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

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

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Blog | Alto Pharmacy

While fertility treatments like in vitro fertilization (IVF) have become an increasingly common path to parenthood, helping millions of individuals conceive throughout the past four decades, they remain a significant financial investment.

How Alto Lowers the Cost of Fertility Treatment Through Better Medication Management

Fertility medications used to support egg production, retrievals, and implantations frequently factor heavily into the overall cost of treatment. An average IVF cycle costs between $10,000 and $15,000, with medications an additional $5,000 or more depending on factors like a patient’s age and health history and a clinic’s treatment approach. Unfortunately, a portion of these medications often go unused, as many fertility treatment plans involve last-minute medication changes unsuited for the traditional retail pharmacy model.

As part of our commitment to your financial well-being, we offer a medication management experience that reduces fertility medication waste to lower the cost of treatment, developed in collaboration with Progyny. Take a closer look at our approach.

IVF is a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy. Multiple medications are used on a precisely timed schedule to grow follicles — fluid-filled sacs in the ovaries that potentially contain an egg — retrieve eggs, and, finally, implant a fertilized egg into the uterus. 

Here’s a snapshot of a typical IVF medication schedule:

Days 1-4: stimulation medications such as Gonal-f®, Follistim®, Menopur®, or Low-Dose hCG to stimulate egg production, so that you produce multiple follicles

Days 5-10: continuation of stimulation medications and introduction of antagonists such as Fyremadel™ (ganirelix acetate) and Cetrotide® to prevent premature ovulation

Days 10+: trigger shots of leuprolide acetate, Ovidrel®, and/or Novarel®/Pregnyl® to stimulate final growth spurt and ovulation

After transfer: estrogen and progesterone to support successful implantation of the embryo

Fertility medications are complex, with nightly dosages dependent upon hormone levels measured through bloodwork and ultrasounds. Not only do medication protocols vary from one individual to another, they are typically adjusted throughout the course of a cycle as hormones fluctuate.

Unused medication during fertility treatment

To prevent any missed doses, providers typically prescribe all medications that could be needed in bulk at the beginning of fertility treatment. However, dosages often decrease once a cycle is underway based on a provider’s discretion, ultrasounds, and bloodwork.

At traditional pharmacies, patients undergoing fertility treatment might end up paying for unused medication, as all potential medications are filled upfront. This contributes to the $5.4 billion epidemic of medication waste in the U.S. — one that is particularly acute in fertility, leading some individuals to buy and sell excess medication to each other on social media sites.

Our approach to fertility medication management

Alto has partnered with fertility benefits manager Progyny on an algorithm-powered, app-based medication management experience that reduces unneeded fertility medications while protecting the integrity of time-sensitive and personalized treatment plans.

First, we collect fertility cycle information through the Alto app and run the data through the Progyny algorithm to determine exactly what medication volumes are needed for the next phase of treatment. We then prepare a custom order for just the medications that are immediately needed, which are then delivered directly to your doorstep by our courier team. 

You will receive multiple deliveries throughout the course of your cycle, determined by your specific dosing, trigger schedule and other inputs from your clinical team. Carefully timed check-ins and local courier delivery make last-minute adjustments possible. This approach allows you to manage your medications as your IVF cycle progresses, giving you more control over the total amount of medication that you fill.

Additional financial resources for fertility medications

Alto is committed to helping you save as much as possible on your fertility medications. In addition to our personalized medication management approach, we’ll automatically search for savings and connect you with programs that require you to apply directly, including patient assistance programs from fertility medication manufacturers.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono or Ferring Pharmaceuticals. EMD has several programs that lower the cost of fertility treatment, including the Compassionate Care program, which offers income-based assistance for fertility medications that aren’t covered by insurance, and special opportunities for military veterans and cancer survivors.

Ferring Pharmaceuticals also offers financial assistance programs to offset the cost of fertility medications, including the HeartTomorrow program for individuals who elect to freeze their eggs, and special opportunities for military veterans and cancer patients.

Read Managing the Costs of Fertility Treatment for more on Alto’s financial support for fertility treatment and medications.

Choose a flexible and reliable pharmacy partner

Fertility treatment can be challenging, but we’ll be with you every step of the way. To ensure that your treatment plan is followed correctly, we offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

Interested in learning more about how Alto can support your fertility treatment? Request a price quote online or reach out through secure in-app messaging or by phone at 1-800-874-5881.

