One telehealth provider would have to shut down for two weeks. Some abortion clinics in Ohio are considering ditching the drug altogether. Meanwhile, other doctors are looking for legal loopholes to dispense the drug, called mifepristone.

People who live far from abortion clinics will be particularly hard hit, abortion rights advocates say. The restrictions could force people to travel hundreds of miles for care and stay for days, said Kirsten Moore, director of the Expanding Medication Abortion Access Project.

“This is going to have a severe, severe impact on access,” she said, adding that it will be “devastating” for underserved rural populations.

This is the second time in less than a week that the legal sands have shifted around medication abortions, which account for more than half of abortions in the U.S.

The late Wednesday decision narrowed a Texas court judge’s effort to block the Food and Drug Administration’s approval of mifepristone. It allows patients to keep using the drug, but only at a higher dosage and if patients are seven weeks or fewer pregnant. The decision also prohibits the medication from being sent by mail and requires people to have three in-person visits with their doctor to take the pills. The Department of Justice plans to appeal the decision to the U.S. Supreme Court.

Mifepristone, approved by the FDA in 2000, blocks the hormone progesterone and is also used to treat miscarriages. Millions of women around the world have used the drug, and medical groups say complications occur at a lower rate than with routine medical procedures such as wisdom teeth removal and colonoscopies.

Abortion providers and patient advocates said the restrictions imposed by the court could affect thousands of people if they go into effect on Saturday.

Since Roe v. Wade was overturned last year, telehealth abortions have more than doubled, according to a report released this week by the Society of Family Planning. Abortions by virtual clinic telehealth providers rose to 8,540 last December, or 11% of all abortions, compared with 3,610 in April 2022, the report said.

Wisp, a company that provides telehealth medication abortions in nine states, plans to close down for two weeks if the ruling goes into effect on Saturday to switch to a one-drug regimen that uses misoprostol, a medication not challenged in the courts but considered slightly less effective.

Monica Cepak, the company’s chief marketing officer, said they are also looking at providing misoprostol to people who want to stock up on that drug.

“Telehealth remains a really important piece of the accessibility puzzle because as demand for in-person care will likely go up, the time to get an in-person appointment is often 20-30 days, and telehealth fills that really important gap for patients,” she said.

Telehealth abortion providers were already facing restrictions. According to a February report from the Kaiser Family Foundation, six of the states that have not banned abortion have at least one requirement for at least one trip to the clinic.

But order-by-mail abortion provider Aid Access won’t let a U.S. court order stop it from prescribing mifepristone and misoprostol by telehealth, Dr. Rebecca Gomperts wrote in an email.

Gomperts is based in Europe, and the company’s website advertises that it can mail pills to all 50 states in the U.S.

The company has a history of flouting U.S. laws and rules on the issue. In 2019, Aid Access defied an order from the FDA to stop distributing medications in the country.

Some abortion clinics in Ohio may stop dispensing mifepristone entirely by Saturday, said Jessie Hill, an attorney who represents several independent clinics in the state. The state’s law requires doctors to follow federal label guidelines when prescribing mifepristone, which means clinics will have to follow the court’s order. The order will “make it incredibly inconvenient,” to prescribe mifepristone, she said, because patients will have to make three in-person doctor’s visits and pay more for a higher dosage.

The clinics are also considering a misoprostol-only medication abortion method.

In Illinois, operations will continue much the same at the Planned Parenthood clinic in Fairview Heights, Dr. Colleen McNicholas told the Associated Press.

The clinic, which expects to serve about 10,000 abortion patients this year, will continue to provide medication abortions through a combination of mifepristone and misoprostol.

That’s in part because the state allows doctors to write prescriptions “off-label,” which gives providers the ability to prescribe a drug in a way that hasn’t been approved by the federal government. McNicholas said the practice is common among physicians with drugs that have long proven to be safe for patients.

It also gives abortion providers an added layer of protection that the clinic is located in one of the most abortion-friendly states in the country, she said.

Providers in many states can still prescribe mifepristone off-label in places where it’s not prohibited by state law, which means they can offer the drug to patients later in pregnancy than seven weeks, said David Cohen, a law professor at Drexel University in Philadelphia.

But he doesn’t see how they can legally get around the requirement for an in-person appointment.

“It will still be available up to and maybe even beyond ten weeks, depending on what your provider feels comfortable prescribing,” he said. “But whereas before you could have had the pills mailed to you at home … now, you have to get them in person from a doctor.”