A federal appeals court has restricted access to one of the most common methods of abortion in the United States by blocking the mailing of mifepristone prescriptions.
A unanimous three-judge panel of the New Orleans-based 5th U.S. Circuit Court of Appeals ruled Friday that the abortion pill must be distributed only in person and at clinics, overturning federal Food and Drug Administration regulations that allowed mailing and pharmacy dispensing. The decision is likely to be appealed to the U.S. Supreme Court and is being described as the biggest shift in abortion policy since the 2022 Supreme Court ruling that overturned Roe v. Wade.
Judge Kyle Duncan, a Trump appointee, sided with Louisiana’s argument that allowing the drug to be mailed effectively nullifies the state’s ban on abortion at all stages of pregnancy. The ruling says FDA action facilitating mailed mifepristone “cancels Louisiana’s ban on medical abortions and undermines its policy” recognizing the unborn as legal persons.
Mifepristone, approved in 2000, is typically used with misoprostol to end early pregnancies. Surveys show that medication abortions account for the majority of abortions in the U.S., and about one in four abortions nationally are prescribed via telehealth. One provider survey last year estimated that more women in states with abortion bans obtained abortions through mailed pills than by traveling to other states. Some Democratic-led states have adopted laws intended to protect providers who prescribe via telehealth to patients in states with bans. The pills’ growing role in abortion care is a major reason opponents have targeted them through legislation and litigation.
The ruling departs from the usual judicial deference to FDA scientific judgments; federal courts have rarely overruled the agency’s drug-safety decisions. The judges, all appointed by Republican presidents, noted that the FDA under Trump said it was conducting a new review of mifepristone’s safety and was still collecting data, without a clear timeline for completion.
Because of rare bleeding risks, the FDA initially limited distribution to specially certified physicians after an in-person visit. Those requirements were lifted during the COVID-19 pandemic. FDA officials under President Joe Biden said that after more than two decades of monitoring and dozens of studies involving thousands of women, mifepristone can be used safely without direct supervision.
GenBioPro, which manufactures a generic version of mifepristone, said the court’s decision “ignores the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents.”
The impact of the ruling goes beyond states with abortion bans. In filings, Louisiana’s attorney general and a woman who said she was coerced into taking abortion pills sought to roll back the FDA rules to the prior in-person-only model. A federal judge in Louisiana had earlier found that the relaxed allowances undermined the state’s ban but did not immediately undo the regulations. The appeals court’s order is in effect as the case proceeds and applies nationwide, blocking telehealth prescriptions even in states where abortion remains legal.
“This is going to affect patients’ access to abortion and miscarriage care in every state in the nation,” said Julia Kaye, an ACLU lawyer, warning that restrictions on telemedicine will disproportionately harm rural communities, low-income people, people with disabilities, survivors of intimate partner violence and communities of color.
The National Right to Life Committee praised the ruling, saying it “restores a critical layer of oversight” in women’s health. “Women deserve better than an abortion-by-mail system that prioritises ideology over safety,” said Carol Tobias, the group’s president.
