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Blog | Alto Pharmacy

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

Alto Pharmacy Launches Local Daily Delivery in Seattle Metro Area

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

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

Courier delivery windows
Monday — Friday: 

12:30 pm - 3:30 PM (1:30 -4:30 pm PT for outlying area) 

6:00 pm – 9:00 pm PT (6:30 pm to 9:30 pm PT for outlying areas)

2:00 pm – 5:00 pm PT (2:30 pm - 5:30 pm for outlying areas)

Walk-in hours
Monday — Friday: 9 – 7 pm PT
Saturday: 8 am – 4:30 pm PT 

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

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

Alto knows fertility pharmacy. With more than 50,000 patients served, we understand the treatment complexities and concerns of fertility patients. Our dedicated patient care team is available in the evenings and on weekends to walk you through your first injection or answer questions about medication storage, dosing or interactions. Our fertility deliveries include all necessary ancillary supplies, such as syringes, sharps container and alcohol swabs, and are carefully packaged for temperature control. Delivery is always free.

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

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

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

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

The View from Both Sides of the Fertility Pharmacy Experience

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

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

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

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

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

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

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

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

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

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

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

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

Alto is the West Coast’s leading fertility pharmacy with more than 50,000 patients served. We’re open evenings and weekends, offer free delivery seven days a week, and will always work to help you find the best price. Interested in using Alto’s services for your fertility medications? Ask your care team to send your prescriptions to Alto or give us a call at 1 (800) 874–5881.

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

The Founding Story of Alto

Mattieu Gamache-Asselin, CEO & Co-founder

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

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

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

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

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

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

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

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

Our mission is to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it. That takes a dedicated team of mission-driven, value-minded people. Read on to figure out if Alto is the right career move for you.

Help Us Shape the Future of Healthcare

Working at Alto isn’t just a job. For every team member, from product designers to pharmacists to patient care gurus, Alto is a means to a fulfilling career focused on making a difference in the lives of people who rely on prescription medicine to lead healthy, happy lives. In the process, we’re also changing an industry that has long gone unchecked.

At the highest level, Alto is a pharmacy. But we are not a traditional pharmacy. Instead of operating dozens of small-volume distribution sites across a metro area like chain pharmacies, we own and operate high-volume pharmacy fulfillment centers staffed by small, highly efficient teams supported by proprietary technology. We have one fulfillment center per metro area that we serve, including San Francisco, Los Angeles, and Orange County, and a centralized operations facility in Denver. Out of our fulfillment centers, we process and fill prescription orders and deliver directly to patients’ homes or offices by way of our free, same-day courier service.

On top of the convenience and accessibility of same-day delivery, Alto has three product pillars that allow us to deliver an exceptional experience to our users: the Alto Patient app, Alto MD, and Wunderbar. Learn more about our products and our industry-disrupting business model.

Alto is the world’s most patient-centric pharmacy. Our goal is not simply to distribute prescription medications but to improve patients’ health outcomes and their quality of life and to make those improvements accessible to everybody.

To get to that point, we need to understand what’s preventing patients from accessing all the benefits medicine has to offer. We believe it’s especially important to address the high-level problem of non-adherence, which is when patients don’t take the medication they’re prescribed. It also means learning how to scale our technology and processes to bring our products to more people in current and new markets. To achieve both of these things, we need to first scale our team. Learn more about Alto’s potential for growth and plans for the future, and how our team contributes to our success.

Loving what you do starts with doing something you believe in. It’s enriched by working alongside people who share your goals in an environment conducive to your work style and aspirations. At the foundation of Alto’s culture is our mission; our core values like acting empathically, thinking rigorously, making impact, staying humble, and putting patients first; the diverse backgrounds of our team members; and the supportive but highly autonomous way we get work done. Learn more about the Alto’s values and culture through the eyes of our CTO and co-founder, Jamie Karraker.

If Alto sounds like an environment you would thrive in, we would love to hear from you! We’re always on the lookout for great people to fill in our product, design, engineering, analytics, people, recruiting, finance, sales, business operations, logistics, pharmacy, and patient care teams. Check out our open positions to see if there is an opportunity that’s right for you!

