Investing in Alto — A Pharmacy That Cares

Jonathan Shriftman
3 min readJan 28, 2022


I’m excited to back Alto Pharmacy in their Series E!

Alto is now the leader in America’s rapidly expanding digital pharmacy market.

Yesterday, Alto announced they had raised approximately $200 million in an oversubscribed round led by returning investor Softbank Vision Fund.

Alto was founded in 2015 to fix the broken pharmacy industry. Before Alto, the experience was broken for both patients and providers.

Patients had to deal with inconvenient in-store pharmacy experiences, lack of pricing transparency and affordability, and lack of clear support channels. Providers were challenged with manual processes which cause administrative burden, lack of visibility to patient adherence, and patient dissatisfaction with lead times and refill requests. Even today, according to the company, yearly, around $100b in medical waste is directly tied to the following criteria:

  • 90% of pharmaceutical scripts (prescriptions) are picked up at retail pharmacies
  • 33% of scripts are never picked up
  • The NPS at the largest U.S. pharmacy, CVS, is -5
  • The U.S. is the number 1 country in drug spend per capita

Enter Alto. For patients, Alto feels like a beloved eCommerce brand, not a pharmacy. They have a simple order fill, cart review, and checkout process. Like shopping online, it offers price transparency and automated coupon search; customers always know what their prescription will cost. They provide best-in-class customer service, even in-app messaging for any questions. Alto has built real-time courier and delivery tracking, and finally, smart refill reminders.

For providers, Alto adds value by eliminating 20+ hours per week of back-office time, providing core infrastructure to track prescription adherence, and providing patient satisfaction with the prescription service. The system integrates with providers and insurance for payment processing, rate negotiation, and automatic refills of meds.

In the two years since its series D, Alto has solidified its position as the leader in disrupting the $500 billion retail pharmacy industry, including:

  • Growing revenue to over $700 million annual run rate, up more than 100% in the last 12 months
  • Expanding to 12 markets across the United States
  • Continuing to delight customers, consistently earning a Net Promoter Score of 86, on par with top brands like Tesla and Apple, compared to negative five for the leading retail chain pharmacy

The best part about Alto is this: The most effective intervention a payor/provider can do into a patient’s life to improve their outcome is to make sure they’re taking the right medication, at the right time, or at all. Because of Alto’s patient experience, they keep patients more adherent. Because of Alto’s provider-side software, AltoMD, fills for providers using AltoMD are generally ~7x higher!

It’s tough to compete against giants like CVS, and negotiate with manufacturers, distributors, and PBMs but Alto has such an obvious benefit for patients & Drs. I’m excited to watch them keep more people healthy and adherent.



Jonathan Shriftman

Resident of NYC. Partner at Expanding Capital. Previous founder at @Humin (acq. by Tinder) & @SoleBicycles, and head of BD at Snaps.