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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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From strengthening your heart to promoting better sleep, regular exercise offers a number of physical and mental health benefits. But getting up and moving can be easier said than done. Here are some suggestions for building a fitness routine that sticks.

How to Start and Stick to a Fitness Routine

No one is immune to the physical and mental benefits of exercise. Beyond helping to manage a wide range of health conditions — from hypertension and diabetes to COPD and anxiety disorders — regular physical activity strengthens cardiovascular health, supports healthy sleep patterns, and lowers your risk for many preventable diseases.

But while there are many reasons to exercise, getting up and moving is often easier said than done. Less than 5% of US adults get 150 minutes of weekly exercise — the minimum suggested by the U.S. Department of Health and Human Services. And up to 65% of all those who begin a fitness program don’t continue it beyond the 3-6 month window, according to the New York Times.

Whether you’re trying to get back in the swing of a fitness routine or struggling to carve out time for your favorite workout, use the suggestions below to build an exercise plan that sustains you for the long haul.

On those days when life gets in the way of sticking to your routine, it’s easier to stay committed if you have a clear reason to prioritize exercise.

While the benefits of physical activity are universal, motivation looks different for everyone. Perhaps you’re navigating a recent diagnosis of a chronic condition or proactively taking care of your mental health. Whatever your reason may be, keep it in the back of your mind. And if you haven’t found one yet, here are some additional exercise benefits to consider:

It can help slow aging-related changes like the loss of bone density or shifts in cognitive function.

It’s fundamental to practicing a heart-healthy lifestyle.

There are as many reasons to exercise as there are activities to choose from. And if you don’t consider yourself an “exercise person,” there’s a good chance you haven’t found your go-to workout just yet.

As you make your fitness plan, give some thought to how you really want to spend those 150 minutes each week. Research and experts both agree that people are more likely to stick to an exercise routine if they actually enjoy it, and your chosen workout often plays a role in the consistency of your habits.

Take your interests, strengths, and personality all into account. Are you most comfortable at a fast or slow pace? Inspired by nature? Enjoy a healthy dose of competition? More fond of team sports or solo challenges? You might be surprised by the amount of options.

When in doubt, think of activities you feel confident doing or skills you would like to continue to build. If certain types of exercise aren’t the right fit, there’s often an alternative to consider. For example, the rowing machine is a great alternative to swimming for anyone seeking a low-impact cardio workout.

Create a routine that sustains your goals.

Repetition and consistency will keep you going when motivation wanes, so build a routine that sustains your habits.

First and foremost, make sure there’s time in your schedule for exercise. Block off a half hour for a workout on your calendar, just as you would for a meeting or doctor’s appointment. Make sure to have a back-up plan, too — if your 7 am pilates class isn’t feasible one week, leave room for a midday walk or run around the neighborhood.

Life too busy? We have a couple of tips for those short on time:

High intensity interval training (HIIT), which alternates quick spurts of intense effort with brief rest, is a great way to fit aerobic exercise into a packed schedule.

Take a few shorter walks throughout the day instead of a 30-minute or hour-long stroll — you’ll still reap the benefits!

Goals are a key component of any exercise plan, but it’s important that they are achievable. Over-ambition is one of the biggest barriers to progress and consistency: if you aim too high right out of the gate, you may find yourself quickly discouraged and decide to throw in the towel altogether.

Be specific: Rather than setting out to “exercise more,” commit to exercising for a certain number of days a week.

Be flexible: Aiming for a range of 3-5 days each week can help you still feel accomplished if you need to slightly scale down during busy times.

Focus on the process: Many behavioral science experts suggest structuring your goals around the process or activity — for instance, how long you exercise — rather than an outcome, which is less within your control. It takes time to form a new habit — 18 to 254 days, to be precise — so simply showing up is a worthwhile goal to work toward.

Gradually build on your goals: Once you have a foundation in place, keep yourself motivated by expanding your goals. If you’re a runner, you might try to gradually increase the length or distance of your regular workout. Make sure to check with a doctor or fitness expert about finding an appropriate level of fitness intensity.

Eliminate obstacles through small actions.

Look for opportunities that make it easier to follow through with your fitness intentions. Having to choose an outfit for your morning workout might not seem like much effort, but packing a gym bag in advance or folding your workout clothes by your bed the night before removes an extra step from the process.

If you’re starting to work out in a gym, plan a specific workout in advance so that you can maximize your time once you’re there.

