Expires 04/01/2021

Specialty Pharmacy

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Alto Pharmacy Technician

Alto Pharmacist

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

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

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

Alto / Blog

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. 

If generic and brand-name medications work the same way, what accounts for the disparity in price? Let’s unravel the facts to discover how this system works. 

What’s the Difference between Generic and Brand-name Medications?

What’s the difference between generic and brand-name medications? 

We tend to feel mistrustful of anything we deem a “knockoff,” assuming we’ll end up with a lesser version of the real thing. With “we get what we pay for” a familiar refrain, we learn to associate better quality with a higher price. So when it comes to generic medications, which can cost 85% less than their brand-name counterparts, it’s no wonder we may cast a suspicious eye. However, unlike a bootleg movie or copycat handbag, generic medications are tightly controlled by the FDA, ensuring they offer the same safety, quality, and results.

Is a generic medication exactly the same as the brand-name version?

According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.” In order to get approval, a generic medication must have the same dosage, strength, safety, manufacturing standards, quality, and effectiveness, and it even needs to be administered in the exact same way.

There is some room for variability between the different versions, however. As C. Michael White, Pharm.D., Professor and Head, Department of Pharmacy Practice, University of Connecticut, explained in an article for the Huffington Post, “the [generic] pill needs to get you within 10 percent above or below the blood concentrations achieved with the brand for the FDA to approve the generic, and in reality, they only usually vary by 3-4 percent in one direction or another. So yes, they are very similar in terms of the active ingredient...Most people will never notice a difference.” According to the FDA, this level of variability is unlikely to have an impact, and could also occur between two batches of the same brand medication. 

Additionally, the inactive ingredients, or the ones with no therapeutic purpose, may differ. Manufacturers might use different binding materials, dyes, and preservatives, but they must prove to the FDA that they’re safe. It is possible, however, that you could be sensitive or allergic to something that’s in one particular version but not another.

How do the different versions come about?

When a brand-name medication enters the market, it is protected by patents and granted a period of exclusivity. In other words, the company that first created the medication has the sole right to sell it for a certain period of time. It takes an incredible amount of money to develop a new medication and see it through the necessary clinical trials—it’s estimated between $2-3 billion per new drug—so this helps drug companies recoup some of that cost. 

Most drugs are granted protection from competition for 5 years, though it can be more or less under certain circumstances. Once the period of exclusivity expires, generic versions of the medication are allowed to seek approval from the FDA to enter the market. 

Why are the generic versions so much cheaper?

Generic medications usually (but not always) cost much less than their brand-name counterparts because they do not have to repeat the expensive research and clinical trials that brand-name drugs undergo to prove they’re safe and effective. Plus, once one or more generic versions enter the market, competition can help drive down the prices. 

So a generic medication can really achieve the same effect for a fraction of the price?

In most cases, yes. According to Harvard Health Publishing, “The bulk of research out there shows that taking the no-name brand not only saves you money, but also provides you with a medication that is just as effective as the original.”

That being said, individual sensitivities can vary, so listen to your body and always report side effects to your doctor. 

If you’re prescribed what is known as a “narrow therapeutic index drug (NTI),” your doctor may recommend that you stick to the brand-name version. That’s because small changes in blood concentration can either render these medications ineffective or possibly cause harm. If you are taking an NTI, such as certain antiseizure medications and blood thinners, it doesn’t mean that you can’t switch to a generic version if it’s available. You’ll want to fully discuss it with your doctor and ensure that you’re closely monitored if you’re cleared to make the switch. 

And again, it’s possible to have sensitivities to a specific version of your medication. If you experience side effects after switching to a generic drug, you may want to consider resuming the brand-name version or trying another generic option. 

Unless your doctor has specified that your prescription is only for the name-brand medication, your pharmacist can suggest a generic option instead. Your insurance company may even require that you take the less expensive generic option or pay the difference for the brand-name version. The team at Alto will always help you find the best price for your prescription by presenting you with all of the options. If you’re curious about whether a generic version is available for any of your current prescriptions, we’d be happy to talk it through with you. Our pharmacists are just a chat, text, or phone call away.

