What does the mifepristone case mean for Plan B? The difference between the two explained.

Emergency contraception is not the same thing as the abortion pill, but these medications are often confused. While both involve reproductive health, emergency contraception ‒ often called Plan B ‒ is meant to stop a pregnancy from happening, and the abortion pill mifepristone ends an existing pregnancy, medical experts say.

Delineating the two medications is more important than ever as the Supreme Court heard arguments Tuesday on a case that could sharply limit access to mifepristone and diminish the independence of the Food and Drug Administration.

An anti-abortion organization is challenging mifepristone's FDA approval, claiming the agency bypassed standard protocols to bring the medication to market.

Abortion advocates say the pill should not lose its FDA approval, citing decades of safety and efficacy in patients across the nation.

Mifepristone remains FDA-approved at the moment and available to many Americans from reproductive health clinics or telemedicine services, although full access to the pill is restricted in 15 states. The "Plan B" pill is legal in all 50 states without age restrictions.

The court's decision in the mifepristone case, expected this summer, could have a long-term impact on the FDA’s ability to make decisions about the safety of all drugs. This means that while neither pill's approval changes today, there could be ramifications for all medications and the future of reproductive health systems nationally.

"Regardless of the result, it will not have an immediate impact on emergency contraception," Dana Singiser, co-founder of the Contraceptive Access Initiative, said of Tuesday's case.

How we got here

Last April, U.S. District Judge Matthew Kacsmaryk in Texas effectively invalidated the FDA's 23-year-old approval for mifepristone.

The Biden administration appealed, but the New Orleans-based 5th U.S. Circuit Court of Appeals affirmed Kacsmaryk's ruling that the FDA was wrong for approving changes in 2016 and 2021 that let women take the drug three weeks longer into a pregnancy and allowed the drugs to be dispensed through the mail without in-person visits with a doctor.

“In loosening mifepristone’s safety restrictions, FDA failed to address several important concerns about whether the drug would be safe for the women who use it," the court wrote. “It failed to gather evidence that affirmatively showed that mifepristone could be used safely without being prescribed and dispensed in person."

The case marks the first time a court has restricted access to an FDA-approved drug by second-guessing the agency’s expert judgement, according to the Biden administration.

A decision against the FDA could open the "barn doors" for future similar claims against a slew of medications if the court sides with the plaintiff, particularly emergency contraception, Singiser and others argued.

Ongoing coverage: Supreme Court hears abortion pill Mifepristone case, nation watches anxiously: Live updates

"If the Supreme Court undermines FDA's authority that could threaten any drug that's ever been approved by the FDA," Singiser said. "That threat is is particularly posed to reproductive health products because there is such an organized advocacy movement against abortion, contraception and IVF."

What is mifepristone?

Mifepristone is one of two pills commonly used in medication abortion, accounting for more than half of all U.S. abortions. according to the Guttmacher Institute, which researches reproductive health policy. Patients take mifepristone with another medication called misoprostol to end a pregnancy that is less than 70 days developed. The pills are taken about two days apart.

The abortion drug has been used in the United States since 2000. The drug accounted for 63% of all U.S. abortions in 2023, an increase from 53% in 2020.

Some insurers and Medicaid plans cover abortion pills, according to Plan C, which hosts a guide to accesses abortion pills per state with financial information. Cost of the pill can range from $150 from online clinics that mail pills, to $500 or more at in-person clinics. Several online providers, such as Hey Jane, offer financial assistance, if needed.

Many medical organizations have rushed to defend mifepristone as "the most studied medication" and "overwhelmingly" safe, with a better track record than commonly used drugs such as Tylenol and Viagra, according to legal briefs filed in support of the FDA by the American Medical Association, the American College of Obstetricians and Gynecologists, American Academy of Family Physicians and several other organizations.

What about Plan B?

Emergency contraception is a type of birth control that should be taken within 72 hours of unprotected sex or birth control failure. The single pill is sold for about $50 at drug stores such as CVS and Walgreens.

It works by delaying ovulation with a hormone called levonorgestrel, according to Planned Parenthood. It's recommended to take Plan B as soon as possible after unprotected sex, but it can be taken up to five days later.

Emergency contraception is not abortion. The morning-after pill can be up to 95% effective in preventing pregnancy, but does not terminate an existing pregnancy. Plan B is designed to prevent ovulation, holding back an egg so that it won't be fertilized by sperm and an embryo formed.

Many Americans confuse Plan B with the abortion pill. Some Americans began hoarding Plan B after Roe v. Wade fell in 2022, causing confusion and panic that emergency contraception was the next best thing, or would be next to be restricted. Even Olivia Rodrigo's current "Guts" Tour had to clarify that it was handing out emergency contraception, not abortion pills, at the pop star's concerts.

This conflation between the two medications is by "design," said Singiser, who said the anti-abortion movement has intentionally framed contraception as an "abortifacient" and worked to codify laws that state life begins at immediate conception, paving the way for legal battles on contraception and IVF, such as the recent attack on IVF in Alabama after the state's high court determined frozen embryos could be considered children.

This has all lead to fears that mifepristone's federal approval changing would cause a ripple effect for Plan B. And this confusion is even worse for people in states where abortion care is already restricted, the independent Kaiser Family Foundation found in a 2023 study. But Americans' access to emergency contraception remains unchanged for now.

Contributed: Maureen Groppe

This article originally appeared on USA TODAY: Mifepristone v. Plan B. The language of reproductive health explained.