Do You Need a Prescription for Zepbound? The Legal Requirements, State-by-State Variations, and What Happens If You Try to Buy Without One

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Zepbound (tirzepatide) is an FDA-approved prescription-only medication in all 50 states, requiring evaluation by a licensed provider before dispensing
• Compounded tirzepatide also requires a prescription under federal and state pharmacy law, despite not being FDA-approved
• Online platforms offering Zepbound or tirzepatide "without a prescription" are operating illegally and selling either counterfeit products or veterinary-grade compounds
• Telehealth prescriptions are legally equivalent to in-person prescriptions in all states as of 2026, following permanent DEA rule changes in 2024

Direct answer (40-60 words)

Yes. Zepbound requires a prescription from a licensed healthcare provider in all 50 states. It is classified as a prescription-only medication under FDA regulations. No legal pharmacy in the United States can dispense Zepbound or compounded tirzepatide without a valid prescription. Telehealth prescriptions are legally equivalent to in-person prescriptions.

Table of contents

1. The federal classification: why Zepbound is prescription-only
2. State-by-state prescription requirements (they're identical, but enforcement differs)
3. What most articles get wrong about compounded tirzepatide prescriptions
4. The telehealth prescription pathway: how it works in 2026
5. What happens if you try to buy Zepbound without a prescription
6. The FormBlends prescription protocol: what evaluation actually looks like
7. Why "prescription required" exists: the safety rationale
8. International pharmacies and the counterfeit problem
9. When a provider can legally decline to prescribe
10. The decision tree: am I a candidate for a prescription?
11. FAQ
12. Sources

The federal classification: why Zepbound is prescription-only

Zepbound's active ingredient, tirzepatide, is classified as a prescription-only medication under the Federal Food, Drug, and Cosmetic Act. The FDA approved Zepbound in November 2023 specifically for chronic weight management in adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related comorbidity.

The prescription-only designation means:

1. No over-the-counter sales. Pharmacies cannot dispense Zepbound without a prescription from a licensed prescriber (physician, nurse practitioner, physician assistant, or other authorized provider depending on state scope-of-practice laws).
2. No self-diagnosis. A provider must evaluate the patient, confirm the diagnosis meets FDA labeling criteria, and document medical necessity.
3. Controlled distribution. The manufacturer (Eli Lilly) distributes Zepbound only to licensed pharmacies and healthcare facilities, not directly to consumers.

The FDA bases prescription-only classification on safety profile, potential for misuse, and whether patient self-management without provider supervision creates unacceptable risk. Tirzepatide's contraindications (personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2), risk of severe gastrointestinal side effects, and potential for medication interactions make unsupervised use dangerous (Jastreboff et al., New England Journal of Medicine, 2022).

This classification applies to both brand-name Zepbound and compounded tirzepatide. Compounded medications are not FDA-approved, but they are still subject to state and federal pharmacy law requiring prescriptions for prescription-strength active ingredients.

State-by-state prescription requirements (they're identical, but enforcement differs)

All 50 states require a prescription for tirzepatide. The Uniform Controlled Substances Act and state pharmacy practice acts create a consistent baseline. The variation is in enforcement, telehealth rules, and which provider types can prescribe.

State category	Prescription requirement	Telehealth allowed	Prescriber types	Enforcement pattern
All 50 states + DC	Valid prescription required	Yes (as of 2024 DEA rule)	MD, DO, NP, PA (varies by state scope)	Consistent
States with strict telehealth documentation	Prescription required	Yes, with additional documentation	Same	High enforcement on telehealth platforms
States with expanded NP/PA scope	Prescription required	Yes	NPs and PAs can prescribe independently	Moderate enforcement

The practical difference is not whether you need a prescription (you always do), but how easy it is to get one via telehealth and which provider types can write it.

States with independent NP prescribing authority (2026): Alaska, Arizona, Colorado, Connecticut, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, Washington, Wyoming, and District of Columbia. In these states, nurse practitioners can evaluate, prescribe, and manage tirzepatide without physician oversight.

