Shop Alto Essentials to add pharmacy products to any delivery!

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

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

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

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

Blog | Alto Pharmacy

If you’re managing a chronic health condition — or multiple conditions — you’re probably familiar with the hassle of filling multiple medications. Not only is it inconvenient to track different refill dates throughout any given month, it makes it much more difficult to prioritize your health, with the potential for missed doses.

To make it as convenient as possible to stay on track with treatment, Alto offers a free medication bundling service that lets you receive all your medications in a single, recurring delivery.

Medication Bundling: One Delivery for All Your Prescriptions

If you’re managing a chronic health condition — or multiple conditions — you’re probably familiar with the hassle of filling multiple medications. Not only is it inconvenient to track different refill dates throughout any given month, it makes it much more difficult to prioritize your health, with the potential for missed doses.

To make it as convenient as possible to stay on track with treatment, Alto offers a free medication bundling service that lets you receive all your medications in a single, recurring delivery.

Medication bundling builds on other tools in the Alto app like auto refills and medication reminders to take the hassle out of living your healthiest life. And like everything at Alto, it bridges innovation with industry-leading care to deliver an exceptional pharmacy experience that puts you first.

While some traditional retail pharmacies offer a similar service, they often require you to do the legwork of coordinating with your doctor and insurance. (Not to mention that there’s the additional inconvenience of traveling to the pharmacy and waiting in line.)

At Alto, it’s a whole lot simpler. The entire process takes place in the app, and if your medications are eligible*, we can organize your bundle within seconds.

We’ll get you started with synchronized refills and bundled deliveries in four simple steps.

1. If you have multiple prescriptions on file with Alto that qualify for bundling, you will be automatically prompted to bundle your medications when you log into the Alto app and we’ll sync your refills. (Have prescriptions at other pharmacies? Transfer them to Alto so we can add them to your refill schedule!)

2. We’ll ask you to confirm your medication list and current supply. Let us know if any of your medications are taken on an as-needed basis, or if any are urgently needed.

3. We’ll create a custom timeline for your synchronized refills. Depending on your insurance coverage, this may be once a month or up to every three months. If needed, we’ll schedule a partial fill upfront to avoid a delay in your treatment while we align your refills.

4. We’ll schedule all refills into a single delivery on your behalf and reach out on a recurring basis when your order is ready for delivery. As always, you’ll pick the delivery window that works best for your schedule.

Ready for one easy delivery? Transfer your prescriptions to Alto to start the medication bundling process today.

*Medication bundling is not available for some medications. In addition, some insurance plans may limit automatic refills.

Juvenile idiopathic arthritis (JIA) is the most common form of arthritis that affects children and adolescents. Like adult rheumatoid arthritis (RA), JIA is characterized by pain and inflammation throughout the body as the result of joint inflammation and stiffness.

In contrast to the ongoing nature of RA, some children do outgrow JIA. However, it can impact a growing child’s bone development, so treatment is important.

What to Know About Arthritis in Children

Juvenile idiopathic arthritis (JIA) is the most common form of arthritis that affects children and adolescents. Like adult rheumatoid arthritis (RA), JIA is characterized by pain and inflammation throughout the body as the result of joint inflammation and stiffness.

In contrast to the ongoing nature of RA, some children do outgrow JIA. However, it can impact a growing child’s bone development, so treatment is important.

Here’s what to know about the causes, symptoms, and treatment options of JIA.

Juvenile idiopathic arthritis affects children and adolescents age 16 and under. It may cause joint pain and inflammation anywhere in the body, but most commonly in the hands, knees, ankles, elbows, and wrists.

If untreated, JIA can lead to health complications, including:

Eye health issues such as cataracts or glaucoma, as JIA can cause inflammation in the eyes

More rarely, issues with the kidneys, heart, or endocrine system

The prognosis of JIA varies by individual. About 50% of children and adolescents with the condition fully recover while others continue to experience arthritis symptoms in adulthood. 

All forms of arthritis including JIA fall under the umbrella of autoimmune diseases. These conditions occur when the immune system mistakenly attacks healthy cells and tissues. With arthritis, the immune system acts on the lining of your joints.

