Access to Abortion Medication Mifepristone Temporarily Preserved by Supreme Court

A series of federal court rulings and emergency appeals have resulted in a temporary continuation of telehealth and mail-order access to the abortion medication mifepristone, pending further review by the U.S. Supreme Court.

Key Developments

On May 1, 2025, a three-judge panel of the 5th U.S. Circuit Court of Appeals in New Orleans issued a ruling that reinstated a nationwide requirement for mifepristone to be prescribed and dispensed only during in-person visits to a clinic. The ruling effectively reversed FDA regulations that had allowed telehealth prescriptions and mail delivery of the drug.

In response, the two manufacturers of mifepristone—Danco Laboratories and GenBioPro—filed emergency appeals with the U.S. Supreme Court, seeking to block the appellate court's decision.

On May 5, 2025, Supreme Court Justice Samuel Alito issued an administrative stay, temporarily blocking the 5th Circuit's ruling. This order maintained the status quo, allowing telehealth prescriptions and mail-order access to continue. The stay was set to expire on May 11, 2025, at 5 p.m.

The Supreme Court later extended this pause with a subsequent order, maintaining current access to mifepristone while the case, Louisiana v. FDA, proceeds in lower courts.

The 5th Circuit Ruling

The original ruling from the 5th U.S. Circuit Court of Appeals was authored by Circuit Judge Kyle Duncan (appointed by President Donald Trump) and joined by Circuit Judges Leslie Southwick (appointed by President George W. Bush) and Kurt Engelhardt (appointed by President Trump).

The panel found that Louisiana had legal standing in the case. The court stated that the FDA's regulations allowing telemedicine access "injures Louisiana by undermining its laws protecting unborn human life and also by causing it to spend Medicaid funds on emergency care for women harmed by mifepristone. Both injuries are irreparable."

The ruling cited Louisiana's state law that "every unborn child is human being from the moment of conception." Judge Duncan wrote that the FDA's allowance of mailed pills "cancels Louisiana's ban on medical abortions."

Legal Background

The current lawsuit was filed in 2024 by Louisiana Attorney General Liz Murrill, arguing that FDA regulations allowing mail-order mifepristone undermined the state's abortion ban. A federal district court had previously paused the litigation in April 2025 to allow the FDA time to complete a safety review, but Louisiana successfully appealed to the 5th Circuit.

This case represents the second time the issue of mifepristone access has reached the U.S. Supreme Court since the 2022 ruling in Dobbs v. Jackson Women's Health Organization, which overturned the constitutional right to abortion.

In 2024, the Supreme Court unanimously rejected a prior challenge to FDA regulations in FDA v. Alliance for Hippocratic Medicine, ruling that the anti-abortion doctors who brought that case lacked legal standing.

The current lawsuit also references the Comstock Act of 1873, with Louisiana arguing that mailing abortion medication violates this law. A 2022 Department of Justice memo stated that the Comstock Act does not prohibit mailing such drugs when intended for lawful use.

Drug and Access Details

• Mifepristone was approved by the FDA in 2000 for early pregnancy termination, typically used in combination with misoprostol.
• The FDA initially required in-person dispensing and prescription by certified physicians. These requirements were lifted during the COVID-19 pandemic, and the FDA made the policy official in 2023, citing over 20 years of safety data.
• Data indicates that mifepristone has fewer reported side effects than Viagra or penicillin, according to a CNN analysis.
• Medication abortions account for approximately two-thirds of all U.S. abortions, according to the Guttmacher Institute.
• According to #WeCount, more than 1 in 4 abortions nationwide were provided via telehealth in the first half of 2025, up from fewer than 1 in 10 in 2022.
• The Guttmacher Institute estimates that in 2025, about 91,000 telehealth abortions were provided under "shield laws" to people in states with total abortion bans.

Reactions

From Mifepristone Manufacturers

• Danco Laboratories stated that the 5th Circuit ruling "injects immediate confusion and upheaval into highly time-sensitive medical decisions."
• GenBioPro stated the decision "ignores the FDA's rigorous science and decades of safe use of mifepristone."

From Supporting Organizations

• Julia Kaye, senior staff attorney for the ACLU's Reproductive Freedom Project, stated the ruling "defies clear science and settled law" and will affect access to abortion and miscarriage care nationwide.
• Nancy Northup, president and CEO of the Center for Reproductive Rights, stated: "Telehealth has been the last bridge to care for many seeking abortion, which is precisely why Louisiana officials want it banned."

From Louisiana and Anti-Abortion Advocates

• Louisiana Attorney General Liz Murrill stated: "Big abortion pharma claims they need an emergency stay because they will lose massive amounts of money... The administrative stay is temporary, and I am confident life and the law will win in the end."
• Carol Tobias, president of the National Right to Life Committee, stated that the 5th Circuit ruling "restores a critical layer of oversight."
• Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, called the 5th Circuit ruling "a huge victory for victims and survivors."
• Kelsey Pritchard of Susan B. Anthony Pro-Life America stated: "What is shocking is that the Trump administration's inaction has stopped pro-life laws from taking effect."

From Providers and Researchers

• Dr. Angel Foster, founder of The Massachusetts Abortion Access Project, stated that her organization had prepared to switch to misoprostol-only regimens but was able to revert to mifepristone after the Supreme Court's order.
• Mary Ziegler, a law professor at UC Davis, stated that the 5th Circuit ruling "sort of puts the president in the position of having to get off the sidelines on this issue in a way we haven't seen before."

Legal Arguments and Dissents

In the Supreme Court's final order, the 7-2 decision allowed telehealth access to continue while litigation proceeds. Justices Clarence Thomas and Samuel Alito dissented.

• Justice Thomas wrote that mailing mifepristone constitutes "criminal enterprise" and invoked the Comstock Act of 1873.
• Justice Alito stated that the decision undermines the Supreme Court's 2022 ruling in Dobbs v. Jackson Women's Health Organization and described telehealth access as a "scheme" to bypass that ruling.

Nearly two dozen Democratic-led states filed an amicus brief arguing the 5th Circuit decision prioritizes the policy choices of states with bans over those promoting abortion access. A group of former FDA leaders also filed a brief defending the agency's drug approval process and arguing the appeals court ruling would undermine it.

Outlook

The case has been sent back to the 5th Circuit for further proceedings. Legal observers anticipate that the lawsuit could return to the Supreme Court on a formal appeal in a future term.

Some providers have indicated they would continue telemedicine abortion using an alternative protocol with higher doses of misoprostol and no mifepristone if access to the drug were restricted. Researchers state that misoprostol-only regimens are equally effective but cause more pain and side effects. Misoprostol is expected to remain fully accessible even if mifepristone is restricted.

The FDA has stated it will complete its science-based safety review of mifepristone and provide updates.

Reports indicate that new FDA Commissioner Kyle Diamantas, appointed in early May 2025, has assured anti-abortion advocates that reviewing mifepristone is a "top priority." The Trump administration has not directly stated its position on the ruling; it has pointed to the ongoing FDA safety review as a reason to pause the lawsuit.