Key Trends and Challenges: Medical Claims and Injectable Drug Trends for 2024

Navigating Rising Costs: The Shifting Landscape of Health Insurance and High-Cost Claims

As the global insurance landscape continues to evolve, complexity and cost pressures are intensifying—particularly in the areas of high-cost medical claims and specialty drug treatments. Drawing from a comprehensive analysis of over $13.5 billion in claims data from 2020 to 2023, this report offers key insights into the financial forces shaping the future of healthcare and insurance.

By examining the trends behind surging medical expenses, this report empowers insurers, employers, and clients with the data needed to make informed, strategic decisions in an increasingly volatile environment.

The Escalating Challenge of High-Cost Claims

One of the most persistent and disruptive trends in the healthcare space is the sharp rise in million-dollar claims. In 2023 alone, the number of claims exceeding $1 million rose by 8%, with 32 claims surpassing the $3 million threshold—nearly double the previous year.

The most frequent drivers of high-cost claims include:

• Malignant neoplasms (cancers)

• Cardiovascular diseases

• Newborn and infant care

• Congenital anomalies

Most notably, congenital anomalies now account for 50% of all $3 million+ claims, revealing a significant and growing impact from lifelong conditions that often originate in infancy. These complex cases represent not only medical but also long-term financial challenges for insurers and plan sponsors alike.

Injectable Drugs: Innovation Driving Cost Pressure

The financial impact of injectable drug therapies continues to climb, fueled by both innovation and necessity. In 2023, Keytruda remained the most expensive injectable drug, with a total spend of $69.7 million.

Cancer therapies dominate this category, representing more than half of the top 20 high-cost injectable drugs. New treatments such as Enhertu—approved for metastatic breast and lung cancers—signal important clinical progress but also introduce heightened financial strain for carriers and employers.

Additionally, ultra-rare disease therapies, including gene therapies, though less frequent, carry price tags that can dramatically disrupt budgets when administered—even to a single patient.

Medical Inflation and Its Ripple Effect on Premiums

Healthcare costs are not rising in isolation—they’re fueling broader medical inflation and pressuring the economics of insurance.

The drivers are multifaceted:

• Demand for advanced diagnostics and biologics

• Aging populations and chronic disease prevalence

• Increased reliance on high-cost therapies

As costs rise, insurance premiums must adapt accordingly—balancing the need for comprehensive coverage with long-term sustainability. For businesses and individuals alike, this underscores the importance of choosing carriers with strong financial ratings, capable of withstanding and absorbing this upward pressure.

Strategic Takeaways for 2025

✅ Early Intervention is Critical

Proactive strategies such as prehabilitation, education, and access to second opinions not only improve clinical outcomes but also help mitigate long-term cost exposure.

✅ Partner-Centric Ecosystems Deliver Value

A strong Third-Party Administrator (TPA) with deep relationships across providers, pharmaceutical partners, and advocacy organizations can streamline care delivery while enhancing cost containment.

✅ Work with the Right Advisory Partner

Insurance Advisors Global Partners brings the expertise and infrastructure to guide clients through today’s challenges with tailored, forward-thinking solutions. Your health coverage strategy should be led by an advisor with a global perspective, strategic mindset, and access to top-rated insurers—ensuring that your protection is not only robust, but sustainable.

The Bottom Line: The rise in high-cost medical claims is not a passing trend—it’s a defining feature of modern healthcare. As we move into 2025, the key to thriving in this environment lies in data-driven strategy, proactive planning, and strong partnerships.