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

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

Alto’s board of advisors was formed in 2020 to deliver strategic guidance as we work toward a better healthcare system for all. With diverse leadership experience in the industry, our board of advisor members ensure that our efforts are both impactful and efficient, with services grounded in the highest standards of operational excellence.

Meet the Newest Members of our Advisory Board | Alto Pharmacy

Today we’re thrilled to welcome three new members to the board of advisors: Adam J. Fein, Harry Leider, and Brad Fluegel. Their passion and expertise will no doubt be an asset as we focus on reaching even more patients — and delivering even more comprehensive care — in service of our mission.

Read on to learn more about their backgrounds in the industry and join us in giving them a warm welcome!

Adam J. Fein, PhD, is the CEO of Drug Channels Institute, a leading source of industry research about pharmaceutical economics and the drug distribution system. Widely published in academic and industry publications, he also heads the Drug Channels website, praised by readers for its comprehensive and witty coverage of pharmacy benefit managers (PBMs), medication pricing, and other industry topics.

Delivering medications to our patients at the lowest price possible is central to our mission. Dr. Fein’s deep expertise in pharmacy economics supports our ongoing commitment to improve adherence rates by way of more affordable medication options and total price transparency.

“The pharmacy industry has entered a period of structural change. There’s a tremendous need for the cost transparency, efficiency, and commitment to patient well-being that Alto delivers. I’m thrilled to support Alto in building innovative solutions to foundational issues within the industry,” Dr. Fein said.

Dr. Fein holds a doctoral degree in managerial science and applied economics from the University of Pennsylvania’s Wharton School of Business.

Harry L. Leider, MD, MBA brings more than 25 years of experience as a senior healthcare executive to our board of advisors. Since 2018, he’s served as Chief Medical Officer and Executive Vice President of Gelesis, an innovative biopharmaceutical company.

In addition to his current leadership in the biotherapeutic space, Dr. Leider has broad experience in telemedicine, retail healthcare, laboratory medicine, and payor strategies, as former Chief Medical Officer of Walgreens Boots Alliance, Ameritox, and Care Improvement Plus.

Dr. Leider shares Alto’s commitment to driving lasting change within the healthcare system for better patient health. With both clinical expertise and executive experience, he’s spent his career designing programs, services, and intellectual property that improve health outcomes.

“Alto’s pharmacy model brings us closer to a future where everyone can receive the highest standard of care and is equipped to manage their health. I’m personally inspired by Alto’s bold vision for healthcare and look forward to what we can accomplish together,” Dr. Leider said.

Dr. Leider has served on the faculty of Harvard Medical School and the Johns Hopkins Carey School of Business and holds five patents in laboratory medicine.

Drawing on more than three decades of healthcare experience, Brad Fluegel is a strategic advisor to organizations, entrepreneurs, and other industry participants. Most recently he served as Senior Vice President and Chief Healthcare Commercial Market Development Officer for Walgreen Co, where he managed all commercial healthcare activities, from sales and contracting to biopharma relationships and market planning.

Previously, Brad oversaw Walgreens’ corporate strategy and business development as Chief Strategy and Business Development Officer. He also led Elevance (then Wellpoint)’s strategic planning and corporate communications as Executive Vice President and Chief Strategy and External Affairs Officer.

His expertise in strategic planning and operations will allow us to deliver an exceptional patient experience as we continue to grow.

“Since 2015, Alto has proven itself to be a leader in the rapidly evolving digital pharmacy space. It’s a privilege to support their efforts to redefine what’s possible in healthcare, and together we can deliver industry-leading care to more patients,” he said.

Brad earned a master’s degree in public policy from Harvard University’s Kennedy School of Government and a bachelor of arts in business administration from the University of Washington. He also serves as a lecturer at the Wharton School of Business.

Dr. Fein, Dr. Leider, and Brad join three other advisory board members: Dr. James Hildreth, the President and Chief Executive Officer of Meharry Medical College; Jennifer Kent, previously the Director for the California Department of Health Care Services; and Ajay Khatri, previously Alto’s Chief Strategy Officer. 

