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

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

   1. (1) Acetyl Carnitine;
   2. (2) EDTA;
   3. (3) GABA;
   4. (4) Glutathione;

   5. (5) Levocarnitine;

      6) Succinic Acid (DMSA); and

   6. (7) Tryptophan;

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

   1. (1) Adrenal;
   2. (2) Thymus;
   3. (3) Thyroid;
   4. (4) Fish oils, including derived mega-3 fatty acids such as Ethyl eicosapentaenoic acid, docosahexaenoic acid, and omega-3 carboxylic acids;
   5. (5) Hyaluronic acid; and
   6. (6) Bile acids, including deoxycholic acid;

3. (c) The following anti-gout agents:

   1. (1) Allopurinol;
   2. (2) Colchicine; and
   3. (3) Probenecid;
4. (d) H1 and H2 antihistamine-class agents;

5. (e) The following anti-leukotriene agents:

   1. (1) Montelukast; and
   2. (2) Zafirlukast;

6. (f) The following anti-hyperglycemic agents:

   1. (1) The alpha glucosidase inhibitor Acarbose;
   2. (2) The biguanide Metformin;
   3. (3) Sulfonylurea-class agents;
   4. (4) Thiazolidinedione-class agents (TZDs);
   5. (5) Sodium-glucose transport protein 2 (SGLT-2) inhibitors;
   6. (6) Dipeptidyl peptidase 4 (DPP-4) inhibitors;
   7. (7) Glucagon-like peptide-1 (GLP-1) receptor agonists; and
   8. (8) Synthetic and human insulin;

7. (g) The following anti-infective agents:

   1. (1) The following antibacterial agents:

      1. a. Aminoglycosides, including but not limited to:

         1. 1. Gentamicin;
         2. 2. Kanamycin sulfate; and
         3. 3. Tobramycin;

      2. b. The following beta-lactam antibiotics:

         1. 1. Cephalosporins, including but not limited to:

            1. (i) Cefaclor;
            2. (ii) Cefadroxil;
            3. (iii) Cefdinir;
            4. (iv) Ceditoren;
            5. (v) Cefibuten;
            6. (vi) Cefixime;
            7. (vii) Cefonicid sodium;
            8. (viii) Cepodoxime proxetil;
            9. (ix) Cefprozil;
            10. (x) Ceftibuten;
            11. (xi) Cefuroxime;
            12. (xii) Cephalexin; and
            13. (xiii) Cephradine; and

         2. 2. Penicillins, including but not limited to:

            1. (i) Amoxicillin and clavulanate;
            2. (ii) Amoxicillin;
            3. (iii) Ampicillin and sulbactam;
            4. (iv) Ampicillin;
            5. (v) Bacampicillin;
            6. (vi) Cloxacillin;
            7. (vii) Dicloxacillin;
            8. (viii) Oxacillin; and
            9. (ix) Penicillin;

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

         1. 1. Azithromycin;
         2. 2. Clarithromycin;
         3. 3. Dirithromycin;
         4. 4. Erythromycins;
         5. 5. Telithromycin; and
         6. 6. Troleandomycin;

      4. d. Quinolones, including but not limited to:

         1. 1. Ciprofloxacin;
         2. 2. Levofloxacin; and
         3. 3. Ofloxacin;

      5. e. The following sulfonamides:

         1. 1. Sulfonamide;
         2. 2. Sofamethoxazole;
         3. 2. Trimethoprim; and
         4. 3. Dapsone;

      6. f. Tetracyclines, including but not limited to:

         1. 1. Demeclocycline hydrochloride;
         2. 2. Doxycycline;
         3. 3. Minocycline;
         4. 4. Oxytetracycline; and
         5. 5. Tetracycline;

      7. g. The following miscellaneous antibacterials:

         1. 1. Bacitracin;
         2. 2. Clindamycin;
         3. 3. Colistimethate;
         4. 4. Lincomycin;
         5. 5. Novobiocin;
         6. 6. Polymyxin B Sulfate;
         7. 7. Spectinomycin;
         8. 8. Vancomycin;
         9. 9. Daptomycin; and

   2. (2) Antifungals, such as:

      1. a. Polyene;
      2. b. Amphotericin B;
      3. c. Nystatin;
      4. d. Fluconazole;
      5. e. Ketoconazole;
      6. f. Clotrimazole;
      7. g. Terbinafine; and
      8. h. Itraconazole;

   3. (3) The following anti-virals:

      1. a. Valcyclovir;
      2. b. Acyclovir;
      3. c. Famciclovir; and
      4. d. Oseltamivir;

   4. (4) Anti-helmetics, such as:

