Key Takeaways:

• A Louisiana woman has joined Louisiana's (and other states') lawsuit against the FDA for changing the abortion pill's REMS during the Biden administration, to allow for mail-order abortion pills.

• The woman, Rosalie Markezich, says her boyfriend ordered abortion pills from a California provider and coerced her into taking the pills. Her baby died.

• Louisiana issued an arrest warrant for the doctor who mailed the pills, but that warrant is still outstanding.

The Backstory:

A REMS (Risk Evaluation and Mitigation Strategy) is a "drug safety program" the FDA can require for certain medications "with serious safety concerns..."

In December of 2021, the Biden FDA weakened the REMS for mifepristone (the abortion pill) by eliminating the in-person dispensing requirement and enabling the drug to be permanently shipped by mail. In January 2023, Biden's FDA announced it would allow retail pharmacies to dispense the drug. 

The most recently published REMS on the abortion pill is dated March of 2023.

The lawsuit, now named State of Missouri v. FDA, was originally filed in Amarillo, Texas, by plaintiff doctors in the Alliance for Hippocratic Medicine (AHM), but in 2024, the U.S. Supreme Court ruled that those plaintiff doctors did not have standing to sue.

In January 2025, U.S. District Judge Matthew Kacsmaryk ruled that the states of Missouri, Kansas, and Idaho could intervene and file a complaint in the lawsuit, but in May, Trump’s Department of Justice (DOJ) called for dismissal of lawsuit.

In August, Texas and Florida petitioned the court to intervene — and now, one month later, the State of Louisiana along with Rosalie Markezich have filed a motion to do the same.

The Details:

State of Louisiana

According to the lawsuit, filed September 19, 2025, "Louisiana sues to vindicate its sovereign, quasi-sovereign, and proprietary interests," the document claimed, adding that the "2023 REMS is arbitrary and capricious and an abuse of discretion."

The state contends:

(A) the 2023 REMS harms Louisiana in its sovereign capacity because it predictably, and by design, enables third parties to violate Louisiana’s pro-life laws, preventing Louisiana from effectively enforcing its prohibition on abortion and preventing the State from protecting the lives of unborn babies despite the promise of Dobbs;

(B) the 2023 REMS harms Louisiana in its quasisovereign capacity by subjecting untold numbers of Louisiana women to injuries and risks of injuries caused by mifepristone; and

(C) the 2023 REMS causes Louisiana textbook pocketbook injuries through the Medicaid payments Louisiana must make to cover the predictable increase in mifepristone-induced harms and the ordinary costs that arise when uninsured or underinsured patients seek services at public hospitals. For any of these reasons, Louisiana has standing to sue.

"A court in this circuit has recently reaffirmed that 'states [hold] a sovereign interest in creating and enforcing their own laws and public policy... Because a federal agency cannot permit what federal law expressly prohibits, FDA lacked legal authority to permanently remove the in-person dispensing requirement through the 2023 REMS." the lawsuit claims.

Case in point:

If states 'have unambiguously expressed their opposition to purely elective abortions by passing laws prohibiting the same,' then 'the principles of federalism' 'clearly give the states Article III standing to challenge' a federal agency’s intrusion upon that sovereign prerogative.'

... Dobbs itself recognized these basic principles, crediting states’ ability to regulate abortion with an eye toward 'legitimate interests' such as: 'respect for and preservation of prenatal life at all stages of development; the protection of maternal health and safety; the elimination of particularly gruesome or barbaric medical procedures; the preservation of the integrity of the medical profession; the mitigation of fetal pain; and the prevention of discrimination on the basis of race, sex, or disability.'

In September, Louisiana's motion to join the existing abortion pill lawsuit was denied, and that same month, the state re-filed the lawsuit in the Western District of Louisiana, Lafayette Division.

Rosalie Markezich and Other Victims

The lawsuit also named Louisiana resident "Rosalie Markezich" as a Plaintiff, claiming she...

... became a victim of FDA’s mail-order abortion scheme in October 2023 when her boyfriend ordered FDA-approved abortion drugs from a California doctor and, by her boyfriend’s actions, she felt coerced to take them. The abortion drugs killed her child.

