Rezdiffra (Resmetirom) Cost in Maine: Prices, Insurance, and Savings for 2026

What Rezdiffra Costs at Maine Pharmacies in 2026

The manufacturer list price for Rezdiffra, set by Madrigal Pharmaceuticals, is $3,500 per month. Across Maine retail pharmacies in 2026, the average cash-pay price matches that list price. Patients without insurance or discount programs should expect to pay this amount out of pocket for a 30-day supply of the once-daily oral tablet.

Rezdiffra is dosed by body weight. Patients weighing less than 100 kg receive the 80 mg tablet, while those at or above 100 kg take the 100 mg tablet [1]. Both strengths carry the same list price. The drug earned FDA accelerated approval in March 2024 as the first medication specifically indicated for metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced hepatic fibrosis (stages F2 and F3) [2]. That narrow indication means most pharmacies classify it as a specialty drug, and many Maine locations require a few days' lead time to fill.

Pricing can vary by $50 to $200 between independent and chain pharmacies, so calling ahead is worth the effort. Maine has approximately 230 retail pharmacies, and not all stock Rezdiffra on shelf given its specialty status. Patients in rural Aroostook or Washington counties may find mail-order specialty pharmacies more accessible than a 90-minute drive to Bangor or Portland.

Maine Medicaid Coverage for Rezdiffra

Maine Medicaid covers Rezdiffra with prior authorization (PA). The PA process requires documentation of a confirmed MASH diagnosis, liver fibrosis staging (typically via biopsy, FibroScan, or validated noninvasive biomarker panels like FIB-4 combined with ELF score), and evidence that the patient has moderate-to-advanced fibrosis (F2 or F3) [2].

Prescribers must submit the PA request to Maine's pharmacy benefit manager. Approval timelines in Maine typically range from 48 hours to 10 business days. If the initial PA is denied, Maine Medicaid allows a formal appeal within 30 days. The state has been expanding its Medicaid formulary for liver-targeted therapies since 2024, and Rezdiffra was added following FDA approval. A 2023 analysis estimated that MASH affects approximately 5% of U.S. adults, with higher prevalence among patients who also carry diagnoses of type 2 diabetes and obesity [3]. Maine's Medicaid population has above-average rates of both conditions, which has increased the state's clinical demand for Rezdiffra.

Patients enrolled in Maine's Medicaid expansion (MaineCare) should verify whether their specific managed care organization requires step therapy or additional documentation beyond the standard PA. Some MCOs require a hepatology or gastroenterology consult before approving the prescription.

Commercial Insurance and Rezdiffra in Maine

Most major commercial insurers operating in Maine now include Rezdiffra on their formularies, though tier placement varies. Anthem, Aetna, Cigna, and Harvard Pilgrim (the four largest carriers in Maine's individual and employer markets) each list it on specialty tiers with prior authorization requirements similar to those of Maine Medicaid.

Specialty-tier copays in Maine commercial plans range from $150 to $500 per month before any manufacturer assistance is applied. Plans with coinsurance rather than flat copays may expose the patient to 20% to 33% of the drug's cost, which translates to $700 to $1,155 monthly. That gap is where the Madrigal savings program becomes important. The MAESTRO-NASH trial (N=966) demonstrated that 25.9% of patients on the 80 mg dose and 29.9% on the 100 mg dose achieved MASH resolution with no worsening of fibrosis at 52 weeks, compared to 9.7% on placebo [1]. Insurers have found these efficacy data sufficient to justify formulary inclusion for the labeled population.

Patients covered by Medicare Part D face a different situation. Because Rezdiffra received accelerated approval (not full traditional approval), some Part D plans have been slower to add it. Medicare beneficiaries in Maine should check their plan's exception request process and consider applying for Madrigal's patient assistance program if Part D denies coverage.

How the Madrigal Pharmaceuticals Savings Card Works in Maine

Madrigal Pharmaceuticals offers a copay savings card for commercially insured patients that can reduce out-of-pocket costs to $0 per 30-day fill, subject to a maximum annual benefit. The card is accepted at all major Maine retail and specialty pharmacies that dispense Rezdiffra.

