The Sunshine Act, explained
Why drug and device makers must report almost every payment to a physician, what counts, what is exempt, and how the data gets published.
What the law requires
The Physician Payments Sunshine Act, passed as part of the Affordable Care Act in 2010, requires drug and medical device manufacturers and group purchasing organisations to report almost every transfer of value they make to physicians and teaching hospitals. CMS publishes the result annually as Open Payments.
The threshold is low by design. Individual transfers above roughly ten dollars must be reported, and smaller ones must be reported once a manufacturer's annual total to that physician passes a modest aggregate. This is why the database is full of sandwiches.
Who is covered
Originally physicians and teaching hospitals. Since program year 2021 the definition has been broader, taking in physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anaesthetists and certified nurse-midwives. That expansion is why provider counts jump between the 2020 and 2021 program years — it is a change in who is counted, not a change in industry behaviour.
What is not in it
Several meaningful categories. Payments to physicians who are bona fide employees of the manufacturer are excluded. Product samples intended for patients are excluded. So are educational materials meant for patients, certain discounts and rebates, and payments below the reporting threshold that never reach the annual aggregate.
Nothing about payments from insurers, hospitals or private practices is here either — the law covers manufacturers and group purchasing organisations only. Absence from Open Payments is not evidence that no money changed hands.
Disputes and corrections
Physicians can review and dispute their records directly with CMS during an annual review period before publication. Disputed records that are not resolved are still published, but flagged.
Because CMS is the system of record, corrections have to happen there rather than here — we republish what CMS publishes and refresh on a stated cadence. If you believe a figure on this site is wrong, our corrections page explains both routes.