How Much Does Rezdiffra (Resmetirom) Cost in Florida in 2026?

Rezdiffra List Price and Florida Retail Pricing

Rezdiffra's manufacturer list price sits at $3,500 per month across all U.S. markets, and Florida retail pharmacies reflect the same figure for cash-pay patients in 2026. This price applies to the standard once-daily oral tablet regimen. Madrigal Pharmaceuticals, the drug's maker, set this price point at launch following the FDA's accelerated approval in March 2024 for adults with MASH and moderate-to-advanced hepatic fibrosis (stages F2-F3) [1].

For context, the annual cash cost totals $42,000 before any insurance or discount programs. Resmetirom is the first thyroid hormone receptor beta (THR-β) agonist approved for MASH, which gave Madrigal significant pricing latitude in a therapeutic area with no prior approved pharmacotherapy [2]. Florida has no state-level drug price cap that applies to specialty oral medications in this class, so the retail price mirrors the national wholesale acquisition cost (WAC).

Patients filling at independent or chain pharmacies in Miami, Tampa, Orlando, or Jacksonville should expect the same $3,500 monthly figure unless a discount program or insurance benefit applies. Specialty pharmacies may also dispense Rezdiffra; some offer limited price matching or coordination with manufacturer programs. Patients can verify current pricing at any Florida pharmacy by requesting a cash-price quote before filling.

Florida Medicaid Coverage for Rezdiffra

Florida Medicaid does not cover Rezdiffra for MASH as a standalone diagnosis. Coverage applies only when the prescribing indication involves type 2 diabetes, which limits access for the majority of MASH patients seeking the drug through Medicaid. This restriction reflects the Florida Agency for Health Care Administration's preferred drug list criteria, which have not yet incorporated MASH-specific coverage for resmetirom.

The coverage gap matters. An estimated 1.5 to 2 million Floridians may have MASH based on national prevalence data extrapolated from the 2023 NHANES analysis, which estimated 6.1% of U.S. adults carry the diagnosis [3]. Many of these patients rely on Medicaid, particularly in counties with higher uninsured-to-Medicaid transition rates under Florida's managed care plans.

Patients on Florida Medicaid who also carry a type 2 diabetes diagnosis may be able to obtain coverage through their managed care organization (MCO), but prior authorization is typically required. The prescribing physician must document fibrosis staging (usually via FibroScan or liver biopsy), confirm the MASH diagnosis, and demonstrate that the patient meets the F2-F3 fibrosis criteria used in the MAESTRO-NASH trial [1]. Denials can be appealed through the MCO's standard grievance process or through a fair hearing request with the state.

Commercial Insurance Coverage in Florida

Several major commercial insurers operating in Florida have begun adding Rezdiffra to formularies, though placement varies. Plans from Florida Blue, Aetna, UnitedHealthcare, and Cigna may cover resmetirom with prior authorization. Step therapy requirements differ by plan: some require documented failure of lifestyle intervention and weight management before approving Rezdiffra, while others accept fibrosis staging alone.

Prior authorization criteria generally mirror the FDA label. Prescribers must confirm a MASH diagnosis with liver biopsy or validated noninvasive testing (such as FibroScan showing a liver stiffness measurement between 8.0 and 13.0 kPa for F2-F3), and the patient must not have decompensated cirrhosis (Child-Pugh B or C). The MAESTRO-NASH trial enrolled patients with biopsy-confirmed NASH and fibrosis stages F1B through F3, and the FDA approval specifically covers F2-F3, so insurers typically enforce this narrower range [1].

Copay amounts for commercially insured patients depend on formulary tier. Rezdiffra lands on specialty tiers for most plans, which means coinsurance of 25% to 40% rather than a flat copay. On a $3,500 monthly cost, that translates to $875 to $1,400 per month out of pocket before reaching the plan's out-of-pocket maximum. Patients with high-deductible health plans face the full $3,500 until their deductible is met.

The Madrigal savings card (discussed below) can offset a significant portion of these costs for eligible patients.

How the Madrigal Pharmaceuticals Savings Card Works

Madrigal Pharmaceuticals offers a copay savings card for commercially insured patients filling Rezdiffra prescriptions. The card reduces out-of-pocket costs at the pharmacy counter, and eligible patients may pay as little as $0 per fill depending on their insurance plan structure.

