a much smaller team thanks to our proprietary technology. That saves our company resources that we reinvest in the Alto experience. By way of example, we’ve developed specialized expertise in managing the coordination of complex therapeutics like fertility treatment, psychiatry, dermatology, and HIV prevention and care. The efficiencies we’ve uncovered make lifesaving and life-improving treatments available to people who might otherwise not have access to them.

The result is a system of products and processes that have demonstrated utility for tens of thousands of people and counting. Alto isn’t just convenient; by keeping people well informed about their prescription medications, Alto helps them make the best possible healthcare decisions for themselves and their families. But we’re not stopping there. Alto is poised for growth, and in the coming months and years, we will be rapidly adding to our team to help us build the technology to continue to solve pharmacy’s deep operational issues at scale.

Learn more about our vision, growth trajectory, and the Alto engineering team that makes it all possible.

Editor's Note: This post was updated on November 8, 2021, to reflect the rebrand of AltoMD to Alto Connect.

Women Leading the Way

On International Women’s Day, we’d like to celebrate the women of Alto. Every day, they care for patients, fill prescriptions, build products, and drive growth.

By the numbers, 63% of our employees, 40% of the executive team, and 60% of people leaders on product and engineering are women. In comparison, 20% of tech jobs are held by women and only 11 percent of executive positions at Silicon Valley companies.

This amazing representation was made possible by the company mission and values. The founders recognized that improving the pharmacy experience for a diverse population of patients meant Alto had to be a diverse company, capable of understanding and empathizing with everyone we serve.

Recruiting this talented mix of people has been one of our greatest successes, and today, our team has a broad representation of age, gender, race, sexual orientation, and socio-economic status. Diversity and inclusion is never a solved problem. We still and always will have room to improve, and will continue working hard to ensure D&I are prioritized as we continue to grow.

Focus at Alto: Providing the best care to Alto’s patients

Why did you join Alto? I was originally drawn to Alto for the opportunity to work at a pharmacy that was questioning the status quo and because, quite frankly, I could not possibly fathom how a pharmacy could have so many positive Yelp! reviews and I needed to see it with my own eyes. I quickly learned that the “Patients Come First” mentality was not just for show — it is brought to life every day through our incredible team and serves as the North Star for every strategic decision we make as a company.

Background: CVS Health, Walgreens, Northeastern

Focus at Alto: Keeping patient and provider information secure

Why did you join Alto? As a parent and patient, I am constantly frustrated by how hard it is to interact with doctors and data, in the name of security and privacy. I believe that we can secure patient data, protect their privacy and still make care accessible and convenient. I joined Alto Pharmacy because their passion for patients aligned so well with this belief. Alto feels like the kind of place I can be impactful. Also, the day I interviewed, they had a holiday cookie exchange and I’m a sucker for homemade baked goods.

Background: Mango Health, HP, Fortify Software, MIT

Focus at Alto: Building products that simplify medication management and improve health outcomes

Why did you join Alto? I love working on complex problems and creating user-friendly products to improve people’s lives. Everyone is a patient at some point in their lives, and we can make the experience so much better! The team here rallies around that mission, and approaches each decision with openness, rigorous intellectual honesty, and the desire to improve patients’ lives.

Background: Tesla, Boku, Intuit, QuestBridge, Stanford

FRANCES SCHENDLE, General Manager of Fertility

Focus at Alto: Developing and growing Alto’s Fertility Services

Why did you join Alto? In all my years in healthcare, I have never heard of a pharmacy creating an awesome experience for patients and clinicians! I wanted to be a part of this team’s mission to make healthcare simpler and more affordable for patients. The fertility space is a particularly meaningful area for me, as it is growing quickly but is still such a confusing and expensive journey. I believe Alto’s technology and dedicated fertility team are making this a more positive experience, and I’m excited to share that with more women and families.

Focus at Alto: Building products that transform pharmacy operations

Why did you join Alto? The two most important factors for me in a career move are 1) a clear, compelling company mission and 2) a strong yet humble team. When I met the Alto team, I was thrilled to find not only these attributes, but so much more to love. The founders set out to solve a hard problem, bought a brick and mortar pharmacy to learn the ropes, developed empathy with doctors, pharmacists and patients, and then built products that solved some of their thorniest problems. This approach demonstrates a hard-to-find mix of drive, fearlessness, humility and talent that I saw in droves as I met the rest of the Alto team. As someone who believes healthcare has to be so much better, I’m thrilled to spend my day contributing to that mission, with a team that inspires me… and shares lots of laughs every day!