      1. a. Mebendazole;
      2. b. Thiabendazole;
      3. c. Nitazoxanide;
      4. d. Albendazole;
      5. e. Ivermectin; and
      6. f. Praziquantel;

   5. (5) The following antitubercular and antimycobacterial agents:

      1. a. Aminosalicylic acid;
      2. b. Cycloserine;
      3. c. Pyrazinamidel
      4. d. Rifabutin; and
      5. e. Rifampin;

   6. (6) The following antiprotozoal and antiparasitic agents:

      1. a. The halogenated 8-hydroxyquinoline iodoquinol;

      2. b. The following nitroimidazoles:

         1. 1. Metronidazole; and
         2. 2. Tinidazole;

      3. c. The following quinolines:

         1. 1. Chloroquine;
         2. 2. Hydroxychloroquine;
         3. 3. Mefloquine; and
         4. 4. Quinine sulfate; and
      4. d. The hydroxynaphthoquinone atovaquone; and

   7. (7) The following miscellaneous anti-infective agents:

      1. a. Mupirocin;
      2. b. Permethrin; and
      3. c. Pyrethrins;

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

   1. (1) Methimazole; and
   2. (2) Propylthiouracil;

9. (i) The following autonomic agents:

   1. (1) The following cholinergic agents:

      1. a. The following antimuscarinic agents:

         1. 1. Atropine;
         2. 2. Atropine sulfate;
         3. 3. Belladonna;
         4. 4. Flavoxate;
         5. 5. Homatropine hydrobromide;
         6. 6. Hyoscyamine;
         7. 7. Methscopolamine; and
         8. 8. Scopolamine;
      2. b. The muscarinic receptor agonist pilocarpine;

      3. c. Nicotinic receptor agonists:

         1. 1. Nicotine; and
         2. 2. Varenicline; and

      4. d. The following acetylcholinesterase inhibitors:

         1. 1. Donepezil;
         2. 2. Galantamine; and
         3. 3. Rivastigmine;

   2. (2) The following ergot derivatives:

      1. a. Ergonovine maleate; and
      2. b. Methergine;

   3. (3) The following sympathomimetics:

      1. a. Ephedrine;
      2. b. Epinephrine, including autoinject forms;
      3. c. Pseudoephedrine;
      4. d. Midodrine;
      5. e. Clonidine;
      6. f. Guanfacine;
      7. g. Albuterol;
      8. h. Formoterol; and
      9. i. Salmetrol;

   4. (4) The following sympatholytic agents:

      1. a. The following alpha adrenergic blocking agents:

         1. 1. Yohimbine; and
         2. 2. Tamulosin; and

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

         1. 1. Atenolol;
         2. 2. Bisoprolol;
         3. 3. Metoprolol;
         4. 4. Propranolol; and
         5. 5. Timolol; and

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

      1. a. Methylphenidate;
      2. b. Dexmethylphenidate;
      3. c. Amphetamine/dextroamphetamine;
      4. d. Dextroamphetamine;
      5. e. Lisdexamfetamine;
      6. f. Atomoxetine; and
      7. g. Modafinil;

10. (j) The following biologicals:

    1. (1) The following biological response modifiers:

       1. a. Candida and tricophyton extracts; and
       2. b. Rho(D) immune globulins;

    2. (2) The following skin test antigens:

       1. a. Purified protein derivative tuberculin tests;
       2. b. Candida albicans skin test antigen; and
       3. c. Coccidioides immitis spherule derived skin test antigen;
    3. (3) Blood typing serum;
    4. (4) Blood and tissue derived products;

    5. (5) Enzymes, including but not limited to:

       1. a. Amylase;
       2. b. Collagenase;
       3. c. Desoxyribonuclease;
       4. d. Fribinolysin;
       5. e. Hyaluronidase;
       6. f. Lipase;
       7. g. Pancrelipase; and
       8. h. Papain;

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

       1. a. Saline solutions;
       2. b. Sterile water;
       3. c. D5W;
       4. d. Lactated ringers solution; and
       5. e. Sodium bicarbonate;
    7. (7) Hormones as described in Nat 406.01(p);
    8. (8) Immune globulins;

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

       1. a. Alprostadil;
       2. b. Bimatoprost;
       3. c. Dinoprostone;
       4. d. Iloprost; and
       5. e. Misoprostal; and

    10. (10) Botolinum toxin derivatives:

        1. a. Onabotilinumtoxin A;
        2. b. Abobotulinumtoxin A; and
        3. c. Incobotilinumtoxin A;

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

    1. (1) Legend or controlled Digitalis species derivatives;
    2. (2) Legend or controlled Coca species derivatives;
    3. (3) Legend or controlled Vinca species derivatives;
    4. (4) Legend or controlled Taxus species derivatives;
    5. (5) Legend or controlled Rauwolfia species derivatives; and
    6. (6) Derivatives of Papaver somniferum unless otherwise specified;

