Expires 04/01/2021

Specialty Pharmacy

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

Alto Pharmacy Technician

Alto Pharmacist

For Black History Month, we’re recognizing pivotal Black leaders in healthcare who’ve paved the way forward for our country and the Black community.

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

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

Alto / Blog

Starting Wednesday, February 24, New York City residents can now choose Alto’s same-day doorstep delivery for all of their pharmacy needs. 

Hello, New York City!

Alto extends beyond fertility medication support to offer full-service pharmacy operations in New York City.

Starting today, Wednesday, February 24, New York City residents can now choose Alto’s same-day doorstep delivery for all of 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: 

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

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

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

Walk-in hours
Need to pick up? Our pharmacy is located at 100 Park Avenue - that's 40th between Park and Madison.
Monday - Friday: 9 am – 7 pm ET
Saturday - Sunday: 10 am - 6 pm ET

New York 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. 

General customer support hours are Monday - Friday 9 am - 12 midnight ET and Saturday - Sunday 10 am - 9 pm ET. 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 currently delivers across the greater Bay Area, Los Angeles, Orange County, Seattle, Denver, Las Vegas, New York City, Houston and Dallas.

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. 

Courier delivery windows
Monday - Friday: 6 - 9 pm CT
Saturday - Sunday: 2 - 5 pm CT

Walk-in hours
Monday - Friday: 9 am – 7 pm CT
Saturday - Sunday: 10 am - 5:30 pm CT

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

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

Need to pick up? Our pharmacy is located at 4950 Terminal Street, Suite 200, in Bellaire.

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 currently delivers across the greater Bay Area, Los Angeles, Orange County, Seattle, Denver, Las Vegas, New York City and Houston.

Here are seven unconventional ways to support your heart that have sparked the interest of leading health experts. 

7 Unusual Heart Health Risk Factors

What Science is Revealing About Heart Health

Researchers are working hard to curb the impact of heart disease, which is currently the leading cause of death in the United States. These efforts to develop new prevention strategies have led them to some surprising heart health hypotheses. You probably know that you should eat well and stay active, but these lesser-known risk factors may not be on your radar. Here are seven unconventional ways to support your heart that have sparked the interest of leading health experts. 

It turns out, brushing your teeth may have more benefits than just sparkly whites and fresh breath. Numerous studies have documented a link between poor dental health and heart disease. The verdict is still out as to why, but the prevailing theories point to inflammation. It could be that the bacteria which infect gums enter the bloodstream and cause blood vessel inflammation or that the body’s immune response is to blame. While more research is needed, it’s one more reason to brush your teeth for the recommended two minutes twice a day and get regular dental checkups. 

There have been some interesting studies exploring the connection between workplace stress and heart health. A decade-long study in Sweden found that having a bad boss increases your risk of a heart attack. Additional research has suggested that working long hours may increase your risk of cardiovascular disease and stroke. 

A key takeaway here is that stress, in general, isn’t great for your overall health. Stress causes your cortisol levels to spike, which can lead to high blood pressure, weight gain, sleep disruption, and reduced energy over time. Not to mention, your diet, exercise routine, and other healthy habits often suffer when you’re stressed out. Make sure to find ways to unwind at the end of your workday, whether that means listening to a relaxing soundtrack on your drive home or a brief meditation before you make dinner. Sometimes you can’t avoid challenging coworkers or chaotic days, but you can put strategies in place to help you feel calmer and more resilient. 

Not that you needed another reason to love your pets, but several studies have shown that pet ownership, especially having a dog, can improve heart health. According to Harvard Health, researchers have found that dog owners have lower blood pressure and cholesterol than non-owners, probably because dogs require daily walks and tend to have a calming effect on their humans. 

If you’re not a dog owner, we don’t advise adding pets to your life purely as a health strategy. Instead, you might consider stopping to meet some of your four-legged neighbors. A few studies have found that just petting a dog can lower your blood pressure. 

Sleep is the unsung hero of the health world. It allows your whole body to rest and replenish. Although your heart never stops beating, it does slow down and recover during sleep. According to John Hopkins Medicine, by depriving your heart of this crucial recovery time, lack of sleep increases your risk of heart attack and heart disease.

