Expires 04/01/2021

Specialty Pharmacy

We're here to support you through COVID-19 with free home delivery.

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

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

How to avoid postal delays and pharmacy lines with Alto

Concerned about Mail Delays tying up your Prescriptions? There’s a Better Way.

With the pandemic pushing many to avoid lines at the pharmacy, more Americans than ever are receiving their prescriptions through the mail. Last year, over 170 million prescriptions were filled by mail in the United States. According to a recent report, that number has increased by 20% since the onset of COVID-19. 

Recently, sweeping policy changes within the United States Postal Service have led to significant delays, with everything from Amazon packages to mail-order prescriptions becoming increasingly bogged down. Now, two U.S. Senators are voicing serious concerns, saying the delays are putting the health of millions of Americans at risk. 

Switch to a better pharmacy and enjoy free same-day delivery

In a recent investigation of five major pharmacies offering mail-order service, Senators Robert Casey (D-PA) and Elizabeth Warren (D-Mass.) found an increase in average delivery times ranging from 18-32%. That means millions of people with chronic conditions like diabetes, heart disease, and asthma are facing a dangerous dilemma. They can either risk unnecessary exposure to COVID-19 knowing they are especially vulnerable to the virus or possibly go without life-saving medications for days due to delays in the mail. 

Alarmed by the striking slow down, Jacqueline W. Fincher, MD, President of the American College of Physicians, released a statement cautioning that “a delay in receiving a necessary prescription could be life-threatening. My patients who rely on their insulin, or their inhalers, or any other type of medication can’t wait weeks to see whether or not their prescription will be delivered.”

This situation is certainly troubling, however, at Alto, we promise to deliver a better experience. Here’s why our courier service is the best method for ensuring your prescriptions arrive safely and on time.

Same-day, contactless delivery: We skip the mail, preferring to hand-deliver your medications that very day. We also provide contactless drop-offs to ensure everyone stays safe.

Zero risk of in-transit delays: Your prescriptions will never change hands during the delivery process, increasing not only speed, but safety as well

Convenient scheduling: Select from multiple 3-hour delivery windows that work best with your schedule

Real-time tracking: Stay updated throughout the delivery process via text or follow along in real-time in the Alto app.

Always free - There are never any hidden fees—your delivery is completely free. 

We’re committed to helping you lead a healthier life by providing swift and safe access to the medicine you need. Making the switch to Alto is easy. We’ll handle the transfer.

Concerned about Mail Delays Tying up Your Prescriptions? There’s a Better Way.

Sandra Aziz, Alto Pharmacy Launch Manager and Pharmacist in Charge of our Los Angeles location, was recently selected by the University of California San Francisco (UCSF) to receive an “Apple for Excellence in Precepting” award.

From Pharmacist to Professor: Sandra Aziz Spotlight

Sandra Aziz, Pharmacy Launch Manager and Pharmacist in Charge of our Los Angeles location, was recently selected by the University of California San Francisco (UCSF) to receive an “Apple for Excellence in Precepting” award. This celebrated accolade recognizes Sandra for her contributions to the experiential preceptorship program over the past academic year. In addition to this award, Sandra was recently appointed Assistant Clinical Professor at UCSF!

Preceptors are practicing pharmacists who provide guidance and supervision to pharmacy students. They selflessly act as mentors in addition to their already demanding day-to-day responsibilities. Over the last two years Sandra has mentored ten interns at our Los Angeles pharmacy location. Her responsibilities include building curriculums for their continued learning, and acting as a mentor and coach to help students reach their goals. With Sandra’s guidance, eight students were accepted at their preferred residency/fellowship programs!

Read on to learn more about Sandra, what brought her to Alto and how the Gilmore Girls inspired her.

Congrats on being recognized as an exceptional teacher, role model and mentor! How does it feel? 

It’s really rewarding! I spend a lot of time creating detailed syllabi to provide students with a wide range of learning opportunities at Alto that they likely would not get at another pharmacy. It feels great knowing that students value their experience and learnings with us. Even further, when students are interested in coming back and working at Alto post graduation — that’s the best feeling.

What would you tell pharmacy students considering selecting Alto Pharmacy as a placement site for their rotations? 

If you’re looking to experience how a healthcare technology startup operates, you should absolutely consider Alto!

In this unique learning environment, you will gain a breadth of experience working on projects alongside clinical care staff, engineers, operations managers, and product designers. You will be involved in process improvement projects that improve efficiencies, quality assurance and further preventative healthcare. Ultimately, you will be helping redefine how community pharmacies can serve patients and their communities!

