Does Simply Healthcare Plans, INC. require prior authorization for Valtoco 5 MG Dose Kit?
Simply Healthcare Plans, INC. 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 | 50 / 50 | 0 | 0 | 50 | 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 |
|---|---|---|---|---|---|
| Simply Complete (HMO D-SNP) | H5471-064 | 4 | No | No | Yes |
| Simply Complete (HMO D-SNP) | H5471-066 | 4 | No | No | Yes |
| Simply Complete (HMO D-SNP) | H5471-072 | 4 | No | No | Yes |
| Simply Complete (HMO D-SNP) | H5471-076 | 4 | No | No | Yes |
| Simply Complete (HMO D-SNP) | H5471-082 | 4 | No | No | Yes |
| Simply Complete (HMO D-SNP) | H5471-084 | 4 | No | No | Yes |
| Simply Complete (HMO D-SNP) | H5471-111 | 4 | No | No | Yes |
| Simply Complete Platinum (HMO D-SNP) | H5471-115 | 4 | No | No | Yes |
| Simply Complete Platinum (HMO D-SNP) | H5471-118 | 4 | No | No | Yes |
| Simply Complete Platinum (HMO D-SNP) | H5471-121 | 4 | No | No | Yes |
| Simply Complete Platinum (HMO D-SNP) | H5471-125 | 4 | No | No | Yes |
| Simply Complete Platinum (HMO D-SNP) | H5471-138 | 4 | No | No | Yes |
| Simply Complete Platinum (HMO D-SNP) | H5471-140 | 4 | No | No | Yes |
| Simply Complete Platinum (HMO D-SNP) | H5471-142 | 4 | No | No | Yes |
| Simply Extra (HMO) | H5471-112 | 4 | No | No | Yes |
| Simply Extra Platinum (HMO) | H5471-113 | 4 | No | No | Yes |
| Simply Extra Platinum (HMO) | H5471-117 | 4 | No | No | Yes |
| Simply Extra Platinum (HMO) | H5471-120 | 4 | No | No | Yes |
| Simply Extra Platinum (HMO) | H5471-123 | 4 | No | No | Yes |
| Simply Integrated (HMO D-SNP) | H5471-127 | 4 | No | No | Yes |
| Simply Integrated (HMO D-SNP) | H5471-128 | 4 | No | No | Yes |
| Simply Integrated (HMO D-SNP) | H5471-129 | 4 | No | No | Yes |
| Simply Integrated (HMO D-SNP) | H5471-130 | 4 | No | No | Yes |
| Simply Integrated (HMO D-SNP) | H5471-131 | 4 | No | No | Yes |
| Simply Integrated (HMO D-SNP) | H5471-132 | 4 | No | No | Yes |
| Simply Integrated (HMO D-SNP) | H5471-133 | 4 | No | No | Yes |
| Simply Integrated Platinum (HMO D-SNP) | H5471-134 | 4 | No | No | Yes |
| Simply Integrated Platinum (HMO D-SNP) | H5471-135 | 4 | No | No | Yes |
| Simply Integrated Platinum (HMO D-SNP) | H5471-136 | 4 | No | No | Yes |
| Simply Integrated Platinum (HMO D-SNP) | H5471-137 | 4 | No | No | Yes |
| Simply Integrated Platinum (HMO D-SNP) | H5471-139 | 4 | No | No | Yes |
| Simply Integrated Platinum (HMO D-SNP) | H5471-141 | 4 | No | No | Yes |
| Simply Integrated Platinum (HMO D-SNP) | H5471-143 | 4 | No | No | Yes |
| Simply Level (HMO C-SNP) | H5471-069 | 4 | No | No | Yes |
| Simply Level (HMO C-SNP) | H5471-070 | 4 | No | No | Yes |
| Simply Level (HMO C-SNP) | H5471-073 | 4 | No | No | Yes |
| Simply Level (HMO C-SNP) | H5471-075 | 4 | No | No | Yes |
| Simply Level (HMO C-SNP) | H5471-080 | 4 | No | No | Yes |
| Simply Level Platinum (HMO C-SNP) | H5471-116 | 4 | No | No | Yes |
| Simply Level Platinum (HMO C-SNP) | H5471-119 | 4 | No | No | Yes |
| Simply Level Platinum (HMO C-SNP) | H5471-122 | 4 | No | No | Yes |
| Simply Level Platinum (HMO C-SNP) | H5471-126 | 4 | No | No | Yes |
| Simply More (HMO) | H5471-065 | 4 | No | No | Yes |
| Simply More (HMO) | H5471-071 | 4 | No | No | Yes |
| Simply More (HMO) | H5471-074 | 4 | No | No | Yes |
| Simply More (HMO) | H5471-077 | 4 | No | No | Yes |
| Simply More (HMO) | H5471-078 | 4 | No | No | Yes |
| Simply More (HMO) | H5471-110 | 4 | No | No | Yes |
| Simply More Platinum (HMO) | H5471-114 | 4 | No | No | Yes |
| Simply More Platinum (HMO) | H5471-124 | 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.