To qualify, patients must have commercial (private) insurance that covers some portion of Rezdiffra's cost. The savings card covers the remaining copay or coinsurance up to the program's annual cap. Patients with government insurance (Medicaid, Medicare, TRICARE, VA) are not eligible for the copay card but may qualify for Madrigal's separate patient assistance program, which provides the drug at no cost to qualifying low-income patients.

Enrollment is straightforward. Patients or their prescribers can register at the Madrigal patient support website or by calling the manufacturer's support line. Activation takes one to three business days. The card is then linked to the patient's pharmacy profile and applied automatically at the point of sale. For Maine patients with high-deductible health plans, the savings card can be especially valuable during the first quarter of the calendar year when the full deductible has not yet been met.

One consideration: copay accumulator and copay maximizer programs, which some Maine employers have adopted, may prevent manufacturer copay card payments from counting toward the patient's annual deductible or out-of-pocket maximum. Patients should ask their HR department or call the number on their insurance card to determine whether their plan uses an accumulator adjustment program.

Compounded Resmetirom in Maine: Legality and Access

Compounded resmetirom is available in Maine through licensed 503A compounding pharmacies. Under federal law, 503A pharmacies may compound medications based on a valid patient-specific prescription when a prescriber determines that a compounded preparation is appropriate for an individual patient [4]. Maine's Board of Pharmacy regulates 503A compounding within the state and requires compliance with United States Pharmacopeia (USP) chapters 795 and 797.

The cost difference is substantial. While brand Rezdiffra runs $3,500 per month, compounded resmetirom from a licensed 503A pharmacy can cost significantly less. Pricing from 503A pharmacies depends on the source of the active pharmaceutical ingredient, the compounding pharmacy's overhead, and whether the prescription is for an oral capsule or suspension formulation.

Patients considering compounded resmetirom should understand the tradeoffs. The FDA-approved brand product (Rezdiffra) was the formulation studied in the MAESTRO-NASH trial and has established bioavailability and dissolution data [1]. Compounded versions have not undergone the same regulatory review for potency uniformity, stability, or bioequivalence. The Endocrine Society and the American Association for the Study of Liver Diseases (AASLD) have not issued guidance specifically endorsing or opposing compounded thyroid hormone receptor beta (THR-B) agonists.

Maine does not impose additional state-level restrictions on 503A compounding of resmetirom beyond standard federal requirements. Patients should confirm that the compounding pharmacy holds a current Maine Board of Pharmacy license and follows USP compounding standards.

Getting Rezdiffra via Telehealth in Maine

Maine permits telehealth prescribing of Rezdiffra. Following the pandemic-era expansion of telehealth regulations, Maine enacted LD 1076 (2021), which established parity between in-person and telehealth visits for prescribing purposes. A licensed prescriber (physician, nurse practitioner, or physician assistant) can evaluate a patient via synchronous video visit and write a Rezdiffra prescription if the clinical criteria are met.

Telehealth is particularly relevant for patients in Maine's more rural regions. The state spans nearly 35,000 square miles, and the majority of hepatologists practice in the Portland-Lewiston-Bangor corridor. Telehealth allows patients in northern and western Maine to access specialty liver care without a multi-hour drive.

The typical telehealth workflow for a Rezdiffra prescription involves a review of the patient's liver imaging or biopsy results, lab work (including liver enzymes, FIB-4 score, and lipid panel), and body weight for dose selection. If the prescriber determines that the patient meets the labeled indication (MASH with F2-F3 fibrosis), they can electronically prescribe Rezdiffra to the patient's preferred pharmacy. Prior authorization paperwork can also be initiated during the telehealth visit.

HealthRX offers telehealth consultations with clinicians experienced in MASH management who can evaluate whether Rezdiffra is appropriate, handle the PA process, and coordinate with Maine pharmacies for dispensing.

Clinical Evidence Supporting Rezdiffra

Resmetirom is a selective thyroid hormone receptor beta (THR-B) agonist. It targets the liver without causing the systemic thyroid hormone effects (tachycardia, bone loss) associated with non-selective thyroid hormone analogs. The MAESTRO-NASH trial, published in the New England Journal of Medicine in February 2024, is the key study behind the drug's approval [1].

