May 14 (Reuters) – The U.S. Supreme Court on Thursday ensured that the abortion pill can continue to be prescribed through telemedicine and dispensed by mail as the justices restored for now a 2023 federal rule challenged by Republican-governed Louisiana that had made access to the medication easier.
The justices granted requests by two manufacturers of the abortion pill, called mifepristone, to lift a lower court’s block on the rule that was issued by the U.S. Food and Drug Administration during Democratic former President Joe Biden’s administration, while Louisiana’s legal challenge plays out.
The brief order was unsigned and offered no reasoning, as is common with emergency actions by the Supreme Court. Conservative Justices Samuel Alito and Clarence Thomas dissented from the decision.
The New Orleans-based 5th U.S. Circuit Court of Appeals on May 1 had ordered the imposition of a previous federal rule that required an in-person clinician visit in order to receive mifepristone.
Drugmakers Danco Laboratories and GenBioPro appealed the 5th Circuit action restricting access to mifepristone, a drug that was given FDA regulatory approval in 2000.
The case had put the contentious issue of abortion back in front of the justices, with the November U.S. congressional elections looming and President Donald Trump’s fellow Republicans fighting to retain control of Congress.
SUPREME COURT’S DOBBS RULING
The Supreme Court has a 6-3 conservative majority. The ongoing battles over abortion rights follow its 2022 ruling that overturned its 1973 Roe v. Wade precedent that had recognized a woman’s constitutional right to terminate her pregnancy and legalized abortion nationwide.
That ruling, in a case called Dobbs v. Jackson Women’s Health Organization, prompted 13 states to enact near-total bans on the procedure, while several others sharply restrict access. Those laws have driven a surge in medication abortion.
Since the Dobbs ruling, anti-abortion advocates have targeted mifepristone, claiming that it is unsafe for women to take and that the FDA should not have approved it or relaxed limits on its use.
In his dissent on Thursday, Alito said that the delivery of abortion pills by mail from out-of-state providers has thwarted efforts by states like Louisiana that have sought to make abortion illegal in the wake of the Dobbs ruling.
“Louisiana’s efforts have been thwarted by certain medical providers, private organizations and states that abhor laws like Louisiana’s and seek to undermine their enforcement,” Alito added.
In a separate dissent, Thomas said the federal Comstock Act prohibits the mailing of drugs intended for abortion.
The drugmakers, Thomas said, “are not entitled to a stay of an adverse court order based on lost profits from their criminal enterprise. They cannot, in any legally relevant sense, be irreparably harmed by a court order that makes it more difficult for them to commit crimes.”
Abortion rights advocates have called the legal challenges to mifepristone the biggest threat to abortion access in the United States since the court’s Dobbs decision.
The Supreme Court in 2024 unanimously rejected an initial bid by anti-abortion groups and doctors to roll back FDA regulations that had eased access to the drug, ruling that these plaintiffs lacked the necessary legal standing to pursue the challenge.
‘DESPERATE ATTEMPT’
Lizzy Hinkley, legal director for the Abortion Coalition for Telemedicine advocacy group, said, “Even this conservative Supreme Court is not willing to endorse anti-abortion extremists’ latest desperate attempt to deprive women of needed healthcare. This case is a deliberate effort to disrupt access to telemedicine abortion across the country and cause undue confusion among patients and providers.”
Alexis McGill Johnson, president of the Planned Parenthood Federation of America, said, “The Supreme Court just did the bare minimum, but this ruling is a relief for patients who can continue to get the care they need. We know this is just one in a long line of attacks on our rights and our care.”
The brand-name version of mifepristone, Mifeprex, is Danco’s only product, and GenBioPro derives most of its revenue from the generic version, the companies said in court filings.
GenBioPro’s Chief Executive Officer Evan Masingil welcomed the ruling, saying in a statement that the company is committed to providing “evidence-based, essential medication to all who need it.”
The 5th Circuit’s ruling had caused “nationwide chaos and confusion for patients and providers,” Danco spokesperson Abby Long said in a statement. “We are pleased that a safe and effective drug Americans depend on will continue to be available while this litigation proceeds.”
Carol Tobias, president of National Right to Life, an anti-abortion group, expressed disappointment.
“This decision is deeply troubling because it leaves women exposed to powerful abortion drugs,” Tobias said. “Women facing unexpected pregnancies deserve real medical care and support, not a one-size-fits-all mail-order abortion system that minimizes risks and leaves women isolated during medical emergencies.”
A TWO-DRUG REGIMEN
Medication abortion, typically a two-drug regimen consisting of mifepristone followed by misoprostol, accounts for about two-thirds of U.S. abortions and is used to terminate a pregnancy within the first 10 weeks.
The FDA has said mifepristone was approved based on scientific evidence and continues to be safe and effective for its intended purpose when used as directed.
Reproductive health experts note that hundreds of clinical trials, studies and medical reviews have shown that mifepristone is safe and that complications are exceedingly rare. They have said abortion opponents have misrepresented studies that actually show that complications and serious adverse events for women who have accessed the pill by telehealth and the mail are rare.
Louisiana sued the Food and Drug Administration in 2025 claiming that the 2023 rule that eliminated the in-person dispensing requirement was illegal and has allowed medication abortions to skyrocket despite the state’s near-total ban on abortion. Louisiana claimed the FDA ignored the risks of serious adverse events posed by mifepristone for women taking it, including sepsis and hemorrhaging.
Danco Laboratories and GenBioPro intervened in the litigation to defend the regulation. Republican President Donald Trump’s administration opposed the state’s challenge, citing an ongoing review of safety regulations concerning mifepristone. The administration also argued that Louisiana does not have legal standing to pursue its case.
In April, U.S. District Judge David Joseph in Lafayette, Louisiana, declined to block the regulation but agreed with the administration to put the case on hold pending the review. A three-judge 5th Circuit panel subsequently blocked the regulation, deciding that Louisiana was likely to prevail in its legal challenge.
Abortion rights advocates have called the Trump administration’s review politically motivated and unnecessary given decades of studies showing the safety of mifepristone. They have said that the review could lead to tighter restrictions on the medication.
Separate from Louisiana’s case, two other pending lawsuits by five Republican-led states are aiming to curb access to the abortion pill even more drastically, including by cutting it off altogether.
In December, Texas and Florida filed a lawsuit targeting the FDA’s initial approval of mifepristone in 2000 and several subsequent approvals and regulations that eased access, including the mail-order access rule. And separately, Missouri, Kansas and Idaho are arguing that the FDA acted improperly when it eased restrictions on mifepristone in 2016.
The Supreme Court in interim decisions on May 4 and May 11 had put the 5th Circuit’s May 1 action on hold to give the justices more time to decide how to proceed.
(Reporting by Andrew Chung in New York; Additional reporting by John Kruzel, Dan Wiessner, Ahmed Aboulenein and Daphne Psaledakis; Editing by Will Dunham)
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