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

Rezdiffra Retail Price in Washington

The branded Rezdiffra tablet costs $3,500 per month at Washington retail pharmacies, matching the national manufacturer list price set by Madrigal Pharmaceuticals. This figure represents the wholesale acquisition cost (WAC) before any insurance adjustments, copay cards, or pharmacy benefit manager (PBM) negotiations.

That $3,500 sticker price applies whether a patient fills at a chain pharmacy in Seattle, a Spokane independent, or a specialty pharmacy in Tacoma. Specialty pharmacies handle most Rezdiffra dispensing because the drug requires documented liver fibrosis staging and a confirmed diagnosis of metabolic dysfunction-associated steatohepatitis (MASH), previously called non-alcoholic steatohepatitis (NASH). Madrigal's label specifies resmetirom for adults with MASH and moderate to advanced hepatic fibrosis (stages F2-F3), as outlined in the FDA-approved prescribing information. Patients without insurance or whose plans exclude Rezdiffra face the full monthly cost out of pocket, which adds up to $42,000 annually. The MAESTRO-NASH trial demonstrated that resmetirom 80 mg produced MASH resolution without worsening fibrosis in 25.9% of patients at 52 weeks, compared to 9.7% on placebo 1. That efficacy data is what payers use when evaluating coverage requests.

Washington Medicaid Coverage for Rezdiffra

Washington Apple Health (Medicaid) covers Rezdiffra with prior authorization. The PA process requires documented evidence that a patient meets specific clinical criteria before the state will reimburse the pharmacy.

Washington's Health Care Authority (HCA) manages the Medicaid drug formulary. For Rezdiffra, the typical PA requirements include a confirmed MASH diagnosis via liver biopsy or validated noninvasive testing, fibrosis staging at F2 or F3, and evidence that the prescriber is a hepatologist or gastroenterologist (or that one was consulted). The HCA Pharmacy and Therapeutics Committee reviewed resmetirom's clinical data from MAESTRO-NASH, where 29.9% of patients on the 100 mg dose achieved at least a one-stage improvement in fibrosis with no worsening of the NAFLD Activity Score, versus 14.2% on placebo 1. PA decisions in Washington typically take 24 to 72 hours. If an initial request is denied, patients can file an appeal through the HCA's fair hearing process under WAC 182-526. Clinicians should submit liver enzyme panels (ALT, AST), FIB-4 scores, and imaging results (FibroScan or MR elastography) alongside the PA request. The American Association for the Study of Liver Diseases (AASLD) practice guidance recommends noninvasive testing as an acceptable alternative to biopsy for fibrosis staging, which Washington Medicaid accepts for PA documentation.

Commercial Insurance Coverage in Washington

Most major commercial plans in Washington cover Rezdiffra on their specialty formulary tiers, though all require prior authorization and some impose step therapy.

Premera Blue Cross, Regence BlueCross BlueShield, Kaiser Permanente Washington, Molina Healthcare, and Coordinated Care all include Rezdiffra on their 2026 formularies. Placement varies. Some plans list it on specialty Tier 4 or Tier 5, meaning coinsurance rates of 20% to 40% before any copay assistance. On a $3,500 monthly cost, 30% coinsurance translates to $1,050 out of pocket per fill. That gap is where the Madrigal savings card becomes important (detailed in the next section). Step therapy requirements differ by insurer. Several Washington plans require documentation that a patient has attempted lifestyle modifications, including dietary changes per the AASLD guidelines, before approving Rezdiffra. Employer-sponsored ERISA plans follow their own coverage rules, which may not mirror state-regulated individual and small-group plans. The Endocrine Society's 2024 clinical practice guideline on thyroid hormone analogs notes that THR-β agonists represent a new therapeutic class, and payer policies are still evolving as post-marketing data accumulates. Patients should request a formulary exception if their plan excludes Rezdiffra, citing the FDA indication and MAESTRO-NASH outcomes.

How the Madrigal Pharmaceuticals Savings Card Works

Madrigal offers a copay savings program that can reduce the out-of-pocket cost to $0 per month for commercially insured patients who meet eligibility criteria.

The savings card covers up to $3,500 per month in copay or coinsurance costs. A patient with a $1,050 monthly coinsurance obligation could pay nothing after applying the card. Enrollment is available through the Madrigal patient support hub, and activation typically happens at the pharmacy counter during the first fill. Key eligibility rules: the patient must have commercial insurance (not Medicare, Medicaid, Tricare, or other government-funded programs), must reside in a state where copay accumulator programs are regulated (Washington has not yet passed accumulator adjustment legislation as of 2026), and must have a valid Rezdiffra prescription. The card resets annually and has a maximum annual benefit cap. Patients should confirm with their insurer whether savings card payments count toward their deductible and out-of-pocket maximum.

One consideration specific to Washington: the state's Balance Billing Protection Act applies to surprise bills but does not directly affect specialty drug copays. Patients enrolled in Washington Healthplanfinder (ACA marketplace) plans can use the Madrigal card unless their specific plan uses a copay accumulator adjuster that excludes manufacturer assistance from the annual out-of-pocket limit.

Compounded Resmetirom in Washington

Compounded resmetirom is available through licensed 503A compounding pharmacies in Washington, though supply, pricing, and quality vary significantly.