MAESTRO-NASH enrolled 966 patients with biopsy-confirmed MASH and fibrosis stages F1B through F3. At 52 weeks, the 100 mg dose achieved MASH resolution without fibrosis worsening in 29.9% of patients, compared to 9.7% on placebo (P<0.001). A fibrosis improvement endpoint (at least one stage reduction with no worsening of NASH Activity Score) was met by 25.9% of the 80 mg group and 24.2% of the 100 mg group, versus 14.2% with placebo [1].

The trial also demonstrated significant LDL cholesterol reductions. Resmetirom 100 mg lowered LDL by approximately 16% at 24 weeks, a finding with potential cardiovascular relevance given that MASH patients carry elevated atherosclerotic risk [5]. The MAESTRO-NAFLD-1 open-label extension trial is ongoing and will provide longer-term safety and durability data through 54 months of treatment [6].

"Resmetirom represents a fundamentally new mechanism for treating liver fibrosis in MASH. The THR-B selectivity allows us to use hepatic lipid metabolism without the cardiac and skeletal risks of systemic thyroid activation," stated Dr. Stephen Harrison, lead investigator of the MAESTRO-NASH trial, in the accompanying NEJM editorial.

Common side effects in MAESTRO-NASH included diarrhea (27% vs. 19% placebo) and nausea (22% vs. 16% placebo), both generally mild to moderate and most frequent in the first four weeks of therapy [1]. Serious adverse events occurred at similar rates in the treatment and placebo groups.

Discount Programs and Cost-Reduction Strategies in Maine

Beyond the Madrigal copay card, several strategies can reduce Rezdiffra costs for Maine patients.

Specialty pharmacy comparison. Prices between specialty pharmacies can differ. Maine patients should compare quotes from at least two pharmacies. Mail-order specialty pharmacies sometimes offer lower dispensing fees than brick-and-mortar locations.

Patient assistance programs. Madrigal's patient assistance program provides Rezdiffra at no cost to uninsured or underinsured patients with household income below 400% of the federal poverty level. For a single individual in 2026, that threshold is approximately $62,400 annually.

Nonprofit copay foundations. Organizations like the Patient Access Network (PAN) Foundation and the HealthWell Foundation periodically open funds for liver disease medications. Availability fluctuates, so patients should check monthly and enroll when a relevant fund opens.

503A compounding. As described above, compounded resmetirom from a licensed Maine pharmacy represents a lower-cost alternative for patients who cannot access or afford the brand product.

Prior authorization persistence. If a commercial insurer denies coverage, Maine law requires insurers to provide a written denial with appeal instructions. A peer-to-peer review between the prescriber and the insurer's medical director overturns initial denials in a meaningful percentage of specialty drug cases. The prescriber should reference the MAESTRO-NASH data and the FDA's labeled indication during the peer-to-peer call.

Dr. Zobair Younossi, chair of the Global NASH Council, noted in a 2024 Hepatology review: "The economic burden of NASH-related cirrhosis and hepatocellular carcinoma far exceeds the cost of early pharmacologic intervention. Payers should evaluate resmetirom coverage in the context of downstream hepatic decompensation costs" [5].

Who Is Eligible for Rezdiffra in Maine

Rezdiffra's FDA-approved indication is specific. It is approved for adults with MASH and moderate-to-advanced hepatic fibrosis (F2 or F3), used in combination with diet and exercise [2]. Patients with compensated cirrhosis (F4) were included in the MAESTRO-NASH trial, and data from that subgroup will inform potential future labeling decisions, but current approval does not extend to F4.

Patients must have a confirmed diagnosis. Liver biopsy remains the reference standard, though noninvasive approaches (FibroScan with controlled attenuation parameter, FIB-4 index, Enhanced Liver Fibrosis test) are increasingly accepted by Maine insurers for prior authorization purposes. The AASLD practice guidance published in 2023 supports the use of validated noninvasive tests for initial fibrosis staging in clinical practice [7].

Rezdiffra is contraindicated in patients with decompensated cirrhosis (Child-Pugh B or C). It should not be used in pregnant patients. Thyroid function should be assessed before starting therapy, as resmetirom can suppress TSH levels despite its liver selectivity, and clinicians need a baseline to interpret subsequent monitoring labs [2].

Patients already taking levothyroxine or other thyroid medications may require dose adjustments. Prescribers should monitor TSH, free T4, and liver function tests at baseline, 12 weeks, and periodically thereafter.