Three states ask court not to pause joint abortion pill lawsuit

The States of Missouri, Kansas, and Idaho filed a legal notice of supplemental authority before the U.S. District Court for the Eastern District of Missouri on May 5. The States point out how the Fifth Circuit Court of Appeals granted a stay (pause) on mail-order abortions in a similar lawsuit brought by Louisiana challenging the 2023 Risk Evaluation and Mitigation Strategy (safety protocols) for mifepristone.

Following the Fifth Circuit's ruling, which stated that Louisiana is "likely to succeed on the merits," abortion pill manufacturer Danco Laboratories filed an emergency application before the Supreme Court and that application to pause the Fifth Circuit's ruling was granted. On May 11, 2026, the Supreme Court is expected to further review the request.

Key Takeaways:

• Missouri, Kansas, and Idaho filed a joint lawsuit with Kansas and Idaho against the FDA's 2023 REMS for the abortion pill mifepristone, claiming that they have suffered financial injury as a result of the changes to the protocols.

• The FDA has promised a safety review. Some courts have halted state lawsuits while the review proceeds; others, like the Fifth Circuit Court of Appeals, have granted the Plaintiffs' requests — like Louisiana — yet action by the U.S. Supreme Court is awaited.

• The Supreme Court is expected to issue some sort of a ruling on the Fifth Circuit's 'pause' of the 2023 REMS next week, which is relevant to Missouri's joint lawsuit.

The Details:

Joint lawsuit

In their lawsuit, Missouri, Kansas, and Idaho allege:

• "[T]he FDA cut corners when it removed safeguards from this dangerous drug [mifepristone]."

• "Sticking its head in the sand, the FDA eliminated non-fatal reporting requirements for abortion providers based on data collected under the originally approved safety standards, leaving no way to fully evaluate the effects of the newly deregulated regime."

• "The FDA’s actions attempt to create a 50-state mail-order abortion drug economy, undermining state abortion laws in Plaintiff states. It also enabled providers to dispense abortion drugs to residents of Plaintiff States later in pregnancy without follow-up care—causing women to seek emergency services in Plaintiff States for treatment of resulting complications."

States argue they have 'suffered financial injury'

The States' legal notice claimed that "the 2023 REMS" caused “federal interference with the enforcement of” state law: “By ending the in-person dispensing requirement, FDA opened the door for mifepristone to be remotely prescribed” and “facilitate[d] nearly 1,000 illegal abortions in Louisiana per month.”

In reference to Louisiana, the States wrote:

• Under Louisiana, States have standing to challenge the mifepristone actions based on sovereign harm and financial injury.

• Louisiana’s, like Missouri’s, sovereign harm stemmed from the “avowed purpose of the 2023 REMS . . . to expand access to medication abortion.”

• Causation and redressability, therefore, were easily shown.

• Further, Louisiana suffered a financial injury—Medicaid costs linked to out-of-state mifepristone.

Missouri et. al. notes that the State's argument is similar to that of Louisiana: "This injury is neither too speculative nor too attenuated; thus, it establishes both Louisiana’s and Missouri’s standing."

The Fifth Circuit Court of Appeals agreed that Louisiana suffered financial harms due to the 2023 REMS by "undermining" Louisiana's pro-life law, and "by causing it to spend Medicaid funds on emergency care for women harmed by mifepristone. Both injuries are irreparable." The Fifth Circuit also noted that state Medicaid costs to pay for women's "complications caused by out-of-state mifepristone... will almost certainly continue" if the FDA continues to allow mail-order abortion.

Missouri et. al.: 'Court should deny FDA’s request to stay indefinitely this case'

Missouri, Kansas, and Idaho repeated points made in other briefs:

• “The public’s interest is not served by perpetuating a medical practice whose safety the agency admits was inadequately studied.”

• "Moreover, staying the REMS 'would do nothing to prevent FDA from completing its review of mifepristone’s safety protocols.'”

The States concluded that since the Fifth Circuit concluded that "the balance of equities and public interest weighed in Louisiana’s favor," that the "FDA’s request for an indefinite stay of this case is inappropriate" and should be denied, and the courts should "conclude that the States have standing" to sue.

