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TOM HOGAN — Doc to a few old-timers — stares down from his perch under a 20-foot-wide sign that says "Prescriptions." For 47 years, Mr. Hogan, a pharmacist, has watched his customers approach the elevated work area in the back of his drugstore and knows most of their names and all their ailments.

The customers come for relief. Some need a prescription only for a temporary illness. But many use drugs every day, especially the older people who populate the retirement communities on the rolling countryside around this rural town of 7,300, which is 55 miles north of Tampa. These retirees need drugs for the chronic conditions that often come with age — arthritis, hypertension, high cholesterol, hormone imbalances. For them, living without these medications could mean not living at all.

"So many people, especially seniors, need drugs for a good quality of life," said Mr. Hogan, 70, the owner of Hogan's Drug Store, which is located on a busy road near Brooksville's downtown. "A prescription can allow a person who might be crippled for life to be mobile and healthier for a number of years."

The importance of prescription drugs to older people is one of the most significant changes in medicine in recent decades. The drugs have allowed millions of people in their 60's, 70's and 80's to not only live longer but also to often stay out of hospitals and nursing homes.

When Medicare was created for the elderly in 1965, the biggest need for aging Americans was insurance coverage for hospital stays and doctor visits, not for drugs. But today more than 88 percent of the program's 42 million beneficiaries use prescription drugs, filling an average of about 20 prescriptions annually. Medicare does not pay for these medications unless someone is in a hospital, nursing home or living with special conditions like a terminal illness or certain cancers.

As drugs have become more important to the aging population, the costs have also soared. Meanwhile, Medicare managed care and other private insurance plans have cut drug benefits in the last few years, meaning that the average older person spends about $500 annually himself for medications, plus hundreds and even thousands more for private insurance policies to cover some of the cost of prescriptions.

The need for a Medicare drug benefit has drawn almost universal support, but not universal agreement on how or when to add coverage for prescriptions. And while the political debate in Washington drags on with little hope for action this year, the reality can be seen in thousands of pharmacies like Tom Hogan's, which serves a town and county where more than 30 percent of the population is 65 years or older. They are places where low-income retirees ration their health care by buying fewer drugs, where the middle class finds its savings squeezed by higher costs and where even people who are well off wonder if they are one illness away from a financial crisis.

Although Mr. Hogan rejects the popular image of financially strapped older people having to choose between buying groceries or prescriptions, he said he knows that the rising cost of medicine is hurting some customers.

"I find the hair rising straight up on the back of my own neck when I pay my wholesale drug bill twice a month," he said. "Drug prices are very high. The government needs to solve the problem, especially for those people who are not covered by private insurance."

Most older people have some form of private drug coverage or qualify for Medicaid, the government medical program for the poor. Studies generally show about 25 to 30 percent of Medicare beneficiaries — more than 10 million persons — have no drug coverage. Another 25 to 30 percent have coverage that some researchers call "unreliable," like H.M.O.'s, which can raise co-payments, cap benefits each year or completely withdraw from a market.

Even people with private insurance find themselves paying hundreds of dollars a month for coverage. Derrill McAteer, a customer of Mr. Hogan's, pays more than $240 a month for a Medicare supplemental policy that only covers about 50 percent of his prescription costs.

In all, he said, he pays another $300 to $400 a month in drug co-payments and other medical costs for him and his wife. "I feel lucky, because I can afford it," said Mr. McAteer, a retired businessman, cattle rancher and real estate developer. "I know so many people who can't. It's terrible."

To look at Mr. McAteer, who is also a former Navy pilot, is to wonder why he needs drugs at all. His trim physique, mighty handshake and confident voice make him seem years younger than 69.

"I was always active," he said. "I still feel like I'm a cowboy out there with the cattle. I never thought it would happen to me. Well, I guess I thought it might happen in another 10 years when I was 80 or so."

"It" is the variety of ailments that have started in Mr. McAteer's retirement, all requiring regular medication. There is the enlarged prostate, high cholesterol, back pain from a car accident and aftereffects of heart bypass surgery in 1999.

"The problem is, we live longer than we used to," Mr. McAteer said as he held a small white bag of prostate pills one recent morning in Hogan's. "I'll be fine as long as I don't get cancer."

As a lifelong Republican, Mr. McAteer supports President Bush's slow approach to reforming Medicare, which involves helping low-income older Americans first. "He's got his hands full right now with the aftermath of 9/11," he said of the president.

Such a supporting view of Mr. Bush is common among Mr. Hogan's customers, but it is mixed with a growing frustration over rising drug prices and the seemingly endless debate over how to add prescription drug coverage to the reforms.

Mr. McAteer is part of the 10 percent of Medicare beneficiaries who get their drug coverage from private insurance policies known as Medigap. There are three Medigap policies that cover medications, which can cost $3,000 to $5,000 a year and never cover more than half the retail cost of prescriptions.

The leading method for older people to obtain drug coverage is through their former employers, whose retirement health plans cover about 33 percent of Medicare beneficiaries. But employers have cut such insurance in recent years, and those retirees fortunate enough to still have coverage are thankful.

"Oh, yes, yes, I feel lucky, because I know how much these drugs cost," said Nathaniel Chester, another customer at Hogan's Drug Store. "Unless I had my insurance, there is no way I could afford them."

The 82-year-old Mr. Chester retired in 1985 from a division of the Xerox Corporation in Rochester, where he worked as a machinist for 15 years. He has insurance through a Xerox-sponsored policy that covers everything except a small co-payment for his prescriptions.

Mr. Chester's biggest problem is arthritis in his left leg and ankle, a condition that came about when he worked as a young man in the 1930's busting rocks in the quarries near Brooksville. He now takes Vioxx, which is among the most heavily used and widely advertised prescription medications in America.

The drugs he takes for his arthritis and other ailments would cost him $300 a month if he did not have insurance. Still, Mr. Chester would like to see Medicare cover prescriptions "because there are so many people who have trouble paying." He added, "It just isn't right."

He also worries that his generous benefits could change in the future, which has happened to other blue- collar retirees. As he talked in his house on a quiet dead-end street here, Mr. Chester rubbed his knee. "I don't know how I would be without this drug," he said. "I guess I'd just sit here all day in this chair. And that's no kind of life."

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