clinicaltrials-gov · CMS
clinicaltrials-gov · CMS
clinicaltrials-gov · CMS
clinicaltrials-gov · CMS
clinicaltrials-gov · CMS
ClinicalTrials.gov is the public ledger of American medical research: every interventional and observational study a sponsor registers, with its phase, its sponsor, its conditions, and — crucially — its status. Most registries are read for what is starting. Read this one for what is stopping and a different picture emerges. Of the studies that have run their course, a sizeable minority never reached the finish line at all, and the trials that stop are not scattered at random. They cluster at one stage of the development pipeline, in a pattern that has a well-known name.
About 1 in 7 settled trials never completes
Of the 373,998 trials on ClinicalTrials.gov that have reached a settled outcome — completed or stopped — 51,959 ended in discontinuation rather than completion. That is 13.9%, about one in seven. Across all 589,453 registered studies, including those still ongoing, the discontinued share is 8.8%.
| Outcome | Trials | Share of settled |
|---|---|---|
| Completed | 322,039 | 86.1% |
| Terminated | 33,776 | 9.0% |
| Withdrawn | 16,459 | 4.4% |
| Suspended | 1,724 | 0.5% |
| Discontinued (any) | 51,959 | 13.9% |
Source: ClinicalTrials.gov, the four settled lifecycle outcomes, snapshot 2026-06-14. "Settled" excludes ongoing trials and the legacy UNKNOWN status.
The denominator matters here. Of the full registry, 322,039 trials are completed and 51,959 are discontinued; the rest are still running or carry the legacy UNKNOWN status — 93,459 studies whose sponsors stopped updating them past their expected end date. Counting discontinuation only over trials that have actually reached an outcome keeps unsettled and abandoned-on-paper records out of the rate.
A discontinued trial is a study-lifecycle event, not a verdict. It records that a registered study stopped before completing — and says nothing about the conduct, competence, or standing of any investigator, sponsor, or provider connected to it.
The Phase 2 valley
Attrition is not spread evenly across the pipeline. 23.0% of settled Phase 2 trials discontinued — the highest of any single phase — against 15.3% at Phase 3 and 14.7% at Phase 1. The combined Phase 1/Phase 2 designs are higher still, at 27.2%.
| Phase | Settled | Discontinued | Discontinuation rate |
|---|---|---|---|
| Phase 1/Phase 2 | 10,141 | 2,761 | 27.2% |
| Phase 2 | 43,693 | 10,031 | 23.0% |
| Early Phase 1 | 3,384 | 771 | 22.8% |
| Phase 2/Phase 3 | 4,762 | 986 | 20.7% |
| Phase 4 | 24,966 | 4,067 | 16.3% |
| Phase 3 | 30,539 | 4,680 | 15.3% |
| Phase 1 | 37,713 | 5,526 | 14.7% |
Source: ClinicalTrials.gov, discontinuation rate by phase among settled trials, snapshot 2026-06-14.
This is the efficacy-stage valley. Phase 1 asks a narrow question — is the candidate safe enough to keep testing? — and most candidates clear it. Phase 2 asks the harder one: does it actually work, and at what dose? That is where a development program most often discovers the answer is no, and stops. The drop back at Phase 3 (15.3%) is partly survivorship — only candidates that already showed a Phase 2 signal advance — and partly stakes: by Phase 3 a sponsor has committed enough that it pushes a marginal program to a definitive read rather than abandoning it. The two-phase Phase 1/Phase 2 designs, which compress dose-finding and efficacy into one protocol, carry the combined risk of both and stop most often of all.
Who stops: a phase-mix illusion
Read across all trials, industry-sponsored studies discontinue slightly more often than everyone else — 15.3% against 13.4%. Hold the phase constant and the order reverses.
| Lead sponsor class | Settled | Discontinued | Discontinuation rate |
|---|---|---|---|
| Other (academic, hospital, foundation) | 247,117 | 33,364 | 13.5% |
| Industry | 101,598 | 15,559 | 15.3% |
| NIH | 9,753 | 1,327 | 13.6% |
| U.S. Fed (non-NIH) | 3,776 | 469 | 12.4% |
| Other government | 7,849 | 633 | 8.1% |
Source: ClinicalTrials.gov, discontinuation rate by lead-sponsor class among settled trials, snapshot 2026-06-14.