In the world of prescription medications, “brand-name” doesn’t mean better. Most of the time, you can achieve the exact same results for a fraction of the price with a generic drug. According to a report by the IQVIA Institute, generics account for approximately 90% of all prescriptions but only about 20% of the overall costs. They estimate that generic medications saved the U.S. healthcare system $1.67 trillion from 2007 to 2016. If you’re cleared to take a generic version of your prescription, you can do so with full confidence—and hopefully some hefty savings. 

Did you know Alto will conduct price investigations for you? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; call or text 1-800-874-5881 or download the mobile app for secure messaging.

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

When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

What’s the Difference between Type 1 and Type 2 Diabetes?

Put very simply, diabetes is a health issue that affects how the body converts food into energy. This simple understanding is complicated, however, by the fact that it’s actually a term for several conditions. When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

Your cells use a simple sugar called glucose for energy. Your body obtains it by breaking down the carbohydrates that you eat. Once the glucose enters your bloodstream, your pancreas releases insulin in response, which promptly helps move the sugar out of your blood and into your cells. In a person with diabetes, however, one of the following things happens: 

The pancreas does not produce any insulin at all

The body doesn’t respond to insulin in the right way, which is known as “insulin resistance.”

Without treatment, a person with diabetes will develop a condition called high blood sugar, which is just as it sounds—too much glucose in the blood. This can lead to serious and even life-threatening complications such as heart disease, vision loss, kidney disease, or nerve damage. There is currently no cure for diabetes, but it can be managed through lifestyle interventions and, depending on the type, oral medication and/or insulin injections. 

According to the Centers for Disease Control and Prevention (CDC), over 34 million Americans, or about 1 in 11, have diabetes. In addition, it’s estimated that 1 in 3 adults are currently at serious risk of developing type 2 diabetes, meaning more than 40% of American adults are in some way affected by this disease. In case you glossed over that last statistic, we’ll let it sink in again. Experts believe that nearly half of all American adults have either diabetes or prediabetes. 

To understand this disease’s startling prevalence, let’s take a look at how and why each type occurs. 

Type 1 diabetes: The immune system on the attack

Type 1 diabetes is an autoimmune condition that occurs when the body mistakenly attacks the pancreas with antibodies. This destroys the pancreas’s insulin-producing cells, meaning people with type 1 diabetes don't produce any insulin at all and must rely on insulin injections to control their blood sugar. 

Because type 1 diabetes commonly begins in childhood, it used to be known as juvenile-onset diabetes. However, it can happen at any age to people of all races and body sizes. The CDC estimates that it affects nearly 1.6 million Americans, making it much rarer than type 2 diabetes.

Symptoms of type 1 diabetes usually come on very quickly and can include excessive thirst or hunger, frequent urination, sweating, nausea or vomiting, and weight loss. The cause is unknown, but genetics plays a role and those with a family history of type 1 diabetes are at increased risk. If you experience these symptoms, it’s important to contact your doctor right away.

Type 2 diabetes: A silently growing epidemic

In the case of type 2 diabetes, the pancreas is usually able to produce some insulin. The problem is either that it’s not enough insulin or the body isn’t able to use it properly. This means glucose doesn’t easily reach the body’s cells to provide essential fuel. 

Type 2 accounts for over 90% of all people with diabetes. It develops over the course of many years due to a mix of genetic, lifestyle, and environmental factors. Unlike in the case of type 1 diabetes, those at risk for type 2 can often prevent its onset through lifestyle interventions such as losing weight, eating healthy, and staying active. 

This high-risk phase is known as prediabetes, and occurs when a person’s blood sugar levels are significantly elevated, but not high enough for a type 2 diagnosis. It’s estimated that more than 88 million adults have prediabetes and 85% of them have no idea. 

So how do you determine if you’re within this group? Well, you could be at higher risk of prediabetes if you are:

Black, Hispanic/Latino, American Indian, Asian American, or Pacific Islander (The reasons are not yet understood, but researchers have found varying rates of diabetes among different racial and ethnic groups)

High blood pressure or take medication for it

Low HDL cholesterol and/or high triglycerides

Been diagnosed with Polycystic Ovary Syndrome (PCOS)

Falling into just one of these categories puts you at higher risk, however they do not mean that a diagnosis is in your future. Staying active and eating well is the best way to lower your risk.

