The Fifth Circuit Court of Appeals has issued a new ruling that is certain to send yet another abortion case to the Supreme Court.

Thanks to the Dobbs decision of nearly four years ago, abortion law in the United States is a hodgepodge mess of conflicting rulings. That is not necessarily a bad thing, but it does mean that national regulations can be challenged at the state level, when the state’s laws conflict. This includes the use and dispensation of the so-called “abortion pill,” mifepristone. The Biden Food and Drug Administration decided in 2021 to allow mifepristone to be prescribed via telehealth – meaning a doctor never phyically examined or even met the patient in person – and then had the drug sent to the patient via mail (or sent a prescription to a pharmacy if one that carried the drug was nearby). The FDA claimed that this was “necessary” due to COVID restrictions, but then decided to make that rule permanent in 2023. Multiple states objected, since Dobbs allowed states to create their own abortion laws, and there were also valid concerns about the safety of the drugs involved, especially if a patient was never seen by a doctor. The FDA itself conceded that there had been 36 deaths associated with the use of mifepristone since 2000, with most deaths occuring due to sepsis (after an “incomplete” abortion), along with 97 cases where ectopic pregnancies were involved and required hospitalization (where mifepristone should not have been prescribed in the first place, as the FDA admits in their data).

The Fifth Circuit Court of Appeals is halting the dispensing of mifepristone through the mail, and pointing out the problems that the FDA has created for itself.

The court’s order blocks mail-order distribution of the drug and effectively halts pharmacy-based dispensing allowed under recent FDA rule changes, requiring it to be dispensed in person under earlier safety protocols.

“It is true, as the district court noted, that a § 705 stay ‘would, as a practical matter, have a nationwide effect.'” the court wrote, putting in plain terms the sweeping implications of the decision.

Judges sharply criticized the FDA’s handling of the drug’s safety data, saying the agency had “previously eliminated the requirement to report mifepristone’s adverse events,” and calling it “unreasonable” to remove reporting requirements and then rely on the resulting lack of data to justify expanded access.

This particular case, which came out of Louisiana, seems likely to move forward to the Supreme Court ahead of other states’ cases.

This case is one of several filed by GOP state attorneys general seeking to cut off access to pills that are being mailed to patients in their states in defiance of bans on abortion. Idaho, Kansas, and Missouri are making arguments similar to Louisiana’s in the hopes of a telehealth ban, while Florida and Texas are trying to go further and outlaw the sale of mifepristone altogether, challenging the 25-year-old FDA approval of the drug.

In all the lawsuits, the Trump administration has declined to defend the FDA’s rules for the drugs on the merits, and has instead argued the states lack standing or are acting prematurely, and has requested courts allow the agency to conduct its review without interference.

Naturally, Republicans are cheering the ruling…

The Biden administration endangered the lives of women and girls by removing safeguards for mifepristone. Today’s Fifth Circuit decision takes a big step to right this wrong. Let's make sure women and girls are protected from this dangerous drug.https://t.co/Hkhf7g5dp9

— Sen. James Lankford (@SenatorLankford) May 1, 2026

… while Democrats are mad about it.

This is yet another attack on reproductive care access. Access to mifepristone is particularly critical for women in rural and underserved communities where healthcare access is limited.

California will continue to fight like hell against those who seek to reach across our… https://t.co/4BRfKAyjix

— Governor Gavin Newsom (@CAgovernor) May 2, 2026

The drug companies, of course, have already asked for a stay in the ruling so they can file their appeal up the legal ladder.

On Friday night, Danco Laboratories, a mifepristone manufacturer and defendant in the lawsuit, filed a motion asking the Fifth Circuit to stay its ruling for a week for time “to seek relief in the United States Supreme Court.” The motion asked the court to rule on that request by 9 p.m. Central time “because the panel’s order threatens Danco with immediate harm.” If a weeklong stay is not issued, the company said it will file an emergency appeal with the Supreme Court.

It was unclear Friday night whether the Trump administration would seek a similar stay or appeal the ruling to the Supreme Court. Administration officials did not immediately respond to requests for comment.

The Trump administration probably does not want another high-profile abortion case in the docket right away, but even if the case does go to the Supreme Court, would it be heard immediately? Seeing as we are rapidly approaching the end of the current term, that seems unlikely. The FDA is supposedly reviewing all the data on mifepristone, as HHS Secretary Kennedy stated last October. One would assume that the administration would include that data in this case, once it actually is complete. Is the FDA slow-walking the assessment because they have concerns about the political implications, or are they trying to be as thorough as possible to avoid claims of “ignoring the science“?

The Supreme Court will have to decide if they should issue a stay on the Fifth Circuit’s ruling, or let it stand while the appeals process plays out. The idea that a drug like mifepristone could or should be prescribed via telehealth was always a dangerous concept to begin with, precisely because of what Gavin Newsom claims. If women in “rural or underserved communities” get the pill, take it, and then have complications because of an incomplete abortion, or an ectopic pregnancy, and they have never seen a doctor to begin with, whom exactly do they go to for follow-up care? Telehealth is a real game-changer in many ways, but in this case, when a woman is consciously seeking a specific drug for a specific purpose from a provider who they don’t know and have never met in person, is this is their best interests? And never mind the baby, whose potential life gets terminated in a “clean” fashion before it can even truly begin.

Democrats love the abortion pill because it allows them to push the lie that the growing embryo, doubling in size and rapidly developing in those first eight weeks after conception, is just a “clump of cells” of no more consequence than a bowel movement. Just take this pill and then flush away your problems, divorcing women from the reality of fetal development and the reality of motherhood. And if that fails, and something terrible, traumatic, or fatal happens, oh well! They chalk it up as a statistic and move on. There are legitimate medical uses for mifepristone, but that doesn’t mean that it should be handed out like candy to those who ask for it. Neither the court nor the FDA is likely to ban it outright, but treating it like what it is – a prescription medication that requires a doctor’s examination – is the least that can be done. We shall have to see how the Supreme Court decides to deal with – or punt – on this one.

Featured image via succo on Pixabay, cropped, Pixabay license