How Can We Operationalize Biologic Dose Reduction?
During a recent conversation with a health plan, we were asked how it's possible to bring to life the consensus recommendations established through the DR Delphi study.
The truth is, we've already been doing it.
At Zest Health, we have long recognized that the overutilization of biologics among patients with psoriasis is a significant driver of specialty drug spend. We've also seen firsthand—both through the growing body of clinical evidence and through our own care model—that many patients who achieve sustained remission can maintain excellent outcomes with less treatment.
In fact, more than 50% of members who come to Zest on a biologic successfully reduce their treatment intensity while maintaining or improving their outcomes.
The DR Delphi Consensus Creates a Framework for Change
The recently published DR Delphi consensus is an important milestone because it formalizes what many dermatologists have observed in practice for years: treatment success shouldn't always mean continuing the exact same therapy indefinitely. For some patients in remission, reassessing biologic dosage and considering structured dose reduction or step-down therapy may be appropriate.
With additional validation from the consensus, the question is no longer whether biologic dose reduction is possible. The challenge now is operationalizing it at scale.
Why Reassessment Has Been Difficult to Implement
One of the biggest barriers to biologic stewardship is that most care models were built to initiate treatment—not continually optimize it. Once patients achieve remission, there is often no structured point for reassessment. Follow-up visits become less frequent, creating fewer opportunities to evaluate whether treatment intensity still aligns with a patient's clinical needs.
As a result, many patients remain on therapies that may no longer be necessary at their current intensity—not because providers are making the wrong decisions, but because the healthcare system lacks the operational infrastructure to support routine reassessment.
For some patients who have achieved sustained disease control, the medication effect may be greater than what is needed to maintain outcomes, resulting in treatment intensity that exceeds clinical need and unnecessary healthcare spending.
The DR Delphi consensus helps define when dose reduction conversations should occur. The next step is creating care models capable of supporting those conversations consistently—something Zest has been building into its care model from the start.
How Zest Operationalizes Biologic Stewardship
At Zest, biologic stewardship begins with ongoing clinical engagement. We've built a value-based, technology-enabled dermatology model that gives providers the structure, visibility, and touchpoints needed to regularly reassess treatment appropriateness.
Through its patient portal and provider platform, members are monitored by board-certified dermatology providers through regular virtual visits, symptom assessments, and ongoing clinical oversight. This creates opportunities to identify patients who may be candidates for dose reduction while ensuring disease activity remains controlled.
The DR Delphi consensus provides a framework for identifying when reassessment may be appropriate. Zest's care model operationalizes that framework, making evaluations more consistent, timely, and scalable.
Virtual care also helps address one of the biggest barriers to reassessment: capacity. Traditional dermatology practices are often overwhelmed, making it difficult to schedule frequent follow-up appointments focused on long-term treatment optimization. By expanding access to dermatology specialists and enabling continuous monitoring, virtual care creates the infrastructure needed to support remission management over time.
Importantly, biologic dose reduction is never a one-size-fits-all decision. Right-sized care must always be the goal. Not every patient is a candidate, and treatment changes should be guided by clinical judgment, disease activity, and shared decision-making between patients and providers.
Final Thoughts: Moving from Consensus to Implementation
The DR Delphi consensus provides the industry with an important roadmap. It also validates a care approach that Zest has been implementing for years.
By combining evidence-based reassessment, ongoing clinical monitoring, and technology-enabled care delivery, healthcare organizations can move biologic stewardship from a theoretical concept to an operational reality.
Because the future of value-based dermatology isn't just about helping patients get better. It's about ensuring they remain on the most appropriate treatment for their current needs—and reassessing that decision as those needs evolve.
Learn how Zest is helping health plans operationalize biologic stewardship and treatment reassessment at scale:
