OBJECTIVES: To understand how best to facilitate effective, early dialogue between pharma and payers by determining payer needs and drivers, facilitating sponsor alignment of market access strategies to meet those needs, and ultimately ensuring patient access to innovative and effective treatments. METHODS: Questionnaires were sent to 5 pharmaceutical companies to determine their payer engagement strategies, whilst individual interviews were conducted with 5 payer proxies (Spain, Italy, France, UK, Germany) to gather their feedback on current payer engagement practices and suggestions for future working practices with pharma. A decision tree was then constructed to provide a framework detailing the optimal engagement format for specific time points in the product lifecycle, which was subsequently verified by all participants to substantiate its utility in meeting the needs of both parties. RESULTS: Sponsors favoured face-to-face ‘advisory board’ meetings for payer engagement, whilst payer interviewees cited a neutral reaction towards this type of engagement, preferring more dynamic engagement activities closely tailored to both the individual issue at hand and their own objectives.  Additional payer emphasis was placed on the need for early engagement and incorporation of key variables into clinical trial outcomes. Finally, feedback from both samples suggested an ‘advisory board’ structure for engagement is not always efficient or effective, prompting us to develop a framework detailing alternative engagement options aligned to key research questions. Both groups responded positively to the model: sponsors citing efficiency and payers an appreciation of the range of ways sponsors were prepared to engage. However, some payers cited a hesitancy toward more virtual methods and their ability to facilitate effective two-way dialogue.  CONCLUSIONS: Payers are open to and supportive of alternative modes of engagement with sponsors to promote more effective, early collaboration whereby each parties’ needs, drivers and constraints can be understood to ultimately ensure mutual benefit and fair and appropriate patient access.