Texas and Louisiana Attorneys General Seek to End Access to Abortion Medication

In recent weeks, the Texas and Louisiana Attorneys General (“AG”) have escalated their efforts to end access to abortion medication through a coordinated set of civil, criminal, and regulatory actions. These filings target individual providers, non-profit organizations, and interstate telehealth networks, as well as take aim at the federal regulations governing the dispensing of mifepristone—the medication used in combination with misoprostol to medically terminate a pregnancy.

• On February 24, the Texas AG sued the European non-profit Aid Access and its founder, seeking injunctions and civil penalties. The suit also names a California physician who is alleged to have prescribed abortion medication to Texas residents.
• That same day, the Louisiana AG argued before a federal district court that the FDA’s 2023 policy allowing abortion medication to be dispensed by mail should be overturned. This litigation proceeds alongside criminal charges the Louisiana AG recently filed against two out-of-state prescribers.

Taken together, these actions reflect a strategy aimed not merely at enforcing state abortion bans within state borders, but at disrupting the legal infrastructure that allows medication abortion to be provided more easily across state lines. As these cases continue, access to abortion medication—and the legal protections for those who prescribe it—remain at risk nationwide.

The AGs’ Attacks on Abortion Medication

The AGs in Texas and Louisiana have used four primary legal tools to target access to abortion medication.

(1) Lawsuits Against Providers

Over the past 15 months, the Texas AG sued providers from , , and—most recently—, alleging that each prescribed mifepristone and misoprostol to Texas patients in violation of Texas’s abortion ban and medical licensure laws.

Only the New York case has progressed beyond the initial stage. The New York physician did not appear to defend the case in Texas, so the court imposed a $100,000 civil penalty and enjoined her from practicing medicine in Texas without a license.

For providers protected by Shield Laws, it can be a reasonable strategy not to appear in court in the state bringing the case. Litigating there is costly, and instead of fighting on that front, the provider can wait to challenge the judgment later when the state looks to the provider’s home state to enforce the judgment. At that point, if the Shield Law blocks enforcement of penalties arising out of lawful abortion care, the provider’s home state courts should refuse to help.

Relying on its state Shield Law, the New York courts Texas’s attempt to enforce the judgment. Texas has now the decision to the Appellate Division of the New York courts.

(2) Lawsuits Against Non-Profits

Texas has also pursued enforcement actions against organizations that facilitate access to abortion medication. Last month, the Texas AG Aid Access, alleging that it operates “an international abortion-by-mail enterprise that illegally ships abortion-inducing drugs into Texas.” The AG sent a similar cease-and-desist letter to Plan C, a California-based program. The AG alleges that both are violating Texas’s abortion ban and prohibition on the unlicensed practice of medicine.

(3) Prosecutions of Providers

The Louisiana AG filed criminal charges against the same New York and physicians sued by the Texas AG. Both cases charged the physicians with prescribing abortion medication to Louisiana residents in violation of the state’s abortion ban. In both cases, the Louisiana Governor issued , which were rejected by the and governors, relying on their states’ Shield Laws. Without the defendants present in Louisiana, both prosecutions remain stalled.

(4) Challenge to FDA Policy Allowing Mail-Order Dispensing of Mifepristone

On February 24, 2026, in , the Louisiana AG that the FDA’s 2023 revision to the mifepristone Risk Evaluation and Mitigation Strategy (REMS)—which for the first time removed the in‑person dispensing requirement and allowed access by telemedicine—was arbitrary and capricious and should be set aside. The AG seeks reinstatement of the in-person dispensing requirements that were previously in place. A court ruling could come any day.

Issues to Watch

As these cases progress, there are two key issues to watch.

(1) Application of State Shield Laws

To date, the New York and California Shield Laws have prevented Louisiana from extraditing the physicians charged under Louisiana’s abortion ban. Those protections, however, apply only if the provider remains in those states; the physicians remain subject to arrest if they travel to Louisiana while the warrants are active.

The New York shield law has also prevented Texas from enforcing its civil penalty judgment against the New York physician. Although Texas argued that the Shield Law did not apply to its attempt to enforce the judgment, Texas did not argue that the New York Shield Law is unconstitutional. As a result, the case is unlikely to result in a decision on the constitutionality of the Shield Law.

Finally, Texas’s pending suits against providers in Delaware and California may test whether those states’ Shield Laws afford protections comparable to New York’s by preventing enforcement of any judgment the Texas courts impose against the out-of-state providers. We could see proceedings as early as this summer.

(2) Attorney General Standing to Challenge FDA Mifepristone Policy

The mifepristone REMS has been challenged for years in litigation from both sides. Reproductive rights advocates have argued that the REMS is overly restrictive, while opponents have argued that it was too permissive. In , the Supreme Court concluded that the anti-abortion doctors and associations did not have standing to challenge the policy, avoiding a ruling on the merits. To the surprise of some, the Trump Administration’s FDA has continued to defend against legal challenges to the current REMS, citing its ongoing of the safety of mifepristone. At the same time, the Agency has made note of “recent studies” suggesting “potential dangers that may attend offering mifepristone without sufficient medical support or supervision”.

A decision on the Louisiana AG’s legal standing to challenge the REMS will be an important step in determining whether FDA’s actions with respect to mifepristone—particularly its decision to permit dispensing via telemedicine—will remain in effect. Standing determines not only who may bring a challenge, but also whether a court may review the merits of a dispute at all. If the states (along with providers and advocates) are found to lack legal standing, the REMS may remain for some time. If, however, the court finds that the AG does have standing, it could require FDA to reinstate the prohibition on dispensing mifepristone by mail.

What is at Stake?

The use of mifepristone and misoprostol has increased significantly in recent years—so much so that medication abortion now for the majority of abortions in states where abortion is legal, and telehealth abortions now make up more than 1 in 4 abortions across the U.S.

The Texas and Louisiana AGs’ legal tactics put access to abortion medication—and those who prescribe abortion medication—at risk. If the AG’s challenge to the FDA REMS is successful, it will become illegal under federal law to dispense mifepristone by mail in any state. That single change could make more than 25% of abortions that occur today illegal.

If the AG legal actions against prescribers and the networks that support them succeed despite state Shield Laws, providers in every state will be at risk, and access to abortion medication may shrink even further across the country.