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

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World AIDS Day, observed on December 1st every year, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

Take Action for World AIDS Day 2021

World AIDS Day, observed on December 1st every year since 1988, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

AIDS (acquired immunodeficiency syndrome) was heavily stigmatized from the beginning of the epidemic in the 1980s. Four years passed between the first cases of AIDS in the U.S. in 1981 and the Reagan administration’s first public mention of the disease. There were many misconceptions about how HIV (human immunodeficiency virus) — the virus that causes AIDS — can be transmitted and who is at risk of contracting it.

The stigma and lack of information about transmission and prevention led to many preventable cases of HIV/AIDS in the U.S. At the peak of the epidemic in 1995, complications from the disease were the leading cause of death for adults ages 25-44, and to date, more than 700,000 people in the U.S. have died from an HIV-related illness.

The HIV and AIDS landscape looks dramatically different today than it did back when World AIDS Day was first established. With greater awareness of HIV and AIDS, and more government funding of research, new HIV infections in the U.S. decreased by 73% between 1984 and 2019. Still, the fight to end AIDS isn’t over, with more than 1.2 million people living with HIV in the U.S.

In honor of World AIDS Day 2021, take a look at what has already been accomplished in the fight against AIDS and learn about what is needed next.

There were 34,800 new HIV infections in 2019

13% of those living with HIV don’t know it

57% of those living with HIV are virally suppressed (meaning they are not at risk of transmitting the virus to others)

Milestones in the history of HIV and AIDS

AIDS first emerged in the U.S. in 1981, but researchers did not learn that HIV caused AIDS until three years later in 1984. The history of HIV medication dates back to 1986, when clinical trials for azidothymidineor (AZT), the first antiretroviral HIV/AIDS medication, began. AZT was approved to treat HIV a year later.

Highly active antiretroviral therapy, often referred to as antiretroviral therapy (ART), became the frontline treatment for HIV in 1997. ART is a combination of medications that lower your viral load, which is the amount of HIV in your bloodstream. When taken every day as prescribed, these medications can help individuals with HIV maintain an undetectable viral load, virtually eliminating their risk of transmitting the virus to others.

The U.S. Food and Drug Administration (FDA) first approved a PrEP medication in 2012. PrEP, or pre-exposure prophylaxis, can lower the risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%.

With these breakthroughs in HIV treatment and prevention therapies, the U.S. government recently announced a goal to reduce the number of new HIV infections by 75% by 2025 and at least 90% by 2030, preventing an estimated 250,000 additional cases of HIV.

Next steps in the fight against HIV and AIDS

Despite the progress that has been made in the fight against HIV and AIDS, prevention, care, and treatment remain inaccessible for many individuals at risk of contracting HIV — both in the U.S. and around the world. The theme for World AIDS Day 2021 is Ending the HIV Epidemic: Equitable Access, Everyone’s Voice, in recognition of how health inequities contribute to the epidemic.

In the U.S., racial discrimination and deeper inequities in healthcare have contributed to HIV’s disproportionate impact upon people of color. Black and Latinx individuals — particularly gay and bisexual men — are among the groups disproportionately affected by HIV. A variety of factors contribute to these disparities, including income inequality, unequal access to healthcare, and lower use of HIV prevention and treatment services. According to 2016 CDC data, white individuals accounted for 69% of PrEP use, while Latinx and Black individuals accounted for 13% and 11%, respectively.

Fortunately, HIV prevention medication continues to become more accessible, with generic medication options and expanded health insurance coverage of PrEP. And legislation in a handful of states, including California and Colorado, allows pharmacists to prescribe PrEP. There are also a number of organizations working hard to make HIV services more accessible to communities of color, like NMAC and Black AIDS Institute.

Getting an HIV test is one of the most important things you can do for World AIDS Day. Not only will learning your HIV status give you the information you need to take control of your health, it will also help combat the stigma surrounding HIV and AIDS. Each person who makes use of testing and prevention services — and each person who speaks openly about HIV and AIDS, without perpetuating fear or stigma — brings us closer to a future without AIDS.

Search for a free and confidential HIV testing site near you.

View the CDC’s HIV stigma language guide to learn the power of the words you use when discussing HIV and AIDS.

Get support navigating HIV treatment and prevention medication

At Alto, we’re committed to doing our part to make HIV treatment and prevention services as accessible as possible. Our extensive library of HIV-focused content covers the information you need to make informed decisions about your health. And if you take PrEP or ART, our team will coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option for your health needs at the lowest price.

To learn more, 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.

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

How to Take Action for World AIDS Day 2021

In honor of National ERG Day, which falls on November 17 every year, we’re highlighting the important work of Alto’s six ERGs. 

Celebrating National ERG Day at Alto

The history of employee resource groups (ERGs) in the U.S. dates back to the 1960s, when a group of Black employees at Xerox self-organized to discuss their experiences of workplace discrimination and advocate for more inclusive policies. At the time, these networks of employees united by a shared identity or experience were known as affinity groups.

Today, ERGs can be found at companies of all sizes and industries where they play an important role in shaping an inclusive culture and fostering a sense of belonging in the workplace. In honor of National ERG Day, which falls on November 17 every year, we’re highlighting the important work of Alto’s six ERGs. 

At Alto, we believe that every perspective matters, and that diversity fosters creativity and leads to innovation. Our six ERGs are part of our broader commitment to diversity, equity, and inclusion (DEI), both in creating our company culture and delivering an exceptional pharmacy experience.

"At Alto, we’re committed to building and sustaining an inclusive workplace that both supports our employees and helps us deliver on our mission to improve the quality of life for everyone who needs medicine,” shared Ty Bledsoe, Head of Diversity, Equity & Inclusion. “Our ERGs help foster authentic relationships, offer safe spaces for education and conversation, and celebrate the incredible diversity of our Altoids and our communities."

By building community, providing support, and contributing to an individual’s personal and professional well-being, these groups help ensure that every Altoid feels a sense of belonging each day at work and that we appreciate the diversity of the customers we serve.

Here are just a few ways that each Alto ERG contributes to a more inclusive culture and pharmacy experience.

Umoja’s mission is to inform, educate, and empower Black Altoids and allies. The group has deepened Altoids’ understanding of the Black experience by sharing educational resources in support of Black History Month, Juneteenth, and Pride.

They also help our team explore the intersection of identity and healthcare as it relates to our services. After Dr. Reverend Stacey Edwards, founder of Fertility for Colored Girls, spoke at Alto about the fertility journeys of Black families this spring, Umoja continued the conversation by inviting Dr. Temeka Zore, OB GYN and reproductive endocrinologist at Spring Fertility, and Esther Ebeuhi, a licensed doula and birth equity analyst, to speak on Black motherhood.

Alto Auténtico aims to build community among Latinx Altoids and ensure that they have a voice at Alto. In addition to facilitating company-wide learning about the Latinx experience and the diversity within Latinx culture, Alto Auténtico’s mentorship program connects junior and senior Latinx team members for coaching sessions and professional development. The group is also working with Alto’s operations, product, and marketing teams to establish a bilingual team to better support Spanish-speaking individuals using our pharmacy services across our communities.

Proud unites LGBTQ+ Altoids and allies in creating an environment where all Altoids can be their most authentic selves. The group has led Alto in celebrating important LGBTQ+ awareness days with events such as drag queen bingo nights for Pride and LGBTQ+ history month. Two Proud members who identify as bisexual gave a talk for Bi Visibility Day on September 23 and also shared their experiences of coming out in in observance of National Coming Out Day on October 11.

Proud also invites experts to speak at Alto about a range of LGBTQ+ issues. They recently hosted a session with Chris Tompkins, author of Raising LGBTQ Allies: A Parent’s Guide to Changing the Message from the Playground, and a fireside chat with Dr. Lisa Capaldini, who has focused on HIV since the beginning of the epidemic.

Women of Alto + Allies (WOAA) helps create an inclusive community for women at Alto with mentorship and networking opportunities that advance their leadership potential. Their newly launched initiative, WOAA Project Spotlight, celebrates female-identifying team members who have helped us deliver on our mission while living our values, and a quarterly webinar series shares how various self-identifying Altoid women launched their careers.

Working Parents + Allies facilitates discussion and collaboration in celebration of our working parents. The ERG has led Alto in supporting working parents with a variety of initiatives, including a community event with the Kids & Art Foundation’s Purvi Shah in honor of Bereaved Parents Month this July; an “Ask a Parent Anything” Slack advice hotline for parents, caretakers, and allies; and free access to Outschool’s live online classes for kids ages 3-18.

And with their second annual Holiday Giveback Program, which donates gifts to kids and families in need through Marine Toys for Tots and the Boys & Girls Club of America, Working Parents + Allies is an example of how our ERGs look for opportunities to give back and show support beyond the immediate Alto community.

During Asian American Pacific Islander month, the Asians ERG shared resources for individuals like Modern Health's Healing Asian Communities Circles and highlighted community groups for volunteerism and donations.

To learn more about any of our employee resource groups, contact the emails below.

Women of Alto + Allies: womensERG@alto.com

Working Parents & Allies: parents@alto.com

Visit alto.com/careers to learn more about our open roles and join us in delivering industry-leading pharmacy care.

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.

