Republican attorneys general from 14 states and 19 GOP members of Congress are asking U.S. Environmental Protection Agency Administrator Lee Zeldin to classify and regulate the abortion medication mifepristone as a water contaminant.

Mifepristone is prescribed as part of a two-drug medication regimen to terminate a pregnancy. Studies have shown medication abortion to be safe and effective.

In a letter last Friday, the state officials argued that mifepristone is “a growing threat to the country’s waterways.” The letter was signed by the attorneys general of Alabama, Alaska, Arkansas, Florida, Idaho, Indiana, Kansas, Kentucky, Missouri, Nebraska, Louisiana, Oklahoma, South Carolina and Texas.

A concurrent letter, led by Republican Rep. Chris Smith of New Jersey, made similar claims and was signed by 18 other GOP members of Congress.

Environmental health science experts say there is no evidence that mifepristone in wastewater causes harm to the environment or to humans.

“There’s no evidence that medication abortion is affecting U.S. water systems, including drinking water and aquatic wildlife,” the Center for Biological Diversity, which advocates for stronger environmental protections, says on its website.

The GOP letters cite a 1996 FDA Center for Drug Evaluation and Research statement that said harmful environmental effects from mifepristone were “not anticipated,” while acknowledging that the drug may enter the environment via excretion or disposal of pharmaceutical waste. But drug trace amounts in water are a common occurrence, experts say, and state environmental agencies and scientists check for harmful contaminants in water as part of protocols and research.

In 2025, state lawmakers in seven states introduced nine bills that included claims about medication abortion and its effects on the environment and water. State lawmakers also introduced legislation calling for testing for mifepristone in water systems.

Last year, Republican members of Congress brought up similar concerns in a letter to the EPA.

The U.S. Supreme Court decided last month to preserve telehealth access to mifepristone until after the U.S. 5th Circuit Court of Appeals has ruled on the merits of the high-stakes federal lawsuit Louisiana v. Food and Drug Administration.

Medication abortion accounted for nearly two-thirds of all clinician-provided abortions in states without abortion bans in 2023, according to the most recent data available from the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Carrie Frail was in the process of leaving an abusive relationship when she discovered she was pregnant. Her partner told her he could hit her in the stomach until she had a miscarriage, and it would save some money.

“I firmly believe he would have killed me at some point, whether accidentally or intentionally,” Frail said.

She had a medication abortion at a Planned Parenthood clinic in St. Louis, Missouri, in 2008 while serving in the U.S. Air Force. She was relieved to have the option of using medication instead of a procedure, and it let her take less time off work. It wasn’t an easy decision, she said, but she knew if she hadn’t done it, she never would have been able to get away from that partner.

“I was too wrapped up mentally and emotionally in my life with him that … I needed to be able to leave without giving him a phone number or letting him know where I was,” Frail said. “I still believe that an abortion saved my life.”

Access to telehealth prescriptions of mifepristone, one of two drugs used to terminate a pregnancy in the first trimester or to treat miscarriages, is threatened by an ongoing lawsuit in Louisiana. That state government has sued the U.S. Food and Drug Administration, trying to strike down the agency’s 2023 rule allowing the medication to be dispensed without an in-person visit.

Researchers, advocates and survivors of domestic violence say it’s vital to keep telehealth access available for people in abusive relationships who need discreet abortion options. The Louisiana lawsuit, however, argues in part that mifepristone has been weaponized against pregnant women in abusive relationships and shouldn’t be available by telehealth.

The 5th U.S. Circuit Court of Appeals temporarily blocked the FDA’s 2023 rule in early May, making in-person visits required for mifepristone prescriptions for two days before the U.S. Supreme Court paused that decision on emergency appeal. The court, with the exceptions of Justices Samuel Alito and Clarence Thomas, decided to keep the rule in place while the appeals case proceeds. But the rule could still be struck down again later, and the full case may end up in front of the Supreme Court.

Data from the federal Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence Survey from 2023-24 showed about 34% of women and 17% of men experienced physical or sexual violence or stalking by an intimate partner. Those figures could be higher because of hesitance to report incidents of abuse. States with high rates of violence include many with near-total abortion bans, including Arkansas, Indiana, Oklahoma, Tennessee and West Virginia — meaning residents who are victims of reproductive coercion have less access to abortion medication.

