US Appeals Court Restores In-Person Requirement for Mifepristone, Prompting Provider Shift to Misoprostol-Only Regimens

A U.S. federal appeals court on Friday reinstated a mandate that mifepristone must be dispensed after an in-person encounter, overturning the FDA’s 2023 policy that had lifted that requirement. The decision created immediate uncertainty for patients who had been obtaining the drug via telehealth.

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Mifepristone was developed in France in the 1980s and received FDA approval in 2000. During the COVID-19 pandemic, the Biden administration authorized mail delivery in April 2021, making it permanent in 2023. The 2022 Dobbs decision eliminated the constitutional right to abortion, boosting reliance on medication abortion via telehealth.

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Providers shifted to prescribing misoprostol alone, a regimen predating the two-pill protocol but slightly less effective. Carafem quickly adopted the misoprostol-only approach and said it could revert if the restriction persists. Planned Parenthood also uses misoprostol-only regimens and assures patients of safety and legality. Digital clinic HeyJane will follow the same protocol if needed. The Supreme Court issued a temporary stay on Monday, pausing the appeals-court order for a week and allowing virtual clinics to dispense mifepristone until at least May 11, when the Court will revisit the case.

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The reinstated requirement triggered anxiety among patients. “People are afraid, and they’re angry,” said Melissa Grant, chief operations officer of Carafem. She noted callers were “bargaining” to confirm medication availability. The reactions highlight the immediate impact of the legal shift on individuals seeking abortion care.

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Public-health nonprofit Plan C estimates that about one-third of abortions in the first half of 2025 used medication obtained via telehealth. The figure reflects the growing importance of remote access in states with restrictive abortion laws.

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The Supreme Court’s temporary reprieve expires on May 11, when the justices will review the mifepristone dispensing policy. The outcome will decide whether telehealth provision of the drug remains permissible nationwide.

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• “People are afraid, and they’re angry,” — Melissa Grant, Chief Operations Officer, Carafem

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• “I had people contact us saying, This can’t be true. Do you still have the medication available? Can’t you just give it to me? They were bargaining.” — Melissa Grant, Carafem

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• “We feel comfortable prescribing it,” — Melissa Grant, Carafem

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• “Planned Parenthood providers are doing everything they can to make sure patients know that medication abortion is still safe, legal, and available,” — Danika Severino, Vice President of Care and Access, Planned Parenthood Federation of America

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