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Vaccines — which were first developed in 1796 for smallpox and continue to evolve with new research and technology — build on your immune system’s natural function to protect you from serious diseases. Just like white blood cells and the other components of your immune system, vaccines help you develop immunity, but without the initial illness and risk of health complications. Here’s a look at how vaccines work.

The Science Behind Vaccines

Your immune system has a natural way of defending you from the viruses and bacteria that cause illness. As these germs multiply rapidly and infect your body, an army of white blood cells fights back, producing antibodies that attack the invaders.

The first time you are infected by a specific virus or bacteria, your immune system often cannot destroy the germ quickly enough to prevent you from becoming sick. After you’ve recovered, certain immune cells hold onto the memory of the infection. This allows them to mobilize quickly if they encounter the same germ again, preventing illness in the future. Immunity, your body’s resistance to certain types of infection, is the outcome of this process.

To understand how vaccines work, it’s helpful to know how your immune system naturally fights an infection. B-lymphocyte white blood cells produce blood proteins called antibodies, which attack antigens — the part of the invading germ that triggers an immune response. T-lymphocyte white blood cells attack already infected cells in the body. After the infection has ended, a few T-lymphocytes, or memory cells, remain to ensure a fast immune response should the same germ reappear.

Vaccines imitate infections, triggering the process of building immunity to a specific disease without causing illness. Your immune system responds to these imitation infections the same way it would to an actual infection. Detecting antigens from the vaccine, your immune system produces antibodies and T-lymphocyte cells. The imitation infection leaves your body with T-lymphocyte memory cells and B-lymphocytes, which will know how to quickly fight that antigen in the future. This prevents you from becoming sick if you are exposed to the virus or bacteria that cause the disease.

It typically takes several weeks for your body to produce T-lymphocyte and B-lymphocyte cells in response to a vaccine, which is why in most cases you will not immediately develop immunity. This means that you could become infected with a disease and develop symptoms shortly after vaccination, so it’s important to take necessary precautions until you become fully immune to the virus or bacteria. The healthcare professional administering your vaccine will inform you of the anticipated timeline for immunity.

Sometimes the imitation infection created by a vaccine causes mild symptoms such as a fever. These side effects are normal and indicate that your body is building immunity.

While all vaccines arrive at the end result of immunity, there are several paths for getting there. When deciding which type of vaccine to create for a disease, researchers consider a variety of factors, including the immune system’s response to the germ that causes the disease, the population likely to receive the vaccine, and the regions of the world where it will be used. These are the seven types of vaccines commonly used in the U.S.

Live vaccines use a weakened version of the living virus or bacteria that causes a disease. They are most similar to the natural infection and produce long-lasting immunity. The weakened form of the germ does not lead to serious disease, like that caused by the wild form of the germ, for most individuals with strong immune systems. However, live vaccines aren’t safe for those who are immunocompromised, including children undergoing cancer treatment. Examples of live vaccines include the measles, mumps, and rubella (MMR) vaccine and the chickenpox vaccine.

Inactivated vaccines are produced by inactivating, or killing, the germ that causes a disease. Examples include the polio, hepatitis A, and flu vaccines. They don’t provide as strong of immunity as live vaccines, so additional doses, also referred to as booster shots, are often needed for ongoing protection.

Toxoid vaccines target a toxin, a harmful substance produced by a germ, rather than the entire germ itself. They contain a weakened version of the toxin to be targeted called a toxoid, which teaches your immune system how to fight off the natural toxin. Similar to the germs used in live vaccines, toxoids are weakened to a point where they do not cause illness. These vaccines are used to prevent diseases caused by toxin-producing bacteria such as diphtheria and tetanus.

Subunit vaccines use portions of a virus or bacteria called subunits rather than the entire germ. Vaccines for diphtheria, tetanus, and pertussis, or whooping cough, are combined into the DTaP vaccine. The pertussis component is a subunit vaccine.

Conjugate vaccines fight a specific type of bacteria whose antigens are more difficult for a child’s immune system to detect due to their outer coating. The vaccines link the coating to stronger antigens that the immune system can more easily respond to. Like subunit vaccines, these vaccines are more targeted and only use part of the germ. Examples of conjugate vaccines include the haemophilus influenzae type B (Hib) vaccine.

