Supreme Court restores access to abortion pill mifepristone through telehealth, mail and pharmacies

Those rules had been in effect for several years until a federal appeals court imposed new restrictions last week.

The latest order will remain in effect for another week while both sides respond and the high court considers the issue more fully.

Most abortions use pills rather than procedures

The majority of abortions in the U.S. are obtained through medications. Some Democratic-led states have laws that seek to give legal protection to those who prescribe the drugs via telehealth to patients in states with bans.

Those prescriptions have blunted the impact of abortion bans that most Republican-led states have sought to enforce since the 2022 Supreme Court ruling that overturned Roe v. Wade. One recent report suggested that in the 13 states where abortion is banned at all stages of pregnancy, more women obtained abortions with pills prescribed by telehealth last year than by traveling to other states.

Louisiana sued to roll back the Food and Drug Administration's rules on how mifepristone can be prescribed, asserting that the policy undermines the ban there. The case also questioned the safety of the drug.

That lawsuit is the furthest along of several efforts by abortion opponents to curtail access to mifepristone.

Restrictions would not end telehealth abortions

Mifepristone is usually taken with a second drug, misoprostol, for abortions. According to the FDA label on mifepristone, the combination completes medical abortion 97.4% of the time.

Misoprostol can also be used alone for terminating pregnancies, with some studies putting its effectiveness at around 80% or higher.

In countries where mifepristone is banned or unavailable, misoprostol is frequently used alone.

Unlike mifepristone, misoprostol has never been formally approved by the FDA for abortion. The drug is most commonly used to treat stomach ulcers, but it has been adapted by doctors for use in medication abortions. Because the FDA never cleared the drug for ending pregnancies, it has faced far less scrutiny from anti-abortion groups.

Several groups that prescribe abortion bills by telehealth made the switch over the weekend to misoprostol only, a regimen that can cause longer-lasting side effects.

Dr. Angel Foster, founder of The Massachusetts Abortion Access Project, said her organization was prepared to send misoprostol only on Monday afternoon but was able to switch back to the two-drug combination.

"Regardless of what happens with this regulatory issue, we and other groups will continue to provide high-quality abortion care to patients in all 50 states," she said.

Rapid rulings have created confusion

Foster said her organization spent the weekend guiding different groups of patients: those who were sent mifepristone but had not received it yet; those who had been approved for the drugs but had not paid or been sent them; and those who reached out with initial requests.

For now, she said, they are asking patients to approve being sent pills with or without mifepristone — in case of another change.

Monday's ruling offers more time to figure out a course of action in case mifepristone prescriptions are curtailed again.

"We have a little bit more time to navigate this new landscape with the stay," said Julie Burkhart, the founder of Wellspring Health Access, a Wyoming abortion clinic that provides roughly 100 abortions a year through pills prescribed by telehealth.

Elizabeth Ling, associate director of legal services at If/When/How, which provides legal guidance for people considering abortion, said that wherever the legal battle goes next, there's one thing women need to understand: "The outcome is not going to make it a crime for people to access care."

None of the state laws currently include any punishment for women who obtain abortions.

The court fight continues

Anti-abortion groups vowed to continue the legal battle.

Monday's ruling "is a temporary procedural step that leaves unresolved the very real concerns about the safety of these drugs and the decision under the Biden administration's FDA to recklessly remove longstanding safeguards," Carol Tobias, president of National Right to Life, said in a statement.

Louisiana Attorney General Liz Murrill, who filed the lawsuit against the FDA along with a woman who says her boyfriend coerced her into taking abortion pills to end a pregnancy, criticized drug companies for their role in the case.

"Big abortion pharma claims they need an emergency stay because they will lose massive amounts of money if they can't kill more babies quickly and efficiently by mail without medical oversight," Murrill said in a statement. "The administrative stay is temporary, and I am confident life and the law will win in the end."