The causes of JIA aren’t fully known (idiopathic means unknown). Genetics likely play a component. Some evidence suggests that some children have a gene that leads to the development of JIA when activated by external factors such as a virus or bacteria.

Symptoms of juvenile idiopathic arthritis

Symptoms of JIA can vary from one child to another. Some individuals experience flare-ups, or periods when symptoms intensify, while others have a more chronic experience of the condition.

Pain and inflammation in the joints, most commonly in the hands, knees, ankles, elbows, and wrists. (For many, this symptom frequently occurs in the morning or after sleeping.)

The process of diagnosing JIA often involves several steps, as symptoms may resemble those of other conditions.

A physical exam is typically the starting point, after which a doctor may recommend one or more of the following blood tests to confirm a diagnosis of JIA: 

Antibody tests such as the antinuclear antibody (ANA) test, which measures blood levels of antibodies linked to rheumatic disease

Tests that check for levels of red and white blood cells and platelets - lower levels of red and white blood cells may be indicative of JIA

An erythrocyte sedimentation rate (ESR) test, which examines how quickly your red blood cells sink to the bottom of a test tube - higher rates of settlement may indicate inflammation

A c-reactive protein (CRP) test, which identifies blood levels of CRP, an inflammation-linked protein produced in your liver

A creatinine test, which checks for kidney disease

A rheumatoid factor (RF) test, which checks for rheumatoid factor, an antibody found in about 80% of individuals with rheumatoid arthritis

Imaging tests such as X-rays, CT scans, MRIs, and bone scans may also be used to support a JIA diagnosis.

Treatment for JIA encompasses medications, lifestyle changes, and physical and occupational therapy, with the goal of reducing symptoms and supporting an active life.

Individual treatment plans depend on a child’s symptoms, age, and overall health history.

The following types of medications may be included in a JIA treatment plan:

Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil®) and naproxen (Aleve®) may be used to reduce pain and inflammation during flare-ups. While these medications are available over the counter, your child may need a prescription for a higher dose.

Oral corticosteroids such as prednisone may also be used to reduce inflammation in children with JIA.

Disease-modifying antirheumatic medicines (DMARDs) such as methotrexate (Rheumatrex®) reduce the immune system’s response to triggers, easing inflammation and controlling JIA symptoms.

Injectable biologic DMARDs — which target more specific pathways in the immune system — are also used in the treatment of JIA, typically after other treatments have proven ineffective. Commonly prescribed biologics include abatacept (Orencia®), adalimumab (Humira®), canakinumab (Ilaris®), etanercept (Enbrel®) and tocilizumab (Actemra®).

Sugars, refined carbohydrates, and gluten can contribute to joint pain and inflammation, so it is often recommended for those with any type of arthritis to reduce their intake of these foods. With JIA, there is the additional consideration of incorporating nutrient-rich foods to support a child’s healthy growth and development. Consider speaking with a nutrition specialist to develop a balanced meal plan.

Regular physical activity is another component of managing JIA. Swimming and other water exercises, yoga, and cycling may be a good fit for children and adolescents with the condition. Physical therapy may be involved in treatment to help a child improve muscle and joint function. 

Lastly, it’s important for a child with JIA to get plenty of rest.

JIA is linked to eye inflammation, which can cause more serious eye problems later in life. Staying on track with regular eye exams can prevent and detect potential problems.

Life with juvenile idiopathic arthritis is easier with a reliable pharmacy partner by your side. Our pharmacists have specialized training in arthritis treatment and can answer any questions you may have, from medication side effects to navigating lifestyle changes.

In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with your treatment.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

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

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

An asthma attack is an acute flare-up of symptoms defined by sudden shortness of breath and difficulty breathing. Managing asthma attacks includes both proactively responding to symptoms when they arise and staying on track with treatment in the long term. Learn more here.

Treatment and Prevention of Asthma Attacks | Alto Pharmacy

Many individuals with asthma are familiar with the experience of an asthma attack — an acute flare-up of symptoms defined by sudden shortness of breath and difficulty breathing. These exacerbations vary in intensity and require efficient and prompt treatment.

