Our mission: to provide crucial insights into high-cost claims and injectable drug trends, enabling self-funded employers to make informed decisions that benefit both their employees and their bottom line. Armed with these insights, you'll be better equipped to refine your risk management strategy, optimize your benefit offerings, and stay ahead of industry shifts.

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2026 Sun Life Stop-Loss High-cost claim and injectable drug trends analysis

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Top 10 Conditions by Industry

Top 5 Conditions by Deductible

Top 50 High-cost Injectible Drugs

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Report Highlights

Source: Sun Life book of business data. Top 20 rank order, average paid, total paid and condition category are all based on 2025 book of business data. Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL REV 7-12 and 22-SL. In New York, Group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12 and 22-NYSL. Policy offerings may not be available in all states and may vary due to state laws and regulations. © 2026 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. The Sun Life name and logo are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. SLDX-1573-3-b #1362359261 05/26 (exp. 05/28)

• 73% of all reimbursed stop-loss claims are from the top 10 conditions.

• In 2025, the top 3 conditions totaled 40% of all reimbursements

#1 Malignant Neoplasm #2 Cardiovascular (CVD) #3 Orthopedics/Musculoskeletal (Ortho/MSK) #4 Newborn/Infant Care #5 Leukemia, Lymphoma, Multiple Myeloma #6 Respiratory #7 Gastrointestinal #8 Sepsis #9 Neurological #10 Congenital Anomaly

Top high-cost claim conditions

• 7 of the top 10 injectable drugs are used to treat cancer. • Keytruda, Darzalex Faspro, Opdivo and Enhertu remain top within our injectables chart, being the only four drugs with over $20M in spending each, and over $170M total spend in 2025.

#1 Keytruda #2 Darzalax Faspro #3 Opdivo #4 Enhertu #5 Ultomiris #6 Perjeta #7 Yervoy #8 Elevidys #9 Durvalumab #10 Ocrevus

Top injectable drugs

Recommendations

Top 5 Conditions by Deductible

Top 50 High-cost Injectible Drugs

Top 10 Conditions by Industry

Report Highlights

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Report highlights

• Million-dollar+ claims are up 46% since 2022. In 2025, 11 of the $3M+ claims were for individuals with a primary diagnosis of Ortho/MSK, compared to just 3 in 2024, driven in part by gene therapies.

Condition/Disease/Disorder

Average Cost

Top 10 high-cost claim conditions by industry and size

Sun Life is committed to sharing data on high-cost claims trends to help you plan and design coverage that works for you. See what conditions are most likely to be a high-cost claim for your group based on total cost (inclusive of first-dollar and stop-loss reimbursements) by clicking on your industry and size.

