Background Since 2002 the US Veterans Affairs (VA) healthcare system has initiated national policies and programmes to reduce smoking among its patients and to increase evidence-based treatment for smoking.

Objective To document changes in dispensing rates of cessation-related medications in VA from 2004 to 2008.

Design Retrospective analysis of VA administrative data.

Results Prescription fills for nicotine replacement therapy (NRT), and for bupropion among NRT users, each grew more than 60% in four years. The increase stemmed primarily from treating more people rather than from filling more prescriptions per person.

Conclusion The results provide strong support for the efficacy of these policies and illustrate how healthcare systems can successfully employ multiple strategies to increase evidence-based smoking-cessation treatment.