When engineering incidents happen, typical deployment pipelines are just too slow—especially if customers’ medications are on the line. Here’s the speedier rollback process we use at Alto Pharmacy to ship fixes in 3 minutes, flat.

How Alto Reduced Time to Resolution for Production Incidents

Production incidents caused by newly-merged code happen to us all. When they do, most engineering organizations discuss the root cause and how to prevent similar incidents in the future. At Alto, we evaluate two additional metrics:

Time to detection: How quickly did we know something was wrong?

Time to resolution: How quickly did we restore service?

Time to resolution is especially critical for us as a pharmacy, where a long-running incident could block a user from getting their medication on time.

Over 30 times a day, an engineer at Alto hits the merge button, deploying a new build to production. Our well-automated CI/CD pipeline, built by our Infrastructure team, handles the 3-step deployment process:

1. Build: install Ruby & JavaScript dependencies

The average runtime for our standard deployment pipeline is 30 minutes—reasonable for a CI/CD pipeline, but too long when shipping a fix for a production incident.

We introduced a “hotfix” workflow as a first pass at an expedited deployment pipeline for incident response. A hotfix is a commit that introduces new code to address the incident by either removing or reverting the buggy code that introduced the issue in the first place or by shipping new code that fixes the initial issue. 

The hotfix deployment pipeline reduces incident time to resolution by triggering a specific CI job that removes the test step from our standard pipeline, reducing the workflow to just the Build and Deploy steps.

Implementing a hotfix pipeline on top of our standard pipeline in CircleCI was relatively simple—in our `.circleci/config.yml`, any part of our CI workflow that should be skipped in case of a hotfix runs a job called “early_exit_if_hotfix” that will skip the current step if the last commit message of the code being built includes the keyword “[hotfix]”.

early_exit_if_hotfix:
    steps:
      - run:
          name: Early exit if hotfix
          command: |
            git_commit_message=$(git log --format=%B -n 1)
            if [[ $git_commit_message =~ "Merge pull request #" ]]; then
              echo "This is a merge commit. Checking if this is a hotfix deploy"
              git_commit_sha=$(git log --format=%H -n 1)
              git_commit_message=$(git log --format=%B $git_commit_sha^-)
            fi
            if [[ $git_commit_message =~ "[hotfix]" ]]; then
              echo "exiting early for hotfix deploy"
              circleci-agent step halt
            fi
            echo "not a hotfix deploy, continuing"

run_ruby_tests:
  steps:
early_exit_if_hotfix
run_tests

The hotfix workflow reduces time to ship a resolution, once we identify the fix, from 30 minutes to ~18 minutes. It’s faster than our standard pipeline but still requires considerable hands-on work from the engineer performing the hotfix.

To further speed up deployment and reduce manual work, we introduced a workflow that simply rolls back to a previously-built healthy deployment image. In this workflow, the entire pipeline is reduced to just the Deploy step.

To invoke a rollback, an engineer commits a message with the keyword “[rollback]”, followed by the SHA of the commit to rollback to. Similar to the hotfix approach, any build step that should be skipped during a rollback checks the commit message for the “[rollback]” keyword before running:

early_exit_if_rollback:
    steps:
      - run:
          name: Early exit if rollback
          command: |
            git_commit_message=$(git log --format=%B -n 1)
            if [[ $git_commit_message =~ "Merge pull request #" ]]; then
              echo "This is a merge commit. Checking for rollback sha..."
              git_commit_sha=$(git log --format=%H -n 1)
              git_commit_message=$(git log --format=%B $git_commit_sha^-)
            fi
            if [[ $git_commit_message =~ "[rollback]" ]]; then
              echo "exiting early for rollback deploy"
              circleci-agent step halt
            fi
            echo "not a rollback deploy, continuing"

run_ruby_tests:
  steps:
early_exit_if_hotfix
early_exit_if_rollback
run_tests

The rollback workflow looks for a build matching the specified SHA and posts a confirmation message for the engineer, then deploys that build to production. The rollback approach dropped our time to resolution even further, from 30 minutes to ~3 minutes.

There are three edge cases that we’ve also baked into our rollback workflow: potentially stale images, database migrations, and blocking new merges and deployments.

Our script has a special block warning the engineer if a target image is older than an hour. The older the image, the riskier the rollback, as the delta between the image and the latest commit on main is larger.

time_rollback=$(git show -s --format=%ct ${rollback_revision})
time_now=$(date '+%s')
if [ $(($time_now - $time_rollback)) -gt 3600 ]; then
    message="${message}\n\n:warning:The rollback commit is more than an hour old."
    message="${message}\nThe [hotfix workflow](https://www.notion.so/alto/Deploying-a-Hotfix-Rolling-Forward-bb8e9cea05b44c67a64e23ae652653b6) might be a better candidate for this deployment."
fi

We also want to warn engineers if any database migrations have occurred between the current image and the target by checking the diff of the db/migrate directory. Rolling back application code without applying changes to the database can result in the database and application code becoming out of sync, resulting in further problems. Our script will warn engineers if a migration has been detected between the current and target image and provide instructions on how to rollback migrations if required.

