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Blog | Alto Pharmacy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How Alto Delivers More, at No Additional Cost

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

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

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

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

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

Need a Refresher? These Alto Benefits are Completely Free

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

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

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

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

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

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

Streamlined Medications for You and Your Family

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

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

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

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

Fertility Patient Story: Tiffany Shares Her Experience with Alto

How One Couple Navigated Their Infertility Journey

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fertility Patient Story: Tiffany Shares Her Experience with Alto 

There is quite a bit that sets Alto apart from other pharmacies. Let’s take an in-depth look at how Alto was built to be a better pharmacy in all aspects of care. 

Traditional vs. Online Pharmacies: How Alto Built Something Better

Is there anything we can’t buy online these days? Over the past decade, e-commerce has surged, as promises of convenience and low prices have lured shoppers away from brick and mortar stores. Yet even with almost 8 out of 10 Americans shopping online, there’s a pervasive sense of nostalgia for “the way things were.” We love the convenience of clicking “buy” from the comfort of home, but we often lament the loss of human touch in our transactions.

It’s probably not surprising that prescription medications have followed the same trend. Most of us are eager to avoid the lines at traditional retail pharmacies. A quick search will turn up scores of online pharmacies, all boasting low prices and convenient mail-delivery. You might think Alto is one of this bunch, however, there is quite a bit that sets us apart. Let’s take an in-depth look at how Alto was built to be a better pharmacy in all aspects of care. 

A major factor driving people to their local pharmacies is the chance for a face-to-face interaction with a pharmacist they can trust. Traditional retail pharmacies generally have established reputations and physical locations that help make customers feel secure. However, retail pharmacists are often distracted by the laundry list of tasks they’re expected to complete each day. You may have to wait in line, potentially when you’re feeling unwell, only to receive just a minute or two of face time. 

Online pharmacies, on the other hand, can spring up overnight—and disappear just as fast. Unfortunately, there are many illegitimate internet-based pharmacies that may be selling counterfeit or unsafe drugs. In fact, the National Association of Boards of Pharmacy (NABP) labeled about 95% of the online pharmacies they reviewed as “not recommended.” The FDA provides this list of safety checks and warning signs when considering an online pharmacy. Even with legitimate online pharmacies, it may not be easy, or even possible, to talk with a real pharmacist when you have questions about your medication. 

At Alto, your care is our priority. Just ask our happy customers. Not only are we fully accredited by the NABP, but we also have fulfillment centers in every area we serve, staffed by our incredible local teams. These neighborhood pharmacies are where we process and fill your prescription orders, then hand-deliver them directly to your doorstep. We have expert pharmacists in all areas of specialty care who are available to talk through questions as they come up, for as long as you need. It’s easy to get in touch—send a quick message through our in-app messenger or give us a call. 

With the cost of prescription medications on a seemingly endless upward trend, more and more Americans are looking for ways to save money. Many people may not realize that the cost of their medication can vary from pharmacy to pharmacy, though they’re unlikely to spend hours driving between locations to find the best price. For that reason, traditional retail pharmacies have little incentive to seek ways to lower your costs. After waiting in line to pick up your medications, there’s little choice but to accept the price you’ve been given or leave empty handed. 

Online pharmacies make it easy to compare prices and often seem to offer better deals on the surface. You should be wary of pricing that seems “too good to be true,” however, and make sure you are visiting a reputable source. Counterfeit medications pose a significant risk to your health, so make purchases with discernment. 

At Alto, not only are we the real deal, but we’re committed to finding you the best price. We match every single prescription against our extensive database of savings options. Plus, our services and delivery are always completely free. For a closer look at how we find the lowest prices, read our article, “How Alto Saves You Money on Prescriptions.” We’ve saved our patients more than $36 million on their medications so far.

Some people stick to their local retail pharmacy because they need or prefer to pick up their medication the same day. Others continue making the trip simply because it’s the way they’ve always handled their prescriptions. Switching pharmacies might seem like a hassle, but what about having to drive to the pharmacy and wait in line every time you need your medication? 

