Does Aetna Medicare Chronic Care Value (HMO C-SNP) cover diazepam?
Aetna Medicare Chronic Care Value (HMO C-SNP)
H3146-044-0 · MA_LOCAL · Medicare Part D
diazepam
Do you get help with your Medicare drug costs?None of these
Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.
diazepamunder Aetna Medicare Chronic Care Value (HMO C-SNP)
Covered — some forms require prior authorization
9 of 12 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$5per 30-day fill
Part D caps what you pay out of pocket at $2,100 for 2026. From the first fill — no deductible on this drug.
This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.
Amount limit applies — how much depends on the strength you are prescribed — the cap for each one is listed below. You can still fill it; more than that needs your plan's approval, which your doctor's office requests.
- Tier
- Tier 2
- Approval first
- Required
- Try another first
- No
- Amount limit
- Varies by strength
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.
Covered forms and strengths (12)
- {1 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 10 MG Dose Kit]Tier 4Approval first10 packs per 30 days
- {1 (0.1 ML) (diazepam 50 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 5 MG Dose Kit]Tier 4Approval first10 packs per 30 days
- {2 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 20 MG Dose Kit]Tier 4Approval first10 packs per 30 days
- {2 (0.1 ML) (diazepam 75 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 15 MG Dose Kit]Tier 4Approval first10 packs per 30 days
- 0.5 ML diazepam 5 MG/ML Rectal GelTier 45 tubes per 30 days
- 2 ML diazepam 5 MG/ML Rectal GelTier 45 tubes per 30 days
- 4 ML diazepam 5 MG/ML Rectal GelTier 45 tubes per 30 days
- diazepam 1 MG/ML Oral SolutionTier 4Approval first1200 mL per 30 days
- diazepam 10 MG Oral TabletTier 3Approval first120 tablets per 30 days
- diazepam 2 MG Oral TabletTier 3Approval first120 tablets per 30 days
- diazepam 5 MG Oral TabletTier 3Approval first120 tablets per 30 days
- diazepam 5 MG/ML Oral SolutionTier 2Approval first240 mL per 30 days