Background: Granular, Inkling, BrightRoll, Apple, MIT, Berkeley

Alto's Mission & Values

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

Patients come before all other stakeholders, including our teammates and our bottom line.

Every time we have to make a choice, we will always choose the well-being of our patients.

We work because we care, not because it’s expected of us.

If patients are happy and healthy, our business will be too.

Be reliable. It’s more important to be good for all than to be great for some.

Every patient puts their life in our hands, so we have a moral obligation to provide high quality care.

When difficult situations arise, we go above and beyond to make sure our patients are taken care of.

Before every interaction, pause and place yourself in the other person’s shoes, be it a patient, provider, or teammate.

Strive to deeply understand the thoughts and feelings of the people you interact with.

Patients are at their most vulnerable when interacting with us. Always try to understand their context.

Choose the work that makes the biggest impact toward our goals.

Always strive to understand the impact your work will make.

Prioritize impact over activity. Hard work alone won’t get us closer to our mission — only real results will.

Being right matters. It’s how we make the most impact.

Start from first principles and question underlying assumptions. There’s nothing sacred about the status quo.

Follow the scientific method: hypothesize, test, analyze, and iterate off a failed hypothesis to find the right solution.

Recognize when you’re wrong to get to right faster. Be open to changing your mind.

Be introspective. Your own strengths and weaknesses are important variables.

We are students of the industry. We learned to be a caring community pharmacy from AG, and we will stay true to our roots.

We’re not above other players in the industry who care. We support anybody who aligns with our mission to help patients.

Every Alto employee has important expertise, regardless of their role, tenure, or seniority.

Why We Prioritize Diversity at Alto

The Alto team has been growing quickly, doubling in the last 6 months, and we are thinking a lot about the importance of diversity to building a world-class company. We are putting a lot of time and energy into making sure we build a diverse team and an inclusive culture, and one of the foundational discussions we’ve had is why diversity matters to us. Aside from the fundamental ethical reasons, having a diverse team is particularly important for us as a healthcare company because it allows us to to empathize with our patients, innovate on our product, and hire the best teammates who share our values.

I wrote an internal post codifying how we prioritize diversity, which we presented at an all-hands meeting, and subsequently in every new hire’s onboarding.

I’m sharing this publicly in hopes that it can help frame how other companies discuss the business case for diversity.

Most of any success I’ve had comes down to luck. My family prioritized education and had money to spend on it. I went to an elite prep school, then MIT, then had my first ever job at Facebook. Each step led to the next, with a lot of help along the way. In my time in Silicon Valley, I’ve seen the limits of my well-off, millennial, straight, white, male perspective. I’ve seen the ways that my type of privilege leads to the proliferation of companies building photo sharing apps and other tools that make life easier for the 1%. The massive changes in technology in the last decade have dramatically increased my quality of life, but those who don’t share my privilege have not seen nearly the benefit. Healthcare is clearly broken and hasn’t seen many improvements from improving technology, and many of those most affected by bad healthcare are also the most underserved by the tech industry. We founded Alto to use our backgrounds in tech and our skill sets to try to give some of the benefits of technology to those underserved by the current state of the healthcare industry.

I can have a hard time understanding the thoughts and feelings of our diverse patient base, given my life story and the fact that I’ve never had prescriptions. In the early days of Alto, we primarily dispensed birth control. We thought it was a good beachhead market of young, tech-savvy users, with a long lifetime of monthly refills. We discovered very quickly that birth control has a lot of different brands, some much more expensive than the generic equivalents. I assumed everyone would want the cheaper form, given that they have chemically identical active ingredients. Fortunately, though, some of our earliest teammates were women, and they helped me understand that when dealing with hormones, small differences can really affect how you feel. We then asked our patients about side effects they’d encountered switching to generics and found out how common these issues really were, and how frustrating it could be when the pharmacy tried to switch them to a generic. Now, we make sure to stock every brand of birth control.

In trying to empathize with our patients and my teammates here at Alto, I have seen firsthand the benefits of a diversity of backgrounds and perspectives. We realize that we are a company founded by millennial white males from relatively privileged backgrounds. This makes it even more pressing that we focus our energy on building a diverse team and inclusive culture.

Diversity means many different things to different people, so I think it’s important to define exactly what we mean here. What we’re really after is diversity of thought and skills applied towards a singular mission with unifying values. It’s not always easy to know whether someone has a different way of thinking about the world, so we often use proxies to accomplish this. By attempting to build a team with a broad representation of ability, age, education, gender, race, ethnicity, religion, sexual orientation, socio-economic status, and personality type, we can hopefully build a team that also brings a diversity of thought and experiences.

