Federal appeals court blocks mail distribution of mifepristone, setting up likely Supreme Court review

The 5th U.S. Circuit Court of Appeals on Friday blocked mail distribution of mifepristone, one of two drugs commonly used in medication abortions, overruling regulations finalized under President Joe Biden in 2023 that had ended a longstanding in-person dispensing requirement. The three-judge panel — composed of Judges Kyle Duncan, Leslie Southwick, and Kurt Engelhardt, appointed by Presidents Trump, George W. Bush, and Trump, respectively — acknowledged the ruling would "as a practical matter, have a nationwide effect," including in states where abortion remains legal.

The ruling arose from a lawsuit filed by Louisiana, which alleged that federal regulations allowing mail-order mifepristone created "an effective way for an out-of-state prescriber to place the drug in the hands of Louisianans in defiance of Louisiana law." The court sided with Louisiana's argument that each abortion facilitated by FDA rules "cancels Louisiana's ban" and undermines the state's policy that "every unborn child is a human being from the moment of conception." The court also criticized the FDA for having "previously eliminated the requirement to report mifepristone's adverse events," calling it unreasonable to remove reporting requirements and then rely on a resulting lack of data to justify expanded access.

CNN led its coverage with the ruling's impact on abortion access, noting that medication abortion now accounts for roughly two-thirds of all abortions in the U.S. and that more than one in four abortions nationally were provided via telehealth in the first half of 2025, according to #WeCount data. Fox News led with the court's reasoning on state sovereignty and patient safety protocols, quoting pro-life advocates who praised the decision as a long-awaited win. The Associated Press framed the ruling as the most significant jolt to abortion policy since the overturning of Roe v. Wade and noted it was the first time a federal court had overruled FDA scientific regulations of this kind.

Supporters of the ruling, including Louisiana Attorney General Murrill and Marjorie Dannenfelser of Susan B. Anthony Pro-Life America, described it as a victory for state sovereignty and patient safety. Opponents, including the Center for Reproductive Rights, the ACLU, and New York Attorney General Letitia James, said the ruling defied scientific consensus on mifepristone's safety record and would most heavily affect people in rural areas, those experiencing intimate partner violence, and people with disabilities. GenBioPro CEO Evan Masingill said the company is "alarmed by this court's decision to ignore the FDA's rigorous science and decades of safe use of mifepristone."

The Trump administration had not defended the FDA's regulatory approach on its merits, instead arguing that Louisiana's lawsuit had procedural defects — arguments the 5th Circuit rejected, according to CNN. The Associated Press reported that some anti-abortion advocates also directed criticism at Trump, with Dannenfelser saying it was "shameful that the Trump administration's inaction has forced pro-life states to take their battle to the federal courts." The FDA has said it is conducting a new review of mifepristone's safety, but the appeals court noted no timeline had been set for its completion.

Eight states currently have shield laws covering telehealth abortion provision, and Guttmacher Institute estimates show that approximately 91,000 telehealth abortions were provided under those laws in 2025 to people in states with total abortion bans. The ruling is expected to be appealed to the U.S. Supreme Court, which previously declined to rule on mifepristone access in a separate case after finding that the challengers lacked standing.