Conservative Appeals Court Blocks Mail-Delivered Abortion Pills Nationwide

A federal appeals court dominated by conservative judges has delivered a major setback to abortion rights advocates by reinstating in-person dispensing requirements for the abortion medication mifepristone. The Fifth US Circuit Court of Appeals issued a 3-0 ruling on Friday, granting Louisiana’s request for an injunction against FDA rule changes from 2023 that had allowed telemedicine providers in states with legal abortion to mail mifepristone to patients nationwide.

The decision temporarily halts mail delivery of mifepristone, a critical medication used in medication abortions, and likely forces telemedicine providers to suspend operations. While the ruling does not affect misoprostol—another abortion medication used in combination with mifepristone—it will severely disrupt access to mifepristone, particularly in states where abortion is banned.

Judge Stuart Kyle Duncan, writing for the court, argued that the FDA’s 2023 rule change caused irreparable harm to Louisiana by undermining its laws protecting fetal life and increasing state Medicaid costs for emergency care related to mifepristone use. Duncan, appointed to the Fifth Circuit by President Donald Trump in 2017, stated,

"Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is a human being from the moment of conception and is, therefore, a legal person.’"

Nancy Northup, president and CEO of the Center for Reproductive Rights, criticized the ruling, saying,

"Telehealth has been the last bridge to care for many seeking abortion, which is precisely why Louisiana officials want it banned. This isn’t about science—it’s about making abortion as difficult, expensive, and unreachable as possible. Telehealth has transformed healthcare. Selectively stripping that away from abortion patients is a political blockade."

The legal battle began last fall when Louisiana Attorney General Liz Murrill filed a lawsuit challenging the Biden administration’s decision to drop the in-person dispensing requirement for mifepristone. Murrill argued that the FDA’s rule change was arbitrary, capricious, and politically motivated, intended to circumvent the Supreme Court’s 2022 Dobbs decision, which overturned Roe v. Wade. She also claimed the rule change interfered with Louisiana’s right to regulate abortion within its borders.

In April, US District Judge David Joseph—a Trump appointee—paused the lawsuit while the FDA conducted a safety review of mifepristone, which has been ongoing since fall 2023. The Trump administration, despite its own concerns about the rule changes, argued that blocking the Biden-era rules during the FDA’s review would constitute judicial intervention in the agency’s established drug approval process. The administration warned that an injunction may prove unnecessary and disruptive if the FDA ultimately decides to restore the in-person dispensing requirement.