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Alto Pharmacy Technician

Alto Pharmacist

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

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

Be Part of a Great Place to Work — Join Our Team

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Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

In honor of National ERG Day, which falls on November 17 every year, we’re highlighting the important work of Alto’s six ERGs. 

Celebrating National ERG Day at Alto

The history of employee resource groups (ERGs) in the U.S. dates back to the 1960s, when a group of Black employees at Xerox self-organized to discuss their experiences of workplace discrimination and advocate for more inclusive policies. At the time, these networks of employees united by a shared identity or experience were known as affinity groups.

Today, ERGs can be found at companies of all sizes and industries where they play an important role in shaping an inclusive culture and fostering a sense of belonging in the workplace. In honor of National ERG Day, which falls on November 17 every year, we’re highlighting the important work of Alto’s six ERGs. 

At Alto, we believe that every perspective matters, and that diversity fosters creativity and leads to innovation. Our six ERGs are part of our broader commitment to diversity, equity, and inclusion (DEI), both in creating our company culture and delivering an exceptional pharmacy experience.

"At Alto, we’re committed to building and sustaining an inclusive workplace that both supports our employees and helps us deliver on our mission to improve the quality of life for everyone who needs medicine,” shared Ty Bledsoe, Head of Diversity, Equity & Inclusion. “Our ERGs help foster authentic relationships, offer safe spaces for education and conversation, and celebrate the incredible diversity of our Altoids and our communities."

By building community, providing support, and contributing to an individual’s personal and professional well-being, these groups help ensure that every Altoid feels a sense of belonging each day at work and that we appreciate the diversity of the customers we serve.

Here are just a few ways that each Alto ERG contributes to a more inclusive culture and pharmacy experience.

Umoja’s mission is to inform, educate, and empower Black Altoids and allies. The group has deepened Altoids’ understanding of the Black experience by sharing educational resources in support of Black History Month, Juneteenth, and Pride.

They also help our team explore the intersection of identity and healthcare as it relates to our services. After Dr. Reverend Stacey Edwards, founder of Fertility for Colored Girls, spoke at Alto about the fertility journeys of Black families this spring, Umoja continued the conversation by inviting Dr. Temeka Zore, OB GYN and reproductive endocrinologist at Spring Fertility, and Esther Ebeuhi, a licensed doula and birth equity analyst, to speak on Black motherhood.

Alto Auténtico aims to build community among Latinx Altoids and ensure that they have a voice at Alto. In addition to facilitating company-wide learning about the Latinx experience and the diversity within Latinx culture, Alto Auténtico’s mentorship program connects junior and senior Latinx team members for coaching sessions and professional development. The group is also working with Alto’s operations, product, and marketing teams to establish a bilingual team to better support Spanish-speaking individuals using our pharmacy services across our communities.

Proud unites LGBTQ+ Altoids and allies in creating an environment where all Altoids can be their most authentic selves. The group has led Alto in celebrating important LGBTQ+ awareness days with events such as drag queen bingo nights for Pride and LGBTQ+ history month. Two Proud members who identify as bisexual gave a talk for Bi Visibility Day on September 23 and also shared their experiences of coming out in in observance of National Coming Out Day on October 11.

Proud also invites experts to speak at Alto about a range of LGBTQ+ issues. They recently hosted a session with Chris Tompkins, author of Raising LGBTQ Allies: A Parent’s Guide to Changing the Message from the Playground, and a fireside chat with Dr. Lisa Capaldini, who has focused on HIV since the beginning of the epidemic.

Women of Alto + Allies (WOAA) helps create an inclusive community for women at Alto with mentorship and networking opportunities that advance their leadership potential. Their newly launched initiative, WOAA Project Spotlight, celebrates female-identifying team members who have helped us deliver on our mission while living our values, and a quarterly webinar series shares how various self-identifying Altoid women launched their careers.

Working Parents + Allies facilitates discussion and collaboration in celebration of our working parents. The ERG has led Alto in supporting working parents with a variety of initiatives, including a community event with the Kids & Art Foundation’s Purvi Shah in honor of Bereaved Parents Month this July; an “Ask a Parent Anything” Slack advice hotline for parents, caretakers, and allies; and free access to Outschool’s live online classes for kids ages 3-18.