Viral vector vaccines produce immunity to a virus by using a modified version of a different virus to deliver instructions to your immune cells. The modified version of the other virus is referred to as a vector virus. Recent Ebola vaccines have used this technology, and the Johnson & Johnson COVID-19 vaccine is also a viral vector vaccine.

mRNA vaccines help your body produce a protein that triggers an immune response and the development of antibodies. This technology was used to create the Pfizer-BioNTech and Moderna COVID-19 vaccines.

Read ‘What the COVID-19 Vaccine Means for Those With HIV’

All vaccines in the United States require approval by the Food and Drug Administration (FDA) and are held to rigorous safety and effectiveness standards. The vaccine approval process starts with lab tests, which may take years in some cases. The FDA analyzes the results to determine if the vaccine should be tested with people. If the vaccine moves forward, the next step is clinical trials where the vaccine is tested on volunteers.

Clinical trials typically begin with a smaller group of 20 to 100 volunteers before including thousands more. The trials gather information about vaccine safety, the typical immune response, and dosing. If any safety concerns emerge during this stage, the FDA must address them before it can authorize the vaccine.

Vaccine manufacturers are required to continuously monitor vaccine safety after approval and test every batch produced to ensure effectiveness, quality, and purity. These test results are reviewed by the FDA, which also conducts an inspection of the factory where the vaccine was produced. If you experience severe side effects after vaccination, contact your healthcare provider so that they can report potential concerns to the Centers for Disease Control and Prevention (CDC)’s vaccine monitoring database.

COVID-19 mRNA vaccines were developed and approved more quickly than a typical vaccine given the urgent nature of the pandemic. This expedited timeline was made possible by significant investment from governments and companies in the vaccine development process and decades of research on mRNA vaccine technology. These vaccines were as thoroughly vetted for quality and safety as any other vaccine.

Many vaccines are received during childhood, like the polio, chickenpox, and MMR vaccines, but there are others you may need as an adult. The CDC recommends the zoster vaccine, which prevents shingles, for adults ages 50 and older and the pneumonia vaccine for those over 65. Other vaccines may be recommended based on additional factors including job or school requirements, travel, and health conditions. Check in with your doctor about which vaccines you need.

The CDC also recommends an annual flu vaccine for everyone 6 months and older. New versions of flu vaccines are developed annually in anticipation of circulating flu virus strains, so health experts recommend getting one every year to prepare for cold and flu season. It’s especially important to be proactive about flu vaccination if you are over the age of 65 or have a chronic condition such as COPD or diabetes.

For detailed vaccine recommendations by age group, reference the CDC’s recommended immunization schedules for children and adolescents and adults.

At Alto, a pharmacist is your partner in health. If you take medication, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. And our team of pharmacists is available to chat whenever questions come up. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

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

Working from home offers many benefits. The lack of commute to and from the office can mean more quality time with family, mid-day workouts, or a load of laundry over lunch. And with fewer distractions, the environment of a home office is a productivity boost for certain work styles.

How to Say Healthy While Working From Home

At the same time, some individuals may find it more difficult to concentrate outside of a physical office, and remote work can also impact your mental health. In a recent public opinion poll conducted by the American Psychiatric Association (APA), nearly two-thirds of the respondents reported feeling isolated or lonely at least sometimes as a result of working from home, while 17% said that they experience isolation and loneliness all the time. And a majority of the respondents who partially work from home said that they find it difficult to step away from work at the end of the day.

With remote work on the rise — the number of U.S. adults who work from home increased from 22% to 42% between 2019 and 2020 — it is important to prioritize your mental and physical well-being and create boundaries between work and social life. Here are steps you can take to stay sane and healthy while working from home.

A physical office space naturally incorporates structure into your day. Simply sitting down at your desk and seeing colleagues allows you to mentally shift into work mode. This is important for not only productivity, but also for work-life balance — just as you are able to jump right into your to-do list once you enter the office, the clear boundary between work and home means you’re less likely to revisit that list once the day is over. Plus, watching a coworker take a break may be a much needed reminder that it’s time to grab lunch or get some fresh air.

There are several ways to give yourself structure while working from home. First, mimic the experience of going to work. It may be tempting to stay in pajamas and check emails from bed, but many remote employees find it easier to concentrate — and to leave work behind at the end of the day — by creating a morning routine and using a designated workspace that’s not in your bedroom.

In addition, having a clear plan for the day can boost both productivity and mental health, as you will have carved out time for high-priority tasks and breaks. For some individuals, planning the day the night before makes it easier to jump into work the next morning, so consider incorporating this into your end of day routine if you find it helpful. There are a variety of ways to lay out what needs accomplishing, from organizing your day entirely on a calendar to using a task management tool. Increasing focus and productivity while working from home is all about finding the system that’s right for you.