For an extra boost of motivation, make your fitness routine more social. Research has found a link between the success of a workout program and social accountability. So dig through your personal network to find a gym or yoga buddy, or search for a local running club. Not only will you benefit from the extra accountability — you’ll be offering it in return.

Navigating exercise with a chronic health condition

There’s often a misconception that certain conditions, including diabetes and COPD, prevent exercise. In actuality, regular physical activity is part of managing many chronic conditions. However, there may be additional considerations to account for when creating an exercise routine.

Here are some general guidelines to be mindful of when exercising with diabetes, COPD, asthma, osteoporosis, or arthritis. Always speak with your provider to discuss what activities are appropriate for your personal health history.

Maintaining healthy blood sugar is a crucial part of diabetes management. Exercise is a factor in your glucose levels, and some people experience decreased blood sugar during or after exercise. 

A variety of factors can affect your blood sugar response to exercise, including:

Your blood sugar levels prior to exercise

To exercise safely as a person with diabetes, check your blood sugar before, during, and after exercise, and be prepared to treat low blood sugar, or hypoglycemia.

In strengthening your respiratory muscles and making it easier to breathe, regular physical activity is key to maintaining an active life while living with COPD. However, it’s important to practice gentle exercises that don’t overexert your lungs. Your provider can help you determine appropriate activities.

You may also benefit from pulmonary rehabilitation, an outpatient exercise and education program that helps those with COPD manage the condition.

As many as 90% of people with asthma experience respiratory symptoms during physical activity. For some, symptoms begin right at the start of exercising while others experience airflow obstruction after returning to a state of rest. In some cases, symptoms quickly resolve, but they may last up to 24 hours in others.

Rather than avoiding exercise to prevent an asthma flare-up, speak with your healthcare provider about your asthma treatment plan and look for forms of exercise with an appropriate level of intensity.

The weakening of the bones in osteoporosis increases the risk for fractures, so those with the condition should take precautions to avoid exercise-related injuries.

Here are some general guidelines for exercising with osteoporosis. Check with your provider about which activities are the best for you. 

Unless otherwise informed by your doctor, avoid high-impact exercises and activities that involve frequent bending or twisting, as they may increase your risk of fractures.

Explore weight-bearing aerobic activities to strengthen bones in your legs, hips, and lower spine.

Try simple balancing exercises or movement-based stability exercises such as tai chi to maintain good stability and balance.

Opt for gentle activities like water exercises, tai chi, yoga, and stretching, all of which reduce joint pressure and expand your joints’ range of motion.

Let Alto support your health and wellness

Staying on top of your health should be as simple as possible, and we’re here to support you with exceptional pharmacy care. We offer fast and reliable courier delivery and medication management tools like reminders and auto refills in our mobile app.

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

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

How Alto’s High-Touch Model Supports Patient Engagement

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

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

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

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

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

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

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

Partner Opportunities to Supplement Patient Support

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

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

Follow-Up and Improving the Patient Experience

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

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

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

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

Choose Alto Pharmacy for your limited distribution network

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

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

Tech-Based, High-Touch Patient Engagement at Alto

A great pharmacy is so much more than a place where patients fill their prescriptions — it’s a partner in their care. The quality of a pharmacy is especially important for specialty medications, which typically include additional considerations like cost, storage requirements, administration, side effects, and more.

There’s no better judge of pharmacy care than the patients themselves. Alto is an industry leader with an NPS score of 85, positioning patients and caregivers to regard your medication in the highest possible light.

What to Consider When Choosing Your Limited Distribution Drug Partner

A great pharmacy is so much more than a place where patients fill their prescriptions — it’s a partner in their care. The quality of a pharmacy is especially important for specialty medications, which typically include additional considerations like cost, storage requirements, administration, side effects, and more.

There’s no better judge of pharmacy care than the patients themselves. Alto is an industry leader with an NPS score of 85, positioning patients and caregivers to regard your medication in the highest possible light.

Here’s what makes a great patient experience at a specialty pharmacy, and how Alto offers support for specialty medications at every step.

It can be time-consuming and stressful for a patient to get started with any type of medication, from getting that medication covered by insurance to searching for savings opportunities. With limited distribution drugs in particular, there are usually many steps between getting a prescription from a provider and actually beginning treatment, as these medications often require a prior authorization for insurance coverage. And since they are typically more expensive, thorough research into medication cost savings is essential from the standpoint of both a patient’s physical and financial wellness.

