What the Supreme Court case on mifepristone means for abortion access

On June 13, 2024 the Supreme Court voted 9-0 to reject Alliance for Hippocratic Medicine v. FDA on standing. In their decision, they reversed the baseless 2023 ruling from the Fifth Circuit Court of Appeals, which sought to force the FDA to significantly restrict access to mifepristone (one of two medicines used in a medication abortion) by rewinding regulations to 2016 before telehealth prescribing was permitted. This decision preserves FDA’s approval and regulatory framework for mifepristone, including accessing it through telemedicine. It does not, however, change state-level restrictions on abortion.

As the Justices addressed during the oral arguments for the case in March 2024, the case is weak and the facts are evident: mifepristone is extremely safe, effective, and still legally available through Hey Jane. 

As the leading virtual abortion provider in the US, Hey Jane will continue to deliver evidence-based, compassionate medication abortion care to our patients. Care with Hey Jane continues to be legal in the states that we operate in, and no attack on individual liberty and equity will stop Hey Jane from doing all that we can to provide high-quality abortion access.

Here’s what you need to know about medication abortion, the federal courts’ decisions regarding Alliance for Hippocratic Medicine v. FDA and State of Washington v. FDA, what Hey Jane is doing to ensure abortion access to those who need it, and what you can do to take action.

What is this case about?

‍The Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration is a court case that completely disregards science and medicine in a political effort to restrict access to mifepristone—which has been used for decades to safely and effectively end an early stage pregnancy. For many people, medication abortion is the best and sometimes the only option, which is why it now accounts for more than 63% of all abortions in the U.S., and why abortion opponents are trying so hard to prevent people from accessing it. It is extremely safe, effective, affordable and discreet, and can be cheaper and easier to access than in-person clinics.

What is mifepristone?

‍Mifepristone is a medication that blocks the hormone progesterone, which is needed to continue a pregnancy. When taken in conjunction with misoprostol (which causes the uterus to contract, leading to cramping and bleeding), mifepristone is up to 98% effective at ending pregnancies up to 11 weeks. It has a significant adverse reaction rate of less than .2%. 

This is not a new medication: Mifepristone was first developed by French researchers in the 1980s. Countries like China, Great Britain and Sweden all legalized the medication abortion regimen of mifepristone and misoprostol in the late-80s and early-90s. In 2000, the FDA approved mifepristone for medical termination of pregnancy in the US. 

Medication abortion can be more affordable and easier to access than in-person clinics, and allows for discreet, safe care from the comfort and convenience of home. (With Hey Jane, for example, patients complete an intake form online and hear back from one of our providers within 24 hours—and, if approved for care, have access at the tap of a button to our clinical care team for both emotional and medical support.)

For many people, medication abortion is the best and sometimes the only option, and it now accounts for more than half of all abortions in the US—a number that continues to increase following the 2021 FDA ruling allowing abortion pills to be mailed and the 2022 overturning of Roe v. Wade. This is why the vast majority of people (72% of Americans) oppose laws that would make it illegal to use or receive abortion pills through the mail, which explains why abortion opponents are trying so hard to prevent people from accessing medication abortion. 

The plaintiffs

‍There are eight plaintiffs listed in this case, including several physicians and medical organizations opposed to abortion, all led by The Alliance for Hippocratic Medicine. This umbrella organization is made up of five anti-abortion groups, and was formed in 2022 in Amarillo, Texas despite none of its member groups being based there. This calculated choice in location allowed this group to file their lawsuit in Amarillo where conservative Judge Matthew Kacsmaryk hears 95% of filed cases.

Current status (Updated June 13, 2024):  

The Supreme Court unanimously ruled that the original plaintiffs in this case do not have standing. However, three states have intervened in this case—meaning that it returns to the lower courts. Mifepristone remains FDA-approved and available through virtual abortion providers like Hey Jane.

Key dates so far for Alliance for Hippocratic Medicine v. FDA

March 2024: Oral arguments occurred for Alliance for Hippocratic Medicine v. FDA in the Supreme Court

Here are our four key takeaways:

• Overall, the justices appeared skeptical of the case’s weak standing and appear unlikely to restrict abortion pill access
• Oral arguments made clear that this case has never been about patient safety, but rather about pushing an anti-abortion political agenda
• Plaintiffs continued to attack the FDA’s authority and safety precautions despite abundant evidence to support mifepristone’s safety and efficacy
• The Supreme Court will continue to discuss this case internally, and we expect a decision sometime in the next few months

‍During this time, mifepristone remains safe, effective, and FDA-approved—and is available through providers like Hey Jane.

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January 2024: Leading reproductive health, rights, and justice organizations, including Hey Jane, file an amicus brief with the Supreme Court

Hey Jane joined other leading reproductive health, rights, and justice organizations in urging the Supreme Court to follow the science and reverse the Fifth Circuit court's baseless ruling. Supporters include the American College of Obstetricians and Gynecologists, American Medical Association, Guttmacher Institute, and numerous other organizations who know that the facts are clear: mifepristone is safe, mifepristone is effective, and mifepristone is still FDA-approved.

December 13, 2023: Supreme Court agrees to review the Fifth Circuit’s order restricting access to mifepristone

The Supreme Court agreed to review the Fifth Circuit’s order restricting access to mifepristone—a move we at Hey Jane are glad to see, as it closed the door on the challenge tothe initial FDA approval of mifepristone and opened the door on reversing the rest of this baseless ruling.

August 16, 2023: The Fifth Circuit narrows the Supreme Court’s preliminary injunction

The Fifth Circuit substantially narrowed the preliminary injunction by rejecting the challenge to the initial 2000 approval of mifepristone. This means that the FDA’s approval of mifepristone remains in place. The new ruling is on hold pending Supreme Court appeal.

