The last time the Supreme Court threatened to end access to the country's most popular abortion method, California's online provider network and its pharmaceutical suppliers were quick to respond.
Now, with the fate of the cocktail used in roughly two-thirds of U.S. layoffs once again at stake, they're not even breaking a sweat.
Dr. Michele Gomez, co-founder of MYA Network, a consortium of virtual reproductive healthcare providers, said the supply chain is “ready to shift in one day” to an alternative drug combination.
“This is not going away and it is not going to diminish,” Gómez said.
On May 1, the U.S. Court of Appeals for the Fifth Circuit ruled to prevent the drug mifepristone from being prescribed virtually and delivered by mail, making such deliveries illegal nationwide. On Monday, the Supreme Court stayed that decision, allowing the statute of limitations to resume until the court issues an emergency ruling next week.
Mifepristone is the first half of a two-drug protocol for medical abortion, which accounted for 63% of all legal abortions in the US in 2023.
Between a quarter and a third of those abortion drugs are now prescribed by health care providers over the Internet and delivered by mail, a path that Louisiana and other prohibitionist states are fighting to prevent.
“Access to abortion has increased with all the telehealth providers,” Gómez said. “We discovered an unmet need.”
But the cocktail's second ingredient, misoprostol, can be used to produce an abortion on its own, a method that is often more painful and slightly less effective.
It would be easy for providers to switch to a misoprostol-only protocol, and much harder for courts to block it, experts said.
“We found out about this on Friday and the organizations that sent pills through the mail were sending misoprostol on Saturday,” Gómez said. “They already knew what to do.”
After the Supreme Court overturned Roe v. Wade in 2022, California became one of the first states to enshrine residents' abortion rights in its Constitution and legislate protections for doctors who prescribe abortion pills to women in states with bans.
Last fall, Sacramento lawmakers expanded those protections by allowing pills to be mailed without including the name of the doctor or patient.
But cases like the one being decided next week could still sharply limit abortion rights even in states with broad legal protections, experts warned.
“Although California has built a fortress around its own constitutional protections of reproductive freedom, those [protections] They become vulnerable to the whims of anti-abortion states if the Supreme Court gives them the go-ahead,” said Michele Goodwin, a Georgetown Law professor and reproductive justice expert.
Coral Alonso sings in Spanish as protesters demonstrate on the third anniversary of the U.S. Supreme Court decision that overturned Roe vs. Wade on June 24, 2025, in Los Angeles. The ruling ended the federal right to legal abortion in the United States.
(David McNew/Getty Images)
Legal experts are divided over how judges will decide the fate of the mail-order drug.
“This is a case where the law clearly doesn't matter,” said Eric J. Segall, a law professor at Georgia State University and an expert on the Supreme Court.
“In a very important midterm election year, I think there are at least two Republicans on the court who will decide that keeping the Fifth Circuit would really hurt Republicans at the polls,” he said. “If women can't receive this in the mail in California or other Democratic states where abortion is legal, it will have devastating consequences, and I think the court knows that.”
But he and others believe it's no longer a matter of if drugs are restricted, but when and how, even in California.
“This is creating a backdrop for a legal showdown that can surely occur,” Goodwin said.
The court's most conservative justices might find cause to act in the long-forgotten Comstock Act of 1873. The law, the brainchild of zealously anti-porn U.S. Postmaster Anthony Comstock, not only prohibited the mailing of “The Birth of Venus” and “Lady Chatterley's Lover,” but also condoms, diaphragms, and any drugs, tools, or texts that could be used to produce an abortion.
Although it has not been enforced since the 1970s, the law's anti-abortion provision remains in effect, experts said.
“The next step is the Comstock Act, which Justices Alito and Thomas have already been hinting at,” Goodwin said. “In that case, it's like playing Monopoly: We could skip the mifepristone and go straight to contraception. The goal is to make sure none of that makes it into the mail.”
That move would upend the way Americans get abortions and birth control, and put a modest Los Angeles County pharmacy squarely in the government's crosshairs.
Although doctors in nearly two dozen states can safely prescribe medication abortions to women anywhere in the U.S., only a handful of specialty pharmacies actually fill those mail-order medications, Gomez explained. Among the largest is Honeybee in Culver City, which did not respond to requests for comment.
Even if the justices don't go with Comstock, a decision in favor of Louisiana next week could create a two-tier abortion system in California and other Democratic states, experts said.
“The people this case harms the most are the poor and rural areas,” said Segall, the Supreme Court expert.
National data show that abortion patients are disproportionately poor. Most are also already mothers. Losing mail access to mifepristone would leave many with the more painful and less effective option, while those with the time and means to get to a clinic will continue to receive standard of care.
“There are fundamental issues of citizenship at the heart of this,” said Goodwin, the constitutional scholar. “Under the 14th Amendment, women are supposed to have equality, citizenship and freedom. It's like the Supreme Court took a black marker and applied it to all of those words.”
For Gómez and other suppliers, that is the problem of tomorrow.
“The lawyers and politicians are just going to do their thing,” the doctor said. “Healthcare providers are simply trying to get medications to the people who need them.”
