Conflicts of interest

Read it this way The 2020 dip shows up even more sharply in the transaction count than in the dollar total: payment records fell to 6.61 million that year from 11.37 million in 2019, roughly half, while the dollar total only dropped from $11.98 billion to $10.63 billion. That gap licenses the conclusion that fewer individual transactions happened, not that manufacturers cut what they paid per transaction. Use this chart to see where payment influence or spending concentration appears, and why the recommendation targets transparency at prescribing and formulary decision points.

CMS, Open Payments FY2025 Report to Congress · 2018-2024 · source

Read it this way Research payments rose every single year, from $6.3 billion in 2018 to $8.52 billion in 2024, while general payments swung as low as $2.19 billion in 2020 and ownership interests slowly shrank from $1.65 billion to $1.34 billion. It is the steadily climbing research band, not the more volatile general-payment band, that is pushing the total higher. Use this chart to see where payment influence or spending concentration appears, and why the recommendation targets transparency at prescribing and formulary decision points.

CMS, Open Payments FY2025 Report to Congress · 2018-2024 · source

Read it this way Orthopedic surgery, neurology/psychiatry, and cardiology each drew more than $1.2 billion cumulatively, but that ranking mixes how many physicians work in a specialty with how much industry paid each one. It cannot show the per-physician size of the payment. The next chart divides these same totals by physician count to answer that. Use this chart to see where payment influence or spending concentration appears, and why the recommendation targets transparency at prescribing and formulary decision points.

Caveat These cumulative multi-year, physician-only, general-payment totals are not comparable to the single-year all-recipient program totals shown in the trend chart. Research and ownership payments are excluded.

JAMA, Industry Payments to US Physicians by Specialty · 2024 · source

Read it this way Endocrinology tops this list at $66,557 per paid physician even though its $546.5 million cumulative total was one of the smallest in the prior chart, because only 8,211 endocrinologists split it. Family medicine sits at the bottom at $4,328 per physician despite a larger $479.1 million total, because 110,692 physicians shared it: concentration among fewer doctors matters as much as the size of the total. Use this chart to see where payment influence or spending concentration appears, and why the recommendation targets transparency at prescribing and formulary decision points.

Caveat Derived by dividing each specialty's cumulative general-payment total by its count of paid physicians. Both figures are physician-only, general-payments-only, and cumulative, so they are not comparable to single-year program totals.

JAMA, Industry Payments to US Physicians by Specialty · 2024 · source

Read it this way Every specialty listed here clears 54 percent, and hematology/oncology reaches 74.2 percent, all well above the often-cited 38.6 percent physician-wide figure noted in the caveat. That gap exists because the 38.6 percent number comes from a different, older study with a different denominator, so read the two figures as complementary evidence, not directly comparable ones, that taking industry money is routine in procedure- and drug-heavy specialties. Use this chart to see where payment influence or spending concentration appears, and why the recommendation targets transparency at prescribing and formulary decision points.

Caveat The workforce-wide figure that 38.6 percent of all physicians take industry money comes from a different study and denominator (a 2014 Medicare Part D linkage), so it is described rather than drawn here as a reference line.

JAMA, Industry Payments to US Physicians by Specialty · 2024 · source

Read it this way In every combination, the manufacturer's own payment carries a higher odds ratio than any industry payment, peaking at 5.96 for naproxen plus esomeprazole and 8.06 for ibuprofen plus famotidine. These are statistical associations from observational studies, not proof the payment caused the prescription, and the reference line at 1.0 marks where a payment would show no relationship at all. Use this chart to see where payment influence or spending concentration appears, and why the recommendation targets transparency at prescribing and formulary decision points.

Caveat These studies show association, not proof that a payment caused the prescribing choice. Ibuprofen plus famotidine has no published any-payment odds ratio, so only its manufacturer-specific bar is shown.

BMC Health Services Research, industry payments and prescribing · 2018 · source

Read it this way Aflibercept alone accounts for $3.36 billion of Medicare Part B spend, nearly twice pembrolizumab's $1.85 billion and almost three times denosumab's $1.18 billion. This shows relative scale among only the three physician-administered drugs flagged in this top-procedures sample, not a complete ranking of all Medicare drug spending. Use this chart to see where payment influence or spending concentration appears, and why the recommendation targets transparency at prescribing and formulary decision points.

Caveat Only three billing codes in this top-procedures sample are flagged as physician-administered drugs. A complete J-code ranking would need the full CMS Part B public use file.

CMS, Medicare Physician and Other Practitioners by Geography and Service · 2022 · source

Read it this way The three coral points sit far to the left and high up: aflibercept at 4,092 providers for $3.36 billion, pembrolizumab at 4,998 providers for $1.85 billion, denosumab at 34,430 providers for $1.18 billion, while the muted office-visit codes cluster at hundreds of thousands of providers for comparable or lower total spend. That pattern shows physician-administered drug dollars concentrate in far fewer hands than routine office-visit billing, though the provider counts are an approximate upper bound, not an exact count. Use this chart to see where payment influence or spending concentration appears, and why the recommendation targets transparency at prescribing and formulary decision points.

Caveat Provider counts are an approximate upper bound. They sum facility and non-facility rows per code, so a provider billing a code in both settings is counted twice.

CMS, Medicare Physician and Other Practitioners by Geography and Service · 2022 · source