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

Wyoming Retail Pricing for Rezdiffra in 2026

The average cash-pay price for Rezdiffra at Wyoming retail pharmacies sits at $3,500 per month, matching the manufacturer list price set by Madrigal Pharmaceuticals. This price applies to both the 80 mg and 100 mg tablet strengths.

Wyoming's pharmacy market is small. The state has roughly 130 retail pharmacies, and not all stock specialty medications like Rezdiffra. Patients in rural areas of Wyoming (which describes most of the state) may need to use a specialty pharmacy or mail-order service to fill their prescription. Specialty pharmacies affiliated with major insurers, such as CVS Specialty, Accredo (Express Scripts), or OptumRx, typically handle Rezdiffra distribution and may offer delivery to any Wyoming address.

Rezdiffra was the first drug approved by the FDA specifically for metabolic dysfunction-associated steatohepatitis (MASH), receiving accelerated approval in March 2024 for adults with noncirrhotic MASH and moderate-to-advanced hepatic fibrosis (stages F2-F3) 1. Dosing is weight-based: patients weighing <100 kg take 80 mg once daily, while those at or above 100 kg take 100 mg once daily 1. The annual cost at list price totals $42,000 before any discounts, copay assistance, or insurance adjustments.

A 2024 analysis in the Journal of Hepatology estimated that the cost-effectiveness threshold for MASH therapies falls between $50,000 and $100,000 per quality-adjusted life year (QALY), and resmetirom's pricing appears to fall within that range when accounting for avoided liver transplants and reduced cirrhosis progression 2.

MAESTRO-NASH Trial: The Evidence Behind the Price

The FDA's approval rested on MAESTRO-NASH, a Phase 3, randomized, double-blind, placebo-controlled trial enrolling 966 patients with biopsy-confirmed MASH and fibrosis stages F1B through F3 2. Results were published in the New England Journal of Medicine in February 2024.

At 52 weeks, 25.9% of patients receiving resmetirom 80 mg and 29.9% of those receiving 100 mg achieved MASH resolution with no worsening of fibrosis, compared to 9.7% on placebo (P<0.001 for both comparisons) 2. For the fibrosis improvement endpoint, 24.2% of the 80 mg group and 25.9% of the 100 mg group had at least a one-stage reduction in fibrosis without MASH worsening, versus 14.2% for placebo 2.

Dr. Stephen Harrison, principal investigator of MAESTRO-NASH, stated: "These results represent the first time a therapy has shown statistically significant improvement in both NASH resolution and fibrosis in a registration trial." That clinical profile is what makes insurers and pharmacy benefit managers pay attention, even at a $3,500/month price point, because no approved alternative exists for this patient population.

Resmetirom also produced significant reductions in liver fat (measured by MRI-PDFF), LDL cholesterol, triglycerides, and several liver injury biomarkers including ALT and AST 2. These secondary outcomes matter to payers evaluating downstream medical cost savings.

Wyoming Medicaid Coverage: Not Available

Wyoming Medicaid does not cover Rezdiffra as of May 2026. The state has not added resmetirom to its preferred drug list (PDL), and no formal coverage determination has been published by the Wyoming Department of Health.

This gap is significant for a state where approximately 58,000 residents are enrolled in Medicaid. MASH disproportionately affects populations with metabolic syndrome, type 2 diabetes, and obesity, conditions that are overrepresented among Medicaid beneficiaries 3. Wyoming Medicaid does cover diagnostic workup for MASH, including FibroScan (vibration-controlled transient elastography) and liver biopsy, but stops short of covering the only FDA-approved pharmacotherapy.

Patients on Wyoming Medicaid who need resmetirom have limited options. They can appeal for an exception through the state's prior authorization process, though approval rates for drugs not on the PDL are low. Alternatively, they may qualify for the Madrigal patient assistance program (discussed below). The American Association for the Study of Liver Diseases (AASLD) 2023 practice guidance recommends pharmacotherapy for patients with biopsy-proven MASH and significant fibrosis 4, which could support a medical necessity argument in an appeal.

Wyoming's Medicaid program operates as a fee-for-service model without managed care organizations, meaning coverage decisions are made centrally by the state. This simplifies the appeal path but also means there is no alternate MCO formulary that might cover the drug.

