Two Fronts, One Strategy: Louisiana, Arkansas, and Alabama Take Aim at Mail-Order Mifepristone Providers and State Shield Laws

On September 30, 2026, Louisiana, Arkansas, and Alabama opened two new fronts in the post-Dobbs fight over medication abortion. In federal court in Lake Charles, Louisiana, the three states sued individual prescribers, organizations, and pharmacies they say mail abortion drugs into their borders. On the same day, they asked the U.S. Supreme Court for permission to file an original action against New York, California, and Massachusetts, challenging those states’ telehealth shield laws. Taken together, the filings show a coordinated plan to close every route by which abortion pills might reach patients in states with strict abortion bans.

The Lake Charles Lawsuit: Going After Providers Directly

In Louisiana v. Nouhavandi, No. 2:26-cv-03836, filed in the U.S. District Court for the Western District of Louisiana, Lake Charles Division, the states allege that nearly three dozen individuals and entity defendants run websites that advertise abortion drugs in the plaintiff states. 

According to the complaint, users answer a short online questionnaire and either pay a fee or indicate they are unable to do so. The drugs are allegedly then shipped—predominantly from California—through mail-order pharmacies or after volunteer “pill-packing” parties. The complaint alleges that one such website sends “more than 6,000” shipments per month and that 95% of them go to states with severe restrictions or near-total bans on abortion. It also alleges that three other websites mailed nearly 500 packages to Louisiana addresses, more than 200 to Arkansas addresses, and more than 500 to Alabama addresses between 2025 and mid-2026.

The plaintiff states allege that the individual health care providers include medical directors of the plaintiff organizations, physicians, and certified nurse-midwives who allegedly prescribe or oversee prescriptions for medications shipped by the defendant organizations and pharmacies.

Legal theories

The main claim is that the defendants’ conduct is a public nuisance under federal common law. The states argue that federal common law is “uniquely suited” to resolve this cross-border dispute because the harm “emanat[es] from another State.” The complaint also brings state-law claims, including violations of the Louisiana Unfair Trade Practices Act––which specifically defines “trade” to include distributing abortion drugs in violation of La. R.S. 40:962.2––the Arkansas Deceptive Trade Practices Act, and the Alabama Deceptive Trade Practices Act. This reflects an increasingly common trend of both federal and state enforcement bodies using consumer protection theories and statutes to enforce politically disfavored health care, such as gender affirming care for transgender patients. However, they are also likely to run into First Amendment questions concerning professional and commercial speech.

The alleged misrepresentations include claims that abortion pills are “safer than Tylenol,” statements suggesting that mail-order abortion is legal in the plaintiff states, and advice telling patients not to disclose that they took abortion drugs. The states seek declaratory and injunctive relief, civil penalties, damages, and attorneys’ fees.

Why Lake Charles?

The states rely on 28 U.S.C. § 1391(b)(2) to argue that a substantial part of the events giving rise to the claims happened in the district. As one example, the complaint points to a photograph of one of the provider defendants in front of a map that it says confirms one of the websites ships to Louisiana, “including to Lake Charles specifically.” The states argue these same allegations support their claim that the court has personal jurisdiction over defendants who, in the complaint’s words, “swear to never set foot” in the plaintiff states. Personal jurisdiction over out-of-state telehealth providers is likely to be one of the first major issues the court must decide and could affect telehealth and direct-to-consumer pharmacy models well beyond this case.

Notably, the Lake Charles division only has one federal judge assigned to it; however, it does not appear that Judge James D. Cain has previously handled significant abortion-related challenges brought by the state.

Going Straight to the Supreme Court on Shield Laws

The second case, Louisiana v. New York, involves a motion for leave to file a bill of complaint under the Supreme Court’s original jurisdiction over disputes between states. It challenges the shield laws of New York, Massachusetts, and California as “representative” of similar laws in states such as Colorado, Maine, Rhode Island, Vermont, Virginia, and Washington. 

What are shield laws?

Shield laws  are state laws that generally protect both health care providers and patients from civil suits, criminal prosecution, and extradition to states where abortion is banned. The laws take different forms depending on the jurisdiction but largely serve one or more of the following purposes: (1) forbidding state agencies from co-operating with information requests from out-of-state enforcement agencies seeking to punish providers for abortion care; (2) prohibiting extradition of health care providers for allegedly providing abortion care to patients in states where that care has been outlawed; (3) allowing providers to use the name of their practice instead of their individual names on prescriptions for medication abortion as a way to prevent threats from individuals who would threaten them for prescribing the medication and protecting providers from professional discipline; and (4) in some states, providing a private cause of action against anyone who sues to stop the mailings.