If you have trouble sleeping, creating a nightly ritual can help. Try to wind down at the same time every evening and create a calm, dark, and quiet environment in your bedroom. You should turn off your electronic devices at least thirty minutes before bedtime to help your body prepare for restful sleep. 

If you find yourself tossing and turning on the regular, it’s best to talk with your doctor. Various underlying and unsuspecting conditions could be causing your lack of sleep and there are many different therapies that can help.  

For more sleep-enhancing tips, read, “Too Stressed to Sleep? These Strategies Can Help.”

Bring on the oatmeal and scrambled eggs! When a panel of experts from the American Heart Association reviewed studies on eating habits and heart health, they formed an intriguing conclusion: breakfast-eaters tended to have lower instances of heart disease and were less likely to have high cholesterol and high blood pressure.

If you struggle to make time to eat in the morning, the American Heart Association suggests these breakfast hacks for some quick and easy meal ideas. Harvard Health recommends including whole grains in your morning meal to further reduce your risk for heart attack, stroke, and heart failure. They offer this menu of options full of whole grains, protein, and fruit. 

We all love a good movie marathon, but regularly sitting for hours at a stretch could be putting your heart at risk. And yes, that includes long workdays at the computer. 

The American Heart Association and the American College of Cardiology have both warned that regularly sitting for long periods is a significant contributor to heart disease. It’s not an issue of laziness—in a world full of deskjobs, car trips, and the all-important need to unwind, many of us struggle to find time to get the consistent movement our bodies need.

If you’re stuck sitting for long periods, the American Heart Association suggests finding ways to sneak movement into your day. You might try setting a timer and taking a five-minute stretch break every hour or using your lunch break to go for a walk. Every extra minute on your feet will help you get to the recommended 150 minutes of activity per week. Exercise also helps you reduce stress and sleep better, making it a true heart-health allstar. 

Several studies suggest an association between optimism and a lower risk of cardiovascular disease. A 2015 study found that those with a more positive outlook were more likely to make healthy lifestyle changes after a heart attack. And a researcher at the University of California, San Diego, found that patients with a greater sense of gratitude had lower levels of inflammation and better heart health overall.

Robert A. Emmons, Ph.D., a professor of psychology at the University of California, Davis, told the American Heart Association, “Clinical trials indicate that the practice of gratitude can have dramatic and lasting effects in a person’s life. It can lower blood pressure and improve immune function...grateful people engage in more exercise, have better dietary behaviors, are less likely to smoke and abuse alcohol and have higher rates of medication adherence.”

If optimism doesn’t always come easy to you, you’re not alone. Psychologists believe we have a natural tendency to fixate on negative information as a way to avoid it in the future. It’s a phenomenon known as “negativity bias.” Practicing gratitude is a powerful way to counteract this inclination. Best of all, it’s easy to get started. Your new habit can be as simple as writing down what you’re grateful for every day. 

When you look closely, these unconventional risk factors aren’t really that surprising. They each relate to foundational heart-healthy lifestyle choices such as managing stress, eating healthy foods, and staying active. This advice aligns with the CDC’s guidance, which outlines six essential strategies for living a heart-healthy lifestyle. 

If you’re concerned about your heart, the CDC recommends learning about your family’s health history and talking to your healthcare provider about your risk. Together you can create an action plan that’s best for you. If your doctor prescribes medication to treat high cholesterol, high blood pressure, or diabetes, the CDC stresses the importance of taking it as directed. 

Alto’s expert pharmacists will always be on call to answer questions about dosage instructions or side effects, and we’d be happy to bring your medications to your doorstep for free. Your heart-healthy lifestyle does not have to include standing in line at the pharmacy or worrying about refills. We’ll take care of the details so you can focus on cooking a healthy breakfast or walking your dog. 

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.

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

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

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

A Fascinating Chat with Dr. James Hildreth

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

Can you tell us about your background and professional journey?

