Why Cost Conversations Matter for Rezdiffra Adherence

Rezdiffra (Resmetirom) is the first FDA-approved treatment for noncirrhotic NASH/MASH with moderate to advanced fibrosis — a breakthrough for a condition that went decades without a pharmacologic option. But with a wholesale acquisition cost of approximately $47,400 per year, cost is one of the biggest barriers to patient adherence.

Patients who can't afford their medication don't take it. Studies consistently show that high out-of-pocket costs lead to delayed fills, skipped doses, and outright abandonment of therapy. As a prescriber, you're uniquely positioned to connect patients with savings programs and build cost transparency into your clinical workflow.

This guide walks through the financial landscape of Rezdiffra and provides actionable strategies to help your patients access and afford their treatment.

What Patients Are Paying for Rezdiffra

Understanding the cost picture helps you anticipate patient concerns:

• Cash price: Approximately $3,950–$4,116 per month without insurance
• Commercial insurance: Most major plans cover Rezdiffra with prior authorization, but copays for specialty tier medications can range from $50 to $500+ per fill depending on plan design
• Medicare Part D: Covered under specialty tier with prior authorization. Patients in the coverage gap ("donut hole") may face significant costs, though the Inflation Reduction Act's $2,000 annual out-of-pocket cap (effective 2025) provides meaningful relief
• Medicaid: Coverage varies by state. Some state Medicaid programs may require additional clinical criteria or step therapy
• Uninsured patients: Face the full cash price unless enrolled in a patient assistance program

The specialty pharmacy distribution model adds complexity — patients can't comparison-shop at retail pharmacies, and many are unfamiliar with the specialty pharmacy process.

Manufacturer Savings Programs

Madrigal Pharmaceuticals offers two key programs that your office should be familiar with:

Madrigal Copay Savings Card

• Eligibility: Commercially insured patients (not valid for Medicare, Medicaid, TRICARE, or other federal/state programs)
• Benefit: Eligible patients may pay as little as $0 per fill
• Enrollment: Patients can enroll at rezdiffra.com/copay-sign-up or by calling 1-877-219-7770
• How it works: The card covers the difference between the patient's copay and the program's maximum benefit. Most commercially insured patients will see their out-of-pocket cost drop to $0 or near-$0

Proactively mention this program at the point of prescribing. Many patients assume specialty drugs are unaffordable and may not fill the prescription without knowing help is available.

Madrigal Patient Support Program

• Services: Benefits investigation, prior authorization assistance, appeals support, financial counseling, and connections to independent charitable foundations
• Contact: 1-877-219-7770 (Monday–Friday, 8 AM–8 PM ET) or madrigalpatientsupport.com
• Who it helps: All patients, including those on Medicare, Medicaid, and the uninsured

This program can handle much of the administrative burden that falls on your office — benefits verification, PA submissions, and appeals. Consider integrating a referral to Madrigal Patient Support as a standard step in your Rezdiffra prescribing workflow.

Coupon and Discount Cards

For specialty medications like Rezdiffra, traditional coupon card platforms (GoodRx, SingleCare, RxSaver, etc.) have limited utility. Most coupon cards are designed for retail pharmacies and may not apply to specialty pharmacy dispensing.

However, it's worth checking these platforms for any available offers:

• GoodRx — goodrx.com/rezdiffra (may show specialty pharmacy pricing)
• SingleCare — singlecare.com/prescription/rezdiffra
• RxSaver — rxsaver.com/drugs/rezdiffra/coupons

In practice, the manufacturer copay card will almost always provide better savings than third-party discount cards for commercially insured patients. For uninsured patients, the Madrigal Patient Support program is the more effective route.

Generic Alternatives and Therapeutic Substitution

As of 2026, there is no generic version of Rezdiffra (Resmetirom) available. This is a first-in-class medication with no direct therapeutic equivalents.

