The article "Psychiatrist Bills Pharmacy Manager for Time" in the November 17, 2006, Psychiatric News raises several interesting issues by Dr. Edward Gordon that merit additional exploration.

First, assuming there is any legal basis for billing a pharmacy benefit manager for the administrative time required to validate a prescription—and by the way, there is none—playing out the scenario would lead to a cascade of events that Dr. Gordon is unlikely to have envisioned and clearly would prefer to avoid.

Last year, Medco safety alerts were triggered more than 11 million times, warning of potential harmful drug interactions and other issues that had been created by prescribers who, for whatever reason, wrote prescriptions that could have potentially harmed their patients. We would ask Dr. Gordon where we might send our invoice for building and maintaining these systems and monitoring and correcting the prescribing errors.

Last year, Medco pharmacists were required to make more than 1.9 million doctor contacts to clarify illegible handwriting on prescriptions. We would be delighted to invoice prescribers to compensate our pharmacists for their lost time.

Last year, Medco pharmacists made an additional 1 million contacts to suggest alternative medicines that, while providing an equivalent therapeutic effect, would save patients and payers tens of millions of dollars.

Countless studies have shown that if physicians made greater use of information technologies currently available, much of this frustrating administrative work would simply disappear. Medco obviously shares Dr. Gordon's interest in helping patients to receive the highest quality care—but we are also committed to ensuring that care remains safe and affordable and in conformance with federally established guidelines for Medicare Part D.