The fight over the abortion pill: mifepristone access and doctors who mail it

The case, brought by the Alliance for Hippocratic Medicine, reached the Supreme Court after the Fifth Circuit appeals court ruled to restrict the drug in August 2023.^[20][21] Before the argument, a publisher retracted studies the Texas judge had relied on.^[22] On June 13, 2024, the court unanimously rejected the challenge, ruling that the anti-abortion doctors who brought it lacked standing to sue.^[3] Walgreens and CVS began selling the drug in some states,^[23] and a survey found that about 8,000 women a month were getting abortion pills despite their states' bans or restrictions, often through telehealth.^[24] Louisiana became the first state to classify mifepristone and misoprostol as controlled dangerous substances.^[25][26]

With Donald Trump's return, the fight moved to doctors who prescribe the pills across state lines under shield laws meant to protect them. Texas Attorney General Ken Paxton sued a New York doctor for mailing pills to Texas,^[27] and a Texas judge fined her more than $100,000;^[28] a Louisiana grand jury indicted a New York doctor, Margaret Carpenter, on charges of prescribing pills to a pregnant minor, and New York Gov. Kathy Hochul signed a law to shield prescribers' identities.^[5][29] Texas passed a law letting residents sue out-of-state pill providers,^[30] and a California doctor became the first sued under it.^[6] Gov. Gavin Newsom refused Louisiana's request to extradite a California doctor it had charged with mailing pills.^[31][32] Meanwhile three states pressed a new suit before the same Texas judge,^[33] the FDA approved a new generic version of the drug, angering conservatives,^[34] and Republican Sen. Josh Hawley introduced a bill to withdraw its approval.^[35]

In May 2026 an appeals court temporarily blocked the federal rule allowing mifepristone to be dispensed by mail,^[36] and after a short stay signed by Justice Samuel Alito, the Supreme Court kept telemedicine and mail access in place.^[37][4] Anti-abortion groups then urged Attorney General Todd Blanche to stop the mailing of abortion pills,^[38] three states with near-total bans asked the Supreme Court to strike down shield laws,^[7] and the FDA said its safety review of the drug would run into next year, a timeline abortion opponents quickly condemned.^[8]