The 2019 Sun Life stop loss trend report is out. Acknowledging the impact of specialty medication costs, this report has been retitled as “High-Cost Claims and Injectable Drug Trends.” The largest single Sun Life claim was $7.5 million and the largest injectable drug claim was $1.8 million. Injectable drugs account for 9.2% of the total cost of large cost claims.
Cancer claims continue to dominate with almost 27% of claims paid. In 2018, 85% of policies have had some reimbursement, with 51.9% of employers submitting at least one cancer claim. Breast cancer claims represent almost one-third of the total cost and 77% of breast cancer claim costs are from those aged 20–59.
Average stop loss deductibles by plan size are:
1,000 or greater lives $300,000
500–999 lives $150,000
200–499 lives $100,000
Fewer than 200 lives $50,000
The number of claims over $3 million doubled from 2017 to 2018. Sun Life expects that severity will continue to increase with gene therapy drug releases expected to explode, and it is anticipated that there will be between 10–20 new Food and Drug Administration approvals by 2025. As a result of these new drugs, cancer survival is expected to increase by 31%.
It is important to understand that all stop loss policies are not the same. Contractual nuances and timely disclosures can have a significant impact on reimbursement.
Expert advice on these placements is essential.