Commercial Insurance Coverage in Wyoming

Most major commercial insurance plans in Wyoming will cover Rezdiffra with prior authorization. Coverage requirements typically include a confirmed diagnosis of MASH with F2 or F3 fibrosis (documented by liver biopsy or validated noninvasive testing), failure of lifestyle modifications, and prescribing by or in consultation with a hepatologist or gastroenterologist.

Blue Cross Blue Shield of Wyoming, the state's largest commercial insurer, requires step therapy documentation and prior authorization. UnitedHealthcare plans available through the Wyoming marketplace also cover Rezdiffra under specialty tier (Tier 4 or 5), with copays ranging from $150 to $500 per month after prior authorization approval 5.

Patients with high-deductible health plans (HDHPs), which are popular in Wyoming due to the state's self-employed and small-business workforce, face the full $3,500/month cost until reaching their deductible. For a plan with a $3,000 individual deductible, this means full price for the first month before the plan begins paying.

The prior authorization process typically takes 5 to 14 business days. Denials can be appealed, and the FDA approval label serves as the primary supporting document. The Endocrine Society's 2024 clinical practice guideline on MASH management also supports resmetirom use in the approved population 6, adding weight to appeal arguments.

Compounded Resmetirom in Wyoming: Legal but Limited

Wyoming permits compounded resmetirom through licensed 503A compounding pharmacies. This is legal. 503A pharmacies compound medications pursuant to individual patient prescriptions under Section 503A of the Federal Food, Drug, and Cosmetic Act 7.

A few realities to consider. First, resmetirom is a relatively new molecular entity, and the number of 503A pharmacies with validated analytical methods for compounding it is small nationally. Second, compounded versions are not FDA-approved, meaning they have not undergone the same bioequivalence testing as brand Rezdiffra. Third, compounded drug pricing varies widely, but some 503A pharmacies have listed compounded resmetirom at substantially lower prices than the $3,500 brand cost.

Wyoming does not have state-specific restrictions beyond federal 503A requirements. A licensed prescriber in Wyoming can write a prescription for compounded resmetirom, and a 503A pharmacy (in-state or out-of-state, if that state permits interstate compounding) can fill it. Patients should confirm that the compounding pharmacy holds current Wyoming Board of Pharmacy registration or operates under an applicable interstate agreement.

The FDA has not placed resmetirom on the "Demonstrably Difficult to Compound" list, which means compounding is not prohibited at the federal level 7. Patients choosing this route should discuss the tradeoffs with their prescriber, particularly around potency verification and the lack of outcomes data for compounded formulations.

The Madrigal Pharmaceuticals Savings Card

Madrigal Pharmaceuticals offers the Rezdiffra Savings Card for commercially insured patients. The program reduces out-of-pocket costs to as low as $0 per month for eligible patients, with a maximum annual benefit (typically capped at $15,000 to $18,000 per calendar year, though exact terms may change).

Eligibility requirements are straightforward. Patients must have commercial insurance (not government-funded plans like Medicare, Medicaid, Tricare, or VA). They must have a valid prescription for Rezdiffra. And they must be a resident of the United States. Wyoming residents with employer-sponsored or marketplace commercial plans qualify.

To activate the card, patients or their pharmacies call the number on the Madrigal support website or enroll through the manufacturer's hub program. The card works at the point of sale: the pharmacy runs the patient's insurance first, then applies the savings card to the remaining copay or coinsurance.

For a Wyoming patient with a Tier 4 specialty copay of $300/month, the savings card would typically reduce that to $0. For a patient on an HDHP still within their deductible, the card could offset a significant portion of the $3,500 cost, though the annual cap means coverage runs out partway through the year. Patients should calculate their expected annual out-of-pocket based on their plan design and the card's cap to avoid surprise costs mid-year.

Telehealth Access in Wyoming

Wyoming permits telehealth prescribing of Rezdiffra. The state enacted permanent telehealth parity legislation, and prescribers licensed in Wyoming (or holding applicable interstate licenses) can evaluate patients, order diagnostic tests, and prescribe resmetirom via synchronous audio-video visits.

