A federal appeals court temporarily reinstated a nationwide requirement that abortion pills be obtained in person, undermining access to the method of abortion that has only grown more widespread since the US Supreme Court overturned Roe v. Wade.

Friday’s ruling from the 5th US Circuit Court of Appeals is a major victory in the anti-abortion movement’s war against medication abortion, which now accounts for roughly two-thirds of all abortions in the United States.

The ruling stems from a lawsuit filed by Louisiana last year against the US Food and Drug Administration, after President Donald Trump’s administration refused to act on calls to reinstate the in-person dispensing requirement for abortion pills through the regulatory process.

The opinion was written by Trump-appointed Circuit Judge Kyle Duncan, joined by Circuit Judges Leslie Southwick and Kurt Engelhardt, who were appointed by Presidents George W. Bush and Trump, respectively.

Referring to Louisiana abortion prohibitions, they wrote that the current federal regulations create “an effective way for an out-of-state prescriber to place the drug in the hands of Louisianans in defiance of Louisiana law.”

Mifepristone manufacturer Danco Laboratories has asked the 5th Circuit to put its ruling on hold for seven days so it can appeal.

Since the Covid-19 pandemic, abortion-seekers have been able to obtain mifepristone – one of the two drugs in the medication abortion regimen – through telehealth appointments. President Joe Biden’s administration finalized rules that ended the requirement that the pills be obtained through an in-person doctor’s visit in 2023, after the US Supreme Court overturned the 1973 Roe precedent protecting abortion rights nationwide with Dobbs v. Jackson Women’s Health Organization.

Louisiana alleged that that regulatory maneuver was aimed at undermining the abortion ban that went into effect in the state with the reversal of Roe and says that now, hundreds of abortions are occurring every year within its borders because women are able to obtain pills via mail after telehealth visits with providers.

“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,’” the appeals court wrote Friday.

Evan Masingill, CEO of mifepristone manufacturer GenBioPro, a party to the case, said in a statement that the company is “alarmed by this court’s decision to ignore the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents. … We remain committed to taking any actions necessary to make mifepristone available and accessible to as many people as possible in the country, regardless of anti-abortion special interests trying to undermine patients’ access.”

Louisiana Attorney General Liz Murrill celebrated the ruling Friday as the end of a nightmare, writing on X, “I look forward to continuing to defend women and babies as this case continues.”

Marjorie Dannenfelser, president of national anti-abortion group Susan B. Anthony Pro-Life America, also praised the ruling in a statement Friday.

“Women and children suffer and state sovereignty is violated every day the FDA allows abortion drugs to flood the mail – harms that are no mere accident, but predictable outcomes of the FDA’s unscientific removal of safeguards like in-person doctor visits,” Dannenfelser said.

The ruling is the latest development in a yearslong legal battle over access to abortion pills. The issue reached the US Supreme Court two years ago, in a case in which the justices ruled that anti-abortion doctors lacked standing to challenge the regulations.

A CNN analysis of mifepristone data shows that the drug is overwhelmingly safe and has fewer reported side effects than Viagra or penicillin. Mifepristone is also safer than procedural abortions, which are banned or heavily restricted in more than a dozen states.

Telehealth abortions on the rise

Most abortions in the United States happen in person, but medication abortion provided through telehealth is becoming more common. More than 1 in 4 abortions nationwide were provided through telehealth in the first half of 2025, according to the latest data from #WeCount, a research project sponsored by the Society of Family Planning — up from fewer than 1 in 10 in 2022.

After the Dobbs decision, some states started to enact shield laws that offer some legal protections for providers who practice where abortion remains legal to prescribe medication abortion drugs via telehealth to people living in states with bans or restrictions. Eight states now have shield laws that cover telehealth provision regardless of where the patient is located, according to the Guttmacher Institute.

In 2025, about 91,000 telehealth abortions were provided under shield laws to people in states with total abortion bans, Guttmacher estimates show. Tens of thousands of people still travel across state lines to receive an abortion in person, but that number is falling as telehealth abortion becomes more common. Between 2024 and 2025, about 12,000 fewer people in states with total abortion bans traveled out-of-state for an abortion, while the number of telehealth abortions to people in states with total abortion bans increased by about 19,000, according to Guttmacher estimates.

The latest #WeCount data shows that people in states where abortion remains legal also utilize telehealth for abortion care, but the share of abortions provided via telehealth varies widely by state.

Several other states with anti-abortion laws are making claims similar to Louisiana’s. Joining Louisiana as a plaintiff in the lawsuit against the FDA is a woman who alleges that she was coerced into terminating a pregnancy by taking abortion pills that were shipped in from out of state.

Previously, the judge overseeing the case expressed sympathy with Louisiana’s arguments but declined to issue a preliminary order reversing the regulations. US District Judge David Joseph had instead granted a Trump administration request to put the case on hold while the FDA does its own review of the current mifepristone regulations.

The Trump administration had stopped short of defending the FDA’s regulatory approach to the mifepristone on the merits, but it argued that Louisiana’s lawsuit suffered procedural defects that warranted ruling against the state. The 5th Circuit rejected those arguments and the arguments of two mifepristone manufacturers that intervened in the case to put up a full-throated defense of the rules that made abortion pills easier to obtain.

Advocates say decision ‘defies clear science’

“Telehealth has been the last bridge to care for many seeking abortion, which is precisely why Louisiana officials want it banned,” Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement. “This isn’t about science – it’s about making abortion as difficult, expensive, and unreachable as possible. Telehealth has transformed healthcare. Selectively stripping that away from abortion patients is a political blockade.”

Julia Kaye, senior staff attorney for the Reproductive Freedom Project of the ACLU, said in a statement that the decision “defies clear science and settled law and advances an anti-abortion agenda that is deeply unpopular with the American people. For countless people, especially those who live in rural areas, face intimate partner violence, or live with disabilities, losing a telemedicine option will mean losing access to this vital medication altogether.”

Reproductive Freedom for All said the court is “dictating medical practice and overriding state laws” in places where abortion is legal.

“The court’s decision moves us one step closer to a national abortion ban. It is now much more difficult for people to access abortion care,” President and CEO Mini Timmaraju said in a statement. “Anti-abortion politicians know their policies are unpopular, so they are using every lever of government they can. Louisiana built this case on debunked, junk science. The safety of mifepristone has never actually been in question. As this case moves towards the U.S. Supreme Court, we will fight until every person has access to the care they need.” (CNN)

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