Shop Alto Essentials to add pharmacy products to any delivery!

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

Alto Pharmacy Technician

Alto Pharmacist

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

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

Be Part of a Great Place to Work — Join Our Team

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

Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

Learn more about the United State Preventative Service Task Force’s Grade "A" recommendation and what it means for your access to PrEP.

What a USPSTF “A” Recommendation Means for PrEP Access

With a Grade A recommendation from the US Preventive Services Task Force (USPSTF), PrEP — an HIV prevention medication that can lower risk of sexual transmission by 99% when taken daily — is now more accessible than ever. Under the Affordable Care Act, most private insurance plans must cover preventive services with an “A” or “B” recommendation from the USPSTF without copays or deductibles. This means that at least one PrEP option will be available at no cost to qualifying individuals on these plans. 

PrEP’s 2019 Grade A recommendation from the USPSTF was implemented this year. Below, we explain more about the Task Force’s recommendation and what it means for your access to PrEP.

The Importance of Preventive Services and the USPSTF

Preventive care — including medications like PrEP, cancer screenings, immunizations, and more — saves lives. These services can prevent serious diseases or detect them early on, when they are more treatable. It’s critical that doctors understand the effectiveness of these screenings and treatments, and the US Preventive Services Task Force was created to fill that need.

The USPSTF is an independent group of prevention experts whose evidence-based evaluations help healthcare providers make informed recommendations for their patients. The Task Force’s membership has expertise in a range of specialties under the umbrella of primary care and preventive medicine, including internal medicine, behavioral health, obstetrics and gynecology, and more. They assign each recommendation an A, B, C, or D grade or an I statement. Here’s what each recommendation means:

“A” Recommendation: The USPSTF recommends the service. There is high certainty that the net benefit is substantial.

“B” Recommendation: The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

“C” Recommendation: Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.

“D” Recommendation: The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

“I” Statement: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Since preventive services are recommended based on a person’s level of risk for a specific disease or condition, there is variation in individual preventive needs. Your primary care provider will recommend screenings and medications depending upon factors like your family history, age, current health status, and more.

With PrEP, the “A” rating and related insurance coverage applies to individuals who are HIV-negative but at high risk of getting HIV from contracting the virus. That includes:

People whose partner is HIV-positive or unsure of their HIV status

The Affordable Care Act and USPSTF Recommendations

Millions of people in the US don’t receive critical, and often life-saving, preventive services. For many, cost is a big barrier. A 2020 study found that 1 in 3 US families postponed medical care services because of the financial strain. And according to the American Journal of Public Health, in the case of PrEP, fewer than 10% of people who could benefit from the medication are taking it.

The Affordable Care Act provision requiring private insurers to cover Grade “A” and “B” preventive services without copays or deductibles was designed to alleviate this financial burden. The Center for Consumer Information and Insurance Oversight (CCIIO) oversees the implementation of law provisions related to private health insurance, and private insurers have a responsibility to monitor USPSTF recommendations and remain compliant with requirements.

While the new provision is a big step forward for HIV prevention, getting the specific brand of PrEP medication you need may require some additional legwork.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. Truvada and Descovy are both effective at preventing HIV, but they are not identical. Some people may need one version over the other due to preexisting health issues. However, the ACA’s provision only requires health plans to cover at least one of the available PrEP options without copays or deductibles.

Government plans including Medicaid typically cover brand-name PrEP medication while most private insurance companies will cover generic PrEP. If your doctor has prescribed a specific brand of PrEP medication not covered by your insurance, a request for coverage may be required. 

This is called a prior authorization. Alto’s dedicated support team can help you understand the details of your insurance plan and will coordinate closely with your doctor’s office on filing prior authorizations to help you get the medication you need. Call us directly at 1-800-874-5881 to confirm coverage.

Too often, preventive services are inaccessible to those without insurance. Thankfully, patient assistance programs for PrEP help make the medication more affordable for those who are uninsured. For example, Truvada’s manufacturer, Gilead, has a Medical Assistance Program for people without insurance, in addition to a copay card for those with insurance.

