Supreme Court restores temporary mail access to abortion pill, mifepristone

The Supreme Court has temporarily restored nationwide access to the abortion medication mifepristone by mail. The brief emergency order, issued by Justice Samuel A. Alito Jr., allows telemedicine prescribing and mail delivery of the drug to continue for now.

At the center of the dispute is whether patients must once again be required to visit a health care provider in person to obtain mifepristone, a medication that has become the dominant method of abortion care in the United States. That requirement had been lifted by the FDA in 2021 as part of broader pandemic-era and post-pandemic regulatory changes expanding telehealth access. A ruling last Friday from the U.S. Court of Appeals for the Fifth Circuit in New Orleans temporarily reinstated the in-person rule.

The Supreme Court’s intervention halts that reinstatement until at least May 11, while briefs are submitted and the justices consider their next steps.

The underlying case originates from Louisiana, which argues that federal rules allowing mifepristone to be mailed have undermined the state’s near-total abortion ban.

Approximately a quarter of abortions in the United States are provided through telemedicine. Medication is the most common form of abortion, accounting for approximately two-thirds of abortions in the United States.

Mifepristone is a medication used to block progesterone, a hormone that allows the pregnancy to continue. When used together with misoprostol, the pregnancy is terminated. The FDA first approved this abortion regimen in 2000 to terminate pregnancies through seven weeks gestation. In 2016, the FDA extended this approval to 10 weeks’ gestation.

Last Friday’s ruling prompted two drug manufacturers of mifepristone, Danco Laboratories and GenBioPro, to ask the Supreme Court to intervene. Danco’s lawyers said that the decision “injects immediate confusion and upheaval into highly time-sensitive medical decisions,” forcing the FDA, providers, pharmacies and patients to “guess at what is allowed and what is not,” according to court filings.

Proponents on either side of the abortion movement have voiced their opinion on today’s emergency order.

Louisiana Attorney General Liz Murrill and the Alliance Defending Freedom, a Christian legal advocacy group that filed the lawsuit to end mail prescribing, released the following statement on social media.

"Big abortion pharma claims they need an emergency stay because they will lose massive amounts of money if they can’t kill more babies quickly and efficiently by mail without medical oversight," Murrill said. "The administrative stay is temporary, and I am confident life and the law will win in the end."

Meanwhile, Alexis McGill Johnson, president of the Planned Parenthood Action Fund, a reproductive health organization that provides abortions, welcomed the decision.

"While mifepristone access returns to where it was on Friday morning, the whiplash and chaos that patients and providers are navigating have already had real consequences for real people's lives and futures,” McGill Johnson said.