Expires 04/01/2021

Specialty Pharmacy

Your partner in navigating the ins and outs of prescriptions — at no extra cost.

Alto Pharmacy Technician

Alto Pharmacist

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

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

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

Alto / Blog

In this post, we'll share how we identified the problem of failing cypress seeds, what the culprit was, and three ways to make seeding test data more robust.

How to Debug Slow and Failing Cypress Seeds

End-to-end test failing before it even begins? Here’s how we timed, debugged, and sped up our seed data.

At Alto, we use Cypress to test our Rails application end-to-end. As our application grows, so does our end-to-end test suite — along with the seed data it requires. This led us recently to a perplexing problem:  when run in CircleCI, our end-to-end tests would mysteriously time out during the seed step, causing them to fail and block deploys.

Seeds can be painful to debug. They’re typically set up through a single request and, depending on how thorough the tests are, call upon most of the models involved in the application. If a model throws, say, a validation error because of bad seed data, you'll see it in your Cypress logs. If a model hangs, the request often doesn't show up in the logs at all. There's no status code, no error message—all you know is that somewhere, somehow, some process is failing to finish.

In this post, I’ll share how we identified the problem, what the culprit was, and three ways to make seeding test data more robust.

To Identify the Problem, Focus on Your Logs

We started by comparing logs from our failing CircleCI runs with those from local test runs. Turns out, our CircleCI logs in failed runs stopped after a specific log message. 

For example, when our test runs succeeded, the logs looked something like this:

...
LOG: creating model
WARN: foo with id=123 not found
WARN: foo with id=456 not found
WARN: bar with id=789 not found
ERROR: Invalid parameter to function `foobar`
LOG: model created
... rest of logs

But when they failed, they instead looked like this:

. . .
LOG: creating model
WARN: foo with id=123 not found
WARN: foo with id=456 not found
[end of logs]

This let us know where to focus: after the function that looks for foo, but before or during the one that looks for bar. Of course, this only works if you have enough log statements scattered around in the first place. I’d recommend logging the time it takes to create each model in seeds, which has the added benefit of telling you where to start if your seeds are becoming annoyingly slow. 

At the top of our file in db/seeds, we declare the following function to add timings to our CI logs:

@last_time = Time.now
def log_time(label)
    Rails.logger.info("Time [#{label}]: #{(Time.now - @last_time)}")
    @last_time = Time.now
end

We then call the function after each create statement in our seeds:

Product.create!({...params})
log_time(“Product Create”)

This prints logs in the following format:

...log metadata message=Time [Product Create]: 12345
...log metadata message=Time [User Create]: 1102
...log metadata message=Time [Address Create]: 105
...

These logs will help you figure out problematic model create calls, but each model may have a lot going on in its callbacks (before_save, before_commit, after_save, etc). You can follow a similar approach to time those callbacks:

# in the model file
Class Model < ApplicationRecord
	
...

before_save :foo

...

def foo()
   start_time = Time.now
   [ ... things that happen inside the function ]
   Rails.logger.info("Time [foo]: #{(Time.now - start_time)}")
   [ function return statement, if applicable ]
end

It’s important to note that the most time-consuming statements in your seeds often cause the most trouble, but that’s not always the case. If your seeds are hanging due to external API calls, it’s entirely possible for those calls to usually take a short time to complete. If you have hanging tests, I would recommend logging test runs in CircleCI, since you may not be able to find the problem locally. 

Through timing our seeds, we narrowed down our search to five of our most time-intensive models. We were then able to time the individual callbacks within those models. One callback  in particular—containing a call to an external database—raised the most suspicion. It took up most of the time it took to create the model, didn’t return any information needed in our test, and was not mocked or stubbed out. 

Requests to this test database would usually work, however, since we call on it multiple times on every CI run, with concurrent CI runs, these requests would sometimes take a long time to complete, leading to a test timeout. 

In our case, since we were making calls to a hosted database in our tests, we changed our test environment to create and refer to an isolated instance of the database. While this was the best approach for our specific issue, we also explored some other ways of stubbing out API calls and skipping callbacks from your seeds file, which we describe below. Use these approaches with caution, as the more you stub, the less true-to-life your tests will be. 

Ideally, you would have already stubbed out third-party API calls in your code using environment variables. An example approach:	

def do_the_thing()
    if Rails.env.production?
    	[ ...do the thing ]
    else
	[ ...do some fake thing if needed ]
       Rails.logger.info("We theoretically would have done the thing.")
end

However, you can also use Typhoeus to mock third-party api calls in seeds, similar to how you might in a test. Imagine that your Product model makes a call to "https://slack.com/api/foo”. We can then mock that call out as follows:

mock_response = Typhoeus::Response.new({code:’500’, body: {
    “ok”: false,
    “error”: ‘not_authed’
}.to_json})
Typhoeus.stub("https://slack.com/api/foo”).and_return(mock_response)
Product.create!({...params})

Again, I would advise you to stub check for environment variables in your code rather than stub out individual API calls in your seeds and tests. But if for some reason you need to do the latter, it’s possible!

