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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We took the best parts of the software engineer interview process from the places we’ve previously worked and interviewed, eliminated stuff we thought wasn’t relevant, and added our own special Alto ingredients!

What to Expect When You Interview as a Software Engineer at Alto

Thank you so much for considering an interview at Alto! At Alto, we’ve devoted a considerable amount of time refining how we interview candidates for software engineering roles. As engineers, engineering managers, and recruiters at a rapidly growing company, this is a big part of our jobs and we want to get it right: for the candidate, for ourselves, and for the team. We took the best parts of the interview process from the places we’ve previously worked and interviewed, eliminated stuff we thought wasn’t relevant, and added our own special Alto ingredients. Let’s dive in!

What does a Software Engineer at Alto do?

First and foremost, Alto exists to serve our patients--whether that be via building products, or providing exemplary service. Engineers at Alto are empowered to go the extra mile to make an impact for our patients, medical providers, and amazing pharmacists and care professionals. We are organized into small mission-focused teams where you will be working closely with Product Managers, Designers, Data Analysts, Data Scientists, and our Care team. Alto Engineers enjoy this cross-functional, collaborative environment where everybody has a voice in the direction of the product and the team. Compared to other companies, we are more end-user focused in most of our teams, even those that work primarily on platform and infrastructure.

Our pragmatic focus on impact includes making sure that we fulfill our company value of Patients Come First. We have a strong culture of code reviews, testing, documentation, and knowledge sharing to ensure that the service consistently meets our patients’ and providers’ expectations for quality and reliability.

Developing a Predictive Interview Process to Reduce Unconscious Bias

We want our engineering team to look like our customers — and we strive to serve everybody. Our mission is to fulfill medicine’s true purpose — to improve the quality of life — for everyone who needs it. In order to effectively carry out our mission, we believe our engineering team should reflect the rich diversity of our customers. Our engineers come from all backgrounds and took many varied paths to arrive here: self-taught, coding bootcamps, and top-tier universities. Prior experience ranges from none to decades at large public tech companies with many joining from other startups and consulting/contracting backgrounds. Reflecting this, we’ve put together an interview process that focuses on predicting job success over testing for rarely-used computer science knowledge and encourages hiring diversity of all kinds rather than filtering for a certain type of engineer.

Throughout the interview, we work on problems that are facing Alto today or that we’ve dealt with recently. Our interview questions rarely have a “right” answer, and if you are writing code, any language works. (We spend our time mostly in Javascript, Ruby, and Go.) Occasionally, you will have more than one interviewer in the session. This is likely because one interviewer is shadowing the other to train, get calibrated, and learn how to deliver and interpret the questions while minimizing bias.

This is a quick chat with a recruiter or a hiring manager to further expand on your experience, capabilities, and interests. Based on this, we’ll have a good idea for which team(s) you would be the best match.

This screen aims to validate your technical skills. You’ll be working in a networked IDE (like CoderPad) with an Altoid (what we call ourselves) to write and run code that addresses a typical problem that you might face at Alto. We’re looking for fluency in the language of your choice and some fundamental object-oriented programming design skills. 

This is based on a typical task that you might face at Alto - something like designing or interfacing with an API. You're welcome to use StackOverflow, Google, or any other resources at your disposal—including your interviewer! We’ll be observing how you understand the problem, communicate with your interviewer to develop requirements, and get to working and well-tested code. 

In this section, you’ll spend some time getting to know a problem we have faced. You’ll spend 10-30 minutes working on how to approach and optimize a challenge that impacts our business everyday, then show that you can translate that into working code.

This module varies depending on your experience and interests. For some folks, we dive deeper into software design and learn how you would break up a hypothetical application into core modules. For senior frontend developers, this might be an app architecture challenge. And for senior backend developers, we’ll address systems architecture with an eye toward scalability, observability, and technology choices. In every case, we’re looking closely at how you approached the problem, gathered requirements, and justified your decisions.

The Engineering Manager is trying to deeply understand who you are as an engineer and a person. What do you get excited about? What type of roles do you like taking on within a team or project? What is your career arc and how can you best advance that at Alto? The questions often asked are behavioral or hypothetical in nature, and we love to hear stories about your proudest accomplishments and challenges you’ve overcome.