Are You Right for Alto?

Why Mission-Driven Software Engineers Hold the Key to Alto’s Continued Success

Alto is the world’s most people-centric pharmacy. Our goal is not simply to distribute medications but to improve health outcomes and quality of life. What’s more, we want to make those improvements accessible to everybody.

To get to that point, we need to understand what is preventing people from accessing all the benefits medicine has to offer. We believe it’s especially important to address non-adherence, which is when people don’t take medications as prescribed. Non-adherence is a national problem that causes 125,000 avoidable deaths per year (more than three times the number of car accident deaths) and $300 billion in avoidable medical costs (more than half the money spent on pharmacy as a whole).

It also means learning how to scale our technology and processes to bring our products to a bigger swath of the population. To achieve both of these things, we need to first scale our engineering team.

Because of our unique business model, Alto is positioned to pursue three exciting growth vectors:

New Therapeutic Specialties: In addition to our general pharmacy capabilities, we have developed specialized expertise and infrastructure for managing complex treatments like fertility, dermatology, HIV, psychiatry, and other therapies that come with sticky coordination issues and unique considerations. We have made it easier than ever for people to navigate these treatment areas, but there is more we can do. Our team has identified 26 additional treatment areas that could benefit from specialized technology and processes. Mastering those areas is high on our to-do list.

New Geographic Markets: By expanding into the top 50 U.S. cities, we could potentially serve 55% of the country’s population. If we expand to the top 100 cities, our coverage would increase to 70%.

New Clinical Partnerships: Alto facilitates coordination between our team, healthcare providers, insurance companies, and the people taking the medications. In the process, we improve workflows and health outcomes. That offers a powerful benefit to clinics, medical groups, and hospital systems. Because of that reputation, we currently have a waiting list of healthcare providers who want to partner with us. That’s more demand than we can keep up with, which isn’t such a terrible problem.

When Opportunity and Demand Exceed Capacity

Alto is in a fortunate position. It is rare among companies to have multiple compounding growth vectors and a reserve of would-be partners angling for our product. We are not demand constrained, we are operationally constrained, and even then, we continue to double our business every six to nine months — just not as quickly as our potential promises.

Scaling up as a means of reaching our potential is an exciting challenge we’re already tackling. In late 2018, we closed our Series C, giving us the fuel we need to build out our engineering team and develop the technology and processes that will make our continued growth possible. That work will entail fleshing out each of our existing product areas, scaling them, and identifying and solving even more deep-rooted industry issues through better technology and better processes.

Currently, Alto boasts a small but talented and agile engineering team staffed by individuals who honed their experience at some of the biggest names in tech like Facebook, Google, Uber, 23andMe, MIT, Stanford, and Berkeley. All of our engineers are relatively senior, so everyone has autonomy and ownership over their projects. It’s a collaborative, supportive, mission-driven environment, which is how we’ve been able to build so much in a relatively short period of time.

Up until now, we have been deliberate about keeping the team small, but we’ve reached an inflection point. In the next 18 months, we’re looking to increase the engineering team four-fold. With our new team in place, we will be in a great position to focus on our objectives: building and perfecting our operational efficiencies and product scalability.

We’re approaching the challenge of scalability from a few angles:

One is automation. We want to take the algorithms that are in our employees’ heads and put them into code, so they can focus more on caring for patients rather than logistics. We’ve done a bunch of automation work already, but there’s a lot left to do.

We’re also intent on designing tools to help our own team be more efficient with their time, which will mean better UX, better UI, more batching, and less context switching.

The third angle is self-service, and it’s the one we’re focused most intently on. Right now, there is significant human interaction between our team and consumers because we want to make sure consumers have the information they need to make optimal healthcare decisions. In our next phase of growth, we want to automate that process without losing any transparency or depriving a consumer of any agency, no matter their technological competence.

