NOT RECOMMENDED FOR PUBLICATION File Name: 25a0406n.06
No. 24-5842
UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT FILED Aug 20, 2025 ) CYPRESS CREEK EQUINE, LLC, KELLY L. STEPHENS, Clerk ) Plaintiff-Appellant, ) ) ON APPEAL FROM THE v. ) UNITED STATES DISTRICT ) COURT FOR THE EASTERN NORTH AMERICAN SPECIALTY ) DISTRICT OF KENTUCKY INSURANCE CO., ) ) Defendant-Appellee. ) OPINION )
Before: THAPAR, NALBANDIAN, and READLER, Circuit Judges
NALBANDIAN, Circuit Judge. Cypress Creek Equine breeds racehorses. Essential to
its business model was Laoban, a stallion who represented the company’s most valuable breeding
stock. Cypress Creek held a fifty-percent ownership stake in Laoban and so made thousands in
stud fees from breeders who wanted to sire foals with his pedigree. But Laoban developed
performance issues. So a veterinarian administered a cocktail containing four chemical
compounds—colloquially known as “the black shot”—to put some pep in his step. It didn’t work.
Minutes after receiving the injection, Laoban was dead. The likely cause of death was an
anaphylactic reaction. But like most valuable studs, Laoban had a mortality insurance policy. And
so Cypress Creek sought a declaratory judgment stating that it had a right to full mortality
coverage. But the district court held that coverage was rightfully denied under the policy. No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
Because the circumstances of Laoban’s death fall within the plain language of the policy’s
Unauthorized Medication Exclusion, we affirm.
I.
Laoban was a Thoroughbred racehorse sired by Uncle Mo in 2013. He had a reasonably
successful racing career, winning one of his nine career starts with a cumulative total of $526,250
in earnings. So in 2017, Laoban was put out to stud in New York. And his first-crop foals did
quite well, making Laoban the second-ranked, first-crop sire for 2020. This prompted his owners
to relocate Laoban to the more competitive Kentucky breeding circuit and increase his stud fee to
$25,000 from the $7,500 it had charged in New York.
This move coincided with a change in Laoban’s ownership. Ownership was divided into
fifty fractional interests with each fractional owner being a member of the Laoban syndicate.1 And
each of these fractional interests entitled the owner to a distribution of the proceeds generated by
Laoban’s stud fees. Cypress Creek Equine acquired twenty-five of these fractional interests from
Southern Equine Stables, LLC. And WinStar Farm of Versailles, Kentucky, bought another
eighteen fractional interests. The remaining ownership interests were spread among several
smaller investors. Following the move to Kentucky, WinStar became the syndicate manager,
meaning that it ran most of the day-to-day operations while Laoban stood at stud in Versailles.
And this change in ownership affected Laoban’s insurance coverage. In 2021, NAS issued
two insurance policies that provided Laoban with a cumulative five-million dollars in mortality
coverage. The policies required NAS to pay this amount upon the “death of a horse for any
reason.” R.13-1, Policy No. 100337500, p.18, PageID 256; R.13-2, Policy No. 100337600, p.12,
1 Because owning a racehorse is a capital-intensive venture, it’s common for multiple investors to come together and form a syndicate to buy shares in the horse. 2 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
PageID 276. But the policy was limited by the Unauthorized Medication Exclusion, which
prevented coverage for “loss caused by or resulting from . . . administration of drugs or medication
to the horse, unless done by or under the direction of a veterinarian and certified by him/her to
have been of a preventative nature or necessitated by accident, sickness or disease of the horse.”
R.13-1, Policy No. 100337500, p.19, PageID 257; R.13-2, Policy No. 100337600, p.13, PageID
277.
After the move, everything seemed to be looking up. Laoban was scheduled to breed his
first book of Kentucky mares and was regarded as a top second-crop sire going into the 2021
breeding season. But even before the move to Kentucky, Laoban had been having breeding issues.
