The Supreme Court has temporarily blocked a lower court ruling that threatened to disrupt nationwide access to mifepristone, the abortion pill that can be obtained by mail without an in-person clinic visit. The emergency action preserves current access to the medication while the legal battle continues.
A federal appeals court in New Orleans had issued a ruling on May 1 that endangered mail-based distribution of the drug. The Supreme Court granted emergency requests from mifepristone manufacturers Danco Laboratories and GenBioPro to block that decision. Justice Samuel Alito had already put the lower court ruling on temporary hold on May 4 while the full court deliberated.
Two conservative justices dissented. Alito issued a separate opinion criticizing the Biden administration's 2023 decision to allow mail distribution, characterizing it as an attempt to undermine the court's 2022 decision overturning Roe v. Wade. Justice Clarence Thomas went further, suggesting the drugmakers had no right to block a court order, claiming they were seeking to protect profits from what he called a "criminal enterprise" since mifepristone distribution by mail is illegal under Louisiana law.
The case centers on Louisiana's challenge to FDA approval allowing mifepristone to be dispensed without an in-person appointment. Anti-abortion groups have pushed to reinstate the in-person requirement, citing safety concerns, though research has repeatedly demonstrated the pill's safety and effectiveness.
Louisiana, where abortion is nearly completely banned, reported in court filings that up to 1,000 abortions per month were occurring through mailed mifepristone pills despite state restrictions. Attorney General Liz Murrill, a Republican, had argued against the Supreme Court's intervention but did so while acknowledging the scope of access the drug provides to state residents.
Mifepristone is the first drug in a two-medication FDA-approved regimen and has become the most common abortion method in the United States. The drug is also used in miscarriage management. Danco manufactures the brand-name Mifeprex version while GenBioPro produces a generic alternative.
The drugmakers argued that Louisiana lacked legal standing to bring the case, citing a 2024 Supreme Court decision that rejected similar challenges to mifepristone approval on grounds that plaintiffs could not demonstrate injury. The Trump administration notably did not file a brief with the Supreme Court, though the FDA remains a defendant in the case. The Justice Department had previously told the appeals court that Louisiana's lawsuit would disrupt FDA's ongoing safety review and threaten administrative chaos.
Abortion access varies dramatically across the country. The medication remains legal by mail even in the 13 states where abortion is effectively banned entirely, plus several others with strict restrictions.
The FDA is currently reviewing safety protocols for mifepristone, meaning mail availability could still face changes through the regulatory process rather than court action. The underlying litigation will continue even as this ruling keeps the drug accessible to patients.
Planned Parenthood Action Fund President Alexis McGill Johnson welcomed the ruling as protective of patient access, though she framed it as merely "the bare minimum" in what she called an ongoing series of attacks on reproductive rights.
Author Sarah Mitchell: "This temporary reprieve doesn't resolve the fundamental tension between the courts and the FDA on how abortion medication gets distributed, and the next round of litigation could still upend access."
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