Expires 04/01/2021

Specialty Pharmacy

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

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

Alto Pharmacy Technician

Alto Pharmacist

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

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

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

Alto / Blog

At Alto, we value effective communication across all teams. In our latest blog post software engineer Eric Leite shares how he set out to make it easier to understand how our repositories change over time while minimizing disruption to engineers’ existing workflows.

How (and Why) We’re Standardizing our Commit Messages

Have you ever tried to debug a production issue by looking at your commit history, only to find a bunch of commits that don’t seem to be connected to any specific feature? Or maybe you've pulled the latest version of a dependency and noticed a bug that wasn’t there before?

It’s hard to pinpoint where a problem might have begun if your project (or its dependencies) don’t rely on standards to commit and release code. This was a problem I set out to tackle in my organization: How can we make it easier to understand how our repositories change over time while minimizing disruption to engineers’ existing workflows?

At Alto, we value effective communication. We keep our pharmacists and operations team in the loop about every new feature we release to production on a daily basis. We also announce changes to our codebase in a dedicated Slack channel to keep our engineers informed. But that raises the question: How do we ensure that someone doesn’t forget to make an announcement? And can we reduce the time we spend writing one up? Introducing a commit standard would enable us to use automated tooling that makes communication about code changes effortless.

Consider an open-source repository with hundreds of contributors. Project owners often adopt standards and industry best practices because it makes the project easier to maintain as the number of contributors increases. Eventually, our engineering team will grow to this point—and, just like in an open-source project, we can’t expect engineers to retain all of our conventions in their heads when they contribute. Standardizing commit messages eliminates one of the many variables around how we commit code. It can give engineers more confidence in their releases, build trust in our codebase, and increase productivity.

Many engineers have a distinct working style. If you propose a change to their everyday workflow, you will likely encounter some resistance. That’s why identifying and working with key stakeholders before you introduce a new process can help ensure its success. One way to do this is to chart stakeholders on two axes—influence in the organization and interest in the project:

I used this chart to decide how I would direct my communication with the team. Folks who fell into the “low influence” and “low interest” quadrants didn’t need to be involved in the whole process. Instead, I kept them informed by using project-specific slack channels and documentation in Notion to communicate status updates and summarize meetings. Topics that required a team decision were discussed verbally rather than using Slack to avoid potential miscommunications.

The more likely someone was to push back on the project or give me valuable feedback, the more involved they were. I included those who fell into the “high influence” and “high interest” quadrants in almost every meeting. These folks served as a kind of litmus test for my ideas. They typically had high standards and expectations and needed to be convinced that a change was worthwhile if they were going to get behind it. Keeping people like this involved in the discussion is a great way to ensure that your initiative will produce value for your organization.

In a perfect world, we’d have standardized commits in every repository. However, given that Alto is a fast-moving startup, foundational changes need to be rolled out incrementally to minimize churn, validate impact, and allow us space to learn and iterate. There’s often not enough time or resources to do everything, and going all-in on something may require more effort than it’s worth.

We began by identifying the knowledge gaps we currently have about commit standardization and how we could iteratively validate the required process changes. We initially considered beta testing with the production app that runs our day to day operations because it had the most contributors and the most to gain from standardization. However, we didn’t want to risk blocking the majority of our team or experimenting with a project that was critical to business operations. The next best option was our internal component library—it had fewer contributors, so fewer engineers would be blocked if something went wrong, and more projects depended on it, so the potential impact would still be significant.

Given that one of our company values is to Focus On Impact, and that internal changes like this are difficult to measure, we quantified our level of success or failure using a team survey. We sent out a series of questions at the start of the project asking the team to rate their satisfaction with our current commit, review, and release processes. We plan to compare these results with a follow-up survey to measure changes in ease of committing code, confidence in releasing, and our developer NPS.

After closing our knowledge gaps and getting a baseline understanding of how the team felt about our release processes, we decided to adjust the scope to include the following changes:

Commit Standardization (i.e., formatting and enforcement of commit titles)

Versioned Release Automation (i.e., automatic version cuts, changelogs, and notifications)

We looked toward existing open source solutions to make these changes because we were on a tight schedule. There were many options to choose from, so narrowing them down to a shortlist before presenting them to the team helped speed up the decision-making process. The best tools for the job will depend on your engineering organization, of course, but we prioritized maturity, flexibility, and compatibility with our existing workflows during our evaluation.

