Prior authorization required

Does Health Alliance Plan Of Michigan require prior authorization for Valtoco 15 MG Dose Kit?

Health Alliance Plan Of Michigan 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	7 / 7	7	0	7	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
HAP Medicare Complete Duals (HMO D-SNP)	H2354-025	5	Yes	No	Yes
HAP Medicare Connect (HMO)	H2354-015	5	Yes	No	Yes
HAP Medicare Diabetes and Heart (HMO C-SNP)	H2354-030	5	Yes	No	Yes
HAP Medicare Superior (HMO)	H2354-028	5	Yes	No	Yes
HAP Senior Plus (HMO-POS)	H2354-021	5	Yes	No	Yes
HAP Senior Plus Henry Ford Tiered Access (HMO)	H2354-018	5	Yes	No	Yes
Henry Ford Select (HMO)	H2354-029	5	Yes	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 15 MG Dose Kit at other payers

Or see Valtoco 15 MG Dose Kit across every payer at once.

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.