WASHINGTON — Two manufacturers of the abortion pill mifepristone rushed to the Supreme Court on Saturday seeking emergency relief after a federal appeals court issued a sweeping ruling the day before that cut off mail-order access to the drug — a decision legal experts say represents the most significant disruption to abortion care in the United States since the fall of Roe v. Wade.
Danco Laboratories asked the high court for an emergency pause on the 5th U.S. Circuit Court of Appeals decision, saying the appellate ruling "injects immediate confusion and upheaval into highly time-sensitive medical decisions." GenBioPro, which makes a generic version of mifepristone, made a similar request.
The New Orleans-based appeals court's unanimous ruling Friday marked a substantial victory for abortion opponents seeking to stem the flow of abortion pills prescribed online, which they view as subverting state bans on the procedure. It requires that mifepristone be distributed only in person and at clinics, overruling regulations set by the federal Food and Drug Administration.
A Decision Without Precedent
The ruling landed with immediate force across the country. Friday's ruling is in effect while the case works its way through the courts. It affects patients in all states, even those without abortion restrictions.
"This is a huge access issue for patients that haven't got providers close by, or providers close by who are willing to prescribe," said Josh Thorburn, owner of Eddie's Pharmacy in Los Angeles.
There is little precedent for a federal court overruling the scientific regulations of the FDA. That dimension of the case has drawn particular attention from legal scholars, who note that courts have historically deferred to the agency's expert judgment on questions of drug safety and efficacy.
"We're now going to see, I think in a way we haven't before, what the nation will look like when abortion bans are actually in effect," said Mary Ziegler, an expert on abortion law and a professor at the University of California at Davis School of Law.
How the Case Reached This Point
Frustrated with a lack of federal action against medicated abortions, Louisiana Attorney General Liz Murrill sued the FDA last year, saying its rules allowing mifepristone to be dispensed through the mail undermined the state's ban on abortions at all stages of pregnancy.
Murrill, a Republican, celebrated the ruling as a "victory for life," while other anti-abortion advocates cheered the reversal of rules finalized under President Biden that ended a longstanding requirement that the pills be obtained at an in-person doctor's visit. Representatives for the FDA and the Justice Department did not immediately respond to requests for comment.
The Scale of What Is at Stake
Mifepristone was approved in 2000 as a safe and effective way to end early pregnancies. It is typically used in combination with a second drug, misoprostol, which is not affected by the ruling but is less effective on its own.
Surveys have found that the majority of abortions in the U.S. are administered using pills and that about one in four abortions nationally are prescribed via telehealth. Providers have suggested that its availability through telehealth is a reason why the number of abortions in the U.S. has not fallen since Roe was overturned in 2022.
Mini Timmaraju, president and CEO of Reproductive Freedom for All, said providers are "in limbo" as they await further court decisions but can pivot to using just misoprostol for abortion care. "It's got a chilling effect on providers across the country, and it's going to have a chilling effect on patients, who are already having a hard time navigating the law state by state," she said.
One telehealth provider in a state with a shield law, Dr. Angel Foster, was working with legal experts to understand how the ruling would impact her organization, The Massachusetts Medication Abortion Project. "We will do everything in our power to continue providing care to people in all 50 states," she said.
Shield Laws and a Fractured Legal Landscape
Some Democratic-led states have adopted laws that aim to protect providers who prescribe via telehealth and mail the pills to states with bans. Those so-called shield laws are being tested through civil and criminal cases in Louisiana and Texas.
The patchwork of state laws — some protecting providers, others criminalizing them — has created an increasingly complex landscape for both patients and clinicians attempting to navigate care across state lines.
Politics, the Midterms, and a President on the Sidelines
The case could again make abortion a key issue in the midterm elections as Democrats aim to take back control of the House and Republicans fight to hold on to a narrow majority. "This is going to be a pretty significant change in terms of how people experience abortion access, probably as significant as anything we've seen since Roe was overturned," Ziegler said.
Recent electoral results suggest that voters seeking to maintain abortion access have the political momentum. Since Roe was overturned, abortion has been on the ballot directly in 17 states. Voters have sided with the abortion-rights side in 14 of those questions.
The ruling also put fresh pressure on President Trump, who has faced criticism from both sides of the abortion debate over his handling of the issue. Trump received criticism after the ruling from some anti-abortion advocates who expressed frustration that he did not take action himself to block distribution of the pill. "It's shameful that the Trump administration's inaction has forced pro-life states to take their battle to the federal courts," said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America.
Ziegler noted that the ruling also puts the president in an uncomfortable position. "Sort of puts the president in the position of having to get off the sidelines on this issue in a way we haven't seen before," she said.
The Supreme Court, which has received emergency requests from both Danco and GenBioPro, now faces a decision that could reshape abortion access across the country while the underlying case continues to work its way through the courts.
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