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

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As you gear up for a flurry of gift-giving and family video calls, there are a few important healthcare items to prioritize on your ever-lengthening to-do list. 

Your End-of-Year Health Checklist

The holiday season can descend with the sudden force of a blizzard, seemingly blanketing the world in twinkly lights and festive cheer overnight. As you gear up for a flurry of gift-giving and family video calls, there are a few important healthcare items to prioritize on your to-do list. 

If you have money in a flexible savings account (FSA), it won’t roll over at the end of the year, meaning any unused funds will be lost. Make sure to spend those dollars before the deadline on December 31st. If you have prescriptions that are ready to be refilled, that’s a great way to use your available funds. 

Don’t forget—your year-end FSA receipts are available for easy download under “Payment Details” within the Alto app and your online account. No need to hang on to unruly paper receipts. We’re keeping track of your prescription spending details for you.  

Even if you’re not traveling for the holidays, the final weeks of December can be a whirlwind. Take stock of your prescription medications now to ensure that you’re covered through the season’s celebrations. If you have a refill due around holiday time, you might consider setting up your delivery window a little early to avoid forgetting in the midst of your holiday fun. 

If you’re planning for extended travel and need to adjust your refill dates accordingly, reach out and let us know as soon as possible. We will do our best to coordinate with your insurance so you can focus on getting from point A to point B. 

Many of us look forward to the onset of the new year as a chance to start fresh or make healthy changes. However, those changes may be less welcome when they involve your medical costs. Here are three variables to keep in mind that may affect your healthcare spending in the new year: 

With most health plans, your deductible—the amount you are responsible for paying out of pocket before your insurance starts covering the costs—resets on January 1st. As you put together your holiday budget, you may want to plan for a temporary uptick in medical costs in the new year until your 2023 deductible has been met. 

Insurance companies often update their medication coverage and pricing at the start of each year. We’ll always show you your out-of-pocket costs before you confirm your delivery window and we’re here to help you re-examine your options if you have any concerns. 

New insurance kicks in at the start of the year if you've made any changes in open-enrollment. Make sure you're getting the most of your prescription benefits and avoid care delays by updating your insurance for Alto and all of your providers. Read more about insurance updates here.

Don’t let last-minute prescription worries diminish your holiday cheer. Take care of these end-of-year details now so you can immerse yourself in the spirit of the season—no matter where it takes you. As always, we’ll be here to help coordinate refills, schedule deliveries, and find the lowest price on your medications. If you need support, we’re just a in-app message or by phone call away.

Editor’s Note: This post was originally published in November 2020 and has been updated for accuracy and completeness.

We are building a pharmacy where every patient matters and is included. To do that, we need to foster a culture and company that is committed to challenging existing racism, injustice and prejudice, in order to create a culture and service that is inclusive. 

Diversity At Alto: Building an Inclusive Healthcare Company and Culture

At Alto, we are redefining the pharmacy experience which has been part of a very old, broken way that has fueled systemic racism. We are building a pharmacy where every patient matters and is included. To do that, we need to foster a culture and company that is committed to challenging existing racism, injustice and prejudice, in order to create a culture and service that is inclusive.  Our team consists of committed and passionate individuals who champion to effect positive change on issues related to race, injustice and prejudice.

This passion for equality is what we strived for when we first set out to build a team with a broad representation of diversity. Our goal was to create a community that reflects an inclusive culture regardless of age, education, gender, race, ethnicity, religion, sexual orientation, socio-economic status, or other dimensions of diversity. Yet even with the best of intentions we recognize that there is more work to be done to dismantle the systems and structures that fuel racism and inequity.

2020 has been a year like none other for so many.  HR professionals around the globe have stepped center stage to support our organizations, teams and communities in ways many of us could not imagine.  I wanted to write this post to share my personal journey on this topic while supporting others in capturing this moment.  I am a white gay cis man.  Many of my identities provide much privilege.  I am committed to educating myself. I am building an environment where our teams can push past their fears to learn and grow.

Read more about Why We Prioritize Diversity at Alto.  

In 2019 we initiated our focused DEI (Diversity Equity Inclusion) work with the goal of ensuring employees felt safe, and included, and ensuring that candidates and employees have equal access to opportunity for advancement in the organization. We learned a few things during the early days of this work including balancing listening while creating the right structure to move to action.  Fast forward to early 2020, in the midst of the global COVID-19 pandemic and the murder of Ahmaud Arbery, Breonna Taylor, Tony McDade, George Floyd, and Jacob Blake, we like many other organizations did not want another moment for action to pass by.

Read more about Alto’s Mission and Values. 

The week after George Floyd’s murder we hosted a series of listening sessions for Altoids.  We began them with a simple statement:  “We are holding this space for you.  Tell us how you are feeling.  Share your experiences.” The results were powerful moments of revelation, pain and heartbreak.  Black, Asian, Native and Latinx Altoids shared experiences of racism, sexism, and prejudice in their lives.  As a leadership team, we started to wake up to the enormity and urgency of the work we had ahead of us.