Essentially, we want to build the pharmacy version of TurboTax (without the part about lobbying to keep the system broken). With the right prompts and information, TurboTax walks users through the U.S. tax system, which is huge and complicated. In effect, the user becomes totally self-servicing. We want to do the same for the people who use Alto. That said, not everybody is proficient or comfortable with technology. In the spirit of accessibility and inclusivity, it will still be important that everyone who uses Alto also has the option to speak to a real, knowledgeable, and friendly person to get their questions answered and needs met. We have a responsibility as a healthcare provider to take care of all our patients, no matter how tech-savvy they might be, but for these patients we can still use technology to enable our team to get the patient the best possible option, quickly and easily.

Our engineering team is working toward products with even more expertise built in. In the process, we will also make our operations more efficient and more scalable, unblocking barriers to expansion in existing markets, new markets, and new verticals.

When we succeed at that alignment, we stand to change the nature of the industry. To get there, we will continue to grow our engineering team with right-fit, world-class talent that not only has the skillset to take Alto to the next level but also the values to keep us aligned and mission-driven in the process.

Learn more about Alto’s company values and mission-driven work culture.

To Alto’s CTO, an ethical, altruistic, supportive workplace is everything.

Every morning (ok, most mornings), I wake up motivated — eager, even — to get out of bed and go to work. But it’s not because I am some super-performing success-bot. This is not another blog post about a c-level executive’s otherworldly, highly-meticulous-yet-seemingly-effortless morning routine, and I have no prescriptive regimen for staying happy and mindful while still managing to “get it all done.” I only have one piece of advice, but it is one that has served me (and my mornings) well:

Work with people who share your passion and values.

At Alto, the company I co-founded in 2015, everyone, from me (the CTO) to product engineers to part-time prescription couriers, is dedicated to the same mission and vision. Every day, we strive to improve health outcomes by optimizing technology and processes to become the world’s most people-centric pharmacy. I am never not excited to work alongside the few hundred Alto employees that daily act in concert to support the success of our company and make a difference in the lives of people who use Alto.

Underlying this relentless drive toward mission and vision is a set of shared core values that defines our internal culture:

Patients come first — even before our bottom line and industry partners. We will always prioritize the wellbeing of the people who use Alto to manage their prescription medications.

Leave no person behind. It’s more important to be good for all than to be great for a select few.

Start with empathy. We strive deeply to understand the thoughts and feelings of everyone we interact with.

Focus on impact. We prioritize impact over activity and focus on the work that makes the biggest strides toward our goals.

Think rigorously. We’re open to changing our minds and never hesitate to question assumptions and first principles. There is nothing sacred about the status quo.

Be humble. Our work — however expert, technical, or specialized — is in service of our team, the people who use Alto, and the greater good. Everyone’s contributions count, and no one is too important to take out the trash, so to speak. And we are certainly not above other players in the industry whose mission to help patients aligns with our own.

For me and my teammates, it’s extremely fulfilling to contribute to this smart, caring, talented team working tirelessly to help so many people. Everyone’s role is different but invaluable, and our efforts have real meaning. I can say with confidence that working in this environment makes a huge difference in how I carry myself, because I know from previous professional experiences what the opposite looks and feels like.

When my co-founder Matt and I started Alto in 2015, we were both software engineers at Parse, a Facebook-owned company. Having spent years in Silicon Valley, we were already jaded by the tech ecosystem and were ready for a change. In thinking about what we wanted to pursue next in our lives, we noticed that other companies were not working on society’s most meaningful problems; they were focused on catering to the 1%. In contrast, we wanted to use our time and skills to build something that makes a tangible, positive impact on the daily lives of all people, especially those ignored by the tech industry.

And so, we found ourselves drawn to healthcare — a big, broken industry that affects most people negatively, especially the underprivileged. We did a lot of research to figure out what our wedge into healthcare would be, and pharmacy jumped out to us. Essentially, pharmacy is the healthcare industry’s consumer product, and consumer products just happens to be our area of expertise.

If you think about it, pharmacy is a product not unlike Facebook; almost everybody in the country uses at some point in their life. But evidence suggests it’s generally a bad one. The net promoter score of chain pharmacies is somewhere in the vicinity of -10. That’s shockingly bad. (For reference, American Airlines has a net promoter score of four.) Our research also found that more than 35% of all medications sent to pharmacies are never picked up as a result of some upstream issue.

