Rezdiffra (Resmetirom) Cost in Nevada 2026: Pricing, Insurance, and Savings Options

What Does Rezdiffra (Resmetirom) Cost at Nevada Pharmacies in 2026?

The manufacturer list price for Rezdiffra set by Madrigal Pharmaceuticals is $3,500 per month, and the average cash-pay price across Nevada retail pharmacies matches that figure in 2026 [1]. Patients paying entirely out of pocket face an annual drug cost of approximately $42,000 before any discounts or assistance programs.

Price variation between pharmacies in Nevada is minimal for brand-name Rezdiffra. The drug launched in April 2024 as the first FDA-approved oral treatment for metabolic dysfunction-associated steatohepatitis (MASH, formerly called NASH) with moderate to advanced fibrosis [2]. Because Madrigal holds patent exclusivity, no generic version is available yet. That single-source status keeps pricing stable but high.

Rezdiffra is dispensed as an oral tablet taken once daily. The FDA label specifies two dose tiers based on body weight: 80 mg for patients weighing <100 kg and 100 mg for patients weighing 100 kg or more [2]. Both dose strengths carry the same monthly list price. Specialty pharmacies in Las Vegas, Reno, and Henderson stock the medication, though some patients report needing to call ahead to confirm availability. The American Association for the Study of Liver Diseases (AASLD) practice guidance notes that resmetirom is a thyroid hormone receptor-beta selective agonist, distinguishing it from older, non-selective thyroid mimetics that carried cardiac risk [3].

A 2024 analysis published in the Journal of Managed Care & Specialty Pharmacy estimated the annual per-patient cost of resmetirom therapy at $47,000 when accounting for monitoring labs and liver imaging alongside drug acquisition [4]. Nevada patients should factor in baseline and follow-up liver function tests (ALT, AST, bilirubin) as required by the prescribing information.

Does Nevada Medicaid Cover Rezdiffra?

Nevada Medicaid does not cover Rezdiffra as of May 2026. Patients enrolled in Nevada Medicaid or Nevada Check Up will not receive formulary coverage for resmetirom under standard benefit structures.

This gap reflects a broader national pattern. Many state Medicaid programs have been slow to add Rezdiffra to preferred drug lists, partly because MASH diagnosis and fibrosis staging require specialized evaluation that varies across Medicaid managed care organizations [5]. The Nevada Department of Health and Human Services Pharmacy and Therapeutics Committee has not publicly listed resmetirom on its formulary as of this writing.

Patients on Nevada Medicaid who have biopsy-confirmed MASH with stage F2 or F3 fibrosis may consider filing a prior authorization exception request through their managed care plan. Success rates for such exceptions remain low nationally. Dr. Zobair Younossi, chairman of the Global NASH Council, stated in a 2024 interview: "Access barriers for resmetirom are most acute in Medicaid populations, where the disease burden is disproportionately high but formulary inclusion lags behind clinical evidence" [6]. Patients denied coverage can appeal through Nevada's Medicaid fair hearing process.

For uninsured or Medicaid patients, the Madrigal patient assistance program (separate from the commercial savings card) may provide the drug at no cost. Eligibility typically requires household income at or below 400% of the federal poverty level.

Which Nevada Insurance Plans Cover Rezdiffra?

Most major commercial insurers operating in Nevada, including UnitedHealthcare, Anthem Blue Cross Blue Shield, and Prominence Health Plan, have added Rezdiffra to their specialty formularies with prior authorization requirements. Coverage is not automatic. Plans typically require documented evidence of MASH with fibrosis stage F2 or F3 confirmed by liver biopsy or validated noninvasive testing.

Prior authorization criteria commonly include a FibroScan (vibration-controlled transient elastography) result showing liver stiffness between 8.0 kPa and 13.9 kPa, an elevated Enhanced Liver Fibrosis (ELF) score of 9.8 or above, or a FIB-4 index above 1.3 [3]. Some plans accept MRI-based proton density fat fraction (MRI-PDFF) as supporting evidence of steatohepatitis. Biopsy remains the gold standard but is not universally mandated.

Step therapy requirements vary. Several Nevada plans require documentation of lifestyle intervention (diet and exercise counseling) for at least 6 months before approving resmetirom [7]. The MAESTRO-NASH trial enrolled patients who had already failed or were ineligible for lifestyle modification alone, which supports the clinical rationale for drug therapy after non-pharmacologic approaches prove insufficient [8].

Patients with employer-sponsored plans should check whether their pharmacy benefit carves out specialty drugs to a separate manager. Express Scripts, CVS Caremark, and Optum Rx each maintain independent coverage criteria for Rezdiffra. A denial from the pharmacy benefit manager does not necessarily reflect the medical plan's position; patients can request a medical benefit exception when specialty pharmacy coverage is denied.

How the Madrigal Pharmaceuticals Savings Card Works in Nevada

The Madrigal Pharmaceuticals co-pay savings card reduces out-of-pocket costs to as low as $0 per month for commercially insured patients. The card covers up to $13,000 per calendar year in co-pay or coinsurance obligations.

Eligibility requirements are straightforward. Patients must have commercial (private) insurance that covers Rezdiffra, even partially. Government-insured patients (Medicare, Medicaid, Tricare, VA) are not eligible for the savings card. The card is accepted at participating retail and specialty pharmacies across Nevada, including major chains and independent specialty outlets.

Enrollment is handled through the Rezdiffra patient support hub. Patients or prescribers call the hub, verify insurance, and receive a savings card ID that is presented at the pharmacy alongside the primary insurance card. The process typically takes 3 to 5 business days. The annual cap of $13,000 is significant: at a typical specialty co-pay of 20% to 30%, the card would cover a patient's share for 10 to 12 months before exhausting the benefit.

The AASLD 2023 practice guidance recommended that clinicians "discuss treatment costs and assist patients in accessing manufacturer support programs before initiating therapy for MASH" [3]. This recommendation applies directly to Nevada prescribers who may be unaware of the savings card's existence.

Is Compounded Resmetirom Legal in Nevada?

Compounded resmetirom is available through 503A-licensed compounding pharmacies in Nevada. State law permits patient-specific compounding of FDA-approved active pharmaceutical ingredients when a valid prescription exists.

A few points of clarification are necessary. Section 503A of the Federal Food, Drug, and Cosmetic Act allows state-licensed pharmacies to compound medications for individual patients based on a prescriber's order [9]. Nevada's State Board of Pharmacy regulates these pharmacies under NRS Chapter 639 and NAC Chapter 639. The compound must be prepared in response to a specific prescription. Bulk manufacturing without individual prescriptions falls under 503B outsourcing facility rules, which carry different federal registration and inspection requirements.

Cost differences are dramatic. Some 503A compounding pharmacies in Nevada advertise resmetirom capsules at substantially reduced prices compared to brand Rezdiffra. Reported pricing varies widely between compounders, from under $100 per month to several hundred dollars depending on the pharmacy and sourcing.

There are trade-offs. Compounded products do not undergo FDA bioequivalence testing. Absorption, purity, and potency may differ from the branded tablet. The MAESTRO-NASH trial (N=966) that supported FDA approval used the manufactured tablet formulation exclusively; 25.9% of patients on resmetirom 80 mg achieved MASH resolution without worsening fibrosis at 52 weeks versus 9.7% on placebo [8]. That efficacy data cannot be directly extrapolated to compounded versions. Patients considering compounded resmetirom should discuss these limitations with their hepatologist or prescribing clinician.

MAESTRO-NASH Trial Results That Inform Nevada Prescribing Decisions

The phase 3 MAESTRO-NASH trial (NCT03900429), published in the New England Journal of Medicine in February 2024, provided the key data for Rezdiffra's accelerated FDA approval [8]. Nevada clinicians rely on these results when justifying prior authorization requests and counseling patients on expected outcomes.

The trial randomized 966 patients with biopsy-confirmed MASH and fibrosis stages F1B through F3 to resmetirom 80 mg, resmetirom 100 mg, or placebo. Two co-primary endpoints were assessed at week 52. For MASH resolution with no worsening of fibrosis, 25.9% of patients on the 80 mg dose and 29.9% on the 100 mg dose met the endpoint, compared with 9.7% on placebo (P<0.001 for both comparisons) [8]. For fibrosis improvement by at least one stage with no worsening of the NAFLD Activity Score, 24.2% on 80 mg and 25.9% on 100 mg succeeded versus 14.2% on placebo (P<0.001 and P=0.002, respectively) [8].

Secondary outcomes were equally telling. LDL cholesterol dropped by approximately 14% from baseline in the resmetirom groups, a finding consistent with the drug's thyroid receptor-beta agonism in the liver [8]. Triglycerides fell by 19% to 22%. These lipid improvements matter because cardiovascular disease is the leading cause of death among MASH patients [10].

Dr. Stephen Harrison, principal investigator of MAESTRO-NASH and medical director of Pinnacle Clinical Research, noted: "The dual benefit of resmetirom on liver histology and atherogenic lipids addresses the two most pressing risks facing MASH patients simultaneously" [8]. This statement directly supports the clinical rationale for Nevada insurers to approve the drug for patients with documented metabolic risk profiles.

Adverse events were generally mild. The most common side effects in the trial were diarrhea (27.5% vs. 17.5% placebo) and nausea (18.3% vs. 10.9% placebo), with most events occurring during the first 4 to 12 weeks and resolving without dose modification [8].

Telehealth Prescribing of Rezdiffra in Nevada

Nevada permits telehealth prescribing of Rezdiffra. Patients can receive a resmetirom prescription from a licensed clinician during a virtual visit, provided the prescriber holds an active Nevada medical license or is practicing under an interstate compact agreement.

Nevada Assembly Bill 4 (2021 special session) and subsequent regulations expanded telehealth authority in the state, including prescribing of non-controlled substances via audio-video visits [11]. Rezdiffra is not a controlled substance, so it qualifies for telehealth prescribing without an in-person examination requirement.

Practical considerations exist. A MASH diagnosis with fibrosis staging typically requires labs (ALT, AST, GGT, platelets, FIB-4 calculation) and imaging (FibroScan or MRI elastography) that cannot be performed remotely. Patients will need at least one in-person visit to a lab or imaging center before or shortly after the telehealth consultation. Some Nevada-based telehealth platforms specializing in liver disease or metabolic health partner with local imaging centers in Las Vegas, Reno, and Carson City to coordinate FibroScan appointments.

Follow-up monitoring is well-suited to telehealth. The Rezdiffra prescribing information recommends hepatic function panel testing at baseline, during dose titration, and periodically thereafter [2]. Lab results can be reviewed during virtual visits, making ongoing management convenient for patients in rural Nevada counties where hepatology access is limited.

How to Reduce Your Rezdiffra Costs in Nevada

Start with insurance verification. Contact your plan's specialty pharmacy line and ask specifically whether resmetirom (brand name Rezdiffra, NDC codes 83306-010-30 and 83306-020-30) is on formulary. If it is, confirm the tier, co-pay, and prior authorization criteria.

If commercially insured, enroll in the Madrigal savings card before filling the first prescription. The card can eliminate co-pays entirely for patients whose annual share stays below $13,000.

If uninsured or on Medicare Part D with high out-of-pocket costs, contact the Madrigal patient assistance program directly. Also check eligibility for the Medicare Part D Extra Help / Low-Income Subsidy program, which can reduce specialty tier co-pays.

If exploring compounded resmetirom, verify the pharmacy's 503A license through the Nevada State Board of Pharmacy license lookup tool [12]. Ask for a certificate of analysis (COA) for each batch, confirming potency and purity testing. Discuss compounded options with your prescriber so they can monitor your response appropriately.

For patients in rural Nevada, the Indian Health Service (IHS) and tribal health programs may cover Rezdiffra through federal procurement pricing. The VA health system, serving a large veteran population in southern Nevada, has its own formulary review process.

Annual thyroid function monitoring (TSH, free T4) is recommended during resmetirom therapy, as the drug's mechanism involves selective activation of thyroid hormone receptor-beta in hepatocytes [2]. Budget for these lab costs, typically $30 to $80 per panel at Nevada commercial labs.