Abortion Pill Mail Access Continues

The Supreme Court kept mifepristone legal to ship through the mail Thursday, pausing a 5th Circuit ruling while lower courts continue fighting it out.

State of play: Louisiana had won a ruling from the 5th Circuit last month reinstating the old in-person dispensing requirement for mifepristone — effectively banning mail-order medication abortions into the state. The drug's manufacturers, Danco and GenBioPro, ran to SCOTUS. The Court's order keeps the pre-ruling status quo alive while litigation proceeds.

Catch up quick: This fight has been running since at least 2023.

• A federal judge in Texas initially tried to rescind the FDA's original 2000 approval of mifepristone entirely.
• SCOTUS unanimously tossed that case in 2024 — the anti-abortion doctors suing didn't have standing.
• Louisiana then filed its own federal suit, and the 5th Circuit ruled in the state's favor this spring.

The two dissenters didn't pull punches. Justice Thomas argued the drug companies have no right to emergency relief because mailing abortion drugs violates the Comstock Act — a 19th-century federal law making it a crime to ship abortion-related materials through the mail. His position: you can't claim irreparable harm from losing profits in a criminal enterprise. Justice Alito called the Court's order "remarkable" and argued it props up a deliberate scheme by blue states — using "shield" laws to protect out-of-state doctors who mail mifepristone into states where abortion is banned — that wouldn't have been possible without the FDA's 2021 and 2023 rule expansions.

The legal question: Standing. Again. Louisiana argued it has the right to sue because it's spent real money — $17,000 investigating mail shipments, $92,000 in Medicaid costs from complications — and because federal policy directly conflicts with its state law. Danco fired back that Louisiana's theory is actually weaker than the standing theories SCOTUS already rejected in 2024.

What to watch: The FDA is conducting its own safety review of mifepristone. That review is the wild card — if it concludes while this litigation is pending, it could reshape the entire legal posture. Alito even flagged it: unless the 5th Circuit's order pushes the FDA to move faster, the manufacturers may not face any real harm anyway.

The bottom line: Nothing is settled. The pill stays in the mail for now, but this case is heading back through the lower courts with Louisiana still swinging — and two Supreme Court justices already on record that they'd have ruled the other way.