N.H. Admin. Code § Nat 406.01

Current through Register No. 2, January 9, 2025

Section Nat 406.01 - Formulary

Pursuant to RSA 328-E:16, III, the formulary for licensees shall be as follows:

(a) Amino acids and peptides, including but not limited to:

(1) Acetyl Carnitine;

(2) EDTA;

(3) GABA;

(4) Glutathione;

(5) Levocarnitine;

6) Succinic Acid (DMSA); and

(7) Tryptophan;

(b) Animal preparations and their derivatives, including but not limited to:

(1) Adrenal;

(2) Thymus;

(3) Thyroid;

(4) Fish oils, including derived mega-3 fatty acids such as Ethyl eicosapentaenoic acid, docosahexaenoic acid, and omega-3 carboxylic acids;

(5) Hyaluronic acid; and

(6) Bile acids, including deoxycholic acid;

(c) The following anti-gout agents:

(1) Allopurinol;

(2) Colchicine; and

(3) Probenecid;

(d) H₁ and H₂ antihistamine-class agents;

(e) The following anti-leukotriene agents:

(1) Montelukast; and

(2) Zafirlukast;

(f) The following anti-hyperglycemic agents:

(1) The alpha glucosidase inhibitor Acarbose;

(2) The biguanide Metformin;

(3) Sulfonylurea-class agents;

(4) Thiazolidinedione-class agents (TZDs);

(5) Sodium-glucose transport protein 2 (SGLT-2) inhibitors;

(6) Dipeptidyl peptidase 4 (DPP-4) inhibitors;

(7) Glucagon-like peptide-1 (GLP-1) receptor agonists; and

(8) Synthetic and human insulin;

(g) The following anti-infective agents:

(1) The following antibacterial agents:

a. Aminoglycosides, including but not limited to:

1. Gentamicin;

2. Kanamycin sulfate; and

3. Tobramycin;

b. The following beta-lactam antibiotics:

1. Cephalosporins, including but not limited to:

(i) Cefaclor;

(ii) Cefadroxil;

(iii) Cefdinir;

(iv) Ceditoren;

(v) Cefibuten;

(vi) Cefixime;

(vii) Cefonicid sodium;

(viii) Cepodoxime proxetil;

(ix) Cefprozil;

(x) Ceftibuten;

(xi) Cefuroxime;

(xii) Cephalexin; and

(xiii) Cephradine; and

2. Penicillins, including but not limited to:

(i) Amoxicillin and clavulanate;

(ii) Amoxicillin;

(iii) Ampicillin and sulbactam;

(iv) Ampicillin;

(v) Bacampicillin;

(vi) Cloxacillin;

(vii) Dicloxacillin;

(viii) Oxacillin; and

(ix) Penicillin;

c. Macrolides and ketolides, including but not limited to:

1. Azithromycin;

2. Clarithromycin;

3. Dirithromycin;

4. Erythromycins;

5. Telithromycin; and

6. Troleandomycin;

d. Quinolones, including but not limited to:

1. Ciprofloxacin;

2. Levofloxacin; and

3. Ofloxacin;

e. The following sulfonamides:

1. Sulfonamide;

2. Sofamethoxazole;

2. Trimethoprim; and

3. Dapsone;

f. Tetracyclines, including but not limited to:

1. Demeclocycline hydrochloride;

2. Doxycycline;

3. Minocycline;

4. Oxytetracycline; and

5. Tetracycline;

g. The following miscellaneous antibacterials:

1. Bacitracin;

2. Clindamycin;

3. Colistimethate;

4. Lincomycin;

5. Novobiocin;

6. Polymyxin B Sulfate;

7. Spectinomycin;

8. Vancomycin;

9. Daptomycin; and

(2) Antifungals, such as:

a. Polyene;

b. Amphotericin B;

c. Nystatin;

d. Fluconazole;

e. Ketoconazole;

f. Clotrimazole;

g. Terbinafine; and

h. Itraconazole;

(3) The following anti-virals:

a. Valcyclovir;

b. Acyclovir;

c. Famciclovir; and

d. Oseltamivir;

(4) Anti-helmetics, such as:

a. Mebendazole;

b. Thiabendazole;

c. Nitazoxanide;

d. Albendazole;

e. Ivermectin; and

f. Praziquantel;

