Mifepristone Access by Mail Continues as FDA Tells Louisiana Court Its Safety Review Should Finish by March 2027

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For now, nothing changes for patients. Under a Supreme Court order issued in May, mifepristone can still be prescribed through telehealth and sent by mail or picked up at pharmacies while the legal fight continues.

The timeline matters to many people. Medication abortion accounts for “over two-thirds of U.S. abortions,” according to KFF, a health policy research group. Patients, clinicians, and pharmacists now face several more months of uncertainty about whether the rules will change.

The filing describes a “statistical data mining method” meant to find “unknown safety concerns” that may exist with the drug, STAT reported. The analysis draws on an electronic database that collects reports of medical injuries and drug side effects from major health networks and insurers. According to the filing, the method is known as a TreeScan analysis and uses data from Sentinel, the FDA’s distributed health data system, on mifepristone use through 70 days (10 weeks) of pregnancy.

The FDA plans to compare mifepristone’s safety with that of surgical abortion through 10 weeks of pregnancy and to measure how often side effects occur among roughly 100,000 women who took the drug, NBC News reported, according to a KFF Health News summary of the filing coverage.

The agency is also reviewing the drug’s safety program, known as a Risk Evaluation and Mitigation Strategy (REMS), along with pending citizen petitions. Some petitions ask the FDA to bring back the in-person dispensing requirement it dropped in 2023. After the review, the agency will decide whether changes to the program are needed. Most major medical groups have said mifepristone is safe and effective when taken as directed and that serious complications are rare. The FDA’s current information page on mifepristone still states that under the REMS program, the drug “may be dispensed in person or by mail.”

Louisiana Attorney General Liz Murrill sued the FDA in October 2025. She was joined by Rosalie Markezich, a Louisiana resident who says her then-boyfriend coerced her into taking the pills. The case challenges the FDA’s 2023 decision to allow telehealth prescribing and mail dispensing.

On April 7, U.S. District Judge David C. Joseph left the 2023 rule in place but paused the case until the FDA finishes its review, directing the agency to act with “deliberate speed,” Stateline reported on the judge’s ruling. He ordered the FDA to file a status report within six months and to notify the court within 14 days of completing its review. Murrill said the judge had concluded that Louisiana “is likely to succeed in showing that the 2023 (rule) is unlawful.” Julia Kaye, a senior staff attorney with the American Civil Liberties Union’s Reproductive Freedom Project, said putting the case on hold was “certainly a better outcome than what Louisiana asked for.”

The case then moved quickly. On May 1, a 5th U.S. Circuit Court of Appeals panel sided with Louisiana and reinstated the in-person dispensing requirement nationwide. The Supreme Court temporarily paused that ruling on May 4. On May 14, the court kept telehealth and mail access in place while the case proceeds, with Justices Clarence Thomas and Samuel Alito dissenting, FOX6 News reported on the Supreme Court order.

On Sept. 9, a 5th Circuit panel heard arguments in Louisiana’s appeal. Several judges questioned whether the state had shown it was harmed enough to have standing to sue, according to coverage of the appeals court hearing. Because of the Supreme Court’s order, any 5th Circuit ruling would not immediately change access.

Abortion opponents criticized the longer timeline. Gavin Oxley of Americans United for Life said the administration is “clearly uninterested in mitigating the ongoing harms caused by the abortion pill,” STAT reported.

Mail and telehealth access to mifepristone remain legal under federal rules today. The longer review matters most for people who rely on telehealth, including rural residents and those who live far from a clinic. Clinicians and pharmacies that dispense by mail may need to plan for rules that could change after the review ends.

People with a current prescription should follow their clinician’s instructions and the drug’s medication guide. The guide says to contact a health care provider right away for bleeding heavy enough to soak through two thick full-size pads per hour for two hours in a row, or for a fever of 100.4°F or higher that lasts more than four hours. Abdominal pain or feeling sick, including weakness, nausea, vomiting, or diarrhea, more than 24 hours after taking misoprostol is also a reason to contact a provider without delay. Anyone who cannot reach a provider should go to the nearest emergency room.

Study results are expected by mid-December, and the FDA expects to finish its review by March 2027. The agency could then keep the current rules, add restrictions such as in-person dispensing, or make other changes.

Can patients still get mifepristone by mail? Yes. A Supreme Court order issued in May keeps telehealth prescribing and mail dispensing in place while the Louisiana case continues.

When will the FDA finish its review? The FDA told the court it expects study results by mid-December 2026 and plans to complete the review no later than March 2027.

What is the FDA studying? The agency is using a data mining analysis of health network and insurer data to look for unknown safety concerns, comparing mifepristone with surgical abortion, and reviewing the drug’s REMS safety program.

Could the rules change? Yes. After the review, the FDA could keep the current rules, add restrictions such as in-person dispensing, or make other changes.

Who filed the lawsuit? Louisiana Attorney General Liz Murrill and Louisiana resident Rosalie Markezich sued in October 2025, challenging the FDA’s 2023 decision to allow telehealth prescribing and mail dispensing.

When should someone contact a provider after taking the medicine? Heavy bleeding, a fever of 100.4°F or higher lasting more than four hours, or abdominal pain or feeling sick more than 24 hours after taking misoprostol are reasons to contact a provider right away.