Prior authorization required
Does UnitedHealthcare require prior authorization for Valtoco 5 MG Dose Kit?
UnitedHealthcare requires prior authorization for Valtoco 5 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 |
|---|---|---|---|---|---|
| {1 (0.1 ML) (diazepam 50 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 5 MG Dose Kit]2272630 | 731 / 731 | 731 | 0 | 731 | Prior authorization required |
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 |
|---|---|---|---|---|---|
| AARP Medicare Advantage Access from UHC AZ-15 (PPO) | H2406-129 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Access from UHC MT-3 (PPO) | H8211-012 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | H2001-084 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Access from UHC VA-20 (PPO) | H2001-115 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Access from UHC WA-11 (PPO) | H2001-138 | 5 | Yes | No | Yes |
| AARP Medicare Advantage CareFlex from UHC AZ-17 (HMO-POS) | H5253-178 | 5 | Yes | No | Yes |
| AARP Medicare Advantage CareFlex from UHC MA-9 (HMO-POS) | H5253-159 | 5 | Yes | No | Yes |
| AARP Medicare Advantage CareFlex from UHC RI-5 (HMO-POS) | H5253-169 | 5 | Yes | No | Yes |
| AARP Medicare Advantage CareFlex from UHC ST-6 (HMO-POS) | H2802-073 | 5 | Yes | No | Yes |
| AARP Medicare Advantage CareFlex from UHC TX-44 (HMO-POS) | H0609-077 | 5 | Yes | No | Yes |
| AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) | H0609-078 | 5 | Yes | No | Yes |
| AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS) | H5253-198 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC AR-1 (HMO-POS) | H2802-060 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC AZ-1 (HMO-POS) | H0609-025 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC AZ-2 (HMO-POS) | H0609-026 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC CO-2 (HMO-POS) | H0609-012 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC CO-4 (HMO-POS) | H0609-036 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC CO-4 (HMO-POS) | H0609-036 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC DE-3 (HMO-POS) | H5253-142 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC EP-1 (PPO) | H2406-039 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC IL-8 (HMO-POS) | H2802-024 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC IN-10 (HMO-POS) | H2802-007 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC IN-11 (HMO-POS) | H2802-008 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC IN-12 (HMO-POS) | H2802-010 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC KC-4 (PPO) | H8768-023 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC KC-6 (HMO-POS) | H2802-076 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC KY-1 (HMO-POS) | H5253-099 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC MO-4 (HMO-POS) | H2802-030 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC NE-3 (HMO-POS) | H2802-001 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC NJ-1 (HMO-POS) | H0755-038 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OH-2 (HMO-POS) | H5253-062 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) | H5253-144 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) | H5253-144 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OH-6 (HMO-POS) | H5253-124 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OH-6 (HMO-POS) | H5253-124 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OH-7 (HMO-POS) | H5253-125 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OH-7 (HMO-POS) | H5253-125 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OK-3 (HMO-POS) | H5253-173 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OR-4 (HMO-POS) | H3805-039 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC OR-4 (HMO-POS) | H3805-039 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) | H5253-154 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC ST-3 (HMO-POS) | H2802-028 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC TX-21 (HMO-POS) | H0609-050 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC TX-22 (HMO-POS) | H0609-051 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC TX-26 (HMO-POS) | H0609-060 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) | H4604-011 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC WA-6 (HMO-POS) | H3805-017 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) | H3805-032 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC WA-8 (HMO-POS) | H3805-033 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) | H5253-033 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Essentials ValueRx NV-5 (HMO-POS) | H0609-038 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC AR-7 (HMO-POS) | H2802-078 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC AZ-4 (HMO-POS) | H0609-045 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC AZ-5 (HMO-POS) | H0609-046 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC CO-20 (HMO-POS) | H0609-073 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC CO-5 (HMO-POS) | H0609-048 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC DE-6 (HMO-POS) | H5253-206 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC EP-3 (PPO) | H2406-121 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC IL-9 (HMO-POS) | H2802-075 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC IN-16 (HMO-POS) | H2802-055 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC IN-17 (HMO-POS) | H2802-056 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC KC-2 (HMO-POS) | H2802-032 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC KC-5 (PPO) | H8768-039 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC KY-5 (HMO-POS) | H5253-128 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC MO-10 (HMO-POS) | H2802-072 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC NE-5 (HMO-POS) | H2802-074 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC NJ-7 (HMO-POS) | H0755-046 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OH-10 (HMO-POS) | H5253-131 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OH-11 (HMO-POS) | H5253-132 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OH-12 (HMO-POS) | H5253-133 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OH-13 (HMO-POS) | H5253-134 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OH-8 (HMO-POS) | H5253-126 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OH-8 (HMO-POS) | H5253-126 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OH-9 (HMO-POS) | H5253-130 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OK-8 (HMO-POS) | H5253-204 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC OR-6 (HMO-POS) | H3805-041 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC PA-18 (HMO-POS) | H5253-203 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC ST-4 (HMO-POS) | H2802-052 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC TX-27 (HMO-POS) | H0609-061 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC TX-28 (HMO-POS) | H0609-063 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC TX-48 (HMO-POS) | H0609-080 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC WA-14 (HMO-POS) | H3805-044 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC WA-15 (HMO-POS) | H3805-045 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras from UHC WI-19 (HMO-POS) | H5253-199 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras UT-7 (HMO-POS) | H4604-018 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Extras ValueRx NV-10 (HMO-POS) | H0609-075 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | H0432-003 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AL-0002 (HMO-POS) | H0432-004 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AL-0003 (HMO-POS) | H2802-041 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AL-0004 (PPO) | H1889-015 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AL-6 (HMO-POS) | H2802-079 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AR-0002 (HMO-POS) | H2802-061 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AR-0004 (PPO) | H1889-014 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AZ-0003 (HMO-POS) | H0609-044 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AZ-0007 (PPO) | H2406-062 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AZ-0008 (PPO) | H2406-063 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AZ-0010 (PPO) | H2406-076 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AZ-0011 (PPO) | H2406-078 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AZ-0013 (HMO-POS) | H5253-035 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC AZ-0014 (HMO-POS) | H5253-036 | 5 | Yes | No | Yes |
Showing 100 of 731 covering plans.
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.