Malignant Neoplasm

$341,345

Cardiovascular

$296,292

Leukemia, Lymphoma, Multiple Myeloma

$370,742

Newborn/Infant Care

$629,882

Orthopedics/Musculoskeletal

$227,541

Respiratory

$208,285

Sepsis

$372,558

Neurological

$223,490

Gastrointestinal Abdominal

$158,236

Congenital Anomaly-Structual

$462,156

Overall - 1000+ Lives

Malignant Neoplasm

$222,374

Cardiovascular

$153,983

Orthopedics/Musculoskeletal

$143,711

Leukemia, Lymphoma, Multiple Myeloma

$225,723

Gastrointestinal/Abdominal

$115,556

Newborn/Infant Care

$397,681

Sepsis

$211,662

Neurological

$132,072

Respiratory

$113,582

Urinary/Renal

$144,257

Overall - 500 to 999 Lives

Malignant Neoplasm

$179,975

Cardiovascular

$112,082

Orthopedics/Musculoskeletal

$94,823

Gastrointestinal/Abdominal

$87,922

Leukemia, Lymphoma, Multiple Myeloma

$192,609

Sepsis

$166,939

Urinary/Renal

$92,410

Neurological

$101,182

Newborn/Infant Care

$274,410

Respiratory

$75,489

Overall - 200 to 499 Lives

Malignant Neoplasm

$122,622

Orthopedics/Musculoskeletal

$59,715

Cardiovascular

$77,426

Gastrointestinal/Abdominal

$59,722

Mental and Behavioral Health

$48,554

Physician Treatment, not elsewhere classified

$23,459

Neurological

$54,889

Respiratory

$47,091

Urinary/Renal

$66,495

Leukemia, Lymphoma, Multiple Myeloma

$151,896

Overall - Under 200 Lives

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Education - 1000+ Lives

Malignant Neoplasm

$339,874

Cardiovascular

$317,040

Leukemia, Lymphoma, Multiple Myeloma

$387,763

Newborn/Infant Care

$606,231

Orthopedics/Musculoskeletal

$238,130

Sepsis

$412,864

Respiratory

$208,009

Gastrointestinal

$137,910

Neurological

$183,511

Congenital Anomaly

$469,406

Education - 500 to 999 Lives

Malignant Neoplasm

$254,278

Orthopedics/Musculoskeletal

$208,574

Leukemia, Lymphoma, Multiple Myeloma

$268,482

Cardiovascular

$136,145

Gastrointestinal

$138,578

Urinary/Renal

$170,504

Sepsis

$231,753

Respiratory

$131,186

Neurological

$133,786

Newborn/Infant Care

$416,921

Education - 200 to 499 Lives

Malignant Neoplasm

$185,303

Orthopedics/Musculoskeletal

$100,683

Cardiovascular

$126,653

Gastrointestinal

$100,781

Leukemia, Lymphoma, Multiple Myeloma

$225,803

Neurological

$99,088

Urinary/Renal

$122,226

Sepsis

$147,277

Respiratory

$64,047

Physician Treatment

$34,794

Malignant Neoplasm

$96,556

Orthopedics/Musculoskeletal

$47,296

Cardiovascular

$75,718

Gastrointestinal/Abdominal

$54,220

Physician Treatment, not elsewhere categorized

$25,990

Mental and Behavioral Health

$47,612

Leukemia, Lymphoma, Multiple Myeloma

$154,124

Neurological

$48,633

Respiratory

$37,243

Urinary/Renal

$59,090

Education - Under 200 Lives

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Malignant Neoplasm

$380,991

Newborn/Infant Care

$769,376

Leukemia, Lymphoma, Multiple Myeloma

$374,326

Congenital Anomaly

$592,323

Orthopedics/Musculoskeletal

$282,625

Cardiovascular

$283,111

Neurological

$293,964

Respiratory

$277,444

Gastrointestinal/Abdominal

$172,732

Sepsis

$339,820

Health & Hospital - 1000+ Lives

Health & Hospital - 500 to 999 Lives

Malignant Neoplasm

$221,430

Cardiovascular

$184,758

Gastrointestinal/Abdominal

$138,570

Orthopedics/Musculoskeletal

$126,547

Leukemia, Lymphoma, Multiple Myeloma

$213,549

Neurological

$144,183

Urinary/Renal

$186,866

Respiratory

$131,094

Newborn/Infant Care

$337,635

Sepsis

$243,694

Health & Hospital - 200 to 499 Lives

Malignant Neoplasm

$168,248

Orthopedics/Musculoskeletal

$93,890

Cardiovascular

$112,454

Gastrointestinal/Abdominal

$88,487

Leukemia, Lymphoma, Multiple Myeloma

