No prior authorization
Does Elevance Health (Anthem) require prior authorization for Valtoco 5 MG Dose Kit?
Elevance Health (Anthem) 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 |
|---|---|---|---|---|---|
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-037 | 4 | No | No | Yes |
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-056 | 4 | No | No | Yes |
| Anthem Dual Advantage (HMO D-SNP) | H0629-002 | 4 | No | No | Yes |
| Anthem Dual Advantage (HMO D-SNP) | H4694-002 | 4 | No | No | Yes |
| Anthem Dual Advantage (HMO D-SNP) | H5854-020 | 4 | No | No | Yes |
| Anthem Dual Advantage (PPO D-SNP) | H2441-001 | 4 | No | No | Yes |
| Anthem Dual Advantage (PPO D-SNP) | H2836-007 | 4 | No | No | Yes |
| Anthem Extra Help (HMO-POS) | H3447-024 | 4 | No | No | Yes |
| Anthem Full Dual Advantage (HMO D-SNP) | H0629-001 | 4 | No | No | Yes |
| Anthem Full Dual Advantage (HMO D-SNP) | H3447-018 | 4 | No | No | Yes |
| Anthem Full Dual Advantage (HMO D-SNP) | H4694-004 | 4 | No | No | Yes |
| Anthem Full Dual Advantage (PPO D-SNP) | H2836-006 | 4 | No | No | Yes |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H3447-053 | 4 | No | No | Yes |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H4694-001 | 4 | No | No | Yes |
| Anthem Full Dual Advantage Select (HMO D-SNP) | H5854-013 | 4 | No | No | Yes |
| Anthem Full Dual Advantage Support (HMO D-SNP) | H4694-003 | 4 | No | No | Yes |
| Anthem HealthPlus Full Dual Advantage (HMO D-SNP) | H8432-042 | 4 | No | No | Yes |
| Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) | H8432-041 | 4 | No | No | Yes |
| Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) | H6988-004 | 4 | No | No | Yes |
| Anthem I PathWays Dual Care Advantage (HMO D-SNP) | H0629-003 | 4 | No | No | Yes |
| Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) | H0629-004 | 4 | No | No | Yes |
| Anthem Kidney Care (HMO-POS C-SNP) | H3447-033 | 4 | No | No | Yes |
| Anthem Kidney Care (HMO-POS C-SNP) | H5854-012 | 4 | No | No | Yes |
| Anthem Kidney Care (PPO C-SNP) | H8552-028 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H3447-013 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H8432-040 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO) | H5854-019 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO) | H5854-019 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO) | H8432-009 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO) | H8432-010 | 4 | No | No | Yes |
| Anthem Medicare Advantage (HMO) | H8432-011 | 4 | No | No | Yes |
| Anthem Medicare Advantage (PPO) | H4036-026 | 4 | No | No | Yes |
| Anthem Medicare Advantage (PPO) | H4036-036 | 4 | No | No | Yes |
| Anthem Medicare Advantage (PPO) | H4909-014 | 4 | No | No | Yes |
| Anthem Medicare Advantage (Regional PPO) | R5941-014 | 4 | No | No | Yes |
| Anthem Medicare Advantage (Regional PPO) | R5941-016 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (HMO-POS) | H3447-025 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-006 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-009 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-010 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (HMO-POS) | H7220-004 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (HMO-POS) | H8432-016 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (PPO) | H1607-015 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (PPO) | H4036-030 | 4 | No | No | Yes |
| Anthem Medicare Advantage 2 (PPO) | H4909-026 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-049 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-050 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-051 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-052 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (HMO-POS) | H6988-007 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (PPO) | H1607-012 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (PPO) | H4036-008 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (PPO) | H4036-025 | 4 | No | No | Yes |
| Anthem Medicare Advantage 3 (PPO) | H4036-034 | 4 | No | No | Yes |
| Anthem Medicare Advantage 4 (HMO-POS) | H3447-039 | 4 | No | No | Yes |
| Anthem Medicare Advantage 4 (HMO) | H7220-010 | 4 | No | No | Yes |
| Anthem Medicare Advantage 4 (PPO) | H4036-017 | 4 | No | No | Yes |
| Blue MedicareRx Premier (PDP) | S2893-003 | 4 | No | No | Yes |
| Blue MedicareRx Value Plus (PDP) | S2893-001 | 4 | 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.