Rezdiffra (Resmetirom) Cost in New York: Pricing, Insurance, and Savings in 2026

What Rezdiffra (Resmetirom) Costs at New York Retail Pharmacies in 2026

The average cash-pay price for Rezdiffra at New York retail pharmacies sits at approximately $3,500 per month in 2026, matching Madrigal Pharmaceuticals' list price. This figure applies to the standard once-daily oral tablet regimen and does not reflect insurance negotiation or copay assistance.

New York's pharmacy market includes major chains like CVS, Walgreens, and Rite Aid, along with independent specialty pharmacies. Pricing across these outlets shows minimal variation for Rezdiffra because the drug is distributed through specialty pharmacy channels rather than open retail networks. Specialty distribution keeps pricing tightly aligned with the wholesale acquisition cost (WAC) that Madrigal sets [1].

For context, $3,500 per month translates to $42,000 annually. That positions Rezdiffra in the mid-range of specialty hepatology drugs. By comparison, obeticholic acid (Ocaliva) carried a list price exceeding $70,000 annually before its manufacturer withdrew the NASH indication in 2023 after an FDA advisory committee vote [2]. The pricing of resmetirom reflects a market where payers had already signaled resistance to five-figure monthly costs for liver disease therapies.

Patients who fill their prescriptions at New York specialty pharmacies affiliated with major PBMs (pharmacy benefit managers) like Express Scripts, CVS Caremark, or OptumRx may see different copay tiers depending on their plan's formulary placement. Preferred specialty tier placement can reduce monthly out-of-pocket costs to $50 to $150 with commercial insurance, while non-preferred placement may mean coinsurance of 25% to 33%, pushing monthly costs above $800 before any manufacturer assistance kicks in [3].

New York Medicaid Coverage for Rezdiffra

New York Medicaid covers Rezdiffra with prior authorization (PA). This means prescribers must submit clinical documentation proving the patient meets specific criteria before the state will approve payment.

The PA process in New York typically requires confirmation of a MASH diagnosis, evidence of moderate to advanced hepatic fibrosis (stages F2 or F3, and now conditionally F4 based on the MAESTRO-NASH data), and documentation that the prescriber is a hepatologist or gastroenterologist, or that the patient has been evaluated by one. New York's Medicaid Drug Utilization Review Board reviews these criteria periodically [4].

Processing times for Medicaid PA in New York average 3 to 5 business days for standard requests and 24 hours for urgent requests. Denials can be appealed through the state's Fair Hearing process. Prescribers submitting through the eMedNY electronic system tend to receive faster turnaround than those using fax-based submissions.

One practical consideration: New York Medicaid managed care plans (like Healthfirst, Fidelis Care, and Amerigroup) may impose additional step therapy requirements beyond the fee-for-service PA criteria. Some plans require documented failure of, or contraindication to, lifestyle interventions and vitamin E before approving Rezdiffra. Dr. Zobair Younossi, a leading MASH researcher at Inova Health System, has noted that "the gap between clinical evidence and payer coverage criteria remains a significant barrier for patients with progressive fibrotic liver disease" [5].

New York Medicaid enrollees pay no copay for Rezdiffra once PA is approved, consistent with the state's policy of $0 copays for most prescription drugs under its managed care contracts.

Insurance Coverage: Which New York Plans Include Rezdiffra

Commercial insurance coverage for Rezdiffra in New York has expanded since the drug's March 2024 FDA approval, though gaps remain. Coverage decisions depend on the specific plan, the PBM managing the pharmacy benefit, and the employer or exchange plan's formulary tier structure.

Among the major insurers operating in New York, UnitedHealthcare, Aetna, Empire BlueCross BlueShield, and Cigna have added Rezdiffra to specialty formularies with PA requirements. Oxford Health Plans (a UnitedHealthcare subsidiary popular with small businesses in the New York metro area) includes Rezdiffra on its 2026 formulary with specialty tier placement [6].

New York State employees covered under the Empire Plan have access to Rezdiffra through the plan's specialty pharmacy benefit, administered by CVS Caremark. The Empire Plan requires PA and classifies Rezdiffra as a specialty drug with coinsurance rather than a flat copay, which means out-of-pocket costs scale with the drug's price until the plan's annual out-of-pocket maximum is reached.

For patients on New York State of Health (the ACA marketplace), silver and gold plans from carriers like Oscar, Fidelis, and Healthfirst generally cover specialty drugs including Rezdiffra, but bronze plans may impose higher coinsurance. Under ACA rules, once a patient hits their annual out-of-pocket maximum ($9,200 for individuals in 2026), all further costs are covered at 100% [7].

