Appeals court blocks access to abortion pills via mail across US

A federal appeals court has significantly restricted access to mifepristone, a common abortion medication, by blocking its distribution through the mail.

A panel from the New Orleans-based 5th U.S. Circuit Court of Appeals now requires the abortion pill to be dispensed solely in person at clinics.

The ruling asserted: "Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person.’"

This decision diverges from the historical judicial deference to the Food and Drug Administration's judgments on drug safety and regulation.

FDA officials under President Donald Trump have repeatedly stated the agency is conducting a new review of mifepristone’s safety, at the direction of the president.

The judges noted in their ruling that FDA “could not say when that review might be complete and admitted it was still collecting data.”

In a court filing, Louisiana’s attorney general and a woman who says she was coerced into taking abortion pills requested that the FDA rules be rolled back to when the pills were allowed to be prescribed and dispensed only in person.

A Louisiana-based federal judge last month ruled that those allowances undermined the state’s abortion ban but stopped short of undoing the regulations immediately.

Since the Supreme Court’s 2022 ruling that overturned Roe v. Wade and allowed enforcement of abortion bans, prescriptions by mail have become a major way that abortions are provided — including to states where bans are in place.

"This is going to affect patients’ access to abortion and miscarriage care in every state in the nation,” said Julia Kaye, an ACLU lawyer. “When telemedicine is restricted, rural communities, people with low incomes, people with disabilities, survivors of intimate partner violence and communities of color suffer the most.”

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.

Because of rare cases of excessive bleeding, the FDA initially imposed strict limits on who could prescribe and distribute the pill — only specially certified physicians and only after an in-person appointment where the person would receive the pill.

Both those requirements were dropped during the COVID-19 years. At the time, FDA officials under President Joe Biden said that after more than 20 years of monitoring mifepristone use, and reviewing dozens of studies involving thousands of women, it was clear that women could safely use the pill without direct supervision.

Friday's ruling sets up a likely appeal to the Supreme Court.

The conservative-majority high court overturned abortion as a nationwide right in 2022 but unanimously preserved access to mifepristone two years later.

That 2024 decision sidestepped the core issues, however, by ruling that the anti-abortion doctors behind the case didn’t have legal standing to sue.