Similarly, you might want to stub out a function you’ve written if it takes a long time to run and doesn’t affect the outcome of your tests. This can’t be stubbed out in the ways we mentioned above since (1) you might need it  for — and hopefully are testing it in  — other tests and (2) it doesn’t have a url. minitest has a tool for this. Imagine you’re trying to stub out some functions from a Photograph model.

require ‘minitest/autorun’

Photograph.stub :fetch_product_photo_url, ‘’ do
   Product.create!({...params})
end

This will return an empty string when Photograph.fetch_product_photo_url is called within the Product model’s callbacks. You can also replace the empty string with anything else you might want the function to return.

Last but not least, it’s possible to skip entire callbacks and validation. I wouldn’t recommend skipping all of them, as that can cause models in your tests to stray very far from how your models actually work, but you may find it useful to skip specific callbacks.

While all the methods that I’ve suggested above are possible and can be useful, remember that stubbing and skipping from your seeds may just be band-aids for issues you have elsewhere. In our case, we could have stubbed out a model function or created an isolated database for testing. While both methods would have been functionally the same, doing the latter allows us to have to worry less about that database in the future—if, for example, we write more functions that depend on it, or update the mocked functions to do more than they currently do. Keeping tests in line with how the product works also keeps it more in line with the actual user experience: if it’s taking a long time to create a model in your seeds, it probably takes a long time for your users, too. 

Since adding timing logs and creating an isolated database to our end-to-end tests, we have a regular source of truth for the efficiency of our models, are able to develop more smoothly with fewer spontaneous test failures, and have more confidence in our ability to quickly pinpoint and resolve seed timeouts in the future. 

We were honored to sit down with Dr. Hildreth to discuss the challenges and opportunities we are facing at this pivotal moment in history. In addition to recounting his inspiring personal story, he shared many profound insights about the COVID-19 pandemic and the state of American healthcare. 

The COVID-19 Vaccine & Racial Disparities in Healthcare: A Q&A with Dr. James Hildreth

In August, we announced that Dr. James Hildreth had joined our newly formed Advisory Board as one of its first two anchor members. Dr. Hildreth’s extensive healthcare expertise has been invaluable as we’ve sought to guide Alto into the future and continue reimagining the pharmacy experience. 

A Fascinating Chat with Dr. James Hildreth

Dr. Hildreth is the President and Chief Executive Officer of Meharry Medical College—one of the nation’s oldest and largest historically Black academic health sciences centers. He is internationally renowned for his decades of influential HIV research and is deeply entrenched in our current global health challenge as a member of the FDA’s COVID-19 Vaccine Review Committee.

Can you tell us about your background and professional journey?

I grew up in a small town in Arkansas. It was one of those towns where if the two traffic signals were synchronized, you could drive right through and not even notice it. My father passed away when I was eleven years old. Quite honestly, because we were poor and Black, my father received very little medical attention. That was what prompted me to become interested in medicine.

I had no role models to look to, so I went to the library and read books about medicine. At age thirteen, I read a series of books that ranked your chances of getting into various medical schools. One of the universities was head and shoulders above all the rest, so my life’s work became getting into Harvard University.

To make a long story short, I got scholarships to Harvard, Princeton, Brown, Yale, Stanford, and many other places. But because my research had shown that Harvard was the place to go, that’s where I went. I got a job at the medical school, and the professor who ran the lab was also from Arkansas. He took me under his wing, and suddenly I wanted to be an immunologist. 

It was too late to change my major, but I was hooked. I applied for and was awarded a Rhodes scholarship in 1978, becoming the first Rhodes scholar from Arkansas who was Black. I got my Ph.D. in Immunology then went to Johns Hopkins School of Medicine. 

I planned to become a transplant surgeon until I met my very first patient. She was an African American woman with HIV who had just given birth to a baby who also tested positive. At the time, all we could do was watch them die, and that impacted me deeply enough to change my trajectory. I became an HIV researcher, and I have been studying HIV for the last thirty-eight years. 

I have been President of Meharry Medical College for five years. I feel that my life has come full circle because Meharry’s mission is to give opportunities to individuals who otherwise wouldn’t have them. 

Can you tell us more about Meharry’s mission?

Meharry was founded in 1876, but the story is that in 1826, a young, white teenage boy named Samuel Meharry was driving his salt wagon in the backwoods of Tennessee. His wagon got stuck in the mud, so he knocked on the door of a nearby cabin. An African American family greeted him, gave him a place to stay for the night, and helped him on his way. He promised them that if he ever had any resources, he would do something for Black people. 

Sure enough, fifty years later, he and his four brothers made a gift to a central Tennessee college to start a medical department for African Americans. That department evolved into Meharry Medical College.

To be leading an organization whose purpose is to give opportunities to people who look like me makes me feel that my life has come full circle. Meharry is one of four Black medical schools in the country, and without us, the face of medicine in this country would look very different. We are very proud of our mission and I’m so happy to be leading the organization at this time. 

Given that you’re on the FDA’s Vaccine Review Committee for COVID-19, what is your perspective on how we’ve handled the pandemic to date?

It’s hard to avoid acknowledging how politics have devastated our response to this pandemic. Viruses don’t respect borders, especially when you’re dealing with a pandemic virus. We should have had a nationwide response from the very beginning. Ideally, the whole country should have shut down for several weeks. That would have saved tens of thousands of lives.

