The U.S. Supreme Court has issued an emergency order, temporarily blocking (PDF) a federal appeals court ruling in Louisiana which would have prevented the abortion pill mifepristone from being prescribed over the phone and sent through the mail in the United States.
The new ruling allows telehealth access to mifepristone to remain intact while litigation plays out in lower courts, with the potential for the case to eventually return to the Supreme Court.
It is the second time this month that the Supreme Court has ruled against Louisiana. On May 4—three days after a lower court’s ruling to immediately halt access to mifepristone—the Supreme Court issued an order granting an “administrative stay,” which allowed it time to review an emergency request by mifepristone manufacturers Danco Laboratories and GenBioPro to restore telehealth access to the pill.
Conservative justices Samuel Alito and Clarence Thomas dissented from the Supreme Court decision on Thursday, with Alito calling the latest order “remarkable,” as it “undermines” the court’s decision in 2022 to restore the right of individual states to “regulate abortions within its borders.”
Meanwhile, abortion advocates hailed the decision while warning that much has yet to be decided.
“The ban on mifepristone through telemedicine was never about safety. It was about controlling people’s bodies and lives,” Angel Foster, the co-founder of The Massachusetts Medication Abortion Access Project, said in a statement. “However, we know that this reprieve is temporary, as lawmakers have made it clear they are desperate to block access to medication abortion by any means necessary.”
Louisiana Attorney General Liz Murrill, who has spearheaded the fight against telehealth access to the pill, has said (PDF) that approximately 1,000 illegal abortions happen each month in the state.
“It’s shocking that the Supreme Court would block this common-sense return to medically ethical practices and oversight,” Murrill said in a statement. “DOJ did not defend Big Pharma, which is profiting from the illegal and unethical distribution of abortion pills. We will keep fighting.”
In 2021, during the coronavirus pandemic, the in-person requirement to receive mifepristone was lifted by the FDA, despite the contention of anti-abortion activists that taking the pill at home was dangerous.
In April of 2023, the Fifth Circuit Court of Appeals in Louisiana moved to prohibit the pill from being delivered by mail and restricted the time frame mifepristone could be used during pregnancy from 10 weeks to 7 weeks. The ruling dovetailed with the Supreme Court’s 2022 decision to overturn the landmark case Roe v. Wade.
On May 1, the New Orleans-based Fifth Circuit, in response to a lawsuit filed by the state of Louisiana, issued an order to block the online distribution of mifepristone in the U.S. The order was a temporary measure to restrict access to the pill until the case was resolved. The lawsuit asked for the reinstatement of a prior FDA requirement that mifepristone be prescribed only by way of in-person consultation.
After the Supreme Court granted the stay early last week, lawmakers, industry leaders and former regulators weighed in to defend the availability of mifepristone.
In an amicus brief, nine former FDA Commissioners said that the appeals court’s approach would “upend FDA’s gold-standard, science-based drug approval system,” and warned that the ruling “creates a roadmap for attacks on science-based drug regulatory decisions.”
Mifepristone was originally approved in 2000 and works by blocking the hormone progesterone, which is needed for a pregnancy to continue. The drug is often used in tandem with another product called misoprostol, which helps induce contractions.
In 2023, the pill accounted for 63% of the abortions in the U.S., which was up from 53% in 2020. Roughly a quarter of the abortions in the U.S. in 2024 were conducted through telehealth.