A Cheaper Diabetes Generic Arrives, yet Some Patients Risk Paying €40 for a €5 Pill

On paper, the arrival of a cheaper generic is unambiguously good news: a medicine that costs the state and the patient less, for the same effect. But Portugal's diabetics' association is warning that a new generic version of a widely used diabetes drug could, through a quirk of how the country prices medicines, leave some patients paying roughly eight times more at the pharmacy counter than they did a month ago.

The drug is dapagliflozin, in its 10-milligram form — one of a class of medicines that has become central to treating type-2 diabetes and that also protects the kidneys and heart. Since the start of August, generic versions have reached Portuguese pharmacies, and with them the medicine has entered the Sistema de Preços de Referência, the reference-pricing system. Under that system the state reimburses up to the price of the cheapest equivalent — here still at the diabetes regime's generous 90% comparticipation — and the patient covers any difference if they buy something dearer.

That is where José Boavida, president of the Associação Protectora dos Diabéticos de Portugal (APDP), sees the trap. If a pharmacy has run out of the cheap generic and a patient, prescription in hand, buys the branded original instead, they pay the gap between the branded price and the new, lower reference price. A medicine that cost four or five euros, Boavida warns, "could now cost around 40 euros." His plea is less about the pricing rule than about supply: he wants Infarmed, the medicines regulator, to guarantee that pharmacies can actually keep the generic in stock. "It is important to avoid this situation harming people," he said, noting that many of the country's diabetics simply "cannot do without" the drug, not only for blood-sugar control but for its cardiovascular and renal benefits and its role in keeping patients out of hospital.

The stakes are large because the population is large. Dapagliflozin and its cousins are prescribed to a substantial share of Portugal's estimated 900,000-plus people living with type-2 diabetes, and the generic is meant to widen access by cutting the price roughly in half. The risk is that a stock shortfall converts a saving into a shock for exactly the patients the reform is supposed to help.

The episode also lands against a backdrop of relentlessly rising public drug spending. The SNS spent 12.4% more on pharmacy-dispensed medicines last year than in 2024, a total of about 1.89 billion euros, and antidiabetics were the single fastest-growing therapeutic class — up around 61 million euros to more than 478 million. Patients' own outlay climbed too, though more modestly, to 966 million euros; the increase came mainly from higher volumes rather than dearer packs, with the average box holding steady at about 4.74 euros. Generics are precisely the tool the state uses to keep that curve in check, which is why a supply wobble at the moment one comes to market is so awkward.

For foreign residents managing a chronic condition here, the practical lesson is worth internalising. When a generic enters the reference-pricing system, ask your pharmacist for the medicamento genérico by name, and if it is out of stock, ask whether another pharmacy has it before defaulting to the pricier brand — the difference is yours to pay. Prescriptions in Portugal are written by active substance, so you are entitled to the cheapest equivalent. As the state continues to reshape how the SNS delivers and pays for care, the fine print of reimbursement is quietly becoming part of the cost of living. A €35 gap on a routine refill is exactly the kind of surprise that rewards knowing the rules in advance.