The List Price of Rezdiffra in the US
As a new and innovative medication, Rezdiffra (resmetirom) carries a high list price. According to manufacturer Madrigal Pharmaceuticals, the annual wholesale acquisition cost (WAC) is around $47,400. This is the price at which the manufacturer sells the drug to wholesalers and is not what most patients pay. The final cost depends heavily on factors like insurance coverage, negotiation with pharmacy benefit managers, and any available patient assistance programs.
What the list price means for patients
The list price of a prescription drug is a starting point, but it's often an inflated figure that doesn't reflect the final cost for consumers. This figure is critical for negotiation within the healthcare system but is not the out-of-pocket price for most individuals with insurance. For uninsured patients, however, the cash price is directly impacted by this high base figure.
Navigating insurance coverage for Rezdiffra
Most patients with health insurance will not be responsible for paying the full list price. However, coverage can be complex and depends on several factors.
Prior authorization requirements
Many insurance plans, including commercial and some Medicare plans, require prior authorization for Rezdiffra. This means your doctor must submit paperwork to prove the medication is medically necessary for your condition before the insurance will agree to cover it. Without this prior approval, you could be responsible for the entire cost.
Coverage tiers and cost-sharing
Even with prior authorization, your out-of-pocket cost will depend on your insurance plan's specific formulary. Brand-name specialty drugs like Rezdiffra are often placed in the highest coverage tiers, which typically involve higher copayments or coinsurance for the patient. Your annual deductible must also be met before coverage begins to kick in.
Programs and options to lower costs
Fortunately, a number of programs and resources are available to help make Rezdiffra more affordable for eligible patients.
Manufacturer-sponsored programs
- Copay Savings Card: Madrigal Pharmaceuticals offers a copay savings program for eligible commercially insured patients. According to the program's website, eligible patients may pay as little as $10 per month. This offer is not valid for those with federally funded insurance, such as Medicare or Medicaid.
- Patient Assistance Program (PAP): For uninsured or underinsured patients who meet specific income and eligibility criteria, Madrigal also offers a Patient Assistance Program. This program may provide the medication free of charge to those in need.
- Madrigal Patient Support: Beyond financial help, Madrigal provides patient support services to help navigate insurance issues and locate a specialty pharmacy for prescription fulfillment.
Third-party assistance and discount programs
- Prescription Discount Cards: Companies like SingleCare provide discount cards and coupons that can be used to purchase Rezdiffra for a lower cash price. For example, SingleCare's price may be significantly lower than the average cash price, though still thousands of dollars per month without insurance.
- Non-profit Foundations: Organizations like the Patient Access Network (PAN) Foundation and the HealthWell Foundation may offer copay assistance for certain patient populations and disease states, though eligibility varies.
Medicare coverage considerations
For Medicare beneficiaries, the cost of Rezdiffra depends on the Part D plan and the stage of coverage. After meeting the annual deductible, the beneficiary enters the initial coverage phase, followed by the coverage gap (or 'donut hole'), and finally, catastrophic coverage, with costs fluctuating at each stage. The Inflation Reduction Act (IRA) has capped out-of-pocket costs for Medicare beneficiaries at $2,000 per year starting in 2025, which may provide significant relief for those taking expensive medications like Rezdiffra.
Comparing typical Rezdiffra costs
To illustrate the wide range of potential costs, here is a comparison of what a patient might pay for Rezdiffra based on their financial situation.
| Cost Scenario | Estimated Monthly Out-of-Pocket Cost | Key Considerations |
|---|---|---|
| Without Insurance | ~$4,000 - $5,000 | Subject to specialty pharmacy pricing and discount card use. Very high cash price. |
| With Commercial Insurance (Eligible for Copay Card) | ~$10 | Requires a valid, commercial insurance plan that does not fully cover the cost. Not valid for government-funded plans. |
| With Commercial Insurance (No Copay Card Eligibility) | Varies widely, potentially hundreds or thousands of dollars | Depends on plan's formulary, deductible status, and coinsurance rate. |
| With Medicare Part D (2025) | Varies significantly, but capped at $2,000 annually | Cost depends on coverage stage (deductible, coverage gap, etc.). Maximum annual out-of-pocket is capped by the IRA. |
| Uninsured or Underinsured (Eligible for PAP) | $0 | Requires meeting income and eligibility criteria set by Madrigal Pharmaceuticals. The medication is provided at no cost. |
Conclusion: Making Rezdiffra accessible
The question of how much is Rezdiffra in the US has no simple answer. While the annual list price is steep, this figure is often misleading for insured patients. A combination of insurance coverage, manufacturer-sponsored assistance, and third-party discount programs can create a wide spectrum of out-of-pocket costs for patients needing this medication for MASH with moderate to advanced fibrosis.
Patients should proactively engage with their healthcare provider, insurance company, and the Madrigal Patient Support program to understand their specific coverage and financial assistance options. For those who meet the eligibility requirements, assistance programs can be a crucial lifeline, ensuring access to this important and innovative treatment for liver disease. Exploring all available pathways is essential to navigating the financial complexities associated with this new therapy.
For more detailed information on eligibility for financial assistance, visit the Madrigal Patient Support website at madrigalpatientsupport.com.
