Employer Coverage, Social Stigma, and the Future of GLP-1s: Tim Church, MD, PhD, MPH

A recent survey from Wondr Health and Harris Poll found that two-thirds of US workers say their employer’s health plan would influence whether they use a glucagon-like peptide 1 (GLP-1) medication.¹ The survey results also show that social stigma plays a large role in GLP-1 uptake among the US workforce, with almost 50% saying that social acceptance influences their decision. Against that backdrop, Tim Church, MD, PhD, MPH, chief medical officer at Wondr Health, spoke with The American Journal of Managed Care^® (AJMC^®) about what the survey results reveal, why weight bias remains deeply entrenched, and why he believes the industry is still in chapter one of a much longer story.

This transcript was lightly edited for clarity.

AJMC: The survey found that two-thirds of workers are more likely to use GLP-1 medications if their employer-sponsored insurance covers them. Does that magnitude of demand surprise you?

Church: In a weird way, it’s the wrong question—or at least an incomplete one. You’re looking at the whole working population, but roughly 20% to 25% of those workers may not medically qualify for a GLP-1. So, if you adjust for eligibility, you’re close to 100% demand among those who actually need these medications, which is 75% to 80%. So, really, the demand is not surprising at all. These drugs are everywhere—social media, billboards, sports sponsorships. Awareness is essentially total at this point.

AJMC: Nearly half of respondents said GLP-1 use would increase if it were more socially acceptable. What does that tell you about the role of weight stigma?

Church: Weight loss bias is, I’ve heard it said, the last socially acceptable bias we still have. And I think that’s true. It operates at every level from individuals to groups to institutions. What really frustrates me is seeing it from smart people in health care. Sometimes it’s coded. Someone says, “We’re not going to pay for this medication until the food supply gets cleaned up.” When and how are we going to magically clean up the food supply? That’s just a way of saying we’re never going to pay for it. We’re genetically designed to store every calorie we can—that’s evolution. And as a country, we’ve done 2 things very effectively: made food cheap and removed physical labor from daily life. The result is predictable. The 2 words I hate most in this space are “willpower” and its newer cousin, “grit.” This is not a willpower problem, and groups like the Obesity Action Coalition have moved the puck, but we are not even at center ice yet.

AJMC: What can actually be done to accelerate that cultural shift?

Church: Honestly, a lot of it is generational, as changing entrenched biases in adults is rare unless they have a lived experience. But here’s the thing: for those of us in a position to change rules and create access to care, we are obligated to do it. Access is the problem we can solve right now. Bias is trickier and slower. I want to work on both, but let’s fix access first.

AJMC: The survey highlights tension between individual willingness and structural barriers and things like cost, coverage, access, and social perception. Which is the most powerful lever for moving the needle?

Church: All of them matter, but the one that can make the biggest difference right now is access to care. We would never attach these attitudes to chemotherapy or hypertension treatment. We would never say, “Have you tried harder before we treat your psoriasis?” But we say it constantly about weight. Access is structural, and structural problems have structural solutions.

AJMC: Employers have been slow to cover GLP-1s for weight loss. What explains that hesitancy, and has anything changed?

Church: I want to give employers some grace here as the last 5 years were genuinely difficult to navigate. Prices were constantly shifting, new medications were arriving, we didn’t have long-term outcomes data, and there were real supply shortages so that even if an employer wanted to cover these drugs, supply wasn’t guaranteed. And pricing opacity was real—employers were told the sticker price was $1300 but had no idea what their actual rebate was. About a year ago, that started to change, and the last 6 months have accelerated things considerably. We now have better price transparency. We know behavioral support is essential and that without it, outcomes fall apart. We know the long-term data and the clinical case keeps broadening as these medications reduce cardiac events, protect kidneys and livers, help with osteoarthritis, even psoriasis. The equation is becoming clearer, and I feel optimistic about the employer side.

AJMC: How do oral GLP-1 formulations change the landscape?

Church: I don’t think people fully appreciate the significance of this innovation; you no longer need cold storage, the medication doesn’t degrade in a bag or a car, and no injections are needed. And Eli Lilly’s new oral product specifically uses a different molecular structure, which makes it easier and cheaper to manufacture, which absolutely matters for pricing long-term. I think orals are going to meaningfully change adoption rates, particularly for people who had psychological barriers to self-injection or logistical barriers around storage and travel.

AJMC: Are there disparities in how coverage decisions are made across employer size and carriers?

Church: You’re already seeing it as some major pharmacy benefit managers are limiting access to only one manufacturer’s products. Can you imagine being told you can only access one type of chemotherapy? That dynamic troubles me. There’s also a new and genuinely strange phenomenon: because direct-to-consumer pricing has become much more affordable, a lot of people are quietly self-paying. They’ve done the math, figured out their net employer’s cost after rebates, and decided to pay out of pocket, so HR never knows. I see a broader shift happening, and for example, I pay cash for MRIs now because it’s cheaper than running it through insurance. A lot of that is happening in the weight loss medication space too.

AJMC: How do you see the GLP-1 landscape evolving over the next 5 to 10 years?

Church: People think I’m being dramatic when I say this, but we haven’t left chapter one. The pipeline is enormous with dozens of compounds at various stages. You’re going to see more orals, once-monthly injectables, formulations that produce substantially greater weight loss, and options targeting a wider range of conditions. This year is relatively quiet on the FDA docket, but next year is when you’ll start seeing regular new approvals. The price question is the one I find most fascinating, as these molecules are not expensive to make. When we get to a price of $100 a month, and I think we will, this conversation changes dramatically.

AJMC: Is there anything the field is getting wrong that you’d want to flag?

Church: The industry is failing to treat people like people. I’ve worked in this space for a long time; I helped bring Contrave [naltrexone/bupropion] to market and I understand bariatric surgery deeply, and the one consistent gap is support. It’s important to remember that these medications are not statins. When someone loses 60 or 80 lb, their entire world shifts. Relationships change, their clothes don’t fit, gym acquaintances call them cheaters, and saboteurs emerge, sometimes from the people you expected to be most supportive. What we learned from bariatric surgery is that the weight loss journey is deeply psychological. Some people discover, mid-journey, that alcohol or food was playing a far larger role in their emotional life than they realized. That requires real support, not calorie counting apps or a pamphlet about vegetables, but people who are genuinely there with you through the weird and difficult parts. We talk about price and we talk about access, both of which matter enormously. But the place we’re most failing is treating patients as humans rather than as numbers on a scale.

References

1. Hohmann E. Employer benefits and social stigma drive GLP-1 use among US workers, survey finds. AJMC. April 8, 2026. Accessed April 13, 2026 https://www.ajmc.com/view/employer-benefits-and-social-stigma-drive-glp-1-use-among-us-workers-survey-finds