$202,686

Newborn/Infant Care

$335,212

Neurological

$72,658

Sepsis

$155,581

Physician treatment, not elsewhere categorized

$35,604

Respiratory

$77,000

Health & Hospital - Under 200 Lives

Malignant Neoplasm

$104,747

Orthopedics/Musculoskeletal

$66,876

Cardiovascular

$70,657

Gastrointestinal/Abdominal

$58,554

Newborn/Infant Care

$333,558

Urinary/Renal

$80,665

Leukemia, Lymphoma, Multiple Myeloma

$145,162

Neurological

$49,478

Physician Treatment, not elsewhere categorized

$17,527

Immune System

$75,106

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Manufacturing - 1000+ Lives

Malignant Neoplasm

$375,210

Leukemia, Lymphoma, Multiple Myeloma

$370,243

Newborn/Infant Care

$688,073

Cardiovascular

$265,773

Orthopedics/Musculoskeletal

$242,101

Sepsis

$369,790

Neurological

$193,405

Respiratory

$222,271

Hemophilia

$580,991

Gastrointestinal/Abdominal

$172,435

Manufacturing - 500 to 999 Lives

Malignant Neoplasm

$229,455

Cardiovascular

$148,036

Leukemia, Lymphoma, Multiple Myeloma

$250,477

Orthopedics/Musculoskeletal

$120,119

Gastrointestinal/Abdominal

$99,243

Respiratory

$121,426

Urinary/Renal

$169,766

Congenital Anomaly-Structual

$464,484

Sepsis

$187,907

Hemophilia

$479,638

Manufacturing - 200 to 499 Lives

Malignant Neoplasm

$195,280

Cardiovascular

$115,146

Orthopedics/Musculoskeletal

$103,786

Gastrointestinal/Abdominal

$84,091

Leukemia, Lymphoma, Multiple Myeloma

$206,178

Sepsis

$194,997

Respiratory

$80,674

Urinary/Renal

$100,221

Neurological

$94,885

Mental and Behavioral Health

$70,307

Manufacturing - Under 200 Lives

Malignant Neoplasm

$139,570

Cardiovascular

$85,035

Orthopedics/Musculoskeletal

$61,063

Gastrointestinal/Abdominal

$56,302

Respiratory

$54,292

Physician Treatment, not elsewhere categorized

$26,678

Mental and Behavioral Health

$49,369

Sepsis

$112,031

Urinary/Renal

$65,576

Neurological

$54,185

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Malignant Neoplasm

$304,226

Leukemia, Lymphoma, Multiple Myeloma

$298,435

Cardiovascular

$260,151

Orthopedics/Musculoskeletal

$180,102

Newborn/Infant Care

$187,822

Neurological

$505,317

Gastrointestinal Abdominal

$196,595

Hemophilia/Bleeding Disorder

$322,587

Sepsis

$149,450

Respiratory

$80,876

Management Services - 1000+ Lives

Management Services - 500 to 999 Lives

Malignant Neoplasm

$229,455

Orthopedics/Musculoskeletal

$120,119

Gastrointestinal Abdominal

$99,243

Cardiovascular

$148,036

Newborn/Infant Care

$307,935

Leukemia, Lymphoma, Multiple Myeloma

$250,477

Sepsis

$187,907

Mental and Behavioral Health

$116,559

Respiratory

$121,426

Physician treatment/not elsewhere categorized

$52,537

Management Services - 200 to 499 Lives

Malignant Neoplasm

$158,252

Cardiovascular

$106,977

Orthopedics/Musculoskeletal

$77,167

Newborn/Infant Care

$301,127

Gastrointestinal Abdominal

$75,181

Mental and Behavioral Health

$76,955

Neurological

$88,251

Urinary/Renal

$101,723

Leukemia, Lymphoma, Multiple Myeloma

$115,598

Sepsis

$207,563

Management Services - Under 200 Lives

Malignant Neoplasm

$111,306

Orthopedics/Musculoskeletal

$58,024

Cardiovascular

$78,499

Gastrointestinal/Abdominal

$66,394

Leukemia, Lymphoma, Multiple Myeloma

$231,373

Neurological

$46,807

Respiratory

$47,447

Mental and Behavioral Health

$42,685

Urinary/Renal

$63,870

Physician Treatment, not elsewhere categorized

$17,118

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Malignant Neoplasm

$297,048

Cardiovascular

$282,736

Orthopedics/Musculoskeletal

$256,866

Newborn/Infant Care

$566,837

Leukemia, Lymphoma, Multiple Myeloma

