Download ABBY ALPERT

ABBY ALPERT
RAND Corporation
1776 Main Street
Santa Monica, CA 90401
(310) 393-0411 ext. 6745
[email protected]
EDUCATION
Ph.D. Economics, University of Maryland, 2011
Committee: Mark Duggan (Co-Chair), Judith K. Hellerstein (Co-Chair), Raymond Guiteras
B.S. Mathematics and Economics, University of Chicago, 2003
EMPLOYMENT
Associate Economist, RAND Corporation, 2011- present
FIELDS OF SPECIALIZATION
Primary: Health Economics, Public Economics
Secondary: Labor Economics, Applied Econometrics
PUBLICATIONS AND WORKING PAPERS
“The Anticipatory Effects of Medicare Part D on Drug Utilization”
“Perverse Reverse Price Competition: Average Wholesale Prices and Medicaid Pharmaceutical
Spending” (with Mark Duggan and Judith Hellerstein), Revise and Resubmit at Journal
of Public Economics
“Estimating Intensive and Extensive Tax Responsiveness: Do Older Workers Respond to
Income Taxes?” (with David Powell)
“Technology, Monopoly, and the Decline of the Viatical Settlements Industry.” 2005. NBER
Working Paper No. 11164. (with Neeraj Sood and Jay Bhattacharya)
“A Socioeconomic Profile of Older Adults with HIV.” 2005. Journal of Health Care for the
Poor and Underserved, 16: pp 19-28. (with Geoffrey Joyce, Dana Goldman, Arleen
Leibowitz, and Yuhua Bao)
“Should California Regulate Health Insurance Premiums?” 2004. California Health Care
Foundation. (with Neeraj Sood, Dana Goldman, and Mary Vaiana)
“Societal perspective: comment.” 2006. Chapter 28 in Futerman, A. and Zimran, A. eds,
Gaucher Disease, pp 489-497. CRC Press. (with Alan Garber and Dana Goldman)
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TEACHING EXPERIENCE
Teaching Assistant, Empirical Microeconomics (Graduate), UMD, Spring 2008, Fall 2008
Instructor, Labor Economics (Undergraduate), UMD, Summer 2008, 2009, 2010
OTHER PROFESSIONAL EXPERIENCE
Research Assistant, Mark Duggan, UMD, 2007, 2009 – 2010
Research Assistant, John Haltiwanger and Seth Sanders, Census Bureau, LEHD, 2007
Research Assistant, Seth Sanders, UMD, 2005 – 2007
Research Assistant, RAND Corporation, Health Economics Group, 2003 – 2005
Summer Internship, Agency for Healthcare Research and Quality (AHRQ), 2002
GRANTS AND FELLOWSHIPS
Co-Investigator. National Cancer Institute R21. “The Welfare Consequences of Oncology Drug
Shortages” (PI: Mireille Jacobson), 2013-2015.
Co-PI. National Institute on Aging P30. “How Do Large Wealth Shocks Affect Retirement
Behavior?” (Co-PI: David Powell), 2012-2013.
Co-PI. Department of Defense. “Factors Affecting Utilization of DoD’s Unemployment
Compensation for Ex-Servicemembers (UCX) Program” (Co-PI: Paul Heaton), 2012-2013
Bing Center for Health Economics Investment Award, RAND Corporation, 2012
Agency for Healthcare Research and Quality Dissertation Fellowship, 2010 – 2011
Economic Club of Washington Doctoral Research Fellowship, 2010
Maryland Population Research Center, University of Maryland, Trainee, 2006 – 2007
INVITED SEMINARS AND CONFERENCES
2012: Conference of the American Society of Health Economists (University of Minnesota),
Midwest Health Economics Conference (Indiana University-Purdue University Indianapolis),
Southern California Conference in Applied Microeconomics (Claremont McKenna College),
University of California- Riverside, University of Chicago
2011: Colorado School of Public Health, IMPAQ, Mathematica Policy Research, Precision
Health Economics, RAND Corporation, University of Colorado- Denver, University of Georgia,
University of Pittsburgh Graduate School of Public Health, U.S. Treasury Department,
Vanderbilt University
2010: Conference of the American Society of Health Economists (Cornell University),
Congressional Budget Office, University of Maryland
PROFESSIONAL MEMBERSHIPS AND ACTIVITIES
American Economic Association
American Society of Health Economists
Referee: Journal of Public Economics, B.E. Journal of Economic Analysis & Policy, Forum for
Health Economics & Policy
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SELECTED WORKING PAPER ABSTRACTS
“The Anticipatory Effects of Medicare Part D on Drug Utilization”
This paper quantifies the anticipatory effects of the passage of Medicare Part D on prescription
drug utilization. Part D expanded Medicare to include insurance coverage for prescription drugs for the
first time. While the program was implemented in 2006, it had been signed into law two years earlier in
December 2003 as part of the widely publicized Medicare Modernization Act. The advance
announcement of this permanent future price reduction may have induced forward-looking individuals to
change their drug spending before Part D took effect. In a life-cycle demand framework, this pre-reform
utilization response is theoretically ambiguous due to opposing income and intertemporal substitution
effects. In this paper, I estimate the causal utilization response to the announcement of Part D in 2003
using data from the MCBS and MEPS. This contrasts with previous evaluations of Part D, and of drug coinsurance changes more broadly, which have estimated only contemporaneous utilization effects, thus
implicitly assuming a myopic policy response.
My main empirical strategy exploits the predicted differential responses of chronic and acute
drugs to anticipated future prices. Given that acute drugs treat illnesses that are largely unpredictable and
short in duration, their demand is more likely to respond to only current prices, whereas chronic drug use
may respond negatively or positively to anticipated future price reductions. I find evidence of an overall
decline in drug use for Medicare beneficiaries between 2003 and 2005. As predicted, this pre-reform
decline is differentially driven by reductions in chronic drug use, while acute drugs are responsive to only
price changes at the time of program implementation. The effect is also concentrated among the youngest
Medicare beneficiaries, for whom the health costs of delaying treatment are lowest, and for those with
below-median incomes. After accounting for this negative anticipatory response, I find a total treatment
effect on utilization in the first year of the program that is substantially smaller than if anticipation effects
are ignored.
“Perverse Reverse Price Competition: Average Wholesale Prices and Medicaid Pharmaceutical
Spending” (with Mark Duggan and Judith K. Hellerstein)
Generic drugs comprise an increasing share of total prescriptions dispensed in the US, rising from
nearly 50 percent in 1999 to 75 percent in 2009. The generic drug market has typically been viewed as a
mostly competitive market with price approaching marginal costs. However, the large presence of third
party payers as final purchasers may distort prices and market shares relative to what a standard model of
price competition would predict. In this paper, we investigate how generic drug producers compete in the
presence of the procurement rules of the Medicaid program. Medicaid reimbursement to pharmacies, like
that of other payers, is based on a benchmark price called the average wholesale price (AWP), which is
published in several pricing catalogues. This list price is reported by generic producers themselves, and
until recently has been subject to essentially no independent verification. As a result, generic producers
have had an incentive to compete for pharmacy market share by reporting AWPs that are much greater
than actual average prices, as this “spread” leads to larger pharmacy profits. In 2000, after a federal
government audit of actual wholesale prices of generic products, states were advised to reduce Medicaid
reimbursement by as much as 95% for about 400 generic and off-patent injectable, infusion, and
inhalation drug products. We use variation induced by the timing of this policy along with its differential
impact on drug products and states to identify the impact of this exogenous price change on the market
share of affected products. Our findings indicate that pharmacies respond to the perverse incentives of the
Medicaid program by stocking products with the highest AWPs.
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