What are your thoughts on how the pandemic might unfold going forward?

In my opinion, we’re entering a frightening period because we’re at the base of an exponential rise in cases. It’s essential to understand that for every case we diagnose, there are probably four, if not eight, cases that go undiagnosed. Many people don’t know they have the virus and are spreading it. 

Our country represents four percent of the global population but twenty percent of the people who are dying. That’s unimaginable to me. When you’re dealing with an airborne pathogen that can be transmitted so easily, it is unacceptable and unethical not to have stronger leadership and mandates in place. 

Can you share any insights on potential vaccines and vaccine distribution?

I’m on the FDA committee that will review the data from the drug companies and make recommendations about approval. In a couple of weeks, we will review the Pfizer vaccine. I can tell you that the data from both Moderna and Pfizer are very compelling. Both vaccines appear to be highly effective.

Neither of these vaccines is what we’d call a “sterilizing vaccine,” They will not prevent a person from getting infected, but they will limit the amount of disease that occurs after infection. The other exciting aspect of these vaccines is that they represent a new type: messenger RNA vaccines. Rather than using a protein for the vaccine, we’re using a message that encodes for the protein. There was some doubt if this new type of vaccine would work in humans, but it does. This development will facilitate future vaccines quite nicely. 

By the spring of next year, there will likely be two vaccines approved for use. The question is: who will get those first forty million doses that become available? Healthcare workers will probably get them first, then people in nursing homes and assisted living facilities. Many experts, myself included, are trying to make the case that those most vulnerable to disease and death should be next in line. The CDC has already worked with the states to develop distribution plans, but they are not in line with that thinking. There are going to be a lot of intense discussions in the coming weeks. 

What are the healthcare topics that get you most excited—or keep you up at night—right now?

The pandemic has revealed something that minority healthcare professionals have known for a long time: there is a wide gap in the health status of Americans. If you are African American or Latinx and live in certain communities, you are much more likely to have certain chronic conditions. This increased risk is related to your zip code, educational attainment, where you work, and what your job might be, but running through all of this is an underlying current of racism. 

We can’t solve the problem until this country has a necessary conversation about the role of racism in every domain of American life. I like the way that Martin Luther King put it. He said that when you have centuries of neglect, suppression, oppression, or denial, there is an interest that accumulates. The answers to these problems are going to be much more expensive and time-consuming than if we had been dealing with them all along. 

No matter what industry we’re in, all of us need to have tough conversations about what race really means. Take, for example, the sequencing of human genomes. African genomes are the ancestral genomes—all of us can link our humanism back to Africa. But of all the hundreds and thousands of genomes that have been sequenced, very few of them come from folks who look like me. 

It’s the same as my experience in medical school in the 1980s. We learned to treat the average, middle-aged white male because that’s who the studies were centered on. The exclusion of certain groups from clinical trials, programs, and conversations has created a wide gap that we now have to close. We need to have every healthcare institution at the table trying to work on it.

On a positive note, as the pandemic reveals these disparities, many organizations are awakening to the fact that there is work to be done. I’m encouraged by what happened after we witnessed the senseless murder of George Floyd. It was a really painful time for me because that could have been me, my son, or my brother. It could have been any one of us. But the response that we witnessed wasn’t just from African Americans and liberals. It seemed to me that people of all different backgrounds and races came together to say that this is unacceptable. It gave me some hope that we can change this and become a better nation.

What opportunities do you see for Alto in the world of healthcare?

I think Alto has a great opportunity to improve people’s quality of life who need to take medications to improve their health status. Before she passed, my mother would complain about how difficult it was to get her prescription medications. The ability to simplify and improve the process for everyone will positively impact a significant population of people. 

I was humbled that you asked me to be in your advisory group. I’m excited about what you’re doing, and I think it’s going to make a big difference for many people. 

As we approach the holidays, I’d like to share something I’ve told my students. The last thing you want to do is create a situation where this is the last holiday you’ll spend with some of your older relatives. Please be mindful that there is a lot of the virus out there, wherever you are in the United States. Please take steps to protect yourselves and your families. Have a wonderful holiday, but if you can, make it virtual.

Note: This interview was conducted in early December 2020. 

Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today. In this blog post we'll share an overview of the options as well as how Alto can help you in the path to parenting.

A Guide to LGBTQ+ Family Building

Assisted reproductive technology (ART) has expanded the paths to parenthood for all types of family structures. Whether exploring fertility as a single person, within a couple, or as a family unit, parenthood is now possible for more people than ever before.

A 2018 study found that 48% of LGBTQ+ millennials (aged 18-35) were actively planning to grow their families, compared to 55% of non-LGBTQ+ millennials. Researchers noted that this gap had narrowed significantly compared to older generations—the result of advances in technology and the movement for equality. 

Still, LGBTQ+ families confront unique challenges in an industry that often fails to center their needs. However, as more and more LGBTQ+ people seek to become parents through ART, the face of fertility is shifting. 

Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today, including using a donor or surrogate for one or more components of biological conception (eggs, sperm, and uterus).

