Industry payments to physicians by state: where the money lands

The Open Payments file records the recipient's state for every payment, which turns the $3.31 billion in 2024 general (non-research) industry payments into a map. The intuitive expectation is that the map tracks population — the biggest states get the most money. It half-does. The states with the most payments are indeed the biggest ones. But the states with the most dollars are bent by something else entirely: where a small number of royalty recipients happen to live.

California leads, but the order is not population order

California received the most: $334.5 million across 1.37 million payments. Then Florida ($304.7M), Pennsylvania ($303.3M), Massachusetts ($225.1M), Texas ($221.2M), and New York ($211.9M). Texas — the second-largest state — sits fifth on dollars, behind both Pennsylvania and Massachusetts, neither of which is close to Texas in population.

The intensity map is the real story

Divide each state's dollars by its payment count and the distortion becomes legible.

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

Massachusetts averaged $1,031 per payment — more than four times California's $244 and nearly seven times Texas's $153. A state can reach the top of the dollar rankings two different ways: with a vast number of small payments (Texas, California — population and marketing reach) or with a modest number of very large ones (Massachusetts, Pennsylvania — royalties). The average-payment column tells you which.

Texas logged 1.45 million industry payments and Massachusetts 218,000 — yet Massachusetts took home more money. Royalties, not meals, draw the map.

Two states, two companies

The royalty geography is traceable to specific firms. Pennsylvania's third-place finish rests heavily on a single company: the three largest royalty payments in the entire 2024 file — $88.6 million, $53.4 million, and $28.3 million — all came from BioNTech to Pennsylvania recipients, $170.3 million in total. That one royalty relationship is most of the gap between Pennsylvania and the similarly sized states below it.

Massachusetts shows the same mechanism with different names: the next cluster of the largest royalty payments went from Genentech and Takeda to Massachusetts recipients — together roughly $77 million among the file's ten biggest royalty checks. These are the same device-and-pharma royalty relationships that put device makers atop the payer list and orthopedic and procedural specialists atop the specialty list; geography simply records where those few recipients live.

Volume versus value, by state

The reason the two maps diverge is the payment-type split playing out geographically. The big-population states accumulate dollars through sheer volume of small food-and-beverage payments — Texas's 1.45 million payments are overwhelmingly meals. The royalty-hub states accumulate dollars through a few enormous transfers. Both are legitimate and both are disclosed, but they describe different relationships between industry and medicine, and the per-payment average is the single number that distinguishes them.

What one record actually is

Each row in cms_open_payments carries the recipient's state — the physician's or teaching hospital's listed location — assigned by the reporting company. A payment is attributed to that state regardless of where the company or the recipient's patients are based. The file's 59 jurisdictions include the 50 states, DC, Puerto Rico and other territories, and military-mail designations (AE, AP, AA). Every figure aggregates these rows by state; 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; state totals are computed server-side in the open_payments_by_state_mv and open_payments_overview_mv materialized views. "General payments" means records with record type general, excluding research and ownership. State grouping uses the CMS recipient_state field. Company-to-state royalty attributions reference the open_payments_largest_general_mv view of the fifty largest individual general payments. 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. Figures reflect the 2026-01-23 PY2024 release; CMS publishes annually and restates prior years.
• Recipient location, not patient location. Payments map to where the paid physician or teaching hospital is listed, not to where care is delivered or where the company sits.
• Totals are population-confounded. Absolute dollars partly track state size and provider supply; per-payment averages are the like-for-like comparison and are reported alongside.
• General payments only. Research ($8.49B) and ownership ($147.8M) are excluded.
• Disclosure, not influence, and aggregate-only. A state total reflects recipient location and payment mix, not any effect on care. No individual physician is named or surfaced.

Sources

• CMS — Open Payments (openpaymentsdata.cms.gov) — the federal disclosure database behind every figure in this study.
• CMS — Open Payments data dictionary and methodology — recipient-state coding 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 — the implementing regulation.