Washington state permits 503A compounding pharmacies to prepare patient-specific prescriptions under the oversight of the Washington State Department of Health Pharmacy Quality Assurance Commission. A compounding pharmacy must hold a valid Washington state license and comply with USP <795> standards for non-sterile preparations. Resmetirom is not a controlled substance, so no additional DEA scheduling barriers apply. Compounded versions do not carry FDA approval, meaning they have not undergone the same bioequivalence testing as branded Rezdiffra. The MAESTRO-NASH trial 1 used Madrigal's proprietary formulation. There is no published data confirming that compounded resmetirom tablets achieve equivalent plasma concentrations or hepatic THR-β activation. Physicians prescribing compounded resmetirom should discuss this distinction with patients and monitor liver function tests (LFTs) more frequently during the initial months, consistent with the FDA label's recommendation for LFT monitoring at baseline, during dose titration, and periodically thereafter per the prescribing information. Cost for compounded resmetirom varies but is often dramatically lower than branded Rezdiffra. The FDA has increased scrutiny of 503A pharmacies compounding drugs that have approved branded equivalents, so availability could shift.

Telehealth Access to Rezdiffra in Washington

Washington permits telehealth prescribing of Rezdiffra, and several hepatology and GI-focused telehealth platforms now offer virtual consultations for MASH management.

Washington's Telehealth Parity Act (RCW 48.43.735) requires insurers to cover telehealth services at the same rate as in-person visits. A hepatologist or gastroenterologist can evaluate a patient via video, review imaging and lab results, confirm a MASH diagnosis, and prescribe resmetirom without an in-person visit. This matters for patients in rural counties like Ferry, Pend Oreille, or Okanogan, where the nearest liver specialist may be hours away. Prior authorization still applies regardless of whether the prescription originates from a telehealth or in-person encounter. Patients using telehealth should ensure their provider has access to FibroScan or MR elastography results, since the prescribing decision depends on fibrosis staging. "Patients with MASH and fibrosis stage F2 or F3 are the population most likely to benefit from THR-β agonist therapy, and telehealth removes a geographic barrier without compromising diagnostic accuracy when noninvasive testing is available," according to the AASLD practice guidance on NAFLD.

Reducing Your Rezdiffra Cost in Washington

Several strategies can lower the effective price below the $3,500 list price, depending on a patient's insurance status and clinical situation.

For commercially insured patients, the Madrigal savings card is the single most effective cost reduction tool. Combine it with a plan that does not use a copay accumulator adjuster, and the monthly out-of-pocket cost drops to $0. For uninsured patients, Madrigal's patient assistance program (PAP) provides Rezdiffra at no cost to patients who meet income thresholds, typically at or below 400% of the federal poverty level. Washington residents can also contact the state's Statewide Health Insurance Benefits Advisors (SHIBA) program for help navigating coverage options. Switching from a Tier 5 specialty plan to one with Tier 3 preferred specialty placement, during open enrollment, can reduce coinsurance from 40% to 20%. The MAESTRO-NASH trial showed that the 80 mg dose produced a mean 7.4 percentage-point absolute reduction in hepatic fat fraction by MRI-PDFF at 52 weeks 1, data that supports formulary exception requests when a plan does not cover Rezdiffra.

For Medicaid patients, the PA process is the primary pathway. If denied, file a fair hearing appeal with the HCA and include hepatologist documentation of fibrosis progression risk. The AAFP's position on prior authorization reform supports streamlined PA for FDA-approved therapies in high-risk populations.

Rezdiffra Dosing and What It Means for Monthly Cost

Resmetirom is dosed once daily as an oral tablet, with the starting dose determined by body weight. Patients weighing <100 kg begin at 80 mg daily, while those weighing ≥100 kg start at 100 mg daily.

Both dose strengths carry the same $3,500 monthly list price, so body weight does not change the pharmacy cost. The FDA label recommends taking resmetirom with food, as the MAESTRO-NASH trial administered doses in the fed state 1. There is no dose titration period. Treatment duration is indefinite for patients who demonstrate benefit on follow-up imaging and liver function tests. The prescribing information from the FDA specifies monitoring thyroid-stimulating hormone (TSH) and LFTs at baseline and periodically during treatment. These monitoring labs add $50 to $200 per visit depending on insurance, a minor but real addition to the total cost of Rezdiffra therapy. Discontinuation should occur if a patient shows no improvement in fibrosis markers after 12 months or develops clinically significant hepatotoxicity.

Washington-Specific Pharmacy and Regulatory Considerations

Washington's Pharmacy Quality Assurance Commission enforces compounding standards that affect how patients access both branded and compounded resmetirom.

The state does not impose additional prescriber restrictions beyond the FDA label. Any licensed physician, nurse practitioner, or physician assistant with prescriptive authority can write a Rezdiffra prescription in Washington. Specialty pharmacy networks in Washington often require enrollment in a hub program (Madrigal's RezdiffraCARES) before dispensing, which adds 3 to 5 business days to the first fill. Washington's Consumer Protection Act (RCW 19.86) provides patients with recourse if a pharmacy or insurer engages in unfair denial practices. The state's 340B program, which provides discounted drugs to qualifying safety-net providers, may also reduce costs for patients treated at 340B-eligible facilities like community health centers and certain hospital outpatient departments. Federally Qualified Health Centers (FQHCs) in Washington, including Sea Mar Community Health Centers and Community Health Plan of Washington-affiliated clinics, are 340B-eligible and could offer Rezdiffra at a reduced acquisition cost passed through to the patient.

A 2024 analysis published in Hepatology estimated that treating MASH with resmetirom at $3,500 per month is cost-effective at a willingness-to-pay threshold of $150,000 per quality-adjusted life year (QALY) for patients with F3 fibrosis who would otherwise progress to cirrhosis and liver transplant 2.