Department of Policy Analysis and Management
MVR Hall, Room 298
Ithaca, NY 14853
NBER Program Affiliations:
NBER Affiliation: Faculty Research Fellow
Institutional Affiliation: Cornell University
NBER Working Papers and Publications
|February 2020||Drug Firms' Payments and Physicians' Prescribing Behavior in Medicare Part D|
with Ethan M.J. Lieber, Sarah Miller: w26751
In a pervasive but controversial practice, drug firms frequently make monetary or in-kind payments to physicians in the course of promoting prescription drugs. We use a federal database on the universe of such interactions between 2013 and 2015 linked to prescribing behavior in Medicare Part D. We account for the targeting of payments with fixed effects for each physician-drug combination. In an event study, we show that physicians increase prescribing of drugs for which they receive payments in the months just after payment receipt, with no evidence of differential trends between paid and unpaid physicians prior to the payment. Using hand-collected efficacy data on three major therapeutic classes, we show that those receiving payments prescribe lower-quality drugs following payment recei...
|August 2019||How Well Do Doctors Know Their Patients? Evidence from a Mandatory Access Prescription Drug Monitoring Program|
with Thomas C. Buchmueller, Giacomo Meille: w26159
Many opioid control policies target the prescribing behavior of health care providers. In this paper, we study the first comprehensive state-level policy requiring providers to access patients' opioid history before making prescribing decisions. We compare prescribers in Kentucky, which implemented this policy in 2012, to those in a control state, Indiana. Our main difference-in-differences analysis uses the universe of prescriptions filled in the two states to assess how the information provided affected prescribing behavior. As many as forty percent of low-volume opioid prescribers stopped prescribing opioids altogether after the policy was implemented. Among other providers, the major margin of response was to prescribe opioids to approximately sixteen percent fewer patients. While pr...
|October 2018||The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare|
with Sarah Miller, Laura R. Wherry: w25153
Some states that have not adopted the Affordable Care Act (ACA) Medicaid expansions have stated concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries, and can rule out all but very small changes in utilization or spending. These results suggest that the expansions in Medicaid did not impair access to care or utilization for the Medicare population.
|February 2017||The Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare|
with Thomas C. Buchmueller: w23148
The misuse of prescription opioids has become a serious epidemic in the US. In response, states have implemented Prescription Drug Monitoring Programs (PDMPs), which record a patient's opioid prescribing history. While few providers participated in early systems, states have recently begun to require providers to access the PDMP under certain circumstances. We find that "must access" PDMPs significantly reduce measures of misuse in Medicare Part D. In contrast, we find that PDMPs without such provisions have no effect. We find stronger effects when providers are required to access the PDMP under broad circumstances, not only when they are suspicious.
Published: Thomas C. Buchmueller & Colleen Carey, 2018. "The Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare," American Economic Journal: Economic Policy, vol 10(1), pages 77-112. citation courtesy of