Today, the United States Court of Appeals for the Fifth Circuit blocked the Food and Drug Administration’s 2023 rules for mifepristone, an oral medication prescribed for medication abortion and miscarriage management. The ruling comes in State of Louisiana v. Food and Drug Administration, a lawsuit brought by Louisiana challenging the FDA’s decision to allow mifepristone to be prescribed by telemedicine and sent by mail. The Fifth Circuit reinstated an in-person dispensing requirement, putting those options out of reach for patients while the case continues in the courts. DREDF is deeply disappointed by this outcome.
Background
The FDA approved mifepristone in 2000, subject to strict rules requiring patients to pick up the medication in person. Over the following two decades, the agency updated those rules as evidence of the medication’s safety grew. In 2023, the FDA formally removed the in-person requirement, allowing mifepristone to be prescribed by telemedicine and sent by mail. That change was consistent with Congress’s directive that FDA rules should not create unnecessary burdens on patients—including disabled patients.
In October 2025, Louisiana sued the FDA in State of Louisiana v. Food and Drug Administration, arguing that the FDA’s decision to drop the in-person requirement was not adequately supported by data—a claim that doctors, medical experts, and scientists say is not backed by real evidence.
The trial court agreed that Louisiana would likely win on that argument, but rather than blocking the 2023 rules, it paused the entire case to let the FDA finish an ongoing review. Louisiana appealed that decision, and today the Fifth Circuit ruled in the state’s favor—putting the in-person requirement back in place.
Amicus Brief
DREDF, joined by eight organizations and advocates, including the Autistic Self Advocacy Network, Autistic Women and Nonbinary Network, New Disabled South, Women Enabled International, and leading disability law scholars, filed a brief asking the court to deny Louisiana’s request. We did so because disabled people have a distinct and urgent stake in this case that the parties were unlikely to address on their own.
For disabled people, the 2023 rule change was a lifeline. Disabled people face serious, well-documented obstacles to in-person health care: inaccessible clinics and medical equipment, lack of accessible transportation, financial hardship, provider bias, and heightened risk of coercion when they need help from others to access care. These barriers are just as present in reproductive health care as in any other context. Research shows that 69% of disabled people report barriers to accessing reproductive health care, and that 44% of gynecology practices cannot accommodate patients with mobility disabilities. Telemedicine and mail delivery directly addressed those barriers. Today’s ruling eliminates those options, cutting off access to a safe and highly effective medication.
The brief also argued that putting the in-person requirement back in place would violate federal law in two ways. First, Congress explicitly prohibited the FDA from imposing rules that create unnecessary burdens on patients with “functional limitations” (i.e., disabilities). Second, the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act require health care entities to provide equal access and make reasonable adjustments to avoid excluding disabled people. Telemedicine is exactly that kind of adjustment—and the law requires it.
The stakes are grave. Disabled people become pregnant at similar rates as nondisabled people but face dramatically elevated health risks during pregnancy—including an approximately eleven-times greater chance of dying in childbirth. They experience higher rates of sepsis, hemorrhage, serious heart complications, and other life-threatening conditions. For many, quick and private access to mifepristone is the difference between safety and catastrophic, irreversible harm.
Our Response to Today’s Ruling
The Fifth Circuit’s decision focuses on the procedural question at the heart of the lawsuit, but it says nothing about the disability-specific legal arguments DREDF and our co-amici raised. The court did not address whether putting the in-person requirement back in place violates the ADA, Section 504, or Congress’s prohibition on unduly burdensome FDA rules. Those questions go directly to whether the court correctly weighed who gets hurt by this ruling, and in whose interest the law should operate. Disabled people’s lives and legal rights were absent from that analysis.
DREDF will continue to pursue every available avenue to protect the right of people with disabilities to equal, accessible, and nondiscriminatory health care—including reproductive health care. The law demands no less, and our communities deserve nothing less.
