Justice Samuel Alito on Monday paused a federal appeals court ruling that had cut off mail-order and telehealth access to the abortion pill mifepristone nationwide, restoring the rules that governed dispensing of the drug as recently as Friday morning. The administrative stay, issued in response to emergency appeals from drugmakers Danco Laboratories and GenBioPro, will hold until 5 p.m. on May 11.

The order returns the country, for one week, to the dispensing regime in place before the 5th U.S. Circuit Court of Appeals sided with Louisiana on Friday and ordered the Food and Drug Administration to revert to a 2022 rule requiring patients to obtain mifepristone from a clinician in person. Medication abortions account for nearly two-thirds of all abortions in the United States, according to the Guttmacher Institute, and roughly 1 in 4 abortions were provided via telehealth by the end of 2024, according to KFF, a nonpartisan health policy research group. The case, brought by Louisiana against the FDA, now puts the legality of mailed and pharmacy-dispensed mifepristone before the Supreme Court for a second time in two years.

What the order does

Alito, who handles emergency matters out of the 5th Circuit, granted the stay in two brief orders. He directed Louisiana to file its response to the drugmakers' applications by 5 p.m. Thursday, May 7. The court has not said when it will rule on whether to extend the pause through the duration of the litigation or take up the merits of the case.

The 5th Circuit's Friday ruling, written by Judge Stuart Kyle Duncan, an appointee of President Trump, applied nationwide and took effect immediately, with no transition period. Duncan wrote that telemedicine access to mifepristone "injures Louisiana by undermining its laws protecting unborn human life and also by causing it to spend Medicaid funds on emergency care for women harmed by mifepristone. Both injuries are irreparable." The panel found Louisiana had standing because its Medicaid program had paid for emergency-room care for two women who suffered complications after receiving the drug from an out-of-state provider.

The drugmakers' case

Danco, which makes the brand-name Mifeprex, and GenBioPro, which makes a generic, told the court the appeals ruling "injects immediate confusion and upheaval into highly time-sensitive decisions." In its filing, Danco said patients with appointments scheduled for as soon as Monday morning "are in limbo," and that providers "who have already screened, counseled, and prepared patients for care may have to stop midstream." GenBioPro told the justices the order had "unleashed regulatory chaos" for clinicians and pharmacies that have prescribed and dispensed the drug remotely for years.

Dr. Angel Foster, founder of The Massachusetts Abortion Access Project, told Fox News her organization had been preparing Monday afternoon to ship a misoprostol-only regimen to patients before Alito's order allowed it to switch back to the two-drug protocol.

Where the litigation stands

The Louisiana suit is the second mifepristone case to reach the Supreme Court since the 2022 decision overturning Roe v. Wade. In 2024, the justices unanimously rejected a challenge from a group of anti-abortion physicians, ruling that the plaintiffs lacked standing. The new case targets the Biden administration's 2023 decision to make permanent the Covid-era waiver of an in-person dispensing requirement that had been suspended during the pandemic. Mifepristone, used with misoprostol to end pregnancies up to 10 weeks of gestation, has been taken by more than 7 million U.S. patients since the FDA first approved it in 2000.

The FDA in January asked the district court to pause the case while the agency completed a fresh safety review of the drug, commissioned by Health Secretary Robert F. Kennedy Jr. last year. A district judge in Louisiana agreed; the appeals court intervened anyway. Louisiana in 2024 also enacted a state law designating mifepristone and misoprostol as controlled substances and criminalizing their possession without a prescription.

The political response

White House spokesperson Allison Schuster said the administration "remains committed to the President's pro-life, pro-family, and pro-safety agenda and are closely following the active litigation on this issue," adding that the FDA "continues to work on a rigorous, Gold Standard Science review." Senate Minority Leader Chuck Schumer (D., N.Y.) called the stay welcome but said "this fight is just beginning." Louisiana Attorney General Liz Murrill, who brought the suit alongside the Alliance Defending Freedom, said the stay was "temporary, and I am confident life and the law will win in the end."

The counterpoint

Anti-abortion groups argue that home use of mifepristone is unsafe and that the FDA cut corners when it lifted the in-person rule. Kristan Hawkins, president of Students for Life, said in a statement that "Pill pushers receive every benefit of the doubt, including today, as Justice Alito allows pill traffickers and big pharma to operate temporarily while arguments are sent to the Court." Their core safety claim leans heavily on a report from the Ethics and Public Policy Center, a conservative think tank, that NBC News reported was not peer-reviewed or published in a medical journal and that researchers who study reproductive health have characterized as exaggerating the drug's risks. The FDA has consistently found mifepristone safe and effective.

Briefs from Louisiana are due Thursday. The administrative stay expires at 5 p.m. Monday, May 11, when the justices will decide whether to extend the pause, lift it, or take up the case on the merits.