Alto will automatically conduct a thorough price investigation to identify these potential sources of financial assistance and ensure you're getting the lowest possible price. We also carry a generic PrEP option that currently runs at $36.60 a month out of pocket.*

Read more about PrEP access and affordability.

Get the PrEP medication you need at the best possible price

Getting PrEP at the most affordable price shouldn’t be a hassle. At Alto, our team will do the research for you and coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option. Our pharmacists have deep expertise in many clinical areas, including patients living with HIV, and those taking PrEP, PEP and HRT medications.

Adherence support with pharmacist lab reminders

Discrete, private packaging and free, same-day delivery

Med syncing support and in-app reminders to stay on track

Pharmacists directly available through phone or within the Alto app  

We’re hard at work the moment we receive your prescription, handling insurance and prior authorizations, as well as making sure you get your medicine, at the best price, delivered at no additional cost. Reach out any time to get started via phone at 1-800-874-5881 or in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

In this post we’ll take you on a tour of our app including how to transfer and pay for a prescription, schedule upcoming deliveries, and message a pharmacist, all from your device. 

How to Make the Most of the Alto Pharmacy App

The Alto app puts pharmacy at your fingertips. With a nearly perfect customer rating, it’s one more way we make managing your medications easier and convenient. In this post we’ll take you on a tour of our app including how to transfer and pay for a prescription, schedule upcoming deliveries, and message a pharmacist, all from your device. 

Download the Alto Pharmacy app today to get started. 

Have prescriptions at other pharmacies? It’s now even easier to transfer your prescriptions to Alto -  just take a photo of your current medication’s label and we’ll do the rest! Select “Add medications” from the main page in the app and upload a photo that clearly shows: 

Our team will coordinate the transfer, search for any savings on your medications, and reach out when it’s time to schedule your free delivery.

At the doctor’s office? Tell them your pharmacy of choice is Alto and show the staff our handy pharmacy info card. It’s available in the top left corner (click the Info Card icon) and pick the Alto location closest to you.  

As soon as your prescription is ready, we’ll reach out within the hour to schedule your free delivery. It’s really that simple.

With our latest iOS app release, you can now check out with Apple Pay. This feature allows you to make contactless, secure purchases. To set up Apple Pay on your device, follow these instructions. 

You can also manage other payment options (including FSA/HSA, debit and credit cards, and automatic funds transfer) in the Payment Methods menu in your Account settings. And Android users - we didn’t forget you. 

Our free, same-day courier delivery model means you’ll never need to go to the pharmacy again. Pick the day and delivery window that works best and let us know if we should deliver to your home or office. You can designate a safe place for packages to be left if you won’t be home. We also offer contact-free signature capture for those expensive medications. 

Your medications will be hand-delivered by a member of our local courier team. Not sure if we deliver to your neighborhood? View our full list of locations here.

Busy schedules mean it can be hard to remember when to take your medications. With custom medication reminders, it’s easier to stay on top of your prescriptions. Head to “Reminders,” select the prescription you’d like to set a reminder for and input the specifics of your medication’s schedule: day(s) of the week, time(s) of day, amounts.

You’ll receive a push notification at the scheduled time and once you've taken your medication, you can check off the dose in the app to track your progress. To turn on push notifications select “Settings” on your phone, tap “Notifications,” and select “Allow notifications” for the Alto app.

Future You will thank you when you turn on Auto Refills for recurring medications to automatically receive refill deliveries right on schedule. Plans change? We’ll confirm the delivery ahead of time in case there’s anything you need to update. 

From your Meds list: open an active prescription to view medication details, your last copay and next available delivery date. Turn on Auto Refills to receive your next delivery a few days before your current supply runs out.

From your cart: turn on Auto Refills during checkout so your next delivery is automatically scheduled.

From your Account settings: view and edit details for all active eligible medications, enroll eligible medications,* and schedule deliveries in the Auto Refill menu.

Questions about coverage, copays or medication side effects? First time taking an injectable medication? Our pharmacists are available to provide advice via in-app secure messaging. 

We take your privacy seriously - our in-app messaging is built with industry-standard encryption and data security practices. Our pharmacists and care team are just an in-app message chat, or an email away: 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends.

