Working Papers

The Prescription Drug Paradox: Pipeline Pressure and Rising Prices - Job Market Paper
​(with Anirban Basu)
Under Review 
Link to NBER working paper here. 
Abstract:  Economic literature has extensively studied how prices for incumbent firms respond to competition after entry, especially in prescription drug markets following generic entry. However, less attention has been paid to firm behavior prior to entry. We contribute to this gap in the literature by both developing a model of pricing strategies for incumbent drug manufacturers under health insurance and empirically assessing pricing adjustments for incumbent firms, using the insulin market as a natural experiment. We consider the price strategy of incumbent firms among branded, horizontally-differentiated drugs under tiered insurance, which predicts rising prices for incumbent drugs for a range of elasticities as the likelihood of entry increases. Empirically, we exploit exogenous variation in a potential entrant's completion of clinical trials to identify the effect of drug pipeline pressure on the prices of incumbent drugs. Results suggest that pipeline pressure significantly increases the prices of incumbent drugs, and potential biosimilar entry may drive this effect. 
Flipping the Script: the Effect of Prescription Drug Monitoring Programs on Prescribing Behavior
(with Jevay Grooms and Alberto Ortega)
Under Review 
Abstract: Provider-patient informational gaps make appropriate opioid prescribing difficult. Many states have implemented Prescription Drug Monitoring Programs (PDMPs) to curb the epidemic at a common point of initiation of use, the prescription. We assess the effect of a mandatory query and/or a daily update component of a state's PDMP on specialty-specific opioid prescribing behavior using the Medicare Part D Public Use Files. We find that PDMP characteristics differentially affect prescribing across provider specialty, particularly a program's update frequency.  Our results suggest that policymakers should consider informational asymmetries across the provider spectrum when implementing programs to address opioid prescribing.​
Can Malpractice Pressure Compel a Physician to Relocate?  (with Justin Robertson)
Under Review at Contemporary Economic Policy
Abstract: This analysis measures the effect of malpractice pressure on negative defensive medicine. Existing literature considers the effect of tort reforms on physician supply. However, some avoidance behaviors may not be observable at the aggregate level. Using a panel dataset which follows a random sample of 28,227 family medicine physicians in the United States from 1992-2007, this paper evaluates one of these avoidance behaviors by asking whether changes in malpractice premiums impact a physician’s decision to relocate their practice. Results indicate that group and hospital practice physicians are more likely to relocate to another state when premiums are high compared to solo and partnership practice physicians. Our findings also suggest that even large premium growth has only minor implications on the physician relocation decision. Generally, these results suggest that family medicine physicians do not use relocation as a strategy to avoid malpractice pressure.
"The Clinical and Economic Impact of Washington State's Oral Anticancer Treatment Parity Law"
​(with Anirban Basu)
Abstract: Several states have implemented legislation in recent years to control the rising cost of oral chemotherapy drugs. This study examines the impact of Washington State’s oral chemotherapy parity law on access to cancer treatment options and two aspects of treatment costs, patient out-of-pocket spending and health plan spending. We consider about 22,000 patients with newly diagnosed cancer about 4 years before and 3.5 years after the parity law took effect in 2012 by linking claims and enrollment data to the Washington State SEER cancer registry data. About half of the patients were in fully insured plans that are subject to the parity law (treatment group) and the other half were in self-insured plans that are exempt from the law (control group). Using an interrupted time series approach, we compare changes across these two groups following the implementation of the parity law. The analyses will also investigate differential impacts by type of cancer.

Works in Progress

"The Effect of Police Institutions and Resources on the Use of Force" (with Brian Meehan)

"Not quite a pill mill: effects of PDMPs on overprescribing providers" (with Jevay Grooms and Alberto Ortega)
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"Switching the script: Post-PDMP Pain Prescribing Substitution Effects" (with Jevay Grooms and Alberto Ortega)

"Family Medicine: Malpractice Pressure, Practice Consolidation, Access to Care and Chronic Disease"

“Buffalo Wars: An Economic Analysis of Intertribal Relationships on the Great Plains” (with Bruce Benson)