Dissertation Title: “Evaluating Intended and Unintended Consequences of Health Policy and Regulation in Vulnerable Populations”
The objective of this dissertation is to evaluate whether two different types of policy interventions in the United States are associated with health care utilization and economic outcomes. In Paper 1, I use Medicare and Medicaid claims data to evaluate how an off-label marketing lawsuit and its accompanying media coverage affected utilization and spending on gabapentin as well as other anticonvulsant medications. In this interrupted time series analysis of dual eligible patients with bipolar disorder, we found that the lawsuit and accompanying media coverage corresponded with a decrease in market share of gabapentin, a substitution of newer and expensive anticonvulsants, and a substantial increase in overall spending on anticonvulsants.
Paper 2 investigates whether differences in generosity of Medicaid drug benefits were associated with differential changes in drug utilization and out-of-pocket spending for dual eligibles after they transitioned to Medicare Part D. My finding suggest that those who previously encountered a monthly drug cap prior to Part D implementation experienced a differentially higher increase in annual prescription drug fills compared with those who did not face a cap.
In my third paper, I evaluate whether Part D implementation may have been associated with changes in antidepressant drug utilization for the disabled and elderly Medicare populations. I found that Part D implementation was not associated with a change prevalence of antidepressant treatment for both, but treatment intensity increased following Part D.