Q&A: Government coverage for wigs can help patients with hair loss disorders
Key takeaways:
- Cranial prostheses, or wigs, can cost thousands of dollars, which is often difficult for patients with hair loss disorders to afford.
- Nine states currently cover wigs for these patients, but advocacy is ongoing for more support across the country.
Patients with hair loss disorders often suffer severe mental health effects. While medical intervention has grown in recent years, many individuals still rely on cranial hair prostheses, or wigs, which can be costly.
There are groups currently lobbying to get government assistance in covering some or all these costs for patients with hair loss disorders, which can include alopecia areata or chemotherapy-induced alopecia.
Michelle S. Min, MD, MSci, director of rheumatologic dermatology at the University of California, Irvine, School of Medicine, and a team of medical students, dermatology residents and dermatologists recently advocated for the passage of California Assembly Bill 2668, which was passed through the Health Committee but halted at the Appropriations Committee of the state legislature this year. The bill would have required insurers to provide up to $750 for wigs to patients with specified health conditions.
Healio spoke to Min about the how wigs can benefit these patients, the government’s role in providing them and how physicians can be involved in advocacy efforts.
Healio: What role do wigs have for patients with hair loss?
Min: Hair loss can have a huge psychosocial impact.
We’ve made major strides in medical treatment. Since the early 2020s, we now have three oral options to treat alopecia areata, so the medical advancements are impressive. But there are certain types of alopecia where there will be no regrowth because it’s a scarring hair loss or the alopecia might be caused by something that is not alopecia areata, such as chemotherapy-induced hair loss. Frankly, medical therapy might be too late for some patients. Some have had alopecia areata for decades, so when they go on treatment and haven’t had hair growth in a certain area for a long time, it’s a lot harder to get medications to regrow hair.
Despite all our amazing advancements in medicine for alopecia or hair loss, wigs have a really important role. Wigs can help these patients who, for whatever reason, medication is not growing their hair back. It can also help pediatric patients who cannot be on these medications.
Certain hair losses tend to impact people with economically disadvantaged backgrounds more, so being able to provide cranial prosthesis or wigs at an affordable cost to those patients is really important.
Healio: How can cost affect the ability for these patients to attain wigs they may need?
Min: It was shocking to me to find out that a decent wig, a wig that doesn’t look like a wig, can cost upwards of $1,500 and you often need to replace that every year or 2. That’s pretty expensive. And again, there are certain types of hair losses that impact the financially disadvantaged population even more, so we were hoping to pass this bill in California to make it a little bit more affordable.
Healio: How was your team involved in the legislative process of California Assembly Bill 2668?
Min: A few years ago, a UCSF medical student, Richard Kim, and I created California Advocacy Day, in which a group of passionate medical students organiza an annual meeting to help discuss certain bills of interest to our patients and providers, and the population as a whole. Last year, we met with several representatives or their aids, emphasizing the importance of cranial prostheses or wigs.
We were asking just for half the cost to be covered by insurances: $750.
Unfortunately, this past year bills that required financial funding from the government struggled to pass in the state of California. We wanted the bill to include government-based insurances or Medicaid patients. But that leads to a bigger financial impact of the government, so unfortunately it didn’t pass. We’ll keep trying in future years.
Healio: Are wigs covered anywhere in the U.S.?
Min: Nine states have some type of coverage, but it is variable. In 1987, Minnesota was the first state to pass some kind of legislation covering cranial prostheses. There was no activity for over a decade until Massachusetts passed its own bill. Since 2000, seven states have passed laws that mandate some kind of wig coverage. Nine other states did try and have failed, mostly because of the financial implications to the state government.
There is also advocacy at the federal level, but these efforts are currently stalled.
Healio: What role do you think insurers, Medicare and Medicaid should be playing in helping patients to achieve wigs?
Min: I think it’s the physicians and advocates, especially patients themselves or the loved ones of patients who see the psychosocial impact hair loss can have, that can help show legislators why it’s important to financially support the coverage of cranial prostheses.
Healio: How can dermatologists add to the advocacy efforts?
Min: We have many impactful patient stories that we can share as physicians. We can also help provide guidelines for indications where it would be appropriate to cover a wig for a medical reason. I think physicians can play a significant role. Advocacy is really important for us all to be involved in.
References:
- Kim RW, et al. J Am Acad Dermatol. 2024;doi:10.1016/j.jaad.2024.11.013.
- AB-2668 coverage for cranial prostheses. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB2668
- Published April 24, 2024. Accessed Dec. 3, 2024.