In reflecting on these tragic murders and Altoid voices, we realized we needed to expand the building blocks of our 2020/2021 DEI strategy. We recognized that we didn’t want to rely on the members of our underrepresented communities to lead us on this journey.  We do not expect underrepresented professionals to teach us, especially cis white men, about the history and experiences that led us to this moment. 

We made the decision to find a partner to help.  What struck me about Pathfinder and Trier Bryant, is their ability to push our thinking on this critical work while meeting us where we are (each one of us). Trier is a strategic leader with distinctive Tech, Wall Street, and military experience spanning across 15 years. Pathfinder has an unwavering commitment to advise leaders on how to create a more equitable, inclusive, and thriving culture to produce prosperous companies. I appreciate many aspects of Trier’s support including that she too is a Chief People Officer, she wears these shoes.  Given that experience plus Pathfinder’s work with clients like Equinox, Compass, SoundCloud, Gusto, and eBay, we gain perspective and lessons learned.

Our first half-day session with Trier focused on educating the group about the language of diversity (e.g. Is it okay to say Black? What makes up the LGBTQIA+ community?).  Next we spent time learning about key historical events starting from 1619 that have shaped our current society with respect to race, oppression, and white supremacy in America.  We watched videos displaying more covert forms of white supremacy [see Ellen Tuzzelo’s Pyramid of White Supremacy]. 

These are actions I could recognize in myself (i.e. not challenging racist jokes when told by my family members, not always believing the stories of Black victims).  I felt sadness and shame. Sharing these feelings and our part in the current state of our nation is an important step. We took time to process and walked away with an epiphany.  

Over the past decades, America and specifically Corporate America lulled itself into thinking that we’ve been fighting bias.  Our aim up until this moment was to reduce or eliminate bias.  We were wrong.   Our fight, our work is to eliminate racism and white supremacy in America. This work is neither a marathon nor a sprint; we’re committed to doing this work all our lives.   

With that realization in mind we got more specific about what diversity meant to us and where we wanted to focus our teams at Alto. Diversity by nature is very broad and inclusive. We used individual characteristics, experiences, and abilities consistent with our values and mission that includes but is not limited to:

*Sexual Orientation and language abilities will begin to be captured with Workday, our new HR system.

As a part of the above education, we learned that while we all have various identities and intersections that represent our Altoids, intersectionality is a term that must be clearly understood to comprehend unique modes of discrimination and privilege that occur in the workplace.  

Identity - the fact of being who or what a person is; affinity (i.e. Hispanic/Latinx, Black, Male, Female, Nonbinary) 

Intersections - a point at which two or more identities  intersect (i.e. Hispanic/Latinx Gay Male, Black Heterosexual Female)

Intersectionality -  the cumulative way in which the effects of multiple forms of self-identifications intersect, overlap, or combine to create unique modes of discrimination and privilege; intersectionality identifies advantages and disadvantages that are felt by people due to a combination of factors

While Alto recognizes a broad and inclusive definition for diversity of various identities, there are strategic priorities for underrepresented groups at the company. After benchmarking current tech and health care demographics, we decided to focus our DEI work for Altoids including our leadership, managers and independent contractors on the following underrepresented groups at Alto: 

Women in STEM (Science Technology Engineering Math)

The following month we read So You Want to Talk about Race by Ijeoma Oluo. What an incredible read! This engaged us in thinking about and naming our privilege.  In the next half-day session with Trier, we discussed the book to name our privilege and explored how it influenced our personal and professional development.  

We learned several lessons from Ijeoma and Trier including that we’re going to make mistakes and say the wrong thing; that is part of the journey yet we still must do the work.  Also that microaggressions are as damaging as overt racism and we must do better at calling these detrimental behaviors out everyday. 

Lastly, non-white people fear retaliation most when the topic of racism and prejudice comes up; we must create a space for everyone’s voices and perspectives to not only be heard but respected.

As I reflected on our second half-day session together, I saw the journey for our leadership team through four stages.

Stage 1: Self-Awareness-doing the personal work regarding racism and privilege

Stage 2: Awakening-acknowledgement of role of racism, privilege, and gressions,; doing the work in our professional life

Stage 3: Empowering-identifying the work to be done with our team, team members and building more inclusion on our teams

Stage 4: Advocating-taking our roles as a senior leaders at Alto to change behaviors and lead change at the company and our communities 

For the last round of workshops we split up our senior leaders into smaller groups so that we could focus on the work needed to be done with each of their teams.  In these sessions, we learned more about identities.  How do we identify?  What do we learn and acknowledge about our team members identities?  We discussed specific examples of how intersectionality shows up in the workplace and the role it places in each other’s experiences.  This pivot allowed us to move into Stage 3.

