Abortion pill access faces new legal test as court weighs tighter rules

A panel of federal judges in New Orleans is set to hear arguments Wednesday over whether prescribing rules for mifepristone — a key drug in the most common abortion method in the United States — should be tightened. The case is one of several ongoing efforts to restrict abortion access four years after the Supreme Court left the issue to the states.

The dispute before the 5th U.S. Circuit Court of Appeals centers on whether current rules, which allow the drug to be prescribed via telehealth and dispensed through mail-order pharmacies, are too permissive. The case was brought by Louisiana Attorney General Liz Murrill and Rosalie Markezich, who says she was coerced into taking abortion pills.

At least three in five U.S. abortions now use a two-drug combination, with mifepristone being one component. A survey conducted for the Society of Family Planning estimates that between 770 and 900 women in Louisiana obtained abortions each month in 2025 using pills prescribed online or by out-of-state providers.

The three judges hearing the case include two nominated by Democratic presidents and one by a Republican. Two earlier three-judge panels on the same circuit, as well as two district courts, have already agreed that prescribing rules are too loose. However, the Supreme Court unanimously rejected a similar effort in 2024, not on the merits but because the anti-abortion groups bringing the challenge lacked legal standing.

Mifepristone manufacturers argue that states also lack standing to sue. Even if the 5th Circuit rules against them, the Supreme Court has blocked changes to prescribing rules until it reviews the case again. The FDA could also alter the rules on its own, though such a move would likely face legal challenges.

Other Republican state officials are pursuing separate lawsuits against FDA rules. Attorneys general from Florida and Texas have filed one case, while top government lawyers from Idaho, Kansas, and Missouri have filed another. Meanwhile, federal judges in Hawaii and Virginia have found current FDA rules too restrictive.

Abortion pills were widely used before the Supreme Court overturned Roe v. Wade in the 2022 Dobbs decision. Currently, 13 states ban abortion at all stages of pregnancy, and four more restrict it after about six weeks. Many Democratic-controlled states have added protections for providers who prescribe pills to patients in other states via telehealth.

Opponents argue these shield laws undermine state bans. "This case is going to have a huge impact," said Gabriella McIntyre of Alliance Defending Freedom, which represents the plaintiffs. Abortion rights advocates warn that a ruling for Louisiana could restore in-person requirements nationwide, affecting patients even in states with strong legal protections.

The FDA, whose scientists have repeatedly found mifepristone safe and effective, is the defendant in these cases. The agency says it is reviewing prescribing rules and studying the drug's safety. Trump's latest nominee to head the FDA, Dr. Heidi Overton, has publicly criticized the agency for relaxing rules around the drug.

Even if mifepristone access is curtailed, advocates say it would not end access to abortion pills. The most common regimen combines mifepristone with misoprostol, which can also cause abortions on its own. Some studies put misoprostol's individual effectiveness at around 80% or higher. Organizations that prescribe pills by telehealth say they would shift to misoprostol alone if mifepristone could only be dispensed at medical clinics.