Federal Appeals Court Blocks Remote Prescribing of Abortion Medication Nationwide
Why It Matters
A federal appeals court ruling issued Friday could significantly alter how women in abortion-ban states access abortion medication, with ripple effects felt across the country — including in states that have relied on mail-based prescribing to serve patients traveling from more restrictive states. The decision immediately blocks a pathway used for more than one-quarter of all abortions in the first half of 2025.
For patients in states with near-total abortion bans who have relied on telehealth providers in other states, the ruling means they may now be required to physically travel out of state to obtain the medication in person — adding time, cost, and logistical burden.
What Happened
The U.S. Court of Appeals for the 5th Circuit issued a decision Friday blocking a 2023 Food and Drug Administration rule that had allowed mifepristone — one of two drugs used to terminate a pregnancy before 10 weeks — to be dispensed without an in-person visit to a healthcare provider. The ruling applies nationwide while underlying litigation continues in lower court.
Louisiana Republican Attorney General Liz Murrill had sued the FDA in October, challenging the 2023 provision. A lower court initially declined to block the rule, with U.S. District Judge David C. Joseph saying a stay was premature while the FDA completed a safety review of mifepristone. Louisiana appealed that decision to the 5th Circuit, which reversed course and imposed the block.
The three-judge panel — consisting of Judge Leslie Southwick, an appointee of former Republican President George H.W. Bush, and Judges Stuart Kyle Duncan and Kurt D. Engelhardt, both appointed by President Donald Trump — issued the decision without any dissent.
Friday’s ruling explicitly cited Louisiana’s interest in protecting unborn life, stating: “Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person.'”
By the Numbers
- More than 27% of all abortions in the first six months of 2025 were provided through telehealth appointments, according to the Society of Family Planning.
- Nearly 15,000 abortions per month were provided under state shield laws during that same period.
- 13 states have near-total abortion bans in effect, meaning residents there would now likely need to travel across state lines for in-person care.
- Louisiana’s Medicaid program identified $92,000 spent on emergency care for two women in 2025 who suffered complications the state attributed to out-of-state mifepristone use.
- A combined review of studies spanning 2005 to 2015 found severe complications — including hospitalization or blood transfusion — occurred in less than 1% of mifepristone cases.
Zoom Out
The 5th Circuit’s decision comes amid a broader national legal landscape in which courts are reassessing federal agency authority — including the FDA’s regulatory reach. The ruling could set the stage for an emergency appeal to the U.S. Supreme Court, which has already been active in reviewing questions tied to federal power and state sovereignty. The Supreme Court recently limited race-conscious congressional redistricting, signaling continued willingness to roll back expansive federal interpretations of law.
In recent years, a network of states — primarily in the Pacific Northwest, Mountain West, and Midwest — enacted so-called shield laws to protect providers who mail abortion medication across state lines into ban states. Friday’s ruling undermines that network’s effectiveness by targeting the FDA authorization those providers relied upon. The FDA retains the option to file an emergency appeal to the Supreme Court, which has recently signaled alignment with the current administration on a range of contentious legal questions.
Attorney General Murrill credited the Alliance Defending Freedom for helping secure the ruling. “Today, that nightmare is over, thanks to the hard work of my office and our friends at Alliance Defending Freedom,” Murrill said in a public statement. “I look forward to continuing to defend women and babies as this case continues.”
What’s Next
The block on the 2023 FDA rule will remain in effect as the lower court case moves forward. The FDA can file an emergency appeal to the U.S. Supreme Court in the coming weeks, which legal observers expect may happen given the nationwide scope of the ruling.
Patients in states with abortion bans who previously accessed medication through telehealth may need to explore in-person options in states where abortion remains legal. A misoprostol-only protocol remains available as an alternative, though providers note it is slightly less effective and can require higher dosages with increased side effects.
Manufacturers of mifepristone have indicated they intend to pursue further legal avenues. Evan Masingill, CEO of GenBioPro, one of the primary manufacturers of mifepristone, said in a public statement that the company is “reviewing the court’s order in detail” and remains “committed to taking any actions necessary to make mifepristone available and accessible.”
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