While the lawsuit does not name the "doctor" who mailed the abortion drugs, the lawsuit states:

The State found out about Rosalie’s circumstances in 2024, and it has issued a warrant for the arrest of the California-based doctor from whom Rosalie’s boyfriend ordered the abortion drugs. That warrant is still outstanding. Rosalie learned about this case and the opportunity to seek relief against FDA in 2025.

In addition to Markezich, the court document pointed to "women who have faced complications from unlawful abortions induced by mifepristone that was mailed into Louisiana":

One Lafayette OB/GYN treated a woman suffering complications after taking remotely dispensed mifepristone this year. He performed a dilation and curettage (D&C) procedure to resolve an incomplete abortion and bleeding at five weeks’ gestation. Another teenage woman and her mother requested from the Lafayette doctor an ultrasound to confirm the teen’s uterus was empty following an elective abortion and brought with them the envelope that had contained the abortion drugs they received in the mail from New York.

Another New Orleans OB/GYN and ACOG fellow has personally treated at least fourteen patients for abortion-drug complications—including roughly eleven for incomplete abortion and three for infection and sepsis—since Louisiana’s pro-life law went into effect in 2022. One patient took the drugs at 19 weeks’ gestation. Roughly half of the patients this doctor treats are Medicaid recipients. This doctor’s staff saw roughly 30 serious abortion-drug complications, including bleeding,hemorrhaging, suction D&C, blood transfusions, and hospital stays, in just a twomonth span (from April through May 2025). The total number of abortion-drug complications treated by this doctor’s hospital system is roughly 30 per month.

In addition to women who suffer from and are treated for complications, many more call local hospitals concerned about heavy bleeding or taking multiple doses without knowing how far along they are in their pregnancies or whether they have an ectopic or molar pregnancy.

"The State is also aware of many women who have sought the assistance and support of pregnancy care centers after taking abortion drugs received through the mail, including from out-of-state prescribers and facilitators of FDA-approved mifepristone like Dr. Margaret Carpenter and Aid Access," the State wrote.

Preborn Victims

The State also referred to the preborn baby as another victim, writing:

Consider also the fatal injuries to the unborn babies that are the subject of hundreds of unlawful mifepristone abortions every month in Louisiana. By Louisiana law, an unborn child is 'considered [] a natural person for whatever relates to its interests from the moment of conception.'

In seeking to protect such natural persons by generally prohibiting all abortions, including mifepristone-induced abortion, Louisiana has precisely sought to regulate the 'legitimate' interest Dobbs credited: 'respect for and preservation of prenatal life at all stages of development.'

The State was clear that "Louisiana is invoking the direct harm from the 2023 REMS to Louisiana’s own sovereign right to regulate for the protection of its citizens."

Economic Harms from Complications

In their motion to intervene, the states of Texas and Florida claimed that "inadequate adverse event reporting" has led to the undercounting of "true rates of risks associated with chemical abortion drugs," meaning that the risks are "therefore... unknown."

Now, the State of Louisiana has cited economic harms from women who suffer adverse events after taking abortion inducing drugs. "First, Louisiana is on the hook for any Medicaid-related expenses arising from these emergency room and other hospital visits..." the document states. "The State has reason to believe that it has already expended Medicaid dollars on treating abortion-drug complications. And the State ultimately covers medical expenses for treating abortion drug-related complications."

The State then pointed to a scheme (exposed by Live Action News) to hide abortion pill complications, by advising women to lie and claim they are experiencing complications from natural miscarriage:

Louisiana Medicaid likewise covers miscarriage treatment. Patients often present their abortion-drug complications as miscarriages for several reasons, including...prescribers’ advice that patients do not disclose the fact that they took abortion drugs and rather let emergency-room doctors assume they are treating a miscarriage...

...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.

"If the State pays only a portion of a medical bill related to a mifepristone induced abortion, the public hospital will incur as an expense the difference between the full amount of the medical bill and what was paid. In that way, too, the State suffers a monetary injury every time a public hospital foots the remainder of a bill that Medicaid does not cover," the state noted.

The Bottom Line:

Today, abortion providers in multiple states are admittedly shipping abortion pills “unlawfully” into states that prohibit them or restrict telehealth dispensing.

Yet, the federal Comstock Act (U.S.C. §§ 1461–62) prohibits the shipment or mailing of abortion drugs.

Two U.S. Supreme Court Justices previously hinted that Comstock could be in play, during oral arguments in the AHM v. FDA lawsuit.