It’s just as important to consider your personal preferences and work habits when planning breaks. The frequency of your breaks should correlate to how long you can maintain a state of deep focus. Taking breaks every 75 to 90 minutes may be realistic for some individuals, but others may find shorter bursts of work more helpful. The pomodoro method has become a common approach to time management. You will focus on a single task for 25 minutes then take a five minute break, repeating the pattern three more times before taking a 15 minute break.

Whichever system you choose for breaks, remember to use some of that time for physical activity. Exercise affects both your physical and mental health and may help reduce some of the stress and isolation that often comes with remote work.

Having a designated workspace can help you create boundaries between work and social life. Working from home can contribute to burnout, and using your bedroom as the office can often lead to a workday that stretches well past eight hours. If you can, make a workspace in another room. If you don’t have space to use as a designated home office, try the kitchen table or living room.

In addition to supporting your mental health, working in a space that’s set aside for work can help minimize distractions and maximize productivity, particularly if you live with family members or roommates. Young children or anyone who’s never worked from home themselves may not know to avoid interrupting you during your workday. You can set boundaries by informing everyone at home of your working hours and communicating your expectations.

The design of your workspace can also impact your emotional well-being and physiological health. Exposure to sunlight is linked to higher levels of serotonin, a hormone believed to regulate your mood and lower anxiety. If possible, use a workspace that gets a lot of natural light, and use part of your break time to soak up some sun. Add some greenery to your home office too — research has found that having plants nearby as you work can increase productivity.

Maintaining good posture while you work can prevent tightness in your neck or back pain. If working while seated, keep your feet flat on the ground beneath your knees. Avoid working from a chair that’s too tall and prevents your feet from reaching the ground. If you can, use an ergonomic office chair or a standing desk, which offers many health benefits. If using an office chair, remember that each person’s physiological needs are different, so take time searching for the right fit.

The repetitive motion of typing in a seated position has been linked to carpal tunnel syndrome — numbness and tingling in your hand, wrist, and/or arm caused by pressure on your median nerve. A hunched posture can put strain on your wrists and hands, so using an ergonomic chair or standing desk is already a step toward preventing carpal tunnel syndrome. Be mindful of your arm and wrist position as well. Work with your elbows bent by your side and keep your forearms stretched out in front of you parallel to the floor. Using an external computer monitor or keyboard can make it easier to maintain this position.

Working in silence by yourself can lead to greater concentration and productivity in some cases, but too much isolation and loneliness affects your mental health. An office environment allows for natural socialization and conversation throughout the day, and recreating this experience at home requires a bit more intention.

If you work on a team, use workplace messaging tools to maintain connections with coworkers. Take the initiative in setting up virtual or in-person events like happy hours. And if you’re located in the same area as your colleagues, schedule a coworking session in a local coffee shop. Remote work is also a great opportunity to expand your professional network by joining a coworking space.

It’s important to maintain other social connections, too. Schedule after-work plans with friends and family, and don’t forget to pause notifications and sign off for the day.

Let Alto support your health and wellness

Practicing good self-care while working from home involves prioritizing your physical health. Alto is here to support you with exceptional pharmacy care at every step of the way. We make it simple to stay on top of your medications with free, same-day delivery and medication management tools like reminders and auto refills in our mobile app.

How to Stay Healthy While Working From Home

In our previous post, we discussed how we designed our biometric authentication system with both privacy and a better user experience in mind. In this post, we'll show you exactly how we did it.

Considerations and Approaches for Implementing Biometric Login: Part 2

In Part 1, we discussed how we designed our biometric authentication system with both privacy and a better user experience in mind. In this post, we'll show you exactly how we did it.

To build a new authentication mechanism, we opted to use the react-native-biometrics library. This library interfaces with the device's biometrics, generates a keypair, and stores the private key within the device's keystore. When logging in with biometrics, the library creates a signature using the stored private key, and the signature is then sent to the server for validation. (Note: this library is now unmaintained. At the time of writing, this implementation can instead be accomplished with the following maintained libraries: expo-local-authentication to access device biometrics, keypair to generate a keypair, react-native-keychain to access the device keystore.)

