A unanimous three-judge panel of the 5th U.S. Circuit Court of Appeals in New Orleans has blocked the mailing and pharmacy dispensing of mifepristone, limiting how the drug is distributed nationwide. The panel ruled that mifepristone must be dispensed only in person at clinics, overturning FDA policies that had allowed telehealth prescriptions and mailing. The decision is expected to be appealed and has been called the most significant change in abortion policy since the Supreme Court’s 2022 Dobbs ruling.
Judge Kyle Duncan, a Trump appointee on the panel, sided with Louisiana officials who argued that allowing mailed mifepristone effectively nullifies the state’s near-total abortion ban and undermines Louisiana’s recognition of the unborn as legal persons. The appeals court noted the FDA under the Trump administration had said it was conducting a new review of mifepristone’s safety and was still collecting data, a point the judges cited in departing from the usual deference courts show to agency drug-safety determinations.
Mifepristone, approved in 2000 and typically used with misoprostol to end early pregnancies, now accounts for a growing share of U.S. abortions. Surveys indicate medication abortions are the majority of procedures nationally, and roughly one in four abortions are prescribed via telehealth. One provider survey found that in states with abortion bans, more women received abortions through mailed pills than by traveling to other states. Some states led by Democrats have passed measures intended to shield telehealth prescribers who treat patients in states with bans; opponents have increasingly targeted the pills through legislation and litigation.
The FDA originally limited distribution to certified clinicians after an in-person visit because of potential bleeding risks; those restrictions were relaxed during the COVID-19 pandemic. The agency under President Biden has maintained that decades of monitoring and numerous studies show mifepristone can be used safely without direct supervision. The manufacturer of a generic version, GenBioPro, criticized the ruling as ignoring the agency’s science and long record of safe use.
The appeals decision goes beyond states with bans: it takes effect nationwide while the underlying case proceeds, blocking telehealth prescriptions even where abortion remains legal. Louisiana’s attorney general and a woman who said she had been coerced into taking abortion pills had sought to restore the pre-pandemic in-person-only rules; a lower federal judge previously found the relaxed rules undermined the state ban but did not immediately reinstate the old regime.
Civil rights advocates warn the ruling will restrict access to both abortion and miscarriage care across the country and disproportionately harm rural residents, low-income people, people with disabilities, survivors of intimate partner violence and communities of color. Anti-abortion groups praised the decision as restoring oversight and criticized ‘‘abortion-by-mail’’ as prioritizing ideology over safety.