Management of asthma attacks is twofold. To immediately address symptoms in the moment, work with your provider to identify your asthma attack warning signs and establish a treatment strategy. In the longer term, identify and avoid triggers and stay on track with treatment, so as to reduce the frequency and intensity of these flare-ups.

Here’s more on recognizing, treating, and preventing asthma attacks.

Effective management of an asthma attack starts by recognizing the signs and symptoms and understanding what to do when they occur.

While individual experiences of an asthma attack may vary, these are some common signs and symptoms. Your doctor can help you in identifying your individual warning signs of an asthma attack.

The following symptoms of a severe asthma attack warrant immediate medical attention:

Severe breathlessness or wheezing, especially at night or in the early morning

Difficulty speaking due to shortness of breath

No improvement from quick-relief medication

Everyone with asthma should have an asthma action plan that documents their treatment needs, including what steps to take when asthma symptoms intensify. Work with your doctor to create your individual asthma action plan.

If and when you experience a flare-up of asthma symptoms, follow the steps in your treatment plan. If your PEF readings fall between 51% to 79% of your baseline, a common first step is to take quick-relief or “rescue” asthma medications.

These medications are taken on an as-needed basis, as prescribed by your doctor, and relax airway muscles to open the lungs. They relieve shortness of breath and wheezing within minutes and can stop an asthma attack in progress.

Common quick-relief asthma medications include:

Albuterol (ProAir® HFA, Proventil® HFA, and Ventolin® HFA)

Inhalers are the most common form of quick-relief asthma medications. Albuterol and levalbuterol are also available as a liquid solution for nebulizer use.

A quick-relief medication may sufficiently relieve symptoms and improve PEF readings. If symptoms do not improve, emergency medical care may be necessary. Your asthma action plan should help you determine when to seek emergency care.

In many cases, asthma attacks may be preventable. When followed on an ongoing basis, the steps below can help lower your chances of experiencing an asthma attack.

1. Follow your treatment plan and take maintenance medications as prescribed (if applicable).

Many individuals with moderate to severe asthma take long-term maintenance medication in addition to a quick-relief medication.

These medications ease inflammation in the airways, preventing exacerbations and controlling symptoms. You must take them as prescribed every day to experience their benefits.

There are two main types of long-term asthma control medications:

Inhaled corticosteroids including Flovent® HFA and Qvar Redihaler® 

Combination inhalers that contain both corticosteroids and long-acting beta agonists (LABAs) including fluticasone and salmeterol (Advair Diskus®); budesonide and formoterol (Symbicort®); mometasone and formoterol (Dulera®); and fluticasone and vilanterol (Breo Ellipta®)

Asthma attacks may be caused by a variety of triggers including:

Each individual has different triggers. To identify yours, make a note of your asthma symptoms as they appear, including environmental factors that may have contributed to them. As you begin to learn your triggers, take necessary precautions to avoid them.

3. Avoid all cigarette smoke, including secondhand and thirdhand smoke.

Everyone with asthma can benefit from limiting their exposure to cigarette smoke, a frequent trigger of asthma attacks.

In addition to refraining from smoking yourself, avoid exposure to secondhand smoke and thirdhand smoke, the residual smoke that remains on clothing or surrounding indoor surfaces. (Don’t hesitate to ask your doctor for smoking cessation resources if needed.)

Allergic asthma accounts for 60% of all asthma cases in the U.S. and is triggered by allergens such as household dust mites, pet dander, and pollen. There are many ways to reduce the presence of allergens in your home, including:

Using the AC rather than opening windows when pollen counts are high

Using a dehumidifier to keep indoor air dry, which will in turn prevent mold growth and dust mites

Vacuuming at least once a week, ideally using a vacuum cleaner with a high-efficiency particulate air (HEPA) filter, which catches smaller particles like allergens

It’s especially important for those with asthma to stay current with vaccines, as respiratory infections like the flu can become more serious and/or trigger asthma symptoms.

Check with your doctor about which vaccines you need. For detailed vaccine recommendations by age group, reference the CDC’s recommended immunization schedules for children and adolescents and adults.