WinStar ordered a pre-purchase physical examination by a reproductive specialist, who
recommended certain breeding conditions and medications before noting that further
“pharmaceutical aids” might be necessary “[i]f ejaculatory issues arise.” R.36-4, Pre-Purchase
Report, p.2, PageID 642. Once at WinStar, Laoban intermittently had trouble breeding, often
refusing to mount the mares. Because each refusal put the associated $25,000 stud fee in jeopardy,
WinStar began searching for solutions. The company consulted several fertility and reproductive
specialists who prescribed treatments such as shockwave therapy and regular testosterone
injections. And in February and March 2021, Laoban was diagnosed with degenerative arthritis
of the C5-6 and C6-7 caudal cervical facets in his neck.
Despite these issues, WinStar proceeded to breed Laoban to 126 mares during the first
three months of the 2021 season. This was a dramatic increase from the 67 mares that he was bred
to during the 2020 season. At $25,000 a pop, the economic incentives are obvious.2
2 The economics of Thoroughbred breeding are driven by genetic pedigree. These genetic records are kept by a private entity called the Jockey Club, which runs the breed registry for all American Thoroughbreds. To be in this registry, known as the American Stud Book, a Thoroughbred foal 3 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
But matters came to a head when Laoban refused to breed his mares during consecutive
sessions on May 22 and 23. Unable to find any physical ailment that would cause Laoban’s
reluctance, WinStar’s associate veterinarian, Dr. Heather Wharton, conducted shockwave therapy
on the horse’s neck. But still Laoban refused to breed. And so Wharton consulted David Hanley,
WinStar’s general manager, and Larry McGinnis, the farm’s stallion manager. At that meeting,
Hanley suggested that Wharton give Laoban a “vitamin shot” that contained Vitamin B12, though
he didn’t specify what else that shot should contain. R.33-6, Wharton Examination Under Oath,
pp.66–69, PageID 531.3
With this instruction, Wharton administered an intravenous injection containing not just
Vitamin B12 but also Vitamin C, Vitamin B Complex, and Iron Hydrogenated Dextran. Wharton
developed the injection by drawing on her experience working with racehorses in California where
she had often administered the shot to aid post-race recovery. She referred to this particular
cocktail as “the black shot” because the Iron Hydrogenated Dextran gave the solution a dark black
color. Id. at p.79, PageID 534. Though Wharton later testified that she learned this technique
from the supervising veterinarian she worked for in California, she admitted that she didn’t know
of any other veterinarians who administered this exact vitamin combination intravenously.
must be conceived through live cover breeding (i.e., not through artificial insemination or cloning.) This means that there is a huge economic incentive to breed stallions as often as possible during a season. Though the Jockey Club has attempted to limit the number of mares a stallion can breed in a single season to 140, there is no restriction—besides the stamina of the horse. 3 An examination under oath is an investigatory device used by insurance companies when investigating a claim. Similar to a deposition in federal practice, the insurer can compel the insured or a relevant witness to submit to questioning under oath. But unlike in a deposition, the insured has no right to cross-examine the witness. See Jordan R. Plitt et al., Couch on Insurance § 196:3 (3d ed. 2025). Consenting to examination under oath is often a condition precedent to coverage. See State Farm Mut. Auto. Ins. Co. v. Adams, 526 S.W.3d 63, 67–68 (Ky. 2017). 4 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
As a result, Wharton began preparing the shot. But in collecting these ingredients from
WinStar’s onsite pharmacy, Wharton neglected to read the labels. If she had, she would have seen
that the Vitamin B Complex expired in April 2019, the Iron Hydrogenated Dextran expired in July
2012, and the Vitamin B12 expired in February 2020. More importantly she would have seen that
warnings on at least some of the shot’s components stated that they contained compounds that
have “resulted in anaphylactic shock.” R.36-13, Label Photos, p.1, PageID 686.. Laoban had
never been given any of the shot’s components, so Wharton knew nothing about his sensitivity to
the ingredients.
On the morning of May 24, 2021, Wharton combined 10cc’s each of Vitamin C, Vitamin
B12, and Vitamin B Complex with 2 cc’s of Iron Hydrogenated Dextran into a syringe. She then
administered the black shot to Laoban’s jugular vein—even though the warning label on the Iron
Hydrogenated Dextran solution emphasized that it was “[f]or intramuscular injection only.” R.36-
13, Label Photos, p.6, PageID 691. Wharton left the stallion barn immediately without waiting to
see what effect the medication would have. For that reason, no one was there to render aid when
Laoban staggered and fell against the stall wall about a minute after the injection. It took several
minutes for a groom to look in and realize the situation’s severity.
