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

Indiana Retail Pricing: What You Will Actually Pay

The average cash-pay price for Rezdiffra at Indiana retail pharmacies is $3,500 per month in 2026, matching the manufacturer list price set by Madrigal Pharmaceuticals. That translates to $42,000 per year for patients paying entirely out of pocket. Prices are consistent across major Indiana pharmacy chains, including CVS, Walgreens, and Kroger Pharmacy locations in Indianapolis, Fort Wayne, and Evansville.

Rezdiffra received FDA accelerated approval in March 2024 as the first drug specifically indicated for metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced hepatic fibrosis (stages F2 and F3) [1]. Because it remains the only FDA-approved therapy in this class, there is no generic equivalent and no direct therapeutic competitor at retail. The MAESTRO-NASH trial (N=966) demonstrated that resmetirom 100 mg achieved MASH resolution without worsening fibrosis in 29.9% of patients at 52 weeks versus 9.7% with placebo, and a fibrosis improvement endpoint was also met (P<0.001 for both co-primary endpoints) [1]. Those results justified the pricing tier Madrigal selected for launch.

Indiana patients should know that the sticker price is rarely the final cost for those with commercial insurance. The real question is what your plan covers and what assistance programs you qualify for.

Indiana Medicaid Coverage: Current Exclusions

Indiana Medicaid does not cover Rezdiffra for MASH as of May 2026. The Indiana Health Coverage Programs formulary restricts resmetirom reimbursement to type 2 diabetes-related indications only, which means most MASH patients on Hoosier Healthwise, Healthy Indiana Plan (HIP), or traditional Medicaid fee-for-service will be denied.

This is a common pattern nationally. Many state Medicaid programs have been slow to add Rezdiffra because MASH is a relatively new standalone indication and long-term outcomes data beyond 52 weeks remain limited. The FDA label notes that continued approval may be contingent on verification of clinical benefit in confirmatory trials [2]. State pharmacy and therapeutics committees often wait for full approval and additional cost-effectiveness analyses before expanding formulary access.

If you are on Indiana Medicaid and have been diagnosed with MASH with F2-F3 fibrosis, your prescriber can submit a prior authorization request. Denials can be appealed through the Indiana Family and Social Services Administration (FSSA) fair hearing process. Some patients have obtained coverage by documenting elevated liver stiffness on FibroScan (liver stiffness measurement >8.0 kPa) along with biopsy-confirmed fibrosis staging.

"For patients with biopsy-proven MASH and significant fibrosis, the risk of progression to cirrhosis and liver-related mortality is substantial enough to warrant access to the only approved pharmacotherapy," the American Association for the Study of Liver Diseases (AASLD) practice guidance states in its 2023 updated recommendations [3].

Commercial Insurance in Indiana: Prior Authorization and Formulary Tiers

Most major commercial insurers operating in Indiana, including Anthem Blue Cross Blue Shield, UnitedHealthcare, Cigna, and Aetna, have placed Rezdiffra on specialty tier formularies with mandatory prior authorization. Approval typically requires documentation of biopsy-confirmed MASH with F2 or F3 fibrosis, a body mass index above a plan-specific threshold (often BMI >27), and evidence that lifestyle interventions alone have been insufficient.

Expect the prior authorization process to take 5 to 14 business days. Plans frequently require step therapy, meaning you may need to show failure of or contraindication to other liver-directed interventions. Some insurers require documentation of elevated ALT levels (>1.5 times the upper limit of normal) and imaging or elastography consistent with hepatic steatosis.

Copay amounts for Indiana patients with commercial coverage vary widely. Specialty tier drugs on high-deductible health plans can carry coinsurance of 25% to 50%, which at $3,500 per month could mean $875 to $1,750 out of pocket before meeting annual out-of-pocket maximums. Under the Affordable Care Act, Indiana marketplace plans cap annual out-of-pocket spending at $9,200 for individuals in 2026, which limits total annual exposure regardless of coinsurance percentage.

