What drives multimillion-dollar medical claims? Sun Life report shows secondary health conditions, hospital stays and specialty drugs among key factors

WELLESLEY, Mass., May 21, 2026 /PRNewswire/ -- Sun Life U.S. has released its annual High-Cost Claims and Injectable Drug Trends report, which analyzed over 70,000 high-dollar medical claims from more than 3,300 self-funded employers across the country. This year's report shows that secondary (comorbid) conditions, long inpatient hospitalizations and injectable drugs are the biggest drivers of claims above $3 million. Other contributing factors include conditions existing from birth (congenital anomalies), complicated surgeries and gene therapies.

Some of the most common conditions resulting in claims above $3 million include orthopedic/musculoskeletal (MSK) conditions, newborn/infant care (premature birth) and cancer. While cancer and premature births have been top drivers of million-dollar and multimillion-dollar claims for several years, orthopedic/MSK conditions have only recently reached this level, suggesting increases in severity as well as developments in therapies and treatments. Orthopedic/MSK conditions and cancer are also two of the most frequent diagnoses 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, Health and Risk Solutions, 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."

Comorbidities have long been a major contributor to high-cost and multimillion-dollar claims. Multiple conditions can complicate treatment plans, exacerbate the primary diagnosis and prolong recovery. Sun Life's claims data analysis in the report identifies strong connections among cancer, cardiovascular and chronic kidney diseases, and orthopedic/MSK conditions. These conditions share several risk factors, including age, obesity, diabetes and inflammation.

Rising cost of care

Healthcare costs continue to increase as specialty treatments and gene therapies become more prevalent. Supporting these life-saving treatments is crucial, as Sun Life continues to explore ways to improve outcomes and manage risk.

• Million-dollar+ claims increased in frequency by 46% from 2022 – 2026.
• Spending on treating liver disease grew 43% in 2025 from the previous year, with an average cost per patient of $230,000.
• The most expensive drug treatment, at an average cost of $3.6 million, was Elevidys, a gene therapy that slows the progression of Duchenne muscular dystrophy.
• The highest multimillion-dollar claims were for blood cancers (leukemia/lymphoma/myeloma), with an average of $5.45 million in 2025; the highest claim for a single leukemia patient in 2025 was nearly $8 million.

Impact of GLP-1s

Many high-dollar conditions are associated with obesity and diabetes. Employers have an opportunity to broaden coverage of GLP-1s and proactively reduce the risk of major health conditions that can result in high-dollar claims.

• While the cost of GLP-1s per person is still relatively low, high-dollar claims that include GLP-1s increased by 24% over the past year.
• GLP-1s have broader patient eligibility than many of the higher-cost specialty drugs in Sun Life's report, and can significantly reduce the risk of costlier conditions associated with obesity.
• Several of the highest-cost conditions (kidney disease, cardiovascular disease and orthopedic/MSK conditions), are often associated with obesity and related health issues.

Why health services matter

Programs that provide health support services can have substantial impact on health outcomes and reduce medical costs, particularly if they target the more frequently seen conditions like cancer and MSK – also both common conditions for disability leave.

• Osteoarthritis (OA), a common MSK condition, is more prevalent (54%) in patients on dialysis for chronic kidney disease (CKD). Research cited in the report suggests that OA may even be considered a predictor for CKD.
• The most prevalent and frequent diagnosis among people aged 20–59 (i.e. those in the workforce) were solid cancers (malignant neoplasm).

Sun Life's Health and Risk Solutions are designed to address the conditions and factors that drive high-dollar claims and are available with its stop-loss coverage. The solutions include:

• Orthopedic/MSK health support services through Hinge Health
• Clinical 360 
  • High-dollar claims review from clinical experts to identify cost reduction opportunities
  • Access to site- or home-based specialty drug infusions through OptiMed
• Health Navigator – personalized healthcare navigation services that get people the right care at the right time
• Expert Cancer Review – second opinions from expert oncologists to ensure patients receive right diagnosis and treatment plan (also part of Health Navigator services)

Sun Life issues the High-Cost Claims and Injectable Drug Trends report annually, covering four-year spans of medical stop-loss claims. As the largest independent stop-loss provider in the country, Sun Life is uniquely qualified to offer analysis and commentary on the prevailing trends in care navigation, rising cost of care, complex conditions and drug treatments.

Click here to register for Sun Life's upcoming webinar to learn more about this year's report from Sun Life experts. To explore Sun Life's Health and Risk Solutions, including stop-loss insurance, visit: Stop-Loss insurance | Sun Life U.S.

About Sun Life

Sun Life is a leading international financial services organization providing asset management, wealth, insurance and health solutions to individual and institutional Clients. Sun Life has operations in a number of markets worldwide, including Canada, the U.S., the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Australia, Singapore, Vietnam, Malaysia and Bermuda. As of March 31, 2026, Sun Life had total assets under management of C$1.58 trillion. For more information, please visit www.sunlife.com.

Sun Life Financial Inc. trades on the Toronto (TSX), New York (NYSE) and Philippine (PSE) stock exchanges under the ticker symbol SLF.

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 48 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. Sun Life employs nearly 8,300 people in the U.S., including associates in our partner dental practices and affiliated companies in asset management. Group insurance policies are issued by Sun Life Assurance Company of Canada (Wellesley Hills, Mass.), except in New York, where policies are issued by Sun Life and Health Insurance Company (U.S.) (Lansing, Mich.). For more information visit our website and newsroom.

Media Contact:

Devon Fernald

Sun Life U.S.

Devon.portney.fernald@sunlife.com

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SOURCE Sun Life U.S.