The Supreme Court unanimously rejected calls to restrict access to mifepristone, one of the two drugs used in medication abortion, in a Thursday morning ruling.
The ruling is a win for abortion rights groups, who believe the case was brought to the Supreme Court by a politically motivated anti-choice group that had no scientific-based evidence to roll back access to mifepristone.
The ruling, written by Justice Brett Kavanaugh, rejected the plaintiffs on standing. “Under Article III of the Constitution, a plaintiff’s desire to make a drug less available for others does not establish standing to sue. Nor do the plaintiffs’ other standing theories suffice,” Kavanaugh wrote.
The plaintiff in the case, Alliance for Hippocratic Medicine, a collection of five anti-abortion medical groups, had claimed that the Food and Drug Administration overlooked safety issues when it loosened the rules for prescribing the abortion drug in 2016 and again in 2021, amid the COVID-19 pandemic. AHM wanted to prohibit mifepristone from being sent through the mail or distributed at large pharmacy chains, among other restrictions.
In 2022, the Supreme Court overturned Roe v. Wade, setting off a wave of abortion bans across the U.S. But abortion rates have generally stayed the same in large part because these bans did not stop people from ordering pills through the mail.
Mifepristone is prescribed as part of a two-drug regimen alongside misoprostol for abortion and miscarriage care. The drug is also used to treat other medical conditions, including Cushing syndrome and hyperglycemia, or high blood glucose, as well as other diseases. The FDA approved mifepristone in 2000, and the medication has since been used by nearly 6 million people in the U.S., according to the department.
The ruling in the case — known as FDA v. Alliance for Hippocratic Medicine — is surprising given what happened during March oral arguments. A majority of the justices, including some conservatives, appeared highly skeptical of whether plaintiff Alliance for Hippocratic Medicine, a collection of five anti-abortion medical groups, could even bring the case.
Plaintiffs are required to show they’ve suffered real harm in order to obtain standing to sue, and from the moment arguments began, the justices honed in on whether the group — and specifically, the doctors cited as examples in its briefs — met that bar. Many of the questions asked during arguments suggested that even the court’s most conservative justices saw the alliance’s standing argument as tenuous at best.
The COVID-19 pandemic led to government regulators loosening rules around mifepristone prescriptions in 2021, sparking the rise of online pharmacies in the U.S. that ship abortion pills directly to patients’ homes. Since the repeal of Roe, nearly 20 states have enacted abortion restrictions, making access to abortion pills via mail critically important.
Mifepristone and misoprostol are more than 95% effective and pose fewer risks than Tylenol, and over 100 studies have corroborated their safety and effectiveness. Medication abortion accounts for 63% of abortion care in the U.S., according to a study from the reproductive rights group the Guttmacher Institute.
Major medical groups have repeatedly said that mifepristone should be accessible to patients across the country. The drug is a “safe, effective and important component of treatment and management for early pregnancy loss … and induced abortion,” the American Medical Association and the American College of Obstetricians and Gynecologists wrote in a letter to the FDA, in response to the initial Alliance for Hippocratic Medicine lawsuit filed in 2022.