Once Laoban’s condition was discovered, McGinnis called Wharton to let her know that
they had a horse down in the stall. Wharton rushed back and determined that Laoban seemed to
be suffering anaphylaxis—a potentially life-threatening allergic reaction. She tried to stabilize
him with several steroid injections but didn’t have any epinephrine on hand to alleviate the most
dangerous symptoms of anaphylaxis—such as total cardiac system collapse. Laoban didn’t
respond to the treatments and died soon after. A postmortem analysis confirmed anaphylactic
shock as the most likely cause of death.
5 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
Seeing the writing on the wall, WinStar chose to settle. The farm offered Laoban’s owners
$166,500.00 for each fractional share. Assuming Cypress Creek accepted, its twenty-five
fractional interests would have resulted in a payment of $4,162,500 to release WinStar from
liability for Laoban’s death.
But there was still the issue of individual liability. After investigating Laoban’s death, the
Kentucky Board of Veterinary Examiners filed a complaint against Wharton alleging that her
treatment “did not conform to the appropriate standard of care” based on veterinary negligence
and violations of the professional code of conduct. R.36-16, Settlement Agreement, pp.1–2,
PageID 809–10. To avoid a formal hearing, Wharton entered a settlement agreement that waived
her “right to contest the Board’s allegation that [her] care for the patient did not conform to the
appropriate standard of care.” Id. at p.2, PageID 810. And the Board disciplined her by
(1) suspending her license for ninety days, (2) assessing an administrative fine, and (3) requiring
her to undergo a continuing education course on “drug interactions and dosages, pharmacy effects
and procedures, and the management of medical emergencies, such as anaphylactic shock.” Id. at
pp.2–3, PageID 810–11.
After Laoban’s death, Cypress Creek submitted a claim under Laoban’s mortality
coverage. In response, NAS sent a letter refusing “to make any commitments as to acceptance of
coverage for this loss” before it had completed its own investigation into Laoban’s death. R.33-3,
NAS Letter, p.1, PageID 508. NAS’s investigation centered on reviewing Laoban’s veterinary
records, conducting examinations under oath for the resident veterinarians at WinStar, and
consulting board-certified veterinarians about the appropriate standard of care. After completing
the investigation, NAS concluded that Laoban’s death wasn’t covered, citing the Unauthorized
Medication Exclusion among other policy provisions.
6 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
Unsatisfied with this result, Cypress Creek sued in state court and sought a declaration that
it was entitled to the full amount of Laoban’s mortality coverage under the two policies. Because
Cypress Creek and NAS were diverse parties, the insurer removed the case to federal court. And
NAS responded to Cypress Creek’s complaint with an Answer and Counterclaim seeking a
declaration that coverage wasn’t warranted or that it should be offset by WinStar’s settlement
payment.
After discovery, the parties each moved for summary judgment. And the district court
agreed with NAS, holding that the insurance company rightfully denied coverage under the terms
of the insurance policy, including the Unauthorized Medication Exclusion. Cypress Creek
appealed.
II.
This court reviews the district court’s grant of summary judgment de novo. Capen v.
Saginaw County, 103 F.4th 457, 461 (6th Cir. 2024). Summary judgment is appropriate only when
the moving party “shows that there is no genuine dispute as to any material fact and the movant is
entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a).
A.
The parties agree that Kentucky law governs this diversity case. Under Kentucky insurance
law, a policy’s coverage is defined by the contract’s terms. State Farm Mut. Ins. v. Fireman’s
Fund Am. Ins., 550 S.W.2d 554, 557 (Ky. 1977). And that contract’s interpretation is a legal
question for the court. Kemper Nat. Ins. v. Heaven Hill Distilleries, Inc., 82 S.W.3d 869, 871 (Ky
2002). The court’s interpretation is informed by the “two cardinal principles” that “(1) the contract
should be liberally construed and all doubts resolved in favor of the insureds; and (2) exceptions
and exclusions should be strictly construed to make insurance effective.” K.M.R. v. Foremost Ins.,
7 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
171 S.W.3d 751, 753 (Ky. Ct. App. 2005) (quoting Ky. Farm Bureau Ins. v. McKinney, 831 S.W.2d
164, 166 (Ky. 1992)).
