Key takeaways:
- The 5th U.S. Circuit Court of Appeals is temporarily halting mail-order mifepristone access.
- The ruling is expected to be appealed to the Supreme Court.
The 5th Circuit Court of Appeals has temporarily restored a rule the FDA lifted in 2023 that requires mifepristone to be dispensed in person, blocking mail-order access, court documents show.
The ruling halts mail-order telehealth access even in states without restrictions on abortions, according to reporting by The Associated Press. It will likely be appealed to the Supreme Court.
A federal appeals court has temporarily restored a rule the FDA lifted in 2023 that requires mifepristone to be dispensed in person, blocking mail-order access.
The case was filed against the FDA by the state of Louisiana and “a woman who said she was coerced into taking abortion pills,” The AP reported. The judges sided with the plaintiffs that mail-order mifepristone “cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person.’”
In a statement emailed to Healio, ACOG Chief Legal Officer Molly Meegan, JD, said the ruling “creates more confusion for patients and physicians and puts pregnant patients seeking reproductive health care, including those who need mifepristone for miscarriage management, immediately at risk.”
“Mifepristone is one of the most studied medications on the market and is conclusively safe, including when prescribed through telehealth and dispensed via mail,” Meegan said. “The court’s decision to restrict access to this medication infringes on patients’ access to health care, especially for people who rely on telehealth or face barriers to care. More than 2 decades of evidence and volumes of research prove mifepristone is a safe, essential part of reproductive health care.”
Each year, more than 60% of abortions in the United States involve medication abortion, which is typically a combination of mifepristone and misoprostol, according to a press release from the Center for Reproductive Rights. About one-quarter of all U.S. abortions are now provided through telehealth, “a two-fold increase since Roe v. Wade was overturned,” the release said.
“Telehealth has been the last bridge to care for many seeking abortion, which is precisely why Louisiana officials want it banned,” Nancy Northup, president and CEO of the Center for Reproductive Rights, said in the release. “This [ruling] isn’t about science — it’s about making abortion as difficult, expensive and unreachable as possible.”
The Louisiana ruling is one of several ongoing cases, the Center for Reproductive Rights said. Other cases in Texas and Missouri “could go even further, including by directing the FDA to withdraw its approval of mifepristone altogether,” according to the organization.
The FDA initiated a comprehensive review of mifepristone in September 2025 after 22 Republican state attorneys general sent a letter to HHS Secretary Robert F. Kennedy, Jr. and FDA Commissioner Martin A. Makary, MD, MPH, outlining their concerns with the drug. In the letter, the state attorneys general claimed the drug is not as safe and effective as stated on the drug’s label. The FDA’s review is ongoing.
“Hundreds of studies confirm mifepristone’s safety, and 7.5 million Americans have used the drug since it was approved by the FDA in 2000,” according to the Center for Reproductive Rights.
In February, a coalition of 15 organizations led by ACOG filed an amicus brief supporting the FDA’s 2023 decision to end in-person requirements for mifepristone dispensing.
“We at ACOG will redouble our efforts to ensure that patients’ needs, science and evidence — not ideology — guide medical decisions relating to reproductive health care,” Meegan said. “Safe, essential reproductive health care, including mifepristone, should be available to the women of America without unnecessary burdens and barriers; they deserve no less.”
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