Constitutional theories

The states ask the Court to declare that the shield laws violate the Full Faith and Credit Clause, the equal-sovereignty doctrine recognized in Shelby County v. Holder, 570 U.S. 529 (2013), and the federal common law of public nuisance. The bill of complaint also makes a dormant Commerce Clause argument under which the plaintiff states assert they have lawfully “closed their markets” to remotely dispensed abortion drugs. The states describe shield laws as “swords disguised as shields,” arguing that the laws impermissibly attack abortion restrictions and enforcement mechanisms that have been duly passed in the plaintiff states.

Why skip the lower courts?

The states argue that the Supreme Court’s jurisdiction is exclusive, so other federal courts necessarily lack jurisdiction. They also make a practical argument: because shield-law provisions are spread across criminal, civil-procedure, health, and insurance codes, it would be difficult, if not impossible, to identify proper defendants for each provision in a single district court case. The states further contend that shield laws are designed to keep anyone from suing, so a sovereign state is likely the only party with the resources and protection to bring this challenge. In the words of the filing, “[i]f Dobbs is more than a parchment promise, then the court's exercise of original jurisdiction is urgently needed.”

A Three-Part Strategy

In the complaint, the states openly describe the two new cases as pieces of a larger plan. The complaint identifies three “essential components” of what it calls a nationwide scheme: (1) FDA’s 2023 removal of the Risk Evaluation and Mitigation Strategy (“REMS”) in-person dispensing requirement for mifepristone, which is being challenged in Louisiana v. FDA, No. 6:25-cv-01491 (W.D. La.), a case that has been appealed to the U.S. Court of Appeals for the Fifth Circuit; (2) shield laws, which are being challenged in Louisiana v. New York; and (3) the actions of the providers themselves in prescribing the medications, who are being sued in Louisiana v. Nouhavandi, 2:26-cv-03836 (W.D. La.). This architecture gives the Nouhavandi suit potential significance beyond the requested injunction and also marks a shift from single-physician enforcement efforts that stalled at shield laws to multi-defendant federal suits seeking injunctive relief.

The states acknowledge that no single lawsuit can deliver the complete relief they seek. They warn that winning against FDA could lead providers to switch to non-FDA-approved mifepristone or to misoprostol-only regimens. On the same day it filed the new cases, Louisiana told a panel of the Fifth Circuit hearing the state’s appeal of the Louisiana v. FDA case that none of the Nouhavandi defendants “could carry out their current operations without the 2023 REMS’s removal of the in-person dispensing requirement.” That argument appears aimed at the standing questions in the FDA case. The states’ acknowledgment of the litigations’ limitations could also signal the next fronts: importation, compounding, state-controlled substance scheduling (such as Louisiana’s 2024 legislation), and pharmacy board discipline.

The Response

The defendant states say they will fight back. New York Attorney General Letitia James said the plaintiffs want to “impose their abortion bans on New York and punish our doctors,” and predicted the suit “inevitably fails.” Massachusetts Attorney General Andrea Joy Campbell said she would defend the state’s authority to protect the privacy of its patients and providers. California’s attorney general’s office said it would fight to keep the state a “safe haven for reproductive rights.”

 What to Watch

Several questions will shape both cases in the coming months:

• Original jurisdiction: Whether the Supreme Court grants leave to file the bill of complaint, how it will limit any challenge to other states’ shield laws, and whether it will use original jurisdiction for this interstate dispute. 
• Personal jurisdiction: Whether the federal court in Lake Charles can exercise personal jurisdiction over out-of-state telehealth providers, with implications for direct-to-consumer pharmacy models.
• Federal common law: Whether courts will recognize a federal common-law public nuisance claim in this setting or find that the FDCA/REMS framework displaces it.
• The FDA appeal: How the Fifth Circuit resolves the standing questions in Louisiana v. FDA and how that ruling affects the REMS and preemption arguments here. 

However these issues are resolved, the September 30 filings make clear that the direct confrontation between states with opposing laws on abortion is now squarely in the federal courts. Potential exposure may extend beyond prescribers to medical directors and pharmacies––and potentially platforms, payment processors, logistics vendors, and volunteers––while discovery into patient and shipment data may create HIPAA, state health privacy, and shield law conflicts.

Telehealth providers, pharmacies, and platforms should (1) review website and marketing claims about safety and legality; (2) audit geolocation, shipping, and website data that could support jurisdiction; (3) confirm malpractice, D&O, and cyber coverage for out-of-state enforcement; (4) implement litigation-hold and data-minimization practices for patient and shipment data; and (5) map shield law protections and their limits by state. For assistance with any of these, please contact Reed Smith’s health care, data privacy, insurance, and litigation teams.

Reed Smith will continue to follow developments with regard to reproductive health. If you have any questions about these cases or the impacts of various laws concerning reproductive health, please don’t hesitate to reach out to the authors or to the health care lawyers at Reed Smith.