The Food and Drug Administration approved a second generic version of the abortion pill mifepristone this week, creating tension within the Trump administration as Health and Human Services Secretary Robert F. Kennedy Jr. simultaneously conducts a safety review of the medication.
The FDA officially approved the generic mifepristone manufactured by Evita Solutions LLC on Tuesday, with the agency concluding that "adequate information has been presented to demonstrate that the drug meets the requirements for approval." The company's website states that "all people should have access to safe, affordable, high-quality, effective, and compassionate abortion care."
Regulatory Context and Timeline
This marks the second generic approval for mifepristone, following GenBioPro's generic version approved in 2019. The original mifepristone was approved by the FDA in 2000, with access gradually expanded over time. In 2021, the FDA under the Biden administration permitted online prescribing and mail-order delivery of the drug.
Filing documents show that Evita Solutions submitted its application four years ago, well beyond the typical 10-month FDA approval timeline for generic drugs. HHS Communications Director Andrew Nixon explained that "the FDA has very limited discretion in deciding whether to approve a generic drug. By law, the Secretary of Health and Human Services must approve an application if it demonstrates that the generic drug is identical to the brand-name drug."
Political Tensions and Safety Review
The approval comes as Kennedy has been telling Republican officials that HHS is conducting a safety review of mifepristone. Less than two weeks before the FDA's decision, Kennedy sent a letter to Republican attorneys general stating that "HHS is committed to studying the adverse consequences reported in relation to mifepristone" and that "HHS — through the FDA — is conducting its own review of the evidence, including real-world outcomes and evidence, relating to the safety and efficacy of the drug."
Nixon confirmed that the agency is still "conducting a study of the reported adverse effects of mifepristone to ensure the FDA's risk mitigation program for the drug is sufficient to protect women from unstated risks."
Congressional and Advocacy Group Response
Republican Senator Josh Hawley, who has been leading congressional calls for HHS to review mifepristone, expressed strong criticism on X: "FDA had promised to do a top-to-bottom safety review of the chemical abortion drug, but instead they've just greenlighted new versions of it for distribution. I have lost confidence in the leadership at FDA."
Anti-abortion organizations quickly condemned the decision. Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, called it "a reckless decision by the FDA to expand the availability of abortion drugs" that is "unconscionable." Tony Perkins of the Family Research Council said the approval shows "the federal government is undermining states and the intent of the Dobbs decision."
Kristan Hawkins of Students for Life America described the approval as "a true failure" and "a stain on the Trump presidency and another sign that the deep state at the FDA must go."
Medical and Scientific Context
Republicans and anti-abortion groups have cited a report by the conservative Ethics and Public Policy Center claiming that nearly 11% of women experienced serious adverse effects after taking mifepristone. However, the paper is not peer-reviewed, and some anti-abortion leaders have reportedly acknowledged that it is "not a study in the traditional sense" and "not conclusive proof of anything."
Mifepristone is considered safe and effective by leading medical organizations, including the American Medical Association. The drug is approved to end pregnancies through 10 weeks and is typically taken with misoprostol. This combination accounts for roughly two-thirds of all U.S. abortions, with mifepristone dilating the cervix and blocking progesterone while misoprostol causes uterine contractions.
Market Impact and Access
The approval of a second generic is unlikely to significantly affect access to the medication, as restrictions remain in place across large sections of the country due to state laws that ban abortion or impose separate restrictions on the drug's use. These laws are subject to ongoing lawsuits working through the legal system.
A Planned Parenthood spokesperson welcomed the decision, stating: "Over two decades of research and evidence shows mifepristone is extremely safe and effective. This newly approved generic mifepristone will provide another option for people in a time when access is being restricted for political reasons."