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

Reach out by phone at 1-800-874-5881 or in-app messaging to learn how we can support your treatment plan.

Treatment and Prevention of Asthma Attacks

The Alto product and engineering team has long been focused on initiatives that improve our unit profitability. Now that we’ve laid a strong foundation, we've started to think about our next big bets: How do we expand our services beyond delivering prescriptions? How do we test new value-add offerings quickly and iteratively? That’s where the incubation team comes in.

Meet the Innovation Team Building Alto's Next Big Bets

The Alto product and engineering team has long been focused on initiatives that improve our unit profitability. Now that we’ve laid a strong foundation, we've started to think about our next big bets: How do we expand our services beyond delivering prescriptions? How do we test new value-add offerings quickly and iteratively? That’s where the innovation team comes in.

Newly launched in 2022, the team is small and scrappy by design. We’re a product manager, two engineers, a part-time designer, and a part-time manager with a single mission: to launch at least two significant new business experiments per year. If an experiment is successful, we’ll scale it into a full workstream before handing it off to a stand-alone product team.

We started with over-the-counter (OTC) medications. OTCs, or medications you can buy without a prescription, like Advil, are high-margin products that users are accustomed to purchasing at traditional, brick-and-mortar pharmacies. The goal of this experiment was to assess how much interest users have in adding OTCs to their order while checking out in the Alto app. We set a target conversion rate and offered OTCs only from our San Jose pharmacy, which is less busy than our San Francisco pharmacy but close enough to engineers in San Francisco for in-person troubleshooting.

Our initial hypothesis: if we present users with a small selection of OTCs targeted to their needs (based on the prescriptions in their cart), they’ll be more likely to convert. With support from our pharmacy partners, we carefully curated a recommendation algorithm that would suggest nine OTCs based on the medications already in the user’s cart.

In the interest of lean experimentation, we wanted a scrappy technical solution that could be implemented quickly while meeting our high user experience standards and minimizing operational risk. We settled on the following architecture:

We prioritized creating a clean API for Alto’s customer-facing app and using as much of our current infrastructure as possible. Although OTCs are distinct from prescriptions, we decided to reuse our existing prescription model rather than build a new one from scratch. This allowed us to leverage existing systems and operational workflows, reducing engineering time and risk of regression.

Behind the API, we opted to store our OTC formulary and associated metadata in in-memory data structures:

ADVIL = SkuId.new(sku: '...', sku_type: '...').freeze
CLARITIN = SkuId.new(sku: '...', sku_type: '...').freeze
FISH_OIL = SkuId.new(sku: '...', sku_type: '...').freeze
...
METADATA_BY_SKU_ID = {
  ADVIL.hash_code => {
    image_url: '...',
    name: 'Advil Ibuprofen 200mg Coated Tablets',
    quantity_description: '100 tablets',
    product_description: 'Easy to swallow powerful pain reliever for headaches, joint and muscle pain.',
  },
  CLARITIN.hash_code => {
    image_url: '...',
    name: 'Claritin 24 Hour Allergy Tablets',
    quantity_description: '30 tablets',
    product_description: 'Non-drowsy, 24 hour relief of symptoms due to allergies: sneezing, runny nose, itchy and watery eyes.',
  },
  FISH_OIL.hash_code => {
    image_url: '...',
    name: 'Fish Oil 500mg Softgels',
    quantity_description: '130 softgels',
    product_description: 'Dietary supplement with EPA and DHA omega-3 fatty acids to support heart health and maintain normal triglyceride levels.',
  },
  ...
}.freeze

This gave us a nice balance of speed and flexibility. We knew that we could optimize once we had established our OTC offering and gained an understanding of how it would evolve within Alto.

The results of phase 1 were a bit disappointing, but very interesting: the conversion rate of users who checked out with an OTC was just under our target. However, nearly half of all users who saw the experience would scroll down to peruse all nine OTCs that were offered.

Based on this positive sign of engagement, we hypothesized that perhaps we just weren’t showing the right OTC products to the user. For phase 2, we decided to scrap the limited recommendations and allow users to explore an entire catalog of OTCs.

