On Friday, the Fifth Circuit Court of Appeals issued a unanimous ruling that reverses existing FDA policy and prevents the mailing of chemical abortion drugs. As recently as 2021, women seeking chemical abortions had to have at least one in-person meeting with a medical professional. However, during the Covid-19 pandemic, the FDA liberalized its policy. An in-person meeting with a health professional was no longer required and women could obtain chemical abortion pills through the mail. Both the Biden administration FDA and the Trump administration FDA have continued this policy after the Covid-19 pandemic’s conclusion.
Since chemical abortion drugs can be mailed into pro-life states, these telehealth abortions undermine the strong pro-life laws that many states have enacted since the Supreme Court’s Dobbs decision. As such, in recent years, pro-lifers have pursued a number of litigation strategies to limit telehealth abortions. Pro-lifers have argued persuasively that the FDA’s justification for remotely dispensing mifepristone violated the Administrative Procedures Act. This was because the FDA relied on flawed or non-existent data when it enacted its policy change. However, in 2024 the Supreme Court ruled against a group of pro-life physicians in FDA v. Alliance for Hippocratic Medicine stating they lacked legal standing.
The legal strategy pursued by the state of Louisiana has been more fruitful. State attorneys have argued they have standing on state sovereignty grounds and because the state Medicaid program has incurred costs due to injuries caused by mail-order chemical abortion drugs. This past April, a federal district court judge agreed Louisiana had standing and ruled the state would likely win the appeal. However, the district court judge refused to pause the availability of pills by mail — stating the FDA had an interest in continuing its safety review of mifepristone. However, the case was appealed to the Fifth Circuit and they issued a stay on Friday — preventing the mailing of mifepristone. The Fifth Circuit ruled existing policy irreparably harms Louisiana by undermining its pro-life laws and causing it to spend Medicaid funds on women injured by mifepristone.
Friday’s ruling could have a substantial impact on the incidence of abortion. Data from the Society of Family Planning indicates that telehealth abortion numbers have consistently increased since the summer of 2022. Overall, approximately 247,000 telehealth abortions took place in 2024. As of June 2025, approximately 28 percent of all abortions that took place in the United States were done via telehealth
Litigation will certainly continue. On Saturday, two manufacturers of the abortion pill mifepristone, Danco and GenBioPro, appealed the Fifth Circuit’s decision to the U.S. Supreme Court. They requested an administrative stay that would allow the mailing of chemical abortion drugs. They also asked the Supreme Court to hear oral arguments before summer recess. It is unclear what the Supreme Court will do. However, there a number of cases pertaining to access to chemical abortion pending in federal courts. These include separate cases brought by attorneys general in Florida and Texas. Also, the state attorneys general of Missouri, Idaho, and Kansas have joined a revised lawsuit that was filed by the Alliance for Hippocratic Medicine in 2024. As such, the Supreme Court will be unable to avoid the issue of telehealth abortion.