Harold Marion Palma, APRN
Adult Health · Honolulu, HINPI 1003367087
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 100.0% of the total across 57 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. 14 manufacturers reported payments, led by Amgen at 32.5% of the total. Reporting peaked in 2024 at $1,364 and has fallen 51.3% since, to $664 in 2025. Among adult health clinicians in HI with any reported payments, this total sits in the top 10% — high for the specialty, which is a reason to read the composition above rather than the number alone.
Across 57 payments — averaging $76.28 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Amgen$1K
- AstraZeneca$670
- Ardelyx, Inc.$576
- Nxstage Medical, Inc.$280
- Vifor Pharma, Inc.$235
- Baxter Healthcare$154
- plus $1K from 8 others
What the payments were for
- Food & beverage$4,348100%
Most of this is food and beverage — typically meals provided during product presentations at a clinic or hospital. Nationally that is the single largest category of reported payments by count.
General payments by program year
Who reported the general payments
Companies are grouped under their corporate parent — a single manufacturer often files under several CMS reporting entities. Research and ownership payments are counted separately and are not in this table.
| Company | Payments | Total |
|---|---|---|
| Amgen(2 entities) | 17 | $1,414 |
| AstraZeneca | 7 | $670 |
| Ardelyx, Inc. | 16 | $576 |
| Nxstage Medical, Inc. | 4 | $280 |
| Vifor Pharma, Inc. | 2 | $235 |
| Baxter Healthcare | 2 | $154 |
| Calliditas Therapeutics US Inc. | 1 | $143 |
| Novartis | 1 | $138 |
| Fresenius USA Marketing, Inc. | 2 | $134 |
| GSK | 1 | $125 |
| Mallinckrodt Hospital Products Inc. | 1 | $125 |
| Akebia Therapeutics Inc | 1 | $122 |
| Bayer | 1 | $122 |
| Sanofi-aventis U.S. LLC | 1 | $112 |
What the payments were tied to
Products named in the reported payments. Only payments of $100 or more are attributed here — the typical reported payment nationally is a meal worth about $16, and listing those product-by-product would be noise.
- Parsabiv$824
- Tavneos$603
- XPHOZAH 30 MG$370
- LOKELMA$359
- FARXIGA$249
- NXSTAGE SYSTEM ONE$245
- Aranesp$227
- TARPEYO$143
- NXSTAGE CARTRIDGE EXPRESS$131
- PUREFLOW SL$131
- NXSTAGE PUREFLOW SOLUTION$131
- BENLYSTA$125
- ACTHAR$125
- KRYSTEXXA$125
- Kerendia$122
- Vafseo$122
- Renal - PD$115
- Velphoro$112
- THYMOGLOBULIN$112
- Veltassa$110
How this compares
$4,348 in reported general payments places this provider in the 90th percentile of 44 adult health providers in Hawaii.
Medicare billing
What this is not: this is the amount Original Medicare Part B allowed for services this provider billed in 2024. It is not their income. It excludes Medicare Advantage — now more than half of all Medicare enrollment — along with Medicaid and all commercial insurance, and it is gross practice revenue before staff, rent, supplies and malpractice premiums. CMS also suppresses any figure covering ten or fewer patients, so low-volume providers appear smaller than they are.
Most prescribed under Part D
| Drug | Claims | Cost to plans & patients |
|---|---|---|
| XphozahTenapanor Hcl | 49 | $164,710 |
| VelphoroSucroferric Oxyhydroxide | 40 | $109,846 |
| AuryxiaFerric Citrate | 22 | $47,838 |
| Sevelamer Carbonate | 134 | $29,249 |
| EdarbiAzilsartan Medoxomil | 12 | $3,320 |
| Calcium Acetate | 20 | $2,254 |
| Midodrine Hcl | 13 | $1,389 |
| Metoprolol Succinate | 39 | $859 |
| Carvedilol | 69 | $858 |
| Losartan Potassium | 60 | $659 |
| Amlodipine Besylate | 51 | $510 |
| Gabapentin | 48 | $423 |
| Lisinopril | 11 | $287 |
| Nifedipine ErNifedipine | 18 | $258 |
| Hydralazine Hcl | 16 | $253 |
Paid to pharmacies, not to this prescriber.
Companies that both paid and supply prescribed drugs
These companies both reported payments to this provider and make drugs the provider prescribed under Medicare Part D in 2024. For most specialties this overlap is expected — a cardiologist who is paid by a cardiology drugmaker also treats heart disease. It is shown so the reader can see it, not because it implies anything on its own.
| Company | Paid to this provider | Part D cost of their drugs |
|---|---|---|
| Fresenius USA Marketing, Inc.Velphoro | $134 | $109,84640 claims |
| Akebia Therapeutics IncAuryxia | $122 | $47,83822 claims |
Reading this fairly. The Part D column is what drug plans and patients paid pharmacies — this provider received none of it, and it reflects how many patients they treat and what those drugs cost. Against peers, this provider's reported payments sit in the 90th percentile of 44 adult health providers in Hawaii.
Other adult health in Honolulu
- Christina WangHonolulu$257K
- Christella GuzmanHonolulu$8K
- Hee Yun JangHonolulu$6K
- Mandi BentonHonolulu$4K
- Terri ImadaHonolulu$4K
- Lauren ThomasHonolulu$4K
- Reid KawakamiHonolulu$3K
- Carl PitreHonolulu$2K
- Chen Yen WangHonolulu$2K
- Rozanne SchirmerHonolulu$2K
Where these figures come from
- Payments: CMS Open Payments, program years 2019–2025 (publication P06302026_06032026).
- Billing: Medicare Physician & Other Practitioners, data year 2024. Original Medicare Part B only.
- Identity: NPPES NPI Registry, July 2026.