Check if biometrics are supported and configured by the user for this device.

const { available } = await ReactNativeBiometrics.isSensorAvailable();

If yes, prompt the user for a biometric scan.

const { success } = await ReactNativeBiometrics.simplePrompt({ promptMessage: 'Confirm ID' });

If the scan succeeds, generate a keypair. The react-native-biometrics library's createKeys method will automatically save the private key to the device's keystore, and return the public key counterpart. Send the public key to your server.

const { publicKey } = ReactNativeBiometrics.createKeys('Confirm biometrics');

// Save the public key to your database
post('/save_biometric_key', { key: publicKey, device_id: 'xyz' })

When the user tries to login with biometrics, scan their biometrics. This time, if the scan succeeds, create a signature using the stored private key. The react-native-biometrics library's createSignature method handles all of this.

// Prompts for scan
// On scan success, accesses private key and uses it to generate a signature, which is then returned
const signatureResponse = ReactNativeBiometrics.createSignature({
  promptMessage: 'Face or fingerprint ID for Alto Pharmacy',
  payload: BIOMETRIC_SIGNATURE_PAYLOAD,
});

Send the signature to the server to validate against the public key. If validation succeeds, the user has successfully authenticated with biometrics and can proceed into the app.

// Call your server API to validate the signature against the public key that you've stored in the database
const validationSuccess = await post(
  `/validate_biometric_signature`,
  {
    signature: signatureResponse.signature,
    payload: BIOMETRIC_SIGNATURE_PAYLOAD,
		device_id: 'xyz',
  },
);

if (validationSuccess) {
  // Login Success
} else {
  // Login failure
}

import ReactNativeBiometrics from 'react-native-biometrics';

const setUpBiometricLogin = async () => {
  // Check if biometrics are supported and configured on this device
  const { available } = await ReactNativeBiometrics.isSensorAvailable();

  if (available) {
    // Prompt user to scan biometrics
    const { success } = await ReactNativeBiometrics.simplePrompt({ promptMessage: 'Confirm ID' });
      
    if (success) {
      // If scan is successful, generate a keypair, then save the public key to the server
      const { publicKey } = await ReactNativeBiometrics.createKeys('Confirm biometrics');

      post('/save_biometric_key', { key: publicKey, device_id: 'xyz' })
    }
  }
}

const loginWithBiometrics = async () => {
  // Scan user's biometrics. On scan success, generate a signature
  const signatureResponse = await ReactNativeBiometrics.createSignature({
    promptMessage: 'Face or fingerprint ID for Alto Pharmacy',
    payload: BIOMETRIC_SIGNATURE_PAYLOAD,
  });

  // Validate the signature against the public key saved on the server
  const validationSuccess = await post(
    `/validate_biometric_signature`, 
    {
      signature: signatureResponse.signature,
      payload: BIOMETRIC_SIGNATURE_PAYLOAD,
      device_id: 'xyz',
    },
  );

  if (validationSuccess) {
    // Login Success
  } else {
    // Login failure
  }
}

1. build a way to store a public key associated with a device

2. write a method to validate a signature against a public key

3. expose endpoints to save a public key, and validate a signature

Once biometric authentication is built, there are additional decisions to make. The right decisions for your app will depend on your goals; the approach we took here at Alto may not align with what is best for your app.

How should biometric sessions interact with our existing email and password sessions?

We opted to treat email and password sessions as longer-lived primary sessions, with biometrics as a shorter-lived secondary session on top of that primary session. This means that a user must first login with email and password in order to use biometrics on subsequent app opens. If the user logs out for any reason, they will need to log in again with email and password before they can use biometrics again.

How often should we prompt the user for biometrics vs. email and password?

We opted to prompt the user for biometrics far more frequently than email and password, but made this configurable in case we want to adjust.

We use tokens and cookies for session management.

There are plenty of edge cases to consider as you're developing biometric capabilities for your app, including: what should happen when the biometric scan fails, or when the signature validation fails? What should happen if a user disables biometric permissions from their device? What should happen when two users share a device? What should happen if 'risky' activity is flagged for this account? How can we disable biometric login if needed?

Face and fingerprint ID login has clear benefits for both the end-user and the application itself, but it comes with a host of implementation decisions. If you're considering building biometric login for your app, I hope this article gives you clarity on what biometrics is, the different ways you can integrate it into your app, and the tradeoffs and edge cases to consider.

At Alto, the Patients Engineering team worked closely with our Security Engineering and Product teams to align on our goals and build the best solution for our needs. Our Security team offered deep expertise on the authentication strategies to adopt and avoid, and our Product team kept us tethered to building the best experience for our users.

