Medical wig FSA/HSA, how does TrueMed / Flex / Sika integration work?

Cranial prostheses for chemo, alopecia areata / totalis / universalis, trichotillomania, lupus-related hair loss, scarring alopecia are FSA/HSA eligible in the US per IRS Publication 502 when ordered with a Letter of Medical Necessity (LMN).

The three integration partners and what they each do:

• TrueMed, the dominant player. Customer reaches checkout, selects “Use HSA/FSA,” answers a 4-question medical eligibility quiz, TrueMed generates an LMN signed by a licensed physician (their network), customer pays via FSA/HSA debit card or gets a reimbursement receipt. Fee: ~3% of order. Magento integration via TrueMed JS widget + order-attribute capture.
• Flex, similar model, slightly different physician network. Used by Truly Beauty, Origins, several supplement brands. Magento integration via Flex SDK.
• Sika Health, newer entrant, lower fee (~2%), tighter UX. Better fit for brands under $2M GMV in the medical channel.

Magento side, the architecture:

• Product-attribute flag: medical_wig=1 on cranial-prosthesis SKUs only. Quality-grade attribute, not every wig in the catalog qualifies; the product must be sold specifically as a cranial prosthesis with appropriate construction.
• Separate “Medical” checkout flow: routes to the FSA/HSA payment widget when cart contains medical_wig=1 items. HIPAA-conscious data handling on the medical-eligibility quiz responses.
• Sales-tax exemption: most US states exempt cranial prostheses from sales tax when prescribed for medical hair loss. Magento tax rules per state + product-attribute condition handle this.
• Compliant marketing copy: “FSA/HSA eligible” is OK to claim; “medical device” or specific medical-treatment claims invite FTC scrutiny. The widget partner provides the compliance language.

The medical channel is small in unit volume (1-3% of orders for typical brands) but high in basket value ($300, $1,500) and customer loyalty, chemo patients reorder for the duration of treatment, alopecia patients reorder for life.