Courts in the United States continue to litigate the distribution by mail of the abortion pill, mifepristone. After a federal appeals court this spring ruled that mifepristone can only be distributed in person and at clinics, the Supreme Court temporarily restored access. Access is preserved for now in states where (medication) abortion is legal, but the issue of future availability remains unresolved.
Acting attorney general Todd Blanche has committed to stopping the shipment of abortion medication through the mail. Sen. Josh Hawley (R-Mo.) sent Blanche a letter, referring the nonprofit Plan C and manufacturer Danco Laboratories for criminal investigation.
Yet last week, a federal judge in Virginia upheld the safety of the abortion medication mifepristone and ordered the Trump administration to reconsider restrictions on the drug.
At the same time, the U.S. Court of Appeals for the Fifth Circuit is set to hear oral arguments next month in a case brought by the state of Louisiana. The state is asking the court to block telemedicine prescriptions and mail delivery of mifepristone. Separately, the attorneys general of Louisiana, Idaho and Missouri filed a federal lawsuit in October 2025 seeking to ban telehealth abortion and pharmacy dispensing of mifepristone nationwide.
One possible outcome of all this legal wrangling is that in-person dispensing requirement could eventually be reinstated. This would mean that patients seeking medication abortion could only obtain mifepristone directly from their provider in-clinic, rather than at their local pharmacy or through the mail via telemedicine.
In parallel with the ongoing court and legislative battles, the Food and Drug Administration is moving ahead with a retrospective data analysis looking at real-world outcomes and safety data pertaining to mifepristone. Reproductive rights groups and most medical esearchers have criticized the federal review as politically motivated, emphasizing that decades of data already prove the medication is safe and effective.
Since the FDA approved mifepristone over 25 years ago, the drug has been part of a two-drug regimen, which also includes misoprostol. Mifepristone blocks progesterone, which is needed for a pregnancy to continue. When taken in conjunction with misoprostol, mifepristone ends early pregnancies (up to 10 weeks following fertilization). Public health experts consider the combination to be a safe and effective way to terminate a pregnancy. The risk of serious complications is well below 1%.
Nearly two-thirds of all people seeking abortion in America choose medication over the surgical procedure. And since 2021, abortion medication has been accessible through telemedicine with the most recent data showing that about 28% of all abortions are through telemedicine.
Despite tight restrictions or near-total bans in 13 states, the total number of abortions in the U.S. has slightly increased since the Dobbs decision by the Supreme Court in 2022 that overturned Roe v. Wade. This ruling stated that the Constitution does not confer a right to abortion and returned the authority to regulate abortion to individual states.
The upward trend in abortions is primarily driven by expanded access to telehealth and medication abortion pills sent by mail, combined with significant interstate travel to states where the procedure remains legal.
While the national volume has gone up, access is highly fragmented. States with near-total bans saw local numbers fall close to zero, while states where abortion remained legal experienced a massive surge in patients.
And so, the abortion pill continues to be in the crosshairs of American politics and the judicial system. Despite more than two decades of safe and effective use, politicians have been debating and courts litigating mifepristone since its regulatory approval in 2000. The intensity of the legal challenges has grown considerably in recent years, particularly in the wake of the Supreme Court’s decision in 2022 to strike down Roe v. Wade.
The U.S. is an outlier among its peers regarding the mifepristone dispute. Many other wealthy industrialized nations treat abortion largely as a public health matter. Moreover, mifepristone is considered one of roughly 500 essential medicines by the World Health Organization. On the other hand, in the American political and judicial systems, abortion is highly politicized and a morally charged debate plays a more significant role.
The Supreme Court preserved access to mifepristone while Louisiana’s challenge to the drug’s availability and regulation works its way through the courts. Although the Court’s action staved off uncertainty regarding access for the time being, threats to mifepristone and FDA’s regulatory authority are likely to continue.
The FDA’s mandate is to review the safety and efficacy of drugs based on clinical evidence. As such, the FDA is the federal authority for all pharmaceuticals distributed throughout the U.S., including mifepristone and misoprostol.
And so, these court cases along with requests for additional regulatory examination set a potentially unsettling precedent in which the FDA’s regulatory authority from past decisions is subverted. Experts argue that this could disrupt pharmaceutical regulation, as courts could supersede decisions made by the FDA.
