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Understanding Tubal Factor Infertility

There are many potential causes of female infertility. Blocked fallopian tubes, also referred to as tubal disease or tubal factor infertility, account for 25-30% of all cases. Below, we explain how fallopian tube obstruction may prevent natural conception and what treatment options can support your family building journey.

How do blocked fallopian tubes impact fertility and pregnancy?

Fallopian tubes are female reproductive organs that connect the ovaries and uterus. They transport an egg from an ovary to the uterus during ovulation, the phase of each menstrual cycle in which the ovaries release a mature egg.

Healthy, functioning fallopian tubes are involved in several key steps of the natural conception process. First, they are the passageway through which sperm reaches an egg for fertilization. The fertilized egg will then move through the fallopian tubes until it reaches the uterus for implantation.

There are varying degrees of fallopian tube obstruction. The condition may take the form of:

Mild adhesions or scar tissue in either or both fallopian tubes

One narrowed fallopian tube as the result of adhesions or scar tissue

Two narrowed fallopian tubes as the result of adhesions or scar tissue

One completely blocked fallopian tube as the result of adhesions or scar tissue

Two completely blocked fallopian tubes as the result of adhesions or scar tissue

Hydrosalpinx, a severe form of tubal disease in which a blocked fallopian tube becomes enlarged and filled with fluid

While any of the above structural issues can potentially interfere with the fertilization of an egg, it is possible to become pregnant naturally if the fallopian tubes are only partially blocked. However, conceiving naturally with a partial blockage may increase the risk of an ectopic pregnancy, which is when an embryo implants outside of the uterus. (90% of ectopic pregnancies occur in the fallopian tubes.)

Ectopic pregnancies can lead to very serious complications, such as ruptured fallopian tubes, without prompt treatment to end the pregnancy. Given this risk, anyone with a history of fallopian tube blockage should inform their doctor as soon as they think they might be pregnant.

A hydrosalpinx may prevent the possibility of pregnancy in some cases, as the fluid can be toxic to an embryo. This interferes with successful embryo implantation in the uterus, a critical step in the reproductive process. In other cases, a person with hydrosalpinx may be able to become pregnant, but the resulting inflammation of the uterine lining can still interfere with the typical development of an embryo in a healthy pregnancy.

Blocked fallopian tubes may develop as the result of the following health conditions and infections.

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows in the ovaries, fallopian tubes, or lining of the pelvic cavity. When it develops in the fallopian tubes, the resulting scar tissue may lead to fallopian tube blockage.

Physical trauma to the female reproductive organs, like a previous abdominal surgery or ruptured appendix, can also contribute to the accumulation of scar tissue in the fallopian tubes.

Pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, or ovaries, can lead to the accumulation of scar tissue and fluid in these organs. PID typically develops when bacteria enter the female reproductive tract. It is often a complication of untreated chlamydia or gonorrhea.

What are typical symptoms of blocked fallopian tubes?

Blocked fallopian tubes are rarely accompanied by noticeable symptoms other than difficulty becoming pregnant. Many women first learn that they have a fallopian tube blockage after consulting a doctor for a fertility evaluation. However, more extensive fallopian tube obstruction may be accompanied by chronic mild pelvic or abdominal pain. This is most common with a hydrosalpinx.

How is fallopian tube blockage diagnosed?

Blocked fallopian tubes are typically diagnosed with a hysterosalpingogram (HSG) or a laparoscopy.

A hysterosalpingogram (HSG) is an x-ray taken to examine issues within the uterus and fallopian tubes. In this process, dye is injected into the uterine cavity through the vagina and cervix. If there is no fallopian tube blockage, the dye will flow through the fallopian tubes.

A laparoscopy is a minimally invasive procedure that inserts a small camera through the abdomen to evaluate reproductive organs including the fallopian tubes.

Surgery and in vitro fertilization (IVF) are the two main treatment options for people with tubal factor infertility. The best option for you depends on the extent of the blockage and individual reproductive health factors.

Surgery may be an appropriate treatment option for someone whose fallopian tubes are not severely damaged if there aren’t additional infertility factors. If you are conceiving as a couple, a partner’s sperm count and quality should be accounted for as well.

Tubal surgery can increase the risk of an ectopic pregnancy. If you have had this procedure, it’s even more critical to contact your doctor right away if you believe you may be pregnant.

