Telemedicine access to abortion pill mifepristone is in legal limbo : NPR

It’s been a whirlwind week when it comes to mifepristone, one of the medications used for abortion and the management of miscarriages.

A federal appeals court ruling on May 1 immediately rolled back telemedicine access to mifepristone nationwide. Two drugmakers appealed to the Supreme Court right away. For several days, it was not clear what the appeals court ruling meant in the real world.

Now, telemedicine access to the pill is back. On Monday, the Supreme Court put the appeals court ruling on hold for one week. That means mifepristone can still be prescribed through telemedicine and sent through the mail through May 11, at least.

There’s a lot to follow in the mifepristone legal saga — it can get really confusing. Here’s what to know.

1. How it all started 

First, some background. When the FDA approved mifepristone in 2000, it came with a requirement that patients would have to go in person to a clinic or a doctor’s office to receive it. That changed during the COVID-19 pandemic — as telemedicine expanded dramatically, FDA began to allow mifepristone to be dispensed at a local pharmacy or through the mail.

FDA made the policy official in 2023. By that point, the Supreme Court had overturned the constitutional right to abortion in the Dobbs decision. In the years since, the use of telemedicine abortion has grown, and now accounts for one quarter of abortions across the country.

It’s a big part of the reason why the number of abortions has actually increased since Roe v. Wade was overturned nearly four years ago and many states instituted restrictions. The most recent estimate from the Guttmacher Institute, a nonprofit research organization that supports abortion access, found that there were 1.1 million abortions in the U.S. in 2025.

2. Why Louisiana 

Louisiana is on the vanguard of anti-abortion actions, says Mary Ziegler, law professor and abortion historian at the University of California Davis. It is the first state to schedule mifepristone as a controlled substance and to criminally indict an out-of-state physician providing telemedicine abortion.

Last fall, Louisiana sued the FDA, arguing that the fact that patients can use telemedicine to receive the medication undermines their strict abortion ban. Guttmacher’s latest estimate found there were 9,000 abortions in Louisiana in 2025.

A district court judge put the case on hold in April, then Louisiana appealed that decision to the 5th Circuit Court of Appeals, based in New Orleans.

That’s when things got dramatic. A panel of judges on that court agreed with the state of Louisiana’s argument and, on May 1, brought the in-person requirement back nationwide, effective immediately. (The Supreme court stayed that decision for one week.)

Judge Stuart Kyle Duncan, a Trump-appointee, wrote in his 19-page opinion that telemedicine access to mifepristone “injures Louisiana by undermining its laws protecting unborn human life and also by causing it to spend Medicaid funds on emergency care for women harmed by mifepristone. Both injuries are irreparable.”

Ziegler says that when it comes to abortion access Duncan’s order “is the most consequential ruling we’ve had since Dobbs from a lower court.”

3. This case has national stakes

Since FDA’s prescribing rules for medications apply to the whole country, a change to the rules about how mifepristone can be accessed has national impact. That means it affects states with constitutionally-protected access to abortion, states with criminal bans, like Louisiana, and everything in between.

Nearly two dozen Democratic-led states submitted an amicus brief in this case, writing that the appeals court decision put the policy choices of states with bans above the choices of states “that have made the different but equally sovereign determinations to promote access to abortion care,” and asking the Supreme Court to keep the decision on hold.

There are also stakes related to the power of FDA and other expert agencies to set rules. While the Trump administration’s FDA has yet to respond to the Supreme Court, a group of former leaders of the agency wrote about this in an amicus brief. They defended the FDA’s process in approving the medication and modifying the rules for prescribing it, and say the appeals court decision “would upend FDA’s gold-standard, science-based drug approval system.”

4. The patients most affected by the case

During pregnancy, days and hours matter. The uncertainty around the availability of this medication has sent “shockwaves” through medicine, says Ziegler. Telemedicine abortion is especially important in places with provider shortages, such as rural areas, and for low-income patients who may not be able to easily travel to a doctor’s office.

NPR spoke with Jane, a 44-year-old who lives in Florida, where there’s a ban after six weeks of pregnancy. She requested that NPR use only her first name to speak candidly about sensitive medical information.

She already had two kids, and found out she was pregnant in February 2024. “My husband and our kids were all just treading water financially, psychologically, emotionally,” she says. She is the primary earner in the family, and had experienced pregnancy complications in the past. “It didn’t feel like an option to have a third child, so I had to very quickly — I sort of had a ticking clock in my brain — figure out how to get an abortion.” She found it simpler in her hectic life to use a telemedicine provider and receive the medication at her house. She says she was “relieved and grateful” to have that option.

Other patients in remote parts of California, in Louisiana, and in Georgia told NPR that they relied on telemedicine to get mifepristone.

Some reproductive health providers have prepared to switch to a different protocol for medication abortion that is just as safe and effective, which uses misoprostol, another medication that’s not affected by this case at all. However, that protocol tends to have worse side effects for patients.

5. What happens next in this case is up in the air

The Supreme Court’s one week stay expires on Monday, May 11. At that point, Justice Samuel Alito could extend the temporary stay (as he did in the earlier mifepristone case).

He could also grant a stay of the decision that lasts until it’s officially appealed to the Supreme Court.

Finally, the justices could decline to stay the decision, and telemedicine access to abortion would end again nationally while the legal process unfolds.

6. This isn’t the first time the Supreme Court has weighed in on mifepristone

The Supreme Court recently decided another case about mifepristone, but there were some key differences.

In 2023, a federal judge in Texas named Matthew Kacsmaryk ruled that mifepristone should be pulled from the market altogether. That decision also prompted a very confusing scramble that ultimately ended when the Supreme Court decided to stay the decision and hear the case. It was unanimously dismissed in 2024, because the justices determined that the group of pro-life doctors who filed the lawsuit didn’t have standing.

Anti-abortion rights politicians have been bringing new cases against mifepristone in the years since, including this one. In fact, the case that the Supreme Court dismissed in 2024 is still alive in Missouri.

With the case from Louisiana, “I think there’s some deliberate effort to try to fix the mistakes that doomed the first mifepristone lawsuit,” Ziegler says. “Focusing on the in-person dispensation requirement is more politically modest-seeming.”

7. The Trump administration is in a difficult position

President Trump has been pretty understated on abortion this term. He faced pushback earlier this year from congressional Republicans when he suggested they be “flexible” about abortion restrictions in health care legislation. Abortion was also notably absent from Trump’s State of the Union address in February. Opposition to abortion is popular with Trump’s base, but independent voters, who were key to his win, favor abortion rights.

Anti-abortion advocates have noticed Trump’s lack of action on abortion and have called for him to be more forceful. In earlier stages of this case, the Department of Justice argued for the whole thing to be put on hold until the end of the year.

Ziegler says the fact that this case is generating big news during campaign season is “going to require every politician to weigh in, and it doesn’t really leave the Trump administration the option of doing nothing anymore.”