Sun Life, a prominent stop-loss provider for self-funded employers, has released its 13th annual high-cost claim and injectable drugs trend analysis. The report examined over 65,000 health claims from 3,000 employers between 2021 and 2024. It revealed a significant rise in million-dollar stop-loss claims, which increased by 29% this year based on claims-per-million-covered employees and have surged by 61% over the past four years.
"Sun Life's annual high-cost claims report illustrates the escalating nature of healthcare costs and the growing financial burden on employers and the healthcare system," stated Jen Collier, president of Health and Risk Solutions at Sun Life U.S. She highlighted the importance of analyzing clinical data to create solutions that can positively impact health outcomes and cost containment.
Cancer remains the most frequent and costly condition, with malignant neoplasms generating $1.2 billion in spending across approximately 5,000 claims in 2024. Blood cancers remain in the top five categories despite moving down one spot.
The report also noted an increase in orthopedics/musculoskeletal conditions, placing them among the top three categories for the first time. The total spend in this category reached $1.18 billion during the reporting period.
Congenital anomaly claims saw a 70% increase in average cost since 2021, with more than 450 members experiencing such anomalies at an average claim cost of $335,000.
Uncategorized drugs emerged as one of the highest-cost categories among injectable drugs due to gene therapies. Despite a relatively low average treatment cost of $5,900, two members received gene therapies totaling $6.8 million in 2024.
Eight out of ten highest-cost drugs are primarily used for cancer treatment. Keytruda was identified as both the costliest cancer treatment and overall drug with an expenditure of $84.4 million.
"As a physician, I am keenly aware that factors such as chronic conditions, medical advancements, drug spend, and delayed care are putting pressure on employers and their workforces," said Dr. Miles Varn, chief medical officer at Sun Life U.S., emphasizing Sun Life's programs aimed at improving individual outcomes while managing costs sustainably for employers.
Sun Life covers high-cost claims for employers who self-fund their employee health plans. According to KFF data, about 63% of covered workers in the U.S. are enrolled in self-funded plans.
For further insights into these findings, Sun Life will host a webinar on June 5 featuring key company figures including Jennifer Collier and Dr. Miles Varn.