Strive antitrust lawsuit against Lilly and Novo stays dismissed after judge rejects reconsideration

The Strive antitrust lawsuit against Eli Lilly and Novo Nordisk is still closed. A federal judge in San Antonio has refused to reopen the case, which a compounding pharmacy filed in January to argue that the two drugmakers shut compounded GLP-1 drugs out of telehealth. The order reached the public docket on October 23, about eleven weeks after the same judge threw out the suit with prejudice. Nothing changes at the pharmacy counter today, but the ruling limits how far compounders can take this kind of fight in court.

What the judge decided in October

Senior U.S. District Judge Micaela Alvarez of the Western District of Texas has handled the case, Strive Specialties v. Eli Lilly, since it was filed. On August 21, Strive asked her to alter or amend the judgment and to reconsider it, or at least to let the company file a second amended complaint, which it attached to the request. Lilly and Novo filed separate oppositions on September 4, and Strive replied a week later. The court answered with an order on the motion for reconsideration, entered on October 23. According to Law360, the judge found that Strive's claim of a manifest legal error rested on the company's own misunderstanding of her ruling. The full order sits behind the federal court paywall and was not available for this story.

The October order keeps the Strive antitrust lawsuit closed but says nothing new about competition in the GLP-1 market. It leaves in place the August 3 opinion, which dismissed all claims with prejudice, so Strive cannot simply refile the same complaint in that court. The pharmacy's remaining path is an appeal to the Fifth Circuit. Under federal appellate rules, a notice of appeal is generally due within 30 days of an order that resolves a request like this one. No notice of appeal had appeared on the public court docket by October 23. None of Strive's allegations were ever tested with evidence. The case ended at the pleading stage, and discovery had been on hold since June, so no documents or witnesses from either drugmaker entered the record.

What Strive said Lilly and Novo did

Strive, a state licensed maker of compounded GLP-1 medicines, sued under the Sherman Act and the Clayton Act. It said that from late 2024 the two companies signed telehealth partnerships on the understanding that those online providers would stop sending prescriptions to compounding pharmacies, even when a doctor had written one for a compounded drug. Strive alleged that telehealth accounts for about half of cash pay GLP-1 prescriptions, so the deals cut it off from much of its market. It also pointed to the direct to patient pharmacies the companies built, LillyDirect and Novo's NovoCare Pharmacy, and to warning letters, public statements and website pages that called compounded drugs risky. Lilly alone also faced a monopolization claim.

Strive alleged that telehealth accounts for about half of cash pay GLP-1 prescriptions, so the deals cut it off from much of its market.

Both companies rejected the claims from the start. When the suit was filed in January, a Novo Nordisk spokesperson called the claims "without merit," and a Lilly spokesperson said the suit was "wrong, on both the facts and law," according to Pharmaceutical Technology. Lilly added that it had already sued Strive in October 2025 over the way the pharmacy advertised its compounded products. That earlier case is separate and is not touched by the San Antonio ruling. Deals between drugmakers and online clinics have been fragile before. In 2025 Novo ended its partnership with Hims and Hers after only eight weeks, saying the platform kept selling compounded semaglutide. The Strive case tested whether such deals could be attacked as illegal exclusive dealing.

Why the court said compounded copies are a different market

The August opinion turned on how Strive defined the market. Strive offered two versions: all GLP-1 drugs used for obesity and chronic weight management across the country, and a narrower slice of those drugs bought for cash by people paying outside their insurance network. The judge accepted that a cash pay group might be a real customer base, since coverage for weight loss is often missing or tightly limited. Her problem was elsewhere. Outside a declared shortage, federal law lets a pharmacy compound a drug only when a prescriber decides that a patient needs something the approved product cannot provide. For that reason, the court wrote, compounded GLP-1 drugs "cannot reasonably be understood as an interchangeable substitute" for the branded medicines, and a market built on that idea fails.

The judge added that even without the market problem, Strive described harm to itself rather than to competition. Losing access to telehealth channels, filling fewer prescriptions and paying more to grow are injuries to one business, she wrote, while antitrust law protects the competitive process and not any single rival. Claims about lost patient choice failed for a similar reason, because access to compounded drugs depends on medical need and regulation rather than on what shoppers prefer. The Clayton Act claim fell with the rest, since it rested on the same facts. The opinion did note that Strive's allegation that the drugmakers pushed compounded products off the market might fit other legal theories. No such claim is pending in this case.

What the ruling means for cash pay patients

For people who pay for weight loss drugs with their own money, the decision mainly confirms the current setup. Compounding of near copies became much harder after the FDA declared the semaglutide and tirzepatide shortages over, and courts have already refused to undo the end of the tirzepatide shortage. The Strive antitrust lawsuit was a different attack on the same outcome: instead of fighting the FDA, it went after the deals that steer online patients toward branded drugs. With the case closed, those partnerships stay in place, and the drugmakers' own cash channels keep competing for the same patients. Compounded products remain unapproved, and the FDA does not review them for safety or quality before they are sold.

The ruling does not declare the telehealth partnerships lawful in every respect. It holds only that Strive did not plead a valid antitrust case, mainly because compounded drugs and branded drugs do not compete in one market under this reading of the law. Other judges are not bound by the opinion, and another compounder could frame a claim differently. Three things are worth watching now. The first is whether Strive files an appeal within the deadline. The second is Lilly's own false advertising suit against Strive, which is still a separate fight. The third is the federal rules for compounding itself, which decide far more about cash pay access than any one antitrust case. Patients who are unsure what they are taking should ask their prescriber and pharmacist.

Conclusion

The Strive antitrust lawsuit will not be revived in San Antonio. The judge kept her August dismissal in place, finding that compounded GLP-1 drugs do not share a market with the branded medicines and that Strive showed harm to itself rather than to competition. An appeal is the only path left. For cash pay patients the practical picture is unchanged: branded drugs come through the makers' own channels and partners, and compounded copies remain unapproved products.