Pregnancy is a time of heightened risk in a relationship with domestic abuse, according to research, and intimate partner violence is a leading non-obstetric related cause of death among pregnant and postpartum women. Those risks are highest among Black and Indigenous people in the United States.

Reproductive coercion 

The lawsuit over mifepristone access includes Louisiana resident Rosalie Markezich as a plaintiff, who says the availability of the drug without an in-clinic visit allowed her boyfriend to order the pills in 2023 and pressure her to take them. In her written statement in the case, Markezich said the pressure caused ongoing trauma, and that if she’d had to see a doctor beforehand, she could have told the provider she didn’t want an abortion and the pills would never have been prescribed.

Anti-abortion groups, including Susan B. Anthony Pro-Life America and Family Research Council, submitted amicus briefs to the U.S. Supreme Court about the type of coercion Markezich said she experienced. The telehealth option prevents in-person screenings for coercion, Susan B. Anthony Pro-Life America said, and the in-person requirement provided “a line of defense” against reproductive coercion. Family Research Council also argued that because the FDA’s initial approval of the telehealth provision did not include a thorough study of how it could be used for coercion, it should be struck down.

Liz Tobin-Tyler, professor of health services, policy and practice at the Brown University School of Public Health, said people in abusive relationships very commonly experience what researchers call reproductive coercion. According to the American College of Obstetricians and Gynecologists, that includes situations in which a partner tries to control when and how pregnancy occurs, either by intentionally causing a pregnancy or forcing someone to end it, as with Markezich.

Coercion can also occur when a partner interferes with contraceptive methods, such as trying to force the use of a certain method or intentionally failing to use contraception. Tobin-Tyler said sometimes the abusive partner attends medical appointments to try to influence decisions related to birth control and other medical care discussions.

“It all comes back to that aspect of control,” she said.

Robin Turner, Montana director at gender equity organization Legal Voice, said what happened to Markezich was terrible, but that Louisiana could prosecute Markezich’s partner under existing laws, including harm induced by drugs. She said reinstating the in-person requirement for mifepristone would harm many other people because it would apply nationwide.

“It’s not a reasonable or proportional way to address what happened to the client,” Turner said. “We have to take what happened to the plaintiff seriously — and understand that taking that (access) away is not effective.”

Turner co-authored a brief for Legal Voice submitted to the U.S. Supreme Court during the emergency appeal proceedings that centered on the importance of access to mifepristone for people in relationships marked by domestic violence.

“A lot of what being in these relationships is about is your world getting smaller, and we don’t want our systems to imitate the dynamics of abuse. But that’s what happens when the government takes away the access to the healthcare that they need,” Turner told Stateline.

Safety planning for hotline callers

Kaelah Oberdorf, 24, said she was on birth control when she discovered she was pregnant in 2023 in upstate New York.

She was in an emotionally abusive relationship, struggling financially and still recovering from the postpartum depression she experienced after having her first child when she was 20, despite thinking that she couldn’t get pregnant because of a medical condition. The depression was so severe she had to be hospitalized. She decided that ending the pregnancy was the right thing to do for her mental health and the daughter she already had.

“I didn’t want to be tied to him for life, I didn’t want my daughter, or any of my children, to be tied to him for life,” said Oberdorf, who now lives in Georgia. “I already had a living child who did not need to be kept in that situation, and if I’d had another one, even if I left him, I mentally would not have been able to handle it.”

Research also shows that pregnant and postpartum women in rural areas experience higher rates of intimate partner violence, possibly because they’re farther from in-person medical care, which could contribute to lower rates of preventive screenings for abuse.

Elizabeth Ling, associate director of legal services at nonprofit hotline If/When/How, which offers reproductive legal aid, estimated the hotline receives between five and 10 calls a week from people who talk about experiencing intimate partner violence, whether it’s physical, emotional or some form of coercion. She said callers in rural communities are some of those who need access to medication abortion by telehealth and via mail because they are often the furthest away from a clinic and can’t travel because a partner is actively watching their movements.

If/When/How talks callers through their legal options and counsels them about legal risks, which Ling said is a top concern for people in abusive relationships. It’s common for them to be fearful of their partner reporting them for having an abortion, which can bring unwanted attention from police and investigations even if it doesn’t result in charges.

