New York and Louisiana have become the first states to mandate private insurance coverage of scalp cooling, a treatment that is effective in preventing hair loss for many patients receiving chemotherapy.
The move could widen use of the technology, also known as cold capping. Without insurance, scalp cooling can run $1500-$3000 per round of chemotherapy.
The New York law, which took effect January 1, is “huge,” Anthony Rossi, MD, a dermatologist and attending physician at Memorial Sloan Kettering Cancer Center in New York City, told Medscape Medical News.
The enactment of the New York law was “breathtakingly refreshing,” said Nancy Marshall, co-founder of the Rapunzel Project, a Wayzata, Minnesota-based nonprofit educational organization dedicated to increasing awareness of scalp cooling therapy for chemotherapy-related hair loss.
Marshall told Medscape Medical News that even though many clinicians have long been aware of scalp cooling — the FDA cleared the first device in 2015 — they can be reluctant to prescribe the technology because of the cost.
Automated (also known as mechanical) scalp cooling circulates a cold liquid or gel into a bathing-cap like helmet to decrease blood flow to the scalp and thus prevents chemotherapy from being taken up by hair follicles. FDA has cleared devices made by three companies: Paxman (in 2017), Dignitana (in 2015, and now merged with Paxman), and Cooler Heads (2021). The caps are usually worn shortly before, during, and up to 2 hours after each chemotherapy session.
Manual caps — which use frozen liquid and must be replaced every half hour — are not regulated by the FDA.
Both the New York law and Louisiana law require large group insurers to provide coverage for scalp cooling systems, whether manual or automated.
At least a handful of other states are considering mandating coverage, including Maryland, Massachusetts, New Jersey, and West Virginia, said Marshall. A billin Rhode Island that would have required coverage for patients with breast cancer starting in 2026 was tabled for further study.
Insurers have deemed hair loss related to cancer treatment a cosmetic issue and thus tended not to cover cold capping, said Rossi. He argues that it is a medical procedure and said that hair loss has emotional, physical, and psychosocial implications, and often can be a reminder to the individual of their cancer and signifies to others that they are sick.
“Cold capping technology has been shown to be really beneficial in keeping scalp hair,” said Rossi, adding that it has “been a real big game changer.”
Medicare has reimbursed facilities for the technology but not very well. The American Medical Association has now created current procedural terminology codes for scalp cooling. Beginning in 2026, automated scalp cooling will be reimbursed on the physician fee schedule, according to the American Cancer Society (ACS).
The ACS states that scalp cooling is not recommended for people who have a central nervous system cancer; are having chemotherapy to prepare for a stem cell transplant; had or will have radiation therapy to the skull; or who have leukemia, lymphoma, or multiple myeloma, or a cold-agglutinin disease, cryoglobulinemia, or posttraumatic cold dystrophy (due to the risk for toxicity)….
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