OBJECTIVES: To evaluate medical and pharmacy costs associated with breakthrough pain (BTP) in a commercially-insured population with chronic, cancer-related pain. METHODS: The National Breakthrough Pain Survey studied a large commercially-insured population using claims data and structured interviews to assess the prevalence, characteristics, and impact of BTP. Adult patients with ≥2 medical claims at an interval ≥3 months with an ICD-9-CM code indicating a chronic pain condition (cancer or noncancer) and ≥3 opioid prescription claims consistent with chronic use were eligible. Patients were called and interviewed after providing consent; those verifying cancer pain were included in this sub-analysis. All-cause medical and pharmacy costs in 2010 US dollars were determined from administrative claims data for the 12-month period before the survey date. Generalized linear models with gamma distribution were constructed because of the skewed nature of the cost data. RESULTS: A total of 2198 patients were interviewed, 1279 had controlled persistent pain, and 145 of the latter group had cancer pain. Of those with cancer pain, BTP was reported by 77.2% (BTP, 112; no BTP, 33). Mean (SD) total annual healthcare costs for patients with and without BTP were $84,049 ($129,279) and $77,926 ($98,785), respectively. Costs in patients with BTP were 28.6% higher than patients without BTP (P=0.3211) after controlling for health plan, patient demographics, comorbidities, history of prior surgery, neuropathic pain, baseline pain severity, treatment by a pain specialist, and patient-reported pain interference. Mean (SD) total annual pharmacy costs for patients with BTP were $20,088 ($35,406) versus $9,939 ($9,715) for patients without BTP. Patients with BTP had pharmacy costs that were 81.7% higher than patients without BTP (P=0.0265) after controlling for the above variables. CONCLUSIONS: In a commercially-insured population, cancer patients with controlled, persistent pain and BTP had higher total health care and pharmacy costs than cancer patients with controlled, persistent pain without BTP.