IVF is a form of assisted reproductive technology (ART) in which an egg is fertilized with sperm outside of the body and then placed into the uterus with the potential outcome of a pregnancy. Since IVF bypasses the fallopian tubes, implanting a fertilized egg directly into the uterine lining, it is a common treatment for tubal factor infertility.

It is typically recommended for people with fallopian tube blockage who are less likely to have success conceiving naturally. This includes people with severely damaged fallopian tubes as well as those with less severe fallopian tube damage but other infertility risk factors.

Hydrosalpinx has been associated with lower IVF success rates. If you have this type of fallopian tube damage, your doctor may recommend fallopian tube removal before starting IVF.

The cost of treatment and insurance coverage are also important factors to consider as you explore your options.

Fertility treatment can be a challenging journey, but Alto is with you every step of the way. We offer reliable same-day delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

Interested in learning more about how Alto can support your treatment? Request a price quote online or reach out through secure in-app messaging.

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

There’s a spectrum of infertility experiences. The 11% of US couples affected by secondary infertility first have difficulty conceiving after previously giving birth without fertility treatment.

Infertility can be overwhelming to navigate regardless of when it occurs in the family building journey. And secondary infertility can bring unique challenges of its own. Fortunately, the condition is just as treatable as primary infertility, or difficulty becoming pregnant for the first time.

What to Know About Secondary Infertility

There’s a spectrum of infertility experiences. The 11% of US couples affected by secondary infertility first have difficulty conceiving after previously giving birth without fertility treatment.

Infertility can be overwhelming to navigate regardless of when it occurs in the family building journey. And secondary infertility can bring unique challenges of its own. Fortunately, the condition is just as treatable as primary infertility, or difficulty becoming pregnant for the first time.

Here’s what to know about causes, treatment options, and support resources for secondary infertility.

Like primary infertility, secondary infertility can be caused by female reproductive factors, male reproductive factors, a combination of both, or unknown causes.

Causes of secondary infertility in women and people assigned female at birth

Women become less fertile as they age, with a significant decline in the quantity and quality of their eggs from the mid 30s until they eventually reach menopause. Lower-quality eggs are more likely to have chromosomal abnormalities, which increases the chance of miscarriage and reduces the chance of a successful pregnancy.

Structural issues with reproductive organs

Blocked or damaged reproductive organs, specifically the fallopian tubes or uterus, can result in secondary infertility. There are several potential reasons for damage to the female reproductive organs.

Complications related to sexually transmitted infections (STIs) like pelvic inflammatory disease (PID), chlamydia, or gonorrhea can block the fallopian tubes.

Procedures such as dilation and curettage (D&C) or a c-section delivery can cause scarring in the uterus.

Benign polyps or fibroids may block fallopian tubes or interfere with the implantation of a fertilized egg, or embryo.

Polycystic ovary syndrome (PCOS) is characterized by a hormone imbalance that impacts ovulation. It is a leading cause of female infertility.

Endometriosis occurs when tissue that should only grow in the uterus implants and grows elsewhere. The abnormal tissue growth — as well as surgical procedures to remove it — can block the fallopian tubes, preventing the fertilization of an egg. Endometriosis can also interfere with embryo implantation.

Changes in weight or other lifestyle factors

Being underweight or overweight can both impact a woman’s fertility. So can behavioral or lifestyle factors including smoking and substance use.

Causes of secondary infertility in men and people assigned male at birth

Male infertility most often stems from issues with sperm production, including sperm quality, motility, or quantity. Contributing factors may include the following.

Decline in the quality of semen, the fluid that carries sperm

Health conditions including hormone, pituitary gland, or immune system problems and genetic conditions like cystic fibrosis

Certain medications and medical treatments, including some blood pressure and arthritis medications and treatment for cancer, urinary tract infections, and more

If you are experiencing secondary infertility, you may be wondering why it’s more difficult to conceive than before. Here are some reasons why a fertility issue may develop later in life.

Both male and female fertility change over time. The quantity and quality of a woman’s eggs decline with age. There is a similar, though not as severe, relationship between age and sperm quantity and quality. It’s also possible that a fertility issue has become more severe over time. 

Physical changes, new health issues, or lifestyle factors can influence a male or female partner’s fertility. Weight gain or loss or shifts in habits like smoking or substance use may lead to more difficulty conceiving.

A new diagnosis of pelvic inflammatory disease, chlamydia, or gonorrhea is another potential factor in secondary infertility.

