By Daniel Wiessner
Jan 5 (Reuters) – Since the U.S. Supreme Court rolled back the constitutional right to abortion in 2022, nearly half of U.S. states have banned or severely restricted the procedure, driving a surge in medication abortion – now used in more than 60% of abortions nationwide.
That has fueled a new wave of legal battles, with Republican-led states and conservative groups pressing to curb access to the abortion drug mifepristone, while providers and Democratic-led states push to expand it. Here’s a look at the key lawsuits and regulatory fights whose outcomes could impact access to the drug in the year ahead:
LAWSUITS SEEKING TO RESTRICT ACCESS
Six Republican-led U.S. states in three separate pending lawsuits are seeking to curb access to mifepristone, the first of two pills used for medication abortion in the first 10 weeks of pregnancy. Louisiana sued in October, challenging a 2023 regulation allowing for the drug to be prescribed remotely and dispensed through the mail. In December, Texas and Florida filed a broader legal challenge targeting the U.S. Food and Drug Administration’s initial approval of mifepristone in 2000 and several subsequent approvals and regulations that eased access. The three states had sought to join a separate case by Missouri, Kansas and Idaho, but a judge in Texas in September said that request was moot when he transferred the lawsuit to St. Louis federal court. The Missouri lawsuit was first filed in 2022 by anti-abortion groups and doctors, but the U.S. Supreme Court in 2024 found they did not have the necessary legal standing to challenge the FDA’s regulation of mifepristone. The states, which had intervened in the case, are pressing forward with arguments that the FDA acted improperly when it eased restrictions on mifepristone in 2023.
STATES SEEKING TO EXPAND ACCESS
Meanwhile, physicians and medical groups are challenging FDA rules also adopted in 2023 requiring providers and pharmacies to be certified to prescribe and dispense mifepristone and to obtain a signed authorization from patients. They claim the restrictions are unwarranted because mifepristone is safe and effective. A group of Democratic-led states had sued over those rules but a judge in Washington state dismissed the case in July and the states did not appeal.
In a case brought by abortion providers, a federal judge in Hawaii ruled in October that the FDA had failed to explain why the dispensing requirements were necessary and directed the agency to reconsider them, but said the rules would remain in place in the meantime. A judge in Virginia is expected to rule soon in a similar case. Four Democratic-led states have filed a petition urging the FDA to remove the restrictions.
Separately, at least three lawsuits are pending that challenge state laws limiting access to mifepristone despite its approval on the federal level. A Virginia-based federal appeals court in July rejected a challenge to West Virginia’s abortion ban by drugmaker GenBioPro, and is now considering how that ruling will impact a case involving a North Carolina law placing various restrictions on medication abortion. A challenge to a Louisiana law designating mifepristone as a dangerous controlled substance is moving forward after a state judge in June denied the state’s motion to dismiss the case.
SHIELD LAWS
More states could move to limit access to mifepristone by prosecuting out-of-state doctors who prescribe it within their borders. In an unprecedented interstate conflict, the Texas Attorney General’s office in July asked a New York state court to order a New York county to enforce a $100,000 judgment against a doctor for sending abortion pills to Texas. The case will test New York’s so-called shield law precluding the enforcement of other states’ abortion bans against New Yorkers. About 20 other states have similar laws.
Texas and Louisiana also passed laws in 2025 allowing private citizens to sue anyone who mails or distributes abortion medication to or from the state.
REGULATORY ACTION
President Donald Trump’s administration has sent mixed signals on its stance on mifepristone, launching a safety review of the drug earlier in 2025 while also approving a new generic version in October, which it was required to do by federal law. The administration has also pushed forward with the defense of the 2023 rules allowing prescriptions through the mail. And the FDA in December delayed the safety review until after the November 2026 midterm elections, according to a report by Bloomberg. The agency in response said it was taking the time needed to conduct a comprehensive scientific review.
The review delay and approval of the new generic have angered many conservatives and anti-abortion groups. Missouri, Kansas and Idaho are challenging the approval as part of their broader lawsuit, and some Republican lawmakers have called on the FDA to complete the review.
The Center for Reproductive Rights and the ACLU have filed separate lawsuits seeking to force the release of documents related to the scope of the safety review and the sources of information the FDA is considering.
(Reporting by Daniel Wiessner in Albany, New York, Editing by Alexia Garamfalvi and Bill Berkrot)
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