Erzofri extended-release injectable

Generic: paliperidone palmitate

Suspension

Injectable Antipsychotics — Injectable Long Acting

Also known as: paliperidone palmitate
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via Erzofri 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Erzofri 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026
via Erzofri 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026
via Erzofri 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Value 2026
via Erzofri 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Advantage 2026
via Invega Hafyera 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Invega Hafyera 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026
via Invega Hafyera 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026
via Invega Hafyera 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Value 2026
via Invega Hafyera 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Advantage 2026
via Invega Sustenna 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Invega Sustenna 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026
via Invega Sustenna 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026
via Invega Sustenna 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Value 2026
via Invega Sustenna 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Advantage 2026
via Invega Trinza 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Invega Trinza 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026
via Invega Trinza 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026
via Invega Trinza 		Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Value 2026
via Invega Trinza 		Tier 4 - Higher Cost Brand — — — None
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 4 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Erzofri 		Tier 5 - Specialty ✓ — ✓ 2.25 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
Troy Medicare (HMO)
via Erzofri 		Tier 5 - Specialty ✓ — ✓ 2.25 per 28 days PA | QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Erzofri 		Tier 5 - Specialty ✓ — ✓ 2.25 per 28 days PA | QL
Aetna Medicare Signature (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Dual (HMO D-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Signature (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Value Plus (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Prime (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Signature Care (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Enhanced (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Signature (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Enhanced (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Enhanced (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Signature Extra (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Signature (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Signature (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Signature Giveback (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Signature (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.50 per 365 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED DUAL 009 NC (HMO D-SNP)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED CORE 001 NC (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED GIVEBACK 002 NC (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED GIVEBACK 012 NC (HMO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED CHOICE 001 NC (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED CHOICE 003 NC (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED CHOICE 005 NC (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
DEVOTED CHOICE 008 NC (PPO)
via Erzofri 		Tier 5 - Specialty — — ✓ 4.5 per 365 days QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Invega Sustenna 		Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Invega Trinza 		Preferred — — — None
NC Medicaid Preferred Drug List 2026 Preferred — — — None
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