And with their second annual Holiday Giveback Program, which donates gifts to kids and families in need through Marine Toys for Tots and the Boys & Girls Club of America, Working Parents + Allies is an example of how our ERGs look for opportunities to give back and show support beyond the immediate Alto community.

During Asian American Pacific Islander month, the Asians ERG shared resources for individuals like Modern Health's Healing Asian Communities Circles and highlighted community groups for volunteerism and donations.

To learn more about any of our employee resource groups, contact the emails below.

Women of Alto + Allies: womensERG@alto.com

Working Parents & Allies: parents@alto.com

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

When you’re happy, we’re happy. That’s why we put together a quick guide with five tips for a great delivery experience, based on what we’ve learned from making more than a million deliveries to Alto customers just like you.

How to Have an Easy Alto Pharmacy Delivery Experience

When you’re happy, we’re happy. That’s why we put together a quick guide with four tips for a great delivery experience, based on what we’ve learned from making more than a million deliveries to Alto customers just like you.

Share any information needed to access your house or apartment  — for example, your intercom, gate code or apartment number/letter — by verifying your delivery address details and completing the “Delivery Instructions'' section in the Alto app. Head to Account > Delivery Addresses > Edit Address> Delivery Instructions to provide all of the specific info our delivery team needs to find your location. (If you don’t want us to ring the doorbell, this is the place to note that, too!)

2. Review your medication’s signature requirements

For controlled substances and medications of more than $500, either you or an authorized signer will need to be present to sign for your delivery. Many Alto customers with limited mobility choose to designate a caregiver as an authorized signer. Head to Account > Delivery Addresses > Edit Address> Delivery Instructions in the Alto app to add an authorized signer .

When required, you may sign electronically on your phone via a link you’ll receive by text, but your driver will need to physically see you during the delivery handoff. If an authorized signer is receiving medication on your behalf, they will be asked to sign for the medication and share their full name with our driver, who will note it in our delivery tracking system.

3. Designate a safe delivery space (and leave the front lights on!)

If your medication does not require a signature, you may schedule your delivery for a time when you are not at home by designating a safe space in the Alto app. Head to Account > Delivery Addresses > Edit Address >Delivery Instructions to provide all the specific info for your safe space. As a reminder, due to federal law, mailboxes are no longer accepted as safe spaces. Pro tip: you may also designate a separate safe space in case of rain or snow! 

We love pets, but please keep your four-legged friends secured when your delivery arrives, both for our drivers’ comfort and your animal’s safety.

At Alto, we’re more than just a pharmacy — we’re a partner in your health, and we go above and beyond to get you the medication you need at the best price possible.

Free, same-day delivery is only the beginning. Our pharmacists are available until 9 pm PST on weeknights and 6 pm PST on weekends to answer any questions you have about your medication. We also offer support with insurance and finding the best price possible on your prescriptions.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn more or transfer your prescriptions to Alto.

We explain how to manage asthma at night through a combination of asthma medications, healthy lifestyle choices, and good sleep hygiene.

How to Manage Asthma at Night

Have you noticed that your asthma symptoms like wheezing, shortness of breath, and tightening of the chest intensify in the nighttime? You’re not alone: nocturnal asthma symptoms are common, especially if you are living with more severe asthma. A Journal of Asthma study involving around 14,000 individuals with asthma found that 60% of those with chronic asthma experienced nocturnal asthma symptoms.

Below, we explain how to manage asthma at night through a combination of asthma medications, healthy lifestyle choices, and good sleep hygiene.

Nocturnal asthma occurs when your symptoms are noticeably worse at night. (If you experience intense symptoms at any time of day, including nighttime, you may need to reevaluate your overall asthma treatment plan with your doctor.)

If you have nocturnal asthma, you may experience the following symptoms while you sleep, and your sleep may be interrupted as a result.

Numerous factors can contribute to nocturnal asthma, including environmental triggers and your personal health history.

The presence of allergens like dust mites and mold can trigger asthma symptoms, especially if you have allergy-induced asthma. Dust mites are small pests that generate allergens. They often live in your pillows, blankets, and mattress, so exposure to them at night is common. In some cases, nocturnal asthma may also be a delayed reaction to exposure to an allergen during the day.

Inhaling cold air from an air conditioner or outside source may contribute to more intense asthma symptoms at night. In addition, sleeping in a reclining position causes your chest and lungs to experience additional pressure, which can also contribute to asthma symptoms. Elevating your shoulders and neck with additional pillows or lying on your left side with or without a pillow between your legs may help you sleep more comfortably.

