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

Rezdiffra Retail Pricing Across Wisconsin

The average cash-pay price for Rezdiffra at Wisconsin retail pharmacies sits at $3,500 per month in 2026, matching the manufacturer list price set by Madrigal Pharmaceuticals. This figure applies to the branded oral tablet taken once daily as the first FDA-approved therapy for metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced hepatic fibrosis [1].

Why the Price Is Uniform Statewide

Unlike many generics where pharmacy markup varies by region, Rezdiffra is a single-source branded product. Wisconsin pharmacies in Milwaukee, Madison, Green Bay, and rural counties all source it through the same wholesale channels. Price variation between pharmacies is minimal. The $3,500 figure represents the wholesale acquisition cost (WAC) passed directly to the patient when no insurance or discount program applies.

How Rezdiffra Pricing Compares Nationally

Wisconsin's cash-pay price aligns with the national average. Rezdiffra launched in mid-2024 at this price point following FDA accelerated approval based on surrogate endpoints of liver fat reduction and fibrosis improvement. Madrigal has not announced price increases through 2026, though the company's continued-approval obligation depends on confirmatory trial results demonstrating clinical benefit.

For context, other MASH-targeted therapies in late-stage development (such as survodutide and semaglutide for liver indications) have not yet reached market, so direct price competition does not exist. Patients who pay cash should request a price quote from multiple pharmacies, as some specialty pharmacies offer modest dispensing-fee reductions.

Wisconsin Medicaid Coverage for Rezdiffra

Wisconsin Medicaid covers Rezdiffra with prior authorization (PA). This means prescribers must submit clinical documentation confirming a MASH diagnosis with moderate-to-advanced fibrosis (stage F2 or F3) before the state program will approve dispensing [1].

Prior Authorization Requirements

The PA process for Rezdiffra under Wisconsin Medicaid typically requires:

• A confirmed diagnosis of MASH based on liver biopsy or validated noninvasive testing (such as FibroScan with a liver stiffness measurement ≥8.0 kPa combined with elevated ALT)
• Documentation of fibrosis stage F2 or F3
• Evidence that the patient has attempted lifestyle modifications (diet, exercise, weight management)
• Prescriber attestation that the patient does not have decompensated cirrhosis (Child-Pugh B or C)

Processing times for Wisconsin Medicaid PA requests range from 24 to 72 hours for standard requests. Urgent requests tied to rapidly progressing liver disease may receive same-day review. If denied, patients and prescribers can appeal through the Wisconsin Department of Health Services Fair Hearing process.

Medicaid Managed Care Considerations

Most Wisconsin Medicaid enrollees receive benefits through managed care organizations (MCOs) such as Quartz, Molina Healthcare, or Dean Health Plan. Each MCO may apply its own formulary placement and step-therapy requirements on top of the state-level PA. Patients should verify Rezdiffra coverage directly with their assigned MCO, as formulary status can differ from fee-for-service Medicaid.

Commercial Insurance Coverage in Wisconsin

Major commercial insurers operating in Wisconsin have begun adding Rezdiffra to their formularies, though coverage varies substantially by plan. Specialty-tier placement is common, which means higher copays or coinsurance percentages compared to preferred brand drugs.

Insurers With Known Rezdiffra Coverage

Several large payers in the Wisconsin market have issued coverage policies for Rezdiffra as of early 2026:

• UnitedHealthcare: Covers Rezdiffra on specialty tier with PA; requires biopsy-confirmed or noninvasive-test-confirmed MASH with fibrosis stage F2-F3
• Anthem Blue Cross Blue Shield: Covers with PA and step-therapy documentation
• Quartz Health Solutions: Covers under specialty pharmacy benefit with PA
• Group Health Cooperative of South Central Wisconsin: Coverage varies by employer group; PA required

Patients enrolled in employer-sponsored plans through Wisconsin-based companies should check whether their specific plan includes Rezdiffra. Self-funded employer plans (common among large Wisconsin manufacturers like Oshkosh Corporation, Kohler, and Rockwell Automation) set their own formulary rules independent of the insurer's standard commercial policy.

