Maryland Bill Aims to Expand Scalp Cooling Coverage for Chemo Patients

ANNAPOLIS — Tom Hutchinson remembers the moment vividly: standing with his then-wife, Lynn Dymond, in the shower, shaving her head. It was roughly 15 years ago, shortly after Dymond received a Stage 4 breast cancer diagnosis. Choosing to shave her head, rather than endure the gradual hair loss of chemotherapy, was a way for Dymond to reclaim a small measure of control in the face of a devastating illness. “I feel like I almost passed out,” Dymond recalled, describing looking in the mirror after her hair was gone. “It just hit me so hard. This was it. This was real.” Hutchinson, speaking in an empty chamber of the Maryland House of Delegates, described the day as a “traumatic event” that still affects him deeply. Dymond’s experience is among those driving Maryland legislators to consider expanding access to scalp cooling technology, which aims to mitigate hair loss during chemotherapy. House Bill 393, sponsored by Hutchinson and 21 other delegates, would require private health insurers to cover scalp cooling for breast cancer patients. The technology involves wearing a cold cap during chemotherapy, constricting blood vessels in the scalp to reduce the treatment’s impact on hair follicles. Hutchinson, a Republican representing Caroline, Dorchester, Talbot, and Wicomico counties, emphasized the bill’s broad bipartisan support. The Food and Drug Administration granted expanded approval for scalp cooling in 2017. New York and Louisiana have already enacted legislation to increase access to the technology, reducing out-of-pocket costs for patients. Maryland advocates, survivors, and a majority of lawmakers are now seeking to follow suit. “It’s more than hair,” said Rossalynn Ripper, an Anne Arundel County resident and a leading advocate for the bill, who completed her own treatment for HER2-positive breast cancer last year. Ripper spent thousands of dollars on scalp cooling to preserve her hair during chemotherapy. “Cancer is a personal journey for everybody. For me, keeping my hair changed the trajectory of my cancer journey completely. It changed my life. Because I was able to appear normal at a time when anything was but normal.” House Bill 393 and a companion bill in the Senate appear poised for passage. The Senate approved the measure 43-0 last month, and the House followed with a 129-7 vote. The bills have now crossed over to the House, with a committee hearing scheduled for Thursday. If approved by the General Assembly and signed by the governor, the law would take effect January 1, 2027. As currently drafted, the bill would mandate coverage from some insurers and nonprofit health service plans, provided they already cover chemotherapy. Hutchinson indicated the bill would apply to approximately “20% of potential coverage” – primarily larger carriers, but not Medicaid. The bill faced delays last year due to a requirement for a cost analysis by the state Health Care Commission. The commission’s report, completed before the bill’s reintroduction, indicated a minimal financial impact. Del. LaToya Nkongolo (R-Anne Arundel), a lead sponsor, stated in a committee hearing in February that the cost impact would be “just pennies per month per member.” The commission’s report found scalp cooling to be 40% to 80% effective in minimizing or eliminating hair loss during chemotherapy, though oncologists remain divided on its use, citing financial concerns among other factors. The report estimated the additional coverage would impact premiums by 0.00% to 0.05%. Yet, the League of Life and Health Insurers of Maryland, a trade association representing insurance companies, opposes the bill. Matthew Celentano, the league’s executive director, argued the mandate is “inappropriate” and could limit access to care. He also stated that scalp cooling falls outside the definition of medical necessity and is not universally recommended, particularly for patients with certain cancers, liver problems, or cold allergies. Celentano warned that the bill’s requirements could shift costs to other insured individuals. Supporters maintain the benefits outweigh the costs. Melissa Bourestom, an advocacy and communications professional for Paxman Scalp Cooling, a leading provider of the technology, testified during a health committee hearing that the average cost of scalp cooling is around $2,500, a fraction of the overall cost of chemotherapy treatment. Dr. Mark Goldstein, an oncologist and president of the Maryland/D.C. Society of Clinical Oncology, said scalp cooling can be beneficial for many patients, even those with ovarian or other types of cancer. “It can be fairly beneficial, and at least half the patients, they can have excellent results,” Goldstein said, adding that increased affordability could lead to wider adoption. The only legislative opposition has come from seven Republicans in the House Freedom Caucus, who echoed the insurers’ fiscal concerns. Del. Robin Grammer Jr. (R-Baltimore County) compared the scalp cooling mandate to past energy mandates, citing current energy affordability issues in Maryland. “This bill is an insurance mandate,” Grammer said on the House floor February 26. “And I would ask you to consider: How does it serve our people if we continue to pass laws that make the coverage unaffordable for this service, or the actual care of the cancer itself, and every other condition?” Ripper and other advocates emphasize the emotional and psychological impact of hair loss. “Women seek to keep their own hair. I see it every single day in support groups, where women want to keep their own hair,” Ripper said. “But we have to fight it out with insurance companies, and they will never just stand up and say, ‘Let’s do this for chemo patients.’ We have to put laws in place to force the issue.” Testimony on the House floor last month was deeply personal. Legislators shared stories of family members impacted by breast cancer. Hutchinson spoke of his former wife, Lynn Dymond, and the “horrific” memory of shaving her head. Del. Diana Fennell (D-Prince George’s), a breast cancer survivor, recalled her own experience with hair loss in 2022. Del. April Miller (R-Frederick) described her mother’s cancer battle, stating, “It is one of the most devastating things for women to go through…You’ve lost your breasts, and then you lose your hair.” Dymond, now living in Cambridge and working as an attorney, is currently designated as having “no evidence of disease” (NED) and continues to receive treatment at Johns Hopkins. She said she would have undoubtedly utilized scalp cooling if it had been available during her initial diagnosis in 2010. Ripper’s son was 16 during her breast cancer battle. She believes preserving her hair through scalp cooling helped him cope with the situation. “I could get up in the morning, even on my worst day when I felt horrible from chemo. I looked like myself,” Ripper said. “My son could look at me, and he didn’t see me as sick.” Hutchinson urged families facing breast cancer to prioritize mental health for all members. “Don’t overlook the mental health aspect of this, and the trauma that it not only inflicts on women, but the entire family,” he said. “Keep an eye on the entire family, keep an eye on the children.” Dymond, reflecting on the lasting effects of cancer more than a decade later, expressed hope that House Bill 393 will provide relief for others facing the disease. “The emotional toll it takes is huge,” Dymond said. “Any one thing that could be done to help get somebody through that process, I think, would be fantastic.”