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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · PsychiatryMedium impact

Erzofri (paliperidone palmitate)

Act
by Aug 1, 2025
Effective date
Aug 1, 2025
Identified
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.

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What to do

by Aug 1, 2025 · 3 steps
01Billing team must update system to flag HCPCS code J2428 (Erzofri injections) as requiring prior authorization through BCBSMS PA review process before administration.
02Notify providers that this medication is considered not medically necessary and claims will be denied without approved PA.
03Update encounter forms and EMR templates to remind staff of PA requirement.

Codes mentioned

J2428

Original notice

Erzofri (paliperidone palmitate)
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
State and School Employees' Health Insurance Plan - Erzofri (paliperidone palmitate)MediumEffective Aug 1, 2025 · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesMS policy changesPsychiatryCode J2428

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