Cancer continues to top the list as the highest-cost condition, accounting for 27% of total stop-loss reimbursements. Injectable drugs also have a significant impact, accounting for 9% of total paid claims. The largest claim for a single injectable drug was $1.8m. With the FDA approval of Zolgensma, a $2M+ treatment for a rare childhood disorder and just the latest example of a high-priced specialty drug, employers can only expect to see multi-million-dollar claims with greater frequency.
In this new landscape, it’s hard for even the largest employers to forgo stop-loss insurance. Mercer’s National Survey of Employer-Sponsored Health Plans found that among jumbo employers – those with 20,000 or more employees – the use of stop-loss jumped from 31% to 38% from 2016 to 2018. Sun Life’s highest claim topped out at $7.5 million in 2018, but we’ve seen claims over $20 million. Make sure you’re not taking unnecessary risks with your health dollars. If you have stop-loss in place, how good is it? Despite the increased risk, we’ve been able to negotiate contracts that include a rate cap and no new laser provisions, good for at least two renewals periods. Check your stop-loss policy and see if you need to negotiate better terms.