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

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

Justices heard oral arguments in the pivotal case FDA v. Alliance for Hippocratic Medicine on Tuesday and will likely issue their decision in late June or early July before going on recess. 

The consequential case has the potential to impact abortion access not just in states that have moved to further restrict or ban abortion since Roe v. Wade was overturned in 2022 but also states where abortion rights are protected or have even been expanded.

Fourteen states already have near-total abortion bans in place, so those states would not be greatly impacted by the decision because their laws already prevent medication abortion in nearly all cases.

More than a handful of other states had passed other restrictions since Roe fell  including bans on abortion starting at six weeks to eighteen weeks that could see some access impacted if the pill mifepristone were further limited.

Limiting access to the abortion pill would have less impact on states with near total abortion bans because abortion is already completely blocked in most cases. It could have some impact on states where there are further restrictions in the books depending on the states

At least fifteen states have medication abortion restrictions requiring the pill be distributed by a physician. Several have other restrictions such as a ban on mailing pills or requiring an in-person visit with a doctor. Several other states have such restrictions held up in court

Mifepristone is part of a two-drug process to end 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 pro-abortion rights research organization, 15 states, not including the states with near-total abortion bans, currently have additional restrictions specifically on medication abortion already in place beyond the FDA rules. 

Most common among the restrictions is requiring the abortion pill be provided by a physician.

In 2016, the FDA expanded who could prescribe the abortion pill beyond doctors to include those such as nurse practitioners and physician assistants. But currently, fifteen states have laws requiring it be provided by a physician. 

The FDA also changed in-person disbursing requirements in 2021 amid the coronavirus pandemic, but at least five states have laws requiring patients have an in-person visit with a physician. 

Additionally, Wisconsin requires patients have the first dose in the presence of a physician, and Arizona has a ban on mailing abortion pills. 

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

But as the case over access to abortion pills made its way to the Supreme Court, states where abortion access has been expanded warned it would impact them as well, and some states started taking precautionary action. 

As these states started to face the possibility of restrictions on abortion pills being reimposed, some began stockpiling the drugs used in medication abortion last year.

Several states began stockpiling abortion pills including mifepristone and misoprostol amid concern that access to abortion pills would be limited or blocked with the Alliance for Hippocratic Medicine lawsuit

The governor of Massachusetts Maura Healey said last year her state had enough doses of mifepristone stockpiled to last more than a year.

In California, Governor Gavin Newsom revealed the state had a stockpile of up to two million misoprostol pills, the other drug used in medication abortion. 

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

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

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