Dr. Hildreth, Jennifer, and Ajay have offered invaluable guidance as we’ve grown throughout the past two years, and we couldn’t be more grateful for their partnership and support.

Learn more about Dr. Hildreth and Jennifer’s healthcare experience.

Visit alto.com/careers to learn more about our open roles and join us in delivering industry-leading pharmacy care.

Meet the Newest Members of Our Advisory Board

If you are considering freezing your eggs, it’s important to take the financial aspects of treatment into account. Here are our top financial planning tips and resources to support your egg freezing journey.

A Financial Planning Guide for Egg Freezing

Egg freezing — a fertility preservation treatment that allows you to freeze unfertilized eggs and store them for later use — has allowed millions of individuals to leave open the possibility of having children in the future and experience more flexibility in their family-planning timelines.

If you are considering freezing your eggs, it’s important to take the financial aspects of treatment into account. While it’s true that egg freezing is a significant investment of time and resources, there are many options for managing or lowering the costs of treatment so that you can move forward with the process. Here are our top financial planning tips and resources to support your egg freezing journey.

Before you can determine how to pay for egg freezing, it’s important to have a sense of the total cost. Keep in mind that egg freezing expenses are ongoing. In the short term, you are accounting for fertility medications and the egg freezing cycle (or cycles). These costs vary from one individual to another, as your reproductive health — including the number of eggs in your ovarian reserve — will inform your individual medication protocol and the number of cycles needed to retrieve your target number of eggs.

Long-term egg freezing expenses include the cost of storing your eggs and in vitro fertilization (IVF) — the process of thawing your eggs, fertilizing them with sperm, and having them placed into your uterus through a non-surgical procedure — if you decide to use them in the future. The length of time that you store your eggs will impact the overall cost. 

You may not be able to accurately predict all of these variables in advance, but identifying your longer-term reproductive goals and mapping out a vision can help you prepare as much as possible for the total investment. Setting up a consultation with a fertility clinic can be a good first step toward getting the information you need about your reproductive health to plan accordingly. The cost of a consultation typically ranges from $250-500, and clinics typically list these fees on their website or can provide specific information over the phone.

Savings and support from family and friends

Depending on your individual circumstances, you may have money in a savings account that you can use for part of your egg freezing expenses. If you have questions about getting started with a savings account, a financial planner or a budgeting tool like NerdWallet, Mint or Savology can help you determine how much money you may need to seek through grants, loans, and other resources.

You may also have family or friends who are able to contribute. If you are comfortable sharing your egg freezing experience with others, consider using fundraising websites like GoFundMe to reach out to your extended network for donations.

Health insurance coverage and workplace benefits

Some health insurance plans offer partial or full coverage of egg freezing-related costs including medications and IVF. Note that most insurance plans have separate medical and pharmacy benefits. In most cases, professional services provided by your doctor or clinic will fall under medical benefits. Fertility medications will likely fall under pharmacy benefits, though in some cases they may fall under your medical benefits.

If you have a health savings account (HSA) or a flexible spending account (FSA) — two types of pre-tax accounts you can use for healthcare expenses — consider planning ahead to use these accounts to reduce the total cost of your fertility treatments and your taxable income.

In addition, some employers offer egg freezing coverage as part of their employee benefits, separate from your health insurance plan. Do not be discouraged if you learn that your employer doesn’t currently cover egg freezing: employers who offer fertility coverage often do so in response to an employee’s request. RESOLVE: The National Infertility Association, a nonprofit that supports individuals and couples affected by infertility, has resources to help you start a conversation with your employer about fertility coverage benefits.

Your total egg freezing expenses also depend on your choice of fertility clinic. Most clinics can share the total out of pocket costs for egg freezing if you do not have any insurance coverage. As you explore your options, call various clinics to ask about costs with a list of questions prepared in advance. Here are examples of questions to ask:

Based on my specific treatment plan, what is the typical all-inclusive cost?

What is included in the treatment cost and what is not?

Can you provide a detailed list of procedures and costs?

What is the typical cost of fertility medications for my treatment plan?

You may also want to ask if they will store eggs for up to a year as part of the cost of an IVF cycle, which is a common practice at many clinics.

In addition, some fertility clinics offer no- or low-interest payment plans. During your search, ask various clinics about any available financial assistance.

