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An Arizona-based compounding pharmacy has filed what it calls a landmark antitrust lawsuit accusing Eli Lilly & Co. and Novo Nordisk of using their dominance in the weight-loss and diabetes drug market to suppress competition, including through allegedly unlawful exclusivity agreements with major telehealth providers.

Strive Compounding Pharmacy alleges in a complaint filed Wednesday in Texas federal court that the two pharmaceutical giants coordinated to restrict access to compounded glucagon-like peptide-1 medications, commonly known as GLP-1 drugs, in order to protect sales of their branded products and preserve billions of dollars in revenue.

According to the lawsuit, Eli Lilly controls roughly 55 percent of the U.S. GLP-1 market, while Novo Nordisk holds about 35 percent. Compounding pharmacies collectively account for the remaining share, Strive claims.

The complaint says compounding pharmacies began producing customized GLP-1 medications when branded versions were placed on the U.S. Food and Drug Administration’s drug shortage list. Strive alleges it manufactures physician-prescribed, patient-specific compounded GLP-1 treatments at substantially lower prices than the defendants’ branded drugs.

In response to that competition, Strive claims, Lilly and Novo launched their own direct-to-consumer online pharmacies and heavily discounted prescriptions to draw patients away from compounders. The lawsuit alleges the companies then went further by entering into exclusive arrangements with telehealth providers, including Teladoc, Ro, and LifeMD, preventing clinicians affiliated with those platforms from prescribing compounded GLP-1 medications.

“Prescriptions are the lifeblood of compounding pharmacies,” the complaint states, adding that without access to prescribing channels, compounders cannot remain viable competitors.

Strive further alleges the exclusivity agreements limited physician discretion and patient choice, steering patients toward higher-priced branded medications even when compounded alternatives might be clinically appropriate.

The pharmacy also accuses Eli Lilly of publicly disparaging compounded GLP-1 products by suggesting they are inherently illegal, despite federal law expressly allowing compounding under certain circumstances.

According to the complaint, the alleged conduct has reduced competition, restricted access to personalized medications, and forced patients to pay inflated prices for GLP-1 treatments.

Strive asserts claims for monopolization and restraint of trade under the Sherman Act and seeks injunctive relief, treble damages, attorneys’ fees, and costs.

“This case is about protecting the right of patients to receive the medication their doctors prescribe without interference from monopolistic practices,” Strive co-founder and CEO Nate Hill said in a statement. He added that fair competition is essential to maintaining access and affordability in the pharmaceutical market.

Novo Nordisk rejected the allegations, saying the claims are meritless and that the company will defend itself. Eli Lilly similarly denied the accusations, calling the lawsuit an attempt to distract from Strive’s own conduct. Lilly pointed to prior litigation in which regulators and courts found certain marketing claims about compounded GLP-1 products to be misleading.

The antitrust suit comes amid broader litigation surrounding GLP-1 medications. Both drugmakers face a multidistrict litigation in Pennsylvania federal court involving claims that they failed to adequately warn patients about gastrointestinal side effects. At the same time, Lilly and Novo have pursued legal actions against multiple compounding pharmacies, alleging the sale of unauthorized copycat drugs.

Investor lawsuits have also emerged as volatility surrounding GLP-1 shortages and pricing has affected company valuations and market expectations.

Strive is represented by counsel from BakerHostetler and Prichard Oliver Montpas. Counsel for Eli Lilly and Novo Nordisk has not yet been identified.

The case is Strive Specialties Inc. v. Eli Lilly & Co. et al., case number 5:26-cv-00155, in the U.S. District Court for the Western District of Texas.