When Rezdiffra is unaffordable or inaccessible, providers may consider off-label alternatives that address NASH/MASH through different mechanisms:

• Pioglitazone: Generic, low-cost ($4–$15/month). Improves insulin sensitivity and has shown histological improvement in NASH. Limitations include weight gain, fluid retention, and bladder cancer risk with long-term use. Best suited for patients with concurrent type 2 diabetes.
• Vitamin E (high-dose, 800 IU/day): Low-cost OTC option. Shown to improve NASH in non-diabetic patients in the PIVENS trial, but does not meaningfully improve fibrosis and carries long-term safety concerns.
• Semaglutide (Ozempic/Wegovy): GLP-1 receptor agonist with promising NASH data but not FDA-approved for this indication. Costs $800–$1,200/month without coverage. May be covered for type 2 diabetes or obesity indications.

None of these are direct substitutes for Rezdiffra, and none are FDA-approved for NASH/MASH. Document your clinical rationale thoroughly if prescribing off-label alternatives. For a detailed comparison, see our post on alternatives to Rezdiffra.

Building Cost Conversations into Your Workflow

Cost shouldn't be an afterthought — it should be part of your prescribing process. Here are practical strategies:

1. Discuss Cost at the Point of Prescribing

When you decide to prescribe Rezdiffra, proactively address cost:

• "Rezdiffra is a specialty medication that can be expensive at the pharmacy counter, but most patients with commercial insurance end up paying $0 with the manufacturer's savings card. Let's get you enrolled before we send the prescription."
• For Medicare patients: "Your out-of-pocket costs will depend on your plan, but with the new $2,000 annual cap, the cost is more manageable. We'll also connect you with Madrigal's support program to explore additional assistance."

2. Delegate to Your Support Staff

Train medical assistants or care coordinators to:

• Initiate copay card enrollment at the time of prescribing
• Submit prior authorization requests proactively (don't wait for the denial)
• Provide patients with the Madrigal Patient Support phone number (1-877-219-7770)
• Follow up on PA status within 5 business days

3. Use a Prior Authorization Checklist

Most insurers require the following for Rezdiffra PA approval:

• Confirmed diagnosis of NASH/MASH
• Documented liver fibrosis stage F2 or F3 (via FibroScan, ELF, FIB-4, or biopsy)
• Evidence that diet and exercise have been recommended
• Absence of decompensated cirrhosis
• Prescriber is a hepatologist, gastroenterologist, or relevant specialist

Having this documentation ready before submitting the PA reduces denial rates and speeds up approval.

4. Plan for Appeals

If a PA is denied, don't give up. Common denial reasons include:

• Insufficient fibrosis documentation — submit additional imaging or lab results
• Step therapy requirement — document why alternatives are inappropriate or have failed
• Non-formulary — request a formulary exception with clinical justification

Madrigal Patient Support can assist with appeals and provide clinical support letters.

5. Monitor for Abandonment

Track whether patients actually fill their first prescription. Specialty pharmacy data suggests that up to 30% of specialty prescriptions are never picked up. A simple follow-up call from your office ("Did you receive your Rezdiffra? Any issues with cost?") can catch problems early and improve adherence.

Connecting Patients with Medfinder

For patients who need help locating a specialty pharmacy with Rezdiffra in stock, Medfinder for Providers offers tools to check availability and connect patients with dispensing pharmacies. It's a free resource that can complement your existing workflow.

You can also direct patients to medfinder.com to search on their own.

Final Thoughts

Rezdiffra is a landmark treatment for NASH/MASH, but its impact depends on patients actually being able to afford and access it. By integrating cost conversations, manufacturer programs, and proactive PA management into your prescribing workflow, you can significantly improve adherence and outcomes.

The resources are there — the Madrigal Copay Savings Card, the Patient Support program, and tools like Medfinder for Providers. The key is making sure patients know about them before they see the price tag and walk away.

For more provider-focused resources on Rezdiffra, see our guides on shortage updates for prescribers and helping patients find Rezdiffra in stock.