Key Takeaways:

• A Louisiana woman has joined Louisiana's (and other states') lawsuit against the FDA for changing the abortion pill's REMS during the Biden administration, to allow for mail-order abortion pills.

• The woman, Rosalie Markezich, says her boyfriend ordered abortion pills from a California provider and coerced her into taking the pills. Her baby died.

• Louisiana issued an arrest warrant for the doctor who mailed the pills, but that warrant is still outstanding.

The Backstory:

A REMS (Risk Evaluation and Mitigation Strategy) is a "drug safety program" the FDA can require for certain medications "with serious safety concerns..."

In December of 2021, the Biden FDA weakened the REMS for mifepristone (the abortion pill) by eliminating the in-person dispensing requirement and enabling the drug to be permanently shipped by mail. In January 2023, Biden's FDA announced it would allow retail pharmacies to dispense the drug. 

The most recently published REMS on the abortion pill is dated March of 2023.

The lawsuit, now named State of Missouri v. FDA, was originally filed in Amarillo, Texas, by plaintiff doctors in the Alliance for Hippocratic Medicine (AHM), but in 2024, the U.S. Supreme Court ruled that those plaintiff doctors did not have standing to sue.

In January 2025, U.S. District Judge Matthew Kacsmaryk ruled that the states of Missouri, Kansas, and Idaho could intervene and file a complaint in the lawsuit, but in May, Trump’s Department of Justice (DOJ) called for dismissal of lawsuit.

In August, Texas and Florida petitioned the court to intervene — and now, one month later, the State of Louisiana along with Rosalie Markezich have filed a motion to do the same.

The Details:

State of Louisiana

According to the lawsuit, filed September 19, 2025, "Louisiana sues to vindicate its sovereign, quasi-sovereign, and proprietary interests," the document claimed, adding that the "2023 REMS is arbitrary and capricious and an abuse of discretion."

The state contends:

(A) the 2023 REMS harms Louisiana in its sovereign capacity because it predictably, and by design, enables third parties to violate Louisiana’s pro-life laws, preventing Louisiana from effectively enforcing its prohibition on abortion and preventing the State from protecting the lives of unborn babies despite the promise of Dobbs;

(B) the 2023 REMS harms Louisiana in its quasisovereign capacity by subjecting untold numbers of Louisiana women to injuries and risks of injuries caused by mifepristone; and

(C) the 2023 REMS causes Louisiana textbook pocketbook injuries through the Medicaid payments Louisiana must make to cover the predictable increase in mifepristone-induced harms and the ordinary costs that arise when uninsured or underinsured patients seek services at public hospitals. For any of these reasons, Louisiana has standing to sue.

"A court in this circuit has recently reaffirmed that 'states [hold] a sovereign interest in creating and enforcing their own laws and public policy... Because a federal agency cannot permit what federal law expressly prohibits, FDA lacked legal authority to permanently remove the in-person dispensing requirement through the 2023 REMS." the lawsuit claims.

Case in point:

If states 'have unambiguously expressed their opposition to purely elective abortions by passing laws prohibiting the same,' then 'the principles of federalism' 'clearly give the states Article III standing to challenge' a federal agency’s intrusion upon that sovereign prerogative.'

... Dobbs itself recognized these basic principles, crediting states’ ability to regulate abortion with an eye toward 'legitimate interests' such as: 'respect for and preservation of prenatal life at all stages of development; the protection of maternal health and safety; the elimination of particularly gruesome or barbaric medical procedures; the preservation of the integrity of the medical profession; the mitigation of fetal pain; and the prevention of discrimination on the basis of race, sex, or disability.'

In September, Louisiana's motion to join the existing abortion pill lawsuit was denied, and that same month, the state re-filed the lawsuit in the Western District of Louisiana, Lafayette Division.

Rosalie Markezich and Other Victims

The lawsuit also named Louisiana resident "Rosalie Markezich" as a Plaintiff, claiming she...

... became a victim of FDA’s mail-order abortion scheme in October 2023 when her boyfriend ordered FDA-approved abortion drugs from a California doctor and, by her boyfriend’s actions, she felt coerced to take them. The abortion drugs killed her child.