12. (l) The following cardiovascular agents:

    1. (1) The following antilipemics:

       1. a. HMG CoA reductase inhibitors, such as:

          1. 1. Atorvastatin;
          2. 2. Fluvastatin;
          3. 3. Lovastatin;
          4. 4. Pravastatin; and
          5. 5. Simvastatin;
       2. b. Cholestyramine; and
       3. c. Colesevelam;

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

       1. a. Ranolazine; and
       2. b. Trimetazidine;

    3. (3) The following anti-angina nitrates:

       1. a. Nitroglycerin;
       2. b. Isosorbide dinatrate; and
       3. c. Isosobide mononitrate;
    4. (4) Dihydropyridine-class calcium channel blockers;

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

       1. a. Diltiazem; and
       2. b. Verapamil;
    6. (6) Angotensin converting enzyme inhibitors;
    7. (7) Angiotensin II receptor blockers;

    8. (8) The following diuretics:

       1. a. Chlorthalidone;
       2. b. Hydrochlorothiazide;
       3. c. Epleronone; and
       4. d. Spironolactone; and

    9. (9) The following anti-coagulant agents:

       1. a. Heparin for in-office use;
       2. b. Heparin flushes;
       3. c. Warfarin;
       4. d. Apixaban; and
       5. e. Rivaroxaban;

13. (m) The following central nervous system agents:

    1. (1) The following anticonvulsant and antipeptic agents:

       1. a. Gabapentin;
       2. b. Tiagabine;
       3. c. Pregabalin;
       4. d. Carbamazepine;
       5. e. Oxcarbazepine;
       6. f. Lamotrigine; and
       7. g. Toiramate;

    2. (2) The following antispasmodics:

       1. a. Baclofen;
       2. b. Cyclobenzaprine;
       3. c. Methocarbamol; and
       4. d. Tizanidine;

    3. (3) The following anxiolytics, sedatives and hypnotics:

       1. 1. The following benzodiazepines;
       2. a. Alprozolam;
       3. b. Chlordiazepoxide;
       4. c. Clobazam;
       5. d. Clonazepam;
       6. e. Diazepam;
       7. f. Lorazepam; and
       8. g. Temazapam;
       9. 2. The following non-benzodiazepine sedative-hypnotic agents:
       10. a. The imidazopyridine agent Zolpidem;
       11. b. The cyclopyrrolone agent Eszopiclone;
       12. c. Suvorexant; and
       13. d. Ramelteon;
       14. 3. The anti-manic agent Lithium; and
       15. 4. The anxiolytic Buspirone; and

    4. (4) Antidepressants for FDA approved age groups:

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

          1. 1. Citalopram;
          2. 2. Escitalopram;
          3. 3. Fluoxetine;
          4. 4. Paroxetine; and
          5. 5. Sertraline;

       2. b. Serotonin-norepinephirene reuptake inhibitors (SNRIs):

          1. 1. Duloxetine;
          2. 2. Desvenlafaxine; and
          3. 3. Venlafaxine; and

       3. c. The following tricyclic antidepressants (TCAs):

          1. 1. Amitriptyline;
          2. 2. Doxepin;
          3. 3. Imipramine;
          4. 4. Nortriptyline; and
          5. 5. Clomipramine;

14. (n) The following erectile dysfunction agents:

    1. (1) Tadalafil; and
    2. (2) Sildenafil;
15. (o) Homeopathic preparations and their derivatives including both sterile injectable and non-injectable dosage forms;

16. (p) Hormones such as:

    1. (1) Adrenal hormones, such as:

       1. a. Aldosterone;
       2. b. DHEA;
       3. c. Epinephrine;
       4. d. Pregnenalone; and

       5. e. Synthetic glucocorticoids such as:

          1. 1. Betamethasone;
          2. 2. Cortisone acetate;
          3. 3. Dexamethasone;
          4. 4. Triamcinolone and Triamcinolone acetonide;
          5. 5. Methylprednisolone and Prednisolone;
          6. 6. Prednisone; and
          7. 7. Hydrocortisone;

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

       1. 1. Clomiphene;
       2. 2. Tamoxifen;
       3. 3. Toremifene; and
       4. 4. Raloxifene; and

    3. (3) Gonadal hormones, such as:

       1. a. Conjugated estrogens;
       2. b. Estrogen;
       3. c. Estradiol;
       4. d. Estriol;
       5. e. Estrone;
       6. f. Estropipate;
       7. g. Ethinyl estradiol;
       8. h. HCG;
       9. i. Progesterone;
       10. j. Quinestrol; and
       11. k. Testosterone;

