A federal appeals court is considering whether to reinstate nationwide restrictions on how patients receive mifepristone, a medication used in abortions and miscarriage treatment—a move that could sharply limit one of the few remaining avenues for Texans seeking abortion care. The 5th U.S. Circuit Court of Appeals heard arguments Sept. 9 in a lawsuit brought by Louisiana against the U.S. Food and Drug Administration and mifepristone manufacturers Danco Laboratories and GenBioPro. Louisiana is seeking a requirement that patients collect the drug in person at a hospital or medical office, ending the ability of providers to mail it or send it to a pharmacy for pickup. For Texans living under the state’s near-total abortion ban, the change could mean traveling across state lines to obtain medication that is now often prescribed through an out-of-state telehealth provider and delivered by mail or made available at a pharmacy. “That would affect underrepresented communities the most,” said Yaneth Flores of Avow Texas, an abortion-rights organization, noting that travel is generally more expensive and difficult than accessing care remotely. Danco and GenBioPro have argued that telehealth prescribing is as safe as an in-person visit. The companies have cited research indicating that requiring in-person dispensing is not medically necessary. Supporters of continued remote access also warn that restricting mifepristone could worsen health outcomes. Flores pointed to rising maternal and infant mortality and increasing rates of sepsis in Texas, saying the state is already experiencing a severe maternal health crisis. The case has an unusual procedural history. In May, the 5th Circuit temporarily barred telehealth prescribing, mail delivery and pharmacy access to mifepristone. The U.S. Supreme Court later lifted that order, leaving those forms of access in place while the broader lawsuit continues. During the latest hearing, the appeals panel’s three judges questioned whether they had authority to reverse or “stay the stay” imposed by the Supreme Court. The dispute is widely expected to return to the high court. Louisiana attorney Jorge Aguiñaga argued that the state has the authority to regulate abortion without federal interference. Opponents say Louisiana is attempting to impose its restrictions nationwide, including in states that protect abortion access. “Louisiana should not be able to export its own restrictive policies to the rest of the country,” said Caroline Sacerdote, a senior staff attorney at the Center for Reproductive Rights. She said a nationwide dispensing requirement would affect care even where abortion is legally protected. The case also raises broader questions about state shield laws, which protect providers in states such as New York and California who prescribe abortion medication to patients elsewhere. Texas officials have objected to those laws, but legal challenges seeking to undermine them have so far failed. The continuing litigation has left patients and clinicians uncertain about what care is legally available, Flores said. They urged cities such as Austin to provide clearer public-health information and counter misleading claims about abortion law. “Lots of folks are already really blurry on what abortion law is currently,” Flores said. “Many folks actually do believe that if they have an emergency situation, they can get the care that they need. And unfortunately, that’s just not something we can promise folks.” Until the courts issue another ruling, mailed and pharmacy access to mifepristone remains available under the Supreme Court’s temporary order. A final decision could determine whether that access continues nationwide—or whether patients, including Texans, must travel to obtain the medication.