Headquarters: San Francisco, CA
Alto is America’s leading digital pharmacy, transforming a $500 billion industry. Founded in 2015, Alto’s better pharmacy model is centered on the critical role of pharmacists as the final link in a person’s health journey. Alto combines expert pharmacist care with purpose-built technology to deliver a more convenient and affordable experience for those who need medication. To date, Alto has fulfilled more than four million prescriptions, expanded to thirteen markets, and built a mobile app experience that makes it easier than ever to manage medications and chat with a pharmacist. As Alto continues its rapid growth, it remains customer obsessed, with an industry leading NPS score of 90. Alto’s services include unique technological capabilities in prescription processing, fulfillment, and delivery. Alto provides some of the highest quality and premium services in the industry at the highest efficiency. Alto’s services save providers hours of time on the phone with pharmacies and insurance companies to find affordable treatment options for patients and provide a convenient and seamless delivery experience to the patients.
The pharmaceutical industry, despite its pivotal role in public health and significant financial growth, faces notable inefficiencies and outdated practices that limit its accessibility and efficacy. One glaring inadequacy is the current underutilization of online platforms, with only 1% of the total market being online and 90% of scripts still being picked up at retail stores, despite the industry's colossal size of $450 billion.
This lack of digital adoption has resulted in numerous patient and provider pain points, including inconvenient pharmacy experiences, lack of pricing transparency, and administrative burdens, contributing to $100 billion in medical waste and $300 billion in costs from non-adherence. To improve patient care, adherence, and overall health outcomes, the pharmaceutical industry must urgently adopt digital transformation strategies to streamline operations, increase transparency, and foster a more patient-centric approach.
"One of our biggest insights was pharmacy is not actually eCommerce, it's not a customer store transaction. You have a different person choosing the product, the doctor, a different person paying for the product, the insurance, and a third person getting the product, the patient, and someone has to coordinate between all of these parties for the transaction to actually happen. And no one was really managing any of that coordination and most of that coordination was getting done almost entirely by fax and phone call," said Jamie Karraker.
Alto Pharmacy is addressing the complexities and inefficiencies inherent in the traditional pharmacy model, where patients bear the burden of coordinating various elements of the prescription process. By implementing a digital platform, Alto seeks to streamline the process, automating the backend coordination among doctors, pharmacy benefit managers, and manufacturers, while providing real-time care access and prescription delivery services.
Alto's suite of products, which includes the Alto app, AltoMD, and Wunderbar (PharmacyOS), offers comprehensive solutions for every stakeholder in the value chain. Alto's focus on technological innovation not only enhances prescription order management and delivery, but also offers price transparency, optimizes adherence, and reduces administrative burden, making it an evolving, patient-centric solution in the pharmaceutical space.
Alto’s goal is to simplify the process for patients by developing technology that automates all the backend coordination between physicians, pharmacy benefit managers (PBMs, which act on behalf of insurers), and sometimes manufacturers—from handling prior authorizations to finding coupons that may lower the prescription price to sending the meds out for same-day delivery. After seeing their doctor, all patients need to do is interact with the Alto app (or via text) and receive the prescription at their front door.
Alto solves this opaque and inefficient system by providing prescription price visibility/optimization, real-time care access by phone, text, or app, flexible and fast courier delivery, eliminating 20+ hours per week of back-office time, and core infrastructure to track prescription adherence and patient satisfaction with prescription service.
The Alto app offers a world-class eCommerce-like experience for prescription orders and delivery, fast and friendly customer service, and medication management that increases patient adherence and saves patients money. The Alto app provides: (1) Auto-refills and reminders, (2) Courier delivery, and (3) Price transparency/optimization.
Alto automatically coordinates refills and delivery for users. Users can also use the Alto app to set reminders to take their medications.
Alto hand-delivers users’ medications at the time and location that works best for them. Users also get delivery updates via text, or they can track their courier in real time within the Alto app. Alto will leave users’ medications in a designated safe place for secure, contactless delivery.