The all-trials gap is an artifact of what each kind of sponsor runs, not of how often each one fails a comparable trial. Industry runs disproportionately many phased drug trials — exactly the high-attrition designs in the table above — while academic and government sponsors run a larger share of non-phased (NA) and observational work that stops less often. Restrict the comparison to phased interventional trials and the picture flips: non-industry sponsors discontinue 21.0% of those trials against 15.8% for industry, and the gap holds inside Phase 2 specifically (24.7% non-industry versus 20.6% industry). The most plausible reading is structural — better-resourced trial monitoring and operational support on the industry side — not a quality verdict on academic science. The headline number and the phase-controlled number point in opposite directions, and the phase-controlled one is the fairer comparison.
Two kinds of stopping
"Discontinued" hides two structurally different events, and the enrollment data separate them cleanly. 98.8% of withdrawn trials enrolled zero participants; terminated trials had a median enrollment of 21.
| Status | Trials | Enrolled zero | Median enrollment |
|---|---|---|---|
| Terminated | 33,776 | 0.1% | 21 |
| Withdrawn | 16,459 | 98.8% | 0 |
Source: ClinicalTrials.gov, enrollment profile of withdrawn versus terminated trials, snapshot 2026-06-14 (over trials with a reported enrollment count).
A withdrawn trial was called off before it touched a single participant — a registered intention that never became a running study, abandoned at the planning line. A terminated trial is the harder case: it enrolled real people, generated real data, and then stopped before reaching its endpoint. The distinction is why this study reports the two separately rather than collapsing them into one "failure" count. They describe different points in a study's life, and treating a never-started protocol the same as a halted mid-stream trial would blur exactly the thing the registry is precise about.
What one row actually is
Each row in clinical_trials is one registered study: its NCT identifier, brief and official titles, overall status, study type and phase, lead sponsor and sponsor class, enrollment count, conditions, start and completion dates, and the listed overall officials. The published registry is the current roster of registered studies as of the snapshot, and counting and grouping these rows is the entire method here. Investigator names are present where ClinicalTrials.gov published them, but the name-to-entity-graph link is deferred and held, so no trial or investigator renders on any individual provider profile. Every figure in this study is a count or percentage at the status, phase, or sponsor-class level. No investigator, sponsor, or trial is named, ranked, or scored.
Methodology
All figures are direct aggregations over the clinical_trials table, populated from the ClinicalTrials.gov Data API v2 — the U.S. National Library of Medicine's registry of interventional and observational clinical studies. The table holds 589,453 registered studies across 50,756 distinct lead sponsors; snapshot 2026-06-14; public, read-only; license per the ClinicalTrials.gov Terms & Conditions for NLM public data. Fonteum re-pulls the registry on snapshot publication, so figures advance with each refresh.
Discontinuation rates are computed over settled trials only — those whose overall_status is COMPLETED, TERMINATED, WITHDRAWN, or SUSPENDED (373,998 trials) — because ongoing statuses (RECRUITING, ACTIVE_NOT_RECRUITING, NOT_YET_RECRUITING, ENROLLING_BY_INVITATION) and the legacy UNKNOWN status have not reached an outcome and would distort the denominator. "Discontinued" is the union of TERMINATED, WITHDRAWN, and SUSPENDED. Phase figures use the registry's phase field as recorded; the phase-held-constant sponsor comparison restricts to the seven phased interventional buckets (Early Phase 1 through Phase 4) so that industry and non-industry trials are compared on like designs. Because these are counts and ratios over a published registry, every figure is exact as of the snapshot rather than estimated. Methodology version: clinicaltrials/v1. The source-provenance contract is documented in the provenance methodology.
Limitations
- A lifecycle event, not a quality or conduct signal. Discontinuation records that a registered study stopped before completing. It is unrelated to exclusion, sanction, discipline, or any assessment of an investigator's, sponsor's, or provider's competence or conduct. This study draws no inference about any party from a trial's status.
- Aggregate and category-level only. Every figure is a count or percentage at the status, phase, or sponsor-class level. No investigator, sponsor, or individual trial is named, ranked, or scored, and the name-to-entity-graph link is deferred, so no trial renders on any provider profile.
- Status is self-reported by the sponsor. ClinicalTrials.gov statuses are filed and updated by the responsible party. The large UNKNOWN block (93,459 studies) is precisely the population whose sponsors stopped updating; this study excludes it from rate denominators rather than guessing an outcome.
- Reasons for stopping are not modeled. Terminated, withdrawn, and suspended cover many underlying causes — recruitment, funding, business decisions, interim efficacy looks, safety findings — which the status field alone does not distinguish. This study reports rates of stopping, not why trials stopped.
