The states where mifepristone abortion pill is already banned and those stockpiling it as Supreme Court considers limiting access to key medication

The Supreme Court appears skeptical about restricting access to the abortion pill mifepristone nationwide, but if they were to rule in favor of the Food and Drug Administration, it would not mean the pill would become universally available in the United States.

The justices heard oral arguments Tuesday in the pivotal case of FDA v. Alliance for Hippocratic Medicine and will likely announce their decision in late June or early July before beginning recess.

The resulting case has the potential to impact abortion access not only in states that have further restricted or banned abortion since Roe v Wade was overturned in 2022, but also in states where abortion rights are protected or even expanded.

Fourteen states have already passed near-complete abortion bans, so those states wouldn’t be much affected by the decision because their laws already ban medication abortion in almost all cases.

More than a handful of other states had passed other restrictions since Roe fell, including bans on abortion from six weeks to 18 weeks, with some access potentially affected if the pill mifepristone were further restricted.

At least 15 states have medication abortion restrictions, which require the pill to be dispensed by a doctor. Several have other restrictions, such as a ban on mailing pills or requiring an in-person visit to a doctor. Several other states have challenged such restrictions in court

Mifepristone is part of a two-drug process to terminate a pregnancy. First a person uses mifepristone, followed by the drug misoprostol. The drug is currently approved for abortion during the first 70 days or up to 10 weeks of pregnancy, a change made in 2016.

According to the Guttmacher Institute, a research organization that studies pro-abortion rights, 15 states, not including those with near-total abortion bans, currently have additional restrictions specifically on medication abortion that go beyond FDA rules.

The most common restriction is that the abortion pill must be provided by a doctor.

In 2016, the FDA expanded who could prescribe the abortion pill beyond physicians, to include nurses and physician assistants. But currently, fifteen states have laws that require it to be provided by a doctor.

The FDA also changed requirements for in-person payouts in 2021 due to the coronavirus pandemic, but at least five states have laws requiring patients to have an in-person visit with a doctor.

In addition, Wisconsin requires patients to receive the first dose in the presence of a doctor, and Arizona has a ban on mailing abortion pills.

In 2023, the FDA also approved it allowing pharmacies to dispense mifepristone directly to patients.

But as the case over access to abortion pills reached the Supreme Court, states that have expanded access to abortion warned that it would affect them too, and some states began taking precautions.

As these states began to face the possibility of renewed restrictions on abortion pills, some began stockpiling the drugs used in abortion medications last year.

Massachusetts Governor Maura Healey said last year that her state had stockpiled enough mifepristone doses to last more than a year.

In California, Governor Gavin Newsom revealed that the state had a stockpile of as many as two million misoprostol pills, the other drug used in abortion medications.

In Washington state, Governor Jay Inslee said the state was also stockpiling generic mifepristone.

Last June, Maryland also approved the purchase of abortion pills for a state stockpile. In August last year, Hawaii had also started stockpiling abortion pills.

In New York, Governor Kath Hochul announced last spring that the state would stockpile 150,000 doses of misoprostol, a five-year supply, amid fears that access to abortion pills would be blocked.