OBJECTIVES: To document the current level of need for medications among currently underinsured elderly individuals and to describe the medical conditions that lead to hospitalizations in this group. METHODS: This study utilizes a unique data base containing "quasi-claims" data on 5303 Maryland residents 65 years of age or older who received free drugs from Patient Assistance Programs (PAPs). MEDBANK, a program that helps low-income individuals cope financially by assisting them in applying for free-drug programs, maintains an internal data base on the drugs requested and those that were received. This data base makes it possible to identify the drugs that were requested and received by this group for which no claims data base exists. Elderly MEDBANK recipients are then matched to the state of Maryland inpatient discharge data base to identify the diagnoses for which these individuals were hospitalized. RESULTS: The most frequently requested drugs were cardiovascular agents, which account for 42% of all requests. Commensurate with that result, we find that the top primary diagnosis for hospitalizations of this population was for diseases of the circulatory system. The least accessible drugs were anti-infective systemic agents, for which patients received only 34% of their requests. Overall, MEDBANK recipients received 59% of the drugs requested. The median patient received about two-thirds of their requests, while the median number of drugs requested and received, respectively, were six and three. CONCLUSIONS: PAPs allowed Maryland Medicare eligible individuals to receive only 59% of the drugs they requested, highlighting the need for additional coverage.