Dr. Angel Foster, a physician with Cambridge Reproductive Health Consultants, said it felt like she was “sitting on pins and needles” waiting for word from the court, which came shortly after 5 p.m.
“The ban on mifepristone through telemedicine was never about safety. It was about controlling people’s bodies and lives,” said Foster, whose nonprofit serves a significant number of telehealth patients through the Massachusetts Medication Abortion Access Project, or MAP.
The Supreme Court’s intervention came after a three-judge panel of the US Court of Appeals for the Fifth Circuit ruled that mailing the medication violated federal law, siding with Louisiana officials who argued the policy undermined the state’s near-total abortion ban. The ruling was appealed by drug manufacturers Danco Laboratories and GenBioPro.
Mifepristone, approved by the Food and Drug Administration in 2000, is used with a second drug, misoprostol, to terminate early pregnancies. The expansion to have the two-drug termination issued by telehealth and sent through mail has become a central battleground since the Supreme Court’s 2022 decision in the Dobbs case. Since then, more than a dozen states have banned abortion outright. Abortion remains legal in Massachusetts.
However, the court decision does not settle the underlying question, but rather reverts to the status quo in which patients can receive mifepristone through telehealth appointments, pharmacies, and the mail while a broader legal fight moves forward. For now, it’s used by millions of patients nationwide, many of which are issued in Massachusetts.
Justices Clarence Thomas and Samuel Alito dissented. Thomas wrote that the drugmakers were not entitled to emergency relief protecting them from what he described as “lost profits from their criminal enterprise.”
Alito, who wrote the 2022 Dobbs decision overturning Roe v. Wade, agreed that Louisiana’s abortion restrictions have been undermined by medical providers and organizations that mail abortion pills to the state despite its ban. He wrote that the companies “are obviously aware of what is going on yet nevertheless supply the drug and reap profits from its felonious use in Louisiana.”
Earlier this week, FDA Commissioner Marty Makary resigned after months of criticism from the Trump administration’s political allies, including abortion opponents.
In a statement, FDA officials said the ruling keeps current restrictions and telehealth access to mifepristone in place while the agency continues its safety review of prescribing rules for the drug.
Massachusetts abortion providers had spent the past two weeks scrambling to prepare for the possibility that mailed prescriptions would suddenly become illegal nationwide. Clinics discussed shifting patients to misoprostol-only regimens, stockpiling medication, and rerouting care through states with shield laws.
“We know that this reprieve is temporary, as lawmakers have made it clear they are desperate to block access to medication abortion by any means necessary,” said Foster, who added that the Massachusetts organization will continue to provide abortion medicines to patients in other states.
There are 20 US-based online clinics that mail mifepristone. Four of those, including Foster’s, are based in Massachusetts. Her MAP nonprofit allows patients to pay what they can afford, asking for a minimum of $5, and is supplemented by donations. Many patients find options through Plan C websites.
Massachusetts has emerged as a national hub for abortion access since the fall of Roe v. Wade, in part because the state has one of the most expansive shield laws that protect providers here from prosecution by states that have tighter restrictions.
Data from the Massachusetts Department of Public Health shows terminations using medication have more than doubled in recent years due to remote access to abortion medication, which has rapidly become the primary method statewide. The shift has been so pronounced that patients from other states now outnumber Massachusetts residents seeking abortion care.
State officials created a stockpile of mifepristone doses after Roe v. Wade’s overturn, in anticipation of shortages or efforts to curb access to the drug. There are 7,500 doses remaining that are set to expire in 2029.
Governor Maura Healey touted the court’s ruling Thursday as an “important victory for the health and well-being of women across the country.”
But Healey cautioned the decision is only temporary and said attacks on abortion access are likely to continue.
Ameet Sarpatwari, an assistant professor of population medicine at Harvard Medical School, said the rapidly shifting legal landscape has raised broader questions about the willingness of federal courts to override the authority of the FDA.
“It’s a critical ruling, preserving for now public health gains from wider access to a safe and effective medication,” he said. “It does not, however, resolve fundamental concerns about the court’s willingness to override FDA’s careful decision-making regarding prescription drugs, which will only come with final resolution of the case.”
Thomas argued in his dissent that mailing abortion pills violates the Comstock Act, a 19th-century law that has long gone unenforced and bans mailing any “article, instrument, substance, drug, medicine, or thing which is advertised or described in a manner calculated to lead another to use or apply it for producing abortion.”
Melanie Israel, a fellow at the conservative think tank The Heritage Foundation, said that in-person dispensing requirement for mifepristone was in place as a safeguard until it was removed by the Biden administration.
“When it was removed during the pandemic, the FDA also scaled back some of its data collection on adverse events. If you’re not collecting that data, you may be missing problems,” Israel said.
Israel said the FDA has not fully addressed how expanded mail-order access to mifepristone aligns with the Comstock Act, which she said has become increasingly central to legal challenges over abortion pills. She also argued that requiring in-person visits can help screen for complications such as ectopic pregnancies and ensure patients receive follow-up care.
“While the mail order and online may be good for the abortion industry it is really terrible for women’s health and pregnancy,” she said. “There are many ways that in-person dispensing would protect women and it’s reckless for this to continue.”
Dominique Lee, chief executive of Planned Parenthood League of Massachusetts, said the decision allows patients and providers to exhale, but argued courts should not interfere in medical decisions.
“A court has no place in the relationship between a patient and their clinician and no place in determining the course of clinical care using a long-approved drug,” Lee stated. “It is the FDA’s job to follow and uphold evidence-backed science for dispensing medications, and mifepristone’s safety and efficacy record has been clear for decades.”
Material from Globe wire services was used in this story.
Sarah Rahal can be reached at sarah.rahal@globe.com. Follow her on X @SarahRahal_ or Instagram @sarah.rahal.
