The Fifth Circuit Court of Appeals temporarily reinstated a requirement on Friday that abortion pills be obtained in person, setting up a fresh Supreme Court fight over access to mifepristone. Danco Laboratories asked the high court on Saturday to step in and pause the ruling, which would temporarily restore access to the drug by mail.
The order keeps the in-person rule in place as the case continues and overrides a lower court decision from earlier this month that had paused the dispute while the Trump administration carries out an FDA review. The appellate ruling came out of a lawsuit brought by Louisiana, and it requires mifepristone to be distributed only in person and at clinics, blocking prescriptions from being mailed anywhere in the U.S.
The stakes are immediate because mifepristone is the first drug in the two-pill regimen the FDA recommends to end a pregnancy, and it is used in nearly two-thirds of U.S. abortions. More than 1 in 4 people who have an abortion in the U.S. now do so through telemedicine, and one survey of abortion providers last year estimated that more women in states where abortion is banned obtained abortions that way than by traveling to other states.
Mifepristone was approved in 2000 as a safe and effective way to end early pregnancies. The FDA expanded access in April 2021 during the Covid-19 pandemic, then made the in-person dispensing change permanent in January 2023, allowing doctors to send the drug without seeing patients face to face. The U.S. Supreme Court unanimously rejected a bid in 2024 to restrict access to the medication, but the latest appellate order has reopened the issue while the case remains active.
The ruling also sharpened the political divide around the drug. Louisiana Attorney General Liz Murrill said the broader practice had “facilitated the deaths of thousands of Louisiana babies (and millions in other states),” while the Fifth Circuit said every abortion enabled by the FDA’s action cancels Louisiana’s ban on medical abortions and undermines its view that every unborn child is a human being from the moment of conception and therefore a legal person.
Abortion rights advocates said the court is forcing ideology into a settled medical and legal question. Julia Kaye said the decision “defies clear science and settled law and advances an anti-abortion agenda that is deeply unpopular with the American people.”
New York Attorney General Letitia James said the decision would not change the law in her state, where abortion access remains legal. “In New York, our laws ensure that anyone who needs abortion care can seek it here. That has not changed, and we will continue to protect access to abortion, including medication abortion,” she said.
Danco told the Supreme Court the ruling would create “chaos for patients, providers, pharmacies, and the drug-regulatory system,” and said that was an irreparable harm that justified emergency relief. The immediate question is whether the justices step in before the Fifth Circuit’s order can reshape how millions of patients obtain abortion pills, especially in states where telemedicine and mailing prescriptions have become central to access.
