The U.S. Supreme Court stepped in on May 4 to temporarily block a ruling that had threatened to cut off mail-order access to mifepristone, the medication used in nearly two-thirds of all abortions in the United States.
Justice Samuel Alito issued the pause, halting a May 1 decision by the Fifth Circuit Court of Appeals in New Orleans that sided with Louisiana in arguing that dispensing mifepristone through telehealth posed safety risks to patients. The order holds at least until May 11, when the full Court may weigh in further.
The Fifth Circuit ruling had created immediate confusion among providers and patients. Beyond abortions, mifepristone is also used to manage miscarriages and other gynecological conditions, and the lower court's decision had attempted to block mail access for those purposes as well. Louisiana bans abortion in nearly all cases.
The legal tangle has a separate thread running through a federal district court. Last month, U.S. District Judge David Joseph paused the Louisiana lawsuit while the Food and Drug Administration reviews its own safety requirements for the drug, known as the Risk Evaluation and Mitigation Strategy, or REMS rules. The FDA has 60 days to report back to the court and six months to complete the review. Those rules govern who can prescribe mifepristone and whether it can be sent through the mail.
Louisiana Attorney General Liz Murrill has argued that the 2023 REMS framework is unlawful and that the state is likely to prevail. The Fifth Circuit is scheduled to hear arguments in the case.
Advocates for continued access pushed back sharply on the FDA review itself. Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, told Healthline that the review is a "sham" designed to eliminate access rather than evaluate safety. Sarah Prager, an OB-GYN at University of Washington Medical Center, said the medications are safe enough to be sold over the counter in other countries.
Roughly one in four people currently seeking an abortion do so through telehealth. If the FDA's safety framework changes, that share could drop sharply. Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, said that while access remains unchanged for now, "the judge's ruling leaves the door open for future restrictions."
