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Million-dollar medical claims went up 87% in last three years

24 Jul 2018 5:32 PM | Bill Brewer (Administrator)


Valerie Bolden-Barrett


July 24, 2018

Dive Brief:

  • The number of patients filing million-dollar medical claims rose 87% from 2014 to 2017, Sun Life Financial's 2018 High-Cost Claims Report found. Cancer treatments remain the costliest of healthcare services; high-cost medical conditions added up to $6.9 billion in paid charges from 2014 to 2017 during the four-year period.
  • According to Sun Life Financials, re-imbursements to self-insured employers totaled $798.7 million from 2014 to 2017. Of charges over $1 million, most ranged from $1 million to $1.5 million, with a total of more than $935 million in paid charges. Dan Fishbein, M.D., president of Sun Life Financial U.S., said that new life-saving treatments are fueling the growth in million-dollar claims.  
  • The report also found that rare medical conditions, including hereditary conditions like angioedema and hemophilia, had the highest costs. Patients with claims higher than $1 million made up 2% of stop-loss claims from 2014 to 2017; and four of the five most expensive injectable medications, used to treat cancer-related conditions, accounted for about $45 million. 

Dive Insight:

Drug costs account for much of the rise in medical expenses; prescription drug plans can make up from 18% to 25% of total healthcare costs, according to a PwC report. And for specialty drugs, the percentage can rise as much as 30%. Employers can reap some of the savings through rebates and discounts from pharmacy benefit managers (PBMs). Savings, however, are mostly on brand-name drugs, rather than less costly generic drugs. 

Some proposals for saving on drug and medical costs include: conducting clinical reviews of drug formularies; eliminating unnecessary or low-value medical procedures; and offering account-based health plans (ABHPs) with health savings accounts (HSAs), strategies attributed to "high-performing" organizations, according to a Willis Towers Watson study released in March.

The industry has seen a number of big moves, company-wise, in the pharmaceutical space in recent months, including CVS's deal to buy Aetna — a move that experts say could force employers to rethink common assumptions about how they purchase prescription drug benefits. Amazon, also, recently made headlines for its purchase of PillPack, an online pharmacy offering home delivery.

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Source: HR Dive


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