Harlene Kopp can't stop worrying. The 70-year-old widow from Evanston, Ill., is up to 20 or so prescriptions a month for ailments including stomach problems and osteoporosis. Her stomach drug, Prilosec, by itself costs $227 for a two-month supply. With no prescription drug coverage--and with only about $4,000 in income from Social Security left after paying property taxes--Kopp must rely on a patchwork solution. She uses a state aid program that discounts drugs for certain conditions, hoards free doctors' samples, and is exploring purchasing cheap drugs from Canada. "It's not easy living these days," she sighs.

Kopp has plenty of company in her struggles. A recent survey by the Henry J. Kaiser Family Foundation found that roughly 2 in 5 Medicare beneficiaries, or 13 million seniors, lacked drug coverage altogether in the fall of 1999, and millions more are struggling to foot their pharmacy bills. Those daunting numbers are likely only to rise as Medicare HMOs continue to disappoint seniors by dropping prescription drug coverage and reducing benefits, and as corporations cut employee retirement benefits. Meanwhile, drug prices are soaring: They rose more than 17 percent last year and are projected to climb an additional 13.5 percent in 2002. Throw in the facts that seniors are now living longer--and drugs that aren't covered by Medicare are used to treat chronic conditions that once were treated in hospital procedures covered by the government program. So it's no surprise that seniors like Kopp are facing prescription price-pinch paralysis.

Steep drug prices are just part of the problem as so many seniors have no drug coverage at all, putting drugs like Prilosec out of reach whether the cost is $140 or $180 a month. (Other popular drugs, such as Zocor for high cholesterol and Vioxx for arthritis, also are expensive, costing anywhere from $80 to $112 a month.) Yet Medicare, which was developed decades ago when drug treatment was cheaper and less prevalent, doesn't cover the vast majority of drugs.

Political football. Seniors' sticker shock may one day lead to Congress's adding more prescription drugs to Medicare coverage and has already created a campaign issue in statehouses and the nation's capital. Republicans and drug industry lobbyists want private insurers to administer any new Medicare drug coverage benefit. But the GOP also seeks to spend less on drug benefits than the Democrats--many of whom want the government, rather than private insurers, to administer the program and to bargain for the best price. The election-year battles make it unlikely that a Medicare drug benefit will pass this year. Meanwhile, states and consumer groups are pursuing legal action to fight rising prices.

For now, seniors are left to fend for themselves. But if there are no easy solutions to the cost problem, there are some band-aids that can help mend financial wounds. A good place to start is with your doctor and pharmacist, says David Gross, senior policy adviser with AARP. Tell them that cost is a problem, make sure drugs being prescribed are necessary, and check that you're using the least expensive but effective drug--which may well be a cheaper generic. Doctors are showered with samples of the latest and greatest drugs by sales reps; many will hand them out to patients to help them save money. "My doctor has a closet full of samples," says Kopp. "You see everyone leaving with a little brown lunch sack."

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