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

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

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

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

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

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

Can you tell us more about Meharry’s mission?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Note: This interview was conducted in early December 2020. 

Blood pressure is one critical way the heart maintains its happy, healthy medium. In this article we'll explore how to manage high blood pressure and what you can do to maintain healthy blood pressure.

The Lowdown on Healthy Blood Pressure

Blood is constantly flowing through every part of your body, propelled by the beating of your heart. Though this hardworking muscle is only about the size of your fist, it contracts sixty to eighty times per minute, sending oxygen-rich blood to the farthest reaches of your body and back. 

Like any finely-tuned machine, the heart requires balance to remain in optimal condition. If it doesn’t pump hard enough, its vital job doesn’t get done. But if it starts working too hard, it runs the risk of tiring and eventually giving out. Blood pressure is one critical way the heart maintains its happy, healthy medium.

Blood pressure is the force of the blood as it moves through the body. It’s important because we need blood to deliver the oxygen and nutrients that nourish our tissues along with antibodies and white blood cells for immunity. Blood pressure also helps us remove the waste products of our metabolism, like carbon dioxide and toxins from the liver and kidneys. 

The heart creates blood pressure with every contraction, but there are other forces at work as well. Blood keeps moving through the network of blood vessels in our bodies because of differences in pressure in our continuously narrowing arteries, veins, and capillaries. It’s similar to what occurs with multi-function showerheads. The amount of water flowing through your pipes remains the same, but a more narrow flow exerts more pressure while a widened spray feels more gentle.  

The initial, most substantial pressure comes from the heart, and the arteries’ structure helps maintain it as the blood continues to flow. 

A blood pressure reading measures two forces. Systolic pressure is the force that occurs as blood flows out of the heart and into the arteries. Diastolic pressure is the force created when the heart fills with blood as it rests between beats. 

These forces are measured using a sphygmomanometer, or what many of us know as the inflatable arm cuff that healthcare providers use during checkups. 

The cuff is inflated enough to stop the pulse, and a reading is taken. When the pulse returns, the cuff is allowed to deflate slowly, and another reading is taken. The numbers are expressed in terms of the pressure it takes to move mercury around a tube against gravity, a unit called millimeters of mercury (mm Hg). Your healthcare provider will give your reading as two figures—systolic pressure first and the diastolic pressure second—such as “140 over 80 mm Hg.” 

The National Institutes of Health advises that normal blood pressure for most adults is below 120 mm Hg systolic and 80 mm Hg diastolic. While both readings provide important information, “high blood pressure” typically refers to systolic pressure, the first number in your blood pressure reading. 

High blood pressure, also known as hypertension, is a condition that occurs when the force of the blood flowing through a person’s arteries is consistently above 130 over 80. The added pressure forces the heart to work harder and can stretch or injure the blood vessels. It also speeds the build-up of harmful plaque that can block blood flow, increasing blood pressure even further.

Over time, high blood pressure can lead to life-threatening issues like heart disease, heart attack, and stroke. It can also damage major organs such as your heart, brain, kidneys, and eyes. According to the CDC, high blood pressure usually has no early warning signs or symptoms. Getting your blood pressure checked regularly by your healthcare provider is the only way to determine whether your blood pressure is too high. 

It’s critical to detect high blood pressure early because it can be treated, usually through heart-healthy lifestyle changes with or without prescription blood pressure medications. Your healthcare provider can determine the right treatment plan for you. 

The American Heart Association encourages everyone to know their blood pressure numbers and adopt a more heart-healthy lifestyle. Impactful changes include eating a well-balanced diet that limits salt, staying physically active, taking steps to manage stress, reducing alcohol, and eliminating smoking. 

Even if you don’t have high blood pressure, eating less salt is one of the best choices you can make for your heart. Though sodium is essential for life, consuming too much salt pulls water into the bloodstream, increasing the volume of your blood. More blood flowing through your blood vessels exerts greater pressure on your heart. 	