This matters in Wyoming more than most states. Wyoming is the least populous U.S. state, with roughly 577,000 residents spread across 97,813 square miles 8. The state has no academic medical center with a dedicated MASH clinic. Hepatology specialists are concentrated in Cheyenne and Casper, leaving patients in areas like Sheridan, Rock Springs, or Gillette hours from in-person specialty care.

A telehealth-based MASH evaluation can include review of lab work (ALT, AST, metabolic panel, FIB-4 index), FibroScan results from a local imaging center, and clinical history. If the FIB-4 score suggests F2+ fibrosis (typically >1.3), many hepatologists will initiate resmetirom after confirming no contraindications (including decompensated cirrhosis, which is excluded from the approved indication).

HealthRX offers telehealth consultations with providers experienced in MASH evaluation and resmetirom prescribing for Wyoming residents.

Cost Comparison: Brand vs. Compounded vs. With Savings Card

Understanding the actual out-of-pocket for each pathway helps Wyoming patients plan.

Brand Rezdiffra at retail (no insurance): $3,500/month, $42,000/year. This is the ceiling.

Brand Rezdiffra with commercial insurance: Varies by plan. Specialty tier copays in Wyoming typically range from $150 to $500/month. With the Madrigal savings card applied, many patients pay $0 out-of-pocket monthly until the annual cap is reached.

Brand Rezdiffra on Medicare Part D: Covered by some Part D plans with prior authorization. The Inflation Reduction Act's $2,000 annual out-of-pocket cap on Part D spending (effective 2025) limits total annual patient cost to $2,000, making Medicare plans one of the more predictable cost structures for Rezdiffra 9.

Compounded resmetirom via 503A: Pricing reported by some compounding pharmacies is substantially lower, though availability and pricing fluctuate. Patients should verify potency testing and pharmacy credentials.

Patient assistance (uninsured/underinsured): Madrigal's patient assistance program may provide free drug to patients who meet income criteria (typically at or below 400% of the federal poverty level). Wyoming's median household income of approximately $72,000 places some residents near this threshold.

Monitoring Costs Beyond the Drug

Resmetirom requires baseline and periodic monitoring that adds to total treatment cost. The FDA label recommends thyroid function tests (TSH, free T4) before starting and periodically during treatment, along with liver function tests 1.

A standard metabolic and hepatic monitoring panel costs $50 to $200 per draw at Wyoming labs, typically covered by insurance as routine lab work. FibroScan, used to track fibrosis regression, runs $150 to $400 per session out-of-pocket and is covered by most plans when ordered with an appropriate diagnosis code (K75.81 for MASH).

The most common adverse effects in MAESTRO-NASH were diarrhea (27.1% vs. 18.5% placebo) and nausea (20.5% vs. 14.7% placebo), which were generally mild and self-limited 2. These do not typically generate significant additional medical costs but may prompt a clinic visit or two in the first months of treatment.

Steps to Get Rezdiffra in Wyoming

A practical sequence for Wyoming residents seeking resmetirom:

1. Get a MASH diagnosis confirmed. This requires either a liver biopsy showing MASH with F2-F3 fibrosis or a combination of noninvasive markers (FIB-4, FibroScan, MRI-PDFF) interpreted by a qualified provider. AASLD guidance supports noninvasive pathways for treatment initiation in clinical practice 4.

2. Consult a hepatologist or gastroenterologist. In-person or telehealth. Wyoming has no specific specialist requirement, but most insurers require specialist involvement for prior authorization.

3. Start prior authorization early. Have your provider's office submit PA with supporting documentation (imaging, labs, biopsy if available) before the first fill to avoid delays.

4. Enroll in the Madrigal savings card if commercially insured. Do this before the first fill so the pharmacy can apply it immediately.

5. Choose your pharmacy. Specialty pharmacy (mail-order) is the most reliable pathway for consistent supply in Wyoming. Confirm the pharmacy is in your plan's network.

6. Schedule monitoring. Baseline labs before starting, then follow-up labs at 12 weeks and periodically thereafter per the prescribing information 1.

The average time from initial MASH evaluation to first Rezdiffra fill in clinical practice has been approximately 4 to 6 weeks, driven primarily by prior authorization turnaround.