We’re here to support you with exceptional pharmacy care every step of the way. Our team will look for any available savings to help you get the lowest price, and we’ll deliver your medications to your home for free. 

You can also switch to Alto in minutes by going online at alto.com or by calling us at 1(800) 874-5881. For more information on how to transfer a prescription to Alto visit here.

*Automatic refills are only available for prescription medications that have refills remaining on the prescription and are not available for controlled substances. Some insurance plans may also limit automatic refills.

Editor’s Note: This post was originally published in April 2021 and has been updated for accuracy and completeness.

How to Make the Most of the Alto Pharmacy App 

In recognition of Women’s History Month, we highlight four women at Alto shaping the future of pharmacy. These leaders share their advice for women in the workplace, their unique super powers, and what they appreciate most about Alto's culture.

Celebrating Women at Alto Pharmacy

Liz Kelly, Sr. Director Sales, Fertility 

I'm responsible for hiring, coaching and supporting the needs of the national fertility sales team. I also work closely with fertility business and operations teams to deliver on our clinic and customer promises.

Before joining Alto, I was finishing up a sabbatical where I spent my time volunteering on the board of a non-profit called ServeHAITI. Prior to that, I was the West Coast Area Business Director at EMD Serono and worked with Matt and Jaime [Alto’s co-founders] to secure a contract to distribute fertility meds when they were still working out of AG Pharmacy!

What do you appreciate the most about Alto's culture? 

Hands down my favorite part of being on the Alto team is that the patient is truly at the center of every decision we make. I value that we make business decisions with our mission in mind.

What do you like doing outside of work?  

Of late, my favorite pastime is heading to the dog beach with my rescue, Bodhi, who has been the best medicine to ease some of the COVID-19 isolation I experienced over the past year. Before the pandemic, I made sure to travel to at least one new international spot a year. I love the experience of getting exposed to all things about another culture: cuisine, culture, belief systems, language.

I like to think that my super power is seeing the greatness in others, sometimes before they see it in themselves.

I aspire to live by the motto "be the change you wish to see in the world." I encourage women to speak up for what they believe is right, even if nobody else agrees. That includes planning for your own career path and making it a priority to develop your skill sets so that you are prepared to climb the ladder that serves your own greatness.

I graduated from pharmacy school in May of 1979 and started working at AG Pharmacy after passing my boards later that year. I bought AG in 1998 when the previous owner wanted to retire - he had been with AG since it first opened in the early 60's.

My family moved to San Francisco from Hong Kong when I was five years old. Our story is one similar to those of many immigrant families who came to America looking for a better life in search of the American dream: own a home, have a car, raise children safely and give them the opportunity of a good education and a chance to have a better life. My parents raised their children here, emphasizing family, hard work and education. They lived their American dream, and I have them to thank for all that I am today.

What’s your favorite thing to do outside of work? 

I love to travel. There are so many unique places to visit in this world. With the different cultures, the food, and the amazing sceneries/landscapes, there are endless things to see and experience! 

The thing I appreciate most about Alto's culture is that everyone works so hard together to bring about the best pharmacy experience for all our customers. You can feel the energy and the motivation of all the Altoids. I cannot emphasize how amazing it is to be a part of this team and to watch Alto grow and evolve into the pharmacy of the future and the pharmacy of our dreams!

What’s your favorite memory thus far at Alto? 

In the very early days, when Alto was still Scriptdash Pharmacy, a customer needed to get her trigger shot [as part of a fertility protocol] within the next few hours. It was close to rush hour, and we had no couriers available to deliver to the South Bay. Our CEO Matt came to the rescue on his motorcycle, and off he went to make the delivery. It was such a wonderful and warm feeling to watch and cheer him on together. That is truly what Alto love is all about!

I manage our amazing IT Support team, helping all Altoids get the technology support they need, when they need it. 

For the better part of the last decade I have been managing IT Support teams. From Facebook and Twitter to Lyft and Uber, I’ve seen it all (or at least most of it!).

Our incredible dedication to our mission. In my short time here, I truly see us putting patients first, and it’s moving to see. 