Online pharmacies exist to eliminate the inconvenience of picking up your prescriptions. No more rushing to the pharmacy during business hours, standing in long lines, or driving back and forth for multiple prescriptions. However, online pharmacies send your medications through the mail, so you won’t receive them right away. And when questions about your prescription arise, you may find yourself stuck on hold or resorting to an internet deep dive. 

With Alto, your days of waiting in line are over but you won’t miss out on real, human care. We’ll take care of transferring your prescriptions for you, then one of our local couriers will hand-deliver your medications at a time and location that’s convenient for you—even that very same day. Our expert pharmacists are always on-call to answer any questions or provide guidance. With the Alto app, you can manage your and your family’s prescriptions, chat with a pharmacist, and coordinate refills, all in one place. 

Some retail pharmacies offer delivery options, however, they usually require a paid membership or the use of an outside delivery service. With prescription medication already a significant expense for many people, stacking on additional fees isn’t a very attractive prospect. 

Online pharmacies use mail delivery, so it can be difficult to determine exactly when your medications will arrive. If you’re running low or are on a timed regimen, the possibility of mail-based delays can present a significant challenge and become a potential health risk. 

When you fill a prescription with Alto, a member of our local team will hand-deliver it to you that very same day—for free. No more worrying about mail delays or wondering when your medication will arrive. Simply select a delivery window and a location and we’ll make sure your care package arrives safely, securely, and on time. You can even track your delivery as it makes its way to you. And did we mention that our delivery service is always completely free? 

As you can see, Alto is just like your neighborhood pharmacy. We just happen to believe that your medication should come to you. We’re committed to providing you with exceptional care—from free, same-day delivery to exhaustive price investigations to always-there support from our dedicated pharmacists and care team. When it comes to your prescriptions, you don’t have to sacrifice trust, price, convenience, or delivery. We’ll give you the very best experience in every area of care. 

Ready to switch to a better pharmacy? Our team is available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out by in-app secure messaging or phone.

Fertility patients in New York City can now choose Alto’s same-day doorstep delivery and have their medications delivered by our Alto team.

Hello, New York

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

Starting Monday, November 2, fertility patients in New York City can now choose Alto’s same-day doorstep delivery and have their medications delivered by our Alto team.

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

Courier delivery windows
Monday - Friday 

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

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

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

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

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

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

Alto knows fertility pharmacy. With more than 50,000 patients served, we understand the treatment complexities and concerns of fertility patients. Our dedicated patient care team is available in the evenings and on weekends to walk you through your first injection or answer questions about medication storage, dosing or interactions. Our fertility deliveries include all necessary ancillary supplies, such as syringes, sharps container and alcohol swabs, and are carefully packaged for temperature control. Delivery is always free.

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

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

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

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

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

Celebrating National Pharmacist Month at Alto

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

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

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

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

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

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

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

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

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

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

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

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

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

Rather than letting every cough or sniffle cause a panic, let’s sort through the most likely symptoms of the three respiratory illnesses to look out for this season: the cold, flu, and COVID-19.

Cold, Flu, or COVID-19? Your Seasonal Symptom Guide

For most of the year, we’ve had one virus on our minds. But as cold and flu season moves into full swing, an onslaught of new symptoms could sow confusion. Rather than letting every cough or sniffle cause a panic, let’s sort through the most likely symptoms of the three respiratory illnesses to look out for this season: the cold, flu, and COVID-19.

We can usually get an idea of what the flu season holds in store for us by studying recent flu activity in the Southern Hemisphere. This year, reported infection rates were 99% below normal, which epidemiologists credit to the fact that people were wearing masks, social distancing, and washing their hands frequently. The same precautions that prevent the spread of the coronavirus will also stop the flu (and the common cold too).

Still, experts are urging everyone to get their flu shot this year. More people getting sick could cause more than just confusion over symptoms. It could put a strain on testing supplies and medical care. Getting your flu shot will not only make you less likely to get sick with the flu, but it can also reduce the severity of your symptoms if you do get sick.

