{ "study": { "slug": "open-payments-top-manufacturers-2024", "title": "Which companies pay U.S. doctors the most? Device makers, not pharma", "standfirst": "In 2024, drug and device companies disclosed $3.31 billion in general payments to U.S. physicians under the Sunshine Act — and the largest payers are device makers, not pharma. BioNTech led at $180.6 million from just 164 royalty payments; the top 25 of 1,763 reporting companies account for 52% of every general-payment dollar.", "desk": "financial-distress", "article_type": "Original Research", "published": "2026-06-12", "issue": 60, "doi": "10.5072/fonteum/open-payments-top-manufacturers-2024", "url": "https://fonteum.com/research/open-payments-top-manufacturers-2024", "methodology_version": "open-payments/v1" }, "data_as_of": "2026-01-23", "datasets": [ { "slug": "cms-open-payments", "name": "CMS Open Payments", "publisher": "CMS — Open Payments", "upstream_url": null } ], "key_findings": [ { "number": "$3.31B", "finding": "in 2024 general payments from industry to 979,136 U.S. physicians and other providers, disclosed by 1,763 reporting companies under the Physician Payments Sunshine Act", "dataset": "cms-open-payments" }, { "number": "$180.6M", "finding": "from BioNTech SE — the single largest payer — across only 164 payments, almost all royalty or license income on its mRNA platform", "dataset": "cms-open-payments" }, { "number": "52%", "finding": "of all general-payment dollars ($1.73 billion) flow from just the top 25 of 1,763 reporting companies — a heavily concentrated payer field", "dataset": "cms-open-payments" }, { "number": "1.72M", "finding": "separate payments from AbbVie, the second-largest payer by dollars ($156.4M) and by far the broadest-reach payer — mostly food, beverage and speaking", "dataset": "cms-open-payments" } ], "faqs": [ { "q": "What is Open Payments and the Sunshine Act?", "a": "Open Payments is the federal transparency program created by the Physician Payments Sunshine Act, a provision of the Affordable Care Act. It requires drug and medical-device manufacturers and group purchasing organizations to report payments and transfers of value made to physicians and teaching hospitals. CMS publishes the data annually at openpaymentsdata.cms.gov." }, { "q": "Which company paid U.S. doctors the most in 2024?", "a": "By general-payment dollars, BioNTech SE was the largest single payer at $180.6 million across just 164 payments — almost entirely royalty or license income tied to its mRNA platform. AbbVie was second at $156.4 million, but spread that across 1.72 million separate payments, making it the broadest-reach payer in the file." }, { "q": "Why are device companies near the top of the payer list?", "a": "Medical-device makers pay surgeons royalties for intellectual property used in implants and instruments, and those royalties are large per recipient. Stryker ($132.2M), Medtronic ($117.6M), Arthrex ($104.2M) and Zimmer Biomet ($83.9M) all rank in the top eight payers — driven by orthopedic-device royalties rather than the small, frequent meals that characterize pharma marketing." }, { "q": "How concentrated is the payer field?", "a": "Highly. Of 1,763 companies that reported general payments in 2024, the top 25 account for $1.73 billion — 52% of every general-payment dollar. The long tail of more than 1,700 smaller manufacturers and group purchasing organizations splits the remaining 48%." }, { "q": "Does a large industry payment mean a doctor did something wrong?", "a": "No. These are lawful, federally disclosed payments, and many reflect legitimate work — royalties on invented devices, paid consulting, or research support. The data shows correlation and scale, not wrongdoing. Open Payments exists so that patients, journalists and researchers can see the financial relationships, not to assert misconduct." }, { "q": "Do these figures include research payments?", "a": "No. This study covers general (non-research) payments only — the $3.31 billion bucket that includes consulting, speaking, royalties, food and