We landed on the Conventional Commits standard because it has been vetted and used extensively in other projects, and a whole ecosystem of release tooling has been built around it. It also has a short learning curve, is flexible enough to work with all our repositories, and only enforces the bare minimum necessary to generate semantic versions based on commit titles.

We chose Commitizen to help engineers get familiar with the new standard, Commitlint to warn about (but not block) contributions with invalid commits, and Semantic Pull Requests to serve as the final gate for validating commit titles. This way, non-standardized commits are only stopped from being merged when a pull request is made, and it can be easily corrected using the GitHub UI.

The open-source tooling for release automation was sparse and highly specialized, but we found Semantic Release to be the exception as it offered the most mature, flexible solution. It manages everything from cutting a release to generating a changelog to publishing packages and notifications. It also isn’t limited to only publishing NPM packages, making it an excellent fit for our multi-language codebase.

While we have a ways to go before versioned releases are automated in all of Alto’s repositories, we’ve made a significant first step with commit standardization. Some engineers have already proactively adopted the new standard without any tooling, and I’ve personally found that it has helped my commits stay focused and become more granular.

So far, we’ve standardized our component library. The commit history in this repository used to look like this:

Commits now have more context in them that’s visible at a glance (e.g., feature vs. fix), and breaking changes are explicitly noted in the commit message using an exclamation point (e.g., refactor!). These commit titles are used to automatically generate a changelog any time we cut a release. We can even automatically cut and version-bump a release for every new commit because we follow a commit standard.

The next phase of this project will be to review and act on the feedback from the follow-up survey. We will continue to build on top of these standards with release automation tooling and discuss what process changes make sense for the rest of our codebase. We are confident that through these changes, we will be able to de-risk code contributions, reduce the burden of cutting a release, and better prepare for our engineering team’s future growth.

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

How (and Why) We’re Standardizing Our Commit Messages

Every year, we look forward to October, when we get a whole month to honor the extraordinary work of the pharmacists and pharmacy technicians at Alto and around the world.

Celebrating National Pharmacist Month at Alto

Every year, we look forward to October, when we get a whole month to honor the extraordinary work of the pharmacists and pharmacy technicians at Alto and around the world. National Pharmacist Month is a time to celebrate the many ways that pharmacy professionals positively impact their communities. At Alto, we get an intimate look at how pharmacists improve the health and well-being of others every single day through their expertise and exceptional care.

This year’s theme is “Essential Providers, Accessible Care,” recognizing the vital roles that pharmacists and pharmacy technicians are playing on the front lines of healthcare during the COVID-19 pandemic. From the common cold to chronic disease, pharmacists are always there to answer important health questions and make sure medications are not only accessible but used safely and effectively.

National Pharmacist Month is a great time to show your appreciation for the pharmacy professionals who help with your medications. It’s also an opportunity to learn more about the depth of their expertise. For example, did you know that becoming a pharmacist requires a doctorate degree? Pharmacists are not only experts on medication management, they also serve as patient educators, perform laboratory studies and health screenings, and act as skillful problem solvers. Whether we’re facing an acute issue or a chronic condition, many of us turn to our pharmacists to suggest supplements, over-the-counter medicines, or lifestyle adjustments that can help us feel better. 

In addition to our month-long celebration of pharmacy professionals, the third Tuesday of October has its own special designation: National Pharmacy Technician Day. On this day, we recognize the unique and invaluable contributions of pharmacy technicians. A critical part of any healthcare team, pharmacy technicians work closely with pharmacists to make sure patients get the medications they need. Technicians not only assist in the preparation and distribution of medications, but they also work directly with community members to collect patient information and help process billing claims.

Both pharmacists and pharmacy technicians are essential in providing us with access to safe and effective treatment when health issues arise. This year, more than ever, we are grateful for their steadfast dedication to your care. 

In honor of the 116 incredible men and women who perform these vital roles at Alto, here are five facts you may not know about the pharmacy profession:

October 12th is Women Pharmacists Day! About 55% of pharmacists are women, making pharmacy a predominantly female field. 

