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

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

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Alto / Blog

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

A software engineer's journey to Alto

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 

Anna left her doctor’s office with a glimmer of hope. For months, Anna had been struggling with digestive issues and now her doctor had suggested they try a promising new medication. Finally, she thought, maybe this new medication could provide some relief and her life could return to normal. But when Anna arrived at her pharmacy, she was shocked to discover the medication would cost $400 per month! The pharmacist at the counter explained that if she couldn’t afford the copay, she would need to call her insurance or her doctor to “figure it out.” Frustrated and overwhelmed, Anna left the pharmacy empty-handed and with the distinct feeling that healthcare had been designed to work against her.

Unfortunately, Anna is not alone in encountering obstacles that prevent her from getting the medication she needs. From the moment we leave the doctor’s office, we are thrust into a maddening, depersonalized system that feels like a big black box. We are left to navigate it all on our own, especially when it comes to medication pricing. 1 in 3 Americans admit that they aren’t taking the medication they need because of cost. This is not only harmful to our long term health as patients, but also a devastating cost to our country. It is estimated that there are 125,000 avoidable deaths per year and nearly $300 billion in downstream medical costs due medication non-adherence. You may have heard stories of diabetic patients who, faced with climbing insulin costs, died from skipping doses or resorting to cheaper alternatives. For these patients and their families, getting the right medication is an issue of life or death. And for many like Anna, it’s, at the very least, very high stakes.

Today, medication pricing is set by multiple stakeholders in a process that is entirely hidden from patients and doctors:

Your employer contracts with a pharmacy benefits manager (or “PBM”, like Caremark, Express Scripts, etc.) whose job is to determine which medications should be covered or not under your insurance plan (even down to the exact dosage and brand that your doctor prescribes).

The PBM negotiates with the drug manufacturers to agree upon a specific price to charge the employer for a medication, the remaining copay for patients, and the PBM’s hefty cut for administering the service. It’s not hard to imagine how commercial incentives might color decisions on which medications are covered and how they are priced.

Drug manufacturers also offer copay assistance programs for select medications, with varying eligibility criteria, but these are marketed primarily through doctors, meaning patients often don’t know these assistance programs exist or if they qualify.

Today, none of this data is transparent or shared. These parties (doctors, drug manufacturers, PBMs) do not have the incentives nor the technology in place to coordinate with one another to act in the patient’s best interest. Drug manufacturers and pharmacies get paid by the medications dispensed, doctors get paid by the appointment/procedure, and PBMs get paid through taking a hefty cut of the negotiated medication price. These parties are naturally incentivized to pursue a path that delivers the highest financial return with the least amount of effort. Sitting in the center of this web, pharmacies are uniquely positioned to coordinate the best outcome for the patient. Traditional retail pharmacies, however, don’t have access to technology solutions that would easily bridge the gap between insurer, manufacturer and physician. It’s no wonder medication prices continue to climb and the process of getting medication remains so inefficient.

At Alto, we asked ourselves, “What if every patient could have a pharmacy expert on standby to help him/her navigate the complex world of medication pricing?”

We believe that pharmacy’s role is to make the process work around patients, rather than asking patients to learn how to work the system. So we built a modern pharmacy software platform that enables our Alto pharmacists, billing specialists and patient advocates to coordinate between doctors and insurance companies to ensure patients have clear choices and transparency on medication pricing.

Alto is the first pharmacy to proactively:

Show patients the price of a medication both with and without insurance, within minutes of receiving their prescription. These prices matter because sometimes the price without insurance is actually cheaper.

Match patients with savings and copay assistance programs offered through drug manufacturers. Often, patients and doctors don’t have time to manually keep track of these programs, so our service automatically searches for eligible programs.

Help patients and doctors navigate the complexities of insurance, whether by identifying an alternative medication that is more affordable under the patient’s plan or helping to petition insurance to cover the medication (a process called Prior Authorization). Compiling all the paperwork and medical history data required by these insurance processes takes up valuable time from doctors (estimated at 20 hours of work per week per doctor). Our technology automates this process so patients can quickly get access to the medications they need.

