A federal appeals court on Friday blocked the mailing of the abortion pill mifepristone under current Food and Drug Administration (FDA) rules, a move the court acknowledged would, "as a practical matter, have a nationwide effect," one that sets up a likely Supreme Court battle over abortion access.
The 5th U.S. Circuit Court of Appeals ruling could restrict abortion pill access across the country, restoring rules supporters say protect patient safety and state authority, while critics warn it will make access harder even in states where abortion remains legal.
The decision means women will now have to see a medical professional to obtain a mifepristone prescription, restoring a requirement that had been lifted during the COVID-19 pandemic under former President Joe Biden.
Mifepristone is one of two drugs commonly used in medication abortions and accounts for a majority of abortions in the U.S., according to research from the Guttmacher Institute.
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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.
The ruling also sided with arguments from pro-life states, including Louisiana, which said federal policy undermined their abortion laws.
"Every abortion facilitated by FDA's action cancels Louisiana's ban," the court wrote, adding that the state's policy recognizes "every unborn child is [a] human being … from the moment of conception.
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"Once lost, that sovereign prerogative of protecting unborn life cannot be regained."
The ruling marks a major escalation in the legal fight over abortion drugs, pitting federal regulators against states seeking to enforce stricter abortion laws after the Supreme Court's 2022 decision overturning Roe v. Wade.
Pro-life groups quickly praised the decision.
"This is a win we've been waiting for, and we pray it holds," Students for Life President Kristan Hawkins said.
"We can't remain the United States of America if abortion-loving states allow criminal enterprises to be set up, breaking the laws of their pro-life neighbors."
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Family Research Council President Tony Perkins called the ruling "great news for the unborn," adding that the issue "should be before the U.S. Supreme Court soon."
Pro-choice advocates sharply criticized the decision.
New York Attorney General Letitia James said mifepristone is "safe, effective and essential," calling the ruling "yet another cruel attack on abortion access."
"Restrictions on abortion care are restrictions on life-saving health care," she added.
As Fox News Digital previously reported, a federal judge had allowed mifepristone to remain available by mail on a temporary basis last month while legal challenges and federal review efforts continued.
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Judge David C. Joseph previously cautioned against "government by lawsuit," emphasizing that the FDA's ongoing safety review, not litigation, should determine long-term policy.
That review remains underway, with the Department of Health and Human Services and the FDA tasked with examining safety data, adverse events and the regulatory framework on mifepristone.
Louisiana Attorney General Liz Murrill had argued the policy caused "irreparable harm every day" it remained in place, warning expanded access was designed to "reach into jurisdictions like Louisiana" despite state-level abortion restrictions.
Friday's ruling now sets up a likely appeal to the Supreme Court, where a new challenge to federal authority over abortion drug regulation could take center stage.
The Associated Press contributed to this reporting.
