The U.S. Supreme Court on Thursday ruled that the abortion drug mifepristone may continue to be distributed through telehealth appointments, mail delivery, and retail pharmacies while the Court considers an ongoing legal challenge over the drug’s availability nationwide.
The decision temporarily preserves expanded access to the drug after a lower court earlier this month ordered the Food and Drug Administration to reinstate stricter safety requirements requiring an in-person doctor visit before a prescription could be issued. Drug manufacturers appealed that ruling, prompting the Supreme Court to intervene and pause the restrictions while the case proceeds.
The lawsuit centers on whether the FDA acted lawfully when it loosened regulations surrounding mifepristone in recent years. Louisiana officials and several Republican-led states argue the federal government moved too aggressively in allowing the drug to be prescribed remotely and shipped across state lines.
Thursday’s ruling keeps current FDA rules in place indefinitely while the justices continue reviewing the broader dispute. Justices Clarence Thomas and Samuel Alito dissented from the decision.
In his dissent, Thomas argued that drug manufacturers should not be permitted to avoid enforcement of the lower court’s order. Alito, meanwhile, accused the Biden administration of using mail-order access to abortion drugs to weaken the impact of the Court’s 2022 Dobbs decision, which overturned Roe v. Wade and returned abortion regulation to the states.
The case has become a major flashpoint in the national abortion debate as chemical abortions now account for a significant majority of abortions performed in the United States. Opponents of expanded access argue the mail distribution system makes it difficult for states with abortion restrictions to enforce their laws.
Louisiana Attorney General Liz Murrill has argued that mifepristone carries serious health risks, including hemorrhaging, infections, and sepsis, and should not be prescribed without an in-person medical evaluation. State officials also contend that mail-order abortion pills are enabling women to bypass Louisiana’s abortion restrictions.
The legal battle has also exposed divisions within the Republican Party and among pro-life organizations over the Trump administration’s handling of abortion drug policy. Although President Donald Trump has long positioned himself as a strong ally of the pro-life movement, his administration has so far left in place Biden-era policies allowing providers in states where abortion remains legal to prescribe abortion pills to women living in states with tighter bans.
Last fall, the FDA approved a generic version of mifepristone, further intensifying criticism from anti-abortion activists. The agency later announced it would conduct a safety review of the drug following pressure from conservatives and from Health and Human Services Secretary Robert F. Kennedy Jr..
Much of that pressure stemmed from a study published by the Ethics and Public Policy Center, which claimed nearly 11 percent of women experienced serious complications within 45 days of taking mifepristone. The study relied on insurance claims data covering more than 865,000 abortions between 2017 and 2023. Abortion-rights advocates and medical groups have criticized the study, arguing it was not peer reviewed and conflicts with decades of research supporting the drug’s safety.
Missouri Senator Josh Hawley has been among the most vocal supporters of tighter restrictions and renewed FDA oversight. Pro-life leaders including Tony Perkins and Marjorie Dannenfelser have also criticized the Trump administration for not taking stronger action against mail-order abortion access.