It became clear to us that none of the pharmacy incumbents thought of themselves like a product, and especially not one that is consumer focused. None of them had the mindset to prioritize and optimize the user experience, which is the mindset Silicon Valley applies to photo-sharing apps and ad optimization tools and all sorts of other products we aren’t so passionate about. Instead, pharmacy incumbents focus on extracting value from the system and pushing the cost off onto patients. In that gap, we saw opportunity — and a moral imperative.

Today, Alto is making pharmacy convenient, accessible, and user-friendly. We make it easy for consumers to get information on their medications so that they can make informed healthcare decisions. To get there, we have built and continually work to improve a robust set of user-facing and internal tools to guide consumers through the complex and often barrier-laced process of prescription procurement, payer authorization, and medication fulfillment.

Because health outcomes are what we care about, we’re not pushing pills for profit. We are just as happy if a patient pursues an alternative therapy so long as it is in his or her best clinical interest. Our unique business and operational models make that possible.

In disrupting an industry that can be predatory to the most vulnerable among us, I am proud to say Alto attracts some of the most ethical, altruistic talent I have ever worked with. They make coming to work a pleasure and a privilege, and that makes all the difference, not just in my mornings but also my professional satisfaction and overall well-being. If any of that resonates with you, you might be just our type.

"Work With People Who Share Your Passion"

At Alto, we’re putting patients first with free, same-day medication delivery; always-there, cost-saving support from our dedicated pharmacists and care team; and a cheerful online interface where people can conveniently manage all their prescriptions. Here’s how we make it work.

How Alto Pharmacy Is Using Tech to Put Patients First

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

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

Our model is made possible thanks to three Alto products:

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

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

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

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

Our research revealed that no pharmacy incumbents think of themselves as consumer product companies. Unlike the Facebooks of the world, which are constantly optimizing how people use their products, pharmacy incumbents deprioritize it. We saw that gap as an opportunity to use our technical expertise to bring a people-focused mindset to the industry.

Back then, neither Matt nor I had any pharmacy experience. So, we left our jobs and dove in headfirst. After raising some capital, we purchased and ran a mom-and-pop operation, A-G Pharmacy, that had been serving San Francisco’s Mission District for more than 50 years.

We learned by fire how pharmacies work (and don’t). Soon enough, it became clear to us that despite caring about their patients, the A-G team wasn’t able to give them the best possible experience because they didn’t have the right tools. They were using antiquated software that required clumsy, inefficient work-arounds like relying on analog typewriters to create prescription labels. Because they didn’t have a streamlined operation, patients didn’t receive a streamlined experience.

We further discovered that technology wasn’t connecting the right stakeholders across the industry either. Pharmacy transactions require coordination between the physicians choosing the medication, the insurance companies paying for the medication, the pharmacies filling the orders, and the patients ultimately using the medications. The industry standard has been to conduct that coordination by fax and phone. That makes coordination slow, disjointed, and prone to things falling through the cracks. Patients take the brunt of those issues.

It became clear to us that Alto’s software needed to deeply integrate with and connect the disparate systems that stakeholders use. We also wanted to give stakeholders tools to solve other workflow issues not being addressed by their existing systems. And so Alto’s suite of products came to be.

A single Alto fulfillment center can serve as many people as 400 chain pharmacy locations, and we do it with a much smaller team thanks to our proprietary technology. That saves our company resources that we reinvest in the Alto experience. By way of example, we’ve developed specialized expertise in managing the coordination of complex therapeutics like fertility treatment, psychiatry, dermatology, and HIV prevention and care. The efficiencies we’ve uncovered make lifesaving and life-improving treatments available to people who might otherwise not have access to them.

The result is a system of products and processes that have demonstrated utility for tens of thousands of people and counting. Alto isn’t just convenient; by keeping people well informed about their prescription medications, Alto helps them make the best possible healthcare decisions for themselves and their families. But we’re not stopping there. Alto is poised for growth, and in the coming months and years, we will be rapidly adding to our team to help us build the technology to continue to solve pharmacy’s deep operational issues at scale.

