Million-dollar medical claims surge 87% from 2014-2017, says Sun Life

An analysis of stop-loss claims sheds light on the impact of rare diseases and high-cost injectables

Million-dollar medical claims surge 87% from 2014-2017, says Sun Life

A new report from Sun Life Financial suggests that claims for the most costly diseases are increasing, and they’re taking up an even bigger share of healthcare-claim dollars than before.

In its 2018 High-Cost Claims Report, Sun Life analysed its database of over 62,000 medical stop-loss claimants from 2014 to 2017; it included claims data from Sun Life stop-loss policyholders with around 50 to over 100,000 employees across the US.

The top 10 costliest claim conditions accounted for over half of the US$3 billion that Sun Life reimbursed to stop-loss policyholders from 2014 to 2017; when including first-dollar claims costs, reimbursements for high-cost conditions totalled US$6.9 billion. Among the top 10, cancer treatment costs were the most significant, representing 26.7% of all stop-loss claim reimbursements.

Patients with claims of over US$1 million also left a big impression, accounting for some 19.9% of the US$3 billion in stop-loss reimbursements even though they made up only 2.1% of the total number of claims. The number of patients claiming over a million US dollars also surged 87%, from 104 in 2014 to 194 in 2017, with the majority of charges falling within the US$1 million-US$1.5 million range.

“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,” noted Sun Life Financial US President Dan Fishbein.

In 2017 alone, 418 high-cost injectables contributed to a total cost of US$186.3 million; 3% of that total was contributed by the top 20 injectable medications. The total paid charges for injectable drugs associated with claims of a million US dollars and above swelled by 80% from 2014 to reach $18.7 million in 2017.

The two highest claims for a patient in a single policy year were for hereditary angioedema, a metabolic/immunity disorder, which totalled US$6.7 million in treatment costs in 2016; and haemophilia/bleeding disorder, totalling US$6.7 million in treatment costs in 2017.

Sun Life also noted the potential of gene therapy, which could replace drugs or surgery in treating certain genetic disorders. “[W]e continue to monitor this new emerging therapy class for