OBJECTIVES:  The purpose of this study was to assess the impact of active, telephonic patient counseling by a specialty pharmacist on medication adherence and persistance. We examined prescription patterns for whether patients elected to receive counseling related to the use of their prescription medication indicated for management of moderate to moderately severe pain treated with a self-administered, intranasal, prescription, non-steroidal anti-inflammatory drug. METHODS:  Utilizing a proprietary specialty pharmacy medication therapy management (MTM) program, we conducted a six month study to assess the impact of counseling. Specialty pharmacy patients with a chronic pain diagnosis (n=5,262 - migraine/cephalgia comprising 72% of those with known diagnosis) were counseled during the start of care (SOC) assessment prior to dispensing the initial dose of the pain medication and then at the time of refilling their prescription. Patients were divided into two separate cohorts at SOC by those that elected to receive counseling by a pharmacist (RPh) and those that did not elect to receive counseling. Adherence and persistance were assessed at 6 months after start of treatment and the proportion of patients remaining on treatment was compared using a chi-square analysis. RESULTS:  Of the 5,262 patients that started treatment, 1,446 (27%) elected to receive counseling at SOC. After 6 months of treatment 548 (10%) of patients remained on treatment. The proportion of patients remaining on treament and requested refills differed depending on whether the patient elected to receive counseling (250 of 1446 remained on treatment, 17.3%) or did not receive counseling (298 of 3816 remained on treatment; 7.8%). The difference in proportion of patients still on treatment and requesting refills after 6 months was statistically signficant (p<.001). CONCLUSIONS:  This specialty pharmacy data analysis demonstrates the value of patient counseling by specialty pharmacists that was associated with a positive impact on prescription filling persistance.