Many individuals and couples fund a portion of their egg freezing expenses through a personal loan. There are companies that provide loans for fertility treatments, with flexible monthly payment options, including Lending Club and CapExMD. Some lenders focus exclusively on fertility, including Origin Finance, and can lend enough to cover the entire cost of the treatment, with plans starting around $250/ month. (Great news: the Origin application fee is waived for Alto customers!)

Regardless of which lender you choose, verify the interest rate and any other fees. Many of these companies have budgeting tools on their websites so that you can get a sense of what your monthly payments will be before you decide to take out a loan.

In addition, many companies and organizations offer grants that help cover a portion of fertility treatment costs. Some are based on income level and demonstrated financial need while others are designed to support specific groups including members of the LGBTQ+ community and people of color.

Fertility for Colored Girls (FFCG) offers grants for Black women and couples.

Men Having Babies, which supports gay men and couples in starting their families through surrogacy, offers income-based cash grants through the Gay Parenting Assistance Program. (If you are starting a family as a gay man, your path to parenthood will likely include an egg donor and IVF but not necessarily egg freezing.) In addition, Family Equality has a list of family-building grants that help LGBTQ+ families afford fertility treatment.

You can also search for additional grant opportunities through RESOLVE.

In addition to applying the loans or grants mentioned above toward your fertility medication expenses, some fertility medication manufacturers offer patient assistance programs in partnership with fertility clinics to further alleviate these expenses.

Read our previous blog to learn more about EMD Serono's financial assistance programs and how to apply.

Your choice of fertility pharmacy matters

There’s one more factor that can significantly impact the cost of your fertility medications: your choice of fertility pharmacy partner.

Alto is committed to your financial well-being alongside your physical health. To help you save as much as possible on your fertility medications, we’ll automatically search for and apply any savings, as well as connect you with any outside programs that require you to apply directly.

We know that managing the costs of egg freezing is just one part of your fertility journey, and we’re here to make the process as easy as possible. We offer free same-day delivery of your medications, with discreet packaging, and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

If you’re interested in learning more about how Alto can support your fertility treatment, you can request a price quote online. 

Despite the initial challenges of a type 1 diagnosis, managing your child’s diabetes does get easier. Here’s an overview of the information you need to manage your child’s diagnosis.

How to Manage Your Child’s Type 1 Diabetes Diagnosis

Your child’s type 1 diabetes diagnosis affects the entire family. As a parent, it’s understandable to feel overwhelmed as you get up to speed on their treatment plan, including insulin therapy,  blood glucose testing, and coordinating with your insurance provider.

“There’s so much information thrown at you right away, and we didn’t know what we didn’t know,” shared Lucinda, a Partnership Manager at Alto whose 5-year-old son was diagnosed with type 1 diabetes last year. “Insurance coverage is particularly complicated with diabetes, even for someone who works in healthcare like me, because you’re dealing with so many medications and supplies that aren’t commonly prescribed.”

Despite the initial challenges of a type 1 diagnosis, managing your child’s diabetes does get easier. By staying on top of daily blood sugar management and surrounding your family with a strong support system, your child will be able to have a healthy, active life — and you will be able to find some peace of mind. Here’s an overview of the information you need to manage your child’s type 1 diabetes diagnosis

Type 1 diabetes is an autoimmune disease in which the body mistakenly destroys the pancreas’s insulin-producing cells. Your body needs insulin to properly convert a simple sugar known as glucose into energy. Without insulin, blood sugar levels rise in people with type 1 diabetes, which can cause life-threatening health complications if untreated.

While type 1 diabetes can be diagnosed in adults, the majority of cases develop during childhood (the condition was once referred to as juvenile diabetes). In some cases, symptoms appear in children less than a year old.

Blood sugar levels typically rise very quickly as the condition develops. Some of the common initial symptoms of type 1 diabetes include increased thirst, frequent urination, extreme hunger, weight loss, and fatigue. Your child may feel very sick within two to three weeks following the onset of the condition.

Insulin therapy is the cornerstone of treatment for type 1 diabetes. Since individuals with type 1 diabetes don’t produce any insulin at all, they need to take insulin every day to maintain healthy blood sugar levels.

