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.  

One of the main methods of obtaining abortion medication for those living in states with bans is now blocked nationwide, after a federal appeals court decision issued Friday afternoon.

The 5th Circuit Court of Appeals blocked a U.S. Food and Drug Administration rule from 2023 that allowed mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be dispensed without an in-person visit with a health provider. 

In the years since, states with abortion access have increased their telemedicine offerings to prescribe the medication remotely and send it through the mail. Many of those states also enacted shield laws to prevent officials from states with abortion bans from prosecuting or investigating their providers — meaning many patients have been able to receive the medication across state lines.

Louisiana judge preserves telehealth abortion access provision for now, puts case on hold

The block will remain in effect as the lower court case proceeds, but the FDA could file an emergency appeal to the U.S. Supreme Court in the coming weeks.

More than 27% of all abortions were provided through telehealth appointments in the first six months of 2025, according to the Society of Family Planning, a research and advocacy group that publishes a report called #WeCount. Nearly 15,000 abortions per month were provided under shield laws during that same time frame, according to the report.

Louisiana Republican Attorney General Liz Murrill sued the FDA in October, seeking to strike down the 2023 provision, and the lower court declined to do so in early April. U.S. District Judge David C. Joseph said then that the stay was premature while the FDA completed a safety review of mifepristone, but allowed state officials the opportunity to re-file the motion after that review was complete. The state appealed that decision to the 5th Circuit.

“Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person,’” Friday’s decision said.

There were no dissenting opinions among Judge Leslie Southwick, an appointee of former Republican President George H.W. Bush, and Judges Stuart Kyle Duncan and Kurt D. Engelhardt, both appointees of Republican President Donald Trump.

Without access to telemedicine and the opportunity to receive the medication through the mail, people in 13 states with near-total abortion bans may have to travel to another state to get an abortion.

There is a misoprostol-only abortion pill protocol that some providers can use, but it is slightly less effective and requires a higher dosage, which can increase side effects.

“Reinstating in-person dispensing requirements would force people to travel farther, take more time off work, and absorb costs that are simply too high. For people living in states already hostile to abortion access, many of which are home to Black women and families, this is not health care,” said Regina Davis-Moss, CEO of advocacy group In Our Own Voice: National Black Women’s Reproductive Justice Agenda, in a statement. 

Murrill said in a statement on Friday that former Democratic President Joe Biden’s administration facilitated “illegal mail-order abortion pills.”

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“Today, that nightmare is over, thanks to the hard work of my office and our friends at Alliance Defending Freedom. I look forward to continuing to defend women and babies as this case continues,” Murrill said, crediting the advocacy legal organization that helped in the case.

The court also found Friday that the 2023 rule injures Louisiana by causing it to spend Medicaid funds for emergency care for women harmed by using the drug. The state identified $92,000 paid by Medicaid for two women who needed emergency care in 2025 from complications “caused by out-of-state mifepristone.”

Numerous studies have shown mifepristone is safe to use, with very low complication rates. A combined review of 10 years’ worth of studies between 2005 and 2015 found that severe outcomes requiring blood transfusion and hospitalization occurred in less than 1% of cases.

“We are alarmed by this court’s decision to ignore the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents. We are reviewing the court’s order in detail,” said Evan Masingill, CEO of GenBioPro, one of the main manufacturers of mifepristone, in a statement. “We remain committed to taking any actions necessary to make mifepristone available and accessible to as many people as possible in the country, regardless of anti-abortion special interests trying to undermine patients’ access.”

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