Should dignity during chemotherapy be a right, or a privilege reserved for those who can afford it? This legislative session, California has the opportunity to answer that question.
Authored by Assemblymember Gregg Hart, AB 1682 would require health plans and Medi-Cal to cover scalp cooling, a treatment that can help preserve hair for patients receiving chemotherapy. It is a National Comprehensive Cancer Network-backed policy that would correct a real inequity.
Scalp cooling, often called “cold capping,” uses a Food and Drug Administration–cleared device before, during, and after infusions to reduce chemotherapy-induced hair loss. It does not compromise cancer outcomes and is recommended by experts, reflecting broad consensus that it is an evidence-based supportive care intervention.
Yet today, access too often depends on a patient’s insurance plan, income, and zip code. Reimbursement is inconsistent across insurers and geographic regions. Many patients are forced to pay thousands of dollars out of pocket for a therapy their oncologist may recommend but their insurer refuses to cover.
As a hematology/oncology physician at UC Davis, I care for patients receiving intensive chemotherapy regimens, including many patients with breast cancer. These treatments save lives. They also cause profound, visible, and deeply personal side effects.
Earlier this year, one of my young patients, whom I will call Cecilia, started intensive chemotherapy for her breast cancer. Like many patients, Cecilia was not only worried about nausea, fatigue, or blood counts. She was tearful about what hair loss would mean for her life outside of the infusion center.
As a teacher, Cecilia could not afford to stop working at the beginning of treatment. She also worried that losing her hair would force her to disclose her diagnosis before she was ready. She worried about stigma, how her students and colleagues would respond, and the daily loss of privacy that comes when cancer becomes visible to everyone.
Scalp cooling was an option, but it would have cost approximately $2,000 per month out of pocket. I tried to obtain prior authorization from Cecilia’s insurance company, but the request was denied. Ultimately, the choice about disclosing her diagnosis was not hers to make.
That is the problem AB 1682 seeks to solve.
Hair loss from chemotherapy is not cosmetic. For many patients, it is one of the most distressing side effects of cancer treatment. It can cause anxiety, depression, altered body image, social isolation, reduced self-esteem, and loss of privacy. It can affect employment, parenting, relationships, cultural identity, and the ability to move through the world without being publicly marked as a cancer patient.
We already recognize that supportive care matters. Insurers cover interventions that help patients preserve fertility, sexual function, body integrity, and dignity — including sperm banking before chemotherapy, testicular prostheses after orchiectomy, and reconstruction after cancer surgery.
We do not dismiss those services as vanity. But when women with breast cancer ask for an FDA-cleared approved intervention to reduce hair loss caused by chemotherapy, insurers too often call it cosmetic. That double standard is indefensible.
There is a growing momentum to address this. In 2024, New York enacted legislation requiring private insurance coverage of scalp cooling for chemotherapy patients, and Louisiana followed suit the following year. In June, the American Medical Association adopted policy encouraging insurance coverage and reduced cost-sharing for scalp cooling therapy for patients receiving chemotherapy.
AB 1682 is carefully tailored. It applies to FDA-cleared scalp cooling devices and systems in connection with chemotherapy for cancer and allows for reasonable cost-sharing.
Cancer patients already endure enough. They should not have to crowdfund for dignity or forgo scalp cooling altogether. Supportive cancer care is cancer care, and AB 1682 is California’s chance to ensure equitable access to it.
Dayna Isaacs, MD, MPH, is a hematology/oncology physician based in Sacramento and serves on the California Medical Association Board of Trustees.
