Federal appeals court blocks mail-order access to abortion pill mifepristone

A federal appeals court on Friday blocked shipments of the abortion pill mifepristone under current Food and Drug Administration (FDA) rules, a move the court said would have “in practice a nationwide effect” that would likely trigger a Supreme Court battle over abortion access.

The ruling by the 5th U.S. Court of Appeals could restrict access to the abortion pill across the country, restoring rules that supporters say protect patient safety and state authority, while critics warn it will make access more difficult even in states where abortion remains legal.

The move means women will now have to see a healthcare professional to get a prescription for mifepristone, reinstating a requirement that was waived during the COVID-19 pandemic under former President Joe Biden.

Mifepristone is one of two drugs commonly used in medical abortions and accounts for the majority of abortions in the United States, according to a study by the Guttmacher Institute.

The abortion pill mifepristone remains available by mail for now as the FDA faces a 6-month review deadline.

A packet of misoprostol abortion pills. (Sergueï Gapon/AFP)

The court order blocks mail-order distribution of the drug and effectively ends pharmacy distribution permitted by recent FDA rule changes, requiring it to be distributed in person under previous safety protocols.

“It is true, as the district court noted, that a stay under Section 705 ‘would, as a practical matter, have nationwide effect,'” the court wrote, putting in stark terms the broad implications of the ruling.

The justices sharply criticized the FDA’s handling of the drug’s safety data, saying the agency had “previously eliminated the requirement to report adverse reactions to mifepristone,” and calling it “unreasonable” to remove reporting requirements and then rely on the resulting lack of data to justify expanded access.

The decision also joins arguments from pro-life states, including Louisiana, who say the federal policy undermines their abortion laws.

“Every abortion facilitated by the FDA’s action voids Louisiana’s ban,” the court wrote, adding that state policy recognizes that “every unborn child is [a] the human being… from conception.

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Pro-life protesters march past the Supreme Court for the annual March for Life in Washington, DC in 2025. (Bryan Dozier/Middle East Images/AFP via Getty Images, File)

“Once lost, this sovereign prerogative to protect unborn life cannot be regained.”

The ruling marks a major escalation in the legal fight over abortion drugs, pitting federal regulators against states seeking to enforce stricter abortion laws after the Supreme Court’s 2022 decision overturning Roe v. Wade.

Pro-life groups quickly welcomed the decision.

“This is a victory we have been waiting for and we hope it endures,” said Kristan Hawkins, president of Students for Life.

“We cannot remain the United States of America if pro-abortion states allow the creation of criminal enterprises, thereby breaking the laws of their pro-life neighbors.”

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Boxes of mifepristone used for medical abortions. (Evelyn Hockstein/Reuters, file)

Family Research Council President Tony Perkins called the ruling “good news for unborn children,” adding that the issue “should soon go before the United States Supreme Court.”

Choice advocates sharply criticized the decision.

New York Attorney General Letitia James said mifepristone is “safe, effective and essential,” calling the decision “yet another cruel attack on abortion access.”

“Restrictions on abortion care are restrictions on vital health care,” she added.

As Fox News Digital previously reported, a federal judge last month allowed mifepristone to remain available by mail on a temporary basis while legal challenges and federal review efforts continued.

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Pro-life supporters hold signs outside the Supreme Court in Washington, DC (Olivier Douliery/AFP via Getty Images, File)

Justice David C. Joseph previously warned against “government by lawsuit,” emphasizing that the FDA’s ongoing safety review, not litigation, should determine long-term policy.

This review is still ongoing, with the Department of Health and Human Services and the FDA responsible for reviewing the safety data, adverse events, and regulatory framework for mifepristone.

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Louisiana Attorney General Liz Murrill had argued that the policy caused “irreparable harm every day” while it remained in effect, warning that expanded access was designed to “reach jurisdictions like Louisiana” despite state-level abortion restrictions.

Friday’s ruling paves the way for a likely appeal to the Supreme Court, where a new challenge to federal authority to regulate abortion drugs could take center stage.

The Associated Press contributed to this report.