    4. (4) Thyroid hormones, such as:

       1. a. Levothyroxine;
       2. b. Liothyronine;
       3. c. Natural dessicated thyroid hormones; and
       4. d. Calcium;

    5. (5) Pituitary hormones, such as:

       1. a. ACTH;
       2. b. Growth hormones; and
       3. c. Oxytocin; and

    6. (6) Hormonal modifiers, such as:

       1. a. Dutasteride;
       2. b. Finasteride; and
       3. c. Anastrazole;

17. (q) Antitussives, such as:

    1. (1) Codeine for cough;
    2. (2) Guafenesin; and
    3. (3) Benzonatate;

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

    1. (1) Amino esters for in-office use:

       1. a. Procaine;
       2. b. Chloroprocaine;
       3. c. Tetracaine; and
       4. d. Benzocaine;

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

       1. a. Lidocaine;
       2. b. Mepivocaine;
       3. c. Bupivacaine;
       4. d. Levobupacaine;
       5. e. Etidocaine; and
       6. f. Prilocaine;

    3. (3) The following other topical anesthetics:

       1. a. The ketone Dyclonine, for in-office use;
       2. b. The ether Pramoxine;
       3. c. The skin refrigerant ethyl chloride, also known as chloroethane; and
       4. d. Topical lidocaine; and
    4. (4) The methyl group donor betaine;

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

    1. (1) Dithranol (anthralin);
    2. (2) Calcipotriene;
    3. (3) Fluocinonide; and
    4. (4) Tacrolimus;
20. (t) Minerals, trace minerals, and their derivatives, such as super saturated potassium iodine (SSKI);

21. (u) The following miscellaneous agents:

    1. (1) Acamprosate;
    2. (2) Acetazolamide;
    3. (3) Bee venom;
    4. (4) Crofelemer;
    5. (5) Cromolyn sodium;
    6. (6) DMPS;
    7. (7) DMSO;
    8. (8) Ethyl Chloride spray;
    9. (9) Fluro-ethyl spray;
    10. (10) Fluro-methane spray;
    11. (11) Hydrogen peroxide;
    12. (12) Hydrochloric acid;
    13. (13) Methylsulfonylmethane;
    14. (14) Ondansetron;
    15. (15) Oxygen;
    16. (16) Ozone;
    17. (17) Poly-L-lactic acid and derivatives;

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

        1. a. Mesalamine;
        2. b. Topical salicyclic acid preparations;
        3. c. Indomethacin;
        4. d. Ibuprofen;
        5. e. Naproxen;
        6. f. Ketorolac; and
        7. g. Diclofenac; and
    19. (19) Urea;

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

    1. (1) Needles;
    2. (2) Syringes;
    3. (3) IV Tubing;
    4. (4) Filters;

    5. (5) The following barrier contraceptives:

       1. a. Cervical caps; and
       2. b. Diaphragms, excluding intrauterine devices;
    6. (6) Nebulizers, inhalers, spacers, actuators, and mouthpieces for medication delivery;
    7. (7) CPAP machies and medical devices for the treatment and prevention of sleep apnea; and
    8. (8) Auditory devices.

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

    1. (1) Mannitol;
    2. (2) Methacholine;
    3. (3) Dexamethasone;

    4. (4) Dyes and contrasts such as:

       1. a. Imaging contrasts;
       2. b. Methylene blue; and
       3. c. Triple dye;

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

    1. (1) BCG;
    2. (2) Cholera;
    3. (3) Diphtheria;
    4. (4) DPT;
    5. (5) Haemophilus b Conjugate;
    6. (6) Hepatitus A Virus;
    7. (7) Hepatitus B;
    8. (8) Influenza Virus;
    9. (9) Japanese Encaphalitis Virus;
    10. (10) Measles Virus;
    11. (11) Mumps virus;
    12. (12) Pertussis;
    13. (13) Plague;
    14. (14) Pneumococcal;
    15. (15) Polio virus – inactivated;
    16. (16) Poliovirus – live oral;
    17. (17) Rabies;
    18. (18) Rubella;
    19. (19) Smallpox;
    20. (20) Tetanus IG;
    21. (21) Tetanus Toxoid;
    22. (22) Typhoid;
    23. (23) Varicella;
    24. (24) Yellow fever; and
    25. (25) Covid-19.
25. (y) All forms of prescription and non-prescription vitamin preparations and their derivatives, except for Isotretinoin; and

26. (z) Anti-addictive agents:

    1. (1) Disulfiram;
    2. (2) Naltrexone; and
    3. (3) Naloxone.

Source. #8679, eff 7-11-06; ss by #9656, eff 2-13-10; ss by #12176, eff 5-17-17; ss by #13112, eff 9-24-20