Learn more about our vision, growth trajectory, and the Alto engineering team that makes it all possible.

Editor's Note: This post was updated on November 8, 2021, to reflect the rebrand of AltoMD to Alto Connect.

Empowering Patients By Accelerating Healthcare Innovation

Editor's Note: This post was updated on November 8, 2021, to reflect the rebrand of AltoMD to Alto Connect.

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

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

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

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

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

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

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

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

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

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

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

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

Alto's Mission & Values | Alto Pharmacy

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

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

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

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

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

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

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

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

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

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

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

Why We Prioritize Diversity at Alto

The Alto team has been growing quickly, doubling in the last 6 months, and we are thinking a lot about the importance of diversity to building a world-class company. We are putting a lot of time and energy into making sure we build a diverse team and an inclusive culture, and one of the foundational discussions we’ve had is why diversity matters to us. Aside from the fundamental ethical reasons, having a diverse team is particularly important for us as a healthcare company because it allows us to to empathize with our patients, innovate on our product, and hire the best teammates who share our values.

I wrote an internal post codifying how we prioritize diversity, which we presented at an all-hands meeting, and subsequently in every new hire’s onboarding.

I’m sharing this publicly in hopes that it can help frame how other companies discuss the business case for diversity.

Most of any success I’ve had comes down to luck. My family prioritized education and had money to spend on it. I went to an elite prep school, then MIT, then had my first ever job at Facebook. Each step led to the next, with a lot of help along the way. In my time in Silicon Valley, I’ve seen the limits of my well-off, millennial, straight, white, male perspective. I’ve seen the ways that my type of privilege leads to the proliferation of companies building photo sharing apps and other tools that make life easier for the 1%. The massive changes in technology in the last decade have dramatically increased my quality of life, but those who don’t share my privilege have not seen nearly the benefit. Healthcare is clearly broken and hasn’t seen many improvements from improving technology, and many of those most affected by bad healthcare are also the most underserved by the tech industry. We founded Alto to use our backgrounds in tech and our skill sets to try to give some of the benefits of technology to those underserved by the current state of the healthcare industry.

I can have a hard time understanding the thoughts and feelings of our diverse patient base, given my life story and the fact that I’ve never had prescriptions. In the early days of Alto, we primarily dispensed birth control. We thought it was a good beachhead market of young, tech-savvy users, with a long lifetime of monthly refills. We discovered very quickly that birth control has a lot of different brands, some much more expensive than the generic equivalents. I assumed everyone would want the cheaper form, given that they have chemically identical active ingredients. Fortunately, though, some of our earliest teammates were women, and they helped me understand that when dealing with hormones, small differences can really affect how you feel. We then asked our patients about side effects they’d encountered switching to generics and found out how common these issues really were, and how frustrating it could be when the pharmacy tried to switch them to a generic. Now, we make sure to stock every brand of birth control.

In trying to empathize with our patients and my teammates here at Alto, I have seen firsthand the benefits of a diversity of backgrounds and perspectives. We realize that we are a company founded by millennial white males from relatively privileged backgrounds. This makes it even more pressing that we focus our energy on building a diverse team and inclusive culture.

Diversity means many different things to different people, so I think it’s important to define exactly what we mean here. What we’re really after is diversity of thought and skills applied towards a singular mission with unifying values. It’s not always easy to know whether someone has a different way of thinking about the world, so we often use proxies to accomplish this. By attempting to build a team with a broad representation of ability, age, education, gender, race, ethnicity, religion, sexual orientation, socio-economic status, and personality type, we can hopefully build a team that also brings a diversity of thought and experiences.

As a pharmacy, we have one of the most diverse user bases of any product. Almost everyone uses the pharmacy at some point in their life, and so the population of people that we serve is just as diverse as the entire population. We serve patients of every age, race, religion, gender, sexual orientation, ability, and socio-economic status. Having a diverse team allows us to understand and empathize with the people Alto serves. We are building the best pharmacy for everybody, everywhere.

One of our core values is “Patients come first,” and in order to truly embody that value, it is imperative that we have a diverse team. Whether we are designing a new feature to improve our fertility onboarding flow, or talking through a complex prior authorization with an elderly medicare patient who knows English only as a second language, having a diverse team helps us to put ourselves in our patients’ shoes and empathize with their challenges.