Because a rollback deploys an image that’s older than our latest build, we also need to block continuous deployment until we’ve restored the main branch to a safe state — typically by deploying a hotfix as soon as we can identify an appropriate fix. We accomplish this using a Github issue with a specific tag that, when open, triggers a job causing any active CI job to fail. After the incident is resolved, the incident manager closes the issue, which will retrigger the blocked jobs and resume the normal build and deploy workflow.

The expedited rollback process has reduced our overall time to ship a resolution for incidents down to a speedy 3 minutes—a valuable improvement for our internal operations users, as well as for our customers and healthcare providers who rely on Alto’s service to get prescriptions filled. Branching these incident response workflows off of our existing standard deploy pipeline keeps the maintenance cost low for our infrastructure team, and robust automation reduces the risk of manual error for our product engineers when they need to invoke these workflows.

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

If you are considering freezing your eggs, it’s important to take the financial aspects of treatment into account. Here are our top financial planning tips and resources to support your egg freezing journey.

A Financial Planning Guide for Egg Freezing

Egg freezing — a fertility preservation treatment that allows you to freeze unfertilized eggs and store them for later use — has allowed millions of individuals to leave open the possibility of having children in the future and experience more flexibility in their family-planning timelines.

If you are considering freezing your eggs, it’s important to take the financial aspects of treatment into account. While it’s true that egg freezing is a significant investment of time and resources, there are many options for managing or lowering the costs of treatment so that you can move forward with the process. Here are our top financial planning tips and resources to support your egg freezing journey.

Before you can determine how to pay for egg freezing, it’s important to have a sense of the total cost. Keep in mind that egg freezing expenses are ongoing. In the short term, you are accounting for fertility medications and the egg freezing cycle (or cycles). These costs vary from one individual to another, as your reproductive health — including the number of eggs in your ovarian reserve — will inform your individual medication protocol and the number of cycles needed to retrieve your target number of eggs.

Long-term egg freezing expenses include the cost of storing your eggs and in vitro fertilization (IVF) — the process of thawing your eggs, fertilizing them with sperm, and having them placed into your uterus through a non-surgical procedure — if you decide to use them in the future. The length of time that you store your eggs will impact the overall cost. 

You may not be able to accurately predict all of these variables in advance, but identifying your longer-term reproductive goals and mapping out a vision can help you prepare as much as possible for the total investment. Setting up a consultation with a fertility clinic can be a good first step toward getting the information you need about your reproductive health to plan accordingly. The cost of a consultation typically ranges from $250-500, and clinics typically list these fees on their website or can provide specific information over the phone.

Savings and support from family and friends

Depending on your individual circumstances, you may have money in a savings account that you can use for part of your egg freezing expenses. If you have questions about getting started with a savings account, a financial planner or a budgeting tool like NerdWallet, Mint or Savology can help you determine how much money you may need to seek through grants, loans, and other resources.

You may also have family or friends who are able to contribute. If you are comfortable sharing your egg freezing experience with others, consider using fundraising websites like GoFundMe to reach out to your extended network for donations.

Health insurance coverage and workplace benefits

Some health insurance plans offer partial or full coverage of egg freezing-related costs including medications and IVF. Note that most insurance plans have separate medical and pharmacy benefits. In most cases, professional services provided by your doctor or clinic will fall under medical benefits. Fertility medications will likely fall under pharmacy benefits, though in some cases they may fall under your medical benefits.

If you have a health savings account (HSA) or a flexible spending account (FSA) — two types of pre-tax accounts you can use for healthcare expenses — consider planning ahead to use these accounts to reduce the total cost of your fertility treatments and your taxable income.

In addition, some employers offer egg freezing coverage as part of their employee benefits, separate from your health insurance plan. Do not be discouraged if you learn that your employer doesn’t currently cover egg freezing: employers who offer fertility coverage often do so in response to an employee’s request. RESOLVE: The National Infertility Association, a nonprofit that supports individuals and couples affected by infertility, has resources to help you start a conversation with your employer about fertility coverage benefits.

Your total egg freezing expenses also depend on your choice of fertility clinic. Most clinics can share the total out of pocket costs for egg freezing if you do not have any insurance coverage. As you explore your options, call various clinics to ask about costs with a list of questions prepared in advance. Here are examples of questions to ask:

Based on my specific treatment plan, what is the typical all-inclusive cost?

