Supreme Court Allows Mail Delivery of Abortion Pill Mifepristone

The Supreme Court on Thursday preserved broad access to the abortion pill mifepristone, allowing it to continue being prescribed through telehealth and delivered by mail while litigation brought by Louisiana against the Food and Drug Administration proceeds.

The court's unsigned order sets aside a federal appeals court ruling from earlier this month that had reinstated an in-person dispensing requirement for the drug. Two manufacturers, Danco Laboratories and GenBioPro, had warned the lower court decision created confusion for patients, providers and pharmacies nationwide.

The high court's intervention ensures patients can keep obtaining mifepristone without an in-person doctor visit at least into next year as the case plays out. The FDA first approved the drug in 2000 and stopped requiring in-person visits five years ago during the COVID-19 pandemic, later formalizing the change in 2023.

Louisiana filed suit against the FDA last year, arguing the relaxed rules undermine the state's abortion ban and allow out-of-state providers to ship the drug into Louisiana. State officials said medication abortions have increased sharply since the end of Roe v.

Wade in 2022, costing the state through its Medicaid program and requiring more than $17,000 in investigations of out-of-state providers. The state enacted a 2024 law designating mifepristone and misoprostol as controlled substances. A federal district court paused the case in April while the FDA reviews the drug's safety.

Louisiana appealed, and the 5th U.S. Circuit Court of Appeals temporarily blocked the 2023 policy allowing remote prescribing and mail delivery. The full court then agreed to maintain access. Mifepristone is used with misoprostol to end early pregnancies and accounted for 65 percent of abortions in 2023, according to the Guttmacher Institute.

Thomas and Samuel Alito dissented from Thursday's order. Thomas wrote that the manufacturers are not entitled to a stay based on lost profits from what he called their criminal enterprise under the Comstock Act, an 1873 law banning the mailing of abortion-related items.

Alito argued there is no indication the FDA plans to enforce the in-person rule and said continued availability of the drug in Louisiana has thwarted the state's efforts to regulate abortion following the 2022 Dobbs decision. He wrote that what is at stake is a scheme to undermine the ruling that restored states' rights to regulate abortions.

>The makers of mifepristone did not show that they will suffer irreparable injury if the appellate court ruling is left in place. The FDA did not take a position on whether the Supreme Court should preserve mail access.

This marks the second time in recent years the issue of mifepristone access has reached the Supreme Court. In 2024 the justices unanimously dismissed a challenge from anti-abortion doctors, ruling they lacked standing to sue the FDA over the drug's approval and relaxed conditions.

Major medical associations have stated that serious adverse events occur in less than 0.32 percent of patients using mifepristone. The current case stems from Louisiana's effort to roll back the FDA's rules, with the state questioning the drug's safety despite repeated FDA findings that it is safe and effective.

Anti-abortion groups have pressed the Trump administration to accelerate an FDA review of mifepristone that could lead to further restrictions. The administration has said the review will be completed sooner than the typical one-year timeline for such studies but has remained largely silent before the Supreme Court in this dispute.

The decision comes more than three years after the Supreme Court overturned Roe v. Wade, prompting more than half the states to impose limits or bans on abortion. In Louisiana, abortion is banned except in narrow circumstances.