If we do use PDLs, we should acknowledge that we are rationing medications. Rationing is an unfortunate policy, but we'd best start to get used to it. If rationing occurs, it should always be a public and societal event. We need best-practice models to ensure transparency in decision making and public accountability for the quality of care that ensues from all rationing decisions. Payer reviews must include completely independent parties, and the procedures that accompany rationing decisions should be crystal clear to all stakeholders. We need long-term comparative studies to inform us, so that we can make sound scientific decisions about the use of these medications. Twenty-two states have rushed to employ PDLs and more are considering it. I hope that the states consider the potential consequences of their decisions: are we hurting patients or inflating costs? For more background, see my Web site: www.medaccessonline.com.