CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - 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
Blue Cross Blue Shield of Mississippi has established a new policy stating that Erzofri (paliperidone palmitate) injections are considered not medically necessary for treating schizophrenia and schizoaffective disorder due to available alternatives. All services related to delivery and administration require prior authorization approval through BCBSMS.
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. Update encounter forms and EMR to alert providers that this medication is considered not medically necessary by BCBSMS and alternative covered medications should be considered first. Claims without prior authorization will be denied.