Cancer and cardiovascular conditions account for over one-third of stop-loss reimbursements, according to a recent report from stop-loss carrier Sun Life.
As the chart below shows, the top three conditions represent 38% of total payments. Additionally, 70% of all member stop-loss reimbursements came from the top 10 conditions, and 91% come from the top 20 conditions.
The ranking of costliest conditions has remained fairly stable in recent years, though the pandemic has impacted things a bit. For the four-year period from 2018 to 2021, COVID-19 ranked as the 19th most costly condition, despite amassing only two years worth of claims. (COVID-19 claim reimbursements ranked #8 overall in 2021.)
Other findings include:
- 21% of employers had a member with over $1 million in claims during the 2017-2020 benefit period. (From 2020 to 2021 alone, total million-dollar claims increased by 19%.)
- Members with a Mental and Behavioral Health claim is up 21% over 2020.
- Cancer conditions have been the #1 and #2 high-cost claims for the past decade, with cancer drugs making up 11 of the top 20 high-cost injectable drugs in 2021.