On 10 May, President Clinton and congressional Democrats proposed a bill to expand the coverage offered by US Medicare to include a voluntary outpatient prescription drug benefit.1*The bill is one of several Medicare drug benefit proposals already introduced in Congress, and hopes are high that this election year will see the pharmaceutical industry, legislators and the administration reach a compromise over this pressing issue. However, compromise may not be easy as prescription drug coverage for America's elderly presents significant challenges for those involved, particularly pharmaceutical manufacturers.