The nation’s highest court bought itself more time on Monday to decide whether to restrict the mailing and telehealth prescription of mifepristone, one of two main forms of abortion medication. Mifepristone will continue to be fully accessible through Thursday.
The case before the Supreme Court originates from a lawsuit Louisiana filed last year, claiming that the accessibility of abortion medication via telehealth subverts the state’s abortion ban. The lawsuit does not name misoprostol, the other form of abortion medication. Experts say doctors will likely shift to prescribing misoprostol-only regimens for abortions and miscarriage management, but that it is not the gold standard of care. The lawsuit opens the door to banning telehealth prescriptions of misoprostol, as well.
Justices have until Thursday to push the deadline back again or make a substantive decision that would affect hundreds of Mississippians who rely on telehealth to access these drugs each month.
The lawsuit is “the biggest upset since the Dobbs decision,” said Rachel Jones, principal research scientist at the Guttmacher Institute, a reproductive health research and policy organization. In 2022, the Dobbs decision overturned the constitutional right to an abortion. Since then, the number of abortions performed in the U.S. has paradoxically increased. Experts say that’s largely due to the expansion of telemedicine, which allows patients in states with abortion bans to access abortion medications through the mail.
Now, the potential federal restriction on mail-order mifepristone could lower the number of abortions in a way that the Dobbs decision, and other state laws — such as one recently passed in Mississippi — have not.
“This would be the silver bullet that the Mississippi Legislature has been looking for in terms of shutting down access to abortion,” said Mary Ziegler, a law professor and abortion historian at the University of California Davis.
On April 8, Republican Gov. Tate Reeves signed a bill that will criminalize abortion-inducing drugs in Mississippi, starting July 1. Experts say that on its own, Mississippi’s law likely will not do much to stop the flow of abortion medication coming in from other states. They say the most profound effect of the state’s law will likely take place in doctors’ offices, where providers may become hesitant to prescribe the medications for their non-abortion uses, such as in the case of miscarriages, postpartum hemorrhaging and labor induction, out of fear of their actions being misinterpreted by law enforcement.
However, despite the profound effect on healthcare, the state’s new law would do little to cut down on the number of abortions happening in the state. That’s because under abortion shield laws, which protect abortion providers, patients and helpers from out-of-state investigations, Mississippians could likely continue to access mail-order abortion medications without consequence, Ziegler said.
In 2023, 65% of abortions in the U.S. were medication abortions. Each month in Mississippi, there are anywhere from 200 to more than 600 medication abortions.
But the federal case before the Supreme Court could change that.
“If Mississippi wants to go after doctors in other states,” Ziegler said, “shield laws won’t protect those doctors if the federal law no longer allows them to operate via telehealth.”
An abortion-rights activist holds a box of mifepristone pills as demonstrators from both anti-abortion and abortion-rights groups rally outside the Supreme Court in Washington on March 26, 2024. Credit: AP Photo/Amanda Andrade-RhoadesThe timeline of Louisiana v. FDA
How the case started
In October 2025, Louisiana sued the Food and Drug Administration, arguing that Louisianans’ ability to receive out-of-state abortion medication in the mail undermines the state’s abortion ban. In December 2025, Louisiana requested an injunction to stop the telehealth prescribing and mailing of mifepristone until the full case was heard in court. In April, Judge David C. Joseph, a federal judge in Louisiana’s Western District, declined that request and ordered a pause on case proceedings until the FDA finished a review of mifepristone.This month
On May 1, a federal appeals court granted Louisiana’s request and rolled back telemedicine access to mifepristone. On May 4, the Supreme Court put the appeals court ruling on hold for one week, allowing telemedicine prescriptions of mifepristone to continue. On Monday, the Supreme Court temporarily extended full access to mifepristone through at least Thursday.When the lower court restricted access to mifepristone on May 1, nearly two dozen states signed an amicus brief opposing the ruling. They argued the court was prioritizing the policy preferences of states with abortion bans over the policy preferences of states that promote access to abortion care.
Why mifepristone?
Unlike misoprostol, which is FDA approved for several non-abortion conditions, mifepristone is only FDA approved for medication abortions and to treat high blood sugar in adults with Cushing’s syndrome, a rare disease caused by high cortisol levels.
Because there are fewer approved uses of mifepristone, it is the more obvious target for anti-abortionists, said Dr. Kristin Lyerly, a Wisconsin-based OB-GYN who successfully fought to reinstate legal abortion in her home state. Lyerly said she believes the stigma is part of the reason the drug doesn’t have more approved uses.
If politics didn’t interfere with science and healthcare, Lyerly said she believes there would be far more approved uses for mifepristone.
“It’s just been hard to study, it’s been hard to access and it continues to be controversial,” she said.
One of mifepristone’s off-label uses is to aid in miscarriages. The American College of Obstetricians and Gynecologists recommends using a combination of misoprostol and mifepristone, when available. The addition of mifepristone “may significantly improve treatment efficacy,” according to ACOG’s practice bulletin.
It’s important to note, Lyerly said, that misoprostol-only regimens are safe and highly effective for miscarriage management and abortion care. But they are suboptimal, she said, because of the risk of having to repeat the dosage or undergo another procedure, increased side effects and time away from work.
If the Supreme Court ultimately rules in favor of Louisiana, Lyerly worries misoprostol and countless other drugs could be banned next.
“Can you just now wave a magic wand and say that this medication that’s been known to be safe and effective for over 25 years — not just by scientific studies but experience — can you just say that it’s not safe anymore?”
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