Here’s what the decision does, what the dissenting justices argued, and why state attorneys general are calling it a win.

What the Court Actually Decided

The case, Danco Laboratories, LLC v. Louisiana (consolidated with GenBioPro, Inc. v. Louisiana), reached the Court after the Fifth Circuit Court of Appeals issued a May 1, 2026 order that suspended the FDA’s 2023 rule changes. Those 2023 changes had eliminated the requirement that patients pick up mifepristone in person from a provider, clearing the way for telehealth prescribing and mail-order delivery through certified pharmacies.

The Supreme Court’s order stays the Fifth Circuit’s ruling pending the outcome of the appeal in the Fifth Circuit and any petition for certiorari. In plain terms: the in-person dispensing requirement does not snap back into effect, and patients can continue to access mifepristone under the rules that have been in place since 2023, at least until the case is resolved. If the Court ultimately declines to hear the case, the stay dissolves automatically.

The majority did not write an opinion explaining its reasoning — a common feature of orders on emergency stay applications.

Justice Thomas: The Drug’s Distribution Is a Federal Crime

This is the part worth being precise about. Justice Thomas dissented and went further than the procedural question, arguing flatly that shipping mifepristone for abortion is already illegal under existing federal law.

His argument rests on the Comstock Act, a 19th-century federal statute. Thomas pointed to 18 U.S.C. § 1461, which bans using the mails to ship any “drug … for producing abortion,” and a neighboring provision, § 1462(c), which he reads as making it a felony to use a common carrier or “interactive computer service” to ship any drug “designed, adapted, or intended for producing abortion.” Because the manufacturers ship mifepristone to certified pharmacies, which in turn ship it to patients, Thomas concluded that — in his words, quoting a lower-court opinion — “all of this violates the Comstock Act.”

From that premise, Thomas reasoned that the manufacturers could not be entitled to a stay. His logic: the companies were claiming harm in the form of lost profits, but those are profits he characterized as flowing from a “criminal enterprise.” A party cannot be “irreparably harmed,” he argued, by a court order that merely makes it harder to commit what he views as crimes, and the public interest favors reducing the “opportunity to commit crimes,” not protecting it.

It’s important to be clear about the status of this view: it is a dissent, not the law. Thomas’s position that mifepristone distribution is criminal under the Comstock Act did not command a majority. The Court’s order points the other way, preserving access. The Comstock Act’s application to abortion medication is legally contested, and the FDA has not been enforcing it as Thomas describes. But Thomas’s dissent lays down a clear marker of how at least one justice would rule on the merits.

Justice Alito: The Manufacturers Didn’t Clear the Legal Bar

Justice Alito also dissented, but on narrower, more technical grounds. He would have denied the stay because, in his view, the manufacturers failed to show they would suffer “irreparable injury” — a required element for emergency relief.

Alito argued that the FDA has signaled it does not intend to resume enforcing the in-person dispensing requirement anytime soon, so the Fifth Circuit’s order was unlikely to affect the manufacturers in the near term. He noted the companies devoted only about three of their 80-plus pages of briefing to the irreparable-harm question, and contended that inconveniences like updating prescriber agreements or adjusting pharmacy operations don’t rise to the level of irreparable harm. He also framed the broader dispute in terms of Dobbs v. Jackson Women’s Health Organization, describing an “operation” by which providers and states with “shield laws” enable patients in states like Louisiana — which bans most abortions — to order the medication online.

Alito’s dissent, like Thomas’s, did not carry the day.

Why State Attorneys General Are Calling It a Win

A coalition of 22 states and the District of Columbia — joined by the Governor of Pennsylvania — had urged the Court to keep mifepristone available, filing an amicus brief led by the attorneys general of New York, California, Massachusetts, and Washington.

Connecticut Attorney General William Tong, who joined the coalition, framed the issue around patient access and described the Fifth Circuit’s restrictions as imposed “with zero medical justification.” He argued the coalition is “fighting on every possible front” to keep mifepristone available and urged the Court to protect patients’ ability to make medical decisions “free from needless political control.”

Massachusetts Attorney General Andrea Joy Campbell, who co-led the coalition, said the decision “preserves access to mifepristone as critical reproductive healthcare while this litigation continues” and emphasized the importance of telehealth for patients seeking timely care. She said her office “will continue to fight to preserve access in the face of this lawsuit and other threats.”

The attorneys general had argued that reinstating the in-person requirement would create administrative chaos, strain clinics already facing increased demand since Dobbs, and override the policy choices of states where abortion remains legal.

The Backdrop: Mifepristone by the Numbers

Mifepristone, used together with misoprostol, is the standard medication for terminating a pregnancy through 10 weeks. The FDA first approved it in 2000, and an estimated 7.5 million people in the U.S. have used it since. Medication abortion now accounts for roughly 63 percent of abortions in the formal U.S. health care system, and about one in four abortions is provided via telehealth. The share of abortions provided through telemedicine grew from about 5 percent in 2022 to 27 percent in 2025 nationwide. The FDA eliminated the in-person dispensing requirement in 2023 after concluding it was medically unnecessary, a decision the agency said was supported by years of evidence.

What Happens Next

This order is a pause, not a final answer. The merits of Louisiana’s challenge to the FDA’s 2023 rule are still working their way through the Fifth Circuit, and the case could return to the Supreme Court on a petition for certiorari. For now, the practical effect is straightforward: telehealth prescribing and mail-order access to mifepristone continue under the existing FDA framework — but the legal fight is far from over, and the two dissents signal that at least some justices are prepared to revisit the question.

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