A new Sun Life analysis shows high-cost claims continue to strain employer health plans. The annual High-Cost Claims and Injectable Drug Trends report identifies comorbid conditions, long inpatient stays, and injectable specialty drugs as primary drivers of claims over $3 million.
Key findings:
- Million-dollar-plus claims rose 46% from 2022 to 2026.
- Top drivers include cancer, cardiovascular disease, orthopedic/MSK conditions, and premature births.
- Blood cancers produced the highest claims, averaging $5.45 million in 2025.
- Injectable specialty drugs and gene therapies are driving costs higher, with Elevidys (Duchenne muscular dystrophy) averaging $3.6 million per patient.
- High-dollar GLP-1 claims increased 24% in the past year.
The report highlights how comorbidities — such as cancer, cardiovascular disease, chronic kidney disease, obesity, and MSK disorders — are worsening claim severity by complicating treatment and extending recovery.
Sun Life stresses the need for strong cost-containment: clinical claim reviews, care navigation, specialty pharmacy management, and wellness programs to prevent chronic conditions from becoming catastrophic.
These strategies align closely with MedBen’s 2026 Client Report, which offers practical solutions for controlling medical and pharmacy spend while reducing risk for employers and members.