Insulin is most commonly administered with a syringe, but additional methods of delivery include insulin pumps and pens. There are five main types of insulin categorized by how quickly they work and how long they last: rapid-acting, regular or short-acting, intermediate-acting, long-acting, and ultra long-acting. 

It’s important to work with your child’s healthcare provider to find the right insulin dosage, as taking too much or too little can cause rapid changes in blood glucose levels. Many people with diabetes need to take a combination of rapid or short-acting and long-acting insulins throughout the day. This best replicates the natural actions of a normally functioning pancreas, which releases a continual supply of insulin with additional bursts when you eat.

Read our previous blog to learn more about getting started with insulin therapy.

The goal of insulin therapy is to keep your child’s blood sugar in a healthy range. For people without diabetes, a typical blood sugar range is 70 to 125 mg/dL when fasting. People with diabetes should typically try to stay between 70 to 180 mg/dL. 

Your child’s healthcare provider will let you know what your child’s blood sugar target range is. Individual blood sugar targets will vary depending on factors like age, physical activity, and the severity of the condition. It will likely change as your child grows.

Daily testing is the only way to ensure that your child’s blood sugar is within their target range. It will also offer insight into how food and physical activity affect your child’s blood sugar levels throughout the day.

As with insulin therapy, checking your child’s blood sugar using a blood glucose meter will become routine. You will likely need to check and record your child’s blood sugar several times throughout the day, including before meals and snacks, before and after exercise, and before bed. Logging results from blood sugar tests is very important for noticing patterns and determining if any adjustments to your child’s treatment are necessary. Apps like Glucose and mySugr are helpful tools that allow you to identify trends over time.

Your doctor will advise you on your child’s individual needs with blood sugar monitoring. You may have to check their blood sugar levels more frequently when they are sick, if their routine changes, or if they start a new medication. A continuous glucose monitoring (CGM) device, which measures blood sugar every few minutes through a temporary or implanted sensor inserted under the skin, is helpful for individuals who need to monitor blood sugar levels more closely. Consult with your child’s healthcare provider about whether or not a CGM device is appropriate.

Carbohydrates increase blood sugar levels more than any other nutrient, so monitoring how many carbs your child consumes every day is another important aspect of blood sugar management.

Advanced meal planning is important, as your child’s daily insulin dosage is based on their insulin-to-carb ratio. They should be able to eat a variety of foods so long as you carefully plan out meals and spread their carb intake throughout the day.

Your child’s healthcare provider can help you determine your child’s target carb ratio. While this is a healthy baseline to aim for, blood sugar naturally fluctuates throughout the day. There may be times when additional carbs are needed to treat low blood sugar, or when extra insulin is required to bring high blood sugar levels down.

By no means should a type 1 diabetes diagnosis prevent your child from staying active. In fact, exercise offers individuals with type 1 diabetes additional benefits like lowering blood sugar and improving insulin sensitivity. 

However, exercise may sometimes cause a drop in blood sugar levels, so it’s important to check blood sugar levels beforehand. Stock up on carbohydrate-rich snacks such as dried fruits, trail mix, or granola bars to treat low blood sugar, keeping in mind that physical activity is often more unplanned and spontaneous with children and adolescents than it is with adults. 

The American Diabetes Association recommends giving 5-15 grams of carbs, depending on your child’s age and weight, for every 30 minutes of sustained physical activity in tandem with frequent monitoring of blood sugar levels.

Low blood sugar is also known as hypoglycemia. For many individuals with diabetes, hypoglycemia occurs when their blood sugar is less than 70 mg/dL. However, diabetes treatment plans are individualized, and your child may have a different blood sugar target range, so be sure to consult with your child’s physician.

There are many reasons why blood sugar may fall, including not eating enough, exercising too much, taking too much insulin, or not taking insulin at the right time. Initial signs of hypoglycemia include feeling sweaty, shaky, and hungry. As blood sugar drops further, additional symptoms include feeling weak, having difficulty walking or seeing clearly, getting disoriented, and having seizures.

If you notice any of these symptoms in your child, check their blood sugar and treat immediately with fast-acting sources of glucose, including fruit snacks, juice boxes, glucose tabs, or glucose gels. In cases of severe hypoglycemia — 55 mg/dL or less for many individuals with diabetes — glucagon can be used to restore blood sugar.

