Mailing of abortion pill mifepristone restricted by federal appeals court

A federal appeals court has limited access to one of the most prevalent methods of abortion in the United States by prohibiting the mailing of mifepristone prescriptions.

The unanimous decision from a three-judge panel of the 5th U.S. Circuit Court of Appeals in New Orleans mandates that the abortion pill be dispensed only in person at clinics, overturning existing federal Food and Drug Administration regulations.

This ruling, which is expected to be challenged in the U.S. Supreme Court, marks the most significant shift in U.S. abortion policy since the 2022 Supreme Court decision overturning Roe v. Wade, which allowed states to impose abortion bans.

Judge Kyle Duncan, appointed by President Donald Trump, sided with Louisiana’s argument that mailing the drug negates the state’s ban on abortion at any pregnancy stage.

The ruling states, “Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is a human being from the moment of conception and is, therefore, a legal person.’”

Mifepristone is involved in most abortions in the U.S.

Approved in 2000, mifepristone is deemed a safe and effective method to end early pregnancies, typically used with another drug, misoprostol.

Surveys indicate that most abortions in the U.S. are conducted using pills, with about 25% of abortions nationally prescribed via telehealth.

According to a survey of abortion providers last year, more women in states with abortion bans obtained abortions through these pills than by traveling to other states.

Some states led by Democrats have enacted laws to protect providers who prescribe via telehealth to patients in banned areas.

The increased use of these pills has prompted abortion opponents to target them through legislation and legal action.

Ruling goes against how courts usually view FDA decisions

There is little precedent for a federal court overruling FDA’s scientific regulations, and it remains unclear how or when this decision will affect mailing the drug nationwide.

Courts traditionally defer to the FDA’s judgments on drug safety and regulation.

Under Trump, FDA officials have stated that the agency is conducting a new review of mifepristone’s safety, as directed by the president.

The judges, all nominated by Republican presidents, mentioned that the FDA “could not say when that review might be complete and admitted it was still collecting data.”

Initially, due to rare cases of excessive bleeding, the FDA imposed strict rules allowing only specially certified physicians to prescribe and distribute the pill after an in-person appointment. These requirements were lifted during COVID-19. At that time, FDA officials under President Joe Biden indicated that, after over 20 years of monitoring and numerous studies, it was clear that the drug could be safely used without direct supervision.

GenBioPro, a manufacturer of generic mifepristone, criticized the court’s decision, stating it “ignores the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents.”

The impact isn’t just in states with bans

In a court filing, Louisiana’s attorney general and a woman who claimed she was coerced into taking abortion pills requested a rollback of FDA rules to when in-person prescriptions were mandatory.

A federal judge in Louisiana recently found that these rules undercut the state’s abortion ban but did not immediately reverse the regulations.

The ruling is in effect as the case progresses through the courts, impacting both Louisiana and states without abortion bans.

Telehealth prescriptions have become standard practice even in states permitting abortion, but the ruling also restricts them there.

“This is going to affect patients’ access to abortion and miscarriage care in every state in the nation,” said Julia Kaye, an ACLU lawyer. “When telemedicine is restricted, rural communities, people with low incomes, people with disabilities, survivors of intimate partner violence and communities of color suffer the most.”

The National Right to Life Committee praised the ruling, stating it “restores a critical layer of oversight” in women’s health.

“Women deserve better than an abortion-by-mail system that prioritizes ideology over safety,” said Carol Tobias, president of the group.

Next step could be an appeal to the nation’s top court

Danco Laboratories, another mifepristone manufacturer involved in the lawsuit, requested that the appeals court delay its order for one week to allow the company to seek relief from the Supreme Court. If denied, the company intends to file an emergency appeal with the high court.

The Supreme Court, with a conservative majority, overturned the nationwide right to abortion in 2022 but upheld access to mifepristone two years later.

The 2024 decision avoided central issues, ruling that the anti-abortion doctors who initiated the case lacked legal standing to sue.

Louisiana Attorney General Liz Murrill expressed her commitment to continue defending the state’s position in this ongoing case.

Representatives for the FDA and the U.S. Department of Justice did not immediately comment on the ruling.

Anti-abortion groups have lauded the ruling, with Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, celebrating it as “a huge victory for victims and survivors of Biden’s reckless mail-order abortion drug regime.” She criticized the Trump administration for the delay in reviewing mifepristone, saying it compelled states to take action.

“Women and children suffer and state sovereignty is violated every day the FDA allows abortion drugs to flood the mail,” Dannenfelser stated.

— Geoff Mulvihill and Hannah Schoenbaum. Associated Press reporters John Hanna, Matthew Perrone and Lindsay Whitehurst contributed.