WELLESLEY, Mass., June 25, 2020 /PRNewswire/ -- Cancer once
again tops the list of the ten costliest medical conditions in Sun
Life's 2020 High-cost claims and injectable drug trends report,
which offers self-funded employers key insights into the healthcare
and medical trends that drive high-cost claims. Conditions such as
renal failure, transplants, and congenital anomalies (conditions
present at birth) were also high on the list. Cancer holds the top
six positions on the list of the 20 highest-cost drugs, and the
average cost for cancer drugs was over $76,000 per person in 2019.
A Sun Life webinar on June 30 will offer expert insight and analysis of
"We fully support the expansion of life-saving drug treatment
options that are becoming available to patients with cancer and
other serious medical conditions – it's also important to
note that this trend of increasing costs will continue, and the
trillions of dollars spent on healthcare are the responsibility of
employees, their families and the businesses where they work," said
Jen Collier, R.N., senior vice
president, Stop-Loss & Health at Sun Life U.S. "We are here to
guide self-funded employers through the changing healthcare
landscape so they can make informed, data-driven decisions in their
plan design and contain rising costs while addressing their
employees' healthcare needs."
According to Kaiser Health, about 61 percent of workers in
America are in self-funded plans, which means their employers pay
their medical claims. Self-funding provides employers with more
flexibility in health plan design as well as cost containment
options, but also means they take on a financial risk. Stop-loss
insurance mitigates that risk by providing self-funded employers
protection from high-dollar claims. Sun Life's research shows that
about 86 percent of employers who self-fund will see a stop-loss
(high-dollar) claim in any given year, eight percent of whom will
see a million-dollar+ claim. As one of the largest stop-loss
providers in the country, Sun Life's report analyzed over 40,000
stop-loss claims from approximately 2,600 employer clients in the
U.S., covering more than 4.7 million lives.
Other key takeaways from the report include:
- Million-dollar claims continue to rise: From 2016-2019,
the largest increases in multi-million dollar claims were in the $3
million+ category, which doubled from 7 to 14 claims; $2 million - $3
million claims increased 44%, from 16 to 23.
- Million-dollar conditions: Some of the highest claims in
excess of $3 million were for
conditions including congenital anomalies, various types of cancer,
genetic disorders (such as spinal muscular atrophy) and
- Injectable drugs: Of the top 10 costliest
conditions cancer, hemophilia, and aftercare (care received after a
significant diagnosis, surgery or other complications) had a
quarter or more of their total cost from drug spend; Hemophilia is
the one condition that incurs almost all cost from specialty drugs
(92% of total claim dollars).
- Single drug spend: Zolgensma, introduced in 2019 to
treat spinal musclar atrophy, had the highest average cost of
nearly $2.2 million per patient.
- Age factor: 46% of million-dollar claims were for
patients under the age of 20, and 71% of the $3 million+ claims
were for patients under 12 – the most common conditions were
various forms of cancer and congenital anomalies.
- COVID-19: Although many COVID-19 claims do not breach
the stop-loss deductible level, the stop-loss claims we have seen
to date have had hospitalization stays between 3 and 35 days; the
highest hospitalization cost for an individual patient exceeded
"We are seeing a continuously active pipeline of new drugs,
medical procedures and emerging treatments that improve and extend
patients' lives, which is very exciting," said Dan Fishbein, M.D., president of Sun Life U.S.
"As healthcare and insurance continues to change, we are remaining
nimble and innovating to make sure members and their families get
the care they need, and our employer clients can better manage
"Employers should embrace a holistic approach to health in their
plan design," added Collier. "This will help address comorbid and
underlying conditions such as mental health issues, which can drive
up costs and more importantly, negatively impact the employee's
Sun Life uses clinical expertise to analyze stop-loss claims and
identify opportunities for cost reduction, such as improper
prescription amounts, billing errors, or changes in treatment
settings that not only reduce cost but better accommodate the
patient. Further analysis of the stop-loss research and current
healthcare cost trends can be viewed in a recent webinar conducted
by Sun Life. That and other webinars, including important
information on COVID-19, can be found here. For the full report
analysis, register for our next webinar on June 30.
About Sun Life
Sun Life is a leading international
financial services organization providing insurance, wealth and
asset management solutions to individual and corporate Clients. Sun
Life has operations in a number of markets worldwide, including
Canada, the United States, the United Kingdom, Ireland, Hong
Kong, the Philippines,
Japan, Indonesia, India, China,
Australia, Singapore, Vietnam, Malaysia and Bermuda. As of March
31, 2020, Sun Life had total assets under management of
C$1,023 billion. For more
information, please visit www.sunlife.com.
Sun Life Financial Inc. trades on the Toronto (TSX), New
York (NYSE) and Philippine (PSE) stock exchanges under the
ticker symbol SLF.
In the United States, Sun Life
is one of the largest group benefits providers, serving more than
60,000 employers in small, medium and large workplaces across the
country. Sun Life's broad portfolio of insurance products and
services in the U.S. includes disability, absence management, life,
dental, vision, voluntary and medical stop-loss. Sun Life and its
affiliates in asset management businesses in the U.S. employ
approximately 5,500 people. Group insurance policies are issued by
Sun Life Assurance Company of Canada (Wellesley
Hills, Mass.), except in New
York, where policies are issued by Sun Life and Health
Insurance Company (U.S.) (Lansing,
Mich.). For more information, please visit
Sun Life U.S.
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SOURCE Sun Life U.S.