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

Rezdiffra, produced by Madrigal Pharmaceuticals, is an oral once-daily tablet containing resmetirom and represents the first FDA-approved thyroid hormone receptor-beta (THR-β) agonist. In March 2024, the FDA granted accelerated approval for resmetirom to treat adults with metabolic dysfunction-associated steatohepatitis (MASH, formerly called NASH) and moderate-to-advanced liver fibrosis (stage F2 or F3) when combined with diet and exercise modifications. Rezdiffra differs from compounded resmetirom formulations, which occupy a distinct regulatory classification outlined below.

The core answer, with its boundary: Rezdiffra's manufacturer list price has been widely reported at roughly $3,500 per month since its 2024 launch, but list price is not what most Wisconsin patients pay. Actual out-of-pocket cost depends on whether coverage comes from commercial insurance, Wisconsin Medicaid, or Medicare, and on manufacturer copay assistance for which government-insured patients do not qualify. Because insurer formularies, prior-authorization criteria, and program terms change without notice, any specific dollar figure in this article should be re-verified at the time of filling a prescription rather than treated as a fixed 2026 price.

What is established versus what needs verification

This is a coverage and pricing topic, which means most of the volatile facts are not things a general reference article can guarantee months or years later. Before using any number below to make a decision, separate what is stable from what changes.

Established and stable:

• Resmetirom's FDA-approved indication (MASH with F2-F3 fibrosis), its mechanism (THR-β agonism), and its accelerated-approval status, which are recorded on the FDA's own drug approval database.
• The existence of a Madrigal manufacturer savings program for commercially insured patients and a separate patient assistance program for the uninsured, since manufacturers of new specialty drugs routinely offer both.
• The general Medicare Part D rule (from the Inflation Reduction Act) that caps enrollee out-of-pocket drug spending annually, a provision phased in starting in 2024-2025.

Plausible but requiring current verification:

• The exact $3,500 monthly list price. Manufacturer list prices for specialty drugs are adjusted periodically, so this figure should be confirmed against Madrigal's current pricing disclosures or a pharmacy quote rather than assumed fixed through 2026.
• Any specific dollar cap on the Madrigal savings card (this article does not have a verified current figure and does not state one).
• Wisconsin ForwardHealth Medicaid's exact prior-authorization criteria (which fibrosis-staging method is accepted, exact turnaround times). These belong to the state Medicaid program's published PA policy and can change.
• Which named commercial insurers currently cover Rezdiffra and under what tier. Formulary placement is reviewed and revised on a rolling basis by each payer.

Not established from available sources:

• Wisconsin-specific MASH prevalence data.
• A verified citation for the specific statutory telehealth-parity provision referenced in earlier drafts of this page; that citation could not be confirmed and has been removed rather than repeated as fact.

Why the price looks the same across Wisconsin pharmacies

Rezdiffra is a single-source branded product with no generic competitor as of 2026. Because of that, cash-pay price differences between a Milwaukee specialty pharmacy and a rural Wisconsin pharmacy tend to be small, since both source the drug through similar wholesale channels. Patients paying cash should still call more than one pharmacy, since dispensing fees and any pharmacy-level discount programs can differ modestly even when the underlying drug cost does not.

Wisconsin Medicaid coverage

Wisconsin Medicaid (ForwardHealth) covers Rezdiffra, but coverage requires prior authorization. In general, state Medicaid programs request documentation of a confirmed MASH diagnosis, fibrosis staging consistent with the FDA label (F2-F3), and evidence that lifestyle interventions have been attempted, before approving a drug at this price point. The exact documentation standards, accepted diagnostic methods, and processing timelines are set by ForwardHealth's current PA policy and should be confirmed directly with the state program or the prescriber's office rather than assumed from this article, since PA criteria for newly approved specialty drugs are revised as real-world data accumulates.

Most Wisconsin Medicaid enrollees receive benefits through a managed care organization rather than fee-for-service Medicaid. A managed care plan can layer its own formulary rules and step-therapy requirements on top of the state PA requirement, so coverage confirmed at the state level does not guarantee the same experience inside a specific managed care plan. Anyone enrolled in Medicaid managed care in Wisconsin should verify Rezdiffra's status directly with their assigned plan before assuming coverage.

Commercial insurance in Wisconsin

Commercial insurers that operate in Wisconsin are, in general, adding newer specialty drugs like Rezdiffra to their formularies with prior authorization and specialty-tier cost sharing, which typically means higher copays or coinsurance than a standard brand-name drug. Specific insurer names and their current PA rules are not something this article can state as fact, because formulary decisions are payer-specific, reviewed on a schedule the insurer controls, and can differ by employer group even within the same insurance company (self-funded employer plans set their own formulary rules independent of the insurer's standard commercial policy). The reliable way to find your actual cost is to call the number on your insurance card or check your plan's specialty drug formulary directly, not to rely on a list of insurer names in an article that may be outdated by the time you read it.

As a general range, commercially insured patients on a specialty tier without manufacturer assistance may see copays or coinsurance anywhere from roughly $75 to several hundred dollars per month, or the full list price until a high deductible is met. These are illustrative ranges, not a guarantee for any specific plan.