Alto’s team searches through their database and locates all coupons, copay cards and manufacturer savings programs for a user’s prescription, and even identifies alternative options that are covered by their insurance when needed.
AltoMD is a web and mobile app for healthcare providers that reduces their pharmacy workload and replaces the status quo black box with real-time visibility to enable better, faster patient care. AltoMD offers providers workflow optimization, benefits coordination, lower administrative burden, increased transparency, real-time communication, and increased patient fill rate and adherence.
Wunderbar is a patient-centric prescription processing, fulfillment, and customer service app that enables Alto’s operations team to support patients and providers.
Wunderbar is the internal technology pharmacists and care teams use to manage their workflows. It also controls the robots that fill every prescription order. Wunderbar was built and continues to be improved in-house, giving Alto a strong foundation to grow and scale.
Alto continues to build on its technology and launched Alto Connect, a mobile app for doctor offices. Alto claims to have been the first pharmacy in the U.S. to introduce a prescriber-focused pharmacy communication platform with the original desktop-based AltoMD product in 2016. Alto Connect is an evolved version of that software. The company also launched Alto Essentials to enable consumers to buy over-the-counter health and wellness products along with their medication delivery orders.
According to CEO Alicia Davis in an interview with The Information, “We have most of our business in the specialty areas, so you think about Fertility, Endocrinology, Cardiac, Pulmonary, that type of more critical care area. And then we also have core medicines that we also focus on.”
Alto’s provider-driven go-to-market strategy drives patient engagement, enabling wallet and margin expansion.
According to Fortune, “Though it’s not alone in its mission to build a business around better serving pharmacy patients, Alto stands apart in its trajectory—the company already hit $1 billion in revenue this year—and in the bold-faced names it has drawn to its cause.”
According to Fierce Healthcare, the company is now in 13 markets and has doubled year-over-year since the company started eight years ago. Alto is focused on continuing its upward growth trajectory, aiming for 100% year-over-year top-line growth and improving its unit economics as it automates pharmacy backend operations. The company is planning to expand into new markets in 2023.
Alto, which is growing fast but not yet profitable, is also still working out the finer points of its business model. It makes money, like other pharmacies, off the margins in selling prescription drugs. It’s also finding places where it can trim costs from its evolving business. In June 2022, the company laid off 9% of its workforce, “mainly in roles focused on back-office function where we have learned how to be a leaner, more efficient team,” according to the company. Alto says it continues to hire aggressively to fill front-line roles. "We've been driving massive progress on our unit economics as we've gotten more scale. Those two factors simply multiply to pipe down to the bottom line and get us closer and closer to full company profitability," said Jamie Karraker, saying Alto is on track to get into the black (profitable) in the next "few years."
Alto also wants to expand its business lines and services on top of its core pharmacy business to connect patients with digital therapeutics.
"There are all these new waves of therapy that are coming onto the market that are showing huge clinical efficacy and potential but they're all struggling with distribution. These digital therapeutic companies are struggling to find the patients that need them the most and get to them and it's costing them tons of money to do distribution. We've already built that distribution channel for physical medication. That's what a pharmacy is. We have this really powerful platform and distribution platform that over time we can leverage to distribute all types of therapy, not just physical medications. That's an important part of our vision as well," said Jamie Karraker.
Alto Pharmacy can leverage its data on hundreds of thousands of patients to help connect digital therapeutics companies with the right doctors and patients who could benefit most from those therapies. As an example, a patient living with diabetes could benefit from using a digital health platform that provides nutritional coaching and meal plans. "We can help connect all the dots and just be a win-win-win for all the players involved," said Co-Founder Jamie Karraker.
"We've created value that, quite honestly, we haven't started monetizing yet," CEO Alicia Davis said, citing the value of Alto's software to streamline the experience for both patients and doctors without needing phones or fax machines.
