Secondary (comorbid) conditions, long inpatient hospitalizations and injectable drugs are the biggest drivers of expensive claims, according to the latest High-Cost Claims and Injectable Drug Trends report from Sun Life U.S. Other contributing factors include congenital anomalies, complicated surgeries and gene therapies, according to an analysis of more than 70,000 high-dollar claims from self-funding employers .
Some of the most common conditions resulting in claims greater than $3 million include orthopedic/musculoskeletal (MSK) conditions, premature birth and cancer. Although cancer and premature births have been top drivers of million-dollar and multimillion-dollar claims for several years, orthopedic/MSK conditions 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.
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. Data analysis in the report identifies strong connections between cancer, cardiovascular and chronic kidney diseases, and orthopedic/MSK conditions. These conditions share several risk factors, including age, obesity, diabetes and inflammation.
See also: As chronic illness drives persistent high-cost claims, how HR can strategize
Healthcare costs increase as specialty treatments, gene therapies rise
Healthcare costs continue to increase as specialty treatments and gene therapies become more prevalent:
- Million-dollar-plus claims increased in frequency by 46% from 2022 to 2026.
- Spending on treating liver disease grew 43% in 2025 from the previous year, with an average per-patient cost 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, with an average of $5.45 million in 2025. Meanwhile, the highest claim for a single leukemia patient in 2025 was nearly $8 million.
- 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.
Programs that provide health support services can have a substantial impact on health outcomes and reduce medical costs, particularly if they target more frequently seen conditions such as cancer and MSK.
“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 for 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.”
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