A federal appeals court has significantly restricted access to one of the most commonly used abortion methods in the United States, ruling that prescriptions for mifepristone can no longer be distributed by mail.

In a unanimous decision, a three-judge panel of the U.S. Court of Appeals for the Fifth Circuit determined that the abortion pill must be dispensed in person at medical facilities, overturning prior regulations set by the Food and Drug Administration.

The ruling marks one of the most consequential developments in abortion policy since the Dobbs v. Jackson Women’s Health Organization decision, which overturned the constitutional protections established under Roe v. Wade.

Writing for the panel, Judge Kyle Duncan sided with arguments from the state of Louisiana, which contended that allowing the drug to be mailed undermines its near-total abortion ban. The ruling states that broader access to mifepristone conflicts with Louisiana’s legal position that life begins at conception.

The decision is expected to be appealed to the Supreme Court of the United States, setting the stage for another major legal battle over abortion access nationwide.