That being said, many options come with formidable costs so determining how to pay for treatment is an important part of planning. Family Equality Council shares this list of family-building grants that can help make ART more affordable. Your clinic may also offer financial assistance programs and payment plans. If prescription fertility medications are part of your treatment, we’ll comb through the available discount and rebate programs to ensure you get the lowest possible price. 

To clarify which of the many paths-to-parenthood might be right for you, it can help to seek out an organization such as Family Equality Council that can provide specialized advice for LGBTQ+ families. It’s also essential to choose a clinic and doctor who can understand your needs and put you at ease. 

For LGBTQ+ couples exploring using a donor, it’s also essential to research the laws in your state regarding legal parentage procedures after your baby is born. For a starting point, you can learn about the laws in your area through Movement Advancement Project’s interactive ART law map; however, you should also speak with an experienced LGBTQ+ family lawyer in your state. 

Every budding family follows a unique path. It may include natural conception, adoption, foster care, or ART. For those considering the latter, here are some of the places your ART journey might take you. 

For those whose bodies cannot produce sperm or are experiencing infertility, a donor can be used. There are two ways to obtain donor sperm: from someone you know or from a sperm bank.

If you use a known donor—often a friend, family member, or other acquaintance—it’s crucial that you fully discuss the relational complexities involved and consult with a lawyer who specializes in working with LGBTQ+ families in your state. When choosing an unknown donor through a sperm bank, the donation’s legalities are less complex because the donor has already surrendered their parental rights. 

If you or your partner plan to carry the pregnancy, donor insemination is the process of placing the donated sperm inside the vagina or uterus to facilitate fertilization. There are two methods of insemination that may be used: 

Intrauterine insemination (IUI) is a simple medical procedure performed by a medical doctor where the sperm is placed directly into the uterus by using a very small tube passed up through the cervix.

With intravaginal insemination (IVI), the sperm is placed directly into the vagina. You can often perform IVI at home; however, many people choose to have a medical professional complete the insemination to increase the chances of success. 

Parents-to-be who were not born with ovaries or are experiencing infertility can use an egg donor. Like with sperm donors, an egg donor can be a known donor or be found through an agency. Again, when using a known donor, be sure to thoroughly discuss the arrangement’s details and consult with a lawyer who specializes in working with LGBTQ+ families in your state.

With both known and unknown egg donors, the egg must be fertilized in a lab and placed in a uterus through a medical procedure known as in vitro fertilization (IVF). 

Intended parents who cannot or will not be carrying the pregnancy for any reason can use a gestational carrier. The gestational carrier will have the embryos (eggs fertilized by sperm) transferred into their uterus, then carry and deliver the baby.

Choosing a gestational carrier is a critical decision that can take time. After all, your relationship will last the better part of a year. An agency can help you meet and screen candidates until you find the right match. 

IVF  is one of the most common fertility treatments. It involves combining an egg and sperm in a laboratory dish then transferring the resulting embryo into a uterus. IVF can be performed with donor sperm, donor eggs, or donor embryos. 

Reciprocal IVF, also known as co-maternity, is a specific instance of IVF where one partner provides the egg and the other carries the pregnancy. In this way, one partner is genetically related to the child while the other becomes biologically bonded through pregnancy. 

Egg or sperm freezing, also known as cryopreservation, is available to preserve future fertility for those looking to delay pregnancy or undergo gender affirmation treatment. Because gender affirmation treatment may affect fertility, it’s important to discuss the possibility of freezing your sperm or eggs with your doctor before undergoing treatment if you may want children who share your DNA in the future. For those currently undergoing Hormone Replacement Therapy (HRT), there may still be options available to preserve your fertility. Talk with your doctor about which choices may be right for you. 

There are many routes available to expand your family. Ultimately, every journey has the same destination in mind: the beautifully chaotic, utterly unique, yet completely universal journey of parenthood.

As you assemble a team you trust to guide your path forward, we’ll be here to support you if prescription medications become part of your plan. Our team of specialists has experience working with the LGBTQ+ community and receives training on how the nuances of the fertility experience may vary for each individual. We’d be happy to manage your medication needs so you can focus on your family during this life-changing time. Visit us at alto.com/fertility or reach out via phone, text, or the app to learn more. 

Last year, we built a feature to show patients all of their medication pricing options, including when paying cash might be cheaper. Here are two surprising trends we've discovered since.

Two Engineers Crunch the Numbers: When Is It Cheaper to Pay Cash for Your Medication?

Tom Cahill and Ashley Qian, Sr. Software Engineers

In 2019, we launched a streamlined flow in our patient app to handle a surprising scenario: when the out-of-pocket price for a medication is less than the insurance copay.

Since launching our price selection feature last year, we've saved thousands of patients money by bringing this disparity to their attention. On average, patients save 30% off their total copay when their out-of-pocket price for a medication is cheaper than the insurance copay. The average savings per prescription is $23.30. 

While several factors impact how drug pricing works, here are two trends we’ve seen in the data so far.