“I had an amazing interview experience with Alto - although the recruiters were super busy, they made sure to accommodate my timeline," shares Jacinda Zhong, Software Engineer, Core Services at Alto.  "I was really pleased to find out that Alto asks questions based on the type of work I’d be doing - no obscure CS concepts, and questions centered around complex business logic that you’d encounter working at Alto. Before my onsite, my recruiter gave me a call to provide context on what they’d be asking. No gotchas and no surprises, plus lots of detail so that I could be prepared to do my best. So excited to be working here and contributing to a great mission!”

The interviewers get together promptly—we try to do it no later than the next day—to discuss next steps. Prior to our discussion, we individually assess your performance against a rubric that takes into account your level of experience and the requirements for the role.

There is rarely unanimity in the panel. Almost everybody at Alto was discussed in a panel where there were some mix of Yeses and Nos. Often, we ask ourselves questions like, “What is the candidate’s superpower?”, “What will they add to the team?”, and “For which open role are they the best match?” Our hardest decisions are the ones where we all agree that the candidate is somebody we want to work with but we don’t have exactly the right role.

Don’t be surprised if your interview is slightly different from what is described here. We’re constantly refining our process to get to better hiring decisions more quickly and with less bias with regular feedback from candidates, interviewers and recruiters. 

Have you had an interview experience that you thought was exceptional? Let us know at feedback@alto.com.

In this post we’ll define what a prior authorization is, 3 tips to plan for them, and how Alto provides support in the process.

What is a Prior Authorization?

Imagine going to your doctor’s office and receiving a treatment plan only to learn that your medication or procedure needs approval, commonly referred to as a prior authorization (PA). This might seem odd given that your physician recommended your prescription or procedure as the best option. However, the approval isn’t required from your doctor but rather your insurance company. This is to ensure that the treatment complies with their coverage standards. 

A prior authorization is a request to your insurance company for coverage of certain medications or medical procedures. You can think of a prior authorization as the “green light” to proceeding with your physician’s recommended treatment plan. Insurance companies typically require this approval process for the following situations: 

Medications that may be misused, abused or have adverse effects

Medications that are new to market and not yet listed on insurance formularies (i.e. may be at a higher cost than other drugs that are similar/more cost effective) 

Medications that your doctor prescribed to treat a condition other than those officially approved by the FDA, also known as "off-label use”

Medical procedures that are not deemed medically necessary 

Why are Prior Authorizations so Important?

A recent study shows that 1 in 4 doctors believe the prior authorization process has a disadvantageous effect on their patients’ well-being due to delays caused in treatment. Despite this, prior authorizations remain a key part in gaining insurance approval. Put simply, this is their way of “gatekeeping” cost effective coverage appropriate for each patient. 

At Alto, we understand why insurance companies want extra due diligence on expensive or risky medications, but we don't think patients should have to navigate this complicated world on their own. And these hurdles/hoops should never substantially delay access to treatment. That’s why we proactively file prior authorizations when they are needed, ensuring there are no delays. In fact, we have a dedicated support team who works closely with your doctor’s office the moment a prescription comes in that requires approval. We’ll also always keep both you and your physician in the loop throughout the process so you know the current status of the request. 

Ask your doctor if a prior authorization might be necessary when discussing treatment 

Consider a pharmacy, like Alto, that is action-oriented in filing prior authorizations (and we offer this support for free!)

Don’t be discouraged by the process. While this might be an extra step it’s likely to save you from paying full-price. 

Regardless of whether or not you may need a prior authorization now, it’s helpful to understand what to expect so that you are prepared. In the event that the prior authorization request is denied, we will work directly with your doctor to either process an appeal or find covered alternative treatments so that you don't have to. Gaining access to your medications isn’t limited by a prior authorization, and with the right pharmacy partner you can feel confident that you’ll have an advocate on your side. 

Questions about Alto or our cost savings approach? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text or the app.

In this interview, Alto's third engineer shares how her background and experiences, from her nomadic upbringing to serving as student body president in college, led her to where she is today at Alto.

Building an Engineering Career at Alto 

This interview has been edited for length and clarity.

Elnaz joined as Alto’s third software engineer in 2016, coming from Lob. She has since gone on to shape Alto’s culture and recruiting efforts and rose to become an Engineering Manager. In this interview, she shares how her background and experiences, from her nomadic upbringing to serving as student body president in college, led her to where she is today.

