Appeals court approves sweeping abortion pill restrictions, teeing up SCOTUS showdown

The federal court sided with Louisiana, which challenged the FDA's regulations allowing the drug to be prescribed by telehealth and distributed by mail. | Drew Angerer/AFP.

The 5th Circuit Court of Appeals on Friday rolled back access to the abortion pill mifepristone nationwide — blocking a 2023 Food and Drug Administration policy allowing the drug to be prescribed by telemedicine and delivered by mail.

A panel of three judges ruled unanimously in favor of arguments from Louisiana that the Biden-era regulations on the drug threaten the state’s sovereignty and the safety of pregnant women. Two of the judges were appointed by Donald Trump and the other by George W. Bush.

“The regulation creates an effective way for an out-of-state prescriber to place the drug in the hands of Louisianans in defiance of Louisiana law,” wrote the judges. They added that the federal telemedicine policy is responsible for “undermining [Louisiana’s] laws protecting unborn human life” and causing the state “irreparable harm.”

The decision, which applies to both states like Louisiana that ban abortion and states that allow the procedure, restores the FDA’s prior policy mandating that patients only obtain the drug in person from a physician. It is arguably the biggest rollback in access to abortion since the Supreme Court’s 2022 ruling overturning Roe v. Wade.

In their ruling, the judges rejected the Trump administration’s assertion that the state lacks standing, and that the court should hit pause on the case while the FDA conducts its own review of the drug. The court also rebuffed arguments by the two pharmaceutical companies that make mifepristone, Danco and GenBioPro, who argued that the court should defer to the FDA’s scientific judgment when it comes to whether and how patients can access the pills.

“We are alarmed by this court’s decision to ignore the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents,” GenBioPro CEO Evan Masingill said in a statement. “We remain committed to taking any actions necessary to make mifepristone available and accessible to as many people as possible.”

A Louisiana district court ruled in April to grant the Trump administration’s request to put its lawsuit against the FDA on ice, but demanded the agency quickly complete its review of the pill’s safety and give the court a status report by this coming October.
That judge, Trump appointee David C. Joseph, warned that granting Louisiana’s request to reimpose the rule that patients only obtain mifepristone in person from a doctor would be, in effect, “government by lawsuit.”

Louisiana quickly appealed that ruling, arguing that its residents needed immediate “relief” from the influx of abortion pills prescribed online by doctors in other states.

This case is one of several filed by GOP state attorneys general seeking to cut off access to pills that are being mailed to patients in their states in defiance of bans on abortion. Idaho, Kansas, and Missouri are making arguments similar to Louisiana’s in the hopes of a telehealth ban, while Florida and Texas are trying to go further and outlaw the sale of mifepristone altogether, challenging the 25-year-old FDA approval of the drug.
In all the lawsuits, the Trump administration has declined to defend the FDA’s rules for the drugs on the merits, and has instead argued the states lack standing or are acting prematurely, and has requested courts allow the agency to conduct its review without interference.

That stance has exacerbated the anti-abortion movement’s frustration with the administration over its inaction to curb the availability of pills. Some GOP lawmakers, who say they don’t believe FDA is reviewing mifepristone in good faith, have introduced bills to force the agency’s hand, but they are not likely to pass in the currently gridlocked Congress.

Anti-abortion activists celebrated Friday’s ruling as a “crippling” blow to the “abortion industry” and a reversal of “injudicious FDA deregulation under the Biden Administration.”

“The era of mail-order abortion is near its end,” said Gavin Oxley, a spokesperson for Americans United for Life.

Medical and progressive advocacy groups predicted the case will be swiftly appealed to the Supreme Court, which could pause the ruling and restore telemedicine access to the drugs while the case plays out in lower courts.

“I expect briefs to be filed likely next week,” said Molly Meegan, the chief legal officer for the American College of Obstetricians and Gynecologists, which is supporting the drugmakers in the case in defending access to the pills. “And, in all likelihood, a ruling just on the stay within the next couple weeks.”
But even a temporary disruption of access to the drugs will have massive implications. Abortion pills are used in nearly two-thirds of all pregnancy terminations, and a quarter of patients depend on telehealth to obtain them. The ruling also cuts off telemedicine prescription of the drug for non-abortion purposes, such as easing miscarriages. Peer-reviewed studies have found that mifepristone is equally safe whether obtained in person from a doctor or online. (Politico)

Trump.

Today is the deadline for President Donald J. Trump to ask Congress for approval for his war on Iran. Under the 1973 War Powers Act, a president has the authority to respond to an “imminent threat” without congressional approval, so long as he notifies Congress in writing within 48 hours. Then the president has 60 days either to withdraw U.S. forces from their engagement or to get Congress to authorize the military action.

Trump launched U.S. attacks on Iran alongside Israeli attacks on February 28. He notified Congress on March 2. Sixty days from March 2 is today.

And today, Trump sent letters to House speaker Mike Johnson (R-LA) and Senate president pro tempore (officially the leader of the Senate if the vice president is not present) Chuck Grassley (R-IA) to inform them that so far as the White House is concerned, “the hostilities that began on February 28…terminated” on April 7, when Trump ordered a two-week ceasefire. Ignoring the fact the U.S. fired on an Iranian tanker on April 19, the letter says “there has been no exchange of fire between United States Forces and Iran since April 7, 2026.”

The next paragraph notes that the administration is nonetheless continuing to build up its military presence in the region “to address Iranian and Iranian proxy forces’ threats and to protect the United States and its allies and partners.”

In other words, the administration is trying to get around the War Powers Act with the dodge Secretary of Defense Pete Hegseth tried in front of the Senate yesterday: a ceasefire stops the War Powers clock. This is not what the law says. (Letters from an American, Heather Cox Richardson, May 2, 2026)

The fallout from Supreme Court “Callais” decision continues.

Good thing happening today.

Friends Central School in Philadelphia is honoring someone near and dear to me.

See you on Tuesday!