WASHINGTON — The Supreme Court on Tuesday will hear its biggest abortion case since it ended the constitutional right to the procedure two years ago by reversing Roe vs. Wade. A ruling could affect access to a drug used in more than half of all abortions across the country. The dispute is over the Food and Drug Administration's regulation of the abortion drug mifepristone.

“This is a really important case, because this is one of the first times that the Supreme Court is considering the medication abortion pill, and if they decide that some of the restrictions for the pill should remain in place, then that's going to impact every state, even abortion protective states,” said Seema Mohaptra, a law professor at Southern Methodist University. 

Opponents of abortion rights are seeking to reduce the limit for prescribing the drug to seven weeks of pregnancy instead of 10 weeks. They also want to ban prescriptions issued as a result of telehealth appointments and stop distribution of the drug by mail. 

“What the Supreme Court agreed to here is the question of whether the FDA was protecting women's health and safety when it removed critical safeguards on chemical abortion drugs, safeguards like having the in-person care of a doctor,” said Julie Blake, senior counsel for Alliance Defending Freedom, which is representing the groups challenging the FDA. 

The FDA approved mifepristone more than 20 years ago, and abortion rights groups as well as the Biden administration argue the federal agency’s safety standards and scientific judgment should not be called into question. In 2016, the FDA eased the rules around administrating the pill. 

Any new restrictions on mifepristone would significantly curtail access to abortion, even in states where such rights are protected. According to a new report by the Guttmacher Institute, which supports abortion rights, medication-induced abortions in 2023 accounted for 63% of all abortions in the formal health care system.

The organization Plan C, which advocates for the use of mifepristone prescribed through telemedicine, says traffic to its website has risen since Roe was overturned. The group says about a quarter of all visits now comes from Texas, where providing abortions was banned with few exceptions as a result of the Supreme Court’s decision.

“People are interested in abortion access, and they are looking for routes of access as courts and state legislatures take away what should be a basic medical right for bodily autonomy and a right to access what is modern medical care in the United States,” said Elisa Wells, co-founder and co-director of Plan C. 

In overturning the constitutional right to an abortion, Supreme Court Justice Samuel Alito wrote in the conservative-majority’s opinion, “It is time to heed the Constitution and return the issue of abortion to the people's elected representatives.”

But some public health law experts say they expect the justices to remain at the center of the abortion debate. 

“What has happened is that there is a lot of conflict in abortion policies between states, between state and federal agencies,” Mohapatra said. “I just don't think we're, this is the end of it. And the fact that it's, you know, hasn't even been two years since Dobbs, and we're already seeing so much action in the Supreme Court. I think that's going to continue.”

Justices are also scheduled to take up another case in April brought by the Republican-led states of Texas and Idaho that challenges a federal policy requiring hospitals to provide abortions in medically urgent circumstances. The Supreme Court is expected to rule on both cases by early summer.