Indicators of type 2 diabetes include tingling in the hands and feet, excessive hunger or thirst, fatigue, frequent urination, slow-healing cuts and bruises, and blurry vision. Quite often, however, there are no symptoms at all or they develop very gradually. If you’re feeling uncertain, talk to your doctor. They may recommend an A1C blood test to check your average blood sugar levels over the past few months. The American Diabetes Association offers a free one-minute test that can help you or a loved one learn more about your risk. They also provide a variety of tools focused on preventing or managing a diagnosis, from recipes to fitness plans.

Since a type 1 diabetes diagnosis means you cannot produce your own insulin, you will require regular insulin injections and frequent testing of your blood sugar levels. Even with an insulin prescription, meal planning and daily exercise will help to further regulate your blood sugar. The important thing to remember is that this disease is manageable and it doesn’t have to mean being held back in life. The American Diabetes Association puts out a magazine called Diabetes Forecast that’s full of information, recipes, and fitness tips and there are many online communities you can join for advice and support.

Managing your insulin prescription might feel overwhelming at first, but the team of pharmacists at Alto will have your back, answering your questions and ensuring the seamless delivery of your insulin and other medications. 

Treatment for type 2 diabetes works a little differently for everyone. You may need to take oral medications or insulin injections, or you might be able to manage it with lifestyle changes alone. 

Oftentimes, treatment includes a mix of several oral medications and/or insulin. To minimize confusion over multiple prescriptions, the Alto app can help you easily manage everything in one place and set up automatic refills. Not to mention, our team of pharmacists will always be standing by to offer guidance. 

But whether you need a prescription or not, eating right and exercising will be extremely important parts of your life with type 2 diabetes. A healthy lifestyle will help keep your blood sugar stable, maintain healthy cholesterol levels, and control your blood pressure. The American Diabetes Association offers free resources that can help you get started, and you certainly won’t be alone. There are many millions of people currently living and thriving with type 2 diabetes around the world. An online community is a great place to start connecting.

A diabetes diagnosis can be daunting, but it never has to mean missing out on life. Remember, we’ll be here to help you understand your medications and set up a delivery plan that fits into your schedule. 

Looking for a partner to help you manage your prescriptions? Our team is available to answer your questions from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text, or the app.

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

In this post we’ll define what a prior authorization is, 3 tips to plan for them, and how Alto provides support in the process.

What is a Prior Authorization?

Imagine going to your doctor’s office and receiving a treatment plan only to learn that your medication or procedure needs approval, commonly referred to as a prior authorization (PA). This might seem odd given that your physician recommended your prescription or procedure as the best option. However, the approval isn’t required from your doctor but rather your insurance company. This is to ensure that the treatment complies with their coverage standards. 

A prior authorization is a request to your insurance company for coverage of certain medications or medical procedures. You can think of a prior authorization as the “green light” to proceeding with your physician’s recommended treatment plan. Insurance companies typically require this approval process for the following situations: 

Medications that may be misused, abused or have adverse effects

Medications that are new to market and not yet listed on insurance formularies (i.e. may be at a higher cost than other drugs that are similar/more cost effective) 

Medications that your doctor prescribed to treat a condition other than those officially approved by the FDA, also known as "off-label use”

Medical treatments or procedures where medical necessity requires assessment

Why are Prior Authorizations so Important?

A recent study shows that 1 in 4 doctors believe the prior authorization process has a disadvantageous effect on their patients’ well-being due to delays caused in treatment. Despite this, prior authorizations remain a key part in gaining insurance approval. Put simply, this is their way of “gatekeeping” cost effective coverage appropriate for each patient. 

At Alto, we understand why insurance companies want extra due diligence on expensive or risky medications, but we don't think patients should have to navigate this complicated world on their own. And these hurdles/hoops should never substantially delay access to treatment. That’s why we proactively file prior authorizations when they are needed, ensuring there are no delays. In fact, we have a dedicated support team who works closely with your doctor’s office the moment a prescription comes in that requires approval. We’ll also always keep both you and your physician in the loop throughout the process so you know the current status of the request. 

