Five Questions Health Plans Should Be Asking About Runaway Dermatology Biologic Spend

There have been many conversations around how to address the rising dermatology biologic spend, which continues to grow 45.7% year over year — one of the fastest-growing categories in specialty pharmacy, and a top driver of spend for most health plans. Current care models simply aren't built to reduce it. Formulary strategy and prior authorizations control which drug gets paid for; they don't reassess whether a member still needs the drug (or the same amount). That's the gap.

For finance and pharmacy teams, though, questions around care models haven't traditionally been part of the cost conversation. But with new data on the safety and efficacy of biologic dose reduction showing the opportunity to reduce runaway drug spend, this needs to change. 

Here are five questions health plans should be asking about a member's biologic prescription before the next formulary or budget cycle.

The Questions Health Plans Should Ask Now

1. Do we know how many members are still on full dose after reaching remission?

While most plans can answer questions about prescriptions, almost none can answer questions about disease activity, such as if a member is in remission. That means you know who filled a biologic prescription last quarter but you don't know how many of those members have been in stable, controlled disease for six months or longer.

Based on the DR Delphi consensus and the population studies in the BeNeBio trial, these people may be eligible for dose reduction, meaning a more appropriate and less expensive prescription. In fact, of those who attempted dose reduction, 73.2% successfully were.

Zest Health can help you identify those members and determine if they will clinically benefit from a change in their dose.

2. Is our formulary strategy bending the trend or just shifting which drug we pay for?

Your plan’s formulary strategy may circle around step therapy and biosimilar substitution, but that does not address whether a member still needs the biologic their clinician prescribed. 

Unless a formulary strategy is supported by a new approach to prescribing, you’re missing a larger opportunity to safely step down, not just step sideways to a different drug. 

Tech-enabled reassessment and monitoring are key for ensuring that patients continue to remain on an appropriate treatment. 

3. Is there a clinical case for dose reduction?

In 2026 there were two publications that underscore the safety, efficacy, and outcomes of biologic dose reduction in patients with stabilized moderate to severe psoriasis. There has been compelling evidence behind reassessing patients in remission and either reducing or deprescribing their biologic dose to both improve outcomes and reduce total drug cost. Additionally, a global body of expert dermatologists collectively agree.

The peer-reviewed clinical evidence is specific for the newer, most expensive biologics on formularies. They are very effective at improving psoriasis and may not be needed once a member reaches sustained control. 

4. What’s the budget liability of biologics and how is ROI of dose reduction calculated? 

Zest Health’s partnership with not-for-profit health plan Independent Health, which covers approximately 325,000 lives, confirmed delivery of a 3.1:1 ROI and more than $17,000 annual net savings per member enrolled, with more than 50% successfully deprescribed biologics with improved outcomes. 

While cost savings data for biologic dose reduction can be hard to calculate, these results show that more than half of patients may be eligible for a decrease in their biologic dose, which means they aren’t on the correct medication. 

Finance teams at health plans are often asking about liability. Ask any vendor proposing a dose-reduction or biologic stewardship program for their actual return on investment, calculated against your own population, not just an industry average. This is the difference that’s being shown through offering value-based dermatology to members. 

5. Are we sizing a narrow pilot or a program built to reach enough members to matter?

More than 28 million people live with eczema and 8 million with psoriasis, and biologic spending is concentrated enough — with dose-reduction eligibility broad enough — to make a program like Zest worth implementing.

The value-based dermatology care model is at-risk, meaning Zest is paid based on the outcomes and savings it delivers for your population, not a guaranteed fee regardless of performance.

When evaluating partners, ask what enrollment volume the program is actually designed to reach and whether that number is big enough to move your trend line, not just produce a case study. With Zest Health, you can get up and running in as little as six weeks.

Final Thoughts on Navigating Runaway Dermatology Biologic Spend

Prior authorization and biosimilar substitution were built to answer "which drug." They were never built to answer "does this member still need it." 

That “off-ramp gap” is exactly where dermatology biologic spend keeps growing, unbothered by the utilization management tools plans already have in place.

The clinical evidence for closing that gap is no longer theoretical. Zest Health's value-based dermatology model is built specifically to operationalize dose reduction by identifying eligible members, monitoring disease activity, and enabling clinicians to safely reassess treatment intensity at scale, not one pilot cohort at a time.

None of this requires waiting for a new formulary cycle to start asking the questions. Pharmacy already has the utilization data. Finance already owns the budget conversation. The only missing piece has been a clinical case solid enough to act on. Between the DR Delphi consensus and the BeNeBio trial, that piece is no longer missing.