A US appeals court has reinstated a requirement that the abortion pill mifepristone must be obtained in person, effectively ending mail-order access in many states. The Fifth Circuit Court of Appeals issued the order on Friday, temporarily blocking a 2023 FDA rule that allowed the medication to be prescribed via telemedicine and sent by mail.
The decision, stemming from a lawsuit filed by Louisiana, primarily affects states where abortion is already banned, as it prevents patients from using telehealth to access the drug. Mifepristone is the first of a two-pill regimen used to terminate early pregnancies and is the most common method of abortion in the US.
The appeals court wrote that "every abortion facilitated by FDA's action cancels Louisiana's ban on medical abortions" and undermines the state's policy protecting unborn life. The order overrides a lower court ruling that had paused the case pending an FDA review by the Trump administration.
Julia Kaye, an attorney with the American Civil Liberties Union, criticized the decision, stating it "defies clear science and settled law and advances an anti-abortion agenda." She added that losing telemedicine access would be devastating for people in rural areas, those facing intimate partner violence, or individuals with disabilities.
Louisiana Attorney General Liz Murrill praised the ruling, saying the Biden-era rule "facilitated the deaths of thousands of Louisiana babies." In contrast, New York Attorney General Letitia James reaffirmed that abortion access remains legal in her state, calling mifepristone "safe, effective, and essential."
The FDA first approved mifepristone in 2000 for pregnancies up to seven weeks, later extending its use to 10 weeks. The drug is also used to manage miscarriages and Cushing syndrome. Medical organizations have long deemed both mifepristone and misoprostol safe, with studies showing the two-step regimen is about 95% effective.
This ruling follows a 2024 Supreme Court decision that unanimously rejected a broader challenge to mifepristone access but left the door open for state-specific restrictions.