What do you like doing outside of work? 

I’m a big traveler, but since COVID-19 has put a damper on that, I enjoy flying around Colorado with my partner in our vintage Beechcraft Bonanza. I also love hopping on my motorcycle and just exploring! 

I’m in love with Central and Eastern Europe. Some of my favorite places are Prague, Vienna and Budapest. 

I’m originally from Iran but moved a lot growing up, including Oklahoma, Australia, Qatar, Kuwait, and Chicago. I have been in San Francisco for the last six years. I stumbled across software engineering in college and found a passion for building products and teams. I joined Alto as the third engineer and this is now the largest company I’ve ever worked at. 

I lead a group of 20 engineers across three teams. Two teams are focused on getting prescriptions ready to schedule quickly and accurately, and one is focused on enabling faster, higher quality, and more enjoyable product development across the broader product and technology organization. My work involves a lot of collaboration, creativity, transparency, and flexibility. 

I was an early software engineer at a small startup; before that I was a hybrid software engineer and product manager at a design and development studio. 

I like how passionate everyone is about what they do. 

I’m at my best managing a crisis or finding a path through conflicting strong opinions. 

I want to start with some advice for our allies: get more curious about the experience of the women you work with and learn about ways you can support and amplify the work of the women around you. Diversity, equality and inclusion is a team sport and, even if we win a game or two, it’s about the continuous pursuit of excellence. 

For my fellow women at Alto, I wish I knew earlier to focus more on improving my craft and impact so I can get a seat at the table, rather than trying to juggle advocacy and my own work. Once you’re at the table, you can really advocate for hiring, growing, and retaining women. 

To learn more about the work of our six employee resource groups (ERG’s) focused on building community - including Umoja (Black), Auténtico (LatinX/Hispanic), Women (WOAA), Proud (LGBTQIA+), Asian/Pacific Islander, and Working Parents - read our 2020 Diversity, Equality and Inclusion Report. 

Are you passionate about shaping the future of pharmacy? Join us as we deliver our industry-leading pharmacy care to millions of Americans. 

If you have received a prescription delivery from Alto, chances are high that you’ve noticed a caramel sitting alongside your medications. Read on to learn more about Béquet Confection’s start and how this female-founded business remains successful twenty years later.

Béquet Confections: The Story Behind Alto Pharmacy’s Caramel

If you have received a prescription delivery from Alto, chances are high that you’ve noticed a caramel sitting alongside your medications. Alto’s co-founders knew early on that they wanted to include an unexpected moment of delight in each delivery: “We wanted to put a smile on our customers' faces, knowing that taking medicine may not always be the most pleasant experience,” shared Matt Gamache-Asselin, Alto’s CEO and co-founder. “After tasting Béquet’s caramel, we knew we found a winner.”

Read on to learn more about Béquet Confection’s start and how this female-founded business remains successful twenty years later. 

Béquet Confections was founded in 2001 by Robin Béquet and is now one of the largest gourmet caramel manufacturers in the U.S. Robin transformed her hobby into a full-fledged entrepreneurial endeavor at the encouragement of friends and family who couldn’t get enough of her gourmet caramel.

Twenty years later, Béquet Confections continues to delight customers across the nation with varieties such as Celtic Sea Salt®, Salt-Chocolate, and Butterscotch. They’ve received numerous accolades including the sofi™ award, presented by the Specialty Food Association, which is considered one of the most prestigious awards in the gourmet food industry. 

So what sets Béquet Gourmet Caramel apart from the competition? It’s about having a passion for doing something better than anyone else, and that starts with using high quality ingredients. 

The entire process takes place at a facility in Bozeman, Montana, the town where Robin originally started the business. Each batch of Bequet’s Celtic Sea Salt® caramel is hand-crafted under the watchful eye of a master caramel chef, and includes non-GMO sugar, antibiotic-free milk and, of course, authentic Celtic Sea Salt®. This particular grey salt is harvested from the north of France and undergoes a thorough sifting process. 