These Two Therapeutic Classes Are Most Likely to Be Cheaper Out of Pocket

A therapeutic class is a method of categorization that groups medications based on the conditions that they are intended to treat. Here's what we found when we aggregated prescriptions by therapeutic class:

Across the 394,367 prescriptions we examined, roughly 0.5% had lower out-of-pocket costs. Comparing different therapeutic classes, anti-parasitic drugs (example: permethrin) appear most likely to have a cheaper out-of-pocket price by a fairly wide margin at 2.94% of cases. Cardiac/cardiovascular drugs (example: rosuvastatin calcium aka Crestor) and blood medications (example: tranexamic acid) stand out as well with over 1% of cases.

Looking at the results in terms of median percentage savings, a few classes stand out as having a fairly high disparity between prices: anti-histamines, contraceptives, anti-neoplastics and anti-infectives. 

Brand Medications Are Less Likely to Be Cheaper Out of Pocket

You're up on Family Feud, and Steve Harvey asks you to name some differences between brand-name and generic medications. The first thing that probably comes to mind is cost: In general, one expects generic medications to be cheaper than their brand-name alternatives. We might expect brand name medications to incur higher copays and thus a larger opportunity for Alto to provide savings. However, we see a surprising trend in our data:

In fact, only .01% of brand name medications we've delivered since shipping this feature had lower out-of-pocket prices (compared to .6% for generics).

So what gives? The cash price we’re able to offer for a medication is mostly determined by the cost we paid a wholesaler or manufacturer to buy it. The copay set by insurance plans, however, is often impacted by behind-the-scenes negotiations between the drug manufacturer and the pharmacy benefit manager, or PBM. As a result, the cash price isn't always strongly correlated with the insurance copay:

Among a set of equivalent products, the one with the cheapest cash price might not be the one with the lowest insurance copay, and that difference can be significant enough to make it worthwhile to forego using insurance.

As engineers who are tasked from time to time with investigating issues with our billing system, we've experienced our fair share of bewilderment at the surprising outcomes we sometimes see. The complexity of pricing is why we've invested so heavily in making sure both our internal tools and patient-facing applications present users with the information they need to understand their options and make well-informed decisions.

We have countless opportunities to help our patients achieve better health outcomes, save money, and be more informed about their choices when it comes to their medication. There’s a lot of exciting work to do, and if this sounds interesting to you, please reach out to us on LinkedIn. We’d love to hear from you!

At Alto, we believe your medications should come to you—at the best price, on time, and with the ongoing support you need.

How Alto Delivers More, at No Additional Cost

At Alto, we believe your medications should come to you—at the best price, on time, and with the ongoing support you need. However, when we explain to people that we can save them money while providing free home delivery and easy access to expert care, we often encounter disbelief. In a world where we usually pay a premium for special care, how can Alto’s services really be free?

Traditional retail pharmacies often build hundreds of storefronts in a single metro area in an effort to lure customers through proximity. We, however, are taking a totally different approach. We’ve redesigned the pharmacy experience by building a single distribution center in each metro area. By reducing our overhead costs, we’re able to hire teams of patient care pharmacists who are always on-call to offer guidance and local couriers who will deliver your medications straight to your doorstep.  

What’s more, because we’re not using our resources to stock and equip a fleet of locations, we can invest in innovations that elevate your prescription experience. We built our own pharmacy software platform that enables our pharmacists and patient advocates to effortlessly perform price investigations and coordinate between doctors and insurance companies. We also developed the Alto app, which puts pharmacy care at your fingertips—from ordering refills to chatting with a pharmacist. 

In a traditional pharmacy setting, pharmacists are often required to fill prescriptions, work the register, answer phones, counsel patients, administer flu shots, and call doctors and insurance companies—all on a strictly timed schedule. We don’t believe that sets pharmacists up to provide the best care. At Alto, pharmacists work in two teams with close collaboration. Our production pharmacists can focus on the important task of medication preparation while our patient care pharmacists get to focus on you. Whether you’re concerned about a side effect or wondering if you should take your medication with a meal, you can talk through any issue with an expert who cares. 

By bringing our pharmacy to you, we’re able to offer you a better experience at no additional cost. From uninterrupted, one-on-one consultations with pharmacists to timely hand-delivery of your medications, we think “above and beyond” is simply what you should expect from your pharmacy. 

Need a Refresher? These Alto Benefits are Completely Free

Have you ever meticulously crafted an online dinner order only to cancel once you saw how all the delivery and service fees added up? We’re never going to put you through that type of frustration. When we say “free delivery,” we mean absolutely, completely, 100% free. There won’t be any additional fees sneaking up on you. Ever.

Send us your prescription and a member of our team will hand-deliver your medication directly to your home or office. Pick a date and delivery window that works for you—most medications are available the very same day—then track your courier as they make their way to your doorstep. 

Opportunities to save money are out there, but they can be confusing to identify. When we set out to revolutionize the pharmacy experience, we knew that we needed to help make these resources more accessible. So, we created our own database of discounts, coupons, and pricing options that we could match against every single prescription. By automating the process, we’re able to exhaust all the options and find you the lowest price—at no extra cost. 

If you currently have a prescription at another pharmacy, we’ll take care of the transfer for you. It’s the least we can do to welcome you into our care. For more on how the free transfer process works (spoiler: it’s incredibly easy), see How Do I Transfer a Prescription to Alto?

