A federal appeals court panel is scheduled to take up arguments Wednesday in a closely watched abortion pill case that could determine whether access rules are narrowed for a major medication used in the most common form of abortion in the United States. The dispute is part of a broader legal push to limit abortion access nearly four years after the U.S. Supreme Court returned abortion policy decisions to the states.
The case before the New Orleans-based 5th U.S. Circuit Court of Appeals is one of three moving through the courts as abortion opponents seek to stop clinicians in states where abortion remains legal from mailing or otherwise providing medication abortion pills to patients in states with bans or tighter restrictions.
The U.S. Food and Drug Administration has also said it is reassessing the current prescribing requirements and could ultimately recommend changes to how the drug is regulated.
The legal fight is unfolding during a midterm election year, as anti-abortion allies of President Donald Trump voice frustration that medication abortion has continued to provide a path around state bans, even as polling shows most voters support some level of abortion access.
The competing cases and regulatory questions could eventually leave the U.S. Supreme Court to decide how far states and federal agencies can go in shaping abortion pill access nationwide.
Medication abortion now accounts for at least three out of every five abortions in the U.S., typically using a two-drug regimen. The appeals court case centers on one of those medications: mifepristone.
Wednesday’s hearing stems from a lawsuit brought by Louisiana Attorney General Liz Murrill and Rosalie Markezich, who says she was pressured into taking abortion pills. A survey conducted for the Society of Family Planning, an organization that supports legal abortion access, estimated that in 2025 between 770 and 900 women in Louisiana received abortions each month through pills prescribed online or by doctors and nurse practitioners based in other states.
The three-judge panel assigned to hear the case includes two judges nominated by Democratic presidents Barack Obama and Joe Biden, along with one judge nominated by Republican President George W. Bush.
Three other three-judge panels on the 5th Circuit — one in this case and two in an earlier one — and two district courts have already agreed that rules for prescribing mifepristone are too loose.
But the Supreme Court unanimously rejected an effort to roll back availability in 2024 — not because of the core legal argument, but rather because the court found the anti-abortion groups who brought the challenge didn’t have legal standing to make it. The companies that make mifepristone argue that the states also lack legal standing.
Another ruling from the 5th Circuit would not immediately change the landscape because the Supreme Court has also blocked changes to the prescribing rules until it sees the case again. The FDA could also make changes without court approval — though such an action would surely be challenged.
Other GOP state officials are also challenging the FDA’s rules. The attorneys general of Florida and Texas have filed one lawsuit and the top government lawyers of Idaho, Kansas and Missouri have another.
Meanwhile, over the past year, federal judges in Hawaii and Virginia found that current FDA rules for mifepristone prescribing are too restrictive.
Abortion methods have changed since Roe was overturned
Abortion pills were already widely used before the Supreme Court overturned Roe v. Wade in the 2022 Dobbs v. Jackson Women’s Health Organization case that allowed states to enforce abortion bans.
Currently, 13 states ban abortion at all stages of pregnancy. Another four do so after about the first six weeks, before many women realize they’re pregnant. Most states controlled by Democrats have added protections for abortion providers — including some intended to offer legal backup for those who prescribe pills to patients in other states via telehealth services.
Opponents say that’s undermined the bans.
“This case is going to have a huge impact,” said Gabriella McIntyre, legal counsel at Alliance Defending Freedom, which is representing Murrill and the other plaintiff in the case. “The promise of the Dobbs decision was that states would be able to decide on their own how to regulate abortion.”
Abortion rights advocates also believe there would be major consequences if Louisiana eventually prevails. “They’re asking to restore an in-person requirement for every person across the country to access this medication regardless of whether they live in a state with strong legal protection for abortion access,” said Amanda Allen, executive director of the Abortion Coalition for Telemedicine.
The political situation is tricky for Trump
Anti-abortion groups who want to rein in pill access have been Trump’s key supporters.
Abortion opponents have called on the FDA to settle the lawsuit with Louisiana and roll back prescribing rules to how they were before telehealth prescriptions were allowed. They also want the administration to enforce an 1873 “anti-vice” law to bar mailing the pills.
But on state ballot questions and in public opinion polls, voters have generally supported legal abortion access in most cases.
The administration has been mostly quiet through the legal battles, even though the FDA, whose scientists have repeatedly found mifepristone to be safe and effective, is the defendant in the cases.
The FDA’s position could change. Trump’s latest nominee to head the agency, Dr. Heidi Overton, the deputy director of the White House Domestic Policy Council, has publicly criticized the agency for relaxing its prescribing rules for the drug — the most recent change coming in 2023.
The FDA says it’s studying mifepristone’s safety and reviewing prescribing rules around the drug. One judge ordered the agency to provide a status update by Oct. 7, less than a month before the midterm elections in which control of Congress is in play. It’s not clear how detailed an update might be — or when the full study could be completed.
Some states, including Mississippi and Texas, have adopted laws with civil or criminal penalties for those who prescribe abortion pills.
Prescribers are preparing to shift which drug they ship
Even if mifepristone access is curtailed, advocates say it won’t stop access to abortion pills.
The most common regimen for pills in the U.S. is a combination of mifepristone and misoprostol. Misoprostol, which is commonly used to treat stomach ulcers and has never been formally approved for abortion, can cause abortions on its own. According to the FDA label on mifepristone, the combination completes medical abortion 97.4% of the time. Some studies have found misoprostol’s individual effectiveness at around 80% or higher.
Organizations that prescribe abortion pills by telehealth for women who are in states with bans say they would shift to sending misoprostol alone if mifepristone could be dispensed only at medical clinics rather than at pharmacies and through the mail.
