Sun Life Sees 46% Jump in $3M+ Claims; Elevidys Costs Average $3.6M
Sun Life U.S. data shows $3M+ medical claims frequency rose 46% from 2022–2026, driven by comorbidities, long hospitalizations and injectable drugs. The most expensive gene therapy, Elevidys, averages $3.6M per patient, while blood cancer claims top $5.45M, prompting Sun Life to expand Health & Risk Solutions.
1. Key Drivers of Soaring Medical Claims
Sun Life U.S. analyzed over 70,000 high-dollar medical claims from more than 3,300 self-funded employers, identifying comorbid conditions, extended inpatient stays and injectable drugs as primary factors in claims exceeding $3 million. Orthopedic/musculoskeletal issues, premature infant care and cancer emerged as the most frequent diagnoses in these multimillion-dollar claims.
2. Escalating Therapy and Hospitalization Costs
Million-dollar-plus claims surged 46% between 2022 and 2026, with liver disease spending up 43% in 2025 at $230,000 per patient. The gene therapy Elevidys averaged $3.6 million per treatment, and blood cancer claims averaged $5.45 million, with the largest single leukemia claim approaching $8 million.
3. Implications for Stop-Loss Insurance
The dramatic rise in high-cost claims increases pressure on Sun Life’s stop-loss underwriting, potentially driving premium adjustments and higher loss reserves. These trends could materially affect the company’s underwriting margins and risk management strategies in its employee benefits segment.
4. Expanded Health & Risk Solutions
To mitigate escalating costs, Sun Life has bolstered its Health & Risk Solutions offerings, including Hinge Health orthopedic support, Clinical 360 high-cost claims reviews, OptiMed specialty drug infusion access, Health Navigator care coordination and Expert Cancer Review second opinions.