Comprehensive medication guide to Resmetirom including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
Specialty tier copay ranges from $0 to $500+ per fill depending on plan design and copay card eligibility. Medicare Part D patients are subject to a $2,000 annual out-of-pocket cap (effective 2025). Prior authorization is required by most plans.
Estimated Cash Pricing
Approximately $3,950–$4,116 per month (around $47,400 per year) without insurance or savings programs. No generic version is available as of 2026. With the Madrigal Copay Savings Card, eligible commercially insured patients may pay as little as $0 per month.
Medfinder Findability Score
72/100
Summarize with AI
On this page
Resmetirom, sold under the brand name Rezdiffra, is the first FDA-approved pharmacologic treatment for noncirrhotic nonalcoholic steatohepatitis (NASH), now known as metabolic dysfunction-associated steatohepatitis (MASH), with moderate to advanced liver fibrosis. Manufactured by Madrigal Pharmaceuticals, resmetirom received FDA accelerated approval on March 14, 2024 — a historic milestone for a disease that had no approved medication for decades.
Resmetirom is classified as a thyroid hormone receptor-beta (THR-β) agonist — the first drug in this class to receive FDA approval. It is indicated for adults with noncirrhotic MASH and Stage F2 or F3 liver fibrosis, used in conjunction with diet and exercise. The drug is available as oral tablets in 60 mg, 80 mg, and 100 mg strengths, taken once daily with or without food.
By at least one estimate, approximately 6–8 million people in the United States have MASH with moderate to advanced liver scarring. MASH is closely associated with obesity, type 2 diabetes, high blood pressure, and high cholesterol — conditions that define metabolic syndrome. Resmetirom directly addresses the liver pathology rather than relying solely on lifestyle changes.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Resmetirom is a selective, liver-directed partial agonist of thyroid hormone receptor-beta (THR-β). Thyroid hormone receptors regulate how cells process fats and sugars, but natural thyroid hormones affect the entire body — including the heart. Resmetirom is specifically engineered to concentrate in the liver and selectively activate THR-β (not THR-α, the cardiac subtype), allowing it to reduce liver fat without systemic cardiovascular thyroid effects.
When resmetirom activates THR-β in liver cells, it triggers increased fat oxidation (burning), reduced fat synthesis, and decreased intrahepatic triglyceride accumulation. As liver fat decreases, inflammation driven by fat toxicity is reduced, and fibrosis biomarkers improve. In clinical trials, resmetirom also lowered atherogenic lipids including LDL and lipoprotein(a) — potentially reducing cardiovascular risk in MASH patients.
In the Phase 3 MAESTRO-NASH trial, 26–36% of patients on resmetirom achieved MASH resolution versus 9–13% on placebo, and 23–28% achieved fibrosis improvement versus 13–15% on placebo. Early efficacy signals can be detected on MRI-PDFF imaging at 12–24 weeks — patients with a ≥30% relative reduction in liver fat fraction have a more than 5-fold greater likelihood of histologic response.
80 mg — tablet
For patients weighing less than 100 kg (220 lbs). Once daily, with or without food.
100 mg — tablet
For patients weighing 100 kg (220 lbs) or more. Once daily, with or without food.
60 mg — tablet
Reduced dose for patients under 100 kg when co-administered with moderate CYP2C8 inhibitors (e.g., clopidogrel).
As of 2026, resmetirom is not listed on the FDA drug shortage database — supply from Madrigal Pharmaceuticals has been consistent since the April 2024 commercial launch. However, patients frequently find access difficult because Rezdiffra is a Limited Distribution Drug (LDD), dispensed exclusively through specialty pharmacies. It is not stocked at retail chains such as CVS, Walgreens, or Rite Aid.
The primary access barriers are insurance prior authorization (required by most commercial and Medicare Part D plans), specialty tier cost (up to $500+ per fill without assistance), and unfamiliarity with the specialty pharmacy system. The typical access timeline — from prescription to first dose — ranges from 5 business days (smooth commercial insurance case) to 3–6 weeks (when PA is denied and appealed).
Enrolling in Madrigal Patient Support (877-219-7770) immediately after the prescription is written is the single most important step. For help finding which specialty pharmacies near you carry Rezdiffra, medfinder calls pharmacies on your behalf to find which ones can fill your prescription.
Resmetirom is not a controlled substance and does not require DEA special registration or a REMS program. Any licensed physician with prescribing authority can prescribe it. However, because the drug's indication requires a biopsy-confirmed diagnosis of MASH with F2–F3 fibrosis, in practice it is prescribed almost exclusively by liver disease specialists who manage these patients and coordinate the diagnostic workup.
Prescribers of resmetirom include:
Hepatologists — primary prescribers; most familiar with MASH protocols and specialty pharmacy systems
Gastroenterologists — growing prescribers since 2024; manage MASH in many community settings
Endocrinologists — increasingly involved in MASH care given metabolic comorbidities (T2D, obesity)
Primary care physicians (PCPs) — in integrated care settings with appropriate biopsy workup completed
Nurse practitioners and physician assistants — in states where scope of practice permits, particularly in hepatology/GI practices
Telehealth is growing in hepatology for follow-up management of established patients on resmetirom. However, initial diagnosis typically requires an in-person visit for liver biopsy coordination. Some telehealth hepatology services can initiate the evaluation and referral process for rural patients who do not have local specialist access.
