Slides
Page 1
Aroosha, patient ambassador 3Q26 Financial Results Nov. 3, 2026
Page 2
Forward-looking Statements This presentation includes “forward-looking statements” made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, as amended, that are based on Madrigal’s beliefs and assumptions and on information currently available to it but are subject to factors beyond its control. Forward-looking statements include all statements that are not historical facts; statements referenced by forward-looking statement identifiers and include statements related to the expected growth of Rezdiffra, expected growth of the MASH market, our leadership position in the MASH sector, the potential benefit of resmetirom in patients with compensated MASH cirrhosis, the expected receipt of data from the MAESTRO-NASH OUTCOMES trial in late 2027, the expected initiation of the MAESTRO-CSPH trial in the first half of 2027, the potential impact of positive results from our outcomes trials, expectations regarding competitor trials and the potential benefit of our pipeline candidates in the treatment of MASH. Forward-looking statements can be identified by terms such as “accelerate,” “achieve,” “allow,” “anticipates,” “appear,” “be,” “believes,” “can,” “confidence,” “continue,” “could,” “demonstrates,” ”design,” “estimates,” “expectation,” “expects,” “forecasts,” “future,” “goal,” “help,” “hopeful,” “inform,” “intended,” “intends,” “may,” “might,” “on track,” “planned,” “planning,” “plans,” “positions,” “potential,” “powers,” “predicts,” ”predictive,” “projects,” “seeks,” “should,” “will,” “will achieve,” “will be,” “would”, “future” or similar expressions and the negatives of those terms. Forward-looking statements are subject to a number of risks and uncertainties including, but not limited to: the assumptions underlying the forward-looking statements; our ability to successfully commercialize Rezdiffra in the U.S. and Europe; conditions imposed by regulators relating to the scope and design of our clinical trials; risks related to obtaining and maintaining regulatory approvals, including, but not limited to, potential regulatory delays or rejections; our history of operating losses and the possibility that we may never achieve or maintain consistent profitability; risks associated with meeting the objectives of our clinical trials, including, but not limited to our ability to achieve enrollment objectives concerning patient numbers (including an adequate safety database), outcomes objectives and/or timing objectives for our trials; any delays or failures in enrollment, and the occurrence of adverse safety events; risks related to the effects of Rezdiffra’s (resmetirom’s) mechanism of action or of any other product candidate; market demand for and acceptance of Rezdiffra; our ability to service indebtedness and otherwise comply with debt covenants; outcomes or trends from competitors; future topline data timing or results; our ability to prevent and/or mitigate cyber-attacks; our ability to protect our intellectual property rights; the uncertainties inherent in clinical testing; uncertainties concerning analyses or assessments outside of a controlled clinical trial; and changes in laws and regulations applicable to our business and our ability to comply with such laws and regulations. Undue reliance should not be placed on forward-looking statements, which speak only as of the date they are made. Except as required by applicable law, Madrigal undertakes no obligation to update any forward-looking statements to reflect new information, events, or circumstances after the date they are made, or to reflect the occurrence of unanticipated events. Please refer to Madrigal’s reports filed with the U.S. Securities and Exchange Commission (SEC) for more detailed information regarding these risks and uncertainties and other factors that may cause actual results to differ materially from those expressed or implied. Madrigal specifically discusses these risks and uncertainties in greater detail in the sections appearing in Part I, Item 1A of its Annual Report on Form 10-K for the year ended December 31, 2025, and as updated from time to time by Madrigal’s other filings with the SEC. Madrigal may use its website to comply with its disclosure obligations under Regulation FD. Therefore, investors should monitor Madrigal’s website in addition to following its press releases, filings with the SEC, public conference calls, and webcasts. Madrigal Pharmaceuticals, Rezdiffra® and associated logos are trademarks of Madrigal Pharmaceuticals, Inc.
