WASHINGTON — The Biden administration warned the nation’s 60,000 retail pharmacies on Wednesday that they threat violating federal civil rights regulation in the event that they refuse to fill prescriptions for capsules that may induce abortion — the second time this week that it has used its govt authority to arrange showdowns with states the place abortion is now unlawful.

In 4 pages of steerage, the federal Division of Well being and Human Providers ticked off a collection of circumstances — together with miscarriage, abdomen ulcers and ectopic being pregnant — which can be generally handled with medicine that may induce abortion. It warned that failing to dispense such capsules “could also be discriminating” on the idea of intercourse or incapacity.

The steerage got here two days after Xavier Becerra, President Biden’s well being secretary, instructed hospitals that even in states the place abortion is now unlawful, federal regulation requires docs to carry out abortions for pregnant girls who present up of their emergency departments in the event that they consider it’s “the stabilizing remedy essential” to resolve an emergency medical situation.

The back-to-back actions clarify that whereas Mr. Biden’s authority to protect entry to abortion is proscribed after the Supreme Court docket eradicated the constitutional proper to the process final month, he’ll push these limits the place he can. Authorized specialists on each side of the problem agreed in interviews that the administration was attempting to claim that federal regulation pre-empts that of states which have banned abortion, a transfer that may nearly absolutely be challenged in court docket.

“They’re attempting to determine federal statutes that not directly will supersede state abortion restrictions and bans,” stated Lawrence O. Gostin, an professional in public well being regulation at Georgetown College. Of the steerage for pharmacists, he stated, “The plain aim is to have abortion remedy in inventory to deal with a variety of medical circumstances and to be out there for an abortion.”

But the brand new steerage is cautiously written, and steers away from telling pharmacies that they’ve to supply the medicine for the aim of remedy abortion, which is banned or restricted in sure states. Nor does the steerage deal with how a provision in federal regulation referred to as the Church Amendments would apply. That measure permits well being care suppliers, together with pharmacists, to not carry out or help in abortions if they’ve spiritual or ethical objections.

At situation are three medicine — mifepristone, misoprostol and methotrexate — which can be usually prescribed for different circumstances however also can induce abortions. Consultants stated the administration was reacting to reviews that ladies of childbearing age are being denied the medicine after the ruling.

Mifepristone is used to handle sure sufferers with a hormonal dysfunction referred to as Cushing’s syndrome, and misoprostol is prescribed for ulcers. However they’re additionally approved by the Meals and Drug Administration as a two-drug mixture that may be taken to terminate a being pregnant throughout the first 10 weeks, and can be utilized in mixture following miscarriages. Methotrexate is used to deal with autoimmune issues, equivalent to rheumatoid arthritis, in addition to most cancers.

“These are very respectable points when it comes to folks worrying about accessing the fundamental medicines that they’ve been receiving for years, simply because these medicines have the capability to finish a being pregnant,” stated Alina Salganicoff, the director of ladies’s well being coverage on the Kaiser Household Basis. “It doesn’t sound like they’re blocking this for males.”

The administration’s strikes will nearly actually be challenged in court docket, and advocates for abortion rights concede that it might be a dropping battle. If authorized challenges work their approach as much as the Supreme Court docket, the administration should make its case earlier than the identical conservative supermajority who voted to overturn Roe v. Wade, the landmark authorized case that established a proper to abortion in 1973.

“They’re attempting to mandate the stocking of abortion-inducing medicine and the efficiency of abortions throughout the nation utilizing instruments that don’t grant the federal authorities that authority,” stated Roger Severino, who ran the Workplace of Civil Rights inside the Division of Well being and Human Providers when Donald J. Trump was president. “They’re attempting to shoehorn abortion into legal guidelines that clearly weren’t designed to deal with abortion.”

Wednesday’s motion may put pharmacists in a thorny place. The Nationwide Neighborhood Pharmacists Affiliation, which represents 19,400 unbiased pharmacies throughout the nation, stated pharmacists “performing in good religion in accordance with their state’s legal guidelines” lacked “a transparent pathway ahead” and wanted extra steerage from states.

“States have supplied little or no readability on how pharmacists ought to proceed in mild of conflicting state and federal legal guidelines and rules,” B. Douglas Hoey, the group’s chief govt, stated in a press release. “It’s extremely unfair for state and federal governments to threaten aggressive motion towards pharmacists who’re simply attempting to serve their sufferers inside new authorized boundaries which can be nonetheless taking form.”

A spokesman for Walgreens, one of many nation’s largest pharmacy chains, stated the corporate would evaluate the rules; he had no additional remark.

Throughout a background name with reporters, an official from the Division of Well being and Human Providers stated that when state and federal legal guidelines conflicted, federal regulation took precedent.

Mr. Biden has been underneath intense stress from Democrats and advocates for reproductive rights to take daring steps to protect the precise to abortion after the court docket’s choice in Dobbs v. Jackson Girls’s Well being Group. Amongst different issues, they’ve been pushing for him to declare a public well being emergency — one thing his administration appears unwilling to do.

Wednesday’s steerage was issued by the well being division’s Workplace of Civil Rights. Monday’s steerage for hospitals was accompanied by a letter to well being care suppliers, delineating their tasks underneath the Emergency Medical Remedy and Lively Labor Act, often called EMTALA, a 1986 regulation that requires anybody coming to an emergency division to be stabilized and handled no matter insurance coverage standing or capacity to pay.

Mr. Severino argued that the steerage to hospitals “flips EMTALA on its head,” as a result of the regulation defines an emergency as a situation during which the absence of instant medical consideration “may moderately be anticipated to end in putting the well being of the affected person, or (in case of being pregnant, the unborn youngster) in critical jeopardy.” However Mr. Gostin took the administration’s place, saying that within the case of a pregnant girl in misery, the regulation permitted abortion “if it was essential to avoid wasting her life and there was no different option to stabilize her.”