There’s a reason we call it “the common cold.” According to the American Lung Association, most adults come down with two to four colds per year. With more than 200 viruses that can cause the common cold floating around out there, it’s not all that surprising. Here are the main symptoms most cold sufferers can look forward to: 

The CDC reports that a cold usually begins gradually with a sore throat and a runny nose and then progresses to include coughing and sneezing. It is rare for cold symptoms to include fever, and diarrhea is not considered a symptom of a cold. 

There is no cure for the common cold, but most people recover within 7-10 days. The best way to feel better is to rest and drink plenty of fluids, although over-the-counter cold medications can help ease your symptoms. Since colds are contagious, try to be mindful and cover up when you cough or sneeze. 

The flu tends to hit us like a ton of bricks. Unlike the more gradual onset of a cold, flu symptoms are known to appear suddenly and with force. Along with a tell-tale fever often comes headaches, body aches, and a general feeling of exhaustion. 

The CDC reports that the following symptoms are common with the flu:

Vomiting and diarrhea (more common in children)

You may have noticed that the common cold shares some of these symptoms. Deciphering the differences is not always cut and dry. Generally, it’s that “hit by a bus” feeling that differentiates the flu. If you’re suddenly sidelined by a fever, chills, aches, and pains, you’re probably not dealing with a cold. It’s important to note, however, that not everyone experiences fever with the flu. 

Your healthcare provider can determine if you have the flu with a simple swab test. As with a cold, you should drink plenty of fluids and try to rest. You should feel better after a few days. Antiviral drugs can be used to reduce symptoms and shorten the amount of time you are sick. Antiviral medications are available by prescription only and work best when started soon after you get sick. When you send your prescription directly to Alto, we can make sure you get your flu medication delivered safely to your home that very same day. 

Here’s where our symptom detective work gets really tricky. Not only are the symptoms of COVID-19 all over the map, many of them closely mimic those of the flu. The coronavirus has confounded experts by showing up in strange and disparate ways. The only true way to know if you have symptoms of coronavirus infection is to get tested, but there are a few red flags to watch out for.

What’s so confusing is that COVID-19 is a respiratory illness like the cold and flu, but it’s not only a respiratory illness. Experts consider it to be a multi-organ disease. Symptoms may appear from head to toe, range from mild to severe, and often come on gradually. While there isn’t a clear set of symptoms that always distinguishes COVID-19, these four seem to be the most common:

The CDC also lists the following symptoms of COVID-19:

Shortness of breath or difficulty breathing

Interestingly, a sudden loss of smell or taste seems to be emerging as a defining symptom of coronavirus infection. While it doesn’t occur in every patient, some studies have indicated that nearly 65% of people with COVID-19 experience this symptom. Additionally, while you may be accustomed to having your temperature checked when you visit a restaurant or store, fever is a common symptom of COVID-19, but by no means always present. About 55% of all infections are accompanied by a fever. 

The rule of thumb is this: if you think your symptoms could be COVID-19, you should act as if you’ve been infected until you can be tested. Call your doctor right away and self-quarantine while you monitor your symptoms and wait for further instructions. It’s crucial that you take every precaution to ensure you don’t transmit the virus to anyone else.  According to the CDC, you should also be on alert for more dangerous symptoms, which include trouble breathing, pain or pressure in the chest, bluish lips or face, confusion or incoherence, and an inability to wake or stay awake. Seek emergency medical care if any of these symptoms occur.

Coronavirus infections tend to last longer than the flu, but those with mild cases should recover on their own in about two weeks. Even if you have only mild symptoms, you need to call your doctor and self-quarantine immediately. With more severe cases, doctors may provide patients with intravenous fluids, medicines to reduce a fever, or oxygen to help with breathing.

If all you know is that you’re feeling terrible, give your doctor a call. Generally speaking, if you’re sniffly, sneezy, and slightly rundown, you’re probably battling the common cold. If you suddenly come down with a fever or chills, body aches, and heavy fatigue, the flu may be to blame. However, with COVID-19 so tricky to identify, it’s vital that you rule it out whenever troubling symptoms crop up. 