Your circadian rhythm — the 24-hour natural process that regulates your sleep cycles — affects your nighttime levels of hormones like epinephrine, which relaxes and widens your airways, and histamine, which restricts your airways. Nightly fluctuations in these hormones may contribute to inflammation in your airways, prompting nocturnal asthma symptoms. You are most likely to experience nocturnal asthma symptoms when your epinephrine levels are at their lowest and your histamine levels are at their highest.

The following health conditions have also been linked to nighttime asthma:

Sinusitis, a condition in which there is increased drainage from your sinuses

Mental health disorders and chronic stress

If you have asthma and wake up several nights a week even after following your individual asthma treatment plan, consult with your doctor about additional treatment options. They can evaluate your symptoms, identify potential causes, and suggest modifications to your treatment plan if needed.

Common daily asthma medications can also help you manage worsening symptoms at night. Inhaled corticosteroids like Flovent® HFA and Qvar Redihaler®, which reduce inflammation and swelling in the airways, making them less likely to react to asthma triggers, are frequently prescribed for people who experience nocturnal asthma symptoms.

Quick-acting bronchodilators like albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) or levalbuterol (Xopenex HFA®) may also be used to treat acute asthma symptoms at night. These inhalers relax the muscles around your airways to make it easier to breathe and are taken on an as-needed basis for immediate relief of symptoms . Common side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches.

If you have any concerns about potential side effects of asthma medications, your doctor can explain more about the potential benefits and risks of taking corticosteroids or bronchodilators.

If allergens like dust mites are contributing to your nocturnal asthma symptoms, regularly washing your sheets, blankets, and mattress protector may help you avoid triggers. Wash bedding in hot water if possible, since this will help kill dust mites. In addition, maintain a comfortable temperature — 65-70 degrees Fahrenheit is a good range for many individuals with asthma — by making sure your room is well-insulated and shutting windows to keep cold air out. Using a humidifier to add moisture to the air inside your room can also help.

Better sleep hygiene isn’t a substitute for asthma medication, but getting a good quality of sleep at night can minimize the negative effects of any sleep disturbances you experience from nighttime asthma.

Avoid use of electronic devices like cell phones, tablets, and computers at least 30 minutes before you go to sleep, if possible. In addition to stimulating your brain, these devices emit blue light, which can affect your production of melatonin, a hormone that regulates your sleep.

Meditating and exercising before sleeping can also help you fall and stay asleep more easily, but avoid high-intensity exercise close to when you go to bed.

Create an environment that sets you up for a good night’s sleep. In addition to maintaining a comfortable temperature, make sure that your room is dark or dimly lit without distracting lights from electronic devices. You may also want to consider sleeping with your humidifier on, if you have one.

If you think you may have a sleep disorder like sleep apnea or insomnia, consult with your doctor for a diagnosis and treatment, in addition to taking the actions above.

Alto is here every step of the way to make it easy to manage your asthma symptoms at any time of day. Our team of pharmacists is available to answer questions about your asthma medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

 Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can support your asthma treatment plan.

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

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

Woman sleeping; asthma inhaler on bedside

A consistent lack of sleep can also affect your physical and mental health in the long term. Here's what you can do to improve your sleep hygiene.

How Sleep Affects Heart Health | Alto Pharmacy

If you’ve ever slept less than the CDC-recommended minimum of seven hours per night, you may have experienced short-term effects of sleep deprivation like forgetfulness, irritability, and an inability to focus. A consistent lack of sleep can also affect your physical and mental health in the long term. And just like diet choices and frequency of physical activity, your sleep habits are linked to your risk for heart disease.

Below, we explain more about how sleep affects heart health and what you can do to improve your sleep hygiene.

Sleep allows your body to recharge. As you enter a state of deep sleep, your heart rate slows down and your blood pressure drops. These physical changes give your heart a chance to recover from how hard it works when you’re awake.

When you don’t spend enough time in uninterrupted deep sleep, your heart doesn’t get the opportunity to rest. Research has found that chronic sleep deprivation and sleep disorders can contribute to numerous cardiovascular health issues including high blood pressure, high cholesterol, and a greater risk for a heart attack or stroke.

