States with the Highest Pharmaceutical Payments

How to read this leaderboard

This page is generated dynamically from the latest PlainPharmaWatch snapshot of the CMS Open Payments database. Each row reflects an entity's reported total within the selected ranking dimension — companies, states, physicians, or teaching hospitals — and is recomputed on every request so values track the underlying ETL output rather than a frozen build-time copy. CMS publishes the dataset annually, with corrected snapshots issued mid-cycle when Sunshine-Act disputes change a record set. Anywhere PlainPharmaWatch presents a payment total, the figure is reconcilable to the row-level entries in the source dataset published at openpaymentsdata.cms.gov.

The Physician Payments Sunshine Act, enacted as Section 6002 of the Affordable Care Act, requires applicable manufacturers (drug, device, biological, and medical-supply makers) and applicable group purchasing organizations to report transfers of value made to physicians and teaching hospitals. Reportable categories include consulting fees, food and beverage, travel and lodging, education, gifts, speaking compensation, charitable contributions, royalties or licenses, research-related payments, and ownership or investment interests. Some categories are excluded by statute — payments under specific de minimis thresholds, research-related transfers tied to active clinical trials, and certain product samples — and these exclusions explain why aggregate figures here do not match every alternative pharma-spending measure.

Interpreting rank changes

Rank movement between annual releases reflects two distinct phenomena. Real underlying shifts occur when a manufacturer launches a major product, exits a therapeutic area, restructures its commercial organization, or settles a Department of Justice investigation that alters its marketing approach. Reporting-level shifts occur when CMS revises submission guidelines, when applicable-manufacturer definitions change, or when a previously unreported subsidiary begins consolidated reporting. PlainPharmaWatch does not attempt to attribute rank changes to either cause — that requires looking at the underlying payment-category breakdown on each company's detail page, which itself links back to the raw CMS records.

For physicians ranked individually, year-over-year rank instability is the norm: an active clinical-trial principal investigator may receive the bulk of their reported payments in one program year and far less in adjacent years. A surgeon who licenses a successful medical device may show a sudden royalty-driven spike and then stable lower amounts thereafter. Teaching-hospital rankings tend to be more stable because they reflect institution-wide aggregates across many simultaneously active research programs.

Where to look next

Click any entity name to drill into its full per-entity detail page. Company detail pages decompose total payments by category (consulting, food, royalties, etc.) and show the top recipient physicians and teaching hospitals. State detail pages show payments split between physician and teaching-hospital recipients, plus per-physician averages and recipient counts. The methodology page documents ingestion, normalization, and known limitations end-to-end. For context on the Sunshine Act itself and how the Open Payments dataset compares to alternative pharmaceutical-spending measures (Centers for Medicare and Medicaid Services Open Payments Frequently Asked Questions, the U.S. Food and Drug Administration's drug-approval registers, and academic literature on payment-prescribing correlations), the guides section walks through the relevant regulatory background.