(1) In a well-functioning healthcare system treating significant numbers of elderly patients with multimorbidity, polypharmacy (5 or more drugs daily) is a consequence rather than a cause of illness. (2) Polypharmacy can increase the risk of adverse drug events but may be essential for an optimal patient therapy. (3) The number of drugs taken will be higher, and probably rightly so, in multimorbid pa-tients with chronic (incurable) diseases. (4) Targeting pill count as a measure to re-duce adverse drug events has failed to impact patient well-being, whereas a strategy that assesses patient characteristics, such as disease burden, patient functionality, care situation, and patient needs can reduce the risk of PIMs and ADEs.