Phase 2 required categorizing our list of OTCs into buckets such as “Top Sellers,” “Covid Care,” and “Allergy & Asthma.” We built a new fetch_categorized endpoint to return our OTC catalog structured by category, adding search functionality into the client so that users could quickly filter for a specific product. This search field was also heavily tracked with analytics events to help us learn which products to add to our catalog in the future.

This new experience immediately outperformed phase 1. After a few performance improvements (speeding up our catalog and product image load times), we eventually hit our target conversion rate — even managing to surpass it on some weeks!

Our eventing did show that a significant number of users with multiple prescriptions or smaller screens were not even seeing the OTCs in Cart, as they were pushed below the fold. We tried experimenting with alternate spots to show our catalog:

1. An interstitial that shows after Cart and before Checkout - this didn’t perform any better than the control and was quickly scrapped.

2. A single carousel at the top of Cart - this out-performed the control but at the cost of our guardrail metric. With a decrease in the overall checkout rate, we decided to stick with the control for now.

This phase of UI experimentation validated that our users wanted an offering of categorized OTCs. However, our initial technical solution wouldn’t scale as we rolled out to more of our pharmacies. The following questions led us to this conclusion.

How might we support changes to our OTC catalog on a per-pharmacy basis?

Given factors such as inventory, geography-related price sensitivities, and experimentation, we wanted to make sure that we could tweak the OTC experience for users getting deliveries from a specific pharmacy.

In the status quo implementation, that would have likely meant adding an additional layer to our data structures like so:

SKUS_BY_PHARMACY_AND_CATEGORY = {
  SF_PHARMACY_ID => [
    AddOnOtcCategoryType::TopSellers => [
      IHEALTH,
      FLONASE,
      ASPIRIN,
      ...
    ],
    ...
  ],
  ...
}

We weren’t worried about memory space limits given our relatively small number of pharmacies and OTC catalog. We were concerned, however, that each modification would require an engineer to go in and make code changes, get PR approval, and wait for a full deploy for the update to go live. This would be a bad use of engineering time, and our CI/CD process would become a bottleneck to otherwise quick modifications.

How might we add and remove OTCs from our catalog?

Similarly, we knew that adding and removing OTCs from our catalog would also be a somewhat regular workflow. There are some other considerations when adding a new OTC (Is it in our product database? Do we need any new procurement/inventory workflows to make sure it gets stocked in our pharmacies? Do we have a nice image to render in the app?), but we wanted to automate the technical side as much as possible — or at least be able to automate it.

The natural next step was to move our OTC catalog into the database.

Alto’s OTC Database Schema. Some columns excluded for brevity.

Now, rather than grabbing from in-memory data structures, we are efficiently querying the database for the OTC catalog of a user’s specific pharmacy, preloading all of the associated models needed for our API response.

OtcCategory
  .includes(otc_category_products: { otc_product: :otc_product_metadata })
  .where(otc_category_products: { pharmacy_id: pharmacy_id })
  .where(otc_product_metadata: { pharmacy_id: pharmacy_id })


At the time of writing, an engineer is still required to go in and make the changes at the database level. However, we plan to build an admin dashboard so that designated pharmacy partners can tweak our OTC catalog without the help of an engineer.

We’re excited about our next iteration, which will allow users to add OTCs to their upcoming deliveries at any point, not only when checking out. It will likely be live by the time you read this.

Once that’s released, we will continue to learn, iterate, and pay down technical debt — more specifically, maturing the OTC data model in our backend and eliminating the need for them masquerade as prescriptions.

Looking even further ahead, the innovation team has more exciting and impactful projects on our roadmap. We can’t wait to share what’s in store!

When Jake Moffatt says he loves building things, he means it — sometimes literally. A construction project manager turned engineer, Jake has spent the past decade building software at mission-driven organizations. Today, as Engineering Manager of Alto Assistant, he leads the team that’s bringing wizard-like support to Alto’s customer-facing app.

Get to know Jake Moffatt, Engineering Manager on the Alto Assistant Team

When Jake Moffatt says he loves building things, he means it — sometimes literally. A construction project manager turned engineer, Jake has spent the past decade building software at mission-driven organizations. Today, as Engineering Manager of Alto Assistant, he leads the team that’s bringing wizard-like support to Alto’s customer-facing app.
Below, Jake chats with fellow engineering manager Mike Riess and recruiter Braden Hanlon about the work ahead for Alto Assistant.

