Supreme Court Blocks Restrictions on Abortion Pill Access—Order Pauses Fifth Circuit Ruling Until May 11

The U.S. Supreme Court on Monday temporarily reinstated a Food and Drug Administration (FDA) rule permitting the abortion pill mifepristone to be prescribed via telemedicine and dispensed through the mail. The order, issued by Justice Samuel Alito Jr., paused a ruling by the U.S. Fifth Circuit Court of Appeals that had sought to block nationwide access to mifepristone by restricting telemedicine providers.

The Fifth Circuit’s ruling, issued on Friday, prompted providers, advocates, and patients to scramble over the weekend to implement contingency plans to maintain access to abortion medication. Currently, nearly two-thirds of abortions in the U.S. involve abortion pills, with nearly 30 percent occurring via telemedicine.

Louisiana filed a lawsuit against the FDA last fall, arguing that a 2023 Biden administration rule change allowing telemedicine prescriptions for mifepristone was “arbitrary,” “capricious,” and politically motivated. The drug, part of a two-pill regimen that includes misoprostol, was approved by the FDA in 2000.

Louisiana had requested that lower courts issue a nationwide injunction on the telemedicine rule and reinstate a requirement that abortion pills be prescribed and dispensed in person. While the trial court judge declined, the Fifth Circuit—composed of anti-abortion ideologues—complied. In its 3-0 ruling, the Fifth Circuit claimed the telemedicine rule “injures Louisiana by undermining its laws protecting unborn human life” and “causing it to spend Medicaid funds on emergency care for women harmed by mifepristone.” The court described both injuries as “irreparable.”

On Monday, Alito granted temporary relief to Danco Laboratories, the manufacturer of mifepristone, and GenBioPro, a generic manufacturer, both of which had filed emergency appeals over the weekend. Alito’s order pauses the case until at least May 11.

Alito, a conservative justice, authored the Dobbs v. Jackson Women’s Health Organization decision in 2022, which overturned Roe v. Wade and ended the national right to abortion. Monday’s order coincides with the four-year anniversary of the Dobbs opinion leak, which triggered widespread turmoil in abortion access that persists today.

As previously noted, the Louisiana lawsuit “reflects widespread anger within the anti-abortion movement over the continued availability of abortion pills in the post-Roe era, even in states with near-total bans.” Despite Louisiana’s near-total abortion ban, nearly 1,000 patients in the state receive abortion pills from telemedicine providers each month. Louisiana classifies mifepristone and misoprostol as “controlled substances” and equates abortion providers with “drug dealers.”

The case mirrors FDA v. Alliance for Hippocratic Medicine, a 2024 Supreme Court decision in which a coalition of anti-abortion medical groups and doctors sought to overturn the FDA’s initial approval of mifepristone and subsequent rule changes. The Court ruled 9-0 that the doctors lacked standing because they could not demonstrate direct harm from the FDA regulations. However, the ruling left open the possibility that states might have legal standing to sue the FDA.