Taking a new medication could also change a person’s fertility. For example, common treatments for high blood pressure, arthritis, seizures, or ulcerative colitis can impact sperm quality. And treatment for certain types of cancer can also affect both male and female fertility.

Fertility issues caused by a previous pregnancy or birth

Structural issues with the fallopian tubes or uterus can develop as the result of a complication from a previous miscarriage, pregnancy, or birth.

The timeline for seeking treatment for secondary infertility is the same as that for primary infertility and depends on your age. 

If you are under 35, most health experts suggest consulting a reproductive specialist after a year of trying to conceive.

If you are between 35 and 40, you may want to pursue testing or treatment after six months of trying to become pregnant.

If you are over 40, you may want to pursue testing or treatment before you start trying to conceive.

It’s important to be proactive about seeking treatment for secondary infertility. To increase your chances of success with treatment, don’t wait to pursue a consultation with a fertility specialist based on your past experience(s) conceiving.

It is also recommended to pursue testing or treatment before trying to conceive if you or your partner have any of the following risk factors for secondary infertility:

A history of a sexually transmitted infection such as pelvic inflammatory disease

Common treatment options for secondary infertility

There are many treatment options that can help increase your chances of conception. The most effective course of treatment depends on the underlying cause of your or your partner’s fertility issues. These are some common treatments for secondary infertility.

In vitro fertilization (IVF) is a form of assisted reproductive technology (ART) in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. In addition to treating female infertility, IVF can also be used when male infertility is a factor.

Intrauterine insemination (IUI) is a type of artificial insemination in which sperm that have been washed and concentrated are placed directly into a woman’s uterus during ovulation.

Injectable fertility medications like gonadotropins and oral fertility medications such as Clomid® and Femara® can treat fertility-related hormonal imbalances in women.

Oral fertility medications such as Clomid®, letrozole (Femara®), and anastrozole (Arimidex®) and injectable gonadotropin therapy are common treatments for male infertility.

Secondary infertility can be a difficult and emotionally complex diagnosis to process. The need for support is just as great as it is for primary infertility. It’s often helpful to connect with others who have faced similar challenges. RESOLVE: The National Infertility Association offers virtual and in-person support groups specifically for secondary infertility.

To learn more, search their directory of support groups by topic.

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.

Staying on track with treatment and fully benefiting from a medication entails more than simply filling a prescription. It requires patients to take an active role in their health journeys, with education, clinical monitoring, and side effect management all necessary for proper drug utilization.

How Alto’s High-Touch Model Supports Patient Engagement

Pharmacists are an invaluable healthcare resource for those with complex treatment plans. Unfortunately, the traditional retail and mail-order models fail to maximize the possibilities of pharmacy care, without opportunities for ongoing engagement with patients. Not only are retail pharmacists often inundated with many tasks, it’s difficult for patients to discuss their health in a crowded store with a line of other customers behind them. And patients receiving their medication by mail often have limited visibility into delivery details or difficulty connecting with the pharmacy team. 

Alto Pharmacy offers a supported and convenient prescription journey at every step. We ensure that our patients have the information they need to get started with specialty medications and feel confident about their care. In addition to providing a simple onboarding experience, we have a team with robust clinical expertise and a high-touch model that allows patients to easily benefit from it.

We are also expanding our reach to fertility patients through our new nationwide* mail-order offering. Patients who receive fertility medications through mail-order experience the same convenience and support as those we serve via local courier delivery, with seamless onboarding, easy and supported medication management, and access to experts. 

And with an integrated and customizable tech stack — including both our proprietary pharmacy management software and our patient app — there are many ways for partners to provide additional engagement and supplement other support programs.

Here’s how Alto’s model enhances medication education and gives you, as a partner, the opportunity to more deeply engage our shared patients.

Alto offers a supportive and simple patient onboarding experience with proactive multichannel communication. We give patients a welcome text or call within 60 minutes of receiving their prescription, guiding them through their first order. Those who need to transfer an existing prescription to Alto can do so within minutes in our app.

If more information is necessary to fill a prescription, we make sure that patients and providers are both fully in the loop. We keep the patient informed at every step of the billing process, offering support with prior authorizations as needed. Through Alto Connect, our free communications portal for providers, clinical teams can view active medication details and quickly understand when additional steps are required to fill a prescription.