Indiana employers with self-funded plans have the most variable coverage. Self-funded plans are not bound by state insurance mandates and may exclude MASH therapies entirely. Check your Summary of Benefits and Coverage or call the number on the back of your insurance card to confirm formulary status before filling.

The Madrigal Pharmaceuticals Savings Card: How It Works in Indiana

Madrigal Pharmaceuticals offers a copay savings program for commercially insured patients that can reduce monthly out-of-pocket costs to as low as $0 for eligible Indiana residents. The card covers the difference between your plan's copay or coinsurance and $0, up to a maximum annual benefit (typically $15,000 to $20,000 per year, though the exact cap may change).

Eligibility requirements are straightforward. You must have commercial insurance (not Medicare, Medicaid, TRICARE, or other government-funded programs), be a resident of the United States, and have a valid prescription for Rezdiffra. Indiana residents can enroll directly through the Madrigal patient support website or through their specialty pharmacy at the time of fill.

The savings card does not work for patients on Indiana Medicaid, Medicare Part D, or Medicare Advantage plans. This is a federal anti-kickback statute restriction, not a Madrigal policy. Medicare Part D patients may instead qualify for the Extra Help/Low-Income Subsidy program, which reduces Part D cost-sharing, though Rezdiffra must be on the plan's formulary.

Dr. Zobair Younossi, a hepatologist and researcher who contributed to MASH burden-of-disease analyses, has noted: "The economic burden of NASH [MASH] in the United States was estimated at $103 billion annually in direct medical costs, making effective pharmacotherapy a potential offset against downstream liver transplant and hepatocellular carcinoma expenses" [4].

Compounded Resmetirom in Indiana: Legality and Access

Compounded resmetirom is available in Indiana through licensed 503A compounding pharmacies. Under the Federal Food, Drug, and Cosmetic Act Section 503A, a 503A pharmacy may compound a drug using a bulk drug substance if the compound is prescribed by a licensed practitioner for an individual patient, the pharmacy does not compound in anticipation of receiving prescriptions (no bulk manufacturing), and the drug is not essentially a copy of a commercially available product.

That last condition is where legal complexity enters. The FDA's guidance on "essentially a copy" has been interpreted differently across enforcement actions. A 503A pharmacy compounding resmetirom in Indiana may argue that its formulation differs from the commercial tablet in dosage form, excipients, or strength. But the FDA could challenge this if the compounded product is therapeutically equivalent to Rezdiffra.

From a practical standpoint, compounded resmetirom in Indiana is marketed at substantially lower prices than brand Rezdiffra. Some 503A pharmacies have listed compounded resmetirom capsules at prices that undercut the $3,500 monthly brand cost by a significant margin. The tradeoff: compounded products do not undergo the same FDA review for bioavailability, stability, and purity as commercially manufactured drugs. The MAESTRO-NASH efficacy and safety data apply specifically to the Madrigal-manufactured tablet [1].

The Indiana Board of Pharmacy regulates 503A pharmacies under Indiana Code 25-26. Indiana does not have state-specific restrictions beyond federal 503A requirements that would prohibit compounding resmetirom, provided the pharmacy holds a valid Indiana compounding license and obtains the active pharmaceutical ingredient from an FDA-registered supplier.

Telehealth Prescribing in Indiana: Getting Rezdiffra Remotely

Indiana permits telehealth prescribing of Rezdiffra. A provider licensed in Indiana can evaluate a patient via synchronous audio-video visit, review diagnostic workup (including liver biopsy reports, FibroScan results, and laboratory panels), and transmit a prescription to a specialty pharmacy.

Indiana's telehealth parity law (Indiana Code 25-1-9.5) requires that insurers cover telehealth-delivered services at the same rate as in-person visits, which means your evaluation for Rezdiffra should be covered by your plan at the same copay as an office visit. This is relevant for patients in rural Indiana counties where hepatology subspecialists are scarce. Only 12 of Indiana's 92 counties have a practicing gastroenterologist or hepatologist, according to Health Resources and Services Administration data on healthcare professional shortage areas [5].