I’d love to learn more about your background to get us started. How did you end up in software engineering?

When I was twelve, I started learning to code in QBASIC because I wanted to make video games. Once I wrote my first program, I was hooked! I loved computers and the creative power they gave to anyone willing to invest the time and energy to learn. Since then, I’ve built games, personal tools and projects, desktop software, and a number of apps and services — I love building things. My career has gone back and forth between construction and software engineering, but it’s been firmly in the software industry for the last ten years or so.

My favorite place to be in a company is working on something new that has a big impact or addresses an important problem. In a previous role, I built an app that helped people find roommates in a city where housing is prohibitively expensive. At that same company, I led the team responsible for creating a new vertical that eventually split off into its own company.

The goal of Alto Assistant is to help customers help themselves before reaching out to support. Our first project is introducing a wizard-like support “assistant” (hence the team name!) that guides the customer through a series of questions to narrow down the area of support. We’ve already identified a few tasks the assistant can help customers complete on their own, including making changes to upcoming deliveries or scheduling new orders.

In cases where we can’t help them just yet, our new tool generates data to help us to learn exactly what customers need help with. It’s a top priority to bake analytics into every new feature we build; even though we have years of experience supporting our customers — and we know intuitively which problems they frequently experience — we don’t have conclusive data to draw upon just yet.

We plan to start with a couple of frequent use cases and measure how often customers reach out to us for support. Then, we’ll chip away at the problem until we’ve seen a substantial improvement in the user experience. From there, we’ll move on to the next biggest problem and repeat the cycle. There’s a reason “Chip away it” is an Alto value: It’s the playbook that we’ve used to automate other critical parts of the pharmacy value stream like intake, billing, and fulfillment.

What opportunities are you most excited about?

Support drives much of the cost of every shipment today, so this is a high-impact area for our business. A year from now, it would be a stellar outcome if the Assistant team could reduce the number of issues that customers need support on by half.

We’re also thinking about the user experience beyond the app. We plan to improve the tooling that our care specialists use to provide support as well. We’ve already discussed some promising ideas like creating the concept of a conversation in support communications rather than an infinite stream of messages and building out enriched communications. We also intend to develop a custom tool that can expedite a customer’s prescription when they need their medication ASAP.

The possibilities are many, and it will take a team of determined, passionate, empathetic people to solve these challenging problems. I’m super excited to see what the Assistant team will do together.

Any lessons learned from previous experience that you’re applying to your role at Alto?

There’s always the temptation to tackle everything at once with new business initiatives. My experience leading new verticals at Apartment List and Snapdocs taught me the importance of being laser-focused on one or two key metrics instead of trying to build out a fully-realized product from the beginning. That’s exactly what we’re doing on the Alto Assistant Team with our clear focus on reducing communications per shipment — how often customers reach out for help because they could not find what they needed in our app.

It’s also important to recognize that we won’t have all the answers right out of the gate! I like to think of product development as a three-step sequence: learning, growth, and maintenance. Alto Assistant is so young that we’re very much still in the learning phase. We maintain a tight iteration loop with everything we ship: launch, measure the impact, and use the results to iterate and refine our hypotheses about what our users want. Our final product could be anything from a customer support wizard to an AI chatbot to a ticketing system — we have to rely on our key metric of communications per shipment, experimentation, and user feedback to shape the direction.

What got you excited to join Alto? What would you pass on to an engineer thinking about applying to the company?

I was impressed by the Altoids I met during the interview process. I knew I would be working with people from whom I could learn a lot, like Elnaz, who started as an individual contributor and went on to become Director of Engineering and, now, Alto’s first Head of Strategy & Operations. I was also impressed by the quality of the interview process itself — a good sign that the company was well-organized internally. Finally, the pitch for the role was extremely clear, with already-established key metrics that would directly contribute to the company’s bottom line and help Alto become more profitable.

