VALTOCO

Indicated For

seizure clusters, acute repetitive seizures

About This Medication

# myNEURELIS Patient Assistance Program Patient Guide: How to Get VALTOCO at Low or No Cost VALTOCO (diazepam nasal spray) is a prescription medication used to treat seizure clusters in adults and children 6 years and older. The **myNEURELIS Patient Assistance Program** from Neurelis helps eligible uninsured or underinsured patients get VALTOCO at no cost if they lack prescription coverage and financial resources.[5][4] ## About VALTOCO **VALTOCO** is a nasal spray form of diazepam, a benzodiazepine that works quickly to stop prolonged or repeated seizures known as seizure clusters. Unlike rectal gels, it's administered intranasally, making it easier for caregivers to use during an emergency without invading privacy. Always discuss with your doctor if you have conditions like breathing problems, history of substance abuse, depression, liver/kidney issues, or if pregnant, as VALTOCO carries risks including potential harm to an unborn baby.[1] This guide explains the myNEURELIS Patient Assistance Program (PAP), designed for patients facing barriers to accessing VALTOCO due to cost or lack of insurance coverage.[3][5] ## Who Qualifies for the Program? The program targets **uninsured or underinsured patients without prescription coverage for VALTOCO** who lack the financial resources to afford it.[5][4] You must be a U.S. resident. Key eligibility factors include: - No medical insurance or specific coverage for VALTOCO. - Limited financial means, based on household income and dependents (exact guidelines not publicly disclosed; assessed case-by-case).[4][7] - Prescribed VALTOCO by a licensed U.S. healthcare provider for an FDA-approved use.[4] Patients with commercial insurance may qualify for a separate copay card (as low as $20), but the PAP is for those without coverage.[2][5] ## Income Eligibility Breakdown Specific income thresholds (e.g., Federal Poverty Level percentages) are not publicly available and are evaluated individually.[7] Applications require details like annual household income, number of dependents, and last 4 digits of Social Security Number.[4] Contact the program for a personalized assessment. | Household Size | Estimated Eligibility Notes | |---------------|----------------------------| | Individual | Must demonstrate lack of resources; income reviewed case-by-case[4] | | Couple | Household income and dependents considered[4] | | Family of 3 | Full financial disclosure required[4] | | Family of 4+ | U.S. residency and no VALTOCO coverage essential[4] | **Note:** Provide accurate financial info, as you must notify the program if circumstances change (e.g., gaining insurance).[4] ## Insurance Requirements Eligible patients have **no prescription coverage for VALTOCO** through private insurance, Medicare, Medicaid, or other programs.[4][5] If insured but uncovered for this drug, or fully uninsured, you may qualify. The program certifies lack of coverage; gaining coverage later requires notification.[4] Medicare patients without VALTOCO coverage might be eligible, but confirm via phone.[5] ## Step-by-Step Application Process 1. **Talk to Your Doctor:** Ensure you have a prescription for VALTOCO. Your doctor may help complete referral forms.[4] 2. **Contact myNEURELIS:** Call **1-866-696-3873** (Monday-Friday, 8 AM-8 PM ET). This is the primary application method—no online form specified for PAP.[2][3] 3. **Provide Patient Info:** Share name, DOB, address, phone, gender, last 4 SSN digits.[4] 4. **Submit Financial Details:** Annual household income, number of dependents, U.S. residency confirmation.[4] 5. **Doctor Involvement:** Program may require prescriber details (NPI, DEA, signature). A referral form exists for download.[4][10] 6. **Sign Agreements:** Authorize sharing health/financial info for eligibility review and agree to notify changes.[4] 7. **Wait for Approval:** Processed by Neurelis team; medication ships directly to you if approved.[5] Enroll in broader myNEURELIS support online at myNEURELIS.com for nurse educators or coverage checks.[1][2] ## Timeline and Delivery Processing time not specified—call for updates. Approved VALTOCO is **shipped directly to the patient** at no cost.[5] Support line operates M-F 8 AM-8 PM ET.[2] Refills/reauthorization details assessed per case. ## Alternatives if Denied - **Copay Card:** Commercial insurance patients may pay $20; no enrollment needed.[2][5] - **Insurance Appeal:** Ask your plan to cover VALTOCO. - **Other Assistance:** Nurse educators via myNEURELIS can connect to epilepsy resources.[3] - **State Programs:** Check local Medicaid or generic diazepam options (discuss with doctor). - **Reapply:** If finances change or with more documentation.[4] No biosimilar alternatives listed for VALTOCO. ## Important Disclaimer This guide is for informational purposes based on available program details as of March 2026. Eligibility, terms, and availability can change—**always verify directly with myNEURELIS at 1-866-696-3873 or myNEURELIS.com**.[2][5] Not medical advice; consult your healthcare provider before starting VALTOCO. Neurelis may share your info with partners for processing.[4] You agree to report changes in insurance/income promptly.[4]

Program information last verified: March 30, 2026