A federal appeals court on Friday blocked the mailing of prescriptions for the abortion pill mifepristone, ruling that the medication must be dispensed only in person at clinics and cannot be prescribed through telehealth or shipped across state lines.
The unanimous three-judge panel of the 5th U.S. Circuit Court of Appeals in New Orleans overturned years of regulations from the Food and Drug Administration, including rules that had been in place since the COVID-19 era. The decision is the most sweeping court-imposed restriction on abortion since the Supreme Court’s 2022 ruling in Dobbs v. Jackson Women’s Health Organization ended the constitutional right to the procedure.
Judge Kyle Duncan, a Trump appointee, wrote for the court that allowing mifepristone to be mailed into Louisiana makes the state’s ban on abortion at all stages of pregnancy “moot.” The ruling quoted Louisiana’s policy that “every unborn child is a human being from the moment of conception and is, therefore, a legal person,” adding that “every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions.”
Mifepristone was approved in 2000 and is used in combination with a second drug, misoprostol, to end early pregnancies. Surveys cited by the Associated Press found that the majority of U.S. abortions are now provided via pills, and about one in four nationally are prescribed through telehealth. In states with abortion bans, more women obtained pills that way last year than by traveling to other states, according to one survey of providers.
The FDA initially required that the drug be prescribed and dispensed only in person by specially certified physicians. Those restrictions were lifted during the Biden administration after the agency reviewed more than two decades of safety data and dozens of studies involving thousands of women, concluding that patients could safely use the medication without direct supervision. The 5th Circuit panel, however, noted that the FDA under the Trump administration has opened a new review of mifepristone’s safety and “could not say when that review might be complete.”
GenBioPro, which manufactures generic mifepristone, said the ruling “ignores the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents.” Danco Laboratories, another manufacturer, asked the appeals court to pause its order for one week to give the company time to seek relief from the Supreme Court, saying it would otherwise file an emergency appeal.
The ruling extends well beyond states with abortion bans. Telehealth prescriptions have become common in states where the procedure remains legal, and the decision blocks them everywhere. “This is going to affect patients’ access to abortion and miscarriage care in every state in the nation,” said Julia Kaye, an attorney with the American Civil Liberties Union. “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.”
Anti-abortion groups celebrated the decision. Carol Tobias, president of the National Right to Life Committee, said the ruling “restores a critical layer of oversight” and that “women deserve better than an abortion-by-mail system that prioritizes ideology over safety.” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, called it “a huge victory for victims and survivors of Biden’s reckless mail-order abortion drug regime” and criticized the Trump administration for moving too slowly on its own review.
Louisiana Attorney General Liz Murrill, a Republican, said she was “look[ing] forward to continuing to defend women and babies as this case continues.” The FDA and the U.S. Department of Justice did not immediately respond to requests for comment.
The case now heads toward the Supreme Court, whose conservative majority overturned the right to abortion three years ago but in 2024 unanimously preserved access to mifepristone by ruling that the anti-abortion doctors who brought that challenge lacked legal standing. That decision left the door open for a new case brought by a state, which is what Louisiana and its co-plaintiffs have now done.