The Supreme Court intervened Thursday to preserve the status quo on mifepristone access, granting emergency applications from the pill’s two manufacturers — Danco Laboratories and GenBioPro — and blocking a ruling from the 5th U.S. Circuit Court of Appeals that would have required in-person doctor visits and suspended delivery of the medication through the mail. The order keeps in place the Food and Drug Administration’s current prescribing framework, which has allowed mifepristone to be dispensed at pharmacies and through telehealth platforms without an in-person visit since 2021.
The ruling, issued without a full hearing on the merits, means patients seeking medication abortions can continue to obtain mifepristone under the existing regulatory structure while Louisiana’s lawsuit challenging the FDA’s prescribing rules works its way through the courts. Access is likely to remain unchanged at least into next year, as the case may eventually return to the Supreme Court for a full review.
The case stems from a lawsuit Louisiana filed to roll back the FDA’s rules on how mifepristone can be prescribed. The state claims the policy undermines its abortion ban and questions the safety of the drug — a safety profile the FDA has repeatedly affirmed since first approving mifepristone for abortion use in 2000. Lower courts concluded Louisiana is likely to prevail, and the 5th Circuit panel ruled that mail access and telehealth visits should be suspended while the case plays out.
Justices Clarence Thomas and Samuel Alito dissented from the court’s order, each writing separately. Thomas wrote that Danco and GenBioPro are seeking to spare themselves “lost profits from their criminal enterprise.” He also argued that those who mail the pills violate the Comstock Act, a 19th-century law that bans mailing any item “advertised or described in a manner calculated to lead another to use or apply it for producing abortion.” The law has gone unenforced for decades.
Alito, who authored the 2022 opinion overturning Roe v. Wade, wrote that Louisiana’s efforts to enforce its abortion ban have been thwarted by medical providers and private organizations that mail pills to residents. Danco and GenBioPro “are obviously aware of what is going on yet nevertheless supply the drug and reap profits from its felonious use in Louisiana,” Alito wrote.
Medication abortions — typically a two-drug regimen of mifepristone and misoprostol — accounted for nearly two-thirds of all abortions in the United States in 2023, according to the most recent available data. Telehealth prescribers had indicated they were prepared to switch to a misoprostol-only regimen if the court had allowed the 5th Circuit’s restrictions to take effect.
The Trump administration has been “unusually quiet” in the litigation, the Associated Press reported, declining to file a written brief recommending what the court should do even though federal regulations are at issue. Both supporters and opponents of abortion access interpreted the silence as an implicit endorsement of the appellate ruling. The case places the administration in a politically difficult position: Trump has relied on the support of anti-abortion groups but has also seen ballot-question and poll results showing broad public support for abortion rights.
The administration’s posture on mifepristone is further complicated by anti-abortion groups’ frustration with the pace of the FDA’s review of the drug. Earlier this week, FDA Commissioner Marty Makary resigned after months of criticism from Trump’s political allies, including abortion opponents. The groups, including Susan B. Anthony Pro-Life America, had called on Trump to fire Makary over what they characterized as the slow pace of the mifepristone review.
Gavin Oxley, a spokesperson for the anti-abortion advocacy group Americans United for Life, called Thursday’s ruling “extremely disappointing” but not a defeat. “The Supreme Court still has the opportunity to hear the case in full and bring justice to Louisiana,” Oxley said.
Serra Sippel, executive director of The Brigid Alliance, which helps coordinate travel and logistical support for women traveling for abortion care, said the organization is relieved that access remains protected for now. “But this should never have been on the table in the first place,” Sippel said. “Patients and providers should not be forced to wait on court rulings to know whether people can access critical health care.”
The current dispute mirrors one the court handled three years ago, when the justices also blocked a 5th Circuit ruling in a suit filed by anti-abortion doctors and kept mifepristone widely available — again over dissents from Thomas and Alito. In 2024, the high court unanimously dismissed that suit after determining the doctors lacked legal standing to bring it.
The pharmaceutical industry, mainstream medical groups, and Democratic members of Congress have filed briefs in the current case cautioning the court against limiting access to mifepristone. Pharmaceutical companies argued that a ruling for abortion opponents would destabilize the drug approval process more broadly.
The debate over mifepristone’s safety has persisted for more than 25 years. The FDA has progressively eased restrictions on the drug since its initial approval in 2000, expanding the categories of providers who can prescribe it, changing how it is dispensed, and modifying safety-reporting requirements. Anti-abortion groups have responded with a series of petitions and lawsuits, generally alleging that the agency violated federal law by overlooking safety concerns — allegations the FDA’s own scientific determinations have consistently rejected.