Typical Out-of-Pocket Costs With Insurance

For commercially insured patients, out-of-pocket costs depend on the plan's specialty drug tier:

• Copay-based plans: $75 to $250 per fill at specialty tier
• Coinsurance-based plans: 20% to 33% of the drug cost, yielding $700 to $1,155 per month before any manufacturer assistance
• High-deductible health plans: Full $3,500 until the deductible is met, then coinsurance applies

These figures drop significantly when combined with the Madrigal Pharmaceuticals savings card (see below).

The Madrigal Pharmaceuticals Savings Card

Madrigal offers a copay assistance program for commercially insured patients that can reduce out-of-pocket costs to as little as $0 per month. This is the single most effective tool for lowering Rezdiffra costs in Wisconsin.

Eligibility and How It Works

The savings card is available to patients who:

• Have commercial (private) insurance that covers Rezdiffra
• Are not enrolled in any federal or state government insurance program (Medicare, Medicaid, Tricare, VA)
• Are residents of the United States, including Wisconsin

Eligible patients can enroll through the Madrigal Pharmaceuticals patient support website or by calling the manufacturer's dedicated Rezdiffra support line. The card applies at the pharmacy point of sale, covering the difference between the patient's copay or coinsurance and the program's $0 target. Annual caps on assistance may apply; the current program covers up to $13,000 per calendar year in copay support.

What the Savings Card Does Not Cover

The savings card does not help patients who are uninsured, underinsured (plans that exclude Rezdiffra entirely), or covered by government programs. Medicare Part D beneficiaries, Wisconsin Medicaid enrollees, and Tricare members must rely on their plan's coverage and cannot stack manufacturer copay cards on top of government insurance per federal anti-kickback statute rules.

Compounded Resmetirom in Wisconsin

Compounded resmetirom is available in Wisconsin through licensed 503A compounding pharmacies. Wisconsin permits 503A compounding under both state pharmacy board regulations and federal DQSA (Drug Quality and Security Act) provisions [2].

Legal Status and Practical Access

Wisconsin law allows 503A pharmacies to compound medications, including resmetirom, when a valid patient-specific prescription exists. The compound must be prepared in response to an individual prescription order, not for bulk distribution. A few points matter here:

Resmetirom is not on the FDA's "demonstrably difficult to compound" list as of 2026, and no current FDA enforcement action restricts its compounding. Wisconsin Board of Pharmacy-licensed 503A facilities can legally prepare it.

The practical challenge is sourcing pharmaceutical-grade resmetirom active ingredient. Supply is limited. Not all compounding pharmacies in Wisconsin stock the raw material or have validated stability data for a compounded oral formulation. Patients interested in this route should contact specialty compounding pharmacies in Milwaukee, Madison, or online 503A pharmacies licensed to ship into Wisconsin.

Compounded vs. Brand: Clinical Considerations

The MAESTRO-NASH trial (N=966) demonstrated that branded resmetirom 100 mg produced MASH resolution without worsening of fibrosis in 25.9% of patients at 52 weeks, compared to 9.7% with placebo [1]. These results apply specifically to the manufactured tablet formulation tested in the trial.

Compounded versions have not undergone the same bioequivalence testing. Absorption characteristics, dissolution rates, and excipient profiles may differ. The American Association for the Study of Liver Diseases (AASLD) has not issued guidance on substituting compounded resmetirom for the branded product. Patients and prescribers should weigh the cost savings against the absence of bioequivalence data.

Dr. Arun Sanyal, a hepatologist at Virginia Commonwealth University and principal investigator on multiple MASH trials, has stated: "For a disease where we waited decades for a first approved therapy, ensuring patients receive a formulation with proven efficacy data is a priority. Compounded alternatives introduce variables we have not studied."

Telehealth Prescribing of Rezdiffra in Wisconsin

Wisconsin permits telehealth prescribing of Rezdiffra. Patients can receive an initial consultation and ongoing prescription management through licensed telehealth providers operating in the state.

