OBJECTIVES: Buprenorphine transdermal system (BTDS) is indicated for the management of moderate to severe chronic pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. The purpose of this study was to assess medication persistence in patients on BTDS across varying dose strengths and in patients who had a dose change. METHODS: Patients aged >18 years initiating BTDS during 1/1/2011-11/30/2011 were identified in the IMS Private Practitioner Medical Claims database and IMS Pharmacy Claims database. The index date was defined as the first prescription of BTDS. Medication persistence, dose change and final dose strength were assessed in the post-index 6-month period. Persistence was defined as the duration of BTDS therapy prior to the 1st28-day refill gap. Descriptive statistics, t-tests and ANOVA were used to compare differences in persistence across patient cohorts. RESULTS: The study included 10,457 patients newly treated with BTDS. Medication persistence was significantly higher across patients receiving higher final doses (49.1 days (n=3,769), 69.2 days (n=4,463) and 97 days (n=2,225) for 5mcg/hr, 10 mcg/hr and 20 mcg/hr doses, respectively, p<0.0001). Additionally, persistence for patients who had a dose change (n=3,297) was 111.4 days, compared to 47.8 days for those who did not (p<0.0001). Sensitivity analyses on patients with ≥ 2 BTDS claims (n=5,444) showed that patients on final dose strength 10 mcg/hr and 20 mcg/hr had 8.9 days and 19.2 days longer persistence when compared to patients on 5 mcg/hr (p<0.0001). Also, among patients with ≥2 BTDS claims, persistence was, on average, 17.1 days longer for patients who had a dose change compared to patients who did not (p<0.0001). CONCLUSIONS: BTDS persistence was longer among patients with higher final dose strengths and who had a dose change. Management of BTDS dosage over time and appropriate dose titration may impact persistence on BTDS therapy.