Who is/was an influential person in your life and why? 

I always struggle with this question because growing up, my answer was Lorelai and Rory Gilmore from the TV show Gilmore Girls - two strong, well-spoken women who worked hard to be self-sufficient. 

But the most influential person in my life was my dad; no matter what battle he was facing, he always met it with a smile, kindness, and an awful joke. 

You’ve been with Alto now for three years. What do you enjoy most about being a part of the team? 
My favorite thing about working at Alto is that I get to work with folks from a variety of backgrounds and disciplines on a daily basis: finance, product, engineering, etc. It gives me perspective and allows me to see challenges from various angles and problem solve accordingly. 

And finally, what do you like to do outside of work? 

I love looking at real estate, especially being in LA. My RedFin filter is set to $10M+ and any chance I can get to an open house, I absolutely will. Additionally, I have a sweet little black cat named Noodle whose self-designated play time is 2AM. 

If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

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.

At Alto, we believe you shouldn’t have to stress over savings. In this blog post, we’ll share how our team works to reduce your cost.

How Alto Saves You Money on Prescriptions

Finding the lowest price for your medications shouldn’t be a hassle. Yet with countless options like rebates, manufacturer coupons, and discount saving programs, knowing where to start can be confusing. Add to that recent headlines that seem unclear and it’s no wonder the search for discounts often leads to frustration. At Alto, we believe you shouldn’t have to stress over how to save on your prescriptions. 

In this blog post, we’ll share how our team works to reduce your cost for most insurance-covered prescriptions. Keep in mind that certain treatment options, such as fertility, often require additional benefits investigation or aren't covered by traditional insurance. If your prescription isn't covered by traditional insurance we can also help with the approval process. But first, let's quickly review how pricing is set. But first, let’s quickly review how pricing is set. 

Your insurance plan contracts with a pharmacy benefits manager (PBM) whose job is to determine which medications should be covered or not under your insurance plan (even down to the exact dosage and brand that your doctor prescribes). This creates preferred coverage - and therefore pricing - for certain medications.

The PBM negotiates with the drug manufacturers to agree upon a specific price to charge the insurance plan for a medication, the remaining copay that you’ll be responsible for covering, and the PBM’s fee for administering the service.

Pharmacies purchase drugs from third party wholesalers or directly from manufacturers. If you plan to use your pharmacy benefits to pay for your medications, your out-of-pocket price is determined by the PBM+insurance plan. If you’re not using insurance, the pharmacy will provide a cash price.

Some drug manufacturers will also offer coupons, copay cards or financial assistance programs to help patients afford particularly expensive or new-to-the-market medications. 

Confused? Don’t worry. That’s why we’re here to help. 

Need more details? Read Breaking open the black box of medication pricing

We believe medication pricing should be transparent and that you shouldn’t have to investigate savings options on your own. The infographic below compares Alto’s cost saving measures to traditional retail pharmacies and how this impacts your overall cost. 

Every prescription sent to Alto is matched against our database of coupons, copay cards, and other savings options (like manufacturer-sponsored assistance programs). We automatically apply any savings we find so that you can trust you’re always getting the best price. If paying out of pocket will be the cheapest option, we'll be sure to let you know. 
Medications still too expensive? Let us know and we'll work with your doctor to identify alternative medication options, if available. Our price investigation services are completely free. 

A good pharmacy should never leave you to do the pricing legwork on your own. If you’re in the process of finding the right partner for your prescriptions, make sure cost savings assistance is part of the deal. Your financial wellness matters too.

“As a veteran pharmacist, I’ve never witnessed other pharmacies apply the same cost saving services that Alto does automatically,” shares Luisa Nazareno, Patient Care Pharmacist. “Our team understands that price can be a limiting factor in fulfilling prescriptions so we work tirelessly until we can provide our patients the most affordable option. It’s really rewarding to know that we’re helping patients save money and stay on track with their treatment plan.” 

Questions about Alto or pricing on your medications? 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.

Here are some of the most useful tips we’ve found to support healthy aging, no matter your current stage of life.

Aging Well at any Age: Our Pharmacists Weigh in

Aging isn’t something that suddenly happens to us when we reach a landmark birthday. At every moment in our lives, time is marching forward. We tend to think about growing older with dread, but given the chance to go back and relive a former decade, most of us would prefer to stay right where we are. For all it’s advantages, youth isn’t easy, and the wisdom we gain throughout our lives is hard-won. 

