Expanding Wig Coverage under Medicare: Improving Access for Patients with Alopecia

J Clin Aesthet Dermatol. 2023;16(6):52

by Fatuma-Ayaan Rinderknecht, BA, MS; Vinod Nambudiri, MD, MBA;
Michelle S Lee, MD; Avery Lachance, MD, MPH; and Arash Mostaghimi, MD, MPA, MPH

Ms. Rinderknecht is with the University of California San Francisco School of Medicine in San Francisco, California. Drs. Lee, Mostaghimi, LaChance, and Nambudiri are with Harvard’s Medical School in Boston, Massachusetts and the Department of Dermatology at Brigham and Women’s Hospital in Boston, Massachusetts.

FUNDING: No funding was provided for this article.

DISCLOSURES: Dr. Mostaghimi reported consulting fees recieved from Pfizer, hims, Digital Diagnostics, Concert, Lilly, Abbvie, Equillium, Boehringer Ingelheim. Dr. LaChance reports a research grant was recieved from Pfizer. All other authors report no conflicts of interest relevant to the content of this article.

Hair loss can result in significant mental health and financial distress for patients with alopecia, with up to 47 percent reporting anxiety and depression.¹ Given the complexity of treating alopecia, many patients utilize wigs or other hair prosthetics as a coping strategy.¹ While patients with alopecia report that wearing wigs has a positive impact on their quality of life,¹ expenditures on wigs can lead to significant financial burden. Patients with alopecia areata report spending between $50-$1,500 per year on wigs and headwear, and many use their savings or decrease discretionary spending to pay for hair pieces.² 

H.R. 3332– the Wigs as Durable Medical Equipment Act was introduced in the U.S. House of Representatives in September 2021 with the aim of providing Medicare coverage for wigs by reclassifying them as durable medical equipment. This legislation would improve access to cranial prosthetics for Medicare patients with alopecia who would no longer need to rely on out-of-pocket spending. 

The approval of H.R. 3332 is essential for improving equitable wig access for our most vulnerable populations. Many enrollees on Medicare are older, low-income patients with chronic illnesses. About 18 million Medicare beneficiaries have incomes below $18,000 or 150 percent of the federal poverty line, nearly half of whom spend over 20 percent of their income on healthcare costs.³ Additionally, Black Americans– particularly Black women are disproportionately affected by conditions causing hair loss, including alopecia areata and central centrifugal cicatricial alopecia when compared to White Americans.⁴ Passing this bill would provide relief to populations that are already marginalized and underserved. 

It is imperative that the dermatology community comes together to support this bill and similar policies to advocate for our patients with alopecia. As experts in skin and hair, dermatologists are on the frontlines of diagnosing and treating alopecia and guiding our patients through the profound impact of hair loss on mental and overall health.⁵ Dermatologists’ support of the bill is crucial to acknowledging that hair loss is not just cosmetic, but a significant health issue. 

Importantly, wig coverage under Medicare is a necessary but an incomplete solution to reducing the financial and emotional burden that people with alopecia face, particularly among those too young to qualify for Medicare. At present, coverage by state-based Medicaid and private insurance companies for wigs is variable. Establishing a national standard through Medicare will impact policies at the state and private level.  

As dermatologists and medical experts on alopecia, we must use our platform to support the Wigs as Durable Medical Equipment Act to ensure our patients have access to wigs to mitigate the immense psychological, financial, and health burden of alopecia.

References

1. Montgomery K, White C, Thompson A. A mixed methods survey of social anxiety, anxiety, depression and wig use in alopecia. BMJ open. 2017 Apr 1;7(4):e015468.
2. Li SJ, Mostaghimi A, Tkachenko E, et al. Association of out-of-pocket health care costs and financial burden for patients with alopecia areata. JAMA Dermatol. 2019 Apr 1;155(4):493–494. 
3. Schoen C, Davis K, Willink A, et al. A policy option to enhance access and affordability for Medicare’s low-income beneficiaries. Issue Brief (Commonwealth Fund). 2018 Sep 1;2018:1–5.
4. Thompson JM, Park MK, Qureshi AA, et al. Race and alopecia areata amongst US women. Journal of Investigative Dermatology Symposium Proceedings. 2018 Jan 1;19(1):S47–50.
5. ​​Korta DZ, Christiano AM, Bergfeld W, et al. Alopecia areata is a medical disease. Journal of the American Academy of Dermatology. 2018 Apr 1;78(4):832–834.