Defense officials are weighing new initiatives to limit access to the Tricare retail drug network, particularly for older beneficiaries who are using neighborhood drug outlets to get their maintenance medications.

Proposals under review, some of which require congressional action to implement, were discussed Tuesday at a public meeting of the Task Force on the Future of Military Healthcare.

The Department of Defense wants help from the task force to drive a larger proportion of 6.7 million Tricare pharmacy users into the mail-order program that is far more efficient. Prescriptions filled by retail outlets cost Tricare about 40 percent more than drugs obtained by mail.

After a yearlong marketing campaign, the number of beneficiaries using mail order rose by only 11 percent. Meanwhile, users relying solely on the retail network, with its 59,000 participating pharmacy outlets, climbed by another 170,000 in 2006.

Retail costs are $4.4 billion, or 63 percent of the Defense Department's pharmacy budget. Retail outlets, however, fill only 35 percent of all prescriptions. Mail-order costs are $740 million, or 12 percent of the budget, and handle 14 percent of pharmacy workload.

Rear Adm. Thomas McGinnis, chief of Tricare pharmaceutical operations, told the task force that co-pays for the retail network are too low to drive beneficiaries into the mail-order option to help control costs.

Of four initiatives McGinnis asked the task force to study and perhaps endorse, two would block beneficiaries who need maintenance drugs for chronic conditions from filling their prescriptions in the retail network.

Maintenance drugs are medicines, McGinnis said, that patients likely will need for the rest of their lives. For that reason, they are seen as ideal for supplying conveniently to patients by mail order. Yet beneficiaries have been reluctant to make the shift, McGinnis said.

One initiative would require that all "third tier" maintenance medications, those not on the department's uniform formulary of approved drugs, be available only by mail order, not in retail outlets. This could take effect with a change in regulation, though Congress also could block such a move. McGinnis said this change would save Tricare at least $50 million a year.

Gen. John D. W. Corley, Air Force vice chief of staff, suggested that service people need to be told that pharmacy costs are skyrocketing and choosing mail order over retail is both the smart and right thing to do.

Co-chairwoman Gail Wilensky, with the Institute of Medicine, said perhaps beneficiaries need to be warned more bluntly that their drug benefit is at risk if they don't make better choices for themselves and the government.

Perhaps they should be told "flat out," Wilensky said, "that this is what will allow us to keep your benefit — and you can help us a whole lot more than you've been doing."