Rezdiffra (Resmetirom) Cost in New Hampshire: Prices, Insurance, and Savings in 2026

What Does Rezdiffra (Resmetirom) Actually Cost in New Hampshire?

The retail price for Rezdiffra at New Hampshire pharmacies in 2026 is approximately $3,500 per month, matching the national manufacturer list price set by Madrigal Pharmaceuticals. That figure represents the wholesale acquisition cost (WAC) before any insurance negotiation, rebate, or copay assistance is applied.

For patients paying cash without insurance, this means an annual spend near $42,000. Prices at individual New Hampshire pharmacies, including chains like CVS, Walgreens, and Rite Aid locations across Manchester, Nashua, and Concord, generally do not deviate from the $3,500 WAC because Rezdiffra has no generic equivalent and limited pharmacy-level discounting use. Specialty pharmacies, which handle most Rezdiffra dispensing, typically bill at or near list price before applying manufacturer rebates.

The drug's pricing sits below several injectable biologics used in hepatology but well above generic liver-supportive medications like vitamin E or off-label pioglitazone, which cost under $30 per month. The FDA-approved labeling for Rezdiffra specifies two dose strengths (80 mg and 100 mg tablets), and both are priced identically at the $3,500 monthly rate. Your prescriber selects the dose based on body weight: 80 mg for patients weighing under 100 kg and 100 mg for those at or above 100 kg.

One variable that can change your actual out-of-pocket number dramatically is your insurance plan's formulary tier. Rezdiffra lands on specialty tiers for most commercial plans, which means coinsurance (often 25%-33% of the drug cost) rather than a flat copay. Without the manufacturer's savings program, that coinsurance could mean $875 to $1,155 per month out of pocket, even with active coverage. The sections below break down each path to lower that figure in New Hampshire specifically.

New Hampshire Medicaid and Rezdiffra: Current Coverage Status

New Hampshire Medicaid does not cover Rezdiffra as of May 2026. Patients enrolled in NH Medicaid managed care plans, including those administered through AmeriHealth Caritas and Well Sense Health Plan, will not find resmetirom on the preferred drug list.

This gap is not unique to New Hampshire. Most state Medicaid programs have been slow to add Rezdiffra to formularies since its FDA approval in March 2024. The delay reflects several factors: the relatively recent approval, the high monthly cost, and ongoing post-marketing data collection from the MAESTRO-NASH trial's open-label extension phase. Medicaid formulary committees typically require 12 to 24 months of post-approval real-world evidence before initiating coverage reviews for high-cost specialty drugs.

New Hampshire's Medicaid Drug Utilization Review (DUR) Board evaluates new specialty medications on a quarterly cycle. As of mid-2026, resmetirom has not appeared on a published DUR agenda. Patients who believe they meet clinical criteria can ask their prescriber to submit a prior authorization request, which triggers an individual case review. Approval through this exception pathway remains uncommon, but documented F2 or F3 fibrosis staging on liver biopsy or validated noninvasive testing (FibroScan with a score above 8.0 kPa) strengthens the case.

For NH Medicaid enrollees who cannot access Rezdiffra through the state program, two alternatives exist. The Madrigal patient assistance program provides free drug to qualifying uninsured or underinsured patients with household incomes at or below 400% of the federal poverty level. Separately, licensed 503A compounding pharmacies in New Hampshire can legally prepare resmetirom formulations (discussed in detail below).

Commercial Insurance Coverage for Rezdiffra in New Hampshire

Most major commercial insurers operating in New Hampshire will cover Rezdiffra with prior authorization. Anthem Blue Cross Blue Shield, Harvard Pilgrim Health Care, Cigna, and Aetna each list resmetirom on specialty formulary tiers, though specific cost-sharing varies by plan.