Pharmacists are the most frequently visited healthcare providers in America. They can be found working in a variety of settings—from hospitals to the neighborhood pharmacy—and we turn to them most often for health advice. 

The world’s oldest prescriptions were etched into tablets around 2100 B.C

Benjamin Franklin is considered one of the founding fathers of pharmacy. He helped to establish the first public hospital and hospital pharmacy in the United States. 

Agatha Christie, the crime novelist, worked as an apothecary’s assistant, or what we would now call a pharmacy technician. Her interest in medicine was apparent in much of her writing, inspiring her many plot lines about poisoning and disease. 

We at Alto could not be more proud of our incredible pharmacists and pharmacy technicians. Through your skills as educators and guides, you uplift the health and well-being of the communities you serve. 

Want to express your gratitude to the pharmacists at Alto? You can reach out by phone, text, or through the app to say thanks and brighten their day. 

In July 2020, Catherine Scott joined Alto as Head of IT, responsible for building and leading a high performing IT team. We sat down with Scott to learn more about her plan to build Alto’s IT strategy and support teams focused on End-User Support, Infrastructure & Networks and Business Applications. 

Airbnb’s Former Head of Business Technology Joins Alto

In July 2020, Catherine Scott joined Alto as Head of IT, responsible for building and leading a high performing IT team. Previously, Cat spent five years at AirBnB where she acted as the  Global Head of Business Technology during their worldwide growth and was pivotal in delivering exceptional technology experiences to employees. With this expertise, and over 20 years experience spanning startups to Fortune 500 Companies, we are excited to officially call her an Altoid! 

We sat down with Scott to learn more about her plan to build Alto’s IT strategy and support teams focused on End-User Support, Infrastructure & Networks and Business Applications. 

Welcome to Alto! What excites you most about recently joining the team? 

Thank you! I’ll start by sharing that I am excited by companies that have a strong mission. This was an important consideration for joining Airbnb.  When contemplating what was next, I knew that this was a primary driver for my next move.  Alto’s mission - to improve the quality of life for everyone - very much resonated with me. 

Aside from that, my conversations with Altoids during the hiring process reflected a sense of passion and humility that I found to be rare in a successful company. There is a culture of really intelligent, driven individuals here that are unpretentious about their accomplishments. 

Likewise, any time I evaluate an opportunity for growth, I assess the impact that I can have based on my experience. Given my background in consulting, startups, and Fortune 500 companies, I found Alto’s goals to be in line with my ability to improve efficiency and help IT mature into being viewed as a critical enabler to our business.

You were the Global Head of Business Technology (Products) at Airbnb for 5 years. How did this experience shape your outlook on strategic growth and what was the most important lesson that you learned? 

When I joined Airbnb the IT organization was in its infancy. We were present in 192 countries and yet there were only six people assigned to the global team.  It was imperative to create a global strategy quickly that would both enable the hyper-growth of the company and consider how to scale in a cost effective way.

I think the key takeaway is that IT is everywhere. It's a foundational layer supporting how everything functions. Thinking about IT early in a company’s lifecycle is essential, but above that you have to ensure everything is thought of from a scalable perspective. If we only build for right now there will inevitably be a technical rework later so making sure the IT services are both built for increased volume and still cost effective is important.

Can you share a little bit about your goals at Alto for the remainder of the year? 

Right now I’m very focused on what I would call core/foundational IT (network infrastructure, IT support function, etc.) -- essentially the programs that are the enablers for everyone. I’m also working closely with Alto’s Director of Security to ensure that we continue to protect our patients' data with the utmost level of reliability. 

Next year I’d love to start addressing  how IT can enable more business return on investment. For example, managing and implementing 3rd party applications. Typically, and this was the same at Airbnb, if everyone is going off and buying different, potentially duplicative, applications, we start to leave money on the table and can have disjointed data and compromise security. This is where IT starts to become a case for ROI and business benefit. 

I’ll actually contend that Alto is a forward thinking in recognizing the importance of IT. Because of this, I know I’ll be able to create positive benefits because we’ll be in front of the curve. At the end of the day, if we can grow in a thoughtful manner, we’ll arrive at a place where we’ll have a really high performing IT organization that contributes to the bottom line. 