travel. Open Payments separately reports $8.49 billion in research payments and $147.8 million in ownership interests for 2024; those flow largely to institutions and principal investigators and are analyzed in our companion national overview." }, { "q": "Can I reproduce these company rankings?", "a": "Yes. Every figure is an aggregation over the cms_open_payments table (16,146,544 records, program year 2024) via the open_payments_by_manufacturer_mv materialized view. The exact SQL is published in the reproducibility block below. No individual physician is named; aggregates are by company only." } ], "citation": { "apa": "Fonteum Research. (2026, June 12). Which companies pay U.S. doctors the most? Device makers, not pharma. Fonteum Research, Issue 60. https://doi.org/10.5072/fonteum/open-payments-top-manufacturers-2024", "url": "https://fonteum.com/research/open-payments-top-manufacturers-2024" }, "reproducible_sql": "-- Which companies pay U.S. doctors the most? — fully reproducible query.\n--\n-- Source: CMS Open Payments, program year 2024 (PGYR2024, published 2026-01-23).\n-- Table: public.cms_open_payments (16,146,544 records, public, read-only).\n-- Scope: General (non-research) payments only (record_type = 'general').\n-- Identity: one row = one reported transfer of value from a company to a covered\n-- recipient. Aggregates are by manufacturer only; no recipient is named.\n--\n-- The study reads the bounded open_payments_by_manufacturer_mv / _overview_mv\n-- materialized views; their exact definitions are reproduced here.\n\n-- Headline totals (open_payments_overview_mv):\nSELECT\n count(*) FILTER (WHERE record_type = 'general') AS general_records, -- 15,385,047\n round(sum(total_amount_usd) FILTER (WHERE record_type = 'general')) AS general_value, -- 3,313,801,737\n count(DISTINCT recipient_npi) FILTER\n (WHERE record_type = 'general' AND recipient_npi IS NOT NULL) AS recipients, -- 979,136\n count(DISTINCT manufacturer_name) FILTER\n (WHERE record_type = 'general' AND manufacturer_name IS NOT NULL) AS companies -- 1,763\nFROM public.cms_open_payments\nWHERE program_year = 2024;\n\n-- Top 15 companies by general-payment dollars (open_payments_by_manufacturer_mv):\nSELECT\n manufacturer_name AS manufacturer,\n count(*) AS payment_count,\n round(sum(total_amount_usd))::bigint AS general_payments\nFROM public.cms_open_payments\nWHERE record_type = 'general' AND program_year = 2024 AND manufacturer_name IS NOT NULL\nGROUP BY manufacturer_name\nORDER BY general_payments DESC\nLIMIT 15;\n-- BioNTech SE 180,558,679 164 <- largest payer; royalty income\n-- ABBVIE INC. 156,382,683 1,720,745 <- broadest reach; avg $91/payment\n-- Stryker Corporation 132,155,940 162,439\n-- Medtronic, Inc. 117,649,217 342,148\n-- Arthrex, Inc. 104,199,464 49,443\n-- Edge Endo LLC 91,139,127 11 <- avg $8.3M/payment (acquisition)\n-- Zimmer Biomet Holdings, Inc. 83,904,351 32,760\n-- INTUITIVE SURGICAL, INC. 72,225,869 116,855\n-- Takeda Pharmaceuticals U.S.A. 71,616,187 171,595\n-- Advanced Accelerator Applications 63,931,988 167\n-- AstraZeneca Pharmaceuticals LP 63,099,382 609,976\n-- Boston Scientific Corporation 61,435,976 265,585\n-- Genentech, Inc. 59,226,516 2,534\n-- GENZYME CORPORATION 55,555,371 181,575\n-- DePuy Synthes Products, Inc. 50,211,032 2,541\n\n-- Payer concentration — top 25 share of all general-payment dollars:\nWITH ranked AS (\n SELECT manufacturer_name, sum(total_amount_usd) AS amt\n FROM public.cms_open_payments\n WHERE record_type = 'general' AND program_year = 2024 AND manufacturer_name IS NOT NULL\n GROUP BY manufacturer_name\n ORDER BY amt DESC\n LIMIT 25\n)\nSELECT\n round(sum(amt))::bigint AS top25_value, -- 1,731,853,106\n round(100.0 * sum(amt) / (SELECT sum(total_amount_usd)\n FROM public.cms_open_payments\n WHERE record_type = 'general' AND program_year = 2024), 1) AS top25_pct -- 52.3\nFROM ranked;", "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)", "generated_by": "Fonteum — https://fonteum.com", "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included." }