The raw ingredients are poured into small stainless steel kettles and slow-simmered to a very specific temperature. This a key component of the process as temperature dictates both the flavor and color profile of the finished sweets. Once the caramel is cooked to perfection, it is poured onto a cooling table and cut into strips. The staff then completes a quality control check to ensure the salt is evenly distributed  for the perfect balance of sweet and salty. 

Robin credits the community of Bozeman for supporting her dream and helping the business grow. Without the local assistance of retailers who took a chance on stocking the product, neighbors who championed for her, and even landlords who offered reduced rent, Béquet Confections wouldn’t be where it is today. 

Two years ago, Life is Sweet purchased Béquet Confections. “We’re proud to be a part of the Life is Sweet family of brands and look forward to continuing Robin’s legacy of producing the most exquisite gourmet caramel,” shared Lyndsey Althans, Director of Finance & Administration at Béquet Confections.

To learn more about Béquet Confections and find a local retailer near you, visit their site. Use the code ALTO20* to save 20% off your next online purchase. 

*Limit one use per customer, shipping fees are excluded. Not valid in stores or on previous orders; may not be combined with other offers. Béquet Confections reserves the right to terminate special offers without notice at any time.

Alto Pharmacy is recognized by Forbes as one of America’s Best Startup Employers in 2021, ranking 13th among 60 healthcare startups.

Alto Pharmacy Announced as One of Forbes Best Startup Employers

After discovering that half of all prescriptions aren’t even picked up—resulting in 125,000 avoidable deaths every year—we set out to build a new kind of pharmacy that focuses on the person behind every prescription.

Here at Alto, we’re transforming a $500 billion industry by reinventing what a pharmacy can do—from hand-delivering medications for free to offering on-call help by text or chat. Our customers are at the center of everything we do, and it shows. After delivering more than one million prescriptions, we have an NPS score of 86 and over a thousand five-star reviews on Yelp.

In addition to delivering a better pharmacy experience for everyone who needs medicine, we’re committed to cultivating a better workplace for for our team, every day. That’s why we’re honored to be recognized by Forbes as one of America’s Best Startup Employers in 2021, ranking 13th among 60 healthcare startups. Inclusion on the list was based on professional reputation, employee satisfaction, and growth, among other criteria. 

This accolade follows several others in recent months including LinkedIn’s Top Startups in 2020 and San Francisco Business Times Largest Bay Area Digital Health Companies in 2020. In addition, Alto’s CEO, Matt Gamache-Asselin, recently received recognition as one of The Top 25 Consumer Health Tech Executives of 2020 by The Healthcare Technology Report. 

“We have a lot to be proud of in the past year, especially in light of the challenges presented by the COVID-19 pandemic,” shared Gamache-Asselin. “I’m so proud of the hard work and commitment exhibited by every member of our team in providing exceptional pharmacy care in our communities. As we continue to expand our services to more and more people, we’ll also be growing our team of incredibly knowledgeable and caring professionals.”

Are you passionate about shaping the future of pharmacy? Join us as we  deliver our industry-leading pharmacy care to millions of Americans. 

For the full employers list and an overview of the selection methodology, head to the Forbes site. .

Alto Pharmacy Announced as One of Forbes Best Startup Employers 

Forbes 2021 America's best startup employers

Starting Friday, March 12, residents of the greater Dallas-Fort Worth metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs.

Hello, Dallas-Fort Worth!

Alto’s launch in the Dallas-Fort Worth market extends our industry-leading patient care model to even more Texans. 

Starting Friday, March 12, residents of the Dallas-Fort Worth metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

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

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

Courier delivery windows
Monday - Friday: 

12:30 pm - 3:30 pm CT (1:00 pm - 4:00 pm CT for outlying areas) 

6:00 pm - 9:00 pm CT(7:00 pm - 10:00 pm CT for outlying areas)

2:00 pm - 5:00 pm CT (3:00 pm - 6:00 pm CT for outlying areas)

Walk-in hours
Monday - Friday: 9:00 am – 7:00 pm CT
Saturday - Sunday: 8:00 am - 4:30 pm CT

Dallas-Fort Worth residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax). 

Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch. 

Need to pick up? Our pharmacy is located at 475 State Highway 121, Suite 150, in Lewisville.

