Supreme Court Preserves Mail Access to Abortion Pill Mifepristone

WASHINGTON — The Supreme Court on Thursday kept mail access to the abortion pill mifepristone in place. The court set aside a lower court order that had blocked abortion providers from prescribing the drug through telehealth and shipping it to patients.

The unsigned decision means patients across the country can continue to get mifepristone while a challenge to the Food and Drug Administration's relaxed policy moves forward. Louisiana brought the lawsuit.

Justices Samuel Alito and Clarence Thomas dissented.

The order followed a federal appellate court's ruling earlier this month. That court reinstated an FDA rule requiring in-person dispensing of mifepristone. Danco Laboratories and GenBioPro, two companies that make the drug, told the Supreme Court the ruling created confusion for patients, providers and pharmacies. They asked the court to block the appellate decision and allow mail delivery to continue.

Louisiana officials wanted the stricter in-person rule to stay. The FDA dropped that requirement in 2021. State officials said ending it let out-of-state providers dodge Louisiana's abortion ban. That led to more than 1,000 medication abortions in the state. The FDA did not tell the Supreme Court whether to preserve mail access.

Alito had issued a temporary order last week to pause the appellate ruling. That pause was due to expire Thursday. The full court then agreed to maintain mail access to the drug.

The case stems from Louisiana's lawsuit against the FDA last year. It threatened to cut off mail delivery of mifepristone nationwide, even in states where abortion is legal. Patients take mifepristone with misoprostol to end early pregnancies.

Medication abortions made up 65 percent of all clinician-provided abortions in 2023, according to the Guttmacher Institute. That group supports abortion rights. More than 1.1 million abortions came from health care workers last year. The total includes telehealth medication abortions in states with restrictions.

Access to the pill gained urgency after the Supreme Court overturned Roe v. Wade in 2022. More than half the states then limited abortion. Louisiana bans it with narrow exceptions. The state passed a 2024 law making mifepristone and misoprostol controlled substances. Possession without a prescription is now a crime.

The Biden administration eased access during the COVID-19 pandemic. It suspended the in-person rule after finding the drug safe without it. The FDA formally approved telehealth prescriptions and mail dispensing in 2023.

Louisiana said in its suit that mifepristone was flooding the state. Officials claimed it caused thousands of unlawful abortions yearly and cost tens of thousands of dollars in Medicaid.

A federal district court paused the case in April. The FDA is reviewing mifepristone's safety. The Trump administration said studies usually take a year but the agency plans to finish sooner.

Louisiana appealed. The U.S. Court of Appeals for the 5th Circuit blocked the 2023 policy on remote prescriptions and mail delivery.

Danco and GenBioPro appealed to the Supreme Court. They said the appellate order caused chaos and risked cutting off nationwide mail access. "Patients and clinicians have, for years, relied on dispensing mifepristone without an in-clinic visit, particularly for women from rural areas and those for whom transportation, childcare, or occupational constraints make it difficult to see providers in person," GenBioPro said. "As a direct result of the Fifth Circuit's order, patients nationwide may face delay or denial of access to time-sensitive medical care, supply-chain disruptions, and attendant health risks."

Louisiana said in-person abortions have almost disappeared since Roe ended. But medication abortions have surged. Beyond Medicaid costs, the state spent more than $17,000 investigating out-of-state providers who shipped mifepristone into Louisiana.

This marks the second time the Supreme Court has taken up mifepristone access. After overturning Roe, anti-abortion groups sued over the FDA's 2000 approval and later easing of rules. They said the agency ignored safety and effectiveness issues. Major medical groups, including the American Medical Association and the American College of Obstetricians and Gynecologists, say serious problems occur in less than 0.32 percent of cases.