Fifth Circuit hears Louisiana challenge to telehealth abortion pill access

Doctor says 95% of Tucson patients choose telemedicine appointments

The Fifth Circuit Court of Appeals in New Orleans is hearing oral arguments this week in Louisiana v. FDA, a case that targets the federal rules allowing patients to receive the abortion medication mifepristone through telehealth appointments and mail-order pharmacies. A ruling for Louisiana could end that access for patients across the country, including in states where abortion itself remains legal. The case has already been considered by the U.S. Supreme Court earlier this year and is widely expected to return there.

The case tests the legal foundation of the FDA’s 2023 decision to make permanent a pandemic-era rules-change. During the COVID-19 public health emergency, the agency began letting patients consult with providers by video or phone and receive mifepristone by mail, rather than picking it up in person at a clinic or pharmacy. The medication, marketed under the brand name Mifeprex, is taken together with misoprostol and is approved by the FDA for medication abortion before 11 weeks of pregnancy.

In Louisiana v. FDA, Louisiana Attorney General Liz Murrill’s office questions the FDA’s decision-making process, argues the telehealth rules violate states’ rights, and alleges that patient safety requires in-person visits. If the lawsuit succeeds, telehealth abortion access could be restricted nationwide.

At a Senate committee hearing in January, Murrill described the stakes in terms of state enforcement. “Until then, Louisiana’s efforts to protect mothers and their unborn children and to hold out-of-state abortion pill traffickers accountable for the harm they inflict will be all but futile,” she said.

The Fifth Circuit argument is being watched closely by abortion providers who have built telehealth practices since the FDA made its rules-change permanent. In Tucson, Arizona, Dr. William Richardson has provided abortion care for 25 years at his clinic, Choices Women’s Center. He launched telehealth services in May 2026 after a February court ruling in his favor — in a lawsuit brought by the Center for Reproductive Rights — cleared the way under Arizona’s state-level restrictions.

“I would say 95% of our patients want to use telemedicine in some form,” Richardson said. “Patients are loving it.” He described patients who arrive at the clinic for an ultrasound when their last menstrual period is uncertain, then sit in a “telehealth suite” decorated with portraits of Rosa Parks, Princess Diana, and Angela Merkel to consult with him by video. “That pretty much is what the appointment looks like,” he said. “I would say that most of the time it’s less than 30 minutes.”

Richardson said the two-drug regimen is the same whether patients see him in person or by telehealth. He explains that mifepristone, marketed as Mifeprex, blocks a hormone needed to sustain the pregnancy. Twenty-four to 48 hours later, the patient takes four misoprostol tablets, two placed between the cheek and gum on each side for 30 minutes before swallowing. “Expect cramping and bleeding within 4 to 6 hours of swallowing,” he tells patients.

For patients, telehealth can be “the difference between receiving care and not receiving care,” Richardson said, especially those who live far from clinics or face logistical obstacles. He pointed to a same-day appointment with a patient who lives 100 miles from his clinic; without the telehealth option, she would have had to make the round trip, take time off an hourly job, and arrange childcare for two children. “Sometimes I have to catch myself, like — I can’t believe that that was that easy,” Richardson said.

The legal landscape has made telehealth abortion a particular target for anti-abortion-rights groups. Patients in states with strict abortion bans, including Louisiana, can consult with a doctor licensed in a state with a shield law — Colorado was cited as an example — and have the medication shipped directly to their homes. That mechanism has prompted multiple lawsuits aimed at telehealth access nationally.

“My sense, as well as the sense of every other legitimate medical organization, is that medication abortion has been proven to be safe, effective and well-tolerated by patients worldwide,” Richardson said. His own contingency plans, he said, include remaining entirely remote, entirely in person, or a mix — whatever the legal landscape requires.

“Our victory has the potential to be short-lived,” Richardson said of his February Arizona ruling. Beyond the federal cases, Arizona could reimpose telemedicine restrictions through new legislation or an appeal of his lawsuit. At 66, Richardson said he has prepared for multiple outcomes. “We are ready to do all of those things if we have to, based on what happens here locally or what happens at the federal level,” he said. “We try to be ready for all of that.”