The hotline also helps people make a safety plan for receiving abortion medication, talking through steps such as where medication will be mailed, who has access to that mailbox and how to navigate a situation with a partner tracking their movements.

“Abortion pills really are a lifeline for those who call and share their experiences with us,” Ling said.

Frail, who still lives in Missouri, now has a daughter and a son who are in their 20s. She has left many voicemail messages recently for Republican U.S. Sens. Josh Hawley and Eric Schmitt, who have advocated for the withdrawal of FDA approval for mifepristone and called for federal investigations into drug manufacturers. In her messages, she says that being able to choose when she had her children made her a better parent.

“I know if I had not had an abortion, I would not have ever been able to get away from that abusive partner,” Frail said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

The U.S. Supreme Court decided Thursday to preserve telehealth access to the abortion drug mifepristone until after the U.S. 5th Circuit Court of Appeals has ruled on the merits of the high-stakes federal lawsuit Louisiana v. Food and Drug Administration.

Justices Samuel Alito and Clarence Thomas issued dissenting opinions.

In his dissent, Thomas said the rule violates the Comstock Act, a long unenforced 1873 law that bans the mailing of “obscene” material. During the 2024 presidential campaign, President Donald Trump said he didn’t support using the Comstock Act to stop mail delivery of abortion pills, saying he thought the federal government should have nothing to do with the issue.

Mifepristone’s manufacturer “makes a passing reference to the possibility of lost sales,” Alito wrote in his dissent. “But lost sales in states where abortifacients are generally illegal are not ‘irreparable injuries’ that can justify granting a stay.”

Abortion-rights advocates around the country called the decision a relief after two weeks of uncertainty.

On May 1, the appellate court sided with Louisiana, where state officials sued the FDA in October, arguing that a rule allowing telehealth access to mifepristone, one of two drugs used to terminate a pregnancy in the first trimester or to treat miscarriage, undermines the state’s abortion ban. Danco Laboratories and GenBioPro, two manufacturers of mifepristone, filed emergency appeals, leading the Supreme Court to issue a 10-day stay on May 4, extended until today.

“Though today’s decision means that mifepristone remains available through telehealth for now, this fight is not over,” said Dr. Camille A. Clare, president of the American College of Obstetricians & Gynecologists, in an emailed statement. “The chaos and confusion wrought by competing decisions and the revocation and restoration of access on an almost daily basis do real harm to patients and to the clinicians who care for them.”

Abortion opponents decried Thursday’s decision.

“Women deserve better than dangerous abortion drugs sent through the mail without physician oversight or in-person support,” said Jor-El Godsey, president of Heartbeat International, a major network of anti-abortion crisis pregnancy centers. “A state like Louisiana that values life in its laws should be able to protect its smallest residents as well as their moms.”

The FDA’s approved two-drug regimen via telemedicine is an increasingly common abortion method, especially for people living in parts of the country where abortion is banned or difficult to access.

Last month, a federal district court paused the lawsuit at the request of the FDA until after the completion of a safety review on mifepristone. That review was prompted by non-peer reviewed, anti-abortion research and in spite of the drug’s record of safety and efficacy since 2000. The state appealed to the 5th Circuit.

Due to multiple ongoing efforts to restrict or block mifepristone, abortion providers have told Stateline they are ready to eventually switch to a misoprostol-only method, which researchers have found to be as safe as the two-drug regimen but typically involves more symptoms and is slightly less effective.

National groups have tried to pressure the Trump administration to drop the Biden-era rule allowing telehealth abortion and called for the head of FDA Commissioner Marty Makary for reportedly slow-walking a safety review of the drug until after the midterm elections. Makary resigned on Tuesday, and anti-abortion groups wasted no time in getting Acting Commissioner Kyle Diamantas on the phone.

Live Action founder and president Lila Rose, in a written statement, said she talked to the acting commissioner on Wednesday and that he said he was morally opposed to abortion. “Diamantas told me that reviewing the abortion pill is a top priority for him and the administration,” Rose posted on X.

Students for Life of America President Kristan Hawkins wrote a similar message to supporters in an email on Thursday, saying Diamantas will be the “most pro-life FDA commissioner in American history.”

But many doctors around the country say curbing access to telehealth abortion is likely to cause harm to people in states with bans who may face more barriers to obtaining an abortion without that option.