As a pharmacy, we have one of the most diverse user bases of any product. Almost everyone uses the pharmacy at some point in their life, and so the population of people that we serve is just as diverse as the entire population. We serve patients of every age, race, religion, gender, sexual orientation, ability, and socio-economic status. Having a diverse team allows us to understand and empathize with the people Alto serves. We are building the best pharmacy for everybody, everywhere.

One of our core values is “Patients come first,” and in order to truly embody that value, it is imperative that we have a diverse team. Whether we are designing a new feature to improve our fertility onboarding flow, or talking through a complex prior authorization with an elderly medicare patient who knows English only as a second language, having a diverse team helps us to put ourselves in our patients’ shoes and empathize with their challenges.

As a healthcare company, we are often interacting with patients when they are at their most vulnerable.

We have a responsibility to our patients, and the best way to serve them is to be sensitive to their needs and experiences.

Real innovation happens when you combine people from diverse backgrounds, with different skill sets, to solve a hard problem together. Research has shown over and over the positive effect of diversity on innovation (here, here), and diversity played a key role in many of the greatest inventions of all time. The transistor, a critical building block of the modern computer, was invented at Bell Labs in the 1940s, by a diverse group of scientists and engineers. According to Walter Isaacson,

“The lesson of Bell Labs is that most feats of sustained innovation cannot and do not occur in an iconic garage or the workshop of an ingenious inventor. They occur when people of diverse talents and mind-sets and expertise are brought together.”

Fixing the broken pharmacy industry is an extremely difficult challenge, and we will need a broad range of people, with different ways of thinking, to help solve it. An engineer can quickly write code to automate a tedious task that a pharmacist has to do everyday, like looking up patients to reach out to those who may want a consultation. A pharmacy technician can easily help a designer figure out what the right packaging looks like for fertility ancillary items. By building a team where people with different backgrounds, skill sets, and ways of thinking collaborate daily, eat lunch with each other, and form relationships, we enable more of these interactions, where teammates help solve each other’s problems from different perspectives.

We have hired many of the best people from the tech and healthcare industries, from many different backgrounds. We want to keep doing that.

Most A-players who share our values do not want to work on a team as the only member of a small minority. Neither do they want to work on a team of only people like themselves.

By recruiting a world-class, diverse team, we are in turn enabling ourselves to recruit more world-class, diverse people. It has a compounding effect.

Many of the most talented people who share our company values of empathy, humility, and putting patients first also enjoy working with teammates with different backgrounds and experiences. We enjoy learning from each other and being open minded, and believe that we learn things from each other that actually make us better at our jobs. We feel that a diverse team makes us happier and more productive, and that the best people who share our values feel this way too.

We are all working at Alto because we care about helping people and care about making the world a better place. It is well-known the tech industry has a massive problem with under-representation. Women are under-represented by a factor of 4, and Black and Latino minorities are under-represented by a factor of 2. Women leave tech at more than twice the rate men do, and women are under-represented in leadership positions in tech by a factor of 10.

A study by the Kapor Institute earlier this year found that the primary reason women and under-represented minorities leave their jobs was due to unfairness in the workplace. At Alto, we value fairness and equality as important moral foundations, and work to promote those values in the workplace. We find it sickening to read over and over again about sexual harassment, stereotyping, and unfair treatment in the tech industry, and we want to do something about it. By actively committing to diversity and inclusion at Alto, we hope to do our small part in helping to change the industry for the better.

This post is all about the “why” when thinking about diversity at Alto, and in the future we will be sharing more about what we are actually doing to make sure that we have a diverse team and inclusive culture. We’ve put a lot of work into diversity and inclusion so far, and made some great progress, but we understand there is always more we can do and this is a challenge that will never be “done.” This post is intended only to lay the foundation for taking initiative to improve diversity here at Alto. Without actual changes this is all just talk.

As a mission-driven healthcare company, there are clearly many important reasons why we care about diversity. It helps us empathize with our patients, innovate on our product, hire the best teammates, and change the tech industry for the better. We are growing quickly, so now is the time to double down on our commitment to having a diverse team. It is not something that happens on its own, and will take a lot of work from all of us to foster the inclusive environment in which a diverse team thrives, but we wholeheartedly believe it will be worth it.

