RESEARCH OBJECTIVE: Novel antipsychotic medications have several advantages over traditional agents in the treatment of schizophrenia. Little is known about factors that affect prescribing of novel agents. This study examines variation in novel antipsychotic prescribing at 13 VA Medical Centers from six Veterans Integrated Service Networks (VISNs). STUDY DESIGN: Using automated data from 13 VA Medical Centers at six VISNs, we identified 740 patients with an outpatient prescription for antipsychotic medication following their last discharge with a diagnosis of schizophrenia in 1997. Most patients (711) were male. Approximately 46% were African American, 46% were white, and 7% were Hispanic. Mean age was 48.5 (range 22-89). POPULATION STUDIED: Schizophrenic patients. PRINCIPLE FINDINGS: Novel antipsychotic medications were prescribed for 46.2% of the subjects, with significant variation among the facilities (?2 = 24.9, df=12, P=0.015, range 26.8-58.9%) and less significant variation among the VISNs (?2 = 9.85, df=5, P=0.08, range 39.5-54.4%). About 6% of the patients (46) were given depot antipsychotic medications. Only 1 person received both depot and novel antipsychotic medications. Although the study population consisted of approximately equal numbers of white and African American subjects, 72% (33) of the subjects prescribed depot antipsychotics were African Americans. White patients were more likely than non-whites to receive novel antipsychotic medications (OR=1.836, P=0.0002) controlling for marital status, gender, age, and facility. CONCLUSIONS: Less than half of patients with schizophrenia are receiving novel antipsychotic medications in this sample. In addition, there is significant variation among facilities as well as by ethnicity. IMPLICATIONS FOR DELIVERY AND PRACTICE: The variation among facilities as well as by ethnicity suggests that prescribing practices for these agents could be improved. Further research is needed to determine the factors that influence these practices.