Nikhil Sharma

I examine regulatory actions taken by Ohio Medicaid targeting spread pricing, in which a Pharmacy Benefit Manager (PBM) bills the payer more for a drug than it reimburses the dispensing pharmacy, retaining the difference. Ohio Medicaid first introduced a payment transparency audit in 2018 and subsequently banned spread pricing in 2019. Using a difference-in-differences design on a coarsened exact-matched sample, complemented by an event-study analysis using synthetic controls, I find that (i) payment transparency reduced Medicaid payer costs and lowered drug-quality risk, (ii) the subsequent spread-pricing ban reversed a substantial portion of the initial cost savings while the overall quality improvement persisted, and (iii) these effects varied across drugs. The findings offer practical insights for other states considering regulation of PBM spread pricing.

This study explores the use of AI-enabled curbside feedback — a novel approach that delivers personalized, non-punitive nudges to households — to improve recycling quality. In a 48-week field experiment across a Midwest community, we used AI-based smart recycling trucks to audit recycling carts for contamination and administer two types of green nudges — "moral suasion" and "pure" (purely informational) — to 7,600 households. We find that the AI-enabled nudges meaningfully reduced contamination and improved participation, and that moral-suasion nudges were more effective than purely informational ones.

This integrative review develops a conceptual framework on supply chain intermediaries (SCIs) by synthesizing prior literature and incorporating emerging industry trends. It examines the mechanisms and factors that shape whether and how intermediaries create and destroy value in the supply chain, and organizes the existing literature around open questions about how intermediaries' compensation and practices affect supply chain outcomes across different settings.

Focusing on evidence from metformin drug quality, this study explores whether meaningful quality differences exist among generic drugs and whether the market rewards those differences. Using FDA drug manufacturing facility inspection data, we find that inspection outcomes do not predict a drug's market price or reliably predict its sales volume, and that manufacturing quality varies by country of origin and is typically not a primary factor rewarded by the market.

I study how the aggregate nature of PBM contracts with retailers affects retailers' multiproduct ordering decisions relative to individual payment contracts. Using a 2x2 laboratory newsvendor experiment, I compare individual and aggregate payment contracts to understand retailers' ordering behavior under demand uncertainty. I find that aggregate contracts led to weaker overall performance and stronger pull-to-center behavior, while individual contracts were more exposed to demand uncertainty. A second experiment, designed around these results, will examine the underlying behavioral mechanisms.

Using richer five-state Medicaid prescription claims data, I examine how curbing intermediary practices affected retailers' product mix, the quality of dispensed drugs, and the extent to which payer-side cost changes were ultimately passed through to retailers. This study extends the job market paper's investigation to the retailer side.