“Women will be forced to travel long distances — at times hundreds of miles — to access safe, essential health care at a doctor’s office, no longer having the option to receive mifepristone via telemedicine,” wrote Rob Davidson, an emergency physician in Michigan and executive director of the Committee to Protect Health Care, in a letter asking the Supreme Court to maintain access to telehealth abortion. The letter was cosigned by more than 2,200 physicians.

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.  Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org. 

WASHINGTON — U.S. Food and Drug Administration Commissioner Marty Makary on Tuesday became the latest member of President Donald Trump’s administration to leave their post this year. 

“I want to thank Dr. Marty Makary for having done a great job at the FDA. So much was accomplished under his leadership,” Trump wrote on social media. “He was a hard worker, who was respected by all, and will go on to have an outstanding career in Medicine. Kyle Diamantas, a very talented person, will be put in the Acting position.”

Diamantas was working as the deputy commissioner for food, leading the program that focuses on nutrition and food safety.

Health and Human Services Secretary Robert F. Kennedy Jr. wrote in a social media post that Makary “pushed forward critical reforms and helped advance our mission to Make America Healthy Again.”

“I also want to thank Kyle Diamantas for stepping in as Acting Commissioner — his leadership has already delivered remarkable wins on the MAHA food agenda, and I have full confidence in his continued work,” Kennedy added. “We have an outstanding team at FDA, and the work continues without pause. The search for a new Commissioner is already underway, and we will move forward with urgency.”

Makary’s resignation marks the fourth time a senior member of the Trump administration has either left or been forced out during the last few months. 

Kristi Noem was ousted as Homeland Security secretary in early March, moving to a different job as a special envoy. Pam Bondi resigned as attorney general in early April to move back to the private sector. And Lori Chavez-DeRemer stepped down as Labor secretary in late April, following scandals.

The Senate voted to confirm Makary to lead the FDA in March 2025, with Democratic Sens. Dick Durbin of Illinois as well as Maggie Hassan and Jeanne Shaheen of New Hampshire supporting him. 

Medication abortion

Makary’s decision to leave the FDA comes several months after anti-abortion organizations and some Republicans in Congress called for Trump to fire him over his record on access to medication abortion. 

Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, and Lila Rose, founder of Live Action, both released statements in December pressing for the FDA to restrict access to mifepristone. 

“The FDA needs a new commissioner who will immediately reinstate in-person dispensing as it existed under President Trump’s first term and immediately conduct a comprehensive study,” Dannenfelser wrote in a statement at the time. “Commissioner Makary is severely undermining President Trump and Vice President Vance’s pro-life credentials and their position that states should have the right to enact and enforce pro-life protections. Makary must go.”

Missouri U.S. Sen. Josh Hawley sent a letter to Makary the following day urging him to wrap up a review of the current prescribing guidelines for mifepristone. 

Their frustration followed a Bloomberg Law news article that said Makary didn’t want to release the results of the study until after November’s midterm elections, which will determine which political party controls Congress for the next two years.

The U.S. Supreme Court on Monday extended a highly anticipated stay blocking an appellate court’s pause on telehealth abortion access until May 14.

The U.S. Food and Drug Administration’s approved medication-abortion regimen remains available via telehealth until then, following a week of uncertainty among abortion patients and providers.

“With this critical temporary administrative stay extended, we hope that some of the chaos and confusion inflicted on patients and providers last weekend will be abated,” said Evan Masingill, CEO of abortion-pill manufacturer GenBioPro, one of the defendants in the case, in a statement.

On May 4, the Supreme Court temporarily stayed the 5th Circuit Court of Appeals’ ruling to reinstate the FDA’s in-person dispensing requirement for mifepristone that the Biden administration officially lifted in 2023. Over the past week, several doctors groups submitted friend-of-the-court briefs arguing that cutting off access to mifepristone could harm many women seeking abortions and miscarriage management. Republican attorneys general from 23 states, meanwhile, urged the Supreme Court not to allow providers to send mifepristone through the mail. 

People in states with abortion bans or diminished abortion access continue to depend on abortion providers prescribing FDA’s approved mifepristone-misoprostol regimen through telemedicine and sending it to patients by mail.

According to new preliminary findings from the Society of Family Planning, telehealth abortion comprised 28% of all abortions at the end of 2025, an increase from 25% at the end of 2024.

Attorneys representing Louisiana have argued that in addition to undermining a state abortion ban, the federal rulemaking process allowing telehealth prescriptions of medication abortion was flawed.  

University of Michigan law professor Samuel Bagenstos, who served as general counsel of the U.S. Department of Health and Human Services at the time the Biden-era rule was implemented, said the policy was well considered and based on evidence. 

“The 2023 update was the result of an incredibly careful, deliberate, time-consuming, painstaking process to make sure that they were following what the evidence was,” Bagenstos said. If, the plaintiffs were to prevail, he added, ending telehealth access to mifepristone nationwide would have “really harmful effects on women across the country, as well as really destabilizing effects on the drug approval system.” 

Louisiana’s lawsuit against mifepristone has nationwide implications and could threaten residents in states with abortion access and so-called abortion shield laws, such as Maryland. 

Regardless of what happens in this case, abortion providers told Stateline they are determined to continue providing telehealth abortions, though potentially without mifepristone. Dr. Angel Foster, a telehealth provider in Massachusetts, a shield law state, said in the past week, about 100 patients have requested pills for future use, compared with 34 in the entire month of April. She said constantly changing rules around abortion access followed by sensational news headlines continue to create confusion for people seeking termination or miscarriage management.

“I live and breathe abortion at this point, and I find it can be hard to keep up with the ever-changing legal environment and the way that things are getting framed and phrased,” Foster said. “When you’re a patient and what you see are just the headlines, and you’ve got to figure out what it means for you, it’s really complicated.”

Editor’s note: This story has been updated to correct the number of Republican attorneys general who asked the Supreme Court to keep mifepristone from being prescribed via telehealth visits. It should be 23. 

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.

Advocates and opponents of abortion access say they’re wondering what happens next in a critical telehealth medication case that created chaos and confusion over the past week after an appeals court blocked nationwide access to the drug and, days later, U.S. Supreme Court Justice Samuel Alito issued a temporary stay.

Alito’s stay preserves telehealth access until May 11. But it’s unclear what happens next for patients and providers.

The Supreme Court on Monday temporarily blocked the 5th U.S. Circuit Court of Appeals’ Friday ruling to suspend a federal rule allowing telehealth prescriptions of the drug mifepristone while the lawsuit Louisiana v. U.S. Food and Drug Administration unfolds. Abortion providers are determined to continue providing the service, though potentially without mifepristone, the drug at the center for the case, which has had a high record of safety and efficacy since 2000.

Anti-abortion advocates have pushed to reverse the 2023 policy, enacted under former Democratic President Joe Biden, that allowed the FDA to drop its requirement that a patient see a provider in person before the medication can be prescribed. One similar national case already failed unanimously before the Supreme Court, but anti-abortion advocates are hoping this time around, with a more tailored approach, they will be successful.

Abortion-rights advocates say they’re prepared for whatever might happen in the courts, with contingency plans and a message that abortion will still be available even if the particular medication — mifepristone — is not.

Has the abortion pill been banned?

No. Mifepristone is still a legally approved FDA drug commonly used to terminate a pregnancy before 10 weeks’ gestation and is used off-label to treat miscarriages.

Is telehealth abortion still legal?

Yes, for now. Under the U.S. Supreme Court’s administrative stay that expires on May 11, it is still legal to obtain abortion medication through telemedicine under the FDA’s regulations. Mifepristone is commonly used with a second drug, misoprostol, in medication abortions. The case doesn’t include misoprostol.

Who would be affected if telehealth access is struck down?

According to the Society of Family Planning’s #WeCount report, 27% of all abortions in the first six months of 2025 were obtained through telehealth, adding up to more than 162,000 cases.

Mifepristone is also used for patients experiencing a miscarriage; those patients also would have to visit a provider in person.

The ruling would apply nationwide, meaning that health providers couldn’t prescribe mifepristone without an in-person visit with the patient, even in states with abortion access.

What are the arguments on each side in Louisiana v. FDA?

Louisiana says the Biden-era policy undermines a state law banning abortion, and that the federal rulemaking process allowing telehealth prescriptions was flawed.

The Food and Drug Administration says the state doesn’t have standing to sue, but also notes that it’s taking more time to review the drug’s safety.

Two mifepristone drugmakers, meanwhile, have intervened on the FDA’s side.

What could happen next?