Page 3
Madrigal: Well Positioned to Lead in MASH, a Highly Attractive Market Opportunity EXCEPTIONAL MARKET DYNAMICS BEST-IN-DISEASE PROFILE LEADERSHIP: TODAY & IN THE FUTURE • U.S. F2-F3 market accelerating • Limited competition • Rezdiffra patent protection into 2045 • 3Q net sales: $431M • YTD net sales: >$1B • Foundational therapy • Market leader in F2-F3 • Strengthening leadership in F4c • #1 MASH pipeline Our Strategy • Maximizing the value of Rezdiffra • Advancing the industry-leading MASH pipeline + = 3
Page 4
2Q26 Earnings Call Option D Agenda R&D Update Rezdiffra Launch Update Company Financials 3Q26 Earnings 4
Page 5
$287.3M $431.3M 3Q25 3Q26 3Q26 net sales $431.3M 3Q26 Rezdiffra Net Sales Reflect Continued Strong Uptake Rezdiffra Net Sales YoY growth 50% $1.1B in First Nine Months Solidifies Rezdiffra’s Blockbuster Status 5
Page 6
>2,000 >6,800 >11,800 >17,000 >23,000 >29,500 >36,250 >42,250 >49,000 >55,850 2Q24 3Q24 4Q24 1Q25 2Q25 3Q25 4Q25 1Q26 2Q26 3Q26 Steadily Adding Patients in a Large and Growing Market Patients on Rezdiffra: Steadily Adding Patients1 ~2x Patient growth vs. 3Q25 Strong Patient Growth YoY 1. Specialty pharmacy and distribution dispense data. 6
Page 7
Increased from ~460K to ~530K patients through 6.30.26 On Track for >30% Growth by YE26 U.S. F2-F3 MASH Market Growth is Accelerating; Tracking for >30% Growth by YE26 Key Drivers of MASH Market 1. Diagnosed F2-F3 U.S. MASH patients being seen by target liver specialists; Estes et al. (F2-F3 staging); Forian claims data. U.S. F2-F3 MASH Market1 Diagnosis rate (~10% today) Urgency to treat Disease awareness New entrants Treatment penetration (~10% today) 12.31.25 6.30.26 12.31.26 ~460K >530K 7
Page 8
Rezdiffra’s target market of F2-F3 patients diagnosed and seeing a treating specialist is rapidly growing ~10% Penetrated in a Market with ~10% Diagnosis Rate; Addressable Patient Population Poised for Significant Expansion Significant opportunity for market growth and Rezdiffra penetration ~10% Rezdiffra penetration ~10% of MASH Patients diagnosed 8
Page 9
Future market opportunity is significant ~$1.1B YTD net sales1 1. Rezdiffra net sales; YTD: Year to date. Rezdiffra’s YTD Net Sales Already >$1B in a Market That’s Still in its Infancy Screening Diagnosis Treatment Awareness 9
Page 10
Launch Success: What Matters is What’s Below the Surface FDA Label? • Final efficacy claims • Boxed warnings, contraindications and precautions • Monitoring requirements Real World? • Efficacy • Safety • Tolerability • Subtherapeutic dosing (titration) • NIT-based monitoring • Investigator-sponsored studies • Guidelines and care pathways Adherence? • Ease of administration • Manageable side effects • Simplicity; no additional therapies Oral • Size and number of tablets • Frequency • Food restrictions • Storage conditions Injectable • Frequency • Volume • Device • Storage conditions Launch Success Topline Results Market Access? • Distribution • Payer coverage • Prior authorization criteria • Formulary positioning • Pricing/contracting • Dedicated access support team Disease Leadership? • Disease education • Patient advocacy • Indication/label expansion • Evidence generation • Combination therapies • Pipeline • IP strategy Infrastructure? • Field structure: sales, MSLs and support • Marketing, analytics, medical, pharmacovigilance • Data/AI Patient support? • Insurance navigation • Patient assistance • Nursing support • Patient adherence programs 10 Dosing and Administration? MSLs: Medical Science Liaisons
