Carol Dunn is a hunter on the policy and restriction team at MMIT. She finds information on new-to-market drugs on insurer websites, so that health providers can utilize the information to ensure patient access. Dunn tracks down what barriers are in place to these drugs, such as step therapy, specific indications or prior authorizations. That information is then triple-checked by our teams, ending up in the hands of providers who prescribe those new drugs.
What do you do, in your own words?
I’m in the PAR department, and PAR stands for policy and restriction. It’s not a client facing role, but rather, behind the scenes. I go to the controller websites, which are where insurers like UnitedHealthcare and Aetna store their pharmacy data. The information we collect then creates policies for these medications, information like details on what’s required in order to prescribe the medications.
So I’m at the beginning of the market access puzzle. I find [the data] and I pass it on to the policy team, and they go in and assess that everything is correct. Then that information gets put into Analytics, where the providers can find the documents for what they’re looking for.
We have our team meetings every couple of weeks. Our managers will bring us up to speed on anything that’s new that we need to be aware of, like certain FDA indications that are approved for certain drugs, and not for other drugs. As they find out [new information], we find out. The main thing is sharing of information.
What’s your day to day like?
Right now, I am finding new indications for botulism drugs. That’s my project for the next couple of days. I’m looking at four different drugs right now that all came out with new indications For Botox, one of the new indications is called blepharospasm, which is spasms of the eyelids. The other is chronic sialorrhea, which is chronic drooling. I’m going to the controller websites now to look for criteria for Botox that says that insurers will cover it for these two indications.
There are more than 150 different controller sites, so normally a new project like this will take about three days.
What are some of the common challenges of your role?
My drugs, they’re brand new, they’ve just been approved by the FDA and released. And there’s hardly any information to find on them, so you really, really, really have to go hunt deep. It’s really challenging to go in there and find what you can find, because it’s hidden behind the scenes
But if it’s a medical benefit drug — these are drugs that are provider-administered, like intravenously or through injection — they have more stringent requirements and more restrictions to get the drugs. Trying to find that information is tricky. Sometimes I might not find actual criteria, but we might be able to find proof that it is a medical benefit drug, and that’s enough to create a policy to provide to the prescribers.
What’s been your biggest victory with the company so far?
[Most of my projects are] already mapped out for me. When I get assigned these drugs, there’s already a process that’s been put in place by another department that tells me where to go and what to do. And then I might go to the controller sites, but when I get there, I can’t find what I need.
But I like to dig deeper. When I can find reliable resources on my own, things that were not mapped out for me, I submit my findings to the powers-that-be. If it ends up getting approved, that gets incorporated into the official hunting process. When I’m able to find something that wasn’t provided to me, that’s like a “woo-hoo” moment for me.
What changes are you seeing in the industry that clients should be aware of?
A lot of the insurer websites are starting to batten down the hatches. Some of the nice, beautiful websites that we used to be able to use to find data, they’re locking it down. We can only get in there now with special provider portals.
Also, you might go to the website and it might say, ‘This site has formulary data,’ which means it’s where the drug lives, and it might have prior prioritization forms that are needed. But I’ll go in and open up a page, and there’s nothing there. You have to dig deep to make sure that you find it, and see if really does exist. If it doesn’t exist, you give it up.
What do you like about working at MMIT?
The management, upper level management, is just fantastic. They are all employee-driven, and employee-sensitive as far as our welfare and our safety. And they are very accessible. You can go to this director, go to the office and say hello, and sit down and just start talking.
What do you like to do outside of work?
Well, yesterday was my birthday, and I took my first social outing since March! [We] went to Great Adventure Safari Park in New Jersey and saw lions, tigers and bears…oh my!
Life outside of work has pretty much slowed down for me. I am 64 and married 43 years. At this point in my life, I am much more into being with my family and I’m looking forward to times [when] we’ll be able to get together.
Other than that, I really enjoy cooking. And, since the Parx casino is about 30 minutes away, we enjoy occasional trips there.