Supreme Court Temporarily Restores Access to Abortion Pill by Mail

• The Supreme Court temporarily paused a lower court decision to restrict nationwide access to the abortion pill mifepristone.
• A Louisiana lawsuit challenging mail-order mifepristone prescriptions remains on pause while the FDA completes its own review of the drug’s safety.
• Medication abortion now accounts for nearly two-thirds of all U.S. abortions, with telehealth delivering one in four — a share that could shrink if the FDA’s safety framework changes.

The fate of nationwide access by mail for the abortion pill mifepristone has returned to the U.S. Supreme Court.

On May 4, Justice Samuel A. Alito Jr. temporarily halted a recent lower-court ruling that restricted nationwide access to the abortion pill by mail — at least for now.

The Supreme Court’s ruling reverses a May 1 decision by the 5th Circuit Court of Appeals in New Orleans, which ruled in favor of a Louisiana lawsuit that dispensing the abortion pill via telehealth threatens the safety of pregnant people.

Louisiana currently bans abortion in almost all instances. The lower court’s ruling also attempted to block access to dispensing the drug by mail for miscarriage management and other non-abortion procedures. The ruling sowed confusion and chaos among providers and patients alike.

Justice Alito’s order issued a temporary pause until at least May 11.

Last month, a Louisiana judge paused a lawsuit challenging mail access to mifepristone until the a Food and Drug Administration completes its review of whether its own safety requirements for the drug are sound.

According to U.S. District Judge David Joseph’s decision, the FDA has 60 days to update the court on its review of the REMS rules, which dictate who can prescribe the drug and whether it can be mailed. The agency has six months to finish.

In a post on X, Louisiana Attorney General Liz Murrill said she asked the Fifth Circuit to suspend the 2023 rules, arguing the state “is likely to succeed in showing that the 2023 REMS is unlawful.”

“Decades of evidence and research from the U.S. and around the world show that mifepristone is safe and effective,” Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, told Healthline in April.

“These medications are so safe, they can be used as over-the-counter medications (and are in other countries),” said Sarah Prager, MD, an OB-GYN at University of Washington Medical Center.

Friedrich-Karnik called the FDA review a “sham” designed to cut off access. Murrill said Louisiana is likely to win. The Fifth Circuit will hear arguments next.

For the estimated 1 in 4 people currently seeking abortion through telehealth, the outcome will determine whether this remains an option.

“While this case is paused and mifepristone access remains unchanged for now, we know the fight is far from over. The judge’s ruling leaves the door open for future restrictions to mifepristone access, said Alexis McGill Johnson, president and CEO, Planned Parenthood Federation of America (PPFA), in a statement shared with Healthline.

“From the courts to the Trump administration to state legislatures across the country, mifepristone and abortion access are very much still under attack. Planned Parenthood organizations will continue to fight for patients to have the freedom to access care that is safe and effective — free from political interference,” McGill Johnson continued.

Medication abortion involves two drugs taken days apart.

“Mifepristone is a medication that competitively binds to progesterone receptors and thus prevents progesterone from maintaining a pregnancy. When used in combination with misoprostol, it is a safe and highly effective way to help the uterus expel a pregnancy for either abortion or miscarriage,” Prager told Healthline.

Misoprostol is taken 24 to 48 hours after mifepristone.

Through a telehealth appointment, a provider reviews a person’s medical history, confirms eligibility, and issues a prescription — all without an in-person visit.

“Providers will take a really thorough health history to screen for allergies, worrisome pregnancy complications like ectopic pregnancy, anemia, or contraindications to medication abortion,” Alyssa Sherer, DNP, a medical consultant to the Abortion Coalition for Telemedicine, told Healthline.

Guttmacher later estimated that in 2025, residents of the 13 states with total abortion bans received about 91,000 telehealth abortions, including about 9,350 in Louisiana. The state has already issued the first post-Dobbs criminal indictment of an abortion provider — a New York physician who prescribed pills via telehealth to a Louisiana teenager.

“Reimposing barriers on mifepristone use would upend abortion provision nationwide, deepen racial and socioeconomic inequities in who can access care, and place additional strain on providers who are already navigating a fractured landscape,” said Friedrich-Karnik.

Part of what’s driving demand for telehealth abortion is the disappearance of local abortion clinics.

When Planned Parenthood in Marquette, Michigan, closed last spring, it left about 1,100 patients without an in-person provider.

Brown, who described herself as ‘individually pro-life,’ added medication abortions to her urgent care practice to fill the gap.

“This preference for telemedicine is often due to barriers to care that are created by stigma, time, jobs, children, school, geography, ability, or many other aspects,” Prager said. “Telemedicine is a safe and evidence-based way to get care for both miscarriage and abortion.”

When asked how a telehealth abortion appointment differs from any other virtual visit, Sherer said, “They look pretty much the same.”

Once the health history is reviewed, she explained, the provider sends prescriptions to a mail-order or retail pharmacy, and the patient can stay in touch with their provider throughout the process. Follow-up care, including confirming the abortion is complete, can also happen remotely.

Abortion access across the United States varies widely from state to state. More information on finding access can be found here.