Supreme Court delays ruling on mail-order abortion pills, impacting Mississippi access
The Supreme Court on Monday paused its decision on whether to restrict the mailing and telehealth prescribing of mifepristone, one of the primary medications used for medication abortions. The court will decide by Thursday whether to impose restrictions that could limit access for many Mississippians, according to court documents.
The case originated from a lawsuit filed by Louisiana in 2025, claiming that allowing out-of-state access to abortion medication via telehealth undermines the state’s abortion ban. The lawsuit does not target misoprostol, the other drug used in abortion care, but experts warn that a ruling could lead to bans on telehealth prescriptions for misoprostol as well.
Rachel Jones, a research scientist at the Guttmacher Institute, called the case “the biggest upset since the Dobbs decision” in 2022, which overturned the federal right to abortion. Since then, telemedicine has expanded, enabling patients in states with bans to access abortion pills by mail. A ruling to restrict mifepristone could significantly reduce access, experts say.
Mississippi recently enacted a law criminalizing the use of abortion-inducing drugs starting July 1. However, legal protections like abortion shield laws may allow Mississippians to continue obtaining mail-order medications, as the laws protect providers from out-of-state investigations. Still, doctors may hesitate to prescribe these drugs for non-abortion reasons, such as miscarriage management, out of fear of legal repercussions.
In 2023, medication abortions made up 65% of all U.S. abortions, with monthly totals in Mississippi ranging from 200 to over 600. A federal restriction on mail-order mifepristone could alter this landscape, especially if telehealth access is curtailed and shield laws prove ineffective against federal limits, said Ziegler, a law professor and abortion historian at UC Davis.
The legal battle began in October 2025, when Louisiana sued the Food and Drug Administration, arguing that out-of-state mail delivery of abortion medication violates its laws. Federal courts have since issued rulings affecting telehealth access, with the Supreme Court’s intervention providing a temporary extension through Thursday.
Mifepristone is FDA-approved only for medication abortions and treating high cortisol levels in Cushing’s syndrome. Its limited approved uses make it a target for anti-abortion advocates, who argue for restricting access. Dr. Kristin Lyerly, an OB-GYN from Wisconsin, noted that stigma and politics have hindered broader approval and research for the drug.
Off-label uses of mifepristone include aiding in miscarriage management, where it, combined with misoprostol, is considered highly effective. Experts emphasize that misoprostol-only regimens remain safe and effective but are less optimal than combination therapy. A potential ruling in favor of Louisiana raises concerns that other drugs, including misoprostol, could face similar bans, Lyerly said.
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