By MILT FREUDENHEIM

Consumer advocates are warning that millions of elderly Americans will face a bewildering array of new government-approved drug discount cards this spring, and Bush administration officials acknowledge that a major effort will be needed to clear up the confusion.

Administration officials said yesterday that 106 health industry companies - an unexpectedly large number - met a deadline last week for applying to sponsor the new cards. The cards will be available to 10 million Medicare beneficiaries who do not have drug coverage, as a precursor to the prescription drug benefit scheduled to begin in 2006.

Industry executives and consumer advocates say that officials have not yet answered many questions about the cards - how users will go about making the most of the available discounts, for example, or how the cards will mesh with existing drug subsidy programs.

"We're talking about people who are vulnerable economically and who may be taking quite a few medications," said John C. Rother, director of policy and legislative affairs for AARP. "This will be complicated. We need to get clarity, guidance from the administration."

The applicants include retail pharmacy groups, health insurers, pharmacy benefit managers and other companies. Medicare officials said they would announce the approved sponsors in late March, but companies that specialize in managing drug benefits have already faxed contracts to thousands of pharmacies, urging them to agree to payment terms for the cards.

Each sponsor will offer a unique mix of discounts based on the deals that they cut with drug makers, but Medicare participants will be allowed to have only one government-approved card.

Sponsors will begin marketing the cards in April, enrollment will start in May and officials have promised that pharmacies will start accepting the cards in June. Medicare says that the cards will provide discounts of 10 to 25 percent from retail prices on many drugs.

Companies that have applied to offer cards include the big pharmacy benefit management companies, including Medco Health Solutions, AdvancePCS, Express Scripts and Caremark Rx; health insurers like UnitedHealthcare, Aetna and Wellpoint Health Networks; and pharmacy trade groups, including the National Community Pharmacists Association and the National Association of Chain Drug Stores. As card sponsors, health plans and pharmacy benefit managers hope to get a head start on capturing Medicare customers before 2006, when the cards will be replaced by a government-financed drug benefit under the new law. The sponsors will be closely watched by government officials and patient advocates to ensure that rebates they obtain from drug makers are passed along to Medicare enrollees, as the program requires.

Pfizer and Eli Lilly, which issue cards offering discounts to low-income people on drugs they make, said that they would make the same discounts available to any holder of a Medicare drug card who meets their income limits. A spokeswoman for GlaxoSmithKline said the company would continue to offer its own discount card as well as the TogetherRx card that it sponsors with seven other manufacturers.

Officials of the government's Centers for Medicare and Medicaid Services said that they were working at a breakneck pace to meet the program's timetable.

"It's important that we get information out in a way that people will understand it," said Leslie V. Norwalk, acting deputy administrator of the agency, which has lost several of its top officials to private industry since the passage of the new Medicare law last November. "It's critical that we educate as many Medicare beneficiaries as we can possibly reach."

No one knows how many competing cards will be available in a given city or state, but residents of big cities are likely to face complicated choices. "If there are 30 or 40 card sponsors in the New York area, including chain drugstores and insurers, it is going to be really hard to compare card to card in a way that will make sense to a lot of people," Mr. Rother said.

According to Ms. Norwalk, consumers will be able to use the Medicare Web site, www.medicare.gov, to compare prices of 209 classes of drugs offered through cards available in their ZIP code. Card sponsors will be required to cover those classes of drugs.

But only 6.5 million, or about 19 percent, of Americans 65 and older have access to the Internet at home or work, according to comScore Media Metrix, an Internet research firm. And in December, fewer than one-half of 1 percent of those looked at the Medicare site, where basic information about the cards is available.

"They talk like everybody is a technology specialist," said John M. Rector, senior vice president of the National Community Pharmacists Association, which represents independent drugstores and worries that their competitors, the pharmacy benefit managers, will use the program to build enrollment in mail-order drug plans. "Not everybody can do those things."

The drugstores, not surprisingly, have a different strategy. They plan to urge Medicare customers to enroll in a pharmacy-sponsored card plan, which will offer 90-day supplies and counseling by pharmacists and will stress lower-cost generic drugs.

Ms. Norwalk at Medicare agreed that it would be "confusing for a beneficiary" to decide which of many possible discount cards to use.

Medicare participants are permitted to have only one Medicare-approved card, for which the sponsor can collect a maximum $30 annual fee, but "the number of other cards they have is up to the individual," she said. "We hope the pharmacy can help the beneficiary figure it out." Participants can switch Medicare-approved cards once over the program's lifetime.

Companies applying to be card sponsors through Medicare must arrange networks of conveniently located pharmacies, but pharmacies do not have to accept the Medicare cards.

"The reimbursements are very poor," said Russell Gelles, owner of the Apthorp Pharmacy on the Upper West Side of Manhattan. "A lot of pharmacists are taking a wait-and-see attitude" before deciding whether to accept the cards.

Many health care companies say the new cards will be good for business. "The government expects to spend $1.8 trillion on drugs over the next 10 years," said Alan Spielman, general manager of federal programs at Medco Health Solutions, a big pharmacy benefit manager. "It is a major growth opportunity for us."

David B. Snow Jr., chief executive of Medco, said he expected that drug makers would agree to sizable rebates for the Medicare program, resulting in lower prices for consumers than through other discount programs.

"The manufacturers are under pressure to provide access to their drugs to people who can't afford them,'' said Barbara A. Ryan, a drug analyst at Deutsche Bank Alex. Brown. "They want to prevent the government from stepping in with price controls on drugs some day."

The annual fee for the card will be waived for an estimated 4.5 million low-income Medicare enrollees, and they will be eligible for a $600 credit to use toward discounted drugs.

But in the past it has been difficult to enroll all those eligible for low-income health programs. Consumer advocates say that some low-income people may be better off sticking with coverage from subsidized drug programs in states like New York, New Jersey and Pennsylvania.

People also may be able to save money by buying drugs from Canada, experts said, though the Bush administration, under pressure from American drug makers and distributors, has warned about safety and quality issues with such drug imports, which are illegal.

"It's going to be near impossible to make an informed choice," said Diane Archer, a policy expert at the Medicare Rights Center, a patient advocacy organization that has posted questions and answers about the program on its own Web site, www.medicarerights.org.