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

Rezdiffra List Price and Maryland Retail Pricing

The manufacturer list price for Rezdiffra is $3,500 per month, set by Madrigal Pharmaceuticals. In Maryland, cash-pay pricing at retail pharmacies averages this same $3,500 figure in 2026, though individual pharmacy markup can shift the number by $50 to $200 depending on location and dispensing volume. That works out to roughly $42,000 per year before any insurance or discount program offsets.

This price point places Rezdiffra in a similar tier to other specialty hepatology drugs. For context, obeticholic acid (Ocaliva) carried a wholesale acquisition cost exceeding $6,000 per month before its voluntary market withdrawal in 2024. Rezdiffra is currently the only FDA-approved therapy specifically indicated for metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced hepatic fibrosis (stages F2-F3), which limits direct price comparisons [1].

Patients filling at Maryland retail chains like CVS, Walgreens, or independent pharmacies should request a price quote before dispensing. Specialty pharmacy channels may offer different pricing structures through payer contracts. The gap between list price and actual out-of-pocket cost depends entirely on insurance status, which we break down below.

Maryland Medicaid Coverage for Rezdiffra

Maryland Medicaid covers Rezdiffra with prior authorization (PA). The PA process requires documentation of a confirmed MASH diagnosis, liver biopsy or validated noninvasive testing showing fibrosis stage F2 or F3, and a prescribing clinician's attestation that the patient has not responded adequately to lifestyle modifications alone.

The Maryland Department of Health Medicaid Pharmacy Program follows a preferred drug list (PDL) model. Because resmetirom is first-in-class with no therapeutic alternatives in the same mechanism category, PA approval rates tend to be higher than for drugs with multiple competitors in the same class. Denials most often stem from incomplete fibrosis staging documentation or missing lab values.

If a PA is denied, Maryland Medicaid allows a formal appeal within 30 days. Patients and prescribers can also request an expedited review if clinical urgency exists (for example, biopsy-confirmed progression from F2 to F3 during a monitoring period). According to the AASLD 2023 practice guidance on NAFLD/MASH, fibrosis stage is the strongest predictor of liver-related mortality, which supports the clinical rationale for timely access to anti-fibrotic therapy [2].

Maryland HealthChoice managed care organizations (MCOs) including CareFirst, Priority Partners, Jai Medical Systems, and others each process Rezdiffra PAs through their own pharmacy benefit managers. Processing times average 3 to 7 business days, though expedited requests can resolve in 24 to 72 hours.

Commercial Insurance Coverage in Maryland

Most major commercial insurers operating in Maryland cover Rezdiffra on their specialty pharmacy formularies. CareFirst BlueCross BlueShield, Cigna, Aetna, and UnitedHealthcare all list it, typically at a specialty tier (Tier 4 or Tier 5), which means higher copays or coinsurance compared to generic medications.

A Tier 4 specialty copay in Maryland commonly runs 25% to 33% coinsurance after the deductible, translating to $875 to $1,155 per month out of pocket on a $3,500 list price. Some plans cap specialty copays at $150 to $250 per fill. Patients should check whether their plan imposes step therapy requirements. Several Maryland insurers require documentation that the patient has attempted at least 6 months of structured lifestyle intervention (diet and exercise counseling) before approving Rezdiffra [3].

The FDA-approved prescribing information for Rezdiffra specifies its indication for adults with noncirrhotic MASH and moderate-to-advanced fibrosis. Insurers in Maryland generally follow this label indication closely. Off-label use for MASH without significant fibrosis (F0-F1) is typically denied.

Employer-sponsored plans represent another significant coverage pathway. Maryland state employees covered under the State Employee and Retiree Health and Welfare Benefits Program should verify Rezdiffra formulary status through their specific plan administrator, as coverage can differ between the PPO and EPO options.

The Madrigal Pharmaceuticals Savings Card

Madrigal Pharmaceuticals offers a copay savings card that can reduce out-of-pocket costs to $0 per month for commercially insured patients. The card covers up to $13 to 000 in annual copay assistance, which is sufficient to eliminate most commercial copays entirely given the $3,500 monthly list price.

Eligibility requirements are straightforward. The patient must have commercial (private) insurance that covers Rezdiffra. Government-insured patients on Medicare, Medicaid, Tricare, or VA benefits do not qualify for the savings card. There is no income requirement.

Enrollment happens through the Madrigal patient support hub, either by phone or online. Prescribers can also initiate enrollment at the point of prescribing. Once activated, the card functions like a secondary insurance, automatically applied at the pharmacy point of sale. The pharmacist enters the savings card BIN and PCN numbers, and the system calculates the remaining patient responsibility after the primary insurer adjudicates the claim.

One important detail: the savings card does not count toward the patient's annual out-of-pocket maximum or deductible under most commercial plans. This is a federal accumulator adjustment program issue that affects many specialty drugs, not just Rezdiffra. Maryland passed HB 1397 in 2022, which limits certain accumulator adjustment practices for state-regulated plans, but self-funded employer plans (governed by ERISA) are exempt from state law on this point.

Patients using the savings card should confirm whether their plan applies manufacturer copay assistance toward the deductible and out-of-pocket maximum, or whether it is excluded.

Compounded Resmetirom in Maryland

Compounded resmetirom is legal in Maryland through licensed 503A compounding pharmacies. A 503A pharmacy compounds medications pursuant to individual patient prescriptions under the supervision of a licensed pharmacist, following state Board of Pharmacy regulations and Section 503A of the Federal Food, Drug, and Cosmetic Act [4].

