U.S. Senate Republicans launched an investigation last week into the three FDA-approved manufacturers of the abortion pill mifepristone, questioning their adherence to federal safety protocols amid a surge in online and mail-order sales.

Sen. Bill Cassidy (R-LA), chairman of the Senate Health, Education, Labor and Pensions Committee, spearheaded the probe alongside Sens. Steve Daines (R-MT), James Lankford (R-OK), Cindy Hyde-Smith (R-MS) and Lindsey Graham (R-SC). On March 25, they sent letters to Danco Laboratories LLC, which makes Mifeprex; GenBioPro Inc.; and Evita Solutions LLC, seeking detailed information on how the companies ensure prescribers and pharmacies follow the FDA's Risk Evaluation and Mitigation Strategy (REMS) requirements.

The lawmakers raised concerns about the manufacturers' roles in facilitating online sales that bypass in-person medical oversight, potentially exposing women to serious health risks. Mifepristone carries a black box warning and is associated with emergency room visits; senators cited evidence that more than one in 10 women experience serious adverse events such as hemorrhage or infection when using the drug at home without supervision.

"Chemical abortion drug makers profit off killing innocent children while putting mothers’ lives at risk," Cassidy said. "These manufacturers and websites have facilitated the explosion in online sales of these harmful drugs without regard for women’s health and safety while opening the door for coercion and abuse."

The group also wrote to FDA Commissioner Marty Makary, urging the agency to enforce existing laws against unapproved and misbranded abortion drugs sold by domestic and international websites. They called for warning letters to violators, shipment interdictions with U.S. Customs and Border Protection and the Postal Service, and potential criminal prosecutions. The senators advocated reinstating prior REMS elements, including in-person dispensing and non-fatal adverse event reporting, which were lifted during the COVID-19 pandemic under the Biden administration.

Online sales have driven abortion numbers above 1.1 million annually, with pills used in about two-thirds of cases. In 2025, 91,000 women from states banning abortion received pills by mail, up from 72,000 the prior year. Critics argue these shipments undermine state protections and heighten risks of coercion in abusive situations.

A Department of Health and Human Services spokesperson responded that the FDA remains committed to curbing illegal drug marketing and is conducting a safety study on mifepristone prescribing standards. Danco Laboratories declined comment, GenBioPro expressed eagerness to inform lawmakers on medication abortion, and Evita Solutions did not respond.

This probe builds on earlier Republican efforts. On March 19, Sen. Josh Hawley (R-MO) initiated his own inquiries into two mifepristone makers over documented risks to women. The actions reflect ongoing conservative pressure on the FDA to tighten access to medication abortion following regulatory changes that expanded telehealth and mail-order options.