Does Allina Health And Aetna Insurance Company require prior authorization for Valtoco 15 MG Dose Kit?
Allina Health And Aetna Insurance Company requires prior authorization for Valtoco 15 MG Dose Kit on every Medicare Part D plan of theirs that covers it.
Every plan from this payer that covers the drug requires authorization before it is dispensed.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| {2 (0.1 ML) (diazepam 75 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 15 MG Dose Kit]2272636 | 9 / 9 | 9 | 0 | 9 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — {2 (0.1 ML) (diazepam 75 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 15 MG Dose Kit]
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Allina Health Aetna Medicare Chronic (PPO C-SNP) | H3219-015 | 4 | Yes | No | Yes |
| Allina Health Aetna Medicare Enhanced (PPO) | H3219-002 | 4 | Yes | No | Yes |
| Allina Health Aetna Medicare Enhanced (PPO) | H3219-014 | 4 | Yes | No | Yes |
| Allina Health Aetna Medicare Grand (PPO) | H3219-003 | 4 | Yes | No | Yes |
| Allina Health Aetna Medicare Grand Extra (PPO) | H3219-004 | 4 | Yes | No | Yes |
| Allina Health Aetna Medicare Signature (PPO) | H3219-001 | 4 | Yes | No | Yes |
| Allina Health Aetna Medicare Signature (PPO) | H3219-012 | 4 | Yes | No | Yes |
| Allina Health Aetna Medicare Signature Fit (PPO) | H3219-008 | 4 | Yes | No | Yes |
| Allina Health Aetna Medicare Value (PPO C-SNP) | H3219-016 | 4 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Valtoco 15 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.