A federal appeals court on Friday temporarily halted the 2023 FDA rule permitting mifepristone prescriptions via telemedicine and mail, significantly restricting access to the drug used in most U.S. abortions.
The order from the 5th U.S. Circuit Court of Appeals hands Louisiana a major win and sets up an emergency appeal to the Supreme Court.
A unanimous three-judge panel granted Louisiana's motion to stay the FDA's 2023 Risk Evaluation and Mitigation Strategy. This ruling lifts a long-standing requirement that mifepristone be dispensed in person.
The order has a nationwide effect and "temporarily voids the challenged authority" while Louisiana's appeal proceeds, the panel wrote. The court found the state likely to prevail on the merits.
The opinion was written by Circuit Judge Kyle Duncan and joined by Judges Leslie Southwick and Kurt Engelhardt. Duncan and Engelhardt are Trump appointees; Southwick was appointed by President George W. Bush.
The panel rejected the Trump administration's argument that Louisiana lacks standing and should wait for the FDA's own ongoing safety review. It also turned aside drugmakers Danco Laboratories and GenBioPro, intervenors who urged deference to FDA scientific judgment.
The panel credited Louisiana's claims of sovereign and financial harm, citing roughly $92,000 in state Medicaid costs in 2025 from emergency care for two women with mifepristone complications, and a record indicating the rule facilitates nearly 1,000 illegal abortions in Louisiana per month.
The FDA and the public, the court reasoned, have no interest in enforcing a regulation that likely violates federal law, and pausing it does not stop the agency review.
The decision overrides an April 7 ruling by U.S. District Judge David C. Joseph, a Trump appointee, who agreed Louisiana was likely to win on the merits but stayed the case to let the FDA finish its review, with a status report due Oct. 7. Joseph warned that granting Louisiana's request without that review would amount to "government by lawsuit."
The Trump administration has declined to defend the 2023 rule on the merits in this and parallel cases, pressing procedural arguments and urging courts to wait.
The ruling reframes the legal challenge to medication abortion around state sovereignty injuries, a theory the Supreme Court left unresolved when it dismissed an earlier industry-wide suit in 2024 on standing grounds.
Idaho, Kansas and Missouri are pursuing similar telehealth challenges; Florida and Texas are trying to undo the FDA's 25-year-old approval entirely.
A Supreme Court appeal is widely expected.
Until the justices act, the practical effect is immediate: telehealth providers built around the 2023 rule face nationwide disruption, and patients in states where abortion remains legal lose the mail-order option for medication abortion.
Reuters contributed to this report.
Jim Thomas ✉
Jim Thomas is a writer based in Indiana. He holds a bachelor's degree in Political Science, a law degree from U.I.C. Law School, and has practiced law for more than 20 years.
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