No — resmetirom (Rezdiffra) is not a controlled substance. It is not scheduled by the DEA under any classification (Schedules I through V). Resmetirom does not have the addiction, dependence, or abuse potential that characterizes controlled substances.
Because resmetirom is not controlled, it does not require a triplicate prescription, DEA prescriber registration specifically for this drug, or any REMS (Risk Evaluation and Mitigation Strategy) program. It can be prescribed by any licensed physician, nurse practitioner, or physician assistant with prescribing authority and electronically transmitted to the specialty pharmacy.
Prescriptions for resmetirom can be refilled without the restrictions that apply to controlled substances, though insurance prior authorization typically requires annual renewal. There are no prescription limits, mandatory drug monitoring programs, or mandatory urine drug screens associated with resmetirom.
In the MAESTRO-NASH Phase 3 trial, the most common adverse reactions reported in 5% or more of patients on Rezdiffra (and more frequently than placebo) were:
Diarrhea — most common; typically early-onset, mild to moderate
Nausea — common early in treatment; leading cause of discontinuation along with diarrhea
Pruritus (itching) — generalized itching; discuss with provider if severe
Vomiting — less common than nausea
Constipation — reported in some patients
Abdominal pain — stomach discomfort; seek care if accompanied by jaundice
Dizziness — use caution when driving until you know how resmetirom affects you
Hepatotoxicity (liver injury): Signs include jaundice, fatigue, right upper abdominal pain, fever, or rash. Discontinue Rezdiffra if suspected.
Gallbladder events: Cholelithiasis (gallstones), cholecystitis, and obstructive pancreatitis occurred at higher rates in treated patients. Interrupt treatment if acute gallbladder event is suspected.
Statin-related muscle toxicity: Resmetirom increases statin blood levels. Report muscle pain, weakness, or darkened urine immediately.
Know what you need? Skip the search.
Semaglutide (Wegovy)
FDA-approved August 2025 as second MASH treatment (F2-F3). GLP-1 receptor agonist; weekly injection. Promotes weight loss; preferred for patients with obesity/T2D.
Pioglitazone
Off-label PPAR-gamma agonist used in NASH. Generic, ~$4-$15/month. Shown histological improvement but not FDA-approved for MASH and carries weight gain/fluid retention risks.
Vitamin E (800 IU/day)
Off-label antioxidant for non-diabetic NASH patients. Low cost, no prescription needed. Limited fibrosis improvement evidence compared to resmetirom.
Lanifibranor
PPAR pan-agonist in Phase 3 trials for MASH. Not yet FDA-approved. May be available in the future for patients who cannot access or tolerate resmetirom.
Prefer Resmetirom? We can find it.
Gemfibrozil
majorStrong CYP2C8 inhibitor; significantly increases resmetirom blood levels. Concomitant use not recommended.
Cyclosporine
majorPotent OATP1B1/1B3 inhibitor; markedly increases resmetirom exposure. Avoid concomitant use.
Erythromycin
majorOATP1B1/1B3 inhibitor. Avoid concomitant use; consider alternative antibiotic.
Atazanavir
majorHIV antiretroviral and OATP1B1/1B3 inhibitor; increases resmetirom exposure. Avoid.
Rosuvastatin
moderateResmetirom increases rosuvastatin Cmax 4.6-fold. Limit to 20 mg/day. Monitor for myopathy.
Simvastatin
moderateSignificant exposure increase. Limit to 20 mg/day. Monitor for myopathy and rhabdomyolysis.
Pravastatin
moderateCmax increased 1.3-fold, AUC 1.4-fold. Limit to 40 mg/day.
Atorvastatin
moderateAUC increased 1.4-fold. Limit to 40 mg/day. Monitor liver enzymes and muscle symptoms.
Clopidogrel
moderateModerate CYP2C8 inhibitor. Reduce resmetirom dose: 60 mg (<100 kg) or 80 mg (≥100 kg).
Resmetirom (Rezdiffra) represents a genuine therapeutic breakthrough — the first pharmacologic treatment in history for MASH with liver fibrosis. For the estimated 6–8 million Americans with MASH and Stage F2–F3 fibrosis, it offers a meaningful chance to resolve MASH inflammation and improve fibrosis without waiting years for lifestyle changes alone to take effect. The MAESTRO-NASH trial results are compelling, and the drug's cardiovascular lipid benefits add additional value for a population at elevated cardiac risk.
Access remains the primary challenge in 2026 — not supply, but the specialty pharmacy system, prior authorization, and cost. Most patients with commercial insurance can access Rezdiffra at little to no out-of-pocket cost with the Madrigal Copay Savings Card. Enrolling in Madrigal Patient Support immediately upon receiving a prescription is the most impactful single step any patient can take. As the MASH treatment landscape continues to evolve — with semaglutide now approved as a second option and additional drugs in late-stage trials — resmetirom's role as the first-line, liver-directed oral therapy is well-established.
If you are struggling to find resmetirom in stock or need help navigating the specialty pharmacy system, medfinder calls pharmacies on your behalf to find which ones can fill your prescription. Enter your medication, dosage, and location to get started.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini