pill

WASHINGTON — The Supreme Court is leaving access to a widely used abortion pill untouched until at least Thursday, while the justices consider whether to allow restrictions on the drug, mifepristone, to take effect.

Justice Samuel A. Alito Jr.’s order Monday allows women seeking abortions to continue obtaining the pill at pharmacies or through the mail, without an in-person visit to a doctor. It prevents restrictions on mifepristone imposed by a federal appeals court from taking effect for the time being.

The court is dealing with its latest abortion controversy four years after its conservative majority overturned Roe vs. Wade and allowed more than a dozen states to effectively ban abortion outright.

The case before the court stems from a lawsuit Louisiana filed to roll back the Food and Drug Administration’s rules on how mifepristone can be prescribed. The state claims the policy undermines the ban there, and it questions the safety of the drug, which was first approved in 2000 and has repeatedly been deemed safe and effective by FDA scientists.

Lower courts concluded that Louisiana is likely to prevail, and a three-judge panel of the U.S. 5th Circuit Court of Appeals ruled that mail access and telehealth visits should be suspended while the case plays out.

The drug is most often used for abortion in combination with another drug, misoprostol. Medication abortions accounted for nearly two-thirds of all abortions in the U.S. in 2023, the last year for which statistics are available.

The current dispute is similar to one that reached the court three years ago.

Lower courts then also sought to restrict access to mifepristone, in a case brought by physicians who oppose abortion. They filed suit in the months after the court overturned Roe.

The Supreme Court blocked the 5th Circuit ruling from taking effect over the dissenting votes of Alito and Justice Clarence Thomas. Then, in 2024, the high court unanimously dismissed the doctors’ suit, reasoning they did not have the legal right, or standing, to sue.

In the current dispute, mainstream medical groups, the pharmaceutical industry and Democratic members of Congress have weighed in cautioning the court against limiting access to the drug. Pharmaceutical companies said a ruling for abortion opponents would upend the drug approval process.

The FDA has eased a number of restrictions initially placed on the drug, including who can prescribe it, how it is dispensed and what kinds of safety complications must be reported.

Despite those determinations, abortion opponents have been challenging the safety of mifepristone for more than 25 years. They have filed a series of petitions and lawsuits against the agency, generally alleging that it violated federal law by overlooking safety issues with the pill.

President Trump’s administration has been unusually quiet at the Supreme Court. It declined to file a written brief recommending what the court should do, even though federal regulations are at issue.

The case puts Trump’s Republican administration in a difficult place. Trump has relied on the political support of antiabortion groups but has also seen ballot question and poll results that show Americans generally support abortion rights.

Both sides took the silence as an implicit endorsement of the appellate ruling. Alito is both the justice in charge of handling emergency appeals from Louisiana and the author of the 2022 decision that declared abortion is not a constitutional right and returned the issue to the states.

Sherman, Mulvihill and Perrone write for the Associated Press. Mulvihill reported from Haddonfield, N.J.

The last time the Supreme Court threatened to end access to the country’s most popular abortion method, California’s network of online providers and their pharmaceutical suppliers scrambled to respond.

Now, with the fate of the cocktail used in roughly two-thirds of U.S. terminations once again in the balance, they’re not even breaking a sweat.

Dr. Michele Gomez, co-founder of the MYA Network, a consortium of virtual reproductive healthcare providers, said the supply chain is “ready to switch in a day” to an alternative drug combination.

“It’s not going away and it’s not going to slow down,” Gomez said.

On May 1, the 5th U.S. Circuit Court of Appeals ruled to block the drug mifepristone from being prescribed virtually and shipped through the mail, making such deliveries illegal across the country. On Monday, the Supreme Court stayed that decision, allowing prescriptions to resume until the court issues an emergency ruling next week.

Mifepristone is the first half of a two-drug protocol for medication abortion, which made up 63% of all legal abortions in the U.S. in 2023.

Between a quarter and a third of those abortions are now prescribed by healthcare providers over the internet and delivered by mail — a path Louisiana and other ban states are fighting to bar.

“Abortion access has gone up with all the telehealth providers,” Gomez said. “We uncovered an unmet need.”

But the cocktail’s second ingredient, misoprostol, can be used to produce abortion on its own — a method that’s often more painful and slightly less effective.

It would be easy for suppliers to switch to a misoprostol-only protocol — and much harder for courts to block it, experts said.

“We heard about this on Friday and organizations that mail pills were mailing misoprostol on Saturday,” Gomez said. “They already knew what to do.”

After the Supreme Court overturned Roe vs. Wade in 2022, California became one of the first states to enshrine abortion rights for residents in its Constitution and legislate protection for clinicians who prescribe abortion pills to women in states with bans.

Last fall, legislators in Sacramento expanded those protections by allowing pills to be mailed without either the doctor or the patient’s name attached.

But cases like the one being decided next week could still sharply limit abortion rights even in states with extensive legal protections, experts warned.

“Even though California has built a fortress around its own constitutional protections of reproductive freedom, those [protections] become vulnerable to the whims of antiabortion states if the Supreme Court gives those states their imprimatur,” said Michele Goodwin, professor at Georgetown Law and an expert on reproductive justice.

Coral Alonso sings in Spanish as protesters rally on the three-year anniversary of the U.S. Supreme Court decision overturning Roe vs. Wade on June 24, 2025, in Los Angeles. The ruling ended the federal right to legal abortion in the United States.

(David McNew / Getty Images)

Legal experts are split over how the justices will decide the medication’s mail-order fate.

“This is a case where law clearly won’t matter,” Eric J. Segall, a law professor at Georgia State University and an expert on the Supreme Court.

“In a very important midterm election year, I think there’s at least two Republicans on the court who will decide that upholding the 5th Circuit would really hurt the Republicans at the polls,” he said. “If women can’t get this by mail in California or other blue states where abortion is legal, it’s going to have devastating consequences, and I think the court knows that.”

But he and others believe it’s no longer a matter of if — but when and how — the drugs are restricted, including in California.

“This is curating a backdrop for a legal showdown that may surely come,” Goodwin said.

The court’s most conservative justices could find grounds to act in the long-forgotten Comstock Act of 1873. The brainchild of America’s zealously anti-porn postmaster Anthony Comstock, the law not only banned the mailing of the “Birth of Venus” and “Lady Chatterley’s Lover,” but also condoms, diaphragms and any drug, tool or text that could be used to produce an abortion.

Though it hasn’t been enforced since the 1970s, the antiabortion provision of the law remains on the books, experts said.

“The next move is with the Comstock Act, which Justices Alito and Thomas have already been hinting at,” Goodwin said. “In that case, it’s like playing Monopoly — we could skip mifepristone and go straight to contraception. The goal is to make sure none of that gets to be in the mail.”

That move would upend how Americans get both abortions and birth control, and put an unassuming L.A. County pharmacy squarely in the government’s crosshairs.

Although doctors in nearly two dozen states can safely prescribe medication abortion to women anywhere in the U.S., only a handful of specialty pharmacies actually fill those mail orders, Gomez explained. Among the largest is Honeybee in Culver City, which did not reply to requests for comment.

Even if the justices don’t reach for Comstock, a decision in Louisiana’s favor next week could create a two-tiered system of abortion across California and other blue states, experts said.

“The people this case hurts the most are the poor and the rural,” said Segall, the Supreme Court expert.

National data show that abortion patients are disproportionately poor. Most are also already mothers. Losing mail access to mifepristone would leave many with the more painful, less effective option while those with the time and means to reach a clinic continue to get the gold standard of care.

“There are fundamental questions of citizenship at the heart of this,” said Goodwin, the constitutional scholar. “Under the 14th Amendment, women are supposed to have equality, citizenship, liberty. It’s as though the Supreme Court has taken a black marker and pressed it against all of those words.”

For Gomez and other providers, that’s tomorrow’s problem.

“The lawyers and the politicians are just going to do their thing,” the doctor said. “The healthcare providers are just trying to get medications to people who need them.”

The United States Supreme Court has temporarily reinstated a rule allowing an abortion pill to be prescribed through telemedicine and dispensed through the mail, lifting a judicial ban that narrowed access to the medication nationwide.

Justice Samuel Alito issued an interim order on Monday, pausing for one week a decision by the New Orleans-based 5th US Circuit Court of Appeals to reimpose an older federal rule requiring an in-person clinician visit to receive mifepristone.

The 5th Circuit acted in a challenge to the rule by the Republican-led state of Louisiana.

The Supreme Court’s action, called an “administrative stay”, gives the justices more time to review emergency requests by two manufacturers of mifepristone to ensure that the drug can be provided via telehealth and the mail while the legal challenge plays out.

Alito ordered Louisiana to respond to the drugmakers’ requests by Thursday and indicated that the administrative stay would expire on May 11. The court would be expected to extend the interim stay or formally decide the requests by that time.

Alito, one of the nine-member court’s six conservative justices, acted because he is designated by the court to oversee emergency matters that arise in a group of states that includes Louisiana.