Here’s what all this means for a patient like Anna:

When Anna told her doctor about the expensive copay, her doctor sent the prescription to Alto. Anna’s doctor knew that Alto would help with the paperwork needed to petition insurance to cover a patient’s medication. Within a few hours, Anna received a notification from Alto that they’d worked with her doctor to start the process with her insurance. In the meantime, Alto had matched her with a program from the drug manufacturer that would reduce her copay so she could get started on her therapy right away. When her first Alto package was delivered that evening, Anna regained that early glimmer of hope, relieved to have the Alto team in her corner. Within days, Anna’s insurance approved the coverage, and Anna has been able to stay on the medication, better managing her symptoms (and her medication costs) for over a year now. Anna has been able to focus on her health and feel some semblance of her new “normal.”

Since Alto Pharmacy opened four years ago, we’ve had the privilege to help hundreds of thousands of patients and physicians. By harnessing the power of our pharmacy team and our technology, patients get access to the best medications, at the best possible prices, delivered to their home the same day. 

We are proud to be cracking open the black box surrounding medication pricing and giving Alto patients a new level of transparency and control in their health journey. And we are hopeful that with increased awareness and patient advocacy, systemic changes are on the way that will help make medications more accessible and affordable for everyone.

Monica Tran has led the Product and Design team at Alto for two years, helping build a suite of products for pharmacists, physicians and patients that allows Alto to break down barriers to medication access and transform the pharmacy experience. She recently transitioned into a leadership development and coaching role, helping to scale Alto’s organization, values and patient experience.

Breaking Open the Black Box of Medication Pricing

Mattieu Gamache-Asselin, CEO & Co-founder

Today, we are excited to announce a $250 million Series D funding round, bringing our total funding to over $350M. We are honored to welcome Softbank to our team of investors and thrilled that our existing investors — including Greenoaks, Jackson Square Ventures, OliveTree Capital, and Zola Global — have reinvested to accelerate our mission to bring the Alto experience to 100 million people by 2025.

Over the past four years, we’ve delivered over 1 million prescriptions directly to our patients’ doors, and created a service that makes our patients happier — our patient NPS is over 80 for the fourth year in a row — and healthier — our medication adherence rate is 77% compared to an industry average of 50%.

This has been possible because we’ve learned from experienced community pharmacists, we’ve reimagined and rebuilt the underlying infrastructure of pharmacy, and, most important of all, we’ve built an amazing and diverse team that truly lives out our values every day. Never in my wildest dreams did I imagine I’d get to work on such a meaningful mission with such a genuinely passionate and talented team. Whenever I have a tough day and need a boost of energy, I walk through our pharmacies and look around in awe at all the hard work, care and perseverance that goes into making this type of service possible for our patients — from our pharmacists and patient care champions to our couriers and product managers, all working together.

This new round of funding will enable us to take everything we’ve built and learned over the past four years and bring it to more people and more patient demographics. I’ve seen many companies scale too quickly, hire too fast, and in that process lose sight of the heart of the company’s values and mission. What is most important to me as Alto enters this next chapter is that we maintain the same empathy and human connection we’ve had since we were a small community pharmacy.

I want to thank our team for joining us on this mission, to thank our investors for believing in us, and most importantly, I want to thank our patients for reminding me every day of why we’re on this journey.

Alto’s launch in the Seattle market extends our industry-leading patient care model to Washington state.

Starting Tuesday, January 21, fertility patients in the Seattle metro area can now choose Alto’s same-day doorstep delivery and have their medications delivered by our Alto team.

Our evening delivery windows allow patients to more easily plan to be available to receive their packages. Patients schedule deliveries to the location of their choice — home, work or hotel — and on the day of their choosing. They can even track our couriers in real time on our mobile app. Next-day mail order service is also available for patients outside of the courier zone.

Courier delivery windows
Monday — Friday: 6–9 pm PT
Saturday: 2–5 pm PT

Walk-in hours
Monday — Friday: 12:30–7 pm PT
Saturday: 10–5 pm PT (closed on Sundays)

Fertility patients interested in using Alto’s services for their medication needs can ask their care team to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax).

Fertility is Complicated. Your Medications Don’t Have to Be.

Alto knows fertility pharmacy. With more than 15,000 patients served, we understand the treatment complexities and concerns of fertility patients. Our dedicated patient care team is available in the evenings and on weekends to walk you through your first injection or answer questions about medication storage, dosing or interactions. Our fertility deliveries include all necessary ancillary supplies, such as syringes, sharps container and alcohol swabs, and are carefully packaged for temperature control. Delivery is always free.