Partner Opportunities to Supplement Patient Support

The majority of Alto patients use our app for intake, medication ordering, and delivery scheduling. Not only does this give patients control and convenience in managing their prescriptions, it provides opportunities for additional engagement from partners.

Our flexible technology capabilities allow for many possibilities, including in-app introductions to your medications. In this video, a specialist from our fertility team walks patients through injecting the Gonal-f® RFF Redi-ject® Pen.

Follow-Up and Improving the Patient Experience

Easy onboarding is just the beginning. Alto supports patients at every stage of the prescription journey so that they can get the most benefit from their medication. Our dedicated medication therapy management pharmacists, who focus entirely on disease state education and support for chronic conditions, proactively contact patients who take specialty medications to review their regimens.

We ask if they are experiencing any side effects and track all patient-reported outcomes. As a partner, you can have access to data and insights into your patients’ experience of your medications.

We’re also able to tailor a patient’s treatment to any titration schedule prescribed by their provider. In these cases, we inform the patient of this schedule and change in medication dosage at every step of the treatment.

We see our NPS of 88 as an attestation of our patients’ love and commitment to both Alto and their health. 

Choose Alto Pharmacy for your limited distribution network

Alto’s end-to-end dispensing model is specifically built for specialty and specialty lite products. To learn more about partnering with us, reach out to partnerships@alto.com.

Tech-Based, High-Touch Patient Engagement at Alto

At Alto Pharmacy, a patient’s financial wellness is of the utmost importance. We understand that cost is one of the most common barriers to medication access, and we go above and beyond to connect patients with any savings opportunities that they may qualify for. 

Alto Pharmacy’s Product Controls for Coupons

At the same time, as a specialty pharmacy, we have a responsibility to protect the integrity of assistance programs and ensure that only eligible patients benefit from these resources. Our integrated technology stack provides the controls needed to restrict savings access to qualifying patients. Take a look.

The two components of Alto’s technology stack are both integral to our coupon controls.

Our proprietary pharmacy management software, Wunderbar — through which more than 80% of our prescriptions are automatically billed by algorithms — gives us both control and flexibility, with the ability to set custom workflows and requirements.

Our patient app — which the majority of Alto patients use for intake, medication ordering, and delivery scheduling — integrates with Wunderbar. With many areas for patient input, including coupon sign-ups, the app allows us to easily provide data to partners and further supports our controls.

Multiple guardrails for controlling coupon use

Our robust technology platform gives us multiple ways to ensure that coupons are applied to those who are eligible.

Providers often include ICD-10 diagnosis codes on prescriptions to aid in prior authorizations and coupon use. The provided information is entered into Wunderbar during our automated intake process. Our billing controls can limit coupon use to a specific diagnosis code if necessary, allowing for proper distribution of a medication. 

If a provider did not include the necessary diagnosis code for coupon verification, the patient can verify their diagnosis through the app. Our tech capabilities allow us to create pop-ups or notifications as needed for patient input. This patient attestation can be customized for different medication coupon scenarios and reported outcomes.

With a flexible tech stack, we can easily create additional workflows or automations to further regulate savings applications. These are some of the filters we can use:

Since we use proprietary software, we’re not only able to ensure appropriate application of savings opportunities — we have so much available data about coupon use to share with partners like you.

We can provide NDC and patient-level insights, including coupon application, the exact amount of money saved, and how many fills were delivered. These data insights could help develop market access strategies by monitoring gross to net gaps and identifying the opportunities for copay accumulators and maximizers.

At Alto Pharmacy, a patient’s financial wellness is of the utmost importance. We understand that cost is one of the most common barriers to medication access, and we go above and beyond to connect patients with any savings opportunities that they may qualify for. 

At the same time, as a specialty pharmacy, we have a responsibility to protect the integrity of assistance programs and ensure that only eligible patients benefit from these resources. Our integrated technology stack provides the controls needed to restrict savings access to qualifying patients. Take a look.

Despite how widespread infertility is, affecting about 9% of U.S. men and 11% of U.S. women, the condition remains underdiscussed and misunderstood.

Information is critical to making the right decisions throughout your family building journey, but with so many misconceptions about fertility — and so much unsolicited advice — it can be difficult to know the best way forward. To help set the record straight, we’ve debunked several common myths about infertility.

Top Fertility Myths Debunked

Despite how widespread infertility is, affecting about 9% of U.S. men and 11% of U.S. women, the condition remains underdiscussed and misunderstood.