Prior authorization requirements are consistent across carriers. Prescribers must document a confirmed diagnosis of metabolic dysfunction-associated steatohepatitis (MASH), formerly called non-alcoholic steatohepatitis (NASH), with liver fibrosis stage F2 or F3. The MAESTRO-NASH trial, published in the New England Journal of Medicine in 2024, enrolled adults with biopsy-confirmed NASH and fibrosis stages F1b through F3, and the FDA label restricts the indication to moderate-to-advanced fibrosis specifically. Insurers mirror this scope. Requests for patients with F1 or F4 (cirrhotic) disease are routinely denied.

Documentation that strengthens a PA submission in New Hampshire includes: liver biopsy results with NAS (NAFLD Activity Score) of 4 or higher, FibroScan results showing liver stiffness above 8.0 kPa, lab evidence of elevated ALT, and records showing the patient has attempted lifestyle modifications (diet and exercise) for at least 6 months. Some carriers also require documentation that vitamin E or pioglitazone was tried or considered.

Turnaround for PA decisions ranges from 48 hours (Anthem electronic submissions) to 15 business days (Cigna standard review). If denied, New Hampshire insurance law (RSA 420-J:5) grants patients the right to an external review by an independent review organization (IRO) at no cost. The IRO decision is binding on the insurer.

Copay exposure on specialty tiers typically runs 25% to 33% coinsurance after deductible. For a $3,500 monthly drug, that means $875 to $1,155 per fill before applying the Madrigal savings card. High-deductible health plans (HDHPs) paired with HSAs present a sharper problem: patients may owe the full $3,500 until they clear their deductible, which can be $3,200 or more for individual coverage in 2026.

How the Madrigal Pharmaceuticals Savings Card Works in New Hampshire

The Madrigal Rezdiffra Savings Card is the single most effective tool for reducing out-of-pocket costs for commercially insured patients in New Hampshire. Eligible patients can pay as little as $0 per monthly fill.

Eligibility is straightforward. You must have commercial (private) insurance that covers at least part of Rezdiffra's cost. Patients on Medicare, Medicaid, Tricare, or other government-funded programs do not qualify. There is no income test. The card covers the difference between your insurer's approved amount and your remaining copay or coinsurance, up to an annual benefit maximum. Madrigal has not publicly disclosed the annual cap, but similar specialty savings programs typically set limits between $15,000 and $25,000 per calendar year.

To activate the card in New Hampshire, patients call the Madrigal support line or enroll online through the Rezdiffra HCP portal. The program issues a BIN/PCN/Group number that your specialty pharmacy processes as a secondary payer at the point of sale. No physical card is mailed. The process takes 10 to 15 minutes, and most specialty pharmacies in New Hampshire (including Accredo, CVS Specialty, and AllianceRx Walgreens Prime) are familiar with the adjudication workflow.

One limitation: the savings card does not apply to deductible accumulation on most plans. Some plans use copay accumulator or copay maximizer programs that prevent manufacturer assistance from counting toward your annual out-of-pocket maximum. New Hampshire has not enacted copay accumulator reform legislation as of 2026, so patients on plans with these programs may face repeated high costs each month even with the savings card active. Ask your benefits coordinator whether your plan uses a copay accumulator before assuming the card will zero out your costs for the full year.

Compounded Resmetirom in New Hampshire: Legality and Access

Compounded resmetirom is legal in New Hampshire through licensed 503A compounding pharmacies. This pathway exists because resmetirom's active ingredient is not currently on the FDA's "do not compound" list, and New Hampshire's Board of Pharmacy permits 503A compounding consistent with federal law under Section 503A of the Federal Food, Drug, and Cosmetic Act.

A 503A pharmacy compounds medications on a patient-specific basis with a valid prescription. The compounded product is not FDA-approved and does not carry the Rezdiffra brand name. Quality, bioequivalence, and purity standards for compounded drugs differ from commercially manufactured products. The FDA's guidance on compounding makes clear that compounded drugs are not evaluated for safety and efficacy through the new drug approval process.

Pricing for compounded resmetirom varies. Some 503A pharmacies in New Hampshire and neighboring states (Massachusetts, Vermont, Maine) advertise compounded thyroid hormone receptor beta (THR-B) agonist formulations. Actual costs depend on the pharmacy's sourcing for bulk resmetirom powder, which remains limited as of mid-2026. Patients should verify that any compounding pharmacy they use holds an active New Hampshire Board of Pharmacy license and sources active pharmaceutical ingredients (APIs) from FDA-registered facilities.

The clinical tradeoff is real. The MAESTRO-NASH trial demonstrated that resmetirom 100 mg achieved NASH resolution without worsening fibrosis in 29.9% of patients versus 9.7% on placebo at 52 weeks (P<0.001), and a 1-point or greater improvement in fibrosis stage in 25.9% versus 14.2% on placebo [1]. Those results were generated using the manufactured Rezdiffra tablet with validated dissolution and bioavailability profiles. Compounded formulations have not been tested in controlled trials, and absorption may differ. Patients considering compounded resmetirom should discuss the uncertainty with their hepatologist or gastroenterologist.

Getting Rezdiffra via Telehealth in New Hampshire

Telehealth prescribing of Rezdiffra is permitted in New Hampshire. State law (RSA 329:1-d) authorizes physicians and advanced practice providers to prescribe medications, including specialty drugs, through telehealth encounters as long as a valid provider-patient relationship is established.

Practically, this means a New Hampshire resident can consult a licensed hepatologist or gastroenterologist via video visit and receive a Rezdiffra prescription without an in-person office visit. The prescriber must be licensed in New Hampshire or hold a valid interstate compact license. Several national telehealth platforms now include hepatology specialists who can evaluate MASH patients, review imaging and lab results, and initiate resmetirom therapy.

However, the prior authorization process adds complexity. Most insurers require fibrosis staging documentation, which typically involves either a liver biopsy (performed in person) or a FibroScan (also in person at a facility with the device). The telehealth visit itself is straightforward, but the diagnostic workup that supports the prescription almost always requires at least one in-person encounter. Dartmouth-Hitchcock Medical Center in Lebanon, Elliot Hospital in Manchester, and Catholic Medical Center in Manchester all offer FibroScan services.

For follow-up monitoring, telehealth is well suited. The FDA prescribing information recommends checking hepatic function panels at baseline, during dose titration, and periodically thereafter. Lab orders can be placed during a telehealth visit and completed at any Quest Diagnostics or Labcorp draw station in New Hampshire. Results review and dose adjustments happen efficiently over video.

Discount Programs and Financial Assistance Beyond Insurance

Beyond the Madrigal savings card and compounding, several additional pathways may reduce Rezdiffra costs for New Hampshire patients.

Madrigal Patient Assistance Program (PAP). Uninsured patients or those denied coverage may qualify for free Rezdiffra directly from the manufacturer. Income limits are typically set at 400% of the federal poverty level ($62,400 for an individual in 2026). Applications require documentation of insurance denial or uninsured status plus income verification.

Specialty pharmacy coupons. Some specialty pharmacies negotiate supplemental discounts or rebates. These are uncommon for new specialty drugs like Rezdiffra, but worth asking about. Accredo and CVS Specialty are the two most common dispensing pharmacies for Rezdiffra in New Hampshire.

Employer advocacy. For patients on employer-sponsored plans where Rezdiffra is not yet on formulary, a letter from the prescribing physician to the employer's benefits team can sometimes trigger a formulary exception. Large self-insured employers in New Hampshire (BAE Systems, Dartmouth Health, Liberty Mutual's Concord office) have more flexibility to approve individual drug exceptions than fully insured small-group plans.

Clinical trials. Madrigal's ongoing open-label extension study and additional post-marketing trials may offer access to resmetirom at no cost. ClinicalTrials.gov lists active resmetirom studies; New Hampshire patients can also access trials at Boston-area academic centers within a 90-minute drive from southern NH.

The Endocrine Society's 2024 clinical practice guideline on MASH pharmacotherapy notes that cost remains a significant barrier to THR-B agonist adoption and recommends that prescribers actively assist patients with financial navigation [2]. The American Association for the Study of Liver Diseases (AASLD) echoed this position, stating: "Access programs and copay assistance should be discussed with every patient initiated on resmetirom, given the current wholesale acquisition cost" [3].

Clinical Eligibility: Who Qualifies for Rezdiffra in New Hampshire?

Rezdiffra is FDA-approved for adults with MASH and moderate-to-advanced hepatic fibrosis (stages F2 and F3), used alongside diet and exercise. Not every patient with fatty liver disease qualifies. The distinction matters because it determines both clinical appropriateness and insurance approval.

MASH is confirmed by either liver biopsy showing steatohepatitis (NAS score of 4 or higher with at least 1 point in each component: steatosis, lobular inflammation, and hepatocyte ballooning) or by a combination of validated noninvasive markers. The MAESTRO-NASH phase 3 trial used biopsy-confirmed entry criteria, enrolling 966 patients with fibrosis stages F1b through F3 [1]. The primary endpoints were met at both the 80 mg and 100 mg doses.

At 52 weeks, NASH resolution without fibrosis worsening occurred in 25.9% of patients on resmetirom 80 mg and 29.9% on resmetirom 100 mg, compared to 9.7% on placebo. Fibrosis improvement by at least one stage occurred in 24.2% on 80 mg and 25.9% on 100 mg versus 14.2% on placebo [1]. LDL cholesterol dropped by approximately 14% to 16% across dose groups, an important secondary benefit given the high cardiovascular risk in this population.

Dr. Stephen Harrison, the trial's lead investigator, noted: "Resmetirom is the first drug to demonstrate both histological improvement in NASH and fibrosis regression in a phase 3 trial, which is why the FDA granted accelerated approval based on the surrogate endpoint of fibrosis improvement" [1].

Patients with compensated cirrhosis (F4) were not included in MAESTRO-NASH, and the FDA label does not include this group. Decompensated cirrhosis (Child-Pugh B or C) is a contraindication. New Hampshire prescribers should also note that resmetirom carries warnings for drug-induced liver injury, and baseline hepatic function must be assessed before starting therapy. The drug is contraindicated in patients with severe hepatic impairment per the FDA label.

Side Effects and Monitoring Costs to Budget For

Beyond the drug's sticker price, New Hampshire patients should account for monitoring costs. Rezdiffra requires periodic lab work and potentially imaging to track both efficacy and safety.

The FDA prescribing information recommends liver function tests (AST, ALT, total bilirubin) before starting treatment, during dose adjustments, and periodically during therapy. In the MAESTRO-NASH trial, diarrhea occurred in 27.5% of the 100 mg group versus 15.7% on placebo, and nausea occurred in 21.7% versus 12.8% [1]. Most gastrointestinal side effects were mild to moderate and self-limiting within the first 4 to 6 weeks.

Lab panels at Quest Diagnostics or Labcorp in New Hampshire typically cost $15 to $45 per panel with insurance, or $80 to $150 cash pay. FibroScan monitoring (if repeated to track fibrosis response) runs $150 to $400 per session depending on the facility. Dartmouth-Hitchcock charges on the higher end; outpatient imaging centers in Manchester and Nashua tend to charge less.

Thyroid function monitoring is also recommended. Resmetirom is a selective thyroid hormone receptor beta agonist, and while it does not significantly affect TSH or free T4 in most patients, the MAESTRO-NASH safety data showed small reductions in circulating thyroid hormone levels that were generally subclinical [1]. A TSH panel adds $25 to $60 per test. Annual monitoring costs for a typical Rezdiffra patient in New Hampshire total roughly $200 to $600 out of pocket, depending on insurance and testing frequency.