As we embarked on taking this work to our team, we felt more prepared and comfortable because of the time spent educating, processing and doing our own work ahead of time. This allowed each of us to live one of our core values “start with empathy.” Being empathetic is hard when you haven’t done your own work.

As a result of all the foundational work we’d done as individuals, as a team and as a company, in July, our leadership team committed to a bolder, crisper DEI plan that includes four strategies with clear goals:

Hire - ensure we have diverse teams and insure all are valued

Include - increase inclusion and community 

Develop - educate our leadership team and all Altoids

Invest - support initiatives with money and time  

This new DEI plan rallied the team and catalyzed us to make some significant changes with clear alignment, commitment and clarity around the problem we’re trying to solve. For example, one immediate change we made was to focus our executive search process on underrepresented talent. I’m excited to share that only a few months later (most searches take 6 months), we were able to hire several outstanding candidates from underrepresented backgrounds. 

Before, we had just been “hoping” for diversity and thus looking in all the wrong places.  Once hiring diverse talent  at the executive level became a critical mandate, that forced us to really seek the right kind of strategy. I’m excited to share some more of the significant changes we’ve made, over a series of posts over the next few months.

We are far from perfect.  We have work to do to meet our goals.  These are our first steps.

In January, we will share our first DEI Report including workforce demographics, success stories, lessons learned from 2020, and aspirational goals for 2021 and beyond.

We condemn the violence and systemic racism that has harmed marginalized communities, specifically Black communities, for far too long. At the same time, we commit to look inward and educate ourselves to continue to create safe spaces for Altoids and to act on what we learn. 

This will be a lifelong journey and we will continue to share updates on our progress. Our actions must be sustained and focused on keeping the momentum of enabling change now and for future generations. 

Last, personally this work is the most fulfilling of my career. There are days I am exhausted.  There are days I need help.  Yet there are many days I overflow with pride in our team.  I am most hopeful about the work ahead and seeing the early fruits of this work while challenging us each day to do more.

Mike McClay has spent the better part of two decades working in Silicon Valley. Here, he chats with software engineer Akash Gupta about the road from Software Engineer to VP, what it’s like to work in digital health, and his best advice to both independent contributors (ICs) and managers. 

Get to Know Alto’s VP of Engineering, Mike McClay

I'd love to first understand a bit about you personally. What do you like to do in your off time? What’s something most people don't know about you?

I grew up in Orange County, which is pretty suburban, so that afforded us a lot of time outdoors as a family. A life goal of mine is to do a solo hike of the John Muir Trail. The route starts in Yosemite Valley and heads south to Mt. Whitney. It’s about 225 miles and typically takes a few weeks to complete.

Currently though, I have a two-year-old and a four-year-old, and we have another baby on the way, so my outdoor activities tend to be much shorter and closer to home. I got into road biking about 10 years ago and transitioned to mountain biking a few years back when my family moved to Marin. Being able to get out onto the local trails a couple times per week is an amazing opportunity to get a great workout in, and unplugging does wonders.

Finally, a ton of family time with my partner and kids. A big reason I decided to join Alto is because it provides a great balance of simultaneously being a high growth startup but it’s also a company that has an eye on culture and achieving work-life balance. At Alto, we're playing to win, and we’ve got a lot of things to get done, but there's a lot of support and representation for people with families with kids. It's nice to be able to work hard towards an incredible mission but also not have to sacrifice too much on the family front; so outside of work, I’m mostly focused on spending quality time with my family getting outdoors, getting to the beach, and things like that.

That's very exciting, having another child on the way. How has COVID-19 impacted your responsibilities of being a VP Engineering and a father?

Life is a lot harder during COVID, though I say that with a fair amount of awareness of the privilege my family and I have. On the home front, we are constantly trying to find that balance of keeping the kids entertained and learning but also doing it in a safe way that protects everyone. My wife and I are pretty fastidious about keeping the house organized and clean but that’s relaxed quite a bit during this time; there’s a lot of resetting of expectations, and I try to do as much as I can to support my wife.

Professionally, probably about half of our engineering team has interviewed and onboarded since the shift to remote work in March, and I’d say we are still iterating and adapting each month to work better in a fully remote environment. It’s been incredible to see our teams adapt to this new style of work, and while it’s not quite the same as our in-person environment was, it’s been really cool to see the team grow and have our organization make a bigger and bigger impact for our patients each month.

I'd love to talk about some of your past experiences. You went to the University of California, Berkeley (Go Bears!), then Expedia, then Uber, and now you're at Alto. What prompted each of those transitions?

Yeah, I’m kind of an outlier in the tech world in that I’ve only worked at 3 companies since graduating undergrad in 2004. I think I’ve been fortunate to find myself at companies that have had no shortage of growth opportunities and that led me to stay for considerable amounts of time at both Expedia and Uber. 

