Does Medicaid Pay For Resmetirom Tablet In Nevada? Full Coverage Breakdown

Resmetirom, marketed under the brand name Rezdiffra, is a new prescription treatment developed for patients with nonalcoholic steatohepatitis (NASH) who do not have cirrhosis. As the first FDA-approved therapy specifically designed to target liver fibrosis in NASH patients, Resmetirom represents a critical breakthrough in liver disease treatment.

However, its high cost and limited insurance availability raise essential questions—especially for those covered by state healthcare programs. One of the most pressing questions is: Does Medicaid Pay For Resmetirom Tablet In Nevada?

This guide explores the answer in-depth, covering everything from the drug’s purpose and clinical role to the Medicaid coverage process in Nevada. Whether you’re a patient, caregiver, or medical provider, this comprehensive resource will help you navigate the path to accessing Resmetirom through Medicaid.

What Is Resmetirom and Why Is It Prescribed?

Resmetirom is a thyroid hormone receptor-β selective agonist that works by reducing liver fat and inflammation, slowing down the progression of fibrosis in patients with NASH. NASH (nonalcoholic steatohepatitis) is an advanced form of nonalcoholic fatty liver disease (NAFLD), characterized by liver cell damage, inflammation, and scarring (fibrosis). Left untreated, NASH can progress to cirrhosis and even liver cancer.

The FDA approved Resmetirom in March 2024 for adult patients diagnosed with non-cirrhotic NASH with moderate to advanced fibrosis (F2 to F3 stage). This approval marked a milestone for the liver disease community, especially for those who had no previously approved drug therapies available.

Medicaid in Nevada: How Drug Coverage Works

Medicaid in Nevada, overseen by the Division of Health Care Financing and Policy (DHCFP), provides medical coverage to low-income individuals and families. Prescription drugs under Nevada Medicaid are managed through a Preferred Drug List (PDL). Drugs listed on the PDL are typically easier to obtain, while those not listed require extra steps—usually involving prior authorization (PA).

Resmetirom, as of 2025, is not on the preferred drug list, meaning it falls under the non-preferred or specialty medication category. Therefore, Medicaid may pay for Resmetirom, but only if certain clinical criteria are met and prior authorization is approved.

Clinical Coverage Requirements for Resmetirom in Nevada Medicaid

To answer the question “Does Medicaid Pay For Resmetirom Tablet In Nevada?” clearly: Yes, but coverage is conditional. Nevada Medicaid does provide payment for Resmetirom, provided the following criteria are satisfied:

Key Medical Requirements

Confirmed NASH Diagnosis
A diagnosis of nonalcoholic steatohepatitis with fibrosis stage F2 or F3 must be established. This can be documented through:
- Liver biopsy (considered the gold standard), or
- Non-invasive testing such as FibroScan, MRI, or biomarkers (if sufficient evidence is provided).
Specialist Involvement
A hepatologist or gastroenterologist must confirm the diagnosis or participate in the patient’s care. This ensures the patient is appropriately managed and monitored.
Previous Treatment History
Medicaid typically requires documentation showing the patient has attempted lifestyle interventions such as weight loss, dietary changes, and exercise with inadequate response before initiating Resmetirom.

The Prior Authorization Process

Because Resmetirom is not listed on the Nevada Medicaid PDL, prior authorization is mandatory before the medication can be dispensed. Here’s what the process involves:

Step-by-Step Breakdown

Step	Action Required
1	Diagnosis confirmation and medical documentation by a specialist
2	Completion of the Medicaid PA request form, including lab results, imaging reports, and treatment history
3	Submission of the form via the Nevada Medicaid Provider Web Portal
4	Medicaid review (typically 3–10 business days)
5	Approval or denial issued; appeal process available if denied

Once approved, Resmetirom can be dispensed by a pharmacy and is billed through the Medicaid system.

Cost of Resmetirom with Nevada Medicaid

Resmetirom, like many specialty medications, comes with a significant price tag. Without insurance, monthly costs can exceed $7,000–$10,000 depending on dosage and pharmacy. Thankfully, Medicaid covers the vast majority of the expense for those who qualify.

Medicaid Beneficiary Cost Breakdown

Category	Out-of-Pocket Cost
Children under CHIP	$0 copay
Adults under Traditional Medicaid	$0–$3.50 per prescription
Dual-eligibles (Medicare + Medicaid)	Minimal or no cost depending on plan

It’s important to verify coverage and copay specifics directly with your Medicaid Managed Care Organization (MCO), such as SilverSummit Healthplan, Molina Healthcare, or Anthem Blue Cross and Blue Shield in Nevada.

What to Do If Coverage Is Denied

Denials can happen if required documentation is missing or if criteria are not fully met. But a denial is not the end of the road. Nevada Medicaid allows for a formal appeals process.

Tips to Improve Approval Chances

Ensure a specialist submits the documentation
Include imaging and biopsy reports with detailed diagnosis
Describe failure of other treatment options (e.g., lifestyle intervention)
Follow up with Medicaid regularly

If denied, patients and providers can request reconsideration or submit additional documentation to support medical necessity.

Manufacturer and Financial Assistance Programs

For patients who do not qualify under Medicaid or are awaiting approval, there are alternative financial support options available:

Madrigal Pharmaceuticals (maker of Resmetirom) may offer a Patient Assistance Program (PAP).
Nonprofit organizations like PAN Foundation or GoodRx may help with co-pays or access discounts.
Specialty pharmacies often work directly with patients to find funding solutions.

Conclusion

To summarize, yes, Medicaid does pay for Resmetirom tablet in Nevada, but approval is not automatic. You must go through a prior authorization process, provide sufficient medical evidence of non-cirrhotic NASH with F2–F3 fibrosis, and work with a specialist. While the process may seem complex, the outcome can provide access to a life-changing medication for those battling progressive liver disease.

By following the correct steps and gathering the necessary documentation, patients and providers can improve the chances of getting Resmetirom covered under Nevada Medicaid and begin a more targeted path to liver health.

Does Medicaid Pay For Resmetirom Tablet In Nevada? Full Coverage Breakdown

What Is Resmetirom and Why Is It Prescribed?

Medicaid in Nevada: How Drug Coverage Works