In a rapidly escalating legal battle with sweeping national implications, the State of Louisiana on December 17, 2025, asked a federal judge to impose strict nationwide restrictions on mifepristone—a medication that plays a pivotal role in two-thirds of U.S. abortions and is widely recognized as a gold-standard treatment for miscarriage care. The move, if granted, would force patients across the country to pick up the pill in person at a medical facility, eliminating the ability to receive mifepristone by mail or through pharmacies—even in states where abortion remains legal and protected.
The lawsuit, Louisiana v. FDA, is just one front in a growing legal offensive targeting mifepristone and telemedicine abortion access. According to reporting from the ACLU and other major outlets, the restrictions would apply even when patients have already received care via telemedicine and when there is no medical reason for requiring in-person pickup. This, advocates warn, could have a devastating effect on abortion access, particularly for those who live in rural areas, have low incomes, lack reliable transportation, or face barriers such as domestic violence.
"This attack is about one thing only: making it as hard as possible for people everywhere in the country to get an abortion," said Julia Kaye, senior staff attorney with the ACLU’s Reproductive Freedom Project. "Forcing patients to travel hundreds of miles to a health center just to be handed a pill obviously has no safety benefit, which is why every leading medical group opposes this change."
The legal landscape is further complicated by a flurry of related lawsuits. On December 9, 2025, Texas and Florida filed a 120-page complaint in federal court in Wichita Falls, challenging the FDA’s original approval of mifepristone in 2000 and its subsequent generic versions. The lawsuit, spearheaded by Texas Attorney General Ken Paxton, claims the FDA failed to properly evaluate the drug’s safety and effectiveness and challenges the agency’s more recent moves to expand access—including allowing the medication to be dispensed by mail.
In the Texas and Florida complaint, the plaintiffs argue that the Comstock Act of 1873—an antiquated federal law—prohibits the mailing or delivery of anything intended for producing abortion. While the Biden administration interprets this statute as only applying to unlawful abortions, Texas and Florida contend it should apply broadly, potentially impacting not just mifepristone but any medication or device used for abortion. The FDA, for its part, declined to comment on the ongoing litigation, telling The New York Times that by law, generic applications must be approved if "the generic drug is identical to the brand-name drug."
Mifepristone, when used in combination with misoprostol, is the most common way Americans end their pregnancies. Its safety and efficacy are well-established in medical literature: more than a hundred peer-reviewed studies and leading authorities such as the American Medical Association and the American College of Obstetricians and Gynecologists have affirmed its strong safety record. Nevertheless, Texas and Florida’s lawsuit insists that the FDA’s regulation of mifepristone was "political from the start" and calls for the drug’s removal from the market.
Abortion access advocates have condemned these legal maneuvers. "If they succeed in restricting access to mifepristone, abortion access will be devastated across the country, even in states where abortion remains legal," said Shellie Hayes-McMahon, executive director of Planned Parenthood Advocates of Texas, in a December 10 news release. "This lawsuit is not about safety or health care; it is about control. And nothing short of full control over our bodies will satisfy them."
The stakes are enormous. According to recent data, by June 2025, more than one in four U.S. abortions were provided via telemedicine using mifepristone—including over 25% of abortions in states such as Colorado, Delaware, Hawaii, Maine, Michigan, Minnesota, Montana, Nevada, New Hampshire, Ohio, Rhode Island, and Virginia. For many patients, telemedicine and mail delivery have become essential, especially during the COVID-19 pandemic and in regions where clinics are scarce or travel is prohibitively difficult.
Legal experts say these lawsuits reflect a new phase in the ongoing national struggle over abortion rights. Mary Ziegler, a professor and abortion legal historian at the University of California Davis School of Law, told The Texas Tribune that this latest round of litigation is not surprising. "What we’re seeing is Texas is behaving more like Joe Biden as president than you would expect, right? This is not a situation where Ken Paxton is sitting back and saying, 'You know, the FDA is going to make these changes.'" Ziegler added that anti-abortion movements are increasingly turning to the courts to achieve their goals, as legislative avenues have become less politically viable in much of the country.
Indeed, the legal strategy is multifaceted. Alongside Louisiana v. FDA, two other federal lawsuits—Missouri v. FDA and Florida v. FDA—are pending. While Missouri’s case seeks to impose further nationwide restrictions, Florida’s suit goes even further, aiming to ban mifepristone entirely by challenging the FDA’s original approval from 25 years ago. Meanwhile, Texas’ House Bill 7, which recently went into effect, allows private citizens to sue anyone who manufactures or distributes abortion drugs to or from Texas—another layer of legal risk for providers and patients alike.
These legal efforts are unfolding against a backdrop of public concern and political polarization. A June 2025 poll by Navigator Research found that nearly seven in ten voters believe abortion will become harder to access in the next five years—a sentiment that cuts across party lines. At the same time, polling consistently shows that American voters support access to abortion, including medication abortion via mail and telemedicine.
Complicating the picture further, the Trump administration earlier this year announced that the FDA is conducting a new review of its mifepristone regulations. This move was prompted by a self-published report from a Project 2025 sponsor—a report that has been widely criticized by more than 260 expert researchers for distorting the medication’s safety record. Abortion rights advocates warn that this review could pave the way for additional federal restrictions, even as legal battles rage in the courts.
For states that have enacted abortion shield laws to protect providers from out-of-state prosecution, the outcome of these federal cases could be decisive. As Ziegler points out, a federal policy change could undermine these protections, rendering state-level efforts to safeguard abortion access moot.
All the while, the lived realities of patients hang in the balance. For those already facing barriers to reproductive health care, the potential loss of telemedicine and mail-order options for mifepristone would represent a significant setback. As legal challenges multiply and the courts take center stage, the future of medication abortion in America remains uncertain—and millions of patients, providers, and advocates are watching closely.
The coming months will be critical as federal judges weigh these lawsuits and the FDA’s own review unfolds. The outcome could reshape abortion access nationwide, with ripple effects in every state—regardless of local laws or political leanings.