Towards the tail end of my tenure at Expedia, I was managing the engineering team of a start-up that Expedia had acquired, and I knew in my heart that I wanted to move to a much smaller company. I spent a few months talking to a bunch of early stage start-ups but hadn’t found anything that felt right yet.

At the urging of my recruiter, I took a call with a company called Uber, which had seemed way too “big” for what I was looking for in that the engineering team was about forty people. Despite the role feeling different from what I was expecting, I was excited by the mission and the team, so I made the leap. Fast forward six years or so and it was an amazing ride, full of a lot of ups and definitely some learnings, but it was a truly formative experience for me.

Uber ultimately got to a point where I struggled a bit to pinpoint the impact I was making, and things overall at the company just felt slow. I wanted to work on something that was even more mission-driven, and one of my colleagues insisted that I chat with Alto. I was introduced to Jamie (Alto’s CTO). We talked over a number of months and found Alto’s needs and the challenges I was looking to solve aligned in a great way. So that's why I ended up joining.

Each of the companies that you’ve worked at have had large operational components. What are some of the key pieces to creating a strong partnership in a tech-enabled company?

What I would definitely say is that the tooling and the product that we built for ops at Uber was, at the time, world-class; it was just beautiful. Design was a first class citizen in our operational tooling because the workflow of our ops team was so critical to our company’s success. 

This is something that Jamie and I bonded over about Alto; our internal platform (called Wunderbar) powers the functionality that allows us to process our patient’s prescriptions in an efficient and effective way. Getting this right is critical for our patients, and the fact that we put so much time and energy into getting the technology platform right goes a long way to build a great working relationship with our operations team. 

Additionally, I’m passionate in general about operations since it’s often an area of the business that creates strategic advantages over competitors. And what I love about building software with operations is that it can’t be copied easily by competitors since there is no public surface area to observe. I view our task as an engineering team as getting to where we're crushing it as a business because we have nailed supporting operations with our product engineering work.

On that note, would you say Alto is an operations company, a pharmacy, or a tech company?

We aspire to a model of cross-functional leadership, whether it's between Engineering, Product, Ops, Growth, Marketing—whatever it is, the leads of areas and even the team members of each area need to be empowered to achieve the mission that they're setting out to do. If that's to enable, say, the flow of prescriptions coming through our system, maybe you could call that Ops-led, but at the end of the day, multiple functions have to come together to solve the problem. I almost want to call it vision-led.

There’s a time and a place where we need to be creating a faster horse, and there's a time and a place where we need to be thinking one to two years out about what the step up is from the faster horse: bringing the car into the situation, so to speak. Ultimately we need to be thinking on multiple time horizons at the company, and depending on the time and place and the strategy, you might see one function spiking up in terms of what we're rallying around versus another.

The engineering team at Alto has grown from eleven engineers and four managers when you started a year ago to more than fifty-five engineers with nine managers, directors, senior managers, and managers. What would you say has enabled that dramatic growth, and how do you plan on ensuring that that growth is well-managed?

For engineers, there are a lot of choices out there, and a big part of our hiring process is spent not only assessing technical skills, but also looking for signals that candidates align well with our patient-focused mission. From the beginning, we created an interview process that is fair and equitable, and that resonates strongly with our candidates. From there, we set out some really big goals that energized the team to push to make it happen.

I'm really proud that we've grown while maintaining a solid level-mix in terms of junior, mid-level, and senior engineers. Our engineering team is ~25% female, and while we only have single digit percentage points of representation of other underrepresented groups, representation is improving every quarter. Our goal over the next several years is for the team to achieve 50% gender representation and 30% from other underrepresented groups, so that our engineering team is representative of those we ultimately serve: our patients.

In order to make sure this growth is well managed, my philosophy is to hire or grow Engineering Managers well in advance of the acute need. On the manager side—and this was a big learning for everyone at Uber—we’d grow a team of fifteen to twenty engineers under a manager and not really have a great plan in place for how to bring in additional leadership and get the teams down to a right size of ten. When we approached that number, we'd battlefield promote someone and everything just felt strained. So I'm really proud of the fact that even at nearly seventy people now, we have a management team of nine that could actually support one hundred people pretty well. As the team continues to grow we’ll be making sure to stay ahead of the growth on the management side.

On that note, Uber has been reported to have an unhealthy culture. What have you learned from it to engender a more positive, inclusive culture at Alto?

Yeah, I’ve had a lot of reflection on this and a lot of learnings from my time at Uber. First, it’s that as a leadership team, we need to be vigilant about creating a team environment where team members feel they can do their best work. We need to always have great managers leading teams that are right-sized, and we need to have people-focused cultural values that help guide our behaviors and how we interact with one another. 

