Federal Appeals Court Temporarily Restores In-Person Requirement for Abortion Pill

On May 1 2026, the New Orleans-based 5th U.S. Circuit Court of Appeals issued a temporary nationwide injunction that reinstates the requirement that mifepristone, one of the two drugs used for medication abortion, be prescribed and dispensed only after an in-person clinical encounter. The three-judge panel—Judges Stuart Kyle Duncan, Leslie Southwick and Kurt Engelhardt—unanimously ruled in favor of Louisiana, which argued that the 2023 FDA rule allowing mail-order and telehealth provision undermines the state’s near-total abortion ban. The order blocks the mailing of mifepristone but leaves the second drug, misoprostol, unaffected.

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The Dobbs v. Jackson decision (2022) overturned Roe v. Wade, prompting many states to restrict or ban abortions. Medication abortion now accounts for roughly two-thirds of U.S. abortions, with mifepristone used in about 60 % of cases. During the COVID-19 pandemic the FDA temporarily lifted the in-person requirement; the agency made the change permanent in 2023. Louisiana’s Attorney General Liz Murrill filed suit last year, claiming the rule enables out-of-state prescribers to circumvent state law.

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• Judges: Stuart Kyle Duncan (Trump appointee), Leslie Southwick (Bush appointee), Kurt Engelhardt (Trump appointee)

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• State: Attorney General Liz Murrill (Republican, Louisiana)

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• Federal Agency: U.S. Food and Drug Administration (FDA) – no comment provided

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• Pharmaceuticals: GenBioPro (CEO Evan Masingill) and Danco Laboratories (manufacturer of brand-name Mifeprex)

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• Reproductive-rights groups: Center for Reproductive Rights (Nancy Northup), ACLU (Julia Kaye), Reproductive Freedom for All (Mini Timmaraju), Planned Parenthood Action Fund (Alexis McGill Johnson)

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• Legislators: Senator Bill Cassidy (R-LA)

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• 2020-2021: FDA temporarily lifts, then reinstates, the in-person requirement amid the pandemic.

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• 2023: FDA permanently removes the requirement, expanding mail-order access.

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• 2024-2025: Telehealth abortions rise; >1 in 4 abortions nationwide provided via telehealth in the first half of 2025 (WeCount).

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• May 1 2026: 5th Circuit issues the temporary injunction.

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• Medication abortion ? 66 % of all abortions.

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• 91,000 telehealth abortions were provided under state shield laws in 2025 (Guttmacher Institute).

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• Between 2024-2025, out-of-state travel for abortions fell by 12,000 while telehealth abortions increased by 19,000.

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• Major adverse events from mifepristone occur in < 1 % of patients; side-effect profile is milder than that of Viagra or penicillin (CNN analysis).

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By limiting mail-order and telehealth distribution, the ruling could reduce access for patients in states with abortion bans, especially those in rural areas, low-income households, or experiencing intimate-partner violence. The case may set a precedent for future regulatory challenges to medication-abortion access.

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Louisiana’s AG Murrill hailed the decision as protecting “women and babies.” GenBioPro CEO Masingill warned the court ignored FDA science. Center for Reproductive Rights’ Northup called the move a “political blockade.” ACLU attorney Kaye said the ruling “defies clear science.” Reproductive Freedom for All’s Timmaraju warned it brings the nation closer to a national ban. Planned Parenthood’s Johnson reaffirmed the organization’s commitment to provide care where legal. Senator Cassidy praised the ruling as a victory for mothers.

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Reproductive-rights advocates argue the injunction disregards decades of safety data, threatens vulnerable populations, and undermines the progress made in expanding medication-abortion access.

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Sources differ on telehealth-abortion counts (WeCount vs. Guttmacher) and on the number of states with shield laws (eight states cited). The FDA has not issued a comment, and the precise number of patients affected by the temporary block remains unspecified.

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• “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,’” — Liz Murrill, Attorney General, Louisiana

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• “We are 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.” — Evan Masingill, CEO, GenBioPro

NBC News

• “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.” — Nancy Northup, President & CEO, Center for Reproductive Rights

CNN

• “This decision defies clear science and settled law and advances an anti-abortion agenda that is deeply unpopular with the American people,” — Julia Kaye, Senior Staff Attorney, ACLU

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• “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,” — Mini Timmaraju, President & CEO, Reproductive Freedom for All

CNN

Louisiana is expected to appeal the injunction, potentially to the Supreme Court. The FDA continues its safety review of mifepristone, and both state and federal legislators are monitoring the case for possible legislative responses.

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