Judges press both sides on standing as 5th Circuit hears Louisiana’s abortion pill access case

A federal appeals court heard oral arguments Wednesday in a Louisiana-led effort to address medical providers from other states using telehealth to provide the abortion pill mifepristone in violation of Louisiana’s pro-life laws. The three-judge panel repeatedly pressed both sides on the threshold question of whether Louisiana has legal standing to bring the case at all.

The panel of the 5th U.S. Circuit Court of Appeals heard oral arguments in Louisiana v. Food and Drug Administration in New Orleans, targeting a 2023 FDA rule that allows mifepristone to be prescribed via telehealth without an in-person visit. The panel included two judges appointed by Democratic presidents and one appointed by President George W. Bush. 

Medication abortion now accounts for at least 3 in 5 U.S. abortions, and the Guttmacher Institute estimates about 91,000 abortions last year involved pills mailed by telehealth providers into states with bans, including more than 9,300 into Louisiana alone.

Standing questions dominated today’s arguments. Louisiana contends it’s harmed because women who obtain pills through telehealth sometimes seek treatment for complications, many on Medicaid, at state expense. Circuit Judge Stephen Higginson pushed back on tying that harm to the FDA’s rule itself, noting the pills largely reach Louisiana through other states’ “shield laws” that protect out-of-state prescribers. 

“Those are state shield laws,” Higginson said. “The government has nothing to do with the shield laws.” 

Benjamin Aguinaga, Louisiana's solicitor general, responded that the state is still affected because it bears the downstream Medicaid costs regardless of which law lets the pills through. A Society of Family Planning survey cited in arguments estimated 770 to 900 women a month obtained abortions in Louisiana in 2025 through pills prescribed by out-of-state telehealth providers.

On the merits, Louisiana argues the FDA’s 2023 permission for prescription via telehealth conflicts with the Supreme Court’s Dobbs decision striking down Roe v. Wade by letting prescribers in other states effectively override its abortion ban through the mail. A lawyer for mifepristone maker Danco Laboratories told the panel the 2023 rule change was never intended to undermine state abortion laws. Gabriella McIntyre of Alliance Defending Freedom, representing Louisiana, said “this case is going to have a huge impact,” adding that Dobbs promised states the power to regulate abortion on their own terms. 

The panel’s eventual ruling won’t immediately change anything nationwide, since the Supreme Court has separately blocked changes to the prescribing rules until the case returns to it. Three other 5th Circuit panels and two district courts have already found the FDA’s mifepristone rules too permissive, according to the Associated Press, though the FDA itself says it’s still reviewing the rules and owes a status update to a district court by Oct. 7, roughly a month before the midterm elections. President Donald Trump’s pick to lead the FDA, Dr. Heidi Overton, has previously criticized the agency’s 2023 decision to loosen mifepristone's dispensing rules.

The Louisiana case is one of several fronts in the broader legal fight over mifepristone. A separate Texas and Florida lawsuit Zeale has reported on challenging the drug's underlying FDA approval was recently paused until after the midterms, and a suit from Missouri, Idaho, and Kansas seeks to roll back the drug’s rules to their pre-2016 standard. 

A related but distinct fight is playing out in California, where closing arguments are set for Sept. 17 in a state lawsuit accusing the pro-life groups Heartbeat International and RealOptions of making false claims about abortion pill reversal, a treatment some women seek after taking mifepristone in an attempt to continue their pregnancy. That case, unlike Louisiana’s, doesn't challenge mifepristone’s availability directly but is part of the same post-Dobbs landscape of state-level fights over how the drug is regulated and discussed.