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ABBY ALPERT
University of Maryland, Department of Economics
College Park, MD 20742
Phone: (310) 560-6113 Email: [email protected]
Website: http://econweb.umd.edu/~alpert/
EDUCATION
Ph.D. Economics, University of Maryland at College Park, expected May 2011
B.S. Mathematics and Economics, University of Chicago, June 2003
DISSERTATION
Consequences of Publicly Provided Prescription Drug Insurance
Committee: Professor Mark Duggan (Co-Chair), Professor Judith K. Hellerstein (Co-Chair),
Professor Raymond Guiteras
FIELDS OF SPECIALIZATION
Primary: Health Economics, Public Economics
Secondary: Labor Economics, Applied Econometrics
PUBLICATIONS AND PAPERS
“The Anticipatory Effects of Medicare Part D on Drug Utilization,” Job Market Paper.
Presented at the Conference of the American Society of Health Economists, June 2010
“Perverse Reverse Price Competition: Average Wholesale Prices and Medicaid Pharmaceutical
Spending” (with Mark Duggan and Judith Hellerstein), work in progress.
“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)
TEACHING EXPERIENCE
Teaching Assistant, Empirical Microeconomics (Graduate), UMD, Spring 2008, Fall 2008
Instructor, Labor Economics (Undergraduate), UMD, Summer 2008, 2009, 2010
RESEARCH EXPERIENCE
Research Assistant, Prof. Mark Duggan, UMD, Fall 2007, Spring 2009-Summer 2010
Research Assistant, Profs John Haltiwanger and Seth Sanders, Census Bureau, LEHD, Sum. 2007
Research Assistant, Prof. Seth Sanders, UMD, Fall 2005-Spring 2007
Research Assistant, RAND Corporation, Health Economics Group, 2003-2005
Summer Internship, Agency for Healthcare Research and Quality (AHRQ), 2002
AWARDS
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
Abby Alpert – Page 2
REFERENCES
Prof. Mark Duggan University of Maryland [email protected] (301) 405-3532
Prof. Judith K. Hellerstein University of Maryland [email protected] (301) 405-3545
Prof. Raymond Guiteras University of Maryland [email protected] (301) 405-3480
ABSTRACTS
“The Anticipatory Effects of Medicare Part D on Drug Utilization” [Job Market Paper]
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
co-insurance 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) [Work in Progress]
Generic drugs comprise an increasing share of total prescriptions dispensed in the US, rising from
47 percent in 2000 to 63 percent in 2007. 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 third-party reimbursement 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 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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PERSONAL INFORMATION Citizenship: U.S. Gender: Female
