For decades, abortion pills have been used to end pregnancies in the first trimester, but starting around April 2023, mifepristone, one of the main drugs in the two-step process, was under federal scrutiny.

Ultimately, after a ton of other moving parts and lots of drama, the Supreme Court heard oral arguments about the drug from opposing sides in March 2024. And on June 13, 2024, the Court gave a final ruling in an unanimous vote that mifepristone will remain legal and widely available.

But now, lawmakers are fighting to limit mifepristone’s availability through telemedicine. Basically, they want to make the medication only available from in-person doctor’s appointments and not available through the mail. Obviously this would be incredibly inconvenient for many people looking for an abortion, not to mention oppressive since you’d have to live near a doctor and be able to afford the visit’s co-pay.

That said, keep reading for the full timeline of everything that happened to get us to SCOTUS's decision nearly two years ago, and where we are with mifepristone now. Below is every single thing you should know about the abortion pill federal rulings, how they impact abortion pills in general, and what that means for overall abortion access nationwide.

A reminder first: What exactly are abortion pills?

Great question. In 2000, the FDA approved this noninvasive method of abortion that is safe to take at home. In essence, abortion pills are a set of two separate pills: The first, mifepristone, blocks the hormone that allows an embryo to attach to the uterus and grow, and the second, misoprostol, empties the uterus, basically causing a super-heavy period.

Their processes are pretty different (one you take with a sip of water; the other involves letting the medication dissolve either under the tongue or through the vagina), but together, these work to fully terminate a pregnancy that isn’t further along than 11 weeks.

Gotcha. So what were the rulings involving abortion pills?

A lot has gone down, so buckle up. It all mostly started back in April 2023 when Texas-based, Trump-appointed U.S. district court judge Matthew Kacsmaryk ruled that the FDA’s 23-year approval of mifepristone should come to an end.

In his 67-page ruling opinion, Judge Kacsmaryk wrote that part of his reasoning for appealing the FDA’s ruling is that the government organization, he says, didn’t take into account “the intense psychological trauma and post-traumatic stress women often experience from chemical abortion.” Judge Kacsmaryk also used typical anti-choice rhetoric like “abortionist,” “unborn human,” and “chemical abortion.”

In the other case, which was filed just a few hours after Kacsmaryk’s, Washington district court judge Thomas O. Rice ruled the opposite—that the FDA should keep its original approval and the medication should remain legal and available in 17 states plus D.C. after some blue states sued to keep the medication abortion access legal.

Then on April 12, 2023, the U.S. 5th Circuit Court of Appeals halted part of Kacsmaryk’s request to end mifepristone’s approval, but ultimately, that decision made obtaining the drug harder. Essentially, being able to receive the pill via mail from a telehealth organization—an extremely common and preferred way to get it—was off the table at that time, per CNN. The decision also gave a shorter window for when the drug could be taken, closing the cap from 11 weeks of pregnancy to 7 weeks.

Later in the same month, Supreme Court Justice Samuel Alito temporarily blocked the ruling that put tighter restrictions on mifepristone, preserving full access to mifepristone in a 7-2 vote for the time being.

After aaaall of this, the Supreme Court announced in December 2023 that it would hear oral arguments and then give a final ruling on the 5th Circuit’s decision that restricted access to mifepristone.

Has a final decision been made about mifepristone yet?

Well, there was. On June 13, 2024, SCOTUS decided to keep mifepristone access legal and widely available in a unanimous vote. If they would have banned the drug, the ruling would have went into effect across the entire country, regardless of whether abortion is permitted, per CBS News.

But as of May 2026, being able to access mifepristone via telemedicine is being debated. On May 1, a federal appeals court outlawed getting mifepristone through mail nationwide, according to NPR. But on May 4, the Supreme Court stepped in and reinstated full, nationwide access to mifepristone through telemedicine until May 11.

After that, it’s up in the air on if mifepristone will remain widely available, or if it will be banned from being ordered and delivered through the mail.

Yes, but only until May 11. The pill is available in states where abortion pills are still legal and don’t have any restrictions. According to a statement from Elisa Wells, co-founder of Plan C, the campaign and educational resource spreading awareness about self-managed abortions, she asserted that not only are all abortion pills safe forms of medicine, but that there might be way of getting access to the medications in restricted states too. She said:

We want to be clear – abortion pills remain safe and effective medicines. And, they remain available in all 50 states, including places where abortions are restricted. This is possible due to a robust system of alternative suppliers that has emerged in the United States in response to unjust bans, including community support networks, new telehealth services operating from supportive states, international telehealth services, and online pill vendors. These sources have already served more than a hundred thousand people since Dobbs and are poised to expand to meet demand.

Additionally, reproductive justice advocates and abortion providers have committed to offering misoprostol-only abortions, which are just as safe and effective as those involving mifepristone. Get the full scoop on those below:

So, what happens next?

As mentioned, we’ll know a little more come May 11. Until there's more on that, if you or someone you know needs an abortion, be sure to check out resources like:

• Abortion Finder for their state-by-state guide on service providers and any type of assistance resources needed.
• Hey Jane for getting abortion pills through the mail discreetly to your front door.
• Plan C that offers another state-based guide on how you can access pills, whether by in-person clinic, online clinic, traveling, or other supplier.