The Supreme Court of the United States (“SCOTUS”) temporarily reinstated[1] the ability of patients to receive mifepristone via mail-order after a telehealth visit following a recent decision by the U.S. Court of Appeals for the Fifth Circuit (the “Fifth Circuit”) staying implementation of guidelines previously adopted by the Food and Drug Administration (the “FDA”) that eliminated in-person physician consultation and dispensing requirements for the drug. This action effectively maintains the current status quo while SCOTUS weighs ongoing arguments that could dramatically impact access to abortion and other reproductive care services.
In the wake of the Dobbs[2] decision in 2022, which effectively eliminated the nationwide right to abortion, some states took steps to limit access to abortions, including through strict bans. As a counter, the FDA took steps to formally alter its safety guidelines related to mifepristone by allowing patients to secure prescriptions for the drug through mail-order following a telehealth visit (the “Updated Safety Guidelines”). The Updated Safety Guidelines effectively eliminated in-person physician consultation and dispensing requirements for mifepristone. Separately, some states further countered by enacting protections for providers (also referred to as “Shield Laws”) prescribing mifepristone via mail-order following telehealth consultations, including to patients residing in states with strict abortion bans.
On May 1, 2026, the Fifth Circuit issued a ruling[3] staying implementation of the Updated Safety Guidelines (the “Ruling”), effectively reinstating the in-person physician consultation requirement and eliminating the option for patients to obtain mifepristone prescriptions via mail-order following telehealth consultation. The Ruling culminated after Louisiana sued the FDA in 2025 in an effort to restrict access to mifepristone. Notably, Louisiana argued that the FDA’s actions to alter the safety guidelines for mifepristone effectively permitted the drug to be prescribed online without an in-person provider consultation, and permitted mifepristone to be dispensed through the mail in circumvention of in-person dispensing standards. Louisiana further argued that the FDA’s adjustments to its safety guidelines were based on flawed or nonexistent data, and that such adjustments resulted in numerous illegal abortions in Louisiana and caused the state’s Medicaid program to incur abortion-related costs.
Following the Ruling, one of the manufacturers of mifepristone asked SCOTUS to intervene, arguing that the Ruling “injects immediate confusion and upheaval into highly time-sensitive medical decisions.” In response, SCOTUS entered an administrative order staying implementation of the Ruling and extended that stay until May 14, 2026, but did not provide any supporting rationale for its decision. As a result, it remains unclear whether SCOTUS will extend the stay beyond the May 14, 2026 expiration date, which leaves patients, providers, and other stakeholders in a state of uncertainty. Notably, if SCOTUS elects to allow the Ruling to take effect, patients on a nationwide basis would no longer be able to rely on the Updated Safety Guidelines and would be prohibited from receiving mifepristone prescriptions by mail-order following a telehealth consultation. In effect, the rollback of the Updated Safety Guidelines would affect providers in every state, not just within the Fifth Circuit.
UPDATE: The United States Supreme Court entered an order on May 14, 2026, staying the Fifth Circuit’s Ruling pending disposition of the appeal to the Fifth Circuit and petition for certiorari before the Supreme Court. As a result, the FDA’s Updated Safety Guidelines remain in effect, and mifepristone remains available by mail-order following a telehealth consultation.
FOOTNOTES
[1] Danco Labs. v. Louisiana, et al., No. 25A1207, 2026 WL 1204237 (U.S. May 4, 2026).
[2] Dobbs v Jackson Women’s Health Org., 597 U.S. 215 (2022).
[3] Louisiana v. Food & Drug Administration, et al., No. 26-30203, 2026 WL 1194924 (5th Cir. May 1, 2026).