The abortion pill mifepristone, fresh off the Supreme Court’s ruling to uphold its approval by the Food and Drug Administration, will likely soon face another challenge brought by three states with abortion bans, an opportunity that anti-abortion advocates hope will spur the court to curtail the drug.

In the ruling Thursday in Alliance for Hippocratic Medicine v. FDA, written by Trump-appointed Justice Brett Kavanaugh, the justices found that the group of anti-abortion doctors who brought the suit had not been sufficiently harmed by the FDA’s approval to be able to merit redress.

However, a case filed in November 2023 by the attorneys general of Missouri, Idaho, and Kansas could open the door for the court to consider the merits of the case or whether the FDA’s removal of in-person doctor visits for mifepristone was based on sufficient scientific evidence.

“The Supreme Court’s decision was limited to finding that our clients do not have standing,” said Erin Hawley, who argued on behalf of AHM before the court in March. “That ruling does not impact the states below, and the action will presumably continue with those states.”

Hawley, the wife of Sen. Josh Hawley (R-MO), is senior counsel for the conservative legal advocacy organization Alliance Defending Freedom. Hawley also led arguments for the anti-abortion side in the Dobbs v. Jackson Women’s Health Organization decision in 2022 that upended federal protections for abortion.

Hawley told reporters following the release of the decision that the justices’ unanimous ruling was largely based on murky court precedent regarding whether associations, such as the AHM in this case, have the ability to sue on behalf of their members.

“None of this changes the merit,” Hawley said. “This legal technicality doesn’t change the FDA label saying that roughly one in 25 women will likely end up in the emergency room.”

The agency’s warning label on mifepristone estimates that between 2.9% and 4.6% of self-managed abortion patients will go to the emergency room due to complications, such as severe and sustained bleeding or life-threatening infections. With nearly 643,000 medication abortions in 2023, that translates to roughly 20,000 emergency visits for self-managed abortion patients.

Anti-abortion advocates from SBA Pro-Life America also came out fully supporting the state-based case.

“It is a sad day for all who value women’s health and unborn children’s lives, but the fight to stop dangerous mail-order abortion drugs is not over,” SBA state policy director Katie Daniel said. “We stand with our allies, Attorneys General Raúl Labrador, Kris Kobach, and Andrew Bailey, fighting to hold government bureaucrats accountable for betraying women and children.”

In January, the court rejected the proposal for the three states to join the appeal with the anti-abortion doctors, but, as per the institution’s custom, did not provide a justification for the move.

Missouri Attorney General Andrew Bailey told the Washington Examiner that he does not anticipate Thursday’s ruling to hinder his state’s case against the FDA.

“We are moving forward undeterred with our litigation to protect both women and their unborn children,” Bailey said.

“The states in this case possess the standing that the doctors did not,” Kansas Attorney General Kris Kobach said in a statement to the Washington Examiner. “It is essential that this case continue in order to ensure that the FDA operates within the law.”

Of the three, Missouri has the strictest anti-abortion laws, only allowing abortion in the case of a life-threatening condition for the mother. Idaho allows abortions also in the case of rape or incest and fatal fetal anomalies.

Kansas voters in 2022 rejected an amendment to the state constitution that would have removed access to an abortion as a fundamental right, but the state legislature is still largely anti-abortion. The procedure is legal in the state up to 22 weeks gestation.

A spokesperson for Danco Laboratories, makers of the brand-name drug Mifeprex, told the Washington Examiner that the company is not prepared at this time to comment on this secondary case.

Health and Human Services Secretary Xavier Becerra lauded the court’s decision but said “women’s health remains under attack” following the overturning of Roe v. Wade in 2022.

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“Every day, women in states across America are forced to live with the devastating consequences of these attacks on reproductive rights,” Becerra said. “We will continue the fight to restore Roe v. Wade and defend reproductive rights for all Americans.”

The Idaho attorney general’s office did not respond to the Washington Examiner‘s request for comment by the time of publication.