The Supreme Court ruled Wednesday that a medication abortion drug must remain accessible in every state, including those where abortion is illegal. The vote was seven to two. The majority determined that federal drug law still applies even when some justices find its results distasteful.
The decision leaves mifepristone on pharmacy shelves and in the mail for at least another eighteen months. It marks a rare moment in which the high court declined to accelerate a state-level abortion ban. The drug has been approved by the FDA for more than two decades. Federal regulators have repeatedly found it safer than over-the-counter aspirin.
Justices Samuel Alito and Clarence Thomas filed dissents. Alito argued that permitting the continued sale of a federally approved medication was an evasion of his own Dobbs decision, which ended the constitutional right to abortion. He wrote that drug companies were performing "an end run around this court."
Thomas went further. He called the pharmaceutical firms "criminal enterprises" and accused them of prioritizing profit over what he described as the public interest. Neither justice explained why a drug with a lower complication rate than common pain relievers should be treated as a menace to society.
The ruling was not a broad endorsement of reproductive rights. It simply confirmed that a lawful FDA process remains in force while litigation drags on. That modest procedural step was enough to enrage the court's most conservative members, who appeared to believe that destroying Roe gave states permission to ignore the rest of federal law whenever they pleased.
"The justices who dissented are operating in a fantasy world where executive branch agencies don't exist unless the court personally likes the outcome," said Eleanor Meech, a health law scholar at the University of Chicago. "They're essentially mad that the FDA didn't ask permission before keeping women alive."
A spokesperson for the drug manufacturer involved in the case, GenBioPro, delivered a statement that sounded like it had been run through legal review nine times. "We comply with all applicable federal regulations and categorically deny that we are a criminal enterprise," it read. "We just sell a very safe pill."
The ruling lands as the Tangerine Cock-Womble's allies in state legislatures have been pushing a patchwork of total abortion bans, many premised on the idea that medication abortion could eventually be outlawed by judicial fiat. Wednesday's order suggests that even a Supreme Court that overturned Roe is not yet prepared to let Louisiana's attorney general dictate which medicines are available in California.
In his dissent, Alito warned that the country was now stuck with a system in which a woman could receive reproductive care by certified mail. He described this as a profound injustice. Justice Thomas, for his part, did not respond to a request for comment. His staff indicated he was researching the 17th-century legal status of apothecaries.
