The Fifth U.S. Circuit Court of Appeals will hear arguments Wednesday over Louisiana’s bid to reinstate in-person dispensing requirements for mifepristone, a case that could affect access to the abortion drug nationwide.
By yourNEWS Media Newsroom.
A federal appeals court in New Orleans will hear arguments Wednesday in a closely watched challenge to federal rules allowing the abortion drug mifepristone to be prescribed through telehealth and mailed to patients, including those living in states where abortion is banned.
Louisiana Attorney General Liz Murrill and co-plaintiff Rosalie Markezich are challenging the Food and Drug Administration’s 2023 decision eliminating an in-person dispensing requirement for mifepristone. Alliance Defending Freedom represents the plaintiffs. The hearing before the Fifth U.S. Circuit Court of Appeals is scheduled to begin Wednesday morning.
Louisiana argues that the FDA’s rules interfere with enforcement of the state’s abortion laws by allowing pills prescribed elsewhere to enter the state through the mail. The state also contends it incurs Medicaid expenses when residents require treatment after using mifepristone obtained from out-of-state providers. Markezich alleges she was coerced into taking abortion medication ordered through the mail by a former boyfriend.
The case carries consequences beyond Louisiana because the relief sought concerns federal FDA regulations that operate nationwide. If the challengers ultimately succeed in restoring an in-person dispensing requirement, mail-order access could be restricted even in states where abortion remains legal. Abortion is currently banned at all stages of pregnancy in 13 states, while other states have enacted laws intended to protect providers who prescribe abortion medication across state lines.
The FDA approved mifepristone in 2000. During the COVID-19 pandemic, the agency stopped enforcing the requirement that the drug be dispensed in person and formally removed that restriction in 2023, allowing certified pharmacies to distribute mifepristone by mail.
The litigation has already produced conflicting rulings.
A federal district court in April allowed Louisiana’s challenge to proceed but paused the case while the FDA conducts a new review of mifepristone’s safety requirements. Louisiana appealed, and on May 1 the Fifth Circuit suspended the 2023 dispensing rules while the appeal continued.
Drugmakers Danco Laboratories and GenBioPro then sought emergency intervention from the Supreme Court. On May 14, the justices stayed the Fifth Circuit’s order, allowing the existing FDA rules to remain in effect while the appeal proceeds. Justice Clarence Thomas dissented.
The Justice Department, representing the FDA under the Trump administration, has not joined Louisiana’s effort to immediately suspend the current rules. Instead, federal attorneys have sought to keep the litigation paused while the agency completes its ongoing review. The FDA began that review in 2025 and has said it is examining whether changes to mifepristone’s existing safeguards are warranted.
That position has frustrated some abortion opponents who have pressed the Trump administration to reverse Biden-era changes permitting broader mail distribution of the drug.
Danco and GenBioPro, meanwhile, argue that Louisiana lacks legal standing and that reinstating the in-person requirement would disrupt a nationwide system used by pharmacies, physicians and patients. In their Supreme Court filings, the manufacturers argued that abruptly suspending the 2023 rules would force significant changes throughout the mifepristone distribution system.
The dispute follows the Supreme Court’s 2024 decision in FDA v. Alliance for Hippocratic Medicine, which rejected an earlier challenge to mifepristone because the physician plaintiffs lacked standing. The justices did not decide whether the FDA acted lawfully when it loosened restrictions on the drug.
Louisiana is not the only state pursuing the issue.
Florida and Texas have filed a separate lawsuit challenging multiple FDA actions involving mifepristone and misoprostol. A federal judge on Aug. 30 declined to dismiss that case but paused it until Dec. 1 or until the FDA completes its current review, whichever comes first.
The Fifth Circuit case presents one of the most significant tests yet of how federal drug regulation and conflicting state abortion laws interact following the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision.
At issue Wednesday is not whether mifepristone remains federally approved, but whether Louisiana can use the federal courts to force the FDA to restore restrictions on how the drug is dispensed — restrictions that would potentially extend well beyond Louisiana’s borders.
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