Despite this win, this case continues to spread needless confusion over access to mifepristone, the first medicine taken in a medication abortion, which has been approved by the FDA for over 20 years and is safer than taking Tylenol.

April 11, 2023: Reproductive health, rights, and justice organizations, including Hey Jane file an Amicus Brief with the Fifth Circuit Court of Appeals

In response to the baseless ruling in Texas, Hey Jane signed an amicus brief (alongside 100 other leading reproductive health, rights and justice organizations) filed with the Fifth Circuit Court of Appeals. The brief reflects our belief that removing access to the safe and effective mifepristone is not based in science or medicine and would lead to irreparable harm for people across the country. 

April 7, 2023: Two federal judges issued conflicting rulings on the FDA approval of mifepristone and the Supreme Court steps in

District court ruling in Amarillo, Texas ordered in Alliance for Hippocratic Medicine v. FDA

On Friday, April 7, federal judge Matthew Kacsmaryk took the unprecedented step of attempting to block the FDA approval of mifepristone. The order had no immediate effect and went to appeals almost immediately. Ultimately, the Supreme Court did not allow the preliminary injunction out of Texas to go into effect. At this point, the case returned to the Fifth Circuit.  

District court ruling in Spokane, Washington ordered in State of Washington v. FDA

On Friday, April 7, federal judge Thomas O. Rice barred the FDA from limiting access to mifepristone in 18 states and territories—Washington, Oregon, Arizona, Colorado, Connecticut, Delaware, Illinois, Michigan, Nevada, New Mexico, Rhode Island, Vermont, Hawaii, Maine, Maryland, Minnesota, the District of Columbia, and Pennsylvania—while the attorneys general of those states litigate their claim that the FDA has imposed needlessly burdensome restrictions on mifepristone, singling it out despite ample evidence of its safety. This ordered that the 2023 REMS, which was not challenged in the Fifth Circuit case, remains in place. The preservations of the 2023 REMS means that mifepristone can still be prescribed and distributed through telemedicine care, even if the Supreme Court had not stepped in to hold the decision in Texas from being executed.

November 18, 2022: Challenge against the FDA filed by anti-choice extremists in Texas’ Fifth Circuit

The Alliance for Hippocratic Medicine, an anti-choice group, filed this case with the District Court in Amarillo, Texas where known anti-choice judge, Matthew Kacsmaryk, presides. This was a calculated act of “judge shopping” that allowed them to essentially select the judge with similar anti-choice opinions in hopes that it would add merit to their baseless case. 

This case challenges the 2000 approval of mifepristone, the 2016 Risk Evaluation & Mitigation Strategy (REMS), and the 2021 REMS.

What does this mean for abortion care from Hey Jane?

Care with Hey Jane has not been impacted, and we will continue providing our current medication abortion protocol (mifepristone and misoprostol) to our patients.

‍In other words: If you are seeking medication abortion care, Hey Jane is still an option for you—and care with Hey Jane continues to be incredibly safe, effective, and legal.

Since our founding, Hey Jane has used a mifepristone and misoprostol protocol to help over 50,000 patients safely end early-stage pregnancies. Our focus remains on our patients and delivering the best possible evidence-based, compassionate care.

“This case serves as a tough reminder that the attack on reproductive rights didn’t end with the reversal of Roe,” says Kiki Freedman, Hey Jane’s co-founder and CEO. “As the most-trusted telehealth medication abortion clinic, we will continue to provide educational resources, physical and emotional support, and safe and effective medication for all individuals seeking abortions as we navigate this rapidly changing legal landscape.”

‍And let us be clear: Abortion is still legal in the states Hey Jane operates in—California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Virginia, and Washington—and it’s your right to access care. 

No one should have their options for abortion care limited for political gain, and we urge our leaders to follow the science and do all that they can to push back on these baseless and extremely harmful attacks. 

What can I do to support abortion access?

There are concrete ways to act. If you'd like to join us in the fight for abortion access, sign up to join Hey Jane’s Un-Whisper Network.

Spread the word about medication abortion options

Medication abortion is a safe, effective, common, and private abortion option. While a majority of abortions performed in the US are medication abortions, only 54% of people know about this option—and baseless lawsuits serve to further confuse people. Use your platform to spread the word—to your friends, your family, your community.

Donate to an abortion fund or practical support groups

Abortion funds—which are able to cover costs for those who need assistance paying for an abortion—have been vital in helping to get people the care they need; they will play an even more important role in the future. Now more than ever, they need your support. You can find your local abortion fund through the National Network of Abortion Funds (NNAF), donate to NNAF directly, or donate to one of Hey Jane’s official abortion fund partners.

There are also practical support groups, which help coordinate and pay for other logistical needs that come up—such as transportation to/from a clinic, hotel stays, childcare, and more. These are often entirely funded by donations, so please consider supporting The Brigid Alliance, Jane’s Due Process, or another local practical support organization (you can find one through Apiary Collective).

Tell your elected officials to protect medication abortion, abortion providers, and abortion patients

It’s past time for states to pass laws that support abortion access. Urge your state representatives to prioritize passing “shield laws,” legislation that will protect providers, patients (both from in and out of state), and clinics. These state laws are imperative to prevent a chilling effect in the immediate future. 

Stay up to date on the latest news

Follow Hey Jane on Instagram, TikTok, Twitter (X), Facebook, and LinkedIn, and sign up to join the Un-Whisper Network to stay up to date on the latest—and help us spread the word so that everyone knows about their options for having a safe, effective, and legal medication abortion.

The movement protecting abortion access is committed, organized, and more motivated than ever, and Hey Jane will continue doing our part to provide this essential health care.