CommercialCoverageMedium impact
Erzofri (paliperidone palmitate)
Blue Cross & Blue Shield of Mississippi·MS · Psychiatry·Medical Policy
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has added a new policy declaring Erzofri (paliperidone palmitate) injections as not medically necessary for schizophrenia and schizoaffective disorder treatment due to availability of covered alternatives. All services related to this medication will be denied without prior authorization approval.
Action Required
By August 1, 2025: Billing team must update system to flag HCPCS code J2428 (Erzofri injections) as requiring prior authorization through BCBSMS PA review process before administration. Notify providers that this medication is considered not medically necessary and claims will be denied without approved PA. Update encounter forms and EMR templates to remind staff of PA requirement.