Supreme Court Allows Continued Telehealth Access to Mifepristone

The Supreme Court ruled on Thursday that mifepristone can continue to be prescribed remotely and sent by mail while litigation continues. The decision reverses an order from the 5th Circuit Court of Appeals that had prohibited providers from remotely prescribing or mailing the drug.

The plaintiff in the case is the State of Louisiana. The 5th Circuit had ruled that prior restrictions on remote prescribing, which the FDA lifted in 2021, should be reinstated during the proceedings. The Supreme Court reversed that order, although the underlying case will continue through the courts.

The ruling came after a chaotic weekend in April when the appeals court issued its prohibition. Demand for telehealth abortion has increased since the FDA lifted the restrictions during the Covid-19 pandemic and following the 2022 overturn of Roe v.

Wade. Current estimates indicate that about one-quarter of all abortions in the United States are now prescribed via telehealth, a doubling since 2022. Multiple studies have found telehealth medication abortion to be as effective and safe as in-person care.

Providers have other pharmacological methods to terminate pregnancies if mifepristone access is limited. Misoprostol, which is currently used alongside mifepristone, can be used alone. The drug causes uterine contractions but is associated with side effects including nausea, vomiting, diarrhea and flu-like symptoms.

Without mifepristone, misoprostol is slightly less effective and typically requires repeated doses over several days. More patients ultimately need follow-up care for incomplete abortions compared with the two-drug regimen. The process can be longer and more unpleasant for patients.

Methotrexate has also been studied as an alternative, though it requires administration three to seven days before misoprostol in some protocols. The drug is often given as an injection and requires laboratory monitoring of liver and kidney function.

It is not considered practical for telehealth use in the current environment.

Researchers have investigated letrozole as another potential substitute over the past decade. The only regimen studied with comparable efficacy requires three separate doses over three days before misoprostol. A more efficient protocol has not yet been established.

A 2025 study examined ulipristal acetate, which is approved for emergency contraception. The research found that a double dose followed by misoprostol 24 hours later showed similar efficacy to the mifepristone-misoprostol combination. The results were described as a proof of concept and the drug is not ready for use outside research settings.

Large-volume telehealth providers are prepared to shift to prescribing misoprostol alone if needed, according to one doctor who spoke before the ruling. Safe and effective medication abortion via telehealth is expected to continue regardless of the case outcome.

The case is expected to produce further court decisions in coming months.