The Supreme Court has many options available moving forward, but a few options are most likely, said Katie Keith, founding director of the Center for Health Policy and the Law at the Georgetown University Law Center. The justices could extend the stay when it expires May 11, or the court could make a longer-term ruling.

That could mean sending it back to the 5th U.S. Circuit Court of Appeals, with or without upholding the initial ruling blocking the 2023 provision while the appeals case proceeds. Or justices could decide to take up the case and bypass the rest of the 5th Circuit appeal.

If it did that, the manufacturer defendants Danco Laboratories and GenBioPro have asked for an expedited process with a decision by June. That seems unlikely, Keith said, but the court has conducted expedited cases related to abortion before, such as the Moyle v. United States case in 2024 related to the federal Emergency Medical Treatment and Labor Act.

What will providers do if they can’t use the combination of mifepristone and misoprostol?

Brittany Fonteno, president and CEO of the National Abortion Federation, said providers have been preparing since 2023 for the possibility of losing access to mifepristone. There have long been plans to switch to a misoprostol-only protocol, which is the main method of pregnancy termination across much of the world, she said.

“A lot of providers had created these policies and just needed to dust them off,” Fonteno said.

Dr. Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, which provides telehealth abortions to patients in all 50 states, said she and her team spent the weekend scrambling to contact patients waiting on medication abortion pills they had ordered before the ruling, and implementing a contingency plan that many abortion providers have been planning for since the lawsuits against mifepristone began in 2023.

That contingency involves pivoting from the FDA-approved mifepristone-misoprostol regimen to a misoprostol-only regimen.

Early Monday, Foster said her team was getting ready to ship misoprostol-only packages to patients at 2 p.m., but after the Supreme Court stayed the appeals court’s ruling on Monday morning, she said they were able to switch back to the mifepristone-misoprostol regimen.

Foster also said her organization was inundated with requests for pills that people could stockpile — people who didn’t need an abortion but were worried about losing access to the pills. Normally that’s a small fraction of the requests they receive, she said, but on Tuesday, they sent out more than had been sent in the entire month of April.

“Over the last two days, we’ve had a huge increase in the number of people from Louisiana requesting pills, especially pills for future use,” Foster said.

What are the pros and cons of the misoprostol-only regimen?

Dr. Maya Bass, a family physician in New Jersey who also provides abortions in Delaware, said misoprostol-only regimens are still safe and highly effective, but that the regimen has a lower efficacy rate than the combination of the two drugs and comes with potentially more side effects and risks.

Misoprostol-only regimens vary between 85% and 90% effective, while the combination is between 93% and 99% effective. The effective rates are lower as the gestational age increases.

The combination works well, Bass said, because mifepristone stops the hormone that allows the pregnancy to continue and signals to the body that the pregnancy is over. The misoprostol then helps soften the cervix and prompts the uterus to contract and expel the pregnancy tissue.

Without that hormonal signal, Bass said, a higher dose of misoprostol is needed to empty the uterus. The usual side effects of nausea, diarrhea, chills and sometimes fevers can be more severe because of the higher dosage. And it may lead to more people needing to seek in-person follow-up care to fully remove all of the pregnancy tissue, which can cause infection if it stays in the uterus.

“A lot of the people who are using telehealth for their medication abortion are not necessarily in places where they can safely access that care,” Bass said. “So it is concerning that we might be relying more on a regimen that means that many more people needing to seek care.”

What are the details of the legal arguments?

Louisiana officials, including Republican Attorney General Liz Murrill, argue that the state is harmed by the 2023 telehealth policy because it undermines a state law banning abortion at all stages of pregnancy, with few exceptions that don’t include rape or incest. The state also challenged the Food and Drug Administration’s process in deciding to eliminate the in-person dispensing requirement, saying it was based on flawed or nonexistent data.

The state also said the rule has resulted in $92,000 in Medicaid bills from two women who went to the emergency room because of complications related to mifepristone in 2025. And the state says the rule harmed the other plaintiff in the case, Louisiana resident Rosalie Markezich, who said her ex-boyfriend ordered the medication online and pressured her into taking it. That wouldn’t have been possible if the medication had to be dispensed through an in-person visit, the state argues.

