Judge Allows Mifepristone Mail Distribution to Continue Pending FDA Safety Review

A federal judge has ruled that the abortion pill mifepristone can continue to be distributed by mail nationwide for the time being, while ordering the Food and Drug Administration (FDA) to complete a comprehensive safety review of the drug’s current regulations.

U.S. District Court Judge David C. Joseph, who was appointed by President Donald Trump, issued the ruling on Tuesday, April 8, 2026. The decision denied a request for an injunction brought by Louisiana Attorney General Liz Murrill, who sought to end the certified pharmacies regulation that allows the medication to be mailed across state lines.

The legal challenge targets the FDA’s January 2023 Risk Evaluation and Mitigation Strategy (REMS). This policy expanded access to the drug, which has become the most popular method of abortion in the United States, accounting for approximately 60% of all abortions according to Reuters.

Court Order and FDA Review

Judge Joseph ordered the FDA to finish its safety review of the 2023 REMS and report back to the court within six months. The judge noted that this review had previously been postponed through the November midterm elections.

In his ruling, Judge Joseph emphasized that the public interest is served by the completion of an evidence-based review rather than what he termed government by lawsuit.

…It is the completion of FDA’s promised good faith, evidence-based, and expeditious review of the mifepristone REMS, not “government by lawsuit,” that this Court finds to be in the public interest

Judge David C. Joseph

The judge warned that if the agency fails to complete the review and make necessary revisions within a reasonable timeframe, his analysis of the case and the weight given to certain factors will change.

The ruling follows a letter from FDA Commissioner Marty Makary and Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., both of whom requested that their respective agencies conduct a comprehensive safety review of the 2023 REMS guidelines.

Louisiana’s Legal Challenge

Attorney General Liz Murrill argued that the 2023 REMS is unlawful and that Louisiana suffers irreparable harm every day the policy remains in effect. She stated her intention to take the case to the Fifth Circuit court of appeals to seek a vacation of the 2023 REMS pending the outcome of the litigation.

Judge Joseph acknowledged that Louisiana has standing to sue, citing the 2022 Dobbs decision which allowed states to ban abortion. He wrote that there is evidence the 2023 REMS may have been approved without adequate consideration in an effort to circumvent the ability of anti-abortion states to regulate the procedure.

The judge further noted that the consequences of the policy were predictable, as out-of-state providers would use the regulations to expand access to mifepristone in jurisdictions like Louisiana.

Regulatory History of Mifepristone

Mifepristone was first approved by the FDA in 2000. At that time, it was subject to strict guidelines requiring the pregnancy to be at seven weeks’ gestation or fewer and requiring the drug to be administered in person by a prescribing physician.

These guidelines were relaxed in 2016, extending the gestational age limit to 10 weeks and reducing the number of required in-person visits.

Following the COVID-19 pandemic, during which the drug was prescribed and mailed under unprecedented circumstances, the FDA formalized these rules under the 2023 REMS, legalizing the mail-order distribution process.

The current legal battle is part of a broader trend where several red states have challenged the mail-order regulations in court over the past year. This includes ongoing litigation such as Rodriguez v. Coeytaux, in which a Texas man sued a California doctor who prescribed mifepristone to his ex-girlfriend via the organization Aid Access.

Shawn Carney, President of 40 Days for Life, told Fox News Digital that the investigation into the FDA must be accelerated so that states can begin regulating abortions if the federal government does not, describing the mail-order pills as an unregulated danger.

The FDA has not responded to requests for comment regarding the ruling.