Your specialty pharmacy partner should offer the support patients need to access their medications as quickly and affordably as possible. Alto supports the prior authorization process, keeping both patients and providers informed at every step. And with Alto Connect — our free pharmacy communications portal for providers — it’s fast and easy for clinical teams to collaborate with our team on administrative work as needed.

We also conduct price investigations to help patients save on each prescription through manufacturer coupons, assistance programs, and other resources.

Once a medication has been approved by insurance, there shouldn’t be any additional barriers to receiving it. Not only should it be as simple as possible to fill a prescription and place a delivery, patients should be able to trust that their medication will arrive on time, and in the right condition.

Alto’s easy patient onboarding experience features proactive multichannel communication. We send patients a welcome text within 60 minutes of receiving their prescription to help them schedule their first delivery. (Those with a landline will get a call.) And our team is available to answer any questions via in-app messaging or phone.

Our same-day delivery service allows for quick and easy medication access seven days a week, and in-house couriers guarantee reliability and quality. We also offer a free medication bundling service, so those who take multiple medications have the convenience of one easy delivery. And patients are never left wondering where their medication is — the Alto app offers simple and accurate delivery tracking.

Additionally, we use special packaging to ensure that temperature-controlled medications are always stored appropriately before they reach a patient, with clear instructions about safe storage at home. Those who wish to pick up their medication can always visit our pharmacy in person.

Ongoing support with care and patient education is extremely important with specialty medications and limited distribution drugs, which typically require patients to make an ongoing commitment to their health and wellness. Treatment often includes routine testing, clinical monitoring, and side effect management to ensure proper drug utilization and maximize adherence.

So that patients can follow their treatment plan as directed by their doctor, your specialty pharmacy should have robust clinical expertise in specific conditions. It should also have a high-touch model that makes it as easy as possible for patients to benefit from that expertise.

At Alto, patient education and care isn’t a nice-to-have — it’s a must. To ensure that our pharmacists can actively participate in patient health journeys, we have a team of medication therapy management pharmacists who focus entirely on disease state education and support for chronic conditions.

These pharmacists regularly contact patients who take multiple medications or specialty medications to review their regimen by phone. During these calls, our pharmacists ensure that patients understand the purpose of each medication they’re taking and are staying on track with necessary testing.

Coupled with medication management tools like auto refills and medication bundling, our disease state education keeps patients coming back to Alto month after month, improving adherence for the long term.

While fertility treatments like in vitro fertilization (IVF) have become an increasingly common path to parenthood, helping millions of individuals conceive throughout the past four decades, they remain a significant financial investment.

How Alto Lowers the Cost of Fertility Treatment Through Better Medication Management

Fertility medications used to support egg production, retrievals, and implantations frequently factor heavily into the overall cost of treatment. An average IVF cycle costs between $10,000 and $15,000, with medications an additional $5,000 or more depending on factors like a patient’s age and health history and a clinic’s treatment approach. Unfortunately, a portion of these medications often go unused, as many fertility treatment plans involve last-minute medication changes unsuited for the traditional retail pharmacy model.

As part of our commitment to your financial well-being, we offer a medication management experience that reduces fertility medication waste to lower the cost of treatment, developed in collaboration with Progyny. Take a closer look at our approach.

IVF is a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy. Multiple medications are used on a precisely timed schedule to grow follicles — fluid-filled sacs in the ovaries that potentially contain an egg — retrieve eggs, and, finally, implant a fertilized egg into the uterus. 

Here’s a snapshot of a typical IVF medication schedule:

Days 1-4: stimulation medications such as Gonal-f®, Follistim®, Menopur®, or Low-Dose hCG to stimulate egg production, so that you produce multiple follicles

Days 5-10: continuation of stimulation medications and introduction of antagonists such as Fyremadel™ (ganirelix acetate) and Cetrotide® to prevent premature ovulation

Days 10+: trigger shots of leuprolide acetate, Ovidrel®, and/or Novarel®/Pregnyl® to stimulate final growth spurt and ovulation

After transfer: estrogen and progesterone to support successful implantation of the embryo

Fertility medications are complex, with nightly dosages dependent upon hormone levels measured through bloodwork and ultrasounds. Not only do medication protocols vary from one individual to another, they are typically adjusted throughout the course of a cycle as hormones fluctuate.

Unused medication during fertility treatment

To prevent any missed doses, providers typically prescribe all medications that could be needed in bulk at the beginning of fertility treatment. However, dosages often decrease once a cycle is underway based on a provider’s discretion, ultrasounds, and bloodwork.