The secret to aging well is learning to roll with changes as they come while putting strategies in place to support better health. Science is revealing new insights about longevity all the time, and we’re learning that it’s never too early—or too late—to slow the less desirable effects of time. Here are some of the most useful tips we’ve found to support healthy aging, no matter your current stage of life. 

Right now, you might be grappling with subtle signs of aging for the very first time, or it could be the furthest thing from your mind. Nevertheless, the habits you create now can set you up for a lifetime of wellness. 

We know you’re probably tired of hearing it, but one of the most common regrets we hear among older adults is a lack of diligence about sunscreen. And critically, we now know that more than half of UVA rays—the main contributor to skin aging—can penetrate glass. If you sit by a window at work or spend significant time in your car, you’re exposed to these damaging rays much more than you think. Wear sunscreen every day, use at least SPF 30, and reapply often. To make it really easy on yourself, choose a moisturizer with SPF built in so you start each day with effortless protection. We promise you, your future self will thank you. 

Whether you’re staying out late, pulling all-nighters in grad school, or enduring round-the-clock feedings as a new parent, these decades aren’t exactly known for healthy sleep. With so much going on, it’s tempting to push back bedtime and steal a few more hours of productivity. However, those stolen hours are subject to diminishing returns and often end in complete burnout. Researchers have found that being chronically deprived of sleep can cause an increase in the stress hormone cortisol, impaired immune function, a decline in cognitive function, and changes in mood. And when dealing with fatigue, poor focus, and low endurance, you’re certainly not going to enjoy your next workout or outing with friends. Sleep is the best investment you can make for your health, happiness, and productivity, offering the sustained energy you need to be at your best. 

Life can be exciting and busy right now. You may move around, change doctors, or just generally be distracted by the experience of living. Do yourself a favor and keep a log of your doctor visits, test results, treatments, and prescriptions. Make note of the date, issues discussed, and any notable outcomes. If you’re an iOS user, Apple Health lets you store medical records, log symptoms, and track health trends over time. You can also sync up a variety of third-party apps to see all your health data in one place. Health Champion offers an alternative app with similar features—symptom tracking, electronic health records, connected data from other wellness apps, and even a health journal and timeline. If you have trouble remembering to take your medications, the Alto app can help you set up dose reminders and automatic refills. Starting these habits now will help you manage your health and notice any issues earlier, which can make a huge difference down the line. 

After overcoming outdated notions about middle age, many find that these decades are truly the prime of their lives. While this is usually when you’ll begin to notice the physical signs of getting older, there’s plenty you can do to support healthy aging and stay on top of your game.

Researchers have found that after 30, we lose approximately 3-5% of our muscle mass every decade. This might not sound like a lot, but it could add up to almost a third of your total muscle mass over a lifetime. The good news is, you can improve this outcome with a consistent fitness routine. Aim for 30 minutes of moderate aerobic exercise a day with strength training several times a week. 

As we pour ourselves into developing careers and starting families, our friendships often take a back seat. But now, with the mounting responsibilities of your 30s finally leveling off, it’s important to return some of your focus to your social circle. Recent studies have revealed that loneliness can shorten life expectancy by up to 15 years—proving just as detrimental to your health as smoking 15 cigarettes a day. 

In today’s hyper-busy world, stress is unavoidable. But it’s how we manage our stress that determines its impact on our health and well-being. Developing the skill of emotional resilience helps you roll with challenges as they arise and maintain a positive outlook. Practices that encourage introspection, present moment awareness, and relaxation will help you build resilience and become better at managing stress. Meditation often comes to mind first for good reason, but other great options are yoga, walking, or tai chi. And don’t underestimate the power of slowly savoring a cup of tea, spending time in nature, or closing your eyes and deepening your breath. What matters most is that your practice works for you.

Everyone ages differently, and though your previous lifestyle will play a large role, it’s never too late to make positive changes that you’ll see and feel. There’s a reason they call this phase “the golden years.” 

Studies show that daily exercise is incredibly important for longevity. It can add years to our lives—no matter what age we get started. Not only will exercise increase physical strength and vitality, but it can also prevent memory loss and cognitive decline. In fact, recent research has even shown that exercise actually makes our cells biologically younger. When researchers analyzed DNA samples from highly active participants, they appeared to be years—even decades—younger than their actual age. With results like these, staying physically fit may be the closest thing we have to the fountain of youth.  