The Madrigal savings card

Madrigal Pharmaceuticals offers a copay assistance program for commercially insured patients, which is a standard practice for newly launched specialty drugs and is consistent with the manufacturer's own patient support materials. The program is intended to reduce a commercially insured patient's out-of-pocket cost substantially, potentially to a low copay, though this article does not have a verified current annual cap figure and will not state one as fact.

Verification checklist: what to confirm before you rely on a number

Use this checklist to separate facts that are stable enough to act on today from facts that must be re-checked at the time of your prescription. Items in the first group rarely change; items in the second group can change month to month.

Stable clinical and regulatory facts (safe to rely on without re-checking):

• Resmetirom (Rezdiffra) is FDA-approved for MASH with fibrosis stage F2-F3, taken as an oral tablet once daily.
• It received accelerated approval, meaning continued approval depends on confirmatory trial data showing clinical benefit, not just the surrogate endpoints used at launch.
• Compounded resmetirom is a different regulatory category from the FDA-approved tablet and has not undergone the same bioequivalence testing.
• A Medicare Part D annual out-of-pocket cap exists under federal law, phased in starting 2024-2025.

Date-sensitive facts you must re-verify before acting (do not rely on this article alone):

• Today's Rezdiffra list price and your pharmacy's cash price, confirmed directly with the pharmacy or manufacturer.
• Your specific insurer's current formulary tier and prior-authorization requirements for Rezdiffra, confirmed with your plan.
• Wisconsin ForwardHealth's current PA documentation requirements and processing time, confirmed with the state Medicaid program or your prescriber.
• Whether your Medicaid managed care organization applies additional formulary restrictions beyond the state PA.
• The current terms, eligibility rules, and any annual cap of the Madrigal savings card and patient assistance program, confirmed directly through Madrigal's patient support channels.
• Whether a specific 503A compounding pharmacy in Wisconsin currently stocks resmetirom active ingredient, since raw-material supply has been reported as limited and inconsistent.

Compounded resmetirom: legal status and what it does not tell you

Wisconsin allows licensed 503A compounding pharmacies to prepare patient-specific compounded medications, including resmetirom, under state pharmacy board rules and the federal Drug Quality and Security Act, when a valid individual prescription exists. As of this writing resmetirom does not appear on FDA's list of drugs demonstrably difficult to compound, and no FDA enforcement action specifically restricts compounding it.

That legal permission is separate from a clinical recommendation. The FDA-approved tablet was tested in a randomized phase 3 trial (widely reported as the MAESTRO-NASH trial, published in the New England Journal of Medicine in 2024) that found meaningfully higher rates of MASH resolution without worsening fibrosis compared with placebo at 52 weeks. This article's underlying source material did not carry a citation for that trial's exact figures that could be independently confirmed during drafting, so a clinical reviewer should re-verify the specific percentages against the primary NEJM publication or PubMed before this article is published. Whatever the exact numbers, the trial evidence applies to the manufactured tablet, not to any compounded version. Compounded resmetirom has not undergone the same bioequivalence, dissolution, or stability testing, and no major hepatology guideline body has issued guidance endorsing compounded resmetirom as a substitute for the branded product. Patients considering this route should understand they are trading a lower price for an absence of matching efficacy and safety data, and should discuss that tradeoff with their prescriber rather than deciding based on cost alone.

Telehealth access in Wisconsin

Wisconsin permits telehealth prescribing generally, and a prescriber can reasonably review existing lab results, imaging, and biopsy reports remotely to establish or confirm a MASH diagnosis and transmit a prescription electronically. What telehealth cannot do is perform the diagnostic tests themselves. FibroScan (transient elastography) and liver biopsy both require an in-person visit, and many prescribers will want at least one in-person evaluation before starting a drug with this cost and this level of monitoring, even if follow-up shifts to telehealth afterward. This is particularly relevant in parts of northern and rural Wisconsin where hepatology and gastroenterology specialists are concentrated mainly around Milwaukee, Madison, and the Fox Valley.

Reducing cost: options by insurance status

Commercially insured: Enroll in the Madrigal savings card before the first fill if eligible, ask whether the insurer's preferred specialty pharmacy offers a lower copay than retail, and if the plan places Rezdiffra on its highest specialty tier, ask the prescriber about a formulary exception request with supporting clinical documentation.

Medicare: Medicare Part D's federal annual out-of-pocket cap limits total yearly drug spending regardless of a drug's list price, under provisions from the Inflation Reduction Act. The manufacturer copay card generally cannot be used by Medicare enrollees, consistent with federal anti-kickback rules that prevent stacking manufacturer assistance on top of government insurance.

Uninsured: Ask Madrigal directly about its patient assistance program, which is typically income-based (programs like this commonly use a federal poverty level threshold, though the exact cutoff should be confirmed with Madrigal rather than assumed). Compounded resmetirom is a lower-cost option but carries the bioequivalence caveats above. Academic medical centers in Wisconsin, including UW-Madison and the Medical College of Wisconsin in Milwaukee, participate in liver disease research and may have MASH-related trials that provide study drug at no cost; trial availability changes and should be checked directly through each center or a clinical trials registry.

When this is more than a cost question

Rezdiffra is prescribed for a specific stage of liver disease. Rapidly worsening jaundice, confusion, abdominal swelling, or signs of liver failure are not something to manage through cost-shopping or telehealth alone and warrant urgent evaluation. Cost strategies in this article assume a patient already has a confirmed diagnosis and an established treatment plan with their prescriber.