How Portugal's Medicine Prices Are Costing Lives—and What Could Change It

The Crisis in Numbers

Portugal's pharmaceutical access gap is costing lives. If the country matched France's equity standards, it could prevent 1,577 preventable deaths annually from treatable diseases, according to a landmark study published by the Portuguese Association for Medicines for Equity in Health (EQUALMED). The research reveals that Portugal's residents face the highest financial burden for medication among comparable European nations—a structural flaw that translates directly into premature mortality.

Why This Matters

• Financial strain: Portuguese citizens spend €148.30 per year on medicines—0.73% of the average annual salary (€20,451), the highest proportion among Spain, Italy, France, and Belgium. 16.1% of the population reports difficulty affording prescriptions.

• Phantom approvals: Roughly 33% of medicines authorized for sale in Portugal never reach pharmacy shelves, including critical drugs, due to pricing disputes and economic viability concerns.

• Innovation delays: The median wait for innovative drug financing in Portugal is 795 days (2024), compared to 391 in Italy, 523 in France, and 567 in Spain.

• Lost lives: A 5% increase in medication equity could cut treatable-disease mortality by 3% annually, according to the EQUALMED Index.

The Hidden Cost of Inaccessibility

Portugal's Ministry of Health and the national medicines regulator, INFARMED, face mounting criticism over a system that approves drugs but fails to deliver them. The EQUALMED study—covering 2022 to 2025—graded Portugal's medication equity at 52%, a "moderate" score that has declined steadily over the past three years. By contrast, France, Spain, Italy, and Belgium all score higher, benefiting from faster reimbursement pathways and greater pharmaceutical competition per active substance.

The consequences are quantifiable. Portugal records four fewer years of quality life compared to France, with only 42 out of 100 Portuguese patients reporting positive quality of life. João Paulo Nascimento, president of EQUALMED, responded to these findings with a pointed observation: "We're talking about 1.7 million Portuguese treated since 2016 thanks to generics and biosimilars. But we could be doing so much more."

The crux of the problem lies in a pricing and reimbursement bottleneck. While INFARMED authorizes hundreds of new drugs each year—928 in 2025 alone, 79% of them generics—one-third never proceed to commercialization. Pharmaceutical companies cite unsustainable economics: Portugal's low price ceiling, combined with mandatory rebates to the state that can reach 30% of hospital National Health Service (SNS) market value by 2026, makes the Portuguese market unattractive. Parallel exports to higher-priced EU markets further drain supply, as distributors prioritize more lucrative destinations.

Regional and Systemic Inequities

Medication access is not uniform across Portugal. The Alentejo, Oeste, and Vale do Tejo regions rank worst for equity, while the North, Greater Lisbon, and Setúbal Peninsula fare better. These disparities reflect rural versus urban infrastructure gaps: rural regions struggle with lower hospital density and fewer healthcare professionals per capita, while urban centers benefit from stronger professional networks and easier access to specialized services. Portugal has one of the lowest ratios of active healthcare professionals per 100,000 inhabitants in Europe—a constraint that throttles prescription capacity, the essential gateway to treatment.

Helder Mota Filipe, president of the Portuguese Pharmacists' Order, responded to the EQUALMED report with a pointed statement: "Budget targets cannot override the mission to guarantee equitable, safe, and rational access to medicines." He argued that drug policy must be grounded in scientific evidence, not cost-reduction imperatives, and called for structural reforms prioritizing effective therapeutic access over fiscal austerity.

The Generic and Biosimilar Paradox

Portugal is a European leader in generic and biosimilar adoption—a bright spot in an otherwise troubled landscape. These medicines accounted for 74% of the increase in total patients treated since 2016, driving a 6.2% annual growth in treatment rates and reducing average treatment costs by 15%. INFARMED fast-tracks generic and biosimilar reimbursement, contributing to market shares of 53% and 62% respectively.

Yet even here, progress has stalled for five years, hovering between 50-52%, while more developed European markets reach 80%. Nascimento emphasized the untapped potential: "Portugal made extraordinary strides for a decade, but our share has plateaued. We need policies that actively stimulate use of these health technologies—they are essential to system sustainability and free up resources for therapeutic innovation."

