Abortion planner Carafem’s phones were ringing off the hook all weekend after a U.S. federal appeals court reinstated a nationwide requirement that mifepristone, one of two pills used in medical abortions, must be picked up in person. The decision released Friday left patients unsure whether they would be able to access treatment via telehealth. “People are scared and angry,” says Carafem chief operating officer Melissa Grant. “People met us and said: This can’t be true. Do you still have the medicine available? Can’t you just give it to me? They haggled.”
Once restrictions were introduced, Carafem quickly moved to a backup approach. Instead of prescribing the two-drug protocol typical of a medication abortion – mifepristone, which blocks progesterone and prevents pregnancy from progressing, followed by misoprostol, which causes uterine contractions – the organization began prescribing misoprostol alone. Although slightly less effective than the two-pill option, it has been widely used in the past. “We feel comfortable prescribing this drug,” Grant says.
This weekend, some Planned Parenthood clinics also switched to a misoprostol-only regimen. “Planned Parenthood providers are doing everything they can to make sure patients know that medication abortion is still safe, legal and available,” says Danika Severino, vice president of care and access at Planned Parenthood Federation of America.
On Monday, the Supreme Court proposed a ephemeral postponement of the ruling, putting the appeals court’s ruling on hold for a week. The solution allows patients to again obtain mifepristone through virtual clinics until at least May 11, when SCOTUS will take another look at the matter. Carafem and Planned Parenthood say they are prepared to return to using misoprostol alone if necessary. Other providers, including digital abortion clinic HeyJane, have confirmed they will also adopt this approach if necessary.
Mifepristone was developed in the 1980s in France and remains so today studied intensively for safety and effectiveness. It was approved by the Food and Drug Administration in 2000. Under President Joseph Biden, the FDA first allowed people to receive the drug by mail instead of in person in April 2021, during the Covid-19 pandemic. In 2023, the agency permanently eliminated the requirement for in-person prescriptions.
After the overthrow of the Supreme Court Roe v. Wade in 2022, ending the constitutional right to abortion, medical abortion via telehealth has become a more sought-after option, especially for patients in states that have adopted abortion restrictions. According to the public health nonprofit Plan C, approximately one in three abortions performed in the first half of 2025 used abortion pills obtained through telehealth.
Access to mifepristone has become another major reproductive health battleground, with politicians and anti-abortion lobbyists seeking to reinstate in-person dispensing requirements and thus make medication abortion more tough.
After conflicting legal rulings in 2023 caused confusion over the availability of mifepristone in virtual clinics, some of them planned to temporarily switch to offering abortions using only misoprostol. Some virtual clinics have offered single-pill options before. Offered by Carafem abortion using only misoprostol starting in 2020 to ensure patients could benefit from virtual care during the early days of the pandemic.
Misoprostol, originally developed to treat stomach ulcers, has been used to treat abortion since the slow 1980s. It remains the primary method of medical abortion in many parts of the world where access to mifepristone is narrow.
“Both mifepristone and misoprostol are very safe drugs, and generally speaking, having mifepristone increases the effectiveness and reduces the risk of complications of medication abortion,” says Rachel Jensen, a member of the American College of Obstetricians and Gynecologists, who supports the protocol of using mifepristone alone when mifepristone is not available. The single-drug regimen is also approved by World Health Organization, Family Planning Societyand National Abortion Federation.