And yet “[a] liberal interpretation is not synonymous with a strained one.” Id. After all,
the goal is to give effect “to the parties’ mutual understanding at the time they entered into the
contract.” Nationwide Mut. Ins. v. Nolan, 10 S.W.3d 129, 131 (Ky. 1999). When possible, this
mutual understanding should be deduced “from the language of the contract alone” and “clear and
unambiguous” words should be given “their plain and ordinary meaning.” Id. at 131–32 (internal
quotation marks omitted). But if that fails, the general rule remains “that uncertainties and
ambiguities must be resolved in favor of the insured.” Ky. Ass’n of Cntys. All Lines Fund Tr. v.
McClendon, 157 S.W.3d 626, 630 (Ky. 2005).
Why? Most insurance policies are contracts of adhesion written by the insurance company
with little input from the insured. Jones v. Bituminous Cas. Corp., 821 S.W.2d 798, 801 (Ky.
1991). So Kentucky courts interpret ambiguity against the drafter “in order to circumvent the
technical, legalistic and complex contractual terms which limit benefits to the insured.” Birdwell
v. Shelter Mut. Ins., 367 S.W.3d 585, 588 (Ky. 2012) (quoting Simon v. Cont’l Ins., 724 S.W.2d
210, 213 (Ky. 1986)).
Connected to this rule of construing ambiguity is the “corollary” doctrine of reasonable
expectations. Woodson v. Manhattan Life Ins., 743 S.W.2d 835, 839 (Ky. 1987). Under this
doctrine, “the insured is entitled to all the coverage he may reasonably expect . . . under the policy”
such that “[o]nly an unequivocally conspicuous, plain and clear manifestation of the company’s
intent to exclude coverage will defeat that expectation.” Sparks v. Trustguard Ins., 389 S.W.3d
121, 127 (Ky. Ct. App. 2012) (internal quotation marks omitted). And yet this doctrine “does not
interfere with the rule that the policy must receive a reasonable interpretation consistent with the
8 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
plain meaning in the contract.” Tower Ins. v. Horn, 472 S.W.3d 172, 174 (Ky. 2015). So an
insured’s attempts “to muddy the water and create some question of interpretation” isn’t sufficient
since “[o]nly actual ambiguities, not fanciful ones, will trigger application of the doctrine.” True
v. Raines, 99 S.W.3d 439, 443 (Ky. 2003) (internal quotation marks omitted).
But what counts as an actual ambiguity? An insurance contract “is ambiguous if a
reasonable person would find it susceptible to different or inconsistent interpretations.” Ky. State
Univ. v. Darwin Nat. Assurance Co., 677 S.W.3d 294, 300 (Ky. 2023) (quoting Hazard Coal Corp.
v. Knight, 325 S.W.3d 290, 298 (Ky. 2010)). But because a court “cannot enlarge coverage or
make new contracts under the guise of construction,” such inconsistent interpretations must stem
from the contract’s text. McClendon, 157 S.W.3d at 633. And if the insurance policy doesn’t give
a specific definition for a word, the ordinary meaning governs. Am. Mining Ins. v. Peters Farms,
LLC, 557 S.W.3d 293, 296 (Ky. 2018). So where a policy term is susceptible to multiple
reasonable meanings, the failure to define that term in the contract can give rise to ambiguity. See
Bituminous Cas. Corp. v. Kenway Contracting, Inc., 240 S.W.3d 633, 641 (Ky. 2007).
B.
