Prescriber Incentives Drive Shifts in Nicotine Replacement Therapy Use at Discharge

In an interview with Pharmacy Times, Taylor Fewox, PharmD, PGY-2 psychiatry pharmacy resident at the Medical University of South Carolina, explores how prescriber incentives affected nicotine replacement therapy (NRT) prescribing at discharge, as discussed at the 2025 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exhibition. After the incentives were implemented, NRT use increased, though some prescriptions did not align with the therapies patients received during their inpatient stay. Expanded access through the indigent fund also helped more patients obtain the smoking cessation support they needed. Looking ahead, Fewox notes that the team plans to refine the process through motivational interviewing and stronger interdisciplinary collaboration to better guide patients in their cessation journey.

Pharmacy Times: What prompted this medication use evaluation on how prescriber incentives influence nicotine replacement therapy prescribing at discharge?

Taylor Fewox, PharmD: A few years ago, they had ran a report looking at all of the prescribing patterns throughout our healthcare system, and they had noticed that the psychiatry portion of the hospital didn't have adequate prescribing of NRT. So we wanted to see what we were doing on our end to make sure that we were doing our part in prescribing the most accurate for our patients. So that's what really prompted this initiative.

Pharmacy Times: What changes in NRT prescribing patterns did you observe after prescriber incentives were introduced?

Fewox: We saw an increase in the number of NRT that were prescribed upon discharge. We also saw the number of nicotine patches especially was increased. So looking at that, we saw overall more was prescribed, but also more was not appropriately prescribed, not looking at what the patients were actually using while inpatient, but just the higher number at discharge.

Pharmacy Times: How did these changes impact patient access to smoking cessation therapy at discharge?

Fewox: With the use of our indigent fund as well, we had more access to NRT therapies for our patients, which played a huge role in getting the medications to our patients to ensure that if they did want to quit smoking or work on that journey for themselves, we had that avenue for them to go.

Pharmacy Times: What key lessons can other health systems and pharmacists take from this evaluation to improve NRT prescribing and tobacco cessation outcomes?

Fewox: I think overall it's more interdisciplinary, so looking at not only us as the pharmacists but also our psychiatrists as well as our nurses and our tobacco cessation group, working with them and the patients to see where they're at in their tobacco cessation journey to make sure that we have the best tools and resources for them to be successful in that.

Pharmacy Times: Is there anything you would like to add?

Fewox: I think overall from this project that Madison and I did, we're hoping to do a revamp of the process that we do when looking at NRT prescribing patterns, so looking at motivational interviewing for our patients to see where they're at in their journey so that we can relay not only to the patients but also our attendings and psychiatrists if the patient is interested in extra resources, not only just getting NRT at discharge.