Court restricts abortion access across the US by blocking the mailing of mifepristone

A federal appeals court has restricted access to one of the most common means of abortion in the U.S. by blocking the mailing of mifepristone.

A panel of the New Orleans-based 5th U.S. Circuit Court of Appeals is requiring that the abortion pill be distributed only in-person at clinics.

Danco Laboratories and GenBioPro, the two makers of mifepristone, have directly asked the Supreme Court to grant them emergency relief, to allow mifepristone to remain available through telemedicine as the case continues.

"The Fifth Circuit's order has unleashed regulatory chaos," reads the GenBioPro emergency application to the Supreme Court. The brief also points out that access via pharmacies is restricted by the new order. "Today, patients who planned to pick up a mifepristone prescription at their local pharmacy may no longer be able to do so, regardless of which state they live in."

Since the Supreme Court's 2022 ruling that overturned Roe v. Wade and allowed enforcement of abortion bans, prescriptions by mail has become a major way that abortions are provided — including to states where bans are in place.

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

Judges have long deferred to the Food and Drug Administration's judgments on the safety and appropriate regulation of drugs.

FDA officials under President Donald Trump have repeatedly stated the agency is conducting a new review of mifepristone's safety, at the direction of the president.

The appeals court judges noted in their ruling that FDA "could not say when that review might be complete and admitted it was still collecting data."

In a court filing, Louisiana's attorney general and a woman who says she was coerced into taking abortion pills requested that the FDA rules be rolled back to when the pills were allowed to be prescribed and dispensed only in person.

A Louisiana-based federal judge last month ruled that those allowances undermined the state's abortion ban but stopped short of undoing the regulations immediately.

"This is going to affect patients' access to abortion and miscarriage care in every state in the nation," said Julia Kaye, an ACLU lawyer. "When telemedicine is restricted, rural communities, people with low incomes, people with disabilities, survivors of intimate partner violence and communities of color suffer the most."

Mifepristone was approved in 2000 as a safe and effective way to end early pregnancies. It is typically used in combination with a second drug, misoprostol.

Misoprostol is an older medication that is also used to treat gastric ulcers. It can be used alone to induce abortion and may remain available via telemedicine. The two-drug regimen is preferred because it generally causes less cramping and bleeding for most patients.

When mifepristone was approved in 2000, the FDA initially imposed strict limits on who could prescribe and distribute the pill — only specially certified physicians and only after an in-person appointment where the person would receive the pill.

Both those requirements were dropped during the COVID-19 years. At the time, FDA officials under President Joe Biden said that after more than 20 years of monitoring mifepristone use, and reviewing dozens of studies involving thousands of women, it was clear that women could safely use the pill without direct supervision.

The conservative-majority high court overturned abortion as a nationwide right in 2022 but unanimously preserved access to mifepristone two years later.

That 2024 decision sidestepped the core issues, however, by ruling that the anti-abortion doctors behind the case didn't have legal standing to sue.

NPR staff Selena Simmons-Duffin and Diane Webber contributed to to this report.
Copyright 2026 NPR