Mifepristone can still be mailed to patients across the United States, at least for now. A federal judge in Louisiana paused a legal challenge to the FDA's mail-access rules while the agency conducts its own review of whether those rules remain appropriate.
U.S. District Judge David Joseph gave the FDA 60 days to report back on its progress and six months to finish the review. The rules under scrutiny are known as REMS — Risk Evaluation and Mitigation Strategy requirements — which govern who can prescribe mifepristone and whether it can be dispensed through the mail.
The stakes are substantial. Medication abortion accounted for 63% of all U.S. abortions in 2023. Of those, roughly one in four were obtained through telehealth. Any change to the REMS framework could significantly narrow that access.
Louisiana Attorney General Liz Murrill is not waiting for the FDA's review to conclude. She has already taken the case to the Fifth Circuit Court of Appeals, asking that court to suspend the 2023 mifepristone rules while litigation proceeds. In a post on X, Murrill argued the state "is likely to succeed in showing that the 2023 REMS is unlawful."
Reproductive health advocates pushed back. Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, told Healthline that "decades of evidence and research from the U.S. and around the world show that mifepristone is safe and effective." Sarah Prager, an OB-GYN at University of Washington Medical Center, went further, saying the medications are safe enough to be sold over the counter — as they already are in some countries.
Friedrich-Karnik described the FDA review itself as a "sham" intended to restrict access rather than evaluate science.
Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, said the judge's ruling leaves the door open for future restrictions. "From the courts to the Trump administration to state legislatures across the country, mifepristone and abortion access are very much still under attack," she said in a statement shared with Healthline.
The Fifth Circuit will hear Louisiana's appeal next. That court, which covers Texas, Louisiana, and Mississippi, has previously ruled against the FDA's expansion of mifepristone access in related litigation. The outcome of the appeal could determine whether mail-order access survives before the FDA's review is even complete.