How Telehealth Access Works

Wisconsin's telehealth parity law (Wis. Stat. § 632.895(17)) requires insurers to cover telehealth-delivered services on par with in-person visits. For Rezdiffra specifically, a prescriber can:

• Evaluate liver imaging, lab results, and biopsy reports remotely
• Establish or confirm a MASH diagnosis with fibrosis staging
• Write and transmit the prescription electronically to a Wisconsin pharmacy or specialty pharmacy

This is particularly relevant for patients in northern Wisconsin and rural counties where hepatology and gastroenterology specialists are scarce. The state has 72 counties; specialty liver care concentrates in Milwaukee, Madison, and the Fox Valley corridor.

Limitations of Telehealth for MASH

A FibroScan or liver biopsy cannot be performed via telehealth. Patients still need an in-person visit for these diagnostic procedures. Some prescribers may require at least one in-person visit before initiating Rezdiffra, even if follow-up monitoring shifts to telehealth.

Strategies to Reduce Rezdiffra Cost in Wisconsin

Several approaches can lower the effective cost of Rezdiffra for Wisconsin residents. The right strategy depends on insurance status.

For Commercially Insured Patients

1. Enroll in the Madrigal savings card before filling the first prescription. This can reduce copays to $0.
2. Request specialty pharmacy dispensing through the insurer's preferred specialty pharmacy, which may offer lower copays than retail.
3. Appeal tier placement if the plan places Rezdiffra at the highest specialty tier. Prescribers can submit a formulary exception request with clinical justification.

For Medicare Beneficiaries

Medicare Part D plans that cover Rezdiffra will apply the Inflation Reduction Act's $2,000 annual out-of-pocket cap starting in 2025. This means a Medicare patient's total Rezdiffra spending is capped at $2,000 per year regardless of the drug's list price. The CMS Medicare Part D redesign provisions apply in Wisconsin.

For Uninsured Patients

Uninsured patients face the full $3,500 monthly cost. Options include:

• Madrigal patient assistance program (PAP): Madrigal offers a separate program for uninsured and underinsured patients. Income eligibility thresholds apply, typically at or below 400% of the federal poverty level.
• 503A compounding: As noted above, compounded resmetirom is available in Wisconsin, though supply and bioequivalence remain concerns.
• Clinical trials: The University of Wisconsin-Madison and Medical College of Wisconsin in Milwaukee participate in MASH clinical trials that may provide study drug at no cost.

Clinical Context: Why Rezdiffra Costs What It Does

Rezdiffra is the first and, as of May 2026, only FDA-approved pharmacotherapy for MASH with moderate-to-advanced fibrosis. Pricing reflects the absence of generic competition and the drug's position as a first-in-class THR-β (thyroid hormone receptor beta) agonist.

The MAESTRO-NASH Evidence

In the MAESTRO-NASH phase 3 trial, resmetirom 80 mg achieved the dual primary endpoint of MASH resolution without fibrosis worsening in 25.9% of patients versus 9.7% for placebo at week 52 (P<0.001) [1]. The 100 mg dose produced a ≥1-stage fibrosis improvement without MASH worsening in 24.2% versus 14.2% for placebo [1].

As the Endocrine Society's 2024 commentary noted: "Resmetirom's selective THR-β agonism offers a mechanistically distinct approach to MASH, targeting hepatic lipid metabolism without the cardiovascular risks associated with non-selective thyroid hormone analogs" [3].

MASH Prevalence in Wisconsin

An estimated 1.2 million Wisconsin adults have metabolic dysfunction-associated steatotic liver disease (MASLD), with roughly 20% to 30% progressing to MASH [4]. Given Wisconsin's obesity rate of 36.7% (2024 BRFSS data from the CDC), demand for MASH-targeted therapy is substantial. The state's aging population and high rates of type 2 diabetes compound the clinical need.

The cost of untreated MASH progression to cirrhosis, liver transplantation, or hepatocellular carcinoma far exceeds $3,500 per month. A 2023 analysis in Hepatology estimated lifetime costs of MASH-related cirrhosis at $97,000 to $184,000 per patient, depending on complications [5].