$318,739

Sepsis

$370,781

Gastrointestinal/Abdominal

$153,389

Hemophilia/Bleeding

$543,680

Physician Treatment, not elsewhere categorized

$94,355

Neurological

$221,315

Mining/Construction - 1000+ Lives

Malignant Neoplasm

$197,241

Cardiovascular

$127,212

Orthopedics/Musculoskeletal

$106,890

Gastrointestinal/Abdominal

$91,100

Cerebrovascular

$193,746

Congenital Anomaly

$254,162

Neurological

$82,779

Respiratory

$71,476

Newborn/Infant Care

$309,024

Sepsis

$144,169

Mining/Construction - 500 to 999 Lives

Malignant Neoplasm

$161,100

Orthopedics/Musculoskeletal

$103,766

Cardiovascular

$130,603

Gastrointestinal/Abdominal

$79,293

Sepsis

$149,913

Physician Treatment, not elsewhere categorized

$42,219

Mental/Behavioral Health

$108,684

Respiratory

$75,468

Newborn/Infant Care

$207,171

Neurological

$89,070

Mining/Construction - 200 to 499 Lives

Malignant Neoplasm

$131,513

Orthopedics/Musculoskeletal

$62,064

Cardiovascular

$82,038

Gastrointestinal/Abdominal

$62,808

Sepsis

$148,112

Respiratory

$58,495

Mental/Behavioral Health

$49,631

Newborn/Infant Care

$183,349

Physician Treatment, not elsewhere categorized

$22,284

Urinary/Renal

$74,424

Mining/Construction - Under 200 Lives

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Malignant Neoplasm

$337,433

Leukemia, Lymphoma, and/or multiple myeloma

$495,686

Sepsis

$533,147

Cardiovascular

$272,297

Orthopedics/Musculoskeletal

$203,661

Newborn/Infant Care

$529,645

Gastrointestinal/Abdominal

$189,976

Respiratory

$173,012

Neurological

$211,941

Urinary/Renal

$190,192

Public/Government - 1000+ Lives

Malignant Neoplasm

$221,498

Orthopedics/Musculoskeletal

$175,267

Cardiovascular

$162,764

Gastrointestinal/Abdominal

$119,332

Mental/Behavioral Health

$160,087

Respiratory

$123,889

Newborn/Infant Care

$313,920

Neurological

$120,498

Urinary

$138,500

Physician Treatment, not elsewhere categorized

$56,378

Public/Government - 500 to 999 Lives

Malignant Neoplasm

$192,401

Orthopedics/Musculoskeletal

$107,284

Cardiovascular

$112,133

Gastrointestinal/Abdominal

$90,238

Respiratory

$105,690

Sepsis

$200,697

Neurological

$106,396

Leukemia, Lymphoma, Multiple Myeloma

$183,530

Physician Treatment, not elsewhere categorized

$45,336

Newborn/Infant Care

$277,621

Public/Government - 200 to 499 Lives

Malignant Neoplasm

$178,304

Orthopedics/Musculoskeletal

$70,784

Cardiovascular

$64,068

Gastrointestinal/Abdominal

$60,520

Neurological

$69,244

Immune System

$83,295

Newborn/Infant Care

$229,643

Congenital Anomaly

$128,952

Cerebrovascular

$109,804

Physician Treatment, not elsewhere categorized

$20,795

Public/Government - Under 200 Lives

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Malignant Neoplasm

$362,627

Cardiovascular

$331,590

Newborn/Infant Care

$595,376

Leukemia, Lymphoma, Multiple Myeloma

$347,834

Gastrointestinal/Abdominal

$178,864

Sepsis

$354,732

Respiratory

$190,910

Neurological

$244,861

Orthopedics/Musculoskeletal

$173,324

Congenital Anomaly

$384,266

Finance, Insurance & Real Estate - 1000+ Lives

Malignant Neoplasm

$204,075

Cardiovascular

$141,504

Orthopedics/Musculoskeletal

$132,648

Gastrointestinal

$110,753

Newborn/Infant Care

$443,887

Neurological

$178,029

Leukemia, Lymphoma, Multiple Myeloma

$184,041

Respiratory

$113,879

Mental and Behavioral Health

$120,122

Urinary/Renal

$112,551

Finance, Insurance & Real Estate - 500 to 999 Lives

Malignant Neoplasm

$168,248

Orthopedics/Musculoskeletal

$93,890

Cardiovascular

$112,454

Gastrointestinal

$88,487

Newborn/Infant Care

$335,212