Medicare Part D plans in New York present a mixed picture. Some plans have added Rezdiffra, while others are still completing their formulary reviews. The Inflation Reduction Act's $2,000 annual out-of-pocket cap on Part D spending, fully effective since 2025, limits the maximum yearly cost for Medicare beneficiaries regardless of Rezdiffra's list price [8].

How the Madrigal Pharmaceuticals Savings Card Works in New York

Madrigal Pharmaceuticals offers a copay assistance program that can reduce out-of-pocket costs to $0 per month for eligible commercially insured patients. The program is available to New York residents who carry commercial insurance (not Medicare, Medicaid, or other government-funded coverage).

Eligibility requires a valid Rezdiffra prescription and active commercial insurance that covers at least part of the drug's cost. Patients enroll through the Madrigal website or by calling the company's patient support line. Once activated, the savings card is linked to the patient's specialty pharmacy account and automatically applies at each fill.

The card covers up to a specified annual maximum (reported at $15,000 to $20,000 in annual copay assistance for 2026, though Madrigal adjusts this periodically). For most commercially insured patients in New York, this amount is sufficient to eliminate monthly copays entirely, since even high-coinsurance plans rarely generate more than $10,000 to $14,000 in annual patient responsibility for a $42,000-per-year drug once the plan covers its share [9].

There are two limitations worth noting. First, patients in accumulator adjustment programs, a practice where PBMs do not count manufacturer copay assistance toward the patient's deductible or out-of-pocket maximum, may face a coverage gap partway through the year when the card's annual limit is exhausted. New York has not yet passed legislation banning accumulator adjustment programs, unlike states such as Virginia and Arizona. Second, patients on government insurance (Medicare Part D, Medicaid, TRICARE, VA) are ineligible for the savings card under federal anti-kickback statutes [10].

Compounded Resmetirom in New York: Legality and Access

Compounded resmetirom is available in New York through licensed 503A compounding pharmacies. The state permits compounding of FDA-approved drugs when a prescriber writes a patient-specific prescription, and the pharmacy operates under a valid New York Board of Pharmacy license.

New York's compounding regulations align with federal law under the Drug Quality and Security Act (DQSA) of 2013, which distinguishes between 503A pharmacies (patient-specific compounding) and 503B outsourcing facilities (large-batch compounding for office use) [11]. Both pathways are legal in New York, though 503A is the more common route for individual patient prescriptions.

The state Board of Pharmacy enforces strict oversight of compounding operations, including requirements for potency testing, beyond-use dating, and adverse event reporting. New York inspects compounding pharmacies on a regular cycle and can issue cease-and-desist orders for non-compliant operations.

From a cost perspective, compounded resmetirom is listed at $0 per month in some directories, but this figure is misleading. It typically reflects the ingredient cost before the pharmacy's compounding fee, dispensing fee, and consultation charges are added. Actual out-of-pocket costs for compounded resmetirom in New York range from $150 to $600 per month depending on the pharmacy, dose, and whether the patient's insurance covers compounded medications (most do not).

A critical clinical consideration: compounded versions of resmetirom are not FDA-approved and have not undergone the bioequivalence testing required of generic drugs. The MAESTRO-NASH trial, which enrolled 966 patients and demonstrated statistically significant fibrosis improvement (25.9% of patients on resmetirom 80 mg achieved at least one stage of fibrosis improvement with no worsening of NAFLD Activity Score, compared with 14.2% on placebo, P<0.001), used the branded Rezdiffra formulation [1]. Compounded versions may differ in absorption, bioavailability, or stability. The American Association for the Study of Liver Diseases (AASLD) has not issued a position statement endorsing compounded resmetirom as interchangeable with the branded product.

Telehealth Prescribing of Rezdiffra in New York

New York permits telehealth prescribing of Rezdiffra. The state's telehealth parity law, updated in 2023, requires insurers to cover telehealth visits on the same terms as in-person visits, and does not restrict prescribing of non-controlled substances via telemedicine [12].

Hepatologists and gastroenterologists practicing via telehealth in New York can prescribe Rezdiffra after conducting an appropriate clinical evaluation. This evaluation typically includes review of liver biopsy results or validated non-invasive fibrosis markers (FibroScan, FIB-4 score, or ELF test), liver function tests, and metabolic panel results.