You’ve lived in 8 cities spanning 5 countries and 3 continents! Tell me more about that and how it shaped you?

My family started moving around from a really early age. My dad was a chemical engineering professor in Iran for around 25 years. When my siblings started going to college in the United States, we started moving around to pay for their college tuition. He did a sabbatical in Australia (where I learned English!), a short stint at his alma mater Oklahoma State, time at a research institute in Kuwait, and a few other locations. 

As a result, I’ve been exposed to such extremes in my life in moving from the Middle East to Oklahoma, or between Chicago and San Francisco. I’ve just been exposed to such a variety of people that’s allowed me to both blend in with a lot of different folks, but also be able to be a bridge and a translator. Regardless of whether it's in work or my personal life, I think “passionate” is maybe the most consistent way I would describe myself. I'm either passionate about the work I'm doing or passionate about getting outside for camping and traveling. There's an intensity in all aspects of my life. 

From my past roles, I realized I loved working on cross-functional problems. I stumbled across Alto, eventually realizing that working cross-functionally was such a unique and fundamental opportunity with this company. We would not succeed if engineering sat in one corner and operations in another - we had to work together. The other piece was that I knew I wanted to work on something more meaningful. I felt like I was able to close the loop on what started off my career – working in civic tech and on public interest projects – and do that as a more effective person in the healthcare business. Finally, I wanted to learn more about the business side of things. What I learned in my first job out of school was that nonprofits and civic tech are great, but they don’t work unless you can fund them. I really wanted to find businesses that were viable and also added value.

You were Alto’s third engineer. What was that like?

In retrospect, it was fantastic. I was able to shape the culture, see the evolution of the company, and develop a lot of relationships. For example, I was really passionate about engineering being a partner to the rest of the organization and for us to go into the trenches to understand how the frontlines use our product to figure out how to make things better. I was given a lot of unique opportunities, including working on recruiting to make sure we were building a more equitable interview process, and also ensuring that folks are successful once they got here. I was able to influence Alto’s diversity and inclusion efforts and grow as a leader to pave the path for more people after me.

How was the transition from engineer to management like for you?

The first feeling was just sheer excitement. So much of what I’d been passionate about up until then had been done on the side: building an onboarding program for new hires, building out better interview questions, improving our on-call process. Becoming a manager was validation of how things that I'm good at are not just pure engineering skills, but also things that make engineering more effective. I'd been worried about being perceived as not technical enough, or that the soft skills didn’t matter, and it really validated that what I wanted to work on was valued. The second feeling was, “How do I actually know if I'm doing a good job?” I think that's one of the hardest things when you first become a manager. 

As an engineer, you have these tight feedback loops: you build something, the test runs, and you see the product and the impact. As a manager, you might have a conversation or make one comment to someone only to find out months later what the actual impact of that comment was on the person. I had to get accustomed to slower feedback loops and being more comfortable with less structure.

You were your college’s student government president. Tell me more about that and how it relates to what you do now?

What I quickly learned from that position was that defusing tense situations was my superpower. When there were disagreements between the students and the university, I felt like I could speak to both sides and bridge the gap. That was the first time I really began to appreciate my upbringing of having been exposed to a lot of different cultures and different people. This becomes relevant in basically every intersection at work: how engineering and operations relate to each other, how engineering and design relate to each other, or being able to see different perspectives within the same discipline. 

In particular, I think it was helpful for me to spend time with a design and development firm because I saw the anxiety that designers can have around not solving the problem at the core or being forced to make sacrifices about the fidelity of their solution. Now when I'm working with a designer I make sure they understand when I’m talking about velocity, but I can also put that hat aside and talk about what's possible given a longer timeframe. 

What’s the best piece of advice you’ve ever received?

I've always felt like I've seesawed between coming on too strong or being too shy. The advice I received was to not think about them as binary aspects, but rather celebrate that I have both of those attributes. So when I was weighing the idea of whether I’m really great at people management, does that make me less of a technical person? Or if I'm technical, does that mean I can't be good at the people side of things? I think this advice was really helpful for me to stop seeing it as an either-or choice and recognize I can be great at both. It makes me think of a clip of Dave Chappelle where he talks about advice that his mom gave him that really resonates with me. His mom told him, “Sometimes you gotta be a lion so you can be the lamb you really are.”	