At traditional pharmacies, patients undergoing fertility treatment might end up paying for unused medication, as all potential medications are filled upfront. This contributes to the $5.4 billion epidemic of medication waste in the U.S. — one that is particularly acute in fertility, leading some individuals to buy and sell excess medication to each other on social media sites.

Our approach to fertility medication management

Alto has partnered with fertility benefits manager Progyny on an algorithm-powered, app-based medication management experience that reduces unneeded fertility medications while protecting the integrity of time-sensitive and personalized treatment plans.

First, we collect fertility cycle information through the Alto app and run the data through the Progyny algorithm to determine exactly what medication volumes are needed for the next phase of treatment. We then prepare a custom order for just the medications that are immediately needed, which are then delivered directly to your doorstep by our courier team. 

You will receive multiple deliveries throughout the course of your cycle, determined by your specific dosing, trigger schedule and other inputs from your clinical team. This approach allows you to manage your medications as your IVF cycle progresses, giving you more control over the total amount of medication that you fill.

Additional financial resources for fertility medications

Alto is committed to helping you save as much as possible on your fertility medications. In addition to our personalized medication management approach, we’ll automatically search for savings and connect you with programs that require you to apply directly, including patient assistance programs from fertility medication manufacturers.

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

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

Read Managing the Costs of Fertility Treatment for more on Alto’s financial support for fertility treatment and medications.

Choose a flexible and reliable pharmacy partner

Fertility treatment can be challenging, but we’ll be with you every step of the way. To ensure that your treatment plan is followed correctly, we offer fast, reliable delivery of your medications and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

In addition to local service offerings at our brick-and-mortar locations, we’re serving more patients throughout the United States through our mail order service. We offer free FedEx next-day delivery of all fertility medications and supplies to patients served via mail order.

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

Alto’s launch in the Long Island market extends our industry-leading patient care model to even more of the New York metro area.

Hello, Long Island!

Alto’s launch in Long Island, New York, extends our industry-leading patient care model to even more New York-area residents.

With the addition of our latest pharmacy location in Plainview, Long Island, even more residents of the greater New York City metro area can now choose Alto’s same-day doorstep delivery for all of their pharmacy needs. Alto Long Island opens its doors today, Tuesday, April 5, 2022.

At Alto, we believe it’s our job to ensure you have your medications at the best price, on time and with the support you need. We bring the pharmacy to you - no more waiting in line, making an extra trip, or finding out your prescription isn’t ready to be picked up after you’ve already arrived. Our free doorstep delivery means your medications come directly to you on the day and time you select, and most medications are available the same-day. Stay up to date on your courier’s progress with text alerts and in our mobile app. 

Starting a new medication or doing an injection for the first time? Message a pharmacist with your questions, even in the evenings and on weekends. And we’re a full service pharmacy - we stock all major brand, generic, over-the-counter and specialty medications, meaning your entire family’s pharmacy needs can be managed in the Alto app and coordinated into one delivery.

Courier delivery windows
Monday - Friday: 

12:30 – 3:30 pm ET (1:30 – 4:30 pm ET for outlying areas)*

6:00 – 9:00 pm ET (7:00 – 10:00 pm ET for outlying areas)

2:00 –5:00 pm ET (3:00 – 6:00 pm ET for outlying areas)

Need to pick up? Our new Long Island pharmacy is located at 100 Manetto Hill Road, Suite 104, in Plainview.

Monday - Friday: 9:00 am – 7:00 pm ET
Saturday - Sunday: 8:00 am – 4:30 pm ET

New York residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe or phone). Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch. 

General customer support hours are Monday - Friday 9 am - 12 midnight ET and Saturday - Sunday 10 am - 9 pm ET. Patients can reach out to Alto via phone at 1 (800) 874-5881 or app.

*Weekday afternoon delivery is only available to residents of New York City's five boroughs at this time.

Founded in 2015, Alto is a patient-centric digital pharmacy based committed to the health and wellbeing of you and your family. We provide free same-day delivery to your door seven days a week for prescriptions, but, more importantly, offer cost transparency, personalized in-app and phone support, and real-time coordination with doctors and insurance companies to get you the care that you need. Alto is headquartered in San Francisco with offices in Denver and Dallas, and currently delivers across the greater Bay Area, Los Angeles, Orange County, San Diego, Seattle, Denver, Las Vegas, New York City, Houston, Dallas and Austin.

To automate a manual, error-prone pharmacy workflow, we turned to event streaming. Here’s what we learned from one of the first Kafka use cases at Alto.