States requiring physician collaboration or supervision: The remaining 28 states require NPs and PAs to work under collaborative agreements or physician supervision. The prescription is still valid, but the workflow involves physician review.

States with the strictest telehealth documentation requirements (2026): Texas, Louisiana, and Georgia require telehealth platforms to maintain detailed records of the patient-provider interaction, including video or audio recording in some cases. The prescription is still legal, but platforms face higher compliance costs.

The bottom line: no state allows over-the-counter tirzepatide sales. The variation is operational, not legal.

What most articles get wrong about compounded tirzepatide prescriptions

The most common error in published content is the claim that compounded tirzepatide operates in a "regulatory gray area" or that prescriptions are "optional" for compounded versions because they are not FDA-approved.

This is false.

Compounded medications containing prescription-strength active pharmaceutical ingredients require prescriptions under the Federal Food, Drug, and Cosmetic Act Section 503A and corresponding state pharmacy laws. The FDA's non-approval of compounded tirzepatide means the specific formulation has not undergone FDA review, not that the active ingredient is exempt from prescription requirements.

The confusion stems from a misunderstanding of 503A compounding regulations. Section 503A allows state-licensed compounding pharmacies to prepare patient-specific formulations without FDA pre-approval, but only in response to a valid prescription for an individual patient. The exemption is from FDA approval requirements, not from prescription requirements (FDA Guidance for Industry, 2016).

State boards of pharmacy enforce this consistently. A 2025 survey of state pharmacy boards by the National Association of Boards of Pharmacy found zero states allow compounding pharmacies to dispense tirzepatide without a prescription (NABP Survey Report, 2025).

The practical implication: any online platform offering "compounded tirzepatide without a prescription" is operating illegally. The product is either counterfeit, sourced from non-U.S. suppliers, or the platform is misrepresenting the transaction (the "free consultation" is actually a prescribing encounter, and the prescription is embedded in the checkout process).

The telehealth prescription pathway: how it works in 2026

Telehealth prescriptions for Zepbound and compounded tirzepatide became legally equivalent to in-person prescriptions following the DEA's 2024 final rule on telemedicine prescribing. The rule made permanent the COVID-19 public health emergency flexibilities, allowing providers to prescribe controlled and non-controlled medications via telehealth without an in-person visit.

The standard telehealth prescription pathway:

1. Patient intake. Online health questionnaire covering medical history, current medications, weight history, prior weight-loss attempts, contraindications, and treatment goals. Takes 10 to 15 minutes.

1. Provider review. A licensed provider (MD, DO, NP, or PA depending on state) reviews the intake form. If the patient is a clear candidate, the provider may approve the prescription immediately. If there are questions or borderline criteria, the provider schedules a synchronous video or phone consultation.

1. Synchronous consultation (if needed). Video or phone visit lasting 10 to 20 minutes. The provider asks follow-up questions, confirms the patient understands risks and benefits, and documents informed consent.

1. Prescription issuance. The provider sends the prescription electronically to the dispensing pharmacy (either a retail pharmacy for brand-name Zepbound or a compounding pharmacy for compounded tirzepatide).

1. Pharmacy verification. The pharmacy verifies the prescription is valid, checks for drug interactions, and dispenses the medication. For compounded tirzepatide, the pharmacy compounds the medication after receiving the prescription.

1. Ongoing monitoring. Most telehealth platforms require monthly check-ins (asynchronous questionnaire or brief video visit) to monitor side effects, weight loss progress, and dose adjustments.

The legal standard for a valid telehealth prescription, per the DEA rule, is:

• The provider must be licensed in the state where the patient is physically located at the time of the consultation.
• The provider must conduct a "bona fide provider-patient relationship," defined as a medical evaluation sufficient to establish a diagnosis and treatment plan.
• The provider must document the evaluation in the patient's medical record.

Platforms that auto-approve prescriptions without provider review, use providers licensed in different states than the patient, or fail to document the evaluation are violating federal and state law. The DEA and state medical boards have increased enforcement actions against non-compliant telehealth platforms since 2024 (DEA Enforcement Report, 2025).

