Compounding Pharmacy Sues Eli Lilly, Novo Nordisk Over Alleged GLP-1 Antitrust Violations

An Arizona-based compounding pharmacy has filed an antitrust lawsuit accusing Eli Lilly and Novo Nordisk of unlawfully restricting competition in the market for GLP-1 medications, escalating a legal battle over compounded versions of blockbuster obesity and diabetes drugs.

Strive Compounding Pharmacy filed the complaint on January 14, 2026, in the US District Court for the Western District of Texas, alleging that the 2 pharmaceutical manufacturers engaged in exclusionary conduct designed to suppress compounded GLP-1 products and preserve market dominance for their branded therapies.

Allegations of Anticompetitive Conduct

According to the lawsuit, Eli Lilly and Novo Nordisk entered into exclusive agreements with telehealth companies that prohibited those platforms from working with compounding pharmacies. Strive claims these arrangements prevented clinicians from prescribing, and patients from accessing, compounded GLP-1 medications—particularly personalized versions tailored to individual patient needs.

The complaint alleges that Lilly also disparaged compounded GLP-1 drugs by falsely characterizing them as unsafe and grouping them alongside “counterfeit” or “fake” medications. Strive contends this messaging was intended to discourage prescribers and telehealth providers from issuing prescriptions for compounded GLP-1 therapies.

“Eli Lilly and Novo Nordisk’s conduct has unlawfully restricted competition and directly harmed GLP-1 patients in the United States,” the complaint states. Strive alleges that patients have been forced to pay higher prices and have faced reduced access to GLP-1 medications as a result.

Background: GLP-1 Shortages and Compounding Practices

Compounding pharmacies have historically produced customized versions of branded medications during periods of drug shortages or when patients require formulations not commercially available, such as alternative dosages or the removal of allergenic ingredients. While compounded drugs are not US Food and Drug Administration (FDA)-approved, compounding facilities are regulated by the FDA and state boards of pharmacy.

Between 2022 and 2025, shortages of GLP-1 medications created an opportunity for compounding pharmacies to produce copies of semaglutide and tirzepatide products to fill gaps in patient access. Although the FDA later declared the shortages resolved, many compounding pharmacies continued producing customized GLP-1 formulations.

Strive argues that it introduced meaningful competition by offering compounded GLP-1 medications “at a fraction of the price” of branded alternatives. The lawsuit claims Lilly and Novo responded not by competing on price or access, but by working to limit prescriptions for compounded drugs.

Prior Litigation Between the Parties

The lawsuit follows earlier litigation initiated by Eli Lilly against Strive. In April 2025, Lilly sued Strive over its compounded tirzepatide products, alleging the pharmacy made false claims regarding safety, efficacy, and personalization. That case was dismissed for lack of personal jurisdiction, though Lilly refiled the lawsuit in Arizona in October.

A Lilly spokesperson responded to Strive’s antitrust filing by stating that the lawsuit is “wrong, on both the facts and law,” and characterized it as an attempt to deflect attention from Strive’s own conduct. Novo Nordisk did not immediately comment on the lawsuit.

Claims of Market Interference

Strive’s complaint also alleges that Lilly interfered with its relationships with medical practitioners, technology platforms, and payment processors. According to the filing, public disparagement of compounded GLP-1 drugs contributed to social media platforms removing GLP-1-related groups and prompted payment processors such as Tebra and Stripe to warn prescribers that payment processing could be paused for issuing prescriptions for compounded medications.

Strive claims these actions collectively restricted its ability to operate and limited patient access to compounded GLP-1 therapies.

Key Takeaways

• Antitrust scrutiny is expanding into pharmaceutical manufacturers’ relationships with telehealth companies and their impact on compounded drug access.
• Compounding pharmacies continue to face legal and regulatory pressure following the resolution of GLP-1 drug shortages.
• Pharmacy professionals should monitor how exclusive contracting and product disparagement claims may influence prescribing practices and patient access to personalized medications.

Reference

Strive Specialties, Inc. v Eli LIlly & Co., Novo Nordisk A/S, and Novo Nordisk, Inc. US District Court for the Western District of Texas San Antonio Division. Case No. 5:26-CV-1055. 

Livingston S. A compounding pharmacy hits back at Eli Lilly, Novo Nordisk with antitrust lawsuit. Endpoints News. Published January 15, 2026. Accessed January 21, 2026. https://endpoints.news/a-compounding-pharmacy-hits-back-at-eli-lilly-novo-nordisk-with-antitrust-lawsuit/