Eligibility requirements are straightforward. The patient must have commercial insurance (not Medicare, Medicaid, TRICARE, or any other federal or state government program). They must have a valid prescription for Rezdiffra and fill it at a participating pharmacy. Florida pharmacies broadly accept manufacturer copay cards, and most chain pharmacies (CVS, Walgreens, Publix) can process the card at the point of sale.

The savings card typically covers the difference between the patient's copay or coinsurance and a predetermined floor (often $0 to $25 per month), up to an annual maximum benefit. Madrigal has not publicly disclosed the annual cap for 2026, but similar specialty drug copay programs in the hepatology space cap benefits between $15,000 and $25,000 per year. Patients should confirm the current benefit maximum by calling the number on the savings card or visiting the Madrigal patient support website.

One practical note: copay accumulator and copay maximizer programs used by some Florida insurers (including certain Florida Blue and Aetna plans) may prevent savings card dollars from counting toward the patient's annual out-of-pocket maximum. Patients enrolled in plans with accumulator adjustor programs should ask their pharmacist or benefits coordinator whether the savings card value applies to their deductible and out-of-pocket cap.

Compounded Resmetirom in Florida: Legality and Access

Compounded resmetirom is available in Florida through licensed 503A compounding pharmacies. Florida law permits 503A pharmacies to compound medications based on a valid patient-specific prescription, and the Florida Board of Pharmacy maintains active oversight of these operations. The legal framework falls under Florida Statute 465.0158 and aligns with federal 503A provisions under the Drug Quality and Security Act.

A few important distinctions apply. Compounded resmetirom is not FDA-approved. It does not carry the same bioequivalence data as brand-name Rezdiffra, and no compounded version has undergone the dissolution, stability, or pharmacokinetic testing performed during the MAESTRO-NASH program [1]. Physicians prescribing compounded resmetirom should document the clinical rationale, which most commonly involves cost barriers to the branded product.

Florida's Board of Pharmacy requires 503A pharmacies to compound only in response to individual prescriptions (not in bulk for office use without a prescription), use pharmaceutical-grade ingredients from FDA-registered suppliers, and maintain detailed compounding logs. The board has increased inspection frequency for pharmacies compounding newer specialty molecules, including thyroid hormone receptor agonists.

Pricing for compounded resmetirom varies by pharmacy but is substantially lower than the branded product. Some 503A pharmacies in Florida have listed compounded resmetirom at price points between $200 and $600 per month, though availability and pricing fluctuate. Patients considering this route should verify that their pharmacy holds a current Florida 503A license and that the prescribing physician is comfortable monitoring treatment with a non-FDA-approved formulation.

Telehealth Prescribing of Rezdiffra in Florida

Florida permits telehealth prescribing of Rezdiffra. Physicians licensed in Florida can evaluate patients via synchronous audio-video telehealth visits, confirm MASH diagnosis based on existing labs and imaging, and issue prescriptions for resmetirom. This is legal under Florida's telehealth statute (F.S. 456.47), which was expanded and made permanent following temporary COVID-era provisions.

Telehealth access is particularly relevant for patients in rural Florida counties where hepatology and gastroenterology specialists are scarce. The MAESTRO-NASH trial required liver biopsy for enrollment, but clinical practice now accepts noninvasive fibrosis assessment in many cases [1]. A patient with a recent FibroScan, FIB-4 index, or Enhanced Liver Fibrosis (ELF) test result can present these to a telehealth provider for evaluation without needing an in-person visit.

Prescriptions issued via telehealth can be sent electronically to any Florida pharmacy, including specialty pharmacies that coordinate with the Madrigal savings card. Telehealth visits may also be covered by Florida commercial insurance plans, often at a lower copay than in-office specialist visits. Florida Medicaid managed care plans cover telehealth visits as well, though the Rezdiffra coverage limitation for MASH without T2D still applies regardless of how the visit is conducted.

