Current through Register No. 13, March 27, 2025
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:
6) Succinic Acid (DMSA); and
(b) Animal preparations and their
derivatives, including but not limited to:
(4) Fish oils, including derived mega-3 fatty
acids such as Ethyl eicosapentaenoic acid, docosahexaenoic acid, and omega-3
carboxylic acids;
(6) Bile acids, including
deoxycholic acid;
(c)
The following anti-gout agents:
(d) H1 and
H2 antihistamine-class agents;
(e) The following anti-leukotriene agents:
(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:
2. Kanamycin sulfate; and
b. The following beta-lactam antibiotics:
1. Cephalosporins, including but not limited
to:
(viii) Cepodoxime proxetil;
2. Penicillins, including but not limited to:
(i) Amoxicillin and clavulanate;
(iii) Ampicillin and sulbactam;
c. Macrolides and ketolides,
including but not limited to:
d. Quinolones, including but not
limited to:
e. The following sulfonamides:
f. Tetracyclines, including but not limited
to:
1. Demeclocycline hydrochloride;
g. The following miscellaneous
antibacterials:
(2) Antifungals, such as:
(3) The following anti-virals:
(4) Anti-helmetics, such as:
(5) The following antitubercular and
antimycobacterial agents:
(6) The following antiprotozoal and
antiparasitic agents:
a. The halogenated
8-hydroxyquinoline iodoquinol;
b.
The following nitroimidazoles:
c. The
following quinolines:
d. The
hydroxynaphthoquinone atovaquone; and
(7) The following miscellaneous
anti-infective agents:
(h) The following
anti-thyroid agent thionamides (thioureylenes) :
(i) The following autonomic agents:
(1) The following cholinergic agents:
a. The following antimuscarinic agents:
5. Homatropine hydrobromide;
b. The muscarinic receptor agonist
pilocarpine;
c. Nicotinic receptor
agonists:
d. The following acetylcholinesterase
inhibitors:
(2) The following ergot
derivatives:
a. Ergonovine maleate;
and
(3) The following
sympathomimetics:
b. Epinephrine, including autoinject forms;
(4) The following sympatholytic agents:
a. The following alpha adrenergic blocking
agents:
b. Beta adrenergic blocking agents, including
but not limited to:
(5) The following agents for
ADHD/Narcolepsy treatment:
c.
Amphetamine/dextroamphetamine;
(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;
(4) Blood and tissue derived
products;
(5) Enzymes, including
but not limited to:
(6) Electrolytes and fluid replacements,
including but not limited to:
d. Lactated ringers solution; and
(7) Hormones as described in Nat
406.01(p);
(9) Prostaglandins and
prostaglandin analogs, including but not limited to:
(10) Botolinum toxin derivatives:
b. Abobotulinumtoxin A; and
(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:
(2) The following anti-angina, piperazine
derivative, metabolism modifiers, or p-FOX inhibitors;
(3) The following anti-angina nitrates:
b. Isosorbide dinatrate; and
c. Isosobide mononitrate;
(4) Dihydropyridine-class calcium
channel blockers;
(5) The following
non-dihydropyridine calcium channel blockers:
(6) Angotensin converting enzyme
inhibitors;
(7) Angiotensin II
receptor blockers;
(8) The
following diuretics:
(9) The following
anti-coagulant agents:
a. Heparin for
in-office use;
(m) The following central nervous
system agents:
(1) The following
anticonvulsant and antipeptic agents:
(2) The following antispasmodics:
(3) The following anxiolytics, sedatives and
hypnotics:
1. The following benzodiazepines;
2. The following non-benzodiazepine
sedative-hypnotic agents:
a. The
imidazopyridine agent Zolpidem;
b.
The cyclopyrrolone agent Eszopiclone;
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):
b. Serotonin-norepinephirene reuptake
inhibitors (SNRIs):
c. The following tricyclic antidepressants
(TCAs):
(n) The following
erectile dysfunction agents:
(o) Homeopathic preparations and
their derivatives including both sterile injectable and non-injectable dosage
forms;
(p) Hormones such as:
(1) Adrenal hormones, such as:
e. Synthetic glucocorticoids such as:
4. Triamcinolone and Triamcinolone
acetonide;
5. Methylprednisolone
and Prednisolone;
(2) Selective
estrogen-receptor modulators (SERMs), and anti-estrogens or estrogen
antagonists, such as:
(3) Gonadal hormones, such as:
(4) Thyroid hormones, such as:
c. Natural dessicated thyroid hormones;
and
(5) Pituitary hormones, such as:
(6) Hormonal modifiers, such as:
(q) Antitussives, such as:
(r) Local anesthetics, including both
injectable and non-injectable dosage form such as:
(1) Amino esters for in-office use:
(2) Amino amides, for in-office use:
(3) The following other topical anesthetics:
a. The ketone Dyclonine, for in-office
use;
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);
(t) Minerals, trace minerals, and their
derivatives, such as super saturated potassium iodine (SSKI);
(u) The following miscellaneous agents:
(8) Ethyl Chloride spray;
(10) Fluro-methane spray;
(13) Methylsulfonylmethane;
(17) Poly-L-lactic acid and
derivatives;
(18) Salicylates,
propionic acid, and acetic acid derivatives such as:
b. Topical salicyclic acid
preparations;
(v) In-office medical equipment, medical
devices, and therapeutic devices such as:
(5) The following barrier contraceptives:
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
(w) Agents needed to carry out diagnostic
tests or physiological function tests such as:
(4) Dyes and contrasts such as:
(x) Vaccinations, provided they
are for use and not prescription, including but not limited to:
(5) Haemophilus b Conjugate;
(9) Japanese Encaphalitis Virus;
(15) Polio virus - inactivated;
(16) Poliovirus - live oral;
(y) All forms of prescription and
non-prescription vitamin preparations and their derivatives, except for
Isotretinoin; and
(z)
Anti-addictive agents:
#8679, eff 7-11-06; ss by #9656, eff
2-13-10