What is included in the treatment cost and what is not?

Can you provide a detailed list of procedures and costs?

What is the typical cost of fertility medications for my treatment plan?

You may also want to ask if they will store eggs for up to a year as part of the cost of an IVF cycle, which is a common practice at many clinics.

In addition, some fertility clinics offer no- or low-interest payment plans. During your search, ask various clinics about any available financial assistance.

Many individuals and couples fund a portion of their egg freezing expenses through a personal loan. There are companies that provide loans for fertility treatments, with flexible monthly payment options, including Lending Club and CapExMD. Some lenders focus exclusively on fertility, including Origin Finance, and can lend enough to cover the entire cost of the treatment, with plans starting around $250/ month. (Great news: the Origin application fee is waived for Alto customers!)

Regardless of which lender you choose, verify the interest rate and any other fees. Many of these companies have budgeting tools on their websites so that you can get a sense of what your monthly payments will be before you decide to take out a loan.

In addition, many companies and organizations offer grants that help cover a portion of fertility treatment costs. Some are based on income level and demonstrated financial need while others are designed to support specific groups including members of the LGBTQ+ community and people of color.

Fertility for Colored Girls (FFCG) offers grants for Black women and couples.

Men Having Babies, which supports gay men and couples in starting their families through surrogacy, offers income-based cash grants through the Gay Parenting Assistance Program. (If you are starting a family as a gay man, your path to parenthood will likely include an egg donor and IVF but not necessarily egg freezing.) In addition, Family Equality has a list of family-building grants that help LGBTQ+ families afford fertility treatment.

You can also search for additional grant opportunities through RESOLVE.

In addition to applying the loans or grants mentioned above toward your fertility medication expenses, some fertility medication manufacturers offer patient assistance programs in partnership with fertility clinics to further alleviate these expenses.

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

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

Read our previous blog to learn more about EMD Serono's financial assistance programs and how to apply.

Your choice of fertility pharmacy matters

There’s one more factor that can significantly impact the cost of your fertility medications: your choice of fertility pharmacy partner.

Alto is committed to your financial well-being alongside your physical health. To help you save as much as possible on your fertility medications, we’ll automatically search for and apply any savings, as well as connect you with any outside programs that require you to apply directly.

We know that managing the costs of egg freezing is just one part of your fertility journey, and we’re here to make the process as easy as possible. We offer free same-day delivery of your medications, with discreet packaging, and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

If you’re interested in learning more about how Alto can support your fertility treatment, you can request a price quote online. 

We’re excited to welcome Ramiah Martin to Alto as Vice President, Operations & Supply Chain. Here’s more on what drew him to Alto and the opportunities he’s most excited about, in his own words. 

Meet Ramiah Martin, VP, Operations & Supply Chain

We’re excited to welcome Ramiah Martin to Alto as Vice President, Operations & Supply Chain. Prior to joining Alto, Ramiah was Senior Director of Operations at Amazon, where he developed the strategic vision for the company’s operations and led a cross-functional team in implementing new processes and technologies to streamline use of resources.

His dedication to continually improving the customer experience is matched by a passion for healthcare change, and we could not be more thrilled to have Ramiah on the team. Here’s more on what drew him to Alto and the opportunities he’s most excited about, in his own words. 

Welcome to Alto! What inspired you to join the team?

When I first learned about Alto, its mission and values stood out to me first and foremost. I immediately felt a strong connection with the company’s mission of improving the quality of people’s lives through medicine and its commitment to putting customers first.

I was compelled by the opportunity to truly make a positive impact and help transform an industry that is both in need of improvement and slow to evolve. Through my previous experiences in operations management at Amazon and UPS, I know that streamlined processes can have a massive impact on a company’s results. At Alto, all of those efforts to innovate and maximize efficiency are in the service of driving broader change within pharmacy and healthcare.

I also appreciated that Alto is intentional about investing in talent representative of the communities we serve. As we continue to grow, and our customer base diversifies, it’s critical to have that diversity represented in the people building our new model for pharmacy care.

What is the focus of your role and what opportunities are you excited about?

As Vice President of Operations & Supply Chain, I’m focused on creating a scalable and sustainable organization, ensuring that as we grow, we continue to deliver an exceptional experience for our customers.

We have a great opportunity to ensure that individuals who have been historically underserved by medicine receive the standard of care that they deserve. I believe in the product — we make it as simple as possible to manage your health and learn more about medication and pricing, and our customers’ medication adherence rates are far above industry standards. I know there’s a lot more we can accomplish, and it’s a privilege to lead a team that’s united by a bold vision for healthcare.

I love movies, except for horror (Michael Jackson's “Thriller” video and Children of the Corn scarred me). I will go to the movies by myself as long as I have my Cherry Coke. It’s my way of shutting off my brain for an hour or two and relaxing.

