21 states join Louisiana's lawsuit challenging the FDA's abortion pill changes

Twenty-one (21) states have filed an amicus brief in support of Louisiana’s lawsuit seeking injunctive relief from the erosion of the U.S. Food and Drug Administration's (FDA) 2023 changes to the abortion pill's safety measures, which expanded access to abortion drugs through mail-order and telehealth.

Various states with laws restricting abortion have been left without recourse as bad actors flood their states with abortion pills, while the states housing the bad actors pass "shield laws" to protect this illegal activity.

The amici states include Nebraska, Alabama, Alaska, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Mississippi, Missouri, Montana, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia, and Wyoming.

Key Takeaways:

• Louisiana filed suit in 2025 against the FDA over its 2023 changes to the Risk Evaluation and Mitigation Strategies (REMS) for the drug mifepristone, or the abortion pill, which allowed the drug to be obtained via mail-order and telehealth and removing the requirement for an in-person visit.

• The Trump administration's FDA countered, asking the court to stay the lawsuit until it does its own studies to determine whether the changes to the REMS should remain in place.

• However, Louisiana — and now, 21 other states — claim that because of the Biden FDA's changes to the REMS, their state sovereignty over their own abortion laws is being thwarted by the refusal to return to the previous in-person requirement.

The Timeline:

• 2000: The abortion pill is approved by the FDA.

• 2011: After several women suffered serious complications and death the drug was placed under Risk Evaluation and Mitigation Strategies (REMS).

• 2016: President Obama's FDA eroded the REMS, expanding use of the drugs use from 7 weeks to 10 weeks, and all required complication reports except deaths were removed.

• 2022: The U.S. Supreme Court overturned Roe v. Wade in the Dobbs v. Jackson Womens Health Organization case.

• 2023: President Biden's FDA further eroded the REMS to allow the drug to be dispensed through mail-order and in pharmacies.

• December 2025: Lawsuits were filed by the State of Florida and the State of Texas v. FDA, and the State of Louisiana, which sought preliminary injunctive relief.

• January 2026: President Trump's FDA filed a motion to stay the case against it, claiming it needs time to perform studies on the abortion pill.

• February 2026: 21 states join Louisiana in its lawsuit, asking for the 2023 REMS to be preliminarily enjoined.

The Details:

The states argue that when the Supreme Court “return[ed] the issue of abortion to the people’s elected representatives” in 2022, this allowed states to enact and enforce laws “based on their belief that abortion destroys an ‘unborn human being.’”

States allege that the Biden-era change in 2023 was an "attack on state sovereignty" by seeking to "establish a nationwide abortion standard," suggesting that "the 2023 REMS does an end-run around amici States’ validly enacted laws."

"These laws represent the considered judgments of 'the people and their elected representatives' after hard-fought democratic deliberation," they wrote, adding that "Rather than respect these States’ prerogatives to protect prenatal life, the Biden Administration sought to undermine them."

At issue is the fact that...

... the 2023 REMS removed a long-standing requirement that mifepristone be dispensed in-person and allowed the drug to be prescribed via telehealth...

Even though States—like Nebraska—require a prescribing doctor to be physically present, doctors in California and New York can now prescribe mifepristone through telehealth under the 2023 REMS, and they are doing so without fear of consequences for breaking other States’ laws.

Like Louisiana, amici States believe that the Biden Administration’s attempt to establish a nationwide abortion standard is an attack on state sovereignty. The Constitution does not give the federal government power over “every nook and cranny of daily life.”

... The 2023 REMS allows California to set nationwide policy, regardless of what citizens in Louisiana and Nebraska may think. The Constitution promises more.

Louisiana has suffered concrete harm and thus has standing to challenge the Biden Administration’s unlawful actions.

States contend that the 2023 REMS change was an "infringement on state sovereignty" by allowing some states to "superimpose their views" on others.

This attempts to:

• "enshrine the policy preferences of some States over and against those of other States."

• "usurp the States’ prerogatives on chemical abortion and federalize it."

"Amici States have experienced sovereign harms as a result of the 2023 REMS" including an increase in telehealth abortions "despite a clear prohibition on the practice," they wrote.

Pro-abortion Guttmacher Institute researchers recently acknowledged that telehealth abortion has contributed to increased numbers since the end of Roe v. Wade.

In addition, states argue they could face "economic injury" after women are advised to present to the emergency room often at taxpayer expense should a complication arise.

As a result of the illegal abortion drugs flowing into its borders, Louisiana has experienced “actual emergency-room visits by patients who took mifepristone received by mail and whose care costs will likely ultimately fall to Medicaid and the State.”

.... The State will have to pick up the tab when its women are harmed from a drug that the State considers too dangerous to prescribe via telehealth. FDA cannot deny that is an economic harm....

... Louisiana has pled at least $92,000 in increased Medicaid costs from two mifepristone-induced abortions in 2025

The Bottom Line:

The 21 states are asking the Court to grant motion for a preliminary injunction in part because:

• "The Constitution establishes a limited federal government confined to enumerated powers. It leaves to the States 'great latitude' to protect 'the lives, limb, health, comfort, and quiet of all persons.'"

• "The 2023 REMS was a direct attack on these States’ duly enacted laws, striking at the very heart of state sovereignty."

“This is about protecting life, but it’s also about state sovereignty,” South Carolina Attorney General Wilson said in a release. “What good does it do for one state to pass a law banning something, like chemical abortion drugs, if another state is still allowed to mail them into our state?”