The Supreme Court Could Limit Access To The Abortion Pill. Here’s How

It could become harder for Californians to get access to one of the drugs used in medication abortions, depending on how the Supreme Court rules this summer.

The high court will hear arguments Tuesday in a case brought by the conservative group Alliance for Hippocratic Medicine, challenging policies that expand access to the drug mifepristone.

The medication is used in combination with another drug, misoprostol, in a majority of abortions nationwide.

The case is the court’s first significant return to the abortion issue since the court overturned Roe v. Wade in 2022. If the court restricts access, health care for millions could be affected, including in California and other states that protect abortion rights.

California voters added access to abortion and contraception as a protected right in the state constitution in 2022, but a ruling from the high court would supersede that.

What is the case?

The Alliance for Hippocratic Medicine, a group of anti-abortion emergency room doctors, filed the legal challenge. They claim the federal Food and Drug Administration overlooked the health risks of the drug at the time it was approved in 2000 and again when the agency later approved wider access to the drug in 2016 and 2021 through telemedicine, mail delivery and prescribing by pharmacists. The court will only consider the actions that broadened access to the drug.

In February, a scientific paper that raised concerns about the safety of mifepristone was retracted by its publisher. NPR reported that the study was cited three times by a federal judge who ruled against the FDA last spring.

The FDA has said it stands by its research that found complications from taking mifepristone are extremely rare. The Biden administration, major pharmaceutical companies and medical societies point to extensive data documenting the drug’s safety.

The government’s lawyers say ruling against the FDA will set a precedent, allowing people to bring challenges to other medications they may disagree with, including contraceptives and vaccinations.

Amanda Barrow, a senior staff attorney at UCLA’s Center on reproductive health, law and policy who is not directly involved in the case, shares some of those concerns.

“If the Supreme Court affirms the 5th circuit's decision, it would reinstate onerous restrictions on mifepristone not just in states with restrictions or bans, but also in states like California where abortion is legal and even constitutionally protected,” she said.

If the court sides with federal government lawyers, current access to mifepristone would continue.

How could abortion pill access change? 

Medication abortion accounts for more than half of abortions across the country. Mifipristone can also speed up miscarriages once they’ve already begun, reducing the need for surgeries.

The recent FDA policies at the center of the case have allowed the pills to be prescribed online, mailed to patients and dispensed at pharmacies.

Mifipristone is approved for use up to around 10 weeks of pregnancy, though the Supreme Court could roll that back to seven weeks, in addition to requiring an in-person visit with a doctor in order to obtain the pills.

If the court drops telehealth as an option, people could only obtain the drug in-person at the office or clinic of the health care provider who prescribed it, rather than through the mail or at another pharmacy.

Requiring people to physically see a doctor takes time and money, and would hit under resourced Californians the hardest, Barrow said.

“In California, allowing medication abortion via telehealth has been really important in reaching rural and underserved communities,” she said. “All of these modifications have been helpful to not only serving Californians but also responding to the post Roe influx of patients traveling from states with bans and restrictions.”

The Supreme Court is expected to issue a ruling in the case in June.