Supreme Court Temporarily Blocks 5th Circuit Order on Mifepristone Telemedicine Rules

The Supreme Court issued an order signed by Justice Samuel Alito that temporarily blocks a 5th Circuit ruling requiring an in-person visit for mifepristone. The order will remain in effect until Monday while both sides respond and the high court considers the issue more fully.

The 5th Circuit Court of Appeals in New Orleans issued a ruling on May 1 blocking telehealth access to mifepristone nationwide. The three-judge panel took the unusual step of putting its order into effect immediately. Two drugmakers appealed the 5th Circuit ruling to the Supreme Court right away. The parties involved had until Thursday evening to file briefs.

Louisiana state attorneys on Thursday urged the Supreme Court to uphold the appeals court ruling. Louisiana Attorney General Liz Murrill wrote in a brief that although Louisiana law generally prohibits abortion, out-of-state prescribers freed from the in-person dispensing requirement are causing approximately 1,000 illegal abortions in Louisiana each month by mailing FDA-approved mifepristone into the state.

Murrill argued that the Biden administration undermined the state's strict bans on abortion and that the Trump administration has been slow-walking a study on the federal regulations that permit sending the pills through the mail.

Judge Stuart Kyle Duncan, a Trump appointee, wrote a 19-page opinion stating that telemedicine access to mifepristone injures Louisiana by undermining its laws protecting unborn human life and by causing it to spend Medicaid funds on emergency care for women harmed by mifepristone.

Louisiana is the first state to schedule mifepristone as a controlled substance and to criminally indict an out-of-state physician providing telemedicine abortion. Last fall Louisiana sued the FDA, arguing that patients using telemedicine to receive mifepristone undermines the state's strict abortion ban.

A district court judge put the Louisiana case on hold in April. Louisiana appealed to the 5th Circuit Court of Appeals. A panel of judges on the 5th Circuit agreed with Louisiana's argument and on May 1 brought the in-person requirement back nationwide effective immediately.

The justices have to decide whether Louisiana had standing to sue over the federal drug regulations and, if so, whether judges have the authority to overrule the Food and Drug Administration. The Supreme Court by a 9-0 vote dismissed a similar challenge to the abortion pills that came from the 5th Circuit two years ago.

In 2023 a federal judge in Texas named Matthew Kacsmaryk ruled that mifepristone should be pulled from the market altogether and the Supreme Court unanimously dismissed that case in 2024 because the justices determined that the group of pro-life doctors who filed the lawsuit did not have standing.

The FDA approved mifepristone in 2000 with a requirement that patients go in person to a clinic or doctor's office to receive it. During the COVID-19 pandemic the FDA began to allow mifepristone to be dispensed at a local pharmacy or through the mail.

The FDA made the policy allowing pharmacy or mail dispensing of mifepristone official in 2023. Telemedicine abortion now accounts for one quarter of abortions across the country. Guttmacher's latest estimate found there were 9,000 abortions in Louisiana in 2025.

Nearly two dozen Democratic-led states submitted an amicus brief in the case. A group of former leaders of the FDA wrote an amicus brief defending the FDA's process in approving mifepristone and modifying the rules for prescribing it. Two makers of mifepristone filed emergency appeals arguing the pills have been shown to be safe and effective for ending an early pregnancy.

In October Louisiana Attorney General Liz Murrill decided to bypass the FDA review and went to federal court seeking a ruling that would prevent the pills being sent by mail. A federal judge refused to decide on the issue while the FDA was undertaking its review.

Health and Human Services Secretary Robert F. Kennedy Jr. agreed to have the FDA review the safety record of mifepristone. The Department of Justice which represents the Food and Drug Administration did not file anything by the Thursday evening deadline defending the agency's 2023 rule.

The Trump administration has yet to tell the court of its views on this case. The case that the Supreme Court dismissed in 2024 is still alive in Missouri.