- Snapshot, not a trend model. Figures reflect the single registry snapshot dated 2026-06-14. The registry is refreshed on publication and ongoing trials continue to settle, so rates shift between releases; this study does not model change over time.
- Phase as recorded. Grouping follows the registry's phase labels exactly. Non-phased (NA) and unphased records are reported as their own rows and are excluded from the phase-held-constant sponsor comparison.
Sources
- ClinicalTrials.gov — the U.S. National Library of Medicine registry behind every figure in this study.
- ClinicalTrials.gov Data API v2 — the public API Fonteum pulls the registry snapshot from.
- ClinicalTrials.gov — trial status definitions — the official definitions of completed, terminated, withdrawn, and suspended used to group outcomes here.
The companion dataset page for ClinicalTrials.gov Studies lists the full schema and refresh cadence, and the clinical-trials data explorer exposes the underlying records. For the drug-and-device lifecycle that begins where these trials end see the 2026 drug and device recall landscape; for who funds the research economy these trials sit inside, the manufacturers behind industry payments to clinicians and the pharma payments tied to GLP-1 prescribing; and for the providers on the other side of that pipeline, the changing shape of Medicare enrollment and who opts out of Medicare entirely.
Frequently asked questions
- What does it mean for a clinical trial to be 'discontinued'?
- It means the study stopped before completing. ClinicalTrials.gov records three discontinued states: terminated (the study halted after enrolling participants), withdrawn (it halted before enrolling its first participant), and suspended (it paused). Together these are 51,959 of the 373,998 trials that have reached a final outcome — 13.9%, about 1 in 7. Discontinuation is a study-lifecycle event, not a quality or conduct signal.
- Which phase of clinical trial fails most often?
- Phase 2. Among settled trials, 23.0% of Phase 2 studies discontinued, the highest of any single phase, against 15.3% at Phase 3 and 14.7% at Phase 1. Combined Phase 1/Phase 2 designs are higher still at 27.2%. Phase 2 is the efficacy stage — the point where a candidate that already cleared initial safety must show it actually works — so attrition concentrates there rather than at the safety-focused Phase 1.
- Do industry-sponsored trials fail more often than academic ones?
- It depends how you count. Across all trials, industry-sponsored studies discontinue slightly more often (15.3% vs 13.4% for all other sponsors). But that is a phase-mix effect — industry runs disproportionately many phased drug trials, which fail more. Hold phase constant and the order reverses: among phased interventional trials, non-industry sponsors discontinue more (21.0% vs 15.8%), and the gap holds inside Phase 2 (24.7% vs 20.6%).
- What is the difference between a withdrawn and a terminated trial?
- A withdrawn trial stops before enrolling its first participant; a terminated trial stops after enrolling some. The registry data confirm the distinction cleanly: 98.8% of the 16,459 withdrawn trials enrolled zero participants, with a median enrollment of 0, while the 33,776 terminated trials had a median enrollment of 21. One is an abandonment on paper; the other is a study halted mid-stream.
- Does a discontinued trial mean someone did something wrong?
- No. A discontinued status is a lifecycle record, not a disciplinary or quality signal. Trials stop for many reasons — slow recruitment, funding, a business decision, an interim look that changed the calculus, or a safety finding — and the registry status alone does not distinguish them. This study draws no inference about any investigator, sponsor, or provider from a trial's status.
- Why are so many registered trials still marked 'unknown' or ongoing?
- ClinicalTrials.gov holds 589,453 registered studies, but only 373,998 have reached a final outcome. The rest are ongoing (recruiting, active, not yet recruiting) or carry the legacy UNKNOWN status — 93,459 studies whose sponsors stopped updating them past their expected completion date. This study computes discontinuation rates only over settled trials, so unsettled and never-updated records do not distort the denominator.
- Can I reproduce these figures?
- Yes. Every number is a direct count over the public clinical_trials table — the ClinicalTrials.gov Data API v2 registry, snapshot 2026-06-14 — with no modeling. The exact SQL for the discontinuation rate, the phase breakdown, the sponsor-class split, the phase-held-constant reversal, and the withdrawn-versus-terminated enrollment profile is published in the reproducibility block below.
Who uses this data
The source data behind this study is public
Compliance teams, journalists, and researchers work from the same federal source families cited above — queried by NPI or facility identifier through Fonteum’s open dataset pages and API. Every figure traces to a frozen, downloadable snapshot you can reproduce yourself.
