One Pill, One Week

What the 5th Circuit Ruling Means for Texans

On Friday, May 1st, the 5th Circuit Court of Appeals—the same court that has repeatedly been ground zero for the most aggressive anti-abortion legal strategy in the country—issued a ruling ordering the FDA to reimpose in-person dispensing requirements on mifepristone, effective immediately, and with nationwide reach.

Then on Monday, May 4th, U.S. Supreme Court Justice Samuel Alito, who delivered the opinion of the court in the Dobbs decision, issued a one-week administrative stay, blocking the lower court’s ruling from taking effect until May 11th while the Supreme Court considers what to do next. There is a grim irony in the fact that the man who dismantled the constitutional right to abortion is the one currently holding the door open, however briefly.

That door could close Monday.

So let’s talk about what happened, what it means for Texans specifically, and what comes next.

What is Mifepristone

Johns Hopkins states that mifepristone, also called “the abortion pill,” is a U.S. FDA-approved oral medication used—along with misoprostol—in a two-drug regimen to end a pregnancy up to 70 days into gestation. According to the Guttmacher Institute, this combination accounted for more than 98% of medication abortions in the United States in 2020, the last year for which comprehensive data are available.

Mifepristone is also used to manage pregnancy loss in early pregnancy; to induce labor; treat endometriosis and fibroids; treat hyperglycemia associated with Cushing syndrome.

What the 5th Circuit Ruled

The case is State of Louisiana v. Food and Drug Administration, and it centers on a 2023 FDA rule that expanded access to mifepristone by allowing patients to be prescribed the medication via telehealth and to have it dispensed through the mail. The FDA rule was based on more than two decades of safety data, and the change was consistent with the recommendations of leading medical associations. The state of Louisiana sued the FDA arguing that the rule undermined the state’s near total ban on abortion.

The 5th Circuit granted Louisiana Attorney General Liz Murrill’s motion to stay the 2023 rule while the state’s lawsuit proceeds. The court found that the 2023 regulation likely violated federal law because it did not meet the FDA’s mandate to ensure that drugs marketed in the United States are safe and effective. (The decision to remove the in-person requirements was based on data supporting the safety and efficacy of mifepristone, a claim that according to anti-abortion advocates and now the courts, is in question.)

The ruling meant mifepristone must now be picked up in person from a doctor or clinic: no telehealth prescribing, no pharmacy dispensing, no mail delivery. And, it took effect immediately.

Mifepristone manufacturers Danco Laboratories and GenBioPro appealed directly to the Supreme Court within hours of the 5th Circuit ruling, stating in court filings that the ruling had created “immediate confusion and upheaval into highly time-sensitive medical decisions.” Justice Alito’s one-week stay restores the previous access while the full Court reviews the emergency appeal. All parties have been asked to file briefs by Thursday, May 7th.

It’s not the first time that anti-abortion groups have sued the FDA over this rule. In 2024, the Supreme Court unanimously ruled Alliance for Hippocratic Medicine (the medical associations and doctors challenging the FDA’s relaxation of mifepristone access requirements) did not have standing to bring their claims because they did not prescribe or use mifepristone. This was a narrow ruling on procedure, not on the merits, leaving abortion access advocates wary of future decisions about mifepristone. The current case, brought by a state rather than private medical groups, raises questions of standing the Court has not yet resolved.

What This Means for Texans

Texas already operates under one of the most restrictive abortion bans in the country. Since Dobbs, many Texans seeking abortion care have turned to telehealth providers in states with so called “shield laws.” According to the Center for Reproductive Rights, “shield laws are legal protections enacted by states to safeguard providers of reproductive health care services, such as abortion. These laws are designed to prevent out-of-state legal actions from affecting those who provide legal care within the shield law state.”

This ruling would close the pathway for anyone in a state with an abortion ban seeking out of state care via telehealth.

The numbers help illustrate the stakes. Medication abortion now accounts for roughly two-thirds of all abortions nationally. In the first half of 2025, about one in four abortions in the country was provided via telehealth. In states with total abortion bans, average travel time to the nearest abortion clinic has quadrupled since Dobbs, from under three hours to more than eleven. For Texans in rural areas, the Panhandle, or the Rio Grande Valley, telehealth access to mifepristone has not been merely a convenience—it’s been the only realistic option.

Texas has also been an active participant in the broader legal landscape surrounding mifepristone. Under House Bill 7, passed in September, doctors who prescribe or companies that distribute abortion-inducing drugs like mifepristone can be sued by private citizens for up to $100,000 per violation. Attorney General Ken Paxton has filed lawsuits against healthcare providers in California and Delaware. Texas has also joined Florida in separately suing the FDA over mifepristone’s original approval, arguing the department shouldn’t have approved the drug back in 2000. It remains unclear how the 5th Circuit’s ruling will affect those pending cases.

Twenty-two states have shield laws that provide civil and criminal protections for physicians who assist patients in states like Texas, but the 5th Circuit’s ruling, if it stands, would remove the federal regulatory framework that makes mail dispensing possible regardless of what those shield laws say.

Where Things Stand

Until May 11th, the status quo holds. Telehealth access and mail dispensing remain available while the Supreme Court reviews the emergency appeal.

What happens after that depends on what the Court decides to do. The judges could issue a longer stay while they consider whether to take the case. It could allow the 5th Circuit’s ruling to take effect. It could refer the emergency request to the full nine-justice Court for a vote. The Administration, which had previously asked the lower courts to pause the case until the FDA completed an ongoing review of mifepristone safety protocols, has not publicly indicated if the review will continue if either court blocks the telehealth availability of the medication.

A Word for Those Doing This Work

For those who approach this work from a place of faith, moments like this call for both clarity and compassion: clarity about what the facts are and compassion for the people most directly affected by them.

The patients who stand to lose access if this ruling takes effect are not abstractions. They are people already navigating some of the most difficult circumstances healthcare can present: facing an unplanned pregnancy, managing a miscarriage, or making decisions in tight windows of time. They are disproportionately people with fewer resources, fewer options for travel, and fewer days they can take off work. They are the people our faith traditions call us to see and to accompany.

That doesn’t require us to have a settled view on every dimension of this debate. It just requires us to be honest about what these policies do to real people and to hold that honesty alongside everything else we believe.

What You Can Do Right Now

The window before May 11th is short, but you don’t have to stand idly by:

Contact your representatives. Texas constituents calling their members of Congress right now, particularly those on health and judiciary committees, can help keep this on their radar.

Support organizations doing the on-the-ground work. The Lilith Fund,Texas Equal Access Fund, Fund Texas Choice, and the Brigid Alliance help Texans navigate the practical and financial barriers to accessing care. Whatever happens legally, that work continues.

Talk to your communities. If you’re in a faith community, a civic group, or a neighborhood network, this is a moment where clear, factual information matters. Most people haven’t tracked the details of this case. Helping them understand what’s at stake is itself an act of service.

Pray. For those of us who feel called, this moment not only requires action but also prayer. We pray for the people watching a clock tick down, as well as for the wisdom to know how to be the most useful in the time we have.

There is still a great deal we don’t know: about what the Supreme Court will do, about how the ongoing FDA review will factor in, about how the ruling would interact with Texas-specific litigation if it takes effect. We will keep tracking it.

What we do know is that access for tens of thousands of Texans hangs in the balance, and the deadline is close.