Objective. To compare the usage of bupropion hydrochloride and nicotine replacement in Australia between 2001 and 2005. Design and Setting. We analysed aggregate data on the utilisation of: (1) bupropion under the Pharmaceutical Benefit Scheme (PBS) between 2001 and 2005; (2) bupropion and nicotine replacement therapy (NRT) on the Repatriation Pharmaceutical Benefit Scheme (RPBS) between 1995 and 2005; and (3) NRT aggregate sales data from GlaxoSmithKline for 2001-05. The National Drug Strategy Household Survey (NDSHS) 2004 was used to estimate the proportion of smokers who received a bupropion prescription in each year. Main Outcome Measures. Numbers of annual prescriptions for bupropion on the PBS and buproprion and NRT on the RPBS; annual sales figures on NRT patches (2001-05); and the estimated proportion of Australian smokers who used bupropion in 2003. Results. The number of bupropion prescriptions on the PBS peaked at 351 772 in 2001 (costing the PBS $83 million). This declined by 72% to 97 173 in 2005 (a cost of $12 million). The estimated percentage of smokers in Australia who used bupropion in a year fell from 11% in 2001 to 3.6% in 2005. The annual number of bupropion prescriptions on the RPBS fell from 3786 in 2001 to 1173 in 2005, while there was no change in the number of NRT prescriptions (3793 in 2001 and 3886 in 2005). Sales data from the leading market supplier of NRT also indicated that NRT use continued to grow in Australia while bupropion use declined. Conclusions. Bupropion usage has fallen by 72% since a peak in the year of first listing on the PBS, while the utilisation of NRTs appears to have increased, despite the price differential in favour of bupropion. Implications. Given the greater interest among smokers in NRT than bupropion (and evidence of the effectiveness and cost-effectiveness of NRT), the Australian government should reconsider its decision not to list NRT on the PBS.