We review whether the Unauthorized Medication Exclusion applies to the circumstances
of Laoban’s death. Cypress Creek argues that the contract’s plain meaning supports its position
that the exclusion doesn’t apply.4 And so it discusses the potential ambiguity in the contract’s
4 NAS argues that Cypress Creek waived this argument by failing to “clearly argue in the summary judgment briefing or otherwise that the Policies were ambiguous.” Appellee Br. at 28. While it is generally true that “arguments raised for the first time on appeal are forfeited,” no such forfeiture occurred here. Kreipke v. Wayne State Univ., 807 F.3d 768, 781 (6th Cir. 2015). Cypress Creek raised the ambiguity issue and offered argument on it in its briefing before the district court. These arguments apprised the district court of Cypress Creek’s alternative argument that the challenged policy language was at least ambiguous. And the court addressed these arguments in its opinion granting summary judgment. So Cypress Creek has done all that is necessary to preserve this issue for appellate review. 9 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
language only as a fallback. Still it maintains that the terms “drugs or medication” either support
its position or are, at minimum, ambiguous. The meaning of this term is crucial to applying this
exclusion. And as a result, Cypress Creek alleges error in the district court’s refusal to declare this
term ambiguous and resolve the ambiguity for the insured.
1.
Begin with the meaning of the term “drugs or medication” in the Unauthorized Medication
Exclusion. While this term is not specifically defined in the insurance policy, that doesn’t mean
it’s ambiguous. Davis v. Progressive Direct Ins., 626 S.W.3d 518, 521 (Ky. 2021). When faced
with an undefined term in an insurance contract, Kentucky courts give the term “its ordinary and
everyday meaning.” Id. And as in other interpretative contexts, ordinary meaning “is often
determined by reference to dictionary definitions.” Erie Ins. Exch. v. Johnson, 713 S.W.3d 149,
156 (Ky. 2025) (quoting Jefferson Cnty. Bd. of Educ. v. Fell, 391 S.W.3d 713, 719 (Ky. 2012)).
Start with the word “drugs.” NAS points to Merriam-Webster, which defines “drug” as “a
substance used as medication or in the preparation of medication.” Drug, Merriam-Webster
Dictionary, https://www.merriam-webster.com/dictionary/drug. That’s somewhat unhelpful. But
Merriam-Webster’s second definition of “drugs” gives the term meaning independent from
“medication.” Drawing from the Federal Food, Drug, and Cosmetics Act, the dictionary defines
a drug as (1) “a substance recognized in an official pharmacopoeia or formulary”; (2) “a substance
intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease”; (3) “a
substance other than food intended to affect the structure or function of the body”; and (4) “a
substance intended for use as a component of a medicine but not a device or a component, part, or
accessory of a device.” Id.; cf. FDA v. Brown & Williamson Tobacco Corp, 529 U.S. 120, 126
(2000) (discussing the Federal Food, Drug, and Cosmetics Act’s definition of drug). Similarly,
10 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
the dictionary defines “medication” as a synonym of “medicine.” Medication,
https://www.merriam-webster.com/dictionary/medication. And it defines “medicine,” in turn, as
“a substance or preparation used in treating disease.” Medicine, Merriam-Webster Dictionary,
https://www.merriam-webster.com/dictionary/medicine.
Rather than contesting these definitions, Cypress Creek asserts a distinction between
vitamins and drugs or medication. In effect, Cypress Creek argues that vitamins are dietary
supplements that cannot be “drugs or medication manufactured for the prevention or treatment of
illness or injury,” and that the black shot cocktail consisted only of vitamins and a mineral, not
drugs. Appellant Br. at 12. But Cypress Creek cites no authority to support that position. Because
Cypress Creek provides no reasonable interpretation to oppose the plain meaning of the
Unauthorized Medication Exclusion, the provision is unambiguous and should be applied as
written. See Wehr Constr., Inc. v. Assurance Co. of Am., 384 S.W.3d 680, 687 (Ky. 2012). And
the only question that remains is whether the circumstances of Laoban’s death fall within the plain
meaning of that exclusion.
2.
So we address whether the black shot or its constituent ingredients are “drugs or
medication” under the exclusion. As discussed, this court should afford the words “drugs or
medication” their ordinary meaning because the policy provides no specific definition for the term.