Ask your doctor if a prior authorization might be necessary when discussing treatment 

Consider a pharmacy, like Alto, that is action-oriented in filing prior authorizations (and we offer this support for free!)

Don’t be discouraged by the process. While this might be an extra step it’s likely to save you from paying full-price. 

Regardless of whether or not you may need a prior authorization now, it’s helpful to understand what to expect so that you are prepared. In the event that the prior authorization request is denied, we will work directly with your doctor to either process an appeal or find covered alternative treatments so that you don't have to. 

In some cases such as fertility medications, we will help you to understand your out-of-pocket costs and to identify alternative sources of financial assistance to ensure you're getting the best possible prices. Gaining access to your medications isn’t limited by a prior authorization, and with the right pharmacy partner you can feel confident that you’ll have an advocate on your side. 

Questions about Alto or our cost savings approach? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text or the app.

In this post we'll explain what causes medication side effects, how to manage them, and provide 5 suggestions to remedy. 

How to Manage Medication Side Effects

From the occasional skin rash to more chronic illnesses such as diabetes, prescription drugs are often critical in treating or even preventing symptoms and improving overall quality of life. All medications carry the potential for complications or other symptoms known as side effects. From periodic nausea or upset stomach to more adverse effects such as liver or heart problems, each medication carries its own potential for introducing ailments unrelated to the original diagnosis. In this post we'll explain what causes side effects, how to manage them, and provide 5 suggestions to remedy. 

What is a medication side effect and why does it matter?

Put simply, medication side effects are unexpected reactions that can occur as a result of using a prescription, over the counter medication or herbal supplement. There are two types of side effects: common and adverse. Common side effects are generally described as “normal” after-effects of treatment such as constipation, dizziness, dry mouth, headaches and skin rash. Adverse side effects are much more serious and can include internal bleeding, kidney damage and heart dysfunction among other symptoms. 

The main difference is that common side effects are unwanted, but known, while adverse side effects are unintended, and often not accounted for in treatment plans. Side effects can vary with all medications, so it’s important to understand what is common and what is adverse with the particular medication you are taking. Side effects are also not always dose dependent, meaning that they can occur at any dose or strength; some side effects, however, are worse or more pronounced the higher the dose. It's always important to take the medication as prescribed by your provider and to not increase your dose without first consulting your physician.

1) Communicate with your healthcare professional: Informing your healthcare provider of any allergies or known reactions to medications before starting a new medication can reduce the possibility of side effects. Be sure to also include all disease states past and present as this will help your doctor make the best choice for your medical care. New patient intake forms or patient portals usually provide an opportunity to list any known reactions to medications. Otherwise, be sure to update your doctor if anything has changed since your last visit. 

2) Discuss current medications: Transparency is key for all members of your healthcare team. If you have multiple doctors or pharmacies for different treatment plans, be sure to keep them each informed of all your current medications, including over the counter medications such as pain relievers and wellness supplements such as multi-vitamins or herbal supplements. Full-service pharmacies like Alto make it easier to track all of your medication needs in one place.

3) Review the patient package insert (PPI) included with your prescriptions: All prescriptions include a PPI that contains information on the medication, indications and usage, contraindications, warnings, precautions, and dosage administration. This is a quick way to reference any possible side effects so that you know what to be on the lookout for. Take the time to read it and reach out to your prescribing physician or pharmacist with any questions. 

4) Contact your pharmacist: Pharmacists are responsible for patient safety and often act as the bridge between a patient and physician when there are questions about a patient's medications. Pharmacists review all of a patient's current medications to identify any potential adverse effects, and are available to answer questions about your medications' intended use and effects. Look for pharmacies that make it easy for you to ask questions; Alto's pharmacists are available via phone, text and secure message in our mobile app.

5) Be open to alternatives: Stay in contact with your doctor to discuss potential changes to your treatment plan if side effects present a problem. Your physician can evaluate other medications or treatment options if appropriate; simply forgoing treatment without consultation with your healthcare provider presents additional risks and is not advised.

