N.H. Admin. Code § He-W 570.04

Current through Register No. 50, December 12, 2024

Section He-W 570.04 - Covered Items

With the exception of those items specified in He-W 570.05, the following FDA approved drugs, if rated effective, and if produced by manufacturers who are participating in the United States Department of Health and Human Services' (USDHHS) drug rebate agreement, shall be covered when prescribed by a licensed practitioner and subject to the prior authorization requirements in He-W 570.06:

(a) Legend drugs, only when prescribed as part of the course of medical treatment for a specific illness, injury, or disease for use specified by the FDA, or for non-experimental purposes, as supported by accepted medical practice, and in accordance with He-W 570.08;

(b) Select non-legend drugs, with the exception of those specified in He-W 570.05 and, only when prescribed as part of the course of medical treatment for a specific illness, injury, or disease for use specified by the FDA, or for non-experimental purposes, as supported by accepted medical practice, and in accordance with (c) below and He-W 570.08;

(c) Non-legend drugs, only when prescribed or dispensed as generic drugs including:

(1) Antihistamines;

(2) Antacids and H2-Receptor Agonists;

(3) Analgesics, salicylates, and antipyretics;

(4) Magnesium, iron, niacin, and calcium;

(5) Ganglionic stimulants;

(6) Laxatives and cathartics;

(7) Hyperglycemics;

(8) Topical steroids;

(9) Vaginal and topical antifungals;

(10) Topical antimicrobials;

(11) Lice treatments; and

(12) Oral contraceptives;

(d) Opioid rescue, both brand and generic;

(e) Compound drugs when at least one ingredient can be identified by a rebatable NDC; and

(f) Nutritional supplements when needed to sustain life.

N.H. Admin. Code § He-W 570.04

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99

New. #7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRES: 12-19-02

New. #7805, eff 12-21-02; ss by #8372, eff 8-1-05; ss by #9586, eff 11-4-09

Amended by Volume XXXVII Number 50, Filed December 14, 2017, Proposed by #12421, Effective 11/21/2017, Expires 5/20/2018.

Amended by Volume XXXVIII Number 23, Filed June 7, 2018, Proposed by #12529, Effective 5/22/2018, Expires 5/22/2028.

Amended by Number 10, Filed March 7, 2024, Proposed by #13880, Effective 2/21/2024, Expires 2/21/2034.