The American Heart Association recommends that everyone limit their sodium intake to 1,500 mg/day. The biggest sodium culprits in the average American diet often don’t emerge from the salt shaker on the table. Processed or prepackaged foods like soups, cold cuts, bread, and frozen meals are major sources of excess salt because they often contain sodium-based preservatives and additives to enrich their flavor. It’s not always easy to determine by looking at their labels, however, there are several sodium-containing compounds to watch out for in the ingredient list, such as sodium benzoate, sodium tripolyphosphate, and monosodium glutamate (MSG). 

Start to make a habit of looking at labels while you grocery shop and choosing low-sodium options when possible. The American Heart Association created this sodium fact sheet to help you make heart-healthy choices. 

If your doctor determines that your blood pressure is too high, you’re certainly not alone. According to the CDC, nearly half of American adults have hypertension. If blood pressure medications become part of your treatment plan, we’d be happy to connect you with one of our pharmacists, who are specialists in heart medications. Plus, our free hand-delivery means you’ll never have to plan an extra trip to the pharmacy. With a few healthy lifestyle changes and the support of your doctor and pharmacy, your life doesn’t have to miss a beat. 

For an inside perspective on sales at Alto, we sat down with Craig Thompson, our Vice President of Sales, to learn about his experience at Alto and his advice for qualified sales professionals looking to join the team.

An Inside Look at a Sales Career with Alto

Why Our Sales Team is Central to Our Mission at Alto

Like so many big ideas, Alto began with a question: what if we reimagined the pharmacy experience to make people happier and healthier? Improvements were begging to be made: not only were most people and providers frustrated and dissatisfied with the status quo,  but medication non-adherence—when people don’t take the medication they’re prescribed—has hovered at 50%. In addition to $300 billion in avoidable medical costs, non-adherence is estimated to cause approximately 125,000 preventable deaths per year in the United States. 

With these problematic statistics in mind, Alto set out to do more than just dispense and deliver medications. Our mission is to fulfill medicine’s true purpose: to improve the quality of life for everyone who needs it. We aim to make our better pharmacy experience available to 100 million people by 2025 and we’ve raised over $350 million—including more than $250 million at the beginning of the year—in pursuit of this goal. 

To reach more people and expand into new markets, we are building a strong, mission-driven sales team to help forge the way. For an inside perspective on sales at Alto, we sat down with Craig Thompson, our Vice President of Sales, to learn about his experience at Alto and his advice for qualified sales professionals looking to join the team.

Can you tell us about your own career path and why you joined Alto?

Prior to joining Alto, I spent about 20 years in the medical device space. Early on, I worked for a few different companies before landing at Abbott Vascular where I started as a sales representative, led trainings across the U.S. as the Director of Medical Education, then pivoted back to become VP of Sales. I always envisioned that my next role would be a bigger version of that position; one where I could swing big and settle in for the long haul. 

What intrigued me about Alto was the size of the market. We spend more than $330 billion on prescription drugs a year in the U.S., but it didn’t seem like anyone was nailing the pharmacy experience, especially from the patient’s perspective. When I met Matt, Alto’s CEO, I was impressed by his patient-centered mission and his humble approach. The opportunity to build something from the ground up really appealed to me. I also loved the idea of working alongside a team of high caliber people with diverse professional backgrounds.

Alto represents a true convergence of healthcare and technology. Moving from medical devices or pharmaceuticals and coming here, you learn new ways to communicate and have access to new technology and resources.  We have our eyes on the future and a vision for how we want to scale. By keeping a strong focus, we’ve more than doubled our revenue each year for the past few years. As we continue to expand into major markets across the U.S., we’re looking to bring in highly talented people with existing relationships to build out our sales team. 

While we've delivered fantastic growth over the last few years, we're still in a phase of evolution where a new member of the team can have a meaningful impact on our organization. This is an ideal opportunity to take part in building something new and to know that as you help build a better business, you’re also helping to improve people’s and healthcare professionals’ lives. Not only have we leveled up the patient experience with our app, but we’re also making the pharmacy experience easier for healthcare professionals. Alto is uniquely suited for those who care about benefiting the stakeholders we work with. It’s genuinely all about the mission.

What makes a successful partnership manager at Alto? 

