A federal district court has ruled favorably for religious freedom in declaring moot a case over the right of pharmacies’ not to stock and dispense abortion drugs.

The U.S. District Court for the Western District of Texas ruled on April 5 that the legal case the state of Texas and Mayo Pharmacy, Inc., had made against the federal Department of Health and Human Services (HHS) was now moot due to a revision of the original guidance issued by HHS’ Office of Civil Rights. In 2022, HHS’ guidance seemed to trample on the conscience rights of pharmacists, but it later made changes to that guidance and denied that it had required the dispensation of abortion drugs in conflict with state law or religious convictions.

“Unelected bureaucrats can’t force Americans to dispense abortion-inducing drugs against their conscience,” said ADF Senior Council Matt Bowman. “HHS changed its pharmacy abortion guidance after the court ruled in favor of religious pharmacies in July. Now, the court made it clear that the guidance can’t require pharmacies to dispense abortion drugs or violate their religious beliefs.

“The ruling also indicated that the court will likely stop any future attempts by HHS to use this guidance to open a burdensome investigation against our client, Mayo Pharmacy in North Dakota, or pharmacies in Texas if they decline to dispense abortion drugs,” he continued.

Following the Supreme Court’s Dobbs decision overturning Roe v. Wade in July 2022, HHS issued a guidance that the state of Texas and Martian said required pharmacies that receive federal financial assistance to dispense abortion drugs. Texas claimed the guidance attempted to preempt its abortion laws after Dobbs, and Dr. Kevin Martian, owner of Mayo Pharmacy, alleged that it violated his sincerely held religious beliefs.

On Friday, the court ruled that the case was now moot due to a revision of the original guidance issued by HHS’ Office of Civil Rights (OCR), which argued that it did not require the dispensation of abortion drugs in conflict with state law or religious convictions—but only after the court did not buy their original arguments.

In July of 2022, two weeks after Dobbs, President Biden issued an executive order instructing HHS to “identify potential actions (A) to protect and expand access to abortion care, including medication abortion; and (B) to otherwise protect and expand access to the full range of reproductive healthcare services,” according to the District Court ruling.

Three days later, OCR released the guidance, titled “Guidance to Nation’s Retail Pharmacies: Obligations under Federal Civil Rights Laws to Ensure Access to Comprehensive Reproductive Health Care Services,” which says that pharmacies that are recipients of federal financial assistance, such as Medicare and Medicaid, are prohibited from discriminating based on race, color, national origin, sex, age or disability under the Affordable Care Act and the Rehabilitation Act of 1973. The guidance seemed to equate a pharmacy’s refusal to carry and dispense abortion-related drugs to discrimination on the basis of sex and disability, and names several situations in which that may be the case.

The guidance presents hypothetical cases in which the abortion-inducing drug would be used in emergency situations or to treat conditions entirely unrelated to abortion—but Texas and Martian believed it threatened state abortion bans and the religious rights of individuals. Well over half of elective abortions in the U.S. are accomplished through the abortion pill regimen consisting of mifepristone and misoprostol, which the guidance seemed to require the pharmacies to stock and dispense in addition to other abortive drugs like methotrexate.

The complaint by Texas and Mayo Pharmacy argues that the guidance misrepresents the acts and statutes on which it is based, and that none of them require pharmacies to stock or dispense abortion drugs. The Affordable Care Act specifically includes a section barring any preemption of state abortion laws, which, they argue, is what OCR attempted to do with the guidance. The complaint names several more pieces of legislation with which the guidance conflicts.

“Federal agencies must be held accountable when they overstep their authority,” Bowman said.

Above: Dr. Kevin Martian, owner of Mayo Pharmacy in North Dakota. Photo: Alliance Defending Freedom