Rezdiffra (Resmetirom) Cost in South Carolina 2026

Brand-Name Pricing at South Carolina Pharmacies

Rezdiffra carries a manufacturer list price of $3,500 per month, set by Madrigal Pharmaceuticals at the drug's March 2024 launch. That figure holds across South Carolina retail pharmacies in 2026 for patients paying cash without insurance or discount programs.

The $3,500 monthly figure represents the wholesale acquisition cost (WAC) passed through to patients at the pharmacy counter. Actual out-of-pocket costs vary based on insurance tier placement, copay accumulator programs, and whether a patient qualifies for manufacturer assistance. Patients filling at independent pharmacies in Columbia, Charleston, or Greenville report consistent pricing at or near WAC when no third-party coverage applies.

For context, this positions Rezdiffra in a similar price band to other specialty hepatology drugs. The annual cost of approximately $42,000 aligns with Madrigal's stated pricing strategy following the MAESTRO-NASH trial results, which demonstrated that resmetirom 80 mg and 100 mg achieved MASH resolution without worsening fibrosis in 25.9% and 29.9% of patients respectively at 52 weeks, compared to 9.7% with placebo [1].

South Carolina Medicaid Coverage Status

South Carolina Medicaid does not cover Rezdiffra as of May 2026. The South Carolina Department of Health and Human Services has not added resmetirom to its preferred drug list.

This exclusion affects a significant patient population. MASH disproportionately affects individuals with metabolic syndrome, type 2 diabetes, and obesity, conditions prevalent among Medicaid beneficiaries. South Carolina's Medicaid program covers roughly 1.4 million residents, and the state has not expanded Medicaid under the Affordable Care Act, limiting the pool of covered adults further.

Patients on SC Medicaid who need resmetirom have limited options. They may file an exception request through their managed care organization, though approval rates for non-formulary specialty drugs remain low without a failed trial of formulary alternatives. Since Rezdiffra is the only FDA-approved drug specifically for MASH with fibrosis, the "step therapy" argument carries less weight here than in therapeutic classes with multiple approved options.

The Endocrine Society and AASLD guidance both recognize the unmet need in MASH therapeutics, which may support future Medicaid formulary inclusion as real-world data accumulates.

Insurance Coverage from Commercial Plans in South Carolina

Most major commercial insurers operating in South Carolina have added Rezdiffra to their formularies with restrictions. BlueCross BlueShield of South Carolina, the state's dominant carrier, covers resmetirom under specialty tier with prior authorization requirements.

Prior authorization criteria typically require documentation of: biopsy-confirmed or imaging-confirmed MASH with stage F2 or F3 fibrosis, prescribing by or in consultation with a hepatologist or gastroenterologist, and evidence that lifestyle interventions have been attempted. Some plans also require a FibroScan score or NFS (NAFLD Fibrosis Score) above specific thresholds.

Without manufacturer assistance, specialty tier copays in South Carolina commercial plans range from $150 to $500 per month depending on plan design. High-deductible health plans may expose patients to the full $3,500 until the deductible is met. Copay accumulator programs, increasingly adopted by SC employers, can prevent manufacturer copay cards from counting toward the annual out-of-pocket maximum.

Dr. Michael Charlton, a hepatologist who contributed to AASLD practice guidance, has noted: "Access to resmetirom remains inconsistent across payers, and prior authorization requirements create delays that may allow fibrosis progression in the interim" [2].

The Madrigal Pharmaceuticals Savings Card

Madrigal offers the Rezdiffra Complete savings program for commercially insured patients in South Carolina. The program reduces out-of-pocket costs to as low as $0 per month for eligible patients.

Eligibility requirements include: active commercial insurance coverage (not government-funded plans like Medicaid, Medicare, or Tricare), a valid prescription for Rezdiffra, and U.S. residency. The card covers the difference between the patient's copay and $0, up to a maximum annual benefit that Madrigal sets (typically $15,000 to $20,000 per year in commercial copay assistance).

To enroll, patients or their prescribers contact Madrigal's patient support hub. Activation takes 24 to 48 hours. The card integrates at the pharmacy point of sale, meaning the discount applies automatically at fill. South Carolina pharmacies participating in the program include major chains (CVS, Walgreens, Publix) and specialty pharmacies.

One limitation: if a patient's employer uses a copay accumulator or maximizer program, the savings card benefit may not count toward the deductible or out-of-pocket maximum. Patients should verify their plan's accumulator status before assuming the card eliminates all cost exposure for the year.

Compounded Resmetirom Through 503A Pharmacies

Compounded resmetirom is available in South Carolina through licensed 503A compounding pharmacies. This route offers a lower-cost alternative to the brand product, though with important distinctions.

Under FDA regulations, 503A pharmacies may compound medications pursuant to a valid patient-specific prescription when certain conditions are met. Resmetirom's active pharmaceutical ingredient (API) must be sourced from an FDA-registered facility, and the compounding pharmacy must hold a valid South Carolina Board of Pharmacy license.

Cost through SC 503A pharmacies varies but runs significantly below brand pricing. Some compounding pharmacies advertise resmetirom formulations at markedly reduced rates compared to the $3,500 brand price. Patients should verify that their chosen pharmacy sources USP-grade resmetirom API and follows current Good Manufacturing Practice (cGMP) standards for compounding.

The trade-off: compounded products lack the bioequivalence testing required of FDA-approved drugs. The MAESTRO-NASH trial used specific tablet formulations with defined dissolution profiles. A compounded version may differ in absorption characteristics, and no published data confirm therapeutic equivalence between compounded resmetirom and brand Rezdiffra.