Datasets used
Reproducibility
Every claim, reproducible
The SQL
-- How often clinical trials STOP before completing — and where the attrition
-- concentrates. Fully reproducible query.
--
-- Question: of the studies registered on ClinicalTrials.gov, how many end in
-- discontinuation (terminated, withdrawn, or suspended) rather than completion,
-- and how does that rate vary by trial phase and by who sponsors the trial?
-- The lead figure: of the 373,998 trials that have reached a settled outcome
-- (completed OR stopped), 51,959 — 13.9%, about 1 in 7 — ended in
-- discontinuation rather than completion. Discontinuation is a study-lifecycle
-- signal, NOT a quality, fraud, or wrongdoing signal of any kind, and says
-- nothing about any investigator, sponsor, or provider.
--
-- Source:
-- public.clinical_trials — ClinicalTrials.gov Data API v2 (the U.S. National
-- Library of Medicine registry of interventional and observational
-- studies). 589,453 registered studies; snapshot 2026-06-14. Public,
-- read-only. License: ClinicalTrials.gov Terms & Conditions (NLM public
-- data). methodology_version = 'clinicaltrials/v1'.
--
-- Universe: this study reads the published registry AS A WHOLE — every row is a
-- study CMS/NLM lists on ClinicalTrials.gov as of the 2026-06-14 snapshot.
-- "Settled" = a study that has reached a final lifecycle outcome (COMPLETED,
-- TERMINATED, WITHDRAWN, or SUSPENDED); ongoing statuses (RECRUITING,
-- ACTIVE_NOT_RECRUITING, etc.) and the legacy UNKNOWN status are excluded from
-- rate denominators because they have not yet settled.
--
-- Counting note: 589,453 distinct NCT IDs, one row each; no row is duplicated.
-- No individual investigator, sponsor, or provider is named in the study.
-- ============================================================================
-- (1) Universe reconciliation — the registry at a glance.
-- ============================================================================
SELECT
count(*) AS studies,
count(DISTINCT nct_id) AS distinct_nct,
count(DISTINCT lead_sponsor_name) AS sponsors,
count(*) FILTER (WHERE study_type = 'INTERVENTIONAL') AS interventional,
count(*) FILTER (WHERE study_type = 'OBSERVATIONAL') AS observational,
max(ingested_at)::date AS snapshot
FROM public.clinical_trials;
-- studies 589,453 · distinct_nct 589,453 · sponsors 50,756
-- interventional 449,800 (76.3%) · observational 137,624 (23.3%) · snapshot 2026-06-14
-- ============================================================================
-- (2) HEADLINE: the discontinuation rate. Of all 589,453 registered studies,
-- 51,959 (8.8%) are discontinued. Restricted to the 373,998 that have
-- SETTLED (reached a final outcome), the discontinuation rate is 13.9% —
-- about 1 in 7. Discontinuation = TERMINATED (stopped after starting),
-- WITHDRAWN (stopped before the first participant), or SUSPENDED (paused).
-- ============================================================================
SELECT
count(*) AS all_studies,
count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) AS discontinued,
round(100.0 * count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) / count(*), 1) AS disc_pct_of_all,
count(*) FILTER (WHERE overall_status IN
('COMPLETED','TERMINATED','WITHDRAWN','SUSPENDED')) AS settled,
round(100.0 * count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) / count(*) FILTER
(WHERE overall_status IN
('COMPLETED','TERMINATED','WITHDRAWN','SUSPENDED')), 1) AS disc_pct_of_settled,
count(*) FILTER (WHERE overall_status = 'TERMINATED') AS terminated,
count(*) FILTER (WHERE overall_status = 'WITHDRAWN') AS withdrawn,
count(*) FILTER (WHERE overall_status = 'SUSPENDED') AS suspended
FROM public.clinical_trials;
-- all_studies 589,453 · discontinued 51,959 · disc_pct_of_all 8.8%
-- settled 373,998 · disc_pct_of_settled 13.9%
-- terminated 33,776 · withdrawn 16,459 · suspended 1,724
-- ============================================================================
-- (3) WHERE attrition concentrates — discontinuation rate by trial phase,
-- among settled trials. Phase 2 is the high-attrition phase (23.0%); the
-- combined Phase 1/Phase 2 designs are worse (27.2%). Phase 3 (15.3%) and
-- Phase 1 (14.7%) are markedly lower. This is the classic efficacy-stage
-- "valley" — the point where a candidate must show it works.