On the other end of the spectrum, a blood sugar of 180 mg/dL or higher is usually considered hyperglycemia or high blood sugar. It frequently occurs when too little insulin is taken for the amount of carbs consumed, but factors like illness, stress, and hormonal changes can also lead to hyperglycemia. Common signs include extreme thirst, frequent urination, or increased hunger.

If you notice any of these hyperglycemia symptoms in your child, check their blood sugar levels and follow the treatment plan your doctor has recommended, which may include a dose of rapid acting insulin, water, or other carbohydrate-free beverages.

A crucial step to preparing for emergency hypoglycemia or hyperglycemia is informing your child’s school of their type 1 diabetes diagnosis. View the JDRF’s back to school checklist for more on what your child’s teachers should know.

You never have to be alone on this journey. In addition to your child’s clinical team, other parents of children with diabetes, who know exactly what you’re going through, are a powerful resource. And for Lucinda and her family, growing a strong support network has been invaluable.

“Your child’s diabetes diagnosis changes everything in your life, and that’s the part that people don’t always get to discuss at the doctor’s office,” she said. “I wish I had known to connect with other parents of children with type 1 diabetes immediately.”

Visit the caregiving section of the American Diabetes Association’s online Support Community to start building your own network of parents who are also managing their children’s diabetes.

It’s also important to have a pharmacy that will advocate for your child’s care, as the condition involves a steep learning curve with medications and supplies.

“I never felt supported by a pharmacy until I used Alto for my son’s diabetes medications,” Lucinda said. “Questions about insurance coverage are handled seamlessly, and as a busy working mom, it’s so helpful to be able to quickly schedule a delivery in the app.”

She added, “With diabetes, any pharmacy missteps like improper medication packaging or storage can be life-threatening. It brings me so much peace of mind to know that I never have to worry about that with Alto.”

A diabetes pharmacy partner you can rely on

Alto is with you every step of the way in managing your child’s diabetes. We make it simple to follow the treatment plan your child’s doctor recommends, with proper packaging of temperature-controlled medications and free same-day delivery right to your doorstep.

We also offer extra support to address the challenges that are specific to managing diabetes, like getting started with insulin therapy. Our pharmacists are available to walk you through your child’s first insulin doses and discuss any symptoms or side effects to determine if an adjustment is needed.

And since a diabetes diagnosis brings lots of new insurance terminology related to your child’s medications and supplies, we compiled a guide that breaks down the key insurance terms you’re likely to encounter. We’ll tackle the administrative legwork, too, coordinating with your doctor’s office and submitting any necessary paperwork, so that you can focus on your child’s care instead of phone calls with your insurance provider.

Get started or learn more about Alto by reaching out at any time via phone at 1-800-874-5881 or in-app messaging.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2020 Diversity, Equity & Inclusion Report

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. 

Bad disruption would be anything that goes against protecting a patient or their privacy. At Alto the engineering and security teams are tightly coupled so that we can best solve for the needs and privacy of our patients.

You mentioned technical challenges. What would engineers and other technical people get excited about in this space?

We don't yet have our architecture mapped out for scaling 100x on our business over the next couple of years, and it’s been really exciting to start to discuss our technical plans to enable that. At Uber, we went from a monolith to a full micro SOA (Service-Oriented Architecture)—both extremes that had quite a few problems as implemented. At Alto, we aim to find a better middle ground. 

Additionally, we need to think about what the pharmacy experience will look like five to ten years from now and start building some of the pieces that will work us toward that future. Safety and accuracy are incredibly important to us now, but at one hundred times our scale, we’ll need to be constantly innovating our technology so that we can minimize / eliminate errors in our operational process. 

We’re also bringing data silos together that have never been joined before. For example, as many as 50% of prescriptions are not picked up for retail pharmacies. Doctors have no idea which of their patients pick up medications or not. Insurers don't know what happens to patients after they take their medication. We are the interconnect between all of these customers.

As we grow, that data is going to grow inside of our systems. The information and the insights that we can derive from it is going to be incredibly powerful. But we're going to need a ton of awesome data analysis, products that allow us to collect the data while respecting patient privacy, etc. I'm really excited about that.

What are you most proud of from your time at Alto so far, and what are you most excited about in the next year?

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