Supreme Court Case & Abortion Pill Access (Mifepristone)

Medication abortion is currently the most common way of having an abortion within the U.S., thus it makes sense that legal disputes surrounding mifepristone are integral to the national discussion regarding access to abortion. Based on information published by Guttmacher Institute, 63% of abortions performed in 2023 (clinically provided) were through medication methods. Therefore, the ongoing legal challenges to the accessibility of mifepristone are critical considerations when looking at the complexity of the landscape of legal and safe abortion access post-Dobbs.

This guide will summarize the U.S. Supreme Court case related to mifepristone rulings from 2024 and what (or did not) change and will help to explain how they continue to be a major factor in the overall legality and availability of both abortion and the medications that were used by women seeking abortions.

What Is Mifepristone?

Mifepristone, a prescription drug, can be used with misoprostol for a medical abortion. The U.S. Food and Drug Administration explains that mifepristone will block the hormone progesterone necessary to continue a pregnancy, and then misoprostol can be used to complete the abortion process. The U.S. Food and Drug Administration (FDA) has approved the use of mifepristone for 70 days of pregnancy.

Mifepristone is not only a new medicine; the U.S. Supreme Court’s materials from this case indicate that the FDA approved mifepristone in 2000. There were several actions taken on or after 2000 regarding mifepristone, including changes in the way it is prescribed and dispensed by the FDA in 2016 and 2021.

Many medical organizations are defending the safety of mifepristone. In 2025, the American College of Obstetricians and Gynecologists and many other organizations confirmed the safety and effectiveness of mifepristone based on years of research and clinical use. Similarly, the Society for Maternal-Fetal Medicine states that there is continued and overwhelming evidence that mifepristone can continue to be safely available in the U.S.

What Was the Supreme Court Case About?

A challenge was initiated against mifepristone’s regulation through the case, FDA v. Alliance for Hippocratic Medicine. This case attempted to reverse recent FDA actions expanding access to mifepristone, particularly in connection with telehealth and mail-order dispensing. The litigation focused on the history of FDA approval and other FDA actions in regards to mifepristone.

The practical effect of this case would have resulted in narrowing access to mifepristone by reversing rules that made it available more widely. If the plaintiffs had succeeded on the merits of the case, their arguments could have impacted how mifepristone could be prescribed anywhere in the country — even in states where abortion remains legal. This case received tremendous attention from healthcare providers and public health organisations as a result.

What Did the Supreme Court Rule?

In a decision issued in June 2024, the Justices of the Supreme Court unanimously rejected the allegations raised by the plaintiffs. The Justices concluded that the plaintiffs did not have standing to pursue their challenge in the Federal Courts. Justice Kavanaugh concluded that policy or moral objections, by themselves, do not satisfy the requirements for standing as to concrete injuries.

The Supreme Court’s decision is important because it maintains the integrity of the FDA’s current regulatory scheme for mifepristone.

What the Ruling Did Not Change

The decision made by the Supreme Court regarding abortion pills in 2024 does not impact the right to abortion pills on a national level. In addition, the decision has not caused the abortion bans set by states or the restrictions on medication abortion to no longer be enforced. In short, the decision kept intact the federal laws regarding the medication, however, the legality of abortion will still rely heavily on the state laws where you get the care or where you live.

This is important to note because patients in places where abortion is restricted still have barriers to accessing abortion care, because the state laws can stop someone from having an abortion or from having a telehealth abortion. The Federal Government has approved mifepristone for use and individual states have restricted the access to mifepristone — these are two separate legal issues.

Why This Case Mattered So Much

The case was important because medication abortion has become an important part of the abortion care continuum in the US. With the expansion of telehealth, and increased frequency of people using the mail to have medications shipped to them, the importance of access to mifepristone has only gotten stronger in both protective and restricting states. In 2023, the Guttmacher Institute reported that 63% of abortions provided by clinicians were medication abortions indicating the shifting importance of medication abortion in the provision of abortion care.

The case was also important because federal rule changes have made accessing mifepristone easier in many areas. The ACOG (American College of Obstetrics and Gynecology) notes that under the new rules for REMS (Risk Evaluation Mitigation Strategy), certified pharmacies who sell mifepristone either in a retail location or via mail can dispense mifepristone if they are certified to do so and have a prescription for mifepristone from a certified prescriber.

Can Patients Still Access Mifepristone by Mail?

At this time, under federal law it is legal to mail by a certain method as set forth by the FDA as long as the state allows the sale of mifepristone (the abortion pill). The FDA rules allow certified pharmacies to dispense mifepristone if they have been certified, according to the American College of Obstetricians and Gynecologists (ACOG), who reported (among other things) that these pharmacies include both traditional “brick-and-mortar” and mail order pharmacies.

