Does Health Care Service Corporation require prior authorization for Valtoco 5 MG Dose Kit?
Health Care Service Corporation 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 | 31 / 31 | 0 | 0 | 31 | 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 |
|---|---|---|---|---|---|
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | H8634-009 | 1 | No | No | Yes |
| Blue Cross Medicare Advantage Balance (PPO) | H8634-031 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Basic (HMO) | H3822-001 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Basic (HMO) | H3822-002 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Basic (HMO) | H3822-012 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Basic Plus (HMO-POS) | H3822-007 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Choice Plus (PPO) | H0107-005 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Choice Plus (PPO) | H8634-003 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Choice Premier (PPO) | H8634-004 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Classic (PPO) | H0107-003 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Classic (PPO) | H8634-008 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Classic (PPO) | H8634-010 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Classic (PPO) | H8634-022 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Classic (PPO) | H8634-027 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Complete (PPO) | H8634-023 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H0107-007 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H8634-021 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H8634-024 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H8634-029 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | H3251-029 | 1 | No | No | Yes |
| Blue Cross Medicare Advantage Essential (PPO) | H8634-012 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Health Choice (PPO) | H0107-010 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Health Choice (PPO) | H8634-018 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Health Choice (PPO) | H8634-025 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Health Choice (PPO) | H8634-030 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Optimum (PPO) | H0107-004 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Optimum (PPO) | H8634-032 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Preferred (PPO) | H8634-033 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Premier Plus (HMO-POS) | H3822-008 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Select (HMO) | H3251-002 | 4 | No | No | Yes |
| Blue Cross Medicare Advantage Value (HMO) | H3822-014 | 4 | 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.