At Alto, half of our cultural values are focused on skills that foster an environment where folks can do their best work. Yes, we're thinking constantly about impact, but we make sure to hold ourselves to a high interpersonal bar. This type of behavior has also been institutionalized at Alto in our engineering career ladder. Culture amplification is one of the five skills engineers are evaluated against, and I think it’s a very strong signal into what we hold dear and how we want to roll here.

Finally, I’ve put a strong emphasis on making sure that interviews at Alto assess behavioral skills in addition to technical ones. We didn’t do this well at Uber for too many years, and I believe it led to some of the cultural negatives that you’ve likely read about in the news. To me, it’s critical that we hire really talented folks who can work seamlessly with one another. Getting signal on this during our interview process is a big part of growing a healthy engineering organization.

You've gone from being a Software Engineer to Tech Lead, Engineering Manager, Director, and now, VP. What advice would you give someone at each of those stages? What advice do you wish you had back then?

The main piece of advice I’d relay is to make sure that you spend enough time in each role to get solid proficiency. I’ve come across a number of folks in my career who look to move through roles as quickly as possible, and I think that doesn't allow for solid bases of knowledge to be built up. The foundation I built up in my experience as an engineer I believe resonates with engineers; I’m not just a people manager that helps coordinate minutiae. Additionally, a lot of the skill-building in these roles happens as you encounter various real life situations; the only way to accumulate experience is over time. So my advice is to be patient.

I would definitely encourage everyone to work at a company where there are clear career paths for both ICs and managers. You should never feel like you need to move into management to “grow in your career.” One of the first things we put in place after I joined Alto was a career ladder so that folks could reason about how they wanted to grow over time and come up with a growth plan with their managers.

Finally, don’t go too long in a role or at a company where you don’t feel challenged and don’t feel like you are growing. To me, growth and challenge are proxies for job satisfaction. I would say I've achieved it about 80 to 90% of the time in my career. If you're not in a place where you're feeling like you're growing, you should go somewhere else.

What would you say to someone considering working in digital health? What are some challenges and benefits in this space?

It's not so fraught with red tape that you can’t get anything done. There is a process to work through with HIPAA (Health Insurance Portability and Accountability Act) to ensure patient privacy; there is a massive set of opportunities that support all of the activity in the space; and there are seams where startups can begin disrupting entrenched players.

There’s also a massive opportunity to solve hard technical problems while achieving these amazing, mission-driven ends. I think sometimes it seems that those can be separated to where it’s almost mutually exclusive. While we don't yet have the volume nor traffic that you might receive at companies like Uber or Google, there are still meaty technical challenges that haven’t been solved before.

What disruption is good in healthcare and what may not be?

The good disruption comes in places where companies can plug into an existing experience that patients go through to solve a problem and figure out new ways to address that problem. In the pharmacy space, we are disrupting the brick and mortar pharmacy experience that is effectively in the business of selling you Coca-Cola while you wait for your medication. 

Bad disruption would be anything that goes against protecting a patient or their privacy. At Alto the engineering and security teams are tightly coupled so that we can best solve for the needs and privacy of our patients.

You mentioned technical challenges. What would engineers and other technical people get excited about in this space?

We don't yet have our architecture mapped out for scaling 100x on our business over the next couple of years, and it’s been really exciting to start to discuss our technical plans to enable that. At Uber, we went from a monolith to a full micro SOA (Service-Oriented Architecture)—both extremes that had quite a few problems as implemented. At Alto, we aim to find a better middle ground. 

Additionally, we need to think about what the pharmacy experience will look like five to ten years from now and start building some of the pieces that will work us toward that future. Safety and accuracy are incredibly important to us now, but at one hundred times our scale, we’ll need to be constantly innovating our technology so that we can minimize / eliminate errors in our operational process. 

We’re also bringing data silos together that have never been joined before. For example, as many as 50% of prescriptions are not picked up for retail pharmacies. Doctors have no idea which of their patients pick up medications or not. Insurers don't know what happens to patients after they take their medication. We are the interconnect between all of these customers.

As we grow, that data is going to grow inside of our systems. The information and the insights that we can derive from it is going to be incredibly powerful. But we're going to need a ton of awesome data analysis, products that allow us to collect the data while respecting patient privacy, etc. I'm really excited about that.

What are you most proud of from your time at Alto so far, and what are you most excited about in the next year?

What I'm most proud of is the team that's been hired. They are just amazing. Last year, we had a team of eleven engineers with such a large surface area: fulfillment, operations, customer app, customer website, our provider portal, etc. With so much to do across a team of that size, we were constantly making really hard prioritization decisions and were not able to tap into what we saw as our full potential.

Fast forward to today, we're now in a world where we have dedicated teams for surface areas, and we’re solidly parallelizing efforts. Seeing the bandwidth, the throughput that's going to be rolling out each quarter, is really cool. We're going to have orders of magnitude more output each quarter than we did a year ago. That's what I'm most proud of now.