If you have questions about which medications can help you deal with your seasonal symptoms, our pharmacists are standing by. And if you do come down with the flu, we can hand-deliver your antiviral medication quickly and safely, while you stay home and get that all-important rest. 

Want Alto by your side this cold and flu season? Our team is available to answer your questions from 6 am - 9 pm PT Monday - Friday, and 7 am - 6 pm PT on weekends; reach out by phone 1-800-874-5881 or download the mobile app for secure messaging.

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

We combed through the latest advice from the experts to give you some actionable steps that may help protect your health.  

Managing Diabetes During COVID-19

Pre-existing condition. These two words have echoed across news broadcasts and government briefings about COVID-19, stirring up fears in those living with chronic disease. But as we’ve gathered data and learned more about the novel coronavirus, a clearer picture has emerged. We now better understand how people with underlying medical conditions like diabetes can take careful precautions to decrease their likelihood of getting sick. 

According to the ADA, it does not appear that people with diabetes are more likely to get COVID-19. They do, however, have a higher risk of developing serious symptoms and severe complications that require hospitalization if exposed. This increased risk makes prevention and early detection critical. 

If you are living with diabetes, it’s important to focus on what you can control right now. In addition to following the CDC’s prevention guidelines, which include wearing a mask, washing your hands frequently, and avoiding unnecessary social contact, you can manage your risk by planning ahead. With this in mind, we combed through the latest advice from the experts to give you some actionable steps that may help protect your health.  

The world is full of very real stressors right now. It’s easy to let healthy habits slip when you’re anxious or under pressure, however, it’s more important than ever to stay on top of your health. The ADA advises that your risk of experiencing severe illness from COVID-19 is likely to be lower if your diabetes is well-managed. Dr. Janaki Vakharia, MD, clinical fellow in the Endocrinology Division at Massachusetts General Hospital, explains, "Studies have reported that patients with well-controlled diabetes who have been hospitalized for COVID-19 have a higher rate of survival. Better controlled diabetes is also associated with lower markers of inflammation, which may explain this better rate.” 

Do your best to stick to the care plan you’ve created with your doctor—keep taking your insulin and/or other medication, test and track your blood glucose, exercise at home, and maintain a healthy diet. Make sure you have enough medication on hand to last you several weeks and continue your doctor’s appointments virtually if telemedicine is an option. 

In his FAQs about Diabetes + COVID-19 for Johns Hopkins Medicine, Mohammed Al-Sofiani, MBBS, MSc, writes, “I strongly encourage all people with diabetes to make sure that they have enough supply of insulin and all the tools they typically use to manage their glucose...I also encourage people with diabetes to avoid going to the clinics or pharmacies unless it is for urgent matters.”

You should never have to risk your health to obtain your insulin and other medications. That’s why we offer free contactless delivery when you fill your prescription through Alto. Simply let us know where and when to drop it off, and we’ll make sure your medications and supplies arrive safely. 

We’re about to enter cold and flu season. More viruses going around means more chances of getting sick so experts are urging everyone to get a flu shot. This year, a sore throat or runny nose could produce more anxiety than usual, but try not to let yourself slide into fearful thinking. Stay home and report your symptoms to your doctor, especially if you experience a fever, dry cough, or shortness of breath. There is a wide range of symptoms associated with the onset of COVID-19, but the CDC offers this list as well as an interactive coronavirus self-checker. Mild symptoms can often be managed and monitored from home, but don’t make that decision without your doctor. 

If you develop any emergency warning signs for COVID-19, seek medical attention immediately. According to the CDC, these emergency signs include difficulty breathing, chest pain or pressure, confusion or inability to arouse, or bluish lips or face, though they stress that severe symptoms of any kind should be immediately reported to your medical provider. 

Preparing for the possibility of getting sick is especially important right now. The ADA recommends having enough supplies to last you several weeks in case you are symptomatic and unable to leave your home. If you do get sick and your doctor has recommended that you remain at home, take that as good news and try to focus your attention on resting while keeping an eye on your glucose levels and symptoms. 

