OBJECTIVES: As payer decisions become increasingly evidence based, a key question is whether payer on national/regional level are impacted by company perceptions when assessing evidence and making decisions. To identify what perceptions payers have, if and how these impact their decisions and what differences exist across stakeholders and companies, we analysed unprompted expressions of perceptions obtained from interviews performed with national/regional payers. METHODS: We analysed 543 national/regional payer interviews, performed for 100 projects by IMSCG 2008-2011 in Europe, including 900 quotes with unprompted expressions compressed in 1900 buzz-words. Interviews were screened for quotes reflecting perceptions of pharma unrelated to research objectives. Only unprompted expressions were extracted and buzz-words created that compressed expressed perceptions into single words/phrases. Half of the quotes expressed perceptions of specific companies. Analysis of the impact of perception on payer decisions was based on 5% of overall quotes containing that link. Buzz-words were valued, ranked according to occurrence and categorized into perception causes (reputation, interaction, employees, portfolio and research). Payers validated approach and outcomes. RESULTS: Perceptions are predominantly caused by company reputation and interaction, with national payers more influenced by reputation, regional by pharma interactions.  Differences exist between portfolio versus employee perception, the former predominant in national, the latter in regional payers. While 60% of buzz-words were positive, results differ with national payers being significantly more critical towards industry then regional. The industry perception was more negative than perceptions expressed for individual companies. Perceptions directly impacting payer decisions were all negatively motivated by reputation, interactions and product perceptions (‘me-too’), predominantly impacting access. CONCLUSIONS: Payers are influenced by company perceptions, which impact their decisions. Negative industry perceptions can be changed by companies; focus should be on national payers as regional have more positive perceptions already.  Changing negative perceptions of company reputation, collaboration experience and employees’ qualifications might avoid negative impact on access decisions.