As a healthcare company, we are often interacting with patients when they are at their most vulnerable.

We have a responsibility to our patients, and the best way to serve them is to be sensitive to their needs and experiences.

Real innovation happens when you combine people from diverse backgrounds, with different skill sets, to solve a hard problem together. Research has shown over and over the positive effect of diversity on innovation (here, here), and diversity played a key role in many of the greatest inventions of all time. The transistor, a critical building block of the modern computer, was invented at Bell Labs in the 1940s, by a diverse group of scientists and engineers. According to Walter Isaacson,

“The lesson of Bell Labs is that most feats of sustained innovation cannot and do not occur in an iconic garage or the workshop of an ingenious inventor. They occur when people of diverse talents and mind-sets and expertise are brought together.”

Fixing the broken pharmacy industry is an extremely difficult challenge, and we will need a broad range of people, with different ways of thinking, to help solve it. An engineer can quickly write code to automate a tedious task that a pharmacist has to do everyday, like looking up patients to reach out to those who may want a consultation. A pharmacy technician can easily help a designer figure out what the right packaging looks like for fertility ancillary items. By building a team where people with different backgrounds, skill sets, and ways of thinking collaborate daily, eat lunch with each other, and form relationships, we enable more of these interactions, where teammates help solve each other’s problems from different perspectives.

We have hired many of the best people from the tech and healthcare industries, from many different backgrounds. We want to keep doing that.

Most A-players who share our values do not want to work on a team as the only member of a small minority. Neither do they want to work on a team of only people like themselves.

By recruiting a world-class, diverse team, we are in turn enabling ourselves to recruit more world-class, diverse people. It has a compounding effect.

Many of the most talented people who share our company values of empathy, humility, and putting patients first also enjoy working with teammates with different backgrounds and experiences. We enjoy learning from each other and being open minded, and believe that we learn things from each other that actually make us better at our jobs. We feel that a diverse team makes us happier and more productive, and that the best people who share our values feel this way too.

We are all working at Alto because we care about helping people and care about making the world a better place. It is well-known the tech industry has a massive problem with under-representation. Women are under-represented by a factor of 4, and Black and Latino minorities are under-represented by a factor of 2. Women leave tech at more than twice the rate men do, and women are under-represented in leadership positions in tech by a factor of 10.

A study by the Kapor Institute earlier this year found that the primary reason women and under-represented minorities leave their jobs was due to unfairness in the workplace. At Alto, we value fairness and equality as important moral foundations, and work to promote those values in the workplace. We find it sickening to read over and over again about sexual harassment, stereotyping, and unfair treatment in the tech industry, and we want to do something about it. By actively committing to diversity and inclusion at Alto, we hope to do our small part in helping to change the industry for the better.

This post is all about the “why” when thinking about diversity at Alto, and in the future we will be sharing more about what we are actually doing to make sure that we have a diverse team and inclusive culture. We’ve put a lot of work into diversity and inclusion so far, and made some great progress, but we understand there is always more we can do and this is a challenge that will never be “done.” This post is intended only to lay the foundation for taking initiative to improve diversity here at Alto. Without actual changes this is all just talk.

As a mission-driven healthcare company, there are clearly many important reasons why we care about diversity. It helps us empathize with our patients, innovate on our product, hire the best teammates, and change the tech industry for the better. We are growing quickly, so now is the time to double down on our commitment to having a diverse team. It is not something that happens on its own, and will take a lot of work from all of us to foster the inclusive environment in which a diverse team thrives, but we wholeheartedly believe it will be worth it.

The following are the most common reasons for a high copay.

Deciphering Your Copay — What Your Pharmacy Isn’t Telling You

You see your doctor and he or she writes you a new prescription, sending it electronically to your pharmacy of choice. You then receive a call from your pharmacy and the copay is much higher than you anticipated.

Your jaw drops. You find yourself thinking that something must be wrong with this calculation. How did your doctor think you could afford this drug?… Did the pharmacy apply your insurance correctly?… Is this for a whole year’s worth of medication?

