The conservative Fifth Circuit Court of Appeals in Louisiana on Friday temporarily blocked telehealth provision of abortion pills nationwide. 

All three of the court’s judges — two appointed by President Donald Trump and one appointed by former President George W. Bush —unanimously ruled in favor of Louisiana’s request to temporarily halt telehealth access to mifepristone while a legal battle over its broader availability continues to play out. Mifepristone is one of the two pills used in medication abortions.

The ruling is expected to have immediate repercussions for abortion access nationwide as it stops mifepristone from being prescribed virtually and delivered by mail. Medication abortions account for the majority of abortions in the United States, according to the Guttmacher Institute, a research and policy institute that supports abortion rights.

The decision comes as the latest and most significant chapter in Louisiana’s lawsuit against the U.S. Food and Drug Administration, which regulates the availability of the pills.

In October, Louisiana Attorney General Liz Murrill, a Republican, filed the suit seeking to stop the mailing of the pills — a major goal for anti-abortion Republicans — arguing that the Biden administration violated the Administrative Procedure Act in making the pills permanently available by mail in 2021. Previously, an in-person doctor’s visit was required to receive the drugs.

Early last month, a federal judge determined the case should be paused until the FDA completes an ongoing safety review of mifepristone, which was prompted by demands from anti-abortion Republicans.

Louisiana subsequently appealed that decision in the Fifth Circuit and asked the court to temporarily block telehealth provision of the pills while the case proceeds. The appeals court granted that request Friday in an 18-page order.

More than 100 scientific studies have shown that the two-pill medication abortion regimen is safe and effective in ending pregnancy, including when the pills are prescribed virtually and mailed to patients.

In a post on X, Murrill called Friday’s decision a “Victory for Life!” 

“The Biden abortion cartel facilitated the deaths of thousands of Louisiana babies (and millions in other states) through illegal mail-order abortion pills,” Murrill wrote. “Today, that nightmare is over, thanks to the hard work of my office and our friends at[conservative legal nonprofit Alliance Defending Freedom]. I look forward to continuing to defend women and babies as this case continues.”

The ruling will likely be appealed to the Supreme Court.

Evan Masingill, CEO of GenBioPro, which manufactures the medication, said in a statement that the company was “alarmed by the court’s decision.” GenBioPro is listed as an intervener in this case, along with Danco Laboratories.

“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,” Masingill said.

Spokespeople for Danco and HHS did not immediately respond to MS NOW’s requests for comment on Friday.

Mary Ziegler, a scholar of reproductive rights law based at the University of California, Davis, said the ruling puts “the ball in the Trump administration’s court.” 

The ruling forces the Trump administration to face the political unpopularity of restricting abortion access. Trump officials can either concede to abortion opponents’ demands to restrict access and let the court ruling stand, or intervene and risk further alienating anti-abortion conservatives before the midterms. 

“Everyone who was slow-walking decision-making in the White House and at HHS is now going to be forced to confront this in a way they haven’t had to yet,” Ziegler said. “The Trump administration is a wildcard and everyone will be watching what they do.” 

In the meantime, she added, the ruling will foreground the “reality of the post-Roe world in a way Americans have never experienced before” due to shield laws, which have protected providers who mailed abortion pills into states with bans from being prosecuted. 

The order does not affect the mailing or availability of misoprostol — the second pill used in conjunction with mifepristone for medication abortions — which providers may continue to mail to patients, Elisa Wells, co-founder of the abortion access information website Plan C, told MS NOW.

“I anticipate that many of the telehealth providers are going to pivot … to using other regimens that are still effective and safe for medication abortion,” she said, adding that Plan C will update its website with information as they learn of providers’ plans.

Research shows the use of misoprostol by itself to induce abortion is slightly less effective than using both pills together. However, advocates say misoprostol-only regimens are likely the most commonly used form of medication abortion due to its availability.

The latest ruling temporarily reverses a decision implemented in December 2021 under the Biden administration allowing the pills to be permanently prescribed remotely rather than in person. That decision, along with the Supreme Court’s June 2022 overruling of Roe v. Wade and the subsequent development of so-called shield laws — which protect providers in blue states from prosecution for mailing pills into red states — has led to a massive surge in use of the pills nationwide.

Abortion rights opponents celebrated the ruling, while abortion rights advocates slammed it.

Marjorie Dannenfelser, president of the anti-abortion group Susan B. Anthony Pro-Life America, called the ruling “a huge victory” while CEO of Americans United for Life John Mize called it “a monumental win for women across the nation.”

Abortion rights opponents argue the virtual prescribing and mailing of the pills endanger those who take them and could facilitate domestic abuse, though widespread evidence does not support those claims, and providers dispute them.

Mini Timmaraju, president and CEO of the abortion rights group Reproductive Freedom for All, said the decision “moves us one step closer to a national abortion ban.”

Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, called it “another attack on abortion that is rooted in politics, not science.”

Wells, the co-founder of Plan C, said Friday’s ruling is “a very significant attack on abortion access and attack on science,” but added she does not expect it to stop the mailing of abortion pills entirely.

“Obviously telehealth is a huge way of providing care to people now, especially in states with abortion bans,” she said. “We don’t anticipate that that will stop. These providers are dedicated and creative and wanting to help the people that are coming to them.”

Fallon Gallagher contributed reporting.

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