OBJECTIVES: To examine the most common reasons for primary or specialty care visits among fibromyalgia patients initiated duloxetine or pregabalin. METHODS: Using a large US commercially-insured administrative claims database, we examined fibromyalgia patients aged 18-64 who initiated duloxetine or pregabalin in 2006. All patients were required to have 12 months of continuous enrollment prior to and after the initiation. Applying propensity scoring, we constructed the duloxetine and pregabalin cohorts to have similar demographics, comorbid medical conditions, prior healthcare utilization and costs, and prior medication use. Using the first diagnosis recorded in all outpatient claims, we examined the reasons for primary vs. specialty care over the 12-month post-index period. Controlling for cross-cohort differences, we assess the impact of duloxetine vs. pregabalin initiation on the top reasons for primary care or specialty care visits via logistic regressions. RESULTS: The study sample included 3,711 duloxetine and 4,111 pregabalin patients with a mean age of 51 years and around $19,000 prior total healthcare costs. Duloxetine and pregabalin patients shared 8 (9) out of the 10 top reasons for primary (specialty) care visits, with most of the prevalence rates/10,000 being higher (lower) among the duxeteine patients. Controlling for cross-cohort differences, duloxetine patients were more likely to have a primary care visit due to disorder of soft tissue, essential hypertension, or other general symptoms (odds ratios=1.12, 1.16, 1.14, respectively), but less likely to go to specialty care due to disorder of soft tissue, nonspecific backache/other back/neck pain, or intervertebral disc disorder (odds ratios=0.83, 0.69, 0.63, respectively) (all p<0.05). CONCLUSIONS: Among commercially-insured fibromyalgia patients who initiated duloxetine or pregabalin, the most common reason for primary or specialty care was somewhat different. Duloxetine initiators tended to be less likely to use specialty care, and more likely to use primary care for disorder of soft tissue.