We’re looking for builders—creative people who can operate in ambiguity and thrive in a startup environment. Working at Alto is an opportunity to build new territories and make a real difference for people. It’s for those who want to create novel solutions rather than work with rails around them. We need innovative people with existing relationships who are motivated by Alto’s mission to improve lives. 

What exciting challenges await a potential team member? 

We're really at the tip of the iceberg as far as the products that we are bringing forward. There's a ton of work to be done as we consider how we can continue to meet the needs of both people and health care professionals. We’re always working to develop services and technology that can help impact adherence rates, improve the overall quality of life for people, and make physicians' lives easier by reducing the burden that exists on their teams from insurance companies. 

There will be a ton of opportunities for people to come in, demonstrate success, and find fulfilling professional paths. One of my visions for the coming year is to develop additional resources dedicated to professional and personal growth and implement programs with specific learning tracks. 

We work cross-functionally and are always open to learning new ways of operating and finding success. If you’re excited by the opportunity to create something new rather than inherit an existing territory, we’d love to hear from you. 

This is an exciting time to join the team at Alto. As we continue to forge new territory, expand into new markets, and develop our specialty areas, we’re already on track to achieve $1 billion in annual recurring revenue by 2021. To maintain this trajectory, we’re looking to grow our team with highly skilled individuals who align with our values and are motivated to create change. There is abundant opportunity to not only achieve success but find fulfillment by working toward a mission that positively impacts people’s lives.  

If you've found yourself considering embarking on a new adventure, we’d be thrilled to have you consider Alto as your next career milestone. Visit our careers page to see if we're actively hiring in your city. If you're not quite ready to make a move, join our talent community and follow us on LinkedIn to stay apprised of upcoming opportunities. 

Mike McClay has spent the better part of two decades working in Silicon Valley. Here, he chats with software engineer Akash Gupta about the road from Software Engineer to VP, what it’s like to work in digital health, and his best advice to both independent contributors (ICs) and managers. 

Get to Know Alto’s VP of Engineering, Mike McClay

I'd love to first understand a bit about you personally. What do you like to do in your off time? What’s something most people don't know about you?

I grew up in Orange County, which is pretty suburban, so that afforded us a lot of time outdoors as a family. A life goal of mine is to do a solo hike of the John Muir Trail. The route starts in Yosemite Valley and heads south to Mt. Whitney. It’s about 225 miles and typically takes a few weeks to complete.

Currently though, I have a two-year-old and a four-year-old, and we have another baby on the way, so my outdoor activities tend to be much shorter and closer to home. I got into road biking about 10 years ago and transitioned to mountain biking a few years back when my family moved to Marin. Being able to get out onto the local trails a couple times per week is an amazing opportunity to get a great workout in, and unplugging does wonders.

Finally, a ton of family time with my partner and kids. A big reason I decided to join Alto is because it provides a great balance of simultaneously being a high growth startup but it’s also a company that has an eye on culture and achieving work-life balance. At Alto, we're playing to win, and we’ve got a lot of things to get done, but there's a lot of support and representation for people with families with kids. It's nice to be able to work hard towards an incredible mission but also not have to sacrifice too much on the family front; so outside of work, I’m mostly focused on spending quality time with my family getting outdoors, getting to the beach, and things like that.

That's very exciting, having another child on the way. How has COVID-19 impacted your responsibilities of being a VP Engineering and a father?

Life is a lot harder during COVID, though I say that with a fair amount of awareness of the privilege my family and I have. On the home front, we are constantly trying to find that balance of keeping the kids entertained and learning but also doing it in a safe way that protects everyone. My wife and I are pretty fastidious about keeping the house organized and clean but that’s relaxed quite a bit during this time; there’s a lot of resetting of expectations, and I try to do as much as I can to support my wife.

Professionally, probably about half of our engineering team has interviewed and onboarded since the shift to remote work in March, and I’d say we are still iterating and adapting each month to work better in a fully remote environment. It’s been incredible to see our teams adapt to this new style of work, and while it’s not quite the same as our in-person environment was, it’s been really cool to see the team grow and have our organization make a bigger and bigger impact for our patients each month.