How We Used Kafka to Build an Event-Driven Automation Pipeline and Scale Our Pharmacy

Imagine this: You're at the doctor’s office, and your doctor just wrote you a new prescription. Minutes later, before you even check out with the receptionist, you already have a notification from Alto Pharmacy on your phone that your prescription is ready. All you have to do is pick the date and time that works best for your free courier delivery.

This is the future we’re building at Alto: a future where a prescription can be transcribed, billed, and verified by a pharmacist in five minutes, flat. To get there without dramatically increasing Alto’s head count, we need to automate much of the process, starting with the first step: transcribing, or intaking, a prescription.

As a pharmacy, we receive prescriptions in many different forms. Some are sent electronically, in a structured format, but others are handwritten, phoned in, or even faxed. To represent all of these forms in a single table, we previously required every incoming prescription to be transcribed by an Alto team member, who would answer questions like:

Whom is this prescription for? Is this customer already in our system?

Where did this prescription come from? Who wrote it?

What is the relevant prescription information (medication to dispense, quantity, days supply, directions, etc.)?

This manual process is both time-consuming and prone to human error, which, if uncaught, could impact our ability to process the prescription downstream. Furthermore, at our busiest times, it could take up to two hours for a team member to get through the pending intake queue — unacceptable if we hope to have prescriptions ready to schedule before people even leave their doctor’s office. 

Automating intake required close collaboration between three teams:

Data Science, who built the decision-making algorithms 

Data Engineering, who served up the results of those algorithms

Product Engineering, who used those results to automatically intake prescriptions 

To allow the teams to operate in parallel without toe-stepping — and in the language most suitable for each (the Data Science and Data teams prefer Python, while product engineers work mainly in Ruby) — we separated the code into two environments: 

1. Data Prod Interface (DPI), where the code for generating automation results lives

2. Wunderbar (our proprietary pharmacy operations platform), where the code for requesting and using those automation results lives

The key question: to establish robust communication between these two environments, should we use an API-based approach, or an event-driven one? Each has its pros and cons. 

Legacy approach everyone at Alto is familiar with

Existing enforcement of strong types and data

Difficult to scale with increased data & requests

Requires ongoing authorization / authentication

Infrastructure relevant to other business areas

Automatic retries, reprocessing, and queueing

Our existing infrastructure currently utilizes a hefty API-based structure, so there was a natural tendency to go down this path, but we knew that beginning to migrate services towards an event-based architecture with Kafka at its heart would help us in the long term.

Kafka is a framework implementation developed by LinkedIn, now open-source with the Apache Software Foundation. It aims to provide a unified, high-throughput, and low-latency platform for handling real-time data feeds. 

Alto uses Amazon Web Services as our cloud provider, and luckily, they offer an out-of-the-box managed solution for Kafka, MSK. To configure Kafka with our system, our infrastructure team worked with AWS to set up managed instances to comply with our business requirements. Our Infrastructure team will share more details about this work in an upcoming blog post. 

Kafka offers many benefits. The asynchronous nature of the message system allows for retries, reprocessing, and queueing as well as easy recovery from outages. In addition, the infrastructure work done for setting up the managed cluster would be a one-off workstream. When complete, we’d be able to re-use the same setup and configurations across various business needs to streamline other projects that leverage Kafka. 

Setting up for success: defining a strict contract

One element we had to get right from the start was the data contract. As we send messages between DPI and Wunderbar, we need to ensure messages are produced with the correct schema, so that downstream consumers know what to expect.

Protocol Buffers, or Protos, is an open-source, cross-platform data format used to serialize structured data. Developed by Google, Protos allow you to define how you structure your data once and then use generated code to easily write and read the structured data in a variety of different languages. 

At Alto, we’ve been using Protos for the past few years to speed up development with auto-generated code and ensure data continuity between our Ruby on Rails backend and JavaScript / React / React Native frontend. Protos may seem antithetical to JavaScript and Ruby since they’re both dynamically typed languages, but in practice, they have saved us countless hours of debugging and back-and-forth Slack messages. 

For this project, we turned again to Protos to define the schema for messages produced by DPI and Wunderbar. We defined IntakeAutomationRequest and IntakeAutomationResult messages in Go and generated the types (Sorbet, Flow, etc.), which both DPI and Wunderbar now refer to when producing or consuming messages.

Because Wunderbar is already configured to run on AWS and houses our existing intake logic, it was easy enough to send a prescription to DPI for automation. Where we would normally create a task for an operations team member to manually transcribe the prescription, we instead produce a message to our “request automation” Kafka topic using the ruby-kafka library.

