Supreme Court allows telehealth and mail access to mifepristone for now

By John Fritze, Devan Cole, CNN

(CNN) — The Supreme Court on Thursday allowed women to continue to access the abortion pill mifepristone through telehealth visits, maintaining the status quo while officials in Louisiana continue to push for limiting availability of the drug in lower courts.

The conservative Supreme Court imposed a pause on a May 1 decision from the 5th US Circuit Court of Appeals that abruptly required women to obtain the drug through in-person visits. The focus will now return to the New Orleans-based appeals court, which will decide the merits of Louisiana’s challenge.

The court did not explain its reasoning, nor did it disclose the vote count. Justices Clarence Thomas and Samuel Alito dissented from the decision.

The order landed nearly half an hour after an earlier “administrative” stay extending widespread access to the drug expired at 5 p.m. ET.

“The court’s unreasoned order granting stays in this case is remarkable,” Alito wrote in his dissent.

“What is at stake,” he added, “is the perpetration of a scheme to undermine our decision” overturning Roe v. Wade four years ago.

Thomas wrote in a brief solo dissent that he thought a long-dormant 19th Century law that bans the mailing of drugs used for abortions, as well as the state’s strict abortion ban, barred the manufacturers from getting courts to intervene on their behalf.

The companies, he wrote, “are not entitled to a stay of an adverse court order based on lost profits from their criminal enterprise. They cannot, in any legally relevant sense, be irreparably harmed by a court order that makes it more difficult for them to commit crimes.”

Also notable was that the court did not agree to hear arguments in the case, as both sides had asked it to do. Instead, the decision means the merits of the case will now be hashed out in a federal appeals court and the issue will likely reach the Supreme Court again in the future.

The case is the most significant involving abortion to reach the high court since the overturning of Roe v. Wade, the 1973 precedent that established a constitutional right to abortion. And both the case and mifepristone are heavily wrapped up in that decision. After the fall of Roe in 2022, many conservative states banned in-clinic abortions, which increased demand for mifepristone.

Women have been able to obtain mifepristone – one of the two drugs in the medication abortion regimen – through telehealth appointments since the pandemic. President Joe Biden’s Food and Drug Administration finalized that situation in 2023, ending the requirement that the medication be obtained through an in-person doctor’s visit.

As conservative states responded to the Supreme Court’s decision by banning or severely limiting access to clinic abortions, demand for use of telehealth to access mifepristone increased. Medication abortions were already the most common option — they account for more than 60% of abortions in the US, according to Guttmacher Institute research. And the Society of Family Planning, a research group that has opposed mifepristone restrictions, estimates that roughly 1 in 4 abortions nationwide were provided through telehealth in 2025, up from up from fewer than 1 in 10 in 2022.

Data analyzed by CNN show that mifepristone is safer than other common, low-risk prescription drugs, including penicillin and Viagra. There were five deaths associated with mifepristone use for every 1 million people in the US who have used the drug since its approval in 2000, according to the FDA  as of 2023.

Louisiana sued the FDA over that policy last year, asserting in part that the Biden-era regulation undermined its own strict abortion ban. A federal district court in April partly sided with the state, finding that the FDA’s new policy was arbitrary because, it said, the agency did not have adequate data to gauge the drug’s safety. But the district court blocked its decision from taking effect to give the FDA time to complete an ongoing review of the drug.

But a 5th Circuit panel of three judges, all appointed by Republican presidents, put the FDA’s rule about mifepristone on hold immediately earlier this month. That meant that women seeking to access the drug were suddenly required to do so with in person visits. Medical providers who spoke to CNN described the hours following that order as some of the “craziest” and most “chaotic” they’ve experienced.

Danco Laboratories, the maker of mifepristone, raced up to the Supreme Court on May 2 with an emergency appeal, warning of the chaos. GenBioPro, which makes a generic version of the drug, filed its own appeal asserting that the 5th Circuit’s ruling risked “cutting off access for patients nationwide.”

The appeal is largely a repeat of an issue the justices just took up two years ago. In 2024, a unanimous court rejected a lawsuit challenging the same FDA regulation dealing with the same drug. But the court resolved that dispute by concluding a group of doctors and anti-abortion organizations that challenged access to the drug did not have standing to sue. That technical, narrow decision meant that future challenges were almost guaranteed to reach the justices again.

“We recognize that many citizens, including the plaintiff doctors here, have sincere concerns about and objections to others using mifepristone and obtaining abortions,” Justice Brett Kavanaugh wrote for the court. “But citizens and doctors do not have standing to sue simply because others are allowed to engage in certain activities – at least without the plaintiffs demonstrating how they would be injured by the government’s alleged under-regulation of others.”

Similar questions are already being raised about whether Louisiana has standing to sue over a decision by the FDA to regulate a drug on a nationwide basis. The state has made two claims to argue it can bring its suit, first that it has suffered “sovereign harm” because the drug use allows women to effectively bypass the state’s ban on abortion. But that theory rests on the idea that the state can stop activity beyond its border to enforce its laws.

Louisiana also says it has suffered an economic injury because of state-funded Medicaid costs for women who take mifepristone and endure costly complications. But the Supreme Court rejected the idea that parties could claim “downstream” economic injuries from an FDA-approved drug just two years ago in the earlier mifepristone case.

The dynamic of defending the FDA rule on mifepristone – for now – has put the Trump administration in the unusual position of being on the outs with anti-abortion groups, who want the White House to reverse Biden’s expanded access to the drug. So far the administration has declined to do so, and it opposed Louisiana’s challenge at the 5th Circuit. Even though the legal fight before the Supreme Court deals with a decision by the FDA, the agency has said nothing – allowing a deadline to submit a brief pass without comment.

CNN’s Tierney Sneed and Jamie Gumbrecht contributed to this report.

This story has been updated with additional details.

The-CNN-Wire
™ & © 2026 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.