The Portuguese Pharmacists' Order echoed this view, noting that despite Portugal having the lowest per capita spending on medicines among comparators and one of the lowest shares of pharmaceutical spending in total health expenditure, the financial burden on families remains disproportionately high. The paradox is stark: low public spending, high private burden.

Innovation Access: Europe's Laggard

Portugal's delay in financing innovative drugs is among the worst in the European Union. The median time from approval to reimbursement jumped to 795 days in 2024, an increase of eight days from 2022, and 179 days above the EU average. For oncology drugs specifically, the wait stretches to 794 days—more than two years.

Italy has addressed similar challenges by restructuring its Innovative Medicines Fund (FMI), allocating €1.3 billion annually (€900 million for general innovative drugs, €300 million for conditionally approved treatments, and €100 million for critical antibiotics). France pursues state-backed "bioclusters" and public-private partnerships through its "France 2030" plan, though regulatory timelines of 3-5 years for reimbursement still strangle many MedTech startups before market entry.

Portugal, by contrast, has resorted to increasing rebate demands on pharmaceutical companies, a strategy the industry calls unsustainable and a disincentive to launching new products. INFARMED concluded financing for 51 innovative medicines in the first half of 2025 and has begun evaluating outcome-based financing models—payment structures tied to therapeutic results—to reduce uncertainty for rare-disease and high-cost therapies. The question is whether reform can accelerate before more patients fall through the gap.

Policy Prescriptions

The EQUALMED Index evaluates four pillars: household economic capacity, health system sustainability, drug regulation and approval speed, and healthcare workforce density. Portugal's shortcomings span all four. To close the gap, stakeholders propose:

• Outcome-based payment models: Linking reimbursement to clinical results rather than blanket rebates, sharing risk between state and industry.

• Generic and biosimilar promotion: Extending use from 52% toward the 80% benchmark, liberating funds for innovation without increasing household out-of-pocket costs.

• Regional workforce investment: Deploying more healthcare professionals in underserved regions to ensure prescription access.

• Price and value recognition: Aligning pricing policies with therapeutic efficiency rather than lowest-common-denominator benchmarks across reference countries.

• Supply chain transparency: Regulating parallel exports that siphon approved drugs to higher-price EU markets, starving domestic pharmacies.

INFARMED has introduced digital tools such as the "Poupe na Receita" mobile app, allowing residents to compare medicine prices and identify cheaper equivalents. The agency is also participating in EU-wide projects to harmonize shortage management and bolster supply chain robustness, with new regulatory discussions scheduled for March 2025.

What This Means for Residents

If you live in Portugal, the practical implications are immediate. One in six residents struggles to afford prescribed medication, and nearly one in three approved drugs never becomes available for purchase. The wait for cutting-edge cancer treatments or rare-disease therapies can exceed two years, during which time conditions may progress or become irreversible.

How to take action:

• Use the "Poupe na Receita" app: Download this free INFARMED tool to compare prices for your prescribed medications and discover cheaper equivalent options before heading to the pharmacy.

• Ask your pharmacist about biosimilars and generics: When prescribed a new medication, ask whether a bioequivalent or generic alternative exists. These are often significantly cheaper and equally effective.

• Consult your doctor: If your prescribed medication is unavailable or unaffordable, discuss with your physician whether alternative treatments or generic versions might work for your condition.

• Connect with patient advocacy groups: Organizations representing patients with chronic or rare diseases often provide resources, legal support, and collective advocacy. Contact your condition-specific patient association for guidance.

Generic and biosimilar alternatives remain the most reliable and cost-effective option, yet even these are underutilized compared to European peers. For those with chronic or rare diseases, advocacy and visibility are critical. Patient associations and industry groups are pressing the Portugal Ministry of Health to adopt evidence-based drug policies that prioritize therapeutic access over short-term budgetary goals. As Nascimento put it: "This isn't just about balancing the books. It's about equity, access, and the lives we can save."

The Bottom Line

Portugal's pharmaceutical system is caught in a vice: it approves medicines it cannot afford to reimburse quickly, prices them so low that companies withdraw or never launch, and leaves residents shouldering costs they can barely sustain. The result is a mortality and quality-of-life penalty measurable in thousands of preventable deaths per year. Reform is not a policy luxury—it is a public health necessity. The question is whether Portugal's policymakers will act before the equity gap widens further.