Working as a team is one of the best parts about developing at Alto. If you want to meet the awesome team I'm talking about, come join us - we're hiring!

Face and fingerprint ID login is a convenient, seamless way to gain app access on a mobile device. Instead of typing in a lengthy, hard-to-remember username and password, many apps allow you login with just a quick scan of your face or fingerprint (also known as biometrics).

Considerations and Approaches for Implementing Biometric Login: Part 1

It's a desirable feature for both our end user and the Patients Team here at Alto — we want to make it as easy as possible for users to log in while also performing more frequent authentication checks. Improve the user experience and the security of our app? Sounds like a win-win.

As an engineer, implementing biometric login might seem easy, as mobile devices already capture, manage, and encrypt biometric data and expose APIs for app developers like myself to initiate a biometric scan. All I need to do is call that API and wait to hear if the scan is successful or not. What isn't as simple, though, is figuring out what to actually do with a successful biometric scan response. What does a successful scan mean, and how does that relate to the username and password credentials that users currently use to access our app?

This post walks through the decision points we encountered while implementing biometric login and how our healthcare privacy concerns influenced the final implementation approach.

Prior to implementing biometric login, the only way for users to access the Alto app was with email (username) and password. A valid email and password generates a session, which expires at some frequency. Once the session expires, the user must re-enter their email and password to regain access to the app.

From the beginning, we knew that biometrics would need to be built with our existing email and password session management in mind. This is made clear in the Apple developer docs: "Use biometrics as a supplement to something you’re already doing. Don’t depend on biometrics as your only authentication option."

Make it easier for users to login. Nobody likes typing in an email and password — especially on a mobile app. Our goal was to reduce the number of times a user must enter their email and password.

Enhance the security of our app using more frequent authentication checks. As a healthcare app that displays Personal Health Information (PHI), conducting more frequent authorization checks decreases the likelihood of PHI becoming exposed to an unauthorized third party.

Have the ability to revoke biometric access from a particular user. Similarly, we want to be extra careful to ensure that if a device is lost or stolen, we have a fallback plan to invalidate a user's session and protect the user’s PHI. For email and password initiated sessions, this happens when a user changes their password, as any change in login credentials will invalidate all active sessions for that user. We needed a similar contingency plan for biometric login.

There are several ways to use a mobile device's biometrics to authenticate a user, with varying degrees of security.

No server-side authentication. Simply integrate with the device's biometrics as an extra layer of authentication. If the biometric scan is successful, let the user proceed into the app.

Provides an extra check and gives your app a sense of modern polish

No server-side validation means that nothing is being validated against your system, so this is not a good substitute for account authentication. Therefore, even if you add this check, the user should still be prompted to re-enter their email and password at the same frequency as before.

Given this, this approach wouldn't help us reach our goal of reducing the number of times a user must enter their email and password.

This approach is a good fit if your application already has an existing login and session management system, and you want extra authentication checks throughout the user's session without modifying any other part of the system.

Tie biometrics to our existing email and password authentication. Use the user's biometrics to unlock an encrypted version of their email and password credentials. When a user sets up biometric login, store the user's login credentials within the device's keystore — the keystore will automatically encrypt the credentials. After a successful biometric scan, retrieve those credentials from the keystore and send them to your existing login API.

Still easy to implement, no backend changes needed

Biometric scan can be used in place of entering an email and password

Changing email and password credentials will revoke biometric access: if a user changes their credentials, their biometrics will access stale credentials and fail to login. (This is somewhat of a con as well — it provides a poor user experience, but it's an edge case that should happen infrequently.)

There is still only one way for a user to authenticate server-side, but now two ways to pass server-side authentication — essentially weakening your app's existing account security.

This approach effectively hands out internal login credentials to third party storage. While not a huge risk considering a device's secure storage is encrypted and trusted by most users, it’s not necessarily a best practice either.

This approach is a good fit if your application doesn't contain sensitive data, and your goal is to make it more convenient for a user to login by replacing email and password with a biometric scan.

Create a separate authentication mechanism for biometrics. Introduce a new authentication mechanism specifically for biometrics, resulting in two independent forms of server-side session authentication: email with password and biometrics. The implementation could look like generating a keypair or a shared secret to save and validate against the server whenever a user attempts to login with biometrics.

Biometrics is now tied to its own secure server-side authentication mechanism, which means it can be used independently of email/password (or even replace it, if you choose to).

Two layers of authentication adds security to the app. Not only does a user need a valid email/password session, they also need a valid biometric session.

It provides fine-grain control over a user's biometric session. You can invalidate a user's biometric session by invalidating the public key and can even invalidate a biometric session without impacting an email-and-password session if needed.

Requires building and maintaining a separate authentication mechanism

This approach is a good fit if your application contains sensitive data (e.g. PHI or financial information), and your goals are to make it both more convenient for a user to login by replacing email and password with a biometric scan while also strengthening the security of your account management system.

Because we are a healthcare company dealing with sensitive data, we chose this last path. It required greater engineering investment, but we agreed it was imperative that we maintain a secure system while introducing biometric login for users.

In part 2, we talk implementation details, including the library we used, code snippets, and questions to consider before you get started. 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. 

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: 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.

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.

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

When you’re happy, we’re happy. That’s why we put together a quick guide with five tips for a great delivery experience, based on what we’ve learned from making more than a million deliveries to Alto customers just like you.

How to Have an Easy Alto Pharmacy Delivery Experience

When you’re happy, we’re happy. That’s why we put together a quick guide with four tips for a great delivery experience, based on what we’ve learned from making more than a million deliveries to Alto customers just like you.

Share any information needed to access your house or apartment  — for example, your intercom, gate code or apartment number/letter — by verifying your delivery address details and completing the “Delivery Instructions'' section in the Alto app. Head to Account > Delivery Addresses > Edit Address> Delivery Instructions to provide all of the specific info our delivery team needs to find your location. (If you don’t want us to ring the doorbell, this is the place to note that, too!)

2. Review your medication’s signature requirements

For controlled substances and medications of more than $500, either you or an authorized signer will need to be present to sign for your delivery. Many Alto customers with limited mobility choose to designate a caregiver as an authorized signer. Head to Account > Delivery Addresses > Edit Address> Delivery Instructions in the Alto app to add an authorized signer .

When required, you may sign electronically on your phone via a link you’ll receive by text, but your driver will need to physically see you during the delivery handoff. If an authorized signer is receiving medication on your behalf, they will be asked to sign for the medication and share their full name with our driver, who will note it in our delivery tracking system.

3. Designate a safe delivery space (and leave the front lights on!)

If your medication does not require a signature, you may schedule your delivery for a time when you are not at home by designating a safe space in the Alto app. Head to Account > Delivery Addresses > Edit Address >Delivery Instructions to provide all the specific info for your safe space. As a reminder, due to federal law, mailboxes are no longer accepted as safe spaces. Pro tip: you may also designate a separate safe space in case of rain or snow! 

We love pets, but please keep your four-legged friends secured when your delivery arrives, both for our drivers’ comfort and your animal’s safety.

At Alto, we’re more than just a pharmacy — we’re a partner in your health, and we go above and beyond to get you the medication you need at the best price possible.

Free, same-day delivery is only the beginning. Our pharmacists are available until 9 pm PST on weeknights and 6 pm PST on weekends to answer any questions you have about your medication. We also offer support with insurance and finding the best price possible on your prescriptions.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn more or transfer your prescriptions to Alto.

Alto Connect is the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go.

Introducing Alto Connect

Big news from the team here at Alto: today we launched Alto Connect, the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go! You’ll also see the new Alto Connect brand on our desktop portal, formerly known as AltoMD: new name, same great pharmacy services.

The Alto Connect mobile app is the next evolution of Alto’s custom-built provider communications center, formerly known as AltoMD. Alto was the first pharmacy in the United States to offer a prescriber-focused pharmacy communication platform when the original desktop-based AltoMD product launched in March 2016. Since then, more than 500 doctors offices have integrated Alto Connect into their daily workflows and prescription management. 

Doctors offices who work with Alto Pharmacy can now access Alto Connect across all of their devices, providing greater flexibility and convenience for monitoring prescriptions on busy days spent juggling patient consultations and other business needs. Instead of spending hours on the phone or fighting with the fax machine, Alto Connect provides instant access to prescription information and pharmacy messaging, and Alto Connect users can move seamlessly between the two platforms throughout their workday.

With Alto Connect, clinical staff can view all current prescriptions at Alto Pharmacy, including delivery status, out-of-pocket costs and refills. You'll never have to wonder if a patient picked up their prescription or stayed on track with their refills between visits - our system tells you exactly where every prescription stands for every patient.

