Benefily
Prior authorization required

Does Independent Health Association, INC. require prior authorization for Valtoco 15 MG Dose Kit?

Independent Health Association, INC. 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 productPlans coveringRequire prior authStep therapyQty limitStatus
{2 (0.1 ML) (diazepam 75 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 15 MG Dose Kit]22726365 / 5500Prior 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]

PlanContractTierPrior authStep therapyQty limit
Independent Health's Assure Advantage (HMO C-SNP)H3362-0405YesNoNo
Independent Health's Encompass 65 RED 042 (HMO)H3362-0425YesNoNo
Independent Health's Encompass 65 RED 043 (HMO)H3362-0435YesNoNo
Independent Health's Encompass 65 RED 044 (HMO)H3362-0445YesNoNo
Independent Health's Medicare Family Choice (HMO I-SNP)H3362-0205YesNoNo
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.