What are you most excited about at Alto in the next year?

Personally, I’m most excited for my parents to be able to use Alto as we expand our service areas so they understand what I've been doing the past three years! Professionally, I'm excited about the big dent we can make in technical scalability, as well as making it easier for our operations team to provide a consistently excellent patient experience.

If you have any questions about Alto, or are interested in joining our team, please reach out via LinkedIn.

Senior Manager, Engineering at Alto Pharmacy

The first two members of our Advisory Board are Dr. James Hildreth and Jennifer Kent. Their years of experience as leaders in the healthcare industry will be invaluable to us as we continue to grow.

Alto Pharmacy's newly formed Advisory Board launches today with two anchor team members.

Since our launch in 2015, Alto has been committed to fulfilling medicine’s true purpose, and improving quality of life, for everyone who needs it. Today, we announce our newly formed Advisory Board and our first two anchor members, who will help guide Alto towards our mission, advise on key decisions, and support strategic initiatives. We’ve formed the Advisory Board to support our leadership as we navigate the regulatory landscape, launch new features to modernize the pharmacy experience, and adhere to the highest standards of operational excellence and patient care.

The first two members of our Advisory Board are Dr. James Hildreth and Jennifer Kent. Their years of experience as leaders in the healthcare industry will be invaluable to us as we continue to grow. 

Dr. Hildreth is the President and Chief Executive Officer of Meharry Medical College, one of the nation’s oldest and largest private historically Black academic health sciences centers. He received his Bachelor’s degree from Harvard University, his Ph.D. in immunology from Oxford University as a Rhodes Scholar, and his medical degree from Johns Hopkins School of Medicine. He was the first Black American in the 125-year history of Johns Hopkins School of Medicine to earn full professorship with tenure and is internationally known for his influential HIV research.


Jennifer Kent served as the Director for the California Department of Health Care Services, where she led the second largest public healthcare system in the nation, with an annual budget of over $100B and serving over 13 million Californians. She oversaw the administration of 24 managed care plans as well as 56 county behavioral health plans. She has also held leadership roles in the Health & Human Services Agency, Governor's Office and has experience in the private sector as a lobbyist, consultant, and association executive. She has more than 15 years of health administration and policy experience in California.

This is an important milestone for Alto, and we look forward to working closely with Dr. Hildreth and Jennifer on the future of Alto. 

Today, we announce our newly formed Advisory Board and our first two anchor members, who will help guide Alto towards our mission, advise on key decisions, and support strategic initiatives.

Announcing Alto’s Advisory Board

A personal health journey with hyperthyroidism, Graves’ Disease, and Horner's Syndrome led Alto's Head of Talent to improve the patient pharmacy experience.

Alto's Head of Talent Shares His Personal Health Journey

As a patient, I dreaded my pharmacy experience. So I joined Alto to change it. 

My first sign of hyperthyroidism showed up when I was 20 and my struggle with pharmacies started soon after. It would be more than a decade before I found a way to be a part of solving this industry’s problems.

When I first heard about the opportunity at Alto in 2019, I actually laughed. Why would I want to work at a pharmacy? I hated pharmacies. But the recruiter I was working with convinced me to reconsider and after speaking to Jamie, one of the founders, I understood. Alto was unlike any other pharmacy out there. In fact, they weren’t just a pharmacy. They were on a mission to improve patients’ quality of life. I jumped at the chance to fix a broken industry that is hungry for innovation.

I had just come back from a trip to New York and went for a routine run around the neighborhood. I was so drained after running one mile that I had to stop and sit down. This didn’t make sense; at 20, I was in the best shape of my life. As the next few weeks went on, the symptoms worsened: severe chest pain, shortness of breath, and anxiety attacks. Being the stubborn athlete I am, I pushed through it, until one day, I blacked out during a run and woke up lying face down in the dirt. Around that same time, I developed a lazy eye and finally decided to go to the doctor.

After that delayed visit I was diagnosed with hyperthyroidism, Graves’ Disease, and Horner's Syndrome. My standing heart rate was 105, or about 50 BMP more than it should have been! I'm so thankful for my family members and the doctors who acted quickly to get me medical care. While my treatment plan was straight-forward, my experience as a patient on prescription medications became a nightmare. I quickly learned how inconvenient, impersonal, and non-patient-centric the pharmaceutical industry was.