Cincinnati Ins. v. Motorists Mut. Ins., 306 S.W.3d 69, 73 (Ky. 2010). The black shot and at least
some of its ingredients meet the different definitions of a drug for purposes of the policy. The shot
consisted of injectable substances intended for use in the diagnosis, cure, mitigation, treatment, or
prevention of disease—such as the Iron Hydrogenated Dextran, which is intended for treating
anemia in baby pigs. Several of the ingredients had a National Drug Code issued by the FDA and
11 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
is listed in the NIH’s National Library of Medicine. And at least some of the ingredients are
substances other than food intended to affect the structure or function of the body. Even Wharton
herself referred to these ingredients as “pretty harmless drugs” while being interviewed about the
incident. R.33-6, Wharton Examination Under Oath, p.92, PageID 537. So at least some of the
ingredients separately meet the requirement of being “drugs” under the common meaning of that
word.
In a similar vein, the combination of these ingredients into a single treatment—the black
shot—falls within the ordinary understanding of “medication” as a substance used for treating
disease. Even if the individual vitamins were not drugs,5 their combination into an intravenous
injection administered by a registered veterinarian meets the ordinary definition of medicine. See
R.36-13, Daily Med. PDF, pp.1–9, PageID 677–685. And Wharton admitted that she administered
the black shot with the intent to treat Laoban’s low energy levels, which she thought was a
symptom of a vitamin deficiency. R.33-6, Wharton Examination Under Oath, pp.68–69, PageID
531.
The black shot’s medical purpose and method of administration make it “medication” even
if the ingredients didn’t qualify as drugs on their own. An example illustrates this point. The
ingredients of sterile saline solution are just salt and water, which by themselves aren’t drugs. But
5 Notwithstanding the dictionary definitions of “drugs,” there are good reasons for not wanting to say that vitamins (as a class) are always drugs. After all, most English speakers wouldn’t call a Flintstones multivitamin a “drug”—even though it is a substance other than food intended to alter the structure or function of the body. But this case doesn’t require the panel to decide whether vitamins are always “drugs.” Instead, this case poses the narrower question of whether the injectable vitamin solutions used here in the black shot are drugs. These vitamin solutions can be purchased only by a licensed veterinarian and were locked in the WinStar pharmacy to prevent unauthorized use. R.33-6, Wharton Examination Under Oath, pp.70–74, PageID 532–33. And so they are a far cry from an over-the-counter multivitamin or dietary supplement. 12 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
once combined and administered via an IV-drip to treat dehydration, saline becomes medicine. So
too here.
3.
Cypress Creek’s contrary arguments are—in a word—unconvincing. In essence, it claims
that “vitamin and mineral supplements to increase breeding effort are not drugs and medications.”
Reply Br. at 9. But it has little in the way of support for this claim.6 So Cypress Creek resorts to
rhetoric, claiming that the black shot was “no different than if Laoban was provided a different
type of hay to eat and suffered anaphylaxis.” Appellant Br. at 17. But this comparison is facially
inapt. Food is excluded from the definition of drugs. And beyond that, there is clearly no
comparing a cocktail of expired vitamin solutions administered by intravenous injection with a
new type of hay. So Cypress Creek’s parade of horribles never gets off the ground because the
common meaning of the terms “drugs” and “medication” distinguishes between an intravenous
injection conducted by a veterinarian and an extra serving of hay for dinner.
Because the ordinary meaning of “drugs or medicine” applies to the injection Wharton
gave Laoban, NAS appropriately denied coverage under the Unauthorized Medication Exclusion.
And so the district court didn’t err in granting summary judgment.
6 Cypress Creek does cite an FDA landing page on dietary supplements—though it didn’t add it to the record. Appellant Br. at 12. Setting aside whether we should consider extra-record evidence, the website doesn’t support Cypress Creek’s contention. The page notes that “finished dietary supplement products” are subject to “a different set of regulations than those covering ‘conventional’ . . . drug products.” FDA, Dietary Supplements (Oct. 1, 2014), https://www.fda.gov/food/dietary-supplements. But the linked fact sheets make clear that there is a distinction between pure dietary supplements and the “prescription form” of the vitamin often “given as a shot . . . to treat” vitamin deficiencies. See, e.g., NIH, Vitamin B12 Fact Sheet for Consumers (Dec. 15, 2023), https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/. So, at most, this fact sheet supports the view that some vitamins can be medication. 13 No. 24-5842, Cypress Creek Equine, LLC v. N. Am. Specialty Ins.
III.
For this reason, we affirm.