New York and Louisiana have become the first U.S. states to require private health insurers to cover scalp cooling, a medical technology proven to reduce or prevent hair loss in many patients undergoing chemotherapy — a development that advocates and clinicians say could dramatically expand access to the treatment.
Scalp cooling, often referred to as cold capping, can cost between US$1,500 and US$3,000 for a full course of chemotherapy when paid out of pocket, putting it out of reach for many patients. New York’s law took effect on January 1, while Louisiana enacted a similar mandate, with both states requiring large group insurance plans to cover the therapy.
“This is huge,” said Dr Anthony Rossi, a dermatologist and attending physician at Memorial Sloan Kettering Cancer Center in New York City. He described New York’s move as a long-awaited recognition that preventing chemotherapy-related hair loss is not a cosmetic luxury but a meaningful part of patient care.
Nancy Marshall, co-founder of the Rapunzel Project, a Minnesota-based nonprofit that promotes awareness of scalp cooling, called the legislation “breathtakingly refreshing.” Although the US Food and Drug Administration cleared the first automated scalp cooling device in 2015, she said many clinicians have been hesitant to recommend the technology because of its high cost and inconsistent insurance reimbursement.
Automated scalp cooling systems work by circulating chilled liquid or gel through a helmet-like cap worn before, during and for up to two hours after chemotherapy, reducing blood flow to the scalp and limiting the amount of chemotherapy drugs that reach hair follicles. The FDA has cleared devices from three companies — Dignitana, Paxman and Cooler Heads — while manual systems use frozen caps that must be replaced every 30 minutes and are not FDA-regulated.
Both the New York and Louisiana laws require coverage for manual and automated systems. Several other states, including Maryland, Massachusetts, New Jersey and West Virginia, are now considering similar mandates, according to Marshall, although a proposed bill in Rhode Island was recently postponed for further study.
Historically, insurers have classified hair loss from cancer treatment as a cosmetic issue, leaving patients to shoulder the cost themselves. Rossi disputes that view, noting that hair loss carries significant emotional, physical and psychosocial consequences. “It can be a constant reminder to the patient of their cancer and a visible signal to others that they are sick,” he said, calling scalp cooling “a real game changer” for many people.
Momentum is also building at the federal level. While Medicare has reimbursed facilities for scalp cooling, payments have been limited. The American Medical Association has now created billing codes for the procedure, and from 2026, automated scalp cooling will be reimbursed under the physician fee schedule, according to the American Cancer Society (ACS).
The ACS cautions that scalp cooling is not suitable for everyone. It is not recommended for patients with certain blood cancers, those undergoing stem cell transplant preparation, people receiving radiation to the skull, or individuals with specific cold-sensitivity disorders, because of safety concerns.
Even with these limitations, Marshall said the new state mandates could be transformative. For some patients, cold capping is affordable, but for many others it has been “completely unattainable” amid the financial strain of cancer care. She also stressed the importance of awareness: “You can’t save your hair if you don’t know there’s an option to save your hair.”
Both Marshall and Rossi reported no conflicts of interest.