General customer support hours are Monday - Friday 9 am - 11 pm CT and Saturday - Sunday 10 am - 7 pm CT. Patients can reach out to Alto via phone/text at 1 (800) 874-5881, email or app.

Founded in 2015, Alto is a patient-centric digital pharmacy based committed to the health and wellbeing of you and your family. We provide free same-day delivery to your door seven days a week for prescriptions, but, more importantly, offer cost transparency, personalized in-app and phone support, and real-time coordination with doctors and insurance companies to get you the care that you need. Alto is headquartered in San Francisco with offices in Denver and Dallas, and currently delivers across the greater Bay Area, Los Angeles, Orange County, San Diego, Seattle, Denver, Las Vegas, New York City, Houston, Dallas and Austin.

Editor’s Note: This post was originally published in March 2020 and has been updated for accuracy and completeness.

At Alto, we’re obsessed with our mission to improve quality of life for everyone who needs the help of medicine. Our mission guides us in all we do and every decision we make. 

Our mission and diversity work are tied together with one word from our mission -- everyone. Too often, only those with significant resources access the best and benefit from innovation in healthcare. We see it everyday in the data. Too many among us continue to struggle with solvable challenges, in our own wellbeing and in the larger healthcare system. These statements and environments have existed in the workplace as well, influencing the products, services, and policies that steer how the organization works for all of us.  Our work is to make Alto different.  Our work is to build and sustain an inclusive culture.  Our work is to attract, develop, reward and retain talent from all the communities we serve as patients and build a product that supports everyone. 

Today marks another step in our diversity, equity, and inclusion journey as we release our first annual diversity report. We share it because this work is central to our mission and in doing so, we use transparency to hold ourselves accountable, as well as hopefully play a part in raising expectations and norms throughout the healthcare and technology industries.

In 2020, across the company we saw a 13ppt increase in women and 7ppt increase in underrepresented groups (Black, Hispanic/LatinX and Native professionals).

As for women in leadership, we saw increases of 3ppts in Women Managers and 1ppt in Product, Engineering and Design driven by both hiring and promotion. At the leadership level, 32% of leaders identify as women.

In 2020, we saw 10ppt increase across our underrepresented managers to 13% Black, 16% Hispanic/LatinX, 2% Native/Indigenious.  In the leadership group, we saw an 8ppt increase to 15% Black and 2% Hispanic/LatinX. 

In 2020, we also established our Alto Advisory Board and our first two anchor members, who will help guide Alto towards our mission, advise on key decisions, and support strategic initiatives. We’ve formed the Advisory Board to support our leadership as we navigate the regulatory landscape, launch new features to modernize the pharmacy experience, and adhere to the highest standards of operational excellence and patient care.  

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

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

Alto created our DEI strategy with our team aligned to four pillars – Hire, Include, Develop, and Invest.  Each pillar's actions tie to our people and our business. This means the return on investment is clear and goals are aligned to business outcomes.

Medical Health Care Premiums and Part Time Health Care Benefits in SF: 

In order to increase access and affordability to critical health-care services, we asked our broker to offer a special mid-year open enrollment 2020, reducing premiums for most plans by 5%. We reduced out-of-pocket maximums and speciality office visits by an average of 37%. We reduced co-insurance as well as costs for labs, x-Rays, and emergency room visits for our Cigna plan by 50%. Finally, prescriptions copays were reduced by 25% for Brand medications and 75% for Generic prescriptions. This benefits the employee with direct access to care and a better employee experience as compared to direct contribution to the city fund.

We increased our paid parental leave across all US locations to 8 weeks (up from 6 in 2020) for all parents requesting leave as of January 1st.  Throughout 2020 parents and other caregivers were impacted significantly as schools, daycare, and caregivers were closed, isolated, or unable to rely on pre-covid support. We offered laptops to parents who couldn’t afford them for each child to participate in remote learning.  We offered expanded benefits above and beyond FFCRA. Finally, we offered paid sessions for remote learning, tutoring, and experiences for parents and caregivers.

Finally, in December we launched Modern Health with 6 paid coach/therapy sessions and access to a digital wellbeing library and resources to all Altoids.

