Supreme Court Extends Access to Abortion Pill Mifepristone Through Thursday

m. Justice Samuel Alito issued the order after pharmaceutical manufacturers asked the court to block a ruling from the 5th U.S. Circuit Court of Appeals that would have restored an in-person dispensing requirement nationwide. The move came one day before the deadline for the justices to act on emergency applications filed by Danco Laboratories and GenBioPro, the two companies that produce mifepristone.

Lower courts had sided with Louisiana, which argued that the Food and Drug Administration's 2023 decision to allow remote prescriptions undermined the state's near-total abortion ban and increased costs for its Medicaid program from emergency room visits.

Mifepristone is taken with a second drug, misoprostol, to end early pregnancies. Medication abortions accounted for 63 to 65 percent of all abortions in the United States in 2023, according to data cited across multiple outlets. The current dispute echoes a 2024 case in which the Supreme Court unanimously ruled that a group of anti-abortion doctors lacked standing to challenge the same FDA rules.

Louisiana sued the FDA in October over its removal of the in-person screening requirement for mifepristone, which had been in place when the drug was first approved in 2000. State officials said the policy change allowed thousands of pills to reach residents despite the state's ban on elective abortions, effectively nullifying its law that declares an unborn child a legal person from conception.

The 5th Circuit agreed in early May that Louisiana faced irreparable harm and temporarily blocked the 2023 FDA policy. The appeals court cited insurance claims data showing that nearly 11 percent of women who take mifepristone require follow-up medical care for complications.

A federal district court had paused the case while the FDA conducts a safety review, but Louisiana appealed that pause. The Trump administration has remained silent in the litigation, declining to file briefs supporting the FDA's regulations even though federal policy is at stake.

Social conservatives in Congress have pressed FDA Commissioner Dr. Marty Makary and Health and Human Services Secretary Robert F. Kennedy Jr. to reinstate in-person requirements following their confirmation promises to review the drug's safety.

California providers said they were prepared to switch to a misoprostol-only regimen if mail access to mifepristone is ultimately curtailed. The alternative is slightly less effective and often more painful but cannot easily be blocked by courts because it has long been used for other medical purposes.

The Supreme Court four years ago overturned Roe v. Wade, returning abortion regulation to the states. More than a dozen states, including Louisiana, effectively banned the procedure. Even in states with strong legal protections like California, experts said a Supreme Court decision favoring abortion opponents could still limit access by validating interstate enforcement efforts.

Mainstream medical organizations, the pharmaceutical industry and Democratic lawmakers have warned the court that limiting mifepristone would disrupt the FDA's drug approval process. Abortion opponents have challenged the pill's safety for more than 25 years despite repeated FDA findings that it is safe and effective.

“The supply chain is ready to switch in a day. It's not going away and it's not going to slow down.”

The case also raises questions about the scope of nationwide injunctions after the Supreme Court last year limited lower courts' ability to block federal policies universally. Legal experts remain divided on how the justices will ultimately rule on the merits. The court is expected to issue a further order on the emergency application by the end of the week.