United States securities and exchange commission logo January 3, 2024 Alex G. Howarth Chief Financial Officer Madrigal Pharmaceuticals, Inc. Four Tower Bridge 200 Barr Harbor Drive, Suite 200 West Conshohocken, PA 19428 Re: Madrigal Pharmaceuticals, Inc. Form 10-K for Fiscal Year Ended December 31, 2022 Response Dated December 14, 2023 File No. 001-33277 Dear Alex G. Howarth: We have reviewed your December 14, 2023 response to our comment letter and have the following comment. Please respond to this letter within ten business days by providing the requested information or advise us as soon as possible when you will respond. If you do not believe a comment applies to your facts and circumstances, please tell us why in your response. After reviewing your response to this letter, we may have additional comments. Unless we note otherwise, any references to prior comments are to comments in our November 21, 2023 letter. Form 10-K for Fiscal Year Ended December 31, 2022 Research and Development, page 65 1. We note your response to prior comment 2. For each period presented in your financial statements, please revise future MD&A to provide a quantified breakdown of research and development expenses by the type or nature of expense. Alex G. Howarth Madrigal Pharmaceuticals, Inc. January 3, 2024 Page 2 Please contact Gary Newberry at 202-551-3761 or Kevin Kuhar at 202-551-3662 if you have questions regarding comments on the financial statements and related matters. FirstName LastNameAlex G. Howarth Sincerely, Comapany NameMadrigal Pharmaceuticals, Inc. Division of Corporation Finance January 3, 2024 Page 2 Office of Life Sciences FirstName LastName