Cardiovascular health issues related to sleep

Over time, many sleepless nights can lead to higher baseline blood pressure levels during the day. High blood pressure, or hypertension, is among the leading risk factors for heart disease and stroke. If you experience consistent stress or if you have other risk factors for high blood pressure, you may be more likely to develop high blood pressure as a result of sleep deprivation.

Poor sleep may also contribute to these cardiovascular health issues:

Coronary artery disease occurs when cholesterol and other fatty material (collectively referred to as plaque) builds up in your arteries, making it harder for your heart to pump blood to the rest of your body. This accumulation of plaque is also called atherosclerosis.

Some research has found that a lack of sleep may contribute to atherosclerosis. This is partially due to the connection between sleep deprivation and hypertension, as high blood pressure strains your arteries. In addition, poor sleep can trigger chronic inflammation over time, which also contributes to the accumulation of plaque and the hardening of your arteries.

Chronic sleep deprivation may also increase your risk for a heart attack. One research study found that people who slept less than six hours per night had a 20% higher risk of a heart attack in comparison to those who got more sleep.

While your heart slows down when you are in a state of deep sleep, your heart rate and blood pressure can increase if you wake up suddenly. Over time, consistent sleep disruptions can put greater stress on your heart and contribute to your overall heart attack risk.

A stroke is a cardiac event in which blood flow to your brain is interrupted, causing brain cells to die. Because sleep deprivation can drive high blood pressure and plaque accumulation in your arteries — two leading risk factors for strokes — there is also a correlation between a lack of sleep and your risk of having a stroke.

Type 2 diabetes is a condition in which your body’s cells become resistant to insulin, and your pancreas cannot produce enough insulin to regulate levels of blood glucose. It develops gradually due to a mix of genetic, lifestyle, and environmental factors.

Research has linked poor sleep to prediabetes, a health condition defined primarily by blood sugar levels that are higher than normal but below the official range for a type 2 diabetes diagnosis. If left untreated, prediabetes can progress into type 2 diabetes and lead to health complications in the long term, including cardiovascular issues.

If you already have diabetes, a lack of sleep or frequently interrupted sleep may also impact blood sugar management.

There are two primary sleep problems that can impact your long-term cardiovascular health: sleep apnea and insomnia.

Sleep apnea is a disorder in which your airway is blocked during sleep, which causes you to stop breathing for short periods of time. It affects your oxygen levels while sleeping and may increase your risk for high blood pressure, heart attack, and stroke.

Insomnia is when you have trouble going to sleep or staying asleep. Many individuals have experienced insomnia in the short-term, and the CDC estimates that 1 in 10 U.S. adults may experience chronic insomnia.

More than 1 in 3 adults in the U.S. report getting less than the recommended seven hours of sleep per night. The good news is there are steps you can take to improve your sleep hygiene. Start with the following:

Maintain a consistent sleep schedule, going to bed and waking up at the same time every day, including weekends.

Avoid use of electronic devices close to your bedtime.

Get plenty of natural light and stay physically active during the day, but avoid exercising close to bedtime.

Avoid consuming food or beverages close to bedtime, particularly caffeine, alcohol, and high-sugar or high-fat foods.

Keep your bedroom dark and quiet and maintain a comfortable temperature. 

Read our previous blog for strategies that can help you avoid stress-related sleep problems..

If you think you may have a sleep disorder, you should also consult with your doctor for a diagnosis and treatment, in addition to taking the actions above.

At Alto, we’re committed to making it as simple as possible to protect your heart health and stay on top of cholesterol-lowering or blood pressure management medications.  We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

How Sleep Affects Heart Health & Tips for Better Sleep

Alto Connect is the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go.

Introducing Alto Connect

Big news from the team here at Alto: today we launched Alto Connect, the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go! You’ll also see the new Alto Connect brand on our desktop portal, formerly known as AltoMD: new name, same great pharmacy services.

The Alto Connect mobile app is the next evolution of Alto’s custom-built provider communications center, formerly known as AltoMD. Alto was the first pharmacy in the United States to offer a prescriber-focused pharmacy communication platform when the original desktop-based AltoMD product launched in March 2016. Since then, more than 500 doctors offices have integrated Alto Connect into their daily workflows and prescription management. 

