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State and School Employees' Health Insurance Plan - Erzofri (paliperidone palmitate)
Act
by Aug 1, 2025
Effective date
Aug 1, 2025
Identified
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.
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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.
02Update 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.
03Claims without prior authorization will be denied.
Codes mentioned
J2428
Original notice
State and School Employees' Health Insurance Plan - Erzofri (paliperidone palmitate)
bcbsms.com · Always check the source before changing claims.