Does Freedom Health, INC. require prior authorization for Valtoco 5 MG Dose Kit?
Freedom Health, 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 | 24 / 24 | 0 | 0 | 24 | 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 |
|---|---|---|---|---|---|
| Freedom Medi-Medi Full (HMO D-SNP) | H5427-087 | 3 | No | No | Yes |
| Freedom Medi-Medi Partial (HMO D-SNP) | H5427-078 | 3 | No | No | Yes |
| Freedom Medicare Plan Rx (HMO) | H5427-059 | 3 | No | No | Yes |
| Freedom Medicare Plan Rx (HMO) | H5427-060 | 3 | No | No | Yes |
| Freedom M�ximo (HMO-POS) | H5427-112 | 3 | No | No | Yes |
| Freedom M�ximo (HMO-POS) | H5427-113 | 3 | No | No | Yes |
| Freedom Platinum Plan Rx (HMO) | H5427-088 | 3 | No | No | Yes |
| Freedom Platinum Plan Rx (HMO) | H5427-089 | 3 | No | No | Yes |
| Freedom Platinum Plan Rx (HMO) | H5427-091 | 3 | No | No | Yes |
| Freedom Platinum Plan Rx (HMO) | H5427-093 | 3 | No | No | Yes |
| Freedom Platinum Plan Rx (HMO) | H5427-094 | 3 | No | No | Yes |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-096 | 3 | No | No | Yes |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-102 | 3 | No | No | Yes |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-103 | 3 | No | No | Yes |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-105 | 3 | No | No | Yes |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-106 | 3 | No | No | Yes |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-107 | 3 | No | No | Yes |
| Freedom VIP Care (HMO C-SNP) | H5427-070 | 3 | No | No | Yes |
| Freedom VIP Rewards (HMO C-SNP) | H5427-099 | 3 | No | No | Yes |
| Freedom VIP Rewards (HMO C-SNP) | H5427-108 | 3 | No | No | Yes |
| Freedom VIP Savings (HMO C-SNP) | H5427-072 | 3 | No | No | Yes |
| Freedom VIP Savings (HMO C-SNP) | H5427-082 | 3 | No | No | Yes |
| Freedom VIP Savings COPD (HMO C-SNP) | H5427-077 | 3 | No | No | Yes |
| Freedom VIP Savings COPD (HMO C-SNP) | H5427-083 | 3 | No | No | Yes |
- 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.