U.S. Supreme Court preserves access to widely used abortion pill, while lawsuit plays out

Boxes of the drug mifepristone sit on a shelf at the West Alabama Women's Center in Tuscaloosa, Ala., March 16, 2022. (AP Photo/Allen G. Breed)

WASHINGTON — The U.S. Supreme Court on Thursday preserved women’s access to a drug used in the most common method of abortion, rejecting lower-court restrictions while a lawsuit continues.

The court’s order allows women seeking abortions to continue obtaining the drug, mifepristone, at pharmacies or through the mail, without an in-person visit to a doctor. Access is likely to remain uninterrupted at least until into next year as the case plays out, including a potential appeal to the high court.

The justices granted emergency requests from makers of mifepristone, who are appealing a federal appeals court ruling that would require women to see a doctor in person and halt delivery of mifepristone through the mail. The federal Food and Drug Administration, which first approved mifepristone for use in abortion in 2000, stopped requiring in-person visits five years ago.

Justices Clarence Thomas and Samuel Alito dissented, with Thomas writing that the two companies, Danco Laboratories and GenBioPro, are not entitled to the court’s action to spare them “lost profits from their criminal enterprise.”

Anti-abortion groups, frustrated with U.S. President Donald Trump’s administration, are pushing the FDA to move faster with a review that they hope will result in restrictions on mifepristone, including blocking its prescribing via telehealth platforms. The Republican administration says the work takes time.

Earlier this week, FDA Commissioner Marty Makary resigned after months of criticism from Trump’s political allies, including abortion opponents.

Susan B. Anthony Pro-Life America and similarly aligned groups had called on Trump to fire Makary over the slow pace of the mifepristone review.

The court is dealing with its latest abortion controversy four years after its conservative majority overturned Roe v. Wade and allowed more than a dozen states to effectively ban abortion outright.

The case before the court stems from a lawsuit Louisiana filed to roll back the Food and Drug Administration’s rules on how mifepristone can be prescribed. The state claims that the policy undermines the ban there, and it questions the safety of the drug, which has repeatedly been deemed safe and effective by FDA scientists.

Alito, who wrote the opinion overturning Roe, agreed that the state’s efforts have been thwarted by medical providers and private organizations that mail the pills to women in Louisiana, despite the abortion ban. Danco and GenBioPro “are obviously aware of what is going on yet nevertheless supply the drug and reap profits from its felonious use in Louisiana,” he wrote.

Thomas said those who mail the pills are in violation of the Comstock Act, a 19th-century law that has long gone unenforced and bans mailing any “article, instrument, substance, drug, medicine, or thing which is advertised or described in a manner calculated to lead another to use or apply it for producing abortion.”

Lower courts concluded that Louisiana is likely to prevail, and a three-judge panel of the 5th U.S. Circuit Court of Appeals ruled that mail access and telehealth visits should be suspended while the case plays out.

The drug is most often used for abortion in combination with another drug, misoprostol. Medication abortions accounted for nearly two-thirds of all abortions in the U.S. in 2023, the last year for which statistics are available.

The current dispute is similar to one that reached the court three years ago.

Lower courts then also sought to restrict access to mifepristone, in a case brought by physicians who oppose abortion. They filed suit in the months after the court overturned Roe.

The Supreme Court blocked the 5th Circuit ruling from taking effect over dissenting votes by Alito and Thomas. Then, in 2024, the high court unanimously dismissed the doctors’ suit, reasoning they did not have the legal right, or standing, to sue.

In the current dispute, mainstream medical groups, the pharmaceutical industry and Democratic members of Congress have weighed in cautioning the court against limiting access to the drug. Pharmaceutical companies said a ruling for abortion opponents would upend the drug approval process.

Debate over the safety of mifepristone has churned for more than 25 years. The FDA has eased a number of restrictions initially placed on the drug, including who can prescribe it, how it is dispensed and what kinds of safety complications must be reported.

Despite those determinations, anti-abortion groups have filed a series of petitions and lawsuits against the agency, generally alleging that it violated federal law by overlooking safety issues with the pill.

Trump’s administration has been unusually quiet at the Supreme Court. It declined to file a written brief recommending what the court should do, even though federal regulations are at issue.

The case puts the administration in a difficult place. Trump has relied on the political support of anti-abortion groups but has also seen ballot question and poll results that show Americans generally support abortion rights.

Both sides took the administration’s silence as an implicit endorsement of the appellate ruling.

Mark Sherman, Geoff Mulvihill and Matthew Perrone, The Associated Press

Mulvihill reported from Haddonfield, N.J.