You can find more information about Ramiah or connect with him directly on LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

October is American Pharmacist Month, a time to celebrate the critical role that pharmacists and pharmacy technicians play within healthcare.

Celebrating American Pharmacist Month At Alto

October just might be our favorite month of the year, and for a good reason: it’s American Pharmacist Month, a time to celebrate the critical role that pharmacists and pharmacy technicians play within healthcare.

Pharmacists are one of the most accessible healthcare professionals, seeing people 5 to 8 times more frequently per year than primary care providers. And as such, they are integral to your overall health and well-being. 

You may not realize all the responsibilities that a pharmacist’s role encompasses. In addition to filling your prescriptions, they also educate on medication usage, advocate for changes that improve care, and problem solve clinical, ethical, managerial, economic, and legal compliance issues, becoming a trusted resource to the individuals they care for. Extensive training and education are required to enter the profession: a pharmacist must earn a doctorate in Pharmacy and complete state-specific licensing requirements before becoming licensed to practice pharmacy.

At many traditional retail pharmacies, each pharmacist is expected to tackle a broad assortment of tasks that often leave them feeling overwhelmed and stressed, like managing transactions for customers, answering questions about where non-pharmacy items are stocked, and contacting insurance companies on top of ensuring prescriptions are dispensed properly and safely. At Alto, however, pharmacists align with one of several practice areas — fulfillment, customer care, and onboarding — so that they are able to focus on specific aspects of pharmacist practice and deliver exceptional care to Alto’s customers.

Fulfillment pharmacists are responsible for inventory management, medication preparation, physical quality checks, and dispensing, all to make sure the right medication arrives at your door, on schedule. Our customer care pharmacists review prescriptions for accuracy and for potential complications with other medications on file; provide individualized consultations on dosing, side effects and other concerns; and partner with healthcare providers on clinical recommendations. And our onboarding pharmacists — a relatively new role at Alto — are a bridge to an individual's broader team, supporting healthcare providers and ensuring continuity of care between prescriber and pharmacy.

“At Alto, we are proud of our customer-focused services and forward-thinking means of providing those services,” shares Ashley Lee, Onboarding Pharmacist. “Being a pharmacist at Alto gives me the unique opportunity to not only practice patient care, but also to design it to be meaningful to as many individuals in need as possible. The innovation never stops here at Alto.”

How Alto pharmacists serve our communities

There’s no shortage of opportunities for a pharmacist to support an individual with their medication needs or to be a partner in their health journey alongside their doctor’s office, family and other support networks. Here are just a few of the many roles that Alto pharmacists fulfill.

Literally. Our pharmacists are educators who mentor other pharmacists-in-training. Sandra Aziz, Pharmacy Compliance Program and Training Manager, is responsible for training new Pharmacy Managers and Supervisors at our dispensing sites, ensuring they have the resources needed to be effective managers and to oversee their pharmacy location’s compliance program and daily operations.

Sandra also manages our internship programs for pharmacy students. Alto offers an immersive 10-week Pharmacy Operations Management summer internship program for eligible students at Howard University’s School of Pharmacy (HUCOP). The program provides an opportunity to gain a breadth of experience across clinical pharmacy care, operations, and business development. Students also have the opportunity to actively influence Alto’s software development and implement ideas that further preventative healthcare and pharmacist involvement in community health.

Sandra also launched our Introductory Pharmacy Practice Experiences (IPPE) and Advanced Pharmacy Practice Experiences (APPE) programs, which allow students from pharmacy schools across the country to select Alto as a practice site. While at Alto, they are exposed to highly skilled and entrepreneurial pharmacists, engineers, and operations experts with whom they can partner to challenge, reinvent, and improve pharmacy. 

“It’s been really rewarding to see more pharmacy students expressing interest in our programs,” Sandra said. “We have a rare opportunity to give students an experiential learning experience that you won’t find at any other pharmacy. At Alto, our pharmacists work cross-functionally across operations, engineering, and design to build a better, more intuitive community pharmacy from the ground up. We focus on challenges faced by patients, providers, and payers, and find solutions that optimize experience, transparency, and health outcomes.”

Read our previous post, 'From Pharmacist to Professor: Sandra Aziz Spotlight'.

They’re also here to teach you! Our pharmacists are happy to chat on the phone for however long you need to offer individualized support. Many customers use these one-on-one consultations to learn how to give themselves injections as part of fertility treatment or diabetes management or to confirm special storage or dosing instructions, but our pharmacists are happy to share their expertise on any question related to your prescriptions or health needs.

