Top 50 States by Total Pharma Payments

The CMS Open Payments dataset records payments from pharmaceutical and medical device companies to U.S. physicians, teaching hospitals, and other healthcare providers. This ranking surfaces the top 50 states by total payment amounts as ingested into PlainPharmaWatch, distinguishing between physician and teaching hospital receipts alongside transaction volumes. Top 5 states account for 42.0% of nationwide payments.Source: CMS Open Payments Summary Data, https://openpaymentsdata.cms.gov/summary

Top 10 states by total payments

Top 50 ranking (full list)

Methodology

Aggregations group CMS Open Payments general payment records by the recipient's primary practice location state. Physician payments encompass MDs, DOs, and other individual providers; teaching hospitals are separately categorized per CMS definitions. Transaction counts reflect unique payment records post-ETL deduplication. Totals exclude ownership and investment interests, focusing on general payments like consulting fees, travel, and meals.

Caveats and Limitations

State assignments use recipient mailing addresses, potentially understating activity in border regions or telehealth scenarios. Data omits non-disclosable research payments and reflects self-reported figures subject to amendments. Comparisons across years require inflation adjustment. For detailed recipient views, see the top recipients page.

Why state-level payment totals vary

The states near the top of this list, led by California at $342.4M and Florida at $334.6M - are not necessarily the states whose physicians are "paid the most." They are the states with the largest absolute aggregate payments, which tracks closely with three structural factors: the number of practicing physicians in the state, the density of academic medical centers and teaching hospitals, and the presence of pharmaceutical-industry corporate offices. New York, California, Massachusetts, Pennsylvania, and Texas typically lead this ranking by aggregate because they combine all three: large physician populations, multiple major academic systems, and at least one cluster of pharma headquarters or research operations.

If you want to know which states' physicians receive the most per-capita pharmaceutical-industry support, the highest per-physician spending leaderboard normalizes for state size and surfaces a different list. Per-physician rankings tend to elevate smaller states with specialty-care concentrations, academic transplant programs, oncology centers, and specialty cardiology practices generate disproportionate consulting and speaking-engagement volume relative to general internal medicine.

Reading the physician vs. teaching-hospital split

Each row of the table above shows two recipient categories: payments routed to individual physicians (left column) and payments routed to teaching hospitals or covered teaching institutions (right column). The split is informative. Some states (typically those with prominent academic-medicine ecosystems) show a heavier teaching-hospital share, these payments often represent industry support for clinical trials, fellowship programs, continuing-medical-education funding, or research royalties paid through institutional channels rather than to individual physicians. Other states show a heavier individual-physician share, these payments are more concentrated in consulting fees, speaker bureaus, and direct-to-physician meals and gifts.

For policy researchers studying conflict-of-interest exposure or payment-prescribing correlations, both columns matter and they reflect different industry-engagement models. The methodology page documents how PlainPharmaWatch separates the two recipient categories during ingestion. The top recipients view drills into the specific physicians and teaching hospitals driving each state's totals.

Geographic patterns to watch

Several geographic patterns appear consistently across program years and are worth flagging for anyone using state-level totals to draw inferences. Northeastern states, particularly Massachusetts, New York, New Jersey, and Pennsylvania, show payment volumes that exceed what their physician populations alone would predict, because they host concentrations of academic medical centers and pharmaceutical-industry headquarters that drive elevated research-payment and royalty volume. California, Texas, and Florida appear near the top of the absolute ranking primarily on the strength of their physician-workforce size; per-physician normalization (available on the highest-per-physician leaderboard) typically moves them down the list.

Smaller states with disproportionately high teaching-hospital concentrations, Connecticut, Rhode Island, Delaware, Vermont, can punch above their weight on a per-physician basis because a small set of major academic institutions concentrates a meaningful share of national clinical-trial activity. Western and mountain states with smaller physician populations and fewer academic medical centers (Wyoming, Montana, Alaska, Idaho, North and South Dakota) typically sit near the bottom of the absolute ranking; the absence does not indicate anything about prescribing practices in those states, it primarily reflects the scarcity of high-volume reportable transfers in regions without large research-intensive institutions.

Where to dig deeper

Clicking any state name in the table above opens the per-state detail page, which shows the same totals broken out by payment category (consulting, food and beverage, travel, royalties, education, research, ownership, and others), surfaces the top recipient physicians and teaching hospitals within the state, and where available shows year-over-year trend data. For an alternative view of the same dataset, the highest-per-physician leaderboard normalizes for state size; the top physicians leaderboard ranks individual NPI recipients; the top hospitals leaderboard ranks teaching-hospital recipients. The methodology page documents ingestion details, normalization choices, and known limitations of the underlying CMS dataset.