A total of 18 Republican states are asking a federal appeals court to overturn a decision that invalidates North Carolina ’s law that limits the use of the abortion pill mifepristone .
On Monday, attorneys general from Iowa , Arkansas , and South Carolina headed the coalition of red states as they filed a brief to the U.S. 4th Circuit Court of Appeals to support North Carolina’s law restricting access to mifepristone, which was struck down by a federal court in June.
The states joined North Carolina to argue that healthcare policies have historically fallen under state jurisdiction and they each have the authority and responsibility to regulate access to medication.
“Each amicus State has a sovereign interest in protecting its citizens and in ensuring its laws are not preempted by an aggressive and expansive interpretation of the Food, Drug and Cosmetic Act,” the attorneys general wrote.
The states argue that jurisdiction over abortion regulation returned to the states following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization in June 2022, overturning Roe v. Wade .
The abortion pill mifepristone, initially approved by the Food and Drug Administration in 2000, came under scrutiny this year in the first Supreme Court case on abortion issues since Dobbs.
In that case, anti-abortion advocates argued that the FDA did not have a proper basis to roll back regulatory restrictions on mifepristone, chiefly by allowing healthcare providers to prescribe the abortion pill without physically examining a patient.
The Supreme Court ruled in favor of the FDA but did so on a narrow legal technicality, leaving the door open for further litigation in the future.
North Carolina’s law regulating mifepristone, the Care Act, requires that only physicians can prescribe mifepristone, which is not necessary to get certification from the FDA to prescribe the abortion pill.
The law also required in-person prescribing and mandatory in-person follow-up appointments and required physicians to report non-fatal adverse events to the FDA, none of which are required by the public health agency.
“North Carolina’s common-sense laws protecting unborn life, maternal healthcare, and the integrity of the medical profession do not conflict with the FDA’s regulation of mifepristone, and the judgment below should be vacated,” the attorneys general in support of the Tar Heel State wrote.
Mifepristone has a black box warning from the FDA, the highest safety warning that can be given to any drug, as well as a Risk Evaluation and Mitigation Strategy.
According to the FDA warning labels for the abortion pill, 1 in 25 women who take the drug will require emergency medical treatment for mifepristone complications, including hemorrhaging or sepsis.
Lawyers for Dr. Amy Bryant , the physician who sued to challenge the North Carolina law, contend that the Care Act inhibits the FDA’s authority to “reduce burdens on patient access and the healthcare system.”
“As part of its meticulous, statutorily mandated review of the Mifepristone REMS, FDA has rejected the very restrictions North Carolina imposes,” Bryant’s lawyers wrote in their federal district court brief in February.
The heightened debate over mifepristone is likely to continue to have an effect on the 2024 election cycle as Vice President Kamala Harris and running mate Gov. Tim Walz (D-MN) continue to make abortion their central campaign issue.
Nearly two-thirds of all abortions in the United States involve mifepristone.
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