Supreme Court Preserves Mail Access to Abortion Pill Mifepristone While Lawsuit Continues

The U.S. Supreme Court on May 14, 2026 maintained nationwide access to the abortion pill mifepristone through telehealth and mail delivery, setting aside a 5th Circuit order that had blocked remote prescribing. The unsigned decision, with dissents from Justices Alito and Thomas, preserves access to a medication used in 65% of all clinician-provided abortions while litigation continues. Louisiana filed the lawsuit in 2025 after the FDA formally allowed telehealth prescribing in 2023, arguing that out-of-state providers evaded Louisiana's abortion ban and led to over 1,000 medication abortions in the state. The dissenting justices argued the telehealth policy undermines the 2022 Dobbs decision and potentially violates the 1873 Comstock Act, while a federal district court paused the case in April 2026 pending an FDA safety review of mifepristone.

Supreme Court mifepristone ruling

• ▪The Supreme Court ruled in 2024 that anti-abortion rights plaintiffs did not have the legal right to sue the FDA over mifepristone
• ▪The Supreme Court in 2024 unanimously rejected a challenge to mifepristone from anti-abortion rights doctors and medical groups
• ▪More than half of U.S. states imposed limits on abortion after the Supreme Court overturned Roe v. Wade in 2022
• ▪Justice Samuel Alito's temporary pause on the appellate court's mifepristone decision was set to expire on May 14, 2026
• ▪Conservative Justices Samuel Alito and Clarence Thomas dissented from the Supreme Court's May 14, 2026 mifepristone decision
• ▪The Supreme Court's May 14, 2026 decision on mifepristone was unsigned
• ▪The Supreme Court on May 14, 2026 maintained mail access to the abortion pill mifepristone
• ▪The Supreme Court's May 14, 2026 decision set aside a lower court order that blocked abortion providers from prescribing mifepristone through telehealth and shipping it to patients

Louisiana lawsuit against FDA

• ▪Louisiana filed a lawsuit against the FDA in 2025 that threatened to cut off mail access to mifepristone for women nationwide
• ▪Louisiana enacted a law in 2024 that designates mifepristone and misoprostol as controlled substances and criminalizes possession without a prescription
• ▪Louisiana has spent more than $17,000 investigating out-of-state providers who shipped mifepristone into Louisiana

Medication abortion statistics

• ▪The 1.1 million abortions provided by health care workers in 2023 includes medication abortions provided by telehealth to patients in states where abortion is restricted
• ▪More than 1.1 million abortions were provided by health care workers in 2023
• ▪Medication was used in 65% of all clinician-provided abortions in 2023
• ▪Major adverse events occur in less than 0.32% of patients when mifepristone is used in medication abortions

FDA telehealth policy changes

• ▪The FDA lifted the in-person dispensing requirement for mifepristone in 2021
• ▪The FDA formally allowed mifepristone to be prescribed through telehealth and dispensed through the mail in 2023
• ▪The Biden administration suspended enforcement of the in-person dispensing rule for mifepristone during the COVID-19 pandemic

Conservative justice dissents

• ▪Justice Clarence Thomas pointed to the Comstock Act, an 1873 law that banned the mailing of abortion-related drugs and contraceptives, in his dissent

Perspective of Justice Clarence Thomas

• ▪Justice Clarence Thomas invokes the 1873 Comstock Act as legal basis for banning the mailing of mifepristone