Remember—any infection, including COVID-19, will likely cause your blood glucose levels to start rising. It’s important to pay close attention to your blood sugar, continue taking your medications, and drink plenty of fluids to prevent dehydration. If your blood sugar becomes hard to manage and your body doesn’t have enough insulin, you are at risk of developing diabetic ketoacidosis (DKA). The ADA advises that if your blood sugar has registered high (greater than 240mg/dL) more than twice in a row, you should use an over-the-counter kit to test your urine for ketones. If ketones are present, call your doctor right away. 

Continuing to take your insulin and other medications must be your top priority, so be sure that you don’t risk running out. According to ADA, the leading manufacturers of insulin and other supplies are not reporting any impact on their manufacturing and distribution capabilities due to COVID-19. There have been, however, widespread reports of mail delays that could affect the timely delivery of mail-order prescription drugs. 

When you fill your prescriptions through Alto, we’ll coordinate your refills automatically, then one of our couriers will hand-deliver them to your home. Your prescriptions will never change hands during the delivery process and you can designate a safe place for your courier to leave your medications for contact-free drop-offs. 

Finally, if like so many you are currently experiencing unemployment, loss of insurance, or economic hardship, there are options to get help. The ADA offers this list of resources and the team at Alto is always here to help you find options that can save you money. Reach out to us at any time via phone call (1-800-874-5881), or in-app messaging.

So many of us are feeling anxious and uncertain right now, and that can interfere with our ability to sleep well, manage stress, and practice self-care. Be sure to keep in touch with the people you love and talk to them about your fears. Joining an online community for people with diabetes can also help you get the emotional support you need. 

We're here to support you through COVID-19 with free home delivery. Our team is available 6 am - 9 pm PT Monday - Friday and 7 am - 6 pm PT on weekends; call 1-800-874-5881 or download the mobile app for secure messaging.

Switching to Alto is easy and takes only a few minutes. Here's what you can expect to know about savings, free same-day delivery, and access to our expert pharmacists.

How Do I Transfer a Prescription to Alto?

It really is possible. In just a few minutes, your days of standing in line at the pharmacy could be over for good. From now on, your refills will arrive safely at your doorstep exactly when you need them — no more wondering if they’ll make it on time or if they’re even on their way. And you’ll have ongoing support from a team of pharmacists through secure in-app message, helping you feel comfortable discussing any health concerns freely. 

You can switch to Alto in minutes using our app, by going online at alto.com, or by calling Alto at 1 (800) 874-5881. 

We’ll contact your current pharmacy to arrange the transfer right away. It may take a few business days to receive your prescription from your old pharmacy, but we’ll keep you up to date along the way. As an alternative, you can ask your doctor to send a new prescription directly to Alto.

Not only are the services we provide at Alto completely free, but we’ll also do our best to identify ways to save you money. It’s true—your copay stays the same when you switch to Alto and there are absolutely no hidden delivery or service fees. We’ll investigate coupons, copay cards, and other savings options in order to find you the best price — we’ve saved our patients more than $23 million on their medications! 

Once your transfer is complete, we’ll reach out to schedule your free delivery. You select the delivery date and window that works best for you, and you can follow your courier in real-time as they make their way to your door. Your medications will be hand-delivered by a member of our local courier team. In most instances, you can designate a safe place for your medications to be left in the event you are not home or if you prefer contact-free delivery. 

Blog

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

How Alto Delivers More, at No Additional Cost

Fertility Patient Story: Tiffany Shares Her Experience with Alto

Traditional vs. Online Pharmacies: How Alto Built Something Better

Hello, New York!

Celebrating National Pharmacist Month at Alto

Cold, Flu, or COVID-19? Your Seasonal Symptom Guide

Managing Diabetes During COVID-19

How Do I Transfer a Prescription to Alto?

How to Be a Prescription Overachiever!

IVF Medications: Schedule and Side Effects Explained

All about PrEP for HIV Prevention

Switch to a better pharmacy.