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Blog | Alto Pharmacy

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

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 50,000 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.

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

Here are the values that guide our work at Alto Pharmacy today.

Alto's Mission & Values | Alto Pharmacy

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

This was at the top of our founding values, and it’s still here. In fact, our resolve to put patients first has only gotten stronger — not because it’s what is best for the business, but because it is our only reason for being in business. Each member of our team strives to build a world where healthcare companies truly prioritize the needs of their patients, and we’ll do everything in our power to make that a reality.

My personal favorite of all our new values, dancing in the storm is about embracing the bumps in the road — and there are many when you’re taking on challenges within healthcare — and recognizing that you can always choose joy. We strive to help our teammates do the same by infusing a little bit of levity and laughter into the workday. It only takes one person to start a dance party!

Humility is not thinking less of yourself, but thinking of yourself less. Nor is it the absence of strong opinions, but the willingness to learn and change our minds. Sometimes our ego takes over — that’s only human. But we try to be mindful of it, and willing to let go of our ego and instead put our mission, customers, and teammates ahead of ourselves.

We view ourselves as creators of our circumstances, responsible for our actions and our own well-being. When we don’t like an outcome, we don’t project blame onto others or ourselves, but rather take radical responsibility for how we created the situation. More than any other value, this is an opportunity for deep internal reflection, and by practicing it consistently, we can maximize our own individual growth.

We say what is true for us in the moment, even when it is uncomfortable. We support our teammates to do the same by recognizing the validity of their experience and not taking it personally. Leading with candor isn’t always easy, but it feels much better to live authentically and honestly and to work with others who do as well. Candor doesn't have to be angry or hurtful - it can be kind and binding, compassionate and respectful.

It’s easy to become paralyzed by fear, overwhelmed by all of the possibilities in a complex situation. So unless a decision involves customer or employee safety, we don’t wait for perfect information. We trust our intuition and common sense and simply forge ahead, knowing that mistakes are in fact one of the best ways to learn.

There are no shortcuts or silver bullets in an industry as complex as healthcare. The way to achieve transformational change is through continuous improvement over a long period of time. When we’re overwhelmed by the magnitude of what we’re trying to accomplish, we remember that what each of us does adds up — one step at a time, one customer at a time — and that with small but steady progress we can accomplish great feats.

As a company grows, issues no longer affect a few customers, but a few thousand. It’s tempting to only look at trends and aggregates, but we know this is a trap. Greater distance from individual examples creates more opportunity for misunderstanding, bias, and incorrect assumptions. So we look beyond surface-level data and dive deep into the details. Only then can we fully understand an issue to its core.

Values themselves are just words, and the words themselves are not that important. What’s important is how we live them day in and day out, and the culture they support. In the months ahead, we’ll continue to integrate these values into the fabric of our company processes, our products, our customers’ experiences, and our work lives. And this work is not something just a few leaders or HR team members do -everyAltoid has a hand in bringing these values to life and co-creating our culture.

Here are the values that are guiding our work at Alto Pharmacy today.

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:

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