A top priority is finding innovative ways to get a handle on pharmaceutical spending, especially for the ever-rising cost of specialty medications, according to the survey.

Nearly half (49 percent) of the respondents are now exploring how to cover the increasing cost utilizing their medical benefit in addition to their Rx benefit, with 85 percent doing so by 2021. As part of this, employers are trying to influence where workers can pick up their specialty pharmaceuticals, by changing the coverage on the site of care within their medical benefit. One in five (21 percent) are doing this today, with 55 percent planning to do so by 2021.

A third (30 percent) of employers this year are evaluating formulary strategies within their plan to either incentivize or require the use of lower-cost biosimilars when available, and another 39 percent say they plan to do this by 2021. More employers are also adopting a "high-performance formulary" with very limited brand coverage across the therapy classes – 21 percent are doing so this year, rising to 43 percent in 2021.

Other ways that employers are proactively manage pharmacy benefit costs include:

• Requiring mandatory mail for maintenance medications
• Adopting point-of-sale rebates through the pharmacy benefit manager and passing them through to individual members at the time of purchase
• Following Institute for Clinical and Economic Review recommendations regarding drug coverage based on cost-effectiveness
• Implementing a narrow retail network
• Having a contract with a PBM based on an acquisition cost-plus model
• Engaging in direct contracting with pharma, retail and/or specialty pharmacies to secure improved drug pricing
• Carving out the utilization management review process to a third party other than the PBM
• Considering a new form of PBM contracting that may include guaranteed fixed per-member per-year cost every year

Employers are also getting more proactive in steering workers toward high-performance networks and centers of excellence. Growing practices include reducing out-of-pocket costs for use of high-value services supported by evidence; increasing out-of-pocket costs for use of specific services that are commonly overused; reducing out-of-network reimbursement; and offering a plan that excludes select services but allows buy-up for additional coverage of service when needed throughout the year.

More employers also plan to negotiate full disclosure administrative fees that include all charges; select health plans that include bundled payments in their contracting terms that reimburse providers on the basis of expected costs for clinically defined episodes of care; offer plan options that eliminate non-emergency out-of-network coverage; and use medical plans that pay reference-based pricing without a provider agreement to accept that price.

"With greater access to accurate and transparent data, employers can create value-based designs that make a smaller dent in employees' wallets and a big impact on their health," Stone says. "This value-based approach holds the promise of the best health results at the best price."

To further cut health care costs and improve employee well-being and productivity, a third (33 percent) of the respondents are redesigning their employee assistance programs to better address emotional and financial well-being, jumping to 74 percent by 2021. As part of this, the percentage of respondents that are measuring the stress level of their employees is on track to triple by 2021, from 16 percent to 53 percent.

"Looking at emerging strategies and solutions shines a light on things to come," says Regina Ihrke, senior director and co-leader, Integrated Wellbeing, Willis Towers Watson.

"Health care cost challenges are real and significant," Ihrke says. "However, from encouraging the use of biosimilars to creating an environment that makes it clear and easy for employees to opt for high-value services, and by engaging effective programs to help manage anxiety and stress, there are many worthy options on the table that can make a difference."

Read more: 

• Top health care spenders cost $87,870 a year
• 10 drugs topping employers' pharma spend
• How self-funded employers can shrink health care costs–instead of benefits–in 2020