One of the most important aspects of pharmacy care is the ability to chat with a pharmacist whenever questions come up. Whether you’re starting a new medication for the first time or unsure if a certain supplement could interfere with your regimen, you can call or message an Alto pharmacist at any time—even evenings and weekends. You’ll never have to wait in line or feel like you’re being rushed along, and your messages will be private and secure. Our patient care pharmacists focus solely on consultations, which means you’ll always have their undivided attention. 

Whether you’re facing a full day of meetings, navigating a complex schedule of pickups and errands, or dealing with an unexpected challenge, it’s easy to let your daily dose fall through the cracks. So we created a few helpful features within the Alto app that can help you stick to your schedule. The Reminders feature lets you set up medication alerts so you’ll never miss your next dose, and you can turn on Auto Refills to get your future refills delivered automatically. We’ll even reach out to remind you when your next fill is on its way so you can make updates to the delivery if needed.

Streamlined Medications for You and Your Family

Imagine if everything you needed to know about your and your family’s prescriptions was all in one place? We thought that would be pretty great too. With the Alto app, you can set up a family account to see and manage medications for your whole family from a single account. View all your current and past prescriptions, along with detailed medication information, and even coordinate your medications into one delivery. 

We set out to make the traditional pharmacy experience better by bringing the medications you need—along with exceptional care—straight to your doorstep. Some might find it unbelievable that we offer our services for free; we simply believe that we’re providing pharmacy care as it should be. 

Experience a better pharmacy. Our team is available to answer your questions from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone/text at 1-800-874-5881, or download the app to securely chat with a pharmacist.

There is quite a bit that sets Alto apart from other pharmacies. Let’s take an in-depth look at how Alto was built to be a better pharmacy in all aspects of care. 

Traditional vs. Online Pharmacies: How Alto Built Something Better

Is there anything we can’t buy online these days? Over the past decade, e-commerce has surged, as promises of convenience and low prices have lured shoppers away from brick and mortar stores. Yet even with almost 8 out of 10 Americans shopping online, there’s a pervasive sense of nostalgia for “the way things were.” We love the convenience of clicking “buy” from the comfort of home, but we often lament the loss of human touch in our transactions.

It’s probably not surprising that prescription medications have followed the same trend. Most of us are eager to avoid the lines at traditional retail pharmacies. A quick search will turn up scores of online pharmacies, all boasting low prices and convenient mail-delivery. You might think Alto is one of this bunch, however, there is quite a bit that sets us apart. Let’s take an in-depth look at how Alto was built to be a better pharmacy in all aspects of care. 

A major factor driving people to their local pharmacies is the chance for a face-to-face interaction with a pharmacist they can trust. Traditional retail pharmacies generally have established reputations and physical locations that help make customers feel secure. However, retail pharmacists are often distracted by the laundry list of tasks they’re expected to complete each day. You may have to wait in line, potentially when you’re feeling unwell, only to receive just a minute or two of face time. 

Online pharmacies, on the other hand, can spring up overnight—and disappear just as fast. Unfortunately, there are many illegitimate internet-based pharmacies that may be selling counterfeit or unsafe drugs. In fact, the National Association of Boards of Pharmacy (NABP) labeled about 95% of the online pharmacies they reviewed as “not recommended.” The FDA provides this list of safety checks and warning signs when considering an online pharmacy. Even with legitimate online pharmacies, it may not be easy, or even possible, to talk with a real pharmacist when you have questions about your medication. 

At Alto, your care is our priority. Just ask our happy customers. Not only are we fully accredited by the NABP, but we also have fulfillment centers in every area we serve, staffed by our incredible local teams. These neighborhood pharmacies are where we process and fill your prescription orders, then hand-deliver them directly to your doorstep. We have expert pharmacists in all areas of specialty care who are available to talk through questions as they come up, for as long as you need. It’s easy to get in touch—send a quick message through text or our in-app messenger or give us a call. 

With the cost of prescription medications on a seemingly endless upward trend, more and more Americans are looking for ways to save money. Many people may not realize that the cost of their medication can vary from pharmacy to pharmacy, though they’re unlikely to spend hours driving between locations to find the best price. For that reason, traditional retail pharmacies have little incentive to seek ways to lower your costs. After waiting in line to pick up your medications, there’s little choice but to accept the price you’ve been given or leave empty handed. 

Online pharmacies make it easy to compare prices and often seem to offer better deals on the surface. You should be wary of pricing that seems “too good to be true,” however, and make sure you are visiting a reputable source. Counterfeit medications pose a significant risk to your health, so make purchases with discernment. 

At Alto, not only are we the real deal, but we’re committed to finding you the best price. We match every single prescription against our extensive database of savings options. Plus, our services and delivery are always completely free. For a closer look at how we find the lowest prices, read our article, “How Alto Saves You Money on Prescriptions.” We’ve saved our patients more than $36 million on their medications so far.

Some people stick to their local retail pharmacy because they need or prefer to pick up their medication the same day. Others continue making the trip simply because it’s the way they’ve always handled their prescriptions. Switching pharmacies might seem like a hassle, but what about having to drive to the pharmacy and wait in line every time you need your medication? 

Online pharmacies exist to eliminate the inconvenience of picking up your prescriptions. No more rushing to the pharmacy during business hours, standing in long lines, or driving back and forth for multiple prescriptions. However, online pharmacies send your medications through the mail, so you won’t receive them right away. And when questions about your prescription arise, you may find yourself stuck on hold or resorting to an internet deep dive. 

With Alto, your days of waiting in line are over but you won’t miss out on real, human care. We’ll take care of transferring your prescriptions for you, then one of our local couriers will hand-deliver your medications at a time and location that’s convenient for you—even that very same day. Our expert pharmacists are always on-call to answer any questions or provide guidance. You can even send them a text message if you’d prefer. Plus, with the Alto app, you can manage your and your family’s prescriptions, chat with a pharmacist, and coordinate refills, all in one place. 

Some retail pharmacies offer delivery options, however, they usually require a paid membership or the use of an outside delivery service. With prescription medication already a significant expense for many people, stacking on additional fees isn’t a very attractive prospect. 

Online pharmacies use mail delivery, so it can be difficult to determine exactly when your medications will arrive. If you’re running low or are on a timed regimen, the possibility of mail-based delays can present a significant challenge and become a potential health risk. 

When you fill a prescription with Alto, a member of our local team will hand-deliver it to you that very same day—for free. No more worrying about mail delays or wondering when your medication will arrive. Simply select a delivery window and a location and we’ll make sure your care package arrives safely, securely, and on time. You can even track your delivery as it makes its way to you. And did we mention that our delivery service is always completely free? 

As you can see, Alto is just like your neighborhood pharmacy. We just happen to believe that your medication should come to you. We’re committed to providing you with exceptional care—from free, same-day delivery to exhaustive price investigations to always-there support from our dedicated pharmacists and care team. When it comes to your prescriptions, you don’t have to sacrifice trust, price, convenience, or delivery. We’ll give you the very best experience in every area of care. 

Ready to switch to a better pharmacy? 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.

Fertility patients in New York City can now choose Alto’s same-day doorstep delivery and have their medications delivered by our Alto team.

Hello, New York

Alto’s launch in the New York market extends our industry-leading patient care model to the East Coast.

Starting Monday, November 2, fertility patients in New York City can now choose Alto’s same-day doorstep delivery and have their medications delivered by our Alto team.

Our daily delivery windows allow patients to more easily plan to be available to receive their medications. 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 and text with a pharmacist for support.

Courier delivery windows
Monday - Friday 

3 – 5 pm ET for Manhattan to 125th Street, 4 - 6 pm ET full service area

6 - 8 pm ET for Manhattan to 125th Street, 7 - 9 pm ET full service area

4 - 6 pm ET for Manhattan to 125th Street, 5 - 7 pm ET full service area

Next-day mail order service is also available for patients outside of the courier zone within New York state.

Walk-in hours
Monday - Friday: 9 am – 7 pm ET
Saturday - Sunday: 10 am - 6 pm ET 

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 or phone).

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

Alto knows fertility pharmacy. With more than 30,000 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 and many leading financing and loan providers. If we cannot bill your insurance, we’ll find you a pharmacy that can.

 Our customer service team is available to support NY patients and providers from 9 am - Midnight ET, Monday - Friday, and 10 am - 8 pm ET, Saturday - Sunday. 

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

At Alto, we value effective communication across all teams. In our latest blog post software engineer Eric Leite shares how he set out to make it easier to understand how our repositories change over time while minimizing disruption to engineers’ existing workflows.

How (and Why) We’re Standardizing our Commit Messages

Have you ever tried to debug a production issue by looking at your commit history, only to find a bunch of commits that don’t seem to be connected to any specific feature? Or maybe you've pulled the latest version of a dependency and noticed a bug that wasn’t there before?

It’s hard to pinpoint where a problem might have begun if your project (or its dependencies) don’t rely on standards to commit and release code. This was a problem I set out to tackle in my organization: How can we make it easier to understand how our repositories change over time while minimizing disruption to engineers’ existing workflows?

At Alto, we value effective communication. We keep our pharmacists and operations team in the loop about every new feature we release to production on a daily basis. We also announce changes to our codebase in a dedicated Slack channel to keep our engineers informed. But that raises the question: How do we ensure that someone doesn’t forget to make an announcement? And can we reduce the time we spend writing one up? Introducing a commit standard would enable us to use automated tooling that makes communication about code changes effortless.

Consider an open-source repository with hundreds of contributors. Project owners often adopt standards and industry best practices because it makes the project easier to maintain as the number of contributors increases. Eventually, our engineering team will grow to this point—and, just like in an open-source project, we can’t expect engineers to retain all of our conventions in their heads when they contribute. Standardizing commit messages eliminates one of the many variables around how we commit code. It can give engineers more confidence in their releases, build trust in our codebase, and increase productivity.