Information is critical to making the right decisions throughout your family building journey, but with so many misconceptions about fertility — and so much unsolicited advice — it can be difficult to know the best way forward. To help set the record straight, we’ve debunked several common myths about infertility.

Myth: Infertility is purely a female health issue

Infertility is often considered a women’s health issue, but in reality, only a third of all infertility cases are exclusively caused by female reproductive factors. Of the remaining two-thirds, half stem from only a male reproductive factor and half stem from a combination of male and female factors or unknown causes.

Male infertility is most often the result of issues with sperm production, including problems with sperm quality and quantity. Fertility treatment can help address both male and female fertility issues. In fact, one reason for the perception of infertility as purely a female health condition is that it is sometimes women who undergo assisted reproductive technology (ART) treatments such as in vitro fertilization (IVF) and intrauterine insemination (IUI) even for a male infertility factor. (Men can be treated for infertility with oral medications or injectable hormone therapy, but these treatments can take six months to a year or more whereas a typical IVF cycle is just two weeks.)

If you and your partner are experiencing challenges conceiving, you both may wish to consult with a doctor about a fertility evaluation to determine the best next steps. Experts recommend seeking an evaluation after six months of trying to conceive if the female partner is over 35 and after a year if the female partner is 35 or younger.

Read Male Infertility: Causes, Symptoms, and Treatment.

Myth: Age doesn’t affect male fertility

Many people are aware that women become less fertile as they age, with a significant decline in the quantity and quality of their eggs from the mid 30s until they eventually reach menopause. Male fertility also declines with age, typically beginning around 35-40. And though the changes men experience are less significant — men never stop producing sperm and may be able to conceive well into their 50s, 60s, or later — a male partner’s age can influence pregnancy rates and how long it takes to conceive.

The age-related decrease in male fertility often stems from changes in sperm quantity and quality. Sperm quantity refers to the amount of sperm produced, while quality refers to its movement, size, and shape. These characteristics are important factors in male fertility, as they affect sperm’s ability to reach and fertilize an egg.

Myth: You’re too young to experience fertility challenges

Given that age is a factor in both male and female infertility cases, it’s understandable to assume that you won’t have difficulty conceiving in your 20s or early 30s. However, infertility affects people of different ages. According to the American Society for Reproductive Medicine, 7% of women between the ages of 20-24 face infertility, as do 9% of women between the ages of 25-29.

Age-related changes in fertility can vary by individual. While fertility typically begins to decline around the ages of 30-35 for most women, it’s possible to enter premature menopause and experience these changes even earlier.

Beyond the variation in age-related fertility issues, there are some causes of infertility entirely unrelated to age, including:

A history of pelvic inflammatory disease, chlamydia, or gonorrhea — conditions that can lead to blocked fallopian tubes

Other health issues including a history of chronic illnesses or cancer of a reproductive organ

Lifestyle factors including smoking and substance use issues

Remember that no one is ever too young to pursue fertility testing, and you are your own best advocate.

Myth: Getting a regular monthly period means you won’t struggle with fertility

Yes, the majority of female infertility cases are caused by problems with ovulation — the release of a mature egg from the ovaries — and a regular period typically indicates that you are ovulating normally. However, there are other drivers of female infertility, and it is possible to struggle to conceive even with a regular menstrual cycle.

Here are some reasons why you might have difficulty conceiving despite getting a regular monthly period:

Structural issues with the uterus or cervix

Endometriosis, a condition in which tissue that should only grow in the uterus implants and grows elsewhere

Silent anovulation*, a condition in which a person does not ovulate despite getting a regular period

Fortunately, there is treatment for a wide range of fertility issues. A fertility evaluation is an important first step toward addressing your specific challenge.

*The majority of anovulation cases are characterized by an irregular period and therefore more easily recognizable, hence why those that include a regular period are referred to as silent cases.

Myth: Couples who naturally conceived previously won’t struggle with fertility in the future

Having an easy time getting pregnant once doesn’t necessarily indicate that you will have the same experience in the future. Infertility may develop at different stages of life, particularly when age is a contributing factor.

Secondary infertility occurs when individuals or couples who already have one or more children have difficulty conceiving again. It affects approximately 11% of U.S. couples and is caused by many of the same factors as primary infertility, or difficulty conceiving for the first time.

Regardless of whether you’ve been pregnant previously, don’t delay on seeking a fertility evaluation if you are struggling to conceive.