We often fall into old habits later in life or subscribe to the myth that learning is for the young. This couldn’t be further from the truth. Now is the ideal time to pursue your interests, learn new skills, and mix up your routine. Not only will it help to keep your mind and memory sharp, but it will ensure you stay invigorated and inspired.

The food we eat is a means of expression and enjoyment. It also has a huge impact on our overall health. The simplest way to maintain a healthy diet is to experiment with your cooking. That way, you’ll eat a wider variety of whole foods. You might try swapping out red meat for one of the new plant-based alternatives that are barely discernible from the real thing, or adding a rotating lineup of sautéed vegetables to your favorite pasta sauce. Subscribing to a health-conscious cooking newsletter is a great way to stay inspired. Challenge yourself to try three new recipes every week. Not only will you unleash your creative side and enjoy new flavors and textures, but you’ll also ensure you’re getting the nutrients you need. Keep in mind that sometimes certain health conditions or medications can affect your appetite or sense of taste. Talk with your pharmacist about the potential side effects of any current or new prescriptions. Alto’s pharmacists are always standing by to answer your questions by phone, text, or in-app messaging.

Aging is certainly not the slow decline that many of us imagine. Rather, each season of our lives brings new challenges and opportunities. Healthy aging isn’t just about staving off illness; it’s about living our lives to the fullest. If we continue to put effort into our health and well-being, we will continue to reap the rewards. Rest assured, our best days are always ahead. 

Questions about Alto or interested in transferring your prescriptions? 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.

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.

We took the best parts of the software engineer interview process from the places we’ve previously worked and interviewed, eliminated stuff we thought wasn’t relevant, and added our own special Alto ingredients!

What to Expect When You Interview as a Software Engineer at Alto

Thank you so much for considering an interview at Alto! At Alto, we’ve devoted a considerable amount of time refining how we interview candidates for software engineering roles. As engineers, engineering managers, and recruiters at a rapidly growing company, this is a big part of our jobs and we want to get it right: for the candidate, for ourselves, and for the team. We took the best parts of the interview process from the places we’ve previously worked and interviewed, eliminated stuff we thought wasn’t relevant, and added our own special Alto ingredients. Let’s dive in!

What does a Software Engineer at Alto do?

First and foremost, Alto exists to serve our patients--whether that be via building products, or providing exemplary service. Engineers at Alto are empowered to go the extra mile to make an impact for our patients, medical providers, and amazing pharmacists and care professionals. We are organized into small mission-focused teams where you will be working closely with Product Managers, Designers, Data Analysts, Data Scientists, and our Care team. Alto Engineers enjoy this cross-functional, collaborative environment where everybody has a voice in the direction of the product and the team. Compared to other companies, we are more end-user focused in most of our teams, even those that work primarily on platform and infrastructure.

Our pragmatic focus on impact includes making sure that we fulfill our company value of Patients Come First. We have a strong culture of code reviews, testing, documentation, and knowledge sharing to ensure that the service consistently meets our patients’ and providers’ expectations for quality and reliability.

Developing a Predictive Interview Process to Reduce Unconscious Bias

We want our engineering team to look like our customers — and we strive to serve everybody. Our mission is to fulfill medicine’s true purpose — to improve the quality of life — for everyone who needs it. In order to effectively carry out our mission, we believe our engineering team should reflect the rich diversity of our customers. Our engineers come from all backgrounds and took many varied paths to arrive here: self-taught, coding bootcamps, and top-tier universities. Prior experience ranges from none to decades at large public tech companies with many joining from other startups and consulting/contracting backgrounds. Reflecting this, we’ve put together an interview process that focuses on predicting job success over testing for rarely-used computer science knowledge and encourages hiring diversity of all kinds rather than filtering for a certain type of engineer.

Throughout the interview, we work on problems that are facing Alto today or that we’ve dealt with recently. Our interview questions rarely have a “right” answer, and if you are writing code, any language works. (We spend our time mostly in Javascript, Ruby, and Go.) Occasionally, you will have more than one interviewer in the session. This is likely because one interviewer is shadowing the other to train, get calibrated, and learn how to deliver and interpret the questions while minimizing bias.

This is a quick chat with a recruiter or a hiring manager to further expand on your experience, capabilities, and interests. Based on this, we’ll have a good idea for which team(s) you would be the best match.