Pricing for compounded resmetirom varies by pharmacy but is typically far lower than the branded $3,500 monthly cost. Some 503A pharmacies list compounded resmetirom at prices that make the branded version's cost difficult to justify for uninsured or underinsured patients.

There are clinical caveats worth understanding. Compounded drugs do not undergo the same FDA review process as commercially manufactured products. The FDA notes that compounded medications are not evaluated for safety, effectiveness, or manufacturing quality in the same manner as approved drugs [5]. Bioavailability, stability, and potency can differ between a compounded preparation and the branded tablet.

For patients considering compounded resmetirom, Maryland law requires that the compounding pharmacy hold an active Maryland Board of Pharmacy license. The pharmacy must compound from bulk drug substance that meets USP-NF standards. Patients should ask the pharmacy whether it holds accreditation from the Pharmacy Compounding Accreditation Board (PCAB) or similar body, which signals adherence to higher quality standards.

Dr. Mary Rinella, hepatologist at the University of Chicago and lead author on AASLD guidance documents, stated in a 2024 clinical commentary: "For the first time, we have an FDA-approved, disease-modifying therapy for MASH that targets the underlying metabolic dysfunction. Access barriers including cost and insurance hurdles should not prevent appropriate patients from receiving treatment."

Clinical Evidence Behind Rezdiffra

Rezdiffra's approval rests on the MAESTRO-NASH trial, a Phase 3, randomized, double-blind, placebo-controlled study published in the New England Journal of Medicine in February 2024 [1]. The trial enrolled 966 participants with biopsy-confirmed MASH and fibrosis stages F1B through F3.

At 52 weeks, resmetirom 100 mg achieved MASH resolution without worsening of fibrosis in 29.9% of patients versus 9.7% on placebo. The 80 mg dose showed a 25.9% MASH resolution rate. For the fibrosis improvement endpoint (at least one stage reduction without MASH worsening), the 100 mg dose achieved 25.9% versus 14.2% placebo [1].

These numbers matter for Maryland patients evaluating whether the drug justifies its $3,500 monthly price tag. The number needed to treat (NNT) for MASH resolution at 100 mg was approximately 5, meaning roughly 1 in 5 patients treated experienced histologic resolution of steatohepatitis at one year. That is a clinically meaningful effect size for a disease that previously had no approved pharmacotherapy.

Secondary endpoints showed significant improvements in liver fat content (measured by MRI-proton density fat fraction), with a mean relative reduction of 45% to 51% from baseline in the resmetirom groups compared to 10% in the placebo arm. LDL cholesterol also decreased by 13% to 16%, reflecting resmetirom's thyroid hormone receptor beta agonism in the liver, which upregulates LDL receptor expression [1].

The most common adverse events were diarrhea (27% vs. 18% placebo) and nausea (19% vs. 14% placebo), both predominantly mild and concentrated in the first 4 to 8 weeks of treatment [6]. Thyroid function monitoring is required: the FDA label mandates TSH measurement before initiation and periodically during treatment, as resmetirom can suppress TSH even though it selectively targets the beta receptor.

Telehealth Access to Rezdiffra in Maryland

Maryland permits telehealth prescribing of Rezdiffra. State telehealth parity laws, codified under Maryland Code Health-General §19-143, require that insurers cover telehealth-delivered services at the same rate as in-person visits. This means a hepatologist or gastroenterologist can evaluate a patient via video, review existing imaging and lab work, and prescribe resmetirom without requiring an in-person encounter.

For patients in rural Maryland counties (such as Garrett, Allegany, or Dorchester) where hepatology specialists are scarce, telehealth provides a practical access pathway. The prescription itself can be transmitted electronically to any Maryland pharmacy, including specialty pharmacies equipped to dispense Rezdiffra.

A telehealth visit does not bypass the diagnostic requirements. The prescriber still needs biopsy results or validated noninvasive markers (FibroScan with liver stiffness measurement, FIB-4 index, or Enhanced Liver Fibrosis [ELF] test) confirming fibrosis stage F2 or F3. According to AASLD guidance, noninvasive tests can be used for initial risk stratification, though biopsy remains the reference standard for confirming MASH histology [2].

Reducing Your Out-of-Pocket Cost: A Practical Checklist

Start with insurance verification. Call the number on the back of your insurance card and ask three specific questions: Is Rezdiffra on formulary? What tier? Are there step therapy or PA requirements?

If commercially insured, enroll in the Madrigal savings card before your first fill. The card can eliminate your copay entirely if your annual out-of-pocket costs fall below $13,000.

If uninsured, contact Madrigal's patient assistance program directly. Pharmaceutical manufacturers of specialty drugs typically offer free drug programs for patients below 400% of the federal poverty level (roughly $62,400 for a single individual in 2026).

If on Medicare Part D, Rezdiffra falls under the specialty tier. The Inflation Reduction Act's $2,000 annual out-of-pocket cap on Part D spending (effective January 2025) means Medicare beneficiaries in Maryland pay no more than $2,000 total per year for all covered Part D drugs, including Rezdiffra [7]. This represents significant savings compared to the pre-2025 catastrophic coverage structure.

If on Maryland Medicaid, submit the PA with complete fibrosis documentation upfront. Include the FibroScan report, relevant labs (ALT, AST, platelet count, FIB-4 score), and a brief clinical narrative. Incomplete submissions are the primary cause of delays.

For patients exploring compounded resmetirom, verify the pharmacy's Maryland Board of Pharmacy license number and ask about third-party testing of compounded batches. Cost savings can be substantial, but quality assurance varies.