I tried pharmacy after pharmacy, and the issues and frustrations remained the same. My script would be sent to the wrong address, or I’d receive the wrong dosage and brand of medication, even though my medication never changed! It became so routine that once a month, I’d block off two hours to talk through my refill requests with the pharmacy. But like clockwork, the same problems would reoccur—year after year after year. Having told my story to tons of other patients and caretakers, I know I’m not alone in this experience.

Like any disappointed customer in the 2000s, I took to the internet to learn more. What I found was alarming. The NPS scores for the leading pharmacies are abysmal. CVS Pharmacy, one of the largest retail pharmacies, has an NPS score of -10. Yes, negative ten. It's also estimated that up to 50% of medications are not taken as prescribed, creating up to $300 billion in avoidable drug costs annually. Even worse, it's estimated that more than 125,000 preventable deaths each year can be attributed to medication non-adherence. That's three times more than deaths from car accidents nationally!

While there was comfort in knowing others felt my pain and were experiencing the same frustrations, I was angry that there wasn't anything being done about it. I was frustrated, both as a patient and as a civilian, and didn’t know how to try to solve the problem. 

Meanwhile, after graduating college, I began my career in Michigan, where I’m from. Working for a recruiting agency, Aerotek, I was hiring for all sorts of roles—from machine operators to janitors—but I always had an interest in tech.  I found out about Barracuda Networks, a security tech company with an office in Ann Arbor. I originally joined to build their data protection division from 20 to 250. Their office was about 20 people and it needed to grow to 250. I had a ton to learn—when I started, I didn’t even know what a software engineer was! My role evolved quickly, eventually broadening to manage all tech recruiting across the U.S. and later, to building their first international recruiting team.

After almost five years, I started to look at other companies. Quora had been a long-time favorite product of mine. I loved that they connected knowledge with people all over the world. The perspectives I found were genuine, diverse, and fascinating. On Quora, there are professors, industry experts, and people who just got out of prison, sharing their knowledge and experience. I joined Quora to grow their team and jumped into the consumer internet space for the first time. Working there, I learned how to refine and scale processes to enable hiring for balanced and diverse teams. At a certain point though, I was ready for a new challenge, to move outside of an advertising-based business model, and to be in a steep learning curve again.

I had no idea where I wanted to go next. Looking around the Bay Area, I felt that with so many smart, capable people in tech, we could be doing more. I didn’t agree with a lot of what I was seeing, especially in terms of the kinds of problems that were getting the most investment, time, and resources. I’d spent almost 10 years building my career and didn’t even know if I wanted to stay in tech. I’d lost touch with a sense of purpose and meaningful legacy. 

I knew I wanted to have a lot of personal impact, and a mission I completely aligned with. I wanted a company where employees care about the lives they’re touching, the people they’re working with, and the communities they are impacting. And I wanted to work with a small team and grow it. I didn’t know if I could find all of that within Silicon Valley.

Then I got introduced to Alto. I toured the pharmacy, met with the leadership team, and learned about their ambitious plans for growth, and how I could be part of making those happen successfully. The things I noticed during my interview process with Alto are still very real today as an employee, especially the level of empathy people bring to work. Alto was the first place I interviewed where people were truly getting to know me, and understanding the motivation behind my past professional decisions.

I joined Alto in August of 2019 as their Head of Talent. I'm grateful to have the opportunity to work for a company whose culture, people, and mission are centered on supporting others and making a change in an industry that hasn't seen any significant transformation in the last 50 years. We’re seeking to understand but also wanting to be principled in our approach, and not compromise on patient health outcomes. 

Over the last year, the recruiting team has grown from 4 to 30, and our primary focus has been embedding solutions focused on building a diverse workforce. From implementing our first early talent apprenticeships, to building an inclusive hiring process by creating a training culture, we've grown the company from 180 to 750 across 4 states and 7 office locations.

This industry serves a diverse population and I’m learning a ton along the way. Working at Alto allows me to be a part of creating a healthcare solution that will truly be patient-centric. I want to continue to surround myself with people who have the same passion and bring their unique experiences, thoughts, and ideas to help us build tomorrow's pharmacy and fulfill medicine's true purpose: to improve quality of life—for everyone who needs it.