What am I most excited about? There's the business aspect, expansion. We've really only covered six markets and are now looking at covering many, many more lives. The next couple of years are going to be a lot of fun.

Last question. Someone's considering working at Alto: Why should or shouldn't they join?

Alto’s at a stage where things are changing constantly. Folks who like dynamic environments will thrive here, as the work is challenging, and we are trying to solve problems that have not been solved before. Given that Alto operates within a multi-sided network, we have a lot of opportunity to create value, but it also means there are multiple players to think about when building a product. There's a richness to our patient, provider, and insurer base that makes it both challenging and exciting to make sure that we're finding the opportunities that deliver value to broad strokes of folks without leaving others behind.

Finally, engineers should join if they want to be part of a mission-driven company, enjoy working in an inclusive environment and diverse team, and like to be at the intersection of technology and the physical world, whether that's operations, delivery of things to humans, etc. If we succeed,  the way society thinks about health, prescriptions, etc, ten to twenty years from now will look very different because of the work we’re doing here. If that's inspiring to you, and you want to be part of that, you should join.

Interested in joining the team? Reach out to us on LinkedIn.

At Alto, we believe your medications should come to you—at the best price, on time, and with the ongoing support you need.

How Alto Delivers More, at No Additional Cost

At Alto, we believe your medications should come to you—at the best price, on time, and with the ongoing support you need. However, when we explain to people that we can save them money while providing free home delivery and easy access to expert care, we often encounter disbelief. In a world where we usually pay a premium for special care, how can Alto’s services really be free?

Traditional retail pharmacies often build hundreds of storefronts in a single metro area in an effort to lure customers through proximity. We, however, are taking a totally different approach. We’ve redesigned the pharmacy experience by building a single distribution center in each metro area. By reducing our overhead costs, we’re able to hire teams of patient care pharmacists who are always on-call to offer guidance and local couriers who will deliver your medications straight to your doorstep.  

What’s more, because we’re not using our resources to stock and equip a fleet of locations, we can invest in innovations that elevate your prescription experience. We built our own pharmacy software platform that enables our pharmacists and patient advocates to effortlessly perform price investigations and coordinate between doctors and insurance companies. We also developed the Alto app, which puts pharmacy care at your fingertips—from ordering refills to chatting with a pharmacist. 

In a traditional pharmacy setting, pharmacists are often required to fill prescriptions, work the register, answer phones, counsel patients, administer flu shots, and call doctors and insurance companies—all on a strictly timed schedule. We don’t believe that sets pharmacists up to provide the best care. At Alto, pharmacists work in two teams with close collaboration. Our production pharmacists can focus on the important task of medication preparation while our patient care pharmacists get to focus on you. Whether you’re concerned about a side effect or wondering if you should take your medication with a meal, you can talk through any issue with an expert who cares. 

By bringing our pharmacy to you, we’re able to offer you a better experience at no additional cost. From uninterrupted, one-on-one consultations with pharmacists to timely hand-delivery of your medications, we think “above and beyond” is simply what you should expect from your pharmacy. 

Need a Refresher? These Alto Benefits are Completely Free

Have you ever meticulously crafted an online dinner order only to cancel once you saw how all the delivery and service fees added up? We’re never going to put you through that type of frustration. When we say “free delivery,” we mean absolutely, completely, 100% free. There won’t be any additional fees sneaking up on you. Ever.

Send us your prescription and a member of our team will hand-deliver your medication directly to your home or office. Pick a date and delivery window that works for you—most medications are available the very same day—then track your courier as they make their way to your doorstep. 

Opportunities to save money are out there, but they can be confusing to identify. When we set out to revolutionize the pharmacy experience, we knew that we needed to help make these resources more accessible. So, we created our own database of discounts, coupons, and pricing options that we could match against every single prescription. By automating the process, we’re able to exhaust all the options and find you the lowest price—at no extra cost. 

If you currently have a prescription at another pharmacy, we’ll take care of the transfer for you. It’s the least we can do to welcome you into our care. For more on how the free transfer process works (spoiler: it’s incredibly easy), see How Do I Transfer a Prescription to Alto?

One of the most important aspects of pharmacy care is the ability to chat with a pharmacist whenever questions come up. Whether you’re starting a new medication for the first time or unsure if a certain supplement could interfere with your regimen, you can call or message an Alto pharmacist at any time—even evenings and weekends. You’ll never have to wait in line or feel like you’re being rushed along, and your messages will be private and secure. Our patient care pharmacists focus solely on consultations, which means you’ll always have their undivided attention. 

Whether you’re facing a full day of meetings, navigating a complex schedule of pickups and errands, or dealing with an unexpected challenge, it’s easy to let your daily dose fall through the cracks. So we created a few helpful features within the Alto app that can help you stick to your schedule. The Reminders feature lets you set up medication alerts so you’ll never miss your next dose, and you can turn on Auto Refills to get your future refills delivered automatically. We’ll even reach out to remind you when your next fill is on its way so you can make updates to the delivery if needed.

