A three-judge federal appeals panel in New Orleans pressed Louisiana on September 9 over whether it can legally blame the FDA for mifepristone being mailed into the state, and it issued no decision. For now, the medication remains available through telehealth prescriptions and by mail.
The drug is part of the most common U.S. medication abortion regimen and is also used in miscarriage care, which is why the case reaches beyond states with abortion bans. Louisiana wants the FDA's in-person dispensing requirement restored nationwide. That would require patients, including those in states that protect abortion access, to obtain mifepristone in person rather than through the mail.
The hearing does not change access today. What it added is a clearer picture of the questions the judges appear to consider decisive, with no timeline for a decision.
Standing Took Center Stage in New Orleans
The panel included Judges Priscilla Richman, Stephen Higginson and Dana Douglas, according to Courthouse News Service. Much of the argument focused on standing, the requirement that a plaintiff show a concrete injury traceable to the government action it is challenging.
Louisiana argues it is harmed through Medicaid costs for treating complications and because mailed pills undercut its abortion ban. State Solicitor General Ben Aguiñaga told the court there was no dispute that about 1,000 abortions a month in Louisiana involve mifepristone mailed into the state. A Society of Family Planning survey estimated that 770 to 900 abortions a month in Louisiana during 2025 involved pills prescribed online or by providers in states with shield laws, The Center Square reported. Richman said she was "having trouble finding anywhere in the record" that the FDA had approved mailing the drug into states where doing so is unlawful.
Higginson noted that laws in other states protect clinicians who prescribe to patients in states with bans, which raised the question of whether Louisiana's injury flows from the FDA or from those laws. "The government has nothing to do with the shield laws," he said. He also questioned Louisiana's request that the panel reinstate the requirement but then pause its own order while the Supreme Court weighs in, saying the approach seemed self-defeating, and he criticized the FDA for declining to defend its own 2023 rule while it conducts a review.
Louisiana says it is not asking the court to block telehealth prescribing itself, only to reinstate the requirement that the drug be dispensed in person. In practice, that would end delivery by mail.
A Legal Fight That Already Reached the Supreme Court
MedicalDaily previously reported that a separate Texas and Florida mifepristone lawsuit was paused until December while the FDA reviews the drug's safety program. The Louisiana case has moved on its own track.
Louisiana and a Louisiana woman, Rosalie Markezich, sued in October 2025 to challenge the FDA's 2023 decision to permanently remove the in-person dispensing rule. U.S. District Judge David Joseph declined to reinstate the rule, finding that the balance of interests favored letting the FDA finish its review, and he paused the case in April. A Fifth Circuit panel then reinstated the in-person requirement nationwide on May 1, and the Supreme Court stayed that order on May 14, according to the Center for Reproductive Rights case tracker.
That stay preserved access while the appeal continues, but the Supreme Court did not rule on the merits. In its brief, the FDA asked the appeals court to affirm the district court's decision or pause the appeal while the agency conducts its review. Drugmakers Danco Laboratories and GenBioPro argue that Louisiana lacks standing altogether.
Patients and Clinicians Planning Around Uncertainty
Mifepristone has been FDA-approved since 2000 and is typically taken with a second drug, misoprostol. Under the current safety program, it must be prescribed by a certified prescriber and may be dispensed in person or by mail through a certified pharmacy, according to the FDA's mifepristone information page. Medication abortion accounts for more than 60 percent of U.S. abortions, according to Guttmacher Institute data.
The people with the most at stake are those who rely on telehealth because of distance, work schedules or child care, including rural patients far from a clinic. People managing an early pregnancy loss may also be prescribed mifepristone, so a change in dispensing rules could affect miscarriage care as well as abortion. In states that already ban or restrict abortion, the practical effect would depend on how any ruling interacts with state laws, including shield laws elsewhere.
As of September 10, federal rules still allow telehealth prescribing and mail dispensing by certified pharmacies, while state laws vary. Patients should confirm current options with a licensed clinician or pharmacy. The FDA advises against buying mifepristone online outside its safety program, which bypasses safeguards meant to protect patients.
Anyone who has taken mifepristone should seek urgent care for heavy bleeding that soaks through two thick, full-size pads an hour for two hours in a row, severe abdominal pain, or a fever of 100.4 degrees Fahrenheit or higher that lasts more than four hours. Those warning signs apply regardless of how the medication was obtained.
Signals to Watch After the Hearing
The panel set no timeline for a decision, and whichever side loses could seek further review, including a return to the Supreme Court. Separately, the FDA must file a status report on its mifepristone review with the district court by October 7, according to the Center for Reproductive Rights. The review could lead the agency to change the rules itself, which could reshape the litigation. MedicalDaily will report the ruling and any FDA action.
September 9, 2026: The Fifth Circuit hears arguments focused on standing and issues no ruling.
May 14, 2026: The Supreme Court stays the May 1 order, preserving mail and telehealth access during the appeal.
May 1, 2026: A Fifth Circuit panel temporarily reinstates in-person dispensing of mifepristone nationwide.
April 7, 2026: Judge Joseph pauses the case for the FDA review and denies Louisiana's request to reinstate the in-person rule.
October 2025: Louisiana files suit challenging the FDA's 2023 removal of the in-person dispensing requirement.
The newest development is that the judges questioned whether Louisiana can bring this challenge at all. Access by mail continues for now, and the next turning point will be a written ruling whose timing is unknown.
Key Questions Answered
Can people still get mifepristone by mail?
Yes. As of September 10, federal rules allow telehealth prescribing and mail dispensing because the Supreme Court stayed a May 1 order that would have ended it. State laws still vary.
What happened at the September 9 hearing?
A Fifth Circuit panel heard arguments in Louisiana's challenge to the FDA's 2023 decision. The judges focused on whether Louisiana has standing to sue, and they did not issue a ruling.
What is Louisiana asking for?
The state wants the FDA's in-person dispensing requirement restored. Louisiana says it is not seeking to block telehealth prescribing itself, but in-person dispensing would end mail delivery.
Does the case affect miscarriage care?
It could. Mifepristone is also used to manage early pregnancy loss, so changes in how it is dispensed could affect patients who are not seeking an abortion.
When will the court decide?
The panel did not set a date. Either side could seek further review after a ruling, including at the Supreme Court.
Is the FDA reviewing mifepristone?
Yes. The agency is reviewing the drug's safety program and must file a status report with the district court by October 7. It asked the appeals court to affirm the lower court's decision or pause the case while that review continues.
What warning signs need urgent care after taking mifepristone?
Heavy bleeding that soaks two thick, full-size pads an hour for two hours in a row, severe abdominal pain, or a fever of 100.4 degrees Fahrenheit or higher lasting more than four hours. Seek care regardless of how the medication was obtained.
