INTRODUCTION
Hair loss is a common dermatological complaint that impacts patients’ self-confidence and quality of life. Since its FDA approval, topical minoxidil has been widely used for hair loss due to its proven efficacy for hair regrowth in both men and women. Though not FDA-approved for hair loss, low-dose oral minoxidil (LDOM) is also widely prescribed off-label.1 Other commonly used medications taken orally or applied topically to treat hair loss include spironolactone, finasteride, and latanoprost.
Importantly, treatment of hair loss requires long-term medication use to sustain benefits, posing a financial burden for patients.1 Despite the prevalence of hair loss, there is limited research on the insurance coverage of its treatment. This study aims to assess differences in insurance coverage for minoxidil, spironolactone, finasteride, and latanoprost.
We evaluated formularies from the 5 largest health insurance companies determined by number of insured members: Anthem, Kaiser Permanente, United Health Group, HCSC (a Blue Cross licensee), and Centene (Ambetter). Medicaid and Medicare Part D were also included. Formularies were accessed through company websites to determine if the treatment agent was designated as a dermatological or skin agent. For Medicaid, the Gainwell formulary for Ohio Medicaid was used, while Medicare Part D coverage was determined using formularies from CVS/Caremark, Humana, and UnitedHealth. Treatments analyzed included minoxidil, spironolactone, finasteride, and latanoprost.
Results revealed that none of the insurance companies analyzed designated 5% topical minoxidil as a dermatological agent, suggesting it may not be covered for hair loss. Spironolactone, finasteride, and latanoprost were classified as cardiovascular, diuretic, genitourinary, ophthalmologic, or “miscellaneous therapeutic” agents. Of note, oral minoxidil was listed as covered when prescribed for cardiovascular indications.
This study highlights significant gaps in insurance coverage for the treatment of hair loss. Despite its widespread use, topical minoxidil is rarely covered by insurance. Medicaid and Medicare, which collectively cover 242 million beneficiaries, fail to provide adequate coverage, disproportionately affecting underserved populations.2,3 Women, who represent most Medicaid enrollees, bear the brunt of this financial burden. While insurance formularies typically allow appeals for coverage denials, many explicitly exclude medications for cosmetic or hair loss indications.4 Additionally, the appeal process often involves extensive paperwork and coordination, adding more stress to patients.
Hair loss is a prevalent concern, yet insurance coverage for treatments remains sparse. Dermatologists must recognize the financial challenges faced by patients and advocate for improved access to affordable therapies to reduce health disparities and improve outcomes for all patients.
Importantly, treatment of hair loss requires long-term medication use to sustain benefits, posing a financial burden for patients.1 Despite the prevalence of hair loss, there is limited research on the insurance coverage of its treatment. This study aims to assess differences in insurance coverage for minoxidil, spironolactone, finasteride, and latanoprost.
We evaluated formularies from the 5 largest health insurance companies determined by number of insured members: Anthem, Kaiser Permanente, United Health Group, HCSC (a Blue Cross licensee), and Centene (Ambetter). Medicaid and Medicare Part D were also included. Formularies were accessed through company websites to determine if the treatment agent was designated as a dermatological or skin agent. For Medicaid, the Gainwell formulary for Ohio Medicaid was used, while Medicare Part D coverage was determined using formularies from CVS/Caremark, Humana, and UnitedHealth. Treatments analyzed included minoxidil, spironolactone, finasteride, and latanoprost.
Results revealed that none of the insurance companies analyzed designated 5% topical minoxidil as a dermatological agent, suggesting it may not be covered for hair loss. Spironolactone, finasteride, and latanoprost were classified as cardiovascular, diuretic, genitourinary, ophthalmologic, or “miscellaneous therapeutic” agents. Of note, oral minoxidil was listed as covered when prescribed for cardiovascular indications.
This study highlights significant gaps in insurance coverage for the treatment of hair loss. Despite its widespread use, topical minoxidil is rarely covered by insurance. Medicaid and Medicare, which collectively cover 242 million beneficiaries, fail to provide adequate coverage, disproportionately affecting underserved populations.2,3 Women, who represent most Medicaid enrollees, bear the brunt of this financial burden. While insurance formularies typically allow appeals for coverage denials, many explicitly exclude medications for cosmetic or hair loss indications.4 Additionally, the appeal process often involves extensive paperwork and coordination, adding more stress to patients.
Hair loss is a prevalent concern, yet insurance coverage for treatments remains sparse. Dermatologists must recognize the financial challenges faced by patients and advocate for improved access to affordable therapies to reduce health disparities and improve outcomes for all patients.
DISCLOSURES
Dr Dulmage is a consultant for Novocure and serves on the
Data Safety and Management Board of Hoth Therapeutics. The
remaining authors have no conflicts of interest to disclose.
REFERENCES
- Minta A, Park C, Rose L, et al. Retrospective review of oral and topical minoxidil for cancer treatment-induced hair loss. Arch Dermatol Res. 2023;315:2613–2615. https://doi.org/10.1007/s00403-023-02660-z
- Center for Medicare Advocacy. Medicare Enrollment Numbers - Center for Medicare Advocacy. Center for Medicare Advocacy. https:// medicareadvocacy.org/medicare-enrollment-numbers/#:~:text=The%20 Centers%20for%20Medicare%20%26%20Medicaid. Accessed April 2024.
- Medicaid. May 2023 Medicaid & CHIP Enrollment Data Highlights. Medicaid. gov. https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html. Accessed April 2024.
- Drug List Selection. Anthem.com. https://www.anthem.com/ca/ms/ pharmacyinformation/home.html#formulary. Accessed April 2024.
AUTHOR CORRESPONDENCE
Sonja Kobayashi BS sonja.kobayashi@osumc.edu
