{ "study": { "slug": "open-payments-types-of-payments-2024", "title": "What pharma actually buys: food, travel, consulting and royalties", "standfirst": "Industry made 15.4 million general payments to U.S. physicians in 2024, worth $3.31 billion — but the two halves barely overlap. Royalties, speaking and consulting are 2.9% of payments yet 63% of the dollars; food and beverage is 91.7% of payments but 12.4% of the money. The average meal was $29; the average royalty, $56,258.", "desk": "financial-distress", "article_type": "Original Research", "published": "2026-06-12", "issue": 62, "doi": "10.5072/fonteum/open-payments-types-of-payments-2024", "url": "https://fonteum.com/research/open-payments-types-of-payments-2024", "methodology_version": "open-payments/v1" }, "data_as_of": "2026-01-23", "datasets": [ { "slug": "cms-open-payments", "name": "CMS Open Payments", "publisher": "CMS — Open Payments", "upstream_url": null } ], "key_findings": [ { "number": "$846.8M", "finding": "in royalty and license payments — the largest single category, 25.6% of all general-payment dollars — from just 15,053 payments averaging $56,258 each", "dataset": "cms-open-payments" }, { "number": "14.1M", "finding": "food-and-beverage payments — 91.7% of all general payments by count, yet only 12.4% of the dollars, averaging $29 apiece", "dataset": "cms-open-payments" }, { "number": "63%", "finding": "of all general-payment dollars come from royalties, speaking and consulting combined — categories that together are only 2.9% of the payment count", "dataset": "cms-open-payments" }, { "number": "$516,842", "finding": "average acquisition payment — only 413 occurred, but they moved $213.5 million, the highest per-payment value of any category", "dataset": "cms-open-payments" } ], "faqs": [ { "q": "What kinds of payments does Open Payments track?", "a": "Open Payments classifies every general (non-research) transfer of value into one of about sixteen payment-nature categories: food and beverage, travel and lodging, consulting fees, speaking fees, royalties or licenses, grants, education, honoraria, gifts, charitable contributions, acquisitions, and a few others. Each 2024 payment carries one nature code, reported by the paying company." }, { "q": "What is the most common type of payment to doctors?", "a": "Food and beverage, by a wide margin. Of 15.4 million general payments in 2024, 14.1 million — 91.7% — were food and beverage. These are the catered lunches and dinners sales representatives provide. But because each averages just $29, they account for only $411.8 million, or 12.4% of all general-payment dollars." }, { "q": "Where does most of the money actually go?", "a": "Into a small number of large payments. Royalties and licenses ($846.8M), speaking fees ($694.5M) and consulting ($556.5M) together are 63% of all general-payment dollars — yet only 2.9% of the payment count. The dollars and the payment counts live in almost completely different categories." }, { "q": "Why are royalty payments so large?", "a": "Royalties compensate physicians — usually surgeons — for intellectual property used in marketed devices and drugs. They are paid per recipient and can run for years, so the average royalty payment was $56,258, against $29 for a meal. Just 15,053 royalty payments moved more money than 14.1 million meals." }, { "q": "What are acquisition payments?", "a": "Acquisitions are transfers tied to a company buying a physician-owned business or its assets. Only 413 occurred in 2024, but they averaged $516,842 — the highest per-payment value of any category — and totaled $213.5 million. A single $91.1 million acquisition was the largest general payment in the entire file." }, { "q": "Does a meal from a drug company change prescribing?", "a": "This study does not test that. It measures the volume and value of each payment type, not their effect. Independent peer-reviewed research has examined associations between industry meals and prescribing, but Open Payments is a disclosure record. Nothing in this breakdown asserts that any meal, fee or royalty altered a clinical decision." }, { "q": "Can I reproduce this payment-type breakdown?", "a": "Yes. Every figure aggregates the cms_open_payments table (16,146,544 records, program year 2024) through the open_payments_by_nature_mv materialized view, which covers all sixteen payment-nature categories. The exact SQL is in the reproducibility block below. No individual physician is named." } ], "citation": { "apa": "Fonteum Research. (2026, June 12). What pharma actually buys: food, travel, consulting and royalties. Fonteum Research, Issue 62. https://doi.org/10.5072/fonteum/open-payments-types-of-payments-2024", "url": "https://fonteum.com/research/open-payments-types-of-payments-2024" }, "reproducible_sql": "-- What pharma actually buys: payment-type breakdown — reproducible query.\n--\n-- Source: CMS Open Payments, program year 2024 (PGYR2024, published 2026-01-23).\n-- Table: public.cms_open_payments (16,146,544 records, public, read-only).\n-- Scope: General (non-research) payments only (record_type = 'general').\n-- Grain: nature_of_payment (16 categories). No recipient named.\n--\n-- Reads open_payments_by_nature_mv; definition reproduced for audit.\n\n-- All payment-nature categories, by total dollars (open_payments_by_nature_mv):\nSELECT\n nature_of_payment AS nature,\n count(*) AS payments,\n round(sum(total_amount_usd))::bigint AS total_usd,\n round(sum(total_amount_usd) / count(*), 0) AS avg_per_payment\nFROM public.cms_open_payments\nWHERE record_type = 'general' AND program_year = 2024 AND nature_of_payment IS NOT NULL\nGROUP BY nature_of_payment\nORDER BY total_usd DESC;\n-- Royalty or License 846,848,447 15,053 56,258\n-- Compensation for services other than consulting 694,537,282 238,656 2,911 (speaking, non-CME)\n-- Consulting Fee 556,511,013 185,882 2,994\n-- Food and Beverage 411,750,206 14,101,484 29 <- 91.7% of payment count\n-- Acquisitions 213,455,947 413 516,842 <- highest avg\n-- Travel and Lodging 202,500,154 588,784 344\n-- Grant 123,006,051 7,263 16,937\n-- Education 67,045,121 151,641 442\n-- Honoraria 43,422,896 16,448 2,640\n-- Debt forgiveness 40,810,437 7,687 5,309\n-- Long term medical supply or device loan 37,760,405 17,141 2,203\n-- Space rental or facility fees (teaching hosp.) 33,805,521 7,511 4,500\n-- Compensation for faculty/speaker (CME program) 32,855,300 14,013 2,345\n-- Gift 4,477,576 25,972 172\n-- Charitable Contribution 4,404,912 696 6,329\n-- Entertainment 610,469 6,403 95\n\n-- The two economies — share of count vs share of dollars:\nWITH g AS (\n SELECT count(*) AS recs, sum(total_amount_usd) AS val\n FROM public.cms_open_payments\n WHERE record_type = 'general' AND program_year = 2024\n)\nSELECT\n -- food = 91.7% of payments, 12.4% of dollars\n round(100.0 * (SELECT count(*) FROM public.cms_open_payments\n WHERE record_type='general' AND program_year=2024\n AND nature_of_payment='Food and Beverage') / g.recs, 1) AS food_count_pct, -- 91.7\n -- royalty + speaking + consulting = 2.9% of payments, 63.3% of dollars\n round(100.0 * (SELECT sum(total_amount_usd) FROM public.cms_open_payments\n WHERE record_type='general' AND program_year=2024\n AND nature_of_payment IN (\n 'Royalty or License',\n 'Consulting Fee',\n 'Compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program'\n )) / g.val, 1) AS top3_dollar_pct -- 63.3\nFROM g;", "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)", "generated_by": "Fonteum — https://fonteum.com", "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included." }