Leukemia, Lymphoma, Multiple Myeloma

$202,686

Respiratory

$77,000

Urinary/Renal

$92,302

Mental and Behavioral Health

$97,532

Hemophilia/Bleeding

$372,253

Finance, Insurance & Real Estate - 200 to 499 Lives

Malignant Neoplasm

$131,513

Orthopedics/Musculoskeletal

$62,064

Cardiovascular

$82,038

Gastrointestinal/Abdominal

$62,808

Respiratory

$58,495

Mental and Behavioral Health

$49,631

Physician Treatment, not elsewhere categorized

$22,284

Leukemia, Lymphoma, Multiple Myeloma

$109,321

Newborn/Infant Care

$183,349

Neurological

$45,335

Finance, Insurance & Real Estate - Under 200 Lives

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Services - 1000+ Lives

Malignant Neoplasm

$344,994

Newborn/Infant Care

$666,460

Cardiovascular

$316,243

Leukemia, Lymphoma, Multiple Myeloma

$396,399

Sepsis

$394,403

Orthopedics/Musculoskeletal

$157,364

Respiratory

$183,634

Malnutrition

$605,817

Gastrointestinal Abdominal

$132,201

Neurological

$191,645

Services - 500 to 999 Lives

Malignant Neoplasm

$214,189

Newborn/Infant Care

$991,454

Cardiovascular

$149,093

Orthopedics/Musculoskeletal

$121,187

Leukemia, Lymphoma, Multiple Myeloma

$262,121

Gastrointestinal/Abdominal

$107,608

Neurological

$173,287

Sepsis

$190,936

Respiratory

$142,196

Urinary/Renal

$151,675

Services - 200 to 499 Lives

Malignant Neoplasm

$177,777

Cardiovascular

$106,922

Gastrointestinal/Abdominal

$82,983

Orthopedics/Musculoskeletal

$84,305

Neurological

$114,904

Leukemia, Lymphoma, Multiple Myeloma

$198,908

Urinary/Renal

$102,571

Newborn/Infant Care

$283,163

Sepsis

$150,432

Mental and Behavioral Health

$86,043

Services - Under 200 Lives

Malignant Neoplasm

$122,523

Orthopedics/Musculoskeletal

$54,921

Cardiovascular

$73,603

Gastrointestinal/Abdominal

$59,169

Mental and Behavioral Health

$48,784

Physician Treatment, not elsewhere categorized

$24,602

Neurological

$51,880

Immune System

$85,800

Respiratory

$41,896

Urinary/Renal

$54,793

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Malignant Neoplasm

$340,431

Cardiovascular

$390,726

Orthopedics/Musculoskeletal

$309,356

Leukemia, Lymphoma,Multiple Myeloma

$368,725

Neurological

$224,239

Sepsis

$501,008

Respiratory

$231,971

Urinary/Renal

$226,504

Hemophilia/Bleeding Disorder

$542,460

Gastrointestinal Abdominal

$193,870

Transportation, Communication & Utilities - 1000+ Lives

Malignant Neoplasm

$227,151

Cardiovascular

$234,862

Orthopedics/Musculoskeletal/Disease/Disorder

$184,652

Congenital Anomaly

$433,308

Gastrointestinal Abdominal

$243,495

Leukemia, Lymphoma, Multiple Myeloma

$307,234

Malnutrition

$500,300

Newborn/Infant Care

$249,727

Cerebrovascular

$343,130

Respiratory

$116,014

Transportation, Communication & Utilities - 500 to 999 Lives

Malignant Neoplasm

$201,123

Cardiovascular

$96,392

Orthopedics/Musculoskeletal

$81,901

Urinary/Renal

$127,669

Gastrointestinal/Abdominal

$76,241

Mental and Behavioral Health

$89,149

Respiratory

$78,560

Sepsis

$151,046

Physician treatment/not elsewhere categorized

$37,288

Neurological

$62,770

Transportation, Communication & Utilities - 200 to 499 Lives

Malignant Neoplasm

$120,181

Cardiovascular

$87,192

Newborn/Infant Care

$1,304,485

Orthopedics/Musculoskeletal

$58,828

Gastrointestinal/Abdominal

$74,757

Sepsis

$125,859

Mental and Behavioral Health

$64,390

Neurological

$66,091

Physician treatment/not elsewhere categorized

$28,688

Cerebrovascular

$124,609

Transportation, Communication & Utilities - Under 200 Lives

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Wholesale & Retail Trade - 1000+ Lives

Malignant Neoplasm

$298,851

Cardiovascular

$316,030

Newborn/Infant Care

$649,800

Leukemia, Lymphoma, Multiple Myeloma

$377,923

Orthopedics/Musculoskeletal

$225,207

Congenital Anomaly

$624,720

Respiratory

$211,653

Sepsis

$351,664

Neurological

$229,606

Gastrointestinal/Abdominal

$130,518

Wholesale & Retail Trade - 500 to 999 Lives

Malignant Neoplasm

$213,270

Cardiovascular

$154,860

Orthopedics/Musculoskeletal

$123,915

Sepsis

$265,278

Neurological

$148,165

Leukemia, Lymphoma, Multiple Myeloma

$163,444

Gastrointestinal/Abdominal

$87,330

Urinary/Renal

$111,447

Cerebrovascular

$206,779

Respiratory

$81,091

Wholesale & Retail Trade - 200 to 499 Lives

Malignant Neoplasm

$173,997

Cardiovascular

$108,633

Orthopedics/Musculoskeletal

$93,612

Gastrointestinal/Abdominal

$97,935

Urinary/Renal

$113,653

Neurological

$105,384

Sepsis

$156,308

Leukemia, Lymphoma, Multiple Myeloma

$174,013

Respiratory

$85,253

Newborn/Infant Care

$290,809

Wholesale & Retail Trade - Under 200 lives

Malignant Neoplasm

$119,160

Cardiovascular

$80,171

Orthopedics/Musculoskeletal

$60,564

Gastrointestinal/Abdominal

$62,234

Sepsis

$122,845

Urinary/Renal

$73,763

Neurological

$69,790

Mental and Behavioral Health

$52,191

Respiratory

$51,351

Leukemia, Lymphoma, Multiple Myeloma

$160,647

1000+ Lives

500-999 Lives

200-499 Lives

U200 Lives

Due to industry and size segment breakdown, some of the conditions have a very small number of claims impacting average cost. Therefore, some of the averages may be higher or lower than expected. Source: Ranking and average cost is from 2021-2024 Sun Life Book of Business, first-dollar data and stop-loss reimbursements. Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL REV 7-12 and 22-SL. In New York, Group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12 and 22-NYSL. Policy offerings may not be available in all states and may vary due to state laws and regulations. Not approved for use in New Mexico. © 2025 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. The Sun Life name and logo are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. SLDX-1573-2-a #1362359261 05/24 (exp. 05/26)

Overall

Education

Health & Hospital

Manufacturing

Management Services

Mining & Construction

Public & Government

Finance, Insurance & Real Estate

Services

Transportation, Communication & Utilities

Wholesale & Retail Trade

Click here to select an Industry

Recommendations

Top 5 Conditions by Deductible

Top 50 High-cost Injectible Drugs

Top 10 Conditions by Industry

Report Highlights

Home

Top five high-cost conditions by deductible level

All Deductible Levels

Up to $50,000

$51,000–$100,000

$101,000–$250,000

$251,000–$500,000

OVER $500,000

Choose a deductible level:

Click on each condition to learn more

Condition

ALL DEDUCtiBLE LEVELS

Malignant Neoplasm

Cardiovascular

Orthopedics/Musculoskeletal

Newborn/ Infant Care

Leukemia, Lymphoma, Multiple Myeloma

Up to $50K

Malignant neoplasm

Orthopedics/Musculoskeletal

Cardiovascular

Gastrointestinal/Abdominal

Neurological

$51K–100K

Malignant neoplasm

Cardiovascular

Orthopedics/Musculoskeletal

Gastrointestinal

Leukemia, Lymphoma, Multiple Myeloma

$101K–250K

Malignant neoplasm

Cardiovascular

Orthopedics/Musculoskeletal

Gastrointestinal

Leukemia, Lymphoma, Multiple Myeloma

$251K–500K

Malignant neoplasm

Cardiovascular

Leukemia, Lymphoma, Multiple Myeloma

Orthopedics/Musculoskeletal

Newborn/infant care

Over $500K

Malignant neoplasm

Newborn/Infant care

Cardiovascular

Leukemia, Lymphoma, Multiple Myeloma

Orthopedics/Musculoskeletal/

Malignant neoplasm

This category contains diagnoses of what are commonly thought of as solid tumors, including treatment for the tumor, secondary conditions directly related to the tumor, and/or its treatment. Malignant neoplasm claims are over double the spend of the second most expensive condition: Leukemia, lymphoma, and/or multiple myeloma (blood cancers)

Average cost: $213.3K Highest cost: $2.7M

Medical 61%

Rx 39%

Leukemia, lymphoma and/or multiple myeloma

This category contains acute and chronic diagnoses of what are commonly thought of as cancers of the blood, secondary conditions directly related to leukemia, and/or its treatment.