However, it should be noted/understood that not all states offer access to mifepristone through the mail. Some states prevent the use of telehealth to obtain an abortion as well as the mail-order distribution of the abortion pill while others allow for various options to obtain the abortion pill through various means. Although the current federal regulations do allow for the mail-order distribution of mifepristone, the ability to access mifepristone through the mail really depends upon what resources you have available to you or where you live.

Patients in states with strong legal protections, such as Illinois, can learn more about how to access abortion care in Illinois including how to obtain medication abortion safely and legally.

Is the Legal Fight Over?

No, but there is a separate legal fight regarding Mifeprex access being fought in the courts. There are continuing legal efforts regarding mifepristone (through UCLA Law School’s “Mifepristone Status Tracker”) and many of them are being litigated in accordance with federal law. Since the court ruled in favor of the FDA, it does not mean that further mifepristone access restrictions cannot be imposed on future providers, either by state or federal legislation or through new judicial lawsuits attempting to limit Mifeprex’s access will be about mifepristone access in the future.

Additional information regarding mifepristone-related matters continues to evolve, including Missouri’s reported continued involvement with litigation surrounding FDA actions regarding mifepristone in 2025, as well as multiple pieces of legislation filed to limit the availability of mifepristone in 2026 and the continued attempts by policymakers to restrict access to mifepristone. Thus, the ongoing due process issues involving mifepristone will continue into future years beyond what has already occurred.

What Does This Mean for Patients Right Now?

According to the latest court ruling, patients will continue to have access to mifepristone as it is already FDA approved and legally available under current federal law. The FDA’s approval was never overturned by this case, and the way that patients can obtain medications through telehealth and pharmacies will stay the same.

However, state law is still very important for patients to consider when deciding whether or not to have an abortion. The law around abortion varies greatly depending on where you live and where you are physically located when you seek care; so even though a medication may be federally approved, it may still be difficult or impossible for patients in certain states to access it due to local restrictions. Patients seeking abortion pill services from a licensed provider can consult with Serenity Choice Health to understand what options are available based on their location.

What This Means for Providers and Telehealth

The ruling confirms that the lawsuit didn’t take away from the FDA’s framework so certified prescribers and certified pharmacies will be able to continue operating under the REMS rules unless another court or other regulatory authority changes them.

With regard to telehealth, the ruling allows for the continued use of this very important way of accessing medications for the purpose of having an abortion by patients across the country. That is significant for women living in rural areas, women who are students, women who are impacted by clinic closures, and women who desire privacy/flexibility. Patients can explore telehealth abortion care options through Serenity Choice Health to connect with a licensed provider from home.

Why the Safety Debate Continues

Despite the fact that many major medical and public health organizations stand behind continued access to the medication, there continues to be a significant amount of both safety concerns raised in courts as well as active lobbying efforts against the use of the medication. In February of 2025, ACOG, SMFM, and other medical and public health organizations publicly reaffirmed the safety and efficacy of mifepristone, and urged policymakers to allow public policy to be built upon the body of evidence surrounding mifepristone, rather than upon political ideology or lobbying efforts.

The debate is very much about who will determine the future of reproductive healthcare policy; whether it be based upon proven scientific evidence by federal and state regulatory agencies, or whether governmental bodies will set the rules for reproductive healthcare based upon political pressure instead. The ongoing legal challenges and political activities will ultimately determine whether pregnant women have continued legal access to abortion services, and whether or not mifepristone is one of the drug options available for use in abortion services situations.

How Serenity Choice Health Supports Patients

As many patients are confused by the rapidly changing legal landscape surrounding mifepristone, and are unsure of what their options may be regarding telehealth and/or in-clinic options, as well as what the current access rules may be, providers such as Serenity Choice Health are able to guide patients through the process of making a telehealth or an in-clinic medication abortion option; and can discuss what options may be available to them based upon where they live and their personal circumstances.

Due to the fact that the legal and access rules regarding mifepristone are continually evolving, patients benefit from consultation with a licensed provider who is knowledgeable about the services available in their home state and the next steps that the patient should take to access abortion services. Patients needing in-clinic abortion services can access professional, compassionate care at our Matteson, IL location serving Illinois, Indiana, and New York.

To take the next step, schedule an appointment with a licensed provider at Serenity Choice Health and get the guidance you need to navigate your options with confidence.

The Bottom Line

The Supreme Court’s 2024 decision upheld the FDA’s framework regarding mifepristone, allowing for continued use according to the federal standards by both patients and providers who were benefitting from use of telehealth and pharmacies for access to medication abortions.

However, this decision did not resolve every issue—accessing mifepristone is based heavily upon state law; thus, future state court cases may impact how mifepristone is provided to patients through court orders, as well as how laws are created at the federal level regarding the use of telehealth or pharmacies for accessing mifepristone; therefore, while this was a significant development in terms of mifepristone access, it does not address all issues related to the legality of abortion or access to abortion medication (through mifepristone) in our country.