Rapidly Growing San Francisco-based Startup Teams Up with Specialty Pharmaceuticals Veteran to Build the Modern Pharmacy

ScriptDash Appoints Dr. Mike Cunningham to Board of Advisors

SAN FRANCISCO, CA; November 3rd, 2016 — ScriptDash Pharmacy, a health-tech startup focused on building the modern pharmacy, announced today that Dr. Mike Cunningham has joined the one year old startup’s Board of Advisors.

Dr. Cunningham was most recently Vice President and General Manager, GPO Services, for McKesson Specialty Health (MSH), a business unit of the McKesson Corporation. There, he oversaw day-to-day business operations and long-term strategic planning for MSH’s group purchasing organizations, Onmark and Unity. Dr. Cunningham has deep expertise in healthcare having spent more than 30 years structuring, developing, and implementing relationships with pharmaceutical companies on behalf of practices and pharmacies.

“Dr. Cunningham has devoted his entire career to oncology and has accomplished remarkable feats in the industry. His reputation precedes him. We are excited to work with Mike as we build the pharmacy of tomorrow together.” — Vlad Blumen, Co-Founder

At ScriptDash, Dr. Cunningham will be a key advisor and partner in securing access to new, limited distribution specialty medications.

“I’ve been very impressed with the senior management team and their desire to significantly improve the patient pharmacy experience through modernization” — Dr. Mike Cunningham

ScriptDash Pharmacy is a year-old software startup based in the historic Dogpatch neighborhood of San Francisco. ScriptDash is disrupting the CVS and Walgreens dominated pharmacy industry of big box retail pharmacy chains by offering free same-day delivery of prescriptions.

ScriptDash is a modern pharmacy that delivers your prescriptions, same-day, to your home or office. We’ve automated most of what your local pharmacy does and we deliver. It’s pretty rad.

My First Week at ScriptDash

Beginnings are special. After four amazing years building the Optimizely rocketship, I’ve begun a new journey with ScriptDash.

A Slack bot posts every NPS survey response we get from a patient that’s just received a delivery. Throughout the day these will light up Slack, and they’re a joy to read.

What’s struck me most this week is how deeply everyone here cares about patient outcomes and improving healthcare. The current system is outdated. Broken. It not only causes millions of headaches, it also costs thousands of lives. Hundreds of thousands, in fact.

When people don’t take their medication as directed (or at all), the results can sometimes be fatal. This is called non-adherence. The CDC says non-adherence causes 125,000 deaths annually, or ~340 deaths per day. How does this happen?

The patient isn’t able to get to a pharmacy on time, safely, or at all.

The patient can’t afford the copay because their doctor inadvertently selected a drug that wasn’t covered by their insurance.

The patient can’t afford their meds because the pharmacy didn’t apply a coupon making the drug free or affordable. This coupon process is murky and manual.

The drug prescribed isn’t covered by insurance and requires special approval (“prior authorization”) from the insurance provider. Either the pharmacy or the doctor dropped the ball in this manual, shitty process, and the patient never got their prescription.

The patient didn’t take their prescription as-directed because they were given multiple meds with different instructions (this can be confusing!)

ScriptDash is a pharmacy built for 2016, from first principles, as a software company. We’ve built our own Pharmacy Management System that lets us solve patient and doctor issues that have been lingering for decades.

We automagically find and apply relevant manufacturer drug coupons, prior authorizations, and renewals. If there’s an alternative medication that’s cheaper or covered by your insurance, we’ll contact your doctor to switch the prescription.

We offer same-day delivery to your home or office via our own fleet of in-house couriers so you don’t have to burn time at the pharmacy waiting. Many people can’t get to a pharmacy safely or at all because of their work hours, and this makes a huge difference in their lives.

Others had same-day surgery or are suffering from ailments that limit mobility or energy.

We offer SmartPacks that group multiple drugs into easy-to-take little packets. It’s pretty cool.

When I’ve explained ScriptDash to a few friends, they think we’re just picking up your prescription from a regular pharmacy. We are the pharmacy! No pickup! Just delivery! From our pharmacy!

We love software engineering, operations, design, pharmacy, and pizza. Every other Thursday we volunteer at the nearby SF Marin Food Bank. This week our group and a number of others re-packaged some 3,000 lbs of cashews. Hella nuts. It feels good to do good.

Most of the hard work lies ahead of us. We’re looking for a few more good humans that want to explore the intersection of software, logistics, and healthcare. Check us out or say hi the cool way:

// Send a POST to https://www.scriptdash.com/careers/apply
{
  "name": "Your name",
  "about": "Tell us about yourself!",
  "email": "Your email address",
  "links": [ "link to your resume", "link to anything else cool" ]
}