OBJECTIVES: The Academy of Managed Care Pharmacy (AMCP) dossier format was introduced in 2000 to guide manufacturers in presenting evidence for new pharmaceuticals, biologics, and vaccines to gain reimbursement and/or formulary placement in the United States (US) health care system. Limited information has been published on the role of these dossiers in health care decision making; therefore, this study aimed to characterize decision makers’ use of AMCP dossiers in access and formulary placement for new health technologies.   METHODS: We reviewed the published literature and third-party websites to identify how health care decision makers employ AMCP dossiers. We then developed a discussion guide for use in one-on-one interviews with medical and pharmacy directors involved in formulary decision making at a range of US health plans (national, regional, integrated). These interviews focused on how AMCP dossiers inform decision making and the usefulness of each dossier section. RESULTS: Decision makers’ reports of the utility of AMCP dossiers varied greatly. Some decision makers use AMCP dossiers directly; others conduct research independent of the dossier. Pharmacy directors are more likely to use AMCP dossiers than medical directors, who typically are provided with briefs based partly on AMCP dossiers. Clinical study data, comparator information, and drug price are key in decision making. Decision makers are highly skeptical of AMCP dossier modeling sections and offered several suggestions to increase transparency and accountability. Great value is placed on succinctness and information relevant to the disease area (e.g., in less-prevalent diseases). CONCLUSIONS: Although there are formal guidelines for AMCP dossiers, health care decision makers seek information tailored to the disease and technology. Given the varied use of AMCP dossiers in practice and the reality of US health care reform, clearly understanding payer use and perspectives is important. Brevity and accuracy are crucial for health care decision making.