Supreme Court Temporarily Blocks Restrictions on Mail-Order Abortion Pill Mifepristone

The U.S. Supreme Court has stepped in to keep the abortion pill mifepristone available by mail for now.

On May 4, Justice Samuel A. Alito Jr. issued a temporary halt to a lower court ruling that would have restricted nationwide access to the drug through mail delivery. This pause is in effect at least until May 11.

The Supreme Court’s action reverses a May 1 decision by the 5th Circuit Court of Appeals in New Orleans. That court had sided with a lawsuit from Louisiana, which argued that prescribing the abortion pill through telehealth puts pregnant people at risk.

Louisiana currently bans abortion in nearly all cases. The lower court’s ruling also tried to block mail delivery of the drug for miscarriage care and other non-abortion uses. This left many patients and providers confused.

A separate lawsuit in Louisiana that challenges mail-order prescriptions for mifepristone is still on hold. A federal judge paused that case until the U.S. Food and Drug Administration (FDA) finishes its own safety review of the drug. The FDA has 60 days to update the court on its progress and up to six months to complete the review.

Louisiana Attorney General Liz Murrill said in a social media post that she asked the Fifth Circuit to suspend the current rules, arguing the state is likely to prove the safety regulations are unlawful.

Experts say the drug has a strong safety record. “Decades of evidence and research from the U.S. and around the world show that mifepristone is safe and effective,” said Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute.

Sarah Prager, MD, an OB-GYN at the University of Washington Medical Center, added, “These medications are so safe, they can be used as over-the-counter medications (and are in other countries).”

Friedrich-Karnik called the FDA review a “sham” designed to cut off access. Murrill said Louisiana is likely to win its case. The Fifth Circuit will hear arguments next.

For the estimated 1 in 4 people who now get abortions through telehealth, the outcome will decide if that option remains available.

“While this case is paused and mifepristone access remains unchanged for now, we know the fight is far from over. The judge’s ruling leaves the door open for future restrictions to mifepristone access,” said Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, in a statement.

“From the courts to the Trump administration to state legislatures across the country, mifepristone and abortion access are very much still under attack,” she continued.

1 in 4 rely on telehealth abortion

Medication abortion is now the most common way to end a pregnancy in the United States. According to the Centers for Disease Control and Prevention (CDC), it made up 63% of all abortions in 2023.

The process uses two drugs taken days apart. Mifepristone blocks the hormone progesterone, which is needed to maintain a pregnancy. Then, 24 to 48 hours later, a second drug called misoprostol helps the uterus expel the pregnancy.

By the end of 2024, 1 in 4 people got their abortion through a telehealth visit, according to the Society of Family Planning. During a virtual appointment, a provider reviews a person’s medical history, confirms they are eligible, and sends a prescription — all without an in-person visit.

“Providers will take a really thorough health history to screen for allergies, worrisome pregnancy complications like ectopic pregnancy, anemia, or contraindications to medication abortion,” said Alyssa Sherer, DNP, a medical consultant to the Abortion Coalition for Telemedicine.

The Guttmacher Institute estimates that in 2025, people living in the 13 states with total abortion bans received about 91,000 telehealth abortions. That includes about 9,350 in Louisiana. The state recently issued the first criminal indictment of an abortion provider since the Dobbs decision — a New York doctor who prescribed pills via telehealth to a Louisiana teenager.

“Reimposing barriers on mifepristone use would upend abortion provision nationwide, deepen racial and socioeconomic inequities in who can access care, and place additional strain on providers who are already navigating a fractured landscape,” said Friedrich-Karnik.

As abortion clinics close, telehealth and urgent care fill gaps

Part of the reason more people are turning to telehealth for abortion is that local clinics are closing.

When Planned Parenthood in Marquette, Michigan, closed last spring, it left about 1,100 patients without an in-person provider.

“It’s a 500-mile stretch of no access,” Shawn Brown, MD, told Kaiser Family Foundation Health News. Brown, who describes herself as “individually pro-life,” started offering medication abortions at her urgent care practice to fill the gap.

“This preference for telemedicine is often due to barriers to care that are created by stigma, time, jobs, children, school, geography, ability, or many other aspects,” Prager said. “Telemedicine is a safe and evidence-based way to get care for both miscarriage and abortion.”

When asked how a telehealth abortion visit compares to other virtual appointments, Sherer said, “They look pretty much the same.” After reviewing a patient’s health history, the provider sends a prescription to a mail-order or retail pharmacy. Follow-up care, including confirming the abortion is complete, can also happen remotely.

Abortion access varies widely by state. More information on finding care can be found here.

Source: Healthline