Supreme Court Preserves Abortion Pill Access by Mail for Now (2)

A divided US Supreme Court let a widely used abortion pill continue to be dispensed by mail, putting on hold a federal appeals court decision that had briefly required patients to make an in-person visit to a provider.

In a one-paragraph order that gave no explanation, the justices granted requests from the drug’s manufacturers to keep it fully available while a legal fight goes forward. Louisiana is seeking to upend the Food and Drug Administration’s decision during Joe Biden’s presidency to permit remote prescriptions for mifepristone, a drug the FDA first approved in 2000.

Justices Clarence Thomas and Samuel Alito issued strongly worded dissents. Thomas said the companies were engaged in a “criminal enterprise.”

Alito said the case was about a “scheme to undermine our decision in Dobbs v. Jackson Women’s Health Organization,” the 2022 ruling he wrote to overturn the constitutional right to abortion. Louisiana, one of 13 states that now have total abortion bans, told the justices that remote prescriptions are undermining its prohibition.

The case could have upended abortion access nationwide. Pill-induced abortions accounted for 63% of all pregnancy terminations in 2023, and mifepristone was used in the vast majority of cases, according to the Guttmacher Institute, a research organization that supports reproductive rights.

“We are pleased that a safe and effective drug Americans depend on will continue to be available while this litigation proceeds,” said Abby Long, a spokesperson for Danco Laboratories LLC, which makes the brand-name version of the drug.

Louisiana Attorney General Liz Murrill said it was “shocking that the Supreme Court would block this common-sense return to medically ethical practices and oversight.”

The reprieve may only be temporary. The FDA under President Donald Trump says it is conducting a safety review of mifepristone, and it could try to impose new restrictions down the road. The FDA didn’t take a stance on the issue at the Supreme Court, though the agency had urged the 5th US Circuit Court of Appeals to keep the drug fully available for now.

Bloomberg News reported in December that the FDA was slow-walking its safety study until after the midterm elections. The Health and Human Services Department, which includes the FDA, denied the report.

Mifepristone has been available by mail since 2021, when the FDA said it would stop enforcing the in-person rule because of the pandemic. The FDA formally lifted the requirement in 2023.

The 5th Circuit, perhaps the country’s most conservative appeals court, said the FDA gave short shrift to safety concerns when it made the 2023 decision. The May 1 ruling blocked remote prescriptions for three days until the Supreme Court put the decision on temporary hold while the justices decided how to handle the case.

Danco and GenBioPro Inc., which makes a generic version of mifepristone, filed separate requests urging the Supreme Court to keep the drug fully available. The companies said the FDA acted in 2023 based on a wealth of evidence that mifepristone is safe without an in-person visit to a medical provider. The companies also said the 5th Circuit created chaos by restricting mifepristone even in states where abortion is legal.

Louisiana told the Supreme Court that out-of-state prescribers are causing 1,000 illegal abortions each month by shipping mifepristone into the state.

The Supreme Court grappled with similar issues in 2023 and 2024 after a federal judge ordered mifepristone pulled from the market. The Supreme Court ultimately kept mifepristone fully available, ruling the anti-abortion doctors and organizations that sued lacked legal “standing” because they weren’t directly affected by the FDA’s actions.

The 5th Circuit said Louisiana had standing because the availability of mifepristone was undermining the state’s abortion ban. The 5th Circuit also said the state was having to pay medical costs for patients who suffered complications from mifepristone.

The cases are Danco v. Louisiana, 25a1207, and GenBioPro v. Louisiana, 25a1208.

(Updates with reaction in sixth and seventh paragraph.)

--With assistance from Rachel Cohrs Zhang.

© 2026 Bloomberg L.P. All rights reserved. Used with permission.