No prior authorization
Does Devoted Health require prior authorization for Valtoco 5 MG Dose Kit?
Devoted Health 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 | 415 / 415 | 0 | 0 | 415 | 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 |
|---|---|---|---|---|---|
| DEVOTED C-SNP 003 NM (HMO C-SNP) | H9977-003 | 4 | No | No | Yes |
| DEVOTED C-SNP 007 NM (HMO C-SNP) | H9977-007 | 4 | No | No | Yes |
| DEVOTED C-SNP 011 AZ (HMO C-SNP) | H8173-011 | 4 | No | No | Yes |
| DEVOTED C-SNP 023 AZ (HMO C-SNP) | H8173-023 | 4 | No | No | Yes |
| DEVOTED C-SNP 027 TX (HMO C-SNP) | H7993-027 | 4 | No | No | Yes |
| DEVOTED C-SNP 046 TX (HMO C-SNP) | H7993-046 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE 004 SC (PPO C-SNP) | H7028-004 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE 006 AR (PPO C-SNP) | H7397-006 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE 006 MS (PPO C-SNP) | H7355-006 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE 008 AL (PPO C-SNP) | H9888-008 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE 010 AL (PPO C-SNP) | H9888-010 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP) | H0413-003 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) | H4348-004 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 004 KY (PPO C-SNP) | H5718-004 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 006 NE (PPO C-SNP) | H9802-006 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 006 SC (PPO C-SNP) | H7028-006 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 006 WA (PPO C-SNP) | H8917-006 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 007 UT (PPO C-SNP) | H4473-007 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 008 OK (PPO C-SNP) | H2845-008 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 010 AR (PPO C-SNP) | H7397-010 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 010 MS (PPO C-SNP) | H7355-010 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 012 AL (PPO C-SNP) | H9888-012 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) | H8320-012 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) | H7471-013 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 014 LA (PPO C-SNP) | H7766-014 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 015 AL (PPO C-SNP) | H9888-015 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) | H5453-016 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) | H9231-020 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) | H4348-003 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 003 UT (PPO C-SNP) | H4473-003 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 005 KY (PPO C-SNP) | H5718-005 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) | H7028-005 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) | H8917-005 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) | H5718-006 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 007 AR (PPO C-SNP) | H7397-007 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) | H4348-007 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 007 MS (PPO C-SNP) | H7355-007 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 009 AL (PPO C-SNP) | H9888-009 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) | H9802-009 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) | H2845-009 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) | H2845-010 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) | H9888-011 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 011 IL (PPO C-SNP) | H8320-011 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) | H7766-012 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) | H8320-013 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) | H7766-013 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) | H8320-014 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 014 IN (PPO C-SNP) | H7471-014 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) | H5453-015 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 015 IN (PPO C-SNP) | H7471-015 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 016 IN (PPO C-SNP) | H7471-016 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) | H9231-016 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) | H5453-017 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) | H7471-017 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) | H9231-017 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 018 GA (PPO C-SNP) | H5453-018 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 018 TN (PPO C-SNP) | H9231-018 | 4 | No | No | Yes |
| DEVOTED C-SNP CHOICE PREMIUM 019 TN (PPO C-SNP) | H9231-019 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 003 HI (HMO C-SNP) | H5397-003 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) | H9977-004 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 004 VA (HMO C-SNP) | H6994-004 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 006 IL (HMO C-SNP) | H7151-006 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 009 OR (HMO C-SNP) | H2923-009 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 013 CO (HMO C-SNP) | H7147-013 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | H5299-015 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 016 MO (HMO C-SNP) | H2041-016 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) | H2697-016 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) | H6852-021 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) | H8173-022 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 022 PA (HMO C-SNP) | H6852-022 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 024 TX (HMO C-SNP) | H7993-024 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) | H8173-025 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) | H8173-027 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 029 TX (HMO C-SNP) | H7993-029 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 031 TX (HMO C-SNP) | H7993-031 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) | H7993-033 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 036 IA (HMO C-SNP) | H7993-036 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 084 FL (HMO C-SNP) | H1290-084 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 085 FL (HMO C-SNP) | H1290-085 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 086 FL (HMO C-SNP) | H1290-086 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 087 FL (HMO C-SNP) | H1290-087 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 088 FL (HMO C-SNP) | H1290-088 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) | H1290-089 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 090 FL (HMO C-SNP) | H1290-090 | 4 | No | No | Yes |
| DEVOTED C-SNP PLUS 091 FL (HMO C-SNP) | H1290-091 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 003 VA (HMO C-SNP) | H6994-003 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) | H7151-005 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 009 CO (HMO C-SNP) | H7147-009 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 010 CO (HMO C-SNP) | H7147-010 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) | H6994-010 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) | H7147-011 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) | H2041-012 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) | H2041-013 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) | H6994-013 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) | H8173-014 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) | H2041-014 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | H5299-014 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 015 MO (HMO C-SNP) | H2041-015 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | H5299-016 | 4 | No | No | Yes |
| DEVOTED C-SNP PREMIUM 016 PA (HMO C-SNP) | H6852-016 | 4 | No | No | Yes |
Showing 100 of 415 covering plans.
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.