Alto will automatically connect you with all manufacturer-sponsored financial assistance programs for qualifying prescriptions. Alto also works with many fertility benefits programs, including ProgynyRx, and many leading financing and loan providers. If we cannot bill your insurance, we’ll find you a pharmacy that can.

At this time, Alto is only offering fertility medication services in the Seattle market. Any updates to service areas and offerings will be available at alto.com/locations.

Alto Pharmacy Launches Local Daily Delivery in Seattle Metro Area

How My Experience as an IVF Coordinator Showed Me the Importance of Alto’s Care Model

I knew from a very young age that I wanted to work with moms and babies. My mother ran a daycare from our home throughout my childhood, and for my sixth grade report on “what I want to be when I grow up,” I interviewed a well baby RN at a local hospital. After completing my Bachelor’s degree, I started working as front desk staff at a fertility clinic and I knew immediately that I had found my spot. I could work with soon-to-be moms and new moms every day.

I quickly shifted from the front desk to being a Medical Assistant for a physician where I was able to participate in ultrasounds, retrievals and transfers. The first time I was in a pregnancy ultrasound and heard a baby’s heartbeat, I was in tears and overcome with emotion. Eventually I transitioned into the role of IVF Coordinator where I was a key part of a patient’s — and their partner’s — journey to building a family.

I really got to know my patients — in fertility, you become a trusted confidant. Their loss is your loss, and their win is your win. While you might not bring your work home physically, emotionally the job never really leaves you — IVF coordinator was the most emotionally taxing job I’ll ever have. But each time we received a positive pregnancy test, it made up for all the ups and downs.

Alto’s model shouldn’t be so revolutionary, but it is. Clinics and patients don’t have to be okay with today’s standard pharmacy experience — Alto offers a fundamentally better model.

Fertility pharmacy plays a key role in a patient’s fertility journey. Medications need to arrive on time, in the correct assortment, with all necessary ancillary supplies. Often, the decision to change a dose or initiate a trigger shot means that medications are needed that same day or on the weekend. As an IVF coordinator, helping my patients make a decision about pharmacy was tricky — each pharmacy option offered some of the service qualities I was looking for, but no pharmacy offered all of the things I wanted for my patients. Remembering which pharmacy checked which boxes was really challenging.

It was so important to me that my patients were taken care of and receiving the highest quality of care. When they had questions, I was always available and responsive, even in the evenings and on weekends. What was most frustrating about working with fertility pharmacies was that when I’d send a prescription out, I’d have no control over the quality of the patient’s experience with the pharmacy.

For my patients, I wanted a pharmacy option that was accessible, responsive, cost conscious, and accountable for making sure nothing was getting lost or off track. For my clinic team, I wanted a pharmacy partner that didn’t require me to micromanage everything about a patient’s medications. I hated being the middle person between the patient and the pharmacy. The first time a pharmacy [Alto] came in and told me I could send any patient with any insurance to them and they would triage it, I thought, “We’ll send everything to them.”

Alto Pharmacy’s patient care model checked all those boxes. When I first heard about their same day delivery, evening and weekend hours and benefits coordination, it sounded too good to be true. Having access to a local fertility pharmacy with same day delivery was simply unheard of.

But if this was all true, it was clearly something that I wanted to be a part of. I knew from my experience as an IVF coordinator that this model served a crucial need for both patients and their care teams. I wanted to bring my knowledge and experience to help make the Alto care model even better than it already was.

What I quickly learned after joining Alto Pharmacy to help build partnerships with fertility clinics was that while same day delivery is extremely practical and necessary in fertility, it’s our patient care team that is the most standout quality. Our patient care staff have the same drive and commitment to helping build families that initially drew me to work in fertility. They genuinely care about the success of the treatment and making sure that the patients are being taken care of. This focus on the patient is unmatched in the pharmacy space — fertility pharmacy is not a truly personalized experience anywhere else but Alto.

The patient care team consistently goes above and beyond to make sure that patients have what they need, when they need it, so that cycles aren’t interrupted. Those same-day medication changes and trigger shot decisions mean that our team is processing late notice prescriptions and frequently staying late to get deliveries out the door. Many members of our patient care team have even driven medications direct to patient’s homes so that cycles stay on track. They know how much going the extra mile is going to relieve the patient’s stress.

