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Samuel Alito on Monday temporarily blocked a lower court order that would have sharply curtailed access to the abortion pill mifepristone, preserving for now a federal rule allowing the drug to be prescribed online and delivered by mail.
The administrative stay pauses a decision from the U.S. Court of Appeals for the Fifth Circuit that had moved to reinstate older restrictions on the medication. Alito’s order gives the Supreme Court of the United States time to consider emergency appeals from drugmakers seeking to keep current access in place while litigation continues.
The stay will remain in effect until 5 p.m. on May 11. Alito also directed Louisiana officials to respond to the appeal by Thursday.
Access preserved — for now
The case centers on mifepristone, one of two drugs used in medication abortions and among the most widely used methods of terminating pregnancies in the United States.
The Food and Drug Administration first approved mifepristone in 2000 and has gradually expanded access over the past decade. In 2023, the agency formally allowed the drug to be prescribed via telehealth and shipped by mail, building on pandemic-era policies that removed in-person dispensing requirements.
Friday’s ruling from the 5th Circuit would have rolled back those changes, requiring patients to obtain the medication in person from a provider. That decision immediately triggered warnings from drug manufacturers about disruptions to care.
Alito’s intervention maintains the current system — at least temporarily — avoiding what manufacturers described as widespread confusion for patients and providers.
Drugmakers warn of “regulatory chaos”
The appeals were filed by Danco Laboratories and GenBioPro, which argued that the lower court ruling would create immediate uncertainty across the country.
“The Fifth Circuit’s unprecedented order forces patients, providers, and pharmacies into immediate uncertainty,” Danco wrote in its filing, noting that some patients already scheduled for treatment could be left without care.
GenBioPro warned the ruling could “abruptly cut off access” nationwide, including in states where abortion remains legal, particularly affecting patients in rural areas or those unable to travel for in-person visits.
Louisiana challenge drives case
The dispute stems from a lawsuit brought by the state of Louisiana, which challenged the FDA’s decision to allow mail distribution of the drug.
A federal district court had paused the case earlier this year, keeping the FDA’s relaxed rules in place. But the 5th Circuit stepped in Friday, siding with Louisiana officials and finding the state had standing to sue.
The appellate panel said the policy harms the state by undermining its abortion laws and increasing Medicaid costs tied to complications from the drug.
Louisiana bans most abortions following the 2022 decision overturning Roe v. Wade and has also classified abortion medications, including mifepristone and misoprostol, as controlled substances under state law.
Familiar fight returns to high court
The case marks the second time in recent years the Supreme Court has been asked to weigh in on access to mifepristone.
In 2024, the justices unanimously rejected a challenge brought by anti-abortion rights groups, ruling those plaintiffs lacked legal standing to sue the FDA. That decision left intact the agency’s broader efforts to expand access to the drug.
The current dispute, however, arrives under different circumstances, with a state government directly challenging federal policy — a legal posture that could give the court a clearer path to address the merits.
Alito’s temporary order does not resolve the underlying legal questions but signals the court is likely to take a closer look at the case.
The justices could extend the stay, lift it, or agree to hear the case in full — a move that would set up a major ruling on the future of medication abortion access nationwide.
For now, patients can continue to receive prescriptions for mifepristone via telehealth and obtain the drug by mail, maintaining a system that has become a central part of abortion access in the United States since the fall of Roe.
