-- June 5 webinar
will review report, which shows trends of common and rare diseases,
injectable drugs, and emerging health trends --
WELLESLEY, Mass., May 30, 2024
/PRNewswire/ -- Sun Life has released its annual High-Cost Claims
and Injectable Drug Trends Analysis report, analyzing 60,000
stop-loss claims from a member database of 6 million people. The
findings, which span from 2019 – 2022, showed that 87% of
self-funded employers experienced at least one high-cost claim
during the four-year time period. The number of claims over the
study period rose as the result of increases in underlying medical
claims cost as well as changes to Sun Life's book of covered
business.
Cardiovascular disease moved up to the
second spot of highest-paid claims, surpassing blood cancers for
the first time
"Our extensive claims database allows us to provide guidance to
our self-funded clients so they can understand how to best manage
their health plans and costs, while ensuring they can choose
additional solutions that drive the best care for their employees,"
said Jen Collier, president, Health
and Risk Solutions, Sun Life U.S. "Additionally, the data informs
our health and risk product development team as they create
solutions and programs that directly support the health and
wellness of our members, regardless of whether their condition has
resulted in a high-cost claim."
One of the most notable observations in this year's report is
that cardiovascular disease (CVD) moved up to the second spot of
highest-paid claims, surpassing blood cancers for the first time in
the company's 12 years of reporting. The average cost for CVD
claims increased 33% since 2020, which is higher than the increase
in average cost across all medical claims. Malignant neoplasm
(solid tumors) continues to hold the top spot with double the
medical spend of CVD.
"There are various factors that can contribute to cardiovascular
disease, including congenital heart defects, aging and lifestyle
risk factors such as smoking and obesity. More recently, there is
evidence that post-COVID-19 infection and long COVID increase the
risk of cardiovascular complications," said Dr. Miles Varn, Sun Life's chief medical officer and
head of PinnacleCare. "Sun Life has dedicated teams and clinicians
committed to using our data and expertise to remove barriers to
health care so our members can achieve optimal health care
outcomes."
Other key takeaways from the report:
Medical cost trends
- 72% of all stop-loss reimbursements came from the top 10
high-cost medical conditions and 92% came from the top 20
conditions.
- Newborn/infant care disease/disorder claims rose by an average
of $100,000 from 2022 to 2023, with
an annual average cost of $470,800.
The highest claim for this condition was $11.5 million.
- Orthopedics/musculoskeletal conditions came in at #4 in the
single year for 2023 reimbursements. It has the highest number of
individual members with a high-cost claim compared to any other top
20 condition, besides solid cancers (#1); it also has more
utilization than other conditions, but a lower average cost at just
over $100,000.
Multimillion-dollar claims continue to rise
- All top 20 claim categories experienced at least one
million-dollar+ claim; the highest cost claim this year was for
newborn/infant care at over $11
million.
- In 2023, a notable change occurred in the $3 million+ category,
with 32 claims—nearly double the number of such claims from
2022.
- Of the 32 claims over $3 million,
half were related to a diagnosis of congenital anomaly. While these
claims are often associated with birth/early years, they can have
implications on the health of an individual for their entire
lifetime.
Monitoring trends in injectable drugs
- The top 10 injectable drugs all had more than $10 million in total spend. Keytruda has claimed
the top position for the past four years and totaled nearly
$70 million in spend in 2023
alone.
- Of the top 20 drugs, 11 were used primarily in the treatment of
cancer; Enhertu and Tecentriq are new additions to the list.
- Four drugs on our top 20 list had an average cost over
$400K: Tepezza, Ultomiris, Krystexxa
and Rylaze. All four of these drugs received their FDA approval
within the past six years and are currently under patent, which
tends to result in a higher average cost.
Sun Life, the largest independent stop-loss provider in the
U.S., covers high-dollar claims for employers that self-fund their
health plans. In 2023, the Health Benefits Survey by KFF, an
independent nonprofit organization focused on national health
issues, found that 65% of employees in the U.S. who receive
health benefits from their employer are enrolled in self-funded
plans. Since 2011, Sun Life has published the high-cost
claims and injectables report as a tool to better understand cost
drivers and healthcare trends.
Register for Sun Life's High-Cost Claims and Injectables webinar
on June 5 featuring Jennifer Collier, Sun Life's President of Health
and Risk Solutions, Mike Huppert,
VP, Actuarial & Risk Management, and Lisa Hundertmark, Director of Clinical Services
who will provide additional insights from the report.
About Sun Life
Sun Life is a leading international financial services
organization providing asset management, wealth, insurance and
health solutions to individual and institutional 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, 2024, Sun Life had total assets under management of
$1.47 trillion. 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.
Sun Life U.S. is one of the largest providers of employee and
government benefits, helping more than 50 million Americans access
the healthcare and coverage they need. Through employers, industry
partners and government programs, Sun Life U.S. offers a portfolio
of benefits and services, including dental, vision, disability,
absence management, life, supplemental health, medical stop-loss
insurance, and healthcare navigation. Sun Life employs more than
8,500 people in the U.S., including associates in our partner
dental practices and affiliated companies in asset management.
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 visit
our website and newsroom.
Media Contacts:
Anjie
Coplin
Sun Life U.S.
Anjie.Coplin@sunlife.com
Devon Fernald
Sun Life U.S.
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.