Have a question for our pharmacy team? Curious about insurance coverage, delivery times, or other aspects of our service? Our team is here to help! You can send us a general message or ask a question specific to one of your patient's prescriptions. 

Alto Connect's push and email notifications alert you when a prescription needs additional information to move forward — most commonly, a clinical clarification or additional data needed for a prior authorization. We'll only alert you when we're certain we need your team's input, so you can stay focused on your patients.

Using AltoMD on your computer today? Nothing changes other than the name! Ready to try Alto Connect mobile for yourself? Scan the QR code above to download the app - your AltoMD login works on the mobile app. 

Need help setting up an Alto Connect account or want training for your staff? Reach out to providersuccess@alto.com.

Get an inside look at the patients team at Alto Pharmacy to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

Get to Know the Team That Builds Alto's Customer-Facing Apps

Imagine an app that allows you to buy things and have them delivered to you the same day, for free. Now take that app and put it in a highly regulated space like pharmacy. You face the challenge not only of building an e-commerce platform from scratch, but also of navigating medication pricing, federal and state regulations, and patient safety—and that's just the way the Patients Team likes it.

"It's a really exciting and fun problem to solve," says Mike Riess, the team's Engineering Manager. Software Engineer Angelique Nehmzow agrees: "There's a really strong product and design aspect, like more traditional startups, but then everything gets a little bit more interesting because it's healthcare."

Below, we chat with the team to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

What does the Patients Team do at Alto? 

Ask anyone on the team why they joined, and chances are, they'll tell you they wanted to be on the product team closest to Alto's customers: "We really try to own the customer experience," says Peter Zeng, the latest Software Engineer to join the team. "If a customer is coming to the web app, or they're coming to our mobile app, we want to make sure that they're able to onboard with us as easily and conveniently as possible."

The team is also responsible for the customer experience beyond onboarding, from the moment a customer schedules a medication for delivery to the time that it shows up on their doorstep. "We already offer great services like free, same-day delivery and cost savings. The Patients Team empowers customers to make the most of our offering," Nehmzow explains. "You can see what prescriptions you have, check on the status of your order, and schedule automatic refills. In a more traditional pharmacy, you don't get that kind of visibility. You have to call them up or even wait in line in person. At Alto, it's a different experience."

What was it like in the team's early days?

Today, there are eleven engineers on the team working to build that better end-to-end experience—but it wasn't always that way. When the team first formed in 2019, it consisted of just three members: Riess, Brian McRae, and Andy Lau, all of whom are still on the team.

"The first priority for us was just stabilizing the foundations," Riess says of the team's early days. Every other week, the three team members, along with Alto co-founders Matt Gamache-Asselin and Jamie Karraker, would meet to audit the app's core flows. "For the first three months we probably didn't make it through some flow at least 50% of the time," Riess recalls. "There would be a ton of bugs in the onboarding experience, things that weren't working with the flows or navigation or deep linking."

Among the team's first projects was a redesign of the checkout flow. "There was a lot of work to be done to streamline the checkout flow, which is pretty much the main function of the app," says McRae, who initially joined the team as a software engineer and later transitioned into product management. "We had to make it easier to add a payment, add your addresses, everything you need to do to schedule your prescription for delivery."

"The growth of the team, in terms of both size and stability of the platform, has allowed us to swing at more interesting bets for the company," Riess says. In particular, the Patients Team has turned their attention toward experiences personalized for specific medical conditions.

"Different customers have different needs. A customer who wishes to start a family will have a different experience than a customer who needs to order their routine heart medications that they've been taking for the last eight years,” McRae says. “The challenge for us is how we serve all these customers well through the app."

"I think that's where Alto can be such a differentiator," Riess adds. "A world-class pharmacy experience is about so much more than just dispensing medications. We want to build tools for customers that help them get the most out of their medications—everything from simple videos teaching them how to perform injections safely at home to the ability to synchronize deliveries for multiple prescriptions for managing complex health conditions."

With these new projects on the horizon, engineers have ample opportunity to focus on the areas that excite them most. "We're full-stack and mobile and web," Nehmzow says. "Part of the team focuses more on experimentation, iterating quickly, and using data to make decisions. Part of the team focuses more on platform work, tooling, and improving the developer experience. There are a lot of areas to explore and contribute to."

One spring night, the Patients Team gathered in a back yard in San Francisco’s Mission District for short ribs and an impressive spread of side dishes. "Kudos to Robbi, who's the grill master. I just provide the grill!" Nehmzow says, laughing. While the team barbecue was the first time some members had met in person, Zeng notes that the team has been supportive of one another even while working remotely during the pandemic.

