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President Trump's bombshell executive order aimed at lowering U.S. drug prices is a step toward a worst-case scenario for the pharmaceutical industry. Some critics say the industry could have done more to avoid it, even though Trump's policies are causing turmoil in almost every sector of the economy.

Why it matters: Trump's announcement could be the start of enormous global disruption for the pharmaceutical industry — or it's the least-bad version of what was on the table, depending on who you ask.

• But the continued risk of a "most favored nation" policy that pegs U.S. drug prices to those paid in other developed nations is a massive threat to drugmakers' bottom lines, especially coming on top of the pharmaceutical tariffs Trump has said he wants to impose.
• The big questions are whether it ever comes to fruition, and whether drugmakers could have done more to avoid getting to this place at all, especially given Trump's laser focus on drug prices and the populist leanings within the GOP.

What they're saying: "The biopharmaceutical industry is working with President Trump and Capitol Hill on solutions to help patients access and afford the treatments they need," Alex Schriver, senior vice president of public affairs at the trade group PhRMA, said in a statement.

• "We remain committed to finding areas of alignment with policymakers to support making America healthy."

The big picture: Yesterday's announcement was sparse on details about how the administration plans to harmonize what the U.S. and other countries pay for drugs, meaning there's no way to know exactly how much trouble the pharmaceutical industry is in.

• The announcement also took a deep swipe at drug "middlemen," who the pharmaceutical industry faults for drug affordability issues.
• But the predicament drugmakers find themselves in marks a fall from grace for an industry that was recently considered among the most powerful in Washington.

Yes, but: Pharma is far from alone in being on the losing side of Trump's economic policies, and is joined by industries that have bent over backward to curry favor with the administration.

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Related: Trump drug price order puts new pressure on pharma

The White House's executive order to lower drug prices is largely an exercise in applying leverage, rather than actual policymaking — and it may not amount to much, experts said.

The big picture: President Trump says his directive will dramatically reduce drug costs for U.S. consumers, and quickly. But there are few details as to how he plans to accomplish that.

• Instead, Trump appears to be adapting the playbook he's used on universities over Gaza protests: Threaten administrative actions that could be financially painful, set a deadline — in this case 30 days — and then see what happens.
• "It reminds us of how in President Trump's first term he was 'all bark, no bite' on drug pricing," Chris Meekins, a managing director at Raymond James, wrote in an investor note Monday.
• "We don't completely discount the possibility that the EO could eventually lead to some one-off deals, but the order itself is so vague that it's difficult to predict the exact impact it may have," Capital Alpha's Kim Monk wrote in a note.

State of play: The order calls for drugmakers to voluntarily cut prices or face the threat of a "most favored nation" pricing regime that would peg the cost of their medicines to what's paid in other wealthy nations, where they often sell for less.

• The timeline for the administration to actually secure lower drug prices is slippery. Trump posted on social media Sunday that American consumers would "almost immediately" see their drug prices fall by 30% to 80%.
• In reality, it would take much longer than that. The executive order gives administration officials 30 days to come up with new target drug prices and to communicate them to companies. If the companies don't agree to lower prices voluntarily, HHS will kick off a rulemaking process and other enforcement actions — all of which take considerable amounts of time.

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Nearly 63% of the U.S. population was served by fluoridated community water systems as of 2022, per the latest CDC estimates.

Why it matters: Fluoridation is once again becoming a political flashpoint, with Utah and Florida recently moving to ban the practice — a step encouraged by HHS Secretary Robert F. Kennedy Jr.

The big picture: Dental and public health experts have long argued in favor of community fluoridation, wherein fluoride is added to public water supplies to help prevent tooth decay.

• "If I have new patients come into my practice, I can guess probably eight or nine times out of 10 if they've grown up in a fluoridated community" because "they don't have cavities," one pediatric dentist recently told CNN.

By the numbers: Washington, D.C. (100%); North Dakota (90.6%) and Kentucky (89.8%) had the greatest shares of residents served by fluoridated community water as of 2022, per CDC estimates.

• Hawai'i (8.2%), New Jersey (14.4%) and Oregon (22.3%) had the smallest.

The bottom line: People without easy access to fluoridated water can still get fluoride through other means — by using fluoridated toothpaste, for example (though Texas is now investigating toothpaste manufacturers over how they market such products).

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Tell Congress: Don’t cut Medicaid for America’s children and families.

The reason: Medicaid helps keep more than 30 million children across America healthy, including nearly half of all children with special healthcare needs.

Learn more.

High-protein yogurt brand Oikos is expanding beyond the dairy aisle with protein shakes geared to GLP-1 users, Danone North America shared exclusively with Axios.

Why it matters: Food giants are rolling out new products to cater to the changing appetites of the growing number of people taking Ozempic, Wegovy, Mounjaro or Zepbound.

The big picture: Danone joins other companies betting on the GLP-1 trend, which includes Nestlé and Conagra with frozen meals, Smoothie King with its GLP-1 menu and a wide-range of supplements.

• Nearly 18 million Americans are expected to be taking versions of GLP-1 drugs by 2029, according to investment bank UBS.

More here

Work requirements for Medicaid will reduce the number of eligible Americans covered under the health insurance program, according to experts and evidence from states that imposed them.

Why it matters: Work requirements are part of a budget bill from House Republicans that would impose big cuts to the health insurance program for the poor that covers 21% of Americans.

Where it stands: The bill would require Medicaid recipients who are under 65 years old, without dependents, to confirm they are working at least 80 hours a month. Another provision requires some to certify twice a year that they qualify for insurance.

• This provision, and other changes including increased fees for recipients, would increase the number of people without health insurance by nearly 14 million, according to the Congressional Budget Office's tally Sunday night.

By the numbers: There's little evidence that people are free-riding on Medicaid.

• 64% of adults with Medicaid work full time or part time, according to an analysis of census data by the Center on Budget and Policy Priorities.
• Another 32% are taking care of home or family, are ill or disabled, attend school, or are retired. 2% could not find work. And there's another 2% in an "other" category.

"Work requirements don't work," says Jennifer Wagner, director of Medicaid eligibility at the Center for Budget and Policy Priorities.

The other side: The idea is to avoid subsidizing those who choose not to work, Rep. Brett Guthrie, (R-Ky.) said in a WSJ op-ed.

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