Dermatologists have several prescription treatment options for hair loss, including minoxidil, spironolactone, finasteride, and latanoprost. Yet despite the commonality of hair loss, insurance coverage of hair loss treatments is rare. An editorial published in the August Journal of Drugs in Dermatology assesses the differences in insurance coverage of these hair loss medications.
I interviewed author Kimberly S. Salkey, MD, associate professor and residency program director at the VCU Health System Department of Dermatology.
What led you to study the insurance coverage of commonly prescribed hair loss treatments?
Having a weekly clinic focused on patients with hair loss, I am very familiar with the challenges these patients face in acquiring their medications. Hopefully exploring the depths of this challenge will bring it to light and help work toward solutions.
Why is it especially important for insurance plans to cover hair loss medications?
The impact of hair loss on patients’ self-esteem and quality of life cannot be over-estimated. The existence of good treatments that are unattainable because of cost adds insult to injury, forcing patients to make difficult decisions about their finances. This disproportionately affects underserved populations
You looked at the differences in the insurance coverage of minoxidil, spironolactone, finasteride, and latanoprost by the top five health insurance companies according to the number of insured members. What did you discover?
We found that none of these insurance companies covered any of these medications for dermatologic indications. Meaning, when these medications are prescribed for hair loss, they are not covered.
What did you find when it comes to Medicare and Medicaid coverage of these hair loss medications?
For the purposes of this study, Medicare Part D and the Gainwell formulary for Ohio Medicaid were analyzed. Both fail to provide adequate coverage for topical minoxidil. Because of the majority of Medicaid enrollees are women, they are left to shoulder this financial burden.
You note that many insurance formularies explicitly exclude medications for hair loss indications. How do dermatologists go about turning the tide with the insurance companies to help them understand that the impact of hair loss is beyond cosmetic?
This is a difficult question without an easy answer. Dermatologists have been making the case that hair loss (and many other dermatologic conditions) are not simply cosmetic for decades. Knowledge and numbers can be helpful to support this case so we must continue to do research demonstrating quality of life impacts of hair loss. This data can be used as we advocate for our patients. We can also empower our patients to contact their insurance companies to advocate for themselves.
In the meantime, how may dermatologists help their patients access these medications without insurance coverage?
Doing some retail research on behalf of our patients allows us to direct them to retailers with the best prices. We can also direct patients to online companies that track and report prescription prices and/or provide digital coupons. Compounding pharmacies are another way that custom treatment formulations can be acquired with pre-set pricing. Finally, dermatologists can partner with primary care providers to determine if the patient may qualify for these medications under any of the approved insurance indications. For example, a patient with hypertension may benefit from oral minoxidil for blood pressure management as well as hair growth.
What else should dermatologists know about your study and the issue overall?
This article highlights the sometimes overlooked financial burden faced by patients with hair loss. It’s easy to recommend Rogaine and move on to the next patient, but we must consider barriers to patients obtaining this medication just like any of the others we prescribe. We need to continue to support our patients by providing them with resources and advocating for them with insurance companies.
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