The U.S. Supreme Court on Monday restored broad access to the abortion pill mifepristone, stepping in to block a lower-court ruling that had threatened to upend a key way medication abortions are provided across the United States. The action came in an order signed by Justice Samuel Alito, which temporarily permits patients to obtain mifepristone through pharmacies or through the mail, including without an in-person visit to a doctor.
The order maintains the status quo for about a week, giving the parties time to respond as the Supreme Court considers the dispute more fully. Alito’s temporary relief follows last week’s federal appeals court decision that imposed new restrictions on how the drug could be prescribed.
Medication abortions dominate in the United States, according to the AP. In many cases, providers use mifepristone in combination with a second drug, misoprostol, which the FDA labels describe as completing medical abortion in most instances. Some reports have also discussed how misoprostol alone can be used when mifepristone is not available.
The dispute is also tied to how abortion bans have been enforced after the Supreme Court’s 2022 decision overturning Roe v. Wade. Some states with abortion protections have enacted laws aimed at shielding clinicians who prescribe the drugs through telehealth to patients in states where abortion is banned, a strategy that has sought to reduce the impact of restrictions that require patients to travel.
The litigation that prompted Monday’s Supreme Court action was brought by Louisiana, which sued to roll back U.S. Food and Drug Administration rules governing how mifepristone can be prescribed. Louisiana argued that the FDA policy undermined the state’s ban, and the case also questioned the safety of mifepristone, a drug approved about 25 years ago that FDA scientists have repeatedly found safe and effective.
In the order’s immediate run-up, abortion providers navigated rapid changes and uncertainty created by the shifting rulings. Dr. Angel Foster, the founder of The Massachusetts Abortion Access Project, said her organization was prepared to move to a misoprostol-only approach before Monday, but it was able to return to the two-drug mifepristone-and-misoprostol regimen. Foster said the organization continued to provide information while guiding patients through different situations depending on where they were in the process.
Foster said the weekend was spent directing patients who had been sent mifepristone but had not received it yet, those who had been approved but had not paid or received the medication, and those who reached out with initial requests. For now, she said, the groups were asking patients to approve being sent pills with or without mifepristone, in case another change occurs.
Julie Burkhart, founder of Wellspring Health Access, said the Supreme Court’s stay provides additional time for clinics that provide roughly 100 abortions per year through pills prescribed by telehealth to decide on next steps if mifepristone prescribing is curtailed again. Elizabeth Ling, associate director of legal services at If/When/How, said that regardless of how the legal battle proceeds, patients need to understand that the outcome of the court fight would not necessarily criminalize people for seeking or accessing care.
Meanwhile, anti-abortion groups said they will keep pursuing litigation. Carol Tobias, president of National Right to Life, called Monday’s ruling a temporary procedural step and said it leaves unresolved concerns about the drugs’ safety and about the Biden administration’s FDA actions. Louisiana Attorney General Liz Murrill, who brought the lawsuit against the FDA along with a woman who said her boyfriend coerced her into taking abortion pills, criticized drug companies for their role in the case, arguing that the stay is temporary and expressing confidence the state’s position will prevail.