In the news release, $3 million+ medical claims rose 104% from
2015 to 2018, issued 12-Jun-2019 by
Sun Life U.S. over PR Newswire, we are advised by the company that
factual information regarding changes in the number of medical
claims has changed in the headline, sub headline and fourth
paragraph. The complete, corrected release follows:
$3 million+ medical claims more than doubled from 2015 to 2018
Patients with
$1.5 million or more in
claims rose 54%
WELLESLEY, Mass., June 12, 2019 /PRNewswire/ -- Specialty
drugs, extended hospital stays and complex treatments are major
cost drivers in million-dollar+ claims, according to the Sun Life
2019 High-cost claims and injectable drug trends report. The report
analyzed nearly 37,000 high-dollar medical cases in its database
from 2015 to 2018. In total, Sun Life currently has approximately
2,300 U.S. employer clients that cover more than 4.7 million
people.
The costliest condition driving these claims is cancer, with
injectable drugs contributing significantly to the total
cost. All of the top five high-cost injectable drugs are most
frequently used to treat cancer. These include radiation and
chemotherapy drugs, but other cancer treatments are emerging that
may point to changes in the treatment landscape.
"There are incredible steps forward in medical care, where we
are seeing better survival rates and quality of life for patients,"
said Dan Fishbein, M.D., president
of Sun Life U.S. "Self-funded employers should understand medical
cost trends and their key drivers. While we see other factors
contributing to high-cost claims, including complicated surgeries
and long hospital stays, specialty drugs continue to be a major
factor in the increasing frequency and size of million-dollar and
multi-million-dollar claims."
According to the report, in 2018 the conditions most likely to
result in claims exceeding $3 million
per person were organ transplants, cancer and related treatments,
and congenital anomalies. These patients experienced a combination
of complicated procedures, advanced life-sustaining treatments and
other complications requiring extended in-patient stays. The number
of patients with more than $1.5
million in claims went up 54 percent, from 46 in 2015 to 71
in 2018, and the number of patients with more than $3 million in claims rose 140 percent, from five
in 2015 to 12 in 2018.
Other key findings from the report include:
- Age factor: 64 percent of million-dollar+ patients were
under 40 years of age.
- Injectable drugs: The highest injectable-drug charges
for a single patient in 2018 were for Soliris, used to treat blood
disorders, at $1.8 million, and
Erwinaze, which treats cancer, at $1.7
million. The top 10 highest-cost drugs are all used for
either cancer or blood disorders.
- Frequency vs. severity: Injectable drugs for more common
diseases such as cancer typically generate high costs because they
are frequently prescribed; other drugs accumulate high costs
because the medication itself has a high average cost.
- Emerging treatments: New gene therapies could cure
diseases with just one dose, but they come at a high cost – a new
drug from Novartis that cures spinal muscular atrophy will cost
just over $2 million per
patient.
According to the annual Kaiser Employer Health Benefits Survey,
61 percent of covered workers in the U.S. are in a self-funded
health plan. Employers who self-fund purchase stop-loss insurance
to protect against high-dollar claims. Sun Life U.S.'s research
shows that 85 percent of self-funded employers saw a stop-loss
claim in any given policy year, and, over a four-year period, 22
percent had at least one member with a claim of more than
$1 million.
Sun Life uses clinical expertise to analyze claims and identify
opportunities to reduce claims costs for employer clients. Cost and
clinical management approaches include identifying improper
prescription amounts and/or billing errors, and finding centers of
excellence or alternative treatments, which may result in better
patient outcomes and a more comfortable, convenient treatment
setting.
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, 2019, Sun Life had total assets under management of
C$1,011 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 employs
approximately 6,000 people in its U.S insurance and asset
management businesses. 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 www.sunlife.com/us.
Media contact:
Devon Fernald
Sun Life U.S.
781-800-3609
Devon.Portney.Fernald@sunlife.com
Connect with Sun Life U.S.
https://www.facebook.com/SLFUnitedStates/
https://www.linkedin.com/company/sun-life-financial/
https://twitter.com/SunLifeUS
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SOURCE Sun Life U.S.