Your Patients Need Rezdiffra — Here's How to Get It to Them

You've diagnosed your patient with noncirrhotic MASH and moderate to advanced fibrosis. Rezdiffra (Resmetirom) is the clear treatment choice — the only FDA-approved therapy for this indication. You write the prescription, and then the real work begins.

The specialty pharmacy model, prior authorization gauntlet, and high price tag mean that many of your patients will face weeks of delays or outright denials before they receive their medication. As their provider, you're uniquely positioned to accelerate this process.

This guide lays out a practical, step-by-step approach to helping your patients find and access Rezdiffra in 2026.

Current Availability: What You Need to Know

Rezdiffra is not in a manufacturing shortage. It has never appeared on FDA or ASHP shortage lists since its March 2024 approval. The access challenges are structural:

• Distribution: Available only through authorized specialty pharmacies — not retail
• Coverage: Requires prior authorization from virtually all payers
• Cost: WAC of ~$47,400/year (~$3,950/month); specialty tier in most formularies
• Awareness: Many patients (and some referring physicians) are unfamiliar with the specialty pharmacy process

For a comprehensive overview of the access landscape, see our provider briefing on Rezdiffra availability for providers and prescribers.

Why Patients Can't Find Rezdiffra

Understanding the barriers helps you anticipate and address them proactively:

The Specialty Pharmacy Bottleneck

Patients are accustomed to filling prescriptions at their neighborhood pharmacy. When told Rezdiffra isn't available there, many don't know what to do next. They may call multiple retail pharmacies, waste time, and become frustrated or discouraged — potentially abandoning treatment.

Prior Authorization Delays and Denials

PA requirements vary by insurer but generally require:

• Confirmed MASH/NASH diagnosis
• Fibrosis staging (F2–F3) via biopsy or validated non-invasive method (e.g., FibroScan, ELF test)
• Documentation that the patient does not have decompensated cirrhosis
• Prescribing by or in consultation with hepatology/GI

Incomplete documentation is the most common reason for PA delays and denials. Some insurers also require step therapy or documentation of lifestyle modification failure.

Cost Shock

Even with insurance coverage, patients may face substantial copays on a specialty tier. Uninsured patients face the full ~$3,950/month cost. Cost concerns cause treatment abandonment before the prescription is ever filled.

What Providers Can Do: 5 Practical Steps

Step 1: Submit a Complete PA on Day One

The single most impactful thing you can do is submit a thorough PA the same day you write the prescription. Include:

• ICD-10 diagnosis code for MASH/NASH (K75.81)
• Fibrosis staging with method used (biopsy report, FibroScan results, or ELF score)
• Documentation of diet and exercise counseling
• Current medication list (especially noting statin doses for dose-limit compliance)
• Body weight (to justify 80 mg vs. 100 mg dosing)
• Statement of medical necessity

Electronic PA platforms (e.g., CoverMyMeds, Surescripts) can expedite submission.

Step 2: Connect the Patient With Madrigal Patient Support

Madrigal's support hub handles much of the heavy lifting:

• Benefits investigation and insurance verification
• PA tracking and follow-up
• Appeals assistance when PA is denied
• Copay savings card enrollment (eligible commercially insured patients may pay $0)
• Patient assistance program referrals

Provider line: 1-877-219-7770 (M–F, 8 AM–8 PM ET) | madrigalpatientsupport.com

Handing the patient Madrigal's contact information at the time of prescribing dramatically improves follow-through.

Step 3: Use Medfinder to Identify Available Pharmacies

Medfinder for Providers lets you check which specialty pharmacies currently have Rezdiffra available and can coordinate with your office. Bookmark it as a workflow tool and use it proactively when writing Rezdiffra prescriptions.

Step 4: Prepare for Peer-to-Peer Reviews

If a PA is denied, most insurers offer a peer-to-peer review where you speak directly with the plan's medical director. Tips for success:

• Have the patient's fibrosis data ready
• Emphasize that Rezdiffra is the only FDA-approved therapy for this indication
• Note that MASH with F2–F3 fibrosis is a progressive disease that can advance to cirrhosis without treatment
• Reference the MAESTRO-NASH trial data showing statistically significant NASH resolution and fibrosis improvement

Step 5: Set Expectations With the Patient

Proactive communication reduces frustration and dropout. At the time of prescribing, tell your patient:

• "This medication goes through a specialty pharmacy — it will be delivered to your home."
• "Insurance approval usually takes 1–3 weeks. We'll follow up."
• "There are financial assistance programs that may lower your cost to $0."
• "Here's Madrigal's number — they can help with the process."

Alternatives When Rezdiffra Isn't Accessible

For patients who cannot access Rezdiffra due to insurance denials, cost, or contraindications, evidence-based alternatives include:

• Pioglitazone (30–45 mg daily): Generic, ~$4–15/month; best for patients with comorbid T2DM; improves insulin sensitivity and liver histology
• Vitamin E (800 IU daily): OTC, ~$10–20/month; evidence supports use in non-diabetic MASH patients (PIVENS trial)
• Semaglutide: Weekly injection; strong MASH resolution data; particularly useful for patients with comorbid obesity/T2DM; may have better insurance coverage under diabetes or obesity indications

For a patient-facing version of this information, refer patients to our article on alternatives to Rezdiffra.

Workflow Tips for Your Practice

Integrating Rezdiffra into your prescribing workflow doesn't have to be burdensome. Consider these practice-level strategies:

• Designate a PA coordinator: Train a staff member to handle Rezdiffra PAs, track status, and follow up with insurers
• Create a Rezdiffra checklist: Standardize the documentation package for PA submission
• Batch PA submissions: Process Rezdiffra PAs at a set time daily to improve efficiency
• Bookmark key resources: Medfinder for Providers, rezdiffrahcp.com, and Madrigal's provider line
• Follow up at 2 weeks: Schedule a check-in with the patient to confirm they've received the medication or troubleshoot delays

Final Thoughts

Rezdiffra is a meaningful therapeutic advance for MASH, and your patients are counting on you to help them access it. The specialty pharmacy model and insurance barriers add administrative burden, but with a structured workflow and the right tools, you can significantly improve your patients' chances of starting treatment promptly.

Use Medfinder for Providers to streamline pharmacy coordination. Contact Madrigal Patient Support at 1-877-219-7770 for case-by-case assistance. And remember: every week of delay is a week your patient's liver disease could be progressing.

For provider strategies on cost reduction, see our guide on how to help patients save money on Rezdiffra.