Medicare Part D coverage · 1 · RxCUI 2699351
1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri]
Per the CMS 2026 Part D formulary file, 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] is covered by 1,765 Medicare Part D plans (34.9% of enrollable products), averaging Tier 4.2, with prior authorization required on 14% of covering formularies.
- 34.9%
- Plan coverage
- 1,765
- Plans covering
- T4.2
- Avg tier
- 14%
- Prior auth required
What the CMS Formulary Data Shows for 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri]
Per the CMS 2026 Part D formulary file, 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] (RxNorm concept RXCUI 2699351, generic name 1) appears on 150 distinct formulary files spanning 1,765 Medicare Part D plan offerings - 34.9% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.2.
Real-world access to 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] depends on utilization management as much as tier placement: 14% of covering formularies require prior authorization. 1.3% require step therapy. 94% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] today.
Coverage Details
- Formularies covering
- 150
- Plans covering
- 1,765
- Coverage rate
- 34.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 14% of formularies
- Step therapy required
- 1.3% of formularies
- Quantity limits
- 94% of formularies
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue MedicareRx Value Plus (PDP) | Anthem Insurance Co. & Bcbsma & Bcbsri & Bcbsvt | T4 | No | No | $20.70 | - |
| BlueMedicare Value Rx (PDP) | Usable Mutual Insurance Company | T4 | No | No | $52.50 | - |
Medicare Advantage Plans (MA-PD) Covering 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
Show the next 30 plans
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | No | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | No | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | No | $17.00 | AZ |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | Viva Health, Inc. | T1 | No | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | Viva Health, Inc. | T1 | No | $27.70 | AL |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | No | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | No | $32.70 | WV |
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | No | $38.40 | IN, MD, OH |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | Elderplan, Inc. | T1 | No | $44.80 | NY |
Showing top 50 of 98 plans.
Frequently Asked Questions
Is 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] covered by Medicare Part D?
Yes, 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] is covered by 1,765 Medicare Part D plans (34.9% of all Part D formularies).
What tier is 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] on Medicare Part D plans?
1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] require prior authorization?
14% of Part D formularies require prior authorization for 1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri]. Step therapy: 1.3%. Quantity limits: 94%.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- aripiprazole 2 MG Oral Film [Opipza] T4.2
- 2.4 ML aripiprazole lauroxil 281.3 MG/ML Prefilled Syringe [Aristada] T4.2
- {7 (24 HR deutetrabenazine 12 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 18 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 24 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 30 MG Extended Release Oral Tablet [Austedo]) } Pack [Austedo XR Once Daily, 4 Week Titration Pack, 12 MG / 18 MG / 24 MG / 30 MG] T4.2
- abiraterone acetate 500 MG Oral Tablet T4.2
- glecaprevir 100 MG / pibrentasvir 40 MG Oral Tablet [Mavyret] T4.2
- selexipag 1.6 MG Oral Tablet [Uptravi] T4.2
Similar prior-authorization rate
- haloperidol 5 MG/ML Injectable Solution 14% PA
- tigecycline 50 MG Injection 14% PA
- colistin 75 MG/ML Injectable Solution 14% PA
- 0.5 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] 14% PA
- 0.75 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] 14% PA
- 1.5 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Erzofri] 14% PA