For example, did you know that our pharmacists are experts on managing side effects? As a bridge between you and your doctor, our pharmacists review all of your current medications to identify any potential symptoms or medication interactions, and they’re available to talk through any questions or concerns.

Lawmakers in several states have recognized the accessibility of pharmacists and their potential to play an even larger role in healthcare, specifically in the HIV prevention space. California became the first state to allow pharmacists to prescribe HIV prevention medication like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in 2019, and Colorado became the second in November 2020. 

“As healthcare providers in the community, there is a big opportunity for us as pharmacists to play a critical role in HIV prevention and help increase accessibility to medications like PrEP and PEP,” explains Susan Sun, Specialty Pharmacist. “It’s been wonderful to see growing recognition of a pharmacist’s impact even outside of the healthcare community, and the recent legislation that allows pharmacists to prescribe in some states is just a start. It’s a privilege for pharmacists to be a part of these exciting changes and make HIV prevention easier for others.”

In honor of American Pharmacist Month, we’d like to say a big and heartfelt thank you to our incredible team of 175+ pharmacists. Each of you plays a critical role in the wellbeing of our customers, the strength of our provider relationships and the quality of our service — we’re grateful for your hard work all year long. 

Here are just a few of the faces responsible for providing exceptional pharmacist care at Alto!

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

We’re excited to welcome Christopher Tidball to the Alto team as Director of Product Management, Supply Chain & Fulfillment. Learn more about his passions both in and outside of work and what drew him to Alto.

Introducing Christopher Tidball, Director of Product Management - Supply Chain & Fulfillment

We’re excited to welcome Christopher Tidball to the Alto team as Director of Product Management, Supply Chain & Fulfillment. Most recently, Christopher led a large team of product managers, engineers and program managers at Amazon to power the company’s most complex fulfillment operations. 

As Alto continues to expand our geographic footprint and customer base, Christopher’s nearly 20 years of industry experience will support us in scaling our systems, so that we can continue to deliver the same high standards of care and service to even more communities.

We recently sat down with Christopher to learn more about his passions both in and outside of work, what drew him to Alto, and the operational opportunities he’s most excited about. 

Before a recruiter ever reached out to me about a role at Alto, my wife and I were very satisfied customers. We had been on a long journey of trying to start a family, and that ultimately led us to a fertility clinic that recommended Alto. We had a great experience from day one: the app was easy to use, the same-day deliveries from couriers were always on time, and Alto’s pharmacists walked us through the various medications in our delivery and answered all of our questions. 

Alto’s focus on the customer experience was immediately clear, and I made a mental note that this was the type of company I’d like to work for. Fast forward a few months later, a recruiter reached out and introduced me to the leadership team whose passion and experience sold me on leaving Amazon to come here.

As the Director of Product Management - Supply Chain and Fulfillment, I'll focus on the technology investments that can help us continue to grow and offer exceptional service to our customers. “Supply chain” covers a lot of ground: procurement, inventory, pharmacy operations, delivery, and more. There are tons of opportunities to automate processes to make it easier for Altoids to run the business, especially as we grow and expand. 

What areas of the business are you most excited about?

The operations side has always been exciting to me—it's where the magic happens. At the end of the day, if we don't have sustainable, efficient ways to fulfill the promises we make to our customers, we won't survive. 

Alto has a great business model, and many happy customers to show for it, but there’s always room to continue to innovate and improve the delivery experience. It's one of the few in-person interactions we have with the customer and we want to make it exceptional.

Tell us about life outside of Alto. Are you doing anything interesting at the moment?

I'm a pilot in training — I'm about 75% of the way to getting my single-engine license. I live in Seattle so the aerial views of the city, Puget Sound, and the Cascade Mountains are absolutely breathtaking. Flying gives you a sense of freedom that reminds me of when I first got my driver's license.

You can find more information about Christopher or connect with him directly on LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

Insulin pumps have become increasingly widespread in diabetes treatment in recent years due to their convenience and ease of use. Read on for more information about these devices.

The Role of Insulin Pumps in Diabetes Treatment

Both type 1 and type 2 diabetes involve complications with the body’s production of insulin, a hormone produced in the pancreas that converts sugar into energy. People living with type 1 diabetes do not produce any insulin at all, so they have to take insulin every day to keep their blood sugar levels in a healthy range.

Insulin therapy may also play a role in managing type 2 diabetes, since individuals with the condition do not produce a sufficient amount of insulin to regulate blood sugar levels. However, some individuals with early-stage type 2 diabetes are able to manage their blood sugar with other medications and healthy lifestyle habits — make sure to consult with your doctor on the best course of treatment given your needs.

There are several methods available for delivering insulin into the body, including syringes,  insulin pumps, and pens. Insulin pumps have become increasingly widespread in diabetes treatment in recent years due to their convenience and ease of use.