-- ============================================================================
SELECT
coalesce(phase, '(none)') AS phase,
count(*) AS settled,
count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) AS discontinued,
round(100.0 * count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) / count(*), 1) AS disc_pct
FROM public.clinical_trials
WHERE overall_status IN ('COMPLETED','TERMINATED','WITHDRAWN','SUSPENDED')
GROUP BY phase
ORDER BY settled DESC;
-- NA 141,021 · 15,474 · 11.0%
-- (none) 77,779 · 7,663 · 9.9%
-- PHASE2 43,693 · 10,031 · 23.0% <- the valley
-- PHASE1 37,713 · 5,526 · 14.7%
-- PHASE3 30,539 · 4,680 · 15.3%
-- PHASE4 24,966 · 4,067 · 16.3%
-- PHASE1/PHASE2 10,141 · 2,761 · 27.2%
-- PHASE2/PHASE3 4,762 · 986 · 20.7%
-- EARLY_PHASE1 3,384 · 771 · 22.8%
-- ============================================================================
-- (4) WHO stops — discontinuation rate by lead-sponsor class, among settled
-- trials. Headline: industry-sponsored trials discontinue slightly more
-- often than everyone else (15.3% vs 13.4%). But that is a phase-mix
-- artifact: industry runs disproportionately many phased drug trials, which
-- fail more. Hold phase constant (next query) and the order REVERSES.
-- ============================================================================
SELECT
coalesce(lead_sponsor_class, '(none)') AS sponsor_class,
count(*) AS settled,
count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) AS discontinued,
round(100.0 * count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) / count(*), 1) AS disc_pct
FROM public.clinical_trials
WHERE overall_status IN ('COMPLETED','TERMINATED','WITHDRAWN','SUSPENDED')
GROUP BY sponsor_class
ORDER BY settled DESC;
-- OTHER 247,117 · 33,364 · 13.5% INDUSTRY 101,598 · 15,559 · 15.3%
-- NIH 9,753 · 1,327 · 13.6% OTHER_GOV 7,849 · 633 · 8.1%
-- FED 3,776 · 469 · 12.4% NETWORK 3,456 · 541 · 15.7%
-- industry 15.3% vs all-other 13.4% overall (the phase-mix headline)
-- ============================================================================
-- (4b) The reversal, holding phase constant: among PHASED interventional
-- trials (Early Phase 1 .. Phase 4), NON-industry sponsors discontinue
-- MORE than industry (21.0% vs 15.8%) — and the gap holds inside Phase 2
-- specifically (24.7% non-industry vs 20.6% industry). Better-resourced
-- industry monitoring, not a quality verdict on academic science.
-- ============================================================================
WITH p AS (
SELECT
CASE WHEN lead_sponsor_class = 'INDUSTRY' THEN 'industry'
ELSE 'non-industry' END AS grp,
phase, overall_status
FROM public.clinical_trials
WHERE overall_status IN ('COMPLETED','TERMINATED','WITHDRAWN','SUSPENDED')
AND phase IN ('EARLY_PHASE1','PHASE1','PHASE1/PHASE2','PHASE2',
'PHASE2/PHASE3','PHASE3','PHASE4')
)
SELECT
grp,
count(*) AS settled,
count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) AS discontinued,
round(100.0 * count(*) FILTER (WHERE overall_status IN
('TERMINATED','WITHDRAWN','SUSPENDED')) / count(*), 1) AS disc_pct,
count(*) FILTER (WHERE phase = 'PHASE2') AS phase2_settled,
round(100.0 * count(*) FILTER (WHERE phase = 'PHASE2'
AND overall_status IN ('TERMINATED','WITHDRAWN','SUSPENDED'))
/ nullif(count(*) FILTER (WHERE phase = 'PHASE2'), 0), 1) AS phase2_disc_pct
FROM p
GROUP BY grp
ORDER BY settled DESC;
-- non-industry 81,817 · 17,202 · 21.0% · phase2 25,509 · 24.7%
-- industry 73,381 · 11,620 · 15.8% · phase2 18,184 · 20.6%
-- ============================================================================
-- (5) TWO kinds of stopping — withdrawn vs terminated by enrollment profile.
-- A WITHDRAWN trial stops before enrolling its first participant; a
-- TERMINATED trial stops after enrolling some. The data confirm the
-- distinction: 98.8% of withdrawn trials enrolled zero participants
-- (median 0), against a median of 21 for terminated trials.