Doctors offices who work with Alto Pharmacy can now access Alto Connect across all of their devices, providing greater flexibility and convenience for monitoring prescriptions on busy days spent juggling patient consultations and other business needs. Instead of spending hours on the phone or fighting with the fax machine, Alto Connect provides instant access to prescription information and pharmacy messaging, and Alto Connect users can move seamlessly between the two platforms throughout their workday.

With Alto Connect, clinical staff can view all current prescriptions at Alto Pharmacy, including delivery status, out-of-pocket costs and refills. You'll never have to wonder if a patient picked up their prescription or stayed on track with their refills between visits - our system tells you exactly where every prescription stands for every patient.

Have a question for our pharmacy team? Curious about insurance coverage, delivery times, or other aspects of our service? Our team is here to help! You can send us a general message or ask a question specific to one of your patient's prescriptions. 

Alto Connect's push and email notifications alert you when a prescription needs additional information to move forward — most commonly, a clinical clarification or additional data needed for a prior authorization. We'll only alert you when we're certain we need your team's input, so you can stay focused on your patients.

Using AltoMD on your computer today? Nothing changes other than the name! Ready to try Alto Connect mobile for yourself? Scan the QR code above to download the app - your AltoMD login works on the mobile app. 

Need help setting up an Alto Connect account or want training for your staff? Reach out to providersuccess@alto.com.

When engineering incidents happen, typical deployment pipelines are just too slow—especially if customers’ medications are on the line. Here’s the speedier rollback process we use at Alto Pharmacy to ship fixes in 3 minutes, flat.

How Alto Reduced Time to Resolution for Production Incidents

Production incidents caused by newly-merged code happen to us all. When they do, most engineering organizations discuss the root cause and how to prevent similar incidents in the future. At Alto, we evaluate two additional metrics:

Time to detection: How quickly did we know something was wrong?

Time to resolution: How quickly did we restore service?

Time to resolution is especially critical for us as a pharmacy, where a long-running incident could block a user from getting their medication on time.

Over 30 times a day, an engineer at Alto hits the merge button, deploying a new build to production. Our well-automated CI/CD pipeline, built by our Infrastructure team, handles the 3-step deployment process:

1. Build: install Ruby & JavaScript dependencies

The average runtime for our standard deployment pipeline is 30 minutes—reasonable for a CI/CD pipeline, but too long when shipping a fix for a production incident.

We introduced a “hotfix” workflow as a first pass at an expedited deployment pipeline for incident response. A hotfix is a commit that introduces new code to address the incident by either removing or reverting the buggy code that introduced the issue in the first place or by shipping new code that fixes the initial issue. 

The hotfix deployment pipeline reduces incident time to resolution by triggering a specific CI job that removes the test step from our standard pipeline, reducing the workflow to just the Build and Deploy steps.

Implementing a hotfix pipeline on top of our standard pipeline in CircleCI was relatively simple—in our `.circleci/config.yml`, any part of our CI workflow that should be skipped in case of a hotfix runs a job called “early_exit_if_hotfix” that will skip the current step if the last commit message of the code being built includes the keyword “[hotfix]”.

early_exit_if_hotfix:
    steps:
      - run:
          name: Early exit if hotfix
          command: |
            git_commit_message=$(git log --format=%B -n 1)
            if [[ $git_commit_message =~ "Merge pull request #" ]]; then
              echo "This is a merge commit. Checking if this is a hotfix deploy"
              git_commit_sha=$(git log --format=%H -n 1)
              git_commit_message=$(git log --format=%B $git_commit_sha^-)
            fi
            if [[ $git_commit_message =~ "[hotfix]" ]]; then
              echo "exiting early for hotfix deploy"
              circleci-agent step halt
            fi
            echo "not a hotfix deploy, continuing"

run_ruby_tests:
  steps:
early_exit_if_hotfix
run_tests

The hotfix workflow reduces time to ship a resolution, once we identify the fix, from 30 minutes to ~18 minutes. It’s faster than our standard pipeline but still requires considerable hands-on work from the engineer performing the hotfix.

To further speed up deployment and reduce manual work, we introduced a workflow that simply rolls back to a previously-built healthy deployment image. In this workflow, the entire pipeline is reduced to just the Deploy step.

