OBJECTIVES:  Research has indicated that aligning prescribed treatments with patient preferences can maximize adherence and clinical outcomes. Herein we describe the development of a usability/preference survey for the purpose of evaluating insulin pens. METHODS:  A multi-phased study was conducted in the United States, United Kingdom, and Canada. Adhering to ISPOR Good Research Practices, desk literature was reviewed and certified diabetes educators (CDEs) were interviewed by a trained moderator to develop a draft survey to assess preferences and usability of insulin pens. Two rounds of qualitative interviews were then conducted with CDEs and patients with diabetes. Each interview served a dual purpose of both concept elicitation and cognitive debriefing, with the survey being administered on a study-provided electronic tablet. No further feedback was given after these two rounds and the survey was then considered final. RESULTS: The structured interviews (N=3; 1 per country) with CDEs provided the initial language for the survey items (e.g., rating how “smooth”, “easy to learn”, “easy to inject” each pen was). Interviews with both CDEs and patients in the first round of cognitive debriefing (N=3 CDEs and N=6 patients, with representation from each country) introduced minor changes to the wording of the instructions and the addition of the item “ability to reach the injection button” based on patients who had finger dexterity limitations. The final round of cognitive debriefing (N=3 CDEs and N=6 patients) confirmed the acceptance of the changes and tablet presentation, with nearly all respondents reporting using the tablet was “very easy”. CONCLUSIONS: The multi-phased approach helped to develop a preference and usability survey with content validity in the populations of interest. Future insulin pen studies can utilize this survey to comprehensively capture the patient/CDE perspective.