There are a variety of insulin pump options to choose from. Read on for more information about these devices.

What is an insulin pump and how does it work?

An insulin pump is a small electronic device that delivers doses of insulin at specific times. It mimics the activities of a normally functioning pancreas by delivering small, continuous doses of insulin throughout the day and surges of insulin while you eat. You set the schedule, and it is easy to make adjustments if your dosage changes or if you eat or exercise more than usual on any given day.

While an insulin pump’s consistent delivery of insulin is effective in keeping your blood sugar levels within a healthy range, it is still important to check your blood sugar throughout the day using either a blood glucose meter or a continuous glucose monitor (CGM). Some newer insulin pumps are connected to a CGM, which allows for both automated glucose monitoring and insulin delivery.

Many people who use insulin pumps find them to be more convenient than insulin injections, particularly while on the go. Insulin pumps offer the flexibility to work, socialize, or engage in just about any other activity without stepping aside to give yourself an insulin injection. And their automated, adjustable delivery makes it simple to maintain healthy blood sugar levels: not only do you not have to worry about missing a dose, but you can easily add, remove or modify a dose depending on your calorie intake and level of physical activity.

Most insulin pumps are designed to store dosing data, so you and your doctor’s office will have easy access to details about your insulin regimen should you need to make any adjustments to your treatment plan. 

Depending on the type of insulin pump you have, the device may be able to streamline other aspects of diabetes management. In addition to the automated blood sugar readings offered by CGM-connected pumps, some pumps have tools to help with carbohydrate counting. (Monitoring how many carbohydrates you consume is an important aspect of diabetes management as they increase your blood sugar, and your daily insulin dosage depends on your insulin-to-carb ratio.)

Insulin pumps deliver very precise doses of insulin, so there is a low risk of complications. However, it’s important to make sure you know how to properly set up your pump and to continually monitor your blood sugar levels. Your doctor or a diabetes educator can help you get started.

Choosing between an insulin pump and other delivery methods is ultimately a matter of personal preference, but they are often a good fit for children and anyone who has had difficulty remembering the timing of their insulin injections. You may also want to consider using an insulin pump if you absorb food slowly or if you often experience low blood sugar as a result of insulin use (also referred to as an insulin reaction or hypoglycemia). Consult with your doctor to choose the best insulin delivery method for your individual health needs.

Many women who are pregnant or trying to conceive also benefit from the consistent and precise delivery of an insulin pump, as blood sugar management is especially critical while your baby’s major organs develop. If you are pregnant or thinking of becoming pregnant, you may want to ask your doctor if an insulin pump is right for you.

There are two main types of insulin pumps: tubed insulin pumps (sometimes referred to as traditional insulin pumps) and insulin patch pumps. Tubed insulin pumps deliver insulin from a delivery chamber — in this case a container located within the pump — into a tube inserted beneath your skin, usually on the abdomen. (A healthcare professional like your doctor or a diabetes educator can show you how to insert the tubing.) Manufacturers of commonly used tubed insulin pumps include Medtronic and Tandem®.

Insulin patch pumps combine the delivery chamber and tube into a single “pod” placed on your skin with an adhesive patch. Insulin patch pumps do not have any external tubing and are controlled wirelessly. Commonly used patch pumps include Omnipod® and V-Go®.

You can put a tubed insulin pump in your pocket, on your belt, or attach it to a strap beneath your clothes. Insulin patch pumps are most commonly placed directly on your stomach or arm. Both types of insulin pumps require you to change the tubing or pods every one to three days. A diabetes educator or healthcare provider can answer any questions and help you become more comfortable using the device.

What to consider when deciding to use an insulin pump

When talking to your doctor, here are some considerations that may help you determine if an insulin pump is the most convenient way to manage your blood sugar, or your child’s.

An insulin pump may feel slightly more complex than injections, as it involves frequent interactions with technology. Your diabetes care team can help you become more comfortable with the device.

You will need to verify which type of pump(s) your insurance plan covers and decide if those options are the right fit for your needs and budget.

Blog

How to Take Action for World AIDS Day 2021

Celebrating National ERG Day at Alto

Introducing Alto Connect

How Alto Reduced Time to Resolution for Production Incidents

A Financial Planning Guide for Egg Freezing

Meet Ramiah Martin, VP, Operations & Supply Chain

Celebrating American Pharmacist Month At Alto

Introducing Christopher Tidball, Director of Product Management - Supply Chain & Fulfillment

The Role of Insulin Pumps in Diabetes Treatment

National Gay Men's HIV/AIDS Awareness Day

What to know about RESOLVE: The National Infertility Association

Get to Know the Team That Has Doctors Calling Alto “The Pharmacy of The Future”

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