Our consumer, instantiated in an executable that runs on a dedicated worker, consumes messages from a “receive automation” Kafka topic. First, the consumer verifies that a given message corresponds to a prescription we previously sent to DPI. Then, it persists any automation results included in that message. If the automation results are sufficient, we skip intake altogether. Otherwise, we create an intake task to be handled by an operations team member.

Because this project was among our early use cases for Kafka, we wanted to be prepared for the worst-case scenario: we produce a message requesting automation results, and for whatever reason—maybe DPI is down—we don’t hear back. For us, we defined a reasonable time frame as fifteen minutes, in order to avoid building up a large backlog of work that would have to be offloaded back onto our operations team.
To this end, we store metadata about the automation lifecycle in an intake_automation_results table, which includes timestamps representing when we sent a message to DPI and when we received a response back. A cron job runs every minute to check that table for rows where received_at is blank, and sent_at was more than fifteen minutes ago. If this occurs, we flag the prescription to be manually intaken by an operations team member.

The diagram below illustrates our intake automation architecture.

Intake automation is now live at Alto. We’re seeing prescriptions fly through in just a few minutes — during which time our automation creates a user profile if one doesn’t already exist, links the new prescription to that profile, and finds and bills the user’s insurance; a pharmacist reviews the prescription for clinical accuracy; and the user receives a text message to schedule their delivery. This single flow, prior to intake automation, once took up to four hours to complete!

Going from zero to one is quite a feat, and it wouldn’t have been possible without an event-based approach. Now that intake automation has laid the groundwork, we know that Kafka will only continue to provide exponential value to Alto as we grow and migrate more of our services to this event-based architecture. 

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

Residents of the Austin metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

Hello Austin

Alto's new Austin-based pharmacy marks our third location in Texas.

Starting today, December 7th, residents of the Austin metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

At Alto, we believe it’s our job to ensure you have your medications at the best price, on time and with the support you need. We bring pharmacy to you - no more waiting in line, making an extra trip, or finding out your prescription isn’t ready to be picked up after you’ve already arrived. Our free doorstep delivery means your medications come directly to you on the day and time you select, and most medications are available the same-day. Stay up to date on your courier’s progress with text alerts or in our mobile app. 

Courier delivery windows
Monday - Friday: 6 - 9 pm CT (7 - 10 pm CT for outlying areas)
Saturday - Sunday: 2 - 5 pm CT (3 - 6 pm CT for outlying areas)

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

Austin residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax).

Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch.

Need to pick up? Our pharmacy is located at 4175 Freidrich Lane, Suite 202.

General customer support hours are Monday - Friday 8 am - 11 pm CT and Saturday - Sunday 9 am - 8 pm CT. Patients can reach out to Alto via phone at 1 (800) 874-5881 or in the Alto app.

Editor’s Note: This post was originally published in December 2021 and has been updated for accuracy and completeness.

Starting Monday, August 16, residents of the San Diego metro area can now choose Alto's same-day doorstep delivery for their pharmacy needs.

Hello, San Diego!

Alto's launch in San Diego extends our free, same-day pharmacy delivery model to even more Californians.

Starting today, August 15th, residents of the San Diego metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

Courier delivery windows
Monday - Friday: 6 - 9 pm PT (6:30 - 9:30 pm PT for outlying areas)
Saturday - Sunday: 2 - 5 pm PT (2:30 - 5:30 pm PT for outlying areas)

Walk-in hours
Monday - Friday: 9 am – 7 pm PT
Saturday - Sunday: 8:00 am - 4:30 pm pT

San Diego residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax). 

Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch. 

Need to pick up? Our pharmacy is located at 4240 Kearny Mesa Road, Suite 107.

General customer support hours are Monday - Friday 6 am - 9 pm PT and Saturday - Sunday 7 am - 6 pm PT. Patients can reach out to Alto via phone at 1 (800) 874-5881 or app.

Founded in 2015, Alto is a patient-centric digital pharmacy based committed to the health and wellbeing of you and your family. We provide free same-day delivery to your door seven days a week for prescriptions, but, more importantly, offer cost transparency, personalized in-app and phone support, and real-time coordination with doctors and insurance companies to get you the care that you need. Alto is headquartered in San Francisco with offices in Denver and Dallas, and currently delivers across the greater Bay Area, Los Angeles, Orange County, San Diego, Seattle, Denver, Las Vegas, New York City, Houston, Dallas, and Austin.

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