No prior authorization
Does Alignment Healthcare require prior authorization for Valtoco 5 MG Dose Kit?
Alignment Healthcare does not require prior authorization for Valtoco 5 MG Dose Kit on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| {1 (0.1 ML) (diazepam 50 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 5 MG Dose Kit]2272630 | 67 / 67 | 0 | 0 | 67 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — {1 (0.1 ML) (diazepam 50 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 5 MG Dose Kit]
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Alignment Health + Intermountain Health (HMO) | H9686-009 | 5 | No | No | Yes |
| Alignment Health Advantage PPO (PPO) | H8832-001 | 5 | No | No | Yes |
| Alignment Health Advantage PPO (PPO) | H8832-002 | 5 | No | No | Yes |
| Alignment Health AllCare Preferred (HMO) | H3815-011 | 5 | No | No | Yes |
| Alignment Health AVA (PPO) | H7074-001 | 5 | No | No | Yes |
| Alignment Health Balance (HMO C-SNP) | H3815-033 | 5 | No | No | Yes |
| Alignment Health Balance (PPO) | H4961-006 | 5 | No | No | Yes |
| Alignment Health BreathEasy (HMO C-SNP) | H3815-041 | 5 | No | No | Yes |
| Alignment Health Clarity (HMO C-SNP) | H3815-042 | 5 | No | No | Yes |
| Alignment Health CommUnity (HMO) | H3815-046 | 5 | No | No | Yes |
| Alignment Health Dual Select+ (HMO-POS D-SNP) | H5472-007 | 5 | No | No | Yes |
| Alignment Health Freedom (PPO) | H8832-003 | 5 | No | No | Yes |
| Alignment Health Harmony (HMO) | H3815-031 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes (HMO C-SNP) | H3443-003 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes (HMO C-SNP) | H3815-010 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes (HMO C-SNP) | H9686-004 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes (HMO-POS C-SNP) | H5472-002 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes Access (HMO C-SNP) | H3815-044 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) | H3443-007 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) | H3815-039 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | H3815-048 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | H3815-054 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | H5296-011 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes Choice (HMO C-SNP) | H3815-051 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | H5296-009 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) | H9686-006 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes Plus (HMO C-SNP) | H3443-006 | 5 | No | No | Yes |
| Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) | H5472-004 | 5 | No | No | Yes |
| Alignment Health Honor+ Plan (HMO) | H3815-052 | 5 | No | No | Yes |
| Alignment Health L.A. Premium Giveback (HMO) | H3815-055 | 5 | No | No | Yes |
| Alignment Health My Choice (HMO) | H3815-001 | 5 | No | No | Yes |
| Alignment Health My Choice (HMO) | H3815-028 | 5 | No | No | Yes |
| Alignment Health My Choice (PPO) | H4961-001 | 5 | No | No | Yes |
| Alignment Health My Choice (PPO) | H4961-003 | 5 | No | No | Yes |
| Alignment Health My Choice CalCare (HMO) | H3815-050 | 5 | No | No | Yes |
| Alignment Health My Choice Select (HMO) | H3815-049 | 5 | No | No | Yes |
| Alignment Health NC Duals (HMO-POS D-SNP) | H5296-004 | 5 | No | No | Yes |
| Alignment Health Platinum (HMO) | H5296-003 | 5 | No | No | Yes |
| Alignment Health Platinum + Instacart (HMO-POS) | H3815-016 | 5 | No | No | Yes |
| Alignment Health Platinum + Instacart (HMO) | H3815-008 | 5 | No | No | Yes |
| Alignment Health Platinum + Instacart (HMO) | H5296-007 | 5 | No | No | Yes |
| Alignment Health Platinum + Instacart (HMO) | H9686-007 | 5 | No | No | Yes |
| Alignment Health Platinum Select (HMO) | H5296-010 | 5 | No | No | Yes |
| Alignment Health S.D. Premium Giveback (HMO) | H3815-056 | 5 | No | No | Yes |
| Alignment Health Silicon (HMO C-SNP) | H3815-045 | 5 | No | No | Yes |
| Alignment Health smartHMO (HMO-POS) | H5472-003 | 5 | No | No | Yes |
| Alignment Health smartHMO (HMO) | H3443-005 | 5 | No | No | Yes |
| Alignment Health smartHMO (HMO) | H3815-013 | 5 | No | No | Yes |
| Alignment Health smartHMO (HMO) | H3815-038 | 5 | No | No | Yes |
| Alignment Health smartHMO (HMO) | H3815-040 | 5 | No | No | Yes |
| Alignment Health smartHMO (HMO) | H5296-006 | 5 | No | No | Yes |
| Alignment Health smartHMO (HMO) | H5296-008 | 5 | No | No | Yes |
| Alignment Health smartHMO (HMO) | H9686-008 | 5 | No | No | Yes |
| Alignment Health smartSavings (HMO-POS) | H5472-010 | 5 | No | No | Yes |
| Alignment Health smartSavings (HMO) | H3815-047 | 5 | No | No | Yes |
| Alignment Health Sutter Advantage +More (HMO) | H3815-019 | 5 | No | No | Yes |
| Alignment Health Sutter Advantage +More (HMO) | H3815-020 | 5 | No | No | Yes |
| Alignment Health Sutter Advantage +More (HMO) | H3815-021 | 5 | No | No | Yes |
| Alignment Health Sutter Advantage +More (HMO) | H3815-023 | 5 | No | No | Yes |
| Alignment Health the ONE (HMO D-SNP) | H9686-005 | 5 | No | No | Yes |
| Alignment Health the ONE (HMO) | H3815-034 | 5 | No | No | Yes |
| Alignment Health the ONE + Walgreens (HMO-POS) | H5472-001 | 5 | No | No | Yes |
| Alignment Health the ONE + Walgreens (HMO) | H3443-001 | 5 | No | No | Yes |
| Alignment Health the ONE + Walgreens (HMO) | H3443-002 | 5 | No | No | Yes |
| Alignment Health the ONE + Walgreens (HMO) | H3815-035 | 5 | No | No | Yes |
| Alignment Health Total Dual+ (HMO-POS D-SNP) | H5472-009 | 5 | No | No | Yes |
| Alignment Health ValorCare (HMO) | H3815-053 | 5 | No | No | Yes |
Source
Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Valtoco 5 MG Dose Kit at other payers
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.