The fate of mifepristone, the abortion drug used widely for over two decades across the United States, may rest in the hands of the U.S. Supreme Court if its members decide to take up requests from the drugs manufacturer and the Justice Department.

Both Danco Laboratories and the Biden administration have asked the high court to overturn a lower courts ruling that would limit access to the medication nationwide. That ruling is currently on hold.

If the Supreme Court takes up the case as part of its fall docket, it will mean a decision would likely come down in 2024, with months left before the next presidential election. The courts decision to ax the nationwide right to abortion by overturning Roe v. Wade last year was widely credited for fueling strong voter turnout in the 2022 midterm elections.

Setting aside evidence of mifepristones safety and efficacy, lower federal courts have sided with an ultraconservative coalition challenging the Food and Drug Administrations decision to approve the drug.

The FDA first cleared mifepristone for use back in 2000 through a lengthy and expert-led approval process ; in 2016 and 2021, the agency removed certain barriers to access so that pregnant patients could obtain the drug through a telehealth appointment, if desired. Mifepristone is generally prescribed as part of a two-drug regimen to end a pregnancy; the other drug is misoprostol.

In April, however, a federal judge in Texas sided with abortion opponents who had filed suit against the FDA over its mifepristone approval. U.S. District Judge Matt Kacsmaryk ruled that the agency had manipulated and misconstrued the drug approval process to greenlight elective chemical abortions on a wide scale, mimicking language used by the anti-abortion activists.

The case was appealed. Based on where it was initially filed, the conservative U.S. Court of Appeals for the 5th Circuit was tasked with reviewing it. A panel of three judges, two of whom were nominated by former President Donald Trump , came down against the FDA in part.