This screen aims to validate your technical skills. You’ll be working in a networked IDE (like CoderPad) with an Altoid (what we call ourselves) to write and run code that addresses a typical problem that you might face at Alto. We’re looking for fluency in the language of your choice and some fundamental object-oriented programming design skills. 

This is based on a typical task that you might face at Alto - something like designing or interfacing with an API. You're welcome to use StackOverflow, Google, or any other resources at your disposal—including your interviewer! We’ll be observing how you understand the problem, communicate with your interviewer to develop requirements, and get to working and well-tested code. 

In this section, you’ll spend some time getting to know a problem we have faced. You’ll spend 10-30 minutes working on how to approach and optimize a challenge that impacts our business everyday, then show that you can translate that into working code.

This module varies depending on your experience and interests. For some folks, we dive deeper into software design and learn how you would break up a hypothetical application into core modules. For senior frontend developers, this might be an app architecture challenge. And for senior backend developers, we’ll address systems architecture with an eye toward scalability, observability, and technology choices. In every case, we’re looking closely at how you approached the problem, gathered requirements, and justified your decisions.

The Engineering Manager is trying to deeply understand who you are as an engineer and a person. What do you get excited about? What type of roles do you like taking on within a team or project? What is your career arc and how can you best advance that at Alto? The questions often asked are behavioral or hypothetical in nature, and we love to hear stories about your proudest accomplishments and challenges you’ve overcome.

“I had an amazing interview experience with Alto - although the recruiters were super busy, they made sure to accommodate my timeline," shares Jacinda Zhong, Software Engineer, Core Services at Alto.  "I was really pleased to find out that Alto asks questions based on the type of work I’d be doing - no obscure CS concepts, and questions centered around complex business logic that you’d encounter working at Alto. Before my onsite, my recruiter gave me a call to provide context on what they’d be asking. No gotchas and no surprises, plus lots of detail so that I could be prepared to do my best. So excited to be working here and contributing to a great mission!”

The interviewers get together promptly—we try to do it no later than the next day—to discuss next steps. Prior to our discussion, we individually assess your performance against a rubric that takes into account your level of experience and the requirements for the role.

There is rarely unanimity in the panel. Almost everybody at Alto was discussed in a panel where there were some mix of Yeses and Nos. Often, we ask ourselves questions like, “What is the candidate’s superpower?”, “What will they add to the team?”, and “For which open role are they the best match?” Our hardest decisions are the ones where we all agree that the candidate is somebody we want to work with but we don’t have exactly the right role.

Don’t be surprised if your interview is slightly different from what is described here. We’re constantly refining our process to get to better hiring decisions more quickly and with less bias with regular feedback from candidates, interviewers and recruiters. 

Have you had an interview experience that you thought was exceptional? Let us know at feedback@alto.com.

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.

In this interview, Alto's third engineer shares how her background and experiences, from her nomadic upbringing to serving as student body president in college, led her to where she is today at Alto.

Building an Engineering Career at Alto 

This interview has been edited for length and clarity.

Elnaz joined as Alto’s third software engineer in 2016, coming from Lob. She has since gone on to shape Alto’s culture and recruiting efforts and rose to become an Engineering Manager. In this interview, she shares how her background and experiences, from her nomadic upbringing to serving as student body president in college, led her to where she is today.

You’ve lived in 8 cities spanning 5 countries and 3 continents! Tell me more about that and how it shaped you?

My family started moving around from a really early age. My dad was a chemical engineering professor in Iran for around 25 years. When my siblings started going to college in the United States, we started moving around to pay for their college tuition. He did a sabbatical in Australia (where I learned English!), a short stint at his alma mater Oklahoma State, time at a research institute in Kuwait, and a few other locations. 

As a result, I’ve been exposed to such extremes in my life in moving from the Middle East to Oklahoma, or between Chicago and San Francisco. I’ve just been exposed to such a variety of people that’s allowed me to both blend in with a lot of different folks, but also be able to be a bridge and a translator. Regardless of whether it's in work or my personal life, I think “passionate” is maybe the most consistent way I would describe myself. I'm either passionate about the work I'm doing or passionate about getting outside for camping and traveling. There's an intensity in all aspects of my life. 