(5) The following antitubercular and antimycobacterial agents:

a. Aminosalicylic acid;

b. Cycloserine;

c. Pyrazinamidel

d. Rifabutin; and

e. Rifampin;

(6) The following antiprotozoal and antiparasitic agents:

a. The halogenated 8-hydroxyquinoline iodoquinol;

b. The following nitroimidazoles:

1. Metronidazole; and

2. Tinidazole;

c. The following quinolines:

1. Chloroquine;

2. Hydroxychloroquine;

3. Mefloquine; and

4. Quinine sulfate; and

d. The hydroxynaphthoquinone atovaquone; and

(7) The following miscellaneous anti-infective agents:

a. Mupirocin;

b. Permethrin; and

c. Pyrethrins;

(h) The following anti-thyroid agent thionamides (thioureylenes) :

(1) Methimazole; and

(2) Propylthiouracil;

(i) The following autonomic agents:

(1) The following cholinergic agents:

a. The following antimuscarinic agents:

1. Atropine;

2. Atropine sulfate;

3. Belladonna;

4. Flavoxate;

5. Homatropine hydrobromide;

6. Hyoscyamine;

7. Methscopolamine; and

8. Scopolamine;

b. The muscarinic receptor agonist pilocarpine;

c. Nicotinic receptor agonists:

1. Nicotine; and

2. Varenicline; and

d. The following acetylcholinesterase inhibitors:

1. Donepezil;

2. Galantamine; and

3. Rivastigmine;

(2) The following ergot derivatives:

a. Ergonovine maleate; and

b. Methergine;

(3) The following sympathomimetics:

a. Ephedrine;

b. Epinephrine, including autoinject forms;

c. Pseudoephedrine;

d. Midodrine;

e. Clonidine;

f. Guanfacine;

g. Albuterol;

h. Formoterol; and

i. Salmetrol;

(4) The following sympatholytic agents:

a. The following alpha adrenergic blocking agents:

1. Yohimbine; and

2. Tamulosin; and

b. Beta adrenergic blocking agents, including but not limited to:

1. Atenolol;

2. Bisoprolol;

3. Metoprolol;

4. Propranolol; and

5. Timolol; and

(5) The following agents for ADHD/Narcolepsy treatment:

a. Methylphenidate;

b. Dexmethylphenidate;

c. Amphetamine/dextroamphetamine;

d. Dextroamphetamine;

e. Lisdexamfetamine;

f. Atomoxetine; and

g. Modafinil;

(j) The following biologicals:

(1) The following biological response modifiers:

a. Candida and tricophyton extracts; and

b. Rho(D) immune globulins;

(2) The following skin test antigens:

a. Purified protein derivative tuberculin tests;

b. Candida albicans skin test antigen; and

c. Coccidioides immitis spherule derived skin test antigen;

(3) Blood typing serum;

(4) Blood and tissue derived products;

(5) Enzymes, including but not limited to:

a. Amylase;

b. Collagenase;

c. Desoxyribonuclease;

d. Fribinolysin;

e. Hyaluronidase;

f. Lipase;

g. Pancrelipase; and

h. Papain;

(6) Electrolytes and fluid replacements, including but not limited to:

a. Saline solutions;

b. Sterile water;

c. D5W;

d. Lactated ringers solution; and

e. Sodium bicarbonate;

(7) Hormones as described in Nat 406.01(p);

(8) Immune globulins;

(9) Prostaglandins and prostaglandin analogs, including but not limited to:

a. Alprostadil;

b. Bimatoprost;

c. Dinoprostone;

d. Iloprost; and

e. Misoprostal; and

(10) Botolinum toxin derivatives:

a. Onabotilinumtoxin A;

b. Abobotulinumtoxin A; and

c. Incobotilinumtoxin A;

(k) Botanical preparations, with the following exceptions::

(1) Legend or controlled Digitalis species derivatives;

(2) Legend or controlled Coca species derivatives;

(3) Legend or controlled Vinca species derivatives;

(4) Legend or controlled Taxus species derivatives;

(5) Legend or controlled Rauwolfia species derivatives; and

(6) Derivatives of Papaver somniferum unless otherwise specified;

(l) The following cardiovascular agents:

(1) The following antilipemics:

a. HMG CoA reductase inhibitors, such as:

1. Atorvastatin;

2. Fluvastatin;

3. Lovastatin;

4. Pravastatin; and

5. Simvastatin;

b. Cholestyramine; and

c. Colesevelam;

(2) The following anti-angina, piperazine derivative, metabolism modifiers, or p-FOX inhibitors;

a. Ranolazine; and

b. Trimetazidine;

(3) The following anti-angina nitrates:

a. Nitroglycerin;

b. Isosorbide dinatrate; and

c. Isosobide mononitrate;

(4) Dihydropyridine-class calcium channel blockers;

(5) The following non-dihydropyridine calcium channel blockers:

a. Diltiazem; and

b. Verapamil;

(6) Angotensin converting enzyme inhibitors;

(7) Angiotensin II receptor blockers;

(8) The following diuretics:

a. Chlorthalidone;

b. Hydrochlorothiazide;

c. Epleronone; and

d. Spironolactone; and

(9) The following anti-coagulant agents:

a. Heparin for in-office use;

b. Heparin flushes;

c. Warfarin;

d. Apixaban; and

e. Rivaroxaban;

(m) The following central nervous system agents:

(1) The following anticonvulsant and antipeptic agents:

a. Gabapentin;

b. Tiagabine;

c. Pregabalin;

d. Carbamazepine;

e. Oxcarbazepine;

f. Lamotrigine; and

g. Toiramate;

(2) The following antispasmodics:

a. Baclofen;

b. Cyclobenzaprine;

c. Methocarbamol; and

d. Tizanidine;

(3) The following anxiolytics, sedatives and hypnotics:

1. The following benzodiazepines;

a. Alprozolam;

b. Chlordiazepoxide;

c. Clobazam;

d. Clonazepam;

e. Diazepam;

f. Lorazepam; and

g. Temazapam;

2. The following non-benzodiazepine sedative-hypnotic agents:

a. The imidazopyridine agent Zolpidem;

b. The cyclopyrrolone agent Eszopiclone;

c. Suvorexant; and

d. Ramelteon;

3. The anti-manic agent Lithium; and

4. The anxiolytic Buspirone; and

(4) Antidepressants for FDA approved age groups:

a. The following selective serotonin reuptake inhibitors (SSRIs):

1. Citalopram;

2. Escitalopram;

3. Fluoxetine;

4. Paroxetine; and

5. Sertraline;

b. Serotonin-norepinephirene reuptake inhibitors (SNRIs):

1. Duloxetine;

2. Desvenlafaxine; and

3. Venlafaxine; and

c. The following tricyclic antidepressants (TCAs):

1. Amitriptyline;

2. Doxepin;

3. Imipramine;

4. Nortriptyline; and

5. Clomipramine;

(n) The following erectile dysfunction agents:

(1) Tadalafil; and

(2) Sildenafil;

(o) Homeopathic preparations and their derivatives including both sterile injectable and non-injectable dosage forms;

(p) Hormones such as:

(1) Adrenal hormones, such as:

a. Aldosterone;

b. DHEA;

c. Epinephrine;

d. Pregnenalone; and

e. Synthetic glucocorticoids such as:

1. Betamethasone;

2. Cortisone acetate;

3. Dexamethasone;

4. Triamcinolone and Triamcinolone acetonide;

5. Methylprednisolone and Prednisolone;

6. Prednisone; and

7. Hydrocortisone;

(2) Selective estrogen-receptor modulators (SERMs), and anti-estrogens or estrogen antagonists, such as:

1. Clomiphene;

2. Tamoxifen;

3. Toremifene; and

4. Raloxifene; and

(3) Gonadal hormones, such as:

a. Conjugated estrogens;

b. Estrogen;

c. Estradiol;

d. Estriol;

e. Estrone;

f. Estropipate;

g. Ethinyl estradiol;

h. HCG;

i. Progesterone;

j. Quinestrol; and

k. Testosterone;

(4) Thyroid hormones, such as:

a. Levothyroxine;

b. Liothyronine;

c. Natural dessicated thyroid hormones; and

d. Calcium;

(5) Pituitary hormones, such as:

a. ACTH;

b. Growth hormones; and

c. Oxytocin; and

(6) Hormonal modifiers, such as:

a. Dutasteride;

b. Finasteride; and

c. Anastrazole;

(q) Antitussives, such as:

(1) Codeine for cough;

(2) Guafenesin; and

(3) Benzonatate;

(r) Local anesthetics, including both injectable and non-injectable dosage form such as:

(1) Amino esters for in-office use:

a. Procaine;

b. Chloroprocaine;

c. Tetracaine; and

d. Benzocaine;

(2) Amino amides, for in-office use:

a. Lidocaine;

b. Mepivocaine;

c. Bupivacaine;

d. Levobupacaine;

e. Etidocaine; and

f. Prilocaine;

(3) The following other topical anesthetics:

a. The ketone Dyclonine, for in-office use;

b. The ether Pramoxine;

c. The skin refrigerant ethyl chloride, also known as chloroethane; and

d. Topical lidocaine; and

(4) The methyl group donor betaine;

(s) Anti-psoriatic agents for topical use only:

(1) Dithranol (anthralin);

(2) Calcipotriene;

(3) Fluocinonide; and

(4) Tacrolimus;

(t) Minerals, trace minerals, and their derivatives, such as super saturated potassium iodine (SSKI);

(u) The following miscellaneous agents:

(1) Acamprosate;

(2) Acetazolamide;

(3) Bee venom;

(4) Crofelemer;

(5) Cromolyn sodium;

(6) DMPS;

(7) DMSO;

(8) Ethyl Chloride spray;

(9) Fluro-ethyl spray;

(10) Fluro-methane spray;

(11) Hydrogen peroxide;

(12) Hydrochloric acid;

(13) Methylsulfonylmethane;

(14) Ondansetron;

(15) Oxygen;

(16) Ozone;

(17) Poly-L-lactic acid and derivatives;

(18) Salicylates, propionic acid, and acetic acid derivatives such as:

a. Mesalamine;

b. Topical salicyclic acid preparations;

c. Indomethacin;

d. Ibuprofen;

e. Naproxen;

f. Ketorolac; and

g. Diclofenac; and

(19) Urea;

(v) In-office medical equipment, medical devices, and therapeutic devices such as:

(1) Needles;

(2) Syringes;

(3) IV Tubing;

(4) Filters;

(5) The following barrier contraceptives:

a. Cervical caps; and

b. Diaphragms, excluding intrauterine devices;

(6) Nebulizers, inhalers, spacers, actuators, and mouthpieces for medication delivery;

(7) CPAP machies and medical devices for the treatment and prevention of sleep apnea; and

(8) Auditory devices.

(w) Agents needed to carry out diagnostic tests or physiological function tests such as:

(1) Mannitol;

(2) Methacholine;

(3) Dexamethasone;

(4) Dyes and contrasts such as:

a. Imaging contrasts;

b. Methylene blue; and

c. Triple dye;

(x) Vaccinations, provided they are for use and not prescription, including but not limited to:

(1) BCG;

(2) Cholera;

(3) Diphtheria;

(4) DPT;

(5) Haemophilus b Conjugate;

(6) Hepatitus A Virus;

(7) Hepatitus B;

(8) Influenza Virus;

(9) Japanese Encaphalitis Virus;

(10) Measles Virus;

(11) Mumps virus;

(12) Pertussis;

(13) Plague;

(14) Pneumococcal;

(15) Polio virus - inactivated;

(16) Poliovirus - live oral;

(17) Rabies;

(18) Rubella;

(19) Smallpox;

(20) Tetanus IG;

(21) Tetanus Toxoid;

(22) Typhoid;

(23) Varicella;

(24) Yellow fever; and

(25) Covid-19.

(y) All forms of prescription and non-prescription vitamin preparations and their derivatives, except for Isotretinoin; and

(z) Anti-addictive agents:

(1) Disulfiram;

(2) Naltrexone; and

(3) Naloxone.

N.H. Admin. Code § Nat 406.01

#8679, eff 7-11-06; ss by #9656, eff 2-13-10

Amended by Volume XXXVII Number 23, Filed June 8, 2017, Proposed by #12176, Effective 5/17/2017, Expires 5/17/2027.

Amended by Volume XL Number 41, Filed October 8, 2020, Proposed by # 13112, Effective 9/24/2020, Expires 9/24/2030.