Eli Lilly has filed lawsuits against four digital health companies that it claims are distributing unauthorized compounded versions of its blockbuster medications Mounjaro and Zepbound. These drugs are widely used to treat diabetes and obesity and together brought in more than 16 billion dollars for Lilly last year. The lawsuits name Mochi Health, Fella and Delilah Health, Willow Health, and Henry Meds as the defendants. According to Lilly, these companies are selling formulations that include unapproved additives like vitamins and amino acids in an effort to differentiate their products from the original medications. Lilly alleges that these compounded drugs are not only untested but also being produced in bulk, rather than in response to individual prescriptions, which violates federal compounding rules. The Food and Drug Administration (FDA) had previously declared that shortages of Mounjaro and Zepbound had been resolved, eliminating one of the main legal justifications for compounding these drugs. Nevertheless, some telehealth startups have continued to market compounded versions, prompting legal action. The lawsuits bring to light the growing friction between pharmaceutical manufacturers and the rapidly expanding telehealth sector. As patients increasingly seek online alternatives for care, questions around regulation, safety, and quality control have become more urgent. Regulatory agencies have started cracking down on unlicensed compounding operations, some of which have already been forced to shut down. Lilly’s legal campaign could set an important precedent that reshapes how compounded drugs are governed in the digital age. It also underscores the importance of ensuring patient safety in a space that is evolving faster than policy can keep up.