Federal judge gave FDA six months to respond before blocking mail-order mifepristone in Louisiana
Judge Joseph signaled that Louisiana will win its challenge to mail-order abortion pill access
Judge David Joseph issued a 37-page ruling on April 7-8, 2026, in State of Louisiana v. Food and Drug Administration. Joseph was nominated by President Trump on November 20, 2019, and confirmed 55-42 by the Senate on July 28, 2020. All 53 Republican senators voted yes. Only two Democrats, Doug Jones of Alabama and Joe Manchin of West Virginia, crossed party lines.
Joseph made a critical procedural split. He found that Louisiana has legal standing to sue, concluded the state is "likely to succeed" on the merits, but declined to block the 2023 FDA rules immediately. Instead, he stayed the case for six months while the FDA completes a safety review. He warned that if the FDA fails to finish its review, "the Court's analysis will inevitably change," signaling he'll likely rule for Louisiana after the deadline.
Key Concepts
Essential concepts and terms to understand this topic
Federal Limits
The constitutional principle that federal power is limited to powers explicitly granted in the Constitution.
Medication Abortion
The use of FDA-approved drugs — mifepristone and misoprostol — to end a pregnancy without surgery, now the most common abortion method in the United States.
Risk Evaluation and Mitigation Strategy
An FDA-required safety program that sets conditions for how certain high-risk medications can be prescribed, dispensed, and used.
State sovereign standing
A legal doctrine that gives state governments broader access to federal courts to sue on behalf of their citizens and state interests.
Abortion Shield Laws
State laws that protect doctors in abortion-access states from prosecution or lawsuits for providing legal care to patients who travel from states where abortion is banned.
Comstock Act
An 1873 federal law that criminalized mailing "obscene" materials, including contraception and abortion-related items, now being revived as a tool to restrict medication abortion.
Cases and Controversies
The constitutional requirement that federal courts only decide real, active legal disputes between parties with a personal stake in the outcome.
Conflict Preemption
Federal law blocking state law when the two cannot coexist
Federal Preemption
Federal law supersedes conflicting state or local law under the Supremacy Clause.
Dobbs v. Jackson Women's Health Organization
The 2022 Supreme Court decision that overturned Roe v. Wade, ruling the Constitution doesn't protect a right to abortion and returning regulation to the states.
Key People
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David Joseph
U.S. District Judge, Western District of Louisiana
Nominated by President Trump in 2019, confirmed 55-42 in 2020. Issued 37-page ruling finding Louisiana has standing and is 'likely to succeed' but stayed the case for six months. Warned his 'analysis will inevitably change' if FDA doesn't complete its review.
Liz Murrill
Attorney General of Louisiana
Filed the lawsuit using state sovereign standing to avoid the standing problem that killed the 2024 Supreme Court challenge. Announced she'll appeal to the 5th Circuit to block the 2023 REMS changes immediately.
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Martin Makary
FDA Commissioner
Named defendant in the case. The FDA under his leadership must complete a safety review of mifepristone's mail-order dispensing rules within six months or face likely adverse ruling.
Robert F. Kennedy Jr.
Secretary of Health and Human Services
Named defendant in the case as HHS Secretary. HHS oversees the FDA, making Kennedy's department ultimately responsible for the mifepristone REMS review.
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Tony Perkins
President, Family Research Council
Filed amicus brief supporting Louisiana. Issued statement calling the FDA policy destructive and expressing skepticism about the FDA completing a timely review. Supports Louisiana's 5th Circuit appeal.
Bill Cassidy
U.S. Senator (R-LA)
Among 60 members of Congress who filed amicus briefs supporting Louisiana's challenge. Also voted to confirm Judge Joseph in 2020.
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Rosalie Markezich
Lead Individual Plaintiff, Louisiana v. FDA
Louisiana resident whose boyfriend ordered mifepristone from California physician Dr. Rémy Coeytaux in October 2023. Markezich says she was pressured into taking the pills and couldn't regurgitate them. Her individual harm claim paired with Louisiana's sovereign standing argument gave the state a path into federal court after pro-life doctors were thrown out for lack of standing in 2024.
