Written by: Zane McNeill
In the most recent attack on abortion medication, anti-abortion extremists are trying to restrict access to a safe, effective treatment used in nearly two-thirds of abortions in the United States.
On May 1, 2026, a panel of Republican-appointed judges on the 5th Circuit Court of Appeals granted Louisiana’s request to pause a 2023 Food and Drug Administration (FDA) policy allowing the abortion medication mifepristone to be prescribed online and sent by mail. This created widespread confusion about what care was still legally permissible. Intervenor pharmaceutical companies that produce mifepristone quickly appealed the 5th Circuit’s grant and on May 4, 2026 the Supreme Court issued a temporary stay, allowing the telehealth provision of mifepristone until at least May 11, 2026. Briefing in the case is due on Thursday, May 7th.
Anti-abortion advocates have been trying to limit the availability of mifepristone for years. In 2022, the anti-LGBTQ and anti-abortion nonprofit Alliance Defending Freedom (ADF) represented the anti-abortion organization Alliance for Hippocratic Medicine. The group strategically incorporated in Amarillo, Texas for the seemingly sole purpose of filing a lawsuit challenging the provision of mifepristone in the district of one of the most conservative federal judges, Matthew Kacsmaryk, in the country. In 2023, Judge Kacsmaryk suspended the FDA’s 2000 approval of mifepristone, along with the agency’s removal of medically unnecessary restrictions that had limited access to the medication. Kacsmaryk’s order was appealed to the 5th Circuit Court of Appeals, which is notoriously the most conservative appellate court in the country. The Fifth Circuit upheld part of Matthew Kacsmaryk’s injunction, rolling back the FDA’s 2016 and 2021 changes that had expanded access to mifepristone.
The Supreme Court temporarily paused the 5th Circuit's ruling and, in June 2024 it found that plaintiffs’ lacked standing and bumped the case back to the lower courts. While the original plaintiffs’ lacked standing to bring the legal challenge, Missouri, Kansas, and Idaho had intervened in January 2024 and were able to keep the litigation alive. In September 2025, Texas, Florida, and Louisiana also tried to join the litigation as plaintiffs but were denied. Judge Kacsmaryk transferred the case to the Eastern District of Missouri –a move designed to support the ongoing viability of the lawsuit – where briefing is ongoing.
In October 2025, Louisiana–supported by the ADF as co-counsel–filed its own legal challenge to the FDA’s allowance of telehealth provision for mifepristone. In its complaint, Louisiana argued that it had standing because 1) the telehealth provision of abortion medication allows providers in other states to provide abortion care that cannot be provided in the state; 2) abortion medication has led to hospitalizations of women in Louisiana; and, 3) Louisiana had to reimburse two Louisiana women on Medicaid who needed emergency care in 2025 from complications “caused by out-of-state mifepristone.” Louisiana’s motion to stay the telehealth provision of abortion medication is what is now being considered by the Supreme Court.
Texas and Florida also filed a separate challenge in December, 2025 suing the FDA over its original approval of mifepristone in 2000 and subsequent approval of a generic version of the medication in 2019, as well as the agency’s removal of restrictions to the medication. Briefing is also ongoing in this case. In their complaint, the states cite a non-peer reviewed and self-published study by the anti-abortion group Ethics and Public Policy Center as evidence that mifepristone is unsafe. This self-published report is being used by the FDA to justify its own review into the safety of mifepristone, despite decades of research finding that it is safe and effective.
The FDA appears to be delaying its review, and any changes it may make to mifepristone regulations based on it, until after the midterm elections likely to avoid any potential political backlash for Republicans since abortion care remains widely popular. The Supreme Court may keep mifepristone access available until after the FDA finishes conducting its review or until the other cases challenging the availability and regulations of mifepristone make their way to the Court.
Access to mifepristone is undoubtedly in danger and any restriction to mifepristone will have a detrimental effect on people across the country. Eliminating the telehealth provision for mifepristone would sharply reduce abortion access nationwide and severely impact people living in states where abortion is banned, as well as for those who are low-income, live in rural areas, or have disabilities. While people may still be able to access mifepristone and others could receive misoprostol-only abortion care, access to and optimality of care would be negatively affected. This would not only harm patients who are seeking a desired abortion,but also significantly impact the entire spectrum of reproductive healthcare, including miscarriage care, obstetrical emergencies, and postpartum care.
Beyond the direct harm to reproductive healthcare in communities across the country, a Supreme Court decision granting one of these states standing–and recognizing sufficient injury to challenge the FDA’s authority–could have far-reaching consequences for access to broader healthcare. The FDA regulates all sorts of medication–if states can use junk science and debunked studies to go after politicized healthcare, they will likely take their win and run with it.
Many of these states have also opposed “shield laws” that protect access to abortion and gender-affirming care, and states like Louisiana and Texas have already attempted, with limited success, to pursue providers across state lines. A ruling in their favor could escalate interstate legal conflicts and increase risks for providers.
Finally, some states, including Louisiana, and far-right actors are attempting to revive the Comstock Act, arguing that mailing abortion medication violates federal law. If the Supreme Court lends any support to that interpretation, the provision of abortion care across the country could be severely curtailed.
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