I'd love to talk about some of your past experiences. You went to the University of California, Berkeley (Go Bears!), then Expedia, then Uber, and now you're at Alto. What prompted each of those transitions?

Yeah, I’m kind of an outlier in the tech world in that I’ve only worked at 3 companies since graduating undergrad in 2004. I think I’ve been fortunate to find myself at companies that have had no shortage of growth opportunities and that led me to stay for considerable amounts of time at both Expedia and Uber. 

Towards the tail end of my tenure at Expedia, I was managing the engineering team of a start-up that Expedia had acquired, and I knew in my heart that I wanted to move to a much smaller company. I spent a few months talking to a bunch of early stage start-ups but hadn’t found anything that felt right yet.

At the urging of my recruiter, I took a call with a company called Uber, which had seemed way too “big” for what I was looking for in that the engineering team was about forty people. Despite the role feeling different from what I was expecting, I was excited by the mission and the team, so I made the leap. Fast forward six years or so and it was an amazing ride, full of a lot of ups and definitely some learnings, but it was a truly formative experience for me.

Uber ultimately got to a point where I struggled a bit to pinpoint the impact I was making, and things overall at the company just felt slow. I wanted to work on something that was even more mission-driven, and one of my colleagues insisted that I chat with Alto. I was introduced to Jamie (Alto’s CTO). We talked over a number of months and found Alto’s needs and the challenges I was looking to solve aligned in a great way. So that's why I ended up joining.

Each of the companies that you’ve worked at have had large operational components. What are some of the key pieces to creating a strong partnership in a tech-enabled company?

What I would definitely say is that the tooling and the product that we built for ops at Uber was, at the time, world-class; it was just beautiful. Design was a first class citizen in our operational tooling because the workflow of our ops team was so critical to our company’s success. 

This is something that Jamie and I bonded over about Alto; our internal platform (called Wunderbar) powers the functionality that allows us to process our patient’s prescriptions in an efficient and effective way. Getting this right is critical for our patients, and the fact that we put so much time and energy into getting the technology platform right goes a long way to build a great working relationship with our operations team. 

Additionally, I’m passionate in general about operations since it’s often an area of the business that creates strategic advantages over competitors. And what I love about building software with operations is that it can’t be copied easily by competitors since there is no public surface area to observe. I view our task as an engineering team as getting to where we're crushing it as a business because we have nailed supporting operations with our product engineering work.

On that note, would you say Alto is an operations company, a pharmacy, or a tech company?

We aspire to a model of cross-functional leadership, whether it's between Engineering, Product, Ops, Growth, Marketing—whatever it is, the leads of areas and even the team members of each area need to be empowered to achieve the mission that they're setting out to do. If that's to enable, say, the flow of prescriptions coming through our system, maybe you could call that Ops-led, but at the end of the day, multiple functions have to come together to solve the problem. I almost want to call it vision-led.

There’s a time and a place where we need to be creating a faster horse, and there's a time and a place where we need to be thinking one to two years out about what the step up is from the faster horse: bringing the car into the situation, so to speak. Ultimately we need to be thinking on multiple time horizons at the company, and depending on the time and place and the strategy, you might see one function spiking up in terms of what we're rallying around versus another.

The engineering team at Alto has grown from eleven engineers and four managers when you started a year ago to more than fifty-five engineers with nine managers, directors, senior managers, and managers. What would you say has enabled that dramatic growth, and how do you plan on ensuring that that growth is well-managed?

For engineers, there are a lot of choices out there, and a big part of our hiring process is spent not only assessing technical skills, but also looking for signals that candidates align well with our patient-focused mission. From the beginning, we created an interview process that is fair and equitable, and that resonates strongly with our candidates. From there, we set out some really big goals that energized the team to push to make it happen.

I'm really proud that we've grown while maintaining a solid level-mix in terms of junior, mid-level, and senior engineers. Our engineering team is ~25% female, and while we only have single digit percentage points of representation of other underrepresented groups, representation is improving every quarter. Our goal over the next several years is for the team to achieve 50% gender representation and 30% from other underrepresented groups, so that our engineering team is representative of those we ultimately serve: our patients.

