A federal appeals court is temporarily reinstating a requirement that abortion pills be picked up in person instead of sent through the mail — a victory for antiabortion advocates that one of the drug’s manufacturers quickly sought to place on pause.
The move from the U.S. Court of Appeals for the 5th Circuit will make it harder for women to access the commonly used abortion pill, abortion rights advocates said. The ruling stems from Louisiana’s lawsuit against the Food and Drug Administration, which allowed patients to access pills through telehealth and mail. Louisiana asked that the FDA rule get put on hold as the state challenges the agency in court. The decision remains in effect while the case plays out.
Drugmaker Danco Laboratories swiftly filed an emergency motion for a one-week pause through May 8 to allow the company to seek an opinion from the Supreme Court. Danco, a maker of mifepristone, is seeking a decision on its ask from the circuit court by 9 p.m. Central time, arguing the ruling resulted in “immediate chaos.”
“It is now unclear whether pharmacies nationwide may still dispense mifepristone to women tonight,” the filing states. “It is unclear what patients and providers must do if they have an appointment this weekend or early next week.”
It’s the latest twist in a legal battle over the pill that intensified after the Supreme Court overturned Roe v. Wade in 2022. When the justices threw out Roe, members of the antiabortion movement hoped the decision would curb abortions and more American women living in states with bans would carry their pregnancies to term.
Instead, abortions in the United States have held steady — and also risen — in recent years because of the availability of abortion pills, including mifepristone. Abortion drugs can be remotely dispensed through telehealth providers and mailed under “shield laws,” passed in Democratic-led states after Dobbs v. Jackson Women’s Health Organization to give providers the ability to legally send the pills to women regardless of their location.
Vexed by that availability, Republicans and antiabortion activists have been pushing President Donald Trump and the FDA to bring back restrictions on mifepristone, the first of the typical two-step medication abortion regimen. The administration has been hesitant, with FDA Commissioner Marty Makary promising to conduct a safety review of the pill but not delivering on full restrictions in the eyes of the antiabortion movement.
The FDA approved mifepristone in 2000, and medical providers and legal experts have said there is “robust evidence” gathered over more than two decades showing the pill is safe and effective. Over the years, the agency has eased some of the restrictions around the medication and removed the requirement to pick up the medication in person several years ago.
The ruling said Louisiana has laws banning abortion or the sales of drugs like mifepristone. But an FDA rule finalized under Biden making the pill easier to access undermines the state law and gives Louisiana grounds to challenge the federal agency in court.
“Predictably, the regulation has had that effect in Louisiana, despite the fact that its laws ban the practice,” the ruling said. “By ending the in-person dispensing requirement, FDA opened the door for mifepristone to be remotely prescribed to Louisiana women. The record shows that the policy now facilitates nearly 1,000 illegal abortions in Louisiana per month.”
John Seago, the president of Texas Right to Life, hailed the ruling as a victory but said reinstating the in-person requirement is the “bare minimum.”
Seago called medication abortion “the biggest target for the pro-life movement,” because the procedure is still accessible in states with strict abortion bans.
Ultimately, Seago said the goal of his group and their antiabortion allies is to undo shield laws, which would outlaw abortion pills in states where the pills are banned, including Texas.
Abortion rights groups panned the ruling as creating barriers to abortion pills that could result in women driving hundreds of miles for the medication.
“It is now much more difficult for people to access abortion care,” Mini Timmaraju, the president and CEO of Reproductive Freedom for All, said in a statement. “Anti-abortion politicians know their policies are unpopular, so they are using every lever of government they can.”
Greer Donley, professor at the University of Pittsburgh School of Law, said the injunction will be a massive disruption for telehealth providers, saying that brick-and-mortar clinics are already stretched thin. The impact also depends on whether providers switch to a misoprostol-only regimen, the second pill in the two-step regimen. Misoprostol pills can be used effectively on their own but are considered somewhat less effective and can cause longer discomfort and cramping.
Legal experts and advocacy groups expect the abortion pill issues to once again land before the Supreme Court. In 2024, the Supreme Court upheld access to mifepristone in a separate case that challenged access to the drug.
The court unanimously ruled that the antiabortion doctors who brought the case did not have grounds to sue the FDA because they did not prescribe or use abortion pills. Three Republican-led states — Missouri, Kansas and Idaho — have since taken up that case to restrict mifepristone. In another lawsuit, Texas and Florida are asking for mifepristone to be taken off the market entirely.
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