Author: Corey Wise, RPh, M.S., BCOP, Senior Clinical Oncology Pharmacist, OncoHealth
Health insurance premiums are projected to see their largest increase in 15 years — and rising cancer rates among working-age adults are partly to blame. Here’s how prevention and utilization management can help keep healthcare sustainable.
If your health insurance premiums are going up, you’re not alone. The Wall Street Journal recently reported that employers are bracing for the largest health premium increases in 15 years, with costs expected to rise by nearly 9.5% in 2026 (WSJ, 2025). While inflation and drug prices play a role, a less obvious driver is emerging: the rising tide of cancer among younger, working-age adults.
Recent studies show cancers once considered diseases of aging — colorectal, uterine, kidney, and pancreatic — are appearing with increasing frequency in adults under 50 (Sung et al., 2019; Koroukian et al., 2019; Shiels et al., 2025). Researchers point to the obesity epidemic, environmental exposures, and delayed screenings as key contributors (Berger, 2018). This trend has sweeping economic consequences, hitting both household budgets and employer-sponsored health plans.
For people in their prime working years, a cancer diagnosis often brings more than a health crisis — it triggers financial turbulence. Among privately insured patients, especially those in high-deductible plans, out-of-pocket costs during the first six months of treatment typically exceed $3,500–$4,700 (Fu et al., 2021; Zhao et al., 2024). Lost wages, reduced productivity, and time away from work compound the burden (Yabroff et al., 2024; Grabowski et al., 2023).
At the system level, these individual hardships translate into mounting claims for employers and insurers. Modern cancer treatments — immunotherapies, targeted biologics, genomic testing, and long-term surveillance — are medical marvels, but they are also major cost drivers (Walker et al., 2022). As utilization rises, so do premiums, affecting every policyholder in the pool.
This is where utilization management (UM) steps in. Often criticized for red tape, UM strategies — such as medical necessity review and clinical pathways — are designed to help ensure that expensive therapies are used appropriately and supported by clinical evidence.
In cancer care, where costly, often biomarker-driven new therapies come to market at a rapid pace, UM helps verify that a six-figure drug truly matches the patient’s tumor type, molecular profile, and treatment stage and aligns with standard-of-care or best-practice guidelines. UM reviews in oncology are best led by highly experienced, expert teams that include oncology pharmacists and board-certified oncologists. These reviews may seem bureaucratic, but they play a vital role in curbing unnecessary spending and helping slow runaway premium growth, not to mention providing much needed clinical decision support in a dynamic treatment landscape.
Utilization management can’t reverse cancer trends alone. The deeper solution lies upstream — in prevention, early detection, and policy design. Employers can champion workplace wellness programs, promote cancer screenings, and adopt benefit structures that reward preventive care. Policymakers can strengthen coverage continuity and try to address modifiable cancer risks such as obesity and inactivity (Albright et al., 2021).
Rising cancer rates among working-age adults are reshaping the healthcare landscape and helping fuel the biggest premium surge in over a decade. Meeting this challenge will require a united front:
- Employers: Invest in prevention, early detection and evidence-based plan design.
- Insurers: Use utilization management responsibly to balance access with affordability.
- Policymakers: Stabilize coverage markets and support prevention research.
- Individuals: Stay proactive — get screened, stay informed, and live healthier.
Cancer may be striking earlier, but with prevention, smart oversight, and policy reform, we can protect both patients — and the insurance system — for the long run.
References
- Wall Street Journal. Health Insurance Costs for Businesses to Rise by Most in 15 Years. Sept. 10, 2025. wsj.com
- Sung H, Siegel RL, Rosenberg PS, Jemal A. Emerging Cancer Trends Among Young Adults in the USA. The Lancet Public Health. 2019;4(3):e137–e147.
- Koroukian SM, Dong W, Berger NA. Changes in Age Distribution of Obesity-Associated Cancers. JAMA Network Open. 2019;2(8):e199261.
- Shiels MA, Haque AT, de Gonzalez AB, et al. Trends in Cancer Incidence and Mortality Rates in Early-Onset and Older-Onset Age Groups in the United States, 2010-2019. Cancer Discovery. 2025;15(7):1363-1376.
- Berger NA. Young Adult Cancer: Influence of the Obesity Pandemic. Obesity (Silver Spring). 2018;26(4):641–650.
- Yabroff KR, Doran JF, Zhao J, et al. Cancer Diagnosis and Treatment in Working-Age Adults. CA: A Cancer Journal for Clinicians. 2024;74(4):341–358.
- Grabowski DC, Kansal AR, Goldman DP, Lakdawalla DN. Assessment of Medical and Public Assistance Expenditures and Employment Among US Adults With Cancer. JAMA Network Open. 2023;6(5):e2315823.
- Fu SJ, Rose L, Dawes AJ, et al. Out-of-Pocket Costs Among Patients With a New Cancer Diagnosis in High-Deductible vs Traditional Insurance Plans. JAMA Network Open. 2021;4(12):e2134282.
- Zhao J, Parsons H, Perraillon M, et al. Healthcare Spending and Out-of-Pocket Burden After a Cancer Diagnosis. JCO Oncol Pract. 2024;20(Suppl 10):16.
- Walker SL, Williams JS, Lu K, Dawson AZ, Egede LE. Trends in Healthcare Expenditures Among Adults by Cancer Status, 2008–2016. Cancer Epidemiol Biomarkers Prev. 2022;31(8):1661–1668.
- Albright BB, Chino F, Chino JP, et al. Insurance Churn and Catastrophic Health Expenditures Post-ACA Among Nonelderly Cancer Patients. JAMA Network Open. 2021;4(9):e2124280.