Financial constraints versus public desire for more-generous healthcare create a difficult dilemma for countries globally. As each market strives to manage its prescription drug market, highly specific market access requirements and challenges abound for drugmakers. Innovative developers must engage with payers much earlier in the product development cycle in order to optimize trial design to satisfy specific MA and payer requirements on demonstrating innovation (e.g. selecting the appropriate comparator, targeting the correct/local patient population, gathering the most compelling head-to-head). By exploring how pricing and reimbursement (P&R) decisions are made in many major and developing markets around the world, we have developed a Country Archetypes model that identifies similarities among payer requirements, and, vitally, determines where product value messaging can be leveraged to optimize market access strategy. Data on payer type and drug review processes, payer fragmentation, percentage of individuals covered by a health insurance system, size of the pharmaceutical market, percentage of government and individuals in healthcare spending, and use as a reference country for other nations were collected for 27 of the largest pharmaceutical markets in the world. Considerations around free pricing, health technology assessment, and review of pharmacoeconomic and outcomes research data rules were made, and further segmentations on decision impact, size of reimbursable market, out-of-pocket costs, role of health insurance and market fragmentation applied. Ultimately, from the 27 nations examined, six groups emerged, each comprising countries with commonalities across all measures, albeit distinct profiles that affect P&R: Accountants, Pragmatists, Evidence seekers, Deal-makers, Ceiling setters, and Independents. Our Country Archetype model is intended to help multinational pharmaceutical companies prepare for local reimbursement evaluations, and pinpoint where decision-makers can be found. With classifications based on the most important set of reimbursement criteria necessary to attain favorable access in each market, the keys to access can be found and turned.