Pharmacy & Therapeutics Formulary Summary
The following charts show medications added to the Windsor Medicare Extra formulary, effective through January 31, 2008, by plan.
- Tier 1: generic medication
- Tier 3: brand name (nonpreferred)
- Tier 2: brand name (preferred)
- Tier 4: specialty drugs (drug cost > $1,000 per month)
Abbreviations
PA— prior authorization required by physician
QL—quantity limit
PA— prior authorization required by physician
QL—quantity limit
