A federal appeals court has limited access to one of the most common abortion methods by blocking the mailing of mifepristone prescriptions. A panel of the New Orleans-based 5th U.S. Circuit Court of Appeals ordered that the abortion pill be distributed only in person at clinics, setting up a likely appeal to the Supreme Court.
Since the Supreme Court’s 2022 ruling that overturned Roe v. Wade and allowed states to enforce abortion bans, mailing prescriptions has become a major way abortions are provided, including in states with bans. The panel said FDA policies allowing mail prescriptions undermine Louisiana’s abortion ban, writing, “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 noted that courts generally defer to the Food and Drug Administration’s judgments on drug safety and regulation. They also said the FDA was conducting a review of mifepristone’s safety and “could not say when that review might be complete and admitted it 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 a court to roll back FDA rules to when mifepristone could be prescribed and dispensed only after an in-person appointment. A Louisiana-based federal judge last month ruled that the pandemic-era allowances undermined the state’s ban but did not immediately undo the regulations.
Mifepristone was approved in 2000 for ending early pregnancies and is typically used with misoprostol. Because of rare cases of excessive bleeding, the FDA initially limited who could prescribe and dispense it—only specially certified physicians and only after an in-person visit. Those requirements were lifted during the COVID-19 years. At that time, FDA officials under President Biden said that after more than 20 years of monitoring and reviewing dozens of studies involving thousands of women, it was clear the pill could be used safely without direct supervision.
Critics say restricting telemedicine and mail delivery will disproportionately harm 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-majority Supreme Court overturned a nationwide right to abortion in 2022 but in 2024 unanimously preserved access to mifepristone; that ruling avoided core issues, however, by finding the anti-abortion doctors who sued lacked legal standing. Friday’s appeals-court decision is likely to prompt renewed litigation and another trip to the high court.