To invoke a rollback, an engineer commits a message with the keyword “[rollback]”, followed by the SHA of the commit to rollback to. Similar to the hotfix approach, any build step that should be skipped during a rollback checks the commit message for the “[rollback]” keyword before running:

early_exit_if_rollback:
    steps:
      - run:
          name: Early exit if rollback
          command: |
            git_commit_message=$(git log --format=%B -n 1)
            if [[ $git_commit_message =~ "Merge pull request #" ]]; then
              echo "This is a merge commit. Checking for rollback sha..."
              git_commit_sha=$(git log --format=%H -n 1)
              git_commit_message=$(git log --format=%B $git_commit_sha^-)
            fi
            if [[ $git_commit_message =~ "[rollback]" ]]; then
              echo "exiting early for rollback deploy"
              circleci-agent step halt
            fi
            echo "not a rollback deploy, continuing"

run_ruby_tests:
  steps:
early_exit_if_hotfix
early_exit_if_rollback
run_tests

The rollback workflow looks for a build matching the specified SHA and posts a confirmation message for the engineer, then deploys that build to production. The rollback approach dropped our time to resolution even further, from 30 minutes to ~3 minutes.

There are three edge cases that we’ve also baked into our rollback workflow: potentially stale images, database migrations, and blocking new merges and deployments.

Our script has a special block warning the engineer if a target image is older than an hour. The older the image, the riskier the rollback, as the delta between the image and the latest commit on main is larger.

time_rollback=$(git show -s --format=%ct ${rollback_revision})
time_now=$(date '+%s')
if [ $(($time_now - $time_rollback)) -gt 3600 ]; then
    message="${message}\n\n:warning:The rollback commit is more than an hour old."
    message="${message}\nThe [hotfix workflow](https://www.notion.so/alto/Deploying-a-Hotfix-Rolling-Forward-bb8e9cea05b44c67a64e23ae652653b6) might be a better candidate for this deployment."
fi

We also want to warn engineers if any database migrations have occurred between the current image and the target by checking the diff of the db/migrate directory. Rolling back application code without applying changes to the database can result in the database and application code becoming out of sync, resulting in further problems. Our script will warn engineers if a migration has been detected between the current and target image and provide instructions on how to rollback migrations if required.

Because a rollback deploys an image that’s older than our latest build, we also need to block continuous deployment until we’ve restored the main branch to a safe state — typically by deploying a hotfix as soon as we can identify an appropriate fix. We accomplish this using a Github issue with a specific tag that, when open, triggers a job causing any active CI job to fail. After the incident is resolved, the incident manager closes the issue, which will retrigger the blocked jobs and resume the normal build and deploy workflow.

The expedited rollback process has reduced our overall time to ship a resolution for incidents down to a speedy 3 minutes—a valuable improvement for our internal operations users, as well as for our customers and healthcare providers who rely on Alto’s service to get prescriptions filled. Branching these incident response workflows off of our existing standard deploy pipeline keeps the maintenance cost low for our infrastructure team, and robust automation reduces the risk of manual error for our product engineers when they need to invoke these workflows.

The Engineering Team is hiring! Learn more about open positions here.

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

A Financial Planning Guide for Egg Freezing

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

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

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

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

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

Savings and support from family and friends

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

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

Health insurance coverage and workplace benefits

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

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

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

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

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

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

Can you provide a detailed list of procedures and costs?

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

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

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

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

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

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

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

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

You can also search for additional grant opportunities through RESOLVE.

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

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

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

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

Your choice of fertility pharmacy matters

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

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

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

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

We’re excited to welcome Ramiah Martin to Alto as Vice President, Operations & Supply Chain. Here’s more on what drew him to Alto and the opportunities he’s most excited about, in his own words. 

Meet Ramiah Martin, VP, Operations & Supply Chain

We’re excited to welcome Ramiah Martin to Alto as Vice President, Operations & Supply Chain. Prior to joining Alto, Ramiah was Senior Director of Operations at Amazon, where he developed the strategic vision for the company’s operations and led a cross-functional team in implementing new processes and technologies to streamline use of resources.

His dedication to continually improving the customer experience is matched by a passion for healthcare change, and we could not be more thrilled to have Ramiah on the team. Here’s more on what drew him to Alto and the opportunities he’s most excited about, in his own words. 

Welcome to Alto! What inspired you to join the team?

When I first learned about Alto, its mission and values stood out to me first and foremost. I immediately felt a strong connection with the company’s mission of improving the quality of people’s lives through medicine and its commitment to putting customers first.

