This review examines the national trends in out-of-pocket and high economic burden of prescription drug expenditures by elderly people aged 65 years and older. From 1992 to 2000, prescription out-of-pocket drug expenditures increased at an annual rate of 7%. During this period the proportion of elderly without prescription drug coverage steadily decreased from 42% in 1992 to 21% in 2000. The proportion of elderly bearing high burden declined from 1992 to 1996 and steadily increased after 1997, despite the growth in prescription drug coverage. Taken together, these findings suggest that coverage expansion alone may not be sufficient to reduce the out-of-pocket prescription expenditures burden on the elderly. Some subgroups of the elderly, such as women and the chronically ill, were vulnerable to a high prescription expenditures burden throughout the 1990s.