What pharma actually buys: food, travel, consulting and royalties

The Open Payments file does more than total the money drug and device companies give to physicians; it labels every payment with what it was for. Sort the $3.31 billion in 2024 general (non-research) payments by that label, and a single fact organizes everything: the payments that are most numerous and the payments that carry the most money are almost entirely different things.

Two economies in one file

There were 15,385,047 general payments in 2024. Of those, 14,101,484 — 91.7% — were food and beverage: the catered lunches and dinners that sales representatives bring to clinics and hospitals. Yet because each food payment averaged just $29, the entire category came to $411.8 million — 12.4% of the dollars.

The money lives somewhere else. Royalty and license payments — $846.8 million — were the single largest category, 25.6% of every general-payment dollar — from only 15,053 payments, an average of $56,258 each. Add speaking fees ($694.5M) and consulting ($556.5M), and these three categories account for 63% of all general-payment dollars while making up just 2.9% of the payment count.

Nine in ten industry payments to U.S. doctors are food and drink. Together they add up to one-eighth of the money.

The full ledger, by type

All sixteen general-payment categories, ranked by total dollars:

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

What the averages reveal

The "average" column is where the structure lives. Acquisitions averaged $516,842 — the highest per-payment value of any category — across only 413 payments, reflecting companies buying physician-owned practices and assets. Royalties averaged $56,258. At the other end, food and beverage averaged $29 and gifts $172. The file is not one stream of money; it is a handful of large, infrequent transfers to a small number of physicians sitting alongside tens of millions of small, frequent transfers to nearly a million.

The same shape as the drug market

This split echoes a pattern Fonteum found in Medicare drug spending. In our analysis of Medicare Part D prescribing, generic drugs were 76% of prescriptions but only 10% of the dollars, while brand-name drugs were 24% of prescriptions and 90% of the spending. Open Payments shows the marketing-side mirror: the cheap, high-volume activity (meals, generics) is where the count is, and the expensive, low-volume activity (royalties, brand drugs) is where the money is. In both files, counting transactions and counting dollars produce nearly opposite league tables.

The payment-type mix also explains why device makers, not drug makers, top the list of largest payers and why orthopedic surgeons are the highest-paid specialty: royalties are a device-and-surgeon phenomenon, and royalties are where the money is.

What one record actually is

Each row in cms_open_payments is one reported transfer of value, tagged by the paying company with one nature-of-payment code. A company that buys 14 million lunches files 14 million food-and-beverage rows; a company that pays one large royalty files one. Because the unit is the payment, the count column measures activity volume and the dollar column measures value — and this study reports both, side by side, for every category. No row is attributed to a named recipient here.

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; category totals are computed server-side in the open_payments_by_nature_mv and open_payments_overview_mv materialized views. "General payments" means records with record type general, excluding research and ownership. Categories use the CMS nature_of_payment field exactly as published; averages are total dollars divided by payment count per category. 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.
• Self-classified categories. The nature-of-payment code is assigned by the reporting company; classification practices can vary between companies.
• General payments only. Research ($8.49B) and ownership ($147.8M) are excluded — this is the consulting / speaking / royalty / food / travel ledger.
• Gross transfers. A royalty reflects licensed intellectual property and a consulting fee reflects work performed; the dollar figure is the transfer, not net benefit.
• Disclosure, not influence, and aggregate-only. Category totals measure the structure of industry payments, not their effect on prescribing or 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 — the nature-of-payment categories 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 regulation defining reportable payment categories.