Weight-Loss Drugs Threaten to Blow Portugal’s Medicine Budget

Portuguese citizens watching their household budgets, pharmacists concerned with supply, and treasury officials crunching spreadsheets are converging on a single explosive statistic. A confidential draft obtained by our newsroom shows that subsidising the new generation of anti-obesity medicines would cost more money than the entire yearly public reimbursement bill for community pharmacies. In other words, a policy designed to trim national waistlines could expand the State’s drug budget beyond €2 B, dwarfing what is currently spent on cardio-cerebrovascular therapies or oncology pills.

The finding lands at a delicate moment. Lisbon has just created a National Programme for Obesity Prevention and Management, asked Infarmed to finish a full cost study within 30 days, and faced renewed pressure from both the Socialist Party and medical societies to ensure every clinically eligible patient can obtain semaglutide, tirzepatide and their rivals. Whether the cabinet chooses full, partial or zero coverage will shape public health, pharmaceutical retail and the 2026 State Budget in equal measure.

Portugal’s Waistline Meets the Ledger

Obesity has quietly reached 1.6 M adults across the country, a tally that places Portugal among Europe’s highest prevalence rates once age is factored in. The National Statistics Office estimates that the condition drains €1.2 B each year in direct treatment for diabetes, heart disease and joint disorders—an amount equal to about 0.6 % of GDP. Doctors argue that addressing the root cause could slash those downstream costs, yet insurers and the State still treat slimming drugs as an optional extra rather than a medical necessity.

Behind the numbers sits a potent new class of GLP-1 and GIP agonists. Brands such as Wegovy, Mounjaro and Saxenda can deliver double-digit weight reductions, eclipsing older pills like Orlistat. A single maintenance dose of tirzepatide retails near €337, while a semaglutide injector hovers at €244.80. With no subsidy, Portuguese families have already paid €21 M out of pocket during the first four months of this year—evidence, advocates say, of pent-up demand that would surge if prices fell.

The Treasury’s Worst-Case Projection

Infarmed’s preliminary modelling assumes a 90 % reimbursement for every approved anti-obesity product. Under that generous scenario, annual spending would leap to roughly €2 B, eclipsing the entire 2024 out-patient drug bill of €1.68 B. Even a narrower plan that limits coverage to Grade II and III obesity still pierces the half-billion mark, coming in at €600 M. By comparison, the State currently devotes just €115 M to medicines for stroke and heart-disease combined. Officials fear that opening the reimbursement gate too wide could crowd out funds for cancer immunotherapies, rare-disease treatments and the next influenza vaccine campaign.

Adding to the squeeze, the draft 2026 Budget already trims hospital drug purchases by €208 M and chops 10.1 % from the goods-and-services line that finances most pharmaceutical orders. Health-economy analysts note that any new subsidy would therefore require either unexpected tax revenue, painful reallocations or a politically risky rise in patient co-payments elsewhere.

Iberian Contrasts and Wider European Clues

Lisbon’s caution contrasts with Madrid and Paris, where Wegovy is now available under tightly controlled protocols for patients with an BMI above 30, or lower if comorbidities exist. The NHS in the UK is rolling out a pilot that pairs semaglutide with digital coaching to 10 000 volunteers, funded by what Downing Street calls a multi-billion-pound investment. Italy, meanwhile, grants partial reimbursement once lifestyle interventions have failed, setting a de-facto precedent for Southern Europe.

Germany provides the opposite example: a long-standing statute bans coverage for "lifestyle" drugs, forcing 90 % of citizens to pay full price. Portuguese lawmakers studying that model point out that Germany’s rule contains an escape clause for severe obesity yet remains largely unused, suggesting cultural factors weigh as heavily as euros in these decisions.

Possible Compromises Under Discussion

Health Minister Ana Povo has floated a tiered system that would subsidise only two molecules, possibly cap annual doses and require enrolment in a multidisciplinary care pathway involving dietitians, psychologists and exercise physiologists. Economists inside the Ministry calculate that such guardrails could hold first-year costs below €300 M, still high but closer to the amount the State already spends on renal-dialysis treatments.

Parliamentary sources confirm that the ruling coalition is also studying a risk-sharing contract whereby manufacturers refund part of the cost if patients fail to lose a predefined percentage of body weight after six months. The pharmaceutical industry counters that it needs predictable volumes to justify lower prices, pointing to tender agreements in Denmark that have cut unit costs by nearly 30 %.

Stakes for Pharmacies and Patients

Retail chemists view the coming decision with a blend of optimism and anxiety. Subsidy could unleash a surge in prescriptions, improving turnover, yet sharper controls on electronic prescribing could also reduce the off-label sales that now pad margins. For patients like Carla Mendes, a 42-year-old from Porto who spends €300 every month on tirzepatide, reimbursement would mean the difference between continuing treatment and abandoning her progress. She has shed 18 kg since January and now speaks of climbing the Arrábida Bridge stairs without stopping.

Medical societies, led by the Portuguese Association for the Study of Obesity, insist that denying access amounts to rationing a scientifically proven therapy. They cite a May 2024 cost-effectiveness study showing semaglutide’s incremental cost per quality-adjusted life-year well below the threshold Portugal generally accepts for oncology drugs.

Countdown to an Infarmed Verdict

The agency’s final pharmacoeconomic report is due before early December. If results mirror the preliminary figures, the cabinet must decide whether the long-term savings in hospital admissions, disability benefits and lost productivity compensate for an immediate hit to the drug budget. Insiders hint that a pilot limited to 40 000 high-risk patients could serve as a political compromise, offering evidence without bankrupting the system.

Whatever formula emerges, Portugal’s debate is now part of a broader European reckoning over how to finance medicines that straddle the line between chronic-disease management and lifestyle enhancement. For a nation that already spends less per capita on health than most of its Western neighbours, the choice will test both fiscal prudence and its commitment to tackling a condition that affects one in three adults.