From my past roles, I realized I loved working on cross-functional problems. I stumbled across Alto, eventually realizing that working cross-functionally was such a unique and fundamental opportunity with this company. We would not succeed if engineering sat in one corner and operations in another - we had to work together. The other piece was that I knew I wanted to work on something more meaningful. I felt like I was able to close the loop on what started off my career – working in civic tech and on public interest projects – and do that as a more effective person in the healthcare business. Finally, I wanted to learn more about the business side of things. What I learned in my first job out of school was that nonprofits and civic tech are great, but they don’t work unless you can fund them. I really wanted to find businesses that were viable and also added value.

You were Alto’s third engineer. What was that like?

In retrospect, it was fantastic. I was able to shape the culture, see the evolution of the company, and develop a lot of relationships. For example, I was really passionate about engineering being a partner to the rest of the organization and for us to go into the trenches to understand how the frontlines use our product to figure out how to make things better. I was given a lot of unique opportunities, including working on recruiting to make sure we were building a more equitable interview process, and also ensuring that folks are successful once they got here. I was able to influence Alto’s diversity and inclusion efforts and grow as a leader to pave the path for more people after me.

How was the transition from engineer to management like for you?

The first feeling was just sheer excitement. So much of what I’d been passionate about up until then had been done on the side: building an onboarding program for new hires, building out better interview questions, improving our on-call process. Becoming a manager was validation of how things that I'm good at are not just pure engineering skills, but also things that make engineering more effective. I'd been worried about being perceived as not technical enough, or that the soft skills didn’t matter, and it really validated that what I wanted to work on was valued. The second feeling was, “How do I actually know if I'm doing a good job?” I think that's one of the hardest things when you first become a manager. 

As an engineer, you have these tight feedback loops: you build something, the test runs, and you see the product and the impact. As a manager, you might have a conversation or make one comment to someone only to find out months later what the actual impact of that comment was on the person. I had to get accustomed to slower feedback loops and being more comfortable with less structure.

You were your college’s student government president. Tell me more about that and how it relates to what you do now?

What I quickly learned from that position was that defusing tense situations was my superpower. When there were disagreements between the students and the university, I felt like I could speak to both sides and bridge the gap. That was the first time I really began to appreciate my upbringing of having been exposed to a lot of different cultures and different people. This becomes relevant in basically every intersection at work: how engineering and operations relate to each other, how engineering and design relate to each other, or being able to see different perspectives within the same discipline. 

In particular, I think it was helpful for me to spend time with a design and development firm because I saw the anxiety that designers can have around not solving the problem at the core or being forced to make sacrifices about the fidelity of their solution. Now when I'm working with a designer I make sure they understand when I’m talking about velocity, but I can also put that hat aside and talk about what's possible given a longer timeframe. 

What’s the best piece of advice you’ve ever received?

I've always felt like I've seesawed between coming on too strong or being too shy. The advice I received was to not think about them as binary aspects, but rather celebrate that I have both of those attributes. So when I was weighing the idea of whether I’m really great at people management, does that make me less of a technical person? Or if I'm technical, does that mean I can't be good at the people side of things? I think this advice was really helpful for me to stop seeing it as an either-or choice and recognize I can be great at both. It makes me think of a clip of Dave Chappelle where he talks about advice that his mom gave him that really resonates with me. His mom told him, “Sometimes you gotta be a lion so you can be the lamb you really are.”	

What are you most excited about at Alto in the next year?

Personally, I’m most excited for my parents to be able to use Alto as we expand our service areas so they understand what I've been doing the past three years! Professionally, I'm excited about the big dent we can make in technical scalability, as well as making it easier for our operations team to provide a consistently excellent patient experience.

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

Senior Manager, Engineering at Alto Pharmacy

The first two members of our Advisory Board are Dr. James Hildreth and Jennifer Kent. Their years of experience as leaders in the healthcare industry will be invaluable to us as we continue to grow.

Alto Pharmacy's newly formed Advisory Board launches today with two anchor team members.

Since our launch in 2015, Alto has been committed to fulfilling medicine’s true purpose, and improving quality of life, for everyone who needs it. Today, we announce our newly formed 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.

The first two members of our Advisory Board are Dr. James Hildreth and Jennifer Kent. Their years of experience as leaders in the healthcare industry will be invaluable to us as we continue to grow. 

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.

This is an important milestone for Alto, and we look forward to working closely with Dr. Hildreth and Jennifer on the future of Alto. 

Today, we announce our newly formed Advisory Board and our first two anchor members, who will help guide Alto towards our mission, advise on key decisions, and support strategic initiatives.

Announcing Alto’s Advisory Board

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.

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