Sun Life U.S. announced on May 21 the release of its annual High-Cost Claims and Injectable Drug Trends report, which examined more than 70,000 high-dollar medical claims from over 3,300 self-funded employers nationwide. The report found that secondary health conditions, long hospital stays, and injectable drugs are key factors behind claims exceeding $3 million.
The findings highlight the growing financial impact of complex medical conditions on employers and health plans. Understanding these drivers is important for managing risk and improving care outcomes for patients with costly or complicated diagnoses.
According to Sun Life U.S., some of the most common conditions leading to claims above $3 million include orthopedic or musculoskeletal (MSK) issues, newborn or infant care related to premature birth, and cancer. While cancer and premature births have consistently driven high-cost claims in recent years, orthopedic/MSK conditions have only recently reached this level due to increased severity and advancements in treatment options. These two categories—orthopedic/MSK conditions and cancer—are also frequent reasons for short-term disability claims.
“We have a real opportunity to help people achieve meaningful, improved health outcomes by prioritizing whole-person care,” said Jennifer Collier, president of Health and Risk Solutions at Sun Life U.S. “Several of these high-cost health conditions occur as comorbidities, such as orthopedic/MSK and cancer. We tend to think about diagnoses and treatments individually, but care is more effective when we recognize the interconnectedness of health conditions. By getting people the right care, we can improve both health and cost outcomes, benefitting both members and employers.” Collier said that multiple coexisting diseases can complicate treatment plans: “Comorbidities have long been a major contributor to high-cost and multimillion-dollar claims.” The analysis identified strong links among cancer, cardiovascular disease, chronic kidney disease (CKD), and MSK disorders—all sharing risk factors like age or obesity.
The report also noted that healthcare costs continue rising as specialty treatments such as gene therapies become more common. Million-dollar-plus claims increased by 46% from 2022–2026; spending on liver disease grew by 43% in one year; Elevidys—a gene therapy for Duchenne muscular dystrophy—averaged $3.6 million per patient; while blood cancers generated some of the highest individual claim amounts.
Conditions associated with obesity—including kidney disease or cardiovascular issues—remain significant contributors to large medical expenses. GLP-1 medications are seeing broader use among eligible patients: “While the cost of GLP-1s per person is still relatively low,” Sun Life reported that “high-dollar claims that include GLP-1s increased by 24% over the past year.”
Programs providing targeted support services—for example those addressing MSK problems through Hinge Health or offering clinical reviews—can help reduce costs while improving patient outcomes for frequent high-expense diagnoses like cancer or orthopedic injuries.
Sun Life Financial operates internationally across Canada, the United States, Asia, and Europe; it provides insurance products along with wealth management solutions for individuals as well as corporate clients according to the official website. Kevin Strain serves as president and chief executive officer according to the official website.
