Sun Life Report Highlights Surge in High-Cost Claims and New Drug Trends for 2024

Sun Life’s latest report on high-cost claims and injectable drug trends reveals significant insights into healthcare expenses for self-funded employers. Analyzing data from 2020 to 2023, the study covers nearly 60,000 members, representing over $6.1 billion in reimbursements and nearly $13.5 billion in total costs.

Key Findings:

Top Conditions: The top 10 conditions account for 72% of all stop-loss claims, with malignant neoplasms (cancer) leading at $415.6 million in 2023 and $1.31 billion over four years.

Rising Cardiovascular Costs: Cardiovascular diseases have surged to the second-highest claim category, with $165.8 million in 2023.

Injectable Drugs: Five new drugs entered the top 20 high-cost injectable list, with Keytruda maintaining the highest spend at $69.7 million.

Million-Dollar Claims: These claims rose by 8% in 2023, with a notable increase in claims over $3 million.

Impact of New Drugs: The report highlights the entry of five new injectable drugs, predominantly for cancer and blood disorders, reflecting advances in treatment but also higher costs.

Legislative and Regulatory Updates: The study notes the impact of Solvency U.K. reforms, IFRS 17, and ongoing U.S. legislative efforts aimed at improving access to high-cost therapies and managing healthcare price transparency.

Strategic Recommendations: Sun Life emphasizes the importance of robust risk management strategies, including updated stop-loss coverage, enhanced scenario modeling for climate and geopolitical risks, and proactive health management programs for employees.

Sun Life’s comprehensive analysis aims to help employers navigate the complexities of high-cost claims, ensuring better financial planning and employee health outcomes.