Does Excellus Health Plan, INC. require prior authorization for Valtoco 5 MG Dose Kit?
Excellus Health Plan, INC. 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 | 16 / 16 | 0 | 0 | 0 | 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 |
|---|---|---|---|---|---|
| Medicare Blue Choice Core (HMO) | H3351-022 | 5 | No | No | No |
| Medicare Blue Choice Optimum (HMO-POS) | H3351-006 | 5 | No | No | No |
| Medicare Blue Choice Prime (HMO) | H3351-023 | 5 | No | No | No |
| Medicare BlueActive (PPO) | H3335-055 | 5 | No | No | No |
| Medicare BlueBalanced (PPO) | H3335-062 | 5 | No | No | No |
| Medicare BlueClassic (PPO) | H3335-038 | 5 | No | No | No |
| Medicare BlueEnhanced (PPO) | H3335-015 | 5 | No | No | No |
| Medicare BlueEssential (PPO) | H3335-053 | 5 | No | No | No |
| Medicare BluePlus (PPO) | H3335-018 | 5 | No | No | No |
| Medicare BlueVital (PPO) | H3335-061 | 5 | No | No | No |
| Univera SeniorChoice Advanced (HMO-POS) | H3351-019 | 5 | No | No | No |
| Univera SeniorChoice Basic (HMO) | H3351-017 | 5 | No | No | No |
| Univera SeniorChoice Core (PPO) | H3335-060 | 5 | No | No | No |
| Univera SeniorChoice Extra (HMO) | H3351-020 | 5 | No | No | No |
| Univera SeniorChoice Secure (HMO-POS) | H3351-002 | 5 | No | No | No |
| Univera SeniorChoice Value Plus (HMO-POS) | H3351-012 | 5 | No | No | No |
- 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.