I was compelled by the opportunity to truly make a positive impact and help transform an industry that is both in need of improvement and slow to evolve. Through my previous experiences in operations management at Amazon and UPS, I know that streamlined processes can have a massive impact on a company’s results. At Alto, all of those efforts to innovate and maximize efficiency are in the service of driving broader change within pharmacy and healthcare.

I also appreciated that Alto is intentional about investing in talent representative of the communities we serve. As we continue to grow, and our customer base diversifies, it’s critical to have that diversity represented in the people building our new model for pharmacy care.

What is the focus of your role and what opportunities are you excited about?

As Vice President of Operations & Supply Chain, I’m focused on creating a scalable and sustainable organization, ensuring that as we grow, we continue to deliver an exceptional experience for our customers.

We have a great opportunity to ensure that individuals who have been historically underserved by medicine receive the standard of care that they deserve. I believe in the product — we make it as simple as possible to manage your health and learn more about medication and pricing, and our customers’ medication adherence rates are far above industry standards. I know there’s a lot more we can accomplish, and it’s a privilege to lead a team that’s united by a bold vision for healthcare.

I love movies, except for horror (Michael Jackson's “Thriller” video and Children of the Corn scarred me). I will go to the movies by myself as long as I have my Cherry Coke. It’s my way of shutting off my brain for an hour or two and relaxing.

You can find more information about Ramiah or connect with him directly on LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

From vigilant hand-washing to getting enough vitamin C and D, here are a few ways to give yourself an immunity boost in advance of cold and flu season.

How to Prepare for Cold and Flu Season

The leaves are turning and the days are getting shorter, which means it’s time to start preparing for cold and flu season. The flu — shorthand for influenza — is a respiratory illness caused by viruses that affect your nose, throat, and lungs. In the U.S. and the rest of the Northern Hemisphere, flu cases typically ramp up toward the end of October and peak between December and February.

One reason the flu spreads more easily during the winter months is that cold air protects the virus as it travels through the air in the form of tiny droplets. The other main reason is that people socialize indoors more frequently, where it’s easier for the flu to spread when someone affected by the virus coughs or sneezes.

The good news is that there are simple steps you can take to strengthen your immunity. From vigilant hand-washing to getting enough vitamin C and D, here are a few ways to give yourself an immunity boost in advance of cold and flu season.

The number one thing you can do to protect your health and that of your loved ones is to get an annual flu shot, which will prompt your immune system to create antibodies that will defend you against the flu. Medical experts recommend getting the vaccine each and every year. every year.

Keep in mind it can take up to two weeks for the antibodies to provide sufficient protection. Given that flu season often peaks around December, the best time to get vaccinated is during September and October, and ideally no later than the end of October.

The flu can cause more serious health problems for people over the age of 65 and individuals living with chronic conditions such as COPD or diabetes, so it’s even more important to be proactive about flu vaccination if you fall into one of these groups.

Good personal hygiene can lower your risk of getting the cold or flu and spreading it to others. Practice simple preventative measures like frequently washing your hands, disinfecting frequently touched surfaces, and keeping a healthy distance from anyone who isn’t feeling well.

And yes, there is a “right way” to wash your hands when it comes to cold and flu prevention. The CDC recommends following the simple steps below to stay healthy and avoid spreading germs.

1. Wet your hands with warm or cold running water and apply soap.

2. Lather your hands, including the backs of your hands, between your fingers, and beneath your nails. 

3. Scrub your hands for at least 20 seconds. (Singing “Happy Birthday” twice is one option for timing yourself.)

Get a good night’s sleep and regular exercise

Your body is better prepared to defend against infectious diseases when it’s well-rested. Research has found that sleep can strengthen your T cells’ ability to help you fight infection. (T cells are a specific type of white blood cell and an important part of your immune system.)

Blog

Celebrating National ERG Day at Alto

How to Have an Easy Alto Pharmacy Delivery Experience

How to Manage Asthma at Night

How Sleep Affects Heart Health & Tips for Better Sleep

Introducing Alto Connect

How Alto Reduced Time to Resolution for Production Incidents

A Financial Planning Guide for Egg Freezing

Meet Ramiah Martin, VP, Operations & Supply Chain

How to Prepare for Cold and Flu Season

What to Know About the Heart and Gut Health Connection

How to Manage and Prevent a COPD Flare-Up

Celebrating American Pharmacist Month At Alto

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