The Supreme Court temporarily restored broad access to mifepristone, allowing the abortion pill to remain available nationwide while the justices consider an emergency appeal in a legal battle over medication abortion.
Concretely, Justice Samuel Alito issued an administrative stay that blocks a ruling from the 5th U.S. Circuit Court of Appeals, which would have reinstated stricter limits on the drug, including an in-person dispensing requirement. The order keeps the current Food and Drug Administration rules in place until May 11unless the court acts sooner or extends the pause.
The case was brought by Louisiana, which challenged the FDA's 2023 rules allowing mifepristone to be prescribed remotely and dispensed by mail. The state argued that the FDA's rules conflicted with its abortion restrictions and exposed the state to costs tied to emergency care.
The 5th Circuit agreed, at least temporarily, finding that Louisiana had standing because its Medicaid program had covered emergency-room care for two women who experienced complications after receiving the drug from an out-of-state provider.
Danco Laboratories, which makes the branded version of mifepristone, and GenBioPro, which makes the generic version, asked the Supreme Court to intervene. They warned that the appeals court order would cause immediate disruption for patients, prescribers and pharmacies, and would abruptly undo a regulatory framework that has allowed mifepristone access through telehealth and mail.
The legal fight revolves around the FDA's risk-management rules for mifepristone, known as REMS. The agency first approved mifepristone in 2000. The FDA later expanded access, including allowing the drug to be used through 10 weeks of pregnancy, permitting additional health care providers to prescribe it, and eventually removing an in-person dispensing requirement. The FDA formally allowed telehealth prescriptions and mail delivery in 2023 after earlier suspending enforcement of the in-person rule during the COVID-19 pandemic.
Monday's order, however, does not solve the case. An administrative stay is a short-term pause that gives the Supreme Court time to review emergency filings. Alito, who handles emergency matters from the 5th Circuit, ordered responses by Thursday, May 7. The justices could extend the stay, let the 5th Circuit restrictions take effect, or issue a broader order while litigation continues.
The case is the second major mifepristone fight to reach the Supreme Court in two years. In 2024, the justices unanimously rejected a challenge from anti-abortion doctors and medical groups, ruling that they lacked legal standing to sue the FDA. That decision preserved access to the drug but did not decide broader questions about the FDA's authority or stop states from filing new challenges.
Mifepristone is used with misoprostol in medication abortions, which account for a majority of U.S. abortions. The drug is also used in some miscarriage care, a point raised by providers who warned that the 5th Circuit order could create confusion beyond abortion services.
