Payments by State — 62 U.S. States & Territories

How state-level pharma payment data is collected

The Centers for Medicare and Medicaid Services (CMS) operates the Open Payments program under the Physician Payments Sunshine Act, Section 6002 of the Affordable Care Act. Under this statute, every applicable manufacturer of drugs, medical devices, biologicals, and medical supplies — along with applicable group purchasing organizations — must report annually on transfers of value to physicians, teaching hospitals, and other covered recipients. State-level aggregates on this page are computed from the public CMS release, joined on the recipient's primary state of practice or institutional state of operation. Each row reflects the full amount reported for the most recently completed program year and is recomputed from the live PlainPharmaWatch database on every request.

States vary substantially in total reported payment volume, and that variation tracks closely with three structural factors. First, the size of the physician workforce in the state — California, Texas, New York, Florida, Pennsylvania, and Illinois consistently lead in absolute payment volume because they each contain large numbers of practicing physicians. Second, the density of academic medical centers and teaching hospitals — Massachusetts, New York, Pennsylvania, North Carolina, and California concentrate a disproportionate share of clinical-research activity and accordingly receive a large share of research-related transfers. Third, the presence of pharmaceutical-industry headquarters and operating facilities — New Jersey, Pennsylvania, Massachusetts, and Indiana host major employer footprints for the largest manufacturers, and physicians practicing in those states show different industry-engagement patterns than colleagues in states with little industry presence.

How to use this state directory

The table below lists every state and territory in the dataset, with totals split between payments to individual physicians and payments to teaching hospitals. The split is meaningful: physician-routed payments are concentrated in consulting fees, speaker bureaus, advisory boards, food and beverage, and travel; teaching-hospital payments are concentrated in clinical-trial research support, fellowship and education funding, and royalty arrangements tied to institutionally licensed inventions. Click any state to drill into its detail page, which decomposes the state's total by payment category, highlights the top recipient physicians and teaching hospitals, and surfaces year-over-year trend metrics where available.

For policy researchers, journalists, and academic researchers, the per-physician normalization (visible on the highest per-physician rankings page) is often more useful than the absolute total: it controls for state population and physician workforce size and highlights states where the average physician is paid more by the pharmaceutical industry. For physicians who want to inspect their own state's totals or compare to a neighboring state, click the state name. For full methodology — including how PlainPharmaWatch handles records with ambiguous or missing state assignments, how teaching-hospital aggregations are built, and known limitations such as telehealth-routed payments — see the methodology page. Browse the full company list at companies, the top recipients at top recipients, and the cross-cutting leaderboards at rankings.

Understanding state-level variability

Two states with similar physician workforces can show meaningfully different aggregate payment totals, and the underlying reasons are worth unpacking before drawing inferences. The first major driver is the mix of medical specialties practiced within the state. Specialties such as oncology, cardiology, neurology, rheumatology, gastroenterology, and certain surgical sub-specialties generate substantially more reportable industry engagement than specialties such as family medicine, general internal medicine, pediatrics, and emergency medicine. A state with a heavy concentration of academic-affiliated subspecialists will accordingly show higher per-physician payment totals than a state with a similar physician count but a primary-care-heavy mix.

The second major driver is the presence and density of academic medical centers and teaching hospitals. Clinical-trial research support flows through institutional channels to teaching hospitals rather than to individual physicians, and a state hosting multiple major academic medical centers can show a substantial teaching-hospital share even if its individual-physician total is unremarkable. The third major driver is the geographic concentration of pharmaceutical-industry corporate offices and operating facilities. States hosting manufacturer headquarters often show elevated levels of industry-physician engagement simply because the convening of advisory boards, clinical investigator meetings, and key-opinion-leader programs happens near the corporate hubs.

What you will and will not find on state detail pages

Each per-state detail page (accessible by clicking the state name in the table below) decomposes the state's total into payment categories — consulting, food and beverage, travel and lodging, education, gifts, speaker compensation, charitable contributions, royalties or licenses, and research-related payments — and shows the top individual physician recipients and the top teaching-hospital recipients within the state. State detail pages also surface the manufacturers most active in the state, the breakdown between physician-routed and hospital-routed payments, and where available historical trend metrics. What state pages do not show is per-prescription drug-utilization data (that lives in Medicare Part D and state Medicaid claims systems), state-level pricing or wholesale-acquisition-cost figures, or measures of patient outcomes by state.