"The first real project that I was assigned to was working with the communications system. Before writing my first piece of code, I spent two weeks exploring what already exists and understanding the different parts of the system," Zeng says. "I've been really impressed with how understanding my teammates have been. They make the space for you to learn all the different pieces of code we own."

That culture of support is by design, reflected in the six principles—complete with matching emojis—at the top of the #patients-team Slack channel: "Empower each other," "be an owner," "find the path," "learn by doing," "embrace complexity," and "foster trust." 

While these principles echo Alto's company-wide values, they are unique to the Patients Team. "For a long time, we were the only external-facing product team at Alto," Riess says. "These principles were intended to be this motivation around how we win. It's a combination of how we treat each other, how we reason about decision making, and how we approach solving a problem that's never existed before."

As the team looks toward the future, those principles have never been more relevant: "We have a goal and an area we want to focus on, but in terms of which projects we're going to do, it's not a top-down thing," Nehmzow says. "It's very much, 'We're going to figure out how to solve this problem together, even when it's difficult.' That's my favorite part about the team."

The Patients Team is hiring! Learn more about open positions here.

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.

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

If you’re allergy-prone, this time of year goes hand in hand with itchy eyes, congestion, heavy sneezing, and other unpleasant allergy symptoms. Here’s a quick primer on how to prepare for spring allergies.

The Best Ways to Prepare for Seasonal Allergies

Spring brings everything out of hibernation: baseball, perennials, and seasonal allergies, as millions of people in the U.S. unfortunately know all too well. If you’re allergy-prone, this time of year goes hand in hand with itchy eyes, congestion, heavy sneezing, and other unpleasant allergy symptoms. The good news is that small preventative steps, like extra cleaning and paying attention to pollen counts, can reduce your exposure to allergens. Here’s a quick primer on how to prepare for spring allergies.

Spring is a time of growth and renewal, and the science responsible for the fresh green leaves is also what causes pollen allergy symptoms. Pollen is a tiny grain that’s essential for plant reproduction. While some plant varieties count on insects to carry the tiny particles from one plant to another, others — like grasses and native trees including oaks, cedars, and birches — are wind-pollinated. That means these plants produce vast amounts of pollen to ensure the next generation of plants have a high chance of reproduction. Unfortunately for your sinuses, it can trigger allergic reactions that are uncomfortable and irritating.

As you’re waiting for winter to end, you may find that your allergy symptoms have already arrived. Trees start to release their pollen in late winter and early spring, while grasses pollinate in late spring. There’s lots of regional variation too, so depending on which part of the country you live in, you might experience pollen allergy symptoms as early as February or as late as fall.

While wind pollination is the primary source of seasonal allergies, mold also releases spores in the spring which travel by wind and can cause allergy symptoms.

What are the most common allergy symptoms?

As spring breezes begin to disperse pollen and mold spores, the body’s immune system goes into overdrive, leading to allergy symptoms like the following:

Hives may occur in some cases, though they are rare.

People with asthma should take extra precautions, as the same substances that trigger seasonal allergies — and even those that trigger year-round allergies, like pet dander — can also trigger acute asthma attacks. Allergy-triggered asthma, which is relatively common in children, affects the lungs and may lead to coughing, wheezing, chest tightness, shortness of breath, or rapid breathing.

With COVID-19, this year’s spring season poses some additional challenges for asthma sufferers, even as vaccination numbers increase. If you have asthma, follow the suggestions below on how to prevent spring allergies and learn more about asthma coping strategies during COVID.

We can’t change how susceptible our bodies are to allergies or asthma, but we do have some control in preparing for seasonal allergies and preventing pollen allergy symptoms. Here are three prevention tips.

After more than a year of travel restrictions, remote work, and limited access to public spaces, we’re all understandably eager to spend lots of time outdoors, where — you guessed it — there’s plenty of pollen in the air. You can limit your exposure to allergens and reduce your chances of an allergic reaction by taking a few extra steps before going outside. Check the local pollen count online — most weather apps include this as well — and take allergy medication in advance if the forecast is high. Pollen counts are typically highest in the morning, so consider opting for an indoor workout rather than an early run. In general, it’s best to stay inside when it’s dry and windy while rainy days offer a reprieve for allergy sufferers.

You’re unlikely to completely eliminate all allergens from your house, but there are some steps you can take to keep indoor air as clean as possible:

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