Alto’s Head of Talent Shares His Personal Health Journey

Alto is committed to ensuring affordable, timely access to medications and full-service pharmacy coverage, including specialty medications for the treatment of complex and chronic conditions.

Hims & Hers, the direct-to-consumer digital health company, has partnered with Alto Pharmacy to offer free, same-day courier medication delivery for customers accessing primary care services through its growing telehealth platform. 

Patients using the Hims & Hers platform to access primary care services in the San Francisco Bay Area, Los Angeles, Orange County, Seattle, Las Vegas and Denver-Boulder communities will have the option to select Alto as their preferred pharmacy for prescription delivery. Prescriptions for patients selecting Alto will flow automatically to Alto for fulfillment, and patients can use the Alto app to select their preferred date and time for free home delivery, review copay and medication info, and message a pharmacist with any questions. 

“At Alto, we’re constantly looking for new ways to improve the healthcare and pharmacy experience and we’re excited to partner with Hims & Hers to offer free, same-day courier medication delivery for their patients,” says Omar Nagji, Vice President of Enterprise at Alto Pharmacy. “Our partnership with Hims & Hers offers patients control, discretion, and pharmacist access without making a trip to a doctor’s office or pharmacy.”

“Hims & Hers is a natural partner to Alto’s courier-based platform,” says Melissa Baird, COO of Hims & Hers. “We’re excited to work with Alto to bring the ease and convenience of their same-day delivery experience to those using Hims & Hers to access primary care services."

Streamlined digital healthcare services are more critical than ever as patients look to balance healthcare needs with social distancing considerations, and are key to expanding access to traditionally underserved communities. Alto is committed to ensuring affordable, timely access to medications and full-service pharmacy coverage, including specialty medications for the treatment of complex and chronic conditions.

Hims & Hers customers using Alto will get full access to Alto’s exceptional care and services: price investigation and automatic coupon application, easy access to chat with a pharmacist, medication reminders and other support tools, and the option to streamline all medications for the household into one easy delivery. Alto’s safe, secure courier delivery is always free.

Hims & Hers Partners with Alto for Same-Day Prescription Delivery for Primary Care Patients

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

Alto’s expansion brings free daily doorstep delivery of medications to Seattle metro area residents

Starting Wednesday, April 15, residents of the Seattle metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

At Alto, we believe it’s our job to ensure you have your medications at the best price, on time and with the support you need. We bring pharmacy to you - no more waiting in line, making an extra trip, or finding out your prescription isn’t ready to be picked up after you’ve already arrived. Our free doorstep delivery means your medications come directly to you on the day and time you select, and most medications are available the same-day. Stay up to date on your courier’s progress with text alerts or in our mobile app. 

Starting a new medication or doing an injection for the first time? Message a pharmacist with your questions, even in the evenings and on weekends. And we’re a full service pharmacy - we stock all major brand, generic, over-the-counter and specialty medications, meaning your entire family’s pharmacy needs can be managed in the Alto app and coordinated into one delivery.

Monday - Friday: 6 – 9 pm PT
Saturday: 2 – 5 pm PT

Monday - Friday: 12:30 – 7 pm PT
Saturday: 10 am – 5 pm PT (closed on Sundays)
Please note that we are currently offering curbside pick-up only for walk-in business.

Seattle area residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax). Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch.

Alto is proud to be growing in Seattle, and we’re committed to bringing exceptional care to our families, neighbors, friends and fellow healthcare professionals. Our Seattle location allows us to provide a better pharmacy experience to the hundreds of thousands of residents who call this area home.

“I know that the Seattle community is going to love both the convenience of Alto’s delivery and high quality service that Alto’s team provides,” says Betty Cheung, Pharmacist in Charge of Alto’s Seattle location. “As a pharmacist and healthcare professional, I’m particularly glad more residents will now have access to our contact-free delivery model - it’s the safest choice for medication needs during our current shelter-in-place period for COVID-19.”

Once things get back to normal and we’re all moving out and about, come say hello! Stop by during our in-person pickup hours to meet Betty and the team. We're located at 13010 NE 20th Street, Suite 200 in Bellevue.

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