Does Wellpoint Texas, INC. require prior authorization for Valtoco 15 MG Dose Kit?
Wellpoint Texas, INC. does not require prior authorization for Valtoco 15 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 |
|---|---|---|---|---|---|
| {2 (0.1 ML) (diazepam 75 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 15 MG Dose Kit]2272636 | 16 / 16 | 0 | 0 | 16 | No prior authorization |
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 |
|---|---|---|---|---|---|
| Wellpoint Chronic Care 2 (HMO-POS C-SNP) | H2593-006 | 4 | No | No | Yes |
| Wellpoint Dual Advantage 2 (HMO D-SNP) | H2593-032 | 4 | No | No | Yes |
| Wellpoint Full Dual Advantage (HMO D-SNP) | H2593-053 | 4 | No | No | Yes |
| Wellpoint Full Dual Advantage 2 (HMO D-SNP) | H2593-048 | 4 | No | No | Yes |
| Wellpoint Full Dual Advantage 2 (HMO D-SNP) | H2593-051 | 4 | No | No | Yes |
| Wellpoint Full Dual Advantage Aligned (HMO D-SNP) | H2593-044 | 4 | No | No | Yes |
| Wellpoint Full Dual Advantage Aligned (HMO D-SNP) | H2593-045 | 4 | No | No | Yes |
| Wellpoint Full Dual Advantage Aligned (HMO D-SNP) | H2593-046 | 4 | No | No | Yes |
| Wellpoint Full Dual Advantage Aligned (HMO D-SNP) | H2593-047 | 4 | No | No | Yes |
| Wellpoint I CareMore Home Care 2 (HMO I-SNP) | H2593-003 | 4 | No | No | Yes |
| Wellpoint I CareMore Kidney Care (HMO-POS C-SNP) | H2593-040 | 4 | No | No | Yes |
| Wellpoint Kidney Care (HMO-POS C-SNP) | H2593-031 | 4 | No | No | Yes |
| Wellpoint Kidney Care (HMO-POS C-SNP) | H2593-043 | 4 | No | No | Yes |
| Wellpoint Lung Care 2 (HMO-POS C-SNP) | H2593-005 | 4 | No | No | Yes |
| Wellpoint Medicare Advantage 2 (HMO-POS) | H2593-001 | 4 | No | No | Yes |
| Wellpoint Medicare Advantage 2 (HMO-POS) | H2593-029 | 4 | No | 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.