What can dermatologists do to advocate for expanded insurance coverage of wigs for patients with scarring types of alopecia?
Clinical Applications
By Kathryn Schwarzenberger, MD, FAAD, November 1, 2025
In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Michelle Se Won Min, MD, MSci, FAAD, about her recent JAAD paper, ‘Legislative efforts to expand insurance coverage of wigs for individuals with medical causes of alopecia.’
DermWorld: In case any of our colleagues missed your article, can you briefly describe the issue addressed?
Nine states have passed legislation supporting wig coverage in various capacities, but many other states have failed to do so, with proposed bills primarily stalling in committees that review fiscal implications. Additionally, there are often limitations in which types of alopecia are covered (only chemotherapy-associated, alopecia areata, etc.). Scarring types of alopecia are generally not included for wig coverage.
DermWorld: I’m sure this audience already knows the answer to this question, but why are wigs important? What do you tell insurers or other interested parties?
Dr. Min: Subsequent responses to our article, including our own reply, have underscored several reasons why wigs are so important to many of our patients with alopecia. First, it is well-established that alopecia can have profound negative psychosocial impacts, particularly affecting vulnerable populations such as children and minorities. Additionally, even though there are novel therapies, such as JAK-inhibitors for alopecia areata, there are prior authorization hurdles and lack of insurance approval even for FDA-approved treatments.
Finally, we cannot forget those who suffer from scarring alopecia (for example, lichen planopilaris or discoid lupus). These types of hair loss are permanent and irreversible, despite medical advancements. As a specialist in rheumatologic-dermatology, I see first-hand how disfiguring and devastating discoid lupus-associated alopecia can be. Cranial prostheses, or wigs, are often critical for these patients.
DermWorld: Only a small number of insurers cover wigs as a benefit. Why do you think this is the case?
Dr. Min: Alopecia treatments and wigs continue to be considered “cosmetic” by some insurers, which fails to recognize their clinical necessity and profound psychosocial impact. Therefore, we need legislation to establish medical necessity. It is important to weigh the costs of repeated physician visits for alopecia and worsened mental health. Future studies that explore impacts on net finances and overall well-being are warranted.
DermWorld: Do we have good data showing that wigs provide benefit to those who use them? Could/should we be doing better studies to show this?
Dr. Min: Several articles have called to action or highlighted the importance of wigs for patients with alopecia. A few discuss the high costs associated with cranial prostheses or wigs ($500-1,500 per year). Unfortunately, there is limited data that show what physicians already know in practice: Wigs improve well-being and may offset financial impact to insurers. Additional studies would certainly be beneficial.
DermWorld: How can the average dermatologist help their patients who need wigs obtain them?
Dr. Min: I encourage all dermatologists to become more involved in legislative efforts and advocacy. It is powerful when legislators hear personal stories from physicians and patients. The AAD and numerous state societies are already fighting the good fight for physicians and patients. Continuing to work with patient advocacy groups and meeting with legislators is important.
The editors would like to thank Klint Peebles, MD, FAAD, and the Academy’s Access to Dermatologic Care Committee for suggesting this paper for DermWorld Clinical Applications.
Michelle Se Won Min, MD, MSci, FAAD, is the director of rheumatologic dermatology in the dermatology department at the University of California Irvine School of Medicine. Dr. Min serves as the founding faculty advisor for the California Dermatology Advocacy Group, as part of the Dermatology Trainee Advocacy Group, and on the Legislative Committee for CalDerm. Dr. Min has no relevant financial or commercial conflicts of interest.
Her paper appeared in the JAAD.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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