Supreme Court upholds mail access to abortion pill mifepristone for now

Washington- The Supreme Court on Thursday maintained access to the mail of abortion pill mifepristonevacating for now a lower court order that blocked abortion providers from prescribing the widely used drug through telehealth and shipping it to patients.

The high court’s unsigned ruling ensures that patients across the country will continue to have broad access to mifepristone while litigation challenging the Food and Drug Administration’s relaxed policy for obtaining the drug brought in by the state of Louisiana moves forward.

Conservative Justices Samuel Alito and Clarence Thomas dissented.

The order came after a federal appeals court earlier this month reinstated an FDA rule requiring mifepristone to be dispensed in person. Two pharmaceutical companies that make the drug, Danco Laboratories and GenBioPro, warned that the ruling caused confusion and chaos for patients, abortion providers and pharmacies, and asked the Supreme Court to block the lower court’s decision and continue to allow patients to obtain the pills by mail.

But Louisiana officials urged the high court to uphold the stricter rule for obtaining mifepristone, which the FDA lifted in 2021. They warned that ending the in-person dispensing requirement allowed out-of-state providers to circumvent its abortion ban, leading to more than 1,000 medication abortions in the state. The FDA has not taken a position before the Supreme Court on whether it should preserve mail access to mifepristone.

Alito issued a temporary order last week that suspended the decision of the court of appeal while the court considered the matter, even though its break was set to expire on Thursday. The entire Supreme Court has now agreed to maintain broad access to abortion medication through the mail.

The judges’ intervention follows a lawsuit Louisiana filed last year against the FDA, which threatened to cut off mail-in access to mifepristone for women nationwide, including in states where abortion is legal. Mifepristone is taken with a second medicine, misoprostol, to terminate an early pregnancy.

Medications were used in 65% of all clinician-performed abortions in 2023, according to the Guttmacher Institute, a research organization that supports abortion rights. More than 1.1 million abortions were performed by health care workers last year, a figure that includes medical abortions offered via telehealth to patients in states where abortion is restricted, Guttmacher found.

Preserving access to the abortion pill has become a new urgency after the Supreme Court overturned Roe v. Wade in 2022, after which more than half of states have imposed limits on the procedure. In Louisiana, abortion is prohibited, with few exceptions. The State too promulgated a law in 2024, which designates mifepristone and misoprostol as controlled substances and criminalizes possession without a prescription.

But the Biden administration made getting mifepristone easier when it execution suspended of the in-person distribution rule during the COVID-19 pandemic, concluding that the drug “can be used safely without in-person distribution.” The FDA has officially authorized mifepristone to be prescribed via telehealth and distributed by mail in 2023.

In their lawsuit, Louisiana officials said that because of these actions, mifepristone was flooding into the state, causing “thousands” of illegal abortions each year and costing the state tens of thousands of dollars through its Medicaid program.

A federal district court had stayed Louisiana’s lawsuit against the FDA in April while the agency examined the safety of mifepristone. The Trump administration has said that although studies typically take at least a year, the FDA’s plan is to complete the review “sooner than that time frame.”

But Louisiana officials appealed the ruling, and the U.S. Court of Appeals for the 5th Circuit agreed to temporarily block the 2023 policy allowing mifepristone to be prescribed remotely and sent by mail.

In emergency appeals to the Supreme Court, Danco and GenBioPro warned that the appeals court decision had caused chaos and threatened to abruptly eliminate nationwide access to mifepristone by mail.

“Patients and clinicians have relied on dispensing of mifepristone without a clinic visit for years, particularly for women in rural areas and those for whom transportation, child care, or work constraints make it difficult to visit providers in person,” GenBioPro said. “As a direct result of the Fifth Circuit’s order, patients across the country may face delays or denial of access to urgent medical care, supply chain disruptions, and resulting health risks.”

Louisiana officials, meanwhile, said that while in-person abortions “virtually disappeared” in the state after Roe ended, medication abortions “skyrocketed.” Beyond Medicaid costs, the state said it also spent more than $17,000 investigating out-of-state providers who shipped mifepristone to Louisiana.

The emergency appeals brought the issue of mifepristone’s availability to the Supreme Court for a second time. Months after the high court struck down the constitutional right to abortion, abortion rights groups filed a lawsuit challenging the FDA’s approval of mifepristone in 2000 and several steps the agency took to relax conditions for its use.

The groups argued that the FDA failed to adequately consider the safety and effectiveness of the drug. Major medical associations, including the American Medical Association and the American College of Obstetricians and Gynecologists, have stated that major adverse events occur in fewer than 0.32% of patients when mifepristone is used in medical abortions.

The Supreme Court in 2024 unanimously rejected the challenge from anti-abortion doctors and medical groups, ruling that the plaintiffs did not have the legal right to sue the FDA.