Does Medica Health Plans require prior authorization for Valtoco 15 MG Dose Kit?
Medica Health Plans 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 | 17 / 17 | 17 | 0 | 17 | 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 |
|---|---|---|---|---|---|
| Medica Advantage Dual (PPO D-SNP) | H8889-016 | 3 | Yes | No | Yes |
| Medica Advantage Preferred (PPO) | H8889-011 | 3 | Yes | No | Yes |
| Medica Advantage Preferred (PPO) | H8889-013 | 3 | Yes | No | Yes |
| Medica Advantage Select (PPO) | H8889-012 | 3 | Yes | No | Yes |
| Medica Advantage Select (PPO) | H8889-015 | 3 | Yes | No | Yes |
| Medica Advantage Select (PPO) | H8889-018 | 3 | Yes | No | Yes |
| Medica Advantage Solution H6154-001 (HMO-POS) | H6154-001 | 3 | Yes | No | Yes |
| Medica Advantage Solution H8889-001 (PPO) | H8889-001 | 3 | Yes | No | Yes |
| Medica Advantage Solution H8889-002 (PPO) | H8889-002 | 3 | Yes | No | Yes |
| Medica Advantage Solution H8889-003 (PPO) | H8889-003 | 3 | Yes | No | Yes |
| Medica Advantage Solution H8889-004 (PPO) | H8889-004 | 3 | Yes | No | Yes |
| Medica Advantage Solution H8889-005 (PPO) | H8889-005 | 3 | Yes | No | Yes |
| Medica Advantage Solution H8889-008 (PPO) | H8889-008 | 3 | Yes | No | Yes |
| Medica Advantage Value (PPO) | H8889-010 | 3 | Yes | No | Yes |
| Medica Advantage Value (PPO) | H8889-014 | 3 | Yes | No | Yes |
| Medica Advantage Value (PPO) | H8889-017 | 3 | Yes | No | Yes |
| Medica DUAL Solution (HMO D-SNP) | H2458-002 | 3 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Valtoco 15 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.