For engineers, I think Alto is a great place for both technical challenges and career growth. We’re still small enough that every individual gets exposure to a broad portfolio of high-impact projects. It’s also a great environment for learning about how a business works — the Product & Technology organization does a great job of sharing information and presenting problems in a way that gets to the root business problem we’re trying to solve. There’s a clear line between any project a team is working on and a foundational business metric. Most importantly, we’re a company that makes a truly positive impact on our users’ lives.

Interested in learning more about engineering at Alto? Follow us on LinkedIn.

Birth control is essential healthcare, allowing you to prevent pregnancy and take charge of your reproductive health. There are many contraceptive methods to choose from. Learning more about the available options can help you, and in some cases, your partner, make the best decisions for your needs and reproductive goals.

Choosing the Right Birth Control for You | Alto Pharmacy

Read on for an overview of some common birth control methods. Our list focuses on hormonal birth control, which contain synthetic versions of estrogen and progesterone. These two hormones play a significant role in reproduction.

There are other options for contraception that must be used every time you have sex, including condoms and diaphragms. When used correctly, condoms and diaphragms are 98% and 88% effective at preventing pregnancy, respectively.

Permanent birth control is also available in the form of surgical procedures (tubal ligation for women and a vasectomy for men). These procedures must be performed by a healthcare provider. Discuss your options for contraception with your provider.

In addition, there are two options for oral emergency contraception to be taken after unprotected sex: levonorgestrel (Plan B®, Mirena®, Kyleena®) and ulipristal (Ella®). Levonorgestrel is sometimes available without a prescription. Ulipristal is prescription-only.

Like all forms of hormonal birth control, the pill stops ovulation, which is the release of a mature egg from the ovaries during each menstrual cycle. The hormones also thicken cervical mucus, an additional layer of pregnancy prevention that keeps sperm from reaching an egg, should one be released.

There are two types of birth control pills:

Combination pills, or combined oral contraceptives (COCs), contain both estrogen and progestin. (Progestin is a synthetic form of progesterone.) COCs are the more common of the two types.

Progestin-only pills (POPs) contain only progestin.

In both cases, the pills come in a pack and you take one every day.

Many individuals choose the pill for its affordability and effectiveness. However, it must be taken on time every day in order to prevent pregnancy. You may find it helpful to combine taking your birth control with another daily habit such as brushing your teeth, or to set a reminder on your phone. The Alto app has medication management reminders to help you continue with your treatment.

While the pill is 91% effective at preventing pregnancy when taken as prescribed, it does not offer protection against sexually transmitted infections (STIs). If you have an STI or are unsure about a sexual partner’s health history, use condoms every time you have sex to protect your health and your partner’s.

The birth control ring, also referred to as the vaginal ring, consists of a small, flexible ring worn inside of your vagina. It releases hormones, which are absorbed through the vaginal lining, for ongoing pregnancy prevention. Like birth control pills, these hormones prevent ovulation and thicken cervical mucus.

There are two types of birth control rings. NuvaRing® lasts for up to five weeks. It is worn continuously and typically replaced about once a month. It may also be used to skip your period.

An Annovera® ring lasts for a year. You wear it in your vagina for 21 days, take it out for seven days, and then put it back in your vagina to restart the cycle.

A vaginal ring must be used correctly to offer full benefits. That includes replacing it when needed and, in the case of an Annovera ring, taking it out and putting it back in on time. To stay on schedule, set reminders or alarms on your phone, or keep track on a calendar. You can also check out Planned Parenthood’s free birth control reminder app, Spot On.

The birth control ring is prescription-only. It does not offer protection against STIs.

The transdermal contraceptive patch releases estrogen and progestin through the skin and into your body to prevent pregnancy. There are two branded options available in the U.S.: Xulane® and Twirla®. Both patches may be worn on your belly, butt, or back. The Xulane patch can also be worn on your upper arm.

The birth control patch is worn for a total of 21 days. You will need to replace the patch during that time, wearing a new patch each week for three weeks. During the fourth week, you will not wear a patch so that menstrual bleeding may occur. The cycle then restarts.

A patch must be used correctly and on schedule to offer effective pregnancy prevention. Set reminders or alarms on your phone, keep track on a calendar, or use a birth control reminder app.