Many engineers have a distinct working style. If you propose a change to their everyday workflow, you will likely encounter some resistance. That’s why identifying and working with key stakeholders before you introduce a new process can help ensure its success. One way to do this is to chart stakeholders on two axes—influence in the organization and interest in the project:

I used this chart to decide how I would direct my communication with the team. Folks who fell into the “low influence” and “low interest” quadrants didn’t need to be involved in the whole process. Instead, I kept them informed by using project-specific slack channels and documentation in Notion to communicate status updates and summarize meetings. Topics that required a team decision were discussed verbally rather than using Slack to avoid potential miscommunications.

The more likely someone was to push back on the project or give me valuable feedback, the more involved they were. I included those who fell into the “high influence” and “high interest” quadrants in almost every meeting. These folks served as a kind of litmus test for my ideas. They typically had high standards and expectations and needed to be convinced that a change was worthwhile if they were going to get behind it. Keeping people like this involved in the discussion is a great way to ensure that your initiative will produce value for your organization.

In a perfect world, we’d have standardized commits in every repository. However, given that Alto is a fast-moving startup, foundational changes need to be rolled out incrementally to minimize churn, validate impact, and allow us space to learn and iterate. There’s often not enough time or resources to do everything, and going all-in on something may require more effort than it’s worth.

We began by identifying the knowledge gaps we currently have about commit standardization and how we could iteratively validate the required process changes. We initially considered beta testing with the production app that runs our day to day operations because it had the most contributors and the most to gain from standardization. However, we didn’t want to risk blocking the majority of our team or experimenting with a project that was critical to business operations. The next best option was our internal component library—it had fewer contributors, so fewer engineers would be blocked if something went wrong, and more projects depended on it, so the potential impact would still be significant.

Given that one of our company values is to Focus On Impact, and that internal changes like this are difficult to measure, we quantified our level of success or failure using a team survey. We sent out a series of questions at the start of the project asking the team to rate their satisfaction with our current commit, review, and release processes. We plan to compare these results with a follow-up survey to measure changes in ease of committing code, confidence in releasing, and our developer NPS.

After closing our knowledge gaps and getting a baseline understanding of how the team felt about our release processes, we decided to adjust the scope to include the following changes:

Commit Standardization (i.e., formatting and enforcement of commit titles)

Versioned Release Automation (i.e., automatic version cuts, changelogs, and notifications)

We looked toward existing open source solutions to make these changes because we were on a tight schedule. There were many options to choose from, so narrowing them down to a shortlist before presenting them to the team helped speed up the decision-making process. The best tools for the job will depend on your engineering organization, of course, but we prioritized maturity, flexibility, and compatibility with our existing workflows during our evaluation.

We landed on the Conventional Commits standard because it has been vetted and used extensively in other projects, and a whole ecosystem of release tooling has been built around it. It also has a short learning curve, is flexible enough to work with all our repositories, and only enforces the bare minimum necessary to generate semantic versions based on commit titles.

We chose Commitizen to help engineers get familiar with the new standard, Commitlint to warn about (but not block) contributions with invalid commits, and Semantic Pull Requests to serve as the final gate for validating commit titles. This way, non-standardized commits are only stopped from being merged when a pull request is made, and it can be easily corrected using the GitHub UI.

The open-source tooling for release automation was sparse and highly specialized, but we found Semantic Release to be the exception as it offered the most mature, flexible solution. It manages everything from cutting a release to generating a changelog to publishing packages and notifications. It also isn’t limited to only publishing NPM packages, making it an excellent fit for our multi-language codebase.

While we have a ways to go before versioned releases are automated in all of Alto’s repositories, we’ve made a significant first step with commit standardization. Some engineers have already proactively adopted the new standard without any tooling, and I’ve personally found that it has helped my commits stay focused and become more granular.

So far, we’ve standardized our component library. The commit history in this repository used to look like this:

Commits now have more context in them that’s visible at a glance (e.g., feature vs. fix), and breaking changes are explicitly noted in the commit message using an exclamation point (e.g., refactor!). These commit titles are used to automatically generate a changelog any time we cut a release. We can even automatically cut and version-bump a release for every new commit because we follow a commit standard.

The next phase of this project will be to review and act on the feedback from the follow-up survey. We will continue to build on top of these standards with release automation tooling and discuss what process changes make sense for the rest of our codebase. We are confident that through these changes, we will be able to de-risk code contributions, reduce the burden of cutting a release, and better prepare for our engineering team’s future growth.

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

How (and Why) We’re Standardizing Our Commit Messages

Every year, we look forward to October, when we get a whole month to honor the extraordinary work of the pharmacists and pharmacy technicians at Alto and around the world.

Blog

How to Debug Slow and Failing Cypress Seeds

The COVID-19 Vaccine & Racial Disparities in Healthcare: A Q&A with Dr. James Hildreth

A Guide to LGBTQ+ Family Building

Two Engineers Crunch the Numbers: When Is It Cheaper to Pay Cash for Your Medication?

How Alto Delivers More, at No Additional Cost

Traditional vs. Online Pharmacies: How Alto Built Something Better

Hello, New York!

How (and Why) We’re Standardizing Our Commit Messages

Celebrating National Pharmacist Month at Alto

How Do I Transfer a Prescription to Alto?

Concerned about Mail Delays Tying up Your Prescriptions? There’s a Better Way.

Announcing Alto’s Advisory Board

Switch to a better pharmacy.