What I like to tell people is that we haven’t found some magical secret sauce at Alto — we didn’t create texting, or mobile apps — but pharmacy has been behind the times for so long compared to many other industries and especially within healthcare. Alto’s model shouldn’t be so revolutionary, but it is. Clinics and patients don’t have to be okay with today’s standard pharmacy experience — Alto offers a fundamentally better model.

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

Tina Simon is a Fertility Partnerships Manager for Alto Pharmacy in the San Francisco Bay area.

The View from Both Sides of the Fertility Pharmacy Experience

On August 1st, 2015, I was so excited to move into my shiny, new office: a storage closet. I looked across to my co-founder, Jamie, and wondered how two engineers from Facebook ended up in the back of a small, family-run pharmacy in the Mission.

Earlier that summer, Jamie and I had left our jobs to start a company that could create lasting change in the world and have massive impact on people’s lives. We were drawn to healthcare and shocked to learn that in the U.S., 50% of people don’t get or take their medications as prescribed. This problem, referred to as medication non-adherence, is one of the country’s leading causes of hospitalization and deaths, and is often due to the high costs and friction in the pharmacy experience. We’d both been at big, retail pharmacies and saw how broken the system was — deeply inefficient and in many ways, inhumane. So, we decided to start by tackling pharmacy.

We ran some Facebook ads, offering a pretty simple service that would pick up your prescriptions and deliver them to your doorstep. That first week, we succeeded in delivering medications to our first happy, paying customers. We thought speed was the key benefit, so we named the company “ScriptDash.” Little did we know, we would need to build so much more (including a new company name, Alto — a nod to a higher, elevated experience).

We heard about a small, beloved community pharmacy, called AG. Located at Army & Guerrero in the Mission district, AG had been owned by pharmacist Vivian Cheung for over 30 years. We befriended Vivian, and she let us follow her around and learn. As weeks went by, we became more curious and amazed by all the backend steps required to make things work — not only behind the counter at the pharmacy, but also between the doctor, the insurance companies and the patient. Vivian was very kind and patiently explained every step to her two newest ‘interns.’

One day, we were watching Vivian prepare a prescription for a patient, Walter, when she noticed that the copay increased from last month’s copay by a few dollars. Vivian knew that for Walter, a few dollars would matter to him. We watched Vivian pick up the phone to call Walter and explain the copay change. Walter was thankful for Vivian’s call and ultimately came in to pick up his meds that evening. It was that day when I realized that what patients need is for their pharmacist to really know them — the way Vivian knew Walter’s health conditions, medication history and his preferences — so that pharmacists can help patients navigate the complexities of healthcare and get the medication they need. I was excited to think about how technology, alongside a caring, patient-focused pharmacy team, could help us bring this type of experience to millions of patients who desperately need an expert pharmacist like Vivian in their corner. It quickly became clear to us that what patients needed was way more than just delivery, that in order to do this right, we needed to be a fully-fledged pharmacy.

Looking back, one of the most important moments in Alto’s history was raising enough capital to purchase AG pharmacy, allowing us to continue partnering with Vivian and her team. We were fully aligned on our mission, and couldn’t have imagined doing this with anyone else.

Being fully immersed in the pharmacy and working alongside pharmacists every day allowed us to more deeply understand the issues with the existing pharmacy experience and why so many patients don’t get or take their medications as needed. We quickly built out our team, bringing together even more expertise across both technology and healthcare, grounded by the core values and caring ways we learned from AG. That first year, we also built the core pieces of our technology stack — our pharmacy operating system, our physician collaboration tool and an app for Alto patients.

Fast-forward to today. We’ve far outgrown that storage closet. We now serve tens of thousands of patients across multiple cities and multiple specialties, all made possible by our incredible team of nearly 300 and the technology platform we’ve built. We’re able to better educate patients about their medication and pricing, deliver medication to their doorstep and provide expert pharmacist advice on an ongoing basis. We are thrilled when customers tell us that they are happy (our NPS satisfaction rate is 80+, compared to pharmacy chains with 5 points) and healthier (we’ve seen our patient’s medication adherence rise to 70% from the industry norm of 50%). That first year with AG really shaped our vision for what a great pharmacy could be and the type of multidisciplinary team we’d need to build it. It’s amazing to think about how far we’ve come, but in many ways, it still feels like the early days. There’s so much more we need to do to bring this type of caring, community pharmacy experience to all the patients who need and deserve it. We are still just getting started!