JK
Julia Kaye
Senior Staff Attorney, ACLU Reproductive Freedom Project
Responded to Joseph's ruling saying putting the case on hold is a better outcome than what Louisiana requested but warned of continued risk: severe and immediate restrictions on mifepristone that would upend abortion and miscarriage care. Monitoring the case as it heads to the 5th Circuit.
AM
Alexis McGill Johnson
President and CEO, Planned Parenthood Federation of America
Issued statement warning that mifepristone and abortion access are very much still under attack from the courts, the Trump administration, and state legislatures. Said the judge's ruling leaves the door open for future restrictions on mifepristone access.
RC
Rémy Coeytaux
California Physician, Indicted Defendant
California-licensed doctor indicted in January 2026 by a St. Tammany Parish grand jury for criminal abortion after mailing mifepristone to plaintiff Rosalie Markezich in October 2023. California Governor Gavin Newsom refused extradition. His case is the first criminal prosecution of an out-of-state doctor under Louisiana's post-Dobbs abortion enforcement theory.
Claims & Perspectives
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Judge Joseph was nominated by Trump and confirmed 55-42.
Joseph was nominated November 20, 2019, renominated January 6, 2020, and confirmed July 28, 2020, by a 55-42 vote. All 53 Republicans voted yes; only Democrats Doug Jones and Joe Manchin crossed party lines.
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The Supreme Court unanimously dismissed the Alliance for Hippocratic Medicine challenge in 2024 for lack of standing.
In FDA v. Alliance for Hippocratic Medicine, 602 U.S. 367 (2024), the Supreme Court ruled unanimously that the pro-life doctors lacked Article III standing because they couldn't show personal injury from mifepristone's dispensing rules.
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One-quarter of all US abortions now involve telehealth prescribing.
By the end of 2024, approximately 25% of all abortions in the US were accessed via telehealth, a fivefold increase in two years since the January 2023 REMS changes took effect.
Sources
True
Twenty-one Republican attorneys general filed amicus briefs supporting Louisiana.
Twenty-one state attorneys general from 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 filed amicus briefs.
True
The 5th Circuit is reversed by the Supreme Court more often than any other circuit.
In recent Supreme Court terms, the 5th Circuit has been reversed more often than any other federal appeals court. In one recent term it had 3 rulings upheld and 8 overturned.
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Murrill announced she'll appeal to the 5th Circuit.
Louisiana AG Murrill announced immediately after the ruling that she will appeal to the 5th Circuit to block the 2023 REMS changes while the FDA completes its safety review.
What you can do
Contact your senator about FDA independence in drug safety decisions
civic action
The mifepristone case raises fundamental questions about whether courts or scientists should determine drug safety. Your senators need to hear from constituents about protecting the FDA's scientific authority.
Track the 5th Circuit appeal timeline
civic action
Louisiana AG Liz Murrill announced on April 8, 2026 that she would appeal to the Fifth Circuit immediately, seeking to block the 2023 REMS rules while the FDA's six-month review proceeds. A Fifth Circuit preliminary injunction could cut off mail-order mifepristone access for the one quarter of abortion patients who currently rely on telehealth — without any final ruling on the merits. PACER is free to create an account; Democracy Docket at democracydocket.com also publishes plain-language updates on this docket as filings occur.
Learn how your state's laws interact with federal drug regulations
civic action
Eight states have enacted shield laws protecting providers who prescribe abortion pills by telehealth and mail them into states where abortion is banned. Whether you live in one of those states — or in a state actively trying to restrict access — determines what options are available to you if the Fifth Circuit issues a nationwide injunction. The Guttmacher Institute's state policy database is the most comprehensive public tracker of abortion laws; it is updated within days of any legislative or judicial change.