Million-dollar+ medical claims increase 87 percent from 2014-2017: Sun Life report
Injectable drugs and in-patient care drive costliest claims
WELLESLEY, Mass. (July 16, 2018) – In Sun Life Financial’s 2018 High-Cost Claims Report, cancer remains the costliest medical condition, with $798.7 million in reimbursements to self-funded employers from 2014 to 2017. The report, based on analysis of Sun Life’s database of over 62,000 medical stop-loss claimants from 2014-2017, shows that high-cost conditions totaled $6.9 billion in paid charges over the four-year period. The number of patients with million-dollar+ claims rose 87 percent, from 104 in 2014 to 194 in 2017, with most charges ranging from $1 million to $1.5 million, and totaling over $935 million in paid charges.
“We’re seeing continued significant growth in the number of million-dollar-plus claims as the result of new life-saving treatment options coming to market, as well as existing treatments getting approved for expanded use,” said Dan Fishbein, M.D., president of Sun Life Financial U.S. “This means better care and outcomes for patients, and is also an important consideration for employers who self-fund their medical plans. We partner with our clients to protect them from the financial risks of these high-dollar claims, but also to work with them to identify opportunities for cost savings that may improve patient care as well.”
Other analysis from the report showed that:
- Rare conditions hit highest dollars – The two highest claims for a patient in a single policy year were for metabolic/immunity disorder (hereditary angioedema, a severe, recurrent swelling of various parts of the body) in 2016, with a total of $6.7 million in treatment costs; and hemophilia/blood disorder with a total treatment cost of $5 million in 2017.
- Million-dollar cases leave big footprint – Patients with claims over $1 million represented only 2 percent of the total number of stop-loss claims from 2014-2017, but about 20 percent, or nearly $600 million, of the total $3 billion in stop-loss reimbursements.
- Impact of injectable drugs – In 2017 four of the five costliest injectable drugs, used to treat cancer or related conditions, accounted for approximately $45 million, or 24 percent of the total $186.3 million spent on injectable drugs that year.
- Looking to the future – Gene therapy is an emerging treatment gaining more attention and utilization, and may pave the way to treat costly genetic disorders, such as hemophilia.
- Employers’ considerations – Employers have an 85 percent chance of seeing a high-dollar (stop-loss eligible) claim in any given policy year.
Employers who self-insure their health plans use stop-loss coverage to protect themselves from excessive financial losses from high-dollar claims. Sun Life, the largest independent stop-loss provider in the country, analyzes its vast database of client medical stop-loss claims each year to assess industry and health care trends. Sun Life has over 35 years in the industry and currently covers 4.2 million lives under stop-loss policies.
About Sun Life Financial
Sun Life Financial is a leading international financial services organization, providing a diverse range of insurance, wealth and asset management solutions to individuals and corporate Clients. Sun Life Financial 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, 2018, Sun Life Financial had total assets under management of C$979 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 Financial 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 products and services in the U.S. includes disability, absence management, life, dental, vision, voluntary and stop-loss insurance. For more information, please visit www.sunlife.com/us.
Devon Portney Fernald
SLPC 29196 07/2018 Exp 07/2020