FDA promised safety review

In May of 2025, the Ethics and Public Policy Center (EPPC) published an analysis, “The Abortion Pill Harms Women,” which examined insurance data. EPPC says the records reveal serious adverse events from mifepristone are happening about 22 times more often than the FDA reports. That same month, the FDA Secretary asked the FDA for a complete review of the drug.

Additional analysis by the EPPC suggested that the rate of serious adverse events following the use of the abortion pill (mifepristone) significantly increases when the in-person dispensing requirement is removed.

• In September 2025, the FDA Secretary told Republican states that the FDA will conduct a new review of abortion pills.

• By February 2026, FDA's website claimed it is "conducting a safety study of mifepristone" and it would be "done sooner than" the typical year-or-more timeframe.

• In April 2026, HHS spokesperson Andrew Nixon told Bloomberg Law that the FDA plans "to have this study done sooner than that timeframe.”

• The Appeals Court in Louisiana noted that the FDA "conceded it had failed to adequately study whether remotely prescribing mifepristone is safe" but "resisted staying the regulation, arguing it was in the midst of a comprehensive review of mifepristone protocols."

Yet the FDA couldn't offer a date for the review's completion, and "admitted it was still collecting data."

Mailing abortion drugs is already federally illegal

The Comstock Act is a federal law that prohibits the mailing of “any article, instrument, substance, drug, medicine, or thing [that] may, or can be used or applied for producing abortion” through the mail.

Yet, when the FDA allowed the mailing of the abortion pill during the COVID-19 pandemic, this law was violated and continues to be ignored.

Pro-life leaders have repeatedly requested that the Department of Justice enforce Comstock. Recently Students for Life (SFLA) president Kristan Hawkins claimed her team spoke to "high ranking officials at the DOJ" about Comstock.

In an X video post, Hawkins claimed the DOJ "assured" her that that they were "aware" and were "looking into it" and that "multiple conversations" have taken place.

Kristan Hawkins

@KristanHawkins

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Watch for the DC Update👇: After our @StudentsforLife press conference at the DOJ this morning, I spoke with senior officials who confirmed there are already ongoing conversations about enforcing the Comstock Act. I also had the chance to walk them through a clear path  Show more

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Watch on X

8:12 PM · May 6, 2026

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Timelines:

The abortion pill

2000: FDA approved mifepristone (200mg)/Mifeprex.

2011: FDA placed the drug under a safety system known as REMS due to significant adverse events and deaths.

2016: Big Abortion conspired to erode the REMS on the drug. The Obama FDA weakened the REMS, even removing the requirement to report the drug's adverse events other than deaths.

2023: Despite a prohibition under the federal Comstock Act, Biden's FDA weakened the REMS again to remove the in-person dispensing requirement and allow for mail order and pharmacy dispensing of the drug.

Missouri lawsuit

• January 2024: State of Missouri v. FDA (which included the states of Idaho and Kansas) were granted permission to intervene in an older lawsuit filed by the Alliance for Hippocratic Medicine (AHM), after the Supreme Court ruled that the Plaintiff doctors in the case at that time did not have standing to sue.

• May 2025: Trump's FDA moved to dismiss based on improper venue, lack of standing, and failure to exhaust administrative remedies, and because some of their claims were barred by the statute of limitations.

• August 2025: The venue was moved from Texas (under AHM v FDA) to Missouri.

• March 6, 2026: Danco moved to dismiss. The FDA also filed a motion to stay or dismiss the Missouri lawsuit.

• April 8, 2026: Louisiana appealed the 'stay' ruling (LAN).

• April 17, 2026: Louisiana filed their appeal 

• May 1, 2026: US Court of Appeals ruling favors Louisiana and pauses abortion pill dispensing by mail.

• May 2, 2026: Danco on behalf of all defendants filed an emergency application before the Supreme Court.

• May 4, 2026: The Supreme Court granted a temporary administrative stay on the Fifth Circuit's decision, allowing mail-order abortion pill dispensing to be restored. The stay will end on May 11, 2026.

The Bottom Line:

The Supreme Court is expected to issue some sort of a ruling on the 'pause' of the 2023 REMS allowing mail-order abortion pill dispensing, at issue in the Louisiana case next week, which is relevant to Missouri's joint lawsuit.