Incorrect Billing on Nayzilam® and Valtoco® Can Cost You
Nayzilam® and Valtoco® are indicated for the short-term treatment of seizure clusters that are distinct from a patient’s usual seizure pattern in patients with epilepsy. A seizure cluster is defined as periods of increased seizure activity-having two or more seizures in a 24-hour period.
Nayzilam®: Per the manufacturer product label, section 2.2 (Dosing Information), the initial dose of Nayzilam® is one spray into one nostril. If needed, and the directions support, an additional spray may be administered into the opposite nostril 10 minutes after the initial dose if the patient has not responded to the initial dose.
Valtoco®: The number of sprays per dose is dependent on the strength prescribed. According to the manufacturer product label, section 2.2 (Dosing Information), the initial dose for the 5 mg and 10 mg strengths is one spray into one nostril while the initial dose for the 15 mg and 20 mg strengths is two sprays – one spray into each nostril. If needed, and the directions support, a second dose may be administered at least 4 hours after the initial dose if the patient has not responded.
Also, it is important to know the maximum number of episodes the patient can treat per month to correctly calculate the day’s supply. FDA-approved directions recommend no more than two doses of Nayzilam® should be used to treat a single episode and it should not be used to treat more than one episode every three days with a maximum of five episodes per month. Similarly, FDA-approved directions recommend that no more than two doses of Valtoco® should be used to treat a single episode, and it should not be used to treat more than one episode every five days with a maximum of five episodes per month.
Both Nayzilam® and Valtoco® are rescue medications that are different from daily epilepsy medications used to manage epilepsy. Please see the chart below and PAAS Tips for recommended billing guidance and to protect your pharmacy from audit recoupments.
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| Drug Name | NCPDP Billing Unit per Box (i.e., number of doses/box) | Number of Sprays per Dose | Number of Sprays per Box | Suggested Days’ Supply per Box where the Rx indicates a repeat dose per episode | Max Quantity for 30 Days’ Supply where the Rx indicates a repeat dose per episode |
| Nayzilam® 5 mg/spray | 2 EA | 1 dose = 1 spray | 2 x 5 mg | 3 days | 10 EA (5 boxes) |
| Valtoco® 5 mg/spray | 5 EA | 1 dose = 1 spray | 5 x 5 mg | 10 days* | 10 EA (2 boxes) |
| Valtoco® 10 mg/spray | 1 dose = 1 spray | 5 x 10 mg | |||
| Valtoco® 15 mg/2 sprays | 1 dose = 2 sprays | 10 x 7.5 mg | |||
| Valtoco® 20 mg/2 sprays | 1 dose = 2 sprays | 10 x 10 mg |
*A patient who is only prescribed one box with directions to use up to two doses per episode (every 5 days), will only have 1 dose left after 10 days, hence a 10 days’ supply since the patient will not have enough to complete another treatment.
PAAS Tips:
- Medi-Span shows Valtoco® NDCs with the billing unit of 2 EA were inactivated as of 3/25/2025
- Please refer to the July 2024 Newsline article, Proper Billing of Nayzilam® and Valtoco® Nasal Sprays for guidance on billing the 2 EA NDC’s if you still have them in stock
- Ensure both the quantity and unit of measure are clear on the prescription as “5 boxes” and “5 EA” will lead to different billing outcomes
- Note the number of anticipated episodes the patient will be treating per month to ensure proper billing and use, paying particular attention to the refill intervals
- If any clarifications need to be made on the directions, be sure to include a full clinical note, complete with the date, name and title of person spoken with, what was communicated, and your initials. The patient label must also be updated prior to dispensing to reflect the clarified directions
- Nayzilam® and Valtoco® are both DEA schedule 4 controlled substances, so be sure to include all controlled substance requirements on the hard copy – patient address, physician address and physician DEA # and any additional state requirements
- Refer to our updated Nasal Inhaler Chart on the Member Portal
I have a Bachelor of Science degree from the University of Wisconsin-River Falls and have been a Certified Pharmacy Technician since 2001. Prior to joining the PAAS team, I was a floating technician, 3rd party district chargeback specialist, and district pharmacy training coordinator. Formerly, I was also an instructor for pharmacy technician certification classes.
PAAS’ personal, one-on-one connection will help your pharmacy become more successful in dealing with tiresome PBM audits. It is a pleasure knowing that my colleagues and I can help member pharmacies.
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