Page 11
Launch Success: What Matters is What’s Below the Surface Blockbuster Launch Success Patients on Therapy >55,850 Topline Results 11 FDA Label Real World Adherence Dosing and Administration Infrastructure Market Access Patient Support Disease Leadership
Page 12
Strengthening our F4c Leadership Position DYNAMIC, RAPIDLY GROWING MARKET OPPORTUNITY ~360,000¹ U.S. addressable F4c patients >45% vs. prior 245,000 estimate Our objective: FIRST + BEST in F4c FIRST-TO-MARKET MAESTRO-NASH OUTCOMES Ongoing Phase 3 outcomes trial; expected regulatory path to an F4c indication ONGOING PRACTICE-SHAPING MAESTRO-CSPH2 New trial that raises the bar for the field; built on 5 years of F4c insights NEW F4c could double the opportunity for Rezdiffra • Larger than the F2-F3 addressable population at Rezdiffra launch • No approved therapies; no competition expected before 2030 • Patients face 42x higher risk of liver- related mortality 12 1. Diagnosed F4c U.S. MASH patients being seen by target liver specialists; Forian claims data; 2. MAESTRO-CSPH Phase 3 trial expected to initiate following FDA discussions; CSPH: Clinically significant portal hypertension. +
Page 13
Advancing our F4c Clinical Development Program 1. Alkouri, N et al. Treatment with resmetirom for up to two years led to improvement in liver stiffness, fibrosis biomarkers, fibrosis scores and portal hypertension in 122 patients with compensated MASH cirrhosis [Presentation], EASL Congress, May 7 – 12, 2025, Amsterdam, the Netherlands; 2. MAESTRO-CSPH Phase 3 trial expected to initiate following FDA discussions. 13 MAESTRO-NASH OUTCOMES ONGOING + MAESTRO-CSPH2 NEW Together, the two trials advance Madrigal’s first-and-best strategy in F4c FIRST-TO-MARKET PRACTICE-SHAPING URGENT UNMET NEED Liver decompensation, liver cancer and premature death 65% of Rezdiffra patients with CSPH at baseline moved to a lower-risk category at two years; broad efficacy across key biomarkers1 122-patient open-label MAESTRO-NAFLD-1 F4c cohort 1H 2027 Planned initiation Builds on open-label F4c data and MAESTRO-NASH OUTCOMES experience Incorporates the latest advances in the field 845 patients | Placebo-controlled Phase 3 Primary endpoint: liver-related clinical outcomes Positive results would support F4c indication and full approval F2 to F4c MASH On track; data expected late 2027
Page 14
1 CSPH-enriched patient population >2,000 patients planned Significantly enriched for CSPH; greatest likelihood of events 2 Most comprehensive • Clinical outcomes • Key subgroups • Latest noninvasive measures • Disease-progression endpoints 3 Rezdiffra-specific biomarker evidence • Gather insights unique to Rezdiffra validated by outcomes data • Distinct advantage for our pipeline programs 4 Largest outcomes- based F4c program ~3,000 patients across MAESTRO- NASH OUTCOMES and MAESTRO-CSPH 1. MAESTRO-CSPH Phase 3 trial expected to initiate following FDA discussions. 14 MAESTRO-CSPH Designed to be Practice Shaping Built on Madrigal’s unique F4c insights and the latest advances in CSPH assessment MAESTRO-CSPH1 is designed to shape clinical practice and extend Rezdiffra’s competitive advantage MAESTRO-NASH OUTCOMES + MAESTRO-CSPH