The birth control patch is prescription-only. It does not offer protection against STIs.

The birth control shot, also referred to as the depo shot or Depo-Provera®, is an injection administered about every three months. It contains progestin and works similarly as the above forms of hormonal birth control to prevent pregnancy.

Many individuals choose the shot for the convenience of the injection schedule and privacy. In order to experience the benefits of the birth control shot, you must stay on track and get a new shot every 12-13 weeks. In most cases, a doctor or nurse will give you the shot. In some cases, you may be able to get a supply of shots from a health center to self-administer.

Use a birth control reminder app or a calendar to stay on track with your injections.

Long-term use of the Depo-Provera shot may increase an individual’s risk for significant and potentially irreversible bone mineral loss. Additionally, it has been associated with an increased risk of breast cancer and is not recommended for those with a known or suspected breast malignancy.

There are two types of longer-term birth control: intrauterine devices (IUDs) and birth control implants. Both methods release hormones into your body to prevent pregnancy.

The implant (Nexplanon®) is a tiny, thin rod implanted into your arm that offers pregnancy prevention for up to five years. It must be implanted in a doctor’s office. If your family planning goals change, a doctor can easily remove the implant before it expires.

The IUD is a small device implanted into your uterus that prevents pregnancy. There are different types of IUDs that offer protection for varying amounts of time.

Hormonal IUDs release progestin to prevent pregnancy. There are four FDA-approved hormonal IUDs in the U.S.:

Paragard® is a copper IUD that does not contain hormones. It prevents pregnancy for up to 12 years.

An IUD must be implanted by a healthcare professional. It is reversible and can be easily removed.

There are many factors to consider when choosing a birth control method. While many individuals find these forms of longer-term birth control more convenient, they are typically more expensive than other forms of contraception.

Timing is essential with many forms of hormonal birth control. We make it easy to stick to the schedule, with free same-day delivery and medication management reminders in the app. In addition, our pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to answer any questions you may have.

Many oral medications are available in several formulations that affect how the medication is released into your bloodstream. If your medication is followed by letters such as ER, XR, SR, CR, or DR, it means you’re taking a modified-release formulation. With these formulations, a medication’s effects are either extended over a longer period of time or delayed. They are often prescribed to decrease side effects or reduce the number of pills you have to take.

The Difference Between Extended- and Immediate-Release Medications

It’s important to understand how your body absorbs a medication. Read on to learn the key differences between the available medication formulations.

The standard dosage form of most oral medications is immediate-release. If your medication is not followed by one of the letter combinations above, it typically means that you’re taking an immediate-release formulation.

These medications are both fast-acting and short-lasting. Your body absorbs an immediate-release medication quickly after it enters your bloodstream, with the medication effects peaking within a small window of time. This can lead to greater side effects in some cases.

Your body’s levels of an immediate-release medication decline as it leaves your bloodstream. As a result, many immediate-release medications require you to take multiple doses each day so that you maintain a consistent amount of it.

An extended-release medication — typically indicated on the prescription label with an “ER” or “XR” after the medication’s name — prolongs a medication’s effects and its levels in your body. With many medications, this reduces the number of daily doses.

Examples of extended-release medications include:

Estradiol ER transdermal patch (Alora®, Climara®, Dotti®, Lyllana®, Menostar®, Minivelle®, Vivelle-Dot®)

Metformin ER (Fortamet ER® , Glucophage XR®, Glumetza®)

Blog

Medication Bundling: One Delivery for All Your Prescriptions

What to Know About Arthritis in Children

Treatment and Prevention of Asthma Attacks

Meet the Innovation Team Building Alto's Next Big Bets

Get to know Jake Moffatt, Engineering Manager on the Alto Assistant Team

Choosing the Right Birth Control for You

The Difference Between Extended- and Immediate-Release Medications

A Full Pharmacy At Your Doorstep: Introducing Essentials from Alto

The Evolution of HIV Medication

The Medicare Donut Hole, Explained

A Guide to Traveling With Asthma

Why We Switched to React Query for Managing Server State

Switch to a better pharmacy.