Which companies pay U.S. doctors the most? Device makers, not pharma

Once a year, the Centers for Medicare & Medicaid Services publishes a complete ledger of the money that drug and medical-device companies move to American doctors. It exists because of the Physician Payments Sunshine Act, the Affordable Care Act provision that forces manufacturers and group purchasing organizations to disclose, payment by payment, every consulting fee, speaking honorarium, royalty check, research grant, and catered lunch. The 2024 release — published 2026-01-23 — holds 16,146,544 records.

Strip out research grants and ownership stakes and you are left with general payments: $3.31 billion that flowed to 979,136 distinct physicians and other providers from 1,763 reporting companies. Ask which company pays doctors the most, and the intuitive answer is "a big pharma brand." The data says something more specific — and the gap between who pays the most dollars and who reaches the most doctors turns out to be the whole story.

Device makers, not drug makers, sit at the top

The single largest payer of general-payment dollars in 2024 was BioNTech SE, at $180.6 million — paid across just 164 payments. Almost every dollar is royalty or license income tied to the mRNA platform the company co-developed. The second-largest payer, AbbVie at $156.4 million, could not be more different: it spread that money across 1.72 million separate payments.

Behind BioNTech and AbbVie, the upper ranks are dominated by medical-device companies: Stryker ($132.2M), Medtronic ($117.6M), Arthrex ($104.2M), Zimmer Biomet ($83.9M), Intuitive Surgical ($72.2M), Boston Scientific ($61.4M), DePuy Synthes ($50.2M), Smith+Nephew ($46.4M), and Edwards Lifesciences ($27.8M). Device makers pay surgeons royalties for the intellectual property embedded in implants and instruments — payments that are few in number but very large per recipient. That is why a single orthopedic-device firm can out-pay most of the pharmaceutical industry on this measure.

The company that pays U.S. doctors the most does it through 164 checks. The company in second place does it through 1.72 million.

The top 25 of 1,763 companies hold most of the money

The payer field is concentrated. Of the 1,763 companies that reported any general payment in 2024, the top 25 account for $1.73 billion — 52% of every general-payment dollar. The remaining 48% is split among more than 1,700 smaller manufacturers and group purchasing organizations.

Source: CMS Open Payments PY2024, general payments only, via open_payments_by_manufacturer_mv.

Two payer archetypes

Set the dollar total beside the payment count and the file resolves into two distinct strategies for moving money to physicians.

The contrast is the point. Edge Endo LLC disclosed $91.1 million across 11 payments — an average of more than $8 million each, reflecting an acquisition-related transfer to a small number of physician-owners. AbbVie's average general payment was $91: the cost of a sales rep's lunch. Both are legitimate, both are disclosed, and both count as "paying doctors" — but they are not the same activity.

Why the device-royalty pattern matters

The reason device makers cluster at the top is structural. When a surgeon's design ends up in a marketed implant, the manufacturer owes a royalty — often for years, often large. Those payments concentrate in a handful of high-volume orthopedic and cardiovascular specialists, which is why a company like Arthrex can rank fifth among all payers while making fewer than 50,000 payments, and why orthopedic surgery is the single highest-paid specialty in the file. The money and the recipients are tightly coupled: a small number of device firms paying a small number of surgeons very large sums.

Pharmaceutical marketing works the opposite way. Its general-payment footprint is built from millions of small food-and-beverage and speaker payments spread across hundreds of thousands of prescribers — broad, shallow, and frequent. The dollars are real, but per-doctor they are small. That is the pattern our companion analysis of the kinds of payments industry makes takes apart in detail.

What one record actually is

Each row in cms_open_payments is one reported transfer of value from a company (or group purchasing organization) to a covered recipient — a physician, a non-physician practitioner, or a teaching hospital — in a given program year, with the dollar amount and a payment-nature code. Manufacturers self-report under penalty of law, and CMS publishes the file without editing the underlying amounts. Because the unit is the payment, a company that buys 1.7 million lunches generates 1.7 million rows, while a company that pays four large royalties generates four. Every count and sum in this study aggregates those rows by manufacturer; none names a recipient.

Methodology

All figures are aggregations over the cms_open_payments table, populated from the CMS Open Payments program-year-2024 release (PGYR2024, published 2026-01-23, RLS Pattern B — public read). The table holds 16,146,544 records; because that is far above PostgREST's row cap, every aggregate is computed server-side in the open_payments_by_manufacturer_mv and open_payments_overview_mv materialized views rather than by selecting rows. "General payments" means records with payment type general — excluding research and ownership. Company totals use the reporting-entity name as published by CMS; no entity-resolution merge is applied across name variants, so a parent and a subsidiary that report separately appear separately. The exact query is in the reproducibility block below and on the Open Payments dataset page. Methodology version: open-payments/v1.

Limitations

• Snapshot, not a trend. These figures reflect the 2026-01-23 PY2024 release. CMS restates prior years and publishes a new file annually; rankings shift.
• Reported names, not resolved entities. Totals are grouped by the company name as reported. A corporate family that files under several legal entities is not consolidated here, so true parent-company totals may be higher.
• General payments only. Research ($8.49B) and ownership ($147.8M) are excluded; this is the consulting / speaking / royalty / food / travel bucket.
• Gross transfers, not net benefit. A royalty reflects licensed intellectual property; a consulting fee reflects work performed. The dollar figure is the transfer, not a measure of profit or influence.
• Disclosure, not wrongdoing, and aggregate-only. Open Payments is a transparency record. No figure here implies misconduct, and no individual physician is named or surfaced.

Sources

• CMS — Open Payments (openpaymentsdata.cms.gov) — the federal disclosure database and the source of every figure in this study.
• CMS — Open Payments data dictionary and methodology — payment-nature codes, covered recipients, and reporting rules.
• Physician Payments Sunshine Act — 42 U.S.C. §1320a-7h — the statute requiring manufacturer disclosure.
• 42 CFR Part 403, Subpart I — Transparency Reports and Reporting of Physician Ownership — the implementing regulation governing what must be reported.