If you find yourself in this situation, you are not alone.

There isn’t one simple answer to this question, but hopefully this article will help you understand the potential causes of a high copay and recognize which one might apply to you. The following are the most common reasons for a high copay:

If you notice your prescription drug costs escalate at the beginning of a new year, your deductible is the most likely culprit. With a deductible, patients will pay the majority of the cost of their medications out of pocket until a certain dollar amount has been reached. This amount varies significantly by plan and can range anywhere from the low hundreds to thousands. Once you hit this set amount, your typical copays will return and remain until the start of the next calendar year.

Copayment or drug coverage tiers are a way that insurance companies categorize drugs, and those from higher tiers will most likely cost you more than those from a lower tier. For instance, a brand name drug in Tier 3 will cost you more out of pocket than a generic alternative in Tier 1. Speciality drugs, or those prescribed as treatment for rare or serious medical conditions are commonly at the highest tier, and therefore, are also the most expensive. It is important to note that not all prescription insurance plans utilize tiers, and tiers differ immensely across various plans.

3. The drug requires a Prior Authorization

Oftentimes, insurance companies will reject claims for specialty, brand, or expensive medications without a Prior Authorization in place. A Prior Authorization, or PA, is an appeal process that, if accepted, will result in your Insurance covering a portion of your prescription costs. A PA may require your doctor to submit prerequisite therapy information and diagnosis, and ultimately, justify the reason he or she is requesting this treatment for you.

The important thing to note about PAs is that many drugs that require PAs are also more costly and specialized to begin with, which may affect your out of pocket cost even after it is approved by your insurance.

A formulary is a list of drugs which are covered in some part by your Insurance plan. Each plan has a unique formulary, which you can locate online or by calling your plan. If a drug is not on your “open” formulary, you may have the option of submitting a PA; however, if you have a “closed” formulary, a PA will not be approved. Your pharmacy will be able to inform you on your options and if you have an “open” or “closed” formulary. One thing to keep in mind is that formularies may change without warning, and a medication you are currently taking may be fully covered ($0 copay) one day and not covered, or covered with a copay the next.

We have seen this occur many times with birth control medication, for example, where a patient has been taking one brand for months with $0 copay, and all of a sudden she is subject to a $25 copay for the same medication. In this instance, the formulary has changed, and her Insurance plan is now requesting she takes a different brand, or generic equivalent of birth control medication.

5. You are in the “donut hole” (Medicare Part D only)

The “donut hole” or coverage gap, is specific to Medicare Part D participants, and means there is a temporary limit on what your plan will cover. The gap begins after you and your plan have spent a certain amount towards covered medication for the calendar year. For instance, this number in 2017 is $3,700. Once you are in the coverage gap, you could pay up to 40% of the plan’s cost for covered brand name drugs, and will pay 51% of the cost for generic drugs. These percentages may change year after year, and your costs incurred will add up over time to get you out of the coverage gap. You can find more information and specific examples of the coverage gap on the Medicare website.

Fortunately, you may have a couple options to cut your costs. If your doctor prescribed a brand name medication and there’s an alternative available, you may have the option of filling this instead. If the doctor requires that specific medication, talk to him or her about why, or ask your pharmacist to follow up for a new prescription. If an equivalent generic does not exist, there still may be a comparable substitute, which you should discuss with your doctor or pharmacist.

In the case of a Prior Authorization, your doctor can submit documentation to your insurance company explaining why this specific treatment is necessary. At Alto (formerly ScriptDash Pharmacy), we initiate this process with your doctor and track its progress, as well as notify you along the way.

A third way to lower your out of pocket costs, perhaps significantly, is to apply a manufacturer’s copay savings card. These savings cards are typically found with more expensive brand name medications and are accepted for the most part after your commercial insurance has paid for a portion of the medication. Lo Loestrin Fe, for instance, has a savings card that will bring down out of pocket expenses to $25 for a 28-day supply, which can be much lower than your initial copay when you only use your insurance. At Alto, we make this process easy on you and will actively search for, and apply, any savings cards for which you are a candidate.