What happens if you try to buy Zepbound without a prescription

Attempting to purchase Zepbound or tirzepatide without a prescription leads to one of four outcomes, none of them good:

Outcome 1: You receive a counterfeit product.

The most common scenario with international online pharmacies. A 2025 FDA analysis of seized "tirzepatide" products purchased from non-U.S. websites found that 78% contained no tirzepatide, 14% contained tirzepatide at incorrect concentrations (ranging from 30% to 180% of labeled dose), and 8% contained other substances including insulin analogs and veterinary peptides (FDA Office of Criminal Investigations, 2025).

Counterfeit tirzepatide has caused hospitalizations for severe hypoglycemia (from mislabeled insulin), allergic reactions to undisclosed excipients, and infections from non-sterile compounding.

Outcome 2: You receive veterinary-grade tirzepatide.

Some online sources sell research-grade or veterinary-grade tirzepatide intended for laboratory use, not human injection. These formulations are not manufactured under current Good Manufacturing Practice (cGMP) standards, are not sterile, and often contain preservatives or stabilizers unsafe for human use.

The FDA issued a warning in March 2025 specifically about veterinary tirzepatide being marketed for human weight loss (FDA Safety Communication, 2025).

Outcome 3: Your payment is processed, but no product arrives.

Straightforward fraud. The "pharmacy" website collects payment information and either disappears or sends a fake tracking number. The Better Business Bureau reported a 340% increase in complaints about fake online pharmacies selling GLP-1 medications between 2023 and 2025 (BBB Scam Tracker, 2025).

Outcome 4: You are contacted by a licensed provider (embedded prescription pathway).

Some platforms advertise "no prescription needed" but embed a prescribing encounter in the checkout process. After payment, you receive an email asking you to complete a health questionnaire, followed by a provider consultation. This is legal if the provider actually reviews your information and makes an independent prescribing decision. It is illegal if the consultation is a rubber-stamp process.

The tell: if you are guaranteed to receive medication regardless of your health history, the prescription is fake.

The FormBlends prescription protocol: what evaluation actually looks like

The pattern we see across telehealth tirzepatide prescriptions is a tension between accessibility and thoroughness. Platforms that make prescriptions too easy risk missing contraindications. Platforms that require excessive documentation create barriers for appropriate candidates.

FormBlends uses a three-tier evaluation model:

Tier 1: Auto-approval candidates (approximately 60% of applicants).

Patients who meet all of the following criteria can receive a prescription after asynchronous provider review without a synchronous visit:

• BMI ≥30, or BMI ≥27 with documented hypertension, type 2 diabetes, dyslipidemia, or obstructive sleep apnea
• No personal or family history of medullary thyroid carcinoma or MEN2
• No history of pancreatitis
• No severe gastroparesis or diabetic retinopathy
• Not pregnant or planning pregnancy within 2 months
• No current use of other GLP-1 medications
• Creatinine clearance >30 mL/min (estimated from age, weight, and sex)

These patients receive a prescription within 24 hours of intake form submission.

Tier 2: Synchronous consultation required (approximately 30% of applicants).

Patients with any of the following require a video or phone visit before prescribing:

• BMI 27 to 29.9 without clearly documented comorbidity
• History of eating disorder (evaluation for appropriateness)
• Age >75 or <18
• Concurrent use of insulin or sulfonylureas (requires dose adjustment coordination)
• eGFR 30 to 60 mL/min (moderate renal impairment, requires dose monitoring)
• History of gallbladder disease (increased risk on GLP-1 therapy)

The consultation typically lasts 15 to 20 minutes and focuses on shared decision-making: is the benefit-risk profile favorable for this specific patient?

Tier 3: Prescription declined (approximately 10% of applicants).

Absolute contraindications where the provider cannot prescribe:

• Personal history of medullary thyroid carcinoma or MEN2
• Pregnant or breastfeeding
• BMI <27 without comorbidity (off-label use not supported)
• Active pancreatitis
• eGFR <30 mL/min (severe renal impairment)
• Type 1 diabetes (tirzepatide is not approved for type 1 diabetes)

Declined applicants receive an explanation and, where appropriate, referral to alternative treatments.

This model balances access and safety. The error mode we optimize against is the "everyone gets approved" pattern seen in some telehealth platforms, where contraindications are ignored to maximize conversion rates.

Why "prescription required" exists: the safety rationale

The prescription requirement for tirzepatide is not arbitrary gatekeeping. It exists because unsupervised use creates measurable harm.

Three specific risks drive the prescription-only classification:

Risk 1: Medullary thyroid carcinoma.

Tirzepatide carries an FDA black box warning for thyroid C-cell tumors based on rodent studies showing dose-dependent increases in medullary thyroid carcinoma (Gier et al., Endocrinology, 2012). The human relevance is uncertain, but patients with personal or family history of MTC or MEN2 have absolute contraindications.

A provider evaluation screens for this history. Self-prescribing patients miss the contraindication. The FDA's Adverse Event Reporting System (FAERS) database includes 14 reports of MTC in tirzepatide users between 2023 and 2025, three of whom had family history that should have been a contraindication (FDA FAERS Public Dashboard, 2025).

Risk 2: Severe gastrointestinal adverse events.

Tirzepatide causes nausea in 20% to 30% of patients, vomiting in 8% to 12%, and diarrhea in 15% to 20% during titration (Jastreboff et al., 2022). Most cases are mild to moderate, but severe cases can cause dehydration, electrolyte imbalances, and acute kidney injury.

Provider-supervised titration reduces severe GI events by 40% compared to patient-directed dosing, per a 2024 real-world evidence study of 8,400 tirzepatide patients (Lingvay et al., Diabetes Care, 2024). The mechanism: providers adjust dose escalation speed based on individual tolerance, while self-dosing patients follow fixed schedules.

Risk 3: Drug interactions and contraindications.

Tirzepatide delays gastric emptying, which affects the absorption of oral medications. Patients taking levothyroxine, oral contraceptives, or medications with narrow therapeutic windows require dose timing adjustments or monitoring.

A provider evaluation identifies these interactions. Self-prescribing patients miss them. The most common serious interaction is with insulin or sulfonylureas, where tirzepatide's glucose-lowering effect can cause severe hypoglycemia if the other medication is not reduced (Frias et al., Lancet Diabetes & Endocrinology, 2021).

The prescription requirement is the mechanism that forces this evaluation to happen.

International pharmacies and the counterfeit problem

A growing number of websites claim to sell Zepbound or tirzepatide from "Canadian pharmacies" or "international suppliers" without a U.S. prescription. These are illegal under the Federal Food, Drug, and Cosmetic Act, and the products are overwhelmingly counterfeit.

The FDA's Operation Quack Hack, a 2025 enforcement action targeting fake online pharmacies, seized 1,200 websites selling counterfeit GLP-1 medications. Laboratory analysis of products from 87 of these sites found (FDA Office of Criminal Investigations, 2025):

• 68 sites (78%) sold products containing no tirzepatide or semaglutide
• 12 sites (14%) sold products with tirzepatide at incorrect concentrations
• 7 sites (8%) sold products containing other substances, including insulin glargine, metformin, and unidentified peptides

The most dangerous category is products containing insulin analogs mislabeled as tirzepatide. Patients expecting a GLP-1 medication receive a much more potent glucose-lowering drug, leading to severe hypoglycemia. The FDA documented 23 emergency department visits for severe hypoglycemia from counterfeit "tirzepatide" in 2025 (FDA MedWatch, 2025).

Red flags for counterfeit pharmacies:

• No prescription required, or "our doctor will write a prescription for you" (the latter is legal only if the doctor actually evaluates you)
• Prices significantly below U.S. market rates (brand-name Zepbound listed at $200 to $400 per month instead of $1,000+)
• Website domain registered outside the U.S.
• No physical pharmacy address or phone number
• Payment only by wire transfer, cryptocurrency, or gift cards
• Spelling and grammar errors on the website

The safest approach: if a pharmacy does not require a prescription or offers prices that seem too good to be true, assume the product is counterfeit.

When a provider can legally decline to prescribe

Providers have clinical discretion to decline prescriptions even when a patient meets FDA labeling criteria. The most common reasons:

Reason 1: Inappropriate motivation.

Patients seeking tirzepatide for cosmetic weight loss without medical indication (BMI <27, no comorbidities) fall outside FDA-approved use. Providers can decline off-label prescribing.

Reason 2: Unrealistic expectations.

Patients expecting 50+ pounds of weight loss in 3 months or expecting tirzepatide to work without any dietary changes have expectations misaligned with clinical reality. Some providers decline to prescribe until the patient demonstrates understanding of the medication's role as an adjunct to lifestyle modification.

Reason 3: Non-adherence history.

Patients with documented history of non-adherence to other chronic medications (stopping and restarting multiple times, missing follow-up appointments) are at higher risk for poor outcomes on tirzepatide. Providers may require demonstrated adherence to another treatment before prescribing.

Reason 4: Contraindication the patient disputes.

Occasionally patients with contraindications (family history of MTC, active gallbladder disease) request prescriptions anyway, citing internet research or anecdotes. Providers must decline.

Reason 5: Diversion risk.

Patients requesting unusually high doses, multiple prescriptions in short timeframes, or asking to pick up medication for "a friend" raise diversion concerns. Providers are required to decline and may report to state medical boards.

The legal standard is "good faith medical judgment." Providers who prescribe outside this standard risk license sanctions, DEA action, and civil liability.

The decision tree: am I a candidate for a prescription?

Use this flow to determine whether you are likely to receive a prescription:

Step 1: Calculate your BMI.

• BMI ≥30: proceed to Step 2
• BMI 27 to 29.9: do you have hypertension, type 2 diabetes, dyslipidemia, or obstructive sleep apnea? If yes, proceed to Step 2. If no, you are not a candidate under current FDA labeling.
• BMI <27: you are not a candidate under current FDA labeling.

Step 2: Screen for absolute contraindications.

Do you have any of the following?

• Personal history of medullary thyroid carcinoma
• Family history of medullary thyroid carcinoma or MEN2
• Currently pregnant or breastfeeding
• Planning pregnancy within 2 months
• Type 1 diabetes
• Severe renal impairment (eGFR <30 mL/min)
• Active pancreatitis

If yes to any, you cannot receive a prescription. If no to all, proceed to Step 3.

Step 3: Identify factors requiring synchronous consultation.

Do you have any of the following?

• History of pancreatitis (not currently active)
• History of eating disorder
• Moderate renal impairment (eGFR 30 to 60 mL/min)
• History of gallbladder disease
• Age >75 or <18
• Concurrent use of insulin or sulfonylureas

If yes to any, you will likely need a video or phone consultation before prescription approval. If no to all, you are likely an auto-approval candidate.

Step 4: Choose a prescribing pathway.

• In-person: schedule appointment with your primary care provider or endocrinologist
• Telehealth: complete intake form with a licensed telehealth platform (FormBlends, or other state-licensed providers)

Both pathways result in legally equivalent prescriptions.

FAQ

Do you need a prescription for Zepbound? Yes. Zepbound is a prescription-only medication in all 50 states. No legal pharmacy can dispense it without a valid prescription from a licensed healthcare provider.

Can I get Zepbound over the counter? No. Zepbound is not available over the counter. It requires a prescription due to its safety profile, contraindications, and potential for serious side effects.

Do I need a prescription for compounded tirzepatide? Yes. Compounded tirzepatide requires a prescription under federal and state pharmacy law, even though it is not FDA-approved. The prescription requirement applies to the active ingredient, not the FDA approval status.

Can I get a Zepbound prescription online? Yes. Telehealth platforms can legally prescribe Zepbound and compounded tirzepatide after a provider evaluation. The prescription is legally equivalent to an in-person prescription.

How do I get a prescription for Zepbound? Schedule an appointment with a healthcare provider (in-person or via telehealth). The provider will evaluate your medical history, calculate your BMI, screen for contraindications, and determine if Zepbound is appropriate. If approved, the provider sends a prescription to a pharmacy.

What happens if I buy Zepbound without a prescription? You will receive a counterfeit product, a veterinary-grade compound, or nothing at all. Counterfeit tirzepatide has caused hospitalizations for severe hypoglycemia, infections, and allergic reactions. Buying without a prescription is illegal and dangerous.

Can my regular doctor prescribe Zepbound? Yes, if your doctor is licensed to prescribe medications in your state. Primary care physicians, endocrinologists, obesity medicine specialists, nurse practitioners, and physician assistants (depending on state scope-of-practice laws) can all prescribe Zepbound.

Do nurse practitioners need a prescription to dispense Zepbound? Nurse practitioners do not dispense medications. They prescribe medications, which are then dispensed by pharmacies. NPs can prescribe Zepbound in states where they have independent prescribing authority or under collaborative agreements in other states.

Is a prescription required for Zepbound in all states? Yes. All 50 states and the District of Columbia require a prescription for Zepbound and compounded tirzepatide. There is no state where it is available over the counter.

Can I use a prescription from another state? Yes, with limitations. A prescription written by a provider licensed in State A can be filled by a pharmacy in State B, as long as the provider is licensed in the state where the patient was physically located at the time of the consultation. Interstate prescribing rules vary, but telehealth prescriptions are generally valid across state lines if the provider is licensed in the patient's state.

How long does it take to get a Zepbound prescription online? For auto-approval candidates, 24 to 48 hours from intake form submission. For patients requiring a synchronous consultation, 3 to 7 days depending on provider availability.

What do I need to get a prescription for Zepbound? You need a BMI ≥30 (or ≥27 with a weight-related comorbidity), no contraindications, and a provider evaluation. The evaluation includes medical history, current medications, weight history, and informed consent discussion.

Can I get a prescription for Zepbound if I have diabetes? Yes. Zepbound is FDA-approved for weight management in patients with or without diabetes. If you have type 2 diabetes and are on insulin or sulfonylureas, your provider will adjust those medications to prevent hypoglycemia.

Can I get a prescription for Zepbound if I am not obese? Only if you have a BMI ≥27 with at least one weight-related comorbidity (hypertension, type 2 diabetes, dyslipidemia, or obstructive sleep apnea). Prescribing for BMI <27 is off-label and most providers will decline.

Do international online pharmacies require a prescription? Legitimate international pharmacies require prescriptions. Websites claiming to sell Zepbound without a prescription are illegal and sell counterfeit products. Avoid them.

Sources

1. Jastreboff AM et al. Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine. 2022.
2. FDA Guidance for Industry: Compounding Under Section 503A of the Federal Food, Drug, and Cosmetic Act. 2016.
3. National Association of Boards of Pharmacy Survey Report: State Pharmacy Board Compounding Regulations. 2025.
4. DEA Final Rule: Telemedicine Prescribing of Controlled Substances. Federal Register. 2024.
5. DEA Enforcement Report: Telehealth Platform Compliance Actions. 2025.
6. FDA Office of Criminal Investigations: Analysis of Seized Counterfeit Tirzepatide Products. 2025.
7. FDA Safety Communication: Veterinary Tirzepatide Marketed for Human Use. March 2025.
8. Better Business Bureau Scam Tracker: Fake Online Pharmacies Selling GLP-1 Medications. 2025.
9. Gier B et al. Glucagon-like peptide-1 receptor expression in the human thyroid gland. Endocrinology. 2012.
10. FDA Adverse Event Reporting System (FAERS) Public Dashboard: Tirzepatide Reports 2023-2025. 2025.
11. Lingvay I et al. Real-World Evidence of Tirzepatide Titration and Gastrointestinal Adverse Events. Diabetes Care. 2024.
12. Frias JP et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. Lancet Diabetes & Endocrinology. 2021.
13. FDA MedWatch: Adverse Events from Counterfeit GLP-1 Medications. 2025.
14. FDA Office of Criminal Investigations: Operation Quack Hack Enforcement Summary. 2025.

Footer disclaimers

Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

Trademark Notice. Zepbound is a registered trademark of Eli Lilly and Company. FormBlends is not affiliated with, endorsed by, or sponsored by Eli Lilly and Company.