“The priority of safety supersedes the priority of access, and that is what ultimately, I believe, needs to be looked at directly,” Sarah Zagorski, senior director of public relations at Americans United for Life, told Stateline on Wednesday. The anti-abortion organization submitted a brief supporting Louisiana’s case to the U.S. Supreme Court this week.

The FDA’s response has been to try to dismiss the claims in part on the grounds that Louisiana doesn’t have standing to sue, but agency officials have also said they are in the middle of conducting a safety review of mifepristone and need more time.

GenBioPro and Danco Laboratories, two of the manufacturers of mifepristone, intervened as defendants in the case, which can happen when the party that is sued may not be willing to fully defend the case for various reasons.

The two companies argue that Louisiana does not have proper standing to sue because the state does not prescribe or use mifepristone and is an “unregulated party” as it relates to the 2023 telehealth provision. They also noted that the FDA reviewed 15 studies evaluating medication abortion outcomes for more than 55,000 patients before approving the rule, “all of which supported the safety and effectiveness of dispensing mifepristone by mail, courier, or through pharmacies.”

How does this compare to the 2023 case Alliance for Hippocratic Medicine v. FDA?

Both lawsuits were designed to restrict access to mifepristone. The plaintiffs in the Alliance for Hippocratic Medicine case included a group of anti-abortion doctors who said they would be harmed by having to care for people who took mifepristone. They also argued that the FDA’s approval of the drug was improper.

The 5th U.S. Circuit Court of Appeals was involved in that case as well, and determined that the FDA should roll back its decision to ease restrictions on the drug, including the 2023 telehealth rule. But the U.S. Supreme Court unanimously decided in June 2024 that the Alliance plaintiffs didn’t have proper standing and sent it back to the lower court.

After that ruling, the attorneys general of Missouri, Idaho and Kansas stepped in as plaintiffs, and the case was transferred to Missouri’s U.S. district court, where it’s still pending.

The Louisiana case is more limited because it would strike down one provision of mifepristone regulation, noted Jenna Hudson, senior counsel at the Center for Reproductive Rights. The Alliance plaintiffs sought to revoke the drug’s approval altogether.

Stateline reporters Kelcie Moseley-Morris can be reached at kmoseley@stateline.org and Sofia Resnick can be reached at sresnick@stateline.org.  

The U.S. Supreme Court issued a temporary stay on an appeals court ruling from Friday that was blocking remote access to an abortion drug, restoring access until at least May 11.

The administrative stay, issued by Justice Samuel Alito, pauses Friday’s decision by the 5th Circuit Court of Appeals. That ruling blocked a 2023 rule adopted by the U.S. Food and Drug Administration allowing mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be prescribed without an in-person visit with a health care provider and also allowed it to be mailed to recipients in states with abortion bans.

“The administrative stay is temporary, and I am confident life and law will win in the end,” said Louisiana Republican Attorney General Liz Murrill in a statement. 

Thirteen states have near-total abortion bans, including Louisiana. Murrill sued the FDA in October, saying the rule undermines the state’s laws and causes financial harm because the state paid $92,000 in Medicaid bills for two women who needed emergency care in 2025 from complications related to mifepristone. 

In the years since the 2022 U.S. Supreme Court decision allowing states to regulate abortion access, telehealth prescriptions of abortion medication have become increasingly popular, with more than 27% of all abortions provided that way in 2025, according to data from the Society of Family Planning.

“While this is a positive short-term development, no one can rest easy when our ability to get this safe, effective medication for abortion and miscarriage care still hangs in the balance,” said Julia Kaye, senior staff attorney for the Reproductive Freedom Project at the American Civil Liberties Union, in a statement. “The Supreme Court needs to put an end to this baseless attack on our reproductive freedom, once and for all.”

The case could follow a similar pattern to one that played out in 2023, after U.S. District Court Judge Matthew Kacsmaryk of Texas issued a ruling that would have revoked access to the abortion drug mifepristone altogether. 

The U.S. Supreme Court intervened shortly after that ruling and kept mifepristone available while the case proceeded in the 5th Circuit appeals court, which eventually decided that more restrictions were warranted, but not pulling the drug’s approval. The Supreme Court officially took the case several months later, and unanimously ruled in June 2024 that the plaintiffs suing the FDA did not have standing, keeping access to mifepristone intact.

Responses from the attorneys in the latest case are expected to be filed with the Supreme Court by Thursday, according to Alito’s order.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.