1.5 minute read
A report by independent stop-loss provider Sun Life found that cardiovascular disease surpassed blood cancers for the first time in 12 years. It has now become the second-highest stop-loss claim reimbursement during 2020-2023.
Sun Life’s report analyzed 60,000 stop-loss claims from 6 million people. Seventy-two percent of claims were from the top 10 conditions, with 37% of reimbursements from the top three conditions. Here are the top 10 conditions for the four-year view:
- Malignant neoplasms (solid tumors)
- Cardiovascular
- Leukemia, lymphoma, and multiple myeloma (blood cancers)
- Newborn and infant care
- Orthopedics and musculoskeletal
- Respiratory
- Sepsis
- Gastrointestinal and abdominal
- Neurological
- Urinary and renal
Here are some additional key findings:
- The top 10 injectable medications accounted for more than $10 million in overall spending, with Keytruda maintaining its lead by surpassing $69.7 million in expenditure.
- Five new medications have been added to the list of the top 20 high-cost injectable drugs for 2023, offering treatment for immunodeficiency disorders, cancer, gout, and blood disorders.
- Million-dollar claims have increased by 8% in the past year and by 50% over the past four years.
Employer Takeaways
Sun Life's annual report helps self-funded employers understand high-cost medical and injectable drug claims trends and impacts. Employers may want to consider purchasing stop-loss coverage for self-funded health plans to enjoy flexibility without unlimited liability risk. Factors like cash flow, risk tolerance, and company size influence the level of protection needed for effective risk management decisions. Download the bulletin for more details.
