N.H. Admin. Code § He-W 570.05

Current through Register No. 50, December 12, 2024

Section He-W 570.05 - Non-Covered Items

Non-covered items shall include:

(a) Experimental or investigational drugs not approved by the FDA;

(b) Drugs listed by the FDA as being DESI drugs or IRS drugs;

(c) Legend and non-legend drugs that are not part of a medical treatment for a specific illness, injury, or disease;

(d) Non-legend drugs when:

(1) A legend drug effecting the same health outcome is available and:

a. Is more clinically effective; or

b. Is therapeutically equivalent and more cost effective; or

(2) The non-legend drug is being used to primarily treat discomfort or to maintain comfort, including, but not limited to:

a. Antidiarrheals;

b. Antiflatulants;

c. Nasal decongestants;

d. Eye and ear preparations; and

e. Topical antipruitics;

(e) Non-legend drugs and supplies, which are household and medicine chest items, including, but not limited to:

(1) Band-aids;

(2) Corn plasters;

(3) Contact lens products;

(4) Cough drops and lozenges;

(5) Mouthwash;

(6) Nursery supplies;

(7) Nutritional supplements when not needed to sustain life;

(8) Odor barrier products;

(9) Personal hygiene items;

(10) Sunscreen;

(11) Soaps and cleansers;

(12) Acne products;

(13) Products to mitigate seborrheic dermatitis; and

(14) Fluoride preparations;

(f) Legend and non-legend drugs used for the symptomatic relief of cough and colds, pursuant to Section 1396r-8(d) (2) (D) of the Social Security Act;

(g) Legend and non-legend drugs used for cosmetic purposes or hair growth, pursuant to Section 1396r-8(d) (2) (C) of the Social Security Act;

(h) Legend and non-legend drugs which enhance or promote fertility or procreation, or for which the labeled use is ovulation stimulation, pursuant to Section 1396r-8(d) (2) (B) of the Social Security Act;

(i) Legend and non-legend drugs without a prescription from a licensed practitioner;

(j) Legend and non-legend drugs when used for the treatment of sexual or erectile dysfunction, unless such agents are used to treat a condition, other than sexual or erectile dysfunction, for which the agents have been approved by the FDA, pursuant to Section 1396r-8(d) (2) (k); and

(k) Items which are free to the general public.

N.H. Admin. Code § He-W 570.05

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93; amd by #5874, eff 8-1-94; ss by #7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02

New. #7805, eff 12-21-02; ss by #8372, eff 8-1-05; ss by 8628, eff 5-6-06; ss by #9831, eff 12-21-10

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