The case puts the contentious issue of abortion back in front of the justices, who must confront another effort by abortion opponents to scale back access to mifepristone, with the November US congressional elections looming.

The court in 2024 unanimously rejected an initial bid by anti-abortion groups and doctors to roll back Food and Drug Administration (FDA) regulations that had eased access to the drug, ruling that these plaintiffs lacked the necessary legal standing to pursue the challenge.

Mifepristone, given FDA regulatory approval in 2000, is taken with another drug called misoprostol to perform medication abortions, a method that now accounts for more than 60 percent of all abortions in the US.

The ongoing battles over abortion rights follow the court’s 2022 ruling that overturned its 1973 Roe v Wade precedent that had legalised abortion nationwide.

That ruling has prompted 13 states to enact near-total bans on the procedure, while several others have sharply restricted access.

Louisiana sued the FDA last year, claiming that a rule adopted during the administration of former US President Joe Biden, a Democrat – a rule that eased access to mifepristone by eliminating the in-person dispensing requirement – is illegal and undermines the state’s abortion ban.

The pill’s manufacturer, Danco Laboratories, and GenBioPro, which makes a generic version, intervened in the litigation to defend the 2023 regulation. The administration of current US President Donald Trump, a Republican, cited an ongoing review of safety regulations concerning mifepristone and opposed the state’s challenge.

In April, US Judge David Joseph in Lafayette, Louisiana, declined to block the regulation but agreed with the administration to put the case on hold pending the review. The 5th Circuit blocked the rule on May 1.

The legal and political fight over access to mifepristone has dominated the debate over abortion in the US over the past few years.

The American Civil Liberties Union (ACLU) called the top court’s decision on Monday a “positive short-term development”.

“The Supreme Court needs to put an end to this baseless attack on our reproductive freedom, once and for all,” Julia Kaye, senior lawyer for the Reproductive Freedom Project of the ACLU, said in a statement.

Since the Supreme Court revoked the right to abortion in 2022, Democrats have been seizing on the unpopularity of bans on the procedure and emphasising the issue in their electoral platforms.

Chuck Schumer, the top Democrat in the Senate, welcomed the top court’s decision on Monday, but said, “This fight is just beginning.”

“We will stop at nothing to prevent the Republicans from putting a national abortion ban into effect,” Schumer wrote on X.

On Monday, Republican Senator Josh Hawley cited disputed findings on the health risks associated with mifepristone, urging lawmakers to act.

“Now it’s time for Congress to ban it completely for use in abortion,” he said in a social media post.

May 2 (UPI) — A company that makes the abortion drug mifepristone on Saturday asked the U.S. Supreme Court to immediately pause a ruling that prevents doctors from prescribing it during telehealth visits.

Late Friday, a three judge panel on the 5th Circuit Court of Appeals unanimously ruled in favor of the state of Louisiana in a case asking the court to block doctors from prescribing the drug in telehealth visits.

Louisiana in the last four years has moved to prevent women in the state from obtaining abortion care legislators there were among the first to ban abortion after the repeal of Roe v. Wade, and later blocked doctors from prescribing the medical abortion pill in virtual telehealth visits.

The company, which is not the only drugmaker planning to file an appeal, said that patients will be stuck in limbo because of the lack of clarity it leaves for legal use of the drug, NBC News and Politico reported.

Roughly half of all abortions in the United States are performed using medications.

“Danco has been free to rely on procedures set by the FDA to distribute its product,” lawyers for the company said in a filing with the court.

“The Fifth Circuit’s decision immediately ends that,” the lawyers said. “A stay should issue to prevent the disruption and confusion that will result if the decision below were to remain operative.”

In addition to Danco, Politico reported that GenBioPro, which also manufactures the drug, has indicated that it will also file an appeal with the court.

Mifepristone was approved by the U.S. Food and Drug Administration in 2000 for medical termination of pregnancy and, until the COVID-19 pandemic, could only be prescribed during in-person appointments.

Early in the pandemic and the country locked down in an effort to stem the spread of the virus, doctors sued the FDA to allow them to prescribe mifepristone during telehealth visits.

The FDA temporarily changed the rule, but in 2023 adopted it permanently as some states started to restrict access to abortion and abortion services after the Supreme Court struck down Roe v. Wade.

Pharmaceutical companies and patient advocates warned that the restriction circumvents the FDA’s regulatory authority, which is based on evidence and data, and that it may offer a path for people to challenge other medications based on personal interest or opinion.

In the case of Danco, it also immediately filed the appeal because it is the only product it makes and “without a valid legal framework for distributing that product, Danco will lose its only source of revenue and may be unable to continue operating.”