While the lawsuit does not name the "doctor" who mailed the abortion drugs, the lawsuit states:

The State found out about Rosalie’s circumstances in 2024, and it has issued a warrant for the arrest of the California-based doctor from whom Rosalie’s boyfriend ordered the abortion drugs. That warrant is still outstanding. Rosalie learned about this case and the opportunity to seek relief against FDA in 2025.

In addition to Markezich, the court document pointed to "women who have faced complications from unlawful abortions induced by mifepristone that was mailed into Louisiana":

One Lafayette OB/GYN treated a woman suffering complications after taking remotely dispensed mifepristone this year. He performed a dilation and curettage (D&C) procedure to resolve an incomplete abortion and bleeding at five weeks’ gestation. Another teenage woman and her mother requested from the Lafayette doctor an ultrasound to confirm the teen’s uterus was empty following an elective abortion and brought with them the envelope that had contained the abortion drugs they received in the mail from New York.

Another New Orleans OB/GYN and ACOG fellow has personally treated at least fourteen patients for abortion-drug complications—including roughly eleven for incomplete abortion and three for infection and sepsis—since Louisiana’s pro-life law went into effect in 2022. One patient took the drugs at 19 weeks’ gestation. Roughly half of the patients this doctor treats are Medicaid recipients. This doctor’s staff saw roughly 30 serious abortion-drug complications, including bleeding,hemorrhaging, suction D&C, blood transfusions, and hospital stays, in just a twomonth span (from April through May 2025). The total number of abortion-drug complications treated by this doctor’s hospital system is roughly 30 per month.

In addition to women who suffer from and are treated for complications, many more call local hospitals concerned about heavy bleeding or taking multiple doses without knowing how far along they are in their pregnancies or whether they have an ectopic or molar pregnancy.

"The State is also aware of many women who have sought the assistance and support of pregnancy care centers after taking abortion drugs received through the mail, including from out-of-state prescribers and facilitators of FDA-approved mifepristone like Dr. Margaret Carpenter and Aid Access," the State wrote.

Preborn Victims

The State also referred to the preborn baby as another victim, writing:

Consider also the fatal injuries to the unborn babies that are the subject of hundreds of unlawful mifepristone abortions every month in Louisiana. By Louisiana law, an unborn child is 'considered [] a natural person for whatever relates to its interests from the moment of conception.'

In seeking to protect such natural persons by generally prohibiting all abortions, including mifepristone-induced abortion, Louisiana has precisely sought to regulate the 'legitimate' interest Dobbs credited: 'respect for and preservation of prenatal life at all stages of development.'

The State was clear that "Louisiana is invoking the direct harm from the 2023 REMS to Louisiana’s own sovereign right to regulate for the protection of its citizens."

Economic Harms from Complications

In their motion to intervene, the states of Texas and Florida claimed that "inadequate adverse event reporting" has led to the undercounting of "true rates of risks associated with chemical abortion drugs," meaning that the risks are "therefore... unknown."

Now, the State of Louisiana has cited economic harms from women who suffer adverse events after taking abortion inducing drugs. "First, Louisiana is on the hook for any Medicaid-related expenses arising from these emergency room and other hospital visits..." the document states. "The State has reason to believe that it has already expended Medicaid dollars on treating abortion-drug complications. And the State ultimately covers medical expenses for treating abortion drug-related complications."

The State then pointed to a scheme (exposed by Live Action News) to hide abortion pill complications, by advising women to lie and claim they are experiencing complications from natural miscarriage:

Louisiana Medicaid likewise covers miscarriage treatment. Patients often present their abortion-drug complications as miscarriages for several reasons, including...prescribers’ advice that patients do not disclose the fact that they took abortion drugs and rather let emergency-room doctors assume they are treating a miscarriage...

...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.

"If the State pays only a portion of a medical bill related to a mifepristone induced abortion, the public hospital will incur as an expense the difference between the full amount of the medical bill and what was paid. In that way, too, the State suffers a monetary injury every time a public hospital foots the remainder of a bill that Medicaid does not cover," the state noted.

The Bottom Line:

Today, abortion providers in multiple states are admittedly shipping abortion pills “unlawfully” into states that prohibit them or restrict telehealth dispensing.

Yet, the federal Comstock Act (U.S.C. §§ 1461–62) prohibits the shipment or mailing of abortion drugs.

Two U.S. Supreme Court Justices previously hinted that Comstock could be in play, during oral arguments in the AHM v. FDA lawsuit.