While this isn’t an exhaustive list of everything that could contribute to your copay, it covers the majority of cases we see here at Alto. If you have any questions on what your insurance covers, you can always contact us for help. Alternatively, you can learn more about your insurance coverage by calling the number on the back of your card or by looking up your formulary online. We hope this takes some of the guess work out of deciphering your copay and will help you make more informed healthcare decisions in the future!

The following are the most common reasons for a high copay:

In recent years, EHRs and medical providers started to dispose of the paper prescription pad and began to send some prescriptions electronically from their EHRs. Those that know Alto Pharmacy know that we want all prescriptions to be sent electronically. It’s more efficient for providers and safer for patients.

The Case for E-Prescribing

Did you know that Electronic Health Record Systems (EHRs) have been around since the 1960s? Pretty much as soon as we got computers we realized that they could be used to make healthcare more efficient and more effective. Despite the massive forward leap in adopting EHRs, the tools used for prescribing medication didn’t change for another 50 years.

In recent years, EHRs and medical providers started to dispose of the paper prescription pad and began to send some prescriptions electronically from their EHRs. Those that know Alto Pharmacy know that we want all prescriptions to be sent electronically. It’s more efficient for providers and safer for patients. Whenever we broach this topic with medical providers we often hear them say “It’s illegal to send Schedule Two Narcotics (CIIs) electronically.”

The DEA made EPCS (Electronic Prescribing of Controlled Substances) a legally acceptable option for prescribing in June of 2010. Unfortunately the belief that it’s illegal to e-prescribe CIIs is widespread among medical providers and undoing it requires an awareness campaign. In 2012 the State of New York recognized the benefits of EPCS and passed legislation making it mandatory to E-prescribe all medications as of March 2016. We believe many more states will soon follow.

The Center for Disease Control and Prevention (CDC) has declared prescription drug abuse in the US an epidemic. Nearly 10% of all prescriptions written are pain relievers (opioids), which too frequently lead to patient dependence and abuse. It’s important to remember that seventy-eight Americans die every day from an opioid overdose.

As long as these prescriptions are written on a piece of paper, the pharmacies dispensing the medications can be easily manipulated and the dispensing cannot be easily tracked. Electronic prescribing saves lives by making it harder to commit fraud.

Did you know that the street value of the paper in a prescription printer is over $20,000? Get your hands on one of these printers (or even easier, a paper prescription pad) and you can mint whatever prescriptions you want. As long as you take each prescription to a different pharmacy and always pay cash, it’s hard to get caught. The result of this paper based prescription process and the large volume of CIIs being prescribed in the US is causing epidemic scale drug abuse and nearly 29,000 preventable deaths every year.

Although undocumented, medical errors have recently been estimated as the number-three cause of death in the United States. As an example, today it is far too easy for a pharmacy to accidentally translate a handwritten prescription for Oxycontin (extended release) into Oxycodone (immediate release). Depending on the prescription strength and the patient’s tolerance for opioids this could be a very serious medical error that in some cases may result in death. EPCS significantly reduces the risk of this medical error and saves lives by eliminating room for interpretation.

3) Make Medication Reconciliation Accurate

Reducing medical errors and helping prevent opioid abuse are great reasons to get rid of all paper prescription pads, but there’s another reason that’s not so obvious. When a patient’s prescriptions are sent electronically they can be easily tracked, which means they can also be used in medical reconciliation. Imagine if you had a complete and accurate view of all of your patient’s prescription medications? Imagine if your EHR allowed you to see everything that was prescribed in the last two years and when it was last picked up? Now imagine the power of this information in an emergency inpatient setting. How many lives could be saved?

PDMP is currently enacted in every state except Missouri, and is invaluable in helping pharmacists track controlled substance transactions. PDMP, also known as ‘CURES’ in California, requires pharmacies to report controlled substance dispensing to a searchable database. In California, pharmacies are able to log into CURES and view data on all reported dispensing of controlled substances.

‘Red-flags’ dispensing pharmacies look for:

Multiple controlled substances dispensed under multiple providers.

Large quantities of controlled substances regularly dispensed.

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