Court of appeals upholds abortion pill limits

But justices will have the final say on mail availability, usage timeline and need for a doctor’s presence.

NEW ORLEANS — New restrictions on access to a drug used in the most common form of abortion in the U.S. would be imposed under a federal appeals court ruling issued Wednesday, but the Supreme Court will have the final say.

The ruling by three judges on the U.S. 5th Circuit Court of Appeals in New Orleans overturned part of a lower court ruling that would have revoked the Food and Drug Administration’s 23-year-old approval of mifepristone. But it left intact part of the ruling that would end the availability of the drug by mail, allow it to be used through only the seventh week of pregnancy rather than the 10th, and require that it be administered in the presence of a physician.

Even those restrictions won’t take effect right away, because the Supreme Court previously intervened to keep the drug available during the legal fight.

The FDA granted access to mifepristone in 2000. The panel’s ruling would reverse changes the FDA made in 2016 and 2021 to loosen some conditions for administering the drug.

“In loosening mifepristone’s safety restrictions, FDA failed to address several important concerns about whether the drug would be safe for the women who use it,” Judge Jennifer Walker Elrod wrote for a panel of three 5th Circuit judges.

She was joined by Judge Cory Wilson. Judge James Ho dissented, arguing to fully uphold a Texas-based federal judge’s April ruling that would revoke the drug’s approval, which the FDA granted in 2000.

There is virtually no precedent for a U.S. court overturning the approval of a drug that the FDA has deemed safe and effective. Although new drug safety issues often emerge after FDA approval, the agency is required to monitor medicines on the market, evaluate emerging issues and take action to protect U.S. patients. Congress delegated that responsibility to the FDA — not the courts— more than a century ago.

But during a May 17 hearing, the 5th Circuit panel pushed back frequently against assertions that U.S. District Judge Matthew Kacsmaryk’s April 7 ruling was unprecedented and unwarranted.

Kacsmaryk, Ho and Wilson are all appointees of former President Trump. Elrod was appointed to the 5th Circuit by former President George W. Bush. All of the judges have a history of supporting abortion restrictions.

Elrod’s opinion Wednesday said the full revocation of the FDA’s approval of the drug was probably barred by legal time limits. Ho argued that the approval violated the 19th century Comstock Act.

The Texas lawsuit was filed by the Alliance Defending Freedom, a conservative Christian legal group that was also involved in the Mississippi case that led to the June 2022 Supreme Court ruling overturning Roe vs. Wade and the nationwide right to abortion.

Mifepristone is one of two pills used in medication abortions. The other drug, misoprostol, is also used to treat other medical conditions. Healthcare providers have said they could switch to misoprostol if mifepristone is no longer available or is too hard to obtain. Misoprostol is somewhat less effective in ending pregnancies.