Supreme Court Extends Abortion Pill Access by Mail

The U.S. Supreme Court extended access to the abortion pill mifepristone by mail until Thursday at 5 p.m., maintaining a temporary order that blocks a lower court ruling restricting nationwide access to the drug. Justice Samuel Alito signed the extension, which will expire on Thursday.

This decision follows a Fifth Circuit ruling in a case where Louisiana sued the U.S. Food and Drug Administration (FDA) to restrict access to mifepristone. In 2023, the FDA adopted a new regulation allowing patients to be prescribed mifepristone through telehealth, certified pharmacies, or by mail order.

Louisiana officials argue that the FDA's regulation allows providers to circumvent Louisiana's near-total ban on abortion. The Supreme Court is now weighing emergency requests from two pharmaceutical companies, Danco Laboratories and GenBioPro, which asked the court to set aside the Fifth Circuit's ruling. Mifepristone, used in 65% of all clinician-provided abortions in 2023 according to the Guttmacher Institute, is taken together with misoprostol to terminate an early pregnancy.

California-based abortion pill suppliers are preparing backup plans in case the Supreme Court restricts access to mifepristone. Dr. Michele Gomez, co-founder of the MYA Network, stated that supply chains in California are 'ready to switch in a day' to alternative abortion drugs like misoprostol.

The current dispute is similar to one that reached the court three years ago. Lower courts then also sought to restrict access to mifepristone, in a case brought by physicians who oppose abortion. They filed suit in the months after the court overturned Roe v. Wade. The Supreme Court blocked the 5th Circuit ruling from taking effect over the dissenting votes of Alito and Justice Clarence Thomas. Then, in 2024, the high court unanimously dismissed the doctors’ suit, reasoning they did not have the legal right, or standing, to sue.

Mainstream medical groups, the pharmaceutical industry, and Democratic members of Congress have weighed in cautioning the court against limiting access to the drug. Pharmaceutical companies said a ruling for abortion opponents would upend the drug approval process. The FDA has eased a number of restrictions initially placed on the drug, including who can prescribe it, how it is dispensed, and what kinds of safety complications must be reported.

Since 2023, almost two-thirds of abortions in the United States have involved mifepristone. In late 2024, one-quarter of all abortions occurred through abortion pills provided via telehealth. The outcome of this case will significantly impact access to abortion care across the country, particularly for women with low incomes and disabilities or those living in rural areas where reproductive services are limited.

The case began in October 2025 when Louisiana argued that the Biden administration’s allowance of telehealth abortions was for 'avowedly political reasons.' The state asserted that the FDA had insufficient evidence to remove the requirement that the drug be dispensed in person, which had been in place from 2000 through 2021. The state also argued that mailing mifepristone violated an 1873 federal law known as the Comstock Act.

The lower court thought Louisiana would likely win but decided to keep the FDA regulations in place while the case made its way through the courts. On May 1, 2026, however, the appellate court suspended the FDA regulation allowing mifepristone to be prescribed via telehealth. As a result, mifepristone could no longer be mailed or prescribed via telehealth nationwide.

Three days later, on May 4, after the manufacturers of mifepristone appealed, the Supreme Court put the 5th U.S. Circuit Court of Appeals’ decision on hold for a week to give it more time to consider the legal issues. On May 11, it extended the stay for a few more days.

On May 14, the Supreme Court decided to leave the FDA’s regulation in effect, so mifepristone remains available for prescription via telehealth. Justices Samuel Alito and Clarence Thomas dissented, with Alito accusing the court of 'perpetrat[ing] a scheme to undermine' the court’s decision in the 2022 Dobbs ruling that overturned the constitutional right to an abortion and allowed states to ban it.