In order to make sure this growth is well managed, my philosophy is to hire or grow Engineering Managers well in advance of the acute need. On the manager side—and this was a big learning for everyone at Uber—we’d grow a team of fifteen to twenty engineers under a manager and not really have a great plan in place for how to bring in additional leadership and get the teams down to a right size of ten. When we approached that number, we'd battlefield promote someone and everything just felt strained. So I'm really proud of the fact that even at nearly seventy people now, we have a management team of nine that could actually support one hundred people pretty well. As the team continues to grow we’ll be making sure to stay ahead of the growth on the management side.

On that note, Uber has been reported to have an unhealthy culture. What have you learned from it to engender a more positive, inclusive culture at Alto?

Yeah, I’ve had a lot of reflection on this and a lot of learnings from my time at Uber. First, it’s that as a leadership team, we need to be vigilant about creating a team environment where team members feel they can do their best work. We need to always have great managers leading teams that are right-sized, and we need to have people-focused cultural values that help guide our behaviors and how we interact with one another. 

At Alto, half of our cultural values are focused on skills that foster an environment where folks can do their best work. Yes, we're thinking constantly about impact, but we make sure to hold ourselves to a high interpersonal bar. This type of behavior has also been institutionalized at Alto in our engineering career ladder. Culture amplification is one of the five skills engineers are evaluated against, and I think it’s a very strong signal into what we hold dear and how we want to roll here.

Finally, I’ve put a strong emphasis on making sure that interviews at Alto assess behavioral skills in addition to technical ones. We didn’t do this well at Uber for too many years, and I believe it led to some of the cultural negatives that you’ve likely read about in the news. To me, it’s critical that we hire really talented folks who can work seamlessly with one another. Getting signal on this during our interview process is a big part of growing a healthy engineering organization.

You've gone from being a Software Engineer to Tech Lead, Engineering Manager, Director, and now, VP. What advice would you give someone at each of those stages? What advice do you wish you had back then?

The main piece of advice I’d relay is to make sure that you spend enough time in each role to get solid proficiency. I’ve come across a number of folks in my career who look to move through roles as quickly as possible, and I think that doesn't allow for solid bases of knowledge to be built up. The foundation I built up in my experience as an engineer I believe resonates with engineers; I’m not just a people manager that helps coordinate minutiae. Additionally, a lot of the skill-building in these roles happens as you encounter various real life situations; the only way to accumulate experience is over time. So my advice is to be patient.

I would definitely encourage everyone to work at a company where there are clear career paths for both ICs and managers. You should never feel like you need to move into management to “grow in your career.” One of the first things we put in place after I joined Alto was a career ladder so that folks could reason about how they wanted to grow over time and come up with a growth plan with their managers.

Finally, don’t go too long in a role or at a company where you don’t feel challenged and don’t feel like you are growing. To me, growth and challenge are proxies for job satisfaction. I would say I've achieved it about 80 to 90% of the time in my career. If you're not in a place where you're feeling like you're growing, you should go somewhere else.

What would you say to someone considering working in digital health? What are some challenges and benefits in this space?

It's not so fraught with red tape that you can’t get anything done. There is a process to work through with HIPAA (Health Insurance Portability and Accountability Act) to ensure patient privacy; there is a massive set of opportunities that support all of the activity in the space; and there are seams where startups can begin disrupting entrenched players.

There’s also a massive opportunity to solve hard technical problems while achieving these amazing, mission-driven ends. I think sometimes it seems that those can be separated to where it’s almost mutually exclusive. While we don't yet have the volume nor traffic that you might receive at companies like Uber or Google, there are still meaty technical challenges that haven’t been solved before.

What disruption is good in healthcare and what may not be?

The good disruption comes in places where companies can plug into an existing experience that patients go through to solve a problem and figure out new ways to address that problem. In the pharmacy space, we are disrupting the brick and mortar pharmacy experience that is effectively in the business of selling you Coca-Cola while you wait for your medication. 

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