A three-judge panel of the New Orleans-based 5th U.S. Circuit Court of Appeals issued a unanimous ruling Friday that eliminates the nationwide option to receive mifepristone through telehealth prescriptions and postal delivery, reinstating an in-person dispensing requirement the Food and Drug Administration dropped in 2023.
The ruling in State of Louisiana v. Food and Drug Administration was written by Circuit Judge Kyle Duncan, a Trump appointee, joined by two other Republican-nominated judges. The panel agreed with Louisiana’s argument that the FDA’s 2023 regulatory change — formalizing mail-order and telehealth dispensing — effectively nullified the state’s abortion ban by enabling out-of-state providers to ship the drug directly to Louisiana residents.
Mifepristone was FDA-approved in 2000 and is typically combined with misoprostol to end early pregnancies. In-person requirements were lifted during the COVID-19 pandemic and made permanent in 2023 after agency officials said more than two decades of data and dozens of studies showed the drug could be used safely without direct clinical supervision. The court found those conclusions inadequately supported and noted the FDA could not say when its ongoing safety review — ordered by President Trump — would conclude.
The ruling takes effect immediately and applies nationwide, blocking telehealth prescriptions even in states where abortion remains legal. Medication abortion now accounts for roughly two-thirds of all U.S. abortions, and about one in four abortions nationally were provided through telehealth in the first half of 2025, according to research from the Society of Family Planning. The case is widely expected to reach the Supreme Court, which preserved mifepristone access in 2024 by finding the plaintiffs in that challenge lacked standing — leaving core regulatory questions unresolved.
South Carolina Sen. Lindsey Graham led 51 Republican senators in an October 2025 letter urging the FDA to suspend mifepristone approvals and reinstate in-person dispensing requirements while its review remained open. Friday’s ruling achieves through judicial order what that letter sought from regulators. South Carolina already enforces a six-week abortion ban upheld by the state Supreme Court in August 2023, and the SC Senate’s Medical Affairs Committee advanced S. 1095 in April 2026, a measure that would criminalize mailing abortion-inducing drugs into the state.
