Supreme Court allows abortion pill to be distributed by mail

The Supreme Court on Thursday allowed the abortion pill to remain available via telehealth, meaning it can be prescribed remotely and delivered by mail, even in states where abortion is restricted.

A lower court ruled two weeks ago that the Food and Drug Administration likely erred in its 2023 decision allowing mifepristone, a key ingredient in the pill, to be prescribed during virtual doctor visits and delivered by mail. The justices stayed that ruling, allowing access to the pill by mail while the case develops.

Their action defuses what could have been a significant political issue for Democrats heading into the midterm congressional elections in November.

The high court did not explain its reasoning, but to get a stay it had to agree with the drug’s makers that the lower court’s ruling was wrong and that the drug companies would be harmed if the justices did not intervene now.

Two of the court’s conservative justices, Samuel A. Alito Jr. and Clarence Thomas, filed dissenting opinions, saying the drug companies should not have had standing to bring the case before the justices.

Justice Alito also criticized his colleagues for undermining their 2022 decision, the Dobbs case, which saw the high court overturn Roe v. Wade and return the issue of abortion to the states.

“What is at stake is the perpetration of a scheme to undermine our decision in Dobbs…which restored the right of each state to decide how to regulate abortions within its borders,” he wrote.

Louisiana had challenged the FDA’s 2023 policy, saying it undermined the state’s abortion restrictions.

The FDA, now led by President Trump, said it botched the decision in 2023. It is now conducting a new review.

The 5th U.S. Circuit Court of Appeals said this month that the policy should be suspended in the meantime.

Louisiana Attorney General Liz Murrill expressed disappointment Thursday with the justices for overturning the ruling.

“It is shocking that the Supreme Court is blocking this common-sense return to medically ethical practices and oversight,” Ms. Murrill said.

Democrats welcomed the decision, although they made clear they would still try to use abortion as a political issue — just as they did in the 2022 election, after Roe was overturned.

“Drugs such as mifepristone have been shown to be safe and effective and have been widely used for decades. Today’s order preserves access for now, but it does not change the fact that safe access to abortion and reproductive health care remains under attack,” said Senate Minority Leader Charles E. Schumer, Democrat of New York.

The Biden FDA first relaxed rules for mailing the abortion pill in 2021, affirming the need for exceptions during the COVID-19 pandemic.

He formalized the policy in 2023, in what pro-life activists saw as a way to undermine states that imposed abortion restrictions after Roe ended.

These activists say the pill is too dangerous to be prescribed and dispensed outside of a doctor’s direct care. Pro-choice activists say this is a subterfuge, and the real goal of pro-life activists is to prevent abortions.

Mifepristone works by blocking progesterone, weakening the lining of the uterus and causing the fertilized egg to detach. Another medication, misoprostol, is then taken to force the contractions that expel the egg.

As of early last year, 27% of all abortions in the United States were performed via telehealth, fueling a rise in the overall number of abortions nationwide.

The total rose from 1,058,650 in 2023 to 1,123,920 in 2024 and 1,126,470 in 2025, according to the Guttmacher Institute. The abortion pill, by mail or in person, now accounts for about two-thirds of all terminations of pregnancies.

The increase has dismayed pro-life advocates, who have called on the Trump administration to do more to suppress the numbers. FDA Commissioner Marty Makary, who resigned this week, had become a particular target.

Before the Supreme Court, the Trump administration remained surprisingly silent on the case, failing to file a brief even though the FDA was the named defendant.

That left two pharmaceutical companies that produce mifepristone, Danco Laboratories LLC and GenBioPro Inc., to defend the FDA’s 2023 policy in front of judges.

They argued that the potential loss of business gave them legal standing to defend the policy.

Justice Thomas, in his dissent, said sending abortion medications through the mail violates one part of federal law: the Comstock Act. Justice Thomas said this meant the pharmaceutical companies were alleging legal harm from something that was, in essence, a “criminal enterprise”.

“They cannot, in any legally relevant sense, be irreparably harmed by a court decision that makes it more difficult for them to commit crimes,” Justice Thomas wrote.

Abortion rights supporters criticized the Trump administration for dropping the case.

“When nationwide access to a critical drug for abortion and miscarriage was at stake, the Trump administration refused to defend the FDA’s action and threw patients under the bus,” said Julia Kaye, an attorney at the American Civil Liberties Union.