Horacio Alvarez Ramirez, MD
Family Medicine · Lincoln, NENPI 1093155517
Payments from drug & device makers
What this record shows
Almost everything reported here is food and beverage — 100.0% of the total across 76 separate payments, which is the pattern of a clinician who attends manufacturer presentations rather than one with a consulting arrangement. 23 manufacturers reported payments, led by Novo Nordisk at 28.4% of the total. 2025 is the largest year on record at $316, 2.1 times the $154 reported in 2019.
Across 76 payments — averaging $17.85 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Novo Nordisk$385
- AbbVie$166
- Otsuka America Pharmaceutical, Inc.$140
- Pfizer$71
- Astellas Pharma US Inc$69
- Boehringer Ingelheim$58
- plus $468 from 17 others
Across 8 payments — averaging $228.12 each. Payments tied to a research study. These frequently flow through the physician to a hospital or research institution rather than to the physician personally.
- Sanofi US Services Inc.$2K
What the payments were for
- Food & beverage$1,357100%
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.
How this compares
$1,357 in reported general payments places this provider in the 65th percentile of 981 family medicine providers in Nebraska.
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 |
|---|---|---|
| OzempicSemaglutide | 70 | $86,359 |
| JardianceEmpagliflozin | 82 | $85,358 |
| Trelegy ElliptaFluticasone/Umeclidin/Vilanter | 59 | $45,514 |
| Combivent RespimatIpratropium/Albuterol Sulfate | 25 | $21,983 |
| TrulicityDulaglutide | 19 | $20,750 |
| XareltoRivaroxaban | 13 | $17,305 |
| Tresiba Flextouch U-100Insulin Degludec | 14 | $9,426 |
| Breo ElliptaFluticasone/Vilanterol | 13 | $8,255 |
| SymbicortBudesonide/Formoterol Fumarate | 17 | $7,150 |
| Humalog Mix 75-25 KwikpenInsulin Lispro Protamin/Lispro | 15 | $4,329 |
| Lantus SolostarInsulin Glargine,hum.Rec.Anlog | 41 | $4,004 |
| Humalog Kwikpen U-100Insulin Lispro | 11 | $3,206 |
| Atorvastatin Calcium | 319 | $2,181 |
| Albuterol Sulfate HfaAlbuterol Sulfate | 86 | $2,090 |
| Omeprazole | 100 | $2,077 |
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 |
|---|---|---|
| Boehringer IngelheimJardiance, Combivent Respimat | $58 | $107,342107 claims |
| Novo NordiskOzempic | $385 | $86,35970 claims |
| GSKTrelegy Ellipta, Breo Ellipta | $42 | $53,76972 claims |
| Lilly USA, LLCTrulicity | $13 | $20,75019 claims |
| Johnson & JohnsonXarelto | $48 | $17,30513 claims |
| AstraZenecaSymbicort | $26 | $7,15017 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 65th percentile of 981 family medicine providers in Nebraska.
Other family medicine in Lincoln
- Michael IsraelLincoln$375K
- Randy KohlLincoln$67K
- Matthew GlennLincoln$17K
- Uma NookaLincoln$12K
- Kylie ParshallLincoln$12K
- Michael HuffmanLincoln$11K
- Gary van ErtLincoln$10K
- Kelly PierceLincoln$10K
- Charles KreshelLincoln$10K
- Mark ButlerLincoln$8K
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.