Health Secretary Robert F. Kennedy Jr.'s push to remove fluoride from public water supplies is playing out on dual tracks, as the EPA advances a fast-track review of health risks and at least 16 states weigh new restrictions.

Why it matters: The efforts show how key parts of Kennedy's "Make America Healthy Again" agenda are being steered outside of the department he oversees.

• New fluoride limits could upend an 80-year-old standard that's widely credited with reducing tooth decay by 25% and narrowing disparities for people without regular dental care.

State of play: The EPA last week released a preliminary plan for a study of potential toxic effects of fluoride exposure, which could be the basis of changes to drinking water standards.

• The federal government can't require communities to add or remove the mineral, but can set maximum allowable amounts.
• The current standard is 4 milligrams of fluoride per liter of water — far above the CDC's recommendation of no more than 0.7 milligrams per liter.
• The activity is a "mechanism by which you could see a federal ban or federal action on water fluoridation," said Melissa Burroughs, senior director of public policy at CareQuest Institute for Oral Health.

Where it stands: The agency's review of fluoride "will not prejudge any outcomes," EPA biologist Todd Zurlinden said during a webinar about the proposed work plan last week.

• But Kennedy said in a statement that "a growing body of evidence indicates that ingesting fluoride can cause neurological harm, and other adverse effects." EPA Administrator Lee Zeldin said he's "working in lockstep with Secretary Kennedy."
• The proposed study plan is open for public comment.

Context: U.S. cities have been adding extra fluoride — a naturally occurring mineral — to their drinking water since 1945 to improve dental health and prevent cavities.

• Excessive fluoride can cause cosmetic tooth damage, and some studies link very high exposure to lower IQ scores in children.

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Pharmacy benefit managers are facing more pressure after the Department of Labor issued new requirements for disclosing their financial dealings with drugmakers, pharmacies and others health system players.

Why it matters: The proposed rule stems from President Trump's executive order on lowering drug prices and comes as Congress is targeting the drug supply intermediaries with more transparency rules.

Driving the news: PBMs like CVS Caremark, Express Scripts and Optum Rx would have to make semiannual disclosures to employers of what they earn for negotiating drug prices on behalf of health plans.

• Those would include payments, rebates and incentives from manufacturers for placing drugs on formularies.
• The proposal released late last week would also require them to disclose any compensation they get when a health plan pays more for a drug than the amount reimbursed to the pharmacy.
• Self-insured group health plans would get to audit the PBMs at least once a year.

Yes, but: The rule stops short of limiting "spread pricing," where a PBM charges a health plan more than it pays a pharmacy for a drug, or requiring 100% of rebates to be passed through to the health plan.

What they're saying: Labor Secretary Lori Chavez-DeRemer said the rule would bring "unprecedented transparency to an otherwise opaque industry" and better let health plan fiduciaries size up if the PBMs are being paid reasonably.

• A spokesperson for PCMA, a trade group for PBMs, said the companies "have significantly reformed their models to maximize transparency in recent years" and that surveys show employers are "overwhelmingly satisfied."

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U.S. life expectancy hit an all-time high in 2024 as the toll from leading causes of death fell and the effects of the COVID-19 pandemic receded.

• An infant born in 2024 could expect to live 79 years, an increase of 0.6 years from 2023, according to the CDC.
• Suicide replaced COVID-19 as the 10th leading cause of death, while heart disease, cancer and unintentional injuries remained the top three killers.
• The infant mortality rate did not change significantly from 2023.
• The biggest change was in unintentional injuries — including drug overdoses — which fell 14%.

Yes, but: Life expectancy still lagged behind most other developed nations, according to United Nations data.

The rollout of the daily pill version of Novo Nordisk's blockbuster weight-loss drug Wegovy is being hailed as the speediest adoption of a new drug in history.

Why it matters: Brand recognition plus the initiation of direct-to-consumer advertising right after the January launch fueled what's become "the fastest drug launch ever," Leerink analyst David Risinger wrote in a note.

By the numbers: Oral Wegovy had about 26,100 total prescriptions for the week ending Jan. 23, up 42% from the prior week.

• By comparison, Eli Lilly's Zepbound pen had about 1,300 total prescriptions in the first week of full commercial launch in December 2023 and about 8,000 in the second week.

Yes, but: Risinger noted the total Wegovy franchise (injectable and oral versions) decreased 6% week over week, while Zepbound's rose.

Between the lines: GLP-1 drugs in pill form could be more convenient and cheaper than injectable versions.

• A recent KFF poll found about 1 in 8 U.S. adults say they're taking a GLP-1 either to lose weight or treat a chronic condition.
• The oral Wegovy experience may bode well for Novo Nordisk's broader positioning in obesity and diabetes care, Yahoo Finance noted, coming as the Danish drugmaker expands a cell therapy venture with a focus on potential treatments for diabetes.

🧾 Technology vendors are offering $600 million worth of discounts to states that pick them to help implement Medicaid work requirements. (Stat)

⚖️ California Gov. Gavin Newsom (D) filed a civil rights complaint against CMS administrator Mehmet Oz, charging he discriminated against Armenian Americans in California with a video on health care fraud. (NYT)

⚠️ Regulators in the U.K. strengthened warnings on GLP-1 drugs to include the potential risk for acute pancreatitis, including fatal cases. (MedPage Today)