You know, my motto is to “embrace the adventure.” I love spending time outdoors, whether hiking, skiing, or sailing, so it really resonates in my professional life as well. I feel excited about developing an IT strategy that will ensure high quality services both in our sites and remotely, protect our internal data, maximize productivity of our workforce, and ultimately contribute to the company mission of improving the quality of life for everyone.

The good news is, having done this before, I don’t think there’s anything that’s a surprise yet. During the interview process, I knew that this role would require another ground-up build and that it would require a strategic and thoughtful leader. Having said that, the results are always less about me and more about what the team has been able to do and how we have contributed to Alto’s success.

On that note, how would your prior teams describe you? 

I think, or hope, my team would say that I’m incredibly supportive in removing anything that is keeping them from being able to achieve maximum impact or create maximum value for the company. I define myself as authentic, trustworthy and driven -- and value those qualities in others. I definitely have a high bar for excellence and want my team to be successful at performing but at the same time, I’m also there to help when needed and support their professional development. 

Stylistically I’ve always been a leader where I kind of exist to support others and provide thought leadership. You are nothing without your team. To quote Steve Jobs, "It doesn't make sense to hire smart people and tell them what to do; we hire smart people so they can tell us what to do." This philosophy is one that has always resonated with me. 

How do you feel about technology changing our work culture given the current climate of COVID-19? 

Alto is the first job where I joined having never met a single team member in person. It’s definitely changed things up but I’m pretty comfortable with it at this point. Looking forward though, I think it’s important to consider how we can recreate the “magic” that happens in person when a number of our workforce is remote. 

COVID highlighted the significance of innovative IT related to remote work and collaboration that is essential for everyone. That area of creativity is where I think IT will fundamentally shift how we continue to work and communicate with one another in what may be an increasingly remote workforce. 

Are you working on any passion projects outside of Alto at the moment? 

Yes! I’m very passionate about animals and am currently looking to rescue another dog. Aside from that, I’m recently new to the Tahoe, CA, area so hope to become more embedded in community volunteering. 

My other personal passion project is actually an overhaul remodel on our Tahoe house which has required a fair amount of architecture and engineering for my husband and myself. It’s a fun project that keeps us constantly engaged with one another. 

What would you say to someone interested in joining the Alto team, specifically in a technology driven role? 

Just do it, it’s an amazing opportunity! I believe so strongly in what Alto is doing. If you ever have an opportunity to work for a company that is founder-led you should make it happen. There is a palpable passion that resonates throughout a company when the founders are present. It’s an experience worth doing because it creates a belief and excitement around the company that might not happen otherwise. 

For more information on Scott, or to connect with her directly, reach out via LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers. 

Airbnb’s Former Head of Business Technology Joins Alto 

In honor of National Coming Out day our Proud Employee Resource Group sat down with Altoid Nicholas Satow, Partnerships Manager HIV/PreP, to learn about his own personal experience and his advice for others on coming out.

Coming Out with Pride: Nicholas Satow Shares His Story

This year marks the 32nd anniversary of National Coming Out Day, a time to support lesbian, gay, bisexual, queer, and transexual individuals. In honor of this awareness day our Proud Employee Resource Group sat down with Altoid Nicholas Satow, Partnerships Manager HIV/PrEP, to learn about his own personal experience and his advice for others on coming out. ERG’s are voluntary, employee-led groups that foster a diverse, inclusive workplace aligned with organizational mission, values, goals, business practices, and objectives.

Q: Tell us a little about your coming out experience. When did it happen and who did you first tell? 

A: My coming out story starts with the story of my best friend. We met in third grade and were just 15-years-old when she came out to me. She was a star basketball player and met a girl from an opposing high school team 45 miles away. We quickly turned 16, and without our parents’ knowledge, we were driving 90 miles round trip every weekend to go see her girlfriend and hang out with a group of kids who didn’t know anyone from our school district. The 45 miles of distance made her feel safe from our friends and family finding out about her double life.

