Supreme Court Lets Abortion Pill Mail Delivery Continue

The Supreme Court on Thursday ensured that the abortion pill can continue to be prescribed through telemedicine and dispensed by mail, as the justices restored for now a 2023 federal rule challenged by Republican-governed Louisiana that had made access to the medication easier.

The justices granted requests by two manufacturers of the abortion pill, called mifepristone, to lift a lower court’s block on the rule that was issued by the U.S. Food and Drug Administration during Democratic former President Joe Biden’s administration, while Louisiana’s legal challenge plays out.

The brief order was unsigned and offered no reasoning, as is common with emergency actions by the Supreme Court. Conservative Justices Samuel Alito and Clarence Thomas dissented from the decision. 

The 5th U.S. Circuit Court of Appeals on May 1 had ordered the imposition of a previous federal rule that required an in-person clinician visit in order to receive mifepristone. 

Drugmakers Danco Laboratories and GenBioPro appealed the 5th Circuit action restricting access to mifepristone, a drug that was given FDA regulatory approval in 2000. The two companies welcomed the court’s action on Thursday.

The case had put the contentious issue of abortion back in front of the justices, with the November congressional elections looming and President Donald Trump’s fellow Republicans fighting to retain control of Congress.

In his dissent on Thursday, Alito said that the delivery of abortion pills by mail from out-of-state providers has thwarted efforts by states like Louisiana that have sought to make abortion illegal in the wake of the Dobbs ruling.

“Louisiana’s efforts have been thwarted by certain medical providers, private organizations and states that abhor laws like Louisiana’s and seek to undermine their enforcement,” Alito added. 

In a separate dissent, Thomas said the federal Comstock Act prohibits the mailing of drugs intended for abortion. 

The drugmakers, Thomas said, “are not entitled to a stay of an adverse court order based on lost profits from their criminal enterprise. They cannot, in any legally relevant sense, be irreparably harmed by a court order that makes it more difficult for them to commit crimes.”

President Donald Trump’s administration opposed Louisiana’s legal challenge, citing an ongoing FDA review of safety regulations concerning mifepristone. The administration also argued that Louisiana does not have legal standing to pursue its case. 

Abortion rights advocates have called the legal challenges to mifepristone the biggest threat to abortion access in the United States since the court’s Dobbs decision. They also have called the Trump administration’s review politically motivated and unnecessary given decades of studies showing the safety of mifepristone, and said it could lead to tighter restrictions on the medication.

The Supreme Court in 2024 unanimously rejected an initial bid by pro-life groups and doctors to roll back FDA regulations that had eased access to the drug, ruling that these plaintiffs lacked the necessary legal standing to pursue the challenge.

The brand-name version of mifepristone, Mifeprex, is Danco’s only product, and GenBioPro derives most of its revenue from the ​generic version, the companies said in court filings. 

Carol Tobias, president of the pro-life group National Right to Life, called Thursday’s decision deeply troubling.

“Women facing unexpected pregnancies deserve real medical care and support, not a one-size-fits-all mail-order abortion system that minimizes risks and leaves women isolated during medical emergencies,” Tobias said.

Sen. Bill Cassidy, R-La., said in a post on X that the decision “doesn’t change the fact that mail-order chemical abortion drugs are a danger to women and babies in Louisiana and across the country.”

“Despite this outcome, FDA can and must immediately reinstate the in-person dispensing requirement to protect mothers from abuse and coercion,” Cassidy said.

“We are deeply disappointed the Supreme Court will not respond to the harm occurring nationwide with mercy and stop the dangerous mail-order abortion drug regime. Today’s decision does not touch the merits of the case as it returns to the 5th Circuit,” said SBA Pro-Life America President Marjorie Dannenfelser.

Reuters contributed to this report.