How I decided to step down as CEO

Jamie Karraker is the co-founder and CEO of Alto Pharmacy, a prescription delivery company that he and Mattieu Gamache-Asselin launched in 2015. The company’s grown to almost $1 billion annualized revenue, but Karraker said it still only represents 2% of the pharmacy market. The company believes it found just the right person to take Alto to the next level.

Alicia Boler Davis, a member of Amazon’s S-Team who served as SVP of global customer fulfillment, will become Alto’s CEO on Sept. 1. Karraker said letting her take charge of Alto would maximize its chance of changing the pharmacy industry for the better.

Karraker’s story, as told to Protocol, has been edited for clarity and brevity.

I don't think there was one point where we said, “Oh, now we need a new CEO.” We’re constantly talking to senior executives as potential advisers or board members or candidates for any particular role. And we're always looking for people that we think can complement our own skill sets well and have always been open-minded to what that might mean in terms of a role or a title … It was just so obvious that we needed Alicia on the team and needed her at the helm. It was a little less about it being time for a new CEO and more “Alicia is the right person for us.”

Matt and I have always been not particularly attached to any role or title. And we’re relatively humble about sort of what we're good at and what we're not good at. And the opportunity that we have in front of us and the scale of the opportunity is just getting bigger and bigger. We've come a long way since we started back in 2015.

We're not hiring Alicia because there's a huge problem that needs fixing immediately. We're actually making more progress right now than any other point in the company's history. But it's so obvious to us that if we want to keep getting better, and keep staying ahead of the rest of the pack, it's important to look ahead and hire for the next few years versus for right now.

"It was a little less about it being time for a new CEO and more 'Alicia is the right person for us,'" said Alto Pharmacy co-founder James Karraker on naming Alicia Boler Davis CEO.Photo: Alto Pharmacy

Alicia has an insane amount of leadership experience at the highest levels for really challenging operational problems. She most recently led all of fulfillment for Amazon, which is a team of over 800,000 people reporting up to her, which is a quite massive scale. She was responsible for doubling Amazon's fulfillment network capacity during COVID, which is a pretty insane task to undertake at Amazon's current stage.

I think we've always been able to recruit a bit above and out of our league. And a big part of that in my mind is that it's actually very rare to have an opportunity where you can create tremendous business value. This is a $500 billion market, and completely broken. There's a huge opportunity to fix it and to monetize that and create a valuable, lasting, large business and actually really help people live happier, healthier lives. And I think a lot of experienced executives are looking for more than just a job. They're looking for more than just another opportunity to make money … And that's exciting to some people like Alicia.

Matt and I aren’t going anywhere. We're more committed and optimistic than ever and will be 100% full-time with the company. There is no shortage of important problems to work on. For at least the first six months we'll be focused on helping Alicia get ramped up … After that, we will look at where the biggest gaps are and the biggest opportunities are, and we will go find where we can make the biggest impact. That will then lead to the title, the scope definition.