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Update: A federal judge on April 7 refused Louisiana’s request to pause filling mifepristone prescriptions by mail while a court challenge to the 2023 federal policy proceeds. U.S. District Judge David Joseph said his decision was not final and he could side with Louisiana later.

A federal judge in Louisiana is weighing whether to roll back a key federal policy change that has allowed abortion patients to receive mifepristone—one of the two drugs used in the most common medication abortion regimen—through certified pharmacies and the mail. Abortion providers and legal advocates say the case, brought by Louisiana’s attorney general, is part of a broader effort to choke off access to medication abortion nationally, including in states where abortion remains protected.

The lawsuit, State of Louisiana et al. v. Food and Drug Administration et al., challenges the FDA’s 2023 revision to the mifepristone Risk Evaluation and Mitigation Strategy (REMS), which removed an in-person dispensing requirement and helped expand access to telehealth abortion care. Louisiana has banned abortion in almost all circumstances, but the state’s lawsuit takes aim at the federal rules that govern how mifepristone can be dispensed nationwide.

Last week, U.S. District Judge David Joseph in the Western District of Louisiana heard arguments on Louisiana’s request for a temporary court order while the case proceeds, which would reimpose the in-person requirement nationwide, forcing patients to obtain mifepristone directly from a health care provider, rather than through a local pharmacy or by mail. The judge did not issue a decision during the hearing and asked the FDA to submit additional written arguments. Those filings have now been submitted, and a ruling could come at any time.

If the judge grants Louisiana’s request for a preliminary injunction, it could effectively recreate an earlier era of access when patients had to travel to a clinic to obtain abortion medication in person.

“It is completely inappropriate for Louisiana to try to export its own restrictive laws in this way,” said Caroline Sacerdote, a senior staff attorney at the Center for Reproductive Rights who litigates reproductive rights cases. Sacerdote said the state’s request would impose barriers across the country, even for patients and providers in states that protect abortion rights.

Reinstating the in-person requirement would have immediate consequences for people living far from abortion clinics, Sacerdote said, including those in rural areas where “the nearest clinic can be hundreds of miles away.” Patients could be forced to travel long distances, cross state lines, or even fly to reach care.

Louisiana has argued that the court should act quickly because medication abortion undermines the states’ ability to enforce its abortion laws and creates ongoing harm that requires immediate action. But Sacerdote called the alleged emergency medically baseless.

“There is absolutely no medical basis for reinstating that unnecessary in-person dispensing requirement,” she said, adding that mifepristone is safe, effective, and “incredibly important for access.”

Telehealth is embedded in modern health care delivery, said Dr. Libby Wetterer, a family medicine physician in Pennsylvania and a former Physicians for Reproductive Health fellow who provides abortion care in brick-and-mortar settings and through online services.

During the COVID-19 pandemic, Wetterer said health care broadly shifted to include telehealth options, and abortion care followed once federal rules allowed clinicians to send prescriptions to pharmacies or mail directly to patients.

In practice, Wetterer said, telehealth medication abortion appointments often look like other telehealth visits: Clinicians counsel patients on how to take the medications and what to expect, and they evaluate safety using a patient’s medical history and questions about the length of the pregnancy. 

“The main difference that people think about is an ultrasound,” Wetterer said, but growing evidence supports no-test models for many patients, based on accurate last menstrual period reporting and symptom screening.

That model can reduce not just travel, but also the hidden costs that shape abortion access: missed work, child care, transportation, and the risk of encountering harassment outside clinics.

Telehealth can also be a cost-saving option, Wetterer said, because providers who don’t need to maintain physical clinic infrastructure for every appointment can sometimes offer care at a lower price, particularly important when insurance doesn’t cover abortion.

The FDA’s 2023 REMS change formalized an access shift that had already been playing out for years, Sacerdote said, after the in-person requirement had been effectively lifted for several years. Over that period, she said, “we saw … that mifepristone continues to be safe and it continues to be effective,” including when provided through telemedicine.

Wetterer described the extensive research showing telehealth medication abortion is as safe as in-person care. 

“It’s the exact same safety profile, which is incredibly safe,” Wetterer said.

That’s why, to Sacerdote and Wetterer, the Louisiana case feels like an attempt to use federal regulation to achieve what abortion bans seek locally: making abortion harder to get in practice.

“Anti-abortion extremists really are trying to turn back the clock,” Sacerdote said, arguing there is no medical reason to carve abortion out from broader telehealth laws and norms.

Wetterer said the stakes are especially high in the post-Dobbs landscape, when telehealth and mailed pills have helped stabilize overall abortion access even as many states have enacted bans.

“It’s weird to say ‘lucky,’” Wetterer said, “but … we’ve seen the amount of abortions stay stable or even increase” in part because telehealth and mail access expanded reach to patients who previously lacked practical access, even under Roe.

If telehealth access is restricted, Wetterer and Scardote said, the restrictions won’t land evenly.

Sacerdote said communities already facing barriers to health care would bear the brunt: people living in rural areas, people with disabilities, and communities of color, who often confront compounded obstacles in accessing care. Wetterer added that geography matters even in protective states. 

“Just because there’s lots of abortion access doesn’t mean it’s easy for someone to get there logistically,” Wetterer said, noting that large states with rural areas can still leave patients far from clinics.

The Louisiana case is one piece of what advocates describe as a multi-front strategy to restrict medication abortion through courts and federal regulatory pressure. While Joseph, the district judge, considers Louisiana’s emergency request, the federal government has asked the court to pause the case while the FDA conducts a new review of mifepristone. The judge has not ruled on that request either, Sacerdote said.

Meanwhile, GenBioPro, the manufacturer of generic mifepristone, has moved to intervene in the case to defend both access to its product and the FDA’s regulatory authority. The court granted GenBioPro’s motion to intervene on Feb. 24, according to a statement from the company’s legal team.

Beyond Louisiana, states are testing new legal strategies to reach across borders and target abortion pill providers.

In Texas, Attorney General Ken Paxton filed suit on Feb. 24 against Aid Access, a nonprofit that provides access to medication abortions, a California-based physician, and Aid Access founder Rebecca Gomperts, alleging that they prescribed and mailed abortion pills into Texas in violation of the state’s abortion ban. The lawsuit is among a series of cases testing whether “shield laws” in states that protect abortion can insulate providers from enforcement actions brought by states with bans.

For Sacerdote, that broader landscape underscores what she sees as the danger of Louisiana’s approach: using one state’s restrictive policy preferences to reshape access far beyond its borders.

She pointed to a recent example from Arizona, where she said abortion providers successfully challenged a state telemedicine ban under a new state constitutional amendment protecting abortion rights. A nationwide rollback of FDA policy, she warned, could still “hamper their ability to actually incorporate telehealth,” despite state-level legal protections.

The next major development in Louisiana v. FDA will be Joseph’s decisions on two questions: whether to grant Louisiana’s request for a preliminary injunction restoring an in-person dispensing requirement, and whether to pause the case during the FDA’s review. After that, Sacerdote said, the case could move quickly to the appellate level.

For patients and providers trying to track fast-moving litigation, Wetterer recommended monitoring the UCLA Law mifepristone litigation tracker and staying connected to advocacy updates through major reproductive health organizations. “Further restricting access to medication abortion really would exacerbate the growing public health crisis that has been unfolding since Roe v. Wade was overturned,” Sacerdote said. “It could cut off the last line of access for many pregnant people.”

Editorial Team:
Sahar Fatima, Lead Editor
Lara Witt, Top Editor
Stephanie Harris, Copy Editor