Average cost: $222.2K Highest cost: $2.1M

Medical 66%

Rx 34%

Neurological

This category contains acute and chronic disease and injury related to the neurological system, including traumatic injury, primary and acquired disease, infectious disease, secondary conditions directly related to neurological compromise, and complications of treatment. This category combines what was previously five separate categories.

Average cost: $97.5K Highest cost: $2.86M

Medical 73%

Rx 27%

Gastrointestinal/Abdominal

This category contains disease and injury related to the gastrointestinal system (mouth to anus), including traumatic injury, infectious disease, thoracic organ disease, dental conditions covered under medical plan, oral and pharyngeal-esophageal disease, secondary conditions directly related to GI system compromise, and complications of treatment.

Average cost: $96.5K Highest cost: $2.4M

Medical 65%

Rx 35%

Respiratory

This category contains acute and chronic disease and injury related to the respiratory system, including primary and acquired disease, infectious disease, pulmonary heart disease, secondary conditions directly related to respiratory dysfunction, and complications of treatment. This category includes five conditions from our prior claims mapping.

Average cost: $99.5K Highest cost: $5.5M

Medical 82%

Rx 18%

Orthopedics/ Musculoskeletal

This category contains acute and chronic disease and injury of bone and soft tissue, including traumatic injury, primary and acquired disease and deformity, secondary conditions directly related to orthopedic dysfunction, and complications of treatment.

Average cost: $102.5K Highest cost: $3.3M

Medical 71%

Rx 29%

Newborn

This category contains disease and injury related to newborn infants, including disease and complications of prematurity and/or low birthweight, complications related to maternal conditions, complications and birth trauma related to labor/delivery, dysfunction related to immaturity of body systems, and complications of treatment. Four categories from our prior grouping system are now included in this condition.

Average cost: $470.8K Highest cost: $11.5M

Medical 100%

Cardiovascular

This category contains acute and chronic disease and injury related to the heart and blood vessels, including primary and acquired disease, traumatic injury, secondary conditions directly related to cardiovascular dysfunction, and complications of treatment.

Average cost: $144.2K Highest cost: $5.3M

Medical 94%

Rx 6%

To learn more, contact your Sun Life Stop-Loss Specialist or reach out here!

Recommendations

Top 5 Conditions by Deductible

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Top 10 Conditions by Industry

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Average cost

$81,962

$47,191

$57,211

$44,980

$47,077

$127,651

$90,042

$69,667

$71,240

$150,961

$200,706

$138,688

$117,243

$102,256

$200,670

$326,080

$253,748

$323,574

$205,165

$508,160

$600,812

$993,039

$605,431

$625,059

$551,436

$228,088

$275,357

$423,438

$119,866

$143,905

Recommendations

Top 5 Conditions by Deductible

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Click here to see our compilation of the top 50 injectable drugs to help you anticipate what drugs could impact your claims.

Top 50 high-cost Injectable drugs

Learn more about each injectable drug including year-over-year member data, ranking changes, usage, and more.

Recommendations to improve population health and manage high-cost claims

To learn more, contact your Sun Life Stop-Loss Specialist or reach out here!

By providing solutions that focus on preventative measures, early intervention, and support for both common and complex health conditions, employers can more effectively manage population health risks and improve employee well-being while better managing high-cost claims.

Maximizing your benefits to improve care and cost

• Focus on preventative resources and early intervention solutions before care needs become more severe. • Offer resources that help employees make timely, informed decisions about their health like second opinion services and care navigation. • Implement solutions that can make a measurable difference for more severe conditions that are likely to impact your book of business.

Solving for access challenges

• Invest in care navigation/advocacy support so employees get help finding the right in-network providers, get appointments quickly, and get help with any prior authorization or other hurdles.

Sun Life stop-loss clients have access to many health solutions for their employees that target many of these strategies. Click here to learn more!

Recommendations

Top 5 Conditions by Deductible

Top 50 High-cost Injectible Drugs

Top 10 Conditions by Industry

Report Highlights

Home

Understanding your risk preferences

• Understand expected claims by staying informed on trends specific to your employer size and deductible level. • Build the right stop-loss coverage by strategically selecting your deductible, aggregate protection, and contract terms that match your cash-flow preferences and expected claims levels.