Rezdiffra (Resmetirom) Access Update: What Patients Need to Know in 2026

When Rezdiffra (resmetirom) received FDA accelerated approval on March 14, 2024, it made history as the first pharmacologic treatment for noncirrhotic MASH (metabolic dysfunction-associated steatohepatitis) with moderate to advanced liver fibrosis. Two years later, in 2026, patients are asking: Is Rezdiffra in a shortage? Can I still get it? What has changed?

Here is a comprehensive update on Rezdiffra availability, access, and what you can do if you're struggling to fill your prescription.

Is Rezdiffra in a Drug Shortage in 2026?

No — as of 2026, Rezdiffra is not listed on the FDA drug shortage database. Madrigal Pharmaceuticals has maintained consistent supply since the drug's commercial launch in April 2024. There have been no manufacturing disruptions reported.

However, patients frequently describe their experience as shortage-like — because the access pathway is so different from filling a typical prescription. Understanding why helps you navigate it.

The Rezdiffra Access Landscape in 2026

Here is where things stand as of 2026:

Supply: Adequate. Rezdiffra is manufactured and distributed by Madrigal Pharmaceuticals with no known supply interruptions.

Distribution: Limited Distribution Drug (specialty pharmacy only). Not available at retail pharmacies.

Insurance coverage: Improving but still requires prior authorization with most commercial plans and Medicare Part D.

Cost without insurance: ~$47,400/year (~$3,950–$4,116/month). No generic available.

With copay card: Commercially insured patients may pay as little as $0/month with the Madrigal Copay Savings Card.

Medicare: Covered under Part D with $2,000 annual OOP cap (2025). Some patients still face high initial costs before the cap is reached.

Accelerated approval status: Still under accelerated approval as of 2026. Full approval awaits confirmatory data from the ongoing 54-month MAESTRO-NASH trial. Coverage could become more robust with full FDA approval.

What Changed in 2025: A Second MASH Drug Is Approved

A significant development in August 2025: the FDA approved semaglutide (Wegovy, 2.4 mg weekly) as a second treatment for MASH with moderate to advanced liver fibrosis (F2-F3). This gives patients and prescribers a second FDA-approved option when Rezdiffra is inaccessible or not tolerated. The two drugs work differently — Rezdiffra targets the liver's THR-β receptor to reduce fat and inflammation, while semaglutide is a GLP-1 receptor agonist that promotes weight loss and reduces systemic metabolic stress.

For patients with obesity and type 2 diabetes, semaglutide may be a natural fit given its broader metabolic benefits. For patients without significant weight issues, Rezdiffra's liver-directed mechanism may remain the preferred choice.

What the MAESTRO-NASH Trial Means for You

Rezdiffra's current FDA approval is based on surrogate endpoints from the first 12 months of the MAESTRO-NASH Phase 3 trial (improvement in liver biopsy readings at month 12). The ongoing 54-month study is collecting hard clinical outcome data — including progression to cirrhosis, liver decompensation events, and all-cause mortality. Positive results from this confirmatory trial will be needed for full FDA approval.

For patients already on Rezdiffra: the drug's accelerated approval does not mean it will be pulled from the market if trial results are mixed — but full approval would open up additional insurance formulary access and potentially reduce prior authorization hurdles.

Common Access Challenges Patients Are Reporting in 2026

Prior authorization delays: The most common barrier. PA can take 1–3 weeks and may be denied on the first submission.

State Medicaid variation: Not all state Medicaid programs cover Rezdiffra, and some require step therapy documentation.

Specialty pharmacy confusion: Patients are accustomed to retail pharmacies and are surprised when their local pharmacy cannot fill the prescription.

Biopsy requirement: Insurers typically require a confirmed liver biopsy showing NASH with F2 or F3 fibrosis for PA approval. Patients without a recent biopsy may need one before accessing the drug.

Action Steps for Patients in 2026

Contact Madrigal Patient Support immediately at 877-219-7770 when your prescription is written

Ensure your biopsy documentation is on file with your prescriber and ready for the PA submission

Enroll in the Rezdiffra Copay Savings Card if you have commercial insurance (visit copay.rezdiffra.com)

If PA is denied, ask your hepatologist to submit an appeal with a letter of medical necessity

Ask your doctor whether semaglutide (Wegovy) could be an appropriate alternative if Rezdiffra access is delayed

Where to Find Help

If you are struggling to locate a pharmacy that can fill your Rezdiffra prescription, medfinder calls specialty pharmacies near you to find which ones can fill your prescription. For more detailed steps, see: How to Find Rezdiffra in Stock Near You (Tools + Tips).