The Supreme Court took action on Monday to preserve online mifepristone abortion pill sales temporarily nationwide as a lawsuit between Louisiana and the Food and Drug Administration continues to work its way through the courts.
Monday was the deadline for Supreme Court justices to strike down the emergency ruling from the U.S. Court of Appeals for the 5th Circuit, a temporary injunction that put a national pause on online abortion pill sales as part of temporary relief in Louisiana’s lawsuit against the FDA.
Justice Samuel Alito put a temporary pause on the lower court’s decision last week. In an unexpected twist on Monday, Alito issued an extension of the temporary pause, giving him and his colleagues more time to decide on the merits of the case of whether to allow mifepristone to be sold online.
Louisiana sued the FDA in October 2025 over its 2023 decision to allow doctors to prescribe mifepristone via telehealth and send abortion pills through the mail. The FDA’s decision undid restrictions mandating in-person screening before and after dispensing the pill.
Louisiana Attorney General Liz Murrill argued in the case that the FDA’s removal of the in-person requirement harmed her state, along with the other 12 states that have outlawed elective abortion following the overturning of Roe v. Wade.
Abortion policy experts estimate that the slight increase in the number of abortions each year in the United States, reaching 1.1 million last year, is largely due to online abortion sales, including in the states that have banned elective abortions.
Mifepristone is used in roughly two-thirds of all abortions in the U.S. A report last year from the anti-abortion Ethics and Public Policy Center that examined insurance claims data found that nearly 11% of women who undergo mifepristone abortions require medical care for complications.
The 5th Circuit sided with Louisiana, acknowledging that emergency room visits due to complications from at-home abortions significantly contribute to the state’s Medicaid budget, which covers health expenses for low-income residents.
The 5th Circuit opinion, written by Trump-nominated Judge Stuart Kyle Duncan, agreed with Louisiana and said the state has “suffering irreparable harm” because being able to obtain the pills online effectively nullifies state law prohibiting elective abortion.
Alito issued his temporary pause on the 5th Circuit opinion last week after the two pharmaceutical companies that make mifepristone, Danco Laboratories and GenBioPro, filed emergency petitions with the Supreme Court.
The pharmaceutical companies argued that the appeals court ruling “injects immediate confusion and upheaval into highly time-sensitive medical decisions.”
The Supreme Court’s decision is likely complicated by the precedent the justices set last year regarding universal injunctions, in which judges at lower courts block federal policies for everyone rather than just the plaintiffs involved in the case.
Last year, the high court ruled in the case Trump v. Casa that federal district and circuit courts do not have the constitutional authority to issue nationwide injunctions.
The Supreme Court in 2024 upheld the FDA’s regulations allowing mifepristone to be prescribed online, unanimously ruling that the doctor’s group that sued the FDA, the Alliance for Hippocratic Medicine, did not have proper standing to file the legal challenge in the first instance.
But during oral arguments in the 2024 case, conservative justices appeared sympathetic to the arguments from the doctor group, signaling that Louisiana’s case against the Trump administration might have a chance if the full case is argued before the Supreme Court next term.
The Trump administration, through the Justice Department, has remained silent during the legal proceedings thus far, not filing briefs or making statements in support of the FDA’s 2023 decision.
Social conservatives in Congress have increasingly put pressure on the Trump administration and FDA Commissioner Marty Makary to reinstitute in-person screening requirements for mifepristone.
FDA CHIEF MARTY MAKARY UNDER FIRE FROM MULTIPLE DIRECTIONS
Makary and Health and Human Services Secretary Robert F. Kennedy Jr. each promised during their Senate confirmation hearings that the agency would be conducting a safety review of mifepristone following the change in prescribing guidelines.
Critics from within the GOP have accused Makary and Kennedy of slow-walking the safety review until after the midterm elections.