Myth: If you’re trying to conceive, just relax

It’s commonly assumed that stress makes it more difficult to get pregnant. While chronic stress may affect a person’s ability to conceive, it’s important to remember that infertility is a medical condition, and stress alone is unlikely to drive fertility struggles. In other words, try not to let your stress become a new source of stress.

That said, while healthy stress management isn’t a substitute for fertility treatment, staying mindful of your emotional and mental well-being can only make it easier to navigate the challenges of infertility.

A pharmacy partner for your fertility journey

Fertility treatment can be a challenging journey, but Alto is with you every step of the way. We offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

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

Pharmacists are one of the most accessible healthcare professionals, seeing people 5 to 8 times more frequently per year than primary care providers. Their role has become more expansive than ever, and many people don’t realize just how integral they are to a patient’s health and well-being.

National Pharmacists Month Spotlight: Travis Allison

At Alto, fulfillment pharmacists focus on dispensing medication — ensuring that the entire process is carefully monitored every step of the way — while patient advocacy pharmacists tackle anything related to a patient’s wellness, from provider communication and insurance coordination to guidance on managing chronic health conditions.

These specializations have opened up entirely new possibilities for the patient-pharmacist relationship at Alto. And this October, as we celebrate American Pharmacist Month, we’re spotlighting a few of the extraordinary Alto pharmacists who focus on patient advocacy.

To kick things off, we’re pleased to introduce Travis Allison, a patient care pharmacist based in Dallas, Texas.

What motivated you to pursue a career in pharmacy?

I took the long and winding road here. I didn’t always know this was what I wanted to do. In college, I started off as an English major but had a change of heart after a semester or two. I went on to study agriculture, and those experiences made me believe that I could pursue a path grounded in science.

My childhood memories of visiting the pharmacist were always in the back of my mind. As a kid, I hated going to the doctor. When those dreaded appointments were over and done with, I knew I’d get to see a guy in a white coat who would give me something to feel better. I always saw pharmacists as a comfort in the often scary world of healthcare.

What challenges have you encountered as a pharmacist?

At any chain pharmacy — which is where I spent my career before Alto — pharmacists are inundated with so many tasks. It isn’t that these tasks are unrelated to pharmacy, but they interfere with our ability to deliver patient care.

On a typical day, I would give 100 Covid shots and fill 200 prescriptions by myself while also coordinating billing and calling doctors’ offices. We also had to think about corporate metrics. I was frequently asked to get more people signed up for text message alerts and hit specific quotas.

Patient care is always the priority, for any pharmacist, but the reality of my job made it extremely difficult, and often impossible, to give patients the time they deserved.

The first thing I noticed when I started at Alto were the specializations. We have many different team members to handle all the responsibilities that fall on a single person’s shoulders at a traditional retail pharmacy.

I’m a patient care pharmacist, which is distinct from fulfillment pharmacists who process prescriptions.

I review prescriptions for accuracy and initiate medication transfers, and I interact with both patients and doctors. I’m here to answer any questions a patient has about their medication.

In a way, I feel like I’m on the frontlines the same way that I was when I worked in a pharmacy chain. It’s all of what I liked about retail pharmacy without the distractions of retail. We’re able to practice our most important functions as pharmacists without the noise.

We’re utilizing technology in a way no other pharmacy does, which allows us to communicate with patients and providers in so many different ways — without having to rush through interactions.

And the wheels of change turn much more quickly at a tech-oriented company than they do at a massive corporation. At my previous job, you could have conversations all day about what improvements were needed, but nothing ever happened. Alto was founded by software engineers, and we’re able to easily make changes in real time.

As a digital pharmacy, we serve so many patients that only we can serve. I talk to many who are homebound without a caretaker. Because of Alto’s model, I’m able to communicate with them, and we’re often their only point of contact within the healthcare system. I don’t know of another way these patients could get pharmacy care.

The digital model also allows us to get a broader view of healthcare, and to make an impact on a larger scale. Alto was one of few places where New Yorkers could get the Covid medication Paxlovid when it was first introduced.

It was incredible to be sitting here in Texas, getting prescriptions out in New York City just as a new variant came out that was really devastating to the city. At no other pharmacy would I have been able to help out my neighbors in New York.

Those moments where you can tell in a patient’s voice that you seriously helped them. To me, that’s an indication of how well I’m doing my job, much more so than the number of prescriptions processed or dollars generated.

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?

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