The State of Louisiana asked a federal judge on Tuesday to block the nationwide distribution of abortion pills via mail and telehealth, arguing that federal regulations allow residents to bypass state-level bans and pose significant economic and safety risks.
The high-stakes hearing in the U.S. District Court for the Western District of Louisiana marks the latest legal front in the battle over medication abortion following the 2022 Supreme Court decision to overturn Roe v. Wade. Louisiana, joined by a coalition of 21 states, is seeking a preliminary injunction to halt a 2023 rule by the U.S. Food and Drug Administration (FDA) that expanded access to mifepristone.
The 2023 FDA policy removed long-standing requirements for in-person dispensing, allowing certified healthcare providers to prescribe the drug via telehealth and permitting pharmacies to ship it across state lines. Louisiana officials contend this “mail-order abortion scheme” directly undermines state sovereignty and violates the Comstock Act, a 19th-century federal law that prohibits the mailing of abortion-inducing drugs.
Louisiana Attorney General Liz Murrill, who is leading the challenge alongside the conservative legal group Alliance Defending Freedom (ADF), characterized the FDA’s actions as a deliberate attempt to circumvent state laws. In a statement regarding the litigation, Murrill compared the unauthorized mailing of the drugs to the illegal trafficking of firearms.
“If I mailed a gun into their state — if I filed the identification number off that gun and mailed it into their state — that is the equivalent of what they’re doing in our state,” Murrill told WGNO. “And I feel confident that they would want to hold me accountable if I were mailing guns to people illegally in their state.”
The legal challenge has drawn significant support from other Republican-led states. Alabama Attorney General Steve Marshall, whose state joined the multistate brief, called the FDA’s rule “unlawful, plain and simple.” Marshall argued that the Biden administration used executive action to “override” the Supreme Court’s Dobbs decision, which returned abortion policy to the states.
Erik Baptist, senior counsel at ADF, told activists on Monday that he views the proceedings as “the most important case for the pro-life movement since the Dobbs decision.”
A central component of the hearing focuses on whether Louisiana has the “standing” to sue. To establish standing, a plaintiff must prove they have suffered a concrete injury caused by the defendant that the court can redress. Louisiana argues it has suffered “sovereign and economic harms,” citing nearly $90,000 in Medicaid expenditures used to treat adverse events allegedly traceable to two mifepristone-induced abortions.
The state further alleges that the FDA’s removal of in-person safeguards has led to roughly 1,000 “illegal abortions” occurring in Louisiana every month through the mail. Louisiana’s brief claims the FDA knew that removing these requirements would increase emergency-room visits, citing a baseline warning that “roughly 1 in 25 women would end up in the emergency room.”
Conversely, the U.S. Department of Justice is expected to argue that Louisiana lacks standing and that the court should pause the case. Federal officials have requested a stay while they conduct their own internal review of the drug’s safety, a process the FDA says could take a year or more.
The two primary manufacturers of mifepristone, Danco Laboratories and GenBioPro, have also petitioned to intervene in the case to defend the FDA’s regulatory authority. Supporters of the current rules, including major medical organizations, maintain that expanded telehealth access improves patient care and aligns with modern medical standards. They cite peer-reviewed studies finding that medication abortion is equally safe whether obtained in person or online.
The outcome of the Lafayette hearing could have sweeping implications for reproductive healthcare across the United States. Abortion pills are currently used in nearly two-thirds of all pregnancy terminations, and approximately one-quarter of patients rely on telehealth to access them.
The Louisiana case is one of several targeting federal regulation of abortion drugs. While Idaho, Kansas, and Missouri are pursuing similar telehealth bans, Florida and Texas have filed lawsuits seeking to outlaw the sale of mifepristone entirely, challenging the FDA’s original 25-year-old approval of the medication.
In its final response to the court, Louisiana urged the judge to reject the FDA’s request for a stay and reinstate the “in-person dispensing guardrail” immediately.
The state’s filing argued that allowing the current rules to remain in place would ignore “at least 18,000 unborn lives” and “at least 720 emergency room visits” in Louisiana alone while the federal review proceeds.
The case remains pending as the court considers the request for a preliminary injunction.