Keep in mind that not all medications will produce side effects and not all side effects will be significant enough to change the course of your treatment. It’s important to pay attention to how you are feeling both before and after taking prescribed medications and to always stay in touch with a healthcare provider to discuss any unexpected symptoms or changes. For more information on how to manage your medications check out this article from Alto.  

Looking for a partner to help you manage your prescriptions? Our team is available to answer your questions from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text, or theapp.

A personal health journey with hyperthyroidism, Graves’ Disease, and Horner's Syndrome led Alto's Head of Talent to improve the patient pharmacy experience.

Alto's Head of Talent Shares His Personal Health Journey

As a patient, I dreaded my pharmacy experience. So I joined Alto to change it. 

My first sign of hyperthyroidism showed up when I was 20 and my struggle with pharmacies started soon after. It would be more than a decade before I found a way to be a part of solving this industry’s problems.

When I first heard about the opportunity at Alto in 2019, I actually laughed. Why would I want to work at a pharmacy? I hated pharmacies. But the recruiter I was working with convinced me to reconsider and after speaking to Jamie, one of the founders, I understood. Alto was unlike any other pharmacy out there. In fact, they weren’t just a pharmacy. They were on a mission to improve patients’ quality of life. I jumped at the chance to fix a broken industry that is hungry for innovation.

I had just come back from a trip to New York and went for a routine run around the neighborhood. I was so drained after running one mile that I had to stop and sit down. This didn’t make sense; at 20, I was in the best shape of my life. As the next few weeks went on, the symptoms worsened: severe chest pain, shortness of breath, and anxiety attacks. Being the stubborn athlete I am, I pushed through it, until one day, I blacked out during a run and woke up lying face down in the dirt. Around that same time, I developed a lazy eye and finally decided to go to the doctor.

After that delayed visit I was diagnosed with hyperthyroidism, Graves’ Disease, and Horner's Syndrome. My standing heart rate was 105, or about 50 BMP more than it should have been! I'm so thankful for my family members and the doctors who acted quickly to get me medical care. While my treatment plan was straight-forward, my experience as a patient on prescription medications became a nightmare. I quickly learned how inconvenient, impersonal, and non-patient-centric the pharmaceutical industry was.

I tried pharmacy after pharmacy, and the issues and frustrations remained the same. My script would be sent to the wrong address, or I’d receive the wrong dosage and brand of medication, even though my medication never changed! It became so routine that once a month, I’d block off two hours to talk through my refill requests with the pharmacy. But like clockwork, the same problems would reoccur—year after year after year. Having told my story to tons of other patients and caretakers, I know I’m not alone in this experience.

Like any disappointed customer in the 2000s, I took to the internet to learn more. What I found was alarming. The NPS scores for the leading pharmacies are abysmal. CVS Pharmacy, one of the largest retail pharmacies, has an NPS score of -10. Yes, negative ten. It's also estimated that up to 50% of medications are not taken as prescribed, creating up to $300 billion in avoidable drug costs annually. Even worse, it's estimated that more than 125,000 preventable deaths each year can be attributed to medication non-adherence. That's three times more than deaths from car accidents nationally!

While there was comfort in knowing others felt my pain and were experiencing the same frustrations, I was angry that there wasn't anything being done about it. I was frustrated, both as a patient and as a civilian, and didn’t know how to try to solve the problem. 

Meanwhile, after graduating college, I began my career in Michigan, where I’m from. Working for a recruiting agency, Aerotek, I was hiring for all sorts of roles—from machine operators to janitors—but I always had an interest in tech.  I found out about Barracuda Networks, a security tech company with an office in Ann Arbor. I originally joined to build their data protection division from 20 to 250. Their office was about 20 people and it needed to grow to 250. I had a ton to learn—when I started, I didn’t even know what a software engineer was! My role evolved quickly, eventually broadening to manage all tech recruiting across the U.S. and later, to building their first international recruiting team.

After almost five years, I started to look at other companies. Quora had been a long-time favorite product of mine. I loved that they connected knowledge with people all over the world. The perspectives I found were genuine, diverse, and fascinating. On Quora, there are professors, industry experts, and people who just got out of prison, sharing their knowledge and experience. I joined Quora to grow their team and jumped into the consumer internet space for the first time. Working there, I learned how to refine and scale processes to enable hiring for balanced and diverse teams. At a certain point though, I was ready for a new challenge, to move outside of an advertising-based business model, and to be in a steep learning curve again.

