A divided panel of the U.S. Court of Appeals for the Fourth Circuit on July 15 upheld West Virginia’s Unborn Child Protection Act, concluding that the state’s near-total abortion ban—including severe limits on the medication mifepristone—is not pre-empted by federal drug regulation. Writing for the 2–1 majority in GenBioPro Inc. v. Raynes, Judge J. Harvie Wilkinson III said the 2007 Food and Drug Administration Amendments Act “falls well short of expressing a clear intention to displace the states’ historic and sovereign right” to regulate health and safety. Judge Rossie Alston Jr. joined the opinion; Judge DeAndrea Gist Benjamin dissented. The ruling affirms an August 2023 district-court decision and is the first by a federal appeals court to permit a state to bar an FDA-approved abortion drug. GenBioPro, which sells a generic version of mifepristone used in more than half of U.S. abortions, argued that West Virginia’s law conflicts with the federal risk-management programme governing the pill. The panel rejected that claim, finding no congressional intent to guarantee nationwide access to the medication. Enacted after the Supreme Court’s 2022 Dobbs decision, West Virginia’s statute prohibits abortion at all stages of pregnancy except for non-viable pregnancies, medical emergencies, or rape and incest reported within 48 hours. The Fourth Circuit decision bolsters efforts by other states to impose additional restrictions on medication abortions and could prompt further challenges to the scope of FDA authority. GenBioPro is expected to seek rehearing en banc or petition the Supreme Court for review.