FillMapAetna Medicare Dual (HMO D-SNP)

Does Aetna Medicare Dual (HMO D-SNP) cover diazepam?

Aetna Medicare Dual (HMO D-SNP)
H3146-002-0 · MA_LOCAL · Medicare Part D
diazepam
Your Extra Help level

Everyone on this plan has Medicare and Medicaid, which qualifies you for Extra Help automatically — so the figures below already use the statutory copays, not this plan’s published cost sharing. Nothing here is saved.

Full Extra Help: no deductible, and at most $5.10 generic or $12.65 brand-name per fill.

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 Dual (HMO D-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
$0per 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

← All coverage for diazepam