A federal appeals court has restricted access to a widely used abortion method by blocking the mailing of mifepristone prescriptions and ordering that the drug be dispensed only in person at clinics. The New Orleans-based 5th U.S. Circuit Court of Appeals panel’s ruling sets up a likely appeal to the Supreme Court.
The decision targets FDA policies that allowed mifepristone to be prescribed remotely and shipped to patients — an approach that became a major way to obtain medication abortions after the Supreme Court’s 2022 ruling that removed a nationwide right to abortion and left regulation to the states. The panel said the FDA’s mail-prescription allowances undermine Louisiana’s abortion ban, writing in part, “Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person.’”
The judges acknowledged that courts normally defer to the Food and Drug Administration on drug safety and regulation, but noted the agency was conducting a review of mifepristone’s safety, had not said when that review would conclude, and was still collecting data.
The challenge was brought by Louisiana’s attorney general and a woman who says she was coerced into taking abortion pills. They asked courts to return to pre-pandemic rules that limited mifepristone prescriptions and dispensing to in-person visits with specially certified physicians. A federal judge in Louisiana last month ruled that the pandemic-era allowances undermined the state’s ban but did not immediately rescind the FDA’s regulations.
Mifepristone was approved in 2000 for ending early pregnancies and is typically used with misoprostol. Because of rare but serious bleeding risks, the FDA originally restricted who could prescribe and dispense it and required an in-person appointment; those limits were eased during the COVID-19 pandemic after the agency reviewed years of safety data and studies.
Reinstating in-person and no-mail requirements, critics say, would disproportionately affect rural patients, people with low incomes, people with disabilities, survivors of intimate partner violence, and communities of color. “This is going to affect patients’ access to abortion and miscarriage care in every state in the nation,” said Julia Kaye, an ACLU lawyer.
The conservative Supreme Court overturned a nationwide right to abortion in 2022 but in 2024 unanimously left access to mifepristone in place, a ruling limited by the court’s finding that the plaintiffs lacked standing. The 5th Circuit’s decision is expected to trigger renewed litigation and potentially another review by the high court.