The last time the Supreme Court threatened to end access to the country’s most popular abortion method, California’s network of online providers and their pharmaceutical suppliers scrambled to respond.

Now, with the fate of the cocktail used in roughly two-thirds of U.S. terminations once again in the balance, they’re not even breaking a sweat.

Dr. Michele Gomez, co-founder of the MYA Network, a consortium of virtual reproductive healthcare providers, said the supply chain is “ready to switch in a day” to an alternative drug combination.

“It’s not going away and it’s not going to slow down,” Gomez said.

On May 1, the 5th U.S. Circuit Court of Appeals ruled to block the drug mifepristone from being prescribed virtually and shipped through the mail, making such deliveries illegal across the country. On Monday, the Supreme Court stayed that decision, allowing prescriptions to resume until the court issues an emergency ruling next week.

Mifepristone is the first half of a two-drug protocol for medication abortion, which made up 63% of all legal abortions in the U.S. in 2023.

Between a quarter and a third of those abortion drugs are now prescribed by healthcare providers over the internet and delivered by mail — a path Louisiana and other ban states are fighting to bar.

“Abortion access has gone up with all the telehealth providers,” Gomez said. “We uncovered an unmet need.”

But the cocktail’s second ingredient, misoprostol, can be used to produce abortion on its own — a method that’s often more painful and slightly less effective.

It would be easy for suppliers to switch to a misoprostol-only protocol — and much harder for courts to block it, experts said.

“We heard about this on Friday and organizations that mail pills were mailing misoprostol on Saturday,” Gomez said. “They already knew what to do.”

After the Supreme Court overturned Roe vs. Wade in 2022, California became one of the first states to enshrine abortion rights for residents in its Constitution and legislate protection for clinicians who prescribe abortion pills to women in states with bans.

Last fall, legislators in Sacramento expanded those protections by allowing pills to be mailed without either the doctor or the patient’s name attached.

But cases like the one being decided next week could still sharply limit abortion rights even in states with extensive legal protections, experts warned.

“Even though California has built a fortress around its own constitutional protections of reproductive freedom, those [protections] become vulnerable to the whims of antiabortion states if the Supreme Court gives those states their imprimatur,” said Michele Goodwin, professor at Georgetown Law and an expert on reproductive justice.

Legal experts are split over how the justices will decide the medication’s mail-order fate.

“This is a case where law clearly won’t matter,” said Eric J. Segall, a law professor at Georgia State University and an expert on the Supreme Court.

“In a very important midterm election year, I think there’s at least two Republicans on the court who will decide that upholding the 5th Circuit would really hurt the Republicans at the polls,” he said. “If women can’t get this by mail in California or other blue states where abortion is legal, it’s going to have devastating consequences, and I think the court knows that.”

But he and others believe it’s no longer a matter of if — but when and how — the drugs are restricted, including in California.

“This is curating a backdrop for a legal showdown that may surely come,” Goodwin said.

The court’s most conservative justices could find grounds to act in the long-forgotten Comstock Act of 1873. The brainchild of America’s zealously anti-porn postmaster Anthony Comstock, the law not only banned the mailing of the “Birth of Venus” and “Lady Chatterley’s Lover,” but also condoms, diaphragms and any drug, tool or text that could be used to produce an abortion.

Though it hasn’t been enforced since the 1970s, the antiabortion provision of the law remains on the books, experts said.

“The next move is with the Comstock Act, which Justices Alito and Thomas have already been hinting at,” Goodwin said. “In that case, it’s like playing Monopoly — we could skip mifepristone and go straight to contraception. The goal is to make sure none of that gets to be in the mail.”

That move would upend how Americans get both abortions and birth control, and put an unassuming L.A. County pharmacy squarely in the government’s crosshairs.

Although doctors in nearly two dozen states can safely prescribe medication abortion to women anywhere in the U.S., only a handful of specialty pharmacies actually fill those mail orders, Gomez explained. Among the largest is Honeybee in Culver City, which did not reply to requests for comment.

Even if the justices don’t reach for Comstock, a decision in Louisiana’s favor next week could create a two-tiered system of abortion across California and other blue states, experts said.

“The people this case hurts the most are the poor and the rural,” said Segall, the Supreme Court expert.

National data show that abortion patients are disproportionately poor. Most are also already mothers. Losing mail access to mifepristone would leave many with the more painful, less effective option while those with the time and means to reach a clinic continue to get the gold standard of care.

“There are fundamental questions of citizenship at the heart of this,” said Goodwin, the constitutional scholar. “Under the 14th Amendment, women are supposed to have equality, citizenship, liberty. It’s as though the Supreme Court has taken a black marker and pressed it against all of those words.”

For Gomez and other providers, that’s tomorrow’s problem.

“The lawyers and the politicians are just going to do their thing,” the doctor said. “The healthcare providers are just trying to get medications to people who need them.”