Clinical Efficacy: What MAESTRO-NASH Showed

The MAESTRO-NASH trial (N=966) provided the primary efficacy data supporting Rezdiffra's FDA approval. At 52 weeks, 25.9% of patients receiving resmetirom 80 mg and 29.9% of those receiving 100 mg achieved MASH resolution with no worsening of fibrosis, compared to 9.7% with placebo (P<0.001 for both doses vs. placebo) [1]. Fibrosis improvement by at least one stage (with no worsening of the NAFLD Activity Score) occurred in 25.9% of the 80 mg group and 24.2% of the 100 mg group, versus 14.2% for placebo [1].

These numbers represent clinically meaningful histological improvement. Dr. Stephen Harrison, principal investigator of the MAESTRO-NASH trial, noted that resmetirom's mechanism of action through selective THR-β activation directly addresses the hepatic fat accumulation and fibrogenic signaling that drive MASH progression. The drug reduced LDL cholesterol by approximately 14% and triglycerides by approximately 19% at the 100 mg dose [1], which carries additional relevance given that cardiovascular disease is the leading cause of death in MASH patients [4].

The FDA granted accelerated approval based on the surrogate endpoint of MASH resolution and fibrosis improvement on biopsy. A confirmatory phase 3 trial (MAESTRO-NASH outcomes study) is underway and expected to report data on clinical outcomes including progression to cirrhosis and liver-related events.

Safety data from MAESTRO-NASH showed that the most common adverse events were diarrhea (27% vs. 18% placebo at the 100 mg dose) and nausea (13% vs. 8% placebo). These were generally mild to moderate and led to treatment discontinuation in fewer than 5% of patients [1]. Thyroid function monitoring is recommended, though clinically significant thyroid suppression was uncommon in trial participants with normal baseline thyroid function.

Reducing Your Rezdiffra Cost in Florida: A Step-by-Step Approach

Start with insurance verification. Call your plan's pharmacy benefits number and ask specifically about Rezdiffra (resmetirom) coverage, tier placement, prior authorization requirements, and whether a copay accumulator program applies. Get this in writing if possible.

If commercially insured, enroll in the Madrigal savings card before your first fill. Your prescriber's office or specialty pharmacy can often support enrollment. Confirm whether your plan uses a copay accumulator, as this affects the long-term value of the savings card.

If uninsured or underinsured, ask your prescriber about patient assistance programs. Madrigal's patient support line can screen for eligibility. Some Florida-based nonprofit organizations and disease-specific foundations (such as the American Liver Foundation) offer copay assistance grants for liver disease medications [5].

If cost remains prohibitive, discuss compounded resmetirom with your physician. Ensure the compounding pharmacy is a licensed Florida 503A facility. Your physician should plan appropriate monitoring, including liver function tests and lipid panels, at the same intervals recommended for branded Rezdiffra.

Florida patients near the Georgia or Alabama borders may also compare pricing at out-of-state specialty pharmacies, though insurance network restrictions typically limit this option.

Rezdiffra vs. Other MASH Treatments: Cost Comparison

No other FDA-approved pharmacotherapy for MASH existed before resmetirom. Off-label options used in clinical practice include vitamin E (approximately $10 to $20 per month), pioglitazone ($15 to $50 per month generic), and GLP-1 receptor agonists such as semaglutide (approximately $900 to $1,350 per month at weight-management doses) [6]. None of these carry an FDA-approved MASH indication.

Vitamin E at 800 IU daily showed histological improvement in the PIVENS trial (N=247), with 43% of patients on vitamin E achieving the primary endpoint versus 19% on placebo [7]. Pioglitazone demonstrated similar benefits in the same trial. Both are dramatically cheaper than Rezdiffra but lack the fibrosis-specific endpoint data that the MAESTRO-NASH trial produced.

Semaglutide showed promise for MASH in a phase 2 trial published in the New England Journal of Medicine, with 59% of patients on the 0.4 mg dose achieving MASH resolution at 72 weeks versus 17% on placebo [8]. A dedicated MASH indication for semaglutide has not been granted, and the cost comparison depends on whether the patient has a concurrent obesity or T2D diagnosis that supports insurance coverage for the GLP-1.

The cost calculus for Florida patients often comes down to insurance coverage. Rezdiffra at $3,500 per month with a copay card reducing costs to $0 to $25 may actually be cheaper out of pocket than a GLP-1 on a specialty tier without a comparable savings program.