Bolton Labor News: Edition No. 9: April 2024

By Bolton April 18th, 2024

Traditionally, January is the month that ushers in changes and resolves. But in terms of Stop-Loss high-cost claims and injectable drugs, the real changes happen in April when Sun Life releases their annual report. Last year, we highlighted some the of the key takeaways from Sun Life’s 2022 Stop-Loss Research Report. Our analysis helped alert our readers to costly healthcare trends, enabling them to make money-saving and health-boosting changes. After reading Sun Life’s new 2023 report, some of the key factors professionals should know are:

  • 71% of all stop-loss reimbursements came from the top 10 conditions, and 92% came from the top 20 conditions.
  • While cancer continues to be the largest driver of high-cost claims, cardiovascular disease rose one spot to the #2 claim condition.
  • 11 of the top 20 high-cost injectable drugs are related to cancer treatments. This includes Rylaze, the cancer drug with the highest average cost ($808.7K), is new to the top 20 injectables drug list.
  • Approximately one in nine employers (11%) experienced a birth-related stop-loss claim in the four-year benefit period of 2018 through 2021.
  • Million-dollar claims on a per million covered employees basis rose 15% in the past year and 45% over the past four years.
  • Mental health conditions increased in both the four-year and single-year rankings. As the top subcategory, alcohol-related disorders are contributing to this increase.
  • Osteoarthritis is the most common cause of spinal stenosis and most common form of arthritis affecting approximately 32.5 million U.S. adults.
  • Arthritis continues to be the leading cause of work disability, with annual costs for medical care and lost earnings of $303.5 Billion nationally.
  • More than half, (57.3%) of U.S. working-age adults (ages 18 to 64) have some type of arthritis.

We are living in an exciting time of medical advancement, allowing millions to live healthier lives. The growing list of gene therapies and new drug classes are delivering hope to million searching for better health outcomes, either for themselves or a family member. However, these costs are not insignificant. Employers today need to use a strategy that will:

  • Bundle procedures for complex care.
  • Handle disease-specific care coordination services like cancer navigation.
  • Have a specific focus on services that are not only cost-effective but provide a good benefit to members for things like fertility and heart health.
  • Put in cost-control guardrails for your health plan while offering better member benefits.