Leading a double life and constantly hiding our whereabouts started to wear on us. Especially for her after family and friends started becoming suspicious. Who is this girl you’re always on the phone with? Why are there so many miles on your car? Where are you going? Her fear of being outed or disowned started to build as rumors began to circulate between friends and family.

It was a Saturday night, and we were halfway through our 45 mile drive home. She broke down in tears and started to share terrifying thoughts she’d been having. She said she couldn’t take the pressure of the double life anymore and the rumors circulating at school. She felt extremely overwhelmed, isolated, and scared. Thoughts of teenage suicide and stories I had heard of queer teens taking their own lives started to consume my mind. Even though I wasn’t ready to come out of the closet yet, I knew in that moment my friend needed me more than ever. I felt responsible for her loneliness and selfish for making her go through this journey alone. She said, “I can’t take this anymore. I can’t live like this,” Staring at the road ahead, I said, “You need to stay strong. You make me strong.” I turned and looked at her and said, “I’m gay, too.” This was the first time I said those words out loud. It was terrifying and relieving at the same time. It was the first time I felt authentically me. 

It’s 15+ years later, and we’ve helped each other get through many scary thoughts and tough times, come out of the closet to friends and family (sometimes while sitting side-by-side) and navigate difficult romantic relationships as we learned what it was like to be a young gay person in Cleveland, Ohio.

Q: How did you feel as a result of coming out? 

A: After coming out to my best friend, I felt a sense of relief and companionship. Our double lives became more of a shared experience and a lot easier to manage, knowing we had each other to rely on. I also started to feel more comfortable coming out to other friends. At 18, I came out to all my friends. At 22, I came out to my parents and family.

Q: What resources, support groups, or communities did you rely on when coming out? 

A: At the time, I wasn’t aware of any resources or support groups, so this wasn’t something I utilized. Another best friend’s older brother was gay, so I learned a lot from him, and he took me out to introduce me to the community and become comfortable in my own skin.

Q: What advice would you give to others? 

A: The best advice I’d give to LGBTQIA+ youth is to find a support system of like-minded individuals and come out when you feel it’s safe to do so. If you’re in an environment where you feel your mental or physical safety could be jeopardized, don’t come out until those dangers are gone. If being disowned, financially cut-off, or assaulted is a possible reality, make sure you have somewhere safe to go where your basic needs can be met. There will always be people who won’t accept you for who you are, but there will be even more who will support you. You just need to find that community. 

Q:  Why is it important for you to work at a company that values diversity in all forms?

A: Companies that support diversity help us evolve into a more accepting society. When people are exposed to colleagues who are different from them, they get to know each other on a personal level and start to realize that we are all more similar than different. I believe these experiences translate into the way people treat others outside of work and how they raise their children.

At Alto, we believe in a world where every perspective matters and that diversity fosters creativity and creates innovation. We welcome candidates of all backgrounds, skill sets, and experiences. To learn more, read Why We Prioritize Diversity at Alto. 

For more information on how to make your workplace safe and equitable for all, read 11 Simple Ways You (Yes, You!) Can Make Your Workplace More LGBTQ Inclusive. 

If you or someone you know is considering coming out, we encourage you to review these resources: 

Parents, Families, and Friends of Lesbians and Gays (PFLAG) Recommended Reading: Coming Out

Coming Out with Pride: Nicholas Satow Shares His Story 

Nicholas Satow (center) with Camp Lightbulb leaders

Erik Gregorio Cruz, Micaela Moss, and Jordane Thomas joined Alto this summer as the company’s first engineering interns! Here they share their learnings, accomplishments, and their advice for future Alto interns.

How to Make the Most of Your Engineering Internship — Advice From Alto's First Interns

Erik Gregorio Cruz, Micaela Moss, and Jordane Thomas joined Alto this summer as the company’s first engineering interns! In their three months with us they blazed the trail for future Alto interns while adjusting to a new norm of fully remote work during the global pandemic. Here they share their learnings, accomplishments, and advice for future Alto interns.

Coming out of a bootcamp program rather than a traditional Computer Science degree program, Micaela hoped to find a company open to non-traditional educational paths. “I know that a company that is welcoming of bootcamp grads values diversity, inclusivity, and mentorship.” 

