A three-judge panel of the New Orleans-based 5th U.S. Circuit Court of Appeals unanimously ruled Friday to reinstate a requirement that mifepristone, one of two drugs used in medication abortions, be dispensed only in person at clinics or medical offices. The decision overrides a 2023 Food and Drug Administration regulation that had permanently allowed the pill to be prescribed via telehealth and mailed directly to patients. The ruling stems from a lawsuit brought by the state of Louisiana and will remain in effect as that case continues through the courts.

The panel, composed of judges nominated by Republican presidents, sided with Louisiana's argument that allowing mifepristone to be mailed into the state undermines its near-total ban on abortion. Circuit Judge Stuart Kyle Duncan wrote that every abortion facilitated by the FDA's mailing regulation "cancels Louisiana's ban on medical abortions" and conflicts with the state's legal position that life begins at conception. Louisiana Attorney General Liz Murrill celebrated the ruling, while the American Civil Liberties Union's Julia Kaye called the decision one that "defies clear science and settled law."

Mifepristone was first approved by the FDA in 2000 and is typically used alongside a second drug, misoprostol, to end early pregnancies. The FDA originally required in-person dispensing, but that restriction was lifted temporarily during the Covid-19 pandemic under President Biden and made permanent in 2023. Surveys indicate that medication abortion now accounts for more than half of all abortions in the United States, and approximately one in four abortions nationally are prescribed through telehealth.

On Friday night, Danco Laboratories, the manufacturer of mifepristone, filed for an emergency one-week stay of the court's order and said it would appeal to the U.S. Supreme Court if the appellate court does not grant relief. Danco's lawyers warned the ruling created "immediate chaos," leaving it unclear whether pharmacies could continue dispensing the drug. The FDA under the Trump administration has said it is conducting its own safety review of mifepristone, though the agency has not indicated when that review will be complete.

The ruling is considered the most significant blow to abortion access in the United States since the Supreme Court overturned Roe v. Wade in 2022. The impact is expected to fall most heavily on people in states where abortion is banned who have relied on telehealth prescriptions and mail delivery to obtain the medication. The case is widely expected to reach the Supreme Court, which in 2024 unanimously rejected a separate challenge to mifepristone's FDA approval but left open the possibility of future legal challenges to the drug's distribution rules.