Page 15
1. Higher percentages in fibrosis reduction relative to placebo reflect better outcomes, with points farther to the right indicating greater benefit; 2. Harrison SA, et al. A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis. N Engl J Med. 2024;390(6 Suppl 1):S31; 3. Resmetirom Effects on NASH With Liver Fibrosis in Patients With NASH Genetic Risk Alleles. Gastroenterol Hepatol (N Y). 2024;20(12 Suppl 11):16-17; Genetic subgroup data results are based on consensus reads and a standard unstratified analysis method; 4. Results displayed only show the effects of the use of 100mg resmetirom, 80mg data available in cited publications. BMI: Body mass index; CI: Confidence interval; HSD17B13: Hydroxysteroid 17-beta dehydrogenase 13, loss of function variant is protective against MASH; PBO: Placebo; PNPLA-3: Patatin-like phospholipase domain-containing protein 3, homozygous genotype strongly associated with MASH progression; T2D: Type-2 diabetes. Data from Ph.3 MAESTRO-NASH Supports Rezdiffra’s Broad and Consistent Efficacy Across Each Patient Subgroup 11.3 (4.4, 18.3) 11.4 (2.1, 20.8) 11.0 (4.8, 17.3) 13.2 (3.0, 23.4) F3 (n=207) F2 (n=99) T2D (n=212) No T2D (n=109) 22.0 (8.7, 35.3) 23.2 (7.5, 38.9) 19.2 (10.0, 28.4) 19.0 (6.5, 31.6) No PNPLA3 Variant (n=72) Homozygous PNPLA3 Variant (n=55) No HSD17B13 Variant (n=151) HSD17B13 Variant (n=78) 11.8 (4.2, 19.4) 11.1 (3.4, 18.9) BMI<35 kg/m2 (n=162) BMI≥35 kg/m2 (n=159) -10 0 10 20 30 40 % relative to PBO (95% CI) Fibrosis Reduction1 (Resmetirom 100mg) Key Patient Subgroup Rezdiffra demonstrated efficacy across each key patient subgroup2,3,4 15
Page 16
0 20 40 Fibrosis Improvement1 PNPLA3 HSD17B13 TM6SF2 Recent Publication in Journal of Hepatology Supports that Rezdiffra Works Across Common Genetic Variants % Responders -60 -40 -20 0 % Hepatic Fat ReductionPNPLA3 MRI-PDFF % Change from Baseline1 HSD17B13 TM6SF2 100 mg Rezdiffra Placebo 1. Chalasani NP, et al. Effects of MASH risk genotypes on resmetirom efficacy in patients with MASH and fibrosis. J Hepatol. Published online October 5, 2026; HSD17B13: Hydroxysteroid 17-beta dehydrogenase 13; MRI PDFF: Magnetic resonance imaging-proton density fat fraction; PNPLA3: Patatin-like phospholipase domain containing 3; TM6SF2: Transmembrane 6 superfamily member 2. 16
Page 17
Strong Madrigal Presence at AASLD Nov. 5 – 9, 2026 │ Denver, CO 18 Total abstracts accepted 13 Real-world abstracts; largest spans nearly 12,000 patients Resmetirom featured in more abstracts than any other MASH therapy 17 AASLD: American association for the study of liver diseases
Page 18
Multiple Initiatives Geared Toward Understanding More About MASH Continued real-world data generation demonstrating Rezdiffra’s efficacy in everyday clinical practice Real World Evidence Understanding Rezdiffra’s role in vulnerable patient populations Special Populations Evaluating the safety and efficacy of combination treatment with approved therapies for comorbid diseases Practice-Informing Studies Examples: Post-transplant MASH patients; HIV + MASH patients; Heart Failure + MASH patients Examples: Signal-finding basket study: pioglitazone + Rezdiffra; SGLT-2 + Rezdiffra Presented multiple abstracts at EASL and more to come at AASLD 2026 18 EASL: European association for the study of the liver; SGLT-2: Sodium-glucose cotransporter 2.
