Trump Admin Gears Up for Post-Midterm Crackdown on Abortion Drug

A Calculated Delay

The Trump Justice Department has mapped out its coming attack on mifepristone — much thirsted for by anti-abortion advocates, but deliberately delayed to avoid midterm backlash — in a new court filing. 

The first step to imposing new restrictions (or reimposing ones previously lifted) is to conduct a “safety review.” Experts often point out that there are few drugs that have been studied and scrutinized as much as mifepristone, making the pretense of discovering some heretofore unknown risk factor fairly absurd.  

“FDA is on track to obtain study results by mid-December 2026,” DOJ wrote of its review. “FDA will then need to review and evaluate/interpret the results and draft a report. FDA expects to complete that process not later than March 2027.” 

The agency will then use those “findings” to justify a change to mifepristone’s REMS — Risk Evaluation and Mitigation Strategy — or restrictions meant to police the use of highly dangerous drugs. Mifepristone’s safety profile has never justified these restrictions, but the anti-abortion movement’s decades of smearing the drug as unsafe has successfully made it harder to get under Republican and Democratic FDAs alike. 

The Biden administration took the largest strides yet in removing some of these barriers. Most importantly, it lifted the in-person dispensing requirement, which has allowed patients even in red states to be prescribed the medicine over telehealth by doctors in blue ones, and receive it in the mail. So far, blue state shield laws have protected those providers from prosecution by red states, though a massive legal reckoning on these state jurisdictional issues is certainly coming. 

That Biden-era REMS change is the crux of a Louisiana lawsuit against the FDA seeking to restrict mifepristone, with the state arguing that allowing the drug to be remotely prescribed and mailed undermines its abortion ban and forces it to expend money on Medicaid patients that have mifepristone-related complications. This week’s filing is part of that lawsuit. Historically, these lawsuits have struggled to amass legitimate examples of such mifepristone-related injuries, and Louisiana’s complaint leans heavily on state sovereignty. 

The DOJ filing stated that the FDA is looking at the in-person dispensing requirement in particular. 

“Following completion of its study and review, FDA will decide whether changes to the Mifepristone REMS Program are necessary and, if applicable, initiate any such changes in accordance with established processes,” it said. “FDA anticipates that it will be able to provide an update to its estimated date of completion as more information becomes known, particularly in March 2027 when it expects to complete its report on the final study results.” 

This filing is as much a signal to the anti-abortion movement as it is an attempt to get Louisiana to cool it until the midterms are safely finished and the FDA can do the dirty work itself. Activists have been outraged at the lack of movement in President Donald Trump’s second term, though they were somewhat assuaged when he nominated Heidi Overton — who has called mifepristone “dangerous to women” and celebrated Dobbs — as the new FDA commissioner. She has not yet received a confirmation vote.