OBJECTIVES: Since the 1990s, many articles have documented problems with US payers’ utilization of pharmacoeconomic studies for decision-making.  By replicating an in-depth survey methodology, this study aimed to determine the extent to which US practices had changed over the past decade. METHODS: Semi-structured exploratory interviews were conducted in 2007 to develop a survey instrument – fielded in 2007-08 with key formulary decision-makers at US insurers and US public payers in 9 pre-identified categories.  The structured set of questions examined US health care payers’ 1) use of, and attitudes and perceptions regarding, pharmacoeconomic information, and 2) opinions about how pharmaceutical manufacturers present pharmacoeconomic information. RESULTS: Compared to 10 years ago, U.S. payers regard pharmacoeconomic information much more favorably, despite variation in their use of and attitudes toward pharmacoeconomics.  Payers cluster in three groups: a minority who use pharmacoeconomic information frequently and rigorously; a broader group who examine pharmacoeconomic information informally and do rigorous analysis occasionally; and a group who only review pharmacoeconomic information in broad terms along with other drug-related information.  Across all categories, payers acknowledge that the quality of pharmacoeconomic studies has improved. Payers suggest that pharmacoeconomic studies often “answer the wrong questions”— e.g., by failing to identify the subset(s) of patients where the drug is most effective.  Payers remain skeptical towards pharmacoeconomic information and studies provided/sponsored by industry – e.g., when they perceive companies present only favorable studies. Increasingly, payers separate clinical reviews from pharmacoeconomic evaluations; the latter may be integrated with rebating discussions.  CONCLUSIONS:   US payer attitudes about and use of pharmacoeconomic information have improved; however, formal, rigorous use of cost-effectiveness analysis is not the norm.  Most payers foresee their organizations using pharmacoeconomic evaluation slightly more and would welcome a neutral entity that produced pharmacoeconomic evidence – although some question whether even government funding could insulate it from industry and political influence.