OBJECTIVES: The purpose of the study was to assess the impact of a specialty pharmacy’s (SP) medication therapy management (MTM) program on the incidence of self-reported missed/skipped doses (M/SD) of analgesic(s) in patients with chronic moderate to severe pain associated with various disease states. METHODS:  A six month study was conducted to assess the association of pharmacist counseling (PhC) on the incidence of patient self-reported M/SD of a non-narcotic analgesic. A start-of-care (SOC) assessment prior to the initial/first prescription fill at the SP included an opt-in for PhC (n = 1,410). M/SD of analgesics during the most recent prescription fulfillment period were compared at SOC and at the six month refill, using a Chi-Square analysis, Yates Correction for data continuity at p<0.05. RESULTS:  Of the 4,103 patients on an analgesic, (72% migraine/headache, 27% bone pain), 1,410 (34%) opted to receive PhC at SOC. Of the initial 4103, 1,696 continued to refill analgesic prescriptions six months after SOC with 360 (21%) being in the PhC cohort. 81 of 1,696 (4.8%) patients at SOC reported having recently M/SD and 2 of the 360 (0.56%) patients reported M/SD at six months refill, a statistically significant difference (p<0.05 level). CONCLUSIONS: This SP MTM program incorporating PhC was associated with an 88% reduced incidence of M/SD doses of non-narcotic analgesic use. Further research is recommended to determine the impact of patient counseling and to identify sub groups of patients where counseling may be of particular value. Extension of the study to additional therapeutic areas and specialty drug classes is recommended.