Drug and medical device makers reported approximately $2.6 billion in payments to more than 665,000 physicians through the Open Payments program in 2025, according to a new analysis of federal data. 

The manufacturers paid an additional $1.3 billion to teaching hospitals and nonphysician practitioners, bringing total spending to about $3.9 billion, an 18.4% increase from the previous year.

The analysis was conducted by MedScout, an Austin, Texas-based healthcare data analytics company. The company recently published the findings on a searchable platform that allows users to examine Open Payments data by provider, company, product, and year-over-year changes since 2022.

The three highest-paid physicians were specialists in internal medicine, orthopedic surgery, and urology, respectively, and the 50 highest-paid providers received payments ranging from $2.2 million to $55 million.

Created under the Physician Payments Sunshine Act in 2013, Open Payments is intended to increase transparency around financial relationships between industry and healthcare providers. Drug and device manufacturers must submit information to the Centers for Medicare & Medicaid Services (CMS) on payments to physicians and teaching hospitals, including payments for consulting, speaking engagements, royalties, licensing, meals, and other transfers of value.

Notably, the analysis found that approximately $1.33 billion, or 34% of payment dollars in 2025, were designated as not product-related, up from 21% the previous year. An additional $352 million in payments were either marked as product-related but did not specify an associated drug or device or used only generic product descriptions instead of a product name. CMS did not respond to a request for comment by publication time.

“There’s a lot there that is clearly product spend that isn’t [being] associated with the product,” Evan Knopp, head of market strategy at MedScout, told Medscape Medical News.

Knopp said that while the findings do not imply that manufacturers deliberately hid product information, they do raise questions about whether the Open Payments platform offers the level of transparency intended by the Sunshine Act.

Where’s the Money Going?

Royalties accounted for the largest share of payment dollars in 2025, at 30.7% of the total, followed by speaking payments at 20% and consulting payments at 16.5%.

The analysis found that Open Payments spending increased alongside claims volume for several high-profile drugs.

Payments associated with Wegovy, a GLP-1 medication, increased 166% from 2023 to 2025, whereas prescription volume rose 108%. Prescriptions for Leqembi, an early Alzheimer’s disease treatment, increased by more than 3500%, whereas Open Payments spending associated with the drug climbed 91%.

BioNTech ranked as the highest-paying company in MedScout’s analysis, reporting $536.4 million in payments — more than twice the amount reported by AbbVie, the next-highest-paying company, which reported about $202 million.

Genevieve Kanter, PhD, associate professor of public policy at the USC Sol Price School of Public Policy in Los Angeles, whose research focuses on conflicts of interest in medicine, told Medscape Medical News that unusually large royalty payments and transactions tied to acquisitions can skew Open Payments data, making it difficult to identify a true shift in physician-industry payments.

One payment in MedScout’s analysis illustrated that effect. In 2025, BioNTech reported a $536 million royalty payment to the Hospital of the University of Pennsylvania in Philadelphia for the messenger RNA COVID vaccine Comirnaty. BioNTech designated it as not product-related, whereas from 2022 through 2024, the company had reported the royalty under the Comirnaty product name.

That payment alone accounted for most of the $637 million in royalty and licensing payments MedScout found were designated as not product-related last year. “It’s unlikely the company is trying to hide anything,” noted the researchers in their analysis, “as the Comirnaty royalty settlement with its development partners was public news.”

After removing the BioNTech payment, about $101 million in royalty dollars remained unlinked to a specific product. “The reporting gap is not surprising, necessarily, but it doesn’t make sense to not have any product associated with a royalty,” Knopp said.

Even so, not all payments are required to identify a specific product.

Kanter said some payments may legitimately lack a product because they involve items still in development or that do not yet have an official brand name. She also noted that product names are entered in a free-text field rather than selected from a standardized list, leaving room for variation in how manufacturers describe them. Historically, medical device manufacturers were only required to report the general therapeutic categories rather than specific products, but reporting requirements have since changed, she said.

“It looks like some firms are still continuing to do that [when] they should be reporting the names of the products,” said Kanter. “And it also shows that there’s a lot of discretion in how manufacturers are reporting.”

Improving Open Payments Transparency

Although manufacturers are ultimately responsible for submitting Open Payments records and attesting to their accuracy and completeness, physicians can review records attributed to them and dispute information they believe is inaccurate. CMS may also audit manufacturers either randomly or in response to potential compliance issues, including incomplete or inaccurate records, and impose penalties for noncompliance.

Based on these findings, Kanter said that more frequent audits — possibly using AI to identify missing or inconsistent data — could improve transparency.

“It doesn’t seem as if the records are being audited. If we have missing product information, it’s a problem because it gives an incomplete picture and a biased one, and it’s not serving the [intended] function,” she said.

Kanter added that physicians would also benefit from accurate reporting because it allows them to present a complete accounting of their relationships with industry and reassure patients that those relationships do not unduly influence their recommendations.

“My sense is that patients and the public are sophisticated enough to know that just having some engagement with industry is not some kind of scarlet letter,” she said.

MedScout plans to continue tracking Open Payments as new federal data are released, adding new years and analyses to its database.

Knopp is head of market strategy at MedScout, which conducted the Open Payments analysis described in this article. Kanter had no relevant disclosures. 

Steph Weber is an award-winning freelance journalist specializing in healthcare and law.