US appeals court skeptical of bid to curtail abortion pill access

A U.S. appeals court appeared doubtful on Wednesday of a bid by Republican-led Louisiana to limit access to the abortion drug mifepristone by halting a 2023 rule that permits telemedicine prescriptions and mail-order delivery of the medication nationwide. Louisiana Solicitor General Ben Aguinaga asked a three-judge panel of the 5th U.S. Circuit Court of Appeals in New Orleans to void the rule, arguing it conflicts with abortion restrictions enacted by Louisiana and other states following the 2022 U.S. Supreme Court overturning of the constitutional right to abortion.

Louisiana has been experiencing about 1,000 abortions per month due to mifepristone being mailed in, Aguinaga noted. The state sued the U.S. Food and Drug Administration (FDA) last year, asserting the agency overlooked potential severe side effects of mifepristone, such as sepsis and hemorrhaging, when it implemented the 2023 rule during former Democratic President Joe Biden’s term and removed a requirement that the drug be dispensed in-person at a medical facility.

That argument had previously persuaded another 5th Circuit panel earlier this year to temporarily block the rule. However, the Supreme Court lifted that injunction in May, enabling the drug to remain accessible via telemedicine and mail-order, a point repeatedly emphasized by U.S. Circuit Judge Stephen Higginson. The conservative-leaning 5th Circuit, which has a majority of Republican appointees, previously reversed a similar attempt by anti-abortion groups and physicians to revoke FDA regulations in 2024.

Both Higginson and U.S. Circuit Judge Dana Douglas, also appointed by a Democratic president, expressed skepticism about Louisiana's legal standing to sue the FDA. They questioned whether all the abortions occurring in the state were specifically due to the 2023 rule rather than other factors. If the panel rules against Louisiana, it could either appeal to the Supreme Court or request the full 5th Circuit, which is dominated by Republican appointees, to revisit the case.

Restricting access to mifepristone, including its availability through telehealth appointments with out-of-state providers, has been a top priority for Republican-led states that have implemented abortion bans. Nearly half of U.S. states have either banned or severely restricted abortion since the Supreme Court's ruling, resulting in a significant increase in medication abortion, a two-drug regimen involving mifepristone followed by misoprostol.

According to data from the Guttmacher Institute, an abortion rights advocacy group, medication abortion now accounts for more than 60% of all U.S. abortions. A U.S. District Judge temporarily halted the case in April pending a review by President Donald Trump's administration of the safety of mifepristone. Abortion rights advocates claim the Trump administration's review is politically motivated and unnecessary.

The FDA, which approved mifepristone in 2000, maintains that the drug is safe and effective, stating that periodic reviews have not uncovered any new safety concerns. U.S. Department of Justice attorney Daniel Winik stated that the review is still ongoing and that the matter should be left to the agency to decide. GenBioPro and Danco Laboratories, the drug manufacturers, argued that mifepristone is safe and that the FDA's 2023 assessment adequately addressed the drug's risks.