Topline
The Supreme Court upheld the approval of abortion drug mifepristone Thursday, ruling challengers trying to restrict the medication don’t have standing to sue, keeping mifepristone’s approvals intact as medication abortion has become a more prominent method in the wake of the high court overturning Roe v. Wade in June 2022.
Key Facts
The Supreme Court ruled Thursday a coalition of anti-abortion medical groups don’t have standing to sue the Food and Drug Administration over mifepristone’s approval, after an appeals court ruling revoked several updates to the drug’s approval that made it easier to access.
Anti-abortion rights plaintiffs originally sued to block FDA approval of mifepristone entirely, but the 5th Circuit Court of Appeals only rolled back updates that made the drug available through telehealth and through the mail; the Supreme Court’s ruling Thursday overturns that ruling entirely, maintaining access to mifepristone via telehealth.
Mifepristone is one of two drugs that’s taken to terminate a pregnancy—it stops a pregnancy, and then a second drug, misoprostol, induces contractions to expel the tissue—and it is approved for use up to 10 weeks into a pregnancy, though in practice it’s often used until weeks 12 or 13.
The drug must be prescribed and cannot be obtained over the counter, and historically it’s only been available in-person from a physician or clinic certified to prescribe mifepristone, or more recently, prescribed through telehealth appointments and dispensed through mail-order pharmacies approved to supply the drug.
The Food and Drug Administration finalized regulations in January 2023 that now allow mifepristone to also be dispensed at brick-and-mortar retail pharmacies after being prescribed by a medical provider, after those pharmacies become certified to dispense it and agree to certain criteria.
Major retailers including CVS and Walgreens largely agreed to carry mifepristone in states where abortion is legal, and though backlash to the move led Walgreens to walk back its decision in at least some states, the pharmacy chains started selling the pills in select states in March.
Lawmakers in many GOP-led states have also introduced or floated legislation that could threaten access to medication abortion or punish people for using it—though pregnant people have been able to skirt state-level abortion bans by obtaining pills through the mail or traveling to nearby states—and Wyoming became the first state in March 2023 to enact a ban on abortion pills specifically, which was subsequently blocked in court.
What To Watch For
The Supreme Court’s ruling Thursday is unlikely to end legal challenges to mifepristone entirely, given that the justices just narrowly ruled that these specific challengers—who don’t prescribe or use mifepristone themselves—didn’t have standing to bring the case. The Washington Post reported before the ruling came out that GOP-led states including Missouri, Kansas and Idaho are likely to try to challenge the drug in court next, after those three states already tried to intervene in the case that went to the Supreme Court. It remains unclear if they’ll have better luck getting the courts to rule in their favor.
Tangent
If access to mifepristone had been restricted, telehealth patients would still have been able to have a medication abortion using only misoprostol. The drug—which has been subject to fewer legal attacks than mifepristone—can be taken on its own to terminate a pregnancy, though it is marginally less effective and carries more side effects than using mifepristone. The FDA has not approved a misoprostol-only abortion regimen, but the World Health Organization and other major groups, including the American College of Obstetricians and Gynecologists, have recommended the protocol as an acceptable alternative if mifepristone isn’t available.
Big Number
63%. That’s the percentage of all abortions in the U.S. that were medication abortions in 2023, according to the pro-abortion rights Guttmacher Institute. Research has consistently shown medication abortion to be highly safe and 99.6% effective in terminating a pregnancy, with only 0.4% of medical abortions resulting in serious complications. The FDA reports only 28 deaths have been reported in patients “associated with mifepristone” between September 2000 and June 2022, though it notes it’s not clear if those deaths were actually caused by mifepristone, as they may have been due to other factors. A February study in Nature also found that medication abortion is equally safe and effective when prescribed via telehealth as when prescribed and taken in a clinical setting.
Key Background
Medication abortion through mifepristone and misoprostol was first approved by the FDA in 2000. Though widely used even when abortion was legal throughout the U.S., the abortion drugs have gained attention in the wake of the Supreme Court overturning Roe v. Wade in June 2022, as they’re an easier way for patients in states where the procedure is banned to more easily obtain an abortion as clinics providing surgical abortions have shut down. The wave of state-level bans on abortion has prompted new tactics to make abortion pills available, such as mail-order services—and mail-forwarding services that can help skirt state bans—and abortion providers setting up mobile clinics on the borders of states where abortion is outlawed. The broadening of access to abortion pills has been cited as a reason why abortion rates have actually gone up since Roe was overturned. The FDA’s expansion of mifepristone to retail pharmacies was part of the Biden Administration’s broader efforts to blunt the impact of the Supreme Court’s ruling, as the administration has pointed to medication abortion and the fact the FDA has authorized abortion pills for use nationwide as a key way of counteracting state bans. The DOJ also issued a legal opinion clarifying that abortion pill can be mailed to states where abortion is banned under federal law, though it remains to be seen how that could be impacted by the Supreme Court’s opinion.
Surprising Fact
In addition to abortion, mifepristone can also be used for other medical conditions, though it remains to be seen how the Supreme Court’s case could impact access in those cases. The drug can also be used for miscarriages and early pregnancy loss or used off-label for other gynecological uses, such as treating uterine fibroids. Mifepristone is also used at a separate dosage as a treatment for Cushing’s syndrome, a rare endocrine disease that overproduces the hormone cortisol—which mifepristone blocks—and clinical trials have examined how the medication can be used to treat such conditions as multiple forms of cancer and depression.
Further Reading
Supreme Court Upholds Abortion Drug Mifepristone (Forbes)
Supreme Court Will Consider Restrictions On Abortion Drug Mifepristone Today—What To Know (Forbes)
Mifepristone Ruling: Here Are The Unintended Health Consequences Of Attacks On Abortion Pills (Forbes)
Medication Abortion Without Mifepristone? What To Know About Misoprostol-Only Abortions In Wake Of Court Ruling (Forbes)
What is medication abortion? Your questions answered (Association of American Medical Colleges)
Information about Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation (U.S. Food and Drug Administration)
The Availability and Use of Medication Abortion (Kaiser Family Foundation)
Abortion Pill Providers Experiment With Ways to Broaden Access (New York Times)
