Portugal tightens Ozempic access, leaving expats scrambling for refills

A narrow rule that arrived in Portuguese law books earlier this month has rippled far beyond medical waiting rooms. For many foreign residents living with diabetes—or hoping to use the new generation of weight-loss drugs—the decree suddenly dictates which doctors may write a prescription, how fast refills can be secured, and even the odds of finding Ozempic on a Lisbon pharmacy shelf. While officials insist the measure is about safeguarding supplies, professional societies and opposition lawmakers see it as a squeeze on multidisciplinary care. The coming weeks will show whether Portugal sticks to its guns or bows to escalating pressure to loosen the rules.

From “any specialist” to four: how the new gatekeeping works

The legal pivot is tucked inside Portaria 170/2025/1, activated on 8 August. It restricts prescriptions for interstitial glucose sensors and every medicine in the GLP-1 receptor agonist family—semaglutide, dulaglutide, liraglutide, exenatide—to physicians certified in Endocrinology and Nutrition, Internal Medicine, Paediatrics, or General & Family Medicine. In theory, the change answers a run of stock outages that plagued pharmacies last winter when Ozempic demand doubled. Officials argue that concentrating prescribing power with “better-trained” clinicians will dampen off-label, weight-loss-only demand and allow the Serviço Nacional de Saúde (SNS) to track true medical need. For foreigners accustomed to more open systems, the new Portuguese rule can feel abrupt: yesterday your cardiologist could renew an injection pen; today only an endocrinologist may.

Why expats feel the pinch first

International patients often rely on the private sector because public queues can stretch for months. Yet most English-speaking practices serving Lisbon’s expat community lack in-house endocrinologists. The decree therefore forces many newcomers to seek unfamiliar specialists, adding translation costs, fresh blood work, and an average 4-6-week wait for slots in the capital—longer in the Algarve or interior. For a drug that requires clock-like dosing, any gap can mean losing glycaemic control or interrupting a weight-loss protocol. The decree does not change Portugal’s generous 90 % state co-pay for diabetes indications, but access rather than price is now the hurdle.

Medical voices call foul on the “one-size-fits-all” model

Less than forty-eight hours after enforcement began, the Portuguese Society of Cardiology publicly warned that sidelining cardiologists undermines evidence that GLP-1s cut heart-failure and stroke risk. Nephrology and transplant groups added that thousands of diabetics with kidney disease could see their care fragmented. Now the Socialist Party (PS)—the largest opposition force—has filed a formal query to Health Minister Ana Paula Martins. The MPs argue the decree “builds a wall” between patients and therapies with proven cardiovascular benefit and ask whether any scientific societies were heard before the rules were signed. Government sources counter that an impact study is underway; they hint at a limited rollback for hospital cardiology units but refuse to commit to a date.

Portugal in the wider European and Latin American mosaic

Elsewhere, policymakers are drawing very different lines. Spain still bars public funding for obesity treatments but lets any doctor prescribe GLP-1s, a freedom offset by the full retail price. France, facing similar shortages, swung the opposite way in June: it opened prescriptions to all physicians yet imposed post-market surveillance and required patients to pay up front before later reimbursement. Across the Atlantic, Brazil toughened the screws on 23 June with RDC 973/2025, obliging pharmacies to retain one copy of each GLP-1 prescription, register sales in a national database, and limit validity to 90 days. Compared with these models, Portugal now offers the narrowest prescriber list but one of Europe’s most generous reimbursement rates—a mixture that may keep costs down for chronic users yet raise barriers for anyone outside the four blessed specialties.

What could happen next—and when

Sources inside the Health Ministry say officials will review stock reports and clinic waiting times at the end of September before deciding on amendments. Two scenarios circulate: extending prescribing rights to cardiology departments in public hospitals, or issuing a “fast-track renewal” protocol that lets any specialist renew an existing GLP-1 script without issuing the first one. Parliamentary committees can also propose revocation, but that path is slower and hinges on coalition maths. In practical terms, expats should plan around the current framework at least until mid-autumn.

Staying one step ahead: tips for foreign residents

Before booking the next refill, confirm that your chosen clinic has a doctor from one of the four authorised specialties. Bring a recent lab panel, your previous prescription, and, if possible, a Portuguese translation of medical notes. Pharmacies will not accept a foreign script, even from another EU country, unless rewritten by a local physician. If you live outside metropolitan areas, consider teleconsultations; several private networks now offer remote appointments with endocrinologists who can issue electronic prescriptions valid nationwide. And keep spare needles or pens in hand luggage when travelling—shortages inside Portugal have improved since spring but are not yet history.

For now, the tug-of-war between supply security and clinical autonomy continues. Whether the decree ultimately protects or endangers patients depends on how nimbly the government adjusts—and how quickly the market stabilises. Foreign residents, used to juggling paperwork for visas and bank accounts, may add “find an approved specialist” to the list. The upside? Portugal still shoulders most of the bill once you do.