501+ employees
251 - 500 engineers
$100m+ funding
Series d

Our mission at Alto is to fulfill medicine’s true purpose—to improve quality of life—for everyone who needs it. We've built a completely new pharmacy experience from the ground up. We use technology and empathy to advance a broken pharmacy industry and make a high-quality healthcare accessible to all. You will build across the breadth of our products — from extending our patient mobile application in React Native to creating new web features on our doctor/patient dashboards to scaling the infrastructure of our in-house pharmacy management system.

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Active Roles

Why join us?

  • Save Lives — Every year in America, there are 125,000 preventable deaths caused by medication non-adherence (that's 5x the number of deaths caused by car accidents). We're lowering that number by making it super simple for patients to order, refill, and receive their medications through technology and same-day free delivery service. Prescription delivery is especially important for elderly or very sick patients who lack the mobility to travel to their local pharmacy.

  • Build the best patient experience — We are completely rethinking how a pharmacy works from the ground up. We've built our own custom software to manage our pharmacy operations and we're using this to automate and improve our processes. This lets us create the best possible patient experience. You can read honest reviews of our patient care on our Yelp page here:

  • Strong engineering team — Our engineering and product team has previously worked at companies like Parse/Facebook, Google, Apple, Tesla, and 23andMe. We were motivated to build Alto because we wanted to work on something that was truly meaningful and improved the lives of normal people. Once we realized that the pharmacy experience was something almost everyone interacts with at some point and it's universally hated, we knew there was a big opportunity.

  • Strong growth — We've been doubling our revenue approximately every 6 months since we started, and we are currently doing over $120M in ARR, in only two geographies - SF and LA. We have a pipeline of over $300M in additional deals waiting for our operational capacity to continue to scale to support the growth.

  • Great company — You will a make direct impact with your code and save patient lives! We also offer awesome office vibes, free lunch/dinner/snacks, apple equipment, standing desks, company social and volunteer events, 99% medical insurance coverage, commuter benefits, PTO, and unlimited sick days.

Engineering at Alto

Engineering team and processes

Our current Engineering Teams


  • Mike McClay, VP of Engineering (Uber, Expedia)

  • Tim Frederick, Director of Engineering (Uber)

Engineering Managers:

  • Amir Ghazvinian (CoFounder of Exec and Interstate Analytics, both went through YC)

  • Elnaz Mosheghian (Lob)

  • Mike Riess (Lumity, Inc.)

  • Nicolas Helvig (internal promotion/Thoughtworks)

Technical Challenges

Simple experience for patients

Providing a simple experience for our patients is key to our success. We’re focused on building out support for complex edge cases and providing relevant info to the patients at the right time, but the real challenge is presenting this complicated stuff to the patient without overwhelming them. We like to use TurboTax as a metaphor: taxes are a super messy process with many branches, but TurboTax walks the user through it one step at a time, holding their hand throughout the process so they don’t get overwhelmed. This is our goal. But of course, the simpler something looks on the outside, the more complex it is on the backend, so we’re focused on building out frameworks in the backend to support this outward simplicity.

Improving clinical outcomes

Our goal is to become more than just a distributor of meds — we want to empower our patients to make the right decisions about their health. If we provide them with the right information at the right time, they’ll have everything they need to choose the right solution. Our data becomes a valuable resource here: by collecting data on how patients’ decisions help or hurt their overall health, we can use what we learn to help future patients make better decisions, and point them towards solutions that they might not be aware of otherwise.


Automation is the core of our product and an ongoing challenge for us. We have lots of interesting technical problems in this area as we work to automate more and more of our internal logistics and operations workflows.

Projects you might work on
  • Fertility Project - The pharmacy is not a one-size fits all product. Using React to improve UI functionality for patients and Rails to simplify complex billing algorithms for providers and Pharmacy Ops, Alto elevates the experience of fertility patients by building specific features on our patient and provider dashboards to cater to their unique needs.

  • React Native Patient App - Building a patient mobile app from scratch in React Native for both iOS and Android, along with the API endpoints to integrate the app with Alto’s backend. This app enables patients to onboard, schedule deliveries, order refills, communicate with their pharmacist, and better understand their medications.

  • Expansion Project - Creating changes across all our backend systems and internal tools with Rails to support operating pharmacies in multiple locations. This includes scaling our codebase for additional zip codes and integrating our software with the physical infrastructure for high volume filling robots and printers.

Tech stack
Ruby on Rails
React Native

Working at Alto

We're a mission-driven company that cares about our patients. Our 6 core company values are:

Patients Come First Leave No Patient Behind Start with Empathy Focus on Impact Think Rigorously Be Humble

Read more here:️-a6a555df1875

Diversity and Inclusion
Connect with our team during your hiring process

As part of our commitment to an inclusive workplace, we are happy to offer prospective engineers the chance to connect with our engineering employees who come from underrepresented backgrounds. It’s a way to get a better sense of our team and what it might be like to work with us.

If you’re interested in connecting with our team, be sure to bring this up during one of our introductory calls!

Perks & benefits
  • Free Food

    Catered lunch by Zesty everyday so you can try different restaurants throughout the city + kitchens stocked with snacks + Philz just around the corner (literally)

  • Beautiful Office

    We're HQ'ed in SF with easy access to public transportation, office bike racks, and free street parking.

  • Health Insurance

    Medical, Dental, & Vision

  • 401(k) Contribution

    401K available, but no match currently (we're hoping this will change in the future!)

  • Generous Vacation

    Take-what-you-need PTO + 12 national holidays off + unlimited sick days

  • Team Activities

    We like each other! We host office events and celebrations, biweekly Pharmaly dinners, volunteer at SF Marin Food Bank, and coffee/tea run to Philz often.

  • Maternal/Paternal Leave
  • Transportation

    Commuter benefits through WageWorks

  • Company Retreats

    Every half we go up to an investors ranch/mansion in Sea Ranch, right on the coast! We spend the weekend cooking and baking gourmet feasts, riding ATVs around the property, and playing games!

  • Relocation

    We offer a minimum of $10,000 for relocation for engineering roles.

  • Dedicated Human Resources team
  • Social impact driven
  • Prioritizes diversity in hiring
  • Flexible Hours
Our Team by the Numbers

Interested in this company?
Skip straight to final-round interviews by applying through Triplebyte.