Streamlined Medications for You and Your Family

Imagine if everything you needed to know about your and your family’s prescriptions was all in one place? We thought that would be pretty great too. With the Alto app, you can set up a family account to see and manage medications for your whole family from a single account. View all your current and past prescriptions, along with detailed medication information, and even coordinate your medications into one delivery. 

We set out to make the traditional pharmacy experience better by bringing the medications you need—along with exceptional care—straight to your doorstep. Some might find it unbelievable that we offer our services for free; we simply believe that we’re providing pharmacy care as it should be. 

Experience a better pharmacy. Our team is available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out via phone at 1-800-874-5881, or download the app to securely message with a pharmacist.

This fall, we had the opportunity to meet Tiffany Remington and her husband Caleb, who spoke to us about the importance of having a pharmacy partner they could rely on through their own infertility journey.

Fertility Patient Story: Tiffany Shares Her Experience with Alto

How One Couple Navigated Their Infertility Journey

Facing fertility issues can feel like entering completely unfamiliar territory. From deciding when and how to pursue treatment to navigating the ensuing procedures and medication protocols, uncertainties can surface at every turn. However, while no two journeys are completely alike, there is so much to be learned from the many hopeful parents who have traveled the various paths of infertility treatment before. 

This fall, we had the opportunity to meet Tiffany Remington and her husband Caleb, who spoke to us about the importance of having a pharmacy partner they could rely on through their own infertility journey. Read on to learn more about how the process unfolded in Tiffany’s own words and her advice for others going through a similar experience. 

My husband, Caleb, and I love to seek out adventure in almost everything we do. For the past two years, we’ve been living full-time in an RV that we renovated into the coziest home on wheels. Before pursuing our wild dreams of living tiny, we created a one-off event called The Greatest Wedding Ever Donated, where we turned our wedding into a gala and benefit concert and raised $207,000 for charity. 

So what’s next in our books? Starting a family. To our surprise, it took us a year and a half to start our journey of growing our family, and most of the waiting was out of our control. When we had our initial visit with our reproductive endocrinologist back in May of 2019, we thought things were going to happen fast—boom, bam, baby in the utero in one month. We quickly found out how intense the process is and how little we fully understood. All we knew was that we needed help. 

My husband was born with a condition called cystic fibrosis (CF), a genetic condition that creates a thick buildup of mucus in his lungs and other organs of his body. 98% of men with CF are also born infertile due to the absence or underdevelopment of the vas deferens (think of it as the highway for the sperm). After trying to conceive for two years on our own, we had a gut feeling that the lottery win for natural conception was not in the cards. We are a couple affected by male factor infertility.

After choosing a clinic, we had blood work done within the month. We then planned for Caleb’s microTESE, a surgical procedure to extract sperm from the seminiferous tubules of a male’s testes and epididymis. Unfortunately, that was round one of delays. We had to wait five months for an open spot for surgery. The initial disappointment rapidly turned into gratitude knowing that we had more time to fully wrap our head around this process, find a community for support, and educate ourselves in the decisions we would have to make along the way.

In February of 2020, we joyfully celebrated the eleven vials of sperm that were collected and were ready to start our IVF protocol. To ours and the world’s dismay, COVID-19 restrictions were put into place and our clinic shut down in March, just as we were about to begin. Due to Caleb’s health and the nature of the virus, we decided to move our IVF funds back to his medical emergency savings in case something happened. 

For five and a half months, we waited. We finally came to a place of comfort to move forward once our clinic allowed for new patient protocols to resume. We officially started our IVF stimulation protocol for egg retrieval at the beginning of August. After fifteen days of shots, we pulled the trigger and were able to produce seventeen beautiful mature eggs. Of the seventeen eggs, fourteen were fertilized, thirteen made it to Day 3 Blastocysts, four to Day 5 Blastocysts, and two to Day 6. We ended up with a total of six embryos that got sent off for PGS testing. A week later, we found out that of the six embryos, three came back genetically normal.

We wanted to keep the momentum going, so we opted to transfer our first frozen embryo as soon as possible. I had surgery to remove a couple of polyps and by the beginning of October, I was in the clear with a healed uterus, ready to welcome our baby home. With the transfer protocol moving rapidly, I knew I had to find a new pharmacy that I felt like I could rely on. 

During egg retrieval, I ordered from my clinic’s partnered pharmacy without realizing that I had much of a choice otherwise. My medication was delivered to the wrong address, and the idea that it might happen again stressed me out because timing is everything in this process! When speaking with some of my IVF friends, I kept hearing about Alto Pharmacy. I took a deep dive to see what all the “buzz” was about.