-- ============================================================================
SELECT
overall_status,
count(*) AS trials,
count(*) FILTER (WHERE enrollment_count = 0) AS zero_enrolled,
round(100.0 * count(*) FILTER (WHERE enrollment_count = 0)
/ count(*), 1) AS zero_enroll_pct,
percentile_cont(0.5) WITHIN GROUP (ORDER BY enrollment_count) AS median_enrolled
FROM public.clinical_trials
WHERE overall_status IN ('WITHDRAWN','TERMINATED')
AND enrollment_count IS NOT NULL
GROUP BY overall_status
ORDER BY trials DESC;
-- TERMINATED 33,529 · zero 29 · 0.1% · median_enrolled 21
-- WITHDRAWN 16,441 · zero 16,237 · 98.8% · median_enrolled 0The snapshot
| dataset_id | clinicaltrials-gov |
| snapshot_date | 2026-06-14 |
| sha256 | |
| doi | 10.5072/fonteum/clinical-trial-discontinuation-2026 |
| slsa_provenance_url |
The JOINs
universe: the registry as a whole -- 589,453 registered studies, snapshot 2026-06-14 settled = overall_status IN (completed, terminated, withdrawn, suspended) -- 373,998 trials that reached a final outcome discontinued = overall_status IN (terminated, withdrawn, suspended) -- 51,959 = 13.9% of settled, 8.8% of all 589,453 by phase: GROUP BY phase among settled -- Phase 2 23.0%, Phase 1/2 27.2%, Phase 3 15.3%, Phase 1 14.7% by sponsor: GROUP BY lead_sponsor_class among settled -- industry 15.3% vs all-other 13.4% (phase-mix headline) phase-held-constant: phased interventional trials only -- non-industry 21.0% vs industry 15.8%; within Phase 2, 24.7% vs 20.6% withdrawn vs terminated by enrollment_count -- withdrawn 98.8% zero-enrolled (median 0); terminated median 21
The pipeline version
| git_sha | |
| slsa_provenance | |
| methodology_version | clinicaltrials/v1 |
Reproduce this
Run the exact query against the frozen 2026-06-14.
Cite this study
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Check the chain
Each figure is snapshot-attested — re-derive the hash from the federal file.
clinicaltrials-gov · 2026-06-14SHA-256 a3f1c9…7e6b- CARE QUALITY · JUN 2026How serious is the average FDA recall? About one in eleven is the most serious tierOf 56,777 FDA drug and device recalls on file, 5,237 — 9.2%, about one in eleven — carry Class I, the agency's most serious tier, signaling a reasonable probability of serious injury or death. Devices drive 68.9% of recalls; 99.4% are voluntary, company-initiated withdrawals, not FDA-ordered.
- FINANCIAL DISTRESS · JUN 2026Which companies pay U.S. doctors the most? Device makers, not pharmaIn 2024, drug and device companies disclosed $3.31 billion in general payments to U.S. physicians under the Sunshine Act — and the largest payers are device makers, not pharma. BioNTech led at $180.6 million from just 164 royalty payments; the top 25 of 1,763 reporting companies account for 52% of every general-payment dollar.
- FINANCIAL DISTRESS · JUN 2026GLP-1 makers paid 120,237 Medicare prescribers $32.8 million in 2024 — and the prescribers they paid wrote far moreIn 2024, the makers of Ozempic and Mounjaro paid $32.8 million to 120,237 Medicare prescribers for meals, talks, and travel tied to GLP-1 drugs. Prescribers who accepted a payment wrote 78% more GLP-1 prescriptions than those who did not — a correlation this study reports at the group level, without inferring cause.
- FINANCIAL DISTRESS · JUN 2026The few drugs that drive most of Medicare's Part D bill, 2023Medicare Part D paid $275.9 billion for 3,598 drugs in 2023. The 100 costliest — just 2.8% of the list — account for $176.2 billion, 63.8% of the bill. Ten drugs alone are a quarter of it, and 61.5% of priced drugs cost more per dose than a year earlier.
- WORKFORCE · JUN 2026Who is enrolled in Medicare? The nurse practitioner is now the most common clinician413,539 nurse practitioner enrollments make NPs the single most common clinician type in Medicare's provider-enrollment file — 13.9% of all 2.98 million PECOS records, nearly triple the largest physician specialty. Together, NPs and physician assistants are one in five enrollments. Advanced-practice providers now anchor the Medicare workforce.
Federal source citations
Fonteum Research · June 16, 2026 · All figures trace to the frozen federal-data snapshot cited above.