Supreme Court Grants One-Week Stay on Fifth Circuit Mifepristone Ruling

The Supreme Court on May 5 2026 stayed a Fifth Circuit Court of Appeals order that had blocked providers nationwide from prescribing mifepristone online or mailing it to patients. Telemedicine access to the drug can continue through Monday May 11 2026 under the one-week stay. The parties had until Thursday evening May 7 2026 to file briefs with the Supreme Court.

Louisiana asked the Supreme Court to halt abortion pill access by mail. The state wrote a brief arguing the justices should allow the Fifth Circuit ruling to take effect. The Department of Justice, representing the FDA, did not file a brief by the May 7 2026 deadline.

A federal appeals court temporarily blocked an FDA regulation that expanded access to mifepristone. On May 1 2026 the Fifth Circuit panel agreed with Louisiana and brought the in-person requirement for mifepristone back nationwide effective immediately. The ruling barred telehealth prescription and mail delivery of mifepristone while the FDA review proceeds.

The FDA approved mifepristone for pregnancy termination in 2000. Prior to the coronavirus pandemic the FDA required doctors to prescribe it in person and supervise patients taking it. During the pandemic the FDA began allowing mifepristone to be prescribed via telehealth and delivered by mail after reviewing safety data.

The agency made the telehealth and mail policy official in 2023. In September the FDA announced it would revisit mifepristone’s prescribing rules. Louisiana sued the FDA last fall arguing that telemedicine access undermines the state’s near-total abortion ban.

A district court judge put the Louisiana v. FDA case on hold in April 2026. Louisiana appealed that decision to the Fifth Circuit. Judge Stuart Kyle Duncan wrote a 19-page opinion stating that telemedicine access to mifepristone injures Louisiana by undermining its laws and causing Medicaid spending on emergency care.

"It's the most consequential ruling we've had since Dobbs from a lower court," Mary Ziegler stated. Medication abortion accounted for nearly two-thirds of pregnancy terminations in the United States as of 2023 according to the Guttmacher Institute. About a quarter of all abortions are provided via telehealth.

U.S. in 2025 and 9,000 abortions in Louisiana in 2025. Louisiana became the first state to classify both mifepristone and misoprostol as controlled dangerous substances in 2024.

The law took effect in October 2024. In December 2024 a doctor performing an emergency C-section in Louisiana had to wait for misoprostol stored in a locked pharmacy cabinet because the hospital no longer kept it on delivery-room trays. Nearly two dozen Democratic-led states submitted an amicus brief arguing the appeals court decision prioritizes states with bans over states promoting abortion access.

A group of former FDA leaders submitted an amicus brief defending the FDA’s process and stating the appeals court decision would upend FDA’s science-based drug approval system. If mifepristone access is curtailed providers may turn to misoprostol-only regimens. The National Abortion Federation and the Society of Family Planning shared a standardized misoprostol-only protocol in 2023.

A 2024 review of studies following that protocol found misoprostol-only abortion has an effectiveness rate ranging from 82 to 100 percent. 2 percent of patients undergoing misoprostol-only first-trimester abortion require hospitalization or a blood transfusion.

The standard mifepristone-misoprostol regimen is roughly 95 percent effective while misoprostol alone is about 78 percent effective according to studies from 1994-2019.

Heidi Moseson led the 2024 review of misoprostol-only studies and is leading the first randomized controlled trial comparing the two protocols. Misoprostol can treat stomach ulcers and postpartum hemorrhage and has never been subject to the FDA’s special prescribing requirements. As of 2023 mifepristone can be dispensed by certified retail pharmacies but in-store availability remains limited.

Louisiana, Florida, and Missouri argue in lawsuits that the Comstock Act bars the mailing of any drug used to induce abortion including misoprostol.