Abortion pill rulings cause whiplash and confusion

Nationwide access to abortion pills is again in legal limbo, almost two years after the Supreme Court threw out a case challenging mail-order prescribing of the widely used drug mifepristone.

Why it matters: A circuit court ruling on Friday that dramatically dialed back access to the drug has caused confusion for pharmacies, telehealth companies and other clinicians, even in states where abortion is legal.

• Some providers are stopping their prescriptions, others are switching to different drugs, and patients are left wondering what's coming next.
• While the Supreme Court on Monday froze that decision for a week, it could rule as soon as next week that the drug can only be dispensed in person.

The big picture: Regardless of what happens, the 5th U.S. Circuit Court of Appeals decision on Friday put abortion access front and center in an election year and placed the Trump administration in a political bind.

• The administration has argued that courts should pause proceedings until the Food and Drug Administration completes a safety review of the drug, which was first approved in 2000.
• That stance has angered anti-abortion advocates who want the administration to invalidate a Biden administration policy and restore in-person dispensing requirements.
• "It's shameful that the Trump administration's inaction has forced pro-life states to take their battle to the federal courts," SBA Pro-Life America president Marjorie Dannenfelser said Friday.

What they're saying: The back-and-forth has created "whiplash and chaos" for patients and providers making time-sensitive medical decisions, said Alexis McGill Johnson, president of Planned Parenthood Action Fund.

• Friday's ruling amounts to "the biggest disruption to abortion access since the Dobbs decision" overturning Roe v. Wade, said Brittany Fonteno, CEO of the National Abortion Federation.

Context: Louisiana originally brought the lawsuit against the FDA to challenge Biden administration rules that expanded access to mifepristone by removing the requirement that patients see a provider in person before getting the medication.

• Federal judges have not yet issued any decisions on Louisiana's underlying legal argument against the FDA rules.

The administration has been conspicuously silent since Friday's ruling, and White House and Department of Health and Human Services spokespeople did not respond to a request for comment on Monday.

• The administration's failure to more actively defend the FDA's rules factored into the circuit court's decision to halt teleprescribing, said Katie Keith, director of the Center for Health Policy and the Law at Georgetown University's O'Neill Institute.
• Both abortion backers and opponents have said the ability to mail abortion pills into states with abortion bans, after being prescribed via telehealth, has blunted the impacts of the overturning of Roe v. Wade.

Driving the news: Fonteno, of the National Abortion Federation, said some providers paused teleprescribing of abortion pills following Friday's ruling.

• Others like Planned Parenthood of Greater New York temporarily switched to another abortion drug, misoprostol, for telehealth abortions. Misoprostol is usually used in combination with mifepristone, but it's safe when used on its own.
• Fonteno said Monday's stay brought "some relief" but given the temporary nature there is also a "sense of waiting for the other shoe to drop, knowing this is not over."

Where it stands: It's not clear how the health system would have to shift if the court decides to limit teleprescribing for mifepristone.

• The FDA has been vague on what the prescribing rules for mifepristone would be if the current system is overturned, as mifepristone maker Danco noted in a brief to the Supreme Court.
• There's also no public guidance on what would happen to prescriptions that have already been written under the current rules.
• "There's a ton of unanswered questions," Keith said.

What we're watching: Whether the Trump administration weighs in now that the Supreme Court is involved.

• The current stay that preserves telehealth access is in effect until next Monday evening, and parties have until Thursday evening to send the Supreme Court more information.