Why Biologic Deprescription Should Matter More for Health Plans

Specialty drug spend has become one of the fastest-growing cost pressures for health plans. In dermatology, psoriasis biologics are a major contributor—driving dermatology to become the fastest-growing specialty drug category, increasing 45.7% year over year.

Biologics have transformed care for members with moderate-to-severe psoriasis. But for health plans, the financial challenge is not just the price of a biologic—it’s how long members remain on therapy.

Many members stay on biologics for years without structured reassessment of whether the therapy is still clinically necessary or whether biologic deprescription could be appropriate,  costing health plans hundreds of thousands of dollars in runaway spend.

As a result, psoriasis continues to drive specialty drug spend upward across health plans.

For health plans, this raises an important question: Should biologics be treated as lifelong therapies?  

Biologics Should Not Be Lifelong Therapies 

Several areas of medicine incorporate structured deprescription or treatment step-down strategies—from antibiotic stewardship to oncology to geriatric medication management.

Psoriasis rarely does. 

Today’s dermatology system was designed to start patients on biologics—not reassess it. Limited dermatology access, fee-for-service incentives, and the absence of structured monitoring means biologics continue indefinitely. 

Recent updates to the International Psoriasis Council guidelines have further expanded eligibility to biologics beyond what was originally studied while offering limited guidance on treatment duration or deprescription.   

For health plans, the result is predictable: biologic therapy has become the long-term pathway, steadily increasing specialty drug spend—with no off-ramp in sight.

Biologic Deprescription is Possible

Research shows biologic dose reduction can be successful in 75% of patients after 18 months of treatment, meaning patients who achieve disease control can maintain outcomes with less frequent biologic dosing or lower-cost therapies. 

For health plans, this represents a meaningful opportunity to control specialty drug spend while supporting clinical outcomes in members.  

The barrier has not been clinical—it’s been the lack of care models designed to prevent worsening disease, monitor remission, reassess therapy, and support deprescription. 

Why Biologic Deprescription Matters for Health Plans Managing Specialty Drug Spend

One regional health plan with 325,000 members faced this challenge directly. Dermatology pharmacy costs had grown to more than $100 million, with dermatology biologics among the largest drivers of spend. A significant share of prescriptions were also off-formulary, accounting for 22% of dermatologic systemic drug spend. 

When the health plan implemented a dermatology care model focused on remission monitoring and biologic deprescription, the results were significant:

• 53% of enrolled members reduced their drug utilization from baseline
• 94% of members achieved improved or stable disease
• More than $17,000 in annual per-member savings, net of rebates
• 3.3:1 return on investment

These results highlight an important reality for health plans: managing how long members remain on biologics can significantly reduce specialty drug spend for health plans without sacrificing member outcomes. 

The Missing Piece: A Care Model Built for Biologic Deprescription 

For health plans facing rising specialty drug spend, the need for care models that evaluate when biologic therapy should continue—and when biologic deprescription is appropriate—is increasingly clear. 

By giving members access to structured monitoring, remission-first care, and more access, the opportunity is not simply to manage prescribing—it is to actively manage duration of therapy, and in turn, make treatment more clinically appropriate and affordable. 

To learn more about how one health plan reduced dermatology specialty drug spend through biologic deprescription, read the full case study: