The Fifth Circuit Court of Appeals affirmed a lower court's summary judgment ruling in *Endure Industries v. Vizient*, rejecting an antitrust challenge by a medical supply distributor against one of the nation's largest healthcare group purchasing organizations. The January 13, 2026 decision, written by Circuit Judge Jerry E. Smith, emphasized the critical importance of market definition in antitrust cases.
Endure Industries, Inc., a seller of disposable medical supplies including bandages, medical tape, and syringes, filed suit against Vizient Incorporated and its affiliated companies in the U.S. District Court for the Northern District of Texas in 2020. The case centered on allegations that Vizient, a Delaware corporation operating as a group purchasing organization for healthcare providers, engaged in anticompetitive practices that harmed competition in the medical supply distribution market.
The Fifth Circuit's opinion focused primarily on the fundamental antitrust principle that plaintiffs must establish proper market definition to demonstrate injury, except in cases involving per se violations such as horizontal price fixing or market division agreements. Judge Smith wrote that "antitrust plaintiffs must always establish market definition to show injury" in cases that do not fall under the narrow category of per se antitrust violations.
The appeals court reviewed the district court's grant of summary judgment in favor of the defendants, which was based on a finding that Endure had failed to identify any genuine dispute of material fact regarding its proposed market definitions. The trial court concluded that no reasonable jury could return a favorable verdict for Endure with respect to the two markets the plaintiff had proposed in its antitrust claims.
Group purchasing organizations like Vizient have faced increased scrutiny in recent years as healthcare costs continue to rise and consolidation in the industry has accelerated. These organizations negotiate contracts with suppliers on behalf of their member healthcare providers, theoretically leveraging collective buying power to reduce costs. Critics argue that the largest GPOs have accumulated excessive market power that can exclude competitors and ultimately harm consumers through reduced competition and innovation.
The case highlights ongoing tensions in healthcare supply chain management, where efficiency gains from consolidated purchasing must be balanced against antitrust concerns about market concentration. Disposable medical supplies represent a significant expense for healthcare providers, making the competitive dynamics in this market particularly important for controlling healthcare costs.
Vizient operates as one of the largest group purchasing organizations in the United States, serving hospitals and other healthcare facilities across the country. The company's business model involves negotiating volume-based contracts with medical supply manufacturers and distributors, then making those contracts available to member healthcare organizations. Endure's challenge appears to have targeted this business model as potentially anticompetitive.
The Fifth Circuit's decision underscores the difficulty antitrust plaintiffs face in establishing the foundational elements of their claims, particularly market definition. Courts require plaintiffs to define the relevant product market and geographic market with sufficient precision to demonstrate that defendants possess market power and that the challenged conduct has caused antitrust injury.
The three-judge panel that decided the case included Circuit Judges Smith, Stewart, and Ramirez. The unanimous decision reflects the court's view that the district court correctly applied summary judgment standards in concluding that Endure's market definition evidence was insufficient to survive pretrial disposition.
For medical supply companies seeking to challenge the practices of large group purchasing organizations, the decision suggests that courts will require robust economic evidence to support market definition claims. The ruling may influence how similar antitrust challenges are structured and what types of evidence plaintiffs must develop to survive summary judgment motions.
The case also reflects broader trends in antitrust enforcement, where courts have increasingly emphasized the importance of rigorous economic analysis in market definition. This approach requires plaintiffs to present detailed evidence about product substitutability, geographic scope of competition, and competitive dynamics that support their proposed market boundaries.
While the specific details of Endure's proposed markets were not fully described in the available portions of the opinion, the court's analysis suggests that the company failed to present sufficient evidence that reasonable jurors could find in favor of its market definition theories. This failure proved fatal to the antitrust claims, as proper market definition serves as the foundation for establishing both market power and antitrust injury.
The decision represents a significant victory for Vizient and other large healthcare group purchasing organizations facing antitrust challenges. By affirming the summary judgment ruling, the Fifth Circuit has endorsed a rigorous approach to market definition that may make it more difficult for suppliers to successfully challenge GPO practices in federal court.