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.

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.

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!

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"

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

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

Our model is made possible thanks to three Alto products:

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

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

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

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

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.

How Alto Pharmacy Is Using Tech to Put Patients First

Today, I’m proud to announce Alto’s Series C round of $50 million. Over the past three years, we’ve proven that Alto’s model works for doctors and patients alike, reducing administration time for physicians and improving drug adherence rates for patients. This new funding will enable us to expand, reaching even more patients, and to further develop our full-stack platform, driving better health outcomes at a lower cost.

Alto removes the complexity from prescriptions to improve patients’ quality of life. Every prescription requires coordination among doctors, insurance companies, pharmaceutical companies, and of course the patient. Traditional brick-and-mortar pharmacies depend on fax, phone and paper, which causes delays, errors in fulfillment, poor adherence rates, and 20 hours of administrative work a week per physician.

We’ve reimagined and completely rebuilt the pharmacy infrastructure to eradicate these problems. Through our provider platform (AltoMD) and pharmacy management software, doctors and insurers spend less time on administration and more time on patient care. For patients, we offer free same-day prescription delivery, but more importantly, cost transparency, personalized in-app and phone support, and faster coordination with doctors and insurance companies to get patients the care they need. Learn more about our app.

The typical Silicon Valley playbook is to enter many new markets rapidly, throw money at problems, and figure things out on the fly. That’s never been Alto’s approach. Because we’re working with critical, life-saving medications, messing up is not an option. We’ve diligently, methodically built robust systems to make certain we leave no patient behind, and we’ll keep that mentality as we expand. Now that we’ve built our critical foundations — the platforms and clinical expertise — it’s time to scale.

Geographic expansion
We want to make sure all of America can benefit from the Alto experience. Last month, we opened our HQ2 in Denver, where we’ve already hired 60 employees across patient care, pharmacy and clinical operations, as a stepping stone to nationwide expansion.

Therapeutic area expansion
So far, we’ve focused on deeply understanding and serving the retail, dermatology, fertility, biologics, and HIV markets. We’re now bringing the same empathy and customized service to autoimmune, endocrinology, and cardiology — areas where patients are frequently overwhelmed with logistics, paperwork and side effects, and where Alto could offer deep value as a trusted partner.

Pharmacy represents 10% of healthcare spending, a $3.3 trillion market. Most pharmacies focus on just capturing as much of that 10% as possible. A select few are working to eliminate the ineffective portions of pharmacy spending. But even they look at the pharmacy spending in isolation.

The truth is, pharmacy shouldn’t be viewed as a disjoint piece. At Alto, we believe better pharmacy will make all of healthcare more effective and reduce healthcare spending overall. We’ve already seen progress — for instance, Alto’s primary adherence rate is 40% higher than the industry average.

From patients, we’ve heard, “Being able to speak to an Alto pharmacist directly allowed me to figure out how my drugs were interacting and causing painful side effects.” Some patients are cost-sensitive and consider skipping the medications that manage their chronic conditions and prevent hospitalizations. We’ve helped by delivering $11 million in medication savings to our patients so far.

From doctors, a common refrain is: “This is the first time my patients have talked to me positively about a pharmacy, and it’s the first time I can actually see what happens to a prescription after I write it.” This experience is why doctors have been the primary fuel of Alto’s growth. UCSF, One Medical, Stanford, and over 10,000 other providers recommend Alto as their preferred pharmacy.

This early progress is energizing, and only possible because of the dedication of Alto’s hardworking team, investors, and partners. Thank you all! The feedback I’m getting from the health ecosystem is even more inspiring — that our potential is nothing short of transformative for our patients and healthcare as a whole. As far as we’ve come, we’re only just getting started.

Empowering Patients By Accelerating Healthcare Innovation

Blog

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

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

Breaking Open the Black Box of Medication Pricing

Bringing Alto to a Neighborhood Near You

Alto Pharmacy Launches Local Daily Delivery in Seattle Metro Area

The View from Both Sides of the Fertility Pharmacy Experience

The Founding Story of Alto

Help Us Shape the Future of Healthcare

Are You Right for Alto?

"Work With People Who Share Your Passion"

How Alto Pharmacy Is Using Tech to Put Patients First

Empowering Patients By Accelerating Healthcare Innovation

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