In May, Texans’ access to abortion drug mifepristone was thrown into disarray after a federal appeals court ruled that people across the country must obtain the drug in person, and then, three days later, the Supreme Court temporarily blocked that ruling.
The 5th U.S. Circuit Court of Appeals’ ruling, stemming from a Louisiana lawsuit, blocks a 2023 Food and Drug Administration rule allowing mifepristone to be delivered by mail — a provision commonly used to get around Texas’ abortion ban. With the Supreme Court’s temporary pause on the 5th Circuit’s ruling scheduled to expire Monday evening, the future of Texans’ access to mifepristone remains unclear.
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Abortion advocates condemned the ruling as a gateway into a national abortion ban, while anti-abortion groups heralded the 5th Circuit’s decision as a first step in the right direction.
Here’s what to know about the drug, court ruling and more.
Are abortion pills illegal in Texas?
Mifepristone and misoprostol, pills commonly taken to end a pregnancy, are not illegal in Texas and often prescribed to manage miscarriages, but it is illegal to supply them for elective abortions because of Texas’ ban on abortions.
Providing abortion pills in violation of the state’s abortion ban can result in criminal charges. Over the summer, a North Texas man was charged with capital murder after slipping mifepristone into his girlfriend’s food and she miscarried. That case is still pending.
Additionally, state law allows private citizens to sue virtually anyone who assists in providing abortion, including medical professionals, companies that facilitate the movement of abortion pills into the state and family or friends who purchase pills for a pregnant person. Any individual can file the suit to seek up to $100,000, a provision commonly referred to as a “bounty hunter” law.
Women who seek out abortions or take abortion pills are exempt from criminal charges or lawsuits under Texas’ abortion restrictions.
Despite Texas laws that penalize the supply of abortion pills, thousands enter Texas from 22 other states with “shield laws.” Texas has sued medical providers in New York, Delaware and California who have sent abortion pills over alleged violations of Texas’ abortion restrictions, but those states’ shield laws provide civil and criminal protections over their healthcare providers against Texas’ legal actions. These providers continue to provide prescriptions, often through telehealth appointments, to people in states like Texas that have abortion bans.
Roughly 25% of abortions nationwide are done through telehealth, an estimate that is “likely an undercount” because it may not include those having abortions illegally, University of California Davis Law professor Mary Ziegler, said.
What does the ruling restrict and why?
The 5th Circuit’s ruling on May 1 only restricts mail access to mifepristone, one of two drugs commonly used in medication abortions, including in managing miscarriages. The FDA approved mifepristone in 2000, and also approved two generic versions of the drug in 2019 and 2025. Multiple studies have shown the drug to be a safe and effective means of ending a pregnancy.
In 2023, the FDA established a rule allowing doctors to prescribe mifepristone remotely and for the drug to be mailed to patients, including those in Texas from other states where abortion is legal. The May 1 ruling overturned that rule, arguing it was put in place without proper FDA review of the drug’s effects.
If the 5th Circuit’s ruling stands and the 2023 rule goes away, people will not be charged with a crime for possessing or using mifepristone and the drug would still be available for in-person prescription. Mifepristone is solely used in ending pregnancies, unlike the second drug it is commonly paired with, misoprostol, which is used to treat ulcers but prescribed off-label to end pregnancies.
Pairing mifepristone and misoprostol helps the body to safely speed up the passing of pregnancy-related tissue, which is particularly important during miscarriages to avoid complications like increased bleeding, infection, scarring of the uterus and future invasive procedures.
The Supreme Court’s temporary block of the 5th Circuit’s ruling on May 4 restored medical providers’ ability to provide the drug through mail after a brief pause. The order expires on May 11 at 5 p.m. EST unless the court extends the block. Rachel Rebouche, a University of Texas at Austin law professor, said the Supreme Court’s order was unsurprising and likely designed to offset disruption in medical care caused by mifepristone’s sudden unavailability. The court’s one-page order did not provide an explanation for the block.
“It’s really hard to have a legal status for a drug that thousands and thousands of people use flicker,” Rebouche said. “Just maintaining the status quo is a way to damp down the confusion that occurs when something changes overnight.”
Will out-of-state organizations that mail abortion pills stop sending them to Texas?
While mailing of mifepristone is expected to stop if the Supreme Court’s temporary block expires and the 2023 FDA rule goes away, abortion pills will still be mailed into the state. That’s because providers will likely switch to misoprostol-only prescriptions, Ziegler and Rebouche said.
Studies have shown misoprostol-only abortions to also be safe, and the prescription is commonly used around the world, Ziegler said, but may come with additional side effects and potential for complications.
Shield laws would not protect the continued mailing of mifepristone under the 5th Circuit’s ruling and the 2023 FDA rule’s withdrawal because mailing the drug would violate federal regulations and result in penalties. But, the switch to exclusively sending misoprostol would likely make that moot, Ziegler and Rebouche said.
What are anti-abortion advocates saying about pulling the 2023 FDA rule?
Texas Right to Life president John Seago described the ruling as a restoration of a “common sense safeguard,” but stopped short of calling the ruling a full win, as he and other anti-abortion groups have urged the federal government to get more involved in halting abortion access.
“This is not an ultimate victory by any stretch of the imagination,” Seago said.
Seago said that the FDA could pause distribution of abortion pills nationally, and suggested that President Donald Trump could enforce a 150-year-old federal law called the Comstock Act to ban mail access to mifepristone and misoprostol. Texas joined Florida in filing a lawsuit in December seeking to challenge the FDA’s approval of mifepristone, arguing the agency did not properly evaluate the drug and also citing the Comstock Act.
“The rhetorical point we’ve been making is, we expect more and have higher expectations of the federal government, [and] for the FDA there’s a couple of things immediately they can do,” Seago said.
Rebouche said the FDA or Trump administration can’t simply “snap their fingers” and suspend availability of the two drugs, both because the FDA has not shown an immediate harm from the drugs and because any changes would likely be immediately sued and enjoined by a court.
“Somewhere, a court will do that, because there isn’t credible evidence that mifepristone is in any way dangerous or not effective,” Rebouche said.
What are abortion advocates saying about the latest ruling?
Groups that support and help assist access to abortion nationwide called the 5th Circuit’s ruling and subsequent stay from the Supreme Court “chaos” as access to mifepristone was limited and subsequently restored over the course of a few days. They say the latest court actions further chills people from trying to obtain the drug because they think it’s illegal, even though the drug itself is not.
“Today’s stay gives patients and providers only a brief moment to breathe as the dust settles on the most severe blow to abortion access since Dobbs,” Reproductive Freedom for All President and CEO Mini Timmaraju said on Monday when the Supreme Court issued its temporary block.
In states where abortion is still legal, advocacy groups have pushed for legislators to pass and bolster shield laws allowing residents in states like Texas to maintain access in part through telehealth prescriptions. The courts’ rulings underscore the unpredictable nature of the courts and need for federal abortion protections, Timmaraju said in her statement.
“Blocking the baseless in-person dispensing requirement for mifepristone from going into effect for a week may help to offset some disruptions to care following the Fifth Circuit ruling last week — but the underlying threat to access remains just as dire as it was before,” said Kelly Baden, vice president for public policy at the Guttmacher Institute in a statement.
When will a permanent decision be made about mifepristone?
It is currently unclear when the 5th Circuit or the Supreme Court may rule more definitively on the 2023 FDA rule, as the blocking of the 2023 rule came “very quick on the draw” in the appellate court case, Ziegler said.
Disclosure: University of Texas at Austin has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.