Page 19
Population Preclinical Phase 1 Phase 2 Phase 3 Approved MASH F2-F3 (MAESTRO-NASH) MASH F4c (MAESTRO-NASH OUTCOMES) MASH F4c (MAESTRO-CSPH)5 Ervogastat/resmetirom combo2 Oral DGAT-2 inhibitor/oral THR-β agonist MASH MGL-2086/resmetirom combo3 Oral GLP-1 RA/oral THR-β agonist MASH MGL-0795/resmetirom combo4 siRNA PNPLA3/oral THR-β agonist MASH siRNA/resmetirom combo (6 programs) MASH Additional MASH Assets 3 exploratory assets in varying stages of development MASH Advancing the Industry-Leading MASH Pipeline to Transform Patient Care Resmetirom Oral THR-β agonist 1 1. Rezdiffra in F2-F3 MASH is approved under accelerated (conditional) approval based on improvement of MASH and fibrosis; continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials; 2. Ervogastat monotherapy Phase 2b trial completed by Pfizer; drug-drug (resmetirom/ervogastat) interaction (DDI) trial initiated in October 2026; Phase 2 combination trial expected to initiate in 2027 following regulatory discussions; 3. MGL-2086 Phase 1 single ascending dose (SAD) trial initiated in 2Q26; 4. MGL-0795 (formerly ARO-PNPLA3) monotherapy Phase 1 trial completed by Arrowhead; 5. MAESTRO-CSPH Phase 3 trial expected to initiate following FDA discussions; DGAT-2: Diacylglycerol O-acyltransferase 2; CSPH: Clinically significant portal hypertension; GLP-1 RA: Glucagon-like peptide-1 receptor agonist; siRNA: Small interfering RNA; THR-β: Thyroid hormone receptor beta. 19
Page 20
Strong cash position4: $961.8M Consolidated Statement of Operations: 3Q26 Three Months Ended Sept. 30 (in thousands)1 2026 2025 Revenues: Product revenue, net $431,268 $287,268 Operating expenses: Cost of sales $37,815 $18,122 Research and development $71,755 $174,004 Selling, general and administrative $265,709 $209,117 Total operating expenses2 $375,279 $401,243 Income (loss) from operations $55,989 ($113,975) Interest income $8,239 $10,308 Interest expense ($8,069) ($7,451) Loss on extinguishment of debt - ($2,779) Other expense, net ($717) ($293) Net income (loss) $55,442 ($114,190) Basic net income (loss) per common, Series A and Series B preferred share $1.90 ($4.01) Diluted net income (loss) per common, Series A and Series B preferred share $1.83 ($4.01) Basic weighted average number of shares outstanding3 29,247,673 28,508,089 Diluted weighted average number of shares outstanding3 30,313,137 28,508,089 Rezdiffra 3Q26 net sales: $431.3M First quarter of profitability 20 1. In thousands except for basic and diluted net income (loss) per common, Series A and Series B preferred share and basic and diluted weighted average number of shares outstanding; 2. Amounts include non- cash stock-based compensation expense as follows for 3Q26 and 3Q25: Cost of sales: $0.1 million and $0.0 million, respectively; Research and development: $8.7 million and $6.5 million, respectively; Selling, general and administrative: $30.1 million and $19.8 million, respectively; 3. Basic weighted-average shares outstanding reflect the weighted-average impact of common stock, previously issued pre-funded warrants, previously issued Series A and Series B convertible preferred shares outstanding, and earned PSUs during the period. For 3Q26, diluted weighted-average shares outstanding also include the incremental effect of dilutive potential common shares, including those issuable under outstanding equity awards. For 3Q25, diluted weighted-average shares outstanding equal basic weighted-average shares outstanding because the inclusion of potential common shares would have been antidilutive; 4. Incl udes cash, cash equivalents, restricted cash and marketable securities as of 9.30.26.
Page 21
Madrigal is Well-Positioned for Continued Value Creation in 2026 and Beyond Leading the Fight Against MASH >$1B YTD sales Rezdiffra F2-F3 Launch Building Our Pipeline Pipeline programs >10>30% F2-F3 MASH Market Growth Accelerating Growth anticipated by YE26 Strengthening Leadership Largest and most comprehensive program F4c 21
Page 22
Aroosha, patient ambassador 3Q26 Financial Results Nov. 3, 2026