I had no idea where I wanted to go next. Looking around the Bay Area, I felt that with so many smart, capable people in tech, we could be doing more. I didn’t agree with a lot of what I was seeing, especially in terms of the kinds of problems that were getting the most investment, time, and resources. I’d spent almost 10 years building my career and didn’t even know if I wanted to stay in tech. I’d lost touch with a sense of purpose and meaningful legacy. 

I knew I wanted to have a lot of personal impact, and a mission I completely aligned with. I wanted a company where employees care about the lives they’re touching, the people they’re working with, and the communities they are impacting. And I wanted to work with a small team and grow it. I didn’t know if I could find all of that within Silicon Valley.

Then I got introduced to Alto. I toured the pharmacy, met with the leadership team, and learned about their ambitious plans for growth, and how I could be part of making those happen successfully. The things I noticed during my interview process with Alto are still very real today as an employee, especially the level of empathy people bring to work. Alto was the first place I interviewed where people were truly getting to know me, and understanding the motivation behind my past professional decisions.

I joined Alto in August of 2019 as their Head of Talent. I'm grateful to have the opportunity to work for a company whose culture, people, and mission are centered on supporting others and making a change in an industry that hasn't seen any significant transformation in the last 50 years. We’re seeking to understand but also wanting to be principled in our approach, and not compromise on patient health outcomes. 

Over the last year, the recruiting team has grown from 4 to 30, and our primary focus has been embedding solutions focused on building a diverse workforce. From implementing our first early talent apprenticeships, to building an inclusive hiring process by creating a training culture, we've grown the company from 180 to 750 across 4 states and 7 office locations.

This industry serves a diverse population and I’m learning a ton along the way. Working at Alto allows me to be a part of creating a healthcare solution that will truly be patient-centric. I want to continue to surround myself with people who have the same passion and bring their unique experiences, thoughts, and ideas to help us build tomorrow's pharmacy and fulfill medicine's true purpose: to improve quality of life—for everyone who needs it.

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

Alto’s Head of Talent Shares His Personal Health Journey

Empowering Patients By Accelerating Healthcare Innovation

Mattieu Gamache-Asselin, CEO & Co-founder

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3. The drug requires a Prior Authorization

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

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

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

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

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

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

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

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

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

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

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

Rapidly Growing San Francisco-based Startup Teams Up with Specialty Pharmaceuticals Veteran to Build the Modern Pharmacy

ScriptDash Appoints Dr. Mike Cunningham to Board of Advisors

SAN FRANCISCO, CA; November 3rd, 2016 — ScriptDash Pharmacy, a health-tech startup focused on building the modern pharmacy, announced today that Dr. Mike Cunningham has joined the one year old startup’s Board of Advisors.

Dr. Cunningham was most recently Vice President and General Manager, GPO Services, for McKesson Specialty Health (MSH), a business unit of the McKesson Corporation. There, he oversaw day-to-day business operations and long-term strategic planning for MSH’s group purchasing organizations, Onmark and Unity. Dr. Cunningham has deep expertise in healthcare having spent more than 30 years structuring, developing, and implementing relationships with pharmaceutical companies on behalf of practices and pharmacies.

“Dr. Cunningham has devoted his entire career to oncology and has accomplished remarkable feats in the industry. His reputation precedes him. We are excited to work with Mike as we build the pharmacy of tomorrow together.” — Vlad Blumen, Co-Founder

At ScriptDash, Dr. Cunningham will be a key advisor and partner in securing access to new, limited distribution specialty medications.

“I’ve been very impressed with the senior management team and their desire to significantly improve the patient pharmacy experience through modernization” — Dr. Mike Cunningham

ScriptDash Pharmacy is a year-old software startup based in the historic Dogpatch neighborhood of San Francisco. ScriptDash is disrupting the CVS and Walgreens dominated pharmacy industry of big box retail pharmacy chains by offering free same-day delivery of prescriptions.

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