For telehealth-based prescribing of Rezdiffra, your provider will still need the same diagnostic documentation required for in-person prescriptions: liver biopsy or validated noninvasive test results confirming MASH with F2-F3 fibrosis. The prescription is then routed to a specialty pharmacy (Accredo, CVS Specialty, or Optum Specialty are common in Indiana) that ships directly to your home.

Strategies to Lower Your Rezdiffra Cost in Indiana

Reducing your monthly cost for Rezdiffra in Indiana requires a layered approach. Start with the Madrigal copay savings card if you have commercial insurance. Next, ask your prescriber to submit a prior authorization with comprehensive documentation, including the specific fibrosis stage, imaging results, liver enzyme trends, and a letter of medical necessity.

If your commercial plan denies coverage, file an internal appeal within 30 days. Indiana's Department of Insurance allows external review for denied claims, and an independent review organization will evaluate whether Rezdiffra is medically necessary based on your clinical documentation. The external review decision is binding on the insurer under Indiana Code 27-8-29.

For patients without insurance, Madrigal's patient assistance program may provide Rezdiffra at no cost to qualifying individuals whose household income falls below 400% of the federal poverty level. Contact Madrigal's patient support line directly, as eligibility criteria and application processes are updated periodically.

Specialty pharmacies may also offer price-matching or discount programs. Compare prices across at least three specialty pharmacies before filling. The AASLD recommends that patients with MASH and significant fibrosis discuss all available access pathways with their hepatology team, as untreated F3 fibrosis carries a 5-year cirrhosis progression rate of approximately 20% to 30% [3][6].

One additional option: if your employer offers a Health Savings Account (HSA) or Flexible Spending Account (FSA), Rezdiffra copays qualify as eligible medical expenses. For Indiana residents on high-deductible health plans paired with HSAs, using pre-tax dollars effectively reduces the net cost by your marginal tax rate.

Clinical Context: Why Resmetirom Costs What It Does

Rezdiffra is a thyroid hormone receptor beta (THR-beta) agonist. It selectively activates the THR-beta receptor in the liver, reducing hepatic fat, inflammation, and fibrosis without the cardiac effects of systemic thyroid hormone excess [1]. This mechanism is distinct from GLP-1 receptor agonists, which reduce liver fat indirectly through weight loss and metabolic improvement.

The MAESTRO-NASH phase 3 trial enrolled 966 patients with biopsy-confirmed MASH and F1B to F3 fibrosis. At 52 weeks, resmetirom 80 mg achieved MASH resolution in 25.9% of patients (vs. 9.7% placebo), and resmetirom 100 mg achieved it in 29.9% (P<0.001). Fibrosis improvement by at least one stage without worsening of MASH was observed in 24.2% on the 80 mg dose and 25.9% on the 100 mg dose, compared to 14.2% on placebo [1].

MASH is now the fastest-growing indication for liver transplantation in the United States, accounting for an increasing share of transplant waitlist registrations over the past decade [7]. A single liver transplant costs between $800,000 and $1,000,000 in the first year alone. From a health-economics perspective, Madrigal has positioned the $42,000 annual cost of Rezdiffra as a fraction of the downstream costs of progression to decompensated cirrhosis, hepatocellular carcinoma, or transplant.

The drug's most common adverse effects in MAESTRO-NASH were diarrhea (27.0% vs. 18.5% placebo) and nausea (20.2% vs. 12.8% placebo), both of which were predominantly mild and transient [1]. No clinically significant thyrotoxicosis events were reported.

What Indiana Patients Should Do Next

If you have been diagnosed with MASH and moderate to advanced fibrosis, bring your liver biopsy or FibroScan report and recent liver panel (AST, ALT, GGT) to your gastroenterologist or hepatologist. Ask them to initiate prior authorization for Rezdiffra with your insurance plan, enroll you in the Madrigal savings card program if commercially insured, and provide a letter of medical necessity that references the MAESTRO-NASH co-primary endpoint data. Indiana residents in underserved counties can access hepatology specialists via telehealth. The standard starting dose is resmetirom 80 mg once daily, titrated to 100 mg based on clinical response and tolerability [2].