South Carolina does not impose additional state-level restrictions on 503A compounding beyond federal requirements. Prescribers may write prescriptions for compounded resmetirom that SC-licensed pharmacies can fill without geographic restriction within the state.

Telehealth Access for South Carolina Patients

South Carolina permits telehealth prescribing of Rezdiffra. Patients do not need an in-person visit to receive a resmetirom prescription from a licensed provider.

The South Carolina Telemedicine Act establishes that telehealth encounters satisfy the provider-patient relationship requirement for prescribing. This means hepatologists, gastroenterologists, or primary care physicians licensed in South Carolina can evaluate patients via video visit and prescribe Rezdiffra if clinically appropriate.

For rural SC patients, this matters. The state has 46 counties, many without a practicing hepatologist. Telehealth eliminates the drive to Charleston, Columbia, or Greenville for specialty consultation. Patients in the Pee Dee region, Upstate communities, or coastal areas away from academic medical centers can access prescribing without travel burden.

Telehealth prescribing still requires appropriate diagnostic workup. Providers will need lab results (liver enzymes, metabolic panel, FIB-4 score), imaging or elastography results, and clinical documentation supporting MASH with fibrosis. These tests must be performed locally, but the prescribing decision and ongoing monitoring can occur via telehealth.

According to guidelines from the American Association for the Study of Liver Diseases, non-invasive assessment combining FIB-4 with vibration-controlled transient elastography (VCTE) can identify patients with significant fibrosis (F2-F3) without liver biopsy, making telehealth-based prescribing feasible [3].

Comparing Cost-Reduction Strategies

South Carolina patients have several paths to reduce Rezdiffra costs. Each carries distinct advantages and limitations.

Manufacturer savings card: Best option for commercially insured patients. Reduces copay to $0 in most cases. Does not help uninsured or government-insured patients. Annual benefit cap applies.

503A compounding: Lowest absolute cost. Available to any patient with a valid prescription. Trade-off is absence of bioequivalence data and potential variability in product quality between pharmacies.

Patient assistance programs (PAP): Madrigal offers a separate free-drug program for uninsured patients meeting income thresholds (typically below 400% of the federal poverty level). Application requires income documentation and denial from insurance or lack of coverage.

Clinical trials: The MAESTRO-NAFLD-1 long-term extension study and other Madrigal-sponsored trials may still be enrolling at South Carolina sites. ClinicalTrials.gov lists active resmetirom studies, and trial participation provides the drug at no cost with additional monitoring.

Employer advocacy: For patients whose commercial plan excludes Rezdiffra or places it on a high-cost tier, engaging the employer's benefits team directly may result in a formulary exception, particularly when the prescriber documents that no therapeutic alternative exists for MASH-specific treatment.

Clinical Context: Why Resmetirom Costs What It Does

Rezdiffra's pricing reflects its position as the first and only FDA-approved therapy for MASH with moderate-to-advanced hepatic fibrosis (stage F2-F3). The FDA granted accelerated approval in March 2024 based on surrogate endpoints from MAESTRO-NASH [4].

In that Phase 3 trial (N=966), resmetirom 100 mg achieved the dual primary endpoints: MASH resolution without worsening fibrosis in 29.9% of patients versus 9.7% placebo, and fibrosis improvement by at least one stage without MASH worsening in 25.9% versus 14.2% placebo [1]. These results, published in the New England Journal of Medicine, represented the first time any drug met both histologic endpoints in a registrational MASH trial.

The drug works as a thyroid hormone receptor beta (THR-β) agonist, selectively activating hepatic THR-β to reduce liver fat, improve lipid profiles, and attenuate fibroinflammatory pathways. In MAESTRO-NASH, LDL cholesterol fell by 13.6% with the 80 mg dose and 16.3% with 100 mg at week 24 [1]. This lipid-lowering effect is relevant because cardiovascular disease remains the leading cause of death in MASH patients.

Dr. Stephen Harrison, principal investigator of MAESTRO-NASH, stated: "Resmetirom represents a mechanistically distinct approach to MASH, and the histologic improvements observed at 52 weeks support its use in patients with significant fibrosis who face progression risk" [5].

What South Carolina Patients Should Do Next

Patients diagnosed with MASH and fibrosis stage F2 or F3 in South Carolina should take these steps to access resmetirom at the lowest possible cost:

1. Confirm fibrosis staging with FIB-4 calculation plus elastography (available at most SC gastroenterology practices).
2. If commercially insured, have the prescriber submit prior authorization with fibrosis documentation. Simultaneously enroll in the Madrigal savings card program.
3. If uninsured, apply to Madrigal's patient assistance program. Processing takes 2 to 4 weeks.
4. If on SC Medicaid, file a formulary exception request citing lack of therapeutic alternatives. Consider compounded resmetirom through a licensed 503A pharmacy as a bridge.
5. For patients in rural SC without local hepatology, schedule a telehealth consultation with a licensed SC provider who prescribes Rezdiffra.

The SC Board of Pharmacy maintains a searchable database of licensed compounding pharmacies. Verify 503A licensure before filling a compounded resmetirom prescription.

Resmetirom 100 mg taken once daily with food is the standard maintenance dose after a 60-day titration period starting at 80 mg [4]. Liver function tests (ALT, AST, bilirubin) should be monitored at baseline, during titration, and periodically thereafter per the FDA-approved labeling.