The Supreme Court extended temporary mail access to abortion pill mifepristone on Monday.
Justice Samuel Alito said that the administrative stay announced last week will continue to be in place until at least Thursday at 5 p.m.
In the meantime, the Supreme Court will continue considering a decision from a court of appeals restoring an FDA rule requiring the pill to be given in person.
The case was brought by Louisiana, which challenged the FDA's 2023 rules allowing mifepristone to be prescribed remotely and dispensed by mail. The state argued that the FDA's rules conflicted with its abortion restrictions and exposed the state to costs tied to emergency care.
The 5th Circuit agreed, at least temporarily, finding that Louisiana had standing because its Medicaid program had covered emergency-room care for two women who experienced complications after receiving the drug from an out-of-state provider.
Danco Laboratories, which makes the branded version of mifepristone, and GenBioPro, which makes the generic version, asked the Supreme Court to intervene. They warned that the appeals court order would cause immediate disruption for patients, prescribers and pharmacies, and would abruptly undo a regulatory framework that has allowed mifepristone access through telehealth and mail.
The legal fight revolves around the FDA's risk-management rules for mifepristone, known as REMS. The agency first approved mifepristone in 2000. The FDA later expanded access, including allowing the drug to be used through 10 weeks of pregnancy, permitting additional health care providers to prescribe it, and eventually removing an in-person dispensing requirement. The FDA formally allowed telehealth prescriptions and mail delivery in 2023 after earlier suspending enforcement of the in-person rule during the COVID-19 pandemic.
The case is the second major mifepristone fight to reach the Supreme Court in two years. In 2024, the justices unanimously rejected a challenge from anti-abortion doctors and medical groups, ruling that they lacked legal standing to sue the FDA. That decision preserved access to the drug but did not decide broader questions about the FDA's authority or stop states from filing new challenges.
Mifepristone is used with misoprostol in medication abortions, which account for a majority of U.S. abortions. The drug is also used in some miscarriage care, a point raised by providers who warned that the 5th Circuit order could create confusion beyond abortion services.