I could feel the grin stretch across my face when clicking enter on the URL. The website was already drawing me in. This is a pharmacy? Free delivery, advice, price investigation, and they work with your insurance? I’ve been managing my husband’s medication for years. I know first-hand how time-consuming all of the things that Alto provides can be—it’s a full-time job. This isn't just a pharmacy, it's a care team.

When I saw that Alto would take the burden off my shoulders, I was INSTANTLY sold. No need for spreadsheets, no need to play phone manager while connecting insurance and pharmacies, no need to Google down a rabbit hole. They would take care of all the details and that in itself is priceless.

I had my nurse place my next order with Alto and within the hour I had a text message to my phone prompting me to download the Alto app where I could manage deliveries and medications, connect with a pharmacist, and track my orders. Again, mind blown. An app? For a pharmacy? Can someone bring Alto their crown? One of the best parts is that the delivery windows were only a couple of hours—not like most other pharmacies where you have to wait the entire day to receive your medications. They also have one of their own courier team members HAND-deliver it to you.

Boutique service with savings—I couldn’t be a bigger fan. This whole IVF process can sometimes make you feel like a number. Alto is one of those companies doing it right by honoring you as a human. They show up in the app. They show up on the phone. I felt heard and fought for.

If you are walking through this (in)fertility process, or any medical journey for that matter, my advice is: don’t be afraid to advocate for yourself. Speaking as both a caretaker and patient, medicine is often routine and anonymous, and personalized care has not yet been perfected. Pharmacy choice, specifically, matters. Are they reliable? Do they advocate for you as a patient? Can they cut costs? What’s their customer service like? What are patient reviews? Do they deliver on time? You have a choice, even if the options aren’t clear at the start.

The team at Alto is ready to be your partner through it all, from your first cycle to your last. Questions about using Alto? Visit alto.com/fertility or give us a call at 1-800-874-5881. Our team is available from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends.

To connect with Tiffany and Caleb follow them on Instagram @ustheremingtons. 

Disclosure: Tiffany received medications at no cost from Alto Pharmacy in order to share her opinion about our services. The views expressed are solely her own. 

Fertility Patient Story: Tiffany Shares Her Experience with Alto 

Starting Monday, November 2, fertility patients in New York City can have their medications delivered straight to their door by our Alto team.

Hello, New York

Alto’s launch in the New York market extends our industry-leading patient care model to the East Coast.

Our daily delivery windows allow patients to more easily plan to be available to receive their medications. Patients schedule deliveries to the location of their choice — home, work or hotel — and on the day of their choosing. They can even track our couriers in real time on our mobile app and text with a pharmacist for support.

Courier delivery windows
Monday - Friday 

6:00 –9:00 pm ET in all areas west of Patchogue (7:00 – 10:00 pm ET in areas east of Patchogue)

2:00 –5:00 pm ET in all areas west of Patchogue (3:00 – 6:00 pm ET in areas east of Patchogue)

Compounds must be prescribed and confirmed with the patient by 1:30 pm ET, Monday – Friday, for same-day delivery. At this time, compounds are not available for same-day delivery on Saturday and Sunday.

Walk-in hours
Monday - Friday: 9 am – 7 pm ET
Saturday - Sunday: 8 am - 4:30 pm ET 

Fertility patients interested in using Alto’s services for their medication needs can ask their care team to send all prescriptions to Alto Pharmacy (via ePrescribe or phone).

Fertility is Complicated. Your Medications Don’t Have to Be.

Alto knows fertility pharmacy. With more than 100,000 patients served, we understand the treatment complexities and concerns of fertility patients. Our dedicated patient care team is available in the evenings and on weekends to walk you through your first injection or answer questions about medication storage, dosing or interactions. Our fertility deliveries include all necessary ancillary supplies, such as syringes, sharps container and alcohol swabs, and are carefully packaged for temperature control. 

Alto will automatically connect you with all manufacturer-sponsored financial assistance programs for qualifying prescriptions. Alto also works with many fertility benefits programs and many leading financing and loan providers. If we cannot bill your insurance, we’ll find you a pharmacy that can.

 Our customer service team is available to support NY patients and providers from 9 am - Midnight ET, Monday - Friday, and 10 am - 9 pm ET, Saturday - Sunday. 

At this time, Alto is only offering fertility medication services in the New York City market. Any updates to service areas and offerings will be available at alto.com/locations.

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

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. 

Blog

Your End-of-Year Health Checklist

Diversity At Alto: Building an Inclusive Healthcare Company and Culture

Get to Know Alto’s VP of Engineering, Mike McClay

How Alto Delivers More, at No Additional Cost

Fertility Patient Story: Tiffany Shares Her Experience with Alto

Hello, New York!

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

Airbnb’s Former Head of Business Technology Joins Alto

Coming Out with Pride: Nicholas Satow Shares His Story

What’s the Difference between Generic and Brand-name Medications?

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

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

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