For Erik, it came down to his interview experience: “Everyone seemed to really enjoy their experience and really believed in the mission they were working on.” Micaela agreed, adding that it also ultimately came down to the people for her. “You can tell a lot about a company’s culture based on what the people who interview you are like,” she said. “From the recruiter to the engineers, everyone was incredibly friendly and a joy to interact with.”

What was the most fun moment of your internship? (That is, assuming you had fun!)

Virtual team lunches were a highlight for all 3 interns. However, one special moment during Micaela’s internship actually came from resolving a ticket that involved writing an end-to-end (E2E) test—something she was not looking forward to. “I was dreading it for two reasons: First, I do not particularly enjoy writing tests—I’d rather write the code that passes them—and second, I had never worked with Cypress before. Several hours later, after reading lots of documentation, studying previously written E2E tests, and getting stumped by a hidden selector, I managed to write the test. When I finally ran it and got to watch the video as it clicked on buttons and filled out inputs, I became instantly enchanted. I may have run it several more times just to watch it, smiling like a goofball, knowing that this test that I had created would be run every time code was pushed and merged.” 

In addition to their respective engineering managers, whom the interns had weekly 1:1s with, each intern was also assigned a dedicated mentor, who committed at least 5 hours a week of dedicated support to their interns over Slack and Zoom. Mentors were able to provide historical and business context, help interns get ramped up on Alto’s tech stack, codebase, and tools, and pair program as needed. “Working with my mentor definitely made me more productive,” said Jordane.

The mentors added that working with the interns actually helped them improve their ability to articulate technical concepts, as well as their ability to talk through technical challenges with others more effectively in their day to day work.

What was it like interning during the pandemic and being fully remote?

“I found myself setting up ‘Hey, there’s a pandemic, and this is crazy, so let’s get introduced virtually, maybe?’ meetings,” said Micaela. “Although, as someone who is horrible with names, it is worth noting that a silver lining to being entirely remote is having everyone’s name in the corner of their zoom video. That, and sweatpants everyday!” 

Erik and Jordane agreed that being remote required a little extra effort. Alto’s engineering office is based in SF, and since they weren’t required to be physically in-office this summer due to the pandemic, both Erik and Jordane were based in other time zones. “In the beginning I was starting my day at 9am EST/6am PST, but if I got stuck I would have to wait until West Coast working hours before I could reach out,” explained Jordane. With time, “I picked up a different working rhythm that worked better for everyone.”

While Jordane was surprised by just “how friendly and accessible everyone was,” Erik was surprised by how quickly he was able to actually deploy code. 

Acknowledging that her chosen career path has a history of gender imbalance, Micaela shared that she “was pleasantly surprised” to have both a female manager and a female mentor. “It was a great experience getting to have two strong female role models to learn from during my internship.”

Micaela and Jordane were both on the Pharmacy Platform team, which defines best practices and processes that promote a future-forward and scalable way of development. The platform team provides tools, libraries, and services that make development work at Alto and enable all of Alto's engineers to write performant code. Erik was on the Pharmacy Supply Chain team, which enables a better, faster experience for patients by ensuring the right medications get out the door, on time, and at the lowest cost possible.

Erik’s mentor, Eric Leite, helped us understand what Erik contributed to the Pharmacy Supply Chain team: “Sometimes our operations workflow requires manual intervention to resolve issues. We use an extendable admin interface to help us navigate the more complex issues. Erik created an add-on to this application that helped our on-call team work more efficiently. We can now resolve a specific kind of complex insurance claim issue by using his add-on to guide us through the multi-day resolution process. Erik learned about our supply chain operations workflow, how insurance claims are processed, how to model out a problem using Ruby on Rails, and how to write effective tests using RSpec.”

Micaela and Jordane, both on the Pharmacy Platform team, worked on optimizing performance and cleaning up legacy code. For instance, Jordane helped standardize Alto’s frontend by increasing adoption of our component library. “Although this was a relatively straight-forward task that didn’t require much problem solving, it did require a lot of endurance,” said Jordane. “I had to edit and test changes to over 300 files by hand. There were many times I could have broken [the platform], and changes needed to be made very carefully.”

What is the biggest learning you are taking away from this experience?