We launched six ERGs in 2020. Formalizing the work of our original Diversity Committee into six groups: Umoja (Black), Auténtico (LatinX/Hispanic), Women, Proud (LGBTQIA+), Asian/Pacific Islander, and Working Parents. These groups are focused on building community with both those who identify and allies. They support our education, development and investment in our communities. Each has been given a budget, an executive sponsor, and access to other company resources.

We recognized as a leadership team that we needed to educate ourselves. We were not going to rely on those from underrepresented communities to educate us. We embarked on four three-hour sessions focused on learning about diversity and inclusive language, naming our privilege, and starting the work each of us wanted to do. It was only after these sessions, with clear self-awareness and awakening; that began the work of empowering other leaders -- managers and other Altoids on this journey. There is more work to be done, as Neil Frye, Chief People Officer, mentioned in his blog post in late 2020 -- this is not a sprint, nor is it a marathon; it is life-long work.

Focus on Latinx Senior Manager to VP talent; with targeted outreach, activation and networking for opportunistic and open hiring

Expand employee resource group events throughout the year supporting inclusive environment, educating and investing in our communities

Get to full participation in DEI Workshops and launch additional sessions like What’s My Privilege and Moving to Action across the company

Explore new partnerships with Community & Higher Ed Institutions (i.e. Historically Black Colleges and Universities, Hispanic Serving Institutions, etc.)

2020 Diversity, Equity & Inclusion Report

Justin Moy, Senior Software Engineer at Alto, explains how the engineering team developed a staging environment strategy that could keep up with our growing organization.

Creating Sandboxes: How to Make It Easy for Your Engineering and Product Teams

When we formed our Infrastructure team in 2020, our charter centered on scale, reliability, and the developer experience. Our first priority? Developing a staging environment strategy that could keep up with our growing organization.

Initially, we had a set of command-line tools for staging environments that could be run from an engineer’s workstation. However, this approach required significant manual effort to create and manage an environment which led to inconsistencies like outdated data and lack of full application coverage and integration. The required workstation dependencies and maintenance added to the overhead. These tools were also different from the ones used to create a production environment, causing drift between the two.

To address these issues, we focused on improving our tooling to create consistent and reproducible results for both our staging and production environments. Here are the five steps we took to get there:

Luckily, we were already here. Our deployment process involved creating and deploying Docker containers and using a Procfile to run specific parts of our applications (think separating out web and workers). Packaging our applications as immutable Docker images allowed us to ship consistent and portable code. These images are run as containers which can be executed on separate hosts and scaled independently of each other.

We wanted to increase our observability, mature our internal monitoring, and maintain our infrastructure in a more consistent and reproducible manner. Kubernetes, and its automated container orchestration (deployment, scaling, and management), allowed us to accomplish all of the above goals.

It was easy for us to get started in Kubernetes thanks to Kind, which allowed us to run clusters locally. This increased development speed and reduced the friction of learning a new external provider.

Helm makes it easy to manage packaged applications in Kubernetes. Some community-provided applications include: NGINX for load balancing and reverse proxying HTTP and other traffic; Prometheus and Cortex for metrics, monitoring, alerting, and dashboarding, Loki for logs; and Sentry for exceptions.

In order to ease the integration with other infrastructure components, enable rapid deployment, and, most importantly, provide us with the consistency and reproducibility we wanted, we created and deployed Helm charts for our applications.

From here, we could stamp out our applications for developer use in sandbox environments: complete end-to-end environments, separate from production, that enable engineers to rapidly develop and test their code. And if an engineer is working on multiple features, they can spin up multiple sandbox environments and manage their applications and data independently of each other. Victory!

We had already created pipelines in Concourse to automatically deploy and upgrade our infrastructure Helm charts. To eliminate the manual toil of spinning up new environments and to reduce the friction around sandbox adoption for our engineers, we extended these automated pipelines by building a Git-driven continuous deployment pipeline. When an engineer created a commit to a repo defining the state of a sandbox, our Concourse job would apply these changes.

At this point, we could deploy environments that resembled production but were separate from production and other sandbox environments. They connected to the rest of our observability stack, including metrics, logs, traces, and exceptions.

