Compounding pharmacy Strive sues Lilly and Novo Nordisk over GLP-1 competition

Strive Compounding Pharmacy, an Arizona-based compounder, filed a federal antitrust lawsuit on Jan. 14, 2026, accusing Eli Lilly and Novo Nordisk of a coordinated effort to squeeze compounded GLP-1 medicines out of the U.S. market ^[1][3][4]. The complaint was filed in the U.S. District Court for the Western District of Texas, San Antonio Division, Case No. 5:26-CV-1055 ^[5].

According to the complaint, the two drugmakers — which dominate the market for GLP-1 receptor agonists — signed exclusive agreements with telehealth providers that barred those platforms from working with compounding pharmacies ^[1][2][4]. Strive also alleges Lilly interfered with its relationships with payment processors, technology platforms and social media sites, and that the companies regularly described compounded medicines as illegal or unsafe ^[1][4]. The suit says payment processors including Tebra and Stripe warned prescribers that payment processing could be paused for writing prescriptions for compounded GLP-1s ^[5], and that Lilly grouped compounded products with "counterfeit" or "fake" medicines ^[5].

Strive argues in the lawsuit that Lilly and Novo "unlawfully restricted competition and directly harmed patients in the U.S.," leaving patients "forced to pay inflated prices" with "reduced access" to medicines, "particularly personalized versions of those medicines" ^[1]. Nate Hill, Strive's co-founder and CEO, said the case is "more than just a business dispute; it's a fight for the right of every patient to have access to the medicine their doctor prescribes, at a price that isn't dictated by a monopoly" ^[3]. The complaint asks the court to stop the alleged practices and "restore competitive conditions" ^[4].

Both manufacturers dispute the claims. A Novo Nordisk spokesperson said the claims "are without merit, and we will vigorously defend against them in court," adding that the company works with regulators to ensure patients have access to "safe, effective, and FDA-approved treatment options" and to protect them from "unapproved knockoff drugs" ^[2]. A Lilly spokesperson called the suit "wrong, on both the facts and law" and an attempt to shift focus away from Strive's own conduct, noting Lilly sued Strive over advertising "unapproved, mass-compounded products as clinically proven and personalised." The spokesperson said FDA and a federal court have found those kinds of statements false and misleading ^[2].

Compounded drugs are custom-made, unbranded medicines that contain the same active ingredient as a marketed product — for GLP-1s, that means semaglutide (Ozempic, Wegovy and Rybelsus) or tirzepatide (Mounjaro and Zepbound) — and they are not FDA-approved ^[2][5]. A shortage of a commercially available drug is one criterion that allows compounded production under FDA rules ^[2]. Use of compounded GLP-1s surged during 2024 shortages of Mounjaro, Zepbound, Wegovy and Ozempic, and many patients found those versions far cheaper than the branded products at the time ^[2]. FDA ended the shortage for Lilly's GLP-1 drugs in December 2024 and gave compounders 60 to 90 days to stop making their own versions ^[4]. With supply chains stabilized, the agency no longer allows compounded GLP-1 production ^[2], and FDA Commissioner Marty Makary announced a crackdown on illegal GLP-1 compounders in October 2025 ^[2].

The dispute has a longer history. Lilly sued Strive in April 2025 over compounded tirzepatide; that case was dismissed for lack of personal jurisdiction, and Lilly refiled it in Arizona in October ^[5]. Lilly also sued four telehealth providers in April 2025 ^[4]. The Outsourcing Facilities Association challenged FDA's shortage decision in February 2025, and that case was dismissed ^[2][4]. At the J.P. Morgan Healthcare Conference in January 2026, Novo CEO Maziar Mike Doustdar estimated that about 1.5 million U.S. patients are using compounded versions of its GLP-1s and said compounders targeted consumers who were price sensitive ^[2][4].

Why it matters for patients

For several years, compounded semaglutide and tirzepatide were a lower-cost route to GLP-1 treatment, especially while the branded products were in shortage ^[2]. That route is now closed at the federal level, because FDA no longer permits compounded GLP-1 production now that the shortages are resolved ^[2]. Strive's lawsuit is one of the remaining challenges to how tightly the brand manufacturers can control that market ^[1][4].

Strive says its products are "personalized for individual patients according to a medical practitioner's prescription — medicines that Eli Lilly and Novo Nordisk did not offer" ^[4]. Lilly disputes that framing, saying FDA and a federal court found some of Strive's claims false and misleading ^[2]. For patients, the practical questions are the price and availability of compounded versions and whether telehealth prescribers are willing to write for them — both of which Strive says were affected by the conduct it describes in the suit ^[1][4][5]. The lawsuit does not change the approval status of Ozempic, Wegovy, Rybelsus, Mounjaro or Zepbound ^[2].

What happens next

The antitrust case is pending in the Western District of Texas, and no ruling on the claims has been reported ^[5]. Lilly's separate suit against Strive, refiled in Arizona in October, is also unresolved ^[5]. At the time Strive filed its complaint, FDA was carrying out the crackdown on compounders it considers illegal that the agency announced in October 2025 ^[2].