“The biggest learning I am taking away from this experience is nicely summed up by the grail knight in Indiana Jones and the Last Crusade: ‘You have chosen...wisely.’” said Micaela. “I knew I enjoyed software engineering when I was learning it, or when I was working on my personal projects, but that can change when it becomes a job. After spending the summer as a software engineering intern at Alto, I can say with confidence that I have chosen...wisely.”

Jordane discovered that “engineering isn’t just innovation,” as he came into the experience believing; “it’s also investigation.” When we asked the interns’ mentors and managers what they had learned from the interns, they all recognized the genuine curiosity the interns brought into their respective teams and projects, which helped them to see Alto’s codebase through new eyes. They also gushed about the excitement the interns had when pushing to production for the first time.

What words of wisdom would you give to future Alto interns?

All three agreed: ask as many questions as you need to! “Over communicate, and just relax & enjoy the process!” offered Jordane. Erik agreed sharing, “Do not be afraid to reach out when you get stuck. Reaching out for help is essential.” 

“An internship is all about learning and growing,” said Micaela, “so take advantage of the wisdom and experience of your peers. They have a lot to offer!”

Ashley Qian, the Senior Engineer who mentored Micaela, advised, “Know your limits! Take breaks! Find something else to enjoy other than software engineering because your work is not your life, and your life is not work. Surround yourself with people who are your advocates and go to bat for you, and if you find yourself in a system or an environment that does not support you, try to understand what your boundaries are, and leave if you can. You always have a shoulder to lean on if that's the case, here, with the friends you've made at Alto!

Interested in being an intern at Alto? Check out our careers page HERE.

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

From Pharmacist to Professor: Sandra Aziz Spotlight

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What does a Software Engineer at Alto do?

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

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

Developing a Predictive Interview Process to Reduce Unconscious Bias

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Building an Engineering Career at Alto 

This interview has been edited for length and clarity.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Senior Manager, Engineering at Alto Pharmacy

Jaime Tolbert is a Patient Care Pharmacist based out of Alto’s Denver office. Here she shares what drew her to Alto and how the company is fulfilling its mission to be a better pharmacy.

Delivering the Best Care

Jaime Tolbert is a Patient Care Pharmacist based out of Alto’s Denver office. Here she shares what drew her to Alto and how the company is fulfilling its mission to be a better pharmacy. 

Prior to Alto, I worked in retail pharmacy for 13 years. My patients were the best part of my practice and helping them live healthier and happier lives was very fulfilling. When our company was bought out by CVS, there was a shift from caring about people and their health to a very task based environment. Spending the majority of my day on administrative work, being timed to finish each task, and not having time to really engage with my patients was devastating to me as a health care professional, and my work became less meaningful. One of my former colleagues had taken a position at Alto and shared how much she loved the company and its values. She offered to introduce me around and show me first hand what it was like to work here. I found that Alto puts their patients above all, and really cares about both the people they serve, and their employees. They are open to new ideas and changes, and really listen when you have thoughts and ideas about how to better serve our community or improve processes. 

Coming to Alto meant leaving behind my “family” of patients whom I loved and had worked with for years. Although this was a difficult decision, it is one I would make again in a heartbeat. This company is making a real change in pharmacy and in healthcare. After 6 months, I can honestly say I love to come to work, and I am so thankful every day for the opportunity to be part of something that is changing the face of healthcare. (And, as Alto expands our services in Denver, I am hopeful to bring many of those wonderful people to our company and offer them the personalized care they deserve.)

Working for Alto has brought me back to the reason that I became a pharmacist…to help people and to make a difference. My primary role is to focus on our patients- making sure they understand their medications, have a resource for information to answer all of their questions, and to give them the care that they deserve while keeping them safe from drug interactions or other medical issues. 

As patient care pharmacists, we are problem solvers, detectives, drug information resources, and caring providers of health and wellness to our patients. Regardless of what we do, we want to make sure we are acting in the best interest of the patient. There are instances in which people call in late at night with medication issues such as: their fertility medication has not been stored correctly and they need their injection right away, or their injection did not go as expected and they don’t know how to proceed. In these moments, we have to do some detective work and figure out if the drug is OK to use or not, or make judgement calls on the best course of action for these patients. It can be difficult to remain calm when patients are panicked or confused, but it’s our job to be a voice of reason, a sense of calm in the storm for the patient.

In the 13 years I spent in retail pharmacy, I wasn’t able to go nearly as in-depth with patient care as I do at Alto. In the retail setting, you perform all aspects of the job from start to finish mostly on your own, often within a strict time limit. At Alto, the company has separated the pharmacist role into two teams: a production team and a patient care team. The production pharmacists get to focus solely on medication preparation and inventory management while the patient care pharmacists can focus on patient consultations and clinical recommendations.

We definitely still try to work efficiently, but we have the luxury to take a 30-45 minute phone call to consult our patients and comfort them, if necessary. Some of the medications that we administer, like our fertility meds, can be really overwhelming. We have the benefit of taking time to walk patients through tough moments like their first injection, which is especially helpful on evenings and weekends when their doctor isn’t available.

Unlike the retail setting, all of Alto’s patient care interactions are done through phone calls, text messages, or secure message via our app. This model presents a lot of benefits including more privacy for the patient/pharmacist conversation.  Another benefit is the ability to reference those dialogues with the pharmacy in the event, for example, the patient forgets how the pharmacist advised to take the medication. The model also forces our team to really focus on every aspect of our messaging. We work hard to tailor both how we speak to patients and how we draft messages to ensure our patients feel a strong sense of empathy and can understand their instructions clearly. Our team also shares one voice. If a patient speaks with me about their defective medication on Tuesday, and that patient is then put in touch with one of my colleagues the following Wednesday, they will receive the same quality care and same customer service, and my colleague will have all of their most current information in detailed notes. 

Another unique factor about Alto is the team dynamic. There are 20 patient care pharmacists between the Denver and San Francisco offices. Working alongside other pharmacists every day, I’ve been able to learn so much about pharmacy that I didn’t know before. In a retail setting you're the lone individual making decisions and calls based on your interpretation of a situation.  Now, I have this entire team with varying perspectives to bounce ideas off of or go to for advice if something comes up that I have never dealt with before.

Our supervisors at Alto are also very skilled in identifying their employees’ strengths and inviting them to work on new projects. I really enjoy explaining things to people, so I’ve helped to re-write the training program for our patient care pharmacists; everything from surveys of how my team thinks we should train, to the training schedule, to physical training guides to help develop our new PCPs. That’s an opportunity I never would have had in traditional retail and I am grateful for the opportunity to help expand and train our team. I feel like working as a team is a great way to grow as a pharmacist, and ultimately benefits our patients which is why we are here.

Delivering the Best Care: Why a Veteran Pharmacist Chose to Join the Alto Team 

When the city of Denver instituted a shelter-in-place order, the non-profit A Precious Child (APC), based in Broomfield, CO, suddenly saw both a dramatic decrease in donations and an increase in people in need. With COVID-19, APC found that many children and families were still in dire need of donations of cleaning supplies, hygiene products, and more, but it was much harder for APC to collect and distribute these goods. The Alto team in Denver started a food and clothing drive to help support APC's efforts and is offering free delivery of donations to people in need.

Matt Alley, Sr. Manager of Operations at Alto Pharmacy in Denver, had previously been a volunteer at A Precious Child and received a message from APC as they were looking for organizations to help support their efforts. We caught up with Matt to hear more about Alto's commitment to the Denver community.

Q: Can you share how the Denver Alto team got involved in efforts to support A Precious Child?

Blog

How (and Why) We’re Standardizing Our Commit Messages

Celebrating National Pharmacist Month at Alto

Airbnb’s Former Head of Business Technology Joins Alto

Coming Out with Pride: Nicholas Satow Shares His Story

How to Make the Most of Your Engineering Internship — Advice From Alto's First Interns

From Pharmacist to Professor: Sandra Aziz Spotlight

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

Building an Engineering Career at Alto

Delivering the Best Care: Why a Veteran Pharmacist Chose to Join the Alto Team

Alto’s Denver Team is Delivering Impact During the COVID-19 Pandemic

Alto Pharmacy’s Las Vegas Team is Committed to Community Service

An Altoid Profile: How Marsha Delivers Impact Daily

Switch to a better pharmacy.