Portugal Debates Weight-Loss Drug Coverage as Budget Tightens

Portugal’s health budget is facing an uncomfortable arithmetic lesson. A forthcoming decision on whether the National Health Service should help pay for new weight-loss medicines threatens to eclipse every other line of the country’s pharmacy bill. Officials have been warned that a generous subsidy could double public drug expenditure, yet patients, doctors and industry insist that doing nothing is costlier in the long run.

A Bill Too Heavy For The Treasury

Calculations delivered to the Ministry of Health show that a 90% subsidy for the five anti-obesity products already on Portuguese shelves would drain about €2 B per year. To grasp the scale: the State’s entire outpatient medicines budget came to €1.68 B in 2024. In other words, reimbursing Mounjaro, Wegovy, Saxenda, Mysimba and Orlistat at the level usually reserved for chronic diseases would consume more money than every antibiotic, blood-pressure tablet and cancer pill currently co-funded by taxpayers.

Why The Price Tag Echoes Across Society

Roughly 1.6 M adults in Portugal meet the clinical definition of obesity, a prevalence of nearly 16%. Cardiovascular events, type 2 diabetes and joint replacements linked to excess weight already cost the public purse well over €100 M annually. Advocates for reimbursement argue that medicines capable of trimming body mass by 15-20% could prevent strokes, heart attacks and early retirements, ultimately sparing the Social Security system and boosting productivity. Critics counter that the same resources might achieve more if channelled into prevention programmes, healthier school meals or urban redesign that encourages physical activity.

International Cautionary Tales

Lisbon is hardly alone in wrestling with this dilemma. In the United Kingdom, the NHS offers Wegovy to carefully selected patients and is testing Mounjaro in a five-year, £279 M pilot aimed at bringing people back to work. The scheme covers only about 250 000 citizens, revealing how tightly eligibility can be drawn. Across the border in Spain and France, weight-loss drugs remain largely out-of-pocket purchases; both governments have tightened health budgets and shied away from broad reimbursement. Health economists inside Infarmed point to these examples as proof that no European country has ventured a blanket subsidy.

A Narrower Door Under Consideration

Government sources say the conversation has shifted from "all or nothing" to "who benefits most?" One model would restrict co-payment to individuals with class II or class III obesity, roughly a quarter of the eligible population. Even so, actuarial tables predict an annual outlay north of €600 M, still four times what the State now spends treating cerebrovascular disease. The Secretary of State for Health, Ana Povo, has signalled that Infarmed will deliver a refined cost-effectiveness dossier before Christmas, paving the way for a political decision early next year.

Prevention And Surgical Options Gain Momentum

In parallel, the government has launched the National Programme for Obesity Prevention and Management (PNPGO) and a new Integrated Care Pathway that pledges earlier diagnosis, dietetic support and—when needed—bariatric surgery within the public network. Hospitals already perform subsidised gastric bypasses, a procedure proven to cut diabetes incidence and hospital admissions. Finance officials quietly note that a sleeve gastrectomy, priced around €6 000, may yield greater lifetime savings than a decade of weekly injections costing €245-€338 per month.

The Patients’ Counter-Argument

Demand for the injectable drugs is soaring despite the absence of State help; pharmacies reported €21 M in sales of Mounjaro and Wegovy in just the first four months of 2025. Patient associations and the Portuguese Society of Gastroenterology call the lack of reimbursement “discriminatory,” stressing that obesity is a chronic disease recognised by the World Health Organization. They contend that Portugal’s current stance leaves treatment out of reach for low-income families, widening health inequalities and pushing some toward unregulated online suppliers.

What Happens Next

The Ministry of Health expects fresh budget-impact models from Infarmed within weeks. Any green light for partial reimbursement would still need approval from the Finance Ministry and, ultimately, a vote in Parliament. Behind closed doors, officials acknowledge that even a tightly targeted subsidy would require either new revenue—potentially via a higher sugar levy—or cuts elsewhere in the health portfolio. With European neighbours also calibrating their response, Portugal’s decision could become a template for mid-sized economies grappling with the price of tackling the world’s fastest-growing non-communicable epidemic.