According to TechCrunch’s Pitchdeck Teardown, Alto sees promising expansion opportunities, potentially enlarging its total addressable market to $800 billion. These include: (1) Prescriptions: $450 billion, (2) Subscription: $13 billio, (3) Over-the-Counter: $65 billion, (4) Telemedicine: $250 billion, (5) Population Health: $24 billion.
In 2022, Alto reportedly considered a merger with a blank-check firm backed by billionaire Alec Gores, according to Bloomberg, but the deal was said to have fallen through in later months.
According to Axios, after a deal last year to acquire patients from digital pharmacy NowRx, which was going out of business, CEO Alicia Davis said Alto is still hunting for more acquisitions. "I think the organic growth is really important, but I also think that there's opportunities for acquisition to really grow and leverage the platform we've built," said CEO Alicia Davis.
In October 2022, Alto Pharmacy was ranked #29 on Fortune’s “Change the World” list. The annual Change the World list highlights companies that are doing well by doing good.
In November 2022, Alto agreed to acquire NowRx’s patient files in California. Terms of the transaction were not disclosed. On November 30, 2022, Alto Pharmacy started providing all prescription delivery and services to NowRx patients in California, ensuring the continuity of the high-quality service that NowRx customers have come to expect. “Alto Pharmacy has a proven track record of excellent customer service and competitive pricing, so we are thrilled that our patients will continue to receive a high level of service going forward. They are in great hands with Alto Pharmacy,” said Cary Breese, CEO of NowRx. At its peak, NowRx operated 8 DEA-licensed micro fulfillment pharmacies spread across the San Francisco Bay Area, Orange County, Los Angeles, and Phoenix with more than 64,000 customers and 487,000 prescriptions successfully delivered.
In November 2022, Alto Pharmacy announced Essentials from Alto. Essentials from Alto is a curated collection of over 50 widely used pharmacy products, conveniently featured in the Alto app. This new offering gives users the option to purchase essential pharmacy items right from their Alto account, from Tums and Tylenol to Covid tests, face masks, and more. This initiative aligns with Alto’s commitment to making it easy for users to prioritize their health and wellness.
In December 2022, Oma Fertility, a full-service fertility clinic that combines AI and robotics in the lab and human-centered care in the clinic, partnered with Alto Pharmacy to enhance the fertility care journey beyond the clinic. Through this partnership, Oma’s patients will benefit from free same-day prescription delivery, cost transparency, and pharmacist access.
In May 2023, Alto Pharmacy secured the #6 spot on CNBC’s 2023 Disrupter 50 list. This annual list recognizes private companies that are chasing some of the market’s biggest opportunities and growing despite a tough capital markets environment and slowing economy.
In October 2023, Alto Pharmacy announced that Jamie Cohen has joined the company as Chief Financial Officer. As Chief Financial Officer, Cohen will lead Alto’s finance function including its accounting, business transformation, contracts, and financial planning & analysis teams. She previously served as Chief Financial Officer at Vacasa, the leading vacation rental management platform in North America, and Angi, a trusted and comprehensive solution for everything home. During those tenures, Cohen played a pivotal role in Angi’s successful 2017 public listing and simultaneous reverse merger of Angie’s List with HomeAdvisor, and later, led Vacasa’s 2021 public listing. Prior to that, she served more than six years at HomeAdvisor, in various finance roles, including as Executive Vice President of Finance & Accounting.
In October 2023, Alto Pharmacy and Mark Cuban Cost Plus Drug Company (Cost Plus Drugs), which offers generic and brand medicines at cost-plus prices, announced that hundreds of low-cost medications are now available for delivery and pickup to Team Cuban Card users in the metros where Alto has pharmacy locations. Cost Plus Drugs is a public-benefit corporation that prioritizes its social mission of improving public health. The company offers more than 1,000 drugs at its actual acquisition cost plus a transparent 15% markup. In April, Cost Plus Drugs launched the Team Cuban Card program, a free prescription benefit with amazingly low prices. Medications through Team Cuban Card are always priced at the Cost Plus Drugs acquisition price, plus 15%, plus a fair dispensing fee to support independent pharmacies.