No prior authorization
Does Molina Healthcare require prior authorization for Valtoco 5 MG Dose Kit?
Molina Healthcare 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 | 51 / 51 | 0 | 0 | 51 | 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 |
|---|---|---|---|---|---|
| Molina Complete Care for MyCare Ohio (HMO D-SNP) | H9955-008 | 4 | No | No | Yes |
| Molina Dual MI Coordinated Health (HMO D-SNP) | H5926-008 | 4 | No | No | Yes |
| Molina Dual MI Coordinated Health (HMO D-SNP) | H5926-009 | 4 | No | No | Yes |
| Molina Medicare Choice Care (HMO) | H2715-003 | 4 | No | No | Yes |
| Molina Medicare Choice Care (HMO) | H5810-014 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H1799-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H1799-005 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H2478-001 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H2715-006 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H2715-006 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5628-001 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5628-013 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5628-013 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5823-013 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5823-013 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5926-001 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H7678-006 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H7678-006 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-001 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-005 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-007 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-007 | 4 | No | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H9955-007 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3038-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3038-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3038-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3038-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-001 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-002 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-003 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-005 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-001 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-002 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-003 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-005 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H8176-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H8176-004 | 4 | No | No | Yes |
| Molina Medicare Complete Care Select (HMO D-SNP) | H5628-012 | 4 | No | No | Yes |
| Molina Medicare Complete Care Select (HMO D-SNP) | H5628-014 | 4 | No | No | Yes |
| Molina Medicare Complete Care Select (HMO D-SNP) | H5628-014 | 4 | No | No | Yes |
| Molina Medicare Complete Care Select (HMO D-SNP) | H5823-010 | 4 | No | No | Yes |
| My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) | H5209-006 | 4 | No | No | Yes |
| My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) | H5209-006 | 4 | No | No | Yes |
| My Choice Wisconsin Partnership Plan (HMO D-SNP) | H5209-005 | 4 | No | No | Yes |
| My Choice Wisconsin Partnership Plan (HMO D-SNP) | H5209-005 | 4 | No | No | Yes |
| Passport Advantage (HMO D-SNP) | H1799-003 | 4 | No | No | Yes |
| Passport Advantage (HMO D-SNP) | H1799-003 | 4 | No | No | Yes |
| Passport Advantage (HMO D-SNP) | H1799-003 | 4 | No | 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 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.