As we prepared to scale to the rest of the product and engineering organization, we focused on the following ideas: further reducing manual toil, removing barriers to entry, reducing cost, and optimizing the development workflow. The diagram below shows our sandbox architecture.

In Kubernetes, an operator acts on custom resources in order to automate a task or set of tasks. The custom resource allows us to create a well-defined entity and extend configurability options to users. The operator allows us to customize individual sandbox environments based on changes to the custom resource.

We utilized Kubebuilder to create our operator and CRD (custom resource definition). Kubebuilder was a great starting point and provides tools to ease rapid development of a new operator.

Using this pattern, we could easily perform CRUD operations (create, read, update, delete) on a custom resource using standard tools like kubectl, and the operator would handle updating our deployments in Kubernetes. These updates could include: updates to application configuration, deploying a new Docker container, injecting different secrets, etc. This flexibility allows for testing of many different scenarios like: developing a new feature, reproducing a bug, upgrading frameworks, and security and load testing.

Increase adoption by removing barriers to entry (admin web UI)

We built a web UI so users would be able to deploy sandboxes intuitively and easily without extensive knowledge of the underlying tools. The web UI interacts with our custom resource and lets the operator handle updates. It allows our teammates—both engineers and non-engineers—to easily spin up their own environments for development, demo, or training purposes without modifying production data.

In addition, we show helpful information about a sandbox to a user. This includes links to each of our applications; pre-filtered logs, metrics, tracing, and exceptions; and commands to connect to specific applications to ease debugging.

Because the sandbox environments are integrated with our monitoring stack, we have the full metrics and logging that we expect from our applications. We created an autoscaler service that performs queries against this information and scales our sandbox environments up and down. We’re able to decrease our costs by over 90% when these environments are not in use and are able to quickly scale them back up when they are being used.

Optimize the development workflow (image updater)

An additional feature we built into our sandbox environment is the ability to follow a feature branch in our applications. When an engineer pushes a commit to a pull request in Github, a corresponding sandbox will automatically update to this commit. This reduces several manual steps in the development workflow and allows engineers to test their code in near-to real time.

Sandbox environments have made an impact on the engineering organization and beyond.

Engineers can quickly desk check new code in a production-like environment during code reviews.

Shared sandboxes reduce the blast radius of bug bashes.

Non-engineers can spin up sandboxes to demo or provide training on features without impacting production data via the Admin UI. This has proven particularly useful for Product Managers and Designers on the team to be able to play with product features and better understand how they work in order to suggest improvements.

Teams have built use case scenarios into their applications. This allows easy reproducibility of critical paths and functionality.

With these five steps—Containerize, Kubernetes-ize, Helm-ify, Automate, Optimize—we’ve laid the foundation for deploying all of our environments in an automated and consistent manner. In addition to applying many of our learnings to improve our production environment, we successfully built core infrastructure that our engineers, product managers, and designers use each month to test their changes and reduce production downtime.

Interested in learning more about engineering at Alto? Follow us on LinkedIn. 

Starting Monday, February 1, residents of the greater Houston metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs.

Hello, Houston!

Alto’s launch in the Houston market extends our industry-leading patient care model to Texas.

Starting Monday, February 1, residents of the greater Houston metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

12:30 - 3:30 pm CT (1:00 - 4:00 pm CT for outlying areas) 

6:00 - 9:00 pm CT (7:00 - 10:00 pm CT for outlying areas) 

2:00 - 5:00 pm CT (3:00 - 6:00 pm CT for outlying areas)

Blog

What a USPSTF “A” Recommendation Means for PrEP Access

How to Make the Most of the Alto Pharmacy App

Celebrating Women at Alto Pharmacy

Béquet Confections: The Story Behind Alto Pharmacy’s Caramel

Alto Pharmacy Announced as One of Forbes Best Startup Employers

Hello, Dallas!

2020 Diversity, Equity & Inclusion Report

Creating Sandboxes: How to Make It Easy for Your Engineering and Product Teams

Hello, Houston!

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

Switch to a better pharmacy.