My primary concern is that popularizing the use of pill splitting for cost-saving reasons may ultimately boomerang and not only increase pharmaceutical costs but also adversely affect medication adherence. How could this happen? On the basis of several years of consulting with the pharmaceutical industry, my guess is that this kind of study would steer a company away from a "flat pricing" policy in which the cost per pill is roughly the same regardless of dose. Such a study may also cause a company to reconsider whether it made sense to make the tablets easy to split. It is probably not a coincidence that risperidone has all of these patient-friendly dose-regimen features and has wound up being the choice for the VA pill-splitting project. Therefore, from a financial perspective, new medications may be "punished" for having patient-friendly regimen features. Then no one should be surprised when new medications are priced per milligram rather than what is effective for the individual patient, or when the medications are not easy to split or are inconvenient in other ways.