Strive Sues Lilly and Novo in Antitrust Challenge Over GLP-1 Access

Originally posted on obesity.news on January 14th, 2026

Strive Specialties, a national compounding pharmacy, has filed suit in federal court accusing Eli Lilly and Novo Nordisk of unlawfully shutting down competition in the GLP-1 market.

This is not a patent challenge.It is not a safety enforcement action.It is an antitrust case about market control.

And the complaint lays out a specific theory: that Lilly and Novo did not just outcompete compounders, they systematically excluded them.

The lawsuit groups the alleged conduct into three buckets: disparagement, third party interference, and exclusive dealing.

First, the disparagement claims

The complaint alleges Lilly repeatedly characterized compounded GLP-1 medications as unsafe, illegal, counterfeit, or never safe, despite individualized compounding being explicitly authorized under federal law when prescribed for individual patients.

According to Strive, this messaging appeared in open letters, website content, and executive statements, and was aimed at prescribers, patients, platforms, and partners.

Why that matters legally is structural.

Compounding pharmacies are prohibited from marketing their products as FDA approved or from claiming safety and efficacy in the way branded manufacturers can. That means when a large pharmaceutical company labels compounding as dangerous or illegitimate, the target cannot meaningfully respond in kind.

The lawsuit frames this not as education, but as product disparagement designed to erode trust in a lawful competitor that relies heavily on physician confidence.

While Lilly is the primary actor named in this section, the complaint argues Novo benefited from the same narrative once paired with its own market conduct.

Second, third party interference

This is where the case moves from messaging to leverage.

Strive alleges Lilly and Novo interfered with the relationships compounding pharmacies depend on to function at scale, including physicians, telehealth platforms, payment processors, and online communities.

The complaint alleges that doctors received letters implying that prescribing compounded GLP-1s was unlawful, despite Section 503A expressly permitting individualized compounding. Strive claims this created a chilling effect, discouraging physicians from prescribing compounded therapies even when medically appropriate.

On the infrastructure side, the lawsuit focuses heavily on Lilly, alleging it influenced or triggered actions by payment processors, accreditation bodies, and social media platforms. According to the complaint, this led to threatened payment shutdowns and the removal of online patient communities discussing compounded GLP-1 use.

The theory is not that compounding was banned outright, but that it was made operationally fragile. If you cannot get paid, cannot host patient education, and cannot reassure prescribers, you do not need to be illegal to be eliminated.

Third, exclusive dealing with telehealth

This is the core of the antitrust case.

Strive alleges that both Lilly and Novo entered into exclusive agreements with major telehealth providers that barred those platforms from working with compounding pharmacies.

Under these agreements, physicians operating on those platforms allegedly could not prescribe compounded GLP-1s, even when they believed individualized therapy was clinically appropriate. Access to branded GLP-1 drugs was conditioned on exclusivity.

The complaint emphasizes why this matters. Telehealth now represents roughly half of the cash pay GLP-1 prescription market. Cutting compounders off from that channel effectively forecloses competition at a national scale.

Strive alleges that these exclusivity provisions are unprecedented in telehealth and that at least one Novo partnership was terminated after a platform continued working with compounding pharmacies.

In antitrust terms, the allegation is not aggressive contracting, but foreclosure. The claim is that Lilly and Novo used control over must have drugs to prevent downstream competitors from reaching patients at all.

What Strive is asking for

Strive is seeking both injunctive relief and damages.

The company wants the court to block exclusive telehealth agreements that prevent compounding, prohibit allegedly false disparagement of lawful compounding, and stop interference with third party platforms and payment systems.

It is also seeking monetary damages under federal antitrust law.

But structurally, this case is about access, not reimbursement. It is about whether competition in the GLP-1 cash market is decided by innovation and pricing, or by control over distribution and narrative.

What happens next

This is a complaint, not a ruling.

Lilly and Novo will respond. Motions to dismiss are likely. The case will take time.

But antitrust cases change posture once discovery begins. Contracts, internal communications, and strategy discussions come into play. That is where exclusionary conduct either collapses or hardens.

For now, the filing itself matters.

It puts into the court record an argument that the rapid consolidation of GLP-1 access may not be purely the result of clinical superiority or manufacturing scale, but of deliberate market design.

And that is exactly the kind of question antitrust law exists to answer.

QUESTION FOR READERS:Do you think exclusivity in telehealth crosses a line when it limits physician choice, or is this simply the inevitable outcome of branded competition in a cash market?

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