For New York City residents, telehealth access to hepatology specialists is relatively straightforward given the concentration of academic medical centers (Mount Sinai, NYU Langone, Weill Cornell, Columbia) that offer virtual hepatology consultations. Patients in upstate New York, western New York, and rural areas of the state benefit significantly from telehealth access, as hepatology specialists are concentrated in urban centers.

The telehealth prescriber must hold a valid New York medical license. Out-of-state physicians treating New York patients must be licensed in New York or qualify under one of the state's limited telemedicine registration pathways.

Discount Programs and Financial Assistance Beyond the Savings Card

Several additional programs can reduce the cost of Rezdiffra for New York patients who do not qualify for the manufacturer savings card or who need supplemental assistance.

Patient Assistance Programs (PAPs): Madrigal Pharmaceuticals operates a patient assistance program for uninsured or underinsured patients who meet income eligibility criteria (typically below 400% of the federal poverty level). Approved patients receive Rezdiffra at no cost. Applications require proof of income, insurance status, and a valid prescription [9].

Specialty pharmacy discount programs: Some specialty pharmacies in New York offer competitive pricing or payment plans for self-pay patients. Accredo (an Express Scripts specialty pharmacy), AllianceRx Walgreens, and Optum Specialty Pharmacy each maintain financial counseling teams that can identify the lowest-cost pathway for a given patient.

Non-profit assistance foundations: Organizations like the Patient Access Network (PAN) Foundation and the HealthWell Foundation periodically open disease-specific funds that cover copays for liver disease medications. Fund availability changes throughout the year, and patients should check these resources monthly.

New York's Extra Help program (for Medicare beneficiaries) and the Medicare Savings Programs administered by local Departments of Social Services can reduce Part D premiums, deductibles, and copays, indirectly lowering Rezdiffra costs for eligible seniors [8].

Clinical Context: Why Rezdiffra Costs What It Does

Rezdiffra (resmetirom) is the first FDA-approved oral therapy specifically indicated for MASH with moderate to advanced liver fibrosis. The drug received accelerated approval in March 2024 based on the MAESTRO-NASH trial, a Phase 3 randomized, double-blind, placebo-controlled study published in the New England Journal of Medicine [1].

The trial demonstrated that resmetirom 80 mg daily achieved MASH resolution (defined as ballooning of 0, lobular inflammation of 0 or 1, and at least a 2-point reduction in NAFLD Activity Score) in 29.9% of patients at 52 weeks, versus 9.7% on placebo. The fibrosis improvement endpoint also reached statistical significance. These results represent meaningful clinical progress for a disease affecting an estimated 6 to 8 million Americans with fibrotic MASH, many of whom previously had no pharmacotherapy option beyond off-label vitamin E or pioglitazone [1].

Madrigal's $3,500 monthly price reflects several factors: the drug targets a large but previously untreated population, the clinical trial program cost exceeded $1 billion, and the company has no other commercial products to subsidize development costs. The Institute for Clinical and Economic Review (ICER) assessed resmetirom's value-based price benchmark at $3,200 to $5,400 per month depending on the modeling assumptions used, placing Madrigal's actual price within the lower range of estimated value [13].

According to the AASLD 2023 Practice Guidance on MASLD, "pharmacotherapy should be considered for patients with biopsy-confirmed NASH and significant fibrosis (F2 or greater)" [14]. Resmetirom fits squarely within this recommendation. The drug's mechanism of action, selective thyroid hormone receptor beta agonism, reduces hepatic fat content, and the MAESTRO-NASH histological endpoints confirm downstream benefit on inflammation and fibrosis [1].

Comparing Rezdiffra Costs Across the New York Metro Area

Pricing within New York state shows minimal geographic variation for Rezdiffra specifically because specialty pharmacy distribution centralizes pricing. Whether a patient fills in Manhattan, Buffalo, Syracuse, or Albany, the WAC-based pricing remains consistent at approximately $3,500 per month.

The meaningful variation occurs in ancillary costs. Hepatology consultation fees, FibroScan costs, and laboratory monitoring expenses differ between New York City (where facility fees at academic centers can add $200 to $500 per visit) and community practices in suburban or rural areas. A patient at a community gastroenterology practice in Westchester or on Long Island may pay lower facility fees than one seen at a Manhattan academic center, even though the drug itself costs the same.

New York's surprise billing protections under the No Surprises Act and the state's own out-of-network billing law provide some safeguard against unexpected charges related to specialist visits and laboratory work associated with Rezdiffra monitoring [15].